Since this is for chronic you'll never get insurance to pay for it. Hope you can figure oure how to do this on your own.
Our fucking failures of stroke associations should be creating protocols for this but they DO NOTHING.
Hand Rehabilitation Following Stroke: A Pilot Study of Assisted Finger Extension Training in a Virtual Environment
2007, Topics in Stroke Rehabilitation
Heidi C. Fischer, Kathy Stubblefield, Tiffany Kline, Xun Luo, Robert V. Kenyon, and Derek G. Kamper
Top Stroke Rehabil
2007;14(1):1–12© 2007 Thomas Land Publishers, Inc.www.thomasland.comdoi: 10.1310/tsr1401-1
1
Heidi C. Fischer, MS, OTR/L,
is Clinical ResearchCoordinator, Sensory Motor Performance Program,Rehabilitation Institute of Chicago, Chicago, Illinois.
Kathy Stubblefield, OTR/L,
is Research OccupationalTherapist, Rehabilitation Institute of Chicago, Chicago, Illinois.
Tiffany Kline, MS,
is Software Engineer, Northstar Neuroscience, Seattle, Washington.
Xun Luo, MS,
is Doctoral Student, Computer ScienceDepartment, University of Illinois at Chicago.
Robert V. Kenyon, PhD,
is Associate Professor, Computer Science Department, University of Illinois at Chicago.
Derek G. Kamper, PhD,
is Research Scientist, Sensory Motor Performance Program, Rehabilitation Institute of Chicago, and Assistant Professor, Department of Biomedical Engineering,Illinois Institute of Technology, Chicago, Illinois.
A
Background and Purpose:
The purpose of this pilot study was to investigate the impact of assisted motor training in avirtual environment on hand function in stroke survivors.
Participants:
Fifteen volunteer stroke survivors (32–88 years old)with chronic upper extremity hemiparesis (1–38 years post incident) took part.
Method:
Participants had 6 weeks of training in reach-to-grasp of virtual and actual objects. They were randomized to one of three groups: assistance of digit extension provided by a novel cable orthosis, assistance provided by a novel pneumatic orthosis, or no assistance provided.Hand performance was evaluated at baseline, immediately following training, and 1 month after completion of training.Clinical assessments included the Wolf Motor Function Test (WMFT), Box and Blocks Test (BB), Upper Extremity Fugl-MeyerTest (FM), and Rancho Los Amigos Functional Test of the Hemiparetic Upper Extremity (RLA). Biomechanical assessments included grip strength, extension range of motion and velocity, spasticity, and isometric strength.
Results:
Participants demonstrated a significant decrease in time to perform functional tasks for the WMFT (p = .02), an increase in the number of blocks successfully grasped and released during the BB (p = .09), and an increase for the FM score (p = .08). There were no statistically significant changes in time to complete tasks on the RLA or any of the biomechanical measures. Assistance of extension did not have a significant effect.
Discussion and Conclusion:
After the training period, participants in all 3 groups demonstrated a decrease in time to perform some of the functional tasks. Although the overall gains were slight, the general acceptance of the novel rehabilitation tools by a population with substantial impairment suggests that a larger randomized controlled trial, potentially in a subacute population, may be warranted.
Key words:
hand, finger extension orthosis, stroke,virtual reality
approximately 60% of stroke survivors experience upper extremity dysfunction limiting participation in functionalFunctional magnetic resonance imaging and transcranial magnetic stimulation studies in hu-mans provide evidence for functional adaptation of the motor cortex following injury.8–12 Imaging performed after constraint-induced training proto-cols has shown evidence of cortical plasticity as well.13,14
Furthermore, many studies have demonstrated that neuroplasticity can occur even in the chronic stages of stroke.14–18
Rehabilitation is more effective when individuals are allowed opportunities for massed practice in a task oriented context.4
Robotics emerged in an effort to provide opportunities for this massed practice, which may be difficult for therapists to provide due to time and staffing limitations. For example, in lower extremity rehabilitation, body weight supported treadmill training has been found to be effective for individuals with decreased sensorimotor control.19,20
However, this type of treadmill training is labor intensive, requiring assistance from up to three therapists for walking. Robotic machines have been introduced to assist with this task and to,ideally, make this treatment more readily available to clients.21
Similarly, for the upper extremity, robots have been created to assist with therapeutic training of the arm and shoulder.22–25
Robotic devices have also been investigated as tools in upper extremity rehabilitation for chronic stroke survivors20,24,26,27
in an effort to allow rehabilitation professionals to focus on functional independence and increased motor recovery for their clients. Research studies indicate that devices which incorporate intensive training of active repetitive movements increase upper extremity function following stroke.
20,28–30
However, few devices have been designed specifically for hand rehabilitation,31,32
especially for stroke survivors with moderate to severe impairments.Robots and mechatronics also provide a convenient interface with virtual reality environments.These virtual environments have been recently applied to rehabilitation paradigms for stroke survivors.31,33–38
The use of virtual reality in rehabilitation affords the opportunity for individuals to practice movements in several different environments, allows rapid transition between tasks, and provides unlimited options for object size, type,and location. Researchers have previously integrated a hand actuator with a virtual reality system for the purposes of rehabilitation after stroke, but the hand actuator was intended for individuals with relatively mild impairment and could not be used with real objects.33,34,36–38
In previous studies, we have found that individuals with moderate to severe chronic hemiplegia subsequent to stroke have directionally dependent weakness, such that finger extension is impaired to a greater extent than finger flexion.39 Thus, we have developed two devices to assist finger extension when needed: a portable, cable orthosis (CO) with which the user could provide self-assistance, and a pneumatic orthosis (PO) that could provide automatic assistance. These devices were integrated with a virtual reality system. The purpose of this study was to explore whether repetitive practice with finger extension assistance could improve hand function in stroke survivors with moderate to severe upper extremity hemiparesis.
Heidi C. Fischer, Kathy Stubblefield, Tiffany Kline, Xun Luo, Robert V. Kenyon, and Derek G. Kamper
Top Stroke Rehabil
2007;14(1):1–12© 2007 Thomas Land Publishers, Inc.www.thomasland.comdoi: 10.1310/tsr1401-1
1
Heidi C. Fischer, MS, OTR/L,
is Clinical ResearchCoordinator, Sensory Motor Performance Program,Rehabilitation Institute of Chicago, Chicago, Illinois.
Kathy Stubblefield, OTR/L,
is Research OccupationalTherapist, Rehabilitation Institute of Chicago, Chicago, Illinois.
Tiffany Kline, MS,
is Software Engineer, Northstar Neuroscience, Seattle, Washington.
Xun Luo, MS,
is Doctoral Student, Computer ScienceDepartment, University of Illinois at Chicago.
Robert V. Kenyon, PhD,
is Associate Professor, Computer Science Department, University of Illinois at Chicago.
Derek G. Kamper, PhD,
is Research Scientist, Sensory Motor Performance Program, Rehabilitation Institute of Chicago, and Assistant Professor, Department of Biomedical Engineering,Illinois Institute of Technology, Chicago, Illinois.
A
Background and Purpose:
The purpose of this pilot study was to investigate the impact of assisted motor training in avirtual environment on hand function in stroke survivors.
Participants:
Fifteen volunteer stroke survivors (32–88 years old)with chronic upper extremity hemiparesis (1–38 years post incident) took part.
Method:
Participants had 6 weeks of training in reach-to-grasp of virtual and actual objects. They were randomized to one of three groups: assistance of digit extension provided by a novel cable orthosis, assistance provided by a novel pneumatic orthosis, or no assistance provided.Hand performance was evaluated at baseline, immediately following training, and 1 month after completion of training.Clinical assessments included the Wolf Motor Function Test (WMFT), Box and Blocks Test (BB), Upper Extremity Fugl-MeyerTest (FM), and Rancho Los Amigos Functional Test of the Hemiparetic Upper Extremity (RLA). Biomechanical assessments included grip strength, extension range of motion and velocity, spasticity, and isometric strength.
Results:
Participants demonstrated a significant decrease in time to perform functional tasks for the WMFT (p = .02), an increase in the number of blocks successfully grasped and released during the BB (p = .09), and an increase for the FM score (p = .08). There were no statistically significant changes in time to complete tasks on the RLA or any of the biomechanical measures. Assistance of extension did not have a significant effect.
Discussion and Conclusion:
After the training period, participants in all 3 groups demonstrated a decrease in time to perform some of the functional tasks. Although the overall gains were slight, the general acceptance of the novel rehabilitation tools by a population with substantial impairment suggests that a larger randomized controlled trial, potentially in a subacute population, may be warranted.
Key words:
hand, finger extension orthosis, stroke,virtual reality
approximately 60% of stroke survivors experience upper extremity dysfunction limiting participation in functionalFunctional magnetic resonance imaging and transcranial magnetic stimulation studies in hu-mans provide evidence for functional adaptation of the motor cortex following injury.8–12 Imaging performed after constraint-induced training proto-cols has shown evidence of cortical plasticity as well.13,14
Furthermore, many studies have demonstrated that neuroplasticity can occur even in the chronic stages of stroke.14–18
Rehabilitation is more effective when individuals are allowed opportunities for massed practice in a task oriented context.4
Robotics emerged in an effort to provide opportunities for this massed practice, which may be difficult for therapists to provide due to time and staffing limitations. For example, in lower extremity rehabilitation, body weight supported treadmill training has been found to be effective for individuals with decreased sensorimotor control.19,20
However, this type of treadmill training is labor intensive, requiring assistance from up to three therapists for walking. Robotic machines have been introduced to assist with this task and to,ideally, make this treatment more readily available to clients.21
Similarly, for the upper extremity, robots have been created to assist with therapeutic training of the arm and shoulder.22–25
Robotic devices have also been investigated as tools in upper extremity rehabilitation for chronic stroke survivors20,24,26,27
in an effort to allow rehabilitation professionals to focus on functional independence and increased motor recovery for their clients. Research studies indicate that devices which incorporate intensive training of active repetitive movements increase upper extremity function following stroke.
20,28–30
However, few devices have been designed specifically for hand rehabilitation,31,32
especially for stroke survivors with moderate to severe impairments.Robots and mechatronics also provide a convenient interface with virtual reality environments.These virtual environments have been recently applied to rehabilitation paradigms for stroke survivors.31,33–38
The use of virtual reality in rehabilitation affords the opportunity for individuals to practice movements in several different environments, allows rapid transition between tasks, and provides unlimited options for object size, type,and location. Researchers have previously integrated a hand actuator with a virtual reality system for the purposes of rehabilitation after stroke, but the hand actuator was intended for individuals with relatively mild impairment and could not be used with real objects.33,34,36–38
In previous studies, we have found that individuals with moderate to severe chronic hemiplegia subsequent to stroke have directionally dependent weakness, such that finger extension is impaired to a greater extent than finger flexion.39 Thus, we have developed two devices to assist finger extension when needed: a portable, cable orthosis (CO) with which the user could provide self-assistance, and a pneumatic orthosis (PO) that could provide automatic assistance. These devices were integrated with a virtual reality system. The purpose of this study was to explore whether repetitive practice with finger extension assistance could improve hand function in stroke survivors with moderate to severe upper extremity hemiparesis.
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