Browsing by Subject "Rehabilitation"
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Item MIRROR THERAPY'S EFFICACY AND MECHANISM IN THE PROMOTION OF MOTOR RECOVERY IN HEMIPARETIC POST STROKE POPULATIONS(2013-04-12) Guild, JeffreyPurpose: Mirror therapy (MT) has been thought to be affective for treating complex regional pain syndrome, hemiparesis, and phantom limb pain. This treatment uses imagery to reflect movements of the unaffected side off a mirror as if it were the affected side. The purpose of this review is to highlight the advances in MT research as a treatment option for patients suffering from hemiparesis post stroke. Methods: Five authors searched all accessible databases from a university. All significant randomized controlled trials (RCT's) and history of mirror therapy were obtained. For context, cortical neuroplasticity post stroke, bilateral training, imagery training, electrical cortical stimulation, and constraint-induced movement therapy (CIMT) were also reviewed. Results: Over the past decade RCT's and reviews have supported the efficacy for treating motor impairments due to stroke in acute, subacute, and chronic conditions. Functional outcome measures to support these findings were the Fugl-Meyer Assessment, Brunnstrom scale, and the Motor Assessment Scale. The mechanism for MT is based on fMRI studies which show MT promotes cortical reorganization of the ipsilesional primary motor cortex (M1) and may even prevent over dominance of the contralesional M1 region. CIMT and electrical stimulation use the same mechanism of preventing inhibition of the ipsilesional M1 region by the contralesional M1 region by stimulating the ipsilesional side. While the MT literature addresses the upper extremities the most, some RCT's have shown similar outcomes with the lower extremities. Outcomes for treating sensory recovery has been supported with some evidence, however, there are stronger arguments and evidence that mirror therapy is most effective with motor recovery in patients suffering from hemi-paresis post stroke. Conclusions: By providing patients with a mirror at home or in the clinic, MT provides a simple, inexpensive, and effective way to improve functional motor recovery in patients suffering from hemiparesis. Other methods have been used consistently in the literature along with MT including standard physical and occupational therapy, bilateral arm training, strength training, and neuromuscular electrical stimulation. CIMT has not been studied with MT. Since a functional extremity is required with CIMT and MT has promoted motor recovery in acute populations, MT may be the beginning segway into motor recovery before transitioning to CIMT along with other treatment methods.Item Soft robotic devices for hand rehabilitation and assistance: a narrative review(BioMed Central Ltd., 2018-02-17) Chu, Chia-Ye; Patterson, Rita M.Introduction: The debilitating effects on hand function from a number of a neurologic disorders has given rise to the development of rehabilitative robotic devices aimed at restoring hand function in these patients. To combat the shortcomings of previous traditional robotics, soft robotics are rapidly emerging as an alternative due to their inherent safety, less complex designs, and increased potential for portability and efficacy. While several groups have begun designing devices, there are few devices that have progressed enough to provide clinical evidence of their design's therapeutic abilities. Therefore, a global review of devices that have been previously attempted could facilitate the development of new and improved devices in the next step towards obtaining clinical proof of the rehabilitative effects of soft robotics in hand dysfunction. Methods: A literature search was performed in SportDiscus, Pubmed, Scopus, and Web of Science for articles related to the design of soft robotic devices for hand rehabilitation. A framework of the key design elements of the devices was developed to ease the comparison of the various approaches to building them. This framework includes an analysis of the trends in portability, safety features, user intent detection methods, actuation systems, total DOF, number of independent actuators, device weight, evaluation metrics, and modes of rehabilitation. Results: In this study, a total of 62 articles representing 44 unique devices were identified and summarized according to the framework we developed to compare different design aspects. By far, the most common type of device was that which used a pneumatic actuator to guide finger flexion/extension. However, the remainder of our framework elements yielded more heterogeneous results. Consequently, those results are summarized and the advantages and disadvantages of many design choices as well as their rationales were highlighted. Conclusion: The past 3 years has seen a rapid increase in the development of soft robotic devices for hand rehabilitative applications. These mostly preclinical research prototypes display a wide range of technical solutions which have been highlighted in the framework developed in this analysis. More work needs to be done in actuator design, safety, and implementation in order for these devices to progress to clinical trials. It is our goal that this review will guide future developers through the various design considerations in order to develop better devices for patients with hand impairments.