Archive for February, 2016

[WEB SITE] When brain injury becomes a family affair – BrainLine.org

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.

Source: When brain injury becomes a family affair

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[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

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Trial registration

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.

Background

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 [3]. In stroke survivors, the distal upper extremity is severely affected and is the last body part to recover [4]. 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 [58]. 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 [9]. 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

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[WEB SITE] If we want medicine to be evidence-based, what should we think when the evidence doesn’t agree?

To understand if a new treatment for an illness is really better than older treatments, doctors and researchers look to the best available evidence. Health professionals want a “last word” in evidence to settle questions about what the best modes of treatment are.

But not all medical evidence is created equal. And there is a clear hierarchy of evidence: expert opinion and case reports about individual events are at the lowest tier, and well-conducted randomized controlled trials are near the top. At the very top of this hierarchy are meta-analyses – studies that combine the results from multiple studies that asked the same question. And the very, very top of this hierarchy are meta-analyses performed by a group called the Cochrane Collaboration.

To be a member of the Cochrane Collaboration, individual researchers or research groups are required to adhere to very strict guidelines about how meta-analyses are to be reported and conducted. That’s why Cochrane reviews are generally considered to be the best meta-analyses.

However, no one has ever asked if the results in meta-analyses performed by the Cochrane Collaboration are different from meta-analyses from other sources. In theory, if you compared a Cochrane and non-Cochrane meta-analysis, both published within a similar time frame, you’d tend to expect that they’d have chosen the same studies to analyze, and that their results and interpretation would more or less match up.

Our team at Boston University’s School of Public Health decided to find out. And surprisingly, that’s not what we found.

What is a meta-analysis, anyway?

Imagine you have five small clinical trials that all found a generally positive benefit for, let’s say, taking aspirin to prevent heart attacks. But because each of the studies only had a small number of study subjects, none could confidently state that the beneficial effects weren’t simply due to chance. In statistical-speak, such studies would be deemed “underpowered.”

There is a good way to increase the statistical power of those studies: combine those five smaller studies into one. That’s what a meta-anaysis does. Combining several smaller studies into one analysis and taking the average of those studies can sometimes tip the scales, and let the medical community know with confidence whether a given intervention works, or not.

Taking the average. Magazine image via www.shutterstock.com.

Meta-analyses are efficient and cheap because they don’t require running new trials. Rather, it’s a matter of finding all of the relevant studies that have already been published, and this can be surprisingly difficult. Researchers have to be persistent and methodical in their search. Finding studies and deciding whether they are good enough to trust is where the art – and error – of this science becomes a critical issue.

That’s actually a major reason why the Cochrane Collaboration was founded. Archie Cochrane, a health services researcher, recognized the power of meta-analyses, but also the tremendous importance of doing them right. The Cochrane Collaboration meta-analyses must adhere to very high standards of transparency and methodological rigor and reproducibility.

Unfortunately, few can commit the time and effort to join the Cochrane Collaboration, and that means that the vast majority of meta-analyses are not conducted by the Collaboration, and are not bound to adhere to their standards. But does this actually matter?

Not quite the same. Apple and orange via www.shutterstock.com

How different can two meta-analyses be?

To find out, we started by identifying 40 pairs of meta-analyses, one from Cochrane and one not, that covered the same intervention (e.g., aspirin) and outcome (e.g., heart attacks), and then compared and contrasted them.

First, we found that almost 40 percent of the Cochrane and non-Cochrane meta-analyses disagreed in their bottom-line statistical answers. That means that typical readers, doctors or health policymakers, for instance, would come up with a fundamentally different interpretation of whether the intervention was effective or not, depending on which meta-anlyses they happened to read.

Second, these differences appeared to be systematic. The non-Cochrane reviews, on average, tended to suggest that the interventions they were testing were more potent, more likely to cure the condition or avert some medical complication than the Cochrane reviews suggested. At the same time, the non-Cochrane reviews were less precise in their accuracy, meaning that there was a higher chance that the findings were merely due to chance.

A meta-analysis is nothing more than just a fancy weighted average of its component studies. We were surprised to find that approximately 63 percent of the included studies were unique to one or the other set of meta-analyses. In other words, despite the fact that the two sets of meta-analyses would presumably look for the same papers, using similar search criteria, over a similar period of time and from similar databases, only about a third of the papers the two sets had included were the same.

It seems likely that most or all of these differences come down to the fact that Cochrane insists on tougher criteria. A meta-analysis is only as good as the studies it includes, and taking the average of poor research can lead to a poor result. As the saying goes, “garbage in, garbage out.”

Interestingly, the analyses that reported much higher effect sizes tended to get cited again in other papers at a much higher rate than the analyses reporting the lower effect size. This is a statistical embodiment of the old journalistic saying “If it bleeds, it leads.” Big and bold effects get more attention than results showing marginal or equivocal outcomes. The medical community is, after all, just human.

Why does this matter?

At its most basic level, this shows that Archie Cochrane was absolutely correct. Methodological consistency and rigor and transparency are essential. Without that, there’s a risk of concluding that something works when it doesn’t, or even just overhyping benefits.

But at a higher level this shows us, yet again, how very difficult it is to generate a unified interpretation of the medical literature. Meta-analyses are often used as the final word on a given subject, as the arbiters of ambiguity.

Clearly that role is challenged by the fact that two meta-analyses, ostensibly on the same topic, can reach different conclusions. If we view the meta-analysis as the “gold standard” in our current era of “evidence-based medicine,” how is the average doctor or policymaker or even patient to react when two gold standards contradict each other? Caveat emptor.

Source: If we want medicine to be evidence-based, what should we think when the evidence doesn’t agree?

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[WEB SITE] Common Physical Therapy Abbreviations

 

Physical therapy abbreviations are used in the clinic to shorten commonly used documentation terms. Here’s a list of PT abbreviations commonly used.

Common Physical Therapy Abbreviations

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[WEB SITE] TBI: drug shows promise for reducing harmful brain inflammation – Medical News Today

Published: Monday 22 February 2016
In recent years, researchers have highlighted the potential long-term effects of traumatic brain injury, which include increased risk of dementia and other neurological disorders. Now, a new study has uncovered a drug that shows promise for reducing the brain damage caused by such an injury.
[A brain wrapped in a bandage]

The drug MW151 was found to reduce inflammation in the brain after TBI by blocking a pro-inflammatory cytokine, while maintaining the brain’s repair process.

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.

Source: TBI: drug shows promise for reducing harmful brain inflammation – Medical News Today

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[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

ABSTRACT

Statement of the Problem: Upper limb hemiparesis is a common impairment underlying disability after Stroke. Transfer of treatment to daily functioning remains a question for traditional approaches used in treatment of upper extremity hemiparesis. Approaches based on Motor Learning principles may facilitate the transfer of treatment to activities of daily living.
Methodology: Forty one subjects with chronic stroke, attending department of occupational therapy, National Institute for the Orthopaedically Handicapped, Kolkata, West Bengal, India participated in a single blinded randomized pre-test and post-test control group training study. Subjects were randomized over three intervention groups receiving modified Constraint Induced Movement Therapy (n = 13), Bilateral Arm training (n = 14), and an equally intensive conventional treatment program (n = 14). Subjects in the bilateral arm training group participated in bilateral symmetrical activities, where as subjects in constraint induced movement therapy group performed functional activities with the affected arm only and conventional group received conventional Occupational Therapy. Each group received intensive training for 1 hour/day, 5 days/week, for 8 weeks. Pre-treatment and post-treatment measures included the Fugl-Meyer measurement of physical performance (FMA- upper extremity section), action research arm test, motor activity log. Assessments were administered by a rater blinded to group assignment.
Result: Both m-CIMT (p = 0.01) and bilateral arm training (p = 0.01) group showed statistically significant improvement in upper extremity functioning on Action Research Arm Test score in comparison to the conventional therapy group (p = 0.33). The bilateral arm training group had significantly greater improvement in upper arm function (Proximal Fugl-Meyer Assessment score, p = 0.001); while the constraint induced movement therapy group had greater improvement of hand functions (Distal Fugl-Meyer Assessment score, p = 0.001. There is an improvement seen in Quality of movement in the Conventional Therapy group. (p = 0.001).
Conclusion: Both the treatment techniques can be used for upper extremity management in patients with chronic stroke. Bilateral arm training may be used to improve upper arm function and m-CIMT may be used to improve hand functions, while the group that received modified constraint induced movement therapy had greater improvement.

References

[1] 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.
http://dx.doi.org/10.1161/01.STR.31.10.2390
[2] 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
[3] Radomski, M.V. and Trombly Latham, C.A. (2008) Occupational Therapy for Physical Dysfunction. 6th Edition, Lippincott Williams and Wilkins, Philadelphia.
[4] 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.
[5] 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
[6] Taub, E., et al. (1993) Techniques to Improve Chronic Motor Deficits after Stroke. Archive of Physical Medicine and Rehabilitation, 74, 347-354.
[7] 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
[8] 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
[9] 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
[10] 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
[11] 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.
[12] 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.
http://dx.doi.org/10.1080/165019701750165916
[13] 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.
http://dx.doi.org/10.1161/01.STR.30.11.2369
[14] 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.
http://dx.doi.org/10.1212/WNL.56.3.401
[15] 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.
http://dx.doi.org/10.1080/14640748308402139
[16] Carr, J. and Shepherd, R. (1998) Neurological Rehabilitation: Optimizing Motor Performance. Butterworth-Heineman, Edinburgh, 241-264.
[17] Levine, P. and Page, S.J. (2004) Modified Constraint Induced Movement Therapy: A Promising Restorative out Patient Therapy. Top Stroke Rehabilitation, 11, 1-10.
http://dx.doi.org/10.1310/R4HN-51MW-JFYK-2JAN

Source: Effectiveness of Modified Constraint Induced Movement Therapy and Bilateral Arm Training on Upper Extremity Function after Chronic Stroke: A Comparative Study

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[Abstract] One-Therapist to Three-Patient Telerehabilitation Robot System for the Upper Limb after Stroke

Abstract

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.

Source: One-Therapist to Three-Patient Telerehabilitation Robot System for the Upper Limb after Stroke – Online First – Springer

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 [Abstract] Compensating Hand Function in Chronic Stroke Patients Through the Robotic Sixth Finger – IEEE Xplore

Abstract

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.

Source: IEEE Xplore Abstract – Compensating Hand Function in Chronic Stroke Patients Through the Robotic Sixth Finger

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[Abstract] Effects of training with a passive hand orthosis and games at home in chronic stroke: a pilot randomised controlled trial – Clinical Rehabilitation

Abstract

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.

 

Source: Effects of training with a passive hand orthosis and games at home in chronic stroke: a pilot randomised controlled trial

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[Abstract] Effects of repetitive transcranial magnetic stimulation on lower extremity spasticity and motor function in stroke patients – Disability and Rehabilitation

Effects of repetitive transcranial magnetic stimulation on lower extremity spasticity and motor function in stroke patientsAbstract

Purpose: To investigate the effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) on lower extremity (LE) spasticity, motor function and motor neurone excitability in chronic stroke patients.
Method: This study was a randomised sham-controlled cross-over trial with 1-week follow-up. A total of 20 post-stroke patients were randomised to receive active (n = 10) or sham (n = 10) rTMS. Fourteen of them (7 in each group) crossed over to the sham or active rTMS after a washout period of 1 month. Interventions consist of five consecutive daily sessions of active or sham rTMS to the unaffected lower extremity motor area (1000 pulses; 1 Hz; 90% of the tibialis anterior motor threshold). Outcome measures were modified modified ashworth scale (MMAS), the H-reflex, lower extremity section of Fugl–Mayer assessment (LE-FMA) and timed UP and GO (TUG) test. All outcomes were measured at three levels in each intervention period: pre- and post-intervention and 1-week follow-up.
Results: Friedman’s test revealed significant improvement in MMAS score only after active rTMS. This improvement lasted for one week after the active rTMS. Repeated measure analysis of variance (ANOVA) showed significant time*intervention interaction for LE-FMA. There are no differences between groups for the MMAS and LE-FMA. No significant change inHmax/Mmax ratio and TUG test was noted.
Conclusion: Low-frequency rTMS over the LE motor area can improve clinical measures of muscle spasticity and motor function. More studies are needed to clarify the changes underlying this improvement in spasticity.

  • 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.

View all related articles

Source: Effects of repetitive transcranial magnetic stimulation on lower extremity spasticity and motor function in stroke patients – Disability and Rehabilitation –

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