Archive for February, 2019

[Abstract] A three-site clinical investigation and feasibility study of a flexible functional electrical stimulation system to support functional task practice for upper limb recovery in people with stroke.

Introduction: Of those people who survive a stroke, only between 40% and 70% regain upper limb dexterity. A number of reviews have suggested that functional electrical stimulation (FES) may have a beneficial effect on upper limb motor recovery. In light of the promise offered by FES and the limitations with current systems a new system was developed (FES-UPP) to support people with stroke (PwS) to practice a range of voluntary controlled, FES-assisted functional activities.

Objective: This paper reports on a three centre clinical investigation with the primary aim of demonstrating compliance of the new FES system with relevant essential requirements of the EU Medical Device Directive, namely to evaluate whether use of the FES-UPP enables PwS to perform a wider range of functional activities, and/or perform the same activities in an improved way.

Design: Clinical investigation and feasibility study

Settings: An in-patient stroke unit, a combined Early Supported Discharge (ESD) and community service, and an outpatient clinic and in-patient stroke unit.
Participants: Nine therapists and 22 PwS with an impaired upper limb.
Intervention: Every PwS was offered up to 8 sessions of FES-UPP therapy, each lasting approximately one hour, over a period of up to six weeks.
Primary and secondary outcome measures: The operation, acceptability and feasibility of the interventions were assessed using video rating and the Wolf Motor Function Test Functional Ability Scale (WMF-FAS), direct observations of sessions and questionnaires for therapists and PwS.

Results: The system enabled 24% (Rater A) and 28% (Rater B) of PwS to carry out a wider range of functional tasks and improved the way in which the tasks were performed (mean scores of 2.6 and 2.2 (with FES) versus mean scores 1.5 and 1.3 (without FES) (p<.05).

Conclusion: The FES-UP proved feasible to use in three different clinical environments, with PwS who varied widely in their impairment levels and time since stroke. Therapists and therapy assistants from a wide range of backgrounds, with varying degrees of computer and/or FES knowledge, were able to use the system without on-site technical support.

via Frontiers | A three-site clinical investigation and feasibility study of a flexible functional electrical stimulation system to support functional task practice for upper limb recovery in people with stroke. | Neurology

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[WEB SITE] Seize life with both hands

Engaging stroke rehabilitation exercise through smart games.


The NeuroBall allows users to complete upper limb rehabilitation exercise by playing games. It intelligently adapts to your ability and becomes increasingly challenging as you progress.

“It’s amazing!

After 4.5 years, to still feel you can achieve things”

Learn more

Developed with stroke survivors and therapists

Comprehensive upper limb exercise

Train all key movements including flexion and extension, side-to-side and grasping.

Adapts to your ability

Games change to your movement ability and become more challenging as you progress

Measures progress

Monitor engagement and performance over time and see real progress.


Don’t just take our word for it

Richard Sealy, Physiotherapist



The NeuroBall is fun and engaging. It allows you to track progress and see your achievements. The games motivate you to keep playing and reach the next level. It is fantastic because this repetitive practice is essential for progress. It builds physical strength and also trains the neurological pathways too.

via Neurofenix – Home

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[RESOURCE] Conversations About Intimacy and Sexuality: A Training Toolkit Using MI

The NIDILRR-funded Rehabilitation Research and Training Center on Community Living and Participation of People with Serious Mental Illness (TU Collaborative) has published Conversations About Intimacy and Sexuality: A Training Toolkit Using Motivational Interviewing (MI). The toolkit is designed to prepare direct service professionals to have discussions with people with mental health conditions on the topics of intimacy and sexuality. The toolkit was informed by the motivational interviewing technique and includes experiential exercises with instructions, evaluation forms, resources, and references to be used by trainers.

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[Abstract] The effect and optimal parameters of repetitive transcranial magnetic stimulation on motor recovery in stroke patients: a systematic review and meta-analysis of randomized controlled trials

The primary aim of this meta-analysis was to evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) on limb movement recovery post-stroke and cortex excitability, to explore the optimal parameters of rTMS and suitable stroke population. Second, adverse events were also included.

The databases of PubMed, EBSCO, MEDLINE, the Cochrane Central Register of Controlled Trials, EBM Reviews-Cochrane Database, the Chinese National Knowledge Infrastructure, and the Chinese Science and Technology Journals Database were searched for randomized controlled trials exploring the effects of rTMS on limb motor function recovery post-stroke before December 2018.

The effect sizes of rTMS on limb motor recovery, the effect size of rTMS stimulation parameters, and different stroke population were summarized by calculating the standardized mean difference (SMD) and the 95% confidence interval using fixed/random effect models as appropriate.

For the motor function assessment, 42 eligible studies involving 1168 stroke patients were identified. The summary effect size indicated that rTMS had positive effects on limb motor recovery (SMD = 0.50, P < 0.00001) and activities of daily living (SMD = 0.82, P < 0.00001), and motor-evoked potentials of the stimulated hemisphere differed according to the stimulation frequency, that is, the high-frequency group (SMD = 0.57, P = 0.0006), except the low-frequency group (SMD = –0.27, P = 0.05). No significant differences were observed among the stimulation parameter subgroups except for the sessions subgroup (P = 0.02). Only 10 included articles reported transient mild discomfort after rTMS.

rTMS promoted the recovery of limb motor function and changed the cortex excitability. rTMS may be better for early and pure subcortical stroke patients. Regarding different stimulation parameters, the number of stimulation sessions has an impact on the effect of rTMS.

via The effect and optimal parameters of repetitive transcranial magnetic stimulation on motor recovery in stroke patients: a systematic review and meta-analysis of randomized controlled trials – Huifang Xiang, Jing Sun, Xiang Tang, Kebin Zeng, Xiushu Wu, 2019

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[NEWS] Focused ultrasound offers potential new epilepsy treatment

29 Jan 2019 Tami Freeman
Clinical trial
Researchers at the Ohio State University College of Medicine are studying how well focused ultrasound can treat medication-refractory lobe focal onset epilepsy. (Courtesy: Ohio State University)

Focused ultrasound treatments use multiple ultrasound beams focused deep within the body to provide non-invasive, targeted therapy for a wide range of clinical applications. Now, researchers at The Ohio State University College of Medicine have begun a clinical trial investigating the use of transcranial focused ultrasound to control a specific type of epilepsy in which seizures are not controlled by medication.

The study will enrol up to 10 patients with medication-refractory lobe focal onset epilepsy. Patients will receive MR-guided focused ultrasound through an intact skull to ablate tissue deep in the brain. The treatment works by passing 1024 ultrasound beams through the scalp, skull and brain tissue (without causing any harm) until they converge at a focal point to ablate a specific part of the brain involved in epilepsy.

“We’re pursuing this clinical trial because we know there’s a large unmet clinical need. More than 20 million people worldwide live with uncontrollable seizures because no available treatment works for them,” explains neurosurgeon Vibhor Krishna, who is leading the study. “Our goals are to test the safety of this procedure and study changes in seizure frequency in these patients.”

Earlier this month, a 58-year-old man became the first patient to be treated with focused ultrasound for epilepsy at Ohio State. During the three-hour surgery in an intraoperative MRI-surgical suite, he remained awake and alert, providing real-time feedback to the treatment team. His feedback helped the team safely ablate the brain region involved in spread of his epilepsy without causing undesirable side effects.

After treatment, the research team plan to monitor all the patients closely for one year. They will use neurological exams and neuro-psychological exams to assess language, memory and executive functioning.

“This is an important step in the evolution of focused ultrasound as a mainstream therapy for disorders affecting the brain,” said Neal Kassell, founder and chairman of the Focused Ultrasound Foundation, which is funding the clinical trial. “Ultimately, the results of this study could lead to new, more effective therapies for certain patients with epilepsy.”



via Focused ultrasound offers potential new epilepsy treatment – Physics World

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[NEWS] ReStore Gait Rehab Exo-Suit On Path for FDA 510(k) Nod, Company Notes

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ReWalk Robotics Ltd has submitted a 510(k) application to the US Food and Drug Administration (FDA) for the ReStore exo-suit for gait training during stroke rehabilitation—the next step in the commercialization process, according to the company.

Introduced in 2017, the ReStore soft garment-like exo-suit is designed to allow variability of movement in combination with active ankle assistance that adaptively synchronizes with the patient’s natural gait, to facilitate functional gait training activities. The device also provides therapists the ability to adjust and optimize a patient’s treatment using real-time analytics.

”This submission marks a significant milestone for robotic rehabilitation technologies and represents a clear, distinct evolution in powered rehabilitation solutions,” says Larry Jasinski, ReWalk CEO, in a media release from the Marlborough, Mass-based company.

“The ReStore is a versatile device which will provide high-level, reproducible care for a broad range of a clinic’s gait training clients, at a price point accessible to many more clinics than current technologies.”

The 510(k) submission follows the completion of a nationwide clinical study, with 44 patients enrolled across five leading rehabilitation centers in the United States:

  • The Shirley Ryan AbilityLab in Chicago
  • Spaulding Rehabilitation Hospital in Boston, in partnership with Boston University College of Health and Rehabilitation Sciences: Sargent College
  • MossRehab Stroke and Neurological Disease Center in Elkins Park, Pa
  • TIRR Memorial Hermann in Houston
  • Kessler Foundation in West Orange, NJ

“As part of the multi-site study of the ReStore exo-suit, we applied the device to a broad range of individuals with post-stroke gait dysfunctions. The device allowed the study participants to walk effectively and efficiently, and we are encouraged with the potential of this technology to interact with and enhance everyday clinical care” explains Arun Jayaraman, PT, PhD, who is director of the Max Nader Lab for Rehabilitation Technologies & Outcomes Research at Shirley Ryan AbilityLab and lead investigator for the ReStore clinical study.

Following CE submission in Q4 of 2018, ReWalk anticipates commercializing the ReStore device for use by stroke patients and rehab clinics in Europe in mid-2019. In the United States a  potential launch of the product could occur in late Q2 or Q3, pending clearance from the FDA, per the release.

[Source(s): ReWalk Robotics Ltd, PR Newswire]


via ReStore Gait Rehab Exo-Suit On Path for FDA 510(k) Nod, Company Notes – Rehab Managment

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[ARTICLE] Experimental Study on Upper-Limb Rehabilitation Training of Stroke Patients Based on Adaptive Task Level: A Preliminary Study – Full Text


During robot-aided motion rehabilitation training, inappropriate difficulty of the training task usually leads the subject becoming bored or frustrated; therefore, the difficulty of the training task has an important influence on the effectiveness of training. In this study, an adaptive task level strategy is proposed to intelligently serve the subject with a task of suitable difficulty. To make the training task attractive and continuously stimulate the patient’s training enthusiasm, diverse training tasks based on grabbing game with visual feedback are developed. Meanwhile, to further enhance training awareness and inculcate a sense of urgency, a dynamic score feedback method is used in the design of the training tasks. Two types of experiments, functional and clinical rehabilitation experiments, were performed with a healthy adult and two recruited stroke patients, respectively. The experimental results suggest that the proposed adaptive task level strategy and dynamic score feedback method are effective strategies with respect to incentive function and rehabilitation efficacy.

1. Introduction

Stroke is a cerebral blood circulation disorder, which is mainly divided into hemorrhagic and ischemic stroke based on the pathogenesis [1]. Based on the report [1], the global prevalence of stroke was 42.4 million in 2015. In China, approximately 13 million individuals are stroke survivors, and the prevalence is increasing, with 2 million new stroke patients yearly [2]. Overall, the mean age of stroke patients worldwide is increasing, whereas the onset of stroke tends to be younger in China [2] and Sweden [3]. Due to the lack of effective treatment for the disease, stroke is characterized by high mortality and disability. How to effectively treat stroke and reduce the poor consequences is a common problem in the medical field.

Stroke is referred to as a cerebrovascular accident with a sudden decrease in blood supply to the brain tissue, which may result in brain tissue ischemia and brain cell damage. When the brain nerve cells are damaged, the body functions controlled by these nerve cells are impaired. Stroke treatment and rehabilitation are usually divided into two stages, namely, acute and chronic phases of stroke [45]. During the acute phase, the patient’s corresponding function is restored when the impaired neural connections are recovered within the called sensitive time-limited window. Based on neuroplasticity and compensation of brain function theory, in recent decades, many advanced stroke rehabilitation techniques have been developed and utilized, such as robot-aided device [6], virtual reality [7], brain stimulation, and constraint-induced therapy, for the patients in the chronic phase of stroke [89]. To aid the patient in recovering the lost function to the greatest extent, these advanced techniques using unconventional drug therapy for the recovery of the patient’s body functions have received increasing attention from researchers for the past few years.

Stroke may be associated with disabilities for the survivor. The disabilities usually affect the activities of daily living, such as motion ability, walking, speech, and cognition [1011]. In clinics, motor deficits are some of the most prevalent symptoms, and 69% of stroke patients have some degree of motion disability of the upper extremity [12]. Fortunately, clinic investigations in both human and animal models demonstrate that massive and intensive motion training can induce cortical changes and reorganization, which construct a relative ability to produce skilled action [4]. Thus, motor function improvements beyond the subacute stage might be induced by rehabilitative therapies. Exercise therapy plays an important role in functional recovery and reconstruction, and it is a popular therapeutic method for stroke rehabilitation. Effectiveness of motion training for motor function improvement has been widely reported [13]. In clinics, motion training is usually conducted by a physiotherapist. The traditional hand-to-hand treatment by a physiotherapist has many disadvantages, such as high labor intensity, low efficiency, and rehabilitation effectiveness varying with the physician. To effectively offer stroke patients with modern technology, all kinds of motion training robots are developed to replace the physiotherapist to offer the patient with designed motion training, which presents the advantages with recording process data, high convenience providing task-oriented practice, and high accuracy in measuring outcomes. In recent years, the rehabilitation robot has become a hot topic in the field of robotics. Robotics is increasingly used in poststroke upper extremity rehabilitation [14]. With regard to the upper extremity rehabilitation robot, studies have greatly contributed to the system mechanism design [1516], control method [1718], rehabilitation training method [19], visual feedback, and so on [20]. The aim of developing motion-rehabilitation training robots is to help patients affected with motor disability relearn motion skills based on the experience-dependent neural plasticity with robot-aided motion training. How to stimulate the enthusiasm of the subject to the greatest extent is one of the main considered issues throughout the design of the rehabilitation system. Many training or controlling strategies have been adopted to improve training motivation, such as varied training tasks, vivid visual feedback or virtual reality, friendly interaction, and intelligent control methods [2123]. However, the training task is usually appointed in advance during the robot-aided motion exercise. Too difficult training tasks will lead the trainer to lose confidence, and too easy training tasks will lead to boredom. Therefore, the level of training tasks during one training session needs to be adjusted based on the training performances. Motion training with matching difficulty level can effectively stimulate the enthusiasm of the subject and make the movement undergo better cooperation.

In this study, the training task based on a game with various levels of difficulty was designed to improve the effectiveness of the rehabilitation training for robot-aided free movement training. Moreover, an adaptive strategy for selection of task level and dynamic visual feedback method were adopted; these interventions can provide the patients with the appropriate training task and motivational visual feedback, which may motivate interest in training and participation awareness.

2. Materials and Methods

2.1. Motion Training Type

In clinics, the motion training type of robot-aided rehabilitation exercise is usually varied with the rehabilitant stage and the state of illness. The motion training types are divided into three modes based on the condition that the robot provides auxiliary force: the passive, aided active, and free motions.

The passive motion training is usually utilized in the early recovery phase where the stroke patient does not present any motion ability, and the movement is fully towed by robot following the predefined trajectory. When the stroke patient possesses a certain active ability but cannot completely overcome gravity, the aided active motion is utilized to arouse the active movement consciousness. During the aided active motion, an appropriate aided force is supplied by the robot to help the subject perform training tasks based on the designed control algorithm. Free motion is used in the stage where the subject can fully overcome gravity. Free movement refers to the movement initiated by the patient himself, and the whole movement process is completely self-initiated by the patient. The end of robot manipulation follows the subject’s hand and does not provide any force or any direction guidance for the movement of the patient. Free motion is fully controlled by the trainer, and the exercise process is actually a coordinated control process of body. The active participation of patients is conducive to accelerating the control of the central nervous system reconstruction on the affected limb. Meanwhile, subjects can freely move according to their wishes, which largely increase their confidence and inspire their motion enthusiasm.

With regard to each motion training type, the training form and control strategy are usually different due to the specific characteristics and goals. To increase interest in training, visual feedback techniques are usually used to design and develop free motion training. This study focuses on free movement training and evaluates the effective training methods using an adaptive training strategy and dynamic visual feedback.

2.2. Rehabilitation System Set-Up

The constructed motion rehabilitation system mainly includes two parts: the hardware and software sections. The four-degree-of-freedom Barrett Whole Arm Manipulator (WAM), which has been widely used as an experimental platform in the medical field, was used as the main platform to construct the upper-limb motion rehabilitation system. The Barrett WAM can be well controlled in joint space, and each joint can be driven by setting the control torque; the position of each rotary joint is measured timely. Additionally, the Barrett WAM was designed with cable-driven technology, presenting outstanding back drivability and safety, which is suitable for an ideal hardware platform for motion training. To monitor the interactive force during rehabilitation, a three-dimensional (3-D) force sensor was developed and installed on the end-effector. An arm-support device was designed and installed to support the impaired limb for stroke patients to perform certain types of motion training. In this investigation, the motion rehabilitation system, which is presented in Figure 1, mainly consists of the WAM manipulator, 3-D force sensor, arm-support device, and controlling PC. More detailed information on the constructed motion rehabilitation system can be acquired from our previous studies [2425].


Continue —> Experimental Study on Upper-Limb Rehabilitation Training of Stroke Patients Based on Adaptive Task Level: A Preliminary Study

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[Abstracts] British Association oh Hand Therapists(BAHT) Annual Conference 9–10 November 2018, Birmingham

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via BAHT Annual Conference9–10 November 2018, Birmingham, 2019

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[NEWS] Walk This Way to Post-Stroke Recovery

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by Kate Drolet, PT, DPT, NCS, CLT-LANA, and Kristine Buchler, PT, DPT

In the heart of Chicago’s bustling Streeterville neighborhood lies Shirley Ryan AbilityLab, formerly the Rehabilitation Institute of Chicago. In March 2017, the organization opened a $550 million, 1.2-million-square-foot facility as a “translational” research hospital in which clinicians, scientists, innovators, and technologists work together in the same space, surrounding patients, discovering new approaches, and applying (or “translating”) research in real time.

Within the 27-floor rehabilitation hospital, this translational model plays out in the five ability labs—applied research and therapeutic spaces—each focused on specific functional outcomes. Together, therapists and researchers offer evidence-based interventions for a minimum of 3 hours each day. The goal: better, faster outcomes for patients.

For instance, the Legs + Walking Lab is a dynamic, two-story space designed for inpatients to focus specifically on gait training, stairs, balance and strengthening related to lower-body impairments due to brain injury, stroke, spinal cord injury, or diseases of the nerves, muscles, or bones.

While this list is not all-encompassing, one of the most prevalent diagnoses treated in the Legs + Walking Lab is stroke—and one of the most common therapies offered for post-stroke patients is gait training.

At the heart of Shirley Ryan AbilityLab’s efforts to lead patients toward an optimum outcome are more than 200 active clinical trials and research studies aimed at improving recovery post-stroke. Interdisciplinary teams consisting of physical therapists, occupational therapists, speech-language pathologists, doctors, nurses, researchers, psychologists, and social workers work together with patients to identify specific goals and then outline a treatment program aimed at maximizing functional independence.

Patients also are referred to therapists based within the various ability labs who specialize in areas such as gait training, vestibular therapy, task-specific upper extremity training, aphasia, dysphagia, cognition, and pain. These therapists work closely with the primary therapists to identify the proper dosage, intensity and duration of sessions needed to facilitate neural reorganization for their specific interventions.



Gait Training Out of the Gate

In the Shirley Ryan AbilityLab Legs + Walking Lab, gait therapists focus on promoting locomotor recovery for patients post-stroke. The primary physical therapists refer patients to gait therapy if walking goals are indicated, usually soon after completion of the initial evaluation.

Why is it so important to commence gait therapy soon after evaluation? Research indicates that earlier and more intensive rehabilitation post-stroke yields a quicker return to independent ambulation and improved functional mobility.1As a result, getting patients up and moving as quickly as possible is the expectation once vitals are stable. If gait training is indicated but is not yet safe due to unstable vitals or orthostatic hypotension, patients still often will be referred to gait therapists to assist with tolerance to upright training using the tilt table or stander before progressing to ambulation.

The literature has shown that repetition, intensity, and task-specificity are important principles of neuroplasticity to consider for gait recovery post-stroke.2 Gait therapists work with the primary physical therapists to promote large amounts of high-intensity, task-specific gait training with each patient to facilitate plasticity of both neuromuscular and cardiopulmonary systems. Walking practice is prioritized during most physical therapy sessions to achieve sufficient dosage and repetition.

Although conventional practice often involves spending time on multiple different interventions, research has indicated that high-intensity gait training also can translate to improvements in non-walking tasks such as balance and transfers, despite not focusing on those tasks.2-4

Using the Latest Specialized Equipment

At Shirley Ryan AbilityLab, therapists are fortunate to have a great deal of specialized equipment readily available to assist with implementing gait interventions with stroke survivors.

Therapists often are helping patients get up for the first time after their strokes. This may require a great deal of assistance. Because the safety of both patients and therapists is always a priority, the Legs + Walking Lab is outfitted with body-weight supported treadmills and overhead gait tracks for mobilizing lower-level patients.

Even for patients who may not require body weight support, harness systems are still used for safety and fall prevention when performing treadmill training or when challenging patients during higher-level balance activities overground. There is also a suspension system over the staircase in the Legs + Walking Lab, which provides a safe method for patients to relearn stair climbing.

In terms of modality of walking practice, the evidence is unclear as to whether treadmill or overground training is more effective in facilitating locomotor recovery. Therefore, therapists must consider how best to achieve the principles of neuroplasticity when choosing the modality for gait training. For lower-level patients who require more assistance, this generally means an increased, early focus on body weight-supported treadmill training early on to maximize repetition and intensity. Then, as patients progress, therapists can integrate overground gait training more frequently to promote increased task specificity. For patients who require less assistance, treatment sessions are generally more evenly divided between treadmill and overground gait training.

Although the Legs + Walking Lab has a robotic treadmill device, it is not commonly used during stroke rehabilitation. Evidence indicates that robotic-assisted gait training is less effective than therapist-assisted gait training in improving walking ability post-stroke.5,6 However, there are certain circumstances in which robotic-assisted gait training may be indicated to reduce the physical burden placed on therapists when gait training with stroke survivors who do not have much motor return and require a significant amount of assistance to advance both legs.

In addition, therapists have access to various exoskeletons for patients in the Legs + Walking Lab that are used in conjunction with treadmill and overground gait training due to limited research using exoskeletons in the post-stroke population.

The Shirley Ryan AbilityLab’s Legs + Walking Lab is designed for patients and research participants with diagnoses affecting lower-body function due to brain or spinal cord injury and diseases of the nerves, muscles, and bones. Researchers and clinicians focus on  advancing trunk, pelvic, and leg function, movement, and balance in this dynamic, applied research and therapeutic space.

The Shirley Ryan AbilityLab’s Legs + Walking Lab is designed for patients and research participants with diagnoses affecting lower-body function due to brain or spinal cord injury and diseases of the nerves, muscles, and bones. Researchers and clinicians focus on advancing trunk, pelvic, and leg function, movement, and balance in this dynamic, applied research and therapeutic space.

When to Challenge, When to Modify

When progressing gait interventions for patients post-stroke, the initial focus is on decreasing the amount of body weight support or level of assistance as able. Once patients begin to require less assistance and are able to perform stepping without assistance, therapists can begin to progress the challenge of the task. Evidence suggests that variability and error play an important role in motor learning and can contribute to improvements in locomotor function in stroke survivors.3,5-8 Therefore, these principles are crucial to integrate into gait interventions. This is done by allowing kinematic variability and providing variation to the task and environment, incorporating activities such as multi-directional stepping, obstacle negotiation, uneven surfaces, or changes in gait speed. Therapists can then adjust the level of challenge depending on patient response. If a patient does not make any errors, it generally means that the task is not challenging enough and should be progressed. Conversely, if a patient demonstrates several consecutive errors and is unable to correct without assistance, that generally indicates that the task is too challenging and should be modified.

Throughout the progression of gait training, the physical therapists monitor intensity and exercise tolerance based on heart rate and blood pressure response to activity, rating of perceived exertion (RPE), and verbal and nonverbal signs and symptoms if a patient has cognitive and/or communication deficits. It is also important to evaluate progress in order to guide clinical decision-making and determine whether the interventions are effective. This is done using various outcome measures, such as the Functional Independence Measure, 6 Minute Walk Test, 10 Meter Walk Test, Berg Balance Scale and Functional Gait Assessment, in addition to clinical judgment and observation. At times, primary physical therapists or lab therapists who specialize in gait training may need to decrease the frequency of gait training sessions if a patient is not responding well, if progress is limited, or if the goals of a patient’s stay shift to family education in preparation for discharge.

The Next Chapter: Therapy After Discharge

After patients discharge from the hospital, they will likely continue at a Shirley Ryan AbilityLab DayRehab or Shirley Ryan AbilityLab outpatient location. There, they will receive additional therapy, similar to the inpatient setting, while commuting to and from their homes. Therapists at DayRehab and outpatient locations continue to promote high-intensity gait training with an emphasis on home exercise programs, community reintegration, and return to work, when appropriate.

Some patients travel long distances for the intensive inpatient therapy program, so outpatient therapy at a local clinic or hospital may be the only option close to home after discharge. For these patients, inpatient therapists at the Shirley Ryan AbilityLab train families and personal caregivers to implement the principles of neuroplasticity and advocate for high-intensity gait training after discharge.

Regardless of a patient’s particular journey, the message for post-stroke recovery is clear: the more walking, the better. RM

Kate Drolet, PT, DPT, NCS, CLT-LANA, earned a bachelor’s degree in exercise physiology and a doctorate in physical therapy from Marquette University in Milwaukee. She is a Board Certified Clinical Specialist in Neurological Physical Therapy and a Certified Lymphedema Therapist through the Lymphology Association of North America. She practices at the Shirley Ryan AbilityLab (formerly Rehabilitation Institute of Chicago) and specializes in gait training for patients with neurologic conditions in the inpatient setting.

Kristine Buchler, PT, DPT, earned a bachelor’s degree in kinesiology at the University of Illinois at Urbana-Champaign and a doctor of physical therapy degree at Northwestern University. She currently practices as a physical therapist at the Shirley Ryan AbilityLab and specializes in gait training for patients with neurologic conditions in the inpatient setting. For more information, contact

This article appears in the January/February 2019 print issue of Rehab Management with the title, “Walk This Way.”


1. Cumming TB, Thrift AG, Collier JM, et al. Very early mobilization after stroke fast-tracks return to walking. Stroke. 2011;42(1):153-158.

2. Hornby TG, Straube DS, Kinnaird CR, et al. Importance of specificity, amount, and intensity of locomotor training to improve ambulatory function in patients poststroke. Top Stroke Rehabil. 2011;18(4):293-307.

3. Hornby TG, Holleran CL, Hennessy PW, et al. Variable intensive early walking poststroke (VIEWS). Neurorehabil Neural Repair. 2015;30(5):440-450.

4. Straube DD, Holleran CL, Kinnaird CR, Leddy AL, Hennessy PW, Hornby TG. Effects of dynamic stepping training on nonlocomotor tasks in individuals poststroke. Phys Ther. 2014;94(7):921-933.

5. Hornby TG, Campbell DD, Kahn JH, Demott T, Moore JL, Roth HR. Enhanced gait-related improvements after therapist- versus robotic-assisted locomotor training in subjects with chronic stroke. Stroke. 2008;39(6):1786-1792.

6. Hidler J, Nichols D, Pelliccio M, et al. Multicenter randomized clinical trial evaluating the effectiveness of the Lokomat in subacute stroke. Neurorehabil Neural Repair. 2009;23(1):5-13.

7. Holleran CL, Straube DD, Kinnaird CR, Leddy AL, Hornby TG. Feasibility and potential efficacy of high-intensity stepping training in variable contexts in subacute and chronic stroke. Neurorehabil Neural Repair. 2014;28(7):643-651.

8. Reisman DS, McLean H, Keller J, Danks KA, Bastian AJ. Repeated split-belt treadmill training improves poststroke step length asymmetry. Neurorehabil Neural Repair. 2013;27(5):460-468.


via Walk This Way to Post-Stroke Recovery – Rehab Managment

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[Abstract] A Greedy Assist-as-Needed Controller for Upper Limb Rehabilitation


Previous studies on robotic rehabilitation have shown that subjects’ active participation and effort involved in rehabilitation training can promote the performance of therapies. In order to improve the voluntary effort of participants during the rehabilitation training, assist-as-needed (AAN) control strategies regulating the robotic assistance according to subjects’ performance and conditions have been developed. Unfortunately, the heterogeneity of patients’ motor function capability in task space is not taken into account during the implementation of these controllers. In this paper, a new scheme called greedy AAN (GAAN) controller is designed for the upper limb rehabilitation training of neurologically impaired subjects. The proposed GAAN control paradigm includes a baseline controller and a Gaussian RBF network that is utilized to model the functional capability of subjects and to provide corresponding a task challenge for them. In order to avoid subjects’ slacking and encourage their active engagement, the weight vectors of RBF networks evaluating subjects’ impairment level are updated based on a greedy strategy that makes the networks progressively learn the maximum forces over time provided by subjects. Simultaneously, a challenge level modification algorithm is employed to adjust the task challenge according to the task performance of subjects. Experiments on 12 subjects with neurological impairment are conducted to validate the performance and feasibility of the GAAN controller. The results show that the proposed GAAN controller has significant potential to promote the subjects’ voluntary engagement during training exercises.

via A Greedy Assist-as-Needed Controller for Upper Limb Rehabilitation – IEEE Journals & Magazine

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