Rehabilitation of gait after stroke: a review towards a top-down approach

This document provides a review of the techniques and therapies used in gait rehabilitation after stroke. It also examines the possible benefits of including assistive robotic devices and brain-computer interfaces in this field, according to a top-down approach, in which rehabilitation is driven by neural plasticity

A review of computer vision-based approaches for physical rehabilitation and assessment

The computer vision community has extensively researched the area of human motion analysis, which primarily focuses on pose estimation, activity recognition, pose or gesture recognition and so on. However for many applications, like monitoring of functional rehabilitation of patients with musculo skeletal or physical impairments, the requirement is to comparatively evaluate human motion. In this survey, we capture important literature on vision-based monitoring and physical rehabilitation that focuses on comparative evaluation of human motion during the past two decades and discuss the state of current research in this area. Unlike other reviews in this area, which are written from a clinical objective, this article presents research in this area from a computer vision application perspective. We propose our own taxonomy of computer vision-based rehabilitation and assessment research which are further divided into sub-categories to capture novelties of each research. The review discusses the challenges of this domain due to the wide ranging human motion abnormalities and difficulty in automatically assessing those abnormalities. Finally, suggestions on the future direction of research are offered

A locomoción reflexa de Vojta: unha revisión bibliográfica

[Resumen] Introducción: La Locomoción Refleja de Vojta es una sistemática de valoración y tratamiento de Fisioterapia utilizada y enseñada en la CEE, Norteamérica, Sudamérica y Asia. Objetivo: Conocer la evidencia científica actual de las bases neurofisiológicas, de la sistemática de valoración y de tratamiento de la Locomoción Refleja de Vojta. Material y método: Se ha realizado una revisión bibliográfica en las bases de datos de Pubmed, Scopus, WOS, PEDro y Cochrane. Los criterios de inclusión establecidos fueron: artículos que abordan la Locomoción Refleja de Vojta, publicados en español/inglés/portugués, en los últimos 10 años y cuyo tipo de publicación fuese: metaanálisis, revisión sistemática, EC, EC controlado y/o aleatorizado, EO y estudios comparativos. La búsqueda se ha realizado en marzo-abril-mayo de 2019. Resultados: Se han analizado 1 revisión sistemática, 2 artículos de validez y fiabilidad, 1 EO y 12 EC. Se demostró activación del SNC (formación reticular pontemedular, putamen, ganglios basales y cerebelo) implicado en el control postural y generación de patrones motores de locomoción cruzados y, a nivel periférico, a través de la activación de musculatura cruzada, activación del tracto largo propioespinal implicado en activar centros generadores de movimiento. Luego, se han encontrado altos valores de fiabilidad y validez de los EL para PC a través de la correlación con la GMFCS y, para LM a través de la correlación con la SCIM. Por último, existe eficacia de la Terapia Vojta aplicada de manera aislada, o combinada con otros métodos en patologías con déficit respiratorio, de control postural u ortopédico en infantes y adolescentes. Conclusiones: Aunque la evidencia científica actual es escasa, se ha incrementado en los últimos años. Es necesario más investigación, con calidad metodológica más rigurosa, con mayor tamaño muestral, aplicando ambos complejos de la Locomoción, sobre sujetos con afectación tanto en infantes, como en adolescentes y adultos.[Abstract] Background: Vojta´s Reflex Locomotion is a systematic diagnosis and treatment used and taught in Europe, North América, South America and Asia. Objetive: To know the current scientific evidence of neurophysiological bases, diagnostic and treatment systematics of Vojta´s Reflex Locomotion. Methods: A bibliographic review was carried out in the Pubmed, Scopus, WOS, PEDro y Cochrane databases. The established inclusion criteria were: articles dealing with Vojta´s Reflex Locomotion, published in Spanish/ English/Portuguese in the last 10 years, and whose type of publication was: meta-analysis, systematic review, review, controlled clinical trials and/or randomized, clinical trials, observational study. The search was made in March- April- May 2019. Outcomes: 1 systematic review, 2 validity and reliability articles, 1 observational study, 12 clinical trials have been analyzed. Central Nervous System activation (pontemedullary reticular formation, putamen,basal ganglia, cerebellum) involved in postural control and in the generation of patterns of cross-locomotion and, at the peripheral nevel, through the activation of the cross musculature, by activation of the propospinal long tract involved in activating movement generating centers. Then, high values of reliability and validity of locomotion stages were found for cerebral palsy through correlation with GMFCS and for cord injury through correlation with SCIM. Finally, Vojta Therapy is effective when applied isolated or combined with other methods in diseases with respiratory or postural deficit or orthopedic alteration in children or adolescents. Conclusions: Although the current scientific evidence is small, it has increased in the last years. More research is needed with methodological quality rigorous and larger sample size, applying both locomotion complexes in children, adolescents or adults.[Resumo] Introdución: A Locomoción Reflexa de Vojta é unha sistemática de valoración e tratamento de Fisioterapia utilizada e ensinada na CEE, Norteamérica, Sudamérica e Asia. Obxectivo: Coñecer a evidencia científica actual das bases neurofisiolóxicas, da sistemática de valoración e de tratamento da Locomoción Reflexa de Vojta. Material e método: Realizouse unha revisión bibliográfica nas bases de datos de Pubmed, Scopus, WOS, PEDro e Cochrane. Os criterios de inclusión establecidos foron: artigos que versan a Locomoción Reflexa de Vojta, publicados en español/inglés/portugués, nos últimos 10 anos e cuxo tipo de publicación foi: metaanálise, revisión sistemática, EC, EC controlado e/ou aleatorizado, EO e estudos comparativos. A busca levouse a cabo en marzo-abril-maio de 2019. Resultados: Analizáronse 1 revisión sistemática, 2 artigos de validez e fiabilidade, 1 EO, 12 EC. Demostrouse a activación do SNC (formación pontemedular reticular, putamen, ganglios basais e cerebelo) implicados no control postural e xeneración de patróns motores de locomoción cruzados e, a nivel periférico, a través da activación de musculatura cruzada, activación do trato longo propioespinal implicado en activar centros xeneradores de movemento. Logo, encontráronse altos valores de fiabilidade e validez dos EL para a PC a través da correlación coa GMFCS e, para a LM a través da correlación coa SCIM. Finalmente, existe eficacia da Terapia Vojta aplicada de maneira aislada, ou combinada con outros métodos, en patoloxías con déficit respiratorio, de control postural ou ortopédico en infantes e adolescentes. Conclusións: Aínda que a evidencia científica actual é escasa, incrementouse nos últimos anos. É necesario máis investigación, con calidad metodolóxica rigurosa, con maior tamaño mostral, aplicando ambos complexos de locomoción, sobre suxeitos con afectación tanto en infantes, como en adolescentes e adultos.Traballo fin de grao (UDC.FCS). Fisioterapia. Curso 2018/201

Automated Assessment of Balance Rehabilitation Exercises With a Data-Driven Scoring Model: Algorithm Development and Validation Study

BACKGROUND: Balance rehabilitation programs represent the most common treatments for balance disorders. Nonetheless, lack of resources and lack of highly expert physiotherapists are barriers for patients to undergo individualized rehabilitation sessions. Therefore, balance rehabilitation programs are often transferred to the home environment, with a considerable risk of the patient misperforming the exercises or failing to follow the program at all. Holobalance is a persuasive coaching system with the capacity to offer full-scale rehabilitation services at home. Holobalance involves several modules, from rehabilitation program management to augmented reality coach presentation. OBJECTIVE: The aim of this study was to design, implement, test, and evaluate a scoring model for the accurate assessment of balance rehabilitation exercises, based on data-driven techniques. METHODS: The data-driven scoring module is based on an extensive data set (approximately 1300 rehabilitation exercise sessions) collected during the Holobalance pilot study. It can be used as a training and testing data set for training machine learning (ML) models, which can infer the scoring components of all physical rehabilitation exercises. In that direction, for creating the data set, 2 independent experts monitored (in the clinic) 19 patients performing 1313 balance rehabilitation exercises and scored their performance based on a predefined scoring rubric. On the collected data, preprocessing, data cleansing, and normalization techniques were applied before deploying feature selection techniques. Finally, a wide set of ML algorithms, like random forests and neural networks, were used to identify the most suitable model for each scoring component. RESULTS: The results of the trained model improved the performance of the scoring module in terms of more accurate assessment of a performed exercise, when compared with a rule-based scoring model deployed at an early phase of the system (k-statistic value of 15.9% for sitting exercises, 20.8% for standing exercises, and 26.8% for walking exercises). Finally, the resulting performance of the model resembled the threshold of the interobserver variability, enabling trustworthy usage of the scoring module in the closed-loop chain of the Holobalance coaching system. CONCLUSIONS: The proposed set of ML models can effectively score the balance rehabilitation exercises of the Holobalance system. The models had similar accuracy in terms of Cohen kappa analysis, with interobserver variability, enabling the scoring module to infer the score of an exercise based on the collected signals from sensing devices. More specifically, for sitting exercises, the scoring model had high classification accuracy, ranging from 0.86 to 0.90. Similarly, for standing exercises, the classification accuracy ranged from 0.85 to 0.92, while for walking exercises, it ranged from 0.81 to 0.90. TRIAL REGISTRATION: ClinicalTrials.gov NCT04053829; https://clinicaltrials.gov/ct2/show/NCT04053829

Traditionelle Konzepte der physiotherapeutischen Säuglingsbehandlung - fokussiert auf den Einfluss zwischenmenschlicher Beziehungen

Auffälligkeiten in der Entwicklung von Säuglingen zeigen sich allgemein darin, dass sich bestimmte Fähigkeiten und Funktionen eingeschränkt oder verzögert herausbilden. Säuglinge mit motorischen Entwicklungsstörungen nehmen deshalb häufig Physiotherapie, in Form von Bobath- oder Vojta-Therapie, wahr. Innerhalb der ersten Lebensmonate ist die Zuwendung insbesondere in Form von verbaler und nonverbaler Kommunikation bedeutend. Dies lässt sich als eine grundlegende Form der zwischenmenschlichen Beziehung zusammenfassen. Zur Förderung der Entwicklung gilt es, jene Beziehung der Interaktionspartner zu betrachten. Jenes soll mit folgender Forschungsfrage beantwortet werden: Inwiefern tragen zwischenmenschliche Beziehungen bei der Anwendung traditioneller physiotherapeutischer Säuglingsbehandlungen zur motorischen Entwicklung des Säuglings bei? Um im Sinne dieser Frage zu forschen, wurde eine Mixed-Methods-Umfrage zum Einfluss verbaler und nonverbaler Kommunikation sowie weiterer Faktoren auf die physiotherapeutische Säuglingsbehandlung durchgeführt. Diese fand in ambulanten Praxen statt. Damit wurde untersucht, wie sich der Einfluss gestaltet und dieser effektiv genutzt werden kann. Den Teilnehmenden wurden überwiegend geschlossene Fragen mit einer Antwortskala von „1 bis 6“ gestellt. Im Anschluss an die Umfragen-Durchführung erfolgte eine quantitative und qualitative Auswertung. Die daraus geschlossenen Ergebnisse zeigen, dass die physiotherapeutische Säuglingsbehandlung sowohl aus Sicht der Therapeuten als auch aus Sicht der Eltern durch die untersuchten Gesprächsformen und persönliche Faktoren beeinflusst wird. Unterschiedliche Einflussfaktoren führen zu einer hinderlichen oder fördernden Beeinflussung. Anhand dessen wurden Handlungsempfehlungen erstellt. Weiterführende Forschung in diesem Bereich könnte zur Bekräftigung der erlangten Ergebnisse hilfreich sein und zudem auf weitere Altersgruppen ausgeweitet werden

Effectiveness of intensive physiotherapy for gait improvement in stroke: systematic review

Introduction: Stroke is one of the leading causes of functional disability worldwide. Approximately 80% of post-stroke subjects have motor changes. Improvement of gait pattern is one of the main objectives of physiotherapists intervention in these cases. The real challenge in the recovery of gait after stroke is to understand how the remaining neural networks can be modified, to be able to provide response strategies that compensate for the function of the affected structures. There is evidence that intensive training, including physiotherapy, positively influences neuroplasticity, improving mobility, pattern and gait velocity in post-stroke recovery. Objectives: Review and analyze in a systematic way the experimental studies (RCT) that evaluate the effects of Intensive Physiotherapy on gait improvement in poststroke subjects. Methodology: Were only included all RCT performed in humans, without any specific age, that had a clinical diagnosis of stroke at any stage of evolution, with sensorimotor deficits and functional gait changes. The databases used were: Pubmed, PEDro (Physiotherapy Evidence Database) and CENTRAL (Cochrane Center Register of Controlled Trials). Results: After the application of the criteria, there were 4 final studies that were included in the systematic review. 3 of the studies obtained a score of 8 on the PEDro scale and 1 obtained a score of 4. The fact that there is clinical and methodological heterogeneity in the studies evaluated, supports the realization of the current systematic narrative review, without meta-analysis. Discussion: Although the results obtained in the 4 studies are promising, it is important to note that the significant improvements that have been found, should be carefully considered since pilot studies with small samples, such as these, are not designed to test differences between groups, in terms of the effectiveness of the intervention applied. Conclusion: Intensive Physiotherapy seems to be safe and applicable in post-stroke subjects and there are indications that it is effective in improving gait, namely speed, travelled distance and spatiotemporal parameters. However, there is a need to develop more RCTs with larger samples and that evaluate the longterm resultsN/

Proceedings of the 11th International Conference on Kinanthropology

The 11th International Conference on Kinantropology was held on the Nov 29 – Dec 1, 2017 in Brno and was organized by the Faculty of Sports Studies, Masaryk University and the Faculty of Kinesiology, University of Zagreb. This year was divided into several themes: sports medicine, sport and social science, sport training, healthy lifestyle and healthy ageing, sports management, analysis of human movement. Part of the conference was also a symposium Atletika and Ortoreha that gathered specialists in physiotherapy

The effect of functional electrical stimulation on abdominal muscle strength and gross motor function in children with cerebral palsy a randomised control trial

Includes abstract. Includes bibliographical references

Momentum: Research & Innovation for Spring 2018

The Spring 2018 issue of Momentum: Research & Innovation, a periodical focused on research at the University of Rhode Island

Actual versus best practices for young children with cerebral palsy : a survey of pediatric occupational therapists and physical therapists in Quebec, Canada

Background and rationale. Cerebral palsy (CP) is one of the most common disabling disorders of childhood and constitutes a substantial portion of pediatric rehabilitation. This condition demands comprehensive rehabilitation using age-appropriate tasks and activities and encompassing aspects of body function and structure, activity and participation, and personal and environmental factors. Yet little is known regarding actual occupational therapy (OT) and physical therapy (PT) practices.Objective. The primary objective of this doctoral thesis was to describe OT and PT practices for young children with CP in the Province of Quebec, Canada.Methods. This was a cross-sectional, multi-centered survey. All eligible and consenting pediatric occupational therapists (OTs) and physical therapists (PTs) were interviewed using a structured telephone interview based on vignettes of two typical children with CP at two age points---18 months and 4 years. Reported practices were grouped according to the International Classification of Functioning, Disability, and Health (ICF). Literature review of pediatric assessments and interventions potentially used for CP was done to determine their level of evidence of effectiveness. In addition, two expert groups provided, for each vignette, a best practice problem identification list and a best practice intervention list.Results. A total of 62 PTs (83.8% participation rate) and 85 OTs (91.4% participation rate) participated in the study. Overall, 91.9% of PTs and 67.1% of OTs reported using at least one standardized pediatric assessment for at least one vignette. OT and PT interventions focused primarily on impairments and primary function, with less attention to interventions related to play and recreation/leisure. Clinicians reported the need for more training and education specific to CP and to the use of research findings in clinical practice. Wide variations and gaps were identified in therapists' responses suggesting the need for a basic standard of PT and OT management as well as strategies to encourage knowledge dissemination regarding current best practice. Further, implementation of evidence-based practice necessitates more collaboration between researchers, clinicians and administrators