Posts Tagged orthosis

[ARTICLE] Feasibility and clinical experience of implementing a myoelectric upper limb orthosis in the rehabilitation of chronic stroke patients: A clinical case series report – Full Text

Abstract

Individuals with stroke are often left with persistent upper limb dysfunction, even after treatment with traditional rehabilitation methods. The purpose of this retrospective study is to demonstrate feasibility of the implementation of an upper limb myoelectric orthosis for the treatment of persistent moderate upper limb impairment following stroke (>6 months). Methods: Nine patients (>6 months post stroke) participated in treatment at an outpatient Occupational Therapy department utilizing the MyoPro myoelectric orthotic device. Group therapy was provided at a frequency of 1–2 sessions per week (60–90 minutes per session). Patients were instructed to perform training with the device at home on non-therapy days and to continue with use of the device after completion of the group training period. Outcome measures included Fugl-Meyer Upper Limb Assessment (FM) and modified Ashworth Scale (MAS). Results: Patients demonstrated clinically important and statistically significant improvement of 9.0±4.8 points (p = 0.0005) on a measure of motor control impairment (FM) during participation in group training. It was feasible to administer the training in a group setting with the MyoPro, using a 1:4 ratio (therapist to patients). Muscle tone improved for muscles with MAS >1.5 at baseline. Discussion: Myoelectric orthosis use is feasible in a group clinic setting and in home-use structure for chronic stroke survivors. Clinically important motor control gains were observed on FM in 7 of 9 patients who participated in training.

Fig 1

Introduction

Stroke is a leading cause of long term disability in the United States[1]. Traditional rehabilitation does not restore normal motor control for all stroke survivors, and upwards of 50% live with persistent upper limb dysfunction[2]. This leads to diminished functional independence and quality of life[3]. Motor learning-based interventions have shown promise[4]. However in today’s health care milieu, for those with chronic motor deficits, provision of the intensive rehabilitation necessary to provide motor learning-based interventions is challenging. Therefore, new treatment methods are needed under these constraints.

An emerging technology that warrants further investigation is myoelectric control which harnesses the user’s EMG signal to power a custom fabricated orthotic device. When the user activates a target muscle, the EMG signal from that muscle signals a motor to produce a desired movement. Myoelectric control has been studied in different populations[5], but its study in stroke has been limited. One commercially available upper limb myoelectric device is the MyoPro motion-G (Cambridge, MA). The MyoPro motion-G provides assistance to the weak upper limb and allows the patient to perform movement they otherwise are unable to complete. Preliminary evidence suggests it may be effective in improving motor control[69] and one study showed improvement in self-reported function and perception of recovery[10]. This device has been utilized in the occupational therapy (OT) clinic at our medical center for 5 years. The purpose of this study is to demonstrate feasibility of administering treatment with the MyoPro using a group therapy design in a cohort of patients with chronic stroke whose progress with standard OT had plateaued.[…]

Continue —> Feasibility and clinical experience of implementing a myoelectric upper limb orthosis in the rehabilitation of chronic stroke patients: A clinical case series report

, , , , , , , ,

Leave a comment

[WEB PAGE] Robotic Hand Orthosis for Therapy and Assistance in Activities of Daily Living

tenoexo is a compact and lightweight hand exoskeleton which has been developed in collaboration with Jumpei Arata at Kyushu University. The EMG-controlled device assists patients with moderate to severe hand motor impairment during grasping tasks in rehabilitation training and during activities of daily living. Its soft mechanism allows for grasping of a variety of objects. Thanks to 3D-rapid prototyping, it can be tailored to the each individual user.

RELab tenoexo

Stroke, spinal cord injury and muscular atrophy are just few examples of diseases leading to persistent hand impairment. No matter the cause, the inability to use the affected hand in activities of daily living will affect independence and quality of life. Wearable robotic devices can support the use of the impaired limb in activities of daily living, and provide at-home rehabilitation training. In collaboration with the groups of Prof. Jumpei Arata at Kyushu University, Japan, and Gregory Fischer at Worcester Polytechnic Institute, USA, we have developed a highly compact and lightweight hand exoskeleton.

Our exoskeleton aims to assist patients in grasping tasks during physiotherapy and in activities of daily living such as eating or grooming. Various grasp types, intuitive control based on electromyography (Ryser et al., 2017) and numerous usability features should increase the independence of the user. The current prototype, RELab tenoexo, is fully wearable and consists of a lightweight hand module (148 g) as well as an actuation box including motors, power source and controllers (720 g), all located in a compact backpack. tenoexo’s remote actuation system (Hofmann et al., 2018) and its compliant 3-layered sliding spring mechanism (Arata et al., 2013) ensure safe operation and inherent adaptation to the shape of the grasped objects. The palmar side of the hand is minimally covered to allow for natural somatosensory feedback during object manipulation. The actuated thumb module allows for both opposition and lateral grasps. tenoexo is fabricated to a large extent by 3D-printing technology. With an underlying automatic tailoring algorithm it can be adapted to the individual user within a few minutes. The maximal fingertip force of 4.5 N per finger allows for grasping and lifting of most everyday objects, up to 0.5-liter water bottles.

Our current focus is on the evaluation of tenoexo with several individuals suffering from stroke or spinal cord injury and exploring its potential as both assistive and therapeutic device in these populations. In related projects, we are investigating intention detection through functional near-infrared spectroscopy (fNIRS) and electroencephalography (EEG) to allow for cortically-triggered assistance. Our vision is to realize a thought-controlled robotic hand exoskeleton for upper limb therapy and assistance in the clinic and at home.

Pictures (source: ETH Zurich / Stefan Schneller)

ReHand

Videos

RELab tenoexo: functions and grasp types

RELab tenoexo: setup, donning and doffing

RELab tenoexo: gesture classification training routine

A hand exoskeleton robot for rehabilitation using a three-layered sliding spring mechanism

Funding

  • Swiss National Science Foundation through the National Center of Competence in Research (NCCR) Robotics
  • Strategic Japanese-Swiss Cooperative Research Program on “Medicine for an Aging Society”
  • Japan Society for the Promotion of Science

Publications

Hofmann, U.A., Bützer, T., Lambercy, O., and Gassert, R. (2018). Design and Evaluation of a Bowden-Cable-Based Remote Actuation System for Wearable Robotics. IEEE Robotics and Automation Letters, 3(3):2101–2108.

Ryser, F., Bützer, T., Held, J.P., Lambercy, O., and Gassert, R. (2017). Fully embedded myoelectric control for a wearable robotic hand orthosisIEEE International Conference on Rehabilitation Robotics (ICORR).

Nycz, Ch., Bützer, T., Lambercy, O., Arata, J., Fischer, G.S., and Gassert, R. (2016). Design and Characterization of a Lightweight and Fully Portable Remote Actuation System for Use with a Hand Exoskeleton. IEEE Robotics and Automation Letters, 1(2):976–983.

Lambercy, O., Schröder, D., Zwicker, S. and Gassert, R. (2013). Design of a thumb exoskeleton for hand rehabilitation (PDF, 1.1 MB). Proc. International Convention on Rehabilitation Engineering and Assistive Technology (i-CREATe).

Arata, J., Ohmoto, K., Gassert, R., Lambercy, O., Fujimoto, H. and Wada, I. (2013). A new hand exoskeleton device for rehabilitation using a three-layered sliding spring mechanism. IEEE International Conference on Robotics and Automation, pp. 3902–3907.

 

via Robotic Hand Orthosis for Therapy and Assistance in Activities of Daily Living – Rehabilitation Engineering Laboratory | ETH Zurich

, , , , , , , , , , , ,

Leave a comment

[WEB SITE] Technology helps stroke patients get moving again

Electronic devices are helping stroke patients walk and move their hands again.
Provided

Electronic devices are helping stroke patients walk and move their hands again.

This may bode well for the 20 percent of survivors that have foot drop, and 87 percent of stroke survivors that have lost the use of their hands.

When a person has a stroke, multiple sclerosis or brain injury, most of the neurons that help signal muscles to move are broken. This keeps the brain from being able to send signals to certain muscle groups telling them to move.

A stroke, for example, can destroy millions of brain cells that you need to tie your shoes, pick up a grandchild or reach into your closet. To gain lost function, rehabilitation used to focus on teaching patients how to compensate for their physical deficits.

Today, research shows that neural plasticity (the ability of the brain to repair itself) can be applied effectively for improved outcomes and enhanced functional abilities.

To do this successfully, the central nervous system must seek other neural pathways and find new connections that bypass the damaged areas. With a little help from functional electrical stimulation (FES), which is low energy electrical pulses, the process to find the new connections is a bit easier.

New electrical orthotics target muscles with FES and can help accelerate muscle-nerve recovery. The electronic orthosis and its control unit transmit synchronized electric pulses to the peripheral nerves through electrodes built into the orthosis — these pulses are driven in precise sequence and accurately activate five muscles in the forearm.

“Muscles relearn when electrical stimulation provides feedback to the brain that can facilitate neuro re-education and promote neuroplasticity, which is the ability of the central nervous system to remodel itself,” says physical therapist Imelda Ungos, director of rehabilitation for Melbourne Terrace, a facility that specializes in the active and aging population. “And patients can learn a better way to function just by having new input, regardless of age.”

Ungos reports that the ultimate goal with this method of therapy is to restore voluntary movement. Patients with a history of brain lesions, such as stroke conditions and movement disorders, may have the most to gain with the neuro-orthotics and the rehab to learn how to use them.

“The latest therapy equipment from Bioness can drive the brain to new connections, and newer technology and techniques encourage the neuronal changes necessary for improved function,” says Ungos. “This kind of therapy is very specialized, and we’re the only sub-acute facility in the Space Coast area with the Bioness FES technologies,” says Ungos.

For improved hand function, the orthosis fits to the forearm and wrist, and communicates wirelessly with the control unit. Inside the orthosis, electrodes deliver mild pulses to stimulate muscle contraction.

The level of stimulation can be adjusted toward each function. With an intuitive interface, clinicians are better able to help their patients obtain simple control of desired hand activation.

The wireless device is portable and allows for quick detection of the best electrode position for each individual. A control unit enables easy programming of functional modes and training regimens.

For patients with poor safety and balance due to foot drop, which is the inability to lift the foot during walking, there’s an electronic orthosis that fits below the knee. The unit has stimulating electrodes placed over the correct nerve and fits below the knee. A heel sensor sends a muscle-contracting signal during the correct step phase to enable the foot to lift.

After the initial custom fitting of the orthosis, patients can enhance their abilities to perform daily activities, and the carry-over results from continued use will improve voluntary movement.

Ungos adds that the other benefits of interacting with the device include a reduction in muscle spasm, an increase in range of motion, and improved blood circulation. “That all goes towards retarding disuse atrophy,” she says.

“Efforts must be directed towards preventing complications and learning how to use affected limb along with active rehabilitation… especially when the use is started early in post stroke rehabilitation,” says online Bioness reports from Harold Weingarden, MD, Director of Rehabilitation Day Hospital Sheba Medical Center in Israel.

“An early start to rehab gives patients hope of what is possible in terms of present and future improvement,” says Ungos. She adds that the devices allow patients to move in more natural ways.

Feeling “normal” again can improve mood, function, and quality of life.

For more information, call Melbourne Terrace Rehabilitation Center at 321-725-3990. They offer comprehensive rehabilitative outpatient and inpatient services for short or long term care located at 251 East Florida Ave., Melbourne, FL 32901

via Technology helps stroke patients get moving again

, , , , , ,

Leave a comment

[WEB SITE] Kinetic Research Flagship Ankle-Foot Orthosis

The Noodle is Kinetic Research’s flagship ankle-foot orthosis.  This patented technology creates a quick and simple solution for drop foot.   What makes this ultra-lightweight AFO special is its next generation of carbon fiber properties that allow it to maintain dynamic motion and energy return. The Noodle positions the foot correctly during the swing phase and dampens heel strike for a natural loading response, minimizing foot slap. The Noodle is available with either lateral or medial strut and is the least restrictive design for controlling drop foot.

For all off-the-shelf orders, Kinetic Research will precut the footplate to size at no additional cost. The Noodle is also available in build-to-order allowing you to adjust color, height, and flexibility.

Kinetic Research offers a variety of off-the-shelf and custom dynamic ankle braces each with its own character and effect to meet the individual needs of the user.

Kinetic Research

800/919-3668

kineticresearch.com

via Kinetic Research Flagship Ankle-Foot Orthosis | Lower Extremity Review Magazine

, , , ,

Leave a comment

[WEB SITE] Several Types of Foot Drop Treatment

Recuperation relies upon the reason for foot drop and to what extent you’ve had it. Now and again it can be lasting. Rolling out little improvements in your home, for example, expelling mess and utilizing non-slip mats and tangles, can help avoid falls. There are likewise measures you can take to help settle your foot and enhance your strolling capacity.

Medicines for drop foot include:

  • Physiotherapy – to reinforce your foot, ankle and lower leg muscles
  • Wearing an ankle-foot orthosis – to hold your foot in a typical position
  • Electrical nerve incitement – in specific cases it can help lift the foot.
  • Surgery – an activity to combine the ankle or foot bones might be conceivable in extreme or long haul cases

Non-intrusive treatment:

In circumstances where foot drop has caused a significant walk unsettling influence, exercise-based recuperation might be required. Specific practice based recovery for foot drop may incorporate stride preparing that encourages the patient how to walk once more.

In less emotional circumstances, specific activities may essentially be encouraged to encourage the influenced muscles. Active recuperation might be called for in blend with different types of treatments, for example, those demonstrated as follows.

Ankle-foot orthosis:

An ankle-foot orthosis for foot drop is worn on the lower some part of the leg to help manage the ankle and foot. If your GP figures an AFO will enable, they’ll to allude you for an evaluation with an orthopedist. Wearing a snug sock between your skin and the AFO will guarantee solace and help anticipate rubbing. Your footwear ought to be fitted around the orthosis.

Ribbon up shoes or those with Velcro fastenings are prescribed for use with AFOs because they’re anything but trying to alter. Shoes with a removable trim are likewise valuable because they give additional room. High-obeyed shoes ought to be kept away from.

Breaking your orthosis in gradually is essential. Once broken in, wear it however much as could reasonably be expected while strolling because it will enable you to walk all the more proficiently and keep you stable. There exists a wide assortment of orthosis so discovering one that is agreeable and practical gives numerous alternatives.

Electrical nerve incitement:

Now and again, an electrical incitement gadget, like a TENS machine, can be utilized to enhance strolling capacity. It can enable you to walk quicker, with not so much exertion but rather more certainty. Two self-glue anode patches are set on the skin. One is placed near the nerve providing the muscle and the other over the focal point of the muscle.

The trigger produces electrical driving forces that animate the nerves to contract (abbreviate) the influenced muscles. The trigger is activated by a sensor in the shoe and is initiated each time your sole foot area leaves the ground as you walk.

Medical procedure:

The medical process might be an alternative in severe or long haul instances of foot drop that have caused perpetual development misfortune from muscle loss of motion. The technique more often than not includes exchanging a ligament from the more grounded leg muscles to the muscle that ought to pull your ankle upwards. Another sort of medical procedure comprises combining the foot or ankle unresolved issues balance out the ankle.

via Several Types of Foot Drop Treatment

 

, , ,

Leave a comment

[Abstract + References] Virtual Rehabilitation System for Fine Motor Skills Using a Functional Hand Orthosis –

Abstract

This article describes a virtual rehabilitation system with work and entertainment environments to treat fine motor injuries through an active orthosis. The system was developed in the Unity 3D graphic engine, which allows the patient greater immersion in the rehabilitation process through proposed activities; to identify the movement performed, the Myo armband is used, a device capable of receiving and sending the signals obtained to a mathematical algorithm which will classify these signals and activate the physical hand orthosis completing the desired movement. The benefits of the system is the optimization of resources, infrastructure and personnel, since the therapy will be assisted by the same virtual environment, in addition it allows selecting the virtual environment and the activity to be carried out according to the disability present in the patient. The results show the correct functioning of the system performed.

References

1.
Sanchez, J.S., et al.: Virtual Rehabilitation System for Carpal Tunnel Syndrome Through Spherical Robots. Accepted 2014
Google Scholar
2.
Naiker, A.: Repetitive Strain Injuries (RSI) – an ayurvedic approach. J. Ayurveda Integr. Med. Sci. 2(2), 170–173 (2017). ISSN 2456-3110
Google Scholar
3.
Rosales, R.S., Martin-Hidalgo, Y., Reboso-Morales, L., Atroshi, I.: Reliability and construct validity of the Spanish version of the 6-item CTS symptoms scale for outcomes assessment in carpal tunnel syndrome. BMC Musculoskelet. Disord. 17, 115 (2016)
CrossRefGoogle Scholar
4.
Uehli, K., et al.: Sleep problems and work injuries: a systematic review and meta-analysis. Sleep Med. Rev. 18(1), 61–73 (2014)
CrossRefGoogle Scholar
5.
Patti, F., et al.: The impact of outpatient rehabilitation on quality of life in multiple sclerosis. J. Neurol. 249(8), 1027–1033 (2002)
CrossRefGoogle Scholar
6.
Ueki, S., et al.: Development of a hand-assist robot with multi-degrees-of-freedom for rehabilitation therapy. IEEEASME Trans. Mechatron. 17(1), 136–146 (2012)
CrossRefGoogle Scholar
7.
Chang, W.H., Kim, Y.-H.: Robot-assisted therapy in stroke rehabilitation. J. Stroke 15(3), 174–181 (2013)
CrossRefGoogle Scholar
8.
Laver, K., George, S., Thomas, S., Deutsch, J.E., Crotty, M.: Virtual reality for stroke rehabilitation. Stroke 43(2), e20–e21 (2012)
CrossRefGoogle Scholar
9.
Lohse, K.R., Hilderman, C.G.E., Cheung, K.L., Tatla, S., der Loos, H.F.M.V.: Virtual reality therapy for adults post-stroke: a systematic review and meta-analysis exploring virtual environments and commercial games in therapy. PLoS ONE 9(3), e93318 (2014)
CrossRefGoogle Scholar
10.
North, M.M., North, S.M., Coble, J.R.: Virtual reality therapy: an effective treatment for the fear of public speaking. Int. J. Virtual Real. IJVR 03(3), 1–6 (2015)
Google Scholar
11.
Turolla, A., et al.: Virtual reality for the rehabilitation of the upper limb motor function after stroke: a prospective controlled trial. J. Neuroeng. Rehabil. 10, 85 (2013)
CrossRefGoogle Scholar
12.
Romero, P., León, A., Arteaga, O., Andaluz, V.H., Cruz, M.: Composite materials for the construction of functional orthoses. Accepted 2017
Google Scholar
13.
Benalcázar, M.E., Jaramillo, A.G., Jonathan, A., Zea, A., Páez, V.H.: Andaluz: hand gesture recognition using machine learning and the Myo armband. In: 2017 25th European Signal Processing Conference (EUSIPCO), pp. 1040–1044 (2017)
Google Scholar
14.
Maroukis, B.L., Chung, K.C., MacEachern, M., Mahmoudi, E.: Hand trauma care in the united states: a literature review. Plast. Reconstr. Surg. 137(1), 100e–111e (2016)
CrossRefGoogle Scholar
15.
Feron, L.O., Boniatti, C.M., Arruda, F.Z., Butze, J., Conde, A.: lesões por esforço repetitivo em cirurgiões-dentistas: uma revisão da literatura. Rev. Ciênc. Saúde 16(2), 79–86 (2014)
Google Scholar
16.
Putz-Anderson, V.: Cumulative Trauma Disorders. CRC Press, Boca Raton (2017)
Google Scholar
17.
Oktayoglu, P., Nas, K., Kilinç, F., Tasdemir, N., Bozkurt, M., Yildiz, I.: Assessment of the presence of carpal tunnel syndrome in patients with diabetes mellitus, hypothyroidism and acromegaly. J. Clin. Diagn. Res. JCDR 9(6), OC14–OC18 (2015)
Google Scholar
18.
Villafañe, J., Cleland, J., Fernánde-de-las-Peñas, C.: the effectiveness of a manual therapy and exercise protocol in patients with thumb carpometacarpal osteoarthritis: a randomized controlled trial. J. Orthop. Sports Phys. Ther. 43(4), 204–213 (2013)
CrossRefGoogle Scholar
19.
Langer, D., Maeir, A., Michailevich, M., Applebaum, Y., Luria, S.: Using the international classification of functioning to examine the impact of trigger finger. Disabil. Rehabil. 38(26), 2530–2537 (2016)
CrossRefGoogle Scholar
20.
da Silva Dulci Medeiros, M., Santana, D.V.G., de Souza, G.D., Souza, L.R.Q.: Tenossinovite de Quervain: aspectos diagnósticos. Rev. Med. E Saúde Brasília 5(2), 307–312 (2016)
Google Scholar
21.
Werthel, J.-D., Cortez, M., Elhassan, B.T.: Modified percutaneous trigger finger release. Hand Surg. Rehabil. 35(3), 179–182 (2016)
CrossRefGoogle Scholar
22.
Chang, K.-H.: Motion Simulation and Mechanism Design with SOLIDWORKS Motion 2016. SDC Publications (2016)
Google Scholar
23.
Andaluz, V.H., Pazmiño, A.M., Pérez, J.A., Carvajal, C.P., Lozada, F., Lascano, J., Carvajal, J.: Training of tannery processes through virtual reality. In: De Paolis, L.T., Bourdot, P., Mongelli, A. (eds.) AVR 2017. LNCS, vol. 10324, pp. 75–93. Springer, Cham (2017).  https://doi.org/10.1007/978-3-319-60922-5_6
CrossRefGoogle Scholar

via Virtual Rehabilitation System for Fine Motor Skills Using a Functional Hand Orthosis | SpringerLink

, , , , , , , , ,

Leave a comment

[Abstract + References] Virtual Rehabilitation System for Fine Motor Skills Using a Functional Hand Orthosis – Conference paper

Abstract

This article describes a virtual rehabilitation system with work and entertainment environments to treat fine motor injuries through an active orthosis. The system was developed in the Unity 3D graphic engine, which allows the patient greater immersion in the rehabilitation process through proposed activities; to identify the movement performed, the Myo armband is used, a device capable of receiving and sending the signals obtained to a mathematical algorithm which will classify these signals and activate the physical hand orthosis completing the desired movement. The benefits of the system is the optimization of resources, infrastructure and personnel, since the therapy will be assisted by the same virtual environment, in addition it allows selecting the virtual environment and the activity to be carried out according to the disability present in the patient. The results show the correct functioning of the system performed.

References

  1. 1.
    Sanchez, J.S., et al.: Virtual Rehabilitation System for Carpal Tunnel Syndrome Through Spherical Robots. Accepted 2014Google Scholar
  2. 2.
    Naiker, A.: Repetitive Strain Injuries (RSI) – an ayurvedic approach. J. Ayurveda Integr. Med. Sci. 2(2), 170–173 (2017). ISSN 2456-3110Google Scholar
  3. 3.
    Rosales, R.S., Martin-Hidalgo, Y., Reboso-Morales, L., Atroshi, I.: Reliability and construct validity of the Spanish version of the 6-item CTS symptoms scale for outcomes assessment in carpal tunnel syndrome. BMC Musculoskelet. Disord. 17, 115 (2016)CrossRefGoogle Scholar
  4. 4.
    Uehli, K., et al.: Sleep problems and work injuries: a systematic review and meta-analysis. Sleep Med. Rev. 18(1), 61–73 (2014)CrossRefGoogle Scholar
  5. 5.
    Patti, F., et al.: The impact of outpatient rehabilitation on quality of life in multiple sclerosis. J. Neurol. 249(8), 1027–1033 (2002)CrossRefGoogle Scholar
  6. 6.
    Ueki, S., et al.: Development of a hand-assist robot with multi-degrees-of-freedom for rehabilitation therapy. IEEEASME Trans. Mechatron. 17(1), 136–146 (2012)CrossRefGoogle Scholar
  7. 7.
    Chang, W.H., Kim, Y.-H.: Robot-assisted therapy in stroke rehabilitation. J. Stroke 15(3), 174–181 (2013)CrossRefGoogle Scholar
  8. 8.
    Laver, K., George, S., Thomas, S., Deutsch, J.E., Crotty, M.: Virtual reality for stroke rehabilitation. Stroke 43(2), e20–e21 (2012)CrossRefGoogle Scholar
  9. 9.
    Lohse, K.R., Hilderman, C.G.E., Cheung, K.L., Tatla, S., der Loos, H.F.M.V.: Virtual reality therapy for adults post-stroke: a systematic review and meta-analysis exploring virtual environments and commercial games in therapy. PLoS ONE 9(3), e93318 (2014)CrossRefGoogle Scholar
  10. 10.
    North, M.M., North, S.M., Coble, J.R.: Virtual reality therapy: an effective treatment for the fear of public speaking. Int. J. Virtual Real. IJVR 03(3), 1–6 (2015)Google Scholar
  11. 11.
    Turolla, A., et al.: Virtual reality for the rehabilitation of the upper limb motor function after stroke: a prospective controlled trial. J. Neuroeng. Rehabil. 10, 85 (2013)CrossRefGoogle Scholar
  12. 12.
    Romero, P., León, A., Arteaga, O., Andaluz, V.H., Cruz, M.: Composite materials for the construction of functional orthoses. Accepted 2017Google Scholar
  13. 13.
    Benalcázar, M.E., Jaramillo, A.G., Jonathan, A., Zea, A., Páez, V.H.: Andaluz: hand gesture recognition using machine learning and the Myo armband. In: 2017 25th European Signal Processing Conference (EUSIPCO), pp. 1040–1044 (2017)Google Scholar
  14. 14.
    Maroukis, B.L., Chung, K.C., MacEachern, M., Mahmoudi, E.: Hand trauma care in the united states: a literature review. Plast. Reconstr. Surg. 137(1), 100e–111e (2016)CrossRefGoogle Scholar
  15. 15.
    Feron, L.O., Boniatti, C.M., Arruda, F.Z., Butze, J., Conde, A.: lesões por esforço repetitivo em cirurgiões-dentistas: uma revisão da literatura. Rev. Ciênc. Saúde 16(2), 79–86 (2014)Google Scholar
  16. 16.
    Putz-Anderson, V.: Cumulative Trauma Disorders. CRC Press, Boca Raton (2017)Google Scholar
  17. 17.
    Oktayoglu, P., Nas, K., Kilinç, F., Tasdemir, N., Bozkurt, M., Yildiz, I.: Assessment of the presence of carpal tunnel syndrome in patients with diabetes mellitus, hypothyroidism and acromegaly. J. Clin. Diagn. Res. JCDR 9(6), OC14–OC18 (2015)Google Scholar
  18. 18.
    Villafañe, J., Cleland, J., Fernánde-de-las-Peñas, C.: the effectiveness of a manual therapy and exercise protocol in patients with thumb carpometacarpal osteoarthritis: a randomized controlled trial. J. Orthop. Sports Phys. Ther. 43(4), 204–213 (2013)CrossRefGoogle Scholar
  19. 19.
    Langer, D., Maeir, A., Michailevich, M., Applebaum, Y., Luria, S.: Using the international classification of functioning to examine the impact of trigger finger. Disabil. Rehabil. 38(26), 2530–2537 (2016)CrossRefGoogle Scholar
  20. 20.
    da Silva Dulci Medeiros, M., Santana, D.V.G., de Souza, G.D., Souza, L.R.Q.: Tenossinovite de Quervain: aspectos diagnósticos. Rev. Med. E Saúde Brasília 5(2), 307–312 (2016)Google Scholar
  21. 21.
    Werthel, J.-D., Cortez, M., Elhassan, B.T.: Modified percutaneous trigger finger release. Hand Surg. Rehabil. 35(3), 179–182 (2016)CrossRefGoogle Scholar
  22. 22.
    Chang, K.-H.: Motion Simulation and Mechanism Design with SOLIDWORKS Motion 2016. SDC Publications (2016)Google Scholar
  23. 23.
    Andaluz, V.H., Pazmiño, A.M., Pérez, J.A., Carvajal, C.P., Lozada, F., Lascano, J., Carvajal, J.: Training of tannery processes through virtual reality. In: De Paolis, L.T., Bourdot, P., Mongelli, A. (eds.) AVR 2017. LNCS, vol. 10324, pp. 75–93. Springer, Cham (2017).  https://doi.org/10.1007/978-3-319-60922-5_6CrossRefGoogle Scholar

via Virtual Rehabilitation System for Fine Motor Skills Using a Functional Hand Orthosis | SpringerLink

, , , ,

Leave a comment

[Case Report] Case report on the use of a functional electrical orthosis in rehabilitation of upper limb function in a chronic stroke patient – Full Text PDF

Abstract

Introduction. The increasing incidence of strokes and their occurrence in younger active people require the development of solutions that allow participation, despite the debilitating deficit that is not always solved by rehabilitation. The present report shows
such a potential solution.
Objective. In this presentation we will show the effects of using a functional electric orthosis, the high number of repetitions and daily electrostimulation in a young stroke patient with motor deficit in the upper limb, the difficulties encountered in attempting to
use orthosis, the results and the course of its recovery over the years.
Materials and Methods. The present report shows the evolution of a 31-year-old female patient with hemiplegia, resulting from a hemorrhagic stroke, from the moment of surgery to the moment of purchasing a functional electrical orthosis and a few months
later, highlighting a 3-week period when the training method focused on performing a large number of repetitions of a single exercise helped by the orthosis – 3 weekly physical therapy sessions, with a duration of one hour and 15 minutes, plus 2 electrostimulation sessions lasting 20 minutes each and 100 elbow extension, daily, 6 times a week. The patient was evaluated and filmed at the beginning and end of the 3 week period. The patient’s consent was obtained for the use of the data and images presented.
Results. Invalidating motor deficiency and problems specific to the use of upper limb functional electrostimulation in patients with stroke sequelae (flexion synergy, exaggeration of reflex response, wrist position during stimulation, etc.) made it impossible to use orthosis in functional activities within ADL although it allowed the achievement of a single task. Evaluation on the FuglMayer assessment does not show any quantifiable progress, although it is possible to have slightly improved the control of the
shoulder and elbow and increased the speed of task execution.
Conclusions. The use of functional orthoses of this type may be useful in patients who still have a significant functional rest in the shoulder, elbow and hand, and where the orthosis can produce an effective grasp. However for some patients, perhaps those who
would have been desirable to benefit most from this treatment, the benefit of using this orthosis is minimal.[…]

Full Text PDF

, , , , , , , , ,

Leave a comment

[ARTICLE] The impact of ankle–foot orthoses on toe clearance strategy in hemiparetic gait: a cross-sectional study – Full Text

Abstract

Background

Ankle–foot orthoses (AFOs) are frequently used to improve gait stability, toe clearance, and gait efficiency in individuals with hemiparesis. During the swing phase, AFOs enhance lower limb advancement by facilitating the improvement of toe clearance and the reduction of compensatory movements. Clinical monitoring via kinematic analysis would further clarify the changes in biomechanical factors that lead to the beneficial effects of AFOs. The purpose of this study was to investigate the actual impact of AFOs on toe clearance, and determine the best strategy to achieve toe clearance (including compensatory movements) during the swing phase.

Methods

This study included 24 patients with hemiparesis due to stroke. The gait performance of these patients with and without AFOs was compared using three-dimensional treadmill gait analysis. A kinematic analysis of the paretic limb was performed to quantify the contribution of the extent of lower limb shortening and compensatory movements (such as hip elevation and circumduction) to toe clearance. The impact of each movement related to toe clearance was assessed by analyzing the change in the vertical direction.

Results

Using AFOs significantly increased toe clearance (p = 0.038). The quantified limb shortening and pelvic obliquity significantly differed between gaits performed with versus without AFOs. Among the movement indices related to toe clearance, limb shortening was increased by the use of AFOs (p < 0.0001), while hip elevation due to pelvic obliquity (representing compensatory strategies) was diminished by the use of AFOs (p = 0.003). The toe clearance strategy was not significantly affected by the stage of the hemiparetic condition (acute versus chronic) or the type of AFO (thermoplastic AFOs versus adjustable posterior strut AFOs).

Conclusions

Simplified three-dimensional gait analysis was successfully used to quantify and visualize the impact of AFOs on the toe clearance strategy of hemiparetic patients. AFO use increased the extent of toe clearance and limb shortening during the swing phase, while reducing compensatory movements. This approach to visualization of the gait strategy possibly contributes to clinical decision-making in the real clinical settings.

Background

Impaired paretic limb advancement is a clearly observable manifestation of gait pathology in individuals with hemiparesis due to stroke [123]. Previous studies have reported specific gait changes following hemiparesis, such as decreased knee flexion, hip flexion, and ankle dorsiflexion during the swing phase, which can negatively influence the achievement of toe clearance [123456]. Reduction in toe clearance of the affected limb leads to tripping while walking, which is a major cause of falls [78]. In healthy individuals, toe clearance is mainly achieved by limb shortening, which is affected by hip flexion, knee flexion, and ankle dorsiflexion. On the other hand, to obtain sufficient toe clearance during the swing phase, individuals with hemiparesis often require compensatory strategies that modify the kinematic pattern, including hip hiking and circumduction, which are common gait deviations [39]. These changes during the swing phase have a reciprocal relationship. When the limb shortening is reduced due to paresis, the compensatory movements will be increased to contribute to toe clearance; hence, they are in a trade-off relationship [10].

Ankle–foot orthoses (AFOs) are frequently prescribed to improve walking ability in hemiparetic patients, as they provide passive or dynamic support of ankle movement. AFOs provide support not only during the stance phase of gait by encouraging lateral stability or improving early stance knee moments, but also in the swing phase to maintain ankle dorsiflexion and facilitate toe clearance [11121314151617]. The effect of AFOs on the swing phase is additionally reflected in the compensatory movements. Cruz et al. [18] demonstrated that the compensatory pelvic obliquity observed in response to impaired ankle dorsiflexion in hemiplegic patients was minimized when the patients wore an AFO. Improved joint motions and decreased compensatory movement when using AFOs could potentially contribute to an efficient gait and promote walking activity in hemiparetic patients.

Clarification of the mechanical effect of AFOs on these gait parameters, and quantifications of compensatory movements would be helpful for clinical decision-making in rehabilitation clinics. For example, understanding the influence of rehabilitative training and the use of AFOs on gait indices (i.e., ankle angle, knee angle, hip elevation, or toe clearance) would help to determine the best rehabilitative strategy and to identify the need for AFO use in individual patients.

The aim of this study was to clarify the mechanical effect of AFOs and to quantify the impact of AFO use on hemiparetic gait pattern during the swing phase, as this information would be helpful for clinical decision-making in rehabilitation clinics. For example, understanding the influence of rehabilitative training and the AFO and its types on gait indices (i.e., ankle angle, knee angle, hip elevation, or toe clearance) would help to determine the best rehabilitative strategy and to investigate the need for AFO use in individual patients. Based on a prior study showing the relationship between limb shortening and compensatory movements [10], we hypothesized that the AFOs would positively affect functional limb shortening in a way that would consequently impact on toe clearance and compensatory maneuvers, particularly represented by hip elevation. Previous studies have shown the effects of AFOs and a relationship between limb shortening and compensatory movements. In the normal gait pattern, functional limb shortening (representing lower limb joint movement) is a main strategy for toe clearance. However, patients with hemiparesis have impaired lower limb function, and thus require compensatory strategies (e.g., hip hiking, circumduction of the paretic limb) to promote swing phase propulsion [1920]. Additionally, the extent of toe clearance is mainly determined by the extent of functional limb shortening and hip elevation as compensatory movements, which are in a trade-off relationship [10]. AFO usage reduces the gait pattern deviation and increases the walking ability, thereby reducing energy costs [2122]. In this study, we hypothesized that the AFOs would positively affect functional limb shortening in a way that would consequently impact on toe clearance and compensatory maneuvers, particularly represented by hip elevation. To determine the actual impact of limb shortening and compensatory movements on toe clearance, the vertical component of the movements that comprised toe clearance was calculated using three-dimensional kinematic motion analysis. The changes in joint angles were also investigated.[…]

Continue —> The impact of ankle–foot orthoses on toe clearance strategy in hemiparetic gait: a cross-sectional study | Journal of NeuroEngineering and Rehabilitation | Full Text

Figure 1

Fig. 1 Marker placement. The positions of 12 measurement markers (bilateral acromion, iliac crest, hip, knee, ankle and toe)

, , , , ,

Leave a comment

[WEB SITE] Myomo – My own motion

Even if you haven’t moved your hand and arm in years due to a neuromuscular injury or disease, it is possible the MyoPro® may be able to help you use your arm and hand again.

Myopro 2My Own Motion

Myomo empowers individuals with a neuromuscular condition who have lost movement in a hand and arm to perform activities of everyday life. Myomo offers the MyoPro, a myoelectric elbow/wrist/hand orthosis (powered brace) to support the weak arm and enable patients to move an impaired hand and arm again.  MyoPro is the only product of its kind for people who suffer from debilitating neurological disorders such as brachial plexus injury, brain or spinal cord injury, CVA stroke, multiple sclerosis or amyotrophic lateral sclerosis (ALS).

MyoPro is covered by most commercial insurance companies in the U.S., and by the U.S. Veterans Administration – click here for more information for veterans.[…]

 

VISIT SITE —>  Home | Myomo

, , , , , , , ,

Leave a comment

%d bloggers like this: