Posts Tagged hemiplegic
[ARTICLE] Usability engineering in the design and evaluation of a functional electrical stimulation system for upper limb rehabilitation – University of Salford Institutional Repository
Chronic physical impairment of the hemiplegic upper limb (UL) is seen in an estimated 50-70% of stroke patients, who place a high priority on regaining upper limb function. Current therapy is insufficiently intensive, often not task-oriented and hence poorly aligned with the evidence base.
Functional electrical stimulation (FES) has the potential to not only increase the intensity of task-focused therapy, but also provide certain unique features, notably direct excitation of lower motor neurons. However, current FES systems are limited in their functionality and/or difficult to use. Systems are also poorly aligned to therapists’ ways of working and uptake remains limited.
To address these problems, a novel FES technology (UL FES Rehab Tool) has been developed. The control system design is reported in Sun, (2014). The aims of my thesis were to:
- 1) design a Graphical User Interface (GUI) that would enable therapists to quickly and easily set up an individually tailored library of FES tasks for each patient;
- 2) evaluate the usability and functionality of the UL FES Rehab Tool (software and hardware) in both laboratory (lab) and clinical settings.
An iterative, mixed methods, five-phase usability engineering approach was used to design and evaluate the UL FES Rehab Tool. Phases one to three incorporated identification of therapists’ requirements, a user ‘assisted walkthrough’ of the software with expert and novice FES users and ‘rapid prototyping’ of the full system, using healthy participants. Further usability testing of the software & hardware was conducted in phase four with 1 physiotherapist and 6 patients, (total of 24 visits), in the chronic stage post-stroke. The work demonstrated in detail, for the first time, the impact of therapist involvement in the design of novel rehabilitation technology.
To address therapists’ focus on setup time, using the phase four data set, a novel model to predict setup time was devised. This model was able to explain 51% of the variance in setup time based on two parameters, task complexity and patient impairment. Finally, in phase five, a summative usability evaluation of the final prototype was carried out in 2 sub-acute stroke units. Four therapists and 1 rehabilitation assistant used the UL FES Rehab Tool with 6 patients in the acute stage post-stroke. The UL FES Rehab Tool enabled all therapists and one therapy assistant to effectively deliver FES assisted upper limb task-oriented therapy to a range of stroke patients (Fugl-Meyer scores 8–65). The usability methods effectively captured objective and subjective feedback from therapists and patients. However the previous setup time model was unable to predict setup time, suggesting other factors were important in a clinical setting.
Although participant numbers were low, the results suggested therapists’ predisposition to using technology and post-training confidence in using the technology may influence their willingness to engage with novel rehabilitation technologies.
This study is the first to describe in detail the impact of a usability engineering approach on the design of a complex upper limb rehabilitation technology from early stage design to clinical evaluation. These methods can be generalised to other studies seeking to explore the usability of new forms of rehabilitation technologies.
[ARTICLE] The effects of a progressive resistance training program on walking ability in patients after stroke: a pilot study – Full Text PDF
[Purpose] The purpose of this study was to evaluate the effects of a progressive resistance training (PRT) program on the walking ability of chronic stroke patients with hemiparesis following chronic stroke.
[Subjects and Methods] The participants of this study were fifteen hemiplegic patients. The main outcomes measured for this study were the peak torque of the knee extensor; the gait ability as measured by electric gait analysis of walking speed, walking cycle, affected side stance phase, affected side stride length, symmetry index of stance phase, and symmetry index of stride length; and 10-m walking speed; and the Berg balance scale test.
[Results] Walking speed and affected side stride length significantly increased after the PRT program, and 10-m walking time significantly decreased after RPT in stroke patients.
[Conclusion] These results suggest that the progressive resistance training program may, in part, improve the stride of the affected side leg of stroke patients after stroke and also positively impact walking speed.
To compare the effectiveness of constraint induced movement therapy versus motor relearning programme to improve motor function of hemiplegic upper extremity after stroke – Full Text PDF
Objective: To compare the effectiveness of constraint induced movement therapy versus motor relearning programme to improve motor function of hemiplegic upper extremity after stroke.
Method: A sample of 42 patients was recruited from the Physiotherapy Department of IPM&R and Neurology OPD of Civil Hospital Karachi through non probability purposive sampling technique. Twenty one patients were placed to each experimental and control groups. Experimental group was treated with Constraint Induced Movement Therapy (CIMT) and control group was treated with motor relearning programme (MRP) for three consecutive weeks. Pre and post treatment measurements were determined by upper arm section of Motor Assessment Scale (MAS) and Self Care item of Functional Independence Measure (FIM) Scale.
Results: Intra group analysis showed statistically significant results (p-value<0.05) in all items of MAS in both groups. However, advanced hand activities item of MAS in MRP group showed insignificant result (p-value=0.059). Self-care items of FIM Scale also showed significant result (p-value< 0.05) in both groups except dressing upper body item (p-value=0.059) in CIMT group and grooming and dressing upper body items (p-value=0.059 & 0.063) in MRP group showed insignificant p-values.
Conclusion: CIMT group showed more significant improvement in motor function and self-care performance of hemiplegic upper extremity as compared to MRP group in patients with sub-acute stroke assessed by the MAS and FIM scales. Thus CIMT is proved to be more statistically significant and clinically effective intervention in comparison to motor relearning programme among the patients aged between 35-60 years. Further studies are needed to evaluate CIMT effects in acute and chronic post stroke population.
Full Text: PDF
Source: To compare the effectiveness of constraint induced movementtherapy versus motor relearning programme to improve motor function of hemiplegic upper extremity after stroke | Batool | Pakistan Journal of Medical Sciences
[ARTICLE] Research of rehabilitation aid system by DOF constraintable mechanism and NMES for hemiplegic upper limbs
In this paper, rehabilitation aid system by selectable DOF constraintable mechanism and NMES (Neuromuscular Electrical Stimulation) for hemiplegic upper limbs was developed. By using this mechanism, it became possible to separate synergic movement while flexion-extension training of shoulder and elbow by constraining each individual joints. As the clinical trial result by using this mechanism and NMES, the shoulder-elbow UE-FMA sub-scores improved significantly.
In this research, NMES timing control system and quantitative evaluation method for sensing the flexion-extension movement of the elbow and shoulder joints are proposed.
Background: The stroke population needing physical rehabilitation of the upper extremity is constantly increasing. To solve this problem, robot devices for improving motor performance are developed to assist physical rehabilitation in Korea. The aim of this study was to develop the robot-assisted wrist training system and to apply this to the chronic hemiplegic stroke participants.
Methods: Bilateral wrist robotic device was developed and we applied this to four chronic hemiplegic stroke participants. Robot-assisted wrist training system was assessed by Hand grip force, Medical Research Council, Range of motion, Upper extremity Fugl-Meyer Assessment, and Motor Activity Log. In addition, we measured functional magnetic Resonance Imaging (fMRI) analysis for cortical reorganization during both hand movement. Participants received 60 min, 20 sessions, five days a week, for four consecutive weeks. The assessments were done before and after 20 training sessions
Results: Robot-assisted wrist training system was built with the bilateral wrist flexion/extension and pronation/supination performance that provides a repetitive active-active, active-passive, and passive-passive mode. Muscle strength, Motion of wrist, and motor function were enhanced after 4-week training of wrist. And the cortical activity change was associated with inducing reorganization of motor cortex networks
Conclusion: We developed bilateral wrist robotic device and robot-assisted wrist training system. Robot-assisted wrist training system showed improvement of upper limb function after training of wrist. Our system might be efficient robot-assisted wrist training for improving muscle strength, motor performance, and cortical reorganization in patients with chronic hemiplegic stroke and contribute to the development of translational research in rehabilitation robot.