Posts Tagged physiotherapy

[VIDEO] PTX Physio Therapy eXercises for people with injuries & disabilities

 

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[ARTICLE] Media: Home exercise programs made effortless using the PhysioTherapy eXercises patient app – Journal of Physiotherapy

PhysioTherapy eXercises website: www.physiotherapyexercises.com

PhysioTherapy eXercises is a publicly available website, created by Harvey, Messenger, Glinsky, Pattie and a collaboration of physiotherapists. It was designed as a resource for creating and distributing home exercise programs. The website has a database of images, videos and instructions for over 1000 exercises focusing on impairments (strength, balance, range of motion, and cardiovascular fitness), and activities (reaching and manipulation, sit to stand, transfers, and mobility), and is available in 13 different languages. The exercises are evidence-based and include exercises for children through to the elderly, as well as exercises targeting specific populations, such as acute and degenerative neurological conditions, and musculoskeletal conditions, including whiplash and hand injuries. The Physiotherapy Exercises App is one feature of this web-based software and is the focus of this review.

The Physiotherapy Exercises App is free and can be used on both Apple and Android tablets and phones. The app is designed for patients to use, and allows them to access their prescribed home exercise program on their devices, record their progress online, and share this information remotely with their therapist. A recent randomised, controlled trial reported that using the Physiotherapy Exercises App increased adherence to home exercise programs when compared with paper-based methods.1

The therapist designs a home exercise program by selecting relevant exercises from the database and scheduling the frequency and duration of the exercises using the PhysioTherapy eXercises website. The patient then accesses and installs the Physiotherapy Exercises App via a link embedded in an email or smart phone text message that is sent from the website. Once the app is installed, patients have direct access to their home exercise program. The app allows patients to view their program, record completion of each exercise, and provide feedback to the therapist via a ‘notes’ function. The therapist has the ability to remotely monitor the patient’s exercise adherence, review notes recorded by the patient, and adjust the program as required by logging onto the website. Therapists can also receive a notification via an email when a patient’s adherence has decreased below a set threshold, which can be adjusted by the therapist for each patient.

Ease of use

Overall, the design of the Physiotherapy Exercises App is straightforward and the basic features are easy to use. My experience suggests that patients who already use the Internet and/or mobile devices are willing to use the Physiotherapy Exercises App, and use it successfully. Patients with limited technology experience are able to use the app successfully if provided with assistance to download the app and are given a demonstration of how to use it. Once the app has been downloaded, patients have two options: view the exercises that are to be completed on that day via the home screen (Figure 1A); or touch the screen to access the illustration, aims, instructions and dosage for each exercise (Figure 1B). Similarly, recording of the completed exercises can be done by ticking the ‘done all’ box on the home screen or ticking a box on each screen for an individual exercise. Patients can record completing an exercise even if it is not scheduled for a particular day. Notes can be added on each screen that details an individual exercise.

Figure 1 Opens large image

Figure 1
A. Example of the home screen of an exercise program on the Physiotherapy Exercises App. B. Example of an individual exercise screen, including illustration, patient’s aims, patient’s instructions, instructions for repetitions and the exercise schedule. The black boxes indicate the days the exercise has been scheduled, and ticks indicate that the patient has completed those exercises on that day.

From the perspective of therapist use, the home exercise program is prescribed and monitored by logging directly onto the website. The website has an extensive help section to assist the therapist if required.

Strengths and limitations

The Physiotherapy Exercises App is very well designed for clinical use. One of the key strengths is that patients can only access their home exercise program once it has been prescribed to them by a therapist, which ensures that patients complete exercises appropriate for their rehabilitation. Another valuable feature is that once the Physiotherapy Exercises App has been downloaded, there is no requirement for the patient to login or remember passwords. Other strengths are that the interface is easy to understand, and patients receive detailed information about each exercise, including the aims of the exercise, illustrations, instructions on how to complete the exercise, dosage, precautions, and progressions. Furthermore, therapists have the ability to select what information the patient views on the app and/or modify the instructions and information if required. When the home exercise program is updated online, all changes occur in real time.

Limitations of the Physiotherapy Exercises App are that few patients use all the features of the app, for example the notes function. My experience using the app with people who have Parkinson’s disease is that most people primarily use the app to view and record completion of their home exercise programs. Further encouragement by the therapist is necessary to ensure regular use of the notes function, if desired. At present, patients do not receive an alert via the Physiotherapy Exercises App that their program has been updated; it simply changes on the home screen. Consequently, if the program is updated independently of a consultation, an additional form of communication may be required to inform the patient of changes made.

Conclusion

Overall, the Physiotherapy Exercises App is an excellent and easy to use clinical resource. Increasing the use of devices to provide home exercise programs directly to patients is highly desirable and resource-efficient. It gives patients access to their home exercise program at all times, facilitates self-management, and, importantly, increases communication between the patient and therapist. The advantages of the Physiotherapy Exercises Appare that it is freely available, has an extensive range of exercises covering both musculoskeletal and neurological conditions, and is easy to use for both therapist and patient. Combined with the ability to remotely monitor patients’ adherence to the home exercise program, the Physiotherapy Exercises App has been a valuable addition to my clinical practice and role as a clinical educator.

Reference

  1. Lambert, T. et al. J Physiother201763161–167

View in Article – Abstract – Full Text –  Full Text PDF – PubMed – Scopus (3) – Google Scholar

 

via Media: Home exercise programs made effortless using the PhysioTherapy eXercises patient app – Journal of Physiotherapy

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[BLOG POST] Physical rehabilitation after stroke – Evidently Cochrane

Physical rehabilitation after stroke

In this blog for stroke survivors, their families and clinical staff, Mark Smith, Consultant Physiotherapist in Stroke Rehabilitation, looks at Cochrane evidence on physical rehabilitation approaches for the recovery of function and mobility following stroke and explores the importance of the findings with respect to service delivery in an ever changing landscape of health and social care.

Stroke is often termed a “recovering neurological condition”, but how much recovery can we expect in response to what sorts of intervention and in what doses? Strokes happen as a result of a disturbance of the blood supply to the brain, mostly in older people and mostly due to the blocking of arteries supplying oxygenated blood to the brain. But less commonly, strokes can affect younger people (and children) and may also be the result of a burst blood vessel causing a haematoma (collection of blood) within the brain mass.

Acting FAST

The stroke “pathway” extends from the initial hyper-acute episode, usually the first minutes and hours post onset of symptoms in the community setting, emphasising that “time is brain” through the “FAST” (Face, Arm, Speech, Time to call 999) campaign supported by the main UK stroke charities, Stroke Association and Chest, Heart & Stroke Scotland. The aim is to deliver patients with a suspected stroke to appropriately specialist hospital/stroke unit care as soon as possible in order to receive life saving and disability reducing hyper-acute interventions such as thrombolysis (using clot-busting drugs) and more recently thrombectomy (breaking and removing the clot with tools) in patients who meet the necessary criteria.

ambulance emergency

This hyper-acute stage of the pathway is highly evidence-based, medicalised and thoroughly audited across the UK by the two main stroke audits – Sentinel Stroke National Audit Programme (SNNAP) in England and Wales, and the Scottish Stroke Care Audit (SSCA) in Scotland, with a view to time critical delivery to all eligible patients. However, the subsequent audit around rehabilitation interventions can be less thorough despite a growing body of evidence to support physical interventions.

Ongoing physical rehabilitation: what should we do?

Most patients with stroke will need some kind of ongoing physical rehabilitation to assist them in achieving best outcomes possible (with respect to the severity of the stroke but also with respect to the resource available) and we are increasingly becoming aware that there are some critical elements in achieving that. But can we, and do we, deliver what patients should receive in our publicly funded UK health and social care system and is the evidence sufficiently persuasive to argue strongly for this? How do we ensure that a health condition such as stroke which spans a pathway from the community through hyper-acute medical hospital care, possibly downstream in-patient rehabilitation and back to the community via health and social care is fit for purpose? And how do we remove the diagnostic stroke “badge” and simply allow an individual to function again in society with the support they need to manage their long term condition?

Perhaps there is a persuasive argument for delivering evidence-based stroke rehabilitation with appropriate levels of quality and intensity as it is considered a human right in many societies?

The evidence for physical rehabilitation after stroke

Evidence for physical interventions relating to walking and physical rehabilitation after stroke is becoming increasingly available in the form of high quality systematic reviews that can inform clinical guidelines as well as high level government strategy with respect to stroke. We tend to find it mostly relating to physical therapy and exercise/fitness interventions.

Updating Cochrane evidence: a novel approach

Pollock et al (2014a) revisited an older Cochrane Review (Pollock et al 2009). Previous versions of the review had focussed on physiotherapy interventions for the lower limb and walking after stroke but they decided to use a novel approach in the reappraisal of the literature and update of the evidence. The review was subsequently re-titled Physical Rehabilitation Approaches for the Recovery of Function, Balance and Walking following Stroke. The academic elements of reviewing papers followed the usual Cochrane protocol.

Seeking “real world” views on the evidence

In order to gauge the relevance of the evidence for clinical practice, but also critically for stroke survivors and carers, in parallel with revisiting the evidence through systematic review,co Pollock and colleagues also convened a multi key stakeholder short life working group comprised of stroke survivors, carers and clinical staff. This group was charged with sense-checking and “validating” the evidence as being clinically relevant as it emerged, using formal group consensus methods based on nominal group techniques. This involved a system of voting which focussed the group in reaching consensus. The academic researchers involved in the systematic review attended the working group meetings and presented the various options in directing the review, but did not vote themselves so as to minimise bias. This arm of the project culminated in a presentation at the 2014 Cochrane UK and Ireland Symposium, held in Manchester, in which key stakeholders in the review led a workshop on user-involvement in writing Cochrane Reviews. The dual aims of this work were to determine if physical treatment approaches are effective in the recovery of function and mobility in patients with stroke and to see whether any one physical treatment approach is more effective than any other approach.

The presentation of the updated evidence as a result

Ninety six studies, involving 10,401 stroke were included in the review (Pollock et al 2014a). Results of 27 studies (3243 stroke survivors) could be combined comparing physical rehabilitation with no treatment at all. Twenty five of these studies were carried out in China and were unusual in that they compared an active treatment/intervention group to a control group with no clinical intervention. Additional physical rehabilitation versus usual care was described in 12 of these studies demonstrating improved motor function (887 stroke survivors), standing balance (five studies, 246 stroke survivors) and walking speed (14 studies, 1126 stroke survivors). There was also limited evidence of dose intensity for the first time, with treatment durations given between 30 and 60 minutes per day apparently carrying the most significant benefits, but future research needs to verify this.

Key messages:

  • Physiotherapy, using a mix of components from different approaches, is effective for the recovery of function and mobility after stroke. Treatment sessions of 30-60 minutes, 5-7 days a week may provide a significant beneficial effect.
  • No one approach to physical treatment is any more (or less) effective in promoting recovery of function and mobility after stroke.

Physiotherapists should use their expert clinical reasoning to select individualised, patient-centred, evidence-based physical treatment, with consideration of all available treatment components, and should not limit their practice to a single “named” approach.

physical rehabilitation

Fitness training after stroke

This work is supported by another recently updated Cochrane Review around Fitness Training for Stroke Survivors (Saunders et al 2016) which included 58 trials involving 2797 participants with stroke. These studies were grouped according to the type of fitness training intervention – cardiorespiratory (28 trials, 1408 participants) resistance (13 trials, 432 participants) and mixed training (17 trials, 4342 participants).

Key messages:

  • Cardiovascular fitness training, particularly involving walking, can improve exercise ability and walking after stroke.
  • Mixed training improves walking ability and improves balance.
  • Unable to draw reliable conclusions regarding effects on quality of life, mood or cognitive function.
  • No evidence of injury or other health problems and exercise appears to be a safe intervention.

Circuit Class Therapy

English et al (2017) included 17 trials involving 1297 stroke survivors (most of whom could walk 10 metres) in another recent Cochrane Rcoeview to examine the effectiveness and safety of Circuit Class Therapy (CCT) on mobility in adults with stroke. Ten studies (835 participants) measured walking capacity, demonstrating that CCT was superior to the comparison intervention, eight measured gait speed again finding that CCT was of significant benefit. Their conclusion was that there was moderate evidence to suggest that CCT is effective in improving mobility for people after stroke. These effects may be greater later after the stroke and stroke survivors may be able to walk further, faster, with more independence and confidence in their balance, but further high quality research is required.

Other relevant reviews

There have also been Cochrane Reviews providing low to moderate quality evidence of the rehabilitation benefits of electro mechanically or robotic assisted gait training devices (Mehrholz et al 2017a), treadmill training for stroke patients who could already walk (Mehrholz et al 2017b) and repetitive task training (French et al 2016). A Cochrane overview (a review of systematic reviews) presenting moderate quality evidence for upper limb rehabilitation after stroke, suggested beneficial effects of constraint-induced movement therapy (CIMT), mental practice, mirror therapy, interventions for sensory impairment, virtual reality and a relatively high dose of repetitive task practice (Pollock et a. 2014b). Again, information was insufficient to reveal the relative effectiveness of different interventions.

So what…

Well, the research evidence, albeit largely of moderate quality, points to the efficacy of a broad range of interventions in the physical rehabilitation of people with stroke, with little detail about which specific interventions are of most value in which settings, and indeed the best delivery mechanisms to make them most easily and effectively implemented. More research is needed to generate higher quality evidence and implementation guidance. Recommendations in stroke guidelines (RCP 2016) and stroke strategies (Scottish Government 2014) have been made on the basis of these findings, particularly with respect to adequate dose. However, given that studies are disparate, have been derived from around the world and as a result conducted within a great variety of different healthcare (and social care/leisure) settings, it is challenging for clinicians to know exactly how to implement the reported findings.

The work of Pollock et al (2014) in engaging multi key stakeholders in making more “real” the findings of their systematic review made an effort to think about how we might implement the evidence, particularly in relation to the views of stroke survivors, carers and therapists. Perhaps we need to be less defensive of historical professional and service silo boundaries and use this evidence in the best interests of the stroke survivors we aim to serve, though imaginative use of commissioning mechanisms, third sector organisations, the leisure industry, healthcare staff resources and the capacity we have to deliver stroke rehabilitation interventions?

The World Health Organisation (WHO) has recently argued that the benefits of rehabilitation are realised beyond the health sector and that delivered appropriately can reduce care costs and enable participation in education and gainful employment (WHO 2017). With respect to the stroke pathway, if we are serious about saving lives at the “front door”, let’s also make them worth living at the “back door” and beyond.

Join in the conversation on Twitter with @CochraneUK #LifeAfterStroke or leave a comment on the blog.

References may be found here.

Mark Smith is a Trustee of the Stroke Association.

 

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[Abstract] Systematic review of high-level mobility training in people with a neurological impairment.

Abstract

AIM:

The objective of this paper was to systematically review the efficacy of interventions targeting high-level mobility skills in people with a neurological impairment.

METHODS:

A comprehensive electronic database search was conducted. Study designs were graded using the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) system and methodological quality was described using the Physiotherapy Evidence Database (PEDro) scale.

RESULTS:

Twelve exploratory studies (AACPDM levels IV/V), of limited methodological quality (PEDro scores of 2-3 out of 10), were included. Interventions included treadmill training, a three-phase programme, a high-level mobility group, plyometric training, running technique coaching and walk training with blood flow restriction. Diagnoses included acquired brain injury, cerebral palsy, incomplete spinal cord injury and neurofibromatosis type 1. There were difficulties generalizing results from exploratory designs with a broad range of participants, interventions and outcome measures. However, it seems that people with a neurological impairment have the capacity to improve high-level mobility skills, running speed and distance with intervention. There were no adverse events that limited participation.

CONCLUSION:

There is preliminary evidence to support the efficacy of interventions to improve high-level mobility skills in people with neurological impairments. Well-controlled research with a larger sample is required to provide sufficient evidence to change clinical practice.

 

via Systematic review of high-level mobility training in people with a neurological impairment. – PubMed – NCBI

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[Article in Press] Home exercise programs made effortless using the PhysioTherapy eXercises patient app – Full Text

PhysioTherapy eXercises website: www.physiotherapyexercises.com

PhysioTherapy eXercises is a publicly available website, created by Harvey, Messenger, Glinsky, Pattie and a collaboration of physiotherapists. It was designed as a resource for creating and distributing home exercise programs. The website has a database of images, videos and instructions for over 1000 exercises focusing on impairments (strength, balance, range of motion, and cardiovascular fitness), and activities (reaching and manipulation, sit to stand, transfers, and mobility), and is available in 13 different languages. The exercises are evidence-based and include exercises for children through to the elderly, as well as exercises targeting specific populations, such as acute and degenerative neurological conditions, and musculoskeletal conditions, including whiplash and hand injuries. The Physiotherapy Exercises App is one feature of this web-based software and is the focus of this review.

The Physiotherapy Exercises App is free and can be used on both Apple and Android tablets and phones. The app is designed for patients to use, and allows them to access their prescribed home exercise program on their devices, record their progress online, and share this information remotely with their therapist. A recent randomised, controlled trial reported that using the Physiotherapy Exercises App increased adherence to home exercise programs when compared with paper-based methods.1

The therapist designs a home exercise program by selecting relevant exercises from the database and scheduling the frequency and duration of the exercises using the PhysioTherapy eXercises website. The patient then accesses and installs the Physiotherapy Exercises App via a link embedded in an email or smart phone text message that is sent from the website. Once the app is installed, patients have direct access to their home exercise program. The app allows patients to view their program, record completion of each exercise, and provide feedback to the therapist via a ‘notes’ function. The therapist has the ability to remotely monitor the patient’s exercise adherence, review notes recorded by the patient, and adjust the program as required by logging onto the website. Therapists can also receive a notification via an email when a patient’s adherence has decreased below a set threshold, which can be adjusted by the therapist for each patient.

Ease of use

Overall, the design of the Physiotherapy Exercises App is straightforward and the basic features are easy to use. My experience suggests that patients who already use the Internet and/or mobile devices are willing to use the Physiotherapy Exercises App, and use it successfully. Patients with limited technology experience are able to use the app successfully if provided with assistance to download the app and are given a demonstration of how to use it. Once the app has been downloaded, patients have two options: view the exercises that are to be completed on that day via the home screen (Figure 1A); or touch the screen to access the illustration, aims, instructions and dosage for each exercise (Figure 1B). Similarly, recording of the completed exercises can be done by ticking the ‘done all’ box on the home screen or ticking a box on each screen for an individual exercise. Patients can record completing an exercise even if it is not scheduled for a particular day. Notes can be added on each screen that details an individual exercise.

Figure 1

Enter a caption

From the perspective of therapist use, the home exercise program is prescribed and monitored by logging directly onto the website. The website has an extensive help section to assist the therapist if required.

Strengths and limitations

The Physiotherapy Exercises App is very well designed for clinical use. One of the key strengths is that patients can only access their home exercise program once it has been prescribed to them by a therapist, which ensures that patients complete exercises appropriate for their rehabilitation. Another valuable feature is that once the Physiotherapy Exercises App has been downloaded, there is no requirement for the patient to login or remember passwords. Other strengths are that the interface is easy to understand, and patients receive detailed information about each exercise, including the aims of the exercise, illustrations, instructions on how to complete the exercise, dosage, precautions, and progressions. Furthermore, therapists have the ability to select what information the patient views on the app and/or modify the instructions and information if required. When the home exercise program is updated online, all changes occur in real time.

Limitations of the Physiotherapy Exercises App are that few patients use all the features of the app, for example the notes function. My experience using the app with people who have Parkinson’s disease is that most people primarily use the app to view and record completion of their home exercise programs. Further encouragement by the therapist is necessary to ensure regular use of the notes function, if desired. At present, patients do not receive an alert via the Physiotherapy Exercises App that their program has been updated; it simply changes on the home screen. Consequently, if the program is updated independently of a consultation, an additional form of communication may be required to inform the patient of changes made.

Conclusion

Overall, the Physiotherapy Exercises App is an excellent and easy to use clinical resource. Increasing the use of devices to provide home exercise programs directly to patients is highly desirable and resource-efficient. It gives patients access to their home exercise program at all times, facilitates self-management, and, importantly, increases communication between the patient and therapist. The advantages of the Physiotherapy Exercises Appare that it is freely available, has an extensive range of exercises covering both musculoskeletal and neurological conditions, and is easy to use for both therapist and patient. Combined with the ability to remotely monitor patients’ adherence to the home exercise program, the Physiotherapy Exercises App has been a valuable addition to my clinical practice and role as a clinical educator.

Reference

  1. Lambert, T. et al. J Physiother201763161–167

View in Article   Abstract   Full Text   Full Text PDF   PubMed   Scopus (1)  Google Scholar

 

via Home exercise programs made effortless using the PhysioTherapy eXercises patient app – Journal of Physiotherapy

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[REVIEW] Development of Upper Limb Assistive Robotic Devices for Arm Functionality Rehabilitation- Full Text PDF

ABSTRACT

Use of assistive robotic devices and exoskeletons help to achieve the main purpose of
rehabilitation and increased functionality in medical sector. In order to treat patients after stroke or with a condition of myasthenia, physiotherapy is needed for rehabilitating the weakened set of muscles. The exoskeleton devices not only treat the patient well but also help them to relearn the basic movements of the affected limb. They help strengthen the weak part/limb of a person withcondition of partial paralysis / myasthenia with the help of assistive exoskeleton rehabilitation device via training sessions to improve daily primary activities.

I. Introduction

In our country, every year there are almost a million people affected with paralysis and
myasthenia. According to social security disability (S.S.D.) myasthenia is a disability and there is no cure. But it can be treated with medication, physiotherapy and sometimes surgery. To avoid the surgery stage, in this condition the affected patient needs to take specific treatment to give considerable strength to the affected limb. Myasthenia is the state in which abnormal weakening of muscles takes place. It is caused due to severe strokes & accidental nerve damage. In most of the cases severe strokes & nerve damage leads to weakening of arm muscles & it becomes necessary to get expensive physiotherapies in rehabilitation centers or hospitals. Here a particular device that is perfectly designed to impart confidence in the patient to exercise by themselves and
work efficiently to strengthen the muscles of affected limb is beneficial, under the guidance of a physiotherapist. In this paper, we will discuss different devices/exoskeleton which are used for rehabilitation of weak muscles to find the most effective device and ways by which they achieve their objective of strengthening the weakened part or a limb and regain its functionality.

Full Text PDF

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[WEB SITE] How virtual reality is changing physiotherapy for the better

VR, disabilities
Several hospitals in the UAE have shown interest in adopting these technology-based therapies that can have significant impact on people with disabilities.

Virtual reality and 3D-based video games are fast becoming popular alternatives to physiotherapy.

Physiotherapists and clinicians are now working closely with computer experts to design computer games that would promote specific body movements – notably shoulder, elbow, knee and hip movements – needed in therapy. With proper instructions from therapists, the game developers also set instructions and create personalised exercise plans for patients, keeping in mind the movements and difficulty faced by specific patient.

Dr. Imad Afyouni, Assistant Professor in Computer Science at the University of Sharjah, introduced the interesting facts about the cutting-edge technology to the audience as he delivered a lecture on game-based physiotherapy solutions at the Sharjah Centre for Astronomy and Space Sciences as part of the UAE Innovation Month in Sharjah.

“It is catching fast because it is non-invasive, home-based, highly accurate, and laced with intelligent alerting and automatic correction system. Several hospitals in the UAE have shown interest in adopting these technology-based therapies that can have significant impact on people with disabilities, people injured badly due to accidents as well as people with special needs in our society,” he said.

Usually patients go to rehabilitation centres or physiotherapy centres for conventional treatments like occupational therapies to make muscles and bones getting right positions. Now there are much more effective treatments available, which have been developed jointly by experts in computer science and physiotherapy.

“In many cases, patients are suggested to exercise at home after a few sessions at the therapy centre. But, people get bored by the repetitive exercises. Sometimes, it fails to show the desired results because it is not practiced under the supervision of a qualified therapist. Now we are making these therapies work effectively without invasive censors on the body,” he said.

“We develop games to engage them in virtual environment, so that they do the required exercise while playing games. It’s fun way to achieve a task that can be painful and boring if practiced in conventional manner,” he added.

The Sharjah Innovation Week is being celebrated from February 15th-21st as part of the UAE Innovation Month at Al Majaz Waterfront and the Sharjah Centre for Astronomy and Space Sciences.

 

via How virtual reality is changing physiotherapy for the better

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[Abstract] A smart brace to support spasticity management in post-stroke rehabilitation – Master Thesis

Abstract

This report covers the design of a product to help stroke survivors who are suffering from chronic spasticity manage their everyday activities. In the Netherlands alone, 44.000 people suffer from a Cerebro-Vascular Accident (CVA) each year. A CVA, more commonly known as a stroke, results in brain trauma with afflictions such as paralysis, fatigue and spasticity. It is possible to recover some, if not all, motor function though intensive physiotherapy, which requires long-term stay at a rehabilitation clinic in severe cases. Due to limited room and staff, only 12% of stroke survivors end up rehabilitating in a clinic. The remaining survivors are sent home, and will to travel to the clinic 3-5 times per week for therapy as part of the outpatient rehabilitation. Adjuvo Motion, a young start-up, aims to improve the situation of stroke survivors by bringing the rehabilitation centre to their home through the Adjuvo Platform, which allows them to perform exercises in the context of virtual tasks. They proposed an assignment to extend their product portfolio with a Range of Motion assessment device that is suited for those suffering from spasticity. Spasticity occurs in roughly 60% of stroke survivors with varying degrees of intensity. It is caused by the damaged parts of the brain sending conflicting signals to the muscles, causing them to contract. This inhibits the survivor’s ability to perform daily tasks, but can be solved temporarily with stretching exercises. A solution to compensate for these spastic forces using a passive-assist device was proposed at the start of this project. The project was divided into four stages: Analysis, Synthesis, Embodiment and Evaluation. During the Analysis stage, interviews with a Physiotherapist and stroke survivor and literature studies regarding anatomy, the state of the art and relevant technologies were used to create a framework for the design of a smart passive-assist glove. Looking at competing products, there is a demand for passive assist and Range of Motion assessment functionalities, yet a combination of these in a single device is not yet present in the market. During the Synthesis stage, the design problem of the passive assist device was split into three groups: Orthoses; the connections to the body, Passive Assist; the compensation medium, and RoM measurement; the sensing mechanism(s). These three groups were further split into sub-problems, the solutions to which were compiled into a Morphological Chart. By combining the solution within this chart, three promising concept designs were created: One upgrade to the existing sensor glove, one full integration of sensing and passive assist, and one passive assist glove with removeable sensors. To evaluate these concepts, eight criteria were established and weighted with the help of a physiotherapist. In order to create an objective assessment, the criteria were kept strictly quantitative and the three designs were first scored against the Raphael Smart Glove by Neofect using early prototypes. These scores were then used to evaluate the designs relative to each other, which resulted in an overall higher score for the concept with separable electronics. Making the sensor part of the brace removeable allowed the product to be used during daily life as well as physiotherpy exercises, and proved a key benefit in keeping the product clean. Based on the chosen design, four iterations of prototypes were made, which were tested with healthy subject. During this stage, it became clear that flex sensors are be best suited to create a range of motion assessment for spastic stroke patients, since it is less important to know how well they perform a task, and more important to know if they can actually perfrom it. Based on a quantified use case, the four sub-assemblies; the Wrist Wrap, Finger Modules and Sensor Module, and their connections were materialized in the Embodiment design stage. When selecting production methods, the main challenge was a small batch size of 1000 units, which made conventional techniques for mass production, such as Injection Molding, less attractive. This stage ended in an assesment of the product’s production price and durability: The product would cost €250 to make, and would last for 2.5 years before the Velcro connection on the Wrist Wrap would become too weak to sustain the spasticity forces. In the Evaluation stage, the product was evaluated on the seven most important requirements established during the analysis stage. For several of these, a user test was performed, again with healthy subject. While the Adjuvo Auxilius passed most theoretical requirements, the user tests on healthy subjects could not be used to draw any conclusions regarding its effectiveness on spastic stroke patients. However, since the product’s working principle is based on that of existing spasticity compensation products, the prediction is that the Auxilius will be an effective therapy supplement. The result of this project is the Adjuvo Auxilius; a spasticity-compensation glove with modular sensors, which can be added to allow virtual (stretching) exercises through the Adjuvo Motion’s platform. The results of these exercises are used to create a remote assessment of the patients motor skills, and to adjust the therapy if needed.

via A smart brace to support spasticity management in post-stroke rehabilitation | TU Delft Repositories

 

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[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.

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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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