Central post-stroke pain syndrome (CPSP) is described by patients as sharp, stabbing, or burning pain and the experience of hyperpathia – an abnormally exaggerated subjective response to painful stimuli and allodynia – where normally non-painful stimuli evoke pain. Pharmacological therapy, magnetic stimulation, and invasive electrical stimulation are reviewed and recommendations made for the treatment of Central post-stroke pain syndrome (CPSP) in Topics in Stroke Rehabilitation, 05/08/2013. The researchers are from the Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA.
Posts Tagged ‘stroke recovery’
Dr. Fisher and team from the division of Rehabilitation and Ageing, Community Health Sciences, University of Nottingham, UK examined the delivery of community based stroke rehabilitation and care in the UK. Evidence–based community stroke services need to support the current policy of early supported discharge. The group writing in Clinical Rehabilitation.outlined the challenge of giving tailored care to individual stroke patients with stroke specialist rehabilitation including occupational and physiotherapy being tailored to clinical need following discharge from hospital.
What do the following have in common?
Rural areas, medical insurance companies, 200,000 patients, cardiac patients, mental health patients, neurological telehealthdisease patients, suicide prevention and oncology follow-up care. An unlikely group of terms? Not if you consider that all of these derive a benefit or support from TELEHEALTH. In this age of high technology many medical procedures and benefits can be accomplished remotely and with as much expertise as with a face to face encounter with a professional.
Today, telehealth is fast taking its place as a major aspect of healthcare and is understood more than ever before.
Motor imagery is a well known practice that refers to mentally rehearsing motor acts instead of actual movement production.
Two-thirds of the 700,000 Americans who have a stroke each year survive and require rehabilitation. But fewer than one in three post-stroke patients undergoing physical therapy perform the at-home exercises their physical therapists recommend.
A team of researchers at Ohio State University is using a $653,000 grant from the Patient-Centered Outcomes Research Institute to develop a more fun and effective way for patients to work on regaining movement and mobility in their upper limbs.
Lynne Gauthier, an assistant professor of physical medicine and rehabilitation, is leading the team creating a video game for the Microsoft Kinect that the team hopes could expand access to a specific kind of rehabilitation called constraint-induced movement therapy. The game would allow patients with mild-to-moderate upper-limb impairment to perform guided CI therapy in their homes.
Studies have demonstrated the ability of CI therapy to improve upper extremity function in patients shortly after stroke and after time has passed. Several studies have also shown changes in brain activity associated with the therapy.
Despite a body of research that suggests CI therapy is more effective than standard rehabilitation, it hasn’t become standard of care because it costs about $6,000 and isn’t typically covered by insurance, Gauthier said, so only a small number of specialty clinics offer it. Less than one percent of patients who are eligible for it are able to travel to those clinics and pay for it, she added.
Gauthier said her team’s objective is to develop and pilot a home-based program that retains the fundamental principles of CI therapy but changes the way it’s delivered, so more patients can access it for a lower cost ($500 or less). The video game the team is developing targets both subacute stroke patients who have completed inpatient rehabilitation as well as patients with chronic post-stroke impairment.
The game uses Microsoft Kinect’s motion capture technology to guide patients through a series of therapeutic exercises set in a river adventure theme, Gauthier said. Patients would visit a clinic for initial consultation and the game would act as a consultant to guide them through exercises at home. Patients would also be given a restraint mitt to encourage them to use their affected side more often in daily activities.
“A lot of these kinds of rehab games are basically about just getting the person to move a lot,” she said. “But we’re trying to make it so that the game would stimulate what the therapist would do. Just as a therapist would make a task harder when the person improves, the game would do the same thing.”
To do that, Gauthier is working with a cross-disciplinary team made up of a computer scientist, an electrical engineer, a biomechanist, two physical therapists and Gauthier, a psychologist and neuroscientist.
Eventually the team will create computer algorithms that would allow the program to track patients’ progress over time and provide performance feedback to patients and therapists. For the first year of the grant, though, it’s focused on game design.
Over the next several months, the team will work with patients and therapists to refine the game; the second year of the grant will focus on testing it in patients’ homes. “We feel it’s very important to involve stakeholders,” she said. “We don’t really know what the therapist response is going to be, but we are trying to involve them to make sure that we design a product that they would actually use.”
Kinect joins other physical therapy solutions already helping patients recover their lost mobility strengths. One such product is the TUTOR family of products. The HANDTUTOR, ARMTUTOR,LEGTUTOR and 3DTUTOR are ergonomically designed comfortable gloves and braces which are placed strategically on affected limbs and allows the patient to get intensive self initiated exercises via sensors that are connected to dedicated software.
The ARMTUTOR specifically trains the upper limb through dedicated software games such as : snowman, asteroid attack, car race and others. The exercises are designed to increase brain activity. Therapists monitor progress and then design a customized exercise program for that patient giving him appropriate feedback. The TUTORs are currently in use in leading U.S. and European hospitals and clinics and are available through telerehabilitation in the patient’s home.
The TUTORs can be used by adults as well as children from the age of 5 and up and are fully certified by the FDA and CE.
See WWW.MEDITOUCH.CO.IL for further information.
Recently, interest in virtual-reality technology as used in physical rehabilitation has risen drastically. The applications in this field are varied. They range from simulations that address various phobias, to physical interfaces that help to improve and analyze fine motor control. In Physical Therapy, the majority of virtual-reality applications focus on hand and arm movements. This is because of the variety of available hand interfaces developed by the gaming industry. However, when used within the context of VR therapy, these hand interfaces only provide limited sensory information, which often yields unreliable results. For example, if an application requires the patient to move their arm in a certain manner, and the patient is unable to do this satisfactorily, he may compensate for the action by adjusting his posture or his shoulders. In that case, the patient fails in accomplishing the intended therapeutic objectives but the application may still register the action as a ‘success’.
Researchers note that typically, the patient compensates for a reach task mostly through moving the trunk forward and to a lesser extent, shoulder flexion. This movement compensation is used instead of the natural reach pattern, which involves interjoint co-ordination of shoulder, elbow and hand. Technologies that are available do address shoulder and posture control with the precision required by researchers but are cost-prohibitive and bulky. These include camera based motion-capture systems, which require high setup and maintenance costs. However physical and occupational therapists can now use the HANDTUTOR, ARMTUTOR and 3DTUTOR to allow their patients to practice intensive reaching and gripping exercises and receive feedback on the position of the trunk as they are performing the reaching task. The software also shows the patient how to reposition the trunk in the correct way. Being aware of the trunk position during reaching exercises using the ARMTUTOR and or HANDTUTOR will allow the patient to practice active trunk constraint.
The TUTOR system (which also includes a LEGTUTOR) was originally designed to assist patients recovering from stroke, brain/spinal cord injuries and other upper and lower limb disabilities. The TUTOR system consists of ergonomically designed gloves and braces which include sensors connected to dedicated exercise software. The patient uses his own power to move objects on the screen. Physical and occupational therapists record and evaluate the patient’s progress and then design a customized exercise program for the patient.
See WWW.MEDITOUCH.CO.IL for further information.
The methods used were data from a longitudinal survey on a national sample of some 830 adults covered by health insurance who had one of the four disabling conditions: cerebral palsy, multiple sclerosis, arthritis and spinal cord injury. Cross sectional analysis of the data produced estimates of annual prevalence and reasons and symptoms for which CAM practitioners were consulted.
The results showed that CAM practitioners were consulted by 19% of the sample, a rate similar to, or higher than the general population. The use of CAM was more prevalent among women than men (24 vs. 10%), in the Western US (30%) compared to the Midwest (20%) Northeast (14%), and South (10%). It was used by former devotees (62%) compared to non-users (8%). Spinal cord injury reported the lowest use (14%). The most common symptoms treated were pain (80%), decreased functioning (43%), and lack of energy (24%). The common reasons for using CAM practitioners included a lifestyle choice (67%) and also because they are perceived to be more effective than conventional medicine (44%).
The conclusions of the survey suggest that a significant proportion of people with physical disabilities consult CAM practitioners. Many of those who use CAM do so because it fits their lifestyle and because they perceive it to be more effective than conventional medicine for treating common symptoms including pain and decreased functioning.
Effective treatment of physical disability can also be achieved by obtaining and using the correct physical therapy product. Leading the pack is the TUTOR system. Consisting of the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR these recent innovations have been created to treat physical limb disabilities as a result of a stroke, brain or spinal cord injury, Parkinson’s disease, MS, CP and other upper or lower limb disabilities.
The TUTOR system consists of motivating and challenging games that allow the patient to practice isolated and/or interjoint coordination exercises. The dedicated software allows the therapist to fully customize the exercises to the patient’s movement ability. Consisting of ergonomicaly designed gloves and braces the TUTORs optimize the patient’s motor, sensory and cognitive performance and allows him to better perform daily functional tasks and thereby improve his quality of life.
The TUTORs are currently in use in leading U.S. and European hospitals and clinics and are available at home through telerehabilitation. Fully certified by the FDA and CE the TUTORs can be used by adults as well as children from the age of 5 and up.
See WWW.MEDITOUCH.CO.IL for further information.