Posts Tagged coordination

[ARTICLE] Long-Dose Intensive Therapy Is Necessary for Strong, Clinically Significant, Upper Limb Functional Gains and Retained Gains in Severe/Moderate Chronic Stroke – Full Text

Background. Effective treatment methods are needed for moderate/severely impairment chronic stroke.

Objective. The questions were the following: (1) Is there need for long-dose therapy or is there a mid-treatment plateau? (2) Are the observed gains from the prior-studied protocol retained after treatment?

Methods. Single-blind, stratified/randomized design, with 3 applied technology treatment groups, combined with motor learning, for long-duration treatment (300 hours of treatment). Measures were Arm Motor Ability Test time and coordination-function (AMAT-T, AMAT-F, respectively), acquired pre-/posttreatment and 3-month follow-up (3moF/U); Fugl-Meyer (FM), acquired similarly with addition of mid-treatment.

Findings. There was no group difference in treatment response (P ≥ .16), therefore data were combined for remaining analyses (n = 31; except for FM pre/mid/post, n = 36). Pre-to-Mid-treatment and Mid-to-Posttreatment gains of FM were statistically and clinically significant (P < .0001; 4.7 points and P < .001; 5.1 points, respectively), indicating no plateau at 150 hours and benefit of second half of treatment. From baseline to 3moF/U: (1) FM gains were twice the clinically significant benchmark, (2) AMAT-F gains were greater than clinically significant benchmark, and (3) there was statistically significant improvement in FM (P < .0001); AMAT-F (P < .0001); AMAT-T (P < .0001). These gains indicate retained clinically and statistically significant gains at 3moFU. From posttreatment to 3moF/U, gains on FM were maintained. There were statistically significant gains in AMAT-F (P = .0379) and AMAT-T P = .003.

Many stroke survivors do not fully recover upper limb function following stroke, leading to significant disability and diminished quality of life.1 Effective treatments are needed for chronic, severely impaired stroke survivors.2 Other studies showed improved upper limb motor function in chronic stroke for mild/moderately impaired,313 with traditional “constraint induced” treatment studies enrolling only those with preserved wrist and finger extension (acceptance rate, 10%).14 However, for those with moderate/severe impairment after stroke, improvement in function has been more difficult to realize. A recent study of constraint-induced movement therapy in more severe stroke reported no clinically significant change in upper limb Fugl-Meyer assessment scores.15 Others have also tested the application of technologies and devices, in moderately/severely impaired chronic stroke survivors, with the following: functional electrical stimulation (FES),1618 sequenced bilateral and unilateral task orientated training,19 mirror therapy,20 progressive abduction loading therapy,21 contralaterally controlled FES,22 and robotics.2327 Limitations included small sample size,1618,2223 lacking control group,16,23 lacking statistically significant gains on impairment or functional measures,23 lacking clinically significant change,20,21,2325,27 lacking retention of clinically significant gains,16,19,25,26 or lacking study of retention.20,23 Furthermore, many studies do not include both a measure of impairment and an array of actual everyday functional tasks. Our work has focused on moderately/severely impaired chronic stroke survivors, and in prior work we developed and tested a protocol that combines technology applications and motor learning.28,29 We found clinically and statistically significant gains for those with moderate/severe stroke considerably beyond that reported by others (eg, gains in coordination, Fugl-Myer coordination scale [FM], and gains on the Arm Motor Ability Test [AMAT; 13 complex functional tasks]).

Others have cited this work stating that “a change in impairment of this magnitude was previously considered almost impossible in chronic stroke patients,”30 and that this is important first evidence for use of high dose neurorehabilitation.31 Therefore, we considered it important to replicate the administration of the upper limb motor learning protocol in a follow-on study and again quantify response. Another consideration was that we had not given technology a full chance in application to the “whole arm,” that is, both distal and proximal upper limb regions. Therefore, a first purpose was to replicate administration of the upper limb motor learning protocol and to include a treatment group that would receive technology applications to both distal and proximal limb regions. In addition, there were 2 important and unanswered questions regarding the dose and efficacy of this new treatment protocol.

The first question is whether a shorter treatment duration (ie, <300 hours) could produce the same degree of recovery, given that the existing protocol was tested in the paradigm of long-duration dose of 300 hours of therapy. Therefore, in the current work, we administered the same protocol as in prior work,28 and acquired mid-treatment (at 150 hours of treatment) data on the Fugl-Meyer impairment measure, which underlies complex functional task performance. We studied whether a mid-treatment plateau occurred or whether significant recovery occurred in response to the second half of treatment (mid-treatment to posttreatment).

The second question is whether the observed gains can be retained after cessation of treatment. Therefore, we studied retention of gains at 3 months after treatment ended.[…]

 

Continue —> Long-Dose Intensive Therapy Is Necessary for Strong, Clinically Significant, Upper Limb Functional Gains and Retained Gains in Severe/Moderate Chronic Stroke – Janis J. Daly, Jessica P. McCabe, John Holcomb, Michelle Monkiewicz, Jennifer Gansen, Svetlana Pundik, 2019

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[WEB SITE] The Newest Technology Impacting Physical Therapy – Virtual Reality

Digital technologies are increasingly becoming more important in the medical sphere every single day. Already, technologies like telemedicine have proven to be an effective method of treatment and has quickly gained in popularity over the years proving that technology can swiftly replace old systems with new, more efficient methods of treatment. Now, a new technology called Virtual Reality is coming into the therapy world and is changing it forever.
 
HOW IS VR IMPACTING PHYSICAL THERAPY?
Virtual Reality (VR) is now being used by physical therapists for the successful treatment of stroke victims, walking disorders and back pain. The technology has been shown to improve the patients motor learning and coordination skills by using gamified, immersive environments that have been created to help patients suffering from pain and injury relearn the use of their limbs in a way that is motivating and fun.
 
WHY IT MATTERS
Lets be honest, most times physical therapy can be a painful and overwhelming experience. With VR, the patient is able to experience a three-dimensional world surrounding their vision that is quite convincing to the sense’s. Many people report that they actually feel present in another environment, separate from reality. This is the element that aids in eliminating pain during exercises and encourages more repeat workouts. For example, if the patient was exercising their lower limbs, they would be able to appear as if they are walking on a beach or in a forest instead of on a boring treadmill. In another scenario, if the patient was exercising their upper extremities, then they could experience the thrill of being rewarded for successfully climbing up a mountain. Games like this provide motivation at home for the patient to continue exercising, enabling them with visual data on how they are improving their range of motion. These type of “experiences” help to keep the patient on the right path outside of the treatment room, which is a huge bonus because studies have shown that only 30% of exercises get accomplished after leaving rehabilitation.
 
 
What this will do to the therapy industry is still unknown but it is obvious that there is enormous potential for this technology to impact it in a large way.

 

via The Newest Technology Impacting Physical Therapy – Virtual Reality

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[BLOG POST] At Home Leg Exercises For Stroke Recovery Patients – Saebo

Reclaim Mobility With Leg Exercises For Stroke Recovery

Stroke recovery can be a long process. Managing the ongoing need to rebuild bodily control and strength after neurological damage is no easy task. Each year nearly 800,000 people in the United States alone will suffer from a stroke, leaving them with ongoing physical and neurological damage.

If you have suffered from a stroke, loss of balance and control can make standing and walking difficult. While outpatient stroke recovery therapy is vital to improving this problem, you can also continue improving after returning home with the help of these leg exercises for stroke recovery.

Leg Exercises for Stroke Recovery

Richard Sealy, director of The Rehab Practice, a private neuro-therapy rehabilitation program in the United Kingdom, regularly works with individuals, families, and caregivers to establish custom exercise routines to aid in recovery from from long-term neurological problems, like the damage caused by stroke. While he acknowledges that each patient should have a custom exercise routine specific and personal to their struggles, he recommends a series of exercises to help strengthen the legs and improve range of motion during stroke recovery.

Sealy understands the importance of fast progress after a stroke, and including ongoing at-home exercises can improve health and well-being. These low-impact strength and stretching leg exercises for stroke recovery are a good complement to use in conjunction with the Saebo MyoTrac Infiniti biofeedback system.

As with any exercise program, please consult your healthcare provider before you begin. If you notice increased pain, discomfort, or other troubling systems, stop these exercises immediately and talk to your doctor.

Exercise #1 – Standing and Balance

Balance and coordination are often lost after a stroke. This can make simple actions, like standing and walking,
difficult. In addition, weakness can occur around the muscles on the exterior of the hip area.

Exercises for standing and balance are vital to helping you regain your quality of life after a stroke. When performing these exercises, always hold onto a table or similar stable surface to avoid a fall.

 

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Basic Level Standing and Balance Exercise

Hold on to a stable surface, standing straight and tall while you transfer your weight to one side. Swing the other leg to the side. Use your balance to hold this position for 10 seconds. Slowly lower your leg back down. Repeat a few times, as long as you have the strength, and then switch legs.

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Intermediate Standing and Balance Exercises

Once you have mastered the first exercise, move on to the intermediate level. Again, hold on to a stable surface, keeping your back tall and straight. Transfer your weight to one leg, and bring the other leg up in front of you, bending the knee. Hold this position for a count of 10, and slowly lower it back down. Repeat, then switch legs.

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Advanced Standing and Balance Exercises

Finally, progress to the advanced level. This time, stand straight and tall and transfer your weight to one leg. Swing the other leg out behind you as far as you can. Hold for 10 seconds, if you can, and lower it back down slowly. Repeat and switch legs.

This progression of exercises will strengthen the hip muscle and improve balance, so you can regain normal use of your legs. This exercise series pairs well with the Saebo MayoTrac Infiniti biofeedback triggered stimulation system.

 

Exercise #2 – Bridging

Often after a stroke, the hips and the core muscle groups, which are crucial to standing and walking, become weak. Bridging exercises help to strengthen these core muscles. Like the standing and balance exercises, bridging exercises move through a progression to help rebuild your strength and coordination.

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Basic Bridging Exercise

The basic bridging exercise, called “Inner Range Quad Movement”, builds strength in the thigh muscles. To perform this exercise, lay down and place a pillow or rolled towel under the knee joint. Then, press the back of the knee into the pillow or rolled towel to lift your heel off the floor.

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Intermediate Bridging Exercise

“Ski Squats” take bridging exercises to the next level. For this exercise, lean against a flat wall, placing your feet in front of you. Using the wall to support your weight and your back, slowly bend your knees to lower yourself down. Hold this position for 10 seconds, if you can. Slide back up, supporting your weight on the wall, until you are in a standing position.

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Advanced Bridging Exercise

To take bridging exercises to the advanced level, repeat the “Ski Squat”, but place a gym ball between yourself and the wall when you bend your knees into the squat position.

 

Exercise #3 – Clams

If the lower legs are affected after a stroke, Clams can provide strengthening and improved range of motion. Clams focuses on building strength and coordination in the lower leg, increasing range of motion and control.

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Basic Clams Exercise – In Sitting

Before starting Clams, you must stretch the calf muscle and build coordination in the lower body. In Sitting helps with this. In a sitting position, create a stirrup around one foot using a towel or belt, placing the stirrup around the ball of the foot. Gently pull the stirrup up towards your body to stretch the calf muscle. Then, pull it with the outer hand to turn the foot out, continuing to stretch the muscle.

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Intermediate Clams Exercise

Once you have build some flexibility, you are ready for the Clams exercise. Lay down on your side, and bend your knees, resting one on top of the other. Then, while you keep your feet together, lift the upper knee away from the other knee, holding them apart for a count of 10 seconds. Slowly lower your knee back down. While performing this exercise, make sure that you do not roll your hips back.

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Advanced Clams Exercise

After mastering Clams, take it to the next level by lifting the knee and the foot of the upper leg. Again, hold the position for a count of 10 seconds. Lower it back down. Repeat a few times to build strength and range of motion.

Rebuild Strength and Coordination with Stroke Recovery Exercises

Strokes can occur in people of any age, although nearly 75% of all strokes occur after the age of 65, and an individual’s risk doubles after 55. Each year, approximately 600,000 people suffer from their first stroke, and an additional 185,000 have a recurrent stroke.

If you have suffered one or more strokes, it can be easy to feel discouraged at the lack of mobility and control you experience. Stroke exercises, like these, can help you regain that control and build up your strength again, so you can recover from the neurological damage of a stroke.

For extra support in advancing your recovery after a stroke, check out the many advanced products from Saebo to help you every step of the way.

Which Product is Right for Me?

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[WEB SITE] Cognitive Assessment: Neurocognitive Assessment Battery Online for the detection of cognitive deterioration (CAB).

General Cognitive Assessment Battery (CAB)

Innovative online neuropsychological test. Study brain function and complete a comprehensive online screening. Precisely evaluate a wide range of abilities and detect cognitive well-being (high-moderate-low). Identify strengths and weaknesses in the areas of memory, concentration/attention, executive functions, planning, and coordination.

WHO IS IT FOR?

    • For my own evaluation
    • For a family member
    • For my patients
    • For my students
    • For a research study

TOTAL PRICE 49.95

 

Cognitive assessment battery to study brain function and cognitive performance

  • Assess current state of the user’s cognitive skills
  • For children 7 years and older and adults.
  • The complete battery lasts about 30-40 minutes.

The General Cognitive Assessment Battery (CAB) from CogniFit is a leading professional tool that makes it possible to get study the brain function of children 7 years and older and adults in depth, using online cognitive tasks. The results from this neuropsychological tool are useful for understanding the user’s cognitive state, strengths, and weaknesses. This can help determine whether or not the cognitive changes that the user may be experiencing are normal, or if they reflect some kind of neurological disorder. Any private or professional user can easily use this cognitive assessment.

This normalized cognitive test is completely online and lasts about 30-40 minutes. After completing the evaluation, a report will automatically be generated with the user’s neurocognitive profile. This report gathers useful information and presents data in an easy-to-understand format to make it possible to understand the functioning of different cognitive skills. It also provides valuable information that can help detect the risk of some disorder or problem, recognize its severity, and identify support strategies for each case.

We recommend using this neuropsychological assessment to better understand cognitive function, or cognitive, physical, psychological, or social well-being, and where there are symptoms or difficulties related o concentration/attention, memory, reasoning, planning, or coordination. We recommend using this complete cognitive test to complement a professional diagosis, and never to substitute a clinical consultation.[…]

 

Visit Site —> Cognitive Assessment: Neurocognitive Assessment Battery Online for the detection of cognitive deterioration (CAB).

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[ARTICLE] Reorganization of finger coordination patterns through motor exploration in individuals after stroke – Full Text

 

Abstract

Background

Impairment of hand and finger function after stroke is common and affects the ability to perform activities of daily living. Even though many of these coordination deficits such as finger individuation have been well characterized, it is critical to understand how stroke survivors learn to explore and reorganize their finger coordination patterns for optimizing rehabilitation. In this study, I examine the use of a body-machine interface to assess how participants explore their movement repertoire, and how this changes with continued practice.

Methods

Ten participants with chronic stroke wore a data glove and the finger joint angles were mapped on to the position of a cursor on a screen. The task of the participants was to move the cursor back and forth between two specified targets on a screen. Critically, the map between the finger movements and cursor motion was altered so that participants sometimes had to generate coordination patterns that required finger individuation. There were two phases to the experiment – an initial assessment phase on day 1, followed by a learning phase (days 2–5) where participants trained to reorganize their coordination patterns.

Results

Participants showed difficulty in performing tasks which had maps that required finger individuation, and the degree to which they explored their movement repertoire was directly related to clinical tests of hand function. However, over four sessions of practice, participants were able to learn to reorganize their finger movement coordination pattern and improve their performance. Moreover, training also resulted in improvements in movement repertoire outside of the context of the specific task during free exploration.

Conclusions

Stroke survivors show deficits in movement repertoire in their paretic hand, but facilitating movement exploration during training can increase the movement repertoire. This suggests that exploration may be an important element of rehabilitation to regain optimal function.

Background

Stroke often results in impairments of upper extremity, including hand and finger function, with 75% of stroke survivors facing difficulties performing activities of daily living [12]. Critically, impairments after stroke not only include muscle- and joint-specific deficits such as weakness, and changes in the kinetic and kinematic workspace of the fingers [34], but also coordination deficits such as reduced independent joint control [5] and impairments in finger individuation and enslaving [6789]. Therefore, understanding how to address these coordination deficits is critical for improving hand rehabilitation.

Typical approaches to hand rehabilitation emphasize repetition [10] and functional practice based on evidence that such experience can cause reorganization in the brain [11]. Although this has proven to be reasonably successful, functional practice (such as repetitive grasping of objects) does not specify the coordination pattern to be used when performing the tasks. As a result, because of the redundancy in the human body, there is a risk that stroke survivors may adopt atypical compensatory movements to perform tasks [12]. These compensatory movements have been mainly identified during reaching [1314], but there is evidence that they are also present in finger coordination patterns during grasping [15]. Although there is still debate over the role of compensatory movements in rehabilitation [16], there is at least some evidence both in animal and humans that continued use of these compensatory patterns may be detrimental to true recovery [171819].

To address this issue, there has been a greater focus on directly facilitating the learning of new coordination patterns. Specifically, in hand rehabilitation, virtual tasks (such as playing a virtual piano) have been examined as a way to train finger individuation [2021]. In these protocols, individuation is encouraged by asking participants to press a particular key with a finger, while keeping other fingers stationary. A similar approach to improve hand dexterity was also adopted by developing a glove that could be used as a controller for a popular guitar-playing video game [22]. However, directly instructing desired coordination patterns to be produced becomes challenging as the number of degrees of freedom involved in the coordination pattern increase. For example, the hand has approximately 20 kinematic degrees of freedom, and providing verbal, visual or auditory feedback for simultaneously controlling all these degrees of freedom would be a major challenge. A potential solution that has been suggested is not to directly instruct the coordination pattern itself, but rather let participants explore different coordination patterns [23]. This idea of motor exploration is based on dynamical systems theory that suggests that variability and exploration may help participants escape sub-optimal pre-existing coordination patterns and potentially settle in more optimal coordination patterns [24252627]. Such exploration has been shown to be important in adapting existing movement repertoire [28], and has also been shown to be associated with faster rates of learning [29].

In order to test the hypothesis that exploration of novel coordination patterns can improve overall movement repertoire, I used a body-machine interface [3031] to examine how stroke survivors explore and reorganize finger coordination patterns with practice. A body-machine interface maps body movements (in this case finger movements) to the control of a real or virtual object (in this case a screen cursor), which can provide a way to elicit different coordination patterns in the context of an intuitive task. Specifically I examined: (i) how stroke survivors reorganize their finger coordination patterns, (ii) how training to explore novel coordination patterns affects their ability to reorganize their coordination pattern, and (iii) if training to explore novel coordination patterns has an effect on their overall movement repertoire. In this context, I use the term “novel” to indicate coordination patterns that require finger individuation. This assumption is motivated by the finding that stroke survivors have difficulty producing finger individuation even under explicit instruction [69], and therefore it is highly likely that they would not use coordination patterns requiring finger individuation frequently in activities of daily living.[…]

Continue —>  Reorganization of finger coordination patterns through motor exploration in individuals after stroke | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 1 a Experimental setup – participants wore a data glove and moved their fingers to control a screen cursor b Schematic of task – participants moved a cursor between two targets using movements of four fingers (thumb excluded). c Experimental protocol. Participants came in for 5 total sessions – an initial assessment phase, followed by a learning phase. d Weighting coefficients of the index and middle (blue), and ring and little (red) fingers during the initial assessment phase, and e weighting coefficients during the learning phase

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[ARTICLE] Faster Reaching in Chronic Spastic Stroke Patients Comes at the Expense of Arm-Trunk Coordination

Abstract

Background. The velocity of reaching movements is often reduced in patients with stroke-related hemiparesis; however, they are able to voluntarily increase paretic hand velocity. Previous studies have proposed that faster speed improves movement quality.

Objective. To investigate the combined effects of reaching distance and speed instruction on trunk and paretic upper-limb coordination. The hypothesis was that increased speed would reduce elbow extension and increase compensatory trunk movement.

Methods. A single session study in which reaching kinematics were recorded in a group of 14 patients with spastic hemiparesis. A 3-dimensional motion analysis system was used to track the trajectories of 5 reflective markers fixed on the finger, wrist, elbow, acromion, and sternum. The reaching movements were performed to 2 targets at 60% and 90% arm length, respectively, at preferred and maximum velocity. The experiment was repeated with the trunk restrained by a strap.

Results. All the patients were able to voluntarily increase reaching velocity. In the trunk free, faster speed condition, elbow extension velocity increased but elbow extension amplitude decreased and trunk movement increased. In the trunk restraint condition, elbow extension amplitude did not decrease with faster speed. Seven patients scaled elbow extension and elbow extension velocity as a function of reach distance, the other 7 mainly increased trunk compensation with increased task constraints. There were no clear clinical characteristics that could explain this difference.

Conclusions. Faster speed may encourage some patients to use compensation. Individual indications for therapy could be based on a quantitative analysis of reaching coordination.

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[ARTICLE] Comparison of Robotics, FES, and Motor Learning Methods for Treatment of Persistent Upper Extremity Dysfunction after Stroke: a Randomized Controlled Trial

Abstract

Objective: To compare response to upper limb treatment using robotics (ROB) + motor learning (ML) vs. functional electrical stimulation (FES) + ML vs. ML alone, according to a measure of complex functional everyday tasks for chronic, severely impaired stroke survivors.

Design: single-blind, randomized trial.

Setting: Clinical research lab, Medical Center.

Participants: 39 enrolled subjects, >1 year post single stroke (attrition rate=10%; 35 completed the study). No adverse effects.

Interventions: All groups received treatment 5 days/week, 5hrs/day (60 sessions), with unique treatment as follows: ML alone (n=11), 5hrs/day partial and whole task practice of complex functional tasks; ROB+ML (n=12), 3.5hrs/day ML and 1.5hrs/day shoulder/elbow robotics; FES+ML (n=12), 3.5hrs/day ML and 1.5hrs/day FES wrist/hand coordination training.

Main Outcome Measures: Primary measure: Arm Motor Ability Test (AMAT), 13 complex functional tasks; secondary measure: upper limb Fugl-Meyer coordination (FM).

Results: No significant difference found in treatment response across groups (AMAT (p≥.584) and FM (p≥.590)). All three treatment groups demonstrated clinically and statistically significant improvement in response to treatment (AMAT and FM, p≤.009). A group treatment paradigm of 1:3 (therapist:patient) ratio proved feasible for provision of the intensive treatment.

Conclusions: Severely impaired stroke survivors with persistent (>1yr) upper extremity dysfunction can make clinically and statistically significant gains in coordination and functional task performance, in response to ROB+ML, FES+ML, and ML alone, in an intensive and long-duration intervention, and no group difference was found. Additional study is warranted to determine the effectiveness of these methods in the clinical setting.

via Comparison of Robotics, FES, and Motor Learning Methods for Treatment of Persistent Upper Extremity Dysfunction after Stroke: a Randomized Controlled Trial – Archives of Physical Medicine and Rehabilitation.

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