Improvements In Quality Of Movement Research Articles

Group physiotherapy targeting core stability and balance in individuals with multiple sclerosis. ‘Movement analyses and individualisations: potent change-making tools’

Introduction: Individualisation is a prevailing principle in physiotherapy for individuals with multiple sclerosis because it may enhance movement quality and thereby promote functional recovery. Less is known regarding how physiotherapists (PTs) implement these principles in group settings when the exercises target core stability and balance.Materials and methods: Three qualitative non-participating observations were videotaped during a 5-week, new, group-based intervention (GroupCoreSIT) involving three ambulatory individuals with secondary progressive MS. A content analysis was performed using integrated perspectives in the movement quality model.Results: Individual tailoring of exercises is possible in groups of three and is necessary to enhance movement quality as opposed to compensatory strategies. The PTs continuous movement analysis was, combined with a dynamic hands-on/hands-off interplay, vital for nonverbal guidance and to adapt the exercises, although limitations to hands-on interaction were noted. Systematic movement sequencing including knowledgeable explanations enhanced the prerequisites for postural control, enabled exercise progression and promoted understanding of how the exercises could improve activities in daily living. All three participants exhibited improvement in movement quality while walking, although gait training was not part of the intervention.Conclusion: In small groups, sequenced, movement analysis-based instructions and individual hands-on adaptations are change-making tools that can promote improvements in movement quality.

Effects of Assist-As-Needed Upper Extremity Robotic Therapy after Incomplete Spinal Cord Injury: A Parallel-Group Controlled Trial.

Robotic rehabilitation of the upper limb following neurological injury has been supported through several large clinical studies for individuals with chronic stroke. The application of robotic rehabilitation to the treatment of other neurological injuries is less developed, despite indications that strategies successful for restoration of motor capability following stroke may benefit individuals with incomplete spinal cord injury (SCI) as well. Although recent studies suggest that robot-aided rehabilitation might be beneficial after incomplete SCI, it is still unclear what type of robot-aided intervention contributes to motor recovery. We developed a novel assist-as-needed (AAN) robotic controller to adjust challenge and robotic assistance continuously during rehabilitation therapy delivered via an upper extremity exoskeleton, the MAHI Exo-II, to train independent elbow and wrist joint movements. We further enrolled seventeen patients with incomplete spinal cord injury (AIS C and D levels) in a parallel-group balanced controlled trial to test the efficacy of the AAN controller, compared to a subject-triggered (ST) controller that does not adjust assistance or challenge levels continuously during therapy. The conducted study is a stage two, development-of-concept pilot study. We validated the AAN controller in its capability of modulating assistance and challenge during therapy via analysis of longitudinal robotic metrics. For the selected primary outcome measure, the pre-post difference in ARAT score, no statistically significant change was measured in either group of subjects. Ancillary analysis of secondary outcome measures obtained via robotic testing indicates gradual improvement in movement quality during the therapy program in both groups, with the AAN controller affording greater increases in movement quality over the ST controller. The present study demonstrates feasibility of subject-adaptive robotic therapy after incomplete spinal cord injury, but does not demonstrate gains in arm function occurring as a result of the robot-assisted rehabilitation program, nor differential gains obtained as a result of the developed AAN controller. Further research is warranted to better quantify the recovery potential provided by AAN control strategies for robotic rehabilitation of the upper limb following incomplete SCI. ClinicalTrials.gov registration number: NCT02803255.

Efeitos de um protocolo modificado da terapia por contensão induzida em criança com paralisia cerebral hemiparética

Evaluate the effects of a modifi ed Constraint- Induced Therapy intervention protocol regarding movement quality and frequency of use of the affected upper extremity on children with hemiplegic cerebral palsy. Longitudinal study of a single case, performed with a four year old submitted to intervention during three hours daily, for ten days, restricting the non-affected upper extremity for eight hours daily. Data were collected using the Pediatric Upper Extremity Motor Activity Log and analyzed using the arithmetic mean. Significant improvement in quality of movement and frequency of use of the upper limb from pre to post-intervention were noted, maintaining the result in later data collection, besides the acquisition of functional motor skills. The modifi ed constraint-induced movement therapy protocol of this study was effective in treating the child with hemiplegic cerebral palsy, the results may be useful for professionals working with this clientele, assisting them in the intervention process.

Clinical changes during an intervention based on constraint‐induced movement therapy principles on use of the affected arm of a child with obstetric brachial plexus injury: a case report

The objective of this study was to test the feasibility of a treatment programme based on the elements of constraint-induced movement therapy (CIMT) to encourage use of the affected arm of a child with obstetric brachial plexus injury (OBP), as well as to document clinical changes observed with this intervention. A 2-year-old female child with Erb's palsy had 14 weeks of daily home-based treatment with 30-minute sessions planned according to the principles of CIMT. The child was assessed every 2 weeks with the Toddler Arm Use Test. Test scores throughout the intervention period demonstrated improvements in quality of movement, amount of use and willingness to use the affected extremity. The child's mother reported improved ability to perform bimanual activities at home. The results suggest that treatment based on CIMT principles has potential to promote functional gains for children with OBP. Experimental studies should test the effects of this kind of intervention for children with OBP.

Rhythmic Auditory-Motor Entrainment Improves Hemiparetic Arm Kinematics During Reaching Movements: A Pilot Study

Purpose: Recovery of skilled upper limb movement remains a critical focus of rehabilitation in individuals post stroke. Conventional treatments, however, have demonstrated limited capability to produce substantial improvements in poststroke quality of movement. Recently, rhythmic auditory stimulation (RAS) has emerged as efficacious in improving and normalizing limb movements in neurologically impaired populations. This pilot study examined changes in pre- to post-RAS reach kinematics and functional outcomes in survivors of stroke. Method: Five individuals in the chronic poststroke phase participated in a 2-week program of RAS training. Kinematic reaching variables were trunk, shoulder, and elbow segment contribution; movement time; and reach velocity. Functional outcomes were the Wolf Motor Function Test, Motor Activity Log, and Fugl-Meyer Assessment. Results: Post-RAS assessment of reaching kinematics revealed a significant (p < .05) decrease in compensatory trunk movement, increase in shoulder flexion, and a slight increase in elbow extension. Movement time and velocity significantly improved post RAS. Significant gains were observed on all functional assessments. Conclusions: Post RAS, participants demonstrated substantial decreases in compensatory reaching movements. These changes in motor control strategy were paralleled by gains in functional abilities, suggesting that reduced reliance on compensatory movements may translate to improved performance of daily activities.