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Khallaf ME. Effect of Gravity and Task Specific Training of Elbow Extensors on Upper Extremity Function after Stroke. Neurol Res Int 2018; 2018:4172454. [PMID: 30112205 PMCID: PMC6077607 DOI: 10.1155/2018/4172454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 05/10/2018] [Accepted: 06/05/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In individuals with hemiparetic stroke, reaching with the paretic arm can be impaired by abnormal muscle coactivation. Prior trails for improving upper extremity functions after stroke have underestimated the role of gravitational force in motor planning and execution. OBJECTIVE The aims this trial were to study the effect of gravity as a facilitator for elbow extension and to estimate the immediate and retention effects of task specific training of elbow extensors on upper extremity function after stroke. METHODS Twenty-six right handed patients with first ever stroke represented the sample of the study. The participants were randomly assigned into two equal groups. The study group received treatment through two phases. Phase one included training for the elbow extensors in an antigravity position. Phase two included a set of task specific exercise for 16 weeks. The control group received traditional passive stretch and range of motion exercises. Manual dexterity and upper limb function were assessed by Nine-Hole Peg Test and Fugl-Meyer upper extremity. Goniometry was used for measuring elbow extension and forearm supination active ranges of motion. RESULTS Significant improvements were observed in Nine-Hole Peg Test, Fugl-Meyer upper extremity, and ranges of motion at postintervention and follow-up compared to preintervention at P≤0.05. CONCLUSIONS The results of this study provide an evidence that antigravity positions can be used as a centrally presented facilitator of elbow extension. Additionally, task specific training was effective in improving upper extremity function and elbow extension range of motion.
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Affiliation(s)
- Mohamed E. Khallaf
- Department of Physical Therapy for Neuromuscular Disorders and Its Surgery, Faculty of Physical Therapy, Cairo University, Egypt
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152
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Washabaugh E, Guo J, Chang CK, Remy D, Krishnan C. A Portable Passive Rehabilitation Robot for Upper-Extremity Functional Resistance Training. IEEE Trans Biomed Eng 2018; 66:496-508. [PMID: 29993459 DOI: 10.1109/tbme.2018.2849580] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Loss of arm function is common in individuals with neurological damage, such as stroke or cerebral palsy. Robotic devices that address muscle strength deficits in a task-specific manner can assist in the recovery of arm function; however, current devices are typically large, bulky, and expensive to be routinely used in the clinic or at home. This study sought to address this issue by developing a portable planar passive rehabilitation robot, PaRRo. METHODS We designed PaRRo with a mechanical layout that incorporated kinematic redundancies to generate forces that directly oppose the user's movement. Cost-efficient eddy current brakes were used to provide scalable resistances. The lengths of the robot's linkages were optimized to have a reasonably large workspace for human planar reaching. We then performed theoretical analysis of the robot's resistive force generating capacity and steerable workspace using MATLAB simulations. We also validated the device by having a subject move the end-effector along different paths at a set velocity using a metronome while simultaneously collecting surface electromyography (EMG) and end-effector forces felt by the user. RESULTS Results from simulation experiments indicated that the robot was capable of producing sufficient end-effector forces for functional resistance training. We also found the endpoint forces from the user were similar to the theoretical forces expected at any direction of motion. EMG results indicated that the device was capable of providing adjustable resistances based on subjects' ability levels, as the muscle activation levels scaled with increasing magnet exposures. CONCLUSION These results indicate that PaRRo is a feasible approach to provide functional resistance training to the muscles along the upper extremity. SIGNIFICANCE The proposed robotic device could provide a technological breakthrough that will make rehabilitation robots accessible for small outpatient rehabilitation centers and in-home therapy.
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153
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Toovey R, Harvey AR, McGinley JL, Lee KJ, Shih STF, Spittle AJ. Bike skills training for children with cerebral palsy: protocol for a randomised controlled trial. BMJ Open 2018; 8:e019898. [PMID: 29431140 PMCID: PMC5829908 DOI: 10.1136/bmjopen-2017-019898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/28/2017] [Accepted: 12/06/2017] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Two-wheel bike riding can be a goal for children with cerebral palsy (CP) and a means of participating in physical activity. It is possible for some children with CP to ride a two-wheel bike; however, currently far fewer can ride compared with their typically developing peers. Evidence supports training targeted towards goals of the child with CP and their family; yet there is little evidence to guide best-practice bike skills training. Task-specific training may lead to attainment of two-wheel bike-specific goals. This study aims to determine if a novel task-specific approach to training two-wheel bike skills is more effective than a parent-led home programme for attaining individualised two-wheel bike-specific goals in independently ambulant children with CP aged 6-15 years. METHODS AND ANALYSIS Sixty eligible children with CP (Gross Motor Function Classification System levels I-II) aged 6-15 years with goals relating to riding a two-wheel bike will be randomised to either a novel task-specific centre-based group programme (intervention) or a parent-led home-based programme (comparison), both involving a 1-week intervention period. The primary outcome is goal attainment in the week following the intervention period (T1). Secondary outcomes include: goal attainment and participation in physical activity at 3 months postintervention (T2) and bike skills, attendance and involvement in bike riding, self-perception and functional skills at T1 and T2. Economic appraisal will involve cost-effectiveness and cost-utility analyses. Adherence of clinicians and parents to the intervention and comparison protocols will be assessed. Linear and logistic regression will be used to assess the effect of the intervention, adjusted for site as used in the randomisation process. ETHICS AND DISSEMINATION This study was approved by the Human Research and Ethics Committees at The Royal Children's Hospital (#36209). Results will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER NCT03003026; Pre-results.
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Affiliation(s)
- Rachel Toovey
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, Australia
- Victorian Paediatric Rehabilitation Service, Monash Children's Hospital, Melbourne, Australia
| | - Adrienne R Harvey
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, Australia
- Neurodevelopment and Disability, The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | | | - Katherine J Lee
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne Children's Trials Centre, Melbourne Children's Campus, Melbourne, Australia
| | - Sophy T F Shih
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Australia
| | - Alicia J Spittle
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
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154
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Chaturvedi P, Singh AK, Kulshreshtha D, Maurya PK, Thacker AK. Proprioceptive neuromuscular facilitation (PNF) vs. task specific training in acute stroke: the effects on neuroplasticity. ACTA ACUST UNITED AC 2018. [DOI: 10.15406/mojap.2018.05.00181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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155
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Abstract
Stroke, or cerebrovascular accident, involves injury to the central nervous system as a result of a vascular cause, and is a leading cause of disability worldwide. People with stroke often experience sensory, cognitive, and motor sequelae that can lead to difficulty walking, controlling balance in standing and voluntary tasks, and reacting to prevent a fall following an unexpected postural perturbation. This chapter discusses the interrelationships between stroke-related impairments, problems with control of balance and gait, fall risk, fear of falling, and participation in daily physical activity. Rehabilitation can improve balance and walking function, and consequently independence and quality of life, for those with stroke. This chapter also describes effective interventions for improving balance and walking function poststroke, and identifies some areas for further research in poststroke rehabilitation.
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Affiliation(s)
- Avril Mansfield
- Toronto Rehabilitation Institute, University Health Network and Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
| | - Elizabeth L Inness
- Toronto Rehabilitation Institute, University Health Network and Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - William E Mcilroy
- Department of Kinesiology, University of Waterloo and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Waterloo, ON, Canada
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156
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Bonney E, Ferguson G, Smits-Engelsman B. The efficacy of two activity-based interventions in adolescents with Developmental Coordination Disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 71:223-236. [PMID: 29055242 DOI: 10.1016/j.ridd.2017.10.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 10/11/2017] [Accepted: 10/14/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Adolescents with Developmental Coordination Disorder (DCD) usually experience psychomotor difficulties that affect their participation in everyday tasks and sports. Without effective intervention, adolescents show persistent motor deficits through adulthood. It is therefore critical to develop interventions to address the specific needs of this population. Studies evaluating the impact of motor interventions among adolescents with DCD are limited. AIM The study evaluated the efficacy of two activity-based motor interventions in female adolescents with DCD. METHODS AND PROCEDURES Forty-three female participants (Mean±SD: 14.3±1.1years) were identified as having DCD using the DSM-5 criteria. They were randomly assigned to either Task-oriented Functional Training (TFT) or Wii training. Both groups received 45min training per week for 14 weeks. Outcome measures included isometric muscular strength, motor proficiency, functional performance and participation in activities of daily living (ADL). OUTCOMES AND RESULTS At the conclusion of the intervention, the two groups had significant improvement in muscular strength, motor proficiency, running and agility, predilection for physical activity and generalized self-efficacy. However, there was no difference in outcomes for the two interventions. CONCLUSIONS AND IMPLICATIONS The findings highlight the potential benefits of activity-based motor interventions in reducing impairments, improving functional performance, and enhancing participation. These results support previous findings on the efficacy of task-oriented interventions and demonstrate the value of these approaches at all levels of functioning.
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Affiliation(s)
- Emmanuel Bonney
- Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa; Department of Physiotherapy, University of Ghana, Accra, Ghana.
| | - Gillian Ferguson
- Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Bouwien Smits-Engelsman
- Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
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157
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Zhang X, Yong X, Menon C. Evaluating the versatility of EEG models generated from motor imagery tasks: An exploratory investigation on upper-limb elbow-centered motor imagery tasks. PLoS One 2017; 12:e0188293. [PMID: 29186170 PMCID: PMC5706687 DOI: 10.1371/journal.pone.0188293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 11/03/2017] [Indexed: 11/19/2022] Open
Abstract
Electroencephalography (EEG) has recently been considered for use in rehabilitation of people with motor deficits. EEG data from the motor imagery of different body movements have been used, for instance, as an EEG-based control method to send commands to rehabilitation devices that assist people to perform a variety of different motor tasks. However, it is both time and effort consuming to go through data collection and model training for every rehabilitation task. In this paper, we investigate the possibility of using an EEG model from one type of motor imagery (e.g.: elbow extension and flexion) to classify EEG from other types of motor imagery activities (e.g.: open a drawer). In order to study the problem, we focused on the elbow joint. Specifically, nine kinesthetic motor imagery tasks involving the elbow were investigated in twelve healthy individuals who participated in the study. While results reported that models from goal-oriented motor imagery tasks had higher accuracy than models from the simple joint tasks in intra-task testing (e.g., model from elbow extension and flexion task was tested on EEG data collected from elbow extension and flexion task), models from simple joint tasks had higher accuracies than the others in inter-task testing (e.g., model from elbow extension and flexion task tested on EEG data collected from drawer opening task). Simple single joint motor imagery tasks could, therefore, be considered for training models to potentially reduce the number of repetitive data acquisitions and model training in rehabilitation applications.
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Affiliation(s)
- Xin Zhang
- Menrva Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Metro Vancouver, British Columbia, Canada
| | - Xinyi Yong
- Menrva Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Metro Vancouver, British Columbia, Canada
| | - Carlo Menon
- Menrva Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Metro Vancouver, British Columbia, Canada
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158
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Reinkensmeyer DJ, Blackstone S, Bodine C, Brabyn J, Brienza D, Caves K, DeRuyter F, Durfee E, Fatone S, Fernie G, Gard S, Karg P, Kuiken TA, Harris GF, Jones M, Li Y, Maisel J, McCue M, Meade MA, Mitchell H, Mitzner TL, Patton JL, Requejo PS, Rimmer JH, Rogers WA, Zev Rymer W, Sanford JA, Schneider L, Sliker L, Sprigle S, Steinfeld A, Steinfeld E, Vanderheiden G, Winstein C, Zhang LQ, Corfman T. How a diverse research ecosystem has generated new rehabilitation technologies: Review of NIDILRR's Rehabilitation Engineering Research Centers. J Neuroeng Rehabil 2017; 14:109. [PMID: 29110728 PMCID: PMC5674748 DOI: 10.1186/s12984-017-0321-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 10/26/2017] [Indexed: 01/14/2023] Open
Abstract
Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a "total approach to rehabilitation", combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970's, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program.
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Affiliation(s)
| | | | | | - John Brabyn
- The Smith-Kettlewell Eye Research Institute, San Francesco, USA
| | | | | | | | | | - Stefania Fatone
- Northwestern University Prosthetics-Orthotics Center, Evanston, USA
| | - Geoff Fernie
- Toronto Rehabilitation Institute, Toronto, Canada
| | - Steven Gard
- Northwestern University Prosthetics-Orthotics Center, Evanston, USA
| | | | | | | | | | - Yue Li
- Toronto Rehabilitation Institute, Toronto, Canada
| | | | | | | | | | | | - James L. Patton
- Rehabilitation Institute of Chicago, University of Illinois at Chicago, Chicago, USA
| | | | - James H. Rimmer
- Lakeshore FoundationUniversity of Alabama-Birmingham, Birmingham, USA
| | | | - W. Zev Rymer
- Rehabilitation Institute of Chicago, Chicago, USA
| | | | | | | | | | - Aaron Steinfeld
- Robotics Institute, Carnegie Mellon University, Pittsburgh, USA
| | | | | | | | | | - Thomas Corfman
- National Institute on Disability, Independent Living, and Rehabilitation Research, Washington, DC, USA
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159
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Khallaf ME, Ameer MA, Fayed EE. Effect of task specific training and wrist-fingers extension splint on hand joints range of motion and function after stroke. NeuroRehabilitation 2017; 41:437-444. [PMID: 28946577 DOI: 10.3233/nre-162128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Most stroke patients experience hand impairments that can result in persistent limitations in daily activities. OBJECTIVE This study aimed at estimating the immediate and retention effects of task specific training and wrist/fingers extension splint on hand joints range of motion and function after stroke. METHODS Twenty-four right handed patients with first ever stroke represented the sample of the study. The participants were randomly assigned into two equal groups. The study group received task specific exercises five times a week for an hour concurrently with wrist/fingers extension splint which was used two hours for each three hours (day and night) excluding exercises and sleeping hours for 16 weeks. The control group received traditional passive stretch and range of motion exercises. Manual dexterity and upper limb function were assessed by nine holes peg test and Fugl-Meyer upper extremity and hand. Goniometry was used for measuring wrist, metacarpophalangeal, thumb carpometacarpal joints active range of motion. RESULTS Significant improvements were observed in nine holes peg test, Fugl-Meyer upper extremity and hand scores and ranges of motion at post-intervention and follow-up compared to pre-intervention at P≤0.05. CONCLUSIONS The results of this study provide an evidence that task specific training and wrist/fingers extension splint are effective in improving fingers dexterity, upper extremity function and wrist/hand range of motion.
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Affiliation(s)
- Mohamed E Khallaf
- Department of Physical Therapy for Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Mariam A Ameer
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Eman E Fayed
- Department of Biomechanics, Faculty of Physical Therapy, Misr University for Sciences and Technology, Giza, Egypt
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160
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Valkenborghs SR, Visser MM, Dunn A, Erickson KI, Nilsson M, Callister R, van Vliet P. AExaCTT - Aerobic Exercise and Consecutive Task-specific Training for the upper limb after stroke: Protocol for a randomised controlled pilot study. Contemp Clin Trials Commun 2017; 7:179-185. [PMID: 29696183 PMCID: PMC5898578 DOI: 10.1016/j.conctc.2017.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 07/02/2017] [Accepted: 07/20/2017] [Indexed: 11/23/2022] Open
Abstract
Motor function may be enhanced if aerobic exercise is paired with motor training. One potential mechanism is that aerobic exercise increases levels of brain-derived neurotrophic factor (BDNF), which is important in neuroplasticity and involved in motor learning and motor memory consolidation. This study will examine the feasibility of a parallel-group assessor-blinded randomised controlled trial investigating whether task-specific training preceded by aerobic exercise improves upper limb function more than task-specific training alone, and determine the effect size of changes in primary outcome measures. People with upper limb motor dysfunction after stroke will be allocated to either task-specific training or aerobic exercise and consecutive task-specific training. Both groups will perform 60 hours of task-specific training over 10 weeks, comprised of 3 × 1 hour sessions per week with a therapist and 3 × 1 hours of home-based self-practice per week. The combined intervention group will also perform 30 minutes of aerobic exercise (70-85%HRmax) immediately prior to the 1 hour of task-specific training with the therapist. Recruitment, adherence, retention, participant acceptability, and adverse events will be recorded. Clinical outcome measures will be performed pre-randomisation at baseline, at completion of the training program, and at 1 and 6 months follow-up. Primary clinical outcome measures will be the Action Research Arm Test (ARAT) and the Wolf Motor Function Test (WMFT). If aerobic exercise prior to task-specific training is acceptable, and a future phase 3 randomised controlled trial seems feasible, it should be pursued to determine the efficacy of this combined intervention for people after stroke.
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Key Words
- 6MWT, Six Minute Walk Test
- ARAT, Action Research Arm Test
- Aerobic exercise
- BDNF, brain-derived neurotrophic factor
- CERT, Consensus on Exercise Reporting Template
- CM, centimetre
- CONSORT, Consolidated Standards of Reporting Trials
- ECG, electrocardiography
- ELISA, enzyme-linked immunosorbent assay
- FAS, Fatigue Assessment Scale
- GP, general practitioner
- HRmax, age-predicted maximal heart rate maximum
- HRpeak, peak heart rate
- IPAQ, International Physical Activity Questionnaire
- MAL, Motor Activity Log
- MRI, magnetic resonance imaging
- MS, Microsoft
- Motor function
- NAA, N-acetyl Aspartate
- PD, Peak Deceleration
- PV, Peak Velocity
- REDCap, Research Electronic Data Capture
- RPE, rating of perceived exertion
- RPM, revolutions per minute
- SIS, Stroke Impact Scale
- Stroke
- Task-specific training
- VO2, oxygen uptake
- VO2peak, peak oxygen uptake
- WMFT, Wolf Motor Function Test
- m/s, millimetres per second
- mL.kg−1.min−1, millilitres per kilogram per minute
- reps, repetitions
- s, seconds
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Affiliation(s)
- Sarah R. Valkenborghs
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia
- Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Milanka M. Visser
- Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Ashlee Dunn
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Kirk I. Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Michael Nilsson
- Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Robin Callister
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Paulette van Vliet
- Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- School of Health Sciences, University of Newcastle, Callaghan, NSW 2308, Australia
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161
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Fong J, Crocher V, Tan Y, Oetomo D, Mareels I. EMU: A transparent 3D robotic manipulandum for upper-limb rehabilitation. IEEE Int Conf Rehabil Robot 2017; 2017:771-776. [PMID: 28813913 DOI: 10.1109/icorr.2017.8009341] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This paper introduces the EMU, a three-dimensional robotic manipulandum for rehabilitation of the upper extremity for patients with neurological injury. The device has been designed to be highly transparent, have a large workspace, and allow the use of the hand for interaction with real-world objects to provide additional contextual cues during exercises. The transparency is achieved through the use of a capstan transmission for the drive joints; a hybrid serial parallel kinematics minimising moving inertia; and lightweight materials. An experimental protocol is reported here which demonstrates the transparency through a comparison to out-of-robot movements, and with an existing rehabilitation robotic device. Additionally, an adjustable gravity compensation method is constructed, which minimises the torque required at the shoulder to carry the subject's arm. These characteristics allow the EMU to serve as a multi-purpose platform for the further development of novel robot assisted rehabilitation strategies.
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Abstract
Study Design Case series. Background Recent evidence suggests that traditional impairment-based rehabilitation approaches for patients with knee pain may not result in improved function or reduced disability. This case series describes a novel task-specific training approach to exercise therapy for patients with chronic knee pain and reports changes in measures of clinical outcome (pain and physical function) following participation in the training program. Case Description Seven patients with chronic knee pain aged 40 years or older were included. Each reported at least "moderate" difficulty with sit-to-stand transfers, floor transfers, and/or stair negotiation at baseline. Experienced physical therapists provided between 8 and 16 treatment sessions focusing on improving performance of difficult or painful tasks. Outcomes A majority of patients demonstrated clinically important improvements in both patient-rated outcomes (Knee injury and Osteoarthritis Outcome Score, numeric pain-rating scale, modified Arthritis Self-Efficacy Scale) and performance-based outcomes (30-second chair-rise test, timed stair-climb test, floor transfer test, Performance Assessment of Self-Care Skills). Discussion A task-specific training approach for patients with chronic knee pain was described and yielded considerable improvement in pain and function for most of the individuals in this case series. Larger studies are needed to determine how task-specific training compares with more traditional impairment-based exercise approaches for chronic knee pain. Level of Evidence Therapy, level 5. J Orthop Sports Phys Ther 2017;47(8):548-556. doi:10.2519/jospt.2017.7349.
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163
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Salsich GB, Yemm B, Steger-May K, Lang CE, Van Dillen LR. A feasibility study of a novel, task-specific movement training intervention for women with patellofemoral pain. Clin Rehabil 2017; 32:179-190. [PMID: 28750548 DOI: 10.1177/0269215517723055] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To investigate whether a novel, task-specific training intervention that focused on correcting pain-producing movement patterns was feasible and whether it would improve hip and knee kinematics, pain, and function in women with patellofemoral pain. DESIGN Prospective, non-randomized, within-group, double baseline, feasibility intervention study. SUBJECTS A total of 25 women with patellofemoral pain were enrolled. INTERVENTION The intervention, delivered 2×/week for six weeks, consisted of supervised, high-repetition practice of daily weight-bearing and recreational activities. Activities were selected and progressed based on participants' interest and ability to maintain optimal alignment without increasing pain. MAIN MEASURES Primary feasibility outcomes were recruitment, retention, adherence, and treatment credibility (Credibility/Expectancy Questionnaire). Secondary outcomes assessing intervention effects were hip and knee kinematics, pain (visual analog scale: current, average in past week, maximum in past week), and function (Patient-Specific Functional Scale). RESULTS A total of 25 participants were recruited and 23 were retained (92% retention). Self-reported average daily adherence was 79% and participants were able to perform their prescribed home program correctly (reduced hip and knee frontal plane angles) by the second intervention visit. On average, treatment credibility was rated 25 (out of 27) and expectancy was rated 22 (out of 27). Hip and knee kinematics, pain, and function improved following the intervention when compared to the control phase. CONCLUSION Based on the feasibility outcomes and preliminary intervention effects, this task-specific training intervention warrants further investigation and should be evaluated in a larger, randomized clinical trial.
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Affiliation(s)
- Gretchen B Salsich
- 1 Program in Physical Therapy, Saint Louis University, St. Louis, MO, USA
| | - Barbara Yemm
- 1 Program in Physical Therapy, Saint Louis University, St. Louis, MO, USA
| | - Karen Steger-May
- 2 Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Catherine E Lang
- 3 Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA.,4 Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA.,5 Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Linda R Van Dillen
- 3 Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA.,6 Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
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164
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Boone AE, Morgan KA, Engsberg JR. A new combined motor and cognitive strategy training intervention for stroke: Stakeholder perceptions. Br J Occup Ther 2017. [DOI: 10.1177/0308022617714748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anna E Boone
- PhD Graduate, Program in Occupational Therapy, Washington University School of Medicine, USA
| | - Kerri A Morgan
- Assistant Professor, Programs in Occupational Therapy and Neurology, Washington University School of Medicine, USA
| | - Jack R Engsberg
- Professor, Programs in Occupational Therapy, Neurosurgery, and Orthopedics, Washington University School of Medicine, USA
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165
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Martins JC, Aguiar LT, Nadeau S, Scianni AA, Teixeira-Salmela LF, Faria CDCDM. Efficacy of Task-Specific Training on Physical Activity Levels of People With Stroke: Protocol for a Randomized Controlled Trial. Phys Ther 2017; 97:640-648. [PMID: 28371936 DOI: 10.1093/physth/pzx032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 03/15/2017] [Indexed: 11/14/2022]
Abstract
BACKGROUND The majority of people after stroke demonstrate mobility limitations, which may reduce their physical activity levels. Task-specific training has been shown to be an effective intervention to improve mobility in individuals with stroke, however, little is known about the impact of this intervention on levels of physical activity. OBJECTIVES The main objective is to investigate the efficacy of task-specific training, focused on both upper and lower limbs, in improving physical activity levels and mobility in individuals with stroke. The secondary objective is to investigate the effects of the training on muscle strength, exercise capacity, and quality of life. DESIGN This is a randomized controlled trial. SETTING The setting is public health centers. PARTICIPANTS Community-dwelling people with chronic stroke. INTERVENTIONS Participants will be randomized to either an experimental or control group, who will receive group interventions 3 times per week over 12 weeks. The experimental group will undertake task-specific training, while the control group will undertake global stretching, memory exercises, and health education sessions. MEASUREMENTS Primary outcomes include measures of physical activity levels and mobility, whereas secondary outcomes are muscle strength, exercise capacity, and quality of life. The outcomes will be measured at baseline, postintervention, and at the 4- and 12-week follow-ups. CONCLUSIONS The findings of this trial have the potential to provide important insights regarding the effects of task-specific training, focused on both upper and lower limbs, in preventing secondary poststroke complications and improving the participants' general health through changes in physical activity levels.
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Affiliation(s)
- Júlia Caetano Martins
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Larissa Tavares Aguiar
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Sylvie Nadeau
- Centre de Recherche Interdisciplinaire en Réadaptation, Institut de Réadaptation Gingras-Lindsay de Montréal, Université de Montreal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | - Aline Alvim Scianni
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
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166
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Hulbert S, Ashburn A, Roberts L, Verheyden G. Dance for Parkinson’s—The effects on whole body co-ordination during turning around. Complement Ther Med 2017; 32:91-97. [DOI: 10.1016/j.ctim.2017.03.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/21/2017] [Accepted: 03/22/2017] [Indexed: 11/28/2022] Open
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167
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Park CF, Sheinbaum JM, Tamada Y, Chandiramani R, Lian L, Lee C, Da Silva J, Ishikawa-Nagai S. Dental Students’ Perceptions of Digital Assessment Software for Preclinical Tooth Preparation Exercises. J Dent Educ 2017; 81:597-603. [DOI: 10.21815/jde.016.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 10/09/2016] [Indexed: 12/20/2022]
Affiliation(s)
| | | | - Yasushi Tamada
- Department of Prosthodontics and Oral Implantology; School of Dentistry, Iwate Medical University; Japan
- Department of Restorative Dentistry and Biomaterial Sciences; Harvard School of Dental Medicine
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168
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Peters HT, Pisegna J, Faieta J, Page SJ. Functional Brain Stimulation in a Chronic Stroke Survivor With Moderate Impairment. Am J Occup Ther 2017; 71:7103190080p1-7103190080p6. [PMID: 28422634 DOI: 10.5014/ajot.2017.025247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To determine the impact of transcranial direct current stimulation (tDCS) combined with repetitive, task-specific training (RTP) on upper-extremity (UE) impairment in a chronic stroke survivor with moderate impairment. METHOD The participant was a 54-yr-old woman with chronic, moderate UE hemiparesis after a single stroke that had occurred 10 yr before study enrollment. She participated in 45-min RTP sessions 3 days/wk for 8 wk. tDCS was administered concurrent to the first 20 min of each RTP session. RESULTS Immediately after intervention, the participant demonstrated marked score increases on the UE section of the Fugl-Meyer Scale and the Motor Activity Log (on both the Amount of Use and the Quality of Movement subscales). CONCLUSION These data support the use of tDCS combined with RTP to decrease impairment and increase UE use in chronic stroke patients with moderate impairment. This finding is crucial, given the paucity of efficacious treatment approaches in this impairment level.
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Affiliation(s)
- Heather T Peters
- Heather T. Peters, MOT, OTR/L, is PhD Candidate, Department of Occupational Therapy and B.R.A.I.N. Laboratory, Ohio State University Medical Center, Columbus;
| | - Janell Pisegna
- Janell Pisegna, MOT, OTR/L, is Occupational Therapist, Licking Memorial Hospital, Newark, NJ
| | - Julie Faieta
- Julie Faieta, MOT, OTR/L, is PhD Student, Department of Occupational Therapy and B.R.A.I.N. Laboratory, Ohio State University Medical Center, Columbus
| | - Stephen J Page
- Stephen J. Page, PhD, MS, MOT, OTR/L, FAHA, FACRM, FAOTA, is Associate Professor, Department of Occupational Therapy and B.R.A.I.N. Laboratory, Ohio State University Medical Center, Columbus
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169
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Cunha RG, Da-Silva PJG, Dos Santos Couto Paz CC, da Silva Ferreira AC, Tierra-Criollo CJ. Influence of functional task-oriented mental practice on the gait of transtibial amputees: a randomized, clinical trial. J Neuroeng Rehabil 2017; 14:28. [PMID: 28399873 PMCID: PMC5387354 DOI: 10.1186/s12984-017-0238-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 03/27/2017] [Indexed: 12/04/2022] Open
Abstract
Background Mental practice (MP) through motor imagery is a cognitive training strategy used to improve locomotor skills during rehabilitation programs. Recent works have used MP tasks to investigate the neurophysiology of human gait; however, its effect on functional performance has not been evaluated. In the present study, the influence of gait-oriented MP tasks on the rehabilitation process of gait in transtibial amputees was investigated by assessing the vertical (V), anterior-posterior (AP), and medio-lateral (ML) ground reaction forces (GRFs) and the time duration of the support phase of the prosthetic limb. Methods Unilateral transtibial amputees, who were capable of performing motor imagination tasks (MIQ-RS score ≥4), were randomly divided into two groups: Group A (n = 10), who performed functional gait-oriented MP combined with gait training, and Group B (n = 5), who performed non-motor task MP. The MP intervention was performed in the first-person perspective for 40 min, 3 times/week, for 4 weeks. The GRF outcome measures were recorded by a force platform to evaluate gait performance during 4 distinct stages: at baseline (BL), 1 month before the MP session; Pre-MP, 1–3 days before the MP session; Post-MP, 1–3 days after the MP session; and follow-up (FU), 1 month after MP session. The gait variables were compared inter- and intra-group by applying the Mann-Whitney and Friedman tests (alpha = 0.05). Results All volunteers exhibited a homogenous gait pattern prior to MP intervention, with no gait improvement during the BL and Pre-MP stages. Only Group A showed significant improvements in gait performance after the intervention, with enhanced impact absorption, as indicated by decreased first V and AP peaks; propulsion capacity, indicated by increasing second V and AP peaks; and balance control of the prosthetic limb, indicated by decreasing ML peaks and increasing duration of support. This gait pattern persisted until the FU stage. Conclusions MP combined with gait training allowed transtibial amputees to reestablish independent locomotion. Since the effects of MP were preserved after 1 month, the improvement is considered related to the specificity of the MP tasks. Therefore, MP may improve the clinical aspect of gait rehabilitation when included in a training program.
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Affiliation(s)
- Rodrigo Gontijo Cunha
- Graduate Program in Neuroscience-Federal University of Minas Gerais, Avenue Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil.,Engineering School, Center for Research and Education in Biomedical Engineering-Pampulha, Belo Horizonte, MG, 31270-901, Brazil
| | - Paulo José Guimarães Da-Silva
- Alberto Luiz Coimbra Institute for Graduate Studies and Research in Engineering, Biomedical Engineering Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Ana Carolina da Silva Ferreira
- Biomechanics Laboratory of Federal University of Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Carlos Julio Tierra-Criollo
- Engineering School, Center for Research and Education in Biomedical Engineering-Pampulha, Belo Horizonte, MG, 31270-901, Brazil. .,Alberto Luiz Coimbra Institute for Graduate Studies and Research in Engineering, Biomedical Engineering Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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170
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Turville M, Carey LM, Matyas TA, Blennerhassett J. Change in Functional Arm Use Is Associated With Somatosensory Skills After Sensory Retraining Poststroke. Am J Occup Ther 2017; 71:7103190070p1-7103190070p9. [DOI: 10.5014/ajot.2017.024950] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. We investigated changes in functional arm use after retraining for stroke-related somatosensory loss and identified whether such changes are associated with somatosensory discrimination skills.
METHOD. Data were pooled (N = 80) from two randomized controlled trials of somatosensory retraining. We used the Motor Activity Log to measure perceived amount of arm use in daily activities and the Action Research Arm Test to measure performance capacity. Somatosensory discrimination skills were measured using standardized modality-specific measures.
RESULTS. Participants’ arm use improved after somatosensory retraining (z = −6.80, p < .01). Change in arm use was weakly associated with somatosensation (tactile, β = 0.31, p < .01; proprioception, β = −0.17, p > .05; object recognition, β = 0.13, p < .05).
CONCLUSION. Change in daily arm use was related to a small amount of variance in somatosensory outcomes. Stroke survivors’ functional arm use can increase after somatosensory retraining, with change varying among survivors.
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Affiliation(s)
- Megan Turville
- Megan Turville, B. OT (Hons), B. BSc, is Doctoral Candidate, Department of Community and Clinical Allied Health, School of Allied Health, College of Science, Health, and Engineering, La Trobe University, Melbourne, Victoria, Australia; and Neurorehabilitation and Recovery, Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia;
| | - Leeanne M. Carey
- Leeanne M. Carey, PhD, OT, FAOTA, is Professor of Occupational Therapy, Discipline Lead, Occupational Therapy, Department of Community and Clinical Allied Health, School of Allied Health, College of Science, Health, and Engineering, La Trobe University, Melbourne, Victoria, Australia; and Head, Neurorehabilitation and Recovery, Stroke Division, Florey Institute of Neuroscience and Mental Health,
| | - Thomas A. Matyas
- Thomas A. Matyas, PhD, is Adjunct Professor, Occupational Therapy, School of Allied Health and School of Psychology and Public Health, College of Science, Health, and Engineering, La Trobe University, Melbourne, Victoria, Australia; and Honorary Professional Fellow, Neurorehabilitation and Recovery, Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Austral
| | - Jannette Blennerhassett
- Jannette Blennerhassett, PhD, PT, is Physical Therapist, Austin Health, Melbourne, Victoria, Australia
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171
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Tavakolan M, Frehlick Z, Yong X, Menon C. Classifying three imaginary states of the same upper extremity using time-domain features. PLoS One 2017; 12:e0174161. [PMID: 28358916 PMCID: PMC5373527 DOI: 10.1371/journal.pone.0174161] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 03/03/2017] [Indexed: 11/18/2022] Open
Abstract
Brain-computer interface (BCI) allows collaboration between humans and machines. It translates the electrical activity of the brain to understandable commands to operate a machine or a device. In this study, we propose a method to improve the accuracy of a 3-class BCI using electroencephalographic (EEG) signals. This BCI discriminates rest against imaginary grasps and elbow movements of the same limb. This classification task is challenging because imaginary movements within the same limb have close spatial representations on the motor cortex area. The proposed method extracts time-domain features and classifies them using a support vector machine (SVM) with a radial basis kernel function (RBF). An average accuracy of 74.2% was obtained when using the proposed method on a dataset collected, prior to this study, from 12 healthy individuals. This accuracy was higher than that obtained when other widely used methods, such as common spatial patterns (CSP), filter bank CSP (FBCSP), and band power methods, were used on the same dataset. These results are encouraging and the proposed method could potentially be used in future applications including BCI-driven robotic devices, such as a portable exoskeleton for the arm, to assist individuals with impaired upper extremity functions in performing daily tasks.
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Affiliation(s)
- Mojgan Tavakolan
- Menrva Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Zack Frehlick
- Menrva Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Xinyi Yong
- Menrva Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Carlo Menon
- Menrva Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Burnaby, British Columbia, Canada
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172
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Huang X, Naghdy F, Naghdy G, Du H, Todd C. Robot-assisted post-stroke motion rehabilitation in upper extremities: a survey. ACTA ACUST UNITED AC 2017. [DOI: 10.1515/ijdhd-2016-0035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractRecent neurological research indicates that the impaired motor skills of post-stroke patients can be enhanced and possibly restored through task-oriented repetitive training. This is due to neuroplasticity – the ability of the brain to change through adulthood. Various rehabilitation processes have been developed to take advantage of neuroplasticity to retrain neural pathways and restore or improve motor skills lost as a result of stroke or spinal cord injuries (SCI). Research in this area over the last few decades has resulted in a better understanding of the dynamics of rehabilitation in post-stroke patients and development of auxiliary devices and tools to induce repeated targeted body movements. With the growing number of stroke rehabilitation therapies, the application of robotics within the rehabilitation process has received much attention. As such, numerous mechanical and robot-assisted upper limb and hand function training devices have been proposed. A systematic review of robotic-assisted upper extremity (UE) motion rehabilitation therapies was carried out in this study. The strengths and limitations of each method and its effectiveness in arm and hand function recovery were evaluated. The study provides a comparative analysis of the latest developments and trends in this field, and assists in identifying research gaps and potential future work.
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173
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Toovey R, Bernie C, Harvey AR, McGinley JL, Spittle AJ. Task-specific gross motor skills training for ambulant school-aged children with cerebral palsy: a systematic review. BMJ Paediatr Open 2017; 1:e000078. [PMID: 29637118 PMCID: PMC5862184 DOI: 10.1136/bmjpo-2017-000078] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/06/2017] [Accepted: 07/08/2017] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The primary objective is to systematically evaluate the evidence for the effectiveness of task-specific training (TST) of gross motor skills for improving activity and/or participation outcomes in ambulant school-aged children with cerebral palsy (CP). The secondary objective is to identify motor learning strategies reported within TST and assess relationship to outcome. DESIGN Systematic review. METHOD Relevant databases were searched for studies including: children with CP (mean age >4 years and >60% of the sample ambulant); TST targeting gross motor skills and activity (skill performance, gross motor function and functional skills) and/or participation-related outcomes. Quality of included studies was assessed using standardised tools for risk of bias, study design and quality of evidence across outcomes. Continuous data were summarised for each study using standardised mean difference (SMD) and 95% CIs. RESULTS Thirteen studies met inclusion criteria: eight randomised controlled trials (RCTs), three comparative studies, one repeated-measures study and one single-subject design study. Risk of bias was moderate across studies. Components of TST varied and were often poorly reported. Within-group effects of TST were positive across all outcomes of interest in 11 studies. In RCTs, between-group effects were conflicting for skill performance and functional skills, positive for participation-related outcomes (one study: Life-HABITS performance SMD=1.19, 95% CI 0.3 to 2.07, p<0.001; Life-HABITS satisfaction SMD=1.29, 95% CI 0.40 to 2.18, p=0.001), while no difference or negative effects were found for gross motor function. The quality of evidence was low-to-moderate overall. Variability and poor reporting of motor learning strategies limited assessment of relationship to outcome. CONCLUSIONS Limited evidence for TST for gross motor skills in ambulant children with CP exists for improving activity and participation-related outcomes and recommendations for use over other interventions are limited by poor study methodology and heterogeneous interventions. REGISTRATION PROSPERO ID42016036727.
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Affiliation(s)
- Rachel Toovey
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Charmaine Bernie
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Neurodevelopment and Disability, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Adrienne R Harvey
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Neurodevelopment and Disability, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Jennifer L McGinley
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Alicia J Spittle
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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174
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Fleming MK, Newham DJ, Rothwell JC. Explicit motor sequence learning with the paretic arm after stroke. Disabil Rehabil 2016; 40:323-328. [PMID: 27927022 DOI: 10.1080/09638288.2016.1258091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Motor sequence learning is important for stroke recovery, but experimental tasks require dexterous movements, which are impossible for people with upper limb impairment. This makes it difficult to draw conclusions about the impact of stroke on learning motor sequences. We aimed to test a paradigm requiring gross arm movements to determine whether stroke survivors with upper limb impairment were capable of learning a movement sequence as effectively as age-matched controls. MATERIALS AND METHODS In this case-control study, 12 stroke survivors (10-138 months post-stroke, mean age 64 years) attempted the task once using their affected arm. Ten healthy controls (mean 66 years) used their non-dominant arm. A sequence of 10 movements was repeated 25 times. The variables were: time from target illumination until the cursor left the central square (onset time; OT), accuracy (path length), and movement speed. RESULTS OT reduced with training (p < 0.05) for both groups, with no change in movement speed or accuracy (p > 0.1). We quantified learning as the OT difference between the end of training and a random sequence; this was smaller for stroke survivors than controls (p = 0.015). CONCLUSIONS Stroke survivors can learn a movement sequence with their paretic arm, but demonstrate impairments in sequence specific learning. Implications for Rehabilitation Motor sequence learning is important for recovery of movement after stroke. Stroke survivors were found to be capable of learning a movement sequence with their paretic arm, supporting the concept of repetitive task training for recovery of movement. Stroke survivors showed impaired sequence specific learning in comparison with age-matched controls, indicating that they may need more repetitions of a sequence in order to re-learn movements. Further research is required into the effect of lesion location, time since stroke, hand dominance and gender on learning of motor sequences after stroke.
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Affiliation(s)
- Melanie K Fleming
- a Centre of Human and Aerospace Physiological Sciences , King's College London , London , UK
| | - Di J Newham
- a Centre of Human and Aerospace Physiological Sciences , King's College London , London , UK
| | - John C Rothwell
- b Institute of Neurology , University College London , London , UK
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175
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Arcolin I, Pisano F, Delconte C, Godi M, Schieppati M, Mezzani A, Picco D, Grasso M, Nardone A. Intensive cycle ergometer training improves gait speed and endurance in patients with Parkinson's disease: A comparison with treadmill training. Restor Neurol Neurosci 2016; 34:125-38. [PMID: 26684265 DOI: 10.3233/rnn-150506] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Cycle ergometer training improves gait in the elderly, but its effect in patients with Parkinson's disease (PD) is not completely known. METHODS Twenty-nine PD inpatients were randomized to treadmill (n = 13, PD-T) or cycle ergometer (n = 16, PD-C) training for 3 weeks, 1 hour/day. Outcome measures were distance travelled during the 6-min walking test (6MWT), spatio-temporal variables of gait assessed by baropodometry, the Timed Up and Go (TUG) duration, the balance score through the Mini-BESTest, and the score of the Unified Parkinson's Disease Rating Scale (UPDRS). RESULTS Sex, age, body mass index, disease duration, Hoehn-Yahr staging, comorbidity and medication did not differ between groups. At end of training, ANCOVA showed significant improvement, of similar degree, in both groups for 6MWT, speed, step length and cadence of gait, TUG, Mini-BESTest and UPDRS. CONCLUSIONS This pilot study shows that cycle ergometer training improves walking parameters and reduces clinical signs of PD, as much as treadmill training does. Gait velocity is accompanied by step lengthening, making the gait pattern close to that of healthy subjects. Cycle ergometer is a valid alternative to treadmill for improving gait in short term in patients with PD.
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Affiliation(s)
- Ilaria Arcolin
- Posture and Movement Laboratory, Division of Physical Medicine and Rehabilitation, Scientific Institute of Veruno (NO), Fondazione Salvatore Maugeri (IRCCS), Veruno (NO), Italy
| | - Fabrizio Pisano
- Division of Neurological Rehabilitation, Scientific Institute of Veruno (NO), Fondazione Salvatore Maugeri (IRCCS), Veruno (NO), Italy
| | - Carmen Delconte
- Division of Neurological Rehabilitation, Scientific Institute of Veruno (NO), Fondazione Salvatore Maugeri (IRCCS), Veruno (NO), Italy
| | - Marco Godi
- Posture and Movement Laboratory, Division of Physical Medicine and Rehabilitation, Scientific Institute of Veruno (NO), Fondazione Salvatore Maugeri (IRCCS), Veruno (NO), Italy
| | - Marco Schieppati
- Centro Studi Attività Motorie (CSAM), Fondazione Salvatore Maugeri (IRCCS), Scientific Institute of Pavia, Italy.,Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - Alessandro Mezzani
- Division of Cardiac Rehabilitation, Scientific Institute of Veruno (NO), Fondazione Salvatore Maugeri (IRCCS), Veruno (NO), Italy
| | - Daniele Picco
- Division of Neurological Rehabilitation, Scientific Institute of Veruno (NO), Fondazione Salvatore Maugeri (IRCCS), Veruno (NO), Italy
| | - Margherita Grasso
- Posture and Movement Laboratory, Division of Physical Medicine and Rehabilitation, Scientific Institute of Veruno (NO), Fondazione Salvatore Maugeri (IRCCS), Veruno (NO), Italy
| | - Antonio Nardone
- Posture and Movement Laboratory, Division of Physical Medicine and Rehabilitation, Scientific Institute of Veruno (NO), Fondazione Salvatore Maugeri (IRCCS), Veruno (NO), Italy.,Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
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176
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On the Efficacy of Isolating Shoulder and Elbow Movements with a Soft, Portable, and Wearable Robotic Device. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/978-3-319-46532-6_15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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177
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Srikesavan CS, Shay B, Szturm T. Task-Oriented Training with Computer Games for People with Rheumatoid Arthritis or Hand Osteoarthritis: A Feasibility Randomized Controlled Trial. Games Health J 2016; 5:295-303. [DOI: 10.1089/g4h.2016.0005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Cynthia Swarnalatha Srikesavan
- Centre for Rehabilitation Research in Oxford (RRIO), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Barbara Shay
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Tony Szturm
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
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178
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Graef P, Michaelsen SM, Dadalt MLR, Rodrigues DAMS, Pereira F, Pagnussat AS. Effects of functional and analytical strength training on upper-extremity activity after stroke: a randomized controlled trial. Braz J Phys Ther 2016; 20:543-552. [PMID: 27683837 PMCID: PMC5176200 DOI: 10.1590/bjpt-rbf.2014.0187] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 03/14/2016] [Indexed: 11/25/2022] Open
Abstract
Objective To investigate the effects of functional strengthening (using functional movements) and analytical strengthening (using repetitive movements) on level of activity and muscular strength gain in patients with chronic hemiparesis after stroke. Method A randomized, assessor-blinded trial was conducted in a therapist-supervised home rehabilitation program. Twenty-seven patients with chronic stroke were randomly allocated one of two groups: functional strengthening (FS) (n=13) and analytical strengthening (AS) (n=14). Each group received a five-week muscle strengthening protocol (30 minutes per day, three times per week) including functional movements or analytical movements, respectively. Pre-, post-, and ten-month follow-up outcomes included the Upper-Extremity Performance Test (primary outcome), Shoulder and Grip Strength, Active Shoulder Range of Motion (ROM), the Fugl-Meyer Assessment, and the Modified Ashworth Scale (MAS) (secondary outcomes). Results There was significant improvement in the Upper-Extremity Performance Test for the combined unilateral and bilateral task scores in the FS Group (mean difference 2.4; 95% CI=0.14 to 4.6) in the 10-month follow-up. No significant difference was observed between groups in the other outcomes (p>0.05). Conclusion A five-week home-based functional muscle strengthening induced positive results for the upper-extremity level of activity of patients with moderate impairment after chronic stroke.
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Affiliation(s)
- Patrícia Graef
- Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.,Escola da Saúde, Centro Universitário Ritter dos Reis (UNIRITTER), Porto Alegre, RS, Brazil.,Programa de Pós-graduação em Ciências da Saúde, UFCSPA, Porto Alegre, RS, Brazil
| | - Stella M Michaelsen
- Programa de Pós-graduação em Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil
| | | | | | - Franciele Pereira
- Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Aline S Pagnussat
- Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.,Programa de Pós-graduação em Ciências da Saúde, UFCSPA, Porto Alegre, RS, Brazil.,Departamento de Fisioterapia, UFCSPA, Porto Alegre, RS, Brazil
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179
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Effects of Pilates-Based Core Stability Training in Ambulant People With Multiple Sclerosis: Multicenter, Assessor-Blinded, Randomized Controlled Trial. Phys Ther 2016; 96:1170-8. [PMID: 26893507 DOI: 10.2522/ptj.20150166] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 01/25/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pilates exercise is often undertaken by people with multiple sclerosis (MS) who have balance and mobility difficulties. OBJECTIVES The primary aim of the study was to compare the effects of 12 weeks of Pilates exercises with relaxation on balance and mobility. Secondary aims were: (1) to compare standardized exercises with relaxation and (2) to compare Pilates exercises with standardized exercises. METHODS A multicenter, assessor-blinded, randomized controlled trial was conducted. Participants with Expanded Disability Status Scale scores of 4.0 to 6.5 were randomly allocated to groups receiving 12 weeks of Pilates exercises, standardized exercises, or relaxation. Assessments were undertaken at baseline and weeks 12 and 16 (primary outcome measure: 10-Meter Timed Walk Test [10MTW]). RESULTS One hundred participants (mean age=54 years, 74% female) were randomized to study groups. Six participants relapsed (withdrew from the study), leaving 94 participants for intention-to-treat analysis. There was no significant difference in mean 10MTW measurements between the Pilates and relaxation groups. At 12 weeks, there was a mean reduction of 4.2 seconds for the standardized exercise group compared with the relaxation group (95% confidence interval [relaxation group minus standardized exercise group measurements]=0.0, 8.4) and a mean reduction of 3.7 seconds for the Pilates group compared with the standardized exercise group (95% confidence interval [Pilates group minus standardized exercise group measurements]=-0.4 to 7.8). At 16 weeks, mean 10MTW times for the standardized exercise group remained quicker than those for the Pilates and relaxation groups, although the differences were nonsignificant. There were no significant differences between the Pilates and relaxation groups for any secondary outcome measure. LIMITATIONS In this study, therapists were limited to a standardized basket of exercises that may have affected the study outcomes. Furthermore, choosing measures such as posturography to assess balance, accelerometry to assess walking, or a specific trunk assessment scale might have been more responsive in detecting changes in outcome. CONCLUSION Participants did not improve significantly, either in the short term or at the 4-week follow-up, on the 10MTW after 12 weeks of Pilates exercises compared with 12 weeks of relaxation.
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180
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Hansen AØ, Cederlund R, Kristensen HK, Tromborg H. The effect of an occupation-based intervention in patients with hand-related disorders grouped using the sense of coherence scale: Study protocol. HAND THERAPY 2016. [DOI: 10.1177/1758998316651456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction High-quality rehabilitation is required if patients with hand-related disorders are to achieve high levels of functioning. Occupation-based interventions are effective in stroke, hip fractures, and for elderly people, but there is limited knowledge of their effect in hand therapy. Sense of coherence may affect rehabilitation outcome, since patients with weak sense of coherence experience lower functioning, are less satisfied with their occupational performance, have inferior quality of life and more pain compared to patients with stronger sense of coherence . Method Following SPIRIT guidelines, we present a randomized, controlled, parallel-grouped trial. It investigates the effect of an occupation-based intervention for outpatients with hand-related disorders and whether sense of coherence influences the outcomes. Patients are stratified into three groups (weak, medium and strong sense of coherence) and randomized to occupation-based or exercise-based hand therapy. Sample size calculation indicates that 70 patients are required in each intervention in each separate sense of coherence group. With an expected drop-out of 20%, a total of 504 participants will be randomized. Primary analysis is score change in functioning measured by the Disabilities of the Arm, Shoulder and Hand from start of rehabilitation to three months’ follow-up. Secondary outcomes are self-evaluated occupational performance and satisfaction with occupational performance. Conclusion This study will add valuable knowledge to the field of hand therapy regarding the therapeutic use of occupations that patients find meaningful. Moreover, it may show which patients will benefit the most from an occupation-based intervention in relation to their sense of coherence.
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Affiliation(s)
- Alice Ø Hansen
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Orthopedic Surgery, Odense University Hospital, Odense, Denmark
- Department of Rehabilitation, Odense University Hospital, Odense, Denmark
| | | | - Hanne K Kristensen
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Rehabilitation, Odense University Hospital, Odense, Denmark
- University College Lillebaelt, Jelling, Denmark
| | - Hans Tromborg
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Orthopedic Surgery, Odense University Hospital, Odense, Denmark
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181
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Conductive Education as a Method of Stroke Rehabilitation: A Single Blinded Randomised Controlled Feasibility Study. Stroke Res Treat 2016; 2016:5391598. [PMID: 27418997 PMCID: PMC4935920 DOI: 10.1155/2016/5391598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/29/2016] [Indexed: 11/22/2022] Open
Abstract
Background. Conductive Education for stroke survivors has shown promise but randomised evidence is unavailable. This study assessed the feasibility of a definitive randomised controlled trial to evaluate efficacy. Methods. Adult stroke survivors were recruited through local community notices. Those completing the baseline assessment were randomised using an online program and group allocation was independent. Intervention group participants received 10 weekly 1.5-hour sessions of Conductive Education at the National Institute of Conductive Education in Birmingham, UK. The control group participants attended two group meetings. The study evaluated the feasibility of recruitment procedures, delivery of the intervention, retention of participants, and appropriateness of outcome measures and data collection methods. Independent assessments included the Barthel Index, the Stroke Impact Scale, the Timed Up and Go test, and the Hospital Anxiety and Depression Scale. Results. Eighty-two patients were enrolled; 77 completed the baseline assessment (46 men, mean age 62.1 yrs.) and were randomised. 70 commenced the intervention (n = 37) or an equivalent waiting period (n = 33). 32/37 completed the 10-week training and 32/33 the waiting period. There were no missing items from completed questionnaires and no adverse events. Discussion. Recruitment, intervention, and assessment methods worked well. Transport issues for intervention and assessment appointments require review. Conclusion. A definitive trial is feasible. This trial is registered with ISRCTN84064492.
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182
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Ovechkin AV, Sayenko DG, Ovechkina EN, Aslan SC, Pitts T, Folz RJ. Respiratory motor training and neuromuscular plasticity in patients with chronic obstructive pulmonary disease: A pilot study. Respir Physiol Neurobiol 2016; 229:59-64. [PMID: 27137413 PMCID: PMC4887410 DOI: 10.1016/j.resp.2016.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/03/2016] [Accepted: 04/11/2016] [Indexed: 12/29/2022]
Abstract
The objective of this study was to examine the feasibility of a full-scale investigation of the neurophysiological mechanisms of COPD-induced respiratory neuromuscular control deficits. Characterization of respiratory single- and multi-muscle activation patterns using surface electromyography (sEMG) were assessed along with functional measures at baseline and following 21±2 (mean±SD) sessions of respiratory motor training (RMT) performed during a one-month period in four patients with GOLD stage II or III COPD. Pre-training, the individuals with COPD showed significantly increased (p<0.05) overall respiratory muscle activity and disorganized multi-muscle activation patterns in association with lowered spirometrical measures and decreased fast- and slow-twitch fiber activity as compared to healthy controls (N=4). Following RMT, functional and respiratory sEMG activation outcomes during quite breathing and forced expiratory efforts were improved suggesting that functional improvements, induced by task-specific RMT, are evidence respiratory neuromuscular networks re-organization.
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Affiliation(s)
- Alexander V Ovechkin
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.
| | - Dimitry G Sayenko
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA; Department of Integrative Biology and Physiology, University of California, Los Angeles, CA, USA
| | - Elena N Ovechkina
- Department of Medicine: Division of Pulmonary, Critical Care and Sleep Disorders, University of Louisville, Louisville, KY, USA
| | - Sevda C Aslan
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Teresa Pitts
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Rodney J Folz
- Department of Medicine: Division of Pulmonary, Critical Care and Sleep Disorders, University of Louisville, Louisville, KY, USA; Department of Medicine: Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals and Case Western Reserve University, Cleveland, OH, USA
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183
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Cunningham P, Turton AJ, Van Wijck F, Van Vliet P. Task-specific reach-to-grasp training after stroke: development and description of a home-based intervention. Clin Rehabil 2016; 30:731-40. [DOI: 10.1177/0269215515603438] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 08/09/2015] [Indexed: 11/16/2022]
Abstract
This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is to transparently describe the process of developing a complex intervention for people after stroke as part of a feasibility randomised controlled trial. Objective: To describe and justify the development of a home-based, task-specific upper limb training intervention to improve reach-to-grasp after stroke and pilot it for feasibility and acceptability prior to a randomized controlled trial. Intervention description: The intervention is based on intensive practice of whole reach-to-grasp tasks and part-practice of essential reach-to-grasp components. A ‘pilot’ manual of activities covering the domains of self-care, leisure and productivity was developed for the feasibility study. The intervention comprises 14 hours of therapist-delivered sessions over six weeks, with additional self-practice recommended for 42 hours (i.e. one hour every day). As part of a feasibility randomized controlled trial, 24 people with a wide range of upper limb impairment after stroke experienced the intervention to test adherence and acceptability. The median number of repetitions in one-hour therapist-delivered sessions was 157 (interquartile range IQR 96–211). The amount of self-practice was poorly documented. Where recorded, the median amount of practice was 30 minutes (interquartile range 22–45) per day. Findings demonstrated that the majority of participants found the intensity, content and level of difficulty of the intervention acceptable, and the programme to be beneficial. Comments on the content and presentation of the self-practice material were incorporated in a revised ‘final’ intervention manual. Discussion: A comprehensive training intervention to improve reach-to-grasp for people living at home after stroke has been described in accordance with the Template for Intervention Description and Replication (TIDieR) reporting guidelines. The intervention has been piloted, and found to be acceptable and feasible in the home setting. Trial registration: ISRCTN56716589
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Affiliation(s)
- Paul Cunningham
- Department of Allied Health Professions, University of the West of England, Bristol, UK
| | - Ailie J Turton
- Department of Allied Health Professions, University of the West of England, Bristol, UK
| | | | - Paulette Van Vliet
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Hunter Medical Research Institute, Australia
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184
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Hsieh YW, Wu CY, Wang WE, Lin KC, Chang KC, Chen CC, Liu CT. Bilateral robotic priming before task-oriented approach in subacute stroke rehabilitation: a pilot randomized controlled trial. Clin Rehabil 2016; 31:225-233. [PMID: 26893457 DOI: 10.1177/0269215516633275] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate the treatment effects of bilateral robotic priming combined with the task-oriented approach on motor impairment, disability, daily function, and quality of life in patients with subacute stroke. DESIGN A randomized controlled trial. SETTING Occupational therapy clinics in medical centers. SUBJECTS Thirty-one subacute stroke patients were recruited. INTERVENTIONS Participants were randomly assigned to receive bilateral priming combined with the task-oriented approach (i.e., primed group) or to the task-oriented approach alone (i.e., unprimed group) for 90 minutes/day, 5 days/week for 4 weeks. The primed group began with the bilateral priming technique by using a bimanual robot-aided device. MAIN MEASURES Motor impairments were assessed by the Fugal-Meyer Assessment, grip strength, and the Box and Block Test. Disability and daily function were measured by the modified Rankin Scale, the Functional Independence Measure, and actigraphy. Quality of life was examined by the Stroke Impact Scale. RESULTS The primed and unprimed groups improved significantly on most outcomes over time. The primed group demonstrated significantly better improvement on the Stroke Impact Scale strength subscale ( p = 0.012) and a trend for greater improvement on the modified Rankin Scale ( p = 0.065) than the unprimed group. CONCLUSION Bilateral priming combined with the task-oriented approach elicited more improvements in self-reported strength and disability degrees than the task-oriented approach by itself. Further large-scale research with at least 31 participants in each intervention group is suggested to confirm the study findings.
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Affiliation(s)
- Yu-Wei Hsieh
- 1 Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,2 Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Yi Wu
- 1 Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,2 Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Wei-En Wang
- 1 Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Keh-Chung Lin
- 3 School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,4 Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Ku-Chou Chang
- 5 Division of Cerebrovascular Diseases, Department of Neurology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,6 Department of Senior Citizen Service Management, Yuh-Ing Junior College, Kaohsiung, Taiwan.,7 Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Chi Chen
- 7 Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,8 Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Ting Liu
- 9 Department of Physical Medicine and Rehabilitation, Taipei Tzuchi Hospital, Buddhist Tzuchi Medical Foundation, New Taipei City, Taiwan
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185
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Cho KH, Song WK. Robot-Assisted Reach Training for Improving Upper Extremity Function of Chronic Stroke. TOHOKU J EXP MED 2016; 237:149-55. [PMID: 26460793 DOI: 10.1620/tjem.237.149] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Stroke, as a major risk factor for chronic impairment of upper limb function, can severely restrict the activities of daily living. Recently, robotic devices have been used to enhance the functional upper extremity movement of stroke patients. The purpose of the current study was to assess whether a robot-assisted reach training program using a whole arm manipulator (WAM) could improve upper extremity kinematic performance and functional movement for chronic stroke patients. Using a single-group design, this study followed 10 people with chronic stroke (6 men, 61.5 years; Mini-Mental State Examination score: 27.0; onset duration: 8.9 years). WAM with seven degrees of freedom for the shoulder, elbow, and wrist joints was used during robot-assisted reach exercises. Subjects participated in the training program for 40 minutes per day, 2 times a week, for 4 weeks. The main outcome measures were upper extremity kinematic performance (movement velocity) for three directions and functional movement (Action Research Arm Test). Upper extremity kinematic performance and functional movement measures were performed three times: at baseline, during intervention (at 2 weeks), and post intervention. Upper extremity kinematic performance and functional movement showed improvement after two weeks (P < 0.05) and four weeks (P < 0.05) of training compared to baseline. The findings of the current study demonstrated the positive effects of short-term robot-assisted reach training on upper extremity kinematic performance as well as functional movement in individuals with chronic stroke. In addition, the findings of the current study may provide valuable information for subsequent randomized controlled trials.
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Affiliation(s)
- Ki Hun Cho
- Department of Rehabilitative and Assistive Technology, Korea National Rehabilitation Research Institute, Korea National Rehabilitation Center
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186
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Pedersen M, Bundgaard TH, Zeeman P, Jørgensen JR, Sørensen PMB, Berro HM, Larsson BW. Action research in rehabilitation with chronic stroke recovery: A case report with a focus on neural plasticity. NeuroRehabilitation 2016; 39:261-72. [PMID: 27372361 DOI: 10.3233/nre-161356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Chronic stroke patients are primarily referred to general rehabilitation, rather than to specific neurorehabilitation. Currently, there are no Danish clinical guidelines for chronic stroke, but recent research in neuroplasticity has contributed to possible rehabilitation interventions for these patients. OBJECTIVE The purpose of this project is to describe the use of a specialized neuroplastic approach in combination with an already existing training program. METHODS The project is designed as an action research project concerning four participants with chronic stroke. Through ten intervention, a neuroplastic focus has been added to their group training program including daily home training. Participants were tested before and after the intervention with MAS, DGI, 6MWT, SSQLS. RESULTS All four participants improved their functional levels and their quality of life following the intervention. CONCLUSIONS This report indicates that a specific neuroplastic focus in combination with action research has an impact on the participants with chronic stroke. However, there is still no clarity regarding what type of rehabilitation methods can be considered the most efficacious in promoting neuroplasticity. This case report serves as a pilot project for further studies of how to implement neuroplasticity in physical therapy.
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Affiliation(s)
| | | | - Peter Zeeman
- Center for Rehabilitation of Brain Injury, University of Copenhagen, Denmark
| | - Jørgen R Jørgensen
- Center for Rehabilitation of Brain Injury, University of Copenhagen, Denmark
| | | | - Hamza M Berro
- Department of Neurorehabilitation, Region S, Denmark
| | - Bodil W Larsson
- Metropolitan University College, Physiotherapy, Copenhagen, Denmark
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187
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Proffitt R. Home Exercise Programs for Adults With Neurological Injuries: A Survey. Am J Occup Ther 2016; 70:7003290020p1-8. [PMID: 27089296 DOI: 10.5014/ajot.2016.019729] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The purpose of this study was to describe current occupational therapy practices in the usage and prescription of and clinical reasoning process supporting home exercise programs (HEPs) for clients with neurological injuries (CWNIs). METHOD A survey was distributed via mail to 2,000 members of the American Occupational Therapy Association. The survey questions concerned basic demographics, current HEP practices, and attitudes toward using HEPs with CWNIs. RESULTS In the 360 returned surveys, occupational therapists reported numerous benefits of using HEPs and were able to clearly articulate their clinical reasoning. Commonly reported HEP activities were preparatory in nature, and the most frequently prescribed dosage was 16-30 min daily. Most therapists relied on the same clinical reasoning process but varied in implementation methods. CONCLUSION This study's results highlight the gaps between evidence and practice. The active ingredients in HEPs for CWNIs need to be more clearly defined and described.
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Affiliation(s)
- Rachel Proffitt
- Rachel Proffitt, OTD, OTR/L, is Assistant Professor, Department of Occupational Therapy, University of Missouri, Columbia;
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188
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Salsabili H, Bahrpeyma F, Esteki A. The effects of Task-Oriented Motor Training on gait characteristics of patients with type 2 diabetes neuropathy. J Diabetes Metab Disord 2016; 15:14. [PMID: 27231683 PMCID: PMC4881175 DOI: 10.1186/s40200-016-0236-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 05/01/2016] [Indexed: 12/01/2022]
Abstract
Background It is known that general gait training improves lower extremity muscle strength and endurance in Diabetes Neuropathy (DN). But, it is still unknown whether Task-Oriented (TO) gait training would change gait biomechanics and the risk of falling in DN. TO gait training focuses on promoting timing and coordination of lower extremity movements through goal-directed practices with sufficient repetition. Methods A group of 14 patients with DN participated in a time-series study. All subjects participated in four sessions of assessments (Initial, Pre, Post and Follow-Up). Training was twice a week for 12 weeks. Vertical and horizontal Ground Reaction Forces (GRF), Time Get up and Go (TGUG) and Fall Efficacy Scale-International (FES-I) were evaluated. Gait training started with stepping patterns that progressively changed to complicated patterns of walking. Then, training continued combining walking patterns with upper extremity activities and then ended with treadmill-paced practice. Results DN patients significantly increased Second Vertical Peak Force and Horizontal Propulsive Force in addition decrease in Minimum Vertical Force. TGUG significantly decreased while FES-I reflected significant increase after gait training. Discussion Conclusively, training not only improved gait performance, confidence in daily activities and attenuated risk of falling, but also helped DN patients to improve feet biomechanics, muscles timing and coordination. Conclusions Gait training with respect to principles of motor learning allowed patients to effectively improve through sessions.
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Affiliation(s)
- Hoda Salsabili
- Department of Physiotherapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Farid Bahrpeyma
- Department of Physiotherapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Ali Esteki
- Medical Physics and Engineering Department, Shahid Beheshti University of Medical Science, Tehran, Iran
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189
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Im SJ, Kim YH, Kim KH, Han JW, Yoon SJ, Park JH. The effect of a task-specific locomotor training strategy on gait stability in patients with cerebellar disease: a feasibility study. Disabil Rehabil 2016; 39:1002-1008. [DOI: 10.1080/09638288.2016.1177124] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Seung-Jin Im
- Department of Physical Education, Korea University, Seoul, South Korea
| | - Yong-Hyun Kim
- Department of Physical Education, Korea University, Seoul, South Korea
| | - Kwon-Hee Kim
- Department of Mechanical Engineering, Korea University, Seoul, South Korea
| | - Jae-Woong Han
- Department of Mechanical Engineering, Korea University, Seoul, South Korea
| | - Sung-Jin Yoon
- Department of Physical Education, Korea University, Seoul, South Korea
| | - Jin-Hoon Park
- Department of Physical Education, Korea University, Seoul, South Korea
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190
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Barrett N, Swain I, Gatzidis C, Mecheraoui C. The use and effect of video game design theory in the creation of game-based systems for upper limb stroke rehabilitation. J Rehabil Assist Technol Eng 2016; 3:2055668316643644. [PMID: 31186903 PMCID: PMC6453078 DOI: 10.1177/2055668316643644] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/04/2016] [Indexed: 12/30/2022] Open
Abstract
Upper limb exercise is often neglected during post-stroke rehabilitation. Video
games have been shown to be useful in providing environments in which patients
can practise repetitive, functionally meaningful movements, and in inducing
neuroplasticity. The design of video games is often focused upon a number of
fundamental principles, such as reward, goals, challenge and the concept of
meaningful play, and these same principles are important in the design of games
for rehabilitation. Further to this, there have been several attempts for the
strengthening of the relationship between commercial game design and
rehabilitative game design, the former providing insight into factors that can
increase motivation and engagement with the latter. In this article, we present
an overview of various game design principles and the theoretical grounding
behind their presence, in addition to attempts made to utilise these principles
in the creation of upper limb stroke rehabilitation systems and the outcomes of
their use. We also present research aiming to move the collaborative efforts of
designers and therapists towards a model for the structured design of these
games and the various steps taken concerning the theoretical classification and
mapping of game design concepts with intended cognitive and motor outcomes.
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Affiliation(s)
- N Barrett
- Odstock Medical Limited, Salisbury District Hospital, Salisbury, UK.,Faculty of Science and Technology, Bournemouth University, Poole, UK
| | - I Swain
- Odstock Medical Limited, Salisbury District Hospital, Salisbury, UK.,Faculty of Science and Technology, Bournemouth University, Poole, UK
| | - C Gatzidis
- Faculty of Science and Technology, Bournemouth University, Poole, UK
| | - C Mecheraoui
- Odstock Medical Limited, Salisbury District Hospital, Salisbury, UK
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191
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Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, Deruyter F, Eng JJ, Fisher B, Harvey RL, Lang CE, MacKay-Lyons M, Ottenbacher KJ, Pugh S, Reeves MJ, Richards LG, Stiers W, Zorowitz RD. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 47:e98-e169. [PMID: 27145936 DOI: 10.1161/str.0000000000000098] [Citation(s) in RCA: 1519] [Impact Index Per Article: 189.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. METHODS Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential. CONCLUSIONS As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts. (Stroke.2016;47:e98-e169. DOI: 10.1161/STR.0000000000000098.).
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192
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Nagpal A, Kremer KL, Hamilton-Bruce MA, Kaidonis X, Milton AG, Levi C, Shi S, Carey L, Hillier S, Rose M, Zacest A, Takhar P, Koblar SA. TOOTH (The Open study Of dental pulp stem cell Therapy in Humans): Study protocol for evaluating safety and feasibility of autologous human adult dental pulp stem cell therapy in patients with chronic disability after stroke. Int J Stroke 2016; 11:575-85. [PMID: 27030504 DOI: 10.1177/1747493016641111] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 12/11/2015] [Indexed: 12/24/2022]
Abstract
RATIONALE Stroke represents a significant global disease burden. As of 2015, there is no chemical or biological therapy proven to actively enhance neurological recovery during the chronic phase post-stroke. Globally, cell-based therapy in stroke is at the stage of clinical translation and may improve neurological function through various mechanisms such as neural replacement, neuroprotection, angiogenesis, immuno-modulation, and neuroplasticity. Preclinical evidence in a rodent model of middle cerebral artery ischemic stroke as reported in four independent studies indicates improvement in neurobehavioral function with adult human dental pulp stem cell therapy. Human adult dental pulp stem cells present an exciting potential therapeutic option for improving post-stroke disability. AIMS TOOTH (The Open study Of dental pulp stem cell Therapy in Humans) will investigate the use of autologous stem cell therapy for stroke survivors with chronic disability, with the following objectives: (a) determine the maximum tolerable dose of autologous dental pulp stem cell therapy; (b) define that dental pulp stem cell therapy at the maximum tolerable dose is safe and feasible in chronic stroke; and (c) estimate the parameters of efficacy required to design a future Phase 2/3 clinical trial. METHODS AND DESIGN TOOTH is a Phase 1, open-label, single-blinded clinical trial with a pragmatic design that comprises three stages: Stage 1 will involve the selection of 27 participants with middle cerebral artery ischemic stroke and the commencement of autologous dental pulp stem cell isolation, growth, and testing in sequential cohorts (n = 3). Stage 2 will involve the transplantation of dental pulp stem cell in each cohort of participants with an ascending dose and subsequent observation for a 6-month period for any dental pulp stem cell-related adverse events. Stage 3 will investigate the neurosurgical intervention of the maximum tolerable dose of autologous dental pulp stem cell followed by 9 weeks of intensive task-specific rehabilitation. Advanced magnetic resonance and positron emission tomography neuro-imaging, and clinical assessment will be employed to probe any change afforded by stem cell therapy in combination with rehabilitation. SAMPLE SIZE ESTIMATES Nine participants will step-wise progress in Stage 2 to a dose of up to 10 million dental pulp stem cell, employing a cumulative 3 + 3 statistical design with low starting stem cell dose and subsequent dose escalation, assuming that an acceptable probability of dose-limiting complications is between 1 in 6 (17%) and 1 in 3 (33%) of patients. In Stage 3, another 18 participants will receive an intracranial injection with the maximum tolerable dose of dental pulp stem cell. OUTCOMES The primary outcomes to be measured are safety and feasibility of intracranial administration of autologous human adult DPSC in patients with chronic stroke and determination of the maximum tolerable dose in human subjects. Secondary outcomes include estimation of the measures of effectiveness required to design a future Phase 2/3 clinical trial.
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Affiliation(s)
- Anjali Nagpal
- School of Medicine, The University of Adelaide, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia
| | - Karlea L Kremer
- School of Medicine, The University of Adelaide, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia
| | - Monica A Hamilton-Bruce
- Neurology Department, The Queen Elizabeth Hospital, Woodville, South Australia School of Medicine, University of Adelaide, Adelaide, South Australia
| | - Xenia Kaidonis
- School of Medicine, The University of Adelaide, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia
| | - Austin G Milton
- Neurology Department, The Queen Elizabeth Hospital, Woodville, South Australia
| | - Christopher Levi
- Hunter Medical Research Institute, University of Newcastle, New South Wales, Australia
| | - Songtao Shi
- School of Dental Medicine, University of Pennsylvania, Philadelphia, USA
| | - Leeanne Carey
- Neurorehabilitation and Recovery research group, Stroke Division, Florey Institute of Neuroscience and Mental Health La Trobe University, Melbourne, Victoria, Australia School of Allied Health, La Trobe University, Melbourne, Australia
| | - Susan Hillier
- Health Sciences Divisional Office School of Health Sciences, University of South Australia, Adelaide, South Australia
| | - Miranda Rose
- School of Allied Health, La Trobe University, Melbourne, Australia
| | - Andrew Zacest
- Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia
| | - Parabjit Takhar
- Molecular Imaging and Therapy Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia
| | - Simon A Koblar
- School of Medicine, University of Adelaide, Adelaide, South Australia SAHMRI & Basil Hetzel Institute, The Queen Elizabeth Hospital, Woodville, South Australia
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193
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Fleming MK, Pavlou M, Newham DJ, Sztriha L, Teo JT. Non-invasive brain stimulation for the lower limb after stroke: what do we know so far and what should we be doing next? Disabil Rehabil 2016; 39:714-720. [PMID: 27013330 DOI: 10.3109/09638288.2016.1161835] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Non-invasive brain stimulation (NIBS) is promising as an adjuvant to rehabilitation of motor function after stroke. Despite numerous studies and reviews for the upper limb, NIBS targeting the lower limb and gait recovery after stroke is a newly emerging field of research. PURPOSE To summarize findings from studies using NIBS to target the lower limb in stroke survivors. METHODS This narrative review describes studies of repetitive transcranial magnetic stimulation, paired associative stimulation and transcranial direct current stimulation with survivors of stroke. RESULTS NIBS appears capable of inducing changes in cortical excitability and lower limb function, but stimulation parameters and study designs vary considerably making it difficult to determine effectiveness. CONCLUSIONS Future research should systematically assess differences in response with different stimulation parameters, test measures for determining who would be most likely to benefit and assess effectiveness with large samples before NIBS can be considered for use in clinical practice. Implications for Rehabilitation Stroke is a leading cause of disability, often resulting in dependency in activities of daily living and reduced quality of life. Non-invasive brain stimulation has received considerable interest as a potential adjuvant to rehabilitation after stroke and this review summarizes studies targeting the lower limb and gait recovery. Non-invasive brain stimulation can be used to modulate excitability of lower limb muscle representations and can lead to improvements in motor performance in stroke survivors. Non-invasive brain stimulation for gait recovery needs further investigation before translation to clinical practice is possible.
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Affiliation(s)
- Melanie K Fleming
- a Centre of Human & Aerospace Physiological Sciences, Faculty of Life Sciences and Medicine , King's College London , London , UK
| | - Marousa Pavlou
- a Centre of Human & Aerospace Physiological Sciences, Faculty of Life Sciences and Medicine , King's College London , London , UK
| | - Di J Newham
- a Centre of Human & Aerospace Physiological Sciences, Faculty of Life Sciences and Medicine , King's College London , London , UK
| | - Laszlo Sztriha
- b Department of Stroke & Neurology , Princess Royal University Hospital, King's College Hospital NHS Foundation Trust , London , UK
| | - James T Teo
- b Department of Stroke & Neurology , Princess Royal University Hospital, King's College Hospital NHS Foundation Trust , London , UK.,c Institute of Neurology , University College London , London , UK
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Salter K, Musovic A, F. Taylor N. In the first 3 months after stroke is progressive resistance training safe and does it improve activity? A systematic review. Top Stroke Rehabil 2016; 23:366-75. [DOI: 10.1080/10749357.2016.1160656] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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195
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Shin JH, Kim MY, Lee JY, Jeon YJ, Kim S, Lee S, Seo B, Choi Y. Effects of virtual reality-based rehabilitation on distal upper extremity function and health-related quality of life: a single-blinded, randomized controlled trial. J Neuroeng Rehabil 2016; 13:17. [PMID: 26911438 PMCID: PMC4765099 DOI: 10.1186/s12984-016-0125-x] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/12/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Virtual reality (VR)-based rehabilitation has been reported to have beneficial effects on upper extremity function in stroke survivors; however, there is limited information about its effects on distal upper extremity function and health-related quality of life (HRQoL). The purpose of the present study was to examine the effects of VR-based rehabilitation combined with standard occupational therapy on distal upper extremity function and HRQoL, and compare the findings to those of amount-matched conventional rehabilitation in stroke survivors. METHODS The present study was a single-blinded, randomized controlled trial. The study included 46 stroke survivors who were randomized to a Smart Glove (SG) group or a conventional intervention (CON) group. In both groups, the interventions were targeted to the distal upper extremity and standard occupational therapy was administered. The primary outcome was the change in the Fugl-Meyer assessment (FM) scores, and the secondary outcomes were the changes in the Jebsen-Taylor hand function test (JTT), Purdue pegboard test, and Stroke Impact Scale (SIS) version 3.0 scores. The outcomes were assessed before the intervention, in the middle of the intervention, immediately after the intervention, and 1 month after the intervention. RESULTS The improvements in the FM (FM-total, FM-prox, and FM-dist), JTT (JTT-total and JTT-gross), and SIS (composite and overall SIS, SIS-social participation, and SIS-mobility) scores were significantly greater in the SG group than in the CON group. CONCLUSIONS VR-based rehabilitation combined with standard occupational therapy might be more effective than amount-matched conventional rehabilitation for improving distal upper extremity function and HRQoL. TRIAL REGISTRATION This study is registered under the title "Effects of Novel Game Rehabilitation System on Upper Extremity Function of Patients With Stroke" and can be located in https://clinicaltrials.gov with the study identifier NCT02029651 .
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Affiliation(s)
- Joon-Ho Shin
- National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea.
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, Samgaksan-ro 58, Gangbuk-gu, Seoul, 142-884, Korea.
| | - Mi-Young Kim
- National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea.
| | - Ji-Yeong Lee
- National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea.
| | - Yu-Jin Jeon
- National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea.
| | - Suyoung Kim
- Department of Law, Hanyang University, Seoul, Korea.
| | | | - Beomjoo Seo
- School of Games, Hongik University, Seoul, Korea.
| | - Younggeun Choi
- Neofect, Yong-in, Korea.
- Department of Applied Computer Engineering, Dankook University, Yong-in, Korea.
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196
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Fong SSM, Guo X, Liu KPY, Ki WY, Louie LHT, Chung RCK, Macfarlane DJ. Task-Specific Balance Training Improves the Sensory Organisation of Balance Control in Children with Developmental Coordination Disorder: A Randomised Controlled Trial. Sci Rep 2016; 6:20945. [PMID: 26864309 PMCID: PMC4750073 DOI: 10.1038/srep20945] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 01/14/2016] [Indexed: 11/09/2022] Open
Abstract
Sensory organisation of balance control is compromised in children with developmental coordination disorder (DCD). A randomised controlled trial involving 88 children with DCD was conducted to evaluate the efficacy of a task-specific balance training (functional-movement training, FMT) programme in improving balance deficits in a DCD population. The DCD participants were randomly assigned to either a FMT group or a control group. The FMT group received two training sessions/ week for 3 months. Measurements of the participants' sensory organisation (somatosensory, vestibular and visual ratios), balance and motor proficiency (Movement Assessment Battery for Children, MABC scores) and center of pressure sway velocity (Unilateral Stance Test, UST scores) were taken at baseline, immediately after FMT and 3 months after FMT. The FMT group showed greater improvements than the controls in somatosensory ratio at 3 and 6 months (all P < 0.001), but the within-group changes were not significant (P > 0.05). The results of both the MABC and the UST also indicated that the balance performance of the FMT group was significantly better than that of the control group at 3 and 6 months (all P < 0.05). Task-specific balance training was found to marginally improve the somatosensory function and somewhat improve the balance performance of children with DCD.
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Affiliation(s)
- Shirley S M Fong
- Institute of Human Performance, The University of Hong Kong, Pokfulam, Hong Kong
| | - X Guo
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Karen P Y Liu
- School of Science and Health (Occupational Therapy), University of Western Sydney, NSW, Australia
| | - W Y Ki
- Institute of Human Performance, The University of Hong Kong, Pokfulam, Hong Kong.,Health, Physical Education and Recreation Department, Emporia State University, USA
| | - Lobo H T Louie
- Department of Physical Education, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Raymond C K Chung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Duncan J Macfarlane
- Institute of Human Performance, The University of Hong Kong, Pokfulam, Hong Kong
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197
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Winstein CJ, Wolf SL, Dromerick AW, Lane CJ, Nelsen MA, Lewthwaite R, Cen SY, Azen SP. Effect of a Task-Oriented Rehabilitation Program on Upper Extremity Recovery Following Motor Stroke: The ICARE Randomized Clinical Trial. JAMA 2016; 315:571-81. [PMID: 26864411 PMCID: PMC4795962 DOI: 10.1001/jama.2016.0276] [Citation(s) in RCA: 209] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
IMPORTANCE Clinical trials suggest that higher doses of task-oriented training are superior to current clinical practice for patients with stroke with upper extremity motor deficits. OBJECTIVE To compare the efficacy of a structured, task-oriented motor training program vs usual and customary occupational therapy (UCC) during stroke rehabilitation. DESIGN, SETTING, AND PARTICIPANTS Phase 3, pragmatic, single-blind randomized trial among 361 participants with moderate motor impairment recruited from 7 US hospitals over 44 months, treated in the outpatient setting from June 2009 to March 2014. INTERVENTIONS Structured, task-oriented upper extremity training (Accelerated Skill Acquisition Program [ASAP]; n = 119); dose-equivalent occupational therapy (DEUCC; n = 120); or monitoring-only occupational therapy (UCC; n = 122). The DEUCC group was prescribed 30 one-hour sessions over 10 weeks; the UCC group was only monitored, without specification of dose. MAIN OUTCOMES AND MEASURES The primary outcome was 12-month change in log-transformed Wolf Motor Function Test time score (WMFT, consisting of a mean of 15 timed arm movements and hand dexterity tasks). Secondary outcomes were change in WMFT time score (minimal clinically important difference [MCID] = 19 seconds) and proportion of patients improving ≥25 points on the Stroke Impact Scale (SIS) hand function score (MCID = 17.8 points). RESULTS Among the 361 randomized patients (mean age, 60.7 years; 56% men; 42% African American; mean time since stroke onset, 46 days), 304 (84%) completed the 12-month primary outcome assessment; in intention-to-treat analysis, mean group change scores (log WMFT, baseline to 12 months) were, for the ASAP group, 2.2 to 1.4 (difference, 0.82); DEUCC group, 2.0 to 1.2 (difference, 0.84); and UCC group, 2.1 to 1.4 (difference, 0.75), with no significant between-group differences (ASAP vs DEUCC: 0.14; 95% CI, -0.05 to 0.33; P = .16; ASAP vs UCC: -0.01; 95% CI, -0.22 to 0.21; P = .94; and DEUCC vs UCC: -0.14; 95% CI, -0.32 to 0.05; P = .15). Secondary outcomes for the ASAP group were WMFT change score, -8.8 seconds, and improved SIS, 73%; DEUCC group, WMFT, -8.1 seconds, and SIS, 72%; and UCC group, WMFT, -7.2 seconds, and SIS, 69%, with no significant pairwise between-group differences (ASAP vs DEUCC: WMFT, 1.8 seconds; 95% CI, -0.8 to 4.5 seconds; P = .18; improved SIS, 1%; 95% CI, -12% to 13%; P = .54; ASAP vs UCC: WMFT, -0.6 seconds, 95% CI, -3.8 to 2.6 seconds; P = .72; improved SIS, 4%; 95% CI, -9% to 16%; P = .48; and DEUCC vs UCC: WMFT, -2.1 seconds; 95% CI, -4.5 to 0.3 seconds; P = .08; improved SIS, 3%; 95% CI, -9% to 15%; P = .22). A total of 168 serious adverse events occurred in 109 participants, resulting in 8 patients withdrawing from the study. CONCLUSIONS AND RELEVANCE Among patients with motor stroke and primarily moderate upper extremity impairment, use of a structured, task-oriented rehabilitation program did not significantly improve motor function or recovery beyond either an equivalent or a lower dose of UCC upper extremity rehabilitation. These findings do not support superiority of this program among patients with motor stroke and primarily moderate upper extremity impairment. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00871715.
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198
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Kim YJ, Kim JK, Park SY. Effects of modified constraint-induced movement therapy and functional bimanual training on upper extremity function and daily activities in a patient with incomplete spinal cord injury: a case study. J Phys Ther Sci 2016; 27:3945-6. [PMID: 26834387 PMCID: PMC4713826 DOI: 10.1589/jpts.27.3945] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/24/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] In this study, we examined effects of modified constraint-induced movement
therapy (m-CIMT) and functional bimanual training, when applied to a patient with
incomplete spinal cord injury, on upper extremity function and daily activities. [Subject
and Methods] One patient, diagnosed with C4 incomplete spinal cord injury, underwent
physical therapy with constraint-induced movement therapy for 3 hours and task-oriented
bimanual training for 1 hour, per day. This combined 4-hour session was performed five
times a week, for 3 weeks, totaling 15 sessions. Upper extremity function was measured
using the Manual Function Test (MFT) and Box & Block Test (BBT). Additionally, Spinal
Cord Independence Measure Version III (SCIM-III) and Short Form 36 Health Survey (SF-36)
were used to assess functional outcomes. [Results] Mobility of the hand and overall
function of upper extremities were enhanced following intervention. Moreover, the
subject’s quality of life and ability to carry out daily activities also improved.
[Conclusion] Modified constraint-induced movement therapy and bimanual training was
effective in enhancing upper extremity function and performance of daily routines in a
patient with incomplete spinal cord injury. Further studies, recruiting multiple subjects,
should focus on m-CIMT using diverse methods, performed during the course of daily
activities.
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Affiliation(s)
- Yeon-Ju Kim
- Department of Occupational Therapy, Dawoori Medical Center, Republic of Korea
| | - Jin-Kyung Kim
- Department of Occupational Therapy, College of Health Science, Hanseo University, Republic of Korea
| | - So-Yeon Park
- Department of Occupational Therapy, College of Health Science, Hanseo University, Republic of Korea
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The Effects of Combination of Robot-Assisted Therapy With Task-Specific or Impairment-Oriented Training on Motor Function and Quality of Life in Chronic Stroke. PM R 2016; 8:721-9. [PMID: 26805909 DOI: 10.1016/j.pmrj.2016.01.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 12/14/2015] [Accepted: 01/13/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Robot-assisted therapy (RT) is a promising intervention for stroke rehabilitation. RT hybridized with therapist-mediated therapy (eg, RT plus task-specific or impairment-oriented training) may possibly yield functionally relevant improvements. A comparative study of the different combination regimens is needed. OBJECTIVE To investigate the efficacy of RT combined with task-specific training or impairment-oriented training on motor function and quality of life in patients with chronic stroke. DESIGN A single-blind, randomized comparative efficacy study. SETTING Two medical centers in Taiwan. PARTICIPANTS Twenty-one subjects with chronic stroke. INTERVENTIONS Participants were recruited and randomized into 1 of 2 groups: (1) RT combined with task-specific (RTT) training (enrolled, n = 11; completed, n = 11) or (2) RT combined with impairment-oriented (RTI) training (enrolled, n = 10; completed, n = 9). Participants received 20 intervention sessions (90-100 min/d, 5 d/wk for 4 weeks). OUTCOMES The Fugl-Meyer Motor Assessment Upper Extremity subscale, Stroke Impact Scale, Action Research Arm Test, and Medical Research Council Scale were administered at baseline, posttreatment, and at 3-month follow-up. Two-way repeated-measures analysis of variance was used to investigate the treatment effects. RESULTS The improvements of the RTT group in motor function measured by the Fugl-Meyer Motor Assessment Upper Extremity subscale and quality of life assessed by the Stroke Impact Scale were significantly superior to the RTI group after the interventions. The improvements of the RTT group were maintained for 3 months. Both groups demonstrated significant within-group improvements in motor function, muscle power, and quality of life. CONCLUSIONS RTT may be a more compelling approach to enhance motor function and quality of life for a long-term period than RTI. The combination of RT with task-specific training and with impairment-oriented training had similar benefits on upper limb motor function and muscle strength immediately after the interventions.
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200
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Kehoe R, Rice M. Reality, virtual reality, and imagery: Quality of movement in novice dart players. Br J Occup Ther 2016. [DOI: 10.1177/0308022615616820] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Meaning and purpose have been tenets of occupational therapy since the profession’s inception. Therefore, it is important to understand how to best employ these central concepts in practice. One way to do this is to study the “same” task under materials-based, imagery-based, and virtual reality conditions. Method Participants included 34 adult novice dart players, each of whom experienced all three conditions in a randomized order. Motion capture technology was used to evaluate the quality of motion during the three conditions. Results Similarities between the materials-based and imagery-based condition ( p > 0.0167) suggest participants utilized preconceived concepts of throwing real darts during these two conditions. Differences between the virtual reality and imagery-based conditions ( p < 0.0167) suggest that the virtual reality condition utilized a different motor performance, focusing less on perceptions of throwing darts and more on achieving successes within the virtual environment. Conclusion Implications are that utilizing materials-based occupations may be more efficient than imagery-based to enhance development of a skill; imagery-based performance is more similar to the materials-based performance than the virtual reality performance. Virtual reality occupations can be utilized should the patient find meaning and purpose in virtual reality occupations or if the patient cannot engage in a materials-based counterpart.
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Affiliation(s)
- Reggie Kehoe
- Occupational Therapist, Hillsdale Community Health Center Occupational Therapy, Hillsdale, MI, USA
| | - Martin Rice
- Dean, School of Health Sciences, Indiana Wesleyan University, Marion, Indiana, USA
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