Use of optokinetic chart stimulation to restore mobility and reduce ataxia in a patient with pseudo-Cushing ataxia.

A 61-year-old patient was admitted to hospital after a fall. She presented with bilateral muscle weakness and severe ataxia. She was unable to maintain sitting balance or place feet on the floor and was unable to tolerate hoist transfers due to the severity of her ataxia. Nursing and physiotherapy staff found it difficult to sit her out of bed. Her physiotherapy intervention changed to optokinetic chart stimulation (OKCS) and sensory interaction for balance. After treatment for 5 days, her intention tremor fully resolved. At discharge, she was mobile with a wheeled zimmer walking frame and supervision of one person. At follow-up after 8 months, she was independently mobile without any walking aid in and around her house. She was going out shopping with her son. For recovery from ataxia, it is recommended that further research on restorative intervention at the nervous system level be carried out.

Use of optokinetics based OKCSIB protocol in restoring mobility in primary progressive MS.

The case is of a mid-40s patient who developed progressive muscle weakness and loss of mobility over 6 weeks due to primary progressive multiple sclerosis. 2.5 days before admission, she became bed bound with weakness of 1/5 on the Oxford scale. She normally rested for a couple of days after similar periods of worsening symptoms and then got back on her feet although with worse balance. She was treated with optokinetic chart stimulation and sensory interaction for balance (OKCSIB) protocol. Within 2 days of intervention, she was mobile with a delta frame and supervision of one. By the end of a week, she was independently mobile with her delta frame. It is recommended that instead of just practising function, the OKCSIB protocol be used to regain antigravity extensor control loss of which leads to deteriorating function in neurological conditions.

Does use of the optokinetic chart stimulation based OKCSIB protocol improve recovery of upper and lower limb movements, function and quality of life at 3 year follow up in dense strokes? A retrospective case control series.

BACKGROUND AND OBJECTIVE: The aim was to compare follow up impairment, function and quality of life outcomes between dense parietal centred strokes treated by the optokinetic chart based OKCSIB protocol and those treated by conventional neuro-physiotherapy. DESIGN AND SETTING: Follow up retrospective case control series in the community. METHOD AND MATERIALS: 643 persons with stroke were eligible for initial screening to see if they met inclusion criteria. Only 37 potential participants were eligible, with 18 of them still alive. From the 18 only 8 consented to participate in the follow up study. RESULTS: Sixteen mortalities that occurred post discharge were all from the conventional group. The OKCSIB group had statistically significant improved upper limb STREAM scores (p < 0.05). The OKCSIB group had statistically significant reduction in hand spasticity with none of the OKCSIB participants developing hand spasticity (p < 0.05). The OKCSIB group also had better lower limb STREAM scores although these were not statistically significant (p > 0.05). Barthel Index, and quality of Life improvements were non-significant (p > 0.05). CONCLUSION: The OKCSIB protocol led to better recovery of voluntary movements at 3 year follow up. However lack of randomisation and the small number of participants, necessitate further research to be carried out.

Novel use of optokinetic chart stimulation to restore muscle strength and mobility in patients with subdural haemorrhage: two case studies.

BACKGROUND AND PURPOSE: The aim of these case studies is to report on the novel use of optokinetic chart stimulation to restore muscle strength and functional independence in severely disabled patients with subdural haemorrhage. METHODOLOGY: An optokinetic chart was moved in front of the patient: from side to side, up and down and finally forwards and backwards. Once the patient could stand optokinetic chart stimulation was supplemented by sensory interaction for balance. RESULTS: In first case study contractures in the knees improved from 90° short of full passive knee extension bilaterally to full active extension of the right knee joint and 25° short of full active extension of the left knee joint. The Barthel index improved from 0/20 to 18/20. In the second case study the Barthel Index improved from 0/20 to 18/20. From being bed bound the patients were independently mobile with a walking aid, on discharge. DISCUSSION: With optokinetic chart stimulation leading to reversal of knee flexor contractures in one case and restoration of independent mobility in both cases, more research is needed to investigate use of optokinetic chart stimulation in patients with severe subdural haemorrhages and other traumatic brain injuries.

Use of an optokinetic chart stimulation intervention for restoration of voluntary movement, postural control and mobility in acute stroke patients and one post intensive care polyneuropathy patient: A case series.

BACKGROUND AND PURPOSE: The objective of this case series is to report on the use of an optokinetic chart stimulation intervention to restore voluntary movement, postural control and mobility in acute stroke patients and one post intensive care polyneuropathy patient. METHOD: An optokinetic chart was moved in front of the patient: from side to side, up and down and finally forwards and backwards. Specific active-assisted exercises of affected shoulder anti-gravity muscles were also carried out. RESULTS: Except for strokes involving basal ganglia, parietal and temporal lobes simultaneously, optokinetic stimulation was effective in restoring voluntary movements, postural control and mobility. DISCUSSION: In single lobe strokes and those that do not involve simultaneous extensive damage to the basal ganglia, parietal and temporal lobes optokinetics may be one of the neuro-modulation techniques that use cranial nerve circuits of key movement and postural control input organs to enhance neural plasticity. Extensive temporal- parietal strokes may need longer periods of rehabilitation. Further research using a combination of vestibular interventions may provide an effective intervention for severely disabling extensive temporal-parietal strokes. Further studies with this optokinetic chart intervention are also recommended for chronic stroke patients.

A case report on the use of a novel optokinetic chart stimulation intervention for the restoration of voluntary movement and mobility in a patient with an acute hemorrhagic stroke.

BACKGROUND AND PURPOSE: The objective of this case report is to report on the use of novel optokinetic chart stimulation to achieve recovery of affected upper limb and affected lower limb voluntary movements and full recovery of mobility in a patient with an acute hemorrhagic stroke. METHOD: An optokinetic chart was moved in front of the patient: from side to side, up and down and finally forwards and backwards. Specific active-assisted exercises of affected shoulder anti-gravity muscles were also carried out. These were external rotation, abduction, flexion and a combination of these through the D2F proprioceptive neuromuscular facilitation (PNF) pattern. RESULTS: Oxford score improved from 0/5 on admission to 3/5 on discharge, after 8 weeks, while Barthel Index improved from 0/20 to 20/20. STREAM scores improved from 1/70 on admission to 18/70 a month after admission and 70 /70 at follow-up 3 months after discharge. DISCUSSION: Optokinetic chart stimulation led to restoration of voluntary movement on the affected side as well as restoration of independent mobility. Further research on the use of the optokinetic chart to enhance neural plasticity for restoration of voluntary movement and mobility is recommended.