Posts Tagged physiotherapy

[Abstract+References] SMART Arm Training With Outcome-Triggered Electrical Stimulation in Subacute Stroke Survivors With Severe Arm Disability: A Randomized Controlled Trial.

Background. Stroke survivors with severe upper limb disability need opportunities to engage in task-oriented practice to achieve meaningful recovery. Objective. To compare the effect of SMART Arm training, with or without outcome-triggered electrical stimulation to usual therapy, on arm function for stroke survivors with severe upper limb disability undergoing inpatient rehabilitation. Methods. A prospective, multicenter, randomized controlled trial was conducted with 3 parallel groups, concealed allocation, assessor blinding and intention-to-treat analysis. Fifty inpatients within 4 months of stroke with severe upper limb disability were randomly allocated to 60 min/d, 5 days a week for 4 weeks of (1) SMART Arm with outcome-triggered electrical stimulation and usual therapy, (2) SMART Arm alone and usual therapy, or (3) usual therapy. Assessment occurred at baseline (0 weeks), posttraining (4 weeks), and follow-up (26 and 52 weeks). The primary outcome measure was Motor Assessment Scale item 6 (MAS6) at posttraining. Results. All groups demonstrated a statistically (P < .001) and clinically significant improvement in arm function at posttraining (MAS6 change ≥1 point) and at 52 weeks (MAS6 change ≥2 points). There were no differences in improvement in arm function between groups (P= .367). There were greater odds of a higher MAS6 score in SMART Arm groups as compared with usual therapy alone posttraining (SMART Arm stimulation generalized odds ratio [GenOR] = 1.47, 95%CI = 1.23-1.71) and at 26 weeks (SMART Arm alone GenOR = 1.31, 95% CI = 1.05-1.57). Conclusion. SMART Arm training supported a clinically significant improvement in arm function, which was similar to usual therapy. All groups maintained gains at 12 months.

1. Houwink, A, Nijland, RH, Geurts, AC, Kwakkel, G. Functional recovery of the paretic upper limb after stroke: who regains hand capacity? Arch Phys Med Rehabil. 2013;94:839844Google ScholarCrossrefMedline
2. Broeks, JG, Lankhorst, GJ, Rumping, K, Prevo, AJ. The long-term outcome of arm function after stroke: results of a follow-up study. Disabil Rehabil. 1999;21:357364Google ScholarCrossrefMedline
3. Wolf, SL, Kwakkel, G, Bayley, M, McDonnell, MN. Upper Extremity Stroke Algorithm Working Group. Best practice for arm recovery post stroke: an international application. Physiotherapy. 2016;102:14Google ScholarCrossrefMedline
4. Kleim, JA. Neural plasticity and neurorehabilitation: teaching the new brain old tricks. J Commun Disord. 2011;44:521528Google ScholarCrossrefMedline
5. Pollock, A, Farmer, SE, Brady, MC. Interventions for improving upper limb function after stroke. Cochrane Database Syst Rev. 2014;(11):CD010820Google ScholarMedline
6. Zondervan, DK, Augsburger, R, Bodenhoefer, B, Friedman, N, Reinkensmeyer, DJ, Cramer, SC. Machine-based, self-guided home therapy for individuals with severe arm impairment after stroke:a randomized controlled trial. Neurorehabil Neural Repair. 2015;29:395406Google ScholarLink
7. Howlett, OA, Lannin, NA, Ada, L, McKinstry, C. Functional electrical stimulation improves activity after stroke: a systematic review with meta-analysis. Arch Phys Med Rehabil. 2015;96:934943Google ScholarCrossrefMedline
8. McCabe, J, Monkiewicz, M, Holcomb, J, Pundik, S, Daly, JJ. Comparison of robotics, functional electrical stimulation, and motor learning methods for treatment of persistent upper extremity dysfunction after stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2015;96:981990Google ScholarCrossrefMedline
9. Barker, RN, Brauer, SG, Carson, RG. Training of reaching in stroke survivors with severe and chronic upper limb paresis using a novel nonrobotic device: a randomized clinical trial. Stroke. 2008;39:18001807Google ScholarCrossrefMedline
10. Hayward, KS, Barker, RN, Brauer, SG, Lloyd, D, Horsley, SA, Carson, RG. SMART Arm with outcome-triggered electrical stimulation: a pilot randomized clinical trial. Top Stroke Rehabil. 2013;20:289298Google ScholarCrossrefMedline
11. Barker, RN, Brauer, S, Carson, R. Training-induced changes in the pattern of triceps to biceps activation during reaching tasks after chronic and severe stroke. Exp Brain Res. 2009;196:483496Google ScholarCrossrefMedline
12. Barker, RN, Brauer, SG, Barry, BK, Gill, TJ, Carson, RG. Training-induced modifications of corticospinal reactivity in severely affected stroke survivors. Exp Brain Res. 2012;221:211221Google ScholarCrossrefMedline
13. Zeiler, SR, Krakauer, JW. The interaction between training and plasticity in the post-stroke brain. Curr Opin Neurol. 2013;26:609616Google ScholarCrossrefMedline
14. Hayward, KS, Neibling, BA, Barker, RN. Self-administered, home-based SMART (Sensorimotor Active Rehabilitation Training) arm training: a single-case report. Am J Occup Ther. 2015;69:6904210020p1-8. Google ScholarCrossrefMedline
15. Wahl, AS, Schwab, ME. Finding an optimal rehabilitation paradigm after stroke: enhancing fiber growth and training of the brain at the right moment. Front Hum Neurosci. 2014;8:381Google ScholarCrossrefMedline
16. Hatam, SM, Saussez, G, Della Faille, M. Rehabilitation of motor function after stroke: a multiple systematic review focused on techniques to stimulate upper extremity recovery. Front Hum Neurosci. 2016;10:442Google ScholarMedline
17. Murphy, TH, Corbett, D. Plasticity during stroke recovery: from synapse to behaviour. Nat Rev Neurosci. 2009;10:861872Google ScholarCrossrefMedline
18. Kwah, LK, Harvey, LA, Diong, JH, Herbert, RD. Half of the adults who present to hospital with stroke develop at least one contracture within six months: an observational study. J Physiother. 2012;58:4147Google ScholarCrossrefMedline
19. Adey-Wakeling, Z, Arima, H, Crotty, M. Incidence and associations of hemiplegic shoulder pain poststroke: prospective population-based study. Arch Phys Med Rehabil. 2015;96:241.e1247.e1Google ScholarCrossref
20. Kleim, JA. Neural Plasticity: Foundation for Neurorehabilita-tion. Scottsdale, AZTanas2012Google Scholar
21. Brauer, SG, Hayward, KS, Carson, RG, Cresswell, AG, Barker, RN. The efficacy of SMART arm training early after stroke for stroke survivors with severe upper limb disability: a protocol for a randomised controlled trial. BMC Neurol. 2013;13:71Google ScholarCrossrefMedline
22. Malouin, F, Pichard, L, Bonneau, C, Durand, A, Corriveau, D. Evaluating motor recovery early after stroke: comparison of the Fugl-Meyer Assessment and the Motor Assessment Scale. Arch Phys Med Rehabil. 1994;75:12061212Google ScholarCrossrefMedline
23. Hayward, KS, Kuys, SS, Barker, RN, Brauer, SG. Can stroke survivors with severe upper arm disability achieve clinically important change in arm function during inpatient rehabilitation? A multicentre, prospective, observational study. NeuroRehabilitation. 2014;35:1723Google ScholarMedline
24. Bohannon, RW, Smith, MB. Inter-rater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67:206207Google ScholarCrossrefMedline
25. Ritchie, DM, Boyle, JA, McInnes, JM. Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis. Q J Med. 1968;37:393406Google ScholarMedline
26. Khan, A, Chien, CW, Brauer, SG. Rasch-based scoring offered more precision in differentiating patient groups in measuring upper limb function. J Clin Epidemiol. 2013;66:681687Google ScholarCrossrefMedline
27. Duncan, PW, Wallace, D, Lai, SM, Johnson, D, Emberston, S, Laster, LJ. The Stroke Impact Scale Version 2.0. Evaluation of the reliability, validity and sensitivity to change. Stroke. 1999;30:21312140Google ScholarCrossrefMedline
28. Uswatte, G, Taub, E, Morris, D, Light, K, Thompson, PA. The Motor Activity Log-28: assessing daily use of the hemiparetic arm after stroke. Neurology. 2006;67:11891194Google ScholarCrossrefMedline
29. Helm-Estabrooks, N. Cognitive Linguistic Quick Test. Examiner’s Manual. San Antonio, TXPsychological Corporation, Harcourt Assessment Company2001Google Scholar
30. Lincoln, NB, Jackson, JM, Adams, SA. Reliability and revision of the Nottingham Sensory Assessment for stroke patients. Physiotherapy. 1998:358365Google Scholar
31. Winters, C, Heymans, MW, van Wegen, EE, Kwakkel, G. How to design clinical rehabilitation trials for the upper paretic limb early post stroke? Trials. 2016;17:468Google ScholarCrossrefMedline
32. van der Lee, JH, Wagenaar, RC, Lankhorst, GJ, Vogelaar, TW, Deville, WL, Bouter, LM. Forced use of the upper extremity in chronic stroke patients—results from a single-blind randomized clinical trial. Stroke. 1999;30:23692375Google ScholarCrossrefMedline
33. Hayward, KS, Kuys, SS, Barker, RN, Brauer, SG. Clinically important improvements in motor function are achievable during inpatient rehabilitation by stroke patients with severe motor disability: a prospective observational study. NeuroRehabilitation. 2014;34:773779Google ScholarMedline
34. Churilov, L, Arnup, S, Johns, H. An improved method for simple, assumption-free ordinal analysis of the modified Rankin Scale using generalized odds ratios. Int J Stroke. 2014;9:9991005Google ScholarLink
35. Hayward, KS, Barker, RN, Wiseman, AH, Brauer, SG. Dose and content of training provided to stroke survivors with severe upper limb disability undertaking inpatient rehabilitation: an observational study. Brain Impairment. 2013;14:392405Google ScholarCrossref
36. Shirzad, N, Van der Loos, HFM. Evaluating the user experience of exercising reaching motions with a robot that predicts desired movement difficulty. J Mot Behav. 2016;48:3146Google ScholarCrossrefMedline
37. Bernstein, NA. The Co-ordination and Regulation of Movement. Oxford, EnglandPergamon Press1967Google Scholar
38. Krakauer, JW. Rethinking motor rehabilitation after strokePaper presented at: International Conference on Virtual RehabilitationJune 9-12, 2015Valencia, SpainGoogle Scholar
39. Guadagnoli, MA, Lee, TD. Challenge point: a framework for conceptualizing the effects of various practice conditions in motor learning. J Mot Behav. 2004;36:212224Google ScholarCrossrefMedline
40. Winters, C, van Wegen, EE, Daffertshofer, A, Kwakkel, G. Generalizability of the proportional recovery model for the upper extremity after an ischemic stroke. Neurorehabil Neural Repair. 2015;29:614622Google ScholarLinkISI
41. Schneider, EJ, Lannin, NA, Ada, L, Schmidt, J. Increasing the amount of usual rehabilitation improves activity after stroke: a systematic review. J Physiother. 2016;62:182187Google ScholarCrossrefMedline
42. Krakauer, JW, Marshall, RS. The proportional recovery rule for stroke revisited. Ann Neurol. 2015;78:845847Google ScholarCrossrefMedline
43. Duncan, PW, Goldstein, LB, Matchar, D, Divine, GW, Feussner, J. Measurement of motor recovery after stroke—outcome assessment and sample-size requirements. Stroke. 1992;23:10841089Google ScholarCrossrefMedline
44. Birkenmeier, RL, Prager, EM, Lang, CE. Translating animal doses of task-specific training to people with chronic stroke in 1-hour therapy sessions: a proof-of-concept study. Neurorehabil Neural Repair. 2010;24:620635Google ScholarLink
45. Lang, CE, Lohse, KR, Birkenmeier, RL. Dose and timing in neurorehabilitation: prescribing motor therapy after stroke. Curr Opin Neurol. 2015;28:549555Google ScholarCrossrefMedline
46. Magill, RA, Anderson, D. Motor Learning and Control: Concepts and Applications. 10th ed. New York, NYMcGraw-Hill2014Google Scholar
47. Lee, JY, Ready, EA, Davis, EN, Doyle, PC. Purposefulness as a critical factor in functioning, disability and health. Clin Rehabil. 2017;31:10051018Google ScholarLink
48. Bernhardt, J, Borschmann, K, Boyd, L. Moving rehabilitation research forward: developing consensus statements for rehabilitation and recovery research. Int J Stroke. 2016;11:454458Google ScholarLinkISI
49. Hayward, KS. It is time to redefine recovery for individuals with severe upper limb impairment after stroke. IJTR Int J Ther Rehabil. 2016;23:256257Google ScholarCrossref
50. Krebs, HI, Hogan, N. Therapeutic robotics: a technology push. Stroke rehabilitation is being aided by robots that guide movement of shoulders and elbows, wrists, hands, arms and ankles to significantly improve recovery of patients. Proc IEEE Inst Electr Electron Eng. 2006;94:17271738Google ScholarCrossrefMedline
51. de Kroon, JR, van der Lee, JH, Ijzerman, MJ, Lankhorst, GJ. Therapeutic electrical stimulation to improve motor control and functional abilities of the upper extremity after stroke: a systematic review. Clin Rehabil. 2002;16:350360Google ScholarLink
52. Cauraugh, J, Light, K, Kim, S, Thigpen, M, Behrman, A. Chronic motor dysfunction after stroke: recovering wrist and finger extension by electromyography-triggered neuromuscular stimulation. Stroke. 2000;31:13601364Google ScholarCrossrefMedline
53. Veerbeek, JM, Langbroek-Amersfoort, AC, van Wegen, EE, Meskers, CG, Kwakkel, G. Effects of robot-assisted therapy for the upper limb after stroke. Neurorehabil Neural Repair. 2017;31:107121Google ScholarLink
54. Nascimento, LR, Michaelsen, SM, Ada, L, Polese, JC, Teixeira-Salmela, LF. Cyclical electrical stimulation increases strength and improves activity after stroke: a systematic review. J Physiother. 2014;60:2230Google ScholarCrossrefMedline
55. Kwakkel, G, Kollen, BJ, van der Grond, J, Prevo, AJ. Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. Stroke. 2003;34:21812186Google ScholarCrossrefMedline
56. Dromerick, AW, Edwardson, MA, Edwards, DF. Critical periods after stroke study: translating animal stroke recovery experiments into a clinical trial. Front Hum Neurosci. 2015;9:231Google ScholarCrossrefMedline

via SMART Arm Training With Outcome-Triggered Electrical Stimulation in Subacute Stroke Survivors With Severe Arm Disability: A Randomized Controlled TrialNeurorehabilitation and Neural Repair – Ruth N. Barker, Kathryn S. Hayward, Richard G. Carson, David Lloyd, Sandra G. Brauer, 2017

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[WEB SITE] Virtual Reality Tech Tackles Post-Stroke Effects No Worse Than Physiotherapy.

Travel journalists watch a virtual reality presentation given by United Airlines as part of their new international business class dubbed United Polaris in New York, U.S. June 2, 2016

Virtual reality (VR) training is no less effective than conventional physiotherapy during post-stroke rehabilitation, a new report in Neurology magazine states.

German researchers led by Iris Brunner from Bergen University in Norway tested two methodologies as a total of 120 patients underwent post-stroke rehabilitation, comprising a minimum of 16 60-minute sessions over four weeks. The patients with an equal degree of paresis were divided into two groups, 60 in each, to perform either traditional training, or one involving use of VR technologies.

​The study provides sufficient evidence that for patients with upper extremity motor impairment, VR training and physiotherapy contributed equally to upper extremity function improvement, which was estimated at about 21 percent promptly after the training sessions. However, the former also allows doctors to adjust by hand the intensity of the VR training depending on the severity of paresis. Three months after the rehabilitation program, patients could boast of having boosted their motor functions by a staggering 30 percent.

“The results found that additional upper extremity VR training was not superior but equally as effective as additional conventional training (CT) in the subacute phase following a stroke,” the Neurology abstract reads.
VR technologies have long been used for purposes other than entertainment. For instance, VR glasses imitating social interactions are being employed to help cure such medical conditions as paranoia, depression and have even helped eradicate the fear of death in some cases.

via Virtual Reality Tech Tackles Post-Stroke Effects No Worse Than Physiotherapy – Sputnik International

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[Abstract] Post-stroke spasticity management including a chosen physiotherapeutic methods and improvements in motor control – review of the current scientific evidence.

Abstract

Cerebrovascular diseases based on stroke etiology concern millions of people worldwide, and annual rates of disease are still increasing. In the era of an aging society and suffering from a number of risk factors, in particular those modifiable, strokes and muscles’ spastic paresis, subsequently resulting in damage of upper motor neuron structures will become a serious problem for the entire health care system. Effective management and physiotherapy treatment for post-stroke spasticity persisted, both in the acute and chronic, is still a significant medical problem in the interdisciplinary aspect. Care procedures for this type of patient becomes a kind of challenge for specialists in neurology, internal medicine, cardiology, dermatology or neurosurgery, but also for physiotherapists in their everyday clinical practice. The aim of this paper is to present the issues of cerebral stroke and resulting spastic hypertonia in terms of current pharmacological treatment and surgery, and primarily through the use of effective physiotherapy methods, the use of which was confirmed in the way of reliable scientific research in accordance with the principles of Evidence Based Medicine and Physiotherapy (EBMP).

 

via [Post-stroke spasticity management including a chosen physiotherapeutic methods and improvements in motor control – review of the current scientifi… – PubMed – NCBI

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[Abstract] Virtual Rehabilitation through Nintendo Wii in Poststroke Patients: Follow-Up

Objective

To evaluate in the follow-up the sensory-motor recovery and quality of life patients 2 months after completion of the Nintendo Wii console intervention and determine whether learning retention was obtained through the technique.

Methods

Five hemiplegics patients participated in the study, of whom 3 were male with an average age of 54.8 years (SD = 4.6). Everyone practiced Nintendo Wii therapy for 2 months (50 minutes/day, 2 times/week, during 16 sessions). Each session lasting 60 minutes, under a protocol in which only the games played were changed, plus 10 minutes of stretching. In the first session, tennis and hula hoop games were used; in the second session, football (soccer) and boxing were used. For the evaluation, the Fulg-Meyer and Short Form Health Survey 36 (SF-36) scales were utilized. The patients were immediately evaluated upon the conclusion of the intervention and 2 months after the second evaluation (follow-up).

Results

Values for the upper limb motor function sub-items and total score in the Fugl–Meyer scale evaluation and functional capacity in the SF-36 questionnaire were sustained, indicating a possible maintenance of the therapeutic effects.

Conclusion

The results suggest that after Nintendo Wii therapy, patients had motor learning retention, achieving a sustained benefit through the technique.

via Virtual Rehabilitation through Nintendo Wii in Poststroke Patients: Follow-Up

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[ARTICLE] Telephysiotherapy: time to get online – Full Text

The science and practice of telehealth have undergone rapid growth in recent years. A search of the Web of Science for the term ‘telehealth’ would have returned only two papers in 1995, compared with 104 papers in 2000, and 5069 papers in June 2017. This exponential growth is also evident in the number of randomised, controlled trials and systematic reviews indexed in the Physiotherapy Evidence Database with ‘telehealth’ in the title, rising from 10 records in 2008 to 70 records in 2017. These papers span the breadth of physiotherapy practice, with particularly strong representation from musculoskeletal and cardiorespiratory physiotherapy (Figure 1). High-quality randomised, controlled trials that support the benefits of telehealth interventions in many physiotherapy subdisciplines have been published over recent years. These have included telephysiotherapy interventions for chronic knee pain,1 non-specific low back pain,2 chronic obstructive pulmonary disease (COPD),3 heart disease,4 breast cancer,5 joint arthroplasty,6 and urinary incontinence.7Many of these studies have demonstrated significantly better clinical outcomes than usual care that did not include physiotherapy, including improved exercise capacity, better physical function, reduced symptoms and enhanced health-related quality of life.

Figure 1 Number of randomised trials and systematic reviews indexed on the Physiotherapy Evidence Database (PEDro) that have a telehealth element, categorised by subdiscipline. Articles were identified using the search terms tele or internet, with screening by title and abstract to confirm a telehealth element. Subdiscipline categorisations are those on the PEDro website, with some articles categorised under more than one subdiscipline.

Telephysiotherapy can take many different forms, with the components driven by the goals of treatment. Videoconferencing provides direct contact between patients and physiotherapists, either one-to-one1 or in a virtual group setting.3 For some telephysiotherapy programs (eg, pulmonary rehabilitation, stroke rehabilitation) it may be necessary to perform a limited number of home visits, in order to perform assessments or provide instruction in the use of equipment.3, 8 However, some telephysiotherapy programs are delivered entirely from a distance, without ever meeting the patient in person, including notable examples of successful treatment of stress urinary incontinence using email support7 and a mobile app.9 Telephysiotherapy programs may include remote monitoring of physiological signals, such as pulse rate, oxygen saturation, electrocardiograms (ECG), and joint range of movement, in specific populations such as cardiorespiratory or orthopaedic disease.4, 10, 11Whilst some telephysiotherapy models require specially designed equipment,6, 11 others have achieved similarly successful outcomes with off-the-shelf consumer devices and software.1, 3 The ubiquitous nature of the smartphone provides new opportunities for telephysiotherapy, including: physical activity monitoring; sound and light cues to set exercise intensity and duration; real-time feedback on exercise performance; and text messaging to provide exercise advice or progression.10, 12 Simple web-based diaries can be used to record exercise and provide feedback.12 Didactic or interactive education programs can also be provided.1 In some populations it may be possible to automate aspects of a telephysiotherapy program to provide efficient and effective care to large patient populations, for instance using internet platforms that provide automated goal setting and feedback in conjunction with a pedometer for patients with non-specific low back pain.2

The increase in our capacity to deliver physiotherapy at a distance using telehealth has occurred at the same time that ‘hands-on’ physiotherapy techniques have become less important for some health conditions. For example, electrotherapy is no longer recommended for routine treatment of low back pain,13 whereas exercise therapy is an important component of care.14 Interventions designed to increase physical activity and physical fitness now have an important role in physiotherapy management for numerous clinical groups and across the lifespan, recognising the critical impact of these factors on long-term health outcomes.15 Many of these interventions, which typically involve goal setting, exercise prescription and self-management training, do not require hands-on therapy and are highly amenable to telephysiotherapy.

Despite the potential for telehealth to increase the capacity of the health system and deliver better health outcomes, there has been relatively slow uptake in practice. Enthusiasm has been tempered by the lack of clinically relevant benefits seen in some large-scale randomised trials involving people with chronic diseases such as heart failure and COPD;16, 17, 18 however, these trials relied heavily on telemonitoring of physiology and symptoms, rather than on delivery of therapy. Remote monitoring has not delivered consistent benefits over usual care, perhaps because it is difficult to maintain long-term adherence with monitoring, or the difficulty in identifying meaningful changes in monitored variables. Trials in telephysiotherapy, which typically involve delivering a treatment from a remote location, have generally been more successful, producing similar results to interventions that are delivered face to face. For instance, in 205 patients who had undergone knee arthroplasty, in-home rehabilitation delivered by videoconference demonstrated equivalent outcomes for pain, stiffness and function when compared with face-to-face rehabilitation.6 Similarly, in 152 people with heart failure, cardiac rehabilitation with exercise prompts and ECG monitoring transmitted via a mobile phone produced similar benefits to a traditional outpatient cardiac rehabilitation program.10 A key feature of these successful telephysiotherapy interventions is that they delivered treatments of known effectiveness in a different way, using technology to reach patients who are located away from healthcare facilities. […]

CONTINUE —>Telephysiotherapy: time to get online – Journal of Physiotherapy

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[ARTICLE] Late physiotherapy rehabilitation changes gait patterns in post-stroke patients – Full Text PDF

Summary
Study aim: To determine whether a physiotherapy protocol improves the electromyographic activation (EA) during the hemiparetic gait in patients with delayed access to rehabilitation. Material and methods: 40 post-stroke patients underwent clinical evaluation and gait assessment at the time of admission and at the end of treatment.

Results: The anterior leg muscles tibialis anterior and rectus femoris had earlier onset (p = 0.0001).

Conclusion: Electromyographic findings showed altered patterns during the hemiparetic gait cycle, even in patients with delayed access to treatment.

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[WEB SITE] Undergoing physiotherapy exercises from home now a reality for patients

SINGAPORE: Patients from two healthcare institutions across Singapore will be able to carry out physiotherapy exercises in the comfort of their own homes, after a national tele-rehabilitation pilot was launched on Friday (May 5) by Integrated Health Information Systems (IHiS).

IHiS, Singapore’s healthcare technology agency, developed the system together with T-Rehab, a start-up founded by researchers from the National University of Singapore (NUS). 

To use the service, patients open an app on an iPad – called Smart Health TeleRehab – and put on neck and limb sensors, depending on which part of the body they are exercising. The instructions are available in five languages: English, Mandarin, Bahasa Melayu, Tamil and Tagalog. 

Video demonstrations of the exercises prescribed by the therapists will then be played via the app. The therapist is able to customise the level of difficulty of each exercise, from the number of repetitions to the angle of each limb movement.

The patient’s movements are also recorded for the therapist to review, and to motivate the patient to complete his or her exercises, the system designed to have gaming elements. For instance, there are coloured bars to indicate if the patient has achieved the desired exercise angle, and a counter for the number of repetitions completed. 

After the patient completes the exercises, a record of the patient’s performance is sent to the therapist.

The service is available to those deemed suitable to perform physiotherapy exercises without the physical supervision of a physiotherapist. This includes those recovering from strokes, lower limb joint replacements and amputations, falls and fractures. 

It is currently offered by NTUC Health and TOUCH Home Care. Twelve other institutions including Ang Mo Kio-Thye Hua Kwan Hospital, Khoo Teck Puat Hospital, and the National University Hospital will provide the service by end-2017.

There are 200 sets of tele-rehabilitation equipment available, which is rented out to the healthcare institutions for a fee. IHiS hopes to get 1,000 patients on the programme by the end of the two-year pilot and currently has around 11 patients on the service since February this year, said Mr Chua Chee Yong, director of IHiS’ planning group.

OVERCOMING INCONVENIENCE, HIGH COSTS

This service comes two-and-a-half years after clinical trials were conducted by the researchers from T-Rehab. 

A total of 100 stroke patients were recruited from Ang Mo Kio-Thye Hua Kwan Hospital and the Singapore General Hospital since January 2014, said Dr Gerald Koh, an associate professor and the director of medical undergraduate education at Saw Swee Hock School of Public Health at NUS. He is one of the founders of T-Rehab. 

They chose to develop a tele-rehab system after an earlier study he conducted found that only two out of five patients wanted to continue with rehabilitation after discharge, he said. This is despite close to four out of five of them stating that rehabilitation was useful.

According to Dr Koh, many of them cited inconvenience, high costs and difficulty getting to the rehab centre without a caregiver as the main reasons why they stopped going for rehabilitation.

“The very reason why I need rehabilitation is the very reason why I can’t get to the day rehab centre three times a week,” Dr Koh said of the issue of immobility faced by patients. 

His study found that those who got therapy through tele-rehabilitation recovered as well as those who did their exercises with a therapist present. 

This new service, Dr Koh added, will help to boost rehabilitation participation rate and remove the barriers to carrying out physiotherapy and this will prevent their conditions from deteriorating further.

One of the early adopters of the system, TOUCH Home Care, found that the service benefits both patients and its healthcare workers since it implemented the system in March 2017.

For TOUCH Home Care, the price per session is still the same as a home visit at S$18. However, as the patient is able to carry out the exercises more frequently and at their own time, the hope is that he or she will recover faster and overall, fewer therapy sessions are required, said a physiotherapist at TOUCH Home Care Vivian Lim.

The operator’s therapists have also been more productive.

So far, they spend about 50 minutes on each tele-rehabilitation session, which include prescribing the exercise via the system, reviewing the elderly client’s exercise records and conducting video consultations or calling the patients to provide feedback. A home visit will typically take about 100 minutes, including time to travel from one home to another.

The sessions are not meant to substitute home visits entirely, said Ms Lim, but can replace some of the weekly sessions.

However, not all clients are able to benefit from the new service, as those with conditions such as chronic giddiness and seizures will not be able to perform their exercises without direct supervision, said Ms Rachel Lim, a senior occupational therapist from TOUCH Home Care. 

Some of the seniors also “lack confidence” in using technology, while others may not have the right caregivers at home. “There are some caregivers are also elderly who are frail (themselves), with sensory deficits…they can’t help put on the sensors,” said the occupational therapist.

TOUCH Home Care hopes to get 90 of its 300 clients using the remote rehabilitation tool by the end of this year. It now has seven on board.

MEETING SINGAPORE’S HEALTHCARE NEEDS

The tele-rehabilitation service was developed in light of Singapore’s healthcare landscape, said IHiS’ Mr Chua.

“Our growing ageing population (means) we have more aged elderly in the community… more healthcare workers, including our therapists, are also getting older,” he said. This means that there will be greater demand for rehabilitation services, while there will be a growing need to “stretch our manpower resources”.

The service is one of three telemedicine initiatives that will begin this year. A remote vital signs monitoring system will launch later this year, while a national videoconferencing platform for healthcare services was launched in April.

Source: Undergoing physiotherapy exercises from home now a reality for patients

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[WEB SITE] ‘Telerehab’ system allows patients to do physiotherapy at home

SINGAPORE – It is a Friday afternoon and Mr Chin Tian Loke, 72, is watching a video on an iPad Air in his five-room flat in Jurong West. He mimics the movements of the person on screen, lifting his arm, which has a sensor attached to it at a 90-degree angle. A voice from the iPad then congratulates him: “Spectacular!”

It appears as though Mr Chin, a retired odd-job worker, is playing a game. But he is actually undergoing rehabilitation therapy, to help him gain strength in his limbs after he fell and broke his spinal tail bone in November last year.

Mr Chin is one of the first to try out a novel healthcare system, announced on Friday (May 5) by healthcare technology agency Integrated Health Information Systems (IHiS).

The system aims to make physiotherapy as painless as possible: by allowing patients to exercise at any time of the day, within the comfort of their own homes. This removes the need for a patient to commute to and from a rehabilitation centre and hopefully, boost participation rates in attendance for rehabilitative therapy, which would then prevent the chances of re-admission to hospital. As National University of Singapore’s Associate Professor Gerald Koh, who pioneered the system, noted: “Often, the reason why a patient needs therapy is the reason why the patient finds it hard to go for therapy.”

The solution is technology.

All that is required is an iPad and two sets of sensors – which will be loaned to the patient by the healthcare institution – and an open mind.

Believed to be the first of its kind,Smart Health TeleRehab, as the system is known, will enable Mr Chin’s physiotherapist from Touch Home Care to keep tabs on his exercise regime remotely. Each exercise session will be automatically recorded and saved to a digital cloud, which his therapist views within two working days.

If a patient has completed the prescribed exercises successfully, the physiotherapist can increase the difficulty of the exercises at the touch of a button. If not, she will call Mr Chin to guide him on the right way to do the exercises. If further explanation is required, the physiotherapist will pay him a home visit within the week.

Smart Health TeleRehab is currently being used by 11 patients at two healthcare providers – Touch Home Care and NTUC Health. But 12 more -including Changi General Hospital, Khoo Teck Puat Hospital, and SPD (formerly known as the Society for the Physically Disabled) – will come on board by the end of this year (2017), as Singapore ramps up programmes in line with its Smart Nation ambition.

An estimated 1,000 patients are expected to benefit from the pilot programme by the end of next year (2018). IHiS’ latest initiative follows its April roll-out of a video call system for medical consultations to six public healthcare institutions that enables patients to consult experts from the comfort of their homes.

Mr Chee Hong Tat, Senior Minister of State for Health, visited Mr Chin on Friday at his home to see how the Smart Health TeleRehab system could be deployed. He said: “Smart Health TeleRehab could transform how therapy services are delivered in Singapore. Patients will benefit from greater convenience, cost savings and better outcomes. Therapists and therapy service providers will also benefit from the productivity improvements.”

The cost of Smart Health TeleRehab sessions depends on the various healthcare institutions, and the subsidies that a patient qualifies for.

As a gauge, at Ang Mo Kio Thye Hua Kwan Hospital, which will run the programme from next month (June 2017), a patient can expect to pay between $3 and $50 for one Smart Health TeleRehab session. In comparison, a patient has to pay more than $80 for one treatment session at the centre (excluding transportation costs, which could go up to $75 per way), or more than $160 for a therapist to visit him at home.

Singapore’s therapists too, will benefit from productivity gains. In 2016, there were about 2,570 occupational and physiotherapists here. However, figures from the Health Ministry show that 53,000 patients had to undergo physiotherapy in 2014 – and the health authorities are only expecting this number to grow over the years as the population ages.

An initial study led by Prof Koh found that the system could help therapists reap productivity gains of more than 30 per cent. A telerehab session, on average, takes about 52 minutes. A therapy session conducted in the patient’s home, however, could stretch up to almost 80 minutes. So in the time that a therapist usually takes to see three patients the conventional way, the therapist can see four patients instead via the TeleRehab method.

Smart Health TeleRehab may not be suitable for all patients, such as those who have diabetes or other complications.But with more patients on the technological platform, it frees up therapists so they can have more face-time with more needy patients.

Singapore Management University’s (SMU) School of Information Systems’ Associate Professor Tan Hwee Pink volunteers with the Stroke Support Station (Singapore) and has an elderly father recovering from a complex hip fracture after a road accident last year. He welcomed the new platform as a timely one.

https://www.youtube.com/watch?v=idQmQl73-WM

Despite the benefits, however, he pointed out that most patients recovering from an accident or stroke would have weakened mental strength. “This needs to be addressed for the patient to be motivated to do the rehab at home. As we know, patients tend to do what they are told in a controlled environment, but not necessarily so when they are in the home environment,” he added.

One possible way to do this is to allow more functions to be used on the iPads, such as watching TV or making calls, for example, he suggested.

Professor Atreyi Kankanhalli, from the department of information systems at the National University of Singapore’s School of Computing, said the TeleRehab method also give patients a greater sense of autonomy and control, as they can do the rehabilitation exercises on their own. She added: “With the increasing incidence of chronic diseases, shortage of healthcare professionals, and yet the availability of more intelligent technologies, healthcare is a prime sector that can benefit from Smart Nation initiatives – in addition to other key sectors such as transport, commerce, utilities, security and education.”

Source: ‘Telerehab’ system allows patients to do physiotherapy at home, Health News & Top Stories – The Straits Times

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[ARTICLE] Short-term effects of physiotherapy combining repetitive facilitation exercises and orthotic treatment in chronic post-stroke patients – Full Text PDF

Abstract.

[Purpose] This study investigated the short-term effects of a combination therapy consisting of repetitive facilitative exercises and orthotic treatment.

[Subjects and Methods] The subjects were chronic post-stroke patients (n=27; 24 males and 3 females; 59.3 ± 12.4 years old; duration after onset: 35.7 ± 28.9 months) with limited mobility and motor function. Each subject received combination therapy consisting of repetitive facilitative exercises for the hemiplegic lower limb and gait training with an ankle-foot orthosis for 4 weeks. The Fugl-Meyer assessment of the lower extremity, the Stroke Impairment Assessment Set as a measure of motor performance, the Timed Up & Go test, and the 10-m walk test as a measure of functional ambulation were evaluated before and after the combination therapy intervention.

[Results] The findings of the Fugl-Meyer assessment, Stroke Impairment Assessment Set, Timed Up & Go test, and 10-m walk test significantly improved after the intervention. Moreover, the results of the 10-m walk test at a fast speed reached the minimal detectible change threshold (0.13 m/s).

[Conclusion] Short-term physiotherapy combining repetitive facilitative exercises and orthotic treatment may be more effective than the conventional neurofacilitation therapy, to improve the lower-limb motor performance and functional ambulation of chronic post-stroke patients.

 

INTRODUCTION

The mobility of many stroke survivorsislimited, and most identify walking as a top priority for rehabilitation1) . One way to manage ambulatory difficulties is with an ankle-foot orthosis (AFO) or a foot-drop splint, which aims to stabilize the foot and ankle while weight-bearing and lift the toes while stepping1) . In stroke rehabilitation, various approaches, including robotic assistance, strength training, and task-related/virtual reality techniques, have been shown to improve motor function2) . The benefits of a high intensity stroke rehabilitation program are well established, and although no clear guidelines exist regarding the best levels of intensity in practice, the need for its incorporation into a therapy program is widely acknowledged2) . Repetitive facilitative exercises (RFE), which combine a high repetition rate and neurofacilitation, are a recently developed approach to rehabilitation of stroke-related limb impairment2–5) . In the RFE program, therapists use muscle spindle stretching and skin-generated reflexes to assist the patient’s efforts to move an affected joint5) . Previous studies have shown that an RFE program improved lower-limb motor performance (Brunnstrom Recovery Stage, foot tapping, and lower-limb strength) and the 10-m walk test in patients with brain damage3) . An AFO is an assistive device to help stroke patients with hemiplegia walk and stand. A properly prescribed AFO can improve gait performance and control abnormal kinematics arising from coordination deficits6) . Gait training with an AFO has been also reported to improve gait speed and balance in post-stroke patients7, 8) . Therefore, we hypothesized that short-term physiotherapy combining RFE and orthotic treatment would improve both lower-extremity motor performance and functional ambulation. The present study aimed to confirm the efficacy of a combination therapy consisting of RFE for the hemiplegic lower limb and gait training with AFO.

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[Abstract] An observational study of Australian physiotherapy consultations to explore the prescription of strategies.

Abstract

Objective

The aim of the study was to explore the types of self-management strategies prescribed; the number of strategies and the overall length of time allocated to self-management prescription, by consultation type and by injury location, in physiotherapy consultations.

Methods

A cross-sectional, observational study of 113 physiotherapist–patient consultations was undertaken. Regression analyses were used to determine whether consultation type and injury location were associated with the number of strategies prescribed and the length/fraction of time spent on self-management.

Results

A total of 108 patients (96%) were prescribed at least one self-management strategy – commonly exercise and advice. The mean length of time spent on self-management was 5.80 min. Common injury locations were the neck (n = 40) and lower back (n = 39). No statistically significant associations were observed between consultation type or injury location for either outcome (number of strategies and the length/fraction of time allocated to self-management prescription).

Conclusion

Physiotherapists regularly spend time prescribing self-management strategies such as exercise, advice, and the use of heat or ice to patients receiving treatment linked to a range of injury locations. This suggests that self-management is considered to be an important adjunct to in-clinic physiotherapy. The practice implications of this are that clinicians should reflect on how self-management strategies can be used to maximize patient outcomes, and whether the allocation of consultation time to self-management is likely to optimize patient adherence to each strategy.

Source: An observational study of Australian private practice physiotherapy consultations to explore the prescription of self-management strategies – Peek – 2017 – Musculoskeletal Care – Wiley Online Library

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