Posts Tagged neurologic

[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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[Abstract] Robotic and Sensor Technology for Upper Limb Rehabilitation

Abstract

Robotic and sensor-based neurologic rehabilitation for the upper limb is an established concept for motor learning and is recommended in many national guidelines. The complexity of the human hands and arms and the different activities of daily living are leading to an approach in which robotic and sensor-based devices are used in combination to fulfill the multiple requirements of this intervention.

A multidisciplinary team of the Fondazione Don Carlo Gnocchi (FDG), an Italian nonprofit foundation, which spans across the entire Italian territory with 28 rehabilitation centers, developed a strategy for the implementation of robotic rehabilitation within the FDG centers. Using an ad hoc form developed by the team, 4 robotic and sensor-based devices were identified among the robotic therapy devices commercially available to treat the upper limb in a more comprehensive way (from the shoulder to the hand). Encouraging results from a pilot study, which compared this robotic approach with a conventional treatment, led to the deployment of the same set of robotic devices in 8 other FDG centers to start a multicenter randomized controlled trial. Efficiency and economic factors are just as important as clinical outcome.

The comparison showed that robotic group therapy costs less than half per session in Germany than standard individual arm therapy with equivalent outcomes. To ensure access to high-quality therapy to the largest possible patient group and lower health care costs, robot-assisted group training is a likely option.

 

via Robotic and Sensor Technology for Upper Limb Rehabilitation – ScienceDirect

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[Abstract + References] Robotic and Sensor Technology for Upper Limb Rehabilitation – PM&R

Abstract

Robotic and sensor-based neurologic rehabilitation for the upper limb is an established concept for motor learning and is recommended in many national guidelines. The complexity of the human hands and arms and the different activities of daily living are leading to an approach in which robotic and sensor-based devices are used in combination to fulfill the multiple requirements of this intervention. A multidisciplinary team of the Fondazione Don Carlo Gnocchi (FDG), an Italian nonprofit foundation, which spans across the entire Italian territory with 28 rehabilitation centers, developed a strategy for the implementation of robotic rehabilitation within the FDG centers. Using an ad hoc form developed by the team, 4 robotic and sensor-based devices were identified among the robotic therapy devices commercially available to treat the upper limb in a more comprehensive way (from the shoulder to the hand). Encouraging results from a pilot study, which compared this robotic approach with a conventional treatment, led to the deployment of the same set of robotic devices in 8 other FDG centers to start a multicenter randomized controlled trial. Efficiency and economic factors are just as important as clinical outcome. The comparison showed that robotic group therapy costs less than half per session in Germany than standard individual arm therapy with equivalent outcomes. To ensure access to high-quality therapy to the largest possible patient group and lower health care costs, robot-assisted group training is a likely option.

 

References

  1. Lo, A.C., Guarino, P.D., Richards, L.G. et al, Robot-assisted therapy for long-term upper-limb impairment after stroke. N Engl J Med2011;365:1749.
  2. Hesse, S., Heß, A., Werner, C.C., Kabbert, N., Buschfort, R. 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. Clin Rehabil2014;28:637–647.
  3. Smith BM, Albus JS, Barbera AJ. A Glossary of Terms for Robotics. Prepared for U.S. Air Force Materials Laboratory Integrated Computer Aided Manufacturing Program. U.S. Department of Commerce. National Bureau of Standards. 1981. Available at: https://www.gpo.gov/fdsys/pkg/GOVPUB-C13-7a9025561f229e1f7fb504ace852d602/pdf/GOVPUB-C13-7a9025561f229e1f7fb504ace852d602.pdf. Accessed September 5, 2018..

  4. Feigin, V.L., Forouzanfar, M.H., Krishnamurthi, R. et al, Global and regional burden of stroke during 1990-2010: Findings from the Global Burden of Disease Study 2010. Lancet2014;383:245–255.
  5. Mehrholz, J., Pohl, M., Platz, T., Kugler, J., Elsner, B. Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke.Cochrane Database Syst Rev2015;11:CD006876.
  6. Kolominsky-Rabas, P.L., Heuschmann, P.U., Marschall, D. et al, Lifetime cost of ischemic stroke in Germany: Results and national projections from a population-based stroke registry. The Erlangen Stroke Project. Stroke2006;37:1179–1183.
  7. Ringelstein, E.B., Nabavi, D.G. Der ischämische Schlaganfall: Eine praxisorientierte Darstellung von Pathophysiologie, Diagnostik und Therapie. 1st ed. KohlhammerGermany2007.
  8. Deutscher Verband für Physiotherapie. Aktuelle Arbeitsmarktdaten veröffentlicht—Fachkräftemangel in der Physiotherapie mehr als deutlich. Available at: https://www.physio-deutschland.de/fachkreise/news-bundesweit/einzelansicht/artikel/Aktuelle-Arbeitsmarktdaten-veroeffentlicht-Fachkraeftemangel-in-der-Physiotherapie-mehr-als-deutlich.html. Published March 2017. Accessed April 5, 2018..

  9. Wright, D.L., Shea, C.H. Cognition and motor skill acquisition: Contextual dependencies. in: C.R. Reynolds (Ed.) Cognitive assessment: A multidisciplinary perspectiveSpringer Verlag USBoston, MA1994:89–106.
  10. Masiero, S., Armani, M., Rosati, G. Upper-limb robot-assisted therapy in rehabilitation of acute stroke patients: Focused review and results of new randomized controlled trial. J Rehabil Res Dev2011;48:355–366.
  11. Mehrholz, J., Hädrich, A., Platz, T., Kugler, J., Pohl, M. Electromechanical and robot-assisted arm training for improving generic activities of daily living, arm function, and arm muscle strength after stroke. Cochrane Database Syst Rev2012;6:CD006876.
  12. Norouzi-Gheidari, N., Archambault, P.S., Fung, J. Effects of robot-assisted therapy on stroke rehabilitation in upper limbs: Systematic review and meta-analysis of the literature. J Rehabil Res Dev2012;49:479–496.
  13. Masiero, S., Carraro, E., Ferraro, C., Gallina, P., Rossi, A., Rosati, G. Upper limb rehabilitation robotics after stroke: A perspective from the University of Padua, Italy. J Rehabil Med2009;41:981–985.
  14. Wagner, T.H., Lo, A.C., Peduzzi, P. et al, An economic analysis of robot-assisted therapy for long-term upper-limb impairment after stroke. Stroke2011;42:2630–2632.
  15. Masiero, S., Poli, P., Armani, M., Ferlini, G., Rizzello, R., Rosati, G. Robotic upper limb rehabilitation after acute stroke by NeReBot: Evaluation of treatment costs. Biomed Res Int2014;2014:265634.
  16. Aprile I. Multi-segmental robotic and technological upper limb rehabilitation in stroke. Fondazione Don Carlo Gnocchi Onlus. Clinical trial registration number NCT02879279. Available at: https://clinicaltrials.gov..

  17. De Wit, L., Putman, K., Dejaeger, E. et al, Use of time by stroke patients: A comparison of four European rehabilitation centers. Stroke2005;36:1977–1983.
  18. Lee, K.B., Lim, S.H., Kim, K.H. et al, Six-month functional recovery of stroke patients: A multi-time-point study. Int J Rehabil Res2015;38:173–180.
  19. Veerbeek, J.M., van Wegen, E., van Peppen, R. et al, What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PLoS One2014;9 (e87987).

 

via Robotic and Sensor Technology for Upper Limb Rehabilitation – PM&R

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[BLOG POST] Foot Drop Implants Market Analysis and Forecasts 2025

Foot drop can be defined as an abnormality in the gait where the forefoot drops due to factors such as weakness of the ankle and toe dorsiflexion. The abnormality is also caused by paralysis of the muscles in the anterior portion of the lower leg or damage to the fibular nerve. Foot drop can be associated with various conditions, including peripheral nerve injuries, neuropathies, drug toxicities, dorsiflexor injuries, and diabetes. Anatomic, muscular, and neurologic are the three categories of foot drop.

Functional electrical stimulation technology is employed in the foot drop implant to improve the gait of patients and avoid foot drop or tripping while walking. Functional electric stimulators (FES) can either be implanted within the patient’s body or employed externally. External FES is tested on the patient prior to its implantation. Implant FES involves a surgery in which the electrodes are directly placed on the nerves of the patient, which are controlled by the implant placed under the skin. The FES device activates the implant through a wireless antenna that is worn outside the body. Sensors are also associated with FES which trigger events in the walking pattern such as lifting of the heel, thereby stimulating the nerves.

The advantages of implant FES include reduction in sensation that is associated with external stimulation. In addition, it eliminates the need to adjust the electrodes on the skin on a daily basis. Rise in number of foot drop disorders due to nerve injuries, growth in knee and hip replacement therapies that lead to foot drop disorders, and increase in the number of sports related injuries contribute to the growth of the foot drop implants market. Foot drop disorders are commonly observed in diabetic retinopathy patients and this prevalence is growing due to increase in incidence of diabetes, which is propelling the growth of the market. Furthermore, the market players are focus on research and development to increase the number of foot drop implant products available in the market, driving the market growth. However, lack of reimbursement, high cost of the implants, and low awareness among the people are likely to hinder the growth of the foot drop implants market in the near future.

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The global foot drop implants market can be segmented on the basis of product, end-user, and region. On the basis of product, the market is categorized into functional electrical stimulators and internal fixation devices. The internal fixation devices segment is anticipated to record a significant growth during the forecast period owing to increasing demand for the devices and advantages offered by these devices such as elimination of the need to stimulate the electrodes daily. Based on end-user, the market can be segmented into hospitals, orthopedic centers, and palliative care centers, among others. The orthopedic centers segment is anticipated to record a high growth during the forecast period due to the increasing number of foot drop cases due to injuries.

Geographically, the foot drop implants market is distributed over North America, Latin America, Europe, Asia Pacific, and Middle East & Africa. North America dominated the market in 2016 and is anticipated to continue its dominance during the forecast period. The significant growth of the market in the region can be attributed to the strong focus on research and development, increase in health care spending, and growth in awareness about the abnormality. The sluggish economy might have a negative impact on the market growth of Europe. Asia Pacific is anticipated to record a high CAGR during the forecast period, primarily driven by India and China. The rising disposable income is anticipated to contribute to the growth of the Asia Pacific market. In addition, a factor contributing to the market growth is rise in prevalence of diabetes that leads to diabetic retinopathy, which is one of the primary causes of foot drop.

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Key players operating in the foot drop implants market include Finetech Medical, Arthrex, Inc., Zimmer Biomet, Bioness Inc., Stryker Corporation, Wright Medical Group N.V., Ottobock, Narang Medical Limited, PONTiS Orthopaedics, LLC, and Shanghai MicroPort Orthopedics.

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Source: Foot Drop Implants Market Analysis and Forecasts 2025 | Medgadget

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[Abstract] Feasibility Study of a Take-Home Array-Based Functional Electrical Stimulation System With Automated Setup for Current Functional Electrical Stimulation Users With Foot-Drop

Abstract

Objective

To investigate the feasibility of unsupervised community use of an array-based automated setup functional electrical stimulator for current foot-drop functional electrical stimulation (FES) users.

Design

Feasibility study.

Setting

Gait laboratory and community use.

Participants

Participants (N=7) with diagnosis of unilateral foot-drop of central neurologic origin (>6mo) who were regular users of a foot-drop FES system (>3mo).

Intervention

Array-based automated setup FES system for foot-drop (ShefStim).

Main Outcome Measures

Logged usage, logged automated setup times for the array-based automated setup FES system and diary recording of problems experienced, all collected in the community environment. Walking speed, ankle angles at initial contact, foot clearance during swing, and the Quebec User Evaluation of Satisfaction with Assistive Technology version 2.0 (QUEST version 2.0) questionnaire, all collected in the gait laboratory.

Results

All participants were able to use the array-based automated setup FES system. Total setup time took longer than participants’ own FES systems, and automated setup time was longer than in a previous study of a similar system. Some problems were experienced, but overall, participants were as satisfied with this system as their own FES system. The increase in walking speed (N=7) relative to no stimulation was comparable between both systems, and appropriate ankle angles at initial contact (N=7) and foot clearance during swing (n=5) were greater with the array-based automated setup FES system.

Conclusions

This study demonstrates that an array-based automated setup FES system for foot-drop can be successfully used unsupervised. Despite setup’s taking longer and some problems, users are satisfied with the system and it would appear as effective, if not better, at addressing the foot-drop impairment. Further product development of this unique system, followed by a larger-scale and longer-term study, is required before firm conclusions about its efficacy can be reached.

Source: Feasibility Study of a Take-Home Array-Based Functional Electrical Stimulation System With Automated Setup for Current Functional Electrical Stimulation Users With Foot-Drop – Archives of Physical Medicine and Rehabilitation

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[ARTICLE] Feasibility study of a take-home array-based functional stimulation system with automated setup for current functional electrical stimulation users with foot-drop.

Abstract: 

OBJECTIVE: To investigate the feasibility of unsupervised community use of an array-based automated setup functional electrical stimulator for current foot-drop functional electrical stimulation (FES) users.

DESIGN: Feasibility study.

SETTING: Gait laboratory and community use.

PARTICIPANTS: Participants (N=7) with diagnosis of unilateral foot-drop of central neurologic origin (>6mo) who were regular users of a foot-drop FES system (>3mo).

INTERVENTION: Array-based automated setup FES system for foot-drop (ShefStim).

MAIN OUTCOME MEASURES: Logged usage, logged automated setup times for the array-based automated setup FES system and diary recording of problems experienced, all collected in the community environment. Walking speed, ankle angles at initial contact, foot clearance during swing, and the Quebec User Evaluation of Satisfaction with Assistive Technology version 2.0 (QUEST version 2.0) questionnaire, all collected in the gait laboratory.

RESULTS: All participants were able to use the array-based automated setup FES system. Total setup time took longer than participants’ own FES systems, and automated setup time was longer than in a previous study of a similar system. Some problems were experienced, but overall, participants were as satisfied with this system as their own FES system. The increase in walking speed (N=7) relative to no stimulation was comparable between both systems, and appropriate ankle angles at initial contact (N=7) and foot clearance during swing (n=5) were greater with the array-based automated setup FES system.

CONCLUSIONS: This study demonstrates that an array-based automated setup FES system for foot-drop can be successfully used unsupervised. Despite setup’s taking longer and some problems, users are satisfied with the system and it would appear as effective, if not better, at addressing the foot-drop impairment. Further product development of this unique system, followed by a larger-scale and longer-term study, is required before firm conclusions about its efficacy can be reached.

via Feasibility study of a take-home array-based functional electrical … – PubMed – NCBI.

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[ARTICLE] Feasibility Study of a Take-Home Array-Based Functional Electrical Stimulation System With Automated Setup for Current Functional Electrical Stimulation Users With Foot-Drop

…This study demonstrates that an array-based automated setup FES system for foot-drop can be successfully used unsupervised. Despite setup’s taking longer and some problems, users are satisfied with the system and it would appear as effective, if not better, at addressing the foot-drop impairment. Further product development of this unique system, followed by a larger-scale and longer-term study, is required before firm conclusions about its efficacy can be reached…

via Feasibility Study of a Take-Home Array-Based Functional Electrical Stimulation System With Automated Setup for Current Functional Electrical Stimulation Users With Foot-Drop – Archives of Physical Medicine and Rehabilitation.

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