Archive for category Gait/Drop Foot

[Abstract] An attempt to explain the Vojta therapy mechanism of action using the surface polyelectromyography in healthy subjects: A pilot study

Abstract

Background

Rehabilitation according to Vojta is a neurophysiological method used to obtain reflex responses in muscles following stimulation of particular activation zones.

Objectives

This study aims to objectively evaluate the muscular responses following stimulation according to Vojta’s method. The possible routes of spinal transmission responsible for the phenomenon of muscle activation in upper and lower extremities are considered.

Methods

Polyelectromyographic (pEMG) recordings in the upper and lower extremities in healthy volunteers (N = 25; aged 24 ± 1 year) were performed to find out the possible routes of spinal transmission, responsible for muscle activation. The left acromion and right femoral epicondyle were stimulated by a Vojta therapist; pEMG recordings were made including the bilateral deltoid and rectus femoris muscles.

Results and Discussion

Following acromion stimulation, muscle activation was mostly expressed in the contralateral rectus femoris, rather than the contralateral deltoid and the ipsilateral rectus femoris muscles. After stimulation of the lower femoral epicondyle, the following order was observed: contra lateral deltoid, ipsilateral deltoid and the contra lateral rectus femoris muscle.

One of the candidates responsible for the main crossed neural transmission involved in the Vojta therapy mechanism would be the long propriospinal tract neurons.

Source: An attempt to explain the Vojta therapy mechanism of action using the surface polyelectromyography in healthy subjects: A pilot study

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Smart walk assist improves rehabilitation – YouTube

Using smart algorithms to help the brain develop a new way of walking after a stroke. Incredible advances in rehab technologies!

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[WEB SITE] FDA Approves WP-FES for Restorative Therapies’ RT300 FES Cycling System

Published on July 19, 2017

The US Food and Drug Administration has granted marketing clearance to Wide Pulse Functional Electrical Stimulation (WP-FES) for the RT300 cycling system from Restorative Therapies Inc.

This clearance allows Restorative Therapies Inc to begin marketing RT300 systems incorporating the new WP-FES functionality in the United States. It also allows the RT300 cycling system to be marketed for neuromuscular re-education in addition to its existing indications, according to a media release from Restorative Therapies Inc.

According to the Baltimore-based company, WP-FES provides wider stimulation pulses (up to 3,000 microseconds) to help recruit muscles in many patients who are normally less or not responsive to standard FES.

“This development will help to make FES cycling effective in a wider range of patients and help to facilitate clinical use of the latest therapy techniques improving outcomes for patients,” says Andrew Barriskill, CEO of Restorative Therapies, in the release.

“RT300 is the only FES cycling system that offers WP-FES and neuromuscular re-education,” adds Judy Kline, marketing manager at Restorative Therapies.

[Source(s): Restorative Therapies Inc, PRWeb]

Source: FDA Approves WP-FES for Restorative Therapies’ RT300 FES Cycling System – Rehab Managment

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[Abstract] Use of Lower-Limb Robotics to Enhance Practice and Participation in Individuals With Neurological Conditions

Purpose: To review lower-limb technology currently available for people with neurological disorders, such as spinal cord injury, stroke, or other conditions. We focus on 3 emerging technologies: treadmill-based training devices, exoskeletons, and other wearable robots.

Summary of Key Points: Efficacy for these devices remains unclear, although preliminary data indicate that specific patient populations may benefit from robotic training used with more traditional physical therapy. Potential benefits include improved lower-limb function and a more typical gait trajectory.

Statement of Conclusions: Use of these devices is limited by insufficient data, cost, and in some cases size of the machine. However, robotic technology is likely to become more prevalent as these machines are enhanced and able to produce targeted physical rehabilitation.

Recommendations for Clinical Practice: Therapists should be aware of these technologies as they continue to advance but understand the limitations and challenges posed with therapeutic/mobility robots.

Source: Use of Lower-Limb Robotics to Enhance Practice and Participa… : Pediatric Physical Therapy

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[WEB SITE] New algorithm helps neurological disorder patients to walk naturally

Soon, wheelchairs may no longer be needed; new research enables patients with neurological disorders to walk again.

Millions of people cannot move their limbs as a result of a neurological disorder or having experienced an injury. But a newly developed algorithm, when coupled with robot-assisted rehabilitation, can help patients who had a stroke or a spinal cord injury to walk naturally.

In the United States, there are approximately 17,000 new cases of spinal cord injury (SCI) every year. Of these, 20 percent result in complete paraplegia (paralysis of the legs and lower half of body) and over 13 percent result in tetraplegia (paralysis of all four limbs).

But SCI is not the only reason that people experience this type of disability. Stroke, multiple sclerosis, cerebral palsy, and a range of other neurological disorders can all lead to paralysis. In fact, a recent survey estimated that in the U.S., almost 5.4 million people live with paralysis, with stroke being the leading cause of this disability.

Now, researchers from the National Centre of Competence in Research Robotics at École Polytechnique Fédérale de Lausanne (EPFL), and at the Lausanne University Hospital in Switzerland, have come up with a groundbreaking technology that may help these patients to regain their locomotor skills.

The scientists came up with an algorithm that helps a robotic harness to facilitate the movements of the patients, thus enabling them to move naturally.

The new research has been published in the journal Science Translational Medicine, and the first author of the study is Jean-Baptiste Mignardot.

Helping people to walk again

Current rehabilitation technologies for people with motor disabilities as a result of SCI or stroke involve walking on a treadmill, with the upper torso being supported by an apparatus. But existing technologies are either too rigid or do not allow the patients to move naturally in all directions.

As the authors of the new study explain, the challenge of locomotor rehabilitation resides in helping the nervous system to “relearn” the right movements. This is difficult due to the loss of muscle mass in the patients, as well as to the neurological wiring that has “forgotten” correct posture.

In order to overcome these obstacles and promote natural walking, Mignardot and colleagues designed an algorithm that coordinates with a robotic rehabilitation harness. The team tested the algorithm in more than 30 patients. The “smart walk assist” markedly and immediately improved the patients’ locomotor abilities.

This mobile harness, which is attached to the ceiling, enables patients to walk. This video shows how it works:

Additionally, after only 1 hour of training with the harness and algorithm, the “unsupported walking ability” of five of the patients improved considerably. By contrast, 1 hour on a conventional treadmill did not improve gait.

The researchers developed the so-called gravity-assist algorithm after carefully monitoring the movements of the patients and considering parameters such as “leg movement, length of stride, and muscle activity.”

As the authors explain, based on these measurements, the algorithm identifies the forces that must be applied to the upper half of the body in order to allow for natural walking.

The smart walk assist is an innovative body-weight support system because it manages to resist the force of gravity and push the patient back and forth, to the left and to the right, or in more of these directions at once, which recreates a natural gait and movement that the patients need in their day to day lives.

Grégoire Courtine, a neuroscientist at EPFL and the Lausanne University Hospital, comments on the significance of the findings, saying, “I expect that this platform will play a critical role in the rehabilitation of walking for people with neurological disorders.”

This is a smart, discreet, and efficient assistance that will aid rehabilitation of many persons with neurological disorders.”

Prof. Jocelyne Bloch, Department of Neurosurgery, Lausanne University Hospital

Source: New algorithm helps neurological disorder patients to walk naturally

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[WEB SITE] Integration of FES Into G-EO System Gait Trainer Receives FDA Nod

Reha Technology USA Inc announces it now offers FDA-approved integrated Functional Electronic Stimulation (FES) for its G-EO System Evolution robotic gait trainer.

“The FES in conjunction with the G-EO System will allow clinicians to generate contractions in paralyzed or weakened muscles in lower extremities at the appropriate time in the walking cycle to maximize patient outcomes,” says Matthew Brooks, clinical director of Reha Technology USA Inc, in a media release.

The G-EO System robotic gait trainer provides passive and active, assistive and resistive training and the simulation of stairs walking up and down.

“We look forward to add this integrated FES feature to all of our current and future customers and we are confident that this extended offering will create added value for their therapy environment,” adds executive VP Paul Abrams, in the release.

[Source(s): Reha Technology USA Inc, PR Newswire]

Source: Integration of FES Into G-EO System Gait Trainer Receives FDA Nod – Rehab Managment

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[BLOG POST] Multifractality, interactivity, and the adaptive capacity of the human movement system: a perspective for advancing the conceptual basis of neurologic physical therapy.

By James T Cavanaugh, PT, PhD; Damian G. Kelty-Stephen, PhD; Nicholas Stergiou, PhD

Provisional Abstract
Background and Purpose: Physical therapists seek to optimize movement as a means of reducing disability and improving health. The short-term effects of interventions designed to optimize movement ultimately are intended to be adapted for use across various future patterns of behavior, in potentially unpredictable ways, with varying frequency, and in the context of multiple tasks and environmental conditions. In this perspective paper, we review and discuss the implications of recent evidence that optimal movement variability, which previously had been associated with adaptable motor behavior, contains a specific complex nonlinear feature known as “multifractality.”

Summary of Key Points: Multifractal movement fluctuation patterns reflect robust physiologic interactivity occurring within the movement system across multiple time scales. Such patterns provide conceptual support for the idea that patterns of motor behavior occurring in the moment are inextricably linked in complex, physiologic ways to patterns of motor behavior occurring over much longer time periods. The human movement system appears to be particularly tuned to multifractal fluctuation patterns and exhibits the ability to reorganize its output in response to external stimulation embedded with multifractal features.

Recommendations for Clinical Practice: As a fundamental feature of human movement, multifractality opens new avenues for conceptualizing the link between physiologic interactivity and adaptive capacity. Preliminary evidence supporting the positive influence of multifractal rhythmic auditory stimulation on the gait patterns of individuals with Parkinson disease is used to illustrate how physical therapy interventions might be devised to specifically target the adaptive capacity of the human movement system.

Video Abstract Available: For more insights from the authors, see Supplemental Digital Content 1, [insert link here].

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Source: JUST ACCEPTED: “Multifractality, interactivity, and the adaptive capacity of the human movement system: a perspective for advancing the conceptual basis of neurologic physical therapy” |

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[ARTICLE] Effect of upper extremity coordination exercise during standing on the paretic side on balance, gait ability and activities of daily living in persons with stroke – Full Text PDF

Objective: The purpose of this study was to determine the effect of upper extremity coordination exercise (UECE) during standing on the paretic side on balance, gait ability and activities of daily living (ADL) in persons with stroke.
Design: A randomized controlled trial.
Methods: A total of 27 patients with hemiplegic diagnosis after stroke were divided into two groups. Fourteen patients were in the study group and 13 patients were in the control group. The study group received conventional physical therapy and UECE during standing on the paretic side. The control group received conventional physical therapy and simple upper extremity exercise (SUEE). Subjects in both groups were given upper extremity training for 30 minutes per day, five times a week for 4 weeks. Initial evaluation was performed before treatment and reevaluated 4 weeks later to compare the changes of balance, gait ability and ADL (Korean version of modified Barthel index, K-MBI).
Results: Both groups showed a significant effect for balance, gait ability and ADL (p<0.05). In the Independent t-test, between both groups showed a significant effect for balance and gait ability except ADL (p<0.05).
Conclusions: In this paper, we investigated the changes in balance, walking, and ADL through UECE. We found significant changes in the study group and the control group. Results of the present study indicated that UECE during standing on the paretic side for 4 weeks had an effect on balance, gait ability and ADL (K-MBI) in persons with hemiplegia after stroke.

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[BLOG POST] Get Back On Your Feet with Exercises for Foot Drop – Saebo

Foot drop (sometimes called drop foot or dropped foot) is the inability to raise the front of the foot due to weakness or paralysis of the muscles and nerves that lift the foot. Foot drop itself is not a disease, it is a symptom of a greater problem or medical condition.

You can recognize foot drop by how it affects your gait. Someone with foot drop may drag their toes along the ground when walking because they cannot lift the front of their foot with each step. In order to avoid dragging their toes or tripping they might lift their knee higher or swing their leg in a wide arc instead. This is called steppage gait, and is a coping mechanism for foot drop issues.

Causes of Foot Drop

There are three main causes of the weakened nerves or muscles that lead to foot drop:

1: Nerve Injury. The peroneal nerve is the nerve that communicates to the muscles that lift the foot. Damage to the peroneal nerve is the most common cause of foot drop. The nerve wraps from the back of the knee to the front of the shin and sits closely to the surface, making it easy to damage. Damage to the peroneal nerve can be caused by sports injuries, hip or knee replacement surgery, a leg cast, childbirth or even crossing your legs.

2: Muscle Disorders. A condition that causes the muscles to slowly weaken or deteriorate can also cause foot drop. These disorders may include muscular dystrophy, amyotrophic lateral sclerosis (Lou Gehrig’s disease) and polio.

3: Brain or Spinal Disorders. Neurological conditions can also cause foot drop. Conditions may include stroke, multiple sclerosis (MS), cerebral palsy and Charcot-Marie-Tooth disease.

How Foot Drop is Treated

Treatment for foot drop requires treating the underlying medical condition that caused it. In some cases foot drop can be permanent, but many people are able to recover. There are a number of treatments that can help with foot drop:

1: Surgery

If your foot drop is caused by a pinched nerve or herniated disc then you will likely have surgery to treat it. Surgery may also be necessary to repair muscles or tendons if they were directly damaged and are causing foot drop. In severe or long term cases, you might have surgery to fuse your ankle and foot bones and improve your gait.

2: Functional Electrical Stimulation

If your foot drop is being caused by damage to the peroneal nerve than Functional Electrical Stimulation may be an alternative to surgery. A small device can be worn or surgically implanted just below the knee that will stimulate the normal function of the nerve, causing the muscle to contract and the foot to lift while walking.

3: Braces or Ankle Foot Orthosis (AFO)

Wearing a brace or AFO that supports the foot in a normal position is a common treatment for foot drop. The device will stabilize your foot and ankle and hold the front part of the foot up when walking. While traditionally doctors have prescribed bulky stiff splints that go inside the shoe, the SaeboStep is a lightweight and cost effective option that provides support outside the shoe.

4: Physical Therapy

Therapy to strengthen the foot, ankle, and lower leg muscles is the primary treatment for foot drop and will generally be prescribed in addition to the treatment options mentioned above. Stretching and range of motion exercises will also help prevent stiffness from developing in the heel.

 

Rehabilitation Exercises for Foot Drop

Specific exercises that strengthen the muscles in the foot, ankle and lower leg can help improve the symptoms of foot drop in some cases. Exercises are important for improving range of motion, preventing injury, improving balance and gait, and preventing muscle stiffness.

When treating foot drop, you may work with a physical therapist who will help you get started strengthening your foot, leg and ankle muscles. Rehabilitation for foot drop can be a slow process, so your physical therapist will likely recommend that you continue to do strengthening exercises at home on your own.

By being consistent about your exercises at home, you can maximize your chances of making a successful recovery from foot drop. Strengthening the weakened muscles will allow you to restore normal function and hopefully start walking normally again.

Like any exercise program, please consult your healthcare professional before you begin. Please stop immediately if any of the following exercises cause pain or harm to your body. It’s best to work with a trained professional for guidance and safety.

Towel Stretch

1-towel-stretch

Sit on the floor with both legs straight out in front of you. Loop a towel or exercise band around the affected foot and hold onto the ends with your hands. Pull the towel or band towards your body. Hold for 30 seconds. Then relax for 30 seconds. Repeat 3 times.

Toe to Heel Rocks

2-toe-heel-rocks

Stand in front of a table, chair, wall, or another sturdy object you can hold onto for support. Rock your weight forward and rise up onto your toes. Hold this position for 5 seconds. Next, rock your weight backwards onto your heels and lift your toes off the ground. Hold for 5 seconds. Repeat the sequence 6 times.

Marble Pickup

3-marble-pickup

Sit in a chair with both feet flat on the floor. Place 20 marbles and a bowl on the floor in front of you. Using the toes of your affected foot, pick up each marble and place it in the bowl. Repeat until you have picked up all the marbles.

Ankle Dorsiflexion

4-ankle-dorsiflexion

Sit on the floor with both legs straight out in front of you. Take a resistance band and anchor it to a stable chair or table leg. Wrap the loop of the band around the top of your affected foot. Slowly pull your toes towards you then return to your starting position. Repeat 10 times.

Plantar Flexion

5-plantar-flexion

Sit on the floor with both legs straight out in front of you. Take a resistance band and wrap it around the bottom of your foot. Hold both ends in your hands. Slowly point your toes then return to your starting position. Repeat 10 times.

Ball Lift

6-ball-lift

Sit in a chair with both feet flat on the floor. Place a small round object on the floor in front of you (about the size of a tennis ball). Hold the object between your feet and slowly lift it by extending your legs. Hold for 5 seconds then slowly lower. Repeat 10 times.

Get Back On Your Feet

Don’t let foot drop affect your mobility, independence, and quality of life. With proper rehabilitation and assistive devices many people are able to overcome the underlying cause of their symptoms and get back to walking normally. If you are showing symptoms of foot drop, talk to a medical professional about your treatment options.

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All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Saebo website is solely at your own risk.

Source: Get Back On Your Feet with Exercises for Foot Drop | Saebo

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[Abstract] Effects of mirror therapy combined with neuromuscular electrical stimulation on motor recovery of lower limbs and walking ability of patients with stroke: a randomized controlled study 

To investigate the effectiveness of mirror therapy combined with neuromuscular electrical stimulation in promoting motor recovery of the lower limbs and walking ability in patients suffering from foot drop after stroke.

Randomized controlled study.

Inpatient rehabilitation center of a teaching hospital.

Sixty-nine patients with foot drop.

Patients were randomly divided into three groups: control, mirror therapy, and mirror therapy + neuromuscular electrical stimulation. All groups received interventions for 0.5 hours/day and five days/week for four weeks.

10-Meter walk test, Brunnstrom stage of motor recovery of the lower limbs, Modified Ashworth Scale score of plantar flexor spasticity, and passive ankle joint dorsiflexion range of motion were assessed before and after the four-week period.

After four weeks of intervention, Brunnstrom stage (P = 0.04), 10-meter walk test (P < 0.05), and passive range of motion (P < 0.05) showed obvious improvements between patients in the mirror therapy and control groups. Patients in the mirror therapy + neuromuscular electrical stimulation group showed better results than those in the mirror therapy group in the 10-meter walk test (P < 0.05). There was no significant difference in spasticity between patients in the two intervention groups. However, compared with patients in the control group, patients in the mirror therapy + neuromuscular electrical stimulation group showed a significant decrease in spasticity (P < 0.001).

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Source: Effects of mirror therapy combined with neuromuscular electrical stimulation on motor recovery of lower limbs and walking ability of patients with stroke: a randomized controlled studyClinical Rehabilitation – Qun Xu, Feng Guo, Hassan M Abo Salem, Hong Chen, Xiaolin Huang, 2017

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