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1.
Neuron ; 105(4): 604-620, 2020 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-32078796

RESUMO

Stroke is one of the leading causes of long-term disability. Advanced technological solutions ("neurotechnologies") exploiting robotic systems and electrodes that stimulate the nervous system can increase the efficacy of stroke rehabilitation. Recent studies on these approaches have shown promising results. However, a paradigm shift in the development of new approaches must be made to significantly improve the clinical outcomes of neurotechnologies compared with those of traditional therapies. An "evolutionary" change can occur only by understanding in great detail the basic mechanisms of natural stroke recovery and technology-assisted neurorehabilitation. In this review, we first describe the results achieved by existing neurotechnologies and highlight their current limitations. In parallel, we summarize the data available on the mechanisms of recovery from electrophysiological, behavioral, and anatomical studies in humans and rodent models. Finally, we propose new approaches for the effective use of neurotechnologies in stroke survivors, as well as in people with other neurological disorders.


Assuntos
Estimulação Encefálica Profunda/métodos , Destreza Motora/fisiologia , Plasticidade Neuronal/fisiologia , Recuperação de Função Fisiológica/fisiologia , Córtex Sensório-Motor/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Estimulação Encefálica Profunda/instrumentação , Humanos , Doenças do Sistema Nervoso/diagnóstico por imagem , Doenças do Sistema Nervoso/fisiopatologia , Doenças do Sistema Nervoso/reabilitação , Reabilitação Neurológica/instrumentação , Reabilitação Neurológica/métodos , Córtex Sensório-Motor/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Reabilitação do Acidente Vascular Cerebral/instrumentação
2.
Arch Phys Med Rehabil ; 101(1): 113-120, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31568761

RESUMO

OBJECTIVE: To assess safety and feasibility for persons with acute spinal cord injury (SCI) using the robotic exoskeleton. DESIGN: Case series observational study. SETTING: A level-1 trauma center in Canada with both acute and tertiary inpatient SCI rehabilitation units. PARTICIPANTS: Eight male and 3 female (N=11) participants were recruited with a mean age of 41 years and with neurologic level of injury (C6-L2) and severity (American Spinal Injury Association Impairment Scale [AIS] A-D). The time since injury is a range of 3-15 weeks at the onset of training. INTERVENTIONS: Up to 25 one-hour sessions of exoskeletal-assisted walking gait training, with participants less than 6 months from initial SCI. MAIN OUTCOME MEASURES: Cardiopulmonary outcomes including blood pressure, heart rate, and peripheral oxygen saturation; and perceived physical exertion using the Borg CR10 Scale were recorded. Gait parameters were measured by 6-minute walk test (6MWT) and 10-meter walk test (10MWT). Up Time, walk time, and number of steps were detailed longitudinally. Safety was assessed with regard to pain, falls, and skin integrity. RESULTS: No serious adverse events occurred. Blood pressure decreased following initial sit to stand and increased during walking. Symptoms of hypotension were rare and improved with increased number of sessions. Perceived exertion was reported on average to be moderate (mean of 3.1). There was no significant increase in pain scores by Visual Analog Scale. On 6MWT, participants covered more distance (mean [m] ± SD, 117.1±11.7) in session 25 compared to session 2 (mean [m] ± SD, 47.6±6.6). On the 10MWT, all participants showed consistently improved gait speed; with participants traveling an average of 3.2 times faster during their last training session (mean [m/s] ± SD, 0.40±0.04) in comparison to session 2 (mean [m/s] ± SD, 0.12±0.01). CONCLUSIONS: Exoskeletal-assisted walking in acute rehabilitation (<6mo) following SCI appears to be both safe and feasible.


Assuntos
Terapia por Exercício/instrumentação , Exoesqueleto Energizado , Reabilitação Neurológica/instrumentação , Traumatismos da Medula Espinal/reabilitação , Adulto , Canadá , Estudos de Viabilidade , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Esforço Físico , Estudos Retrospectivos , Traumatismos da Medula Espinal/fisiopatologia , Resultado do Tratamento , Teste de Caminhada , Caminhada/fisiologia , Velocidade de Caminhada
3.
NeuroRehabilitation ; 45(4): 519-524, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31868690

RESUMO

BACKGROUND: Contemporary goals of rehabilitation after traumatic brain injury (TBI) aim to improve cognitive and motor function by applying concepts of neuroplasticity. This can be challenging to carry out in TBI patients with motor, balance, and cognitive impairments. OBJECTIVE: To determine whether use of dynamic body-weight support (DBWS) would allow safe administration of intensive motor therapy during inpatient rehabilitation and whether its use would yield greater improvement in functional recovery than standard-of-care (SOC) therapy in adults with TBI. METHODS: Data in this retrospective cohort study was collected from patients with TBI who receive inpatient rehabilitation incorporating DBWS (n = 6) and who received inpatient rehabilitation without DBWS (SOC, n = 6). The primary outcome measure was the change in Functional Independence Measures (FIM) scores from admission to discharge. RESULTS: There was significant improvement in total FIM scores at discharge compared to admission for both the DBWS (p = 0.001) and SOC (p = 0.005) groups. Overall, the DBWS group had greater improvement in total FIM score and FIM subscales compared to the SOC group. CONCLUSIONS: Our results suggest DBWS has the potential to allow a greater intensity of therapy during inpatient rehabilitation and yield better outcomes compared to SOC in patients with TBI.


Assuntos
Lesões Encefálicas Traumáticas/reabilitação , Vida Independente/normas , Reabilitação Neurológica/métodos , Aparelhos Ortopédicos , Adulto , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Movimento , Reabilitação Neurológica/instrumentação , Alta do Paciente/estatística & dados numéricos , Recuperação de Função Fisiológica
4.
NeuroRehabilitation ; 45(2): 285-290, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31498141

RESUMO

BACKGROUND: Parkinson's disease (PD) is a neurodegenerative disease due to dopamine deficiency in the basal ganglia, leading to motor symptoms such as bradykinesia, tremor, stiffness, and postural instability. This disease may also be associated with a broad spectrum of non-motor symptoms. More than 24% of patients with PD have one or more cognitive symptoms. OBJECTIVE: To evaluate the effects of computer-assisted cognitive rehabilitation (CACR) in Parkinson's disease (PD). METHODS: Sixty patients with PD were enrolled in this study and were randomly divided into control group (CG) and experimental group (EG). Each participant was evaluated at the beginning (T0) and at the end of training (T1). The CG underwent standard cognitive training (SCT) while EG performed CACR using the ERICA platform, aimed at improving several cognitive domains. In both the group, each training consisted of 3 sessions a week, each of these lasting sixty minutes, for eight weeks. RESULTS: Although both the groups had significant improvement after CR, we observed more significant changes in the EG, especially concerning attention, orientation and visual-spatial domains. CONCLUSIONS: Our data demonstrate that CACR is more effective than SCT in improving visual-spatial and executive deficits, in patients affected by PD.


Assuntos
Cognição , Função Executiva , Reabilitação Neurológica/métodos , Doença de Parkinson/reabilitação , Comportamento Espacial , Terapia Assistida por Computador/métodos , Atenção , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reabilitação Neurológica/instrumentação , Terapia Assistida por Computador/instrumentação
5.
IEEE Int Conf Rehabil Robot ; 2019: 754-759, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31374721

RESUMO

One of the main challenges in robotic neuroreha-bilitation is to understand how robots should physically interact with trainees to optimize motor leaning. There is evidence that motor exploration (i.e., the active exploration of new motor tasks) is crucial to boost motor learning. Furthermore, effectiveness of a robotic training strategy depends on several factors, such as task type and trainee's skill level. We propose that Model Predictive Controllers (MPC) can satisfy many training/trainee's needs simultaneously, while providing a safe environment without restricting trainees to a fixed trajectory. We designed two nonlinear MPCs to support training of a rich dynamic task (a pendulum task) with a delta robot. These MPCs differ from each other in terms of the application point of the intervention force: (i) to the virtual pendulum mass, and (ii) the virtual rod holding point, which corresponds to the robot end-effector. The effect of the MPCs on task performance, physical effort, motivation and sense of agency was evaluated in fourteen healthy participants. We found that the location of the applied controller force affects the task performance -i.e., the MPC that actuates on the pendulum mass significantly reduced performance errors and sense of agency during training, while the other MPC did not, probably due to low force saturation limits and slow optimization speed of the solver. Participants applied significantly more forces when training with the MPC that actuates on the pendulum holding point, probably because they reacted against the robotic assistance. Although MPCs look very promising for neurorehabilitation, further steps have to be taken to improve their technical limitations. Moreover, the effects of MPCs on motor learning should be evaluated.


Assuntos
Reabilitação Neurológica/instrumentação , Robótica/educação , Robótica/instrumentação , Adulto , Feminino , Humanos , Cinética , Masculino , Inquéritos e Questionários , Adulto Jovem
6.
Dev Neurorehabil ; 22(8): 527-541, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31169045

RESUMO

Background: The use of assistive technology, specifically microswitches, with children with RTT has been shown to effectively moderate the impact of their disability on their quality of life- by facilitating access to meaningful leisure and other activities. Objectives: This study aimed to evaluate the effectiveness of a microswitch intervention on increased choice making, engagement in a targeted sorting activity, and indices of happiness, and decreased stereotypic behaviors for six girls with Rett syndrome. Targeted dependent variables were also assessed at six months post-intervention. Following the intervention study, 90 external raters completed a social validation procedure. Method: An ABABAB experimental sequence was implemented for each participant with a cross-over effect. A social validation assessment involving 90 external raters was carried out. Results: Data emphasized an improved performance for each participants involved (i.e., adaptive responses). Five participants showed a capacity of independent choice. One participant seemed to be closely linked to the position of the container. Social raters favorably endorsed the use of the program since they positively evaluated the use of the technology on all the dimensions investigated. Conclusion: A microswitch intervention may improve choice making and activity engagement for children with Rett syndrome. Further research is needed on the development of more sophisticated forms of individualized technological options to improve opportunities for enhanced engagement and choice-making for individuals with RTT.


Assuntos
Comportamento de Escolha , Síndrome de Rett/reabilitação , Equipamentos de Autoajuda , Criança , Feminino , Felicidade , Humanos , Atividades de Lazer , Reabilitação Neurológica/instrumentação , Reabilitação Neurológica/métodos , Comportamento Estereotipado
7.
Int J Neurosci ; 129(11): 1066-1075, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31220973

RESUMO

Aim: The present study describes the training effects of a novel motorized bicycle-like device for individuals with incomplete spinal cord injury. Methods: Participants were five individuals with motor incomplete spinal cord injury (56 ± 7 years). Four of five participants received two 30-min sessions of training: one with, and one without, mechanical stimulation on the plantar surface of the foot; soleus paired H-reflex depression was examined before and after each session. Three of five participants received 24 sessions of 30-min of training (long-training). Following the long-training, balance, walking and spasticity improvements were assessed using validated clinical outcome measures, in addition to the H-reflex assessment. Results: One cycling session with mechanical stimulation yielded 14% and 32% more reflex depression in participants with moderate spasticity (n = 2/4). The same trend was not observed in non-spastic participants (n = 2/4). All participants who participated in the long-training had spasticity and showed reduced spasticity, improved walking speed, endurance and balance. Conclusions: Overall, participants with spasticity showed increased soleus H-reflex suppression after one training session with mechanical stimulation and reduced spasticity scores after long training. We interpret this as evidence that the training influenced both presynaptic and postsynaptic inhibitory mechanisms acting on soleus motoneurons. Therefore, this training has the potential to be a non-invasive complementary therapy to reduce spasticity after incomplete spinal cord injury.


Assuntos
Terapia por Exercício/instrumentação , Espasticidade Muscular/reabilitação , Músculo Esquelético , Reabilitação Neurológica , Avaliação de Resultados em Cuidados de Saúde , Paralisia/reabilitação , Traumatismos da Medula Espinal/reabilitação , Idoso , Ciclismo , Desenho de Equipamento , Terapia por Exercício/métodos , Feminino , Reflexo H/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Reabilitação Neurológica/instrumentação , Reabilitação Neurológica/métodos , Paralisia/etiologia , Estimulação Física , Estudo de Prova de Conceito , Traumatismos da Medula Espinal/complicações
8.
Restor Neurol Neurosci ; 37(3): 239-244, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31177250

RESUMO

BACKGROUND: Robot-assisted gait training (RAGT) is widely used in children with cerebral palsy (CP), but information about optimal intervention frequency and duration is still lacking and the current evidence about effect of RAGT on motor endurance and fitness is very preliminary. OBJECTIVE: To investigate the effect of RAGT on motor performance and endurance in children affected by CP. METHODS: Data from 14 consecutive children (6 females, age range: 4.6-15.8 years) affected by CP, who underwent a multidisciplinary rehabilitation program during a 18-24 month period, were retrospectively collected. Rehabilitation program included conventional physical therapy and RAGT (60/60 minutes, 20 daily sessions, 5 days/week). CP severity was stratified according to the Gross Motor Function Classification System. Clinical evaluation was performed by means of the six-minute walking test, the modified Ashworth scale, and RAGT measures (total distance, mean distance for session and speed). RESULTS: Clinical outcomes and speed did not improve after treatment, while total distance (p = 0.006) and mean distance for session (p = 0.007) significantly improved. CONCLUSIONS: Our preliminary study suggests that RAGT combined with conventional treatment may improve motor performance and endurance in children with CP. Future randomized controlled trials comparing RAGT to conventional treatment are needed.


Assuntos
Paralisia Cerebral/reabilitação , Transtornos Neurológicos da Marcha/reabilitação , Reabilitação Neurológica , Avaliação de Resultados em Cuidados de Saúde , Resistência Física/fisiologia , Desempenho Psicomotor/fisiologia , Robótica , Equipamentos de Autoajuda , Adolescente , Paralisia Cerebral/complicações , Criança , Pré-Escolar , Feminino , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Reabilitação Neurológica/instrumentação , Reabilitação Neurológica/métodos , Reabilitação Neurológica/normas , Estudos Retrospectivos
9.
Neurol Sci ; 40(10): 2073-2080, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31129775

RESUMO

The recovery of the orthostatism after a severe acquired brain injury (sABI) is an essential objective to pursue in order to avoid the occurrence of secondary complications resulting from prolonged immobilization to which the patient is subjected during the acute phase. This randomized controlled trial aims to evaluate the effect of verticalization with the lower limb robot-assisted training system Erigo® versus conventional neurorehabilitation in 44 adult subjects affected by sequelae of sABI in the acute rehabilitation phase, related to cardiorespiratory signs and measures of impairment and activity. At the end of the study (20 treatment sessions, 5 sessions per week), in both groups of patients, there were no dropouts nor adverse events. In subject verticalized with Erigo®, there were no episodes of (pre)syncope from orthostatic hypotension nor postural orthostatic tachycardia and cardiorespiratory signs remained stable; moreover, there were no increase in muscle tone nor reduction in range of motion at lower limbs. Results obtained show improved outcomes on the whole and in a similar way in both groups; however, the improvement in scores of the National Institutes of Health Stroke Scale, the Tinetti scale, and the Functional Independence Measure from the enrollment to the end of the treatment cycle being equal, the evaluation performed at the 10th session allows to establish that the improvement appears earlier in the intervention group and later in the control group. The more rapid recovery of impairments and some activities in subjects treated with Erigo® could allow a "time-saver" to devote to the rehabilitation of sensory-motor functions which are more complex and subordinated to the preliminary reacquisition of elementary postures and motor strategies.


Assuntos
Lesões Encefálicas/reabilitação , Reabilitação Neurológica/instrumentação , Posicionamento do Paciente/instrumentação , Robótica/instrumentação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intolerância Ortostática/epidemiologia , Intolerância Ortostática/etiologia , Posicionamento do Paciente/efeitos adversos , Adulto Jovem
10.
Turk J Med Sci ; 49(3): 838-843, 2019 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-31134784

RESUMO

Background/aim: The aim of the study was to determine the effects of robotic-assisted gait training on ambulation and functional capacity in patients with spinal cord injury. Materials and methods: In total, 88 patients were included and were randomly divided into two groups. The first group underwent 16 sessions of robotic therapy training for 8 weeks and conventional therapy for 5 days a week. The second group underwent conventional treatment. The Walking Index for Spinal Cord Injury II was used to evaluate functional ambulation, and the functional independence measure score was used to assess patients' functional independence levels in a blind manner. Results: A significant improvement was observed in both groups according to Walking Index for Spinal Cord Injury II and functional independence measure scores (P < 0.001). However, a significantly higher improvement according to the Walking Index for Spinal Cord Injury II (P = 0.011) and functional independence measure scores (P = 0.022) was seen in the robotic group than in the control group Conclusion: Robotic-assisted gait training combined with conventional therapy was found to be superior to the conventional therapy in terms of gait function and level of disability.


Assuntos
Exoesqueleto Energizado , Marcha/fisiologia , Reabilitação Neurológica , Traumatismos da Medula Espinal/reabilitação , Adulto , Feminino , Humanos , Masculino , Reabilitação Neurológica/instrumentação , Reabilitação Neurológica/métodos , Análise e Desempenho de Tarefas , Caminhada
11.
J Neuroeng Rehabil ; 16(1): 53, 2019 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-31036003

RESUMO

BACKGROUND: There is growing interest in the use of technology in neurorehabilitation, from robotic to sensor-based devices. These technologies are believed to be excellent tools for quantitative assessment of sensorimotor ability, addressing the shortcomings of traditional clinical assessments. However, clinical adoption of technology-based assessments is very limited. To understand this apparent contradiction, we sought to gather the points-of-view of different stakeholders in the development and use of technology-aided sensorimotor assessments. METHODS: A questionnaire regarding motivators, barriers, and the future of technology-aided assessments was prepared and disseminated online. To promote discussion, we present an initial analysis of the dataset; raw responses are provided to the community as Supplementary Material. Average responses within stakeholder groups were compared across groups. Additional questions about respondent's demographics and professional practice were used to obtain a view of the current landscape of sensorimotor assessments and interactions between different stakeholders. RESULTS: One hundred forty respondents from 23 countries completed the survey. Respondents were a mix of Clinicians (27%), Research Engineers (34%), Basic Scientists (15%), Medical Industry professionals (16%), Patients (2%) and Others (6%). Most respondents were experienced in rehabilitation within their professions (67% with > 5 years of experience), and had exposure to technology-aided assessments (97% of respondents). In general, stakeholders agreed on reasons for performing assessments, level of details required, current bottlenecks, and future directions. However, there were disagreements between and within stakeholders in aspects such as frequency of assessments, and important factors hindering adoption of technology-aided assessments, e.g., Clinicians' top factor was cost, while Research Engineers indicated device-dependent factors and lack of standardization. Overall, lack of time, cost, lack of standardization and poor understanding/lack of interpretability were the major factors hindering the adoption of technology-aided assessments in clinical practice. Reimbursement and standardization of technology-aided assessments were rated as the top two activities to pursue in the coming years to promote the field of technology-aided sensorimotor assessments. CONCLUSIONS: There is an urgent need for standardization in technology-aided assessments. These efforts should be accompanied by quality cross-disciplinary activities, education and alignment of scientific language, to more effectively promote the clinical use of assessment technologies. TRIAL REGISTRATION: NA; see Declarations section.


Assuntos
Reabilitação Neurológica/instrumentação , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Humanos , Pesquisadores , Inquéritos e Questionários
12.
J Electromyogr Kinesiol ; 47: 35-42, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31108347

RESUMO

BACKGROUND: It is important to monitor progress during rehabilitation of stroke patients. To that end, clinical function tests may be supported by three-dimensional kinematic measures. The aim of this study was to evaluate the inter- and intra-rater reliability of three-dimensional kinematic measures of shoulder movements in stroke patients with reduced shoulder function. METHODS: Seventeen patients were tested in three sessions by two trained raters. Three-dimensional motion capture was performed of the more affected upper extremity and the trunk. Measures of movements of the scapula and humerus related to the trunk, the trunk related to the laboratory, the forearm related to the humerus, and temporospatial measures were obtained during two reach tasks from the Wolf Motor Function Test, ReachLow and ReachHigh. Inter- and intra-rater reliability was quantified with intraclass correlation coefficients (ICC). FINDINGS: In general, range of movements of scapula, shoulder, trunk and elbow and movement time and reach length showed high inter-rater reliability (ICC∞ 0.84-0.98) and intra-rater reliability (ICC∞ 0.75-1.00), A minimum of five trials per task were required to achieve reliable ICC estimates. INTERPRETATION: Selected three-dimensional kinematic measures can be used reliably to evaluate specific movements of the shoulder in stroke patients with reduced shoulder function.


Assuntos
Ombro/fisiologia , Reabilitação do Acidente Vascular Cerebral/instrumentação , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/fisiopatologia , Adulto , Idoso , Fenômenos Biomecânicos/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Movimento/fisiologia , Músculo Esquelético/fisiologia , Reabilitação Neurológica/instrumentação , Reabilitação Neurológica/métodos , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Escápula/fisiologia , Acidente Vascular Cerebral/terapia
13.
J Neuroeng Rehabil ; 16(1): 48, 2019 04 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975167

RESUMO

BACKGROUND: Cervical spinal cord injury (cSCI) often causes chronic upper extremity disability. Reliable measurement of arm function is critical for development of therapies to improve recovery after cSCI. In this study, we report a suite of automated rehabilitative tools to allow simple, quantitative assessment of hand and wrist motor function. METHODS: We measured range of motion and force production using these devices in cSCI participants with a range of upper limb disability and in neurologically intact participants at two time points separated by approximately 4 months. Additionally, we determined whether measures collected with the rehabilitative tools correlated with standard upper limb assessments, including the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP) and the Jebsen Hand Function Test (JHFT). RESULTS: We find that the rehabilitative devices are useful to provide assessment of upper limb function in physical units over time in SCI participants and are well-correlated with standard assessments. CONCLUSIONS: These results indicate that these tools represent a reliable system for longitudinal evaluation of upper extremity function after cSCI and may provide a framework to assess the efficacy of strategies aimed at improving recovery of upper limb function.


Assuntos
Avaliação da Deficiência , Reabilitação Neurológica/instrumentação , Traumatismos da Medula Espinal/reabilitação , Adulto , Medula Cervical/lesões , Feminino , Mãos/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Traumatismos da Medula Espinal/fisiopatologia , Punho/fisiopatologia , Adulto Jovem
14.
Phys Med Rehabil Clin N Am ; 30(2): 301-318, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30954149

RESUMO

This article describes the application of neuromodulation in different ways to motor recovery, to replace lost function, or to improve function of organ systems for those who have experienced spinal cord injury or stroke. Multiple devices have been developed and are currently available for use whereas others are still in the experimental stage. Multiple uses of neuromodulation are described.


Assuntos
Terapia por Estimulação Elétrica , Reabilitação Neurológica , Terapia por Estimulação Elétrica/instrumentação , Terapia por Estimulação Elétrica/métodos , Humanos , Reabilitação Neurológica/instrumentação , Reabilitação Neurológica/métodos , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/reabilitação , Acidente Vascular Cerebral/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/instrumentação , Reabilitação do Acidente Vascular Cerebral/métodos
15.
Phys Med Rehabil Clin N Am ; 30(2): 367-384, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30954153

RESUMO

Tetraplegia resulting from cervical injury is the most frequent neurologic category after spinal cord injury and causes substantial disability. The residual strength of partially paralyzed muscles is an important determinant of independence and function in tetraplegia. Small improvements in upper extremity function can make a clinically significant difference in daily activities. Major advances in rehabilitation technologies over the past 2 decades have allowed testing of robotic devices in rehabilitation of motor impairments. This literature assessment provides an overview of robotic-assisted training research for improving arm and hand functions after cervical spinal cord injury.


Assuntos
Medula Cervical/lesões , Reabilitação Neurológica , Robótica , Traumatismos da Medula Espinal/reabilitação , Terapia Assistida por Computador , Humanos , Reabilitação Neurológica/instrumentação , Quadriplegia/etiologia , Quadriplegia/fisiopatologia , Quadriplegia/reabilitação , Traumatismos da Medula Espinal/fisiopatologia , Terapia Assistida por Computador/instrumentação , Extremidade Superior/fisiopatologia
16.
Phys Med Rehabil Clin N Am ; 30(2): 385-397, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30954154

RESUMO

Improving walking function is a desirable outcome in rehabilitation and of high importance for social and vocational reintegration for persons with neurologic-related gait impairment. Robots for lower limb gait rehabilitation are designed principally to help automate repetitive labor-intensive training during neurorehabilitation. These include tethered exoskeletons, end-effector devices, untethered exoskeletons, and patient-guided suspension systems. This article reviews the first 3 categories and briefly mentions the fourth. Research is needed to further define the therapeutic applications of these devices. Additional technical improvements are expected regarding device size, controls, and battery life for untethered devices.


Assuntos
Reabilitação Neurológica , Robótica , Terapia Assistida por Computador , Humanos , Extremidade Inferior/fisiopatologia , Reabilitação Neurológica/instrumentação , Terapia Assistida por Computador/instrumentação
17.
NeuroRehabilitation ; 44(2): 303-313, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31006691

RESUMO

BACKGROUND: Assistive devices enhance independence and quality of life for people living with motor neuron disease (MND), but prescription can be challenging. OBJECTIVE: Improved prescription of assistive devices, through improved understanding of the relationship between clinical phenotypes, Amyotrophic Lateral Sclerosis Functional Rating Scale - Revised (ALSFRS-R) functional domain sub-scores and assistive technology required by people living with MND. METHODS: Prospective, observational consecutive-sample study of 269 patients with MND diagnosis. MAIN OUTCOME MEASURES: MND phenotype, ALSFRS-R scores and assistive technology devices in use. RESULTS: A statistically significant difference in total concurrent assistive technology item use was found between phenotypes (p = 0.001), with those with ALS Bulbar onset using the least. There was also a statistically significant difference in assistive technology usage in five of seven assistive technology categories across the clinical phenotypes, namely orthoses (p < 0.000), mobility devices (p < 0.000), transfer devices (p < 0.000), communication devices (p < 0.000), and activities of daily living devices (p = 0.016). Correlations between ALSFRS-R sub-score items and assistive technology count confirmed the utility of this outcome measure for equipment prescription. CONCLUSIONS: Clinicians need to consider MND phenotype and/or ALSFRS-R domain sub-score in clinical decision-making regarding assistive technology, as this will determine the pattern of disease and its progression, and hence assistive technology required.


Assuntos
Esclerose Amiotrófica Lateral/reabilitação , Reabilitação Neurológica/instrumentação , Equipamentos de Autoajuda/normas , Atividades Cotidianas , Adulto , Esclerose Amiotrófica Lateral/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reabilitação Neurológica/métodos , Fenótipo , Índice de Gravidade de Doença
18.
Rinsho Shinkeigaku ; 59(3): 157-159, 2019 Mar 28.
Artigo em Japonês | MEDLINE | ID: mdl-30814446

RESUMO

A 64-year-old man was diagnosed with spinal and bulbar muscular atrophy (SBMA) in 2014, and began gait training with the hybrid assistive limb (HAL) in 2017. We conducted 2 courses of HAL-based gait training and temporary improvement was confirmed both before and after intervention based on evaluation of the 2-minute walking distance, walking speed, and the Timed Up and Go test. HAL-based gait training may be effective for improving and maintaining walking ability in SBMA. However, long-term observation of this patient will be performed.


Assuntos
Atrofia Bulboespinal Ligada ao X/reabilitação , Terapia por Exercício/instrumentação , Exoesqueleto Energizado , Marcha/fisiologia , Reabilitação Neurológica/instrumentação , Condicionamento Físico Humano/instrumentação , Modalidades de Fisioterapia/instrumentação , Caminhada/fisiologia , Atrofia Bulboespinal Ligada ao X/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
19.
Int J Neurosci ; 129(8): 770-775, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30621502

RESUMO

Background: At present, there are no meaningful and sophisticated computer games that simultaneously allow the treatment of movement disorders such as Parkinson's syndrome. In particular, there are no systems to consider the severity of the disease and the physical skills of the patient. Methods: A computer game using the Microsoft Kinect as markerless sensor for the 3 D recognition of the patient's movement was developed to support the rehabilitation. The scenario of a basketball game was created after determining that the movement like throwing a ball and the correct posture of the body are important. A study based on system usability was performed with 15 patients to evaluate the system. Results: The technical feasibility of a computer-assisted training system for supporting patients with Parkinson's disease has been demonstrated. No markers on the patient are required for movement detection and allow a user-friendly handling. Regarding the usability study, the patients were accepting of such a system and its at-home use and symptoms like 'freezing' and the Pisa syndrome can be treated. Conclusions: The physiotherapist can be assisted by the developed rehabilitation system. An objective measurement of the patient's training progress delivers valuable information to adjust the training sessions for every patient individually. Due to its modular character, the system can also be applied to other diseases or sports injuries and offers the basis for further development.


Assuntos
Biorretroalimentação Psicológica/métodos , Reabilitação Neurológica/métodos , Doença de Parkinson/reabilitação , Terapia Assistida por Computador/métodos , Jogos de Vídeo , Idoso , Idoso de 80 Anos ou mais , Biorretroalimentação Psicológica/instrumentação , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reabilitação Neurológica/instrumentação , Terapia Assistida por Computador/instrumentação
20.
Expert Rev Med Devices ; 16(3): 187-195, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30677307

RESUMO

INTRODUCTION: In recent years, neurorehabilitation has moved from a 'bottom-up' to a 'top down' approach. This change has also involved the technological devices developed for motor and cognitive rehabilitation. It implies that during a task or during therapeutic exercises, new 'top-down' approaches are being used to stimulate the brain in a more direct way to elicit plasticity-mediated motor re-learning. This is opposed to 'Bottom up' approaches, which act at the physical level and attempt to bring about changes at the level of the central neural system. AREAS COVERED: In the present unsystematic review, we present the most promising innovative technological devices that can effectively support rehabilitation based on a top-down approach, according to the most recent neuroscientific and neurocognitive findings. In particular, we explore if and how the use of new technological devices comprising serious exergames, virtual reality, robots, brain computer interfaces, rhythmic music and biofeedback devices might provide a top-down based approach. EXPERT COMMENTARY: Motor and cognitive systems are strongly harnessed in humans and thus cannot be separated in neurorehabilitation. Recently developed technologies in motor-cognitive rehabilitation might have a greater positive effect than conventional therapies.


Assuntos
Reabilitação Neurológica/instrumentação , Acústica , Interfaces Cérebro-Computador , Humanos , Musicoterapia , Robótica , Realidade Virtual
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