Transcript Document

Scientific Evidence for New Technologies
Audience
Clinicians
Scientific Evidence for New Technologies
Scientists
Engineers
2
Others
Drivers for New Technologies
Societal drivers
• Ageing of population
• Cost of health care
• Burden in daily life
Scientific Evidence for New Technologies
Technological drivers
• Available technology
• Fast growing
• Home use
3
Clinical drivers
• Unused recovery potential
• Evidence-based knowledge
Usage of New Technologies
motor learning
brain injury
assessments
therapy
daily activities
New technologies for enhanced … and assessing recovery
progress
and effective therapy …
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Potential influence of New Technologies
Movement &
sensory input
Muscle strength
Varied, goal oriented
repetitions at limit of
performance
&
Feedback from
successful
performance
Advanced Rehabilitation
Technology
Improved performance
Reduce support
Increase challenge
Principles of New Technologies
5
Neuroplasticity
Motor Learning
Contents
1. Robot-assisted Therapy
2. Non-actuator Devices
3. Functional Electrical Stimulation (FES)
4. Virtual Reality
5. Brain Stimulation
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ROBOT-ASSISTED THERAPY
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Robot-Assisted Therapy: Lower Extremity
Rehabilitation Time
Walking improvements
Non-ambulatory patients in
early rehabilitation profit
most from robot-assisted
therapy
Positive effect on gait
speed, walking distance
and basic activities of daily
living
Effectiveness
Dependency
Robotic therapy in combination
with conventional therapy is
more effective than
physiotherapy alone
Every fifth dependency in
walking could be avoided
using robotic-assisted
training
(Mehrholz et al. 2013)
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Robot-Assisted Therapy: Upper Extremity
Proximal Improvements
Distal Improvements
Significant effect on
motor function of
shoulder and elbow,
muscle strength and
pain reduction
Elbow and wrist training enhances
motor function and muscle
strength
(Veerbeek et al. 2014)
Risk
(Veerbeek et al. 2014)
No increased risk of injury with
intensive training (Mehrholz et al. 2012)
Transfer to Daily Life
Recovery Time
Improves generic
activities of daily living
and arm function
Robotic therapy improves motor
function in a shorter time than
physiotherapy
(Sale et al. 2014)
(Mehrholz et al. 2012)
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Cost effectiveness
Conventional therapy
Profit
450
• Conventional gait training therapy
costs are low
• Robot-assisted therapy fixed costs
(device purchase price) are high
350
250
• In the long term robot-assisted
therapy is cost effective
150
50
Loss
-50
-150
-250
1st year
2nd year
3rd year
4th year
5th year
Time from start of treatment [Years]
Years to break even
•Cost [€]
ТЫСЯЧИ
Robot-assisted therapy
2,08
2
1,6
1
Conventional
therapy
0
years of
to gait
break
even
Type
training
(Morrison 2011, Wagner et al. 2011)
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Robotassisted
therapy
Cost effectivness II
• Costs for 5 weeks of robot-assisted training with a moderate-to-low cost device can be
recovery by a dehospitalization of 1.2 days earlier. Any further reduction would result
in money savings (Stefano et al. 2014).
328,04
328.04
€
€
273,64
273.64
€
€
Cost (€)
Название диаграммы
Time
0
5
10
15
20
25
30
Time (days)
5 weeks robotic therapy
5 weeks of robotic rehabilitation
1 day of hospitalization
1 day of hospitalization
“Robotic technology can be a valuable and economically sustainable
aid in the management of poststroke patient rehabilitation.”, Stefano et al. 2014
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NON-ACTUATOR DEVICES
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Clinical Evidence of Non-Actuator Devices
Functionality
Effectiveness
Arm weight support improves
hand movements important
for functional ability
Matches gains of
conventional therapy
(Bartolo et al. 2014)
(Prange et al. 2014)
Undesired Synergies
Range of Motion
Possibly reduces abnormal
coupling between shoulder
and elbow
Increases range of motion
for hand and arm movements
(Krabben et al. 2012)
(Kloosterman et al. 2010, Krabben et al. 2012)
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3
FUNCTIONAL ELECTRICAL STIMULATION
(FES)
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Clinical Evidence of FES
Functionality
Wrist and Hand
Improves upper extremity function
and motor processing
Positive effect on
muscle strength and
motor function
(Ring and Weingarden 2007)
Spasticity
(Arantes et al. 2007)
Decreased spasticity
(Daly and Ruff 2007, Hara 2008)
Pain
Walking Speed
Significant reduction of
pain
Surface-applied and implanted
FES increases walking speed
(Wilson et al. 2014)
(Kottink 2007, Veerbeek et al. 2014)
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VIRTUAL REALITY
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Clinical Evidence of Virtual Reality
Cognitive aspects
Upper Extremity
Supports cognitive rehabilitation
(Rose et al. 1998)
Improves upper extremity
function and motor
processing
Motivation
Increases self confidence
and motivation
(Riva 1998)
(Kuttuva et al. 2006)
Lower Extremity
Environment
Improves walking speed
and muscle strength,
therefore improving overall
quality of life
VR environments stimulates
neuroplastic change and
enhances learning effects
(Rose et al. 1998)
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(Sviestrup 2004)
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BRAIN STIMULATION
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Clinical Evidence of Brain Stimulation
Optimal Effect
Pain
Best gains if paired with
relevant behavioral
experiences
Relieves 20-58% of chronic
pain
(Gladstone and Black 2000)
(Fregni et al. 2006)
Motor Function
Severely impaired
Improves motor function
which can last for several
weeks
Improvements even for
patients with severe motor
deficits
(Fregni et al. 2006)
(Hummel et al. 2006, Boggio et al. 2006)
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+
Contact
International Industry Society in Advanced Rehabilitation Technology
(IISART)
General Information
[email protected]
www.iisartonline.org
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Literature
[1] Mehrholz et al. 2013, Electromechanicalassisted training for walking after stroke.
[2] Verbeek et al. 2014, What Is the Evidence
for Physical Therapy Poststroke? A Systematic
Review and Meta-Analysis.
combined with rehabilitation games on upperextremity function in subacute stroke: a
randomized controlled trial.
[10] Daly and Ruff 2007, Construction of
efficacious gait and upper limb functional
[3] Mehrholz et al. 2012, Electromechanical and interventions based on brain plasticity evidence
robot-assisted arm training for improving generic and model-based measures for stroke patients.
activities of daily living, arm function, and arm
[11] Kottink et al. 2007, A randomized controlled
muscle strength after stroke.
trial of an implantable 2-channel peroneal nerve
[4] Sale et al. 2014, Effects of upper limb robot- stimulator on walking speed and activity in
assisted therapy on motor recovery in subacute poststroke hemiplegia.
stroke patients.
[12] Hara 2008, Neurorehabilitation with new
[5] Wagner et al. 2011, An economic analysis of functional electrical stimulation for hemiparetic
robot-assisted therapy for long-term upper-limb upper extremity in stroke patients.
impairment after stroke.
[13] Ring and Weingarden 2007,
Neuromodulation by functional electrical
[6] Bartolo et al. 2014, Arm weight support
training improves functional motor outcome and stimulation (FES) of limb paralysis after stroke.
movement smoothness after stroke.
[14] Arantes et al. 2007, Effects on Functional
[7] Kloosterman et al. 2010, Influence of gravity Electrical Stimulation applied to the wrist and
finger muscles on hemiparetic subjects: a
compensation on kinematics and muscle
activation patterns during reach and retrieval in systematic review of the literature.
subjects with cervical spinal cord injury: an
[15] Wilson et al. 2014, Peripheral nerve
explorative study.
stimulation compared with usual care for pain
relief of hemiplegic shoulder pain: a randomized
[8] Krabben et al. 2012, Influence of gravity
compensation training on synergistic movement controlled trial.
patterns of the upper extremity after stroke, a
pilot study.
[16] Kuttuva et al. 2006, The Rutgers Arm, a
Rehabilitation System in Virtual Reality: A Pilot
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[9] Prange et al. 2014, The effect of arm support Study.
[17] Sviestrup 2004, Motor Rehabilitation Using
Virtual Reality.
[18] Rose et al. 1998, Virtual environments in
brain damage rehabilitation: a rational from
basic neuroscience.
[19] Riva 1998, Virtual reality in paraplegiga: a
VR-enhanced orthopaedic appliance for walking
and rehabilitation.
[20] Fregni et al. 2006, A sham-controlled,
phase II trial of transcranial direct current
stimulation for the treatment of central pain in
traumatic spinal cord injury.
[21] Boggio et al. 2006, Hand function
improvement with low-frequency repetitive
transcranial magnetic stimulation of the
unaffected hemisphere in a severe case of
stroke.
[22] Gladstone and Black 2000, Enhancing
recovery after stroke with noradrenergic
pharmacotherapy: a new frontier?
[23] Fregni al. 2006, A randomized, shamcontrolled, proof of principle study of
transcranial direct current stimulation for the
treatment of pain in fibromyalgia
[24] Hummel et al. 2006, Effects of brain
polarization on reaction times and pinch force in
chronic stroke.
Image sources
Slide 2 – Audience
Background:
http://www.iisd.ca/ymb/climate/wcc3/pix/1sept/DSC_6266%20full%20room.jpg
Slide 3 – Reasons for New Technologies
Left:
http://www.unece.org/typo3temp/pics/8346dcaa95.jpg
Middle (upper):
http://emergingtech.tbr.edu/sites/default/files/styles/flexslider_full/public/NewTech_0.jpg?itok=WghHlgJO
Middle (lower):
http://timpexelectronics.com/wp-content/uploads/2014/03/Electronics-0000166421891-1100x732.jpg
Right:
http://www.nature.com/sc/journal/v41/n12/fig_tab/3101518f1.html
Slide 4 – Usage of New Technologies
1st image (motor learning):http://www.vi-hotels.com/typo3temp/pics/s_1ad5acb5b7.jpg
2ndimage (brain injury):
http://www.eusi.org/wp-content/uploads/2012/11/stroke.jpg
3rd image (therapy):
Hocoma
4th image (assessments): http://www.hopkinsmedicine.org/healthlibrary/GetImage.aspx?ImageId=268329
5th image (daily activities): http://static.guim.co.uk/sys-images/Guardian/Pix/pictures/2013/10/28/1382979259350/Gardening-and-DIY-can-pro011.jpg
Slide 5 – Usage of New Technologies II
Images:
Presentation slides
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