[ARTICLE] Short- and Long-term Effects of Repetitive Transcranial Magnetic Stimulation on Upper Limb Motor Function after Stroke: a Systematic Review and Meta-Analysis – Full Text

The aim of this study was to evaluate the short- and long-term effects as well as other parameters of repetitive transcranial magnetic stimulation (rTMS) on upper limb motor functional recovery after stroke.

The databases of PubMed, Medline, Science Direct, Cochrane, and Embase were searched for randomized controlled studies reporting effects of rTMS on upper limb motor recovery published before October 30, 2016.

The short- and long-term mean effect sizes as well as the effect size of rTMS frequency of pulse, post-stroke onset, and theta burst stimulation patterns were summarized by calculating the standardized mean difference (SMD) and the 95% confidence interval using fixed/random effect models as appropriate.

Thirty-four studies with 904 participants were included in this systematic review. Pooled estimates show that rTMS significantly improved short-term (SMD, 0.43; P < 0.001) and long-term (SMD, 0.49; P < 0.001) manual dexterity. More pronounced effects were found for rTMS administered in the acute phase of stroke (SMD, 0.69), subcortical stroke (SMD, 0.66), 5-session rTMS treatment (SMD, 0.67) and intermittent theta burst stimulation (SMD, 0.60). Only three studies reported mild adverse events such as headache and increased anxiety .

Five-session rTMS treatment could best improve stroke-induced upper limb dyskinesia acutely and in a long-lasting manner. Intermittent theta burst stimulation is more beneficial than continuous theta burst stimulation. rTMS applied in the acute phase of stroke is more effective than rTMS applied in the chronic phase. Subcortical lesion benefit more from rTMS than other lesion site.

Continue —> Short- and Long-term Effects of Repetitive Transcranial Magnetic Stimulation on Upper Limb Motor Function after Stroke: a Systematic Review and Meta-Analysis – Feb 17, 2017


Figure 1. The flow diagram of the selection process.



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[Abstract] Determining the benefits of transcranial direct current stimulation on functional upper limb movement in chronic stroke. – International Journal of Rehabilitation Research


Transcranial direct current stimulation (tDCS) has been proposed as a tool to enhance stroke rehabilitation; however, evidence to support its use is lacking. The aim of this study was to investigate the effects of anodal and cathodal tDCS on upper limb function in chronic stroke patients. Twenty five participants were allocated to receive 20 min of 1 mA of anodal, cathodal or sham cortical stimulation in a random, counterbalanced order. Patients and assessors were blinded to the intervention at each time point. The primary outcome was upper limb performance as measured by the Jebsen Taylor Test of Hand Function (total score, fine motor subtest score and gross motor subtest score) as well as grip strength. Each outcome was assessed at baseline and at the conclusion of each intervention in both upper limbs. Neither anodal nor cathodal stimulation resulted in statistically significantly improved upper limb performance on any of the measured tasks compared with sham stimulation (P>0.05). When the data were analysed according to disability, participants with moderate/severe disability showed significantly improved gross motor function following cathodal stimulation compared with sham (P=0.014). However, this was accompanied by decreased key grip strength in the unaffected hand (P=0.003). We are unable to endorse the use of anodal and cathodal tDCS in the management of upper limb dysfunction in chronic stroke patients. Although there appears to be more potential for the use of cathodal stimulation in patients with severe disability, the effects were small and must be considered with caution as they were accompanied by unanticipated effects in the unaffected upper limb.

Source: Determining the benefits of transcranial direct current stim… : International Journal of Rehabilitation Research

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[ARTICLE] New Approaches to Exciting Exergame-Experiences for People with Motor Function Impairments – Full Text


The work presented here suggests new ways to tackle exergames for physical rehabilitation and to improve the players’ immersion and involvement. The primary (but not exclusive) purpose is to increase the motivation of children and adolescents with severe physical impairments, for doing their required exercises while playing. The proposed gaming environment is based on the Kinect sensor and the Blender Game Engine. A middleware has been implemented that efficiently transmits the data from the sensor to the game. Inside the game, different newly proposed mechanisms have been developed to distinguish pure exercise-gestures from other movements used to control the game (e.g., opening a menu). The main contribution is the amplification of weak movements, which allows the physically impaired to have similar gaming experiences as the average population. To test the feasibility of the proposed methods, four mini-games were implemented and tested by a group of 11 volunteers with different disabilities, most of them bound to a wheelchair. Their performance has also been compared to that of a healthy control group. Results are generally positive and motivating, although there is much to do to improve the functionalities. There is a major demand for applications that help to include disabled people in society and to improve their life conditions. This work will contribute towards providing them with more fun during exercise.

1. Introduction

For a number of years, the possibility of applying serious games for rehabilitation purposes has been thoroughly investigated [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28]. It is often claimed that serious games reduce health system costs and efforts as they enable in-home rehabilitation without loss of medical monitoring, and in so doing provide an additional fun factor for patients [22,23,24]. Multiple reviews have summarized the very powerful contributions and reveal that the systems are generally evaluated as feasible, but no state of general applicability has yet been reached [2,3,5,7,11,13].
Most studies are quite specialised and tend to cover the same groups of largely elderly patients (e.g., stroke and Parkinson’s), which do not constitute a credible target group per se for gaming among the population. In addition, the impression is that the same functionalities are being tested repeatedly, without any evolution. Above all, other groups like children and adolescents with chronic diseases are rarely addressed, even though they are an excellent target group and would probably benefit greatly from using exergames as they need to move like any other child but are mostly limited to performing their exercises with a physiotherapist. This is generally boring, time-consuming and prevents them from playing with friends during this time. If instead they could play games involving physical exercises, without it feeling like rehabilitation, due to proper immersion and motivation, they would possibly need fewer sessions with the therapist, which may in turn improve their social life. Commercially available games would be good enough for many children with physical disabilities, if only they were configurable and adaptive to their potential and needs. Remote controls (RC) are typically not sufficiently configurable (button functions cannot be changed or the RC cannot be used with one hand) and are only made for hands (why not for feet or the mouth?) Some RCs are not sufficiently precise in detection, and so the user ends up tired and loses motivation. Motion capture devices like the Kinect sensor seem to provide better prerequisites for exergaming purposes but feature important limitations too, (e.g., detection of fine movements and rotations) such that the needs of many people are still not be covered by commercial solutions.
However, this is not due to the sensors, but rather the software, which lacks configurability for special needs, such as simple adjustments of level difficulties or the option of playing while seated. For the latter, some Kinect games are available [29], but those are hardly the most liked ones, as has been stated by affected users [30]. Therefore, more complex solutions are required to adapt a game to problems like muscle weaknesses (most games require wide or fast movements), spasticity (“strange” movements are not recognized) or the available limbs (for instance configuring a game to be controlled with the feet for players without full hand use).
To fill these gaps, the authors of the work presented here are pursuing the overall aim (as part of a long-term project) of creating an entertaining exergaming environment for adventure games that immerses the players into a virtual world and makes them forget their physical impairments. Knowledge of the gaming industry is applied to create motivating challenges that the users have to solve, which are sufficiently addictive to make the exercises pass to an unconscious plane. The gaming environment is configurable to the user’s potential and requirements. Challenges will be programmable by a therapist and will also adapt themselves to the players automatically real-time, by observing their fatigue or emotional state (lowering the difficulty or switching to more relaxing exercises when needed)…

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Figure 8. Different scenes while the volunteers were playing. (a) “The Paper-Bird”, (b) “The Ladder”, (c) “The Boat” and (d) “Whack-a-Mole”.

Continue —> Sensors | Free Full-Text | New Approaches to Exciting Exergame-Experiences for People with Motor Function Impairments | HTML

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[Cochrane Review] Activity monitors for increasing physical activity in adult stroke survivors – Full Text

Cochrane library logo


This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:

To summarise the available evidence regarding the effectiveness of commercially available wearable devices and smart phone applications for increasing physical activity levels for people with stroke.


Description of the condition

Between 1990 and 2010 absolute numbers of people living with stroke increased by 84% worldwide, and stroke is now the third leading cause of disability globally (Feigin 2014). As such, the disease burden of stroke is substantial. It has been estimated that 91% of the burden of stroke is attributable to modifiable risk factors such as smoking, poor diet, and low levels of physical activity (Feigin 2016). A low level of physical activity (less than four hours per week) is the second highest population-attributable risk factor for stroke, second only to hypertension (O’Donnell 2016). The promotion of physical activity, which has been defined as body movement produced by skeletal muscles resulting in energy expenditure (Caspersen 1985), is therefore an important health intervention for people with stroke.

The association between health and physical activity is well established. Prolonged, unbroken bouts of sitting is a distinct health risk independent of time engaged in regular exercise (Healy 2008). There is evidence from cross-sectional and longitudinal studies that high sitting time and low levels of physical activity contribute to poor glycaemic control (Owen 2010). Three systematic reviews and meta-analyses of observational studies have confirmed that, after adjusting for other demographic and behavioural risk factors, physical activity is inversely associated with all-cause mortality in men and women (Nocon 2008; Löllgen 2009; Woodcock 2011). Yet despite this knowledge, populations worldwide are becoming more sedentary, and physical inactivity has been labelled a global pandemic (Kohl 2012).

In addition to overcoming the sedentary lifestyles and habits prevalent in many modern societies, people with stroke have additional barriers to physical activity such as weakness, sensory dysfunction, reduced balance, and fatigue (Billinger 2014). Directly after a stroke, people should be admitted to hospital for co-ordinated care and commencement of rehabilitation (SUTC 2013). Early rehabilitation after stroke is frequently focused on the recovery of physical independence (Pollock 2014). Recovery after stroke is enhanced by active practice of specific tasks, and greater improvements are seen when people with stroke spend more time in active practice (Veerbeek 2014). Yet findings from research conducted around the world indicate that people in the first few weeks and months after stroke are physically inactive in hospital settings with around 80% of the day spent inactive (sitting or lying) (West 2012). These high levels of inactivity are concerning because recovering the ability to walk independently is an important goal of people with stroke. The reported paucity of standing and walking practice in the early phase after stroke potentially limits the opportunities of people with stroke to optimise functional recovery, particularly for standing and walking goals. Further, physical inactivity may lead to an increased risk of hospital-acquired complications, such as pressure ulcers, pneumonia, and cardiac compromise (Lindgren 2004).

Physical activity levels of people with stroke remain lower than their age-matched counterparts even when they return to living in the community (English 2016). Community-dwelling stroke survivors spend the vast majority of their waking time sitting down (English 2014). Promisingly, early research suggests that increasing physical activity in people with stroke is feasible, and that an increase in physical activity levels after stroke may have a positive impact on fatigue, mood, community participation, and quality of life (QoL) (Graven 2011; Duncan 2015).

Continue —> Activity monitors for increasing physical activity in adult stroke survivors – Lynch – 2017 – The Cochrane Library – Wiley Online Library

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[WEB SITE] Stimulating muscles with electricity

If we can do something in a shorter time and obtain similar or better benefits, why not?

That’s the premise behind Impulse (Electric Muscle Stimulation or EMS) Training, which uses electrical impulses to stimulate voluntary muscular contraction.

What Impulse Training does is reproduce the body’s natural process of voluntary muscular con-traction with “optimal” electrical impulses.

The natural process of the body is to send electrical impulses from your brain through your central nervous system to fire up your muscles, resulting in a contraction.

Impulse Training allows you to elicit deep, intense and complete muscular contractions without further taxing your central nervous system.

Just as your body doesn’t know the difference between squats or deadlifts, it doesn’t know the difference between voluntary contraction and an electrically-induced one. It only recognises stimulus.

Clients getting sprayed down with water before suiting up. -- SAMUEL ONG/The Star

Clients getting sprayed down with water before suiting up.

This “optimal” contraction then allows you to target specific muscles through different intensities of stimulation, length of contraction and rhythm.

The technology has been around for centuries and has its roots in Egypt when they discovered certain fish emitted electric impulses, which were used to treat pain and ailments such as gout.

What Impulse Training does is reproduce the body’s natural process of voluntary muscular contraction with “optimal” electrical impulses.

What Impulse Training does is reproduce the body’s natural process of voluntary muscular contraction with “optimal” electrical impulses.

However, it only started gaining popularity in the 1960s when sports scientists from the then Soviet Union used electrical impulses to train athletes.

Subsequently, the devices have been improved to amplify the effects of the workouts, which claim to provide four times the amount of muscle exertion compared to traditional exercise.

Impulse Training has been applied in the fields of physiotherapy, pro-athletic sports, sports rehabilitation and medicine.

Once astronauts land from space, they also undergo this training to reduce muscle atrophy.

A number of high profile coaches favour this method to supplement the training of Olympic-level athletes. Among EMS proponents are golfer Tiger Woods, sprinter Usain Bolt and footballer Christiano Ronaldo.

Its popularity in Europe has exploded over the past 10 years, and among the first to introduce the technology in Malaysia is Impulse Studio in Bangsar, Kuala Lumpur.

Co-founders Jinie Kamal and Dirk Schmellenkamp are the duo behind Impulse Training, which arrived here in 2014.

Jinie Kamal, CEO and co-founder of Impulse Studio. — SAMUEL ONG/The Star

Jinie Kamal, CEO and co-founder of Impulse Studio.

“Our focus is on strength training because that’s what most people, especially women, are lacking.

“They often think they’re going to build ugly bulk if they lift weights, but this is not true. You need to lift weights to keep your bones strong as you get older.

“We’re not targeting active people, but sedentary ones, because all you need is really twice a week of Impulse Training to increase your muscular strength,” said Jinie.

With Impulse Training, you do a variety of functional, dynamic and easy-to-follow exercises using your own body weight.

Since it elicits much more powerful muscular contractions than is possible from regular training, you cannot do it for more than 20 or 25 minutes at a time.

Impulse Training is gentle on the joints and claims to reduce body fat, build your muscles, shape your body, increase muscular strength, and reduce back and shoulder problems.

Get fit(ter) in half the time? Only twice a week? I put it to test on my body.

There are four different programmes to choose from at Impulse Studio: Weight Loss, Slim/Shape/Tone, Body Sculpting and Sports Performance.

Based on my body composition analysis (unbalanced strength between upper and lower body), Jinie put me in the Slim/Shape/Tone programme.

First, I had to change into a compression garment before she sprayed my front and back down with warm water. (Tap water is a good conductor of electricity. The more the water, the more the client will feel the impulses.)

Then, I was suited up with a spacesuit-looking vest covered in electrodes, wires and straps, before being hooked up to the device.

I was also given a pair of squishy grip balls to squeeze my pain away should the going get too tough.

A tingling sensation rushed through my body, bit by bit.

The electrical impulses generated (in place of weights), are controlled by the trainer via the Impulse Training device.

The first five minutes of the workout is the warm-up comprising a combination of slow jogs, heel-butt kicks jumping jacks and high knee runs. -- SAMUEL ONG/The Star

The first five minutes of the workout is the warm-up comprising a combination of slow jogs, heel-butt kicks jumping jacks and high knee runs.

Jinie gently increased the pulses according to what I could maximally manage.

We warmed-up with a series of slow jogs, heel-butt kicks, high-knee runs, jumping jacks and lunges.

Then it was onto strength-training exercises such as bicep curls, flies, chest presses, tricep kickbacks, deadlifts, etc.

When I felt I could take more “weight”, Jinie ramped up the impulses.

My workout consisted of 12-15 functional exercises, including sprints, mountain-climbers, squats and plank jacks.

Jinie pushed me to my limits and though it didn’t seemed terribly tough, I was sweating aplenty at the end of the 20 minutes.

We ended with a minute of plank.

“Up to 50,000 muscle contractions happen in one session and 90% of all muscles are trained simultaneously,” she explained. “

After two sessions, you should feel your stamina increasing, but if you want to see faster results, you have to up your protein intake.”

I felt light, and it was almost therapeutic to get out of the suit.

I didn’t feel any pain the next day and that was a good sign.

The sceptic in me started doubting the efficacy of the workout, but 48 hours later, muscle fatigue slowly started creeping in.

I couldn’t lift my arms overhead and squatting on the toilet was excruciating as my muscles screamed for mercy!

Jinie recommended waiting seven days before the next session as the workout can increase the level of creatine kinase (CK is an enzyme chiefly found in the brain, skeletal muscles and heart) in the body.

The levels may increase to as much as 30 times the upper limit of normal within 24 hours of strenuous physical activity, then slowly decline over the next seven days.

The degree of CK elevation depends on the type and duration of exercise, with greater elevation in those who are untrained.

Trainer Mumahad Alif Ikhwan guiding a client on the bicep curls. -- SAMUEL ONG/The Star

Trainer Mumahad Alif Ikhwan guiding a client on the bicep curls.

So, if you do a blood test within this seven-day period, the doctor might think you have a medical problem as levels can rise after a heart attack, skeletal muscle injury, strenuous exercise, drinking too much alcohol, and from taking certain medications.

Once your body adapts to the workout, the CK levels normalise.

The question on everyone’s mind is, is Impulse Training dangerous?

Absolutely not. The low frequency impulse only activates skeletal muscles and does not reach the organs or the heart.

According to studies, there are no negative side effects for active healthy humans. However, Jinie cautioned, “If you wear a cardiac pacemaker or have certain pre-existing acute illnesses, then Impulse Training is not for you.”

I’m happy to report that after five sessions, my fitness score was higher, and I’d gained 500 grams of muscles. That’s a lot considering I didn’t make any dietary changes. My muscles are definitely more toned and I feel trimmer.

Ok, maybe there’s only a little bit to trim, but it’s a trim nevertheless!

Revathi Murugappan is a certified fitness trainer who tries to battle gravity and continues to dance, but longs for some bulk and flesh in the right places. She’s planning on bidding adieu to the stage this year with a final performance. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Source: Stimulating muscles with electricity – Star2.com

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[ARTICLE] Near-Infrared Spectroscopy in Gait Disorders – Is it Time to Begin? – Full Text

Walking is a complex motor behavior with a special relevance in clinical neurology. Many neurological diseases, such as Parkinson’s disease and stroke, are characterized by gait disorders whose neurofunctional correlates are poorly investigated. Indeed, the analysis of real walking with the standard neuroimaging techniques poses strong challenges, and only a few studies on motor imagery or walking observation have been performed so far. Functional near-infrared spectroscopy (fNIRS) is becoming an important research tool to assess functional activity in neurological populations or for special tasks, such as walking, because it allows investigating brain hemodynamic activity in an ecological setting, without strong immobility constraints. A systematic review following PRISMA guidelines was conducted on the fNIRS-based examination of gait disorders. Twelve of the initial yield of 489 articles have been included in this review. The lesson learnt from these studies suggest that oxy-hemoglobin levels within the prefrontal and premotor cortices are more sensitive to compensation strategies reflecting postural control and restoration of gait disorders. Although this field of study is in its relative infancy, the evidence provided encourages the translation of fNIRS in clinical practice, as it offers a unique opportunity to explore in depth the activity of the cortical motor system during real walking in neurological patients. We also discuss to what extent fNIRS may be applied for assessing the effectiveness of rehabilitation programs.

Walking is one of the most fundamental motor functions in humans,13 often impaired in some focal neurological conditions (ie, stroke), or neurodegenerative diseases, such as Parkinson’s disease (PD).4 Worldwide almost two thirds of people over 70 years old suffer from gait disorders, and because of the progressively ageing population, an increasing pressure on health care systems is expected in the coming years.5

Although the physiological basis of walking is well understood, pathophysiological mechanisms in neurological patients have been poorly described. This is caused by the difficulty to assess in vivo neuronal processes during overt movements.

During the past 20 years, functional magnetic resonance imaging (fMRI) has been the preferred instrument to investigate mechanisms underlying movement control6 as well as movement disorders.7 fMRI allows measuring the blood oxygenation level-dependent (BOLD) signal that, relying on variations in deoxy-hemoglobin (deoxyHb) concentrations, provides an indirect measure of functional activity of the human brain.8 Patterns of activation/deactivation and connectivity across brain regions can be detected with a very high spatial resolution for both cortical and subcortical structures. This technique, however, is characterized by severe limitations and constraints about motion artifacts and only small movements are allowed inside the scanner. This entails dramatic compromises on the experimental design and on the inclusion/exclusion criteria. Multiple solutions have been attempted to overcome such limitations. For instance, many neuroimaging studies have been performed on the motor imagery,9,10 but imaging can be different from subject to subject,11 and imagined walking and actual walking engage different brain networks.12 Other authors have suggested the application of virtual reality,13 and there have been a few attempts to allow an almost real-walking sequence while scanning with fMRI.14,15Additional opportunities to investigate the mechanisms sustaining walking control include the use of surrogate tasks in the scanner as proxy of walking tasks,16 or to “freeze” brain activations during walking using positron emission tomography (PET) radiotracers, which allow the retrospective identification of activation patterns, albeit with some uncertainties and low spatial and temporal resolution.12

Therefore, until now there has not been an ecological way to noninvasively assess neurophysiological correlates of walking processes in gait disorders.

Functional near-infrared spectroscopy (fNIRS) is becoming an important research tool to assess functional activity in special populations (neurological and psychiatric patients)17 or for special tasks.1821 fNIRS is a noninvasive optical imaging technique that, similarly to fMRI, measures the hemodynamic response to infer the underlying neural activity. Optical imaging is based on near-infrared (650-1000 nm) light propagation into scattering tissues and its absorption by 2 major chromophores in the brain, oxy-hemoglobin (oxyHb) and deoxyHb, which show specific absorption spectra depending on the wavelength of the photons.22 Typically, an fNIRS apparatus is composed of a light source that is coupled to the participant’s head via either light-emitting diodes (LEDs) or through fiber-optical bundles with a detector that receives the light after it has been scattered through the tissue. A variation of the optical density of the photons measured by detectors depends on the absorption of the biological tissues (Figure 1A). Using more than one wavelength and applying the modified Beer-Lambert law, it is possible to infer on the changes of oxyHb and deoxyHb concentrations.23 fNIRS has a number of definite advantages compared to fMRI, its major competitor: (a) it does not pose immobility constrains,25 (b) is portable,26 (c) allows recording during real walking,27 (d) allows long-lasting recordings, (e) it does not produce any noise, (f) it makes possible the investigation of brain activity during sleep,28 (f) it allows to obtain a richer picture of the neurovascular coupling as it measures changes in both oxyHb and deoxyHb concentration with high temporal resolution (up to milliseconds). High temporal resolution is usually not mandatory for the investigation of the hemodynamic response whose dynamic takes at least 3 to 5 seconds, but it can be useful for the study of transient hemodynamic activity like the initial dip29 or to detect subtle temporal variations in the latency of the hemodynamic response across different experimental conditions.19,21,30 The major drawback of fNIRS in comparison to fMRI is its lower spatial resolution (few centimeters under the skull) and its lack of sensitivity to subcortical regions.18,19 However, this might be considered a minor limitation, as there is a large body of evidence suggesting that (a) cortical mechanisms take place in walking,31 (b) the organization of the motor system is distributed along large brain regions,32and (c) the function of subcortical structures is mirrored in the cerebral cortex.33


Figure 1. Illustration of penetration depth of near-infrared light into the tissue in a probe configuration used to investigate motor performances during walking task (upper row). The picture shows brain reconstruction from a high-resolution anatomical MRI. The spheres placed over the skull correspond to vitamin E capsules employed during the MRI to mark the positions of the optodes and to allow the coregistration of the individual anatomy together with the optode position. In this illustration, only the photons propagation from one source (S) to one detector (D) have been simulated. The yellow-red scale indicates the degree of sensitivity74 for the considered source-detector pair to the head/brain structures. (A, B, and C) Lower row: Examples of fNIRS experimental device used for assessing brain activity during real walking tasks. These fNIRS approaches included either commercial device, such as (A) wireless portable fNIRS system (NIRx; Germany) or support systems for treadmill walking activity with body weight support24 (B) or with free movement range (C).

Continue —> Near-Infrared Spectroscopy in Gait Disorders – Feb 14, 2017

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[WEB SITE] Studies uncover long-term effects of traumatic brain injury

Doctors are beginning to get answers to the question that every parent whose child has had a traumatic brain injury (TBI) wants to know: What will my child be like 10 years from now?

In a study to be presented Friday Feb. 10 at the annual meeting of the Association of Academic Physiatrists in Las Vegas, researchers from Cincinnati Children’s will present research on long-term effects of TBI—an average of seven years after injury. Patients with mild to moderate brain injuries are two times more likely to have developed , and those with severe injuries are five times more likely to develop secondary ADHD. These researchers are also finding that the family environment influences the development of these attention problems.

  • Parenting and the exert a powerful influence on recovery. Children with severe TBI in optimal environments may show few effects of their injuries while children with milder injuries from disadvantaged or chaotic homes often demonstrate persistent problems.
  • Early family response may be particularly important for long-term outcomes suggesting that working to promote effective parenting may be an important early intervention.
  • Certain skills that can affect social functioning, such as speed of information processing, inhibition, and reasoning, show greater .
  • Many children do very well long-term after brain injury and most do not have across the board deficits.

More than 630,000 children and teenagers in the United States are treated in emergency rooms for TBI each year. But predictors of recovery following TBI, particularly the roles of genes and environment, are unclear. These environmental factors include family functioning, parenting practices, home environment, and socioeconomic status. Researchers at Cincinnati Children’s are working to identify genes important to recovery after TBI and understand how these genes may interact with to influence recovery.

  • They will be collecting salivary DNA samples from more than 330 children participating in the Approaches and Decisions in Acute Pediatric TBI Trial.
  • he primary outcome will be global functioning at 3, 6, and 12 months post injury, and secondary outcomes will include a comprehensive assessment of cognitive and behavioral functioning at 12 months post injury.
  • This project will provide information to inform individualized prognosis and treatment plans.

Using neuroimaging and other technologies, scientists are also learning more about brain structure and connectivity related to persistent symptoms after TBI. In a not-yet-published Cincinnati Children’s study, for example, researchers investigated the structural connectivity of brain networks following aerobic training. The recovery of structural connectivity they discovered suggests that aerobic training may lead to improvement in symptoms.

Over the past two decades, investigators at Cincinnati Children’s have conducted a series of studies to develop and test interventions to improve cognitive and behavioral outcomes following pediatric . They developed an innovative web-based program that provides family-centered training in problem-solving, communication, and self-regulation.

  • Across a series of randomized trials, online family problem-solving treatment has been shown to reduce behavior problems and executive dysfunction (management of cognitive processes) in older children with TBI, and over the longer-term improved everyday functioning in 12-17 year olds.
  • Web-based parenting skills programs targeting younger children have resulted in improved parent-child interactions and reduced behavior problems. In a computerized pilot trial of attention and memory, children had improvements in sustained attention and parent-reported executive function behaviors. These intervention studies suggest several avenues for working to improve short- and long-term recovery following TBI.

Explore further: Drug shown to aid injured adult brains may exacerbate cognitive problems in children

Source: Studies uncover long-term effects of traumatic brain injury

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[ARTICLE] A modular telerehabilitation architecture for upper limb robotic therapy – Full Text

Several factors may prevent post-stroke subjects from participating in rehabilitation protocols, for example, geographical location of rehabilitation centres, socioeconomic status, economic burden and lack of logistics surrounding transportation. Early supported discharge from hospitals with continued rehabilitation at home represents a well-defined regimen of post-stroke treatment. Information-based technologies coupled with robotics have promoted the development of new technologies for telerehabilitation. In this article, the design and development of a modular architecture for delivering upper limb robotic telerehabilitation with the CBM-Motus, a planar unilateral robotic machine that allows performing state-of-the-art rehabilitation tasks, have been presented. The proposed architecture allows a therapist to set a therapy session on his or her side and send it to the patient’s side with a standardized communication protocol; the user interacts with the robot that provides an adaptive assistance during the rehabilitation tasks. Patient’s performance is evaluated by means of performance indicators, which are also used to update robot behaviour during assistance. The implementation of the architecture is described and a set of validation tests on seven healthy subjects are presented. Results show the reliability of the novel architecture and the capability to be easily tailored to the user’s needs with the chosen robotic device.

Figure 10.
Subject 1 performing 80 repetitions of the clock-game in unassisted simulated post-stroke condition: Cartesian position (upper left side), Cartesian velocity (right upper side), x component of hand velocity over time during NW forward/backward movement (lower left side) and y component of hand velocity over time during NW forward/backward movement (lower right side).

Continue —> A modular telerehabilitation architecture for upper limb robotic therapy – Jan 01, 2017

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[WEB SITE] Five Meaningful Ways to Love the Caregiver in Your Life

Meaningful Ways to Love the Caregiver in Your Life

More than 65 million people, 29% of the U.S. population, provide care for a chronically ill, disabled, or aged family member or friend during any given year and spend an average of 20 hours per week providing care.”

-National Alliance for Caregiving in collaboration with AARP; 2009

Caregivers experience a level of stress that is often misunderstood. Long-term caregivers may suffer deep emotional upset, and burnout with little relief.  The caregivers of traumatic brain injury survivors are people who have been called to walk an extraordinary caregiving journey, often without warning or preparation.

How can we help? Are there practical ways to incorporate the “It takes a village” philosophy into the lives of caregivers that you know? The answer is yes, with a little work and a lot of heart, you can assist those who are in a constant caregiving role.

As a caregiver who often feels lonely and overwhelmed, I’d like to offer some practical solutions that have been helpful to me.

1. Get Specific

Instead of saying, “Let me know what I can do to help,” come up with something you can do, and present it. This is something we are all guilty of doing from time to time. As someone who has been in the throes of caregiving for four years, I find it’s most helpful when someone designs a specific plan and sets it into motion.

For example, “I’d like to prepare dinner for your family once a month. You pick a day, and we will make it happen.” Or, “Let’s plan on my giving you a break, the second Wednesday of every month from 4-7.” This helps the caregiver to see that a break is in sight and set up activities of her own.

It’s important to remember that long-term caregiving may make someone feel as if her resources have been depleted, making it more difficult to reach out. When someone offers something specific that will help in a concrete way, it eases part of the burden for the caregiver involved.

2. Offer Clear Praise

Avoid saying things like, “All things considered; you are doing a good job.” Or, “You are doing the best that you can.” Instead go for specific, genuine praise that doesn’t leave room for questions about what the words you are saying might mean. For example, “I know it’s been a challenging four years, you are handling it so well.” Or a simple,  “I just want to let you know I care about you.” Build the caregiver up, recognizing that their bucket may feel pretty empty at times, and they need a reserve to refill it.

Once, after an unexpected hospitalization, a dear friend looked at me and said with tears in her eyes, “You are my hero.” I knew that her sentiments were genuine. For the next several days, when I felt defeated, I focused on her praise. It not only lifted my spirit but also made me work harder in my role as a caregiver.  Genuine praise is the wind in a caregiver’s sail.

3. Practice Compassion

The caregiver is often pulled in many directions from sun-up to sundown. After spending a month with us, my thirty-year-old nephew said to me, “I don’t know how you do it.”
“Do what?” I asked.
His response: “Life.”

From afar it looks easier than it is. After a time, caregivers pick up on the fact that they can sound like complainers, so instead they often hold things in. Holding in feelings can result in growing frustration. People who offer compassionate understanding when I am overwhelmed allow me to vent in healthy ways.

When a caregiver comes to you and is comfortable enough to share her frustration, please stop, look, and listen. In other words, take time to take in what her reality may look and feel like from her perspective. People often put caregivers on a pedestal, but they get grouchy, groggy and Grinch-like too. Acknowledging the difficulties they face allows them to get to the next step. Denial is unhealthy for everyone, but when faced with continual strain, it is important to have reality checks and friends with whom you can honestly share your feelings.

4. Recognize the Importance of Human Touch

If your finances allow it, consider the gift of massage for a caregiver. Recently, I gave myself this gift and was struck with how much better it made me feel. The massage had barely started, and I could feel the sadness and tension in my entire body. I told myself to relax and let the nurturing take place. Within a few minutes, while lying on the massage table, I began to weep. I was then overcome with such deep sadness, that sobs began to erupt. The therapist’s touch had released a trigger in my body to let some of the pain inside come to the outside. My reaction was not uncommon in this setting. Often, just providing someone a safe place is all that person needs to have the release occur. Caregivers often get in a cycle of not making space for self-care; sometimes a gift is the nudge they need to break away for an hour or so.

5. Less Judgment, More Lovement

I have shared this phrase before in my posts and blogs, but it bears repeating. The caregiver’s life is demanding. We are presented with challenging scenarios, which are new to us. We have to make the best decisions we can in a given set of circumstances. And we make mistakes.

We must decide on things like when and if we should call an ambulance. We have to be the voice for a person who often resents our having to take that role on for them, and we also have to find our own lives in the mix of fully assisting someone else.

Most caregivers I know deal with some level of anxiety, guilt, and frustration that resulted from their caregiving role. At the end of the day, they do need more love, because they are required to give more love away.

These are just a few ways to help caregivers be the best they can be.

Source: Five Meaningful Ways to Love the Caregiver in Your Life

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[WEB SITE] Stroke Recovery Exercises for Your Whole Body – Saebo

Stroke survival rates have improved a lot over the last few years. Stroke was once the third leading cause of death in the United States, but it fell to fourth place in 2008 and fifth place in 2013. Today, strokes claim an average of 129,000 American lives every year. Reducing stroke deaths in America is a great improvement, but we still have a long way to go in improving the lives of stroke survivors.

Stagnant recovery rates and low quality of life for stroke survivors are unfortunately very common. Just 10% of stroke survivors make a full recovery. Only 25% of all survivors recover with minor impairments. Nearly half of all stroke survivors continue to live with serious impairments requiring special care, and 10% of survivors live in nursing homes, skilled nursing facilities, and other long-term healthcare facilities. It’s easy to see why stroke is the leading cause of long-term disability in the United States. By 2030, it’s estimated that there could be up to 11 million stroke survivors in the country.

Traditionally, stroke rehabilitation in America leaves much to be desired in terms of recovery and quality of life. There is a serious gap between stroke patients being discharged and transitioning to physical recovery programs. In an effort to improve recovery and quality of life, the American Heart Association has urged the healthcare community to prioritize exercise as an essential part of post-stroke care.

Unfortunately, too few healthcare professionals prescribe exercise as a form of therapy for stroke, despite its many benefits for patients. Many stroke survivors are not given the skills, confidence, knowledge, or tools necessary to follow an exercise program. However, that can change.

With the right recovery programs that prioritize exercise for rehabilitation, stroke survivors can “relearn” crucial motors skills to regain a high quality of life. Thanks to a phenomenon known as neuroplasticity, even permanent brain damage doesn’t make disability inevitable.

A stroke causes loss of physical function because it temporarily or permanently damages the parts of the brain responsible for those functions. The same damage is also responsible for behavioral and cognitive changes, which range from memory and vision problems to severe depression and anger. Each of these changes correspond to a specific region of the brain that was damaged due to stroke.

For example, damage in the left hemisphere of your brain will cause weakness and paralysis on the right side of your body. If a stroke damages or kills brain cells in the right hemisphere, you may struggle to understand facial cues or control your behavior. However, brain damage due to stroke is not necessarily permanent.

For more Visit Site —> Stroke Recovery Exercises for Your Whole Body

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