Archive for February, 2016
While these estimations alone are frightening, consider the many more millions of family members and loved ones left in the wake. March is Brain Injury Awareness Month — the perfect time to open a meaningful dialogue about the devastating effects of a brain injury on family dynamics and social relationships.
As a neuropsychologist with one of the premier brain injury treatment facilities in the region, I have both researched and seen the impact of moderate to severe brain injury on family functioning.
After a moderate to severe brain injury, an individual may experience physical symptoms such as residual pain and fatigue, and challenges with cognitive abilities such as language, memory and problem solving. Caregivers often experience depression, anxiety, somatic symptoms, social isolation and lower life satisfaction. Furthermore, both the caregiver and the person with brain injury impact each other’s well-being.
Following the injury, family roles and relationships change. Many family members grieve the loss of their loved one’s personality. The behavioral and emotional symptoms are often most difficult to manage, and each family member can be affected differently. Parents of adult children often resume the parental role. Spouses and siblings develop a new caregiving role.
About 75 percent of post-brain-injury caregivers are women, and more than two-thirds hold a job in addition to caring for a loved one. The pressure to properly rehabilitate a child, parent or spouse, on top of the individual’s cognitive and emotional challenges, creates the perfect storm for caregiver burnout and an unhealthy family dynamic.
Family needs change across the spectrum of care, from acute treatment to post-acute rehabilitation. These needs include obtaining more information, managing uncertainty about the future, adapting to changes, finding more services or resources, coordinating care, and increasing peer and professional support.
With the right tools and knowledge of healthy recovery, families can improve quality of life for themselves and the individual with brain injury. The following may help a caregiver and his or her family adjust to the “new normal” after a loved one suffers a brain injury:
- Become active in support and intervention groups. These groups provide families with tools for education, communication and problem-solving as well as crisis intervention and caregiver referrals for respite. Caregivers in support groups show declines in distress, lower levels of depression and greater self-esteem, and they report fewer trips to their physician for physical and mental illness.
- Establish a strong and therapeutic relationship with your loved one’s clinical team. Successful and thorough brain injury treatment requires an interdisciplinary team including a neuropsychologist, medical physician and physical, occupational and speech therapists, to name just a few. Establishing open and frequent communication with a patient’s care continuum will reduce caregiver stress and allow a family to focus on strengthening their relationships rather than deciphering complex medical information.
- Practice self-care and remain committed to favorite pastimes. It’s easy for a caregiver and his or her family to become consumed with their loved one — caregiving is a tall task, and a family will need to navigate many immense changes and obstacles at once. However, it’s crucial for family members to continue in activities they enjoyed before a brain injury. Did you have a standing coffee night with a colleague? Book club? Shopping with friends? To the best of your ability, maintain things you love and don’t neglect your own needs during this period of change and adjustment.
Family dynamics may shift and change as you adjust to a new life post-injury, but patients and their families often discover new ways to enjoy their time together. Go easy on yourself — especially during the first year in a caregiving role — and never be afraid to ask for help and advice from your loved one’s care team.
Dr. Alison Tverdov is a neuropsychologist at Bancroft NeuroRehab whose research was recently published in Brain Injury, the research journal of the International Brain Injury Association. Learn more by calling (844) 234-8387 or visiting http://www.bnrinfo.org to connect with an expert.
[ARTICLE] Effects of virtual reality-based rehabilitation on distal upper extremity function and health-related quality of life: a single-blinded, randomized controlled trial – Full Text HTML/PDF
Virtual reality (VR)-based rehabilitation has been reported to have beneficial effects on upper extremity function in stroke survivors; however, there is limited information about its effects on distal upper extremity function and health-related quality of life (HRQoL). The purpose of the present study was to examine the effects of VR-based rehabilitation combined with standard occupational therapy on distal upper extremity function and HRQoL, and compare the findings to those of amount-matched conventional rehabilitation in stroke survivors.
The present study was a single-blinded, randomized controlled trial. The study included 46 stroke survivors who were randomized to a Smart Glove (SG) group or a conventional intervention (CON) group. In both groups, the interventions were targeted to the distal upper extremity and standard occupational therapy was administered. The primary outcome was the change in the Fugl–Meyer assessment (FM) scores, and the secondary outcomes were the changes in the Jebsen–Taylor hand function test (JTT), Purdue pegboard test, and Stroke Impact Scale (SIS) version 3.0 scores. The outcomes were assessed before the intervention, in the middle of the intervention, immediately after the intervention, and 1 month after the intervention.
The improvements in the FM (FM-total, FM-prox, and FM-dist), JTT (JTT-total and JTT-gross), and SIS (composite and overall SIS, SIS-social participation, and SIS-mobility) scores were significantly greater in the SG group than in the CON group.
VR-based rehabilitation combined with standard occupational therapy might be more effective than amount-matched conventional rehabilitation for improving distal upper extremity function and HRQoL.
This study is registered under the title “Effects of Novel Game Rehabilitation System on Upper Extremity Function of Patients With Stroke” and can be located in https://clinicaltrials.gov with the study identifier NCT02029651.
Regaining upper extremity function is one of the major goals in stroke survivors, as it is important for performing activities of daily living (ADLs). However, approximately 80 % of stroke survivors have upper extremity limitations, and these limitations persist in approximately half of these survivors in the chronic phase [1, 2]. Distal upper extremity function is vital for performing ADLs, such as holding objects like utensils, turning a doorknob or key in a lock, telephone or computer use, and writing, and is strongly related to quality of life (QoL) in stroke survivors . In stroke survivors, the distal upper extremity is severely affected and is the last body part to recover . Therefore, improving distal upper extremity function is of primary importance in the rehabilitation of stroke survivors.
Recent studies have emphasized the use of interventions that are focused and repetitive, relevant to real-life, and actively performed in order to promote cortical reorganization and neuroplasticity [5–8]. In this context, conventional interventions have been complemented by novel technologies such as virtual reality (VR).
VR-based rehabilitation is promising in stroke survivors, and many types of VR-based rehabilitation apparatus from commercial video game equipment to robotics are currently being developed and used. In the area of upper limb rehabilitation, a large number of studies have been performed in stroke survivors, and a recent systematic review concluded that the use of VR-based rehabilitation is superior to amount-matched conventional rehabilitation for improving upper limb function . Nevertheless, most studies on VR-based rehabilitation for the upper extremity reported on the proximal upper extremity, with limited information on the distal upper extremity. Although 2 previous studies showed promising results regarding VR-based rehabilitation for the distal upper extremity, these studies did not include a control group [10, 11]. Randomized control trials have been performed using a VR system with different types of gloves; however, a definite conclusion about the treatment effect could not be obtained owing to the low number of participants [12, 13]. Furthermore, the effects of VR-based rehabilitation on health related quality of life (HRQoL) have not been appropriately assessed, although the QoL of stroke survivors is crucial for comprehensive rehabilitation.
Therefore, the objective of the present study was to examine the effects of VR-based rehabilitation combined with standard occupational therapy (OT) on distal upper extremity function and HRQoL, and compare the findings to those of amount-matched conventional rehabilitation in stroke survivors.
Continue —> Effects of virtual reality-based rehabilitation on distal upper extremity function and health-related quality of life: a single-blinded, randomized controlled trial | Journal of NeuroEngineering and Rehabilitation | Full Text
Physical therapy abbreviations are used in the clinic to shorten commonly used documentation terms. Here’s a list of PT abbreviations commonly used.
Traumatic brain injury (TBI) is defined as a bump, jolt or blow to the head that interferes with normal brain functioning.
Falls, motor vehicle accidents and assault are some of the most common causes of TBI, and people who play contact sports are particularly at risk.
Symptoms of TBI includeheadache, dizziness, fatigue, problems with concentration and memory and poor motor control, though how long these symptoms last depends on the severity of injury. In more severe cases, symptoms can last for weeks or months.
Increasingly, studies have suggested that TBIs can have even longer-term effects on the brain. Recent research reported by Medical News Today, for example, foundevidence of Alzheimer’s brain plaques in people who had suffered a TBI from 11 months to 17 years previously.
As such, there is more focus than ever on identifying ways to reduce both the short- and long-term effects of brain damage caused by TBI.
In a new study published in PLOS One, lead study author Adam Bachstetter, PhD, assistant professor in the Spinal Cord & Brain Injury Research Center and the Department of Anatomy & Neurobiology at the University of Kentucky, and colleagues reveal how an experimental drug called MW151 could do just that.
MW151 ‘dampens down’ damaging inflammatory responses in TBI
Study coauthor Linda Van Eldik, PhD, of the Sanders-Brown Center on Aging and the Department of Anatomy & Neurobiology at Kentucky, explains that after a head injury, the body tells immune cells to respond to the trauma and begin the healing process.
“Although these immune cells help repair the injury, they also cause inflammationthat may damage the tissue – a sort of double-edged sword,” she adds.
Previously, the researchers found that MW151 blocked the release of harmful chemicals that triggered inflammation in a rodent model of closed head injury – a form of TBI in which the brain knocks against the skull – while maintaining the immune cells that repair brain damage.
Additionally, the researchers found that MW151 was able to reduce cognitive impairment caused by closed head injury.
For the new study, the team tested MW151 against a mouse model of mild fluid percussion injury (mFPI), which represents a more severe form of TBI called diffuse axonal injury (DAI).
In DAI, brain injury occurs over a more widespread area as a result of the brain moving back and forth in the skull. It is most common in shaking injuries or motor vehicle accidents.
When the mouse models were treated with MW151, the researchers found that the drug suppressed levels of a pro-inflammatory cytokine in the brain called interleukin-1 beta (IL-1β), which reduced inflammation without interfering with the brain’s repair process.
Commenting on the findings, Bachstetter says:
“We were delighted to see that MW151 is effective in more than one model of TBI. MW151 appears to dampen down the detrimental inflammatory responses without suppressing the normal functions that the cells need to maintain health.”
Van Eldik believes their findings could have a significant impact on the treatment of TBI, an injury that she says represents a “major unmet clinical need.”
“[…] there is currently no effective therapy to prevent the increased risk of dementia and other neurologic complications, such as post-traumatic epilepsy, neuropsychiatric disorders, and post-concussive symptoms such as headaches, sleep disturbances, memory problems, dizziness, and irritability,” she adds.
“MW151 represents an important next step in the process to help people with TBI, including soldiers, athletes, car accident victims and others.”
The researchers say they hope to begin clinical trials of MW151, assessing its effects in people with TBI, within the next few years.
In August 2015, MNT reported on a study suggesting there may be a link between attention-deficit hyperactivity disorder (ADHD) and TBI.
[ARTICLE] Effectiveness of Modified Constraint Induced Movement Therapy and Bilateral Arm Training on Upper Extremity Function after Chronic Stroke: A Comparative Study – Full Text PDF
|||Whittal, J., McCombe Waller, S., Silver, K.H.C., et al. (2000) Repetitive Bilateral Arm Training with Rhythmic Auditory Cueing Improves Motor Function in Chronic Stroke. Stroke, 31, 2390-2395.
|||Bonifer, N.M., Anderson, K.M., Arciniegas, D.B., et al. (2005) Constraint Induced Movement Therapy for Stroke: Efficacy for Patients with Minimal Upper Extremity Motor Ability. Archives of Physical Medicine and Rehabilitation, 86, 1867-1872. http://dx.doi.org/10.1016/j.apmr.2005.04.002|
|||Radomski, M.V. and Trombly Latham, C.A. (2008) Occupational Therapy for Physical Dysfunction. 6th Edition, Lippincott Williams and Wilkins, Philadelphia.|
|||Taub, E., Uswatte, G. and Pidikiti, R. (1999) Constraint Induced Movement Therapy, a New Family of Techniques with Broad Application to Physical Rehabilitation—A Clinical Review. Journal of Rehabilitation Research and Development, 36, 273-251.|
|||Dobkin, B.H. (2005) Clinical Practice. Rehabilitation after Stroke. The New England Journal of Medicine, 352, 1677- 1684. http://dx.doi.org/10.1056/NEJMcp043511|
|||Taub, E., et al. (1993) Techniques to Improve Chronic Motor Deficits after Stroke. Archive of Physical Medicine and Rehabilitation, 74, 347-354.|
|||Page, S.J., Levine, P., Sisto, S., et al. (2002) Stroke Patients and Therapists Opinions of Constraint Induced Movement Therapy. Clinical Rehabilitation, 16, 55-60. http://dx.doi.org/10.1191/0269215502cr473oa|
|||Page, S.J., Sisto, S., Levine, P. and McGrath, R.E. (2004) Efficacy of Modified Constraint Induced Movement Therapy in Chronic Stroke: A Single Blind Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation, 85, 14-17. http://dx.doi.org/10.1016/S0003-9993(03)00481-7|
|||Luft, A.R., McCombe-Waller, S., Whitall, J. et al. (2004) Repetitive Bilateral Arm Training and Motor Cortex Activation in Chronic Stroke. JAMA, 292, 1853-1861. http://dx.doi.org/10.1001/jama.292.15.1853|
|||Uswatte, G. and Taub, E. (1999) Constraint Induced Movement Therapy. New Approaches to Outcome Measurement in Rehabilitation. In: Struss, D.T., Winocur, G. and Robertson, I.H., Eds., Cognitive Neurorehabilitation, a Comprehensive Approach, Cambridge University Press, Cambridge, England, 215-29|
|||Fugl-Meyer, A.R., et al. (1975) The Post Stroke Hemiplegic Patient. I. A Method for Evaluation of Physical Performance. Scandinavian Journal of Rehabilitation Medicine, 7, 13-31.|
|||Vander Lee, J.H., Beckermen, H., Lankhorst, G.J. and Breter, L.M. (2001) The Responsiveness of the Action Research Arm Test and Fugl-Meyer Assessment of Physical Performance Scale in Chronic Stroke Patients. Journal of Rehabilitation Medicine, 33, 110-113.
|||Vander Lee, J.H., Wagenaar, R.C., Lankhorst, G.J., et al. (1999) Forced Use of the Upper Extremity in Chronic Stroke Patients: Results from a Single Blind Randomized Clinical Trial. Stroke, 30, 2369-2375.
|||Staines, W.R., McIlroy, W.E., Graham, S.J. and Black, S.E. (2001) Bilateral Movement Enhances Ipsilesional Cortical Activity in Acute Stroke: A Pilot Functional MRI Study. Neurology, 56, 401-404.
|||Kelso, J.A.S., Putnam, C.A. and Goodman, D. (1983) On the Space-Time Structure of Human Inter Limb Coordination. The Quarterly Journal of Experimental Psychology Section, 35A, 347-375.
|||Carr, J. and Shepherd, R. (1998) Neurological Rehabilitation: Optimizing Motor Performance. Butterworth-Heineman, Edinburgh, 241-264.|
|||Levine, P. and Page, S.J. (2004) Modified Constraint Induced Movement Therapy: A Promising Restorative out Patient Therapy. Top Stroke Rehabilitation, 11, 1-10.
[Abstract] One-Therapist to Three-Patient Telerehabilitation Robot System for the Upper Limb after Stroke
In this paper, a novel one-therapist to three-patient telerehabilitation robot system is developed, which consists of a web-based server computer for therapist at hospital, three telerehabilitation robots for patients at home or in nursing home, three client computers for robot control, and computer networks connect the client computers to the server computer. A kind of light, back-drivable and safe one degree-of-freedom rehabilitation robot with low cost is designed, and a safe control strategy which is combination of PI control and damping control is proposed for the robot control.
Through this telerehabilitation robot system, a therapist can dialogue with post-stroke patients in video communication via the networks, and then he can remotely set or modify the training mode and control parameters of the rehabilitation robots for post-stroke patient training. Haptic based therapy game is also programmed to improve the activity of the patients during training process.
Integrated with database management, the history and current performance data of patients acquired by all sensors of the telerehabilitation robot system during the training process are stored and managed.
Three volunteer individual patients with upper limb disabilities participated in this study. After four weeks of periodic rehabilitation training with the telerehabilitation robot system, the muscle strength and movement coordination of the three patients had been obviously improved.
Our study shows that the one-therapist to three-patient telerehabilitation robot system has good reliability and is able to greatly improve efficiency of the rehabilitation training, which can solve the problem of lack of therapist to a certain extent.
[Abstract] Compensating Hand Function in Chronic Stroke Patients Through the Robotic Sixth Finger – IEEE Xplore
A novel solution to compensate hand grasping abilities is proposed for chronic stroke patients. The goal is to provide the patients with a wearable robotic extra-finger that can be worn on the paretic forearm by means of an elastic band.
The proposed prototype, the Robotic Sixth Finger, is a modular articulated device that can adapt its structure to the grasped object shape. The extra-finger and the paretic hand act like the two parts of a gripper cooperatively holding an object.
We evaluated the feasibility of the approach with four chronic stroke patients performing a qualitative test, the Frenchay Arm Test.
In this proof of concept study, the use of the Robotic Sixth Finger has increased the total score of the patients of 2 points in a 5 points scale. The subjects were able to perform the two grasping tasks included in the test that were not possible without the robotic extra-finger.
Adding a robotic opposing finger is a very promising approach that can significantly improve the functional compensation of the chronic stroke patient during everyday life activities.
[Abstract] Effects of training with a passive hand orthosis and games at home in chronic stroke: a pilot randomised controlled trial – Clinical Rehabilitation
Objectives: To compare user acceptance and arm and hand function changes after technology-supported training at home with conventional exercises in chronic stroke. Secondly, to investigate the relation between training duration and clinical changes.
Design: A randomised controlled trial.
Setting: Training at home, evaluation at research institute.
Subjects: Twenty chronic stroke patients with severely to mildly impaired arm and hand function.
Interventions: Participants were randomly assigned to six weeks (30 minutes per day, six days a week) of self-administered home-based arm and hand training using either a passive dynamic wrist and hand orthosis combined with computerised gaming exercises (experimental group) or prescribed conventional exercises from an exercise book (control group).
Main measures: Main outcome measures are the training duration for user acceptance and the Action Research Arm Test for arm and hand function. Secondary outcomes are the Intrinsic Motivation Inventory, Fugl-Meyer assessment, Motor Activity Log, Stroke Impact Scale and grip strength.
Results: The control group reported a higher training duration (189 versus 118 minutes per week, P = 0.025). Perceived motivation was positive and equal between groups (P = 0.935). No differences in clinical outcomes over training between groups were found (P ⩾ 0.165). Changes in Box and Block Test correlated positively with training duration (P = 0.001).
Conclusions: Both interventions were accepted. An additional benefit of technology-supported arm and hand training over conventional arm and hand exercises at home was not demonstrated. Training duration in itself is a major contributor to arm and hand function improvements.
[Abstract] Effects of repetitive transcranial magnetic stimulation on lower extremity spasticity and motor function in stroke patients – Disability and Rehabilitation
Implications for Rehabilitation
Spasticity is a common disorder and one of the causes of long-term disability after stroke.
Physical therapy modalities, oral medications, focal intervention and surgical procedures have been used for spasticity reduction.
Beneficial effect of the repetitive transcranial magnetic stimulation (rTMS) for post-stroke upper extremity spasticity reduction and motor function improvement was demonstrated in previous studies.
This study shows amelioration of lower extremity spasticity and motor function improvement after five daily sessions of inhibitory rTMS to the unaffected brain hemisphere which lasted for at least 1 week following the intervention.