51
|
Li L, Tyson S, Weightman A. Professionals' Views and Experiences of Using Rehabilitation Robotics With Stroke Survivors: A Mixed Methods Survey. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 3:780090. [PMID: 35047969 PMCID: PMC8757825 DOI: 10.3389/fmedt.2021.780090] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/22/2021] [Indexed: 01/01/2023] Open
Abstract
Objective: To understand the reason for low implementation of clinical and home-based rehabilitation robots and their potential. Design: Online questionnaire (November 2020 and February 2021). Subjects: A total of 100 professionals in stroke rehabilitation area were involved (Physiotherapists n = 62, Occupation therapists n = 35). Interventions: Not applicable. Main Measures: Descriptive statistics and thematic content analysis were used to analyze the responses: 1. Participants' details, 2. Professionals' views and experience of using clinical rehabilitation robots, 3. Professionals' expectation and concerns of using home-based rehabilitation robots. Results: Of 100 responses, 37 had experience of rehabilitation robots. Professionals reported that patients enjoyed using them and they increased accessibility, autonomy, and convenience especially when used at home. The main emergent themes were: "aims and objectives for rehabilitation robotics," "requirements" (functional, software, and safety), "cost," "patient factors" (contraindications, cautions, and concerns), and "staff issues" (concerns and benefits). The main benefits of rehabilitation robots were that they provided greater choice for therapy, increased the amount/intensity of treatment, and greater motivation to practice. Professionals perceived logistical issues (ease of use, transport, and storage), cost and limited adaptability to patients' needs to be significant barriers to tier use, whilst acknowledging they can reduce staff workload to a certain extent. Conclusion: The main reported benefit of rehabilitation robots were they increased the amount of therapy and practice after stroke. Ease of use and adaptability are the key requirements. High cost and staffing resources were the main barriers.
Collapse
Affiliation(s)
- Lutong Li
- Department of Mechanical, Aerospace and Civil Engineering, School of Engineering, University of Manchester, Manchester, United Kingdom
| | - Sarah Tyson
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Andrew Weightman
- Department of Mechanical, Aerospace and Civil Engineering, School of Engineering, University of Manchester, Manchester, United Kingdom
| |
Collapse
|
52
|
Anwer S, Waris A, Gilani SO, Iqbal J, Shaikh N, Pujari AN, Niazi IK. Rehabilitation of Upper Limb Motor Impairment in Stroke: A Narrative Review on the Prevalence, Risk Factors, and Economic Statistics of Stroke and State of the Art Therapies. Healthcare (Basel) 2022; 10:healthcare10020190. [PMID: 35206805 PMCID: PMC8872602 DOI: 10.3390/healthcare10020190] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/05/2022] [Accepted: 01/13/2022] [Indexed: 02/04/2023] Open
Abstract
Stroke has been one of the leading causes of disability worldwide and is still a social health issue. Keeping in view the importance of physical rehabilitation of stroke patients, an analytical review has been compiled in which different therapies have been reviewed for their effectiveness, such as functional electric stimulation (FES), noninvasive brain stimulation (NIBS) including transcranial direct current stimulation (t-DCS) and transcranial magnetic stimulation (t-MS), invasive epidural cortical stimulation, virtual reality (VR) rehabilitation, task-oriented therapy, robot-assisted training, tele rehabilitation, and cerebral plasticity for the rehabilitation of upper extremity motor impairment. New therapeutic rehabilitation techniques are also being investigated, such as VR. This literature review mainly focuses on the randomized controlled studies, reviews, and statistical meta-analyses associated with motor rehabilitation after stroke. Moreover, with the increasing prevalence rate and the adverse socio-economic consequences of stroke, a statistical analysis covering its economic factors such as treatment, medication and post-stroke care services, and risk factors (modifiable and non-modifiable) have also been discussed. This review suggests that if the prevalence rate of the disease remains persistent, a considerable increase in the stroke population is expected by 2025, causing a substantial economic burden on society, as the survival rate of stroke is high compared to other diseases. Compared to all the other therapies, VR has now emerged as the modern approach towards rehabilitation motor activity of impaired limbs. A range of randomized controlled studies and experimental trials were reviewed to analyse the effectiveness of VR as a rehabilitative treatment with considerable satisfactory results. However, more clinical controlled trials are required to establish a strong evidence base for VR to be widely accepted as a preferred rehabilitation therapy for stroke.
Collapse
Affiliation(s)
- Saba Anwer
- School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 45200, Pakistan; (S.A.); (A.W.); (S.O.G.); (J.I.)
| | - Asim Waris
- School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 45200, Pakistan; (S.A.); (A.W.); (S.O.G.); (J.I.)
| | - Syed Omer Gilani
- School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 45200, Pakistan; (S.A.); (A.W.); (S.O.G.); (J.I.)
| | - Javaid Iqbal
- School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 45200, Pakistan; (S.A.); (A.W.); (S.O.G.); (J.I.)
| | - Nusratnaaz Shaikh
- Faculty of Health & Environmental Sciences, Health & Rehabilitation Research Institute, AUT University, Auckland 0627, New Zealand;
| | - Amit N. Pujari
- School of Physics, Engineering and Computer Science, University of Hertfordshire, Hatfield AL10 9AB, UK;
- School of Engineering, University of Aberdeen, Aberdeen AB24 3FX, UK
| | - Imran Khan Niazi
- Faculty of Health & Environmental Sciences, Health & Rehabilitation Research Institute, AUT University, Auckland 0627, New Zealand;
- Center of Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand
- Center for Sensory-Motor Interaction, Department of Health Science & Technology, Aalborg University, 9000 Alborg, Denmark
- Correspondence:
| |
Collapse
|
53
|
Dalla Gasperina S, Longatelli V, Braghin F, Pedrocchi A, Gandolla M. Development and Electromyographic Validation of a Compliant Human-Robot Interaction Controller for Cooperative and Personalized Neurorehabilitation. Front Neurorobot 2022; 15:734130. [PMID: 35115915 PMCID: PMC8804356 DOI: 10.3389/fnbot.2021.734130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Appropriate training modalities for post-stroke upper-limb rehabilitation are key features for effective recovery after the acute event. This study presents a cooperative control framework that promotes compliant motion and implements a variety of high-level rehabilitation modalities with a unified low-level explicit impedance control law. The core idea is that we can change the haptic behavior perceived by a human when interacting with the rehabilitation robot by tuning three impedance control parameters. METHODS The presented control law is based on an impedance controller with direct torque measurement, provided with positive-feedback compensation terms for disturbances rejection and gravity compensation. We developed an elbow flexion-extension experimental setup as a platform to validate the performance of the proposed controller to promote the desired high-level behavior. The controller was first characterized through experimental trials regarding joint transparency, torque, and impedance tracking accuracy. Then, to validate if the controller could effectively render different physical human-robot interaction according to the selected rehabilitation modalities, we conducted tests on 14 healthy volunteers and measured their muscular voluntary effort through surface electromyography (sEMG). The experiments consisted of one degree-of-freedom elbow flexion/extension movements, executed under six high-level modalities, characterized by different levels of (i) corrective assistance, (ii) weight counterbalance assistance, and (iii) resistance. RESULTS The unified controller demonstrated suitability to promote good transparency and render both compliant and stiff behavior at the joint. We demonstrated through electromyographic monitoring that a proper combination of stiffness, damping, and weight assistance could induce different user participation levels, render different physical human-robot interaction, and potentially promote different rehabilitation training modalities. CONCLUSION We proved that the proposed control framework could render a wide variety of physical human-robot interaction, helping the user to accomplish the task while exploiting physiological muscular activation patterns. The reported results confirmed that the control scheme could induce different levels of the subject's participation, potentially applicable to the clinical practice to adapt the rehabilitation treatment to the subject's progress. Further investigation is needed to validate the presented approach to neurological patients.
Collapse
Affiliation(s)
- Stefano Dalla Gasperina
- NeuroEngineering and Medical Robotics Laboratory (NearLab), Department of Electronics, Information and Bioengineering, Politecnico di Milan, Milan, Italy
- WE-COBOT Lab, Polo Territoriale di Lecco, Politecnico di Milano, Lecco, Italy
| | - Valeria Longatelli
- NeuroEngineering and Medical Robotics Laboratory (NearLab), Department of Electronics, Information and Bioengineering, Politecnico di Milan, Milan, Italy
- WE-COBOT Lab, Polo Territoriale di Lecco, Politecnico di Milano, Lecco, Italy
| | - Francesco Braghin
- WE-COBOT Lab, Polo Territoriale di Lecco, Politecnico di Milano, Lecco, Italy
- Department of Mechanical Engineering, Politecnico di Milan, Milan, Italy
| | - Alessandra Pedrocchi
- NeuroEngineering and Medical Robotics Laboratory (NearLab), Department of Electronics, Information and Bioengineering, Politecnico di Milan, Milan, Italy
- WE-COBOT Lab, Polo Territoriale di Lecco, Politecnico di Milano, Lecco, Italy
| | - Marta Gandolla
- NeuroEngineering and Medical Robotics Laboratory (NearLab), Department of Electronics, Information and Bioengineering, Politecnico di Milan, Milan, Italy
- WE-COBOT Lab, Polo Territoriale di Lecco, Politecnico di Milano, Lecco, Italy
| |
Collapse
|
54
|
Kim SH, Ji DM, Kim CY, Choi SB, Joo MC, Kim MS. Therapeutic Effects of a Newly Developed 3D Magnetic Finger Rehabilitation Device in Subacute Stroke Patients: A Pilot Study. Brain Sci 2022; 12:brainsci12010113. [PMID: 35053855 PMCID: PMC8773930 DOI: 10.3390/brainsci12010113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 02/05/2023] Open
Abstract
We developed a magnetic-force-based three-dimensional (3D) rehabilitation device that can perform motor rehabilitation treatment for paralyzed fingers, regardless of upper extremity movement and position, and investigated the therapeutic effects of the device. An end-effector type rehabilitation device that can generate magnetic fields in three directions was developed using electromagnets and permanent magnetics. A double-blinded randomized controlled pilot study was conducted with a total of 12 patients. The intervention group had rehabilitation treatment using the developed magnetic finger rehabilitation device for 30 min a day for four weeks. The control group underwent exercise rehabilitation treatment. The control group received conventional occupational therapy on the upper limbs, including hands, from an occupational therapist, for the same amount of time. Adverse effects were monitored, and the patient’s sensory or proprioceptive deficits were examined before the intervention. No participants reported safety concerns while the intervention was conducted. The Wolf Motor Function Test (WMFT) scores were significantly improved in the intervention group (from 13.4 ± 3.6 to 20.9 ± 4.0 points) compared to the control group (from 13.1 ± 4.0 to 15.2 ± 3.8 points) (p = 0.016). The patients in the intervention group (from 88 ± 12 to 67 ± 13 s) showed greater improvement of WMFT times compared to the control group (from 89 ± 10 to 73 ± 11 s) (p = 0.042). The Manual Function Test and the upper limb score of the Fugl-Meyer Assessment were significantly improved in the intervention group compared with the control group (p = 0.038 and p = 0.042). The patients in the intervention group also showed significantly greater enhancement of the Korean version of the modified Barthel Index than the control group (p = 0.042). Rehabilitation treatment using the 3D magnetic-force-driven finger rehabilitation device helped improve finger motor function and activities of daily living in subacute stroke patients.
Collapse
Affiliation(s)
- Sung-Hoon Kim
- Department of Electronics Convergence Engineering, Wonkwang University, 460 Iksandae-ro, Iksan 54538, Korea; (S.-H.K.); (D.-M.J.)
| | - Dong-Min Ji
- Department of Electronics Convergence Engineering, Wonkwang University, 460 Iksandae-ro, Iksan 54538, Korea; (S.-H.K.); (D.-M.J.)
| | - Chan-Yong Kim
- Department of Rehabilitation Medicine, College of Medicine, Wonkwang University, 460 Iksandae-ro, Iksan 54538, Korea; (C.-Y.K.); (S.-B.C.); (M.-C.J.)
| | - Sung-Bok Choi
- Department of Rehabilitation Medicine, College of Medicine, Wonkwang University, 460 Iksandae-ro, Iksan 54538, Korea; (C.-Y.K.); (S.-B.C.); (M.-C.J.)
| | - Min-Cheol Joo
- Department of Rehabilitation Medicine, College of Medicine, Wonkwang University, 460 Iksandae-ro, Iksan 54538, Korea; (C.-Y.K.); (S.-B.C.); (M.-C.J.)
| | - Min-Su Kim
- Department of Rehabilitation Medicine, College of Medicine, Wonkwang University, 460 Iksandae-ro, Iksan 54538, Korea; (C.-Y.K.); (S.-B.C.); (M.-C.J.)
- Correspondence: ; Tel.: +82-6-3859-1610; Fax: +82-6-3859-2128
| |
Collapse
|
55
|
Goffredo M, Pournajaf S, Proietti S, Gison A, Posteraro F, Franceschini M. Retrospective Robot-Measured Upper Limb Kinematic Data From Stroke Patients Are Novel Biomarkers. Front Neurol 2022; 12:803901. [PMID: 34992576 PMCID: PMC8725786 DOI: 10.3389/fneur.2021.803901] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/17/2021] [Indexed: 02/06/2023] Open
Abstract
Background: The efficacy of upper-limb Robot-assisted Therapy (ulRT) in stroke subjects is well-established. The robot-measured kinematic data can assess the biomechanical changes induced by ulRT and the progress of patient over time. However, literature on the analysis of pre-treatment kinematic parameters as predictive biomarkers of upper limb recovery is limited. Objective: The aim of this study was to calculate pre-treatment kinematic parameters from point-to-point reaching movements in different directions and to identify biomarkers of upper-limb motor recovery in subacute stroke subjects after ulRT. Methods: An observational retrospective study was conducted on 66 subacute stroke subjects who underwent ulRT with an end-effector robot. Kinematic parameters were calculated from the robot-measured trajectories during movements in different directions. A Generalized Linear Model (GLM) was applied considering the post-treatment Upper Limb Motricity Index and the kinematic parameters (from demanding directions of movement) as dependent variables, and the pre-treatment kinematic parameters as independent variables. Results: A subset of kinematic parameters significantly predicted the motor impairment after ulRT: the accuracy in adduction and internal rotation movements of the shoulder was the major predictor of post-treatment Upper Limb Motricity Index. The post-treatment kinematic parameters of the most demanding directions of movement significantly depended on the ability to execute elbow flexion-extension and abduction and external rotation movements of the shoulder at baseline. Conclusions: The multidirectional analysis of robot-measured kinematic data predicts motor recovery in subacute stroke survivors and paves the way in identifying subjects who may benefit more from ulRT.
Collapse
Affiliation(s)
- Michela Goffredo
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
| | - Sanaz Pournajaf
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
| | - Stefania Proietti
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
| | - Annalisa Gison
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
| | - Federico Posteraro
- Rehabilitation Department, Versilia Hospital, Azienda Unità Sanitaria Locale (AUSL) Northwest Tuscany, Camaiore, Italy
| | - Marco Franceschini
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy.,Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, Rome, Italy
| |
Collapse
|
56
|
Turolla A, Kiper P, Mazzarotto D, Cecchi F, Colucci M, D'Avenio G, Facciorusso S, Gatti R, Giansanti D, Iosa M, Bonaiuti D, Boldrini P, Mazzoleni S, Posteraro F, Benanti P, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzon S, Morone G, Petrarca M, Picelli A, Senatore M, Turchetti G, Molteni F. Reference theories and future perspectives on robot-assisted rehabilitation in people with neurological conditions: A scoping review and recommendations from the Italian Consensus Conference on Robotics in Neurorehabilitation (CICERONE). NeuroRehabilitation 2022; 51:681-691. [PMID: 36530100 DOI: 10.3233/nre-220160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Robot-based treatments are developing in neurorehabilitation settings. Recently, the Italian National Health Systems recognized robot-based rehabilitation as a refundable service. Thus, the Italian neurorehabilitation community promoted a national consensus on this topic. OBJECTIVE To conceptualize undisclosed perspectives for research and applications of robotics for neurorehabilitation, based on a qualitative synthesis of reference theoretical models. METHODS A scoping review was carried out based on a specific question from the consensus Jury. A foreground search strategy was developed on theoretical models (context) of robot-based rehabilitation (exposure), in neurological patients (population). PubMed and EMBASE® databases were searched and studies on theoretical models of motor control, neurobiology of recovery, human-robot interaction and economic sustainability were included, while experimental studies not aimed to investigate theoretical frameworks, or considering prosthetics, were excluded. RESULTS Overall, 3699 records were screened and finally 9 papers included according to inclusion and exclusion criteria. According to the population investigated, structured information on theoretical models and indications for future research was summarized in a synoptic table. CONCLUSION The main indication from the Italian consensus on robotics in neurorehabilitation is the priority to design research studies aimed to investigate the role of robotic and electromechanical devices in promoting neuroplasticity.
Collapse
Affiliation(s)
- Andrea Turolla
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum Università di Bologna, Bologna, Italy
- Division of Occupational Medicine, IRCCS Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | - Deborah Mazzarotto
- Medicina Fisica e Riabilitazione, ULSS 4 Veneto Orientale, San Donà di Piave, Italy
| | - Francesca Cecchi
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Florence, Italy
- IRCSS Fondazione Don Carlo Gnocchi, Firenze, Italy
| | | | - Giuseppe D'Avenio
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | | | - Roberto Gatti
- Humanitas University, Department of Biomedical Sciences, via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
- Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Daniele Giansanti
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Marco Iosa
- Department of Psychology, Sapienza Università di Roma, Rome, Italy
- Smart Lab, IRCSS Santa Lucia Foundation, Rome, Italy
| | | | - Paolo Boldrini
- Italian Society of Physical and Rehabilitation Medicine (SIMFER), Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Federico Posteraro
- Department of Rehabilitation, AUSL Toscana Nord Ovest - Camaiore, Versilia Hospital, Lucca, Italy
| | | | - Enrico Castelli
- Department of Neurorehabilitation and Robotics, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (FAIP Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental, Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzon
- Rehabilitation Unit, ULSS (Local Health Authority) Euganea, Camposampiero Hospital, Padua, Italy
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- San Raffaele Institute of Sulmona, Sulmona, Italy
| | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory (MARlab), IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Senatore
- Associazione Italiana dei Terapisti Occupazionali (AITO), Rome, Italy
| | | | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Lecco, Italy
| |
Collapse
|
57
|
Casas R, Sandison M, Nichols D, Martin K, Phan K, Chen T, Lum PS. Home-Based Therapy After Stroke Using the Hand Spring Operated Movement Enhancer (HandSOME II). Front Neurorobot 2021; 15:773477. [PMID: 34975447 PMCID: PMC8719001 DOI: 10.3389/fnbot.2021.773477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/25/2021] [Indexed: 11/13/2022] Open
Abstract
We have developed a passive and lightweight wearable hand exoskeleton (HandSOME II) that improves range of motion and functional task practice in laboratory testing. For this longitudinal study, we recruited 15 individuals with chronic stroke and asked them to use the device at home for 1.5 h per weekday for 8 weeks. Subjects visited the clinic once per week to report progress and troubleshoot problems. Subjects were then given the HandSOME II for the next 3 months, and asked to continue to use it, but without any scheduled contact with the project team. Clinical evaluations and biomechanical testing was performed before and after the 8 week intervention and at the 3 month followup. EEG measures were taken before and after the 8 weeks of training to examine any recovery associated brain reorganization. Ten subjects completed the study. After 8 weeks of training, functional ability (Action Research Arm Test), flexor tone (Modified Ashworth Test), and real world use of the impaired limb (Motor Activity Log) improved significantly (p < 0.05). Gains in real world use were retained at the 3-month followup (p = 0.005). At both post-training and followup time points, biomechanical testing found significant gains in finger ROM and hand displacement in a reaching task (p < 0.05). Baseline functional connectivity correlated with gains in motor function, while changes in EEG functional connectivity paralleled changes in motor recovery. HandSOME II is a low-cost, home-based intervention that elicits brain plasticity and can improve functional motor outcomes in the chronic stroke population.
Collapse
Affiliation(s)
- Rafael Casas
- Biomedical Engineering, The Catholic University of America, Washington, DC, United States
- MedStar National Rehabilitation Network, Washington, DC, United States
| | - Melissa Sandison
- Biomedical Engineering, The Catholic University of America, Washington, DC, United States
- MedStar National Rehabilitation Network, Washington, DC, United States
| | - Diane Nichols
- MedStar National Rehabilitation Network, Washington, DC, United States
| | - Kaelin Martin
- Biomedical Engineering, The Catholic University of America, Washington, DC, United States
| | - Khue Phan
- Biomedical Engineering, The Catholic University of America, Washington, DC, United States
| | - Tianyao Chen
- Biomedical Engineering, The Catholic University of America, Washington, DC, United States
| | - Peter S. Lum
- Biomedical Engineering, The Catholic University of America, Washington, DC, United States
- MedStar National Rehabilitation Network, Washington, DC, United States
| |
Collapse
|
58
|
Angerhöfer C, Colucci A, Vermehren M, Hömberg V, Soekadar SR. Post-stroke Rehabilitation of Severe Upper Limb Paresis in Germany - Toward Long-Term Treatment With Brain-Computer Interfaces. Front Neurol 2021; 12:772199. [PMID: 34867760 PMCID: PMC8637332 DOI: 10.3389/fneur.2021.772199] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/29/2021] [Indexed: 12/03/2022] Open
Abstract
Severe upper limb paresis can represent an immense burden for stroke survivors. Given the rising prevalence of stroke, restoration of severe upper limb motor impairment remains a major challenge for rehabilitation medicine because effective treatment strategies are lacking. Commonly applied interventions in Germany, such as mirror therapy and impairment-oriented training, are limited in efficacy, demanding for new strategies to be found. By translating brain signals into control commands of external devices, brain-computer interfaces (BCIs) and brain-machine interfaces (BMIs) represent promising, neurotechnology-based alternatives for stroke patients with highly restricted arm and hand function. In this mini-review, we outline perspectives on how BCI-based therapy can be integrated into the different stages of neurorehabilitation in Germany to meet a long-term treatment approach: We found that it is most appropriate to start therapy with BCI-based neurofeedback immediately after early rehabilitation. BCI-driven functional electrical stimulation (FES) and BMI robotic therapy are well suited for subsequent post hospital curative treatment in the subacute stage. BCI-based hand exoskeleton training can be continued within outpatient occupational therapy to further improve hand function and address motivational issues in chronic stroke patients. Once the rehabilitation potential is exhausted, BCI technology can be used to drive assistive devices to compensate for impaired function. However, there are several challenges yet to overcome before such long-term treatment strategies can be implemented within broad clinical application: 1. developing reliable BCI systems with better usability; 2. conducting more research to improve BCI training paradigms and 3. establishing reliable methods to identify suitable patients.
Collapse
Affiliation(s)
- Cornelius Angerhöfer
- Clinical Neurotechnology Lab, Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Annalisa Colucci
- Clinical Neurotechnology Lab, Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Mareike Vermehren
- Clinical Neurotechnology Lab, Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Volker Hömberg
- Department of Neurology, SRH Gesundheitszentrum Bad Wimpfen GmbH, Bad Wimpfen, Germany
| | - Surjo R Soekadar
- Clinical Neurotechnology Lab, Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
59
|
Garro F, Chiappalone M, Buccelli S, De Michieli L, Semprini M. Neuromechanical Biomarkers for Robotic Neurorehabilitation. Front Neurorobot 2021; 15:742163. [PMID: 34776920 PMCID: PMC8579108 DOI: 10.3389/fnbot.2021.742163] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/22/2021] [Indexed: 02/06/2023] Open
Abstract
One of the current challenges for translational rehabilitation research is to develop the strategies to deliver accurate evaluation, prediction, patient selection, and decision-making in the clinical practice. In this regard, the robot-assisted interventions have gained popularity as they can provide the objective and quantifiable assessment of the motor performance by taking the kinematics parameters into the account. Neurophysiological parameters have also been proposed for this purpose due to the novel advances in the non-invasive signal processing techniques. In addition, other parameters linked to the motor learning and brain plasticity occurring during the rehabilitation have been explored, looking for a more holistic rehabilitation approach. However, the majority of the research done in this area is still exploratory. These parameters have shown the capability to become the “biomarkers” that are defined as the quantifiable indicators of the physiological/pathological processes and the responses to the therapeutical interventions. In this view, they could be finally used for enhancing the robot-assisted treatments. While the research on the biomarkers has been growing in the last years, there is a current need for a better comprehension and quantification of the neuromechanical processes involved in the rehabilitation. In particular, there is a lack of operationalization of the potential neuromechanical biomarkers into the clinical algorithms. In this scenario, a new framework called the “Rehabilomics” has been proposed to account for the rehabilitation research that exploits the biomarkers in its design. This study provides an overview of the state-of-the-art of the biomarkers related to the robotic neurorehabilitation, focusing on the translational studies, and underlying the need to create the comprehensive approaches that have the potential to take the research on the biomarkers into the clinical practice. We then summarize some promising biomarkers that are being under investigation in the current literature and provide some examples of their current and/or potential applications in the neurorehabilitation. Finally, we outline the main challenges and future directions in the field, briefly discussing their potential evolution and prospective.
Collapse
Affiliation(s)
- Florencia Garro
- Rehab Technologies, Istituto Italiano di Tecnologia, Genoa, Italy.,Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
| | - Michela Chiappalone
- Rehab Technologies, Istituto Italiano di Tecnologia, Genoa, Italy.,Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
| | - Stefano Buccelli
- Rehab Technologies, Istituto Italiano di Tecnologia, Genoa, Italy
| | | | | |
Collapse
|
60
|
Robot-Assisted Training for Upper Limb in Stroke (ROBOTAS): An Observational, Multicenter Study to Identify Determinants of Efficacy. J Clin Med 2021; 10:jcm10225245. [PMID: 34830527 PMCID: PMC8622640 DOI: 10.3390/jcm10225245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 02/01/2023] Open
Abstract
Background: The loss of arm function is a common and disabling outcome after stroke. Robot-assisted upper limb (UL) training may improve outcomes. The aim of this study was to explore the effect of robot-assisted training using end-effector and exoskeleton robots on UL function following a stroke in real-life clinical practice. Methods: A total of 105 patients affected by a first-ever supratentorial stroke were enrolled in 18 neurorehabilitation centers and treated with electromechanically assisted arm training as an add-on to conventional therapy. Both interventions provided either an exoskeleton or an end-effector device (as per clinical practice) and consisted of 20 sessions (3/5 times per week; 6–8 weeks). Patients were assessed by validated UL scales at baseline (T0), post-treatment (T1), and at three-month follow-up (T2). The primary outcome was the Fugl-Meyer Assessment for the upper extremity (FMA-UE). Results: FMA-UE improved at T1 by 6 points on average in the end-effector group and 11 points on average in the exoskeleton group (p < 0.0001). Exoskeletons were more effective in the subacute phase, whereas the end-effectors were more effective in the chronic phase (p < 0.0001). Conclusions: robot-assisted training might help improve UL function in stroke patients as an add-on treatment in both subacute and chronic stages. Pragmatic and highmethodological studies are needed to confirm the showed effectiveness of the exoskeleton and end-effector devices.
Collapse
|
61
|
Mira RM, Molinari Tosatti L, Sacco M, Scano A. Detailed characterization of physiological EMG activations and directional tuning of upper-limb and trunk muscles in point-to-point reaching movements. Curr Res Physiol 2021; 4:60-72. [PMID: 34746827 PMCID: PMC8562137 DOI: 10.1016/j.crphys.2021.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 11/25/2022] Open
Abstract
In recent years, several studies have investigated upper-limb motion in a variety of scenarios including motor control, physiology, rehabilitation and industry. Such applications assess people’s kinematics and muscular performances, focusing on typical movements that simulate daily-life tasks. However, often only a limited interpretation of the EMG patterns is provided. In fact, rarely the assessments separate phasic (movement-related) and tonic (postural) EMG components, as well as the EMG in the acceleration and deceleration phases. With this paper, we provide a comprehensive and detailed characterization of the activity of upper-limb and trunk muscles in healthy people point-to-point upper limb movements. Our analysis includes in-depth muscle activation magnitude assessment, separation of phasic (movement-related) and tonic (postural) EMG activations, directional tuning, distinction between activations in the acceleration and deceleration phases. Results from our study highlight a predominant postural activity with respect to movement related muscular activity. The analysis based on the acceleration phase sheds light on finer motor control strategies, highlighting the role of each muscle in the acceleration and deceleration phase. The results of this study are applicable to several research fields, including physiology, rehabilitation, design of robots and assistive solutions, exoskeletons. Upper-limb motion is assessed with kinematics and EMG in many scenarios: motor control, physiology, rehabilitation, industry Separation of phasic (movement-related) and tonic (postural) EMG, and of acceleration and deceleration phases Comprehensive and detailed characterization of the EMG of upper-limb and trunk muscles in point-to-point upper limb movements EMG magnitude assessment, phasic and tonic EMG activations, directional tuning, acceleration and deceleration phases
Collapse
Affiliation(s)
- Robert Mihai Mira
- Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing (STIIMA), National Research Council of Italy (CNR), 23900, Lecco, Italy
| | - Lorenzo Molinari Tosatti
- Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing (STIIMA), National Research Council of Italy (CNR), 23900, Lecco, Italy
| | - Marco Sacco
- Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing (STIIMA), National Research Council of Italy (CNR), 23900, Lecco, Italy
| | - Alessandro Scano
- Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing (STIIMA), National Research Council of Italy (CNR), 23900, Lecco, Italy
| |
Collapse
|
62
|
Bardi E, Dalla Gasperina S, Pedrocchi A, Ambrosini E. Adaptive Cooperative Control for Hybrid FES-Robotic Upper Limb Devices: a Simulation Study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:6398-6401. [PMID: 34892576 DOI: 10.1109/embc46164.2021.9630331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Robotic systems and Functional Electrical Stimulation (FES) are common technologies exploited in motor rehabilitation. However, they present some limits. To overcome the weaknesses of both approaches, hybrid cooperative devices have been developed, which combine the action of the robot and that of the electrically stimulated muscles on the same joint. In this work, we present a novel adaptive cooperative controller for the rehabilitation of the upper limb. The controller comprises an allocator - which breaks down the reference torque between the motor and the FES a-priori contributions based on muscle fatigue estimation - an FES closed-loop controller, and an impedance control loop on the motor to correct trajectory tracking errors. The controller was tested in simulation environment reproducing elbow flexion/extension movements. Results showed that the controller could reduce motor torque requirements with respect to the motor-only case, at the expense of trajectory tracking performance. Moreover, it could improve fatigue management with respect to the FES-only case. In conclusion, the proposed control strategy provides a good trade-off between motor torque consumption and trajectory tracking performance, while the allocator manages fatigue-related phenomena.Clinical relevance-The use of allocation proves to be effective in both reducing motor torque and FES-induced muscle fatigue and might be an effective solution for hybrid FES-robotic systems.
Collapse
|
63
|
Mashizume Y, Zenba Y, Takahashi K. Occupational Therapists' Perceptions of Robotics Use for Patients With Chronic Stroke. Am J Occup Ther 2021; 75:23067. [PMID: 34787638 DOI: 10.5014/ajot.2021.046110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE The effectiveness of robotic therapy in stroke rehabilitation has been established by many studies, and occupational therapists should consider using robotics in their clinical practice. However, little is known about occupational therapy practitioners' experience using robotics. OBJECTIVE To explore occupational therapists' perceptions of the mechanisms and outcomes of occupational therapy using robotics with chronic stroke patients. DESIGN Qualitative study with semistructured focus group interviews. Data were analyzed using thematic analysis. SETTING Hospitals and institutions in Japan in which occupational therapists used robotics in their clinical practice. PARTICIPANTS Twenty-seven occupational therapists with experience in using robotics with chronic stroke patients as a self-training method that involved repetitive movements of a paralyzed upper extremity. Participants were interviewed in nine focus groups. RESULTS Five themes-(1) body function, (2) values, (3) performance skills, (4) occupational performance, and (5) participation-and 12 subthemes were identified on the basis of the Occupational Therapy Practice Framework: Domain and Process (3rd ed.). Participants indicated that robotics improved patients' body function and promoted a desire for independence, which resulted in improved occupational performance and participation in their desired occupations. CONCLUSIONS AND RELEVANCE Occupational therapists regarded robotics as an adjunct to other therapy, which improved patients' body function and promoted their desire for independence. What This Article Adds: Findings from this research provide insights into using robotics to enhance occupational therapy practice.
Collapse
Affiliation(s)
- Yuki Mashizume
- Yuki Mashizume, MS, OTR, is Graduate Student, Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan;
| | - Yosuke Zenba
- Yosuke Zenba, MBA, OTR, is Assistant Professor, Department of Occupational Therapy, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Kayoko Takahashi
- Kayoko Takahashi, ScD, OTR, is Professor, Department of Occupational Therapy, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| |
Collapse
|
64
|
Clark B, Whitall J, Kwakkel G, Mehrholz J, Ewings S, Burridge J. The effect of time spent in rehabilitation on activity limitation and impairment after stroke. Cochrane Database Syst Rev 2021; 10:CD012612. [PMID: 34695300 PMCID: PMC8545241 DOI: 10.1002/14651858.cd012612.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Stroke affects millions of people every year and is a leading cause of disability, resulting in significant financial cost and reduction in quality of life. Rehabilitation after stroke aims to reduce disability by facilitating recovery of impairment, activity, or participation. One aspect of stroke rehabilitation that may affect outcomes is the amount of time spent in rehabilitation, including minutes provided, frequency (i.e. days per week of rehabilitation), and duration (i.e. time period over which rehabilitation is provided). Effect of time spent in rehabilitation after stroke has been explored extensively in the literature, but findings are inconsistent. Previous systematic reviews with meta-analyses have included studies that differ not only in the amount provided, but also type of rehabilitation. OBJECTIVES To assess the effect of 1. more time spent in the same type of rehabilitation on activity measures in people with stroke; 2. difference in total rehabilitation time (in minutes) on recovery of activity in people with stroke; and 3. rehabilitation schedule on activity in terms of: a. average time (minutes) per week undergoing rehabilitation, b. frequency (number of sessions per week) of rehabilitation, and c. total duration of rehabilitation. SEARCH METHODS We searched the Cochrane Stroke Group trials register, CENTRAL, MEDLINE, Embase, eight other databases, and five trials registers to June 2021. We searched reference lists of identified studies, contacted key authors, and undertook reference searching using Web of Science Cited Reference Search. SELECTION CRITERIA We included randomised controlled trials (RCTs) of adults with stroke that compared different amounts of time spent, greater than zero, in rehabilitation (any non-pharmacological, non-surgical intervention aimed to improve activity after stroke). Studies varied only in the amount of time in rehabilitation between experimental and control conditions. Primary outcome was activities of daily living (ADLs); secondary outcomes were activity measures of upper and lower limbs, motor impairment measures of upper and lower limbs, and serious adverse events (SAE)/death. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies, extracted data, assessed methodological quality using the Cochrane RoB 2 tool, and assessed certainty of the evidence using GRADE. For continuous outcomes using different scales, we calculated pooled standardised mean difference (SMDs) and 95% confidence intervals (CIs). We expressed dichotomous outcomes as risk ratios (RR) with 95% CIs. MAIN RESULTS The quantitative synthesis of this review comprised 21 parallel RCTs, involving analysed data from 1412 participants. Time in rehabilitation varied between studies. Minutes provided per week were 90 to 1288. Days per week of rehabilitation were three to seven. Duration of rehabilitation was two weeks to six months. Thirteen studies provided upper limb rehabilitation, five general rehabilitation, two mobilisation training, and one lower limb training. Sixteen studies examined participants in the first six months following stroke; the remaining five included participants more than six months poststroke. Comparison of stroke severity or level of impairment was limited due to variations in measurement. The risk of bias assessment suggests there were issues with the methodological quality of the included studies. There were 76 outcome-level risk of bias assessments: 15 low risk, 37 some concerns, and 24 high risk. When comparing groups that spent more time versus less time in rehabilitation immediately after intervention, we found no difference in rehabilitation for ADL outcomes (SMD 0.13, 95% CI -0.02 to 0.28; P = 0.09; I2 = 7%; 14 studies, 864 participants; very low-certainty evidence), activity measures of the upper limb (SMD 0.09, 95% CI -0.11 to 0.29; P = 0.36; I2 = 0%; 12 studies, 426 participants; very low-certainty evidence), and activity measures of the lower limb (SMD 0.25, 95% CI -0.03 to 0.53; P = 0.08; I2 = 48%; 5 studies, 425 participants; very low-certainty evidence). We found an effect in favour of more time in rehabilitation for motor impairment measures of the upper limb (SMD 0.32, 95% CI 0.06 to 0.58; P = 0.01; I2 = 10%; 9 studies, 287 participants; low-certainty evidence) and of the lower limb (SMD 0.71, 95% CI 0.15 to 1.28; P = 0.01; 1 study, 51 participants; very low-certainty evidence). There were no intervention-related SAEs. More time in rehabilitation did not affect the risk of SAEs/death (RR 1.20, 95% CI 0.51 to 2.85; P = 0.68; I2 = 0%; 2 studies, 379 participants; low-certainty evidence), but few studies measured these outcomes. Predefined subgroup analyses comparing studies with a larger difference of total time spent in rehabilitation between intervention groups to studies with a smaller difference found greater improvements for studies with a larger difference. This was statistically significant for ADL outcomes (P = 0.02) and activity measures of the upper limb (P = 0.04), but not for activity measures of the lower limb (P = 0.41) or motor impairment measures of the upper limb (P = 0.06). AUTHORS' CONCLUSIONS An increase in time spent in the same type of rehabilitation after stroke results in little to no difference in meaningful activities such as activities of daily living and activities of the upper and lower limb but a small benefit in measures of motor impairment (low- to very low-certainty evidence for all findings). If the increase in time spent in rehabilitation exceeds a threshold, this may lead to improved outcomes. There is currently insufficient evidence to recommend a minimum beneficial daily amount in clinical practice. The findings of this study are limited by a lack of studies with a significant contrast in amount of additional rehabilitation provided between control and intervention groups. Large, well-designed, high-quality RCTs that measure time spent in all rehabilitation activities (not just interventional) and provide a large contrast (minimum of 1000 minutes) in amount of rehabilitation between groups would provide further evidence for effect of time spent in rehabilitation.
Collapse
Affiliation(s)
- Beth Clark
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Jill Whitall
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, Maryland, USA
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences and Amsterdam, Amsterdam Neurosciences, VU University Medical Center, Amsterdam, Netherlands
| | - Jan Mehrholz
- Department of Public Health, Dresden Medical School, Technical University Dresden, Dresden, Germany
| | - Sean Ewings
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - Jane Burridge
- Research Group, Faculty of Health Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
65
|
Kottink AIR, Nikamp CD, Bos FP, van der Sluis CK, van den Broek M, Onneweer B, Stolwijk-Swüste JM, Brink SM, Voet NB, Buurke JB, Rietman JS, Prange-Lasonder GB. The iHand clinical trial protocol: multi-center uncontrolled intervention study to examine the therapeutic effect of a soft-robotic glove as assistive device to support people with impaired hand strength during activities of daily living (Preprint). JMIR Res Protoc 2021; 11:e34200. [PMID: 35380115 PMCID: PMC9019626 DOI: 10.2196/34200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/31/2022] [Accepted: 03/07/2022] [Indexed: 02/05/2023] Open
Abstract
Background Decline of hand function, especially reduced hand strength, is a common problem that can be caused by many disorders and results in difficulties performing activities of daily living. A wearable soft robotic glove may be a solution, enabling use of the affected arm and hand repeatedly during functional daily activities and providing intensive and task-specific training simultaneously with assistance of hand function. Objective We aim to investigate the therapeutic effect of an assistive soft robotic glove (Carbonhand). Methods This multicenter uncontrolled intervention study consists of 3 preassessments (T0, T1, and T2), a postassessment (T3), and a follow-up assessment (T4). Participants are patients who experience hand function limitations. For the intervention, participants will use the glove during activities of daily living at home for 6 weeks, with a recommended use of at least 180 minutes per week. The primary outcome measure is handgrip strength, and secondary outcome measures are related to functional arm and hand abilities, amount of glove use, and quality of life. Results The first participant was included on June 25, 2019. Currently, the study has been extended due to the COVID-19 pandemic; data collection and analysis are expected to be completed in 2022. Conclusions The Carbonhand system is a wearable assistive device, allowing performance of functional activities to be enhanced directly during functional daily activities. At the same time, active movement of the user is encouraged as much as possible, which has potential to provide highly intensive and task-specific training. As such, it is one of the first assistive devices to incorporate assist-as-needed principles. This is the first powered clinical trial that investigates the unique application of an assistive grip-supporting soft robotic glove outside of clinical settings with the aim to have a therapeutic effect. Trial Registration Netherlands Trial Register NTR NL7561; https://www.trialregister.nl/trial/7561 International Registered Report Identifier (IRRID) DERR1-10.2196/34200
Collapse
Affiliation(s)
- Anke Ida Roza Kottink
- Roessingh Research and Development, Enschede, Netherlands
- Department of Biomechanical Engineering, University of Twente, Enschede, Netherlands
| | - Corien Dm Nikamp
- Roessingh Research and Development, Enschede, Netherlands
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | | | - Corry K van der Sluis
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, Netherlands
| | | | - Bram Onneweer
- Rijndam Rehabilitation, Rotterdam, Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, Netherlands
| | - Janneke M Stolwijk-Swüste
- De Hoogstraat Rehabilitation, Utrecht, Netherlands
- Centre of Excellence for Rehabilitation Medicine, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Sander M Brink
- Department of Rehabilitation Medicine, Isala, Zwolle, Netherlands
| | - Nicoline Bm Voet
- Rehabilitation center Klimmendaal, Arnhem, Netherlands
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Jacob B Buurke
- Roessingh Research and Development, Enschede, Netherlands
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | - Johannes S Rietman
- Roessingh Research and Development, Enschede, Netherlands
- Department of Biomechanical Engineering, University of Twente, Enschede, Netherlands
- Roessingh Center for Rehabilitation, Enschede, Netherlands
| | - Gerdienke B Prange-Lasonder
- Roessingh Research and Development, Enschede, Netherlands
- Department of Biomechanical Engineering, University of Twente, Enschede, Netherlands
| |
Collapse
|
66
|
Chen J, Black I, Nichols D, Chen T, Sandison M, Casas R, Lum PS. Pilot Test of Dosage Effects in HEXORR II for Robotic Hand Movement Therapy in Individuals With Chronic Stroke. FRONTIERS IN REHABILITATION SCIENCES 2021; 2. [PMID: 35419565 PMCID: PMC9004134 DOI: 10.3389/fresc.2021.728753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Impaired use of the hand in functional tasks remains difficult to overcome in many individuals after a stroke. This often leads to compensation strategies using the less-affected limb, which allows for independence in some aspects of daily activities. However, recovery of hand function remains an important therapeutic goal of many individuals, and is often resistant to conventional therapies. In prior work, we developed HEXORR I, a robotic device that allows practice of finger and thumb movements with robotic assistance. In this study, we describe modifications to the device, now called HEXORR II, and a clinical trial in individuals with chronic stroke. Fifteen individuals with a diagnosis of chronic stroke were randomized to 12 or 24 sessions of robotic therapy. The sessions involved playing several video games using thumb and finger movement. The robot applied assistance to extension movement that was adapted based on task performance. Clinical and motion capture evaluations were performed before and after training and again at a 6-month followup. Fourteen individuals completed the protocol. Fugl-Meyer scores improved significantly at the 6 month time point compared to baseline, indicating reductions in upper extremity impairment. Flexor hypertonia (Modified Ashworth Scale) also decreased significantly due to the intervention. Motion capture found increased finger range of motion and extension ability after the intervention that continued to improve during the followup period. However, there was no change in a functional measure (Action Research Arm Test). At the followup, the high dose group had significant gains in hand displacement during a forward reach task. There were no other significant differences between groups. Future work with HEXORR II should focus on integrating it with functional task practice and incorporating grip and squeezing tasks. Trial Registration:ClinicalTrials.gov, NCT04536987. Registered 3 September 2020 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT04536987.
Collapse
Affiliation(s)
- Ji Chen
- Department of Mechanical Engineering, University of the District of Columbia, Washington, DC, United States
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC, United States
| | - Iian Black
- MedStar National Rehabilitation Network, Washington, DC, United States
- Biomedical Engineering Department, Florida International University, Miami, FL, United States
| | - Diane Nichols
- MedStar National Rehabilitation Network, Washington, DC, United States
| | - Tianyao Chen
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC, United States
| | - Melissa Sandison
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC, United States
- MedStar National Rehabilitation Network, Washington, DC, United States
| | - Rafael Casas
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC, United States
- MedStar National Rehabilitation Network, Washington, DC, United States
| | - Peter S. Lum
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC, United States
- MedStar National Rehabilitation Network, Washington, DC, United States
- *Correspondence: Peter S. Lum
| |
Collapse
|
67
|
Casas R, Sandison M, Chen T, Lum PS. Clinical Test of a Wearable, High DOF, Spring Powered Hand Exoskeleton (HandSOME II). IEEE Trans Neural Syst Rehabil Eng 2021; 29:1877-1885. [PMID: 34478375 PMCID: PMC8462990 DOI: 10.1109/tnsre.2021.3110201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
In previous work, we developed an exoskeleton, Hand Spring Operated Movement Enhancer (HandSOME II), that allows movement at 15 hand degrees of freedom (DOF). Eleven separate elastic elements can be added to customize the extension assistance for individuals with impaired hand function. In this pilot study of twelve individuals with stroke, we measured the immediate improvements in range of motion (ROM) and upper extremity function when wearing the device. Index finger ROM was significantly improved at the PIP (p=.01) and DIP joints (p=.026), and the max extension was significantly increased at the MCP (p<.001), PIP (p=.013) and DIP joints (p=.016). The thumb CMC abduction max (p=.017) and CMC flexion/extension ROM also increased (p=.04). In a grip and release task involving various objects, six subjects were unable to complete the tasks without assistance. Across these 6 subjects, 13 of 42 tasks were completed without assistance, while 36 of 42 tasks were completed when wearing HandSOME II. Despite the extension assistance provided by the device, flexion grip force was not statistically decreased. HandSOME II can potentially increase the effectiveness of repetitive task practice in patients with moderate-severe hand impairment by allowing completion of grasp and release tasks that are impossible to complete unassisted.
Collapse
|
68
|
Kraaijkamp JJM, van Dam van Isselt EF, Persoon A, Versluis A, Chavannes NH, Achterberg WP. eHealth in Geriatric Rehabilitation: Systematic Review of Effectiveness, Feasibility, and Usability. J Med Internet Res 2021; 23:e24015. [PMID: 34420918 PMCID: PMC8414304 DOI: 10.2196/24015] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/11/2021] [Accepted: 05/16/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND eHealth has the potential to improve outcomes such as physical activity or balance in older adults receiving geriatric rehabilitation. However, several challenges such as scarce evidence on effectiveness, feasibility, and usability hinder the successful implementation of eHealth in geriatric rehabilitation. OBJECTIVE The aim of this systematic review was to assess evidence on the effectiveness, feasibility, and usability of eHealth interventions in older adults in geriatric rehabilitation. METHODS We searched 7 databases for randomized controlled trials, nonrandomized studies, quantitative descriptive studies, qualitative research, and mixed methods studies that applied eHealth interventions during geriatric rehabilitation. Included studies investigated a combination of effectiveness, usability, and feasibility of eHealth in older patients who received geriatric rehabilitation, with a mean age of ≥70 years. Quality was assessed using the Mixed Methods Appraisal Tool and a narrative synthesis was conducted using a harvest plot. RESULTS In total, 40 studies were selected, with clinical heterogeneity across studies. Of 40 studies, 15 studies (38%) found eHealth was at least as effective as non-eHealth interventions (56% of the 27 studies with a control group), 11 studies (41%) found eHealth interventions were more effective than non-eHealth interventions, and 1 study (4%) reported beneficial outcomes in favor of the non-eHealth interventions. Of 17 studies, 16 (94%) concluded that eHealth was feasible. However, high exclusion rates were reported in 7 studies of 40 (18%). Of 40 studies, 4 (10%) included outcomes related to usability and indicated that there were certain aging-related barriers to cognitive ability, physical ability, or perception, which led to difficulties in using eHealth. CONCLUSIONS eHealth can potentially improve rehabilitation outcomes for older patients receiving geriatric rehabilitation. Simple eHealth interventions were more likely to be feasible for older patients receiving geriatric rehabilitation, especially, in combination with another non-eHealth intervention. However, a lack of evidence on usability might hamper the implementation of eHealth. eHealth applications in geriatric rehabilitation show promise, but more research is required, including research with a focus on usability and participation.
Collapse
Affiliation(s)
- Jules J M Kraaijkamp
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- ZZG Zorggroep, Nijmegen, Netherlands
| | | | - Anke Persoon
- Department of Primary and Community Care, Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
| | - Anke Versluis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| |
Collapse
|
69
|
Zhang Z, Prilutsky BI, Butler AJ, Shinohara M, Ghovanloo M. Design and Preliminary Evaluation of a Tongue-Operated Exoskeleton System for Upper Limb Rehabilitation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8708. [PMID: 34444456 PMCID: PMC8393282 DOI: 10.3390/ijerph18168708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 01/17/2023]
Abstract
Stroke is a devastating condition that may cause upper limb paralysis. Robotic rehabilitation with self-initiated and assisted movements is a promising technology that could help restore upper limb function. Previous studies have established that the tongue motion can be used to communicate human intent and control a rehabilitation robot/assistive device. The goal of this study was to evaluate a tongue-operated exoskeleton system (TDS-KA), which we have developed for upper limb rehabilitation. We adopted a tongue-operated assistive technology, called the tongue drive system (TDS), and interfaced it with the exoskeleton KINARM. We also developed arm reaching and tracking tasks, controlled by different tongue operation modes, for training and evaluation of arm motor function. Arm reaching and tracking tasks were tested in 10 healthy participants (seven males and three females, 23-60 years) and two female stroke survivors with upper extremity impairment (32 and 58 years). All healthy and two stroke participants successfully performed the tasks. One stroke subject demonstrated a clinically significant improvement in Fugl-Meyer upper extremity score after practicing the tasks in six 3-h sessions. We conclude that the TDS-KA system can accurately translate tongue commands to exoskeleton arm movements, quantify the function of the arm, and perform rehabilitation training.
Collapse
Affiliation(s)
- Zhenxuan Zhang
- School of Electrical & Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30308, USA;
| | - Boris I. Prilutsky
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA 30332, USA;
| | - Andrew J. Butler
- School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Minoru Shinohara
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA 30332, USA;
| | | |
Collapse
|
70
|
Platz T, Seidel J, Müller A, Goldmann C, Pedersen AL. THERapy-Related InterACTion (THER-I-ACT) in Rehabilitation-Instrument Development and Inter-Rater Reliability. Front Neurol 2021; 12:716953. [PMID: 34421810 PMCID: PMC8377230 DOI: 10.3389/fneur.2021.716953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/02/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To develop an instrument for the observation of therapeutic communication interactions during rehabilitation sessions and test its inter-rater reliability. Methods: The new instrument THER-I-ACT (THERapy-related Inter-ACTion) has been designed to assess both the frequency and timing of therapeutic interactions in the thematic fields information provision, feedback, other motivational interaction, and bonding. For this inter-rater reliability study, a sample of stroke survivors received arm rehabilitation as either arm ability training, arm basis training, or mirror therapy, or neglect training as individually indicated. Therapy sessions were video-recorded (one for each participant) and therapeutic interactions rated by two independent raters using THER-I-ACT. Results: With regard to the instrument's comprehensiveness to document therapeutic interactions with pre-defined categories the data from 29 sessions suggested almost complete coverage. Inter-rater reliability was very high both for individual categories of therapeutic interaction (frequency and time used for interaction) (intraclass correlation coefficient, ICC 0.91-1.00) and summary scores for the thematic fields of interaction (again for frequency and time used for interaction) (ICC 0.98-1.00). The inter-rater reliability for rating engagement and being focussed for both the therapist and patient was substantial (ICC 0.71 and 0.86). Conclusions: The observational study documented that by use of the newly designed THER-I-ACT various types of therapy-related communication interactions performed by therapists can be assessed with a very high inter-rater reliability. In addition, the thematic fields and categories of therapeutic interaction as defined by the instrument comprehensively covered the type of interaction that occurred in the therapeutic sessions observed.
Collapse
Affiliation(s)
- Thomas Platz
- Neurorehabilitation Research Group, University Medical Centre, Greifswald, Germany
- BDH-Klinik Greifswald, Institute for Neurorehabilitation and Evidence-Based Practice, “An-Institut, ” University of Greifswald, Greifswald, Germany
| | - Jonathan Seidel
- Neurorehabilitation Research Group, University Medical Centre, Greifswald, Germany
| | - Andreas Müller
- Neurorehabilitation Research Group, University Medical Centre, Greifswald, Germany
| | - Carolin Goldmann
- Neurorehabilitation Research Group, University Medical Centre, Greifswald, Germany
| | - Ann Louise Pedersen
- Neurorehabilitation Research Group, University Medical Centre, Greifswald, Germany
| |
Collapse
|
71
|
Boldrini P, Bonaiuti D, Mazzoleni S, Posteraro F. Rehabilitation assisted by robotic and electromechanical devices for people with neurological disabilities: contributions for the preparation of a national conference in Italy. Eur J Phys Rehabil Med 2021; 57:458-459. [PMID: 34281336 DOI: 10.23736/s1973-9087.21.07084-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Paolo Boldrini
- Italian Society of Physical and Rehabilitation Medicine (SIMFER), Rome, Italy
| | | | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy
| | - Federico Posteraro
- Rehabilitation Department, Versilia Hospital, AUSL Toscana Nord Overst, Camaiore, Lucca, Italy
| |
Collapse
|
72
|
Effect of Robot-Assisted Therapy on Participation of People with Limited Upper Limb Functioning: A Systematic Review with GRADE Recommendations. Occup Ther Int 2021; 2021:6649549. [PMID: 34393681 PMCID: PMC8349462 DOI: 10.1155/2021/6649549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 07/18/2021] [Indexed: 12/29/2022] Open
Abstract
Background Previous studies have suggested that robot-assisted therapy (RT) is effective in treating impairment and that it may also improve individuals' participation. Objective To investigate the effect of RT on the participation of individuals with limited upper limb functioning (PROSPERO: CRD42019133880). Data Sources: PEDro, Embase, MEDLINE, CINAHL, Cochrane, AMED, and Compendex. Inclusion Criteria. We selected randomized or quasirandomized controlled studies comparing the effects of RT with minimal or other interventions on participation of individuals with limited upper limb functioning. Data Extraction and Synthesis. Methodological quality of the included studies was assessed using the 0-10 PEDro scale, and effect estimates were reported using standardized mean differences (SMDs) with 95% confidence intervals (CIs), and the certainty of the current evidence was assessed using the GRADE. Results Twelve randomized controlled studies involving 845 participants were included. The estimates of medium effects between RT and minimal intervention (MI) at a short-term follow-up were pooled, but there are no short-term effects between RT and OI. Standardized differences in means were as follows: 0.6 (95% CI 0.1 to 1.2) and 0.2 (95% CI -0.0 to 0.4). There were also no effects of additional RT in the short- or medium-term follow-up periods. Standardized differences in means were as follows: -0.6 (95% CI -1.1 to -0.1) and 0.2 (95% CI -0.3 to 0.8). The methodological quality of the included studies potentially compromised the effect estimates of RT. The existing evidence was very low-quality with many confounding variables between studies. Conclusions For patients with upper limb neurological dysfunction, low-quality evidence supports RT over MI in terms of improving individual participation in the short term. The existing low- to very low-quality evidence does not support RT over OI in either the short- or medium-term follow-up periods with respect to community participation.
Collapse
|
73
|
Qu Q, Lin Y, He Z, Fu J, Zou F, Jiang Z, Guo F, Jia J. The Effect of Applying Robot-Assisted Task-Oriented Training Using Human-Robot Collaborative Interaction Force Control Technology on Upper Limb Function in Stroke Patients: Preliminary Findings. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9916492. [PMID: 34368358 PMCID: PMC8342143 DOI: 10.1155/2021/9916492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/13/2021] [Accepted: 07/11/2021] [Indexed: 02/08/2023]
Abstract
Stroke is one of the leading causes of death and the primary cause of acquired disability worldwide. Many stroke survivors have difficulty using their upper limbs, which have important functional roles in the performance of daily life activities. Consequently, the independence and quality of life of most stroke patients are reduced. Robot-assisted therapy is an effective intervention for improving the upper limb function of individuals with stroke. Human-robot collaborative interaction force control technology is critical for improving the flexibility and followability of the robot's motion, thereby improving rehabilitation training outcomes. However, there are few reports on the effect of robot-assisted rehabilitative training on upper limb function. We applied this technology using a robot to assist patients with task-oriented training. Posttreatment changes in Fugl-Meyer and modified Barthel index (MBI) scores were assessed to determine whether this technology could improve the upper limb function of stroke patients. One healthy adult and five stroke patients, respectively, participated in functional and clinical experiments. The MBI and Fugl-Meyer scores of the five patients in the clinical experiments showed significant improvements after the intervention. The experimental results indicate that human-robot collaborative interaction force control technology is valuable for improving robots' properties and patients' recovery. This trial was registered in the Chinese clinical trial registry (ChiCTR2000038676).
Collapse
Affiliation(s)
- Qingming Qu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, China
| | - Yingnan Lin
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, China
| | - Zhijie He
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, China
| | - Jianghong Fu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, China
| | - Fei Zou
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, China
| | - Zewu Jiang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, China
| | - Fengxian Guo
- Shanghai Electric GeniKIT Medical Science and Technology Co. Ltd., Shanghai, China
| | - Jie Jia
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, China
| |
Collapse
|
74
|
Chen ZJ, Gu MH, He C, Xiong CH, Xu J, Huang XL. Robot-Assisted Arm Training in Stroke Individuals With Unilateral Spatial Neglect: A Pilot Study. Front Neurol 2021; 12:691444. [PMID: 34305798 PMCID: PMC8297561 DOI: 10.3389/fneur.2021.691444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/04/2021] [Indexed: 12/05/2022] Open
Abstract
Background: Robot-assisted arm training (RAT) is an innovative exercise-based therapy that provides highly intensive, adaptive, and task-specific training, yet its effects for stroke individuals with unilateral spatial neglect remain to be explored. The study was aimed to investigate the effects of RAT on unilateral spatial neglect, arm motor function, activities of daily living, and social participation after stroke. Methods: In a pilot randomized controlled trial, individuals with unilateral spatial neglect after right hemisphere stroke were equally allocated to intervention group and control group, 45-min training daily, 5 days/week, for 4 weeks. Outcome measures included the Behavioral Inattention Test-conventional section (BIT-C), Catherine Bergego Scale (CBS), Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Modified Barthel Index (MBI), and World Health Organization Disability Assessment Schedule Version 2.0 (WHODAS 2.0). Results: From November 2018 to February 2021, 20 stroke patients (mean age 47.40 ± 8.47) were enrolled in the study. Robot-assisted arm training was feasible and safe for individuals with unilateral spatial neglect. Both groups had significant improvements in all outcome measures. Participants assigned to RAT therapy had significantly greater improvements in BIT-C (difference, 7.70; 95% CI, 0.55–14.85, P = 0.04), FMA-UE (difference, 5.10; 95% CI, 1.52–8.68, P = 0.01), and WHODAS 2.0 (difference, −7.30; 95% CI, −12.50 to −2.10, P = 0.01). However, the change scores on CBS and MBI demonstrated no significance between the groups. Conclusion: Our findings provide preliminary support for introducing robot-assisted arm training to remediate unilateral spatial neglect after stroke. The training program focusing on neglect of contralateral space and affected upper extremity may be effective in neglect symptoms, motor function recovery, and social participation, while not generalizing into improvements in activities of daily living. Clinical Trial Registration: Chinese Clinical Trial Registry (http://www.chictr.org.cn/) on 17 October 2019, identifier: ChiCTR1900026656.
Collapse
Affiliation(s)
- Ze-Jian Chen
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China
| | - Ming-Hui Gu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China
| | - Chang He
- State Key Lab of Digital Manufacturing Equipment and Technology, Institute of Rehabilitation and Medical Robotics, Huazhong University of Science and Technology, Wuhan, China
| | - Cai-Hua Xiong
- State Key Lab of Digital Manufacturing Equipment and Technology, Institute of Rehabilitation and Medical Robotics, Huazhong University of Science and Technology, Wuhan, China
| | - Jiang Xu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China
| | - Xiao-Lin Huang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China
| |
Collapse
|
75
|
Watanabe H, Marushima A, Kadone H, Shimizu Y, Kubota S, Hino T, Sato M, Ito Y, Hayakawa M, Tsurushima H, Maruo K, Hada Y, Ishikawa E, Matsumaru Y. Efficacy and Safety Study of Wearable Cyborg HAL (Hybrid Assistive Limb) in Hemiplegic Patients With Acute Stroke (EARLY GAIT Study): Protocols for a Randomized Controlled Trial. Front Neurosci 2021; 15:666562. [PMID: 34276288 PMCID: PMC8282932 DOI: 10.3389/fnins.2021.666562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/03/2021] [Indexed: 11/29/2022] Open
Abstract
We hypothesized that gait treatment with a wearable cyborg Hybrid Assistive Limb (HAL) would improve the walking ability of patients with hemiparesis after stroke. This study aims to evaluate the efficacy and safety of gait treatment using HAL versus conventional gait training (CGT) in hemiplegic patients with acute stroke and establish a protocol for doctor-initiated clinical trials for acute stroke. We will enroll patients with acute stroke at the University of Tsukuba Hospital. This study is a single-center, randomized, parallel-group, controlled trial (HAL group, n = 20; control group, n = 20) that will include three phases: (1) pre-observation phase (patient enrollment, baseline assessment, and randomization); (2) treatment phase (nine sessions, twice or thrice per week over 3−4 weeks; the HAL and control groups will perform gait treatment using HAL or CGT, respectively, and finally (3) post-treatment evaluation phase. The Functional Ambulation Category score will be the primary outcome measure, and the following secondary outcome measures will be assessed: Mini-Mental State Examination, Brunnstrom recovery stage of lower limbs, Fugl–Meyer assessment of lower limbs, 6-min walking distance, comfortable gait speed, step length, cadence, Barthel Index, Functional Independence Measure, gait posture, motion analysis (muscle activity), amount of activity (evaluated using an activity meter), stroke-specific QOL, and modified Rankin Scale score. The baseline assessment, post-treatment evaluation, and follow-up assessment will evaluate the overall outcome measures; for other evaluations, physical function evaluation centered on walking will be performed exclusively, excluding ADL and QOL scores. This study is a randomized controlled trial that aims to clarify the efficacy and safety of gait treatment using HAL compared with CGT in hemiplegic patients with acute stroke. In addition, we aim to establish a protocol for doctor-initiated clinical trials for acute stroke based on the study results. If our results demonstrate the effectiveness of the proposed treatment regarding outcomes of patients with hemiplegic acute stroke, this study will promote the treatment of these patients using the HAL system as an effective tool in future stroke rehabilitation programs. The study protocol was registered with the Japan Registry of Clinical Trials on October 14, 2020 (jRCTs032200151).
Collapse
Affiliation(s)
- Hiroki Watanabe
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hideki Kadone
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shigeki Kubota
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tenyu Hino
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masayuki Sato
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoshiro Ito
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Mikito Hayakawa
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hideo Tsurushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazushi Maruo
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| |
Collapse
|
76
|
Roby-Brami A, Jarrassé N, Parry R. Impairment and Compensation in Dexterous Upper-Limb Function After Stroke. From the Direct Consequences of Pyramidal Tract Lesions to Behavioral Involvement of Both Upper-Limbs in Daily Activities. Front Hum Neurosci 2021; 15:662006. [PMID: 34234659 PMCID: PMC8255798 DOI: 10.3389/fnhum.2021.662006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/27/2021] [Indexed: 01/02/2023] Open
Abstract
Impairments in dexterous upper limb function are a significant cause of disability following stroke. While the physiological basis of movement deficits consequent to a lesion in the pyramidal tract is well demonstrated, specific mechanisms contributing to optimal recovery are less apparent. Various upper limb interventions (motor learning methods, neurostimulation techniques, robotics, virtual reality, and serious games) are associated with improvements in motor performance, but many patients continue to experience significant limitations with object handling in everyday activities. Exactly how we go about consolidating adaptive motor behaviors through the rehabilitation process thus remains a considerable challenge. An important part of this problem is the ability to successfully distinguish the extent to which a given gesture is determined by the neuromotor impairment and that which is determined by a compensatory mechanism. This question is particularly complicated in tasks involving manual dexterity where prehensile movements are contingent upon the task (individual digit movement, grasping, and manipulation…) and its objective (placing, two step actions…), as well as personal factors (motivation, acquired skills, and life habits…) and contextual cues related to the environment (presence of tools or assistive devices…). Presently, there remains a lack of integrative studies which differentiate processes related to structural changes associated with the neurological lesion and those related to behavioral change in response to situational constraints. In this text, we shall question the link between impairments, motor strategies and individual performance in object handling tasks. This scoping review will be based on clinical studies, and discussed in relation to more general findings about hand and upper limb function (manipulation of objects, tool use in daily life activity). We shall discuss how further quantitative studies on human manipulation in ecological contexts may provide greater insight into compensatory motor behavior in patients with a neurological impairment of dexterous upper-limb function.
Collapse
Affiliation(s)
- Agnès Roby-Brami
- ISIR Institute of Intelligent Systems and Robotics, AGATHE Team, CNRS UMR 7222, INSERM U 1150, Sorbonne University, Paris, France
| | - Nathanaël Jarrassé
- ISIR Institute of Intelligent Systems and Robotics, AGATHE Team, CNRS UMR 7222, INSERM U 1150, Sorbonne University, Paris, France
| | - Ross Parry
- ISIR Institute of Intelligent Systems and Robotics, AGATHE Team, CNRS UMR 7222, INSERM U 1150, Sorbonne University, Paris, France.,LINP2-AAPS Laboratoire Interdisciplinaire en Neurosciences, Physiologie et Psychologie: Activité Physique, Santé et Apprentissages, UPL, Paris Nanterre University, Nanterre, France
| |
Collapse
|
77
|
Kadivar Z, Beck CE, Rovekamp RN, O'Malley MK. Single limb cable driven wearable robotic device for upper extremity movement support after traumatic brain injury. J Rehabil Assist Technol Eng 2021; 8:20556683211002448. [PMID: 34123404 PMCID: PMC8175840 DOI: 10.1177/20556683211002448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/24/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Recently, soft exosuits have been proposed for upper limb movement assistance, most supporting single joint movements. We describe the design of a portable wearable robotic device (WRD), “Armstrong,” able to support three degrees-of-freedom of arm movements, and report on its feasibility for movement support of individuals with hemiparesis after traumatic brain injury (TBI). Methods We introduce Armstrong and report on a pilot evaluation with two male individuals post-TBI (T1 and T2) and two healthy individuals. Testing involved elbow flexion/extension with and without robotic-assisted shoulder stabilization; shoulder abduction with and without robotic-assisted elbow stabilization; and assisted shoulder abduction and flexion. Outcome measures included range of motion and root mean square trajectory and velocity errors. Results TBI subjects performed active, passive, hybrid and active assistive movements with Armstrong. Subjects showed improvements in movement trajectory and velocity. T1 benefited from hybrid, active, and assistive modes due to upper extremity weakness and muscle tone. T2 benefited from hybrid and assistive modes due to impaired coordination. Healthy subjects performed isolated movements of shoulder and elbow with minimal trajectory and velocity errors. Conclusions This study demonstrates the safety and feasibility of Armstrong for upper extremity movement assistance for individuals with TBI, with therapist supervision.
Collapse
Affiliation(s)
- Zahra Kadivar
- Texas Institute for Rehabilitation and Research, Houston, TX, USA
| | | | | | - Marcia K O'Malley
- Department of Mechanical Engineering, Rice University, Houston, TX, USA
| |
Collapse
|
78
|
Gandolfi M, Valè N, Posteraro F, Morone G, Dell'orco A, Botticelli A, Dimitrova E, Gervasoni E, Goffredo M, Zenzeri J, Antonini A, Daniele C, Benanti P, Boldrini P, Bonaiuti D, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzon S, Molteni F, Petrarca M, Picelli A, Senatore M, Turchetti G, Giansanti D, Mazzoleni S. State of the art and challenges for the classification of studies on electromechanical and robotic devices in neurorehabilitation: a scoping review. Eur J Phys Rehabil Med 2021; 57:831-840. [PMID: 34042413 DOI: 10.23736/s1973-9087.21.06922-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The rapid development of electromechanical and robotic devices has profoundly influenced neurorehabilitation. Growth in the scientific and technological aspects thereof is crucial for increasing the number of newly developed devices, and clinicians have welcomed such growth with enthusiasm. Nevertheless, improving the standard for the reporting clinical, technical, and normative aspects of such electromechanical and robotic devices remains an unmet need in neurorehabilitation. Accordingly, this study aimed to analyse the existing literature on electromechanical and robotic devices used in neurorehabilitation, considering the current clinical, technical, and regulatory classification systems. EVIDENCE ACQUISITION Within the CICERONE Consensus Conference framework, studies on electromechanical and robotic devices used for upper- and lower-limb rehabilitation in persons with neurological disabilities in adulthood and childhood were reviewed. We have conducted a literature search using the following databases: MEDLINE, Cochrane Library, PeDro, Institute of Electrical and Electronics Engineers, Science Direct, and Google Scholar. Clinical, technical, and regulatory classification systems were applied to collect information on the electromechanical and robotic devices. The study designs and populations were investigated. EVIDENCE SYNTHESIS Overall, 316 studies were included in the analysis. More than half (52%) of the studies were randomised controlled trials (RCTs). The population investigated the most suffered from strokes, followed by spinal cord injuries, multiple sclerosis, cerebral palsy, and traumatic brain injuries. In total, 100 devices were described; of these, 19% were certified with the CE mark. Overall, the main type of device was an exoskeleton. However, end-effector devices were primarily used for the upper limbs, whereas exoskeletons were used for the lower limbs (for both children and adults). CONCLUSIONS The current literature on robotic neurorehabilitation lacks detailed information regarding the technical characteristics of the devices used. This affects the understanding of the possible mechanisms underlying recovery. Unfortunately, many electromechanical and robotic devices are not provided with CE marks, strongly hindering the research on the clinical outcomes of rehabilitation treatments based on these devices. A more significant effort is needed to improve the description of the robotic devices used in neurorehabilitation in terms of the technical and functional details, along with high-quality RCT studies.
Collapse
Affiliation(s)
- Marialuisa Gandolfi
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Neurorehabilitation Unit, University Hospital of Verona, Italy -
| | - Nicola Valè
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Posteraro
- Rehabilitation Department Versilia Hospital, ASL Toscana Nord-Ovest, Italy
| | | | - Antonella Dell'orco
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Neurorehabilitation Unit, University Hospital of Verona, Italy
| | - Anita Botticelli
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Neurorehabilitation Unit, University Hospital of Verona, Italy
| | - Eleonora Dimitrova
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Michela Goffredo
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Jacopo Zenzeri
- Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Genova, Italy
| | | | | | | | - Paolo Boldrini
- Italian Society of Physical Medicine and Rehabilitation (SIMFER), Italy
| | | | - Enrico Castelli
- Pediatric Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Vincenzo Falabella
- President Italian Federation of Persons with Spinal Cord Injuries (Flip Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli, " Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzon
- ULSS 6 (Unique Sanitary Local Company) Euganea Padova - Distretto IV Alta Padovana, Padova, Italy
| | | | - Maurizio Petrarca
- The Movement Analysis and Robotics Laboratory, Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Neurorehabilitation Unit, University Hospital of Verona, Italy
| | | | | | - Daniele Giansanti
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Italy
| | | |
Collapse
|
79
|
Huang MZ, Yoon YS, Yang J, Yang CY, Zhang LQ. In-Bed Sensorimotor Rehabilitation in Early and Late Subacute Stroke Using a Wearable Elbow Robot: A Pilot Study. Front Hum Neurosci 2021; 15:669059. [PMID: 34108868 PMCID: PMC8180557 DOI: 10.3389/fnhum.2021.669059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/13/2021] [Indexed: 11/13/2022] Open
Abstract
Objects: To evaluate the feasibility and effectiveness of in-bed wearable elbow robot training for motor recovery in patients with early and late subacute stroke. Methods: Eleven in-patient stroke survivors (male/female: 7/4, age: 50.7 ± 10.6 years, post-stroke duration: 2.6 ± 1.9 months) received 15 sessions of training over about 4 weeks of hospital stay. During each hourly training, participants received passive stretching and active movement training with motivating games using a wearable elbow rehabilitation robot. Isometric maximum muscle strength (MVC) of elbow flexors and extensors was evaluated using the robot at the beginning and end of each training session. Clinical measures including Fugl-Meyer Assessment of upper extremity (FMA-UE), Motricity Index (MI) for upper extremities, Modified Ashworth Scale (MAS) were measured at baseline, after the 4-week training program, and at a 1-month follow-up. The muscle strength recovery curve over the training period was characterized as a logarithmic learning curve with three parameters (i.e., initial muscle strength, rate of improvement, and number of the training session). Results: At the baseline, participants had moderate to severe upper limb motor impairment {FMA-UE [median (interquartile range)]: 28 (18-45)} and mild spasticity in elbow flexors {MAS [median (interquartile range)]: 0 (0-1)}. After about 4 weeks of training, significant improvements were observed in FMA-UE (p = 0.003) and MI (p = 0.005), and the improvements were sustained at the follow-up. The elbow flexors MVC significantly increased by 1.93 Nm (95% CI: 0.93 to 2.93 Nm, p = 0.017) and the elbow extensor MVC increased by 0.68 Nm (95% CI: 0.05 to 1.98 Nm, p = 0.036). Muscle strength recovery curve showed that patients with severe upper limb motor impairment had a greater improvement rate in elbow flexor strength than those with moderate motor impairment. Conclusion: In-bed wearable elbow robotic rehabilitation is feasible and effective in improving biomechanical and clinical outcomes for early and late subacute stroke in-patients. Results from the pilot study suggested that patients with severe upper limb motor impairment may benefit more from the robot training compared to those with moderate impairment.
Collapse
Affiliation(s)
- Mei Zhen Huang
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Yong-Soon Yoon
- Department of Rehabilitation Medicine, Presbyterian Medical Center, Jeonbuk, South Korea
| | - Jisu Yang
- Department of Neuroscience and Behavioral Biology, College of Arts and Sciences, Emory University, Atlanta, GA, United States
| | - Chung-Yong Yang
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD, United States.,Department of Physical Medicine and Rehabilitation, The Seum Hospital, Jeonbuk, South Korea
| | - Li-Qun Zhang
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD, United States.,Department of Orthopaedics, University of Maryland, Baltimore, MD, United States.,Department of Bioengineering, University of Maryland, College Park, MD, United States
| |
Collapse
|
80
|
De Oliveira AC, Sulzer JS, Deshpande AD. Assessment of Upper-Extremity Joint Angles Using Harmony Exoskeleton. IEEE Trans Neural Syst Rehabil Eng 2021; 29:916-925. [PMID: 33872155 DOI: 10.1109/tnsre.2021.3074101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The biomechanical complexity of the human shoulder, while critical for functionality, poses a challenge for objective assessment during sensorimotor rehabilitation. With built-in sensing capabilities, robotic exoskeletons have the potential to serve as tools for both intervention and assessment. The bilateral upper-extremity Harmony exoskeleton is capable of full shoulder articulation, forearm flexion-extension, and wrist pronation-supination motions. The goal of this paper is to characterize Harmony's anatomical joint angle tracking accuracy towards its use as an assessment tool. We evaluated the agreement between anatomical joint angles estimated from the robot's sensor data and optical motion capture markers attached to the human user. In 9 healthy participants we examined 6 upper-extremity joint angles, including shoulder girdle angles, across 4 different motions, varying active/passive motion of the user and physical constraint of the trunk. We observed mostly good to excellent levels of agreement between measurement systems with for shoulder and distal joints, magnitudes of average discrepancies varying from 0.43° to 16.03° and width of LoAs ranging between 9.44° and 41.91°. Slopes were between 1.03 and 1.43 with r > 0.9 for shoulder and distal joints. Regression analysis suggested that discrepancies observed between measured robot and human motions were primarily due to relative motion associated with soft tissue deformation. The results suggest that the Harmony exoskeleton is capable of providing accurate measurements of arm and shoulder joint kinematics. These findings may lead to robot-assisted assessment and intervention of one of the most complex joint structures in the human body.
Collapse
|
81
|
Zhou H, Zhang Q, Zhang M, Shahnewaz S, Wei S, Ruan J, Zhang X, Zhang L. Toward Hand Pattern Recognition in Assistive and Rehabilitation Robotics Using EMG and Kinematics. Front Neurorobot 2021; 15:659876. [PMID: 34054455 PMCID: PMC8155590 DOI: 10.3389/fnbot.2021.659876] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/09/2021] [Indexed: 11/13/2022] Open
Abstract
Wearable hand robots are becoming an attractive means in the facilitating of assistance with daily living and hand rehabilitation exercises for patients after stroke. Pattern recognition is a crucial step toward the development of wearable hand robots. Electromyography (EMG) is a commonly used biological signal for hand pattern recognition. However, the EMG based pattern recognition performance in assistive and rehabilitation robotics post stroke remains unsatisfactory. Moreover, low cost kinematic sensors such as Leap Motion is recently used for pattern recognition in various applications. This study proposes feature fusion and decision fusion method that combines EMG features and kinematic features for hand pattern recognition toward application in upper limb assistive and rehabilitation robotics. Ten normal subjects and five post stroke patients participating in the experiments were tested with eight hand patterns of daily activities while EMG and kinematics were recorded simultaneously. Results showed that average hand pattern recognition accuracy for post stroke patients was 83% for EMG features only, 84.71% for kinematic features only, 96.43% for feature fusion of EMG and kinematics, 91.18% for decision fusion of EMG and kinematics. The feature fusion and decision fusion was robust as three different levels of noise was given to the classifiers resulting in small decrease of classification accuracy. Different channel combination comparisons showed the fusion classifiers would be robust despite failure of specific EMG channels which means that the system has promising potential in the field of assistive and rehabilitation robotics. Future work will be conducted with real-time pattern classification on stroke survivors.
Collapse
Affiliation(s)
- Hui Zhou
- School of Automation, Nanjing University of Science and Technology, Nanjing, China
| | - Qianqian Zhang
- School of Automation, Nanjing University of Science and Technology, Nanjing, China
| | - Mengjun Zhang
- School of Automation, Nanjing University of Science and Technology, Nanjing, China
| | - Sameer Shahnewaz
- School of Automation, Nanjing University of Science and Technology, Nanjing, China
| | - Shaocong Wei
- School of Automation, Nanjing University of Science and Technology, Nanjing, China
| | - Jingzhi Ruan
- School of Automation, Nanjing University of Science and Technology, Nanjing, China
| | - Xinyan Zhang
- Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Lingling Zhang
- Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| |
Collapse
|
82
|
Conti S, Spalletti C, Pasquini M, Giordano N, Barsotti N, Mainardi M, Lai S, Giorgi A, Pasqualetti M, Micera S, Caleo M. Combining robotics with enhanced serotonin-driven cortical plasticity improves post-stroke motor recovery. Prog Neurobiol 2021; 203:102073. [PMID: 33984455 DOI: 10.1016/j.pneurobio.2021.102073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/22/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
Despite recent progresses in robotic rehabilitation technologies, their efficacy for post-stroke motor recovery is still limited. Such limitations might stem from the insufficient enhancement of plasticity mechanisms, crucial for functional recovery. Here, we designed a clinically relevant strategy that combines robotic rehabilitation with chemogenetic stimulation of serotonin release to boost plasticity. These two approaches acted synergistically to enhance post-stroke motor performance. Indeed, mice treated with our combined therapy showed substantial functional gains that persisted beyond the treatment period and generalized to non-trained tasks. Motor recovery was associated with a reduction in electrophysiological and neuroanatomical markers of GABAergic neurotransmission, suggesting disinhibition in perilesional areas. To unveil the translational potentialities of our approach, we specifically targeted the serotonin 1A receptor by delivering Buspirone, a clinically approved drug, in stroke mice undergoing robotic rehabilitation. Administration of Buspirone restored motor impairments similarly to what observed with chemogenetic stimulation, showing the immediate translational potential of this combined approach to significantly improve motor recovery after stroke.
Collapse
Affiliation(s)
- S Conti
- Translational Neural Engineering Area, The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - C Spalletti
- Institute of Neuroscience, National Research Council (CNR), Pisa, Italy
| | - M Pasquini
- Translational Neural Engineering Area, The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - N Giordano
- Institute of Neuroscience, National Research Council (CNR), Pisa, Italy
| | - N Barsotti
- Unit of Cell and Developmental Biology, Department of Biology, University of Pisa, Italy
| | - M Mainardi
- Institute of Neuroscience, National Research Council (CNR), Pisa, Italy
| | - S Lai
- Translational Neural Engineering Area, The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - A Giorgi
- Unit of Cell and Developmental Biology, Department of Biology, University of Pisa, Italy
| | - M Pasqualetti
- Unit of Cell and Developmental Biology, Department of Biology, University of Pisa, Italy; Center for Neuroscience and Cognitive Systems, Istituto Italiano di Tecnologia, Rovereto, Italy
| | - S Micera
- Translational Neural Engineering Area, The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; Bertarelli Foundation Chair in Translational NeuroEngineering Laboratory, École Polytechnique Fédérale de Lausanne (EPFL), Centre for Neuroprosthetics and Institute of Bioengineering, Lausanne, Switzerland.
| | - M Caleo
- Institute of Neuroscience, National Research Council (CNR), Pisa, Italy; Department of Biomedical Sciences, University of Padova, Italy.
| |
Collapse
|
83
|
Aprile I, Guardati G, Cipollini V, Papadopoulou D, Monteleone S, Redolfi A, Garattini R, Sacella G, Noro F, Galeri S, Carrozza MC, Germanotta M. Influence of Cognitive Impairment on the Recovery of Subjects with Subacute Stroke Undergoing Upper Limb Robotic Rehabilitation. Brain Sci 2021; 11:brainsci11050587. [PMID: 33946452 PMCID: PMC8147141 DOI: 10.3390/brainsci11050587] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 01/29/2023] Open
Abstract
Cognitive decline is often present in stroke survivors, with a significant impact on motor recovery. However, how specific cognitive domains could impact motor recovery after robotic rehabilitation in patients with stroke is still not well understood. In this study, we analyzed the relationship between cognitive impairment and the outcome of a robot-mediated upper limb rehabilitation intervention in a sample of 51 subacute stroke patients. Participants were enrolled and treated with a set of robotic and sensor-based devices. Before the intervention, patients underwent a cognitive assessment by means of the Oxford Cognitive Screen. To assess the effect of the 30-session rehabilitation intervention, patients were assessed twice with the following outcome measures: the Fugl-Meyer Assessment for Upper Extremity (FMA-UE), to evaluate motor function; the Upper limb Motricity Index (MI), to evaluate upper limb muscle strength; the Modified Barthel Index (mBI), to evaluate activities of daily living and mobility. We found that deficits in spatial attention and executive functions impacted the mBI improvement, while language, number processing, and spatial attention deficits reduced the gains in the FMA-UE. These results suggest the importance to evaluate the cognitive functions using an adequate tool in patients with stroke undergoing a robotic rehabilitation intervention.
Collapse
Affiliation(s)
- Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (I.A.); (G.G.); (V.C.); (D.P.)
| | - Giulia Guardati
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (I.A.); (G.G.); (V.C.); (D.P.)
| | - Valeria Cipollini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (I.A.); (G.G.); (V.C.); (D.P.)
| | - Dionysia Papadopoulou
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (I.A.); (G.G.); (V.C.); (D.P.)
| | - Serena Monteleone
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20121 Milan, Italy; (S.M.); (A.R.); (R.G.); (G.S.); (F.N.); (S.G.); (M.C.C.)
| | - Alessandra Redolfi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20121 Milan, Italy; (S.M.); (A.R.); (R.G.); (G.S.); (F.N.); (S.G.); (M.C.C.)
| | - Romina Garattini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20121 Milan, Italy; (S.M.); (A.R.); (R.G.); (G.S.); (F.N.); (S.G.); (M.C.C.)
| | - Gianluigi Sacella
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20121 Milan, Italy; (S.M.); (A.R.); (R.G.); (G.S.); (F.N.); (S.G.); (M.C.C.)
| | - Fulvia Noro
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20121 Milan, Italy; (S.M.); (A.R.); (R.G.); (G.S.); (F.N.); (S.G.); (M.C.C.)
| | - Silvia Galeri
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20121 Milan, Italy; (S.M.); (A.R.); (R.G.); (G.S.); (F.N.); (S.G.); (M.C.C.)
| | - Maria Chiara Carrozza
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20121 Milan, Italy; (S.M.); (A.R.); (R.G.); (G.S.); (F.N.); (S.G.); (M.C.C.)
- The Biorobotics Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Marco Germanotta
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (I.A.); (G.G.); (V.C.); (D.P.)
- Correspondence: ; Tel.: +39-0633086553
| |
Collapse
|
84
|
Pastorino R, Loreti C, Giovannini S, Ricciardi W, Padua L, Boccia S. Challenges of Prevention for a Sustainable Personalized Medicine. J Pers Med 2021; 11:jpm11040311. [PMID: 33923579 PMCID: PMC8073054 DOI: 10.3390/jpm11040311] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 02/07/2023] Open
Abstract
The development and implementation of the approaches of personalized medicine for disease prevention are still at infancy, although preventive activities in healthcare represent a key pillar to guarantee health system sustainability. There is an increasing interest in finding informative markers that indicate the disease risk before the manifestation of the disease (primary prevention) or for early disease detection (secondary prevention). Recently, the systematic collection and study of clinical phenotypes and biomarkers consented to the advance of Rehabilomics in tertiary prevention. It consents to identify relevant molecular and physiological factors that can be linked to plasticity, treatment response, and natural recovery. Implementation of these approaches would open avenues to identify people at high risk and enable new preventive lifestyle interventions or early treatments targeted to their individual genomic profile, personalizing prevention and rehabilitation. The integration of personalized medicine into prevention may benefit citizens, patients, healthcare professionals, healthcare authorities, and industry, and ultimately will seek to contribute to better health and quality of life for Europe’s citizens.
Collapse
Affiliation(s)
- Roberta Pastorino
- Department of Woman and Child Health and Public Health—Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.P.); (S.B.)
| | - Claudia Loreti
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.G.); (L.P.)
- Correspondence:
| | - Silvia Giovannini
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.G.); (L.P.)
| | - Walter Ricciardi
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Luca Padua
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.G.); (L.P.)
- Dipartimento di Scienze Geriatriche e Ortopediche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Stefania Boccia
- Department of Woman and Child Health and Public Health—Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.P.); (S.B.)
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| |
Collapse
|
85
|
Raglio A, Panigazzi M, Colombo R, Tramontano M, Iosa M, Mastrogiacomo S, Baiardi P, Molteni D, Baldissarro E, Imbriani C, Imarisio C, Eretti L, Hamedani M, Pistarini C, Imbriani M, Mancardi GL, Caltagirone C. Hand rehabilitation with sonification techniques in the subacute stage of stroke. Sci Rep 2021; 11:7237. [PMID: 33790343 PMCID: PMC8012636 DOI: 10.1038/s41598-021-86627-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 03/17/2021] [Indexed: 11/25/2022] Open
Abstract
After a stroke event, most survivors suffer from arm paresis, poor motor control and other disabilities that make activities of daily living difficult, severely affecting quality of life and personal independence. This randomized controlled trial aimed at evaluating the efficacy of a music-based sonification approach on upper limbs motor functions, quality of life and pain perceived during rehabilitation. The study involved 65 subacute stroke individuals during inpatient rehabilitation allocated into 2 groups which underwent usual care dayweek) respectively of standard upper extremity motor rehabilitation or upper extremity treatment with sonification techniques. The Fugl-Meyer Upper Extremity Scale, Box and Block Test and the Modified Ashworth Scale were used to perform motor assessment and the McGill Quality of Life-it and the Numerical Pain Rating Scale to assess quality of life and pain. The assessment was performed at baseline, after 2 weeks, at the end of treatment and at follow-up (1 month after the end of treatment). Total scores of the Fugl-Meyer Upper Extremity Scale (primary outcome measure) and hand and wrist sub scores, manual dexterity scores of the affected and unaffected limb in the Box and Block Test, pain scores of the Numerical Pain Rating Scale (secondary outcomes measures) significantly improved in the sonification group compared to the standard of care group (time*group interaction < 0.05). Our findings suggest that music-based sonification sessions can be considered an effective standardized intervention for the upper limb in subacute stroke rehabilitation.
Collapse
Affiliation(s)
- Alfredo Raglio
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Istituti Clinici Scientifici Maugeri, Music Therapy Research Laboratory, Scientific Institute of Pavia , Via Maugeri 10, 27100, Pavia, Italy.
| | - Monica Panigazzi
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Istituti Clinici Scientifici Maugeri, Music Therapy Research Laboratory, Scientific Institute of Pavia , Via Maugeri 10, 27100, Pavia, Italy
| | - Roberto Colombo
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Istituti Clinici Scientifici Maugeri, Music Therapy Research Laboratory, Scientific Institute of Pavia , Via Maugeri 10, 27100, Pavia, Italy
| | | | - Marco Iosa
- Fondazione S. Lucia, I.R.C.C.S., Rome, Italy
| | | | - Paola Baiardi
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Istituti Clinici Scientifici Maugeri, Music Therapy Research Laboratory, Scientific Institute of Pavia , Via Maugeri 10, 27100, Pavia, Italy
| | - Daniele Molteni
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Istituti Clinici Scientifici Maugeri, Music Therapy Research Laboratory, Scientific Institute of Pavia , Via Maugeri 10, 27100, Pavia, Italy
| | | | - Chiara Imbriani
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Istituti Clinici Scientifici Maugeri, Music Therapy Research Laboratory, Scientific Institute of Pavia , Via Maugeri 10, 27100, Pavia, Italy
| | - Chiara Imarisio
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Istituti Clinici Scientifici Maugeri, Music Therapy Research Laboratory, Scientific Institute of Pavia , Via Maugeri 10, 27100, Pavia, Italy
| | - Laura Eretti
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S, Montescano, PV, Italy
| | - Mehrnaz Hamedani
- Neurological Clinic, S. Martino Hospital, University of Genoa, Genoa, Italy
| | - Caterina Pistarini
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Nervi (GE), Pavia, Italy
| | - Marcello Imbriani
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Istituti Clinici Scientifici Maugeri, Music Therapy Research Laboratory, Scientific Institute of Pavia , Via Maugeri 10, 27100, Pavia, Italy
| | | | | |
Collapse
|
86
|
Bessler J, Prange-Lasonder GB, Schaake L, Saenz JF, Bidard C, Fassi I, Valori M, Lassen AB, Buurke JH. Safety Assessment of Rehabilitation Robots: A Review Identifying Safety Skills and Current Knowledge Gaps. Front Robot AI 2021; 8:602878. [PMID: 33937345 PMCID: PMC8080797 DOI: 10.3389/frobt.2021.602878] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/28/2021] [Indexed: 11/19/2022] Open
Abstract
The assessment of rehabilitation robot safety is a vital aspect of the development process, which is often experienced as difficult. There are gaps in best practices and knowledge to ensure safe usage of rehabilitation robots. Currently, safety is commonly assessed by monitoring adverse events occurrence. The aim of this article is to explore how safety of rehabilitation robots can be assessed early in the development phase, before they are used with patients. We are suggesting a uniform approach for safety validation of robots closely interacting with humans, based on safety skills and validation protocols. Safety skills are an abstract representation of the ability of a robot to reduce a specific risk or deal with a specific hazard. They can be implemented in various ways, depending on the application requirements, which enables the use of a single safety skill across a wide range of applications and domains. Safety validation protocols have been developed that correspond to these skills and consider domain-specific conditions. This gives robot users and developers concise testing procedures to prove the mechanical safety of their robotic system, even when the applications are in domains with a lack of standards and best practices such as the healthcare domain. Based on knowledge about adverse events occurring in rehabilitation robot use, we identified multi-directional excessive forces on the soft tissue level and musculoskeletal level as most relevant hazards for rehabilitation robots and related them to four safety skills, providing a concrete starting point for safety assessment of rehabilitation robots. We further identified a number of gaps which need to be addressed in the future to pave the way for more comprehensive guidelines for rehabilitation robot safety assessments. Predominantly, besides new developments of safety by design features, there is a strong need for reliable measurement methods as well as acceptable limit values for human-robot interaction forces both on skin and joint level.
Collapse
Affiliation(s)
- Jule Bessler
- Roessingh Research and Development, Enschede, Netherlands.,Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | - Gerdienke B Prange-Lasonder
- Roessingh Research and Development, Enschede, Netherlands.,Department of Biomechanical Engineering, University of Twente, Enschede, Netherlands
| | | | - José F Saenz
- Fraunhofer Institute for Factory Operation and Automation, Magdeburg, Germany
| | | | - Irene Fassi
- National Research Council of Italy, Milan, Italy
| | | | - Aske Bach Lassen
- Department of Robot Technology, Danish Technological Institute, Odense, Denmark
| | - Jaap H Buurke
- Roessingh Research and Development, Enschede, Netherlands.,Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| |
Collapse
|
87
|
Chen Z, Xia N, He C, Gu M, Xu J, Han X, Huang X. Action observation treatment-based exoskeleton (AOT-EXO) for upper extremity after stroke: study protocol for a randomized controlled trial. Trials 2021; 22:222. [PMID: 33743788 PMCID: PMC7981809 DOI: 10.1186/s13063-021-05176-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background Stroke produces multiple symptoms, including sensory, motor, cognitive and psychological dysfunctions, among which motor deficit is the most common and is widely recognized as a major contributor to long-term functional disability. Robot-assisted training is effective in promoting upper extremity muscle strength and motor impairment recovery after stroke. Additionally, action observation treatment can enhance the effects of physical and occupational therapy by increasing neural activation. The AOT-EXO trial aims to investigate whether action observation treatment coupled with robot-assisted training could enhance motor circuit activation and improve upper extremity motor outcomes. Methods The AOT-EXO trial is a multicentre, prospective, three-group randomized controlled trial (RCT). We will screen and enrol 132 eligible patients in the trial implemented in the Department of Rehabilitation Medicine of Tongji Hospital, Optical Valley Branch of Tongji Hospital and Hubei Province Hospital of Integrated Chinese & Western Medicine in Wuhan, China. Prior to study participation, written informed consent will be obtained from eligible patients in accordance with the Declaration of Helsinki. The enrolled stroke patients will be randomized to three groups: the CT group (conventional therapy); EXO group (exoskeleton therapy) and AOT-EXO group (action observation treatment-based exoskeleton therapy). The patients will undergo blinded assessments at baseline, post-intervention (after 4 weeks) and follow-up (after 12 weeks). The primary outcome will be the Fugl-Meyer Assessment for Upper Extremity (FMA-UE). Secondary outcomes will include the Action Research Arm Test (ARAT), modified Barthel Index (MBI), kinematic metrics assessed by inertial measurement unit (IMU), resting motor threshold (rMT), motor evoked potentials (MEP), functional magnetic resonance imaging (fMRI) and safety outcomes. Discussion This trial will provide evidence regarding the feasibility and efficacy of the action observation treatment-based exoskeleton (AOT-EXO) for post-stroke upper extremity rehabilitation and elucidate the potential underlying kinematic and neurological mechanisms. Trial registration Chinese Clinical Trial Registry ChiCTR1900026656. Registered on 17 October 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05176-x.
Collapse
Affiliation(s)
- Zejian Chen
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China
| | - Nan Xia
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China
| | - Chang He
- Institute of Rehabilitation and Medical Robotics, State Key Lab of Digital Manufacturing Equipment and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Minghui Gu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China
| | - Jiang Xu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China
| | - Xiaohua Han
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. .,World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China.
| | - Xiaolin Huang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. .,World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China.
| |
Collapse
|
88
|
Cramer SC, Le V, Saver JL, Dodakian L, See J, Augsburger R, McKenzie A, Zhou RJ, Chiu NL, Heckhausen J, Cassidy JM, Scacchi W, Smith MT, Barrett AM, Knutson J, Edwards D, Putrino D, Agrawal K, Ngo K, Roth EJ, Tirschwell DL, Woodbury ML, Zafonte R, Zhao W, Spilker J, Wolf SL, Broderick JP, Janis S. Intense Arm Rehabilitation Therapy Improves the Modified Rankin Scale Score: Association Between Gains in Impairment and Function. Neurology 2021; 96:e1812-e1822. [PMID: 33589538 DOI: 10.1212/wnl.0000000000011667] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/23/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the effect of intensive rehabilitation on the modified Rankin Scale (mRS), a measure of activities limitation commonly used in acute stroke studies, and to define the specific changes in body structure/function (motor impairment) most related to mRS gains. METHODS Patients were enrolled >90 days poststroke. Each was evaluated before and 30 days after a 6-week course of daily rehabilitation targeting the arm. Activity gains, measured using the mRS, were examined and compared to body structure/function gains, measured using the Fugl-Meyer (FM) motor scale. Additional analyses examined whether activity gains were more strongly related to specific body structure/function gains. RESULTS At baseline (160 ± 48 days poststroke), patients (n = 77) had median mRS score of 3 (interquartile range, 2-3), decreasing to 2 [2-3] 30 days posttherapy (p < 0.0001). Similarly, the proportion of patients with mRS score ≤2 increased from 46.8% at baseline to 66.2% at 30 days posttherapy (p = 0.015). These findings were accounted for by the mRS score decreasing in 24 (31.2%) patients. Patients with a treatment-related mRS score improvement, compared to those without, had similar overall motor gains (change in total FM score, p = 0.63). In exploratory analysis, improvement in several specific motor impairments, such as finger flexion and wrist circumduction, was significantly associated with higher likelihood of mRS decrease. CONCLUSIONS Intensive arm motor therapy is associated with improved mRS in a substantial fraction (31.2%) of patients. Exploratory analysis suggests specific motor impairments that might underlie this finding and may be optimal targets for rehabilitation therapies that aim to reduce activities limitations. CLINICAL TRIAL Clinicaltrials.gov identifier: NCT02360488. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that for patients >90 days poststroke with persistent arm motor deficits, intensive arm motor therapy improved mRS in a substantial fraction (31.2%) of patients.
Collapse
Affiliation(s)
- Steven C Cramer
- From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD.
| | - Vu Le
- From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD
| | - Jeffrey L Saver
- From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD
| | - Lucy Dodakian
- From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD
| | - Jill See
- From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD
| | - Renee Augsburger
- From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD
| | - Alison McKenzie
- From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD
| | - Robert J Zhou
- From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD
| | - Nina L Chiu
- From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD
| | - Jutta Heckhausen
- From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD
| | - Jessica M Cassidy
- From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD
| | - Walt Scacchi
- From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD
| | - Megan Therese Smith
- From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD
| | - A M Barrett
- From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD
| | - Jayme Knutson
- From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD
| | - Dylan Edwards
- From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD
| | - David Putrino
- From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD
| | - Kunal Agrawal
- From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD
| | - Kenneth Ngo
- From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD
| | - Elliot J Roth
- From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD
| | - David L Tirschwell
- From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD
| | - Michelle L Woodbury
- From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD
| | - Ross Zafonte
- From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD
| | - Wenle Zhao
- From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD
| | - Judith Spilker
- From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD
| | - Steven L Wolf
- From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD
| | - Joseph P Broderick
- From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD
| | - Scott Janis
- From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD
| |
Collapse
|
89
|
TAŞAR BEYDA, TATAR AHMETBURAK, TANYILDIZI ALPERKADIR, YAKUT OGUZ. DESIGN, DYNAMIC MODELING AND CONTROL OF WEARABLE FINGER ORTHOSIS. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421500068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Human hands and fingers are of significant importance in people’s capacity to perform daily tasks (touching, feeling, holding, gripping, writing). However, about 1.5 million people around the world are suffering from injuries, muscle and neurological disorders, a loss of hand function, or a few fingers due to stroke. This paper focuses on newly developed finger orthotics, which is thin, adaptable to the length of each finger and low energy costs. The aim of the study is to design and control a new robotic orthosis using for daily rehabilitation therapy. Kinematic and dynamic analysis of orthosis was calculated and the joint regulation of orthosis was obtained. The Lagrange method was used to obtain dynamics, and the Denavit–Hartenberg (D–H) method was used for kinematic analysis of hand. In order to understand its behavior, the robotic finger orthotics model was simulated in MatLab/Simulink. The simulation results show that the efficiency and robustness of proportional integral derivative (PID) controller are appropriate for the use of robotic finger orthotics.
Collapse
Affiliation(s)
- BEYDA TAŞAR
- Department of Mechatronics Engineering, Faculty of Engineering, Firat University, Elazig, Turkey
| | - AHMET BURAK TATAR
- Department of Mechatronics Engineering, Faculty of Engineering, Firat University, Elazig, Turkey
| | - ALPER KADIR TANYILDIZI
- Department of Mechatronics Engineering, Faculty of Engineering, Firat University, Elazig, Turkey
| | - OGUZ YAKUT
- Department of Mechatronics Engineering, Faculty of Engineering, Firat University, Elazig, Turkey
| |
Collapse
|
90
|
Morone G, Palomba A, Martino Cinnera A, Agostini M, Aprile I, Arienti C, Paci M, Casanova E, Marino D, LA Rosa G, Bressi F, Sterzi S, Gandolfi M, Giansanti D, Perrero L, Battistini A, Miccinilli S, Filoni S, Sicari M, Petrozzino S, Solaro CM, Gargano S, Benanti P, Boldrini P, Bonaiuti D, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzoleni S, Mazzon S, Molteni F, Petrarca M, Picelli A, Posteraro F, Senatore M, Turchetti G, Straudi S. Systematic review of guidelines to identify recommendations for upper limb robotic rehabilitation after stroke. Eur J Phys Rehabil Med 2021; 57:238-245. [PMID: 33491943 DOI: 10.23736/s1973-9087.21.06625-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Upper limb motor impairment is one of the most frequent stroke consequences. Robot therapy may represent a valid option for upper limb stroke rehabilitation, but there are still gaps between research evidence and their use in clinical practice. The aim of this study was to determine the quality, scope, and consistency of guidelines clinical practice recommendations for upper limb robotic rehabilitation in stroke populations. EVIDENCE ACQUISITION We searched for guideline recommendations on stroke published between January 1st, 2010 and January 1st, 2020. Only the most recent guidelines for writing group were selected. Electronic databases (N.=4), guideline repertories and professional rehabilitation networks (N.=12) were searched. We systematically reviewed and assessed guidelines containing recommendation statements about upper limb robotic rehabilitation for adults with stroke (PROSPERO registration number: CRD42020173386). EVIDENCE SYNTHESIS Four independent reviewers used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, and textual syntheses were used to appraise and compare recommendations. From 1324 papers that were screened, eight eligible guidelines were identified from six different regions/countries. Half of the included guidelines focused on stroke management, the other half on stroke rehabilitation. Rehabilitation assisted by robotic devices is generally recommended to improve upper limb motor function and strength. The exact characteristics of patients who could benefit from this treatment as well as the correct timing to use it are not known. CONCLUSIONS This systematic review has identified many opportunities to modernize and otherwise improve stroke patients' upper limb robotic therapy. Rehabilitation assisted by robot or electromechanical devices for stroke needs to be improved in clinical practice guidelines in particular in terms of applicability.
Collapse
Affiliation(s)
| | - Angela Palomba
- Multidisciplinary Department of Medicine for Surgery and Orthodontics, Luigi Vanvitelli University of Campania, Naples, Italy
| | | | | | - Irene Aprile
- IRCCS Don Carlo Gnocchi Foundation, Florence, Italy
| | | | - Matteo Paci
- AUSL District of Central Tuscany, Florence, Italy
| | - Emanuela Casanova
- Unit of Rehabilitation and Neurorehabilitation Medicine, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Dario Marino
- IRCCS Neurolysis Center "Bonino Pulejo, " Messina, Italy
| | - Giuseppe LA Rosa
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | | | - Silvia Sterzi
- Biomedical Campus University Foundation, Rome, Italy
| | - Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Daniele Giansanti
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Luca Perrero
- Unit of Neurorehabilitation, SS. Antonio e Biagio e Cesare Arrigo University Hospital, Alessandria, Italy
| | | | | | - Serena Filoni
- Padre Pio Foundation and Rehabilitation Centers, San Giovanni Rotondo, Foggia, Italy
| | | | | | | | | | | | - Paolo Boldrini
- Società Italiana di Medicina Fisica e Riabilitativa (SIMFER), Rome, Italy
| | | | - Enrico Castelli
- Unit of Pediatric Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (Faip Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy
| | | | | | - Maurizio Petrarca
- The Movement Analysis and Robotics Laboratory, Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Michele Senatore
- AITO (Associazione Italiana Terapisti Occupazionali), Rome, Italy
| | | | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| | | |
Collapse
|
91
|
Keeling AB, Piitz M, Semrau JA, Hill MD, Scott SH, Dukelow SP. Robot enhanced stroke therapy optimizes rehabilitation (RESTORE): a pilot study. J Neuroeng Rehabil 2021; 18:10. [PMID: 33478563 PMCID: PMC7819212 DOI: 10.1186/s12984-021-00804-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 01/08/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Robotic rehabilitation after stroke provides the potential to increase and carefully control dosage of therapy. Only a small number of studies, however, have examined robotic therapy in the first few weeks post-stroke. In this study we designed robotic upper extremity therapy tasks for the bilateral Kinarm Exoskeleton Lab and piloted them in individuals with subacute stroke. Pilot testing was focused mainly on the feasibility of implementing these new tasks, although we recorded a number of standardized outcome measures before and after training. METHODS Our team developed 9 robotic therapy tasks to incorporate feedback, intensity, challenge, and subject engagement as well as addressing both unimanual and bimanual arm activities. Subacute stroke participants were assigned to a robotic therapy (N = 9) or control group (N = 10) in a matched-group manner. The robotic therapy group completed 1-h of robotic therapy per day for 10 days in addition to standard therapy. The control group participated only in standard of care therapy. Clinical and robotic assessments were completed prior to and following the intervention. Clinical assessments included the Fugl-Meyer Assessment of Upper Extremity (FMA UE), Action Research Arm Test (ARAT) and Functional Independence Measure (FIM). Robotic assessments of upper limb sensorimotor function included a Visually Guided Reaching task and an Arm Position Matching task, among others. Paired sample t-tests were used to compare initial and final robotic therapy scores as well as pre- and post-clinical and robotic assessments. RESULTS Participants with subacute stroke (39.8 days post-stroke) completed the pilot study. Minimal adverse events occurred during the intervention and adding 1 h of robotic therapy was feasible. Clinical and robotic scores did not significantly differ between groups at baseline. Scores on the FMA UE, ARAT, FIM, and Visually Guided Reaching improved significantly in the robotic therapy group following completion of the robotic intervention. However, only FIM and Arm Position Match improved over the same time in the control group. CONCLUSIONS The Kinarm therapy tasks have the potential to improve outcomes in subacute stroke. Future studies are necessary to quantify the benefits of this robot-based therapy in a larger cohort. TRIAL REGISTRATION ClinicalTrials.gov, NCT04201613, Registered 17 December 2019-Retrospectively Registered, https://clinicaltrials.gov/ct2/show/NCT04201613 .
Collapse
Affiliation(s)
- Alexa B. Keeling
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
| | - Mark Piitz
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
| | - Jennifer A. Semrau
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE USA
| | - Michael D. Hill
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
| | - Stephen H. Scott
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON Canada
| | - Sean P. Dukelow
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
| |
Collapse
|
92
|
Mekbib DB, Debeli DK, Zhang L, Fang S, Shao Y, Yang W, Han J, Jiang H, Zhu J, Zhao Z, Cheng R, Ye X, Zhang J, Xu D. A novel fully immersive virtual reality environment for upper extremity rehabilitation in patients with stroke. Ann N Y Acad Sci 2021; 1493:75-89. [PMID: 33442915 DOI: 10.1111/nyas.14554] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/20/2020] [Accepted: 12/02/2020] [Indexed: 12/11/2022]
Abstract
Given the rising incidence of stroke, several technology-driven methods for rehabilitation have recently been developed. Virtual reality (VR) is a promising therapeutic technology among them. We recently developed a neuroscientifically grounded VR system to aid recovery of motor function poststroke. The developed system provides unilateral and bilateral upper extremity (UE) training in a fully immersive virtual environment that may stimulate and activate mirror neurons (MNs) in the brain necessary for UE rehabilitation. Twenty-three participants were randomized to a VR group (n = 12) to receive VR intervention (8 h within 2 weeks) plus 8-h occupational therapy (OT) or a control group (n = 11) to receive time-matched OT alone. Treatment effects on motor recovery and cortical reorganization were investigated using the Barthel Index (BI), Fugl-Meyer Upper Extremity (FM-UE), and resting-state fMRI. Both groups significantly improved BI (P < 0.05), reflecting the recovery of UE motor function. The VR group revealed significant improvements on FM-UE scores (P < 0.05) than the control group. Neural activity increased after the intervention, particularly in the brain areas implicating MNs, such as in the primary motor cortex. Overall, results suggested that using a neuroscientifically grounded VR system might offer additional benefits for UE rehabilitation in patients receiving OT.
Collapse
Affiliation(s)
- Destaw B Mekbib
- Interdisciplinary Institute of Neuroscience and Technology (ZIINT), College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Dereje Kebebew Debeli
- State Key Laboratory of Chemical Engineering, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou, China
| | - Li Zhang
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Shan Fang
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Yuling Shao
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Wei Yang
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Jiawei Han
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Hongjie Jiang
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Junming Zhu
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhiyong Zhao
- MOE & Shanghai Key Laboratory of Brain Functional Genomics (East China Normal University), Institute of Cognitive Neuroscience, East China Normal University, Shanghai, China
- Shanghai Key Laboratory of Magnetic Resonance, Institute of Cognitive Neuroscience, East China Normal University, Shanghai, China
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Ruidong Cheng
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Xiangming Ye
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Jianmin Zhang
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Dongrong Xu
- Molecular Imaging and Neuropathology Division, Department of Psychiatry, Columbia University & New York State Psychiatric Institute, New York City, New York
| |
Collapse
|
93
|
Sehle A, Stuerner J, Hassa T, Spiteri S, Schoenfeld MA, Liepert J. Behavioral and neurophysiological effects of an intensified robot-assisted therapy in subacute stroke: a case control study. J Neuroeng Rehabil 2021; 18:6. [PMID: 33430912 PMCID: PMC7798321 DOI: 10.1186/s12984-020-00792-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 11/25/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Physical training is able to induce changes at neurophysiological and behavioral level associated with performance changes for the trained movements. The current study explores the effects of an additional intense robot-assisted upper extremity training on functional outcome and motor excitability in subacute stroke patients. METHODS Thirty moderately to severely affected patients < 3 months after stroke received a conventional inpatient rehabilitation. Based on a case-control principle 15 patients were assigned to receive additional 45 min of robot-assisted therapy (Armeo®Spring) 5 times per week (n = 15, intervention group, IG). The Fugl-Meyer Assessment for the Upper Extremity (FMA-UE) was chosen as primary outcome parameter. Patients were tested before and after a 3-week treatment period as well as after a follow-up period of 2 weeks. Using transcranial magnetic stimulation motor evoked potentials (MEPs) and cortical silent periods were recorded from the deltoid muscle on both sides before and after the intervention period to study effects at neurophysiological level. Statistical analysis was performed with non-parametric tests. Correlation analysis was done with Spearman´s rank correlation co-efficient. RESULTS Both groups showed a significant improvement in FMA-UE from pre to post (IG: + 10.6 points, control group (CG): + 7.3 points) and from post to follow-up (IG: + 3.9 points, CG: + 3.3 points) without a significant difference between them. However, at neurophysiological level post-intervention MEP amplitudes were significantly larger in the IG but not in the CG. The observed MEP amplitudes changes were positively correlated with FMA-UE changes and with the total amount of robot-assisted therapy. CONCLUSION The additional robot-assisted therapy induced stronger excitability increases in the intervention group. However, this effect did not transduce to motor performance improvements at behavioral level. Trial registration The trial was registered in German Clinical Trials Register. CLINICAL TRIAL REGISTRATION NUMBER DRKS00015083. Registration date: September 4th, 2018. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015083 . Registration was done retrospectively.
Collapse
Affiliation(s)
- Aida Sehle
- Lurija Institute and Department of Neurological Rehabilitation, Kliniken Schmieder, Zum Tafelholz 8, 78476, Allensbach, Germany
| | - Jana Stuerner
- Lurija Institute and Department of Neurological Rehabilitation, Kliniken Schmieder, Zum Tafelholz 8, 78476, Allensbach, Germany
| | - Thomas Hassa
- Lurija Institute and Department of Neurological Rehabilitation, Kliniken Schmieder, Zum Tafelholz 8, 78476, Allensbach, Germany
| | - Stefan Spiteri
- Lurija Institute and Department of Neurological Rehabilitation, Kliniken Schmieder, Zum Tafelholz 8, 78476, Allensbach, Germany
| | - Mircea A Schoenfeld
- Department of Neurological Rehabilitation, Kliniken Schmieder, Heidelberg, Germany.,Department of Neurology, Otto-Von-Guericke-University Magdeburg, Magdeburg, Germany.,Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Joachim Liepert
- Lurija Institute and Department of Neurological Rehabilitation, Kliniken Schmieder, Zum Tafelholz 8, 78476, Allensbach, Germany.
| |
Collapse
|
94
|
Morrow CM, Johnson E, Simpson KN, Seo NJ. Determining Factors that Influence Adoption of New Post-Stroke Sensorimotor Rehabilitation Devices in the USA. IEEE Trans Neural Syst Rehabil Eng 2021; 29:1213-1222. [PMID: 34143736 PMCID: PMC8249076 DOI: 10.1109/tnsre.2021.3090571] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Rehabilitation device efficacy alone does not lead to clinical practice adoption. Previous literature identifies drivers for device adoption by therapists but does not identify the best settings to introduce devices, the roles of different stakeholders including rehabilitation directors, or specific criteria to be met during device development. The objective of this work was to provide insights into these areas to increase clinical adoption of post-stroke restorative rehabilitation devices. We interviewed 107 persons including physical/occupational therapists, rehabilitation directors, and stroke survivors and performed content analysis. Unique to this work, care settings in which therapy goals are best aligned for restorative devices were found to be outpatient rehabilitation, followed by inpatient rehabilitation. Therapists are the major influencers for adoption because they typically introduce new rehabilitation devices to patients for both clinic and home use. We also learned therapists' utilization rate of a rehabilitation device influences a rehabilitation director's decision to acquire the device for facility use. Main drivers for each stakeholder are identified, along with specific criteria to add details to findings from previous literature. In addition, drivers for home adoption of rehabilitation devices by patients are identified. Rehabilitation device development should consider the best settings to first introduce the device, roles of each stakeholder, and drivers that influence each stakeholder, to accelerate successful adoption of the developed device.
Collapse
|
95
|
Aprile I, Guardati G, Cipollini V, Papadopoulou D, Mastrorosa A, Castelli L, Monteleone S, Redolfi A, Galeri S, Germanotta M. Robotic Rehabilitation: An Opportunity to Improve Cognitive Functions in Subjects With Stroke. An Explorative Study. Front Neurol 2020; 11:588285. [PMID: 33329334 PMCID: PMC7710798 DOI: 10.3389/fneur.2020.588285] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/21/2020] [Indexed: 12/18/2022] Open
Abstract
Background: After a stroke, up to three-quarters of acute and subacute stroke survivors exhibit cognitive impairment, with a significant impact on functional recovery, quality of life, and social engagement. Robotic therapy has shown its effectiveness on motor recovery, but its effectiveness on cognitive recovery has not fully investigated. Objective: This study aims to assess the impact of a technological rehabilitation intervention on cognitive functions in patients with stroke, using a set of three robots and one sensor-based device for upper limb rehabilitation. Methods: This is a pilot study in which 51 patients were enrolled. An upper limb rehabilitation program was performed using three robots and one sensor-based device. The intervention comprised motor/cognitive exercises, especially selected among the available ones to train also cognitive functions. Patients underwent 30 rehabilitation sessions, each session lasting 45 minutes, 5 days a week. Patients were assessed before and after the treatment with several cognitive tests (Oxford Cognitive Scale, Symbol Digit Modalities Test, Digit Span, Rey-Osterrieth Complex Figure, Tower of London, and Stroop test). In addition, motor (Fugl-Meyer Assessment and Motricity Index) and disability (modified Barthel Index) scales were used. Results: According to the Oxford Cognitive Scale domains, a significant percentage of patients exhibited cognitive deficits. Excluding perception (with only one patient impaired), the domain with the lowest percentage of patients showing a pathological score was praxis (about 25%), while the highest percentage of impaired patients was found in calculation (about 70%). After the treatment, patients improved in all the investigated cognitive domains, as measured by the selected cognitive assessment scales. Moreover, motor and disability scales confirmed the efficacy of robotics on upper limb rehabilitation in patients with stroke. Conclusions: This explorative study suggests that robotic technology can be used to combine motor and cognitive exercises in a unique treatment session. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT04164381.
Collapse
Affiliation(s)
- Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
| | | | | | | | | | - Letizia Castelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Neuroriabilitazione ad Alta Intensità, Rome, Italy
| | | | | | - Silvia Galeri
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | |
Collapse
|
96
|
Su F, Xu W. Enhancing Brain Plasticity to Promote Stroke Recovery. Front Neurol 2020; 11:554089. [PMID: 33192987 PMCID: PMC7661553 DOI: 10.3389/fneur.2020.554089] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 10/08/2020] [Indexed: 12/11/2022] Open
Abstract
Stroke disturbs both the structural and functional integrity of the brain. The understanding of stroke pathophysiology has improved greatly in the past several decades. However, effective therapy is still limited, especially for patients who are in the subacute or chronic phase. Multiple novel therapies have been developed to improve clinical outcomes by improving brain plasticity. These approaches either focus on improving brain remodeling and restoration or on constructing a neural bypass to avoid brain injury. This review describes emerging therapies, including modern rehabilitation, brain stimulation, cell therapy, brain-computer interfaces, and peripheral nervous transfer, and highlights treatment-induced plasticity. Key evidence from basic studies on the underlying mechanisms is also briefly discussed. These insights should lead to a deeper understanding of the overall neural circuit changes, the clinical relevance of these changes in stroke, and stroke treatment progress, which will assist in the development of future approaches to enhance brain function after stroke.
Collapse
Affiliation(s)
| | - Wendong Xu
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| |
Collapse
|
97
|
Chen Z, Wang C, Fan W, Gu M, Yasin G, Xiao S, Huang J, Huang X. Robot-Assisted Arm Training versus Therapist-Mediated Training after Stroke: A Systematic Review and Meta-Analysis. JOURNAL OF HEALTHCARE ENGINEERING 2020; 2020:8810867. [PMID: 33194159 PMCID: PMC7641296 DOI: 10.1155/2020/8810867] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/03/2020] [Accepted: 10/14/2020] [Indexed: 01/29/2023]
Abstract
Background More than two-thirds of stroke patients have arm motor impairments and function deficits on hospital admission, leading to diminished quality of life and reduced social participation. Robot-assisted training (RAT) is a promising rehabilitation program for upper extremity while its effect is still controversial due to heterogeneity in clinical trials. We performed a systematic review and meta-analysis to compare robot-assisted training (RAT) versus therapist-mediated training (TMT) for arm rehabilitation after stroke. Methods We searched the following electronic databases: MEDLINE, EMBASE, Cochrane EBM Reviews, and Physiotherapy Evidence Database (PEDro). Studies of moderate or high methodological quality (PEDro score ≥4) were included and analyzed. We assessed the effects of RAT versus TMT for arm rehabilitation after stroke with testing the noninferiority of RAT. A small effect size of -2 score for mean difference in Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) and Cohen's d = -0.2 for standardized mean difference (SMD) were set as noninferiority margin. Results Thirty-five trials with 2241 participants met inclusion criteria. The effect size for arm motor impairment, capacity, activities of daily living, and social participation were 0.763 (WMD, 95% CI: 0.404 to 1.123), 0.109 (SMD, 95% CI: -0.066 to 0.284), 0.049 (SMD, 95% CI: -0.055 to 0.17), and -0.061 (SMD, 95% CI: -0.196 to 0.075), respectively. Conclusion This systematic review and meta-analysis demonstrated that robot-assisted training was slightly superior in motor impairment recovery and noninferior to therapist-mediated training in improving arm capacity, activities of daily living, and social participation, which supported the use of RAT in clinical practice.
Collapse
Affiliation(s)
- Zejian Chen
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- World Health Organization Cooperative Training and Research Center, Wuhan 430030, China
| | - Chun Wang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- World Health Organization Cooperative Training and Research Center, Wuhan 430030, China
| | - Wei Fan
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- World Health Organization Cooperative Training and Research Center, Wuhan 430030, China
| | - Minghui Gu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- World Health Organization Cooperative Training and Research Center, Wuhan 430030, China
| | - Gvzalnur Yasin
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- World Health Organization Cooperative Training and Research Center, Wuhan 430030, China
| | - Shaohua Xiao
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- World Health Organization Cooperative Training and Research Center, Wuhan 430030, China
| | - Jie Huang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- World Health Organization Cooperative Training and Research Center, Wuhan 430030, China
| | - Xiaolin Huang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- World Health Organization Cooperative Training and Research Center, Wuhan 430030, China
| |
Collapse
|
98
|
Wu J, Dodakian L, See J, Burke Quinlan E, Meng L, Abraham J, Wong EC, Le V, McKenzie A, Cramer SC. Gains Across WHO Dimensions of Function After Robot-Based Therapy in Stroke Subjects. Neurorehabil Neural Repair 2020; 34:1150-1158. [PMID: 33084499 DOI: 10.1177/1545968320956648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Studies examining the effects of therapeutic interventions after stroke often focus on changes in loss of body function/structure (impairment). However, improvements in activities limitations and participation restriction are often higher patient priorities, and the relationship that these measures have with loss of body function/structure is unclear. OBJECTIVE This study measured gains across WHO International Classification of Function (ICF) dimensions and examined their interrelationships. METHODS Subjects were recruited 11 to 26 weeks after hemiparetic stroke. Over a 3-week period, subjects received 12 sessions of intensive robot-based therapy targeting the distal arm. Each subject was assessed at baseline and at 1 month after end of therapy. RESULTS At baseline, subjects (n = 40) were 134.7 ± 32.4 (mean ± SD) days poststroke and had moderate-severe arm motor deficits (arm motor Fugl-Meyer score of 35.6 ± 14.4) that were stable. Subjects averaged 2579 thumb movements and 1298 wrist movements per treatment session. After robot therapy, there was significant improvement in measures of body function/structure (Fugl-Meyer score) and activity limitations (Action Research Arm Test, Barthel Index, and Stroke Impact Scale-Hand), but not participation restriction (Stroke Specific Quality of Life Scale). Furthermore, while the degree of improvement in loss of body function/structure was correlated with improvement in activity limitations, neither improvement in loss of body function/structure nor improvement in activity limitations was correlated with change in participation restriction. CONCLUSIONS After a 3-week course of robotic therapy, there was improvement in body function/structure and activity limitations but no reduction in participation restriction.
Collapse
Affiliation(s)
- Jennifer Wu
- University of California, Irvine, Orange, CA, USA
| | | | - Jill See
- University of California, Irvine, Orange, CA, USA
| | - Erin Burke Quinlan
- University of California, Irvine, Orange, CA, USA.,Institute of Psychiatry, Psychology, & Neuroscience and King's College London, London, England, UK
| | - Lisa Meng
- University of California, Irvine, Orange, CA, USA
| | - Jeby Abraham
- University of California, Irvine, Orange, CA, USA.,Tripler Army Medical Center, Honolulu, HI, USA
| | - Ellen C Wong
- University of California, Los Angeles, and California Rehabilitation Institute, Los Angeles, CA, USA
| | - Vu Le
- University of California, Irvine, Orange, CA, USA
| | | | - Steven C Cramer
- University of California, Irvine, Orange, CA, USA.,University of California, Los Angeles, and California Rehabilitation Institute, Los Angeles, CA, USA
| |
Collapse
|
99
|
Park JH, Park G, Kim HY, Lee JY, Ham Y, Hwang D, Kwon S, Shin JH. A comparison of the effects and usability of two exoskeletal robots with and without robotic actuation for upper extremity rehabilitation among patients with stroke: a single-blinded randomised controlled pilot study. J Neuroeng Rehabil 2020; 17:137. [PMID: 33076952 PMCID: PMC7574181 DOI: 10.1186/s12984-020-00763-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/20/2020] [Indexed: 12/05/2022] Open
Abstract
Background Robotic rehabilitation of stroke survivors with upper extremity dysfunction may yield different outcomes depending on the robot type. Considering that excessive dependence on assistive force by robotic actuators may interfere with the patient’s active learning and participation, we hypothesised that the use of an active-assistive robot with robotic actuators does not lead to a more meaningful difference with respect to upper extremity rehabilitation than the use of a passive robot without robotic actuators. Accordingly, we aimed to evaluate the differences in the clinical and kinematic outcomes between active-assistive and passive robotic rehabilitation among stroke survivors. Methods In this single-blinded randomised controlled pilot trial, we assigned 20 stroke survivors with upper extremity dysfunction (Medical Research Council scale score, 3 or 4) to the active-assistive robotic intervention (ACT) and passive robotic intervention (PSV) groups in a 1:1 ratio and administered 20 sessions of 30-min robotic intervention (5 days/week, 4 weeks). The primary (Wolf Motor Function Test [WMFT]-score and -time: measures activity), and secondary (Fugl-Meyer Assessment [FMA] and Stroke Impact Scale [SIS] scores: measure impairment and participation, respectively; kinematic outcomes) outcome measures were determined at baseline, after 2 and 4 weeks of the intervention, and 4 weeks after the end of the intervention. Furthermore, we evaluated the usability of the robots through interviews with patients, therapists, and physiatrists. Results In both the groups, the WMFT-score and -time improved over the course of the intervention. Time had a significant effect on the WMFT-score and -time, FMA-UE, FMA-prox, and SIS-strength; group × time interaction had a significant effect on SIS-function and SIS-social participation (all, p < 0.05). The PSV group showed better improvement in participation and smoothness than the ACT group. In contrast, the ACT group exhibited better improvement in mean speed. Conclusions There were no differences between the two groups regarding the impairment and activity domains. However, the PSV robots were more beneficial than ACT robots regarding participation and smoothness. Considering the high cost and complexity of ACT robots, PSV robots might be more suitable for rehabilitation in stroke survivors capable of voluntary movement. Trial registration The trial was registered retrospectively on 14 March 2018 at ClinicalTrials.gov (NCT03465267).
Collapse
Affiliation(s)
- Jin Ho Park
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, 58, Samgaksan-ro, Gangbuk-gu, Seoul, Republic of Korea
| | - Gyulee Park
- Translational Research Program for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Republic of Korea
| | - Ha Yeon Kim
- Translational Research Program for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Republic of Korea
| | - Ji-Yeong Lee
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, 58, Samgaksan-ro, Gangbuk-gu, Seoul, Republic of Korea
| | - Yeajin Ham
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, 58, Samgaksan-ro, Gangbuk-gu, Seoul, Republic of Korea
| | - Donghwan Hwang
- Translational Research Program for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Republic of Korea
| | - Suncheol Kwon
- Translational Research Program for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Republic of Korea
| | - Joon-Ho Shin
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, 58, Samgaksan-ro, Gangbuk-gu, Seoul, Republic of Korea. .,Translational Research Program for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Republic of Korea.
| |
Collapse
|
100
|
[Integrated care management for older people with chronic diseases in domesticity: evidence from Cochrane reviews]. Z Gerontol Geriatr 2020; 54:54-60. [PMID: 33044620 PMCID: PMC7835300 DOI: 10.1007/s00391-020-01796-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/14/2020] [Indexed: 11/05/2022]
Abstract
Hintergrund Die Anzahl multipel chronisch erkrankter Älterer steigt, und Multimorbidität geht mit hoher Inanspruchnahme von Gesundheitsleistungen einher. Um Selbstständigkeit und Verbleib in der Häuslichkeit zu erhalten, wird zunehmend ein integriertes Versorgungsmanagement eingesetzt. Zur Wirksamkeit in der Zielgruppe der multipel chronisch erkrankten Älteren liegen aber kaum belastbare Daten vor. Ziel der Arbeit Bewertung der Wirksamkeit von integriertem Versorgungsmanagement bei Erwachsenen und Abschätzung der Übertragbarkeit auf ältere, multimorbide Personen in Deutschland. Methoden Systematische Literaturrecherche in der Cochrane Library mit Einschluss von Cochrane-Reviews (CR) zu (a) den 13 häufigsten Gesundheitsproblemen im Alter, mit (b) Komponenten des integrierten Versorgungsmanagements bei (c) Erwachsenen jeden Alters. Experten schätzten die Übertragbarkeit der eingeschlossenen CR auf multipel chronisch erkrankte Ältere in Deutschland ein. Ergebnisse Aus 1412 Treffern wurden 126 CR eingeschlossen. Zur Endpunktkategorie Selbstständigkeit und funktionale Gesundheit zeigten 25 CR klinisch relevante Ergebnisse mit moderater Evidenzqualität. Folgende Interventionskomponenten wurden – unter Berücksichtigung identifizierter Barrieren – als übertragbar eingeschätzt und könnten für ein effektives, indikationsspezifisch integriertes Versorgungsmanagement multipel chronisch erkrankter Älterer herangezogen werden: (1) körperliche Aktivierung, (2) multidisziplinäre Interventionen, (3) das Selbstmanagement verstärkende Interventionen, (4) kognitive Therapieverfahren, (5) telemedizinische Interventionen und (6) Disease-Management-Programme. Schlussfolgerungen Die identifizierten Komponenten sollten in versorgungs- und patientennahen randomisierten kontrollierten Studien auf Wirksamkeit bei gebrechlichen Älteren geprüft werden. Zusatzmaterial online Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00391-020-01796-1) enthalten.
Collapse
|