Published in Movement Disorders, 02/26/2013 Dr. Walker compares the incidence and outcomes of Parkinson’s disease (PD) who suffer hip fracture compared to non PD patients in North East England. The team from the Department of Medicine, North Tyneside General Hospital, United Kingdom saw that PD patients had poorer mobility before hip fracture, had less mobility post surgery and took longer to be discharged into community physical rehabilitation. The team concludes that occupational and physiotherapists managing people with PD who sustain a hip fracture should be aware of potential complications of the condition to improve physical rehabilitation outcomes.
Posts Tagged ‘physical rehabilitation’
Kalsi–Ryan S et al in the January edition of World Neurosurgery discuss how the use of functional tests such as the Spinal Cord Independence Measure, Functional Independence Measure together with neurological impairment measures e.g the International Standards for Neurological Classification and electrophysiological measures will provide more insight to the post physical rehabilitation outcome than either of the predictors taken alone.
A 52 year old woman, named Jan Scheuermann, ate chocolate after a brain operation. So what? One might ask. However this simple act made history because Jan is paralyzed from the neck down
Originally diagnosed with a degenerative brain disorder 13 years prior doctors implanted tiny electrodes in her brain which allowed her to operate a robotic arm.
Jan’s ultimate wish was to feed herself chocolate once the electrodes had been in place.
Doctors, led by Professor Andrew Schwartz of the University of Pittsburgh Medical Center, applauded her feat.
The arm is a prosthetic controlled directly by the brain and this achievement marked a major step for people who are unable to move their own arms.
“Our study has shown us that it is technically feasible to restore ability and gives patients hope for the future”, said Dr. Schwartz.
The two microelectrodes were implanted into Jan’s left motor cortex. This is the part of the brain that initiates movement.
A scanning technique called ”functional magnetic resonance imaging” (fMRI) located the part of the brain that lights up when the patient is asked to think about moving her paralyzed arms.
The electrodes were connected to the robotic hand through a computer which ran an algorithm to translate the signals that imitates the way an unimpaired brain is able to control healthy limbs.
Decoding human motion has no limit now. It is quite complex when one works on parts like the hand for example, but once the desired motion is tapped how that motion will be effected has a wide range of possibilities according to the medical researchers.
For those brain injured patients that still have arm mobility the ARMTUTOR and HANDTUTOR offer an effective physical therapy solution.
The ARMTUTOR™ and HANDTUTOR systems have been developed to allow for functional rehabilitation of the upper extremity including the shoulder, elbow and wrist. The system consists of an ergonomic wearable glove and arm brace together with dedicated rehabilitation software. The ARMTUTOR™ and HANDTUTOR systems allow the physical and occupational therapist to report on and evaluate the patient’s functional rehabilitation progress. This allows the PT and OT to prescribe the correct customized and motivating intensive exercise practice to the manual rehabilitation therapy. Intensive repetition of movement is achieved through challenging games set to the patient’s ability. The system provides detailed exercise performance instructions and precise feedback on the patient’s efforts. Controlled exercise of multijoints within the normal movement pattern prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks. Telerehabilitation allows the recovering patient to continue his physical therapy at home. The system is used by many leading rehabilitation centers worldwide and has full FDA and CE certification.
See WWW.MEDITOUCH.CO.IL for more information.
Brasilia, Brazil — It was found in a recent study that stroke patients found greater satisfaction if their progress was assessed on the basis of patient-specified goals.
According to Lisa Shaw, MD, senior research associate, Institute for Ageing and Health in Newcastle University in Newcastle upon Tyne, United Kingdom, one third of patient-driven goals was bimanual, i.e. assessing the function of both hands, which may have been the reason for better outcomes than standard measures which may have missed that.
Using botulinum toxin-A (BT) in conjunction with a standard upper-limb therapy program, it was found that on objective measures of arm function following a stroke, neither therapy showed improved function after 1 month. However, patients stated they were equally satisfied with either therapy if satisfaction was based on attainment of goals that they had chosen themselves.
The original BT for Upper Limb after stroke trial compared upper-limb therapy alone with therapy plus BT, It was found that using BT improved muscle tone after 1 month and a longer-term, arm strength, basic arm function tasks and pain. But it didn’t improve arm function overall. BT has increasingly been used to reduce spasticity.
The investigators then asked the patients which therapy goals they would choose and how attainment of those goals compared with outcomes on a standard arm function test. They designed a controlled, randomized clinical trial with (blinded) observers to look at arm function according to the Action Research Arm Test (ARAT), which consists of grip, grasp, pinch, and gross movement assessments vs patient-specified goal attainment, as assessed by COPM, the Canadian Occupational Performance Measure which involves performance and satisfaction.
Participants were adults with upper-limb spasticity and reduced function at least 1 month after stroke. The average age was 68 years. 65% to 71% of patients were men and about 82% of participants had had a thrombotic stroke.
The interventions consisted of a 1-month upper-limb therapy program for 1 hour twice weekly with or without BT, when outcomes were assessed. BT was injected into muscles of the hand, wrist, elbow, or shoulder depending the individual patterns of spasticity.
Treatments were focused on four set goals and one optional goal within the COPM. The focus was on passive, stretching; active assisted upper-limb movement; positioning; hygiene and intensive task-oriented practice for ARAT.
The most commonly selected goals — about 90% of each group — were washing, dressing, eating and drinking. Participants chose goals of self-care (65%); productivity i.e. working in the kitchen, managing the household, going to school, playing or writing (19%); and leisure activities (16%). One third of the goals were bimanual tasks.
After 1 month, there were no differences in the degree of improvement between the BT and the control groups. No change from baseline on the ARAT occurred in either group.
Dr. Shaw said that despite the finding that BT did not enhance goal attainment or arm function compared with standard upper-limb therapy alone, both the BT and control groups had relevant improvements of greater than 2 points on the COPM. ARAT measures are mostly unimanual, however many COPM measures involve both the hands and arms. Dr. Shaw said the study shows the importance of including patient-specified goals when studying rehabilitation.
Werner Hacke, MD, PhD, MPsych, professor and chairman of the Department of Neurology at the University of Heidelberg, Germany, agreed, saying ”It is about caring about the patient, and I believe it doesn’t matter what you do, if you care and you have a positive psychological impact on the patients, they will benefit, and they feel better. This is what is probably the most important thing about early rehabilitation — spending time with the patient, independent of what you do.”
He added that there is no proof that one or another physical therapy approach is better than another.
In stroke recovery finding the right physical therapy solution is vital. The TUTOR system of products provide an innovative method of providing an intensive exercise regimen to stroke survivors in rehabilitation of their affected limbs. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are ergonomically designed gloves and braces that consist of sensors connected to dedicated software. Physical and occupational therapists monitor the patient’s movement ability and then design a customized exercise program for that patient.
Currently in use in leading U.S. and European hospitals and clinics the TUTORs are fully certified by the FDA and CE. They are available for adults as well as children from the age of 5 and up and can be used in the patient’s home through telerehabilitation.
See WWW.MEDITOUCH.CO.IL for further information.