No description available.

This study investigated the use of biofeedback as part of stress-management training program with head injured adults. The single cases examined were four males with head injuries of moderate severity who were in the post-acute stages of recovery. Treatment involved bi-weekly relaxation training, using EMG biofeedback in combination with deep breathing, autogenic training and/or imagery. Individual subject response to relaxation training was examined during treatment sessions, as was the frequency of stress-related symptomatology outside of sessions, and overall functional adaptation. While all subjects showed evidence of relaxation during treatment sessions, such factors as the nature of the functional disturbance and personal motivation appear to be related to the degree of carryover to the external environment.

Subjects were 2,950 patients who had previously received inpatient treatment for substance abuse at 40 treatment centers in 13 states and were followed up by the Chemical Abuse/Addiction Treatment Outcome Registry (CATOR) via telephone during the 2 years immediately following their treatment. All subjects were contacted every 6 months and asked a series of questions regarding their relapse status, medical utilization, illnesses, injuries, and arrests. Patient status was based on 3 categories: (1) abstinence from any abuse of a chemical, (2) brief relapse of less than 3 months abuse of any chemical, or (3) total relapse of longer than 3 months of any chemical. Findings showed that abstainers had fewer days in the hospital for emotional problems and detoxification. Abstainers also had fewer visits to the hospital for emergency reasons. Males in the brief relapse category had a greater number of injuries than abstainers or total relapsers. Regarding arrests and automobile accidents, no difference was discovered. However, regarding Drunk While Driving (DWI) arrests, abstainers had fewer arrests.

An experiment was conducted to investigate three different treatment strategies in the rehabilitation of coronary artery bypass graft (CABG) patients. Fifteen CABG patients were randomly assigned to one of three training groups: an outpatient cardiac rehabilitation exercise group (which met three times per week for three months); a second group which participated in weekly stress management training for seven weeks in addition to the cardiac rehabilitation exercise sessions; and a third group which participated in a weekly discussion on social support in addition to the exercise sessions. The groups were compared (pre- and post training) on the following physiological dependent measures: systolic and diastolic blood pressure, mean heart rate, cholesterol, triglycerides, high density lipoproteins, and the cholesterol/high density lipoprotein ratio. Psychological self-report measures included: the Beck Depression Inventory, the Spielberger State/Trait Anxiety Index, the Jenkins Activity Survey, and the Hassles and Uplifts Questionnaire. The Structured Interview was given to each patient prior to training only. It was predicted that the group trained in stress management and exercise would show the most positive changes on physiological and psychological dependent measures compared to the other two groups. The results indicated no significant pre/post differences on any of the variables for any of the groups. Thus, the additional components of stress management training and the social support discussion group did not appear to effect more positive change in those patients compared to those who participated in exercise only. Findings may have been influenced by several factors including a small N in each group and large within group variability. Suggestions for future research are discussed.

This study examined the effects of self-monitoring behavior and health locus of control on improvement in a work hardening program. The subjects included 22 male and 18 female outpatients in a hospital-based rehabilitation program. Subjects were classified as having an internal or external health locus of control, and were randomly assigned to either a self-monitoring or a non-self-monitoring group. Improvement was assessed via objective performance data and self-ratings of perceived improvement. The results indicated that individuals identified as having an internal health locus of control did not show greater gains in physical functioning or perceived improvement relative to externally oriented individuals. Additionally, those subjects participating in self-monitoring activities were no different from non-self-monitoring subjects in terms of improvement in exercise activities or perceived improvement. The results also indicated no interaction between health locus of control and the presence or absence of self-monitoring. It was suggested that other factors such as workman's compensation, pain patient characteristics, low self-concept, and severe stress may have proved more powerful influences on patient improvement than internal health locus of control or self-monitoring. It was also suggested that rehabilitation programs might benefit from creating structured environments in which patients receive frequent staff feedback and reinforcement for improvement. Monitoring small, discrete, easily attainable goals might prove more effective than monitoring mood, pain, etc. In addition, teaching specific internal health locus of control behaviors to patients may help them improve their self-concepts and progress. Further research is needed to explore the roles that pain patient personality characteristics, self-concept, and stress play in the progress of patients in a work hardening program.

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.

No description available.

Indiana University-Purdue University Indianapolis (IUPUI)

The purpose of this study was to examine the coping styles, beliefs, and symptoms of head-injured adults during long term recovery. Twenty-eight head-injured and thirty-two control subjects suffering from non-neurological illnesses or injuries participated. Subjects completed the Ways of Coping Questionnaire and two questionnaires developed for this study: the "Why Me?" Questionnaire assessed subjects' causal attributions and beliefs about responsibility and the Head-Injury Symptom List provided self-report of the severity of symptoms of head-injury. The coping and belief profiles of the two groups were compared. Head-injured subjects were more likely to place responsibility for their injury on others and to undertake personal efforts to effect their recovery. Various relations between injury attributions and coping styles were obtained. Among both head-injured and control subjects those who endorsed beliefs of retribution were more likely to cope by wishing they could change their situation. Responses to the Head-Injury Symptom List identified tiredness as the most pervasive symptom. Greater symptomatology was related both to a coping style characterized by lack of ability or willingness to engage in social activity or to seek social support and to beliefs that the injury had occurred to serve a meaningful purpose. Consistent with these quantitative results, interviews with head-injured subjects revealed themes of both loss and enhancement. A majority compared their recovery favorably with that of other individuals. In support of cognitive coping theory, this research demonstrates the feasibility of studying the coping capacities of head-injured individuals and shows that they have distinctive coping styles and beliefs which are related to each other. This knowledge should aid those trying to support the recovery of head-injured individuals by adding to the framework upon which interventions are based.

The following work presents a novel, overground robotic gait trainer: the mobile Tethered Pelvic Assist Device, or mTPAD. The mTPAD is a parallel, cable-driven platform that can apply three-dimensional forces and moments to the user’s pelvis as they walk overground. These forces and moments applied to the pelvis can be timed to the user’s gait and motivated through gait deficits to target specific motions or gait adaptations. An overview of both traditional and robotic gait training is given as an introduction in Chapter 1. The state-of-the-art pelvic robotic gait trainers are discussed, and the need for an overground device that can apply timed forces and moments to the pelvis is highlighted. The design of the mTPAD is covered in Chapter 2. The mechanical structure and the novel controller are discussed and validated through experiments with human participants. The mTPAD device is evaluated on its transparency, accuracy of pelvic localization, and ability to apply specific forces. Chapter 3 illustrates a continuous moment that is applied to the pelvis and synchronized with the user’s gait cycle. The controller is evaluated on its accuracy and ability to alter pelvic kinematics and muscle activations in a group of neurotypical adults. Chapters 4 and 5 highlight the mTPAD’s ability to alter gait characteristics and muscle responses of two groups that exhibit gait deficits: stroke survivors and children with Cerebral Palsy. By evaluating the effects of different force and moment profiles on individuals who may benefit from gait training, this work aims to illustrate the mTPAD’s potential as an overground gait training tool.