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Alashram AR. Task-oriented training for gait rehabilitation in people with multiple sclerosis: A systematic review. J Bodyw Mov Ther 2024; 39:87-96. [PMID: 38876706 DOI: 10.1016/j.jbmt.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 01/14/2024] [Accepted: 02/25/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVES This systematic review aims to examine the effects of task-oriented (TO) training on gait function in people with multiple sclerosis (MS) and to determine the most effective TO training protocol. METHODS We searched PubMed, Web of Science, Scopus, EMBASE, REHABDATA, and PEDro for studies that examined the effects of TO on gait ability (i.e., gait velocity, gait endurance, functional mobility) in people with MS from 1971 to October 2022. The quality of the selected studies was estimated using the Physiotherapy Evidence Database (PEDro) scale. RESULTS Nine studies met the eligibility criteria. A total of 199 people with MS, 58.79% of whom were women, were included. Five studies revealed "good" quality, one revealed "fair", and three exhibited "poor" quality. Four studies administered TO training alone, and five combined TO training with conventional physiotherapy. The selected studies showed varied results for the influences of TO training on gait ability in people with MS. CONCLUSIONS The evidence for the impact of TO training on people with MS was limited. The optimal TO training protocol stills vague. Further studies with larger sample sizes are needed.
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Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Amman, Jordan; Applied Science Research Center, Applied Science Private University, Amman, Jordan; Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.
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Niemrungruang K, Thanakamchokchai J, Pongmala C, Khobkhun F. The effects of combining repetitive transcranial magnetic stimulation with task-specific training on gait performance in individuals with Parkinson's disease: A review article. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2105. [PMID: 38864408 DOI: 10.1002/pri.2105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/11/2024] [Accepted: 05/28/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor impairments, especially in the area of gait disturbances. Physiotherapy, with a focus on task-specific training, has demonstrated a level of efficacy as regards alleviating symptoms and enhancing functional capabilities in individuals with PD. Repetitive Transcranial Magnetic Stimulation (rTMS) has emerged as a potential therapeutic intervention for improving motor functions in individuals with PD. AIMS This review article aims to investigate the effects of combining rTMS with task-specific training on gait performance in individuals with PD. MATERIALS AND METHODS PubMed, Physiotherapy Evidence Database (PEDro), and Scopus were all searched for relevant studies. The focus of the search was on studies that investigated the efficacy of combining rTMS with task-specific training to improve gait performance in individuals with PD. RESULTS Four studies were identified as fulfilling the eligibility criteria and were included in the study. The combination of rTMS with specific treadmill training and weight-bearing exercises can significantly enhance walking efficiency, including improvements in walking speed, self-mobility, and step rate. In addition, the combination of rTMS and task-specific training, such as treadmill-based training, shows promise in enhancing gait performance in individuals with PD. DISCUSSION AND CONCLUSION High-frequency rTMS targeting the primary motor cortex (or M1) can result in improved walking speed, self-mobility, and step rate. However, limited research exists regarding low-frequency stimulation of the supplementary motor area (SMA) in individuals with gait issues. Further research is required to determine the optimal parameters of rTMS, such as strength, frequency, and duration of stimulation and it is worth considering the incorporation of additional training modalities, including cognitive exercises.
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Affiliation(s)
- Kanjana Niemrungruang
- Physical Therapy Center, Faculty of Physical Therapy, Mahidol University, Bangkok, Thailand
| | - Jenjira Thanakamchokchai
- Parkinson Movement and Research Collaboration Laboratory, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Chatkaew Pongmala
- Functional Neuroimaging, Cognitive and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Fuengfa Khobkhun
- Parkinson Movement and Research Collaboration Laboratory, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
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McDonell I, Barr C, van den Berg M. Implementing circuit class training can increase therapy time and functional independence in people with stroke receiving inpatient rehabilitation: findings from a retrospective observational clinical audit. Physiother Theory Pract 2024; 40:1383-1389. [PMID: 36724415 DOI: 10.1080/09593985.2023.2172634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 01/20/2023] [Accepted: 01/20/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Increased therapy time and task-specific practice can improve functional recovery post stroke. This observational study aimed to determine whether the clinical implementation of circuit training increases therapy time and improves function in stroke rehabilitation. METHODS In a retrospective clinical audit, medical records of 110 people (mean age 78.7, standard deviation 13.0, 49.1% male, 57.3% severe stroke) admitted to a stroke inpatient rehabilitation ward were evaluated to determine the differences between pre (Individual Therapy (IT), n = 55) and post (Circuit Class Therapy (CCT), n = 55) service change implementation. The primary outcome was the amount of time spent in physiotherapy daily (minutes). Secondary outcomes included the Functional Independence Measure (FIM) score and length of stay (LOS). RESULTS The CCT Group spent significantly more time in physiotherapy daily during their rehabilitation LOS compared to the IT Group (mean difference 8.45 (95% CI 5.99 to 10.90) mins, p < 0.001). No significant between-group differences were observed for FIM scores or LOS (p ≥ 0.066). CONCLUSION This study suggests that the clinical implementation of CCT can significantly increase therapy time by close to 9 minutes per session, with functional gains that are equivalent to usual care. This was achieved with a patient-to-staff ratio of 3:1, compared to the 1:1 ratio in IT, concurring with existing evidence in support of CCT as an alternative service delivery model for inpatient stroke rehabilitation.
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Affiliation(s)
- Imogen McDonell
- Clinical Rehabilitation, College of Nursing and Health Sciences, Flinders University, Tonsley Campus, Clovelly Park, Australia
- Inpatient Rehabilitation, Mona Vale Hospital, Mona Vale, Australia
| | - Chris Barr
- Clinical Rehabilitation, College of Nursing and Health Sciences, Flinders University, Tonsley Campus, Clovelly Park, Australia
| | - Maayken van den Berg
- Clinical Rehabilitation, College of Nursing and Health Sciences, Flinders University, Tonsley Campus, Clovelly Park, Australia
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Kunugi S, Holobar A, Nakagoshi A, Kawabe K, Watanabe K. Effects of repetition of a car-driving pedal maneuver and neural output in older adults. J Electromyogr Kinesiol 2024; 76:102883. [PMID: 38569438 DOI: 10.1016/j.jelekin.2024.102883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 03/11/2024] [Accepted: 03/30/2024] [Indexed: 04/05/2024] Open
Abstract
Understanding the ability of older adults to control pedal position angle and investigating whether this ability can be enhanced through practice may contribute to the prevention of traffic accidents. This study aimed to investigate repetitive effects on variability of the pedal position and neural drive during car-pedal operation in older adults. Thirteen older and 11 young adults performed 105 (21 sets × 5 repetitions) pedal angle control tasks with plantar flexor contraction. High-density surface electromyograms were recorded of triceps surae muscles. A cumulative spike train as a neural drive was calculated using continuously active motor unit activities. The coefficient of variation of the angle was higher in older (1.47 ± 1.06 %) than young (0.41 ± 0.21 %) adults in the first sets, and improved to 0.67 ± 0.51 % in the final sets in older adults only. There was no significant difference in neural drive variability between older and young adults. Our results suggest that repetition improves angular steadiness in older adults. However, this effect could not be explained by neural output which is estimated from lower threshold motor units that are continuously active.
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Affiliation(s)
- Shun Kunugi
- Center for General Education, Aichi Institute of Technology, 1247 Yachigusa, Yakusa-cho, Toyota-shi, Aichi 470-0392, Japan; Laboratory of Neuromuscular Biomechanics, School of Health and Sport Sciences, Chukyo University 101 Tokodachi, Kaizu-cho, Toyota-shi, Aichi 470-0393, Japan.
| | - Aleš Holobar
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroška cesta 46, 2000 Maribor, Slovenia
| | - Akira Nakagoshi
- Advanced Mobility System Development, Toyota Motor Corporation, 1 Toyota-cho, Toyota-shi, Aichi 471-8571, Japan
| | - Kyosuke Kawabe
- Advanced Mobility System Development, Toyota Motor Corporation, 1 Toyota-cho, Toyota-shi, Aichi 471-8571, Japan
| | - Kohei Watanabe
- Laboratory of Neuromuscular Biomechanics, School of Health and Sport Sciences, Chukyo University 101 Tokodachi, Kaizu-cho, Toyota-shi, Aichi 470-0393, Japan
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Towersey NCM, Sasse K, Stavric V, Alder G, Saywell NL. Freely available, online videos to support neurological physiotherapists and students in task-specific training skill acquisition: a scoping review. BMC MEDICAL EDUCATION 2024; 24:603. [PMID: 38822287 PMCID: PMC11143672 DOI: 10.1186/s12909-024-05545-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 05/09/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Videos to support learning of clinical skills are effective; however, little is known about the scope and educational quality of the content of freely available online videos demonstrating task-specific training (TST). This review aimed to determine the extent, characteristics of freely available online videos, and whether the content is suitable to guide skill acquisition of task-specific training for neurological physiotherapists and students. METHODS A scoping review was conducted. Google video and YouTube were searched in December 2022. Videos that met our eligibility criteria and were explicitly designed for (TST) skill acquisition were included in the report. RESULTS Ten videos met the inclusion criteria and were difficult to find amongst the range of videos available. Most were presented by physiotherapists or occupational therapists, originated from the USA, featured stroke as the condition of the person being treated, and involved a range of interventions (upper limb, constraint induced movement therapy, balance, bicycling). Most videos were created by universities or private practices and only two used people with a neurological condition as the participant. When the content of videos and their presentation (instruction and/or demonstration), was assessed against each key component of TST (practice structure, specificity, repetition, modification, progression, feedback), five of the videos were rated very suitable and five moderately suitable to guide skill acquisition. Most videos failed to demonstrate and provide instruction on each key component of TST and were missing at least one component, with feedback most frequently omitted. CONCLUSIONS There are many freely available online videos which could be described as demonstrating TST; very few are suitable to guide skill acquisition. The development of a standardised and validated assessment tool, that is easy to use and assesses the content of TST videos is required to support learners to critically evaluate the educational quality of video content. Guidelines based on sound teaching theory and practice are required to assist creators of online videos to provide suitable resources that meet the learning needs of neurological physiotherapists and students.
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Affiliation(s)
- Nicola C M Towersey
- School of Clinical Sciences, Department of Physiotherapy, Health and Rehabilitation Research Institute, Auckland University of Technology, Northshore Campus, Private Bag 92006, Auckland, 1142, New Zealand.
| | - Kelvin Sasse
- School of Clinical Sciences, Department of Physiotherapy, Health and Rehabilitation Research Institute, Auckland University of Technology, Northshore Campus, Private Bag 92006, Auckland, 1142, New Zealand
| | - Verna Stavric
- School of Clinical Sciences, Department of Physiotherapy, Health and Rehabilitation Research Institute, Auckland University of Technology, Northshore Campus, Private Bag 92006, Auckland, 1142, New Zealand
| | - Gemma Alder
- School of Clinical Sciences, Department of Physiotherapy, Health and Rehabilitation Research Institute, Auckland University of Technology, Northshore Campus, Private Bag 92006, Auckland, 1142, New Zealand
| | - Nicola L Saywell
- School of Clinical Sciences, Department of Physiotherapy, Health and Rehabilitation Research Institute, Auckland University of Technology, Northshore Campus, Private Bag 92006, Auckland, 1142, New Zealand
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Marin-Pardo O, Donnelly MR, Phanord CS, Wong K, Liew SL. Improvements in motor control are associated with improved quality of life following an at-home muscle biofeedback program for chronic stroke. Front Hum Neurosci 2024; 18:1356052. [PMID: 38818030 PMCID: PMC11138207 DOI: 10.3389/fnhum.2024.1356052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/29/2024] [Indexed: 06/01/2024] Open
Abstract
Introduction Chronic stroke survivors with severe arm impairment have limited options for effective rehabilitation. High intensity, repetitive task practice (RTP) is known to improve upper limb function among stroke survivors who have some volitional muscle activation. However, clients without volitional movement of their arm are ineligible for RTP-based interventions and require hands-on facilitation from a clinician or robotic therapy to simulate task practice. Such approaches can be expensive, burdensome, and have marginal effects. Alternatively, supervised at-home telerehabilitation using muscle biofeedback may provide a more accessible, affordable, and effective rehabilitation option for stroke survivors with severe arm impairment, and could potentially help people with severe stroke regain enough volitional activation to be eligible for RTP-types of therapies. Feedback of muscle activity via electromyography (EMG) has been previously used with clients who have minimal or no movement to improve functional performance. Specifically, training to reduce unintended co-contractions of the impaired hand using EMG biofeedback may modestly improve motor control in people with limited movement. Importantly, these modest and covert functional changes may influence the perceived impact of stroke-related disability in daily life. In this manuscript, we examine whether physical changes following use of a portable EMG biofeedback system (Tele-REINVENT) for severe upper limb hemiparesis also relate to perceived quality of life improvements. Secondarily, we examined the effects of Tele-REINVENT, which uses EMG to quantify antagonistic muscle activity during movement attempt trials and transform individuated action into computer game control, on several different domains of stroke recovery. Methods For this pilot study, nine stroke survivors (age = 37-73 years) with chronic impairment (Fugl-Meyer = 14-40/66) completed 30 1-hour sessions of home-based training, consisting of six weeks of gaming that reinforced wrist extensor muscle activity while attenuating coactivation of flexor muscles. To assess motor control and performance, we measured changes in active wrist ranges of motion, the Fugl-Meyer Assessment, and Action Research Arm Test. We also collected an EMG-based test of muscle control to examine more subtle changes. To examine changes in perceived quality of life, we utilized the Stroke Impact Scale along with participant feedback. Results Results from our pilot data suggest that 30 sessions of remote training can induce modest changes on clinical and functional assessments, showing a statistically significant improvement of active wrist ranges of motion at the group level, changes that could allow some people with severe stroke to be eligible for other therapeutic approaches, such as RTP. Additionally, changes in motor control were correlated with the perceived impact of stroke on participation and impairment after training. We also report changes in corticomuscular coherence, which showed a laterality change from the ipsilesional motor cortex towards the contralesional hemisphere during wrist extension attempts. Finally, all participants showed high adherence to the protocol and reported enjoying using the system. Conclusion Overall, Tele-REINVENT represents a promising telerehabilitation intervention that might improve sensorimotor outcomes in severe chronic stroke, and that improving sensorimotor abilities even modestly may improve quality of life. We propose that Tele-REINVENT may be used as a precursor to help participants gain enough active movement to participate other occupational therapy interventions, such as RTP. Future work is needed to examine if home-based telerehabilitation to provide feedback of individuated muscle activity could increase meaningful rehabilitation accessibility and outcomes for underserved populations.
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Affiliation(s)
- Octavio Marin-Pardo
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States
| | - Miranda Rennie Donnelly
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States
| | - Coralie S. Phanord
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States
| | - Kira Wong
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States
| | - Sook-Lei Liew
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States
- Stevens Neuroimaging and Neuroinformatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Ma HI, Liao WW, Lin CH, Chen IC, Wu CY. Indirect causal path from motor function to quality of life through daily use of the affected arm poststroke after task-specific training: a longitudinal mediation analysis. Disabil Rehabil 2024; 46:2089-2096. [PMID: 37243526 DOI: 10.1080/09638288.2023.2216948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE Task-specific training generally targets motor function, with the ultimate goal of improving quality of life (QoL). This study aimed to determine whether motor function indirectly affects QoL through daily use of the affected arm and activities of daily living (ADL) in patients with chronic stroke. METHODS This was a retrospective cohort study of 155 patients who received training for 90-120 min/session, 3-5 sessions/week, for 4-6 weeks. The training involved specific mirror or robot-assisted therapy, followed by functional task practice for 15-30 min in each session. Patients were assessed before and after the intervention. RESULTS At both pre-test and post-test, significant indirect effects of motor function on QoL through daily use of the affect arm and ADL were observed (β = 0.087-0.124). When the change scores of the measures between the pre-test and post-test were used, significant mediating effects of daily arm use on the relationship between motor function and QoL were identified (β = 0.094-0.103). CONCLUSIONS Enhanced motor function after intervention may lead to an increase in arm use for daily activities and subsequently result in an improvement in QoL. These results highlight the critical role of daily arm use in task-specific training aimed at improving QoL.
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Affiliation(s)
- Hui-Ing Ma
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wan-Wen Liao
- Department of Gerontological Health Care, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
| | - Chu-Hsu Lin
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - I-Chen Chen
- Department of Occupational Therapy, College of Nursing and Health Sciences, Da-Yeh University, Changhua, Taiwan
| | - Ching-Yi Wu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
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Feingold-Polak R, Barzel O, Levy-Tzedek S. Socially Assistive Robot for Stroke Rehabilitation: A Long-Term in-the-Wild Pilot Randomized Controlled Trial. IEEE Trans Neural Syst Rehabil Eng 2024; 32:1616-1626. [PMID: 38598401 DOI: 10.1109/tnsre.2024.3387320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Socially assistive robots (SARs) have been suggested as a platform for post-stroke training. It is not yet known whether long-term interaction with a SAR can lead to an improvement in the functional ability of individuals post-stroke. The aim of this pilot study was to compare the changes in motor ability and quality of life following a long-term intervention for upper-limb rehabilitation of post-stroke individuals using three approaches: 1) training with a SAR in addition to usual care; 2) training with a computer in addition to usual care; and 3) usual care with no additional intervention. Thirty-three post-stroke patients with moderate-severe to mild impairment were randomly allocated into three groups: two intervention groups - one with a SAR (ROBOT group) and one with a computer (COMPUTER group) - and one control group with no intervention (CONTROL group). The intervention sessions took place three times/week, for a total of 15 sessions/participant; The study was conducted over a period of two years, during which 306 sessions were held. Twenty-six participants completed the study. Participants in the ROBOT group significantly improved in their kinematic and clinical measures which included smoothness of movement, action research arm test (ARAT), and Fugl-Meyer upper-extremity assessment (FMA-UE). No significant improvement in these measures was found in the COMPUTER or the control groups. 100% of the participants in the SAR group gained improvement which reached - or exceeded - the minimal clinically important difference in the ARAT, the gold standard for upper-extremity activity performance post-stroke. This study demonstrates both the feasibility and the clinical benefit of using a SAR for long-term interaction with post-stroke individuals as part of their rehabilitation program. Trial Registration: ClinicalTrials.gov NCT03651063.
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Fay A, Synott E, McDaid E, Barrett E. A comparison of the immediate effects of the Andago over ground body weight support trainer versus over ground walking on selected gait parameters in a post-acute rehabilitation population. Physiother Theory Pract 2024; 40:767-777. [PMID: 36593733 DOI: 10.1080/09593985.2022.2162834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND The Andago is an electromechanical gait trainer providing dynamic body weight support while simultaneously enabling over ground walking. The aim of this study was to compare the effects of the Andago with over ground walking on selected gait parameters, during a single gait reeducation session in a post-acute rehabilitation population. METHODS Twenty-seven participants (mean age 78 yrs. (SD = 9.2), female 55.6% (n = 15)) undergoing rehabilitation for neurological (51.8%, n = 14), orthopedic (33.3%, n = 9), and medical conditions (14.8%, n = 4) completed the study. This was a single group, cross sectional, repeated measures study. Participants completed a 10-meter walk test (10MWT) and a 20-minute gait reeducation session under two conditions: i) harnessed in the Andago with body weight support or ii) using their normal walking pattern. Walking speed, steps taken, distance walked, rest breaks, Borg ratings of perceived exertion, and fear of falling were compared over both conditions. RESULTS Walking speed was significantly slower with the Andago (10MWT mean difference 0.12 (95% CI 0.03-0.20), eta squared 0.24, p = .008; 20-min gait mean difference 0.04 (95% CI 0.00-0.09), eta squared 0.15, p = .049). During the 20-minute gait reeducation session, step count, distance walked, and duration of walking was similar over both conditions, however participants recorded less rest breaks and fear of falling at minutes 10 and 20 in favor of the Andago. CONCLUSION Gait parameters measured during a single gait reeducation session in the Andago, in a mixed cohort of predominately older rehabilitation patients, appear comparable to conventional over ground training, other than walking speed which was reduced.
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Affiliation(s)
- Amy Fay
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, University of Dublin, College Green, Dublin, Ireland
| | - Eoin Synott
- Physiotherapy Department, Royal Hospital Donnybrook, Morehampton Road, Dublin, Ireland
| | - Edel McDaid
- Physiotherapy Department, Royal Hospital Donnybrook, Morehampton Road, Dublin, Ireland
| | - Emer Barrett
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, University of Dublin, College Green, Dublin, Ireland
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Linder SM, Bischof-Bockbrader A, Davidson S, Li Y, Lapin B, Singh T, Lee J, Bethoux F, Alberts JL. The Utilization of Forced-Rate Cycling to Facilitate Motor Recovery Following Stroke: A Randomized Clinical Trial. Neurorehabil Neural Repair 2024; 38:291-302. [PMID: 38420848 PMCID: PMC11071159 DOI: 10.1177/15459683241233577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND The potential for aerobic exercise (AE) to enhance neuroplasticity post-stroke has been theorized but not systematically investigated. Our aim was to determine the effects of forced-rate AE (FE) paired with upper extremity (UE) repetitive task practice (FE + RTP) compared to time-matched UE RTP (RTP only) on motor recovery. METHODS A single center randomized clinical trial was conducted from April 2019 to December 2022. Sixty individuals ≥6 months post-stroke with UE hemiparesis were randomized to FE + RTP (N = 30) or RTP only (N = 30), completing 90-minute sessions, 3×/week for 8 weeks. The FE + RTP group underwent 45-minute of FE (5-minute warm-up, 35-minute main set, and 5-minute cool down) followed by 45-minute of UE RTP. The RTP only group completed 90-minute of RTP. Primary outcomes were the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT). The 6-minute Walk Test (6MWT, secondary outcome) assessed walking capacity. RESULTS Sixty individuals enrolled and 56 completed the study. The RTP only group completed more RTP in terms of repetitions (411.8 ± 44.4 vs 222.8 ± 28.4, P < .001) and time (72.7 ± 6.7 vs 37.8 ± 2.4 minutes, P < .001) versus FE + RTP. There was no significant difference between groups on the FMA (FE + RTP, 36.2 ± 10.1-44.0 ± 11.8 and RTP only, 34.4 ± 11.0-41.2 ± 13.4, P = .43) or ARAT (FE + RTP, 32.5 ± 16.6-37.7 ± 17.9 and RTP only, 32.8 ± 18.6-36.4 ± 18.5, P = .88). The FE + RTP group demonstrated greater improvements on the 6MWT (274.9 ± 122.0-327.1 ± 141.2 m) versus RTP only (285.5 ± 160.3-316.9 ± 170.0, P = .003). CONCLUSIONS There was no significant difference between groups in the primary outcomes. The FE + RTP improved more on the 6MWT, a secondary outcome. TRIAL REGISTRATION ClinicalTrials.gov: NCT03819764.
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Affiliation(s)
- Susan M. Linder
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Sara Davidson
- Concussion Center, Neurologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yadi Li
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brittany Lapin
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tamanna Singh
- Department of Cardiovascular Medicine; Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John Lee
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, USA
| | - Francois Bethoux
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, USA
| | - Jay L. Alberts
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Concussion Center, Neurologic Institute, Cleveland Clinic, Cleveland, OH, USA
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Nolan J, Jacques A, Godecke E, Bynevelt M, Dharsono F, Singer B. Lateropulsion resolution and outcomes up to one year post-stroke: a prospective, longitudinal cohort study. Top Stroke Rehabil 2024:1-12. [PMID: 38526999 DOI: 10.1080/10749357.2024.2333186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/17/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Post-stroke lateropulsion is prevalent and associated with poor rehabilitation outcomes; however, data regarding long-term function associated with lateropulsion are lacking. OBJECTIVES This study aimed to explore lateropulsion resolution and associations between lateropulsion, functional outcomes, and fall occurrence up to 12 months post-stroke. METHODS Participants for this prospective, longitudinal cohort study were recruited from a Stroke Rehabilitation Unit (SRU). Assessments were conducted at SRU admission, at discharge, and at three, six, nine, and twelve months post-stroke. Outcomes included the Four-Point Pusher Score (4PPS), Functional Independence Measure (FIM), and fall occurrence. Longitudinal outcomes were modeled using generalized linear mixed-effects models. RESULTS The final analyses included data from 144 participants. Eighty-two participants (56.9) had lateropulsion (4PPS ≥ 1) on admission. Odds of resolved lateropulsion (4PPS = 0) increased longitudinally from discharge for people who participated in rehabilitation physiotherapy (OR: 9.7, 28.1, 43.1, 81.3: <0.001 at three, six, nine, and twelve months respectively). The greatest FIM improvement among participants in all 4PPS categories occurred during the SRU inpatient phase. The probability of falls post-discharge was greatest among participants with 4PPS = 1 at three months, when compared with 4PPS = 0 (p= 0.022). CONCLUSIONS This study showed that lateropulsion can continue to resolve up to one year post-stroke. Earlier lateropulsion resolution was associated with ongoing rehabilitation physiotherapy participation. Long-term functional gains were maintained among people discharged home, whereas functional status deteriorated after six months among those in residential care. Study findings will allow rehabilitation and service providers to better plan for and accommodate the long-term rehabilitation and care needs of people with post-stroke lateropulsion.
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Affiliation(s)
- Jessica Nolan
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
- School of Health Sciences, The University of Notre Dame Australia, Fremantle, Australia
- Physiotherapy Department, Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, Australia
| | - Angela Jacques
- The Institute for Health Research, The University of Notre Dame Australia, Fremantle, Australia
- Department of Research, Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
- Allied Health Research, Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, Australia
- Centre of Research Excellence in Aphasia Rehabilitation, La Trobe University, Melbourne, Australia
| | - Michael Bynevelt
- The Neurological Intervention and Imaging Service of Western Australia, Nedlands, Australia
| | - Ferry Dharsono
- The Neurological Intervention and Imaging Service of Western Australia, Nedlands, Australia
| | - Barbara Singer
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
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Srinivasan S, Kumavor P, Morgan K. A Training Program Using Modified Joystick-Operated Ride-on Toys to Complement Conventional Upper Extremity Rehabilitation in Children with Cerebral Palsy: Results from a Pilot Study. Bioengineering (Basel) 2024; 11:304. [PMID: 38671726 PMCID: PMC11048159 DOI: 10.3390/bioengineering11040304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 02/22/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
The pilot study assessed the utility of a training program using modified, commercially available dual-joystick-operated ride-on toys to promote unimanual and bimanual upper extremity (UE) function in children with cerebral palsy (CP). The ride-on-toy training was integrated within a 3-week, intensive, task-oriented training camp for children with CP. Eleven children with hemiplegia between 4 and 10 years received the ride-on-toy training program 20-30 min/day, 5 days/week for 3 weeks. Unimanual motor function was assessed using the Quality of Upper Extremity Skills Test (QUEST) before and after the camp. During ride-on-toy training sessions, children wore activity monitors on both wrists to assess the duration and intensity of bimanual UE activity. Video data from early and late sessions were coded for bimanual UE use, independent navigation, and movement bouts. Children improved their total and subscale QUEST scores from pretest to post-test while increasing moderate activity in their affected UE from early to late sessions, demonstrating more equal use of both UEs across sessions. There were no significant changes in the rates of movement bouts from early to late sessions. We can conclude that joystick-operated ride-on toys function as child-friendly, intrinsically rewarding tools that can complement conventional therapy and promote bimanual motor functions in children with CP.
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Affiliation(s)
- Sudha Srinivasan
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT 06268, USA
- The Institute for the Brain and Cognitive Sciences (IBACS), University of Connecticut, Storrs, CT 06268, USA
| | - Patrick Kumavor
- Biomedical Engineering Department, University of Connecticut, Storrs, CT 06268, USA; (P.K.); (K.M.)
| | - Kristin Morgan
- Biomedical Engineering Department, University of Connecticut, Storrs, CT 06268, USA; (P.K.); (K.M.)
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13
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Lee CY, Howe TH. Effectiveness of Activity-Based Task-Oriented Training on Upper Extremity Recovery for Adults With Stroke: A Systematic Review. Am J Occup Ther 2024; 78:7802180070. [PMID: 38393992 DOI: 10.5014/ajot.2024.050391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
IMPORTANCE Interventions for improving upper extremity (UE) recovery have become a priority in stroke rehabilitation because UE disability can undermine a person's capacity to perform daily activities after stroke. A better understanding of the use of activity-based task-oriented training (TOT) will inform the development of more effective UE interventions in stroke rehabilitation. OBJECTIVE To examine the effectiveness of activity-based TOT in improving the UE recovery of adults with stroke. DATA SOURCES CINAHL Plus, MEDLINE, and PubMed. STUDY SELECTION AND DATA COLLECTION Inclusion criteria included quantitative studies published between June 2012 and December 2022 that reported UE recovery as an outcome, including measurements of motor function, motor performance, and performance of activities of daily living (ADLs); a sample age ≥18 yr, with stroke in all phases; and interventions that incorporated real-world daily activities. We assessed articles for inclusion, quality, and risk of bias following Cochrane methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. FINDINGS Sixteen studies (692 participants, Level 1-4 evidence) were included. Strong to moderate evidence supported the effectiveness of activity-based TOT in UE motor function, motor performance, and ADL performance for adults with stroke. Strong evidence supported the effectiveness of hospital-based TOT, and moderate evidence supported the effectiveness of home-based TOT. CONCLUSIONS AND RELEVANCE The results not only showed the value of activity-based TOT as an effective UE intervention in stroke rehabilitation but also supported the occupational therapy philosophy of using functional and meaningful activities in practice. Further research on home-based TOT is needed. Plain-Language Summary: This systematic review shows the effectiveness and value of using real-life activities in task-oriented training approaches for adult survivors of stroke. The authors found strong evidence for hospital-based task-oriented training interventions and moderate evidence for home-based interventions for improving upper extremity recovery. This review shows the value of upper extremity task-oriented training as an effective intervention in stroke rehabilitation. The review also supports the occupational therapy philosophy of using functional and meaningful activities in practice as well as the profession's use of evidence-based practice in stroke rehabilitation.
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Affiliation(s)
- Cheng-Yu Lee
- Cheng-Yu Lee, OTD, OTR/L, is OTD Program Graduate, Department of Occupational Therapy, Steinhardt School, New York University, New York, NY;
| | - Tsu-Hsin Howe
- Tsu-Hsin Howe, PhD, OTR, FAOTA, is Associate Professor and Department Chair, Department of Occupational Therapy, Steinhardt School, New York University, New York, NY
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14
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Shierk A, Roberts H, Habeeb Y, Dursun N, Cekmece C, Bonikowski M, Pyrzanowska W, Carranza J, Granados Garcia G, Clegg N, Delgado MR. Development of GO Move: A Website for Children With Unilateral Cerebral Palsy. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024:15394492231225141. [PMID: 38281146 DOI: 10.1177/15394492231225141] [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: 01/30/2024]
Abstract
It is unknown if an online tool is wanted by therapists and parents of individuals with unilateral cerebral palsy (UCP) to support implementation of goal-directed home programs, and if wanted, the recommended features for the tool. The objective was to explore the experiences of therapists and parents who have implemented home programs, seek guidance on translating a paper-based home program toolbox into a mobile website, and develop the website. Qualitative descriptive methodology guided data collection using semi-structured interviews and thematic analysis, validated with field notes and member checking. A team science, iterative approach was used to integrate the themes into the development of the mobile website. Five primary themes including recommendations for the functionality, features, content, and naming of the mobile website were identified. Parents and therapists value home programs. Participants provided recommendations regarding content and features, and the GO Move mobile website was developed based on the recommendations.
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Affiliation(s)
- Angela Shierk
- Scottish Rite for Children, Dallas, TX, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Heather Roberts
- Scottish Rite for Children, Dallas, TX, USA
- Texas Woman's University, Denton, USA
| | | | | | | | | | | | | | | | | | - Mauricio R Delgado
- Scottish Rite for Children, Dallas, TX, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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15
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Ogahara K, Nakashima A, Suzuki T, Sugawara K, Yoshida N, Hatta A, Moriuchi T, Higashi T. Comparing movement-related cortical potential between real and simulated movement tasks from an ecological validity perspective. Front Hum Neurosci 2024; 17:1313835. [PMID: 38298203 PMCID: PMC10828031 DOI: 10.3389/fnhum.2023.1313835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/26/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction Concerns regarding the ecological validity of movement-related cortical potential (MRCP) experimental tasks that are related to motor learning have recently been growing. Therefore, we compared MRCP during real movement task (RMT) and simulated movement task (SMT) from an ecological validity perspective. Methods The participants performed both RMT and SMT, and MRCP were measured using electroencephalogram (EEG). EEG was based on the 10-20 method, with electrodes placed in the motor cortex (C3 and C4) and supplementary motor cortex (FCz [between Fz and Cz] and Cz) areas. This experiment examined the MRCP using Bereitschaftspotential (BP) and negative slope (NS') onset times, and BP, NS', and motor potential (MP) amplitudes during the task. Results The results revealed that the SMT exhibited later BP and NS' onset times and smaller BP, NS', and MP amplitudes than the RMT. Furthermore, in RMT, the onset time of MRCP was delayed, and the amplitude of MRCP was smaller in the second half of the 200 times task than in the first half, whereas in SMT, there was no change in onset time and amplitude. The SMT showed a different MRCP than the RMT, suggesting that the ecological validity of the task should be fully considered when investigating the cortical activity associated with motor skill learning using MRCP. Conclusion Ecological validity of the study should be fully considered when investigating the cortical activity associated with motor skill learning using MRCP. Moreover, it is important to understand the differences between the two methods when applied clinically.
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Affiliation(s)
- Kakuya Ogahara
- Department of Health Sciences, Graduate School of Biomedical Sciences, Health Sciences, Nagasaki University, Nagasaki, Japan
- Department of Occupational Therapy, Kanagawa University of Human Services, Yokosuka, Japan
| | - Akira Nakashima
- Department of Health Sciences, Graduate School of Biomedical Sciences, Health Sciences, Nagasaki University, Nagasaki, Japan
| | - Tomotaka Suzuki
- Department of Physical Therapy, Kanagawa University of Human Services, Yokosuka, Japan
| | - Kenichi Sugawara
- Department of Physical Therapy, Kanagawa University of Human Services, Yokosuka, Japan
| | - Naoshin Yoshida
- Department of Health Sciences, Graduate School of Biomedical Sciences, Health Sciences, Nagasaki University, Nagasaki, Japan
| | - Arihiro Hatta
- Department of Physical Recreation, School of Physical Education, Tokai University, Hiratsuka, Japan
| | - Takefumi Moriuchi
- Department of Health Sciences, Graduate School of Biomedical Sciences, Health Sciences, Nagasaki University, Nagasaki, Japan
| | - Toshio Higashi
- Department of Health Sciences, Graduate School of Biomedical Sciences, Health Sciences, Nagasaki University, Nagasaki, Japan
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16
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Barclay SA, Klausing LN, Hill TM, Kinney AL, Reissman T, Reissman ME. Characterization of Upper Extremity Kinematics Using Virtual Reality Movement Tasks and Wearable IMU Technology. SENSORS (BASEL, SWITZERLAND) 2023; 24:233. [PMID: 38203094 PMCID: PMC10781219 DOI: 10.3390/s24010233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/19/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024]
Abstract
Task-specific training has been shown to be an effective neuromotor rehabilitation intervention, however, this repetitive approach is not always very engaging. Virtual reality (VR) systems are becoming increasingly popular in therapy due to their ability to encourage movement through customizable and immersive environments. Additionally, VR can allow for a standardization of tasks that is often lacking in upper extremity research. Here, 16 healthy participants performed upper extremity movement tasks synced to music, using a commercially available VR game known as Beat Saber. VR tasks were customized to characterize participants' joint angles with respect to each task's specified cardinal direction (inward, outward, upward, or downward) and relative task location (medial, lateral, high, and/or low). Movement levels were designed using three common therapeutic approaches: (1) one arm moving only (unilateral), (2) two arms moving in mirrored directions about the participant's midline (mirrored), or (3) two arms moving in opposing directions about the participant's midline (opposing). Movement was quantified using an XSens System, a wearable inertial measurement unit (IMU) technology. Results reveal a highly engaging and effective approach to quantifying movement strategies. Inward and outward (horizontal) tasks resulted in decreased wrist extension. Upward and downward (vertical) tasks resulted in increased shoulder flexion, wrist radial deviation, wrist ulnar deviation, and elbow flexion. Lastly, compared to opposing, mirrored, and unilateral movement levels often exaggerated joint angles. Virtual reality games, like Beat Saber, offer a repeatable and customizable upper extremity intervention that has the potential to increase motivation in therapeutic applications.
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Affiliation(s)
- Skyler A. Barclay
- EMPOWER Laboratory, University of Dayton, Dayton, OH 45469, USA (A.L.K.); (T.R.); (M.E.R.)
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17
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Baer R, Feingold-Polak R, Ostrovsky D, Kurz I, Levy-Tzedek S. Correlation between kinetic and kinematic measures, clinical tests and subjective self-evaluation questionnaires of the affected upper limb in people after stroke. Front Neurosci 2023; 17:1264513. [PMID: 38178833 PMCID: PMC10765579 DOI: 10.3389/fnins.2023.1264513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/14/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction Assessment of stroke recovery should include multiple sources of information in order to obtain a complete understanding of the individual's rehabilitation progress. Self-evaluation questionnaires' scores do not always correspond to the scores of commonly used clinical evaluation tools. The purpose of this study was to assess the relationship between self-evaluation questionnaires, clinical tests, and kinematic and kinetic analyses of the affected upper limb after stroke, and to determine the correlation between these measures and self-reported general function 2-4 years after the stroke. Methods Twenty-six subjects recovering from stroke were included in the study. Spearman's correlation coefficient was used to measure the correlation between Stroke Impact Scale (SIS), Motor activity Log (MAL), Fugl-Meyer Assessment (FMA) and Action Reach Arm Test (ARAT) scores, and kinematic and kinetic analyses. A logistic regression was used to assess the extent to which these measures may predict the participants' functional self-reported status 2-4 years post stroke. Results Sections regarding hand function, hand force and general ADL of the self-evaluation questionnaires correlated with kinematic variables. However, only questionnaires that focus on hand function correlated with clinical tests. Mean and maximal hand velocity had the strongest correlations with self-evaluation questionnaires and with the clinical tests, more than other kinematic variables. Self-evaluation questionnaires and clinical tests were found to be correlated with hand kinetic metrics force-to-time ratio and number of force peaks. SIS hand force domain, mean velocity and maximal velocity predicted self-reported general function 2-4 years after the stroke. Conclusion Self-evaluation questionnaires should be considered for wider use in the clinical evaluation of a patient's stroke recovery, since they add important information on the individual's functional status, which is not reflected in the clinical tests.
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Affiliation(s)
- Ronnie Baer
- Recanati School for Community Health Professions, Department of Physical Therapy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Ronit Feingold-Polak
- Recanati School for Community Health Professions, Department of Physical Therapy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Herzog Medical Center, Jerusalem, Israel
| | - Daniel Ostrovsky
- Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Ilan Kurz
- Recanati School for Community Health Professions, Department of Physical Therapy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Shelly Levy-Tzedek
- Recanati School for Community Health Professions, Department of Physical Therapy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Zelman Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Freiburg Institute for Advanced Studies (FRIAS), University of Freiburg, Freiburg, Germany
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18
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Stewart AN, Gensel JC, Jones L, Fouad K. Challenges in Translating Regenerative Therapies for Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2023; 29:23-43. [PMID: 38174141 PMCID: PMC10759906 DOI: 10.46292/sci23-00044s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Regenerating the injured spinal cord is a substantial challenge with many obstacles that need to be overcome to achieve robust functional benefits. This abundance of hurdles can partly explain the limited success when applying regenerative intervention treatments in animal models and/or people. In this article, we elaborate on a few of these obstacles, starting with the applicability of animal models and how they compare to the clinical setting. We then discuss the requirement for combinatorial interventions and the associated problems in experimental design, including the addition of rehabilitative training. The article expands on differences in lesion sizes and locations between humans and common animal models, and how this difference can determine the success or failure of an intervention. An additional and frequently overlooked problem in the translation of interventions that applies beyond the field of neuroregeneration is the reporting bias and the lack of transparency in reporting findings. New data mandates are tackling this problem and will eventually result in a more balanced view of the field. Finally, we will discuss strategies to negotiate the challenging course of successful translation to facilitate successful translation of regeneration promoting interventions.
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Affiliation(s)
- Andrew N. Stewart
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, Kentucky, USA
| | - John C. Gensel
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, Kentucky, USA
| | - Linda Jones
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Karim Fouad
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
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19
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Bertels N, Seelen H, Dembele J, Spooren A. Essential training variables of arm-hand training in people with cervical spinal cord injury: a systematic review. J Rehabil Med 2023; 55:jrm7147. [PMID: 37930130 PMCID: PMC10642344 DOI: 10.2340/jrm.v55.7147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 08/29/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVE To identify and evaluate 3 training variables of motor training programmes involving people with a cervical spinal cord injury: i.e. motor training strategies, therapy dosage, and persons' motivation for arm-hand functioning in subacute and chronic phases. METHODS PubMed, Cochrane, CINAHL, EMBASE, and DARE databases were searched for active arm-hand motor training programmes. Two independent reviewers assessed methodological quality. Pre-post effect sizes were calculated using Hedge's g, and mean effect sizes were calculated to compare outcomes on the International Classification of Functioning, Disability, and Health levels of function and activity. RESULTS Twelve training programmes integrated mainly skill training alone or combined with strength and/or endurance training. Task-oriented training components included: multiple movement planes, functional movements, clear functional goals, and bimanual practice. Training duration of 8 weeks was common. Quantitative analyses of 8 training programmes showed an overall small effect (0.34) on function level and an overall moderate effect (0.55) on activity level. In depth-analysis of activity level showed moderate effects of skill training only (0.55) or combined with strength and endurance training (0.53). Moderate effects (0.53-0.60) were found for integrating functional movements, clear functional goals, real-life object manipulation, multiple movement planes, total skill practice, context-specific environment, exercise variety, and bimanual practice. Training of minimum 8 weeks showed a moderate effect (0.60-0.69). CONCLUSION Based on limited studies, arm-hand functioning aiming to improve activity level can be improved using skill training with at least 8 task-oriented training components, additional strength and endurance training, with a minimum training duration of 8 weeks.
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Affiliation(s)
- Nele Bertels
- Rehabilitation Research Center REVAL, Hasselt University, Diepenbeek, Belgium.
| | - Henk Seelen
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Netherlands; Maastricht University, Research School CAPHRI, dept. of Rehabilitation Medicine, Maastricht, Netherlands
| | - Justine Dembele
- Rehabilitation Research Center REVAL, Hasselt University, Diepenbeek, Belgium
| | - Annemie Spooren
- Rehabilitation Research Center REVAL, Hasselt University, Diepenbeek, Belgium
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20
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Ben M, Glinsky JV, Chu J, Spooren AI, Roberts S, Chen LW, Denis S, Lorusso M, Jorgensen V, Gollan EJ, Agostinello J, Van Laake-Geelen CCM, Lincoln C, Stolwijk JM, Bell C, Paddison S, Rainey D, Tranter K, Ilha J, Oostra K, Sherrington C, Harvey LA. Early and intensive Motor Training for people with spinal cord injuries (the SCI-MT Trial): description of the intervention. Spinal Cord 2023; 61:600-607. [PMID: 37468607 PMCID: PMC10645584 DOI: 10.1038/s41393-023-00911-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/21/2023]
Abstract
STUDY DESIGN Descriptive. OBJECTIVES The primary objective is to describe the intervention that will be provided in a large multi-centre randomised controlled trial titled: Early and Intensive Motor Training for people with Spinal Cord Injuries (the SCI-MT Trial). The secondary objective is to describe the strategies that will be used to operationalise and standardise the Motor Training provided to participants while keeping the intervention person-centred. METHODS The paper focuses on the rationale and principles of Motor Training for people with spinal cord injuries (SCI). The description of the intervention is based on the Template for Intervention Description and Replication (TIDieR) checklist. Specifically, it addresses the following 6 criteria of the TIDieR checklist: why the effectiveness of Motor Training is being examined; what, how, where and when the Motor Training will be administered; and how much Motor Training will be provided. RESULTS A detailed intervention manual has been developed to help standardise the delivery of the intervention. CONCLUSIONS This paper describes the details of a complex intervention administered as part of a large randomised controlled trial. It will facilitate the subsequent interpretation of the trial results and enable the intervention to be reproduced in clinical practice and future trials.
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Affiliation(s)
- M Ben
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia
| | - J V Glinsky
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia
| | - J Chu
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia
| | | | - S Roberts
- Fiona Stanley Hospital, Murdoch, WA, Australia
| | - L W Chen
- Royal North Shore Hospital, St Leonards, NSW, Australia
| | - S Denis
- The Prince of Wales Hospital, Wales, NSW, Australia
| | - M Lorusso
- I.R.C.C.S. Foundation Santa Lucia, Rome, Italy
| | - V Jorgensen
- Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - E J Gollan
- The Princess Alexandra Hospital, Harlow, QLD, Australia
| | - J Agostinello
- The Royal Talbot Rehabilitation Centre, Kew Vic, VIC, Australia
| | - C C M Van Laake-Geelen
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - C Lincoln
- Queen Elizabeth National Spinal Injures Unit, Glasgow, Scotland
| | - J M Stolwijk
- Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - C Bell
- Spinal Cord Injury Rehabilitation, Repat Health Precinct, Daw Park, SA, Australia
| | - S Paddison
- London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital Trust, Middlesex, UK
| | - D Rainey
- Royal Rehab, Ryde, NSW, Australia
| | - K Tranter
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia
| | - J Ilha
- Universidade do Estado de Santa Catarina - UDESC, College of Health and Sport Science, Florianopolis, SC, Brazil
| | - K Oostra
- Ghent University Hospital, Ghent, Belgium
| | - C Sherrington
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - L A Harvey
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia.
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Rozevink SG, Hijmans JM, Horstink KA, van der Sluis CK. Effectiveness of task-specific training using assistive devices and task-specific usual care on upper limb performance after stroke: a systematic review and meta-analysis. Disabil Rehabil Assist Technol 2023; 18:1245-1258. [PMID: 34788166 DOI: 10.1080/17483107.2021.2001061] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Task-specific rehabilitation is a key indicator for successful rehabilitation to improve the upper limb performance after stroke. Assistive robotic and non-robotic devices are emerging to provide rehabilitation therapy; however, the effectiveness of task-specific training programs using assistive training devices compared with task-specific usual care training has not been summarized yet. Therefore, the effectiveness of task-specific training using assistive arm devices (TST-AAD) compared with task-specific usual care (TSUC) on the upper limb performance of patients with a stroke was investigated. To assess task specificity, a set of criteria was proposed: participation, program, relevant, repeated, randomized, reconstruction and reinforced. MATERIALS AND METHODS Out of 855 articles, 17 fulfilled the selection criteria. A meta-analysis was performed on the Fugl-Meyer Assessment scores in the subacute and chronic stages after stroke and during follow-up. RESULTS AND CONCLUSION Both TST-AAD and TSUC improved the upper limb performance after stroke. In the sub-acute phase after stroke, TST-AAD was more effective than TSUC in reducing the upper limb impairment, although findings were based on only three studies. In the chronic phase, TST-AAD and TSUC showed similar effectiveness. No differences between the two types of training were found at the follow-up measurements. Future studies should describe training, device usage and criteria of task specificity in a standardized way to ease comparison.Implications for rehabilitationArm or hand function is often undertreated in stroke patients, assistive training devices may be able to improve the upper limb performance.Task-specific training using assistive devices is effective in improving the upper limb performance after stroke.Task-specific training using assistive devices seems to be more effective in reducing impairment compared with task specific usual care in the subacute phase after stroke, but they are equally effective in the chronic phase of stroke.
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Affiliation(s)
- Samantha G Rozevink
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - Juha M Hijmans
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - Koen A Horstink
- University of Groningen, University Medical Center Groningen, Department of Human Movement Sciences, Groningen, The Netherlands
| | - Corry K van der Sluis
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
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Barth J, Geed S, Mitchell A, Brady KP, Giannetti ML, Dromerick AW, Edwards DF. The Critical Period After Stroke Study (CPASS) Upper Extremity Treatment Protocol. Arch Rehabil Res Clin Transl 2023; 5:100282. [PMID: 37744191 PMCID: PMC10517370 DOI: 10.1016/j.arrct.2023.100282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Objective To present the development of a novel upper extremity (UE) treatment and assess how it was delivered in the Critical Periods After Stroke Study (CPASS), a phase II randomized controlled trial (RCT). Design Secondary analysis of data from the RCT. Setting Inpatient and outpatient settings the first year after stroke. Participants Of the 72 participants enrolled in CPASS (N=72), 53 were in the study groups eligible to receive the treatment initiated at ≤30 days (acute), 2-3 months (subacute), or ≥6 months (chronic) poststroke. Individuals were 65.1±10.5 years of age, 55% were women, and had mild to moderate UE motor capacity (Action Research Arm Test=17.2±14.3) at baseline. Intervention The additional 20 hours of treatment began using the Activity Card Sort (ACS), a standardized assessment of activities and participation after stroke, to identify UE treatment goals selected by the participants that were meaningful to them. Treatment activities were broken down into smaller components from a standardized protocol and process that operationalized the treatments essential elements. Main Outcome Measures Feasibility of performing the treatment in a variety of clinical settings in an RCT and contextual factors that influenced adherence. Results A total of 49/53 participants fully adhered to the CPASS treatment. The duration and location of the treatment sessions and the UE activities practiced during therapy are presented for the total sample (n=49) and per study group as an assessment of feasibility and the contextual factors that influenced adherence. Conclusions The CPASS treatment and therapy goals were explicitly based on the meaningful activities identified by the participants using the ACS as a treatment planning tool. This approach provided flexibility to customize UE motor therapy without sacrificing standardization or quantification of the data regardless of the location and UE impairments of participants within the first year poststroke.
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Affiliation(s)
- Jessica Barth
- Veterans Affairs Medical Center, Center of Innovation for Long-Term Supports and Services, Providence, RI
- MedStar National Rehabilitation Hospital, Washington, DC
- Center for Brain Plasticity and Recovery, Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
| | - Shashwati Geed
- MedStar National Rehabilitation Hospital, Washington, DC
- Center for Brain Plasticity and Recovery, Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
| | - Abigail Mitchell
- MedStar National Rehabilitation Hospital, Washington, DC
- Center for Brain Plasticity and Recovery, Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
| | - Kathaleen P. Brady
- MedStar National Rehabilitation Hospital, Washington, DC
- Center for Brain Plasticity and Recovery, Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
| | - Margot L. Giannetti
- MedStar National Rehabilitation Hospital, Washington, DC
- Center for Brain Plasticity and Recovery, Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
| | - Alexander W. Dromerick
- MedStar National Rehabilitation Hospital, Washington, DC
- Center for Brain Plasticity and Recovery, Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
| | - Dorothy F. Edwards
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
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Paparella I, Vanderwalle G, Stagg CJ, Maquet P. An integrated measure of GABA to characterize post-stroke plasticity. Neuroimage Clin 2023; 39:103463. [PMID: 37406594 PMCID: PMC10339061 DOI: 10.1016/j.nicl.2023.103463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/19/2023] [Accepted: 06/24/2023] [Indexed: 07/07/2023]
Abstract
Stroke is a major cause of death and chronic neurological disability. Despite the improvements in stroke care, the number of patients affected by stroke keeps increasing and many stroke survivors are left permanently disabled. Current therapies are limited in efficacy. Understanding the neurobiological mechanisms underlying post-stroke recovery is therefore crucial to find new therapeutic options to address this medical burden. Long-lasting and widespread alterations of γ-aminobutyric acid (GABA) neurotransmission seem to play a key role in stroke recovery. In this review we first discuss a possible model of GABAergic modulation of post-stroke plasticity. We then overview the techniques currently available to non-invasively assess GABA in patients and the conclusions drawn from this limited body of work. Finally, we address the remaining open questions to clarify GABAergic changes underlying post-stroke recovery, we briefly review possible ways to modulate GABA post stroke and propose a novel approach to thoroughly quantify GABA in stroke patients, by integrating its concentration, the activity of its receptors and its link with microstructural changes.
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Affiliation(s)
- Ilenia Paparella
- GIGA-Research, Cyclotron Research Center-In Vivo Imaging Unit, 8 allée du Six Août, Batiment B30, University of Liège, 4000 Liège, Belgium.
| | - Gilles Vanderwalle
- GIGA-Research, Cyclotron Research Center-In Vivo Imaging Unit, 8 allée du Six Août, Batiment B30, University of Liège, 4000 Liège, Belgium
| | - Charlotte J Stagg
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Medical Research Council Brain Network Dynamics Unit, Oxford, UK
| | - Pierre Maquet
- GIGA-Research, Cyclotron Research Center-In Vivo Imaging Unit, 8 allée du Six Août, Batiment B30, University of Liège, 4000 Liège, Belgium; Department of Neurology, Domaine Universitaire du Sart Tilman, Bâtiment B35, CHU de Liège, 4000 Liège, Belgium
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24
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Badran BW, Peng X, Baker-Vogel B, Hutchison S, Finetto P, Rishe K, Fortune A, Kitchens E, O’Leary GH, Short A, Finetto C, Woodbury ML, Kautz S. Motor Activated Auricular Vagus Nerve Stimulation as a Potential Neuromodulation Approach for Post-Stroke Motor Rehabilitation: A Pilot Study. Neurorehabil Neural Repair 2023; 37:374-383. [PMID: 37209010 PMCID: PMC10363288 DOI: 10.1177/15459683231173357] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND Implanted vagus nerve stimulation (VNS), when synchronized with post-stroke motor rehabilitation improves conventional motor rehabilitation training. A non-invasive VNS method known as transcutaneous auricular vagus nerves stimulation (taVNS) has emerged, which may mimic the effects of implanted VNS. OBJECTIVE To determine whether taVNS paired with motor rehabilitation improves post-stroke motor function, and whether synchronization with movement and amount of stimulation is critical to outcomes. METHODS We developed a closed-loop taVNS system for motor rehabilitation called motor activated auricular vagus nerve stimulation (MAAVNS) and conducted a randomized, double-blind, pilot trial investigating the use of MAAVNS to improve upper limb function in 20 stroke survivors. Participants attended 12 rehabilitation sessions over 4-weeks, and were assigned to a group that received either MAAVNS or active unpaired taVNS concurrently with task-specific training. Motor assessments were conducted at baseline, and weekly during rehabilitation training. Stimulation pulses were counted for both groups. RESULTS A total of 16 individuals completed the trial, and both MAAVNS (n = 9) and unpaired taVNS (n = 7) demonstrated improved Fugl-Meyer Assessment upper extremity scores (Mean ± SEM, MAAVNS: 5.00 ± 1.02, unpaired taVNS: 3.14 ± 0.63). MAAVNS demonstrated greater effect size (Cohen's d = 0.63) compared to unpaired taVNS (Cohen's d = 0.30). Furthermore, MAAVNS participants received significantly fewer stimulation pulses (Mean ± SEM, MAAVNS: 36 070 ± 3205) than the fixed 45 000 pulses unpaired taVNS participants received (P < .05). CONCLUSION This trial suggests stimulation timing likely matters, and that pairing taVNS with movements may be superior to an unpaired approach. Additionally, MAAVNS effect size is comparable to that of the implanted VNS approach.
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Affiliation(s)
- Bashar W. Badran
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, USA
- Deparment of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Xiaolong Peng
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, USA
- Deparment of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Brenna Baker-Vogel
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, USA
| | - Scott Hutchison
- Deparment of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Patricia Finetto
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, USA
| | - Kelly Rishe
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- VA RR&D Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI, USA
| | - Andrew Fortune
- Deparment of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Ellen Kitchens
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, USA
| | - Georgia H. O’Leary
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, USA
| | - Abigail Short
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, USA
| | - Christian Finetto
- Deparment of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Michelle L. Woodbury
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA
| | - Steve Kautz
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA
- Ralph H Johnson VA Health Care System, Charleston, SC, USA
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25
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Dudoniene V, Adomaitytė A, Žlibinaitė L. Randomized controlled trial to compare conventional physiotherapy with task-oriented exercises after total hip replacement. J Back Musculoskelet Rehabil 2023:BMR220340. [PMID: 37248880 DOI: 10.3233/bmr-220340] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Different interventions are used during rehabilitation after hip replacement surgery, but it is unclear if task-oriented exercise is more effective than conventional physiotherapy. OBJECTIVE This study compared the effectiveness of conventional physiotherapy (CPT) programme with task-oriented exercise (TOE) on hip pain, function, static and dynamic balance during the early rehabilitation stage after total hip replacement. METHODS This randomized controlled parallel-group trial was executed in an inpatient physical medicine and rehabilitation centre. The study included 40 patients who were randomly classified into CPT and TOE groups (n= 20 in each). Hip pain (assessed by visual analogue scale), function in the operated leg (assessed by modified Harris Hip Score, mHHS), static balance (assessed by Abili Balance analyser system) and dynamic balance (assessed by Berg Balance Scale) were evaluated at baseline and after 18 days of rehabilitation. Cohen's effect size (d) was calculated. RESULTS Greater pain reduction (p< 0.05; d= 0.08) was observed after TOE (1.6 ± 0.68 scores) compared with the CPT programme (2.2 ± 0.83 scores). Hip function assessed by the modified mHHS improved more (p< 0.05; d= 0.30) in the TOE group (73.45 ± 6.23 scores) than in the CPT group (54.90 ± 6.28 scores). Static balance improved significantly in both groups after the interventions but did not differ significantly between the groups. The improvement in dynamic balance was significantly greater (p< 0.05; d= 0.45) after TOE (50.55 ± 1.57 scores) than after CPT (38.55 ± 3.43 scores). CONCLUSION Both interventions reduced pain and improved function of the operated leg and static and dynamic balance. The effect on hip function was superior for TOE compared with CPT.
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Hao J, Buster TW, Cesar GM, Burnfield JM. Virtual reality augments effectiveness of treadmill walking training in patients with walking and balance impairments: A systematic review and meta-analysis of randomized controlled trials. Clin Rehabil 2023; 37:603-619. [PMID: 36366806 DOI: 10.1177/02692155221138309] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To systematically summarize and examine current evidence regarding the combination of virtual reality and treadmill training in patients with walking and balance impairments. DATA SOURCES English language randomized controlled trials, participants with walking and balance impairments, intervention group used virtual reality and treadmill, control group only used treadmill with the same training frequency and number of sessions. Six bioscience and engineering databases were searched. METHODS Two independent reviewers conducted study selection, data extraction, and quality assessment. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. RESULTS Sixteen randomized controlled trials including 829 participants were identified. Compared to treadmill-only training, virtual reality augmented treadmill training induced significantly faster walking (p < 0.001; standardized mean difference (SMD) = 0.55, 95%CI: 0.30 to 0.81), longer step length (p < 0.001; SMD = 0.74, 95%CI: 0.42 to 1.06), narrower step width (p = 0.03; SMD = -0.52, 95%CI: -0.97 to -0.06), longer single leg stance period (p = 0.003; SMD = 0.77, 95%CI: 0.27 to 1.27), better functional mobility (p = 0.003; SMD = -0.44, 95%CI: - 0.74 to -0.15), improved balance function (p = 0.04; SMD = 0.24, 95%CI: 0.01 to 0.47), and enhanced balance confidence (p = 0.03; SMD = 0.73, 95%CI: 0.08 to 1.37). Walking endurance did not differ significantly between groups (p = 0.21; SMD = 0.13, 95%CI: -0.07 to 0.34). CONCLUSIONS Virtual reality augmented treadmill walking training enhances outcomes compared to treadmill-only training in patients with walking and balance impairments. The results of this review support the clinical significance of combining virtual reality with treadmill training with level 1A empirical evidence.
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Affiliation(s)
- Jie Hao
- Institute for Rehabilitation Science and Engineering, 20936Madonna Rehabilitation Hospitals, Lincoln, NE, USA
- Division of Physical Therapy Education, 12284University of Nebraska Medical Center, Omaha, NE, USA
| | - Thad W Buster
- Institute for Rehabilitation Science and Engineering, 20936Madonna Rehabilitation Hospitals, Lincoln, NE, USA
| | - Guilherme M Cesar
- Institute for Rehabilitation Science and Engineering, 20936Madonna Rehabilitation Hospitals, Lincoln, NE, USA
| | - Judith M Burnfield
- Institute for Rehabilitation Science and Engineering, 20936Madonna Rehabilitation Hospitals, Lincoln, NE, USA
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27
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Wang H, Xiang Y, Wang C, Wang Y, Chen S, Ding L, Liu Q, Wang X, Zhao K, Jia J, Chen Y. Effects of transcutaneous electrical acupoint stimulation on upper-limb impairment after stroke: A randomized, controlled, single-blind trial. Clin Rehabil 2023; 37:667-678. [PMID: 36380681 PMCID: PMC10041575 DOI: 10.1177/02692155221138916] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the effects of transcutaneous electrical acupoint stimulation (TEAS) on upper limb motor recovery during post-stroke rehabilitation. DESIGN Single-blind, randomized controlled trial. SETTING Four inpatient rehabilitation facilities. SUBJECTS A total of 204 stroke patients with unilateral upper limb motor impairment were randomly 1:1 allocated to TEAS or sham TEAS group. Baseline demographic and clinical characteristics were comparable between the two groups. INTERVENTIONS Both groups received conventional physical and occupational therapies. TEAS and sham TEAS therapy were administered to two acupoints (LI10 and TE5) with a pulse duration of 300 µs at 2 Hz on the affected forearm for 30 times over 6 weeks. OUTCOME MEASURES The upper-extremity Fugl-Meyer score (primary outcome), manual muscle testing, modified Ashworth scale, Lindmark hand function score, and Barthel index were evaluated by blinded assessors at baseline, 2, 4, 6, 10, and 18 weeks. RESULTS The number of patients who completed the treatment was 99 and 97 in the TEAS and the sham group. No significant between-group difference was found in the Upper-Extremity Fugl-Meyer score, Modified Ashworth Scale, Lindmark hand function score, and Barthel Index after intervention and during follow-up. However, the TEAS group exhibited 0.29 (95% CI 0.02 to 0.55) greater improvements in Manual Muscle Testing of wrist extension than the sham group (p = 0.037) at 18 weeks. CONCLUSIONS Administration of TEAS therapy to hemiplegic forearm could not improve the upper extremity motor recovery. However, TEAS on the forearm might provide potential benefits for strength improvement of the wrist.
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Affiliation(s)
- Hewei Wang
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuzhi Xiang
- Department of Rehabilitation, Shanghai Third Rehabilitation Hospital, Shanghai, China
| | - Chuankai Wang
- Department of Rehabilitation Medicine, South China Hospital, Health Science Center, Shenzhen University, Shenzhen, China
| | - Yingying Wang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- Department of Epidemiology, Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
| | - Shugeng Chen
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai, China
| | - Li Ding
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiang Liu
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaowen Wang
- Department of Rehabilitation, Shanghai Third Rehabilitation Hospital, Shanghai, China
| | - Kun Zhao
- Department of Rehabilitation, Shanghai Third Rehabilitation Hospital, Shanghai, China
| | - Jie Jia
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai, China
| | - Yao Chen
- Department of Rehabilitation, Shanghai Third Rehabilitation Hospital, Shanghai, China
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28
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Hope JM, Field-Fote EC. Assessment of Dorsiflexion Ability across Tasks in Persons with Subacute SCI after Combined Locomotor Training and Transcutaneous Spinal Stimulation. Bioengineering (Basel) 2023; 10:bioengineering10050528. [PMID: 37237598 DOI: 10.3390/bioengineering10050528] [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] [Received: 01/07/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
In people with spinal cord injury (SCI), transcutaneous spinal stimulation (TSS) has an immediate effect on the ability to dorsiflex the ankle, but persistent effects are not known. Furthermore, TSS has been associated with improved walking, increased volitional muscle activation, and decreased spasticity when combined with locomotor training (LT). In this study, the persistent impact of combined LT and TSS on dorsiflexion during the swing phase of walking and a volitional task in participants with SCI is determined. Ten participants with subacute motor-incomplete SCI received 2 weeks of LT alone (wash-in phase), followed by 2 weeks of either LT + TSS (TSS at 50 Hz) or LT + TSSSham (intervention phase). There was no persistent effect of TSS on dorsiflexion during walking and inconsistent effects on the volitional task. There was a strong positive correlation between the dorsiflexor ability for both tasks. There was a moderate effect of 4 weeks of LT on increased dorsiflexion during the task (d = 0.33) and walking (d = 0.34) and a small effect on spasticity (d = -0.2). Combined LT + TSS did not show persistent effects on dorsiflexion ability in people with SCI. Four weeks of locomotor training was associated with increased dorsiflexion across tasks. Improvements in walking observed with TSS may be due to factors other than improved ankle dorsiflexion.
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Affiliation(s)
- Jasmine M Hope
- Hulse Spinal Cord Injury Research Laboratory, Crawford Research Institute, Shepherd Center, Atlanta, GA 30309, USA
- Neuroscience Graduate Program, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA 30322, USA
| | - Edelle C Field-Fote
- Hulse Spinal Cord Injury Research Laboratory, Crawford Research Institute, Shepherd Center, Atlanta, GA 30309, USA
- Division of Physical Therapy, School of Medicine, Emory University, Atlanta, GA 30322, USA
- Program in Applied Physiology, School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA 30318, USA
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Palmer JA, Morris JK, Billinger SA, Lepping RJ, Martin L, Green Z, Vidoni ED. Hippocampal blood flow rapidly and preferentially increases after a bout of moderate-intensity exercise in older adults with poor cerebrovascular health. Cereb Cortex 2023; 33:5297-5306. [PMID: 36255379 PMCID: PMC10152056 DOI: 10.1093/cercor/bhac418] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/02/2022] [Accepted: 09/25/2022] [Indexed: 11/14/2022] Open
Abstract
Over the course of aging, there is an early degradation of cerebrovascular health, which may be attenuated with aerobic exercise training. Yet, the acute cerebrovascular response to a single bout of exercise remains elusive, particularly within key brain regions most affected by age-related disease processes. We investigated the acute global and region-specific cerebral blood flow (CBF) response to 15 minutes of moderate-intensity aerobic exercise in older adults (≥65 years; n = 60) using arterial spin labeling magnetic resonance imaging. Within 0-6 min post-exercise, CBF decreased across all regions, an effect that was attenuated in the hippocampus. The exercise-induced CBF drop was followed by a rebound effect over the 24-minute postexercise assessment period, an effect that was most robust in the hippocampus. Individuals with low baseline perfusion demonstrated the greatest hippocampal-specific CBF effect post-exercise, showing no immediate drop and a rapid increase in CBF that exceeded baseline levels within 6-12 minutes postexercise. Gains in domain-specific cognitive performance postexercise were not associated with changes in regional CBF, suggesting dissociable effects of exercise on acute neural and vascular plasticity. Together, the present findings support a precision-medicine framework for the use of exercise to target brain health that carefully considers age-related changes in the cerebrovascular system.
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Affiliation(s)
- Jacqueline A Palmer
- Department of Neurology, School of Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, United States
| | - Jill K Morris
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, School of Health Professions, University of Kansas Medical Center, 3901 Rainbow Blvd. Kansas City, KS, 66160, United States
- University of Kansas Alzheimer’s Disease Research Center, 4350 Shawnee Mission Parkway, Fairway, KS, 66205, United States
| | - Sandra A Billinger
- Department of Neurology, School of Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, United States
- University of Kansas Alzheimer’s Disease Research Center, 4350 Shawnee Mission Parkway, Fairway, KS, 66205, United States
- Department of Molecular & Integrative Physiology, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, United States
| | - Rebecca J Lepping
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, School of Health Professions, University of Kansas Medical Center, 3901 Rainbow Blvd. Kansas City, KS, 66160, United States
| | - Laura Martin
- University of Kansas Alzheimer’s Disease Research Center, 4350 Shawnee Mission Parkway, Fairway, KS, 66205, United States
| | - Zachary Green
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, School of Health Professions, University of Kansas Medical Center, 3901 Rainbow Blvd. Kansas City, KS, 66160, United States
- University of Kansas Alzheimer’s Disease Research Center, 4350 Shawnee Mission Parkway, Fairway, KS, 66205, United States
| | - Eric D Vidoni
- University of Kansas Alzheimer’s Disease Research Center, 4350 Shawnee Mission Parkway, Fairway, KS, 66205, United States
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30
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Choy J, Pourkazemi F, Anderson C, Bogaardt H. Dosages of Swallowing Exercises Prescribed in Stroke Rehabilitation: A Medical Record Audit. Dysphagia 2023; 38:686-699. [PMID: 35951119 PMCID: PMC10006267 DOI: 10.1007/s00455-022-10500-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 07/13/2022] [Indexed: 01/19/2023]
Abstract
This study investigated how swallowing exercise dosage is recorded, and what swallowing exercise dosages are reported in a stroke rehabilitation setting. We additionally explored the relation between mean daily swallowing repetitions and likelihood of improvement in functional swallowing status and considered how swallowing exercise dosages in practice compared to evidence-based principles of neural plasticity and strength training. We audited medical records for 42 patients with post-stroke dysphagia admitted to an inpatient rehabilitation unit over 18 months. Data were collected on participant characteristics, swallowing exercises and dosages, and clinical outcomes. The relation between dosage and outcomes was investigated using logistic regression analysis. On average, patients were seen for a median of 2.4 swallowing intervention sessions per week (IQR: 1.7) over 21 days (IQR: 16) and received a median 44.5 swallowing exercise repetitions per session (IQR: 39.6). Results indicated variable reporting of swallowing exercise dosages. Frequency, intervention duration, exercise type, and number of repetitions were routinely recorded in medical records, while intensity, session length, content, and adherence to home exercise programs were not. Frequency of swallowing intervention was lower in practice compared to research studies, and swallowing exercises did not follow specificity or progressive resistance principles. Likelihood of improvement in swallowing status was partially explained by age (B = -.015, p = .007) but not by mean daily swallowing exercise repetitions. This study illustrates dosages of swallowing exercises used in clinical practice. Results highlight the need for improved consideration and reporting of dosage, and application of evidence-based principles to swallowing exercise dosages.
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Affiliation(s)
- Jacinda Choy
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia.
- HammondCare Braeside Hospital, 340 Prairie Vale Road, Prairiewood, NSW, 2176, Australia.
| | - Fereshteh Pourkazemi
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Caitlin Anderson
- HammondCare Braeside Hospital, 340 Prairie Vale Road, Prairiewood, NSW, 2176, Australia
| | - Hans Bogaardt
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, SA, 5005, Australia
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Kolmos M, Madsen MJ, Liu ML, Karabanov A, Johansen KL, Thielscher A, Gandrup K, Lundell H, Fuglsang S, Thade E, Christensen H, Iversen HK, Siebner HR, Kruuse C. Patient-tailored transcranial direct current stimulation to improve stroke rehabilitation: study protocol of a randomized sham-controlled trial. Trials 2023; 24:216. [PMID: 36949490 PMCID: PMC10035265 DOI: 10.1186/s13063-023-07234-y] [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] [Received: 02/11/2023] [Accepted: 03/09/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Many patients do not fully regain motor function after ischemic stroke. Transcranial direct current stimulation (TDCS) targeting the motor cortex may improve motor outcome as an add-on intervention to physical rehabilitation. However, beneficial effects on motor function vary largely among patients within and across TDCS trials. In addition to a large heterogeneity of study designs, this variability may be caused by the fact that TDCS was given as a one-size-fits-all protocol without accounting for anatomical differences between subjects. The efficacy and consistency of TDCS might be improved by a patient-tailored design that ensures precise targeting of a physiologically relevant area with an appropriate current strength. METHODS In a randomized, double-blinded, sham-controlled trial, patients with subacute ischemic stroke and residual upper-extremity paresis will receive two times 20 min of focal TDCS of ipsilesional primary motor hand area (M1-HAND) during supervised rehabilitation training three times weekly for 4 weeks. Anticipated 60 patients will be randomly assigned to active or sham TDCS of ipsilesional M1-HAND, using a central anode and four equidistant cathodes. The placement of the electrode grid on the scalp and current strength at each cathode will be personalized based on individual electrical field models to induce an electrical current of 0.2 V/m in the cortical target region resulting in current strengths between 1 and 4 mA. Primary endpoint will be the difference in change of Fugl-Meyer Assessment of Upper Extremity (FMA-UE) score between active TDCS and sham at the end of the intervention. Exploratory endpoints will include UE-FMA at 12 weeks. Effects of TDCS on motor network connectivity and interhemispheric inhibition will be assessed with functional MRI and transcranial magnetic stimulation. DISCUSSION The study will show the feasibility and test the efficacy of personalized, multi-electrode anodal TDCS of M1-HAND in patients with subacute stroke patients with upper-extremity paresis. Concurrent multimodal brain mapping will shed light into the mechanisms of action of therapeutic personalized TDCS of M1-HAND. Together, the results from this trial may inform future personalized TDCS studies in patients with focal neurological deficits after stroke.
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Affiliation(s)
- Mia Kolmos
- Neurovascular Research Unit (NVRU), Department of Neurology, Copenhagen University Hospital -Herlev and Gentofte, Copenhagen, Denmark
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
| | - Mads Just Madsen
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
| | - Marie Louise Liu
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
| | - Anke Karabanov
- Department of Nutrition, Exercise and Sport (NEXS), Copenhagen University, Copenhagen, Denmark
| | - Katrine Lyders Johansen
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Axel Thielscher
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
- Department of Health Technology, Technical University of Denmark, Kgs Lyngby, Denmark
| | - Karen Gandrup
- Department of Radiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Henrik Lundell
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
| | - Søren Fuglsang
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
| | - Esben Thade
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
- Department of Health Technology, Technical University of Denmark, Kgs Lyngby, Denmark
| | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Helle Klingenberg Iversen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Hartwig Roman Siebner
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
- Department of Neurology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christina Kruuse
- Neurovascular Research Unit (NVRU), Department of Neurology, Copenhagen University Hospital -Herlev and Gentofte, Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Mattos DJS, Rutlin J, Hong X, Zinn K, Shimony JS, Carter AR. The Role of Extra-motor Networks in Upper Limb Motor Performance Post-stroke. Neuroscience 2023; 514:1-13. [PMID: 36736882 PMCID: PMC11009936 DOI: 10.1016/j.neuroscience.2023.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Motor improvement post-stroke may happen even if resting state functional connectivity between the ipsilesional and contralesional components of the sensorimotor network is not fully recovered. Therefore, we investigated which extra-motor networks might support upper limb motor gains in response to treatment post-stroke. METHODS Both resting state functional connectivity and upper limb capacity were measured prior to and after an 8-week intervention of task-specific training in 29 human participants [59.24 ± (SD) 10.40 yrs., 12 females and 17 males] with chronic stroke. The sensorimotor and five extra-motor networks were defined: default mode, frontoparietal, cingulo-opercular, dorsal attention network, and salience networks. The Network Level Analysis toolbox was used to identify network pairs whose connectivities were enriched in connectome-behavior relationships. RESULTS Mean upper limb capacity score increased 5.45 ± (SD) 5.55 following treatment. Baseline connectivity of some motor but mostly extra-motor network interactions of cingulo-opercular and default-mode networks were predictive of upper limb capacity following treatment. Also, changes in connectivity for extra-motor interactions of salience with default mode, cingulo-opercular, and dorsal attention networks were correlated with gains in upper limb capacity. CONCLUSIONS These connectome-behavior patterns suggest larger involvement of cingulo-opercular networks in prediction of treatment response and of salience networks in maintenance of improved skilled behavior. These results support our hypothesis that cognitive networks may contribute to recovery of motor performance after stroke and provide additional insights into the neural correlates of intensive training.
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Affiliation(s)
- Daniela J S Mattos
- Departments of Neurology, Washington University School of Medicine, Saint Louis, MO 63110, USA.
| | - Jerrel Rutlin
- Departments of Psychiatry, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Xin Hong
- Departments of Genetics, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Kristina Zinn
- Departments of Radiology, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Joshua S Shimony
- Departments of Radiology, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Alexandre R Carter
- Departments of Neurology, Washington University School of Medicine, Saint Louis, MO 63110, USA
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Elmanowski J, Seelen H, Geers R, Kleynen M, Verbunt J. Effects of a remote-handling-concept-based task-oriented arm training (ReHab-TOAT) on arm-hand skill performance in chronic stroke: a study protocol for a two-armed randomized controlled trial. Trials 2023; 24:189. [PMID: 36918922 PMCID: PMC10012705 DOI: 10.1186/s13063-023-07139-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/07/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Improving arm-hand skill performance is a major therapeutic target in stroke rehabilitation and needs intensive and varied training. However, guided treatment time is limited. Technology can assist in the training of patients, offering a higher intensity and more variety in content. A new task-oriented arm training approach was developed, using a 'Remote Handling concept based' device to provide haptic feedback during the performance of daily living activities (ReHab-TOAT). This study aims to investigate the effects of ReHab-TOAT on patients' arm-hand function and arm-hand skill performance, quality of life of both patients in the chronic phase after stroke and their caregivers and the patients' perception regarding the usability of the intervention. METHODS A randomized clinical trial was designed. Adult chronic stroke patients suffering from hemiparesis and arm-hand problems, with an Utrechtse Arm-hand Test score of 1-3, will be invited to participate. Participants in the experimental group receive ReHab-TOAT additional to care as usual. ReHab-TOAT contains task-oriented arm training for stroke patients in combination with haptic feedback, generated by a remote handling device. They will train for 4 weeks, 3× per week, 1.5h per day. Participants in the control group will receive no additional therapy apart from care as usual. The Fugl-Meyer Assessment (FMA), measuring participants' motor performance of the affected arm, is used as the primary outcome measure. Secondary outcome measures are arm-hand capacity of the patient (ARAT), perceived arm-hand skill performance (MAL), actual arm-hand skill performance (accelerometry), patients' quality of life (EuoQol-5D) and caregivers' quality of life (CarerQoL). Participants' perception regarding the usability of the intervention, including both the developed approach and technology used, will be evaluated by the System Usability Scale and a questionnaire on the user experience of technology. Measurements will be performed at 1, 2, 3 and 4 weeks pre-intervention (baseline); immediately post-intervention; and 3, 6 and 9 months post-intervention. Statistical analysis includes linear mixed model analysis. DISCUSSION This study is designed to investigate the evidence regarding the effects of ReHab-TOAT on patients' performance at different levels of the International Classification of Functioning, disability and health (ICF) model, i.e. a framework measuring functioning and disability in relation to a health condition, and to provide insights on a successful development and research process regarding technology-assisted training in co-creation. TRIAL REGISTRATION Netherlands Trial Register NL9541. Registered on June 22, 2021.
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Affiliation(s)
- Jule Elmanowski
- Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands. .,Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands. .,Adelante Rehabilitation Centre, Hoensbroek, the Netherlands.
| | - Henk Seelen
- Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.,Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Richard Geers
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Melanie Kleynen
- Research Centre for Nutrition, Lifestyle and Exercise, Faculty of Health, Zuyd University of Applied Sciences, Heerlen, the Netherlands
| | - Jeanine Verbunt
- Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.,Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
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Effects of home-based bodyweight squat training on neuromuscular properties in community-dwelling older adults. Aging Clin Exp Res 2023; 35:1043-1053. [PMID: 36853505 DOI: 10.1007/s40520-023-02370-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/15/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND It is important to investigate neural as well as muscle morphological adaptations to evaluate the effects of exercise training on older adults. AIMS This study was aimed to investigate the effects of home-based bodyweight squat training on neuromuscular adaptation in older adults. METHODS Twenty-five community-dwelling older adults (77.7 ± 5.0 years) were assigned to squat (SQU) or control (CON) groups. Those in the SQU group performed 100 bodyweight squats every day and the others in the CON group only performed daily activities for 4 months. Maximum knee extension torque and high-density surface electromyography during submaximal contraction were assessed. Individual motor units (MUs) were identified and divided into relatively low or high-recruitment threshold MU groups. Firing rates of each MU group were calculated. The muscle thickness and echo intensity of the lateral thigh were assessed using ultrasound. As physical tests, usual gait speed, timed up and go test, grip strength, and five-time chair stand test were performed. RESULTS While no improvements in muscle strength, muscle thickness, echo intensity, or physical tests were noted in either group, the firing rate of relatively low recruitment threshold MUs significantly decreased in the SQU group after intervention. CONCLUSIONS These results suggest that low-intensity home-based squat training could not improve markedly muscle strength or physical functions even if high-repetition and high frequency exercise, but could modulate slightly neural activation in community-dwelling older adults.
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Hsu SP, Lu CF, Lin BF, Tang CW, Kuo IJ, Tsai YA, Guo CY, Lee PL, Shyu KK, Niddam DM, Lee IH. Effects of bihemispheric transcranial direct current stimulation on motor recovery in subacute stroke patients: a double-blind, randomized sham-controlled trial. J Neuroeng Rehabil 2023; 20:27. [PMID: 36849990 PMCID: PMC9969953 DOI: 10.1186/s12984-023-01153-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 02/17/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Bihemispheric transcranial direct current stimulation (tDCS) of the primary motor cortex (M1) can simultaneously modulate bilateral corticospinal excitability and interhemispheric interaction. However, how tDCS affects subacute stroke recovery remains unclear. We investigated the effects of bihemispheric tDCS on motor recovery in subacute stroke patients. METHODS We enrolled subacute inpatients who had first-ever ischemic stroke at subcortical regions and moderate-to-severe baseline Fugl-Meyer Assessment of Upper Extremity (FMA-UE) score 2-56. Participants between 14 and 28 days after stroke were double-blind, randomly assigned (1:1) to receive real (n = 13) or sham (n = 14) bihemispheric tDCS (with ipsilesional M1 anode and contralesional M1 cathode, 20 min, 2 mA) during task practice twice daily for 20 sessions in two weeks. Residual integrity of the ipsilesional corticospinal tract was stratified between groups. The primary efficacy outcome was the change in FMA-UE score from baseline (responder as an increase ≥ 10). The secondary measures included changes in the Action Research Arm Test (ARAT), FMA-Lower Extremity (FMA-LE) and explorative resting-state MRI functional connectivity (FC) of target regions after intervention and three months post-stroke. RESULTS Twenty-seven participants completed the study without significant adverse effects. Nineteen patients (70%) had no recordable baseline motor-evoked potentials (MEP-negative) from the paretic forearm. Compared with the sham group, the real tDCS group showed enhanced improvement of FMA-UE after intervention (p < 0.01, effect size η2 = 0.211; responder rate: 77% vs. 36%, p = 0.031), which sustained three months post-stroke (p < 0.01), but not ARAT. Interestingly, in the MEP-negative subgroup analysis, the FMA-UE improvement remained but delayed. Additionally, the FMA-LE improvement after real tDCS was not significantly greater until three months post-stroke (p < 0.01). We found that the individual FMA-UE improvements after real tDCS were associated with bilateral intrahemispheric, rather than interhemispheric, FC strengths in the targeted cortices, while the improvements after sham tDCS were associated with predominantly ipsilesional FC changes after adjustment for age and sex (p < 0.01). CONCLUSIONS Bihemispheric tDCS during task-oriented training may facilitate motor recovery in subacute stroke patients, even with compromised corticospinal tract integrity. Further studies are warranted for tDCS efficacy and network-specific neuromodulation. TRIAL REGISTRATION This study is registered with ClinicalTrials.gov: (ID: NCT02731508).
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Affiliation(s)
- Shih-Pin Hsu
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei City, Taiwan.,Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei City, 11217, Taiwan
| | - Chia-Feng Lu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Bing-Fong Lin
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Chih-Wei Tang
- Department of Neurology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - I-Ju Kuo
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Yun-An Tsai
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Chao-Yu Guo
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Po-Lei Lee
- Department of Electrical Engineering, National Central University, Taoyuan, Taiwan
| | - Kuo-Kai Shyu
- Department of Electrical Engineering, National Central University, Taoyuan, Taiwan
| | - David M Niddam
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei City, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - I-Hui Lee
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei City, Taiwan. .,Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei City, 11217, Taiwan. .,Brain Research Center, National Yang Ming Chiao Tung University, Taipei City, Taiwan.
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36
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Doğan M, Ayvat E, Kılınç M. Telerehabilitation versus virtual reality supported task-oriented circuit therapy on upper limbs and trunk functions in patients with multiple sclerosis: A randomized controlled study. Mult Scler Relat Disord 2023; 71:104558. [PMID: 36812718 DOI: 10.1016/j.msard.2023.104558] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/20/2023] [Accepted: 02/09/2023] [Indexed: 02/13/2023]
Abstract
INTRODUCTION The purpose of this study was to investigate the effects of two different technology-supported rehabilitation approaches which are mobile application based telerehabilitation (TR) and virtual reality supported task oriented circuit therapy groups (V-TOCT) on the upper limb (UL), trunk function, and functional activity kinematics in patients with Multiple Sclerosis (PwMS). METHODS Thirty-four patients with PwMS were included in this study. The participants were evaluated at baseline and after eight weeks of treatment by an experienced physiotherapist using the Trunk Impairment Scale (TIS), kinetic function sub-parameter of the International Cooperative Ataxia Rating Scale (K-ICARS), ABILHAND, Minnesota Manual Dexterity tests (MMDT), and trunk and UL kinematics using inertial sensors. The participants were randomized into the TR and V-TOCT groups with a 1:1 allocation ratio. All participants received interventions for 1 hour per session, 3 sessions per week, for 8 weeks. RESULTS Trunk impairment, ataxia severity, UL, and hand function showed statistically significant improvement in both groups. The functional range of motion (FRoM) of shoulder and wrist increased transversal plane and the FRoM of shoulder increased on sagittal plane in V-TOCT. Log Dimensionless Jerk (LDJ) decreased on transversal plane in V-TOCT group. The FRoM of the trunk joints increased on the coronal plane and the FRoM of the trunk joints increased on the transversal plane in TR. Dynamic balance of the trunk and K-ICARS improved better in V-TOCT than in TR (p < 0,05). CONCLUSIONS V-TOCT and TR improved UL function, TIS, and ataxia severity in PwMS. The V-TOCT was more effective than the TR in terms of dynamic trunk control and kinetic function. The clinical results were confirmed using the kinematic metrics of motor control.
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Affiliation(s)
- Mert Doğan
- Department of Neurological Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
| | - Ender Ayvat
- Department of Neurological Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Muhammed Kılınç
- Department of Neurological Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Kantha P, Lin JJ, Hsu WL. The Effects of Interactive Virtual Reality in Patients with Chronic Musculoskeletal Disorders: A Systematic Review and Meta-Analysis. Games Health J 2023; 12:1-12. [PMID: 36706260 DOI: 10.1089/g4h.2022.0088] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Objective: Interactive virtual reality (iVR) has been widely used for treatment purposes in patients with chronic musculoskeletal disorders. However, no consensus has been reached on the effects of iVR on pain, psychological distress, and functional disability. Therefore, this study aims to investigate the effects of iVR on pain, psychological distress, and functional disability in patients with chronic musculoskeletal disorders compared with no rehabilitation and conventional rehabilitation. Methods: Five electronic databases (PubMed, Cochrane CENTRAL, Scopus, EMBASE, and Web of Science) were searched from January 2016 to December 2021. All randomized controlled trials using iVR for treating pain, psychological distress, and functional disability in patients with chronic musculoskeletal disorders were included. A subgroup analysis was conducted to compare the effects of nonimmersive and immersive types of iVR on the outcomes of interest. Results: Our study provides good quality evidence that iVR reduced overall pain by 9.28 points as compared with no rehabilitation and by 8.09 points as compared with conventional rehabilitation. In the subgroup analysis, nonimmersive iVR showed a reduction in psychological distress (standardized mean differences = -0.35) as compared with no rehabilitation. However, no statistically significant difference in the outcomes existed between nonimmersive and immersive iVR. Furthermore, there were no statistically significant differences in the outcomes of functional disability. Conclusions: iVR is recommended for reducing pain intensity more than no rehabilitation or conventional rehabilitation. Meanwhile, nonimmersive iVR has been proposed for psychological distress improvement, with effects similar to those of conventional rehabilitation. However, iVR may not be an effective intervention in the case of functional disability.
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Affiliation(s)
- Phunsuk Kantha
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jiu-Jenq Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Li Hsu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan
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Langton-Frost N, Orient S, Adeyemo J, Bahouth MN, Daley K, Ye B, Lavezza A, Pruski A. Development and Implementation of a New Model of Care for Patients With Stroke, Acute Hospital Rehabilitation Intensive SErvices: Leveraging a Multidisciplinary Rehabilitation Team. Am J Phys Med Rehabil 2023; 102:S13-S18. [PMID: 36634325 DOI: 10.1097/phm.0000000000002132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
ABSTRACT The optimal timing and intensity of early rehabilitation remain uncertain. The literature has stated that too early high-intensity mobility within 24 hours can result in poor outcomes as compared with the 24- to 48-hour poststroke (Stroke 2012;43:2389-94. Stroke 2004;35:1005-9). However, few studies have shown that mobilizing patients a few times per day can have positive results (Stroke 2004;35:1005-9. Cerebrovasc Dis 2010;29:352-60). In addition to mobility impairments, many patients after stroke have dysphagia, aphasia, and cognitive-linguistic deficits. To date, there is limited literature on early rehabilitation in these areas. Here, we describe a program of enhanced rehabilitation in the acute care hospital. In this enhanced model of care, our team delivers up to six sessions of therapy per day focused on the patient's deficits. A patient can receive up to two sessions of each discipline daily to include physical therapy, occupational therapy, and speech language pathology. The model emphasizes team collaboration between therapy disciplines, physiatry, nursing, and neurology accomplished through a daily therapy schedule, rehabilitation huddle, and direct communication before and after therapy sessions. With this model, we aim to enhance coordination of care resulting in improved patient satisfaction and, ultimately, recovery.
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Affiliation(s)
- Nicole Langton-Frost
- From the Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland (NL-F, SO, JA, KD, BY, AL); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland (MNB); and Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland (AP)
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Chaovalit S, Dodd KJ, Taylor NF. Impaired sit-to-stand is perceived by caregivers to affect mobility and self-care in children with cerebral palsy who had moderate to severe mobility limitations: A mixed methods analysis. Dev Neurorehabil 2023; 26:10-17. [PMID: 36222399 DOI: 10.1080/17518423.2022.2133186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To explore the effects that impaired ability to sit-to-stand has on upright mobility and self-care in children with cerebral palsy and how this in turn may affect their caregivers. METHODS A mixed methods research design was conducted with 25 children who had cerebral palsy with moderate to high mobility limitations (GMFCS levels III and IV) and their caregivers. Caregivers were interviewed about their child's mobility and self-care. The independence of each child's activities was rated using the mobility and self-care domains of the Functional Independence Measure for Children (WeeFIM). RESULTS Two themes were identified from qualitative analyses: Difficulty in sit-to-stand was perceived by caregivers to reduce their child's ability to independently and safely perform mobility and some self-care tasks; and negatively impacted the caregivers physically and psychologically. Mobility and self-care WeeFIM scores showed that these children required moderate assistance, and that self-care tasks involving sit-to-stand (toileting and bathing) required more assistance than self-care tasks that would not be expected to involve sit-to-stand (eating and grooming). Qualitative and quantitative findings were convergent. CONCLUSIONS The ability to sit-to-stand independently may be an important precursor skill for independence in upright mobility and self-care for children with moderate to severe mobility limitations.
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Affiliation(s)
- Sirawee Chaovalit
- School of Allied Health, Human Services and Sport; College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Karen J Dodd
- School of Allied Health, Human Services and Sport; College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.,College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport; College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.,Allied Health Clinical Research Office, Eastern Health, Melbourne, Australia
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40
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Niebla-Cárdenas A, Bareke H, Juanes-Velasco P, Landeira-Viñuela A, Hernández ÁP, Montalvillo E, Góngora R, Arroyo-Anlló E, Silvia Puente-González A, Méndez-Sánchez R, Fuentes M. Translational research into frailty from bench to bedside: Salivary biomarkers for inflammaging. Exp Gerontol 2023; 171:112040. [PMID: 36455696 DOI: 10.1016/j.exger.2022.112040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
Frailty is a complex physiological syndrome associated with adverse ageing and decreased physiological reserves. Frailty leads to cognitive and physical disability and is a significant cause of morbidity, mortality and economic costs. The underlying cause of frailty is multifaceted, including immunosenescence and inflammaging, changes in microbiota and metabolic dysfunction. Currently, salivary biomarkers are used as early predictors for some clinical diseases, contributing to the effective prevention and treatment of diseases, including frailty. Sample collection for salivary analysis is non-invasive and simple, which are paramount factors for testing in the vulnerable frail population. The aim of this review is to describe the current knowledge on the association between frailty and the inflammatory process and discuss methods to identify putative biomarkers in salivary fluids to predict this syndrome. This study describes the relationship between i.-inflammatory process and frailty; ii.-infectious, chronic, skeletal, metabolic and cognitive diseases with inflammation and frailty; iii.-inflammatory biomarkers and salivary fluids. There is a limited number of previous studies focusing on the analysis of inflammatory salivary biomarkers and frailty syndrome; hence, the study of salivary fluids as a source for biomarkers is an open area of research with the potential to address the increasing demands for frailty-associated biomarkers.
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Affiliation(s)
- Alfonssina Niebla-Cárdenas
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Salamanca, 37007 Salamanca, Spain
| | - Halin Bareke
- Department of Pharmaceutical Biotechnology, Faculty of Pharmacy, Institute of Health Sciences, Marmara University, Istanbul, Turkey; Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), 37007 Salamanca, Spain
| | - Pablo Juanes-Velasco
- Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), 37007 Salamanca, Spain
| | - Alicia Landeira-Viñuela
- Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), 37007 Salamanca, Spain
| | - Ángela-Patricia Hernández
- Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), 37007 Salamanca, Spain; Department of Pharmaceutical Sciences: Organic Chemistry, Faculty of Pharmacy, University of Salamanca, CIETUS, IBSAL, 37007 Salamanca, Spain
| | - Enrique Montalvillo
- Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), 37007 Salamanca, Spain
| | - Rafael Góngora
- Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), 37007 Salamanca, Spain
| | - Eva Arroyo-Anlló
- Department of Psychobiology, Neuroscience Institute of Castilla-León, Faculty of Psychology, University of Salamanca, 37007 Salamanca, Spain
| | - Ana Silvia Puente-González
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Salamanca, 37007 Salamanca, Spain; Institute of Biomedical Research of Salamanca. Primary Care, Public Health and Pharmacology Area, 37007 Salamanca, Spain.
| | - Roberto Méndez-Sánchez
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Salamanca, 37007 Salamanca, Spain; Institute of Biomedical Research of Salamanca. Primary Care, Public Health and Pharmacology Area, 37007 Salamanca, Spain
| | - Manuel Fuentes
- Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), 37007 Salamanca, Spain; Proteomics Unit, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), Salamanca, Spain.
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Johnson BP, Cohen LG. Applied strategies of neuroplasticity. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:599-609. [PMID: 37620093 DOI: 10.1016/b978-0-323-98817-9.00011-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Various levels of somatotopic organization are present throughout the human nervous system. However, this organization can change when needed based on environmental demands, a phenomenon known as neuroplasticity. Neuroplasticity can occur when learning a new motor skill, adjusting to life after blindness, or following a stroke. Following an injury, these neuroplastic changes can be adaptive or maladaptive, and often occur regardless of whether rehabilitation occurs or not. But not all movements produce neuroplasticity, nor do all rehabilitation interventions. Here, we focus on research regarding how to maximize adaptive neuroplasticity while also minimizing maladaptive plasticity, known as applied neuroplasticity. Emphasis is placed on research exploring how best to apply neuroplastic principles to training environments and rehabilitation protocols. By studying and applying these principles in research and clinical practice, it is hoped that learning of skills and regaining of function and independence can be optimized.
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Affiliation(s)
- Brian P Johnson
- Human Cortical Physiology and Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Leonardo G Cohen
- Human Cortical Physiology and Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States.
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Combined Transcutaneous Electrical Spinal Cord Stimulation and Task-Specific Rehabilitation Improves Trunk and Sitting Functions in People with Chronic Tetraplegia. Biomedicines 2022; 11:biomedicines11010034. [PMID: 36672542 PMCID: PMC9855778 DOI: 10.3390/biomedicines11010034] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
The aim of this study was to examine the effects of transcutaneous electrical spinal cord stimulation (TSCS) and conventional task-specific rehabilitation (TSR) on trunk control and sitting stability in people with chronic tetraplegia secondary to a spinal cord injury (SCI). Five individuals with complete cervical (C4-C7) cord injury participated in 24-week therapy that combined TSCS and TSR in the first 12 weeks, followed by TSR alone for another 12 weeks. The TSCS was delivered simultaneously at T11 and L1 spinal levels, at a frequency ranging from 20-30 Hz with 0.1-1.0 ms. pulse width biphasically. Although the neurological prognosis did not manifest after either treatment, the results show that there were significant increases in forward reach distance (10.3 ± 4.5 cm), right lateral reach distance (3.7 ± 1.8 cm), and left lateral reach distance (3.0 ± 0.9 cm) after the combinational treatment (TSCS+TSR). The stimulation also significantly improved the participants' trunk control and function in sitting. Additionally, the trunk range of motion and the electromyographic response of the trunk muscles were significantly elevated after TSCS+TSR. The TSCS+TSR intervention improved independent trunk control with significantly increased static and dynamic sitting balance, which were maintained throughout the TSR period and the follow-up period, indicating long-term sustainable recovery.
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Trompetto C, Catalano MG, Farina A, Grioli G, Mori L, Ciullo A, Pittaluga M, Rossero M, Puce L, Bicchi A. A soft supernumerary hand for rehabilitation in sub-acute stroke: a pilot study. Sci Rep 2022; 12:21504. [PMID: 36513775 PMCID: PMC9747903 DOI: 10.1038/s41598-022-25029-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/23/2022] [Indexed: 12/15/2022] Open
Abstract
In patients with subacute stroke, task specific training (TST) has been shown to accelerate functional recovery of the upper limb. However, many patients do not have sufficient active extension of the fingers to perform this treatment. In these patients, here we propose a new rehabilitation technique in which TST is performed through a soft robotic hand (SoftHand-X). In short, the extension of the robotic fingers is controlled by the patient through his residual, albeit minimal, active extension of the fingers or wrist, while the patient was required to relax the muscles to achieve full flexion of the robotic fingers. TST with SoftHand-X was attempted in 27 subacute stroke patients unable to perform TST due to insufficient active extension of the fingers. Four patients (14.8%) were able to perform the proposed treatment (10 daily sessions of 60 min each). They reported an excellent level of participation. After the treatment, both clinical score of spasticity and its electromyographic correlate (stretch reflex) decreased. In subacute stroke patients, TST using SoftHand-X is a well-accepted treatment, resulting in a decrease of spasticity. At present, it can be applied only in a small proportion of the patients who cannot perform conventional TST, though extensions are possible.
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Affiliation(s)
- Carlo Trompetto
- grid.5606.50000 0001 2151 3065Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, 16132 Genova, Italy ,grid.410345.70000 0004 1756 7871Neurorehabilitation Unit, Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genova, 16132 Genova, Italy
| | - Manuel G. Catalano
- grid.25786.3e0000 0004 1764 2907Soft Robotics for Human Cooperation, and Rehabilitation Lab, Fondazione Istituto Italiano di Tecnologia, 16163 Genova, Italy
| | - Alessandro Farina
- grid.410345.70000 0004 1756 7871Neurorehabilitation Unit, Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genova, 16132 Genova, Italy
| | - Giorgio Grioli
- grid.25786.3e0000 0004 1764 2907Soft Robotics for Human Cooperation, and Rehabilitation Lab, Fondazione Istituto Italiano di Tecnologia, 16163 Genova, Italy ,grid.5395.a0000 0004 1757 3729Centro di Ricerca “Enrico Piaggio” and Dipartimento di Ingegneria dell’Informazione, Università di Pisa, 56122 Pisa, Italy
| | - Laura Mori
- grid.5606.50000 0001 2151 3065Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, 16132 Genova, Italy ,grid.410345.70000 0004 1756 7871Neurorehabilitation Unit, Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genova, 16132 Genova, Italy
| | - Andrea Ciullo
- grid.25786.3e0000 0004 1764 2907Soft Robotics for Human Cooperation, and Rehabilitation Lab, Fondazione Istituto Italiano di Tecnologia, 16163 Genova, Italy
| | - Matteo Pittaluga
- grid.410345.70000 0004 1756 7871Neurorehabilitation Unit, Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genova, 16132 Genova, Italy
| | - Martina Rossero
- grid.25786.3e0000 0004 1764 2907Soft Robotics for Human Cooperation, and Rehabilitation Lab, Fondazione Istituto Italiano di Tecnologia, 16163 Genova, Italy
| | - Luca Puce
- grid.5606.50000 0001 2151 3065Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, 16132 Genova, Italy
| | - Antonio Bicchi
- grid.25786.3e0000 0004 1764 2907Soft Robotics for Human Cooperation, and Rehabilitation Lab, Fondazione Istituto Italiano di Tecnologia, 16163 Genova, Italy ,grid.5395.a0000 0004 1757 3729Centro di Ricerca “Enrico Piaggio” and Dipartimento di Ingegneria dell’Informazione, Università di Pisa, 56122 Pisa, Italy
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Wallace TD, McCauley KL, Hodge AT, Moran TP, Porter ST, Whaley MC, Gore RK. Use of person-centered goals to direct interdisciplinary care for military service members and Veterans with chronic mTBI and co-occurring psychological conditions. Front Neurol 2022; 13:1015591. [PMID: 36523344 PMCID: PMC9746344 DOI: 10.3389/fneur.2022.1015591] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/26/2022] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVE To explore the use of person-centered goals (PCGs) to direct interdisciplinary care to support PCG attainment in military service members and Veterans (SM/Vs) with chronic mild traumatic brain injury (mTBI) and co-occurring psychological conditions. METHODS A retrospective chart review was completed for 146 United States military SM/Vs reporting chronic symptoms following mTBI and co-occurring psychological conditions who received care in the SHARE Military Initiative intensive outpatient program, a donor-funded program administered by a not-for-profit hospital, between April 1, 2015 and March 31, 2019. PCGs were used to direct care consisting of individual and group-based interventions and therapies delivered by an interdisciplinary, co-located team including behavioral health, case management, neurology or physiatry, nursing, occupational therapy, physical therapy, recreation therapy, speech-language pathology, and transition support. The primary outcome measure was PCG attainment measured via goal attainment scaling. RESULTS Increased PCG attainment was demonstrated at program discharge and throughout the first year following program discharge. Predictors of goal attainment at discharge included longer participation in treatment, greater reduction in depressive symptoms and greater improvement in adjustment at discharge, male gender, and higher cognitive and physical abilities on admission. CONCLUSIONS This sample of military SM/Vs with mTBI and co-occurring psychological conditions who received intensive, interdisciplinary, PCG directed care demonstrated increased PCG attainment at program discharge which further increased with transition support over the year post-discharge. Results suggest PGC goal directed care is a feasible, promising methodology of individualizing treatment in this population. This exploratory study lays a foundation for future prospective, controlled, comparative effectiveness research that will further understanding of the effectiveness of intensive, interdisciplinary, PCG directed care.
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Affiliation(s)
- Tracey D. Wallace
- SHARE Military Initiative, Shepherd Center, Atlanta, GA, United States
| | | | - April T. Hodge
- SHARE Military Initiative, Shepherd Center, Atlanta, GA, United States
| | - Tim P. Moran
- School of Medicine, Department of Emergency Medicine, Emory University, Atlanta, GA, United States
| | - Stephen T. Porter
- School of Medicine, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States
| | - Maya C. Whaley
- SHARE Military Initiative, Shepherd Center, Atlanta, GA, United States
| | - Russell K. Gore
- SHARE Military Initiative, Shepherd Center, Atlanta, GA, United States
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
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Scrivener K, Shepherd R. The importance of kinesiology, biomechanics and motor learning for movement analysis and clinical reasoning in neuromuscular physiotherapy. PHYSICAL THERAPY REVIEWS 2022. [DOI: 10.1080/10833196.2022.2141529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Roberta Shepherd
- Faculty of Medicine and Health, Sydney School of Health Sciences, University of Sydney, Sydney, Australia
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46
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McCormick SA, Ireland C, Yohannes AM, Holmes PS. Technology-Dependent Rehabilitation Involving Action Observation and Movement Imagery for Adults with Stroke: Can It Work? Feasibility of Self-Led Therapy for Upper Limb Rehabilitation after Stroke. Stroke Res Treat 2022; 2022:8185893. [PMID: 36345552 PMCID: PMC9637031 DOI: 10.1155/2022/8185893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/07/2022] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Motor (re)learning via technology-dependent therapy has the potential to complement traditional therapies available to older adults living with stroke after hospital discharge and increase therapy dose. To date, little is known about the feasibility of technology-dependent therapy in a home setting for this population. OBJECTIVE To develop a technology-dependent therapy that provides mental and physical training for older adults with stroke and assess feasibility. Specifically we ask, "Can it work"? DESIGN Single group repeated measures. METHODS 13 participants, aged 18 years and over, were recruited over a six-month period. All participants had mild upper limb impairment following a stoke and were no longer receiving intensive rehabilitation. All participants received 18 days of technology-dependent therapy in their own home. Information was gathered on recruitment and retention, usability, and suitability of outcome measures. RESULTS 11 participants completed the study. The recruitment rate (number recruited/number canvassed; 10.7%) suggests 1907 participants would need to be canvassed to recruit the necessary sample size (n = 204) for a definitive trial designed to provide 90% power at 5% level of significance to detect a clinically meaningful difference of 5.7 points on the Action Research Arm Test. The usability of the application was rated as exceptional on the System Usability Scale. Effectiveness cannot be determined from this study; however, there was a trend for improvement in measures of upper limb function and emotional well-being. Limitations. The study was limited by a relatively small sample size and lack of control group. CONCLUSIONS This study demonstrated proof of concept of a technology-dependent therapy for upper limb rehabilitation following stroke. The data suggest a definitive trial is feasible, additional strategies to improve recruitment should be considered. Outcome measures aligned with the residual motor function of participants are required.
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Affiliation(s)
- Sheree A. McCormick
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | | | - Abebaw M. Yohannes
- Department of Physical Therapy, Azusa Pacific University, California, USA
| | - Paul S. Holmes
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
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47
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Muacevic A, Adler JR. A Systematic Review of Randomized Controlled Trials on Virtual Reality Application in Pediatric Patients. Cureus 2022; 14:e30543. [PMID: 36320795 PMCID: PMC9614389 DOI: 10.7759/cureus.30543] [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: 09/28/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
Virtual reality is a novel approach for distracting and alleviating anxiety, pain, and other complications during medical procedures, and it can be more effective than conventional methods. In virtual reality, the patient is completely immersed in the virtual environment, which is used to make patients feel more comfortable and can provide a positive prognosis. The data were searched by using the Boolean operator "AND" between the search phrases "Virtual reality," and "Pediatrics" and the relevant literature was extracted. The inclusion criteria were the free full text, randomized controlled trials, studies between 2016 and 2022 and pediatric patients. This systematic review was conducted to compare randomized controlled trials of virtual reality applications in pediatric patients in different clinical settings. Of the included 15 randomized controlled trials, 12 studies were on pain and anxiety, two on brain injury and cerebral palsy, and one on awareness among asthmatic patients. This review concluded that virtual reality exposure has a beneficial effect on pediatric patients in reducing pain and anxiety, improving muscle strength and dexterity, and awareness among asthmatic patients.
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Newcomer V, Metzinger M, Vick S, Robertson C, Lawrence T, Glass A, Elliott L, Williams A. A Stroke Rehabilitation Educational Program for Occupational Therapy Students and Practitioners: Usability Study. JMIR MEDICAL EDUCATION 2022; 8:e35637. [PMID: 36178717 PMCID: PMC9568821 DOI: 10.2196/35637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/12/2022] [Accepted: 09/02/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND There are gaps in knowledge translation (KT) of current evidence-based practices regarding stroke assessment and rehabilitation delivered through teletherapy. A lack of this knowledge can prevent occupational therapy (OT) students and practitioners from implementing current research findings. OBJECTIVE The aim of this pilot study was to create an educational program to translate knowledge into practice regarding the remote delivery of stroke assessment and rehabilitation to OT students and practitioners. Four areas of focus were addressed in the educational program, including KT, task-oriented training, stroke assessments, and telerehabilitation. METHODS Two pilot studies were conducted to assess the knowledge gained via pretests and posttests of knowledge, followed by a System Usability Scale and general feedback questionnaire. Participants in study 1 were 5 OT practitioners and 1 OT assistant. Participants in study 2 were 9 current OT students. Four 1-hour modules were emailed weekly to participants over the course of 4 weeks, with each module covering a different topic (KT, task-oriented training, stroke assessments, and telerehabilitation). Preliminary results were reviewed using descriptive statistics. RESULTS Statistically significant results were found with increased scores of knowledge for both students and practitioners. Most of the educational modules had an above-average score regarding value and positive feedback for the educational program as a whole from the participants. CONCLUSIONS Overall, the results of this pilot study indicate that a web-based educational program is a valuable, informational method of increasing the translation of knowledge in the remote delivery of stroke assessment and rehabilitation. OT students and practitioners found the information presented to be valuable and relevant to their future profession and current practice.
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Affiliation(s)
- Valerie Newcomer
- Department of Occupational Therapy, Georgia State University, Atlanta, GA, United States
| | - Megan Metzinger
- Department of Occupational Therapy, Georgia State University, Atlanta, GA, United States
| | - Sydney Vick
- Department of Occupational Therapy, Georgia State University, Atlanta, GA, United States
| | - Caroline Robertson
- Department of Occupational Therapy, Georgia State University, Atlanta, GA, United States
| | - Taylor Lawrence
- Department of Occupational Therapy, Georgia State University, Atlanta, GA, United States
| | - Amanda Glass
- Department of Occupational Therapy, Georgia State University, Atlanta, GA, United States
| | - Lauren Elliott
- Department of Occupational Therapy, Georgia State University, Atlanta, GA, United States
| | - Ansleigh Williams
- Department of Occupational Therapy, Georgia State University, Atlanta, GA, United States
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49
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Coskunsu DK, Akcay S, Ogul OE, Akyol DK, Ozturk N, Zileli F, Tuzun BB, Krespi Y. Effects of robotic rehabilitation on recovery of hand functions in acute stroke: A preliminary randomized controlled study. Acta Neurol Scand 2022; 146:499-511. [PMID: 35855628 DOI: 10.1111/ane.13672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/19/2022] [Accepted: 07/06/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of EMG-driven robotic rehabilitation on hand motor functions and daily living activities of patients with acute ischemic stroke. MATERIALS & METHOD A preliminary randomized-controlled, single-blind trial rectuited twenty-four patients with acute ischemic stroke (<1 month after cerebrovascular accident) and randomly allocated to experimental group (EG) and control group (CG). Neurophysiological rehabilitation program was performed to both EG and CG for 5 days a week and totally 15 sessions. The EG also received robotic rehabilitation with the EMG-driven exoskeleton hand robot (Hand of Hope®, Rehab-Robotics Company) 15 sessions over 3 weeks. Hand motor functions (Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT)), activities of daily living (Motor Activity Log (MAL)), force and EMG activities of extensor and flexor muscles for the cup test were evaluated before treatment (pretreatment) and after the 15th session (posttreatment). RESULTS Eleven patients (59.91 ± 14.20 yr) in the EG and 9 patients (70 ± 14.06 yr) in the CG completed the study. EG did not provide a significant advantage compared with the CG in FMA-UE, ARAT and MAL scores and cup-force and EMG activities (p > .05 for all). CONCLUSION In this preliminary study, improvement in motor functions, daily living activities and force were found in both groups. However, addition of the EMG-driven robotic treatment to the neurophysiological rehabilitation program did not provide an additional benefit to the clinical outcomes in 3 weeks in acute stroke patients.
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Affiliation(s)
- Dilber Karagozoglu Coskunsu
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Bahcesehir University, Istanbul, Turkey.,Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Fenerbahce University, Istanbul, Turkey
| | - Sumeyye Akcay
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Bahcesehir University, Istanbul, Turkey
| | - Ozden Erkan Ogul
- Faculty of Health Sciences, Department of Ergotherapy, Medipol University, Istanbul, Turkey
| | - D Kubra Akyol
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Istanbul-Cerrahpasa University, Istanbul, Turkey
| | - Necla Ozturk
- Faculty of Medicine, Department of Biophysics, Maltepe University, Istanbul, Turkey
| | - Füsun Zileli
- Neurology Department, İstanbul Haseki Research and Education Hospital, Istanbul, Turkey
| | - Birgul Baştan Tuzun
- Neurology Department, İstanbul Haseki Research and Education Hospital, Istanbul, Turkey
| | - Yakup Krespi
- Faculty of Medicine, Department of Neurology, Istinye University, Istanbul, Turkey
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50
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Washabaugh EP, Brown SR, Palmieri-Smith RM, Krishnan C. Functional Resistance Training Differentially Alters Gait Kinetics After Anterior Cruciate Ligament Reconstruction: A Pilot Study. Sports Health 2022; 15:372-381. [PMID: 35766451 PMCID: PMC10170229 DOI: 10.1177/19417381221104042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Quadriceps weakness is common after anterior cruciate ligament (ACL) reconstruction and can alter gait mechanics. Functional resistance training (FRT) is a novel approach to retraining strength after injury, but it is unclear how it alters gait mechanics. Therefore, we tested how 3 different types of FRT devices: a knee brace resisting extension (unidirectional brace), a knee brace resisting extension and flexion (bidirectional brace), and an elastic band pulling backwards on the ankle (elastic band)-acutely alter gait kinetics in this population. HYPOTHESIS The type of FRT device will affect ground-reaction forces (GRFs) during and after the training. Specifically, the uni- and bidirectional braces will increase GRFs when compared with the elastic band. STUDY DESIGN Crossover study. LEVEL OF EVIDENCE Level 2. METHODS A total of 15 individuals with ACL reconstruction received FRT with each device over 3 separate randomized sessions. During training, participants walked on a treadmill while performing a tracking task with visual feedback. Sessions contained 5 training trials (180 seconds each) with rest between. Vertical and anterior-posterior GRFs were assessed on the ACL-reconstructed leg before, during, and after training. Changes in GRFs were compared across devices using 1-dimensional statistical parametric mapping. RESULTS Resistance applied via bidirectional brace acutely increased gait kinetics during terminal stance/pre-swing (ie, push-off), while resistance applied via elastic band acutely increased gait kinetics during initial contact/loading (ie, braking). Both braces behaved similarly, but the unidirectional brace was less effective for increasing push-off GRFs. CONCLUSION FRT after ACL reconstruction can acutely alter gait kinetics during training. Devices can be applied to selectively alter gait kinetics. However, the long-term effects of FRT after ACL reconstruction with these devices are still unknown. CLINICAL RELEVANCE FRT may be applied to alter gait kinetics of the involved limb after ACL reconstruction, depending on the device used.
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Affiliation(s)
- Edward P Washabaugh
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,Department of Biomedical Engineering, Wayne State University, Detroit, Michigan
| | - Scott R Brown
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,Department of Kinesiology, Aquinas College, Grand Rapids, Michigan
| | - Riann M Palmieri-Smith
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,School of Kinesiology, University of Michigan, Ann Arbor, Michigan.,Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Chandramouli Krishnan
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,School of Kinesiology, University of Michigan, Ann Arbor, Michigan.,Michigan Robotics Institute, University of Michigan, Ann Arbor, Michigan
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