Home therapy to improve arm and hand function after brain injury in New Zealand

Over 30,000 New Zealanders have a traumatic brain injury (TBI) each year. Added to this only 11 per cent of people with stroke receive any rehabilitation therapy after they leave hospital.

Because of this the Health Research council of New Zealand have awarded two grants to physical therapists from  The University of Auckland who will use technologies to treat and support brain injury patietns including stroke after discharge from in patient therapy. Firstly, Dr Kersten and her team will train people in the community who have had a TBI in the past to act as mentors or peer mentors for people with a recent moderate to severe TBI. Participation is considered a fundamental outcome of rehabilitation for people with TBI,” Dr Kersten says.

A second project lead by Dr Stinear will evaluate a new home-coach model of therapy for stroke survivors. In New Zealand, only 11 per cent of people with stroke receive any rehabilitation therapy after they leave hospital. This is despite research that shows rehabilitation therapy is capable of improving hand and arm function months or years after stroke. Dr James Stinear from The University of Auckland says “There are tens of thousands of people living with stroke in our community who have an untapped capacity to recover,” explains Dr Stinear and the objective of this study is to test and design a ‘home-therapy’ protocol.”

After a physiotherapist has assessed the therapy needs of a person with stroke a family member, carer, friend or other volunteer will act as a ‘home-coach’ to deliver daily therapy in the home.

Self–management programmes specific to stroke survivors

Self care is about individuals taking responsibility for their own health and well-being.The experience of a stroke event may result in a disruption to the patients daily life. Stroke patients often report have fears that they will have permanent disability and this leads to major concerns over their ability to recover and be productive and engaged with family, friends and coworkers. 

Lennon S et al. writing in Clinical Rehabilitation, 04/19/2013 from Physiotherapy, School of Medicine, Flinders University, Adelaide, Australia undertook a literature review to examine the evidence base underlying self–management programmes specific to stroke survivors. The group concluded that further work is needed to confirm the feasibility, acceptability, and efficacy of stroke self–management programmes

Who benefits from residential intensive neurorehabilitation as opposed to community therapy in the UK

Answering this question Foy CML et al from the Rehabilitation Services, Brain Injury Centre, Banstead, Surrey, UK and Sutton Hospital, look at patient functional ability following rehabilitation at a mixed therapy and educational residential programme. The clients received 5 hours of education and/or physiotherapy and occupational therapy each day.

BothTBI and nonTBI made clinically and statistically significant improvements in their functional abilities during their neurorehabilitation and benefited from a mixed inpatient neurorehabilitation programme. The movement and functional improvements was predicted by the patients functional abilities at admission and the length of stay. Therefore preinjury and injury variables do give insight into functional recovery in traumatic brain injury (TBI) and non traumatic brain injury (nonTBI) patients.

Tremor dominant and postural gait difficulty subtypes in Parkinson disease

In  Parkinson disease (PD) differences in gray matter (GM) atrophy is seen when looking at patients with tremor dominant (TD) subtype compared to postural instability gait difficulty (PIGD).

GM atrophy in motor–related regions and decreased functional connectivity was associated with gait instability symptoms. The decrease in spontaneous coactivation between cortical and subcortical motor–planning areas may therefore relate to this movement impairment.

The above results was reported in a study published in Neurology. 2013 Mar was conducted by Physical Medicine specialists from the Movement Disorders Unit, Department of Neurology and Department of Physical Therapy Sackler School of Medicine Tel Aviv, Israel together with the Department of Medicine (J.M.H.), Harvard Medical School, Boston, MA USA.

Transcutaneous electrical nerve stimulation (TENS) during everyday activities – ‘activeTENS’

Writing in Clinical Rehabilitation, 03/18/2013, Prof Sarah Tyson (Physiotherapy) and team from Rehabilitation Research Group in the School of Health, Sciences at the University of Salford UK look at  ‘activeTENS’ which is transcutaneous electrical nerve stimulation (TENS) during everyday activities and its benefit in enhancing physical function after stroke. The group showed that balance, gait speed, plantarflexor strength and proprioception of plantarflexion improved during active TENS.

Physiotherapy improves function in patients following total hip replacement (THR)

Published in BMC Musculoskeletal Disorders 03/13/2013 Dr. Okoro T et al from Department of Orthopaedics and Physiotherapy Bangor University, Bangor, UK look at ’standard’ rehabilitation care in the UK after total hip replacement (THR). Because Total hip replacement (THR) is one of the most widely performed procedures in orthopaedic practice with the number of primary total hip replacements (THR) over 79413 in the UK (according to the National joint registry) undergoing THR. This number will increase with the rising age of the population.

THR for patients with end stage joint disease is shown to give pain relief, and substantial improvement in quality of life. However studies show that, even in the absence of pain, there is still movement impairments and functional limitation in post surgery patients including reduced muscle strength, reduced postural stability, and limited flexibility. These impairments cause functional limitations including reduced walking speed, and less functional ability. The group present evidence of prolonged poor function in patients following total hip replacement (THR) in the UK. Patients with poor functional outcome measures 2 years post-operatively after THR are five times more likely to require assistance with ADLs compared to those who have good function. Therefore it is important to  avoid long-term impairment and to optimise functional recovery.

Exercise therapy after TKA means less pain, improved physical function, and better quality of life

Published in Clinical Rehabilitation, 03/12/2013 Dr. Liao et al and team from Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan look at the effects of additional physical therapy and balance training on functional outcome after total knee replacement in patients with knee osteoarthritis (TKR).

By the year 2020, it is estimated that more than 3 million total knee arthroplasty (TKA) surgeries will be performed in the USA for end-stage arthritis in the knee joint.TKA Surgery shows rapid and substantial improvement in knee pain however 37% of patients have limited functional improvement 1 year after the surgery.

Common limitations include diminished walking speed, difficulty ascending and descending stairs.

This work follows up on work done by Dr. Riva and team from Department of Physical Therapy, University of Pittsburgh USA and published in Journal of American Physical therapy Association that also showed that additional balance training in people with TKA was supported by high exercise adherence with a relatively low dropout rate, and no adverse events.

Improvements in lower-extremity functional ability was shown by higher gait speed, single-leg stance time.

In Dr. Liao trial the control group received conventional function training for eight weeks and the experimental group received the same conventional training a +  additional balance exercises program.

Studies have shown the effectiveness of exercise therapy including range of motion, stretching, strengthening, and endurance exercises after hospital discharge. Home based and out patient exercise therapy improves the outcomes of patients after TKA including less pain, improved physical function, and better quality of life.

Main outcome measures were distance of functional forward reach; duration of single leg stance; timed sit-to-stand test; timed up-and-down stair test; timed 10-m walk; timed up-and-go test.

 

Early Discharge of Stroke patients needs to be supported by home based occupational and physiotherapy

Published in Clinical Rehabilitation 03/05/2013 Dr. Cobley discusses Early Supported Discharge service development and provision for Stroke patients in the UK.Using structured interviews with the 27 stroke patients, their families and carers, from the Nottinghamshire region UK his team highlight the need that Early Supported Discharge needs to be supported by home-based rehabilitation and ongoing rehabilitation services.

 

Intense PT promotes motor recovery in SCI patients

Published in Journal of Spinal Cord Medicine, 02/27/2013 Dr.  Larson CA et al present evidence to show evidence as to the effectiveness of intense physical therapy (Physiotherapy, PT) to promote motor recovery and sensory recovery in individuals with spinal cord injury SCI. The group also compares recovery for individuals who had an olfactory mucosa autograft (OMA a neural recovery/regenerative surgical procedure) with individuals who did not have the OMA where both groups participated in the intense PT program. The Physiotherapy was  intense – therapy dosage was 137.3 total hours, activity-based, out-patient and home based physical therapy (PT).

 The outcome measure used was the American Spinal Injury Association examination, motor and sensory scores. Mean . The participants’ total, upper and lower extremity motor scores improved significantly with 14 participants converted from motor-complete to motor-incomplete SCI. Dr. Larson and colleagues work at the Center for Spinal Cord Injury Recovery, the Oakland University Physical Therapy program and the Center for Spinal Cord Injury Recovery, Detroit, MI, USA.

How does movement imagery and observation improve outcomes of intensive and repetitive exercise practice

Writing in Neuropsychologia (Feb 2013) Dr. Maslovat School of Kinesiology, University of British Columbia, BC, Canada and team discuss hte mechanism by which imagery and observation of movements – covert movements involve similar motor preparation and neural pathways to overt movements or exercise practice. MediTouch is currently studying implications on how the timing of these covert movements improve movement ability outcomes of physical and occupational therapy using the HandTutor, ArmTutor and LegTutor.