Tag: physical rehabilitation

Using a Gaming Console can Improve Stroke Patient Rehabilitation

Photo by Tima Miroshnichenko from Pexels

A study by the Faculty of Physiotherapy of the University of Valencia (UV) has shown that a physiotherapy programme using the Nintendo Wii console improves the functionality, balance and daily activities of patients who have suffered a cerebrovascular accident or stroke.
Wii research group

The study found that when the Wii is added to conventional physiotherapy techniques, the benefits are significant in stroke patients. Besides improvements in functionality and balance, the physiotherapy programme using the Wii also helps to improve daily activities.

The use of game consoles in medicine has focused on aspects such as helping build motor skills and pain management with virtual reality immersion. They are relatively cheap and available, and simple to use. One study looked at using a Microsoft Xbox to help rehabilitation of patients with Parkinson’s disease.

Previous research had already shown that the Wii can help normal treatments in restoring functionality in some chronic diseases. However, until now, there was little evidence of its use in people who had suffered strokes. “Before conducting the study we realised that not much research had been done with stroke patients, so we wanted to know if console games could promote mobility, balance and the day-to-day life of people with this pathology”, explained Elena Marqués, one of the researchers and professor of Physiotherapy at the UV.

The study recruited 29 participants into two groups, one using the Wii and conventional techniques, and the other performing traditional physiotherapy exercises. “The sample is relatively large considering it is comprised by patients who suffered strokes, as because they have many physical limitations, their treatment is usually much more individualised than that of other pathologies”, said the author.

These video games allow therapists to design rehabilitation programs that improve the principles of brain plasticity. An additional advantage is that the console provides real-time feedback on performance and progress, which can increase patient motivation, fun, and treatment adherence. “It should be taken into account that some patients have not performed any exercise before, regardless of the pathology they have, so being presented as a game can be an incentive”, said Prof Marqués.

She pointed out that other benefits include the Wii being easy to use, relatively affordable and, most importantly, can be used individually and at home, without needing to visit a rehab centre. This is particularly useful with COVID lockdowns.

This is one of the first studies using consoles as a therapeutic option, but it can be extended to patients with other pathologies, “because it allows you to work the balance with the console table, both in the chronic phase and in the subacute phase”, said Marqués.

Strengthening mirror neurons

Many Wii games use the remote control, but the console also offers a balance table that detects weight transfer by reflecting it in an avatar on the screen, letting the patient observe his/her own movements and generate positive feedback.

Thus, when the person observes his/her movements, the plasticity changes that depend on the use of sensory areas belonging to the mirror neuron system are strengthened. This exemplifies, among other factors, the improvements the Wii can provide in such patients. This feedback could result in a strengthening of the learning mechanisms of different motor and sensory activities and ultimately improving quality of life.

Source: Asociación RUVID

Researchers Discover that Humans can Readily Develop Echolocation Ability

Photo by Pawel Czerwinski on Unsplash

The ability for humans to sense their surrounding space with reflected sounds might sound like a superhero’s ability, but it is a skill that is developed by some blind people, who use clicks as a form of echolocation.

Echolocation is an ability known in dolphins, whales and bat species, which occurs when such animals emit a sound that reflects off objects in the environment, returning echoes that provide information about the surrounding space.

Existing research has shown that some blind people may use click-based echolocation to judge spaces and improve their navigation skills. Armed with this information, a team of researchers led by Dr Lore Thaler explored how people acquire this skill.

Over the course of a 10-week training programme, the team investigated how blindness and age affect learning of click-based echolocation. They also studied how learning this skill affects the daily lives of people who are blind.

Both blind and sighted people between 21 and 79 years of age participated in this study, which provided a training course of 10 weeks. Blind participants also took part in a 3-month follow up survey assessing how the training affected their daily life.

Both sighted and blind people improved considerably on all measures, and in some cases performed as well as expert echolocators did at the end of training. A surprising result was that a few sighted people even performed better than those who were blind.

However, neither age nor blindness limited participants’ rate of learning or in their ability to apply their echolocation skills to novel, untrained tasks.

Furthermore, in the follow up survey, all participants who were blind reported improved mobility, and 83% reported better independence and wellbeing.

Age or vision not a limitation

Overall, the results suggest that the ability to learn click-based echolocation is not strongly limited by age or level of vision. This has positive implications for the rehabilitation of people with vision loss or in the early stages of progressive vision loss.

Click-based echolocation is not presently taught as part of mobility training and rehabilitation for blind people. There is also the possibility that some people are reluctant to use click-based echolocation due to a perceived stigma around  the click sounds in social environments.

Despite this, the results indicate that both blind people who use echolocation and people new to echolocation are confident to use it in social situations, indicating that the perceived stigma is likely less than believed.

Source: Durham University

Journal information: Human click-based echolocation: Effects of blindness and age, and real-life implications in a 10-week training program, PLOS ONE (2021)

Tailored Heart Failure Rehabilitation Improves Outcomes

An innovative early cardiac rehabilitation intervention customised for the individual improved physical function, frailty, quality of life, and depression in hospitalised heart failure patients. 

Photo from Olivier Collett on Unsplash

These findings were published  in the New England Journal of Medicine and also presented at the American College of Cardiology’s 70th Annual Scientific Session.  

“Designing earlier and more personalised individual-specific approaches to heart failure rehab shows great promise for improving outcomes for this common but complex condition that is one of the leading causes of hospitalisation for older adults,” said National Institute on Aging (NIA) Director Richard J Hodes, MD. “These results mark encouraging progress on a path to better overall quality of life and physical function for the millions of older Americans who develop heart failure each year.”

The study team was led by Dalane W Kitzman, MD, professor of cardiovascular medicine and geriatrics/gerontology at Wake Forest School of Medicine, Winston-Salem, North Carolina, and they followed 349 clinical trial participants with heart failure enrolled in “A Trial of Rehabilitation Therapy in Older Acute Heart Failure Patients” (REHAB-HF). On average, participants had five comorbidities that reduced of function — diabetes, obesity, high blood pressure, lung disease or kidney disease.

In an earlier pilot study, Kitzman and colleagues found striking deficits in strength, mobility and balance, along with the expected loss of endurance in older patients with acute heart failure, who were mostly fail or pre-fail. The team decided to focus on improving patients’ physical function, weakened already by chronic heart failure and age, and which was worsened by the traditional cardiac hospital experience involving lots of bedrest and resulting in loss of functions often persisting after discharge.

To address this. The REHAB-HF team designed earlier and more customised exercise programs focusing on improving balance, strength, mobility and endurance. They also began REHAB-HF during a patient’s hospital stay when possible rather than the usual six weeks post-discharge. After discharge, participants shifted to outpatient sessions three times per week for three months.

Compared to a control group getting usual cardiac rehab care, REHAB-HF participants showed significant gains in measures of physical functioning and overall quality of life, including tests for lower extremity function and mobility, and a six-minute walk test. Self-perception of their health status and depression improved in surveys compared to pre-trial baselines. Over 80% of REHAB-HF participants reported they were still doing their exercises six months after study completion.

“These findings will inform choices of heart failure rehabilitation strategies that could lead to better physical and emotional outcomes,” said Evan Hadley, M.D., director of NIA’s Division of Geriatrics and Clinical Gerontology. “Tailored interventions like REHAB-HF that target heart failure’s related decline in physical abilities can result in real overall benefits for patients.”

The study did not show significant differences in related clinical events including rates of hospital readmission for any reason or for heart-failure related rehospitalizations. The research team plans to further explore that and other issues through future expansions of REHAB-HF into larger and longer-term trials with broader participant subgroups.

Source: National Institute on Aging

Journal information: Kitzman et al. Rehabilitation Intervention in Older Patients with Acute Heart Failure with Preserved versus Reduced Ejection Fraction. New England Journal of Medicine. 2021 May 16 doi: 10.1056/NEJMoa2026141.

Neural Control of Prosthetic Ankle Can Restore Agility

Female athlete with prosthetic leg relaxes on a sporting field. Photo by Anna Shvets from Pexels

A recent case study demonstrates that, with training, neural control of a prosthetic ankle with a powered joint can restore agility. 

Traditional prosthetic ankle joints result in slower walking and abnormal gaits due to the way they differ from normal human ankles in distributing walking loads. Autonomously controlled powered prosthetic ankles can restore additional function to users by providing the extra work involved in a natural walking gait. However, they are currently only designed to assist walking or standing, and not to tackle specialised tasks such as squatting.

“This case study shows that it is possible to use these neural control technologies, in which devices respond to electrical signals from a patient’s muscles, to help patients using robotic prosthetic ankles move more naturally and intuitively,” said corresponding author Helen Huang, Jackson Family Distinguished Professor in the Joint Department of Biomedical Engineering at NC State and UNC

“This work demonstrates that these technologies can give patients the ability to do more than we previously thought possible,” says Aaron Fleming, first author of the study and a Ph.D. candidate in the joint biomedical engineering department.

Most research on robotic prosthetic ankles has focused on autonomous control, meaning that the prosthesis handles the fine motions when the wearer decides to walk or stan.

Huang, Fleming and their collaborators sought to find out if amputees could be trained to use a neurally controlled prosthetic ankle to regain more control in the many common motions that people make with their ankles beyond simply walking.

Their powered prosthesis reads electrical signals from two residual calf muscles, which are responsible for controlling ankle motion, and converts the signals into commands for moving the prosthesis.

The researchers recruited a study participant with an amputation between the knee and the ankle, and fitted the powered prosthetic ankle on the participant and did an initial evaluation. Over two and a half weeks, the participant then had five, two-hour training sessions with a physical therapist. A second evaluation was conducted on training completion.

Having had the training, the participant was able to perform a variety of previously challenging tasks, such as going from sitting to standing without any external assistance or squatting to pick something up without compensating for the movement with other body parts. However the participant’s own stability, both self-reported and empirically measured in such tests as standing on foam, was dramatically improved.

“The concept of mimicking natural control of the ankle is very straightforward,” Huang said. “But implementation of this concept is more complicated. It requires training people to use residual muscles to drive new prosthetic technologies. The results in this case study were dramatic. This is just one study, but it shows us what is feasible.”

“There is also a profound emotional impact when people use powered prosthetic devices that are controlled by reading the electrical signals that their bodies are making,” Fleming said. “It is much more similar to the way people move intuitively, and that can make a big difference in how people respond to using a prosthesis at all.”

More participants are already undergoing the training, with the researchers expanding their testing to match. But before this technology is made more widely available, the researchers would like real-world testing, with the prosthesis being used in people’s daily routines.

“As with any prosthetic device for lower limbs, you have to make sure the device is consistent and reliable, so that it doesn’t fail when people are using it,” Huang said.

“Powered prostheses that exist now are very expensive and are not covered by insurance,” Fleming explained. “So there are issues related to access to these technologies. By attempting to restore normal control of these type of activities, this technology stands to really improve quality of life and community participation for individuals with amputation. This would make these expensive devices more likely to be covered by insurance in the future if it means improving the overall health of the individual.”

The researchers are currently working with a larger group of study participants to see how broadly applicable the findings may be.

Source: News-Medical.Net

Journal information: Fleming, A., et al. (2021) Direct continuous electromyographic control of a powered prosthetic ankle for improved postural control after guided physical training: A case study. Wearable Technologies. doi.org/10.1017/wtc.2021.2.