Posts Tagged inpatient rehabilitation
[ARTICLE] Using an upper extremity exoskeleton for semi-autonomous exercise during inpatient neurological rehabilitation- a pilot study – Full Text
Posted by Kostas Pantremenos in Paretic Hand, Rehabilitation robotics on August 5, 2018
Abstract
Background
Motor deficits are the most common symptoms after stroke. There is some evidence that intensity and amount of exercises influence the degree of improvement of functions within the first 6 months after the injury.
The purpose of this pilot study was to evaluate the feasibility and acceptance of semi-autonomous exercises with an upper extremity exoskeleton in addition to an inpatient rehabilitation program. In addition, changes of motor functions were examined.
Methods
Ten stroke patients with a severe upper extremity paresis were included. They were offered to perform a semi-autonomous training with a gravity-supported, computer-enhanced device (Armeo®Spring, Hocoma AG) six times per week for 4 weeks. Feasibility was evaluated by weekly structured interviews with patients and supervisors.
Motor functions were assessed before and after the training period using the Wolf Motor Function Test (WMFT). The Wilcoxon Signed Rank Test was used for assessing pre-post differences. The Pearson correlation co-efficient was used for correlating the number of completed sessions with the change in motor function. Acceptance of the device and the level of satisfaction with the training were determined by a questionnaire based on visual analogue scales.
Results
Neither patients nor supervisors reported side effects. However, one patient had to be excluded from analysis because of transportation difficulties from the ward to the treatment facility. Therefore, analysis was based on nine patients. On average, 13.2 (55%) sessions were realized. WMFT results showed significant improvements of proximal arm functions. The number of sessions correlated with the degree of shoulder force improvement. Patients rated the exercises to be motivating, and enjoyable and would continue using the Armeo®Spring at home if they had the opportunity.
Conclusion
Using an upper extremity exoskeleton for semi-autonomous training in an inpatient setting is feasible without side effects and is positively rated by the patients. It might further support the recovery of upper extremity function.
Background
Stroke belongs to the most common causes of death and disability worldwide [1]. The prevalence increases continuously with age and affects approximately 7% of persons aged 70–79 years [2]. Motor deficits after stroke can be found in up to 82% of the patients [3], and 6 months after stroke, 65% still have difficulties to incorporate the affected upper extremity in activities of daily living [4]. Numerous rehabilitative strategies have been developed for improvement of motor functions [5]. One of these is the use of robot-assisted devices. A recent review concluded that electromechanical and robot-assisted arm training improved activities of daily living, arm function and arm muscle strength more than conventional therapies [6]. Another issue still open for discussion is the dose-response relationship. Some evidence is available that more movement practice results in better outcomes [7, 8]. It is recommended to increase exercise intensity by making the tasks more difficult and/or increasing the number of repetitions [9, 10]. Presumably, robot-assisted therapy is effective because it allows to deliver high-dosage and high-intensity training [11].
In our study, we were interested if technology-assisted exercises that are offered in addition to a conventional inpatient neurological rehabilitation program are accepted by the patients and if such an extra-training apart from the usual therapy schedule and without support by therapists is feasible. We included severely affected stroke patients without ability to use the upper extremity in activities of daily living. An exoskeleton that provides an adjustable arm support and allows gravity-supported and computer-enhanced arm exercises (ArmeoSpring) was chosen for the additional training [12]. Several studies using the ArmeoSpring device have already demonstrated improvements in motor functions, including increases of strength, reductions of spasticity and pain [13, 14, 15, 16, 17]. […]
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[A Systematic Review] The Clinical, Quality of Life and Economic Outcomes of Inpatient Rehabilitation – Full Text PDF
Posted by Kostas Pantremenos in REHABILITATION, Uncategorized on November 27, 2017
Abstract
Objective: To systematically review the clinical, functional and economic benefits of Inpatient Rehabilitation for the most common disorders of the nervous system: stroke, spinal cord injury, and multiple sclerosis.
Methodology: PubMed, Embase, Scopus, CEA Registry, and NHS EED databases were searched using combinations of three sets of keywords using various terms for rehabilitation, benefits, and treatments. The outcomes considered included measures of independence in activities of daily living (ADL), motor function, disability, handicap,
gait velocity, quality of life, and economics. Following the initial literature search, the abstracts and full texts of the identified studies were reviewed and assessed for inclusion by two independent researchers based on pre-determined criteria. The data of selected studies were extracted into a data extraction form and consequently were synthesized.
Results: Forty-six articles met the inclusion criteria. Particularly, 21 studies evaluated inpatient rehabilitation after (or following) stroke, 15 studies evaluated inpatient rehabilitation after SCI, and seven studies evaluated inpatient rehabilitation for MS patients. The remaining three studies referred to mixed patient population. The majority of studies indicated that inpatient rehabilitation can provide clinical and functional benefits for all patient groups under consideration. Moreover, economic evaluations indicate that rehabilitation may be cost saving or cost-effective in certain patient groups such as those with fractures and stroke.
Conclusion: The results of the present review demonstrate that inpatient rehabilitation may deliver significant health and economic benefits for patients suffering from stroke, spinal cord injury, or multiple sclerosis and for health systems. Further research is needed to improve the consistency and robustness of the available evidence.
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[ARTICLE] Cognitive and functional outcomes following inpatient rehabilitation in patients with acquired brain injury: A prospective follow-up study – Full Text
Posted by Kostas Pantremenos in REHABILITATION on June 23, 2017
Abstract
Objectives: To study the effects of cognitive retraining and inpatient rehabilitation to study the effects of cognitive retraining and inpatient rehabilitation in patients with acquired brain injury (ABI).
Design and Setting: This was a prospective follow-up study in a neurological rehabilitation department of quaternary research hospital.
Patients and Methods: Thirty patients with ABI, mean age 36.43 years (standard deviation [SD] 12.6, range 18–60), mean duration of illness 77.87 days (SD 91.78, range 21–300 days) with cognitive, physical, and motor-sensory deficits underwent inpatient rehabilitation for minimum of 14 sessions over a period of 3 weeks. Nineteen patients (63%) reported in the follow-up of minimum 3 months after discharge. Type of ABI, cognitive status (using Montreal Cognitive assessment scale [MoCA] and cognitive Functional Independence Measure [Cog FIM]®), and functional status (motor FIM®) were noted at admission, discharge, and follow-up and scores were compared.
Results: Patients received inpatient rehabilitation addressing cognitive and functional impairments. Baseline MoCA, motor FIM, and Cog FIM scores were 15.27 (SD = 7.2, range 3–30), 31.57 (SD = 15.6, range 12–63), and 23.47 (SD = 9.7, range 5–35), respectively. All the parameters improved significantly at the time of discharge (MoCA = 19.6 ± 7.4 range 3–30, motor FIM® = 61.33 ± 18.7 range 12–89, Cog FIM® =27.23 ± 8.10 range 9–35). Patients were discharged with home-based programs. Nineteen patients reported in follow-up and observed to have maintained cognition on MoCA (18.8 ± 6.8 range 6–27), significantly improved (P < 0.01) on Cog FIM® (28.0 ± 7.7 range 14–35) and motor FIM® =72.89 ± 16.2 range 40–96) as compare to discharge scores.
Conclusions: Cognitive and functional outcomes improve significantly with dedicated and specialized inpatient rehabilitation in ABI patients, which is sustainable over a period.
Introduction
Acquired brain injury (ABI) is defined as “damage to the brain, which occurs after birth and is not related to a congenital or a degenerative disease.” “These impairments may be temporary or permanent and cause physical, functional disability, or psychosocial maladjustment.”[1],[2] By this definition, ABI encompasses a wide variety of disorders of varying etiologies such as vascular, hypoxic, malignant, and traumatic. There are often long-lasting effects on domains of cognition, motor, behavior, and personality in affected individuals.[3] Cognitive impairment is common sequelae and important marker for prediction of rehabilitation outcomes, and cognitive outcome can be modified through targeted interventions.[4]
Studies suggest that traumatic brain injury (TBI) and stroke are the two main causes of ABI and regarded as important public health problem.[5] The incidence of TBI from 23 reports was found to vary greatly among European countries. Most rates were in the range 150–300/100,000 people per year.[6] The prevalence of stroke In western developed world ranges from 500 to 600/100,000. Rates per 100,000 from developing countries are also variable and range from 58 in India and 76 in the United Republic of Tanzania to 620 in China and 690 in Thailand.[7] Between 1.5 and 2 million persons are injured and 1 million die every year in India following TBI.[8] Cardiovascular diseases including stroke caused 19% of deaths in India between 2001 and 2003 and this is estimated to rise to 36% by 2030.[9] According to disease burden in India report September 2005, central nervous system malignancies (included in ABI) comprise 2% of the total cancer burden.[10] Other causes of ABI such as meningoencephalitis and stroke mimics also contribute to this pool of patients.
The majority of ABI survivors continue to live with disabilities without access to comprehensive rehabilitation services and remain a burden on caregivers and society.[11],[12] Physical and cognitive deficits are most commonly observed in these patients but are not adequately addressed due to lack of approachable rehabilitation services and awareness.[13],[14] Many of these patients opt for complementary and alternative medicine, which are popular in India but demonstrate questionable benefits.[15]
It is evident, both clinically and scientifically, that the improvement in motor control after ABI is training dependent, responding best to repetitive task training with continuous modification of the program to keep training tasks challenging to the patients (activity-based recovery and neural plasticity).[16],[17] Single or multiple domains of cognition can be affected in these patients depending on the site (s) and severity of injury. Disturbances in memory, attention, and/or executive functions are commonly involved. Deficits in language and speech, learning, abstract thinking, and orientation occur in severe cases. It is well established that cognitive deficits interfere with rehabilitation efforts and also result in a greater negative impact on quality of life.[18] Cognitive rehabilitation (CR) is a specialized treatment procedure designed to improve the cognition affected by internal or external injury to the brain. There are two types of CR: restorative and compensatory rehabilitation.[19],[20],[21] Restorative rehabilitation enables the patient to develop lost functions through specialized computerized and manual cognitive exercises. Compensatory rehabilitation helps the patient to train and use aids and tools to overcome the impairment. The objective of the present study was to rehabilitate ABI patients in all affected domains including cognitive, physical, sensory-motor, and behavior with customized inpatient programs. Another objective was to observe the effect of inpatient rehabilitation in improving cognition and functionality of the patients (by comparing admission and discharge scores). We also tried to observe whether the benefits of inpatient rehabilitation are sustainable by assessing the patients in follow-up examination a minimum of 3 months after discharge.[…]
TBI Rehabilitation 