44,618 research outputs found

    A Rehabilitation Engineering Course for Biomedical Engineers

    Get PDF
    This paper describes an upper division elective course in rehabilitation engineering that addresses prosthetics and orthotics, wheelchair design, seating and positioning, and automobile modifications for individuals with disabilities. Faculty lectures are enhanced by guest lectures and class field trips. Guest lecturers include a prosthetist and a lower extremity amputee client, an engineer/prosthetist specializing in the upper extremity, and a rehabilitation engineer. The lower extremity prosthetist and his client present a case study for prosthetic prescription, fabrication, fitting, alignment, and evaluation. The engineer/prosthetist contrasts body-powered versus externally powered upper extremity prostheses and associated design, fitting, and functional considerations; he also discusses myoelectric signal conditioning, signal processing, and associated control strategies for upper extremity prosthetic control. Finally, the rehabilitation engineer presents case studies related to assessment and prescription of mobility aids, environmental control systems, and children\u27s toys. The course also includes visits to a local prosthetic and orthotic facility to observe typical fabrication, fitting, and alignment procedures and a driver rehabilitation program for exposure to driver assessment, training, and common vehicle modifications. These applications of biomedical engineering to persons with disabilities have been well received by the students and have furthered interdisciplinary design and research projects

    Optimizing Effects of Occupational and Physical Therapy Post Stroke

    Get PDF
    Even after rehabilitation, 40% of individuals post-stroke are left with upper extremity residual deficits. This capstone, completed at Cleveland Clinic\u27s Department of Physical Medicine and Rehabilitation, focused on current research that is being conducted to optimize the effects of rehabilitation post-stroke. A manuscript was completed that focuses on research findings on the efficacy of bimanual upper extremity training that will be submitted for publication.https://engagedscholarship.csuohio.edu/ot_capstone_posters/1057/thumbnail.jp

    A microcosting study of the surgical correction of upper extremity deformity in children with spastic cerebral palsy

    Get PDF
    _Objective:_ Determine healthcare costs of upper-extremity surgical correction in children with spastic cerebral palsy (CP). _Method:_ This cohort study included 39 children with spastic CP who had surgery for their upper extremity at a Dutch hospital. A retrospective cost analysis was performed including both hospital and rehabilitation costs. Hospital costs were determined using microcosting methodology. Rehabilitation costs were estimated using reference prices. _Results:_ Hospital costs averaged €6813 per child. Labor (50%), overheads (29%), and medical aids (15%) were important cost drivers. Rehabilitation costs were estimated at €3599 per child. _Conclusions:_ Surgery of the upper extremity is an important contributor to the healthcare costs of children with CP. Our study shows that labor is the most important cost driver for hospital costs, owing to the multidisciplinary approach and patient-specific treatment plan. A remarkable finding was the substantial amount of rehabilitation costs

    Observation of Amounts of Movement Practice Provided during Stroke Rehabilitation

    Get PDF
    Objective To investigate how much movement practice occurred during stroke rehabilitation, and what factors might influence doses of practice provided. Design Observational survey of stroke therapy sessions. Setting Seven inpatient and outpatient rehabilitation sites. Participants We observed a convenience sample of 312 physical and occupational therapy sessions for people with stroke. Interventions Not applicable. Main Outcome Measures We recorded numbers of repetitions in specific movement categories and data on potential modifying factors (patient age, side affected, time since stroke, FIM item scores, years of therapist experience). Descriptive statistics were used to characterize amounts of practice. Correlation and regression analyses were used to determine whether potential factors were related to the amount of practice in the 2 important categories of upper extremity functional movements and gait steps. Results Practice of task-specific, functional upper extremity movements occurred in 51% of the sessions that addressed upper limb rehabilitation, and the average number of repetitions/session was 32 (95% confidence interval [CI]=20–44). Practice of gait occurred in 84% of sessions that addressed lower limb rehabilitation and the average number of gait steps/session was 357 (95% CI=296–418). None of the potential factors listed accounted for significant variance in the amount of practice in either of these 2 categories. Conclusions The amount of practice provided during poststroke rehabilitation is small compared with animal models. It is possible that current doses of task-specific practice during rehabilitation are not adequate to drive the neural reorganization needed to promote function poststroke optimally

    Technology-assisted stroke rehabilitation in Mexico: a pilot randomized trial comparing traditional therapy to circuit training in a Robot/technology-assisted therapy gym

    Get PDF
    Background Stroke rehabilitation in low- and middle-income countries, such as Mexico, is often hampered by lack of clinical resources and funding. To provide a cost-effective solution for comprehensive post-stroke rehabilitation that can alleviate the need for one-on-one physical or occupational therapy, in lower and upper extremities, we proposed and implemented a technology-assisted rehabilitation gymnasium in Chihuahua, Mexico. The Gymnasium for Robotic Rehabilitation (Robot Gym) consisted of low- and high-tech systems for upper and lower limb rehabilitation. Our hypothesis is that the Robot Gym can provide a cost- and labor-efficient alternative for post-stroke rehabilitation, while being more or as effective as traditional physical and occupational therapy approaches. Methods A typical group of stroke patients was randomly allocated to an intervention (n = 10) or a control group (n = 10). The intervention group received rehabilitation using the devices in the Robot Gym, whereas the control group (n = 10) received time-matched standard care. All of the study subjects were subjected to 24 two-hour therapy sessions over a period of 6 to 8 weeks. Several clinical assessments tests for upper and lower extremities were used to evaluate motor function pre- and post-intervention. A cost analysis was done to compare the cost effectiveness for both therapies. Results No significant differences were observed when comparing the results of the pre-intervention Mini-mental, Brunnstrom Test, and Geriatric Depression Scale Test, showing that both groups were functionally similar prior to the intervention. Although, both training groups were functionally equivalent, they had a significant age difference. The results of all of the upper extremity tests showed an improvement in function in both groups with no statistically significant differences between the groups. The Fugl-Meyer and the 10 Meters Walk lower extremity tests showed greater improvement in the intervention group compared to the control group. On the Time Up and Go Test, no statistically significant differences were observed pre- and post-intervention when comparing the control and the intervention groups. For the 6 Minute Walk Test, both groups presented a statistically significant difference pre- and post-intervention, showing progress in their performance. The robot gym therapy was more cost-effective than the traditional one-to-one therapy used during this study in that it enabled therapist to train up to 1.5 to 6 times more patients for the approximately same cost in the long term. Conclusions The results of this study showed that the patients that received therapy using the Robot Gym had enhanced functionality in the upper extremity tests similar to patients in the control group. In the lower extremity tests, the intervention patients showed more improvement than those subjected to traditional therapy. These results support that the Robot Gym can be as effective as traditional therapy for stroke patients, presenting a more cost- and labor-efficient option for countries with scarce clinical resources and funding. Trial registration ISRCTN98578807

    Hand rehabilitation with sonification techniques in the subacute stage of stroke

    Get PDF
    After a stroke event, most survivors suffer from arm paresis, poor motor control and other disabilities that make activities of daily living difficult, severely affecting quality of life and personal independence. This randomized controlled trial aimed at evaluating the efficacy of a music-based sonification approach on upper limbs motor functions, quality of life and pain perceived during rehabilitation. The study involved 65 subacute stroke individuals during inpatient rehabilitation allocated into 2 groups which underwent usual care dayweek) respectively of standard upper extremity motor rehabilitation or upper extremity treatment with sonification techniques. The Fugl-Meyer Upper Extremity Scale, Box and Block Test and the Modified Ashworth Scale were used to perform motor assessment and the McGill Quality of Life-it and the Numerical Pain Rating Scale to assess quality of life and pain. The assessment was performed at baseline, after 2 weeks, at the end of treatment and at follow-up (1 month after the end of treatment). Total scores of the Fugl-Meyer Upper Extremity Scale (primary outcome measure) and hand and wrist sub scores, manual dexterity scores of the affected and unaffected limb in the Box and Block Test, pain scores of the Numerical Pain Rating Scale (secondary outcomes measures) significantly improved in the sonification group compared to the standard of care group (time*group interaction < 0.05). Our findings suggest that music-based sonification sessions can be considered an effective standardized intervention for the upper limb in subacute stroke rehabilitation

    Stroke patients’ motivation for home-based upper extremity rehabilitation with eHealth tools

    Get PDF
    Purpose: eHealth-based exercise therapies were developed to increase stroke patients’ adherence to home-based motor rehabilitation. However, these eHealth tools face a rapid decrease in use after a couple of weeks. This study investigates stroke patients’ motivation for home-based upper extremity rehabilitation with eHealth tools and their relation with Basic Psychological Needs. Materials and methods: This is a qualitative study using thematic analysis. We conducted semi-structured interviews with stroke patients with upper extremity motor impairments, who were discharged home from a rehabilitation centre, after they interacted with a novel eHealth coach demonstrator in their homes for five consecutive days. Results: We included ten stroke patients. Thematic analysis resulted in eight themes for home-based rehabilitation motivation: Curiosity, Rationale, Choice, Optimal challenge, Reference, Encouragement, Social Support and Trustworthiness. Those themes are embedded into three Basic Psychological Needs: “Autonomy”, “Competence”, and “Relatedness”. Conclusion: Eight motivational themes related to the three Basic Psychological Needs describe stroke patients’ motivation for home-based upper extremity rehabilitation. We recommend considering those themes when developing a home-based eHealth intervention for stroke patients to increase the alignment of eHealth tools to the patient’s needs and reduce motivational decreases in home-based rehabilitation.</p

    Kinetic Chain Rehabilitation: A Theoretical Framework

    Get PDF
    Sequenced physiologic muscle activations in the upper and lower extremity result in an integrated biomechanical task. This sequencing is known as the kinetic chain, and, in upper extremity dominant tasks, the energy development and output follows a proximal to distal sequencing. Impairment of one or more kinetic chain links can create dysfunctional biomechanical output leading to pain and/or injury. When deficits exist in the preceding links, they can negatively affect the shoulder. Rehabilitation of shoulder injuries should involve evaluation for and restoration of all kinetic chain deficits that may hinder kinetic chain function. Rehabilitation programs focused on eliminating kinetic chain deficits, and soreness should follow a proximal to distal rationale where lower extremity impairments are addressed in addition to the upper extremity impairments. A logical progression focusing on flexibility, strength, proprioception, and endurance with kinetic chain influence is recommended

    Physical therapy in a patient with post-encephalitis tetra-paresis: a case report

    Get PDF
    The purpose of the rehabilitation program is to improve motor skills, coordination, mobilization and other existing disorders to achieve independence in daily living (ADL). Physical therapy as part of the rehabilitation program can provide core stability exercises, facilitation and stimulation of motion of the upper and lower extremities, balance exercises and mobilization exercises, as well as strengthening exercises with facilitation and active stimulation techniques and using the patient's body weight as a training burden. Strengthening exercise can reduce spasticity by strengthening the antagonist muscles. After six months of the rehabilitation program, manual muscle testing (MMT) was evaluated for the right upper extremity 3/5, left upper extremity 5/5, right lower extremity 1/5, left lower extremity 2/5. Ashworth scale right upper extremity 1/4, right lower extremity 2/4, and left lower extremity 1/4. Clonus is reduced, the patient can stand with maximum support without clonus for 10 minutes. Trunk impairment scale 12/23 and Barthel index 65/100. Mobilization of the patient is being able to sit with minimal assistance, namely stabilization in the pelvis, sitting to standing with moderate support, which is supported at the knee bilaterally, and standing with support at the knee and pelvic for 10 minutes. This case report concludes that although physiotherapy is done late with strengthening exercise and core stability strengthening techniques, it can improve motor skills, which in turn will increase the patient's independence in carrying out functional activities and ADLs.
    corecore