Standardizing the intensity of upper limb treatment in rehabilitation medicine
Indexed on pubmed PMID: 20237174
Authors: Wallace AC, Talelli P, Dileone M, Oliver R, Ward N, Cloud G, Greenwood R, Di Lazzaro V, Rothwell JC, Marsden... more
Authors: Wallace AC, Talelli P, Dileone M, Oliver R, Ward N, Cloud G, Greenwood R, Di Lazzaro V, Rothwell JC, Marsden JF
Journal: Clinical Rehabilitation 2010
Epub ahead of print
Objective: To describe a treatment protocol for the upper limb that standardizes intensity of therapy input regardless of the severity of presentation.Design: The protocol is described (Part 1) and feasibility and effect explored (Part 2).Subjects: Participants (n = 11) had a single ischaemic stroke in the middle cerebral artery territory more than one year previously, and had residual weakness of the hand with some extension present at the wrist and the ability to grasp.Interventions: Following two baseline assessments, participants attended therapy for 1 hour a day for 10 consecutive working days. Treatment consisted of a combination of strength and functional task training. Outcomes were measured immediately after training, at one month and three months. OUTCOME MEASURES: Intensity was measured with Borg Rating of Perceived Exertion. Secondary outcome measures included Action Research Arm Test (ARAT), nine-hole peg test, and Goal Attainment Scale.Results: Borg scores indicated that the level of intensity was appropriate and similar across all participants despite individual differences in the severity of their initial presentation (median (interquartile range) = 14 (13-15)). The mean ARAT score significantly increased by 6.8 points (chi(2)(3) = 15.618, P < 0.001), and was maintained at three-month follow-up (z = - 2.384, P = 0.016). The nine-hole peg test also showed a main effect of time and 88% of goals set were achieved.Conclusions: The physiotherapy protocol standardized intensity of treatment by grading exercise and task-related practice according to the person's residual ability, rather than simply standardizing treatment times. It was feasible and well tolerated in this group.
PMID: 20237174 [PubMed - as supplied by publisher]
Self-alert training: Volitional modulation of autonomic arousal improves sustained attention
Redmond G. O’Connell, Mark A. Bellgrove, Paul M. Dockree, Adam Lau, Michael Fitzgerald, Ian H. Robertson
Neuropsychologia 2008
The present study examines a new alertness training strategy (Self-Alert Training, SAT) designed to explore the... more
The present study examines a new alertness training strategy (Self-Alert Training, SAT) designed to explore the relationship between the top–down control processes governing arousal and sustained attention. In order to maximally target frontal control systems SAT combines a previously validated behavioural self-alerting technique [Robertson, I. H., Tegner, R., Tham, K., Lo, A., & Nimmo-Smith, I. (1995). Sustained attention training for unilateral neglect: Theoretical and rehabilitation implications. Journal of Clinical and Experimental Neuropsychology, 17, 416–430] with an autonomic arousal biofeedback protocol in which participants learn to modulate their own arousal levels. The SAT protocol was first validated with a group of 23 neurologically healthy participants and then independently tested in a group of 18 adults with ADHD to determine
its clinical utility. Half of the participants in each group were assigned to a placebo condition to control for non-specific effects. All participants performed the sustained attention to response task (SART) during pre- and post-training testing sessions to assess training effects on sustained attention. By the end of SAT all participants were able to modulate their own arousal levels without external prompting. Comparison of pre- and
post-training baseline data indicated that, as predicted, SAT was associated with increased levels of autonomic arousal accompanied by improved accuracy on the SART. In contrast, participants in the placebo condition exhibited a gradual reduction in arousal over time and increased reaction time variability indicative of a vigilance decrement. These data demonstrate that the recruitment of top–down control processes during volitional modulation of arousal leads to improved sustained attention. These findings have important implications for the rehabilitation of attention deficits arising from frontal dysfunction.
Download (.pdf) Cognitive remediation in ADHD: Effects of periodic non-contingent alerts on sustained attention to response
Redmond G. O’Connell, Mark A. Bellgrove, Paul M. Dockree, and Ian H. Robertson
Neuropsychological Rehabilitation, 2006
Few studies have attempted direct cognitive remediation of attention deficits in attention-deficit hyperactivity... more Few studies have attempted direct cognitive remediation of attention deficits in attention-deficit hyperactivity disorder (ADHD). The present study inves- tigated the efficacy of periodic non-informative alerting cues for improving sustaining attention in ADHD. This technique is known to improve sustained attention in right frontal injury patients and may be effective in ADHD, given that this disorder has also been linked with right frontal dysfunction. Fifteen children with ADHD and 15 matched controls completed four blocks of a modified version of the Sustained Attention to Response Task (SART). Eight random non-contingent alerts were introduced on two of these blocks as a cue for participants to adopt a more supervisory stance to their performance. While the alerting cues did not alter the total number of commission errors committed by ADHD children over a task block, they did produce a significant short-term reduction in commission errors in the period immediately following an alerting cue. Our data demon- strate that sustained attention performance can be enhanced in children with ADHD using a simple cognitive training strategy. Methods from the field of cognitive rehabilitation may be viably applied to the remediation of attention deficits in ADHD.
Robot-aided neurorehabilitation: a robot for wrist rehabilitation
Krebs, H.I. and Volpe, B.T. and Williams, D. and Celestino, J. and Charles, S.K. and Lynch, D. and Hogan, N.
IEEE Transactions on Neural Systems and Rehabilitation Engineering, 2007
In 1991, a novel robot named MIT-MANUS was introduced as a test bed to study the potential of using robots to assist... more In 1991, a novel robot named MIT-MANUS was introduced as a test bed to study the potential of using robots to assist in and quantify the neuro-rehabilitation of motor function. It proved an excellent fit for the rehabilitation of shoulder and elbow of stroke patients with results in clinical trials showing a reduction of impairment in these joints. The greater reduction in impairment was limited to the group of muscles exercised. This suggests a need for additional robots to rehabilitate other degrees of freedom. This paper outlines the mechanical design of a robot for wrist rehabilitation.
Kinematic Analysis of Head, Trunk, and Pelvis Movement When People Early After Stroke Reach Sideways
Verheyden G, van Duijnhoven HJ, Burnett M, Littlewood J, Kunkel D, Ashburn AM. Neurorehabil Neural Repair. 2011 Mar 30. [Epub ahead of print]
BACKGROUND: Sideways reaching with the unaffected arm while seated is a component of everyday activities and can be a... more
BACKGROUND: Sideways reaching with the unaffected arm while seated is a component of everyday activities and can be a challenging task early after stroke. Kinematic analysis of a lateral reach task may provide potential rehabilitation strategies.
OBJECTIVE: The authors examined the difference between people with stroke and healthy controls in the movement sequence of head, trunk, and pelvis, as well as the difference in angle at maximum reach and peak velocity for each body segment during reach and return.
METHODS: Twenty-four people within 12 weeks of a stroke and 20 healthy subjects performed a standardized lateral reach. Using CODAmotion, movement sequence was determined and angles and peak velocities were calculated.
RESULTS: When reaching, people with stroke moved their pelvis first, followed by the trunk and head, whereas healthy controls started with their head and then moved their trunk and pelvis. Patients achieved significantly smaller angles at maximum reach compared with healthy subjects for all body segments and lower peak velocities during the reach (for head, trunk, and pelvis) and the return (for head and trunk).
CONCLUSIONS: Lateral reaching to the unaffected side early after stroke revealed a different pattern than normal and patients reached less far and moved at a slower speed. Specific training strategies to improve reaching are needed.
Myall, D. J., MacAskill, M. R., Davidson, P. R., Anderson, T. J., & Jones, R. D. (2008). Design of a modular and low-latency virtual-environment platform for applications in motor adaptation research, neurological disorders, and neurorehabilitation. IEEE Transactions on Neural Systems & Rehabilitation Engineering, 16(3), 298-309.
We have developed a modular virtual environment platform for movement research and rehabilitation. The system uses... more We have developed a modular virtual environment platform for movement research and rehabilitation. The system uses several networked computers running Linux to share computation. An electromagnetic tracker is the primary position tracker and both a head-mounted display and stereo goggles are used for visual display. System software is written in a combination of C++, JAVA, and Python and makes considerable use of the open-source toolkits VR Juggler and OpenSceneGraph. These are integrated with additional toolkits and custom modules written specifically for the study of motor control and rehabilitation. The system performs well with low latency, accurate calibration, and a consistently high graphics update rate. Preliminary applications have confirmed that the system is a powerful tool for sensory-motor investigation and has considerable potential as a tool for neurorehabilitation. Its primary advantage over other systems is its ability to utilize different display and input devices, and run a range of experiments simply by changing XML configuration files. Additionally, the use of powerful open-source libraries provides a feature-rich foundation for advanced features and low-cost duplication. Further work and experiments are needed to extend, further validate, and fully utilize this platform.
Reliability and Validity of Trunk Assessment for People With Multiple Sclerosis
Verheyden G, Nuyens G, Nieuwboer A, Van Asch P, Ketelaer P, De Weerdt W. Physical Therapy 2006; 86: 66-76.
Time Course of Trunk, Arm, Leg, and Functional Recovery After Ischemic Stroke
Verheyden G, Nieuwboer A, De Wit L, Thijs V, Dobbelaere J, Devos H, Severijns D, Vanbeveren S, De Weerdt W. Neurorehabilitation and Neural Repair 2008; 22: 173-179.
Effect of a Yoga Programme on An Individual With Parkinson's Disease: a Single-Subject Design
Hall E, Verheyden G, Ashburn A. Disability and Rehabilitation, Epub 04 Nov 2010.