[Abstract] Upper Limb Three-Dimensional Reachable Workspace Analysis Using the Kinect Sensor in Hemiplegic Stroke Patients

Abstract

Objective

A reachable workspace evaluation using the Kinect sensor was previously introduced as a novel upper limb outcome measure in neuromuscular and musculoskeletal conditions. This study investigated its usefulness in hemiplegic stroke patients.

Design

Forty-one patients with hemiplegic stroke were included. Kinect-based reachable workspace analysis was performed on both paretic and nonparetic sides. Upper limb impairment was measured using the Fugl-Meyer Assessment and the Motricity Index on the paretic side. Disability was assessed using the shortened Disabilities of the Arm, Shoulder, and Hand questionnaire. Correlations between the relative surface areas, impairment scores, and disability were analyzed.

Results

Quadrants 1, 3, and 4 as well as the total relative surface area of the paretic side were significantly reduced compared with the nonparetic side. The total relative surface area of the paretic side correlated with the Fugl-Meyer Assessment scores, the Motricity Index for Upper Extremity, and the Disabilities of the Arm, Shoulder, and Hand questionnaire score. Furthermore, quadrant 3 was the most important determinant of upper limb impairment and disability.

Conclusions

A reachable workspace (a sensor-based measure that can be obtained relatively quickly and unobtrusively) could be a useful and alternative outcome measure for upper limb in hemiplegic stroke patients.

via Upper Limb Three-Dimensional Reachable Workspace Analysis Us… : American Journal of Physical Medicine & Rehabilitation

[WEB SITE] Telehealth resources in response to COVID-19 for stroke care and rehabilitation professionals

The resources on this page have been collected for use by stroke care and rehabilitation professionals to provide telehealth services due to COVID-19 isolation or social distancing.

Please note

• This web page contains links to information and materials and other content that might assist health professionals work and consult remotely with people with stroke, and with people with stroke who may have been discharged prior to completing their full rehabilitation programs.
  
• The linked information, materials and other content on this web page has not been created, produced or endorsed by the Stroke Foundation.
  
• The linked information, materials and other content on this web page is not intended to replace a health professional’s own professional judgement and decision-making.
  
• The Stroke Foundation shall not bear any liability for reliance by any user on the linked information, materials and other content on this web page.

Medicare item numbers

COVID-19 Telehealth MBS items can now be claimed. See the list at the bottom of the linked news item, or the Australian Government’s fact sheet on Temporary Telehealth Bulk-Billed Items for COVID-19. The government has confirmed that existing face-to-face attendance items under the MBS can be used to deliver telehealth consultations by the following allied health professionals:

• Aboriginal and Torres Strait Islander health workers and health practitioners
• psychologists
• dietitians
• occupational therapists
• audiologists
• optometrists
• orthoptists
• physiotherapists
• social workers.

For more information, see the government’s Frequently asked questions (PDF).

Synapse Medical has a free blog that answers questions about COVID-19 numbers. FAQs are also available, and questions can be posted.

Communication tools for people with aphasia

Accessible healthcare communication materials and resources may be needed by people with aphasia and/or cognitive difficulties. The Centre for Research Excellence in Aphasia Rehabilitation and Recovery have put together a repository of materials, including in languages other than English, and they will continue to update it. Open either the PDF or the Excel document to find all the links. Key information includes:

• General public health information about COVID-19
• Pictographics relating to COVID-19, to support communication
• Supported communication training for health professionals, to enhance their communication with people with aphasia
• Wellbeing, peer support and social connection
• Adapting aphasia assessments
• Technology and telerehabilitation, with aphasia-friendly resources for using web-based platforms.

As healthcare professionals transition to telerehabilitation, it may seem too challenging to include people with aphasia. However, it is absolutely possible and should be promoted.

General telehealth guides and tips

Guide to using telehealth for clinicians during COVID-19 (PDF), a 4-page guide document with instructions on how to set up and run a successful telerehab session, with links to guidelines and tips on effective communication.

Centre of Research Excellence (CRE) in Telehealth, based at the University of Queensland. Highlights include:

• What is Telehealth, with a series of videos describing what it is and gives examples of how it is done
• Policy Digest, which covers a myriad of policy documents from guidelines to codes to conduct to standards to resource packages. It really is comprehensive and worth a look.

NSW Agency for Clinical Innovation’s telehealth website, updated daily with useful resources including:

• Telehealth for patients, carers and other providers, with Resources for patients (4 min. video with subtitles) about how to link to a telehealth provider (note this is specific to NSW Health); and Telehealth etiquette for patients and carers (2 min. read).
• Local contacts and training for clinicians, with an email template for a telehealth clinic appointment, and a clinician script to introduce patients to a telehealth appointment.

NeoRehab telerehabilitation platform eHAB, designed specifically for allied health telerehab services. It contains tools for measurement, data capture, interactive media capabilities, and can do multi-point calls – all of which are often necessary for rehabilitation services. The platform has the necessary security features that health services demand. Training in how to use eHAB is available. The designer of this system, Prof. Trevor Russell, is happy to support teams to get set up with the system. Contact t.russell@uq.edu.au

Video consultation guide for GP practices, a blog post that includes tips for high quality consultations, but is mostly COVID-19 diagnosis related. There is also a PDF document you can scroll through without having to download, which gives references for telehealth effectiveness.

Australian Physiotherapy Association’s webinar series on telehealth is freely available, with a Q&A about how to make a rapid transition. Additionally, the Australian Physiotherapy Neurology Group has a Facebook group you can request to join, where lots of members are sharing ideas and resources. You do not need to be an APA member, but you do need to be a physio and it may take a day or two for the moderator to get you linked in.

Australian Physiotherapy Association’s guidelines on the use of telehealth in response to COVID-19 (PDF, 33 pages) have also been released. These guidelines include practical tips and considerations around privacy, safety and ethics.

Register for free UTS telepractice webinars for rapid transition during COVID-19. SPROUTS Clinic (Speech Pathology Reaching Out at UTS) is not just reaching out to speech pathologists during COVID-19 – they’re reaching out to all disciplines, health professionals, schools and health services caught up in the disruption to allied health services. The webinar is held fortnightly through April/May 2020 depending on demand, to support services Australia-wide in their rapid transition to implementing telehealth-related telepractice. Clinicians in other countries are welcome to attend, but time zones are made to suit UTS staff living in Sydney and NSW, Australia. The examples provided relate to speech pathology but can be easily applied to learning across any health discipline. Webinars will not be recorded. The main benefit in attending is the active learning model enabling engagement and interaction between the participants and with the teachers.

For novice clinicians, the Stroke Training and Awareness Resources (STARS) website includes 19 e-learning resources to support key competencies in stroke care.

Online panel discussion: COVID19 & digital technology: the roles, relevance & risks of using telehealth in a crisis (90 min). Dr Norman Swan talks to Prof Trish Greenhalgh, Dr Amandeep Hansra, Dr Neale Fong, Karrie Long and Dr Daniel Stefanski about their experience of using telehealth.

Free webinar: The role of Telehealth in curbing the COVID-19 Epidemic. Five expert panellists will share practical strategies for health professionals, including lessons from their own journeys and insights to how COVID-19 might change the way we use technology to deliver healthcare in the long-term. Register now for the webinar on Thursday 23 April 2020, 12–1 pm AEST.

Virtual conference 24 April 2020 – From the Frontlines: A Covid-19 Special Event (CPD points apply). The Australian Institute of Digital Health has brought together local and international professionals to discuss the critical role of technology innovation, data innovation, telehealth and virtual care. Attend live on Friday 24 April, or register and get access to watch the conference later, as well as get a month’s access to Digital Health TV – a collection of hundreds of videos and presentations about telehealth and digital healthcare innovation.

Bridges Self Management team have collated some of their evidence-based resources for self management. As they say, “if there was ever a time for good self-management support, it is now.”

Stroke Tele-Etiquette by Victorian Stroke Telemedicine (VST) Service, a short (2 min 15 sec) video on the most important concepts to consider when using telemedicine for clinical consultations: Environment; Technology; Appearance and Communication (ETAC).

Assessment tools

iWalkAssess app from the University of Toronto provides instructions and tools to facilitate measuring walking speed and a 6-minute walk test. It includes automatic comparison to normative data and functions for goal setting. It is not designed for use via telehealth, but could possibly be adapted and may be a useful tool for novice clinicians.

How to administer the Montreal Cognitive Assessment (MoCA), via phone or telehealth. Score sheets can be downloaded from www.mocatest.org

Remote Administration Guidelines for the NIH Toolbox®: Response to COVID-19. From the United States National Institutes of Health (NIH), the Toolbox is a comprehensive set of neuro-behavioral measurements that quickly assess cognitive, emotional, sensory, and motor functions from the convenience of an iPad.

Swallowing examinations

Telepractice Dysphagia Assessment Service is an e-learning program for establishing and conducting adult clinical swallowing evaluations via telepractice. it has separate packages for Speech Pathology Managers implementing telepractice services, and for training clinical speech pathologists and healthcare support workers. The model of care described in this program was developed, tested and validated through research conducted by the Centre for Research in Telerehabilitation at The University of Queensland, and the Speech Pathology & Audiology Department at The Royal Brisbane & Women’s Hospital.

To access the Telepractice Dysphagia Assessment Service as a non-QHealth clinican, you first need to register for the iLearn website following the instructions in iLearn user help for external (PDF). Once your registration is processed, log into iLearn, go to the Course Catalogue, and search for “Telepractice”. Click on the link for the course (AHPOQ-R) Telepractice Dysphagia Assessment Service.

If you have any queries or issues with accessing this resource, please contact clare.burns@health.qld.gov.au or nicky.graham@health.qld.gov.au

Therapy tools and resources

In addition to other resources below, physiotherapyexercises.com has a range of exercises on file that can be prescribed using a mobile option – and it’s free. There is a link to a 9-min video “how to guide” for the mobile version – look for “New Mobile Functionality” on the home page. It is also available in several different languages.

Mobility training

Setting up safe and effective home exercises (PDF), a 3-page guide including photos.

REPS Recovery Exercises app consists of video-guided, post-stroke exercise programs, including TASK. The aim of TASK is to help people after stroke to exercise at home, on an ongoing basis. People can practice everyday tasks, such as sitting, standing, stepping and standing up. It was designed to improve and/or maintain strength and mobility, as well as encourage people after stroke to be more physically active. TASK is also available as a web-based program.

Clock Yourself app is for balance training. It contains five stages that introduce progressively complex activities to train balance – very good for high-level balance exercises and dual tasking. Cost $1.99

AMOUNT trial patient instructions (PDF). This trial used readily available technology (e.g. Wii Fit, Xbox Kinect) and rehab technology (e.g. fysiogaming, Stepping tiles). The 14-page patient instructions are clear and aphasia-friendly, with clear instructions on using iPads as well as the trial-specific apps and FitBits. The AMOUNT trial protocol (DOCX) includes instructions and clinical decision-making guides.

Balance exercise ideas for home programs (PDF), a useful 5-page list from StrokeEd.

Tracking physical activity using devices (PDF), a 9-page document with instructions for using a range of common apps and devices, such as FitBit, Garmin, MapMyWalk and others.

Recovery of upper limb function and Walking learning modules on InformMe were created and reviewed by stroke, occupational therapy and physiotherapy experts. They contain practical advice for therapists when assessing and planning treatment for upper limb recovery and walking after stroke.

Clinician’s guide to task training for stroke survivors – the aim of this program is to help you review rehabilitation techniques with a focus on task-specific training.

HEALTH HUB LIVE is hosted daily at 12.30 pm on Facebook by the team at St Vincent’s Private Hospital Sydney. These sessions guide people through daily prehabilitation exercises that can be done at home, as well as important health and wellness information to support people through COVID-19.

Arm function

ViaTherapy app is designed as a decision tree for prescribing evidence-based arm exercises for people after stroke. It could be particularly useful for novice clinicians, or those with less experience in stroke. Easy to use on a mobile or PC interface.

GRASP program, with therapist Instructor manuals, participant manuals, and exercise log sheet and the target board are all available to download for free once you have registered at the website. GRASP is graded in three levels, dependent on the level of arm movement the person has. The program is available in both hospital and at home versions.

PUSH arm exercise program was originally designed and implemented at Bankstown-Lidcombe Hospital, Stroke Unit. The program is based on evidence regarding arm training and dosage. There is currently no specific evidence validating the PUSH program. PUSH is suitable for stroke survivors with limited movement in their affected arm.

Communication training

See the Accessible healthcare communication materials and resources from the CRE in Aphasia Rehabilitation and Recovery linked above. The full contents are described at the top of this page, but they include information on adapting aphasia assessments, and aphasia-friendly resources for using web-based platforms.

Speech Pathology Australia has a telepractice web page, which is accessible to their members only. The telepractice FAQ page has additional information which may help speech pathology clinicians to set up telepractice services (e.g., videos on practicalities of telepractice), and information on funding streams. These web pages will be updated regularly as new resources become available.

Psychological support

thiswayup.org.au has online courses available for chronic pain and a range of mental health conditions. All courses are free until 30 April 2020.

Vision and perception

Read-Right program for hemianopic alexia: This online program, developed by the team at UCL Queen Square Institute of Neurology, is a practice-based therapy that aims to improve reading speeds in people with hemianopic alexia, a reading disorder related to a visual impairment (hemianopia) usually caused by a stroke or brain injury. The main part of the therapy involves reading scrolling text. The program includes in-built tests of visual fields, reading speed and visual search. Program participants are able to select from a wide range of reading materials including classic novels, current newspapers and popular novels (such as Harry Potter). The program is free for the first 7 days then at a cost of 5 GBP per month (approx $10 AUD).

Eye Search program for visual scanning: Free online therapy for patients with visual search problems (hemianopia or visual neglect) caused by stroke or brain injury, developed by the team at UCL Queen Square Institute of Neurology. It is behavioural therapy designed to improve patients’ speed and accuracy when finding objects through an online game that focuses on visual scanning and the training of the parts of the brain that control eye movements. Each level of the game then becomes increasingly difficult.

Wellness

PAVING the Path to Wellness™: Emergency Response Edition, a free, 6-week virtual program for patients who are recovering from brain injury and stroke and don’t have the funds to pay for this rehabilitation. The program includes a wellness toolkit for building a healthy mindset through lifestyle changes such as creating a wholesome diet and exercise plan, learning how to enjoy regular sleep patterns, identifying important goals, finding meaning and purpose, and forming powerful personal connections. With funding from brain injury charity SameYou, Spaulding Rehabilitation Hospital will accommodate 150 free places on their program, on a first come, first served basis. See eligibility requirements and registration guidelines in the link.

Fitness training

TIME (Together In Movement through Exercise) Program information (PDF). There are exercise and wellness videos for people with mobility challenges and lots of seated options.

Lessons learnt from the ExDose Trial (DOCX 41 KB). Some helpful tips from Margaret Galloway that emerged during a study of a telehealth-delivered exercise program aimed at increasing cardiorespiratory fitness for people after stroke.

ESSA (Exercise and Sports Science Australia) video webinars from exercise physiologists about ‘taking your clinic online’, ‘telehealth in practice’ and ‘how to deliver telehealth: a case study”. (See the “Resources section” at bottom of page). Note: these examples are not stroke specific.

Hacks for exercising after stroke, a 13 min presentation by Dr Sarah Valkenborghs aimed at inspiring stroke survivors, but which includes useful tips for exercising for people with significant mobility issues.

Aerobic exercise after stroke (PDF), from the Canadian Partnership For Stroke Recovery. This guide for stroke survivors addresses the benefits of aerobic exercise, who should participate, why they should participate, how to get started and what’s involved. It also includes a sample program and tips on how to monitor exercise intensity. The accompanying Clinician’s guide (PDF) includes key messages, elements and considerations of an aerobic program, addressing barriers and outcome measures.

EnableMe podcast with physiotherapist Dr Natalie Fini (18 min) to help stroke survivors learn about physical activity and exercise following stroke.

Clock Yourself app is a training tool for patients developed by physiotherapist Meg Lowry. It progressively increases tasks for people and works on improving balance and reaction times.

Free “Senior Strong” workouts from the Body Project. This is a commercial company, but the workouts are freely available on YouTube and via the links below. The workouts were designed in conjunction with a nursing professor from the UK. They include older adults demonstrating as well as the fitness instructor. Instructors are engaging, with lots of talking but clear visual demonstrations. Some use dumbbell weights, which can be substituted with cans of beans or other household items. All (apart from the standing balance one) demonstrate sitting and standing options.

• 18 min ‘mobility’ workout – focus on stretching and gentle movements
• 24 min cardiovascular workout – Level 1
• 24 min cardiovascular workout – Level 2
• 24 min cardiovascular workout – Level 3
• 23 min resistance workout – Level 1
• 30 min resistance workout – Level 2
• 34 min resistance workout – Level 3
• 34 min circuit (cardiovascular and resistance training) – Level 2
• 34 min circuit (cardiovascular and resistance training) – Level 1
• 17 min workout focused on standing balance – only suitable for people with good balance
• 13 min boxing workout. May be difficult for people with a hemiplegic arm
• 27 min high repetition resistance workout. Can do without weights
• 26 min standing Pilates workout – only suitable for people with good balance
• 11 min workout for the abdominals – in chair or standing, no floor work
• 24 min walking cardiovascular workout. Includes some quick side-stepping work. Still includes seated options for all exercises.

Relevant research papers

Safety and feasibility of telehealth delivered exercise (fitness) training. For full text contact Margaret Galloway, Margaret.Galloway@newcastle.edu.au

Hassett L, van den Berg M, Lindley RI, Crotty M, McCluskey A, van der Ploeg HP, Smith ST, Schurr K, Howard K, Hackett ML, Killington M, Bongers B, Togher L, Treacy D, Dorsch S, Wong S, Scrivener K, Chagpar S, Weber H, Pinheiro M, Heritier S, Sherrington C (2020). Digitally enabled aged care and neurological rehabilitation to enhance outcomes with Activity and MObility UsiNg Technology (AMOUNT) in Australia: A randomised controlled trial. PLoS Med. 2020 Feb 18;17(2):e1003029. doi: 10.1371/journal.pmed.1003029. eCollection 2020 Feb.

Laver KE, Adey-Wakeling Z, Crotty M, Lannin NA, George S, Sherrington C (2020). Telerehabilitation services for stroke. Cochrane Database Syst Rev. 2020 Jan 31;1:CD010255. doi: 10.1002/14651858.CD010255.pub3.

Bagot K, Moloczij N, Arthurson L, Hair C, Hancock S, Bladin CF, Cadilhac DA (2020). Nurses’ role in implementing and sustaining acute telemedicine: a mixed-methods, pre-post design using an extended technology acceptance model. J Nurs Scholarsh. 2020 Jan;52(1):34-46. doi: 10.1111/jnu.12509. Epub 2019 Sep 11.

Bagot KL, Moloczij N, Barclay-Moss K, Vu M, Bladin CF, Cadilhac DA (2020). Sustainable implementation of innovative, technology-based health care practices: A qualitative case study from stroke telemedicine. J Telemed Telecare. 2020 Jan-Feb;26(1-2):79-91. doi: 10.1177/1357633X18792380. Epub 2018 Sep 7.

Galloway M, Marsden D, Callister R, Erikson K, Nilsson M, English C (2019). The feasibility of a telehealth exercise program aimed at increasing cardiorespiratory fitness for people after stroke. International Journal of Telerehabilitation 11(2); 9-28. doi:10.5195/ijt.2019.6290

Caughlin S, Mehta S, Corriveau H, Eng JJ, Eskes G, Kairy D, Meltzer J, Sakakibara BM, Teasell R (2019). Implementing telerehabilitation after stroke: lessons learned from Canadian trials. Telemed J E Health. 2019 Sep 9. doi: 10.1089/tmj.2019.0097.

Maddison R, Rawstorn JC, Stewart RAH, Benatar J, Whittaker R, Rolleston A, Jiang Y, Gao L, Moodie M, Warren I, Meads A, Gant N (2018). Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial. Heart. 2019 Jan;105(2):122-129. doi: 10.1136/heartjnl-2018-313189. Epub 2018 Aug 27.

Hamilton C, McCluskey A, Hassett L, Killington M, Lovarini M (2018). Patient and therapist experiences of using affordable feedback-based technology in rehabilitation: a qualitative study nested in a randomized controlled trial. Clin Rehabil. 2018 Sep;32(9):1258-1270. doi: 10.1177/0269215518771820. Epub 2018 Apr 26.

Bagot KL, Cadilhac DA, Kim J, Vu M, Savage M, Bolitho L, Howlett G, Rabl J, Dewey HM, Hand PJ, Denisenko S, Donnan GA, Bladin CF; Victorian Stroke Telemedicine Programme Consortium (2017). Transitioning from a single-site pilot project to a state-wide regional telehealth service: The experience from the Victorian Stroke Telemedicine programme. J Telemed Telecare. 2017 Dec;23(10):850-855. doi: 10.1177/1357633X17734004.

Bagot KL, Cadilhac DA, Bladin CF et al (2017). Integrating acute stroke telemedicine consultations into specialists’ usual practice: a qualitative analysis comparing the experience of Australia and the United Kingdom. BMC Health Serv Res 17, 751 (2017). https://doi.org/10.1186/s12913-017-2694-1

Laver KE1, Lange B, George S, Deutsch JE, Saposnik G, Crotty M (2017). Virtual reality for stroke rehabilitation. Cochrane Database of Systematic Reviews 2017, Issue 11. Art. No.: CD008349. DOI: 10.1002/14651858.CD008349.pub4.

Bagot KL, Bladin CF, Vu M, Kim J, Hand PJ, Campbell B, Walker A, Donnan GA, Dewey HM, Cadilhac DA; VST collaborators (2016). Exploring the benefits of a stroke telemedicine programme: An organisational and societal perspective. J Telemed Telecare. 2016 Dec;22(8):489-494.

Chen J, Jin W, Zhang XX, Xu W, Liu XN, Ren CC (2015). Telerehabilitation approaches for stroke patients: systematic review and meta-analysis of randomized controlled trials. J Stroke Cerebrovasc Dis. 2015 Dec;24(12):2660-8. doi: 10.1016/j.jstrokecerebrovasdis.2015.09.014. Epub 2015 Oct 23.

Clark RA, Conway A, Poulsen V, Keech W, Tirimacco R, Tideman P (2015). Alternative models of cardiac rehabilitation: a systematic review. Eur J Prev Cardiol. 2015 Jan;22(1):35-74. doi: 10.1177/2047487313501093. Epub 2013 Aug 13.

Crotty M, Killington M, van den Berg M, Morris C, Taylor A, Carati C (2014). Telerehabilitation for older people using off-the-shelf applications: acceptability and feasibility. J Telemed Telecare. 2014 Oct;20(7):370-6. doi: 10.1177/1357633X14552382.

PubMed search for systematic reviews on telerehab for stroke (free to access). On 26/3/20 there were 14 hits.

Evidence to guide telehealth physiotherapy. The Physiotherapy Evidence Database (PEDro) has compiled a list of systematic reviews of tele-physiotherapy published in the last 5 years.

via InformMe – Telehealth resources in response to COVID-19

[ARTICLE] Functional outcome of joint mobilization added to task-oriented training on hand function in chronic stroke patients – Full Text

Abstract

Background

Approximately half of stroke patients show impaired upper limb and hand function. Task-oriented training focuses on functional tasks, while joint mobilization technique aims to restore the accessory movements of the joints.

Objective

To investigate the effect of adding joint mobilization to task-oriented training to help the patients in reaching a satisfactory level of recovery for their hand function.

Patients and methods

Thirty chronic stroke patients with paretic hand participated in the study; they were divided equally into study and control groups. The study group received joint mobilization followed by task-oriented training for the affected hand. Meanwhile, the control group received task-oriented training only. Both groups received their treatment in the form of 3 sessions per week for 6 successive weeks. The primary outcome measures were hand function that was assessed by Jebsen-Taylor hand function test (JTT) and active and passive wrist extension range of motion (ROM) that was measured by a standard goniometer. The secondary outcome measure was the grip strength of the hand that was assessed by a JAMAR adjustable hand dynamometer.

Results

There was a significant improvement in all the outcome measurements in both groups that were more evident in the study group.

Conclusion

Combining joint mobilization with task-oriented training had a highly significant effect in improving the hand function in chronic stroke patients compared to task-oriented training alone.

Introduction

Stroke is defined as a neurological deficit attributed to an acute vascular focal injury of the central nervous system [1]. It is a worldwide common disease that leads to serious disabilities [2]. Hemiparesis is the most common motor impairment after a stroke and frequently leads to persistent hand dysfunction [3]. Nearly about 50% of stroke patients show impaired upper limb and hand function and up to 74% rely on long-term help to perform their activities of daily living (ADL) [4, 5]. The hand functions are complex as we use our hands in a vast variety of tasks such as grasping, pushing, holding objects, and expressing emotions [6].

Task-oriented training is a type of physiotherapy that encourages the active participation and focuses on functional tasks rather than simple repetitive training of normal motion patterns [7]. Joint mobilizations are used as an intervention to improve the range of motion (ROM), decreasing pain, and ultimately improving the upper extremity functions [8]. Joint mobilization technique proposed by Maitland is based on a graded system and is intended to restore the accessory movements of the joints by performing passive, rhythmic, and oscillatory movements [9].

After stroke, reduced ROM at joints occurs and it can be complicated by joint contractures. This occurs due to many factors such as reduced muscle length and increased stiffness of muscle and/or connective tissue. Such post stroke consequences can be solved by moving the joints through a full ROM with pressure at the end of range using the manual therapy [10]. Mobilization may help stroke patients in reducing the joint stiffness [11]. Moreover, it provides afferent input that can be used in facilitating the motor activity [12, 13]. Accordingly, we aimed to investigate the effect of adding joint mobilization to task-oriented training in order to help those patients in reaching a satisfactory level of recovery for their hand functions.[…]

Continue —-> Functional outcome of joint mobilization added to task-oriented training on hand function in chronic stroke patients | The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Full Text

 

[WEB PAGE] Physical Therapy at Home – Gorbel Rehab – Videos

Physical Therapy at Home

As rehab professionals around the world work to address patient needs during the COVID-19 pandemic, Gorbel is actively taking steps to improve efforts in delivering therapy during these difficult times. The Gorbel team of physical therapists have created a library of home exercise program videos for those patients who are now unable to receive therapy with the frequency or duration in which they normally would have. The current video categories are Strength, Range of Motion, Balance, and Caregiver Training. Each category has a ‘Playlist’ that includes multiple videos. We will continue to add categories and new videos in our commitment to assist your efforts to advance your patient’s recovery.

Stay safe, healthy and thank you for all you do.
Brian Reh, CEO Gorbel®

 

Physical Therapy Videos

Balance Videos Playlist  /  Caregiver Videos Playlist  /  Range of Motion Videos Playlist  /  Strength Videos Playlist

Balance Videos Playlist

Caregiver Videos Playlist

Range of Motion Videos Playlist

Strength Videos Playlist

 

Physical Therapist Bio

Matthew Klock PT,DPT I am a licensed physical therapist in New York State and the Northeast Account Manager for Gorbel® Rehabilitation. Before joining Gorbel® I worked for Ochsner Health System in New Orleans, LA as the Supervisor of the Ochsner Sports Medicine Clinic. My passions include sports and orthopedics as well as new and emerging technologies. I believe that physical therapists should serve their patients by applying their wealth of knowledge in rehabilitation and pair it with the most cutting edge technologies to get the most out of every treatment.

 

Ramiro Maldonado PT, DPT I am a licensed Physical Therapist in New York State as well as the Clinical Business Development Specialist for Gorbel Rehabilitation. During my ten years as a clinician, my clinical interests lead me to specialize in vestibular and neuromuscular impairment, and I have completed the vestibular competency at Emory University. My passion now lies in helping patients and therapists by increasing awareness of rehabilitation technology and how it can improve patient outcomes. You can find out more about the products I represent, innovations in physical therapy, and me at TheBalancePT.com or follow me on Twitter or Instagram @RamiroDPT. Thank you!! 

Heidi Shenk, PT I am a licensed Physical Therapist in the states of Ohio and Indiana as well as the Account Manager for the Great Lakes Region of Gorbel Rehabilitation. I am a graduate of the Doisy College of Health Sciences at St Louis University. During my twenty-seven years as a clinician, my clinical interests led me to specialize in occupational medicine, outpatient orthopedics and in women’s health. My lifelong interest in technology and in improving therapist safety and patient outcomes has led to a passion in increasing awareness of rehabilitation technology and how it can improve patient care.

via Physical Therapy at Home | Gorbel Rehab

[BLOG POST] Fatigue: Life on an empty tank

Until 2 years ago, I’ve lived my life thinking that I had a pretty good idea of what being tired meant. Being tired was associated with a big week at work, a late night out, a big workout, a bad night sleep, dealing with a stressful event and so on. Being tired was basically a normal physical response when i had put my body under the pump. A bit of quiet time, a bit of extra rest and sleep, a few minor changes in lifestyle and I’d usually bounce back pretty quickly and get back to my usual levels of energy. But what happens when being tired turns into fatigue?

I’ve thought long and hard about some sort of analogy that would draw an accurate picture of what the term fatigue now means for me. Since encephalitis “e” and its resulting brain injury, we have often use the whole energy tank comparison ie. where you start your day on a full tank, mine may only be half full…therefore, I have to choose where I’ll be investing my energy, as comes a point where I will most likely run out of energy. From there, I thought that the whole car analogy could work quite well with the point that I am trying to put across.

What happens if you constantly run your car on an empty tank? Well, you may be able to make it to your destination (or the petrol station) most days, but your chances of running out of fuel are also much greater than someone who is accustomed to run his car on a full tank right? If you’ve run out of fuel while driving before, you know first-hand what happens when the last drop is used. Your car pretty much goes in lock down mode and after a few 100 metres, it will come to quite an abrupt stop. Your car won’t keep moving forward because you so badly want to reach the next petrol station right? You might even see the petrol station 500 metres ahead, but that won’t get your car to it….well not without spending a huge amount of physical effort to get there anyway.

Well it’s a bit the same for me when my weird wonderful brain runs out of energy. Things start to shut down…sometimes gradually and sometimes pretty abruptly. One minute I might interact in a somewhat normal manner, and the next, whoosh things start to crumble one by one right in front of my eyes. Just like a car, my brain may give me warnings signs alerting me to the fact that my fuel light has now lit up, that my fuel is running low and that a pit stop will soon be required or else shut down mode will occur. Other times, it will go from 100 km/h to 0 km/h in a split second…as if the fuel tank was punctured and the fuel is now gushing out on the ground. The speed at which things start to crumble is usually determined by my initial state of fatigue, the time of the day and the environment where I find myself at when shut down mode kicks in. If I’m at a place with lots of people and noise, the brain has to work extra hard to process all the stimuli so even with a full tank the brain energy will drain out pretty quickly…like a car, the faster you go, the more fuel you use and the faster your gauge will start leaning towards E.

Another example is if you head out on a desert road, you’ll probably chose to put a canister full of petrol in your boot to make sure that you have a back up plan should you run out of fuel along the way. It’s a bit the same when chronic fatigue is part of your daily life. You have to plan your days always allowing for a little reserve of energy in case the unforeseen cramps in. Let’s make things clear though, a reserve is called a reserve for a legitimate reason. It is only to be used in case of emergency as once you start tipping into that reserve, this is energy that is taken away from tomorrow’s usual allowed amount. Once you use the fuel canister stored in your boot, it doesn’t replenish automatically does it? Well it’s the same with fatigue. Once you tip into your reserve, you’ll either have to tweak the rest of your day to consume less energy, get additional rest/sleep to recharge or if neither are possible, you simply have to accept that tomorrow’s energy tank may only be a quarter full instead of half full to start with. Tipping into your reserve can have a huge flow-on effect.

To further feed the car analogy, say that your car is undergoing repair…well I think it is safe to say that it will no longer be available for you to use for a certain period of time. As a result, you may need to catch a ride with someone to get you places. Well when energy is limited, you may also have to rely on other people to get you through a day. Sometime just a little, sometimes more heavily, it all depends on how good you’ve been at keeping up with your fatigue management plan. Relying on other people isn’t always easy, particularly when you are used to be your independent self. That being said, you soon realise that sometimes you gotta do what you gotta do to get you to where you need to be until you car is in operating mode again.

When you deal with chronic fatigue, choosing where and when to use your energy ALWAYS comes at a premium. To put it simply, you make choices based on what will bring you joy. Not everyone has the luxury to run their car on premium fuel, but if you chose to do so you’ll do it because you are trying to do what’s best for your engine right? I guess what I’m trying to say here is that no decisions are made blindly with chronic fatigue. When I plan to spend time with people that are dear to me, it most inevitably comes at a cost to me. It’s a cost that I’m willing to waiver but knowing that the quality time spent with a dear one is equally appreciated by both parties is a must. Once I start getting the vibe that the balance is off, I may try a few more times to make sure that my own perception isn’t biased, but eventually I’ll have to make decisions based on self care and maintaining my already fragile well-being. It’s rarely a win-win situation but the people who truly understands that the quality time spent together comes at a premium will eventually step up.

If your car runs out of petrol you generally have a couple of options available to you. You may be able to walk to the nearest petrol station, borrow a fuel canister to refill your car or you may have to call a friend/family/roadside assistance to come and help you out. You will eventually refill your car one way or another and off you’ll go again. You may get to your destination a bit late, have a bit of explaining to do, but generally that’s as bad as things will get.

That’s where the brain/car analogy stops unfortunately. The impact of a brain shutting down can be quite devastating and can include various effects. Your body may stop responding as it should and do lots of weird and wonderful things e.g.: loss of coordination, shaky hands, foggy brain, heart rate ramping up and down randomly, vision going blurry, speech slurring, feeling nauseous, struggling to control your body temperature, headache and hypersensitivity to noise or light to only name a few. From here on, you may get very confused, you may stop being able to make sense of what’s happening around you and you may get very emotional from losing all control over you body. You are aware of what’s happening, you experience every second of it, but not much can be done to slow or stop you from going down the slippery slope apart from seeking quiet place and resting. Unlike a car, you may not be able to hit the road again so quickly either. It may take days/weeks for you to replenish your energy tank sufficiently to recover enough to operate “normally”…or to whatever your new baseline might be.

Fatigue management is all about pacing yourself. It is a fine balance and trial and error is often the best way to learn about your personal limits. These 3 dudes certainly challenge status quo.

I now know that fatigue is very different from being tired or normal levels of fatigue that we all experience from time to time. Fatigue is physical and mental exhaustion that is hard to shake off even with huge amount of sleep. Fatigue is that awful AWFUL feeling of emptiness right in the middle of your chest. Fatigue is struggling to get out and about your usual life in spite of all the motivation/good intention in the world. Fatigue is feeling like your 40 year old body is stuck in that of an elderly person (no offense to older readers here). Fatigue is like having to run a marathon going up and down a mountain range…in knee deep mud. You eventually see the finish line in the distance, but will no doubt need the help and encouragement of those you love the most to get though the 42.2km and to cross the finish line.

Lucky me, I love to run and I have never been one to choose the easy road so I know I will always find that little bit of extra motivation and determination to try to bounce back, to implement the right fatigue management measures to eventually win the battle over a set back and fatigue. Does it still suck? Absolutely. Do I still feel quite misunderstood by most people surrounding me? Absolutely. But I hope that I keep trying to be the best I can be, that I manage to offer my loved ones the best that I have to offer on any given day.

Everyone is different, but check out the following blog which provides some tips on fatigue management.

Read about the spoon theory which is another way to explain fatigue.

via Fatigue: Life on an empty tank

[VIDEO] Best Stroke Recovery Hand Exercises – Stretches For Hand Spasticity – YouTube

For more information on treating spasticity, visit https://www.saebo.com/blog/treat-spas… Saebo, Inc. is a medical device company primarily engaged in the discovery, development and commercialization of affordable and novel clinical solutions designed to improve mobility and function in individuals suffering from neurological and orthopedic conditions. With a vast network of Saebo-trained clinicians spanning six continents, Saebo has helped over 100,000 clients around the globe achieve a new level of independence. In 2001, two occupational therapists had one simple, but powerful goal – to provide neurological clients access to transformative and life changing products. At the time, treatment options for improving arm and hand function were limited. The technology that did exist was expensive and inaccessible for home use. With inadequate therapy options often leading to unfavorable outcomes, health professionals routinely told their clients that they have “reached a plateau” or “no further gains can be made”. The founders believed that it was not the clients who had plateaued, but rather their treatment options had plateaued. Saebo’s commitment – “No Plateau in Sight” – was inspired by this mentality; and the accessible, revolutionary solutions began. Saebo’s revolutionary product offering was based on the latest advances in rehabilitation research. From the SaeboFlex which allows clients to incorporate their hand functionally in therapy or at home, to the SaeboMAS, an unweighting device used to assist the arm during daily living tasks and exercise training, “innovation” and “affordability” can now be used in the same sentence. Over the last ten years, Saebo has grown into a leading global provider of rehabilitative products created through the unrelenting leadership and the strong network of clinicians around the world. As we celebrate our history and helping more than 100,000 clients regain function, we are growing this commitment to affordability and accessibility even further by making our newest, most innovative products more accessible than ever.

via Best Stroke Recovery Hand Exercises – Stretches For Hand Spasticity – YouTube

[Abstract] Computerized cognitive training using virtual reality on everyday life activities for patients recovering from stroke

Abstract

Purpose: Recent studies argue that the use of virtual reality tasks depicting activities daily living may be effective means for cognitive rehabilitation. The aim of this study was to test an ecologically oriented approach in virtual reality resembling the demands of everyday life activities for cognitive rehabilitation following stroke.

Materials and Methods: The sample comprised 30 sub-acute stroke patients recovering from stroke in a rehabilitation hospital. They were assessed in a single-arm pre-post intervention study on global cognition, executive functions, memory and attention abilities. The intervention consisted of virtual reality in a multidomain cognitive training approach depicting everyday life tasks (preparing food, choosing clothes, shopping, etc.).

Results: Improvements were found in the assessed cognitive domains at 6 to 10 post-treatment sessions. In-depth analysis through reliable change scores has suggested larger treatment effects on global cognition.

Conclusions: Overall results suggest that the use of virtual reality-based exercises on everyday life activities may be a useful cognitive rehabilitation approach to provide short-term gains in cognition following stroke.

• Implications for rehabilitation

• Virtual reality-based cognitive rehabilitation resembling everyday life activities may provide short-term gains in cognition of stroke patients;

• Consistent improvements in executive functions may require higher treatment dosage than for improvements in global cognition.

via Computerized cognitive training using virtual reality on everyday life activities for patients recovering from stroke: Disability and Rehabilitation: Assistive Technology: Vol 0, No 0

[Abstract] Developments and clinical evaluations of robotic exoskeleton technology for human upper-limb rehabilitation

Abstract

The development of upper limb and lower extremity robotic exoskeletons has emerged as a way to improve the quality of life as well as act as a primary rehabilitation device for individuals suffering from stroke or spinal cord injury. This paper contains extractions from the database of robotic exoskeleton for human upper limb rehabilitation and prime factors behind the burden of stroke. Various studies on stroke-induced deficiency from different countries were included in the review. The data were extracted from both clinical tests and surveys. Though there have been splendid advancements in this field, they still present enormous challenges. This paper provides the current developments, progress and research challenges in exoskeleton technology along with future research directions associated with the field of exoskeletons and orthosis. Robot-assisted training (RT) was found to be more effective than conventional training (CT) sessions. The present research articles in this field have many weaknesses as they do not cover the systematic review including the clinical studies and various surveys that lay a foundation for the requirement of robotic assistive devices. This review paper also discusses various exoskeleton devices that have been clinically evaluated.

 

via Developments and clinical evaluations of robotic exoskeleton technology for human upper-limb rehabilitation: Advanced Robotics: Vol 0, No 0

[Abstract] Use of mobile applications in hand therapy

Abstract

Introduction

Mobile devices can be incorporated into therapy as an engaging alternative to traditional therapy options. The use of mobile devices and smartphone applications can enhance the quality of care provided by health care professionals.

Purpose

To find mobile apps that can be incorporated into hand therapy practice.

Methods

Hand therapy evaluation, interventions, proprioception, laterality, and home exercise program applications can be incorporated into practice. Patient education can also be provided via the use of mobile applications.

Conclusion

Smartphone applications can be a valuable intervention and impact performance in individuals with impaired hand function. Smartphone applications offer a client-centered, and potentially motivating, activity option that can be utilized to aid the hand therapist.

via Use of mobile applications in hand therapy – ScienceDirect

[Abstract] Advances in motion and electromyography based wearable technology for upper extremity function rehabilitation: A review

Study Design

Scoping review.

Introduction

With the recent advances in technologies, interactive wearable technologies including inertial motion sensors and e-textiles are emerging in the field of rehabilitation to monitor and provide feedback and therapy remotely.

Purpose of the Study

This review article focuses on inertial measurement unit motion sensor and e-textiles–based technologies and proposes approaches to augment these interactive wearable technologies.

Methods

We conducted a comprehensive search of relevant electronic databases (eg, PubMed, the Cumulative Index to Nursing and Allied Health Literature, Embase, PsycINFO, The Cochrane Central Register of Controlled Trial, and the Physiotherapy Evidence Database). The scoping review included all study designs.

Results

Currently, there are a numerous research groups and companies investigating inertial motion sensors and e-textiles–based interactive wearable technologies. However, translation of these technologies to the clinic would need further research to increase ease of use and improve clinical validity of the outcomes of these technologies.

Discussion

The current review discusses the limitations of the interactive wearable technologies such as, limited clinical utility, bulky equipment, difficulty in setting up equipment inertial motion sensors and e-textiles.

Conclusion

There is tremendous potential for interactive wearable technologies in rehabilitation. With the evolution of cloud computing, interactive wearable systems can remotely provide intervention and monitor patient progress using models of telerehabilitation. This will revolutionize the delivery of rehabilitation and make rehabilitation more accessible and affordable to millions of individuals.

via Advances in motion and electromyography based wearable technology for upper extremity function rehabilitation: A review – ScienceDirect