scholarly journals Reinforced Feedback in Virtual Environment for Plantar Flexor Poststroke Spasticity Reduction and Gait Function Improvement

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Carlos Luque-Moreno ◽  
Fátima Cano-Bravo ◽  
Pawel Kiper ◽  
Ignacio Solís-Marcos ◽  
Jose A. Moral-Munoz ◽  
...  
Keyword(s):  
Virtual Environment ◽  
Statistical Significance ◽  
Combined Treatment ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Assessment Tools ◽  
Future Research ◽  
End Of Treatment ◽  
Before And After ◽  
Gait Function

Background. Ankle spasticity is a frequent phenomenon that limits functionality in poststroke patients. Objectives. Our aim was to determine if there was decreased spasticity in the ankle plantar flex (PF) muscles in the plegic lower extremity (LE) and improvement of gait function in stroke patients after traditional rehabilitation (TR) in combination with virtual reality with reinforced feedback, which is termed “reinforced feedback virtual environment” (RFVE). Methods. The evaluation, before and after treatment, of 10 hemiparetic patients was performed using the Modified Ashworth Scale (MAS), Functional Ambulatory Category (FAC), and Functional Independence Measure (FIM). The intervention consisted of 1 hour/day of TR plus 1 hour/day of RFVE (5 days/week for 3 weeks; 15 sessions in total). Results. The MAS and FAC reached statistical significance (P<0.05). The changes in the FIM did not reach statistical significance (P=0.066). The analysis between the ischemic and haemorrhagic patients showed significant differences in favour of the haemorrhagic group in the FIM scale. A significant correlation between the FAC and the months after the stroke was established (P=−0.711). Indeed, patients who most increased their score on the FAC at the end of treatment were those who started the treatment earliest after stroke. Conclusions. The combined treatment of TR and RFVE showed encouraging results regarding the reduction of spasticity and improvement of gait function. An early commencement of the treatment seems to be ideal, and future research should increase the sample size and assessment tools.

Adipokines as Potential Biomarkers in the Neurorehabilitation of Obese Stroke Patients

2020 ◽  
Vol 17 (4) ◽  
pp. 437-445
Author(s):  
Irene Ciancarelli ◽  
Giovanni Morone ◽  
Marco Iosa ◽  
Stefano Paolucci ◽  
Loris Pignolo ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Functional Recovery ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Enzyme Linked Immunosorbent Assay ◽  
Stroke Patients ◽  
Rehabilitation Outcomes ◽  
Before And After ◽  
Forward Stepwise ◽  
Clinical Measures

Background: Limited studies concern the influence of obesity-induced dysregulation of adipokines in functional recovery after stroke neurorehabilitation. Objective: To investigate the relationship between serum leptin, resistin, and adiponectin and functional recovery before and after neurorehabilitation of obese stroke patients. The adipokine potential significance as prognostic markers of rehabilitation outcomes was also verified. Methods: Twenty obese post-acute stroke patients before and after neurorehabilitation and thirteen obese volunteers without-stroke, as controls, were examined. Adipokines were determined by commercially available enzyme-linked immunosorbent assay (ELISA) kits. Functional deficits were assessed before and after neurorehabilitation with the Barthel Index (BI), modified Rankin Scale (mRS), and Functional Independence Measure (FIM). Results: Compared to controls, higher leptin and resistin values and lower adiponectin values were observed in stroke patients before neurorehabilitation and no correlations were found between adipokines and clinical outcome measures. Neurorehabilitation was associated with improved scores of BI, mRS, and FIM. After neurorehabilitation, decreased values of Body Mass Index (BMI) and resistin together increased adiponectin were detected in stroke patients, while leptin decreased but not statistically. Comparing adipokine values assessed before neurorehabilitation with the outcome measures after neurorehabilitation, correlations were observed for leptin with BI-score, mRS-score, and FIM-score. No other adipokine levels nor BMI assessed before neurorehabilitation correlated with the clinical measures after neurorehabilitation. The forward stepwise regression analysis identified leptin as prognostic factor for BI, mRS, and FIM. Conclusions: Our data show the effectiveness of neurorehabilitation in modulating adipokines levels and suggest that leptin could assume the significance of biomarker of functional recovery.

Virtual Environment Training Therapy for Arm Motor Rehabilitation

2005 ◽  
Vol 14 (6) ◽  
pp. 732-740 ◽  
Author(s):  
Lamberto Piron ◽  
Paolo Tonin ◽  
Francesco Piccione ◽  
Vincenzo Iaia ◽  
Elena Trivello ◽  
...  
Keyword(s):  
Virtual Environment ◽  
Motor Impairment ◽  
Functional Independence Measure ◽  
Normal Subjects ◽  
Functional Independence ◽  
Reaching Movements ◽  
Response To Treatment ◽  
Motor Deficits ◽  
The Mean ◽  
Kinematic Measures

Enhanced feedback provided by a virtual reality system has been shown to promote motor learning in normal subjects. We evaluated whether this approach could be useful for treating patients with motor deficits following brain lesions. Fifty subjects with mild to intermediate arm impairments due to stroke were selected for the study. The patients received treatment daily for one month, consisting of an hour of virtual-environment therapy with enhanced feedback. Before and after the therapy, we assessed the degree of motor impairment and autonomy in daily living activities using the Fugl-Meyer scale for the upper extremities and Functional Independence Measure, respectively. We also analyzed the velocity, duration, and morphology of a sequence of reaching movements, finally comparing the kinematic measures with the scores obtained on the clinical scales. The rehabilitation therapy yielded significant improvements over baseline values in the mean scores on the Fugl-Meyer and Functional Independence Measure scales. The mean Fugl-Meyer score correlated significantly with the duration and velocity of reaching movements. The collated data indicate that motor recovery in post-stroke patients may be promoted by the enhanced feedback provided in a virtual environment and that kinematic analysis of their movements provides reliable measures of motor function changes in response to treatment.

Haptic and Visual Feedback Technology for Upper-Limb Disability Assessment

2016 ◽  
Author(s):  
Norali Pernalete ◽  
Amar Raheja ◽  
Stephanie Carey
Keyword(s):  
Virtual Environment ◽  
Upper Limb ◽  
Functional Independence Measure ◽  
Movement Pattern ◽  
Functional Independence ◽  
Video Data ◽  
Haptic Device ◽  
Assessment Procedure ◽  
Therapy Sessions

In this paper, we discuss the possibility to determine assessment metrics for eye-hand coordination and upper-limb disability therapy, using a mapping between a robotic haptic device to a virtual environment and a training algorithm based on Complex Valued Neural Networks that will calculate how close a set movement pattern is in relationship with that traced by a healthy individual. Most of the current robotic systems’ therapy relies on the patient’s performance on standardized clinical tests such as the functional independence measure (FIM), and the upper limb subsection of the Fugl-Meyer (FM) scales. These systems don’t have other standardized metrics for assessment purposes. There is a need to establish a more intelligent and tailored therapy that could be implemented for patients to use at home in between therapy sessions, or in the long term. This therapy should be based on performance data gathered by the robotic/computer system that will provide an assessment procedure with improved objectivity and precision. A set of complex and movement demanding virtual environments, representing various levels of difficulty labyrinths was developed in a virtual environment. The participants were instructed to use a haptic device (Omni) to follow the trajectories. This was completed while video data were collected using a Vicon motion capture system. Readings of traced trajectories, time, and upper limb motions are recorded for further analysis.

scholarly journals NQPC-07 IMMEDIATE POSTOPERATIVE REHABILITATION FOR PATIENTS WITH NEWLY-DIAGNOSED GLIOMA

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii31-ii31
Author(s):  
Mitsuyo Ikeda ◽  
Shin Yamada ◽  
Yasutomo Okajima ◽  
Kuniaki Saito ◽  
Keiichi Kobayashi ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Tumor Type ◽  
Postoperative Rehabilitation ◽  
Cognitive Improvement ◽  
Post Surgery ◽  
Before And After ◽  
Comprehensive Rehabilitation ◽  
Intensive Rehabilitation

Abstract BACKGROUNDS Importance of early intensive rehabilitation is recently emphasized not only for Stroke Unit but for Intensive Care Unit. We have started such early comprehensive rehabilitation for patients after brain tumor surgery. Rehabilitation therapists were specially assigned to our brain surgery unit as members of the ward staffers. The purpose of this study is to show how this rehabilitation trial works for post-surgery patients with glioma. METHODS Thirty-two patients with glioma (20 males and 12 females) who were admitted to our institution in the year of 2018 were included. Mean age was 61.8±13.3 years; glioblastoma was the major tumor type (24 patients). We retrospectively analyzed rehabilitation outcome focusing on improvement of the Functional Independence Measure (FIM) scores during hospitalization. RESULTS Mean duration from surgery to the first rehabilitation intervention was 2.4±1.2 days, and mean hospital stay was 74.4±31.4days. Twenty patients were discharged to home (62 %) and 12 were transferred to other hospitals for convalescence. Motor, cognitive and total FIM scores were 41.0±22.2, 18.0±7.5, and 59.1±27.3 before surgery, whereas they were 61.4±28.6, 21.8±9.4, and 83.2±36.9, respectively, at discharge. Motor FIM items revealed more remarkable improvement than those of cognitive ones. Since starting the early intensive rehabilitation trial, patients with brain tumor have been systematically rehabilitated with an organized manner before and after surgery. CONCLUSION Early intensive rehabilitation for patients with brain tumor is recommended to be done by on-ward therapists who are assigned to work specially as members of the ward. Both motor and cognitive improvement is expected during hospitalization even in patients with malignant brain tumor.

The Falls Efficacy Scale International is a valid measure to assess the concern about falling and its changes induced by treatments

2021 ◽  
pp. 026921552110621
Author(s):  
Antonio Caronni ◽  
Michela Picardi ◽  
Valentina Redaelli ◽  
Paola Antoniotti ◽  
Giuseppe Pintavalle ◽  
...  
Keyword(s):  
Differential Item Functioning ◽  
Rasch Analysis ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Balance Impairment ◽  
Motor Disability ◽  
Item Functioning ◽  
Before And After ◽  
Neurological Patients

Objective To test with the Rasch analysis the psychometric properties of the Falls Efficacy Scale International, a questionnaire for measuring concern about falling. Design Longitudinal observational study, before–after rehabilitation. Setting Inpatient rehabilitation. Subjects A total of 251 neurological patients with balance impairment. Interventions Physiotherapy and occupational therapy aimed at reducing the risk of falling. Main measures Participants (median age, first–third quartile: 74.0, 65.5–80.5 years; stroke and polyneuropathy: 43% and 21% of the sample, respectively) received a balance assessment (Falls Efficacy Scale International included) pre- and post-rehabilitation. Rasch analysis was used to evaluate the Falls Efficacy Scale International. Differential item functioning, which assesses the measures’ stability in different conditions (e.g. before vs. after treatment) and in different groups of individuals, was tested for several variables. Results Patients suffered a moderate balance impairment (Mini-BESTest median score; first–third quartile: 15; 11–19), mild–moderate concern about falling (Falls Efficacy Scale International: 28; 21–37) and motor disability (Functional Independence Measure, motor domain: 70.0; 57.0–76.5). Falls Efficacy Scale International items fitted the Rasch model (range of infit and outfit mean square statistics: 0.8–1.32 and 0.71–1.45, respectively) and the questionnaire's reliability was satisfactory (0.87). No differential item functioning was found for treatment, gender, age and balance impairment. Differential item functioning was found for diagnosis and disability severity, but it is shown that it is not such as to bias measures. Conclusions Falls Efficacy Scale International ordinal scores can be turned into interval measures, i.e. measures of the type of temperature. Being differential item functioning-free for treatment, these measures can be safely used to compare concern about falling before and after rehabilitation, such as when interested in assessing the rehabilitation effectiveness.

scholarly journals The decline of elective operating at major trauma centres

2017 ◽  
Vol 99 (2) ◽  
pp. 166-168
Author(s):  
A Memarzadeh ◽  
H Taki ◽  
EK Tissingh ◽  
P Hull
Keyword(s):  
Lower Limb ◽  
Major Trauma ◽  
Statistical Significance ◽  
Future Research ◽  
Trauma Network ◽  
Trauma Centres ◽  
Joint Registry ◽  
District Hospitals ◽  
Before And After ◽  
Chi Squared

INTRODUCTION Major trauma is a leading cause of death in those aged under 40 years. In order to improve the care for multiply injured patients, the major trauma network was activated in April 2012 in England. Its goal was to link all district hospitals to major trauma centres (MTCs) and allow for rapid transfer of patients. Anecdotally, this has affected elective orthopaedic operating at MTCs. The aim of this study was to compare the number of lower limb arthroplasty procedures performed before and after the establishment of the trauma network. METHODS Data on hip and knee arthroplasties in England during the two years prior to and the two years following the introduction of the trauma network were obtained from the National Joint Registry. These were broken down by type of unit (MTCs vs non-MTCs). Differences between the number of hip and knee arthroplasties undertaken in the two time periods were analysed. The chi-squared test was used to assess statistical significance. RESULTS The total number of lower limb arthroplasties increased after the activation of the trauma network by 5.5% (from 211,453 to 223,119). When stratifying the data by type of unit, this increasing trend was present for non-MTCs; however, in MTCs, a reduction occurred: the number reduced by 13.6% (from 13,492 to 11,657). This reversal of trend was seen in both hip and knee procedures independently (both p<0.01). CONCLUSIONS The introduction of the trauma network has led to a reduction in the total number of lower limb arthroplasty procedures performed in MTCs. Various reasons have been postulated for this but its impact on surgical training and hospital finances must be scrutinised in future research.

scholarly journals Reinforced Feedback in Virtual Environment for Rehabilitation of Upper Extremity Dysfunction after Stroke: Preliminary Data from a Randomized Controlled Trial

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Paweł Kiper ◽  
Michela Agostini ◽  
Carlos Luque-Moreno ◽  
Paolo Tonin ◽  
Andrea Turolla
Keyword(s):  
Randomized Controlled Trial ◽  
Virtual Environment ◽  
Upper Extremity ◽  
Motor Function ◽  
Upper Limb ◽  
Controlled Trial ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Stroke Etiology ◽  
Randomized Controlled

Objectives. To study whether the reinforced feedback in virtual environment (RFVE) is more effective than traditional rehabilitation (TR) for the treatment of upper limb motor function after stroke, regardless of stroke etiology (i.e., ischemic, hemorrhagic).Design. Randomized controlled trial.Participants. Forty-four patients affected by stroke.Intervention. The patients were randomized into two groups: RFVE (N=23) and TR (N=21), and stratified according to stroke etiology. The RFVE treatment consisted of multidirectional exercises providing augmented feedback provided by virtual reality, while in the TR treatment the same exercises were provided without augmented feedbacks.Outcome Measures. Fugl-Meyer upper extremity scale (F-M UE), Functional Independence Measure scale (FIM), and kinematics parameters (speed, time, and peak).Results. The F-M UE (P=0.030), FIM (P=0.021), time (P=0.008), and peak (P=0.018), were significantly higher in the RFVE group after treatment, but not speed (P=0.140). The patients affected by hemorrhagic stroke significantly improved FIM (P=0.031), time (P=0.011), and peak (P=0.020) after treatment, whereas the patients affected by ischemic stroke improved significantly only speed (P=0.005) when treated by RFVE.Conclusion. These results indicated that some poststroke patients may benefit from RFVE program for the recovery of upper limb motor function. This trial is registered withNCT01955291.

scholarly journals Evaluation of Cognitive Dysfunction, Functional Independence and Depression Severity Changes during Rehabilitation in Patients after Cerebral Stroke

2019 ◽  
Vol 2 (17) ◽  
Author(s):  
Gintarė Mankė ◽  
Lina Varžaitytė ◽  
Aistė Berkutė ◽  
Erika Karkauskienė
Keyword(s):  
Cognitive Dysfunction ◽  
Rating Scale ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Cerebral Stroke ◽  
Depression Severity ◽  
Mild Depression ◽  
Before And After ◽  
The Mean ◽  
Long Term Prognosis

 Research background. Cognitive impairment and depression are frequent residual consequences of stroke. They have a large impact on the quality of life and long-term prognosis. The aim is to estimate changes of cognitive dysfunction, functional independence and depression severity before and after rehabilitation in patients after cerebral stroke. Methods. We used Mini-Mental State Examination (MMSE) to estimate cognitive dysfunction, Functional Independence Measure (FIM) – motor and cognitive functions, Montgomery–Asberg Depression Rating Scale (MADRS) – depression severity. Results. There were 14 research participants from Neurorehabilitation department in Hospital of LUHS Kauno klinikos who met with criteria for inclusion and were not included by criteria for exclusion. Before rehabilitation the meanscore of MMSE – 19.93 – mild cognitive dysfunction, the mean score of FIM – 57.71 – medium supervision needed, the mean score of MADRS – 17.71 – mild depression. After rehabilitation the mean score of MMSE – 23.86 – mild cognitive dysfunction, the mean score of FIM – 92.07 – supervision needed, the mean score of MADRS – 10.50 – mild depression. We determined that six women had medium cognitive dysfunction while men did not have it. Conclusions. Cognitive function after rehabilitation signifcantly got better but mild cognitive dysfunction remained. Functional independence improved after rehabilitation and most patients only needed supervision. Mild depression remained after rehabilitation but the score signifcantly reduced. Females had more severe cognitive dysfunctions.Keywords: cerebral stroke, post-stroke depression, cognitive dysfunction, functional independency.

Analysis of the clinical course of chronic gastritis during the three-component treatment regimen of Helicobacter pylori with the inclusion of bismuthi trikalium dicitrate in the treatment

2021 ◽  
Vol 22 (1) ◽  
pp. 87-91
Author(s):  
A. L. Korkin ◽  
◽  
E. V. Khomets ◽  
S. V. Gasanova ◽  
◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Treatment Regimen ◽  
Chronic Gastritis ◽  
Statistical Significance ◽  
Eradication Therapy ◽  
Clinical Manifestations ◽  
Well Being ◽  
City Hospital ◽  
End Of Treatment ◽  
Before And After

Purpose: to evaluate the dynamics of clinical manifestations of the disease in patients with chronic gastritis during the three-component treatment regimen of Helicobacter pylori with the inclusion of bismuthi trikalium dicitrate in the treatment. Material and methods. 38 residents of the Khanty-Mansi Autonomous Okrug-Ugra with chronic gastritis associated with Helicobacter pylori were examined in the Budgetary Establishment «Raduzhninskaya City Hospital». The clinical manifestations of dyspepsia and other manifestations of gastrointestinal dysfunction in patients before and after triple therapy with bismuthi trikalium dicitrate were evaluated. Statistical data processing was carried out using the program Statistica’ 99 Edition (Statsoft). The statistical significance of differences in different treatment periods was assessed using the Pearson – χ2 consent test and the Fisher test. The results. Clinical manifestations of the disease in the examined patients were represented by direct (58-84%) and complementary manifestations of dyspepsia (34-55%), manifestations of intestinal (32%), esophageal dysfunction (42%) in the presence of changes in general well-being (58%). When conducting eradication therapy, regression of direct manifestations of dyspepsia and heartburn is significant by the end of the first week of treatment, complementary criteria of dyspepsia – at the end of treatment. Manifestations of intestinal dysfunction in the form of constipation and discomfort in the mouth regress only 1 week after the end of therapy. Conclusion. The persistence of dyspepsia in 18% of cases after the end of eradication therapy is associated with the absence of eradication of Helicobacter pylori in 5% of cases and the functional origin of dyspepsia in 13% of cases. In patients with functional dyspepsia, the preservation of a low assessment of well-being according to the SAN questionnaire was verified, and in 5% of cases, the preservation of initial diarrhea after eradication therapy of Helicobacter pylori.

scholarly journals Assessment of functional status in the ICU: instruments used in Brazilian settings

2017 ◽  
Vol 30 (1) ◽  
pp. 187-195
Author(s):  
Luiza Martins Faria ◽  
Sayonara de Fátima Faria Barbosa
Keyword(s):  
Functional Status ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Assessment Tools ◽  
Adaptation Studies ◽  
Karnofsky Performance Status Scale ◽  
Treatment Benefits ◽  
Scale Scores

Abstract Introduction: Physical function impairment is a significant concern for patients who survive their intensive care unit (ICU) stay, due to its impact on the patient’s independence and functional status. In this context, the choice of a suitable instrument for the assessing functional status is important, because an inappropriate assessment could lead to incorrect conclusions regarding patient prognosis, treatment benefits, and condition. Objective: To identify which functional assessment tools are used in Brazil to assess patients who are in ICU. Additionally, we investigated the translation, adaptation, and validation of these instruments for use in this population. Methods: We searched Pubmed, SCIELO, Lilacs, and Scopus in November 2015. No language or date restrictions were applied to the search. Results: Ten studies and seven instruments were identified. The most commonly used instruments were the Karnofsky Performance Status Scale Scores and the Functional Independence Measure. Conclusion: The instruments found in the review were neither specifically developed to assess the functional status of ICU patients, nor were they validated for use in this population in Brazil. Transcultural development or adaptation studies should be conducted, followed by a validation process.

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