Posts Tagged mobility
Toyota has introduced a motorized leg that can help people with limited mobility walk again. https://yhoo.it/2L9CzR7
Therapy for Brain Injuries: Facing the Music
July 31, 2018
I recently attended a very interesting workshop delivered by Chroma, which focused on the important role that music therapy can play in the rehabilitation of those who have suffered brain injuries.
Chroma is a national provider of art therapy, music therapy and drama therapy. Their team of therapists works with a range of organisations and professions, including solicitors, to deliver their services.
The workshop touched on the different holistic approaches to rehabilitation that are available to those who have suffered both traumatic and acquired brain injuries ― but focused mainly on a specific type of music therapy known as Neurologic Music Therapy (NMT).
Dealing with a brain injury can cause increased stress and difficulties for those who are affected. Because music evokes emotion and memories in people, it can help them to deal with their anger, anxiety or depression by increasing positive emotions. It can even help improve concentration and coordination, and can assist with basic abilities such as speech and physical movement.
Neurologic Music Therapy
NMT is an advanced type of music therapy, which uses recognised techniques to treat the brain using music and rhythm. NMT can help brain injured patients by using the musical part of the brain, which is undamaged, to encourage them to achieve goals such as re-teaching language or re-learning how to walk.
When merged with other, more traditional therapies (such as physiotherapy and speech and language therapy), NMT is seen to have quite incredible results.
- NMT and language
For instance, where someone has suffered loss of speech due to a stroke, music can create new ways of learning how to verbally communicate again.
To illustrate how this can be achieved, we watched the following short clip showing Peter’s story:
Peter’s progress is a clear example of the positive impact NMT can have on speech and language in even a short period of time – just 5 months in his case.
- NMT and mobility
Where someone’s mobility has been impaired as a result of a brain injury, music can also help to improve their ability to walk, particularly when combined with physiotherapy. This is because rhythm accesses movement centres of the brain.
Here is another clip demonstrating the power of NMT – focusing on mobility this time.
As you can see, George was only able to walk for 40 ft with a walking stick at the start of the session. After just one session, he was able to walk 250 ft, without the aid of the stick and at a much quicker pace.
Costs Benefits of NMT
The above examples demonstrate how effective NMT can be when combined with conventional therapies. Because clients respond to NMT so quickly and with such improved outcomes, the overall rehabilitation costs are often greatly reduced. When combined with traditional rehabilitation treatments, NMT is therefore a cost-effective therapy for clients with either an acquired or traumatic brain injury.
Who can access NMT?
NMT can benefit people with traumatic brain injuries (caused as a result of trauma or a blow to the head) or acquired brain injuries (present since birth or as a result of conditions such as stroke, encephalitis, brain haemorrhage or tumour). NMT can also help people with neurologic disorders such as Parkinson’s Disease, dementia, and multiple sclerosis.
How can we help?
At Bolt Burdon Kemp, we are constantly looking for new and innovative treatments that can help our clients.
If we have supportive evidence from an independent medical expert to say that you suffered a brain injury due to negligent medical treatment and that you could benefit from music therapy, then we can look to recover the costs of the therapy as part of your compensation.
Even while the claim is ongoing, we will do everything that we can to obtain interim payments from the Defendant to pay for this therapy. This means that even before your case has concluded, we can obtain a payout of some compensation to be able to cover the costs of your therapy. This can allow you to access rehabilitation early on in the claim and means you can fund therapies (such as NMT) which may not be freely available on the NHS.
Kate O’Brien is a solicitor in the Adult Brain Injury team at Bolt Burdon Kemp. If you or a loved one is concerned about the treatment you have received, contact Kate free of charge and in confidence on 020 7288 4814 or at KateO’Brien@boltburdonkemp.co.uk. Alternatively, complete this form and one of the solicitors in the Medical Negligence team will contact you. Find out more about the Adult Brain Injury team.
Stroke recovery can be a long process. Managing the ongoing need to rebuild bodily control and strength after neurological damage is no easy task. Each year nearly 800,000 people in the United States alone will suffer from a stroke, leaving them with ongoing physical and neurological damage.
If you have suffered from a stroke, loss of balance and control can make standing and walking difficult. While outpatient stroke recovery therapy is vital to improving this problem, you can also continue improving after returning home with the help of these leg exercises for stroke recovery.
Leg Exercises for Stroke Recovery
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 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 to help strengthen the legs and improve range of motion during stroke recovery.
Sealy understands the importance of fast progress after a stroke, and including ongoing at-home exercises can improve health and well-being. 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.
As with any exercise program, please consult your healthcare provider before you begin. If you notice increased pain, discomfort, or other troubling systems, stop these exercises immediately and talk to your doctor.
Exercise #1 – Standing and Balance
Balance and coordination are often lost after a stroke. This can make simple actions, like standing and walking,
difficult. In addition, weakness can occur around the muscles on the exterior of the hip area.
Exercises for standing and balance are vital to helping you regain your quality of life after a stroke. When performing these exercises, always hold onto a table or similar stable surface to avoid a fall.
Basic Level Standing and Balance Exercise
Hold on to a stable surface, standing straight and tall while you transfer your weight to one side. Swing the other leg to the side. Use your balance to hold this position for 10 seconds. Slowly lower your leg back down. Repeat a few times, as long as you have the strength, and then switch legs.
Intermediate Standing and Balance Exercises
Once you have mastered the first exercise, move on to the intermediate level. Again, hold on to a stable surface, keeping your back tall and straight. Transfer your weight to one leg, and bring the other leg up in front of you, bending the knee. Hold this position for a count of 10, and slowly lower it back down. Repeat, then switch legs.
Advanced Standing and Balance Exercises
Finally, progress to the advanced level. This time, stand straight and tall and transfer your weight to one leg. Swing the other leg out behind you as far as you can. Hold for 10 seconds, if you can, and lower it back down slowly. Repeat and switch legs.
This progression of exercises will strengthen the hip muscle and improve balance, so you can regain normal use of your legs. This exercise series pairs well with the Saebo MayoTrac Infiniti biofeedback triggered stimulation system.
Exercise #2 – Bridging
Often after a stroke, the hips and the core muscle groups, which are crucial to standing and walking, become weak. Bridging exercises help to strengthen these core muscles. Like the standing and balance exercises, bridging exercises move through a progression to help rebuild your strength and coordination.
Basic Bridging Exercise
The basic bridging exercise, called “Inner Range Quad Movement”, builds strength in the thigh muscles. To perform this exercise, lay down and place a pillow or rolled towel under the knee joint. Then, press the back of the knee into the pillow or rolled towel to lift your heel off the floor.
Intermediate Bridging Exercise
“Ski Squats” take bridging exercises to the next level. For this exercise, lean against a flat wall, placing your feet in front of you. Using the wall to support your weight and your back, slowly bend your knees to lower yourself down. Hold this position for 10 seconds, if you can. Slide back up, supporting your weight on the wall, until you are in a standing position.
Advanced Bridging Exercise
To take bridging exercises to the advanced level, repeat the “Ski Squat”, but place a gym ball between yourself and the wall when you bend your knees into the squat position.
Exercise #3 – Clams
If the lower legs are affected after a stroke, Clams can provide strengthening and improved range of motion. Clams focuses on building strength and coordination in the lower leg, increasing range of motion and control.
Basic Clams Exercise – In Sitting
Before starting Clams, you must stretch the calf muscle and build coordination in the lower body. In Sitting helps with this. In a sitting position, create a stirrup around one foot using a towel or belt, placing the stirrup around the ball of the foot. Gently pull the stirrup up towards your body to stretch the calf muscle. Then, pull it with the outer hand to turn the foot out, continuing to stretch the muscle.
Intermediate Clams Exercise
Once you have build some flexibility, you are ready for the Clams exercise. Lay down on your side, and bend your knees, resting one on top of the other. Then, while you keep your feet together, lift the upper knee away from the other knee, holding them apart for a count of 10 seconds. Slowly lower your knee back down. While performing this exercise, make sure that you do not roll your hips back.
Advanced Clams Exercise
After mastering Clams, take it to the next level by lifting the knee and the foot of the upper leg. Again, hold the position for a count of 10 seconds. Lower it back down. Repeat a few times to build strength and range of motion.
Rebuild Strength and Coordination with Stroke Recovery Exercises
Strokes can occur in people of any age, although nearly 75% of all strokes occur after the age of 65, and an individual’s risk doubles after 55. Each year, approximately 600,000 people suffer from their first stroke, and an additional 185,000 have a recurrent stroke.
If you have suffered one or more strokes, it can be easy to feel discouraged at the lack of mobility and control you experience. Stroke exercises, like these, can help you regain that control and build up your strength again, so you can recover from the neurological damage of a stroke.
For extra support in advancing your recovery after a stroke, check out the many advanced products from Saebo to help you every step of the way.
University of California – San Francisco scientists have improved mobility in rats that had experienced debilitating strokes by using electrical stimulation to restore a distinctive pattern of brain cell activity associated with efficient movement. The researchers say they plan to use the 2018 findings to help develop brain implants that might one day restore motor function in human stroke patients.
A release from the university explains that after a stroke, roughly one-third of patients recover fully, one-third have significant lingering movement problems, and one-third remain virtually paralyzed, according to senior author Karunesh Ganguly, MD, PhD, associate professor of neurology and a member of the UCSF Weill Institute for Neurosciences. Even patients who experience partial recovery often continue to struggle with “goal-directed” movements of the arms and hands, such as reaching and manipulating objects, which can be crucial in the workplace and in daily living.
The release quotes Ganguly, who conducts research at the San Francisco VA Health Care System, as saying, “Our main impetus was to understand how we can develop implantable neurotechnology to help stroke patients. There’s an enormous field growing around the idea of neural implants that can help neural circuits recover and improve function. We were interested in trying to understand the circuit properties of an injured brain relative to a healthy brain and to use this information to tailor neural implants to improve motor function after stroke.”
Over the past 20 years, neuroscientists have presented evidence that coordinated patterns of neural activity known as oscillations are important for efficient brain function. More recently, low-frequency oscillations (LFOs)–which were first identified in studies of sleep–have been specifically found to help organize the firing of neurons in the brain’s primary motor cortex. The motor cortex controls voluntary movement, and LFOs chunk the cells’ activity together to ensure that goal-directed movements are smooth and efficient.
In the new study, published in the June 18, 2018 issue of Nature Medicine, the researchers first measured neural activity in rats while the animals reached out to grab a small food pellet, a task designed to emulate human goal-directed movements. They detected LFOs immediately before and during the action, which inspired the researchers to investigate how these activity patterns might change after stroke and during recovery.
To explore these questions, they caused a stroke in the rats that impaired the animals’ movement ability, and found that LFOs diminished. In rats that were able to recover, gradually making faster and more precise movements, the LFOs also returned. There was a strong correlation between recovery of function and the reemergence of LFOs. Animals that fully recovered had stronger low-frequency activity than those that partially recovered, and those that didn’t recover had virtually no low-frequency activity.
To try to boost recovery, the researchers used electrodes to both record activity and deliver a mild electrical current to the rats’ brains, stimulating the area immediately surrounding the center of the stroke damage. This stimulation consistently enhanced LFOs in the damaged area and appeared to improve motor function: when the researchers delivered a burst of electricity right before a rat made a movement, the rat was up to 60 percent more accurate at reaching and grasping for a food pellet.
“Interestingly, we observed this augmentation of LFOs only on the trials where stimulation was applied,” said Tanuj Gulati, PhD, a postdoctoral researcher in the Ganguly lab who is co-first author of the study, along with Dhakshin Ramanathan, MD, PhD, now assistant professor of psychiatry at UC San Diego, and Ling Guo, a neuroscience graduate student at UCSF.
“We are not creating a new frequency, we are amplifying the existing frequency,” added Ganguly. “By amplifying the weak low-frequency oscillations, we are able to help organize the task-related neural activity. When we delivered the electrical current in step with their intended actions, motor control actually got better.”
The researchers wanted to know whether their findings might also apply to humans, so they analyzed recordings made from the surface of the brain of an epilepsy patient who had suffered a stroke that had impaired the patient’s arm and hand movements. The recordings revealed significantly fewer LFOs than recordings made in two epilepsy patients who hadn’t had a stroke. These findings suggest that, just as in rats, the stroke had caused a loss of low-frequency activity that impaired the patient’s movement.
Physical therapy is the only treatment currently available to aid stroke patients in their recovery. It can help people who are able to recover neurologically get back to being fully functional more quickly, but not those whose stroke damage is too extensive. Ganguly hopes that electrical brain stimulation can offer a much-needed alternative for these latter patients, helping their brain circuits to gain better control of motor neurons that are still functional. Electrical brain stimulation is already widely used to help patients with Parkinson’s disease and epilepsy, and Ganguly believes stroke patients may be the next to benefit.
Mobility Mission Online Game
Mobility Mission is an entertaining online game that addresses post-stroke mobility challenges. Stroke is a serious condition, and learning to deal with the effects of surviving a stroke can be challenging. This game will help you gain a better understanding of post-stroke mobility challenges such as spasticity, paralysis, foot drop, as well as management and treatment options you can discuss with your healthcare provider. As you travel through the four levels of the game you will learn how to improve your safety at home and acquire tips to lower your risk of falling. Your journey is waiting!
Researchers propose that video games be used as a complement to physiotherapy treatments to help improve the mobility of patients who have experienced ischemic strokes.
In their study, published in the PNAS Journal, researchers from Basque Center on Cognition, Brain and Language (BCBL) in San Sebastian and the London Imperial College analyzed the architecture of brain injuries in stroke patients.
They propose a new therapeutic pathway that complements the physical treatments received by these patients with therapies to overcome attention deficit disorders, such as working with video games.
“Patients with brain injuries in attention control areas also suffer motility control problems, even when the movement required by the task is very simple,” says BCBL researcher David Soto, in a media release from FECYT – Spanish Foundation for Science and Technology.
The team explored the extent and location of brain injuries in 167 stroke patients for more than 3 years. Through a “mapping” performed with magnetic resonance, they identified the affected part and the type and size of the lesion, and analyzed the connectivity between the different areas of the brain.
Next, they subjected the patients to various motor tasks, some very simple, such as grabbing an object with force. After the tests, the researchers found that these tasks were “impaired” in those patients who had injuries in the area of the brain “involved” in attention, the release explains.
Soto notes that before this study was conducted it was thought that the control of movement and the attention control aspect were “different systems” with little relation to each other, and that the treatments enabled for the patients with cognitive injuries could not serve for those who had mobility problems. However, their research appears to suggest otherwise.
“We have to know first how our brain controls and moves to design effective therapeutic tools for stroke patients and specific therapies for each individual depending on where the injury has occurred,” he concludes.
To confirm these results, the next step will be to establish a clinical trial with patients suffering motor skills disorders due to a stroke and divide them into two groups: one of them undergoing physiotherapy treatment and the other with complementary cognitive training, per the release.
[Source(s): FECYT – Spanish Foundation for Science and Technology, Science Daily]
Technically assisted rehabilitation of mobility after stroke has been well established for several years. There is good evidence for the use of end-effector devices, exoskeletons and treadmill training with and without body weight support. New developments provide the possibility for functional training during mobilization, even in intensive care units. Mobile exoskeleton devices have been developed, but their clinical effects need still to be evaluated. All devices should not only focus on increasing the number of repetitions, but also include motivational aspects such as virtual reality environments. Hygienic aspects impose a special challenge. All devices should be integrated into a rational and clearly-defined therapy concept.
Technicallyassisted rehabilitation of mobility after stroke has been well established for several years . The premise “if you want to learn to walk, you have to walk” is of primary importance. In 1995, the working group led by Stefan Hesse showed that repetitive training of walking movements using a treadmill leads to greater improvement of walking ability in stroke patients compared to conventional physiotherapy .
Since using a treadmill for severely affected patients is not an optimal approach, alternative solutions have been sought . Almost simultaneously two technical solutions were developed. By developing the electromechanical Gangtrainer GT1®, the Berlin group created a so-called end-effector device in which the trajectory of the gait cycle is predefined and the body’s center of gravity is controlled by a belt system in the vertical and horizontal direction. An alternative technical solution, the Lokomat®, was developed by a Zürich working group as an exoskeleton which uses motors to control the knee and hip joints, so that the patient can perform gait exercises even in the case of complete paraplegia.
These approaches can now be classified as clearly evidence-based. Within the framework of the guideline initiative of the German Society for Neurorehabilitation, the guideline “Rehabilitation of Motor Function after Stroke” (ReMos) was published in 2015. Based on a systematic literature search, a total of 188 randomized clinical trials and 11 systematic reviews were identified that met stipulated quality criteria . This literature was grouped not only according to interventions, but also according to the target criteria and thus the severity of the patients’ disability. Based on available evidence, different recommendations were made for gaining and improving mobility, improving walking speed, walking distance and balance .
However, during the last few years the rehabilitation landscape in Germany has been particularly characterized by earlier admissions of patients who are still quite disabled when leaving the primary care hospitals. This is demonstrated by massive increases in early rehabilitation treatment capacity, including those with possibilities of mechanical ventilation . For patients, this development offers the advantage of being transferred early in structured rehabilitative environments where new solutions are being developed. The current state of the art as well as new developments will be discussed below. […]