Haim Ring

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.

Purpose. The aim of this paper is to present the current knowledge regarding return to work (RTW) following traumatic brain injury (TBI). Method. Based on a Medline search, the authors reviewed the current TBI rehabilitation literature regarding (a) predictive factors for successful RTW, and (b) current concepts in rehabilitative strategies for successful RTW. Results. The functional consequences to the victim of traumatic brain injury (TBI) can be severe. Intensive rehabilitative efforts typically emphasize the early phase and address mainly the accompanying functional deficits in the realm of basic activities of daily living and mobility. An otherwise successful medical rehabilitation may end unsuccessfully because of the failure to return to work, with profound consequences to the individual and family, both economic and psychosocial. Even mild TBI may cause lasting problems in tasks calling for sustained attention. There appears to be a complex interaction between pre-morbid characteristics, injury factors, post injury impairments, personal and environmental factors in TBI patients, which influences RTW outcomes in ways that make prediction difficult. Injury severity and lack of self-awareness appear to be the most significant indicators of failure to RTW. Several medical, psychosocial and rehabilitative therapies are currently being implemented in rehabilitation settings which improve the chances of returning to work. Conclusion. Accurate prediction of whether a particular TBI patient will successfully return to work is not feasible, with RTW rates in the 12 – 70% range. A significant proportion of TBI patients, including those who are severely injured, are able to return to productive employment if sufficient and appropriate effort is invested. A comprehensive approach – medical and psychosocial – eventually entailing adequate vocational rehabilitation with supported employment can improve outcomes.

Assess the effects of daily neuroprosthetic (NESS Handmaster) functional electrical stimulation in sub-acute stroke. Controlled study, patients clinically stratified to 2 groups; no active finger movement, and partial active finger movements, and then randomized to control and neuroprosthesis groups. Observer blinded evaluations at baseline and completion of the 6-week study. 22 patients with moderate to severe upper limb paresis 3-6 months post-onset. Patients in day hospital rehabilitation, receiving physical and occupational therapy 3 times weekly. The neuroprosthesis group used the device at home. The neuroprosthesis group had significantly greater improvements in spasticity, active range of motion and scores on the functional hand tests (those with partial active motion). Of the few patients with pain and oedema, there was improvement only among those in the neuroprosthesis group. There were no adverse reactions. Supplementing standard outpatient rehabilitation with daily home neuroprosthetic activation improves upper limb outcomes.

One of the major concerns of a stroke victim is the threatening possibility of loosing all the functional achievements attained through prolonged rehabilitation effort, in case of a recurrent cerebrovascular event. Recently, elevated serum homocysteine (Hcy) level was found to be associated with an increased risk for atherosclerotic vascular disease. The aim of the present study was to assess the yield of screening stroke patients for hyperhomocysteinemia, as part of the measures taken to reduce the risk of stroke recurrence. Blood Hcy levels of stroke patients undergoing rehabilitation were compared to the Hcy levels of patients admitted for rehabilitation following brain damage of non-vascular etiologies. The mean Hcy level was found to be significantly higher in the former group (10.21+/-7.81 micromol/L and 6.16+/-4.28 micromol/L in the stroke group and in the non-vascular group, respectively [p<0.003]). However, when analysis of variance was applied and the correlation with age was accounted for, the difference between the groups became insignificant. Considering the current high cost of blood Hcy tests, the above findings do not support adoption of an overall, non-selective screening policy for hyperhomocysteinemia in stroke patients. However, it may be justified to measure Hcy levels, as well as folic acid, vitamin B6 and vitamin B12 levels, in selected stroke cases. Further study is needed in order to set clear guidelines for the search after this possible risk factor of stroke, one of the major causes of morbidity and mortality in modern society.