Posts Tagged functional rehabilitation

[JUST ACCEPTED] “Increased Sensorimotor Cortex Activation with Decreased Motor Performance during Functional Upper Extremity Tasks Post-Stroke” – Abstract

The following article has just been accepted for publication in Journal of Neurologic Physical Therapy.

“Increased Sensorimotor Cortex Activation with Decreased Motor Performance during Functional Upper Extremity Tasks Post-Stroke”

By Shannon B Lim, MSc, MPT; Janice J Eng

Provisional Abstract:

Background: Current literature has focused on identifying neuroplastic changes associated with stroke through tasks and in positions that are not representative of functional rehabilitation. Emerging technologies such as functional near-infrared spectroscopy (fNIRS) provide new methods of expanding the area of neuroplasticity within rehabilitation.
Purpose: This study determined the differences in sensorimotor cortex activation during unrestrained reaching and gripping after stroke.
Methods: 11 healthy and 11 chronic post-stroke individuals completed reaching and gripping tasks under three conditions using their 1) stronger, 2) weaker, and 3) both arms together. Performance and sensorimotor cortex activation using fNIRS were collected. Group and arm differences were calculated using mixed ANCOVA (covariate: age). Pairwise comparisons were used for post-hoc analyses. Partial Pearson’s correlations between performance and activation were assessed for each task, group, and hemisphere.
Results: Larger sensorimotor activations in the ipsilesional hemisphere were found for the stroke compared to healthy group for reaching and gripping conditions despite poorer performance. Significant correlations were observed between gripping performance (with the weaker arm and both arms simultaneously) and sensorimotor activation for the stroke group only.
Discussion: Stroke leads to significantly larger sensorimotor activation during functional reaching and gripping despite poorer performance. This may indicate an increased sense of effort, decreased efficiency, or increased difficulty after stroke.
Conclusion: fNIRS can be used for assessing differences in brain activation during movements in functional positions after stroke. This can be a promising tool for investigating possible neuroplastic changes associated with functional rehabilitation interventions in the stroke population.

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[BOOK Chapter] Overview of FES-Assisted Cycling Approaches and Their Benefits on Functional Rehabilitation and Muscle Atrophy – Abstract + References

Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1088)

Abstract

Central nervous system diseases include brain or spinal cord impairments and may result in movement disorders almost always manifested by paralyzed muscles with preserved innervations and therefore susceptible to be activated by electrical stimulation. Functional electrical stimulation (FES)-assisted cycling is an approach mainly used for rehabilitation purposes contributing, among other effects, to restore muscle trophism. FES-assisted cycling has also been adapted for mobile devices adding a leisure and recreational benefit to the physical training. In October 2016, our teams (Freewheels and EMA-trike) took part in FES-bike discipline at the Cybathlon competition, presenting technologies that allow pilots with spinal cord injury to use their paralyzed lower limb muscles to propel a tricycle. Among the many benefits observed and reported in our study cases for the pilots during preparation period, we achieved a muscle remodeling in response to FES-assisted cycling that is discussed in this chapter. Then, we have organized some sections to explore how FES-assisted cycling could contribute to functional rehabilitation by means of changes in the skeletal muscle disuse atrophy.

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[BLOG POST] One day at a time. Cognition and Caregiving after a TBI

By Bill Herrin

Thinking comes so naturally that most people take it for granted, but after a traumatic brain injury – many times, thinking can be more of a deliberate action. It takes focus and effort to put a series of thoughts together after TBI, to speak clearly, or to even move. Simply put, the brain (like the body) takes time to heal. Since no two brain injuries are identical, there is no clear path to better cognition. There are, however, certain broad directives that can get you moving in the right direction in most situations. The hardest part of this is to accept your “new normal”. Acceptance, once you come to terms with it, gives you the desire to work toward the goal of better cognition, coordination, memory, anger management, judgement, attention, and other challenges. Once you accept your situation isn’t going to change overnight, you can start the process of healing, along with testing your limitations. Although finding your limitations is difficult, knowing what they are is a huge step towards improvement in areas that need changing. When a person lacks enough cognition to be self-aware or to strive towards improvement, that’s a test for the caregiver’s guidance and patience. Sometimes just being there for your friend, spouse, or loved one is all you can do.

As a caregiver, high expectations from a TBI survivor shouldn’t be overly discouraged, as they can bring progress through their desire to improve. They may not reach the goal they wanted to, but they’ll make strides towards it! That is positivity in its purest form. Nobody wants to be working through such a huge change in their life without encouragement – cheer them onward and upward! Even if they fail, they are trying, and that shows initiative. Their desire to improve should never be underappreciated.

When cognition is in the early stages of improvement, the changes may be noticed more by the family or caregiver than they are by the survivor. Sometimes incremental change is just too subtle for survivors to realize, but pointing out the changes to them is incredibly positive reinforcement. The following tips on cognition are excerpted from Lash & Associates’ tip card titled “Cognition – Compensatory strategies after brain injury”

Cognitive fatigue is one of the most common consequences of brain injury. The survivor’s brain is simply working harder to think and learn. Cognitive rest is just as important – maybe even more important – as physical rest after the brain has been injured. Cognitive fatigue can have a ripple effect. You may have a shorter temper, find it harder to concentrate, make more errors, misplace things or forget appointments. You may feel like you can’t think straight no matter how hard you try. Many survivors describe cognitive fatigue as “hitting the wall”.

Do you…

• Feel tired after mental exertion?

• Have a harder time thinking after working on longer or more complex tasks?

• Need more sleep than usual?

• Find it hard to get through the day without napping?

Tips on compensatory strategies…

• Take breaks.

• Schedule rest periods.

• Stay organized.

• Use a daily planner.

• Use time management strategies.

• Eat nutritious meals on a regular schedule.

• Go to bed at a consistent time.

– Create a weekly exercise routine.

• Request a medical evaluation.

• Discuss medications that may help with a physician specializing in brain injury rehabilitation.

There are a plenty of great suggestions for compensatory strategies for survivors and their caregivers in the tip card referenced above. Here’s a link to it here!

When it comes to cognitive functional rehabilitation – seek professional advice first (of course), but when the TBI survivor is at home with a caregiver, clinician, friend or family member, there are some great approaches to working on communication, social interaction, organization, reading, attention, problem solving, and rebuilding other deficits through consistent application by any or all of the people involved in the care of the TBI survivor.

Referencing the book titled “Cognition Functional Rehabilitation Activities Manual” (Developed by Barbara Messenger, MEd, ABDA and Niki Ziarnek, MS, CCC-SLP/L), I’m sharing an excerpt that provides a glimpse into the workbook’s approach to helping a person with cognitive challenges. Many of the exercises use interaction and documentation to assess where the TBI survivor is at (cognitively speaking) on an ongoing basis. Remember, this is a workbook, and there are plenty of exercises that build activities and responses ongoing. Here is the example of how the manual challenges a TBI survivor with structured and specific activities:

Task: Provide awareness training.

Procedure:

  1. Prompt participant to work on awareness training.
  2. Ask why participant is here receiving rehabilitation.
  3. Ask what skills/activities are harder since the brain injury.
  4. Ask what participant does to compensate for these difficulties and which therapies address them.Ask what participant’s strengths are (what is participant good at?).
  1. Ask the participant how the brain injury and difficulties affect daily activities.
  2. Provide answers and examples when needed.
  3. Provide positive reinforcement for strengths, being receptive to information regarding brain injury, for participating in the task, and for being motivated to participate in rehabilitation.

Staff Reminder: (clinician, caregivers, family, etc.)

Provide a complete description of this activity in the Functional Rehabilitation Documentation Form.

Last words…

By asking specific questions, and recording the corresponding answers, this workbook is a great tool for tracking progress – and the exercises can be done more than once, to check and see how/if the answers have changed. So, what’s the takeaway from this excerpt? It illustrates that structure and consistency of care and treatment by family/caregivers and professionals can overlap and create a solid overview of cognitive deficits, and improvements.

In closing, the main goal of this post is to address the expectations of TBI survivors and their caregivers, to encourage them to strive for progress and to offer resources for compensatory strategies, and cognitive rehabilitation. If all parties work in tandem with the common goal of helping a TBI survivor make it to the next level, they’re all closer to the goal…and the whole team wins. That’s the goal!

 

via cognition-caregiving-tbi

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[Abstract] Feasibility study of a serious game based on Kinect system for functional rehabilitation of the lower limbs

Summary

Introduction

Conventional functional rehabilitation costs time, money and effort for the patients and for the medical staff. Serious games have been used as a new approach to improve the performance as well as to possibly reduce medical cost in the future for cognitive rehabilitation and body balance control. The objective of this present work was to perform a feasibility study on the use of a new real-time serious game system for improving the musculoskeletal rehabilitation of the lower limbs.

Materials and methods

A basic functional rehabilitation exercise database was established with different levels of difficulties. A 3D virtual avatar was created and scaled to represent each subject-specific body. A portable and affordable Kinect sensor was used to capture real-time kinematics during each exercise. A specific data coupling process was developed. An evaluation campaign was established to assess the developed system.

Results

The squats exercise was the hardest challenge. Moreover, the performance of each functional rehabilitation exercise depended on the physiological profile of each participant. Our game system was clear and attractive for all functional rehabilitation exercises. All testing subjects felt motivated and secure when playing the rehabilitation game.

Discussion

The comparison with other systems showed that our system was the first one focusing on the functional rehabilitation exercises of the lower limbs.

Conclusions

Our system showed useful functionalities for a large range of applications (rehabilitation at home, sports training). Looking forward, new in-situation exercises will be investigated for specific musculoskeletal disorders.

via Feasibility study of a serious game based on Kinect system for functional rehabilitation of the lower limbs – ScienceDirect

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[Technical note] Serious game and functional rehabilitation for the lower limbs

Summary

Introduction

Conventional functional rehabilitation consists of a therapeutic consultation, a motor exercise assignment, and an execution task with or without assistance of the therapist. The objective of this technical note was to present a new real-time 3D serious game system concept for musculoskeletal rehabilitation of the lower limbs.

Materials and method

A generic development workflow of real-time 3D serious game systems for functional rehabilitation of the lower limbs was proposed. A user-friendly system flowchart was also established for a better interaction between end-users and the game system.

Result and discussion

Different system components like avatar modeling, subject registration, rehabilitation game and feedback visualization and control were detailed and their advantages and limitations were discussed.

Conclusions

3D serious game technologies open new perspectives for a large range of rehabilitation applications (at home or in clinic environment, sports training).

via Serious game and functional rehabilitation for the lower limbs – ScienceDirect

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[Abstract] Serious game and functional rehabilitation for the lower limbs.

Summary

Introduction

Conventional functional rehabilitation consists of a therapeutic consultation, a motor exercise assignment, and an execution task with or without assistance of the therapist. The objective of this technical note was to present a new real-time 3D serious game system concept for musculoskeletal rehabilitation of the lower limbs.

Materials and method

A generic development workflow of real-time 3D serious game systems for functional rehabilitation of the lower limbs was proposed. A user-friendly system flowchart was also established for a better interaction between end-users and the game system.

Result and discussion

Different system components like avatar modeling, subject registration, rehabilitation game and feedback visualization and control were detailed and their advantages and limitations were discussed.

Conclusions

3D serious game technologies open new perspectives for a large range of rehabilitation applications (at home or in clinic environment, sports training).

Source: Serious game and functional rehabilitation for the lower limbs

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[ARTICLE] Functional versus non-functional rehabilitation in chronic ischemic stroke: evidences from a randomized functional MRI study – Full Text PDF

Abstract

Motor rehabilitation of stroke survivors is often based on different rehabilitation strategies that may include functional and/or non-functional exercises. Although functional strategies are largely used, there are still not enough evidences of its clinical efficacy, neither of its impact on functional neuroplasticity following rehabilitation, when compared with non-functional exercises.

The present study aimed to compare the effect of these strategies by means of clinical scales and functional Magnetic Resonance Imaging (fMRI). Twelve hemiparetic patients with a chronic stroke were selected. Patients were randomly assigned a non-functional (NFS) or functional (FS) rehabilitation scheme. Clinical scales (Fugl-Meyer, ARA Test and modified Barthel) and fMRI were applied at four moments: before rehabilitation (P1), immediately after (P2), 1 month (P3) and three months (P4) after the end of rehabilitation. The NFS group improved significantly their Fugl-Meyer scores at P2, P3, and P4, when compared to P1. On the other hand, the FS group increased significantly in Fugl-Meyer at P2, when compared to P1, and also in ARA and Barthel.

fMRI inspection at the individual level revealed that both rehabilitation schemes most often led to: decreased activation sparseness, decreased activity of contralesional M1, increased asymmetry of M1 activity to the ipsilesional side, decreased perilesional activity, and decreased SMA activity. Increased M1 asymmetry with rehabilitation was also confirmed by lateralization indexes. Nevertheless, no clear fMRI differences were found between groups.

Our analysis revealed similar clinical effects between FS and NFS, indicating that the strategy of choice may ultimately depend on the main goal of the individual rehabilitation program.

Full Text PDF

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[VIDEO] Easy PNF and Physiotherapy Equipment – YouTube

The Freestyler PNF and Physiotherapy Equipment. The Freestyler is a great tool for rehabilitation professionals or for individual to use at home after an injury. The system gives an increased effectiveness for the rehabilitation process and for use of rehabilitation professionals.

Professional physiotherapists can use the Freestyler in everyday therapies. They can use many modified PNF (proprioceptive neuromuscular facilitation) exercises, which enable fast and effective functional rehabilitation. They can be implemented in existing programs or combined with other equipment. Our system enables the rehabilitation professionals to save time and money and increase the quality of rehabilitation process.

We offer a complete home gym rehab solution all in one place. Exercises can be undertaken during the regular rehabilitation process or after institutionalized rehabilitation treatment under supervision of a physiotherapist or a physician. Home rehabilitation users get complete step by step programs with full support and tutorials for a safe and effective home rehabilitation workout.

The Freestyler is a very efficient device with carefully planned exercise programs for muscle strengthening, improvement of coordination and balance as well as for facilitating patients efficient return to everyday activities.

via Easy PNF and Physiotherapy Equipment – YouTube.

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