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Stroke Rehabilitation @ No Barriers Foundation

Stroke is a common condition seen by many physiotherapists, often leading to motor dysfunction and in some cases permanent disability. The rehabilitative objective of stroke patients is based on independent living by improving their functional disabilities. Therefore, rehabilitation training for stroke patients should focus on improving flexibility, muscular strength, coordination, and sense of balance to maintain an independent lifestyle through the recovery of physical functions. Rehabilitation treatment needs to be consistent and long-term.

Exoskeleton has in recent years emerged as a reliable and safe alternative to standard physiotherapy rehabilitation techniques. At the No Barriers Foundation, the exoskeleton is used to provide rehabilitation training and for walking assistance to patients affected by post-stroke disability. Lower-limb rehabilitation robots such as the Ekso GT we currently operate can help patients to carry out reasonable and effective training to improve the motor function of paralysed extremity in a safe effective manner. Exoskeleton rehabilitation allows high intensity repetitive and progressive gait training that is not achievable in many settings.

Another piece of equipment we have at our disposal is the EasyStand Glider which helps many clients in many ways. For example, in stroke survivors aids the reduction in tone while increasing joint range of motion. The EasyStand Glider features state-of-the-art active standing technology found in no other stander. Active standing provides lower body range of motion and upper body strengthening. There are several excellent research studies documenting the benefits of passive standing programs for an individual’s long-term health. The EasyStand Evolv stander allows the user to move in and out of standing without having to be lifted or transferred making it ideal for exercise in its own right but also as an adjunct to the exoskeleton training performed.

Reformer training involves low and intermediate intensity resistance and repetition that matches the patient’s physical ability and can be a remedial exercise program that can improve physical ability and influence quality of life. With hemiplegia, there is a strong tendency to shift completely to the unaffected side, which only reinforces the weakness and poor motor control of the affected side. Reformer Pilates helps to correct that.

At the No Barriers Foundation, we offer a creative rehabilitation program experience that considers both physical and mental components of rehabilitation for improving balance, strength, mobility and ability to walk when using specialist exercise therapy for recovering functions in stroke patients.

Contact us at hello@nobarriers.ie for more details

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Functional Electrical Stimulation

What is Functional Electrical Stimulation (FES)?

Functional Electrical Stimulation (FES) is the application of electrical current to excitable tissue to improve or restore functions lost in neurologically compromised subjects” (Peng et al., 2010).

Electrical stimulation is focused in certain skin surface areas of the body such as the calves and thigh to activate paralysed or weakened muscles using electrodes

Varying types of current can be applied that influence the specificity, effect, ease of application and comfort. For optimal effects the peripheral nervous system is required to be intact, so the neurological compromise is central nervous system (brain and spinal cord) in origin.

This is not to say effects cannot be gained with damage to the peripheral nervous system, but they are likely to require much higher levels of current and will generate smaller, less powerful contractions.

The benefits of FES

Using FES will create patterned movement in conjunction with for example the exoskeleton which will enable the muscles to work and perform activities even though they may be weak or paralysed through neurological disease or injury. This activity will:

  • Improve blood sugar homeostasis
  • Enhance cardiovascular function
  • Enhance endothelial function
  • Decrease chronic inflammation
  • Regulate hormone levels
  • Preserve/build musculoskeletal & neuromuscular integrity
  • Decrease depression, increase cognition

How does FES fit into rehabilitation therapy?

During passive rehabilitation muscles are moved mechanically so in theory muscles don’t do any of the work. Active rehabilitation such as using the exoskeleton and FES together allows muscles to do the work they are meant to do. This is achieved either by an individual moving their muscles on their own, or when muscles are activated by FES.

This means that active rehabilitation ensures muscles are working and performing the activity.

At what stage of rehabilitation is it best to use FES?

FES stimulation can be applied at any stage across the entire continuum of care from the acute phase to chronic intervention. For some FES is a short-term intervention. Whilst, for others, where recovery is longer or less function is regained, patients may benefit from using FES long term at a facility such as that provided by the No Barriers Foundation.

Which pathologies are FES most beneficial for?

FES is useful for stroke and spinal cord injury with strong evidence that FES can make an impact are spasticity and pressure ulcers in SCI. For the stroke group the benefits are likely to be improved movement and enhanced motor control.

Contact us today at hello@nobarriers.ie for more information

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Exoskeleton & Stroke Rehabilitation

Stroke is the leading cause of serious long-term disability with many survivors sustaining functional limitations in activities of daily living as a result of stroke. Many stroke survivors have long-term walking impairment due to hemiplegia or hemiparesis. Impaired ambulation due to hemiplegia or hemiparesis is associated with increased fall risk, limited community participation, and an overall decreased quality of life.

Post-stroke, the long-term goal of rehabilitation is successful reintegration into the community, with recovery of walking ability as a key functional objective. This recovery of function is achieved with progressive, task-specific, repetitive training based on the principles of motor learning and neuroplasticity. Targeted rehabilitation can help to reorganise the brain to relearn skills that may have been lost during, or because of, stroke, with the goal of helping survivors regain their independence. Rehabilitation goals may include coordinating leg movements, shifting weight to walk, or balancing during sit-to-stand transfers.

Functional Improvements

Advances in technology are changing the rehabilitation process. Robotic exoskeletons used during stroke rehabilitation assist with walking during the recovery process by providing earlier mobility and restored independence. Exoskeletons may enhance post-stroke gait training, helping to guide weight shifts and improve step patterns and cadence and enabling individuals to stand and walk over ground early in the recovery process.

For gait rehabilitation after stroke, the technology applications typically include a wearable device such as a robotic exoskeleton, with hip and knee motors providing assistance during walking. A key part of the rehabilitation process is therapy progression, and exoskeleton technology provides options to encourage progress and document improvements. The device chosen should have options for asymmetrical control of the lower limbs and facilitate pre-gait training, transfers, stepping, and balance training.

Additional Benefits

While functional improvement is the primary goal of stroke rehabilitation, exoskeleton devices also have the potential to empower and motivate patients. Initial gait training sessions in the exoskeleton often include meaningful walking time indoors and outdoors, which can improve patient morale, motivation, and enthusiasm. Over the past year using the Ekso GT exoskeleton, we have also seen increased steps per session, improved gait symmetry and balance, and improvements in functional independence throughout many patients rehabilitation.

The ultimate goal of the No Barriers Foundation is always be to maximise recovery of function to support the patient’s ability to maintain independence at home and in the community.

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Exoskeletons Role in Physical Rehabilitation

Originally designed for heavy lifting in factories, the role of exoskeletons has increased in healthcare in recent years more specifically neuro physiotherapy rehabilitation. A robotic exoskeleton suit is made functional by a combination of motors, actuators, and electromechanical and hydraulic systems, all powered by an on-board battery and a computer system designed to mimic the natural gait of the user. In Donegal, thanks to the generous funding of the community an EksoGT is available exclusively for rehabilitation. The EksoGT robotic device helps stroke patients and people with spinal cord injuries regain their mobility sooner, giving them computer guidance to regain a proper gait. It is used under the guidance of trained chartered physiotherapists.

 

For more information email hello@nobarriers.ie

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