Posts Tagged mobility
Virtual reality video games, activity monitors, and handheld computer devices can help people stand as well as walk, the largest trial worldwide into the effects of digital devices in rehabilitation has found. The study was undertaken at hospitals in Sydney and Adelaide, Australia, and had 300 participants ranging from 18 to 101 years old. Those who exercised using digital devices in addition to their usual rehabilitation were found to have better mobility (walking, standing up, and balance) after 3 weeks and after 6 months than those who just completed their usual rehabilitation. The results were published in PLOS Medicine.
Trial participants were recovering from strokes, brain injuries, falls, and fractures. Participants used on average 4 different devices while in hospital and 2 different devices when at home. Fitbits were the most used digital device but also tested were a suite of devices like Xbox, Wii, and iPads, making the exercises more interactive and enabling remote connection between patients and their physical therapists. Having a selection meant the physical therapist could tailor the choice of devices to meet the patient’s mobility problems while considering patient preferences.
Lead author Leanne Hassett, PhD, from the Faculty of Medicine and Health at the University of Sydney, said benefits reported by patients using the digital devices in rehabilitation included variety, fun, feedback about performance, cognitive challenge, that they enabled additional exercise, and the potential to use the devices with others, such as family, therapists, and other patients. “These benefits meant patients were more likely to continue their therapy when and where it suited them, with the assistance of digital healthcare,” she said.
Participants reported doing more walking at 6 months, meaning their rehabilitation was improved, but this was not detected in the physical activity measure (time spent upright) generally. In the younger age group, the devices also increased daily step count. Distinctions between physical activity were made through measurements with an activPAL, a small device attached to the thigh that records how much time is spent in different positions (sitting, standing, lying) as well as number of steps taken each day.
This study used research physical therapists to deliver the study; the next step will be to trial the approach in clinical practice by incorporating it into the work of physical therapists.
DigiTrainer is a tool for reducing the muscle tone and increasing mobility in the fingers
SIMPLY EFFECTIVE HAND THERAPY
DigiTrainer (formerly RehaDigit) can reduce the muscle tone and increase mobility in the fingers of the hand.
Following a stroke, brain injury or spinal cord injury, for example, the muscles and soft-tissues of the hand can become tight and the sensory pathways disrupted.
In order to recover lost tactile sense and to trigger new movement capabilities, intensive rehabilitation is needed and this should start as soon as possible following the injury.
For example, with a cervical level spinal cord injury it is important to avoid complications by early positioning, stretches and oedema management. The hand is perhaps the most important resource after the brain in these cases so the hands must be kept supple if we are to have a chance of developing functional activities. The DigiTrainer makes intensive rehab possible.
DigiTrainer provides both motor and sensory rehabilitation in a simple and effective manner. Through a series of finger-rolls the patient’s fingers are alternately bent and stretched (flexion/extension of the finger joints). The specially designed motor induces a slight vibration into the hand and this supports the relaxation of the finger muscles.
DigiTrainer delivers the following functions
works for the left and the right hand
adjustable rotation velocity
adjustable vibration frequency
continues or periodic crescendo and decrescendo vibrations
ergonomic hand rest (height adjustable)
usage via touch screen
therapy time: 5-30 min
offer price £2,660 ex VAT and shipping
INDICATIONS FOR USE
DigiTrainer can be used for the following indications:
passive bend and stretch movement of the II-V fingers in the rehabilitation of patients with hemi- and tetraparesis from moderate to strong paresis of the upper extremity
for example, after stroke, paraplegia, traumatic brain injury, M. Parkinson or joint injuries
for patients without distal activity of the wrist and finger flexors
incomplete and complete motoric paraplegia after spinal cord injury
for patients with spasticity in arms, low blood circulation and impaired hand mobility
for patients with functional loss after injury or surgery
WHAT IT DOES
DigiTrainer is a CE marked Class II medical device. The items included with the product are 1 DigiTrainer, 2 adapter plates for hand rest (25mm and 20°), 1 power supply and appropriate cable and 1 user manual
Check out the video below to see DigiTrainer in action. The unit accomodates left or right hands of various sizes and allows easy programming via a touch screen interface. The therapist can control the specific nature and speed of the movement as the DigiTrainer stretches and massages the fingers. Integrated vibration relaxes tight fingers in a safe and effective way. DigiTrainer has a unique operating principle – most devices focus on movement whereas DigiTrainer also targets the sensorimotor system. Studies have confirmed the effectiveness of the device.
The DigiTrainer is generally a safe product but we recommend initial supervision and guidance is obtained from knowledgeable person
Contraindications for DigiTrainer include patients with:
fully developed shoulder-arm syndrome
acute arthritis in finger joints, thumb joints and/or wrist
severe contractures of the finger joints, thumb joints and/or wrist
acute disorders requiring special treatment of fingers or hand (e.g. tendinitis)
massively swollen hand
allergic exanthema of hand
Stefan Hesse, H Kuhlmann, J Wilk, C Tomelleri and Stephen GB Kirker (2008) “A new electromechanical trainer for sensorimotor rehabilitation of paralysed fingers: A case series in chronic and acute stroke patients”
Journal of NeuroEngineering and Rehabilitation20085:21
R. Buschfort, J. Brocke, A. Heß, C. Werner, A. Waldner, and Stefan Hesse,
”Arm Studio to intensify upper limb rehabilitation after stroke: Concept, acceptance, utilisation and preliminary clinical results”
J Rehabil Med 2010; 42: 310–314
Stefan Hesse, Anke Heß, Cordula Werner, Nadine Kabbert, Rüdiger Buschfort
“Effect on arm function and cost of robot-assisted group therapy in subacute patients with stroke and a moderately to severely affected arm: a randomized controlled trial”
Clinical Rehabilitation 2014, Vol. 28(7) 637–647
A. Waldner, C. Werner, S. Hesse
“Robot assisted therapy in neurorehabilitation”
EUR MED PHYS 2008;44(Suppl. 1 to No. 3)
Visit site —-> DigiTrainer
[Abstract + References] Unilateral Dorsiflexor Strengthening With Mirror Therapy to Improve Motor Function After Stroke: A Pilot Randomized Study
Background: Independently, cross-education, the performance improvement of the untrained limb following unilateral training, and mirror therapy have shown to improve lower limb functioning poststroke. Mirror therapy has shown to augment the cross-education effect in healthy populations. However, this concept has not yet been explored in a clinical setting.
Objectives: This study set out to investigate the feasibility and potential efficacy of applying cross-education combined with mirror therapy compared with cross-education alone for lower limb recovery poststroke.
Methods: Thirty-one chronic stroke participants (age 61.7 ± 13.3) completed either a unilateral strength training (ST; n = 15) or unilateral strength training with mirror-therapy (MST; n = 16) intervention. Both groups isometrically strength trained the less-affected ankle dorsiflexors three times per week for 4 weeks. Only the MST group observed the mirror reflection of the training limb. Patient eligibility, compliance, treatment reliability, and outcome measures were assessed for feasibility. Maximal voluntary contraction (MVC; peak torque, rate of torque development, and average torque), 10-m walk test, timed up and go (TUG), Modified Ashworth Scale (MAS), and the London Handicap Scale (LHS) were assessed at pretraining and posttraining.
Results: Treatment and assessments were well tolerated without adverse effects. No between group differences were identified for improvement in MVC, MAS, TUG, or LHS. Only the combined treatment was associated with functional improvements with the MST group showing an increase in walking velocity.
Conclusion: Cross-education plus mirror therapy may have potential for improving motor function after stroke. This study demonstrates the feasibility of the combination treatment and the need for future studies with larger sample sizes to investigate the effectiveness of the treatment.
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“I think movement actually is the best medicine. It’s like that saying: ‘If you don’t use it, you lose it’,” Main said. The bike was created by Dutch designer and humanitarian Barbara Alink, who made it initially as a mobility device for her aging mother to use without the stigma attached to mobility walkers and scooters.
A successful crowdfunding campaign in 2014 brought about a launch in the Dutch market and a North America launch followed in 2016. Now the bike, which costs $1,977.00 ships worldwide. “The Alinker is for everybody who identifies as an active person and happens to have a diagnosis,” said Alink.
“The feedback that I’m getting from people is that their life has changed, they can go out again, they have agency back,” she added. The Alinker has three wheels and riders support themselves on a saddle and move their legs to push it forward. It has brakes and the high saddle means users can sit almost at standing height and speak to others at their eye level.
It is used by people with Parkinson’s, arthritis, cerebral palsy, spinal cord injuries, muscular dystrophy, and peripheral neuropathy along with those recovering from strokes and surgery. “Isolation is a bigger disease or a bigger burden on people than the actual symptoms of the disease itself,” said Alink.
“So with the Alinker, being engaged in life again because you can go out… your radius expands again,” she added. Alinker is not classed as a medical device, so many insurance companies do not fund its purchase, leaving people to rely on crowdfunding or using the company’s rent-to-own scheme.
(This story has not been edited by Devdiscourse staff and is auto-generated from a syndicated feed.)
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For older adults, a critical part of living independently is being able to drive. When the unthinkable happens, such as a stroke, it can impact people’s ability to perform everyday tasks, including driving, walking, and picking up objects. Neha Lodha, an assistant professor in the Department of Health and Exercise Science and director of the Laboratory of Movement Neuroscience and Rehabilitation, is conducting research aimed at understanding the impact of stroke on the tasks that are key to functional independence in old age.
Disability from stroke
According to the Centers for Disease Control and Prevention, each year, more than 795,000 Americans have a stroke, and stroke is one of the leading causes of long-term disability in America.
“Stroke risk increases with age, and with our rapidly aging population, these numbers will exponentially increase over the next few years,” said Lodha.
Lodha’s research focuses on understanding the impact that cognitive and motor impairments associated with stroke have on everyday function.
“Stroke often affects the key motor areas in the brain that control our movements,” said Lodha. “As a result, a number of everyday activities are impacted.”
Motor deficits in high-functioning stroke survivors
In a series of publications coming out of her lab, Lodha has looked specifically at the motor deficits apparent in “high-functioning stroke survivors,” a group of people who typically return to their everyday lives, including their jobs and social life, after experiencing a stroke. The demands on them to perform everyday tasks at home and at the office are very high, and require high levels of both mobility and dexterity.
“One area we focus on is functional mobility, which is the ability to safely move in our environment without assistance—including walking and driving,” she said. “The second area of functional independence is the use of our hands to perform dexterous tasks. This involves using our upper limbs to interact with objects in our environment, such steering a car and picking up an object and releasing it safely. Both of these tasks, mobility and dexterity, are important to our functional independence.”
Implications for stroke survivors
Ultimately, Lodha’s work could have important implications for rehabilitation programs for stroke survivors. One of the problems, she says, is that stroke rehabilitation programs are not tailored toward the individual stroke patients and their specific deficits. They tend to be the same for everyone.
Lodha became interested in this problem when she was studying stroke survivors at the University of Florida in her doctoral program in the Department of Applied Physiology and Kinesiology. She noticed that although some severely impaired patients were showing progress in the lab at tasks such as moving objects more quickly, these gains didn’t necessarily translate to everyday tasks that they wanted to do at home, which are more complex, such as lifting a bag of garbage to take it out.
Lodha also noticed that although high-functioning stroke survivors often retained their strength, they weren’t able to control it well enough for delicate tasks. For example, one patient was unable to hold an egg without crushing it.
“What we are beginning to recognize in our stroke research is that the impact of stroke on the movements varies from individual to individual,” said Lodha. “In therapy, we provide a one-size-fits-all rehab program, although the type of motor deficits after stroke depends on the severity of the stroke. We have started asking, how can we identify what the specific motor deficit is so we can target that in a rehab program and see improvement in everyday function?”
This question has become central in her research.
“In order to improve somebody’s mobility or independence, we need to understand what that specific deficit is and fix that to improve their function,” she said.
Lodha’s research is showing that even among high-functioning stroke survivors, those who have robust work and social lives, there are functional deficits that show up in their ability to drive a car.
“We have now found that stroke survivors have the strength and ability to generate forces, but that the ability to modulate the forces is a key deficit,” Lodha said. “This impacts their functional performance in everyday tasks, whether it is walking, driving, steering, or doing fine object manipulation, even if they are seen as functionally recovered.”
High-tech driving simulator
With grant funding from the National Institutes of Health and the American Heart Association, Lodha is studying groups of high-functioning stroke survivors, along with a control group, as they use some unique equipment in her lab, including a high-tech driving simulator.
The driving simulator in Lodha’s lab is from the National Advanced Driving Simulator research center at the University of Iowa. The miniSim is a research-grade, software program which Lodha has coupled with motion-enabled hardware from SimGear. When an individual is driving in the simulator, they get audio and motion feedback as if they are accelerating and braking—making the experience more immersive and realistic. Lodha’s lab is one of the top few sites in the country to install this combined setup. Lodha says both companies were willing to work with her to custom design the research environment.
In a recently published study in the Journal of Rehabilitation and Disability, Lodha and her research team tested grip strength and grip motor control among high-functioning stroke survivors and a control group using the driving simulator. They measured grip strength, grip force modulation, and deviation of the car from the center lane while subjects steered on a winding road in the simulated environment. What they found was that the deficits in grip force modulation rather than grip strength had the most impact on steering performance.
“Typically, insurance companies will not provide rehab for high-functioning stroke survivors,” said Lodha. “Our work is beginning to build an argument for the persistence of motor impairments and therefore the need for rehab for this group.”
While they don’t know yet whether high-functioning stroke survivors can be helped with targeted therapy, Lodha hopes her research showing that this group has persistent deficits will pave the way for new rehabilitation programs to help them succeed in everyday life tasks such as driving safely.
Lodha says her team is now extending its studies to low-functioning stroke survivors to investigate the nature of motor deficits in those patients. The researchers want to find out whether those patients also have difficulty modulating forces or difficulty in even generating forces, such as the stroke survivor in her lab in Florida who was unable to lift a bag of trash.
“Everyday tasks matter to people, and we want to help them perform successfully the tasks that they care about most in their daily lives,” she said.
High-intensity step training that mimics real-world conditions may better improve walking ability in stroke survivors compared to traditional, low-impact training, according to new research published in the American Heart Association’s journal Stroke.
“People who suffer strokes often have difficulty walking and impaired balance. Rehabilitation after a stroke traditionally focuses on patients practicing low-intensity walking, usually only in a forward direction, which does not provide enough of a challenge to the nervous system to enable patients to negotiate real-world situations, such as uneven surfaces, stairs or changing direction,” says study author T. George Hornby, PhD, professor of physical medicine and rehabilitation at Indiana University School of Medicine in Indianapolis, in a media release from the American Heart Association.
“Our study suggests that stroke patients can perform higher-intensity walking exercises and more difficult tasks than previously thought possible. We need to move beyond traditional, low-intensity rehabilitation to challenge the nervous and cardiovascular systems so patients can improve function and perform better in the real world.”
Researchers evaluated 90 people, 18- to 85-years-old with weakness on one side of the body who had survived a stroke at least six months prior.
Participants received training of either high-intensity stepping performing variable, difficult tasks; high-intensity stepping performing only forward walking; or low-intensity stepping of variable tasks. Variable tasks included walking on uneven surfaces, up inclines and stairs, over randomly placed obstacles on a treadmill and across a balance beam.
The researchers observed the following, the release explains:
- Survivors in both the high-intensity, variable training and high-intensity, forward walking groups walked faster and farther than the low-intensity, variable training group.
- For all walking outcomes, 57% to 80% of participants in the high-intensity groups had important clinical gains, while only 9% to 31% of participants did so following low-intensity training.
- High-intensity variable training also resulted in improved dynamic balance while walking and improved balance confidence.
Hornby notes that no serious adverse events occurred during the training sessions, suggesting stroke survivors can be pushed to higher-intensity walking with more variable tasks during rehabilitation.
“Rehabilitation that allows walking practice without challenging the nervous system doesn’t do enough to make a statistical or clinically significant difference in a patient’s recovery after a stroke,” Hornby suggests.
“We found that when stroke patients are pushed harder, they see greater changes in less time, which translates into more efficient rehabilitation services and improved mobility.”
Ultimately, their goal is to incorporate high-intensity variable step training into regular clinical rehabilitation protocols.
The study was small compared to larger, multicenter clinical trials. Hornby adds in the release that the next step would be to test high-intensity, variable step training in larger patient populations in a large, multicenter clinical trial.
[Source(s): American Heart Association, Science Daily]
[Abstract] Effectiveness of static stretching positioning on post-stroke upper-limb spasticity and mobility: Systematic review with meta-analysis
To systematically review the effects of static stretching with positioning orthoses or simple positioning combined or not with other therapies on upper-limb spasticity and mobility in adults after stroke.
This meta-analysis was conducted according to PRISMA guidelines and registered at PROSPERO. MEDLINE (Pubmed), Embase, Cochrane CENTRAL, Scopus and PEDro databases were searched from inception to January 2018 for articles. Two independent researchers extracted data, assessed the methodological quality and rated the quality of evidence of studies.
Three studies (57 participants) were included in the spasticity meta-analysis and 7 (210 participants) in the mobility meta-analysis. Static stretching with positioning orthoses reduced wrist-flexor spasticity as compared with no therapy (mean difference [MD]=-1.89, 95% confidence interval [CI] -2.44 to -1.34; I2 79%, P<0.001). No data were available concerning the spasticity of other muscles. Static stretching with simple positioning, combined or not with other therapies, was not better than conventional physiotherapy in preventing loss of mobility of shoulder external rotation (MD=3.50, 95% CI -3.45 to 10.45; I2 54.7%, P=0.32), shoulder flexion (MD=-1.20, 95% CI -8.95 to 6.55; I2 0%, P=0.76) or wrist extension (MD=-0.32, 95% CI -6.98 to 5.75; I238.5%, P=0.92). No data were available concerning the mobility of other joints.
This meta-analysis revealed very low-quality evidence that static stretching with positioning orthoses reduces wrist flexion spasticity after stroke as compared with no therapy. Furthermore, we found low-quality evidence that static stretching by simple positioning is not better than conventional physiotherapy for preventing loss of mobility in the shoulder and wrist. Considering the limited number of studies devoted to this issue in post-stroke survivors, further randomized clinical trials are still needed.
[Abstract] Mirror therapy for improving lower limb motor function and mobility after stroke: A systematic review and meta-analysis.
Mirror therapy has been proposed as an effective intervention for lower limb rehabilitation post stroke.
This systematic review with meta-analysis examined if lower limb mirror therapy improved the primary outcome measures of muscle tone and motor function and the secondary outcome measures balance characteristics, functional ambulation, walking velocity, passive range of motion (PROM) for ankle dorsiflexion and gait characteristics in patients with stroke compared to other interventions.
Standardised mean differences (SMD) and mean differences (MD) were used to assess the effect of mirror therapy on lower limb functioning.
Nine studies were included in the review. Among the primary outcome measures there was evidence of a significant effect of mirror therapy on motor function compared with sham and non-sham interventions (SMD 0.54; 95% CI 0.24-0.93). Furthermore, among the secondary outcome measures there was evidence of a significant effect of mirror therapy for balance capacity (SMD -0.55; 95% CI -1.01 to -0.10), walking velocity (SMD 0.71; 95% CI 0.35-1.07), PROM for ankle dorsiflexion (SMD 1.20; 95% CI 0.71-1.69) and step length (SMD 0.56; 95% CI -0.00 to 1.12).
The results indicate that using mirror therapy for the treatment of certain lower limb deficits in patients with stroke may have a positive effect. Although results are somewhat positive, overly favourable interpretation is cautioned due to methodological issues concerning included studies.
Brushing teeth, making coffee, unlocking a door – our brain is the central processing unit for many physical movements. This might make you think that without the brain, nothing would happen at all. But that’s not quite true. When a doctor uses a small hammer to tap our knee, we experience a reflexive kick of the lower leg. And when we accidentally touch a hot stovetop, our hand will jerk back immediately. It’s not the brain that’s responsible for such movements, but another part of the central nervous system: the spinal cord. A headless chicken is, albeit somewhat morbid, proof of the fact that a living creature is able to move without a brain. The chicken flaps and runs about for several seconds even after its head has been severed from the body.
But how do these motor circuits in the spine work? What are the underlying control mechanisms for the movement of vertebrates? This is just one of the questions investigated by Auke Ijspeert’s team of 17 at the EPFL in Lausanne. The scientists chose a somewhat unusual approach for their research – they’re building robots. That also explains the name of their work place: Biorobotics Laboratory, or Biorob for short. “We use robots as a scientific tool to help us better understand mobility in living beings,” explains Auke Ijspeert. It’s not so much about building a robot that looks spectacular or is able to work autonomously: “With our robots, we want to contribute to research in the neurosciences and biomechanics.”
Evolutionary biology also benefits from the team’s work. “In many animals, motor control happens mostly in the spinal cord. I find that fascinating.”
The Pleurobot by Auke Ijspeert and his team attracted particular attention. What at first glance looks like a paleontological skeleton assembly kit is actually a sophisticated reproduction of a salamander’s musculoskeletal system. Watching the Pleurobot, which is powered by 27 motors, move in water or on land leaves the observer in awe. The similarity to a salamander’s natural movement is remarkable. The Biorob team made every effort to design the Pleurobot to be as similar to a salamander as possible: They used 3D X-ray videos to analyze every limb of a salamander in motion. This was followed by meticulous mechanical and motor function calculations.
THE BRAIN DOES NOT HAVE SOLE CONTROL
It’s no coincidence that biomechanical research focuses on amphibians. Their locomotor system is interesting because it permits studying the gradual transition of movement on land and in water. Several years ago, neurobiologists were able to show that salamanders can be “remote controlled” by stimulating their spinal cord. Weak electrical stimulation lets the salamander walk; increasing the stimulus beyond a certain threshold results in the salamander performing its typical swimming movements. This ultimately means that the salamander’s brain is not fully in control of the locomotor system. In fact, the spinal cord and limbs form an almost autonomous control and locomotor system. “The brain merely has a stimulating function,” says Auke Ijspeert. The Pleurobot follows this functional principle: Transitioning from walking to swimming movements requires only an increase in the electrical current. “When we control the Pleurobot remotely, we don’t need to control each individual motor. Similar to the brain of a salamander, we only determine the direction, the speed, and the intensity of the stimulus.” The function of the spinal cord in the Pleurobot is assumed by a microcontroller which – put simply – has been programmed with mathematical models of a salamander’s spinal neural network.
THE USE OF ROBOTS TO UNDERSTAND THE NERVOUS SYSTEM
But why go to all this effort? “Our interest is to fundamentally understand how the nervous system in a spinal column functions,” explains Auke Ijspeert. It’s a very complex subject that has by no means been exhaustively researched. The spinal cord’s well-protected location in the canal of the vertebral column in particular makes it very difficult to measure its neuronal activity – even more so than the activity of the brain itself. “You can’t just stick some electrodes into the spinal cord of a moving animal and measure what’s happening.” One reason why Auke Ijspeert likes this combination of biology and robotics is that other scientific disciplines benefit from it. A fundamental understanding of movement can help in the manufacture of neuroprosthetics, for example. Discoveries in the fields of neuronal systems and the spinal cord are incorporated into research work on new paraplegia therapies.
With its Envirobot – a snake-like swimming robot – the EPFL team have also developed and built an inspection robot. It can be used to detect and measure water pollution, for example.
But Auke Ijspeert’s team researches much more than amphibian robots. A cat-like robot named Cheetah and humanoid robots are also part of the lab’s inventory. For many of its projects, including the Pleurobot, the Biorobotics Laboratory uses DC motors from maxon. The modular Dynamixel actuators by Robotis are used mainly in robotics projects. These modules mainly incorporate maxon RE-max motors, the tried and tested brushed motors with an ironless winding. Auke Ijspeert compliments the Swiss drive specialist: “We like maxon a lot!”
By Adrian Venetz