Posts Tagged musculoskeletal

[NEWS] New Virtual Reality Therapy game could offer relief for patients with chronic pain, mobility issues

News-MedicalA Virtual Reality Therapy game (iVRT) which could introduce relief for patients suffering from chronic pain and mobility issues has been developed by a team of UK researchers.

Dr Andrew Wilson and colleagues from Birmingham City University built the CRPS app in collaboration with clinical staff at Sandwell and West Birmingham Hospitals NHS Trust for a new way to tackle complex regional pain syndrome and to aid people living with musculoskeletal conditions.

Using a head mounted display and controllers, the team created an immersive and interactive game which mimics the processes used in traditional ‘mirror therapy’ treatment. Within the game, players are consciously and subconsciously encouraged to stretch, move and position the limbs that are affected by their conditions.

Mirror therapy is a medical exercise intervention where a mirror is used to create areflective illusion that encourages patient’s brain to move their limb more freely. This intervention is often used by occupational therapists and physiotherapists to treat CRPS patients who have experienced a stroke. This treatment has proven to be successful exercises are often deemed routine and mundane by patients, which contributes to decline in the completion of therapy.

Work around the CRPS project, which could have major implications for other patient rehabilitation programmes worldwide when fully realised, was presented at the 12th European Conference on Game Based Learning (ECGBL) in France late last year.

Dr Wilson, who leads Birmingham City University’s contribution to a European research study into how virtual reality games can encourage more physical activity, and how movement science in virtual worlds can be used for both rehabilitation and treatment adherence, explained, “The first part of the CRPS project was to examine the feasibility of being able to create a game which reflects the rehabilitation exercises that the clinical teams use on the ground to reduce pain and improve mobility in specific patients.”

“By making the game enjoyable and playable we hope family members will play too and in doing so encourage the patient to continue with their rehabilitation. Our early research has shown that in healthy volunteers both regular and casual gamers enjoyed the game which is promising in terms of our theory surrounding how we may support treatment adherence by exploiting involvement of family and friends in the therapy processes.”

The CRPS project was realized through collaborative working between City Hospital, Birmingham, and staff at the School of Computing and Digital Technology, and was developed following research around the provision of a 3D virtual reality ophthalmoscopy trainer.

Andrea Quadling, Senior Occupational Therapist at Sandwell Hospital, said “The concept of using virtual reality to treat complex pain conditions is exciting, appealing and shows a lot of potential. This software has the potential to be very helpful in offering additional treatment options for people who suffer with CRPS.”

via New Virtual Reality Therapy game could offer relief for patients with chronic pain, mobility issues

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[Abstract] Development of Digital Control System for Wearable Mechatronic Devices: Applications in Musculoskeletal Rehabilitation of the Upper Limb – Thesis

Abstract

The potential for wearable mechatronic systems to assist with musculoskeletal rehabilitation of the upper limb has grown with the technology. One limiting factor to realizing the benefits of these devices as motion therapy tools is within the development of digital control solutions. Despite many device prototypes and research efforts in the surrounding fields, there are a lack of requirements, details, assessments, and comparisons of control system characteristics, components, and architectures in the literature. Pairing this with the complexity of humans, the devices, and their interactions makes it a difficult task for control system developers to determine the best solution for their desired applications.

The objective of this thesis is to develop, evaluate, and compare control system solutions that are capable of tracking motion through the control of wearable mechatronic devices. Due to the immaturity of these devices, the design, implementation, and testing processes for the control systems is not well established. In order to improve the efficiency and effectiveness of these processes, control system development and evaluation tools have been proposed.

The Wearable Mechatronics-Enabled Control Software framework was developed to enable the implementation and comparison of different control software solutions presented in the literature. This framework reduces the amount of restructuring and modification required to complete these development tasks. An integration testing protocol was developed to isolate different aspects of the control systems during testing. A metric suite is proposed that expands on the existing literature and allows for the measurement of more control characteristics. Together, these tools were used ii ABSTRACT iii to developed, evaluate, and compare control system solutions.

Using the developed control systems, a series of experiments were performed that involved tracking elbow motion using wearable mechatronic elbow devices. The accuracy and repeatability of the motion tracking performances, the adaptability of the control models, and the resource utilization of the digital systems were measured during these experiments. Statistical analysis was performed on these metrics to compare between experimental factors. The results of the tracking performances show some of the highest accuracies for elbow motion tracking with these devices. The statistical analysis revealed many factors that significantly impact the tracking performance, such as visual feedback, motion training, constrained motion, motion models, motion inputs, actuation components, and control outputs.

Furthermore, the completion of the experiments resulted in three first-time studies, such as the comparison of muscle activation models and the quantification of control system task timing and data storage needs. The successes of these experiments highlight that accurate motion tracking, using biological signals of the user, is possible, but that many more efforts are needed to obtain control solutions that are robust to variations in the motion and characteristics of the user.

To guide the future development of these control systems, a national survey was conducted of therapists regarding their patient data collection and analysis methods. From the results of this survey, a series of requirements for software systems, that allow therapists to interact with the control systems of these devices, were collected. Increasing the participation of therapists in the development processes of wearable assistive devices will help to produce better requirements for developers.

This will allow the customization of control systems for specific therapies and patient characteristics, which will increase the benefit and adoption rate of these devices within musculoskeletal rehabilitation programs.

via “Development of Digital Control System for Wearable Mechatronic Devices” by Tyler Desplenter

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[Article in Press] Home exercise programs made effortless using the PhysioTherapy eXercises patient app – Full Text

PhysioTherapy eXercises website: www.physiotherapyexercises.com

PhysioTherapy eXercises is a publicly available website, created by Harvey, Messenger, Glinsky, Pattie and a collaboration of physiotherapists. It was designed as a resource for creating and distributing home exercise programs. The website has a database of images, videos and instructions for over 1000 exercises focusing on impairments (strength, balance, range of motion, and cardiovascular fitness), and activities (reaching and manipulation, sit to stand, transfers, and mobility), and is available in 13 different languages. The exercises are evidence-based and include exercises for children through to the elderly, as well as exercises targeting specific populations, such as acute and degenerative neurological conditions, and musculoskeletal conditions, including whiplash and hand injuries. The Physiotherapy Exercises App is one feature of this web-based software and is the focus of this review.

The Physiotherapy Exercises App is free and can be used on both Apple and Android tablets and phones. The app is designed for patients to use, and allows them to access their prescribed home exercise program on their devices, record their progress online, and share this information remotely with their therapist. A recent randomised, controlled trial reported that using the Physiotherapy Exercises App increased adherence to home exercise programs when compared with paper-based methods.1

The therapist designs a home exercise program by selecting relevant exercises from the database and scheduling the frequency and duration of the exercises using the PhysioTherapy eXercises website. The patient then accesses and installs the Physiotherapy Exercises App via a link embedded in an email or smart phone text message that is sent from the website. Once the app is installed, patients have direct access to their home exercise program. The app allows patients to view their program, record completion of each exercise, and provide feedback to the therapist via a ‘notes’ function. The therapist has the ability to remotely monitor the patient’s exercise adherence, review notes recorded by the patient, and adjust the program as required by logging onto the website. Therapists can also receive a notification via an email when a patient’s adherence has decreased below a set threshold, which can be adjusted by the therapist for each patient.

Ease of use

Overall, the design of the Physiotherapy Exercises App is straightforward and the basic features are easy to use. My experience suggests that patients who already use the Internet and/or mobile devices are willing to use the Physiotherapy Exercises App, and use it successfully. Patients with limited technology experience are able to use the app successfully if provided with assistance to download the app and are given a demonstration of how to use it. Once the app has been downloaded, patients have two options: view the exercises that are to be completed on that day via the home screen (Figure 1A); or touch the screen to access the illustration, aims, instructions and dosage for each exercise (Figure 1B). Similarly, recording of the completed exercises can be done by ticking the ‘done all’ box on the home screen or ticking a box on each screen for an individual exercise. Patients can record completing an exercise even if it is not scheduled for a particular day. Notes can be added on each screen that details an individual exercise.

Figure 1

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From the perspective of therapist use, the home exercise program is prescribed and monitored by logging directly onto the website. The website has an extensive help section to assist the therapist if required.

Strengths and limitations

The Physiotherapy Exercises App is very well designed for clinical use. One of the key strengths is that patients can only access their home exercise program once it has been prescribed to them by a therapist, which ensures that patients complete exercises appropriate for their rehabilitation. Another valuable feature is that once the Physiotherapy Exercises App has been downloaded, there is no requirement for the patient to login or remember passwords. Other strengths are that the interface is easy to understand, and patients receive detailed information about each exercise, including the aims of the exercise, illustrations, instructions on how to complete the exercise, dosage, precautions, and progressions. Furthermore, therapists have the ability to select what information the patient views on the app and/or modify the instructions and information if required. When the home exercise program is updated online, all changes occur in real time.

Limitations of the Physiotherapy Exercises App are that few patients use all the features of the app, for example the notes function. My experience using the app with people who have Parkinson’s disease is that most people primarily use the app to view and record completion of their home exercise programs. Further encouragement by the therapist is necessary to ensure regular use of the notes function, if desired. At present, patients do not receive an alert via the Physiotherapy Exercises App that their program has been updated; it simply changes on the home screen. Consequently, if the program is updated independently of a consultation, an additional form of communication may be required to inform the patient of changes made.

Conclusion

Overall, the Physiotherapy Exercises App is an excellent and easy to use clinical resource. Increasing the use of devices to provide home exercise programs directly to patients is highly desirable and resource-efficient. It gives patients access to their home exercise program at all times, facilitates self-management, and, importantly, increases communication between the patient and therapist. The advantages of the Physiotherapy Exercises Appare that it is freely available, has an extensive range of exercises covering both musculoskeletal and neurological conditions, and is easy to use for both therapist and patient. Combined with the ability to remotely monitor patients’ adherence to the home exercise program, the Physiotherapy Exercises App has been a valuable addition to my clinical practice and role as a clinical educator.

Reference

  1. Lambert, T. et al. J Physiother201763161–167

View in Article   Abstract   Full Text   Full Text PDF   PubMed   Scopus (1)  Google Scholar

 

via Home exercise programs made effortless using the PhysioTherapy eXercises patient app – Journal of Physiotherapy

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[VIDEO] What is Neurological Physiotherapy? – YouTube

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[Abstract] Predictive value of the DASH tool for predicting return to work of injured workers with musculoskeletal disorders of the upper extremity – Occupational and Environmental Medicine.

Abstract

Objectives To determine whether the Disabilities of the Arm, Shoulder, and Hand (DASH) tool added to the predictive ability of established prognostic factors, including patient demographic and clinical outcomes, to predict return to work (RTW) in injured workers with musculoskeletal (MSK) disorders of the upper extremity.

Methods A retrospective cohort study using a population-based database from the Workers’ Compensation Board of Alberta (WCB-Alberta) that focused on claimants with upper extremity injuries was used. Besides the DASH, potential predictors included demographic, occupational, clinical and health usage variables. Outcome was receipt of compensation benefits after 3 months. To identify RTW predictors, a purposeful logistic modelling strategy was used. A series of receiver operating curve analyses were performed to determine which model provided the best discriminative ability.

Results The sample included 3036 claimants with upper extremity injuries. The final model for predicting RTW included the total DASH score in addition to other established predictors. The area under the curve for this model was 0.77, which is interpreted as fair discrimination. This model was statistically significantly different than the model of established predictors alone (p<0.001). When comparing the DASH total score versus DASH item 23, a non-significant difference was obtained between the models (p=0.34).

Conclusions The DASH tool together with other established predictors significantly helped predict RTW after 3 months in participants with upper extremity MSK disorders. An appealing result for clinicians and busy researchers is that DASH item 23 has equal predictive ability to the total DASH score.

Source: Predictive value of the DASH tool for predicting return to work of injured workers with musculoskeletal disorders of the upper extremity — Armijo-Olivo et al. — Occupational and Environmental Medicine

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[BOOK] Musculoskeletal Physical Examination: An Evidence-Based Approach – Chapter 6 – Examination of the Wrist and Hand – Google Books

Musculoskeletal Physical Examination: An Evidence-Based Approach

Front Cover
Elsevier Health Sciences, Jul 27, 2016Medical350 pages

From an interdisciplinary author team now including orthopedic surgeons, PM&R specialists, and primary care and sports medicine experts, the second edition of Musculoskeletal Physical Examination: An Evidence-Based Approach educates physicians on how to give the most thorough physical examinations by understanding the “why” behind each type of exam. In-depth coverage of today’s newest tests and techniques keeps you current in practice, and a new section titled “Author’s Preferred Approach” guides you through difficult areas of examination.

  • Provides complete coverage of every musculoskeletal physical examination.
  • Easy-to-use tables summarize and compare the evidence for specificity and sensitivity of each test for each condition.
  • Utilizes over 200 illustrations to clearly depict each test.
  • Includes in-depth coverage of today’s newest tests, including the Thessaly test, Milking test, and Bear hug test.
  • Distinguished author team now includes orthopedic surgeons, PM&R specialists, and primary care sports medicine experts.
  • New section titled “Author’s Preferred Approach” guides readers through difficult areas of examination.
  • Thorough updates and revisions made throughout each chapter keep you current in the field.
  • Full-color figures enhance visual clarity.

 

Source: Musculoskeletal Physical Examination: An Evidence-Based Approach – Gerard A. Malanga, Kenneth Mautner – Google Books

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[e-BOOK] Chapter 6 – Examination of the Wrist and Hand – Musculoskeletal Physical Examination: An Evidence-Based Approach – Google Books

Musculoskeletal Physical Examination: An Evidence-Based Approach

Front Cover
Elsevier Health Sciences, Jul 27, 2016Medical350 pages

From an interdisciplinary author team now including orthopedic surgeons, PM&R specialists, and primary care and sports medicine experts, the second edition ofMusculoskeletal Physical Examination: An Evidence-Based Approacheducates physicians on how to give the most thorough physical examinations by understanding the “why” behind each type of exam. In-depth coverage of today’s newest tests and techniques keeps you current in practice, and a new section titled “Author’s Preferred Approach” guides you through difficult areas of examination.

  • Provides complete coverage of every musculoskeletal physical examination.
  • Easy-to-use tables summarize and compare the evidence for specificity and sensitivity of each test for each condition.
  • Utilizes over 200 illustrations to clearly depict each test.
  • Includes in-depth coverage of today’s newest tests, including the Thessaly test, Milking test, and Bear hug test.
  • Distinguished author team now includes orthopedic surgeons, PM&R specialists, and primary care sports medicine experts.
  • New section titled “Author’s Preferred Approach” guides readers through difficult areas of examination.
  • Thorough updates and revisions made throughout each chapter keep you current in the field.
  • Full-color figures enhance visual clarity.

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Source: Musculoskeletal Physical Examination: An Evidence-Based Approach – Gerard A. Malanga, Kenneth Mautner – Google Books

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[ARTICLE] Predictors of return to work with upper limb disorders

Abstract

Background: Return to work (RTW) is a key goal in the proper management of upper limb disorders (ULDs). ULDs stem from diverse medical aetiologies and numerous variables can affect RTW. The abundance of factors, their complex interactions and the diversity of human behaviour make it difficult to pinpoint those at risk of not returning to work (NRTW) and to intervene effectively.

Aims: To weigh various clinical, functional and occupational parameters that influence RTW in ULD sufferers and to identify significant predictors.

Methods: A retrospective analysis of workers with ULD referred to an occupational health clinic and further examined by an occupational therapist. Functional assessment included objective and subject ive [Disability of the Arm, Shoulder and Hand (DASH) score] parameters. Quantification of work requirements was based on definitions from the Dictionary of Occupational Titles web site. RTW status was confirmed by a follow-up telephone questionnaire.

Results: Among the 52 subjects, the RTW rate was 42%. The DASH score for the RTW group was 27 compared with 56 in the NRTW group (P < 0.001). In multivariate analyses, only the DASH score was found to be a significant independent predictor of RTW (P < 0.05).

Conclusions: Physicians and rehabilitation staff should regard a high DASH score as a warning sign when assessing RTW prospects in ULD cases. It may be advisable to focus on workers with a large discrepancy between high DASH scores and low objective disability and to concentrate efforts appropriately.

via Predictors of return to work with upper limb disorders.

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[VIDEO] C A R E N – Computer Assisted Rehabilitation Environment System at the University of South Florida – YouTube

Published on Oct 1, 2014

When you see the Computer Assisted Rehabilitation Environment system (CAREN) in action, the room-sized simulator resembles a giant video game, complete with avatars. Scenes projected on its 180-degree screen range from walking through a forest to driving past cityscapes to riding on a wave-tossed boat.

The three-dimensional virtual reality system engages and entertains – but its purpose is serious.

The system’s immersive environment and interactive gaming elements safely challenge people to learn new strategies for coping with changes in their balance, coordination or mobility caused by disability, traumatic injury or aging. The advanced technology also gives researchers the scientific tools they need to advance the diagnosis and treatment of musculoskeletal and neurological disorders.

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