A significant higher median frequency was found in the DEC group in comparison to the CVA group (... more A significant higher median frequency was found in the DEC group in comparison to the CVA group (p<0.05) and to the THR group (p<0.05). This is expected, since postural tremor of deconditioned patients due to muscle weakness may raise sway frequency in comparison to the CVA and THR groups. A significant higher WDI was found in the CVA group and in the THR group in comparison to the DEC group (p<0.05). The uneven weight distribution in CVA and THR patients can be explained by the fact that they usually suffer from paralysis or other orthopedic problem. Conclusions The new posturographic parameters calculated in this study have the potential to differentiate between different pathologies. The sensitivity of these parameters may serve as a valuable tool in monitoring the effects of therapeutic interventions and rehabilitation.
Motor imagery practice refers to the mental rehearsal of motor acts in the absence of actual move... more Motor imagery practice refers to the mental rehearsal of motor acts in the absence of actual movement production. To evaluate the effect of motor imagery practice on the performance of sit to stand (STS) and reaching to grasp in subjects with post stroke chronic hemiparesis. The study was designed as a crossover intervention. Participants were 13 individuals (mean age, 68.9 [±4.9] years) with chronic hemiparesis enrolled in a day center at the Bet-Rivka Rehabilitation Hospital in Petach Tikvah, Israel. Following 1 week of baseline measurements of the performance of STS and reaching to grasp, these functions were mentally practiced for 15 minutes 3 times a week for 4 weeks. Half of the subjects mentally practiced STS, while the other half practiced the reaching imagery protocol. Subsequently, the participants in each group crossed over to practice the second function for the next 4 weeks. All practice sessions were performed according to a pre-established protocol under supervision. ...
In elderly people, owing to a perturbation at several levels, including the motor, sensory and co... more In elderly people, owing to a perturbation at several levels, including the motor, sensory and cognitive levels, a condition of dizziness and unsteadiness complicated by frequent falls often appears. In this article, we review the most recent information about clinical and instrumental tools available for preventing mobility-related accidents and report the results of a comparative study of postural control, carried out through tetraataxiometry (by Tetrax, Tel Aviv, Israel), in two samples of elderly women belonging to two different populations: 24 Italian women (11 reporting falls and 13 without falls) having a mean age of 73.1 years, and 37 Israeli women (12 with falls and 25 without falls) having a mean age of 72.5 years. The posturographic findings show that the falling subjects, to maintain postural control, are highly dependent on somatosensory inputs and have a weaker "systeme postural fin" (fine postural system), according to Gagey. They also show that an elderly s...
2011 International Conference on Virtual Rehabilitation, 2011
This paper reports the outcome and feasibility of using a novel virtual reality system, SeeMe, fo... more This paper reports the outcome and feasibility of using a novel virtual reality system, SeeMe, for the assessment and treatment of unilateral spatial neglect following stroke in a recovered post-stroke subject with residual symptoms of unilateral spatial neglect (USN). The subject received 8 weekly treatment sessions. Outcome measures included the Short Feedback Questionnaire, standard paper and pencil tests and the assessment procedure of the SeeMe system itself. The tests were done on the first and last treatment days. The paper and pencil tests were normal while the SeeMe system showed a clear difference between movement times in the right and left hemispace. Following treatment, the subject showed improved movement times to the left hemispace and also showed functional gains. The subject did not experience any discomfort such as nausea or dizziness while using the system. This initial pilot study indicates that the SeeMe virtual reality system has the potential to be used in clinical settings in order to assess and treat USN. A full clinical trial is necessary in order to examine this premise.
2009 Virtual Rehabilitation International Conference, 2009
This paper is a report of the feasibility and outcome of using a low-cost, commercially available... more This paper is a report of the feasibility and outcome of using a low-cost, commercially available gaming system -Wii Fit -for balance training after stroke. The patient was an 86 year-old woman five weeks after stroke, who was unable to walk without close supervision, even with a walker, due to poor balance and a tendency to fall. In addition to standard physical therapy, the patient participated in four training sessions with the Wii Fit system; each training session included four different games. The outcome measures were Berg Balance Scale (BBS), the Functional Reach and Lateral Reach tests, Timed Up & Go test (TUG), computerized posturography, and the Short Feedback Questionnaire (SFQ). The tests were done before the intervention and on the last day of training. The SFQ was done during the third training session. The patient greatly enjoyed the training sessions and felt that she was receiving very 'up-to-date' treatment. She did not experience any discomfort such as nausea or dizziness while using the system. Following combined Wii and standard treatment, the patient demonstrated improved antero-posterior symmetry of stance, and there was a 10 second improvement in her TUG score. When released from hospital, she was able to walk with a walker with minimal supervision. This initial pilot study indicates that the Wii Fit gaming system has the potential to be used in clinical settings in order to improve balance. A full clinical trial is necessary in order to examine this premise.
Motor imagery practice refers to the mental rehearsal of motor acts in the absence of actual move... more Motor imagery practice refers to the mental rehearsal of motor acts in the absence of actual movement production. To evaluate the effect of motor imagery practice on the performance of sit to stand (STS) and reaching to grasp in subjects with post stroke chronic hemiparesis. The study was designed as a crossover intervention. Participants were 13 individuals (mean age, 68.9 [±4.9] years) with chronic hemiparesis enrolled in a day center at the Bet-Rivka Rehabilitation Hospital in Petach Tikvah, Israel. Following 1 week of baseline measurements of the performance of STS and reaching to grasp, these functions were mentally practiced for 15 minutes 3 times a week for 4 weeks. Half of the subjects mentally practiced STS, while the other half practiced the reaching imagery protocol. Subsequently, the participants in each group crossed over to practice the second function for the next 4 weeks. All practice sessions were performed according to a pre-established protocol under supervision. Measurements of real performance took place twice before and twice immediately following each practice session. For STS, the Tetrax Balance System was used to measure the speed of performance and weight distribution between the legs. Reaching to grasp was appraised via a &amp;amp;amp;amp;quot;kinematic&amp;amp;amp;amp;quot; glove and included speed variables of the hand. A significant decrease was found in the values of STS duration. Weight distribution between the legs was not affected by the intervention. For reaching to grasp, a significant improvement was found in the mean and the maximum reaching velocity. In individuals with chronic hemiparesis, the imagery practice of meaningful motor tasks can positively affect real performance.
International Journal of Rehabilitation Research, 2009
Unilateral spatial neglect is a disabling feature of stroke, with a prevalence of 40% or greater.... more Unilateral spatial neglect is a disabling feature of stroke, with a prevalence of 40% or greater. It is characterized by the inability to orient or respond to stimuli appearing on the side contralateral to the brain lesion. USN is associated with a greater risk of falls, longer ...
International Journal of Rehabilitation Research, 2009
S110 International Journal of Rehabilitation Research 2009, Vol 32 Supplement 1 RESULTS The patie... more S110 International Journal of Rehabilitation Research 2009, Vol 32 Supplement 1 RESULTS The patient greatly enjoyed the training sessions and felt that she was receiving very &#x27;up-to-date&#x27;treatment. She did not ex-perience any discomfort such as nausea or ...
To demonstrate the feasibility of an innovative program of physical activity using a standing-sup... more To demonstrate the feasibility of an innovative program of physical activity using a standing-support device targeted towards adult residents of a nursing home who are unable to transfer or stand independently. Intervention study. Thirteen residents, age 82 +/- 11 years, at the Beit Bayer Nursing Home, Jerusalem, Israel, who were unable to transfer or stand independently. Eight-week observational period followed by 12-week physical activity performed while standing in a Standing-Support Device. Manual Muscle Testing, joint range of motion, forward and lateral reach, time to stand independently, distance walked with a walker, Functional Independence Measure. Compared to the observational period, significant post-intervention improvements were noted particularly in lower extremity muscle strength. Improvements in the Functional Independence Measure were noted in sphincter control, locomotion, mobility, motor score, and total score. Over 60% of those previously requiring assistance in standing became able to stand for an average of 1 min unassisted and walk an average of 14 m with a walker. A pilot program of physical activity using a Standing-Support Device is feasible in selected stance-disabled older adult nursing home residents. Participants showed evidence of muscle strength and functional improvement. Future studies of the device with a concurrent examination of healthcare costs, functional improvement, and staff burden, are recommended.
To present our experience in measuring rehabilitation achievements of post-acute hip fractured pa... more To present our experience in measuring rehabilitation achievements of post-acute hip fractured patients with the FIM instrument; assess its appropriateness as to the patients&amp;amp;amp;amp;amp;amp;#39; various disability levels and describe our experience with other measuring tools in patients less sensitive to changes in the FIM instrument. A retrospective study performed in a post-acute geriatric rehabilitation center. Three hundred and eighty-seven hip fractured patients admitted from January 2010 to May 2012 were included in this study. Patients were evaluated by the Functional Independence Measure (FIM), the Timed Get Up and Go (TUG) test and &amp;amp;amp;amp;amp;amp;quot;bed to chair&amp;amp;amp;amp;amp;amp;quot; transfer FIM parameter. The study population was divided into three disability groups according to their admission disability level: high (admission FIM score &amp;amp;amp;amp;amp;amp;lt;40), moderate (FIM 40-79) and low (FIM ≥ 80). The Mann-Whitney U, ANOVA and Chi square tests analyzed the data. The FIM instrument was found most sensitive in identifying functional change in patients with moderate disability. Low disability patients received more physio- and occupational-therapy treatment time, yet achieved a lower mean FIM score change compared to moderately disabled patients. The smallest real difference (SRD = 13) for the FIM score was achieved by 60% of patients with moderate disability. When assessed by the TUG test, most patients (94%) improved their score. The SRD% of 31% was achieved by 71.7% of the patients. Nineteen patients (35.9%) achieved a discharge score of &amp;amp;amp;amp;amp;amp;lt;20 s. The high disability group achieved the lowest mean FIM score change. On admission, 52/64 (81%) patients required considerable help in transferring from bed to chair (FIM 1-2), however, upon discharge, the majority (69.2%) improved to the level of a one man transfer (FIM ≥ 3). Forty-one (64.1%) patients were discharged home. Post-acute hip fracture patients exhibit variable functional ability. Assessing rehabilitation achievements with a disability measure is limited; therefore, it is advisable to use an instrument most suitable to the patients&amp;amp;amp;amp;amp;amp;#39; disability level.
Fifty-six consecutive elderly ( &gt; or = 65 years) patients, admitted for acute stroke to a ... more Fifty-six consecutive elderly ( &gt; or = 65 years) patients, admitted for acute stroke to a geriatric department were included in the study and underwent CT scanning. Functional status was graded according to the modified Rankin scale. Three patients had primary intra-cerebral haemorrhage, 22 deep hemispheric infarct, 17 had anterior circulation cortical infarcts, five had posterior circulation infarcts and in nine the CT scan was normal. Stroke risk factors were equally distributed among the different CT scan groups, and all three larger groups had similar rates of non-neurological major complications including death (41%). However, independence in ADL (Rankin 0-2) was observed in 72% of deep infarct survivors, but only 15% of the cortical infarct group (p = 0.00018). For the normal scan group, functional recovery was intermediate. In the cortical infarct group patients with an infarct of &gt; or = 50 mm mean diameter (five cases) should worse functional recovery than did eight patients with small infarcts. The mean difference between pre- and post-stroke Rankin score (DR) was 3.4 for the larger infarct patients and 1.9 for the smaller infarct group (p = 0.027). Pearson correlation revealed a direct relationship between the infarction size and DR (p = 0.039). Such a relationship was not observed for the deep hemispheric group.
In elderly people, owing to a perturbation at several levels, including the motor, sensory and co... more In elderly people, owing to a perturbation at several levels, including the motor, sensory and cognitive levels, a condition of dizziness and unsteadiness complicated by frequent falls often appears. In this article, we review the most recent information about clinical and instrumental tools available for preventing mobility-related accidents and report the results of a comparative study of postural control, carried out through tetraataxiometry (by Tetrax, Tel Aviv, Israel), in two samples of elderly women belonging to two different populations: 24 Italian women (11 reporting falls and 13 without falls) having a mean age of 73.1 years, and 37 Israeli women (12 with falls and 25 without falls) having a mean age of 72.5 years. The posturographic findings show that the falling subjects, to maintain postural control, are highly dependent on somatosensory inputs and have a weaker "systeme postural fin" (fine postural system), according to Gagey. They also show that an elderly s...
A significant higher median frequency was found in the DEC group in comparison to the CVA group (... more A significant higher median frequency was found in the DEC group in comparison to the CVA group (p<0.05) and to the THR group (p<0.05). This is expected, since postural tremor of deconditioned patients due to muscle weakness may raise sway frequency in comparison to the CVA and THR groups. A significant higher WDI was found in the CVA group and in the THR group in comparison to the DEC group (p<0.05). The uneven weight distribution in CVA and THR patients can be explained by the fact that they usually suffer from paralysis or other orthopedic problem. Conclusions The new posturographic parameters calculated in this study have the potential to differentiate between different pathologies. The sensitivity of these parameters may serve as a valuable tool in monitoring the effects of therapeutic interventions and rehabilitation.
Motor imagery practice refers to the mental rehearsal of motor acts in the absence of actual move... more Motor imagery practice refers to the mental rehearsal of motor acts in the absence of actual movement production. To evaluate the effect of motor imagery practice on the performance of sit to stand (STS) and reaching to grasp in subjects with post stroke chronic hemiparesis. The study was designed as a crossover intervention. Participants were 13 individuals (mean age, 68.9 [±4.9] years) with chronic hemiparesis enrolled in a day center at the Bet-Rivka Rehabilitation Hospital in Petach Tikvah, Israel. Following 1 week of baseline measurements of the performance of STS and reaching to grasp, these functions were mentally practiced for 15 minutes 3 times a week for 4 weeks. Half of the subjects mentally practiced STS, while the other half practiced the reaching imagery protocol. Subsequently, the participants in each group crossed over to practice the second function for the next 4 weeks. All practice sessions were performed according to a pre-established protocol under supervision. ...
In elderly people, owing to a perturbation at several levels, including the motor, sensory and co... more In elderly people, owing to a perturbation at several levels, including the motor, sensory and cognitive levels, a condition of dizziness and unsteadiness complicated by frequent falls often appears. In this article, we review the most recent information about clinical and instrumental tools available for preventing mobility-related accidents and report the results of a comparative study of postural control, carried out through tetraataxiometry (by Tetrax, Tel Aviv, Israel), in two samples of elderly women belonging to two different populations: 24 Italian women (11 reporting falls and 13 without falls) having a mean age of 73.1 years, and 37 Israeli women (12 with falls and 25 without falls) having a mean age of 72.5 years. The posturographic findings show that the falling subjects, to maintain postural control, are highly dependent on somatosensory inputs and have a weaker "systeme postural fin" (fine postural system), according to Gagey. They also show that an elderly s...
2011 International Conference on Virtual Rehabilitation, 2011
This paper reports the outcome and feasibility of using a novel virtual reality system, SeeMe, fo... more This paper reports the outcome and feasibility of using a novel virtual reality system, SeeMe, for the assessment and treatment of unilateral spatial neglect following stroke in a recovered post-stroke subject with residual symptoms of unilateral spatial neglect (USN). The subject received 8 weekly treatment sessions. Outcome measures included the Short Feedback Questionnaire, standard paper and pencil tests and the assessment procedure of the SeeMe system itself. The tests were done on the first and last treatment days. The paper and pencil tests were normal while the SeeMe system showed a clear difference between movement times in the right and left hemispace. Following treatment, the subject showed improved movement times to the left hemispace and also showed functional gains. The subject did not experience any discomfort such as nausea or dizziness while using the system. This initial pilot study indicates that the SeeMe virtual reality system has the potential to be used in clinical settings in order to assess and treat USN. A full clinical trial is necessary in order to examine this premise.
2009 Virtual Rehabilitation International Conference, 2009
This paper is a report of the feasibility and outcome of using a low-cost, commercially available... more This paper is a report of the feasibility and outcome of using a low-cost, commercially available gaming system -Wii Fit -for balance training after stroke. The patient was an 86 year-old woman five weeks after stroke, who was unable to walk without close supervision, even with a walker, due to poor balance and a tendency to fall. In addition to standard physical therapy, the patient participated in four training sessions with the Wii Fit system; each training session included four different games. The outcome measures were Berg Balance Scale (BBS), the Functional Reach and Lateral Reach tests, Timed Up & Go test (TUG), computerized posturography, and the Short Feedback Questionnaire (SFQ). The tests were done before the intervention and on the last day of training. The SFQ was done during the third training session. The patient greatly enjoyed the training sessions and felt that she was receiving very 'up-to-date' treatment. She did not experience any discomfort such as nausea or dizziness while using the system. Following combined Wii and standard treatment, the patient demonstrated improved antero-posterior symmetry of stance, and there was a 10 second improvement in her TUG score. When released from hospital, she was able to walk with a walker with minimal supervision. This initial pilot study indicates that the Wii Fit gaming system has the potential to be used in clinical settings in order to improve balance. A full clinical trial is necessary in order to examine this premise.
Motor imagery practice refers to the mental rehearsal of motor acts in the absence of actual move... more Motor imagery practice refers to the mental rehearsal of motor acts in the absence of actual movement production. To evaluate the effect of motor imagery practice on the performance of sit to stand (STS) and reaching to grasp in subjects with post stroke chronic hemiparesis. The study was designed as a crossover intervention. Participants were 13 individuals (mean age, 68.9 [±4.9] years) with chronic hemiparesis enrolled in a day center at the Bet-Rivka Rehabilitation Hospital in Petach Tikvah, Israel. Following 1 week of baseline measurements of the performance of STS and reaching to grasp, these functions were mentally practiced for 15 minutes 3 times a week for 4 weeks. Half of the subjects mentally practiced STS, while the other half practiced the reaching imagery protocol. Subsequently, the participants in each group crossed over to practice the second function for the next 4 weeks. All practice sessions were performed according to a pre-established protocol under supervision. Measurements of real performance took place twice before and twice immediately following each practice session. For STS, the Tetrax Balance System was used to measure the speed of performance and weight distribution between the legs. Reaching to grasp was appraised via a &amp;amp;amp;amp;quot;kinematic&amp;amp;amp;amp;quot; glove and included speed variables of the hand. A significant decrease was found in the values of STS duration. Weight distribution between the legs was not affected by the intervention. For reaching to grasp, a significant improvement was found in the mean and the maximum reaching velocity. In individuals with chronic hemiparesis, the imagery practice of meaningful motor tasks can positively affect real performance.
International Journal of Rehabilitation Research, 2009
Unilateral spatial neglect is a disabling feature of stroke, with a prevalence of 40% or greater.... more Unilateral spatial neglect is a disabling feature of stroke, with a prevalence of 40% or greater. It is characterized by the inability to orient or respond to stimuli appearing on the side contralateral to the brain lesion. USN is associated with a greater risk of falls, longer ...
International Journal of Rehabilitation Research, 2009
S110 International Journal of Rehabilitation Research 2009, Vol 32 Supplement 1 RESULTS The patie... more S110 International Journal of Rehabilitation Research 2009, Vol 32 Supplement 1 RESULTS The patient greatly enjoyed the training sessions and felt that she was receiving very &#x27;up-to-date&#x27;treatment. She did not ex-perience any discomfort such as nausea or ...
To demonstrate the feasibility of an innovative program of physical activity using a standing-sup... more To demonstrate the feasibility of an innovative program of physical activity using a standing-support device targeted towards adult residents of a nursing home who are unable to transfer or stand independently. Intervention study. Thirteen residents, age 82 +/- 11 years, at the Beit Bayer Nursing Home, Jerusalem, Israel, who were unable to transfer or stand independently. Eight-week observational period followed by 12-week physical activity performed while standing in a Standing-Support Device. Manual Muscle Testing, joint range of motion, forward and lateral reach, time to stand independently, distance walked with a walker, Functional Independence Measure. Compared to the observational period, significant post-intervention improvements were noted particularly in lower extremity muscle strength. Improvements in the Functional Independence Measure were noted in sphincter control, locomotion, mobility, motor score, and total score. Over 60% of those previously requiring assistance in standing became able to stand for an average of 1 min unassisted and walk an average of 14 m with a walker. A pilot program of physical activity using a Standing-Support Device is feasible in selected stance-disabled older adult nursing home residents. Participants showed evidence of muscle strength and functional improvement. Future studies of the device with a concurrent examination of healthcare costs, functional improvement, and staff burden, are recommended.
To present our experience in measuring rehabilitation achievements of post-acute hip fractured pa... more To present our experience in measuring rehabilitation achievements of post-acute hip fractured patients with the FIM instrument; assess its appropriateness as to the patients&amp;amp;amp;amp;amp;amp;#39; various disability levels and describe our experience with other measuring tools in patients less sensitive to changes in the FIM instrument. A retrospective study performed in a post-acute geriatric rehabilitation center. Three hundred and eighty-seven hip fractured patients admitted from January 2010 to May 2012 were included in this study. Patients were evaluated by the Functional Independence Measure (FIM), the Timed Get Up and Go (TUG) test and &amp;amp;amp;amp;amp;amp;quot;bed to chair&amp;amp;amp;amp;amp;amp;quot; transfer FIM parameter. The study population was divided into three disability groups according to their admission disability level: high (admission FIM score &amp;amp;amp;amp;amp;amp;lt;40), moderate (FIM 40-79) and low (FIM ≥ 80). The Mann-Whitney U, ANOVA and Chi square tests analyzed the data. The FIM instrument was found most sensitive in identifying functional change in patients with moderate disability. Low disability patients received more physio- and occupational-therapy treatment time, yet achieved a lower mean FIM score change compared to moderately disabled patients. The smallest real difference (SRD = 13) for the FIM score was achieved by 60% of patients with moderate disability. When assessed by the TUG test, most patients (94%) improved their score. The SRD% of 31% was achieved by 71.7% of the patients. Nineteen patients (35.9%) achieved a discharge score of &amp;amp;amp;amp;amp;amp;lt;20 s. The high disability group achieved the lowest mean FIM score change. On admission, 52/64 (81%) patients required considerable help in transferring from bed to chair (FIM 1-2), however, upon discharge, the majority (69.2%) improved to the level of a one man transfer (FIM ≥ 3). Forty-one (64.1%) patients were discharged home. Post-acute hip fracture patients exhibit variable functional ability. Assessing rehabilitation achievements with a disability measure is limited; therefore, it is advisable to use an instrument most suitable to the patients&amp;amp;amp;amp;amp;amp;#39; disability level.
Fifty-six consecutive elderly ( &gt; or = 65 years) patients, admitted for acute stroke to a ... more Fifty-six consecutive elderly ( &gt; or = 65 years) patients, admitted for acute stroke to a geriatric department were included in the study and underwent CT scanning. Functional status was graded according to the modified Rankin scale. Three patients had primary intra-cerebral haemorrhage, 22 deep hemispheric infarct, 17 had anterior circulation cortical infarcts, five had posterior circulation infarcts and in nine the CT scan was normal. Stroke risk factors were equally distributed among the different CT scan groups, and all three larger groups had similar rates of non-neurological major complications including death (41%). However, independence in ADL (Rankin 0-2) was observed in 72% of deep infarct survivors, but only 15% of the cortical infarct group (p = 0.00018). For the normal scan group, functional recovery was intermediate. In the cortical infarct group patients with an infarct of &gt; or = 50 mm mean diameter (five cases) should worse functional recovery than did eight patients with small infarcts. The mean difference between pre- and post-stroke Rankin score (DR) was 3.4 for the larger infarct patients and 1.9 for the smaller infarct group (p = 0.027). Pearson correlation revealed a direct relationship between the infarction size and DR (p = 0.039). Such a relationship was not observed for the deep hemispheric group.
In elderly people, owing to a perturbation at several levels, including the motor, sensory and co... more In elderly people, owing to a perturbation at several levels, including the motor, sensory and cognitive levels, a condition of dizziness and unsteadiness complicated by frequent falls often appears. In this article, we review the most recent information about clinical and instrumental tools available for preventing mobility-related accidents and report the results of a comparative study of postural control, carried out through tetraataxiometry (by Tetrax, Tel Aviv, Israel), in two samples of elderly women belonging to two different populations: 24 Italian women (11 reporting falls and 13 without falls) having a mean age of 73.1 years, and 37 Israeli women (12 with falls and 25 without falls) having a mean age of 72.5 years. The posturographic findings show that the falling subjects, to maintain postural control, are highly dependent on somatosensory inputs and have a weaker "systeme postural fin" (fine postural system), according to Gagey. They also show that an elderly s...
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