HESC3592 Lecture Week 7 PDF

Technology in neurorehabilitation HESC3592 Neuromuscular Rehabilitation Dr Paulo Henrique Silva Pelicioni PhD, MSC, PostGrad Cert, BPT Lecturer School of Health Sciences Context Think about it Context • Difficult (e.g., chronic, neurodegeneration) • Adherence • Lack of enjoyment • Up-to-date (c...

Technology in neurorehabilitation HESC3592 Neuromuscular Rehabilitation Dr Paulo Henrique Silva Pelicioni PhD, MSC, PostGrad Cert, BPT Lecturer School of Health Sciences Context Think about it Context • Difficult (e.g., chronic, neurodegeneration) • Adherence • Lack of enjoyment • Up-to-date (contextual) • Motivation • Engagement Context • Interventions • Assessments Interventions • • • • • • Electrical stimulation Transcranial Magnetic Stimulation (TMS) Virtual reality Exergames Robot-assisted training (RAT) Telerehabilitation (Telehealth/ e-health) Electrical stimulation It is a technique that uses low electrical impulses stimulating muscles to make their usual movement It is designed as an alternative tool for rehabilitating damaged, paralysed and weakened muscles Electrical stimulation Electrical impulses provoke an action potential, therefore eliciting muscle contraction. Effects: - peripheral effect: increased muscle trophy and blood flow circulation. - central effect (direct): increased excitability of the primary sensorimotor cortex; - central effect (indirect): increased motor recovery and muscle tone. Electrical stimulation Cerebral Palsy (CP) • It is safe and improves mobility in children with spastic CP - Sitting - Standing - Running - Jumping Salazar et al., 2019; Chen et al., 2023 Electrical stimulation Stroke • When applied two months post-stroke, it improves activities of daily living (ADL) • In the subacute stage, it is efficacious for ADL rehabilitation • It improves functional motor abilities in people with severe paresis (muscle weakness) Eraifej et al., 2017; Kristensen et al., 2022 Electrical stimulation Spinal Cord Injury (SCI) • When integrated with cycling exercises in adults, it improves - Muscle health and strength - Muscle power - Aerobic fitness - Spasticity - Voluntary movement - Functionality Garcia et al., 2020; van der Scheer et al. 2021, Massey et al., 2022 Transcranial Magnetic Stimulation TMS is a non-invasive stimulation using magnetic fields to stimulate nerve cells in different cortical areas (most commonly primary motor cortex and prefrontal cortex) It is believed that TMS increases activity in cortical regions, translating to better performance related to those areas (e.g., prefrontal cortex, improved cognition) Transcranial Magnetic Stimulation Parkinson’s disease (PD) • It promotes positive effects on - Walking - Muscle strength - Lower-limb function - Motor symptoms Krogh S et al., 2022; Zhang et al., 2022; Li et al., 2022; Deng et al., 2022 Transcranial Magnetic stimulation Stroke • It promotes positive effects in - upper limb function (chronic phase and 1-month post-stroke) - Hand function (chronic phase) - Muscle tone (chronic phase) - Balance (chronic phase) - Walking (chronic phase) - Functional ADL (chronic phase) van Lieshout et al., 2019; Krogh S et al., 2022; Chen et al., 2022 Virtual reality It is a computer-based technology that exposes consumers to a multisensory simulated environment and receives real-time feedback on performance Interactive exergames provide consumers with activities relevant to ADL and real-life scenarios Virtual reality Head-mounted VR Immersion VR Virtual reality CP • VR is effective to improve - Arm function - Postural control - Balance - Ambulation - Gross motor function Chen et al., 2018; Liu et al., 2022; Liu et al., 2022 Virtual reality Traumatic Brain Injury (TBI) • VR promotes a positive impact on balance and flexibility in children • VR is effective in enhancing motor skills in adults • VR is as effective in comparison to other modalities in improving balance and mobility Shen et al., 2018; Aulisio et al., 2020; Alashram et al., 2022 Virtual reality Multiple sclerosis (MS) • When examining traditional therapies, VR improves balance • VR has a short-term benefit in improving balance and fear of falling • In comparison to conventional therapy, VR improves fatigue, physical and cognitive function Nascimento et al., 2021; Calafiore et al., 2021; Cortes-Perez et al., 2023; Moeinzadeh et al., 2023 Virtual reality PD • VR has a short-term effect on gait (step/ stride length) • Compared to passive control, VR improves gait speed, step/stride length, balance, ADL and postural control • As effective as other treatments on motor function, step/stride length, balance and quality of life (QoL) Dickx et al., 2017; Lu et al., 2022; Kashif et al., 2022; Rodriguez-Mansilla et al., 2023 Virtual reality Stroke • In comparison to conventional therapy, VR improves - Upper limb function - Physical performance - Muscle strength - Gait - Balance Laver et al., 2017; Patsaki et al., 2022; Demeco et al., 2023; Bargeri et al., 2023 Virtual reality Alzheimer’s disease • VR improves: - Balance - Cognition - Memory - Executive function Yi et al., 2022 Virtual reality SCI • Positive effects on aerobic function, balance (sitting and standing), pain and motor function • In combination with RAT, VR improves upper limb function and muscle strength Araujo et al., 2019; Abou et al., 2020; Miguel-Rubio et al., 2022 Exergames • Technology-driven exercises requiring consumers to be physically active to play the game • It contains principles of video gaming (e.g., motivation, reward, progression) Exergames Not enough high-level evidence (YET!) Check it out our week 7 labs at NeuRA Schoene et al., 2013; Hoang et al., 2016; Schoene et al., 2015; Song et al., 2018; Sturnieks et al., 2019; Pelicioni et al., 2023 Robot-assisted training (RAT) • It is a modality in which a consumer uses the RAT to support their body weight (for gait training). • RAT helps consumers with functional movements to support their functionality. • Resistance and % of body weight can be manipulated as progression. Robot-assisted training (RAT) CP • In comparison to conventional therapy, RAT improves - Lower limb function - Balance - Walking endurance - Gait speed - Walking, running and jumping ability Cortes-Perez et al., 2022; Wang et al., 2023 Robot-assisted training (RAT) Stroke • The combination of conventional therapy with RAT leads to gait improvement • When electrical stimulation is combined with RAT, it leads to more gait improvements in comparison to RAT alone • RAT is better than no treatment for upper limb function and ADL ability Bruni et al., 2018; Yang et al., 2023 Robot-assisted training (RAT) SCI • RAT results in the improvement of - Spasticity - Pain perception - Proprioception - Gait - Sitting posture - Overall mobility Holanda et al., 2017; Bin et al., 2023 Telerehabilitation Telerehabilitation is the use of medical/health information to provide rehabilitation to people in different locations Telehealth E-health Check it out our week 7 labs at NeuRA Telerehabilitation MS • Telerehabilitation is effective in - Reducing motor disability - Improving gait - Improving balance Di Tella et al., 2020 Telerehabilitation SCI • Telerehabilitation improves - QoL - Functional ability - Motor impairment Solomon et al., 2022; Nayak et al., 2023 Telerehabilitation TBI • Telerehabilitation improves - Global functioning - Depression - Symptom management Ownsworth et al., 2018; Suarilah et al., 2022 Telerehabilitation PD • In comparison to standard treatments, telerehabilitation improves the QoL and adherence to treatment • Telerehabilitation maintains/ improves - Gait - Balance - QoL Vellata et al., 2021; Ozden 2023 Telerehabilitation Stroke • In comparison to standard treatments, telerehabilitation improves - Motor function - ADL - Independence • Telerehabilitation improves balance and functional mobility Appleby et al., 2019; Allayat et al., 2022 Assessments • Motion capture systems • Gait mat systems • Wearable devices • Exergames • Telerehabilitation Motion capture systems Kinematic analysis of movement 2D and 3D Remember week 4 and HESC2452 Gait mat systems It has some pressure sensors embedded into it and it easily measures gait parameters Wearable devices It has sensors measuring the acceleration of a person Remember week 4 and some activities that were completed for HESC2452 Exergames Technology-driven assessments requiring consumers to be physically active to play the game Check it out our week 7 labs at NeuRA Schoene et al., 2013; Hoang et al., 2016; Schoene et al., 2015; Song et al., 2018; Sturnieks et al., 2019; Pelicioni et al., 2023 Telerehabilitation “Telehealth is the use of medical information that is exchanged from one site to another through electronic communication to improve a consumer’s health” Check it out our week 7 labs at NeuRA Considerations • Consider the FITT (Frequency, Intensity, Time and Type) principle • Different stages of diseases and conditions • Reliability and validity of outcomes • For outcomes there is still a lack of information. MORE STUDIES ARE NEEDED! References Overall • Lazaro RT, Umphred DA. Umphred’s neurorehabilitation for the Physical Therapist Assistant. 3rd edition, SLACK Incorporated, 2020. Electrical stimulation • Salazar AP et al. Neuromuscular electrical stimulation to improve gross motor function in children with cerebral palsy: a meta-analysis. Braz J Phys Ther. 2019 Sep-Oct;23(5):378-386. • Chen Y et al. Effectiveness of neuromuscular electrical stimulation in improving mobility in children with cerebral palsy: A systematic review and meta-analysis of randomized controlled trials. Clin Rehabil. 2023 Jan;37(1):3-16. • Eraifej J et al. Effectiveness of upper limb functional electrical stimulation after stroke for the improvement of activities of daily living and motor function: a systematic review and meta-analysis. Syst Rev. 2017 Feb 28;6(1):40. • Kistensen MGH et al. Neuromuscular Electrical Stimulation Improves Activities of Daily Living Post Stroke: A Systematic Review and Meta-analysis. Arch Rehabil Res Clin Transl. 2021 Nov 12;4(1):100167. • Garcia AM et al. Transcutaneous Spinal Cord Stimulation and Motor Rehabilitation in Spinal Cord Injury: A Systematic Review. Neurorehabil Neural Repair. 2020 Jan;34(1):3-12. • Massey S et al. Neurophysiological and clinical outcome measures of the impact of electrical stimulation on spasticity in spinal cord injury: Systematic review and meta-analysis. Front Rehabil Sci. 2022 Dec 16:3:1058663. • Van der Scheer AW et al. Functional electrical stimulation cycling exercise after spinal cord injury: a systematic review of health and fitness-related outcomes. J Neuroeng Rehabil. 2021 Jun 12;18(1):99. Transcranial Magnetic Stimulation • Krogh S et al. Efficacy of repetitive transcranial magnetic stimulation for improving lower limb function in individuals with neurological disorders: A systematic review and meta-analysis of randomized sham-controlled trials. J Rehabil Med. 2022 Feb 3:54:jrm00256. • Zhang W et al. Efficacy of repetitive transcranial magnetic stimulation in Parkinson's disease: A systematic review and meta-analysis of randomised controlled trials. EClinicalMedicine. 2022 Jul 29:52:101589. References Transcranial Magnetic Stimulation • Li R et al. Effects of Repetitive Transcranial Magnetic Stimulation on Motor Symptoms in Parkinson's Disease: A Meta-Analysis. Neurorehabil Neural Repair. 2022 Jul;36(7):395-404. • Deng S et al. Effects of repetitive transcranial magnetic stimulation on gait disorders and cognitive dysfunction in Parkinson's disease: A systematic review with meta-analysis. Brain Behav. 2022 Aug;12(8):e2697. • van Lieshout et al. Timing of Repetitive Transcranial Magnetic Stimulation Onset for Upper Limb Function After Stroke: A Systematic Review and Meta-Analysis. Front Neurol. 2019 Dec 3:10:1269. • Chen G et al. Effects of repetitive transcranial magnetic stimulation on sequelae in patients with chronic stroke: A systematic review and meta-analysis of randomized controlled trials. Front Neurosci. 2022 Oct 20:16:998820. Virtual reality • Dockx K et al. Virtual reality for rehabilitation in Parkinson's disease. Cochrane Database Syst Rev. 2016 Dec 21;12(12):CD010760. • Lu Y et al. The effectiveness of virtual reality for rehabilitation of Parkinson disease: an overview of systematic reviews with metaanalyses. Syst Rev. 2022 Mar 19;11(1):50. • Kashif M et al. Systematic review of the application of virtual reality to improve balance, gait and motor function in patients with Parkinson's disease. Medicine (Baltimore). 2022 Aug 5;101(31):e29212. • Rodriguez-Mansilla J et al. Effects of Virtual Reality in the Rehabilitation of Parkinson's Disease: A Systematic Review. J Clin Med. 2023 Jul 26;12(15):4896. • Laver KE et al. Virtual reality for stroke rehabilitation. Cochrane Database Syst Rev. 2017 Nov 20;11(11):CD008349. • Patsaki I et al. The effectiveness of immersive virtual reality in physical recovery of stroke patients: A systematic review. Front Syst Neurosci. 2022 Sep 22:16:880447. • Demeco A et al. Immersive Virtual Reality in Post-Stroke Rehabilitation: A Systematic Review. Sensors (Basel). 2023 Feb 3;23(3):1712. • Bargeri S et al. Effectiveness and safety of virtual reality rehabilitation after stroke: an overview of systematic reviews. EClinicalMedicine. 2023 Sep 14:64:102220. • Chen Y et al. Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Phys Ther. 2018 Jan 1;98(1):63-77. References Virtual reality • Shen J et al. Virtual Reality for Pediatric Traumatic Brain Injury Rehabilitation: A Systematic Review. Am J Lifestyle Med. 2018 Feb 6;14(1):6-15. • Aulisio MC et al. Virtual reality gaming as a neurorehabilitation tool for brain injuries in adults: A systematic review. Brain Inj. 2020 Aug 23;34(10):1322-1330. • Alashram AR et al. Virtual reality for balance and mobility rehabilitation following traumatic brain injury: A systematic review of randomized controlled trials. J Clin Neurosci. 2022 Nov:105:115-121. • Araujo AVL et al. Efficacy of Virtual Reality Rehabilitation after Spinal Cord Injury: A Systematic Review. Biomed Res Int. 2019 Nov 13:2019:7106951. • Abou L et al. Effects of Virtual Reality Therapy on Gait and Balance Among Individuals With Spinal Cord Injury: A Systematic Review and Metaanalysis. Neurorehabil Neural Repair. 2020 May;34(5):375-388. • Miguel-Rubio A et al. A Therapeutic Approach Using the Combined Application of Virtual Reality with Robotics for the Treatment of Patients with Spinal Cord Injury: A Systematic Review. Int J Environ Res Public Health. 2022 Jul 19;19(14):8772. • Nascimento AS et al. Effectiveness of Virtual Reality Rehabilitation in Persons with Multiple Sclerosis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Mult Scler Relat Disord. 2021 Sep:54:103128. • Calafiore D et al. Efficacy of Virtual Reality and Exergaming in Improving Balance in Patients With Multiple Sclerosis: A Systematic Review and Meta-Analysis. Front Neurol. 2021 Dec 10:12:773459. • Cortes-Perez I et al. Virtual reality-based therapy improves balance and reduces fear of falling in patients with multiple sclerosis. a systematic review and meta-analysis of randomized controlled trials. J Neuroeng Rehabil. 2023 Apr 11;20(1):42. • Moeinzadeh AM et al. Comparing virtual reality exergaming with conventional exercise in rehabilitation of people with multiple sclerosis: A systematic review. Neuropsychol Rehabil. 2023 Sep;33(8):1430-1455. • Yi Y et al. Effect of virtual reality exercise on interventions for patients with Alzheimer's disease: A systematic review. Front Psychiatry. 2022 Nov 9:13:1062162. • Liu W et al. Effect of Virtual Reality on Balance Function in Children With Cerebral Palsy: A Systematic Review and Meta-analysis. Front Public Health. 2022 Apr 25:10:865474. • Liu C et al. The Effects of Virtual Reality Training on Balance, Gross Motor Function, and Daily Living Ability in Children With Cerebral Palsy: Systematic Review and Meta-analysis. JMIR Serious Games. 2022 Nov 9;10(4):e38972. References Robot-assisted training • Wang Y et al. Systematic review and network meta-analysis of robot-assisted gait training on lower limb function in patients with cerebral palsy. Neurol Sci. 2023 Nov;44(11):3863-3875. • Cortes-Perez I et al. Efficacy of Robot-Assisted Gait Therapy Compared to Conventional Therapy or Treadmill Training in Children with Cerebral Palsy: A Systematic Review with Meta-Analysis. Sensors (Basel). 2022 Dec 16;22(24):9910. • Bruni MF et al. What does best evidence tell us about robotic gait rehabilitation in stroke patients: A systematic review and metaanalysis. J Clin Neurosci. 2018 Feb:48:11-17. • Yang X et al. Efficacy of Robot-Assisted Training on Rehabilitation of Upper Limb Function in Patients With Stroke: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil. 2023 Sep;104(9):1498-1513. • Holanda LJ et al. Robotic assisted gait as a tool for rehabilitation of individuals with spinal cord injury: a systematic review. J Neuroeng Rehabil. 2017 Dec 4;14(1):126. • Bin L et al. The effect of robot-assisted gait training for patients with spinal cord injury: a systematic review and meta-analysis. Front Neurosci. 2023 Aug 22:17:1252651. Telerehabilitation • Vellata C et al. Effectiveness of Telerehabilitation on Motor Impairments, Non-motor Symptoms and Compliance in Patients With Parkinson's Disease: A Systematic Review. Front Neurol. 2021 Aug 26:12:627999. • Ozden F. The effect of mobile application-based rehabilitation in patients with Parkinson's disease: A systematic review and metaanalysis. Clin Neurol Neurosurg. 2023 Feb:225:107579. • Appleby E et al. Effectiveness of telerehabilitation in the management of adults with stroke: A systematic review. PLoS One. 2019 Nov 12;14(11):e0225150. • Alayat MS et al. The Effectiveness of Telerehabilitation on Balance and Functional Mobility in Patients with Stroke: A Systematic Review and Meta-Analysis. International Journal of Telerehabilitation 2022;14(2). • Solomon RM et al. Telerehabilitation for individuals with spinal cord injury in low-and middle-income countries: a systematic review of the literature. Spinal Cord. 2022 May;60(5):395-403. References Telerehabilitation • Nayak P et al. Effect of telerehabilitation on motor and functional outcomes in people with spinal cord injuries – a systematic review. European Journal of Physiotherapy, DOI: 10.1080/21679169.2023.2195439 • Ownsworth T et al. Efficacy of Telerehabilitation for Adults With Traumatic Brain Injury: A Systematic Review. J Head Trauma Rehabil. 2018 Jul/Aug;33(4):E33-E46. • Suarilah I et al. Effectiveness of telehealth interventions among traumatic brain injury survivors: A systematic review and meta-analysis. J Telemed Telecare. 2022 Jun 3:1357633X221102264. doi: 10.1177/1357633X221102264. • Di Tella S et al. Integrated telerehabilitation approach in multiple sclerosis: A systematic review and meta-analysis. J Telemed Telecare. 2020 Aug-Sep;26(7-8):385-399. Exergames • Sturnieks DL, Menant J, Valenzuela M, et al. Effect of cognitive-only and cognitive-motor training on preventing falls in communitydwelling older people: protocol for the smart±step randomised controlled trial. BMJ Open. 2019 Aug 2;9(8):e029409. doi: 10.1136/bmjopen-2019-029409. • Song J, Paul SS, Caetano MJD, et al. Home-based step training using videogame technology in people with Parkinson's disease: a single-blinded randomised controlled trial. Clin Rehabil. 2018 Mar;32(3):299-311. doi: 10.1177/0269215517721593. • Schoene D, Valenzuela T, Toson B, et al. Interactive Cognitive-Motor Step Training Improves Cognitive Risk Factors of Falling in Older Adults - A Randomized Controlled Trial. PLoS One. 2015 Dec 16;10(12):e0145161. doi: 10.1371/journal.pone.0145161. • Hoang P, Schoene D, Gandevia S, et al. Effects of a home-based step training programme on balance, stepping, cognition and functional performance in people with multiple sclerosis--a randomized controlled trial. Mult Scler. 2016 Jan;22(1):94-103. doi: 10.1177/1352458515579442. • Schoene D, Lord SR, Delbaere K, et al. A randomized controlled pilot study of home-based step training in older people using videogame technology. PLoS One. 2013;8(3):e57734. doi: 10.1371/journal.pone.0057734. • Pelicioni PHS, Lord SR, Menant JC, et al. Combined Reactive and Volitional Step Training Improves Balance Recovery and Stepping Reaction Time in People With Parkinson's Disease: A Randomised Controlled Trial. Neurorehabil Neural Repair. 2023 Oct 21:15459683231206743. doi: 10.1177/15459683231206743. [email protected]