Improving functional ability in stroke patients by improving movement impairments

Do improvements in a specific task used in massed practice therapy transfer to untrained tasks. This question was answered by Schaefer SY et al. from Washington University School of Medicine, St Louis, MO, USA in Neurorehabilitation and Neural Repair, 04/24/2013. The team aimed at showing that task-specific training is a viable approach for recovering motor function after stroke and also to help design task–specific training plans to maximize therapy benefits. The group found that for stroke patients with chronic mild to moderate hemiparesis the improvements in impairments achieved during task practice did transfer to untrained upper-extremity motor tasks e.g washing, feeding and dressing.

 

Factors associated with employment in Spinal Cord Injury (SCI)

Participation in organized sports is positively associated with employment in adults with Spinal Cord Injury (SCI). This conclusion was reached by Blauwet C et al. and published in the American Journal of Physical Medicine & Rehabilitation, 04/22/2013. The researchers are from the Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston and Spaulding-Harvard Model System, Spaulding Rehabilitation Hospital, Boston, Massachusetts USA. Alternatively, sex, duration of injury, wheelchair use, and participation in individually planned exercise were not significantly associated with employment.

 

Predicting early retirement after musculoskeletal disease

Outcome measures after a 3-week, multidisciplinary, in-patient rehabilitation programme in Germany predict early retirement in patients with musculoskeletal diseases. Looking at patients undergoing in patient physical and occupational therapy for musculoskeletal disorders (MSDs) in 10 rehabilitation centres in Southern Germany, the outcomes measures that corresponded to early retirement were pain reduction, improvement in spine motility and improvement of muscle strength.

 

Active movement training of ankle improves mobility impairments in stroke and motor function

Active movement training of the ankle improves motor function and mobility post stroke. Waldman G et al. from Feinberg School of Medicine, Northwestern University, IL, USA looked at patients at least 3 months post stroke. Writing in NeuroRehabilitation, 04/19/2013 the group studied Robot-assisted passive stretching and active movement training as a means of intensive stroke rehabilitation for motor impairments post stroke. The outcome measures looked at include reduction in spasticity measured by modified Ashworth scale, mobility by Stroke Rehabilitation Assessment of Movement (STREAM),

and the balance by Berg balance score. Additional outcome measures were isolated movement parameters including dorsiflexion passive range of motion, dorsiflexion active range of motion and dorsiflexor strength after the training.

The MediTouch can be used to give assisted active ankle stroke rehabilitation practice.

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

Physiotherapy Practice for Stroke Rehabilitation in the UK

Does telling a patient to to be aware of their movements and their performance (internal focus) reduce automaticity and hinder learning and retention in stroke patients?

This question was posed by Johnson L et al from stroke Services, Royal Bournemouth and Christchurch Hospitals NHS Trust, and Royal Bournemouth Hospital, United Kingdom in Physical Therapy, 04/19/2013.

The team aimed to design an experimental study examining the impact of focus of attention on learning post stroke. In order to do this the physiotherapists took video recordings of physiotherapy sessions and analyzed the data for external focus – physical therapists giving guidelines and feedback on performance and internal focus, the – physical therapist telling the patient to think about their movement.

The MediTouch system uses extrinsic feedback – external focus and guidelines during LegTutor open and closed chain customized exercise practice.

Assisted active exercise practice and the HandTutor and ArmTutor

Occupational an physical therapists are using the MediTouch system in combination with active assistance. People with arm weakness can exercise their arms without assistance, but if their arms and hand movement ability is severely impaired, such exercise is difficult and compliance with exercise programs is low. Using the HandTutor and the ArmTutor the occupational therapist and the physical therapist can give the patient “assistance-as needed” to perform the required customized arm or finger a wrist exercise task. This clinical technique is known as active assisted exercise. During active assistance practice the patient actively contributes to the movement, this active exercise contribution is an essential feature of motor sensory and cognitive recovery and allows motor learning and plasticity. This means that the the HandTutor and ArmTutor can be used by patients with very little Active Range of Motion (AROM) as well as by patients with little ROM deficit.

Active assistance therefore allows OT and PT to use the MediTouch and provide their patients with severe deficits in AROM a customized exercise that gives immediate movement feedback and the enjoyment and motivation of video game based rehabilitation.

The MediTouch benefits patients with movement dysfunction or impaired functional activity caused by neurological disorders, including traumatic brain injury (tbi), stroke, cerebral palsy, spinal cord injury, and multiple sclerosis.

OT and PT therapeutic goals

The MediTouch system is a state of the art targeted rehabilitation system that hones in on specific therapeutic goals. Through the enjoyment and motivation of video game based rehabilitation which gives immediate feedback to the patient, the HandTutor, ArmTutor, LegTutor and 3DTutor address the challenge of impaired movement ability. The system is used in the clinic and at home and offers motivating customized exercise practice with OT and PT support.

The system benefits patients with movement dysfunction or impaired functional activity caused by neurological disorders, including traumatic brain injury (tbi), stroke, cerebral palsy, spinal cord injury, and multiple sclerosis. In addition the system is used for physical therapy after shoulder, elbow, hip and knee surgery.

Computer-based cognitive rehabilitation (CBCR) after stroke

Computer-based cognitive rehabilitation (CBCR) effective on improving cognitive function after stroke. This conclusion was reached by occupational therapists from Department of Occupational Therapy, Semyung University, Jecheon, Republic of Korea. The group publish their results in NeuroRehabilitation, 04/16/2013.

The MediTouch HandTutor and ArmTutor work on improving motor sensory and cognitive movement ability through. The system is used in the clinic and at home and offers motivating customized exercise practice with OT and PT support.

Intensive exercise practice improves walking ability in Stroke patients

Resistive training is the use of closed kinetic chain CKC exercise practice. Lee NY et al writing in  NeuroRehabilitation, 04/16/2013  show that both closed kinetic chain CKC exercises and open kinetic chain exercises OKC in a group of stroke patients performing physiotherapy 5 times per week for 6 weeks showed are an effective treatment method for improving normal gait patterns in stroke patients. These findings may be attributed to the fact that  CKC and OKC exercise induced use of the ankle and knee muscles and provided repetitive sensory input from the affected foot. The researchers are from the Department of Rehabilitation Science, Graduate School, Daegu University, Kyeongbuk, Republic of Korea. The LegTutor and 3DTutor is used for customized closed kinetic chain CKC and open kinetic chain exercise practice.