Posts Tagged Activities of daily living
[Abstract] BIGHand – A bilateral, integrated, and gamified handgrip stroke rehabilitation system for independent at-home exercise – Demo Video
Effective home rehabilitation is important for recovery of hand grip ability in post-stroke individuals. This paper presents BIGHand, a bilateral, integrated, and gamified handgrip stroke rehabilitation system for independent at-home exercise. BIGHand consists of affordable sensor-integrated hardware (Vernier hand dynamometers, Arduino Uno, interface shield) used to obtain real-time grip force data, and a set of exergames designed as parts of an interactive structural rehabilitation program. This program pairs targeted difficulty progression with user-ability scaled controls to create an adaptive, challenging, and enticing rehabilitation environment. This training prepares users for the many activities of daily living (ADLs) by targeting strength, bilateral coordination, hand-eye coordination, speed, endurance, precision, and dynamic grip force adjustment. Multiple measures are taken to engage, motivate, and guide users through the at-home rehabilitation process, including “smart” post-game feedback and in-game goals.
[Abstract] Effects of Bihemispheric Transcranial Direct Current Stimulation on Upper Extremity Function in Stroke Patients: A randomized Double-Blind Sham-Controlled Study
RehaCom is a modular software used for cognitive therapy. It assists therapist in the rehabilitation of cognitive disorders that affect specific aspects of attention, concentration, memory, perception, activities of daily living and much more.
[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.
ADLs Are Where the Repetitions Are
Brain plasticity is amazing, but rewiring the brain requires thousands of repetitions (reps). Activities of Daily Living (ADLs) are a great way to get the reps needed to retrain the brain.
Four examples show why three sets of ten each day cannot compete with ADLs.
1) Twice a day I open my hemiplegic (paralyzed) hand to grasp a tube of toothpaste so my sound hand can remove the cap. My hand opens again to hold the tube while I put the cap back on. In nine years I have opened my hand over 5000 times before brushing my teeth.
2) I have to turn 14 times to prepare cereal with a sliced banana. I have made this same breakfast for nine years so I have made over 45,000 turns. Add making a sandwich for lunch and preparing a hot meal for dinner and the number of turns I have made in the kitchen are in the hundreds of thousands.
3) Shopping is therapy for my hand. I open my hemiplegic hand to let go of the cart and reach for items with my sound hand. My hemiplegic hand opens a 2nd time when I grab the cart to move on. My hemiplegic hand opens a 3rd time so I can let go of the cart so I can maneuver to empty the cart in the check-out lane and again to load food into my car. Pick up 30 items + empty cart + load car means I open my hand 60 + 2 + 2 = 64 times. 64 x 2 visits a week x 9 years means I have opened my hemiplegic hand 59,904 times in the grocery store.
4) The distance I have walked at the grocery store is huge. I step away from the shopping cart and bend down or reach up to get items I want. The S-shaped curves I make to detour around people and other carts require more steps than walking in a straight line. According to my pedometer I walk 2,000+ steps each time I visit the grocery store. 2,000 x 2 visits a week x nine years = 1,872,000 steps!
[Abstract] The wearable hand robot: supporting impaired hand function in activities of daily living and rehabilitation
New developments, based on the concept of wearable soft-robotic devices, make it possible to support impaired hand function during the performance of daily activities and intensive task-specific training. The ironHand and HandinMind systems are examples of such novel wearable soft-robotic systems that have been developed in the ironHand and HandinMind projects. Both systems are developed to provide grip support during a wide range of daily activities. The ironHand system consists of a 3-finger wearable soft-robotic glove, tailored to older adults with a variety of physical age-related hand function limitations. The HandinMind system consists of a 5-finger wearable soft-robotic glove, dedicated towards application in stroke. In both cases, the wearable soft-robotic system could be connected to a computer with custom software to train specific aspects of hand function in a motivating game-like environment with multiple levels of difficulty. By adding the game environment, an assistive device is transformed into a dedicated training device.
[Abstract] Electromechanical and robot‐assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke
Electromechanical and robot‐assisted arm training devices are used in rehabilitation, and may help to improve arm function after stroke.
To assess the effectiveness of electromechanical and robot‐assisted arm training for improving activities of daily living, arm function, and arm muscle strength in people after stroke. We also assessed the acceptability and safety of the therapy.
We searched the Cochrane Stroke Group’s Trials Register (last searched January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2018, Issue 1), MEDLINE (1950 to January 2018), Embase (1980 to January 2018), CINAHL (1982 to January 2018), AMED (1985 to January 2018), SPORTDiscus (1949 to January 2018), PEDro (searched February 2018), Compendex (1972 to January 2018), and Inspec (1969 to January 2018). We also handsearched relevant conference proceedings, searched trials and research registers, checked reference lists, and contacted trialists, experts, and researchers in our field, as well as manufacturers of commercial devices.
Randomised controlled trials comparing electromechanical and robot‐assisted arm training for recovery of arm function with other rehabilitation or placebo interventions, or no treatment, for people after stroke.
Data collection and analysis
Two review authors independently selected trials for inclusion, assessed trial quality and risk of bias, used the GRADE approach to assess the quality of the body of evidence, and extracted data. We contacted trialists for additional information. We analysed the results as standardised mean differences (SMDs) for continuous variables and risk differences (RDs) for dichotomous variables.
We included 45 trials (involving 1619 participants) in this update of our review. Electromechanical and robot‐assisted arm training improved activities of daily living scores (SMD 0.31, 95% confidence interval (CI) 0.09 to 0.52, P = 0.0005; I² = 59%; 24 studies, 957 participants, high‐quality evidence), arm function (SMD 0.32, 95% CI 0.18 to 0.46, P < 0.0001, I² = 36%, 41 studies, 1452 participants, high‐quality evidence), and arm muscle strength (SMD 0.46, 95% CI 0.16 to 0.77, P = 0.003, I² = 76%, 23 studies, 826 participants, high‐quality evidence). Electromechanical and robot‐assisted arm training did not increase the risk of participant dropout (RD 0.00, 95% CI ‐0.02 to 0.02, P = 0.93, I² = 0%, 45 studies, 1619 participants, high‐quality evidence), and adverse events were rare.
People who receive electromechanical and robot‐assisted arm training after stroke might improve their activities of daily living, arm function, and arm muscle strength. However, the results must be interpreted with caution although the quality of the evidence was high, because there were variations between the trials in: the intensity, duration, and amount of training; type of treatment; participant characteristics; and measurements used.
Plain language summary
Electromechanical‐assisted training for improving arm function and disability after stroke
To assess the effects of electromechanical and robot‐assisted arm training for improving arm function in people who have had a stroke.
More than two‐thirds of people who have had a stroke have difficulties with reduced arm function, which can restrict a person’s ability to perform everyday activities, reduce productivity, limit social activities, and lead to economic burden. Electromechanical and robot‐assisted arm training uses specialised machines to assist rehabilitation in supporting shoulder, elbow, or hand movements. However, the role of electromechanical and robot‐assisted arm training for improving arm function after stroke is unclear.
We identified 45 trials (involving 1619 participants) up to January 2018 and included them in our review. Twenty‐four different electromechanical devices were described in the trials, which compared electromechanical and robot‐assisted arm training with a variety of other interventions. Participants were between 21 to 80 years of age, the duration of the trials ranged from two to 12 weeks, the size of the trials was between eight and 127 participants, and the primary outcome (activities of daily living: the most important target variable measured) differed between the included trials.
Electromechanical and robot‐assisted arm training improved activities of daily living in people after stroke, and function and muscle strength of the affected arm. As adverse events, such as injuries and pain, were seldom described, these devices can be applied as a rehabilitation tool, but we still do not know when or how often they should be used.
Quality of the evidence
The quality of the evidence was high.
[Abstract + References] A Wearable Hand Neuroprosthesis for Hand Rehabilitation After Stroke: Preliminary Results of the RETRAINER S2 Randomized Controlled Trial – Conference paper
Stroke is the main cause of permanent and complex long-term disability in adults. RETRAINER S2 is a system able to recover and support person’s ability to perform Activities of Daily Living (ADL) in early stage after stroke. The system is based on exercises for hand and wrist performed using Neuro Muscular Electrical Stimulation (NMES). This work describes the preliminary results of a multi-center Randomized Controlled Trial (RCT) aimed at evaluating effectiveness of the system. The preliminary results were calculated on 18 patients who completed the protocol. Data is promising, the RETRANER S2 system seems to be a good tool for stroke rehabilitation. Data confirms also a general good usability of the system.
Background. Humans use voluntary eye movements to actively gather visual information during many activities of daily living, such as driving, walking, and preparing meals. Most stroke survivors have difficulties performing these functional motor tasks, and we recently demonstrated that stroke survivors who require many saccades (rapid eye movements) to plan reaching movements exhibit poor motor performance. However, the nature of this relationship remains unclear.
Objective. Here we investigate if saccades interfere with speed and smoothness of reaching movements in stroke survivors, and if excessive saccades are associated with difficulties performing functional tasks.
Methods. We used a robotic device and eye tracking to examine reaching and saccades in stroke survivors and age-matched controls who performed the Trail Making Test, a visuomotor task that uses organized patterns of saccades to plan reaching movements. We also used the Stroke Impact Scale to examine difficulties performing functional tasks.
Results. Compared with controls, stroke survivors made many saccades during ongoing reaching movements, and most of these saccades closely preceded transient decreases in reaching speed. We also found that the number of saccades that stroke survivors made during ongoing reaching movements was strongly associated with slower reaching speed, decreased reaching smoothness, and greater difficulty performing functional tasks.
Conclusions. Our findings indicate that poststroke interference between eye and limb movements may contribute to difficulties performing functional tasks. This suggests that interventions aimed at treating impaired organization of eye movements may improve functional recovery after stroke.