Posts Tagged Exercise
[ARTICLE] Feedback Design in Targeted Exercise Digital Biofeedback Systems for Home Rehabilitation: A Scoping Review – Full Text PDF
Digital biofeedback systems (DBSs) are used in physical rehabilitation to improve outcomes by engaging and educating patients and have the potential to support patients while doing targeted exercises during home rehabilitation. The components of feedback (mode, content, frequency and timing) can influence motor learning and engagement in various ways. The feedback design used in DBSs for targeted exercise home rehabilitation, as well as the evidence underpinning the feedback and how it is evaluated, is not clearly known. To explore these concepts, we conducted a scoping review where an electronic search of PUBMED, PEDro and ACM digital libraries was conducted from January 2000 to July 2019. The main inclusion criteria included DBSs for targeted exercises, in a home rehabilitation setting, which have been tested on a clinical population. Nineteen papers were reviewed, detailing thirteen different DBSs. Feedback was mainly visual, concurrent and descriptive, frequently providing knowledge of results. Three systems provided clear rationale for the use of feedback. Four studies conducted specific evaluations of the feedback, and seven studies evaluated feedback in a less detailed or indirect manner. Future studies should describe in detail the feedback design in DBSs and consider a robust evaluation of the feedback element of the intervention to determine its efficacy.
[Abstract] Improving Walking Ability in People With Neurologic Conditions: A Theoretical Framework for Biomechanics-Driven Exercise Prescription.
The purpose of this paper is to discuss how knowledge of the biomechanics of walking can be used to inform the prescription of resistance exercises for people with mobility limitations. Muscle weakness is a key physical impairment that limits walking in commonly occurring neurologic conditions such as cerebral palsy, traumatic brain injury, and stroke. Few randomized trials to date have shown conclusively that strength training improves walking in people living with these conditions. This appears to be because
(1) the most important muscle groups for forward propulsion when walking have not been targeted for strengthening, and
(2) strength training protocols have focused on slow and heavy resistance exercises, which do not improve the fast muscle contractions required for walking.
We propose a theoretical framework to improve exercise prescription by integrating the biomechanics of walking with the principles of strength training outlined by the American College of Sports Medicine to prescribe exercises that are specific to improving the task of walking. The high angular velocities that occur in the lower limb joints during walking indicate that resistance exercises targeting power generation would be most appropriate. Therefore, we propose the prescription of plyometric and ballistic resistance exercise, applied using the American College of Sports Medicine guidelines for task specificity, once people with neurologic conditions are ambulating, to improve walking outcomes. This new theoretical framework for resistance training ensures that exercise prescription matches how the muscles work during walking.
Having suffered a car accident, I had some serious injuries. These included my spine, nerves and my brain. I had foot drop, where when you raise your leg, you can not raise your foot from your ankle, leaving it to hang limply. That means you cannot put any weight on it and it will not offer any support or flexibility. On top of this, due tExerciseo a damaged nerve in my neck, and had weakness down my left side. However after 10 days, the hospital team got me walking with crutches, and sent me home.
I knew that I needed to do some exercise to help rebuild some of my strength. But what I didn’t know was how good exercise is for your brain as well.
We all know that the more you practise at something, the better you will get at it. Well, the brain is just the same. Every time you perform an action, you are creating the building blocks for a new pathway in your brain. Let me give you an example. I used to love painting and drawing. But following my brain injury, I could barely write legibly. For me this was depressing, as my art was a part of who I was. My partner James, kept badgering me to keep trying although I felt he just didn’t understand. I couldn’t make my hand follow the instructions I gave it properly, leaving me frustrated.
Exercise doesn’t mean you have to hit the gym. Just practise a physical activity.
So many sheets of paper ended up in the bin. (I would like to apologise to the trees who were sacrificed for my cause.) But in time my writing improved, and I found my artistic flair returning to me. Just by reminding the muscles in my hand and arm how to behave, I had begun to regain my skill. But it wasn’t because the muscles needed to be rebuilt, it was because my brain needed to create new pathways to replace those that were damaged. This is the same process as when you learn a skill for the first time, and why your mother always said “practise makes perfect.” The more we do an action, the more the brain prioritises building pathways which make a shortcut to that action.
Now I know you are saying “but Michelle drawing and writing isn’t exercise.” And yes you are right, but I wanted to share this example with you to help you see that although there is the physical muscles movements, there is much more that needs to happen and I think we can all agree agree creativity is something very much in your brain.
Think about how in sports there is a tactical element, spacial awareness, problem solving… the list goes on.
I’m now 5 years on from my accident, and most people wouldn’t notice my slight limp. For someone who struggled to walk for so long, that’s not bad. I still have nerve damage, and I may do for the rest of my life, but I can deal with it. I’d be frightened to go skiing again, but it doesn’t affect my everyday life much at all. Yes I get pain and tire much easier, but I can cope with that.
My brain is still trying to repair my cognitive skills. Bearing in mind I couldn’t read or write to start with, I think it’s fair to say it’s doing a pretty good job. I even set up this website all by myself even though I had no experience of doing this sort of thing before. (If you are thinking of starting a blog but aren’t sure where to start head over to Starting a blog following a brain injury is difficult, but it is achievable to get some ideas on how to get going.)
No matter what your fitness level, or sporting ability never underestimate the importance of exercise.
You don’t need to run like you’re Mo Farah, just find something you enjoy which you can fit into your busy schedule. Dance, yoga and swimming are all great options. As evidence is growing to show regular exercise can stave off dementia, your brain will thank you for it. We all have days when just getting out of bed is an achievement, so don’t feel any shame in taking it easy. But just remember your efforts will encourage enhancements in much more than just becoming physically stronger. Your mental health and general well being will benefit too. Exercise can help your brain injury recovery process and you might even discover a talent for something new that you never knew you had.
Other articles you may like:
What exercises have you found most beneficial following your brain injury?
[Abstract] Treatments for Poststroke Motor Deficits and Mood Disorders: A Systematic Review for the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Guidelines for Stroke Rehabilitation
[ARTICLE] Effect of Exercise on Gait Kinematics and Kinetics in Patients with Chronic Ischaemic Stroke – Full Text
It is estimated that one in 5 women and one in 6 men will sustain a stroke up to the age of 75 years  . The main purpose of rehabilitation in such patients is to achieve the maximum possible personal performance, physical and psychological, with the ultimate goal of regaining a level of functional independence that will allow them to be re-integrated into social life as much as possible  . However, stroke patients often adopt a sedentary lifestyle     . This may be attributed to 1) factors associated with patients themselves, such as depression, lack of interest or motivation, decreased perception, decreased confidence, ignorance that exercise is possible and desirability and fear of falls, of a new stroke or other undesirable effects; 2) practical factors, such as lack of support from family or other social actors, inability to access exercise sites, inadequate public transport, health professionals’ ignorance of the availability of physical activity services; 3) financial cost      . Conversely, exercise in groups may improve patient motivation  .
In 2014, the council of the American Heart Association and the American Stroke association (AHA/ASA) revised the exercise recommendations for stroke patients at all stages of their recovery  . Therefore, the aim of this study was to assess the effect of an exercise programme based on these recommendations on gait kinematics and kinetics of ischaemic stroke patients in the chronic phase of recovery.[…]
[Abstract] A Preliminary Study of Dual-Task Training Using Virtual Reality: Influence on Walking and Balance in Chronic Poststroke Survivors
Stroke is a leading cause of death and disability in the Western world, and leads to impaired balance and mobility.
To investigate the feasibility of using a Virtual Reality-based dual task of an upper extremity while treadmill walking, to improve gait and functional balance performance of chronic poststroke survivors.
Twenty-two individuals chronic poststroke participated in the study, and were divided into 2 groups (each group performing an 8-session exercise program): 11 participated in dual-task walking (DTW), and the other 11 participated in single-task treadmill walking (TMW). The study was a randomized controlled trial, with assessors blinded to the participants’ allocated group. Measurements were conducted at pretest, post-test, and follow-up. Outcome measures included: the 10-m walking test (10 mW), Timed Up and Go (TUG), the Functional Reach Test (FRT), the Lateral Reach Test Left/Right (LRT-L/R); the Activities-specific Balance Confidence (ABC) scale, and the Berg Balance Scale(BBS).
Improvements were observed in balance variables: BBS, FRT, LRT-L/R, (P < .01) favoring the DTW group; in gait variables: 10 mW time, also favoring the DTW group (P < .05); and the ABC scale (P < .01). No changes for interaction were observed in the TUG.
The results of this study demonstrate the potential of VR-based DTW to improve walking and balance in people after stroke; thus, it is suggested to combine training sessions that require the performance of multiple tasks at the same time.
[ARTICLE] Effect of Exercise on Gait Mechanics in a Patient with Severe Gait Disorder Due to Chronic Ischaemic Stroke: A Case Study – Full Text
We describe the effects of an exercise programme based on the American Heart Association and American Stroke Association guidelines for stroke patients on gait mechanics in a patient with severe gait disorder due to chronic ischaemic stroke. A 74-year-old female patient, with right hemiparesis as a result of a stroke attack before 18 months followed an 8-week exercise programme, consisting of three hourly sessions per week. Patient’s gait mechanics were evaluated before and after the intervention using a three-dimensional gait analysis system, with six infrared cameras, two force plates, and an electronic timing system. Exercise led to increase of spatial and decrease of temporal gait parameters, increase of joint range of motion and lower limb muscle powers during the entire gait cycle and increase of the moments in the support phase. In conclusion, exercise had a positive effect on this patient’s gait pattern and improved her functionality.
Stroke is the most common cause of serious long-term disability  . Although the rate of neurological recovery is rapid in the first 4 weeks after the stroke  , functionality improvement seems to extend beyond this period, possibly through the development of compensatory strategies against neurological deficits  . However, patients often adopt a sedentary lifestyle that leads to dependence on other people, but also to increased risk of falls and recurrence of stroke  , or other cardiovascular events   . In particular, patients after stroke are significantly less physically active in comparison with the elderly who suffer from chronic musculoskeletal diseases or other cardiovascular diseases     . A sedentary lifestyle exacerbates further their cardiovascular function and the already impaired functional capacity   . Furthermore, it leads to increased fatigue, muscle atrophy and weakness, osteoporosis and impaired circulation in the lower limbs. Finally, the greater dependence of patients with stroke on others for daily activities and their impaired ability for usual social activities can have serious negative psychological effects  .
In 2014, the American Heart Association and American Stroke Association (AHA/ASΑ) published the revised recommendations on exercise in patients with stroke  . Nevertheless, to the best of our knowledge, there is no data concerning the effect of the above exercise programme on patients’ gait pattern. Importantly, gait pattern affects muscle and joint loads during movement and thus on the long-term function of the skeletal system    . We herein describe the effect of an exercise programme based on these recommendations on gait mechanics in a patient with severe gait disorder resulting from an ischaemic stroke in the chronic phase of rehabilitation.
Depression is common among brain injury survivors, with half of all survivors experiencing it in the first year following their injury.
It can also develop as the person starts to understand the full impact of their injury, and can lead to feelings of hopelessness and altered self-esteem and identity as the survivor reflects over the changes that they are facing, and may continue to face in the future.
With expert support from Dr Elizabeth Kent and Dr Cliodhna Carroll, from Kent Clinical Neuropsychology Service, and with feedback from brain injury survivors, we’ve put together some top tips to help cope with depression.
More detailed information can be found on our factsheet Depression after brain injury.
The information provided here is not intended to replace medical advice, so if you are experiencing symptoms of depression always speak to your GP or other healthcare professional.
Try to talk to your family or friends about how you’re feeling and why you may appear to be distant. If you find it difficult to speak about how you feel, try to find other ways of communicating such as writing a letter. Consider talking to your employer about depression if you feel that it’s affecting your work performance.
Try to avoid becoming socially isolated. It’s important to spend at least some time socialising with people on a face-to-face basis. If you struggle in crowds, try to arrange meeting a friend at a quiet location. Alternatively, consider finding a local support or activity group that you can attend, such as a local Headway group or branch.
Engage in activities that you enjoy doing, such as listening to uplifting music, creating art or reading a book. Research indicates that these activities can be useful ways of coping with depression. And don’t be afraid to try something new!
Educate yourself on the effects of brain injury. Understanding your injury may be the first step towards accepting it, which might help with managing depression. The Headway website is a good place to start.
Try to exercise for a few minutes every day. This may be difficult if you experience fatigue or have limited mobility. However, exercise is a proven method of improving low mood. Try to set yourself a routine, for example taking a short walk around the neighbourhood in the morning, or doing some gentle stretches for five minutes every afternoon.
Seek support from other services such as the Headway helpline or your local Headway support group or branch. There are also depression-specific support groups, where people can get peer support from others who are also affected by depression, although these tend to be non-brain injury specific.
Identify and seek help for specific issues in your life that may be causing or contributing to the depression, for example financial or relationship problems.
Speak to your doctor about your general health, including any potential hormonal imbalances that can arise after brain injury.
Make a ‘soothe box’
Consider putting together a ‘soothe box’. This is a box that contains personal items that may make you feel better and help you to cope when you are feeling depressed. You could put things in it such as photos or letters, or things that soothe your senses such as perfumes or soft fabrics.
Use wellbeing techniques
Consider wellbeing techniques such as mindfulness, yoga, meditation or other relaxation methods. Although there is limited research to prove their effectiveness, brain injury survivors often report benefiting from them. Speak to a therapist if you are considering trying any of these, as they may be able to guide you through learning how to effectively use them.
Maintain a healthy lifestyle. This involves enjoying a healthy diet, drinking plenty of water, avoiding alcohol and trying to ensure that you have a good night’s sleep.
Severe depression can cause some people to feel suicidal. This is characterised by extremely negative thoughts about oneself or the future, which can lead to the person thinking about or attempting to end their own life.
It is vital that anyone experiencing suicidal thoughts seeks help – however infrequently the thoughts occur and regardless of whether they intend to act on them.
Please, do not ignore these thoughts in the hope that they will go away.
Be honest and talk to your family or friends about how you’re feeling. Alternatively, you can speak confidentially to your GP.
You can also contact the Headway helpline on 0808 800 2244, or speak to Samaritans on its 24-hour support line 116 123.
If you are having recurring thoughts of suicide, ring NHS 111 or make an emergency appointment with your GP.
Explore the links below to access our resources on the psychological effects of brain injury.
If you would like to discuss this issue in more detail, please contact our national helpline on 0808 800 2244 or firstname.lastname@example.org.
[Abstract] Adaptive Physical Activity for Stroke: An Early-Stage Randomized Controlled Trial in the United States
Background. As stroke survival improves, there is an increasing need for effective, low-cost programs to reduce deconditioning and improve mobility.
Objective. To conduct a phase II trial examining whether the community-based Italian Adaptive Physical Activity exercise program for stroke survivors (APA-Stroke) is safe, effective, and feasible in the United States.
Methods. In this single-blind, randomized controlled trial, 76 stroke survivors with mild to moderate hemiparesis >6 months were randomized to either APA-Stroke (N = 43) or Sittercise (N = 33). APA-Stroke is a progressive group exercise regimen tailored to hemiparesis that includes walking, strength, and balance training. Sittercise, a seated, nonprogressive aerobic upper body general exercise program, served as the control. Both interventions were 1 hour, 3 times weekly, in 5 community locations, supervised by exercise instructors.
Results. A total of 76 participants aged 63.9 ± 1.2 years, mean months poststroke 61.8 ± 9.3, were included. There were no serious adverse events; completion rates were 58% for APA-Stroke, 70% for Sittercise. APA-Stroke participants improved significantly in walking speed. Sample size was inadequate to demonstrate significant between-group differences. Financial and logistical feasibility of the program has been demonstrated. Ongoing APA classes have been offered to >200 participants in county Senior Centers since study completion.
Conclusion. APA-Stroke shows great promise as a low-cost, feasible intervention. It significantly increased walking speed. Safety and feasibility in the US context are demonstrated. A pivotal clinical trial is required to determine whether APA-Stroke should be considered standard of care.
via Adaptive Physical Activity for Stroke: An Early-Stage Randomized Controlled Trial in the United States – Mary Stuart, Alexander W. Dromerick, Richard Macko, Francesco Benvenuti, Brock Beamer, John Sorkin, Sarah Chard, Michael Weinrich, 2019