Posts Tagged Walk

[NEWS] Brain-controlled, non-invasive muscle stimulation allows chronic paraplegics to walk

Brain-controlled, non-invasive muscle stimulation allows chronic paraplegics to walk again and exhibit partial motor recovery

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IMAGE: THE NON-INVASIVE CLOSED-LOOP NEUROREHABILITATION PROTOCOL: I) EEG: ELECTROENCEPHALOGRAPHY, NON-INVASIVE BRAIN-RECORDING. II) BRAIN-MACHINE INTERFACE: REAL-TIME DECODING OF MOTOR INTENTIONS. III) THE LEFT OR RIGHT LEG MUSCLES ARE STIMULATED TO TRIGGER THE… view more 
CREDIT: WALK AGAIN PROJECT – ASSOCIAÇÃO ALBERTO SANTOS DUMONT PARA APOIO À PESQUISA

In another major clinical breakthrough of the Walk Again Project, a non-profit international consortium aimed at developing new neuro-rehabilitation protocols, technologies and therapies for spinal cord injury, two patients with paraplegia regained the ability to walk with minimal assistance, through the employment of a fully non-invasive brain-machine interface that does not require the use of any invasive spinal cord surgical procedure. The results of this study appeared on the May 1 issue of the journal Scientific Reports.

The two patients with paraplegia (AIS C) used their own brain activity to control the non-invasive delivery of electrical pulses to a total of 16 muscles (eight in each leg), allowing them to produce a more physiological walk than previously reported, requiring only a conventional walker and a body weight support system as assistive devices. Overall, the two patients were able to produce more than 4,500 steps using this new technology, which combines a non-invasive brain-machine interface, based on a 16-channel EEG, to control a multi-channel functional electrical stimulation system (FES), tailored to produce a much smoother gait pattern than the state of the art of this technique.

“What surprised us was that, in addition to allowing these patients to walk with little help, one of them displayed a clear motor improvement by practicing with this new approach. Patients required approximatively 25 sessions to master the training before they were able to walk using this apparatus,” said Solaiman Shokur one of the authors of the study.

The two patients that used this new rehabilitation approach had previously participated in the long-term neurorehabilitation study carried out using the Walk Again Project Neurorehabilitation (WANR) protocol. As reported in a recent publication from the same team (Shokur et al., PLoS One, Nov. 2018), all seven patients who participated in that protocol for a period of 28 months improved their clinical status, from complete paraplegia (AIS A or B, meaning no motor functions below the level of the injury, according to the ASIA classification) to partial paraplegia (AIS C, meaning partial recovery of sensory and motor function below the injury level). This significant neurological recovery included major clinical improvements in sensory discrimination (tactile, nociception, vibration, and pressure), voluntary motor control of abdomen and leg muscles, and important gains in autonomic control, such as bladder, bowel, and sexual functions.

“The last two studies published by the Walk Again Project clearly indicate that partial neurological and functional recovery can be induced in chronic spinal cord injury patients by combining multiple non-invasive technologies that are based around the concept of using a brain-machine interface to control different types of actuators, like virtual avatars, robotic walkers, or muscle stimulating devices, to allow the total involvement of patients in their own rehabilitation routine,” said Miguel Nicolelis, scientific director of the Walk Again Project and one of the authors of the study.

In a recent report by another group, one AIS C and two AIS D patients were able to walk thanks to the employment of an invasive method for spinal cord electrical stimulation, which required a spinal surgical procedure. In contrast, in the present study two AIS C patients – which originally were AIS A (see Supplemental Material below)- and a third AIS B subject, who recently achieved similar results, were able to regain a significant degree of autonomous walking without the need for such invasive treatments. Instead, these patients only received electrical stimulation patterns delivered to the skin surface of their legs, so that a total of eight muscles in each limb could be electrically stimulated in a physiologically accurate sequence. This was done in order to produce a smoother and more natural pattern of locomotion.

“Crucial for this implementation was the development of a closed-loop controller that allowed real-time correction of the patients’ walking pattern, taking into account muscle fatigue and external perturbations, in order to produce a predefined gait trajectory. Another major component of our approach was the use of a wearable haptic display to deliver tactile feedback to the patients´ forearms in order to provide them with a continuous source of proprioceptive feedback related to their walking,” said Solaiman Shokur.

To control the pattern of electrical muscle stimulation in each leg, these patients utilized an EEG-based brain-machine interface. In this setup, patients learned to alternate the generation of “stepping motor imagery” activity in their right and left motor cortices, in order to create alternated movements of their left and right legs.

According to the authors, the patients exhibited not only “less dependency on walking assistance, but also partial neurological recovery, with substantial rates of motor improvement in one of them.” The improvement in motor control in this last AIS C patient was 9 points in the lower extremity motor score (LEMS), which was comparable with that observed using invasive spinal cord stimulation.

Based on the results obtained over the past 5 years, the WAP now intends to combine all its neurorehabilitation tools into a single integrated, non-invasive platform to treat spinal cord injury patients. This platform will allow patients to begin training soon after the injury occurs. It will also allow the employment of a multi-dimensional integrated brain-machine interface capable of simultaneously controlling virtual and robotic actuators (like a lowerlimb exoskeleton), a multi-channel non-invasive electrical muscle stimulation system (like the FES used in the present study), and a novel non-invasive spinal cord stimulation approach. In this final configuration, this WAP platform will incorporate all these technologies together in order to maximize neurological and functional recovery in the shortest possible time, without the need of any invasive procedure.

According to Dr. Nicolelis, “there is no silver bullet to treat spinal cord injuries. More and more, it looks like we need to implement multiple techniques simultaneously to achieve the best neurorehabilitation results. In this context, it is also imperative to consider the occurrence of cortical plasticity as a major component in the planning of our rehabilitation approach.”

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The other authors of this paper are Aurelie Selfslagh, Debora S.F. Campos, Ana R. C. Donati, Sabrina Almeida, Seidi Y. Yamauti, Daniel B. Coelho and Mohamed Bouri. This project was developed through a collaboration between the Neurorehabilitation Laboratory of the Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), the headquarters of the Walk Again Project, the Biomechanics and Motor Control Laboratory at the Federal University of ABC (UFABC), and the Laboratory of Robotic System at the Swiss Institute of Technology of Lausanne (EPFL). It was funded by a grant from the Brazilian Financing Agency for Studies and Projects (FINEP) 01.12.0514.00, Ministry of Science, Technology, Innovation and Communications (MCTIC), to AASDAP.

Supplemental Material:

https://www.youtube.com/watch?v=AZbQeuJiSOI

Supporting Research Studies:

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0206464

https://www.nature.com/articles/s41598-019-43041-9

 

via Brain-controlled, non-invasive muscle stimulation allows chronic paraplegics to walk | EurekAlert! Science News

 

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[VIDEO] Watch a robotic exoskeleton help a stroke patient walk – YouTube

Although it’s a far cry from the exosuits of science fiction, researchers have developed a robotic exoskeleton that can help stroke victims regain use of their legs. Nine out of 10 stroke patients are afflicted with partial paralysis, leaving some with an abnormal gait. The exosuit works by pulling cords attached to a shoe insole, providing torque to the ankle and correcting the abnormal walking motion. With the suit providing assistance to their joints, the stroke victims are able to maintain their balance, and walk similarly to the way they had prior to their paralysis, the team reports today in Science Translational Medicine. The exosuit is an adaptation of a previous design developed for the Defense Advanced Research Projects Agency Warrior Web program, a Department of Defense plan to develop assistive exosuits for military applications. Although similar mechanical devices have been built in the past to assist in gait therapy, these were bulky and had to be kept tethered to a power source. This new suit is light enough that with a decent battery, it could be used to help patients walk over terrain as well, not just on a treadmill. The researchers say that although the technology needs long-term testing, it could start to decrease the time it takes for stroke patients to recover in the near future.

via Watch a robotic exoskeleton help a stroke patient walk | Science | AAAS

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[WEB SITE] Connecting Care for Stroke Patients – Rehab Managment

 

 

by Meri K. Slaugenhaupt, MPT, and Valerie Bucek, MA, CCC-SLP/L

According to the Centers for Disease Control and Prevention, someone in the United States has a stroke every 40 seconds. Someone dies from a stroke every 4 minutes. It is a leading cause of long-term disability. A stroke occurs when there is a disruption in blood flow to the brain. The most common kind of stroke, ischemic stroke, occurs when a clot or mass obstructs a blood vessel. A hemorrhagic stroke occurs when a weakened blood vessel ruptures.

This article follows the treatment of stroke survivor Greg Myers, who was finishing his workday when he suddenly became confused and had difficulty walking and talking. A co-worker called Emergency Medical Services, and Myers was transported to the nearest acute care primary stroke center for treatment. Myers had suffered a right cerebellar hemorrhage. His hospital course was complicated by the need for evacuation of the hematoma, post-occipital craniotomy, and wound dehiscence. After several days of acute medical care and monitoring, it was determined that Myers would benefit from intensive multidisciplinary rehabilitation services to address his residual physical deficits and cognitive needs. To begin his stroke rehabilitation journey, Myers chose HealthSouth Harmarville Rehabilitation Hospital (which will be known as Encompass Health Rehabilitation Hospital of Harmarville beginning January 1, 2019).

Evidence-Based Rehabilitation

Since 2002, HealthSouth Harmarville has been certified as a Joint Commission Disease-Specific Care Stroke Program. The team follows evidence-based Clinical Practice Guidelines (CPG) for treatment of individuals with stroke. By following these guidelines, the team has confidence that treatments are based upon the most current evidence-based research and philosophies.

Comprehensive rehabilitation services, such as those provided at HealthSouth Harmarville, are found to be one of the most effective ways to achieve functional recovery and independence after a stroke. Intensive rehabilitation services facilitates neuroplasticity and recovery of motor function. Neuroplasticity is the ability for the brain to “rewire” or adapt to new circumstances by reorganizing synaptic connections. By engaging in therapy that is challenging, repetitive, and task specific, motor pathways that have been disrupted by the stroke can be rewired and strengthened.

Reducing Complications of Stroke

One of the goals of the clinical practice guidelines is to reduce the complications of stroke. One of the most frequent complications following a stroke is difficulty swallowing, or dysphagia. Stroke survivors with dysphagia have an increased risk of pneumonia, dehydration, and malnutrition. Instrumental assessment in the form of a Modified Barium Swallow study (MBS) or Fiber-Optic Endoscopic Evaluation of Swallowing (FEES) determine an appropriate, safe diet and the course of treatment. Swallowing difficulty is treated by exercise, diet modification, and technology, such as neuromuscular electrical stimulation.

Early therapy intervention is also important to maximize motor recovery in our stroke patients. Deconditioning and non-use are a hurdle to restoring function, especially with the elderly stroke population. Physiological changes and complications as a result of prolonged bedrest can lead to additional loss of muscle mass, contractures, skin breakdown, and deep vein thrombosis, all of which further hinder the stroke-recovery process.

Technology and the Path to Walking

Being able to walk again is a common goal shared by most stroke survivors, and Myers was no exception. Studies show that stroke affects mobility in greater than half of stroke survivors. Those suffering from gait disturbances often have further difficulties with balance and cardiovascular endurance, and are subsequently more likely to fall. Therefore, improvements achieved with gait function frequently carry over to improvements in many other aspects of daily living.

In the past decade, technology has moved to the forefront of therapeutic intervention as an adjunct to conventional practice. This is true for all disciplines and ranges from Vital Stimulation in the treatment of dysphagia to robotics in the treatment of movement disorders.

Body weight-supported technology is one such area of technological advancement being utilized for gait training. Partial body weight (PBW)-supported devices are designed to use a harness and/or suspension system to assist with standing and safety during ambulation. When partial body weight devices are used over a treadmill, the therapist is able to change gait speed and work on gait quality under controlled, safe conditions. However, many PBW devices do not require use of a treadmill and can be used over the ground while providing similar training benefits to patients.

Automated technology incorporates the use of robotics, using attachments to the patient’s hip, knees, and ankles. These robotics guide the patient’s lower-extremity movement and promote normal movement throughout the entire gait cycle. Robotic body weight support is generally used with more involved patients who have significant difficulty with lower extremity movement. These devices allow the therapist to gradually decrease the support provided as gait improves.

Fall Protection and Balance

A clinical advantage that these technologies have over other conventional gait training is the reduced support required by the therapist. When asked about using a PBW support device, Tammy Whitlinger, a physical therapist assistant at HealthSouth Harmarville for 28 years, states, “I am able to safely initiate gait training earlier, and my patients are less anxious about the training because they know that they can’t fall.”

Balance deficits resulting from a stroke can also be very debilitating and frustrating for individuals. Since Myers had a stroke that affected the cerebellar part of his brain, balance training was also a major component of his therapy program. Myers’s balance program included a variety of approaches including altering visual feedback and multi-surface challenges. Equipment utilized for balance deficits can be as simple as carpet or foam. More complex devices are designed to use interactive technology and visual feedback to further analyze a patient’s posture and balance deficits.

Treadmills are another piece of technology commonly found in the clinic that are used to improve motor recovery after stroke. Treadmill training can be used with or without partial body weight support. When used along with conventional therapy, treadmill training has been shown to improve gait quality and efficiency, strength, and cardiovascular fitness. Other adjunct modalities are also utilized by physical therapists to address aerobic fitness and reciprocal movements of the lower extremities, such as stepper machines, elliptical trainers, and stationary/recumbent bikes.

Upper Extremity Dysfunction

Advanced technology used for the treatment of upper extremity dysfunction has also impacted stroke rehabilitation. Improving deficits in fine motor control, coordination, and weakness are often a focus of treatment in stroke recovery. Electrical stimulation, biofeedback, or robotics are utilized in many technologies to retrain arm movements and hand function. Some of these devices are even coupled with gaming to provide motivation and entertainment for the patient while exercising.

Family/caregiver involvement early on is very beneficial to a successful inpatient rehabilitation stay and transition to home. Our Clinical Practice Guidelines recommend that patients and caregivers be educated throughout the entire stay to learn about disease process, expected outcomes, treatment goals, and follow-up support services available in the home and community. As part of our discharge planning and preparation for a safe transition home, we completed a home visit for Myers. This is when the physical and occupational therapist team takes the patient home in order to problem-solve accessibility issues and to perform caregiver training in their own environment. By doing this, Myers and his wife were less anxious and fearful about their transition home.

Neuro-Focused Outpatient Rehab

Quality inpatient rehabilitation is a vital step in the journey of returning to community participation. Many patients choose to receive home health services after inpatient rehabilitation to assist with the transition to home. Myers briefly utilized home health before initiating the next stage of his recovery, which was a neuro-focused outpatient program found at HealthSouth Harmarville. Outpatient therapy provides an opportunity for stroke survivors to build endurance and to practice skills in higher levels of difficulty. Concerns and issues that have arisen from community integration can be incorporated into treatment and resolved. Instrumental activities of daily living are also a focus of the outpatient program. Participation in activities such as disease-specific support groups and wellness programs can help to facilitate return to the community.

HealthSouth Harmarville offers the entire continuum of care for patients, ranging from inpatient rehabilitation to home health to outpatient services to community support groups. Myers’s wife, Cathy, has become an active participant in the hospital’s Stroke Support Group, attending the educational programs and interacting with families of other stroke survivors. Myers, himself, continues to make gains in physical functioning, daily living skills, communication, and cognitive skills in outpatient therapy. He has returned to some of the leisure activities he enjoyed before his stroke. The couple took another step toward normalcy by going on a vacation to Aruba in August.

Additionally, Greg Myers was honored at the hospital’s National Rehabilitation Awareness Week celebration in September as one of five Rehab Champions treated in the last year who displayed determination, a positive attitude, and the ability to overcome obstacles in order to be successful. RM

Meri K. Slaugenhaupt, MPT, has served on the HealthSouth Harmarville Rehabilitation Hospital team since 1993, beginning as a physical therapist and now serves as the team’s program champion of the stroke program. In this role, Slaugenhaupt has obtained Stroke Joint Commission Disease Specific Certification, making HealthSouth Harmarville the first rehabilitation hospital to achieve this status in 2002. Under Slaugenhaupt’s leadership the hospital has achieved its 8th Joint Commission disease-specific care certification in 2017 for the stroke program. She earned her bachelor’s degree in physiology with a minor in exercise science from Penn State University in 1991. She then earned her master’s in physical therapy at the University of Pittsburgh.

Valerie Bucek, MA, CCC-SLP/L, has been a member of the HealthSouth Harmarville Rehabilitation Hospital team for more than 25 years. She began her work there as a staff speech pathologist and a speech therapy supervisor prior to her current role as the hospital’s therapy manager. Bucek received a bachelor’s degree in speech pathology from Duquesne University and a master’s degree in communication disorders from the University of Pittsburgh. She is one of the leaders of the hospital’s stroke and Parkinson’s disease programs, is founder and facilitator of the HealthSouth Harmarville Community Stroke Support Group, and is an affiliate for the ASHA Special Interest Division-Adult Neurogenic Communication Disorders. For more information, contactRehabEditor@medqor.com.

via Connecting Care for Stroke Patients – Rehab Managment

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[NEWS] From Fiction to Virtual Reality: OmniPad Launches an Innovative Circular Revolving-Tread Omnidirectional Treadmill That Lets Users Naturally Walk, Jog or Run in any Direction Through VR Worlds

 Jan. 15, 2019, 07:52 AM

IRVINE, Calif.Jan. 15, 2019 /PRNewswire/ — Since the beginning, virtual reality paired with an omnidirectional treadmill that allows users to move through the virtual world in any direction has been relegated to realms of fiction…until now. A new company, OmniPad, (OmniPad.com), is looking to change the world of virtual reality with its sleek and innovative game-changing VR treadmill that allows for fully immersive natural 360-degree movement through virtual space.

The OmniPad utilizes a ball-bearing encrusted omnidirectional platform that supports a flattened spherical, revolving treadmill track. The OmniPad platform enables the locomotion surface to freely revolve endlessly, in any direction, creating a unique omnidirectional treadmill. With the OmniPad, gamers, first responders, architects, virtual tourists, and even the military, can freely walk and run around in real time virtual environments, experiencing the most comprehensive and fully immersive VR experience available.

“Being a professional 3D animator for over 25 years, and having worked on very high-end virtual reality projects, the challenge of ‘how to enable 360-degree locomotion on a stationary surface‘ is a question that burned in my mind since the late 1990’s. I contemplated this obstacle to freedom of VR locomotion for months and years. Then, I was lying in bed one night further toiling with the omnidirectional locomotion surface question, and it dawned on me . . . a water balloon!” said Neil Epstein, OmniPad’s CEO and president. “I realized that when you take a small water balloon, press it firmly between your palms so that the top and bottom surfaces are completely flat, and then motion your hands in opposing circular directions, the flattened water balloon freely revolves in all directions while still remaining completely flat on both sides. Hence, the core mechanics of the OmniPad were born.”

The benefits and features of the OmniPad will include:

  • A Unique Omnidirectional Treadmill Design: The circular moving omnidirectional platform sets the company apart in the VR industry.
  • Unmatched Virtual Reality Immersion: The OmniPad lets virtual reality users experience the most immersive VR experience available by letting users freely and naturally walk, jog and run around in the virtual reality world.
  • Patented Treadmill Design and Construction: The dynamic, never before implemented design mechanics that grant the OmniPad its unique immersive locomotion abilities make it the only VR accessory of its type available in the industry.
  • A Multitude Of Uses Possible Uses: With the appropriate Virtual Reality environments, the OmniPad offers a comprehensive gaming experience, as well as highly-effective training of training first responders and soldiers, and allows architects, engineers, and home buyers to visualize buildings and real estate, and even has significant applications in sports training, eSports competitions, and rehabilitation, among so many other applications.

OmniPad has launched a SEC regulation crowdfunding equity campaign, (https://wefunder.com/omnipad.company ), to share awareness and the potential capabilities of this awe-inspiring product. You can check out the company’s YouTube channel, (https://www.youtube.com/channel/UCsR1sCPunIZs2G28DFmmn9A), to see the OmniPad in action.

ABOUT OmniPad

OmniPad is a startup company comprised of some of the brightest and creative minds available. The company’s team includes the world’s foremost expert on omnidirectional locomotion surface technology and Stanford Engineering graduate, David Carmein, the EMMY award-winning 3-D artist and conceptual mind behind OmniPad, Neil Epstein, J.D., and the marketing specialties of Jordan Robinson, Orentheal Williams, and Kenneth Dunn.

Media Contact:
George Pappas
Conservaco/The Ignite Agency
949-339-2002
207740@email4pr.com
https://ignitecfp.com

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SOURCE OmniPad

 

via From Fiction to Virtual Reality: OmniPad Launches an Innovative Circular Revolving-Tread Omnidirectional Treadmill That Lets Users Naturally Walk, Jog or Run in any Direction Through VR Worlds | Markets Insider

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[BLOG POST] Therapy for Brain Injuries: Facing the Music

Therapy for Brain Injuries: Facing the Music

July 31, 2018

 

I recently attended a very interesting workshop delivered by Chroma, which focused on the important role that music therapy can play in the rehabilitation of those who have suffered brain injuries.

Chroma is a national provider of art therapy, music therapy and drama therapy.  Their team of therapists works with a range of organisations and professions, including solicitors, to deliver their services.

The workshop touched on the different holistic approaches to rehabilitation that are available to those who have suffered both traumatic and acquired brain injuries ― but focused mainly on a specific type of music therapy known as Neurologic Music Therapy (NMT).

Ref: https://merrymakers.org/music-brings-memories-back-to-injured-brain/

Music Therapy

Dealing with a brain injury can cause increased stress and difficulties for those who are affected.  Because music evokes emotion and memories in people, it can help them to deal with their anger, anxiety or depression by increasing positive emotions.  It can even help improve concentration and coordination, and can assist with basic abilities such as speech and physical movement.

Neurologic Music Therapy

NMT is an advanced type of music therapy, which uses recognised techniques to treat the brain using music and rhythm.  NMT can help brain injured patients by using the musical part of the brain, which is undamaged, to encourage them to achieve goals such as re-teaching language or re-learning how to walk.

 

When merged with other, more traditional therapies (such as physiotherapy and speech and language therapy), NMT is seen to have quite incredible results.

  • NMT and language

For instance, where someone has suffered loss of speech due to a stroke, music can create new ways of learning how to verbally communicate again.

To illustrate how this can be achieved, we watched the following short clip showing Peter’s story:

Peter’s progress is a clear example of the positive impact NMT can have on speech and language in even a short period of time – just 5 months in his case.

  • NMT and mobility

Where someone’s mobility has been impaired as a result of a brain injury, music can also help to improve their ability to walk, particularly when combined with physiotherapy.  This is because rhythm accesses movement centres of the brain.

Here is another clip demonstrating the power of NMT – focusing on mobility this time.

As you can see, George was only able to walk for 40 ft with a walking stick at the start of the session.  After just one session, he was able to walk 250 ft, without the aid of the stick and at a much quicker pace.

Costs Benefits of NMT

The above examples demonstrate how effective NMT can be when combined with conventional therapies.  Because clients respond to NMT so quickly and with such improved outcomes, the overall rehabilitation costs are often greatly reduced.  When combined with traditional rehabilitation treatments, NMT is therefore a cost-effective therapy for clients with either an acquired or traumatic brain injury. 

Who can access NMT?

NMT can benefit people with traumatic brain injuries (caused as a result of trauma or a blow to the head) or acquired brain injuries (present since birth or as a result of conditions such as stroke, encephalitis, brain haemorrhage or tumour).  NMT can also help people with neurologic disorders such as Parkinson’s Disease, dementia, and multiple sclerosis.

How can we help?

At Bolt Burdon Kemp, we are constantly looking for new and innovative treatments that can help our clients.

If we have supportive evidence from an independent medical expert to say that you suffered a brain injury due to negligent medical treatment and that you could benefit from music therapy, then we can look to recover the costs of the therapy as part of your compensation.

Even while the claim is ongoing, we will do everything that we can to obtain interim payments from the Defendant to pay for this therapy.  This means that even before your case has concluded, we can obtain a payout of some compensation to be able to cover the costs of your therapy.  This can allow you to access rehabilitation early on in the claim and means you can fund therapies (such as NMT) which may not be freely available on the NHS.

Kate O’Brien is a solicitor in the Adult Brain Injury team at Bolt Burdon Kemp.  If you or a loved one is concerned about the treatment you have received, contact Kate free of charge and in confidence on 020 7288 4814 or at KateO’Brien@boltburdonkemp.co.uk.  Alternatively, complete this form and one of the solicitors in the Medical Negligence team will contact you.  Find out more about the Adult Brain Injury team.

via Therapy for Brain Injuries: Facing the Music – Bolt Burdon Kemp

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[WEB SITE] Walk 4,000 steps every day to boost brain function

Recent research led by the University of California, Los Angeles shows that taking a short walk each day can help to keep the brain healthy, supporting the overall resilience of cognitive functioning.
seniors walking in the park

Could a walk in the park help to maintain cognitive health in old age?

As we grow older, memory problems can begin to set in. These could be a natural part of aging and a minor annoyance, but in some cases, the issues may indicate mild cognitive impairment and could even develop into dementia.

Regardless of how mild or severe these memory problems may be, they are definitely distressing and can affect an individual’s quality of life.

New research from the Semel Institute for Neuroscience and Human Behavior at the University of California, Los Angeles suggests that there is a relatively easy way of keeping your brain in top shape as you grow older: take a moderately long walk every day.

This could boost your attention, the efficiency with which you process information, and other cognitive skills, say first study author Prabha Siddarth and colleagues.

The research findings were recently published the Journal of Alzheimer’s Disease.

Cortical thickness to assess cognitive health

Siddarth and team initially recruited 29 adults aged 60 and over, of which 26 completed the study over a 2-year period. The participants were split into two distinct groups:

  • a low physical activity group, comprising people who walked 4,000 or fewer steps each day
  • a high physical activity group, made up of people who walked more than 4,000 steps per day

All the participants reported a degree of memory complaints at baseline, but none of them had a dementia diagnosis.

In order to explore the potential effect of physical activity on cognitive ability, the researchers used MRI to determine the volume and thickness of the hippocampus, which is a brain region associated with memory formation and storage, and spatial orientation.

Previous research suggested that the size and volume of this brain region can tell us something about cognitive health. For instance, a higher hippocampal volume has been shown to indicate more effective memory consolidation.

“Few studies have looked at how physical activity affects the thickness of brain structures,” says Siddarth.

“Brain thickness,” she notes, “a more sensitive measure than volume, can track subtle changes in the brain earlier than volume and can independently predict cognition, so this is an important question.”

Walk more every day for a resilient brain

In addition to the MRI scans, the participants also underwent a set of neuropsychological tests, to consolidate the assessment of their cognitive capacity.

It was found that those in the high physical activity group — who walked more than 4,000 steps (approximately 3 kilometers) each day — had thicker hippocampi, as well as thicker associated brain regions, when compared with that of the those falling under the low physical activity category.

The highly active group was also found to have better attention, speedier information processing abilities, and more efficient executive function, which includes working memory. Working memory is the resource that we tap into on a daily basis when we need to make spontaneous decisions.

However, Siddarth and colleagues reported no significant differences between the high activity and low activity groups when it came to memory recall.

The next step from here, the researchers suggest, should be to undertake a longitudinal analysis in order to test the relationship between physical activity and cognitive ability over time.

They also note the need to better understand the mechanisms behind cognitive decline in relation to hippocampal atrophy.

via Walk 4,000 steps every day to boost brain function

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[WEB SITE] New algorithm helps neurological disorder patients to walk naturally

Soon, wheelchairs may no longer be needed; new research enables patients with neurological disorders to walk again.

Millions of people cannot move their limbs as a result of a neurological disorder or having experienced an injury. But a newly developed algorithm, when coupled with robot-assisted rehabilitation, can help patients who had a stroke or a spinal cord injury to walk naturally.

In the United States, there are approximately 17,000 new cases of spinal cord injury (SCI) every year. Of these, 20 percent result in complete paraplegia (paralysis of the legs and lower half of body) and over 13 percent result in tetraplegia (paralysis of all four limbs).

But SCI is not the only reason that people experience this type of disability. Stroke, multiple sclerosis, cerebral palsy, and a range of other neurological disorders can all lead to paralysis. In fact, a recent survey estimated that in the U.S., almost 5.4 million people live with paralysis, with stroke being the leading cause of this disability.

Now, researchers from the National Centre of Competence in Research Robotics at École Polytechnique Fédérale de Lausanne (EPFL), and at the Lausanne University Hospital in Switzerland, have come up with a groundbreaking technology that may help these patients to regain their locomotor skills.

The scientists came up with an algorithm that helps a robotic harness to facilitate the movements of the patients, thus enabling them to move naturally.

The new research has been published in the journal Science Translational Medicine, and the first author of the study is Jean-Baptiste Mignardot.

Helping people to walk again

Current rehabilitation technologies for people with motor disabilities as a result of SCI or stroke involve walking on a treadmill, with the upper torso being supported by an apparatus. But existing technologies are either too rigid or do not allow the patients to move naturally in all directions.

As the authors of the new study explain, the challenge of locomotor rehabilitation resides in helping the nervous system to “relearn” the right movements. This is difficult due to the loss of muscle mass in the patients, as well as to the neurological wiring that has “forgotten” correct posture.

In order to overcome these obstacles and promote natural walking, Mignardot and colleagues designed an algorithm that coordinates with a robotic rehabilitation harness. The team tested the algorithm in more than 30 patients. The “smart walk assist” markedly and immediately improved the patients’ locomotor abilities.

This mobile harness, which is attached to the ceiling, enables patients to walk. This video shows how it works:

Additionally, after only 1 hour of training with the harness and algorithm, the “unsupported walking ability” of five of the patients improved considerably. By contrast, 1 hour on a conventional treadmill did not improve gait.

The researchers developed the so-called gravity-assist algorithm after carefully monitoring the movements of the patients and considering parameters such as “leg movement, length of stride, and muscle activity.”

As the authors explain, based on these measurements, the algorithm identifies the forces that must be applied to the upper half of the body in order to allow for natural walking.

The smart walk assist is an innovative body-weight support system because it manages to resist the force of gravity and push the patient back and forth, to the left and to the right, or in more of these directions at once, which recreates a natural gait and movement that the patients need in their day to day lives.

Grégoire Courtine, a neuroscientist at EPFL and the Lausanne University Hospital, comments on the significance of the findings, saying, “I expect that this platform will play a critical role in the rehabilitation of walking for people with neurological disorders.”

This is a smart, discreet, and efficient assistance that will aid rehabilitation of many persons with neurological disorders.”

Prof. Jocelyne Bloch, Department of Neurosurgery, Lausanne University Hospital

Source: New algorithm helps neurological disorder patients to walk naturally

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[WEB SITE] Cycling in Bed During ICU Stay May Assist Recovery – Rehab Managment

A mechanically ventilated patient in the ICU uses the RT-300 supine bicycle to strengthen his legs while Dr Michelle Kho looks on. (Photo courtesy of Marta Hewson/Photography)

A mechanically ventilated patient in the ICU uses the RT-300 supine bicycle to strengthen his legs while Dr Michelle Kho looks on. (Photo courtesy of Marta Hewson/Photography)

Critically ill, mechanically ventilated patients in the intensive care unit may safely begin in-bed cycling sessions with their therapists early on in their ICU stay, and may recover more quickly, a recent study suggests.

“People may think that ICU patients are too sick for physical activity, but we know that if patients start in-bed cycling 2 weeks into their ICU stay, they will walk farther at hospital discharge,” says Michelle Kho, an assistant professor with the School of Rehabilitation Science at McMaster University and physiotherapist at St. Joseph’s Healthcare Hamilton, in a media release from McMaster University.

Kho lead author of the TryCYCLE study, published recently in PLOS ONE, adds that, “Our TryCYCLE study finds it is safe and feasible to systematically start in-bed cycling within the first 4 days of mechanical ventilation and continue throughout a patient’s ICU stay.”

The 1-year study, conducted by Kho and her colleages, included 33 patients admitted to the ICU at St Joseph’s Healthcare Hamilton. They all were 18 years of age or older, received mechanical ventilation, and walked independently prior to receiving care.

All patients underwent 30 minutes of supine cycling using a motorized stationary bicycle affixed to the bed, 6 days a week. The special in-bed cycling equipment was provided by the St. Joseph’s Healthcare Foundation, per the release.

The patients started cycling within the first 3 days of ICU admission and cycled about 9 km on average during their ICU stay.

“Patients’ abilities to cycle during critical illness exceeded our expectations,” Kho states in the release.

Kho adds in the release that more research is needed to determine if this early cycling with critically ill patients improves their physical function. The next step could be to have several hospital ICUs start the in-bed cycling study in a pilot randomized trial.

[Source(s): McMaster University, EurekAlert]

Source: Cycling in Bed During ICU Stay May Assist Recovery – Rehab Managment

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[Abstract] Constraining movement reveals motor capability in chronic stroke: An initial study

Abstract

Objective: To determine if persons with chronic stroke and decreased hip and knee flexion during swing can walk with improved swing-phase kinematics when the task demands constrained gait to the sagittal plane.

Design: A one-day, within-subject design comparing gait kinematics under two conditions: Unconstrained treadmill walking and a constrained condition in which the treadmill walking space is reduced to limit limb advancement to occur in the sagittal plane.

Setting: Outpatient physical therapy clinic.

Subjects: Eight individuals (mean age, 64.1 ±9.3, 2 F) with mild-moderate paresis were enrolled.

Main measures: Spatiotemporal gait characteristics and swing-phase hip and knee range of motion during unconstrained and constrained treadmill walking were compared using paired t-test and Cohen’s d (d) to determine effect size.

Results: There was a significant, moderate-to-large effect of the constraint on hip flexion (p < 0.001, d = –1.1) during initial swing, and hip (p < 0.05, d = –0.8) and knee (p < 0.001, d = –1.1) flexion during midswing. There was a moderate effect of constraint on terminal swing knee flexion (p = 0.238, d = –0.6). Immediate and significant changes in step width (p < 0.05, d = 0.9) and paretic step length (p < 0.05, d = –0.5) were noted in the constrained condition compared with unconstrained.

Conclusion: Constraining the treadmill walking path altered the gait patterns among the study’s participants. The immediate change during constrained walking suggests that patients with chronic stroke may have underlying movement capability that they do not preferentially utilize.

 

Source: Constraining movement reveals motor capability in chronic stroke: An initial study

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[Abstract] High-intensity treadmill training improves gait ability, VO2peak and cost of walking in stroke survivors: preliminary results of a pilot randomized controlled trial.  – Europe PMC

Stroke is a major cause of death and long-term disability across the globe. Previous studies have demonstrated the trainability of stroke survivors and documented beneficial effects of aerobic exercises on cardiovascular fitness and gait ability.
The main aim of this study was to compare the effects of a high-intensity treadmill training (HITT) against low-intensity treadmill training (LITT) on gait ability, quality of life, cardiorespiratory fitness and cost of walking in chronic stroke subjects.
Randomized, controlled pilot study.Patients were recruited among Neurorehabilitation Unit outpatient.The sample was composed of 16 subjects suffering from chronic stroke. Subjects were enrolled and randomly allocated either in the HITT (n=8) or in the LITT (n=8). Both groups performed 3-month training, 3 times per week. Subjects were evaluated before starting the training and after the end of the training by mean of clinical scales (Six Minute Walk Test, Ten Meter Walk Test, Health Survey Questionnaire SF-36, Stroke Impact Scale) and instrumental tests (Gait analysis, V02peak and Walking Energy Cost).Fifteen subjects completed the study and no dropouts were observed. One patient in the LITT refused to initiate the training. The HITT group produced greater improvements than LITT group on the Six Minute Walk Test (HITT: 644 meters, LITT: 6 meters; p=0.005) and Ten Meter Walk Test performances (HITT: -1,7 seconds, LITT: 0,6 seconds; p=0.007), stride length (HITT: 3,3 centimetres, LITT: 0,4 centimetres, p=0.003), step length non-paretic side (HITT: 0,5 centimetres, LITT: 2,4 centimetres, p=0.008), step length paretic side (HITT: 1,8 centimetres, LITT: 0,7 centimetres, p=0.004), cadence (HITT: 1,6 step/minute, LITT: 0,6 step/minute, p=0.021) and symmetry ratio (HITT: 0,04, LITT: 0,01, p=0.004), V02peak (HITT: 4,6 ml/kg/min, LITT: 0,87 ml/kg/min; p=0.015) and Walking Energy Cost at 100% of self-selected speed (HITT: -30,8 ml/kg*km, LITT: -20,5 ml/kg*km; p=0.021). Significant changes were found on Six Minute Walk Test (p=0.012) and Ten Meter Walk Test (p=0.042) performances, spatio-temporal gait parameters (stride length p=0.011, step length paretic side p=0.012, cadence p=0.037 and symmetry ratio p=0.012), VO2peak (p=0.025) and cost of walking at 100% of self-selected speed (p=0.018) in the HITT group. In the LITT no significant results were observed.
HITT could be considered a feasible training and led to improvement in gait ability and enhanced VO2peak and reduction in cost of walking compared to LITT. Chronic stroke survivors should be encouraged to engage regular aerobic treadmill training at medium/high intensity. HITT is safe and feasible and has positive effects on gait ability, cardiovascular fitness and cost of walking in subjects with stroke in chronic phase.
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Source: High-intensity treadmill training improves gait ability, VO2peak and cost of walking in stroke… – Abstract – Europe PMC

 

 

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