Posts Tagged physical therapy

[ARTICLE] A neurocognitive approach for recovering upper extremity movement following subacute stroke: a randomized controlled pilot study – Full Text PDF

Abstract.

[Purpose] This study aims to describe a protocol based on neurocognitive therapeutic exercises and determine its feasibility and usefulness for upper extremity functionality when compared with a conventional protocol.

[Subjects and Methods] Eight subacute stroke patients were randomly assigned to a conventional (control group) or neurocognitive (experimental group) treatment protocol. Both lasted 30 minutes, 3 times a week for 10 weeks and assessments were blinded. Outcome measures included: Motor Evaluation Scale for Upper Extremity in Stroke Patients, Motricity Index, Revised Nottingham Sensory Assessment and Kinesthetic and Visual Imagery Questionnaire. Descriptive measures and nonparametric statistical tests were used for analysis.

[Results] The results indicate a more favorable clinical progression in the neurocognitive group regarding upper extremity functional capacity with achievement of the minimal detectable change. The functionality results are related with improvements on muscle strength and sensory discrimination (tactile and kinesthetic).

[Conclusion] Despite not showing significant group differences between pre and post-treatment, the neurocognitive approach could be a safe and useful strategy for recovering upper extremity movement following stroke, especially regarding affected hands, with better and longer lasting results. Although this work shows this protocol’s feasibility with the panel of scales proposed, larger studies are required to demonstrate its effectiveness.

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[ARTICLE] The Efficacy of State of the Art Overground Gait Rehabilitation Robotics: A Bird’s Eye View – Full Text

Abstract

To date, rehabilitation robotics has come a long way effectively aiding the rehabilitation process of the patients suffering from paraplegia or hemiplegia due to spinal cord injury (SCI) or stroke respectively, through partial or even full functional recovery of the affected limb. The increased therapeutic outcome primarily results from a combination of increased patient independence and as well as reduced physical burden on the therapist. Especially for the case of gait rehabilitation following SCI or stroke, the rehab robots have the potential to significantly increase the independence of the patient during the rehabilitation process without the patient’s safety being compromised. An intensive gait-oriented rehabilitation therapy is often effective irrespective of the type of rehabilitation paradigm. However, eventually overground gait training, in comparison with body-weight supported treadmill training (BWSTT), has the potential of higher therapeutic outcome due its associated biomechanics being very close to that of the natural gait. Recognizing the apparent superiority of the overground gait training paradigms, a through literature survey on all the major overground robotic gait rehabilitation approaches was carried out and is presented in this paper. The survey includes an in-depth comparative study amongst these robotic approaches in terms of gait rehabilitation efficacy.

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Source: The Efficacy of State of the Art Overground Gait Rehabilitation Robotics: A Bird’s Eye View

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[Abstract] Gamification in Physical Therapy: More Than Using Games

Abstract

The implementation of computer games in physical therapy is motivated by characteristics such as attractiveness, motivation, and engagement, but these do not guarantee the intended therapeutic effect of the interventions. Yet, these characteristics are important variables in physical therapy interventions because they involve reward-related dopaminergic systems in the brain that are known to facilitate learning through long-term potentiation of neural connections. In this perspective we propose a way to apply game design approaches to therapy development by “designing” therapy sessions in such a way as to trigger physical and cognitive behavioral patterns required for treatment and neurological recovery. We also advocate that improving game knowledge among therapists and improving communication between therapists and game designers may lead to a novel avenue in designing applied games with specific therapeutic input, thereby making gamification in therapy a realistic and promising future that may optimize clinical practice.

Source: Gamification in Physical Therapy: More Than Using Games : Pediatric Physical Therapy

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[BOOK] Physical Therapy Clinical Handbook for Ptas – Google Books

ΕξώφυλλοPhysical Therapy Clinical Handbook For Ptas, Third Edition Is A Concise Clinical Guide Designed Specifically To Help Physical Therapist Assistant Students And Practitioners Easily Obtain Helpful Evidence-Based Information. This Succinct Handbook Covers The Evaluative As Well As The Interventional Aspect Of Physical Therapy And Offers Immediate Guidance Concerning Physical Therapy Data Collection And Interventions, Including Musculoskeletal, Neurologic, Cardiopulmonary, Integumentary, Geriatric, Pediatric, And Acute Care Interventions.

This Third Edition Reflects Updates Featured In The APTA’S Guide To Physical Therapist Practice 3.0, As Well As Contemporary Documentation Requirements And Best Practices. With Its User-Friendly Format That Includes Tabbed Sections For Easy Referencing And The Inclusion Of Clinical Pearls For The PTA, This Handbook Is A Valuable Resource For PTA Practitioners And Students Alike. KEY UPDATES: Expand Information On HIPAA And Bloodborne Pathogens Updated Infection Control Section New Information On Elder And Child Abuse Expanded Information About Documentation Inclusion Of EMR Inclusion Of Common Medication Wider Range Of Musculoskeletal Pathologies Wider Range Of Neurologic Interventions Expanded Section On Geriatric Disorders/Diseases Applicable Courses: Clinical Practicum Clinical Education Clinical Experience.

Source: Physical Therapy Clinical Handbook for Ptas – Kathy Kulinski, Primary Instructor Fox College Monee Illinois Kathy Cikulin-Kulinski – Βιβλία Google

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[ARTICLE] A Rehabilitation-Internet-of-Things in the Home to Augment Motor Skills and Exercise Training – Full Text

Although motor learning theory has led to evidence-based practices, few trials have revealed the superiority of one theory-based therapy over another after stroke. Nor have improvements in skills been as clinically robust as one might hope. We review some possible explanations, then potential technology-enabled solutions.

Over the Internet, the type, quantity, and quality of practice and exercise in the home and community can be monitored remotely and feedback provided to optimize training frequency, intensity, and progression at home. A theory-driven foundation of synergistic interventions for walking, reaching and grasping, strengthening, and fitness could be provided by a bundle of home-based Rehabilitation Internet-of-Things (RIoT) devices.

A RIoT might include wearable, activity-recognition sensors and instrumented rehabilitation devices with radio transmission to a smartphone or tablet to continuously measure repetitions, speed, accuracy, forces, and temporal spatial features of movement. Using telerehabilitation resources, a therapist would interpret the data and provide behavioral training for self-management via goal setting and instruction to increase compliance and long-term carryover.

On top of this user-friendly, safe, and conceptually sound foundation to support more opportunity for practice, experimental interventions could be tested or additions and replacements made, perhaps drawing from virtual reality and gaming programs or robots. RIoT devices continuously measure the actual amount of quality practice; improvements and plateaus over time in strength, fitness, and skills; and activity and participation in home and community settings. Investigators may gain more control over some of the confounders of their trials and patients will have access to inexpensive therapies.

Neurologic rehabilitation has been testing a motor learning theory for the past quarter century that may be wearing thin in terms of leading to more robust evidence-based practices. The theory has become a mantra for the field that goes like this. Repetitive practice of increasingly challenging task-related activities assisted by a therapist in an adequate dose will lead to gains in motor skills, mostly restricted to what was trained, via mechanisms of activity-dependent induction of molecular, cellular, synaptic, and structural plasticity within spared neural ensembles and networks.

This theory has led to a range of evidence-based therapies, as well as to caricatures of the mantra (eg, a therapist says to patient, “Do those plasticity reps!”). A mantra can become too automatic, no longer apt to be reexamined as a testable theory. A recent Cochrane review of upper extremity stroke rehabilitation found “adequately powered, high-quality randomized clinical trials (RCTs) that confirmed the benefit of constraint-induced therapy paradigms, mental practice, mirror therapy, virtual reality paradigms, and a high dose of repetitive task practice.”1 The review also found positive RCT evidence for other practice protocols. However, they concluded, no one strategy was clearly better than another to improve functional use of the arm and hand. The ICARE trial2 for the upper extremity after stroke found that both a state-of-the-art Accelerated Skill Acquisition Program (motor learning plus motivational and psychological support strategy) compared to motor learning-based occupational therapy for 30 hours over 10 weeks led to a 70% increase in speed on the Wolf Motor Function Test, but so did usual care that averaged only 11 hours of formal but uncharacterized therapy. In this well-designed RCT, the investigators found no apparent effect of either the dose or content of therapy. Did dose and content really differ enough to reveal more than equivalence, or is the motor-learning mantra in need of repair?

Walking trials after stroke and spinal cord injury,38 such as robot-assisted stepping and body weight-supported treadmill training (BWSTT), were conceived as adhering to the task-oriented practice mantra. But they too have not improved outcomes more than conventional over-ground physical therapy. Indeed, the absolute gains in primary outcomes for moderate to severely impaired hemiplegic participants after BWSTT and other therapies have been in the range of only 0.12 to 0.22 m/s for fastest walking speed and 50 to 75 m for 6-minute walking distance after 12 to 36 training sessions over 4 to 12 weeks.3,9 These 15% to 25% increases are just as disappointing when comparing gains in those who start out at a speed of <0.4 m/s compared to >0.4 to 0.8 m/s.3

Has mantra-oriented training reached an unanticipated plateau due to inherent limitations? Clearly, if not enough residual sensorimotor neural substrate is available for training-induced adaptation or for behavioral compensation, more training may only fail. Perhaps, however, investigators need to reconsider the theoretical basis for the mantra, that is, whether they have been offering all of the necessary components of task-related practice, such as enough progressively difficult practice goals, the best context and environment for training, the behavioral training that motivates compliance and carryover of practice beyond the sessions of formal training, and blending in other physical activities such as strengthening and fitness exercise that also augment practice-related neural plasticity? These questions point to new directions for research….

Continue —> A Rehabilitation-Internet-of-Things in the Home to Augment Motor Skills and Exercise Training – Mar 01, 2017

Figure 1. Components of a Rehabilitation-Internet-of-Things: wireless chargers for sensors (1), ankle accelerometers with gyroscopes (2) and Android phone (3) to monitor walking and cycling, and a force sensor (4) in line with a stretch band (5) to monitor resistance exercises.

 

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[WEB SITE] Exercise Prescription Software – Physical Therapy Web

Any tool that can help people be more active and involved in their own rehabilitation is worthwhile. An increase in patient compliance can be achieved by making exercise programs easier to adhere to. Clear descriptions of how to perform exercises correctly is also critical to the success of any exercise program. Here is a list of software applications that allow physical therapists to create specific exercise programs for their patients. The list is not complete. If you know of a product that should be included or if you’d like to have your exercise prescription software reviewed, please let us know.

exercise prescription software - diagram

By Udrekeli [Public domain], via Wikimedia Commons

 

Arena Health Systems: Creators of Phys-X software

“Phys-X Advanced includes over 900 of the most often prescribed range of motion, stabilization and strengthening exercises (categories listed below) and includes Full Color Photographs for most exercises! Each exercise includes an illustration and specific easy to follow instructions that allow on-the-fly modification. The exercises can even be printed with Spanish instructions.”

BPM Rx: Exercise prescription for health and fitness professionals

“Whether you’re a personal trainer or physical therapist, exercise prescription is your life. BPM Rx is the ultimate PT Software that allows you to craft stunning exercise handouts that will inspire like never before! Try it out-the first week is free!”

BioEx Systems Inc.: Easy to use home exercise database

“Exercise, Fitness Assessment, Nutrition and Management software for Physical Therapists, Personal Trainers, Dietitians, Nutritionists and other professionals. Windows based software.”

Exercise Prescriber: Provide home exercises and information advice

“…an essential clinical tool for health professionals who routinely provide home exercises and information advice for their clients.”

Exercise Pro Live : Personalized Video and Printed Exercise Programs for Rehabilitation and Fitness

“…designed by physical therapists and other fitness professionals to provide video exercise programs with clear exercise instructions, proper exercise form and improved compliance and communication between health professionals and their clients.”

HEP2go.com: HEP for rehab pro’s

“For rehabilitation professionals such as physical therapists, occupational therapists, athletic trainers, etc. to create home exercise programs for patients and or clients.”

i-HEP.com: iHomeExerciseProgram

“Innovative Video + Web-based Platform = Better HEP Management & Better Patient Education

Mavenlive: Intelligent exercise prescription, customizable images, and documentation (free-trial available)

“Using Mavenlive will benefit you not only from a clinical standpoint, but it will help you improve relationships with your patients and your referral sources. Mavenlive clients tell us that physicians love getting professional correspondence. “

myclinicspace: High quality image and video exercises for patient rehabilitation

“myclinicspace is an online exercise prescription package for health professionals.”

MyPhysioRehab: A global community of therapists helping to speed your recovery (free-demo available)

“MyPhysioRehab allows you as a health professional to provide your patients with an injury profile and a rehabilitation programme to aid rapid recovery.”

PacPacs+: Online Rehabilitation Exercise and Client Management

“Manage your patient aftercare. Prescribe rehabilitation routines with multi-angle videos. Track consultation history and make notes for future sessions.”

Patient Care HEP: MedBridge

“Patient Care HEP is the fast, easy, comprehensive, and engaging home exercise program for rehabilitation professionals.”

Physiotec: Exercise and patient education database software

“Physiotec offers a health and fitness software with exercise programs for physiotherapy, rehabilitation and therapeutic exercises and distributes it across Canada, United-States (USA) and United-Kingdoms.”

PTX – PhysioTherapy eXercises: Create custom programs or choose ready made programs

“A free tool to create exercise programs for people with injuries and disabilities”

PhysioTools Software: Comprehensive and easy to use exercise software

“Exercise software for health and fitness professionals to print and email over 15,000 exercises for rehabilitation, physiotherapy, sports and education”

Physioview: Features professionally produced photographs, audio, video and text

“Physioview redefines the home exercise program from the fundamental to highly customized creation of rehabilitation exercise protocols. “

Physitrack: A mobile phone exclusively for practitioners

“Provides Physical Therapists with the ability to prescribe exercises, send messages to their patients”

The Rehab Lab: Online Exercise Prescription Software

“The Rehab Lab is an online exercise prescription software application that enables physiotherapists to create customised rehabilitation programmes for clients and patients.”

Simple Therapy: video exercise therapy that matches your needs, when and where you want it

“SimpleTherapy® offers more than 20 video-based exercise therapy programs designed by doctors.”

SimpleSet Pro: Advanced Exercise Prescription Software

“SimpleSet Pro is the ultimate online tool for professional exercise program design. With SimpleSet Pro you can create comprehensive exercise programs for your clients, and email or print them in minutes!”

SHAPES: Spatially and Human Aware Performance Evaluation System.

“SHAPES is an interactive, assistive technology (using the Microsoft Xbox Kinect) that enhances exercise routines.”

TheraVid: Connect. Discover. Recover.

“Use our expanding database of HD exercise videos and unique online interface to build better client relationships today. Free while in beta.”

WebExercises: Exercise Prescription Made Easy™

“WebExercises® will promote more frequent and proper form of all prescribed rehabilitation and corrective exercises – resulting in improved recovery and stronger happier patients and clients.”

wellpepper: gives your health a kick

“Wellpepper for iPad and iPhone enables healthcare professionals to prescribe physical therapy exercises and encourages people to complete exercises at home to help speed recovery”

Source: Exercise Prescription Software – Physical Therapy Web

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[BLOG POST] Common Physical Therapy Abbreviations

When Physical Therapists document the progress of a patient, it’s common for abbreviations to be made within the notes. Rules vary depending on your facility, but it’s common to use physical therapy abbreviations such as NWB (non weight bearing) or AD (assistive device).

While the APTA does not endorse a standard set of physical therapy abbreviations (maybe it should…) you can find plenty of resources that share common words that are shortened by PTs. This list is not all inclusive or a ‘standard’ but it gives you an idea of what is commonly being used.

For student PT’s who are just starting in the clinic, it’s great to review this list in case you run into some language in the documentation that you’re not familiar seeing.

Common Physical Therapy Abbreviations

AAROM Active Assistive Range of Motion

ABD        Abduction

ADD        Adduction

(A)      assist

AD       assistive device

Amb.   ambulate, ambulated

Ant      Anterior

ā          before

abd.     abduction

ACL     anterior cruciate ligament

ADL’s activities of daily living

Add.    adduction

AFO     ankle foot orthosis

@        at

AKA     above knee amputee

ALS      Amyotrophic Lateral Sclerosis

amb    ambulate

Appt.   appointment

AROM             active range of motion

As tol   As tolerated

A/P     Anterior Posterior

(B)       Bilateral

B/L      Bilateral

BAPS   Biomechanical Ankle Platform System

bed mob. bed mobility

bk         back

BKA     below knee amputation

BID      Twice a day

BIW     bi-weekly, twice weekly

BOS     Base of support

BP       Blood pressure

bpm    Beats per minute

Bwd    Backward

CA       Cancer

cerv.    cervical

CC       Chief Complaint

CF        Cystic Fibrosis

CGA     Contact Guard Assist

CHF     Congestive Heart Failure

CHI      closed head injury

Cont.   continue

COTA  certifi ed occupational therapy assistant

COPD  Chronic Obstructive Pulmonary Disease

C/o      Complains of

COG     Center of gravity

Cont    Continue

CP       coldpack, cerebral palsy

CPM    Continuous passive motion

C/S      cervical spine

CVA     Cerebral Vascular Accident

CVD     Cardio-Vascular Disease

CRPS   Complex Regional Pain Syndrome

CP       Cerebral Palsy

CTS     Carpal Tunnel Syndrome

Cx.       cancel, cancellation

dep., D      dependent

Dexa   Dexamethazone

DC       discharge, discontinue

D/C     Discharge

DDD    Degenerative Disc Disease

DF       dorsiflexion

Diag    Diagonal

DIP      Distal Interphalangeal Joint

DJD     Degenerative Joint Disease

DM      Diabetes Mellitus

DMD   Duchenne Muscular Dystrophy

DME    durable medical equipment

DOB    Date of birth

DOI     Date of injury

DOS     Date of surgery

DVT     Deep Vein Thrombosis

Dx        Diagnosis

Eval.    evaluation eversion

Ev.       eversion

Equip.   equipment

ER       Emergency Room

E-stim    Electrical Stimulation

EOB     Edge of bed

Ex.        exercise

Ext.      extension

Ext. rot., ER     external rotation

freq       frequency

F,  3/5  fair (in reference to manual muscle testing)

FES      Functional Electrical Stimulation

Flex.    flexion

FCR     Flexor Carpi Radialis

FCU     Flexor Carpi Ulnaris

F/u      Follow up

FWW   Front wheeled walker

FWB    full weight bearing

fwd       forward

Fx.        fracture

GH       Gleno-Humeral

Gt.        Trng. gait training

G, 4/5    good (in reference to manual muscle testing)

GMT    gross muscle test

HA       Headache

Hemi. hemiplegia, hemiparesis

HEP     home exercise program

HHA    home health aide

HKAFO hip knee ankle foot orthosis

HOB    Head of bed

Hor      Horizontal

HP       hot pack

H/S     Hamstring

HNP    Herniated Nucleus Pulposus

HTN    Hypertension

HVGS   high voltage galvanic stimulation

HX       history

H/o     History of

I ,         Indep independent

IDDM  insuline dependent diabetes mellitus

IE        initial evaluation

IFC      interferential current

IMS     intramuscular stimulation

Inf       Inferior

Int. rot., IR   internal rotation

Inv.      inversion

Ionto   Iontophoresis

Isom    isometric

ITB      Ilio-tibial Band

Jt         Joint

KAFO    Knee ankle foot orthosis

L , L, Lt.    left

LAQ     long arc quad (exercise.)

Lat        Lateral

Lats      Latissimus Dorsi

LBP      low back pain

LB         lower body

LBQC   large base quad cane

LCL      Lateral Collateral Ligament

LE        lower extremity

LQ       lower quadrant

LTG     long term goal

L/S      Lumbar Spine

Max     Maximum

MCL    Medial Collateral Ligament

MCP    Metacarpophalangeal Joint

Med     Medial

MDL    moderately limited

MENS microcurrent electrical nerve stimulator

MFR    myofacial release

MI       Myocardial Infarction

Min     Minimum

M/L     Medial Lateral

MFR    Myofascial Release

MHP    Moist Hot Pack

MKL    markedly limited

mm.     muscle

MMT   manual muscle test

MNL    minimally limited

Mob    Mobilization

mod    Moderate

MS       Multiple Sclerosis

MSW   medical social worker

MTP    Metatarsophalangeal Joint

MVA    Motor Vehicle Accident

Max.    maximal

N, .5/5  normal (re: muscle strength)

NAGS     Natural Apophyseal Glides

NBQC     Narrow Based Quad Cane

NCV       nerve conduction velocity

NIDDM non-insulin dependent diabetes mellitus

N/T     numbness and tingling or not tested

NF       No Fault

NMR    Neuromuscular re-education

NWB   non-weight bearing

NS       No Show

OA       Osteoarthritis

OOB    Out of bed

OT       occupational therapy/therapist

OTR     registered occupational therapist

_
p  after

PBall   Physio-Ball

PD       Parkinson’s Disease

P, 2/5      poor (re: muscle strength)

Pec          Pectoral / Pectoralis

PCL         Posterior Cruciate Ligament

PIP          Proximal Interphalangeal Jt

PF            plantar fl exion

PMH       past medical history

Pn           pain

PNF        Proprioceptive Neuromuscular Facilitation

POC     plan of care

P/A     Posterior Anterior

PRE     progressive resistive exercises

Post     Posterior

Prec.    Precautions

Prep.   preparation

Prox    Proximal

Pron    Pronation

Phono Phonophoresis

PRN     As needed

Pt.        patient

PT       physical therapy/therapist

PTA     physical therapist assistant

P/u      Push up

PVD     Peripheral Vascular Disease

PWB    partial weight bearing

Quad   Quadriceps

QS       Quadriceps Set

RA       Rheumatoid Arthritis

R , R, rt right

Re        recheck

Rec’d   received

Rehab. rehabilitation

Reps.   repetitions

Req/d. required

RGO     reciprocating gait orthosis

ROM    Range of Motion

Rot.      rotation

r/o      Rule out

RSD     Reflex Sympathetic Dystrophy

RTC     Rotator Cuff

RTW    Return to work

Rx.       treatment

RW      Rolling Walker

SAQ     short arc quad (exercise)

SB        Sidebend

SBA     standby assist

SBQC   small base quad cane

SCI       spinal cord injury

Script   Prescription

SI, SIJ  sacroiliac joint

Sh        shoulder

S/L      Sidelying

SLP      speech-language pathologist

SLR      Straight Leg Raise

SNAGS Sustained Natural Apophyseal Glides

SOB     Shortness of Breath

S/p      Status post

SPC     Single point cane

SPT     student P.T.

SPTA   student P.T.A.

ST        speech therapy

STG     short term goals

STM    Soft Tissue Mobilization

(S)       Supervision

Sup     Supination or Superior

SW      Standard Walker

T-Band Theraband

T, 1/5 trace (re: muscle strength)

TA         Therapeutic Activities

TBI        Traumatic Brain Injury

TENS    transcutaneous electrical nerve stimulator

THA      total hip arthroplasty

THR      total hip replacement

TIW      three times per week

THA     Total Hip Arthroplasty

THR     Total Hip Replacement

Ther Ex Therapeutic Exercise

TIA      Transient Ischemic Attack

TKA     total knee arthroplasty

TKR     total knee replacement

TLSO   Thoracolumbosacal orthotic

TM      treadmill

TMJ     Temporomandibular Joint

Tol       Tolerated

TTWB   Toe Touch Weight Bearing

T/S      Thoracic Spine

Tx        Traction

UB       upper body

UBE     Upper Body Ergometer

UE       upper extremity

UQ       upper quadrant

US       ultrasound

UV       ultraviolet

VC       verbal cues

VIC      Verbalized informed consent

W/cm2 watts per centimeter squared

WB      weight bearing

WBQC    Wide based quad cane

WBAT     weight bearing as tolerated

W/C    Wheelchair

WFL    within functional limits

WNL    within normal limits

y/o      Years old

// Bars Parallel Bars

4WW Four wheeled walker

_
s          without

_
c          with

1°        primary

2°        secondary

approx. approximately

         pound

(3 dots in a triangle) therefore

(Triangle)         change

=          equals

Z, 0/5 zero (re: muscle strength)

<          Less Than

         Greater Than

1:1      One to one

‘           Foot or Feet

‘’          Inches

         Pounds

↑        Up, increased

↓        Down, decreased

√        Flexion

∕            Extension

↔        To and from

Do you see any common abbreviations that have been left out? Let us know in the comments and we’ll add them.

Source: Common Physical Therapy Abbreviations

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[WEB SITE] Your left hand knows what your right hand is doing

The saying goes that “your left hand doesn’t know what your right hand is doing,” but actually, your left hand is paying more attention than you’d think. Researchers at Tel-Aviv University found that when people practiced finger movements with their right hand while watching their left hand on 3D virtual reality headsets, they could use their left hand more efficiently after the exercise. The work, appearing in Cell Reports, provides a new strategy to improve physical therapy for people with limited strength in their hands.

“We are tricking the brain,” says lead author Roy Mukamel, a professor of psychology at Tel Aviv University in Israel. “This entire experiment ended up being a nice demonstration about how to combine software engineering and neuroscience.”

After completing baseline tests to assess the initial motor skills of each hand, 53 participants strapped on virtual reality headsets, which showed simulated versions of their hands. During the first experiment, the participants completed a series of finger movements with their right hand while the screen showed their virtual left hand moving instead. Next, the participants put a motorized glove on their left hand, which moved their fingers to match the motions of the right hand. While this occurred, the headsets again showed their virtual left hand moving instead of their right.

After analyzing the results, the researchers discovered that the left hand’s performance significantly improved (i.e., had more precise movements in a faster amount of time) when the screen showed the left hand. But the most notable improvements occurred when the virtual reality screen showed the left hand moving while the motorized glove moved the right hand in reality.

The researchers also used fMRI to track which brain structures were activated during the experiments in 18 of the participants. The scientists noted that one section of the brain, called the superior parietal lobe, was activated in each person during training. They also discovered that the level of activity in this brain region was correlated to the level of improved performance in the left hand–the more activity, the better the left hand performed.

“Technologically these experiments were a big challenge,” says Mukamel. “We manipulated what people see and combined it with the passive movement of the hand to show that our hands can learn when they’re not moving under voluntary control.”

The researchers are optimistic that this research can be applied to patients in physical therapy programs who have lost the strength or control of their hands. “We need to show a way to obtain high-performance gains relative to other traditional types of therapies,” says Mukamel. “If we can train one hand without voluntarily moving it and still show significant improvements in the motor skills of that hand, then that’s the ideal.”

This work was supported through the Sagol School of Neuroscience and School of Psychological Sciences at Tel-Aviv University in Israel.

Article: Neural Network Underlying Intermanual Skill Transfer in Humans, Ossmy and Mukamel, Cell Reports, 10.1016/j.celrep.2016.11.009, published 13 December 2016.

Source: Your left hand knows what your right hand is doing – Medical News Today

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[ARTICLE] Biofeedback improves performance in lower limb activities more than usual therapy in people following stroke: a systematic review – Full Text

Abstract

Question: Is biofeedback during the practice of lower limb activities after stroke more effective than usual therapy in improving those activities, and are any benefits maintained beyond the intervention?

Design: Systematic review with meta-analysis of randomised trials with a PEDro score > 4.

Participants: People who have had a stroke.

Intervention: Biofeedback (any type delivered by any signal or sense) delivered concurrently during practice of sitting, standing up, standing or walking compared with the same amount of practice without biofeedback.

Outcome measures: Measures of activity congruent with the activity trained.

Results: Eighteen trials including 429 participants met the inclusion criteria. The quality of the included trials was moderately high, with a mean PEDro score of 6.2 out of 10. The pooled effect size was calculated as a standardised mean difference (SMD) because different outcome measures were used. Biofeedback improved performance of activities more than usual therapy (SMD 0.50, 95% CI 0.30 to 0.70).

Conclusion: Biofeedback is more effective than usual therapy in improving performance of activities. Further research is required to determine the long-term effect on learning. Given that many biofeedback machines are relatively inexpensive, biofeedback could be utilised widely in clinical practice.

[Stanton R, Ada L, Dean CM, Preston E (2016) Biofeedback improves performance in lower limb activities more than usual therapy in people following stroke: a systematic review. Journal of Physiotherapy 63: 11–16]

Introduction

This is an update of a systematic review1 that examined the effect of biofeedback in training lower limb activities after stroke. Biofeedback is equipment that transforms biological signals into an output that can be understood by the learner, providing information to the learner that is not consciously available. That is, biofeedback takes intrinsic physiological signals and makes them extrinsic, giving the person immediate and accurate feedback of information about these body functions. Biofeedback can be delivered through various senses, such as visual, auditory and tactile systems, and can provide information about the kinematics, kinetics and/or electromyography of activities. Biofeedback is available from medical equipment (eg, electromyography, force platforms and positional devices traditionally used in clinical practice); or from non-medical equipment that is increasingly available and used in stroke rehabilitation (eg, recreational games such as the Nintendo® Wii™). Biofeedback can be used in addition to verbal content; however, it also has the advantage that it can be set up for the patient to use when left to practise alone. However, biofeedback is not commonly used in stroke rehabilitation.2

The previous version of this review,2 which was published in 2011, examined biofeedback broadly in training lower limb activities after stroke, including trials where any form of biofeedback was provided during practice of the whole activity (rather than part of the activity), with outcomes measured during the same activity. Twenty-two trials met the inclusion criteria and were included in the review; however, meta-analyses demonstrated significant heterogeneity that was best explained by the quality of the included trials. When analyses were limited to higher quality trials (PEDro score > 4), biofeedback had a moderate effect in the short term (10 trials, 241 participants, SMD 0.49, 95% CI 0.22 to 0.75) compared with usual therapy, which was maintained beyond intervention (five trials, 138 participants, SMD 0.41, 95% CI 0.06 to 0.75), suggesting that learning had occurred. For a direct comparison of the effect of biofeedback interventions and usual therapy (which includes therapist communication), a post hoc meta-analysis was conducted of those trials where the amount of practice was equal in each group. That is, trials where the control group practised the same activity for the same amount of time as the experimental group, with the only difference being the substitution of biofeedback for therapist communication (presumably including feedback) in the experimental group. This meta-analysis demonstrated a moderate effect of a similar magnitude to the overall analysis (eight trials, 170 participants, SMD 0.51, 95% CI 0.20 to 0.83), suggesting that biofeedback is superior to therapist communication.

Since that review1 was published in 2011, a number of additional trials have been published that investigated the effect of biofeedback, warranting an update of the review. In particular, the potential of using recreational games in stroke rehabilitation has gained attention. The inclusion criteria for this updated review incorporated findings from the previous review. Specifically, this meant that the updated review would include any randomised trial investigating biofeedback from any signal (position, force, EMG) via any sense (visual, auditory, tactile), delivered concurrently during whole activity practice, compared with usual therapy that was practice of the same activity for the same amount of time in the control group with no biofeedback (but presumably with therapist communication), with outcome measures at the activity level and congruent with the activity trained. This ensures a true comparison of the effect of biofeedback compared with usual therapist communication. For the biofeedback intervention, inclusion in this update was based on whether the biofeedback delivered was concurrent rather than terminal feedback. This meant that commercially available recreational games would be included if the majority of the games played within the study delivered concurrent biofeedback, rather than inclusion based on the equipment itself. In order to make recommendations based on the highest level of evidence, this review included only randomised trials with a PEDro score > 4.

Therefore, the research questions for this systematic review were:

  • 1. In adults following stroke, is biofeedback during the practice of lower limb activities more effective than usual therapy in improving those activities in the short term?
  • 2. Are any benefits maintained beyond the intervention?

Continue —> Biofeedback improves performance in lower limb activities more than usual therapy in people following stroke: a systematic review – Journal of Physiotherapy

 

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[Systematic Review] Biofeedback improves performance in lower limb activities more than usual therapy in people following stroke – Full Text

Abstract

Question: Is biofeedback during the practice of lower limb activities after stroke more effective than usual therapy in improving those activities, and are any benefits maintained beyond the intervention? Design: Systematic review with meta-analysis of randomised trials with a PEDro score > 4. Participants: People who have had a stroke. Intervention: Biofeedback (any type delivered by any signal or sense) delivered concurrently during practice of sitting, standing up, standing or walking compared with the same amount of practice without biofeedback. Outcome measures: Measures of activity congruent with the activity trained. Results: Eighteen trials including 429 participants met the inclusion criteria. The quality of the included trials was moderately high, with a mean PEDro score of 6.2 out of 10. The pooled effect size was calculated as a standardised mean difference (SMD) because different outcome measures were used. Biofeedback improved performance of activities more than usual therapy (SMD 0.50, 95% CI 0.30 to 0.70). Conclusion: Biofeedback is more effective than usual therapy in improving performance of activities. Further research is required to determine the long-term effect on learning. Given that many biofeedback machines are relatively inexpensive, biofeedback could be utilised widely in clinical practice. [Stanton R, Ada L, Dean CM, Preston E (2016) Biofeedback improves performance in lower limb activities more than usual therapy in people following stroke: a systematic review.Journal of PhysiotherapyXX: XX-XX]

Introduction

This is an update of a systematic review1 that examined the effect of biofeedback in training lower limb activities after stroke. Biofeedback is equipment that transforms biological signals into an output that can be understood by the learner, providing information to the learner that is not consciously available. That is, biofeedback takes intrinsic physiological signals and makes them extrinsic, giving the person immediate and accurate feedback of information about these body functions. Biofeedback can be delivered through various senses, such as visual, auditory and tactile systems, and can provide information about the kinematics, kinetics and/or electromyography of activities. Biofeedback is available from medical equipment (eg, electromyography, force platforms and positional devices traditionally used in clinical practice); or from non-medical equipment that is increasingly available and used in stroke rehabilitation (eg, recreational games such as the Nintendo® Wii™). Biofeedback can be used in addition to verbal content; however, it also has the advantage that it can be set up for the patient to use when left to practise alone. However, biofeedback is not commonly used in stroke rehabilitation.2

Continue —> Biofeedback improves performance in lower limb activities more than usual therapy in people following stroke: a systematic review

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