Posts Tagged lower extremity

[Brochure] THE FUTURE IS MOVING – Revolutionizing Functional Movement Therapy – HOCOMA

HOCOMA REVOLUTIONIZING REHABILITATION

Conventional therapy today is limited—by time, by number of repetitions, by
the lack of reproducible movement quality and by the fact that it is strenuous for both therapists and patients. In other words: there is a disbalance between the therapy we know we should provide according to motor learning principles and all the factors that prevent us from reaching this goal.[…]

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[ARTICLE] Including a Lower-Extremity Component during Hand-Arm Bimanual Intensive Training does not Attenuate Improvements of the Upper Extremities: A Retrospective Study of Randomized Trials – Full Text

Hand-Arm Bimanual Intensive Therapy (HABIT) promotes hand function using intensive practice of bimanual functional and play tasks. This intervention has shown to be efficacious to improve upper-extremity (UE) function in children with unilateral spastic cerebral palsy (USCP). In addition to UE function deficits, lower-extremity (LE) function and UE–LE coordination are also impaired in children with USCP. Recently, a new intervention has been introduced in which the LE is simultaneously engaged during HABIT (Hand-Arm Bimanual Intensive Therapy Including Lower Extremities; HABIT-ILE). Positive effects of this therapy have been demonstrated for both the UE and LE function in children with USCP. However, it is unknown whether the addition of this constant LE component during a bimanual intensive therapy attenuates UE improvements observed in children with USCP. This retrospective study, based on multiple randomized protocols, aims to compare the UE function improvements in children with USCP after HABIT or HABIT-ILE. This study included 86 children with USCP who received 90 h of either HABIT (n = 42) or HABIT-ILE (n = 44) as participants in previous studies. Children were assessed before, after, and 4–6 months after intervention. Primary outcomes were the ABILHAND-Kids and the Assisting Hand Assessment. Secondary measures included the Jebsen-Taylor Test of Hand Function, the Pediatric Evaluation of Disability Inventory [(PEDI); only the self-care functional ability domain] and the Canadian Occupational Performance Measure (COPM). Data analysis was performed using two-way repeated-measures analysis of variance with repeated measures on test sessions. Both groups showed similar, significant improvements for all tests (test session effect p < 0.001; group × test session interaction p > 0.05) except the PEDI and COPM. Larger improvements on these tests were found for the HABIT-ILE group (test session effect p < 0.001; group × test session interaction p < 0.05). These larger improvements may be explained by the constant simultaneous UE–LE engagement observed during the HABIT-ILE intervention since many daily living activities included in the PEDI and the COPM goals involve the LE and, more specifically, UE–LE coordination. We conclude that UE improvements in children with USCP are not attenuated by simultaneous UE–LE engagement during intensive intervention. In addition, systematic LE engagement during bimanual intensive intervention (HABIT-ILE) leads to larger functional improvements in activities of daily living involving the LE.

Introduction

Cerebral palsy (CP) is the most common cause of pediatric motor disability with a prevalence ranging from 2 to 3.6 out of 1,000 children in western countries (12). Motor disorders are often accompanied by sensation, perception, cognition, behavior, communication, and epilepsy disorders (1). Although the lesions are established from birth and are non-progressive, the motor impairments experienced by children with CP affect their autonomy and functional outcomes during their life-span. Moreover, motor symptoms such as impaired ability to walk may worsen during development (3).

One of the most disabling long-term functional deficits in children with unilateral spastic cerebral palsy (USCP) is impaired manual dexterity, i.e., impaired skilled hand movements and precision grip abilities (4). Upper-extremity (UE) impairments may affect functional independence, especially for activities of daily living requiring bimanual coordination (e.g., buttoning one’s shirt). It is now well known that intensive interventions based on motor skill learning principles and goal-directed training are effective for improving UE function in children with USCP (5). Constraint-Induced Movement Therapy (CIMT) was the first intensive intervention adapted to children with USCP (6). CIMT was first designed for adults with stroke and subsequently adapted to children with USCP showing improvements in hand function (5). Taking advantage of the key ingredient of CIMT (intensive practice with the affected UE), Charles and Gordon developed an alternative intensive bimanual approach termed “Hand-Arm Bimanual Intensive Therapy” (HABIT) (7). HABIT was developed with recognition that the combined use of both hands was necessary to increase functional independence in children with USCP (7). Focusing on improving bimanual coordination through structured play and functional activities during HABIT demonstrated efficacy to improve UE function in children with USCP (5).

Both HABIT and CIMT focus only on the UE of children with USCP. Though the lower extremity (LE) is generally less affected than UE in children with USCP, impairments observed in the affected LE range from an isolated equine ankle to hip flexion and adduction with a fixed knee (8). Children with USCP are then unable to achieve postural symmetry while standing, systematically presenting with an overload on one bodyside (8). They also frequently encounter limitations in walking abilities (3). Besides the LE impairments, UE–LE coordination is often impaired in children with USCP (910). This coordination is frequently used in daily living activities (e.g., walking while carrying an object in the hand, climbing stairs while using the railing). A program that simultaneously trains the UE and LE in children with USCP is thus of interest since the UE impairments in children with CP remain stable through time (11) while walking and other LE abilities may decline during development (3). In 2014, taking advantage of the key ingredients in HABIT (intensive bimanual practice), Bleyenheuft and Gordon developed a new intervention focusing on both the UE and LE entitled “Hand-Arm Bimanual Intensive Therapy Including Lower Extremities” (HABIT-ILE) (12). Positive effects of this therapy focusing on both the UE and LE through structured play and functional activities have been demonstrated both for the UE and the LE of children with USCP (13) as well as, more recently, for children with bilateral CP (14). However, it is unknown whether the introduction of a systematic LE engagement in addition to a bimanual intervention may lead to attenuated improvements in UE compared to traditional HABIT due to shifts in attention (multitasking). This retrospective study aimed to compare changes in the UE of children with USCP undergoing 90 h of intensive bimanual intervention either with (HABIT-ILE) or without (HABIT) a LE component. We hypothesized that the introduction of systematic LE training simultaneously added to the bimanual training would lead to reduced improvements in the UE during HABIT-ILE compared to traditional HABIT. […]

Continue —> Frontiers | Including a Lower-Extremity Component during Hand-Arm Bimanual Intensive Training does not Attenuate Improvements of the Upper Extremities: A Retrospective Study of Randomized Trials | Neurology

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[BOOK] Full Stride: Advancing the State of the Art in Lower Extremity Gait Systems – Google Books

Full StrideAdvancing the State of the Art in Lower Extremity Gait Systems

Front Cover
Victoria TepeCharles M. Peterson
SpringerSep 22, 2017 – Medical – 244 pages
This ground-breaking title begins with an introductory overview of the Lower Extremity Gait Systems (LEGS) project, identifying concerns and observations as context for the reader to consider topics and challenges detailed in later chapters. Next are chapters that explore relevant military and civilian needs, and an essential historical context of the capabilities and limitations of contemporary prosthetics. The section concludes with an overview of essential components used in passive and active lower limb prosthetics, including sockets, foot, ankle, and knee systems, as well as emerging bionic systems. A second section considers research and development in orthotics, synthetic and biological materials, volitional control, and wearable robotics (also known as exoskeletons). Finally, expert authors explore advanced science and emerging medical perspectives in research related to limb salvage, osseointegration, limb transplantation, and tissue engineering. Designed for medical practitioners, engineers, students, and researchers who use or develop prosthetic technology for civilian or military amputees, Full Stride: Advancing the State of the Art in Lower Extremity Gait Systems will be of great interest to trauma specialists, orthopedists, rehabilitation specialists, nursing staff and physical therapists, as well as researchers and scientists who specialize in fields that shape and inform advanced prosthetic device development such as materials sciences, engineering (electrical, mechanical, biomedical), robotics, and human physiology.

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Source: Full Stride: Advancing the State of the Art in Lower Extremity Gait Systems – Google Books

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[Abstract] An attempt to explain the Vojta therapy mechanism of action using the surface polyelectromyography in healthy subjects: A pilot study

Abstract

Background

Rehabilitation according to Vojta is a neurophysiological method used to obtain reflex responses in muscles following stimulation of particular activation zones.

Objectives

This study aims to objectively evaluate the muscular responses following stimulation according to Vojta’s method. The possible routes of spinal transmission responsible for the phenomenon of muscle activation in upper and lower extremities are considered.

Methods

Polyelectromyographic (pEMG) recordings in the upper and lower extremities in healthy volunteers (N = 25; aged 24 ± 1 year) were performed to find out the possible routes of spinal transmission, responsible for muscle activation. The left acromion and right femoral epicondyle were stimulated by a Vojta therapist; pEMG recordings were made including the bilateral deltoid and rectus femoris muscles.

Results and Discussion

Following acromion stimulation, muscle activation was mostly expressed in the contralateral rectus femoris, rather than the contralateral deltoid and the ipsilateral rectus femoris muscles. After stimulation of the lower femoral epicondyle, the following order was observed: contra lateral deltoid, ipsilateral deltoid and the contra lateral rectus femoris muscle.

One of the candidates responsible for the main crossed neural transmission involved in the Vojta therapy mechanism would be the long propriospinal tract neurons.

Source: An attempt to explain the Vojta therapy mechanism of action using the surface polyelectromyography in healthy subjects: A pilot study

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[VIDEO] The LegTutor by MediTouch – YouTube

Δημοσιεύτηκε στις 11 Ιουν 2017

The LegTutor consists of an ergonomic wearable leg brace. Its innovative technology allows lower extremity practice of the hip and knee employing both isolated joints and functional tasks.

The LegTutor is used by the therapist to practice both weight bearing and non weight bearing exercises. The system permits a range of biomechanical evaluations including joint active and passive range of motion. This allows the therapist to measure a baseline of movement ability and document and report progress.

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[ARTICLE] Movement visualisation in virtual reality rehabilitation of the lower limb: a systematic review – Full Text

Abstract

Background

Virtual reality (VR) based applications play an increasing role in motor rehabilitation. They provide an interactive and individualized environment in addition to increased motivation during motor tasks as well as facilitating motor learning through multimodal sensory information. Several previous studies have shown positive effect of VR-based treatments for lower extremity motor rehabilitation in neurological conditions, but the characteristics of these VR applications have not been systematically investigated. The visual information on the user’s movement in the virtual environment, also called movement visualisation (MV), is a key element of VR-based rehabilitation interventions. The present review proposes categorization of Movement Visualisations of VR-based rehabilitation therapy for neurological conditions and also summarises current research in lower limb application.

Methods

A systematic search of literature on VR-based intervention for gait and balance rehabilitation in neurological conditions was performed in the databases namely; MEDLINE (Ovid), AMED, EMBASE, CINAHL, and PsycInfo. Studies using non-virtual environments or applications to improve cognitive function, activities of daily living, or psychotherapy were excluded. The VR interventions of the included studies were analysed on their MV.

Results

In total 43 publications were selected based on the inclusion criteria. Seven distinct MV groups could be differentiated: indirect MV (N = 13), abstract MV (N = 11), augmented reality MV (N = 9), avatar MV (N = 5), tracking MV (N = 4), combined MV (N = 1), and no MV (N = 2). In two included articles the visualisation conditions included different MV groups within the same study. Additionally, differences in motor performance could not be analysed because of the differences in the study design. Three studies investigated different visualisations within the same MV group and hence limited information can be extracted from one study.

Conclusions

The review demonstrates that individuals’ movements during VR-based motor training can be displayed in different ways. Future studies are necessary to fundamentally explore the nature of this VR information and its effect on motor outcome.

Background

Virtual reality (VR) in neurorehabilitation has emerged as a fairly recent approach that shows great promise to enhance the integration of virtual limbs in one`s body scheme [1] and motor learning in general [2]. Virtual Rehabilitation is a “group [of] all forms of clinical intervention (physical, occupational, cognitive, or psychological) that are based on, or augmented by, the use of Virtual Reality, augmented reality and computing technology. The term applies equally to interventions done locally, or at a distance (tele-rehabilitation)” [3]. The main objectives of intervention for facilitating motor learning within this definition are to (1) provide repetitive and customized high intensity training, (2) relay back information on patients’ performance via multimodal feedback, and (3) improve motivation [24]. VR therapies or interventions are based on real-time motion tracking and computer graphic technologies displaying the patients’ behaviour during a task in a virtual environment.

The interaction of the user and Virtual environment can be described as a perception and action loop [5]. This motor performance is displayed in the virtual environment and subsequently, the system provides multimodal feedback related to movement execution. Through external (e.g. vision) and internal (proprioception) senses the on-line sensory feedback is integrated into the patient’s mental representation. If necessary, the motor plan is corrected in order to achieve the given goal [5].

A previous Cochrane Review from Laver, George, Thomas, Deutsch, and Crotty [2] on Virtual Reality for stroke rehabilitation showed positive effects of VR intervention for motor rehabilitation in people post-stroke. However, grouped analysis from this review on recommendation for VR intervention provides inconclusive evidence. The author further comments that “[…] virtual reality interventions may vary greatly […], it is unclear what characteristics of the intervention are most important” ([2], p. 14).

Virtual rehabilitation system provides three different types of information to the patient: movement visualisation, performance feedback and context information [6]. During a motor task the patient’s movements are captured and represented in the virtual environment (movement visualisation). According to the task success, information about the accomplished goal or a required movement alteration is transmitted through one or several sensory modalities (performance feedback). Finally, these two VR features are embedded in a virtual world (context information) that can vary from a very realistic to an abstract, unrealistic or reduced, technical environment.

Performance feedback often relies on theories of motor learning and is probably the most studied information type within VR-based motor rehabilitation. Moreover, context information is primarily not designed with a therapeutic purpose. Movement observation, however, plays an important role for central sensory stimulation therapies, such as mirror therapy or mental training. The observation or imagination of body movements facilitates motor recovery [789] and provides new possibilities for cortical reorganization and enhancement of functional mobility. Thus, it appears that movement visualisation may also play an important role in motor rehabilitation [101112], although this aspect is yet to be systematically investigated [13].

The main goal of the present review is to identify various movement visualisation groups in VR-based motor interventions for lower extremities, by means of a systematic literature search. Secondarily, the included studies are further analysed for their effect on motor learning. This will help guide future research in rehabilitation using VR.

An interim analysis of the review published in 2013 showed six MV groups for upper and lower extremity training and additional two MV groups directed only towards lower extremity training. In this paper, we analysed only studies involving lower limb training, leading to a revision and expansion of the previously published MV groups findings [131415].

Continue —> Movement visualisation in virtual reality rehabilitation of the lower limb: a systematic review | BioMedical Engineering OnLine | Full Text

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[ARTICLE] Transcranial Direct Current Stimulation Does Not Affect Lower Extremity Muscle Strength Training in Healthy Individuals: A Triple-Blind, Sham-Controlled Study – Full Text

The present study investigated the effects of anodal transcranial direct current stimulation (tDCS) on lower extremity muscle strength training in 24 healthy participants. In this triple-blind, sham-controlled study, participants were randomly allocated to the anodal tDCS plus muscle strength training (anodal tDCS) group or sham tDCS plus muscle strength training (sham tDCS) group. Anodal tDCS (2 mA) was applied to the primary motor cortex of the lower extremity during muscle strength training of the knee extensors and flexors. Training was conducted once every 3 days for 3 weeks (7 sessions). Knee extensor and flexor peak torques were evaluated before and after the 3 weeks of training. After the 3-week intervention, peak torques of knee extension and flexion changed from 155.9 to 191.1 Nm and from 81.5 to 93.1 Nm in the anodal tDCS group. Peak torques changed from 164.1 to 194.8 Nm on extension and from 78.0 to 85.6 Nm on flexion in the sham tDCS group. In both groups, peak torques of knee extension and flexion significantly increased after the intervention, with no significant difference between the anodal tDCS and sham tDCS groups. In conclusion, although the administration of eccentric training increased knee extensor and flexor peak torques, anodal tDCS did not enhance the effects of lower extremity muscle strength training in healthy individuals. The present null results have crucial implications for selecting optimal stimulation parameters for clinical trials.

Introduction

Transcranial direct current stimulation (tDCS) is a non-invasive cortical stimulation procedure in which weak direct currents polarize target brain regions (Nitsche and Paulus, 2000). The application of anodal tDCS to the primary motor cortex of the lower extremity transiently increases corticospinal excitability in healthy individuals (Jeffery et al., 2007Tatemoto et al., 2013) and improves motor function in healthy individuals and patients with stroke (Tanaka et al., 20092011Madhavan et al., 2011Sriraman et al., 2014Chang et al., 2015Montenegro et al., 20152016Angius et al., 2016Washabaugh et al., 2016). Thus, anodal tDCS has a potential to become a new adjunct therapeutic strategy for the rehabilitation of leg motor function and locomotion following a stroke.

Lower leg muscle strength is an important motor function required for patients who have had a stroke to regain activities of daily living (ADL). Lower leg muscle strength correlates with performance in activities, including sit-to-stand, gait, and stair ascent (Bohannon, 2007). Furthermore, lower leg muscle strength training increases muscle strength and improves ADL in patients with stroke (Ada et al., 2006). Therefore, lower leg muscle strength training is one of the important activities rehabilitating patients with stroke to regain their independence in ADL.

Several studies have examined the effect of a single session of tDCS on lower leg muscle strength, although the evidence is inconsistent (Tanaka et al., 20092011Montenegro et al., 20152016Angius et al., 2016Washabaugh et al., 2016). Its effects seem dependent on tDCS protocols, training tasks, muscle groups, and subject populations. Although, most tDCS studies on lower leg muscle strength have focused on the acute effects of a single tDCS application, to the best of our knowledge, no study has examined how lower extremity strength training combined with repeated sessions of tDCS affects lower leg muscle strength. This type of investigation has strong clinical implications for the application of tDCS in rehabilitation for patients with lower leg muscle weakness.

Thus, to examine whether anodal tDCS can enhance the effects of lower extremity muscle strength training, the present study simultaneously applied anodal tDCS and lower extremity muscle strength training to healthy individuals and evaluated their effects on lower extremity muscle strength.

Continue —> Frontiers | Transcranial Direct Current Stimulation Does Not Affect Lower Extremity Muscle Strength Training in Healthy Individuals: A Triple-Blind, Sham-Controlled Study | Perception Science

Figure 1. Experimental setup of the muscle strength training and torque assessment.

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[VIDEO] Functional electrical stimulation (FES) talk with Christine Singleton and Sarah Joiner – YouTube

Δημοσιεύτηκε στις 22 Μαρ 2017

Lead Clinical Physiotherapist Christine Singleton and Sarah Joiner who has MS discuss Functional electrical stimulation (FES), how it works, who can use it, how to wear it, does it make a difference and how can you get referred for it. For more information about FES visit our website https://www.mstrust.org.uk/a-z/functi…

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[Abstract] Virtual Reality to Assess and Treat Lower Extremity Disorders in Post-stroke Patients

Abstract
Introduction: This article is part of the Focus Theme of Methods of Information in Medicine on “Methodologies, Models and Algorithms for Patients Rehabilitation”.
Objectives: To identify support of a virtual reality system in the kinematic assessment and physiotherapy approach to gait disorders in individuals with stroke.
Methods: We adapt Virtual Reality Rehabilitation System (VRRS), software widely used in the functional recovery of the upper limb, for its use on the lower limb of hemiplegic patients. Clinical scales have been used to relate them with the kinematic assessment provided by the system. A description of the use of reinforced feedback provided by the system on the recovery of deficits in several real cases in the field of physiotherapy is performed. Specific examples of functional tasks have been detailed, to be considered in creating intelligent health technologies to improve post-stroke gait.
Results: Both participants improved scores on the clinical scales, the kinematic parameters in leg stance on plegic lower extremity and walking speed > Minimally Clinically Important Difference (MCID).
Conclusion: The use of the VRRS software attached to a motion tracking capture system showed their practical utility and safety in enriching physiotherapeutic assessment and treatment in post-stroke gait disorders.

Source: Virtual Reality to Assess and Treat Lower Extremity Disorders in Post-stroke Patients

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[WEB SITE] Restorative Therapies to Showcase Xcite FES System at APTA Combined Sections Meeting in San Antonio, TX February.


Restorative Therapies, Inc, the leader in FES powered systems, announced today that it will be exhibiting the new Xcite FES system at APTA’s Combined Sections Meeting taking place at the Henry B. González Convention Center in San Antonio, TX over February 15 to 18, 2017.

Restorative Therapies will be featuring live demonstrations of their new Xcite FES system, and experts will be on hand at booth number 442 to discuss the clinical applications.

Xcite FES Clinical Station is a portable, multi-channel FES therapy system. Easy to use pre-programmed activity libraries for upper extremity, lower extremity and general activities deliver sequenced stimulation enabling a patient’s weak or paralyzed muscles to move through dynamic movement patterns. Xcite assists patients to perform task specific, strengthening and gross motor activities using up to 12 channels of stimulation.

The on screen photo guide for electrode placement facilitates easy set up. An avatar demonstrates each activity and there are chimes to indicate transitions providing visual and auditory cues that assist your patient with timing and awareness of movements.

“Repetitive practice of task specific, strengthening and gross motor activities have long been a cornerstone of PT and OT programs for patients with neurological impairments or muscle weakness,” says Wendy Warfield, MSHA, OTR/L, Clinical Education Manager of Restorative Therapies. “Xcite is designed to be easily integrated into these traditional programs. Xcite enhances the impact of the traditional therapeutic activities that support neuromuscular reeducation.”

“There is nothing else on the market that compares to Xcite…It is great to finally have a device that allows you to work on precise motor control and dexterity while providing FES…Xcite’s ability to control each movement channel individually allows you to facilitate more accurate and functional movement patterns for greater recovery,” said Jenny Suggit, MS OTR/L, CLT, Occupational Therapist, Centre Manager, Neurokinex-Gatwick, UK.

Also on display will be RT300 supine. RT300 supine allows people to leg or arm cycle while in bed. Cycling from bed can be an important component in an Early Mobility program. Early Mobility programs are being adopted by a growing number of Intensive Care Units with the goal of enhancing patient outcomes and reducing lengths of stay.

About Restorative Therapies
Restorative Therapies mission is to help people with a neurological impairment or in critical care achieve their full recovery potential. Restorative Therapies is one of the first companies to target activity-based physical therapy and Functional Electrical Stimulation as a rehabilitation therapy for immobility associated with paralysis such as stroke, multiple sclerosis and spinal cord injury or for patients in critical care.

Restorative Therapies is a privately held company headquartered in Baltimore. To learn more about Restorative Therapies please visit us at http://www.restorative-therapies.com

There is nothing else on the market that compares to Xcite…It is great to finally have a device that allows you to work on precise motor control and dexterity while providing FES

 

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