Papers by Jan Kowalczewski
The online version of this article can be found at: DOI: 10.1177/1545968310394869
A surface stimulator combined with an instrumented workstation comprised of tasks of daily life w... more A surface stimulator combined with an instrumented workstation comprised of tasks of daily life was used to rehabilitate the upper extremity of patients with severe hemiplegia. 20 sub-acute patients (no more than 3 months post stroke) took part in this double blind randomised clinical trial. Ten patients in the experimental group underwent daily 1 hour training sessions on the workstation with functional electrical stimulation for a duration of 4 weeks. The control group of 10 patients received 15 minutes of daily sub threshold stimulation and one training session per week on the workstation. The workstation was used for task-specific training as well as kinematic data recording. Outcome measures of hand function included the Wolf Motor Function Test (WMFT), the Upper extremity Fugl-Myer Test (FMT), the Motor Activity Log (MAL), and the kinematic scores derived from the workstation. The results indicate a significant improvement in hand function for the treatment group over the cont...
Background. Spinal cord injury (SCI) survivors with tetraplegia have great difficulty performing ... more Background. Spinal cord injury (SCI) survivors with tetraplegia have great difficulty performing activities of daily living (ADLs). Functional electrical stimulation (FES) combined with exercise therapy (ET) can improve hand function, but deliver-ing the treatment is problematic. Objective. To compare 2 ET treatments delivered by in-home tele-therapy (IHT). Methods. Each treatment involved ET, tele-supervised 1 h/d, 5 d/wk for 6 weeks. Treatment 1: “conventional ET ” comprised strength training, computer games played with a trackball, and therapeutic electrical stimulation (TES). Treatment 2: “ReJoyce ET” comprised FES-ET on a workstation, the Rehabilitation Joystick for Computerized Exercise (ReJoyce) with which partici-pants played computer games associated with ADLs. Participants were block-randomized into group 1 receiving conven-tional ET first, followed by 1-month washout, and then ReJoyce ET and group 2 in reverse order. In all, 13 participants took part, 5 completing the stu...
The American Journal of Gastroenterology
Journal of Palliative Medicine
Hepatology
Advance care planning (ACP) and goals of care designation (GCD) are being integrated into modern ... more Advance care planning (ACP) and goals of care designation (GCD) are being integrated into modern health care. In cirrhosis, uptake and adoption of these practices have been limited with physicians citing many perceived barriers and limitations. Recognizing the many tangible benefits of ACP and GCD processes in patients with life-limiting chronic diseases, the onus is on health practitioners to initiate and direct these conversations with their patients and surrogates. Drawing upon the literature and our experiences in palliative care and cirrhosis, we provide an actionable framework that can be readily implemented into a busy clinical setting by a practitioner. Conversation starters, visual aids, educational resources (for patients and practitioners), and videos of mock physician-patient scenarios are presented and discussed. Importantly, we have customized each of these tools to meet the unique health care needs of patients with cirrhosis. The inherent flexibility of our approach to ACP discussions and GCD can be further modified to accommodate practitioner preferences. Conclusion: In our clinics, this assemblage of "best practice tools" has been well received by patients and surrogates enabling us to increase the number of outpatients with cirrhosis who have actively contributed to their GCD before acute health events and are supported by well-informed surrogates.
IEEE transactions on neural systems and rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society, Jan 11, 2015
Stroke survivors often have upper limb (UL) hemiparesis, limiting their ability to perform activi... more Stroke survivors often have upper limb (UL) hemiparesis, limiting their ability to perform activities of daily life (ADLs). Intensive, task-oriented exercise therapy (ET) can improve UL function, but motivation to perform sufficient ET is difficult to maintain. Here we report on a trial in which a workstation was deployed in the homes of chronic stroke survivors to enable tele-coaching of ET in the guise of computer games. Participants performed 6 weeks of 1 hour/day, 5 days/week ET. Hand opening and grasp were assisted with functional electrical stimulation (FES). The primary outcome measure was the Action Research Arm Test (ARAT). Secondary outcome measures included a quantitative test of UL function performed on the workstation, grasp force measurements and transcranial magnetic stimulation (TMS). Improvements were seen in the functional tests, but surprisingly, not in the TMS responses. An important finding was that participants commencing with intermediate functional scores imp...
2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 2011
With the advent of new approaches to upper extremity recovery after stroke and spinal cord injury... more With the advent of new approaches to upper extremity recovery after stroke and spinal cord injury, the quantitative evaluation of hand function has become a crucial component of outcome evaluation. Recently we developed a workstation, the ReJoyce (Rehabilitation Joystick for Computer Exercise) on which subjects perform a variety of movement tasks while playing computer games. An important feature of the system is the ReJoyce Automated Hand Function Test (RAHFT). In this study we compared and validated the RAHFT against two widely-used clinical tests, the Action Research Arm Test (ARAT) [1][2] and the Fugl-Meyer Assessment (FMA) [3]. All three tests were performed in 34 separate sessions in 13 tetraplegic individuals. Principal component and regression analyses revealed that both the ARAT and the RAHFT correlated well with the first principle component fitted to the scores of the three tests. The FMA was less well correlated. These data help validate the RAHFT as a quantitative, automated alternative to the ARAT and FMA. The RAHFT is the first comprehensive test of hand function that does not depend on human judgment.
Progress in brain research, 2011
Stroke survivors with hemiparesis and spinal cord injury (SCI) survivors with tetraplegia find it... more Stroke survivors with hemiparesis and spinal cord injury (SCI) survivors with tetraplegia find it difficult or impossible to perform many activities of daily life. There is growing evidence that intensive exercise therapy, especially when supplemented with functional electrical stimulation (FES), can improve upper extremity function, but delivering the treatment can be costly, particularly after recipients leave rehabilitation facilities. Recently, there has been a growing level of interest among researchers and healthcare policymakers to deliver upper extremity treatments to people in their homes using in-home teletherapy (IHT). The few studies that have been carried out so far have encountered a variety of logistical and technical problems, not least the difficulty of conducting properly controlled and blinded protocols that satisfy the requirements of high-level evidence-based research. In most cases, the equipment and communications technology were not designed for individuals w...
Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference, 2011
Neuroprostheses (NPs) are electrical stimulators that help to restore sensory or motor functions ... more Neuroprostheses (NPs) are electrical stimulators that help to restore sensory or motor functions lost as a result of neural damage. The Stimulus Router System (SRS) is a new type of NP developed in our laboratory. The system uses fully implanted, passive leads to "capture" and "route" some of the current flowing between pairs of surface electrodes to the vicinity of the target nerves, hence eliminating the need for an implanted stimulator. In June 2008, 3 SRS leads were implanted in a tetraplegic man for restoration of grasp and release. To reduce the size of the external wristlet and thereby optimize usability, we recently implemented a polarity reversing stimulation technique that allowed us to eliminate a reference electrode. Selective activation of three target muscles was achieved by switching the polarities of the stimulus current delivered between pairs of surface electrodes located over the pick-up terminals of the implanted leads and reducing the amplitu...
Wehave developed an automated system enabling Internet-supervised, FES-assisted hand exercises to... more Wehave developed an automated system enabling Internet-supervised, FES-assisted hand exercises to be ,performed daily in patients’ homes.
A surface stimulator combined with an instrumented workstation comprised of tasks of daily life w... more A surface stimulator combined with an instrumented workstation comprised of tasks of daily life was used to rehabilitate the upper extremity of patients with severe hemiplegia. 20 sub-acute patients (no more than 3 months post stroke) took part in this double blind randomised clinical trial. Ten patients in the experimental group underwent daily 1 hour training sessions on the workstation
Behavioural Brain Research, 2015
The single pellet grasping (SPG) task is a skilled forelimb motor task commonly used to evaluate ... more The single pellet grasping (SPG) task is a skilled forelimb motor task commonly used to evaluate reaching and grasp kinematics and recovery of forelimb function in rodent models of CNS injuries and diseases. To train rats in the SPG task, the animals are usually food restricted then placed in an SPG task enclosure and presented food pellets on a platform located beyond a slit located at the front of the task enclosure for 10-30min, normally every weekday for several weeks. When the SPG task is applied in studies involving various experimental groups, training quickly becomes labor intensive, and can yield results with significant day-to-day variability. Furthermore, training is frequently done during the animals' light-cycle, which for nocturnal rodents such as mice and rats could affect performance. Here we describe an automated pellet presentation (APP) robotic system to train and test rats in the SPG task that reduces some of the procedural weaknesses of manual training. We found that APP trained rats performed significantly more trials per 24h period, and had higher success rates with less daily and weekly variability than manually trained rats. Moreover, the results show that success rates are positively correlated with the number of dark-cycle trials, suggesting that dark-cycle training has a positive effect on success rates. These results demonstrate that automated training is an effective method for evaluating and training skilled reaching performance of rats, opening up the possibility for new approaches to investigating the role of motor systems in enabling skilled forelimb use and new approaches to investigating rehabilitation following CNS injury.
Journal of motor behavior, 2015
ABSTRACT. The Rehabilitation Joystick for Computerized Exercise (ReJoyce, Rehabtronics Inc., Edmo... more ABSTRACT. The Rehabilitation Joystick for Computerized Exercise (ReJoyce, Rehabtronics Inc., Edmonton, Alberta, Canada), is a workstation on which participants exercise dexterous movement tasks in the guise of computer games. The system incorporates the ReJoyce Arm and Hand Function Test (RAHFT). Here the authors evaluate the RAHFT against the Action Research Arm Test (ARAT) and the Fugl-Meyer Assessment (FMA). All 3 tests were performed in 36 separate sessions in 13 tetraplegic individuals. Concurrent and criterion validities of the RAHFT were supported by a high level of correlation with the ARAT (r(2) = .88). Regarding responsiveness, the effect size of the RAHFT at week 6 of 1 hr/day exercise training was 1.8. Regarding reliability, the mean test-retest difference in RAHFT baseline scores was 0.67% ± 3.6%, which was not statistically significant. The RAHFT showed less ceiling effect than either ARAT or FMA. These data help validate the RAHFT as a quantitative, automated alternat...
Neurorehabilitation and Neural Repair, 2011
Background. Spinal cord injury (SCI) survivors with tetraplegia have great difficulty performing ... more Background. Spinal cord injury (SCI) survivors with tetraplegia have great difficulty performing activities of daily living (ADLs). Functional electrical stimulation (FES) combined with exercise therapy (ET) can improve hand function, but delivering the treatment is problematic. Objective. To compare 2 ET treatments delivered by in-home tele-therapy (IHT). Methods. Each treatment involved ET, tele-supervised 1 h/d, 5 d/wk for 6 weeks. Treatment 1: “conventional ET” comprised strength training, computer games played with a trackball, and therapeutic electrical stimulation (TES). Treatment 2: “ReJoyce ET” comprised FES-ET on a workstation, the Rehabilitation Joystick for Computerized Exercise (ReJoyce) with which participants played computer games associated with ADLs. Participants were block-randomized into group 1 receiving conventional ET first, followed by 1-month washout, and then ReJoyce ET and group 2 in reverse order. In all, 13 participants took part, 5 completing the study w...
Neurorehabilitation and Neural Repair, 2012
Background. More than 150 000 neuroprostheses (NPs) have been implanted in people to restore bodi... more Background. More than 150 000 neuroprostheses (NPs) have been implanted in people to restore bodily function in a variety of neural disorders. The authors developed a novel NP, the Stimulus Router System (SRS), in which only passive leads are implanted. Each lead picks up a portion of the current delivered through the skin by an external stimulator. Objective. The authors report on the first human implant of an SRS. Methods. The recipient was a tetraplegic man with bilateral hand paralysis. Three SRS leads were implanted in his right forearm to activate the finger extensors, finger flexors, and thumb flexor. A wristlet containing a surface stimulator and electrodes was used to pass trains of electrical pulses through the skin to each lead. Hand opening and grasp were controlled via a wireless earpiece that sensed small tooth-clicks and transmitted signals to the wristlet. Results. The current required to activate the muscles was less than half that required prior to implantation and below perceptual threshold. Maximal grip force and hand opening aperture were both larger using the SRS. The implanted leads have remained functional for 3 years. The recipient reported various tasks of daily life that improved during SRS usage. An electronic counter revealed mean monthly usage of 18.5 hours, equivalent to 55 hours of continuous manual activity. Conclusions. This first implant of the SRS indicates that it can be effective and reliable and has potential to provide an alternative to existing NPs.
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Papers by Jan Kowalczewski