Dissertations / Theses on the topic 'Hand Surgery Patients Rehabilitation'
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Saleeba, Elizabeth Constance. "Patient compliance and spontaneous movements while following an early active motion protocol after a flexor tendon repair." University of Western Australia. School of Surgery, 2010. http://theses.library.uwa.edu.au/adt-WU2010.0050.
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Compliance to strict home exercise programs is understood to be a mainstay of post-surgical flexor tendon rehabilitation. Therapists recognise the potential of poor compliance (overuse or under-use of prescribed exercise) and spontaneous movements during rehabilitation. Some therapists may suggest that compliance to specific exercise regimens and control of spontaneous or general movements are fundamentally important in optimising the rehabilitation outcomes and minimising the potential of adverse events. Yet there is little objective data to document the actual levels of exercise or spontaneous finger movement performed outside the clinical setting. The purpose of this study was to document both diary and instrumented methods of reporting finger movement during a 48hr period. Following surgical repair of the flexor tendon, subjects attending a private hand therapy clinic provided consent and reported subjective diary (n=16) data of sets and repetitions of exercise for up to 6 weeks post-operatively. Nine subjects also had instrumented data logged on 3 occasions during the first 6 weeks of rehabilitation and were not fully aware of the purpose of the instrumentation. All subjects were instructed to perform 10 passive followed by 10 active exercises every waking hour, for the first 6 weeks and were assessed on range of motion, DASH, pain and strength. Results demonstrated that patients reported, via their diaries, that they are on average 80% compliant. Parallel data logger information suggests that this figure is more likely to reflect 50% compliance. A significant (p< .05) increase in spontaneous movements in the last 2 weeks of the 6 week assessment period was detected. No significant correlation between patient's level of compliance or spontaneous movement and their outcome were detected.
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Mishra, Sankalp. "Use Of Virtual Reality Technology In Medical Training And Patient Rehabilitation." Wright State University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=wright1559144258671291.
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Lynn, Jennifer. "Outcomes of early rehabilitation following lumbar microdiscectomy." University of Western Australia. School of Surgery and Pathology, 2009. http://theses.library.uwa.edu.au/adt-WU2009.0187.
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[Truncated abstract] There have been few studies into the effects of rehabilitation following lumbar microdiscectomy and consequently little evidence of its effect, if any, on outcome. Most studies cited fall into one of two categories: research involving a spinal surgery procedure without rehabilitation, or research involving spinal surgery with a nonspecific generic 'rehabilitation' or 'physical therapy'. In an era of evidence based medicine the efficacy of specific rehabilitation protocols following defined lumbar spine surgical procedures needs to be established for surgeons, therapists and patients to have confidence that the rehabilitation is appropriate and effective. The study was proposed to investigate the outcome of a specific and novel rehabilitation protocol commenced immediately after lumbar microdiscectomy. Data collected from the research cohort were compared to data collected from a contrast group who underwent standard rehabilitation at a distant site. A retrospective study (Phase One) was carried out with a cohort of post-operative microdiscectomy patients between February 2000 and December 2002. The outcome of surgery followed by the rehabilitation protocol was assessed using validated outcome instruments. A contrast or control group was not included. After reviewing the data limitations with the design and implementation of the study were identified. A prospective study (Phase Two) was proposed and changes made in the principal outcome measure used, in the demographic data to be retrieved, the addition of pain scales, and in the exclusion of compensable patients. A contrast group was included for the prospective study. ... The study group commenced exercise and posture correction the day following surgery. There were restrictions placed on activity involving bending. The contrast group followed the advice of the surgeon in Queensland and attended rehabilitation at local physiotherapy facilities. Both groups were followed for 12 months using outcome instruments. Strict comparison between WA and QLD cohorts were limited due to sample size, however trends were observed. Data of the prospective study showed that there was greater reduction in back pain with the early rehabilitation protocol (P<.0001) compared to standard rehabilitation (P=.09), while there was no difference between groups in leg pain. There was a significant improvement in the level of functional disability between time-points for the WA cohort, and overall change from pre-operative RMQ measures to 12 months in both groups were statistically significant. The WA group was less reliant on pain medication and was more satisfied with the results of their surgery. The primary hypothesis of this study that there would be a difference in outcome following lumbar microdiscectomy in patients who receive early specific rehabilitation compared to those who receive standard rehabilitation at another centre, was supported in both primary and secondary outcome data. The key finding of this study was that commencing the early exercise protocol resulted in significantly less back pain over the 12 month time period of the study. Other major findings were that the WA cohort demonstrated significant improvement in function at all time-points and between all time-points except six to 12 months, took less pain medication and were more satisfied with the outcome of their surgery than the QLD cohort.
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Mozaffari, Foumashi Mohammad <1983>. "Synthesis of Hand Exoskeletons for the Rehabilitation of Post-Stroke Patients." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2013. http://amsdottorato.unibo.it/5906/.
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This dissertation presents the synthesis of a hand exoskeleton (HE) for the rehabilitation of post-stroke patients. Through the analysis of state-of-the-art, a topological classification was proposed. Based on the proposed classification principles, the rehabilitation HEs were systematically analyzed and classified. This classification is helpful to both understand the reason of proposing certain solutions for specific applications and provide some useful guidelines for the design of a new HE, that was actually the primary motivation of this study.
Further to this classification, a novel rehabilitation HE was designed to support patients in cylindrical shape grasping tasks with the aim of recovering the basic functions of manipulation. The proposed device comprises five planar mechanisms, one per finger, globally actuated by two electric motors. Indeed, the thumb flexion/extension movement is controlled by one actuator whereas a second actuator is devoted to the control of the flexion/extension of the other four fingers. By focusing on the single finger mechanism, intended as the basic model of the targeted HE, the feasibility study of three different 1 DOF mechanisms are analyzed: a 6-link mechanism, that is connected to the human finger only at its tip, an 8-link and a 12-link mechanisms where phalanges and articulations are part of the kinematic chain. The advantages and drawbacks of each mechanism are deeply analyzed with respect to targeted requirements: the 12-link mechanism was selected as the most suitable solution. The dimensional synthesis based on the Burmester theory as well as kinematic and static analyses were separately done for all fingers in order to satisfy the desired specifications.
The HE was finally designed and a prototype was built. The experimental results of the first tests are promising and demonstrate the potential for clinical applications of the proposed device in robot-assisted training of the human hand for grasping functions.
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Li, Zheng. "Using Robotic Hand Technology for the Rehabilitation of Recovering Stroke Patients with Loss of Hand Power." NCSU, 2003. http://www.lib.ncsu.edu/theses/available/etd-11032003-115737/.
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Stroke is the third leading cause of death in the United States. Nearly 700,000 people suffered from stroke last year and two thirds of them survived but were left with any number of disabilities, one such disability is upper extremity hemiplegia. If the hand and arm doesn?t have therapy immediately after stroke, it will lose it power and muscle control, resulting in a claw like appearance and loss of function. Activities of the patient daily living will be significantly effected. Current therapy on the affected limb in the hospital is expensive and difficult to manage due to the limited amount of resources compared to the number of patients. We introduce a pneumatic actuated wearable hand and forearm device in this thesis. It is designed according to the hand and arm kinematics. It can help the patients keep power on each finger and help maintain the coordination of different fingers to achieve daily living movements. It consists of forearm brace, rehabilitation glove and artificial muscles. The custom made artificial muscles also known as McKibben Artificial Muscles are used in antagonistic pairs to control the fingers flexion and extension. The rehabilitation device is small, lightweight, home-based, and has large force capabilities. It is also affordable to the patients due to the specially designed low-cost artificial muscles. The rehabilitation device was controlled by solenoid valves in conjunction with a Mitsubishi M32/83C 16-bit micro controller. Experiments on the pneumatic elbow brace have shown that it is capable of moving each finger from full extension to flexion, to perform actions like pinching and allows the coordinated movement of two fingers.
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林進其 and Chun-ki Lam. "A modified nurse-led rehabilitation program to accelerate overall recovery of patients after colorectal surgery." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193021.
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The number of patients with colorectal cancer had increased dramatically in recent years (Hong Kong cancer registry, 2012), and surgical resection is the first line treatment of colorectal. To enhance patients’recovery process, there is a need to develop a comprehensive and user-friendly, with most important, an evidence-based guideline for promoting patients’ recovery process. Traditional post-operative management is associated with different postoperative complications, delayed recovery, and lengthened hospital stay. Recent research documented that using a specific rehabilitation programme focused on education; early mobilization and early diet regime could enhance patients’ recovery. Therefore, this transitional research aims to evaluate the current evidence on the effect of adopting a specific rehabilitation programme, to formulate an evidence-based guideline, assess its implementation potential, and to develop an implementation and evaluation plan.
Ten related literature were retrieved from four electronic bibliographical databases. Critical appraisal had been done to ensure the quality and validity of the selected evidences. A clinical guideline is developed based upon the information from the identified high level of literature. The implementation potential is assessed based on the similarity and the readiness of the target setting to the proposed environment. It was found that the transferability of the protocol was high and it was feasible to be implemented into the target site. Little expenditure and input was expected, as the protocol was a systematic reformation of practice, rather that developing a set of totally new practice to current clinical setting.
An implementation plan was then planned, which included the communication plan with all the stakeholders. After reaching a consensus among the stakeholders, a two-month pilot study will be carried out for examining the readiness before the full-scale implementation of the program.
The evaluation plan of the effectiveness of the proposed program is developed. Result will be used to provide recommendation for further adjustment on the protocol to yield a better outcome. The implementation of this nurse-led rehabilitation program is suggested to be worthy of adoption in the clinical setting for bringing benefits to patients, the hospital and staffs.published_or_final_version
Nursing Studies
Master
Master of Nursing
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Whelen, Elizabeth Anne. "Illness perceptions, cardiac rehabilitation and quality of life in cardiac surgery patients." Thesis, University of Manchester, 2011. https://www.research.manchester.ac.uk/portal/en/theses/illness-perceptions-cardiac-rehabilitation-and-quality-of-life-in-cardiac-surgery-patients(63ce3eb5-16c7-487a-8d51-c727a4399a19).html.
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Background: Previous research indicates that for some individuals, quality of life (QoL) post-cardiac surgery (CABG or PTCA ) declines from pre-surgery levels. Using the framework of Leventhal's Common-Sense Model, this longitudinal study examined the associations between patients' illness perceptions and coping strategies, their QoL, attendance at cardiac rehabilitation and lifestyle changes. It was hypothesised that a more negative profile of illness beliefs (weaker control beliefs, belief in more severe consequences, poorer understanding of the condition, and negative emotional representations) together with the use of more emotional coping strategies would be associated with poorer QoL. It was also hypothesised that attendance at cardiac rehabilitation would be associated with greater control beliefs, more severe consequences and a causal attribution of lifestyle. Sample and Methods: 113 patients (93 male, mean age 66 (8.93) who were about to undergo cardiac surgery were recruited from two hospitals. Questionnaire measures of illness perceptions (IPQ-R), coping (CHIP) and cardiac-specific QoL (MacNew) were administered at four time points: pre-surgery, post-surgery, post cardiac rehabilitation, and one-year follow up. Data on attendance at rehabilitation and health behaviours were collected via hospital records and patient report. Results: The best predictors of QoL were not cognitive representations of the cardiac problems, but negative emotional representations and associated emotion-focussed coping strategies, implying that an emotion-regulation intervention could be targeted to improve outcome. The predictive ability of initial QoL on QoL at later stages implies this might be best introduced pre-surgery. Having less severe consequence beliefs prior to surgery predicted greater attendance at cardiac rehabilitation. A better understanding of the cardiac condition predicted attendance at cardiac rehabilitation. There was no evidence of change in lifestyle post-rehabilitation.Discussion: The findings that emotional representations of cardiac problems and the use of emotion focussed coping strategies were predictors of quality of life suggest that interventions to foster adaptive emotion regulation may improve outcome in these patients. Findings with respect to attendance at rehabilitation varied somewhat from the previous literature, possibly because the present study sampled patients who were having elective surgery, rather than those who had recently had a heart attack. The importance of studying defined populations and also the issue of when measures are obtained in relation to cardiac events were also highlighted.
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Wong, Yuk-ping Joyce, and 黃玉萍. "Outcome measures of traumatic hand injury patients in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B31972299.
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陸慧霞 and Wai-ha Veronica Luk. "Evidence-based DVT prophylactic guideline for stroke and neurosurgicalpatients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B43251419.
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Dorow, Marie, Margrit Löbner, Janine Stein, Alexander Pabst, Alexander Konnopka, Hans J. Meisel, Lutz Günther, Jürgen Meixensberger, Katarina Stengler, and Steffi G. Riedel-Heller. "The course of pain intensity in patients undergoing herniated disc surgery." Universitätsbibliothek Leipzig, 2016. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-206139.
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Objectives: The aims of this study are to answer the following questions (1) How does the pain intensity of lumbar and cervical disc surgery patients change within a postoperative time frame of 5 years? (2) Which sociodemographic, medical, work-related, and psychological factors are associated with postoperative pain in lumbar and cervical disc surgery patients? Methods: The baseline survey (T0; n = 534) was conducted 3.6 days (SD 2.48) post-surgery in the form of face-to-face interviews. The follow-up interviews were conducted 3 months (T1; n = 486 patients), 9 months (T2; n = 457), 15 months (T3; n = 438), and 5 years (T4; n = 404) post-surgery. Pain intensity was measured on a numeric rating-scale (NRS 0–100). Estimated changes to and influences on postoperative pain by random effects were accounted by regression models. Results: Average pain decreased continuously over time in patients with lumbar herniated disc (Wald Chi² = 25.97, p<0.001). In patients with cervical herniated disc a reduction of pain was observed, albeit not significant (Chi² = 7.02, p = 0.135). Two predictors were associated with postoperative pain in lumbar and cervical disc surgery patients: the subjective prognosis of gainful employment (p<0.001) and depression (p<0.001). Conclusion: In the majority of disc surgery patients, a long-term reduction of pain was observed. Cervical surgery patients seemed to benefit less from surgery than the lumbar surgery patients. A negative subjective prognosis of gainful employment and stronger depressive symptoms were associated with postoperative pain. The findings may promote multimodal rehabilitation concepts including psychological and work-related support.
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Ebert, Jay Robert. "Post-operative load bearing rehabilitation following autologous chondrocyte implantation." University of Western Australia. School of Sport Science, Exercise and Health, 2008. http://theses.library.uwa.edu.au/adt-WU2008.0196.
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[Truncated abstract] Autologous Chondrocyte Implantation (ACI) has shown early clinical success as a repair procedure to address focal articular cartilage defects in the knee, and involves isolating and culturing a patient's own chondrocytes in vitro and re-implantation of those cells into the cartilage defect. Over time, repair tissue can develop and remodel into hyaline-like cartilage. A progressive partial weight bearing (PWB) program becomes the critical factor in applying protection and progressive stimulation of the implanted cells, to promote best chondrocyte differentiation and development, without overloading the graft. The aim of this thesis was to investigate whether patients could replicate this theoretical load bearing model to possibly render the best quality tissue development. In addition, this proposed external load progression is only a means to loading the articular surface. Several factors, including those that may result from pathology, have the potential to influence gait patterns, and therefore, articular loading. The association between increasing external loads (ground reaction forces - GRF) and knee joint kinetics during partial and full weight bearing gait was, therefore, investigated in the ACI patient group, as was the contribution of other gait variables to these knee joint kinetics which may be modified by the clinician. Finally, current weight bearing (WB) protocols have been based on early ACI surgical techniques. With advancement in the surgical procedure and ongoing clinical experience, we employed a randomised controlled clinical trial to assess the effectiveness of an 'accelerated' load bearing program, compared with the traditionally 'conservative' post-operative protocol. ... Although similar spatio-temporal, knee kinematic and external loading parameters were observed between the traditional and accelerated rehabilitation groups, the accelerated group was 'more comparable' to the controls in their external knee adduction and flexion moments, where the traditional group had lower knee moments. Knee moments greatly affect knee articular loading, and large adduction moments have been related to poor clinical outcomes after surgery. Therefore, the return of normal levels may be ideal for graft stimulation, however, may overload the immature chondrocytes. Acceleration of the intensive rehabilitation program will enable the patient to return to normal activities earlier, whilst reducing time and expenses associated with the rehabilitative process, and may enhance long-term tissue development. However, continued follow-up is required to determine if there are any detrimental effects that may emerge as a result of the accelerated load bearing program, and assess the recovery of normal gait patterns and whether longer term graft outcomes are affected by the recovery time course of normal gait function, and/or abnormal loading mechanics in gait. Furthermore, analysis at all levels of PWB is needed to identify a more complete set of variables attributing to the magnitude of external knee joint kinetics and, therefore, knee articular loading, while the influence muscle activation patterns may have on articular loading needs to be investigated. This becomes critical when you consider loads experienced by the articular surface throughout the early post-operative period following ACI may be important to short- and long-term graft development.
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Kuntz, Michael T. "Time From Booking Until Appointment and Healthcare Utilization in Hand Surgery Patients With Discretionary Conditions." Thesis, Springer Verlag, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:17295874.
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Delaying medical therapy for benign musculoskeletal conditions may allow patients to
develop coping strategies, resulting in less need for medical intervention and reduced cost.
Our primary question was whether time from booking until appointment is associated with
healthcare costs. Our secondary question was whether time from booking to appointment is
associated with healthcare utilizations, including imaging, injections, nerve conduction
studies, occupational therapy visits, surgery, referrals, and second opinions.
We identified 16,750 patients making a first clinic visit to a hand surgery practice from 2003
through 2012. Utilizations were determined until the patient’s second visit. Costs were
determined in Relative Value Units. In multivariable models, duration between booking and
office visit was not associated with higher cost. Duration between booking and office visit
was associated with a higher rate of nerve conduction studies (P < 0.001) and a lower rate
of occupational therapy (P < 0.001). We observed substantial variation in cost and
utilization based on treating surgeon. In a setting with relatively short wait times, greater
wait time was not therapeutic, but is associated with different diagnostic and treatment
measures. The variations by surgeon may make variations based on other factors including
time between booking and appointment difficult to discern.
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Ransom, Kay Johnson. "Imagery/Mental Practice: A Cognitive Technique for Teaching Adaptive Movement to Postoperative Spinal Patients." Thesis, North Texas State University, 1986. https://digital.library.unt.edu/ark:/67531/metadc332028/.
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Postoperative spinal patients were randomly assigned to one of three treatment conditions and were taught five adaptive movements by occupational therapists. The Control group received routine hospital occupational therapy; the Placebo group participated in an imagery relaxation task unrelated to the mental practice task of the Imagery group, which was shown line drawings of the adaptive movements under study, provided movement instructions, and asked to mentally practice each movement in a familiar, daily living situation. Thirty-five patients returned for follow-up, and a measure of outcome was obtained through the use of a quantified movement assessment instrument. Subjective ratings for anxiety, rumination, and imagery were made by the occupational therapists. An occupational motoric-symbolic rating scale was developed to assess the symbolic portion of the patient's job experience. Statistical procedures including chi square, analysis of variance, and Pearson correlation were performed. Results were in the predicted direction although statistical significance was not achieved. Possible explanations for the obtained results were discussed.
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Wilson, Julie Kay. "A comparative study of rehabilitation on total knee replacement." Virtual Press, 1995. http://liblink.bsu.edu/uhtbin/catkey/1014843.
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The purpose of this study was to determine the effectiveness of the Augmented Soft Tissue Mobilization (A.S.T.M.) Rehabilitation Technique on total knee replacement patients. The specific measurements assessed were stride length (SL), stride frequency (SF), walking velocity, support time (ST), total time (TT), static and walking range of motion (ROM) of the hip, knee, and ankle, ground reaction forces (GRF), and torques. Fourteen subjects (Female = 7, Male = 7) completed the study. Subjects were randomly assigned to two experimental groups, the Traditional Therapy treatment or the A.S.T.M. treatment. There were five testing sessions: pre operation, 8 weeks, 12 weeks, 16 weeks, and 24 weeks post operation. On the 12 week test, the subject had completed their assigned of treatment protocol. Static ROM was derived from gonimetric measurements before each testing session. Stride length, stride frequency, velocity, time, and walking ROM were derived from accelerometer data. Statistical analysis using ANOVA revealed a significant change in all static ROM, SL, and ST. The data indicated that both groups of the Total Knee Replacement patients did improve their functional status from their status prior to surgery. In addition, the data indicated that the Augmented Soft Tissue Mobilization program and the Traditional Therapy program are equally acceptable rehabilitation techniques.School of Physical Education
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Tai, Lok-hei Chris, and 戴樂熙. "The effectiveness of EMG biofeedback in hand function training after stroke." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2005. http://hub.hku.hk/bib/B45010419.
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Wittekind, Samuel. "A Novel Mechanism for Improved Exercise Performance in Pediatric Fontan Patients After Cardiac Rehabilitation." University of Cincinnati / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1522419865157589.
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Tarassova, Inna. "Factors associated with recovery from cardiac surgery in female patients." Honors in the Major Thesis, University of Central Florida, 2001. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/254.
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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.Bachelors
Health and Public Affairs
Nursing
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Luhmann, Ole. "Development of a Novel Hand Exoskeleton for the Rehabilitation and Assistance of Upper Motor Neuron Syndrome Patients." Thesis, KTH, Maskinkonstruktion (Inst.), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-281248.
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Hand exoskeletons are wearable robotic devices which are used to compensate for impaired handmovements in patientswith impaired upper-limbs. These devices can either help patients to grasp objects for a therapeutic purpose or to performactivities of daily living. This Thesis describes the development of a novel hand exoskeleton, with a focus on the user, based on the product development methodology "the V-Model". Therefore, user needs are identified through interviews and a thorough literature review. Three potential concepts are developed and sub-sequential a concept is selected based on a logical decision process. A mathematical model of the selected concept is generated and then used for dimensioning the hand exoskeleton. Moreover, three variants of the hand exoskeleton are built as prototypes. Finally, the variants of the device are tested on a bench top. The result of the development process is a novel hand exoskeleton for the rehabilitation of upper motor neuron syndrome patients. Force and range of motion tests revealed, that a design with a higher level of underactuation is favourable. The design presented in this thesis does not reach the defined range of motion and force augmentation. However, the defined target values are the results of a conservative approach, thus are a challenge to reach. The augmented closing force and range of motion surpass other state of the art hand exoskeletons. Nevertheless, the augmented opening force under-performs in comparison with other designs. Decisively, a validation with users is needed for a usability assessment.Exoskelett för händer är robotiska hjälpmedel som kan användas för att kompensera nedsatt muskelstyrka och rörlighet hos patienter med nedsatt muskelfunktion i armarna. Dessa hjälpmedel kan hjälpa patienter att greppa föremål i ett terapeutiskt syfte eller för att utföra vardagliga sysslor. Examensarbetet beskriver utvecklingsarbetet av ett nytt exoskelett med fokus på användaren genom att tillämpa produktutvecklingsmotodikens V-modell. Användarens krav och behov identifieras genom intervjuer och en gedigen litteraturstudie. Tre koncept utvecklas och ett vidareutvecklat koncept väljs slutligen baserat på en logisk beslutsprocess. En matematisk modell genereras och används för att dimensionera exoskelettet. Dessutom tillverkas tre prototyper av exoskelettet i olika utföranden för att slutligen utvärderas i en testrigg. Resultatet av utvecklingsprocessen är ett nytt handexoskelett ämnat för rehabilitering av patienter med övre motorneuronsjukdom. Tester som genomfördes för att mäta Kraft och rörlighet visade att en design med en högre grad av underaktuering är gynnsamt. Designen som presenteras här når inte upp till de krav som ställs på kraft och rörlighet, de målvärden som definieras är dock baserade på ett konservativt synsätt och är därmed svåra att uppnå. Exoskelettet producerar en högre stängningskraft och uppvisar bättre rörlighet än andra toppmoderna exoskelett. Exoskelettet underpresterar dock vad gäller den producerade öppningskraften jämfört med andra modeller och designen behöver valideras hos användarna för att användarbarheten ska kunna bestämmas.
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Verwey, Oriana. "The extent of discharge planning by nurses for patients who have undergone valvular surgery." Thesis, Nelson Mandela Metropolitan University, 2006. http://hdl.handle.net/10948/445.
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Valvular disorders can be corrected by means of surgery, after which very comprehensive discharge planning should be implemented to prevent the occurrence of post-operative complications. Advances in medical technology and intellect instigate earlier discharge for patients after they have undergone valvular surgery. The aim of this research study is to establish the extent of discharge planning by nurses for patients who have undergone valvular surgery, so that practice guidelines in the form of an in-service educational framework can be compiled for nurses in the management of these patients post-operatively. Patients, many of whom are from rural areas, are discharged without an adequate referral system. There are, currently, no set guidelines or referral persons to direct these patients during their rehabilitation period. Based on the researcher’s personal observations, it is evident that many patients suffer from bacterial endocarditis or clotted valves due to poor post-surgery management. However, both of these conditions could be avoided if proper health education was given to these patients. The study will take the form of a quantitative, exploratory, descriptive and contextual survey. Data will be collected by means of a structured questionnaire that will be completed by the nurses working in the cardiac general ward and the cardiac clinic. Findings of the research study will be used to assist the researcher in developing an in-service educational framework for staff that are both nursing and preparing post valvular surgery patients for discharge. The goal is to prevent complications such as clot formation and endocarditis and to enable patients to deal effectively with their rehabilitation period.
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Walters, Yelena. "Task-orientated rehabilitation can improve knee function and satisfaction in patients 12 months after knee replacement surgery for osteoarthritis." Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10045118/.
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End-stage osteoarthritis (OA) requires joint replacement surgery. Although total knee arthroplasty (TKA) usually relieves pain, some patients are disappointed with their mobility, which may result from an abnormal gait. Post-operative physiotherapy following TKA is essential, although little consensus exists regarding longer-term rehabilitation. Typical rehabilitation has an internal focus on specific muscles and joints, but task-orientated rehabilitation (TOR) may be more effective. This study tested the hypothesis that TOR can improve gait and patient reported functional outcome following TKA. Seventy six patients were studied 12 months after TKA during follow up at the Royal National Orthopaedic Hospital, Stanmore. Patient reported functional outcome was assessed using the Oxford Knee Score (OKS) and gait characteristics were measured using inertial measurement units (IMUs). A subset of 21 patients, exhibiting abnormal gait, entered a 4-week TOR programme, based on daily walking and stair climbing. Patients were re-assessed with OKS and IMUs, and gait quantity compared pre- and post-intervention using pedometers. A subset of 4 patients’ baseline gaits was compared to 5 controls, and to their own gait following the TOR, while subjected to differing treadmill conditions. Multiple regression analysis showed that stride duration significantly predicted OKS (p < 0.0001, n=76). Higher OKS was observed in patients who have shorter stride duration, which was in turn a result of greater RoM of the leg joints and segments in the sagittal plane. TKA patients’ response to the varying treadmill conditions was similar, but inferior in the gait parameters’ values as compared to the healthy participants. Following TOR, 21 patients exhibited a significantly higher OKS (p=0.001, n=21). Stride duration, thigh, knee and calf sagittal range of motion and knee flexion in stance significantly increased in both limbs following TOR. In conclusion, the results indicate that there is scope to improve rehabilitation of patients after TKA. TOR improves gait quality and therefore has the potential to improve satisfaction in TKA patients.
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Cantwell, Marie Therese. "An outcomes study: Outpatient versus inpatient hernia repairs." CSUSB ScholarWorks, 1994. https://scholarworks.lib.csusb.edu/etd-project/802.
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The objective of this study was to investigate the quality of clinical outcomes in the surgical setting. Results of the study showed that there is no difference in infection rates between inpatient and outpatient hernia repair patients.
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Sheinbein, Shelly Thurlo. "Return to Sport: Improving Athletes' Confidence and Mindset Post-ACL Surgery." Thesis, University of North Texas, 2017. https://digital.library.unt.edu/ark:/67531/metadc1062815/.
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This study explored the impact of three psychological interventions over seven weeks - goal setting (GS), GS and imagery (IM), and GS and mindful self-compassion (MSC) - on 20 athletes' (Mage = 16.75 years) pain, cognitive appraisal, depression reinjury anxiety, psychological readiness to return to sport, and range of motion (ROM). IM and GS interventions have demonstrated initial effectiveness; however, no study has examined MSC in relation to post-ACL recovery. All athletes experienced significant decrease in pain (F(2) = 97.30, p = .000) from Week 1 to Week 7 and a significant increase in ROM from Week 2 to Week 7 (F(1) = 77.93, p = .000). All athletes experienced significantly higher depression at Week 1 compared to both Week 2 and Week 7 (F(2) = 9.01, p = .001), and significantly higher difficulty coping with their injury at Weeks 1 and 2 compared to Week 7 (F(2) = 6.32, p = .005). There were no statistically significant effects found between the intervention groups at Weeks 1, 2, and 7. However there were moderate effect sizes between interventions which suggest MSC and IM could help athletes cope with their injury during the first few weeks after surgery, and GS may contribute towards less depression at seven weeks post-surgery. Limitations include small sample size, low power, and use of self-report measures. Results have implications for orthopedic surgeons, physical therapists, and health professionals working with athletes recovering from serious sport injury.
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Yates, Christopher. "Effects of reconstruction surgery and individualised rehabilitation on neuromuscular, sensorimotor and musculoskeletal performance in patients with anterior cruciate ligament deficiency." Thesis, Queen Margaret University, 2016. https://eresearch.qmu.ac.uk/handle/20.500.12289/7421.
Full textAbstract:
Rehabilitation following Anterior Cruciate Ligament (ACL) Reconstruction (ACLR) benefits most patients electing ACLR surgery. Contemporary practice offers limited adaptation of the service to the needs of individual patients. This thesis focuses on a Randomised Control Trial (RCT) that evaluated the effects of a novel formulation of patient-centred musculoskeletal rehabilitation involving the Performance Profiling Technique (Butler and Hardy, 1992). Performance Profile Management (PPM), a programme of rehabilitation, was adapted to incorporate patient-physiotherapist negotiation and agreement on decisions for subsequent rehabilitation and treatment strategies. Therefore, the primary aim of the research was primarily to assess the efficacy of individually-tailored, self-managed rehabilitative care (PPM) in comparison to contemporary (CON) clinical practice. The latter would facilitate an understanding of patient needs and verify the circumstances in which rehabilitation might be enhanced by allowing individuals to play a key role in designing their treatment and recovery. A secondary clinical aim was to evaluate the strength of relationships amongst Patient-Based Outcome Measures (P-BOMs) and Clinician-Based Outcome Measures (C-BOMs). Currently, it is unknown which combination of outcome measures (P-BOMs or C-BOMs) delivers an optimum global assessment of functional and physical performance capabilities during patients’ post-surgical rehabilitation. A clinically-relevant and significant association amongst P-BOMs and C-BOMs might indicate correct scaling of patients’ own capability perceptions with those measured using objective assessment methods (C-BOMs) and endorse the utility for the clinical use of P-BOMs.
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Armshaw, Brennan P. "Contingency Management of Physical Rehabilitation: The Role of Feedback." Thesis, University of North Texas, 2018. https://digital.library.unt.edu/ark:/67531/metadc1404528/.
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Modern advances in technology have allowed for an increase in the precision with which we are able to measure, record, and affect behavior. These developments suggest that the domains in which behavior analysis might contribute are considerably broader than previously appreciated, for instance the area of behavioral medicine. One way the field of behavior analysis can begin to address problems in behavioral medicine is with biosensor technology, like surface electromyography (sEMG). For sEMG technology to be useful in behavioral medicine, specifically recovery from total knee arthroplasty, a reference value (the maximum voluntary individual contraction-MVIC) must be established. The MVIC value allows for the comparison of data across days and may allow the programming of contingencies. However, current MVIC methods fall short. Study 1 compares MVIC values produced by a participant given the typical instruction only method with two alternative methods: instruction + feedback, and instruction + feedback in a game context. Across 10 participants both feedback conditions lead to higher MVIC values then the instruction only condition. Study 2 applies the MVIC techniques developed during Study 1 to an exercise procedure. Using an MVIC value as the criteria for feedback Study 2 compares the same three conditions, however this time assessing for the conditions under which exercise performance is optimal. Across all 9 participants the instruction + feedback in a game context lead to the participant ‘working harder' and 8 out of 9 participants exceeded the MVIC value more often during this condition then in the other two conditions.
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Wikehult, Björn. "Use of Healthcare, Perceived Health and Patient Satisfaction in Patients with Burns." Doctoral thesis, Uppsala University, Department of Surgical Sciences, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-9262.
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A severe burn is a trauma fraught with stress and pain and may change the entire course of life. This thesis focuses on care utilisation, care experiences and patient satisfaction after a severe burn.
The patients studied were treated at the Burn Unit at Uppsala University Hospital between 1980 and 2006. Burn-related health was examined using the Burn Specific Health Scale-Brief (BSHS-B), personality traits with the Swedish universities Scales of Personality (SSP), psychological symptoms using the Hospital Anxiety and Depression scale (HADS), symptoms of posttraumatic stress with the Impact of Event Scale-Revised (IES-R) and satisfaction with care using the Patient Satisfaction-Results and Quality (PS-RESKVA) questionnaire.
Those utilising care years after injury reported poorer functioning on three of the BSHS-B subscales. Personality traits had a greater impact on care utilisation than injury severity.
Social desirability was lower among care utilisers and was associated with burn-related health aspects.
The participants reported a low level of negative care experiences, the most common of which was Powerlessness.
Most patients were satisfied with care, more with quality of contact with the nursing staff, and less with treatment information. Multiple regressions showed that the BSHS-B Interpersonal relationships subscale was an independent variable related to all measured aspects of patient satisfaction. The highest adjusted R2 was 0.25.
In a prospective assessment with multiple regression analyses, Age and Education, the personality traits of Stress susceptibility, Trait irritability, Detachment and Social desirability, in addition to the post-traumatic stress symptoms Intrusion and Hyperarousal, were predictors of satisfaction with care. The highest adjusted R2 was 0.19.
The thesis has pointed out that interpersonal factors are related to care utilisation as well as satisfaction with care. However, satisfaction with care was only moderately associated with health and individual characteristics, which may imply that the care itself is of major importance.
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Alzaabi, Hana. "Development and validation of an evidence based educational program for adults undergoing anterior cruciate ligament reconstruction surgery in the United Arab Emirates." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/4223.
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Thesis (MScPhysio (Physiotherapy))--University of Stellenbosch, 2010.Patients’ knowledge about the effectiveness of interventions is now recognized as an important facilitator of the implementation of evidence in practice. Evidence-based, patient education programs aim to impart knowledge about the efficacy and effectiveness about interventions to individuals. However, there is currently a lack of structured evidence-based educational programs to educate patients about the evidence-base for interventions prescribed by the health professionals in the field of orthopaedics. OBJECTIVE: The main objective of this study was to develop and validate an Arabic version of an evidence-based educational program for patients who are scheduled to undergo ACL reconstruction surgery in UAE, based on available evidence collated through a systematic review process. METHODS: A systematic review was conducted to generate clinical recommendations which were used to develop the evidence-based educational program. The evidence-based information was derived from secondary research to determine which rehabilitation strategies were most effective in improving outcome measurements following ACL reconstruction surgery. A pre-final draft of the evidence-based educational program was prepared and forward and back translated from English into the Arabic language. Feedback groups of ACL patients and physiotherapists were used to determine the content and face validity of the program. The final draft was validated in a group of 40 ACL patients waiting to undergo ACL reconstruction surgery at Zayed Military hospital and Abu Dhabi Knee and Sports Medicine Centre in the UAE, using checklists. RESULTS: A total of 40 patients undergoing ACL reconstruction surgery consented to participate in this study. All the subjects were male. The age range was between 18 to 38 years old with mean age of 28.5 years (SD 5.75). Most of the patients (65%) underwent ACL reconstruction surgery to the right knee. Of the total sample (n=40), the majority of the subjects who participated in this study (90 %), had ACL surgery for the first time. Most of the responses to the evidence-based educational program checklist were positive. iv CONCLUSION: It can be recommended that the newly-developed evidence-based educational program is a valid tool which can be given to ACL patients prior to ACL reconstruction to prepare them for the rehabilitation postoperatively. By informing patients of their condition, the expected outcomes of their condition and the effect of doing exercises to improve their condition, the patients will be more encouraged to partake in rehabilitation, as they know it is for their own good. This will ultimately improve overall patient care and improve management of ACL patients.
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Joss, Brendan Keith. "Clinical and biomechanical outcomes following unicondylar knee arthroplasty with Preservation fixed and mobile bearing tibial components." University of Western Australia. School of Surgery and Pathology, 2007. http://theses.library.uwa.edu.au/adt-WU2007.0079.
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[Truncated abstract] Unicondylar knee arthroplasty (UKA) has re-emerged as a successful treatment option for isolated single compartment tibio-femoral joint osteoarthritis. However despite its increasing use, controversy still remains over fixed or mobile bearing tibial components, as there is a lack to prospective randomised studies reported in the literature. In addition, the theoretical advantages of the mobile bearing for knee kinematics, kinetics and clinical outcome have not been evaluated in vivo. The aim of this research study was to explore the clinical and biomechanical outcomes of the fixed and mobile bearing UKA. . . . When the results for the both studies were combined, utilising the Preservation and MG fixed bearing prostheses, there was a significant relationship between knee adduction moment, and a poor prognosis predicted from RSA. Those patients with translation or rotation of the tibial component in any direction above 1mm and 1.5 degrees respectively were considered to have a poor prognosis for long term fixation. Of the 28 patients, the 8 patients considered to have a poor prognosis, had increased knee adduction moments post-surgery (mean difference = 1.66Nm.kg-1, p = 0.007). There was no difference between the groups for knee flexion moment (mean difference 0.16Nm.kg-1, p = 0.844). Pre-surgery gait was unable to predict the post-surgery outcome, due to the significant changes in gait from pre- to post-surgery. Care must taken when implanting the Preservation mobile bearing prosthesis, as long term outcome is questionable. The mobile bearing prosthesis also produced the worst clinical outcome, however the theoretical advantages of the mobile bearing does not affect gait. Gait analysis is a useful tool to identify patient who are overloading their prosthesis, leading to potential early failure. Identification of these gait patterns can allow for early intervention to reduce joint load, and possible extend the longevity of the prosthesis.
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Roberson, Audrey R. "Influence of Muscle Strength on Mobility in Critically Ill Adult Patients on Mechanical Ventilation." VCU Scholars Compass, 2018. https://scholarscompass.vcu.edu/etd/5668.
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Patients in the intensive care unit (ICU) setting are prone to develop muscle weakness and the causes are multi-factorial. Muscle strength in adult, critically ill patients on mechanical ventilation decreases with immobility. The influence of muscle strength on different muscle groups and its influence on progressive mobility in the adult, critically ill patient on mechanical ventilation has not been examined. Identifying muscle strength in this patient population can benefit overall muscle health and minimize muscle deconditioning through a progressive mobility plan. The objective of this dissertation was to describe muscle strength in different muscle groups and to describe the influence of muscle strength on mobility in critically ill adult patients on mechanical ventilation (MV). Fifty ICU patients were enrolled in this descriptive, cross sectional study. Abdominal core, bilateral hand grip and extremity strength was measured using three measurement tools. Mobility was measured using the following scale: 0=lying in bed; 1=sitting on edge of bed; 2=sitting on edge of bed to standing; 3=walking to bedside chair and 4=walking >7 feet from the standing position. Predictors of mobility were examined using stepwise regression. Abdominal core, bilateral hand grip and extremity strength demonstrated statistically significant relationships with all variables. Extremity strength accounted for 82% of the variance in mobility and was the sole predictor (β=0.903; F=212.9; p=0.000). Future research addressing the outcomes of implementing a mobility protocol in this patient population and prioritizing when such a protocol should be implemented would be beneficial to ongoing plans to decrease MV, ICU and hospital days. Muscle strength tests implemented at the bedside are crucial to implementing a progressive mobility plan for critically ill adults while they are on MV therapy.
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Casartelli, Nicola. "La fonction musculaire au niveau de la hanche chez les patients présentant un conflit fémoro-acétabulaire symptomatique." Thesis, Dijon, 2014. http://www.theses.fr/2014DIJOS020/document.
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Le conflit fémoro-acétabulaire (femoroacetabular impingement, FAI) est une pathologie mécanique de la hanche qui peut causer des douleurs et limitations fonctionnelles. Le but de cette thèse était d’étudier la fonction musculaire au niveau de la hanche chez des patients présentant un FAI symptomatique. La fonction musculaire de la hanche a été évaluée, dans un premier temps, chez des patients avant qu’ils ne subissent une opération. Ces patients démontraient un déficit de force qui pourrait être expliqué par de l’inhibition musculaire. Cependant, ce déficit de force n’était pas associé à une plus grande fatigabilité musculaire. Dans un deuxième temps, les altérations de force musculaire ont été évaluées chez des patients ayant subi une arthroscopie de la hanche. Après l’opération, les patients récupéraient un niveau de force normal au niveau de tous les groupes musculaires de la hanche excepté les fléchisseurs. Le cas d’un joueur de hockey sur glace ayant subi une chirurgie ouverte aux deux hanches pour traiter un FAI bilatéral a aussi été décrit. On a démontré que la déhiscence de la bandelette iléo-tibiale pouvait survenir après chirurgie, empêcher l’augmentation de force musculaire des abducteurs de la hanche, et retarder la reprise du sport. Enfin, un protocole d’évaluation du taux de développement de la force normalisé, variable permettant d’estimer l’inhibition musculaire de la hanche, a été proposé chez des sujets sains. La fiabilité et reproductibilité des résultats ont été montrées au niveau des adducteurs, rotateurs externes, et fléchisseurs de la hanche. Ces résultats montrent que ces patients ont une fonction musculaire altérée au niveau de la hanche, qui est toutefois récupéré après une opérationFemoroacetabular impingement (FAI) is a pathomechanical process of the hip joint, which could lead to hip pain and functional disability. Aim of this thesis was to investigate hip muscle function in patients with a symptomatic FAI. Hip muscle function was first investigated before patients underwent any surgical treatment for managing FAI. It was shown that they present with reduced hip muscle strength (i.e., muscle weakness), probably due to hip muscle inhibition. Nevertheless, hip muscle weakness was not associated with exaggerated hip muscle fatigue. Hip muscle strength recovery was then evaluated in a series of patients after hip arthroscopy to treat FAI. These patients demonstrated a good recovery for all hip muscle groups, except for hip flexors. The case of a professional ice hockey player who underwent bilateral hip open surgeries for treating bilateral FAI was also documented. This report showed that iliotibial band dehiscence could occur after hip open surgery, thereby preventing hip abductor strength increase during rehabilitation and delaying the return to sport. In addition, the assessment of the rate of force development scaling factor for the hip muscles was evaluated in a group of healthy adults. This parameter seems to be promising for the evaluation of hip muscle inhibition. The testing protocol was feasible and reproducible for hip adductors, external rotators and flexors. Taken as a whole, these findings show that patients with symptomatic FAI demonstrate an impaired hip muscle function, which is however mainly resolved after surgical treatment
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Hosseinipour, Milad. "Design and Development of an Intra-Ventricular Assistive Device For End Stage Congestive Heart Failure Patients: Conceptual Design." University of Toledo / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1372726495.
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Lannin, Natasha A., University of Western Sydney, College of Health and Science, and School of Exercise and Health Sciences. "The effectiveness of hand splinting to prevent muscle contracture following acquired brain impairment." 2006. http://handle.uws.edu.au:8081/1959.7/23782.
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The aim of the thesis was to evaluate the effectiveness of static hand splints for the prevention of muscle contracture during early rehabilitation following acquired brain impairment. Three studies were undertaken and are reported in the research. The aim of the first study was to appraise the existing research on the effects of hand splinting for adults with hemiplegia following acquired brain impairment. The aim of the second study was to evaluate the effectiveness of static hand splints which position the wrists and fingers in the common ‘functional position’ when provided in conjunction with a rehabilitation program which included daily motor training and prolonged stretches. The aim of the final study was to evaluate the effectiveness of two hand splinting positions, the ‘functional position’ and a position of wrist and finger extension, in comparison to a control group that did not receive prolonged stretches. Findings indicate that splinting the hand in the ‘functional’ position or in a position of greater wrist extension did not prevent contracture following acquired brain impairment over the course of the study periods (4 weeks with follow up at 4 and 6 weeks in studies 2 and 3 respectively).Doctor of Philosophy (PhD)
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Kimber, Dustin. "Does pre-operative frailty predict cardiac rehabilitation completion in cardiac surgery patients?" 2017. http://hdl.handle.net/1993/32068.
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The typical cardiac surgery patient is increasing in age and level of frailty. Frailty can be defined as an increased vulnerability to stressors due to decreased physiological reserve. Previous investigations have demonstrated the benefit of cardiac rehabilitation (CR) programming on surgical outcomes. However, the link between pre-operative frailty and post-operative CR completion is unclear. The purpose of this study was to determine if pre-operative frailty status impacts CR completion post-operatively. A total of 114 cardiac surgery patients with an average age of 71 years were included in the analysis. CR completers were significantly less frail than CR non-completers at baseline based on the Clinical Frailty Scale (CFS; p=0.01), Modified Fried Criteria (MFC; p=0.0005), Short Physical Performance Battery (SPPB; p=0.007) and the Functional Frailty Index (FFI; p=<0.0001). The change in frailty status from baseline to 1-year post-operatively was not statistically different between CR completers and non-completers; CFS (p=0.90), MFC (p=0.70), SPPB (p=0.06) and FFI (p=0.07). However, the MFC frailty domains of cognitive impairment (p=0.0005) and low physical activity (p=0.04), in addition to the FFI physical domain of frailty (p=0.009), did significantly improve among CR completers when compared to non-completers. CR attendance measured by swipe card access did not correlate with frailty modifications. Collectively, these data suggest that participants deemed to be frail at the pre-operative time point attend and complete CR less frequently than non-frail participants. Furthermore, CR completion does not appear to modify frailty status overall; although, some frailty domains appear to be more sensitive to change than others.February 2017
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Chen, Yan-hong, and 陳彥宏. "Real-time hybrid muscle signal isolating system for hand rehabilitation of stroke patients." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/51852375396829415974.
Full textAbstract:
碩士國立雲林科技大學
電子與資訊工程研究所
99
Stroke survivors may losesome of their body functions or even develop hemiplegia (paralysis on one side the body). Although there are already several electrical stimulation hand prostheses in the market, very few of them utilize real-time hybrid muscle signal isolating system. This research examines the hybrid muscle signal isolation procedure, which is necessary for the development of the electrical stimulation hand prostheses. During the development of the electrical stimulation hand prostheses, we found several surface electrical stimulation parameters greatly influence hand posture response. Therefore this study aims to analyze EMG signal-affected parameters, such as EMG sampling rate, signal magnification, ground isolation, noise interference, electrical stimulation frequency, stimulation pulse width, stimulus position, electrode polarity and current phase, so as to design the process for hybrid muscle signal isolation. The isolated muscle signals excluded the noise caused by electrical stimulation, which allows the system todetermine the patients’ strength more accurately. Themeasuredinformation wasstoredin the NI cRIO, for the analysis. The whole procedure was then applied onstrokepatients, with each of these patients received electrical stimulation from the system. Through the hybrid muscle signal isolating system we hope to measure patients’ muscle strength more accurately and provide themwith a more effective treatment.
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Chen-KaiChien and 錢振愷. "Hand Rehabilitation of Stroke Patients Using Digit Pressing Evaluation and Training System (PETS)." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/ekvxa9.
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碩士國立成功大學
生物醫學工程學系
105
The performance of hand such as digit force control and digit independence was influenced due to impaired sensation, insufficient strength, and abnormal synergy pattern on patients after stroke. Previous studies showed lower digit independence and lower strength on affected hand of stroke compared to the control group. However, these literatures didn’t study the training effects on digit force control and digit independence for patients after stroke. The relationship among digit force control, digit independence, and hand function was still unclear. In current study, RMSD and k value calculated from FFT of PETS represented digit force control and digit independence respectively. Multi-digit training with PETS was an intervention for all subjects in the experiment. Twenty seven health controls and ten patients after stroke were recruited to study the relationship among digit force control, digit independence, and hand function. The data of seven patients and seven age-matched controls were analyzed to reveal training effects. The resulted showed digit force control had a significant positive relationship (p-value 〈 .01) with grasp force and hand function. Patients after stroke showed the poor performance of digit force control, digit independence, digit sensation, and hand function than controls. Besides, grasp force of stroke was smaller than controls as well. In the training effects, patients after stroke showed improvement on RMSD, 2-PD, grasp force, B＆BT, and ARAT. k value in stroke increased in some combinations of multi-digit. To sum up, multi-digit training with PETS might improve digit force control and digit independence on patients after stroke. The small sample size of stroke was the limitation in current study. The insufficient number of stroke and high variation within patients might cause no significant change on effects after multi-digit training.
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Pin-JuChen and 陳品儒. "Effects of vibration stimulation on hand rehabilitation in stroke patients: A Case Study." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/fc5qc5.
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Tsai, Jia-Min, and 蔡嘉珉. "A Vibrotactile Glove Design and its Rehabilitation Effects on Hand Function in Stroke Patients." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/792bj7.
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碩士國立臺灣科技大學
機械工程系
103
This study aims to develop a fine motor training glove that integrate a virtual re-ality based interactive environment with vibrotactile feedback for more effective post stroke hand rehabilitation. The proposed haptic rehabilitation device is equipped with small DC vibration motors for vibrotactile feedback stimulation and piezoresistive thin-film pressure sensors for motor function evaluation. Two virtual- reality based games, “gopher hitting” and “musical note hitting”, were developed as a haptic inter-face. According to the designed rehabilitation program, patients intuitively push and practice their fingers to improve the finger isolation function. This study has been cooperated with the physical therapists in Taipei MacKay Memorial Hospital for clin-ical trials. The recruited stroke patients were asked to wear our developed vibrotactile glove for a series of clinical tests. This study specifically discusses the effectiveness of adding vibrotactile feedback and the efficiency of repeated hand rehabilitation. The experiments confirm that giving vibration stimulations at the affected side can in-crease the reaction response of stroke patients.
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Lin, Shu-hui, and 林淑惠. "The Effects of Early Rehabilitation Nursing Program on The Osteoarthritis in Patients After Surgery." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/25225429727927584676.
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碩士長榮大學
護理學系碩士班
99
The purpose of this study was to assess the effectiveness of an early rehabilitation nursing intervention program among women with osteoarthritis knee and after Total Knee Replacement(TKR)surgery. The research applied a quasi-experimental method. A total of 86 participants were recruided using purposed sampling procedure. Forty-three of them were assinged to the control group and received regular nursing care after surgery. Another 43 participants who were assinged to the experimental group were received the rehabilitation nursing program on the next day after surgery. Research data were collected through a structured questionnaire that included all participants’ ages, educational levels, BMIs, the knee angles, and the lower extremity functions on the day before surgery. Then, the 6th day after surgery, all participants were assessed the knee angles and the lower extremity functions again. Results of the study showed that the improvements of the knee angles and the lower extremity functions among the experimental group were higher than the control group significantly. In conclusion, the early rehabilitation nursing intervention program. The result of this study offers a reference for clinical nurses who were working with osteoarthritis knee patients.
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Hsu, Mei-Cheng, and 徐美政. "Hand Pulse Wave Velocity in Healthy Subjects and Patients After Coronary Artery Bypass Graft Surgery." Thesis, 2004. http://ndltd.ncl.edu.tw/handle/65658144355191398967.
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碩士國立陽明大學
傳統醫藥學研究所
92
Pulse diagnosis is one of the important diagnostic methods in Traditional Chinese Medicine. Till now, there are few studies concerning the relation between pulse wave velocity and arterial stiffness. Increasing arterial stiffness is one of the pathological features of vascular disorders, and is closely associated with ageing, gender, hypertension and cardiovascular disease. Pulse wave velocity is known to be an indicator of arterial stiffness and a marker of vascular disorder. The aim of this study was to examine how was the arterial pulse wave velocity measured at the hand (hPWV) affected by age, gender and cardiovascular disease. A total of 146 healthy subjects (72 men and 74 women) and 47 patients after coronary artery bypass graft surgery (CABG) (43 men and 4 women) participated in this study. The transit time and the distance from the styloid process of the radius to the mid-portion of the 1st phalanx of the 3rd finger were measured, and the hPWV was calculated by using the following formula: hPWV (m/s) = traversed distance (m)/transit time (s). The results revealed that age was the strongest contributor to hPWV (p<0.0001). The decrease in hPWV with age in all healthy subjects and CABG patients was - 0.033 and - 0.037 m/s per year, respectively. Multivariate linear regression analysis showed that male gender also account for the ability to predict hPWV (p<0.001) and is a significant and independent factor associated with increased hPWV. Despite higher blood pressure in male CABG patients, there was no significant difference in hPWV when compared with age-matched healthy men. In conclusion, age is the dominant negative factor contributing to hPWV in healthy subjects and patients after CABG, Gender also is a significant and independent factor associated with increased hPWV in healthy subjects. There is no difference in hPWV between healthy subjects and patients after CABG.
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"Holistic aspects of rehabilitation post cardiac surgery in the Bonny method of guided imagery and music." University of Technology, Sydney. Faculty of Nursing, Midwifery & Health, 2003. http://hdl.handle.net/2100/238.
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This thesis has set out to investigate the role of music therapy in the form of the specialist Bonny Method of Guided Imagery and Music (GIM) with a view to exploring how meanings related to adjustment from a health crisis (such as cardiac surgery) are depicted in music-supported imagery. Factors shaping clinical interpretations of verbal and musical responses in music therapy practice are often unclear or undelineated. A systematic interpretive process relevant to clinical health care was developed using the Bonny Method of Guide Imagery and Music (GIM), providing a means for exploring the emotional difficulties of coronary bypass patients, who typically recover quickly from physical surgery but often experience residual symptoms such as depression, pain, and anxiety. The interpretive process accessed both verbal and non-verbal texts, playing them against each other in order to find significance for music therapy practice in rehabilitation. A Bonny Method of Guided Imagery and Music (GIM) series was undertaken by patients recovering from coronary artery bypass grafting (CABG), with each session audiotaped and transcribed. This narrative data was analyzed thematically, and grand themes were used to focus further intertextual (semiotic) and Jungian perspectives, in the process of deriving substantial clinical meanings. Results suggested that participants used a wide range of personal, cultural and archetypal texts to convey meanings about their health care situation, including images of the music during the therapeutic process. Clinical change in the rehabilitative process was suggested by grand themes comprising 'Looking through the frame', 'Feeling the impact', 'Spiralling into the unexpected', 'Sublime plateau', and 'Rehearsing new steps' and the further music-related grand theme of 'Sounding the changes'. This project highlights the value of GIM as a vehicle to track clinical change with cardiac patients, based on a systematic interpretive process sensitive to the interweaving verbal and nonverbal texts evident in the music therapy context.
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Kuo, Nai-Ying, and 郭乃瑛. "The Efficacy Of Home-Based Pulmonary Rehabilitation Training In Older Patients With Lung Cancer After Thoracoscopic Surgery." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/62490959232734748415.
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碩士高雄醫學大學
高齡長期照護碩士學位學程
105
Background and purpose: Older adults are at high risk of physio-psychological complications after thoracic surgery due to aging, multiple comorbidities, and anesthesia during operations. Previous studies have shown the efficacy of pulmonary rehabilitation in individuals with chronic obstructive pulmonary disease after traditional cardiac or thoracic surgery. However, the efficacy of home-based pulmonary rehabilitation in older adults after thoracoscopic surgery has not yet been studied. Method: A randomized controlled trial design was used. This study enrolled a total of 36 patients over 65 years of age with lung tumor post-thoracoscopic surgery.The control group received general education, while the experimental group received home-based pulmonary rehabilitation additionally. Physiological and psychological measurements were followed at 2-week, 6-week, and 12-week after surgery. Result: At 2 weeks after surgery, the intervention group was significantly (p<0.05) improved than the control group on 6-min walk test (408.61± 62.85vs. 311.94 ±84.65m), maximal inspiratory pressure (MIP, 90.00±25.66 vs.67.33±28.14 cmH2O), and Triflo (1450.00±619.53vs.1033.33±388.05ml) , but no significant differences between groups onpulmonary functions, maximal expiratory pressure (MEP) pulmonary complications and Modified Borg score were found. At 6 weeks after surgery, the intervention group was significantly improved than the control group on 6-min walk test (411.63±44.49 vs.332.94 ±54.03m), MIP (93.33± 34.47 vs. 64.67±20.30cmH2O), and Triflo (1683.33±667.96 vs. 1116.67± 382.33ml), but no significant differences between groups on pulmonary functions, MEP, pulmonary complications and Modified Borg score were found. An improved dyspnea level of EORTC QLQ-LC13 was found in the intervention group at 12 weeks after surgery. Conclusion: Home-based pulmonary rehabilitation can significantly improve exercise capacity, inspiratory muscle strength, dyspnea level, and lung expansion capacity in older adults with lung tumor post thoracoscopy surgery. Home-based pulmonary rehabilitation is practical and should be incorporated into the standard discharge plan program of older patients undergoing thoracoscopy surgery.
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Wen-ChuanChang and 張文銓. "Application of Transcranial Direct Current Stimulation to Enhance a Brain-Computer-Interface for Hand Rehabilitation of Stroke Patients." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/64193609458207661613.
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碩士國立成功大學
機械工程學系
102
Recent studies showed that using the feedback of brain-computer- interface (BCI) driven by imaginary movement of stroke patients can provide effective stimulation on the neurous in the cognitive and sensory-motor cortex. Neural rehabilitation can be achieved by activating the neurons in the lesion or other sites. The transcranial direct current stimulation (tDCS) was employed to treat stroke patients and it was found that the potential connectivity and functional structure of the brain can be reorganized. The goal of this study is to integrate the BCI and the tDCS on stroke patients to improve their hand motor controllability. The common spatial filter method was adopted to improve the BCI system developed by us. Eight healthy and two chronic stroke patients were recruited for testing the rehabilitation system. The subjects were randomly divided into tDCS and sham-tDCS. The tDCS group receives 2mA DC stimulation for 20 minutes before each BCI training. On the other hand, the sham-tDCS group only receives same DC stimulation for just 30 seconds. Off-line analyses of the EEG of all subjects showed that the accuracy of cursor control via the BCI is not improved by tDCS. On the contrary, the reaction time is reduced significantly. The brain connectivity analyses showed that for the tDCS group the number of connected nodes was increased, the connecting strength was enhanced and so was the degree of clustering. The results conclude that anodal-tDCS might facilitate the organization of the brain manifested by the reduced reaction time.
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Geller, Daniel. "Home Mirror Therapy: A Randomized Control Study Comparing Unimanual and Bimanual Mirror Therapy for Improved Arm and Hand Function Post-stroke." Thesis, 2018. https://doi.org/10.7916/D83B7GNC.
Full textAbstract:
Stroke is the leading cause of disability in the United States. The majority of stroke survivors have persistent arm dysfunction, which impedes their daily task performance. Mirror therapy (MT) as an adjunct to occupational therapy (OT) has been shown to be effective in upper extremity (UE) recovery post-stroke. Two protocols, unimanual mirror therapy (UMT) and bimanual mirror therapy (BMT), have been used in OT practice; however, research specifically comparing these two intervention protocols is absent. The purpose of this study was to compare: (a) home-based UMT and BMT protocols, and (b) both MT protocols to home-based traditional occupational therapy (TOT) regarding upper limb recovery post-stroke.
Twenty-two chronic stroke participants were randomized into one of three groups: UMT, BMT, or TOT. The Action Research Arm Test (ARAT), Fugl-Meyer Assessment (FMA), ABILHAND, grip strength, and the Stroke Impact Scale (SIS) were administered pre- and post-intervention. Participants received outpatient OT 2 days/week for 45 minutes, plus a home program 30 minutes a day, 5 days/week for 6 weeks. A repeated measure ANOVA, Kruskal-Wallis Test, and Wilcoxon Ranked-Signed Test were used to compare the three groups, and 95% confidence intervals (CI) and effect sizes were calculated.
There was a main effect of time for all groups, except for SIS-strength and activities of daily living (ADL); however, no group differences were noted on any of the measures. When comparing UMT and BMT, the effect size for all measures, except for grip strength, favored UMT. In comparing both mirror groups to TOT, UMT had a moderate to large effect size on the ARAT, FMA, and ABILHAND, as compared to the small effect size for BMT. Furthermore, 95% CI data for the ABILHAND showed clinical significance in favor of UMT compared to TOT, but not for BMT.
This study showed that all groups improved over time and UMT may be more beneficial for UE recovery in chronic stroke individuals, compared to either BMT or TOT. However, given the small sample size, future studies comparing the two mirror protocols are necessary for more definitive conclusions to better inform clinicians of the optimal mode of MT treatment.
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Yeh, Mei Tien, and 葉鎂瑱. "The Effectiveness of Preoperative Cardiopulmonary Rehabilitation For Improvement of Postoperative Fatigue in Patients Undergoing Coronary Artery Bypass Surgery." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/9v5jbh.
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Park, Sangwoo. "Advancing the Functionality and Wearability of Robotic Hand Orthoses Towards Activities of Daily Living in Stroke Patients." Thesis, 2020. https://doi.org/10.7916/d8-1332-f194.
Full textAbstract:
Post stroke rehabilitation is effective when a large number of motor repetitions are provided to patients. However, conventional physical therapy or traditional desktop-size robot aided rehabilitation do not provide sufficient number of repetitions due to cost and logistical barriers. Our vision is to realize a wearable and functional hand orthosis that could be used outside of controlled, clinical settings, thus allowing for more training repetitions. Furthermore, if such a device can prove effective for Activities of Daily Living (ADLs) while actively worn, this can incentivize patients to increase its use, further enhancing rehabilitative effects. However, in order to provide such clinical benefits, the device must be completely wearable without obtrusive features, and intuitive to control even for non-experts. In this thesis, we thus focus on wearability, functionality, and intuitive intent detection technology for a novel hand robot, and assess its performance when used both as a rehabilitative device and an assistive tool.
A fully wearable device must deliver meaningful manipulation capability in small and lightweight package. In this context, we investigate the capability of single-actuator devices to assist whole hand movement patterns through a network of exotendons. Our prototypes combine a single linear actuator (mounted on a forearm splint) with a network of exotendons (routed on the surface of a soft glove). We investigate two possible tendon network configurations: one that produces full finger extension (overcoming flexor spasticity) and one that combines proximal flexion with distal extension at each finger. In experiments with stroke survivors, we measure the force levels needed to overcome various levels of spasticity and to open the hand for grasping using the first of these configurations, and qualitatively demonstrate the ability to execute fingertip grasps using the second. Our results support the feasibility of developing future wearable devices able to assist a range of manipulation tasks.
In order to further improve the wearability of the device, we propose two designs that provide effective force transmission by increasing moment arms around finger joints. We evaluate the designs with geometric models and experiment using a 3D-printed artificial finger to find force and joint angle characteristics of the suggested structures. We also perform clinical tests with stroke patients to demonstrate the feasibility of the designs. The testing supports the hypothesis that the proposed designs efficiently elicit extension of the digits in patients with spasticity as compared to existing baselines. With the suggested transmission designs, the device can deliver sufficient extension force even when the users have increased muscle tone due to fatigue.
The vision of an orthotic device used for ADLs can only be realized if the patients are able to operate the device themselves. However, the field is generally lacking effective methods by which the user can operate the device: such controls must be effective, intuitive, and robust to the wide range of possible impairment patterns. The variety of encountered upper limb impairment patterns in stroke patients means that a single sensing modality, such as electromyography, might not be sufficient to enable controls for a broad range of users. To address this significant gap, we introduce a multimodal sensing and interaction paradigm for an active hand orthosis. In our proof-of-concept implementation, EMG is complemented by other sensing modalities, such as finger bend and contact pressure sensors. We propose multimodal interaction methods that utilize this sensory data as input, and show they can enable tasks for stroke survivors who exhibit different impairment patterns.
We then assess the performance of the robotic orthosis for two possible roles: as a therapeutic tool that facilitates device mediated hand exercises to recover neuromuscular function, or as an assistive device for use in everyday activities to aid functional use of the hand. 11 chronic stroke (> 2 years) patients with moderate muscle tone (Modified Ashworth Scale ≤ 2 in upper extremity) engage in a month-long training protocol using the orthosis. Individuals are evaluated using standardized outcome measures, both with and without orthosis assistance. The results highlight the potential for wearable and user-driven robotic hand orthoses to extend the use and training of the affected upper limb after stroke.
The advances proposed in this thesis have the potential to enable robotic based hand rehabilitation during daily activities (as opposed to isolated hand exercises with limited upper limb engagement) and over extended periods of time, even in a patient’s home environment. Numerous challenges must still be overcome in order to achieve this vision, related to design (compact devices with easier donning/doffing), control (robust yet intuitive intent inferral), and effectiveness (improved functionality in a wider range of metrics). However, if these challenges can be addressed, wearable robotic devices have the potential to greatly extend the use and training of the affected upper limb after stroke, and help improve the quality of life for a large patient population.
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Kehler, Dustin Scott. "Pre-habilitation program for elective coronary artery bypass graft surgery patients: a pilot project." 2012. http://hdl.handle.net/1993/13238.
Full textAbstract:
This study determined whether a pre-operative cardiac “pre-habilitation” (Prehab) program improves the health of elective coronary artery bypass graft (CABG) surgery patients to a greater extent than standard care (StanC). Seventeen elective CABG patients were randomized to StanC (n= 9) or Prehab (n= 8) at Baseline and were followed at 1-2 weeks pre-operatively (Preop) and Three months post-operatively. Functional walking ability was assessed using the 6-Minute Walk Test (6MWT) and 5-meter Gait Speed Test. Baseline data was not different between groups. Patients in StanC did not improve 6MWT scores; whereas Prehab patients improved 6MWT distance by 35% and 39% at Preop and Three months post-operatively, respectively (p<0.05). Gait speed scores were 25% and 27% lower in Prehab patients at Preop and Three months post-operatively, respectively, as compared to StanC (p<0.05). These data suggest that Prehab is an attractive intervention for enhancing functional walking ability before and after elective CABG surgery.
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Gu, Shu-Lin, and 辜淑琳. "Effects of cardiac rehabilitation on the anxiety and body functions of the patients having coronary artery bypass graft surgery." Thesis, 1998. http://ndltd.ncl.edu.tw/handle/62049371897391300181.
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Lin, Yi-Chun, and 林怡君. "The study about using the hand rehabilitation device to do passive range of motion in stroke patients with upper extremity spasticity." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/29833358235747257002.
Full textAbstract:
碩士國立中興大學
運動與健康管理研究所
99
Abstract Object. The purpose of this study was to explore the passive range of motion （PROM）effect between the occupational therapists and the hand rehabilitation device, and if more PROM would decrease the upper extremity spasticity to stroke patients. Methods. Fifteen stroke patients were assigned to two PROM programs. One was to compare the effect under the same number of the PROM exercise giving by the occupational therapists and the hand rehabilitation device; the other was to compare the effect when giving different time of PROM exercise by the hand rehabilitation device. Tardieu Scale was used to present the degree of the upper extremity spasticity. The Myoton was used to test the muscle tone of the upper extremity. Results. No significant differences （p＞0.05） were observed between the occupational therapists and the hand rehabilitation device under the same number of PROM exercise. For giving different time of PROM exercise by the hand rehabilitation device, it exhibited significant difference（p＜0.05） on Tardieu Scale. By using Myoton, no differences were observed for the groups of the occupational therapists and the hand rehabilitation device under the same number of PROM exercise（p＞0.05）. For the effect under different time of PROM exercises by the hand rehabilitation device, there were no significant difference while giving 10-minute PROM exercise（p＞0.05）, whereas it exhibited significant difference（p＜0.05）while giving 20-minute PROM exercise. Conclusion. We provided the evidence of the same PROM effect between the occupational therapists and the hand rehabilitation device. We also provided the evidence of more PROM exercise would decrease the upper extremity spasticity to the stroke patients. Key words：passive range of motion, stroke, upper extremity spasticity, hand rehabilitation device
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Engelbrecht, Karien. "Lifestyle adaptations of patients with coronary artery disease who underwent coronary artery bypass graph surgery, percutaneous transluminal coronary angioplasty or insertion of a coronary stent." Thesis, 2008. http://hdl.handle.net/10210/795.
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Coronary Artery Disease (CAD) is one of the most common cardiovascular disorder in adults. CAD often results in myocardial infarction or angina (Wilson, 2003:21). It is an accepted fact that the incidence of CAD has reached endemic proportions in South Africa (Venter, 1993:15). Coronary Artery Bypass Graft (CABG) surgery, Percutaneous Transluminal Coronary Angioplasty (PTCA) and insertion of a coronary stent are major therapeutic approaches to the treatment of CAD. However, these procedures do nothing to correct the underlying disease process (Hunt, Hendrata, Myles, 2000:389; Venter, 1993:15). Due to physiological changes patients suffering from CAD are expected to make lifestyle adaptations, in order to improve quality of life and prevent further damage to coronary arteries (Gotto, 1987:29). It is suspected that patients do not always adapt their lifestyle when they suffer from CAD, or if they do, do not maintain these adaptations. The following question emerges: • Do patients with coronary artery disease adapt their lifestyle and if they do, do they maintain these adaptations? The purpose of this study is to explore and describe the extent to which patients with CAD who underwent CABG, PTCA or insertion of a coronary stent adapt their lifestyles and to what extent they maintain these adaptations. Secondly, the purpose is to set guidelines to help with the improvement of lifestyle adaptations and contingency of adaptations. The objectives of the study is to explore and describe the extent to which patients with CAD adapt their lifestyles following CABG surgery, PTCA or insertion of a i coronary stent, the comparison of the extent of these lifestyle adaptations after two and four months and to set guidelines to improve the extent and contingency of lifestyle adaptations. An explorative and descriptive study was done in order to explore and describe the extent to which patients with CAD, who underwent CABG surgery, PTCA or insertion of coronary a stent, adapted their lifestyle, and to determine the maintenance of these lifestyle adaptations. For the purpose of this study questionnaires, based on a conceptual framework, were designed. The questionnaires enabled the researcher to explore and describe the lifestyle adaptations that patients with CAD underwent. The study was conducted in five private hospitals in Gauteng. The data obtained confirmed that patients suffering from CAD do adapt their lifestyle after having CABG surgery, PTCA or insertion of a coronary stent. Data also showed that the presence of a cardiac rehabilitation centre at the hospital where participants were treated, has a significant influence on patients’ ability to adapt their lifestyle and to maintain this new lifestyle.Dr. W.O.J. Nel Ms. W. Jacobs
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Hill, Valerie A. "The relationship between touch sensation of the hand and occupational performance in individuals with chronic stroke." Thesis, 2014. http://hdl.handle.net/1805/4651.
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Indiana University-Purdue University Indianapolis (IUPUI)Stroke is the main cause of disability in the United States. Individuals with stroke commonly report sensory impairment affects their recovery. Motor recovery and sensory impairment are related and impact individuals’ ability to perform valued occupations. Despite the prevalence of sensation impairment after stroke, many occupational therapists fail to include sensation assessment and intervention in treatment planning. The exclusion of sensation in occupational therapy interventions during stroke rehabilitation may be due to the lack of literature supporting the association between sensation and occupational performance. The current study aimed to determine the relationship between touch sensation of the affected hand and occupational performance and satisfaction in individuals with chronic stroke. Using a cross-sectional study design, this study associated factors related to hand sensation and function in individuals with chronic stroke. Fifty individuals with chronic stroke participated in a one-time testing session in which assessments related to sensation, movement of the hand and engagement in daily activities were administered. Correlation analyses were utilized to determine relationships between touch sensation of the affected hand with individuals’ abilities to engage in valued daily activities, arm and hand disability, and manual abilities. The main finding of the study was that individuals with intact sensation reported greater ability to perform valued occupations and satisfaction with their performance, as compared with individuals with touch sensation impairment. For individuals with impaired touch sensation of the affected hand, impairment of touch sensation of the hand did not correlate with individuals’ performance or satisfaction with valued occupations, arm or hand movement, or manual abilities. Collectively, the results of this study reflect the complex interaction between touch sensation, occupational performance, motor functioning, and manual abilities of the affected hand for individuals’ who have experienced a stroke. This study informs therapists, rehabilitation scientists, and other healthcare professionals that client-centered, individualized approaches, including a wide array of clinical assessments and intervention, including assessment of occupational performance and sensation, remain important components in stroke rehabilitation.
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Hsin-Chin, Chen, and 陳信誌. "Clinical Assessment of Hand Writing , Shoulder/Elbow Motor Control Function for Upper Motor Neuron Dysfunction Patients and Development of a Rehabilitation Robotic Arm for Upper Extremity Motor Learning." Thesis, 2002. http://ndltd.ncl.edu.tw/handle/69320938591967511117.
Full textAbstract:
碩士長庚大學
機械工程研究所
90
Patients with writer’s cramp or upper motorneuron disease (ex. Parkinson’s disease, stroke, and other brain injuries) often have difficulty in processing upper arm movement because of involuntary muscle contraction or neuron regression. This often results in trembling of the involved extremity. Most patients , still experience palm/arm movement obstacles even after treatment/surgery. Therefore, clinical evaluation and rehabilitation training for writing with a pen and arm movement are important parts of the postoperative management.. In this research , clinical testing and quantitative evaluation of the writing function of the patients was done. A series of robotic manipulators for arm movement assessment and rehabilitation was designed and its applications were tested quantitatively and diagrammatically. In the first part of this research , an evaluation system was developed which aimed to quantitatively measure the patients’ arm function using four parameters : the contact pressure between paper and pen, the time delay before start of writing, the hesitation time spent between words, and the total written words in a given time. An evaluation standard for quantitative writing was set-up, clinical testing and subsequent statistical analysis of the results was done. A total of 26 patients and 13 control subjects were studied. The results were analyzed using the SPSS statistical software and showed that t test values of the four estimation parameters were all less than 0.05. This means that there was a significant difference between the evaluation parameters of the patients and normal control subjects. These results can provide a reference for clinicians when diagnosing patients. The second part of the research was aimed to decrease the time and energy spent by therapists who usually have to repeatedly say or demonstrate the correct motions for arm rehabilitation. A mechanical device was designed to manipulate the arm movement and provide the patient with a continuous passive rehabilitation. The machine used was a SCARA type robotic manipulator with four degrees of freedom. This was connected to a computer with a software based on Windows 2000 and Visual Basic 6.0. Also designed for this project to adjust the rehabilitation parameters (i.e. velocity, circle/ellipse movement locus size, etc.). This set up enables the doctor or therapist to choose the proper rehabilitation parameters and patterns for patients who will undergo a continuous upper arm continuous passive rehabilitation. The third part of the research was aimed to consolidate the mechanical 3-D Digitizer already existing in the market and the interface software we developed into a manipulator for the evaluation of upper arm movement function in order to improve the defects noted during initial rehabilitation. This would also provide diagrammatic (arm movement locus radial error, distribution diagram) and quantitative (radial error of normal value, radial error of absolute value, average drawing circle rate, etc.) evaluation indicators and clinical test standards. This consolidated robotic manipulator was further tested on 11 stroke paralysis patients, 5 normal elders, and 6 normal youths. The results showed that there was a significant difference between the three test groups. From the quantitative evaluation indicators, it is shown that the radial error of absolute value was 2 to 3 times more among the stroke patients compared to that of the normal elders, and 3 to 4 times more compared to that of the normal youths. From the diagrammatic evaluation indicators, we found that in the arm movement locus radial error distribution diagram, stroke paralysis patient had the widest area of radial error of absolute value compared to the rest. The error value was about 4 to 9 times more than the normal elder group and 9 to 16 times more than the normal youth group. This objectively result shows that the stroke patients had more serious functional defects. These results can provide a reference for clinicians in the diagnosis of functional defects of patients. The hand writing function evaluation system for using a pen and the manipulator for the assessment of arm function will be able to provide assistance to the clinician as new tools to evaluate patients’ palm/arm motor function. The robotic manipulator can be used for the postoperative rehabilitation the training of the patient. The standards and quantitative evaluation indicators developed in this research can be used as new tool and methods of the treatment for upper motorneuron or palm/arm movement dysfunction patients.