Exoskeleton-based exercisers for the disabilities of the upper arm and hand (original) (raw)
Related papers
Innovation in neurological upper extremity rehabilitation
Journal of Hand Therapy, 2013
Medical advances have allowed for greater survivorship and longevity among those afflicted with neurological disorders and disease. However, the residual effects can lead to significant and costly long-term disability impairing quality of life. 1 Among adults who have sustained a stroke, 30-60% have residual hand and upper extremity (UE) dysfunction. 2 Medical and pharmaceutical interventions often quiet the intrusive abnormal movement and symptoms experienced with Huntington's disease, and Parkinson's disease, 3,4 but frequently leave impaired hand and UE function. 5,6 When dysfunction persists over time it can lead to debilitating chronic pain syndromes and dependency on others for performance of daily life tasks. The extent to which therapeutic intervention can ameliorate or temper the devastating long-term effects of neurologically mediated hand and UE impairment is unknown. It is clear that individuals who have sought attention in rehabilitation, now desire specialized and focused care targeted at the challenges imposed by their limited hand and UE function. This special issue emerged from a need to better understand how hand therapists can effectively improve hand and UE function and reduce the secondary effects of disuse for individuals who are experiencing neurologically mediated dysfunction. It is our goal to introduce the reader to current theories and principles that can be used to guide assessment and intervention for this varied population. Traditionally, the focus of treatment in the neurological setting has been on fostering compensation as opposed to remediation of prehensile skill. 7 To remediate hand and UE function the astute therapist needs to take into account the myriad of complexities that influence and often impede success. Namely, this cohort of individuals requires innovative practice models that address movement disorders that are impeding function and are congruent with the individual's cognitive and emotional capacities. Thus, effective restoration of hand and UE function calls for the integration of several interrelated abilities with consideration of use-dependent neuroplasticity and principles of motor learning and control.
Recovery of upper-limb function due to enhanced use-dependent plasticity in chronic stroke patients
Brain, 2010
Patients with chronic stroke often show increased flexor hypertonia in their affected upper limbs. Although an intervention strategy targeting the extensors of the affected upper limb might thus be expected to have benefits for functional recovery, conventional repetitive motor training has limited clinical utility. Recent studies have shown that repetitive transcranial magnetic stimulation could induce motor recovery. The present study tested whether 5 Hz repetitive transcranial magnetic stimulation of the upper-limb area of the primary motor cortex, combined with extensor motor training, had a greater effect on motor recovery than either intervention alone in stroke hemiparesis. Nine patients with chronic subcortical stroke and nine age-matched healthy subjects completed the crossover study. In separate sessions, we examined the single intervention effect of repetitive wrist and finger extension exercises aided by neuromuscular stimulation, the single intervention effect of 5 Hz repetitive transcranial magnetic stimulation and the combined effect of the two interventions. The motor functions were evaluated behaviourally in patients (Experiment 1) and electrophysiologically in healthy subjects (Experiment 2), both before and after the intervention. In addition, we tested the long-term effect by repeating the combined interventions 12 times in patients (Experiment 3). The motor functions were measured again 2 weeks after the end of the repetitive intervention period. In Experiment 1, the combined intervention, but neither of the single interventions, resulted in an improvement of extensor movement (P50.0001) and grip power (P50.05), along with a reduction of flexor hypertonia (P50.01), in their paretic upper limbs. In Experiment 2, only the combined intervention resulted in selective plastic changes of cortico-spinal excitability (P50.01), motor threshold (P50.001) and silent period (P50.01) for the extensors. In Experiment 3, we also confirmed longterm beneficial effects of the combined intervention in patients. These findings indicate that combining motor training with
Neurorehabilitation: Motor recovery after stroke as an example
Annals of Neurology, 2013
The field of neurorehabilitation aims to translate neuroscience research toward the goal of maximizing functional recovery after neurological injury. A growing body of research indicates that the fundamental principles of neurological rehabilitation are applicable to a broad range of congenital, degenerative, and acquired neurological disorders. In this perspective, we will focus on motor recovery after acquired brain injuries such as stroke. Over the past few decades, a large body of basic and clinical research has created an experimental and theoretical foundation for approaches to neurorehabilitation. Recent randomized clinical trials all emphasize the requirement for intense progressive rehabilitation programs to optimally enhance recovery. Moreover, advances in multimodal assessment of patients with neuroimaging and neurophysiological tools suggest the possibility of individualized treatment plans based on recovery potential. There are also promising indications for medical as well as noninvasive brain stimulation paradigms to facilitate recovery. Ongoing or planned clinical studies should provide more definitive evidence. We also highlight unmet needs and potential areas of research. Continued research built upon a robust experimental and theoretical foundation should help to develop novel treatments to improve recovery after neurological injury.
2015
This article stresses the plasticity of the adult sensorimotor cortex in response to various injuries or environmental changes. The dominant role of sensory input is discussed. A number of studies are presented that show how input may lead to learning and change. Learning is discussed in relation to recovery. It is shown how concepts from the field of motor control and learning may be used for improving neuro-logical rehabilitation. Specific attention is given to the variability of input, the meaningfulness of input, and the role of the learning context. The learning context and the application context should have essential characteristics in common, otherwise transfer of learning will be non-optimal. It is argued that learning land-scapes are necessary in order to treat patients in such a way that the learned skills are transferable to situations outside the hospital. KEY WORDS recovery, neurological rehabilitation, motor disorders, brain damage
Neurological rehabilitation: a science struggling to come of age
Physiotherapy Research International, 2002
Over the last few decades, there have been considerable improvements in the outcome of stroke patients both as regards mortality and disability. At least some of these improvements can be attributed to better organization of services and improved rehabilitation. Many patients, however, remain severely disabled and we will need to develop new strategies in which the focus will be on reversing impairments rather than simply helping patients to adapt to unaltered impairments. For this to happen, neurological rehabilitation research will have to develop therapies that have a clearly defined rationale and are rooted in neurosciences, are clinically described, are addressed to a well-characterized target population and are evaluated using appropriate outcome measures. Few studies at present meet all these criteria. The recent revolution in our understanding of the nervous system as being soft-wired, of the potential for recovery through reorganization and of the central role of afferent information associated with normal activity is ground for optimism and indicates the direction in which future therapies should be sought. The paper considers some approaches to providing appropriate afferent information, including inputs such as that from electrotherapy, novel approaches to assisted activity and constraint-induced therapy. We are on the verge of a revolution in neurological rehabilitation. If we exploit the new understanding of the nervous system arising from basic neurosciences in developing and evaluating therapies we should be able to build on the achievements of the last few decades so that fewer of our patients have to carry the burden of severe disability.
Adaptability and Flexibility of the Human Motor System: Implications Neurological Rehabilitation
2013
This article stresses the plasticity of the adult sensorimotor cortex in response to various injuries or environmental changes. The dominant role of sensory input is discussed. A number of studies are presented that show how input may lead to learning and change. Learning is discussed in relation to recovery. It is shown how concepts from the field of motor control and learning may be used for improving neurological rehabilitation. Specific attention is given to the variability of input, the meaningfulness of input, and the role of the learning context. The learning context and the application context should have essential characteristics in common, otherwise transfer of learning will be non-optimal. It is argued that learning landscapes are necessary in order to treat patients in such a way that the learned skills are transferable to situations outside the hospital. KEY WORDS recovery, neurological rehabilitation, motor disorders, brain damage
Rehabilitation with poststroke motor recovery: a review with a focus on neural plasticity
Stroke research and treatment, 2013
Motor recovery after stroke is related to neural plasticity, which involves developing new neuronal interconnections, acquiring new functions, and compensating for impairment. However, neural plasticity is impaired in the stroke-affected hemisphere. Therefore, it is important that motor recovery therapies facilitate neural plasticity to compensate for functional loss. Stroke rehabilitation programs should include meaningful, repetitive, intensive, and task-specific movement training in an enriched environment to promote neural plasticity and motor recovery. Various novel stroke rehabilitation techniques for motor recovery have been developed based on basic science and clinical studies of neural plasticity. However, the effectiveness of rehabilitative interventions among patients with stroke varies widely because the mechanisms underlying motor recovery are heterogeneous. Neurophysiological and neuroimaging studies have been developed to evaluate the heterogeneity of mechanisms under...
Physiotherapy after stroke - a lifetime endeavour
2007
Recovery after stroke is influenced by both intrinsic and extrinsic factors and can be categorised as spontaneous, due to reparative processes, and due to reorganisation of neural mechanisms, plasticity. Plasticity is driven by experiences, mobility, activity, interventions and the physical features of the environment and its demands. The overall aim of this research was to evaluate the effect of physiotherapy in the acute and chronic stages of stroke. Physiotherapy treatment using the Motor Learning Programme was found to be preferable to that using the Bobath concept in acute rehabilitation of patients with stroke. There was no carry-over effect of gains obtained during initial physiotherapy regimes on long- term function if the exercises were not sustained. There was a strong relationship between walking and dynamic and static balance in acute rehabilitation of patients with stroke, indicating that static balance and dynamic balance need to be addressed equally in early rehabilit...