Learn about why a biofeedback device might be a better option than a robotic hand for rehabilitation after a stroke from a therapist's perspective.

Is Biofeedback or a Robotic Hand Better for Rehabilitation After Stroke

A Therapist's Perspective - Learn if Biofeedback or a Robotic Hand is better for rehabilitation after stroke.

WHAT HAPPENS TO THE BRAIN DURING A STROKE

A stroke is caused by either a blockage of a blood vessel or bleeding in or
around the brain, which results in a lack of oxygen to the brain and the death
of brain cells. The residual physical effects of the loss of brain cells will
depend on the area of the brain that was affected.

One of the functions of the brain is sending messages to our muscles to move in
a coordinated way to complete functional activities. More than half of stroke
survivors experience a lasting hemiparesis
[https://www.neofect.com/us/blog/hemiplegia-vs-hemiparesis] due to the damage to
the brain. [1] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5688261/#B125] 
Hemiparesis is weakness on one side of the body, and depending on what brain
cells died will determine which pathways to specific muscles will be affected.
Stroke is the leading cause of long term disability in the United States. [2]
[https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000659]

HAND FUNCTION AND ROBOTICS


We often don’t appreciate the complexity of what the arm and hand are able to
do. It’s incredibly complicated. There are 20 joints in the hand alone, and the
joints of the arm are able to move in over 40 different directions. Add in the
degrees of freedom of each joint, the coordination required to grade movement,
the alignment of joints, and exertion of force and you’ve got a very complex
physical system you’re trying to repair after a stroke. That doesn’t even take
into account all the other requirements of a task, such as your visual
perception, your sensation, and your understanding of where your body is in
space. Spasticity
[https://www.neofect.com/us/blog/how-to-improve-spasticity-spinal-cord-injury] 
also develops in stroke, which makes movement of the joint even more difficult.

Robotics used in rehabilitation has made a lot of progress in the last 10 years,
primarily with devices to assist with walking. Upper extremity robotics in
stroke range from full assistance with movement to tracking active movement.
While they are both important, there seems to be a disconnect between designers
and clinicians in the purpose of the device.

Of course it would be awesome if you could put on a robotic glove and suddenly
you would be able to do all the things you were able to do before a stroke, but
it just doesn’t work like that. Even if they were to develop an exoskeleton that
could capture the motor movement parameters of the arm, it wouldn’t be able to
feel and capture the proprioceptive and visual feedback that the neurologically
intact arm provides.

But the brain is an amazing thing! Even though we can’t repair the damage to the
brain, the brain has the capacity to rewire itself. This is called 
neuroplasticity
[https://www.neofect.com/us/blog/using-brain-plasticity-to-supercharge-your-brain]
.

WHAT WE KNOW ABOUT REHABILITATION IN STROKE


There are several evidence-based rehabilitation strategies in stroke that tap
into neuroplasticity including repetitive task practice, constraint-induced and
modified constraint-induced movement therapy, virtual reality, mirror therapy
[https://www.neofect.com/us/blog/stroke-exercises-using-mirror-therapy-and-mirror-neurons]
, and strengthening and exercise. [3]
[https://www.ncbi.nlm.nih.gov/pubmed/25553742] Many of the techniques overlap in
their concepts, and while research is still determining the specifics of which
components of these interventions makes the biggest difference in hand use and
function, it’s clear that you have to put the work in to make neurological
changes.

The commonality for all of the above interventions is frequent repetitions of
movement. We don’t know the magic number of repetitions, but it has to be enough
to create a signal from the brain to the muscle. Imagine you’re trying to build
a road from point A to point B through a pile of dirt with just a truck. The
first time you drive the truck over it’s going to be slow and kind of a bumpy
ride, but then you do it again and again. Each time your truck goes over the
path, it creates a smoother road and gets easier. This is how you train your
brain to send messages to the muscles. Your brain sends a signal to the muscle
to move. The more you do it, the easier it gets. It can be a foreign feeling to
try to isolate a muscle movement because for everyday tasks we use a combination
of muscles and joints to complete the requirements of the task. Creating those
neural pathways to the muscles is the first step of being able to use the
muscles of arm together.

You could sit there and move your hand and arm 200 times everyday for each
motion, but in practical application of rehab this just doesn’t happen. We also
know that initiating movement for a purpose is more likely to develop
neuroplasticity than straight repetitions alone. [3]
[https://www.ncbi.nlm.nih.gov/pubmed/25553742]

The Neofect Smart Glove [https://www.neofect.com/us/smart-glove] is a 
biofeedback
[https://www.neofect.com/us/blog/how-can-biofeedback-jumpstart-your-stroke-rehab-program] 
device that targets movements that are typically impaired for people with
stroke.





It’s training your brain to create those pathways to your muscles, and it does
it in a way that’s motivating and tracks your progress. A typical session will
have you complete 200-300 repetitions. It doesn’t move your hand for you, you
have to do the work. If you have visible movement of your wrist, forearm, and/or
fingers, there is a message that’s trying to get from the brain to the muscle.
The algorithm can create that “just right challenge” to push you just a little
further to really dig into making that path. A robotic hand that moves for you
and doesn’t make you work for it, isn’t sending the truck down the road.

CONTINUING THE REHABILITATION JOURNEY


Repetitive movements are only one piece of the puzzle when it comes to stroke
rehabilitation. Your brain can create pathways to the muscles, but all
functional activities require a variety of muscles and joint movements. You also
have to practice the functional task you want to achieve over and over again
until your brain can learn to do it without thinking about it. It’s not just
about improving your movement, it’s about being able to do the things that give
you quality of life. You don’t have to have full range of motion of each joint
and muscle to be able to do your favorite things, there are a lot of different
ways to accomplish a task.

Depression and a decrease in social activity are common in people with stroke
and impact their quality of life [4]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018998/]. Discover the activities
that make you happy and give you life. As we age we all have to re-evaluate
what’s important to us and grieve the things that are harder than they used to
be. But that doesn’t mean we can’t find new versions and new things that make us
happy. Regardless of the function of your hand, you can live a beautiful,
fulfilling life.

Here at Neofect [https://www.neofect.com/us/], we're committed to supporting you
in your rehabilitation journey. If you have had a stroke and are looking for an
effective solution for your rehabilitation needs, please look into NEOFECT's
line of Smart Rehabilitation Solutions [https://www.neofect.com/en/pt-solution/]
.

To learn more, please call (866) 534-4989 or email contactus@neofect.com.

References

 1. Yue Z, Zhang X, Wang J. (2017) Hand Rehabilitation Robotics on Poststroke
    Motor Recovery [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5688261/#B125].
    Behavioral Neurology
 2. Benjamin, E. J. et al. (2019) Heart Disease and Stroke Statistics—2019
    Update: A Report From the American Heart Association
    [https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000659].
    Circulation
 3. Nilsen, D. M., Gillen, G., Geller, D., Hreha, K., Osei, E., & Saleem, G. T.
    (2015). Effectiveness of interventions to improve occupational performance
    of people with motor impairments after stroke: An evidence-based review
    [https://www.ncbi.nlm.nih.gov/pubmed/25553742]. The American Journal of
    Occupational Therapy, 69(1), 1-5A.
 4. Opara, J. A., & Jaracz, K. (2010). Quality of life of post-stroke patients
    and their caregivers.
    [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018998/] Journal of medicine
    and life, 3(3), 216–220.

All content provided on this blog is for informational purposes only and is not
intended to be a substitute for professional medical advice, diagnosis, or
treatment. Always seek the advice of your physician or other qualified health
provider with any questions you may have regarding a medical condition. If you
think you may have a medical emergency, call your doctor or 911 immediately.
Reliance on any information provided by the Neofect website
[https://www.neofect.com/us/] is solely at your own risk.

Robotic Hand

Is Biofeedback or a Robotic Hand Better for Rehabilitation After Stroke: a Therapist's Perspective

A Therapist's Perspective - Learn if Biofeedback or a Robotic Hand is better for Rehabilitation After Stroke

“Biofeedback can train a stroke survivor to move more naturally.” says Dr. Richard L. Harvey, “medical director at the Rehab Institute of Chicago.

How can biofeedback jumpstart your stroke rehab program?

Biofeedback and Stroke Rehab Program
Biofeedback can be used for the retraining of the arm and hand as a way to
rehabilitate after a stroke. Following a stroke, the central pathways that are
responsible for management of normal muscle tone and functioning can be
disrupted or damaged. Some recent research out of Stanford University involving
stem cells has discovered that those pathways may not be dead, just dormant.
Here’s an interview
[http://www.wbur.org/hereandnow/2017/11/30/stem-cells-stroke-patients] that
talks more about that study.



Other motor pathways that are unused can remain relatively unaffected by the
stroke. Biofeedback is one way that individuals can learn how to activate these
unused pathways in the brain to improve motor function.

Biofeedback works by providing the user with visual reinforcement that a body
part is being moved in the desired way. The concept is as simple as looking in
the mirror to watch yourself move the arm or leg. “After a stroke, it is common
for survivors to move their arms or legs abnormally,” says Dr. Richard L.
Harvey, “medical director of the Stroke Rehabilitation Center at the
Rehabilitation Institute of Chicago, otherwise known as the Shirley Ryan Ability
Lab. “Biofeedback can train a stroke survivor to move more naturally.”

Biofeedback can be particularly helpful in helping someone isolate which muscle
to use when there are two opposing muscles working against each other, as often
happens after stroke. Learning to turn one set of muscles off, or relax them in
order to get the opposing muscles to fire, can be one potential benefit of
therapy involving biofeedback.

Using the Neofect Smart Glove [https://www.neofect.com/us/smart-glove], a user
that may not have wrist extension activation but is able to flex the wrist, may
work on turning off the flexor muscles or firing them in a more moderate way, in
order to allow the extensor muscles to do their job of lifting the wrist, all
while playing an engaging training game like Jewel Pong or or Throwing Darts.



Game-based virtual reality (VR) like Neofect Rehab Solutions
[https://www.neofect.com/us/for-home] apply the principle of neuroplasticity
while utilizing visual and auditory biofeedback. With VR the measured patient
activity is fed back via graphs or audio and visual animations providing a
realistic impression to the user. Visual biofeedback may also stimulate mirror
neurons increasing the potential of the participant to mirror the movement.
Virtual reality combined with biofeedback gives someone recovering from stroke
the opportunity to interact safely with activities that appear similar to
real-world situations.


*Neofect Home Inquiry:
-www.neofect.com [https://www.neofect.com/us]
-Phone: (888) 623-8984 [tel:+18886238984]



--------------------------------------------------------------------------------

 * References

 1. Arya KN, Pandian S, Verma R, Garg RK. Movement therapy induced neural
    reorganization and motor recovery in stroke: A review. Journal of Bodywork
    and Movement Therapies. 2011; 15: 528-537. 
    https://doi.org/10.1016/j.jbmt.2011.01.023
 2. Giggins OM, Persson UM, Caulfield B. Biofeedback in rehabilitation. Journal
    of Neuroengineering and Rehabilitation. 2013; 10: 1-11. doi:
    10.1186/1743-0003-10-60
 3. Kommalapati R, Michmizos KP. Virtual reality for pediatric
    neuro-rehabilitation: Adaptive visual feedback of movement to engage the
    mirror neuron system. In Engineering in Medicine and Biology Society. 2016;
    IEEE 38th Annual International Conference of the (pp. 5849-5852).
 4. Henderson A, Korner-Bitensky N, Levin M. Virtual reality in stroke
    rehabilitation: A systematic review of its effectiveness for upper limb
    motor recovery. Topics in Stroke Rehabilitation. 2007; 14(2): 52. doi:
    10.1310/tsr1402-52

Biofeedback System

How Can Biofeedback Jumpstart Your Stroke Rehab Program?

Learn about top 3 benefits of digital / outpatient stroke rehabilitation and virtual reality.  Read more about virtual reality and occupational therapy.

Top 3 Benefits of Digital / Outpatient Stroke Rehabilitation & Virtual Reality

Digital / Outpatient Stroke Rehabilitation
We live in such a connected world. The ability to get on a Skype call with
relatives or friends across the globe makes us feel more connected than ever
before. With data stored in the “cloud” we can access information from anywhere,
virtually. The evolution of technology has affected the way we communicate, find
information, purchase things and it can also change the way we access
rehabilitation after a stroke or brain injury.



Digital / Outpatient stroke rehabilitation like the Neofect Smart Glove
[https://www.neofect.com/us/smart-glove] and Smart Board
[https://www.neofect.com/us/smart-board] are biofeedback devices that use
virtual reality to turn the hand or arm into a controller for engaging training
games. Through artificial intelligence (the computer providing guidance for a
user’s program through a customized algorithm) the user is challenged to
participate in training games that are focused on activities of daily living as
well as more novel games.

How can users benefit from digital / outpatient stroke rehabilitation through
virtual reality?



Top 3 Benefits of Digital Stroke Rehab / Outpatient Stroke Rehabilitation
1. Training games mimic everyday activities
Context and meaning are important components of the rehabilitation process. When
an activity is in line with a user’s goals, it’s easier to stay engaged and
connected to rehabilitation. Even if a patient cannot perform a task such as
cutting vegetables, playing darts or fishing, they can participate in them
virtually, using the motion that they have to be successful in a meaningful
context.

2. Allows increased access to intensive arm and hand rehab
Between visit limits, challenging therapist schedules, travel, weather and other
factors, it can be difficult to stick to a routine of attending outpatient
stroke rehabilitation appointments. Using a digital outpatient stroke rehab
solution like the Smart Glove or Smart Board, allows users to continue
intensive, repetitive practice from the comfort of their home, even when they
can’t make it to a therapy appointment.

3. Provides motivation through progress tracking
Digital rehabilitation options allow for measurement and tracking of small
changes that may be difficult to capture with the eye. This provides motivation
for users to see their progress over a period of time. In addition, in the hands
of a therapist, the data can be used to justify continued services and to show
improvement in a more objective way.

To read more about Virtual Reality and Occupational Therapy, check out this blog
post by our Clinical Manager, Lauren Sheehan, OTD, OTR/L. The American
Occupational Therapy Association also wrote a recent article about using Virtual
Reality in Your OT Practice. To learn more about our virtual reality Neofect
Smart Rehab products, visit www.neofect.com [https://www.neofect.com/us] or call
us at (888) 623-8984 [tel:+18886238984].


*Neofect Home Inquiry:
-www.neofect.com [https://www.neofect.com/us]
-Phone: (888) 623-8984 [tel:+18886238984]

Digital Rehab

By combining hardware to aid the body movements and software to design appropriate brain therapy program, patients can do hand rehab training continuously.

How Stroke Patients Can Hand Rehab By Playing Games At Home



How Stroke Patients can Do Hand Rehab at Home
After testing the Neofect Smart Glove solution in hospitals around the world and
validating its effectiveness, Neofect [https://www.neofect.com/us] has offered
their device for post-stroke rehabilitation at home.

Stroke patients often experience long term disability, which is more due to
neuro damage than to muscle weakness. By combining hardware to aid the body
movements and software to design appropriate brain therapy program, physicians
can greatly improve the rehab process.

Neofect Smart Glove [https://www.neofect.com/us/smart-glove] is a biofeedback
system which includes a glove-like device with built-in sensors to measure hand,
wrist and finger movements, and a software program to create training games.
There are more than 40 games currently available.



The software has an artificial intelligence component that automatically adjusts
the range of motion and difficulty level. This ensures the patient continues to
stay challenged during the game, at the same time, creating a positive,
encouraging environment. The system monitors the performance data over time and
generates progress reports.

Neofect has been successfully used by a number of hospitals. After getting
positive feedback from medical professionals, the device is now available to
individuals. Stroke victims can buy or rent and work on regaining their hand
mobility at their own pace without leaving their homes.

The first participants of the program have been excessively satisfied with the
results:

> "I really believe in this product. The games keep my mind working, It is great
with the hand, but in a cognitive level, I have come a long way and can make
full sentences now." (Carol S., Va.)


> "Most companies sell you a product and then want nothing to do with you. Neofect
has developed a product that truly helps with rehabilitation, but more than
that, they are a true partner in the process. They are constantly releasing new
games, they check in on progress and are by our side helping us get to the next
stage. We are so very grateful to have found this company and their amazing
product." (Melia W., Wash.)


Neofect [https://www.neofect.com/us] have introduced a special, more powerful
stroke home exercise programs of the Neofect solution since 2017.

In the U.S., every 40 seconds someone is having a stroke. It is the leading
cause of disability, costing the national economy $34 billion and a victim’s
family – an average $17,081 annually.


The majority of patients has never completes their rehabilitation therapy for
one or a combination of three reasons:

 1. Difficulty to visit a doctor’s office on a regular basis.
 2. The lack of noticeable improvement
 3. High cost

The Neofect solution [https://www.neofect.com/us] is designed to solve each of
these problems by making the rehab program engaging, affordable and available
for patients at the convenience of their home.



To learn more about Neofect or get a 7-day free trial, visit the company’s
website www.neofect.com [https://www.neofect.com/us] or call to our office at 
(888) 623-8984 [tel:+18886238984].


*Neofect Home Inquiry:
-www.neofect.com [https://www.neofect.com/us]
-Phone: (888) 623-8984 [tel:+18886238984]