17 research outputs found
Abnormal synergistic gait mitigation in acute stroke using an innovative ankle–knee–hip interlimb humanoid robot: A preliminary randomized controlled trial
Abnormal spasticity and associated synergistic patterns are the most common neuromuscular impairments affecting ankle–knee–hip interlimb coordinated gait kinematics and kinetics in patients with hemiparetic stroke. Although patients with hemiparetic stroke undergo various treatments to improve gait and movement, it remains unknown how spasticity and associated synergistic patterns change after robot-assisted and conventional treatment. We developed an innovative ankle–knee–hip interlimb coordinated humanoid robot (ICT) to mitigate abnormal spasticity and synergistic patterns. The objective of the preliminary clinical trial was to compare the effects of ICT combined with conventional physical therapy (ICT-C) and conventional physical therapy and gait training (CPT-G) on abnormal spasticity and synergistic gait patterns in 20 patients with acute hemiparesis. We performed secondary analyses aimed at elucidating the biomechanical effects of Walkbot ICT on kinematic (spatiotemporal parameters and angles) and kinetic (active force, resistive force, and stiffness) gait parameters before and after ICT in the ICT-C group. The intervention for this group comprised 60-min conventional physical therapy plus 30-min robot-assisted training, 7 days/week, for 2 weeks. Significant biomechanical effects in knee joint kinematics; hip, knee, and ankle active forces; hip, knee, and ankle resistive forces; and hip, knee, and ankle stiffness were associated with ICT-C. Our novel findings provide promising evidence for conventional therapy supplemented by robot-assisted therapy for abnormal spasticity, synergistic, and altered biomechanical gait impairments in patients in the acute post-stroke recovery phase. Trial Registration: Clinical Trials.gov identifier NCT03554642 (14/01/2020)
Comfort-Centered Design of a Lightweight and Backdrivable Knee Exoskeleton
This paper presents design principles for comfort-centered wearable robots
and their application in a lightweight and backdrivable knee exoskeleton. The
mitigation of discomfort is treated as mechanical design and control issues and
three solutions are proposed in this paper: 1) a new wearable structure
optimizes the strap attachment configuration and suit layout to ameliorate
excessive shear forces of conventional wearable structure design; 2) rolling
knee joint and double-hinge mechanisms reduce the misalignment in the sagittal
and frontal plane, without increasing the mechanical complexity and inertia,
respectively; 3) a low impedance mechanical transmission reduces the reflected
inertia and damping of the actuator to human, thus the exoskeleton is
highly-backdrivable. Kinematic simulations demonstrate that misalignment
between the robot joint and knee joint can be reduced by 74% at maximum knee
flexion. In experiments, the exoskeleton in the unpowered mode exhibits 1.03 Nm
root mean square (RMS) low resistive torque. The torque control experiments
demonstrate 0.31 Nm RMS torque tracking error in three human subjects.Comment: 8 pages, 16figures, Journa
Interplay Between Cognition and Mobility in Older Adults
Mobility, the ability to move independently, is a critical function for a human being to live a normal life. Mobility impairment poses a major burden on the individual, family, and society as its prevalence increases worldwide with aging of the population. Gait has long been considered as an automatic motor task and this approach has been followed in clinical practice and in the research field. However, more recently studies have suggested that gait requires high-level cognitive function, leading to increased scientific interest in the association between gait and cognition. These findings have significant implications for the development of novel interventions to prevent mobility and cognitive decline among older adults. This article reviews the current literature on the interplay between gait and cognition and on how these findings should be applied for clinical evaluation and intervention to prevent functional decline in older adults
Response to the Letter to the Editor on "Point-of-Care Ultrasonography Findings and Care Use Among Patients Undergoing Ultrasound-Guided Shoulder Injections"
The vital role of inpatient rehabilitation facilities in a large health system: The COVID-19 pandemic
The current COVID-19 pandemic has put the global health-care system into an unprecedented crisis, leaving hospitals overwhelmed and desperate for additional capacity. As of April 20th, 2020, New York State had the most COVID-19 cases in the US. We here describe the process of transforming our freestanding rehabilitation hospital to help to create additional capacity for our parent system, the Montefiore Health System. This transformation required creating a capacity to handle an increased number of patients with higher medical complexity. The sequence of steps taken at Burke Rehabilitation Hospital to rise to the challenge is outlined in this article
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Point-of-Care Ultrasonography Findings and Care Use Among Patients Undergoing Ultrasound-Guided Shoulder Injections
Objective The aims of the study were to assess the overall reduction of pain in patients undergoing ultrasound-guided shoulder injections and to characterize the preinjection point-of-care ultrasound findings and use of clinical services postinjection including the use of magnetic resonance imaging and surgeries.
Design Data of 172 patients who underwent ultrasound-guided subacromial subdeltoid injection or glenohumeral joint injection were reviewed for preinjection point-of-care ultrasound findings, change in pain intensity at 2 mos from baseline, and use of care at 6 mos' postinjection. Pain intensity was measured by the numeric rating scale and a dichotomous report of global impression of significant improvement in pain. Responders were defined as those with 50% or more reduction in numeric rating scale or those with global impression of 50% or more improvement.
Results There were 141 responders among the 172 patients analyzed. Full-thickness rotator cuff tears were higher in the ultrasound-guided subacromial subdeltoid injection group when compared with the glenohumeral joint injection group (P = 0.038) and abnormal bicipital tendon findings higher in the glenohumeral joint injection group (P = 0.016). There were no significant differences in specific abnormal U findings between responders versus nonresponders. Twelve patients had a shoulder magnetic resonance imaging and four patients underwent operative interventions after the injection.
Conclusions Overall pain reduction after ultrasound-guided shoulder injections was favorable in the short term. There was no specific preinjection point-of-care ultrasound findings associated with clinical pain reduction after injection. Additional imaging and operative intervention after ultrasound-guided shoulder injections seemed to be relatively low
Preventing delirium takes a village: systematic review and meta-analysis of delirium preventive models of care
BACKGROUND: Each hospital day of delirium incurs greater healthcare costs, higher levels of care, greater staff burden, and higher complication rates. Accordingly, administrators are incentivized to identify models of care that reduce delirium rates and associated costs.
PURPOSE: We present a systematic review and meta-analysis of delirium prevention models of care.
DATA SOURCES: Ovid MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, EMBASE, and PsycINFO.
STUDY SELECTION: Eligible models of care were defined as provider-oriented interventions involving revision of professional roles, multidisciplinary teams, and service integration. Included studies implemented multidomain, multicomponent interventions, used a validated delirium instrument, and enrolled a control group to evaluate efficacy or effectiveness.
DATA EXTRACTION: We extracted data on study design, population, model of care, outcomes, and results.
DATA SYNTHESIS: A total of 15 studies were included. All but two studies reported reduction in delirium or its duration, and 11 studies reported statistically significant improvements. Using random effects models, the pooled odds ratios of delirium incidence were 0.56 (95% CI: 0.37-0.85) from three randomized controlled trials, 0.63 (95% CI 0.37-1.07) from four pre-post intervention studies, and 0.79 (95% CI: 0.46-1.37) from three additional nonrandomized studies.
CONCLUSIONS: Several models of care can prevent delirium. In general, higher quality studies were more likely to demonstrate statistical significance of an effect. The diverse models of care included here explored interventions adapted to specific care settings, especially by addressing setting-specific delirium risk factors. These care models illustrate a range of promising strategies that deserve growing recognition, refinement, and implementation
Preventing Delirium Takes a Village: Systematic Review and Meta-Analysis of Delirium Preventive Models of Care
International society of physical and rehabilitation medicine webinar series - An effective global educational initiative during COVID-19 pandemic
The International Society of Physical and Rehabilitation Medicine (ISPRM) has recently started an educational initiative named “ISPRM Webinar Series,” broadcasting a series of live interactive online webinar sessions over 3 months. The objectives of the webinars were to connect rehabilitation professionals worldwide, share experiences/expertise, and create teaching-learning activities during the coronavirus disease 2019 (COVID-19) pandemic. The pandemic has been adversely affecting the lives of people including being a big challenge to the medical community. The specialty of physical and rehabilitation medicine is facing challenges and simultaneously having unique opportunities to contribute to the care of COVID-19 survivors. This article describes the purpose, educational structure, and overall experiences during the ISPRM Webinar Series. Distinguished speakers/panelists from around the world delivered their message, expertise, and experience in several topics with a special emphasis on the COVID-19 pandemic. A historical moment for ISPRM was when the Honorable Director General of the World Health Organization, Dr. Tedros Adhanom Ghebreyesus, sent a special message to ISPRM and its global audience. The audience for the various webinars has included colleagues from 101 countries and territories, with an average number of 365 participants per live session and a high prevalence of youth. In conclusion, based on the feedback of the participants, the ISPRM Webinar Series proved to be a timely and effective educational initiative with wide-spread global reach during the COVID-19 pandemic