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PASSIVEMOBILIZATION - Hand rehabilitation · The aim of every rehabilitation program is to re-educate the patient in the use of the hand and the whole upper limb during the Activities

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Page 1: PASSIVEMOBILIZATION - Hand rehabilitation · The aim of every rehabilitation program is to re-educate the patient in the use of the hand and the whole upper limb during the Activities
Page 2: PASSIVEMOBILIZATION - Hand rehabilitation · The aim of every rehabilitation program is to re-educate the patient in the use of the hand and the whole upper limb during the Activities

Gloreha Collezione is the

complete technological solution

for hand and upper

limb rehabilitation.

This modular system provides

multiple customizable treatment

therapies that allow

individuals to train through all

the recovery stages of the

rehabilitation process.

GLOREHACOLLEZIONEGloreha Sinfonia has many applications for patients with hand paresis or plegia after

injuries of the central nervous system, peripheral nervous system, spinal cord or with

muskoloskeletal deficits.

In the Early Stages of the recovery process, the Gloreha products can be used in the

passive mode to facilitate mobilization of the hand and upper extremity. As the patient

begins to demonstrate signs of motor recovery, the system can be progressed to

accompany active-assisted and functional therapeutic activities.

In the most advanced phase of the rehabilitation process, the Gloreha products offer

interactive games that target finer movement to aid in the improvements of dexterity,

coordination, visuo-spatial and attentive abilities.

Gloreha products not only aim to support the motor rehabilitation of the upper limb

(hand, wrist, and arm) but also to stimulate patient’s neural plasticity, through multiple

audio and visual effects which accompany motor exercise and specific approaches,

such as Action-Observation Therapy and Bilateral Training.

Gloreha products can be a useful support also in the immediate post-operative period

and in the post-acute or chronic treatment of many other diseases.

CLINICALINFORMATION

▪ Maintenance and improvement of the joint range

▪ Proprioceptive stimulation

▪ Improvement of visuo-spatial and attentive abilities

▪ Increase in functional independence

▪ Reduction of pain, edema, and hypertonia

▪ Prevention of adhesions, contractures, damages caused by immobilization

▪ Improvement of joint metabolism, lymphatic and blood circulation

▪ Maintenance of functional skills and body perception

▪ Increase in coordination and dexterity

▪ Increase in grip and pinch force

CLINICALBENEFITS

WEIGHT COMPENSATION

OF THE UPPER LIMB

INTERACTIVE MOTOR AND

COGNITIVE EXERCISES

ROBOTIC GLOVE FOR THE

MOBILIZATION OF THE FINGERS

SENSORS FOR DETECTING

ACTIVE MOVEMENTS

FREE INTERACTION

WITH REAL OBJECTS

Page 3: PASSIVEMOBILIZATION - Hand rehabilitation · The aim of every rehabilitation program is to re-educate the patient in the use of the hand and the whole upper limb during the Activities

PASSIVEMOBILIZATIONWhile the rehabilitation glove

mobilizes finger joints, the patient

simultaneously observes a 3D simulation

of the hand on the screen. The glove

works both in flexion and extension.

Even on the patient who has no active

residual movement, it is possible

to apply passive mobilization from the

first stages of treatment. The software

offers many possibilities for the

customization of the therapy. Any pinch

can be programmed as well as

all combinations of flexion

and extension of the fingers.

▪ 3D animation reproduces the movement the glove is performing on the patient’s hand

▪ The rehabilitation glove is applicable in presence both of flaccidity or spasticity, in

presence of high spasticity level after treatment with botulinum toxin

▪ The palm is completely free, facilitating contact with real objects

▪ The movement generated by the ‘artificial tendons’ is fluid and natural, the glove is

comfortable and lightweight

▪ The therapist can adjust: ROM of each finger, the speed of movement, timing of the

exercise, audio and visual effects

▪ The glove is available in 6 sizes (XXS, XS, S, M, L, XL), the pediatric application included

▪ The patient has not a predefined position; wrist and arm can be moved freely during therapy

▪ An accessory included in the set can stabilize the wrist in a functional position

A repetitive training program based on flexion and extension of the fingers can facilitate neuromuscularre-education, control pain, enhance the treatmentof edema, prevent spasticity and maintain or increase the range of motion and muscle lengths.

Passive stretch combined with virtual reality caninduce plastic changes in neural networks subserving motor control and learning.

“[Gloreha] induced changes in local muscle blood flow, diminished spasticity, and decreased subject-reported symptoms of heaviness and stiffness in subjects with hemiparesis”

L. Bissolotti – J. Phys. Ther. Sci. 28: 769-773 2016

Available inGloreha Workstation • Gloreha Workstation Plus • Gloreha Sinfonia • Gloreha Sinfonia Plus

Many exercises: any combination of flexion and extension

Customization of audio and visual effects

Speed adjustment (6-20 mm/sec)

Setting the ROM of each finger

ROBOTIC GLOVE FOR THE

MOBILIZATION OF THE FINGERS

SENSORS FOR DETECTING

ACTIVE MOVEMENTS

FREE INTERACTION

WITH REAL OBJECTS

Page 4: PASSIVEMOBILIZATION - Hand rehabilitation · The aim of every rehabilitation program is to re-educate the patient in the use of the hand and the whole upper limb during the Activities

BILATERALTRAININGWhile the hemiplegic/hemiparetic

patient actively moves the

healthy hand, at the same time

the robotic glove generates

a similar movement on the

other hand. Flexion and extension

of the fingers are activated

dynamically by the patient

to increase the level of involvement

and motivation.

The mirror motor mechanism,

the observation of two moving

3D hands and the execution of

bilateral functional tasks with

real objects amplify the stimulation

of the cortical areas of the brain.

▪ Like in the traditional Mirror Therapy, the patient is stimulated by the observation of the

affected hand moving

▪ In addition, real motor training is generated by the system, amplifying the positive effects

of rehabilitation

▪ Before motor exercise, the patient can watch a video preview

▪ The performance of functional grasping and reaching tasks can enrich the therapy

▪ The patient activates the functioning of the robotic glove within the speed and ROM

parameters decided by the therapist

▪ The patient should think of a bilateral action, even if the hand to treat is lacking in motor

skills

Mirror Therapy is an up-and-coming approach aimed to provide corrective sensory feedback. The aim is to restore congruence between motor output and sensory input. Several clinical trials investigated the effectiveness of Mirror Therapy for decreasing motor impairment, pain, anxiety, and fear of movement. It can help to improve upper extremity motor function and recovery of body schema.

Gloreha Sinfonia offers a peculiar and innovative kind of therapy that enhances the benefits of conventional Mirror Therapy, beyond the illusion of the movement. Gloreha Sinfonia combines the concepts of Mirror Therapy with Virtual Reality, assisted mobilization, and bilateral tasks.

ROBOTIC GLOVE

ON THE

IMPAIRED HAND

SENSORIZED GLOVE ON

THE HEALTHY HAND

ERGONOMIC WORK AREA

SUITABLE FOR BILATERAL

TRAINING IN THE SPACE

INTERACTION WITH

REAL OBJECTS

Available inGloreha Sinfonia • Gloreha Sinfonia Plus

Page 5: PASSIVEMOBILIZATION - Hand rehabilitation · The aim of every rehabilitation program is to re-educate the patient in the use of the hand and the whole upper limb during the Activities

During these exercises,

the patient is instructed to

independently start the motor

task (flexion and extension of

the fingers) and if unable

to complete the exercise the

robotic glove will provide

assistance

only when necessary.

The software offers exercises

that guide the patient

during therapy to clear objectives

using intuitive graphics

to motivate the patient to do

his best and to overcome the

tasks required.

ACTIVEASSISTEDMOBILIZATION

▪ Performance indexes give immediate feedback on the degree of autonomy of the

patient in flexion and extension

▪ The data of each session can be viewed in intuitive graphs and can be exported to a

pdf/excel file to monitor the patient’s progress

▪ The therapy can be oriented towards functional recovery thanks to exercises that

involve interaction with real objects

▪ The software offers a high degree of customization of the exercise: the therapist can

set different parameters and vary the level of difficulty

Performance measurement

Intuitive graphs PDF and XLS download

Motivating exercises

ARTIFICIAL TENDONS

SUPPORT MOVEMENT

SENSORS DETECT PATIENT’S

ACTIVE MOVEMENTS

“Assist-as-needed” (AAN) training paradigm via robotic training devices may be more involving and effective in case of partial motor skills.

The application of an active-assisted robotic treatment limits the drawbacks of compensatory strategies that lead to learned non-use phenomenon of the affected upper limb.

Adaptive therapies make the exercises always more challenging by exploiting the partial motor skills of the patients.

Available inGloreha Sinfonia • Gloreha Sinfonia Plus

Page 6: PASSIVEMOBILIZATION - Hand rehabilitation · The aim of every rehabilitation program is to re-educate the patient in the use of the hand and the whole upper limb during the Activities

ACTION OBSERVATION THERAPYGloreha allows the execution of

exercises based on the logic

of the Action Observation Therapy,

that provides training

characterized by two steps:

OBSERVATION - first the patient

observes a motor task on the screen

EXECUTION - once the visual preview

ends, the rehabilitation glove

supports the performance of the

specific motor exercise.

The help provided by the device

is calibrated based on the patient’s

abilities.

▪ The software includes a wide range of videos

available: from single articular movements to more

complex actions such as functional grasps of real objects

▪ The therapist can choose the number of repetitions of

a video: the phase of observation of the task, depending

on the settings, can last a few seconds or minutes; then

the software automatically starts the motor exercise phase

▪ New video previews can be easily uploaded by

the therapist, stimulating the patient to train with

objects belonging to his daily life

▪ A customizable voice guide can introduce each video

to explain to the patient how the therapy will take place

Action Observation Therapy (AOT) and Motor Imagery are novel rehabilitation approaches applied to patients affected by hemiplegia, hemiparesis, Parkinson’s disease, cerebral palsy,and even to post-surgical orthopedic patients.The scientific basis of such approaches is the neurophysiological mechanism of mirror neurons: studies confirmed that the imagination of a movement and the observation of actions performed by others activate the same neural structures engaged in the actual executionof those movements.

Scientific literature shows that imitation of observed tasks leads to a re-organization of the primary motor cortex: intact cortical networks reinforce and the damaged ones are activated. AOT can prevent the changes in the cortical re-organization that occur after inactivity and disuse.

THE OBSERVATION OF A

MOTOR TASK ACTIVATES

MIRROR NEURONS

Available inGloreha Workstation • Gloreha Workstation Plus • Gloreha Sinfonia • Gloreha Sinfonia Plus

Page 7: PASSIVEMOBILIZATION - Hand rehabilitation · The aim of every rehabilitation program is to re-educate the patient in the use of the hand and the whole upper limb during the Activities

▪ Several motor tasks can be trained: fist grasp, digital pinch, tridigital pinch, bilateral

grasp

▪ The palm is free: the glove allows tactile sensations when taking objects

▪ The weight of the arm is compensated: the dynamic support favors reaching exercises

▪ The exercise can be guided also through customizable vocal instructions

▪ The movement can be carried out entirely by the rehabilitation glove or by the active

participation of the patient

▪ All the rehabilitation modalities (bilateral therapies, interactive games, passive

mobilization, and active-assisted mobilization) can be performed in functional terms

▪ The device can support occupational therapy activities. Objects of daily life with

different shapes and sizes can be added to re-educate the patient to the functional

gesture through motivating exercises of increasing complexity.

The aim of every rehabilitation program

is to re-educate the patient in the use of

the hand and the whole upper limb during

the Activities of Daily Living (ADLs).

Encouraging the interaction with

real objects is among the main

goals of the rehabilitation glove

and the software.

Through functional exercises, the

movements of the fingers and upper limb

are contextualized, encouraging the

patient not to think of a movement end

in itself, but rather as an action with a

final purpose.

FUNCTIONALEXERCISESCurrent neurorehabilitation approaches support the application of functional tasks compared to performingsystematic training based on isolated movements.

“[Gloreha] may improve not only visuospatial exploration and attention but also speed to execute gross movement of the arm, hand and fingers, as well as fingertip dexterity in stroke patients”.

V. Varalta - J Neuroeng Rehabil. 2014 Dec 5

“A program of robot assisted movements had the advantage of decreasing oedema after just one week of treatment (…). This result could have important consequences on the clinical approaches because a decreased swelling in paretic hand brings a higher possibility to avoid the pain, stiffness (…) and disuse of the hand”.

M.G. Montecchi - Int J Phys Ther Rehab 2016, 2: 114

Available inGloreha Workstation • Gloreha Workstation Plus • Gloreha Sinfonia • Gloreha Sinfonia Plus

Page 8: PASSIVEMOBILIZATION - Hand rehabilitation · The aim of every rehabilitation program is to re-educate the patient in the use of the hand and the whole upper limb during the Activities

▪ The difficulty level self-adapts based on the patient’s

abilities

▪ The playful aspect and the combination of motor tasks

facilitate the level of compliance of the patient with

cognitive deficit

▪ The fundamental principles of neuropsychological

treatment have been included in the exercises proposed

▪ Colors, numbers, images, playing cards: the software

offers interactive exercises of cognitive stimulation,

tailored to the patient

▪ Patients and therapists have immediate feedback on the

performance trend, automatically stored by the system

INTERACTIVEGAMESRehabilitation and amusement:

the software offers several challenging

and recreational exercises, based

on active movements of the upper limb

detected by dedicated sensors.

The graphics interface involves

the patient and enhances the playful

aspect of the treatment. In the motor

exercise, the patient guides a game

character in the execution of tasks of

different complexity. The software

records the levels of performance.

▪ The movements detected by the sensors vary depending

on the model used: flexion-extension of the fingers,

pronation-supination of the wrist, radial-ulnar deviation,

flexion-extension of the wrist, movements of the arm on the

vertical and horizontal plane (back-forth, left-right,

up-down)

▪ The difficulty level of the exercise can be programmed by

the therapist or self-adapted based on the patient’s

performance

▪ The patient is free to actively move the arm in space,

facilitated by a system for weight compensation

▪ All scores can be viewed on the screen and downloaded

to pdf/excel file

COGNITIVEEXERCISESIn a comprehensive rehabilitative path,

neuro-cognitive recovery must support

motor recovery.

Specific exercises, developed by the

Gloreha team with the support of

neuropsychologists, train cognitive

abilities such as attention skills,

problem-solving, memory, shifting skills,

selective attention, visuo-spatial

exploration skills, etc.

The combination of motor and cognitive

tasks also trains the divided attention,

a skill of essential importance to perform

many ADLs.

The aging of the population brings with it an increase in cases of dementia and neurocognitive problems due to brain damage. Computerized cognitive treatments are an excellent treatment to prevent this phenomenon.

Cognitive training stimulates neuroplasticity: the ability of the nervous system to respond to intrinsic and extrinsic stimuli by reorganizing its structure, function, and connections.

Rehabilitation dose is a key point in treatment path. Interactive and challenging games help to increase the time of treatment as well as patients’ motivation and compliance.

“The introduction of [Gloreha] has as its objectiveto support the work of the physiotherapist, to increase the intensity of the therapies administeredand contain treatment costs”.

F. Vanoglio - ClinRehabil. 2016 Apr 7

New technologies help to avoid patient’s frustration, boredom and discouragement. In this way they can positively influence the results of a rehabilitation process.

Collect mushrooms and train grasping movements

Increasingly challenging cognitive tasks train the attentional capacity

Avoid obstacles and train the flexion and extension of the wrist

Different levels of difficulty for the progressive training of shifting skills

Leap MotionTM Technology

Available inGloreha Workstation Plus • Gloreha Sinfonia • Gloreha Sinfonia Plus • Gloreha Aria

Available inGloreha Workstation Plus • Gloreha Sinfonia Plus • Gloreha Aria

It is not easy for patients to understand and admit their cognitive deficits. Combining cognitive exercises with motor tasks can facilitate patients’ compliance and motivation.

RADIAL/ULNAR DEVIATION

FLEXIONEXTENSION

PRONATIONSUPINATION

OPENINGCLOSING

UP/DOWN

LEFT/RIGHT

BACK/FORTH

Page 9: PASSIVEMOBILIZATION - Hand rehabilitation · The aim of every rehabilitation program is to re-educate the patient in the use of the hand and the whole upper limb during the Activities

WEIGHT COMPENSATION OF THEUPPERLIMB

Gloreha devices are equipped

with two dynamic supports that

allow the patient to move the upper

limb with no gravity. The compensation

level is calibrated according to the

weight of the arm and the residual control

and movement abilities of the patient.

These supports are particularly

useful during functional training

because otherwise it often would not

be possible without adequate weight

relief for the upper limb.

JUNCTIONS THAT FACILITATE

PATIENT MOVEMENT IN ALL

DIRECTIONS

12 LEVELS

OF COMPENSATION

LIGHTWEIGHT AND

COMFORTABLE

www.gloreha.comStay up-to-date on our news

Arm supports allow widening the work area during reaching exercises and are therefore particularly useful during the training of ADLs.

The introduction of a weight compensator for the upper limb in post-stroke rehabilitation improves the quality of movements, reduces patient effort and allows an increase in the number of repetitions of the motor task.

Available inGloreha Workstation • Gloreha Workstation Plus • Gloreha Sinfonia • Gloreha Sinfonia Plus • Gloreha Aria

SINCE 2006 IN CONTINUOUS GROWTH

MADE IN

ITALY

MORE THAN 10,000

PATIENTS TREATED

EVERY YEAR

INTERNATIONAL PATENT

INTERNATIONAL PARTNERS (CONTACT US FOR

INFORMATION ABOUT THE DISTRIBUTOR IN YOUR

COUNTRY)

CLINICAL EFFICACY

DEMONSTRATED BY SCIENTIFIC

PUBLICATIONS

ON THE MARKET

SINCE 2011

Page 10: PASSIVEMOBILIZATION - Hand rehabilitation · The aim of every rehabilitation program is to re-educate the patient in the use of the hand and the whole upper limb during the Activities
Page 11: PASSIVEMOBILIZATION - Hand rehabilitation · The aim of every rehabilitation program is to re-educate the patient in the use of the hand and the whole upper limb during the Activities

required by a therapist.

Gloreha Collezione is composed of two ergonomic

work areas, characterized by:

▪ Integrated touchscreen PC

▪ Task-oriented therapies

▪ User-friendly software

▪ Performance evaluation section

▪ Supports for weight compensation of the upper

limb

▪ Applicability in the pediatric field

The solution that doubles the productivity and

intensity of the therapy. A therapist, two devices:

▪ Gloreha Sinfonia focuses on the hand. It adapts

to the rehabilitation of patients from the early sta-

ges of motor recovery

▪ Gloreha Aria focuses on the entire upper limb. It

adapts to the most advanced stages of the rehabili-

tation process.

Gloreha Sinfonia and Gloreha Aria motivate and

stimulate patients with only general supervision

MODULARITYOFGLOREHAgyms can best organize their

technological equipment, integrating

and modifying it over time.

Thanks to the modularity and

versatility of Gloreha products,

hospitals, rehabilitation centers, and

PASSIVE MOBILIZATION ▪ ▪ ▪ ▪ACTION-OBSERVATION THERAPY ▪ ▪ ▪ ▪FUNCTIONAL EXERCICES ▪ ▪ ▪ ▪WEIGHT COMPENSATION OF THE UPPER LIMB ▪ ▪ ▪ ▪ ▪BILATERAL TRAINING ▪ ▪ACTIVE-ASSISTED MOBILIZATION ▪ ▪HAND INTERACTIVEGAMES ▪ ▪ ▪ ▪WRIST INTERACTIVEGAMES ▪ ▪ ▪ARM INTERACTIVEGAMES ▪ ▪ ▪COGNITIVE EXERCISES ▪ ▪ ▪

TWO PATIENTS SIMULTANEOUSLY

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GLOREHACOLLEZIONEThe basic solution, suitable from the early

stage of treatment. The core of the system is a

comfortable and lightweight glove that

mobilizes finger joints even on patients

without any motor skill. Video previews,

audio effects, simultaneous 3D animations,

and functional tasks help stimulate

neural plasticity.

The integrated solution that combines the

advantages of Gloreha Workstation and

Gloreha Aria. Passive mobilization, enriched

by audio and visual effects with the possibility

of performing functional exercises, is ideal

for starting treatment. The use of interactive

games for the entire upper limb is useful

to refine active movements.

GLOREHAWORKSTATION

GLOREHAWORKSTATIONPLUS

The advantages of Gloreha Aria and

Gloreha Sinfonia all in one device. This version

expands the potential of Gloreha Sinfonia:

interactive games can focus both on the

fingers and on the movements of the

wrist and arm. This is the complete

solution for the rehabilitation of the

upper limb.

GLOREHASINFONIAPLUS

Gloreha Sinfonia combines different

tools to treat patients during all

phases of neuromotor recovery: a

robotic glove able to perform

passive, active-assisted and bilateral

mobilization; sensors to detect

active movements and play

interactive games; software with

audio and visual effects and

simultaneous 3D animation;

a pair of dynamic supports to

compensate the weight of the arm

and facilitate functional

exercises.

Gloreha Aria is a sensor-based device

for the therapeutic treatment of the

upper limb and for cognitive training.

Interactive games encourage free

movements of arm, wrist, and hand

in space, with no gravity.

The set-up is immediate: nothing to

wear on the patient.

An extraordinary value for money:

Gloreha Aria is within reach of every

rehabilitation center and

physiotherapy center treating

patients with upper limb motor

deficits.

GLOREHASINFONIA

GLOREHAARIA

Page 12: PASSIVEMOBILIZATION - Hand rehabilitation · The aim of every rehabilitation program is to re-educate the patient in the use of the hand and the whole upper limb during the Activities

IDROGENET SRLVia Monsuello, 246

25065 Lumezzane (BS) ITALYPhone/Fax +39.030.871932

[email protected] www.gloreha.com