Posts Tagged gait

[VIDEO] Fourier X1 Exoskeleton – Fourier Intelligence – YouTube

Δημοσιεύτηκε στις 23 Μαρ 2017

At Fourier Intelligence, we do not believe these people are fated to sit on the wheelchair in their rest life. To let them stand up, and to allow them to walk again, we started to develop a genuinely new exoskeleton products- The Fourier X1

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[ARTICLE] Effectiveness of robotic assisted rehabilitation for mobility and functional ability in adult stroke patients: a systematic review protocol – Full Text

Abstract

Review question/objective: The objective of this review is to synthesize the best available evidence on the effectiveness of robotic assistive devices in the rehabilitation of adult stroke patients for recovery of impairments in the upper and lower limbs. The secondary objective is to investigate the sustainability of treatment effects associated with use of robotic devices.

The specific review question to be addressed is: can robotic assistive devices help adult stroke patients regain motor movement of their upper and lower limbs?

Background

Stroke is a leading cause of long-term disability and is the third most common cause of mortality in developed countries with 15 million people suffering a stroke yearly.1 Different parts of the brain control different bodily functions. If a person survives a stroke, the effects can vary, depending on the location of brain damage, severity and duration of the stroke. Broadly, the effects of stroke can be physical, cognitive or emotional in nature. In terms of the physical effects of stroke, the loss of motor abilities of the limbs presents significant challenges for patients, as their mobility and activities of daily living (ADLs) are affected. The upper or lower limbs can experience weakness (paresis) or paralysis (plegia), with the most common type of limb impairment being hemiparesis, which affects eight out of 10 stroke survivors.2 Other physical effects of stroke are loss of visual fields, vision perception, difficulty swallowing (dysphagia), apraxia of speech, incontinence, joint pain or neuropathic pain (caused by inability of the brain to correctly interpret sensory signals in response to stimuli on the affected limbs). Cognitive effects of stroke are aphasia, memory loss and vascular dementia. Stroke patients can lose the ability to understand speech or the capacity to read, think or reason, and normal mental tasks can present big challenges, affecting their quality of life. The drastic changes in physical and cognitive abilities caused by stroke also lead to emotional effects for stroke patients. Stroke survivors can experience depression when they encounter problems in doing tasks that they can easily do pre-stroke. Along with depression, they can experience a lack of motivation and mental fatigue.

For stroke patients, rehabilitation is the pathway to regaining or managing their impaired functions. There is no definite end to recovery but the most rapid improvement is within the first six months post stroke.3 Before a patient undergoes rehabilitation, an assessment is first done to determine if a patient is medically stable and fit for a rehabilitation program. If the patient is assessed to be suitable, then depending on the level of rehabilitative supervision required, the patient could undergo rehabilitation in various settings – as an in-patient/outpatient (at either a hospital or nursing facility) or at home.3,4Rehabilitation should be administered by a multi-disciplinary team of physiotherapists, occupational therapist, speech therapist and neuropsychologists, who work together to offer an integrated, holistic rehabilitation therapy.4 Depending on the type of impairment, rehabilitation specialists will assess the appropriate therapies needed and set realistic goals for patients to achieve. Generally, stroke patients should be given a minimum of 45 min for each therapy session over at least five days per week, as long as the patient can tolerate the rehabilitation regimen.3

One of the main goals in stroke rehabilitation is the restoration of motor skills, and this involves patients undergoing repetitive, high-intensity, task-specific exercises that enable them to regain their motor and functional abilities.5,6 It is theorized that the brain is plastic in nature and that repetitive exercises over long periods can enable the brain to adapt and regain the motor functionality that has been repeatedly stimulated.7This involves the formation of new neuronal interconnections that enable the re-transmission of motor signals.8

Source: Effectiveness of robotic assisted rehabilitation for mobilit… : JBI Database of Systematic Reviews and Implementation Reports

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[ARTICLE] A wearable exoskeleton suit for motion assistance to paralysed patients – Full Text

Summary

Background/Objective

The number of patients paralysed due to stroke, spinal cord injury, or other related diseases is increasing. In order to improve the physical and mental health of these patients, robotic devices that can help them to regain the mobility to stand and walk are highly desirable. The aim of this study is to develop a wearable exoskeleton suit to help paralysed patients regain the ability to stand up/sit down (STS) and walk.

Methods

A lower extremity exoskeleton named CUHK-EXO was developed with considerations of ergonomics, user-friendly interface, safety, and comfort. The mechanical structure, human-machine interface, reference trajectories of the exoskeleton hip and knee joints, and control architecture of CUHK-EXO were designed. Clinical trials with a paralysed patient were performed to validate the effectiveness of the whole system design.

Results

With the assistance provided by CUHK-EXO, the paralysed patient was able to STS and walk. As designed, the actual joint angles of the exoskeleton well followed the designed reference trajectories, and assistive torques generated from the exoskeleton actuators were able to support the patient’s STS and walking motions.

Conclusion

The whole system design of CUHK-EXO is effective and can be optimised for clinical application. The exoskeleton can provide proper assistance in enabling paralysed patients to STS and walk.

Continue —> A wearable exoskeleton suit for motion assistance to paralysed patients

 

Figure 1

Figure 1. The wearable exoskeleton suit CUHK-EXO. (A) A patient with the wearable exoskeleton suit CUHK-EXO supported by a pair of smart crutches; (B) diagram of the overall mechanical structure of CUHK-EXO; (C) waist structure of CUHK-EXO; (D) thigh structure of CUHK-EXO; (E) shank structure of CUHK-EXO. (F) foot structure of CUHK-EXO.

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[VIDEO] Functional electrical stimulation (FES) talk with Christine Singleton and Sarah Joiner – YouTube

Δημοσιεύτηκε στις 22 Μαρ 2017

Lead Clinical Physiotherapist Christine Singleton and Sarah Joiner who has MS discuss Functional electrical stimulation (FES), how it works, who can use it, how to wear it, does it make a difference and how can you get referred for it. For more information about FES visit our website https://www.mstrust.org.uk/a-z/functi…

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[Abstract] Single Session of Functional Electrical Stimulation−Assisted Walking Produces Corticomotor Symmetry Changes Related to Changes in Poststroke Walking Mechanics

Abstract

Background: Recent research demonstrated that symmetry of corticomotor drive to paretic and nonparetic plantarflexor muscles are related to the biomechanical ankle moment strategy that individuals with chronic stroke used to achieve their greatest walking speeds. Rehabilitation strategies that promote corticomotor balance could potentially improve post-stroke walking mechanics and enhance functional ambulation.

Objective: To 1) test the effectiveness of a single session of gait training using functional electrical stimulation (FES) to improve plantarflexor corticomotor symmetry and plantarflexion ankle moment symmetry and 2) determine if changes in corticomotor symmetry relate to changes in ankle moment symmetry within the session.

Design: A repeated measures cross-over study.

Methods: On separate days, twenty individuals with chronic stroke completed a session of treadmill walking either with or without the use of FES to their ankle dorsi- and plantarflexors muscles. We calculated plantarflexor corticomotor symmetry using transcranial magnetic stimulation and plantarflexion ankle moment symmetry during walking between the paretic and nonparetic limbs before and after each session. We compared changes and tested relationships between corticomotor and ankle moment symmetry following each session.

Results: Following the session with FES there was an increase in plantarflexor corticomotor symmetry that was related to the observed increase in ankle moment symmetry. In contrast, following the session without FES there were no changes in corticomotor symmetry or ankle moment symmetry.

Limitations: No stratification was made based on lesion size, location, or clinical severity.

Conclusions: For the first time, these findings demonstrate the ability of a single session of gait training with FES to induce positive corticomotor plasticity in individuals in the chronic stage of stroke recovery and provide insight into the neurophysiologic mechanisms underlying improvements in biomechanical walking function.

Source: Single Session of Functional Electrical Stimulation−Assisted Walking Produces Corticomotor Symmetry Changes Related to Changes in Poststroke Walking Mechanics | Physical Therapy | Oxford Academic

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[ARTICLE] Short-term effects of physiotherapy combining repetitive facilitation exercises and orthotic treatment in chronic post-stroke patients – Full Text PDF

Abstract.

[Purpose] This study investigated the short-term effects of a combination therapy consisting of repetitive facilitative exercises and orthotic treatment.

[Subjects and Methods] The subjects were chronic post-stroke patients (n=27; 24 males and 3 females; 59.3 ± 12.4 years old; duration after onset: 35.7 ± 28.9 months) with limited mobility and motor function. Each subject received combination therapy consisting of repetitive facilitative exercises for the hemiplegic lower limb and gait training with an ankle-foot orthosis for 4 weeks. The Fugl-Meyer assessment of the lower extremity, the Stroke Impairment Assessment Set as a measure of motor performance, the Timed Up & Go test, and the 10-m walk test as a measure of functional ambulation were evaluated before and after the combination therapy intervention.

[Results] The findings of the Fugl-Meyer assessment, Stroke Impairment Assessment Set, Timed Up & Go test, and 10-m walk test significantly improved after the intervention. Moreover, the results of the 10-m walk test at a fast speed reached the minimal detectible change threshold (0.13 m/s).

[Conclusion] Short-term physiotherapy combining repetitive facilitative exercises and orthotic treatment may be more effective than the conventional neurofacilitation therapy, to improve the lower-limb motor performance and functional ambulation of chronic post-stroke patients.

 

INTRODUCTION

The mobility of many stroke survivorsislimited, and most identify walking as a top priority for rehabilitation1) . One way to manage ambulatory difficulties is with an ankle-foot orthosis (AFO) or a foot-drop splint, which aims to stabilize the foot and ankle while weight-bearing and lift the toes while stepping1) . In stroke rehabilitation, various approaches, including robotic assistance, strength training, and task-related/virtual reality techniques, have been shown to improve motor function2) . The benefits of a high intensity stroke rehabilitation program are well established, and although no clear guidelines exist regarding the best levels of intensity in practice, the need for its incorporation into a therapy program is widely acknowledged2) . Repetitive facilitative exercises (RFE), which combine a high repetition rate and neurofacilitation, are a recently developed approach to rehabilitation of stroke-related limb impairment2–5) . In the RFE program, therapists use muscle spindle stretching and skin-generated reflexes to assist the patient’s efforts to move an affected joint5) . Previous studies have shown that an RFE program improved lower-limb motor performance (Brunnstrom Recovery Stage, foot tapping, and lower-limb strength) and the 10-m walk test in patients with brain damage3) . An AFO is an assistive device to help stroke patients with hemiplegia walk and stand. A properly prescribed AFO can improve gait performance and control abnormal kinematics arising from coordination deficits6) . Gait training with an AFO has been also reported to improve gait speed and balance in post-stroke patients7, 8) . Therefore, we hypothesized that short-term physiotherapy combining RFE and orthotic treatment would improve both lower-extremity motor performance and functional ambulation. The present study aimed to confirm the efficacy of a combination therapy consisting of RFE for the hemiplegic lower limb and gait training with AFO.

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[commentary] Gait and balance training using virtual reality is more effective for improving gait and balance ability after stroke than conventional training without virtual reality.

Commentary

Virtual reality technology, consisting of computer simulations to artificially generate sensory information in the form of a virtual environment that is interactive and perceived as similar to the real world, is recognised as a novel intervention tool in stroke rehabilitation. This timely systematic review addressed the effectiveness of virtual reality training on gait and balance using commonly assessed clinical outcome measures. The meta-analyses conducted on these outcomes all favoured virtual reality training when the time-dose was matched between balance and gait training, with and without virtual reality. Virtual reality-based rehabilitation should thus be considered to be more than an adjunct to conventional gait training, which is recommended by a recent update on stroke rehabilitation best practice.1

While virtual reality offers the opportunity to create unique and customisable interventions that are unavailable or readily accomplished in the real world, its clinical implementation may be challenging. Diverse virtual reality tools exist; they range from computer games (eg, Wii, Kinect) to high-end, immersive, and costly systems.2 The realism and ecological validity of a virtual environment could enhance training efficiency in virtual reality-based rehabilitation. A useful framework3 to guide clinical decision-making consists of three essential phases: (1) interaction between the user and the virtual environment, taking into account the personal and environmental characteristics; (2) transfer of skills learned from the virtual environment to the real world; and (3) participation in the real world and its affordances as a result of rehabilitation. The transfer of virtual reality-based gait and balance training to actual community ambulation should thus be considered. It should be assessed with mobility outcomes recorded in the community and during negotiation of actual environmental challenges, such as slopes and obstacles. Outcomes of participation, motivation and adherence to training should also be evaluated.
Provenance: Invited. Not peer-reviewed.

References

    • 3
    • Weiss PL, et al. In: Selzer ME, et al. (eds). Textbook of neural repair and neurorehabilitation. 2016;2:182–197.

Source: Gait and balance training using virtual reality is more effective for improving gait and balance ability after stroke than conventional training without virtual reality [commentary]

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[Literature Overview] EBRSR – 9 Mobility and the Lower Extremity – Full Text PDF

Abstract

Rehabilitation techniques of sensorimotor complications post stroke fall loosely into one of two categories; the compensatory approach or the restorative approach. While some overlap exists, the underlying philosophies of care are what set them apart. The goal of the compensatory approach towards treatment is not necessarily on improving motor recovery or reducing impairments but rather on teaching patients a new skill, even if it only involves pragmatically using the non-involved side (Gresham et al. 1995). The restorative approach focuses on traditional physical therapy exercises and neuromuscular facilitation, which involves sensorimotor stimulation, exercises and resistance training, designed to enhance motor recovery and maximize brain recovery of the neurological impairment (Gresham et al. 1995).In this review, rehabilitation of mobility and lower extremity complications is assessed. An overview of literature pertaining to the compensatory approach and the restorative approach is provided. Treatment targets discussed include balance retraining, gait retraining, strength training, cardiovascular conditioning and treatment of contractures in the lower extremities. Technologies used to aid rehabilitation include assistive devices, electrical stimulation, and splints.

Full Text PDF (175 pages)

 

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[WEB SITE] Stroke Recovery Exercises for Your Whole Body – Saebo

Stroke survival rates have improved a lot over the last few years. Stroke was once the third leading cause of death in the United States, but it fell to fourth place in 2008 and fifth place in 2013. Today, strokes claim an average of 129,000 American lives every year. Reducing stroke deaths in America is a great improvement, but we still have a long way to go in improving the lives of stroke survivors.

Stagnant recovery rates and low quality of life for stroke survivors are unfortunately very common. Just 10% of stroke survivors make a full recovery. Only 25% of all survivors recover with minor impairments. Nearly half of all stroke survivors continue to live with serious impairments requiring special care, and 10% of survivors live in nursing homes, skilled nursing facilities, and other long-term healthcare facilities. It’s easy to see why stroke is the leading cause of long-term disability in the United States. By 2030, it’s estimated that there could be up to 11 million stroke survivors in the country.

Traditionally, stroke rehabilitation in America leaves much to be desired in terms of recovery and quality of life. There is a serious gap between stroke patients being discharged and transitioning to physical recovery programs. In an effort to improve recovery and quality of life, the American Heart Association has urged the healthcare community to prioritize exercise as an essential part of post-stroke care.

Unfortunately, too few healthcare professionals prescribe exercise as a form of therapy for stroke, despite its many benefits for patients. Many stroke survivors are not given the skills, confidence, knowledge, or tools necessary to follow an exercise program. However, that can change.

With the right recovery programs that prioritize exercise for rehabilitation, stroke survivors can “relearn” crucial motors skills to regain a high quality of life. Thanks to a phenomenon known as neuroplasticity, even permanent brain damage doesn’t make disability inevitable.

A stroke causes loss of physical function because it temporarily or permanently damages the parts of the brain responsible for those functions. The same damage is also responsible for behavioral and cognitive changes, which range from memory and vision problems to severe depression and anger. Each of these changes correspond to a specific region of the brain that was damaged due to stroke.

For example, damage in the left hemisphere of your brain will cause weakness and paralysis on the right side of your body. If a stroke damages or kills brain cells in the right hemisphere, you may struggle to understand facial cues or control your behavior. However, brain damage due to stroke is not necessarily permanent.

For more Visit Site —> Stroke Recovery Exercises for Your Whole Body

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[WEB SITE] Q&A: Lower Extremity Rehab.

Published on February 7, 2017

Whether for temporary application or use over a lifetime, braces and orthoses can be an essential component of rehabilitation programs directed at treating the lower extremities for adults and children. The evolved technology behind today’s bracing and orthotic products are characterized by lightweight support as well as options in materials that offer tailored sizing and customized fit. Construction components made of carbon fiber, rubber, plastic polymers, metal, and leather mean therapists and users may take advantage of devices that are soft, rigid, or semi-soft in structure. As clinicians who assess gait and are often stakeholders in the care of individuals affected by lower extremity impairment, therapists must have a wide grasp of technologies available for this product category.

To provide an update about technologies for lower extremity braces and orthoses for treating the pediatric population as well as the general orthopedic and neurological population, Rehab Management interviewed therapists who practice in these settings. Read this Q&A to find out what these therapists look for in the technologies they recommend, and how their functional properties help maintain mobility and correct physical issues that can affect walking.

Whitney Frisard, PT, DPT, fits an articulating AFO on a patient prior to initiating ambulation and standing at Children’s Hospital of New Orleans.

Whitney Frisard, PT, DPT, fits an articulating AFO on a patient prior to initiating ambulation and standing at Children’s Hospital of New Orleans.

Small Patients, Big Impact

by Whitney Frisard, PT, DPT, and Laura Matthew, PTA, Children’s Hospital of New Orleans, New Orleans, La

Q. What types of lower extremity impairment do you most often see among pediatric patients that require braces/orthoses?
A. We see multiple diagnoses among our patients that require orthotic intervention, but some of the most common are cerebral palsy, traumatic brain injury, and Down Syndrome. We find it easiest to categorize them as having high or low tone. With the high tone patients, we see equinas deformity with decreased dorsiflexion in both AROM and PROM. As the child ages, we see splaying of the forefoot/digits sometimes causing increased deformities of the foot and ankle. However, with low tone patients, medial/lateral instability collapsing into pronation is the most frequent impairment we see. These are just a few types of impairments with the diagnoses mentioned above, but we see many other neurological and orthopedic issues among our patients.

Q. What problems do those impairments create for walking?
A. Patients with high tone often display toe walking demonstrating a lack of heel contact during the gait phase, causing abnormal stresses through the hips and knees. As the child ages, this could result in an antalgic gait pattern. Patients with high tone typically have poor coordination and motor control, resulting in decreased balance. The patients with low tone often demonstrate a wider base of support, decrease balance, knee hyperextension during stance phase, and upper extremity guarding. Both situations require an increased effort by the child for walking and result in many muscle imbalances.

Q. What types of braces/orthoses can help overcome those impairments and achieve more normal gait?
A. Children’s Hospital has an in-house orthotist who is readily available to help consult on bracing for our patients, which is a significant benefit to our patients. For patients with high tone, we mostly recommend a solid AFO with or without a molded inner boot. The molded inner boot is beneficial for those with significantly high tone for additional positioning. We also utilize articulating AFO’s with a plantar flexion stop to facilitate active dorsiflexion in order to obtain a heel-toe gait pattern. With patients with low tone, it depends on the severity. We would typically utilize a supramalleolar orthotic (SMO) to address the medial lateral instability. However, for those with significant hypotonia, we prefer an articulating AFO to promote a normal gait pattern.

Whitney Frisard, PT, DPT, graduated from LSUHSC in New Orleans in 2012. She has been with Children’s Hospital of New Orleans since 2012. Children’s Hospital is a 247-bed, not-for-profit pediatric medical center offering a complete range of healthcare services for children from birth to 21 years.

Laura Matthew, PTA, graduated from Delgado Community College in 1998. She has been with Children’s Hospital of New Orleans since 1998. For more information, contactRehabEditor@allied360.com.

Tiffany Weiser, PT, DPT, C/NDT, assists in fitting AFOs for a an adult client at All Care  Therapies of Georgetown.

Tiffany Weiser, PT, DPT, C/NDT, assists in fitting AFOs for a an adult client at All Care Therapies of Georgetown.

Rehabilitative Care for a Community

by Tiffany Weiser, PT, DPT, C/NDT, All Care Therapies of Georgetown, Georgetown, Texas

Q. What types of lower extremity impairment do you most often see among your patient population?
A. Nothing can prepare a person for life-altering moments caused by a stroke or any type of insult to the brain or spinal cord, which leads to a neurological change within their body. These insults cause patients to lose function and their ability to participate in activities that bring joy, entertainment, exercise, or simply the ability to complete activities of daily living. Overcoming them requires patience, energy, strength, and courage, from the patient and their support system, which includes physical therapists. Therapists must continually perform assessments and be adaptive to evolve patient-specific, need-based treatments.

The variability of impairments that result from an injury to the brain or spinal cord range significantly depending on the location of the insult. Upper motor neuron impairments include hypertonia, spasticity, and clonus, while lower motor neuron impairments cause low muscle tone and flaccid weakness. It is important to note how these upper and lower motor neuron impairments affect each one of the body systems while conducting a patient’s assessment. Assessments should encompass single body systems to identify associated common impairments including muscular tightness and endurance, postural asymmetries in the extremities and trunk, proprioceptive input, and abilities to isolate movement. Evaluating assessment results develops an understanding of how these single system impairments, when combined, affect the patient’s anticipatory control, balance, and movement strategies.

Q. What problems do those impairments create for walking?
A. The aforementioned impairments affect the patient’s functional activities, including walking—considered critical to quality of life. Common gait abnormalities seen with patients that present with increased tone and spasticity after injury include a steppage pattern to compensate for foot drop. This pattern can include an exaggerated thigh lift, excessive hip and knee flexion, and possibly external rotation of the lower extremity to clear the toe during swing phase. Spasticity seen within the gastrocnemius often results in uncontrolled knee hyperextension during stance phase. Typical gait abnormalities seen with patients that have hypotonia and flaccid paralysis after injury include a slap gait pattern due to decreased eccentric control of the ankle dorsiflexors upon initial contact in the gait cycle, knee buckling resulting from quadriceps weakness, insufficient step length due to hip extensor weakness, a crouched gait due to poor ability to initiate and sustain muscle activation primarily in the plantarflexors, and ankle pronation, genu valgum and genu recruvatum during the stance phase due to generalized weakness. In both scenarios, the patient often has decreased proprioceptive input due to malalignment, an increased fall risk due to the gait abnormalities, and requires increased muscle energy expenditure if not appropriately addressed. Additionally, malalignment in the foot can degrade bone health as it is significantly impacted by standing weight bearing.

Q. What types of braces/orthoses can help overcome those impairments and achieve more normal gait?
A. An ankle foot orthotic (AFO) is the most common type of orthotic used to address those patients with neurological impairments because an AFO provides correct calcaneal positioning and arch support at the foot. Components and design of the AFO at the ankle joint and lower leg will be selected based on the patient’s clinical presentation. Patients that present with hypertonia and spasticity typically benefit from an articulated AFO with dorsiflexion assist and a plantarflexion stop to help achieve heel strike at initial contact and reduce knee hyperextension in stance phase. Additional benefits from using this type of AFO include decreased oxygen and energy consumption and improved walking speed, stride length, and single leg support time. Patients who present with low muscle tone and flaccid paralysis often require an AFO that offers sufficient support that provides distal stability due to a patient’s inability to initiate and/or sustain muscle contraction to achieve their ambulation goals.

Distal stability can be achieved using a solid AFO, which also allows the patient to focus their attention on gaining proximal stability. Once reaching proximal stability, the AFO can be hinged, as desired, to allow controlled ankle dorsiflexion and plantarflexion, progressing their goals. A ground reaction AFO is an alternative brace that has shown to be beneficial for patients with low muscle. The solid anterior component of a ground reaction AFO encourages knee extension through the floor reaction at heel contact that improves stance phase. If this brace is considered, the patient must have available range of motion at the knee and hip. RM

Tiffany Weiser, PT, DPT, C/NDT, is director of physical therapy at All Care Therapies of Georgetown, Georgetown, Texas. She attended Duquesne University in Pittsburgh, where she earned her Doctorate of Physical Therapy in 2010. Weiser became certified in Neurodevelopmental Treatment (NDT) in 2014. For more information, contactRehabEditor@allied360.com.

Source: Q&A: Lower Extremity Rehab – Rehab Managment

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