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Tay SS, Visperas CA, Bin Zainul Abideen A, Tan MMJ, Zaw EM, Lai H, Neo EJR. Effectiveness of Adjunct Robotic Therapy With a Patient-Guided Suspension System for Stroke Rehabilitation Using a 7-Days-a-Week Model of Care: A Comparison With Conventional Rehabilitation. Arch Rehabil Res Clin Transl 2021; 3:100144. [PMID: 34589694 PMCID: PMC8463454 DOI: 10.1016/j.arrct.2021.100144] [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] [Indexed: 11/18/2022] Open
Abstract
Objective To determine and compare the effectiveness of robotic therapy with a patient-guided suspension system for stroke rehabilitation using a 7-days-a-week model of care with that of conventional rehabilitation. Design Retrospective cohort study. Setting Inpatient rehabilitation unit of an acute general hospital. Participants A total of 100 consecutive patients with stroke (N=100) admitted within a 7-month period who fulfilled the criteria to undergo robotic therapy with a patient-guided suspension system were enrolled in this study. Interventions Patients either underwent robotic therapy in addition to conventional therapy (robotic group) or conventional therapy only (control group). There were 50 patients in each cohort. Main Outcome Measures FIM and its derivatives (FIM gain and FIM efficiency); Berg Balance Scale (BBS), functional ambulation category (FAC); modified Rankin Scale (mRS); and National Institutes of Health Stroke Scale. Results The average FIM gains in both groups were statistically significant (P<.01). The robotic group had greater improvement in FAC scores (1.24 vs 0.78, P=.007). However, other measurements such as FIM efficiency, BBS, and mRS were not significantly different between the 2 groups. The robotics group reported high patient satisfaction rates, with most patients finding the intervention both beneficial and desirable. Conclusions Adjunct robotic therapy has the potential to increase the efficacy of stroke rehabilitation. However, further studies are needed to strengthen the evidence.
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Affiliation(s)
- San San Tay
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore
- Corresponding author San San Tay, MBBS, Department of Rehabilitation Medicine, Changi General Hospital, 2 Simei St 3, Singapore 529889.
| | | | | | - Mark Min Jian Tan
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore
| | - Ei Mon Zaw
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore
| | - Hsuan Lai
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore
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102
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Cao N, Packel A, Marcy E, Sprik K, Harold E, Xiao R, Esquenazi A. Implementing Robotic-Assisted Gait Training in Acute Inpatient Stroke Rehabilitation: A Quality Improvement Initiative. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2021; 4:168-173. [PMID: 38283707 PMCID: PMC10821733 DOI: 10.4103/jisprm-000130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The recovery of independent walking is one of the major goals of stroke rehabilitation; however, due to the current acute inpatient rehabilitation care paradigm, the intensity of walking practice provided has been far below that recommended for motor recovery to occur. A quality improvement initiative was implemented to encourage the physical therapist (PT) to incorporate various robotic gait training devices as part of the standard allotted PT sessions to improve the intensity of gait training. Materials and Methods After 6 months, a retrospective review was performed to assess the feasibility of the robotic-assisted gait training (RAGT) intervention in limited-ambulatory stroke patients and determine preliminary efficacy of the RAGT program by analyzing Functional Index Measure (FIM) motor gain and accelerometer-based daily step counts in patients who received the RAGT versus a group treated with conventional therapy. Results About 30% of limited-ambulatory patients admitted to the stroke rehabilitation unit received consistent integrated RAGT without safety concerns. Compared to those who received conventional treatment, these patients showed greater mean FIM motor gain (32.30 versus 17.88) at discharge (P < 0.005) and higher number of step counts in PT sessions (P < 0.005). Age, gender, or admission FIM motor were not associated with FIM motor gain. Conclusions Across a 6-month initial implementation period, RAGT was feasible and was associated with higher repetition of walking practice and also with improved FIM motor scores in limited-ambulatory individuals in an acute inpatient stroke rehabilitation program. However, the frequency of RAGT and the percentage of patients participating need to further improve. Some strategies to address these concerns were identified.
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Affiliation(s)
- Ning Cao
- Department of Physical Medicine and Rehabilitation, MossRehab, Elkins Park, Pennsylvania, USA
| | - Andrew Packel
- Department of Physical Medicine and Rehabilitation, MossRehab, Elkins Park, Pennsylvania, USA
| | - Elizabeth Marcy
- Department of Physical Medicine and Rehabilitation, MossRehab, Elkins Park, Pennsylvania, USA
| | - Kelly Sprik
- Department of Physical Medicine and Rehabilitation, MossRehab, Elkins Park, Pennsylvania, USA
| | - Erika Harold
- Department of Physical Medicine and Rehabilitation, MossRehab, Elkins Park, Pennsylvania, USA
| | - Rui Xiao
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Alberto Esquenazi
- Department of Physical Medicine and Rehabilitation, MossRehab, Elkins Park, Pennsylvania, USA
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103
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Martin R. Utility and Feasibility of Transcutaneous Spinal Cord Stimulation for Patients With Incomplete SCI in Therapeutic Settings: A Review of Topic. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:724003. [PMID: 36188824 PMCID: PMC9397733 DOI: 10.3389/fresc.2021.724003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/19/2021] [Indexed: 11/13/2022]
Abstract
Transcutaneous Spinal Cord Stimulation (TSCS) has been shown to enhance the excitability of spinal neural circuits. This excitation is associated with enhanced voluntary performance in patients with incomplete SCI (iSCI). Though there is much we do not know, combining this altered state of exciability with therapy has the potential to enhance the outcomes associated with activity-based interventions. It is a promising tool to augment the work being done in therapeutic settings with the potential to expedite recovery. There is, however, a lag in assimilating the science for clinical practice. This article will examine current literature related to the application of TSCS in combination with therapeutic interventions for motor recovery and aims to elucidate trends in waveform selection, duration and frequency, and combinatorial therapies that may inform clinical practice. With specific consideration for therapeutic settings, potential benefits, applications, and pitfalls for clinical use are considered. Finally, the next steps in research to move toward wider clinical utility are discussed.
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Affiliation(s)
- Rebecca Martin
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, MD, United States
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, United States
- *Correspondence: Rebecca Martin
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104
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Yang CL, Liu J, Simpson LA, Menon C, Eng JJ. Real-World Functional Grasping Activity in Individuals With Stroke and Healthy Controls Using a Novel Wearable Wrist Sensor. Neurorehabil Neural Repair 2021; 35:929-937. [PMID: 34510935 DOI: 10.1177/15459683211041312] [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: 11/16/2022]
Abstract
Background. While wrist-worn accelerometers have been used to measure upper extremity use in the past, they primarily measure arm motion and lack the ability to capture functional hand opening and grasping activities which are essential for activities of daily living. Objectives. To characterize real-world functional hand opening and grasping activities captured over multiple days in adults with stroke and in matched controls using a novel wrist-worn device. Methods. Twenty-eight individuals (fourteen individuals with stroke and 14 healthy controls) wore the devices on both wrists for 3 days. Functional hand activity was characterized by daily hand counts, hourly hand counts, and asymmetry between hands. The Mann-Whitney U test was used to evaluate differences in functional hand activities between the two groups. Results. The stroke group had 1480 and 4691 daily hand counts in their affected and nonaffected hands, respectively. The control group had 3559 and 5021 daily hand counts in their nondominant and dominant hands, respectively. Significantly fewer daily hand counts (P = .019), fewer hourly hand counts (P = .024), and a larger asymmetry index (P = .01) of the affected hand in the stroke group were found compared to that of the nondominant hand in the control group. Conclusions. Real-world functional upper extremity activity can be measured using this novel wrist-worn device. Unlike wrist-worn accelerometers, this wrist-worn device can provide a measurement of functional grasping activity. The findings have implications for clinicians and researchers to monitor and assess real-world hand activity, as well as to apply specific doses of repetitions to improve neural recovery after stroke.
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Affiliation(s)
- Chieh-Ling Yang
- Department of Physical Therapy, Faculty of Medicine, 8166University of British Columbia, Vancouver, BC, Canada.,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Johnson Liu
- Department of Physical Therapy, Faculty of Medicine, 8166University of British Columbia, Vancouver, BC, Canada.,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Lisa A Simpson
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Graduate Programs in Rehabilitation Sciences, Faculty of Medicine, 8166University of British Columbia, Vancouver, BC, Canada
| | - Carlo Menon
- Biomedical and Mobile Health Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.,Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Vancouver, BC, Canada
| | - Janice J Eng
- Department of Physical Therapy, Faculty of Medicine, 8166University of British Columbia, Vancouver, BC, Canada.,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
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105
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Tang ZQ, Heung HL, Shi XQ, Tong RKY, Li Z. Probabilistic Model-based Learning Control of a Soft Pneumatic Glove for Hand Rehabilitation. IEEE Trans Biomed Eng 2021; 69:1016-1028. [PMID: 34516370 DOI: 10.1109/tbme.2021.3111891] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Stroke survivors are usually unable to perform activities of daily living (ADL) independently due to loss of hand functions. Soft pneumatic gloves provide a promising assistance approach for stroke survivors to conduct ADL tasks. However, few studies have explored effective control strategies for the 'human-soft robot' integrated system due to challenges in the nonlinearities of soft robots and uncertainties of human intentions. Therefore, this work aims to develop control approaches for the system to improve stroke survivors hand functions. METHODS Firstly, a soft pneumatic glove was utilized to aid with stroke-impaired hands. Secondly, a probabilistic model-based learning control approach was proposed to overcome the challenges. Then a task-oriented intention-driven training modality was designed. Finally, the control performance was evaluated on three able-bodied subjects and three stroke survivors who attended 20-session rehabilitation training. RESULTS The proposed approach could enable the soft pneumatic glove to provide adaptive assistance for all participants to accomplish different tasks. The tracking error and muscle co-contraction index showed decreasing trends while the hand gesture index showed an increasing tendency over training sessions. All stroke survivors showed improved hand functions and better muscle coordination after training. CONCLUSION This work developed a learning-based soft robotic glove training system and demonstrated its potential in post-stroke hand rehabilitation. SIGNIFICANCE This work promotes the application of soft robotic training systems in stroke rehabilitation.
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106
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Simpson LA, Menon C, Hodgson AJ, Ben Mortenson W, Eng JJ. Clinicians' perceptions of a potential wearable device for capturing upper limb activity post-stroke: a qualitative focus group study. J Neuroeng Rehabil 2021; 18:135. [PMID: 34496894 PMCID: PMC8425094 DOI: 10.1186/s12984-021-00927-y] [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: 05/08/2021] [Accepted: 08/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background There is growing interest in the use of wearable devices that track upper limb activity after stroke to help determine and motivate the optimal dose of upper limb practice. The purpose of this study was to explore clinicians’ perceptions of a prospective wearable device that captures upper limb activity to assist in the design of devices for use in rehabilitation practice. Methods Four focus groups with 18 clinicians (occupational and physical therapists with stroke practice experience from a hospital or private practice setting) were conducted. Data were analyzed thematically. Results Our analysis revealed three themes: (1) “Quantity and quality is ideal” emphasized how an ideal device would capture both quantity and quality of movement; (2) “Most useful outside therapy sessions” described how therapists foresaw using the device outside of therapy sessions to monitor homework adherence, provide self-monitoring of use, motivate greater use and provide biofeedback on movement quality; (3) “User-friendly please” advocated for the creation of a device that was easy to use and customizable, which reflected the client-centered nature of their treatment. Conclusions Findings from this study suggest that clinicians support the development of wearable devices that capture upper limb activity outside of therapy for individuals with some reach to grasp ability. Devices that are easy to use and capture both quality and quantity may result in greater uptake in the clinical setting. Future studies examining acceptability of wearable devices for tracking upper limb activity from the perspective of individuals with stroke are needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00927-y.
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Affiliation(s)
- Lisa A Simpson
- Graduate Program in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada
| | - Carlo Menon
- Biomedical and Mobile Health Technology Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Antony J Hodgson
- Department of Mechanical Engineering, University of British Columbia, Vancouver, Canada
| | - W Ben Mortenson
- Department of Occupational Sciences and Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
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107
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Hung NT, Paul V, Prakash P, Kovach T, Tacy G, Tomic G, Park S, Jacobson T, Jampol A, Patel P, Chappel A, King E, Slutzky MW. Wearable myoelectric interface enables high-dose, home-based training in severely impaired chronic stroke survivors. Ann Clin Transl Neurol 2021; 8:1895-1905. [PMID: 34415114 PMCID: PMC8419406 DOI: 10.1002/acn3.51442] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/21/2022] Open
Abstract
Background High‐intensity occupational therapy can improve arm function after stroke, but many people lack access to such therapy. Home‐based therapies could address this need, but they don’t typically address abnormal muscle co‐activation, an important aspect of arm impairment. An earlier study using lab‐based, myoelectric computer interface game training enabled chronic stroke survivors to reduce abnormal co‐activation and improve arm function. Here, we assess feasibility of doing this training at home using a novel, wearable, myoelectric interface for neurorehabilitation training (MINT) paradigm. Objective Assess tolerability and feasibility of home‐based, high‐dose MINT therapy in severely impaired chronic stroke survivors. Methods Twenty‐three participants were instructed to train with the MINT and game for 90 min/day, 36 days over 6 weeks. We assessed feasibility using amount of time trained and game performance. We assessed tolerability (enjoyment and effort) using a customized version of the Intrinsic Motivation Inventory at the conclusion of training. Results Participants displayed high adherence to near‐daily therapy at home (mean of 82 min/day of training; 96% trained at least 60 min/day) and enjoyed the therapy. Training performance improved and co‐activation decreased with training. Although a substantial number of participants stopped training, most dropouts were due to reasons unrelated to the training paradigm itself. Interpretation Home‐based therapy with MINT is feasible and tolerable in severely impaired stroke survivors. This affordable, enjoyable, and mobile health paradigm has potential to improve recovery from stroke in a variety of settings. Clinicaltrials.gov: NCT03401762.
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Affiliation(s)
- Na-Teng Hung
- Department of Neurology, Northwestern University, Chicago, Illinois, 60611, USA
| | - Vivek Paul
- Department of Neurology, Northwestern University, Chicago, Illinois, 60611, USA
| | - Prashanth Prakash
- Department of Neurology, Northwestern University, Chicago, Illinois, 60611, USA
| | - Torin Kovach
- Department of Neurology, Northwestern University, Chicago, Illinois, 60611, USA
| | - Gene Tacy
- Myomo, Inc., Cambridge, Massachusetts, 02142, USA
| | - Goran Tomic
- Department of Neurology, Northwestern University, Chicago, Illinois, 60611, USA
| | - Sangsoo Park
- Department of Neurology, Northwestern University, Chicago, Illinois, 60611, USA
| | - Tyler Jacobson
- Department of Neurology, Northwestern University, Chicago, Illinois, 60611, USA
| | - Alix Jampol
- Department of Occupational Therapy, Northwestern Medicine, Chicago, Illinois, 60611, USA
| | - Pooja Patel
- Department of Occupational Therapy, Northwestern Medicine, Chicago, Illinois, 60611, USA
| | - Anya Chappel
- Department of Occupational Therapy, Northwestern Medicine, Chicago, Illinois, 60611, USA
| | - Erin King
- Department of Occupational Therapy, Northwestern Medicine, Chicago, Illinois, 60611, USA
| | - Marc W Slutzky
- Department of Neurology, Northwestern University, Chicago, Illinois, 60611, USA.,Departments of Physiology, Northwestern University, Chicago, Illinois, 60611, USA.,Departments of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, 60611, USA.,Departments of Biomedical Engineering, Northwestern University, Chicago, Illinois, 60611, USA
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108
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Hammerbeck U, Hargreaves M, Hollands KL, Tyson S. Stroke survivors' perceptions of participating in a high repetition arm training trial early after stroke. Disabil Rehabil 2021; 44:6026-6033. [PMID: 34372752 DOI: 10.1080/09638288.2021.1955984] [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: 02/04/2023]
Abstract
PURPOSE The study explored the acceptability of high repetition arm training as part of a randomised controlled trial, early after stroke, when fatigue levels and emotional strain are often high. MATERIALS AND METHODS 36 sub-acute stroke survivors (61 years+/-15) attended for assessment sessions at 3, 6, and 12 weeks after stroke. Individuals were randomised to receive 6 high repetition arm training sessions between 3 and 6 weeks (intervention) or the control group. Semi-structured interviews were conducted at trial completion. Interview transcripts were analysed through framework analysis conducted independently by 2 researchers. RESULTS Stroke survivors participated despite high levels of fatigue because they hoped for personal benefit or to potentially benefit future patients. Benefits reported from participation included physical improvements, psychological benefit, improved understanding of their condition as well as a feeling of hope and distraction. The arm training at three weeks after stroke, aiming for 420 movement repetitions was not considered to be too intensive or too early, and most individuals felt lucky to have been, or would have preferred to be in the early training group. CONCLUSION High repetition arm training early after stroke was acceptable to participants. Study participation was generally viewed as a positive experience, suggesting that early intervention may not only be physically beneficial but also psychologically.Implications for rehabilitationStroke survivors report that high repetition arm training early after stroke is acceptable.Participation in rehabilitation research early after stroke provides stroke survivors with hope and meaning despite the high prevalence of fatigue.Complex information needs to be repeated and provided in a number of formats early after stroke.
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Affiliation(s)
- Ulrike Hammerbeck
- School of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK.,Division of Cardiovascular Sciences, University of Manchester, Manchester, UK.,Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance & Greater Manchester Universities, Manchester, UK
| | - Mary Hargreaves
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK.,Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance & Greater Manchester Universities, Manchester, UK
| | - Kristen L Hollands
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance & Greater Manchester Universities, Manchester, UK.,School of Health Sciences, University of Salford, Salford, UK
| | - Sarah Tyson
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance & Greater Manchester Universities, Manchester, UK.,School of Health Sciences, University of Manchester, Manchester, UK
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109
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Dietz V. Restoration of motor function after CNS damage: is there a potential beyond spontaneous recovery? Brain Commun 2021; 3:fcab171. [PMID: 34396118 PMCID: PMC8361425 DOI: 10.1093/braincomms/fcab171] [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: 05/02/2021] [Revised: 06/27/2021] [Accepted: 01/19/2021] [Indexed: 11/14/2022] Open
Abstract
What determines the effectiveness of neurorehabilitation approaches on the outcome of function in stroke or spinal cord injured subjects? Many studies claim that an improvement of function is based on the intensity of training, while some actual studies indicate no additional gain in function by a more intensive training after a stroke. Inherent factors seem to determine outcome, such as damage of specific tracts in stroke and level of lesion in spinal cord injured subjects, while the improvement of function achieved by an intensive training is small in relation to the spontaneous recovery. It is argued that an individual capacity of recovery exists depending on such factors. This capacity can be exploited by a repetitive execution of functional movements (supported as far as required), irrespective of the intensity and technology applied. Elderly subjects have difficulties to translate the recovery of motor deficit into function. Alternative, non-training approaches to restore motor function, such as epidural or deep brain stimulation as well as CNS repair are still in an early clinical or in a translational stage.
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Affiliation(s)
- Volker Dietz
- Spinal Cord Injury Center, University Hospital Balgrist, Zürich, Switzerland
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110
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Kim K, Yoo SJ, Kim SY, Lee T, Lim SH, Jang JE, Je M, Moon C, Choi JW. Subthreshold electrical stimulation as a low power electrical treatment for stroke rehabilitation. Sci Rep 2021; 11:14048. [PMID: 34234199 PMCID: PMC8263745 DOI: 10.1038/s41598-021-93354-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/18/2021] [Indexed: 11/09/2022] Open
Abstract
As a promising future treatment for stroke rehabilitation, researchers have developed direct brain stimulation to manipulate the neural excitability. However, there has been less interest in energy consumption and unexpected side effect caused by electrical stimulation to bring functional recovery for stroke rehabilitation. In this study, we propose an engineering approach with subthreshold electrical stimulation (STES) to bring functional recovery. Here, we show a low level of electrical stimulation boosted causal excitation in connected neurons and strengthened the synaptic weight in a simulation study. We found that STES with motor training enhanced functional recovery after stroke in vivo. STES was shown to induce neural reconstruction, indicated by higher neurite expression in the stimulated regions and correlated changes in behavioral performance and neural spike firing pattern during the rehabilitation process. This will reduce the energy consumption of implantable devices and the side effects caused by stimulating unwanted brain regions.
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Affiliation(s)
- Kyungsoo Kim
- Brain Engineering Convergence Research Center, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea
| | - Seung-Jun Yoo
- Department of Brain and Cognitive Sciences, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea
| | - So Yeon Kim
- Convergence Research Advanced Centre for Olfaction, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea.,Department of Brain and Cognitive Sciences, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea
| | - Taeju Lee
- Department of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Sung-Ho Lim
- Brain Engineering Convergence Research Center, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea
| | - Jae-Eun Jang
- Department of Information and Communication Engineering, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea
| | - Minkyu Je
- Department of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Cheil Moon
- Brain Engineering Convergence Research Center, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea. .,Convergence Research Advanced Centre for Olfaction, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea. .,Department of Brain and Cognitive Sciences, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea.
| | - Ji-Woong Choi
- Brain Engineering Convergence Research Center, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea. .,Department of Information and Communication Engineering, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea.
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111
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Hornby TG, Rafferty MR, Pinto D, French D, Jordan N. Cost-Effectiveness of High-intensity Training vs Conventional Therapy for Individuals With Subacute Stroke. Arch Phys Med Rehabil 2021; 103:S197-S204. [PMID: 34228956 DOI: 10.1016/j.apmr.2021.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/28/2021] [Accepted: 05/06/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This investigation estimated the incremental cost-effectiveness of high-intensity training (HIT) compared with conventional physical therapy in individuals with subacute stroke, based on the additional personnel required to deliver the therapy. DESIGN Secondary analysis from a pilot study and subsequent randomized controlled trial. SETTING Outpatient laboratory setting. PARTICIPANTS Data were collected from individuals with locomotor impairments 1-6 months poststroke (N=44) who participated in HIT (n=27) or conventional physical therapy (n=17). INTERVENTIONS Individuals performing HIT practiced walking tasks in variable contexts (stairs, overground, treadmill) while targeting up to 80% maximum heart rate reserve. Individuals performing conventional therapy practiced impairment-based and functional tasks at lower intensities (<40% heart rate reserve). MAIN OUTCOME MEASURES Costs were assessed based on personnel use with availability of similar equipment. Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves were calculated for quality-adjusted life years (QALYs) derived from the Medical Outcomes Short Form-36 questionnaire and gains in self-selected speeds (SSSs). RESULTS Personnel costs were higher after HIT (mean, $1420±234) vs conventional therapy (mean, $1111±219), although between-group differences in QALYs (0.05 QALYs; 95% confidence interval [CI], 0.0-0.10 QALYs) and SSS (0.20 m/s; 95% CI, 0.05-0.35 m/s) favored HIT. ICERs were $6180 (95% CI, -$96,364 to $123,211) per QALY and $155 (95% CI, 38-242) for a 0.1 m/s gain in SSS. CONCLUSIONS Additional personnel to support HIT are relatively inexpensive but can add substantial effectiveness to subacute rehabilitation. Future research should evaluate patient factors that increase the likelihood of improvement to maximize the cost-effectiveness of treatment post stroke.
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Affiliation(s)
- T George Hornby
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN; Rehabilitation Hospital of Indiana, Indianapolis, IN; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Miriam R Rafferty
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL; Shirley Ryan AbilityLab, Chicago, IL
| | - Daniel Pinto
- Department of Physical Therapy, Marquette University, Milwaukee, WI
| | - Dustin French
- Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Ophthalmology, Northwestern University Feinberg School of Medicine; Chicago, IL; Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, IL
| | - Neil Jordan
- Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, Chicago, IL; Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, IL
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112
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Gracies JM, Francisco GE, Jech R, Khatkova S, Rios CD, Maisonobe P. Guided Self-rehabilitation Contracts Combined With AbobotulinumtoxinA in Adults With Spastic Paresis. J Neurol Phys Ther 2021; 45:203-213. [PMID: 34039905 PMCID: PMC8191476 DOI: 10.1097/npt.0000000000000359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Guided self-rehabilitation contracts (GSCs) are a diary-based rehabilitation strategy, wherein specific muscles are identified for prescription of high-load, home self-stretching techniques. We assessed the effect of GSCs combined with simultaneous upper limb (UL) and lower limb (LL) abobotulinumtoxinA injections on composite active range of motion (CXA) in adults with chronic spastic paresis. METHODS This was an international, prospective, single-arm, open-label study (ENGAGE, NCT02969356). Personalized GSCs were monitored by phone every other week, alongside 2 consecutive abobotulinumtoxinA injections (1500 U) across UL and LL, over 6 to 9 months. Primary outcomes were responder rates (CXA improvement ≥35° [UL] or ≥5° [LL]) at week 6 cycle 2. Secondary outcomes were active function (UL: Modified Frenchay Scale [MFS]; LL: 10-m barefoot maximal walking speed [WS]) and quality of life (12-item Short Form Health Survey, SF-12). RESULTS Of the 153 treated participants, 136 had primary endpoint data; 72.1% (95% confidence interval [CI], 64.0-78.9) were responders. Mean (SD) CXA changes from baseline to last study visit were +49.3° (63.4) for UL and +20.1° (27.6) for LL. Mean (95% CI) changes from baseline to week 12 cycle 2 were +0.55 (0.43-0.66) in MFS, +0.12 m/s (0.09-0.15) for WS, and +4.0 (2.8-5.2) for SF-12 physical scores. In the safety population (n = 157), 49.7% of participants reported treatment-emergent adverse events (AEs); 12.1% reported 25 serious AEs. DISCUSSION AND CONCLUSIONS GSC combined with simultaneous UL and LL abobotulinumtoxinA injections led to improvements in CXA and function in both limbs, and quality-of-life physical scores. These results suggest the beneficial effect of combined GSC and abobotulinumtoxinA therapy in the management of spastic paresis.Video Abstract available for more insight from the authors (see the Supplementary Video, available at: http://links.lww.com/JNPT/A346).
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Affiliation(s)
- Jean-Michel Gracies
- UR 7377 BIOTN, Université Paris-Est Créteil, Albert Chenevier-Henri Mondor Hospital, Department of Neurorehabilitation, Créteil, France (J.M.G.); Department of Physical Medicine and Rehabilitation, the University of Texas Health Science Center at Houston McGovern Medical School, and the Neurorecovery Research Center at TIRR Memorial Hermann, Houston, Texas (G.E.F.); Department of Neurology, First Faculty of Medicine, Charles University, and General Faculty Hospital, Prague, Czech Republic (R.J.); Neurology Department, Federal State Hospital, Treatments and Rehabilitation, Center of Ministry of Health and Social Development of Russian Federation, Moscow, Russia (S.K.); and Ipsen Pharma, Boulogne- Billancourt, France (C.D.R., P.M)
| | - Gerard E. Francisco
- UR 7377 BIOTN, Université Paris-Est Créteil, Albert Chenevier-Henri Mondor Hospital, Department of Neurorehabilitation, Créteil, France (J.M.G.); Department of Physical Medicine and Rehabilitation, the University of Texas Health Science Center at Houston McGovern Medical School, and the Neurorecovery Research Center at TIRR Memorial Hermann, Houston, Texas (G.E.F.); Department of Neurology, First Faculty of Medicine, Charles University, and General Faculty Hospital, Prague, Czech Republic (R.J.); Neurology Department, Federal State Hospital, Treatments and Rehabilitation, Center of Ministry of Health and Social Development of Russian Federation, Moscow, Russia (S.K.); and Ipsen Pharma, Boulogne- Billancourt, France (C.D.R., P.M)
| | - Robert Jech
- UR 7377 BIOTN, Université Paris-Est Créteil, Albert Chenevier-Henri Mondor Hospital, Department of Neurorehabilitation, Créteil, France (J.M.G.); Department of Physical Medicine and Rehabilitation, the University of Texas Health Science Center at Houston McGovern Medical School, and the Neurorecovery Research Center at TIRR Memorial Hermann, Houston, Texas (G.E.F.); Department of Neurology, First Faculty of Medicine, Charles University, and General Faculty Hospital, Prague, Czech Republic (R.J.); Neurology Department, Federal State Hospital, Treatments and Rehabilitation, Center of Ministry of Health and Social Development of Russian Federation, Moscow, Russia (S.K.); and Ipsen Pharma, Boulogne- Billancourt, France (C.D.R., P.M)
| | - Svetlana Khatkova
- UR 7377 BIOTN, Université Paris-Est Créteil, Albert Chenevier-Henri Mondor Hospital, Department of Neurorehabilitation, Créteil, France (J.M.G.); Department of Physical Medicine and Rehabilitation, the University of Texas Health Science Center at Houston McGovern Medical School, and the Neurorecovery Research Center at TIRR Memorial Hermann, Houston, Texas (G.E.F.); Department of Neurology, First Faculty of Medicine, Charles University, and General Faculty Hospital, Prague, Czech Republic (R.J.); Neurology Department, Federal State Hospital, Treatments and Rehabilitation, Center of Ministry of Health and Social Development of Russian Federation, Moscow, Russia (S.K.); and Ipsen Pharma, Boulogne- Billancourt, France (C.D.R., P.M)
| | - Carl D. Rios
- UR 7377 BIOTN, Université Paris-Est Créteil, Albert Chenevier-Henri Mondor Hospital, Department of Neurorehabilitation, Créteil, France (J.M.G.); Department of Physical Medicine and Rehabilitation, the University of Texas Health Science Center at Houston McGovern Medical School, and the Neurorecovery Research Center at TIRR Memorial Hermann, Houston, Texas (G.E.F.); Department of Neurology, First Faculty of Medicine, Charles University, and General Faculty Hospital, Prague, Czech Republic (R.J.); Neurology Department, Federal State Hospital, Treatments and Rehabilitation, Center of Ministry of Health and Social Development of Russian Federation, Moscow, Russia (S.K.); and Ipsen Pharma, Boulogne- Billancourt, France (C.D.R., P.M)
| | - Pascal Maisonobe
- UR 7377 BIOTN, Université Paris-Est Créteil, Albert Chenevier-Henri Mondor Hospital, Department of Neurorehabilitation, Créteil, France (J.M.G.); Department of Physical Medicine and Rehabilitation, the University of Texas Health Science Center at Houston McGovern Medical School, and the Neurorecovery Research Center at TIRR Memorial Hermann, Houston, Texas (G.E.F.); Department of Neurology, First Faculty of Medicine, Charles University, and General Faculty Hospital, Prague, Czech Republic (R.J.); Neurology Department, Federal State Hospital, Treatments and Rehabilitation, Center of Ministry of Health and Social Development of Russian Federation, Moscow, Russia (S.K.); and Ipsen Pharma, Boulogne- Billancourt, France (C.D.R., P.M)
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113
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Fandim JV, Saragiotto BT, Porfírio GJM, Santana RF. Effectiveness of virtual reality in children and young adults with cerebral palsy: a systematic review of randomized controlled trial. Braz J Phys Ther 2021; 25:369-386. [PMID: 33358737 PMCID: PMC8353293 DOI: 10.1016/j.bjpt.2020.11.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 07/06/2020] [Accepted: 11/17/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cerebral palsy (CP) is one of the main causes of disability in childhood. Virtual reality (VR) has been used as a treatment option in this population, however its effectiveness is unclear. OBJECTIVE To evaluate the effectiveness of VR in patients with CP. METHODS We conducted electronic searches in EMBASE, MEDLINE, Cochrane library, PEDro, AMED, PsycoINFO, and LILACS databases and trial site registries such as ClinicalTrials.gov and ICTRP. We included randomized controlled trials that tested the use of VR alone or in combination with other interventions compared to more conventional rehabilitation or usual care in individuals with CP. The primary outcomes were upper and lower limb function, postural control, and balance. The secondary outcomes included global motor function, perception, cognition and spatial functions, motivation, motor learning, and adverse events. Two independent reviewers extracted and assessed included articles for risk of bias using the Cochrane risk of bias tool. We use a meta-analysis with random effect model whenever possible. We analyzed the quality of evidence using theGRADE approach. RESULTS We included 38 trials (pooled n = 1233 participants) in this review. There is very low quality of evidence that VR plus conventional rehabilitation is better than conventional rehabilitation for upper limb function. There is also very low quality evidence that VR alone is no better than conventional rehabilitation for upper and lower limb function. No adverse events were observed among the 10 trials that provided information on this outcome. CONCLUSION At present we have very limited to limited confidence in effect estimation for utilization of VR in this population. Future studies may change our confidence in results and effect estimates. PROTOCOL REGISTRATION PROSPERO CRD 42018102759.
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Affiliation(s)
- Junior Vitorino Fandim
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil.
| | - Bruno Tirotti Saragiotto
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil
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114
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Bozec E, Gorska J, Grampurohit N. Upper Extremity Task-Specific Training: Manual Development and Implementation Research within Inpatient Rehabilitation. Occup Ther Health Care 2021; 35:336-354. [PMID: 34181500 DOI: 10.1080/07380577.2021.1938338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 05/21/2021] [Accepted: 05/29/2021] [Indexed: 10/21/2022]
Abstract
A structured program of manualization and implementation of neurologic upper extremity task-specific training was developed at an inpatient rehabilitation hospital. The study used the Consolidated Framework for Implementation Research and engaged 31 stakeholders in manual refinement and examination of barriers after a year of training and use. Occupational therapists, occupational therapy assistants, and clinical educators provided input for manual revisions until consensus was achieved on usability, applicability, and implementation. Practitioners reported barriers such as intervention complexity, insufficient idea sharing for implementation, and a lack of motivators outside of the organization. The results can inform future implementation research in occupational therapy.Supplemental data for this article is available online at https://doi.org/10.1080/07380577.2021.1938338 .
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Affiliation(s)
- Eron Bozec
- Outpatient Day Rehabilitation, Northwestern Medicine Marianjoy Rehabilitation Hospital, Wheaton, IL, USA
- Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jaime Gorska
- Outpatient Day Rehabilitation, Northwestern Medicine Marianjoy Rehabilitation Hospital, Wheaton, IL, USA
| | - Namrata Grampurohit
- Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
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115
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Proulx CE, Higgins J, Gagnon DH. Occupational therapists' evaluation of the perceived usability and utility of wearable soft robotic exoskeleton gloves for hand function rehabilitation following a stroke. Disabil Rehabil Assist Technol 2021:1-10. [PMID: 34190657 DOI: 10.1080/17483107.2021.1938710] [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: 10/21/2022]
Abstract
PURPOSE To evaluate the perceived usability and utility of using a soft robotic glove to rehabilitate hand function following a stroke. METHODS A convergent parallel mixed-methods design was used to consult a convenience sample of 14 experienced occupational therapists (OTs) practicing within a specialised stroke rehabilitation program. All OTs participated in one 60-to-90-minute individual consultation during which the attributes of a recently-developed soft robotic glove (ExoGlove) were presented before they could test it on themselves. After this consultation, OTs completed the System Usability Scale (SUS) questionnaire and answered open-ended questions focussing on the usability and utility of soft robotic gloves framed according to the Unified Theory of Acceptance and Use of Technology (UTAUT). RESULTS The OTs perceived the glove's usability as being moderate-to-good on the SUS (median score= 63.75 on a scale of 100). Thematic analysis revealed the importance of specifically considering elements such as ease of use (e.g. simplicity and speed), cost, movement precision, durability, and safety, when developing soft robotic gloves such as the ExoGlove. CONCLUSIONS Engagement in a continuous improvement process is essential to maximise the perceived usability and utility of soft robotic gloves, particularly of the ExoGlove, through their final development phase before pilot testing their effects and effectiveness for post-stroke hand rehabilitation.Implications for rehabilitationAll occupational therapists anticipate that a soft robotic glove such as the ExoGlove will allow them to increase treatment intensity and best aligns with principles of neuroplasticity.The clinical judgement and guidance of OTs, developed through practice, experience, and knowledge, remain essential to safely and efficiently exercise with a soft robotic glove.Achieving a balance between effort and performance expectancies is essential in developing and improving the functionality of soft robotic gloves, as with each additional functionality comes new challenges that impact its successful transition to a clinical setting.
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Affiliation(s)
- Camille E Proulx
- School of Rehabilitation, Université de Montréal, Montreal, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | - Johanne Higgins
- School of Rehabilitation, Université de Montréal, Montreal, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | - Dany H Gagnon
- School of Rehabilitation, Université de Montréal, Montreal, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
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116
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Ito K, Uehara S, Yuasa A, Kim CM, Kitamura S, Ushizawa K, Tanabe S, Otaka Y. Electromyography-controlled gamified exercise system for the distal upper extremity: a usability assessment in subacute post-stroke patients. Disabil Rehabil Assist Technol 2021:1-6. [PMID: 34102940 DOI: 10.1080/17483107.2021.1936663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Movement repetition is known to play a key role in promoting functional improvements or maintaining functional levels in post-stroke hemiparetic patients. However, repetitive movements tend to be monotonous, making it challenging for patients to continue. Here, we developed a new gamified system to allow patients perform repetitive movements with enjoyment. The present study aimed to examine the usability of the system in subacute stroke patients. METHOD The exercise system comprised an electromyography-controlled operating system that enabled users to play a virtual game by repetitive finger and wrist movements on the affected side. A total of 13 patients with upper-limb hemiparesis underwent a single bout of exercise using the system and assessed its usability, satisfactoriness, enjoyability, etc. using the System Usability Scale (SUS), Quebec User Evaluation of Satisfaction with assistive Technology (QUEST)-like questionnaire, and numerical rating scale (NRS). RESULTS All the participants, who had a wide range of paretic levels, were able to perform the exercise using the system. Participants scored the system a median of 85.0 for SUS and 4.2 for the QUEST-like questionnaire, with an "excellent" in usability and "satisfied" in user satisfaction with the system. The median NRS scores for enjoyability, potential for continuous use, and effectiveness were 8.0, 9.0, and 9.0, respectively, which were greater than the scores for usual rehabilitation training for the upper extremity. CONCLUSIONS The novel electromyography-controlled gamified exercise system may have sufficient usability and enjoyability to motivate patients with a wide range of paretic levels to perform repetitive finger and wrist movements.IMPLICATIONS FOR REHABILITATIONThe electromyography-controlled gamified exercise system had overall positive perspectives on the usability of the system.This exercise system could help motivate patients with a wide range of paretic levels to perform repetitive finger and wrist movements.
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Affiliation(s)
- Kazuki Ito
- Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan
| | - Shintaro Uehara
- Faculty of Rehabilitation, Fujita Health University School of Health Sciences, Aichi, Japan
| | - Akiko Yuasa
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Aichi, Japan
| | | | - Shin Kitamura
- Faculty of Rehabilitation, Fujita Health University School of Health Sciences, Aichi, Japan
| | - Kazuki Ushizawa
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Aichi, Japan
| | - Shigeo Tanabe
- Faculty of Rehabilitation, Fujita Health University School of Health Sciences, Aichi, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Aichi, Japan
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Dalton EJ, Churilov L, Lannin NA, Corbett D, Campbell BCV, Hayward KS. Multidimensional Phase I Dose Ranging Trials for Stroke Recovery Interventions: Key Challenges and How to Address Them. Neurorehabil Neural Repair 2021; 35:663-679. [PMID: 34085851 DOI: 10.1177/15459683211019362] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite an increase in the amount of published stroke recovery research, interventions have failed to markedly affect the trajectory of recovery poststroke. We argue that early-phase research to systematically investigate dose is an important contributor to advance the science underpinning stroke recovery. In this article, we aim to (a) define the problem of insufficient use of a systematic approach to early-phase, multidimensional dose articulation research and (b) propose a solution that applies this approach to design a multidimensional phase I trial to identify the maximum tolerated dose (MTD). We put forward a design template as a decision support tool to increase knowledge of how to develop a phase I dose-ranging trial for nonpharmaceutical stroke recovery interventions. This solution has the potential to advance the development of efficacious stroke recovery interventions, which include activity-based rehabilitation interventions.
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Affiliation(s)
| | | | - Natasha A Lannin
- Monash University, Melbourne, VIC, Australia.,Alfred Health, Melbourne, Australia
| | | | - Bruce C V Campbell
- University of Melbourne, Parkville, VIC, Australia.,Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Kathryn S Hayward
- University of Melbourne, Parkville, VIC, Australia.,Florey Institute of Neurosciences and Mental Health, Heidelberg, VIC, Australia
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118
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Huygelier H, Mattheus E, Abeele VV, van Ee R, Gillebert CR. The Use of the Term Virtual Reality in Post-Stroke Rehabilitation: A Scoping Review and Commentary. Psychol Belg 2021; 61:145-162. [PMID: 34131490 PMCID: PMC8176935 DOI: 10.5334/pb.1033] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 05/20/2021] [Indexed: 11/20/2022] Open
Abstract
Virtual reality (VR) offers many opportunities for post-stroke rehabilitation. However, "VR" can refer to several types of computer-based rehabilitation systems. Since these systems may impact the feasibility and the efficacy of VR interventions, consistent terminology is important. In this study, we aimed to optimize the terminology for VR-based post-stroke rehabilitation by assessing whether and how review papers on this topic defined VR and what types of mixed reality systems were discussed. In addition, this review can inspire the use of consistent terminology for other researchers working with VR. We assessed the use of the term VR in review papers on post-stroke rehabilitation extracted from Scopus, Web of Science and PubMed. We also developed a taxonomy distinguishing 16 mixed reality systems based on three factors: immersive versus semi-immersive displays, the way in which real and virtual information is mixed, and the main input device. 64% of the included review papers (N = 121) explicitly defined VR and 33% of them described different subtypes of VR, with immersive and non-immersive VR as the most common distinction. The most frequently discussed input devices were motion-capture cameras and handheld devices, while regular 2D monitors were the most frequently mentioned output devices. Our analysis revealed that reviews on post-stroke VR rehabilitation did not or only broadly defined "VR" and did not focus on a specific system. Since the efficacy and feasibility of rehabilitation may depend on the specific system, we propose a new data-driven taxonomy to distinguish different systems, which is expected to facilitate communication amongst researchers and clinicians working with virtual reality.
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Affiliation(s)
| | | | | | - Raymond van Ee
- Brain and Cognition, KU Leuven, Leuven, Belgium
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
- Philips Research, High tech Campus, Eindhoven, The Netherlands
| | - Céline R. Gillebert
- Brain and Cognition, KU Leuven, Leuven, Belgium
- TRACE, Ziekenhuis Oost-Limburg, Genk, Belgium
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119
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Espy D, Reinthal A, Dal Bello-Haas V. A Clinical Decision-Making Framework for the Use of Video Gaming as a Therapeutic Modality. Front Neurol 2021; 12:610095. [PMID: 34122293 PMCID: PMC8193226 DOI: 10.3389/fneur.2021.610095] [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: 09/25/2020] [Accepted: 04/13/2021] [Indexed: 11/24/2022] Open
Abstract
Virtual reality and video gaming offer modulation of more exercise and motor learning parameters simultaneously than other modalities; however, there is a demonstrated need for resources to facilitate their effective use clinically. This article presents a conceptual framework to guide clinical-decision making for the selection, adaptation, modulation, and progression of virtual reality or gaming when used as a therapeutic exercise modality, and two cases as exemplars. This framework was developed by adapting the steps of theory derivation, whereby concepts and parent theories are brought together to describe a new structure or phenomenon of interest. Specifically, motor learning theory, integrated motor control theory, Gentile's Taxonomy of Tasks, and therapeutic exercise principles were integrated to develop this framework. It incorporates person (body segment), environmental, and task demands; each demand is comprised of realm, category, choice, and continuum parameters as motor training considerations and alternatives for decision-making. This framework: (1) provides structure to guide clinical decisions for effective and safe use of virtual reality or gaming to meet therapeutic goals and requirements, (2) is a concise and organized method to identify, document, and track the therapeutic components of protocols and client progression over time; (3) can facilitate documentation for reimbursement and communication among clinicians; and, (4) structures student learning, and (5) informs research questions and methods.
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Affiliation(s)
- Debbie Espy
- School of Health Sciences, Cleveland State University, Cleveland, OH, United States
| | - Ann Reinthal
- School of Health Sciences, Cleveland State University, Cleveland, OH, United States
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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.
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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
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Urbin MA, Collinger JL, Wittenberg GF. Corticospinal recruitment of spinal motor neurons in human stroke survivors. J Physiol 2021; 599:4357-4373. [PMID: 34021605 DOI: 10.1113/jp281311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 04/12/2021] [Indexed: 12/13/2022] Open
Abstract
KEY POINTS Muscle weakness after stroke results from damage to corticospinal fibres that structurally and functionally connect cerebral cortex to the spinal cord. Here, we show an asymmetry in corticospinal recruitment of spinal motor neurons that is linked to maximal voluntary output of hand muscles weakened by stroke. Spike timing-dependent plasticity of synapses between corticospinal and spinal motor neurons transiently reversed recruitment failures in some survivors. These modulatory effects were strongly associated with recruitment asymmetry and hand impairment. Our findings highlight the functional relevance of spinal motor neuron recruitment by corticospinal inputs and the viability of corticospinal motor neuronal synapses for restoring activation of lower motor neurons after stroke. ABSTRACT Corticospinal input to spinal motor neurons is structurally and functionally altered by hemiparetic stroke. The pattern and extent to which corticospinal recruitment of spinal motor neurons is reorganized and whether such changes are linked to the severity of motor impairments is not well understood. Here, we performed experiments using the triple stimulation technique to quantify corticospinal recruitment of spinal motor neurons serving paretic and non-paretic intrinsic hand muscles of humans with longstanding motor impairment secondary to stroke (n = 13). We also examined whether recruitment failures could be transiently reversed by strengthening corticospinal-motoneuronal synaptic connectivity via targeted, temporally controlled non-invasive stimulation to elicit spike timing-dependent plasticity (STDP). Asymmetries were detected in corticospinal recruitment of spinal motor neurons, central conduction time and motor-evoked potential (MEP) latency. However, only recruitment asymmetry correlated with maximal voluntary motor output from the paretic hand. STDP-like effects were observed as an increase in spinal motor neuron recruitment. Control experiments to isolate the locus of plasticity demonstrated a modulation in MEPs elicited by electrical stimulation of primary motor cortex but not F-wave size or persistence, suggesting that plasticity was mediated through enhanced efficacy of residual corticospinal-motor neuronal synapses. The modulation in recruitment was strongly associated with baseline recruitment asymmetry and impairment severity. Our findings demonstrate that asymmetry in corticospinal recruitment of spinal motor neurons is directly related to impairments experienced by stroke survivors. These recruitment deficits may be partially and transiently reversed by spike timing-dependent plasticity of synapses between upper and lower motor neurons in the spinal cord, downstream of supraspinal circuits damaged by stroke.
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Affiliation(s)
- Michael A Urbin
- Human Engineering Research Laboratories, VA RR&D Center of Excellence, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Rehabilitation Neural Engineering Laboratories, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer L Collinger
- Human Engineering Research Laboratories, VA RR&D Center of Excellence, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Rehabilitation Neural Engineering Laboratories, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - George F Wittenberg
- Human Engineering Research Laboratories, VA RR&D Center of Excellence, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Rehabilitation Neural Engineering Laboratories, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
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He P, Kantu NT, Xu B, Swami CP, Saleem GT, Kang J. A Novel 3-RRR Spherical Parallel Instrument for Daily Living Emulation (SPINDLE) for Functional Rehabilitation of Patients with Stroke. INT J ADV ROBOT SYST 2021. [DOI: 10.1177/17298814211012325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Various robotic rehabilitation devices have been developed for acute stroke patients to ease therapist’s efforts and provide high-intensity training, which resulted in improved strength and functional recovery of patients; however, these improvements did not always transfer to the performance of activities of daily living (ADLs). This is because previous robotic training focuses on the proximal joints or training with exoskeleton-type devices, which do not reflect how humans interact with the environment. To improve the training effect of ADLs, a new robotic training paradigm is suggested with a parallel manipulator that mimics rotational ADL tasks. This study presents training of the proximal and distal joints simultaneously while performing manipulation tasks in a device named spherical parallel instrument for daily living emulation (SPINDLE). Six representative ADLs were chosen to show that both proximal and distal joints are trained when performing tasks with SPINDLE, as compared to the natural ADLs. These results show that SPINDLE can train individuals with movements similar to the ADLs while interacting with the manipulator. We envision using this compact tabletop device as a home-training device to increase the performance of ADLs by restoring the impaired motor function of stroke patients, leading to improved quality of life.
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Affiliation(s)
- Peidong He
- Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY, USA
| | - Nikhil Tej Kantu
- Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY, USA
| | - Boxin Xu
- Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY, USA
| | | | | | - Jiyeon Kang
- Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY, USA
- Rehabilitation Science, University at Buffalo, Buffalo, NY, USA
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123
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Balestra N, Sharma G, Riek LM, Busza A. Automatic Identification of Upper Extremity Rehabilitation Exercise Type and Dose Using Body-Worn Sensors and Machine Learning: A Pilot Study. Digit Biomark 2021; 5:158-166. [PMID: 34414353 PMCID: PMC8339513 DOI: 10.1159/000516619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/19/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Prior studies suggest that participation in rehabilitation exercises improves motor function poststroke; however, studies on optimal exercise dose and timing have been limited by the technical challenge of quantifying exercise activities over multiple days. OBJECTIVES The objectives of this study were to assess the feasibility of using body-worn sensors to track rehabilitation exercises in the inpatient setting and investigate which recording parameters and data analysis strategies are sufficient for accurately identifying and counting exercise repetitions. METHODS MC10 BioStampRC® sensors were used to measure accelerometer and gyroscope data from upper extremities of healthy controls (n = 13) and individuals with upper extremity weakness due to recent stroke (n = 13) while the subjects performed 3 preselected arm exercises. Sensor data were then labeled by exercise type and this labeled data set was used to train a machine learning classification algorithm for identifying exercise type. The machine learning algorithm and a peak-finding algorithm were used to count exercise repetitions in non-labeled data sets. RESULTS We achieved a repetition counting accuracy of 95.6% overall, and 95.0% in patients with upper extremity weakness due to stroke when using both accelerometer and gyroscope data. Accuracy was decreased when using fewer sensors or using accelerometer data alone. CONCLUSIONS Our exploratory study suggests that body-worn sensor systems are technically feasible, well tolerated in subjects with recent stroke, and may ultimately be useful for developing a system to measure total exercise "dose" in poststroke patients during clinical rehabilitation or clinical trials.
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Affiliation(s)
- Noah Balestra
- Department of Neurology, University of Rochester, Rochester, New York, USA
| | - Gaurav Sharma
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, New York, USA
- Department of Computer Science, University of Rochester, Rochester, New York, USA
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - Linda M. Riek
- Department of Physical Therapy, Nazareth College, Rochester, New York, USA
| | - Ania Busza
- Department of Neurology, University of Rochester, Rochester, New York, USA
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124
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Bell A, Grampurohit N, Marino RJ, Duff S, Kaplan G, Calhoun Thielen C, Mulcahey M. Home Activity-based Interventions for the Neurologically Impaired Upper Extremity: A Scoping Review. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2021. [DOI: 10.1177/1084822320953836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Activity-based therapy (ABT) for the upper extremity (UE) enables neurologic recovery with tasks that are functional, intense, and highly repetitive. A large proportion of rehabilitation occurs in the home and there is a gap in literature on the application of ABT within the home. The objective of this scoping review was to describe ABT in the home-setting for the neurologically-impaired UE. Methods: A systematic scoping review included searches of: MEDLINE, CINAHL, Cochrane, and OTSeeker. Results: A systematic search yielded 51 final studies. About 61% of ABT studies were exclusively within the home, others included outpatient visits (37%). Telerehabilitation was used in 37% of the studies with live-video and store forward techniques equally represented. ABT supported by technology was used in 61% of studies. Dosing of intervention ranged from 7 to 120 hours, with a mean of 34.5 hours of practice. Adherence with intended dosing was reported in 27% of studies and subjects completed a mean of 86% of the intended practice time. Sixty-seven percent of studies reported some degree of practice without therapist supervision. Conclusions: The results showed wide variability in the intervention methods, dosing and technology used in homebased settings. The high rate of adherence with dosing is encouraging for the application of homebased neurologic UE interventions. This scoping review highlights feasibility of UE ABT within the home and need for further research.
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Affiliation(s)
- Alison Bell
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | | - Gary Kaplan
- Thomas Jefferson University, Philadelphia, PA, USA
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125
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Olivier GN, Paul SS, Walter CS, Hayes HA, Foreman KB, Duff K, Schaefer SY, Dibble LE. The feasibility and efficacy of a serial reaction time task that measures motor learning of anticipatory stepping. Gait Posture 2021; 86:346-353. [PMID: 33857800 PMCID: PMC8092847 DOI: 10.1016/j.gaitpost.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 03/03/2021] [Accepted: 04/02/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Motor learning has been investigated using various paradigms, including serial reaction time tasks (SRTT) that examine upper extremity reaching and pointing while seated. Few studies have used a stepping SRTT, which could offer additional insights into motor learning involving postural demands. For a task to measure motor learning, naïve participants must demonstrate a) improved performance with task practice, and b) a dose-response relationship to learning the task. RESEARCH QUESTION Is a stepping SRTT feasible and efficacious for measuring motor learning? METHODS In this prospective study, 20 participants stood on an instrumented mat and were presented with stimuli on a computer screen. They stepped to the corresponding positions on the mat as quickly as possible. Presented stimuli included random sequences and a blinded imbedded repeating sequence. Three days after completing the randomly assigned practice dose [high dose group (n = 10) performed 4320 steps; low dose group (n = 10) performed 144 steps], a retention test of 72 steps was performed. Feasibility was measured as the proportion of participants who completed the assigned practice dose without adverse events. Efficacy was measured as within-group performance improvement on the random sequences and on the repeating sequence (paired t-tests), as well as a dose-response relationship to learning both types of sequences (independent t-tests). RESULTS All participants (mean age 26.8 years) completed all practice sessions without adverse events, indicating feasibility. High dose practice resulted in performance improvement while low dose did not; a dose-response relationship was found, with high dose practice resulting in greater learning of the task than low dose practice, indicating efficacy. SIGNIFICANCE This stepping SRTT is a feasible and efficacious way to measure motor learning, which could provide critical insights into anticipatory stepping, postural control, and fall risk. Future research is needed to determine feasibility, efficacy, and optimal practice dosages for older and impaired populations.
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Affiliation(s)
- Geneviève N Olivier
- Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA.
| | - Serene S Paul
- Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Christopher S Walter
- Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Heather A Hayes
- Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - K Bo Foreman
- Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Kevin Duff
- Neurology, University of Utah, Salt Lake City, UT, USA
| | - Sydney Y Schaefer
- Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Leland E Dibble
- Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
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126
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Sánchez N, Winstein CJ. Lost in Translation: Simple Steps in Experimental Design of Neurorehabilitation-Based Research Interventions to Promote Motor Recovery Post-Stroke. Front Hum Neurosci 2021; 15:644335. [PMID: 33958994 PMCID: PMC8093777 DOI: 10.3389/fnhum.2021.644335] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/30/2021] [Indexed: 01/02/2023] Open
Abstract
Stroke continues to be a leading cause of disability. Basic neurorehabilitation research is necessary to inform the neuropathophysiology of impaired motor control, and to develop targeted interventions with potential to remediate disability post-stroke. Despite knowledge gained from basic research studies, the effectiveness of research-based interventions for reducing motor impairment has been no greater than standard of practice interventions. In this perspective, we offer suggestions for overcoming translational barriers integral to experimental design, to augment traditional protocols, and re-route the rehabilitation trajectory toward recovery and away from compensation. First, we suggest that researchers consider modifying task practice schedules to focus on key aspects of movement quality, while minimizing the appearance of compensatory behaviors. Second, we suggest that researchers supplement primary outcome measures with secondary measures that capture emerging maladaptive compensations at other segments or joints. Third, we offer suggestions about how to maximize participant engagement, self-direction, and motivation, by embedding the task into a meaningful context, a strategy more likely to enable goal-action coupling, associated with improved neuro-motor control and learning. Finally, we remind the reader that motor impairment post-stroke is a multidimensional problem that involves central and peripheral sensorimotor systems, likely influenced by chronicity of stroke. Thus, stroke chronicity should be given special consideration for both participant recruitment and subsequent data analyses. We hope that future research endeavors will consider these suggestions in the design of the next generation of intervention studies in neurorehabilitation, to improve translation of research advances to improved participation and quality of life for stroke survivors.
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Affiliation(s)
- Natalia Sánchez
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
| | - Carolee J Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States.,Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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127
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Berezny N, Dowlatshahi D, Ahmadi M. Feasibility of a One Degree-of-Freedom Linear Robot for Bed-Bound Stroke Rehabilitation. J Med Device 2021. [DOI: 10.1115/1.4050454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
A 1DOF lower limb rehabilitation robot is presented for delivering leg extension therapy to bed-bound stroke patients. Such a compact and minimal system may be beneficial in terms of compatibility with pre-existing hospital equipment, ease-of-use, safety, and cost. A set of design criteria was created based on the literature and on previous field work at a local hospital. The device uses admittance control to apply assistive or resistive forces, and can also use haptic feedback to increase user engagement. A pilot study on six healthy participants was used to determine the feasibility of such a minimal system in administering assistance or resistance through the leg extension exercise. Results indicate that a single DOF is capable of decreasing trajectory error with assistance and increasing user effort with resistance. Observations confirm that the minimal system is effective; however, extending the robot with additional DOFs so that it can target multiple bed-bound exercises may help to increase therapy duration.
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Affiliation(s)
- Nicholas Berezny
- Department of Mech & Aero Engineering, Carleton University, Ottawa, ON K1S 5B6, Canada
| | - Dar Dowlatshahi
- Department of Medicine at the University of Ottawa, Ottawa Hospital Research Institute, Brain & Mind Institute University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Mojtaba Ahmadi
- Department of Mech & Aero Engineering, Carleton University, Ottawa, ON K1S 5B6, Canada
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128
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James J, McGlinchey MP. How active are stroke patients in physiotherapy sessions and is this associated with stroke severity? Disabil Rehabil 2021; 44:4408-4414. [PMID: 33794718 DOI: 10.1080/09638288.2021.1907459] [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: 10/21/2022]
Abstract
PURPOSE Exercise improves functional outcome post-stroke, but how long patients with differing severity spend undertaking active exercise within physiotherapy sessions is unknown. We aimed to investigate if stroke severity is associated with time undertaking active exercise in physiotherapy sessions, and if any differences between planned and actual physiotherapy session length existed. MATERIALS AND METHODS A prospective observational study of 107 stroke rehabilitation sessions in a UK acute stroke unit. Data recorded included patient demographics (age, gender, time post-stroke and Barthel Index score) and session attributes (planned and actual session length, time undertaking active exercise, grade of treating therapist). RESULTS There was a significant negative association between increasing stroke severity and percentage of time undertaking active exercise in physiotherapy sessions (p < 0.001). No other observed factors were associated with time undertaking active exercise. Mean session length across all levels of stroke severity was 32 min (SD 9.26) which was significantly less than planned (p < 0.05). There was no difference in mean session length or between planned and actual physiotherapy session length between patients of differing severity. CONCLUSIONS Patients with greater stroke severity participate in less active exercise in physiotherapy sessions than those with lesser stroke severity. Reasons for this disparity warrant further investigation.Implications for rehabilitationStroke patients with higher levels of severity engage in less active exercise during rehabilitation.A discrepancy exists between patients' planned physiotherapy session lengths and actual session lengths during stroke rehabilitation.Physiotherapists should be mindful in how to adapt their sessions (particularly with severe stroke patients) to maximise the amount of activity they undertake.Physiotherapists should be flexible in their delivery of rehabilitation to ensure that the length of patient sessions reflect patients' needs.
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Affiliation(s)
- Jimmy James
- Department of Physiotherapy, St. Thomas' Hospital, London, UK
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129
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Krakauer JW, Kitago T, Goldsmith J, Ahmad O, Roy P, Stein J, Bishop L, Casey K, Valladares B, Harran MD, Cortés JC, Forrence A, Xu J, DeLuzio S, Held JP, Schwarz A, Steiner L, Widmer M, Jordan K, Ludwig D, Moore M, Barbera M, Vora I, Stockley R, Celnik P, Zeiler S, Branscheidt M, Kwakkel G, Luft AR. Comparing a Novel Neuroanimation Experience to Conventional Therapy for High-Dose Intensive Upper-Limb Training in Subacute Stroke: The SMARTS2 Randomized Trial. Neurorehabil Neural Repair 2021; 35:393-405. [PMID: 33745372 DOI: 10.1177/15459683211000730] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Evidence from animal studies suggests that greater reductions in poststroke motor impairment can be attained with significantly higher doses and intensities of therapy focused on movement quality. These studies also indicate a dose-timing interaction, with more pronounced effects if high-intensity therapy is delivered in the acute/subacute, rather than chronic, poststroke period. OBJECTIVE To compare 2 approaches of delivering high-intensity, high-dose upper-limb therapy in patients with subacute stroke: a novel exploratory neuroanimation therapy (NAT) and modified conventional occupational therapy (COT). METHODS A total of 24 patients were randomized to NAT or COT and underwent 30 sessions of 60 minutes time-on-task in addition to standard care. The primary outcome was the Fugl-Meyer Upper Extremity motor score (FM-UE). Secondary outcomes included Action Research Arm Test (ARAT), grip strength, Stroke Impact Scale hand domain, and upper-limb kinematics. Outcomes were assessed at baseline, and days 3, 90, and 180 posttraining. Both groups were compared to a matched historical cohort (HC), which received only 30 minutes of upper-limb therapy per day. RESULTS There were no significant between-group differences in FM-UE change or any of the secondary outcomes at any timepoint. Both high-dose groups showed greater recovery on the ARAT (7.3 ± 2.9 points; P = .011) but not the FM-UE (1.4 ± 2.6 points; P = .564) when compared with the HC. CONCLUSIONS Neuroanimation may offer a new, enjoyable, efficient, and scalable way to deliver high-dose and intensive upper-limb therapy.
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Affiliation(s)
| | - Tomoko Kitago
- Burke Neurological Institute, White Plains, NY, USA.,Weill Cornell Medicine, New York, NY, USA.,Columbia University, New York, NY, USA
| | - Jeff Goldsmith
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Omar Ahmad
- Johns Hopkins University, Baltimore, MD, USA
| | - Promit Roy
- Johns Hopkins University, Baltimore, MD, USA
| | - Joel Stein
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Lauri Bishop
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Kelly Casey
- Johns Hopkins University, Baltimore, MD, USA
| | - Belen Valladares
- cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland.,University Hospital and University of Zurich, Switzerland
| | | | - Juan Camilo Cortés
- Johns Hopkins University, Baltimore, MD, USA.,Columbia University, New York, NY, USA
| | | | - Jing Xu
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Jeremia P Held
- University Hospital and University of Zurich, Switzerland
| | - Anne Schwarz
- University Hospital and University of Zurich, Switzerland
| | - Levke Steiner
- University Hospital and University of Zurich, Switzerland
| | - Mario Widmer
- cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | | | | | | | | | - Isha Vora
- Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | - Gert Kwakkel
- Vrije Universiteit Amsterdam, Netherlands.,Amsterdam Rehabilitation Research Centre, Reade, Netherlands
| | - Andreas R Luft
- cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland.,University Hospital and University of Zurich, Switzerland
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130
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Development of a Low-Cost, Modular Muscle-Computer Interface for At-Home Telerehabilitation for Chronic Stroke. SENSORS 2021; 21:s21051806. [PMID: 33807691 PMCID: PMC7961888 DOI: 10.3390/s21051806] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 11/22/2022]
Abstract
Stroke is a leading cause of long-term disability in the United States. Recent studies have shown that high doses of repeated task-specific practice can be effective at improving upper-limb function at the chronic stage. Providing at-home telerehabilitation services with therapist supervision may allow higher dose interventions targeted to this population. Additionally, muscle biofeedback to train patients to avoid unwanted simultaneous activation of antagonist muscles (co-contractions) may be incorporated into telerehabilitation technologies to improve motor control. Here, we present the development and feasibility of a low-cost, portable, telerehabilitation biofeedback system called Tele-REINVENT. We describe our modular electromyography acquisition, processing, and feedback algorithms to train differentiated muscle control during at-home therapist-guided sessions. Additionally, we evaluated the performance of low-cost sensors for our training task with two healthy individuals. Finally, we present the results of a case study with a stroke survivor who used the system for 40 sessions over 10 weeks of training. In line with our previous research, our results suggest that using low-cost sensors provides similar results to those using research-grade sensors for low forces during an isometric task. Our preliminary case study data with one patient with stroke also suggest that our system is feasible, safe, and enjoyable to use during 10 weeks of biofeedback training, and that improvements in differentiated muscle activity during volitional movement attempt may be induced during a 10-week period. Our data provide support for using low-cost technology for individuated muscle training to reduce unintended coactivation during supervised and unsupervised home-based telerehabilitation for clinical populations, and suggest this approach is safe and feasible. Future work with larger study populations may expand on the development of meaningful and personalized chronic stroke rehabilitation.
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131
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Lingo VanGilder J, Lohse KR, Duff K, Wang P, Schaefer SY. Evidence for associations between Rey-Osterrieth Complex Figure test and motor skill learning in older adults. Acta Psychol (Amst) 2021; 214:103261. [PMID: 33524606 DOI: 10.1016/j.actpsy.2021.103261] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 12/21/2020] [Accepted: 01/16/2021] [Indexed: 01/10/2023] Open
Abstract
Age-related declines in motor learning may be related to poor visuospatial function. Thus, visuospatial testing could evaluate older adults' potential for motor learning, which has implications for geriatric motor rehabilitation. To this end, the purpose of this study was to identify which visuospatial test is most predictive of motor learning within older adults. Forty-five nondemented older adults completed six standardized visuospatial tests, followed by three weekly practice sessions on a functional upper-extremity motor task. Participants were re-tested 1 month later on the trained task and another untrained upper-extremity motor task to evaluate the durability and generalizability of motor learning, respectively. Principal component analysis first reduced the dimensions of the visuospatial battery to two principal components for inclusion in a mixed-effects model that assessed one-month follow-up performance as a function of baseline performance and the principal components. Of the two components, only one was related to one-month follow-up. Factor loadings and post hoc analyses suggested that of the six visuospatial tests, the Rey-Osterrieth test (visual construction and memory) was related to one-month follow-up of the trained and untrained tasks. Thus, it may be plausible that older adults' long-term motor learning capacity could be evaluated using the Rey-Osterrieth test, which would be feasible to administer prior to motor rehabilitation to indicate risk of non-responsiveness to therapy.
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132
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Using motor imagery practice for improving motor performance - A review. Brain Cogn 2021; 150:105705. [PMID: 33652364 DOI: 10.1016/j.bandc.2021.105705] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/04/2021] [Accepted: 02/09/2021] [Indexed: 12/19/2022]
Abstract
Motor imagery practice is a current trend, but there is a need for a systematic integration of neuroscientific advances in the field. In this review, we describe the technique of motor imagery practice and its neural representation, considering different fields of application. The current practice of individualized motor imagery practice schemes often lacks systematization and is mostly based on experience. We review literature related to motor imagery practice in order to identify relevant modulators of practice effects like previous experience in motor training and motor imagery practice, the type of motor task to be trained, and strategies to increase sensory feedback during physical practice. Relevant discrepancies are identified between neuroscientific findings and practical consideration of these findings. To bridge these gaps, more effort should be directed at analyzing the brain network activities related to practically relevant motor imagery practice interventions.
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133
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Meyer S, Verheyden G, Kempeneers K, Michielsen M. Arm-Hand Boost Therapy During Inpatient Stroke Rehabilitation: A Pilot Randomized Controlled Trial. Front Neurol 2021; 12:652042. [PMID: 33716948 PMCID: PMC7952763 DOI: 10.3389/fneur.2021.652042] [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: 01/11/2021] [Accepted: 02/05/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: It was the aim to assess feasibility, safety, and potential efficacy of a new intensive, focused arm-hand BOOST program and to investigate whether there is a difference between early vs. late delivery of the program in the sub-acute phase post stroke. Methods: In this pilot RCT, patients with stroke were randomized to the immediate group (IG): 4 weeks (4 w) BOOST +4 w CONTROL or the delayed group (DG): 4 w CONTROL +4 w BOOST, on top of their usual inpatient care program. The focused arm-hand BOOST program (1 h/day, 5x/week, 4 weeks) consisted of group exercises with focus on scapula-setting, core-stability, manipulation and complex ADL tasks. Additionally, 1 h per week the Armeo®Power (Hocoma AG, Switzerland) was used. The CONTROL intervention comprised a dose-matched program (24 one-hour sessions in 4 w) of lower limb strengthening exercises and general reconditioning. At baseline, after 4 and 8 weeks of training, the Fugl-Meyer assessment upper extremity (FMA-UE), action research arm test (ARAT), and stroke upper limb capacity scale (SULCS) were administered. Results: Eighteen participants (IG: n = 10, DG: n = 8) were included, with a median (IQR) time post stroke of 8.6 weeks (5-12). No adverse events were experienced. After 4 weeks of training, significant between-group differences were found for FMA-UE (p = 0.003) and SULCS (p = 0.033) and a trend for ARAT (p = 0.075) with median (IQR) change scores for the IG of 9 (7-16), 2 (1-3), and 12.5 (1-18), respectively, and for the DG of 0.5 (-3 to 3), 1 (0-1), and 1.5 (-1 to 9), respectively. In the IG, 80% of patients improved beyond the minimal clinical important difference of FMA-UE after 4 weeks, compared to none of the DG patients. Between 4 and 8 weeks of training, patients in the DG tend to show larger improvements when compared to the IG, however, between-group comparisons did not reach significance. Conclusions: Results of this pilot RCT showed that an intensive, specific arm-hand BOOST program, on top of usual care, is feasible and safe in the sub-acute phase post stroke and suggests positive, clinical meaningful effects on upper limb function, especially when delivered in the early sub-acute phase post stroke. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT04584177.
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Affiliation(s)
- Sarah Meyer
- Jessa Hospital, Rehabilitation Centre, Campus Sint-Ursula, Herk-de-Stad, Belgium
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Kristof Kempeneers
- Jessa Hospital, Rehabilitation Centre, Campus Sint-Ursula, Herk-de-Stad, Belgium
| | - Marc Michielsen
- Jessa Hospital, Rehabilitation Centre, Campus Sint-Ursula, Herk-de-Stad, Belgium
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134
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Pila O, Koeppel T, Grosmaire AG, Duret C. Comparison of active-assisted and active-unassisted robot-mediated upper limb therapy in subacute stroke. Restor Neurol Neurosci 2021; 39:1-7. [PMID: 33285649 DOI: 10.3233/rnn-201010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Upper-limb robot-mediated therapy is usually carried out in active-assisted mode because it enables performance of many movements. However, assistance may reduce the patient's own efforts which could limit motor recovery. OBJECTIVE The aim of this study was to compare the effects of active-assisted and active-unassisted robotic interactions on motor recovery in subacute stroke patients with moderate hemiparesis. METHODS Fourteen patients underwent a 6-week combined upper limb program of usual therapy and robotic therapy using either the active-unassisted (n = 8) or active-assisted (n = 6) modes. In the active-assisted group, assistance was only provided for the first 3 weeks (1st period) and was then switched off for the remaining 3 weeks (2nd period). The Fugl-Meyer Assessment (FMA) was carried out pre- and post-treatment. The mean number of movements performed and the mean working distance during the 1st and 2nd periods were compared between groups. RESULTS FMA score improved post-treatment in both groups with no between-group differences: active-assisted group: +8±6 pts vs active-unassisted group: +10±6 pts (ns). Between the 1st and 2nd periods, there was a statistical trend towards an improvement in the number of movements performed (p = 0.06) in the active-unassisted group (526±253 to 783±434, p = 0.06) but not in the active-assisted group (882±211 to 880±297, ns). Another trend of improvement was found for the working distance in the active-unassisted group (8.7±4.5 to 9.9±4.7, p = 0.09) but not in the active-assisted group (14.0±0 to 13.5±1.1, ns). CONCLUSIONS The superiority of the non-assistive over assistive robotic modes has not been demonstrated. However, the non-assistive mode did not appear to reduce motor recovery in this population, despite the performance of fewer movements on shorter working distance compared with the group who had assistance. It seems that the requirement of effort could be a determinant factor for recovery in neurorehabilitation however further well-design studies are needed to fully understand this phenomenon.
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Affiliation(s)
- Ophélie Pila
- Microentreprise Recherche Clinique, Pila, Saint-Jean-d'Illac, France
| | - Typhaine Koeppel
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Unité de Neurorééducation, Boissise-Le-Roi, France
| | - Anne-Gaëlle Grosmaire
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Unité de Neurorééducation, Boissise-Le-Roi, France
| | - Christophe Duret
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Unité de Neurorééducation, Boissise-Le-Roi, France.,Centre Hospitalier Sud Francilien, Neurologie, Corbeil-Essonnes, France
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135
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Moore JL, Mbalilaki JA, Graham ID. Knowledge Translation in Physical Medicine and Rehabilitation: A Citation Analysis of the Knowledge-to-Action Literature. Arch Phys Med Rehabil 2021; 103:S256-S275. [PMID: 33556348 DOI: 10.1016/j.apmr.2020.12.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/15/2020] [Accepted: 12/28/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To (1) provide an overview of the use of the Knowledge-to-Action Cycle (KTA) to guide a clinical implementation project; (2) identify activities performed in each phase of the KTA; and (3) provide suggestions to improve KTA activities in physical medicine and rehabilitation. DATA SOURCES Google Scholar and PubMed were searched through December 31, 2019. STUDY SELECTION Two reviewers screened titles, abstracts, and full-text articles to identify published studies that used the KTA to implement a project. DATA EXTRACTION Two reviewers examined full-text articles. Data extraction included activities performed in each phase of the KTA, including measurements used to evaluate the project's effectiveness. DATA SYNTHESIS Commonly performed KTA activities were identified and country of study, area of rehabilitation, and other factors related to the use of the KTA in rehabilitation were described. A total of 46 articles that met the study's inclusion criteria provided an overview of the use of the KTA in rehabilitation. Strengths and weaknesses of the articles are discussed and recommendations for improved KTA use are provided. CONCLUSIONS Implementation of evidence-based practice requires focused engineering and efforts. This review provides an overview of the knowledge translation activities occurring in physical medicine and rehabilitation and considerations to improve knowledge translation research and practice.
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Affiliation(s)
- Jennifer L Moore
- Southeastern Norway Regional Center for Knowledge Translation in Rehabilitation, Oslo, Norway; Institute for Knowledge Translation, Carmel, IN, United States.
| | - Julia A Mbalilaki
- Southeastern Norway Regional Center for Knowledge Translation in Rehabilitation, Oslo, Norway
| | - Ian D Graham
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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136
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Gregor S, Saumur TM, Crosby LD, Powers J, Patterson KK. Study Paradigms and Principles Investigated in Motor Learning Research After Stroke: A Scoping Review. Arch Rehabil Res Clin Transl 2021; 3:100111. [PMID: 34179749 PMCID: PMC8211998 DOI: 10.1016/j.arrct.2021.100111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives To (1) characterize study paradigms used to investigate motor learning (ML) poststroke and (2) summarize the effects of different ML principles in promoting skill acquisition and retention. Our secondary objective is to evaluate the clinical utility of ML principles on stroke rehabilitation. Data Sources Medline, Excerpta Medica Database, Allied and Complementary Medicine, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials were searched from inception on October 24, 2018 and repeated on June 23, 2020. Scopus was searched on January 24, 2019 and July 22, 2020 to identify additional studies. Study Selection Our search included keywords and concepts to represent stroke and "motor learning. An iterative process was used to generate study selection criteria. Three authors independently completed title, abstract, and full-text screening. Data Extraction Three reviewers independently completed data extraction. Data Synthesis The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension guidelines for scoping reviews were used to guide our synthesis. Thirty-nine studies were included. Study designs were heterogeneous, including variability in tasks practiced, acquisition parameters, and retention intervals. ML principles investigated included practice complexity, feedback, motor imagery, mental practice, action observation, implicit and explicit information, aerobic exercise, and neurostimulation. An additional 2 patient-related factors that influence ML were included: stroke characteristics and sleep. Practice complexity, feedback, and mental practice/action observation most consistently promoted ML, while provision of explicit information and more severe strokes were detrimental to ML. Other factors (ie, sleep, practice structure, aerobic exercise, neurostimulation) had a less clear influence on learning. Conclusions Improved consistency of reporting in ML studies is needed to improve study comparability and facilitate meta-analyses to better understand the influence of ML principles on learning poststroke. Knowledge of ML principles and patient-related factors that influence ML, with clinical judgment can guide neurologic rehabilitation delivery to improve patient motor outcomes.
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Affiliation(s)
- Sarah Gregor
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario
| | - Tyler M Saumur
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario
| | - Lucas D Crosby
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario
| | - Jessica Powers
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario
| | - Kara K Patterson
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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137
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Hashim NA, Abd Razak NA, Gholizadeh H, Abu Osman NA. Video Game-Based Rehabilitation Approach for Individuals Who Have Undergone Upper Limb Amputation: Case-Control Study. JMIR Serious Games 2021; 9:e17017. [PMID: 33538698 PMCID: PMC7892285 DOI: 10.2196/17017] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/02/2020] [Accepted: 02/26/2020] [Indexed: 01/10/2023] Open
Abstract
Background Brain plasticity is an important factor in prosthesis usage. This plasticity helps with brain adaptation to learn new movement and coordination patterns needed to control a prosthetic hand. It can be achieved through repetitive muscle training that is usually very exhausting and often results in considerable reduction in patient motivation. Previous studies have shown that a playful concept in rehabilitation can increase patient engagement and perseverance. Objective This study investigated whether the inclusion of video games in the upper limb amputee rehabilitation protocol could have a beneficial impact for muscle preparation, coordination, and patient motivation among individuals who have undergone transradial upper limb amputation. Methods Ten participants, including five amputee participants and five able-bodied participants, were enrolled in 10 1-hour sessions within a 4-week rehabilitation program. In order to investigate the effects of the rehabilitation protocol used in this study, virtual reality box and block tests and electromyography (EMG) assessments were performed. Maximum voluntary contraction was measured before, immediately after, and 2 days after interacting with four different EMG-controlled video games. Participant motivation was assessed with the Intrinsic Motivation Inventory (IMI) questionnaire and user evaluation survey. Results Survey analysis showed that muscle strength and coordination increased at the end of training for all the participants. The results of Pearson correlation analysis indicated that there was a significant positive association between the training period and the box and block test score (r8=0.95, P<.001). The maximum voluntary contraction increment was high before training (6.8%) and in the follow-up session (7.1%), but was very small (2.1%) shortly after the training was conducted. The IMI assessment showed high scores for the subscales of interest, perceived competence, choice, and usefulness, but low scores for pressure and tension. Conclusions This study demonstrated that video games enhance motivation and adherence in an upper limb amputee rehabilitation program. The use of video games could be seen as a complementary approach for physical training in upper limb amputee rehabilitation.
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Affiliation(s)
- N A Hashim
- Department of Biomedical Engineering, Faculty of Engineering, Kuala Lumpur, Malaysia
| | - N A Abd Razak
- Department of Biomedical Engineering, Faculty of Engineering, Kuala Lumpur, Malaysia
| | - H Gholizadeh
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - N A Abu Osman
- Department of Biomedical Engineering, Faculty of Engineering, Kuala Lumpur, Malaysia.,The Chancellery, University of Malaysia, Terengganu, Malaysia
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138
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Alexander J, Dawson J, Langhorne P. Dynamic hand orthoses for the recovery of hand and arm function in adults after stroke: A systematic review and meta-analysis of randomised controlled trials. Top Stroke Rehabil 2021; 29:114-124. [PMID: 33517868 DOI: 10.1080/10749357.2021.1878669] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Repetitive, functional-based rehabilitation is recommended after stroke. However, impaired active digital extension is common after stroke, which limits functional-based rehabilitation and recovery. Non-robotic dynamic hand orthoses (DHOs) may address this.Objectives: We did a systematic review and meta-analysis to determine whether non-robotic DHOs improve upper limb recovery after stroke in comparison to i)placebo or no intervention and ii)usual care.Methods: We followed PRISMA guidelines. We included randomized controlled trials (RCTs) assessing upper limb recovery associated with the use of non-robotic DHOs in adults after stroke. Outcomes of interest were functional upper limb movement and activities of daily living.We performed searches on 27 September 2019 in 10 bibliographic databases including Cochrane Stroke Groups Specialized Trials Register and Cochrane Central Register of Controlled Trials. We also searched gray literature and citations from included studies.Two reviewers independently screened abstracts and full text, extracted data and assessed risk of bias using a Cochrane risk of bias tool.Results: We reviewed 7225 titles and included four studies involving 56 randomized participants, all with a high risk of bias. A positive effect in favor of non-robotic DHOs was observed for two outcomes; upper limb function (mean difference (MD) 6.23, 95% confidence interval (CI) 0.28-12.19 (p = 0.04)) and dexterity (MD 2.99, 95% CI 0.39-5.60 (p = 0.02).Conclusions: The results are encouraging but included studies were small with high risk of bias meaning there is currently insufficient evidence that non-robotic DHOs improve upper limb recovery after stroke.Review Registration: PROSPERO, CRD42020179180. Registered on 20 May 2020.
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Affiliation(s)
- Jen Alexander
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Peter Langhorne
- Academic Section of Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
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139
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Nuara A, Fabbri-Destro M, Scalona E, Lenzi SE, Rizzolatti G, Avanzini P. Telerehabilitation in response to constrained physical distance: an opportunity to rethink neurorehabilitative routines. J Neurol 2021; 269:627-638. [PMID: 33449202 PMCID: PMC7809551 DOI: 10.1007/s00415-021-10397-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 02/07/2023]
Abstract
Ensuring proper dosage of treatment and repetition over time is a major challenge in neurorehabilitation. However, a requirement of physical distancing to date compromises their achievement. While mostly associated to COVID-19, physical distancing is not only required in a pandemic scenario, but also advised for several clinical conditions (e.g. immunocompromised individuals) or forced for specific social contexts (e.g. people living in remote areas worldwide). All these contexts advocate for the implementation of alternative healthcare models. The objective of this perspective is to highlight the benefits of remote administration of rehabilitative treatment, namely telerehabilitation, in counteracting physical distancing barriers in neurorehabilitation. Sustaining boosters of treatment outcome, such as compliance, sustainability, as well as motivation, telerehabilitation may adapt to multiple neurological conditions, with the further advantage of a high potential for individualization to patient's or pathology's specificities. The effectiveness of telerehabilitation can be potentiated by several technologies available to date: virtual reality can recreate realistic environments in which patients may bodily operate, wearable sensors allow to quantitatively monitor the patient's performance, and signal processing may contribute to the prediction of long-term dynamics of patient recovery. Telerehabilitation might spark its advantages far beyond the mere limitation of physical distancing effects, mitigating criticalities of daily neurorehabilitative practice, and thus paving the way to the envision of mixed models of care, where hospital-based procedures are complementarily integrated with telerehabilitative ones.
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Affiliation(s)
- Arturo Nuara
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy. .,Department of Biomedical, Metabolic, and Neuronal Sciences, University of Modena and Reggio Emilia, Modena, Italy. .,Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Maddalena Fabbri-Destro
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy
| | - Emilia Scalona
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy
| | - Stefano Elio Lenzi
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy
| | - Giacomo Rizzolatti
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Pietro Avanzini
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy.,Istituto Clinico Humanitas, Rozzano, Italy
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140
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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.
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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
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141
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Clinical Practice Guideline to Improve Locomotor Function Following Chronic Stroke, Incomplete Spinal Cord Injury, and Brain Injury. J Neurol Phys Ther 2021; 44:49-100. [PMID: 31834165 DOI: 10.1097/npt.0000000000000303] [Citation(s) in RCA: 147] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Individuals with acute-onset central nervous system (CNS) injury, including stroke, motor incomplete spinal cord injury, or traumatic brain injury, often experience lasting locomotor deficits, as quantified by decreases in gait speed and distance walked over a specific duration (timed distance). The goal of the present clinical practice guideline was to delineate the relative efficacy of various interventions to improve walking speed and timed distance in ambulatory individuals greater than 6 months following these specific diagnoses. METHODS A systematic review of the literature published between 1995 and 2016 was performed in 4 databases for randomized controlled clinical trials focused on these specific patient populations, at least 6 months postinjury and with specific outcomes of walking speed and timed distance. For all studies, specific parameters of training interventions including frequency, intensity, time, and type were detailed as possible. Recommendations were determined on the basis of the strength of the evidence and the potential harm, risks, or costs of providing a specific training paradigm, particularly when another intervention may be available and can provide greater benefit. RESULTS Strong evidence indicates that clinicians should offer walking training at moderate to high intensities or virtual reality-based training to ambulatory individuals greater than 6 months following acute-onset CNS injury to improve walking speed or distance. In contrast, weak evidence suggests that strength training, circuit (ie, combined) training or cycling training at moderate to high intensities, and virtual reality-based balance training may improve walking speed and distance in these patient groups. Finally, strong evidence suggests that body weight-supported treadmill training, robotic-assisted training, or sitting/standing balance training without virtual reality should not be performed to improve walking speed or distance in ambulatory individuals greater than 6 months following acute-onset CNS injury to improve walking speed or distance. DISCUSSION The collective findings suggest that large amounts of task-specific (ie, locomotor) practice may be critical for improvements in walking function, although only at higher cardiovascular intensities or with augmented feedback to increase patient's engagement. Lower-intensity walking interventions or impairment-based training strategies demonstrated equivocal or limited efficacy. LIMITATIONS As walking speed and distance were primary outcomes, the research participants included in the studies walked without substantial physical assistance. This guideline may not apply to patients with limited ambulatory function, where provision of walking training may require substantial physical assistance. SUMMARY The guideline suggests that task-specific walking training should be performed to improve walking speed and distance in those with acute-onset CNS injury although only at higher intensities or with augmented feedback. Future studies should clarify the potential utility of specific training parameters that lead to improved walking speed and distance in these populations in both chronic and subacute stages following injury. DISCLAIMER These recommendations are intended as a guide for clinicians to optimize rehabilitation outcomes for persons with chronic stroke, incomplete spinal cord injury, and traumatic brain injury to improve walking speed and distance.
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142
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Burnfield JM, Cesar GM, Buster TW. Feasibility of motor-assisted elliptical to improve walking, fitness and balance following pediatric acquired brain injury: A case series. J Pediatr Rehabil Med 2021; 14:539-551. [PMID: 33935119 DOI: 10.3233/prm-200717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Walking, fitness, and balance deficits are common following acquired brain injury (ABI). This study assessed feasibility, acceptability, and usefulness of a modified motor-assisted elliptical (ICARE) in addressing walking, fitness, and balance deficits in children with chronic ABIs. METHODS Three children (> 5 years post-ABI) completed 24 ICARE exercise sessions (exercise time, speed, and time overriding motor-assistance gradually increased) to promote mass repetition of gait-like movements and challenge cardiorespiratory fitness. Parents' and children's perceptions of ICARE's safety, comfort, workout, and usability were assessed. Cardiovascular response, gait and balance outcomes were assessed. RESULTS No adverse events occurred. Parent's Visual Analogue Scale (VAS) scores of perceived device safety (range 80-99), workout (range 99-100), and usability (range 75-100) were high, while comfort were 76-80 given commercial harness fit and arm support. Children's VAS scores all exceeded 89. Comfortable walking velocity, 2-Minute Walk Test, fitness, and Pediatric Balance Scale scores improved post-training, with many outcomes surpassing established minimal clinically important differences. CONCLUSION Following engagement in moderate- to vigorous-intensity exercise promoting repetitive step-like movements on a specially adapted motor-assisted elliptical, three children with chronic ABI demonstrated improvements in walking, fitness and balance. Future research in community-based environments with a larger cohort of children with ABI is needed.
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Affiliation(s)
- Judith M Burnfield
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE, USA
| | - Guilherme M Cesar
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE, USA
| | - Thad W Buster
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE, USA
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143
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Fahey M, Brazg G, Henderson CE, Plawecki A, Lucas E, Reisman DS, Schmit BD, Hornby TG. The Value of High Intensity Locomotor Training Applied to Patients With Acute-Onset Neurologic Injury. Arch Phys Med Rehabil 2020; 103:S178-S188. [PMID: 33383032 DOI: 10.1016/j.apmr.2020.09.399] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/31/2020] [Accepted: 09/17/2020] [Indexed: 11/02/2022]
Abstract
Long-standing research in animal models and humans with stroke or incomplete spinal cord injury (iSCI) indicate that specific physical training variables, such as the specificity and amount of practice, may influence neurologic recovery and locomotor function. More recent data highlight the contributions of exercise intensity, as estimated indirectly by cardiovascular exertion, as potentially more important than previously considered. The effects of exercise intensity are well described in neurologically intact individuals, although confusion regarding the definitions of intensity and safety concerns have limited its implementation during physical rehabilitation of patients with neurologic injury. The purpose of this review is to delineate some of the evidence regarding the effects of exercise intensity during locomotor training in patients with stroke and iSCI. We provide specific definitions of exercise intensity used within the literature, describe methods used to ensure appropriate levels of exertion, and discuss potential adverse events and safety concerns during its application. Further details on the effects of locomotor training intensity on clinical outcomes, and on neuromuscular and cardiovascular function will be addressed as available. Existing literature across multiple studies and meta-analyses reveals that exercise training intensity is likely a major factor that can influence locomotor function after neurologic injury. To extend these findings, we describe previous attempts to implement moderate to high intensity interventions during physical rehabilitation of patients with neurologic injury, including the utility of specific strategies to facilitate implementation, and to navigate potential barriers that may arise during implementation efforts.
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Affiliation(s)
- Meghan Fahey
- Rehabilitation Institute of Chicago, Chicago, IL
| | | | - Christopher E Henderson
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN; Rehabilitation Hospital of Indiana, Indianapolis, IN
| | | | - Emily Lucas
- Rehabilitation Hospital of Indiana, Indianapolis, IN
| | - Darcy S Reisman
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Brian D Schmit
- Department of Biomedical Engineering, Marquette University, Milwaukee, WI
| | - T George Hornby
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN; Rehabilitation Hospital of Indiana, Indianapolis, IN.
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144
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Abstract
PURPOSE OF REVIEW This article describes restorative therapies to improve patient outcomes after stroke. These therapies contrast with acute stroke treatments such as recombinant tissue plasminogen activator (rtPA) and thrombectomy that target clots, aim to salvage threatened brain tissue to limit injury, and have a time window measured in hours. Restorative therapies target the brain, aim to promote plasticity within surviving brain tissue, and have a time window measured in days to weeks or longer. RECENT FINDINGS A number of drugs are under study. Preclinical studies are providing attractive therapeutic candidates for translation, such as the C-C chemokine receptor 5 inhibitor maraviroc. Some drug studies have used a pragmatic approach, which is premature for the nascent field of neural repair. Substantial data support the utility of activity-dependent therapies, including constraint-induced movement therapy, with recent studies supporting the need for very high doses to generate the best functional gains. While stem cell therapies are at an early stage, mounting preclinical evidence supports the efficacy of mesenchymal stem cells; some initial human studies are supportive. Several types of brain stimulation have been examined, and in some cases initial studies are promising. SUMMARY Improved insights into stroke recovery and its treatment have the potential to reduce disability in a large segment of stroke survivors.
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145
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Nemchek V, Haan EM, Kerr AL. Intermittent Skill Training Results in Moderate Improvement in Functional Outcome in a Mouse Model of Ischemic Stroke. Neurorehabil Neural Repair 2020; 35:79-87. [PMID: 33317421 DOI: 10.1177/1545968320975423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Stroke is a leading cause of disability worldwide. Focused training of the impaired limb has been shown to improve its functional outcome in animal models. However, most human stroke survivors exhibit persistent motor deficits, likely due to differences in rehabilitation intensity between experimental (animal) and clinical (human) settings. OBJECTIVE The current study investigated the effect of training intensity on behavioral outcome in a mouse model of stroke. METHODS Mice were trained preoperatively on a skilled reaching task. After training, mice received a unilateral photothrombotic stroke. Postoperatively, animals received either daily rehabilitative training (traditional intensity), intermittent rehabilitative training (every other day), or no rehabilitative training (control). Assessment of the impaired limb occurred after 14 training sessions (14 days for the Traditional group; 28 days for the Intermittent group). RESULTS Assessment of the impaired limb illustrated that traditional, daily training resulted in significantly better performance than no training, while intermittent training offered moderate performance gains. Mice receiving intermittent training performed significantly better than control mice but did not exhibit reaching performance as strong as that of animals trained daily. CONCLUSIONS The intensity of rehabilitation is important for optimal recovery. Although intermediate intensity offers some benefit, it is not intensive enough to mimic the performance gains traditionally observed in animal models. These results suggest that intensive training, which is often unavailable for human stroke survivors, is necessary to achieve an optimal functional outcome. The lower bounds of training intensity for functional benefit still need to be determined.
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Affiliation(s)
| | - Emma M Haan
- Illinois Wesleyan University, Bloomington, IL, USA
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146
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Vonstad EK, Su X, Vereijken B, Bach K, Nilsen JH. Comparison of a Deep Learning-Based Pose Estimation System to Marker-Based and Kinect Systems in Exergaming for Balance Training. SENSORS (BASEL, SWITZERLAND) 2020; 20:E6940. [PMID: 33291687 PMCID: PMC7730529 DOI: 10.3390/s20236940] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/20/2020] [Accepted: 12/01/2020] [Indexed: 12/28/2022]
Abstract
Using standard digital cameras in combination with deep learning (DL) for pose estimation is promising for the in-home and independent use of exercise games (exergames). We need to investigate to what extent such DL-based systems can provide satisfying accuracy on exergame relevant measures. Our study assesses temporal variation (i.e., variability) in body segment lengths, while using a Deep Learning image processing tool (DeepLabCut, DLC) on two-dimensional (2D) video. This variability is then compared with a gold-standard, marker-based three-dimensional Motion Capturing system (3DMoCap, Qualisys AB), and a 3D RGB-depth camera system (Kinect V2, Microsoft Inc). Simultaneous data were collected from all three systems, while participants (N = 12) played a custom balance training exergame. The pose estimation DLC-model is pre-trained on a large-scale dataset (ImageNet) and optimized with context-specific pose annotated images. Wilcoxon's signed-rank test was performed in order to assess the statistical significance of the differences in variability between systems. The results showed that the DLC method performs comparably to the Kinect and, in some segments, even to the 3DMoCap gold standard system with regard to variability. These results are promising for making exergames more accessible and easier to use, thereby increasing their availability for in-home exercise.
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Affiliation(s)
- Elise Klæbo Vonstad
- Department of Computer Science, Norwegian University of Science and Technology, 7034 Trondheim, Norway; (X.S.); (K.B.); (J.H.N.)
| | - Xiaomeng Su
- Department of Computer Science, Norwegian University of Science and Technology, 7034 Trondheim, Norway; (X.S.); (K.B.); (J.H.N.)
| | - Beatrix Vereijken
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, 7030 Trondheim, Norway;
| | - Kerstin Bach
- Department of Computer Science, Norwegian University of Science and Technology, 7034 Trondheim, Norway; (X.S.); (K.B.); (J.H.N.)
| | - Jan Harald Nilsen
- Department of Computer Science, Norwegian University of Science and Technology, 7034 Trondheim, Norway; (X.S.); (K.B.); (J.H.N.)
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147
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Huber JP, Sawaki L. Dynamic body-weight support to boost rehabilitation outcomes in patients with non-traumatic spinal cord injury: an observational study. J Neuroeng Rehabil 2020; 17:157. [PMID: 33256797 PMCID: PMC7706039 DOI: 10.1186/s12984-020-00791-2] [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: 07/30/2020] [Accepted: 11/18/2020] [Indexed: 11/13/2022] Open
Abstract
Background Dynamic body-weight support (DBWS) may play an important role in rehabilitation outcomes, but the potential benefit among disease-specific populations is unclear. In this study, we hypothesize that overground therapy with DBWS during inpatient rehabilitation yields greater functional improvement than standard-of-care in adults with non-traumatic spinal cord injury (NT-SCI). Methods This retrospective cohort study included individuals diagnosed with NT-SCI and undergoing inpatient rehabilitation. All participants were recruited at a freestanding inpatient rehabilitation hospital. Individuals who trained with DBWS for at least three sessions were allocated to the experimental group. Participants in the historical control group received standard-of-care (i.e., no DBWS). The primary outcome was change in the Functional Independence Measure scores (FIMgain). Results During an inpatient rehabilitation course, participants in the experimental group (n = 11), achieved a mean (SD) FIMgain of 48 (11) points. For the historical control group (n = 11), participants achieved a mean (SD) FIMgain of 36 (12) points. From admission to discharge, both groups demonstrated a statistically significant FIMgain. Between groups analysis revealed no significant difference in FIMgain (p = 0.022; 95% CI 2.0–22) after a post hoc correction for multiple comparisons. In a secondary subscore analysis, the experimental group achieved significantly higher gains in sphincter control (p = 0.011: 95% CI 0.83–5.72) with a large effect size (Cohen’s d 1.19). Locomotion subscores were not significantly different (p = 0.026; 95% CI 0.37–5.3) nor were the remaining subscores in self-care, mobility, cognition, and social cognition. Conclusions This is the first study to explore the impact of overground therapy with DBWS on inpatient rehabilitation outcomes for persons with NT-SCI. Overground therapy with DBWS appears to significantly improve functional gains in sphincter control compared to the standard-of-care. Gains achieved in locomotion, mobility, cognition, and social cognition did not meet significance. Findings from the present study will benefit from future large prospective and randomized studies.
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Affiliation(s)
- Justin P Huber
- Department of Physical Medicine and Rehabilitation, University of Kentucky, 2050 Versailles Road, Lexington, KY, 40504, USA.,Department of Mechanical Engineering, University of Kentucky, 2050 Versailles Road, Lexington, KY, 40504, USA
| | - Lumy Sawaki
- Department of Physical Medicine and Rehabilitation, University of Kentucky, 2050 Versailles Road, Lexington, KY, 40504, USA. .,Department of Neurology, University of Kentucky, 2050 Versailles Road, Lexington, KY, 40504, USA.
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148
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Qiu Q, Cronce A, Patel J, Fluet GG, Mont AJ, Merians AS, Adamovich SV. Development of the Home based Virtual Rehabilitation System (HoVRS) to remotely deliver an intense and customized upper extremity training. J Neuroeng Rehabil 2020; 17:155. [PMID: 33228709 PMCID: PMC7685660 DOI: 10.1186/s12984-020-00789-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background After stroke, sustained hand rehabilitation training is required for continuous improvement and maintenance of distal function. Methods In this paper, we present a system designed and implemented in our lab: the Home based Virtual Rehabilitation System (HoVRS). Fifteen subjects with chronic stroke were recruited to test the feasibility of the system as well as to refine the design and training protocol to prepare for a future efficacy study. HoVRS was placed in subjects’ homes, and subjects were asked to use the system at least 15 min every weekday for 3 months (12 weeks) with limited technical support and remote clinical monitoring. Results All subjects completed the study without any adverse events. Subjects on average spent 13.5 h using the system. Clinical and kinematic data were collected pre and post study in the subject’s home. Subjects demonstrated a mean increase of 5.2 (SEM = 0.69) on the Upper Extremity Fugl-Meyer Assessment (UEFMA). They also demonstrated improvements in six measurements of hand kinematics. In addition, a combination of these kinematic measures was able to predict a substantial portion of the variability in the subjects’ UEFMA score. Conclusion Persons with chronic stroke were able to use the system safely and productively with minimal supervision resulting in measurable improvements in upper extremity function.
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Affiliation(s)
- Qinyin Qiu
- Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, USA.
| | - Amanda Cronce
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, 70102, USA
| | - Jigna Patel
- Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, USA.,Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, 70102, USA
| | - Gerard G Fluet
- Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Ashley J Mont
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, 70102, USA
| | - Alma S Merians
- Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Sergei V Adamovich
- Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, USA.,Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, 70102, USA
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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.
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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
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Niama Natta DD, Lejeune T, Detrembleur C, Yarou B, Sogbossi ES, Alagnidé E, Kpadonou T, Selves C, Stoquart G. Effectiveness of a self-rehabilitation program to improve upper-extremity function after stroke in developing countries: A randomized controlled trial. Ann Phys Rehabil Med 2020; 64:101413. [PMID: 32619630 DOI: 10.1016/j.rehab.2020.03.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 10/26/2019] [Accepted: 03/17/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND About two-thirds of stroke patients present long-term upper-limb impairment and limitations of activity, which constitutes a challenge in rehabilitation. This situation is particularly true in developing countries, where there is a need for inexpensive rehabilitation solutions. OBJECTIVE This study assessed the effectiveness of a self-rehabilitation program including uni- or bi-manual functional exercises for improving upper-limb function after stroke with respect to the context in Benin, West Africa. METHODS In this single-blind randomized controlled trial, chronic stroke individuals (>6 months post-stroke) performed a supervised home-based self-rehabilitation program for 8 weeks (intervention group); the control group did not receive any treatment. Participants were assessed before treatment (T0), at the end of treatment (T1) and 8 weeks after the end of treatment (T2). The primary outcome was the manual ability of the upper limb, assessed with ABILHAND-Stroke Benin. Secondary outcomes were grip force, motor impairment (Fugl-Meyer Assessment - Upper Extremity), gross manual ability (Box and Block test, Wolf Motor Function test) and quality of life (WHOQOL-26). RESULTS We included 28 individuals in the intervention group and 31 in the control group. Adherence to the program was 83%. After 8 weeks of self-rehabilitation, individuals in the intervention group showed significantly improved manual ability and grip force as compared with the control group (P<0.001), with effect size 0.75 and 0.24, respectively. In the intervention group, the difference in average scores was 10% between T0 and T1 and between T0 and T2. Subscores of physical and psychological quality of life were also significantly improved in the intervention group. The other variables remained unchanged. CONCLUSIONS A self-rehabilitation program was effective in improving manual ability, grip force and quality of life in individuals with stroke in Benin. More studies are needed to confirm these results in different contexts.
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Affiliation(s)
- Ditouah Didier Niama Natta
- Physical medicine and rehabilitation department, National university hospital of Cotonou, Cotonou, Benin; NMSK lab, Institut de recherche expérimentale et clinique (IREC), UCLouvain, Brussels, Belgium
| | - Thierry Lejeune
- NMSK lab, Institut de recherche expérimentale et clinique (IREC), UCLouvain, Brussels, Belgium; Physical medicine and rehabilitation department, cliniques universitaires Saint-Luc, Brussels, Belgium; Louvain Bionics, UCLouvain, Louvain-La-Neuve, Belgium
| | - Christine Detrembleur
- NMSK lab, Institut de recherche expérimentale et clinique (IREC), UCLouvain, Brussels, Belgium; Louvain Bionics, UCLouvain, Louvain-La-Neuve, Belgium
| | - Berenice Yarou
- Physical medicine and rehabilitation department, National university hospital of Cotonou, Cotonou, Benin
| | - Emmanuel S Sogbossi
- Physical medicine and rehabilitation department, National university hospital of Cotonou, Cotonou, Benin
| | - Etienne Alagnidé
- Physical medicine and rehabilitation department, National university hospital of Cotonou, Cotonou, Benin
| | - Toussaint Kpadonou
- Physical medicine and rehabilitation department, National university hospital of Cotonou, Cotonou, Benin
| | - Clara Selves
- NMSK lab, Institut de recherche expérimentale et clinique (IREC), UCLouvain, Brussels, Belgium; Physical medicine and rehabilitation department, cliniques universitaires Saint-Luc, Brussels, Belgium; Louvain Bionics, UCLouvain, Louvain-La-Neuve, Belgium
| | - Gaëtan Stoquart
- NMSK lab, Institut de recherche expérimentale et clinique (IREC), UCLouvain, Brussels, Belgium; Physical medicine and rehabilitation department, cliniques universitaires Saint-Luc, Brussels, Belgium; Louvain Bionics, UCLouvain, Louvain-La-Neuve, Belgium.
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