And if you haven't figured out the best solution to preventing falls is 100% recovery then try rubbing your two functioning neurons a little harder. Fall prevention is a secondary problem, intelligent persons solve the primary problem of 100% recovery which negates the need for solving all these secondary problems.
Proceedings of the ASME 2017 International Design Engineering Technical Conferences & Computers and Information in Engineering Conference IDETC/CIE 2017August 6-9, 2017 Cleveland Ohio USA
Erik A. Chumacero-Polanco
Human-Centric Design Research Laboratory Department of Mechanical Engineering Texas Tech University of Lubbock Texas
James Yang*
Human-Centric Design Research Laboratory Department of Mechanical Engineering Texas Tech University of Lubbock Texas James.yang@ttu.edu
Abstract
Stroke basically consists in brain-cells death due to lack or excess of
blood. Stroke has many important consequences and falls are one of the
most concerning. Falls can produce several injures from minor
lacerations to fractures and death. It has been found that balance and
gait impairments after stroke are important risk factors for fall.
Hence, improving balance and gait ability in stroke survivors can
significantly reduce falls rate. In this literature review, we review
the main characteristic and the therapeutic results of different
therapeutic interventions aimed at improving balance and walking
ability. The main therapeutic interventions included are the Bobath
therapy(Well shit, Bobath has been discredited since 2003.), exercise-based interventions, orthotic and assistive devices,
modality treatments, alternative therapies, robotic-assisted training,
and computational-based interventions. The parameters considered as
evidence of balance and/or gait recovery after a specific intervention
are: walking speed (WS), cadence, endurance, stride/step length,
weight/walking symmetry, and sway. Our main findings are: 1) The wide
use of the Bobath concept is not well supported by evidence due to its
performance has been found to be inferior to some exercises-based
interventions such as walking training; 2) exercises-based interventions
were classified as strength and task-specific training. The former
improves muscular and bone health, aerobic capability, and prepares the
patient to perform a more demanding activity. The latter is designed as a
repetitive training of a functional activity, mainly walking, and sit
to stand exercises, which improve both gait and balance. Orthotic and
assistive devices have effects on balance and gait but only while they
are worn or used; 3) robotic assisted walking-training presented similar
results to overground or treadmill walking training in terms of walking
speed and balance recovery. However, the most important advantage lies
on the reduction of burden for therapists; 4) thee most important use of
motion analysis is as a tool for identify the causes deficits in a
patient and the to design a therapy in accordance; 5) motion synthesis
can be used as a tool to answer very specific questions related to
capabilities/limitations of a patient. For instance, “what would be the
effect of increasing hip-torque capability of a stroke survivor on the
walking-symmetry?” The answer to this question would either help to
design an exercise/intervention or to discard such intervention due to
low impact; 6) some treatments are added to a main therapy to increase
its effect on a given parameter. Functional electrical stimulation,
which is added to cycling training to improve motion patterns.
Biofeedback is used during balance training to reduce weight-asymmetry.
And virtual reality and video games are used to increase motivation and
permanence of patient on a therapy; 7) we found some alternative or no
widely used therapies. Among the most promising we can mention Tai-Chi
exercises, which integrates physical and mental activities to improve
balance and gait and rhythmic auditory stimulation that improves WS and
weight-symmetry; and 8) orthotics devices help to reduce falls by
extending the base of support but the effect appears only while they are
worn. In general, there is not an ultimate therapy able to fit to every
patient. The choice should depend on patient’s goals and conditions(Every stroke survivor's goal is 100% recovery, unless you bamboozle them into thinking of much less recovery using your tyranny of low expectations.).
Moreover, falls can not be eliminated but they can be substantially
reduced by improving balance and gait.
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