Is ankle proprioception targeted by exercises on an unstable surface?

Everyone who has ever experienced an ankle sprain knows the exercises done on unstable surfaces, such as wobble boards. This is aiming to improve proprioception. Proprioception is defined according to Physiopedia  as: Proprioception is the sense of the relative position of body Read more

Swiss ball enhances lumbar multifidus activity in chronic low back pain

This study investigated the effects of sitting surfaces on the cross-sectional area of lumbar multifidus (LM) in patients with Chronic Low Back Pain (CLBP) and healthy controls (HC). 40 age and sex matched, sporting participants aged 18-45 years, recruited Read more

Neuro Rehab

The Tibion Bionic Leg

Up to 40 to 50% of individuals who survive stroke experience physical disability. The ability to stand up from sitting is an important functional activity, a prerequisite for upright mobility and an important factor for independent mobility. However, sit-to-stand (STS) is biomechanically demanding and requires higher lower extremity joint torques than walking or stair climbing. Recently, robotic devices have been used in neurorehabilitation to facilitate treatment efficacy. The Tibion Bionic leg is a mobile, intention-based robotic device designed to allow individuals post-stroke to perform activities more normally. Results to date have shown improvements in balance, gait and functional performance in individuals post-stroke following therapeutic intervention using the Tibion Bionic Leg (TBL). Here we studied the effects of actuated limb assistance on hemiparetic limb asymmetry during STS using unilateral and bilateral vertical ground reaction forces (vGRF). We hypothesized that
thumbnailThe Tibion Bionic Leg is a mobile, wearable, intentionbased robotic limb orthosis (Tibion Pk-100 Bionic Leg, Tibion Corporation, Sunnyvale, CA) developed as a therapeutic device. The device is actuated to supply force to assist or resist leg extension and flexion providing limb assistance against gravity during extension (as in sit-to-stand or free standing) and controlled flexion (as in stand-to-sit). Force sensors placed under the foot detect a threshold force and trigger the actuation. In its primary mode (AUTO) the device clearly activates to assist the motion of the wearer. Three settings can be adjusted to individualize participant assistance or therapeutic challenge: threshold (force criterion required to activate the device), assistance (amount of assistance provided as percentage of body weight) and resistance (resistance provided during controlled flexion as in stand-to-sit or stair descent)the actuated limb assistance provided to the paretic side by the TBL would promote more symmetrical movement and force production by individuals post-stroke.

The study suggests that the Tibion allows the user to involve their weaker leg more than would otherwise be possible, enabling greater weight bearing through the involved lower extremity. When used during therapy, it  may enhance the capability of the wearer to perform activities with more appropriate biomechanics. Repetition of appropriate movement patterns with greater engagement of the paretic limb may ensure functional improvements.

 

Read more here!

Byl (2012) concuded in here case series that  additive clinical-functional benefits may be achieved by incorporating mobile, intention-based robotic technology into therapist-supervised mobility training for patients in the late-phase post stroke. 

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Hand Therapy with FES after Stroke in Kinesis

Many patients see a marked improvement after therapy 

 

Mr Yee 54 years old stroke patient is one of our patients that has used the Bioness Hand H200 for his hand therapy.

“Bioness Hand has enabled me to grip firmly,  I can now hold a racket and use a toothbrush with it” – Mr Yee

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Stroke Recovery and Kinesis Physio & Rehab Singapore

 

Stroke Rehab 

Many discoveries have been made in recent years about the brain. One big discovery is that on “Neuroplasticity”

It is found that the brain has the capacity to change, re-organize and re-wire itself, in response to stimulation of learning and experience. This replaces the previous belief that the brain is a static organ and after a certain age, it is fixed and not able to change. With neuroplasticity, it means that with the right stimulation, training and exercise, a stroke patient’s nervous system can generate new connections and pathways, leading to better recovery even after many years of injury.

Therefore it is desirable that the brain re-wire the correct movement rather than a wrong pattern. Hiking of the hip is one such common example of a wrong movement that a stroke patient uses as a compensatory strategy for walking. This may be due in part to a foot drop or a weak hip muscle that is unable to lift the leg up and result in dragging the foot.

With this in mind, Kinesis deploy the help of some of the latest technologies to enable patients to train and walk in the right gait pattern. As most of the time, without the help of a machine, it is almost impossible for patients to repeat each time a movement in a correct pattern, in a consistent manner. We use technologies to our advantage to increase the chances of brain re-wiring.

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Bioness L300 Footdrop system

Now there is a way to regain your freedom and independence by helping you walk with greater speed, stability and confidence.1 The award-winning L300 Foot Drop System is designed to help people with certain neurological conditions walk more naturally, with increased speed and improved balance. The L300’s advanced technology delivers programmed, low-level electrical stimulation to activate nerves and muscles that lift the foot, giving you the mobility to step back into life.

 

 

 

 

 

 

See more at: http://www.bioness.com/Products/L300_for_Foot_Drop.php#sthash.Ft4ekJqh.dpuf

Mehlhaff explained that Foot Drop System stimulates the muscles in a patient’s foot with mild functional electrical stimulation, which prompts him or her to lift toes when the foot is off of the ground.

Once the patient’s heel hits the ground, she said a switch in the patient’s shoe senses that and turns off the electricity so the foot can come down.

“It’s superior to a brace in many ways because the electricity helps strengthen the muscle,” she said. “And it allows a lot more freedom in the ankle motion so that your walking can be much more symmetrical.”

Read more at: http://siouxcityjournal.com/lifestyles/local/stimulating-walk-foot-drop-system-helps-those-with-paralysis-get/article_f8dca8eb-d0ac-591f-85ad-768dd3a6a0cf.html

 

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Tibion Bionic Leg at Kinesis

Stroke rehabilitation has undergone a paradigm shift after research by neuroscientists proved the brain is not hard wired and has the capacity to change. This has been one of the most exciting discoveries of the 21st century- Neuroplasticity.

For neuroplasticity to take place, it is important that the activity that we are aiming at is intention based, task specific, has high repetition and challenging to the Stroke/neuro patient.

Incorporating this approach to the physiotherapy of patients with brain injury is the latest practice. In order to enhance the treatment of our patients we at Kinesis Physio and Rehab are using innovative technologies.

Tibion works on the above concept of neuroplasticity. It is World’s first wearable bionic leg which frees patient from body weight support in treadmill and hence allowing them to practice sit to stand, stairs and other task specific activities. Its activation is intention based as it requires the patient to initiate weight bearing on the affected side which then activates the foot sensors. The robotic exoskeleton then guides the patient into the intended task like standing or walking. It supports the leg well which motivates the patient to move his lower limb repeatedly in a consistent manner allowing high repetition during tasks. Tibion allows symmetrical gait which further prevents compensatory movements that creates abnormal walking pattern in Stroke patients.

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