Occupational therapy and application of Motor Control Part II

P.S:As we discussed in the previous article a theoretical reflection of motor Control and motor learning we will be stepping ahead in understanding few more interesting concepts and its application.
In this article i will be providing a few links to highlight on the concept and discuss varied research works and readers will benefit from it only if they read the research links simultaneously with the article as i have tried to summarize with the evidences of excellent work done by researchers.Covering all the literature is beyond the scope of this article so i will be restricting it to few interesting ones.Readers can further do the review.

The challenge of achieving functional skill given neurological disease or injury may be met by weaving key concepts of motor learning and control into treatment protocols. However, in order to effectively integrate these concepts into rehabilitation programs, motor learning and motor control strategies need to be better understood.Individuals with neurological conditions that affect function may need to relearn previously acquired motor skills with an altered number and quality of resources available to them.

Frame work discussed in previous article reflects the fact that in the early 1900's voluntary movement was thought to occur through reflex linkages. This paradigm led to numerous theories of motor control that have been replaced as knowledge of the nervous system as it expands. Although the assumptions associated with varied motor control theories differ, most current theories have incorporated a Systems view of distributed control of the nervous system.
 A Systems model suggests that movement results from the interaction of multiple systems working in synchrony to solve a motor problem 
The advantage of the Systems model is that it can account for the flexibility and adaptability of motor behavior in a variety of environmental conditions. Functional goals as well as environmental and task constraints play a major role in determining movement. This frame of reference provides a foundation for developing intervention strategies based on task goals that are aimed at improving motor skills.

To understand this concept i would request the readers to read the articles that i will be providing link of.
Applying principles of motor learning and control to upper extremity rehabilitation This article from journal of hand therapy has simplified the understanding of the application with a case study.

Moving ahead to another novel concept of Neural Plasticity.
An article published by Center of General Medicine,Belgium as How much brain does a mind need? Scientific, clinical, and educational implications of ecological plasticity. Lebeer J1
 in developmental Medicine and child Neurology,1988 highlights on Ecological Plasticity as a mew paradigm and well does a young brain adapt better than older one.

Leading from this article we will look in to Motor learning and Brain plasticity.

Studies of adult brain plasticity have shown that substantial improvement in function and/or recovery from losses in sensation, cognition, memory, motor control, and affect should be possible, using appropriately designed  training paradigms.

As occupational therapist our aim on functional rehabilitation demands designing treatment strategies beneficial in retraining the individual in his activities of daily living meeting the temporal factors .

 Thus,Driving brain plasticity with positive outcomes requires engaging adults in demanding sensory, cognitive, and motor activities on an intensive basis, in a behavioral context designed to reengage and strengthen the neuro-modulatory systems that control learning in adults, with the goal of increasing the fidelity, reliability, and power of cortical representations.

A randomized controlled pilot study states that brain-plasticity-based intervention targeting normal age-related cognitive decline may potentially offer benefit to a broad population of older adults. Brain plasticity and functional losses in the aged: scientific bases for a novel intervention. Mahncke HW1, Bronstone A, Merzenich MM. (You can mail me for full article PDF)

Thus the neural circuit is a complex process which can be studied in simplified way.To support my discussion i will refer another very recently published article on 30th May 2018 in Journal of Neurophysiology Case Studies in Neuroscience: Evidence of motor thalamus reorganization following bilateral forearm amputations Benjamin P. Whatley , Jeremy W Chopek , Ron Hill , and Robert M. Brownstone 

There are evidences that people who have suffered brain injuries recover their motor function through therapy and training  ( Dimyan and Cohen 2011)
The above mentioned  article highlights a very interesting case study of development of essential tremor ,52 years bilateral forearm amputation due to which he was not able to able to use his prosthesis efficiently and his independence was severely affected.
He was elected for bilateral DBS procedure under micro electrode guidance.As it would be expected to have neuronal firing on active digit or wrist movement this was not possible to test pertaining to amputation however surprisingly it was found that even on volitional contra lateral elbow movement there was no activity observed at Vim however it was found that there was neuronal firing at ventral intermediate nucleus on shoulder protraction ,an action that was used to operate his terminal hooks.this clearly reflects the motor reorganization at thalamus.


This was in reference to motor control and plasticity.Motor learning is one of the widely studied subjects.At present there is no consensus to which motor control theory would define it best.
However as a therapist we should have an insight on this literature before designing our treatment protocols.

I am providing with another article which states the the limitations and clinical implications of all the discussed theories.
Also it discusses the factors affecting motor learning and the application in neuro-rehabilitation.
Theories and control models and motor learning: clinical applications in neuro-rehabilitation.Cano-de-la-Cuerda R et al. Neurologia. (2015)
 Further reflecting on some research work which can be reviewed and referred by readers.
1) Dr Richard Keegan is an Assistant Professor in Sport and Exercise Psychology
Faculty of Health, and Research Institute for Sport and Exercise Sciences,University of Canberra, Australia.

1) Dr. Kristen Pickett who is an Assistant Professor in the Occupational Therapy Program within the Department of Kinesiology at the University of Wisconsin, Madison. She received her Masters in Kinesiology and her PhD in Kinesiology, Biomechanics, and Neural Control from the University of Minnesota, Twin Cities.
You can view her academic tree here https://academictree.org/csd/publications.php?pid=150826&searchstring=&showfilter=all  and read some of her work done in areas of somato sensory and
motor research .

2)Professor Paul Hodge ,Prof & NHMRC Snr Principal Res Fel,School of Health and Rehabilitation Sciences,Faculty of Health and Behavioural Sciences,University of Queensland.directing to his interesting publications.
https://researchers.uq.edu.au/researcher/1050

3)Dr Andrew Gordon,Professor of Movement Sciences,Teachers College,Columbia University.

The Motor Learning and Neuro rehabilitation Lab is coordinated by Dr. Andrew Gordon and Dr. Lori Quinn. Dr. Gordon, Professor of Movement Sciences, is a motor control scientist and is the director of the Center for Cerebral Palsy Research.A highlight of few of his work will give a good understanding of the updates in research

 https://neurotree.org/beta/publications.php?pid=31671  

4)Dr. Simone V. Gill ,PhD,OT,OTR is the director of Motor development Lab,Sargent College,BU Her interests are in the areas of adaptation and development. She is particularly interested in understanding how types of practice and motor experience affect infants’, children’s, and adults’ ability to adapt to change. Her focus is on capturing the trajectory of change over multiple, nested time scales: across sessions, within sessions, within trials, and in the transition from trial to trial. In her current work, she has used walking to examine how infants and adults modify their gait to cope with changes in the environment and with changes in their body dimensions. She is a member of the American Occupational Therapy Association and the Society for Research in Child Development.
Link to her publications/work  https://www.bu.edu/sargent/profile/simone-gill/


I conclude this article in hope of it being beneficial in understanding the concept.However the topic covers a wide area of research and will need constant updates which i will be posting intermittently.
In my next article i will be discussing some cases ad treatement from occupational therapy perspective with evidence based review.

-SSW

Occupational therapy and application of Motor Control Part 1

This article will involve three parts ,for the convenience of readers and better conceptual understanding i am simplifying by starting with the basic understanding of motor control and motor learning and this will be a revision of theory ,subsequent parts will focus on description of its application and recent research work.

What is Motor Control?

-An ability to regulate and direct the mechanisms essential to movement.
The process of initiating, directing, and grading purposeful voluntary movement".

So lets address  how CNS organizes many individual muscles and joints in to coordinated functional pattern? or
How sensory information from body and environment is used to select and control movement?

Physical and Occupational therapists have been referred to as "Applied Motor Control Physiologist"(Brooks 1986) -because we spend considerable amount of time in understanding Motor control problems and as an occupational therapist our therapeutic strategies is directed in improving and retraining the functional movements & patterns.

The organization and production of movement is a complex problem, so the study of motor control has been approached from a wide range of disciplines, including psychology, cognitive science, bio-mechanics and neuroscience.

The control of human movement has been described in many different ways with many different models of Motor Control put forward throughout the 19th & 20th Centuries. Motor Control Theories include production of reflexive, automatic, adaptive, and voluntary movements and the performance of efficient, coordinated, goal-directed movement patterns which involve multiple body systems (input, output, and central processing) and multiple levels within the nervous system

We will be understanding this in detail:

Let us focus on understanding of Movement:
its interaction of movement ,task and the environment

So organization of movement is constrained by factors

• Within Individual
•  the task
• and environment

Within Individual factors that constrain Movement:

Movement and Action
 Movement and Perception
Movement  and Cognition

Task Constraints on Movement

Environmental constraints on Movement

Theories of Motor Control:

Readers can refer to Motor Control, Ann Shumway-Cook  for detailed description:

MOTOR CONTROL THEORIES	AUTHOR	DATE	PREMISE	CLINICAL IMPLICATIONS
Reflex Theory	Sherrington	1906	Movement is controlled by stimulus-response.  Reflexes are basis for movement - Reflexes are combined into actions that create behavior.	Use sensory input to control motor output  Stimulate good reflexes  Inhibit undesirable (primitive) reflexes  Rely heavily on Feedback
Dynamical Systems Theory	Bernstein  Turvey  Kelso & Tuller  Thelen	1967  1977  1984  1987	Movement emerges to control degrees of freedom.  Patterns of movements self-organize within the characteristics of environmental conditions and the existing body systems of the individual.  Functional synergies are developed naturally through practice and experience and help solve the problem of coordinating multiple muscles and joint movements at once.  De-emphasize commands from CNS in controlling movement and emphasize physical explanations for movement.	Movement is an emergent property from the interaction of multiple elements.  Understand the physical & dynamic properties of the body - i.e. Velocity- important for dynamics of movement. May be good to encourage faster movement in patients to produce momentum and therefore help weak patients move with greater ease.
Hierarchical Theories	Adams	1971	Cortical centers control movement in a top-down manner throughout the nervous system.  Closed-loop Mode: Sensory feedback is needed and used to control the movement.  Voluntary movements initiated by “Will” (higher levels). Reflexive movements dominate only after CNS damage.	Identify & prevent primitive reflexes  Reduce hyperactive stretch  Normalize tone  Facilitate “normal” movement patterns  Developmental Sequence  Recapitulation
Motor Program Theory	Schmidt	1976	Adaptive, exible motor programs (MPs) and generalized motor programs (GMPs) exist to control actions that have common characteristics.  Higher-level Motor Programs - Store rules for generating movements.	Abnormal Movement - Not just reflexive, also including abnormalities in central pattern generators or higher level motor programs.  Help patients relearn the correct rules for action  Retrain movements important to functional task  Do not just reeducate muscles in isolation
Ecological Theories	Gibson & Pick	2000	The person, the task, and the environment interact to in uence motor behavior and learning. The interaction of the person with any given environment provides perceptual information used to control movement.  The motivation to solve problems to accomplish a desired movement task goal facilitates learning.	Help patient explore multiple ways in achieving functional task → Discovering best solution for patient, given the set of limitations
Systems Model	Shumway-Cook	2007	Multiple body systems overlap to activate synergies for the production of movements that are organized around functional goals.  Considers interaction of the person with the environment.  Goal-directed Behavior - Task Orientated	Identifiable, functional tasks  Practice under a variety of conditions  Modify environmental contexts

Let's move to concept of Motor Learning

Motor learning is when complex processes in the brain occur in response to practice or experience of a certain skill resulting in changes in the central nervous system that allow for production of a new motor skill.

So ,Motor Control focuses on  understanding of movement already acquired

Motor learning focuses on understanding the acquisition or modification of movement.

• Motor learning research often considers variables that contribute to motor program formation (i.e., underlying skilled motor behaviour), sensitivity of error-detection processes, and strength of movement schemas. There are many different theories of Motor Learning
• Reference:Roller L et al, Contemporary Issues and Theories of Motor Control, Motor Learning, and Neuroplasticity. In: Neurological Rehabilitation 6th Edition. Mosby, 2012. p69 - 105.

Stages of Motor Learning

Stages of Learning	Characteristics	Attention Demands	Activities	Description
Cognitive	Movements are slow, inconsistent and inefficient. Considerable cognitive activity is required.	Attention to understand what must move to produce a specific result. Large parts of the movement are controlled consciously	Practise sessions are: performance focused less variable incorporate a clear mental image (technical & visual).	Early Cognitive; Essential Elements were not observed or not present
				Late Cognitive; Essential elements are starting to appear
Associative	Movements are more fluid, reliable and efficient Less cognitive activity is required	Some parts of the movements are controlled consciously, some automatically.	Practise sessions link performance and results, conditions can be varied. Clear Mental Image = Accurate Performance	Early Associative; Essential elements appear, but not with consistency.
				Late Associative; Essential elements appear regulalry at a satisfactory level.
Autonomous	Movements are accurate, consistent and efficient. Little or no cognitive activity is required.	Movement is largely controlled automatically Attention can be focused on tactical choices	Practise sessions are more results orientated Focus is on greater range of movement, speed, acceleration and use of skill in a novel situation.	Early Autonomous; Essential elements appear frequently avove required level.
				Late Autonomous; Essential elements appear continuously at a superior level.

 There are many different theories of Motor Learning. 

MOTOR LEARNING THEORY	AUTHOR	DATE	PREMISE	CLINICAL IMPLICATIONS
Adams Closed Loop Theory	Adams	1971	Closed Loop - Sensory feedback is used for the ongoing production of skilled movement  Slow movements  Relies on sensory feedback (Sherrington)  Blocked Practice  Errors = Bad! Needs to be accurate!  Memory Trace - Initiation of movement  Perceptual Trace - Built up over a period of practice & is the reference of correctness.   Improvements = Increased capability of performer to use the reference in closed loop	Perform same exact movement repeatedly to one accurate end point  Increase Practice → Increase Learning  Errors produced during learning → Increase strength of incorrect perceptual trace
Schmidt's Schema Theory	Schmidt	1975	Open Loop  Schema - Abstract memory representation for events → RULE  Generalized Motor Program - Rules that allow for the generation of novel movements  Rapid, ballistic movements = recall memory withmotor programs and parameters to carry out movement without peripheral feedback  Variability of Practice → Improve Motor Learning	Optimal Learning → Task practiced under many different conditions  Positive benefits for error production (learn from own mistakes)  Schema has rules for all stored elements, not just correct elements
Ecological Theory	Newell	1991	Based on Systems & Ecological Motor Control Theories  Motor Learning = Increases coordination between perception and action thru task & environmental constraints.  Perceptual-motor workspace - Identifies movemets and perceptual cues most relevant to performance of task  Optimal task-relevant mapping of perception & action → NO Rules!	Patient learns to distinguish relevant perceptual cues important to action.

Theories Related to Stages of learning Motor Skills:

1) Fitts and posner Three Stage Model:(1967)

They suggest there are three main phases involved in skill learning

First stage:

Learner is focused on understanding the nature of task and developing strategies for the same.

Requires high degree of cognitive activity so referred as cognitive stage of learning.

Eg: first day of driving lesson of Mr Ben would require high degree of attention and consious thought

may make a lot of errors in gear shift and ABC control of manual car.

Second stage:

 By this time person has selected best strategy for task and now begins to refine the skill

less variability in performance ,improvement occurs slowly

Referred as Associative stage of learning

Here,verbal/cognitive component not important as focus is on refining a particular pattern than focusing on alternative strategies.

eg: Mr Ben is learning to shuffle from second to third and then first gear as per the speed of vehicle while simultaneously applying ABC control.He is refining on his learned skills

Third stage:

Autonomous stage-there is automacity of skill and involves low degree of attention

Eg: Mr Ben can now enjoy a long drive with friends enjoying on the laughter,talks and the beautiful climate outside.

2)Systems Three Stage model:

Bernstein 1967

3 stages (novice, advanced, expert) theory of motor learning that accounts for reductions in body degrees of freedom seen in child development and new skill acquisition in general. 

The novice stage involves the learner freezing degrees of freedom by co-contracting agonists and antagonists to constrain a joint to simplify the movement, as with the rigid bracing of the wrist when first learning to use a hammer. 

Degrees of freedom are progressively released through the advanced and expert stages enabling movement at more joints and more sophisticated muscle synergies across multiple joints until smooth, coordinated movements are performed. 

3)Gentile two stage Model

1972,1987

this theory of motor skill acquisition describes the goal of learner in each stage.

First stage :involves understanding the goal of the task,developing movement strategies appropriate to achieving goal and understanding environmental features critical to organization the movement.

 -distinguishes relevant/regulatory features from non regulatory

 Second is fixation/diversification stage,goal is to refine the movement.

References:

Ann Shumway Cook,Motor control 4th edition

Science Direct

Physiopedia

In the Next articles i will be discussing on skills and abilities and therapeutic application.

-SSW

A post by OT Potential on Virtual Reality in OT

P.S:Refer to OT Potential
https://otpotential.com/blog/?author=594aa59f86e6c0d5c8695bec


I think we can safely assume that we are only beginning to see the potential that VR has for transforming occupational therapy (as well as physical therapy and speech therapy.)
There are whole societies that OTs can join, focused on the use of virtual reality (VR) in rehabilitation (like the International Society of Virtual Rehabilitation).  New VR technologies and applications seem to be emerging almost daily.
Whether you are interested in incorporating virtual reality into your therapy practice, are a self-proclaimed "techie" or are just interested in glimpsing the future, this article is for you.
 The post features:

• What the research says about VR and OT
• Therapy focused VR that is currently on the market
• Discussion of product development and VR research that is in the works 

Technology as Occupation: Why VR?

Technology is not only a means for occupation, including how we work and relate to each other, but is also the target of our occupation now more than ever before.  As a human race, technology consumes a great deal of our occupational behavior.  Why?  We are engaged, connected and rewarded through technology.
A number of studies over decade and a half have revealed that game playing triggers dopamine release in the brain, a finding that makes sense, given the instrumental role that dopamine plays in how the brain handles both reward and exploration.  Virtual reality (VR) activities rooted in games or ADL tasks with a distinct aim, reinforce voluntary repetition, which is a key ingredient for motor recovery based prin

 

What the Research Says About VR and Therapy

The literature shows that engagement in graded, appropriately dosed and task-oriented practice are contributors to upper limb improvement and cortical reorganization (Timmermans et al, 2010).
In traditional occupational therapy sessions focused on upper limb improvement post-stroke, research shows that only 23 to 32 repetitions are completed in a standard session (Kimberly et al, 2010).  This is far fewer than is necessary for motor improvement.  In addition, during sub-acute stroke rehab, an average of 4 minutes are spent on task-specific upper limb training in a typical session (Hayward & Brauer, 2015).  In comparison, virtual reality interventions can yield an average of 200-300 functional movements per one hour session (Adams et al, 2015).
A randomized controlled trial using the Neofect Smart Glove compared to a control group of “standard occupational therapy” along with use of the VR tool, demonstrated improvement for both the proximal and distal upper extremity on the Fugl-Meyer.  The device is primarily focused on forearm, wrist and hand motion, yet prompted shoulder and upper arm improvement as well as hand, wrist and forearm (Shin et al, 2016).
This speaks to the engagement in upper extremity task-oriented practice as counteracting the “learned non-use” that many stroke survivors experience.  All participants received a 4-week face to face intervention program that included use of the Smart Glove along with traditional occupational therapy (OT) interventions or traditional OT only.  The dosage of therapy or this study was daily intervention for 30 minutes, five days per week for a total of 20 sessions.  Patients using the Smart Glove also demonstrated improvement in health related quality of life utilizing the Stroke Impact Scale compared to those that did not use the VR intervention (Shin et al, 2016).
Saposnik and Levin (2011), in a review of twelve VR approaches, reported that eleven of the twelve virtual systems showed significant benefit in the selected outcome measure.  In an assessment of the use of virtual environments for stroke rehab, Holden (2005) noted that improvement in motor function appears to translate to real life tasks.  A comparative investigation of an intervention in a real-life environment versus in a virtual environment, yielded nearly equivalent improvements in motor function (Subramanian et al, 2013).

What VR is Currently Available for OTs?

Neofect

Rapael Smart Glove and Smart Kids (Pediatric Version)

 

Description: Smart Glove is a lightweight, silicone exo-glove that interacts with tablet using bluetooth technology.  SG has an assessment mode to track changes in AROM and PROM as well as coordination and timing.  Employs artificial intelligence to change parameters of activities for “just right challenge”.  Even with a small amount of activation, a patient can be successful with the device.
Tasks Involved: Challenges wrist, digit and forearm motion.  Includes activities such as, catching balls or butterflies, squeezing oranges, fishing, cooking, cleaning the floor, pouring wine, painting fences, and turning pages along with other more novel and complex games.  There are also games that target visual and cognitive processes.
Minimal Motion Required: Minimal activation of the forearm (supination/pronation) and wrist (flexion/extension) or digits is needed for best success.  The device does not provide active assistive motion.
Research Support: Randomized controlled trial demonstrates improvement of distal and proximal items on Fugl-Meyer and Jebsen-Taylor as well as quality of life on the Stroke Impact Scale.

Flint Rehabilitation

MusicGlove 

Description: Music Glove is a glove with finger sensors to work on timing of finger motion and fine motor control.
Tasks Involved: Opposition of digits to thumb coordinated to music to improve coordination and timing.  Interface looks like “guitar hero”, encourages the patient to make contact to the beat.
Minimal Motion Required: Lateral pinch is required for successful participation.
Research Support: Music Glove users demonstrated Improvement in box and blocks scores over controls.

 FitMi

Description: FitMi consists of “pucks” that interact with therapeutic exercise apps on Flint Tablet, PC or Mac.  The apps are designed to target hand, arm, trunk and leg impairment.
Tasks: RehabStudio regimens can be created from a library of 40 classic exercises.  Real-time visual, auditory and repetition feedback is provided and tracked.
Minimal Motion Required: Puck can either be handheld or on a tabletop for targeted reaching to full UE ROM.
Research Support: New product, limited published research support at this time.

Saebo

SaeboVR

 

Description: SaeboVR is a virtual ADL (activities of daily living) rehabilitation system. The proprietary platform was specifically designed to engage the client in both physical and cognitive challenges involving daily functional activities.
Tasks: SaeboVR‘s ADL-focused virtual world provides clients with real-life challenges. Users will incorporate their impaired upper limb to perform simulated self-care tasks that involve picking up, transferring and manipulating virtual objects.
Minimal Motion Required: The program detects movement but does not assist with mobility.  A mobile arm support or other assistive device can be used for UE support.
Research Support: Patients engaged in the Saebo VR therapy demonstrated improvement on Fugl-Meyer measures with an average of close to 200 motions per session.

Virtual reality technology is quickly evolving.  Here is a short list of accessible Virtual Reality devices that can be used in your practice:

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The Future of VR and Rehab

Scott Kim, CEO of Neofect, the makers of the Rapael Smart Glove and Smart Kids, has seen patients engage with the device unlike other previous rehabilitation options. He is seeing therapists also find growing value in its use as a rehabilitation tool.  “The more efficient the therapists are, the more they can do their work to best reach the patients.  There is so much more to be learned, discovered, and taught as it relates to neuro-rehabilitation.  The more tools that we can get into the hands of therapists focusing on neurological conditions, the more opportunities for us as a company to learn from them and their experience (S. Kim, personal communication, Nov 13, 2016).”  Neofect has a couple of other developments on the horizon including a Smart Board to encourage shoulder and other upper extremity functions in a virtual reality environment as well as a Smart Pegboard with visual and cognitive components for a multi-sensory rehab experience. The Smart Board launched in June of 2017 and the Smart Pegboard is slated to be released in September of this year.
Upper extremity rehabilitation is often delayed in the acute phase of rehab due to the need for medical stabilization and other priorities.  How might VR change the timing of intensive UE rehabilitation post-stroke? Mind Maze, a company headquartered both in Silicon Valley and Lausanne, Switzerland is attempting to answer that question.  Primary clinical results suggest that their technology, which consists of a motion sensing camera and an avatar of the patient on a screen, can increase the number of repetitions of UE movement by 60% in 10 sessions, improving patient efficiency early in the rehabilitation process (Chevalley et al., 2015).  The company’s main product, currently commercially available in European markets, is the Mind Motion pro  Its main goal is to provide patients with an immersive experience early on in their rehabilitation to capitalize on early upper extremity training.  The device can be wheeled up to the patient’s bedside and lets the patient begin to train using mirror preparation with the unaffected limb right away post-stroke.  This helps to minimize downtime in the acute care and inpatient rehabilitation units.  Patients have been shown to be able to participate as early as 4 days post stroke for an average of 20 minute sessions to start upper limb training early on in the rehab process (Kinzner et al, 2015).
Dr. Karen Kerman, Chief Medical Officer of MindMaze, is encouraged by the reception of virtual reality devices in the medical community.  “The goal of virtual reality and of the Mind Motion Pro, for example, is not to replace the therapist with technology but to provide motivation to the patient and free the patient up a bit as they are tasked to do more within a rehabilitation environment (K. Kerman, personal communication, Dec 17, 2016).”  MindMaze aims to create products throughout the continuum of care as well, training a patient on a device in an outpatient setting that they would have access to at home.  The Mind Motion Go, not yet commercially available in the US, is a portable tabletop unit where the patient plays a series of games to address the wrist, arm, and shoulder using a virtual environment.  While the device doesn’t eliminate compensatory movement, it gives real time feedback, an important hallmark in task-oriented practice.
Beta testing is currently occurring in the US and Europe to get therapist feedback on the device and clinical trials.  MindMaze is seeking to receive feedback from therapists that are technologically savvy as well as those that may not be as comfortable with technology. In doing so, MindMaze hopes to close the gap that some patients experience in regards to an OT’s comfort level with technology driving whether or not they choose to engage a patient with such devices.
“There is a great future in the area of virtual reality and neuro-rehabilitation.  There are patients that have grown up with technology, they interact socially using technology, and they use it to do their work.  We hope that MindMaze technology can allow stroke patients to have a social network to work with and engage in game play.  The technology provides a social connection during this sometimes disconnected experience.  Clinically, We want to increase the number of repetitions and compliance in an enjoyable gaming experience and we hope that this is a gateway to better functional performance for patients,” Dr. Kerman notes.  “If we can motivate and engage patients with games, we hope patients will work harder and feel less isolated overtime.  Our hope is not only to improve the number of rehab sessions, but to customize it overtime so that patients can reach their maximum potential (K. Kerman, personal communication, Dec 17, 2016).” 

https://otpotential.com/blog/virtual-reality-and-occupational-therapy

Adding colors to life

4th February marks a stand as it salutes to the millions of brave hearts fighting a battle with the most dreaded disease.Its world cancer day which deserves to acknowledge the spirit of the survivors,their families and those living with it.
Life is indeed an art ,a canvas we all paint with our experiences ,our attitude and our will to be ourselves.
In conquering our ways we often come across certain lows that hold us back but a few special ones struggle with their health.This not only affects the individual but everyone who is associated to him.I can't put in words to describe the turmoil it brings in life because for once even i have lived such moments and that's exactly why i have deeper understanding of this feel.Being both on doctor's and patients side i have learned life very closely at a very young age and have framed my set of lessons and indeed where there is will there is a way!

Today i am putting up about a very inspiring soul who would have never thought that his smooth career would change its course.Amidst achieving his dreams and setting new ones came the year 2016 when he got diagnosed with medulloblastoma,a type of brain tumour which changed his life perception.A marathon of hospital run ,from surgery to radiation left him not only with certain physical limitations that were seen but also an unseen ones.
This man could have lived questioning  his luck but he carved and built another way to heal himself.He found light in darkness when simple activity like making a straight line seemed challenging he started joining  dots which ultimately forms a line of happiness.
Making n number of dot paintings as medium of his liberation he decided to spread its power.
Hailing from Hyderabad, Mr Anand Reddy contacted a few organizations working with cancer of which the Assistant director of Cancer Survivorship, Indian Cancer Society Mumbai, Dr Vandana ,proactively agreed to his will of conducting an art workshop for brain tumor patients and survivors and i was fortunate to be part of it.So here is glimpse of...

Healing with dots, the Art Workshop was conducted by Mr Anand Reddy supported by Indian Cancer Society.Around 20 participants across different ages along with their caregiver seemed to be enthusiast on a saturday morning of what was coming up next.
An informal introduction was followed by inauguration by Dr Tejpal Gupta, Dr kurkoore and Mrs Savita Goswami.
An amazing display of art work was seen in the presentation of Mr Anand after which a creative blend amongst participants was restored.
Below is the images and what they have to say through my thoughts and of course a note to ponder
.

Event inauguration with motivating speeches of the chief guests and the Assistant Diector of Cancer Survivorship,
Indian Cancer Society.

Only, 
You know your strength & might!
 And,
Doctor's guide but survivors fight!



 Highlights of the events and the activity: 

Once stood in the queue one behind the other are now sharing a space together.

Rehabilitation indeed connects people their hearts and thoughts,their worries and smile.It gives a hope there is a life!

My favorite Smile!

The guy on left who has understood life at a very young age and was prompt in responding to all the positive vibes.
And the guy on right is excited to go back to his state and resume his studies and routine.

Family is always the back!
Be it running for the investigations or sharing tears together,Be it going through the surgery or every week at OPD.
Those continuous radiations to long waits.Chemotherapy to nausea and vomitting.
They are there,for the smiles and tears to share!

   
 And the  zeal to learn was all around the room...

I don't like painting he says...

And when something is done for us,we must attend is what one of the participant said...
Whether you are a patient,survivor or neither you can find time for everything but for self.
However the unstructured activity or a leisure is a must as it rewires the locked thoughts to feel free and adds to the quality of life.

Such group activity not only makes you feel good but also develops your inter personal as well as intra personal relationships.

As you walk ahead you will know there is always a help around.
The ICS Cancer survivors vertical unit.
To right,Mr Sachin,Ugam Member
and Left Ms Shreya ,clinical psycholog

A few more images describing the art play and the enthusiasm amongst our participants and the bonding that developed within few minutes.

And as the workshop was heading further post lunch i could sense a different comfort among everyone in the room.Right from the parents/relatives to the participants each one was engrossed in the ocean of colors.The worries of life seemed to be hidden at the shore and everyone was sailing on the boat of fun.
And that's the play of life.
An idle mind takes away all the energy to live to fullest ,it needs an occupant.
Don;t think is easy to say,but those who prove it deserve a bow.They are the epitome of inspiration.

Everyone achieves something or the other in their life.Some reach the zenith and are known to the world.While for some ,a night's meal is the world.
However special are the ones who loose their world and walk back to relive and form another world.
And survivors are the ones who prove to world 'It is Possible' !

And to end,
All the happy faces....

P.S:Medication saves lives,Rehabilitation makes you live life.A special mention of Mr.Anand Reddy for his courteous thought of sharing his idea/experience of healing and carving a smile on so many faces at once.

 -SSW
Proud occupational therapist.Happiness is seeing them smile.