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Clinical Assessment and Treatment - One important way in which the Rehab R&D Center transfers the results of more basic research into tangible products that help the rehabilitation community is by developing better methods for assessing and treating neuromuscular and musculoskeletal disorders. Some of our products are new devices, such as wearable accelerometers for assessing balance in elderly patients. Other products are software programs for analyzing clinical data, such as programs for analyzing electromyograms. We also develop new therapeutic approaches, such as dynamic exercise programs for rehabilitating stroke patients, and new bioengineering techniques, such as tissue engineering procedures for repairing injured nerves and pressure sores. Although many of these products will be used primarily by physicians and physical therapists, the ultimate beneficiary will be the patient, who will receive better care and more effective rehabilitation.
Our approach is to develop assessment and treatment methods that are firmly based on a scientific understanding of the biomechanics and physiology that underlie particular disorders. The most appropriate variables upon which to base an assessment are often underlying biomechanical or physiologica lproperties that cannot be readily measured. For example, in order to assess a stroke patient's ability to control a hemiplegic limb, we would like to be able to quantify the forces produced by each of his or her muscles during a dynamic task. These forces cannot be measured directly, but they can be estimated from the reaction forces and the motion of the limb segments, using a mathematical model of the musculoskeletal system. As another example, the strength of the femur of a spinal-core-injured patient cannot be measured directly, but it can be estimated from the bone mineral density and the geometry of the bone.
This approach generally leads to measures of function or impairment that are objective and quantitative. This means that the measures can be accurately used to make diagnoses, to track the progress of the patient over time, and to compare different treatment methods. Moreover, since the measures are directly related to underlying physiological variables, they are useful in guiding the course of treatment. For example, knowledge of bone strength will help determine whether a patient is at risk for a fracture. And again, knowledge of the precise mechanical action of the various muscles that act on the thumb and index finger will enable physicians to plan more effective tendon transfer surgeries for spinal-cord-injured patients.
The Rehab R&D Center projects related to assessment and treatment during the last two years are described in this section of the report.
Republished from the 1996 Rehabilitation R&D Center Progress Report.