M.J.A. Jannink

Systematic review of the effectiveness of mirror therapy in upper extremity function

Purpose. This review gives an overview of the current state of research regarding the effectiveness of mirror therapy in upper extremity function. Method. A systematic literature search was performed to identify studies concerning mirror therapy in upper extremity. The included journal articles were reviewed according to a structured diagram and the methodological quality was assessed. Results. Fifteen studies were identified and reviewed. Five different patient categories were studied: two studies focussed on mirror therapy after an amputation of the upper limb, five studies focussed on mirror therapy after stroke, five studies focussed on mirror therapy with complex regional pain syndrome type 1 (CRPS1) patients, one study on mirror therapy with complex regional pain syndrome type 2 (CRPS2) and two studies focussed on mirror therapy after hand surgery other than amputation. Conclusions. Most of the evidence for mirror therapy is from studies with weak methodological quality. The present review showed a trend that mirror therapy is effective in upper limb treatment of stroke patients and patients with CRPS, whereas the effectiveness in other patient groups has yet to be determined.

A Low-Cost Video Game Applied for Training of Upper Extremity Function in Children with Cerebral Palsy: A Pilot Study

The aim of the present study was to determine the user satisfaction of the EyeToy for the training of the upper limb in children with cerebral palsy (CP). User satisfaction was measured in 12 children with CP, using a postexperience questionnaire, primarily based on a presence questionnaire. In general, children with CP were satisfied with and motivated by the EyeToy training. In addition, a first evaluation study was performed to determine the effect of this training method on the upper limb function. Ten children with CP were randomly assigned to the intervention (mean age 11 years, 9 months; SD 2,3) and the control group (mean age 12 years, 3 months; SD 3,2). After a treatment period of 6 weeks, the intervention group completed a user satisfaction questionnaire. Functional outcome was measured using the Melbourne Assessment scores. Percentage scores of the Melbourne Assessment of 7 of the 10 children were the same or changed only 1% to 2% from baseline to followup. However, in the experimental group, two children improved more, 9% and 13% respectively. In conclusion, it can be said that the EyeToy is a motivational training tool for the training of children with CP and has the potential to improve upper extremity function.

Dampace: dynamic force-coordination trainer for the upper extremities

According to reviews, training with upper-extremities rehabilitation robotics is at least as good as regular stroke rehabilitation, probably because the robotics increase the training intensity for the patients. As an alternative to the functional approach mimicking activities of daily living, targeted force-coordination training may also have its benefits. Our passive exoskeleton, the Dampace, has controlled braking on the three rotational axes of the shoulder and one of the elbow. It is designed to combine functional training of activities of daily living with force-coordination training. The Dampace exoskeleton can assist in identifying causes behind the movement disorders of stroke patients, tackle these causes with isolated force-coordination training, possibly simultaneously over multiple joints, and then integrate the isolated training back into a functional, task-specific training protocol. Not needing to align the Dampace axes to the human shoulder and elbow axes overcome some of the difficulties traditionally associated with exoskeletons. Although it adds more complexity, the reduction of setup times to a few minutes and the absence of static reaction forces in the human joints, are major advantages and have been well received by therapists and physicians. Controlled braking instead of actively assisting actuators, has the advantage of inherent safety and always actively participating patients, at the cost of not being able to assist movements or create all virtual environments.

Effect of augmented feedback on motor function of the affected upper extremity in rehabilitation patients: a systematic review of randomized controlled trials

OBJECTIVE Assessment of the available evidence regarding the effect of augmented feedback on motor function of the upper extremity in rehabilitation patients. METHODS A systematic literature search was performed to identify randomized controlled trials that evaluated the effect of augmented feedback on motor function. Two reviewers systematically assessed the methodological quality of the trials. The reported effects were examined to evaluate the effect of therapeutic interventions using augmented feedback and to identify a possible relationship with patient characteristics, type of intervention, or methodological quality. RESULTS Twenty-six randomized controlled trials were included, 9 of which reported a positive effect on arm function tests. Follow-up measurements were performed in 8 trials, 1 of which reported a positive effect. Different therapeutic interventions using augmented feedback, i.e. electromyographic biofeedback, kinetic feedback, kinematic feedback, or knowledge of results, show no difference in effectiveness. CONCLUSION No firm evidence was found of effectiveness regarding the use of augmented feedback to improve motor function of the upper extremity in rehabilitation patients. Future studies should focus more on the content, form and timing of augmented feedback concerning the therapeutic intervention. It should be emphasized that motor learning effects can only be determined by re-examining the population after a follow-up period.

Nature, timing, frequency and type of augmented feedback; does it influence motor relearning of the hemiparetic arm after stroke? A systematic review

Purpose. To investigate the effect of different aspects and types of augmented feedback on motor functions and motor activities of the hemiparetic arm after stroke. Method. Systematic search of the scientific literature was performed in the Pubmed and Cochrane database from 1975 to March 2009. The augmented feedback used in the intervention was classified with respect to aspects (nature, timing and frequency) and types (auditory, sensory and visual). Results. The systematic literature search resulted in 299 citations. On the basis of inclusion and exclusion criteria, 23 full-text articles were included for analysis. There are some trends in favour of providing augmented knowledge of performance feedback, augmented auditory and combined sensory and visual feedback. No consistent effects on motor relearning were observed for summary or faded, terminal or concurrent, solely visual or solely sensory augmented feedback. Conclusions. On the basis of this study, it was not possible to determine which combinations of aspects and types of augmented feedback are most essential for a beneficial effect on motor activities and motor functions of the hemiparetic arm after stroke. This was due to the combination of multiple aspects and types of augmented feedback in the included studies. This systematic review indicates that augmented feedback in general has an added value for stroke rehabilitation.

Influence of Gravity Compensation on Muscle Activation Patterns During Different Temporal Phases of Arm Movements of Stroke Patients

Background. Arm support to help compensate for the effects of gravity may improve functional use of the shoulder and elbow during therapy after stroke, but gravity compensation may alter motor control. Objective. To obtain quantitative information on how gravity compensation influences muscle activation patterns during functional, 3-dimensional reaching movements. Methods. Eight patients with mild hemiparesis performed 2 sets of repeated reach and retrieval movements, with and without unloading the arm, using a device that acted at the elbow and forearm to compensate for gravity. Electromyographic (EMG) patterns of 6 upper extremity muscles were compared during elbow and shoulder joint excursions with and without gravity compensation. Results. Movement performance was similar with and without gravity compensation. Smooth rectified EMG (SRE) values were decreased from 25% to 50% during movements with gravity compensation in 5 out of 6 muscles. The variation of SRE values across movement phases did not differ across conditions. Conclusions. Gravity compensation did not affect general patterns of muscle activation in this sample of stroke patients, probably since they had adequate function to complete the task without arm support. Gravity compensation did facilitate active arm movement excursions without impairing motor control. Gravity compensation may be a valuable modality in conventional or robot-aided therapy to increase the intensity of training for mildly impaired patients.

Analysis of healthy sitting behavior: Interface pressure distribution and subcutaneous tissue oxygenation

Pressure ulcers are a large problem in individuals who use a wheelchair for their mobility and have limited trunk stability and motor function. Because no relation between interface pressure and pressure ulcer development has been established and no clinical threshold for pressure ulcer development can be given, looking at the sitting behavior of nondisabled individuals is important. Nondisabled individuals do not develop pressure ulcers because they continuously shift posture. We analyzed the sitting behavior of 25 nondisabled male subjects by using a combination of interface pressure measurement and subcutaneous tissue oxygenation measurement by means of the Oxygen to See. These subjects shifted posture on average 7.8 +/- 5.2 times an hour. These posture shifts were merely a combination of posture shifts in the frontal and sagittal plane. Subcutaneous oxygen saturation increased on average 2.2% with each posture adjustment, indicating a positive effect of posture shifts on tissue viability. The results of this study can be used as a reference for seating interventions aimed at preventing pressure ulcers. Changing the sitting load at least every 8 minutes is recommended for wheelchair users.

Freebal: dedicated gravity compensation for the upper extremities

In most upper-extremity rehabilitation robotics, several components affect the therapy outcome. A common component is gravity compensation which alleviates upper-extremity movements. Gravity compensation by itself could improve motor control further or faster, separate from other effects of robotic therapy. To investigate the rehabilitation value of gravity compensation separately, we created the dedicated gravity compensation system, Freebal. The sling systems with ideal spring mechanisms in the Freebal are well suited for providing compensation forces. The device has steplessly scalable forces, a large range of motion with constant compensation forces, independent control of the compensation of the lower and upper arm, and low movement impedance. It also does not need external power, force sensors or active controllers. Finally, the Freebal can be easily moved, serviced and used in arm rehabilitation with either sitting or standing subjects.

Systematic review of the effects of exercise therapy on the upper extremity of patients with spinal-cord injury

Objective:To assess the effects of exercise therapy (ET) on motor control and functional ability of the upper extremity in patients with cervical spinal cord injury (SCI).Methods:An extensive systematic literature search in five databases was performed to identify clinical and (randomized) controlled trials, evaluating the effects of ET on motor control and functional ability in patients with SCI. The methodological quality of the selected studies was systematically assessed by three reviewers.Results:Eight studies were included. Seven had good-to-fair methodological quality, six reported positive effects of ET on motor control (for example, muscle strength or muscle grade) and four also reported positive effects on functional ability. Five of these studies focused on patients with long-lasting SCI. A great variety of therapeutic approaches were applied, even within ET there was a wide range of training characteristics.Conclusion:Although ET is a cornerstone in the treatment of the upper extremity in patients with SCI, only a small number of studies were included in the present review. Most of the included studies reported a positive effect of ET on upper extremity motor control and functional ability in SCI patients. As ET is effective in patients with SCI in the chronic stage, this might have implications for the follow up and further treatment of these patients. Future studies should be more specific in describing the characteristics of ET to verify that the ET is in accordance with the current standards for training and motor relearning.

Virtual reality for mobility devices: training applications and clinical results: a review.

Virtual reality technology is an emerging technology that possibly can address the problems encountered in training (elderly) people to handle a mobility device. The objective of this review was to study different virtual reality training applications as well as their clinical implication for patients with mobility problems. Computerized literature searches were performed using the MEDLINE, Cochrane, CIRRIE and REHABDATA databases. This resulted in eight peer reviewed journal articles. The included studies could be divided into three categories, on the basis of their study objective. Five studies were related to training driving skills, two to physical exercise training and one to leisure activity. This review suggests that virtual reality is a potentially useful means to improve the use of a mobility device, in training ones driving skills, for keeping up the physical condition and also in a way of leisure time activity. Although this field of research appears to be in its early stages, the included studies pointed out a promising transfer of training in a virtual environment to the real-life use of mobility devices.