Advances in Stroke Rehab

Randie Carter, OTR/LUAB Spain Rehabilitation Center

Birmingham, ALracarter@uabmc.edu

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

trainingCons:- 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• 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 atrophyTraining for key pinch, grasp and release and three jaw pinch and easy to incorporate into functional activities after repetitionHome 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 visual-vestibular 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

• www.interactivemetronome.com• www.bioness.com• www.saeboflex.com• www.walkaide.com• www.biodex.com• www.dynavision.com