[ARTICLE] Virtual Reality Video Games to Promote Movement Recovery in Stroke Rehabilitation: A Guide for Clinicians

Article Outline

After stroke, people often have difficulty moving one arm and hand, but movement can improve with considerable practice. Arm movements may need to be repeated upwards of 2500 times for a person to approach his/her peak level of motor function.1 Video-gaming technology can effectively deliver engaging, high-repetition movement practice. Use of video games for rehabilitation can be as effective as more conventional approaches.2

There are 2 types of inexpensive, commonly available gaming systems that can be integrated into rehabilitation programs: controller based and camera tracking. In order for the systems to be used most effectively, it is necessary for therapists and/or individuals with stroke to assess both system types to determine which system best suits their needs and impairments.

The following are examples of systems and games that incorporate movements that may be useful for rehabilitation. This is not intended to be an exhaustive list, as new games and gaming systems are constantly being introduced to the market.

Continue —> Virtual Reality Video Games to Promote Movement Recovery in Stroke Rehabilitation: A Guide for Clinicians – Archives of Physical Medicine and Rehabilitation.

[ARTICLE] Effects of upper limb robot-assisted therapy in the rehabilitation of stroke patients – Full Text PDF

 Abstract.

[Purpose] The aim of this study was to examine the effects of upper limb robot-assisted therapy in the rehabilitation of stroke patients.

[Subjects and Methods] Fifteen stroke patients with no visual or cognitive problems were enrolled. All subjects received robot-assisted therapy and comprehensive rehabilitation therapy for 30 minutes each. The experimental group received a conventional therapy and an additional half hour per weekday of robot therapy. The patients participated in a total of 20 sessions, each lasting 60 minutes (conventional therapy 30 min, robot-assisted therapy 30 min), which were held 5 days a week for 4 weeks.

[Result] The patients showed a significant difference in smoothness and reach error of the point to point test, circle size and independence of the circle in the circle test, and hold deviation of the playback static test between before and after the intervention. On the other hand, no significant difference was observed in the displacement of the round dynamic test. The patients also showed significant improvement in the Fugl-Meyer Assessment and Modified Barthel Index after the intervention.

[Conclusion] These kinematic factors can provide good information when analyzing the upper limb function of stroke patients in robot-assisted therapy. Nevertheless, further research on technology-based kinematic information will be necessary.

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[ARTICLE] Effects of virtual reality-based ankle exercise on the dynamic balance, muscle tone, and gait of stroke patients – Full Text PDF

Abstract.

[Purpose] The purpose of this study was to investigate the therapeutic effects of virtual reality-based ankle exercise on the dynamic balance, muscle tone, and gait ability of stroke subjects.

[Subjects and Methods] Twenty persons who were in the chronic stroke subjects of this study and they were included and assigned to two groups: experimental (VRAE; Virtual Reality-based Ankle Exercise group) (n=10) and control groups (n=10). The VRAE group performed virtual environment system ankle exercise, and the control group watched a video. Both groups performed their respective interventions for 30 minutes per day, 5 times per week over a 6-week period. To confirm the effects of the intervention, dynamic balance, muscle tone, and spatiotemporal gait were evaluated.

[Results] The results showed that the dynamic balance and muscle tone was significantly more improved after the intervention compared to before in the VRAE group (dynamic balance: 5.50±2.57; muscle tone: 0.90±0.39), and the improvements were more significant than those in the control (dynamic balance: 1.22±2.05; muscle tone: 0.10±0.21). Spatiotemporal gait measures were significantly more increased in the paretic limb after the intervention compared to before in the VRAE group and the improvements were more significant than those in the control group.

[Conclusion] This study demonstrated that virtual reality-based ankle exercise effectively improves the dynamic balance, muscle tone, and gait ability of stroke patients.

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[WEB SITE] FDA OKs Botox for Adults With Upper Limb Spasticity

The US Food and Drug Administration (FDA) has approved an expanded indication for onabotulinum toxin A (Botox, Actavis) for the treatment of adults with upper limb spasticity, according to a company news release.

The expanded indication now adds two thumb muscles: the flexor pollicis longus, a forearm muscle that flexes the thumb, and the adductor pollicis, a hand muscle that adducts the thumb. The expanded indication increases the maximum dose from 360 to 400 units for the treatment of upper limb spasticity. The FDA also approved an increase to the maximum 3-month cumulative dose from 360 to 400 units in adults treated for one or more indications.

The drug is injected into affected muscles to relieve stiffness. It is unknown whether onabotulinum toxin A is safe or effective in treating upper limb muscles other than those in the elbow, wrist, and fingers or in treating spasticity in lower limb muscles.

“Debilitating Neurological Condition”

Onabotulinum toxin A is the first and only neurotoxin the FDA has approved for the treatment of upper limb spasticity. Upper limb spasticity is a debilitating neurological condition that causes muscle stiffness that can tighten muscles in the wrist, fingers, and thumbs.

More than 1.8 million Americans live with the disorder, which can occur weeks, months, or even years after a stroke.

“Simple tasks such as washing the affected hand or getting dressed can be limiting for patients with the condition, and they’re often left to depend on a caregiver to help them,” said lead clinical trial investigator Allison Brashear, MD, professor and chair, Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, in the company statement.

“It’s important for patients experiencing these types of symptoms to talk to their doctor, who can refer them to a neurologist or physiatrist to discuss their treatment options,” she added.

The FDA approved onabotulinum toxin A to treat spasticity in the flexor muscles of the elbow, wrist, and fingers in adults in March 2010. Spasticity often occurs after stroke, traumatic brain injury, or the progression of multiple sclerosis.

Studies Support Expanded Indication

The expanded indication follows a discussion of two additional randomized, multicenter, double-blind, placebo-controlled studies that evaluated the safety and efficacy of the drug in those with upper limb spasticity in thumb flexor muscle involvement, according to the company statement.

Continue —> FDA OKs Botox for Adults With Upper Limb Spasticity.

[SURVEY] Tele-Rehabilitation Games on the Cloud: A Survey and a Vision – Full Text PDF

ABSTRACT
Rehabilitation is an important branch of health care that aims to restore some or all of the patient’s physical, sensory, and/or mental capabilities that were lost due to injury, illness, or disease.

With the increasing number of people with disabilities, more specialized rehabilitation staff and facilities are needed. However, evidence suggests that people with disabilities face barriers in accessing the health and rehabilitation services they need in many settings.

Therefore, Telerehabilitation has emerged as an evolutionary field of tele-medicine to overcome this availability problem by providing a wide range of consultative, preventative, diagnostic, and therapeutic services via the internet. Pairing these practices with game-based therapy has proved to increase their potential impact specially with pediatric populations. This paper gives a survey on some existing studies and suggests moving these telerehabilitation games into the cloud for the sake of convenience and flexibility.

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[REVIEW] Cognitive Rehabilitation After Traumatic Brain Injury: A Reference for Occupational Therapists – Full Text HTML

Abstract

Nearly 1.7 million Americans sustain a traumatic brain injury (TBI) each year. These injuries can result in physical, emotional, and cognitive consequences. While many individuals receive cognitive rehabilitation from occupational therapists (OTs), the interdisciplinary nature of TBI research makes it difficult to remain up-to-date on relevant findings.

We conducted a literature review to identify and summarize interdisciplinary evidence-based practice targeting cognitive rehabilitation for civilian adults with TBI. Our review summarizes TBI background, and our cognitive remediation section focuses on the findings from 37 recent (since 2006) empirical articles directly related to cognitive rehabilitation for individuals (i.e., excluding special populations such as veterans or athletes).

This manuscript is offered as a tool for OTs engaged in cognitive rehabilitation and as a means to highlight arenas where more empirical, interdisciplinary research is needed.

Read Full Article —> Cognitive Rehabilitation After Traumatic Brain Injury.

[ARTICLE] A randomized clinical trial to determine effectiveness of driving simulator retraining on the driving performance of clients with neurological impairment

Abstract

Introduction Following a neurological event, returning to driving is an important activity contributing to improved participation within the community. The purpose of this study was to examine the effectiveness of driving simulator retraining on driving in clients with neurological impairment and to examine factors associated with treatment effectiveness.

Method Individuals with non-degenerative brain injury were randomized to either a simulator training or control group. The simulator group received individualized training (16 sessions) using a driving simulator. The control group did not receive intervention. A blind evaluator assessed participants on the DriveAble On-Road Driving Evaluation.

Results There was no significant difference between groups in the proportion of individuals who passed the driving evaluation (Chi2 = 0.65; p = 0.42; CI = −0.41 to +0.17). However, participants with moderate impairment who received simulator training were more likely to pass the driving test compared with those in the control group (86% versus 17%; Chi2 = 6.2; p = 0.03; CI = −1.00 to −0.30). There were no differences in pass rate according to diagnosis, gender, or for those with severe impairments.

Conclusion Results provide clinicians with preliminary information on the potential clinical usefulness of driving simulator training. While the findings do not support simulator retraining for the group as a whole, they suggest that clients with moderate impairment have the potential to benefit.

via A randomized clinical trial to determine effectiveness of driving simulator retraining on the driving performance of clients with neurological impairment.

[ARTICLE] Transcranial Direct Current Stimulation of Dorsolateral Prefrontal Cortex of Major Depression: Improving Visual Working Memory, Reducing Depressive Symptoms – Full Text PDF

Abstract

Recent studies on major depression (MD) have used noninvasive brain stimulation techniques such as transcranial direct current stimulation (tDCS) to improve impaired emotion and cognition in MD. However, such experiments have yielded mixed results, specifically with respect to cognition in MD.

This study aimed to investigate whether anodal and cathodal tDCS applied over the dorsolateral prefrontal cortex (DLPFC) would significantly improve visual working memory and reduce depressive symptoms in patients with MD.

Thirty patients with major depression (n = 30) were randomly assigned to receive either experimental (active) or control (sham) tDCS. To measure cognitive functions, the participants underwent a series of visual memory neuropsychological tasks; and to measure depression symptoms, the Beck Depression Inventory (BDI) and Hamilton Depression Scale (HDRS) were used. The parameters of active tDCS included 2 mA for 20 min per day for 10 consecutive days, anode over the left DLPFC (F3), cathode over the right DLPFC (F4) region.

After 10 sessions of anodal and cathodal tDCS, patients showed significantly improved performance in visual working memory tasks. The same results were observed for depression symptoms. This study showed that anodal tDCS over left DLPFC, concurrently with cathodal tDCS over right DLPFC, improved cognitive impairment (specifically visual working memory), as well as reduced depressive symptoms in patients with MD. This finding provides evidence that supports effectiveness of a specific montage of tDCS to improve impaired cognition in MD, specifically in visual working memory.

—> Full Text PDF

[WEB SITE] Study: Magnetics Help Traumatic Brain Injury Headaches

Apr 15, 2015    |    Gale Scott

Drugs have not been shown effective in relieving the debilitating headaches that can follow mild traumatic brain injury (MTBI)

In a study presented at the American Society of Interventional Pain Physicians meeting in Orlando, FL April 11, Robert McLay, MD, PhD and colleagues at the University of California San Diego and the Veterans Administration San Diego Healthcare System in La Jolla, CA, looked at the effects of repetitive transcranial magnetic stimulation (rTMS).

The treatment involves using a basic electromagnetic coupling principle in which a rapid discharge of electric current is converted into dynamic magnetic flux allowing the induction of a localized current in the brain. The idea is to achieve neuromodulation. The treatment has been used for treating other types of headaches.

The researchers treated 6 men with MTBI headaches. To be included in the study, they had to have headaches lasting more than 48 hours. Measured on a pain scale, the average intensity of these headaches was 5.50 before treatment and 2.67 after receiving rTMS.

In addition, headache intensity was reduced by an average of 53.05%, and the average headache exacerbation frequency was reduced by 78.97% with 2 patients reporting no more severe headaches.

The authors concede that randomized trials are needed to confirm their results but say their findings are encouraging.

“MTBI headaches are often treatment-resistant, but in this case series patients were found to have improvements in severity, frequency and duration of their headaches after rTMS,” they wrote in the abstract.

The authors had no conflicts to disclose.

via Study: Magnetics Help Traumatic Brain Injury Headaches.

[ARTICLE] Mirror therapy enhances upper extremity motor recovery in stroke patients

Abstract

The purpose of this study was to evaluate the effects of mirror therapy program in addition with physical therapy methods on upper limb recovery in patients with subacute ischemic stroke. 15 subjects followed a comprehensive rehabilitative treatment, 8 subjects received only control therapy (CT) and 7 subjects received mirror therapy (MT) for 30 min every day, five times a week, for 6 weeks in addition to the conventional therapy.

Brunnstrom stages, Fugl–Meyer Assessment (upper extremity), the Ashworth Scale, and Bhakta Test (finger flexion scale) were used to assess changes in upper limb motor recovery and motor function after intervention.

After 6 weeks of treatment, patients in both groups showed significant improvements in the variables measured. Patients who received MT showed greater improvements compared to the CT group. The MT treatment results included: improvement of motor functions, manual skills and activities of daily living. The best results were obtained when the treatment was started soon after the stroke. MT is an easy and low-cost method to improve motor recovery of the upper limb.

via Mirror therapy enhances upper extremity motor recovery in stroke patients – Online First – Springer.