Hemiparesis,or unilateral paresis,is weakness of one entire side of the body. Hemiplegia is,in its most severe form,complete paralysis of half of the body. Hemiparesis and hemiplegia can be caused by different medical conditions,including congenital causes,trauma,tumors,or stroke.
Rehabilitation of sensory and cognitive function typically involves methods for retraining neural pathways or training new neural pathways to regain or improve neurocognitive functioning that have been diminished by disease or trauma. The main objective outcome for rehabilitation is to assist in regaining physical abilities and improving performance. Three common neuropsychological problems treatable with rehabilitation are attention deficit/hyperactivity disorder (ADHD),concussion,and spinal cord injury. Rehabilitation research and practices are a fertile area for clinical neuropsychologists,rehabilitation psychologists,and others.
Functional electrical stimulation (FES) is a technique that uses low-energy electrical pulses to artificially generate body movements in individuals who have been paralyzed due to injury to the central nervous system. More specifically,FES can be used to generate muscle contraction in otherwise paralyzed limbs to produce functions such as grasping,walking,bladder voiding and standing. This technology was originally used to develop neuroprostheses that were implemented to permanently substitute impaired functions in individuals with spinal cord injury (SCI),head injury,stroke and other neurological disorders. In other words,a person would use the device each time he or she wanted to generate a desired function. FES is sometimes also referred to as neuromuscular electrical stimulation (NMES).
The primary goals of stroke management are to reduce brain injury and promote maximum patient recovery. Rapid detection and appropriate emergency medical care are essential for optimizing health outcomes. When available,patients are admitted to an acute stroke unit for treatment. These units specialize in providing medical and surgical care aimed at stabilizing the patient's medical status. Standardized assessments are also performed to aid in the development of an appropriate care plan. Current research suggests that stroke units may be effective in reducing in-hospital fatality rates and the length of hospital stays.
Physical medicine and rehabilitation,also known as physiatry,is a branch of medicine that aims to enhance and restore functional ability and quality of life to people with physical impairments or disabilities. This can include conditions such as spinal cord injuries,brain injuries,strokes,as well as pain or disability due to muscle,ligament or nerve damage. A physician having completed training in this field may be referred to as a physiatrist.
The Bobath concept is an approach to neurological rehabilitation that is applied in patient assessment and treatment. The goal of applying the Bobath concept is to promote motor learning for efficient motor control in various environments,thereby improving participation and function. This is done through specific patient handling skills to guide patients through the initiation and completing of intended tasks. This approach to neurological rehabilitation is multidisciplinary,primarily involving physiotherapists,occupational therapists,and speech and language therapists. In the United States,the Bobath concept is also known as 'neuro-developmental treatment' (NDT).
Mirror therapy (MT) or mirror visual feedback (MVF) is a therapy for pain or disability that affects one side of the patient more than the other side. It was invented by Vilayanur S. Ramachandran to treat post-amputation patients who had phantom limb pain (PLP). Ramachandran created a visual illusion of two intact limbs by putting the patient's affected limb into a "mirror box," with a mirror down the center.
Edward Taub is a behavioral neuroscientist on the faculty at the University of Alabama at Birmingham. He is best known for his involvement in the Silver Spring monkeys case,for making discoveries in the area of neuroplasticity,and developing constraint-induced movement therapy;a family of techniques which helps the rehabilitation of people who have developed learned non-use as a result of suffering neurological injuries from a stroke or other cause.
Telerehabilitation (or e-rehabilitation is the delivery of rehabilitation services over telecommunication networks and the internet. Telerehabilitation allows patients to interact with providers remotely and can be used both to assess patients and to deliver therapy. Fields of medicine that utilize telerehabilitation include:physical therapy,occupational therapy,speech-language pathology,audiology,and psychology. Therapy sessions can be individual or community-based. Types of therapy available include motor training exercises,speech therapy,virtual reality,robotic therapy,goal setting,and group exercise.
Virtual reality therapy (VRT),also known as virtual reality immersion therapy (VRIT),simulation for therapy (SFT),virtual reality exposure therapy (VRET),and computerized CBT (CCBT),is the use of virtual reality technology for psychological or occupational therapy and in affecting virtual rehabilitation. Patients receiving virtual reality therapy navigate through digitally created environments and complete specially designed tasks often tailored to treat a specific ailment;and is designed to isolate the user from their surrounding sensory inputs and give the illusion of immersion inside a computer-generated,interactive virtual environment. This technology has a demonstrated clinical benefit as an adjunctive analgesic during burn wound dressing and other painful medical procedures. Technology can range from a simple PC and keyboard setup,to a modern virtual reality headset. It is widely used as an alternative form of exposure therapy,in which patients interact with harmless virtual representations of traumatic stimuli in order to reduce fear responses. It has proven to be especially effective at treating PTSD,and shows considerable promise in treating a variety of neurological and physical conditions. Virtual reality therapy has also been used to help stroke patients regain muscle control,to treat other disorders such as body dysmorphia,and to improve social skills in those diagnosed with autism.
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease that affects the central nervous system (CNS). Several therapies for it exist,although there is no known cure.
Neurorehabilitation is a complex medical process which aims to aid recovery from a nervous system injury,and to minimize and/or compensate for any functional alterations resulting from it.
Constraint-induced movement therapy is a form of rehabilitation therapy that improves upper extremity function in stroke and other central nervous system damage patients by increasing the use of their affected upper limb. Due to its high duration of treatment,the therapy has been found to frequently be infeasible when attempts have been made to apply it to clinical situations,and both patients and treating clinicians have reported poor compliance and concerns with patient safety. In the United States,the high duration of the therapy has also made the therapy not able to get reimbursed in most clinical environments.
Low-level laser therapy (LLLT),cold laser therapy,photobiomodulation (PBM) or red light therapy is a form of medicine that applies low-level (low-power) lasers or light-emitting diodes (LEDs) to the surface of the body. Whereas high-power lasers are used in laser medicine to cut or destroy tissue,it is claimed that application of low-power lasers relieves pain or stimulates and enhances cell function. The effects appear to be limited to a specified set of wavelengths and new research has demonstrated effectiveness at myopia control. Several such devices are cleared by the United States Food and Drug Administration (FDA),and research shows potential for treating a range of medical problems including rheumatoid arthritis and oral mucositis.
Motor imagery is a mental process by which an individual rehearses or simulates a given action. It is widely used in sport training as mental practice of action,neurological rehabilitation,and has also been employed as a research paradigm in cognitive neuroscience and cognitive psychology to investigate the content and the structure of covert processes that precede the execution of action. In some medical,musical,and athletic contexts,when paired with physical rehearsal,mental rehearsal can be as effective as pure physical rehearsal (practice) of an action.
Rehabilitation robotics is a field of research dedicated to understanding and augmenting rehabilitation through the application of robotic devices. Rehabilitation robotics includes development of robotic devices tailored for assisting different sensorimotor functions(e.g. arm,hand,leg,ankle),development of different schemes of assisting therapeutic training,and assessment of sensorimotor performance of patient;here,robots are used mainly as therapy aids instead of assistive devices. Rehabilitation using robotics is generally well tolerated by patients,and has been found to be an effective adjunct to therapy in individuals with motor impairments,especially due to stroke.
Cognitive rehabilitation refers to a wide range of evidence-based interventions designed to improve cognitive functioning in brain-injured or otherwise cognitively impaired individuals to restore normal functioning,or to compensate for cognitive deficits. It entails an individualized program of specific skills training and practice plus metacognitive strategies. Metacognitive strategies include helping the patient increase self-awareness regarding problem-solving skills by learning how to monitor the effectiveness of these skills and self-correct when necessary.
Peter G. Levine was an American medical researcher,science educator,and authority on stroke recovery. He published articles on brain plasticity as it relates to stroke,with emphasis on modified constraint induced therapy,cortical reorganization,telerehabilitation,electrical stimulation,electromyography-triggered stimulation,mental practice,cortical plasticity,acquired brain injury,spasticity,sensation recovery,evidence-based practice,outcome measures,and others. His 2013 book Stronger After Stroke is regarded as an authoritative guide for patients and therapists dealing with stroke. The book has received numerous positive reviews,and has been translated into Indonesian,Japanese,and Korean. His seminars throughout the United States were described by one reviewer as "funny,entertaining,engaging,dynamic,well organized,passionate and lighthearted." Levine was a trainer of stroke-specific outcome measures for The Ohio State University;B.R.A.I.N. Lab. He was a researcher and co-director at the Neuromotor Recovery and Rehabilitation Laboratory at the University of Cincinnati College of Medicine. Before that,he was a researcher at the Human Performance &Motion Analysis Laboratory,which is the research arm of the Kessler Institute for Rehabilitation.
Fugl-Meyer Assessment (FMA) scale is an index to assess the sensorimotor impairment in individuals who have had stroke. This scale was first proposed by Axel Fugl-Meyer and his colleagues as a standardized assessment test for post-stroke recovery in their paper titled The post-stroke hemiplegic patient:A method for evaluation of physical performance. It is now widely used for clinical assessment of motor function. The Fugl-Meyer Assessment score has been tested several times,and is found to have excellent consistency,responsivity and good accuracy. The maximum possible score in Fugl-Meyer scale is 226,which corresponds to full sensory-motor recovery. The minimal clinically important difference of Fugl-Meyer assessment scale is 6 for lower limb in chronic stroke and 9-10 for upper limb in sub-acute stroke.
Rehabilitation psychology is a specialty area of psychology aimed at maximizing the independence,functional status,health,and social participation of individuals with disabilities and chronic health conditions. Assessment and treatment may include the following areas:psychosocial,cognitive,behavioral,and functional status,self-esteem,coping skills,and quality of life. As the conditions experienced by patients vary widely,rehabilitation psychologists offer individualized treatment approaches. The discipline takes a holistic approach,considering individuals within their broader social context and assessing environmental and demographic factors that may facilitate or impede functioning. This approach,integrating both personal and environmental factors,is consistent with the World Health Organization's (WHO) International Classification of Functioning,Disability and Health (ICF).
