Physical Medicine and Rehabilitation

Abstract

Semiautomated prosthetic manufacture improves quality and reproducibility, reduces costs, and en¬ hances access to a duplicate limbComprehensive rehabilitation of persons with major disabilities presents a broad spectrum of therapeutic problems, because all aspects of the patient's life are affected. The goal of rehabilitation is to retrain patients to optimize their residual abilities and develop alternative techniques and devices to replace permanent losses. This is best managed by an interdisciplinary team approach, which is one of the hallmarks of rehabilitation. Effective group interaction requires that each member of the team be responsible not only for care related to his/her own discipline but also for the efforts of the group as a whole.1This ideal can be difficult to achieve, because effective channels for keeping professional staff aware of relevant developments across disciplines are limited. Articles about significant research in fields other than medicine, eg, biomedical engineering, are not often indexed in the medical literature. Both the technical vocabulary and state-of-the-art knowledge may present a major barrier across interdisciplinary borders.2 A major impact can be felt from the explosion in technical knowledge represented by advances in biomédical engineering, electronics, and computer-assisted design that are currently being applied to solving problems of functioning and of the quality of life for people with disabilities. Only a few of these advances can be mentioned here, but it is essential that those who come into regular therapeutic contact with these patients become aware of how the bounda¬ ries of potential functional outcome are being expanded by research in other disciplines.Biofeedback, the utilization of externally dis¬ played representations of internal physiological responses as cues for learning voluntary con¬ trol of these responses, has been used for a number of years in training for and treatment of more than 50 medical conditions. Its success¬ ful application in the rehabilitation of physical disablements has led to its rapid acceptance by physical and occupational therapists as an adjunctive treatment technique in most major rehabilitation facilities. The addition of comput¬ er-assisted electromyography has made possible increasing specificity in the application of this modality.Electromyographic biofeedback, a trial and error-based method of opérant conditioning, is used to establish learned control of motor units and improve impaired function. By focusing on neuronal patterns, strength and motion are increased in previously nonfunctioning muscles. The visual display and auditory signals of the electromyographic oscilloscope instantaneously reflect the electrical activity of the targeted function and train the patient to facilitate desired motor activity and inhibit unwanted activity. Specialized instrumentation presents information about ongoing motor activities quantitatively and continuously during the activity.3Opérant conditioning procedures promote learning by a...