Posts Tagged nervous system diseases

[Abstract] Systematic reviews of clinical benefits of exoskeleton use for gait and mobility in neurological disorders: a tertiary study

Abstract

Objective

To describe systematic reviews (SRs) of the use of exoskeletons for gait and mobility by persons with neurological disorders and to evaluate their quality as guidance for research and clinical practice.

Data sources

PubMed, EMBASE, Web of Science, CINAHL Complete, PsycINFO, Cochrane Database of Systematic Reviews, PEDro, and Google Scholar were searched from database inception to January 23, 2018.

Study selection

A total of 331 de-duplicated abstracts from bibliographic database and ancestor searching were independently screened by two reviewers, resulting in 109 articles for which full text was obtained. Independent screening of those 109 articles by two reviewers resulted in a final selection of 17 SRs.

Data extraction

Data were extracted by one reviewer using a pretested Excel form with 158 fields and checked by a second reviewer. Key data included the purpose of the SR, methods used, outcome measures presented, and conclusions. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 were used to evaluate reporting and methodological quality, respectively, of the SRs.

Data synthesis

The SRs generally were of poor methodological and reporting quality. They failed to report some information on patients (e.g. height, weight, baseline ambulatory status) and interventions (e.g. treatment hours/sessions planned and delivered) that clinicians and other stakeholders might want to have, and often failed to notice that the primary studies duplicated subjects.

Conclusions

Published SRs on exoskeletons have many weaknesses in design and execution; clinicians, researchers, and other stakeholders should be cautious in relying on them to make decisions on the use of this technology. Future studies need to address the multiple methodological limitations.

 

via Systematic reviews of clinical benefits of exoskeleton use for gait and mobility in neurological disorders: a tertiary study – Archives of Physical Medicine and Rehabilitation

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[A CLINICAL PRACTICE GUIDELINE] A Core Set of Outcome Measures for Adults With Neurologic Conditions Undergoing Rehabilitation

Background: Use of outcome measures (OMs) in adult neurologic physical therapy is essential for monitoring changes in a patient’s status over time, quantifying observations and patient-reported function, enhancing communication, and increasing the efficiency of patient care. OMs also provide a mechanism to compare patient and organizational outcomes, examine intervention effectiveness, and generate new knowledge. This clinical practice guideline (CPG) examined the literature related to OMs of balance, gait, transfers, and patient-stated goals to identify a core set of OMs for use across adults with neurologic conditions and practice settings.

Methods: To determine the scope of this CPG, surveys were conducted to assess the needs and priorities of consumers and physical therapists. OMs were identified through recommendations of the Academy of Neurologic Physical Therapy’s Evidence Database to Guide Effectiveness task forces. A systematic review of the literature on the OMs was conducted and additional OMs were identified; the literature search was repeated on these measures. Articles meeting the inclusion criteria were critically appraised by 2 reviewers using a modified version of the COnsensus-based Standards for the selection of health Measurement INstruments. (COSMIN) checklist. Methodological quality and the strength of statistical results were determined. To be recommended for the core set, the OMs needed to demonstrate excellent psychometric properties in high-quality studies across neurologic conditions.

Results/Discussion: Based on survey results, the CPG focuses on OMs that have acceptable clinical utility and can be used to assess change over time in a patient’s balance, gait, transfers, and patient-stated goals. Strong, level I evidence supports the use of the Berg Balance Scale to assess changes in static and dynamic sitting and standing balance and the Activities-specific Balance Confidence Scale to assess changes in balance confidence. Strong to moderate evidence supports the use of the Functional Gait Assessment to assess changes in dynamic balance while walking, the 10 meter Walk Test to assess changes in gait speed, and the 6-Minute Walk Test to assess changes in walking distance. Best practice evidence supports the use of the 5 Times Sit-to-Stand to assess sit to standing transfers. Evidence was insufficient to support use of a specific OM to assess patient-stated goals across adult neurologic conditions. Physical therapists should discuss the OM results with patients and collaboratively decide how the results should inform the plan of care.

Disclaimer: The recommendations included in this CPG are intended as a guide for clinicians, patients, educators, and researchers to improve rehabilitation care and its impact on adults with neurologic conditions. The contents of this CPG were developed with support from the APTA and the Academy of Neurologic Physical Therapy (ANPT). The Guideline Development Group (GDG) used a rigorous review process and was able to freely express its findings and recommendations without influence from the APTA or the ANPT. The authors declare no competing interest.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A214.

TABLE OF CONTENTS

  • INTRODUCTION AND METHODS
  • Levels of Evidence and Grades of Recommendations ………………………………………………..178
  • Summary of Action Statements ………………………………………………..179
  • Introduction ………………………………………………..181
  • Methods ………………………………………………..182
  • OUTCOME MEASURE RECOMMENDATIONS
  • The Core Set of Outcome Measures for Neurologic Physical Therapy ………………………………………………..191
  • Action Statement 1: Static and Dynamic Sitting and Standing Balance Assessment ………………………………………………..191
  • Action Statement 2: Walking Balance Assessment ………………………………………………..195
  • Action Statement 3: Balance Confidence Assessment ………………………………………………..197
  • Action Statement 4: Walking Speed Assessment ………………………………………………..199
  • Action Statement 5: Walking Distance Assessment ………………………………………………..203
  • Action Statement 6: Transfer Assessment ………………………………………………..207
  • Action Statement 7: Documentation of Patient Goals ………………………………………………..208
  • Action Statement 8: Use of the Core Set of Outcome Measures ………………………………………………..209
  • Action Statement 9: Discuss Outcome Measure Results and Use
  • Collaborative/Shared Decision-Making With Patients ………………………………………………..211
  • Guideline Implementation Recommendations ………………………………………………..212
  • Summary of Research Recommendations ………………………………………………..215
  • ACKNOWLEDGMENTS AND REFERENCES
  • Acknowledgments ………………………………………………..217
  • References ………………………………………………..217
  • TABLES
  • Table 1: Levels of Evidence ………………………………………………..178
  • Table 2: Grades of Recommendations ………………………………………………..178
  • Table 3: Outline of the CPG Process ………………………………………………..183
  • Table 4: Inclusion and Exclusion Criteria for Article Review ………………………………………………..187
  • Table 5: COSMIN Ratings for Strength of Statistics ………………………………………………..189
  • Table 6: Process Used to Make Recommendations ………………………………………………..190
  • Table 7: Evidence Table, Berg Balance Scale ………………………………………………..192
  • Table 8: Evidence Table, Functional Gait Assessment ………………………………………………..196
  • Table 9: Evidence Table, Activities-specific Balance Confidence ………………………………………………..198
  • Table 10: Evidence Table, 10 meter Walk Test ………………………………………………..201
  • Table 11: Evidence Table, 6-Minute Walk Test ………………………………………………..205
  • Table 12: Evidence Table, 5 Times Sit-to-Stand ………………………………………………..208

[…]

Continue —>  A Core Set of Outcome Measures for Adults With Neurologic Co… : Journal of Neurologic Physical Therapy

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[ARTICLE] Markerless motion capture systems as training device in neurological rehabilitation: a systematic review of their use, application, target population and efficacy  – Full Text

 

Abstract

Background

Client-centred task-oriented training is important in neurological rehabilitation but is time consuming and costly in clinical practice. The use of technology, especially motion capture systems (MCS) which are low cost and easy to apply in clinical practice, may be used to support this kind of training, but knowledge and evidence of their use for training is scarce. The present review aims to investigate 1) which motion capture systems are used as training devices in neurological rehabilitation, 2) how they are applied, 3) in which target population, 4) what the content of the training and 5) efficacy of training with MCS is.

Methods

A computerised systematic literature review was conducted in four databases (PubMed, Cinahl, Cochrane Database and IEEE). The following MeSH terms and key words were used: Motion, Movement, Detection, Capture, Kinect, Rehabilitation, Nervous System Diseases, Multiple Sclerosis, Stroke, Spinal Cord, Parkinson Disease, Cerebral Palsy and Traumatic Brain Injury. The Van Tulder’s Quality assessment was used to score the methodological quality of the selected studies. The descriptive analysis is reported by MCS, target population, training parameters and training efficacy.

Results

Eighteen studies were selected (mean Van Tulder score = 8.06 ± 3.67). Based on methodological quality, six studies were selected for analysis of training efficacy. Most commonly used MCS was Microsoft Kinect, training was mostly conducted in upper limb stroke rehabilitation. Training programs varied in intensity, frequency and content. None of the studies reported an individualised training program based on client-centred approach.

Conclusion

Motion capture systems are training devices with potential in neurological rehabilitation to increase the motivation during training and may assist improvement on one or more International Classification of Functioning, Disability and Health (ICF) levels. Although client-centred task-oriented training is important in neurological rehabilitation, the client-centred approach was not included. Future technological developments should take up the challenge to combine MCS with the principles of a client-centred task-oriented approach and prove efficacy using randomised controlled trials with long-term follow-up.

Background

People with central nervous system diseases such as multiple sclerosis (MS), stroke and spinal cord injury (SCI), demonstrate among others loss of motor and sensory function in the upper and lower limbs. Due to motor impairment in upper limbs, the performance of activities of daily life, sports and leisure activities is affected. Motor impairment in the lower limbs, affects mobility in general and balance control during reaching movement. The impairments of both upper and lower limbs reduce functional independence and thus the quality of life of the individual [1, 2, 3, 4, 5, 6]. Exercise therapy has proven to improve impairments [7, 8, 9], therefore rehabilitation is very important for these patients.

In neurological rehabilitation, training should be challenging, repetitive, task-specific, motivating, salient and intensive to activate neuroplasticity [4]. Moreover, studies have shown the importance and benefits of client-centred task-oriented rehabilitation [10, 11]. The concept of client-centredness not only incorporates patient’s wishes and needs in their rehabilitation, but also actively involves the patient in selecting goals for their own rehabilitation process. Definitions of task-oriented training are still very diverse, but it incorporates that training is directed to a specific, functional, task [10, 12]. Task-oriented training has been proven to be effective in arm-hand skilled performance in stroke patients [12, 13], spinal cord [10] and MS [14]. Spooren et al. [14] demonstrated the importance of specificity of training and inclusion of ‘client-centred training’ and ‘exercise progression’. Timmermans et al. [12] concluded that training components, such as random and distributed practice, together with feedback and clear functional goals, should be incorporated in order to enhance the outcomes of task-oriented training. Despite the advantages of a client-centred task-oriented approach with regard to training outcome and motor learning, this approach requires individualised training schemes and guidance of a therapist. Therefore a client-centred and task-oriented approach is more time consuming and costly for therapists and rehabilitation centres. Hence a new approach is needed where client-centred task-oriented rehabilitation can be administered without extra costs and effort of therapists.

Technology-based rehabilitation systems such as robotics and virtual reality (VR) are promising and may be able to deliver a client-centred task-oriented rehabilitation without extra costs and effort of therapists. Several studies addressed the positive effects of robotics and VR systems as additional therapy in neurological rehabilitation [4, 15, 16, 17, 18, 19]. Robotics have shown positive effects such as the enhancement of function and activity of affected limb and increased motivation, but the costs of the devices is high [3, 20]. In addition, the devices are often uncomfortable as the user needs to wear apparatuses on the body and patients have difficulty using such devices [3]. Although a few studies include some aspects of a client-centred approach in robotic rehabilitation, it remains very difficult to incorporate a full client-centred approach because of the wide variety of choices that can be made (e.g. difficult to select individual parameters, specific movements or activities, to use objects, etc. [19, 20]. VR, on the other hand, is a computer-based technology that allows users to interact with simulated environments and receive feedback on performance. VR also stimulates the increase of intensity of movements, therefore it may facilitate motor learning and neuroplasticity through repetition and increased intensity during task-oriented training [2, 3, 4]. Compared to the traditional methods used in motor rehabilitation of patients with neurological disorders, VR has some advantages: 1) patients can perform different rehabilitation exercises, recreated in a virtual way (i.e. virtual rehabilitation exercises), 2) VR can set up the features of the exercises, control their performance and acquire relevant data from the patient’s performance, and 3) VR can facilitate the interaction between patient and system through a variety of available devices, such as MIT-Manus, RemoviEM, etc. [21, 22]. Non-immersive video games are also a form of VR. They are developed by the entertainment industry for healthy population and home use making it less costly and more acceptable. Markerless (i.e. without markers or sensors on the body) motion capture systems (MCS) such as Nintendo Wii and Playstation Move, make use of non-immersive video games and have been used in VR rehabilitation. Studies showed an increase in motivation for rehabilitation as well as improvement in motor function and correctness of movement after training. Although the results are positive, these commercially available MCS systems with VR have to date limited utility in rehabilitation for impaired populations [1, 3, 4]: the standard games are too difficult or progress too quickly, they do not provide impairment-focused training (e.g. no treatment towards flexion synergies), and do not specifically address independent home usability and safety [1]. Only a few studies have looked into customising Kinect games for stroke, but no specific focus was payed to the coordination patterns which are important in stroke recovery, reducing compensation strategies, or usability and safety for independent home use [1, 23]. At present, validity and accuracy of the Microsoft Kinect in clinical assessment is strong regarding postural control and standing balance [24, 25]. The reproducibility of Kinect when analysing planar motions is similar to traditional marker-based stereophotogrammetry systems [26]. Although there is an increasing number of studies involving markerless motion capture systems in neurological rehabilitation, the knowledge and evidence of training content and training efficacy with Kinect or other markerless motion capture systems is scarce [24, 27].

Because little is known about the various markerless MCS used in neurological rehabilitation, their implementation in rehabilitation training, and effectiveness as a potential device in client-centred task-oriented training, the present study aims to investigate 1) which (markerless) motion capture systems are used as training devices in neurological rehabilitation, 2) how they are applied, 3) in which target population, 4) what the content of the training is and 5) what the efficacy of training with MCS is.

Continue —> Markerless motion capture systems as training device in neurological rehabilitation: a systematic review of their use, application, target population and efficacy | Journal of NeuroEngineering and Rehabilitation | Full Text

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[ARTICLE] Functional electrical stimulation versus ankle foot orthoses for foot-drop: a meta-analysis of orthotic effects – Full Text PDF

ABSTRACT

Objective: To compare the effects on walking of Functional Electrical Stimulation (FES) and Ankle Foot Orthoses (AFO) for foot-drop of central neurological origin, assessed in terms of unassisted walking behaviours compared with assisted walking following a period of use (combined-orthotic effects).

Data Sources: MEDLINE, AMED, CINAHL, Cochrane Central Register of Controlled Trials, Scopus, REHABDATA, PEDro, NIHR Centre for Reviews and Dissemination and clinicaltrials.gov. plus reference list, journal, author and citation searches.

Study Selection: English language comparative Randomised Controlled Trials (RCTs).

Data Synthesis: Seven RCTs were eligible for inclusion. Two of these reported different results from the same trial and another two reported results from different follow up periods so were combined; resulting in five synthesised trials with 815 stroke participants. Meta-analyses of data from the final assessment in each study and three overlapping time-points showed comparable improvements in walking speed over ten metres (p=0.04-0.95), functional exercise capacity (p=0.10-0.31), timed up-and-go (p=0.812 and p=0.539) and perceived mobility (p=0.80) for both interventions.

Conclusion: Data suggest that, in contrast to assumptions that predict FES superiority, AFOs have equally positive combined-orthotic effects as FES on key walking measures for foot-drop caused by stroke. However, further long-term, high-quality RCTs are required. These should focus on measuring the mechanisms-of-action; whether there is translation of improvements in impairment to function, plus detailed reporting of the devices used across diagnoses. Only then can robust clinical recommendations be made.

Full Text PDF

 

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