Posts Tagged hemiplegia

[Abstract] The feasibility, acceptability and preliminary efficacy of a low-cost, virtual-reality based, upper-limb stroke rehabilitation device: a mixed methods study.

Abstract

PURPOSE:

To establish feasibility, acceptability, and preliminary efficacy of an adapted version of a commercially available, virtual-reality gaming system (the Personalised Stroke Therapy system) for upper-limb rehabilitation with community dwelling stroke-survivors.

METHOD:

Twelve stroke-survivors (nine females, mean age 58 years, [standard deviation 7.1], median stroke chronicity 42 months [interquartile range 34.7], Motricity index 14-25 for shoulder and elbow) were asked to complete nine, 40-min intervention sessions using two activities on the system over 3 weeks. Feasibility and acceptability were assessed through a semi-structured interview, recording of adverse effects, adherence, enjoyment (using an 11-point Likert scale), and perceived exertion (using the BORG scale). Assessments of impairment (Fugl-Meyer Assessment Upper extremity), activity (ABILHAND, Action Research Arm Test, Motor Activity Log-28), and participation (Subjective Index of Physical and Social Outcome) were completed at baseline, following intervention, and at 4-week follow-up. Data were analysed using Thematic Analysis of interview and intervention field-notes and Wilcoxon Signed Ranks. Side-by-side displays were used to integrate findings.

RESULTS:

Participants received between 175 and 336 min of intervention. Thirteen non-serious adverse effects were reported by five participants. Participants reported a high level of enjoyment (8.1 and 6.8 out of 10) and rated exertion between 11.6 and 12.9 out of 20. Themes of improvements in impairments and increased spontaneous use in functional activities were identified and supported by improvements in all outcome measures between baseline and post-intervention (p < 0.05 for all measures).

CONCLUSIONS:

Integrated findings suggested that the system is feasible and acceptable for use with a group of community-dwelling stroke-survivors including those with moderately-severe disability. Implications for rehabilitation To ensure feasibility of use and maintenance of an appropriate level of challenge, gaming technologies for use in upper-limb stroke rehabilitation should be personalised, dependent on individual need. Through the use of hands-free systems and personalisation, stroke survivors with moderate and moderately-severe levels of upper-limb impairment following stroke are able to use gaming technologies as a means of delivering upper-limb rehabilitation. Future studies should address issues of acceptability, feasibility, and efficacy of personalised gaming technologies for delivery of upper-limb stroke rehabilitation in the home environment. Findings from this study can be used to develop future games and activities suitable for use in stroke rehabilitation.

 

via The feasibility, acceptability and preliminary efficacy of a low-cost, virtual-reality based, upper-limb stroke rehabilitation device: a mixed meth… – PubMed – NCBI

Advertisements

, , , , ,

Leave a comment

[Abstract] Application of Commercial Games for Home-Based Rehabilitation for People with Hemiparesis: Challenges and Lessons Learned

Objective: To identify the factors that influence the use of an at-home virtual rehabilitation gaming system from the perspective of therapists, engineers, and adults and adolescents with hemiparesis secondary to stroke, brain injury, and cerebral palsy.

Materials and Methods: This study reports on qualitative findings from a study, involving seven adults (two female; mean age: 65 ± 8 years) and three adolescents (one female; mean age: 15 ± 2 years) with hemiparesis, evaluating the feasibility and clinical effectiveness of a home-based custom-designed virtual rehabilitation system over 2 months. Thematic analysis was used to analyze qualitative data from therapists’ weekly telephone interview notes, research team documentation regarding issues raised during technical support interactions, and the transcript of a poststudy debriefing session involving research team members and collaborators.

Results: Qualitative themes that emerged suggested that system use was associated with three key factors as follows: (1) the technology itself (e.g., characteristics of the games and their clinical implications, system accessibility, and hardware and software design); (2) communication processes (e.g., preferences and effectiveness of methods used during the study); and (3) knowledge and training of participants and therapists on the technology’s use (e.g., familiarity with Facebook, time required to gain competence with the system, and need for clinical observations during remote therapy). Strategies to address these factors are proposed.

Conclusion: Lessons learned from this study can inform future clinical and implementation research using commercial videogames and social media platforms. The capacity to track compensatory movements, clinical considerations in game selection, the provision of kinematic and treatment progress reports to participants, and effective communication and training for therapists and participants may enhance research success, system usability, and adoption.

 

via Application of Commercial Games for Home-Based Rehabilitation for People with Hemiparesis: Challenges and Lessons Learned | Games for Health Journal

, , , , , , , , ,

Leave a comment

[Conference Paper] Design and Implementation study of Remote Home Rehabilitation Training Operating System based on Internet – Full Text PDF

Abstract

The proportion of rehabilitation doctors and patients mismatch is very grim in the context of social aging. The Family Rehabilitation System captures the profound information of the trainer’s movements through the kinect bone tracing technique, allowing the doctor to remotely master the patient’s training progress. With the help of computers and the Internet, the patient can consult a physician, while the physician can remotely guide and launch the training “prescription” through the Internet according to the training effect. Patients can have rehabilitated training at home. The results of the test showed that the system has a positive effect on the rehabilitation of the patient.

1. Introduction

The number of patients with motor dysfunction caused by hemiplegia and stroke increased. In order to promote better recovery of their body muscles, patients are still required to perform rehabilitation exercises in the community or family after the treatment of discharge. However, there are still some difficulties in community rehabilitation for patients with motor dysfunction:

  • (1) The number of therapists on-site services is scarce and expensive;
  • (2) In the absence of standard and systematic action guidance, the patients ‘ own training is not only the science is not high and the effect is limited.
  • (3) Patients need to be trained in special environments such as rehabilitation centers, and wearing complex training equipment is inconvenient for them.

The family rehabilitation system collects the depth information of the trainer’s movements through the Kinect skeletal tracking technique; With the help of computers and the Internet, patients can consult physicians, and the doctor through the Internet remote guidance and open training action “prescription” according to the training effect so that patients at home can be rehabilitation training. This liberated the physician’s labour force and formed a network community that was closely linked to the hospital and regularly received “training prescriptions” to improve patient rehabilitation. […]

 Full Text Article PDF

via Design and Implementation study of Remote Home Rehabilitation Training Operating System based on Internet – IOPscience

, , , , , ,

Leave a comment

[ARTICLE] Effectiveness of Mirror Therapy in Rehabilitation of Hand Function in Sub-Acute Stroke – Full Text

Abstract

Aim: Three quarters of strokes occur in the region supplied by the middle cerebral artery. As a consequence, the upper limb will be affected in a large number of patients. Purpose of the study is to examine the effectiveness of mirror therapy in rehabilitation of hand function in sub-acute stroke.

Methodology: An experimental study design, 30 subjects with sub-acute stroke with impaired hand function randomly allocated 15 subjects into each experimental group and conventional group. Both groups received conventional physiotherapy. The experimental group in addition, received Mirror Therapy program of 30 repetition of each exercises per day for 5 days in a week for 4 weeks (total = 20 sessions). Hand functions were measured using Upper extremity motor activity log (UE MAL) and Action research arm test (ARAT) before and after 4 week of intervention.

Results: Results of the study suggested that both the experimental and conventional group had a significant improvement in hand function (AROM, functional task with objects, object manipulation), however experimental group showed significantly more improvement than conventional group, providing Mirror Therapy with conventional treatment is more effective than conventional treatment alone.

Conclusion: Mirror therapy with conventional physiotherapy brings more improvement in hand function than conventional physiotherapy alone.

Introduction

World Health Organization [WHO; Stroke; 1989] defines the clinical syndrome of stroke as ‘rapidly developed clinical signs of focal (or global) distribution of cerebral function with symptoms lasting more than 24 hours or longer or leading to death, with no apparent cause other than vascular origin’.

Prevalence rates reported for stroke or CerebroVascular Accident (CVA) worldwide vary between 500 to 800 per 100,000 population [N.K. Sehi et al 2007] with about 20 million people suffer from stroke each year; out of that 5 million will die as a consequences and 15 million will survive with long term disabilities of varied spectrum. Many surviving stroke patients will often depends on other people‘s continuous support to survive.

Stroke is the most common cause of chronic disability [1]. Of survivors, an estimated one third will be functionally dependent after 1 year experiencing difficulty with activities of daily living (ADL), ambulation, speech, and so forth [2]. Cognitive impairment occurs frequently after stroke, commonly involving memory, orientation, language, and attention. The presence of cognitive impairment in patients with stroke has important functional consequences, independent of the effects of physical impairment (T K Tatemichi et al 1994).

Recovery of function after stroke may occur, but it is unclear whether interventions can improve function beyond the spontaneous process. In particular, recovery of hand function plateaus in about 1 year, and common knowledge is that the patient will remain at that level for the rest of his or her life [3,4]. Typically in such situations, upper arm function is better than that in the hand [5]. An emerging concept in neural plasticity is that there is competition among body parts for territory in the brain [6-11].

Several studies have been conducted to examine the recovery of the hemiplegic arm in stroke patients. Up to 85% of patients show an initial deficit in the arm. Three to six months later, problems remain in 55% to 75% of patients [12-15]. While recovery of arm function is poor in a significant number of patients. Three quarters of strokes occur in the region supplied by the middle cerebral artery [16]. As a consequence, the upper limb will be affected in a large number of patients. Functional recovery of the arm includes grasping, holding, and manipulating objects, which requires the recruitment and complex integration of muscle activity from shoulder to fingers.

Functional brain imaging studies of healthy subjects suggest that excitability of the primary motor cortex ipsilateral to a unilateral hand movement is facilitated by viewing a mirror reflection of the moving hand [17]. Reorganization of motor functions immediately around the stroke site (ipsilesional) is likely to be important in motor recovery after stroke, and a contribution of other brain areas in the affected hemisphere is also possible. Activation when a subject is doing motor tasks can also occur in the bilateral inferior parietal area, the supplementary motor area, and in the premotor cortex. Furthermore, central adaptations occur in networks controlling the paretic as well as the nonparetic lower limb after stroke [18].

The aim of this study is to find the effect of mirror therapy in rehabilitation of hand function in sub-acute stroke. […]

 

Continue —> Effectiveness of Mirror Therapy in Rehabilitation of Hand Function in Sub-Acute Stroke

, , , , , , , , , ,

Leave a comment

[Abstract+References] Effect of Mirror Therapy on Upper Limb Function: A Single Subject Study.

Abstract

Objectives: Mirror therapy is a unique treatment with a touch of modality that is purported to improve the motor function of the affected limb in individuals with hemiplegia. Previous studies have focused on the neuro-physiological factors underlying the mechanism of the clinical effect of this technique. The present study aims to understand the mechanism using the rehabilitation method and neuro-occupation model as well as analyze the effects of mirror therapy on the upper limb function of subjects with spastic hemiplegic cerebral palsy.
Methods: Single subject design known as withdrawal design was used by a convenience sample of four subjects. The study involved three observational phases known as baseline, treatment, and withdrawal phases that took place during a 10 week period. The study contained a home-based mirror therapy protocol whereby the participants were instructed to do some exercises on a daily basis. The improvement of the hand function of the hemiplegic side was examined by Box and Block test along with two more activities including Threading Beads and Stacking Rings.
Results: The ability to perform the Box and Block test, Threading Beads, and Stacking Rings tended to remain steady in the baseline phase, whereas there was a noticeable improvement during the treatment phase and a decline in the withdrawal phase.
Discussion: From the perspective of visual feedback neuro-occupation model, it could be hypothesized that alterations to the sensory system caused by the mirror reflection of non affected hand may have led to the destabilization of the sensory cortices that changed the participants’ intention, meaning, and perception, thereby improving the subject’s motor control.

References
1. Forsyth K, Mann LS, Kielhofner G. Scholarship of practice: Making occupation-focused, theory-driven, evidence-based practice a reality. British Journal of Occupational Therapy. 2005; 68(6):260-8. doi: 10.1177/030802260506800604 [DOI]
2. Deconinck FJ, Smorenburg AR, Benham A, Ledebt A, Feltham MG, Savelsbergh GJ. Reflections on mirror therapy: A systematic review of the effect of mirror visual feedback on the brain. Neurorehabil Neural Repair. 2015; 29(4):349-61. doi: 10.1177/1545968314546134 [DOI]
3. Thieme H, Mehrholz J, Pohl M, Behrens J, Dohle C. Mirror therapy for improving motor function after stroke. Cochrane Database of Systematic Reviews. 2012(3):CD008449. doi: 10.1002/14651858.cd008449.pub2 [DOI]
4. Gordon AL, Di Maggio A. Rehabilitation for children after acquired brain injury: Current and emerging approaches. Pediatric Neurology. 2012; 46(6):339-44. doi: 10.1016/j.pediatrneurol.2012.02.029 [DOI]
5. Feltham MG, Ledebt A, Deconinck FJ, Savelsbergh GJ. Mirror visual feedback induces lower neuromuscular activity in children with spastic hemiparetic cerebral palsy. Research in Developmental Disabilities. 2010; 31(6):1525-35. doi: 10.1016/j.ridd.2010.06.004 [DOI]
6. Royeen CB. Chaotic occupational therapy: Collective wisdom for a complex profession. American Journal of Occupational Therapy. 2003; 57(6):609-24. doi: 10.5014/ajot.57.6.609 [DOI]
7. Lazzarini I. Neuro-occupation: The nonlinear dynamics of intention, meaning and perception. British Journal of Occupational Therapy. 2004; 67(8):342-52. doi: 10.1177/030802260406700803 [DOI]
8. Derakhshanrad SA, Piven E, Zeynalzadeh Ghoochani B. Adaption to stroke: A nonlinear thinking approach in occupational therapy. Occupational Therapy in Health Care. 2017; 31(3):255-69. doi: 10.1080/07380577.2017.1335922 [DOI]
9. Lazzarini I. A nonlinear approach to cognition: a web of ability and disability. In: Katz N, Baum MC, editors. Cognition and Occupation Across the Life Span: Models for Intervention in Occupational Therapy. Bethesda: American Occupational Therapy Association; 2004.
10. Derakhshanrad SA, Piven E, Zeynalzadeh Ghoochani B. Comparing the cognitive process of circular causality in two subjects with strokes through qualitative analysis. Nonlinear Dynamics, Psychology, and Life Sciences. 2017; 21(4):555-567. PMID: 28923161 [PubMed]
11. Parham LD, Mailloux Z. Sensory integration. In: Case-Smith J, O’Brien J, editors. Occupational Therapy for Children. Berlin: Elsevier; 2005.
12. Piven E, Derakhshanrad SA. A case study demonstrating reduction of aggressive client behaviors using the Neuro-Occupation model: Addressing professional burnout through nonlinear thinking. Occupational Therapy in Mental Health. 2017; 33(2):179-94. doi: 10.1080/0164212X.2017.1278734 [DOI]
13. Loukas KM. Occupational placemaking: Facilitating self-organization through use of a sensory room. Mental Health Special Interest Section Quarterly. 2011; 34(2):1-4.
14. Williams KL. Understanding the role of sensory processing in occupation: An updated discourse with cognitive neuroscience. Journal of Occupational Science. 2017; 24(3):302-13. doi: 10.1080/14427591.2016.1209425 [DOI]
15. Carter RE, Lubinsky J, Domholdt E. Rehabilitation research: Principles and applications. Berlin: Elsevier; 2011.
16. Morgan. DL, Morgan. RK. Single-case research methods for the behavioral and health sciences. Thousand Oaks, California: SAGE; 2009.
17. Creswell JW. Research design: Qualitative, quantitative, and mixed methods approaches. Thousand Oaks, California: SAGE; 2013.
18. Eliasson AC, Krumlinde-Sundholm L, Rösblad B, Beckung E, Arner M, Öhrvall AM, et al. The Manual Ability Classification System (MACS) for children with cerebral palsy: Scale development and evidence of validity and reliability. Developmental Medicine and Child Neurology. 2006; 48(7):549-54. doi: 10.1017/S0012162206001162 [DOI]
19. Bohannon RW, Smith MB. Interrater reliability of a Modified Ashworth Scale of muscle spasticity. Physical Therapy. 1987; 67(2):206-7. PMID: 3809245 [PubMed]
20. Park EJ, Baek SH, Park S. Systematic review of the effects of mirror therapy in children with cerebral palsy. Journal of Physical Therapy Science. 2016; 28(11):3227-31. doi: 10.1589/jpts.28.3227 [DOI]
21. Gygax MJ, Schneider P, Newman CJ. Mirror therapy in children with hemiplegia: A pilot study. Developmental Medicine & Child Neurology. 2011; 53(5):473-6. doi: 10.1111/j.1469-8749.2011.03924.x [DOI]
22. Grunt S, Newman CJ, Saxer S, Steinlin M, Weisstanner C, Kaelin-Lang A. The mirror illusion increases motor cortex excitability in children with and without hemiparesis. Neurorehabilitation and Neural Repair. 2017; 31(3):280-9. doi: 10.1177/1545968316680483 [DOI]
23. Smorenburg AR, Ledebt A, Deconinck FJ, Savelsbergh GJ. Practicing a matching movement with a mirror in individuals with spastic hemiplegia. Research in Developmental Disabilities. 2013; 34(9):2507-13. doi: 10.1016/j.ridd.2013.05.001 [DOI]
24. Bruchez R, Jequier Gygax M, Roches S, Fluss J, Jacquier D, Ballabeni P, et al. Mirror therapy in children with hemiparesis: a randomized observer‐blinded trial. Developmental Medicine & Child Neurology. 2016; 58(9):970-8. doi: 10.1111/dmcn.13117 [DOI]

via Effect of Mirror Therapy on Upper Limb Function: A Single Subject Study – Iranian Rehabilitation Journal

, , , , , , , ,

Leave a comment

[ARTICLE] Including a Lower-Extremity Component during Hand-Arm Bimanual Intensive Training does not Attenuate Improvements of the Upper Extremities: A Retrospective Study of Randomized Trials – Full Text

Hand-Arm Bimanual Intensive Therapy (HABIT) promotes hand function using intensive practice of bimanual functional and play tasks. This intervention has shown to be efficacious to improve upper-extremity (UE) function in children with unilateral spastic cerebral palsy (USCP). In addition to UE function deficits, lower-extremity (LE) function and UE–LE coordination are also impaired in children with USCP. Recently, a new intervention has been introduced in which the LE is simultaneously engaged during HABIT (Hand-Arm Bimanual Intensive Therapy Including Lower Extremities; HABIT-ILE). Positive effects of this therapy have been demonstrated for both the UE and LE function in children with USCP. However, it is unknown whether the addition of this constant LE component during a bimanual intensive therapy attenuates UE improvements observed in children with USCP. This retrospective study, based on multiple randomized protocols, aims to compare the UE function improvements in children with USCP after HABIT or HABIT-ILE. This study included 86 children with USCP who received 90 h of either HABIT (n = 42) or HABIT-ILE (n = 44) as participants in previous studies. Children were assessed before, after, and 4–6 months after intervention. Primary outcomes were the ABILHAND-Kids and the Assisting Hand Assessment. Secondary measures included the Jebsen-Taylor Test of Hand Function, the Pediatric Evaluation of Disability Inventory [(PEDI); only the self-care functional ability domain] and the Canadian Occupational Performance Measure (COPM). Data analysis was performed using two-way repeated-measures analysis of variance with repeated measures on test sessions. Both groups showed similar, significant improvements for all tests (test session effect p < 0.001; group × test session interaction p > 0.05) except the PEDI and COPM. Larger improvements on these tests were found for the HABIT-ILE group (test session effect p < 0.001; group × test session interaction p < 0.05). These larger improvements may be explained by the constant simultaneous UE–LE engagement observed during the HABIT-ILE intervention since many daily living activities included in the PEDI and the COPM goals involve the LE and, more specifically, UE–LE coordination. We conclude that UE improvements in children with USCP are not attenuated by simultaneous UE–LE engagement during intensive intervention. In addition, systematic LE engagement during bimanual intensive intervention (HABIT-ILE) leads to larger functional improvements in activities of daily living involving the LE.

Introduction

Cerebral palsy (CP) is the most common cause of pediatric motor disability with a prevalence ranging from 2 to 3.6 out of 1,000 children in western countries (12). Motor disorders are often accompanied by sensation, perception, cognition, behavior, communication, and epilepsy disorders (1). Although the lesions are established from birth and are non-progressive, the motor impairments experienced by children with CP affect their autonomy and functional outcomes during their life-span. Moreover, motor symptoms such as impaired ability to walk may worsen during development (3).

One of the most disabling long-term functional deficits in children with unilateral spastic cerebral palsy (USCP) is impaired manual dexterity, i.e., impaired skilled hand movements and precision grip abilities (4). Upper-extremity (UE) impairments may affect functional independence, especially for activities of daily living requiring bimanual coordination (e.g., buttoning one’s shirt). It is now well known that intensive interventions based on motor skill learning principles and goal-directed training are effective for improving UE function in children with USCP (5). Constraint-Induced Movement Therapy (CIMT) was the first intensive intervention adapted to children with USCP (6). CIMT was first designed for adults with stroke and subsequently adapted to children with USCP showing improvements in hand function (5). Taking advantage of the key ingredient of CIMT (intensive practice with the affected UE), Charles and Gordon developed an alternative intensive bimanual approach termed “Hand-Arm Bimanual Intensive Therapy” (HABIT) (7). HABIT was developed with recognition that the combined use of both hands was necessary to increase functional independence in children with USCP (7). Focusing on improving bimanual coordination through structured play and functional activities during HABIT demonstrated efficacy to improve UE function in children with USCP (5).

Both HABIT and CIMT focus only on the UE of children with USCP. Though the lower extremity (LE) is generally less affected than UE in children with USCP, impairments observed in the affected LE range from an isolated equine ankle to hip flexion and adduction with a fixed knee (8). Children with USCP are then unable to achieve postural symmetry while standing, systematically presenting with an overload on one bodyside (8). They also frequently encounter limitations in walking abilities (3). Besides the LE impairments, UE–LE coordination is often impaired in children with USCP (910). This coordination is frequently used in daily living activities (e.g., walking while carrying an object in the hand, climbing stairs while using the railing). A program that simultaneously trains the UE and LE in children with USCP is thus of interest since the UE impairments in children with CP remain stable through time (11) while walking and other LE abilities may decline during development (3). In 2014, taking advantage of the key ingredients in HABIT (intensive bimanual practice), Bleyenheuft and Gordon developed a new intervention focusing on both the UE and LE entitled “Hand-Arm Bimanual Intensive Therapy Including Lower Extremities” (HABIT-ILE) (12). Positive effects of this therapy focusing on both the UE and LE through structured play and functional activities have been demonstrated both for the UE and the LE of children with USCP (13) as well as, more recently, for children with bilateral CP (14). However, it is unknown whether the introduction of a systematic LE engagement in addition to a bimanual intervention may lead to attenuated improvements in UE compared to traditional HABIT due to shifts in attention (multitasking). This retrospective study aimed to compare changes in the UE of children with USCP undergoing 90 h of intensive bimanual intervention either with (HABIT-ILE) or without (HABIT) a LE component. We hypothesized that the introduction of systematic LE training simultaneously added to the bimanual training would lead to reduced improvements in the UE during HABIT-ILE compared to traditional HABIT. […]

Continue —> Frontiers | Including a Lower-Extremity Component during Hand-Arm Bimanual Intensive Training does not Attenuate Improvements of the Upper Extremities: A Retrospective Study of Randomized Trials | Neurology

, , , , , , ,

Leave a comment

[Abstract+References] Wearable Rehabilitation Training System for Upper Limbs Based on Virtual Reality – Conference paper

Abstract

In this paper, wearable rehabilitation training system for the upper limb based on virtual reality is designed for patients with upper extremity hemiparesis. The six-axis IMU sensor is used to collect the joint training angles of the shoulder and elbow. In view of the patient’s shoulder and elbow joint active rehabilitation training, the virtual rehabilitation training games based on the Unity3D engine are designed to complete different tasks. Its purpose is to increase the interest of rehabilitation training. The data obtained from the experiment showed that the movement ranges of the shoulder and elbow joint reached the required ranges in the rehabilitation training game. The basic function of the system is verified by the experiments, which can provide effective rehabilitation training for patients with upper extremity hemiparesis.

References

 

 

1.
Liang, M., Dou, Z.L., Wang, Q.H.: Application of virtual reality technique in rehabilitation of hemiplegic upper extremities function of stroke patients. Chin. J. Rehabil. Med. 02, 114–118 (2013)Google Scholar

 

2.
Valencia, N., Cardoso, V., Frizera, A.: Serious Game for Post-stroke Upper Limb Rehabilitation. Converging Clinical and Engineering Research on Neurorehabilitation II. Springer, Berlin (2017)Google Scholar

 

3.
Lei, Y., Yu, H.L., Wang, L.L., Wang, Z.P.: Research on virtual reality-based interactive upper-limb rehabilitation training system. Prog. Biomed. Eng. 36(1), 21–24 (2015)Google Scholar

 

4.
Xu, B.G., Peng, S., Song, A.G.: Upper-limb rehabilitation robot based on motor imagery EEG. Robot 33(3), 307–313 (2011)CrossRefGoogle Scholar

 

5.
Wang, H.T.: Status of Application of Virtual Reality Technique in Motor Rehabilitation in Stroke. Chin. J. Rehabil. Theory Pract. 10, 911–915 (2014)Google Scholar

 

6.
Zhang, J.L.: Research of Finger Rehabilitation System Based on Virtual Reality Technology. Huazhong University of Science and Technology (2012)Google Scholar

 

7.
Mei, Z., He, L.W., Wu, L., Jian, Z.: Design and test of a portable exoskeleton elbow rehabilitation training device. Chin. J. Rehabil. Med. 11, 1155–1157 (2015)Google Scholar

 

8.
Mazzone, B., Haubert, L.L., Mulroy, S.: Intensity of shoulder muscle activation during resistive exercises performed with and without virtual reality games. In: International Conference on Virtual Rehabilitation, pp. 127–133. IEEE (2013)Google Scholar

 

9.
Fischer, H.C., Stubblefield, K., Kline, T.: Hand rehabilitation following stroke: a pilot study of assisted finger extension training in a virtual environment. Topics Stroke Rehabil. 14(1), 1–12 (2014)CrossRefGoogle Scholar

 

10.
Kapandji, A.I.: The Physiology of the Joints, 6th edn. People’s Military Medical Press, Beijing (2011)Google Scholar

 

11.
Gu, Y., Tian, L.H., Chen, H.: Application of virtual reality training system and rehabilitation therapy in the treatment in hemiplegic patients with upper limb dysfunction. Chin. J. Rehabil. Med. 26(6), 579–581 (2011)Google Scholar

Source: Wearable Rehabilitation Training System for Upper Limbs Based on Virtual Reality | SpringerLink

, , , , , , , , ,

Leave a comment

[Abstract] Electrically Assisted Movement Therapy in Chronic Stroke Patients With Severe Upper Limb Paresis: A Pilot, Single-Blind, Randomized Crossover Study

 

Abstract

Objective

To evaluate the effects of electrically assisted movement therapy (EAMT) in which patients use functional electrical stimulation, modulated by a custom device controlled through the patient’s unaffected hand, to produce or assist task-specific upper limb movements, which enables them to engage in intensive goal-oriented training.

Design

Randomized, crossover, assessor-blinded, 5-week trial with follow-up at 18 weeks.

Setting

Rehabilitation university hospital.

Participants

Patients with chronic, severe stroke (N=11; mean age, 47.9y) more than 6 months poststroke (mean time since event, 46.3mo).

Interventions

Both EAMT and the control intervention (dose-matched, goal-oriented standard care) consisted of 10 sessions of 90 minutes per day, 5 sessions per week, for 2 weeks. After the first 10 sessions, group allocation was crossed over, and patients received a 1-week therapy break before receiving the new treatment.

Main Outcome Measures

Fugl-Meyer Motor Assessment for the Upper Extremity, Wolf Motor Function Test, spasticity, and 28-item Motor Activity Log.

Results

Forty-four individuals were recruited, of whom 11 were eligible and participated. Five patients received the experimental treatment before standard care, and 6 received standard care before the experimental treatment. EAMT produced higher improvements in the Fugl-Meyer scale than standard care (P<.05). Median improvements were 6.5 Fugl-Meyer points and 1 Fugl-Meyer point after the experimental treatment and standard care, respectively. The improvement was also significant in subjective reports of quality of movement and amount of use of the affected limb during activities of daily living (P<.05).

Conclusions

EAMT produces a clinically important impairment reduction in stroke patients with chronic, severe upper limb paresis.

Source: Electrically Assisted Movement Therapy in Chronic Stroke Patients With Severe Upper Limb Paresis: A Pilot, Single-Blind, Randomized Crossover Study – Archives of Physical Medicine and Rehabilitation

, , , , , , ,

Leave a comment

[ARTICLE] Design and test of an automated version of the modified Jebsen test of hand function using Microsoft Kinect – Full Text

Abstract

Background

The present paper describes the design and evaluation of an automated version of the Modified Jebsen Test of Hand Function (MJT) based on the Microsoft Kinect sensor.

Methods

The MJT was administered twice to 11 chronic stroke subjects with varying degrees of hand function deficits. The test times of the MJT were evaluated manually by a therapist using a stopwatch, and automatically using the Microsoft Kinect sensor. The ground truth times were assessed based on inspection of the video-recordings. The agreement between the methods was evaluated along with the test-retest performance.

Results

The results from Bland-Altman analysis showed better agreement between the ground truth times and the automatic MJT time evaluations compared to the agreement between the ground truth times and the times estimated by the therapist. The results from the test-retest performance showed that the subjects significantly improved their performance in several subtests of the MJT, indicating a practice effect.

Conclusions

The results from the test showed that the Kinect can be used for automating the MJT.

Background

Deficits in motor function, in the form of hemiparesis or hemiplegia, are a frequent consequence of cerebral stroke [1]. Even though motor function may be regained to some extent through intensive rehabilitative training following acute treatment of stroke, deficits in hand function often remain [23]. Following discharge from the rehabilitation unit, patients are typically asked to perform unsupervised self-training in their own home. The lack of supervision during training at home will likely have an impact on the patient’s training compliance and training quality. Therefore, it is important to perform regular evaluations of the patient’s functional level in order to provide useful supervision and to maintain patient motivation. The patients’ performance in a specific motor function test provides valuable insight into whether the training scheme chosen for a patient is effective or it should be changed. Thus, it is very important that the motor function tests being used are objective and reflect the actual functional level of the patient being tested. Several validated motor function tests including assessment of hand function exist, e.g. Jebsen Test of Hand Function [4], Action Research Arm Test [5], Fugl-Meyer Assessment [6], Wolf Motor Function Test (WMFT) [7], Box and Blocks Test [8] and Nine Hole Peg Test [9]. Common for all these tests is that they must be administered by a therapist, which might be a source for variability in the test results, and cause the test results not always to be completely reproducible and objective. In tests including performance time as an outcome measure, e.g. the WMFT, the reaction time of the subject could introduce a bias to the results, as suggested by previous studies [1011]. Likewise, the end time of the test would likely be subjected to a bias, since the examiner has a finite reaction time. Thus, both the reaction time of the examiner and the subject could be potential sources of bias and variability in timed motor function tests. The sensitivity of a motor function test is affected by sources of bias and variability and therefore it is of interest to minimize these, to make detection of even small changes possible.

By automating motor function tests, the objectivity of the tests would be increased. This might also make possible to use the tests at remote sites, without direct supervision, as a part of a tele-rehabilitation service. Finally, automated tests could be administered more frequently. Previous studies have shown that selected parts of the WMFT can be automated by use of motion sensors mounted on the body of healthy subjects [10] and stroke patients [11]. Both systems automated the test by analyzing three-dimensional kinematics data from body-worn sensors (inertial measurement units) mounted on the most affected wrist, arm and shoulder of stroke patients [1011]. Similarly, using inertial measurement unit sensors, Yang et al. (2013) showed that when administering the 10 m walking test, the output from their system was in close agreement with the walking speeds estimated using a stop-watch [12]. These systems require though correct positioning and mounting of the motion sensors [10]. Huang et al. (2012) showed that also a computer vision based approach, consisting of a monitor camera and a Xilinx Virtex II Pro Field Programmable Gate Array (for computation), may be used for automating the WMFT. All participants being tested had to wear a black sweatband on the wrist of the extremity being tested [13]. Another low-price method for capturing the movements of a patient performing a motor function test is the Microsoft Kinect sensor (Kinect). By using a Kinect, the need for body mounted sensors is eliminated, thus lowering the susceptibility to data loss and easing donning and doffing of the system. Furthermore, the Microsoft Kinect sensor is a low-cost commercially available device. In this paper, we describe the design and test of a Kinect based system for automatic evaluation of a standardized, validated motor function test, administered to stroke patients with hand function deficits. The Modified Jebsen Test of Hand Function (MJT) [14], initially proposed by Bovend’Eerdt et al. (2004) as a test for assessment of gross functional dexterity in stroke patients, was selected for automation as this test is easy to administer and takes short time to complete.

Continue —> Design and test of an automated version of the modified Jebsen test of hand function using Microsoft Kinect | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 3 The edge of the table was detected in the binary image (lower) produced by thresholding the depth image (upper) into two parts, one part containing all pixels with a depth value lower than a depth level of 300 mm below the surface of the table and the other part containing pixels with depth values above this threshold

, , , , , , , , , , , ,

Leave a comment

[Abstract] Electrically Assisted Movement Therapy in Chronic Stroke Patients With Severe Upper Limb Paresis: A Pilot, Single-Blind, Randomized Crossover Study  

Abstract

Objective

To evaluate the effects of electrically assisted movement therapy (EAMT) in which patients use functional electrical stimulation, modulated by a custom device controlled through the patient’s unaffected hand, to produce or assist task-specific upper limb movements, which enables them to engage in intensive goal-oriented training.

Design

Randomized, crossover, assessor-blinded, 5-week trial with follow-up at 18 weeks.

Setting

Rehabilitation university hospital.

Participants

Patients with chronic, severe stroke (N=11; mean age, 47.9y) more than 6 months poststroke (mean time since event, 46.3mo).

Interventions

Both EAMT and the control intervention (dose-matched, goal-oriented standard care) consisted of 10 sessions of 90 minutes per day, 5 sessions per week, for 2 weeks. After the first 10 sessions, group allocation was crossed over, and patients received a 1-week therapy break before receiving the new treatment.

Main Outcome Measures

Fugl-Meyer Motor Assessment for the Upper Extremity, Wolf Motor Function Test, spasticity, and 28-item Motor Activity Log.

Results

Forty-four individuals were recruited, of whom 11 were eligible and participated. Five patients received the experimental treatment before standard care, and 6 received standard care before the experimental treatment. EAMT produced higher improvements in the Fugl-Meyer scale than standard care (P<.05). Median improvements were 6.5 Fugl-Meyer points and 1 Fugl-Meyer point after the experimental treatment and standard care, respectively. The improvement was also significant in subjective reports of quality of movement and amount of use of the affected limb during activities of daily living (P<.05).

Conclusions

EAMT produces a clinically important impairment reduction in stroke patients with chronic, severe upper limb paresis.

Source: Electrically Assisted Movement Therapy in Chronic Stroke Patients With Severe Upper Limb Paresis: A Pilot, Single-Blind, Randomized Crossover Study – Archives of Physical Medicine and Rehabilitation

, , , , , , , , , , , ,

Leave a comment

%d bloggers like this: