Exploration of barriers and enablers for evidence-based interventions for upper limb rehabilitation following a stroke : use of Constraint Induced Movement Therapy and Robot Assisted Therapy in NHS Scotland

The routine use of evidence-based upper limb rehabilitation interventions after stroke has the potential to improve function and increase independence. Two such interventions are Constraint Induced Movement Therapy and Robot Assisted Therapy. Despite evidence to support both interventions, their use within the National Health Service appears, anecdotally, to be low. We sought to understand user perceptions in order to explain low uptake in clinical practice. Methods A combination of a cross-sectional online survey with therapists and semi-structured interviews with stroke patients was used to explore uptake and user opinions on the benefits, enablers and barriers to each intervention. Findings The therapists surveyed reported low use of Constraint Induced Movement Therapy and Robot Assisted Therapy in clinical practice within the Scottish National Health Service. Barriers identified by therapists were inadequate staffing, and a lack of training and resources. Interviews with stroke patients identified themes that may help us to understand the acceptability of each intervention, such as the impact of motivation. Conclusion Barriers to the uptake of Constraint Induced Movement Therapy and Robot Assisted Therapy within the clinical setting were found to be similar. Further qualitative research should be completed in order to help us understand the role patient motivation plays in uptake

Rehabilitation Engineering

Population ageing has major consequences and implications in all areas of our daily life as well as other important aspects, such as economic growth, savings, investment and consumption, labour markets, pensions, property and care from one generation to another. Additionally, health and related care, family composition and life-style, housing and migration are also affected. Given the rapid increase in the aging of the population and the further increase that is expected in the coming years, an important problem that has to be faced is the corresponding increase in chronic illness, disabilities, and loss of functional independence endemic to the elderly (WHO 2008). For this reason, novel methods of rehabilitation and care management are urgently needed. This book covers many rehabilitation support systems and robots developed for upper limbs, lower limbs as well as visually impaired condition. Other than upper limbs, the lower limb research works are also discussed like motorized foot rest for electric powered wheelchair and standing assistance device

A methodology for the Lower Limb Robotic Rehabilitation system

The overall goal of this thesis is to develop a new functional lower limb robot-assisted rehabilitation system for people with a paretic lower limb. A unilateral rehabilitation method is investigated, where the robot acts as an assistive device to provide the impaired leg therapeutic training through simulating the kinematics and dynamics of the ankle and lower leg movements. Foot trajectories of healthy subjects and post-stroke patients were recorded by a dedicated optical motion tracking system in a clinical gait measurement laboratory. A prototype 6 degrees of freedom parallel robot was initially built in order to verify capability of achieving singularity-free foot trajectories of healthy subjects in various exercises. This was then followed by building and testing another larger parallel robot to investigate the real-sized foot trajectories of patients. The overall results verify the designed robot’s capability in successfully tracking foot trajectories during different exercises. The thesis finally proposes a system of bilateral rehabilitation based on the concept of self-learning, where a passive parallel mechanism follows and records motion signatures of the patient’s healthy leg, and an active parallel mechanism provides motion for the impaired leg based on the kinematic mapping of the motion produced by the passive mechanism