Person-centered approaches to care require physiotherapists to engage in trying to understand the full range of biomedical, psychological, and social factors that people bring to the consultation, along with the client’s individual responses to those factors. If, however, the main issues of importance to people are not openly declared and discussed they cannot be addressed. This is likely to result in people receiving interventions that clinicians think they need, rather than care based on their expressed needs and preferences.
To understand people’s abilities to express the issues of importance to them within a consultation and clinicians’ abilities to acknowledge and address those issues.
A qualitative study using an interpretive phenomenological approach.
Eight clients were interviewed before they met their physiotherapist, the initial consultation with their physiotherapist was recorded, and both were interviewed separately afterward.
The clients frequently do not raise their emotions or feelings as issues of importance, and physiotherapists generally struggle to elicit, or identify as important, such matters. How these were presented to the clinician and subsequently addressed varied. We formulated three themes: 1) managing complex situations; 2) establishing a person-centered agenda; and 3) addressing emotional issues.
Community physiotherapists may aim for a more person-centered approach; however, their habits, practices and behaviors remain within a culturally entrenched, clinician-centric, biomedical model.
Immersive and non-immersive virtual reality (NIVR) technology can supplement and improve standard physiotherapy and neurorehabilitation in post-stroke patients. We aimed to use MIRA software to investigate the efficiency of specific NIVR therapy as a standalone intervention, versus standardized physiotherapy for upper extremity rehabilitation in patients post-stroke. Fifty-five inpatients were randomized to control groups (applying standard physiotherapy and dexterity exercises) and experimental groups (applying NIVR and dexterity exercises). The two groups were subdivided into subacute (<six months post-stroke) and chronic (>six months to four years post-stroke survival patients). The following standardized tests were applied at baseline and after two weeks post-therapy: Fugl–Meyer Assessment for Upper Extremity (FMUE), the Modified Rankin Scale (MRS), Functional Independence Measure (FIM), Active Range of Motion (AROM), Manual Muscle Testing (MMT), Modified Ashworth Scale (MAS), and Functional Reach Test (FRT). The Kruskal–Wallis test was used to determine if there were significant differences between the groups, followed with pairwise comparisons. The Wilcoxon Signed-Rank test was used to determine the significance of pre to post-therapy changes. The Wilcoxon Signed-Rank test showed significant differences in all four groups regarding MMT, FMUE, and FIM assessments pre- and post-therapy, while for AROM, only experimental groups registered significant differences. Independent Kruskal–Wallis results showed that the subacute experimental group outcomes were statistically significant regarding the assessments, especially in comparison with the control groups. The results suggest that NIVR rehabilitation is efficient to be administered to post-stroke patients, and the study design can be used for a further trial, in the perspective that NIVR therapy can be more efficient than standard physiotherapy within the first six months post-stroke.
Stroke Alliance for Europe states that “every 20 s, someone in Europe has a stroke”, while in the United States, “someone has a stroke every 40 s” a leading cause of significant long-term disabilities [1,2]. According to a European Union (EU) report, Romania has the lowest annual healthcare expenditure per capita (€1029 in 2015, compared to the EU average of €2884). The highest risk factors of a stroke are smoking and alcohol drinking, with males accounting for more than 50% of those impacted. Additionally, the level of education influences both lifestyle and life expectancy, with the Romanian life expectancy being among the lowest in the EU (75.3 years in Romania versus 80.9 years in the EU, in 2015). Moreover, there were 61,552 stroke cases in Romania in 2015 and forecasts state that this number will increase by 24% until 2035 [3,4].Worldwide, the population faces high incidence rates of stroke and post-stroke sequelae with an increased need for neurorehabilitation services. In Europe, it is estimated that the number of annual stroke events will increase from 613,148 registered in 2015 to 819,771 in 2035, an increase of 34%. Considering that post-stroke survival rates have improved; estimations predict that the number of people living with strokes in Europe will grow from 3,718,785 in 2015 to 4,631,050 in 2035 .Stroke complications can be long-lasting; thus, at 15-years post-stroke, two-thirds of survivors live with a disability, nearly two of five suffer from depression, and more than a quarter have cognitive impairment . Post-stroke disability significantly contributes to the increasing use of long-term medical care resources, thus highlighting that efficient rehabilitation can cut costs in the healthcare system  whereas telerehabilitation is still in the early phase of utilization in developing countries.Furthermore, international guidelines for stroke rehabilitation include physiotherapy techniques and methods for the recovery of the swallowing function and the urinary and bowel continence. These techniques and methods are also recommended for the improvement/prevention of shoulder pain, joint misalignments, and limb deviations caused by post-stroke spasticity, also used for secondary prevention of falling, as well as for enhancing the ability to perform self-care and daily living activities. Recovery from post-stroke impairments is facilitated, on the one hand, by increasing the motor function and, on the other hand, by improving the functionality of the limbs and body as a whole functional unit. In order to retrieve functional capacity, the existing guidelines recommend the use of intensive, repetitive training, improvement of functional mobility, use of orthoses, performing specific activities of daily living (ADLs) practiced repeatedly, progressive and bilateral training of the upper limb, the use of virtual reality and assisted robotic therapy, and the use of strength training exercises [7,8,9].The use of virtual reality technology as an adjunct or substitute for traditional physiotherapy has been studied and proved to be effective in improving patients’ functional rehabilitation. However, as regards strokes, some systematic reviews suggest that virtual reality (VR) has not brought more benefits to patients compared to standard physiotherapy alone, while other research advocates for specific VR training as a therapy with a better outcome compared to conventional physiotherapy in the rehabilitation of stroke survivors [10,11,12,13,14].Research on neuroplasticity and learning or relearning abilities shows that there are several principles of motor learning, including multisensory stimulation, explicit feedback, knowledge of results, and motor imagery. These principles, notably explicit feedback and multisensory stimulation, are found in the VR technology used for neuromotor rehabilitation. Accordingly, VR therapy becomes an alternative to classical physiotherapy, as it develops neuroplasticity. So, novel enriched environments are preferred in the context of current rehabilitation methods since guidelines do not provide an accurate record of evidence inferred from the specialized literature about motor skill learning. This evidence is essential in identifying practical methods and applications that could shape future approaches to neuromotor relearning. Furthermore, in animal research, it has been shown that aerobic exercise and environmental enrichment have pleiotropic actions that influence the occurrence of molecular changes associated with stroke and subsequent spontaneous recovery. These aspects may argue in favor of the efficient use of VR in motor and functional recovery after a stroke, by stimulating neuroplasticity [15,16].Over the past ten years, research and literature reviews regarding the use of VR in post-stroke recovery have been homogeneous. Many approaches have focused on the use of VR as adjunct therapy alongside standard physiotherapy, and in some studies, non-dedicated VR technologies have been used, for medical purposes, in the motor rehabilitation of post-stroke patients [17,18]. Previous research on NIVR and immersive VR-based activities suggests that these interventions improve upper extremity rehabilitation after a stroke by providing motivating environments, stimulating extrinsic feedback, or simulating gameplay to facilitate recovery. Besides non-immersive VR therapy use in post-stroke patient’s rehabilitation, immersive VR therapy is used but requires more space and is more expensive, compared to NVIR. Robotic therapy is gaining more ground in neuro-motor rehabilitation, but the costs are very high, and in the case of exoskeletons, complex technology requires a long period of time for physiotherapists to acquire skills in the use of equipment. Currently, research has shown that VR positively influences the recovery of the upper extremity in post-stroke patients, as an adjunct therapy, by using dedicated and non-dedicated technologies [19,20]. The VR action on upper extremity post-stroke rehabilitation, using dedicated NVIR technology as a standalone therapy has not yet been determined at a staged level according to the post-stroke phases. The present study aims to investigate the efficiency of a dedicated NIVR system used in the rehabilitation of patients with subacute and chronic stroke, on upper extremity functionality and motor function. The research was done through specific VR training that incorporates real-time 3D motion capture and built-in visual feedback which provide functional exercises designed to train and regain the neuromotor functions of the upper extremity.Our main goal was to evaluate the efficiency of the proposed protocol, by using staged, specific, and customized NIVR therapy on three levels of difficulty and by using specific exergames according to patient’s capacity, and adjusted by the level of difficulty, compared to standard physiotherapy. Besides, we were looking for differences in post-stroke clinical and functional status in the use of VR that improve or negatively influence the functional outcomes of the upper extremity when exposed to VR-based therapy compared to standard physiotherapy. […]
Background: Functional electrical stimulation (FES) applied to the paretic peroneal nerve has positive clinical effects on foot drop secondary to stroke.
Objective: To evaluate the effectiveness of FES applied to the paretic peroneal nerve on gait speed, active ankle dorsiflexion mobility, balance, and functional mobility.
Methods: Electronic databases were searched for articles published from inception to January 2020. We included randomized controlled trials or crossover trials focused on determining the effects of FES combined or not with other therapies in individuals with foot drop after stroke. Characteristics of studies, participants, comparison groups, interventions, and outcomes were extracted. Statistical heterogeneity was assessed with the I2 statistic.
Results: We included 14 studies providing data for 1115 participants. FES did not enhance gait speed as compared with conventional treatments (i.e., supervised/unsupervised exercises and regular activities at home). FES combined with supervised exercises (i.e., physiotherapy) was better than supervised exercises alone for improving gait speed. We found no effect of FES combined with unsupervised exercises and inconclusive effects when FES was combined with regular activities at home. When FES was compared with conventional treatments, it improved ankle dorsiflexion, balance and functional mobility, albeit with high heterogeneity for these last 2 outcomes.
Conclusions: This meta-analysis revealed low quality of evidence for positive effects of FES on gait speed when combined with physiotherapy. FES can improve ankle dorsiflexion, balance, and functional mobility. However, considering the low quality of evidence and the high heterogeneity, these results must be interpreted carefully.
Virtual reality (VR) games has the potential to improve patient outcomes in stroke rehabilitation. However, there is limited information on VR games as an adjunct to standard physiotherapy in improving upper limb function. This study involved 36 participants in both experimental (n = 18) and control (n = 18) groups with a mean age (SD) of 57 (8.20) and 63 (10.54) years, respectively. Outcome measures were the Fugl-Meyer assessment for upper extremities (FMA-UE), Wolf motor function test (WMFT), intrinsic motivation inventory (IMI), Lawton of instrumental activities of daily living (IADL), and stroke impact scale (SIS) assessed at pre-post intervention. The experimental group had 0.5 h of upper limb (UL) VR games with 1.5 h of standard physiotherapy, and the control group received 2 h of standard physiotherapy. The intervention for both groups was performed once a week for eight consecutive weeks. The results showed a significant time–group interaction effect for IMI (p = 0.001), Lawton IADL (p = 0.01) and SIS domain of communication (p = 0.03). A significant time effect was found in FMA-UE (p = 0.001), WMFT (p = 0.001), Lawton IADL (p = 0.01), and SIS domains; strength, ADL and stroke recovery (p < 0.05). These results indicated an improvement in UL motor ability, sensory function, instrumental ADL, and quality of life in both groups after eight weeks of intervention. However, no significant (p > 0.05) group effect on all the outcome measures was demonstrated. Thus, replacing a portion of standard physiotherapy time with VR games was equally effective in improving UL function and general health compared to receiving only standard physiotherapy among stroke survivors.
Stroke is a leading cause of significant disability among adults globally . Rehabilitation is of utmost importance with an increase in the number of stroke survivors . Stroke rehabilitation requires a multidisciplinary approach, is long-term and challenging due to its complexity . Recent evidence suggests that the extension of a stroke rehabilitation programme may lead to further improvement in function and quality of life among stroke survivors .
Persistent upper limb (UL) dysfunction after a stroke is one of the most challenging issues in rehabilitation . Increasing the dose of rehabilitation among stroke survivors may improve outcomes, and one of the strategies includes performing self-administered exercises using VR games technology . VR is a computer-assisted technology that can provide users with experiences of a simulated “real” environment . VR technology has been used in rehabilitation in addition to standard physiotherapy, or as a preventive therapy . VR-based rehabilitation also offers the capacity to individualise treatment needs while providing the standardisation of assessment and training protocols .
Earlier evidence suggested that VR technology can provide a unique medium whereby rehabilitation can be delivered in a functional and purposeful manner . Moreover, VR technology-based rehabilitation can be readily graded and documented . Other than that, stroke survivors can perform VR training at their home and the therapist can monitor from a distance, known as tele-rehabilitation . Compliance towards treatment and rehabilitation is a vital factor to consider in stroke management . Hence, VR rehabilitation has the potential to improve patient participation, enable intensive therapy and reduce demand on health care professionals [5,6,7].
In previous studies, VR games were shown to be effective in improving physical function among stroke survivors , balance and functional mobility in older adults [10,11], and upper limb reaction time in adults with physical disabilities . However, balance and mobility issues were examined rather than upper limb function [9,11]. There is also limited information on VR games as an adjunct to standard physiotherapy. Moreover, previous evidence mainly demonstrates the effects of VR as a standalone intervention among stroke survivors [13,14]. For example, in a pilot crossover design study involving 14 participants with chronic stroke, VR game-assisted intervention was performed for 45–60 min for a duration of 2.5 weeks . The results showed improved UL motor performance using the Fugl-Meyer assessment for upper extremities (FMA-UE) as the primary outcome measure. In our present study, we aimed to examine the effectiveness of VR games as an adjunct to standard physiotherapy in improving upper limb (UL) function and general health among stroke survivors.[…]
With many physiotherapists moving to delivery of online services because of the Coronavirus Disease 2019 (COVID-19) pandemic, we thought it would be timely to put together some high-quality clinical research to guide telehealth interventions. Following are a list of systematic reviews published in the last 5 years that evaluate the effects of tele-physiotherapy. The Chartered Society of Physiotherapy have produced a guide for the rapid implementation of telehealth consultations that may also be useful.
Background: As a result of stroke, patients have problems with locomotion and transfers, which lead to frequent falls. Recovery after stroke is a major goal of rehabilitation, but it is difficult to choose which treatment method is most beneficial for stroke survivors. Recently, powered robotic exoskeletons are used in treatment to maximize the neural recovery of patients after stroke, but there are no studies evaluating the changes in balance among patients rehabilitated with an exoskeleton.
Purpose: The aim of this study was to evaluate the effects of Ekso GT exoskeleton-assisted gait training on balance, load distribution, and functional status of patients after ischemic stroke.
Methods: The outcomes are based on 44 patients aged 55–85 years after ischemic stroke who were previously randomly assigned into two groups: experimental (with Ekso GT rehabilitation) and control (with classical rehabilitation). At baseline and after 4 weeks of treatment, the patients were evaluated on balance, load distribution, and functional status using, respectively a stabilometric platform, the Barthel Index, and the Rivermead Mobility Index.
Results: In the experimental group, balance improved regarding the variables describing sway area as ellipse major and minor axes. In the control group, improvement was noted in sway velocity. After the therapy, total load distribution on feet in both groups showed a small and insignificant tendency toward reduction in the amount of uninvolved limb loading. In the control group, significant load transfer from the backfoot to the forefoot was noted. Both forms of rehabilitation caused significant changes in functional status.
Conclusions: Both training with the use of the Ekso GT exoskeleton and classical physiotherapy lead to functional improvement of patients after ischemic stroke. However, in the experimental group, improvement was observed in a larger number of categories, which may suggest potentially greater impact of treatment with the exoskeleton on functional status. Also, both forms of rehabilitation caused significant changes in balance, but we have noted some trends indicating that treatment with exoskeleton may be more beneficial for some patients. The load transfer from the backfoot to the forefoot observed in the control group was an unfavorable phenomenon. We suggest that the Ekso GT exoskeleton may be a promising tool in the rehabilitation of patients after stroke.
Stroke is the third leading cause of death worldwide and is the most common cause of disability among adults (1, 2). As a result of stroke, patients have problems with locomotion and transfers, which lead to frequent falls. People with hemiparesis have uneven distribution of body mass between the sides of the body, causing balance and coordination disorders, deep and superficial sensation, increased muscle tone, and fear of falling (2, 3). Patients have problems with lack of normal postural muscle tone, and proper reciprocal innervation as well as normal, automatic movement patterns and balance reactions (4). Some studies have reported that balance alterations significantly limit the physical activity of stroke patients, which may be the reason for deconditioning of patients in the chronic phase and reduction in their gait possibilities as well as other activities of daily living (5). That is why gait rehabilitation and also balance therapy are very important in improving the quality of everyday and social life of those patients (6).
Gait training may improve not only strength, endurance, and coordination of the lower limbs but also the entire body of the patient, influencing general fitness and endurance, balance, normalization of muscle tone, and functional improvement (7). The Barthel Index (BI) and Rivermead Mobility Index (RMI) tests are considered to be proper criteria for assessing a patient’s functional state after stroke and good indicators of the effectiveness of the applied therapy (8, 9).
Recovery after stroke is a major goal of rehabilitation, but it is difficult to choose which treatment method is most beneficial for stroke survivors. Recently, powered robotic exoskeletons are used in treatment to maximize the neural recovery of patients after stroke (10, 11). However, in a review paper, Louie and Eng (12) have reported that only four different types of powered exoskeletons have been studied among a small number of stroke patients, and the published data were controversial. Moreover, in the available literature, there are no studies evaluating the changes in balance among patients rehabilitated with an exoskeleton. Most authors have reported various aspects of walking, and only a few papers have presented data concerning changes in balance. Additionally, most of the studies used subjective tools such as the Berg Balance Scale (13, 14). There is a lack of studies in which changes in balance and load distribution due to rehabilitation with the exoskeleton would be examined using an objective tool—stabilometric platform; therefore, this study undertakes this task for the first time.
The aim of this study was to evaluate the effectiveness of rehabilitation with Ekso GT exoskeleton in patients after ischemic stroke and to compare this type of therapy with the classical model of rehabilitation. The novelty of this study was the verification of the robot-assisted gait training effects on balance, load distribution, and functional status of stroke patients.[…]
Background: Independently, cross-education, the performance improvement of the untrained limb following unilateral training, and mirror therapy have shown to improve lower limb functioning poststroke. Mirror therapy has shown to augment the cross-education effect in healthy populations. However, this concept has not yet been explored in a clinical setting.
Objectives: This study set out to investigate the feasibility and potential efficacy of applying cross-education combined with mirror therapy compared with cross-education alone for lower limb recovery poststroke.
Methods: Thirty-one chronic stroke participants (age 61.7 ± 13.3) completed either a unilateral strength training (ST; n = 15) or unilateral strength training with mirror-therapy (MST; n = 16) intervention. Both groups isometrically strength trained the less-affected ankle dorsiflexors three times per week for 4 weeks. Only the MST group observed the mirror reflection of the training limb. Patient eligibility, compliance, treatment reliability, and outcome measures were assessed for feasibility. Maximal voluntary contraction (MVC; peak torque, rate of torque development, and average torque), 10-m walk test, timed up and go (TUG), Modified Ashworth Scale (MAS), and the London Handicap Scale (LHS) were assessed at pretraining and posttraining.
Results: Treatment and assessments were well tolerated without adverse effects. No between group differences were identified for improvement in MVC, MAS, TUG, or LHS. Only the combined treatment was associated with functional improvements with the MST group showing an increase in walking velocity.
Conclusion: Cross-education plus mirror therapy may have potential for improving motor function after stroke. This study demonstrates the feasibility of the combination treatment and the need for future studies with larger sample sizes to investigate the effectiveness of the treatment.
Aagaard, P., Simonsen, E. B., Andersen, J. L., Magnusson, P., & Dyhre-Poulsen, P. (2002). Increased rate of force development and neural drive of human skeletal muscle following resistance training. Journal of Applied Physiology (Bethesda, MD: 1985), 93(4), 1318-1326. https://doi.org/10.1152/japplphysiol.00283.2002
ACSM (2009). American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Medicine and Science in Sports and Exercise, 41(3), 687-708. https://doi.org/10.1249/MSS.0b013e3181915670
Benjamin, E. J., Blaha, M. J., Chiuve, S. E., Cushman, M., Das, S. R., Deo, R., … Jiménez, M. C. (2017). Heart disease and stroke statistics-2017 update: A report from the American Heart Association. Circulation, 135(10), e146-e603. https://doi.org/10.1161/cir.0000000000000485
Bird, S. P., Tarpenning, K. M., & Marino, F. E. (2005). Designing resistance training programmes to enhance muscular fitness: A review of the acute programme variables. Sports Medicine, 35(10), 841-851. https://doi.org/10.2165/00007256-200535100-00002
Broderick, P., Horgan, F., Blake, C., Ehrensberger, M., Simpson, D., & Monaghan, K. (2018). Mirror therapy for improving lower limb motor function and mobility after stroke: A systematic review and meta-analysis. Gait & Posture, 63, 208-220. https://doi.org/10.1016/j.gaitpost.2018.05.017
Carroll, L. M., Volpe, D., Morris, M. E., Saunders, J., & Clifford, A. M. (2017). Aquatic exercise therapy for people with Parkinson disease: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 98(4), 631-638. https://doi.org/10.1016/j.apmr.2016.12.006
Carson, R., Riek, S., Mackey, D., Meichenbaum, D., Willms, K., Forner, M., & Byblow, W. (2004). Excitability changes in human forearm corticospinal projections and spinal reflex pathways during rhythmic voluntary movement of the opposite limb. The Journal of Physiology, 560(Pt 3, 929-940. https://doi.org/10.1113/jphysiol.2004.069088
Carvalho, D., Teixeira, S., Lucas, M., Yuan, T. F., Chaves, F., Peressutti, C., & Arias-Carrion, O. (2013). The mirror neuron system in post-stroke rehabilitation. International Archives of Medicine, 6(1), 41. https://doi.org/10.1186/1755-7682-6-41
Collen, F. M., Wade, D. T., & Bradshaw, C. M. (1990). Mobility after stroke: Reliability of measures of impairment and disability. International Disability Studies, 12(1), 6-9. https://doi.org/10.3109/03790799009166594
de Morton, N. A. (2009). The PEDro scale is a valid measure of the methodological quality of clinical trials: A demographic study. The Australian Journal of Physiotherapy, 55(2), 129-133. https://doi.org/10.1016/S0004-9514(09)70043-1
Deconinck, F. J., Smorenburg, A. R., Benham, A., Ledebt, A., Feltham, M. G., & Savelsbergh, G. J. (2015). Reflections on mirror therapy: A systematic review of the effect of mirror visual feedback on the brain. Neurorehabilitation and Neural Repair, 29(4), 349-361. https://doi.org/10.1177/1545968314546134
Dragert, K., & Zehr, E. P. (2013). High-intensity unilateral dorsiflexor resistance training results in bilateral neuromuscular plasticity after stroke. Experimental Brain Research, 225(1), 93-104. https://doi.org/10.1007/s00221-012-3351-x
Ehrensberger, M., Simpson, D., Broderick, P., & Monaghan, K. (2016). Cross-education of strength has a positive impact on post-stroke rehabilitation: A systematic literature review. Topics in Stroke Rehabilitation, 23(2), 126-135. https://doi.org/10.1080/10749357.2015.1112062
Eng, J. J., Kim, C. M., & Macintyre, D. L. (2002). Reliability of lower extremity strength measures in persons with chronic stroke. Archives of Physical Medicine and Rehabilitation, 83(3), 322-328. https://doi.org/10.1053/apmr.2002.29622
Faria, C. D., Teixeira-Salmela, L. F., Neto, M. G., & Rodrigues-de-Paula, F. (2012). Performance-based tests in subjects with stroke: Outcome scores, reliability and measurement errors. Clinical Rehabilitation, 26(5), 460-469. https://doi.org/10.1177/0269215511423849
Fimland, M. S., Helgerud, J., Solstad, G. M., Iversen, V. M., Leivseth, G., & Hoff, J. (2009). Neural adaptations underlying cross-education after unilateral strength training. European Journal of Applied Physiology, 107(6), 723-730. https://doi.org/10.1007/s00421-009-1190-7
Flansbjer, U. B., Holmback, A. M., Downham, D., Patten, C., & Lexell, J. (2005). Reliability of gait performance tests in men and women with hemiparesis after stroke. Journal of Rehabilitation Medicine, 37(2), 75-82. https://doi.org/10.1080/16501970410017215
Harbo, T., Brincks, J., & Andersen, H. (2012). Maximal isokinetic and isometric muscle strength of major muscle groups related to age, body mass, height, and sex in 178 healthy subjects. European Journal of Applied Physiology, 112(1), 267-275. https://doi.org/10.1007/s00421-011-1975-3
Holmback, A. M., Porter, M. M., Downham, D., & Lexell, J. (1999). Reliability of isokinetic ankle dorsiflexor strength measurements in healthy young men and women. Scandinavian Journal of Rehabilitation Medicine, 31(4), 229-239.
Hortobagyi, T., Taylor, J. L., Petersen, N. T., Russell, G., & Gandevia, S. C. (2003). Changes in segmental and motor cortical output with contralateral muscle contractions and altered sensory inputs in humans. Journal of Neurophysiology, 90(4), 2451-2459. https://doi.org/10.1152/jn.01001.2002
Howatson, G., Zult, T., Farthing, J. P., Zijdewind, I., & Hortobagyi, T. (2013). Mirror training to augment cross-education during resistance training: A hypothesis. Frontiers in Human Neuroscience, 7, 396. https://doi.org/10.3389/fnhum.2013.00396
Magnus, C. R., Arnold, C. M., Johnston, G., Dal-Bello Haas, V., Basran, J., Krentz, J. R., & Farthing, J. P. (2013). Cross-education for improving strength and mobility after distal radius fractures: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 94(7), 1247-1255. https://doi.org/10.1016/j.apmr.2013.03.005
Manca, A., Cabboi, M., Dragone, D., Ginatempo, F., Ortu, E., De Natale, E., … Deriu, F. (2017). Resistance training for muscle weakness in multiple sclerosis: Direct versus contralateral approach in individuals with ankle dorsiflexors’ disparity in strength. Archives of Physical Medicine and Rehabilitation, 98(7), 1348-1356. https://doi.org/10.1016/j.apmr.2017.02.019
Manca, A., Dragone, D., Dvir, Z., & Deriu, F. (2017). Cross-education of muscular strength following unilateral resistance training: A meta-analysis. European Journal of Applied Physiology, 117(11), 2335-2354. https://doi.org/10.1007/s00421-017-3720-z
Manca, A., Pisanu, F., Ortu, E., & Deriu, F. (2015). Isokinetic cross-training effect in foot drop following common peroneal nerve injury. Isokinetics and Exercise Science, 23(1), 17-20. https://doi.org/10.3233/IES-140559
Michielsen, M. E., Selles, R. W., van der Geest, J. N., Eckhardt, M., Yavuzer, G., Stam, H. J., … Bussmann, J. B. (2011). Motor recovery and cortical reorganization after mirror therapy in chronic stroke patients: A phase II randomized controlled trial. Neurorehabilitation and Neural Repair, 25(3), 223-233. https://doi.org/10.1177/1545968310385127
Park, E., & Choi, Y. (2014). Rasch analysis of the London Handicap Scale in stroke patients: A cross-sectional study. Journal of Neuroengineering and Rehabilitation, 11, 114. https://doi.org/10.1186/1743-0003-11-114
Patten, C., Lexell, J., & Brown, H. E. (2004). Weakness and strength training in persons with poststroke hemiplegia: Rationale, method, and efficacy. Journal of Rehabilitation Research and Development, 41(3a), 293-312. https://doi.org/10.1682/JRRD.2004.03.0293
Perera, S., Mody, S. H., Woodman, R. C., & Studenski, S. A. (2006). Meaningful change and responsiveness in common physical performance measures in older adults. Journal of the American Geriatrics Society, 54(5), 743-749. https://doi.org/10.1111/j.1532-5415.2006.00701
Rossiter, H. E., Borrelli, M. R., Borchert, R. J., Bradbury, D., & Ward, N. S. (2015). Cortical mechanisms of mirror therapy after stroke. Neurorehabilitation and Neural Repair, 29(5), 444-452. https://doi.org/10.1177/1545968314554622
Shaw, L., Rodgers, H., Price, C., van Wijck, F., Shackley, P., Steen, N., & Graham, L. (2010). BoTULS: A multicentre randomised controlled trial to evaluate the clinical effectiveness and cost-effectiveness of treating upper limb spasticity due to stroke with botulinum toxin type A. Health Technology Assessment, 14(26), 1-113. https://doi.org/10.3310/hta14260
Thibaut, A., Chatelle, C., Ziegler, E., Bruno, M. A., Laureys, S., & Gosseries, O. (2013). Spasticity after stroke: Physiology, assessment and treatment. Brain Injury, 27(10), 1093-1105. https://doi.org/10.3109/02699052.2013.804202
Thieme, H., Morkisch, N., Mehrholz, J., Pohl, M., Behrens, J., Borgetto, B., & Dohle, C. (2018). Mirror therapy for improving motor function after stroke. Cochrane Database of Systematic Reviews, (7), Cd008449. https://doi.org/10.1002/14651858.CD008449.pub3
Touzalin-Chretien, P., Ehrler, S., & Dufour, A. (2010). Dominance of vision over proprioception on motor programming: Evidence from ERP. Cerebral Cortex, 20(8), 2007-2016. https://doi.org/10.1093/cercor/bhp271
Trompetto, C., Marinelli, L., Mori, L., Pelosin, E., Currà, A., Molfetta, L., & Abbruzzese, G. (2014). Pathophysiology of spasticity: Implications for neurorehabilitation. BioMed Research International, 2014, 1-8. https://doi.org/10.1155/2014/354906
Urban, P. P., Wolf, T., Uebele, M., Marx, J. J., Vogt, T., Stoeter, P., … Wissel, J. (2010). Occurence and clinical predictors of spasticity after ischemic stroke. Stroke, 41(9), 2016-2020. https://doi.org/10.1161/strokeaha.110.581991
van Wijck, F. M., Pandyan, A. D., Johnson, G. R., & Barnes, M. P. (2001). Assessing motor deficits in neurological rehabilitation: Patterns of instrument usage. Neurorehabilitation and Neural Repair, 15(1), 23-30. https://doi.org/10.1177/154596830101500104
Vattanasilp, W., Ada, L., & Crosbie, J. (2000). Contribution of thixotropy, spasticity, and contracture to ankle stiffness after stroke. Journal of Neurology, Neurosurgery, and Psychiatry, 69(1), 34-39. https://doi.org/10.1136/jnnp.69.1.34
Wissel, J., Schelosky, L. D., Scott, J., Christe, W., Faiss, J. H., & Mueller, J. (2010). Early development of spasticity following stroke: A prospective, observational trial. Journal of Neurology, 257(7), 1067-1072. https://doi.org/10.1007/s00415-010-5463-1
Wolf, S. L., Catlin, P. A., Gage, K., Gurucharri, K., Robertson, R., & Stephen, K. (1999). Establishing the reliability and validity of measurements of walking time using the emory functional ambulation profile. Physical Therapy, 79(12), 1122-1133.
Zult, T., Goodall, S., Thomas, K., Solnik, S., Hortobagyi, T., & Howatson, G. (2016). Mirror training augments the cross-education of strength and affects inhibitory paths. Medicine and Science in Sports and Exercise, 48, 1001-1013. https://doi.org/10.1249/mss.0000000000000871
Zult, T., Howatson, G., Kadar, E. E., Farthing, J. P., & Hortobagyi, T. (2014). Role of the mirror-neuron system in cross-education. Sports Medicine, 44(2), 159-178. https://doi.org/10.1007/s40279-013-0105-2
Whitehead, A. L., Julious, S. A., Cooper, C. L., & Campbell, M. J. (2016). Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable. Statistical Methods in Medical Research, 25(3), 1057-1073. https://doi.org/10.1177/0962280215588241
Physiotherapy has been very monotonous for patients and they tend to lose interest and motivation in exercising. Introducing games with short term goals in the field of rehabilitation is the best alternative, to maintain patients’ motivation. Our research focuses on gamification of hand rehabilitation exercises to engage patients’ wholly in rehab and to maintain their compliance to repeated exercising, for a speedy recovery from hand injuries (wrist, elbow and fingers). This is achieved by integrating leap motion sensor with unity game development engine. Exercises (as gestures) are recognised and validated by leap motion sensor. Game application for exercises is developed using unity. Gamification alternative has been implemented by very few in the globe and it has been taken as a challenge in our research. We could successfully design and build an engine which would be interactive and real-time, providing platform for rehabilitation. We have tested the same with patients and received positive feedbacks. We have enabled the user to know the score through GUI.
Date: February 28, 2020, Source: University of Warwick
Summary: Virtual reality could help physiotherapy patients complete their exercises at home successfully thanks to researchers who managed to combine VR technology with 3D motion capture.
Virtual reality could help physiotherapy patients complete their exercises at home successfully thanks to researchers at WMG, University of Warwick, who managed to combine VR technology with 3D motion capture.
Currently prescribed physiotherapy often requires patients to complete regular exercises at home. Outside of the clinic, patients rarely receive any guidance other than a leaflet of sketches or static photographs to instruct them how to complete their exercises. This leads to poor adherence, with patients becoming anxious about not getting the exercise right, or simply getting bored by the repetitiveness of the movements.
The advent of consumer virtual reality technology combined with 3D motion capture allows real movements to be accurately translated onto an avatar that can be viewed in a virtual environment. Researchers at the Institute of Digital Healthcare, WMG, University of Warwick are investigating whether this technology can be used to provide guidance to physiotherapy patients, by providing a virtual physiotherapist in the home to demonstrate the prescribed exercises.
Their paper, ‘Timing and correction of stepping movements with a virtual reality avatar’ published today the 28th of February, in the Journal PLOS ONE, has focused on whether people are able to accurately follow the movements of a virtual avatar.
Researchers had to investigate whether people were able to accurately coordinate and follow the movements of an avatar in a virtual environment. They asked participants to step in time with an avatar viewed through a VR headset.
Unknown to the participants, the researchers subtly slowed down or speeded up one of the avatar’s steps, such that the participants would have to correct their own stepping movement to stay in time. The effect this correction had on their step timing and synchronisation with the avatar was measured.
Lead author, Omar Khan from WMG, University of Warwick commented:
“If participants were observed to correct their own stepping to stay in time with the avatar, we knew they were able to accurately follow the movements they were observing.
“We found that participants struggled to keep in time if only visual information was present. However, when we added realistic footstep sounds in addition to the visual information, the more realistic multisensory information allowed participants to accurately follow the avatar.”
Dr Mark Elliott, Principal investigator on the project at WMG, University of Warwick added:
“There is huge potential for consumer VR technologies to be used for both providing guidance to physiotherapy exercises, but also to make the exercises more interesting. This study has focused on the crucial question of how well people can follow a virtual guide.”
Prof. Theo Arvanitis, co-author and Director of the Institute of Digital Healthcare, said:
“Our work and digitally-enabled technological solution can underpin transformative health innovations to impact the field of physiotherapy, and have a direct benefit to patients’ rehabilitation. “We now plan to investigate other types of movements working closely in partnership with physiotherapists, to establish the areas of physiotherapy that will benefit most from this technology.”
Omar Khan, Imran Ahmed, Joshua Cottingham, Musa Rahhal, Theodoros N. Arvanitis, Mark T. Elliott. Timing and correction of stepping movements with a virtual reality avatar. PLOS ONE, 2020; 15 (2): e0229641 DOI: 10.1371/journal.pone.0229641
In the clinic, in education or just for professional development mobile Apps can make a big difference to efficiency and effectiveness in physiotherapy practice. This page is intended to list all the mobile applications that might be of use to physiotherapists and physical therapists. Please feel free to add any mobile applications that you find useful and think others may find useful. Alternatively you can email your ideas to us.