how to face upper limb rehabilitation

The complexity of upper limb rehabilitation

The rehabilitation of the upper limb is an extremely wide subject.
It involves functional recovery in patients with both neurological and orthopedic lesions due to pathologies or traumas.

It concerns the rehabilitation of the different anatomical parts that make it up: shoulder, elbow, wrist and hand.

As with all types of rehabilitation, the goal is to bring the affected component back to the best possible functional recovery.

To increase its complexity is its functioning, which depends on the close collaboration between the motor-sensory system and cognitive abilities.

Precisely for this reason it needs targeted and specific treatments, depending on the anatomical parts involved.

Upper limb: the most common problems

Let’s start with have the most complex anatomical part: the shoulder!
The shoulder is the most mobile of all the joints of the human body and for this reason it is the most complex and the most unstable.

The most common pathologies affecting it are: tendinopathies, rotator cuff lesions, instability, impingement syndrome and glenohumeral arthrosis.

Now let’s go down to the elbow, a delicate articulation that we use all the time as it is involved in almost every activity related to the use of the upper limb.

In addition to those of a traumatic nature (eg fractures), the most common problems affecting this joint are tendinopathies such as epicondylitis (better known as “tennis elbow”) and epitrocleite (also called “golfer’s elbow”).

Another delicate joint that is part of the upper limb is the wrist.

The most common problems concerning it are in most cases related to acute trauma, such as a strong distortion or fracture, or to a chronic problem, such as arthritis or carpal tunnel syndrome.

In addition to all the problems of an orthopedic nature, it is necessary to take into consideration those of a neurological nature.

Following a stroke, for example, the loss of functionality in the use of the upper limb is one of the main factors affecting disability.

As regards the hand, in particular, after a neurological damage the activation patterns and dynamics are often very compromised, requiring targeted and specific treatments.

Rehabilitation protocols and upper limb assessment with Riablo and WeReha

Each articulation and each related problem require a specific rehabilitation protocol.

We decided to address these different types of rehabilitation by exploiting the biofeedback technology of Riablo and WeReha.

With Riablo we work in a targeted manner on the shoulder and elbow, thanks to the inertial sensors that the patient wears through appropriate elastic bands.
WeReha is instead designed specifically for the hand and post-stroke rehabilitation, thanks to the inertial sensors inserted within Smart Objects that we project and create.

Using sensors, we can track patient movements and transmit them via bluetooth to the software.

The software processes them by producing visual-auditory feedback that guides the user in the correct execution of the various motor tasks.

Below are 3 examples of rehabilitation protocols for shoulder, elbow and hand.

Rehabilitation protocol for shoulder elbow with Riablo

The shoulder rehabilitation protocol is a consequence of its high degree of mobility.

The shoulder, in fact, has three degrees of freedom that allow it to orient the upper limb in the three planes of space and to perform movements of flexion, extension, abduction-adduction and intrarotation-extrarotation.

Precisely because of this anatomical complexity, it is very complex to trace its movements in space using inertial sensors, ensuring accuracy, precision and simplicity of reading.

Starting from this premise, the Riablo exercises for shoulder that we have included in the database reproduce simple movements that allow a correct reading of the biomechanical parameters and provide the patient with precise and easy to interpret feedback.

The main movements that can be monitored and trained with Riablo are the following:

  • Shoulder flexion, extension and abduction: these exercises can be both monolateral and bilateral and can be performed either in standing or sitting position; in the form of visual-auditory biofeedback they report the angle reached relative to the specific movement together with the compensations of the trunk and the rotation of the wrist.
  • Functional movements, such as triceps traction and wall slides.
    The main goal of elbow rehabilitation is to gradually and correctly recover the complete mobility of the joint, eliminating compensations and actively strengthening the muscles that stabilize the joint.

Among the Riablo exercises suitable for this purpose we find:

  • Hummer Curl: elbow flexion-extension exercise which, thanks to the sensors positioned on the arm and on the wrist, reports in real time to the patient the information regarding the angle of flexion-extension of the joint.
  • Wrist Rotation: exercise to train the prone-supination of the forearm thanks to the sensor positioned on the wrist that records the angle of rotation on the longitudinal axis of the forearm.

 “Riablo allows to perform exercises and range of motion assessments for shoulder elbow”


    Rehabilitation protocol for the hand with WeReha 

    To complete the rehabilitation of the upper limb, we have created a new product: WeReha.

    WeReha was designed for the rehabilitation of the upper limb and, in particular, for the rehabilitation of the hand in stroke patients.

    It allows patients to practice both in the clinic and at home with simplicity, involvement, motivation and with the possible remote supervision of their physiotherapist.

    As for Kari and Riablo, WeReha also uses biofeedback technology, combining it with the use of “smart” objects printed in 3D and equipped with inertial sensors.

    Thanks to these “Smart Objects”, the patient is guided through the exercises through specially designed and studied video games.

    The purpose of WeReha is precisely to train the fine movements of the hand, simultaneously stimulating the cognitive aspect.

    The games allow you to exercise the grip of dishes or large objects, glasses or finer objects, such as a joystick.

    Moreover, a simple and effective gamification based on the presence of indexes of rotation, flexion-extension and prono-supination of the upper limb, constitutes an intuitive and stimulating feedback to highlight the progress of the rehabilitation process and motivate the patient to improve himself day after day.

    Upper limb assessment with Riablo

    Before, during and at the end of the rehabilitation program, it is essential to perform tests to assess the functionality and health of the upper limb.

    The exams to assess the degrees of joint mobility and to highlight any reduction of movement (in addition to the symmetry index between the two limbs) are a fundamental element to allow the prevention and / or treatment of more or less serious problems.

    Riablo allows to perform a complete R.O.M. (range of motion) for shoulder and elbow, generating a report with comparison with normative values ​​recovered from literature and divided by age group and gender.

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