Posts Tagged range of motion.

[ARTICLE] The Use of Functional Electrical Stimulation on the Upper Limb and Interscapular Muscles of Patients with Stroke for the Improvement of Reaching Movements: A Feasibility Study

Introduction: Reaching movements in stroke patients are characterized by decreased amplitudes at the shoulder and elbow joints and greater displacements of the trunk, compared to healthy subjects. The importance of an appropriate and specific contraction of the interscapular and upper limb (UL) muscles is crucial to achieving proper reaching movements. Functional electrical stimulation (FES) is used to activate the paretic muscles using short-duration electrical pulses.

Objective: To evaluate whether the application of FES in the UL and interscapular muscles of stroke patients with motor impairments of the UL modifies patients’ reaching patterns, measured using instrumental movement analysis systems.

Design: A cross-sectional study was carried out.

Setting: The VICON Motion System® was used to conduct motion analysis.

Participants: Twenty-one patients with chronic stroke.

Intervention: The Compex® electric stimulator was used to provide muscle stimulation during two conditions: a placebo condition and a FES condition.

Main outcome measures: We analyzed the joint kinematics (trunk, shoulder, and elbow) from the starting position until the affected hand reached the glass.

Results: Participants receiving FES carried out the movement with less trunk flexion, while shoulder flexion elbow extension was increased, compared to placebo conditions.

Conclusion: The application of FES to the UL and interscapular muscles of stroke patients with motor impairment of the UL has improved reaching movements.


Reaching movements in stroke patients are characterized by decreased amplitudes at the shoulder and elbow joints compared to healthy subjects (16). The movement pattern of patients with stroke is highly related to their level of motor function impairment, which becomes modified due to the lack of inter-articular coordination (1). There is a decrease in the range of motion at the elbow joint with a tendency toward flexion, which avoids correct extension of the upper limb (UL), hampering the ability to perform appropriate reaching movements. Excessive shoulder abduction is also observed as a compensatory movement when there is a lack of appropriate shoulder flexion (7).

In the case of the trunk, greater trunk displacements have been observed in patients with stroke, forward displacements, and torsion movements, which are related to deficits in elbow extension, and shoulder flexion and adduction, as compensatory mechanisms that occur during reaching movements or other activity. Patients are able to develop new motor strategies to achieve their goal despite UL deficits (17). There is a greater involvement of the trunk and scapula during the execution of reaching movements due to the creation of new movement strategies to compensate for the deficiencies (8).

The scientific literature has shown that stroke patients need to create new movement strategies. This involves the development of pathological synergies to carry out the desired movements. An example of this is the excessive movements of the trunk and scapula to compensate the deficiencies resulting from the pathology (7). Proper activation of the interscapular muscles depends on the position of the trunk. Stroke patients, due to the deficits affecting their trunk and scapular movement patterns, are under unfavorable conditions for being able to perform appropriate and selective activation of these muscles, which has a negative impact on the movement of the UL (911).

Regarding the UL muscles involved in reaching movements, a deficit in muscle control and activation has been observed (51213). The synergistic contraction of the shoulder flexor and extensor muscles during reach becomes deteriorated due to muscle weakness and; therefore, the resulting movement is deficient (14). Furthermore, spastic muscle patterns may also prevent the correct performance of UL movements (1518).

Functional electrical stimulation (FES) is a form of treatment that seeks to activate the paretic muscles using short-duration electrical pulses applied via surface electrodes through the skin (19). The use of FES and neuroprostheses has spanned almost four decades (2021). The use of FES as a neuroprosthesis consists of self-treatment at home by means of a neuroprosthetic neuromuscular stimulation system. The objective of this modality is to assist the performance of an activity of daily living (ADL) (22). Recently, functional and clinical improvements have been reported with the therapeutic application of FES, in which stimulation was used to increase voluntary movement after stroke (2223). Therapeutic FES modalities have been used to recruit UL muscles, improving weakness, the dyscoordination of single and multiple joints movements, and spasticity (24).

Most studies employing therapeutic FES for paretic UL rehabilitation are based on stimulation of the shoulder, elbow, and wrist muscles without recruitment of the interscapular muscles (2528). The importance of an appropriate and specific contraction of the interscapular musculature during UL movement is necessary to adapt the position of the scapulothoracic joint to the degree of movement of the glenohumeral joint. This musculature has a stabilizing function upon the entire glenohumeral complex, which is necessary for a correct reaching movement (2931). In healthy subjects, the posture of the trunk has been shown to influence changes in scapular movement and interscapular muscle activity during UL elevation (2932). The motor control of shoulder movement influences the correct and proper activation and synchronization of these muscles (33).

In this study, we tested the ability of a FES system to assist the UL movement of stroke patients based on the stimulation of interscapular, shoulder, elbow, wrist, and finger muscles. To our knowledge, no empirical study to date directly addresses this question. The authors hypothesized that participants receiving FES to the UL and interscapular muscles would be able to perform the movement with less trunk anteroposterior tilt and major shoulder flexion and elbow extension. The aim of this feasibility study was to evaluate whether the application of FES to the UL and interscapular muscles of stroke patients with UL motor impairment would be able to modify their reaching patterns, measured using instrumental movement analysis systems.[…]

Continue —> Frontiers | The Use of Functional Electrical Stimulation on the Upper Limb and Interscapular Muscles of Patients with Stroke for the Improvement of Reaching Movements: A Feasibility Study | Neurology

Figure 1. Patient with the functional electrical stimulation device.

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[WEB SIDE] WalkAide & Foot Drop –

WalkAide & Foot Drop

​​​​WalkAide: Helping​​ You Get a Leg Up on Foot Drop

WalkAide is a class II, FDA cleared medical device, designed to improve walking ability in people experiencing foot drop caused by upper motor neuron injuries or conditions such as:

  • Multiple Sc​​lerosis (MS)​
  • Stroke (CVA)
  • Cerebral Palsy (CP)
  • Incomplete Spinal Cord Injury
  • Traumatic Brain Injury (TBI)​​

​Foot Drop or Dropped Foot is a condition caused by weakness or paralysis of the muscles involved in lifting the front part of the foot, which causes a person to drag the toe of the shoe on the ground or slap the foot on the floor.

Foot drop (also known as drop foot) may result from damage to the central nervous system such as stroke, spinal cord injury, traumatic brain injury, cerebral palsy and multiple sclerosis. The WalkAide is designed to assist with the ability to lift the foot for those individuals who have suffered an injury to their central nervous system. The WalkAide is not designed to work with people who have damage to the lower motor neurons/peripheral nerves.​

WalkAide vs. AFO​

Traditionally, foot drop is treated with bracing using an ankle foot orthosis (AFO). The passive treatement offered by AFOs do not promote active use of neuromuscular systems and also limits ankle range of motion. In addition, AFOs can be uncomfortable, bulky, and, if poorly fitted, produce areas of pressure and tissue breakdown. The WalkAide may replace the traditional AFO to re-engage a person’s existing nerve pathways and muscles. Using the WalkAide, in most cases, frees the patient from AFO restrictions. 

The recruitment of existing muscles results in reduction of atrophy and walking fatigue – a common side effect of foot bracing. WalkAide users have the freedom to walk with or without footwear, up and down the stairs, and even sidestep.

Comparison of Benefits of Functional Electrical
Stimulation (FES) and Ankle Foot Orthosis (AFO) for Foot Drop​

AFO = ankle foot orthosis • FES = functional electrical stimulation • ROM = range of motion

Advanced Technology; Easy to Use

​​​Invented by a team of researchers at the University of Alberta, WalkAide uses functional electrical stimulation (FES) to restore typical nerve-to-muscle signals in the leg and foot, effectively lifting the foot at the appropriate time. The resulting movement is a smoother, more natural and safer stepping motion. It may allow faster walking for longer distances with less fatigue. In fact, many people who try WalkAide experience immediate and substantial improvement in their walking ability, which increases their mobility, functionality, and overall independence.

​A sophisticated medical device, WalkAide uses advanced tilt sensor technology to analyze the movement of your leg. This tilt sensor adjust the timing of stimulation for every step. The system sends electrical signals or stimulation to the peroneal nerve, which controls movement in your ankle and foot. These gentle electrical impulses activate the muscles to raise your foot at the appropriate time during the step cycle.

​Although highly-advanced, WalkAide is surprisingly small and easy to use. It consists of a AA battery-operated, single-channel electrical stimulator, two electrodes, and electrode leads. WalkAide is applied directly to the leg — not implanted underneath the skin — which means no surgery is involved. A cuff holds the system comfortably in place, and it can be worn discreetly under most clothing. With the WalkAide’s patented Tilt Sensor technology, most users do not require additional external wiring or remote heel sensors.

​​WalkAide Provides the Advantages not Found in Typical Foot Drop Treamtents :

  • Easy one-handed operation and application
  • Small, self-contained unit
  • Does not require orthopedic or special shoes
  • May be worn barefoot or with slippers
  • Minimal contact means minimal discomfort with reduced perspiration
  • May improve circulation, reduce atrophy, improve voluntary control and increase joint range of motion

Customized For Individual Walking Pattern

​WalkAide is not a one size fits all device. Rather, a specially trained medical professional customizes and fits the WalkAide. Using WalkAnalyst, a multifaceted computer software program, the clinician can tailor WalkAide to an individual’s walking pattern for optimal effectiveness.

Exercise Mode for Home Use

​In addition fo walking assistance, the WalkAide system includes a pre-programmable exercise mode that allows a user to exercise his/her muscles while resting for a set period of time as prescribed.​

Visit Site —> WalkAide & Foot Drop –

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[ARTICLE] Development and validation of a novel questionnaire for self-determination of the range of motion of wrist and elbow – Full Text



The aim of this study was to develop and validate a novel self-administered questionnaire for assessing the patient’s own range of motion (ROM) of the wrist and the elbow.


In a prospective clinical study from January 2015 to June 2015, 101 consecutive patients were evaluated with a novel, self-administered, diagram-based, wrist motion assessment score (W-MAS) and elbow motion assessment score (E-MAS). The questionnaire was statistically evaluated for test-retest reliability, patient-physician agreement, comparison with healthy population, and influence of covariates (age, gender, affected side and involvement in workers’ compensation cases).


Assessment of patient-physician agreement demonstrated almost perfect agreement (k > 0.80) with regard to six out of eight items. There was substantial agreement with regard to two items: elbow extension (k = 0.76) and pronation (k = 0.75). The assessment of the test-retest reliability revealed at least substantial agreement (k = 0.70). The questionnaire revealed a high discriminative power when comparing the healthy population with the study group (p = 0.007 or lower for every item). Age, gender, affected side and involvement in workers’ compensation cases did not in general significantly influence the patient-physician agreement for the questionnaire.


The W-MAS and E-MAS are valid and reliable self-administered questionnaires that provide a high level of patient-physician agreement for the assessments of wrist and elbow ROM.

Level of evidence: Diagnostic study, Level II


Assessing the patient’s outcome and satisfaction is important in modern orthopedic practice [1, 2, 3]. Using questionnaires to evaluate patients with wrist and elbow disorders is widespread and has been shown to be valid and reproducible [4, 5, 6, 7, 8, 9]. Self-reported outcome measures allow outcomes to be assessed from the patient’s perspective and do not require time in clinic or medical staff for data collection.

Common self-administered questionnaires for the determination of hand- and upper limp specific results of the wrist (e.g. patient-rated wrist evaluation, PRWE [8]) and of the elbow (e.g. The American Shoulder and Elbow Surgeons-Elbow, ASES-E [1]) enable the patient to assess the functional impairment of the joint, but they do not formally assess the range of motion, and patients have to attend clinic for this to be measured [10]. Therefore important data regarding the ROM would be lost in patients who are unable or unwilling to come to the outpatient clinic at the regular follow-up or for clinical research.

To our knowledge no validated self-assessment questionnaire for the ROM of the wrist or the elbow exists, which compares the agreement of the patient’s outcome with the examination by a physician.

Therefore, the aim of the current study was to develop a self-administered, diagram-based wrist motion assessment score (W-MAS) and elbow motion assessment score (E-MAS) to enable the patients to assess their own ROM of the wrist and the elbow. We further evaluated validity and reliability of this novel questionnaire with respect to the accuracy of self-determination of the wrist and elbow ROM.

Continue —>  Development and validation of a novel questionnaire for self-determination of the range of motion of wrist and elbow | BMC Musculoskeletal Disorders | Full Text

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[WEB SITE] Sitroll Offers Older Adults Low Impact and Ease of Use for Strength Building and Range of Motion Exercises – Rehab Managment

Published on June 9, 2016

A Sitroll user demonstrates exercise by grasping both side handles and holding firmly. Both feet are placed on lower resistance bands, and the user then rolls forward and backward at a comfortable speed by pulling and pushing with the arms and legs.

A Sitroll user demonstrates exercise by grasping both side handles and holding firmly. Both feet are placed on lower resistance bands, and the user then rolls forward and backward at a comfortable speed by pulling and pushing with the arms and legs.

The new Sitroll multi-function strength trainer, available from New York-based Sitroll and Amazon, offers a variety of resistance training options that older adults can easily perform from a seated position. Sitroll’s exercises are directed at individuals unable to perform intense, strenuous forms of exercise but who need activity they can perform regularly by themselves or with assistance.

Designed for ease of use, Sitroll is built on wheels and rolls forward and backward smoothly on a track. The patented device is equipped with a series of upper and lower natural rubber tubing, hand gripping slides, and soft balls designed to provide non-strenuous resistance exercise movements.

Sitroll can be used by one or two participants simultaneously. The device’s resistance bands facilitate more than 30 different exercises, including flexion and extension routines, which make it useful for physical therapy and occupational therapy activities. Sitroll is engineered to have a compact design so it can be easily folded and stored when not in use.

A Sitroll user demonstrates optional exercises using resistance bands located on top of the device.

A Sitroll user demonstrates optional exercises using resistance bands located on top of the device.

Applications for the Sitroll include therapeutic activity after accident trauma, stroke, or surgery. It can also be used after any period of hospitalization when a period of remissive time in recovery is required to regain prior health. Populations for whom the Sitroll may be particularly effective include older adults and geriatric users, and individuals affected by high blood pressure, Parkinson’s disease, or diabetes. Those who are affected by arthritis, heart, and lung problems can also benefit from using the Sitroll.

Meyer Rotberg, DPT, Preferred Therapy of New Jersey LLC, describes Sitroll as the perfect home gym that requires minimal setup or supervision.

“Patients being discharged from the clinical setting can continue to progress at home with the use of the Sitroll,” Rotberg says.

Sitroll can also be a valuable asset to long-term care facilities, hospitals, adult day care, or assisted living facilities, according to Rotberg.

“Patients in nursing homes are often faced with many medical issue stemming from a lack of exercise,” Rotberg says. He points out that patients are often limited with the amount of therapy they may receive and frequently are provided maintenance programs with insufficient activity.

“Sitroll can be used in exciting ways to keep patients active by providing a full range of exercises,” Rotberg says.

[Source: Sitroll]

Source: Sitroll Offers Older Adults Low Impact and Ease of Use for Strength Building and Range of Motion Exercises – Rehab Managment

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[Abstract] Range of Motion Requirements for Upper-Limb Activities of Daily Living – AJOT

December 2015


OBJECTIVE. We quantified the range of motion (ROM) required for eight upper-extremity activities of daily living (ADLs) in healthy participants.

METHOD. Fifteen right-handed participants completed several bimanual and unilateral basic ADLs while joint kinematics were monitored using a motion capture system. Peak motions of the pelvis, trunk, shoulder, elbow, and wrist were quantified for each task.

RESULTS. To complete all activities tested, participants needed a minimum ROM of −65°/0°/105° for humeral plane angle (horizontal abduction–adduction), 0°–108° for humeral elevation, −55°/0°/79° for humeral rotation, 0°–121° for elbow flexion, −53°/0°/13° for forearm rotation, −40°/0°/38° for wrist flexion–extension, and −28°/0°/38° for wrist ulnar–radial deviation. Peak trunk ROM was 23° lean, 32° axial rotation, and 59° flexion–extension.

CONCLUSION. Full upper-limb kinematics were calculated for several ADLs. This methodology can be used in future studies as a basis for developing normative databases of upper-extremity motions and evaluating pathology in populations.

Source: Range of Motion Requirements for Upper-Limb Activities of Daily Living

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[ARTICLE] Effects of Electrical Stimulation in Spastic Muscles After Stroke Systematic Review and Meta-Analysis of Randomized Controlled Trials – Full Text PDF

Background and Purpose—Neuromuscular electric stimulation (NMES) has been used to reduce spasticity and improve range of motion in patients with stroke. However, contradictory results have been reported by clinical trials. A systematic review of randomized clinical trials was conducted to assess the effect of treatment with NMES with or without association to another therapy on spastic muscles after stroke compared with placebo or another intervention.

Methods—We searched the following electronic databases (from inception to February 2015): Medline (PubMed), EMBASE, Cochrane Central Register of Controlled Trials and Physiotherapy Evidence Database (PEDro). Two independent reviewers assessed the eligibility of studies based on predefined inclusion criteria (application of electric stimulation on the lower or upper extremities, regardless of NMES dosage, and comparison with a control group which was not exposed to electric stimulation), excluding studies with ❤ days of intervention. The primary outcome extracted was spasticity, assessed by the Modified Ashworth Scale, and the secondary outcome extracted was range of motion, assessed by Goniometer.

Results—Of the total of 5066 titles, 29 randomized clinical trials were included with 940 subjects. NMES provided reductions in spasticity (−0.30 [95% confidence interval, −0.58 to −0.03], n=14 randomized clinical trials) and increase in range of motion when compared with control group (2.87 [95% confidence interval, 1.18–4.56], n=13 randomized clinical trials) after stroke.

Conclusions—NMES combined with other intervention modalities can be considered as a treatment option that provides improvements in spasticity and range of motion in patients after stroke.

Full Text PDF

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[ARTICLE] New Generation Smartphone Models for Patient Rehabilitation Exercises – Full Text PDF


Patients with the frozen shoulder condition that limits their arm movement should seek rehabilitation assistance from a medical facility. The normal process is for the patients to travel from their home to a hospital or a medical center to see a physiotherapist. Such potentially cumbersome effort may reduce their motivation and determination to seek proper treatment. Our approach is to use a single smartphone with accelerometer, magnetic field, and gyroscope sensors to provide the necessary monitoring measurements to enable effective tele-rehabilitation. This work proposes a framework for such a system and has successful developed prototype based on the Android platform. Also, there are many different smartphones in the market. Therefore, we evaluated performance of three different smartphones, which are Samsung Google Nexus S, Samsung Galaxy Note 1, and Sony Xperia Z Ultra. According to the experimentation, we have shown that smartphones with the appropriate sensors are suitable for tele-rehabilitation. Also, a newer generation model would provide more precise measurements, as expected.

Continue —> Full Text PDF

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[VIDEO] Tyromotion – Blog


Pablo- Detailed Explanation of Force Control Index

In this video, we show you how to evaluate individual force control with the Pablo sensor handle. In order to achieve highly specific values for the force control index (FCI)…read more →

Diego- Bilateral Training with Items of Daily Living

TyroS software can be used when the patient is seated facing towards the screen or when he or she is turned the opposite way. The direction of view must be…read more →

Tymo- Standardized Foot Position

In this video we show an example how to conduct a standardized assessment with Tymo in standing position. We use the grid which is represented at the surface and we…read more →

Amadeo- Adjustments for wrist joint position

In this video you can see which different adjustments can be carried out to support and position the wrist joint at Amadeo. The adjustment of the Hand-Arm support for therapy…read more →

Pablo Multibelts- Application for Upper Extremity Movement Therapy

Pablo System includes different sizes of Multibelts, which enable you to fasten Pablo senor handle in different places on the upper or lower extremity or on the trunk. In this…read more →

Diego- The Idea of Intelligent Gravity Compensation

Intelligent gravity compensation (IGC) enables an „assisted-as-needed“ approach with Diego. IGC provides a smooth arm weight support through the entire range of motion. This unique feature enables even severely affected…read more →

Tymo- Strength mode application

In this video we show an example how to use Tymo for stance phase training in strength mode. This strength or force control mode can only be used in 1D…read more →

Amadeo- Dos and Don’ts for using fingerfixes and fingertips

In this video we show how to use fingertips and fingerfixes- the connection elements between the fingers and Amadeo – in an easy way. Before you use the fingertips and…read more →

Pablo Multiball- Range of Motion

In this video we show how you can use Pablo Multiball. If you want to increase the range of motion in the wrist joint, the execution of end of range…read more →

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[ARTICLE] Asymmetric Training Using Virtual Reality Reflection Equipment and the Enhancement of Upper Limb Function in Stroke Patients: A Randomized Controlled Trial


Asymmetric movements with both hands contributed to the improvement of spatially coupled motion. Thus, the aim of this study was to investigate the effects of an asymmetric training program using virtual reality reflection equipment on upper limb function in stroke patients.


Twenty-four stroke patients were randomly allocated to an experimental group (n = 12) or a control group (n = 12). Both groups participated in conventional physical therapy for 2×30 min/d, 5 d/wk, for 4 weeks. The experimental group also participated in an asymmetric training program using virtual reality reflection equipment, and the control group participated in a symmetric training program. Both asymmetric and symmetric programs were conducted for 30 min/d, 5 d/wk, for 4 weeks. To compare upper limb function before and after intervention, the Fugl–Meyer Assessment (FMA), the Box and Block Test (BBT), grip strength, range of motion (ROM), and spasticity were assessed.


Both groups showed significant increases in upper limb function, excepting spasticity, after intervention (P < .05, 1-way repeated-measures analysis of variance [ANOVA]). A significant group–time interaction was demonstrated only for shoulder/elbow/wrist items of FMA, BBT, grip strength, and ROM of wrist flexion, extension, and ulnar deviation (P < .05, 2-way repeated-measures ANOVA).


This study confirms that the asymmetric training program using virtual reality reflection equipment is an effective intervention method for improving upper limb function in stroke patients. We consider that an additional study based on a program using virtual reflection, which is more functional than performing simple tasks, and consisting of tasks relevant to the activities of daily living be conducted.

via Asymmetric Training Using Virtual Reality Reflection Equipment and the Enhancement of Upper Limb Function in Stroke Patients: A Randomized Controlled Trial.

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[WEB SITE] Man vs. Machine on ADVANCE for Occupational Therapy Practitioners

It may sound like a 10-year-old’s dream – working with robots – but for the therapists at the Burke Rehabilitation Center and Ohio State University’s Wexner Medical Center, it’s all in a day’s work.

The core research at Burke, located in White Plains, N.Y., is the physical rehabilitation of the neurological patient. “We’re purely a research institute, and that positions us to put a lot of effort into that,” explained Dylan Edwards, PT, PhD, director of the non-invasive brain stimulation and robotics lab at Burke. The lab is one of the few programs at Burke Medical Research Institute to use human subjects, and complements a large pre-clinical research program.

At the non-invasive brain stimulation and robotics lab, researchers use interactive motion technology robots designed by MIT engineers. There are two: the planar robot -which includes grasp and release – and the wrist robot.

Since 2009, Edwards has led an NIH trial that is funded through 2016. Because of the strict guidelines of clinical trials, participation is limited to first-time, ischemic stroke patients with right side weakness who do not have a history of seizures or a pacemaker.

Trial participants get 20 minutes of brain stimulation followed by 1 hour of upper-limb exercises while hooked up to the robots. They repeat the process three times per week for 12 weeks. Goals include improving their accuracy and upper-extremity range of motion.

The nature of repetition – over 1000 repetitive motions per session – forces their brains to re-wire the connections. Subjects must perform many repetitions of directed, voluntary movement, which they simply can’t do with a traditional therapist.

“These robots deliver more therapy,” said Edwards. “Robotic therapy of the upper limbs reduces impairment.”

Through the trial, researchers like Edwards are testing whether brain stimulation primes the brain prior to movement. Preliminary data, which he termed “promising so far,” showed that even a single stimulation session with robotic wrist practice can lead to improvement in motion.

According to Edwards, studies have shown that brain stimulation alone can be useful tool. Yet as an emerging therapy not yet approved by the FDA, patients must enroll in a clinical trial to reap the benefits. The devices, however, are already endorsed by the American Heart Association and approved overseas by the European equivalent of the FDA.

Researchers at Burke are still trying to understand the specifics of how brain stimulation combined with robotics improves function in stroke patients. They aim to better understand which patients respond best and why, refine therapy techniques to deliver more useful treatments, and give feedback to the robotics industry on what matters to physical therapists, so ultimately engineers can design better machines…

more–> Man vs. Machine on ADVANCE for Occupational Therapy Practitioners.

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