Posts Tagged home-based

[ARTICLE] EMG based FES for post-stroke rehabilitation – Full Text

Abstract.

Annually, 15 million in world population experiences stroke. Nearly 9 million stroke
survivors every year experience mild to severe disability. The loss of upper extremity function in stroke survivors still remains a major rehabilitation challenge. The proposed EMG based FES system can be used for effective upper limb motor re-education in post stroke upper limb rehabilitation. The  governing feature of the designed system is its synchronous activation, in which the FES stimulation is dependent on the amplitude of the EMG signal acquired from the unaffected upper limb muscle of the hemiplegic patient. This proportionate operation eliminates the undesirable  damage to the patient’s skin by generating stimulus in proportion to voluntary EMG signals. This feature overcomes the disadvantages of currently available manual motor re-education systems. This model can be used in home-based post stroke rehabilitation, to effectively improve the upper limb functions.

[…]

Download Full Text PDF

Available from: https://www.researchgate.net/publication/321478935_EMG_based_FES_for_post-stroke_rehabilitation [accessed Dec 09 2017].

 

Advertisements

, , , , , , , , ,

Leave a comment

[Abstract+References] A Home-Based Telerehabilitation Program for Patients With Stroke 

Background. Although rehabilitation therapy is commonly provided after stroke, many patients do not derive maximal benefit because of access, cost, and compliance. A telerehabilitation-based program may overcome these barriers. We designed, then evaluated a home-based telerehabilitation system in patients with chronic hemiparetic stroke. Methods. Patients were 3 to 24 months poststroke with stable arm motor deficits. Each received 28 days of telerehabilitation using a system delivered to their home. Each day consisted of 1 structured hour focused on individualized exercises and games, stroke education, and an hour of free play. Results. Enrollees (n = 12) had baseline Fugl-Meyer (FM) scores of 39 ± 12 (mean ± SD). Compliance was excellent: participants engaged in therapy on 329/336 (97.9%) assigned days. Arm repetitions across the 28 days averaged 24,607 ± 9934 per participant. Arm motor status showed significant gains (FM change 4.8 ± 3.8 points, P = .0015), with half of the participants exceeding the minimal clinically important difference. Although scores on tests of computer literacy declined with age (r = −0.92; P < .0001), neither the motor gains nor the amount of system use varied with computer literacy. Daily stroke education via the telerehabilitation system was associated with a 39% increase in stroke prevention knowledge (P = .0007). Depression scores obtained in person correlated with scores obtained via the telerehabilitation system 16 days later (r = 0.88; P = .0001). In-person blood pressure values closely matched those obtained via this system (r = 0.99; P < .0001). Conclusions. This home-based system was effective in providing telerehabilitation, education, and secondary stroke prevention to participants. Use of a computer-based interface offers many opportunities to monitor and improve the health of patients after stroke.

1. Winstein CJStein JArena R, . Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016;47:e98e169Google Scholar CrossrefMedline
2. Lang CEMacdonald JRReisman DS, . Observation of amounts of movement practice provided during stroke rehabilitation. Arch Phys Med Rehabil. 2009;90:16921698Google Scholar CrossrefMedline
3. Bernhardt JChan JNicola ICollier JM. Little therapy, little physical activity: rehabilitation within the first 14 days of organized stroke unit care. J Rehabil Med. 2007;39:4348Google Scholar CrossrefMedline
4. Kimberley TJSamargia SMoore LGShakya JKLang CE. Comparison of amounts and types of practice during rehabilitation for traumatic brain injury and stroke. J Rehabil Res Dev. 2010;47:851862Google Scholar CrossrefMedline
5. Laver KESchoene DCrotty MGeorge SLannin NASherrington C. Telerehabilitation services for stroke. Cochrane Database Syst Rev. 2013;(12):CD010255Google Scholar Medline
6. Agostini MMoja LBanzi R, . Telerehabilitation and recovery of motor function: a systematic review and meta-analysis. J Telemed Telecare. 2015;21:202213Google Scholar Link
7. Brennan DTindall LTheodoros D, . A blueprint for telerehabilitation guidelines. Int J Telerehabil. 2010;2:3134Google Scholar CrossrefMedline
8. Demiris GShigaki CLSchopp LH. An evaluation framework for a rural home-based telerehabilitation network. J Med Syst. 2005;29:595603Google Scholar CrossrefMedline
9. Bayley MTHurdowar ATeasell R, . Priorities for stroke rehabilitation and research: results of a 2003 Canadian Stroke Network consensus conference. Arch Phys Med Rehabil. 2007;88:526528Google Scholar CrossrefMedline
10. Wolf SLWinstein CJMiller JP, . Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA. 2006;296:20952104Google Scholar CrossrefMedline
11. Wu JQuinlan EBDodakian L, . Connectivity measures are robust biomarkers of cortical function and plasticity after stroke. Brain. 2015;138(pt 8):23592369Google Scholar CrossrefMedline
12. Jimison HGorman PWoods S, . Barriers and Drivers of Health Information Technology Use for the Elderly, Chronically Ill, and Underserved. Rockville, MDAgency for Healthcare Research and Quality2008. Evidence Report/Technology Assessment No. 175. AHRQ Publication No. 09-E004. Google Scholar
13. Woldag HHummelsheim H. Evidence-based physiotherapeutic concepts for improving arm and hand function in stroke patients: a review. J Neurol. 2002;249:518528Google Scholar CrossrefMedline
14. Takahashi CDDer-Yeghiaian LLe VMotiwala RRCramer SC. Robot-based hand motor therapy after stroke. Brain. 2008;131(pt 2):425437Google Scholar CrossrefMedline
15. Kleim JAJones TA. Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. J Speech Lang Hear Res. 2008;51:S225S239Google Scholar CrossrefMedline
16. Cramer SCSur MDobkin BH, . Harnessing neuroplasticity for clinical applications. Brain. 2011;134(pt 6):15911609Google Scholar CrossrefMedline
17. Cramer SCRepairing the human brain after stroke: I. Mechanisms of spontaneous recovery. Ann Neurol. 2008;63:272287Google Scholar CrossrefMedline
18. Dobkin BHDorsch A. The promise of mHealth: daily activity monitoring and outcome assessments by wearable sensors. Neurorehabil Neural Repair. 2011;25:788798Google Scholar Link
19. See JDodakian LChou C, . A standardized approach to the Fugl-Meyer assessment and its implications for clinical trials. Neurorehabil Neural Repair. 2013;27:732741Google Scholar Link
20. Mackay JCharles STKemp BHeckhausen J. Goal striving and maladaptive coping in adults living with spinal cord injury: associations with affective well-being. J Aging Health. 2011;23:158176Google Scholar Link
21. Sherbourne CDStewart AL. The MOS social support survey. Soc Sci Med. 1991;32:705714Google Scholar CrossrefMedline
22. Lewis SCDennis MSO’Rourke SJSharpe M. Negative attitudes among short-term stroke survivors predict worse long-term survival. Stroke. 2001;32:16401645Google Scholar CrossrefMedline
23. Williams LSWeinberger MHarris LEClark DOBiller J. Development of a stroke-specific quality of life scale. Stroke. 1999;30:13621369Google Scholar CrossrefMedline
24. Bunz U. The Computer-Email-Web (CEW) Fluency Scale: development and validation. Int J Hum Comput Interact. 2004;17:479506Google Scholar Crossref
25. Duncan PWallace DLai SJohnson DEmbretson SLaster L. The Stroke Impact Scale version 2.0: evaluation of reliability, validity, and sensitivity to change. Stroke. 1999;30:21312140Google Scholar CrossrefMedline
26. Jones FPartridge CReid F. The Stroke Self-Efficacy Questionnaire: measuring individual confidence in functional performance after stroke. J Clin Nurs. 2008;17(7B):244252Google Scholar CrossrefMedline
27. Zondervan DKFriedman NChang E, . Home-based hand rehabilitation after chronic stroke: Randomized, controlled single-blind trial comparing the MusicGlove with a conventional exercise program. J Rehabil Res Dev. 2016;53:457472Google Scholar CrossrefMedline
28. Page SJFulk GDBoyne P. Clinically important differences for the upper-extremity Fugl-Meyer Scale in people with minimal to moderate impairment due to chronic stroke. Phys Ther. 2012;92:791798Google Scholar CrossrefMedline
29. van der Lee JBeckerman HLankhorst GBouter LThe responsiveness of the Action Research Arm test and the Fugl-Meyer Assessment scale in chronic stroke patients. J Rehabil Med. 2001;33:110113Google Scholar CrossrefMedline
30. Baranowski TBuday RThompson DIBaranowski J. Playing for real: video games and stories for health-related behavior change. Am J Prev Med. 2008;34:7482Google Scholar CrossrefMedline
31. Brox EFernandez-Luque LTøllefsen T. Healthy gaming—video game design to promote health. Appl Clin Inform. 2011;2:128142Google Scholar CrossrefMedline
32. Lieberman D. Designing serious games for learning and health in informal and formal settings. In: Ritterfeld MVorderer P eds. Serious Games: Mechanisms and Effects. New York, NYRouteledge; 2009:117130Google Scholar
33. Chou Y. Actionable Gamification—Beyond Points, Badges, and Leaderboards. Fremont, CAOctalysis Media2015Google Scholar
34. Winstein CJMiller JPBlanton S, . Methods for a multisite randomized trial to investigate the effect of constraint-induced movement therapy in improving upper extremity function among adults recovering from a cerebrovascular stroke. Neurorehabil Neural Repair. 2003;17:137152Google Scholar Link
35. Sluijs EMKok GJvan der Zee J. Correlates of exercise compliance in physical therapy. Phys Ther. 1993;73:771782; discussion 783-786. Google Scholar CrossrefMedline
36. Miller KKPorter REDeBaun-Sprague EVan Puymbroeck MSchmid AA. Exercise after stroke: patient adherence and beliefs after discharge from rehabilitation. Top Stroke Rehabil. 2017;24:142148Google Scholar CrossrefMedline
37. McCabe JMonkiewicz MHolcomb JPundik SDaly JJ. Comparison of robotics, functional electrical stimulation, and motor learning methods for treatment of persistent upper extremity dysfunction after stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2015;96:981990Google Scholar CrossrefMedline
38. Griffith V. A Stroke in the Family. New York, NYDelacorte Press1970Google Scholar
39. Herrmann NSeitz DFischer H, . Detection and treatment of post stroke depression: results from the registry of the Canadian stroke network. Int J Geriatr Psychiatry. 2011;26:11951200Google Scholar Medline
40. Kothari RSauerbeck LJauch E, . Patients’ awareness of stroke signs, symptoms, and risk factors. Stroke. 1997;28:18711875Google Scholar CrossrefMedline
41. Zerwic JHwang SYTucco L. Interpretation of symptoms and delay in seeking treatment by patients who have had a stroke: exploratory study. Heart Lung. 2007;36:2534Google Scholar CrossrefMedline
42. Qureshi AISuri MFGuterman LRHopkins LN. Ineffective secondary prevention in survivors of cardiovascular events in the US population: report from the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2001;161:16211628Google Scholar CrossrefMedline
43. Putrino D. Telerehabilitation and emerging virtual reality approaches to stroke rehabilitation. Curr Opin Neurol. 2014;27:631636Google Scholar CrossrefMedline
44. Chen JJin WZhang XXu WLiu X-NRen C-C. Telerehabilitation approaches for stroke patients: systematic review and meta-analysis of randomized controlled trials. J Stroke Cerebrovasc Dis. 2015;24:26602668Google Scholar CrossrefMedline
45. Nakayama HJorgensen HRaaschou HOlsen T. Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study. Arch Phys Med Rehabil. 1994;75:394398Google ScholarCrossrefMedline
46. Ottenbacher KJSmith PMIllig SBLinn RTOstir GVGranger CV. Trends in length of stay, living setting, functional outcome, and mortality following medical rehabilitation. JAMA. 2004;292:16871695Google Scholar CrossrefMedline
47. Tong XKuklina EVGillespie CGeorge MG. Medical complications among hospitalizations for ischemic stroke in the United States from 1998 to 2007. Stroke. 2010;41:980986Google ScholarCrossrefMedline

Source: A Home-Based Telerehabilitation Program for Patients With StrokeNeurorehabilitation and Neural Repair – Lucy Dodakian, Alison L. McKenzie, Vu Le, Jill See, Kristin Pearson-Fuhrhop, Erin Burke Quinlan, Robert J. Zhou, Renee Augsberger, Xuan A. Tran, Nizan Friedman, David J. Reinkensmeyer, Steven C. Cramer, 2017

, , , , ,

Leave a comment

[WEB SITE] SMARTmove – FES

Summary

SMARTmove is a £1.1 million Medical Research Council research project running for 30 months from September 2016 to February 2019, funded under the Development Pathway Funding Scheme (DPFS). The project brings together a multidisciplinary team with expertise in functional materials, direct printing fabrication, control algorithms, wireless electronics, sensors, and end user engagement to address stroke rehabilitation. Working together with the advisory board members from six institutions, we will deliver a personalised wearable device for home-based stroke upper limb rehabilitation.

     

The Need

Stroke is one of the largest causes of disability: 17 million strokes occur every year worldwide, meaning one stroke every two seconds. Half of stroke survivors lose the ability to perform everyday tasks with their upper limb, which affects their independence. The cost to society in the UK is nine billion pounds per year due to health and social care, informal care, productivity loss and benefit payments. As stroke is an age-related disease, these numbers are set to increase as the population ages.

Novelty

Current commercial devices using functional electrical stimulation (FES) have large electrodes that only stimulate a limited number of muscles, resulting in simple, imprecise movements and the rapid onset of fatigue. In addition, current commercial devices do not employ feedback control to account for the movement of patients, only reducing the level of precision in the resulting movements. In addition, devices are either bulky and expensive, or difficult to set-up due to trailing wires.

Our project uses bespoke screen printable pastes to print electrode arrays directly onto everyday fabrics, such as those used in clothing. The resulting garments will have cutting-edge sensor technologies integrated into them. Advanced control algorithms will then adjust the stimulation based on the patients’ limb motion to enable precise functional movements, such as eating, washing or dressing.

Impact

This project will deliver a fabric-based wearable FES for home based stroke rehabilitation. The beneficiaries include:

  1. Persons with stroke (PwS) and other neurological conditions. Stroke survivors are the direct beneficiaries of our research. The FES clothing can be adapted to also treat hand/arm disabilities resulting from other neurological conditions such as cerebral palsy, head injury, spinal cord injury, and multiple sclerosis. The use of the wearable training system increases the intensity of rehabilitation without an increase in clinical contact time. This leads to better outcomes such as reduced impairment, greater restoration of function, improved quality of life and increased social activity.
  2. The NHS. FES-integrated clothing is comfortable to wear and convenient to use for rehabilitation, enabling impaired people to benefit from FES at home. It will transfer hospital based professional care to home based self-care, and therefore will reduce NHS costs by saving healthcare professionals’ time and other hospital resources.
  3. Industry. Benefits include: bringing business to the whole supply chain; increasing the FES market demand by improving performance; benefiting other industry sectors such as rehabilitation for other neurological conditions.
  4. Research communities in related fields. Specifically, the fields of novel fabrication, control systems, design of medical devices, rehabilitation, smart fabrics, and remote healthcare will benefit from the highly transformative platform technology (e.g. direct write printing, fabric electrodes, iterative learning control systems) developed in this work.

What is FES?

Functional electrical stimulation (FES) is a technique used to facilitate the practice of therapeutic exercises and tasks. Intensive movement practice can restore the upper limb function lost following stroke. However, stroke patients often have little or no movement, so are unable to practice. FES activates muscles artificially to facilitate task practise and improve patients’ movement.

More…..

Source: SMARTmove

, , , , , , ,

Leave a comment

[Abstract] Tele-health, wearable sensors and the Internet. Will they improve stroke outcomes through increased intensity of therapy, motivation and adherence to rehabilitation programs?

Provisional Abstract
Background and Purpose
Stroke, predominantly a condition of older age, is a major cause of acquired disability in the global population and puts an increasing burden on healthcare resources. Clear evidence for the importance of intensity of therapy in optimizing functional outcomes is founded in animal models, supported by neuroimaging and behavioral research, and strengthened by recent meta-analyses from multiple clinical trials. However, providing intensive therapy using conventional treatment paradigms is expensive and sometimes not feasible due to patients’ environmental factors. This paper addresses the need for cost-effective increased intensity of practice and suggests potential benefits of telehealth (TH) as an innovative model of care in physical therapy.

Summary of Key Points
We provide an overview of TH and present evidence that a web-supported program used in conjunction with Constraint Induced Therapy (CIT), can increase intensity and adherence to a rehabilitation regimen. The design and feasibility testing of this web-based program, ‘LifeCIT’ is presented. We describe how wearable sensors can monitor activity and provide feedback to patients and therapists. The methodology for the development of a wearable device with embedded inertial measurement units and mechanomyography sensors, algorithms to classify functional movement, and a graphical user interface to present meaningful data to patients to support a home exercise program is explained.

Recommendations for Clinical Practice
We propose that wearable sensor technologies and TH programs have the potential to provide cost-effective, intensive, home-based stroke rehabilitation.

Source: JUST ACCEPTED: “Tele-health, wearable sensors and the Internet. Will they improve stroke outcomes through increased intensity of therapy, motivation and adherence to rehabilitation programs?” |

, , , , , , , , ,

Leave a comment

[ARTICLE] Efficacy of home-based visuomotor feedback training in stroke patients with chronic hemispatial neglect – Full Text

Hemispatial neglect is a severe cognitive condition frequently observed after a stroke, associated with unawareness of one side of space, disability and poor long-term outcome. Visuomotor feedback training (VFT) is a neglect rehabilitation technique that involves a simple, inexpensive and feasible training of grasping-to-lift rods at the centre. We compared the immediate and long-term effects of VFT vs. a control training when delivered in a home-based setting. Twenty participants were randomly allocated to an intervention (who received VFT) or a control group (n = 10 each). Training was delivered for two sessions by an experimenter and then patients self-administered it for 10 sessions over two weeks. Outcome measures included the Behavioural Inattention Test (BIT), line bisection, Balloons Test, Landmark task, room description task, subjective straight-ahead pointing task and the Stroke Impact Scale. The measures were obtained before, immediately after the training sessions and after four-months post-training. Significantly greater short and long-term improvements were obtained after VFT when compared to control training in line bisection, BIT and spatial bias in cancellation. VFT also produced improvements on activities of daily living. We conclude that VFT is a feasible, effective, home-based rehabilitation method for neglect patients that warrants further investigation with well-designed randomised controlled trials on a large sample of patients.

Continue —> Efficacy of home-based visuomotor feedback training in stroke patients with chronic hemispatial neglect: Neuropsychological Rehabilitation: Vol 0, No 0

Figure

Figure 3 of 5 Figure 3. (A) Lesion map for individual patients. B-C) Lesion overlap map summarising the degree of involvement for each voxel in the intervention (B; N = 8) and control (C; N = 5) groups. Lesions were identified by a clinical neurologist (K.M.), who was blind to the design, group assignment and purpose of the study. Lesions were mapped onto 11 axial slices of a T1-weighted template, corresponding to the MNI z coordinates of −24, −16, −8, 0, 8, 16, 24, 32, 40, 50, 60 mm using identical or closest matching transverse slices for each patient using MRIcro software package (Rorden & Brett, 2000 Rorden, C., & Brett, M. (2000). Stereotaxic display of brain lesions. Behavioural Neurology, 12, 191–200. doi: 10.1155/2000/421719 [CrossRef], [PubMed], [Web of Science ®] ). Due to technical difficulties at the clinical facility, we were able to obtain and map digital brain scans for 13 patients only (6 MRIs and 7 CTs) as the remaining digital brain scans were either lost or corrupted. Please note however, that all brain scan reports were available and confirmed the presence of a stroke and its location for all our patients. The range of colour scale derives from the absolute number of patient lesions involved in each voxel.

, , , , , , , ,

Leave a comment

[Abstract] Feasibility Study of a Take-Home Array-Based Functional Electrical Stimulation System With Automated Setup for Current Functional Electrical Stimulation Users With Foot-Drop

Abstract

Objective

To investigate the feasibility of unsupervised community use of an array-based automated setup functional electrical stimulator for current foot-drop functional electrical stimulation (FES) users.

Design

Feasibility study.

Setting

Gait laboratory and community use.

Participants

Participants (N=7) with diagnosis of unilateral foot-drop of central neurologic origin (>6mo) who were regular users of a foot-drop FES system (>3mo).

Intervention

Array-based automated setup FES system for foot-drop (ShefStim).

Main Outcome Measures

Logged usage, logged automated setup times for the array-based automated setup FES system and diary recording of problems experienced, all collected in the community environment. Walking speed, ankle angles at initial contact, foot clearance during swing, and the Quebec User Evaluation of Satisfaction with Assistive Technology version 2.0 (QUEST version 2.0) questionnaire, all collected in the gait laboratory.

Results

All participants were able to use the array-based automated setup FES system. Total setup time took longer than participants’ own FES systems, and automated setup time was longer than in a previous study of a similar system. Some problems were experienced, but overall, participants were as satisfied with this system as their own FES system. The increase in walking speed (N=7) relative to no stimulation was comparable between both systems, and appropriate ankle angles at initial contact (N=7) and foot clearance during swing (n=5) were greater with the array-based automated setup FES system.

Conclusions

This study demonstrates that an array-based automated setup FES system for foot-drop can be successfully used unsupervised. Despite setup’s taking longer and some problems, users are satisfied with the system and it would appear as effective, if not better, at addressing the foot-drop impairment. Further product development of this unique system, followed by a larger-scale and longer-term study, is required before firm conclusions about its efficacy can be reached.

Source: Feasibility Study of a Take-Home Array-Based Functional Electrical Stimulation System With Automated Setup for Current Functional Electrical Stimulation Users With Foot-Drop – Archives of Physical Medicine and Rehabilitation

, , , , , , , ,

Leave a comment

[WEB SITE] Scientists Test Electrical Stimulation Glove As Poststroke Hand Therapy – Rehab Managment

http://www.dreamstime.com/stock-photos-beautiful-woman-hands-nails-perfect-french-manicure-close-up-image41312553

An experimental stroke therapy involving the wearing of a glove using electrical sensors could help poststroke patients with hand weakness improve their hand dexterity more than an existing stimulation technique, according to a recent study.

In the therapy, developed by researchers at the MetroHealth System, Case Western Reserve University and the Cleveland Functional Electrical Stimulation Center, patients control the stimulation to their weak hand by wearing a glove with sensors on the opposite, unaffected hand.

When the patient opens their unaffected hand, they receive a corresponding amount of stimulation that opens their weak stroke-affected hand. This puts the patient back in control of their hand and enables them to participate in therapy with the assistance of electrical stimulation, notes a media release from the American Heart Association.

The study involved 80 poststroke patients. Half of them used the experimental stroke therapy using the glove, and the other half used a common therapy that uses low levels of electric current to stimulate the paralyzed muscles to open the hand, improve muscle strength, and possibly restore hand function.

Both groups used an electrical stimulator on their own at home for 10 hours a week, plus 3 hours per week practicing hand tasks with an occupational therapist in the lab. Hand function was measured before and after therapy with a standard dexterity test that measured the number of blocks participants can pick up, lift over a barrier, and release in another area on a table within a 60-second period, the release continues.

After reviewing the data, the scientists conclude, per the release, that: Patients who received the new therapy had greater improvement on the dexterity test (4.6 blocks) than the common group (1.8 blocks); and Patients who had the greatest improvements in hand dexterity following the new therapy were less than 2 years poststroke and had at least some finger movement when they started the study. These patients saw an improvement of 9.6 blocks on the dexterity test, compared to 4.1 blocks in the common group.

Further findings include: Patients with no finger movement also saw improvements in arm movement after the new therapy; and At treatment end, 97% of the participants who received the new therapy agreed that they could use their hand better than at the start of the study.

Researchers plan to perform a multi-site study to confirm these findings, as well as to measure quality of life improvements for patients.

They also suggest that the study demonstrates that stroke patients can effectively use technology for self-administered therapy at home.

“Home-based therapy is becoming increasingly important to offset increasing healthcare costs and to meet the need for high doses of therapy that are critical for attaining the best outcomes,” says senior author Jayme S. Knutson, PhD, assistant professor of Physical Medicine and Rehabilitation at Case Western Reserve University School of Medicine in Cleveland, in the release. “The more therapy a patient can get the better potential outcome they will get.”

The study was published recently in Stroke.

Source: Scientists Test Electrical Stimulation Glove As Poststroke Hand Therapy – Rehab Managment

, , , , , ,

Leave a comment

[ARTICLE] A low cost virtual reality system for home based rehabilitation of the arm following stroke: A randomised controlled feasibility trial – Full Text

Abstract

Objective: To assess the feasibility of conducting a randomised controlled trial of a home-based virtual reality system for rehabilitation of the arm following stroke.

Design: Two group feasibility randomised controlled trial of intervention versus usual care.

Setting: Patients’ homes.

Participants: Patients aged 18 or over, with residual arm dysfunction following stroke and no longer receiving any other intensive rehabilitation.

Interventions: Eight weeks’ use of a low cost home-based virtual reality system employing infra-red capture to translate the position of the hand into game play or usual care.

Main measures: The primary objective was to collect information on the feasibility of a trial, including recruitment, collection of outcome measures and staff support required. Patients were assessed at three time points using the Wolf Motor Function Test, Nine-Hole Peg Test, Motor Activity Log and Nottingham Extended Activities of Daily Living.

Results: Over 15 months only 47 people were referred to the team. Twenty seven were randomised and 18 (67%) of those completed final outcome measures. Sample size calculation based on data from the Wolf Motor Function Test indicated a requirement for 38 per group. There was a significantly greater change from baseline in the intervention group on midpoint Wolf Grip strength and two subscales of the final Motor Activity Log. Training in the use of the equipment took a median of 230 minutes per patient.

Conclusions: To achieve the required sample size, a definitive home-based trial would require additional strategies to boost recruitment rates and adequate resources for patient support.

Introduction

Approximately 70% of patients experience impaired arm function after a stroke, and it is estimated that 40% of survivors are left with reduced functioning in the affected arm.1 There is now strong evidence from high-quality trials to support intensive repetitive task-oriented training for recovery after stroke.2 Recent studies3have found improvements in patients as much as 6 months post stroke, long after they have been discharged from any formal rehabilitation. Consequently there is a need to find the best way to support survivors once they stop accessing formal services.4

One route through which this may be achieved is the adoption of virtual reality and interactive video gaming which have emerged as new treatment approaches in stroke rehabilitation.5,6 The emergence of commercial gaming consoles has led to their adoption by therapists in clinical settings.7,8 These consoles have the advantages of mass acceptability, easily perceived feedback and most importantly, they are affordable. A disadvantage however, is that the games are not specifically designed for therapeutic use and while the games encourage movements of the arm, none capture sufficient information about the position of the fingers to be useful in the rehabilitation of the hand.

We developed a low cost home-based system for rehabilitation of the arm and hand designed to be flexible and motivating in order to improve adherence. Given the home-based, self-directed nature of the intervention and the introduction of new technology, a feasibility randomised controlled study was carried out in line with the MRC Framework for Complex Interventions.9 In preparation for an evaluation of the effectiveness of the intervention, the feasibility randomised controlled study aimed to answer the following questions:

  • Can we recruit patients?

  • Can we collect outcome measures?

  • What sample size is indicated by the outcome measures collected?

  • How much researcher and therapist support was required?

Continue —> A low cost virtual reality system for home based rehabilitation of the arm following stroke: A randomised controlled feasibility trial

, , , , , , , ,

Leave a comment

[Abstract] Stroke rehabilitation at home before and after discharge reduced disability and improved quality of life: a randomised controlled trial

Abstract

Objective: To evaluate if home-based rehabilitation of inpatients improved outcome compared to standard care.

Design: Interventional, randomised, safety/efficacy open-label trial.

Setting: University hospital stroke unit in collaboration with three municipalities.

Subjects: Seventy-one eligible stroke patients (41 women) with focal neurological deficits hospitalised in a stroke unit for more than three days and in need of rehabilitation.

Interventions: Thirty-eight patients were randomised to home-based rehabilitation during hospitalization and for up to four weeks after discharge to replace part of usual treatment and rehabilitation services. Thirty-three control patients received treatment and rehabilitation following usual guidelines for the treatment of stroke patients.

Main measures: Ninety days post-stroke the modified Rankin Scale score was the primary endpoint. Other outcome measures were the modified Barthel-100 Index, Motor Assessment Scale, CT-50 Cognitive Test, EuroQol-5D™, Body Mass Index and treatment-associated economy.

Results: Thirty-one intervention and 30 control patients completed the study. Patients in the intervention group achieved better modified Rankin Scale score (Intervention median = 2, IQR = 2-3; Control median = 3, IQR = 2–4; P=0.04). EuroQol-5D™ quality of life median scores were improved in intervention patients (Intervention median = 0.77, IQR = 0.66–0.79; Control median = 0.66, IQR = 0.56 – 0.72; P=0.03). The total amount of home-based training in minutes highly correlated with mRS, Barthel, Motor Assessment Scale and EuroQol-5D™ scores (P-values ranging fromP<0.00001 to P=0.01). Economical estimations of intervention costs were lower than total costs of standard treatment.

Conclusion: Early home-based rehabilitation reduced disability and increased quality of life. Compared to standard care, home-based stroke rehabilitation was more cost-effective.

Source: Stroke rehabilitation at home before and after discharge reduced disability and improved quality of life: a randomised controlled trial

, , , ,

Leave a comment

[WEB SITE] New wireless sleeve to help people recover arm use after stroke – Medical News Today

Scientists at the University of Southampton are to develop and trial a new wearable technology to help people who have had a stroke recover use of their arm and hand.

Led by Professor Jane Burridge, the team will create a wireless sleeve, which will provide automatic, intelligent information about muscle movement and strength while patients practice every-day tasks at home.

The data will be available on a computer tablet to enable patients to review their progress as well as to allow therapists to tailor their rehabilitation programme.

The two-year project has been funded with a grant of just under £1 million from the National Institute for Health Research (NIHR) through its Invention for Innovation (i4i) programme and is a collaboration between the University of Southampton and Imperial College London, two medical technology consultancies; Maddison and Tactiq and NHS Trusts in Bristol and Portsmouth.

Image of wearable technology
Scientists are to develop and trial a new wearable technology to help people who have had a stroke recover use of their arm and hand

Jane Burridge, Professor of Restorative Neuroscience at Southampton, comments: “About 150,000 people in the UK have a stroke each year and, despite improvements in acute care that results in better survival rates, about 60 per cent of people with moderate to severe strokes fail to recover useful function of their arm and hand.

“Stroke rehabilitation is increasingly home-based, as patients are often discharged from hospital after only a few days. This policy encourages independence and avoids problems associated with prolonged hospital stays. However, some patients struggle to carry out the exercises and they may question whether what they are doing is correct. Similarly therapists don’t have objective measurements about their patients’ muscle activity or ability to move. Rehabilitation technologies like our sleeve will address problems faced by both patients and therapists.”

The wearable technology is the first to incorporate mechanomyography (MMG) microphone-like sensors that detect the vibration of a muscle when it contracts, and inertial measurement units (IMU), comprising tri-axial accelerometers, gyroscopes and magnetometers that detect movement. Data from the two types of sensors will be put together and then data that is not needed, for example outside noise, will then be removed from the muscle signal.

The feedback to patients will be presented on a user-friendly computer interface as an accurate representation of their movement, showing them how much they have improved.

The same sleeve and computer tablet technology, but using different software and user-interfaces, will provide therapists with information to help them diagnose specific movement problems, and inform their clinical decision-making, monitor progress and therefore increase efficiency and effectiveness of therapy.

Professor Burridge adds: “We hope that our sleeve will help stroke patients regain the use of their arm and hand, reduce time spent with therapists and allow them to have the recommended 45 minutes daily therapy more flexibly.. It will also be used to assess patients’ problems accurately as well as more cheaply and practically than using laboratory-based technologies.”

The team, which includes members who themselves have suffered strokes, are working with medical device consultancies, Maddison and Tactiq to develop wearable prototypes and graphical user interfaces which can then be trialled with patients from two NHS sites. They will test the user interfaces, wireless connectivity and examine how easy the sleeve is to wear. The potential cost savings to the NHS will also be examined.

Source: New wireless sleeve to help people recover arm use after stroke – Medical News Today

, , , , , , , , , ,

Leave a comment

%d bloggers like this: