Clinical Application of Physical Therapy in Neurorehabilitation

The knowledge from basic neuroscience studies on mechanisms of motor recovery and the development of theoretical models of learning and recovery has favoured the development and implementation of neurophysiologically sounded rehabilitative interventions [...]

Mobile Applications for Resting Tremor Assessment in Parkinson’s Disease: A Systematic Review

(1) Background: Resting tremor is a motor manifestation present in most Parkinson’s disease (PD) patients. For its assessment, several scales have been created, but mobile applications could help in objectively assessing resting tremor in PD patients in person and/or remotely in a more ecological scenario. (2) Methods: a systematic review following the PRISMA recommendations was conducted in scientific databases (PubMed, Medline, Science Direct, Academic Search Premier, and Web of Science) and in the main mobile application markets (Google Play, iOS App Store, and Windows Store) to determine the applications available for the assessment of resting tremor in patients with PD using only the measurement components of the phone itself (accelerometers and gyroscopes). (3) Results: 14 articles that used mobile apps to assess resting tremor in PD were included, and 13 apps were identified in the mobile application markets for the same purpose. The risk of bias and of applicability concerns of the articles analyzed was low. Mobile applications found in the app markets met an average of 85.09% of the recommendations for the development of medical mobile applications. (4) Conclusions: the use of mobile applications for the evaluation of resting tremor in PD patients has great potential, but validation studies for this purpose are scarce

Detecting intention to walk in stroke patients from pre-movement EEG correlates

Background: Most studies in the field of brain-computer interfacing (BCI) for lower limbs rehabilitation are carried out with healthy subjects, even though insights gained from healthy populations may not generalize to patients in need of a BCI. Methods: We investigate the ability of a BCI to detect the intention to walk in stroke patients from pre-movement EEG correlates. Moreover, we also investigated how the motivation of the patients to execute a task related to the rehabilitation therapy affects the BCI accuracy. Nine chronic stroke patients performed a self-initiated walking task during three sessions, with an intersession interval of one week. Results: Using a decoder that combines temporal and spectral sparse classifiers we detected pre-movement state with an accuracy of 64 % in a range between 18 % and 85.2 %, with the chance level at 4 %. Furthermore, we found a significantly strong positive correlation (r = 0.561, p = 0.048) between the motivation of the patients to perform the rehabilitation related task and the accuracy of the BCI detector of their intention to walk. Conclusions: We show that a detector based on temporal and spectral features can be used to classify pre-movement state in stroke patients. Additionally, we found that patients'' motivation to perform the task showed a strong correlation to the attained detection rate of their walking intention

A new lower limb portable exoskeleton for gait assistance in neurological patients: a proof of concept study

Background: Few portable exoskeletons following the assist-as-needed concept have been developed for patients with neurological disorders. Thus, the main objectives of this proof-of-concept study were 1) to explore the safety and feasibility of an exoskeleton for gait rehabilitation in stroke and multiple sclerosis patients, 2) to test different algorithms for gait assistance and measure the resulting gait changes and 3) to evaluate the user's perception of the device. Methods: A cross-sectional study was conducted. Five patients were recruited (4 patients with stroke and 1 with multiple sclerosis). A robotic, one-degree-of-freedom, portable lower limb exoskeleton known as the Marsi Active Knee (MAK) was designed. Three control modes (the Zero Force Control mode, Mode 1 and Mode 3) were implemented. Spatiotemporal gait parameters were measured by the 10-m walking test (10MWT), the Gait Assessment and Intervention Tool (G.A.I.T.) and Tinetti Performance Oriented Mobility Assessment (gait subscale) before and after the trials. A modified QUEST 2.0 questionnaire was administered to determine each participant's opinion about the exoskeleton. The data acquired by the MAK sensors were normalized to a gait cycle, and adverse effects were recorded. Results: The MAK exoskeleton was used successfully without any adverse effects. Better outcomes were obtained in the 10MWT and G.A.I.T. when Mode 3 was applied compared with not wearing the device at all. In 2 participants, Mode 3 worsened the results. Additionally, Mode 3 seemed to improve the 10MWT and G.A.I.T. outcomes to a greater extent than Mode 1. The overall score for the user perception of the device was 2.8 ± 0.4 95% CI. Conclusions: The MAK exoskeleton seems to afford positive preliminary results regarding safety, feasibility, and user acceptance. The efficacy of the MAK should be studied in future studies, and more advanced improvements in safety must be implemented.G. Puyuelo-Quintana has received financial support by the “Doctorado Industrial” grant of Ministerio de Ciencia, Innovación y Universidades de España (reference DI-16- 08731). A. Plaza-Flores and E. Garces-Castellote have received financial support by the “Doctorado Industrial” grant of Comunidad de Madrid (reference IND2017/TIC-7698 and IND2018/TIC-9618, respectively).Peer reviewe

Aplicaciones móviles en la enfermedad de Parkinson: una revisión sistemática

Resumen: Introducción: La enfermedad de Parkinson (EP) es la segunda enfermedad neurodegenerativa más frecuente, pero su diagnóstico, valoración y tratamiento son complejos y requiere de una atención sanitaria continuada en el tiempo. En este sentido, las características de los teléfonos móviles inteligentes o smartphones hacen que se plantee su uso en el ámbito de la asistencia del paciente con EP. Objetivo: El objetivo del presente trabajo es realizar una revisión sistemática sobre el uso de aplicaciones móviles (apps) en la EP. Material y métodos: Se llevó a cabo una búsqueda bibliográfica incluyendo artículos publicados en inglés o castellano, del año 2011 hasta el 2016, y que presentasen, analizasen o validasen un sistema basado en una app con utilidad o diseño específico para la EP. A su vez, se llevó a cabo una búsqueda de aplicaciones móviles en los principales mercados de aplicaciones móviles. Conclusiones: Se encontraron mediante ambas búsquedas 125 aplicaciones, de las cuales 56 se clasificaron con potencial utilidad en la EP, y 69 con un diseño específico para la EP, siendo 23 apps de información sobre EP, 29 apps de valoración, 13 apps de tratamiento y 4 apps de valoración y tratamiento. Existen un gran número de aplicaciones móviles con potencial utilidad y diseño específico en la EP; sin embargo; la evidencia científica acerca de los mismos es escasa y de baja calidad. Son necesarios estudios posteriores para validar esta tecnología, así como una regulación por parte de organismos acerca de su uso. Abstract: Introduction: Parkinson's disease (PD) is the second most common neurodegenerative disease. However, diagnosing, assessing, and treating these patients is a complex process requiring continuous monitoring. In this context, smartphones may be useful in the management of patients with PD. Objective: The purpose of this study is to perform a systematic review of the literature addressing the use of mobile phone applications (apps) in PD. Materials and methods: We conducted a literature search of articles published in English or Spanish between 2011 and 2016 analysing or validating apps specifically designed for or useful in PD. In addition, we searched for apps potentially useful for PD patients in the leading app stores. Conclusions: The literature and app searches yielded a total of 125 apps, 56 of which were classified as potentially useful in PD and 69 as specifically designed for PD (23 information apps, 29 assessment apps, 13 treatment apps, and 4 assessment and treatment apps). Numerous mobile apps are potentially useful in or specifically designed for PD management. However, scientific evidence of their usefulness is scarce and of poor quality. Further studies are needed to validate these tools and regulate their use. Palabras clave: Apps, Aplicaciones móviles, eHealth, Enfermedad de Parkinson, mHealth, Rehabilitación, Keywords: Apps, Mobile phone applications, eHealth, Parkinson's disease, mHealth, Rehabilitatio

Effects of vibrotherapy on postural control, functionality and fatigue in multiple sclerosis patients: A randomised clinical trial

Introduction: Postural and balance disorders, functionality impairment and fatigue, are the most incapacitating problems in multiple sclerosis (MS) patients. Whole Body Vibration (WBV), through the transmission of mechanical stimuli, appears to be a useful therapeutic tool in the treatment of neurological diseases. The objective of this study is to assess the effect of the WBV on postural control, balance, functionality and fatigue in patients with MS. Material and methods: A total of 34 patients with mild–moderate MS were randomised into a control group and an intervention group. For the intervention group, the protocol consisted of 5 consecutive days, daily series of 5 periods of 1 min duration of WBV at a frequency of 6 Hz. Posturographic assessment using the sensory organisation test (SOT) and motor control test (MCT), the timed get up and go test, 10 m test, the Berg balance scale and Krupp's fatigue severity scale were used before and after intervention. Results: The analysis showed improvements in the intervention group for conditions SOT 1, SOT 3 and latency in MCT. In the comparison between groups, only the latency or reaction time in MCT improved significantly in favour of the intervention group (from 173.78 ± 12.46 to 161.25 ± 13.64 ms; P = .04). No side-effects were found. Conclusions: The results of this pilot study show that WBV can improve, in the short-term, the time of response to recover the uprightness after sudden disturbances, appearing as a possible therapeutic tool maintaining balance and posture. Resumen: Introducción: Los trastornos del equilibrio, junto con las alteraciones de la funcionalidad y la fatiga, constituyen los síntomas más incapacitantes en los pacientes con esclerosis múltiple (EM). La vibroterapia de cuerpo entero o whole body vibration (WBV), a través de la transmisión de estímulos mecánicos, se presenta como una herramienta terapéutica útil en el tratamiento de las alteraciones del control postural en diversas patologías neurológicas. El objetivo del presente estudio es valorar el efecto a corto plazo de la vibroterapia sobre el control postural, la funcionalidad y la fatiga en pacientes con EM. Material y métodos: Treinta y cuatro pacientes con EM con afectación leve-moderada, distribuidos aleatoriamente en un grupo control y un grupo experimental, participaron en el estudio. El grupo experimental fue sometido a WBV durante 5 días consecutivos (series diarias de 5 periodos de 1 min de duración) a una frecuencia de 6 Hz. Previamente y post-intervención, fueron realizadas valoraciones con posturografía dinámica computarizada, mediante el test de organización sensorial (SOT) y el test de control motor (MCT), así como con el test timed up and go, la escala de equilibrio de Berg, la prueba los 10 metros y la escala de severidad de fatiga de Krupp. Resultados: El análisis comparativo de datos pre y post-intervención de los grupos mostró mejoras en el grupo experimental para las condiciones SOT 1, SOT 3 y la latencia en el MCT. Realizada la comparación entre grupos, únicamente la latencia o tiempo de reacción en el MCT mejoró significativamente a favor del grupo experimental (de 173,78 ± 12,46 a 161,25 ± 13,64 ms; p = 0,04). No se registraron efectos adversos derivados. Conclusiones: Los resultados de este estudio muestran que el protocolo utilizado de WBV mejoró a corto plazo el tiempo de respuesta para recobrar la verticalidad ante estímulos desestabilizantes, pudiéndose mostrar como una opción terapéutica en el mantenimiento del control postural y el equilibrio en pacientes con EM. Keywords: Balance, Dynamic posturography, Multiple sclerosis, Postural control, Whole Body Vibration, Palabras clave: Control postural, Esclerosis múltiple, Equilibrio, Posturografía dinámica, Vibroterapi

Neurorehabilitation and apps: A systematic review of mobile applications

Introduction: Mobile health or mHealth, defined as the provision of health information or healthcare by means of mobile devices or tablets, is emerging as a major game-changer for patients, care providers, and investors. An app is a programme with special characteristics installed on a small mobile device, either a tablet or smartphone, with which the user interacts via a touch-based interface. The purpose of the app is to facilitate completion of a certain task or assist with daily activities. Objective: The aim of this study was to conduct a systematic review of published information on apps directed at the field of neurorehabilitation, in order to classify them and describe their main characteristics. Material and methods: A systematic review was carried out by means of a literature search in biomedical databases and other information sources related to mobile applications. Apps were classified into five categories: health habits, information, assessment, treatment, and specific uses. Conclusions: There are numerous applications with potential for use in the field of neurorehabilitation, so it is important that developers and designers understand the needs of people with neurological disorders so that their products will be valid and effective in light of those needs. Similarly, professionals, patients, families, and caregivers should have clear criteria and indicators to help them select the best applications for their specific situations. Resumen: Introducción: La mHealth, definida como la prestación de información o asistencia sanitaria a través del uso de dispositivos móviles o tabletas, se postula como una de las grandes apuestas para pacientes, proveedores e inversores. Una app es un programa, con unas características especiales, que se instala en un dispositivo móvil, ya sea tableta digital o teléfono inteligente, y que suele tener un tamaño reducido, y cuyo objetivo es facilitar la consecución de una tarea determinada o asistir en gestiones diarias, siendo el modo de interacción entre el usuario y la aplicación el tacto. Objetivo: El objetivo del presente trabajo fue realizar una revisión sistemática acerca de la información publicada sobre las apps enfocadas al campo de la neurorrehabilitación, con el fin de clasificarlas y llevar a cabo una descripción de las principales características de las mismas. Material y métodos: Se realiza una revisión sistemática mediante búsqueda bibliográfica en bases de datos biomédicas, así como en otras fuentes de información propias del ámbito de las aplicaciones tipo apps. Se clasificaron las apps en 5 categorías: hábitos saludables, informativas, valoración, tratamiento y específicas. Conclusiones: Existe gran cantidad de apps con potencial uso en el campo de la neurorrehabilitación, por lo que es importante que los desarrolladores y diseñadores apps conozcan cuáles son las necesidades de la población con patología neurológica para que sus productos sean válidos y eficaces en dicho contexto. Del mismo modo, los profesionales, pacientes, familiares y cuidadores deberían disponer de criterios claros e indicadores que pudieran ayudarles a seleccionar las aplicaciones óptimas para sus necesidades concretas. Keywords: Apps, Neurorehabilitation, Mhealth, Ehealth, Palabras clave: Apps, Neurorrehabilitación, Mhealth, Ehealt