7 research outputs found

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

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    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/

    Investigation of the feasibility of using focal vibratory stimulation with robotic aided therapy for spasticity rehabilitation in spinal cord injury

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    The occurrence of a traumatic spinal cord injury is in hundreds of thousands of people every year. Survivors are left with loss of many bodily functions, loss of sensation below the point of injury and many more painful and uncomfortable repercussions which interfere with activities of daily living. Over 70% of people with SCI develop spasticity: abnormally increased muscle tone and connected joint stiffness that interfere with residual volitional control of the limbs. Treatments for spasticity include many pharmacological and non-pharmacological techniques, however many of them have severe sideeffects. Evidence suggest the use of vibratory stimulation to relieve repercussions of spasticity, despite not agreeing on the most advantageous protocol. This thesis evaluated effects that focal vibratory stimulation have on the muscle performance. Within two studies, focal muscle vibration is compared against different application conditions such as timing and location. The results suggests that if focal vibrations are applied to the relaxed muscle, the increase in muscle's force is observed. Analysis of the cortical waves indicates minimal cortical involvement in vibratory stimulation modulation. On the other hand, FV applied of the connected tendon/bone imposed to a contraction seems to have a potential to increase muscle's activation. There is evidence that motor cortex is responding to this stimulation to stabilise the muscle in order to perform the contraction. Within clinical trial, focal muscle vibratory stimulation is employed in total of 6 interventional sessions while a joint's spastic exor and extensor muscles were relaxed. Spasticity appears to be reduced as a consequence of the stimulation. Moreover, engaging the joint into robotic-aided therapy increase volitional control of the wrist, according to the analysis of the active range of motion, joint stiffness and kinematic parameters associated to the movement. The measurement and movement facilitation device used in the clinical trial was designed and developed in accordance to the spasticity and spinal cord injury repercussions consideration. The studies conducted for this thesis demonstrated feasibility and potential for the use of focal muscle vibratory stimulation to enhance muscle power in healthy muscles but also relieve consequences of spasticity. Vibrations combined with movement robotic-aided therapy have a prospects to enhance motor control

    Proceedings XXIII Congresso SIAMOC 2023

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    Il congresso annuale della Società Italiana di Analisi del Movimento in Clinica (SIAMOC), giunto quest’anno alla sua ventitreesima edizione, approda nuovamente a Roma. Il congresso SIAMOC, come ogni anno, è l’occasione per tutti i professionisti che operano nell’ambito dell’analisi del movimento di incontrarsi, presentare i risultati delle proprie ricerche e rimanere aggiornati sulle più recenti innovazioni riguardanti le procedure e le tecnologie per l’analisi del movimento nella pratica clinica. Il congresso SIAMOC 2023 di Roma si propone l’obiettivo di fornire ulteriore impulso ad una già eccellente attività di ricerca italiana nel settore dell’analisi del movimento e di conferirle ulteriore respiro ed impatto internazionale. Oltre ai qualificanti temi tradizionali che riguardano la ricerca di base e applicata in ambito clinico e sportivo, il congresso SIAMOC 2023 intende approfondire ulteriori tematiche di particolare interesse scientifico e di impatto sulla società. Tra questi temi anche quello dell’inserimento lavorativo di persone affette da disabilità anche grazie alla diffusione esponenziale in ambito clinico-occupazionale delle tecnologie robotiche collaborative e quello della protesica innovativa a supporto delle persone con amputazione. Verrà infine affrontato il tema dei nuovi algoritmi di intelligenza artificiale per l’ottimizzazione della classificazione in tempo reale dei pattern motori nei vari campi di applicazione

    Complex Shoulder Instability: A combined study of functional MRI, Electromyography and 3-D motion analysis

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    Purpose of Study : The pathophysiology of type II/III shoulder instability under the Stanmore Classification is not understood. This absence of knowledge prevents treatment strategies being devised or a proper understanding of existing therapies. This is the first study to approach this group of patients from both a cerebral and muscle analysis perspective. Methods : The assessment of shoulder movement was undertaken using two simple movements, forward flexion and abduction. The muscles around the shoulder (AD, MD, PD, UT, SA, BB, TM, LD, PM, SSP, ISP and SUB) were assessed in 21 individuals in the standing and supine position using EMG. In the supine position the movement was restricted to the movement possible in a Siemens 1.5 Tesla MRI Scanner. Patients were recruited with Polar type II/III shoulder instability, with their inclusion confirmed by the senior surgeon and physiotherapist. In total, 16 Polar type II/III patients were recruited along with 16 age-matched controls. The patients and the controls underwent an fMRI and EMG. The fMRI protocol involved movements of forward flexion and abduction in a 1.5 tesla MRI Scanner. The EMG movements tested were forward flexion and abductions to 90 degrees (AD, MD, PD, UT, SA, TM, LD, PM, BB, ISP). Both the patients and the controls completed questionnaires: the Western Ontario Shoulder Instability Index (WOSI), Oxford Shoulder Instability Score (OSIS) and Beck’s Depression Inventory. Results : Analysis of the EMG data in the normal shoulder group confirmed activations in both supine and standing positions; however the activations in the supine position were of a different character. There was increased activation in the patient group compared to the control group. In the patient group, with a voxel level familywise error rate (FWER) p=0.04, there was a unique activation at MNI coordinates -38 -26 56. The cluster FWER p<0.001 showed additional clusters in the patient group in the Primary somatosensory cortex, BA 3, Primary Motor Cortex, BA 4, Premotor cortex, BA 6 and Dorsolateral prefrontal cortex, BA 9. When the WOSI and OSIS were used as a contrast, activations were seen in primary somatosensory cortex, BA 3, supplementary motor cortex, BA 11, orbitofrontal area, BA 26, cingulate gyrus and the amygdala. The WOSI and OSIS showed a dramatically different score in the patient group compared to the controls, save for one patient whose symptoms had largely resolved following muscle patterning physiotherapy. Conclusion : The EMG studies in the standing and the supine position confirmed the validity of the fMRI paradigm. The instability questionnaires, WOSI and OSIS confirmed the patient group selection. The unique activation (MNI -38 -26 56) occurred within the primary motor cortex, with the cluster level voxels stretching between both the somatosensory cortex and the motor cortex. The WOSI and OSI comparisons show similar activations. This is thought to be evidence of compensatory activation. This additional activation was also seen in the EMG analysis, with evidence throughout all of the muscles that greater activation was needed to complete simple movement. Overall, the comparative addition cortical and muscles activations in patient group simultaneously demonstrate dysfunction and compensatory strategies employed to achieve simple shoulder movement

    Proceedings of the 9th international conference on disability, virtual reality and associated technologies (ICDVRAT 2012)

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