Posts Tagged Acquired Brain Injury
Ekso Bionics Holdings Inc announces it has received 501(k) clearance from the U.S. Food and Drug Administration (FDA) to market its EksoNR robotic exoskeleton for use with patients with acquired brain injury (ABI).
EksoNR is reportedly the first exoskeleton device to receive FDA clearance for rehabilitation use with ABI. It was previously cleared by the FDA for stroke and spinal cord injury rehabilitation in 2016.
Ekso Bionics Unveils the EksoNR Neurorehabilitation Device
Post Acute Medical Expands Exoskeleton Rehab with New EksoNR Devices
EksoGT Users Have Walked Around the World Twice, Company Estimates
ABI is comprised of both traumatic (TBI) and non-traumatic (n-TBI) brain injury causes. TBI includes severe head injuries and concussions, while n-TBI includes a broader subset of conditions, such as stroke, aneurysms, brain tumors, anoxia, degenerative and metabolic conditions, infections, and surgical injuries, among others, according to a media release from Ekso Biokics.
“With the expanded indications to include the broad category of acquired brain injuries, the EksoNR has the potential to mobilize significantly more patients and improve patient recovery. Based on their experience with EksoNR, customers at leading rehabilitation centers have acknowledged the benefits our technology can offer during recovery from brain injuries. We are excited to see the device used more widely in neurorehabilitation.”
— Jack Peurach, CEO and president of Ekso Bionics
[Source(s): Ekso Bionics, Globe Newswire]
[ARTICLE] Visual processing speed in hemianopia patients secondary to acquired brain injury: a new assessment methodology – Full Text
There is a clinical need to identify diagnostic parameters that objectively quantify and monitor the effective visual ability of patients with homonymous visual field defects (HVFDs). Visual processing speed (VPS) is an objective measure of visual ability. It is the reaction time (RT) needed to correctly search and/or reach for a visual stimulus. VPS depends on six main brain processing systems: auditory-cognitive, attentional, working memory, visuocognitive, visuomotor, and executive. We designed a new assessment methodology capable of activating these six systems and measuring RTs to determine the VPS of patients with HVFDs.
New software was designed for assessing subject visual stimulus search and reach times (S-RT and R-RT respectively), measured in seconds. Thirty-two different everyday visual stimuli were divided in four complexity groups that were presented along 8 radial visual field positions at three different eccentricities (10o, 20o, and 30o). Thus, for each HVFD and control subject, 96 S- and R-RT measures related to VPS were registered. Three additional variables were measured to gather objective data on the validity of the test: eye-hand coordination mistakes (ehcM), eye-hand coordination accuracy (ehcA), and degrees of head movement (dHM, measured by a head-tracker system). HVFD patients and healthy controls (30 each) matched by age and gender were included. Each subject was assessed in a single visit. VPS measurements for HFVD patients and control subjects were compared for the complete test, for each stimulus complexity group, and for each eccentricity.
VPS was significantly slower (p < 0.0001) in the HVFD group for the complete test, each stimulus complexity group, and each eccentricity. For the complete test, the VPS of the HVFD patients was 73.0% slower than controls. They also had 335.6% more ehcMs, 41.3% worse ehcA, and 189.0% more dHMs than the controls.
Measurement of VPS by this new assessment methodology could be an effective tool for objectively quantifying the visual ability of HVFD patients. Future research should evaluate the effectiveness of this novel method for measuring the impact that any specific neurovisual rehabilitation program has for these patients.
Vision is the dominant sensory function in humans because visual search and reach tasks are crucial to efficient performance of the main activities of daily life [1, 2]. The term visual processing speed (VPS), an important variable of visual sensory function, is the amount of time needed to make a correct interaction with a visual stimulus [3, 4]. The term correct interaction is the effective realization of a complete executive action of visual search and reach , e.g., visualizing a glass of water placed on a table and then grasping it by precise eye-hand coordination (EHC). Accordingly, the VPS variable defines the global reaction time (RT) that is composed of two additive RT sub-variables: search reaction time (S-RT) and reach reaction time (R-RT) [6,7,8]. Furthermore, VPS is mainly interdependent on intrinsic visual cognitive processing mechanisms, the complexity of the determined stimulus to be recognized (defined principally in terms of size, contrast, semantic content, and number of traces or interior angles [9, 10]), the number of distractor stimuli surrounding it, and the distance from the point of fixation to the particular stimulus that the person is tasked to identify (eccentricity) [4, 11,12,13]. Thus, VPS is a quantifiable parameter that objectively reflects a subject’s global visual ability.
Recent findings in the field of visual psychophysics show that having adequate VPS is necessary and dependent upon the proper functioning of six main brain-processing systems: auditory-cognitive, attentional, working-memory, visuocognitive, visuomotor, and executive [14,15,16,17,18]. Consequently, an acquired brain injury (ABI) that affects any of these cerebral processing systems could decrease the VPS.
ABI is one of the most important and disabling public health problems of our era due to the high incidence and prevalence . Following an ABI, between 30 and 85% of patients will experience some type of visual dysfunction [20, 21], especially homonymous visual field defects (HVFDs) secondary to lesions involving the visual afferent pathways posterior to the chiasm . Eye tracking technology has shown that HVFDs prevent patients from having the appropriate control of their oculomotor systems [23,24,25,26]. This is especially apparent in the saccadic system, because it is interdependent with the covert attention mechanisms associated with peripheral vision [27, 28]. Thus, patients with HVFDs tend to perform search tasks using unconscious compensatory head movements [25, 29, 30] and employ longer total search times, more frequent fixations, and shorter saccades than normal controls [23, 31,32,33,34,35,36,37]. Therefore, these patients experience a significant reduction in their quality of life and functional independence. They complain that the time they have to invest in carrying out their daily activities is much greater than before suffering from HVFDs [33, 38,39,40]. In this regard, in recent years the scientific community has joined efforts to develop increasingly effective neurovisual rehabilitation training programs (NVRTPs) for these patients . Different forms of NVRTPs have been developed, including compensatory NVRTP (C-NVRTP), restitution NVRTP (R-NVRTP), and substitution NVRTP (S-NVRTP) [41,42,43,44].[…]
[Abstract + References] Do powered over-ground lower limb robotic exoskeletons affect outcomes in the rehabilitation of people with acquired brain injury?
Purpose: To assess the effects of lower limb robotic exoskeletons on outcomes in the rehabilitation of people with acquired brain injury.
Materials and methods: A systematic review of seven electronic databases was conducted. The primary outcome of interest was neuromuscular function. Secondary outcomes included quality of life, mood, acceptability and safety. Studies were assessed for methodological quality and recommendations were made using the GRADE system.
Results: Of 2469 identified studies, 13 (n = 322) were included in the review. Five contained data suitable for meta-analysis. When the data were pooled, there were no differences between exoskeleton and control for 6-Minute Walk Test, Timed Up and Go or 10-Meter Walk Test. Berg Balance Scale outcomes were significantly better in controls (MD = 2.74, CI = 1.12–4.36, p = 0.0009). There were no severe adverse events but drop-outs were 11.5% (n = 37). No studies reported the effect of robotic therapy on quality of life or mood. Methodological quality was on average fair (15.6/27 on Downs and Black Scale).
Conclusions: Only small numbers of people with acquired brain injury had data suitable for analysis. The available data suggests no more benefit for gait or balance with robotic therapy than conventional therapy. However, some important outcomes have not been studied and further well-conducted research is needed to determine whether such devices offer benefit over conventional therapy, in particular subgroups of those with acquired brain injury.
- Implications for Rehabilitation
- There is adequate evidence to recommend that powered over-ground lower limb robotic exoskeletons should not be used clinically in those with ABI, and that use should be restricted to research.
- Further research (controlled trials) with dependent ambulators is recommended.
- Research of other outcomes such as acceptability, spasticity, sitting posture, cardiorespiratory and psychological function, should be considered.
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[I/Ep] Strategies to Cope With Behavior Changes After Acquired Brain Injury – Archives of Physical Medicine and Rehabilitation
Behavior changes are common after acquired brain injury (ABI) because the brain processes information differently after the injury. About 62% of people with ABI experience behavior changes.1 For some people with ABI, the changes in behavior have a major effect on their daily lives, while for others they may be relatively small. These changes can make daily tasks and social interactions difficult. People with ABI may be more sensitive to stress and fatigue, which can make the behaviors described in this article worse.
[Abstract] A systematic review of personal smart technologies used to improve outcomes in adults with acquired brain injuries
This review aimed to determine the effectiveness of personal smart technologies on outcomes in adults with acquired brain injury.
A systematic literature search was conducted on 30 May 2019. Twelve electronic databases, grey literature databases, PROSPERO, reference list and author citations were searched.
Randomised controlled trials were included if personal smart technology was used to improve independence, goal attainment/function, fatigue or quality of life in adults with acquired brain injury. Data were extracted using a bespoke form and the TIDieR checklist. Studies were graded using the PEDro scale to assess quality of reporting. Meta-analysis was conducted across four studies.
Six studies met the inclusion criteria, generating a total of 244 participants. All studies were of high quality (PEDro ⩾ 6). Interventions included personal digital assistant, smartphone app, mobile phone messaging, Neuropage and an iPad. Reporting of intervention tailoring for individual needs was inconsistent. All studies measured goal attainment/function but none measured independence or fatigue. One study (n = 42) reported a significant increase in memory-specific goal attainment (p = 0.0001) and retrospective memory function (p = 0.042) in favour of the intervention. Another study (n = 8) reported a significant increase in social participation in favour of the intervention (p = 0.01). However, our meta-analyses found no significant effect of personal smart technology on goal attainment, cognitive or psychological function.
[ARTICLE] Experiences of treadmill walking with non-immersive virtual reality after stroke or acquired brain injury : A qualitative study – Full Text
It is well known that physical activity levels for persons after stroke or acquired brain injuries do not reach existing recommendations. Walking training is highly important since the ability to walk is considered to be a meaningful occupation for most people, and is often reduced after a brain injury. This suggests a need to innovate stroke rehabilitation, so that forms of walking training that are user-friendly and enjoyable can be provided.
An interview study was carried out with persons after stroke (n = 8), or acquired brain injury (n = 2) at a rehabilitation unit at Sahlgrenska University Hospital. We used a semi-structured interview guide to investigate experiences and thoughts about walking on a treadmill with non-immersive virtual reality feedback. The contents were analyzed through an inductive approach, using qualitative content analysis.
The virtual reality experience was perceived as enjoyable, exciting, and challenging. Participants stressed that the visual and auditory feedback increased their motivation to walk on a treadmill. However, for some participants, the virtual reality experience was too challenging, and extreme tiredness or fatigue were reported after the walking session.
Participants’ thoughts and experiences indicated that the Virtual Reality walking system could serve as a complement to more traditional forms of walking training. Early after a brain injury, virtual reality could be a way to train the ability to handle individually adapted multisensory input while walking. Obvious benefits were that participants perceived it as engaging and exciting.
In general, physical activity levels in rehabilitation units are low  and do not reach the recommendations for persons with stroke or acquired brain injury (ABI) . There are also indications that the intensity of physiotherapy sessions after stroke is mostly at low levels . Several barriers may contribute to inactivity, such as neurological deficits, cognitive impairment, environmental factors, and lack of motivation [4, 5].
A dose-response effect on exercise outcome after stroke has been shown, and training should be highly repetitive and task oriented . Walking training is important and considered to be a meaningful occupation for most people. To increase walking exercise intensity, treadmill walking has been proposed as a means of task-oriented training that gives the opportunity for many repetitions, and has shown to promote a more normal walking pattern . Walking on a moving surface like a treadmill is more demanding than walking on the ground in terms of sensory processing, postural control and movement coordination. From a motivational perspective, treadmill walking may be perceived as boring the long run.
Training of goal-specific activities with a high number of repetitions may be offered using virtual reality (VR) applications, which have been introduced in neurological rehabilitation [8, 9]. Training using VR has also been suggested to enhance neuroplasticity after stroke  by means of offering multisensory stimulation at a high intensity. VR comprises computer-based real-time simulation of an environment with user interaction  visually displayed on a screen or through head-mounted devices. Differences in technology and visual presentations in 2D or 3D enable varying types of feedback, levels of immersion and sense of presence in the virtual environment [9, 11]. VR feedback can be mediated through vision, hearing, touch, movement, or smell. The technique provides performance feedback–both directly experienced and objectively quantified, and may thereby increase exercise motivation, and improve motor performance [12–14].
Following stroke, VR training has been mostly described for the upper limb but also for the lower limb; balance and walking as well as for perceptual/cognitive skills . VR has shown a potential for positive effects on walking and balance abilities, although the number of studies are low and the evidence for its superiority to other methods is low [8, 15, 16].
Although few adverse events from VR training have been described, some participants have reported headache or dizziness  and knowledge is lacking regarding how persons affected by brain injuries perceive the exposure of multisensory input, during a complex activity such as treadmill walking with VR. The potential effects on motivation and participant experience of VR are scarcely investigated  and mostly focused on upper limb activities and games . Based on this, we wanted to investigate patients’ overall experiences of a VR concept in walking training.
The aim of the present study was to explore the experiences of VR in addition to walking on a treadmill in persons with stroke or acquired brain injuries. Participants’ overall experiences and suggestions for development of the exercise method were areas of interest.[…]
[Abstract] Functional independence after acquired brain injury: Prospective effects of health self-efficacy and cognitive impairment.
Objective: To examine how health self-efficacy and cognitive impairment severity relate to functional independence after acquired brain injury (ABI).
Design: Observational. Setting: Outpatient rehabilitation hospital.
Participants: Seventy-five adults with predominately stroke or traumatic brain injury who were beginning a course of occupational therapy.
Main Measures: Health self-efficacy was assessed with the Self-Rated Abilities for Health Practices. Cognitive functioning was assessed via a composite z score of neuropsychological tests. Trait affectivity was assessed with the Positive and Negative Affect Schedule. Functional independence was assessed with the Barthel Index and Lawton Instrumental Activities of Daily Living Scale.
Results: Health self-efficacy correlated moderately with functional independence. A moderation threshold effect was detected that revealed for whom health self-efficacy predicted functional independence. Among participants with normal to mildly impaired cognition (>−2 z cognitive composite), health self-efficacy correlated positively with functional independence, which held after accounting for trait affectivity. In contrast, health self-efficacy was not correlated with functional independence among participants with greater impairment (<−2 z cognitive composite).
Conclusions: Health self-efficacy predicts functional independence and may serve as a protective factor after ABI among individuals with relatively intact cognition. However, health self-efficacy does not predict functional independence among individuals with moderate or severe cognitive impairment, possibly due to limited self-awareness.
This study extends the literature linking health self-efficacy with rehabilitation outcomes and reinforces the need for promoting self-management in ABI. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
[Review] Evidence based position paper on physical and rehabilitation medicine professional practice for adults with acquired brain injury. The European PRM position (UEMS PRM Section)
INTRODUCTION: Acquired brain injury (ABI) is damage to the brain that occurs after birth caused either by a traumatic or by a nontraumatic injury. The rehabilitation process following ABI should be performed by a multi-professional team, working in an interdisciplinary way, with the aim of organizing a comprehensive and holistic approach to persons with every severity of ABI. This Evidence Based Position Paper represents the official position of the European Union through the UEMS Physical and Rehabilitation Medicine (PRM) Section and designates the professional role of PRM physicians for people with ABI.
AIM: The aim was to formulate recommendations on the PRM physician’s professional practice for persons with ABI in order to promote their functioning and enhance quality of life.
METHODS: This paper has been developed according to the methodology defined by the Professional Practice Committee of the UEMS-PRM SECTION: a systematic literature search has been performed in PubMed and Core Clinical Journals. On the basis of the selected papers, recommendations have been made as a result of five Delphi rounds.
RESULTS: The literature review as well as thirty-one reccomendations are presented.
CONCLUSIONS: The expert consensus is that structured, comprehensive and holistic rehabilitation programme delivered by the multi-professional team, working in an interdisciplinary way, with the leadership and coordination of the PRM physician, is likely to be effective, especially for those with severe disability after brain injury.
via Evidence based position paper on physical and rehabilitation medicine professional practice for adults with acquired brain injury. The European PRM position (UEMS PRM Section) – European Journal of Physical and Rehabilitation Medicine 2018 Aug 29 – Minerva Medica – Journals
Brain injury can change nearly everything, not only in the injured person’s life, but also within the lives of his or her family members.
Early after a brain injury, family systems become embroiled in the injury as they address arising issues. Sleep gives way to ICU vigils. Quiet moments give way to prayer. Casual discussions give way to serious conversation. These days are ruled by fear, with small glimmers of hope to serve as momentary relief.
Recovery, to a greater or lesser degree, eventually occurs. Time passes, hospital stays end, and the injured often return home.
Unfortunately, families are all too often solely responsible for redefining a new normal, as our society does not yet effectively provide sustained support. Understanding how to cope with the many changes after brain injury, and a willingness to implement coping mechanisms will make all the difference.
These eight tips are a great place to start:
Counseling can ease burdens and facilitate grieving, adjusting, and managing, all without giving up hope. However, not all families can afford such care, and for that reason, there are the other seven tips.
Realistic optimism, positivity, and hope offer an opportunity for a brighter and happier new normal. Humor can help keep spirits high. And in spiritually oriented families, solace and confidence come from actively practicing their faith.
Everyone handles grief and the subsequent changes within their lives differently. However, it is important to remember that each family member, no matter their role in the injured person’s life, is going through these changes together. Communication is a portal to common ground and unity.
Scheduling a regular time to discuss the injured person, and any related issues, can help family members to open up, creating a more approachable and manageable situation.
Imagine a wagon wheel with a hub and spokes. Families often operate by moving one member or another in and out of the center of the wheel, as his or her issues and needs call for priority. After a brain injury, it can become habitual to keep the injured person in the center of the wheel. It’s important for families to find a way to move others in and out of the circle again.
Taking care of oneself can seem inappropriate, especially for parents. However, if one uses oneself up in the care of others, there will come a time when the person has nothing left to offer others. Take time for yourself, and maintain some semblance of your hobbies and interests.
Because of the many demands of brain injury, it can be difficult to find the energy or money to socialize outside of the home. And it can feel wrong to seek pleasure while a family member with brain injury cannot do the same. Yet, socializing can help heal by providing a healthy sense of perspective.
Tell your friends what works, when you need to discuss the injury, and when you need to discuss anything but the injury. Friends and family may need your patience and forgiveness, as they may offer advice that is not useful or feels judgmental. No one knows how to act in these situations, and they are no exception.
When to Feel
There is time for grieving, sadness, and loss. So too, there must be time for hope, joy, and laughter. It is okay to take out the “pity pot” filled with your sorrow, despair, and loss. But then, with deliberation, put the “pity pot” back in the closet for another day. You will use it again and again, just always remember to put it away. In this way, you can avoid becoming mired in grief.
Some parents fear doing anything that might look or feel like they’ve accepted their child’s level of disability. It’s good to desire further growth and improvement post-injury, but there is a limit, and it is not healthy to be consumed by the drive to wring more recovery out of an injury. It is crucial to balance both acceptance of your new normal and hope for continued improvement.
One day I noticed the fine print on a cereal box, “Contents may settle during shipping.” The advisory served to avert any concern I might develop when opening the cereal to find it only three fourths full. I liken this advisory to balancing acceptance. So too will your “contents” settle as you move through your family’s changed world. One can and should actively explore changes wrought by brain injury in the family because realization of these changes will happen eventually, with or without your consent.
Those who find a way to bring balance back into their world are more apt to successfully take on the ripple effects of brain injury on their family dynamic. And, to be sure, the injured person will also flourish to the best of his or her ability in this normalizing and positive environment.
So, please make the decision to thrive. Be a light for you and your family. Find opportunities each day to laugh, dance, socialize, and communicate deeply. In this way, you can adjust to and manage in your new world.