Posts Tagged assessment

[VIDEO] Assessment of Visual Fields Video: Diane Dirette – YouTube

Watch a demonstration of assessing visual fields.

Read FREE related article: https://www.medbridgeeducation.com/h/…

Visual Deficits:Now You See It, Now You Don’t- A Clinical Pearl by Diane Powers Dirette, PhD, OTL

Visual deficits match many diagnoses and, if undetected, can be mistaken for other problems – e.g. sensory, motor, balance and cognitive deficits. It’s critical, therefore, that therapists know how to complete a basic visual screening and to interpret the results. For example, how can you tell homonymous hemianopia apart from unilateral inattention? The screening tools are virtually the same, but the screening results differ subtly.

via Assessment of Visual Fields Video: Diane Dirette | MedBridge – YouTube

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[ARTICLE] Effects of Hand Configuration on the Grasping, Holding, and Placement of an Instrumented Object in Patients With Hemiparesis – Full Text

Abstract

Objective: Limitations with manual dexterity are an important problem for patients suffering from hemiparesis post stroke. Sensorimotor deficits, compensatory strategies and the use of alternative grasping configurations may influence the efficiency of prehensile motor behavior. The aim of the present study is to examine how different grasp configurations affect patient ability to regulate both grip forces and object orientation when lifting, holding and placing an object.

Methods: Twelve stroke patients with mild to moderate hemiparesis were recruited. Each was required to lift, hold and replace an instrumented object. Four different grasp configurations were tested on both the hemiparetic and less affected arms. Load cells from each of the 6 faces of the instrumented object and an integrated inertial measurement unit were used to extract data regarding the timing of unloading/loading phases, regulation of grip forces, and object orientation throughout the task.

Results: Grip forces were greatest when using a palmar-digital grasp and lowest when using a top grasp. The time delay between peak acceleration and maximum grip force was also greatest for palmar-digital grasp and lowest for the top grasp. Use of the hemiparetic arm was associated with increased duration of the unloading phase and greater difficulty with maintaining the vertical orientation of the object at the transitions to object lifting and object placement. The occurrence of touch and push errors at the onset of grasp varied according to both grasp configuration and use of the hemiparetic arm.

Conclusion: Stroke patients exhibit impairments in the scale and temporal precision of grip force adjustments and reduced ability to maintain object orientation with various grasp configurations using the hemiparetic arm. Nonetheless, the timing and magnitude of grip force adjustments may be facilitated using a top grasp configuration. Conversely, whole hand prehension strategies compound difficulties with grip force scaling and inhibit the synchrony of grasp onset and object release.

 

Introduction

Cerebrovascular accidents (stroke) are a frequent cause of disability (1) and the recovery of upper-limb function in particular, is a key determinant of independence in activities of daily living (2). Broadly speaking, the physical impairment experienced by patients is characterized by loss of strength, abnormal movement patterns (pathological synergies), and changes in muscle tone to the side of the body contralateral to the stroke (34). This presentation is commonly referred to as hemiparesis and its severity tends to reflect the extent of the lesion to the corticospinal tract (5). Subtle changes in movement kinematics and hand function on the ipsilesional upper-limb have also been documented and may be the consequence of direct impairment of ipsilateral motor pathways (67), as well as reorganization of the non-lesioned hemisphere to support recovery of motor-function in the hemiparetic limb (810). Above all though, patients living with stroke find that limitations with manual dexterity of the hemiparetic arm have the most significant effect upon their ability to carry out activities involving hand use in daily life (11).

These impairments in patient hand function manifest in multiple different aspects of motor performance. This may include reduced strength (3), loss of individuated finger control (12), and abnormal force control at the level of the fingers (13). Increased muscle tone and spasticity though the flexors of the wrist and hand may further compound these difficulties and inhibit the ability to open the hand in preparation for grasping (14). Atypical reaching and grasping patterns are often seen to emerge both as a consequence of and as a response to the motor dysfunction (1516).

Unfortunately, rehabilitation of upper limb impairments proves to be challenging. Whilst numerous therapeutic modalities (e.g., bilateral training, constraint-induced therapy, electrical stimulation, task-oriented, high intensity programs) have been evaluated in clinical trials, none have demonstrated consistent effects upon hand function (1719). Indeed, previous research papers have described therapy outcomes in upper limb rehabilitation post stroke as “unacceptably poor” (20). Ideally, the design of neurorehabilitation programs should be grounded upon an understanding of basic mechanisms involved in neural plasticity and motor learning (2122). Part of this process implies coming to terms with the factors which characterize the disorganization in voluntary motor output (21). However, the majority of clinical tools currently used for evaluating hand function distinguish motor performance according to ordinal rating scales or task completion time (e.g., Frenchay Arm Test, Jebson-Taylor Hand Function Test) (2324). These kinds of assessments lack sensitivity and may prove insufficient for detecting the presence of mild motor deficits or subtle, yet clinically important changes in hand coordination (2526). Evidence based frameworks for hand rehabilitation have specifically called for the integration of new technology to support patient assessment and treatment planning (27). Despite this, the transposition of technology for upper limb rehabilitation from the research domain into clinical practice has been limited (2829). In the assessment of manual dexterity, the underlying challenge involves analyzing sensorimotor function of the hand with respect to its interaction with objects in the environment (30).

Successfully managing grasping and object handling tasks requires skilled control of prehensile finger forces. In healthy adults, grip forces are regulated to be marginally greater than the minimum required to prevent the object from slipping (31). This safety margin is calibrated according to the shape, surface friction and weight distribution of the object (3233). As the hand moves through space (lifting, transporting, object placement), grip force is continually modulated, proportional to the load forces associated with the mass and acceleration of that object (34). This temporal coupling between grip and load forces is considered a hallmark of anticipatory sensorimotor control (35). Disruption to motor planning, volitional motor control or somatosensory feedback may lead to a breakdown in the timing and magnitude of grip force adjustments.

Numerous studies have examined grip force regulation in neurological pathologies including cerebellar dysfunction (36), peripheral sensory neuropathy (3738), Parkinson’s disease (36373940) as well as congenital and acquired brain lesions (13364145). For patients suffering from hemiparesis post stroke, difficulty with coordinating the grasping and lifting action are frequently associated with temporal discrepancies between grip forces and load forces (46). The cerebral hemisphere implicated in the CVA (1347) and the extent of the resulting sensory deficits (4849) have also been observed to influence anticipatory grip force scaling. This body of work highlights the potential interest of using instrumented objects for the diagnosis and evaluation of the impairments associated with hemiparesis (4546485053).

As it stands, these objective studies of hand function post stroke have focused primarily upon either the lifting or the vertical movement components in object handling. To a certain extent, this limitation has been related to technical restrictions. Other than a handful of studies by Hermsdorfer et al. (849), research in this field has predominantly used manipulanda designed for the study of precision grip, where strain gauge force transducers are attached to a separate base unit [e.g., (232529333537)]. These devices cannot be freely handled by subjects, much less a person with an upper-limb movement disorder. Indeed, patients with hemiparesis often experience specific impairments with precision grip (53) and regularly use alternative grasping strategies such as whole hand grasping (151654). Previous researchers have hypothesized that these alternative grasp strategies may impact grip force scaling (55) and compromise patient ability to manage hand-object-environment relationships during object manipulation (56).

In a recent study with healthy adult subjects, (57) we demonstrated how an instrumented object with multiple load cells and an integrated inertial measurement unit (58) may be used to examine relationships between different grasp configurations, grip force regulation and object orientation. The purpose of the present investigation was to extend this work to the study of patients with hemiparesis post stroke. The first objective was to compare how four alternative grasp configurations commonly used in daily tasks affect grip force regulation in this population. The second objective was to explore the timing and coordination of the whole task sequence (grasping, lifting, holding, placement and object release). The third and final objective was to evaluate the stability of the hand-held object’s orientation across the different phases of the task.[…]

 

Continue —> Frontiers | Effects of Hand Configuration on the Grasping, Holding, and Placement of an Instrumented Object in Patients With Hemiparesis | Neurology

Figure 1. Illustration of the iBox device and the experimental setup. (A) The iBox instrumented object. (B)Setup for the experimental procedure. Initial positions of the iBox and hand start area are indicated by the dotted lines. The gray shaded rectangle indicates the deposit area for the top grasp task.

 

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[ARTICLE] Development of a Novel Home Based Multiscene Upper Limb Rehabilitation Training and Evaluation System for Post-stroke Patients – Full Text PDF

ABSTRACT

Upper limb rehabilitation requires long-term, repetitive rehabilitation training and assessment, and many patients cannot pay for expensive medical fees in the hospital for so long time. It is necessary to design an effective, low cost, and reasonable home rehabilitation and evaluation system. In this paper, we developed a novel home based multi-scene upper limb rehabilitation training and evaluation system (HomeRehabMaster) for post-stroke patients. Based on the Kinect sensor and posture sensor, multi-sensors fusion method was used to track the motion of the patients. Multiple virtual scenes were designed to encourage rehabilitation training of upper limbs and trunk. A rehabilitation evaluation method integrating Fugl-meyer assessment (FMA) scale and upper limb reachable workspace relative surface area (RSA) was
proposed, and a FMA-RSA assessment model was established to assess upper limb motor function.
Correlation based dynamic time warping (CBDTW) was used to solve the problem of inconsistent upper limb movement path in different patients. Two clinical trials were conducted. The experimental results show that the system is very friendly to the subjects, the rehabilitation assessment results by this system are highly correlated with the therapist’s (the highest forecast accuracy was 92.7% in the 13th item), and longterm rehabilitation training can improve the upper limb motor function of the patients statistically significant (p=0.02<0.05). The system has the potential to become an effective home rehabilitation training and evaluation system.[…]
Full Text PDF —>  IEEE Xplore Full-Text PDF:

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[ARTICLE] Quantification of upper limb position sense using an exoskeleton and a virtual reality display – Full Text

Abstract

Background

Proprioceptive sense plays a significant role in the generation and correction of skilled movements and, consequently, in most activities of daily living. We developed a new proprioception assessment protocol that enables the quantification of elbow position sense without using the opposite arm, involving active movement of the evaluated limb or relying on working memory. The aims of this descriptive study were to validate this assessment protocol by quantifying the elbow position sense of healthy adults, before using it in individuals who sustained a stroke, and to investigate its test-retest reliability.

Methods

Elbow joint position sense was quantified using a robotic device and a virtual reality system. Two assessments were performed, by the same evaluator, with a one-week interval. While the participant’s arms and hands were occluded from vision, the exoskeleton passively moved the dominant arm from an initial to a target position. Then, a virtual arm representation was projected on a screen placed over the participant’s arm. This virtual representation and the real arm were not perfectly superimposed, however. Participants had to indicate verbally the relative position of their arm (more flexed or more extended; two-alternative forced choice paradigm) compared to the virtual representation. Each participant completed a total of 136 trials, distributed in three phases. The angular differences between the participant’s arm and the virtual representation ranged from 1° to 27° and changed pseudo-randomly across trials. No feedback about results was provided to the participants during the task. A discrimination threshold was statistically extracted from a sigmoid curve fit representing the relationship between the angular difference and the percentage of successful trials. Test-retest reliability was evaluated with 3 different complementary approaches, i.e. a Bland-Altman analysis, an intraclass correlation coefficient (ICC) and a standard error of measurement (SEm).

Results

Thirty participants (24.6 years old; 17 males, 25 right-handed) completed both assessments. The mean discrimination thresholds were 7.0 ± 2.4 (mean ± standard deviation) and 5.9 ± 2.1 degrees for the first and the second assessment session, respectively. This small difference between assessments was significant (− 1.1 ± 2.2 degrees), however. The assessment protocol was characterized by a fair to good test-retest reliability (ICC = 0.47).

Conclusion

This study demonstrated the potential of this assessment protocol to objectively quantify elbow position sense in healthy individuals. Futures studies will validate this protocol in older adults and in individuals who sustained a stroke.

 

Background

Proprioception is defined as the ability to perceive body segment positions and movements in space [1]. Sensory receptors involved in proprioception are mostly located in muscle [234], joint [56] and skin [37]. Proprioceptive sense is known to play a significant role in motor control [891011] and learning [812], particularly in the absence of vision. The importance of proprioceptive inputs has been demonstrated while studying individuals who presented lack of proprioception due to large-fiber sensory neuropathy [1112]. Despite an intact motor system, somatosensory deafferentation may lead to limitations in several activities involving motor skills, such as eating or dressing [12]. These disabilities may also be observed in individuals with proprioceptive impairments due to a stroke. Indeed, approximately half of the individuals who sustained a stroke present proprioceptive impairments in contralesional upper limb [13]. After a stroke, proprioception is known to be related to recovery of functional mobility and independence in activities of daily living (ADL; [14]). Fewer individuals with significant proprioceptive and motor losses (25%) were independent in ADL than individuals with motor deficits alone (78%). Moreover, fewer individuals with proprioceptive deficits (60%) after a stroke are discharged from the hospital directly to home compared to those without proprioceptive deficits (92%) [15].

Although the negative impact of proprioceptive impairments on motor and functional recovery is known, a large proportion of clinicians (70%) report not using standardised assessment to evaluate somatosensory deficits in patients with a stroke [16]. In clinical and research settings, proprioception is most frequently assessed with limb-matching tasks. Two types of matching tasks have commonly been used: the ipsilateral remembered matching task and the contralateral concurrent matching task [17]. In an ipsilateral remembered matching task, the evaluator or robotic device brings the patient’s limb to a target joint position, when the patient’s eyes are closed, keeps the limb in this position for several seconds, and then moves back the limb to the initial position. The patient needs to memorize the reference position and replicate it with the same (ipsilateral) limb. This task cannot, however, be used to evaluate proprioception in individuals with working memory issues, which represent around 25% of individuals who sustained a stroke [18]. In such cases, the matching error observed could reflect memory deficits, rather than proprioceptive impairments. Moreover, upper limb paresis affects 76% of individuals who sustained a stroke [19], making the task’s execution difficult or impossible. Assessing proprioception with the less affected arm as the indicator arm is therefore frequently considered in patients with hemiparesis. Indeed, in a contralateral concurrent matching task, the patient has to reproduce a mirror image of the evaluated limb position with the opposite (contralateral) limb [17]. However, considering that 20% of individuals who sustained a stroke also presents proprioceptive impairment on the ipsilateral side of the lesion [13], it would be difficult to ascertain whether the error is due to deficits in the evaluated arm, the opposite arm or both. In addition, interhemispheric communication is required in a contralateral concurrent matching task. Individuals with asymmetric stroke or with transcallosal degeneration would therefore be particularly disadvantaged while being assessed with a contralateral concurrent matching task [17].

In order to study proprioception in individuals who sustained a stroke, we developed an assessment protocol, that combines the use of an exoskeleton and a virtual reality system, enabling the quantification of position sense without using the opposite arm, involving active movement of the evaluated limb or relying on working memory. The primary objective of the present study was to validate the assessment protocol by quantifying the elbow joint position sense of healthy adults, before using this protocol with individuals who sustained a stroke. As a secondary objective, test-retest reliability of the assessment protocol was investigated.[…]

 

Continue —> Quantification of upper limb position sense using an exoskeleton and a virtual reality display | Journal of NeuroEngineering and Rehabilitation | Full Text

 

Fig. 1KINARM Exoskeleton Lab. a Modified wheelchair with each arm supported against gravity by exoskeletons; (b) Virtual reality display; (c) Virtual arm and real arm positions (blue line; non-visible for the participant) where ∆Θ represents the angular difference between the real and the virtual arm. The white circle corresponds to the center of rotation, i.e. the elbow joint

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[ARTICLE] SITAR: a system for independent task-oriented assessment and rehabilitation

Over recent years, task-oriented training has emerged as a dominant approach in neurorehabilitation. This article presents a novel, sensor-based system for independent task-oriented assessment and rehabilitation (SITAR) of the upper limb.

The SITAR is an ecosystem of interactive devices including a touch and force–sensitive tabletop and a set of intelligent objects enabling functional interaction. In contrast to most existing sensor-based systems, SITAR provides natural training of visuomotor coordination through collocated visual and haptic workspaces alongside multimodal feedback, facilitating learning and its transfer to real tasks. We illustrate the possibilities offered by the SITAR for sensorimotor assessment and therapy through pilot assessment and usability studies.

The pilot data from the assessment study demonstrates how the system can be used to assess different aspects of upper limb reaching, pick-and-place and sensory tactile resolution tasks. The pilot usability study indicates that patients are able to train arm-reaching movements independently using the SITAR with minimal involvement of the therapist and that they were motivated to pursue the SITAR-based therapy.

SITAR is a versatile, non-robotic tool that can be used to implement a range of therapeutic exercises and assessments for different types of patients, which is particularly well-suited for task-oriented training.

The increasing demand for intense, task-specific neurorehabilitation following neurological conditions such as stroke and spinal cord injury has stimulated extensive research into rehabilitation technology over the last two decades.1,2 In particular, robotic devices have been developed to deliver a high dose of engaging repetitive therapy in a controlled manner, decrease the therapist’s workload and facilitate learning. Current evidence from clinical interventions using these rehabilitation robots generally show results comparable to intensity-matched, conventional, one-to-one training with a therapist.35 Assuming the correct movements are being trained, the primary factor driving this recovery appears to be the intensity of voluntary practice during robotic therapy rather than any other factor such as physical assistance required.6,7 Moreover, most existing robotic devices to train the upper limb (UL) tend to be bulky and expensive, raising further questions on the use of complex, motorised systems for neurorehabilitation.

Recently, simpler, non-actuated devices, equipped with sensors to measure patients’ movement or interaction, have been designed to provide performance feedback, motivation and coaching during training.812 Research in haptics13,14 and human motor control15,16 has shown how visual, auditory and haptic feedback can be used to induce learning of a skill in a virtual or real dynamic environment. For example, simple force sensors (or even electromyography) can be used to infer motion control17and provide feedback on the required and actual performances, which can allow subjects to learn a desired task. Therefore, an appropriate therapy regime using passive devices that provide essential and engaging feedback can enhance learning of improved arm and hand use.

Such passive sensor-based systems can be used for both impairment-based training (e.g. gripAble18) and task-oriented training (ToT) (e.g. AutoCITE8,9, ReJoyce11). ToT views the patient as an active problem-solver, focusing rehabilitation on the acquisition of skills for performance of meaningful and relevant tasks rather than on isolated remediation of impairments.19,20 ToT has proven to be beneficial for participants and is currently considered as a dominant and effective approach for training.20,21

Sensor-based systems are ideal for delivering task-oriented therapy in an automated and engaging fashion. For instance, the AutoCITE system is a workstation containing various instrumented devices for training some of the tasks used in constraint-induced movement therapy.8 The ReJoyce uses a passive manipulandum with a composite instrumented object having various functionally shaped components to allow sensing and training of gross and fine hand functions.11 Timmermans et al.22reported how stroke survivors can carry out ToT by using objects on a tabletop with inertial measurement units (IMU) to record their movement. However, this system does not include force sensors, critical in assessing motor function.

In all these systems, subjects perform tasks such as reach or object manipulation at the tabletop level, while receiving visual feedback from a monitor placed in front of them. This dislocation of the visual and haptic workspaces may affect the transfer of skills learned in this virtual environment to real-world tasks. Furthermore, there is little work on using these systems for the quantitative task-oriented assessment of functional tasks. One exception to this is the ReJoyce arm and hand function test (RAHFT)23 to quantitatively assess arm and hand function. However, the RAHFT primarily focuses on range-of-movement in different arm and hand functions and does not assess the movement quality, which is essential for skilled action.2428

To address these limitations, this article introduces a novel, sensor-based System for Independent Task-Oriented Assessment and Rehabilitation (SITAR). The SITAR consists of an ecosystem of different modular devices capable of interacting with each other to provide an engaging interface with appropriate real-world context for both training and assessment of UL. The current realisation of the SITAR is an interactive tabletop with visual display as well as touch and force sensing capabilities and a set of intelligent objects. This system provides direct interaction with collocation of visual and haptic workspaces and a rich multisensory feedback through a mixed reality environment for neurorehabilitation.

The primary aim of this study is to present the SITAR concept, the current realisation of the system, together with preliminary data demonstrating the SITAR’s capabilities for UL assessment and training. The following section introduces the SITAR concept, providing the motivation and rationale for its design and specifications. Subsequently, we describe the current realisation of the SITAR, its different components and their capabilities. Finally, preliminary data from two pilot clinical studies are presented, which demonstrate the SITAR’s functionalities for ToT and assessment of the UL. […]

Continue —> SITAR: a system for independent task-oriented assessment and rehabilitation Journal of Rehabilitation and Assistive Technologies Engineering – Asif Hussain, Sivakumar Balasubramanian, Nick Roach, Julius Klein, Nathanael Jarrassé, Michael Mace, Ann David, Sarah Guy, Etienne Burdet, 2017

Figure 1. The SITAR concept with (a) the interactive table-top alongside some examples of intelligent objects developed including (b) iJar to train bimanual control, (c) iPen for drawing, and (d) iBox for manipulation and pick-and-place.

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[ARTICLE] COMBINING UPPER LIMB ROBOTIC REHABILITATION WITH OTHER THERAPEUTIC APPROACHES AFTER STROKE: CURRENT STATUS, RATIONALE AND CHALLENGES – Full Text PDF

Abstract:

A better understanding of the neural substrates that underlie motor recovery after stroke has led to the development of innovative rehabilitation strategies and tools that incorporate key elements of motor skill re-learning, i.e. intensive motor training involving goal-oriented repeated movements. Robotic devices for the upper limb are increasingly used in rehabilitation. Studies have demonstrated the effectiveness of these devices in reducing motor impairments, but less so for the improvement of upper limb function. Other studies have begun to investigate the benefits of combined approaches that target muscle function (functional electrical stimulation and Botulinum Toxin injections), modulate neural activity (Noninvasive Brain stimulation) and enhance motivation (Virtual Reality) in an attempt to potentialize the benefits of robot-mediated training. The aim of this paper is to overview the current status of such combined-treatments and to analyze the rationale behind them.

1. Introduction
Significant advances have been made in the management of stroke (including prevention, acute management and rehabilitation), however cerebrovascular diseases remain the third most common cause of death and the first cause of disability worldwide[1–6]. Stroke causes brain damage, leading to loss of motor function. Upper limb (UL) function is particularly reduced, resulting in disability. Many rehabilitation techniques have been developed over the last decades to facilitate motor recovery of the UL in order to improve functional ability and quality of life [7–10]. They are commonly based on principles of motor skill learning to promote plasticity of motor neural networks. These principles include intensive, repetitive, task-oriented movement-based training [11–19]. A better understanding of the neural substrates of motor re-learning has led to the development of innovative strategies and tools to deliver exercise that meets these requirements. Treatments mostly target the neurological impairment (paresis, spasticity etc.) through the activation of neural circuits or by acting on peripheral effectors. Robotic devices provide exercises that incorporate key elements of motor learning. Advanced robotic systems can offer highly repetitive, reproducible, interactive forms of training for the paretic limb, which are quantifiable. Robotic devices also enable easy and objective assessment of motor performance in standardized conditions by the recording of biomechanical data (i.e., speed, forces, etc.) [20–22]. This data can be used to analyze and assess motor recovery in stroke patients [23–26]. Since the 1990’s, many other technology-based approaches and innovative pharmaceutical treatments have also been developed for rehabilitation, including virtual reality (VR)-based systems, Botulinum neurotoxin (BoNT) injections and Non Invasive Brain stimulation (NIBS) (Direct Current Stimulation (tDCS) and repetitive Transcranial Magnetic Stimulation (rTMS)). There is currently no high-quality evidence to support any of these innovative interventions, despite the fact that some are used in routine practice [27]. By their respective mechanisms of action, each of these treatments could potentiate the effects of robotic therapy, leading to greater improvements in motor capacity. The aim of this paper is to review studies of combined treatments based on robotic rehabilitation, and to analyze the rationale behind such approaches. […]

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[WEB SITE] Technology-Enhanced Stroke Treatment

SaeboFlex from Saebo Inc, Charlotte, NC, is a mechanical wrist and hand orthosis that assists digit extension to allow for object release and improved hand function and use.

In the United States, someone has a stroke every 40 seconds.1 With stroke mortality decreasing, and more people surviving the acute stroke event, stroke is a leading cause of long-term disability in this country.1,2 The resultant immobility and loss of independent functioning in daily activities speaks to the need for comprehensive and intensive stroke rehabilitation that address the often lasting effects of the stroke.

According to the American Heart Association/American Stroke Association, stroke is not just an acute event, but a chronic condition, with rehabilitation requiring “a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others.”3 These stroke rehabilitation guidelines call for programs to include individually designed plans, retraining to improve abilities to perform daily tasks and improve mobility, balance training to improve balance and decrease the risk of falls, and other key components that address impairments in speech, vision, and cognition, among others.3

In order to maximize the potential for recovery, stroke rehabilitation programs should include intensive, repetitive, meaningful, and task-specific therapies.3 These therapies address the devastating effects of stroke—loss of mobility, decreased ambulation, loss of upper extremity function—all of which impact overall and long-term health and quality of life. At Burke Rehabilitation Hospital, White Plains, NY, more than 500 patients who have suffered a stroke are admitted annually for comprehensive, acute inpatient rehabilitation. The large multidisciplinary team is focused on improving functional independence in preparation for discharge and return home. Individual care plans are developed and often utilize the latest technologies to ensure patient access to the most advanced equipment and evidence-based interventions. Investments in rehabilitation technologies have assisted in providing optimal, state-of-the-art rehab care for patients.

Product ResourcesThe following companies provide technologies for functional measurement and assessment:

AMTI
www.amti.biz

APDM
www.apdm.com

Aretech
www.aretechllc.com

Bioness
www.bioness.com

GAITRite/CIR Systems Inc
www.gaitrite.com

Gorbel Medical/SafeGait
www.safegait.com

Hocoma
www.hocoma.com

Mobility Research
www.litegait.com

ProtoKinetics
www.protokinetics.com

Saebo Inc
www.saebo.com

Solo-Step
www.solostep.com

Tekscan
www.tekscan.com

Vista Medical
www.boditrak.com

Woodway USA
www.woodway.com

Mobility Retraining

Gait retraining is one of the primary goals of stroke rehabilitation. Patients often state their goal in rehab is “to walk again.” Many technologies are utilized to support the task-specific and impairment-focused interventions that facilitate pre-gait and ambulation tasks. Each offers unique features and benefits that assist patients and therapists with carrying out each individual’s treatment plan.

The ZeroG Lite from Aretech, Ashburn, Va, is a body-weight support treadmill system that allows patients to safely practice gait training tasks over a treadmill by altering the amount of body-weight support. The difficulty and challenge of the task can be adjusted for the patient’s ability to practice intensive gait and balance activities, and parameters can be changed to change the intensity and duration of the tasks. The treadmill can be inclined and the belt speed can be reversed to facilitate walking up and down slopes.

The Guldmann Active Trainer with Ceiling Mounted Track from Guldmann Inc, Tampa, Fla, is a ceiling track-mounted system that provides adjustable body weight support that is used to provide balance and gait training. Patients with lateropulsion (turning of gait to one side) can safety be brought to a supported upright position to assist with regaining midline orientation and improving posture and weight bearing. Patients who are ambulatory are able to use the trainer in therapy to decrease gait deviations and improve gait quality and speed. Other types of ceiling-mounted body weight support systems that can provide utility for rehabbing individuals affected by stroke include the ZeroG Gait and Balance Training System, also from Aretech. This system can help protect users from falls as well as facilitate functional activities such as walking, sit-to-stand, postural tasks, balance activities, and more. It is also built to accommodate users who weigh up to 400 pounds.

The Bioness Vector from Valencia, Calif-based Bioness is also a ceiling-mounted body-weight support system that can provide a safe environment for over-ground training. The system has an adjustable fall limit setting, and the overhead track designs can be built to a clinic’s specifications. The SafeGait 360° Balance and Mobility Trainer from Gorbel Inc-Medical Division, Fishers, NY, is another overhead track system built to provide dynamic body-weight support and fall protection for early rehab post-stroke.

Other technologies that provide body-weight support for rehab training include LiteGait from Mobility Research, Tempe, Ariz, a gait training device that controls weight bearing, posture, and balance over a treadmill or over ground. It allows individuals to comfortably walk in a secure environment free of falls, altering weight bearing capacity via a sling support. LiteGait provides proper posture, reduces weight bearing, eliminates concerns for balance, and facilitates the training of coordinated lower extremity movement. The device can retrain postural stability and upright posture.

The Lokomat is a robotic device from Hocoma USA, Norwell, Mass, designed to provide highly repetitive physiological gait training that can be useful to therapists treating patients affected by neurological impairment. The user is supported by a harness suspended overhead while using an individually adjustable exoskeleton. Speed, loading, and robotic support all can be adjusted.

The WalkAide System from Innovative Neurotronics, Reno, Nev, is a myo-orthotic device, which combines electrical stimulation with orthotic technology in the treatment of foot drop. It is used to improve independence, functional mobility, and safety.

Also utilized is the NESS L300 Plus Foot Drop System available from Bioness, a neuro-orthotic and rehabilitation system that provides electrical currents to stimulate nerves and muscles to assist with a more natural walking pattern, reduce muscle spasms, reduce muscle loss, maintain or improve range of motion, and increase local blood circulation. It, too, is used to improve independence, functional mobility, and safety in the treatment of foot drop.

The Up n’ Go, offered by Easy Walking, Maple Glen, Pa, is a support device with a suspension system that allows for gait training through partial weight bearing and assists with sit to stand transitions. The device is lightweight and adjustable, allowing use with individuals with a range of balance and strength capabilities…

More —> Technology-Enhanced Stroke Treatment – Physical Therapy Products

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[ARTICLE] Development and assessment of a hand assist device: GRIPIT – Full Text

Abstract

Background

Although various hand assist devices have been commercialized for people with paralysis, they are somewhat limited in terms of tool fixation and device attachment method. Hand exoskeleton robots allow users to grasp a wider range of tools but are heavy, complicated, and bulky owing to the presence of numerous actuators and controllers. The GRIPIT hand assist device overcomes the limitations of both conventional devices and exoskeleton robots by providing improved tool fixation and device attachment in a lightweight and compact device. GRIPIT has been designed to assist tripod grasp for people with spinal cord injury because this grasp posture is frequently used in school and offices for such activities as writing and grasping small objects.

Methods

The main development objective of GRIPIT is to assist users to grasp tools with their own hand using a lightweight, compact assistive device that is manually operated via a single wire. GRIPIT consists of only a glove, a wire, and a small structure that maintains tendon tension to permit a stable grasp. The tendon routing points are designed to apply force to the thumb, index finger, and middle finger to form a tripod grasp. A tension-maintenance structure sustains the grasp posture with appropriate tension. Following device development, four people with spinal cord injury were recruited to verify the writing performance of GRIPIT compared to the performance of a conventional penholder and handwriting. Writing was chosen as the assessment task because it requires a tripod grasp, which is one of the main performance objectives of GRIPIT.

Results

New assessment, which includes six different writing tasks, was devised to measure writing ability from various viewpoints including both qualitative and quantitative methods, while most conventional assessments include only qualitative methods or simple time measuring assessments. Appearance, portability, difficulty of wearing, difficulty of grasping the subject, writing sensation, fatigability, and legibility were measured to assess qualitative performance while writing various words and sentences. Results showed that GRIPIT is relatively complicated to wear and use compared to a conventional assist device but has advantages for writing sensation, fatigability, and legibility because it affords sufficient grasp force during writing. Two quantitative performance factors were assessed, accuracy of writing and solidity of writing. To assess accuracy of writing, we asked subjects to draw various figures under given conditions. To assess solidity of writing, pen tip force and the angle variation of the pen were measured. Quantitative evaluation results showed that GRIPIT helps users to write accurately without pen shakes even high force is applied on the pen.

Conclusions

Qualitative and quantitative results were better when subjects used GRIPIT than when they used the conventional penholder, mainly because GRIPIT allowed them to exert a higher grasp force. Grasp force is important because disabled people cannot control their fingers and thus need to move their entire arm to write, while non-disabled people only need to move their fingers to write. The tension-maintenance structure developed for GRIPIT provides appropriate grasp force and moment balance on the user’s hand, but the other writing method only fixes the pen using friction force or requires the user’s arm to generate a grasp force.

Background

The hand is one of the most essential body parts for independent living because so many tasks of daily life, such as writing, eating, and grasping, require a functional hand. People who suffer from permanent paralysis of the hand owing to cerebral palsy, spinal cord injury (SCI), stroke, and other neurological disorders require assistive or rehabilitation devices in order to regain independence and return to work [1, 2].

A selection of commercialized hand assist devices is shown in Fig. 1. These devices are attached to the user’s arm or hand with Velcro® or elastic bands, and hand tools such as pens, forks, and paintbrushes are clamped into a hole in the devices. One drawback of these devices is that they can only grasp one type of tool because the receiving hole is a constant size. Users also must sometimes sustain an awkward posture to use a tool because it is mounted into the device in an unfamiliar position. Additionally, the Velcro or elastic band used to fix the device can apply high pressure to the skin if the strapping is too tight, and tools can be too shaky to use if the strapping becomes too loose. These problems reduce the usability of these devices and require users to put in a certain of amount of training time to become familiar with their use.

Fig. 1 Various types of hand assist devices for people with hand paralysis. a Writing aid. b Eating aid. c Grasping aid. d Cooking aid

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[ARTICLE] How Can We Improve Current Practice in Spastic Paresis? – Full Text

Abstract:

Spastic paresis can arise from a variety of conditions, including stroke, spinal cord injury, multiple sclerosis, cerebral palsy, traumatic brain injury and hereditary spastic paraplegia. It is associated with muscle contracture, stiffness and pain, and can lead to segmental deformity. The positive, negative and biomechanical symptoms associated with spastic paresis can significantly affect patients’ quality of life, by affecting their ability to perform normal activities. This paper – based on the content of a global spasticity interdisciplinary masterclass presented by the authors for healthcare practitioners working in the field of spastic paresis – proposes a multidisciplinary approach to care involving not only healthcare practitioners, but also the patient and their family members/carers, and improvement of the transition between specialist care and community services. The suggested treatment pathway comprises assessment of the severity of spastic paresis, early access to neurorehabilitation and physiotherapy and treatment with botulinum toxin and new technologies, where appropriate. To address the challenge of maintaining patients’ motivation over the long term, tailored guided self-rehabilitation contracts can be used to set and monitor therapeutic goals. Current global consensus guidelines may have to be updated, to include a clinical care pathway related to the encompassing management of spastic paresis.

Spastic paresis may be caused by a variety of conditions, including stroke, spinal cord injury, multiple sclerosis, retroviral and other infectious spinal cord disorders, cerebral palsy, traumatic brain injury and hereditary spastic paraplegia.1 The exact prevalence of spastic paresis (in which spasticity is the most commonly recognised manifestation) is not known. However, it is estimated that around 30% of stroke survivors are affected by significant spasticity2 and 50% who present to hospital with stroke develop at least one severe contracture.3

Spastic paresis is a complex condition that may be associated with soft tissue contracture, pain and limitations of day-to-day activities, which have a substantial impact on patients’ and caregivers’ quality of life.4 Although treatment guidelines have been developed for (focal) spasticity,5 there remains a lack of consensus on key aspects of diagnosis, approaches to care and the care pathway that would help healthcare practitioners to more fully understand and manage this condition.

To address some of these limitations, a group of physicians and a physiotherapist with expertise in the management of spastic paresis developed a global spasticity masterclass for healthcare practitioners working in this field in order to share best practices and to discuss issues and current trends in the management of patients with spasticity. The outputs of this masterclass are presented here.

Continue —> How Can We Improve Current Practice in Spastic Paresis? | Touch Neurology | Independent Insight for Medical Specialists

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[ARTICLE] How Can We Improve Current Practice in Spastic Paresis? – Full Text HTML

Abstract:

Spastic paresis can arise from a variety of conditions, including stroke, spinal cord injury, multiple sclerosis, cerebral palsy, traumatic brain injury and hereditary spastic paraplegia. It is associated with muscle contracture, stiffness and pain, and can lead to segmental deformity. The positive, negative and biomechanical symptoms associated with spastic paresis can significantly affect patients’ quality of life, by affecting their ability to perform normal activities. This paper – based on the content of a global spasticity interdisciplinary masterclass presented by the authors for healthcare practitioners working in the field of spastic paresis – proposes a multidisciplinary approach to care involving not only healthcare practitioners, but also the patient and their family members/carers, and improvement of the transition between specialist care and community services. The suggested treatment pathway comprises assessment of the severity of spastic paresis, early access to neurorehabilitation and physiotherapy and treatment with botulinum toxin and new technologies, where appropriate. To address the challenge of maintaining patients’ motivation over the long term, tailored guided self-rehabilitation contracts can be used to set and monitor therapeutic goals. Current global consensus guidelines may have to be updated, to include a clinical care pathway related to the encompassing management of spastic paresis.

Spastic paresis may be caused by a variety of conditions, including stroke, spinal cord injury, multiple sclerosis, retroviral and other infectious spinal cord disorders, cerebral palsy, traumatic brain injury and hereditary spastic paraplegia.1 The exact prevalence of spastic paresis (in which spasticity is the most commonly recognised manifestation) is not known. However, it is estimated that around 30% of stroke survivors are affected by significant spasticity2 and 50% who present to hospital with stroke develop at least one severe contracture.3

Spastic paresis is a complex condition that may be associated with soft tissue contracture, pain and limitations of day-to-day activities, which have a substantial impact on patients’ and caregivers’ quality of life.4 Although treatment guidelines have been developed for (focal) spasticity,5 there remains a lack of consensus on key aspects of diagnosis, approaches to care and the care pathway that would help healthcare practitioners to more fully understand and manage this condition.

To address some of these limitations, a group of physicians and a physiotherapist with expertise in the management of spastic paresis developed a global spasticity masterclass for healthcare practitioners working in this field in order to share best practices and to discuss issues and current trends in the management of patients with spasticity. The outputs of this masterclass are presented here.

Pathophysiology and definitions
Spastic paresis
Spasticity is one of several components of spastic paresis, also known as the upper motor neuron (UMN) syndrome. Spastic paresis is primarily characterised by a quantitative lack of command directed to agonist muscles involved in performing movements.1,6,7 In addition, hyperactive spinal reflexes mediate some of the positive phenomena seen in spastic paresis, while other positive symptoms are related to disordered control of voluntary movement in terms of an abnormal efferent drive or are caused

Continue —> How Can We Improve Current Practice in Spastic Paresis? | Touch Neurology | Independent Insight for Medical Specialists

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