Posts Tagged Occupational therapy

[Abstract] Soymilk ingestion immediately after therapeutic exercise enhances rehabilitation outcomes in chronic stroke patients: A randomized controlled trial. – NeuroRehabilitation

Abstract

Study investigated the effects of an 8-week rehabilitation exercise program combined with soymilk ingestion immediately after exercise on functional outcomes in chronic stroke patients.

Twenty-two stroke patients were randomly allocated to either the soymilk or the placebo (PLA) group and received identical 8-weeks rehabilitation intervention (3 sessions per week for 120 minutes each session) with corresponding treatment beverages. The physical and functional outcomes were evaluated before, during, and after the intervention. The 8-week rehabilitation program enhanced functional outcomes of participants.

The immediate soymilk ingestion after exercise additionally improved hand grip strength, walking speed over 8 feet, walking performance per unit lean mass, and 6-Minute Walk Test performance compared with PLA after the intervention. However, the improvements in the total score for Short Physical Performance Battery and lean mass did not differ between groups.

This study demonstrated that, compared with rehabilitation alone, the 8-week rehabilitation program combined with immediate soymilk ingestion further improved walking speed, exercise endurance, grip strength, and muscle functionality in chronic stroke patients.
 

via Articles, Books, Reports, & Multimedia: Search REHABDATA | National Rehabilitation Information Center

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[BLOG POST] Occupational Therapy Month: The Role of OT – NARIC

April is Occupational Therapy Month.  Occupational therapy (OT) is a client-centered health profession that helps people across the lifespan to do the things they want and need to do through therapeutic use of daily activities (occupations).  Occupational therapists use a holistic approach that focuses on the individual and work together with their clients to enhance their ability to engage in the occupations they want, need, or are expected to do. Occupational therapists enable people of all ages to live life to its fullest by helping them promote health, and prevent—or live better with—injury, illness, or disability.

Occupational therapy helps people function in all of their environments (e.g., home, work, school, community) and addresses the physical, psychological, and cognitive aspects of their well-being through engagement in occupation.  Occupational therapists may be employed in a number of roles, including but not limited to, practitioner, academic, manager, advocate, consultant, and researcher.  OT services typically include:

  • An individualized evaluation, during which the client/family and occupational therapist determine the person’s goals,
  • customized intervention to improve the person’s ability to perform daily activities and reach the goals, and
  • an outcomes evaluation to ensure that the goals are being met and/or make changes to the intervention plan.

Additionally, OT services may include comprehensive evaluations of the client’s home and other environments (e.g., workplace, school), recommendations for modifications to these environments or for adaptive equipment and training in its use, and guidance and education for family members and caregivers.  The American Occupational Therapy Association (AOTA) website offers a wide variety of resources on OT for children and youthadults, and caregivers as well as professionals. AOTA offers fact sheets on a variety of conditions related to rehabilitation and disability including the role of occupational therapists in reintegration into the community, chronic disease management, and community mobility and driving, among other topics.

Occupational therapists undergo extensive undergraduate, graduate, and/or doctorial accredited educational programs; as well as entry-level mentored practice.  After completion of a qualified accredited program an individual may sit for the national certification exam administered by the National Board for Certification in Occupational Therapy.  More information on job and career resources including qualifications for becoming an occupational therapist is available on the AOTA website.

 

via Occupational Therapy Month:  The Role of OT | Collection Spotlight from the National Rehabilitation Information Center

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[Abstract + References] Effectiveness and Superiority of Rehabilitative Treatments in Enhancing Motor Recovery Within 6 Months Poststroke: A Systemic Review

Abstract

Objective

To investigate the effects of various rehabilitative interventions aimed at enhancing poststroke motor recovery by assessing their effectiveness when compared with no treatment or placebo and their superiority when compared with conventional training program (CTP).

Data Source

A literature search was based on 19 Cochrane reviews and 26 other reviews. We also updated the searches in PubMed up to September 30, 2017.

Study Selection

Randomized controlled trials associated with 18 experimented training programs (ETP) were included if they evaluated the effects of the programs on either upper extremity (UE) or lower extremity (LE) motor recovery among adults within 6 months poststroke; included ≥10 participants in each arm; and had an intervention duration of ≥10 consecutive weekdays.

Data Extraction

Four reviewers evaluated the eligibility and quality of literature. Methodological quality was assessed using the PEDro scale.

Data Synthesis

Among the 178 included studies, 129 including 7450 participants were analyzed in this meta-analysis. Six ETPs were significantly effective in enhancing UE motor recovery, with the standard mean differences (SMDs) and 95% confidence intervals outlined as follow: constraint-induced movement therapy (0.82, 0.45-1.19), electrostimulation (ES)-motor (0.42, 0.22-0.63), mirror therapy (0.71, 0.22-1.20), mixed approach (0.21, 0.01-0.41), robot-assisted training (0.51, 0.22-0.80), and task-oriented training (0.57, 0.16-0.99). Six ETPs were significantly effective in enhancing LE motor recovery: body-weight-supported treadmill training (0.27, 0.01-0.52), caregiver-mediated training (0.64, 0.20-1.08), ES-motor (0.55, 0.27-0.83), mixed approach (0.35, 0.15-0.54), mirror therapy (0.56, 0.13-1.00), and virtual reality (0.60, 0.15-1.05). However, compared with CTPs, almost none of the ETPs exhibited significant SMDs for superiority.

Conclusions

Certain experimented interventions were effective in enhancing poststroke motor recovery, but little evidence supported the superiority of experimented interventions over conventional rehabilitation.

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via Effectiveness and Superiority of Rehabilitative Treatments in Enhancing Motor Recovery Within 6 Months Poststroke: A Systemic Review – Archives of Physical Medicine and Rehabilitation

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[ARTICLE] Effect of Specific Over Nonspecific VR-Based Rehabilitation on Poststroke Motor Recovery: A Systematic Meta-analysis – Full Text

Background. Despite the rise of virtual reality (VR)-based interventions in stroke rehabilitation over the past decade, no consensus has been reached on its efficacy. This ostensibly puzzling outcome might not be that surprising given that VR is intrinsically neutral to its use—that is, an intervention is effective because of its ability to mobilize recovery mechanisms, not its technology. As VR systems specifically built for rehabilitation might capitalize better on the advantages of technology to implement neuroscientifically grounded protocols, they might be more effective than those designed for recreational gaming.

Objective. We evaluate the efficacy of specific VR (SVR) and nonspecific VR (NSVR) systems for rehabilitating upper-limb function and activity after stroke. Methods. We conducted a systematic search for randomized controlled trials with adult stroke patients to analyze the effect of SVR or NSVR systems versus conventional therapy (CT).

Results. We identified 30 studies including 1473 patients. SVR showed a significant impact on body function (standardized mean difference [SMD] = 0.23; 95% CI = 0.10 to 0.36; P = .0007) versus CT, whereas NSVR did not (SMD = 0.16; 95% CI = −0.14 to 0.47; P = .30). This result was replicated in activity measures.

Conclusions. Our results suggest that SVR systems are more beneficial than CT for upper-limb recovery, whereas NSVR systems are not. Additionally, we identified 6 principles of neurorehabilitation that are shared across SVR systems and are possibly responsible for their positive effect. These findings may disambiguate the contradictory results found in the current literature.

Better medical treatments in the acute phase after stroke have increased survival and with that the number of patients needing rehabilitation with an associated increased burden on the health care system.1 Novel technologies have sought to meet this increased rehabilitation demand and to potentially allow patients to continue rehabilitation at home after they leave the hospital.2 Also, technology has the potential to gather massive and detailed data (eg, kinematic and performance data) that might be useful in understanding recovery after stroke better, improving the quality of diagnostic tools and developing more successful treatment approaches.3 Given these promises, several studies and meta-analyses have evaluated the effectiveness of technologies that use virtual reality (VR) in stroke rehabilitation. In a first review, Crosbie et al4 analyzed 6 studies that used VR to provide upper-limb rehabilitation. Although they found a positive effect, they concluded that the evidence was only weak to moderate given the low quality of the research. A later meta-analysis analyzing 5 randomized controlled trials (RCTs) and 7 observational studies suggested a positive effect on a patient’s upper-limb function after training.5 Another meta-analysis of 26 studies by Lohse et al,6 which compared specific VR (SVR) systems with commercial VR games, found a significant benefit for SVR systems as compared with conventional therapy (CT) in both body function and activity but not between the 2 types of systems. This study, however, included a variety of systems that would treat upper-limb, lower-limb, and cognitive deficits. Saywell et al7 analyzed 30 “play-based” interventions, such as VR systems including commercial gaming consoles, rehabilitation tools, and robot-assisted systems. They found a significant effect of play-based versus control interventions in dose-matched studies in the Fugl-Meyer Assessment of the Upper Extremity (FM-UE).7 In contrast, a more recent large-scale analysis of a study with Nintendo Wii–based video games, including 121 patients concluded that recreational activities are as effective as VR.8A later review evaluated 22 randomized and quasi–randomized controlled studies and concluded that there is no evidence that the use of VR and interactive video gaming is more beneficial in improving arm function than CT.9 In all, 31% of the included studies tested nonspecific VR (NSVR) systems (Nintendo Wii, Microsoft Xbox Kinect, Sony PlayStation EyeToy). Hence, although VR-based interventions have been in use for almost 2 decades, their benefit for functional recovery, especially for the upper limb, remains unknown. Possibly, these contradictory results indicate that, at present, studies are too few or too small and/or the recruited participants too variable to be conclusive.10 However, alternative conclusions can be drawn. First, VR is an umbrella term. Studies comparing its impact often include heterogeneous systems or technologies, customized or noncustomized for stroke treatment, addressing a broad range of disabilities. However, effectiveness can only be investigated if similar systems that rehabilitate the same impairment are contrasted. This has been achieved by meta-analyses that investigated VR-based interventions for the lower limb, concluding that VR systems are more effective in improving balance or gait than CT.11Second, a clear understanding of the “active ingredients”3 that should make VR interventions effective in promoting recovery is missing. Therapeutic advantages of VR identified in current meta-analyses are that it might apply principles relevant to neuroplasticity,5,9 such as providing goal-oriented tasks,5,9 increasing repetition and dosage,5,9 providing therapists and patients with additional feedback,5,6,9 and allowing to adjust task difficulty.6 In addition, it has been suggested that the use of VR increases patient motivation,6 enjoyment,8,9 and engagement7; makes intensive task-relevant training more interesting4,7; and offers enriched environments.9 Although motivational aspects are important in the rehabilitation process because they possibly increase adherence,3 their contribution to recovery is difficult to quantify because it relies on patients’ subjective evaluation.7,1215 Rehabilitation methods, whether VR or not, however, need to be objectively beneficial in increasing the patient’s functional ability. Hence, an enormous effort has been expended to identify principles of neurorehabilitation that enhance motor learning and recovery.1624 Consequently, an effective VR system should besides be motivating, also augment CT by applying these principles in the design.23 Following this argument, we advance the hypothesis that custom-made VR rehabilitation systems might have incorporated these principles, unlike off-the-shelf VR tools, because they were created for recreational purposes. Combining the effects of both approaches in one analysis might, thus, mask their real impact on recovery. Again, in the rehabilitation of the lower limb, this effect has been observed. Two meta-analyses investigating the effect of using commercial VR systems for gait and balance training did not find a superior effect, which contradicts the conclusions of the other systematic reviews.11 In upper-limb rehabilitation, this question has not been properly addressed until the most recent review by Aminov et al.25 However, there are several flaws in the method applied that could invalidate the results they found. Specifically, studies were included regardless of their quality, and it is not clear which outcome measurements were taken for the analysis according to the World Health Organization’s International Classification of Function, Disability, and Health (ICF-WHO).26 In addition, a specifically designed rehabilitation system (Interactive Rehabilitation Exercise [IREX])27 was misclassified as an off-the-shelf VR tool. Because their search concluded in June 2017, the more recent evidence is missing. We decided to address these issues by conducting a well-controlled meta-analysis that focuses only on RCTs that use VR technologies for the recovery of the upper limb after stroke. We analyze the effect of VR systems specifically built for rehabilitation (ie, SVR systems) and off-the-shelf systems (ie, NSVR commercial systems) against CT according to the ICF-WHO categories. Also, we extracted 11 principles of motor learning and recovery from established literature that could act as “active ingredients” in the protocols of effective VR systems. Through a content analysis, we identified which principles are present in the included studies and compared their presence between SVR and NSVR systems. We hypothesized, first, that SVR systems might be more effective than NSVR systems as compared with CT in the recovery of upper-limb movement and, second, that this superior effect might be a result of the specific principles included in SVR systems.

 

This meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.28

Identification of RCTs

We define VR as a computer-based technology that provides the user with a sense of presence in a virtual environment,29 which is induced by exposing the user to computer-generated sources of sensory stimulation that satisfy their perceptual predictions and expected sensorimotor contingencies.30 The studies included aimed at training the upper extremity of stroke patients through active participation, without assistive robotic devices (eg, exoskeleton, end-effector devices) or exogenous stimulation. We compared the impact on body function and activity of 2 kinds of VR systems with CT: SVR and NSVR systems. SVR systems were developed exclusively for neurorehabilitation purposes. NSVR systems, on the other hand, are recreational and/or off-the-shelf video games (eg, Nintendo Wii, Microsoft Xbox). As CT, we considered occupational therapy and physical therapy. To identify all RCTs in these 2 categories, we performed a computerized search in the bibliographic databases MEDLINE (OVID), Cochrane Library Plus (including EMBASE), CINAHL, APA PsycNET, DARE, and PEDro for studies that were published in English from inception until August 7, 2018, the day of the conclusion of the search. The search strategy (Supplementary Table 1) included only RCTs that tested the efficacy of SVR or NSVR systems in recovering the upper limbs of stroke patients who were either in the acute (up to 21 days poststroke), subacute (between 3 weeks and 3 months poststroke), or chronic (after 3 months poststroke) stage. We combined the effects of various chronicity bands because the current literature suggests that principles of motor learning interact constantly with the biological processes of recovery,31 and therefore, no differential effect between SVR and NSVR systems resulting from chronicity should be expected. This notion has also been confirmed by the latest meta-analysis.25 In addition, splitting the identified literature into VR type, ICF-WHO category, and chronicity reduces statistical power because of the small number of studies remaining in each band. Two reviewers (BRB and MM) assessed the studies for eligibility. We excluded studies that were not carried out on humans, lacked a control group, included less than 5 participants per experimental condition, did not target upper-extremity rehabilitation, used exoskeletons as interfaces, used exogenous stimulation (such as transcranial stimulation), or did not provide information on standard clinical scales (Figure 1). Exoskeletons and exogenous stimulation protocol where excluded for the passive or active support provided in the rehabilitation process that might lead to different outcomes.

                        figure

Figure 1. Study flow diagram (PRISMA). The selection process of identified randomized controlled trials.

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Continue —>  Effect of Specific Over Nonspecific VR-Based Rehabilitation on Poststroke Motor Recovery: A Systematic Meta-analysis – Martina Maier, Belén Rubio Ballester, Armin Duff, Esther Duarte Oller, Paul F. M. J. Verschure, 2019

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[NEWS] MbientLab Launches its MIOTherapy Physical Therapy Wearable Technology

Unique technology platform uses smart sensors, therapeutic exercises and games to improve rehabilitation and recovery for patients undergoing physical therapy

MIO is a complete, wearable sensor solution that automatically measures, analyzes, and stores a patient's physical therapy data. (Graphic: Business Wire)

MIO is a complete, wearable sensor solution that automatically measures, analyzes, and stores a patient’s physical therapy data. (Graphic: Business Wire)

January 28, 2019 09:00 AM Eastern Standard Time

 

SAN FRANCISCO–(BUSINESS WIRE)–MbientLab, a company building the next generation of sensors and tools for the healthcare industry, has announced the availability of its MIOTherapy (MIO) wearable technology for physical and occupational therapists. MIO is the first wearable technology platform that integrates the effectiveness of traditional physical therapy with smart sensors, therapeutic exercises, games, and 3D visualization technology to personalize and improve outpatient rehabilitation and accelerate recovery.

.@mbientLab announces the launch of its @MioTherapy wearable technology for physical and occupational therapists to improve rehabilitation and recovery for patients undergoing #physicaltherapy.

Research shows that most physical therapy patients do not fully adhere to their plans for care because of factors that include lack of social support, self-doubt and perceived barriers to exercise.1 This results in millions of Americans living with preventable mobility issues and pain that reduce their quality of life. This lack of compliance also increases the cost of healthcare for these patients due to a higher number of urgent care and emergency room visits related to their injuries, and in some cases, inpatient post-acute care stays.

Using a unique combination of technology software and sensors, MIO helps physical and occupational therapists improve the experience and outcomes of therapy for their patients. MIO provides consistently accurate measurements that can be used to monitor and personalize treatment, increase patient compliance, reduce recovery time, and reduce healthcare costs.

“I’ve found the MIO based technology to be an invaluable tool in improving post-operative care for my patients where position is critical. It’s clear to me that MIO will be a great platform for doctors and physical therapists to analyze, adjust and customize patient treatment plans using precise measurements captured in real time,” said Frank Brodie, M.D., clinical faculty, University of California San Francisco. “This technology provides data that enables me to have an accurate understanding of my patients’ ongoing progress and adjust accordingly. I look forward to integrating MIO even more into my practice.”

Patients using MIO attach its sensors to any body part using stickers or flexible straps, so that physical therapists can measure, collect, and record all motion from a specific body area, delivering key insights about a patient’s range of motion and measurable progress through their exercise program. The extremely accurate sensors measure, analyze, and store a patient’s physical therapy data in the cloud for easy access and analysis via the MIO App. MIO also offers real-time 3D visualization, providing an exact picture of what the patient is doing at any moment, and can be used in-office or via a telehealth platform with clinical oversight.

“We are excited to offer physical and occupational therapists a wearable technology platform that improves patient and provider engagement, and ultimately supports better results and a quicker recovery time for patients,” said Laura Kassovic, co-founder and CEO of MbientLab. “Serving as their virtual assistant, MIO will help physical therapists rethink how they provide physical therapy and work to heal their patients so they can get back to doing the things they enjoy.”

MIO has undergone extensive sensor testing with more than a dozen third-party users, including physical therapists, researchers, clinics, and university labs. Since 2013, there have been more than 250 papers published on the use of the MbientLab sensors used in MIO. Physicians at the University of California, San Francisco have demonstrated that the MIO sensors can increase patient compliance by 20 percent to 80 percent in post-operative retinal surgery patients.2 Researchers at Duke University also found an average cost-savings of $2,745 per patient undergoing virtual physical therapy with MIO compared to traditional physical therapy.3

MIO is now commercially available in the United States and internationally and can be purchased by physical and occupational therapists, caregivers and researchers at www.miotherapy.com. MIO is available through monthly subscription plans that include the app, sensors, and access to the cloud, as well as unlimited and free customer support via email, and on-site services.

About MIOTherapy

MIOTherapy is the first wearable technology that integrates the effectiveness of traditional physical therapy with therapeutic exercises, games, and smart sensors to improve outpatient rehabilitation and speed up recovery. Visit www.miotherapy.com or follow @miotherapy on Twitter, @miotherapy on Facebook and @miotherapy on Instagram for more information.

About MbientLab

MbientLab is building the next generation of sensors and tools for the healthcare industry including motion capture and analytics, biometrics, kinematics, industrial control, research and product development. Visit www.mbientlab.com for more information.

Picha KJ, Howell DM. A model to increase rehabilitation adherence to home exercise programmes in patients with varying levels of self-efficacy. Musculoskeletal Care, 2018; 16:233-237.

Brodie et al., Novel positioning with real-time feedback for improved postoperative positioning: pilot study in control subjects; May 2017

Duke Clinical Research Institute, VERITAS research study, 2016

Contacts

for MbientLab
Hannah Boxerman
707-326-0870
hannah@healthandcommerce.com

 

via MbientLab Launches its MIOTherapy Physical Therapy Wearable Technology | Business Wire

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[BLOG POST] Incorporating the Wii into Occupational Therapy Treatment

This is guest post written by Grant Mitchell, author of TheOTpreneur.com. Grant currently works in Acute Rehab and completed his Master’s thesis on using the Wii as a rehab intervention. We are happy to have him on the My OT Spot blog!

Considering the rising cost of healthcare, consumer technology can often be an effective treatment modality that can double as a home exercise program. An example of consumer technology could include a Nintendo Wii + Sports which can be usually be purchased for less than $50. Given the lack of budget most every practitioner has to deal with, it’s a great opportunity to take advantage of low cost and high tech consumer products for rehabilitation.

Effective implementation of virtual reality (VR) as a treatment modality needs to be practical, accessible, and affordable to the client. The Nintendo Wii and Xbox Kinect are two examples of systems that demonstrate those traits comparatively to the high-end VR products that can cost upwards of $75,000.

Virtual reality can be used in variety of ways across settings. The Xbox Kinect and Nintendo Wii systems have different ways of engaging participants. While the Xbox Kinect doesn’t involve use of a controller, it is played by body motions alone. The Xbox Kinect is easier with a higher functioning population.

Conversely, the Wii system involves the use of a controller and includes games that can be modified to fit a variety of lower functioning populations both cognitively and physically. This article will address Wii use for the general physical disability population. Cognition is a component in the function of clients in the physical disability setting and so will be addressed.

occupational-therapy-wii-alf

 

Benefits of Using the Wii in Treatment

One valuable aspect of incorporating this type of technology in therapy is that it is often a familiar technology to the general public. Its accessibility extends outside that of the clinical setting. The common household, including those in the low socioeconomic bracket, might have access to a Nintendo Wii.

Even adults that have not used a Wii before, can often recall family or friends who might have one or use one. Let’s not forget, video games can be fun! Adding fun can be an effective way to make activity purposeful and meaningful.

One benefit of engaging in a therapeutic activity such as the games found on Wii Sports, is the objective based movements so that patients are focused on moving the virtual character rather than thinking about left, right, up, and down. In this way, the client receives instant visual feedback of their performance as they guide the virtual character (Sparkes-Griffin, 2013).

Wii Sports Games to Incorporate into Treatment

Wii Sports is the most common game as it comes with most Wii consoles. Wii Sports comes with five games: boxing, bowling, tennis, golf, and baseball. The following is short description of the Wii Sports games and how you can incorporate them in treatment.

 

Boxing: This activity is a great strenuous upper extremity activity. Boxing is a go-to game with the Wii due to the level of endurance it facilitates. This game can be completed with either one upper extremity or can incorporate bilateral upper extremities for a greater coordination demand. This activity is one of the least cognitively demanding, involving a repetitive back and forth (punching) motion with no button pushing.

Bowling: The arm motion of this game is similar to that of the real life sport, however this activity can be done from almost any position. The motion does not stray far from the midline but does involve a two-button press and release component increasing the motor planning demand. This can be hard if hand function is minimal, but good if you want to incorporate fine motor and gross motor planning.

Tennis: This game involves no button pressing during game play, only to start and resume. However, tennis involves the most complex upper extremity arm movements of the 5 Wii sports games. Additionally, with either a computer or an opponent (dual play involves a split-screen and can involve family or friends if available), this game is a higher functioning game requiring the player to motor plan and swing the controller according to the direction of the virtual tennis ball.

Golf & Baseball: These two games are similar in that a minimal swinging motion is the primary physical demand to play. The movement can be accomplished with a good wrist flick, and generally requires a purposeful exaggerated real life swing to get therapeutic benefits. To get significant therapeutic benefit, these activities will often have to be modified to increase the challenge.

occupational-therapy-wii-baseball

Modifying the Games

Core Related: The Wii player is moved by the controller; therefore, the actual position of the client can vary. For impaired balance, the therapist can stand behind the client or have a chair available for when the client is fatigued. All games can be completed either standing or sitting. The common high-low mats in rehabilitation gyms provide a great platform for treatment while engaging in the Wii activity. Additionally, clients can participate while sitting on a balance board for a greater challenge.

Upper Extremity Related: Boxing is the only game in Wii sports that can involve both arms with two controllers. However, boxing does allow the option of playing with only one controller. For an added challenge, weights, such as Velcro wrist weights can be utilized to increase the resistance. It is important to note that due to the design of the game system, clients can “cheat” in terms of movement, meaning using little ROM and compensating arm movements with wrist movements. If you as the therapist want good movement, you may have to cue it as little feedback is provided by the Wii.

More on the Research Behind this Post

As a thesis project to complete the requirements of graduating with a Master’s in Occupational Therapy, my classmate Kyle Nelson and I (Grant Mitchell) collected literature surrounding the Wii and Xbox use in rehabilitation.

Our poster has been accepted for display at this coming year’s 2017 AOTA conference. This information is in the process of being made available as a free resource on an independent website. Until then, the Prezi presentation of the initial poster can be viewed describing this thesis project.

For additional questions, please don’t hesitate to email me at TheOTpreneur@gmail.com.

Resources

Emerging Niche: New Technology for Rehab

http://www.aota.org/Practice/Rehabilitation-Disability/Emerging-Niche/NewTech.aspx

Prezi Presentation: Use of VR in Rehab

https://prezi.com/botxz1nkctid/virtual-reality-an-evidence-based-guide-for-occupational-therapy/

Sparkes-Griffin, C. (2013, February 25). Wii-habilitation: Using the Wii as an Effective Intervention Tool for Seniors. OT Practice, p. 18.

via Incorporating the Wii into Occupational Therapy Treatment | myotspot.com

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[Abstract] Advanced Therapy in Traumatic Brain Injury Inpatient Rehabilitation: Effects on Outcomes During the First Year after Discharge

Abstract

Objective

To use causal inference methods to determine if receipt of a greater proportion inpatient rehabilitation treatment focused on higher level functions, e.g. executive functions, ambulating over uneven surfaces (Advanced Therapy, AdvTx) results in better rehabilitation outcomes.

Design

A cohort study using propensity score methods applied to the TBI-Practice-Based Evidence (TBI-PBE) database, a database consisting of multi-site, prospective, longitudinal observational data.

Setting

Acute inpatient rehabilitation (IRF).

Participants

Patients enrolled in the TBI-PBE study (n=1843), aged 14 years or older, who sustained a severe, moderate, or complicated mild TBI, receiving their first IRF admission to one of 9 sites in the US, and consented to follow-up 3 and 9 months post discharge from inpatient rehabilitation.

Interventions

Not applicable. Main Outcome Measures: Participation Assessment with Recombined Tools-Objective-17, FIMTM Motor and Cognitive scores, Satisfaction with Life Scale, and Patient Health Questionnaire-9.

Results

Controlling for measured potential confounders, increasing the percentage of AdvTx during inpatient TBI rehabilitation was found to be associated with better community participation, functional independence, life satisfaction, and decreased likelihood of depression during the year following discharge from inpatient rehabilitation. Participants who began rehabilitation with greater disability experienced larger gains on some outcomes than those who began rehabilitation with more intact abilities.

Conclusions

Increasing the proportion of treatment targeting higher level functions appears to have no detrimental and a small, beneficial effect on outcome. Caution should be exercised when inferring causality given that a large number of potential confounders could not be completely controlled with propensity score methods. Further, the extent to which unmeasured confounders influenced the findings is not known and could be of particular concern due to the potential for the patient’s recovery trajectory to influence therapists’ decisions to provide a greater amount AdvTx.

via Advanced Therapy in Traumatic Brain Injury Inpatient Rehabilitation: Effects on Outcomes During the First Year after Discharge – Archives of Physical Medicine and Rehabilitation

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[ARTICLE] Intensive therapy after botulinum toxin in adults with spasticity after stroke versus botulinum toxin alone or therapy alone: a pilot, feasibility randomized trial – Full Text

Abstract

Background

Botulinum toxin-A is provided for adults with post-stroke spasticity. Following injection, there is a variation in the rehabilitation therapy type and amount provided. The purpose of this study was to determine if it is feasible to add intensive therapy to botulinum toxin-A injections for adults with spasticity and whether it is likely to be beneficial.

Methods

Randomized trial with concealed allocation, assessor blinding, and intention to treat analysis. Thirty-seven adults (n = 3 incomplete or lost follow-up) with spasticity in the upper or lower limb were allocated to one of three groups: experimental group received a single dose of botulinum toxin-A plus an intensive therapy for 8 weeks, control group 1 received a single dose of botulinum toxin-A only, and control group 2 received intensive therapy only for 8 weeks. Feasibility was measured by examining recruitment, intervention (adherence, acceptability, safety), and measurement. Benefit was measured as goal achievement (Goal Attainment Scale), upper limb activity (Box and Block Test), walking (6-min walk test) and spasticity (Tardieu scale), at baseline (week 0), immediately after (week 8), and at three months (week 12).

Results

Overall recruitment fraction for the trial was 37% (eligibility fraction 39%, enrolment fraction 95%). The 26 participants allocated to receive intensive rehabilitation attended 97% of clinic-based sessions (mean 11 ± 2 h) and an averaged 58% (mean 52 ± 32 h) of prescribed 90 h of independent practice. There were no study-related adverse events reported. Although participants in all groups increased their goal attainment, there were no between-group differences for this or other outcomes at week 8 or 12.

Conclusion

Providing intensive therapy following botulinum toxin-A is feasible for adults with neurological spasticity. The study methods are appropriate for a future trial. A future trial would require 134 participants to detect a between-group difference of 7 points on Goal Attainment Scale t-scores with an alpha of 0.05 and power of 80%.

Background

Spasticity affects approximately 20% of stroke survivors [14] and is thought to significantly contribute to falls after stroke [56] as well as decreased activity participation [34]. Unsurprisingly, higher costs are thus incurred by patients with spasticity during the first year of survival [7]. Health professionals identify that addressing spasticity is a high priority during rehabilitation [8], and there is international consensus that localized spasticity (i.e., in the upper or lower limbs) is best managed with a combination of botulinum toxin and physical therapy [910]. While these consensus papers appear to agree, clinical management remains diverse [1112] and provides an ongoing challenge for both therapists and health services alike.

In Australia, stroke rehabilitation is guided by the Stroke Foundation clinical practice guidelines [13]. These guidelines recommend that management of moderate to severe spasticity include the use of botulinum toxin type A in additionto physical therapy interventions [13]. Unfortunately, clinical survey data suggests that occupational therapists and physiotherapists report providing therapy post-botulinum toxin type A injections less than a quarter of the time (an estimated 16%) [12]. This low rate of therapy provision suggests ongoing uncertainty among clinicians as to how to treat patients with spasticity. Such uncertainty is likely to stem from the lack of research studies that describe the type, frequency, intensity, and duration of therapy that is effective for people who have received botulinum toxin injections. While there are previous studies which have tested the efficacy of botulinum toxin type A for spasticity management after stroke [1416], what remains unknown is whether or not therapy should be provided to this group of patients.

To inform best practice in the treatment and rehabilitation of spasticity in people with neurological conditions, understanding whether the suggested combined effects of using both therapy and botulinum toxin type A together is more beneficial than botulinum toxin-A alone or physiotherapy interventions alone is key. Given the lack of research in this area, a large, powered randomized controlled trial is required. In preparation for this trial, it is key to understand both the feasibility and likely effects of the interventions; therefore, the research questions posed in this pilot study were:

  1. In neurological patients with spasticity, is it feasible to add intensive therapy to botulinum toxin-A injections if the therapy includes both clinic-based and home-based therapy sessions?
  2. Is adding intensive therapy likely to be of any benefit to goal attainment, upper limb activity, walking, and spasticity over botulinum toxin-A alone or intensive therapy alone?[…]

Continue —> Intensive therapy after botulinum toxin in adults with spasticity after stroke versus botulinum toxin alone or therapy alone: a pilot, feasibility randomized trial

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[Abstract+References] SMART Arm Training With Outcome-Triggered Electrical Stimulation in Subacute Stroke Survivors With Severe Arm Disability: A Randomized Controlled Trial.

Background. Stroke survivors with severe upper limb disability need opportunities to engage in task-oriented practice to achieve meaningful recovery. Objective. To compare the effect of SMART Arm training, with or without outcome-triggered electrical stimulation to usual therapy, on arm function for stroke survivors with severe upper limb disability undergoing inpatient rehabilitation. Methods. A prospective, multicenter, randomized controlled trial was conducted with 3 parallel groups, concealed allocation, assessor blinding and intention-to-treat analysis. Fifty inpatients within 4 months of stroke with severe upper limb disability were randomly allocated to 60 min/d, 5 days a week for 4 weeks of (1) SMART Arm with outcome-triggered electrical stimulation and usual therapy, (2) SMART Arm alone and usual therapy, or (3) usual therapy. Assessment occurred at baseline (0 weeks), posttraining (4 weeks), and follow-up (26 and 52 weeks). The primary outcome measure was Motor Assessment Scale item 6 (MAS6) at posttraining. Results. All groups demonstrated a statistically (P < .001) and clinically significant improvement in arm function at posttraining (MAS6 change ≥1 point) and at 52 weeks (MAS6 change ≥2 points). There were no differences in improvement in arm function between groups (P= .367). There were greater odds of a higher MAS6 score in SMART Arm groups as compared with usual therapy alone posttraining (SMART Arm stimulation generalized odds ratio [GenOR] = 1.47, 95%CI = 1.23-1.71) and at 26 weeks (SMART Arm alone GenOR = 1.31, 95% CI = 1.05-1.57). Conclusion. SMART Arm training supported a clinically significant improvement in arm function, which was similar to usual therapy. All groups maintained gains at 12 months.

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23. Hayward, KS, Kuys, SS, Barker, RN, Brauer, SG. Can stroke survivors with severe upper arm disability achieve clinically important change in arm function during inpatient rehabilitation? A multicentre, prospective, observational study. NeuroRehabilitation. 2014;35:1723Google ScholarMedline
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27. Duncan, PW, Wallace, D, Lai, SM, Johnson, D, Emberston, S, Laster, LJ. The Stroke Impact Scale Version 2.0. Evaluation of the reliability, validity and sensitivity to change. Stroke. 1999;30:21312140Google ScholarCrossrefMedline
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33. Hayward, KS, Kuys, SS, Barker, RN, Brauer, SG. Clinically important improvements in motor function are achievable during inpatient rehabilitation by stroke patients with severe motor disability: a prospective observational study. NeuroRehabilitation. 2014;34:773779Google ScholarMedline
34. Churilov, L, Arnup, S, Johns, H. An improved method for simple, assumption-free ordinal analysis of the modified Rankin Scale using generalized odds ratios. Int J Stroke. 2014;9:9991005Google ScholarLink
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via SMART Arm Training With Outcome-Triggered Electrical Stimulation in Subacute Stroke Survivors With Severe Arm Disability: A Randomized Controlled TrialNeurorehabilitation and Neural Repair – Ruth N. Barker, Kathryn S. Hayward, Richard G. Carson, David Lloyd, Sandra G. Brauer, 2017

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[ARTICLE] SITAR: a system for independent task-oriented assessment and rehabilitation

Over recent years, task-oriented training has emerged as a dominant approach in neurorehabilitation. This article presents a novel, sensor-based system for independent task-oriented assessment and rehabilitation (SITAR) of the upper limb.

The SITAR is an ecosystem of interactive devices including a touch and force–sensitive tabletop and a set of intelligent objects enabling functional interaction. In contrast to most existing sensor-based systems, SITAR provides natural training of visuomotor coordination through collocated visual and haptic workspaces alongside multimodal feedback, facilitating learning and its transfer to real tasks. We illustrate the possibilities offered by the SITAR for sensorimotor assessment and therapy through pilot assessment and usability studies.

The pilot data from the assessment study demonstrates how the system can be used to assess different aspects of upper limb reaching, pick-and-place and sensory tactile resolution tasks. The pilot usability study indicates that patients are able to train arm-reaching movements independently using the SITAR with minimal involvement of the therapist and that they were motivated to pursue the SITAR-based therapy.

SITAR is a versatile, non-robotic tool that can be used to implement a range of therapeutic exercises and assessments for different types of patients, which is particularly well-suited for task-oriented training.

The increasing demand for intense, task-specific neurorehabilitation following neurological conditions such as stroke and spinal cord injury has stimulated extensive research into rehabilitation technology over the last two decades.1,2 In particular, robotic devices have been developed to deliver a high dose of engaging repetitive therapy in a controlled manner, decrease the therapist’s workload and facilitate learning. Current evidence from clinical interventions using these rehabilitation robots generally show results comparable to intensity-matched, conventional, one-to-one training with a therapist.35 Assuming the correct movements are being trained, the primary factor driving this recovery appears to be the intensity of voluntary practice during robotic therapy rather than any other factor such as physical assistance required.6,7 Moreover, most existing robotic devices to train the upper limb (UL) tend to be bulky and expensive, raising further questions on the use of complex, motorised systems for neurorehabilitation.

Recently, simpler, non-actuated devices, equipped with sensors to measure patients’ movement or interaction, have been designed to provide performance feedback, motivation and coaching during training.812 Research in haptics13,14 and human motor control15,16 has shown how visual, auditory and haptic feedback can be used to induce learning of a skill in a virtual or real dynamic environment. For example, simple force sensors (or even electromyography) can be used to infer motion control17and provide feedback on the required and actual performances, which can allow subjects to learn a desired task. Therefore, an appropriate therapy regime using passive devices that provide essential and engaging feedback can enhance learning of improved arm and hand use.

Such passive sensor-based systems can be used for both impairment-based training (e.g. gripAble18) and task-oriented training (ToT) (e.g. AutoCITE8,9, ReJoyce11). ToT views the patient as an active problem-solver, focusing rehabilitation on the acquisition of skills for performance of meaningful and relevant tasks rather than on isolated remediation of impairments.19,20 ToT has proven to be beneficial for participants and is currently considered as a dominant and effective approach for training.20,21

Sensor-based systems are ideal for delivering task-oriented therapy in an automated and engaging fashion. For instance, the AutoCITE system is a workstation containing various instrumented devices for training some of the tasks used in constraint-induced movement therapy.8 The ReJoyce uses a passive manipulandum with a composite instrumented object having various functionally shaped components to allow sensing and training of gross and fine hand functions.11 Timmermans et al.22reported how stroke survivors can carry out ToT by using objects on a tabletop with inertial measurement units (IMU) to record their movement. However, this system does not include force sensors, critical in assessing motor function.

In all these systems, subjects perform tasks such as reach or object manipulation at the tabletop level, while receiving visual feedback from a monitor placed in front of them. This dislocation of the visual and haptic workspaces may affect the transfer of skills learned in this virtual environment to real-world tasks. Furthermore, there is little work on using these systems for the quantitative task-oriented assessment of functional tasks. One exception to this is the ReJoyce arm and hand function test (RAHFT)23 to quantitatively assess arm and hand function. However, the RAHFT primarily focuses on range-of-movement in different arm and hand functions and does not assess the movement quality, which is essential for skilled action.2428

To address these limitations, this article introduces a novel, sensor-based System for Independent Task-Oriented Assessment and Rehabilitation (SITAR). The SITAR consists of an ecosystem of different modular devices capable of interacting with each other to provide an engaging interface with appropriate real-world context for both training and assessment of UL. The current realisation of the SITAR is an interactive tabletop with visual display as well as touch and force sensing capabilities and a set of intelligent objects. This system provides direct interaction with collocation of visual and haptic workspaces and a rich multisensory feedback through a mixed reality environment for neurorehabilitation.

The primary aim of this study is to present the SITAR concept, the current realisation of the system, together with preliminary data demonstrating the SITAR’s capabilities for UL assessment and training. The following section introduces the SITAR concept, providing the motivation and rationale for its design and specifications. Subsequently, we describe the current realisation of the SITAR, its different components and their capabilities. Finally, preliminary data from two pilot clinical studies are presented, which demonstrate the SITAR’s functionalities for ToT and assessment of the UL. […]

Continue —> SITAR: a system for independent task-oriented assessment and rehabilitation Journal of Rehabilitation and Assistive Technologies Engineering – Asif Hussain, Sivakumar Balasubramanian, Nick Roach, Julius Klein, Nathanael Jarrassé, Michael Mace, Ann David, Sarah Guy, Etienne Burdet, 2017

Figure 1. The SITAR concept with (a) the interactive table-top alongside some examples of intelligent objects developed including (b) iJar to train bimanual control, (c) iPen for drawing, and (d) iBox for manipulation and pick-and-place.

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