Posts Tagged leg

[WEB SITE] HOMEREHAB – Development of Robotic Technology for Post-Stroke Home Tele-Rehabilitation – The European Coordination Hub for Open Robotics Development

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Rehabilitation can help hemiparetic patients to learn new ways of using and moving their weak arms and legs. With immediate therapy it is also possible that people who suffer from hemiparesis may eventually regain movement. However, reductions in healthcare reimbursement place constant demands on rehabilitation specialists to reduce the cost of care and improve productivity. Service providers have responded by shortening the length of patient hospitalisation.

The HOMEREHAB project will develop a new tele-rehabilitation robotic system for delivering therapy to stroke patients at home. It will research on the complex trade-off between robotic design requirements for in home systems and the performance required for optimal rehabilitation therapies, which current commercial systems designed for laboratories and hospitals do not take into account. Additionally, the new home scenario also demands for the smart monitoring of the patient’s physiological state, and the adaptation of the rehabilitation therapy for an optimal service.

 

Contact:

Universidad Miguel Hernández de Elche (UMH)
Nicolas M. Garcia-Aracil
Email: Nicolas.garcia@umh.es
Internet: www.umh.es

 

CEIT – Centro de Estudios e Investigaciones Técnicas
Iñaki Díaz
Email: idiaz@ceit.es
Internet: www.ceit.es

 

Instead Technologies
Alejandro García Moll
Email: Alejandro.garciam@gouhm.umh.es
Internet: www.gouhm.uhm.es

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via HOMEREHAB – Development of Robotic Technology for Post-Stroke Home Tele-Rehabilitation – The European Coordination Hub for Open Robotics Development

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[Abstract] Simultaneous stimulation in bilateral leg motor areas with intermittent theta burst stimulation to improve functional performance after stroke: a feasibility pilot study

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BACKGROUND: Intermittent theta burst stimulation (iTBS) was widely used in stroke rehabilitation and was more efficient than repetitive transcranial magnetic stimulation in terms of inducing larger motor evoked potential and producing longer effects. To our knowledge, the outcomes are not available combining rehabilitation and iTBS for improving motor function of lower extremities in patients with stroke.
AIM: To evaluate the feasibility and effectiveness of intermittent theta burst stimulation aiming to stimulate bilateral leg motor cortex and promote functional improvements.
DESIGN: A single blind, randomized controlled pilot study.
SETTING: Rehabilitation ward.
POPULATION: Twenty patients with chronic stroke finally enrolled for analyzed.
METHODS: Participants were randomized into two groups to receive 10 sessions of iTBS group and sham group over a 5-week period. The iTBS was delivered over the midline of skull to stimulate bilateral leg motor cortex. The outcome measures included balance, mobility, and leg motor functions were measured before and after interventions.
RESULTS: Within-group differences were significant in the Berg Balance Scale for both groups (Z=-2.442, P=0.015 in iTBS group; Z=-2.094, P=0.036 in sham group), in the Fugl-Meyer Assessment (Z=-2.264, P=0.024) and Overall Stability Index of Biodex Balance System of iTBS group (Z=-2.124, P=0.034). However, no significant between-group differences were found.
CONCLUSIONS: There was no powerful evidence to support the effectiveness of iTBS group better than sham control group. Some essential technical issues should be considered for future studies applying iTBS to stimulate bilateral leg motor cortex.
CLINICAL REHABILITATION IMPACT: iTBS combined with stroke rehabilitation are probably expected to be useful for promote brain plasticity and functional performance but some technical issues should be carefully considered.

via Simultaneous stimulation in bilateral leg motor areas with intermittent theta burst stimulation to improve functional performance after stroke: a feasibility pilot study – European Journal of Physical and Rehabilitation Medicine 2018 Aug 27 – Minerva Medica – Journals

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[WEB SITE] Study: Stroke victims regain more limb use with dual-therapy approach

By

Allen Cone

Scientists found a dual-therapy approach — a brain-computer interface and functional electrical stimulation — helped stroke victims regain use of their arms better than a single therapy. Photo courtesy of Federal Institute of Technology

June 20 (UPI) — Stroke victims regain greater use of their paralyzed limbs with a dual-therapy approach than a single method, according to a study in Europe.

Scientists at Federal Institute of Technology in Lausanne, Switzerland, studied the effects of utilizing a brain-computer interface and functional electrical stimulation on people who had strokes. Their findings were published Wednesday in the journal Nature Communications.

After a stroke, patients are often partially or totally unable to move the whole side of the body or just one arm or leg. A variety of therapies are used to bring this movement back, nerve stimulation being among them.

“The key is to stimulate the nerves of the paralyzed arm precisely when the stroke-affected part of the brain activates to move the limb, even if the patient can’t actually carry out the movement,” Dr. Jose del R. Millan, who holds the Defitech Chair at the institute, said in a press release. “That helps reestablish the link between the two nerve pathways where the signal comes in and goes out.”

RELATED Deep brain stimulation promising for mild Alzheimer’s patients older than 65

In the clinical trial, 27 patients aged 36 to 76 were recruited between September 2012 and August 2015. They all had a similar lesion that resulted in moderate to severe arm paralysis after a stroke at least 10 months earlier.

Half the patients, who were treated with the dual-therapy approach, reported significant improvements. The other half were only treated functional electrical stimulation as a control group and the results were not as noticeable.

“Patients who received the BCI treatment showed more activity in the neural tissue surrounding the affected area,” Mill said. “Due to their plasticity, they could help make up for the functioning of the damaged tissue.”

RELATED Brain stimulation restores movement in rats after stroke

The BCI system was linked the patients’ brains to computers using electrodes. Each time the electrical activity was identified, the system stimulated the arm muscle that controls wrist and finger movements.

After 10 one-hour sessions, scientists noted a significant improvement in arm mobility. After the full round of treatment, test scores were more than twice as high as those of the second group.

In the second group, patients also had their arm muscles stimulated, but randomly. As with the control group, the researchers found how much additional motor-function improvement could be attributed to the BCI system.

RELATED Blacks, Hispanics suffer second bleeding strokes more often

EEGs indicated an increase in connections among the motor cortex regions of their damaged brain hemisphere, the researchers said, which was linked to increased ease in movements.

Most importantly, the patients didn’t lose any of their recovered mobility in follow-ups six to 12 months later, the researchers report.

“BCI-FES therapy resulted in a statistically significant, clinically important, and lasting reduction of impairment in chronic moderate-to-severe stroke patients,” researchers wrote in the study. “In particular, the preservation of clinically relevant improvements at least six months after end of therapy is remarkable.”

 

via Study: Stroke victims regain more limb use with dual-therapy approach – UPI.com

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[WEB SITE] Scientists develop combined therapy for stroke victim recovery

Scientists in Switzerland have demonstrated that combining a brain-computer interface (BCI) with functional electrical stimulation (FES) can help stroke victims recover greater use of their paralysed limbs – even years after the stroke.

 

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Paralysis of an arm and/or leg is one of the most common results of a stroke. However, a team of scientists at the Defitech Foundation Chair in Brain-Machine Interface, in association with other members of EPFL’s Center for Neuroprosthetics, the Clinique Romande de Réadaptation in Sion, and the Geneva University Hospitals, have developed a technique aimed at enabling stroke victims to recover greater use of their paralysed limbs. The scientists’ pioneering approach utilises two existing therapies – a brain-computer interface (BCI) and functional electrical stimulation (FES).

Explaining the key to their approach, José del R. Millán, who holds the Defitech Chair at EPFL, said: “The key is to stimulate the nerves of the paralysed arm precisely when the stroke-affected part of the brain activates to move the limb, even if the patient can’t actually carry out the movement. That helps re-establish the link between the two nerve pathways where the signal comes in and goes out.”.

Combined therapy tested on stroke patients

Twenty-seven patients aged between 36 and 76 took part in the clinical trial. All had a similar lesion that resulted in moderate to severe arm paralysis following a stroke occurring at least ten months earlier. Half of the patients were treated with the scientists’ dual-therapy approach and reported clinically significant improvements. The other half were treated only with FES and served as a control group.

For the first group, the scientists used a BCI system to link the patients’ brains to computers by means of electrodes. This enabled them to pinpoint exactly where the electrical activity occurred in the brain tissue when the patients tried to reach out their hands. Each time the electrical activity was identified the system immediately stimulated the arm muscle controlling the corresponding wrist and finger movements. The patients in the second group also had their arm muscles stimulated, but at random times. This control group enabled the scientists to determine how much of the additional motor-function improvement could be attributed to the BCI system.

 

The scientists noted a significant improvement in arm mobility among patients in the first group after just ten one-hour sessions. When the full round of treatment was completed, some of the first-group patients’ scores on the Fugl-Meyer Assessment – a test used to evaluate motor recovery among patients with post-stroke hemiplegia – were over twice as high as those of the second group.

“Patients who received the BCI treatment showed more activity in the neural tissue surrounding the affected area. Due to their plasticity, they could help make up for the functioning of the damaged tissue,” says Millán.

 

Electroencephalographies (EEGs) of the patients clearly showed an increase in the number of connections among the motor cortex regions of their damaged brain hemisphere, which corresponded with the increased ease in carrying out the associated movements. In addition, the enhanced motor function didn’t seem to diminish with time. Evaluated again 6-12 months later, the patients were found to have lost none of their recovered mobility.

The study results were published in Nature Communications.

via Scientists develop combined therapy for stroke victim recovery

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[WEB SITE] Stroke Recovery Exercises for Your Whole Body – Saebo

Stroke survival rates have improved a lot over the last few years. Stroke was once the third leading cause of death in the United States, but it fell to fourth place in 2008 and fifth place in 2013. Today, strokes claim an average of 129,000 American lives every year. Reducing stroke deaths in America is a great improvement, but we still have a long way to go in improving the lives of stroke survivors.

Stagnant recovery rates and low quality of life for stroke survivors are unfortunately very common. Just 10% of stroke survivors make a full recovery. Only 25% of all survivors recover with minor impairments. Nearly half of all stroke survivors continue to live with serious impairments requiring special care, and 10% of survivors live in nursing homes, skilled nursing facilities, and other long-term healthcare facilities. It’s easy to see why stroke is the leading cause of long-term disability in the United States. By 2030, it’s estimated that there could be up to 11 million stroke survivors in the country.

Traditionally, stroke rehabilitation in America leaves much to be desired in terms of recovery and quality of life. There is a serious gap between stroke patients being discharged and transitioning to physical recovery programs. In an effort to improve recovery and quality of life, the American Heart Association has urged the healthcare community to prioritize exercise as an essential part of post-stroke care.

Unfortunately, too few healthcare professionals prescribe exercise as a form of therapy for stroke, despite its many benefits for patients. Many stroke survivors are not given the skills, confidence, knowledge, or tools necessary to follow an exercise program. However, that can change.

With the right recovery programs that prioritize exercise for rehabilitation, stroke survivors can “relearn” crucial motors skills to regain a high quality of life. Thanks to a phenomenon known as neuroplasticity, even permanent brain damage doesn’t make disability inevitable.

A stroke causes loss of physical function because it temporarily or permanently damages the parts of the brain responsible for those functions. The same damage is also responsible for behavioral and cognitive changes, which range from memory and vision problems to severe depression and anger. Each of these changes correspond to a specific region of the brain that was damaged due to stroke.

For example, damage in the left hemisphere of your brain will cause weakness and paralysis on the right side of your body. If a stroke damages or kills brain cells in the right hemisphere, you may struggle to understand facial cues or control your behavior. However, brain damage due to stroke is not necessarily permanent.

For more Visit Site —> Stroke Recovery Exercises for Your Whole Body

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[WEB SITE] Brain Stimulation May Help Make Exercise Seem Easier – Rehab Managment

A study from the University of Kent looks at the impact of transcranial direct-current stimulation (tDCS), a form of noninvasive brain stimulation, on the perception of effort incurred during endurance exercise.

More specifically, the study, published in Neuroscience, investigated the neuromuscular, physiological, and perceptual responses to exhaustive leg exercise.

Dr Lex Mauger from Kent’s School of Sport and Exercise Sciences, and his research team, found that tDCS delayed exhaustion of the leg muscles by an average of 15% during an exercise task, and that this was likely caused by the participants feeling less effort during the exercise. However, tDCS elicited no significant effect on the neuromuscular response to exercise, explains a media release from the University of Kent.

The performance effects of tDCS only occurred when the tDCS electrodes used to deliver the electrical current were positioned in a particular way. This study therefore provides important methodological guidance for the application of tDCS and provides further evidence that brain stimulation can improve endurance exercise performance, although the authors warn against the uncontrolled use of tDCS, the release adds.

[Source(s): University of Kent, Science Daily]

Source: Brain Stimulation May Help Make Exercise Seem Easier – Rehab Managment

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[Thesis] Mirror Therapy for the Lower-Extremities Post-Stroke – Full Text PDF

Abstract

Despite extensive rehabilitation post-stroke gait remains slow, variable and asymmetric. There is a need for simple interventions to improve lower-extremity motor control and walking ability.

Mirror therapy is a promising intervention though little attention has focused on its use on the lower-extremities post-stroke. This thesis investigates the feasibility and potential effects of a bilateral lower-extremity mirror therapy intervention (LE-MT) post-stroke.

A case series involving three participants, who performed twelve 30 minute sessions of LE-MT over four weeks, is presented. Session duration and number of repetitions completed improved over the course of the intervention indicating LE-MT poststroke is feasible.

Some cases demonstrated improved motor recovery of the leg and clinically meaningful improvements to gait velocity and step variability post-intervention indicating some potential benefits of LE-MT. Future directions will identify who may respond best to LE-MT, investigate the dose-response relationship and the underlying mechanisms of the observed improvements associated with LE-MT.

Full Text PDF

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