The Mobility Toolkit: What Actually Changes Your Range of Motion by SIM60

 I bet your incompetent? doctor gave you nothing like this!

SATURDAY DEEP DIVE: THE EQUIPMENT

Sunday’s issue recommended a mobility stick or dowel as the primary tool for split squat work and movement assessment. Today we cover the full landscape of mobility equipment — what actually produces lasting change in active range of motion versus what feels productive in the moment without transferring to movement. THE MOBILITY EQUIPMENT STACK Tool 1: Mobility Stick / Dowel Rod (48 inches) A wooden dowel or PVC pipe is one of the highest-utility, lowest-cost tools in functional training. Primary uses: balance aid during split squats and single-leg drills (holds in one hand, used like a trekking pole), overhead mobility assessment (hold overhead with wide grip and overhead squat to assess shoulder and hip range simultaneously), hip hinge feedback tool (three-point contact along the spine as covered in Issue #30b), and thoracic extension guide. Cost: under ten dollars at any hardware store. Tool 2: Lacrosse Ball or Massage Ball For targeted soft tissue work in areas the foam roller cannot reach precisely: the piriformis (sit on the ball, cross one ankle over the opposite knee, slowly shift weight), the plantar fascia (roll underfoot before the foot mobility drills from Issue #29), the pec minor (place against a wall at chest height and lean into it with slow movement), and the posterior hip capsule. A lacrosse ball is harder than a tennis ball and less forgiving — start with a massage ball if tissue sensitivity is high. Tool 3: Yoga Strap or Long Resistance Band (for Assisted Active Stretching) A strap looped around the foot allows you to perform the Active Hip Internal Rotation drill from Sunday’s issue with greater control at end range. It also enables hamstring active stretching in supine position — loop around the foot, extend the leg toward the ceiling, then slowly work to decrease the angle while maintaining a flat lower back. The key: the strap provides a boundary, not a pulling force. You’re teaching the nervous system to control the end range, not forcing the limb past it. Tool 4: Slant Board (for Ankle Dorsiflexion) As covered in Thursday’s issue, ankle dorsiflexion is the limiting factor for split squat depth, squat depth, and stair climbing mechanics for a significant percentage of adults over 60. A slant board positions the foot at a fixed ankle flexion angle, allowing calf and Achilles stretching at a controlled depth without the unstable footing of a step edge. Adjustable models allow progressive increase in the incline as mobility improves. This is a more controlled and targeted approach than the eccentric calf lowering from Issue #29, and the two complement each other. What Feels Good But Does Little for Lasting Mobility Change Percussion massage guns are excellent for pre-workout tissue stimulation and reducing acute soreness. They do not produce lasting changes in active range of motion. The research on percussive therapy shows short-term improvements in passive flexibility (useful before training) but no evidence of sustained mobility change from use alone. Use them as a warm-up tool, not as a substitute for active mobility drills. Static stretching held for less than 20 seconds has minimal effect on either flexibility or mobility. The minimum effective duration for tissue length change is generally considered 30 to 45 seconds. Bouncing or pulsing at end range activates the stretch reflex and reduces the stretch’s effectiveness — hold still and breathe. ISSUE #33 WEEK IN REVIEW Sunday — Flexibility versus mobility: the passive/active range gap, why stretching alone doesn’t produce functional movement change, and the stretch-then-use sequence that does. Introduced the Active Hip Internal Rotation Drill and the Rear-Foot-Elevated Split Squat. Tuesday — Three hip rotation drills: Active Hip Internal Rotation (seated), Active Hip External Rotation (figure-4 chair), and the Hip Rotation Quadrant Drill (supine, both directions). Why hip rotation is the most undertrained range in the active adult population. Thursday — Three split squat progressions: Static Lunge Hold (beginner), Rear-Foot-Elevated Split Squat with the dorsiflexion cue (intermediate), Bulgarian Split Squat with dumbbell load (advanced). The front-heel-elevation modification for limited ankle mobility. Today — The mobility toolkit: dowel rod, lacrosse ball, yoga strap, slant board, and honest assessments of percussion guns and short static holds. The through-line: stretching creates access. Active work creates ownership. The goal is not more range — it’s more controlled range. Every drill this week was designed to produce both.

Passive Range of Movement of fingers

Who will tell me the number of repetitions that I need to do  for my fingers to kill the spasticity in them? Should the fingers be done individually or can they be done as a group? Tell me a number and I will start counting. 10 million as a group? And then 10 million for each finger?  A billion or two?

I was at Jazz Tuesdays at Moriarties last night, So for three hours I could flex my fingers, if needed I could start counting and calculate how many hours  it would take to get to a specified number.  Others might need little motors to flex for them.  That is something a great stroke association could build and sell to the 10 million yearly stroke survivors.  I could use it also since I have to use my good hand to eat and drink. 

This way back in April 2004 gives some hints as to recovery via PROM. 

The effects of repetitive proprioceptive stimulation on corticomotor representation in intact and hemiplegic individuals.

If anyone followed this up with better research and a protocol I don't know where it is. This is precisely why I call them fucking failures of stroke associations, they do nothing for survivors.

Intensive virtual reality and robotic based upper limb training compared to usual care, and associated cortical reorganization, in the acute and early sub-acute periods post-stroke: a feasibility study

With no protocol written up and distributed worldwide this was a waste of time. My god, I need to fire a lot of people.  

Intensive virtual reality and robotic based upper limb training compared to usual care, and associated cortical reorganization,in the acute and early sub-acute periods post-stroke: a feasibility study

Journal of NeuroEngineering and Rehabilitation , Volume 16(92)

NARIC Accession Number: J81446.  What's this?
ISSN: 1743-0003.
Author(s): Patel, Jigna; Fluet, Gerard; Qui, Qinyin; Yarossi, Mathew; Merians, Alma; Tunik, Eugene; Adamovich, Sergei.
Publication Year: 2019.
Number of Pages: 12.
Abstract: Study investigated the effects of an additional 8 hours of specialized, intensive virtual reality/robotic-based upper-limb training introduced within 1-month post-stroke on impairment and behavior, and the distinct changes in cortical reorganization measured via transcranial magnetic stimulation (TMS). Seven subjects received eight 1-hour sessions of upper-limb VR/robotic training in addition to their inpatient therapy. Six subjects received only their inpatient therapy. All were tested on measures of impairment, assessed with the Upper Extremity Fugl-Meyer Assessment (UEFMA), wrist active range of motion (AROM), and maximum pinch force; and behavior with the Wolf Motor Function Test (WMFT); and also received TMS mapping until 6 months post training. Analyses of variance were conducted to measure differences between groups across time for all outcome measures. Associations between changes in ipsilesional cortical maps during the early period of enhanced neuroplasticity and long-term changes in upper-limb impairment and behavior measures were evaluated. The virtual reality/robotic group made significantly greater improvements on UEFMA and Wrist AROM scores compared to the usual care group. There was also less variability in the association between changes in the first dorsal interosseus muscle map area and WMFT and Maximum Force change scores for the virtual reality/robotic group. An additional 8 hours of intensive virtual reality/robotic based upper-limb training initiated within the first month post-stroke may promote greater gains in impairment compared to usual care alone. Importantly, the findings demonstrated the feasibility of conducting this intervention and multiple outcome measures (impairment, behavioral, neurophysiological) in the early period post-stroke.
Descriptor Terms: BODY MOVEMENT, BRAIN, COMPUTER APPLICATIONS, ELECTRICAL STIMULATION, FEASIBILITY STUDIES, LIMBS, MOTOR SKILLS, PHYSICAL THERAPY, REHABILITATION SERVICES, ROBOTICS, STROKE.


Can this document be ordered through NARIC's document delivery service*?: Y.
Get this Document: https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-019-0563-3.

Citation: Patel, Jigna, Fluet, Gerard, Qui, Qinyin, Yarossi, Mathew, Merians, Alma, Tunik, Eugene, Adamovich, Sergei. (2019). Intensive virtual reality and robotic based upper limb training compared to usual care, and associated cortical reorganization, in the acute and early sub-acute periods post-stroke: a feasibility study.  Journal of NeuroEngineering and Rehabilitation , 16(92) Retrieved 8/20/2019, from REHABDATA database.

The Resonating Arm Exerciser: design and pilot testing of a mechanically passive rehabilitation device that mimics robotic active assistance

I'm sure your therapist could create something similar using Theraband.
http://www.jneuroengrehab.com/content/10/1/39/abstract

Abstract (provisional)

Background

Robotic arm therapy devices that incorporate actuated assistance can enhance arm recovery, motivate patients to practice, and allow therapists to deliver semi-autonomous training. However, because such devices are often complex and actively apply forces, they have not achieved widespread use in rehabilitation clinics or at home. This paper describes the design and pilot testing of a simple, mechanically passive device that provides robot-like assistance for active arm training using the principle of mechanical resonance.

Methods

The Resonating Arm Exerciser (RAE) consists of a lever that attaches to the push rim of a wheelchair, a forearm support, and an elastic band that stores energy. Patients push and pull on the lever to roll the wheelchair back and forth by about 20 cm around a neutral position. We performed two separate pilot studies of the device. In the first, we tested whether the predicted resonant properties of RAE amplified a user's arm mobility by comparing his or her active range of motion (AROM) in the device achieved during a single, sustained push and pull to the AROM achieved during rocking. In a second pilot study designed to test the therapeutic potential of the device, eight participants with chronic stroke (35 +/- 24 months since injury) and a mean, stable, initial upper extremity Fugl-Meyer (FM) score of 17 +/- 8 / 66 exercised with RAE for eight 45 minute sessions over three weeks. The primary outcome measure was the average AROM measured with a tilt sensor during a one minute test, and the secondary outcome measures were the FM score and the visual analog scale for arm pain.

Results

In the first pilot study, we found people with a severe motor impairment after stroke intuitively found the resonant frequency of the chair, and the mechanical resonance of RAE amplified their arm AROM by a factor of about 2. In the second pilot study, AROM increased by 66% +/- 20% (p = 0.003). The mean FM score increase was 8.5 +/- 4 pts (p = 0.009). Subjects did not report discomfort or an increase in arm pain with rocking. Improvements were sustained at three months.

Conclusions

These results demonstrate that a simple mechanical device that snaps onto a manual wheelchair can use resonance to assist arm training, and that such training shows potential for safely increasing arm movement ability for people with severe chronic hemiparetic stroke.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Value-Based Stroke Rehabilitation: Feasibility and Results of Patient-Reported Outcome Measures in the First Year After Stroke

I bet none of the questions ask; 'How close are you to 100% recovery?' Without that single question this is all useless. 

Value-Based Stroke Rehabilitation: Feasibility and Results of Patient-Reported Outcome Measures in the First Year After Stroke

Author links open overlay panelI.F.GroeneveldPhD*^†‡

P.H.GoossensMD, PhD*^†‡W.van Meijeren-PontMsc*^†‡H.J.ArwertMD^†§J.J.L.MeestersPhD^†‡A.D.Rambaran MishreMD^†‖F.Van VreeMsc*^†T.P.M.Vliet VlielandMD, PhD*^†‡SCORE-study group

https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.10.033Get rights and content

Abstract

Purpose

Structured application of patient-reported outcome measures (PROMs) is a key element in Value Based Healthcare. This study aimed to evaluate the feasibility of a broad set of PROMs reflecting similar patient reported health domains as proposed within the International Standard Set of Patient-Centered Outcome Measures After Stroke within the first year after stroke.

Methods

The study included consecutive stroke patients admitted to inpatient or outpatient specialized rehabilitation. PROMs were administered upon admission, discharge (inpatients only), and at 3, 6, and 12 months. PROMs included: EuroQol 5 Dimensions (EQ-5D), Stroke Impact Scale (SIS), Stroke and Aphasia Quality of Life Scale (SAQOL-39NL), Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P), Hospital Anxiety and Depression Scale (HADS), and Fatigue Severity Scale (FSS). Feasibility was defined as participation, retention, and response rates. Paired t tests were conducted to analyze their changes over time.

Results

Of 485 inpatients and 189 outpatients who were invited, 291 (60.0%) and 82 (43.3%) participated, of whom 45 (15.5%) and 7 (8.5%) dropped out before 12 months, respectively. Two hundred seven (71.1%) and 71 (86.6%) of the inpatients and outpatients returned the questionnaires on all or all but one time points, respectively. Between admission and 12 months statistically significant improvements of PROMs addressing general health and quality of life (EQ-5D), psychiatric functioning (HADS), motor functioning (SIS mobility), and social functioning (USER-P, SIS communication) were seen. The SIS memory scale, the SAQOL-39NL and the FSS did not show any changes.

Conclusions

Participation, retention, and response rates for a comprehensive set of PROMS for stroke in patients in rehabilitation were moderate to good, with clinical improvements seen until 1 year post stroke. The SAQOL-39NL and FSS did not demonstrate changes over time and cannot be recommended for repetitive measurements in this setting. By simplifying the set of questionnaires, participation and response rates may be further enhanced.

Degree of muscle shortening in chronic hemiparesis in patients not treated with guided self-rehabilitation contracts (GSC)

More research that describes a problem but offers no solutions or suggests more research.
http://www.sciencedirect.com/science/article/pii/S1877065715001013

• J. Vielotte^, ,
• B. Bignami,
• E. James-Belin,
• C. Colas, Dr,
• C.M. Loche, Dr,
• J.M. Gracies, Prof

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doi:10.1016/j.rehab.2015.07.018

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---

Objectives

Antagonist muscle resistance, including due to muscle contracture, is a fundamental factor of motor impairment in spastic paresis. We aimed to quantify the degree of shortening in the main muscles involved in chronic hemiparesis (>1 year post-lesion), in patients following a conventional system of rehabilitation.

Methods

From their first clinic visit in the neurorehabilitation unit of the PM&R department we retrospectively collected the assessments of passive range of motion (X_V1) – based on the 5-step clinical assessment, including the Tardieu Scale – against 8 key antagonists in the lower limb (n = 19 patients with chronic hemiparesis, age: 48 ± 13, mean ± SD; time since lesion 3.7 ± 3.8 years) and 13 antagonists in the upper limb (n = 13 patients, age: 39 ± 13, mean ± SD; time since lesion 5.2 ± 3.9 years), then derived coefficients of shortening (C_SH) by referring them to the normal expected amplitude (X_N), C_SH = (X_N-X_V1)/X_N.

Results

The higher coefficients of shortening were: vertical adductors (latissimus dorsi – pectoralis major – teres major), 36 ± 3%; shoulder extensors with flexed elbow (long head of triceps; latissimus dorsi) 33 ± 4%; horizontal adductors (pectoralis major), 23 ± 1%; gastrocnemius, 20 ± 1%; soleus, 15 ± 2%; gluteus maximus, 16 ± 3%; rectus femoris, 12 ± 1% and pronator teres, 12 ± 4%.

Conclusion

Shoulder extensors, plantar flexors and gluteus maximus in patients untreated with self-stretching postures have undergone major muscle shortening in chronic hemiparesis. A future study could assess the effectiveness of stretching postures taught and applied from the early phase of stroke on shortening of these muscles.

Effectiveness of a night positioning programme on ankle range of motion in patients after hemiparesis: A prospective randomized controlled pilot study

Finally a research project that might actually be useful for survivors. What is your doctor doing to followup on this by creating a stroke protocol or initiating more research to prove it out?
Or maybe our useless stroke associations could sponsor such research?
http://europepmc.org/abstract/med/26353832
 

(PMID:26353832)

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• Citations
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DeMeyer L, Brown M, Adams A

, Rehabilitation Hospital, New Hanover Regional Medical Center, 2131 S. 17th Street, Wilmington, NC 28401, USA. lauren.demeyer@nhrmc.org.

Journal of Rehabilitation Medicine [2015]

Type: Journal Article
DOI: 10.2340/16501977-2007

Abstract

Highlight Terms Diseases(1)

OBJECTIVE: To investigate the effect of night positioning on ankle motion in patients after stroke or brain injury. DESIGN: Prospective randomized controlled pilot study with 3 groups: bivalve cast; pressure-relieving ankle-foot orthosis; and control. SUBJECTS/ PATIENTS: Adults (n = 46) in inpatient rehabilitation with lower extremity paresis following stroke or brain injury. METHODS: Intervention group participants wore a custom bivalve cast or pre-fabricated orthosis 8-12 h/night. The primary outcome variable was passive ankle dorsiflexion. Muscle spasticity (Modified Ashworth Scale) and functional mobility (Functional Independence Measure) were also assessed. RESULTS: No significant differences were found between groups for all outcome measures at the pilot sample size (p > 0.05). Control and pressure-relieving ankle-foot orthosis groups showed improvement in ankle dorsiflexion, and the bivalve cast group demonstrated a trend toward decreased spasticity. Positioning interventions were tolerated for approximately 11 h/night. Baseline range of motion was measured and a retrospective power analysis determined that a sample size of 234 is needed for 80% power to establish significance. CONCLUSION: Future research with a larger sample size is re-commended to determine significance and whether a more specific subset of patients would benefit from night positioning to maximize treatment time during daytime therapy sessions.

Cadet-designed system aids stroke victim recovery

Have your therapist and doctor track this down to see if they could get early prototypes. Have they adjusted for spasticity problems? 

Cadet-designed system aids stroke victim recovery

 An entrepreneurial collaboration between the Air Force Academy and Penrose-St. Francis Health Services is creating a device to help patients recover their full range of motion after suffering a stroke or injury.

The project - called Neumimic - is the result of a partnership between mechanical and electrical engineering cadets here and Dr. Glen House, head of Penrose's rehabilitation department.

Cadets designed a brace that holds a patient's arm in such a way the patient must move it exactly according to directions from a physical therapist. At the same time, patients are connected to Microsoft Kinect, which records their progress even when therapists aren't in the room.  

More at link.
 
The only image I could find is here.

Hand splinting for poststroke spasticity: A randomized controlled trial

Ask your therapist and doctor what this means for you. 

Hand splinting for poststroke spasticity: A randomized controlled trial

Abstract: Study examined the effect of volar and dorsal splinting on the spasticity of the wrist flexor muscles in patients with stroke. Thirty-nine subjects were randomized to use a dorsal or volar splint or no splint (control group). All the patients underwent home-based exercise program, and the experimental groups used either dorsal or volar hand splints according to their distribution. The primary outcome measure was spasticity assessed clinically by the Modified Ashworth Scale (MAS) and electrophysiologically by H latency and Hmax:Mmax ratio of flexor carpi radialis. Secondary outcome measure was passive range of motion (PROM) of wrist extension. Results showed no statistically significant difference in spasticity parameters (MAS, H latency, Hmax:Mmax ratio) or in wrist PROM between the volar and dorsal splint groups. These splints could be recommended as part of an integrative approach without expecting a major clinical effect rather than as an alternative to other treatments.

Repeated measurements of arm joint passive range of motion after stroke: interobserver reliability and sources of variation.

The conclusion after this should have been that subjective measurements are almost worthless and an objective measurement protocol needs to be defined. But what the hell do I know.

Repeated measurements of arm joint passive range of motion after stroke: interobserver reliability and sources of variation.

Background Goniometric measurements of hemiplegic arm joints must be reliable to draw proper clinical and scientific conclusions. Previous reliability studies were cross-sectional and based on small samples. Knowledge about the contributions of sources of variation to these measurement results is lacking. Objective The aims of this study were to determine the interobserver reliability of measurements of passive range of motion (PROM) over time, explore sources of variation associated with these measurement results, and generate smallest detectable differences for clinical decision making. Design This investigation was a measurement-focused study with a longitudinal design, nested within a 2-arm randomized controlled trial./b> Two trained physical therapists assessed 7 arm movements at baseline and after 4, 8, and 20 weeks in 48 people with subacute stroke using a standardized protocol. One physical therapist performed the passive movement, and the other read the hydrogoniometer. The therapists then switched roles. The relative contributions of several sources of variation to error variance were explored with analysis of variance./b> Interobserver reliability coefficients ranged from .89 to .97. The PROM measurements were influenced by error variance ranging from 31% to 50%. The participant � time interaction made the largest contribution to error variance, ranging from 59% to 81%. Smallest detectable differences were 6 to 22 degrees and were largest for shoulder movements. Limitations Verification of shoulder pain and hypertonia as sources of error variance led to a substantial number of unstable variance components, necessitating a simpler analysis./b> The assessment of PROM with a standardized protocol, a hydrogoniometer, and 2 trained physical therapists yielded high interobserver reliability indexes for all arm movements. Error variance made a large contribution to the variation in measurement results. The resulting smallest detectable differences can be used to interpret future hemiplegic arm PROM measurements with more confidence.

THERAPEUTIC EXERCISE and Range of Motion ROM Exercises

From a PT site, great definitions and one diagram. Just in case your therapist isn't explaining this to you. 

THERAPEUTIC EXERCISE and Range of Motion ROM Exercises

THERAPEUTIC EXERCISE and Range of Motion ROM Exercises

I know this is mainly for therapists but you need to know about this also.
diagrams and explanations at the link.
http://pt-rehabilitation.com/2012/04/therapeutic-exercise-and-range-of-motion-rom-exercises.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+---physiotherapyOnline+%28Physiotherapy+online%29

Electrical stimulation for preventing and treating post-stroke shoulder pain: a systematic Cochrane review

My shoulder pain only occurred when I was on the stationary bike with the moving arms. 

Electrical stimulation for preventing and treating post-stroke shoulder pain: a systematic Cochrane review

Maybe the full article says where FES was placed but this doesn't help at all.

Abstract

Background: Shoulder pain after stroke is common and disabling. The optimal management is uncertain, but electrical stimulation (ES) is often used to treat and prevent pain.

Objectives: The objective of this review was to determine the efficacy of any form of surface ES in the prevention and/or treatment of pain around the shoulder at any time after stroke.

Search strategy: We searched the Cochrane Stroke Review Group trials register and undertook further searches of Medline, Embase and CINAHL. Contact was established with equipment manufacturers and centres that have published on the topic of ES.

Selection criteria: We considered all randomized trials that assessed any surface ES technique (functional electrical stimulation (FES), transcutaneous electrical nerve stimulation (TENS) or other), applied at any time since stroke for the purpose of prevention or treatment of shoulder pain.

Data collection and analysis: Two reviewers independently selected trials for inclusion, assessed trial quality and extracted the data.

Main results: Four trials (a total of 170 subjects) fitted the inclusion criteria. Study design and ES technique varied considerably, often precluding the combination of studies. Population numbers were small. There was no significant change in pain incidence (odds ratio (OR) 0.64; 95% CI 0.19–2.14) or change in pain intensity (standardized mean difference (SMD) 0.13; 95% CI –1.0–1.25) after ES treatment compared with control. There was a significant treatment effect in favour of ES for improvement in pain-free range of passive humeral lateral rotation (weighted mean difference (WMD) 9.17; 95% CI 1.43–16.91). In these studies ES reduced the severity of glenohumeral subluxation (SMD –1.13; 95% CI –1.66 to –0.60), but there was no significant effect on upper limb motor recovery (SMD 0.24; 95% CI –0.14–0.62) or upper limb spasticity (WMD 0.05; 95% CI –0.28–0.37). There did not appear to be any negative effects of electrical stimulation at the shoulder.