DOCSLIB.ORG

Neuromuscular Electrical Stimulation in Neurorehabilitation

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Neuromuscular Electrical Stimulation in Neurorehabilitation INVITED REVIEW ABSTRACT: This review provides a comprehensive overview of the clini- cal uses of neuromuscular electrical stimulation (NMES) for functional and therapeutic applications in subjects with spinal cord injury or stroke. Func- tional applications refer to the use of NMES to activate paralyzed muscles in precise sequence and magnitude to directly accomplish functional tasks. In therapeutic applications, NMES may lead to a specific effect that enhances function, but does not directly provide function. The specific neuroprosthetic or “functional” applications reviewed in this article include upper- and lower- limb motor movement for self-care tasks and mobility, respectively, bladder function, and respiratory control. Specific therapeutic applications include motor relearning, reduction of hemiplegic shoulder pain, muscle strength- ening, prevention of muscle atrophy, prophylaxis of deep venous thrombo- sis, improvement of tissue oxygenation and peripheral hemodynamic func- tioning, and cardiopulmonary conditioning. Perspectives on future developments and clinical applications of NMES are presented. Muscle Nerve 35: 562–590, 2007 NEUROMUSCULAR ELECTRICAL STIMULATION IN NEUROREHABILITATION LYNNE R. SHEFFLER, MD, and JOHN CHAE, MD Cleveland Functional Electrical Stimulation Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, Ohio 44109, USA Accepted 4 January 2007 This article provides a comprehensive review of the performance of activities of daily living, and control clinical uses of neuromuscular electrical stimulation of respiration and bladder function. A neuropros- (NMES) in neurological rehabilitation. NMES refers thesis is a device or system that provides FES. Accord- to the electrical stimulation of an intact lower motor ingly, a neuroprosthetic effect is the enhancement of neuron (LMN) to activate paralyzed or paretic mus- functional activity that results when a neuroprosthe- cles. Clinical applications of NMES provide either a sis is utilized. NMES is also used for therapeutic functional or therapeutic benefit. Moe and Post207 purposes. NMES may lead to a specific effect that introduced the term functional electrical stimula- enhances function but does not directly provide tion (FES) to describe the use of NMES to activate function. One therapeutic effect is motor relearn- paralyzed muscles in precise sequence and magni- ing, which is defined as “the recovery of previously tude so as to directly accomplish functional tasks. In learned motor skills that have been lost following present-day applications, functional tasks may in- localized damage to the central nervous system.”180 clude standing or ambulatory activities, upper-limb Evolving basic science and clinical studies on central motor neuroplasticity now support the role of active repetitive-movement training of a paralyzed limb. If Available for Category 1 CME credit through the AANEM at www.aanem.org. active repetitive-movement training facilitates motor relearning, then NMES-mediated repetitive-move- Abbreviations: ANN, artificial neural network; DVT, deep venous thrombo- sis; ECU, external control unit; EMG, electromyography; FES, functional elec- ment training may also facilitate motor relearning. trical stimulation; Fint, fatigue-intermediate; FR, fatigue-resistant; LMN, lower Other examples of therapeutic applications include motor neuron; LSU-RGO, Louisiana State University Reciprocating Gait Or- thosis; LTP, long-term potentiation; MHC, myosin heavy chain; MRI, magnetic treatment of hemiplegic shoulder pain, cardiovascu- resonance imaging; NMES, neuromuscular electrical stimulation; PG/PS, pat- lar conditioning, treatment of spasticity, and preven- tern generator / pattern shaper; PID, proportional integral derivative; RF, ra- diofrequency; ROM, range of motion; SCI, spinal cord injury; TENS, transcu- tion of muscle atrophy, disuse osteoporosis, and taneous electrical nerve stimulation; UMN, upper motor neuron deep venous thrombosis (DVT). Key words: bladder function; functional electrical stimulation; motor relearn- ing; neuromuscular electrical stimulation; neuroprosthesis; rehabilitation; re- This review focuses on the clinical uses of NMES spiratory control; spinal cord injury; stroke for functional and therapeutic applications in pa- Correspondence to: L.R. Sheffler; e-mail: lsheffl[email protected] tients with spinal cord injury or stroke. In order to © 2007 Wiley Periodicals, Inc. Published online 13 February 2007 in Wiley InterScience (www.interscience. provide a foundation for the various clinical appli- wiley.com). DOI 10.1002/mus.20758 cations, the neurophysiology of NMES and compo- 562 Neuromuscular Electrical Stimulation MUSCLE & NERVE May 2007 nents of NMES systems are briefly reviewed. The fiber diameter. The Henneman size principle of vol- specific neuroprosthetic or “functional” applications untary motor unit recruitment described this pro- include upper- and lower-limb motor movement for gressive size-dependent recruitment of motor self-care tasks and mobility, respectively, bladder units.128 Arbuthnott et al.9 examined in detail this function, and respiratory control. Specific therapeu- relationship between fiber diameter and conduction tic applications include poststroke motor relearning velocity in peripheral nerve. The nerve fiber recruit- as well as the examples mentioned earlier. Lastly, ment pattern mediated by NMES follows the princi- perspectives on future developments and clinical ap- ple of “reverse recruitment order” wherein the nerve plications of NMES are presented. stimulus threshold is inversely proportional to the diameter of the neuron. Thus, large-diameter nerve NEUROPHYSIOLOGY OF NMES fibers, which innervate larger motor units, are re- cruited preferentially. Recent work by Lertmanorat NMES is initiated with the excitation of peripheral and Durand183 proposes the clinical applicability of a nervous tissue. The mathematical characterization of reshaping of the extracellular voltage that may allow neuronal action potential generation is largely predi- the reversal of the “reverse recruitment order” elic- cated on the seminal work of scientists and neurophysi- ited by NMES. ologists including Galvani,106 Lapicque175 and NMES is dependent on an intact (alpha) LMN. Hodgkin and Huxley.130 More recently, McNeal200 Several studies document the therapeutic benefit of mathematically defined the time course of events fol- electrical stimulation on muscle-fiber regeneration lowing stimulus application to the propagation of the in LMN denervation50,149,280; however, the clinical action potential in a normal healthy myelinated nerve. application of NMES is presently limited to neuro- The term “stimulus threshold” defines the lowest level logic injuries involving the upper motor neuron of electrical charge that generates an action potential. (UMN) such as spinal cord injury (SCI), stroke, The “all or none” phenomenon of the action potential brain injury, multiple sclerosis, and cerebral palsy. produced by natural physiologic means is identical to NMES is delivered as a waveform of electrical cur- the action potential induced by NMES. rent characterized by stimulus frequency, amplitude, Conduction of impulses in a nerve is influenced and pulse width. The amplitude and pulse width considerably by the nerve’s cable properties. determine the number of muscle fibers that are Hodgkin and Rushton in 1946131 used extracellular activated.209 Temporal summation is determined by electrodes to measure applied current along lobster the rate at which stimulus pulses are applied to axons to describe the spread of current along nerve muscle. The strength of the resultant muscle con- fibers of uniform diameter composed of a central traction is modulated by adjustment of the stimulus conductor and insulating sheath. Nerve fiber recruit- parameters. The minimum stimulus frequency that ment and resultant force characteristics of muscle generates a fused muscle response is ϳ12.5 Hz. contraction are modulated by both stimulus pulse Higher stimulus frequencies generate higher forces width277 and stimulus frequency.3 Other variables but result in muscle fiber fatigue and rapid decre- include distance from the stimulating electrode and ment in contractile force. An optimal NMES system membrane capacitance. The threshold for eliciting a utilizes the minimal stimulus frequency that pro- nerve fiber action potential is 100 to 1,000 times less duces a fused response.26,173,200 Ideal stimulation fre- than the threshold for muscle fiber stimulation.209 quencies range from 12–16 Hz for upper-limb appli- Thus, clinical NMES systems stimulate either the cations and 18–25 Hz for lower-limb applications nerve directly or the motor point of the nerve prox- (frequency range for NMES systems is 10–50 Hz). imal to the neuromuscular junction. Greater muscle force generation is accomplished by The nerve fiber recruitment properties elicited either increasing the pulse duration (typically 200 by NMES differ from those elicited by normal phys- ␮s) or stimulus amplitude to activate neurons at a iologic means. An action potential produced by nor- greater distance from the activating electrode. Pa- mal physiologic mechanisms initially recruits the rameters for safe stimulation for implanted NMES smallest-diameter neurons prior to recruitment of systems have been established experimentally.209 larger-diameter fibers, such as alpha motor neu- The clinical application of NMES systems is com- rons.127 Rushton248 was one of the first researchers to plicated by the fact that
Load more

Recommended publications
  • Neurological Principles and Rehabilitation of Action Disorders: Rehabilitation Interventions
    Neurorehabilitation and Neural Repair Neurological Principles and Supplement to 25(5) 33$--435 ©TheAuthor(s) 2011 Reprints and permission: http://W'NW. Rehabilitation of Action Disorders: sagepub.com/journalsPermissions.nav DOl: 10.1 1771154596831 1410942 Rehabilitation Interventions http://nnr.sagepub.com ®SAGE I 3 Valerie Pomeroy, PhD , Salvatore M. Aglioti, MD\ VictorW. Mark, MD , 4 6 Dennis McFarland, PhD , Cathy Stinear, PhD\ Steven L. Wolf, PhD , 7 7 Maurizio Corbetta, MD , and Susan M. Fitzpatrick, PhD ,8 This third chapter discusses the evidence for the rehabilitation of the most common movement disorders of the upper extremity. The authors also present a framework, building on the computation, anatomy, and physiology (CAP) model, for incorporating some of the principles discussed in the 2 previous chapters by Frey et al and Sathian et al in the practice of rehabilitation and for discussing potentially helpful interventions based on emergent neuroscience principles. Introduction General Principles for Delivery of Therapy Interventions Much of the evidence-based body of knowledge informing upper-limb rehabilitation has been generated from research Delivery of therapy interventions is multifaceted, and certain with patients recovering from stroke. It is not srnprising, general principles should be considered in each patient: given the number of affected individuals worldwide, that stroke would serve as the dominant model. However, many 1, The establishment of a 'contract' between people principles informing neurorehabilitation interventions can with neurological deficits and their therapy team. be translated from stroke into interventions for other neuro­ 2. Analysis of behavioral deficits in relation to known logical conditions when appropriate. principles of brain organization.
    [Show full text]
  • Occupational Therapy Consensus Recommendations for Functional Neurological Disorder
    Occasional essay J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp-2019-322281 on 30 July 2020. Downloaded from Occupational therapy consensus recommendations for functional neurological disorder Clare Nicholson ,1 Mark J Edwards,2 Alan J Carson,3 Paula Gardiner,4 Dawn Golder,5 Kate Hayward,1 Susan Humblestone,6 Helen Jinadu,7 Carrie Lumsden,8 Julie MacLean,9 Lynne Main,10 Lindsey Macgregor,11 Glenn Nielsen,2 Louise Oakley,12 Jason Price,13 Jessica Ranford,9 Jasbir Ranu,1 Ed Sum,14 Jon Stone 3 ► Additional material is ABSTRact jerks and dystonia), sensory symptoms, cognitive published online only. To view Background People with functional neurological deficits and seizure-like events (commonly known please visit the journal online as dissociative seizures or non- epileptic seizures). (http:// dx. doi. org/ 10. 1136/ disorder (FND) are commonly seen by occupational jnnp- 2019- 322281). therapists; however, there are limited descriptions in the Fatigue and persistent pain are also commonly literature about the type of interventions that are likely experienced as part of the disorder. Symptoms For numbered affiliations see to be helpful. This document aims to address this issue by can present acutely and resolve quickly or can be end of article. providing consensus recommendations for occupational long lasting. Regardless of duration, those affected therapy assessment and intervention. frequently experience high levels of distress, Correspondence to Methods The recommendations were developed in four disability, unemployment, social care utilisation and Mrs Clare Nicholson, Therapy 2 Services, University College stages. Stage 1: an invitation was sent to occupational reduced quality of life. The stigma associated with London Hospitals NHS therapists with expertise in FND in different countries to FND contributes to the burden of the diagnosis.3 Foundation Trust National complete two surveys exploring their opinions regarding OT is generally recognised as an integral part Hospital for Neurology and best practice for assessment and interventions for FND.
    [Show full text]
  • Pes Anserine Bursitis
    BRIGHAM AND WOMEN’S HOSPITAL Department of Rehabilitation Services Physical Therapy Standard of Care: Pes Anserine Bursitis ICD 9 Codes: 726.61 Case Type / Diagnosis: The pes anserine bursa lies behind the medial hamstring, which is composed of the tendons of the sartorius, gracilis and semitendinosus (SGT) muscles. Because these 3 tendons splay out on the anterior aspect of the tibia and give the appearance of the foot of a goose, pes anserine bursitis is also known as goosefoot bursitis.1 These muscles provide for medial stabilization of the knee by acting as a restraint to excessive valgus opening. They also provide a counter-rotary torque function to the knee joint. The pes anserine has an eccentric role during the screw-home mechanism that dampens the effect of excessively forceful lateral rotation that may accompany terminal knee extension.2 Pes anserine bursitis presents as pain, tenderness and swelling over the anteromedial aspect of the knee, 4 to 5 cm below the joint line.3 Pain increases with knee flexion, exercise and/or stair climbing. Inflammation of this bursa is common in overweight, middle-aged women, and may be associated with osteoarthritis of the knee. It also occurs in athletes engaged in activities such as running, basketball, and racquet sports.3 Other risk factors include: 1 • Incorrect training techniques, or changes in terrain and/or distanced run • Lack of flexibility in hamstring muscles • Lack of knee extension • Patellar malalignment Indications for Treatment: • Knee Pain • Knee edema • Decreased active and /or passive ROM of lower extremities • Biomechanical dysfunction lower extremities • Muscle imbalances • Impaired muscle performance (focal weakness or general conditioning) • Impaired function Contraindications: • Patients with active signs/symptoms of infection (fever, chills, prolonged and obvious redness or swelling at hip joint).
    [Show full text]
  • Gait Analysis in Prosthetics by James R
    Gait Analysis in Prosthetics by James R. Gage, M.D. Ramona Hicks, R.P.T., M.A. REVIEW lems faced by lower limb amputees. Inman's measurement techniques included motion pic­ Objective measurement systems which quan­ tures of coronal and sagittal views, as well as tify locomotion have been in use for the past transverse rotations from below using a glass century. But not until World War II, when walkway. Using interrupted light photography, thousands of men returned home to the United the Biomechanics Laboratory team studied the States with amputations, was technology really motion of body segments during gait. Force applied to the understanding of prosthetic gait. plates measured the subject's ground reaction Inman and colleagues1 founded the Biome­ forces, and muscle activity was recorded using chanics Laboratory at the University of Cali­ electromyography (EMG), which measures the fornia to establish fundamental principles of electrical signals associated with contraction of human walking, particularly in relation to prob­ a muscle. Prior to Inman's fundamental studies, prostheses were customized for the individual Temporal and kinematic data, which were col­ amputee, without any particular regard to ra­ lected at slow, free, and fast speeds, showed tional structural design. Inman's goal was to that the hydraulic knees improved the symmetry provide fundamental data essential for the de­ between the prosthetic limb and the sound limb, sign of prosthetic limbs. By analyzing normal especially at the fast and free speeds. This human walking, he and his colleagues laid the finding was true for both cadence and the groundwork for biomechanical analysis of am­ amount of knee-flexion at swing phase.
    [Show full text]
  • Common Gait Deviations in the Patient with Hemiplegia
    Common gait deviations in the patient with hemiplegia Kim Carter, PT, NCS Things to consider • How did the patient walk before? • Any previous orthopedic conditions? • House set up • Where can they practice walking outside of therapy? • Caregiver’s ability (and/or willingness) to help patient Initial Contact • Problems – Ankle • Contacts with forefoot/flat foot – Is the step too short? – Is the gastroc tight? » Stretch in sitting » Stretch in long sit » Stretch in standing » Stretch in supine Initial Contact • Problems – Ankle • Contacts with the forefoot/flat foot – Are the dorsiflexors weak? » Seated exercises » Standing exercises » Supine exercises » Taping » Bracing Initial Contact Initial Contact • Problems – Knee • Flexed at contact – Look at the ankle first – Tone-inability to extend knee with hip flexion at terminal swing – Are the hamstrings tight? » Supine stretch » Long sit stretch » Sitting stretch » Standing stretch Initial Contact • Problems – Pelvis • Rotation – Inadequate advancing of the leg » Manual cues for orientation of pelvis » Muscular tightness Initial Contact • Problems – Trunk • Flexed – Tight hip flexors – May be due to increased plantarflexion • Rotated – May be rotated forward to advance the leg Loading response • Ankle – Foot slap • Weak dorsiflexors – Closed chain dorsiflexion Loading Response • Knee – Hyperextension • May be due to short step • Muscular weakness – Modified stride squats – Standing knee extension against theraband – Affected leg on step, step up with sound side Midstance • Problems – Ankle
    [Show full text]
  • The Role of Spasticity in Functional Neurorehabilitation- Part I: The
    Research article iMedPub Journals ARCHIVES OF MEDICINE 2016 http://www.imedpub.com/ Vol.8 No.3:7 ISSN 1989-5216 The Role of Spasticity in Functional Neurorehabilitation- Part I: The Pathophysiology of Spasticity, the Relationship with the Neuroplasticity, Spinal Shock and Clinical Signs Angela Martins* Department of Veterinary Science, Lusophone University of Humanities and Technology, Hospital Veterinário da Arrábida, Portugal *Corresponding author: Angela Martins, Department of Veterinary Science, Lusophone University of Humanities and Technology, Hospital Veterinário da Arrábida, Portugal, Tel: 212181441; E-mail: [email protected] Rec date: Feb 29, 2016; Acc date: Apr 05, 2016; Pub date: April 12, 2016 Copyright: © 2016 Martins A. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Citation: Martins A. The Role of Spasticity in Functional Neurorehabilitation- Part I: The Pathophysiology of Spasticity, the Relationship with the Neuroplasticity, Spinal Shock and Clinical Signs. Arch Med. 2016, 8:3 the quadrupeds spinal cord injuries are predominantly thoraco-lumbar [6] due to the discontinuity of the intercapital Abstract ligament [6], the clinical sign of spasticity is frequently addressed in functional neurorehabilitation (FNR) [7-9]. The symptom/clinical sign of spasticity is extremely Spasticity both on the biped and quadruped usually develops important in functional neurorehabilitation, since it in the antigravity muscles. reduces the functional independence both in the quadruped animal as in the human biped. In the human biped, spasticity appears in the upper- extremity flexor muscles as result of a stroke, whereas an This clinical sign/symptom manifests itself alonside with excessive muscle spasm is in the lower extremity extensor pain, muscle weakness, impaired coordination and poor muscles is secondary to SCI.
    [Show full text]
  • Brain-Machine Interface: from Neurophysiology to Clinical
    Neurophysiology of Brain-Machine Interface Rehabilitation Matija Milosevic, Osaka University - Graduate School of Engineering Science - Japan. Abstract— Long-lasting cortical re-organization or II. METHODS neuroplasticity depends on the ability to synchronize the descending (voluntary) commands and the successful execution Stimulation of muscles with FES was delivered using a of the task using a neuroprosthetic. This talk will discuss the constant current biphasic waveform with a 300μs pulse width neurophysiological mechanisms of brain-machine interface at 50 Hz frequency via surface electrodes. First, repetitive (BMI) controlled neuroprosthetics with the aim to provide transcranial magnetic stimulation (rTMS) intermittent theta implications for development of technologies for rehabilitation. burst protocol (iTBS) was used to induce cortical facilitation. iTBS protocol consists of pulses delivered intermittently at a I. INTRODUCTION frequency of 50 Hz and 5 Hz for a total of 200 seconds. Functional electrical stimulation (FES) neuroprosthetics Moreover, motor imagery protocol was used to display a can be used to applying short electric impulses over the virtual reality hand opening and closing sequence of muscles or the nerves to generate hand muscle contractions movements (hand flexion/extension) while subject’s hands and functional movements such as reaching and grasping. remained at rest and out of the visual field. Our work has shown that recruitment of muscles using FES goes beyond simple contractions, with evidence suggesting III. RESULTS re-organization of the spinal reflex networks and cortical- Our first results showed that motor imagery can affect level changes after the stimulating period [1,2]. However, a major challenge remains in achieving precise temporal corticospinal facilitation in a phase-dependent manner, i.e., synchronization of voluntary commands and activation of the hand flexor muscles during hand closing and extensor muscles [3].
    [Show full text]
  • Psychotherapy in Neurorehabilitation
    Review Psychotherapy in Neurorehabilitation Neurologie, Eichhornstrasse 68 78464 Konstanz Authors Germany Roger Schmidt1, 2, Kateryna Piliavska2, Dominik Maier­Ring2, roger.schmidt@uni­konstanz.de Dominik Klaasen van Husen1, Christian Dettmers2, 3 ABSTRACT Affiliations 1 Kliniken Schmieder Konstanz, Psychotherapeutische The range of treatments available for neurorehabilitation must Neurologie, Konstanz include appropriate psychotherapeutic approaches, if only be­ 2 Kliniken Schmieder Allensbach, Lurija Institut für cause of the frequent occurrence of psychological co­morbidi­ Rehabilitationswissenschaften und Gesundheitsfor­ ties, not always diagnosed and appropriately treated. The cur­ schung an der Universität Konstanz rent situation is characterized by a large variety of available 3 Kliniken Schmieder Konstanz, Neurologie, Konstanz treatments, dearth of treatment studies and proven evidence. This state of affairs emphasizes the diversity and complexity of Key words neurological disease. The presence of collateral psychological comorbidity, psychotherapeutic approaches, multimodal problems in particular requires individually tailored treat­ psychotherapy, bio­psychosocial approach, interdisciplinary ments. Damage to the CNS requires that particular attention be paid to the closely interwoven functions of the body and Bibliography mind. What follows is the need for multimodal psychotherapy, DOI http://dx.doi.org/10.1055/s-0043-104643 grounded in neurology. Taking into account the various treat­ Neurologie, International Open 2017; 1: E153–E159 ment approaches and regimens, therapy needs to be directly © Georg Thieme Verlag KG Stuttgart · New York integrated in a meaningful, coherent way into other measures ISSN 2511-1795 of neurological rehabilitation. Against this background, the paper gives an overview of clinical needs and therapeutic pro­ Correspondence cedures as well as regarding the requirements and perspectives Prof. Dr.
    [Show full text]
  • Brain-Computer Interfaces in Neurological Rehabilitation
    British Society of Rehabilitation Medicine Brain-Computer Interfaces in neurological rehabilitation Essay Prize Submission 2013 Kundan Iqbal Newcastle University BSRM Essay Prize Submission 2013 Kundan Iqbal During my third year clinical rotations, I met Melissa1, a 12 year old who suffered a haemorrhagic stroke caused by an undetected brain tumour, which left her suffering with locked-in syndrome (LIS). LIS is a rare condition caused by brainstem damage resulting in sudden quadriplegia (sometimes sparing ocular muscles), with preserved consciousness and cognition. Sufferers are left severely limited. Meeting Melissa initiated my interest in therapies to improve the abilities and function of those with severe neuromuscular disorders including LIS. 1 Name and age has been changed to preserve anonymity 1 BSRM Essay Prize Submission 2013 Kundan Iqbal INTRODUCTION ........................................................................................................................................................................3 WHAT ARE BCIS? ......................................................................................................................................................................3 TYPES OF BRAIN SIGNALS........................................................................................................................................................3 HOW DO BCIs WORK?.............................................................................................................................................................5
    [Show full text]
  • Health Sciences Library New Book List: July - December 2018 Page 1 of 6
    Health Sciences Library New Book List: July - December 2018 Page 1 of 6 Peer support best practice toolkit: a resource for individuals developing and providing peer support programs for families of children with medical complexity and other lifelong disabilities. Contents: 1. Background and models of peer support -- 2. Current HQ759.913 .P43 programs in Ontario: case studies -- 3. Resources to help you get started - - 4. Rapid evidence review: peer support for families of children with disabilities. Holland Bloorview Kids Rehabilitation Hospital. Holland Bloorview Kids Rehabilitation Hospital, [2015]. 1 volume (unpaged). A therapeutic clown emerges: our story of recruitment and training. A full-length documentary film which traces the recruitment and training of the newest therapeutic clown. WB880 .D66 Conceived and written by Helen Donnelly. Directed and edited by Helen Donnelly & Greg Vanden Kroonenberg. Narrated by Diane Savage. Holland Bloorview Kids Rehabilitation Hospital, 2018. 1 videodisc (107 min.) Cognitive rehabilitation for pediatric neurological disorders. Chapter contributed by Holland Bloorview staff: Chapter 6 – Lisa Kakonge WS340 .C63 Locascio, Gianna, editor. Cambridge University Press, [2018]. xi, 263 pages Goal setting and motivation in therapy. Chapter contributed by Holland Bloorview staff: Chapter 5 – Gillian King WS350.2 .G62 Poulsen, Anne A., editor. Jessica Kingsley Publishers, 2015. 269 pages. Qualitative research design: an interactive approach. Maxwell, Joseph Alex, 1941-, SAGE Publications, 2013. xi, 218
    [Show full text]
  • Section I Introduction
    SECTION I INTRODUCTION 1. OVERVIEW The National Center for Medical Rehabilitation Research (NCMRR) was established within the National Institutes of Health (NIH) by legislation (P.L. 101-613) passed in 1990. The Center is a component of the National Institute of Child Health and Human Development (NICHD). The mission of NCMRR is to foster development of scientific knowledge needed to enhance the health, productivity, independence, and quality of life of people with physical disabilities. The primary goal of the Center is to bring the health related problems of people with disabilities to the attention of America’s best scientists in order to capitalize upon the myriad advances occurring in the biological, behavioral, and engineering sciences. This is accomplished in part, by supporting research on enhancing the functioning of people with disabilities in daily life. Periodically the Center also sponsors workshops which allow experts in a field to gather and focus on a topic of interest. This document contains a detailed description of the design, execution, results and interpretation of the workshop “Gait Analysis in Rehabilitation Medicine.” 1.1 Purpose The primary purpose of the workshop, described within this document, was to develop and prioritize a set of recommendations that pertain to the future role of gait analysis in enhancing the function of people with disabilities due to functional limitations of the locomotion system. Although the workshop was entitled "Gait Analysis in Rehabilitation Medicine," the range of topics which gait encompasses is much broader than the classical definition of bi or quadri pedal motion might imply. Gait clinics and laboratories include analysis of many forms of human locomotion which often include the use of assistive devices such as crutches, canes, prosthetics, and wheelchairs.
    [Show full text]
  • Neurorehabilitation in MS the Rôle of Neuroplasticity Jürg Kesselring
    Disclosure & declaration of interests Prof. Dr. med. Jürg Kesselring, FRCP Head of the Department of Neurology and Neurorehabilitation Rehabilitation Centre Valens CH-7317 Valens Switzerland Tel +41 (0)81 303 14 08 www.kliniken-valens.ch • Interest in resilience since birth (uplifting forces) • applied learning since school age (uninterrupted since) • practicing & rehearsing music (cello) since november 1960 • applying neuroplasticity to neurological patients in Valens (& elsewhere) since july 1987 • teaching Clinical Neuroscience at Centre of Neuroscience University Zürich since 1999 • DMC FTY/BAF studies (Novartis) since 2005 • Member of ICRC (since 1.1.11) • First Honorary President of Swiss MS Society Recovery mechanisms: diaschisis (von Monakow 1914) A process in which neurons function abnormally because influences necessary to their normal functions have been removed by damage to neurons to which they have been connected Neuroplasticity – the flexible brain Legal basis forGesetzliche neurorehabilitation Grundlagen in Switzerland Base legale KVG Art. 32 Medical applications must be effective appropriate economic effectiveness must be determined and proven by scientific methods Neurorehabilitation Valens (1987 - 2015) N= 373 – 2565 (+687%) Multiple Sclerosis 0 - 652 (+%) stroke 105/124 -796 (+247%) ischemia haemorrhage Tumor 5-89 (+1680%) Trauma+ others 22/40 - 449 (+624%) Parkinson 0-188 (+ %) Epilepsy 0-118 + % Peripheral 14-213 +1421% Multiple Sclerosis: longterm disease course Age 53-57 years RR: after 22,1 years PP: after 9,6
    [Show full text]