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Objective:To design a motor impairment rehabilitation monitoring aid for the assessment of motor impairment in patients who do not have or have difficulty walking independently.Methods:An assistive device vehicle was designed, equipped with an accelerometer and a six-dimensional force sensor. The normal walking (NW) group and abnormal walking group were set up, in which the abnormal walking group included moderate abnormal walking (MA) group, moderate abnormal walking with the aid of the assistive vehicle (MA-V) group, severe abnormal walking (SA) group, and severe abnormal walking with the aid of the assistive vehicle (SA-V) group. In the MA-V group, the range of knee movement was adjusted from 0 to 30°, and in the SA group, the knee joint was completely unbending. The gait cycles, peak and mean acceleration values of the right and left legs were evaluated by accelerometers, and changes in the upper limb forces were assessed by six-dimensional force transducers.Results:For the moderate impairment group, the difference in gait cycle between the MA and MA-V groups was not statistically significant ( P>0.05), and the gait cycle in the MA-V group was slightly greater than that in the MA group. For the severe injury group, the gait cycle of the SA-V group was lower than that of the SA group, and the difference was statistically significant ( P<0.01). For all abnormal groups, the mean and peak acceleration of the left leg were greater than that of the right leg, and the difference between the peak acceleration of the left leg and that of the right leg was statistically significant ( P<0.05). In the abnormal walking pattern, the mean (absolute) value of the left hand force was greater than that of the right hand, especially in the Z-axis. The standard deviations of the combined forces on the left side for the NW, MA-V, and SA-V groups were 2.759, 8.297, and 13.118 N, respectively. The SA-V group had the highest dispersion in the force scatter plot, while the NW group had a better concentration. Conclusions:An assistive vehicle equipped with an accelerometer and a six-dimensional force sensor was designed to help physicians in the assessment and rehabilitation of motor disorders.
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With a rapidly aging population， there is a huge potential demand for rehabilitation and assistive products and services. Especially in the global context where greater attention is given to disadvantaged groups， there is a need to cater to the needs of the elderly in terms of rehabilitation and assistive aid to improve their quality of life. Compared with developed countries， China’s rehabilitation aid industry is still in its early stages of development and needs to move away from traditional equipment manufacturing and integrate with intelligent manufacturing to provide more development possibilities and choices. International cooperation is expected to become one of the future research and development directions for rehabilitation aids. Taking typical cities and countries at home and abroad as examples， this paper explores the development of rehabilitation aids， and calls for the cultivation of more rehabilitation aid professionals to help more people in need.
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Rehabilitation assessment is the basis and important part of rehabilitation diagnosis and treatment. At present, clinical evaluation is usually carried out by observation method and scale method. At the same time, researchers monitor patients' physical condition data through sensor system and other equipment as a supplement. The purpose of this study is to review the application and development of objective rehabilitation assessment technology in clinical practice, and to discuss its limitations and strategies to provide reference for related research.
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Humans , Technology , RehabilitationABSTRACT
In response to the problem that the traditional lower limb rehabilitation scale assessment method is time-consuming and difficult to use in exoskeleton rehabilitation training, this paper proposes a quantitative assessment method for lower limb walking ability based on lower limb exoskeleton robot training with multimodal synergistic information fusion. The method significantly improves the efficiency and reliability of the rehabilitation assessment process by introducing quantitative synergistic indicators fusing electrophysiological and kinematic level information. First, electromyographic and kinematic data of the lower extremity were collected from subjects trained to walk wearing an exoskeleton. Then, based on muscle synergy theory, a synergistic quantification algorithm was used to construct synergistic index features of electromyography and kinematics. Finally, the electrophysiological and kinematic level information was fused to build a modal feature fusion model and output the lower limb motor function score. The experimental results showed that the correlation coefficients of the constructed synergistic features of electromyography and kinematics with the clinical scale were 0.799 and 0.825, respectively. The results of the fused synergistic features in the K-nearest neighbor (KNN) model yielded higher correlation coefficients ( r = 0.921, P < 0.01). This method can modify the rehabilitation training mode of the exoskeleton robot according to the assessment results, which provides a basis for the synchronized assessment-training mode of "human in the loop" and provides a potential method for remote rehabilitation training and assessment of the lower extremity.
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Humans , Exoskeleton Device , Reproducibility of Results , Walking/physiology , Lower Extremity , Algorithms , Stroke Rehabilitation/methodsABSTRACT
Objective:To apply Star Excursion Balance Test (SEBT) in evaluating dynamic balance function in stroke patients. Methods:From September, 2018 to November, 2019, 38 stroke hemiplegic patients of Brunnstrom IV and above who could walk independently were included. They completed SEBT by two testers; the anterior, posteromedial and posterolateral extension standardized distance of the affected leg support were recorded. One of the testers measured SEBT again the day after the next day. The intraclass correlation coefficient (ICC) was calculated. The limits of stability on different directions were measured with active balancer EAB-100 (EAB) and tested with Timed 'Up & Go' Test (TUGT) by the third tester. The correlation of SEBT to EAB and TUGT was analyzed with Pearson correlation coefficient. Results:ICCs of three directions was 0.892 to 0.951 between testers, and 0.888 to 0.963 of test-retest. The standardized distance of three directions of SEBT correlated with the anterior and lateral stability limits of EAB (r = 0.479 to 0.671, P < 0.05), as well as TUGT (r = -0.557~-0.633， P < 0.05). Conclusion:SEBT is valid and reliable for evaluation of the dynamic balance for stroke patients of Brunnstrom IV and above who can walk independently.
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The evaluation of balance includes clinical observation, scales and instrumental measures. Functional Reach Test is simple and can be carried out in both standing and sitting, but the error of reading the measuring ruler is large, which results in new moving rulers and inertial sensors. The factors influencing the results of Functional Reach Test are moving strategy, age, moving efficiency, goal orientation, single or double arms, human characteristics, number of experiments and others. In the future, combination of electromyogram and inertia sensor can be used to discuss the variety of muscles and the changes of muscle strength, and more influence factors for the test are needed to research.
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Objective:To apply real-time shear wave elastography to observe the effect of instrument-assisted soft tissue mobilization (IASTM) on Achilles tendons for healthy adults. Methods:From July to December, 2020, 52 healthy adults were assigned into control group (n = 15) and experimental group (n = 37) randomly. The experimental group received IASTM on left Achilles tendons, once another day for two weeks, while the control group received no treatment. The thickness and elastic modulus of the left Achilles tendons were measured with high-frequency ultrasound and shear wave ultrasound elastography on all the subjects, before treatment, immediately after the first treatment and three days after treatment, respectively. Results:Five cases dropped down in the experimental group. There was no significant difference in thickness and elastic Young's modulus of the left Achilles tendons between two groups before treatment (t < 0.630, P > 0.05). The thickness of the left Achilles tendons was less in the experimental group than in the control group immediately after the first treatment (t = 2.149, P < 0.05), while average and maximum elastic Young's modulus was less three days after treatment (t > 2.134, P < 0.05). Conclusion:Real-time shear wave elastography could quantify the thickness and elasticity of Achilles tendon, to evaluate the effect of IASTM.
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Objective:To apply the ultrasonic shear wave elastography to evaluate triceps surae and Achilles tendon for patients with lower extremity dyskinesia after stroke. Methods:Thirty-two inpatients during 2018 and 2019 with unilateral lower extremity dyskinesia after stroke were studied with 2-D ultrasound and shear wave elastography on the bilateral triceps surae and Achilles tendons before and after rehabilitation. Shear wave velocity (SWV) of the triceps surae and the Achilles tendons, the length and thickness of Achilles tendon (soleus tendon) were measured. Results:Before rehabilitation, the SWV of the Achilles tendons and the triceps surae increased more in the affected side than in the unaffected side (t > 2.426, P < 0.05), as well as the length of the Achilles tendons (t = 11.801, P < 0.001). After rehabilitation, the SWV of the triceps surae decreased (t > 2.447, P < 0.05), as well as the length of the Achilles tendons (t = 8.577, P < 0.001). Conclusion:Ultrasound shear wave elastography can be used to evaluate the elastic characteristics of the Achilles tendon and the triceps surae, to guide the rehabilitation for stroke patients.
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Background: Stroke a global health problem is the second commonest cause of death and fourth leading cause of disability. Bed mobility the most important requisite for all activities in impaired in stroke. Retraining of bed mobility skills is very important to gain better outcome in the later phases of rehabilitation. Based on the concepts of motor learning there are numerous practice methods to retrain motor skills. Since sufficient literatures are not available in comparing the effect of massed practice and distributed practice on bed mobility skills among post stroke patients, there is a need for incorporating it in this study. Objectives: To compare the effect of massed practice and distributed on basic mobility skills among post stroke patients. Materials and Methods: Study was conducted as a quasi experimental design – pretest and posttest designs with two comparison treatments at the Department of Physical Medicine and Rehabilitation ,KMCH Hospitals, Coimbatore, Tamil Nadu, India. A total of 20 stroke patients in the age group of 45 to 60 years participated in the study. The participants who satisfied the selection criteria were selected by convenience sampling and randomly assigned into two groups. Group A received bed mobility training using massed practice method and group B received bed mobility training using distributed practice method for 7 days. Outcomes were measured with bed mobility item of Stroke Rehabilitation Assessment of Movement (STREAM) scale. Results: All participants in group A and group B showed significant improvement in bed mobility item of STREAM scale with a mean difference of 11.2 and 15.9 respectively. The calculated ‘t’ value using the paired test for group A and B were 27.03 and 51.36 (P<0.005) respectively. When comparing between the groups using independent ‘t’ test, the bed mobility item of STREAM scores showed mean difference of 4.9 and ‘t’ value of 9.7 (P<0.005). Conclusion: This study revealed that there was significant improvement in bed mobility skills following distributed practice method than massed practice method among post stroke patients.
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Objective:To explore the influence of social-psychological factors on outcome of joint rehabilitation. Methods:From October, 2015 to April, 2017, 64 inpatients accepting joint rehabilitation were divided into anxiety group and non-anxiety group, and depression group and non-depression group, according to the scores of Hamilton Anxiety Scale and Hamilton Depression Scale. They were assessed with routine joint scores as initial and final stages of joint rehabilitation, as well as Symptom Checklist-90 (SCL-90) and World Health Organization Disability Assessment Schedule 2.0 (WHO-DAS 2.0). The correlation of joint scores to scores of SCL-90 and WHO-DAS 2.0 was analyzed with Spearman correlation analysis. Results:There were significant differences in joint scores between the depression and the non-depression groups initially and finally (|t| > 2.106, P < 0.05). The joint score at the initial stage was negatively correlated with the interpersonal factor score of SCL-90 (r = -0.257, P < 0.05). The joint score at the final stage was negatively correlated (P < 0.05) with the dimension one (r = -0.257) and four (r = -0.278) of WHO-DAS 2.0, total score (r = -0.263), and interpersonal (r = -0.328) and hostile (r = -0.385) factor scores of SCL-90. Improvement of joint score negative correlated with dimension one of WHO-DAS 2.0 score (r = -0.249, P < 0.05). Conclusion:The social-psychological factors affect the outcome of joint rehabilitation. It is necessary to explore the way to take the the social-psychological assessment into the routine three stage evaluation of the joint rehabilitation protocol.
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Objective:To evaluate the concurrent validity of Chinese version of Action Research Arm Test (C-ARAT) in patients with first early cerebral infarction. Methods:From August, 2015 to December, 2018, 90 inpatients with first early cerebral infarction in the department of rehabilitation medicine of the First Affiliated Hospital, Sun Yat-sen University were enrolled. They were evaluated with C-ARAT and Fugl-Meyer Assessment-Upper Extremities (FMA-UE). Concurrent validity was determined using Spearman's rank correlation coefficients (ρ). Results:C-ARAT and subscales generally exhibited good-to-excellent correlations with FMA-UE (ρ > 0.75, P ˂ 0.001). Conclusion:At early stage of first cerebral infarction, C-ARAT demonstrated good-to-excellent concurrent validity.
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Objective:To evaluate the body function, structure, activities and participation, and environmental factors of stroke patients using the Comprehensive ICF Core Set for Stroke, and explore the correlation among them. Methods:From July, 2012 to June, 2014, 2822 stroke inpatients from 57 health service centres were assessed with Comprehensive ICF Core Set for Stroke. The ICF categories and the relationship among them were analyzed. Results:The most serious barriers for the stroke patients involved in gait pattern, muscle power, control of voluntary movement, driving, doing housework, and remunerative employment in the domains of body functions and activities and participation; and products and technology of design, building and construction of buildings, products and technology for personal indoor and outdoor mobility and transportation, labor and employment services and policies in the domains of environmental factors. There was positive correlation between the categories of body functions and activities and participation (r = 0.712, r = 0.694, P < 0.001), activities and participation-performance and activities and participation-capacity (r = 0.877, P < 0.001), and environmental factors-barrier and activities and participation-performance (r = 0.308, P < 0.001). Conclusion:Comprehensive ICF Core Set for Stroke may be used as a standard tool for evaluation for stroke patients, which benefit for rehabilitation practice.
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Objective To evaluate the clinical effect of infrared polarized light irradiation in the treatment of frozen shoulder. Methods A total of 150 patients with frozen shoulder who were treated in the rehabilitation department of Tianjin People's Hospital from October 2015 to December 2018 were randomly divided into a control group (75 cases) and a treatment group (75 cases) using a random number table. Finally, 120 patients who underwent the complete treatment were enrolled including 67 in the treatment group and 53 in the control group. The patients in the treatment group was treated with infrared polarized light irradiation combined with shoulder joint mobilization, and in the control group was treated with shoulder mobilization alone. The whole course is 2 months, and the treatment was 5 times a week. In each treatment, the duration of infrared polarized light irradiation is 10 min and the duration of joint mobilization is 15 to 20 min. Rehabilitation assessment of pain (visual analogue scale, VAS), range of motion (ROM), muscle strength and self-rating anxiety scale (SAS) were performed before the first treatment and after 2 weeks of treatment. Results Before the treatment, there were no statistically significant differences in VAS, ROM, muscle strength and SAS scores between the two groups (all P>0.05). Compared with that before treatment, VAS and SAS scores were significantly decreased, ROM and muscle strength scores were significantly increased in the two groups after 2 weeks treatment (all P<0.01). After 2 weeks of treatment, there were significant differences in VAS scores, muscle strength scores, the ROM of flexion, extension, adduction and abduction between the two groups (all P<0.05), but there were no significant difference in ROM of internal rotation, external rotation and SAS scores between the two groups (all P>0.05). The improvements of the indicators in the treatment group was greater than that of the control group. Conclusions Infrared polarized light irradiation can significantly improve the treatment effect of frozen shoulder.
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@#The bilateral coordination and counterbalance is a major principle that governs the normal function of upper limbs and hands, and its disturbances are the important mechanism underling the dysfunction of upper limbs and hands after stroke. This paper proposed the concept of Left-Right Coordination and Counterbalance of the upper limbs and hands, summarized the normal pattern and abnormal characteristics after stroke, introduced associated neural mechanisms, and analyzed the application in the assessments and rehabilitation after stroke and the prospects in the future. It might be useful to consider this concept in practice to improve the effects of upper limb and hand function rehabilitation.
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@#Objective To investigate the effect of comprehensive rehabilitation on ischemic-hypoxic encephalopathy at recovery stage. Methods From January, 2014 to December, 2016, the general data, rehabilitation evaluation, main problems, rehabilitation methods and the functional scores from 28 patients with ischemic-hypoxic encephalopathy were retrospectively analyzed.Results The patients improved in the scores of Mini-Mental State Examination, motor function and balance of Fugl-Meyer Assessment, Holden Gait Classification and modified Barthel Index after rehabilitation (Z>2.588, P<0.05).Conclusion The patients with ischemic-hypoxic encephalopathy may be benefited from comprehensive rehabilitation in cognition, motor function, walking and activities of daily living, etc.
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@#Objective To explore an accurate, comprehensive and easy-to-operate assessment of lower limbs exercise capacity for the football players. Methods From June, 2012 to June, 2015, seven healthy young football players (healthy group) and their seven teammates after thighs muscle strain returning to play (injured group) were measured the synergism constriction pattern, activation time and the degree of muscle activation of related muscle during single leg jump, with NORAXON, a 16-channel wireless electromyography telemetry system.Results The sequence of force was significant difference between the two groups (t>2.223, P<0.05). The contribution of long head of biceps was more in the injured group (t=2.778, P<0.05).Conclusion The sequence of muscle force in movement varies after lower extremities injury in athletes. Surface electromyography can test the weakness of local muscle of athletes, to help the evaluation and rehabilitation for them.
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@#Dysphagia is most common after medullary infarction, characterized by aspiration, residual pharynx and poor esophageal sphincter opening. The existence and severity of dysphagia can be preliminarily determined according to the site of infarction, and it is more likely to cause dysphagia on rostral, dorsal and lateral part of the medulla oblongata. High resolution manometry can be used to understand the biomechanical characteristics of the pharynx and upper segment of esophagus, and helps to evaluate dysphagia, especially combined with videofluoroscopic swallowing study, to guide the rehabilitation. Compensatory posture, electrical stimulation, transcranial magnetic stimulation and balloon dilatation are effective for the treatment.
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@#Dysphagia commonly occurs in Parkinson's disease (PD) at any stage, which may result in serious complications. The mechanism is uncertain. Swallowing Disturbance Questionnaire (SDQ) and Munich Dysphagia Test-Parkinson's Disease (MDT-PD) are often used for screening dysphagia in PD patients. But Non-motor Symptoms Questionnaire (NMSQ) and Unified Parkinson's Disease Rating Scale (UPDRS) underestimate the severity of dysphagia in PD patients. Videofluoroscopic Swallowing Examination (VFSE) and Videoendoscoptic Swallowing Study (VESS) are the gold standards for the dysphagia. There is no systemic management yet. Interventions includes medication, deep brain stimulation, etc. Early diagnosis and management facilitate to decrease the complications.
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This article showed the work pattern of rehabilitation assessment, and made assessment of a patient who suffered from bilat-eral hemiplegia and pseudobulbar paralysis caused by multiple cerebral apoplexy. Finally, the special characteristics of rehabilitation treat-ment for a patient with bilateral paralysis were summarized.
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@#Objective To explore the application of Brief ICF Core Sets for Chinese Stroke Patients in rehabilitation assessment for patients with stroke. Methods 180 patients with stroke accepted routine rehabilitation for 2 months, and were assessed with ICF core set, Barthel Index (BI), Functional Comprehensive Assessment (FCA) and WHO Disability Assessment Schedule (WHODAS II) before, 2 and 6 months after treatment. Results The score of BI, FCA and WHODAS II correlated with that of ICF core sets (P<0.05). Conclusion ICF core sets can be used as a tool to assess the function of patients with stroke.