Posts Tagged functional independence

[WEB PAGE] Researcher studies how to help stroke survivors function better in everyday life

Researcher studies how to help stroke survivors function better in everyday life
Neha Lodha observes a student in the high-tech driving simulator in her lab. Credit: Colorado State University

For older adults, a critical part of living independently is being able to drive. When the unthinkable happens, such as a stroke, it can impact people’s ability to perform everyday tasks, including driving, walking, and picking up objects. Neha Lodha, an assistant professor in the Department of Health and Exercise Science and director of the Laboratory of Movement Neuroscience and Rehabilitation, is conducting research aimed at understanding the impact of stroke on the tasks that are key to functional independence in old age.

Disability from stroke

According to the Centers for Disease Control and Prevention, each year, more than 795,000 Americans have a , and stroke is one of the leading causes of long-term disability in America.

“Stroke risk increases with age, and with our rapidly aging population, these numbers will exponentially increase over the next few years,” said Lodha.

Lodha’s research focuses on understanding the impact that cognitive and motor impairments associated with stroke have on everyday function.

“Stroke often affects the key motor areas in the brain that control our movements,” said Lodha. “As a result, a number of everyday activities are impacted.”

Motor deficits in high-functioning stroke survivors

In a series of publications coming out of her lab, Lodha has looked specifically at the motor deficits apparent in “high-functioning ,” a group of people who typically return to their everyday lives, including their jobs and social life, after experiencing a stroke. The demands on them to perform everyday tasks at home and at the office are very high, and require high levels of both mobility and dexterity.

“One area we focus on is functional mobility, which is the ability to safely move in our environment without assistance—including walking and driving,” she said. “The second area of functional independence is the use of our hands to perform dexterous tasks. This involves using our upper limbs to interact with objects in our environment, such steering a car and picking up an object and releasing it safely. Both of these tasks, mobility and dexterity, are important to our functional independence.”

Researcher studies how to help stroke survivors function better in everyday life
Neha Lodha in the Laboratory of Movement Neuroscience and Rehabilitation in the Department of Health and Exercise Science. Credit: Colorado State University

Implications for stroke survivors

Ultimately, Lodha’s work could have important implications for  for stroke survivors. One of the problems, she says, is that stroke rehabilitation programs are not tailored toward the individual stroke patients and their specific deficits. They tend to be the same for everyone.

Lodha became interested in this problem when she was studying stroke survivors at the University of Florida in her doctoral program in the Department of Applied Physiology and Kinesiology. She noticed that although some severely impaired patients were showing progress in the lab at tasks such as moving objects more quickly, these gains didn’t necessarily translate to everyday tasks that they wanted to do at home, which are more complex, such as lifting a bag of garbage to take it out.

Lodha also noticed that although high-functioning stroke survivors often retained their strength, they weren’t able to control it well enough for delicate tasks. For example, one patient was unable to hold an egg without crushing it.

“What we are beginning to recognize in our stroke research is that the impact of stroke on the movements varies from individual to individual,” said Lodha. “In therapy, we provide a one-size-fits-all rehab program, although the type of motor deficits after stroke depends on the severity of the stroke. We have started asking, how can we identify what the specific motor deficit is so we can target that in a rehab program and see improvement in everyday function?”

This question has become central in her research.

“In order to improve somebody’s mobility or independence, we need to understand what that specific deficit is and fix that to improve their function,” she said.

Lodha’s research is showing that even among high-functioning stroke survivors, those who have robust work and social lives, there are functional deficits that show up in their ability to drive a car.

“We have now found that stroke survivors have the strength and ability to generate forces, but that the ability to modulate the forces is a key deficit,” Lodha said. “This impacts their functional performance in , whether it is walking, driving, steering, or doing fine object manipulation, even if they are seen as functionally recovered.”

Researcher studies how to help stroke survivors function better in everyday life
Participant tries out the virtual driving simulator. Credit: Colorado State University

High-tech driving simulator

With grant funding from the National Institutes of Health and the American Heart Association, Lodha is studying groups of high-functioning stroke survivors, along with a control group, as they use some unique equipment in her lab, including a  driving simulator.

The driving simulator in Lodha’s lab is from the National Advanced Driving Simulator research center at the University of Iowa. The miniSim is a research-grade, software program which Lodha has coupled with motion-enabled hardware from SimGear. When an individual is driving in the simulator, they get audio and motion feedback as if they are accelerating and braking—making the experience more immersive and realistic. Lodha’s lab is one of the top few sites in the country to install this combined setup. Lodha says both companies were willing to work with her to custom design the research environment.

In a recently published study in the Journal of Rehabilitation and Disability, Lodha and her research team tested grip strength and grip motor control among high-functioning stroke survivors and a control group using the driving simulator. They measured grip strength, grip force modulation, and deviation of the car from the center lane while subjects steered on a winding road in the simulated environment. What they found was that the deficits in grip force modulation rather than grip strength had the most impact on steering performance.

“Typically, insurance companies will not provide rehab for high-functioning stroke survivors,” said Lodha. “Our work is beginning to build an argument for the persistence of  and therefore the need for rehab for this group.”

While they don’t know yet whether high-functioning stroke survivors can be helped with targeted therapy, Lodha hopes her research showing that this group has persistent deficits will pave the way for new rehabilitation programs to help them succeed in everyday life tasks such as driving safely.

Lodha says her team is now extending its studies to low-functioning stroke survivors to investigate the nature of motor deficits in those patients. The researchers want to find out whether those patients also have difficulty modulating forces or difficulty in even generating forces, such as the stroke  in her lab in Florida who was unable to lift a bag of trash.

“Everyday tasks matter to people, and we want to help them perform successfully the tasks that they care about most in their daily lives,” she said.


Explore further

Walking speed may predict return to work in young stroke survivors


More information: Prakruti Patel et al. Impaired force control contributes to car steering dysfunction in chronic stroke, Disability and Rehabilitation (2019). DOI: 10.1080/09638288.2019.1685603

 

via Researcher studies how to help stroke survivors function better in everyday life

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[Abstract] Impaired force control contributes to car steering dysfunction in chronic stroke

Purpose: Precise control of a car steering wheel requires adequate motor capability. Deficits in grip strength and force control after stroke could influence the ability steer a car. Our study aimed to determine the impact of stroke on car steering and identify the relative contribution of grip strength and grip force control to steering performance.

Methods: Twelve chronic stroke survivors and 12 controls performed three gripping tasks with each hand: maximum voluntary contraction, dynamic force tracking, and steering a car on a winding road in a simulated driving environment. We quantified grip strength, grip force variability, and deviation of the car from the center of the lane.

Results: The paretic hand exhibited reduced grip strength, increased grip force variability, and increased lane deviation compared with the non-dominant hand in controls. Grip force variability, but not grip strength, significantly predicted (R2 = 0.49, p < 0.05) lane deviation with the paretic hand.

Conclusion: Stroke impairs the steering ability of the paretic hand. Although grip strength and force control of the paretic hand are diminished after stroke, only grip force control predicts steering accuracy. Deficits in grip force control after stroke contribute to functional limitations in performing skilled tasks with the paretic hand.

  1. Implications for rehabilitation
  2. Driving is an important goal for independent mobility after stroke that requires motor capability to manipulate hand and foot controls.

  3. Two prominent stroke-related motor impairments that may impact precise car steering are reduced grip strength and grip force control.

  4. In individuals with mild-moderate impairments, deficits in grip force modulation rather than grip strength contribute to compromised steering performance with the paretic hand.

  5. We recommend that driving rehabilitation should consider re-educating grip force modulation for successful driving outcomes post stroke.

via Impaired force control contributes to car steering dysfunction in chronic stroke: Disability and Rehabilitation: Vol 0, No 0

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[Abstract] Evaluating the effectiveness of aquatic therapy on mobility, balance, and level of functional independence in stroke rehabilitation: a systematic review and meta-analysis

To meta-analyze and systematically review the effectiveness of aquatic therapy in improving mobility, balance, and functional independence after stroke.

Articles published in Medline, Embase, CINAHL, PsycINFO, and Scopus up to 20 August 2019.

Studies met the following inclusion criteria: (1) English, (2) adult stroke population, (3) randomized or non-randomized prospectively controlled trial (RCT or PCT, respectively) study design, (4) the experimental group received >1 session of aquatic therapy, and (5) included a clinical outcome measure of mobility, balance, or functional independence.

Participant characteristics, treatment protocols, between-group outcomes, point measures, and measures of variability were extracted. Methodological quality was assessed using Physiotherapy Evidence Database (PEDro) tool, and pooled mean differences (MD) ± standard error and 95% confidence intervals (CI) were calculated for Functional Reach Test (FRT), Timed Up and Go Test (TUG), gait speed, and Berg Balance Scale (BBS).

Nineteen studies (17 RCTs and 2 PCTs) with a mean sample size of 36 participants and mean PEDro score of 5.6 (range 4–8) were included. Aquatic therapy demonstrated statistically significant improvements over land therapy on FRT (MD = 3.511 ± 1.597; 95% CI: 0.381–6.642; P = 0.028), TUG (MD = 2.229 ± 0.513; 95% CI: 1.224–3.234; P < 0.001), gait speed (MD = 0.049 ± 0.023; 95% CI: 0.005–0.094; P = 0.030), and BBS (MD = 2.252 ± 0.552; 95% CI: 1.171–3.334; P < 0.001).

While the effect of aquatic therapy on mobility and balance is statistically significant compared to land-based therapy, the clinical significance is less clear, highly variable, and outcome measure dependent.

via Evaluating the effectiveness of aquatic therapy on mobility, balance, and level of functional independence in stroke rehabilitation: a systematic review and meta-analysis – Alice Mary Iliescu, Amanda McIntyre, Joshua Wiener, Jerome Iruthayarajah, Andrea Lee, Sarah Caughlin, Robert Teasell,

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[Review Article] Rehabilitation Technology: Assistance from Hospital to Home – Full Text

Abstract

Rehabilitation is essential for disabled people to achieve the highest level of functional independence, reducing or preventing impairments. Nonetheless, this process can be long and expensive. This fact together with the ageing phenomenon has become a critical issue for both clinicians and patients. In this sense, technological solutions may be beneficial since they reduce the costs and increase the number of patients per caregiver, which makes them more accessible. In addition, they provide access to rehabilitation services for those facing physical, financial, and/or attitudinal barriers. This paper presents the state of the art of the assistive rehabilitation technologies for different recovery methods starting from in-person sessions to complementary at-home activities.

1. Introduction

According to the World Health Organization (WHO), about 15% of the world’s population suffers some form of disability. Due to the ageing phenomenon and the prevalence of chronic diseases such as epilepsy, cancer, or mental health disorders, this percentage has incessantly increased. This fact leads to a growing demand for rehabilitation services since they play an important role in enhancing functioning, reinforcing the person’s autonomy, and improving the patient’s quality of life [12]. This demand far exceeds availability in terms of rehabilitation professionals (i.e., occupational therapists, physiotherapists, and speech therapists) such that the density of those professionals is greatly below the threshold required for providing adequate services (approximately a tenth of that required) [34]. Additionally, different barriers like low-income deny the access to the rehabilitation services required to live in health, comfort, and dignity. These deficiencies could be overcome with technology, reducing the need for formal support services, the time and physical burden for caregivers, and, consequently, their cost [56].

In this context, the key to technology success depends on its functionality and adaptability to the user’s needs and environment. However, rehabilitation is a broad concept covering a wide range of responses to disability. Generally speaking, rehabilitation can be defined as the step-by-step process designed to reduce disability and to optimise functioning in individuals with health conditions, enabling them to better interact with their environment. For that, rehabilitation commonly includes three aspects:(i)Physical, to regain strength, mobility, and fitness(ii)Occupational, to relearn the person’s daily activities(iii)Speech-language, to recover communication skills (i.e., speaking, understanding, reading, or writing)

The duration of the rehabilitation can vary depending on several factors such as the patient’s impairment level, the therapy intensity, or the individual activity and participation. For that reason, new ways without compromising patient wellbeing have been proposed. So, three different modalities can be found in the literature: (1) the in-person rehabilitation, where patients performs their program in presence of a therapist in an inpatient facility; (2) the combined in-person and at-home rehabilitation, where in-person rehabilitation takes place in an outpatient facility and is aided with at-home programs such that patients perform some therapeutic exercises prescribed by the clinician at home; and (3) the at-home rehabilitation, suitable for those requiring minor assistance or support, where a tailored therapy takes place entirely at home.

Focusing on the individual’s functioning, the technological solutions developed up to date have mainly aimed to physical recovery since mobility plays a main role in the independence and confidence of disabled people. More recently, research in occupational rehabilitation has emerged in response to Alzheimer’s disease and neurocognitive impairments.

This paper addresses the state-of-the-art assistive technologies for rehabilitation from the hospital to in-home programs. Despite its great importance in disabled people recovery, devices designed to replace the impaired limb (e.g., prosthetics and artificial limbs [78910] or smart wheelchairs [111213]) are not covered in this work.

2. In-Person Rehabilitation

One application of technology can be found as a support tool in the rehabilitation process. They help clinicians evaluate quantitatively the patient’s performance and progress while providing consistent training, specially for extended periods of time. This results in an increase in therapy access and a health-care cost reduction.

In this sense, Robotics has met this demand with a wide range of assistive products. For example, Andago [14] is a tool for overground gait training, bridging the gap between treadmill-based and free walking. With this technology, the patient’s fear of falling is considerably reduced while therapists focus on the therapy since they do not have to secure the patient. In a similar way, the G-EO System [15] assists therapists in patient’s motor recovery and, more specifically, in teaching patients walking again. Unlike the previous system, G-EO moves the patient’s legs when necessary to help the patient’s brain form new neuroplasticity pathways to replace the ones damaged by injury or disease. Kim and Deshpande presented in [16] HARMONY an upper-body robotic exoskeleton for rehabilitation. This exoskeleton provides natural coordinated motions on the shoulder for patients suffering from spinal and neurological injuries, including a wide range of motion and controllability of force and impedance. Several devices have been also developed for hand rehabilitation (e.g., [17181920]).

Although these robotic devices aid therapists in providing effective repetitive training and quantitative evaluation of patient’s progress, it is necessary to integrate any mechanism that makes rehabilitative exercises fun, challenging, and engaging. In this context, virtual reality (VR) and video game can fill the gap. That is, computer-based programs designed to simulate real-life objects and events in an attractive environment may engage patients to stage on track. In fact, the use of this kind of systems has been shown to be an effective mean for rehabilitation treatments since they offer clinicians the ability to control and grade tasks to challenge the user while providing them with an enriched environment to achieve high user’s engagement [2122].

From this starting point, a treadmill can be combined with VR technology. This is the case of C-Mill [23], a treadmill developed to train and assess patient’s gait and balance for a safe daily walk. It comes in three models: C-Mill, C-Mill VR, and C-Mill VR+ (Figure 1). Although he VR and VR + models use VR elements to stimulate and challenge patients, their final goal is different. That is, the C-Mill VR is aimed at training automated movements and dual tasking, whilst the C-Mill VR+ is a comprehensive solution for early to late rehabilitation with balance and body weight support.[…]

 

Continue —> Rehabilitation Technology: Assistance from Hospital to Home

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[Abstract] Functional independence after acquired brain injury: Prospective effects of health self-efficacy and cognitive impairment.

Abstract

Objective: To examine how health self-efficacy and cognitive impairment severity relate to functional independence after acquired brain injury (ABI).

Design: Observational. Setting: Outpatient rehabilitation hospital.

Participants: Seventy-five adults with predominately stroke or traumatic brain injury who were beginning a course of occupational therapy.

Main Measures: Health self-efficacy was assessed with the Self-Rated Abilities for Health Practices. Cognitive functioning was assessed via a composite z score of neuropsychological tests. Trait affectivity was assessed with the Positive and Negative Affect Schedule. Functional independence was assessed with the Barthel Index and Lawton Instrumental Activities of Daily Living Scale.

Results: Health self-efficacy correlated moderately with functional independence. A moderation threshold effect was detected that revealed for whom health self-efficacy predicted functional independence. Among participants with normal to mildly impaired cognition (>−2 z cognitive composite), health self-efficacy correlated positively with functional independence, which held after accounting for trait affectivity. In contrast, health self-efficacy was not correlated with functional independence among participants with greater impairment (<−2 z cognitive composite).

Conclusions: Health self-efficacy predicts functional independence and may serve as a protective factor after ABI among individuals with relatively intact cognition. However, health self-efficacy does not predict functional independence among individuals with moderate or severe cognitive impairment, possibly due to limited self-awareness.

This study extends the literature linking health self-efficacy with rehabilitation outcomes and reinforces the need for promoting self-management in ABI. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

via PsycNET Record Display – PsycNET

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[ARTICLE] Assessment of the correlations between gait speed in post-stroke patients and the time from stroke onset, the level of motor control in the paretic lower limb, proprioception, visual field impairment and functional independence – Full Text PDF

Abstract

Introduction: Gait recovery is one of the main objectives in the rehabilitation of post-stroke patients. The study aim was to assess the correlations between gait speed in post-stroke hemiparetic patients and the level of motor control in the paretic lower limb, the time from stroke onset, the subjects’ age as well as the impairment of proprioception and visual field.

Materials and methods: This retrospective study was performed at the Clinical Rehabilitation Ward of the Regional Hospital No. 2 in Rzeszow. The study group consisted of 600 patients after a first stroke who walked independently. The measurements focused on gait speed assessed in a 10-meter walking test, motor control in the lower limb according to Brunnström recovery stages, proprioception in lower limbs, visual field as well as functional independence according to The Barthel Index.

Results: The study revealed a slight negative correlation between gait speed and the subjects’ age (r = − 0.25). No correlation was found between mean gait speed and the time from stroke onset. On the other hand, gait speed strongly correlated both with the level of motor control in the lower limb (p = 0.0008) and the incidence of impaired proprioception. Additionally, a strong statistically significant correlation between the patients’ gait speed and the level of functional independence was found with the use of The Barthel Index.

Conclusions: The level of motor control in the paretic lower limb and proprioception are vital factors affecting gait speed and functional independence. Patients with a higher level of functional independence demonstrated higher gait speed.

References

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via Assessment of the correlations between gait speed in post-stroke patients and the time from stroke onset, the level of motor control in the paretic lower limb, proprioception, visual field impairment and functional independence : Advances in Rehabilitation

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[WEB SITE] What is an Occupational Therapist?

Occupational therapy is an allied health profession that plays a key role in the rehabilitation process of many conditions, injuries or illnesses. Occupational therapists possess knowledge about how individuals, the environment and human occupation (activity) stimulate health and well-being.

The Occupational Therapists professional philosophy is to maximise occupational (often referred to as functional) independence.  They use activities that are meaningful to the client to develop treatment plans, taking an holistic and client centred approach.

For occupational therapists, occupation refers to the activities of everyday living that people need to, want to and are expected to do. Therefore an occupational therapist can help a person regain and/or maintain personal purpose and independence in everyday living.

Consider the activities you participate in every day. Getting washed and dressed, cooking, making a drink, getting to work and socialising; or the roles you have, father/mother, son/daughter, colleague, friend and carer.  How would you complete these tasks or perform the expected roles if you were affected by trauma, chronically deteriorating health or relapse of some kind?

The Occupational Therapist provides practical support to enable people to facilitate recovery and overcome any barriers that prevent them from doing the activities that matter to them, covering all developmental & life stages.

Continue —> What is an Occupational Therapist?

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[Doctoral Project] INPATIENT REHABILITATION FOR A PATIENT FOLLOWING A MILD RIGHT ISCHEMIC STROKE – Full Text PDF

Abstract

A patient with right anterior pons and superior cerebellar stroke was seen for
physical therapy treatment for 16 sessions from 6/11/14 to 6/23/14 at an inpatient
physical therapy clinic. Treatment was provided by a student physical therapist under the
supervision of a licensed physical therapist.
The patient was evaluated at the initial encounter with Timed Up and Go, 10 Meter
Walk Test, Dynamic Gait Index, Berg Balance Scale, and Functional Independence
Measure, and a plan of care was established. Main goals for the patient were to improve
strength, range of motion, motor control and sequencing during functional activities, gait
speed, static and dynamic standing balance, and functional independence. Main
interventions used were over-ground gait training, restorative training, task-specific
training, and functional training.

The patient improved strength, motor control and sequencing, gait speed, balance, and
functional independence. The patient was discharged to home with a home exercise
program and with follow up with outpatient physical therapy.

Full Text PDF

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