Dynamic Lycra® orthoses as an adjunct to arm rehabilitation after stroke: a single-blind, two-arm parallel group, randomized controlled feasibility trial

You'll have to ask your doctor what the adverse reactions were since our fucking failures of stroke associations have not created a publicly available database of stroke research. 

Dynamic Lycra® orthoses as an adjunct to arm rehabilitation after stroke: a single-blind, two-arm parallel group, randomized controlled feasibility trial

Jacqui H Morris1, Alexandra John1, Lucy Wedderburn2, Petra Rauchhaus3 and Peter T Donnan4

 Abstract

 Objective: The aim of this study was to explore the feasibility of conducting a randomized controlled trial of dynamic Lycra® orthoses as an adjunct to arm rehabilitation after stroke and to explore the magnitude and direction of change on arm outcomes.
Design: This is a single-blind, two-arm parallel group, feasibility randomized controlled trial.
Setting: In-patient rehabilitation.Subjects: The study participants were stroke survivors with arm hemiparesis two to four weeks after stroke receiving in-patient rehabilitation.Interventions: Participants were randomized 2:1 to wear Lycra® gauntlets for eight hours daily for eight weeks, plus usual rehabilitation (n= 27), or to usual rehabilitation only (n = 16).Main measures: Recruitment, retention, fidelity, adverse events and completeness of data collection were examined at 8 and 16 weeks; arm function (activity limitation; Action Research Arm Test, Motor Activity Log) and impairment (Nine-hole Peg Test, Motricity Index, Modified Tardieu Scale). Structured interviews explored acceptability.
 Results: Of the target of 51, 43 (84%) participants were recruited. Retention at 8 weeks was 32 (79%) and 24 (56%) at 16 weeks. In total, 11 (52%) intervention group participants and 6 (50%) control group participants (odds ratio = 1.3, 95% confidence interval = 0.2 to 7.8) had improved Action Research Arm Test level by 8 weeks; at 16 weeks, this was 8 (61%) intervention and 6 (75.0%) control participants 2 Clinical Rehabilitation 00(0)(odds ratio = 1.1, 95% confidence interval = 0.1 to 13.1). Change on other measures favoured control participants. Acceptability was influenced by 26 adverse reactions. 
Conclusion: Recruitment and retention were low, and adverse reactions were problematic. There were no indications of clinically relevant effects, but the small sample means definitive conclusions cannot be made. A definitive trial is not warranted without orthoses adaptation.

O-2-17. Influence of different types of orthoses on muscle synergy control during gait in stroke patients with hemiparesis

Useless, no mention of interventions mapped to objective disabilities.  No way to use this in your stroke rehab.
https://www.sciencedirect.com/science/article/pii/S1388245718301810

• Masanori Wakida,
• Kimihiko Mori,
• Yuta Chujo,
• Eiko Hirooka,
• Gwang-ho Kim,
• Koji Ohata,
• Kimitaka Hase

 Show more

https://doi.org/10.1016/j.clinph.2018.02.081

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The purpose of this study was to verify the influence of lower limb orthoses on muscle synergy control during gait in stroke patients with hemiparesis. In four subjects with acute stroke, surface EMG signals from eight muscles of the paretic lower limb were measured during gait in two conditions (ankle foot orthosis; AFO or knee ankle foot orthosis; KAFO). The number of modules, muscle weightings and activation timing profile of each module were analyzed using non-negative matrix factorization. In two subjects (Fugl Meyer Assessment; FMA > 20) who walked with mild assistance, three modules were identified during gait with KAFO, whereas two modules were identified with AFO. The third module was composed of triceps surae activities in the late stance phase of the gait cycle. In two subjects (FMA < 20) who required heavy assistance, the number of modules did not change, while muscle weightings and activation timing profile did change, corresponding to the different orthoses. These results indicated that an intervention, according to the change of muscle synergy control, is needed for stroke patients undergoing acute orthotic therapy.

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Mechanical Design of an Affordable Adaptive Gravity Balanced Orthosis for Upper Limb Stroke Rehabilitation

Have your doctor get this paper and see what your therapists can use to recover your upper limb.
http://eprints.soton.ac.uk/376692/

Cannella, G., Laila, D.S. and Freeman, C. T. (2015) Mechanical Design of an Affordable Adaptive Gravity Balanced Orthosis for Upper Limb Stroke Rehabilitation. Mechanics Based Design of Structures and Machines, An International Journal (In Press).

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Description/Abstract

In this paper a novel design of non-powered orthosis for stroke rehabilitation is reported. Designed for home based use, it is the first low-cost, passive design to incorporate an assistive level that can be adaptively varied within a closed-loop control scheme. This allows the device to be integrated with a dual robotic and electrical stimulation control scheme, to thereby enable full exploitation of the motor relearning principles which underpin both robotic therapy and Functional Electrical Stimulation (FES) based stroke rehabilitation. This embeds the potential for more effective treatment. The paper focuses on the mechanical design of the non-powered orthosis, providing detailed design and dynamics analysis and evaluation.

Item Type:	Article
Divisions:	Faculty of Engineering and the Environment > Engineering Sciences > Electro-Mechanical Research Group Faculty of Physical Sciences and Engineering > Electronics and Computer Science > EEE
ePrint ID:	376692
Date Deposited:	30 Apr 2015 16:00
Last Modified:	30 Apr 2015 16:00
Further Information:	Google Scholar
URI:	http://eprints.soton.ac.uk/id/eprint/376692

Power Vest - Orthosis helps avoid incorrect movements

This may be meant for health care workers but I could easily see it being useful for survivors. Ask your doctor what the hell they are doing about this for you.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=151116&CultureCode=en
Each year millions of people within the EU injure themselves in the course of their work due to picking up heavy loads or from one-sided movements – ending up with serious health issues. Together with the industry, Fraunhofer researchers are developing a vest designed to take the burden off caregivers and others with physically demanding jobs.
In Germany, back pain is a national complaint, with nearly ten percent of all lost working days attributable to lower back problems, according to the 2014 Health Report published by the Techniker Krankenkasse. The study found that occupation had a significant impact on the duration and frequency of time taken off due to poor health. Caregivers are particularly affected, because working in a hospital or nursing home requires physical strength. There are patients to move, mobilize and help up – and all that puts the musculoskeletal system under stress. Now, modern technology offers caregivers’ backs extra support. In the “CareJack” project, researchers from the Fraunhofer Institute for Production Systems and Design Technology IPK and the Fraunhofer Institute for Reliability and Microintegration IZM, both in Berlin, are working together with industry partners to develop an active vest designed for these kinds of workers. Cleverly, this non-bulky orthosis (a short form of orthopedic prosthesis) is light, soft and comfortable to wear. That means it can be worn over regular clothes like a coat. Experts call it soft robotics.
“Until now, there haven’t been any efficient support systems to help caregivers with the heavy work they encounter in their extremely varied day-to-day work,” says IPK expert Henning Schmidt, who heads up the project. Anyone working in hospitals, nursing homes or outpatient care needs a strong back. But how can you provide the spine with support without limiting its abundant range of motion? Schmidt and his team have joined forces with company partners to strike out on a new path. Rather than relying on the hard shells often used in orthoses, they’ve instead opted for a material that is flexible and comfortable to wear. All the electronics are incorporated into the material.
The energy required comes from the wearers themselves, through their movements. When a caregiver bends down to lift a patient up, the smart medical aid stores the kinetic energy and can release it again when required.
Orthosis helps avoid incorrect movements
Above all, the orthosis ensures that caregivers perform movements correctly. Lots of orthopedic problems are a result of improper movements: the classic example is lifting something heavy with a rounded back instead of squatting down to lift the object with a straight back. The smart vest features a myriad of sensors that continuously monitor the way the wearer is moving. A processor compares these data against the optimum movement pattern. As soon as it detects any irregularity, a warning lamp is activated. Not only that, but innovative synthetic actuators with adjustable rigidity help avoid incorrect movements and support correct ones. “The wearer can decide themselves what level of support they want,” says Schmidt.
Functions of this sophistication call for a large amount of electronic equipment. “Still, nobody wants to haul around a backpack full of electronics,” says IZM expert Erik Jung. In the CareJack project, he and his team collaborated with company partners to develop miniaturized components, flexible circuit boards and all the necessary sensors. A prototype of the vest should appear in 2015, and Schmidt estimates it will be in series production in one to two years. The demand, he points out, is extremely high. It’s not just caregivers who could make use of this sort of active support, but anyone performing heavy physical work – construction workers, roofers, garbage collectors, brick layers and many more.
https://www.fraunhofer.de/en/press/research-news/2015/March/power-vest.html

The CareJack vest supports the back without restricting freedom of movement.
© Fraunhofer IPK/IZM

Supine Gait Training Device for Stroke Rehabilitation - Design of a Compliant Ankle Orthosis

You'll have to ask your therapist how this works and if it is worthwhile for you.
http://link.springer.com/chapter/10.1007/978-3-319-02913-9_130

• Fang Ming Lim,
• Ruyi Foong,
• Kay Sin Goh,
• Qing Lin Mok,
• Beng Hao Jasper Tan,
• Soon Leng Toh,
• Haoyong Yu

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Abstract

Stroke is the leading cause of chronic physical disability, including locomotion. Patients not only suffer the primary deficits of stroke which include impaired walking, paralysis and poor motor control, but also secondary implications due to lowered cardiovascular performance and musculoskeletal consequences. After the trauma, the Central Nervous System (CNS) undergoes continuous remodelling through cerebral reorganization starting from the acute phase, in response to physical activity of the subject.

A Supine Gait Training Device is developed to enable patients to undergo gait training while lying in bed, thus allowing the early re-education of the CNS immediately after the trauma. Part of this device is the ankle orthosis. It encompasses the metatarsophalangeal (MTP) and tibiotalar (TBT) joints, which according to principles of neuroplasticity, must be activated in meaningful ways for effective rehabilitation. This paper will focus on the mechanical design of the ankle orthosis and its features of compliance and adjustability.

Arm brace helps stroke survivor keep control

So ask your dance instructors wife about finding therapy orthotics. Complete therapist failure here.
http://www.reviewonline.com/page/content.detail/id/568602/Arm-brace-helps-stroke-survivor-keep-control.html?nav=5008
Through daily exercises with the MyoPro brace, Phelps said she is experiencing greater range of motion, control and strength in her right arm. "It makes you stronger as far as when you move your arm, you can move it more and more," she said. "I'm quite pleased with it."
Phelps learned about the MyoPro from her dance instructor's wife, who read about it on the Internet. She researched the device and began using it in physical therapy about nine months ago, she said.

More at the link, including picture.

Effect of a Foot-Drop Stimulator and Ankle–Foot Orthosis on Walking Performance After Stroke: A Multicenter Randomized Controlled Trial

Read the last line. But your therapist probably already figured that out.
http://nnr.sagepub.com/content/27/7/579.abstract

1. Dirk G. Everaert, PhD1
2. Richard B. Stein, DPhil1
3. Gary M. Abrams, MD2
4. Alexander W. Dromerick, MD3
5. Gerard E. Francisco, MD4
6. Brian J. Hafner, PhD5
7. Thy N. Huskey, MD6
8. Michael C. Munin, MD7
9. Karen J. Nolan, PhD8,9
10. Conrad V. Kufta, MD10

1. ¹University of Alberta, Edmonton, Alberta, Canada
2. ²University of California, San Francisco, CA, USA
3. ³National Rehabilitation Hospital and Georgetown University, Washington, DC, USA
4. ⁴University of Texas Health Sciences Center and TIRR Memorial Hermann, Houston, TX, USA
5. ⁵University of Washington, Seattle, WA, USA
6. ⁶Washington University in St. Louis, St. Louis, MO, USA
7. ⁷University of Pittsburgh, Pittsburgh, PA, USA
8. ⁸Kessler Foundation Research Center, West Orange, NJ, USA
9. ⁹UMDNJ–New Jersey Medical School, Newark, NJ, USA
10. ¹⁰Innovative Neurotronics, Inc, Austin, TX, USA

1. Richard B. Stein, University of Alberta, 5005 Katz-Rexall Centre, Edmonton, Alberta, T6G 2E1, Canada. Email: richard.stein@ualberta.ca

Abstract

Background. Studies have demonstrated the efficacy of functional electrical stimulation in the management of foot drop after stroke. Objective. To compare changes in walking performance with the WalkAide (WA) foot-drop stimulator and a conventional ankle–foot orthosis (AFO). Methods. Individuals with stroke within the previous 12 months and residual foot drop were enrolled in a multicenter, randomized controlled, crossover trial. Subjects were assigned to 1 of 3 parallel arms for 12 weeks (6 weeks/device): arm 1 (WA–AFO), n = 38; arm 2 (AFO–WA), n = 31; arm 3 (AFO–AFO), n = 24. Primary outcomes were walking speed and Physiological Cost Index for the Figure-of-8 walking test. Secondary measures included 10-m walking speed and perceived safety during this test, general mobility, and device preference for arms 1 and 2 for continued use. Walking tests were performed with (On) and without a device (Off) at 0, 3, 6, 9, and 12 weeks. Results. Both WA and AFO had significant orthotic (On–Off difference), therapeutic (change over time when Off), and combined (change over time On vs baseline Off) effects on walking speed. An AFO also had a significant orthotic effect on Physiological Cost Index. The WA had a higher, but not significantly different therapeutic effect on speed than an AFO, whereas an AFO had a greater orthotic effect than the WA (significant at 12 weeks). Combined effects on speed after 6 weeks did not differ between devices. Users felt as safe with the WA as with an AFO, but significantly more users preferred the WA. Conclusions. Both devices produce equivalent functional gains.

Control and Implementation of a Powered Lower Limb Orthosis to Aid Walking in Paraplegic Individuals

I'm sure with some modifications this could easily be adapted for a hemiplegic, So ask your doctor who is going to do that for you.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3402219/

Abstract

This paper describes a powered lower-limb orthosis that is intended to provide gait assistance to spinal cord injured (SCI) individuals by providing assistive torques at both hip and knee joints, along with a user interface and control structure that enables control of the powered orthosis via upper-body influence. The orthosis and control structure was experimentally implemented on a paraplegic subject (T10 complete) in order to provide a preliminary characterization of its capability to provide basic walking. Data and video is presented from these initial trials, which indicates that the orthosis and controller are able to effectively provide walking within parallel bars at an average speed of 0.8 km/hr.

Mechanical glove to aid stroke victims

Get your  students to do stuff like this.
http://www.nzherald.co.nz/business/news/article.cfm?c_id=3&objectid=10842220
A Victoria University student has created a rehabilitation device to help stroke patients relearn how to use their hands.
A stroke victim's hand can form a tight fist, which is difficult to unclench and use.
The "mechanical glove" is placed over the hand and guides the patient in unclenching their fist and relearning hand movements.
The engineering masters student and creator, Abigail Arulandu, said repeating actions helped the brain relearn them.

No picture available.

Device inspired by a horse’s leg aims to help people with weak hips walk confidently

See what your therapist thinks about this.
http://medcitynews.com/2012/10/device-inspired-by-a-horses-leg-aims-to-help-people-with-weak-hips-walk-confidently/

Home kit to help stroke patients

Another down under breakthrough, must be the Coriolis effect. They spin those brain cells in a more cerebral direction.
I've always thought that mechanistically opening and closing the fingers thousands of times a day would defeat spasticity and jumpstart the ability to control your fingers correctly.
http://www.stuff.co.nz/national/health/7458365/Home-kit-to-help-stroke-patients/

Stroke patients may soon be able to rehabilitate themselves from home thanks to the invention of a Wellington engineering student.
Victoria University masters student Abigail Rajendran, 23, has designed a stroke rehabilitation device and has a company working to patent and sell it.
Her device straps on to a person's hand to exercise it in an opening and closing motion, while a connected computer game activates and keeps both sides of the brain engaged.
Once the person regains the strength to do the motion themselves, they can increase the resistance from a special liquid in the device also used in Audi car suspensions.
Until now, stroke patients relied on expensive and large rehabilitation equipment available only in hospitals. But this new device would be something they could use regularly at home, Miss Rajendran said.
Im-Able, a New Zealand company specialising in stroke rehabilitation, saw the device's potential and got funding from the Science and Innovation Ministry so Miss Rajendran could develop a prototype.
Chief executive Sunil Vather said there were few, if any, home rehabilitation instruments available for people recovering from strokes.
"It's definitely innovative. The key issue is you have got technology but if it's not accessible to the people who need it you tend to lack a large chunk of the value for it."
New Zealand stroke patients would be lucky to get one or two hours of therapy time with a nurse a week, when it should be about 16 hours, he said.
Miss Rajendran said meeting with stroke victims had made it a lot more real.
"They want to start using it, to start getting better."
The tool was her "baby" that she would be glad to see made a reality.
Since being lured into engineering by a robot at a Victoria University open day, she aimed to build life-changing products rather than gadgets that were "cool".
"I guess it's building devices that are actually useful and necessary. The whole helping people out aspect of it."
One of Miss Rajendran's university supervisors, Dr Will Browne, was impressed by her infectious enthusiasm for creating practical applications.
"Her research into developing a stroke rehabilitation device has the potential to make a significant improvement to the lives of people affected by stroke."
Miss Rajendran will present her idea in Singapore later this month, and in Brisbane in October.

Mr Vather hoped the final product would be completed in about a year.

Armed for therapy: Baptist's new rehab tool helps upper body

I'm sure there's several of these arm rehabbers that your therapists should have all the data on. So ask them.
http://www.commercialappeal.com/news/2012/jun/20/armed-for-therapy/
Whether it's brushing her hair, lifting a fork or tying her shoelaces, there are hundreds of small, everyday tasks Ella Bledsoe no longer takes for granted.

Mike Brown/The Commercial Appeal

Ella Bledsoe, 69, uses the InMotion Robot with occupational therapist Stacy Castleberry at Baptist Rehabilitation-Germantown.

The 69-year-old stroke patient working to regain control of the muscles on the right side of her body said that after her stroke three months ago, she'd felt like "giving up."
But a new friend at Baptist Rehabilitation-Germantown, a nameless robot, recently acquired by the hospital, has helped her find the strength to keep trying.
During a recent therapy session with the InMotion Arm Robot, Bledsoe played a game similar to "Frogger," moving her right arm back and forth to dodge obstacles raining down on the computer screen in front of her.
"I like this," she said, as she waited for the robot to generate her "score," which is also a progress report for her physical therapist.
Baptist bought the InMotion Arm Robot, at a cost of more than $100,000, about four months ago to supplement care for patients suffering from stroke, cerebral palsy and other neurological conditions.
"This is nice because, traditionally, there are not a lot of tools therapists can use for the upper extremities," said Monika Kolwaite, brain injury coordinator at Baptist Rehab-Germantown.
A therapist might get 50 reps out of a patient during an hourlong session, she said, but the robot gets a thousand. On top of that, the robot tracks a patient's progress and pushes harder each time.
Baptist Memorial Health Care spokeswoman Lori Simpson said the Germantown facility has the only InMotion Arm Robot in the Southeast.
"This is not the only tool in our bag of tricks," said clinical director Amy Barringer. "But this is certainly the newest and has a lot of promise."
Stroke survivors in the U.S. typically undergo rehabilitation therapy in the first six months after a stroke, conventional wisdom being that there's nothing to gain past that point. But a 2010 study published in the New England Journal of Medicine found that arm robot technology coupled with intense rehabilitation could benefit patients five years removed from a stroke.
"What we're seeing is that really recent and remote stroke patients can benefit from this," Barringer said. "It's our hope that patients, who maybe didn't get help years ago, can benefit from the technology we have now."

Positive effects of robotic exoskeleton training of upper limb reaching movements after stroke

This is for chronic so thats great, I think I'd prefer the Japanese one
 http://www.jneuroengrehab.com/content/pdf/1743-0003-9-36.pdf
Background
Impairment of upper limb function is one of the most common sequelae following stroke; in
particular arm function is found to be altered in 73% to 88% of first time stroke survivors
(infarctions only), and 55% to 75% still experience problems that impair their activities of
daily living for up to 3 to 6 months or more [1,2].
Impairments limit the patient’s autonomy in daily living and may lead to permanent disability
[3]. The deficits are typically characterized by weakness of specific muscles [4], lack of
mobility between structures at the shoulder girdle [5], incorrect timing of components within
a movement pattern [6,7] and loss of interjoint coordination [8]. Consequently goal directed
movements in hemiplegic patients are characterized by lower movement amplitude,
prolonged movement time, segmented trajectories and abnormal pattern of muscle activation.
Compensatory motor strategies, characterized by adaptations to muscle imbalance [9], are
commonly adopted by stroke patients in attempt to overcome these impairments.
Various rehabilitation interventions to improve skill reacquisition have shown promising
results in overcoming motor impairment after stroke [10].
High intensity and task specific upper limb treatment consisting of active, highly repetitive
movement is one of the most effective approaches to arm function post-stroke restoration
[11-13]. Recent studies moreover suggest that given appropriate training, motor
improvements of the upper limb can continue well into the chronic stage of stroke [14-16].
The use of robot devices in rehabilitation can provide high intensity, repetitive, task specific
and interactive treatment of the impaired upper limb and an objective, reliable mean of
monitoring patients progress. Systematic review confirms the potential for robotic assisted
devices to elicit improvements in upper limb function [17,18]. Moreover virtual reality
provided a unique medium where therapy can be provided within a functional, purposeful and
motivating context and can be readily graded and documented [19]. The cortical
reorganization and associated functional motor recovery after virtual reality in patient with
chronic stroke are documented also by fMRI [20].
 While several studies have already investigated the effects of robot assisted training in planar
movements performed in the horizontal plane [21], the effect of training on the control and
production of multi-joint and spatial functional arm movements, including movements
against gravity, in hemiparetic subjects has received less attention.
It has been already shown that stereotyped movement patterns [8] due to abnormal muscle
co-activation result in a reduced active range of motion against gravity. In particular
providing antigravity limb support, leads to a reduction of the abnormal coupling between
shoulder abduction/elbow flexion [22] and promising results have been found in the robotic
training of patients with antigravity vertical movements that involve shoulder elevation [23].
Moreover orthoses providing only passive gravity assistance to the arm in reaching
movements can induce comparable clinical improvements to those obtained with robotic
training [24].
In this study we have investigated the effects of robot aided training on the recovery of spatial
reaching movements, with a focus on point-to-point reaching movements performed in
different directions, analysing how muscle imbalance in stroke influences the process of
motor recovery in terms of regain of smooth movement, interjoint coordination and
agonistic/antagonistic muscle recruitment.
A robotic treatment was administered through the L-EXOS [25,26], a robotic exoskeleton for
the upper limb, in a group of nine patients with chronic hemiparetic stroke. Exoskeleton
robotic systems allow to execute full spatial multi-joint functional arm movements, including
elevation movements with shoulder abduction, providing either variable gravity support or
active assistance to the impaired arm [27].
To assess the carry-over of the observed improvements in movement during training into
improved function, changes in movement execution and smoothness of motion were analysed
through a kinesiologic assessment, consisting in the motion and dynamic electromyographic
analysis of reaching movements performed before and after training.
The kinesiologic performance (movement time, smoothness of motion) was then analysed in
relation to the changes in the EMG pattern of agonist–antagonist muscle co-activation and
shoulder-elbow interjoint coordination.

Technology can help PTs empower patients in regaining mobility

Found this thru Billy Ethridges site. 

Technology can help PTs empower patients in regaining mobility

Gait Rehabilitation

Virtually every patient who comes to inpatient rehabilitation arrives with the goal to walk again, whether the patient's condition is due to a stroke, spinal cord or traumatic brain injury or other neurological issues.
My job as an inpatient rehab manager at Sheltering Arms Hospital in Richmond, VA, is to facilitate my team's ability to help patients realize this important but often difficult goal. Since I am also a clinician, I understand how challenging it can be to learn to walk again and also how crucial this skill is to quality of life.
Recently, I worked with a patient who had not walked in several weeks. She had a long hospital course with several surgical procedures, resulting in pain and dysfunction. When I asked this patient what her goals for physical therapy were, her answer was simple but familiar: "I just want to walk."
Although she was severely debilitated, I was determined to help her attain her goal. A rehab technician and I attempted to help her stand with a walker and move her legs, but after only a few steps we were all totally exhausted. If you are a PT in inpatient rehabilitation, this frustrating situation is probably one you know well.
Principles of motor learning and neuroplasticity tell us that repetition is essential for recovery.^1,2 Yet how can a patient possibly learn and recover if he or she is only able to walk a few steps at a time? How can physical therapists help patients meet the goal to resume walking and recover faster using evidence-based practice?
The Role of a Rehab Manager
Although most of us take it for granted, the ability to walk independently is required for most daily activities. The majority of patients need to be able to walk fast enough to function in the community in order to return to prior level of mobility.
The unfortunate fact is that studies have shown only 7 percent of patients discharged from rehabilitation meet the criteria for community walking, which includes the ability to cross a road safely, and they continue to demonstrate gait patterns that deviate from the norm.^3,4 This tells the therapy community that we, as caregivers and rehabilitation experts, could do better.
Part of my responsibility as an inpatient rehab manager is providing the finest tools and resources that enable therapists to deliver the best possible care to each patient. Yet there are hundreds of different devices on the market, and it can be difficult to determine which technology is the best fit for a clinic or specific patient populations.
Any new technology must be appropriate for the patient and be designed based on the most recent evidence in motor learning. The technology must also be easy to use; if a piece of equipment takes too long to set up or is difficult to operate, therapists simply will not use it. They want to use their time-and the patient's time-wisely.
Stepping Forward with Technology
At Sheltering Arms we are fortunate to have the resources to acquire new technologies to supplement physical therapy expertise. Our iWALK Recovery Center program includes inpatient and outpatient services built upon the latest research in assessment and intervention.
The center was created to provide the most advanced technologies available to help patients walk again. Our goal is to have a variety of equipment and technology to meet the needs of patients with a range of diagnoses and functional abilities, all in one place. Patients who have reached a plateau with other therapies or who have been living with debilitating conditions for years finally have a resource to make progress.
The iWALK therapy team is also trained in neurorecovery-without highly trained experts to effectively use and operate the technology, devices and equipment cannot deliver on their promise.
After all, these are just tools; without the clinical judgment and expertise of a therapist, they would be useless. The therapist determines the right tool for the right patient at the right time.
Choosing Your Tools
New technologies are designed based on principles of motor learning and the relatively new concept of neuroplasticity; it has not always been known that the brain is capable of modification after injury.
In the case of my patient mentioned above, this is the point where technology came into play for her rehabilitation. After the frustrating effort to help her take a few steps with a walker, we fit her with a harness and hooked it into a dynamic over-ground body weight support system.
The system took some of her body weight away and she was able to stand. Instantly, she was able to move more freely and, with a walker and tactile cues, this patient was able to walk 50 feet over ground. Her relief was clear; she realized that her goals were within reach. She would walk again.
The over-ground body weight support system is just one example of technology that can be used to capitalize on the theories of neurorecovery while keeping patients safe and engaged in therapy.
Because it is a dynamic system and can be used over ground or over a treadmill, patients experience walking in a real-world environment and are safe from falling. Patients are even able to experience loss of balance by being able to fall up to six inches before the system "catches" them.
As recent research indicates, it is important for patients to experience error in order to promote learning in the neural pathways. Coupled with a split-belt treadmill, which uses the principle of motor adaptation to improve asymmetric gait patterns, many patients are able to recover much faster than previously possible.⁵
In addition, advances in functional electrical stimulation (FES) have resulted in the ability to cue and facilitate muscle activity during functional activities. For example, we frequently use a cuff that fits on the patient's lower leg and has three components that communicate with each other through wireless technology to stimulate the muscles used to lift the foot while walking. It is especially useful because it allows for real-time adjustments and adaptations according to the patient's gait pattern.
Recently, we started using a new expansion on the technology that was cleared by the FDA earlier this year. This includes a thigh cuff that works along with the lower leg cuff to stimulate the quad or hamstring muscles used during walking and allows for even greater facilitation of gait kinematics.
Although the technology was just commercially released and is new in our facility, patients are already seeing results from working with the new thigh cuff. Our therapists use these technologies frequently because they are easy to use and can be set up in less than 15 minutes and patients are motivated and engaged by their use.
While the ultimate resource is the expertise and judgment of the therapist, these kinds of advances in the rehabilitation tool kit enable patients to practice walking with appropriate kinematics earlier in their rehabilitation course and promote recovery of the central nervous system.⁶
Early rehabilitation has been associated with improved functional outcomes and quality of life following a stroke.⁷ Therapists need to have the right tools and expertise to help patients improve more quickly and ultimately attain a higher level of recovery.
At Sheltering Arms, our patients benefit from our ability to provide walking retraining earlier in their recovery process. When considering how to best approach patients hoping to walk again, it is important to consider the exciting advances in our constantly evolving field, and how to best marry technological power with clinical expertise.


Before even doing anything an objective assessment like this would be good.

Computerized gait analysis helps patients with brain injuries

Or:

Automatic identification of gait events using an instrumented sock

 

The article covers these types of technology:
Lite Gait except the harness connects to ceiling rails.
 http://www.litegait.com/litegait.html
The picture is the Lokomat which I used and thought was wonderful, my doctor thought it was a waste of time, shows you what he doesn't know.
http://www.hocoma.com/en/products/lokomat/
The FES stuff referred to is something like the Bioness or Walkaide.
Split-belt treadmill here:
http://www.treadmilltalk.com/split-belt-treadmills.html

 Other technology for walking that wasn't mentioned:

1. Hip Flexion Assist Orthosis 

 2. GaitMaster 5: The Mechanical Physical Therapist of the Future

3. ‘Exoskeleton’ Helps Paralyzed Stand, Take Steps

4. Walk Again Project

5. C-Mill: A Plug & Play Treadmill For Gait Training & Rehabilitation

6. powered AFOs

The future:

Body suit may soon enable the paralyzed to walk