Stroke: new technologies (FS-24)

Braintrain: making the most of new technologies for stroke rehabilitation

Mindy F. Levin (Canada), Jane H. Burridge (United Kingdom), Sandeep K. Subramanian (Canada), John M. Solomon (India)

Focused symposium

Saturday 2 May 2015, 13:45-15:15, Hall 406

Braintrain: making the most of new technologies for stroke rehabilitation

Levin M.F. 1,2, Burridge J.H. 3, Subramanian S.K. 2,4, Solomon J.M. 5

1McGill University, School of Physical and Occupational Therapy, Montreal, Canada, 2Centre for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, Canada, 3University of Southampton, Rehabilitation and Health Technologies Research Group, Southampton, United Kingdom, 4University of Montreal, School of Rehabilitation, Montreal, Canada, 5MCOAHS, Manipal University, Department of Physiotherapy, Manipal, India

Learning objectives

  1. To become familiar with the principles of neuroplasticity, motor control and motor learning applicable to stroke rehabilitation
  2. To understand how technology can assist in the application of these principles in therapy
  3. To become familiar with examples of using technology based on motor control and learning principles in developed (UK, Canada) and developing (India) countries and barriers and facilitators to their use.

Description

Neuroplasticity, motor control and motor learning are guiding principles of rehabilitation, especially for neurological disorders such as stroke. Increasing availability of new and exciting technologies such as robotics and virtual reality has led to the potential of integrating these guiding principles more effectively into treatment approaches. With the help of these new technologies, therapy can be administered in a functional, purposeful and motivating context. Salient tasks can be practiced with the added advantage of easily adjusting task difficulty levels to the needs of the individual to enhance motor learning. In the past four to five years, there has been an increase in the number of research papers published about the efficacy and the effectiveness of using such technology for stroke rehabilitation. Evidence-based reviews and best practice recommendations (e.g., Canadian Stroke Network: Evidence Based Reviews of Stroke Rehabilitation) currently agree that therapy involving technology as one component results in better outcomes, after task practice. However, it is not completely clear whether and how new technologies can be implemented in stroke rehabilitation in different settings. The speakers, with appropriate evidence-based recommendations (PEDro scores and Sackett's levels of evidence) will focus on i) the importance of integrating principles of neuroplasticity, motor control and motor learning in stroke rehabilitation such as practice intensity, variability, task specificity, motivation, environment in which the task is practiced and provision of task and/or performance-relevant feedback, with an emphasis on upper limb rehabilitation and ii) how new technologies based on these principles can help in the design and use of effective treatment approaches. Examples of how different technologies are currently being used will be presented and discussed. These include: a) home-based rehabilitation technologies, combining robotic therapy with Functional Electrical Stimulation (FES), b) virtual reality based upper limb training with provision of feedback for patients with chronic stroke in a rehabilitation setting and c) game-based virtual reality treatment in a low-income country, issues concerning the implementation of the technology, factors influencing the use of technology by the patients and preliminary findings of a training program. Attributes and pitfalls of the current technology will be identified and facilitators and barriers to the use of new technologies in developed (UK, Canada) and developing (India) countries will be presented.

Implications / Conclusions

Technology provides a platform for application of neuroplasticity, motor control and motor learning principles derived from basic science to design effective tools for rehabilitation. It offers the option of adjusting treatment parameters to deliver tailor-made personalized interventions to individual patients in particular settings. Knowledge about new technologies will facilitate effective knowledge transfer and will help better inform clinicians about the latest innovations in stroke rehabilitation.

Keywords

Technology; Stroke Rehabilitation; Knowledge Transfer

Funding acknowledgements

Canada Research Chairs, Canadian Foundation for Innovation, GRAND Challenges Canada, Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Centre for Stroke Recovery

Relevance to WCPT and expected audience

Stroke rehabilitation is a primary concern in neurophysiotherapy practice. There is a constant need to develop better methodologies for assessment and treatment. New technologies based on neuroplasticity, motor control and motor learning principles may potentially benefit neurological patients by improving motor recovery. However, there is a need to understand how technologies can use basic principles to promote better motor recovery as well the barriers and facilitators encountered when incorporating new technologies into practice.

Target audience

The session is aimed primarily at physiotherapists, physiotherapy assistants and researchers interested in neurological practice, motor learning, motor control and innovative technology.