2,113 research outputs found

    Wireless Sensing of Lower Lip and Thumb-Index Finger ‘Ramp-and-Hold’ Isometric Force Dynamics in a Small Cohort of Unilateral MCA Stroke: Discussion of Preliminary Findings

    Get PDF
    Automated wireless sensing of force dynamics during a visuomotor control task was used to rapidly assess residual motor function during finger pinch (right and left hand) and lower lip compression in a cohort of seven adult males with chronic, unilateral middle cerebral artery (MCA) stroke with infarct confirmed by anatomic magnetic resonance imaging (MRI). A matched cohort of 25 neurotypical adult males served as controls. Dependent variables were extracted from digitized records of ‘ramp-and-hold’ isometric contractions to target levels (0.25, 0.5, 1, and 2 Newtons) presented in a randomized block design; and included force reaction time, peak force, and dF/dtmax associated with force recruitment, and end-point accuracy and variability metrics during the contraction hold-phase (mean, SD, criterion percentage ‘on-target’). Maximum voluntary contraction force (MVCF) was also assessed to establish the force operating range. Results based on linear mixed modeling (LMM, adjusted for age and handedness) revealed significant patterns of dissolution in fine force regulation among MCA stroke participants, especially for the contralesional thumb-index finger followed by the ipsilesional digits, and the lower lip. For example, the contralesional thumb-index finger manifest increased reaction time, and greater overshoot in peak force during recruitment compared to controls. Impaired force regulation among MCA stroke participants during the contraction hold-phase was associated with significant increases in force SD, and dramatic reduction in the ability to regulate force output within prescribed target force window (±5% of target). Impaired force regulation during contraction hold-phase was greatest in the contralesional hand muscle group, followed by significant dissolution in ipsilateral digits, with smaller effects found for lower lip. These changes in fine force dynamics were accompanied by large reductions in the MVCF with the LMM marginal means for contralesional and ipsilesional pinch forces at just 34.77% (15.93 N vs. 45.82 N) and 66.45% (27.23 N vs. 40.98 N) of control performance, respectively. Biomechanical measures of fine force and MVCF performance in adult stroke survivors provide valuable information on the profile of residual motor function which can help inform clinical treatment strategies and quantitatively monitor the efficacy of rehabilitation or neuroprotection strategies

    Advancing Medical Technology for Motor Impairment Rehabilitation: Tools, Protocols, and Devices

    Get PDF
    Excellent motor control skills are necessary to live a high-quality life. Activities such as walking, getting dressed, and feeding yourself may seem mundane, but injuries to the neuromuscular system can render these tasks difficult or even impossible to accomplish without assistance. Statistics indicate that well over 100 million people are affected by diseases or injuries, such as stroke, Parkinson’s Disease, Multiple Sclerosis, Cerebral Palsy, peripheral nerve injury, spinal cord injury, and amputation, that negatively impact their motor abilities. This wide array of injuries presents a challenge to the medical field as optimal treatment paradigms are often difficult to implement due to a lack of availability of appropriate assessment tools, the inability for people to access the appropriate medical centers for treatment, or altogether gaps in technology for treating the underlying impairments causing the disability. Addressing each of these challenges will improve the treatment of movement impairments, provide more customized and continuous treatment to a larger number of patients, and advance rehabilitative and assistive device technology. In my research, the key approach was to develop tools to assess and treat upper extremity movement impairment. In Chapter 2.1, I challenged a common biomechanical[GV1] modeling technique of the forearm. Comparing joint torque values through inverse dynamics simulation between two modeling platforms, I discovered that representing the forearm as a single cylindrical body was unable to capture the inertial parameters of a physiological forearm which is made up of two segments, the radius and ulna. I split the forearm segment into a proximal and distal segment, with the rationale being that the inertial parameters of the proximal segment could be tuned to those of the ulna and the inertial parameters of the distal segment could be tuned to those of the radius. Results showed a marked increase in joint torque calculation accuracy for those degrees of freedom that are affected by the inertial parameters of the radius and ulna. In Chapter 2.2, an inverse kinematic upper extremity model was developed for joint angle calculations from experimental motion capture data, with the rationale being that this would create an easy-to-use tool for clinicians and researchers to process their data. The results show accurate angle calculations when compared to algebraic solutions. Together, these chapters provide easy-to-use models and tools for processing movement assessment data. In Chapter 3.1, I developed a protocol to collect high-quality movement data in a virtual reality task that is used to assess hand function as part of a Box and Block Test. The goal of this chapter is to suggest a method to not only collect quality data in a research setting but can also be adapted for telehealth and at home movement assessment and rehabilitation. Results indicate that the data collected in this protocol are good and the virtual nature of this approach can make it a useful tool for continuous, data driven care in clinic or at home. In Chapter 3.2 I developed a high-density electromyography device for collecting motor unit action potentials of the arm. Traditional surface electromyography is limited by its ability to obtain signals from deep muscles and can also be time consuming to selectively place over appropriate muscles. With this high-density approach, muscle coverage is increased, placement time is decreased, and deep muscle activity can potentially be collected due to the high-density nature of the device[GV2] . Furthermore, the high-density electromyography device is built as a precursor to a high-density electromyography-electrical stimulation device for functional electrical stimulation. The customizable nature of the prototype in Chapter 3.2 allows for the implementation both recording and stimulating electrodes. Furthermore, signal results show that the electromyography data obtained from the device are of high quality and are correlated with gold standard surface electromyography sensors. One key factor in a device that can record and then stimulate based on the information from the recorded signals is an accurate movement intent decoder. High-quality movement decoders have been designed by closed-loop device controllers in the past, but they still struggle when the user interacts with objects of varying weight due to underlying alterations in muscle signals. In Chapter 4, I investigate this phenomenon by administering an experiment where participants perform a Box and Block Task with objects of 3 different weights, 0 kg, 0.02 kg, and 0.1 kg. Electromyography signals of the participants right arm were collected and co-contraction levels between antagonistic muscles were analyzed to uncover alterations in muscle forces and joint dynamics. Results indicated contraction differences between the conditions and also between movement stages (contraction levels before grabbing the block vs after touching the block) for each condition. This work builds a foundation for incorporating object weight estimates into closed-loop electromyography device movement decoders. Overall, we believe the chapters in this thesis provide a basis for increasing availability to movement assessment tools, increasing access to effective movement assessment and rehabilitation, and advance the medical device and technology field

    An Investigation of the Role of Physical Therapy in the Treatment of Patients with Traumatic Brain Injuries

    Get PDF
    B.A. (Bachelor of Arts

    The Collaboration of Music Therapy and Physical Therapy: A Case Study for Rehabilitation Treatment of a Patient with Chronic Stroke

    Get PDF
    Background and Purpose: Strokes are the fifth leading cause of death in the United States and nearly 800,000 people suffered from a stroke last year alone. Even though two-thirds of those people had survived, many of the survivors were left with a number of activity limitations and participation restrictions. The research is extensive in the realm of physical therapy interventions and how it can help with those disabilities, but truly lacks the knowledge behind the effects of a collaboration of music therapy with physical therapy. Case Description: This case study follows an 85-year-old woman with lasting chronic impairments from a right cerebrovascular accident four years ago to measure the effects of a 13-week interdisciplinary intervention program. Interventions: Following an initial evaluation, the client performed 11 one-hour treatment sessions over an 11-week period. The patient was co-treated during each session by two music therapy students and two physical therapy students under the guidance and direction of a licensed music therapist and a licensed physical therapist. Interventions included gait training with rhythmic auditory stimulation, lower extremity strengthening, proprioceptive neuromuscular facilitation (PNF) patterns, balance training and core vii stability with musical components such as Rhythmic Auditory Stimulation (RAS), Patterned Sensory Enhancement (PSE) and Therapeutic Instrumental Music Performance/Playing (TIMP). Outcomes: After 11 weeks of music and physical therapy collaborative interventions, the client was reassessed, and outcomes were recorded. The client demonstrated increased competency for the Berg Balance Scale, decreased the amount of assist for transfers for all functional outcome measures, decreased time with Five Time Sit to Stand test and showed increase response and awareness of metronome during GaitRITE ®. Discussion: Collaboration of treatment between music therapy and physical therapy improved functional mobility, sitting and standing balance, decreased assist with transfers and increased awareness of RAS (Rhythmic Auditory Stimulation) in gait, with this client with a Chronic Stroke

    Broadening the Role of Occupational Therapists within the ICU Setting: An Occupation-Based Toolkit

    Get PDF
    Purpose: The purpose of this project was to create a quick intervention toolkit for occupational therapists treating clients in the intensive care unit (ICU) in order to increase occupation-based services, quality of care, and improve client outcomes. Additionally, this project hopes to enlighten occupational therapists who may experience burnout while providing services within such an intensive setting

    Studio, progettazione e sviluppo di un sistema elettronico per la misura di segnali biometrici della mano finalizzato ad applicazioni riabilitative

    Get PDF
    In this Thesis the study and implementation of a transduction system for hand functional rehabilitation is described. The prototype is mainly constituted by a sensorized glove, a sensor driving circuitry and a visual feedback software interface. The prototype allows both to collect quantitative data and to analyze them, enabling an objective assessment of rehabilitative protocols effectiveness. The system was developed by the BioDevices Laboratory of the Department of Information Engineering of Padova University in collaboration with Wetware Concepts (University of Padova spin off) and the equipe of severe spinal/brain injured of San Bortolo hospital of Vicenz

    Down-Conditioning of Soleus Reflex Activity using Mechanical Stimuli and EMG Biofeedback

    Get PDF
    Spasticity is a common syndrome caused by various brain and neural injuries, which can severely impair walking ability and functional independence. To improve functional independence, conditioning protocols are available aimed at reducing spasticity by facilitating spinal neuroplasticity. This down-conditioning can be performed using different types of stimuli, electrical or mechanical, and reflex activity measures, EMG or impedance, used as biofeedback variable. Still, current results on effectiveness of these conditioning protocols are incomplete, making comparisons difficult. We aimed to show the within-session task- dependent and across-session long-term adaptation of a conditioning protocol based on mechanical stimuli and EMG biofeedback. However, in contrast to literature, preliminary results show that subjects were unable to successfully obtain task-dependent modulation of their soleus short-latency stretch reflex magnitude

    Modeling & Analysis of Design Parameters for Portable Hand Orthoses to Assist Upper Motor Neuron Syndrome Impairments and Prototype Design

    Get PDF
    Wearable assistive robotics have the potential to address an unmet medical need of reducing disability in individuals with chronic hand impairments due to neurological trauma. Despite myriad prior works, few patients have seen the benefits of such devices. Following application experience with tendon-actuated soft robotic gloves and a collaborator\u27s orthosis with novel flat-spring actuators, we identified two common assumptions regarding hand orthosis design. The first was reliance on incomplete studies of grasping forces during activities of daily living as a basis for design criteria, leading to poor optimization. The second was a neglect of increases in muscle tone following neurological trauma, rendering most devices non-applicable to a large subset of the population. To address these gaps, we measured joint torques during activities of daily living with able-bodied subjects using dexterity representative of orthosis-aided motion. Next, we measured assistive torques needed to extend the fingers of individuals with increased flexor tone following TBI. Finally, we applied this knowledge to design a cable actuated orthosis for assisting finger extension, providing a basis for future work focused on an under-represented subgroup of patients
    • …
    corecore