Posts Tagged mobility
[ARTICLE] How a diverse research ecosystem has generated new rehabilitation technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers – Full Text
Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program.
Disabilities cause complex problems in society often unique to each person. A physical disability can limit a person’s ability to access buildings and other facilities, drive, use public transportation, or obtain the health benefits of regular exercise. Blindness can limit a person’s ability to interpret images or navigate the environment. Disabilities in speaking or writing ability may limit the effectiveness of communication. Cognitive disabilities can alter a person’s employment opportunities. In total, a substantial fraction of the world’s population – at least 1 in 6 people – face these individualized problems that combine to create major societal impacts, including limited participation. Further, the average person in the United States can expect to live 20% of his or her life with disability, with the rate of disability increasing seven-fold by age 65 .
In light of these complex, pervasive issues, the field of rehabilitation engineering asks, “How can technology help?” Answering this question is also complex, as it often requires the convergence of multiple engineering and design fields (mechanical, electrical, materials, and civil engineering, architecture and industrial design, information and computer science) with clinical fields (rehabilitation medicine, orthopedic surgery, neurology, prosthetics and orthotics, physical, occupational, and speech therapy, rehabilitation psychology) and scientific fields (neuroscience, neuropsychology, biomechanics, motor control, physiology, biology). Shaping of policy, generation of new standards, and education of consumers play important roles as well.
In the US, a unique research center structure was developed to try to facilitate this convergence of fields. In the 1970’s the conceptual model of a Rehabilitation Engineering Center (REC), focusing engineering and clinical expertise on particular problems associated with disability, was first tested. The first objective of the nascent REC’s, defined at a meeting held by the Committee on Prosthetic Research and Development of the National Academy of Sciences, was “to improve the quality of life of the physically handicapped through a total approach to rehabilitation, combining medicine, engineering, and related science” . This objective became a working definition of Rehabilitation Engineering .
The first five centers focused on topics including functional electrical stimulation, powered orthoses, neuromuscular control, the effects of pressure on tissue, prosthetics, sensory feedback, quantification of human performance, total joint replacement, and control systems for powered wheelchairs and the environment . The first two RECs were funded by the Department of Health, Education, and Welfare in 1971 at Rancho Los Amigos Medical Center in Downey, CA, and Moss Rehabilitation Hospital in Philadelphia. Three more were added the following year at the Texas Institute for Rehabilitation and Research in Houston, Northwestern University/the Rehabilitation Institute of Chicago, and the Children’s Hospital Center in Boston, involving researchers from Harvard and the Massachusetts Institute of Technology . The Rehabilitation Act of 1973 formally defined REC’s and mandated that 25 percent of research funding under the Act go to them . The establishment of these centers was stimulated by “the polio epidemic, thalidomide tragedy and the Vietnam War, as well as the disability movement of the early 70s with its demands for independence, integration and employment opportunities” .
Continue —> How a diverse research ecosystem has generated new rehabilitation technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers | Journal of NeuroEngineering and Rehabilitation | Full Text
[BOOK] Therapeutic Exercise: Foundations and Techniques – Chapter 4: Streching for Improved Mobility – Google Books
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. […]
[Abstract+References] Interventions to improve real-world walking after stroke: a systematic review and meta-analysis
This study aimed to determine the effectiveness of current interventions to improve real-world walking for people with stroke and specifically whether benefits are sustained.
EBSCO Megafile, AMED, Cochrane, Scopus, PEDRO, OTSeeker and Psychbite databases were searched to identify relevant studies.
Proximity searching with keywords such as ambulat*, walk*, gait, mobility*, activit* was used. Randomized controlled trials that used measures of real-world walking were included. Two reviewers independently assessed methodological quality using the Cochrane Risk of Bias Tool and extracted the data.
Nine studies fitting the inclusion criteria were identified, most of high quality. A positive effect overall was found indicating a small effect of interventions on real-world walking (SMD 0.29 (0.17, 0.41)). Five studies provided follow-up data at >3–6 months, which demonstrated sustained benefits (SMD 0.32 (0.16, 0.48)). Subgroup analysis revealed studies using exercise alone were not effective (SMD 0.19 (–0.11, 0.49)), but those incorporating behavioural change techniques (SMD 0.27 (0.12, 0.41)) were.
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Source: Interventions to improve real-world walking after stroke: a systematic review and meta-analysisClinical Rehabilitation – Caroline M Stretton, Suzie Mudge, Nicola M Kayes, Kathryn M McPherson, 2017
Foot drop (sometimes called drop foot or dropped foot) is the inability to raise the front of the foot due to weakness or paralysis of the muscles and nerves that lift the foot. Foot drop itself is not a disease, it is a symptom of a greater problem or medical condition.
You can recognize foot drop by how it affects your gait. Someone with foot drop may drag their toes along the ground when walking because they cannot lift the front of their foot with each step. In order to avoid dragging their toes or tripping they might lift their knee higher or swing their leg in a wide arc instead. This is called steppage gait, and is a coping mechanism for foot drop issues.
Causes of Foot Drop
There are three main causes of the weakened nerves or muscles that lead to foot drop:
1: Nerve Injury. The peroneal nerve is the nerve that communicates to the muscles that lift the foot. Damage to the peroneal nerve is the most common cause of foot drop. The nerve wraps from the back of the knee to the front of the shin and sits closely to the surface, making it easy to damage. Damage to the peroneal nerve can be caused by sports injuries, hip or knee replacement surgery, a leg cast, childbirth or even crossing your legs.
2: Muscle Disorders. A condition that causes the muscles to slowly weaken or deteriorate can also cause foot drop. These disorders may include muscular dystrophy, amyotrophic lateral sclerosis (Lou Gehrig’s disease) and polio.
3: Brain or Spinal Disorders. Neurological conditions can also cause foot drop. Conditions may include stroke, multiple sclerosis (MS), cerebral palsy and Charcot-Marie-Tooth disease.
How Foot Drop is Treated
Treatment for foot drop requires treating the underlying medical condition that caused it. In some cases foot drop can be permanent, but many people are able to recover. There are a number of treatments that can help with foot drop:
If your foot drop is caused by a pinched nerve or herniated disc then you will likely have surgery to treat it. Surgery may also be necessary to repair muscles or tendons if they were directly damaged and are causing foot drop. In severe or long term cases, you might have surgery to fuse your ankle and foot bones and improve your gait.
2: Functional Electrical Stimulation
If your foot drop is being caused by damage to the peroneal nerve than Functional Electrical Stimulation may be an alternative to surgery. A small device can be worn or surgically implanted just below the knee that will stimulate the normal function of the nerve, causing the muscle to contract and the foot to lift while walking.
3: Braces or Ankle Foot Orthosis (AFO)
Wearing a brace or AFO that supports the foot in a normal position is a common treatment for foot drop. The device will stabilize your foot and ankle and hold the front part of the foot up when walking. While traditionally doctors have prescribed bulky stiff splints that go inside the shoe, the SaeboStep is a lightweight and cost effective option that provides support outside the shoe.
4: Physical Therapy
Therapy to strengthen the foot, ankle, and lower leg muscles is the primary treatment for foot drop and will generally be prescribed in addition to the treatment options mentioned above. Stretching and range of motion exercises will also help prevent stiffness from developing in the heel.
Rehabilitation Exercises for Foot Drop
Specific exercises that strengthen the muscles in the foot, ankle and lower leg can help improve the symptoms of foot drop in some cases. Exercises are important for improving range of motion, preventing injury, improving balance and gait, and preventing muscle stiffness.
When treating foot drop, you may work with a physical therapist who will help you get started strengthening your foot, leg and ankle muscles. Rehabilitation for foot drop can be a slow process, so your physical therapist will likely recommend that you continue to do strengthening exercises at home on your own.
By being consistent about your exercises at home, you can maximize your chances of making a successful recovery from foot drop. Strengthening the weakened muscles will allow you to restore normal function and hopefully start walking normally again.
Like any exercise program, please consult your healthcare professional before you begin. Please stop immediately if any of the following exercises cause pain or harm to your body. It’s best to work with a trained professional for guidance and safety.
Sit on the floor with both legs straight out in front of you. Loop a towel or exercise band around the affected foot and hold onto the ends with your hands. Pull the towel or band towards your body. Hold for 30 seconds. Then relax for 30 seconds. Repeat 3 times.
Toe to Heel Rocks
Stand in front of a table, chair, wall, or another sturdy object you can hold onto for support. Rock your weight forward and rise up onto your toes. Hold this position for 5 seconds. Next, rock your weight backwards onto your heels and lift your toes off the ground. Hold for 5 seconds. Repeat the sequence 6 times.
Sit in a chair with both feet flat on the floor. Place 20 marbles and a bowl on the floor in front of you. Using the toes of your affected foot, pick up each marble and place it in the bowl. Repeat until you have picked up all the marbles.
Sit on the floor with both legs straight out in front of you. Take a resistance band and anchor it to a stable chair or table leg. Wrap the loop of the band around the top of your affected foot. Slowly pull your toes towards you then return to your starting position. Repeat 10 times.
Sit on the floor with both legs straight out in front of you. Take a resistance band and wrap it around the bottom of your foot. Hold both ends in your hands. Slowly point your toes then return to your starting position. Repeat 10 times.
Sit in a chair with both feet flat on the floor. Place a small round object on the floor in front of you (about the size of a tennis ball). Hold the object between your feet and slowly lift it by extending your legs. Hold for 5 seconds then slowly lower. Repeat 10 times.
Get Back On Your Feet
Don’t let foot drop affect your mobility, independence, and quality of life. With proper rehabilitation and assistive devices many people are able to overcome the underlying cause of their symptoms and get back to walking normally. If you are showing symptoms of foot drop, talk to a medical professional about your treatment options.
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.
[WEB SITE] Virtual reality intervention shows promise to repair mobility and motor skills in impaired limb
A combination of traditional physical therapy and technology may improve the motor skills and mobility of an impaired hand by having its partner, more mobile hand lead by example through virtual reality training, new Tel Aviv University research suggests.
“Patients suffering from hemiparesis — the weakness or paralysis of one of two paired limbs — undergo physical therapy, but this therapy is challenging, exhausting, and usually has a fairly limited effect,” said lead investigator Prof. Roy Mukamel of TAU’s School of Psychological Sciences and Sagol School of Neuroscience, who conducted the research with his student Ori Ossmy. “Our results suggest that training with a healthy hand through a virtual reality intervention provides a promising way to repair mobility and motor skills in an impaired limb.” The research was published in Cell Reports.
Does the left hand know what the right hand is doing?
53 healthy participants completed baseline tests to assess the motor skills of their hands, then strapped on virtual reality headsets that showed simulated versions of their hands. The virtual reality technology, however, presented the participants with a “mirror image” of their hands — when they moved their real right hand, their virtual left hand would move.
In the first experiment, participants completed a series of finger movements with their right hands, while the screen showed their “virtual” left hands moving instead. In the next, participants placed motorized gloves on their left hands, which moved their fingers to match the motions of their right hands. Again, the headsets presented the virtual left hands moving instead of their right hands.
The research team found that when subjects practiced finger movements with their right hands while watching their left hands on 3D virtual reality headsets, they could use their left hands more efficiently after the exercise. But the most notable improvements occurred when the virtual reality screen showed the left hand moving while in reality the motorized glove moved the hand.
Tricking the brain
“We effectively tricked the brain,” said Prof. Mukamel.
“Technologically, these experiments were a big challenge,” Prof. Mukamel continued. “We manipulated what people saw and combined it with the passive, mechanical movement of the hand to show that our left hand can learn even when it is not moving under voluntary control.”
The researchers are optimistic that this research could be applied to patients in physical therapy programs who have lost the strength or control of one hand. “We need to show a way to obtain high-performance gains relative to other, more traditional types of therapies,” said Prof. Mukamel. “If we can train one hand without voluntarily moving it and still show significant improvements in the motor skills of that hand, we’ve achieved the ideal.”
The researchers are currently examining the applicability of their novel VR training scheme to stroke patients.
Rehabilitation techniques of sensorimotor complications post stroke fall loosely into one of two categories; the compensatory approach or the restorative approach. While some overlap exists, the underlying philosophies of care are what set them apart. The goal of the compensatory approach towards treatment is not necessarily on improving motor recovery or reducing impairments but rather on teaching patients a new skill, even if it only involves pragmatically using the non-involved side (Gresham et al. 1995). The restorative approach focuses on traditional physical therapy exercises and neuromuscular facilitation, which involves sensorimotor stimulation, exercises and resistance training, designed to enhance motor recovery and maximize brain recovery of the neurological impairment (Gresham et al. 1995).In this review, rehabilitation of mobility and lower extremity complications is assessed. An overview of literature pertaining to the compensatory approach and the restorative approach is provided. Treatment targets discussed include balance retraining, gait retraining, strength training, cardiovascular conditioning and treatment of contractures in the lower extremities. Technologies used to aid rehabilitation include assistive devices, electrical stimulation, and splints.
[Stroke Rehabilitation Clinician Handbook] 4. Motor Rehabilitation – 4A. Lower Extremity and Mobility – Full Text PDF
4.1 Motor Recovery of the Lower Extremity Post Stroke
Factors that Predict Motor Recovery
Motor deficits post-stroke are the most obvious impairment (Langhorne et al. 2012) and have a disabling impact on valued activities and independence. Motor deficits are defined as “a loss or limitation of function in muscle control or movement or a limitation of movement” (Langhorne et al. 2012; Wade 1992). Given its importance, a large proportion of stroke rehabilitation efforts are directed towards the recovery of movement disorders. Langhorne et al. (2012) notes that motor recovery after stroke is complex with many treatments designed to promote recovery of motor impairment and function.
The two most important factors which predict motor recovery are:
- Stroke Severity: The most important predictive factor which reduces the capacity for brain reorganization.
- Age: Younger patients demonstrate greater neurological and functional recovery and hence have a better prognosis compared to older stroke patients (Adunsky et al. 1992; Hindfelt & Nilsson 1977; Marini et al. 2001; Nedeltchev et al. 2005).
Changes in walking ability and gait pattern often persist long-term and include increased tone, gait asymmetry, changes in muscle activation and reduced functional abilities (Wooley 2001; Robbins et al. 2006; Pizzi et al. 2007, Pereira et al. 2012). Ambulation post stroke is often less efficient and associated with increased energy expenditure (Pereira et al. 2012). Hemiplegic individuals have been reported to utilize 50-67% more metabolic energy that normal individuals when walking at the same velocity (Wooley et al. 2001).
For mobility outcome, trunk balance is an additional predictor of recovery (Veerbeek et al. 2011). Nonambulant patients who regained sitting balance and some voluntary movement of the hip, knee and/or ankle within the first 72 hours post stroke predicted 98% chance of regaining independent gait within 6 months. In contrast, those who were unable to sit independently for 30 seconds and could not contract the paretic lower limb within the first 72 hours post stroke had a 27% probability of achieving independent gait.
Regain Independence, Function, and Mobility.
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If you’re living with a disability that makes it challenging to carry out normal activities in the typical home, it can be overwhelming to tackle the necessary modifications. There are many types of disabilities, and each has its own set of helpful home modifications. Of course, these recommendations will not work for everyone, but many can be helpful to a number of common disabilities. If you’re looking at disability-friendly home alterations, here are some good projects to start with.
Accessible Home Security
If you have a mobility issue, keeping yourself safe in your home can be a challenge. Door chains are often placed too high for some people to comfortably reach. Install a door security measure such as a chain at a lower level so that you can easily open the door and talk to someone without putting yourself at risk for forced entry.
Deadbolts are also an ideal home security measure. If your deadbolt is difficult to twist, have someone help you adjust the hardware so that the bolt can glide more smoothly.
Organize for Accessibility
Certain areas can be more expensive to modify for accessibility. The kitchen, for example, has a number of places that should ideally be adjusted such as the stove, sink, and countertops. However, remodeling a kitchen is no easy feat. Instead, you may want to consider organizing it for maximum accessibility.
Place all heavy items, including food items, on lower shelves. Lesser used items such as holiday serving platters can go in harder to reach areas. For deep cabinets or even refrigerators, lazy susans can be a great way to ensure that things in the back are within reach. You might also purchase a grasping tool that extends to reach things that are up high or farther away.
Bathrooms are the Riskiest Room in the House
There are many hazards in the average bathroom. Some disabilities increase the risk of slips and falls. Fortunately, modifying the bathroom can be affordable in many cases. Handrails beside the toilet are a great first step, making it easier to sit and rise from the toilet. A shower seat is another excellent precaution.
Slipping in a shower or tub can be fatal or at least seriously damaging. Furthermore, standing for a shower can be difficult for people with chronic fatigue. The ability to sit makes personal hygiene much simpler.
Dim Lighting Should Be Corrected
Dim lighting can make traversing your own home dangerous. Mobility or vision problems can lead to tripping or other accidents. On top of decluttering your home, improving the lighting can vastly improve your safety and mobility. Take care to light areas that do not receive much natural light and add fixtures where necessary to light main areas of the house.
Altering your home to make it more disability-friendly can vary widely in cost depending on your needs. If you’re struggling to find the money you need to upgrade your house, you can always begin with simpler projects such as reorganizing for convenience or placing smaller safety measures. Every small step can make your life easier.
Image via Pixabay by midascode
This post was written by Paul Denikin, who runs dadknowsdiy.com. On his blog, Paul shares his knowledge with home improvement novices, and connects with other people seeking to modify their homes for a loved one with a disability.