Posts Tagged Occupational therapy

[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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[Abstract] Content of conventional therapy for the severely affected arm during subacute rehabilitation after stroke: An analysis of physiotherapy and occupational therapy practice 


Background and Purpose

Physiotherapy (PT) and occupational therapy (OT) are key professions providing treatment for the arm after stroke; however, knowledge about the content of these treatments is scant. Detailed data are needed to replicate interventions, evaluate their effective components, and evaluate PT and OT practice. This paper describes PT and OT treatment for the severely affected arm in terms of duration, content according to components and categories of the International Classification of Human Functioning, Disability and Health, and to analyze differences between professions.


Design: This is a retrospective analysis of randomized trial data. Participants: 46 patients after stroke with poor arm motor control recruited from inpatient neurological units from three rehabilitation centers in the Netherlands. Procedure: PTs and OTs recorded duration and content of arm treatment interventions for 8 weeks using a bespoke treatment schedule with 15 International Classification of Human Functioning, Disability and Health categories.


PTs and OTs spent on average 4–7 min per treatment session (30 min) on arm treatment. OTs spent significantly more time providing arm treatment and treatment at the activities level than PTs. PTs spent 79% of their arm treatment time on body functions, OTs 41%. OTs spent significantly more time on “moving around using transportation,” “self care,” and “household tasks” categories.


Patients after stroke with a severely affected arm and an unfavorable prognosis for arm motor recovery receive little arm-oriented PT and OT. Therapists spent most arm treatment time on body functions. There was a considerable overlap in the content of PT and OT in 12 of the 15 categories. Results can be generalized only to patients with poor arm motor control and may not represent practice in other countries.

Source: Content of conventional therapy for the severely affected arm during subacute rehabilitation after stroke: An analysis of physiotherapy and occupational therapy practice – Jong – 2017 – Physiotherapy Research International – Wiley Online Library

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[Abstract] Occupational therapy for the upper limb after stroke: implementing evidence-based constraint induced movement therapy into practice. – Doctoral thesis


Constraint induced movement therapy (CIMT), an intervention to increase upper limb (UL) function post-stroke, is not used routinely by therapists in the United Kingdom; reasons for this are unknown. Using the Promoting Action on Research Implementation in Health Services (PARIHS) framework to analyse CIMT research and context, a series of related studies explored implementation of CIMT into practice.

Methods and Findings
Systematic review: nineteen CIMT randomised controlled trials found evidence of effectiveness in sub-acute stroke, but could not determine the most effective evidence-based protocols. Further review of qualitative data found paucity of evidence relating to acceptability and feasibility of CIMT.
Focus group: perceptions of the feasibility, including facilitators and barriers, of implementing CIMT into practice were explored in a group of eight therapists. Thematic analysis identified five themes: personal characteristics; setting and support; ethical considerations; education and training; and practicalities, which need to be addressed prior to implementation of CIMT.

Mixed-methods, pilot study (three single cases): pre- and post-CIMT (participant preferred protocol) interviews explored perceptions and experiences of CIMT, with pre- and post-CIMT measurement of participation and UL function. Findings indicated: (i) provision of evidence-based CIMT protocols was feasible, although barriers persisted; (ii) piloted data collection and analysis methods facilitated exploration of stroke survivors’ perceptions and experiences, and recorded participation and UL function.

Findings traversed PARIHS elements (evidence, context, facilitation), and should be considered prior to further CIMT implementation. Future studies of CIMT should explore: effects of CIMT protocol variations; characteristics of stroke survivors most likely to benefit from CIMT; interactions between CIMT and participation.

Source: Keele Research Repository – Keele University

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[ARTICLE] Rehabilitation plus OnabotulinumtoxinA Improves Motor Function over OnabotulinumtoxinA Alone in Post-Stroke Upper Limb Spasticity: A Single-Blind, Randomized Trial – Full Text HTML


Background: OnabotulinumtoxinA (BoNT-A) can temporarily decrease spasticity following stroke, but whether there is an associated improvement in upper limb function is less clear. This study measured the benefit of adding weekly rehabilitation to a background of BoNT-A treatments for chronic upper limb spasticity following stroke. Methods: This was a multi-center clinical trial. Thirty-one patients with post-stroke upper limb spasticity were treated with BoNT-A. They were then randomly assigned to 24 weeks of weekly upper limb rehabilitation or no rehabilitation. They were injected up to two times, and followed for 24 weeks. The primary outcome was change in the Fugl–Meyer upper extremity score, which measures motor function, sensation, range of motion, coordination, and speed. Results: The ‘rehab’ group significantly improved on the Fugl–Meyer upper extremity score (Visit 1 = 60, Visit 5 = 67) while the ‘no rehab’ group did not improve (Visit 1 = 59, Visit 5 = 59; p = 0.006). This improvement was largely driven by the upper extremity “movement” subscale, which showed that the ‘rehab’ group was improving (Visit 1 = 33, Visit 5 = 37) while the ‘no rehab’ group remained virtually unchanged (Visit 1 = 34, Visit 5 = 33; p = 0.034). Conclusions: Following injection of BoNT-A, adding a program of rehabilitation improved motor recovery compared to an injected group with no rehabilitation.

1. Introduction

While several blinded and open-label studies have demonstrated the ability of botulinum toxin to temporarily decrease spasticity following stroke, as measured by standard assessments such as the Modified Ashworth Scale [1,2,3,4,5,6,7,8], the ability of botulinum toxin to improve upper limb function following stroke is less clear, with some studies [1,3,4,5,6,7,8], though not all [2,7], reporting functional improvement. Two recent meta-analyses of randomized controlled trials demonstrated that botulinum toxin treatment resulted in a moderate improvement in upper limb function [9,10]. Despite large clinical trials [2,3,11] and FDA approval, the exact timing, use of adjunct rehabilitation, and continuation of lifelong botulinum toxin treatment remains unclear [12,13].
A recent Cochrane Review included three randomized clinical trials for post-stroke spasticity involving 91 participants [14]. It aimed to determine the efficacy of multidisciplinary rehabilitation programs following treatment with botulinum toxin, and found some evidence supporting modified constraint-induced movement therapy and dynamic elbow splinting. There have been varied study designs exploring rehabilitation in persons after the injection of botulinum toxin or a placebo [13,15], rehabilitation in persons after the injection of botulinum toxin or no injection [16], or rehabilitation after the injection of botulinum toxin with no control condition [17]. As the use of botulinum toxin expands and is beneficial in reducing spasticity and costs [18], the benefit of adding upper limb rehabilitation continues to be questioned. We designed this multi-center, randomized, single-blind clinical trial to assess improvement in patient sensory and motor outcome following the injection of onabotulinumtoxinA (BoNT-A), comparing the effects of rehabilitation versus no rehabilitation, using the upper extremity portion of the Fugl–Meyer Assessment of Sensorimotor Recovery After Stroke [19] as the primary outcome measure. While patients could not be blinded to their randomization to receive additional rehabilitation versus no rehabilitation, the assessments of all of the outcome measures were performed by evaluators blinded to rehabilitation assignment in this single-blind design.

2. Results

Thirty-one patients with post-stroke upper limb spasticity were enrolled, with 29 completing the study (Figure 1). The strokes occurred an average of 6 years prior to study entry, with a range of 6 months to 16½ years. The upper extremity postures treated included flexed elbow, pronated forearm, flexed wrist, flexed fingers, and clenched fist, and were evenly distributed between the treatment groups (the initial dose of BoNT-A administered was left up to the clinician’s judgment based on the amount of spasticity present, and did not differ between groups). One participant (‘no rehab’, injected at Visits 1 and 3A) left the study after Visit 3A due to a deterioration in general health and an inability to travel to study visits. A second participant (‘no rehab’, injected at Visits 1 and 3A) left the study after Visit 4 due to a fall with a broken affected wrist. All of the participants were injected at Visit 1, 19 were injected at Visit 3 (8 ‘rehab’; 11 ‘no rehab’), and 7 were injected at Visit 3A (3 ‘rehab’; 4 ‘no rehab’). Those participants who did not receive injections at Visits 3 or 3A had a level of spasticity that either did not meet the injection criteria due to an Ashworth score of <2 in the wrist (and/or fingers) or one that was felt to be too low to warrant injection. Table 1 provides a description of each group with regard to age, sex, race, whether the stroke occurred in the dominant hemisphere, and clinical measures. At baseline, the treatment groups did not differ on any demographic or clinical variables. […]

Continue—>  Toxins | Free Full-Text | Rehabilitation plus OnabotulinumtoxinA Improves Motor Function over OnabotulinumtoxinA Alone in Post-Stroke Upper Limb Spasticity: A Single-Blind, Randomized Trial | HTML

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[BOOK] “Occupational Therapy – Occupation Focused Holistic Practice in Rehabilitation” – Chapter 9: Virtual Reality and Occupational Therapy


Virtual reality is three dimensional, interactive and fun way in rehabilitation. Its first known use in rehabilitation published by Max North named as “Virtual Environments and Psychological Disorders” (1994). Virtual reality uses special programmed computers, visual devices and artificial environments for the clients’ rehabilitation. Throughout technological improvements, virtual reality devices changed from therapeutic gloves to augmented reality environments. Virtual reality was being used in different rehabilitation professions such as occupational therapy, physical therapy, psychology and so on. In spite of common virtual reality approach of different professions, each profession aims different outcomes in rehabilitation. Virtual reality in occupational therapy generally focuses on hand and upper extremity functioning, cognitive rehabilitation, mental disorders, etc. Positive effects of virtual reality were mentioned in different studies, which are higher motivation than non‐simulated environments, active participation of the participants, supporting motor learning, fun environment and risk‐free environment. Additionally, virtual reality was told to be used as assessment. This chapter will focus on usage of virtual reality in occupational therapy, history and recent developments, types of virtual reality technologic equipment, pros and cons, usage for pediatric, adult and geriatric people and recent research and articles.

1. Introduction

Enhancement of functional ability and the realization of greater participation in community life are the two major goals of rehabilitation science. Improving sensory, motor, cognitive functions and practice in everyday activities and occupations to increase participation with intensive rehabilitation may define these predefined goals [1, 2]. Intervention is based primarily on the different types of purposeful activities and occupations with active participation [35]. For many injuries and disabilities, the rehabilitation process is long, and clinicians face the challenge of identifying a variety of appealing, meaningful and motivating intervention tasks that may be adapted and graded to facilitate this process [5].

Occupational therapy (OT), which is one of the rehabilitation professions, is a client‐centered profession that helps people who are suffering participation and occupational performance limitations. OT offers a wide range of rehabilitation strategies in different medical and social diagnosis [2]. The common point of all these strategies in rehabilitation is that OT assesses and supports enhancing functional ability and participation throughout participating in meaningful activities in a person’s lifespan. To enhance participation, OT, like the rest of the health professions, uses World Health Organization’s International Classification of Functioning, Disability and Health (ICF) to understand function in a biopsychosocial manner. In ICF framework, function is defined as the interactions between an individual, their health conditions and the social and personal situations in which they thrive. The complex interactions between these variables define function and disability [1].

ICF classifies health and health‐related fields in two groups. These groups are “body functions” and “body structures” and “activity and participation.” Sub heading of these groups is considered as body function and structures (physical, physiological etc), activities (daily tasks) and participation (life roles) [1]. When these groups taken into account in rehabilitation, occupational therapists focus on all areas to enhance a client’s activity participation, social participation, etc. However, in current literature, there are various rehabilitation approaches that are being used for this aim. Advancements in technology in the twenty‐first century create great opportunities for people working in different areas. In particular, in health practices like rehabilitation, technology supports therapists’ to rehabilitate their clients in too many different ways like robotics, stimulation devices, assessment tools and virtual reality [610].

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[Case Study] Improved functional independence measure facilitates return to home after paralyzed upper-limb training: a case report – Full Text PDF


[Purpose] We report a case in which rehabilitation that targeted the paralyzed side’s upper limb in a hemiplegic stroke patient remarkably accelerated the patient’s ability to perform activities of daily living, improved her Functional Independence Measure score, and facilitated the patient’s return to home.

[Subject and Methods] We provided rehabilitation training to a female patient who experienced a cerebral infarction at a nursing home for the elderly and was admitted to the Kaifukuki recovery phase rehabilitation ward in order to improve her activities of daily living and return home. An intensive rehabilitation program incorporating occupational therapy and physical training for upper-limb function on the affected side was instituted over 170 days.

[Results] At presentation, the patient had functional disorders and load-induced pain in both lower limbs requiring her to walk with a fixed-type walker. After the intensive rehabilitation program, her activities of daily living improved and she was able to return home.

[Conclusion] This case suggests that activities of daily living training and simultaneous active training of upper-limb function on the affected side in patients with functional disorders or lower-limb pain could effectively improve their Functional Independence Measure scores, promote functional recovery, and facilitate their return to home.


Motor and cognitive impairments in stroke patients result in disability or dependence during activities of daily living (ADL) among the elderly. ADL performance requires optimal motor function in the trunk and upper and lower extremities. Self-reported disability measures, such as the Functional Independence Measure (FIM), are used to determine functional limitations1) . As it is more difficult to recover function in affected upper extremities than it is in the lower extremities, and since ADL can often be performed with only the unaffected side2, 3) , rehabilitation is aimed at improving function in the unaffected upper extremity4, 5) or switching hand dominance6) . Strategies are designed to improve FIM scores and reduce return-to-home times, as these measures are often also used to evaluate the productivity of rehabilitation clinics and determine budget- and reimbursement-related questions as well7) . In this setting where training to improve function in the affected upper extremity is seldom prioritized, we experienced a rare case wherein functional improvement in the affected dominant upper extremity greatly improved FIM scores and allowed the patient to return home.

Continue —> Full Text PDF

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[BLOG POST] Study Compares Intento Device and Traditional Occupational Therapy  

The Intento device is designed to enable patients to control the functional electronic stimulation that they receive, to help patients regain mobility in arms weakened by a stroke.

The Intento device is designed to enable patients to control the functional electronic stimulation that they receive, to help them regain mobility in arms weakened by a stroke.

A device from Ecole Polytechnique Fédérale de Lausanne startup company Intento is designed to enable stroke patients to self-administer functional electrical stimulation to help regain mobility in their arms weakened by the stroke.

The system consists of electrode patches, a device the patients control using their working hand, and tablet software. The therapist selects one of several programmed movements on the tablet and loads it, with a single click, onto the device. The program shows where the electrodes need to be placed and automatically configures the electrical pulse settings to generate the desired movement. Patients then move their functioning hand to control the electrical stimulation needed.

The ultimate aim is for patients to eventually perform the movements without using the device, explains a media release from Ecole Polytechnique Fédérale.

Results from a study investigating Intento’s device were published recently in Archives of Physical Medicine and Rehabilitation.

In the study, researchers from Lausanne University Hospital (CHUV) compared the device to conventional occupational therapy among 11 patients who were severely paralyzed as the result of a stroke. These patients experienced the stroke more than 6 months prior to the study, and other therapies did not work for them.

Over a period of 10 days, the 11 patients underwent 1.5-hour sessions using the Intento device.

Their mobility results from using the device were then compared to the results following conventional occupational therapy conducted over the same amount of time. The patients’ mobility was measured before and after each type of treatment, according to the release.

The results suggest that 70% of the patients experienced significant improvement in their motor functions, versus only 30% of the patients with the conventional occupational therapy.

“Above and beyond the study’s findings, several of the patients told us a few weeks later that they were already using their arms more than before,” says Andrea Maesani, Intento’s CEO and other cofounder, in the release.

Patients were still making steady progress 6 months after the study was conducted, suggesting that the treatment produces long-term effects, according to the release.

The next step will be a clinical study on a larger group before marketing the device, the founders state in the release.

[Source(s): Ecole Polytechnique Fédérale, EurekAlert]

Source: Study Compares Intento Device and Traditional Occupational Therapy – Rehab Managment

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[BOOK] A Dictionary of Occupational Science and Occupational Therapy – Matthew Molineux – Google Books

Front Cover

A Dictionary of Occupational Science and Occupational Therapy

Matthew Molineux

Oxford University PressMar 23, 2017 – Medical – 512 pages
Including over 600 A to Z entries, this original dictionary provides clear and succinct definitions of the terms used in the related and developing fields of occupational science and occupational therapy. Entries cover a broad range of topics from activities of daily living and autonomy to task-oriented approach and work-life balance and have a clear occupational focus. They provide an overview of the complex nature of human occupation and the impact of illness on occupation and well-being. Descriptions and analysis are backed up by key theories from related areas such as anthropology, sociology, and medicine. This is an authoritative resource for students of occupational science and occupational therapy, as well as an accessible point of reference for practitioners from both subject areas.

Source: A Dictionary of Occupational Science and Occupational Therapy – Matthew Molineux – Google Books

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[Research Poster] Management of Visual Deficits with Neurological Etiology – Implications for Practice Patterns and Inter-professional Collaboration

To investigate and describe:

  1. occupational therapy practice patterns as it relates to low vision and visual dysfunction,
  2. what occupational therapy practitioners perceive as their level of competence in addressing vision and how competence is achieved,

  3. the importance of inter-professional management to provide comprehensive care and best practice for visual deficits,

  4. potential practice guidelines for the management of visual deficits resulting from neurological etiology.

Source: Management of Visual Deficits with Neurological Etiology – Implications for Practice Patterns and Inter-professional Collaboration – Archives of Physical Medicine and Rehabilitation

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