Archive for category REHABILITATION

[Abstract+References] Restoring Motor Functions After Stroke: Multiple Approaches and Opportunities

More than 1.5 million people suffer a stroke in Europe per year and more than 70% of stroke survivors experience limited functional recovery of their upper limb, resulting in diminished quality of life. Therefore, interventions to address upper-limb impairment are a priority for stroke survivors and clinicians. While a significant body of evidence supports the use of conventional treatments, such as intensive motor training or constraint-induced movement therapy, the limited and heterogeneous improvements they allow are, for most patients, usually not sufficient to return to full autonomy. Various innovative neurorehabNIBSilitation strategies are emerging in order to enhance beneficial plasticity and improve motor recovery. Among them, robotic technologies, brain-computer interfaces, or noninvasive brain stimulation (NIBS) are showing encouraging results. These innovative interventions, such as NIBS, will only provide maximized effects, if the field moves away from the “one-fits all” approach toward a “patient-tailored” approach. After summarizing the most commonly used rehabilitation approaches, we will focus on  and highlight the factors that limit its widespread use in clinical settings. Subsequently, we will propose potential biomarkers that might help to stratify stroke patients in order to identify the individualized optimal therapy. We will discuss future methodological developments, which could open new avenues for poststroke rehabilitation, toward more patient-tailored precision medicine approaches and pathophysiologically motivated strategies.

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Taub EMiller NENovack TACook EW3rdFleming WCNepomuceno CS, and others. 1993Technique to improve chronic motor deficit after stroke. Arch Phys Med Rehabil 74(4):34754Google Scholar Medline
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Varkuti BGuan CPan YPhua KSAng KKKuah CW, and others. 2013Resting state changes in functional connectivity correlate with movement recovery for BCI and robot-assisted upper-extremity training after stroke. Neurorehabil Neural Repair 27(1):5362Google Scholar Link
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<via Restoring Motor Functions After Stroke: Multiple Approaches and OpportunitiesThe Neuroscientist – Estelle Raffin, Friedhelm C. Hummel, 2017>

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[Abstract] Neurotech: Robotic Assist Devices Show Gains in Walking for Crouch Gait in Cerebral Palsy and Post-Stroke Hemiparesis

via Neurotech: Robotic Assist Devices Show Gains in Walking for… : Neurology Today

ARTICLE IN BRIEF

Figure

Developers of robotic devices discuss advances in the technologies to help people improve walking post-stroke and improve couch gait in cerebral palsy. Independent experts in neurorehabilitation review the potential and possible caveats of these devices.

Three novel robotic assistance devices, one for hemiparetic gait following stroke, and two for crouch gait in children with cerebral palsy, have each demonstrated improved walking in preliminary clinical trials.

For stroke patients, a robotic exosuit made of a soft, clothing-like anchor attached to motorized cables was shown to increase the paretic limb’s forward propulsion and the paretic ankle’s swing phase dorsiflexion in both treadmill and over-ground walking.

For children with crouch gait due to cerebral palsy, one trial used a cable-driven robot called a Tethered Pelvic Assist Device, or TPAD. The laboratory-based device is designed to strengthen the extensor muscles, especially the soleus in the calves, by putting downward pressure on them during training. After six weeks of practice with the device, the children’s posture was more upright, with greater step length and toe clearance, when walking without it.

Also for children with crouch gait, the third study examined the use of a wearable exoskeleton that provides a burst of knee extension assistance at just the right moment when a child or adolescent is walking. None of the seven participants, age 5 to 17, fell while using it, and six of the seven showed postural improvements equivalent to those previously reported from surgery.

While promising, the devices will require far more testing in randomized trials before their true value can be known, said a leading specialist in neurological rehabilitation.

“These are foundational studies; they’re just beginning to get started,” said Bruce H. Dobkin, MD, FRCP, distinguished professor of clinical neurology and director of the Neurological Rehabilitation and Research Program at the Geffen School of Medicine at the University of California, Los Angeles. “The cost, safety, user-friendliness, and ability to use at differing levels of disability severity — all those are major challenges.”

Even so, each of the three devices employs a new kind of robotic assistance unlike any existing on the market.

“Most robotics for neurological injuries are heavy, power-hungry exosuits for people with spinal cord injuries who can’t walk at all,” said a coauthor of the study for stroke patients, Terry D. Ellis, PT, PhD, NCS, director of the Center for Neurorehabilitation at Boston University. “But there’s a whole bunch of people who have disabilities, who can walk, but don’t walk well. They need facilitation or augmentation to restore some of the normal components of walking.”

A ROBOT POST-STROKE

Published in the July 26 edition of Science Translational Medicine, the study of a robotic exosuit tested in nine post-stroke patients used what it called “garment-like, functional textile anchors” rather than a hard, metallic exterior. Worn on only the paretic limb, the suit was designed to be as unobtrusive as possible.

“It’s much more compatible with the real world than a rigid device would be,” said the first author of the paper, Louis N. Awad, PT, DPT, PhD, an assistant professor of physical therapy at Boston University, and a research faculty member at Spaulding Rehabilitation Hospital. “Ordinary clothes are made of soft material. We don’t don a metallic pair of pants and walk out the door. That’s our goal — robotic clothing that helps people with difficulty walking.”

Attached to cables tethered to a belt worn around the hips, the exosuit functioned in synchrony with a wearer’s paretic limb to facilitate an immediate increase in the paretic ankle’s swing phase dorsiflexion and forward propulsion (p< 0.05), according to the paper.

The improved movements resulted in a 20 percent reduction in forward propulsion interlimb asymmetry and a 10 percent reduction in the energy cost of walking, which together were equivalent to a nearly one-third lower metabolic burden — a 32 percent reduction — while walking.

Although the study did include some over-ground walking, it was not designed to test whether the exosuit had any therapeutic effects that might carry over to when patients are not wearing it.

“This is a proof of concept paper,” said Dr. Ellis. “Down the road we need to conduct trials in more ecologically valid environments, and to see if it has therapeutic value. For now we wanted to demonstrate that the device can facilitate more normal walking.”

While applauding the study as “clever,” Dr. Dobkin said it remained to be seen whether the robotic exosuit would prove to have significant therapeutic effects that would stand up in randomized trials in natural environments. He pointed to randomized trials published in recent years showing that peroneal nerve functional electrical stimulators have no greater therapeutic effect than do standard ankle-foot orthoses.

“It’s similar to all the work that was done using the electrical stimulation of the ankle,” Dr. Dobkin said. “The real question is whether it will lead to improved function when you walk over-ground. Walking on a treadmill is not terribly natural.”

He also pointed out that the nine patients in the study were able to walk on average at about two miles per hour. “That’s already pretty fast,” he said. In addition, he said, the 20 percent reduction in interlimb asymmetry is relatively modest.

But, said Dr. Dobkin, people can improve their gait by 20 percent just by sustained practice. “When you see modest changes like this with the device, you wonder if the same changes couldn’t have been achieved without it,” he said.

Steven L. Wolf, PhD, PT, FAPTA, FAHA, professor in the department of rehabilitation medicine at Emory University School of Medicine, pointed out that existing robotic devices to help people who are completely unable to walk can cost patients up to $250,000. Perhaps the exosuit might become an improvement over what presently exists both in terms of function and cost, he said.

“Most existing devices are beautiful but incredibly expensive,” Dr. Wolf said. “Is the bang in the buck? Not as yet, in my opinion. The evidence for persistent benefit from these device is just not there.”

IMPROVING CROUCH GAIT IN CP

The first of the two studies using robotic devices to improve crouch gait in children with cerebral palsy was published on July 26 in Science Robotics, led by senior author Sunil K. Agrawal, PhD, professor of mechanical engineering and rehabilitation medicine at Columbia University.

Rather than directly straighten the children’s posture, Dr. Agrawal’s seemingly contradictory approach was to increase the downward force on their pelvis as they attempted to walk on a treadmill. The tension in each wire, attached to a belt on the pelvis, is modulated in real time by a motor placed around the treadmill in response to motion capture data from cameras. Unlike other robotic devices that have been tested for treating crouch gait, the TPAD has no rigid links to the body, permitting free movement of the legs.

After training in the device for 15 sessions of 16 minutes each over the course of six weeks, the six participants showed enhanced upright posture, improved muscle coordination, increased step length, range of motion of the lower limb angles, toe clearance, and heel-to-toe pattern.

“You can see a marked difference before and after,” Dr. Agrawal said. “We heard from families and the children themselves that they were walking faster, with better posture. Now we have to see if we should use a higher magnitude of downward pull, how long each training session should be, and for how many sessions.”

Commenting on the TPAD study, Dr. Dobkin said, “The kids who were selected for inclusion were not necessarily the kind who get surgery. They had less of a crouch, a little bit more of a push-off. The question is whether training like this will lead to good over-ground walking. They got a hint of that.”

The second crouch-gait study, published on August 23 in Science Translational Medicine, involved a wearable exoskeleton designed for over-land use, and was described by the authors as the first robotic device designed specifically to treat a gait disorder in children and adolescents. Rather than force the lower limb to move in a particular way, “the exoskeleton dynamically changed the posture by introducing bursts of knee extension assistance during discrete portions of the walking cycle, a perturbation that resulted in maintained or increase knee extensor muscle activity during exoskeleton use,” the paper stated.

“In the last decade, there’s been a groundswell of work on exoskeletons, but a majority of them are designed to permit mobility after spinal injury in adults who have lost the ability to walk,” said senior author Thomas Bulea, PhD, a staff scientist in the functional and applied biomechanics section of the rehabilitation medicine department at the National Institutes of Health Clinical Center in Bethesda, MD. “There hasn’t been much done for the pediatric population who just need to improve their walking.”

A coauthor of the paper, Diane L. Damiano, PT, PhD, chief of the section in which Dr. Bulea works, said the purpose of the wearable exoskeleton is different than that of the TPAD device developed by Dr. Agrawal.

“His device is designed to strengthen the calf muscles by increasing the resistance on them,” she said. “His results were good, but this is very different from what we are doing. We have a wearable device. It’s not meant to be used in a lab for training. We’re not necessarily trying to strengthen them, although that would be a desired outcome; we are instead trying to assist their abilities to help them practice being more upright while they walk. This is something that they would wear throughout the day for several months with the goal that their posture will ultimately be improved without the device.”

A surprising observation, she added, was that some children saw it as something cool to wear.

LINK UP FOR MORE INFORMATION:

•. Awad LN, Bae J, O’Donnell K, et al A soft robotic exosuit improves walking in patients after stroke http://stm.sciencemag.org/content/9/400/eaai9084. Sci Transl Med 2017; 9 (400). pii: eaai9084.

•. Video of the soft robotic exosuit for stroke patients: http://www.sciencetranslationalmedicine.org/cgi/content/full/9/400/eaai9084/DC1

•. Kang J, Martelli D, Vashista V, et al Robot-driven downward pelvic pull to improve crouch gait in children with cerebral palsy http://robotics.sciencemag.org/content/2/8/eaan2634. Sci Robot 2017;2(8): eaan2634.

•. Video of the robot-driven downward pelvic pull device can be seen at http://engineering.columbia.edu/news/sunil-agrawal-cerebral-palsy-crouch-gait

•. Lerner ZF, Damiano DL, Bulea TC. A lower-extremity exoskeleton improves knee extension in children with crouch gait from cerebral palsy http://stm.sciencemag.org/content/9/404/eaam9145. Sci Transl Med 2017; 9 (404). pii: eaam9145.

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[BOOK] Serious Games in Physical Rehabilitation: From Theory to Practice – Google Books

Front Cover
SpringerOct 30, 2017 – Medical – 146 pages

Marketing text: This innovative book explores how games can be serious, even though most people generally associate them with entertainment and fun. It demonstrates how videogames can be a valuable tool in clinics and demonstrates how clinicians can use them in physical rehabilitation for various pathologies. It also describes step by step their integration in rehabilitation, from the (gaming) technology used to its application in clinics. Further, drawing on an extensive literature review, it discusses the pros and cons of videogames and how they can help overcome certain obstacles to rehabilitation.

The last part of the book examines the main challenges and barriers that still need to be addressed to increase and improve the use and efficacy of this new technology for patients. The book is intended for physiotherapists and clinicians alike, providing a useful tool for all those seeking a comprehensive overview of the field of serious games and considering adding it to conventional rehabilitation treatment.

via Serious Games in Physical Rehabilitation: From Theory to Practice – Bruno Bonnechère – Google Books

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[WEB SITE] ISU Engineering continues work on Augmented Reality Device to Aid Arm Rehabilitation

Photo 1

Alba Perez-Gracia and student Omid Heidari demonstrating the virtual reality system.
Photo courtesy of Idaho State University

 

“We have accomplished half of the work, which is creating the engineering systems to test this work and now we have to develop the protocol for using it for rehabilitation to see how well it works,” said Alba Perez-Gracia, ISU chair and associate professor of mechanical engineering, and a lead researcher on the project.

The ISU researchers, who are working on this collaborative project with Texas A&M and California State University, Fullerton, first mapped arm motions and digitalized them and then have created a virtual world where people wearing a portable virtual-reality device can use the system as a therapeutic intervention. The researchers will soon be testing the new tool with human subjects.

Subjects wear a virtual reality headset and use it to complete tasks created for the virtual world. The virtual reality system picks up the actual movements of their own arm and displays it as a cartoon figure within the virtual world. The subject may then participate in the virtual world task that include picking up balls and throwing them at a target or stacking cubes using their right or left hand. In addition, the system has been developed to reflect the image of the arm being used.

For example, if a person is using the right arm to complete the task, the virtual reality system reflects the image so that the cartoon arm actions being portrayed look as if it is the left arm performing the task. This reflected image of arm function has the potential to be used as a therapeutic intervention because previous research has shown that observing an action activates the same area of the brain as performing the action.

“It is called the mirror neuron system,” said Nancy Devine, associate dean of the ISU School of Rehabilitation and Communications Sciences, who is a co-researcher on the project. “When you observe body movements, the cells in the brain that would produce that movement are active even though that arm isn’t being used.”

She said if you just look at brain activity, in some areas of the brain you can’t distinguish an active movement from an observed movement.

“So, if you take someone who has had a stroke and can’t use one arm, you can take their arm that is still working and reflect it to the other arm by putting them in this engaging virtual environment and we can be providing an exercise that is effective in helping rehabilitate the damaged areas,” Devine added.

Although the work on this specific project ends at the end of the academic year, ISU’s work on this type of project may continue.

“We have created the portable virtual-reality device that the patient can wear, which projects the motion happening for the patients,” Perez-Gracia said. “We hope it will be a starting point for future projects on using virtual reality and robotics for helping in rehabilitation and training of human motion.”

This research has been taking place at the ISU Robotics Laboratory and the Bioengineering laboratory at the Engineering Research Complex. On this project, Perez-Gracia and Devine have been working with the third researcher of the team, Marco P. Schoen, professor of mechanical engineering, Omid Heidari, a doctoral student in mechanical engineering, master of science students A.J. Alriyadh, Asib Mahmud, Vahid Pourgharibshahi and John Roylance, and undergraduate students Dillan Hoy, Madhuri Aryal and Merat Rezai. Eydie Kendall, assistant professor of physical and occupational therapy, also collaborated on the project.

“We have very good equipment here that we can do experiments with and that is very appealing,” said Heidari, who said the laboratory has become his second home. “Instead of just writing code on computers and stuff, we are actually doing something here that is very practical and very interesting. We did the motion capture, the kinematic part, and now we are working on finishing the virtual reality part of the project. We are getting closer to having a good model of what we want.”

via ISU Engineering continues work on Augmented Reality Device to Aid Arm Rehabilitation | Community | idahostatejournal.com

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[BLOG POST] SaeboFlex Helps Client Regain Hand Function 23 Years After Stroke

SaeboFlexStroke survivor exhibits remarkable improvement in hand function more than two decades after stroke, disproving theories that recovery window is limited to 6 months. 

Charlotte, N.C. – Tuesday, July 25, 2017 – Until recently, researchers believed that if a stroke survivor exhibited no improvement within the first 6 months, then he or she would have little to no chance of regaining motor function in the future. This assumed end of recovery is called a plateau. However, a groundbreaking new article published in the Journal of Neurophysiology discusses a stroke patient’s remarkable improvement decades after suffering a stroke at the age of 15. Doctors Peter Sörös, Robert Teasell, Daniel F. Hanley, and J. David Spence formally dismiss previous theories that stroke recovery occurs within 6 months, reporting that the patient experienced “recovery of hand function that began 23 years after the stroke.”

The patient’s stroke resulted in paralysis on the left side of his body, rendering his left hand completely nonfunctional, despite regular physical therapy. More than twenty years after his stroke, the patient took up swimming when his doctor recommended he lose weight. A year later, he began to show signs of movement on his affected side and returned to physical therapy. Therapists fitted the patient with the SaeboFlex, a mechanical device shown to improve hand function and speed up recoveryand, after only a few months of therapy, he began picking up coins with his previously nonfunctional hand. He also saw notable improvement in hand strength and control with the SaeboGlove, a low-profile hand device recently patented by Saebo.

Functional MRI studies showed the reorganization of sensorimotor neurons in both sides of the patient’s brain more than two decades after his stroke, resulting in a noticeable recovery in both hemispheres and improved motor function. “The marked delayed recovery in our patient and the widespread recruitment of bilateral areas of the brain indicate the potential for much greater stroke recovery than is generally assumed,” the doctors reported. “Physiotherapy and new modalities in development might be indicated long after a stroke.”

“This article highlights what we have seen for the last 15 years with many of our clients,” states Saebo co-founder, Henry Hoffman. “Oftentimes, stroke survivors are told that they have plateaued and no further progress is possible. We believe it is not the client that has plateaued but failed treatment options have plateaued them. In other words, traditional therapy interventions that lack scientific evidence can be ineffective and can actually facilitate the plateau.”

“The SaeboFlex device is a life-changing treatment designed for clients that lack motor recovery and function,” Hoffman continues. “Whether the client recently suffered a stroke or decades later, they can immediately begin using their hand with this device and potentially make significant progress over time. I agree with the authors that the neurorehabilitation community needs to take a hard look at traditional beliefs with respect to the window of recovery following stroke. It is my hope that this article will spark more interest by researchers to investigate upper limb function with clients at the chronic stage using Saebo’s hand technology.”

The abstract and article in its entirety can be viewed at the Journal of Neurophysiology’s website, jn.physiology.org.

If you are suffering from limited hand function or have been told you have plateaued, then schedule a call with a Saebo Specialist or click here to get started on the road to recovery.

via SaeboFlex Helps Client Regain Hand Function 23 Years After Stroke | Saebo

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[VIDEO] Can functional electrical stimulation restore function? – YouTube

Daniel Becker, MD | The Johns Hopkins University School of Medicine and INI October 21, 2017

via Can functional electrical stimulation restore function? – YouTube

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[WEB SITE] Hot Topic Module: Changes in Memory After Traumatic Brain Injury

This Hot Topic Module consists of a suite of resources to help individuals with traumatic brain injury understand changes in memory after TBI and offers strategies that can help people who experience this function more effectively.

Resources

TBI and Memory Resources

VIDEOS: Changes in Memory After Traumatic Brain Injury
Our featured video and brief video clips explain changes in memory after traumatic brain injury (TBI). Jason Cowper and Tonya Howell share their stories of coming to terms with changes in their memory, and strategies they use to compensate for these changes. The video also includes the perspectives of TBI experts at the Texas TBI Model System of TIRR Memorial Hermann, who provide clinical insight on the changes in memory that some people experience after sustaining a TBI. View the featured video here. View additional video clips here.

FACTSHEET: Memory and Moderate to Severe Traumatic Brain Injury
This fact sheet explains memory problems that may affect people with moderate to severe traumatic brain injury (TBI). By understanding the new limits on their memory and ways to help overcome those limits, people with TBI can still get things done every day. View the factsheet here.

SLIDESHOW: Memory and Moderate to Severe Traumatic Brain Injury
Memory problems are very common in people with moderate to severe TBI. The information in this slideshow explains memory problems that may affect people with moderate to severe TBI. By understanding the new limits on their memory and ways to help overcome those limits, people with TBI can still get things done every day. View the slideshow here.

Related Reso

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FACTSHEET: Depression After Traumatic Brain Injury
Fatigue is one of the most common problems people have after a traumatic brain injury (TBI). If you are experiencing fatigue, there are things you can do to decrease feelings of exhaustion, tiredness, weariness or lack of energy. The information in this factsheet describes causes of fatigue after TBI and ways to help alleviate these problems. View the factsheet here.

FACTSHEET: Emotional Problems After Traumatic Brain Injury
A brain injury can change the way people feel or express emotions. An individual with TBI can have several types of emotional problems. This factsheet discusses possible emotional problems and what can be done about depression. View the factsheet here.

SLIDESHOW: Emotional Problems After Traumatic Brain Injury
Emotional problems occur in people after a traumatic brain injury (TBI). A brain injury can change the way people feel or express emotions. An individual with TBI can have several types of emotional problems. The information in this slideshow describes the causes of emotional problems after a TBI. View the slideshow here.

via Memory

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[ARTICLE] How a diverse research ecosystem has generated new rehabilitation technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers – Full Text

Abstract

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program.

Background

Disabilities cause complex problems in society often unique to each person. A physical disability can limit a person’s ability to access buildings and other facilities, drive, use public transportation, or obtain the health benefits of regular exercise. Blindness can limit a person’s ability to interpret images or navigate the environment. Disabilities in speaking or writing ability may limit the effectiveness of communication. Cognitive disabilities can alter a person’s employment opportunities. In total, a substantial fraction of the world’s population – at least 1 in 6 people – face these individualized problems that combine to create major societal impacts, including limited participation. Further, the average person in the United States can expect to live 20% of his or her life with disability, with the rate of disability increasing seven-fold by age 65 [1].

In light of these complex, pervasive issues, the field of rehabilitation engineering asks, “How can technology help?” Answering this question is also complex, as it often requires the convergence of multiple engineering and design fields (mechanical, electrical, materials, and civil engineering, architecture and industrial design, information and computer science) with clinical fields (rehabilitation medicine, orthopedic surgery, neurology, prosthetics and orthotics, physical, occupational, and speech therapy, rehabilitation psychology) and scientific fields (neuroscience, neuropsychology, biomechanics, motor control, physiology, biology). Shaping of policy, generation of new standards, and education of consumers play important roles as well.

In the US, a unique research center structure was developed to try to facilitate this convergence of fields. In the 1970’s the conceptual model of a Rehabilitation Engineering Center (REC), focusing engineering and clinical expertise on particular problems associated with disability, was first tested. The first objective of the nascent REC’s, defined at a meeting held by the Committee on Prosthetic Research and Development of the National Academy of Sciences, was “to improve the quality of life of the physically handicapped through a total approach to rehabilitation, combining medicine, engineering, and related science” [2]. This objective became a working definition of Rehabilitation Engineering [2].

The first five centers focused on topics including functional electrical stimulation, powered orthoses, neuromuscular control, the effects of pressure on tissue, prosthetics, sensory feedback, quantification of human performance, total joint replacement, and control systems for powered wheelchairs and the environment [2]. The first two RECs were funded by the Department of Health, Education, and Welfare in 1971 at Rancho Los Amigos Medical Center in Downey, CA, and Moss Rehabilitation Hospital in Philadelphia. Three more were added the following year at the Texas Institute for Rehabilitation and Research in Houston, Northwestern University/the Rehabilitation Institute of Chicago, and the Children’s Hospital Center in Boston, involving researchers from Harvard and the Massachusetts Institute of Technology [3]. The Rehabilitation Act of 1973 formally defined REC’s and mandated that 25 percent of research funding under the Act go to them [2]. The establishment of these centers was stimulated by “the polio epidemic, thalidomide tragedy and the Vietnam War, as well as the disability movement of the early 70s with its demands for independence, integration and employment opportunities” [3].

After the initial establishment of these RECs, the governmental funding agency evolved into the National Institute on Disability and Rehabilitation Research (NIDRR, a part of the U.S. Department of Education), and now is the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR, a part of the U.S. Department of Health and Human Services. Today, as we describe below, the RERC’s study a diverse set of technologies and their use by people with a disability, including human-computer interaction, mobile computing, wearable sensors and actuators, robotics, computer gaming, motion capture, wheeled mobility, exoskeletons, lightweight materials, building and transportation technology, biomechanical modeling, and implantable technologies. For this review, we invited all RERCs that were actively reporting to NIDILRR at the onset of this review project in 2015, and had not begun in the last two years, to participate. These were centers that were funded (new or renewal) in the period 2008-2013, except the RERC Wheelchair Transportation Safety, which was funded from 2001-2011. Two of the RERCs did not respond (see Table 1). For each center, we asked it to describe the user needs it targets, summarize key advances that it had made, and identify emerging innovations and opportunities. By reviewing the scope of rehabilitation engineering research through the lens of the RERCs, our goal was to better understand the evolving nature and demands of rehabilitation technology development, as well as the influence of a multidisciplinary structure, like the RERCs, in shaping the producing of such technology. We also performed an analysis of how multidisciplinary the current RERCs actually are (see Table 3), and asked the directors to critique and suggest future directions for the RERC program.[…]

Continue —>  How a diverse research ecosystem has generated new rehabilitation technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 14 Some MARS RERC projects. a) The KineAssist MX® Gait and Balance Device b) The Armeo Spring® reaching assistance device c) The March Hare virtual reality therapy game d) The Lokomat® gait assistance robot e) Robotic Error Augmentation between the therapist and patient f) lever drive wheelchair g) Ekso® exoskeleton h) Body-machine interface for device control

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[WEB SITE] SaeboStep

Get Your FREE Stroke Recovery Exercise Guide! Download

Walk Smarter. Confidence and comfort are one step away.

The SaeboStep consists of a lightweight, uniquely designed foot drop brace that provides convenience and comfort while offering optimum foot clearance and support during walking.

The SaeboStep was designed to replace uncomfortable, stiff, or bulky splints that go inside the shoe as well as poorly manufactured braces designed for outside of the shoe that lack support and durability.

 Learn more about the features and benefits

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Stylish. Safe. Sturdy.

Foot Drop. What is it and how does it affect your recovery?

Foot drop, also known as dropped foot or drop foot, is the inability to raise the front part of the foot due to weakness or paralysis of the muscles that lift the foot (National Institute of Neurological Disorders).

Consequentially, people who have foot drop scuff their toes along the ground; they may also bend their knees to lift their foot higher than usual to avoid the scuffing, which causes what is called a “steppage” gait.

 Learn more about Foot Drop

Why use the SaeboStep?

Universal Eyelets

No Laces? No Problem.

The SaeboStep can even be worn comfortably with the majority of male or female shoe styles. Individuals can use their favorite shoes by ordering the accessory kit to enable footwear without eyelets to be modified.

Learn how to customize your favorite shoes.

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[Abstract] Virtual Rehabilitation through Nintendo Wii in Poststroke Patients: Follow-Up

Objective

To evaluate in the follow-up the sensory-motor recovery and quality of life patients 2 months after completion of the Nintendo Wii console intervention and determine whether learning retention was obtained through the technique.

Methods

Five hemiplegics patients participated in the study, of whom 3 were male with an average age of 54.8 years (SD = 4.6). Everyone practiced Nintendo Wii therapy for 2 months (50 minutes/day, 2 times/week, during 16 sessions). Each session lasting 60 minutes, under a protocol in which only the games played were changed, plus 10 minutes of stretching. In the first session, tennis and hula hoop games were used; in the second session, football (soccer) and boxing were used. For the evaluation, the Fulg-Meyer and Short Form Health Survey 36 (SF-36) scales were utilized. The patients were immediately evaluated upon the conclusion of the intervention and 2 months after the second evaluation (follow-up).

Results

Values for the upper limb motor function sub-items and total score in the Fugl–Meyer scale evaluation and functional capacity in the SF-36 questionnaire were sustained, indicating a possible maintenance of the therapeutic effects.

Conclusion

The results suggest that after Nintendo Wii therapy, patients had motor learning retention, achieving a sustained benefit through the technique.

via Virtual Rehabilitation through Nintendo Wii in Poststroke Patients: Follow-Up

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