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Eriksson BM, Peny-Dahlstrand M, Archenholtz B, Weichbrodt J, Lidman G. Intervention with hand orthosis: experience from boys with Duchenne muscular dystrophy and their parents. Disabil Rehabil 2024; 46:3432-3439. [PMID: 37641887 DOI: 10.1080/09638288.2023.2251393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE To identify and describe possible ways of experiencing an intervention with hand orthoses in a study group including boys with Duchenne muscular dystrophy (DMD) and their parents. To capture the experiences of the persons directly involved as well as their family members. MATERIAL AND METHODS Eight boys with DMD (aged 8-21; median age 17.7) and five of their parents were interviewed immediately post-intervention. Additionally, follow-up interviews were later performed with five boys and three parents. RESULTS Ten categories of intervention experiences emerged and were allocated to three aspects: "Prerequisites in the treatment situation", "The intervention makes a difference" and "Instilling hope for the future". The requirements for intervention success include co-operation with parents and hand orthoses with a good fit. Maintained or increased joint mobility, reduced pain and improved occupational performance were experienced. CONCLUSION The boys and parents perceived that the intervention with hand orthoses could counteract the deterioration of the boys' hands. This instilled hope of preserving occupational performance throughout life. They also considered that a good hand-orthosis fit, appropriate adjustments to daily routines and good co-operation with the people around them were important for the intervention to be and remain successful.
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Affiliation(s)
- Britt-Marie Eriksson
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- Regional Pediatric Rehabilitation Centre, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marie Peny-Dahlstrand
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Birgitha Archenholtz
- Strategic Department of Quality Development, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johanna Weichbrodt
- Regional Pediatric Rehabilitation Centre, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Git Lidman
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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Badini S, Regondi S, Lammi C, Bollati C, Donvito G, Pugliese R. Computational Mechanics of Form-Fitting 3D-Printed Lattice-Based Wrist-Hand Orthosis for Motor Neuron Disease. Biomedicines 2023; 11:1787. [PMID: 37509427 PMCID: PMC10376028 DOI: 10.3390/biomedicines11071787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023] Open
Abstract
Motor neuron disease (MND) patients often experience hand-wrist muscle atrophy resulting in severe social consequences and hampering their daily activities. Although hand-wrist orthosis is commonly used to assist weakened muscles, its effectiveness is limited due to the rapid progression of the disease and the need for customization to suit individual patient requirements. To address these challenges, this study investigates the application of three-dimensional (3D) printing technology to design and fabricate two lattice structures inspired by silkworm cocoons, using poly-ε-caprolactone as feedstock material. Finite element method (FEM) analysis is employed to study the mechanical behavior, enabling control over the geometric configuration incorporated into the hand-wrist orthosis. Through tensile displacement and three-point bending simulations, the stress distribution is examined for both lattice geometries. Geometry-1 demonstrates anisotropic behavior, while geometry-2 exhibits no strict directional dependence due to its symmetry and uniform node positioning. Moreover, the biocompatibility of lattices with human skin fibroblasts is investigated, confirming excellent biocompatibility. Lastly, the study involves semi-structured interviews with MND patients to gather feedback and develop prototypes of form-fitting 3D-printed lattice-based hand-wrist orthosis. By utilizing 3D printing technology, this study aims to provide customized orthosis that can effectively support weakened muscles and reposition the hand for individuals with MND.
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Affiliation(s)
- Silvia Badini
- Nemolab, ASST GOM Niguarda Cà Granda Hospital, 20162 Milan, Italy
| | - Stefano Regondi
- Nemolab, ASST GOM Niguarda Cà Granda Hospital, 20162 Milan, Italy
- NEuroMuscular Omnicenter (NEMO), 20162 Milan, Italy
| | - Carmen Lammi
- Department of Pharmaceutical Sciences, University of Milan, 20133 Milan, Italy
| | - Carlotta Bollati
- Department of Pharmaceutical Sciences, University of Milan, 20133 Milan, Italy
| | - Giordana Donvito
- Nemolab, ASST GOM Niguarda Cà Granda Hospital, 20162 Milan, Italy
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Occupational therapy using a robotic-assisted glove ameliorates finger dexterity and modulates functional connectivity in amyotrophic lateral sclerosis. J Clin Neurosci 2023; 107:144-149. [PMID: 36411175 DOI: 10.1016/j.jocn.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/01/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Although rehabilitation is recommended for amyotrophic lateral sclerosis (ALS), improvement of functional decline has hardly been achieved. We investigated the effect of occupational therapy that uses a robotic-assisted glove (RAG) on hand dexterity and the functional connectivities found in the brain of ALS patients. METHOD Ten patients diagnosed with ALS and admitted to the Shiga University of Medical Science (SUMS) Hospital from December 2018 to December 2021 participated in the study. These participants chose the hand side to wear RAG and exercised for two weeks. A sham movement was performed on the other side. We administered several functional assessments, including the Simple Test for Evaluating Hand Function (STEF), grip strength, pinch meter for grip strength, Canadian occupational performance measure (COPM), as well as nerve conduction study (NCS) before and after the exercise, and evaluated the results. We also analyzed six patients' resting-state functional magnetic resonance imaging (rs-fMRI). RESULTS Two-week robotic rehabilitation improved the STEF, grip strength, and COPM scores when compared with those of the other side. However, no significant effect was observed in the pinch meter and the NCS results. The rs-fMRI data analysis revealed that the robotic rehabilitation augmented two functional connectivities between the left pallidum-right supplementary motor cortex and right insular cortex-right sensorimotor network among the patients, which had beneficial effects. CONCLUSION The occupational therapy using RAG displayed improved hand dexterity. The enhanced functional connectivities around the sensorimotor network might be associated with the improvement in hand dexterity because of the RAG.
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Delijorge J, Mendoza-Montoya O, Gordillo JL, Caraza R, Martinez HR, Antelis JM. Evaluation of a P300-Based Brain-Machine Interface for a Robotic Hand-Orthosis Control. Front Neurosci 2020; 14:589659. [PMID: 33328860 PMCID: PMC7729175 DOI: 10.3389/fnins.2020.589659] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/22/2020] [Indexed: 12/11/2022] Open
Abstract
This work presents the design, implementation, and evaluation of a P300-based brain-machine interface (BMI) developed to control a robotic hand-orthosis. The purpose of this system is to assist patients with amyotrophic lateral sclerosis (ALS) who cannot open and close their hands by themselves. The user of this interface can select one of six targets, which represent the flexion-extension of one finger independently or the movement of the five fingers simultaneously. We tested offline and online our BMI on eighteen healthy subjects (HS) and eight ALS patients. In the offline test, we used the calibration data of each participant recorded in the experimental sessions to estimate the accuracy of the BMI to classify correctly single epochs as target or non-target trials. On average, the system accuracy was 78.7% for target epochs and 85.7% for non-target trials. Additionally, we observed significant P300 responses in the calibration recordings of all the participants, including the ALS patients. For the BMI online test, each subject performed from 6 to 36 attempts of target selections using the interface. In this case, around 46% of the participants obtained 100% of accuracy, and the average online accuracy was 89.83%. The maximum information transfer rate (ITR) observed in the experiments was 52.83 bit/min, whereas that the average ITR was 18.13 bit/min. The contributions of this work are the following. First, we report the development and evaluation of a mind-controlled robotic hand-orthosis for patients with ALS. To our knowledge, this BMI is one of the first P300-based assistive robotic devices with multiple targets evaluated on people with ALS. Second, we provide a database with calibration data and online EEG recordings obtained in the evaluation of our BMI. This data is useful to develop and compare other BMI systems and test the processing pipelines of similar applications.
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Affiliation(s)
- Jonathan Delijorge
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Monterrey, Mexico
| | | | - Jose L Gordillo
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Monterrey, Mexico
| | - Ricardo Caraza
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - Hector R Martinez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - Javier M Antelis
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Monterrey, Mexico
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Spaulding SE, Yamane A, McDonald CL, Spaulding SA. A conceptual framework for orthotic and prosthetic education. Prosthet Orthot Int 2019; 43:369-381. [PMID: 31199192 DOI: 10.1177/0309364619852455] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Variables that influence orthotic and prosthetic patient outcomes beyond direct care are poorly conceptualized for orthotic and prosthetic students. Restructuring educational curricula around important clinical reasoning variables (i.e. factors that may influence outcomes) could improve teaching, learning, and clinical practice. OBJECTIVES To propose an orthotic and prosthetic education framework to enhance the development of orthotic and prosthetic students' clinical reasoning skills. STUDY DESIGN Scoping review. METHODS We conducted a scoping review, identified variables of orthotic and prosthetic usability, and performed a qualitative thematic analysis through the lens of orthotic and prosthetic clinical educators to develop a conceptual framework for orthotic and prosthetic education. RESULTS Sorting of variables identified from the literature resulted in three thematic areas: (1) the state of functioning, disability, and health (International Classification of Functioning, Disability and Health); (2) orthotic and prosthetic technical properties, procedures, and appropriateness; and (3) professional service as part of orthotic and prosthetic interventions. The proposed orthotic and prosthetic education framework includes these three areas situated within the context of patient-centered care. CONCLUSIONS A conceptual framework was developed from variables identified in peer-reviewed literature. This orthotic and prosthetic education framework provides a structure to explore orthotic and prosthetic clinical reasoning and advance our teaching and assessment of students' clinical reasoning skills. CLINICAL RELEVANCE The proposed orthotic and prosthetic (O&P) education framework is intended to promote conversation about variables (e.g. health condition, procedures, services, and O&P principles) that influence O&P clinical practice outcomes and further advance our teaching and assessment of students' clinical reasoning skills.
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Affiliation(s)
- Susan E Spaulding
- 1 Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Ann Yamane
- 1 Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Cody L McDonald
- 1 Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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Weichbrodt J, Eriksson BM, Kroksmark AK. Evaluation of hand orthoses in Duchenne muscular dystrophy. Disabil Rehabil 2017; 40:2824-2832. [DOI: 10.1080/09638288.2017.1347721] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Johanna Weichbrodt
- Regional Pediatric Rehabilitation Centre, The Queen Silvia Children’s Hospital, Sahlgrenska University Hospital Gothenburg, Gothenburg, Sweden
| | - Britt-Marie Eriksson
- Regional Pediatric Rehabilitation Centre, The Queen Silvia Children’s Hospital, Sahlgrenska University Hospital Gothenburg, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden
| | - Anna-Karin Kroksmark
- Regional Pediatric Rehabilitation Centre, The Queen Silvia Children’s Hospital, Sahlgrenska University Hospital Gothenburg, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden
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Paganoni S, Karam C, Joyce N, Bedlack R, Carter GT. Comprehensive rehabilitative care across the spectrum of amyotrophic lateral sclerosis. NeuroRehabilitation 2015; 37:53-68. [PMID: 26409693 PMCID: PMC5223769 DOI: 10.3233/nre-151240] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease) is a neurodegenerative disease that results in progressive muscle weakness and wasting. There is no known cure and the disease is uniformly fatal. PURPOSE This review discusses current concepts in ALS care, from breaking the diagnosis to end-of-life care. People with ALS have several multidisciplinary needs due to a complex and dynamic disease process. They benefit from rehabilitation interventions that are individualized and have the goal of optimizing independence, function, and safety. These strategies also help minimize symptomatic burden and maximize quality of life. CONCLUSION Patient-centered, multidisciplinary care has a significant impact on the life of people with ALS and is the current standard of care for this patient population.
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Affiliation(s)
- Sabrina Paganoni
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Massachusetts General Hospital and Boston VA Healthcare System, Boston, MA, USA
| | - Chafic Karam
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Nanette Joyce
- Department of Physical Medicine and Rehabilitation, Neuromuscular Section, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Richard Bedlack
- Duke University School of Medicine and Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Gregory T Carter
- Department of Physical Medicine and Rehabilitation, St Luke's Rehabilitation Institute, Spokane, WA, USA
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