[WEB SITE] Transcranial Direct Current Stimulation May Help Boost Stroke Recovery – Rehab Managment

Researchers from University of Oxford suggest that the application of a low electric current to the brains of poststroke patients may help improve their hand and arm function.

The scientists—professor Heid Johansen-Berg and Dr Charlotte Stagg from Oxford’s Nuffield Department of Clinical Neurosciences—used a variant of transcranial direct current stimulation called ipsilesional anodal tDCS, where a positive (anodal) current is applied on the side of the brain where damage has occurred, according to a media release from the University of Oxford.

In their study, the duo divided 24 poststroke patients into two groups while receiving 9 days of motor training: one who received tDCS during their training, and another who were fitted with electrodes but did not receive tDCS (control group).

Before, and at various times up to 3 months after their training, the participants’ motor skills were assessed to check for improvement, according to the release.

“Three months after training, the group that had received tDCS had improved more on our clinical measures than those in the control group. This showed that the patients who had received tDCS were better able to use their hands and arms for movements such as lifting, reaching and grasping objects,” says Johansen-Berg in the release.

The participants also underwent MRI scanning, which according to the researchers, showed that the group who received tDCS had more activity in the relevant brain areas for motor skills than the control group, per the release.

The researchers conclude in the release that evidence points to the use of tDCS to aid stroke recovery but caution that it must be proven to have long-term benefits not only in clinical measurements but also in the ability to carry out daily life tasks.

The study was published recently in Science Translational Medicine.

[Source(s): University of Oxford, EurekAlert]

Source: Transcranial Direct Current Stimulation May Help Boost Stroke Recovery – Rehab Managment

[WEB SITE] Wearable Robots, Exoskeletons: Market Shares, Market Strategies, and Market Forecasts, 2015 to 2021

Wearable Robots, Exoskeletons leverage better technology; they support high quality, lightweight materials and long life batteries. Wearable robots, exoskeletons are used for permitting paraplegic wheel chair patients walk. They are used to assist with weight lifting for workers: Designs with multiple useful features are available. The study has 421 pages and 161 tables and figures.

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Wearable robots, exoskeletons units are evolving additional functionality rapidly. Wearable robots functionality is used to assist to personal mobility via exoskeleton robots. They promote upright walking and relearning of lost functions. Exoskeletons are helping older people move after a stroke. Exoskeleton s deliver higher quality rehabilitation, provide the base for a growth strategy for clinical facilities.

Exoskeletons support occupational heavy lifting. Exoskeletons are poised to play a significant role in warehouse management, ship building, and manufacturing. Usefulness in occupational markets is being established. Emerging markets promise to have dramatic and rapid growth.

Industrial workers and warfighters can perform at a higher level when wearing an exoskeleton. Exoskeletons can enable paraplegics to walk again. Devices have the potential to be adapted further for expanded use in healthcare and industry. Elderly people benefit from powered human augmentation technology. Robots assist wearers with walking and lifting activities, improving the health and quality of life for aging populations.

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Exoskeletons are being developed in the U.S., China, Korea, Japan, and Europe. They are useful in medical markets. They are generally intended for logistical and engineering purposes, due to their short range and short battery life. Most exoskeletons can operate independently for several hours. Chinese manufacturers express hope that upgrades to exoskeletons extending the battery life could make them suitable for frontline infantry in difficult environments, including mountainous terrain.

Robotics has tremendous ability to support work tasks and reduce disability. Disability treatment with sophisticated exoskeletons is anticipated to providing better outcomes for patients with paralysis due to traumatic injury. With the use of exoskeletons, patient recovery of function is subtle or non existent, but getting patients able to walk and move around is of substantial benefit, People using exoskeleton robots are able to make continued progress in regaining functionality even years after an injury.

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Rehabilitation robotic technologies developed in the areas of stroke rehabilitation and SCI represent therapeutic interventions with utility at varying points of the continuum of care. Exoskeletons are a related technology, but provide dramatic support for walking for people who simply cannot walk.
Parker Hannifin Indego intends to include functional electrical stimulation. It accelerates recovery of therapy in every dimension. Implementation in these kinds of devices is a compelling use of the electrical stimulation technology.

It is a question of cost. The insurance will only pay for a small amount of exoskeleton rehabilitation. More marketing will have a tremendous effect in convincing people that they can achieve improvements even after years of effort.

Rehabilitation robotics includes development of devices for assisting performance of sensorimotor functions. Devices help arm, hand, leg rehabilitation by supporting repetitive motion that builds neurological pathways to support use of the muscles. Development of different schemes for assisting therapeutic training is innovative. Assessment with sensorimotor performance helps patients move parts of the body that have been damaged.

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Source: Wearable Robots, Exoskeletons: Market Shares, Market Strategies, and Market Forecasts, 2015 to 2021 – Thrasher Backer

[WEB SITE] Foot Drop Treatment: Timing Is Everything.

Patient suffered CVA with resultant right sided hemiparesis. Here, he dons a custom molded ankle foot orthosis and is educated about proper donning/doffing, skin care, and wearing schedule. This particular brace is used to enhance clearance of right lower extremity during ambulation as well as provide joint alignment and stability.

In the rehabilitation world, there are a number of approaches to manage the physical sequelae that occur post-stroke. One of those sequelae is foot drop, which is most common among the impairments characteristic of post-stroke patients, and experienced by an estimated 20% of all stroke survivors.¹ Since foot drop affects ability to safely ambulate throughout the home and community, retraining the impaired muscles that contribute to foot drop becomes a priority. Lower-extremity bracing is one measure that can be used to manage foot drop. Correctly timing the decision to fit a patient with a brace or other orthosis has been heavily discussed in the literature, and understanding the considerations that can help pinpoint that optimum time are explored in this article.

Multidisciplinary Expertise is Essential

At the Kessler Institute for Rehabilitation, patients affected by stroke are seen for initial bracing evaluations during the inpatient and outpatient phases of recovery. They are also reassessed as needed throughout the continuum of care. For some patients, a brace or orthosis for daily use may be prescribed. In such cases, a team of rehabilitation professionals is called on to participate in the decision-making process.

The team physician leads the decision-making process and is ultimately responsible for determining which orthotic best suits the patient’s needs. The physical therapist assists with the bracing decision-making process by contributing gait analysis expertise. An orthotist designs and fabricates an ankle-foot orthosis (AFO) when prescribed, provides expertise in biomechanical gait principles, and integrates that expertise with orthotic-based materials. The patient/caregiver provides feedback for discussion among the other team members and ultimately makes the decision about bracing based on recommendations made by the team.

Other factors weighed during the decision-making process for bracing include limited insurance or financial restrictions put on custom bracing, limited access to an orthotist, and likelihood of compliance.

Timing Variables

Making the decision about the optimal point in time to fit a patient with an orthosis is multifactorial. This decision can be dependent on discharge disposition with particular regard to whether the patient is discharging to home, and if safety is a primary concern secondary to a lack of ankle control. The level of impairment as well as weakness and instability should be taken into consideration, coupled with any prognostic indicators for a positive return in muscle control.

Many variables can account for how an AFO can improve walking endurance and functional ambulation long-term among patients affected by chronic stroke. For example, the AFO will create ankle joint stability and enhance foot clearance through swing phase of gait. This will alter gait mechanics and ultimately help to enhance the patient’s confidence in their own gait ability. An AFO preserves first ankle rocker with hemiplegic patients and provides a more efficient weight acceptance at initial contact to allow for enhanced double limb support and, thus, increased gait speed.² Gait efficiency is also an important factor to consider when discussing energy expenditure and a patient’s ability to perform functional ambulation. Dynamic AFOs were shown to decrease energy cost of walking, as demonstrated from the Physiological Cost Index when compared to shoes only with chronic stroke patients.³

Comparing Braces and Orthoses

There are important pros and cons for each type of orthosis, with cost and weight the two most common factors. Also, there are drawbacks generally associated with the use of an orthosis that include compliance secondary to comfort, limited ankle motion, and a relatively fixed position (unless an articulating AFO is prescribed).

Part of the decision about bracing may come down to trade-offs between a customized AFO and an “off the shelf,” prefabricated brace. The advantages each confers are distinct. For example, a custom molded AFO offers the ability to create an optimal fit and provides maximum control of the limb. In contrast, while mass-produced prefabricated orthoses may sacrifice quality of fit and limb control, they can be used as an evaluative tool or a short-term fix during the rehabilitation process.

The conventional double upright AFO is another common bracing solution that may require review by the multidisciplinary team. This design is used when there is significant or fluctuating edema that may constrict the limb and present pressure-related issues with the fit of an AFO. An articulating (hinge) AFO is used to assist with continued dorsiflexion and allow for great ankle ROM. It is not appropriate if spasticity is present, and can be challenging for shoe wear because width is typically wider to accommodate joint of brace.

Carbon composite AFOs are a dynamic bracing option that allow for push-off during third (forefoot) ankle rocker of gait. These AFOs are made to keep the foot up during swing phase, and provide a soft heel strike and stability in stance. This type of brace is contraindicated for patients affected by significant edema, ulcers, and spasticity. Several types of carbon composite AFOs are offered by Allard USA, Rockaway, NJ, including the ToeOFF, ToeOFF Short, BlueROCKER, KiddieROCKER, KiddieGAIT, and Ypsilon. Each brace in this carbon fiber AFO product line is designed to offer specific benefits such as increased rigid orthotic control, size optimized to wearer’s stature, and to accommodate varying levels of spasticity.

Posterior Leaf Spring (PLS) is another common bracing option usually offered as a prefabricated product. The Superior C-90 from AliMed, Dedham, Mass, is an example of this type of brace, and built to provide a full range of plantar and dorsiflexion. The Superior C-90 also provides a thin trim line and allows for eccentric lowering of foot and dorsiflexion for tibial advancement over foot through mid-stance. One drawback to this design, however, is the lack of medial/lateral stability of ankle and poor knee control. It is also contraindicated for patients with spasticity and genu recurvatum or extensor thrust.

Functional Electrical Stimulation is an Option

Orthoses engineered to provide functional electrical stimulation (FES) to the wearer during use can be an alternative to traditional AFOs. The use of FES, particularly for lower extremity bracing, has been associated with increased gait velocity, decreased energy expenditure with gait, and improved gait symmetry. Two manufacturers that provide these devices include Reno, Nevada-based Innovative Neurotronics, which manufactures the WalkAide, and Valencia, Calif-headquartered Bioness, which manufactures the Bioness L300. Among the two products’ distinguishing structural characteristics, the WalkAide has a built-in tilt sensor while the L300 is designed with a heel switch sensor. Both products are considered FES devices, yet the mechanism of action used by each differs slightly.

At Kessler, the Bioness L300 is available for patients to trial. In my experience, and one of the advantages of using the L300, is the result in physiological changes such as increased muscle strength, improved volitional control, and increased joint range of motion. These changes indicate an increased therapeutic effect not associated with the use of traditional AFOs. Another advantage is highlighted in a study by Everaert et al that examined patient preferences for devices and revealed a statistical difference between patients who preferred to use the WalkAide versus an AFO.4 An additional benefit of using FES devices is a purported decrease in spasticity, which further improves the therapeutic effect.

There are some drawbacks associated with the use of an FES device, however, and the most common is cost. Third-party payors often decline coverage for FES devices, so the cost typically falls to the patient. The patient must also tolerate the stimulation so the motor nerve can be activated. Skin irritation is an undesirable side effect, and the wearer’s tolerance must be carefully monitored. Contraindications for these devices include demand-type pacemakers, any cancerous lesion, fractures, or dislocation. Cognitive impairment that could affect ability to use the device is another important consideration. Ultimately, the decision to use a brace as therapeutic treatment for foot drop is a collaboration with one goal: to improve a patient’s ability to safely ambulate and maximize functional independence. PTP

Farris Fakhoury, PT, DPT, has been a physical therapist in the Outpatient Neurologic Gym at Kessler Institute for Rehabilitation for 4 years, and is also the physical therapy lead for the facility’s amputee program. Fakhoury is the physical therapy lead for Kessler’s Amputees Coming Together (ACT) support group as well as for the Bioness program for outpatient services. He earned a bachelor of arts in psychology from Villanova University and a doctor of physical therapy from the joint program of Rutgers University/University of Medicine and Dentistry of New Jersey PT Program in Stratford, NJ. For more information, contactPTProductsEditor@allied360.com.

Rich Klager, PT, DPT, NCS, has been a physical therapist at the Kessler Institute for Rehabilitation in West Orange, NJ, for more than 8 years. His clinical practice experience expands over the Inpatient and Outpatient facilities in the neurologic population. He currently assists with the Outpatient orthotic clinic decision-making process with the Team Physician and Orthotist for patient bracing needs.

References
1. Bethoux F, Rogers HL, Nolan K, et al. Long term follow-up to a randomized controlled trial comparing peroneal nerve functional electrical stimulation to an ankle foot orthosis for patients with chronic stroke. Neurorehabil Neural Repair. 2015;29(10):911-922.
2. Nolan KJ, Yarossi M. Preservation of the first rocker is related to increases in gait speed in individuals with hemiplegia and AFO. Clin Biomech (Bristol, Avon). 2011;26(6):655-660.
3. Erel S, Uygur F, Engin Simsek I, Yakut Y. The effects of dynamic ankle-foot orthoses in chronic stroke patients at three-month follow-up: a randomized controlled trial. Clin Rehabil. 2011;25(6):515-523.
4. Everaert DG, Stein RB, Abrams GM, et al. Effect of foot-drop stimulator and ankle-foot orthosis on walking performance after stroke: A multicenter randomized controlled trial.Neurorehabil Neural Repair. 2013;27(7):579-591.

Additional reference:
Lusardi MM, Jorge M, Nielsen CC. Orthotics and Prosthetics in Rehabilitation. St Louis: Saunders Elsevier, 2007.

Source: Foot Drop Treatment: Timing Is Everything – Physical Therapy Products

[Abstract] Music supported therapy promotes motor plasticity in individuals with chronic stroke

Abstract

Novel rehabilitation interventions have improved motor recovery by induction of neural plasticity in individuals with stroke. Of these, Music-supported therapy (MST) is based on music training designed to restore motor deficits.

Music training requires multimodal processing, involving the integration and co-operation of visual, motor, auditory, affective and cognitive systems. The main objective of this study was to assess, in a group of 20 individuals suffering from chronic stroke, the motor, cognitive, emotional and neuroplastic effects of MST.

Using functional magnetic resonance imaging (fMRI) we observed a clear restitution of both activity and connectivity among auditory-motor regions of the affected hemisphere. Importantly, no differences were observed in this functional network in a healthy control group, ruling out possible confounds such as repeated imaging testing. Moreover, this increase in activity and connectivity between auditory and motor regions was accompanied by a functional improvement of the paretic hand. The present results confirm MST as a viable intervention to improve motor function in chronic stroke individuals.

Source: Music supported therapy promotes motor plasticity in individuals with chronic stroke – Online First – Springer

[Abstract] Strategies for increasing the intensity of upper limb task-specific practice after acquired brain impairment: A secondary analysis from a randomised controlled trial. –

Abstract

Introduction Patients with acquired brain impairments require intensive, task-specific training to maximise upper limb recovery. Current evidence suggests, however, that they rarely achieve this. The purpose of this study was to describe the amount of practice that can be achieved by patients with acquired brain impairment during intensive upper limb treatment within a public hospital, and to examine the strategies used by therapists to maximise practice.

Method A secondary analysis was conducted using data from a previously published randomised trial. The training received by 20 people with acquired brain impairment over the 6-week trial period was recorded. The strategies used by therapists to maximise practice were also noted.

Results Over the 6-week period, 45 hours of upper limb training was provided. The median (interquartile range) amount of actual practice achieved by patients was 59 (54–63) minutes per day, with a median (interquartile range) of 186 (50–330) repetitions of active movement. Patients’ practice was maximised through the use of task-specific feedback, practice books, counters, environmental cues and stopwatches. In addition, therapists provided coaching as well as ensuring tasks were goal-oriented, measurable and patient-driven.

Conclusion Described strategies enabled patients with acquired brain impairment to practise upper limb tasks at intensities greater than currently reported in the literature.

 

Source: Strategies for increasing the intensity of upper limb task-specific practice after acquired brain impairment: A secondary analysis from a randomised controlled trial

[Abstract] Feasibility and usability of a wearable orthotic for stroke survivors with hand impairment.

Abstract

Purpose: The concept of a vibrating wristband, to improve dextrous hand function of stroke survivors, was recently proposed with clinical results and is referred to as ‘TheraBracelet’ in this paper. The purpose of this study was to demonstrate feasibility of a portable, wearable TheraBracelet, and to apply usability evaluation techniques to assess potential demands of TheraBracelet and to identify critical improvement needs of the prototype. Method: A prototype was developed with a vibrating element housed in an elastic wristband and connected to a wearable electronics box via a cable. Expectation for TheraBracelet and evaluation of the prototype were obtained from 10 chronic stroke survivors using surveys before and after using the prototype and House of Quality analysis. Results: The survey for expectation showed stroke survivors’ willingness to try out TheraBracelet at a low cost. The survey evaluating the prototype showed that the current prototype was overall satisfactory with a mean rating of 3.7 out of 5. The House of Quality analysis revealed that the priority improvement needs for the prototype are to improve clinical knowledge on long-term effectiveness, reduce cost, ease donning/doffing and waterproof.

Conclusions: This study presents a potential for a low-cost wearable hand orthotic likable by stroke survivors.

• Implications for Rehabilitation

• Feasibility for a portable wearable wristband-type hand orthotic was demonstrated.

• The survey showed stroke survivors are willing to try such an orthotic at low cost.

• The current prototype was rated overall satisfactory by stroke survivors.

• This study provides a potential for a low-cost wearable hand orthotic likable by stroke survivors.

Related articles

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Source: Feasibility and usability of a wearable orthotic for stroke survivors with hand impairment – Disability and Rehabilitation: Assistive Technology –

[Abstract] Use of a Portable Assistive Glove to Facilitate Rehabilitation in Stroke Survivors With Severe Hand Impairment.

 

Abstract

Treatment options for stroke survivors with severe hand impairment are limited. Active task practice can be restricted by difficulty in voluntarily activating finger muscles and interference from involuntary muscle excitation. We developed a portable, actuated glove-orthosis, which could be employed to address both issues. We hypothesized that combining passive cyclical stretching (reducing motoneuronal hyperexcitability) imposed by the device with active-assisted, task-oriented training (rehabilitating muscle activation) would improve upper extremity motor control and task performance post-stroke. Thirteen participants who experienced a stroke 2–6 months prior to enrollment completed 15 treatment sessions over five weeks. Each session involved cyclically stretching the long finger flexors (30 min) followed by active-assisted task-oriented movement practice (60 min). Outcome measures were completed at six intervals: three before and three after treatment initiation. Overall improvement in post-training scores was observed across all outcome measures, including the Graded Wolf Motor Function Test, Action Research Arm Test, and grip and pinch strength ( ), except finger extension force. No significant change in spasticity was observed. Improvement in upper extremity capabilities is achievable for stroke survivors even with severe hand impairment through a novel intervention combining passive cyclical stretching and active-assisted task practice, a paradigm which could be readily incorporated into the clinic.

Source: IEEE Xplore Abstract (Abstract) – Use of a Portable Assistive Glove to Facilitate Rehabilitation in Stroke Survivors With Severe Hand …

 

 

[Thesis] Exploring In-Home Monitoring of Rehabilitation and Creating an Authoring Tool for Physical Therapists – Full Text PDF

Abstract

Physiotherapy is a key part of treatment for neurological and musculoskeletal disorders, which affect millions in the U.S. each year. Physical therapy treatments typically consist of an initial diagnostic session during which patients’ impairments are assessed and exercises are prescribed to improve the impaired functions. As part of the treatment program, exercises are often assigned to be performed at home daily. Patients return to the clinic weekly or biweekly for check-up visits during which the physical therapist reassesses their condition and makes further treatment decisions, including readjusting the exercise prescriptions.

Most physical therapists work in clinics or hospitals. When patients perform their exercises at home, physical therapists cannot supervise them and lack quantitative exercise data reflecting the patients’ exercise compliance and performance. Without this information, it is difficult for physical therapists to make informed decisions or treatment adjustments. To make informed decisions, physical therapists need to know how often patients exercise, the duration and/or repetitions of each session, exercise metrics such as the average velocities and ranges of motion for each exercise, patients’ symptom levels (e.g. pain or dizziness) before and after exercise, and what mistakes patients make.

In this thesis, I evaluate and work towards a solution to this problem. The growing ubiquity of mobile and wearable technology makes possible the development of “virtual rehabilitation assistants.” Using motion sensors such as accelerometers and gyroscopes that are embedded in a wearable device, the “assistant” can mediate between patients at home and physical therapists in the clinic. Its functions are to:

• use motion sensors to record home exercise metrics for compliance and performance and report these metrics to physical therapists in real-time or periodically;
• allow physical therapists and patients to quantify and see progress on a fine-grain level;
• record symptom levels to further help physical therapists gauge the effectiveness of exercise prescriptions;
• offer real-time mistake recognition and feedback to the patients during exercises;

One contribution of this thesis is an evaluation of the feasibility of this idea in real home settings. Because there has been little research on wearable virtual assistants in patient homes, there are many unanswered questions regarding their use and usefulness:

• Q1. What patient in-home data could wearable virtual assistants gather to support physical therapy treatments?
• Q2. Can patient data gathered by virtual assistants be useful to physical therapists?
• Q3. How is this wearable in-home technology received by patients?

I sought to answer these questions by implementing and deploying a prototype called “SenseCap.” SenseCap is a small mobile device worn on a ball cap that monitors patients’ exercise movements and queries them about their symptoms. A technology probe study showed that the virtual assistant could gather important compliance, performance, and symptom data to assist physical therapists’ decision-making, and that this technology would be feasible and acceptable for in-home use by patients.

Another contribution of this thesis is the development of a tool to allow physical therapists to create and customize virtual assistants. With current technology, virtual assistants require engineering and programming efforts to design, implement, configure and deploy them. Because most physical therapists do not have access to an engineering team they and their patients would be unable to benefit from this technology. With the goal of making virtual assistants accessible to any physical therapist, I explored the following research questions:

• Q4. Would a user-friendly rule-specification interface make it easy for physical therapists to specify correct and incorrect exercise movements directly to a computer? What are the limitations of this method of specifying exercise rules?
• Q5. Is it possible to create a CAD-type authoring tool, based on a usable interface, that physical therapists could use to create their own customized virtual assistant for monitoring and coaching patients? What are the implementation details of such a system and the resulting virtual assistant?
• Q6. What preferences do PTs have regarding the delivery of coaching feedback for patients?
• Q7. What is the recognition accuracy of a virtual rehabilitation assistant created by this tool?

This dissertation research aims to improve our understanding of the barriers to rehabilitation that occur because of the invisibility of home exercise behavior, to lower these barriers by making it possible for patients to use a widely-available and easily-used wearable device that coaches and monitors them while they perform their exercises, and improve the ability of physical therapists to create an exercise regime for their patients and to learn what patients have done to perform these exercises. In doing so, treatment should be better suited to each patient and more successful.

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[Study] What Do Physiotherapists Do in Stroke Rehabilitation? A Focus Group Discussion – Full Text PDF

Abstract

Background: There are many techniques used for rehabilitation after stroke, and physiotherapists use them eclectically. However, some of the techniques are more effective than others. Objectives: The objective of the study was to determine what techniques physiotherapists in Kano mostly use for stroke rehabilitation. Method: Focused group discussions were carried out with 2 separate groups using a prepared interview guide consisting of 7 items. Results: The result of the study showed that physiotherapists used a combination of techniques for stroke rehabilitation consisting mostly of the Bobath and Bruunstrom techniques. Conclusion: The techniques physiotherapists use for stroke rehabilitation in Kano vary. However, the choice of a particular technique may not be evidence based, but rather from personal preference, experience of the therapists and relevant presentations of the patients.

Introduction

Physiotherapists are health professionals involved in the rehabilitation of stroke patients. They use a number of different approaches for the above purpose, such as neurodevelopmental treatment (NDT), Bruunstrom, constraint-induced movement therapy (Wolf et al., 2006) and repetitive functional task practice (French et al., 2008). These approaches are variously adopted according to personal choices (Pollock et al., 2007; Khan et al., 2012; Tyson et al., 2009) and common practice in the country (Paci, 2003).

However, the specific aims of the approaches fall under 3 categories: remediation, compensation and motor learning (Jette et al., 2005). Remediation has the main goal of improving impairment through the use of techniques such as neuromuscular facilitation, sensory stimulation and resistive training. Compensation focuses on the use of the unaffected side to achieve independence in activities of daily living (ADL). Motor control focuses on task-specific training that simulates real-life conditions to regain functional independence.

Some of the techniques for stroke rehabilitation are known to be superior in terms of effectiveness compared to others (French et al., 2008; Wolf et al., 2006). Additionally, many of these techniques lack detail and clarity of their protocols (Pomeroy & Tallis, 2000a). Studies with poor detail in the protocol are difficult to reproduce and adopt in real world clinical settings. Furthermore, stroke rehabilitation requires high repetition of tasks for motor learning (Birkinmiere et al., 2010; Abdullahi & Shehu, 2014), and this may require hours of rehabilitation per session and/or per day. Thus, practicing the techniques with high quality of evidence of effectiveness is very important for patients, therapists and other caregivers.

Unfortunately, physiotherapists still use techniques for stroke rehabilitation eclectically (Jette et al., 2005). As such, to clearly state what physiotherapists do in stroke rehabilitation is difficult. Even in the 3 © Nigerian Journal of Medical Rehabilitation 2015 Vol. 18, No 2 (2015), Available at http://www.njmr.org.ng What Do Physiotherapists Do in Stroke Rehabilitation? literature, studies exploring what physiotherapists do in stroke rehabilitation using qualitative designs are very rare (Lennon & Ashburn, 2000; Natarajan et al., 2008). The aim of this study is to determine what physiotherapists do in stroke rehabilitation, using a focus group discussion.

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[BOOK] Rehabilitation Strategies for Restorative Approaches After Stroke and Neurotrauma – Springer

Abstract

For acute, subacute, or chronic stroke, and neurotrauma, a range of rehabilitation strategies will be essential to optimize possible benefits of molecular, cellular, and novel pharmacological restorative approaches. The neurorehabilitation strategies must be chosen to engage the targeted networks of these novel approaches, drawing upon studies of motor and cognitive learning-related neural adaptations that accompany progressive practice. Regulatory agencies and the pharma/biotech industry will need to keep an open mind about the likely synergy that will come from interleaving repair strategies and rehabilitation interventions.

For clinical trials aimed at motor restoration, outcome measurement tools should be relevant to the anticipated targets of repair-enhanced rehabilitation. Most outcomes to date have been drawn from disease-specific and rehabilitation toolboxes. In studies that include participants who are more than a few weeks beyond acquiring profound impairments and disabilities, outcome measures will likely have to go beyond off-the-shelf tools that were not designed to detect modest clinical evidence of sensorimotor system repair. This chapter describes specific rehabilitation strategies and outcome assessments in the context of interfacing them with neurorestoration approaches.

Source: Rehabilitation Strategies for Restorative Approaches After Stroke and Neurotrauma – Springer