Posts Tagged physical therapy

[Abstract] Effectiveness of the Bobath concept in the treatment of stroke: a systematic review

Abstract

Purpose: To evaluate the effectiveness of the Bobath concept in sensorimotor rehabilitation after stroke.

Materials and methods: A systematic literature review was conducted on the Bobath concept from the first publication available to January 2018, consulting PUBMED, CENTRAL, CINAHL and PEDro databases. Fifteen clinical trials were selected in two consecutive screenings. Two independent researchers rated the studies according to the PEDro scale from which a best evidence synthesis was derived to determine the strength of the evidence.

Results: The Bobath concept is not more effective than other approaches used in post-stroke rehabilitation. There is moderate evidence for the superiority of other therapeutic approaches such as forced use of the affected upper limb and constraint-induced movement therapy for motor control of the upper limb.

Conclusions: The Bobath concept is not superior to other approaches for regaining mobility, motor control of the lower limb and gait, balance and activities of daily living of patients after stroke. There is moderate evidence regarding the superior results of other approaches in terms of the motor control and dexterity of the upper limb. Due to the limitations concerning the methodological quality of the studies, further well-designed studies are needed.

  • Implications for rehabilitation
  • The Bobath concept is not superior to other approaches for patients after stroke.
  • The treatments that incorporate overuse of the affected upper limb via intensive treatments with high-repetitions with or without robotic aids present greater effectiveness in the motor control of the upper limb and dexterity.


https://www.tandfonline.com/doi/abs/10.1080/09638288.2019.1590865?fbclid=IwAR1Rjzaw7YeLMsgLiHA7Q3ar9-cN6CS58uSdvFVHpNd1WU_mriL7Q2R1_fU&journalCode=idre20

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[NEWS] Researchers: Physical Therapy-Related Cochrane Reviews Largely Inconclusive

The Cochrane Database of Systematic Reviews is widely considered the “gold standard” for health care professionals who want to know what current, high-quality research says about the efficacy of various interventions. But when it comes to physical therapy, a “researcher or clinician would not necessarily be able to turn to [Cochrane reviews] for a definitive answer” on a treatment strategy, write authors of an article in the International Journal of Rehabilitation Research (abstract only available for free).

Reviewers for the Cochrane Collaboration—an international network of subject-matter groups that produces evidence-based resources—are known for their systematic analysis of evidence obtained from randomized clinical trials and provide recommendations for specific interventions. Like any systematic review, Cochrane reviews (CRs) are based on the existing research, and randomized controlled trials vary in quality.

For the Rehabilitation Research study, a multidisciplinary group of researchers in Japan turned to physical therapy to find out what CRs had to say about various interventions. They examined 283 CRs to evaluate just how conclusive the evidence is with regard to physical therapy, as well as what factors influence the degree of conclusiveness.

Authors classified a CR as “conclusive” if it identified a particular intervention as “superior to another” or found that interventions are “equivalent.” Inconclusive reviews concluded that “no decision can be made.”

While the authors acknowledge that CRs “often show a lack of strong evidence for the efficacy of a particular treatment or strategy,” they found that an overwhelming majority of reviews related to physical therapy—94.3%—were inconclusive and recommended further study, a rate higher than in many other areas of study. Reviews that evaluated a larger number of trials or included greater total numbers of patients were more likely to list conclusive results; still, even among CRs with conclusive results, 68.8% recommended further study.

According to the authors, many factors were associated with recommendations for further research, including low-quality study design, small sample sizes, too few available studies, and not enough data on participant subgroups or on adverse effects.

“The low proportion of conclusive studies may be attributable to the poor quality of evidence” in physical therapy, the authors write, noting, however, that, unlike other areas of study, blinded randomized controlled trials are “often hard to achieve” in physical therapy research.

Authors emphasized that although inconclusive reviews cannot assist in clinical decision making, “high-quality inconclusive reviews…are of great value” to identify gaps in the literature and areas for further study.

And while there’s much work to be done to increase the number of physical therapy-related CRs with conclusive recommendations, authors think the effort is worthwhile—and timely.

“Trials in physiotherapy are worth conducting, as the field is positioned as a new frontier and is receiving much attention,” they write. “Future research in physiotherapy and further development of the [Cochrane Collaboration] are eagerly awaited.”

Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association’s PTNow website.

via Researchers: Physical Therapy-Related Cochrane Reviews Largely Inconclusive

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[WEB PAGE] Plantar fasciitis stretches: 6 exercises and other home remedies – Videos

Best exercises and remedies for plantar fasciitis

Last reviewed
Foot stretches and exercises can help plantar fasciitis by relieving pain, improving muscle strength, and promoting flexibility in the foot muscles and ligaments.

Overuse, strain, and inflammation on the plantar fascia ligament that connects the heel to the toes cause the foot injury that doctors refer to as plantar fasciitis. The tissue that the condition affects is under the arch of the foot but can cause a stabbing pain in the heel.

Plantar fasciitis usually resolves within 6 to 18 months without treatment. With 6 months of consistent, nonoperative treatment, people with plantar fasciitis will recover 97 percent of the time.

In this article, we look at stretches and exercises for plantar fasciitis relief and recovery and other home remedies that could help.

Plantar fasciitis stretches

Plantar fasciitis may often be an overuse injury. Often, it occurs in runners or people who are overweight or obese. It may also cause tension in surrounding muscles, leading to pain beyond the heel.

A few simple stretches can reduce tension in the foot and calf. This offers both rapid pain relief and a steady improvement of symptoms over time.

People can perform these exercises two or three times every day. They should not be painful.

1. Stretching the calf

Man doing calf muscle and foot stretch against wall

Muscle tightness in the feet and calves can make the pain of plantar fasciitis worse. Loosening the calf muscles can relieve the pain. Try the following stretch:

  • lean your hands against a wall
  • straighten the knee of the affected leg and bend the other knee in front
  • keep both feet flat on the ground
  • there should be a stretching sensation in the heel and calf of the extended leg
  • hold for 10 seconds
  • repeat two to three times

2. Rolling stretch

Placing a round object under the foot and rolling back and forth can help loosen up the foot muscles. People can use a rolling pin, golf ball, or specialized foam roller for this. Sports stores and online stores sell foam foot rollers.

Use the following steps to stretch the foot:

  • sit tall on a chair
  • roll a round object under the arch of the foot
  • roll for 2 minutes

3. Stretching the plantar fascia

To relieve muscle tightness in the plantar fascia, try the following:

  • sitting on a chair, cross the injured heel over the other leg
  • hold the foot in your opposite hand
  • pull the toes toward the shin to create tension in the arch of the foot
  • place the other hand on the bottom of the foot to feel for tension in the plantar fascia
  • use a towel to grasp and stretch the foot if it is difficult to hold otherwise
  • hold for 10 seconds
  • repeat two to three times

4. Foot flexes

Pregnant woman stretching foot and leg with towel or exercise band

Flexing the foot increases blood flow to the area and relieves tension in the calves, which can help with pain. This exercise uses an elastic stretch band, which people can buy from sports stores or online.

Use the following steps:

  • sit on the floor with legs straight
  • wrap the elastic band around your foot, holding the ends in your hands
  • gently point the toes away from the body
  • slowly return to starting position
  • repeat 10 times

5. Towel curls

Curling a hand towel or facecloth with the toes can stretch the foot and calf muscles. Try doing these stretches before walking or doing any other morning tasks. Use the following steps:

  • sit on a chair with both feet flat and a small towel in front of the feet
  • grasp the center of the towel with your toes
  • curl the towel towards you
  • relax the foot and repeat five times
Marble feet exercise

6. Marble pickups

Picking up a marble with the toes will flex and stretch the foot muscles. Use the following steps:

  • sit on a chair with knees bent and feet flat on the floor
  • place 20 marbles and a bowl at your feet
  • pick up one marble at a time by curling your toes, and place the marble into the bowl
  • repeat 20 times

Other home remedies

A number of other home remedies can help reduce the inflammation and pain of plantar fasciitis:

The RICE method

When the pain first appears, keeping off the injured foot can help. First aid for a foot injury can include the RICE method:

  • Rest the painful area for a few days.
  • Ice the area for 20 minutes at a time to relieve inflammation.
  • Compress the area with a soft wrap to reduce swelling.
  • Elevate the area by putting the foot on a few pillows.

Elevating the foot with a pillow can be especially helpful when a person is sleeping.

Anti-inflammatory medication

Non-steroidal anti-inflammatory drugs (NSAID), such as ibuprofen, help to reduce both pain and inflammation. People may wish to take this medication as directed on the package or recommended by a doctor.

Some people find that a few weeks of NSAID treatment improves their symptoms.

Shoe inserts

Shoe inserts offer additional support to the arch of the foot. Inserts will limit stress on the plantar fascia and may be especially helpful to people who spend much of the day on their feet. Soft, supportive arch inserts may work as well.

Always speak to a doctor who specializes in foot health, called a podiatrist, for more information.

Massage

Some people find that massage helps with symptoms. Focus on massaging the arch of the foot around the injured area.

If surrounding muscles have become tense because of the pain, massage those too. Some people find relief from massaging the arch of the foot with an ice bottle.

Medical treatments

If stretches, exercises, and home remedies do not help, a doctor may recommend medical treatment. However, surgery is rarely needed.

A doctor may suggest the following:

Risk factors for plantar fasciitis

People who walk or run for exercise may be at risk of plantar fasciitis.

People who walk or run for exercise may be at risk of plantar fasciitis.

A thick mass of tissue called the plantar fascia connects the toes to the heel bone. Inflammation in this tissue, called plantar fasciitis, can cause intense pain in the heel.

The pain may get worse when getting out of bed or when standing after a long period of sitting.

Doctors do not fully understand why some people get this injury and others do not. Some evidence suggests that overuse causes the inflammation.

Risk factors for plantar fasciitis include:

  • spending long periods of time standing
  • walking or running for exercise
  • having tight calf muscles
  • overweight and obesity
  • pes cavus, a condition that causes the arch of the foot to be hollow when standing

Outlook

Plantar fasciitis will usually resolve by itself without treatment. People can speed up recovery and relieve pain with specific foot and calf stretches and exercises.

For some people, plantar fasciitis becomes a chronic condition. Symptoms may improve and then appear again, or the pain may remain consistent for a year or longer. A 2018 study suggests that people who have previously had the injury are more likely to have it again.

Because of the risk of chronic pain, people with plantar fasciitis should see a doctor about their symptoms. There are many different treatment options that may help.

 

via Plantar fasciitis stretches: 6 exercises and other home remedies

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[NEWS] MbientLab Launches its MIOTherapy Physical Therapy Wearable Technology

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

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

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

January 28, 2019 09:00 AM Eastern Standard Time

 

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

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

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

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

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

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

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

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

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

About MIOTherapy

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

About MbientLab

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

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

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

Duke Clinical Research Institute, VERITAS research study, 2016

Contacts

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

 

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

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[Abstract] The comparative efficacy of theta burst stimulation or functional electrical stimulation when combined with physical therapy after stroke: a randomized controlled trial

via The comparative efficacy of theta burst stimulation or functional electrical stimulation when combined with physical therapy after stroke: a randomized controlled trial – Fayaz Khan, Chaturbhuj Rathore, Mahesh Kate, Josy Joy, George Zachariah, P C Vincent, Ravi Prasad Varma, Kurupath Radhakrishnan, 2019

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[WEB SITE] This Smart Glove Could Be the Future of Physical Therapy

BY  01.10.2019

Rapael Smart Glove (Photo Credit: Neofect)

Recovering after a stroke isn’t easy, but Neofect is here to help patients track their rehabilitation progress with an innovative wearable solution.

At CES 2019, the company exhibited its Rapael Smart Glove, a high-tech rehab device that helps stroke patients improve their hand movements. The device also syncs with an app, where patients can play rehabilitation games and track milestones.

Neofect didn’t disclose a price for the Rapael Smart Glove, but customers can go on the company’s website to buy it. The Rapael Smart Glove is also available for clinics that need stroke rehabilitation equipment.

https://mashable.com/videos/blueprint:yanmAj9rnK/embed/?player=offsite?wmode=transparent

Using the Rapael Smart Glove is very easy: Gently slide on the device, connect to the Rapael App with a smartphone or tablet, and play a variety of rehabilitation games. The app’s fun games include virtual tennis matches and house painting, and they’re available in different levels to balance challenge and motivation. Plus, the Rapael App collects practice data for patients, so they can track their hand recovery progress.

With the Rapael Smart Glove, patients can practice hand exercises and improve dexterity over time. An advantage of the Rapael Smart Glove is that it can help stroke patients who might not have immediate access to hospitals or physical therapy facilities, so they can work on their hand movements without leaving home.

“We aim to help patients all around the world including, but not limited to, those unable to receive appropriate treatment due to economic or geographic reasons,” says Neofect’s website. “By providing rehab training products and services that are available anytime and anywhere, we are committed to improving patient’s rehab experiences and quality of life.”

 

via This Smart Glove Could Be the Future of Physical Therapy – Geek.com

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[ARTICLE] Home-based transcranial direct current stimulation plus tracking training therapy in people with stroke: an open-label feasibility study – Full Text

Abstract

Background

Transcranial direct current stimulation (tDCS) is an effective neuromodulation adjunct to repetitive motor training in promoting motor recovery post-stroke. Finger tracking training is motor training whereby people with stroke use the impaired index finger to trace waveform-shaped lines on a monitor. Our aims were to assess the feasibility and safety of a telerehabilitation program consisting of tDCS and finger tracking training through questionnaires on ease of use, adverse symptoms, and quantitative assessments of motor function and cognition. We believe this telerehabilitation program will be safe and feasible, and may reduce patient and clinic costs.

Methods

Six participants with hemiplegia post-stroke [mean (SD) age was 61 (10) years; 3 women; mean (SD) time post-stroke was 5.5 (6.5) years] received five 20-min tDCS sessions and finger tracking training provided through telecommunication. Safety measurements included the Digit Span Forward Test for memory, a survey of symptoms, and the Box and Block test for motor function. We assessed feasibility by adherence to treatment and by a questionnaire on ease of equipment use. We reported descriptive statistics on all outcome measures.

Results

Participants completed all treatment sessions with no adverse events. Also, 83.33% of participants found the set-up easy, and all were comfortable with the devices. There was 100% adherence to the sessions and all recommended telerehabilitation.

Conclusions

tDCS with finger tracking training delivered through telerehabilitation was safe, feasible, and has the potential to be a cost-effective home-based therapy for post-stroke motor rehabilitation.

Background

Post-stroke motor function deficits stem not only from neurons killed by the stroke, but also from down-regulated excitability in surviving neurons remote from the infarct [1]. This down-regulation results from deafferentation [2], exaggerated interhemispheric inhibition [3], and learned non-use [4]. Current evidence suggests that post-stroke motor rehabilitation therapies should encourage upregulating neurons and should target neuroplasticity through intensive repetitive motor practice [56]. Previously, our group has examined the feasibility and efficacy of a custom finger tracking training program as a way of providing people with stroke with an engaging repetitive motor practice [789]. In this program, the impaired index finger is attached to an electro-goniometer, and participants repeatedly move the finger up and down to follow a target line that is drawn on the display screen. In successive runs, the shape, frequency and amplitude of target line is varied, which forces the participant to focus on the tracking task. In one study, we demonstrated a 23% improvement in hand function (as measured by the Box and Block test; minimal detectable change is 18% [10]) after participants with stroke completed the tracking training program [9]. While our study did not evaluate changes in activity in daily life (ADL) or quality of life (because efficacy of the treatment was not the study objective), the Box and Block test is moderately correlated (r = 0.52) to activities in daily life and quality of life (r = 0.59) [11]. In addition, using fMRI, we showed that training resulted in an activation transition from ipsilateral to contralateral cortical activation in the supplementary motor area, primary motor and sensory areas, and the premotor cortex [9].

Recently, others have shown that anodal transcranial direct current stimulation (tDCS) can boost the beneficial effects of motor rehabilitation, with the boost lasting for at least 3 months post-training [12]. Also, bihemispheric tDCS stimulation (anodal stimulation to excite the ipsilateral side and cathodal stimulation to downregulate the contralateral side) in combination with physical or occupational therapy has been shown to provide a significant improvement in motor function (as measured by Fugl-Meyer and Wolf Motor Function) compared to a sham group [13]. Further, a recent meta-analysis of randomized-controlled trials comparing different forms of tDCS shows that cathodal tDCS is a promising treatment option to improve ADL capacity in people with stroke [14]. Compared to transcutaneous magnetic stimulation (TMS), tDCS devices are inexpensive and easier to operate. Improvement in upper limb motor function can appear after only five tDCS sessions [15], and there are no reports of serious adverse events when tDCS has been used in human trials for periods of less than 40 min at amplitudes of less than 4 mA [16].

Moreover, tDCS stimulation task also seems beneficial for other impairments commonly seen in people post-stroke. Stimulation with tDCS applied for 20 sessions of 30 min over a 4-week period has been shown to decrease depression and improve quality of life in people after a stroke [1718]. Four tDCS sessions for 10 min applied over the primary and sensory cortex in eight patients with sensory impairments more than 10 months post-stroke enhanced tactile discriminative performance [19]. Breathing exercises with tDCS stimulation seems to be more effective than without stimulation in patient with chronic stroke [20], and tDCS has shown promise in treating central post-stroke pain [21]. Finally, preliminary research on the effect of tDCS combined with training on resting-state functional connectivity shows promise to better understand the mechanisms behind inter-subject variability regarding tDCS stimulation [22].

Motor functional outcomes in stroke have declined at discharge from inpatient rehabilitation facilities [2324], likely a result of the pressures to reduce the length of stay at inpatient rehabilitation facilities as part of a changing and increasingly complex health care climate [2526]. Researchers, clinicians, and administrators continue to search for solutions to facilitate and post-stroke rehabilitation after discharge. Specifically, there has been considerable interest in low-cost stroke therapies than can be administered in the home with only a modest level of supervision by clinical professionals.

Home telerehabilitation is a strategy in which rehabilitation in the patient’s home is guided remotely by the therapist using telecommunication technology. If patients can safely apply tDCS to themselves at home, combining telerehabilitation with tDCS would be an easy way to boost therapy without costly therapeutic face-to-face supervision. For people with multiple sclerosis, the study of Charvet et al. (2017) provided tDCS combined with cognitive training, delivered through home telerehabilitation, and demonstrated greater improvement on cognitive measures compared to those who received just the cognitive training [27]. The authors demonstrated the feasibility of remotely supervised, at-home tDCS and established a protocol for safe and reliable delivery of tDCS for clinical studies [28]. Some evidence shows that telerehabilitation approaches are comparable to conventional rehabilitation in improving activities of daily living and motor function for stroke survivors [2930], and that telemedicine for stroke is cost-effective [3132]. A study in 99 people with stroke receiving training using telerehabilitation (either with home exercise program or robot assisted therapy with home program) demonstrated significant improvements in quality of life and depression [33].

A recent search of the literature suggests that to date, no studies combine tDCS with repetitive tracking training in a home telerehabilitation setting to determine whether the combination leads to improved motor rehabilitation in people with stroke. Therefore, the aim of this pilot project was to explore the safety, usability and feasibility of the combined system. For the tDCS treatment, we used a bihemispheric montage with cathodal tDCS stimulation to suppress the unaffected hemisphere in order to promote stroke recovery [34353637]. For the repetitive tracking training therapy, we used a finger tracking task that targets dexterity because 70% of people post-stroke are unable to use their hand with full effectiveness after stroke [38]. Safety was assessed by noting any decline of 2 points or more in the cognitive testing that persists over more than 3 days. We expect day to day variations of 1 digit. Motor decline is defined by a decline of 6 blocks on the Box and Block test due to muscle weakness. This is based on the minimal detectable change (5.5 blocks/min) [10]. The standard error of measurement is at least 2 blocks for the paretic and stronger side. We expect possible variations in muscle tone that could influence the scoring of the test. Usability was assessed through a questionnaire and by observing whether the participant, under remote supervision, could don the apparatus and complete the therapy sessions. Our intent was to set the stage for a future clinical trial to determine the efficacy of this approach.

Methods

Participants

Participants were recruited from a database of people with chronic stroke who had volunteered for previous post-stroke motor therapy research studies at the University of Minnesota. Inclusion criteria were: at least 6 months post-stroke; at least 10 degrees of active flexion and extension motion at the index finger; awareness of tactile sensation on the scalp; and a score of greater than or equal to 24 (normal cognition) on the Mini-Mental State Examination (MMSE) to be cognitively able to understand instructions to don and use the devices [39]. We excluded those who had a seizure within past 2 years, carried implanted medical devices incompatible with tDCS, were pregnant, had non-dental metal in the head or were not able to understand instructions on how to don and use the devices. The study was approved by the University of Minnesota IRB and all enrolled participants consented to be in the study.

Apparatus

tDCS was applied using the StarStim Home Research Kit (NeuroElectrics, Barcelona, Spain). The StarStim system consists of a Neoprene head cap with marked positions for electrode placement, a wireless cap-mounted stimulator and a laptop control computer. Saline-soaked, 5 cm diameter sponge electrodes were used. For electrode placement, we followed a bihemispheric montage [14] involving cathodal stimulation on the unaffected hemisphere with the anode positioned at C3 and the cathode at C4 for participants with left hemisphere stroke, and vice versa for participants with right hemisphere stroke. Stimulation protocols were set by the investigator on a web-based application that communicated with the tDCS control computer. A remote access application (TeamViewer) was also installed on the control computer, as was a video conferencing application (Skype).

The repetitive finger tracking training system was a copy of what we used in our previous stroke studies [789]. The apparatus included an angle sensor mounted to a lightweight brace and aligned with the metacarpophalangeal (MCP) joint of the index finger, a sensor signal conditioning circuit, and a target tracking application loaded on a table computer. Figure 1 shows a participant using the apparatus during a treatment session.

Fig. 1

Fig. 1 Participant with right hemiparesis receiving transcranial direct current magnetic stimulation (tDCS) in their home simultaneous while performing the finger movement tracking task on the tracking computer (left). The tDCS computer (right) shows the supervising investigator, located off-site, who communicated with the participant through the video conferencing application, controlled the tDCS stimulator through web-based software, and controlled the tracking protocols. (Permission was obtained from the participant for the publication of this picture)

[…]

Continue —> Home-based transcranial direct current stimulation plus tracking training therapy in people with stroke: an open-label feasibility study | Journal of NeuroEngineering and Rehabilitation | Full Text

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

Abstract

Objective

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

Design

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

Setting

Acute inpatient rehabilitation (IRF).

Participants

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

Interventions

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

Results

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

Conclusions

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

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

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[WEB SITE] Stroke survivors rehab involves new walking pattern

Getting stroke survivors back on their feet

Physical therapy expert at USC wants to know if a walking pattern would lower a patient’s risk of falling

 

stroke survivors rehab: gait analysis stroke rehab

A USC study focuses on how to best improve the walking rehabilitation for patients who have suffered a stroke. (Photo/Shutterstock)

Every 40 seconds, someone in the United States has a stroke. And while it is the fifth leading cause of death in America, it’s much more disabling than it is fatal.

Physical therapy for stroke survivors can often mean treatment focused on correcting walking asymmetries (such as a limp) so that the individual can walk in an observationally normal way. But is this the best rehabilitation strategy?

That’s what James Finley aims to investigate in a new study supported by a $1.6 million grant from the National Institutes of Health. The study will examine the advantages and disadvantages associated with restoring symmetry in the walking patterns of survivors of stroke. Finley is an assistant professor and director of the Locomotor Control Laboratory at the USC Division of Biokinesiology and Physical Therapy.

Using a device to measure oxygen consumption, treadmills meant to elicit a stumble response and a motion capture system to record it all, Finley hopes to better understand how correcting gait asymmetries has an impact on energy efficiency and fall risk.

“One thing we would like to do is assess the individual and find the focus areas for how to rehabilitate them,” Finley said. “How can we help an individual reduce energetic costs so they can walk longer distances? Can we train people to have a walking pattern that would lower their risk of falling?”

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[ARTICLE] Vojta Therapy in Patients with Acute Stroke – A New Approach in Stroke Rehabilitation – Full Text PDF

Abstract

Unilateral motor weakness is one of the most common deficits resulting
from stroke and one of the main causes of disability. Stroke rehabilitation is
multidisciplinary and the aim of physiotherapy should be to promote activation
and stabilisation of the remaining innervation and functions of the damaged
central nervous system. Scientific evidence demonstrating the values of
specific rehabilitation interventions after stroke is limited. It is still unclear, which
physiotherapeutic approaches in stroke rehabilitation are most effective. Modern
approaches follow the idea that functional improvement to a large extent relies
on the use of compensatory movement strategies, enabling patients to learn
to cope with their deficits. The Vojta therapy is based on a completely different
approach: the reflex locomotion. Vojta described inborn movement sequences
of reflex locomotion that are retrievable at all times. The therapist stimulates
these innate patterns of movement by applying pressure to defined zones. The
therapeutic use of reflex locomotion enables elementary patterns of movement
in patients with impaired locomotor system, for example due to brain damage
caused by stroke, to be restored once more, assuming that repeated stimulation
of these “reflex-like” movements can lead to something like “new networking”
within functionally blocked neuronal networks. After Vojta treatment, these
patterns are more spontaneously available to the patient. Clinical experience
shows, that Vojta therapy improves postural control, uprighting against gravity
and goal-directed movements. We will discuss implementation of Votja therapy
in stroke rehabilitation and introduce a first ever randomized controlled trial for
this approach in stroke rehabilitation.[…]
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