scholarly journals Single limb cable driven wearable robotic device for upper extremity movement support after traumatic brain injury

2021 ◽  
Vol 8 ◽  
pp. 205566832110024
Author(s):  
Zahra Kadivar ◽  
Christopher E Beck ◽  
Roger N Rovekamp ◽  
Marcia K O’Malley
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Upper Extremity ◽  
Muscle Tone ◽  
Shoulder Abduction ◽  
Movement Trajectory ◽  
Robotic Device ◽  
Robotic Assisted ◽  
Flexion Extension ◽  
Upper Extremity Movement

Introduction Recently, soft exosuits have been proposed for upper limb movement assistance, most supporting single joint movements. We describe the design of a portable wearable robotic device (WRD), “Armstrong,” able to support three degrees-of-freedom of arm movements, and report on its feasibility for movement support of individuals with hemiparesis after traumatic brain injury (TBI). Methods We introduce Armstrong and report on a pilot evaluation with two male individuals post-TBI (T1 and T2) and two healthy individuals. Testing involved elbow flexion/extension with and without robotic-assisted shoulder stabilization; shoulder abduction with and without robotic-assisted elbow stabilization; and assisted shoulder abduction and flexion. Outcome measures included range of motion and root mean square trajectory and velocity errors. Results TBI subjects performed active, passive, hybrid and active assistive movements with Armstrong. Subjects showed improvements in movement trajectory and velocity. T1 benefited from hybrid, active, and assistive modes due to upper extremity weakness and muscle tone. T2 benefited from hybrid and assistive modes due to impaired coordination. Healthy subjects performed isolated movements of shoulder and elbow with minimal trajectory and velocity errors. Conclusions This study demonstrates the safety and feasibility of Armstrong for upper extremity movement assistance for individuals with TBI, with therapist supervision.

Upper Limb Motor Improvement after Traumatic Brain Injury: Systematic Review of Interventions

2021 ◽  
pp. 154596832110566
Author(s):  
Sandeep K. Subramanian ◽  
Melinda K. Fountain ◽  
Ashley F. Hood ◽  
Monica Verduzco-Gutierrez
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Upper Limb ◽  
Muscle Tone ◽  
Motor Impairment ◽  
Preliminary Evidence ◽  
Effect Sizes ◽  
Cell Transplant ◽  
Study Quality ◽  
Motor Improvement

Background Traumatic brain injury (TBI) is a leading cause of adult morbidity and mortality. Individuals with TBI have impairments in both cognitive and motor domains. Motor improvements post-TBI are attributable to adaptive neuroplasticity and motor learning. Majority of the studies focus on remediation of balance and mobility issues. There is limited understanding on the use of interventions for upper limb (UL) motor improvements in this population. Objective We examined the evidence regarding the effectiveness of different interventions to augment UL motor improvement after a TBI. Methods We systematically examined the evidence published in English from 1990–2020. The modified Downs and Black checklist helped assess study quality (total score: 28). Studies were classified as excellent: 24–28, good: 19–23, fair: 14–18, and poor: ≤13 in quality. Effect sizes helped quantify intervention effectiveness. Results Twenty-three studies were retrieved. Study quality was excellent (n = 1), good (n = 5) or fair (n = 17). Interventions used included strategies to decrease muscle tone (n = 6), constraint induced movement therapy (n = 4), virtual reality gaming (n = 5), non-invasive stimulation (n = 3), arm motor ability training (n = 1), stem cell transplant (n = 1), task-oriented training (n = 2), and feedback provision (n = 1). Motor impairment outcomes included Fugl-Meyer Assessment, Modified Ashworth Scale, and kinematic outcomes (error and movement straightness). Activity limitation outcomes included Wolf Motor Function Test and Motor Activity Log (MAL). Effect sizes for majority of the interventions ranged from medium (.5-.79) to large (≥.8). Only ten studies included retention testing. Conclusion There is preliminary evidence that using some interventions may enhance UL motor improvement after a TBI. Answers to emergent questions can help select the most appropriate interventions in this population.

scholarly journals Trends in Utilization of Upper Extremity Reconstructive Surgery Following Traumatic Brain Injury and Stroke

Hand ◽  
2018 ◽  
Vol 15 (1) ◽  
pp. 35-40 ◽  
Author(s):  
Bryan G. Beutel ◽  
Bryan J. Marascalchi ◽  
Eitan Melamed
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Upper Extremity ◽  
Reconstructive Surgery ◽  
Temporal Trends ◽  
Functional Independence ◽  
Case Volume ◽  
Reconstructive Procedures ◽  
Specific Patient ◽  
Over Time

Background: Spasticity resulting from traumatic brain injury (TBI) or stroke can lead to debilitating sequelae, including deformities from joint subluxation and spasticity, causing a loss of functional independence. Despite the effectiveness of surgery to address these issues, it is unclear how often these procedures are performed. The objective of the study was to determine the rate of, and trends associated with, reconstructive upper extremity surgery in patients following TBI or stroke. Methods: The National Inpatient Sample was queried for International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes for TBI and stroke as well as procedural codes representing functional upper extremity reconstruction from 2001 to 2012. Temporal trends were assessed for case volume, patient demographics, financial considerations, and hospitalizations. Results: A total of 2132 reconstructive procedures were performed in patients with TBI or stroke during the study period, with fewer than 230 cases conducted in any given year and no appreciable increase in case volume over time. This represented less than 1% of eligible, appropriate candidates undergoing surgery. Middle-aged, white females were the most common patients to have such surgery. Medicare was the primary payer for reconstruction, and the cost of surgery increased substantially over time. There was a trend toward longer hospital stays, and the inpatient mortality was approximately 0.5%. Conclusions: There is a substantial underutilization of upper extremity reconstructive surgery for patients with spasticity following TBI or stroke. Increasing costs and limited access to appropriate care may be contributing to differences in use among specific patient subgroups.

scholarly journals Effectiveness of early abobotulinum toxin (Dysport®) injections in patients with upper limb spastic paresis after traumatic brain injury in real clinical practice: results of a multicenter observational non-interventional prospective study (Adults with post Traumatic Brain Injury (TBI) upper limb (UL) spasticity – APTULS)

2021 ◽  
Vol 13 (5) ◽  
pp. 48-55
Author(s):  
S. E. Khatkova ◽  
V. P. Diagileva ◽  
L. V. Krylova ◽  
D. V. Pokhabov ◽  
A. G. Arutiunian
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Upper Limb ◽  
Large Scale ◽  
Brain Injuries ◽  
Muscle Tone ◽  
Recovery Period ◽  
Early Period ◽  
Early Recovery ◽  
The World

The article reveals results of the first russian prospective observational study, aimed at evaluating of the clinical results early using injections of abobotulinumtoxinA (Abo-BTA, Dysport®) in patients with upper limb spasticity (ULS), which is one of disabling consequence traumatic's brain injuries (TBI). Currently, botulinum therapy is an integral part of the complex treatment of patients with chronic spasticity, has a high level of evidence (level IA), is included in clinical recommendations, national guidelines in a lot of countries around the world countries. The article analyzes results of studies conducted in the world in recent years, which confirm the effectiveness of Abo-BTA injections in the treatment of spasticity, which developing in early period after acute brain injury. Presented data of their own observations are allowed to authors conclude, that using of Abo-BTA injections in the complex rehabilitation of patients with ULS in the early recovery period of TBI demonstrates its good tolerability and a high safety profile, contributes to improving the effectiveness of treatment by reducing muscle tone and spasticity, increasing the volume of movements in joints. Therefore, Abo-BTA injections can be considered as a necessary addition to standard early rehabilitation programs. However, it is necessary to conduct further large-scale studies to more accurately determine the timing of the start of botulinum therapy, the doses of Abo-BTA, the most effective combinations of rehabilitation methods in the creating of individual programs.

Botulinum toxin in severe upper extremity spasticity among patients with traumatic brain injury: An open-labeled trial

Neurology ◽  
1996 ◽  
Vol 47 (4) ◽  
pp. 939-944 ◽  
Author(s):  
S. A. Yablon ◽  
B. T. Agana ◽  
C. B. Ivanhoe ◽  
C. Boake
Keyword(s):  
Traumatic Brain Injury ◽  
Botulinum Toxin ◽  
Brain Injury ◽  
Upper Extremity

scholarly journals Use of a myoelectric upper limb orthosis for rehabilitation of the upper limb in traumatic brain injury: A case report

2020 ◽  
Vol 7 ◽  
pp. 205566832092106
Author(s):  
Svetlana Pundik ◽  
Jessica McCabe ◽  
Samuel Kesner ◽  
Margaret Skelly ◽  
Stefania Fatone
Keyword(s):  
Traumatic Brain Injury ◽  
Case Report ◽  
Brain Injury ◽  
Upper Limb ◽  
Muscle Power ◽  
Device Fabrication ◽  
Motor Deficits ◽  
Novel Therapy ◽  
Flexion Extension ◽  
Use Phase

Background Upper limb motor deficits following traumatic brain injury are prevalent and effective therapies are needed. The purpose of this case report was to illustrate response to a novel therapy using a myoelectric orthosis in a person with TBI. Case description: A 42-year-old female, 29.5 years post-traumatic brain injury with diminished motor control/coordination, and learned nonuse of the right arm. She also had cognitive deficits and did not spontaneously use her right arm functionally. Intervention Study included three phases: baseline data collection/device fabrication (five weeks); in-clinic training (2×/week for nine weeks); and home-use phase (nine weeks). The orthosis was incorporated into motor learning-based therapy. Outcomes: During in-clinic training, active range of motion, tone, muscle power, Fugl-Meyer, box and blocks test, and Chedoke assessment score improved. During the home-use phase, decrease in tone was maintained and all other outcomes declined but were still better upon study completion than baseline. The participant trained with the orthosis 70.12 h, logging over 13,000 repetitions of elbow flexion/extension and hand open/close. Discussion Despite long-standing traumatic brain injury, meaningful improvements in motor function were observed and were likely the results of high repetition practice of functional movement delivered over a long duration. Further assessment in a larger cohort is warranted.

Management of the Adult, Spastic, Equinovarus Foot Deformity

1994 ◽  
Vol 15 (6) ◽  
pp. 340-346 ◽  
Author(s):  
Steven J. Lawrence ◽  
Michael J. Botte
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Functional Impairment ◽  
Muscle Tone ◽  
Foot Deformity ◽  
Cerebrovascular Accidents ◽  
Operative Planning ◽  
Foot Position ◽  
Shoe Wear

Management of the persistent, acquired, neurogenic equinovarus foot may be a confounding rehabilitative dilemma. Victims of cerebrovascular accidents and traumatic brain injury commonly develop this neurogenic deformity. The plantarflexed and inverted foot position results from an imbalance of forces about the hindfoot due to exaggerated muscle tone and hyperactive stretch reflexes. Significant functional impairment may ensue if a plantigrade foot position cannot be achieved and maintained. Surgical correction may be necessary if conservative measures fail. Determination of the dynamic and static components contributing to the equinovarus deformity is difficult. Gait analysis and dynamic electromyographic studies are valuable adjuncts for operative planning. The wide-ranging goals of surgery vary from improving transfer and ambulation skills, to assisting wheelchair positioning, to facilitating use of braces and/or shoe wear.

scholarly journals Clinical Features of Traumatic Brain Injury in Various Kinds of Brain Damage

2019 ◽  
Vol 8 (3) ◽  
pp. 295-301
Author(s):  
Y. B. Vasilyeva ◽  
A. E. Talypov ◽  
S. S. Petrikov
Keyword(s):  
Traumatic Brain Injury ◽  
Differential Diagnosis ◽  
Brain Injury ◽  
Brain Damage ◽  
Pupil Size ◽  
Muscle Tone ◽  
Neurological Status ◽  
Neurologic Examination ◽  
Different Types ◽  
The Brain

Various circumstances of the injury lead to various types of brain damage. The main types of destructive effects are countracoup effect and acceleration/deceleration. The high intensity injuring force creates conditions for occurrence of combinations of different types of damage leading to aggravation of pathological processes caused by trauma, complication of clinical picture, difficulties of diagnosis and treatment, prolongation of hospital stay, and requires an additional methods of research and treating the injured. Finding the genesis of symptoms observed upon neurologic examination, and especially the differential diagnosis between primary and secondary lesions of the brain stem are nessesary to choose the emergency care for victims with severe traumatic brain injury, as well as to forecast the outcomes of treatment. The dynamics of neurological symptoms (level of wakefulness, pupil size, eyeball mobility, muscle tone and limb movement disorders, pathological plantar reflexes) have significant differences in patients with various types of brain damage, which makes a regular assessment of neurological status extremely important in these patients.

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