Posts Tagged assessment

[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.

Advertisements

, , , , , , , , , , ,

Leave a comment

[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. […]

Download Full Text PDF

, , , , , , , , ,

Leave a comment

[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

, , , ,

Leave a comment

[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

Continue —> Development and assessment of a hand assist device: GRIPIT | Journal of NeuroEngineering and Rehabilitation | Full Text

, , , , , , , , , , ,

Leave a comment

[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

, , , , , , , , , ,

Leave a comment

[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

, , , , , , , , , , ,

Leave a comment

[ARTICLE] Evaluation of upper extremity neurorehabilitation using technology: a European Delphi consensus study within the EU COST Action Network on Robotics for Neurorehabilitation – Full Text

Abstract

Background

The need for cost-effective neurorehabilitation is driving investment into technologies for patient assessment and treatment. Translation of these technologies into clinical practice is limited by a paucity of evidence for cost-effectiveness. Methodological issues, including lack of agreement on assessment methods, limit the value of meta-analyses of trials. In this paper we report the consensus reached on assessment protocols and outcome measures for evaluation of the upper extremity in neurorehabilitation using technology. The outcomes of this research will be part of the development of European guidelines.

Methods

A rigorous, systematic and comprehensive modified Delphi study incorporated questions and statements generation, design and piloting of consensus questionnaire and five consensus experts groups consisting of clinicians, clinical researchers, non-clinical researchers, and engineers, all with working experience of neurological assessments or technologies. For data analysis, two major groups were created: i) clinicians (e.g., practicing therapists and medical doctors) and ii) researchers (clinical and non-clinical researchers (e.g. movement scientists, technology developers and engineers).

Results

Fifteen questions or statements were identified during an initial ideas generation round, following which the questionnaire was designed and piloted. Subsequently, questions and statements went through five consensus rounds over 20 months in four European countries. Two hundred eight participants: 60 clinicians (29 %), 35 clinical researchers (17 %), 77 non-clinical researchers (37 %) and 35 engineers (17 %) contributed. At each round questions and statements were added and others removed. Consensus (≥69 %) was obtained for 22 statements on i) the perceived importance of recommendations; ii) the purpose of measurement; iii) use of a minimum set of measures; iv) minimum number, timing and duration of assessments; v) use of technology-generated assessments and the restriction of clinical assessments to validated outcome measures except in certain circumstances for research.

Conclusions

Consensus was reached by a large international multidisciplinary expert panel on measures and protocols for assessment of the upper limb in research and clinical practice. Our results will inform the development of best practice for upper extremity assessment using technologies, and the formulation of evidence-based guidelines for the evaluation of upper extremity neurorehabilitation.

Continue —> Evaluation of upper extremity neurorehabilitation using technology: a European Delphi consensus study within the EU COST Action Network on Robotics for Neurorehabilitation | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 1 Flowchart of the design and piloting of the questionnaire

, , , , , , , , ,

Leave a comment

[REVIEW] On the assessment of coordination between upper extremities: towards a common language between rehabilitation engineers, clinicians and neuroscientists – Full Text

Abstract

Well-developed coordination of the upper extremities is critical for function in everyday life. Interlimb coordination is an intuitive, yet subjective concept that refers to spatio-temporal relationships between kinematic, kinetic and physiological variables of two or more limbs executing a motor task with a common goal. While both the clinical and neuroscience communities agree on the relevance of assessing and quantifying interlimb coordination, rehabilitation engineers struggle to translate the knowledge and needs of clinicians and neuroscientists into technological devices for the impaired. The use of ambiguous definitions in the scientific literature, and lack of common agreement on what should be measured, present large barriers to advancements in this area. Here, we present the different definitions and approaches to assess and quantify interlimb coordination in the clinic, in motor control studies, and by state-of-the-art robotic devices. We then propose a taxonomy of interlimb activities and give recommendations for future neuroscience-based robotic- and sensor-based assessments of upper limb function that are applicable to the everyday clinical practice. We believe this is the first step towards our long-term goal of unifying different fields and help the generation of more consistent and effective tools for neurorehabilitation.

Background

This work was developed as part of the project “State of the Art Robot-Supported assessments (STARS)” in the frame of the COST Action TD1006 “European Network on Robotics for NeuroRehabilitation” [1]. The goal of STARS is to give neurorehabilitation clinical practitioners and scientists recommendations for the development, implementation, and administration of different indices of robotic assessments, grounded on scientific evidence.

Well-coordinated movements are a characteristic feature of well-developed motor behavior. From neuroscientists to clinicians, quantifying coordination of an individual is of critical importance. Not only does this help in understanding the neurophysiological components of movement (neuroscience field), but it can also help us identify and assess underlying neurological problems of a patient with movement disorders, and guide therapeutic interventions (clinical field).

The term ‘coordination’ is so strongly ingrained in our common language that we do not typically stop to think about the key underlying features that characterize good and bad coordination–even though we can all distinguish the well-coordinated movements of a trained dancer from those of a novice. What exactly is meant by coordination? And how should it be measured? Addressing these questions is particularly difficult when considering such an abstract concept, which encompasses many different aspects that are not straightforward to define formally.

Indeed, coordinated movements are multidimensional and require the organization of multiple subsystems, e.g., eye-hand coordination [2], intersegmental coordination [3], intralimb coordination [4], interlimb coordination [5]. Given the multiple connotations and associations to the word coordination, in this paper, we attempt to summarize how coordination between upper extremities-a form of interlimb coordination-is interpreted and measured by clinicians, neuroscientists and rehabilitation engineers.

As the reader will see in the following pages, the descriptors of interlimb coordination and how it is assessed vary considerably from field to field, and even within a field. This lack of a common language and standard terminology is a huge barrier to relate the observations from different fields, hindering the understanding and discussion needed to move forward. Further, such definitions are critical for engineers working in translational neurorehabilitation, who harness knowledge from basic and clinical neuroscience to produce technological tools (e.g., robotic devices, instrumented tools) to aid clinicians in their everyday practice. The lack of a common understanding has fostered the use of dozens of ad-hoc algorithms and assessment tools (see section 3), most of which have had limited transfer to everyday clinical applications.

Our long-term goal is to standardize the administration of robotic-and sensor-based assessments of sensory-motor function. Towards this end, we present a summary of different ways in which interlimb coordination has been studied and quantified. We start by presenting a general overview of why the study of coordination between upper limbs is relevant for clinicians and behavioral neuroscientists. We then present a summary of how interlimb coordination is typically assessed in clinical environments and during related motor control experiments. This is followed by a proposal of categorization of interlimb tasks and different outcome measures that are applicable to each task. We believe that the growing scientific community in translational neurorehabilitation research would benefit from this condensed review. …

Continue —> On the assessment of coordination between upper extremities: towards a common language between rehabilitation engineers, clinicians and neuroscientists | Journal of NeuroEngineering and Rehabilitation | Full Text

, , , , , , , ,

Leave a comment

[Review] How Can We Improve Current Practice in Spastic Paresis? – Full Text PDF/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.

Downlload Full Text PDF

Visit WEB SITE (HTML Version)

, , , , , , , , , , , ,

Leave a comment

[SCHOLARLY PAPER] Cognitive Deficits Following Stroke – Full Text PDF

Summary

The rehabilitation of survivors of stroke places heavy demands on NHS resources. Studies investigating the efficacy of stroke rehabilitation have produced equivocal results.

In this paper we focus on the effects of cognitive deficits on motor functioning (in particular, disorders of praxis and attention) and report some results of particular relevance to physiotherapists. For instance, a symmetrical approach to treatment may not only improve motor function but may also help reduce the severity of unilateral neglect (ie encouraging the patient to orient visually to the affected side should improve the ability to attend to and to be aware of the affected side of space. Motor cues are more likely to be effective than visual cues if motor performance is required, and in particular cueing is,most likely to be effective if it is initiated by a patient rather than a therapist.

Simultaneous bi-lateral exercises should be avoided unless attempts are made to overcome any effect of extinction, where a patient may attend only to the unaffected limb. In addition, cases of dyspraxia show that palogical functioning may be transferred between the hemispheres. Sequential bi-lateral exercises are to be preferred; the effect of the intact limb performing a pattern of movement may provide the visual experience of what the movement should be, and there also may be actjvation of homologous motor areas via the corpus callosum which may facilite the normal movement pattern.

Full Text PDF 

 

, , , , , , ,

Leave a comment

%d bloggers like this: