Transcript Advances in Stroke Rehab

Advances in Stroke Rehab
Randie Carter, OTR/L
UAB Spain Rehabilitation Center
Birmingham, AL
[email protected]
Advances in Treatment of Stroke
• OT and PT have always focused on both compensatory
and remediation strategies
• Compensatory: using atypical approaches to meet and
accomplish the task at hand using mechanisms not
typically used; changing up how a task was performed
via steps using what they have remaining or modifying
the environment it is being performed in
• Remedial: ID of the core deficit(s) and then utilizing
specific strategies to treat and improve that deficits to
thereby increase and improve function
Body Weight supported Treadmill
training
Pros:
– Dynamic task
– Repetitive task that incorporates weight bearing, stepping
and balance
– Allows for early ambulation; can discourage compensatory
gait patterns
– Practice gait as whole task
– Harness provides a safety measure; can be used for cardio
training
Cons:
- labor intensive = usually 2-3 therapists
- cost of equipment is high
Gait Trainer 3
• The Gait Trainer 3 is a treadmill system that is equipped with an
instrumented deck that provides real time auditory and visual
biofeedback to prompt the patient on ways to improve their gait.
• The patient receives cues on areas like appropriate step length, step
speed, right to left weight shift, and foot placement with each step.
• The patient can attempt to self correct their walking in conjunction
with the skilled intervention of the therapist who is working on
facilitating this process
• By combining the Gait Trainer 3 with the associated Unweighting
Harness System patients are able to begin the task of walking much
sooner than traditional treatment techniques may allow, providing
them with valuable sensory feedback to spur the recovery process.
• Used by Russell Medical Center in Alexander City, AL and Regional
Medical Center in Anniston, AL
Gait Trainer 3 by Biodex
Free Step SAS by Biodex
• The FreeStep SAS - Supported Ambulation System
is an overhead, ceiling mounted track and
harness system aimed at providing a patient with
support while they are performing mobility
activities such as walking and/or stair climbing. By
providing this support and removing the fear of
falling, both the therapist and patient can better
focus on the aspects of coordination, balance and
gait that will ultimately improve an individual's
independence with mobility tasks.
LiteGait
• Body weight supported system to be used
with or without a treadmill
• Allows partial controlled weight bearing for
ambulation/gait training and correct posture
and position
• can add the computerized gait analysis
overview
Lite Gait
Vector Gait and Safety system – By
Bioness
• Completely wireless over ground ambulation
and dynamic balance system – one you can
actually practice falls and positioning
• A unique thing about this system is you can
use it with up to 4 patients at a time with the
overhead ceiling trolley system
Features of Vector
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Features
Un-tethered trolley driven via a conductive Power Rail
Closed loop or linear track designs
400 lbs. static and 200 lbs. dynamic body weight capacity
Icon drive softward interface with secure patient database and wireless hand-held
unit
UL certified
Benefits
Promotes independent walking - a length of stay determinate
Increases clinician productivity allowing one-on-one treatment regimens
Expands Maximizes clinic space with a ceiling mounted design
Enables the clinician to start gait training earlier, accelerating the rehabilitation
process and reducing length of stay
Maintains patient and clinician safety during pre-gait and gait training activities
Vector by Bioness
Bioness for UE
Bioness H200
• The H200 Wireless Hand Rehabilitation System
• State-of-the-art system helps patients regain the
skills for reaching, grasping, opening and closing
the hand
• The H200 Wireless System supports the wrist in a
functioning position, allowing the fingers and
thumb to move efficiently. It can patients to
regain hand function and get back to performing
ordinary and essential activities of daily life.
Bioness H200
• Assist with a reduction in secondary problems of
paresis such as:
– Poor blood circulation
– Limited range of motion
– Muscle spasms
– Muscle disuse atrophy
Training for key pinch, grasp and release and three jaw
pinch and easy to incorporate into functional activities
after repetition
Home product available as well as clinic
Bioness H200 clip
• https://youtu.be/ACSjlWLQ4EA
Bioness for LE L300
Bioness L300
• For foot drop, also the L300 plus for thigh
weakness
• Low level FES to peroneal nerve to enable
dorsiflexion and eversion during gait
• Can reeducate muscles, prevent or reduce
atrophy of the muscles, maintain or increase
joint ROM and increase blood flow in this area
WalkAide System
• WalkAide is a neuro-prosthetics device that channels
functional electrical stimulation to the leg and foot in
order to restore typical nerve-to-muscle signals. During
the swing phase of walking, the WalkAide electrically
stimulates the appropriate muscles that cause ankle
dorsiflexion, effectively lifting the foot at the
appropriate time.
. Other medical benefits of FES may include prevention of
muscle disuse or weakness, increased local blood flow,
muscle strengthening, and maintained or increased joint
range of motion.
WalkAide
Saebo Flex for UE
• Benefits include:
– Custom fabricated at Saebo and adjusted on-site by a Saebo
Trained clinician for comfort and maximum effectiveness
– Supports the weakened elbow, wrist, hand and fingers
– Positions the wrist and fingers into a functional position
– Consists of multiple graded springs to accommodate varying
degrees of tone in the hand
– There is an Elbow extension system that includes graded
tension cords to accommodate varying degrees of tone in the
elbow
– Patients can incorporate their hand immediately for grasp and
release activities which would otherwise be impossible
– Appropriate for patients with severe tone in the elbow and hand
Saebo Flex
https://youtu.be/ACSjlWLQ4EA
BITS by Bioness (Bioness Integrated
Therapy System)
• BITS offers 16 unique programs with
customizable features
• BITS can is a therapy tool that can be used with:
Visual field loss, visual-spatial neglect, and visualvestibular integration problems, problem solving
and cognitive challenges
• It can be used to enhance and treat: Visual
pursuits, fixation stability, eye-hand coordination,
visual reaction time, speed and span of
recognition, automaticity, contrast sensitivity,
plus visual and auditory sequencing and memory.
Bioness integrated therapy system
BITS
• Touchscreen display (either 46,55 or 65 inches) on a
mounted but portable stand
• Runs off software designed to evaluate and improve
abilities and performance
• 7 main therapy programs: eye hand program that can be
user paced, time paced or reaction time; rotator program
working on single color, multicolor, sequencing or gap
sequence; rapid eye movement using sequenced touch,
verbal or competition, memory tasks with words, numbers
and/or letters, metronome tasks, chart tasks or visual
motor tasks
• Results are recorded so the patient can see their
improvement over time
Dynavision
• Used to improve ocular motor skills
(localization, fixation, gaze shift and tracking)
as well as eye hand coordination, motor
planning and visual-motor reaction time
Interactive Metronome
• Uses an auditory visual platform to promote
synchronized timing in the brain
• Promotes return of function and cognition
using repetitive timed activities
Interactive metronome
Utilization of these advanced
treatment tools
• Both OT and PT use these tools to enhance
their therapeutic outcomes
• Still we use a combination of remedial and
compensatory strategies to promote
independence and functional return in an
individualized treatment program
References
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www.interactivemetronome.com
www.bioness.com
www.saeboflex.com
www.walkaide.com
www.biodex.com
www.dynavision.com