Archive for May, 2016

[Bachelor’s thesis] Human-centred research for fine motor control rehabilitation after stroke in the Netherlands – Full Text PDF

Abstract

Stroke disables people globally every day. The rehabilitation process focuses mainly on the big muscle groups and re-learning walking. This is why the upper extremity and fine motor control rehabilitation after a stroke is usually left without significant focus. The dexterity rehabilitation after a stroke is lacking an unambiguous method and the guidelines for stroke rehabilitation present multiple recommendations.

SilverFit is a Dutch wellness technology company, whose focus is to motivate people in rehabilitation and maintain their activity by gamification. The thesis was a part of an international product development project for finding a solution for fine motor control rehabilitation after a stroke. Thesis work focused on an iterative project trying to solve the most effective way for rehabiliating fine motor control after a stroke based on the most recent evidence-based studies and understanding the requirements and problems of the users. The human-centred research was conducted using a Design Thinking -process with methods of online ethnography, interviews and observation.

The results from the evidence-based research and the human-centred research were compared through a theme analysis. The thesis showed that the most problematic thing in fine motor control rehabiliation after a stroke is the lack of knowledge, motivation and time, which together cause feelings of insecurity in the therapists and the stroke survivors.

The recommendation for solving the current situation is to create a technological solution, which is always accessible for the stroke survivor, supports the decisions of the therapists based on the most recent evidence-based studies, gives supportive feedback during the therapy and provides realistic results about the progress of the rehabilitation. The thesis provides the first stage of an iterative product development process.

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[Abstract] Does the use of Nintendo Wii SportsTM improve arm function? Trial of WiiTM in Stroke: A randomized controlled trial and economics analysis

Abstract

Objective: The Trial of Wii™ in Stroke investigated the efficacy of using the Nintendo Wii Sports™ (WiiTM) to improve affected arm function after stroke.

Design: Multicentre, pragmatic, parallel group, randomized controlled trial.

Setting: Home-based rehabilitation.

Subjects: A total of 240 participants aged 24–90 years with arm weakness following a stroke within the previous six months.

Intervention: Participants were randomly assigned to exercise daily for six weeks using the WiiTM or arm exercises at home.

Main measures: Primary outcome was change in the affected arm function at six weeks follow-up using the Action Research Arm Test. Secondary outcomes included occupational performance, quality of life, arm function at six months and a cost effectiveness analysis.

Results: The study was completed by 209 participants (87.1%). There was no significant difference in the primary outcome of affected arm function at six weeks follow-up (mean difference −1.7, 95% CI −3.9 to 0.5, p = 0.12) and no significant difference in secondary outcomes, including occupational performance, quality of life or arm function at six months, between the two groups. No serious adverse events related to the study treatment were reported. The cost effectiveness analysis showed that the WiiTM was more expensive than arm exercises £1106 (SD 1656) vs. £730 (SD 829) (probability 0.866).

Conclusion: The trial showed that the WiiTM was not superior to arm exercises in home-based rehabilitation for stroke survivors with arm weakness. The WiiTM was well tolerated but more expensive than arm exercises.

Source: Does the use of Nintendo Wii SportsTM improve arm function? Trial of WiiTM in Stroke: A randomized controlled trial and economics analysis

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[ARTICLE] The effects of individually tailored rTMS on hand function in chronic stroke: a protocol for an adaptive, phase II, randomized, sham-controlled clinical trial – Full Text PDF

Abstract

Stroke is a leading cause of disability among adults. Existing rehabilitation programs haven’t been able to accomplish full motor recovery partially due to the pathologic plasticity exerted from the unaffected hemisphere to the affected one.
This inhibition can be disrupted using non-invasive brain stimulation (NIBS). Transcranial magnetic stimulation (TMS) is a NIBS technique that has the capacity of depolarizing or hyperpolarizing neurons depending on the frequency of the pulses. Although several trials have been conducted to find the efficacy of low frequency rTMS for motor recovery after stroke, their results have been heterogeneous. One of the main variables that determine the response to rTMS is the dose, corresponding to the number of pulses delivered to the patients.
However, due to the localization and the extension of the stroke, each patient responds differently to certain dose. Therefore, using the SPIRIT statement, we designed a protocol for an adaptive, phase II, randomized, sham-controlled clinical trial. The study proposed will include 75 patients between 45 and 80 years old, with hand function impairment after 1 to 3 years of stroke; it will exclude patients with severe cognitive or neuropsychiatric comorbilities, any previous stroke episode, Fugl Meyer (Upper limb) < 20, inability to understand the task or contraindications for rTMS.
The study will have 3 arms: individually tailored (adaptive dosing) low frequency (1Hz) rTMS plus standard of care rehabilitation (physical therapy) compared to sham and fixed rTMS plus standard of care rehabilitation. The intervention will be applied during 6 weeks after which the main analysis will be performed. Subjects will be followed-up during 3 months and the results from this analysis will be exploratory. This protocol will use the results from the Pegboard test as a primary outcome and SF-36 questionnaire, hand strength, and responder´s rate as secondary outcomes.

Source: The effects of individually tailored rTMS on hand function in chronic stroke: a protocol for an adaptive, phase II, randomized, sham-controlled clinical trial | Jannati | Principles and Practice of Clinical Research

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[ARTICLE] Which is better in the rehabilitation of stroke patients, core stability exercises or conventional exercises? – Full Text PDF

Abstract.

[Purpose] The aim of this study was to determine which is better in the rehabilitation of stroke patients, core stability exercises or conventional exercises.

[Subjects and Methods] Forty participants with hemiplegia were recruited in the Department of Neurology of Yidu Central Hospital of Weifang between January 2014 and February 2015 and randomly divided into either an experimental or control group. The patients in the control group performed conventional exercises for six weeks, and those in the experiment group performed core stability exercises for six weeks. The outcomes were evaluated using Modified Barthel Index and Berg Balance Scale.

[Results] After treatment, the Modified Barthel Index and Berg Balance Scale were significantly increased in both groups when compared with the baseline. The Modified Barthel Index was significantly lower in the control group compared with the experimental group. The Berg Balance Scale scores in the control group were relatively lower than those in the experimental group, but there was no significant difference between the two groups.

[Conclusion] Core stability exercises have a better effect on patients with hemiplegia than conventional exercises.

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[ARTICLE] Handgrip strength deficits best explain limitations in performing bimanual activities after stroke – Full Text

Abstract.

[Purpose] To evaluate the relationships between residual strength deficits (RSD) of the upper limb muscles and the performance in bimanual activities and to determine which muscular group would best explain the performance in bimanual activities of chronic stroke individuals.

[Subjects and Methods] Strength measures of handgrip, wrist extensor, elbow flexor/extensor, and shoulder flexor muscles of 107 subjects were obtained and expressed as RSD. The performance in bimanual activities was assessed by the ABILHAND questionnaire.

[Results] The correlations between the RSD of handgrip and wrist extensor muscles with the ABILHAND scores were negative and moderate, whereas those with the elbow flexor/extensor and shoulder flexor muscles were negative and low. Regression analysis showed that the RSD of handgrip and wrist extensor muscles explained 38% of the variance in the ABILHAND scores. Handgrip RSD alone explained 33% of the variance.

[Conclusion] The RSD of the upper limb muscles were negatively associated with the performance in bimanual activities and the RSD of handgrip muscles were the most relevant variable. It is possible that stroke subjects would benefit from interventions aiming at improving handgrip strength, when the goal is to increase the performance in bimanual activities.

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[Case study] The effect of task-oriented training on the muscle activation of the upper extremity in chronic stroke patients – Full Text

Abstract.

[Purpose] The aim of this study was to determine the effects of task-oriented training on upper extremity muscle activation in daily activities performed by chronic stoke patients.

[Subjects and Methods] In this research, task-oriented training was conducted by 2 chronic hemiplegic stroke patients. Task-oriented training was conducted 5 times a week, 30 minutes per day, for 2 weeks. Evaluation was conducted 3 times before and after the intervention. The Change of muscle activation in the upper extremity was measured using a BTS FreeEMG 300.

[Results] The subjects’ root mean square values for agonistic muscles for the reaching activity increased after the intervention. All subjects’ co-coordination ratios decreased after the intervention in all movements of reaching activity.

[Conclusion] Through this research, task-oriented training was proven to be effective in improving the muscle activation of the upper extremity in chronic hemiplegic stroke patients.

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[ARTICLE] Neurorestoration after stroke – JNS – Full Text

Abstract

Recent advancements in stem cell biology and neuromodulation have ushered in a battery of new neurorestorative therapies for ischemic stroke. While the understanding of stroke pathophysiology has matured, the ability to restore patients’ quality of life remains inadequate. New therapeutic approaches, including cell transplantation and neurostimulation, focus on reestablishing the circuits disrupted by ischemia through multidimensional mechanisms to improve neuroplasticity and remodeling. The authors provide a broad overview of stroke pathophysiology and existing therapies to highlight the scientific and clinical implications of neurorestorative therapies for stroke.

Continue —> JNS – Neurosurgical Focus –

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[ARTICLE] Moving Research From the Bedside Into Practice | Physical Therapy Journal – Full Text

Evidence-based practice (EBP) is firmly entrenched in the lexicon of physical therapist practice,1,2 but beliefs about how best to translate scientific evidence into clinical practice are far from settled. There are major gaps in our scientific knowledge; however, even more disturbing is the fact that an enormous amount of existing scientific knowledge remains unused in practice. As noted in the Institute of Medicine (IOM) report titled Crossing the Quality Chasm, “Between the health care we have and the care we could have lies not just a gap, but a chasm.”3

Thankfully, the infamous 264-year period between the discovery of citrus’s benefit in preventing scurvy and the widespread use of citrus on British ships is no longer the norm.4 But the frequently quoted statement about the lag time between publication and adoption of research—only 14% of original research is applied for the benefit of patient care, and that takes 17 years5,6—is alarming enough. There is consensus that the transfer of evidence from proven health care discoveries to patient care is unpredictable and highly variable and needs to be accelerated.4,7,8

For those of us who want to speed the adoption of EBP in physical therapy and across health care more broadly, Naylor9 described 4 distinct phases or strategies that are instructive:

Phase 1, the “Era of Optimism,” is characterized by a belief in passive diffusion of scientific evidence into practice. In this (still-dominant) phase, students and clinicians are trained to critically appraise the scientific literature to identify valid new information that could be applied to practice.

Phase 2, the “Era of Innocence Lost and Regained,” acknowledges that much of clinical practice is not evidence based and that it is virtually impossible for clinicians to keep up with the explosion of medical literature. This understanding has led to the emergence of evidence-based clinical practice guidelines, in which the literature is systematically reviewed and summary recommendations are graded according to the strength of the supporting evidence. Guidelines are widely disseminated on the assumption that providers will read them and that practice will change accordingly.

Phase 3, the “Era of Industrialization,” is on the rise, as evidence mounts that the passive efforts of phases 1 and 2 fail to actually change practice. In this phase, aggressive strategies are implemented by regulatory entities or professions to improve care. These efforts frequently involve performance measurement and reporting,10 which are intended to encourage providers to become more accountable and more focused on quality improvement. Many professions have risen to this challenge and have developed their own approaches to change patient management as described by Naylor.9APTA’s Physical Therapy Outcomes Registry,11 an organized system for collecting data to evaluate patient function and other clinically relevant measures, is a phase 3 effort, with improving practice and fulfilling quality reporting requirements as 2 of its major goals.

Phase 4, the final phase, is the “Era of Information Technology and Systems Engineering,” which is driven by the belief that it is not sufficient to focus on individual practitioners, but rather the redesign of service delivery systems to address barriers and incentives is required to bridge the wide gap between best evidence and common practice. For this phase, a different type of evidence base—one describing the most effective ways to change provider behavior9,12—is needed. Hence the emergence of the relatively new field of implementation research.

Continue —> Moving Research From the Bedside Into Practice | Physical Therapy Journal

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[Abstract] Design of Smart Portable Rehabilitation Exoskeletal Device for Upper Limb. – IEEE Explore

Summary form only given. Due to raised incidences of stroke, paralysis, or other diseases along with dramatic increment of life expectancy, the number of patients with movement disability has been increasing continuously. Repetitive and intensive voluntary movements in physical therapy are important factors that facilitate significant improvement for motor-impaired patients. The emergence of rehabilitation robotic devices has stimulated the development of physical therapy. However, most of current robotic devices for upper limb are poor in user-friendly interface and bulky as well as assisting only limited part(s) of arm.

We proposed Smart Portable Rehabilitation Exoskeletal Device (SPRED), which is a portable, tele-operatable, and effective exoskeleton type of upper limb rehabilitation robotic device controlled by multimodal signals with smart interfaces for both patients and therapists. The SPRED system supports full range of joint movements and assists disabled arms more naturally through highly accurate, adaptable, and fast responses based on muscle strength, brain activity, and motion tracking technology. The compact size and wireless device allows patients to carry the device during their daily activities so that they can naturally lengthen the training duration and conclude more effective clinical results eventually.

We believe that the research will contribute to development a new generation of exoskeleton type of rehabilitation robotic device for upper limb. As a first step towards the proposed system, this paper presents the design of SPRED and the mirroring motion based self-tuning concept is illustrated. Its simulation result demonstrates its potential in upper limb rehabilitation.

Source: IEEE Xplore Abstract – Design of Smart Portable Rehabilitation Exoskeletal Device for Upper Limb

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[ARTICLE] Accessing rehabilitation after stroke – a guessing game? – Disability and Rehabilitation – Full Text

Abstract

 

Aim: To explore the use, meaning and value of the term “rehabilitation potential”.
Method: The authors of this commentary met to discuss concerns relating to the pressure on health service staff created by reduced length of stay in acute settings of those who have suffered a stroke and the need to determine the potential of a patient for rehabilitation in order to inform discharge arrangements. Points raised at this meeting were shared with an email group who over a 12-month period contributed to this paper.
Results: The group agreed that: (a) Given that there is very limited evidence to guide judgements regarding rehabilitation potential following stroke at an early stage the need for rehabilitation needs to be reviewed on a regular basis over a long period and that this needs to be reflected in clinical guidelines. (b) Rehabilitation needs to be available in a broad range of care settings, in order that discharge from hospital is not equated with a lack of rehabilitation potential. (c) Research related to rehabilitation potential needs to be conducted. This should examine influences of decision-making and the algorithms associated with recovery and local policy on rehabilitation potential. (d) The economic benefits of rehabilitation needs further exploration. (e) Assessment of rehabilitation potential should be made more explicit and supported by appropriate evidence.

Conclusion: Whilst further research is required to assist in determining the right time for people to benefit from formal rehabilitation this gives the impression that one dose of rehabilitation at a specific time will meet all needs. It is likely that a rehabilitation pathway identifying features required in the early stages following stroke as well as that required over many years in order to prevent readmission, maintain fitness and prevent secondary sequelae such as depression and social isolation would be beneficial.

  • Implications for Rehabilitation

  • The potential of a patient to benefit from rehabilitation may be overlooked due to other pressures.

  • Some patients following a stroke will demonstrate potential to benefit from rehabilitation later than the majority and this is not always easy to predict.

  • Regular reassessment is required in order to identify whether an individual will benefit from rehabilitation at a particular time.

Continue —> Accessing rehabilitation after stroke – a guessing game? – Disability and Rehabilitation –

 

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