Posts Tagged independence

[ARTICLE] Virtual rehabilitation of upper extremity function and independence for stoke: a meta-analysis – Full Text


We aimed to conduct a systematic literature review with a meta-analysis to investigate whether virtual reality (VR) approaches have beneficial effects on the upper extremity function and independent activities of stroke survivors. Experimental studies published between 2007 and 2017 were searched from two databases (EBSCOhost and PubMed). This study reviewed abstracts and assessed full articles to obtain evidence on qualitative studies. For the meta-analysis, the studies that estimated the standardized mean between the two groups analyzed the statistical values necessary for calculating the effect size. The present study also evaluated the statistical heterogeneity. In total, 34 studies with 1,604 participants were included, and the number of participants in each study ranged from 10 to 376. Nine studies were assessed to evaluate the quantitative statistical analysis for 698 patients with hemiparetic stroke. The results of the meta-analysis were as follows: The overall effect size was moderate (0.41, P<0.001). The 95% confidence interval ranged from 0.25 to 0.57. However, no significant heterogeneity and publication bias were observed. The results of this study showed that VR approaches are effective in improving upper extremity function and independent activities in stroke survivors.



Stroke has varying severity and subsequent functional impact, which depends on the recovery process of an individual and the extent of neurological damage (Chollet et al., 1991). Several stroke survivors experience physical, cognitive, perceptual, and mental impairments that require a period of intensive rehabilitation and may develop permanent disabilities (Teasell et al., 2005). Some stroke survivors can undergo a short period of inpatient rehabilitation program for recovery of function, and others continue to recover for a long period or throughout their lifetimes (Cramer, 2011). Therefore, in the intensive rehabilitation of individuals with neurological diseases, extremely important considerations must be made because of the reintegration of family and social roles and recreational activities (French et al., 2016West and Bernhardt, 2012).
In rehabilitation settings, functional and task-specific trainings are the key elements of therapy and designed to assist stroke survivors in restoring their motor control to attain more-normal functional movement patterns (Teasell et al., 2005). Stroke survivors must have significant changes in the motor control and strength of the trunk and limbs, with an emphasis on the more-affected side and bilateral symmetric movement; these may be achieved using specific reeducation strategies (Veerbeek et al., 2014West and Bernhardt, 2012). In terms of stroke rehabilitation settings, most previous studies were performed in laboratory or clinical settings that are less complex than the outdoor environment (Cho and Lee, 2013). Laboratory and clinical settings are not appropriate for establishing some complex personal space and community surroundings to meet the demands of multiple tasks for stroke survivors (Demain et al., 2013Fung et al., 2012).
Virtual reality (VR) is a computer-generated environment that simulates a realistic experience for practicing functional tasks at intensities higher than those in traditional rehabilitation programs for stroke survivors (Chen et al., 2016). VR may help engage stroke survivors in a repetitive, intensive, and goal-oriented therapy to improve their functional disabilities, activity limitations, and participation restrictions, without considering the cost and burden associated with increasing the number of therapeutic sessions (Merians et al., 2002). Furthermore, VR provides real-time visual feedback for movements, thereby increasing engagement in enjoyable rehabilitation tasks. VR provides rehabilitative clinicians with new and effective therapeutic tools that can help treat various disabilities and enables remote therapy. VR-based interventions lead to clinical improvement and cortical reorganization through repetitive, adaptive, task-oriented, meaningful, and challenging exercises for stroke survivors (Laver et al., 2012).
As mentioned earlier, several virtual realities in rehabilitation interventions have been applied in the stroke population. However, the efficacy of VR rehabilitation interventions remains to be fully elucidated. In particular, studies on the qualitative and quantitative beneficial effects of VR on upper extremity function and independence in performing activities of daily living among patients with stroke are limited. The objectives of the present study were as follows: (a) to investigate the effectiveness of VR-based interventions in rehabilitation programs for restoring the upper extremity function of stroke survivors through a systematic review and (b) to examine the efficacy of VR-based interventions as part of a therapeutic rehabilitation program to improve upper limb function and independence in performing activities of daily living in stroke survivors by conducting a meta-analysis. Then, the VR-based interventions that are effective for improving upper limb function and independence in performing activities of daily living in stroke survivors were identified.[…]

Continue —> Virtual rehabilitation of upper extremity function and independence for stoke: a meta-analysis

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[BLOG POST] Assistive Technology: How specialist gadgets and software have increased my independence.

I can’t use a computer without assistive technology. Over the years as computers have become more powerful assistive technology has become better and better. There are now hundreds of specialist gadgets and software that can make it easier for people with disabilities to operate computers or smartphones.

via Assistive Technology: How specialist gadgets and software have increased my independence — Where there’s a wheel, there’s a way

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[WEB SITE] Despite Weakness, Stroke Patients Can Learn New Tasks Through Rehab Training – Rehab Managment

Even though rehab training doesn’t change the neurological deficits resulting from a stroke, it can help patients learn new motor skills and achieve more independence in their daily lives, a recent study suggests.

Pablo Celnik, MD, director of the Department of Physical Medicine and Rehabilitation at Johns Hopkins, explains the finding more specifically, in a study published in Neurorehabilitation and Neural Repair.

“What we found is that physical rehab is not going to change the weakness caused by damaged brain cells in chronic patients, but it is going to change how well they can perform certain tasks, which can have a huge impact on a patient’s daily life,” Celnik says in a media release from Johns Hopkins Medicine.

The study included 10 chronic stroke patients with Fugi-Meyer Assessment (FMA) scores of >50 out of 66, categorized as having “mild to moderate” functional deficits; 10 patients with FMA scores of <50 out of 66, categorized as having “moderate to severe” impairment.; and 10 able-bodied participants who served as a control group.

All of the study participants were trained to control a simple video game using a using a robotic piece of equipment that held their dominant arm at 90 degrees from their bodies. This eliminated gravity as a burden for those whose arms were weakened by their strokes. The subjects were then taught to use the muscles around their elbow to move a cursor across a screen into small target windows, the release explains.

The participants were then asked to move the cursor through the windows in time with a metronome and completed nine blocks of 10 trials at various speeds—24, 30, 38, 45, 60, 80, 100, 110, and 120 beats per minute.

Next, the participants attended 30-minute training sessions for 4 consecutive days, during which time they were asked to complete five blocks of 30 trials, all at their own pace, and were encouraged to improve their speed and accuracy in each consecutive block. Following the training sessions, the participants’ skill levels were tested again in another skill assessment.

Results showed that while each group’s skill level improved by the end of the training, those with greater motor impairment still demonstrated less skill in both the pre- and post-training assessments. All participants reached a plateau in their improvement around experimental days 3 and 4.

However, the study showed that there was considerable overlap between the post-training performance of the stroke patients and the pre-training performance of groups with less impairment, the release continues.

“When you look at the data, the post-training mild-to-moderate group is indistinguishable from the pre-training control group. And the same was true for post-training scores of those in the moderate-to-severe group and the mild-to-moderate group,” says Robert Hardwick, PhD, postdoctoral fellow in the Department of Neurology at the Johns Hopkins University School of Medicine, in the release.

“This is good news for patients because it means that even when there is little likelihood of further neurological recovery, it means I can still teach them new tasks through training,” Celnik states in the release.

“What is important is to not create false expectations of neurological recovery, while at the same time being hopeful that patients can learn within the boundaries of their neurological deficit to improve their lives.”

[Source(s): Johns Hopkins Medicine, Science Daily]

Source: Despite Weakness, Stroke Patients Can Learn New Tasks Through Rehab Training – Rehab Managment

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[Abstract] Play-based interventions improve physical function for people with adult-acquired brain injury: a systematic review and meta-analysis of randomised controlled trials [with consumer summary] – PEDro 

Saywell N, Taylor N, Rodgers E, Skinner L, Boocock M

Clinical Rehabilitation 2016 Feb 11:Epub ahead of print

systematic review


OBJECTIVE: To undertake a systematic review and meta-analysis of the effectiveness of play-based interventions compared to traditional therapy in rehabilitation of adults with adult-acquired brain injury.

DATA SOURCES: The search was performed using Medline; CINAHL Plus; Health Source (Nursing/Academic Edition); Psychology and Behavioural Sciences Collection; Biomedical Reference Collection (Basic).

REVIEW METHODS: Studies included were randomised controlled trials that investigated the effect of play-based interventions on physical function of adults with adult acquired brain injury. Two independent reviewers identified eligible studies and assessed methodological quality using a modified Downs and Black. Meta-analysis compared standardised differences in means, to determine effect sizes for grouped functional outcome measures. The GRADE scoring system was used to determine the level of clinical evidence.

RESULTS: Thirty studies met the inclusion criteria, 13 were considered high quality and 17 moderate quality. Studies predominantly involved post-stroke participants, with only three studies including participants with traumatic brain injury. When compared to traditional therapy, dose-matched studies of play-based interventions showed a significant effect on independence (effect size (ES) 0.6) and physical performance (ES 0.43), as measured using the Fugl-Meyer. For non-dose matched studies, play-based interventions showed a significant improvement for balance (ES 0.76) compared with traditional therapy. In all studies that measured participant enjoyment, play-based therapy was rated as more enjoyable than traditional therapy.

CONCLUSION: Play-based interventions for people with adult acquired brain injury are more effective in improving balance and independence, which may be due to them being more enjoyable than traditional therapy.

Full text (sometimes free) may be available at these link(s):


Source: PEDro – Search Detailed Search Results


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[WEB SITE] Traumatic Brain Injury: Effects and Interventions – AOTA

Occupational Therapy: Skills for the Job of Living

Traumatic brain injury (TBI) is caused by an impact to the head from direct blows or sudden movements in other parts of the body, such as severe shaking. TBI can result in physical, cognitive, behavioral, or emotional difficulties. Injuries can range from minor to extremely severe and call for various levels of intervention and treatment.

People with TBI may experience short-term memory loss, have difficulty concentrating or paying attention, become easily disoriented, have impaired judgment, experience headaches or migraines, have slurred speech, experience seizures, become fatigued, depressed, or easily agitated, or experience increased anxiety and impulsive behaviors.

Occupational therapists can help people who have sustained a TBI. The type and duration of intervention depend on how severe the injury.

What can an occupational therapist do?

  • Evaluate the client engaging in daily activities at home, such as dressing and eating; at work; and during leisure activities, and facilitate the resumption of those activities.
  • Establish and restore (depending on the age of the client) endurance and strength so that a person with TBI can bathe, dress, and feed himself or herself.
  • Help the client minimize overstimulation and confusion in his or her environment.
  • Help the client perform simple tasks that are meaningful to the person’s life.
  • Implement weekly checklists of household chores.
  • Recommend equipment that can aid a person in performing daily life activities with greater independence, such as a tub or shower seat to allow bathing without standing when the client has poor balance and grab bars for greater safety when getting in or out of a tub or shower.
  • Teach a person with TBI to compensate for problems with thinking, such as memory impairments.

What can families and friends of a person with a TBI do?

  • Become educated about the recovery process of a family member with a TBI.
  • Provide long-term support to a family member with a TBI.
  • Learn techniques to help the person with a TBI manage cognitive and physical problems.
  • Help the person adapt his or her home to accommodate the effects of a TBI.

Need more information?

A person with traumatic brain injury and his or her family likely will need long-term assistance. If you would like to consult an occupational therapist, they are available through most hospitals, medical centers, and community clinics.

Occupational therapists and occupational therapy assistants are trained in helping adults and children with a broad range of issues in addition to traumatic brain injury, such as arthritis, stroke, and mood disorders. Practitioners also help clients develop wellness techniques that may prevent injury and disease.

via Traumatic Brain Injury: Effects and Interventions.

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