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1、Chrissy Lighthill, MOT, OTR and Rachel Atkins, PT, DPT Introduce theory behind recent advances in rehab technology Provide an overview of 11 devices Description Cost, if available Availability of demo/in-service from the vendors Other clinics who have the products Evidence Videos and Photos Create a

2、n awareness of the presence of these items, not promoting or reflecting a “wish list” Present to teams/therapists Follow up with vendors Provide real-time biofeedback (feel, see, hear) Objective Measures Monitor progress, tracking outcomes, evidence for third party payers, clear to patient Relevant

3、to society Motivating, Engaging, Stimulating Marketing Tool: Screening, Research Real Life Simulation in Clinic Errorless learning 3 crucial elements for the acquisition of motor programs through rehab : adequate feedback, variability of practice, and design of learning situation. “Patients with mot

4、or dysfunction are totally dependent on the information concerning the outcomes of the attempts to perform motor tasks especially during the acute stage”. -Mulder “allow precise recording of movements and application of forcesvaluable tool for motor rehabilitation.visual cues conveyed on a computer

5、screen to convert repetitive movement practice into an engaging task. information sent to the patient about exercise performanceaddress psychosomatic variables influencing therapy” (3). “Assistive technologies can open new worlds for individuals with physical, communication, and cognitive limitation

6、s.” “A new technology may also help someone with a chronic or progressive disabling condition maintain or improve his or her independence” (4). Myomo Neuromove Balancemaster Biodex Balance System SD Armeo Lokomat Restorative FES Cycles GAITRite Free Supported Ambulation System (SAS) Tibion CAREN Des

7、cription: Force platform for testing and training of static and dynamic standing balance. Capabilities: Fall-risk screening and training, Postural stability, Clinical Test of Sensory Integration of Balance (CTSIB), compare scores to age-dependent norms, charts progress over time, determine which of

8、3 balance systems pt is relying on. Screening: Concussions Evidence: Effective with CVA and Mild TBI (Concussion) Cost: $12,000 Very common in clinics Video http:/ (3:08 total (to 1:40) 6 interactive training modes in Static and Dynamic: Postural Stability, Maze Control, Weight Shift, random Control

9、, Limits of Stability, Weight bearing. Large Color Touch Screen, Interactive, game-like balance. 4 Standardized tests: Static Measuring Capability, Increased Dynamic resistance, Standardized Fall Screening Test Protocol, Athlete Knee Injury Screening Test protocol. Cleared by FDA in 2001Stroke rehab

10、 by muscle re-education Relaxation of muscle spasms (spasticity) Prevention of retardation of disuse atrophyIncrease local blood circulationMaintaining or increasing ROM How it worksVideo: http:/ attempts below where trace movements are visible. Distinguishes between regular muscle activity, muscle

11、tone, and real attempts. When a real attempt is detected, the unit rewards the patient with muscle contraction, visual and sensory feedback serves as an important element in relearning the movement. Very motivating, see they could make a difference, where previously, they had no indication of their

12、attempts. More Info Concentration and focus is the key to achieving better control of motor functions Doesnt work on confused or cognitively low patients Use 1 - 3 X/day for 20 minutes; longer intervals not common Effective for spastic 34: 267272. TRUNK CONTROL TEST AS A FUNCTIONAL PREDICTOR IN STRO

13、KE PATIENTS. E. Duarte, et al. No statistically significant effects in function. -Van Peppen 2006. Only a few studies look at long-term effects. Dynamic balance function of patients in the visual feedback training group had significant improvements when compared with the control group. Activities of

14、 daily living (ADL) function in self-care and sphincter control, also had significant improvements at 6 months follow up in the trained group. Less improvement for locomotion on FIM. The results showed that balance training was beneficial f r p tients after hemiplegic stroke. -Chen ,et al. 2002 Suit

15、able for individuals who have suffered strokes, traumatic brain injuries, or neurological disorders resulting in hand and arm impairment. How does it work?Video: http:/ Adjustable arm support with ahighly sensitive hand grip and videogame-like exercises to simulate arm movements used in specific rea

16、l-life tasksExercises are carried out in the virtual environment on a computer screen, providing you with goal-oriented tasks and giving you immediate visual feedback.Because the weight of the arm is counterbalanced in the arm support, you can use residual neuromuscular control to perform the exerci

17、ses and gradually build strength in your arm. Built-in sensors and software record arm movements at each joint, so you and your therapist can track your improvement, determine the appropriate difficulty level for you and customize your training program as you progress. More InfoOther clinics: UT Sou

18、thwestern, TWU Dallas, TIRR Houston, RIC, Ireland, both groups had the same training time and therapist supervision. * (RIC study) The latest clinical findings show that therapeutic methods that are based on active, high-intensity, task-specific movement training are superior to traditional methods

19、Research ResourcesHousman, S. J., Scott K., M. et al. (2009). A Randomized Controlled Trial of Gravity Supported, Computer-enhanced Arm Exercises for Individuals with Severe Hemiparesis. Neurorehabil Neural Repair. Prange, G. B., Jannink M. J. A. et al. (2009). Influence of Gravity Compensation on M

20、uscle Activation Patterns During Different Temporal Phases of Arm Movements of Stoke Patients. Neurorehabil Neural Repair. Stienen, A. H. (2009). Novel Devices for Upper-Extremity Rehabilitation. PhD Thesis, University of Twente, Enschede, The Netherlands. How we can obtain Cost: $60, 500 Lease to o

21、wn option: $1,122 for 60 months “. very reasonably priced unit (called the ArmeoSpring) for patients who are able to self initiate movement.(I am scheduled to install 3 ArmeoSpring units and train the staff for each of the rehab hospitals in Houston/Austin, Texas next week!) Additionally, we have go

22、tten 3 requests for quotes and information on this upper extremity technology from the Dallas area in the last 2 months!Right now the only units in Texas are at UT Southwestern and Texas Womans University in Dallas and at TIRR in Houston.” April Philpot, DPT Southeast Account Manager Presenters will

23、 visit Dallas locations, if possible. Nanos and Pro Robotic Gait Orthoses Longer and more intensive training sessions compared to manual treadmill Training (principles of motor learning), real time feedback for a higher motivation and compliance, physiological gait pattern provided by individually a

24、djustable orthoses, guidance force and body weight support, assessment and reporting functionality for an easy measurement of the patients progress, task-specific, repeated practice of movement (errorless) Gait asymmetry may be associated with many potential negative issues (eg, challenges to balanc

25、e control, increased energy expenditure, increased risk of musculoskeletal injury to the nonparetic LE, and decreased overall activity levels) (12). Evidence: “assumed”Reduced spasticity, Improved walking ability, Increased alertness, Strengthened leg muscles, Improved stamina, Increased motivation

26、Cost: $150-300 K- available for lease for purchase Availability for demo: Inservice or demo at UTSW Other clinics- Craig, RIC, TIRR, Spaulding, Shepherd Center, Carolinas Rehab. VA Houston, Dallas, San Antonio. UTSW Dallas. TIRR Houston. TIRR is only one used for tx. http:/lifecenter.ric.org/index.p

27、hp?tray=content resource for recovery) Simple observational gait analysis is subjective Description: Big screen for patients, Portable, Carpeted, pressure sensors, computer, 1/8 thick, 2-feet wide by 16-feet long(can be up to 26-feet long) and contains 18,482 sensors sandwiched between a thin vinyl

28、top-cover and a rubber bottom. Have norms. It rolls up to fit into a wheeled carrying case. The carpet is portable, can be laid over any flat surface, and requires minimal setup and test time. No markers or devices have to be placed on the patient. Patients can be tested with or without shoes, inclu

29、ding those patients using assistive devices. Purpose: Objective measurement system, quantifiable evidence of change. Electronic footprints: Measures cadence, step length, Step-to-step symmetry and variability, velocity, and other gait parameters. Tracks, reports, graphs, prints- instantaneous data.

30、Validate impairments and progress to insurance/patient/family. Determines dynamic balance and fall risk. Community Screening. Dual Task. Prescribe assistive devices , FES devices, AFO, Neglect glasses. Treatment-Weight Shifting. Evidence: high concurrent validity with various motion analysis systems

31、(2). High test-retest reliability (2). Cost $34-58K Available for on-site demo. Other clinics COPE- Center for Orthotics and Prosthetics in Chicago; San Antonio Videohttp:/ Craig Hospital, CO; CORE, Fl; Total Rehab Care, MD; Shepard Center, GA; Sheltering Arms,VA; Woodrow Wilson Rehab Center, VART30

32、0 may facilitate improvements that help patients reach functional gains in a shorter time period. While it should not be used in place of a functional activity, it can certainly be used as an adjunctive therapy. In a rehab setting, it is more typically used for shorter durations to impact a more tas

33、k specific goal, such as breaking up spasticity or neuro re-education. There is almost no patient with upper motor neuron weakness that cant benefit from some type of FES cycling. It has benefits for cardiovascular conditioning, strength, reciprocal gait patterns and tone modulation. Darryl Kaelin,

34、M.D., Medical Director for the Acquired Brain Injury Program at Shepherd Center in Atlanta, GA. Research ResourcesCycling induced by electrical stimulation improves motor recovery in postacute hemiparetic patients: a randomized controlled trial. (2011). Ambrosini E, et al. Stroke. 42(4):1068-73. The

35、 study demonstrated that 20 sessions of FES cycling training significantly improved lower extremity motor functions and accelerated the recovery of overground locomotion in postacute hemiparetic patients. Improvements were maintained at follow-up.Bilateral upper limb training with functional electri

36、c stimulation in patients with chronic stroke. (2009). Chan, M. K., Tong, R. K., Chung, K. Y. Neurorehabil Neural Repair. 23(4):357-65. This study was a double-blinded randomized controlled trial. At baseline comparison, there was no significant difference in both groups. After 15 training sessions,

37、 the FES group had significant improvement on the Fugel-Meyer and Functional Test for the Hemiplegic Upper Extremity, and active range of motion of wrist extension when compared with the control group. How we can obtain $22,000 for device and cart Trial period is available 4 hour web based course re

38、quired before your new RT in-service Description: Body weight supported harness for gait. Uses an overhead track and harness. Purpose: Therapist and pt safety and independence. Decreases fear of falling Requires less staff for balance activities High fall risk pts 1:1 More assisting less supporting

39、FITT Cost Other clinics: Shepherd Center Video: http:/ (3:11) Description: Robotic aid that aids the knee in flexion and extension. Activated by foot sensor, follows parameters set by PT. Worn during therapy sessions for strengthening and movement retraining.Benefits: More sit-to-stand exercises, Mo

40、re overground steps per session, More repetition of stair-climbing, Increased potential for “neuroplasticity”. Compared to NMES, not affected by tone, spurs motor recovery via sensors that allow the device to respond to patients intentions.Evidence: Improves gait speed, endurance, balance. Even in 1

41、0 years post CVAVideo: Before and After http:/ (1 min) Cost: $700-1,000/month to rent. $40,000. Evidence Untethered mobility. 3 ambulatory s/p CVA All subjects improved balance, gait and functional performances with mean individual improvements of 12.6% for BBS, 12.0% for 6MWT and 16.7% for EFAP pos

42、t-treatment. No adverse events occurred. May have benefited from the task-specific functional training program augmented by RKO use. -Wong, 2011 UCSF Study What do improved gait speed 38(1): 3 9 Effects of visual feedback therapy on postural control in bilateral standing after stroke: A systematic r

43、eview Chen, et al. Effects of Balance Training on Hemiplegic Stroke Patients. Med J 2002;25:583-90 Biodex Balance http:/ Lokomat http:/ Efficacy of rehabilitation robotics for walking training in neurological disorders: A review. Candace Tefertiller, et al. JRRD. 2011 GAITRite (1)http:/ (2) Agreemen

44、t between the GAITRite Walkway System and a Stopwatch-Footfall Count Method for Measurement of Temporal and Spatial Gait Parameters (Youdas, et al 2006) Arch Phys Med Rehabil http:/ Free Step http:/ (3) Med Biol Eng Comput. 2011 Oct;49(10):1103-18. Epub 2011 Jul 20. Advances in upper limb stroke reh

45、abilitation: a technology push. Loureiro RC, Harwin WS, Nagai K, Johnson M. (4) Spaulding. www.spaulding rehab.org. (5) CAREN. http:/ http:/ (6) Tibion. A wearable robotic knee orthosis for gait training: a case-series of hemiparetic stroke survivors. Christopher Wong, Prosthetics and Orthotics Inte

46、rnational. 2011 . (7) Gerontology DOI: 10.1159/000322194. Laboratory Review: The Role of Gait Analysis in Seniors Mobility and Fall Prevention Stephanie A. Bridenbaugh Reto W. Kressig Department of Acute Geriatrics, University Hospital of Basel, Basel , Switzerland (8) Am J Phys Med Rehab. 6 June 20

47、09. Dobrivoje S. Stokic, MD, DSc, Terry S. Horn, PhD, John M. Ramshur, BS, John W. Chow, PhD. Agreement Between Temporospatial Gait Parameters of an Electronic Walkway and a Motion Capture System in Healthy and Chronic Stroke Populations (9) Gait and Posutre Journal. 22 January 2010. Inter-limb cent

48、re of pressure symmetry during gait among stroke survivors Amanda E. Chisholm , Stephen D. Perry, William E. McIlroy . Toronto Rehabilitation Institute. Graduate Department of Rehabilitation Science, University of (10) Journal of Gerontology. August 7 2009. Quantitative Gait Markers and Incident Fal

49、l Risk in Older Adults. Joe Verghese , 1 Roee Holtzer , 1 , 2 Richard B. Lipton , 1 , 3 and Cuiling Wang 3. (11) The Effect of an Ankle-Foot Orthosis on Gait Parameters of Acute andChronic Hemiplegic Subjects February 2009. Jason Wening, MS, CP, Michael Huskey, Daniel Hasso, CPO, Alexander Aruin, Ph

50、D, Noel Rao, MD. The Academy Today: Advancing Orthotic and Prosthetic Care Through Knowledge (12) Changes in Gait Symmetry and Velocity After Stroke: A Cross-Sectional Study From Weeks to Years After Stroke. Kara K. Patterson, PhD1,2, William H. Gage, PhD2,3, Dina Brooks, PhD1,2, Sandra E. Black, MD

51、, FRCP1,2, and William E. McIlroy, PhD1,2,4. Neurorehabilitation and Neural Repair 24(9) 783 790. 2010. (13) Gait Asymmetry in Community-Ambulating Stroke Survivors. Patterson, Kara, et al. Arch Phys Med Rehab. Feb 2008. (14) Quantitative gait dysfunction and risk of cognitive Decline and Dementia.

52、Verghese, Joe, et al. J. Neurol. Neurosurg. Psychiatry 2007;78;929-935 (15) overview of Stroke Literature on Lokomat. https:/ Please see “Research Resources” slide for each of the following devices research articles citations. Neuromove: http:/ http:/ Myomo: http:/ RT300: http:/restorative- Armeo: http:/