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ABSTRACT: Several studies have described the contribution of robotics technology in providing effective treatment options for improving upper-extremity functions in patients with hemiparesis following stroke. The aim of this study was to conduct a preliminary assessment of patient acceptance of an upper extremity robot, the Reo Therapy System (Motorika Ltd., Israel), developed specifically for neuromuscular training of upper extremities for use in rehabilitation centers and outpatient clinics.
Ten in-patient sub-acute stroke patients aged 30-60 years participated in the study. They received 15 sessions of forty five minutes training with the Reo Therapy System, in addition to traditional occupational and physical therapy. A feedback questionnaire of the patients' satisfaction, the Fugl-Meyer test and the Manual Function Test (MFT) were used as outcome measures.
Patient satisfaction with the robot-assisted therapy program and acceptance of working with Reo Therapy System was very good. Arm impairment and functionality as measured with the Fugl-Meyer and the MFT increased significantly after treatment.
The Reo Therapy System was found to be valued by patients. Further research is necessary in order to identify the most efficient balance of Reo Therapy and traditional therapy methods.
European journal of physical and rehabilitation medicine 01/2009; 44(4):431-5. · 1.40 Impact Factor
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H Ring
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ABSTRACT: Functional assessments have become a cornerstone of rehabilitation medicine, assisting in well-defined aspects such as: quality assurance, continuous quality improvement, accountability, cost/benefit analysis, education, and research. In the second part of the 20th century, scaling techniques have become an integral part of the rehabilitation medicine discipline, and everybody is aware of their essential importance. However, even when engaged in a purely scientific discussion on the theoretical, mathematical basis of these measurements, a fundamental question arises as to what depth of accuracy is it possible to bring such measurements into a clinical scenario (or any real scenario). When it comes to the integration of all these principles, a balance must be achieved between pure theory and clinical applications, making it accessible for the average clinician and department routinely running functional evaluations. All these considerations are discussed with examples of data management that can be performed by systematically collecting data with the help of a computerized database where demographic, clinical and functional data is recorded. Rehabilitation teams and systems must be aware of function measurement principles and applications and determine their position in this regard.
Europa medicophysica 01/2008; 43(4):551-5.
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ABSTRACT: To present the current state of knowledge regarding return to work (RTW) following stroke.
A comprehensive review of the current stroke rehabilitation literature pertaining to prognostic and treatment factors for RTW following stroke.
Stroke is a major healthcare problem and one of the most expensive diseases in modern society. Stroke results not only in impairment and limitation in basic daily activities; it also impacts on participation in community activities, such as returning to work. Return to work in post-stroke patients has been reported to range between 19% and 73%. Various studies report on return to work in diverse populations, using different follow-up periods, while utilizing variable definitions of stroke and successful work outcomes. The factors positively related to RTW in stroke patients, as found in the literature, are age less then 65 years, high education level and white-collar employment. The significant negative predictor is the severity of stroke. This is indicated by neurological parameters including functional measures of the presence and extent of motor and cognitive impairment. Significantly, the side of the brain damaged and stroke location were not found to be correlated with RTW. Social and financial factors also significantly influence RTW.
RTW in stroke patients should be considered one of the indicators of a successful rehabilitation as it influences self-image, well-being and life satisfaction. There is still a considerable lack of knowledge regarding effective assessments and interventions in vocational rehabilitation in stroke patients.
Disability and Rehabilitation 10/2007; 29(17):1397-403. · 1.50 Impact Factor
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ABSTRACT: To investigate the pattern of hemispheric activation, according to cerebral blood flow changes, as measured by Transcranial Doppler Ultrasonography (TCD) during language tasks in stroke patients with aphasia.
Prospective study investigating results of TCD monitoring during language naming and recognition tasks in ischemic stroke patients (n = 32) with and without aphasia and 5 control subjects.
Delta mean flow velocity (MFV) in the left Middle Cerebral Artery (MCA) was found to be much lower in aphasia patients as compared to healthy subjects. Negative statistical correlation was found between the improvement of language ability and the blood flow velocity parameters in the left hemisphere. Aphasia patients with good language ability showed much higher MFV in the right MCA during the first test. Left hemispheric blood flow velocity shift was found to be higher during speech tasks in the patients with poor language ability.
Our study suggests that the performance of language tasks in aphasia patients during early recovery after stroke is associated with relatively high right hemisphere activation. High blood flow velocity in the right MCA of aphasia patients was found to be a good prognostic sign for better language ability. Arterial blood flow that shifted towards the left hemisphere during speech tasks was associated with poor language ability.
Disability and Rehabilitation 09/2007; 29(15):1177-83. · 1.50 Impact Factor
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ABSTRACT: Functional Electrical Stimulation (FES) in stroke patients has been demonstrated to provide clinical benefits such as improvement in movement, skills, function and decrease of spasticity. Imaging and neurophysiological studies have shown cortical excitability and reorganization. After injury, the parameters of timing, intensity, frequency, and duration of FES are still to be determined. Additional issues that should be determined are whether the changes induced by FES are long-lasting, and which clinical and electrophysiological parameters are important and to what extent.
Acta neurochirurgica. Supplement 02/2007; 97(Pt 1):375-80.
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ABSTRACT: Rehabilitation as a treatment approach to affect neural remodeling or ''plasticity'' of the injured brain is gaining increasing attention and appreciation. While rehabilitation continues to emphasize re-establishment of functional abilities, the approach of neurorehabilitation attempts to improve recovery by impacting on changes within the central nervous system rather than reliance on compensatory techniques. Functional electrical stimulation is one of the prominent modalities being used for neurorehabilitation. This report provides an overview of the relevance of brain plasticity to rehabilitation, and of the physiological and clinical studies that indicate the effects of functional electrical stimulation as a potential tool in neural remodeling.
Europa medicophysica 07/2006; 42(2):87-90.
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ABSTRACT: The aim of the study is to investigate the correlation between orthostatic hypotension (OH), mean flow velocity (MFV) as measured by transcranial Doppler (TCD) in middle cerebral artery (MCA) bilaterally during tilt table test (TTT) and functional and neurological parameters in acute ischemic stroke patients, undergoing rehabilitation.
Thirteen patients after first ischemic stroke in the MCA territory and 13 healthy volunteers were examined. TTT was performed with elevating the subject from supine to 80 masculine standing position and back to supine within 10 min. Peripheral blood pressure was measured and monitoring of MFV in MCA of damaged and healthy hemisphere by TCD was performed during the TTT. Patients underwent the test few days after admission to rehabilitation department and were classified into 2 subgroups: those with decrease of systolic blood pressure of at least 20 mm/Hg during the test and those without the OH.
Among patients without OH, MFV indexes were almost the same in damaged and healthy MCA and did not changed during the test. Patients with OH symptoms showed significant differences between blood flow velocities in 2 hemispheres in favor of nondamaged size. No association was found between the OH and the severity of functional and neurological status after stroke.
These findings suggest that the appearance of OH after ischemic stroke may be associated with decreased blood flow velocity in damaged MCA at the beginning of rehabilitation treatment, but not with functional and neurological status of the patient.
Europa medicophysica 01/2006; 41(4):293-6.
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ABSTRACT: The goal of this study was to determine whether non immersive interactive virtual environments are an effective medium for training individuals who suffer from Unilateral Spatial Neglect (USN) as a result of a right hemisphere stroke, and to compare it to a standard computer visual scanning training.
Participants included 19 patients with right hemisphere stroke in two groups, 11 in an experimental group were given computer desktop-based Virtual Reality (VR) street crossing training and 8 in a control group who were given computer based visual scanning tasks, both for a total of twelve sessions, 9 hours total, over four weeks. Measures included: 1. Standard USN assessments, paper and pencil and ADL checklist; 2. Test on the VR street program; and 3. Actual street crossing videotaped. Testing was performed pre and post intervention.
The VR group achieved on the USN measures results that equaled those achieved by the control group treated with conventional visual scanning tasks. They improved more on the VR test and they did better on some measures of the real street crossing.
Despite several limitations in this study the present results support the effectiveness of the VR street program in the treatment of participants with USN, and further development of the program.
Disability and Rehabilitation 11/2005; 27(20):1235-43. · 1.50 Impact Factor
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H Ring
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ABSTRACT: Rehabilitation systems are almost universally struggling to maintain or improve their standings. In this sense it is very useful to draw strategic plans for research and development taking into consideration the characteristics of the profession and, at the same time, the environment where they perform. Five domains of activities can be identified in this sense: measurement of clinical outcomes (including cost/effectiveness and quality assurance), services delivery: the continuum of care, technologies/procedures, pharmacological treatments and opportunities (''niches''). Each domain is described and the different possibilities analyzed. Each system--regional, national--or even a facility should make a selection of what fits their strategic plan best and which modality can be easily incorporated and where human and material resources exist or can be acquired. The need for the justification of the rehabilitation services looks by now as a must, universally.
Europa medicophysica 10/2005; 41(3):207-14.
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ABSTRACT: To evaluate heart rate variability (HRV) of patients with traumatic brain injury (TBI).
By a prospective study, the HRV was assessed in 20 patients with TBI during the sub-acute period post-injury (the first test was performed at a mean time post-insult of 38 days) and a matched control. The patients were examined twice, 1 month apart. The assessment included HRV (both in time and frequency domains), GCS, length of coma, brain CT, FIM and FAM.
A significant difference was found between patients and controls concerning HRV total power, i.e. frequencies between 0.01-0.6 Hz (high frequency p = 0.003, low frequency p = 0.013, total power p = 0.034) and for standard deviation of RR interval p = 0.011. HRV changes were related more to the timing of the evaluation than to the severity of the brain damage.
HRV differed of patients with TBI and in the control group. Tendency to HRV normalization changes was detected during the first 3 months after the injury, which suggests recovery of the autonomic nervous system.
Brain Injury 09/2005; 19(8):605-11. · 1.36 Impact Factor
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ABSTRACT: Critical illness polyneuropathy (CIP), a neurologic complication that may occur secondary to cardio-respiratory distress, surgery, trauma and coma, is associated with sepsis or multiple organ failure. CIP is characterized by an axonal distal degeneration of sensory and motor fibres. The patients will often become neurologically conspicuous when weaning from mechanical ventilation is unexpectedly difficult. There are just a few cases reported with description of the functional outcome and rehabilitation issues of this condition. An additional CIP case of a 62-year old man complicated with anoxic brain damage during the respiratory distress is reported here. He was referred for rehabilitation, made a remarkable recovery (FIM gain 45!) and returned home after 79 days of treatment in the ward. A review of the pertinent literature is provided. Rehabilitation specialists and other professionals working within ICU's should be aware of this condition and be able to recognize and treat CIP at early possible stage.
Disability and Rehabilitation 04/2003; 25(6):273-6. · 1.50 Impact Factor
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ABSTRACT: The Spinal Cord Independence Measure (SCIM) is a new disability scale developed specifically for patients with spinal cord lesions (SCL). Its original and second versions (SCIM and SCIM II) were found to be reliable and more sensitive than the Functional Independence Measure (FIM) to functional changes in SCL patients.
To further validate the SCIM II, examining its components on a larger population.
Retrospective cohort study.
Two rehabilitation centers in Israel.
Two hundred and two inpatients with SCL.
Routine SCIM assessments by staff nurses. Rasch and accompanying analyses.
Unidimensionality of subscales (areas of function); goodness of fit of the tasks to the Rasch model; relationship of total-patient and single-task performance-ability; usability of task categories and the order of threshold locations between them; subscale discrimination of ability and difficulty and hierarchical nature; discrimination of task-categories ability, ie, distribution of thresholds along ability levels; and differential task behavior by age, gender and examination subgroups.
Four unidimensional subscales were identified, and an acceptable goodness of fit to the Rasch model was demonstrated in most of their tasks (infit mean square=0.8-1.2, outfit mean square=0.6-1.4). However, some tasks showed overfit (bathing lower body) and some showed misfit (wheelchair-car transfer). Additional analyses performed to check for reasons for less than acceptable fit revealed flaws in a minority of the outcome measures.
The findings of this analysis confirm the validity and reliability of the SCIM II. To a large extent we can infer that the SCIM II construct allows for the detection of any level of disability in any patient with SCL. A few item categories, however, should be rephrased or removed.
Spinal Cord 09/2002; 40(8):396-407. · 1.80 Impact Factor
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ABSTRACT: The effectiveness of ongoing rehabilitation services for post-acute stroke patients is poorly documented. The aim of the present study was describe the relationships between functional status at discharge and intensity of therapies, including occupational therapy, physical therapy, speech therapy and nursing care, during inpatient medical rehabilitation. All patients (30) admitted after a first stroke. The functional status of patients was observed by using the Functional Independence Measure on patient admission to rehabilitation and time per week during the hospitalisation. The neurological status of patients was observed by using the NIH Stroke Scale on patient admission to rehabilitation and at discharge. The study population included 30 patients of average 64.4 years; 60% were men; length of stay was 74 days. Statistical analysis were performed to check for intensity of therapies, discharge motor and cognitive function, the extent to which potential functional gains were achieved. Intensities of physical and speech therapies were not significant predictors of outcomes. Intensity of occupational therapy was significant predictor of outcomes (P = 0.04). We suggest that efficiently staged rehabilitation should vary the intensity and nature of services according to patients functional status, impairments, comorbid conditions and other clinical factors.
Harefuah 01/2002; 140(12):1127-33, 1232.
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ABSTRACT: Feature search for a light bar with one orientation (or color) embedded in an array of bars with a very different orientation (or color) is quick, easy and independent of the number of array elements. In contrast, search for a conjunction target has a linear response time dependence on the number of distractors. Training can improve performance of both these tasks. We report that these properties may not be valid for eccentric stimulus presentation. In general, the two hemifields are not equally suited to search, and training is most effective in the weaker hemifield. In addition, the feature-search independence of set-size may not always be valid for stimulus arrays that are presented peripherally. Subjects were tested on orientation and color feature tasks, and on orientation-color conjunction search with 3 array sizes presented at fixation or eccentrically in the right or left hemifield. During a second testing session, improvement was so much greater for the non-preferred hemifield that sometimes the preference was switched. Surprisingly, preferred hemifield performance actually declined for some subjects. Thus, the hemifield preference effect seems related to competition, and perhaps an automatic attention-directing mechanism. We confirmed the central presentation set-size independence for feature search but found a great difference between large and small arrays when presentation was lateral. There are two sources of this array size effect: 1. Target eccentricity, demonstrated by comparing performance for different target locations with the same array size. 2. Target location uncertainty, seen by comparing performance for different size arrays when the target elements appeared at the same locations. Training also affected the array-size dependence, changing search performance from set-size dependent to independent or vice versa at the point of greatest training effect.
Spatial Vision 07/2001; 14(2):151-73. · 1.04 Impact Factor
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ABSTRACT: To examine the suitability of the revised Spinal Cord Independence Measure, the Catz-ltzkovich SCIM, for evaluation of patients with spinal cord lesions, as compared to the original SCIM and to the Functional Independence Measure (FIM).
The revised SCIM was applied by paired independent teams of occupational therapists, physiotherapists and nurses and the FIM by a single nurse. The examiners assigned scores to the functional capabilities of 28 patients with spinal cord lesions. The scores by the revised SCIM were analysed for reproducibility as between the two teams of examiners (interrater reliability) and for their correlation with the FIM scores.
The frequency of identical scoring by two independent examiners (total agreement) was 80% or higher for 13/18 individual functions listed in the revised SCIM. In the self-care category it was 80-99%, as compared to 75-87% before revision. In neither bowel management nor bed mobility was there an increase over the original SCIM in the frequency of identical scores, despite rephrasing and restructuring of the scoring criteria. A high correlation was noted between the paired scores for all functions listed as well as for those comprising each of the four functional categories (r = 0.90-0.96, p <0.001). The total revised-SCIM scores were significantly correlated with those derived by the FIM (r = 0.835, p < 0.001).
The findings indicate that the newly revised SCIM (Catz-Itzkovich) is a valid and highly reproducible measure of daily function in patients with spinal cord lesions, and is superior to the original SCIM. We recommend that it supersede the original SCIM.
Disability and Rehabilitation 05/2001; 23(6):263-8. · 1.50 Impact Factor
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ABSTRACT: To study the quality of care provided for patients with urinary incontinence following a stroke, by monitoring both process and outcome elements of care simultaneously.
Prospective follow-up of patients (of all ages and of both sexes) with urinary incontinence that appeared following a stroke who were admitted for rehabilitation during a six 6-month period.
A ward for stroke rehabilitation in The Loewenstein Hospital-Rehabilitation Centre in Raanana, Israel.
Thirty-seven patients with stroke and urinary incontinence (mean age 61 years, 68% men) were included in the study; 84% of the 37 patients were discharged, although only 25% of them were continent. No lasting complications of urinary incontinence developed and there was no interference with rehabilitation activities. There was a correlation between incontinence and low score of Functional Independence Measure (FIM) on admission, being higher on discharge in those who became continent than in those who did not.
Ward staff are aware of the potential problem of incontinence in patients with stroke. The problem is identified on admission and accorded adequate attention and care with satisfactory outcomes. The approach of monitoring process and outcome elements of care simultaneously in conditions that, during inpatient rehabilitation of patients with stroke, may endanger life, interfere with rehabilitation and delay functional recovery, could be a useful way to assess and improve the quality of care.
International Journal for Quality in Health Care 03/2001; 13(1):57-61. · 1.96 Impact Factor
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ABSTRACT: The extent of the diagnostic work-up of patients with acute stroke was evaluated in 101 patients admitted for rehabilitation during a 4-month period in 1997. This included specific blood tests and neuro- and cardiac imaging, and compared the extent of work-up in a community hospital versus a rehabilitation center. Comparisons were also made with similar investigations 10 and 20 years earlier. Results demonstrated that the trend to admit younger stroke patients (< 50 years) to neurological (as opposed to medical) departments observed between 1977-1987 persisted in 1997. The use of CT scan increased dramatically from 1977 to 1987 (19% vs 78%), and in 1997 was actually 100%. The use of carotid duplex and echocardiography increased steadily during the 3 decades reaching 26% and 28% respectively. Tests for thrombophilia were seldom done. However, in neurological departments it was done in about 50% of the younger stroke patients. In neurology departments carotid duplex was done 2 to 3 times more often than in medical departments. During rehabilitation imaging tests were done once or more in almost half the patients. The results and those of additional blood tests, have led to modification of antithrombotic treatment in 14% of the younger group and 4% of the older group. We have clearly shown that while stroke work-up has become more comprehensive in recent years, there is still much to do in this field. Stroke units or teams in our general hospitals will increase stroke awareness, improve work-up and hasten definitive treatment.
Harefuah 02/2001; 140(1):1-4, 88.
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ABSTRACT: The spinal cord independence measure (SCIM) is a newly developed disability scale specific to patients with spinal cord lesions (SCL). Its sensitivity to functional changes in a whole cohort of SCL patients was found to be better than that of the functional independence measure (FIM).
o compare the sensitivity to functional changes of the SCIM and the FIM in SCL subgroups.
A comparative self-controlled study.
The Spinal Department, Loewenstein Rehabilitation Hospital, Raanana, Israel.
22 SCL inpatients.
Monthly SCIM and FIM assessments of the subgroups.
Functional change detection rate (FDR) and mean differences between consecutive scores (DCS).
The outcome measures of the SCIM were higher than those of the FIM for tetraplegia and paraplegia, complete and incomplete lesions (the FIM missed 25-27% of the functional changes detected by the SCIM; DSC 8.2-11.4 vs 5.2-9; P<0.05 in most comparisons). The SCIM did not exhibit this advantage, however, in the functional areas of self-care and mobility in the room and toilet. Further subgrouping yielded similar results.
The SCIM is more sensitive than the FIM to functional changes in the subgroups studied, and has the potential to serve as a universal tool for disability assessment of SCL patients.
Spinal Cord 02/2001; 39(2):97-100. · 1.80 Impact Factor
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H Ring
Archives of Physical Medicine and Rehabilitation 10/2000; 81(9):1250-2. · 2.28 Impact Factor
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ABSTRACT: To evaluate the impact of unilateral spatial neglect (USN) on the rehabilitation outcome and long-term functioning in activities of daily living (ADL) and instrumental ADL (IADL) of right hemisphere damaged (RHD) stroke patients.
Assessments of sensory-motor and cognitive impairment and of functional disability were conducted upon admission to rehabilitation, upon discharge from the rehabilitation hospital, and 6 months after discharge, up to a year postonset.
The Loewenstein Rehabilitation Hospital, which receives patients from all general hospitals in Israel.
Forty consecutive admissions of adult right-handed patients with a first, single, right hemispheric stroke proven by computed tomography. Based on their total score in the Behavioral Inattention Test for neglect, patients were divided into two groups: 19 with neglect (USN+) and 21 without neglect (USN-).
Functional Independence Measure, for ADL; The Rabideau Kitchen Evaluation, for IADL.
Impairment and disability levels of RHD patients with and without USN were clearly differentiated. Neglect is associated with lower performance on measures of impairment (sensory-motor and cognitive), as well as on measures of disability in ADL and IADL. Differences were significant in all testing periods. The recovery pattern of USN+ patients is slower and more attenuated. In both groups, most improvement occurs in the first 5 months after onset. USN is the major predictor of rehabilitation outcome from admission to follow-up.
The significance of neglect as a major source of stroke-related long-term disability justifies further research efforts to develop appropriate therapeutic modalities for this complex, multifactorial syndrome.
Archives of Physical Medicine and Rehabilitation 05/1999; 80(4):379-84. · 2.28 Impact Factor
