rehabilitation protocols
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2022 ◽  
Vol 12 (1) ◽  
pp. 59
Author(s):  
Arianna Brancaccio ◽  
Davide Tabarelli ◽  
Paolo Belardinelli

Stroke constitutes the main cause of adult disability worldwide. Even after application of standard rehabilitation protocols, the majority of patients still show relevant motor impairment. Outcomes of standard rehabilitation protocols have led to mixed results, suggesting that relevant factors for brain re-organization after stroke have not been considered in explanatory models. Therefore, finding a comprehensive model to optimally define patient-dependent rehabilitation protocols represents a crucial topic in clinical neuroscience. In this context, we first report on the rehabilitation models conceived thus far in the attempt of predicting stroke rehabilitation outcomes. Then, we propose a new framework to interpret results in stroke literature in the light of the latest evidence regarding: (1) the role of the callosum in inter-hemispheric communication, (2) the role of prefrontal cortices in exerting a control function, and (3) diaschisis mechanisms. These new pieces of evidence on the role of callosum can help to understand which compensatory mechanism may take place following a stroke. Moreover, depending on the individual impairment, the prefrontal control network will play different roles according to the need of high-level motor control. We believe that our new model, which includes crucial overlooked factors, will enable clinicians to better define individualized motor rehabilitation protocols.


Author(s):  
Carlos Alberto Stefano Filho ◽  
Romis Ribeiro de Faisol Attux ◽  
Gabriela Castellano

Abstract – Objective: the use of motor imagery (MI) in motor rehabilitation protocols has been increasingly investigated as a potential technique for enhancing traditional treatments, yielding better clinical outcomes. However, since MI performance can be challenging, practice is usually required. This demands appropriate training, actively engaging the MI-related brain areas, consequently enabling the user to properly benefit from it. The role of feedback is central for MI practice. Yet, assessing which underlying neural changes are feedback-specific or purely due to MI practice is still a challenging effort, mainly due to the difficulty in isolating their contributions. In this work, we aimed to assess functional connectivity (FC) changes following MI practice that are either extrinsic or specific to feedback. Approach: to achieve this, we investigated FC, using graph theory, in electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) data, during MI performance and at resting-state (rs), respectively. Thirty healthy subjects were divided into three groups, receiving no feedback (control), “false” feedback (sham) or actual neurofeedback (active). Participants underwent 12 to 13 hands-MI EEG sessions and pre- and post-MI training fMRI exams. Main results: following MI practice, control participants presented significant increases in degree and in eigenvector centrality for occipital nodes at rs-fMRI scans, whereas sham-feedback produced similar effects, but to a lesser extent. Therefore, MI practice, by itself, seems to stimulate visual information processing mechanisms that become apparent during basal brain activity. Additionally, only the active group displayed decreases in inter-subject FC patterns, both during MI performance and at rs-fMRI. Significance: hence, actual neurofeedback impacted FC by disrupting common inter-subject patterns, suggesting that subject-specific neural plasticity mechanisms become important. Future studies should consider this when designing experimental NFBT protocols and analyses.


2021 ◽  
Vol 11 (24) ◽  
pp. 12061
Author(s):  
Nicola Valè ◽  
Marialuisa Gandolfi ◽  
Laura Vignoli ◽  
Anita Botticelli ◽  
Federico Posteraro ◽  
...  

In the last two decades, a growing interest has been focused on gait and balance robot-assisted rehabilitation in children with neurological disabilities. Robotic devices allow the implementation of intensive, task-specific training fostering functional recovery and neuroplasticity phenomena. However, limited attention has been paid to the protocols used in this research framework. This systematic review aims to provide an overview of the existing literature on robotic systems for the rehabilitation of gait and balance in children with neurological disabilities and their rehabilitation applications. The literature search was carried out independently and synchronously by three authors on the following databases: MEDLINE, Cochrane Library, PeDro, Institute of Electrical and Electronics Engineers, ScienceDirect, and Google Scholar. The data collected included three subsections referring to clinical, technical, and regulatory aspects. Thirty-one articles out of 81 found on the primary literature search were included in the systematic review. Most studies involved children with cerebral palsy. Only one-third of the studies were randomized controlled trials. Overall, 17 devices (nine end-effector systems and eight exoskeletons) were investigated, among which only 4 (24%) were bore the CE mark. Studies differ on rehabilitation protocols duration, intensity, and outcome measures. Future research should improve both rehabilitation protocols’ and devices’ descriptions.


Sensors ◽  
2021 ◽  
Vol 21 (23) ◽  
pp. 8002
Author(s):  
Lorenza Maistrello ◽  
Daniele Rimini ◽  
Vincent C. K. Cheung ◽  
Giorgia Pregnolato ◽  
Andrea Turolla

Recent studies have investigated muscle synergies as biomarkers for stroke, but it remains controversial if muscle synergies and clinical observation convey the same information on motor impairment. We aim to identify whether muscle synergies and clinical scales convey the same information or not. Post-stroke patients were administered an upper limb treatment. Before (T0) and after (T1) treatment, we assessed motor performance with clinical scales and motor output with EMG-derived muscle synergies. We implemented an exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) to identify the underlying relationships among all variables, at T0 and T1, and a general linear regression model to infer any relationships between the similarity between the affected and unaffected synergies (Median-sp) and clinical outcomes at T0. Clinical variables improved with rehabilitation whereas muscle-synergy parameters did not show any significant change. EFA and CFA showed that clinical variables and muscle-synergy parameters (except Median-sp) were grouped into different factors. Regression model showed that Median-sp could be well predicted by clinical scales. The information underlying clinical scales and muscle synergies are therefore different. However, clinical scales well predicted the similarity between the affected and unaffected synergies. Our results may have implications on personalizing rehabilitation protocols.


2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Elske Berkvens ◽  
Bob Bloemendaal ◽  
Marijn Poelman ◽  
Tammo de Vries Reilingh ◽  
Wegdam Johannes

Abstract Aim After any type of musculoskeletal surgery, post-operative rehabilitation with advices on weight baring and physical therapy is normal practice. Rehabilitation protocols lead to early mobilization and shorter hospitalization. Although ventral hernia repair (VHR) is musculotendinous surgery with tremendous impact on muscle strength and coordination, standardized and evidenced rehabilitation protocols for VHR are lacking. This survey aims to provide insight into the rehabilitation protocols after VHR, commonly used in the Netherlands. Material and Methods Hernia-surgeons in all Dutch hospitals were addressed in May 2021 by an electronic survey. Three cases were presented; non-complex (2 cm, primary umbilical repair), moderate-complex (8 cm, Rives-Stoppa) and complex (13 cm, myofascial release). Use of abdominal binders, advice on physical strain and referral for physical therapy were surveyed. Results 75 of 75 (100%) Dutch hospitals responded. In order of increasing hernia complexity an abdominal binder was prescribed in respectively 10%, 74% and 92% with various duration. Reduced physical strain was advised in 73%, 90% and 91%, mainly with a duration of 4-6 weeks (40%, 58% and 70%). Patients were referred for physical therapy after discharge in 4%, 15% and 41%. Conclusions This study describes the practice of rehabilitation after VHR in the Netherlands. Although abdominal binder prescription and physical strain advices increases with hernia complexity, there is no uniformity in duration. Physical therapy was advised only in a minority of the VHR patients, even after complex reconstructions. Lack of standardized rehabilitation protocols after VHR underlines the need for guidelines.


Sensors ◽  
2021 ◽  
Vol 21 (21) ◽  
pp. 7219
Author(s):  
Thomas Guiho ◽  
Victor Manuel López-Álvarez ◽  
Paul Čvančara ◽  
Arthur Hiairrassary ◽  
David Andreu ◽  
...  

Peripheral Nerve Stimulation (PNS) is a promising approach in functional restoration following neural impairments. Although it proves to be advantageous in the number of implantation sites provided compared with intramuscular or epimysial stimulation and the fact that it does not require daily placement, as is the case with surface electrodes, the further advancement of PNS paradigms is hampered by the limitation of spatial selectivity due to the current spread and variations of nerve physiology. New electrode designs such as the Transverse Intrafascicular Multichannel Electrode (TIME) were proposed to resolve this issue, but their use was limited by a lack of innovative multichannel stimulation devices. In this study, we introduce a new portable multichannel stimulator—called STIMEP—and implement different stimulation protocols in rats to test its versatility and unveil the potential of its combined use with TIME electrodes in rehabilitation protocols. We developed and tested various stimulation paradigms in a single fascicle and thereafter implanted two TIMEs. We also tested its stimulation using two different waveforms. The results highlighted the versatility of this new stimulation device and advocated for the parameterizing of a hyperpolarizing phase before depolarization as well as the use of small pulse widths when stimulating with multiple electrodes.


2021 ◽  
Vol 14 ◽  
pp. 243-248
Author(s):  
Christina Hermanns ◽  
Reed Coda ◽  
Sana Cheema ◽  
Matthew Vopat ◽  
Armin Tarakemeh ◽  
...  

Introduction. Rehabilitation after a superior labral anterior posterior (SLAP) repair is an important aspect of patient outcomes, however, no standardized rehabilitation protocol has been defined. The purpose of this paper is to assess the variability of rehabilitation after SLAP repair to understand the need for standardization to improve patient outcomes. Methods. Protocols for SLAP repairs were collected through a search for Academic Orthopedic Programs and a general google search using the terms “[Program Name (if applicable)] SLAP Repair Rehab Protocol”. Protocols were compared by sling, range of motion (ROM), physical therapy, return to sport (RTS), return to throwing, and biceps engagement/ biceps tenodesis recommendations. Protocols for non-operative or generalized shoulders were excluded.  Results. Sixty protocols were included. A total of 61.7% (37/60) recommended a sling for four to six weeks and 90% (54/60) included a full ROM recommendation, but time was variable. There were different exercises recommended, but pendulum swings were recommended by 53% (32/60), submaximal isometrics by 55% (33/60), and scapular strengthening by 65% (39/60). Of the sixty protocols, 33% (20/60) recommended return to sports in 24 weeks and 38.3% (23/60) recommended allowing throwing in 16 weeks. Conclusion. There was variability in protocols for SLAP repair, especially time until full ROM, RTS, and biceps strengthening. Time in sling and scapular strengthening were the least variable. A lack of specificity within protocols in what return to throwing meant for functional ability made it difficult to compare protocols. Considering the large number of Orthopedic programs, a relatively small number had published protocols. Further studies are needed to evaluate a standardized post-operative rehabilitation for SLAP repairs to improve outcomes.


2021 ◽  
Author(s):  
Udara Bandara ◽  
Vincent V. G. An ◽  
Sahand Imani ◽  
Haren Nandapalan ◽  
Brahman S. Sivakumar

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