Posts Tagged Learned non-use

[WEB SITE] Flint Rehab Introduces MiGo Wearable for Stroke Recovery

MiGo

Flint Rehab announces the launch of MiGo, a wearable activity tracker specifically designed for stroke survivors. The device makes its official debut at the 2019 Consumer Electronics Show in Las Vegas.

MiGo is designed to track upper extremity activity — in addition to walking — and is optimized for the movement patterns performed by individuals with stroke. The device is accompanied by a smartphone app that provides motivational support through digital coaching, progressive goal setting, and social networking with other stroke survivors, according to the company in a media release.

“Most wearable fitness trackers are designed to help people get into shape. MiGo is a new type of wearable that helps people regain their independence after a stroke,” says Dr Nizan Friedman, co-founder and CEO of Irvine, Calif-based Flint Rehab, in the release.

“Traditionally, innovation in medical technology has been limited by what insurance companies are willing to cover. As a consumer-level digital health technology, MiGo avoids these constraints, empowering stroke survivors to take their recovery into their own hands.”

A common outcome of stroke is hemiparesis, or impaired movement on one side of the body. One of the leading causes of this lifelong disability is a phenomenon called “learned non-use,” where stroke survivors neglect to use their impaired arm or leg, causing their brain to lose the ability to control those limbs altogether.

MiGo directly addresses the problem of learned non-use by motivating stroke survivors to use their impaired side as much as possible. Using deep-learning algorithms, MiGo accurately tracks how much the wearer is using their impaired side, providing them with an easy-to-understand rep count throughout the day.

MiGo also provides an intelligent activity goal that updates every day based on the wearer’s actual movement ability, ensuring every user stays continuously challenged at the level appropriate for them. Then, the device acts as the wearer’s personal cheerleader, giving them rewards and positive feedback right on their wrist as they work to hit their daily goal, the release explains.

“Suffering a stroke is a traumatic, life-changing event. Many survivors do not have the proper support network to deal with the event, and they may find it difficult to relate with friends and family who don’t understand what they are going through,” states Dan Zondervan, co-founder and vice president of Flint Rehab.

“Using the MiGo app, users can join groups to share their activity data and collaborate with other stroke survivors to achieve group goals. Group members can also share their experiences and offer encouraging support to each other — right in the app,” he adds.

For more information, visit Flint Rehab.

[Source(s0): Flint Rehab, Business Wire]

 

via Flint Rehab Introduces MiGo Wearable for Stroke Recovery – Rehab Managment

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[BLOG POST] Causes And Prevention Of Muscle Atrophy After Stroke – Saebo

After a stroke, the body needs time to recover. Neurological damage prevents the brain from properly sending the signals that trigger body movements, resulting in prolonged muscle inactivity. Though a period of rest after a stroke is necessary, too much rest can be a bad thing. If muscles in the body remain stagnant for too long, a condition called muscle atrophy will take effect. In many cases, a stroke survivor will lose neurological connections to an arm, leg, hand, or foot, and this loss accelerates muscle atrophy, making rehabilitation more difficult.

What Is Muscle Atrophy?

Muscle atrophy is the deterioration of muscle tissue due to extended periods of minimal use. In other words, muscles begin to waste away if they are not exercised consistently. For instance, if someone fractures their leg and wears a cast for weeks, they will see a significant difference in the muscle mass of the injured leg when the cast is removed.

This same reality applies to those who suffer from conditions that prevent use of certain body parts. Stroke is just one of several precipitating factors for muscle atrophy.

 

Causes Of Muscle Atrophy

Neurological Diseases

Conditions such as stroke, learned non-use, neuropathy, cerebral palsy, and spinal cord infections can diminish the stimulation of the nerves in certain body parts, causing those muscles to be inactive. Ultimately, inactive muscles atrophy. Sadly, atrophy makes the patient more prone to injury, exacerbating their underlying neurological disease and making rehabilitation even more challenging.

Learned Non-Use

An individual experiencing difficulties with an unresponsive limb will naturally compensate by relying on their healthy limb. In the short term, this allows a stroke survivor to complete daily tasks, but over time, the inactive limb will weaken further. This compensative imbalance is called learned non-use because one learns to compensate for and, therefore, underuse the weakened limb. “If you don’t use it, you lose it”– unfortunately, a person does actually lose muscle and neural connections over time if they allow a limb to remain dormant.

Prolonged Illness Or Hospitalization

In addition to neurological complications, any illness or injury that requires a lengthy hospitalization will have a profound effect on the substantive properties of the muscle tissues. A combination of immobility, fatigue, and malnutrition can speed up the process of muscular degeneration and prolongs the recovery time for the underlying health issue.

Poor Nutrition

The body requires specific amounts of nutrients and vitamins to function properly—the adage “you are what you eat” holds real truth and what you put in your body plays a pivotal role in your overall health. This is especially true for your muscle health. A body deprived of nutrient-rich foods—such as vegetables, fruits, and essential proteins—can quickly fall victim to muscle atrophy.

Additionally, those who have a hard time chewing and swallowing food, due to any number of health conditions, are at a higher risk of muscle atrophy. If eating is painful, it is likely an individual will naturally limit the amount and variety of foods they eat. This means less nutrition and, if combined with non-use, will speed up atrophy of the muscles.

Preventing And Combating Atrophy

Given the severe consequences of muscle atrophy, it is best to employ preventative measures if possible. Fortunately, the same strategies that prevent atrophy can also facilitate the recovery of someone who has already suffered extensive muscle loss.

Get Your Body Moving

The best way to keep your muscles from wasting away is to get up and move whenever possible. For those recovering from a stroke or any other debilitating disease, exercise may seem like an uphill battle, but remember that when it comes to rehabilitation, no progress is too small. Prolonged inactivity contributes greatly to muscle atrophy, so even the slightest movements can make a big difference.

Work With Your Therapist

Most survivors of stroke may find it challenging to motivate themselves to move and keep moving, so a therapy or rehabilitation program can be incredibly helpful in the pursuit of a swift recovery. Health care professionals can create a personalized routine to provide you with consistency while offering positive reinforcement when facing challenging obstacles.

Electrical Stimulation

Electrical stimulation is a great therapeutic option for many stroke survivors. Different forms of electrotherapy can be deployed to address pain and weakness in affected areas, along with additional targeted benefits, including but not limited to increased circulation and decreased spasticity and pain. Tools like Saebo AvivaStim trigger muscles to relax and contract according to a comprehensive range of programs, aiding in muscle re-education and strengthening. The SaeboStim Micro is an electromesh garment that delivers electrical stimulation to an affected arm and hand, addressing spasticity, weakness, pain, edema and limited function. 

Active Exercises

Active exercises are exercises that require muscle exertion or body movement and are necessary for stroke rehabilitation, especially if muscle atrophy is a concern. Tools like the SaeboGlide can help strengthen the shoulder and elbow. As can be seen in this video, even if a survivor has lost hand function, the SaeboGlide comes with a strap to secure the hand to the sleeve allowing them to actively participate in exercisesIn addition to the improved physical fitness from a regular exercise regimen, there is scientific reason to believe stroke survivors who exercise enjoy cognitive and psychological benefits as well. Learn more about active exercises here.

Don’t Forget To Stretch!

Passive exercises are called as such because the muscles are moved by an outside force: either a machine, another body part, or another person. Also known as range-of-motion, or ROM exercises, passive exercises help prevent stiffness in your joints, work to stretch muscles, and can help increase and maintain range-of-motion. Learn more about passive exercises here.

You Can Combat Muscle Atrophy

Just as a tree is barren in the winter only to regenerate come the spring, muscles in the body can regain strength after they atrophy. If you or a loved one is currently dealing with muscle atrophy, or if feelings of frustration persist during the rehabilitation process, trust that recovery is possible with the right treatment plan and the support of family, friends, and healthcare professionals.

Also, remember that the body heals at its own pace. If a person remains patient in their practice and steadfast in their efforts, they will surely regain strength over time.


All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Saebo website is solely at your own risk.

via Causes And Prevention Of Muscle Atrophy After Stroke | Saebo

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[WEB SITE] 17 Ways To Help Stroke Survivors Recover Faster – Saebo

If you or a loved one has suffered from a stroke, there are many difficulties that can develop as a result. Primarily, these effects are physical, emotional, and cognitive.

Below, we provide tips on how to overcome these common post-stroke conditions. Keep in mind that dealing with the aftermath of a stroke can be frustrating, but with patience and consistent effort, considerable progress can be made.

 

 

Tip 1. Recognize Symptoms of Stroke

One of the most important ways to successfully recover from stroke, is by taking preventative measures such as knowing and recognizing the symptoms of a stroke because immediate treatment can be life saving and greatly affects the chances for a full recovery. Unfortunately the chances of a second stroke occurring increases in stroke survivors. According to The National Stroke Association, about 25% of stroke survivors will experience a second stroke. Within the first 5 years after the first stroke, risk of a second stroke is about 40% higher. Fortunately it is estimated that of all secondary strokes, about 80% of them are preventable with lifestyle changes and medical intervention. Read more about recognizing the symptoms of stroke in men and in women to better prepare you to act FAST.

 

Tip 2. Walking Again and Foot Drop

Foot drop is the difficulty or inability to lift the front part of the foot because of fatigue or damage affecting the muscles and nerves that aid in its movement. To combat this, using a brace or Ankle-foot Orthoses (AFO) has proven to be a major aid in rehabilitation. These devices prevent the front of the foot from dipping down and disrupting walking movements.

Leg exercises described in this supplementary post after experiencing a stroke are crucial for recovery. While each patient should have a custom exercise routine, personalized for you, there are several exercises that should be included in most every stroke survivor’s regimen. These low-impact strength and stretching leg exercises for stroke recovery are a good complement to use in conjunction with the Saebo MyoTrac Infiniti biofeedback system.

Richard Sealy, director of The Rehab Practice, a private neuro-therapy rehabilitation program in the United Kingdom, regularly works with individuals, families, and caregivers to establish custom exercise routines to aid in recovery from long-term neurological problems, like the damage caused by stroke. While he acknowledges that each patient should have a custom exercise routine specific and personal to their struggles, he recommends a series of exercises for anyone working to strengthen their legs and improve range of motion during stroke recovery.

Rehabilitation of the legs and feet can occur at a faster rate with a combination of the aforementioned exercises and orthopedic aids such as the SaeboStep.The SaeboStep is a unique foot drop brace worn on the outside of the shoe that assists with lifting the toes when walking. It is made to eliminate cumbersome, unreliable splints and braces placed within the shoe.

 

Tip 3. Dealing with Curled Toes

Often referred to as “curled toes” or “claw toe,” this symptom is caused by a miscommunication between the brain and muscles within the foot. This misfiring of signals causes an issue with controlling muscular movements, leading to over-contracting of the toes and spasticity, a condition where there is a miscommunication between the brain and the muscles in the toes, causing them to over contract.

The best way to regain strength and movement while dealing with this condition is to create a routine with a variety of exercises—toe taps, floor grips, finger squeezes, and toe-extensor strengthening. With effort and repetition, these workouts can make a huge difference in recovery.

 

Tip 4. Lack of Arm Function

One of the most common deficiencies following a stroke is the impairment of the arm and hand. This typically results in decreased strength, coordination, and range of motion. Those affected are often unable to support their own arms in order to perform rehabilitation exercises. When this occurs it is crucial that you include additional arm support during rehabilitation to avoid the arms becoming weaker due to learned non-use.

Learned non-use occurs when a stroke survivor prefers to use their strong arm because it is easier to move. This tendency makes it even more difficult for a stroke survivor to recover, because challenging the weakened arm with these exercises plays a crucial role in regaining arm function. Often physical therapists and occupational therapists use a technique known as Constraint-Induced Movement Therapy (or CIMT) to challenge a weakened shoulder and make further exercises and drills possible. Mobile arm supports such as the SaeboMAS and SaeboMAS mini help support the weight of the arm, allowing the user to do a much wider range of exercises. For more information about the SaeboMAS and how it can aid in stroke recovery click here.

As with rehabilitating any part of the body with reduced function after a stroke, it is important to consistently repeat the exercises and stretches to strengthen the brain-muscle connections. It is also important to stay positive and try to have fun with your rehab. Here are 35 fun rehab activities for stroke patients to help keep you motivated.

 

Tip 5. Hand Paralysis

Paralysis is the inability of a muscle to move voluntarily. The National Stroke Association sites as many as 9 out of 10 stroke survivors have some degree of paralysis following a stroke. Rehabilitation and therapy can help to regain voluntary movement, even several years after the stroke takes place.

The primary symptoms of hand paralysis are spasticity (stiff muscles), weakness, and lack of coordination. Fortunately, there are several methods of treatment in addition to therapy to help manage and recover from spasticity. Additional treatments include medications to relax muscles, botox injections (relaxes muscles temporarily), stretching exercises, anti-spasticity orthotics, and functional orthoses. Surgery is another option in the most severe cases.

The least invasive and most permanent treatment for hand paralysis is therapy to rehabilitate the connection between your brain and muscles using neuroplasticity. To make these exercises even more effective and to increase your rate of recovery, it is important to repeat your hand exercises often. By performing exercises repeatedly, you are strengthening that brain-muscle connection.

 

Tip 6. Difficulty Speaking and Communicating

Another common side effect of stroke is aphasia, which is the inability to speak or understand speech. This is one of the most frustrating side effects for survivors to deal with. It’s estimated that 25 to 40 percent of people who suffer from a stroke develop aphasia, though this condition is not limited to stroke survivors. Aphasia occurs when there is damage to the brain, specifically the left side that deals with language. There are two primary forms of aphasia: receptive aphasia and expressive aphasia. Receptive aphasia is when the individual has trouble understanding what is being said to them. Expressive aphasia is when the individual is having difficulty expressing what they want to say.

When communicating with someone with receptive aphasia, try not to use long complex sentences. When communicating with someone with expressive aphasia, it is important to be patient and remember that the person’s intelligence has not been affected by the stroke, just their ability to speak.

For those with aphasia, the most important thing you can do to improve your communication is to take a deep breath and try to relax. If you can remain relaxed and focus on what you are trying to say you will have much greater success. It is easy to get flustered or feel self conscious, but you shouldn’t. Create tools that you can use to make communication easier such as a book of words, pictures, phrases, or symbols that can help you get your message across. If you are going out and know you will not be around friends or family, it may also be helpful to carry a card or piece of paper that indicates that you have aphasia and explains what it is, just in case you find yourself needing to explain your condition.

Once these tools are set in place, seeking the help of a speech-language pathologist (SLP) can greatly increase one’s ability to regain normal speech behavior. SLPs can assist in rehabilitating all types of physical speech behavior and offer support and proper guidance for you or a loved one. Read more about aphasia and recovery here.

 

Tip 7: Coping with PTSD After Stroke

Following a stroke, it is fairly common for a survivor to experience PTSD, or Post-Traumatic Stress Disorder. This condition is usually associated with combat veterans and sexual-assault survivors; however, according to a study published in the journal PLoS One, almost a quarter of stroke survivors experience some form of PTSD.

Common symptoms of PTSD include the victim experiencing the traumatic event over and over in their head or in the form of nightmares. This replaying of the event is typically accompanied by the individual’s unyielding anxiety and feelings of self doubt or misplaced guilt over their condition. Some experience a state of hyperarousal or feelings of being overly alert.

The two main treatments for PTSD include medications such as antidepressants, anti-anxiety medications or psychotherapy. If you are experiencing PTSD, it is important that you communicate how you feel with your doctor, family, and friends, as a strong support system can help you find the relief from psychological pain that you deserve.

 

Tip 8: Understanding Fatigue

Feeling tired is a normal part of life for everyone, but for stroke survivor, fatigue is a very common symptom that can be frustrating to deal with. About 40 to 70 percent of stroke survivors experience fatigue, which can make recovering feel even more difficult. Post-stroke fatigue is draining both physically and emotionally/mentally, and rest may not be the only solution.

It is important to discuss the fatigue with a doctor so they can rule out potential medical causes or determine if fatigue might stem from current medications. By speaking with the proper medical professionals and taking time to squeeze in a nap or rest as often as possible—and by maintaining a positive mindset—you can help yourself or a loved one combat the constant drowsiness of fatigue and work on returning to pre-stroke energy levels. The key thing to realize is that some level of post-stroke fatigue is normal and that survivors need to be proactive about treating and working around it.

 

Tip 9: Counteract Learned Non-Use

If the limbs weakened after stroke are not consistently exercised over time, muscles have the potential to atrophy—waste away due to cell degeneration. This often occurs when the person tries to compensate for their weak limb by using their stronger limb more often. Daily attempts to move the affected limbs are necessary to maintain and improve functionality.One method is the use of Constraint-Induced Movement Therapy (CIMT). CIMT is a form of therapy that prevents the unaffected limbs from moving while trying to exercise the affected ones.

 

Tip 10: Reduce Inflammation and Stress

Inflammation in the body can cause other issues to arise, which is why it’s important to stay stress free whenever possible. When stress does begin to take hold, a hormone called cortisol floods the body, causing pH levels to become imbalanced with acidity. High acidity levels—after an extended period of time—can kill good bacteria in the body while giving rise to bad bacteria, ultimately weakening the immune system.

With that in mind, a natural probiotic like yogurt is a great way to boost good bacteria in the body. Supplemental drinks can also improve the immune system significantly. In addition to pH balance, adopting stress management exercises such as yoga, deep breathing, tai chi, qi gong, and meditation, can limit one’s cortisol levels, promoting overall health.

 

Tip 11: Coping with Emotional Effects

Experiencing a stroke is not only a major hardship to overcome physically; it can also take a huge toll on a survivor’s emotions in many ways.

If the area of your brain that controls personality or emotion is affected, you may be susceptible to changes in your emotional response or everyday behavior. Strokes may also cause emotional distress due to the suddenness of their occurrence. As with any traumatic life experience, it may take time for you or your loved one to accept and adapt to the emotional trauma of having experienced a stroke.

Some common emotional changes strokes may cause are PseudoBulbar Affect, depression, and anxiety. Thankfully, there are several methods for treating the emotional changes associated with a stroke, with the first step being to discuss how you or your loved one is feeling with a doctor. Treatment may consist of one, or a combination, of the following: one-on-one counseling, group counseling, medication, diet, and exercise. The most effective treatment is different for everyone, so it is important to discuss and explore which combination works best for your or your loved one.

 

PseudoBulbar Affect

Sometimes referred to as “reflex crying,” “emotional lability,” or “labile mood,” PseudoBulbar Affect (PBA) is a symptom of damage to the area of the brain that controls expression of emotions, and it is one of the most frequently reported post-stroke behaviors. Characteristics of the disorder include rapid changes in mood, such as suddenly bursting into tears and stopping just as suddenly or even beginning to laugh at inappropriate times.

 

Depression

Survivors have a one in four chance of developing serious depression as a side effect of stroke. If you are feeling sad, hopeless, or helpless after having suffered a stroke, you may be experiencing this. Other symptoms of depression may include irritability or changes to your eating and sleeping habits. Talk to your doctor if you are experiencing any of these symptoms, as it may be necessary to treat with prescription antidepressants or therapy to avoid it becoming a road block to your recovery.

Along with medication and therapy, a lot of research shows that a few simple lifestyle changes help relieve the symptoms of depression. If you or a loved one is having a difficult time coping with the emotional repercussions of a stroke, here are tips on how to implement positivity and resilience:

  • Attend a support group. Talking about your struggles with people in the same situation makes you feel less lonely and can offer helpful insight or different approaches to dealing with difficulties.
  • Eat healthy food. A good diet is important for your general health and your recovery from stroke and can also improve your mental health.
  • Remain socially active. Although you may not be able to do as much as you used to, it’s crucial to stay in touch with family and friends and take part in social activities.
  • Be as independent as possible. Humans need to feel independent and competent. Stroke recovery may require the help of caregivers, but if there are things that you can safely do by yourself, insist on it.
  • Exercise regularly. Physical activity, especially a low-impact one like walking, is proven to boost mental health and will also contribute to your recovery.

 

 

Tip 12: Set Recovery Goals with Your Therapist

Setting specific and meaningful goals can help keep one focused and motivated once they are achieved, and these goals can range from simple tasks to long-term accomplishments. By establishing a list consisting of difficulties and goals, overcoming obstacles can be put within reach.

When setting these goals, working with a therapist, doctor, or close friend can be a good way to find encouragement, as well as assistance in creating a list that places goals into an appropriate timeframe. Overall, a therapist will be familiar with your case, understanding the issues and complications, and will be able to offer sound advice in all aspects of recovery.

 

Tip 13: Stay Motivated

Since apathy is common during stroke recovery, staying motivated can be a challenge. Combining one’s interests with a solid rehabilitation regimen can effectively eradicate feelings of lethargy and depression. The best thing to do is to focus on a reason for recovery and to associate it with your plan of action. This can be done by implementing sentimental items into daily routines, thus giving you personal and motivational support at all times. For example, if one of your routines is to write a list of things to do for the day, try writing it on the back of a special photo. That way, as you’re checking things off, you’ll have a little reminder to keep you motivated.

 

Tip 14: Watch Out For The Recovery Plateau Stage

The recovery plateau stage refers to the point at which a stroke survivor begins to see a slow down or stop in the progression in their recovery. Some of the most significant improvements often occur in the subacute phase, which is usually the first three to six months after the stroke  (though there is anecdotal evidence of people making significant stroke recovery progress outside of that zone.)

Seeing improvement in the early days of a survivor’s recovery can make it a lot easier for them to stay motivated and continue working hard in therapy. Research shows that further recovery is still very possible after the plateau stage though, which is why it is so important to have a strong support system to encourage you to continue with therapy and working on recovery.

 

Tip 15: Working After Stroke

Since the brain is a major organ affected when it comes to strokes, chances are that some of its functions may have trouble performing like they did before. After a stroke, learning new things, or even just recalling information can be a challenge, and working through thoughts may suddenly be difficult.

After rehabilitation, many stroke survivors do find themselves able to return to work, but preparing for this transition can come with a lot of questions. Are you physically going to be able to perform your job? Will your disability benefits lapse? What do you need to communicate with your employer? These can be tough questions, but they do have answers. Some may not ever be able to go back to the same work, but for others, just a little assistance is needed.

When you are ready to return to work, it is important to know your rights and what your employer is, and is not, legally required to provide to employees with disabilities. Keep in mind that if you are unable to perform the essential functions of your job even with reasonable accommodation, your employer is not obligated to offer you a different position or create a new role for you. They might be willing to anyway, but it is not a requirement.

 

Tip 16: Understand and Combat Memory Loss

Not only is it common for stroke survivors to experience, but memory loss can affect a wide range of people through multiple factors. Age, physical trauma, and emotional stress have the potential to cause memory decline, but rebuilding memory’s strength is highly possible and can be fun.

Specifically, incorporating technology into daily rehabilitation exercises is a great way to show quick improvements. There are numerous apps for smartphones and tablets that use different techniques to significantly improve memory, and they have the ability to set reminders, schedule appointments, and oversee other illnesses.

 

Tip 17: Be Aware of Vascular Dementia

A common problem among stroke survivors, this symptom disrupts cognitive functions, which can make it challenging for one to sort out information.

Due to the damage of blood vessels from a stroke, blood pressure, cholesterol, and blood sugar must be maintained at healthy levels to ensure good blood flow throughout the body. If you are diabetic, it is crucial that you are paying careful attention to your blood sugar and insulin levels. Studies have shown that by managing these three components, vascular dementia can be decreased or prevented.

Helping Stroke Survivors Help Themselves

The process of stroke recovery is long and full of ups, downs, twists, and turns. It takes hard work and dedication to regain mental and physical function after a stroke. The information and tips above will help you to identify and overcome the many challenges that come with recovery.

To read our answers to the most common stroke recovery questions, click here. And remember, at the end of the day, there are dozens of approaches you can take to improve the speed of stroke recovery.


All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Saebo website is solely at your own risk.

via 17 Ways To Help Stroke Survivors Recover Faster | Saebo

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[ARTICLE] Counteracting learned non-use in chronic stroke patients with reinforcement-induced movement therapy – Full Text

Abstract

Background

After stroke, patients who suffer from hemiparesis tend to suppress the use of the affected extremity, a condition called learned non-use. Consequently, the lack of training may lead to the progressive deterioration of motor function. Although Constraint-Induced Movement Therapies (CIMT) have shown to be effective in treating this condition, the method presents several limitations, and the high intensity of its protocols severely compromises its adherence. We propose a novel rehabilitation approach called Reinforcement-Induced Movement Therapy (RIMT), which proposes to restore motor function through maximizing arm use. This is achieved by exposing the patient to amplified goal-oriented movements in VR that match the intended actions of the patient. We hypothesize that through this method we can increase the patients self-efficacy, reverse learned non-use, and induce long-term motor improvements.

Methods

We conducted a randomized, double-blind, longitudinal clinical study with 18 chronic stroke patients. Patients performed 30 minutes of daily VR-based training during six weeks. During training, the experimental group experienced goal-oriented movement amplification in VR. The control group followed the same training protocol but without movement amplification. Evaluators blinded to group designation performed clinical measurements at the beginning, at the end of the training and at 12-weeks follow-up. We used the Fugl-Meyer Assessment for the upper extremities (UE-FM) (Sanford et al., Phys Ther 73:447–454, 1993) as a primary outcome measurement of motor recovery. Secondary outcome measurements included the Chedoke Arm and Hand Activity Inventory (CAHAI-7) (Barreca et al., Arch Phys Med Rehabil 6:1616–1622, 2005) for measuring functional motor gains in the performance of Activities of Daily Living (ADLs), the Barthel Index (BI) for the evaluation of the patient’s perceived independence (Collin et al., Int Disabil Stud 10:61–63, 1988), and the Hamilton scale (Knesevich et al., Br J Psychiatr J Mental Sci 131:49–52, 1977) for the identification of improvements in mood disorders that could be induced by the reinforcement-based intervention. In order to study and predict the effects of this intervention we implemented a computational model of recovery after stroke.

Results

While both groups showed significant motor gains at 6-weeks post-treatment, only the experimental group continued to exhibit further gains in UE-FM at 12-weeks follow-up (p<.05). This improvement was accompanied by a significant increase in arm-use during training in the experimental group.

Conclusions

Implicitly reinforcing arm-use by augmenting visuomotor feedback as proposed by RIMT seems beneficial for inducing significant improvement in chronic stroke patients. By challenging the patients’ self-limiting believe system and perceived low self-efficacy this approach might counteract learned non-use.

Trial registration

Clinical Trials NCT02657070.

Background

After stroke, a neural shock leads to a learning process in which the brain progressively suppresses the use of the affected extremity [1]. This phenomenon is commonly referred to as learned non-use [2, 3]. Constraint-Induced Movement Therapy (CIMT) [1] implements a technique that aims to re-integrate the affected arm in the performance of Activities of Daily Living (ADLs) and reduce learned non-use. In order to achieve this goal, CIMT proposes to restrict the movement of the patient’s less-affected arm for about 90 % of the patient’s waking hours, which physically forces the use of the affected arm during performance of ADLs. Although a number of studies have shown the effectivity of CIMT [4], the high intensity of its protocols severely compromises its adherence [5] and can be physically and mentally tiring [6]. Moreover, its application is restricted to patients without severe cognitive impairments and with mild hemiparesis, which only accounts for about 15 % of all stroke cases [7]. Due to this limitations, several studies have tested variants of CIMT with reduced intensity protocols, giving rise to a Modified Constraint-Induced Movement Therapy (mCIMT) [8] and the so called Distributed Constraint-Induced Movement Therapy (dCIMT) [9]. However, the inclusion criteria of this type of therapy still remains excessively stringent [8, 10], and its efficacy at the chronic stage is unclear [11]. Given these limitations, there is a need for developing alternative methods that build on CIMT principles to foster the usage of the paretic limb, while mitigate its limitations.

A better understanding of the different factors determining hand selection could provide valuable insights for the development of new treatments that effectively counteract learned non-use and promote functional recovery. Previous studies have shown that the history of rewards may strongly bias action selection and habit learning [12, 13,14, 15]. Indeed, perceived self-efficacy, i.e. one’s own belief in his or her capabilities to successfully execute actions that are required for a desired outcome [16], appears to be an important driver for health behavior improvements [17]. In addition, the minimization of the expected cost/effort associated to a given action may as well regulate the decision making process [18]. The strong influence of these two factors on hand selection (i.e. expected cost and expected reward) may be sufficient to approximate the prediction of hand selection patterns, and may provide a direct explanation of our general preference for the execution of ipsilateral movements [19]. Following this line of research, we have shown in previous studies that hemiparetic stroke patients may be highly sensitive to failure when using the affected limb, therefore exposure to goal-oriented movement amplification in VR when using the affected extremity may serve as implicit reinforcement and promote arm use [20]. The resulting bias in hand selection patterns may rapidly emerge via action selection mechanisms, both reducing the expected cost and increasing the expected outcome associated to those movements executed with the paretic limb. It is generally known that motor learning is driven by motor error, and the high redundancy of the human motor system allows for the optimization of performance through decision making processes (i.e. effector selection). Thus, by virtually reducing sensorimotor error, these decision making processes can be modulated through intrinsic evaluation mechanisms [21, 22]. Previous studies have further proposed that a successful action outcome might reinforce not only the intended action but also any movement that drives the ideomotor system during the course of its execution [23, 24, 25]. This theory suggests that accidental success after action selection may be an effective mechanism for the spontaneous emergence of compensatory movements [26]. On this basis, by reducing sensorimotor feedback of those goal-oriented movements performed with the paretic limb, we may reinforce the future selection of the executed action. Indeed, a fMRI study on one stroke patient suggests that activations in the sensorimotor cortex of the affected hemisphere (the “inactive” cortex) were significantly increased simply by providing feedback of the contralateral hand [27]. This effect was also observed in healthy subjects [27]. In more recent studies, the effect of visuomotor modulations in motor adaptation has been also explored, showing that diminished error feedback and goal-oriented movement amplification does not necessarily compromise error-based learning [22, 28]. Building on these findings and grounding them on the Distributed Adaptive Control (DAC) theory of mind and brain, which proposes that restoring impaired sensorimotor contingencies is the key for promoting recovery [29], we propose a new motor rehabilitation technique that we term Reinforcement-Induced Movement Therapy (RIMT) [20]. This strategy is a combination of the following methods: 1) Shaping through training, while increasing the task difficulty according the patient’s performance; 2) limiting the use of the non-affected arm by introducing contextual restrictions in VR (i.e. restricted and symmetrically matched workspace for each arm); 3) providing explicit feedback about performance to the patient; and 4) augmenting goal-directed movements of the paretic limb in virtual reality (VR), in such a way that the patient executing the movement is exposed to diminished visuomotor errors, both in terms of distance and directional accuracy, thus increasing the expected action outcome (i.e. expected success) and decreasing the expected action cost (i.e. expected effort) [21]. While principles one to three of RIMT are similarly present in CIMT and Occupational Therapy protocols, the novelty of RIMT resides in its fourth principle: the provision of implicit reinforcement through the reduction of sensorimotor errors. This unique component of RIMT is the only variable that will be manipulated in the present study.

We hypothesize that by reducing visuomotor error within RIMT protocols, we may be able to boost the patients’ perceived performance of the paretic limb, leading to an increased use over time. Consequently, the increased spontaneous use of the paretic limb may facilitate intense practice and induce use-dependent plastic changes, therefore establishing a closed loop of recovery in which arm use and motor recovery reinforce each other. In this vein, a recent computational model of motor recovery suggested that there may be a functional threshold that predicts the use of the paretic limb after therapy [13, 30]. According to this model, only therapies that enable the patient to exceed a given functional threshold will recursively increase the spontaneous use of the paretic limb and induce functional improvement, leading to a complete motor recovery. This principle of use it or loose it can as well predict the effectiveness of RIMT. Furthermore, based on simulations from a computational model, we propose that reinforcement-based and constraint-based protocols can be combined to maximally promote the use of the paretic limb and induce functional gains in the chronic phase after the stroke. To test our hypothesis we conduct a randomized, double-blind, longitudinal clinical study with chronic stroke patients, and we analyze the effects of RIMT intervention on counteracting learned non-use and inducing motor recovery.

Fig. 1 Set-up and scenarios. a RGS setup in the hospital showing the transparent acrylic table in front of which the desktop computer with the Kinect (on a tadpole that elevates it above the screen) is placed. In order to use the second Kinect and the overhead projector on the scaffold above the table for the real world evaluation scenario, a white cover can be placed over the acrylic surface. During a training session, the user sits in a chair facing the screen while resting his/her arms on the table. b Spheroids scenario, where sets of colored spheres are launched towards the player who has to intercept them. c Whack-a-mole scenario, where the user freely chooses which limb to use in order to reach towards an appearing mole. d Collector scenario, where a set of patterned spheroids as indicated in the upper-left corner of the screen need to be collected. e Virtual evaluation scenario, an abstract version of the Whack-a-mole scenario, where the patient has to reach towards an appearing cylinder. f Real-world scenario, where the user has to reach towards randomly appearing dots that are projected from above on the table surface in front of him or her

Continue —> Counteracting learned non-use in chronic stroke patients with reinforcement-induced movement therapy | Journal of NeuroEngineering and Rehabilitation | Full Text

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[ARTICLE] Low cost objective diagnosis of learned non-use of the paretic arm after a stroke using Kinect technology

Abstract

Background Post-stroke patient s tend to move their trunk forward to reach an object rather than extending their affected arm, which is detrimental to good recovery of the paretic arm. In order to avoid this maladaptive trunk compensation, an objective assessment is needed. In that context, learned non-use (LNU) of the paretic arm is the difference between what the patient is capable of doing with his paretic arm and what he actually does. LNU has been previously assessed with a costly movement analysis device (Zebris). However, the Kinect 2 (X-box) is an innovative movement sensor that costs a fraction of the price of Zebris (about 200 €). The aim of this study was to show that the results obtained by the Zebris and Kinect are comparable and to see if the Kinect is a valid alternative to Zebris.

Methods Four post-supratentorial stroke participants were asked to reach a cone placed in front of them at 80% of their arm length. The reaching movement was repeated 5 times with the paretic hand, then 5 times with the less-impaired hand. This sequence was first performed with the trunk free, then with the trunk restrained. LNU of the paretic arm was obtained from the difference of the amount of trunk compensation between the free trunk condition and the restrained trunk condition measured by the Zebris and Kinect systems simultaneously.

Results The results of a pilot study showed that the Kinect determination of LNU were similar to those obtained by the Zebris.

Discussion This LNU score measured by Kinect was similar to that measured by Zebris, so we consider Kinect to be accurate enough to measure maladaptive trunk compensation. This LNU score could also be implemented in Kinect video games stroke neurorehabilitation. In the near future, patients could benefit from using low cost Kinect system in their own homes for rehabilitation and to assess their progress.

Source: Elsevier: Article Locator

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[WEB SITE] Neuroplasticity and the Use of Technology

Therapists Kristin Myers, OTR/L, CBIS and Meredith Nichols, DPT, CBIS were invited to spend a week in China to share their experience of using a computer feedback system with Chinese therapists and physicians. During their time in China, they also demonstrated the concept of active and functional retraining following brain injury, and the seemingly novel idea of neuroplastic recovery, especially years after injury.

Myers and Nichols work in a post-acute brain injury program at CORE Healthcare outside of Austin, Texas. This program utilizes aspects of forced use theories and technology to improve functional outcomes for their clients. Their facility was initially one of only six in the United States to acquire and utilize this specific interactive biofeedback equipment. This computer-aided biofeedback system is one of many tools used at their program to facilitate neuroplasticity following traumatic brain injury.

They are currently collecting preliminary data to evaluate the clinical use of this technology to motivate their patients through mass practice. To reverse learned non-use after stroke, practice that has been clustered together (aka mass practice) has improved functional outcomes, such as seen in Edward Taub’s clinical work using constraint induced therapy for stroke recovery.

The biofeedback computer system Nichols and Myers used combats the monotony of repetitive motions and encourages patients to work harder and move toward more complete recovery of function in less time. This work integrating mass practice and forced use theories using the computer system enabled them to be invited to spend a week in China earlier this year, where they shared their knowledge and expertise with Chinese physicians and therapists.

In a whirlwind tour, Myers and Nichols visited five hospitals, in five different major Chinese cities including Shanghai and Harbin, in five days.  They had the honor of providing a picture of rehabilitation in America to over 500 Chinese therapists, doctors, administrators, and government officials.

New Concepts in Therapy

Continue —>  Neuroplasticity and the Use of Technology.

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[WEB SITE] Can virtual reality help stroke patients recover arm movement?

In the US, stroke is the number five cause of death and a leading cause of disability. Many people who have had a stroke experience hemiparesis – reduced muscle strength on one side of the body – and often compensate by relying more heavily on their healthy limb. Prolonged periods of not using the affected limb can lead to further impairment, but now, researchers say virtual reality could help some stroke patients regain the use of their arm.

Virtual reality arm

The researchers – led by Belén Rubio, of the Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems at Universitat Pompeu Fabra in Spain – publish their clinical pilot study in the Journal of NeuroEngineering and Rehabilitation.

They note that “learned non-use” of a limb is common in stroke patients and is linked to reduced quality of life.

“There is a need for designing new rehabilitation strategies that promote the use of the affected limb in performing daily activities,” says Rubio. “Often we neglect the remarkable contribution of the patient’s emotional and psychological states to recover, and this included their confidence.”

To increase patient confidence in using their paralyzed arm, Rubio and colleagues conducted a small pilot study with 20 hemiparetic stroke patients.

Continue —>  Can virtual reality help stroke patients recover arm movement? – Medical News Today.

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[WEB SITE] Can virtual reality help stroke patients recover arm movement? – Medical News Today

In the US, stroke is the number five cause of death and a leading cause of disability. Many people who have had a stroke experience hemiparesis – reduced muscle strength on one side of the body – and often compensate by relying more heavily on their healthy limb. Prolonged periods of not using the affected limb can lead to further impairment, but now, researchers say virtual reality could help some stroke patients regain the use of their arm.

Virtual reality arm

Patients used a Rehabilitation Gaming System to control a virtual body with their own movements. Image credit: Belén Rubio Ballester

The researchers – led by Belén Rubio, of the Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems at Universitat Pompeu Fabra in Spain – publish their clinical pilot study in the Journal of NeuroEngineering and Rehabilitation.

They note that “learned non-use” of a limb is common in stroke patients and is linked to reduced quality of life.

“There is a need for designing new rehabilitation strategies that promote the use of the affected limb in performing daily activities,” says Rubio. “Often we neglect the remarkable contribution of the patient’s emotional and psychological states to recover, and this included their confidence.”

To increase patient confidence in using their paralyzed arm, Rubio and colleagues conducted a small pilot study with 20 hemiparetic stroke patients.

Virtual reality technique changes patients’ beliefs

Using a “Rehabilitation Gaming System” (RGS) with a Microsoft Kinect sensor, the patients were able to control a virtual body with their own movements, from a first-person perspective.

During the study, the researchers asked the patients to reach targets that appeared in a virtual environment. For some of the trials, the team gradually improved the movement of the paretic limb in the virtual world, making it appear faster, more accurate and easier to use – without alerting the participants that they did so.

After sneaking in the gradual changes, the team then recorded the patients’ performance on trials with the normal settings, including the likelihood of them using their paretic arm.

Results showed that after enhancing the movement, the patients began to use their paretic limb more often. Rubio says this suggests that “changing patients’ beliefs on their capabilities significantly improves the use of their paretic limb.”

In detail, the team found that only 10 minutes of enhancement was needed to produce “significant changes in the amount of spontaneous use of the affected limb.”

And after the enhanced trials, the patients were significantly more likely to select their paretic limb when reaching toward a virtual target, despite having no awareness that the previous trials were enhanced.

‘A virtuous circle of recovery’

Rubio and colleagues note that current stroke therapies involve forcing patients to use the paretic limb by limiting movement of the healthy limb, but this study provides hope of an alternative solution – one in which the patient’s confidence is used in recovery.

Commenting on their technique, Rubio says:

“This therapy could create a virtuous circle of recovery, in which positive feedback, spontaneous arm use and motor performance can reinforce each other. Engaging patients in this ongoing cycle of spontaneous arm use, training and learning could produce a remarkable impact on their recovery process.”

She adds that the RGS has demonstrated a “significant impact on recovery of functionality for both acute and chronic patients,” and the system is used in Spanish hospitals and treatment centers.

Next steps for the team are to repeat the study with a larger sample size, to further demonstrate how virtuality reality interventions can be used in therapy.

In August of last year, Medical News Today investigated how surgeons can be trained using gaming technology.

Written by Marie Ellis

via Can virtual reality help stroke patients recover arm movement? – Medical News Today.

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[ARTICLE] The visual amplification of goal-oriented movements counteracts acquired non-use in hemiparetic stroke patients – Full Text HTML

Abstract

Background: Stroke-induced impairments result from both primary and secondary causes, i.e. damage to the brain and the acquired non-use of the impaired limbs. Indeed, stroke patients often under-utilize their paretic limb despite sufficient residual motor function. We hypothesize that acquired non-use can be overcome by reinforcement-based training strategies.

Methods: Hemiparetic stroke patients (n = 20, 11 males, 9 right-sided hemiparesis) were asked to reach targets appearing in either the real world or in a virtual environment. Sessions were divided into 3 phases: baseline, intervention and washout. During the intervention the movement of the virtual representation of the patients’ paretic limb was amplified towards the target.

Results: We found that the probability of using the paretic limb during washout was significantly higher in comparison to baseline. Patients showed generalization of these results by displaying a more substantial workspace in real world task. These gains correlated with changes in effector selection patterns.

Conclusions: The amplification of the movement of the paretic limb in a virtual environment promotes the use of the paretic limb in stroke patients. Our findings indicate that reinforcement-based therapies may be an effective approach for counteracting learned non-use and may modulate motor performance in the real world.

Introduction

Following stroke, a loss of neural tissue induces drastic neurophysiological changes that often result in cognitive and motor impairments, such as hemiparesis. In order to counteract these deficits patients often introduce compensatory movements (e.g. overutilizing their non-paretic limb). Although these compensatory strategies may immediately improve functional motor performance in activities of daily living (ADLs) or reduce the burden of using the paretic limb, a long period of non-use of the affected limb can lead to further reversible loss of neural and behavioral function [1]. This so-called learned non-use has been associated with a reduced quality of life. Hence, methods must be found to reduce the impact of acquired non-use.

A possible treatment for learned non-use is Constraint Induced Movement Therapy (CIMT), which forces the patient to use the paretic limb by constraining the movement of the non-paretic limb. This technique has been shown to be effective in mitigating the effects of learned non-use [2]–[4]. However, due to the high intensity and long duration of CIMT protocols, which can range from 1 to 6 hours of training per session [5], they may reduce quality of life, affect the patient’s adherence to therapy, be prohibitively expensive and even inconvenient for those patients with severe motor or cognitive deficits [6]. Moreover, it remains unclear whether the standard CIMT protocols are more beneficial than bimanual functional rehabilitation [7]. The success rate of the standard CIMT protocols may depend on the severity of upper limb paresis and latency of intervention post-stroke. Consequently, its application remains restricted to subacute patients, with no severe cognitive impairments, and mild hemiparesis. These very stringent inclusion criteria only account for about 15 % of stroke cases [8]. Hence, in light of these limitations it seems opportune to develop rehabilitation techniques that build on the positive aspects of CIMT, i.e. enhanced use of the paretic limb, while mitigating the negative ones.

Full Text PDF —>  JNER | Full text | The visual amplification of goal-oriented movements counteracts acquired non-use in hemiparetic stroke patients.

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