Published on Aug 22, 2015
A.M. Barrett describes how to distinguish whether a patient has spatial neglect, or just a hemianopia. A video on Movement, Action, Space and Vision (MASAV)
Noninvasive brain–machine interfaces (BMIs) are typically associated with neuroprosthetic applications or communication aids developed to assist in daily life after loss of motor function, eg, in severe paralysis. However, BMI technology has recently been found to be a powerful tool to promote neural plasticity facilitating motor recovery after brain damage, eg, due to stroke or trauma. In such BMI paradigms, motor cortical output and input are simultaneously activated, for instance by translating motor cortical activity associated with the attempt to move the paralyzed fingers into actual exoskeleton-driven finger movements, resulting in contingent visual and somatosensory feedback. Here, we describe the rationale and basic principles underlying such BMI motor rehabilitation paradigms and review recent studies that provide new insights into BMI-related neural plasticity and reorganization. Current challenges in clinical implementation and the broader use of BMI technology in stroke neurorehabilitation are discussed.
Methodology Peli prisms consist of a new optic aid incorporated within the patient’s glasses that increase the visual field on the hemianopic side while maintaining unobstructed central vision. When this new technology was introduced to patients, our optometrist specialized in low vision noted difficulties concerning the adaptation to the optic aid and sought the collaboration of an orientation and mobility (O&M) specialist. An interdisciplinary protocol was then developed to improve the patient’s understanding of the optic aid and related strategies. The aim of this protocol is to maximize the patient’s potential in order to improve confidence and security during mobility.
Ramachandran (Nature 377:489–490, 1995) showed that in amputees, phantom limb pain described as a spasming or immobile phantom limb can be alleviated by watching their reflection of the intact limb in a parasagittally placed mirror while moving the intact limb and the phantom simultaneously. This suggested that therapy via mirror visual feedback—mirror therapy—might be considered for other diseases and conditions characterized by poor mobility. We were the first to show that mirror therapy might be beneficial for hemiparesis following stroke. There have now been numerous case reports and studies of mirror therapy for hemiparesis following stroke.
Overall, the majority of studies done thus far on patients with hemiparesis in the subacute or chronic phase following stroke find mirror therapy to be more beneficial than control treatments. Even when mirror therapy is not superior to control therapy, the reason for this is there are similar improvements in both groups. There have not been adverse effects in patients that perform mirror therapy for hemiparesis following stroke.
There appears to be a benefit of mirror therapy for hemiparesis following stroke in the subacute and chronic phase. Trial of mirror therapy for hemiparesis may be warranted. Further study of mirror therapy for hemiparesis following stroke will be welcomed; in particular, it would be important to study different groups of patients given the heterogeneity of stroke.
Spasticity is a part of the upper motor neuron syndrome and can result in reduced function. Reduction of the complications may be facilitated by early intervention, making identification of stroke patients at high risk for developing spasticity essential.
Different predictors of poststroke spasticity (PSS) have been suggested in different studies, including development of increased muscle tone, greater severity of paresis, sensory impairment, and low Barthel Index score. The results also indicate that early identification of factors predictive of PSS is beneficial.
In this review article, the results of five studies are discussed and they all support the notion that early identification of factors predictive of PSS is beneficial and could help to identify individuals who would benefit most from intervention and thereby provide better outcome.
Spasticity is a part of the upper motor neuron syndrome and can result in reduced function. The impact of spasticity on poststroke recovery may not be obvious at first, and hence not addressed in the early phase. Spasticity in the upper limb spasticity has been found to be associated with reduced arm function and lower levels of independence, and with an astounding four-fold increase in direct care costs during the first-year poststroke [1, 2]. It seems as if spasticity in patients with stroke is more common in the upper extremity than in the lower limbs [3•], The frequency of spasticity in the upper limb varies from 7 % to 38 % [2, 4–6] in the first 12 months, and was found to be 46 % in patients with initial impaired arm function .
Early recognition of spasticity, and identification of predictors to assist rehabilitation professionals recognize which stroke patients are at risk for spasticity to develop, is suggested to yield earlier treatment of poststroke spasticity (PSS) and possibly better outcomes . It would be helpful to know which factors can identify patients are at high risk of developing severe (PSS) especially during the initial admission poststroke. Increased knowledge regarding the pathophysiology, evolution of the condition, epidemiology, and therapeutic intervention for PSS, along with identifying PSS risk factors, is a road for better care .
The aim of this review is to present predictors that will help to identify which patients are at risk for the development of PSS.
The development of an effective and inexpensive device to restore and enhance the human musculoskeletal functions is of particular interest. Sling exercise therapy (SET) is one of the most effective developed tools in rehabilitation of musculoskeletal disorders, which has been successfully used in various applications ranging from diagnosis to treatment. To the best of our knowledge, SET has never been comprehended and reviewed previously. Therefore, it was highly required to further understand the role of SET in various therapeutic applications.
Inspired by this herein, this study is dedicated to emphasize the advancement in utilization of the SET in both diagnosis and treatment as well as their related challenges. This would be concluded by future perspectives of the SET.
There are various serious diseases affected thousands of people around worldwide such as low-back pain (LBP) and stroke. Those are subsequently requiring a highly efficient rehabilitation method. Predominately, the hydrotherapy, electrotherapy, and exercise therapy are the most common approaches utilized for musculoskeletal rehabilitation. SET is among most promising approach due to its low-cost, efficiency, and easiness. Furthermore, SET not only promises rapid recovery but also acts as diagnostic tool for detection of biomechanical chain defects. In particular, SET is based on slings attached to a particular part of human body using ropes and pulleys inside a sling system aiding to treat the impairments . There are two main categories of the SET including a traditional SET that is usually used for simple training . While Neurac involves a high level of neuromuscular activation which lead to strengthening muscles, improvement of the sensorimotor/balance, increasing range of motion (ROM), and resolution of pain as well as clinical diagnoses for different impairments. For example, various studies reported the significant effect of SET on restoration of the muscle skeletal functions after stroke and LBP in addition to improving the respiration and chest expansion -. Furthermore, SET has the ability to achieve multi-goals at the same time. For instance, Lee and coworkers reported the substantial effect of Neurac technique-based training on pain reduction, enhancement balance, regression fatigability, and treatment of chronic neck pain . Although SET made massive progress in the rehabilitation centers, but there are no previously reported reviews on the experimental results of SET. In pursuit of this aim, this review is dedicated to synopsize the most significant findings of SET in the therapeutic and diagnostic applications. This includes using SET in rehabilitations after sport injuries, stroke and LBP. This will be concluded with the current challenges and future prospective of SET.
The study provided insight into the way experienced therapist handle the great variety of possible motor learning options, including concrete ideas on how to operationalize these options in specific situations.
Despite differences in patients’ abilities, it seems that therapists use the same underlying clinical reasoning process when choosing a particular motor learning option.
Participating physiotherapists used more than the in guidelines suggested motor learning options and considered more than the suggested factors, hence adding practice based options of motor learning to the recommended ones in the guidelines.
A think-aloud approach can be considered for peer-to-peer and student coaching to enhance discussion on the motor learning options applied and the underlying choices and to encourage research by practicing clinicians.
Source: Physiotherapists use a great variety of motor learning options in neurological rehabilitation, from which they choose through an iterative process: a retrospective think-aloud study – Disability and Rehabilitation –