Scholarly

Effects of Virtual Reality on the Upper Extremity Spasticity and Motor Function in Patients with Stroke: A Single Blinded Randomized Controlled Trial

Year: 2022 Volume: 16 Issue: 4 35 - 38 Pages

Abstract: Background: Stroke is a disabling neurological disease. Rehabilitative therapies are important treatment methods. This clinical trial was done to compare the effects of virtual reality (VR) beside conventional rehabilitation versus conventional rehabilitation alone on the spasticity and motor function in stroke patients. Materials and methods: In this open-label randomized controlled clinical trial, 40 consecutive patients with stable first-ever ischemic stroke in the past three to 12 months that were referred to a rehabilitation clinic in Tehran, Iran in 2020 were enrolled. After signing the informed written consent form, subjects were randomly assigned by block randomization of five in each block as cases with 1:1 into two groups of 20 cases; conventional plus VR therapy group: 45-minute conventional therapy session plus 15-minute VR therapy, and conventional group: 60-minute conventional therapy session. VR rehabilitation is designed and developed with different stages. Outcomes were Modified Ashworth scale, Recovery Stage score for motor function, range of motion (ROM) of shoulder abduction/wrist extension, and patients’ satisfaction rate. Data were compared after study termination. Results: The satisfaction rate among the patients was significantly better in combination group (P = 0.003). Only wrist extension was varied between groups and was better in combination group. The variables generally had statistically significant difference (P < 0.05). Conclusion: VR plus conventional rehabilitation therapy is superior versus conventional rehabilitation alone on the wrist and elbow spasticity and motor function in patients with stroke.

Biomechanical Findings in Patients with Bipartite Medial Cuneiforms

Year: 2022 Volume: 16 Issue: 3 45 - 51 Pages

Abstract: Bipartite medial cuneiforms are relatively rare but may play a significant role in biomechanical and gait abnormalities. It is believed that a bipartite medial cuneiform may alter the available range of motion due to its larger morphological variant, thus limiting the metatarsal plantarflexion needed to achieve adequate hallux dorsiflexion for normal gait. Radiographic and clinical assessment were performed on two patients who reported with foot pain along the first ray. Both patients had visible bipartite medial cuneiforms on MRI. Using gait plate and Metascan ™ analysis, both were noted to have four measurements far beyond the expected range. Medial and lateral heel peak pressure, hallux peak pressure, and 1st metatarsal peak pressure were all noted to be increased. These measurements are believed to be increased due to the hindrance placed on the available ROM of the first ray by the increased size of the medial cuneiform. A larger patient population would be needed to fully understand this developmental anomaly.

Utility of Range of Motion Measurements on Classification of Athletes

Year: 2020 Volume: 14 Issue: 12 404 - 407 Pages

Abstract: In this study, a comparison of Range Of Motion (ROM) of middle and long-distance runners and swimmers has been made. The mobility of the various joints is essential for the quick movement of any sportsman. Knowledge of a ROM helps in preventing injuries, in repeating the movement, and in generating speed and power. ROM varies among individuals, and it is influenced by factors such as gender, age, and whether the motion is performed actively or passively. ROM for running and swimming, both performed with due consideration on speed, plays an important role. The time of generation of speed and mobility of the particular joints are very important for both kinds of athletes. The difficulties that happen during running and swimming in the direction of motion is changed. In this study, data were collected for a total of 102 subjects divided into three groups: control group (22), middle and long-distance runners (40), and swimmers (40), and their ages are between 12 to 18 years. The swimmers have higher ROM in shoulder joint flexion, extension, abduction, and adduction movement. Middle and long-distance runners have significantly greater ROM from Control Group in the left shoulder joint flexion with a 5.82 mean difference. Swimmers have significantly higher ROM from the Control Group in the left shoulder joint flexion with 24.84 mean difference and swimmers have significantly higher ROM from the Middle and Long distance runners in left shoulder flexion with 19.02 mean difference. The picture will be clear after a more detailed investigation.

Creating a Virtual Perception for Upper Limb Rehabilitation

Year: 2017 Volume: 11 Issue: 4 152 - 157 Pages

Abstract: This paper describes the development of a virtual-reality system ARWED, which will be used in physical rehabilitation of patients with reduced upper extremity mobility to increase limb Active Range of Motion (AROM). The ARWED system performs a symmetric reflection and real-time mapping of the patient’s healthy limb on to their most affected limb, tapping into the mirror neuron system and facilitating the initial learning phase. Using the ARWED, future experiments will test the extension of the action-observation priming effect linked to the mirror-neuron system on healthy subjects and then stroke patients.

The Enhancement of Target Localization Using Ship-Borne Electro-Optical Stabilized Platform

Year: 2016 Volume: 10 Issue: 12 1876 - 1882 Pages

Abstract: Electro-optical (EO) stabilized platforms have been widely used for surveillance and reconnaissance on various types of vehicles, from surface ships to unmanned air vehicles (UAVs). EO stabilized platforms usually consist of an assembly of structure, bearings, and motors called gimbals in which a gyroscope is installed. EO elements such as a CCD camera and IR camera, are mounted to a gimbal, which has a range of motion in elevation and azimuth and can designate and track a target. In addition, a laser range finder (LRF) can be added to the gimbal in order to acquire the precise slant range from the platform to the target. Recently, a versatile functionality of target localization is needed in order to cooperate with the weapon systems that are mounted on the same platform. The target information, such as its location or velocity, needed to be more accurate. The accuracy of the target information depends on diverse component errors and alignment errors of each component. Specially, the type of moving platform can affect the accuracy of the target information. In the case of flying platforms, or UAVs, the target location error can be increased with altitude so it is important to measure altitude as precisely as possible. In the case of surface ships, target location error can be increased with obliqueness of the elevation angle of the gimbal since the altitude of the EO stabilized platform is supposed to be relatively low. The farther the slant ranges from the surface ship to the target, the more extreme the obliqueness of the elevation angle. This can hamper the precise acquisition of the target information. So far, there have been many studies on EO stabilized platforms of flying vehicles. However, few researchers have focused on ship-borne EO stabilized platforms of the surface ship. In this paper, we deal with a target localization method when an EO stabilized platform is located on the mast of a surface ship. Especially, we need to overcome the limitation caused by the obliqueness of the elevation angle of the gimbal. We introduce a well-known approach for target localization using Unscented Kalman Filter (UKF) and present the problem definition showing the above-mentioned limitation. Finally, we want to show the effectiveness of the approach that will be demonstrated through computer simulations.

Biomechanical Modeling, Simulation, and Comparison of Human Arm Motion to Mitigate Astronaut Task during Extra Vehicular Activity

Year: 2016 Volume: 10 Issue: 3 107 - 113 Pages

Abstract: During manned exploration of space, missions will require astronaut crewmembers to perform Extra Vehicular Activities (EVAs) for a variety of tasks. These EVAs take place after long periods of operations in space, and in and around unique vehicles, space structures and systems. Considering the remoteness and time spans in which these vehicles will operate, EVA system operations should utilize common worksites, tools and procedures as much as possible to increase the efficiency of training and proficiency in operations. All of the preparations need to be carried out based on studies of astronaut motions. Until now, development and training activities associated with the planned EVAs in Russian and U.S. space programs have relied almost exclusively on physical simulators. These experimental tests are expensive and time consuming. During the past few years a strong increase has been observed in the use of computer simulations due to the fast developments in computer hardware and simulation software. Based on this idea, an effort to develop a computational simulation system to model human dynamic motion for EVA is initiated. This study focuses on the simulation of an astronaut moving the orbital replaceable units into the worksites or removing them from the worksites. Our physics-based methodology helps fill the gap in quantitative analysis of astronaut EVA by providing a multisegment human arm model. Simulation work described in the study improves on the realism of previous efforts, incorporating joint stops to account for the physiological limits of range of motion. To demonstrate the utility of this approach human arm model is simulated virtually using ADAMS/LifeMOD® software. Kinematic mechanism for the astronaut’s task is studied from joint angles and torques. Simulation results obtained is validated with numerical simulation based on the principles of Newton-Euler method. Torques determined using mathematical model are compared among the subjects to know the grace and consistency of the task performed. We conclude that due to uncertain nature of exploration-class EVA, a virtual model developed using multibody dynamics approach offers significant advantages over traditional human modeling approaches.

Pressure Relief in Prosthetic Sockets through Hole Implementation Using Different Materials

Year: 2015 Volume: 9 Issue: 9 1118 - 1122 Pages

Authors:
Gabi N. Nehme

Abstract: Below-knee amputees commonly experience asymmetrical gait patterns. It is generally believed that ischemia is related to the formation of pressure sores due to uneven distribution of forces. Micro-vascular responses can reveal local malnutrition. Changes in local skin blood supply under various external loading conditions have been studied for a number of years. Radionuclide clearance, photo-plethysmography, trans-cutaneous oxygen tension along with other studies showed that the blood supply would be influenced by the epidermal forces, and the rate and the amount of blood supply would decrease with increased epidermal loads being shear forces or normal forces. Several cases of socket designs were investigated using Finite Element Model (FEM) and Design of Experiment (DOE) to increase flexibility and minimize the pressure at the limb/socket interface using ultra high molecular weight polyethylene (UHMWPE) and polyamide 6 (PA6) or Duraform. The pressure reliefs at designated areas where reducing thickness is involved are seen to be critical in determination of amputees’ comfort and are very important to clinical applications. Implementing a hole between the Patellar Tendon (PT) and Distal Tibia (DT) would decrease stiffness and increase prosthesis range of motion where flexibility is needed. In addition, displacement and prosthetic energy storage increased without compromising mechanical efficiency and prosthetic design integrity.

The Effects of Mirror Therapy on Clinical Improvement in Hemiplegic Lower Extremity Rehabilitation in Subjects with Chronic Stroke

Year: 2015 Volume: 9 Issue: 2 163 - 166 Pages

Abstract: Background: The effectiveness of mirror therapy (MT) has been investigated in acute hemiplegia. The present study examines whether MT, given during chronic stroke, was more effective in promoting motor recovery of the lower extremity and walking speed than standard rehabilitation alone. Methods: The study enrolled 30 patients with chronic stroke. Fifteen patients each were assigned to the treatment group and the control group. All patients received a conventional rehabilitation program for a 4-week period. In addition to this rehabilitation program, patients in the treatment group received mirror therapy for 4 weeks, 5 days a week. Main measures: Passive ankle joint dorsiflexion range of motion, gait speed, Brunnstrom stages of motor recovery, plantar flexor muscle tone by Modified Ashworth Scale. Results: No significant difference was found in the outcome measures among groups before treatment. When compared with standard rehabilitation, mirror therapy improved Ankle ROM, Brunnstrom stages and waking speed (p < 0.05). However, there were no significant differences between two groups on MAS (P > 0.05).Conclusion: Mirror therapy combined with a conventional stroke rehabilitation program enhances lowerextremity motor recovery and walking speed in chronic stroke patients.

Construction and Validation of a Hybrid Lumbar Spine Model for the Fast Evaluation of Intradiscal Pressure and Mobility

Year: 2015 Volume: 9 Issue: 2 139 - 150 Pages

Abstract: A novel hybrid model of the lumbar spine, allowing fast static and dynamic simulations of the disc pressure and the spine mobility, is introduced in this work. Our contribution is to combine rigid bodies, deformable finite elements, articular constraints, and springs into a unique model of the spine. Each vertebra is represented by a rigid body controlling a surface mesh to model contacts on the facet joints and the spinous process. The discs are modeled using a heterogeneous tetrahedral finite element model. The facet joints are represented as elastic joints with six degrees of freedom, while the ligaments are modeled using non-linear one-dimensional elastic elements. The challenge we tackle is to make these different models efficiently interact while respecting the principles of Anatomy and Mechanics. The mobility, the intradiscal pressure, the facet joint force and the instantaneous center of rotation of the lumbar spine are validated against the experimental and theoretical results of the literature on flexion, extension, lateral bending as well as axial rotation. Our hybrid model greatly simplifies the modeling task and dramatically accelerates the simulation of pressure within the discs, as well as the evaluation of the range of motion and the instantaneous centers of rotation, without penalizing precision. These results suggest that for some types of biomechanical simulations, simplified models allow far easier modeling and faster simulations compared to usual full-FEM approaches without any loss of accuracy.

A Robotic Rehabilitation Arm Driven by Somatosensory Brain-Computer Interface

Year: 2014 Volume: 8 Issue: 6 310 - 313 Pages

Abstract: It was expected to benefit patient with hemiparesis after stroke by extensive arm rehabilitation, to partially regain forearm and hand function. This paper propose a robotic rehabilitation arm in assisting the hemiparetic patient to learn new ways of using and moving their weak arms. In this study, the robotic arm was driven by a somatosensory stimulated brain computer interface (BCI), which is a new modality BCI. The use of somatosensory stimulation is not only an input for BCI, but also a electrical stimulation for treatment of hemiparesis to strengthen the arm and improve its range of motion. A trial of this robotic rehabilitation arm was performed in a stroke patient with pure motor hemiparesis. The initial trial showed a promising result from the patient with great motivation and function improvement. It suggests that robotic rehabilitation arm driven by somatosensory BCI can enhance the rehabilitation performance and progress for hemiparetic patients after stroke.

The Effects of Extracorporeal Shockwave Therapy on Pain, Function, Range of Motion and Strength in Patients with Plantar Fasciitis

Year: 2013 Volume: 7 Issue: 6 297 - 303 Pages

Authors:
P. Sanzo

Abstract: Ten percent of the population will develop plantar fasciitis (PF) during their lifetime. Two million people are treated yearly accounting for 11-15% of visits to medical professionals. Treatment ranges from conservative to surgical intervention. The purpose of this study was to assess the effects of extracorporeal shockwave therapy (ECSWT) on heel pain, function, range of motion (ROM), and strength in patients with PF. One hundred subjects were treated with ECSWT and measures were taken before and three months after treatment. There was significant differences in visual analog scale scores for pain at rest (p=0.0001); after activity (p= 0.0001) and; overall improvement (p=0.0001). There was also significant improvement in Lower Extremity Functional Scale scores (p=0.0001); ankle plantarflexion (p=0.0001), dorsiflexion (p=0.001), and eversion (p=0.017),and first metatarsophalangeal joint flexion (p=0.002) and extension (p=0.003) ROM. ECSWT is an effective treatment improving heel pain, function and ROM in patients with PF.

The Effects of Extracorporeal Shockwave Therapy on Pain, Function, Range of Motion, and Strength in Patients with Insertional Achilles Tendinosis

Year: 2013 Volume: 7 Issue: 6 273 - 279 Pages

Authors:
P. Sanzo

Abstract: Increased physical fitness participation has been paralleled by increasedoveruse injuries such as insertional Achilles tendinosis (AT). Treatment has provided inconsistentresults. The use of extracorporeal shockwave therapy (ECSWT) offers a new treatment consideration.The purpose of this study was to assess the effects of ECSWTon pain, function, range of motion (ROM), joint mobility and strength in patients with AT. Thirty subjects were treated with ECSWT and measures were takenbefore and three months after treatment. There was significant differences in visual analog scale (VAS) scores for pain at rest (p=0.002); after activity (p= 0.0001); overall improvement(p=0.0001); Lower Extremity Functional Scale (LEFS) scores (p=0.002); dorsiflexion range of motion (ROM) (p=0.0001); plantarflexion strength (p=0.025); talocrural joint anterior glide (p=0.046); and subtalar joint medial and lateral glide (p=0.025).ECSWT offers a new intervention that may limit the progression of the disorder and the long term healthcare costs associated with AT.

Analysis of Lower Extremity Muscle Flexibility among Indian Classical Bharathnatyam Dancers

Year: 2012 Volume: 6 Issue: 6 189 - 194 Pages

Abstract: Musculoskeletal problems are common in high performance dance population. This study attempts to identify lower extremity muscle flexibility parameters prevailing among bharatanatyam dancers and analyze if there is any significant difference exist between normal and injured dancers in flexibility parameters. Four hundred and one female dancers and 17 male dancers were participated in this study. Flexibility parameters (hamstring tightness, hip internal and external rotation and tendoachilles in supine and sitting posture) were measured using goniometer. Results of our study it is evident that injured female bharathnatyam dancers had significantly (p < 0.05) high hamstring tightness on left side lower extremity compared to normal female dancers. The range of motion for left tendoachilles was significantly (p < 0.05) high for the normal female group when compared to injured dancers during supine lying posture. Majority of the injured dancers had high hamstring tightness that could be a possible reason for pain and MSDs.

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