Search

Existing theoretical evidence indicates sensorimotor retraining is beneficial following wrist injury. However, there are no large cohort studies applying the knowledge in a clinical setting.To Determine the clinical benefits of sensorimotor rehabilitation following distal upper extremity injury.Prospective cohort study.A sensorimotor rehabilitation program was evaluated following distal upper extremity injury. A battery of clinical and patient-rated outcome measures (PROM) were taken before and after group completion.Ninety-three patients, 49 males (53%) and 44 females (47%), completed the program. There were statistically significant improvements in 12 clinical measures. However, improvements in 11 of the clinical measures only had a small effect size (0.5). Joint position sense had the greatest clinical change with a median improvement of 4° on the left and 3.9° on the right, and these had moderate effect sizes of 0.5 and 0.7, respectively. There were statistically significant improvements in all PROMs. PRWE had a median improvement of 21 (ES = 1.2). UEFI showed median improvements of 19.7 (ES = 1.4) and NRS (pain) median improved 2.5 (ES = 1.2). All PROM improvements had mean change greater than associated MCIDs.These results indicate the benefits of sensorimotor group rehabilitation and supports existing literature regarding the importance of sensorimotor control for JPS accuracy and function. Group based sensorimotor programs present an efficient and low-cost opportunity to provide intervention to patients following upper extremity injury.A sensorimotor group rehabilitation program may improve patient outcomes following distal upper extremity injury.Level 2b prospective cohort.

Purpose Survivors of stroke experience poor oral health during and following hospitalisation. Health professionals consistently report that oral hygiene is complex. Interventions aiming to improve the delivery of oral hygiene care by health professionals rarely use a theoretically driven approach. This study reports the first phase in an intervention development and uses the action, actor, context, target, time (AACTT) framework and theoretical domains framework (TDF) to understand who needs to do what differently in the delivery of oral hygiene care with hospitalised stroke survivors. Method Mixed methods including analysis of oral health policies and clinical guidelines using the AACTT framework, focus group discussions using the TDF and audit of 60 medical records. Results Policies and guidelines lack specificity regarding what oral hygiene care is and who should be responsible. Health professionals have low beliefs in their capabilities and experience numerous contextual barriers. More than 40% of patients had no documented evidence of oral hygiene care. Conclusion This study used a theoretically driven approach to identify barriers and enablers to health professional delivery of oral hygiene care with stroke survivors. Interventions aiming to improve clinical practice should target beliefs about capabilities, improved access to resources and detailed oral hygiene clinical guidelines.Implications for rehabilitationSurvivors of stroke experience poor oral health which can contribute to further strokes, cardiovascular disease and mortality.Health care professionals report difficulties in delivering oral hygiene care to hospitalised stroke survivors and clinical guidelines lack detail regarding oral health assessments, interventions and training.Interventions aiming to improve the delivery of oral hygiene care should target health professional beliefs about their capabilities using strategies such as behavioural practice.Resources specific to oral hygiene care for more complex patients, including suctioning toothbrushes, should be readily accessible for health professional use.Clinical guidelines and policies on oral hygiene care should include detail about training content, assessments tools and how to adapt information for patients with complex impairments.

Tele-neurorehabilitation has the potential to reduce accessibility barriers and enhance patient outcomes through a more seamless continuum of care. A growing number of studies have found that tele-neurorehabilitation produces equivalent results to usual care for a variety of outcomes including activities of daily living and health related quality of life. Despite the potential of tele-neurorehabilitation, this model of care has failed to achieve mainstream adoption. Little is known about feasibility and acceptability of tele-neurorehabilitation and most published studies do not use a validated model to guide and evaluate implementation. The technology acceptance model (TAM) was developed 20 years ago and is one of the most widely used theoretical frameworks for predicting an individual's likelihood to adopt and use new technology. The TAM3 further built on the original model by incorporating additional elements from human decision making such as computer anxiety. In this perspective, we utilize the TAM3 to systematically map the findings from existing published studies, in order to explore the determinants of adoption of tele-neurorehabilitation by both stroke survivors and prescribing clinicians. We present evidence suggesting that computer self-efficacy and computer anxiety are significant predictors of an individual's likelihood to use tele-neurorehabilitation. Understanding what factors support or hinder uptake of tele-neurorehabilitation can assist in translatability and sustainable adoption of this technology. If we are to shift tele-neurorehabilitation from the research domain to become a mainstream health sector activity, key stakeholders must address the barriers that have consistently hindered adoption.

Evaluating progress throughout a patient's rehabilitation episode is critical for determining the effectiveness of the selected treatments and is an essential ingredient in personalised and evidence-based rehabilitation practice. The evaluation process is complex due to the inherently large human variations in motor recovery and the limitations of commonly used clinical measurement tools. Information recorded during a robot-assisted rehabilitation process can provide an effective means to continuously quantitatively assess movement performance and rehabilitation progress. However, selecting appropriate motion features for rehabilitation evaluation has always been challenging. This paper exploits unsupervised feature learning techniques to reduce the complexity of building the evaluation model of patients’ progress. A new feature learning technique is developed to select the most significant features from a large amount of kinematic features measured from robotics, providing clinically useful information to health practitioners with reduction of modeling complexity. A novel indicator that uses monotonicity and trendability is proposed to evaluate kinematic features. The data used to develop the feature selection technique consist of kinematic data from robot-aided rehabilitation for a population of stroke patients. The selected kinematic features allow for human variations across a population of patients as well as over the sequence of rehabilitation sessions. The study is based on data records pertaining to 41 stroke patients using three different robot assisted exercises for upper limb rehabilitation. Consistent with the literature, the results indicate that features based on movement smoothness are the best measures among 17 kinematic features suitable to evaluate rehabilitation progress.

Purpose: Despite their promise to increase therapy intensity in neurorehabilitation, robotic devices have not yet seen mainstream adoption. Whilst there are a number of contributing factors, it is obvious that the treating clinician should have a clear understanding of the objectives and limitations of robotic device use. This study sought to explore how devices can be developed to support a clinician in providing clinical best practice.Methods and Materials: A user-centred design study of a robotic device was conducted, involving build-then-use iterations, where successive iterations are built based on feedback from the use cycle. This work reports results of an analysis of qualitative and quantitative data describing the use of the robotic device in the clinical sessions, and from a focus group with the treating clinicians.Results and Conclusions: The data indicated that use of the device did not result in patient goal-setting and may have resulted in poor movement quality. Therapists expected a higher level of autonomy from the robotic device, and this may have contributed to the above problems. These problems can and should be addressed through modification of both the study design and device to provide more explicit instructions to promote clinical best practice.IMPLICATIONS FOR REHABILITATIONEncouraging clinical best practice when using evaluating prototype devices within a clinical setting is important to ensure that best practice is maintained - and can be achieved through both study and device designSupport from device developers can significantly improve the confidence of therapists during the use of that device in rehabilitation, particularly with new or prototype devicesEnd effector-based robotic devices for rehabilitation show potential for a wide variety of patient presentations and capabilities.

Rationale, aims and objectives There is a high prevalence of upper limb impairment following a stroke in both the acute and chronic phases of recovery. Evidence suggests that patients do not receive recommended amounts of task specific practice. Robotics provide a potential solution to address this gap but clinical adoption is low. Studies have found that adoption of technology is largely determined by perceived ease of use and perceived usefulness. The aim of this study was to utilise the extended technology acceptance model (TAM2) as a framework to identify factors influencing clinician adoption of a robotic device into clinical practice. Methods Mixed methods study including survey data and focus group discussions across two health services. Participants were allied health professionals whose primary caseload is rehabilitation of the neurologically impaired upper limb. TAM2 surveys were collected pre/post exposure to and use of a robotic device for a period of 3-months. Focus groups were conducted at conclusion of the 3-month period of using the robotic device. Results A total of 34 rehabilitation clinicians completed the pre/post TAM2 surveys. Results indicate that following exposure to the robotic device, there was a statistically significant change in perceived usefulness and perceived ease of use. Two focus groups with 12 participants revealed that lack of experience and protected time to learn how to use such devices were strong moderators of perceived behavioural control. Conclusion This study found that perceived usefulness and perceived ease of use can be moderated through experience. Clinicians reported a need for embedded technological support during the introductory phase of a robotic device in order to acquire the skills for safe and effective use. However, embedded support is rarely offered, suggesting there is a discordance between current implementation of robotic devices into practice and the learning needs of rehabilitation clinicians.

Background - Stroke is a leading cause of disability worldwide, with upper limb deficits affecting an estimated 30% to 60% of survivors. The effectiveness of upper limb rehabilitation relies on numerous factors, particularly patient compliance to home programs and exercises set by therapists. However, therapists lack objective information about their patients’ adherence to rehabilitation exercises as well as other uses of the affected arm and hand in everyday life outside the clinic. We developed a system that consists of wearable sensor technology to monitor a patient’s arm movement and a Web-based dashboard to visualize this information for therapists. Objective - The aim of our study was to evaluate how therapists use upper limb movement information visualized on a dashboard to support the rehabilitation process. Methods - An interactive dashboard prototype with simulated movement information was created and evaluated through a user-centered design process with therapists (N=8) at a rehabilitation clinic. Data were collected through observations of therapists interacting with an interactive dashboard prototype, think-aloud data, and interviews. Data were analyzed qualitatively through thematic analysis. Results - Therapists use visualizations of upper limb information in the following ways: (1) to obtain objective data of patients’ activity levels, exercise, and neglect outside the clinic, (2) to engage patients in the rehabilitation process through education, motivation, and discussion of experiences with activities of daily living, and; (3) to engage with other clinicians and researchers based on objective data. - A major limitation is the lack of contextual data, which is needed by therapists to discern how movement data visualized on the dashboard relate to activities of daily living. Conclusions - Upper limb information captured through wearable devices provides novel insights for therapists and helps to engage patients and other clinicians in therapy. Consideration needs to be given to the collection and visualization of contextual information to provide meaningful insights into patient engagement in activities of daily living. These findings open the door for further work to develop a fully functioning system and to trial it with patients and clinicians during therapy.

OBJECTIVE: To evaluate the implementation of a technology-assisted programme to intensify upper limb rehabilitation after stroke and other neurological conditions in an Australian community cohort. METHODS: A "Hand Hub" was established in a tertiary hospital. Intervention was delivered via individual or group sessions for a period of up to 6 weeks, in addition to the patients' regular therapy. Patients were assessed before and after the programme using validated measures. RESULTS: A total of 92 participants completed both assessments (mean age 57 years (standard deviation 17 years), 58% male and 88% with stroke). Post-intervention, participants showed significant improvement in arm function and strength (p

A new neuro-rehabilitation system is proposed to address the movement quality of post-stroke patients. The system is designed to be used concurrently with existing upper-extremity virtual rehabilitation devices, and to aide correction of compensatory trunk and shoulder movements. A 3D sensor is utilised to estimate the movement of the shoulder, and an auditory cue is given to the patient when the system estimates that a compensatory movement has been made. The results of preliminary trials of this system on a single patient are presented.