Posts Tagged FES

[WEB SITE] Robot-Assisted Therapy: What Is Right for Your Clinic?

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One of the advantages of this gait training system is that it uses end-effector technology to assist patients in stepping, while a therapist provides manual facilitation. (Photo by Kevin Hentz)

by Rebecca Martin, OTR/L, OTD, and Dennis Tom-Wigfield, PT, DPT

Investment in therapeutic technologies spans a continuum from elastic bands that cost a few dollars to room-sized mobility and balance systems that require construction build-outs and additional staff. Inhabiting the middle to upper range of this continuum are robotic devices and associated technology, which have become increasingly popular. Though these advanced technologies deserve a thorough cost-benefit analysis and review of competing products prior to purchase, the payoff they may provide in outcomes and efficiency can make the investment well worth the effort.

Among the facility-based technologies that have grabbed recent headlines, robot-assisted therapy is one that may be attractive to healthcare organizations. Robot-assisted therapy is an efficacious method to remediate disability associated with a wide variety of neurological disorders, most notably stroke and spinal cord injury (SCI). Intensity and repetition has been repeatedly demonstrated to be necessary for central nervous system excitation and associated motor learning.1Massed practice, or high-volume repetition, has been shown to improve muscle strength and voluntary function.2 Robot-assisted therapy has the capacity to provide high numbers of specific movements with support or guidance as necessary, ensuring optimal conditions for motor learning and recovery of function.3 Changes can be observed in as little as 6 weeks and peak around 12 weeks of training.4

Nearly all robotic devices include some sort of computer interface, even a virtual reality component, providing the patient and therapist with real-time feedback to improve performance. Robotic devices also allow for quantitative monitoring; measuring changes in strength, range of motion, and trajectory; and illuminating patient engagement trends, time, and effort.3 As the body of literature expands and supports its use, patients are seeking clinics with these resources. Robotic technology has the potential to align patients’ interests in validated strategies with clinics’ interests in efficiency and payor-supported interventions. Clinics have an opportunity to improve patient outcomes and efficiency with which they reach those outcomes by investing in robotic devices. This investment is not trivial, however, and better understanding of the capacity and scope of different devices will help to make sure that everyone’s resources are utilized appropriately.

Assessment: Get the Complete Picture

Before it begins to investigate and trial devices, a clinic should do a careful self-assessment. Clinics should have a good understanding of their patient factors and needs: demographics, diagnoses, and payor mix. Equally important, clinics should have a good understanding of how much of their own resources—money, time, and space—they have to spend. Although money is often considered to be the limiting factor in the acquisition of technology, time and space deserve equal consideration. Nothing would be worse than investing in the perfect body weight support (BWS) gait trainer, only to find that your ceiling is too low to accommodate it. Similarly, clinics should anticipate that therapists will need time outside patient care to learn the devices and that efficiency will suffer in the early learning phase. Clinics will want to consider existing technology and therapist-driven interventions when deciding on their specific needs. Clinics would benefit from having a clear plan for acquisition and incorporation of robotic technology into existing practices. Acquiring too much technology too quickly is a sure way to reduce integration of devices and waste valuable resources.

 

Visit Site —> Robot-Assisted Therapy: What Is Right for Your Clinic? – Rehab Managment

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[BOOK Chapter] Functional Electrical Stimulation and Its Use During Cycling for the Rehabilitation of Individuals with Stroke – Abstract+References

Advanced Technologies for the Rehabilitation of Gait and Balance DisordersAbstract

Stroke disease involves an increasing number of subjects due to the aging population. In clinical practice‚ the presence of widely accessible rehabilitative interventions to facilitate the patients’ motor recovery‚ especially in the early stages after injury when wider improvement can be gained‚ is crucial to reduce social and economical costs. The functional electrical stimulation (FES) has been investigated as a tool to promote locomotion ability in stroke patients. Particular attention was given to FES delivered during cycling‚ which is recognized as a safe and widely accessible way to provide a FES-based rehabilitative intervention in the most impaired subjects. In this chapter the neurophysiological basis of FES and its potential correlates to facilitate the long-term reorganization at both cortical and spinal level have been discussed. A discussion on clinical evidence and possible future direction is also proposed.

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via Functional Electrical Stimulation and Its Use During Cycling for the Rehabilitation of Individuals with Stroke | SpringerLink

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[THESIS] A home-based functional electrical stimulation system for upper-limb stroke rehabilitation – Abstract

Abstract

Due to an increased population of stroke patients and subsequent demand on health providers, there is an urgent need for effective stroke rehabilitation technology that can be used in patients’ own homes. Over recent years, systems employing functional electrical stimulation (FES) have shown the ability to provide effective therapy. However, there is currently no low-cost therapeutic system available which simultaneously supplies FES to muscles in the patient’s shoulder, arm and wrist to provide co-ordinated functional movement. This restricts the effectiveness of treatment, and hence the ability to support activities of daily living.

In this thesis a home-based low cost rehabilitation system is developed which substantially extends the current state of art in terms of sensing and control methodologies. In particular, it embeds novel non-contact sensing approaches; the first use of an electrode array within a closed-loop model based control scheme; an interactive task display system; and an integrated learning-based controller for multiple muscles within the upper-limb (UL), which supports co-ordinated tasks. The thesis then focuses on compacting the prototype by upgrading the depth sensor and using embedded systems to transfer it to the home
environment.

Currently available home-based systems employing FES for UL rehabilitation are first reviewed in terms of their underlying technology, operation, scope and clinical evidence. Motivated by this, a detailed examination of a prototype system is carried out that combines low cost non-contact sensors with closed-loop FES controllers. Then potential avenues to extend the technology are highlighted, with specific focus given to low-cost non-contact based sensors for the hand and wrist. Sensing approaches are then reviewed and evaluated in terms of their scope to support the intended system requirements. Electrode array hardware is developed in order to provide accurate movement capability. Biomechanical models of the combined stimulated arm and mechanical support are then formulated. Using these, model-based iterative learning control methodologies are then designed and implemented.
The system is evaluated with both unimpaired participants and stroke patients undergoing a course of treatment. Finally, a home-based prototype is developed which integrates and extends the aforementioned components. Results conrm the system’s scope to provide more effective stroke rehabilitation. Based on the achieved results, courses of future work necessary to continue this development are outlined.

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via A home-based functional electrical stimulation system for upper-limb stroke rehabilitation – ePrints Soton

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[DISSERTATION] Tele-Rehabilitation of Upper Limb Function in Stroke Patients using Microsoft Kinect – Full Text PDF

ENGLISH SUMMARY

Stroke is a major cause of death and disability worldwide. The damage or death of
brain cells caused by a stroke affects brain function and leads to deficits in sensory
and/or motor function. As a consequence, a stroke can have a significantly negative
impact on the patient’s ability to perform activities of daily living and therefore also
affect the patient’s quality of life. Stroke patients may regain function through
intensive physical rehabilitation, but often they do not recover their original
functional level. The incomplete recovery in some patients might be related to e.g.
stroke severity, lack of motivation for training, or insufficient and/or non-optimal
training in the initial weeks following the stroke.
A threefold increase in the number of people living past the age of 80 in 2050,
combined with the increasing number of surviving stroke patients, will very likely
lead to a significant increase in the number of stroke patients in need of
rehabilitation. This will put further pressure on healthcare systems that are already
short on resources. As a result of this, the amount of therapeutic supervision and
support per stroke patient will most likely decrease, thereby affecting negatively the
quality of rehabilitation.
Technology-based rehabilitation systems could very likely offer a way of
maintaining the current quality of rehabilitation services by supporting therapists.
Repetition of routine exercises may be performed automatically by these systems
with only limited or even no need for human supervision. The requirements to such
systems are highly dependent on the training environment and the physical and
mental abilities of the stroke patient. Therefore, the ideal rehabilitation system
should be highly versatile, but also low-cost. These systems may even be used to
support patients at remote sites, e.g. in the patient’s own home, thus serving as telerehabilitation systems.
In this Ph.D. project the low-cost and commercially available Microsoft Kinect
sensor was used as a key component in three studies performed to investigate the
feasibility of supporting and assessing upper limb function and training in stroke
patients by use of a Microsoft Kinect sensor based tele-rehabilitation system. The
outcome of the three studies showed that the Microsoft Kinect sensor can
successfully be used for closed-loop control of functional electrical stimulation for
supporting hand function training in stroke patients (Study I), delivering visual
feedback to stroke patients during upper limb training (Study II), and automatization
of a validated motor function test (Study III).
The systems described in the three studies could be developed further in many
possible ways, e.g. new studies could investigate adaptive regulation of the intensity
used by the closed-loop FES system described in Study I, different types of feedback
to target a larger group of stroke patients (Study II), and implementation of more
sensors to allow a more detailed kinematic analysis of the stroke patients (Study III).
New studies could also test a combined version of the systems described in this
thesis and test the system in the patients’ own homes as part of a clinical trial
investigating the effect of long-term training on motor function and/or non-physical
parameters, e.g. motivational level and quality of life.[…]

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via Link to publication from Aalborg University

 

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