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Nath D, Singh N, Saini M, Banduni O, Kumar N, Srivastava MVP, Mehndiratta A. Clinical potential and neuroplastic effect of targeted virtual reality based intervention for distal upper limb in post-stroke rehabilitation: a pilot observational study. Disabil Rehabil 2024; 46:2640-2649. [PMID: 37383015 DOI: 10.1080/09638288.2023.2228690] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/18/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE A library of Virtual Reality (VR) tasks has been developed for targeted post-stroke rehabilitation of distal upper extremities. The objective of this pilot study was to evaluate the clinical potential of the targeted VR-based therapeutic intervention in a small cohort of patients specifically with chronic stroke. Furthermore, our aim was to explore the possible neuronal reorganizations in corticospinal pathways in response to the distal upper limb targeted VR-intervention. METHODOLOGY Five patients with chronic stroke were enrolled in this study and were given VR-intervention of 20 sessions of 45 min each. Clinical Scales, cortical-excitability measures (using Transcranial Magnetic Stimulation): Resting Motor Threshold (RMT), and Motor Evoked Potential (MEP) amplitude, task-specific performance metrics i.e., Time taken to complete the task (TCT), smoothness of trajectory, relative % error were evaluated pre- and post-intervention to evaluate the intervention-induced improvements. RESULTS Pre-to post-intervention improvements were observed in Fugl-Meyer Assessment (both total and wrist/hand component), Modified Barthel Index, Stroke Impact Scale, Motor Assessment Scale, active range of motion at wrist, and task-specific outcome metrics. Pre-to post-intervention ipsilesional RMT reduced (mean ∼9%) and MEP amplitude increased (mean ∼29µV), indicating increased cortical excitability at post-intervention. CONCLUSION VR-training exhibited improved motor outcomes and cortical-excitability in patients with stroke. Neurophysiological changes observed in terms of improved cortical-excitability might be a consequence of plastic reorganization induced by VR-intervention.
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Affiliation(s)
- Debasish Nath
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi, India
| | - Neha Singh
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi, India
| | - Megha Saini
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi, India
| | - Onika Banduni
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi, India
| | - Nand Kumar
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Amit Mehndiratta
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi, India
- Department of Biomedical Engineering, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Newton SP, Dalton EJ, Ang JY, Klaic M, Thijs V, Hayward KS. Dose, Content, and Context of Usual Care in Stroke Upper Limb Motor Interventions: A Systematic Review. Clin Rehabil 2023; 37:1437-1450. [PMID: 37151039 PMCID: PMC10492439 DOI: 10.1177/02692155231172295] [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: 11/05/2022] [Accepted: 04/11/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE The objectives of this systematic review were to describe the current dose and content of usual care upper limb motor intervention for inpatients following stroke and examine if context factors alter dose and content. DATA SOURCES A systematic search (EMBASE, MEDLINE) was completed from January 2015 to February 2023 (PROSPERO CRD42021281986). METHODS Studies were eligible if they reported non-protocolised usual care upper limb motor intervention dose data for stroke inpatients. Studies were rated using the Johanna Briggs Institute critical appraisal tool. Data were descriptively reported for dose dimensions of time (on task or, in therapy) and intensity (repetitions, repetition/minute), content (intervention type/mode), and context (e.g., severity strata). RESULTS Eight studies were included from four countries, largely reflecting inpatient rehabilitation. Time in therapy ranged from 23 to 121 min/day. Time on task ranged from 8 to 44 min/day. Repetitions ranged from 36 to 57/session, and 15 to 282/day. Time on task was lowest in the stratum of people with severe upper limb impairment (8 min/day), the upper limit for this stratum was 41.5 min/day. There was minimal reporting of usual care content across all studies. CONCLUSION Upper limb motor intervention dose appears to be increasing in usual care compared to prior reports (e.g., average 21 min/day and 23 to 32 repetitions/session). Context variability suggests that doses are lowest in the stratum of patients with a severely impaired upper limb. Consistent reporting of the multiple dimensions of dose and content is necessary to better understand usual care offered during inpatient rehabilitation.
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Affiliation(s)
- Sarah P Newton
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
- Department of Occupational Therapy, Austin Health, Melbourne, Australia
| | - Emily J Dalton
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
- Department of Occupational Therapy, Austin Health, Melbourne, Australia
| | - Jia Y Ang
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Marlena Klaic
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Vincent Thijs
- Stroke Theme, Florey Institute of Neurosciences and Mental Health, Melbourne, Australia
- Department of Neurology, Austin Health, Melbourne, Australia
- Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Kathryn S Hayward
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
- Stroke Theme, Florey Institute of Neurosciences and Mental Health, Melbourne, Australia
- Melbourne Medical School, University of Melbourne, Melbourne, Australia
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Mahmood W, Ahmed Burq HSI, Ehsan S, Sagheer B, Mahmood T. Effect of core stabilization exercises in addition to conventional therapy in improving trunk mobility, function, ambulation and quality of life in stroke patients: a randomized controlled trial. BMC Sports Sci Med Rehabil 2022; 14:62. [PMID: 35395819 PMCID: PMC8991663 DOI: 10.1186/s13102-022-00452-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/23/2022] [Indexed: 11/10/2022]
Abstract
Background Stroke is a major cause of disability with mainly affecting trunk mobility and function. The purpose of this study is to determine the effectiveness of core stabilization exercises versus conventional therapy on trunk mobility, function, ambulation, and quality of life of stroke patients. Design Assessor blinded randomized control trial.
Setting Ibrahim polyclinic—Shadman, Ch Muhammad Akram teaching hospital-Raiwind, Rasheed hospital-Defence. Subjects Chronic ischemic stroke patients. Intervention Control group (n = 21) underwent conventional treatment for stroke for 40 min/ day, 5 times/ week for 8 weeks. Experimental group (n = 20) received core stability training for additional 15 min along with conventional treatment. Main measures Main outcome measures were Trunk impairment scale (TIS), functional ambulation category (FAC), stroke specific quality of life (SSQOL) and trunk range of motion (ROM). Results The differences between the control group and experimental group post-treatment were statistically significant for trunk impairment, functional ambulation, quality of life, and frontal plane trunk motion (p-value < 0.05) with higher mean values for core stabilization training. The frontal plane trunk mobility and rotation showed non-significant differences post-treatment (p-value > 0.05). Conclusion This study concluded that core stabilization training is better as compared to the conventional physical therapy treatment for improving trunk impairments, functional ambulation and quality of life among patients of stroke. The core stabilization training is also more effective in improving trunk mobility in sagittal plane. This study is registered in Iranian Registry of Clinical Trials IRCT20210614051578N1 and was approved by the local research ethics committee of Riphah International University.
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Affiliation(s)
- Wajeeha Mahmood
- Department of Physical Therapy, Superior University, Lahore, Pakistan.
| | | | - Sarah Ehsan
- Riphah International University, Islamabad, Pakistan
| | | | - Tahir Mahmood
- Imran Idrees Institute of Rehabilitation Sciences, Sialkot, Punjab, Pakistan
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van Bladel A, Cools A, Michielsen M, Oostra K, Cambier D. Passive mobilisation of the shoulder in subacute stroke patients with persistent arm paresis: A randomised multiple treatment trial. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2022; 78:1589. [PMID: 35281779 PMCID: PMC8905406 DOI: 10.4102/sajp.v78i1.1589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/16/2021] [Indexed: 11/01/2022] Open
Affiliation(s)
- Anke van Bladel
- Department of Rehabilitation Sciences, Faculty of Medicine and Health, Ghent University, Ghent, Belgium
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - Ann Cools
- Department of Rehabilitation Sciences, Faculty of Medicine and Health, Ghent University, Ghent, Belgium
| | | | - Kristine Oostra
- Department of Rehabilitation Sciences, Faculty of Medicine and Health, Ghent University, Ghent, Belgium
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - Dirk Cambier
- Department of Rehabilitation Sciences, Faculty of Medicine and Health, Ghent University, Ghent, Belgium
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Rodgers H, Bosomworth H, Krebs HI, van Wijck F, Howel D, Wilson N, Finch T, Alvarado N, Ternent L, Fernandez-Garcia C, Aird L, Andole S, Cohen DL, Dawson J, Ford GA, Francis R, Hogg S, Hughes N, Price CI, Turner DL, Vale L, Wilkes S, Shaw L. Robot-assisted training compared with an enhanced upper limb therapy programme and with usual care for upper limb functional limitation after stroke: the RATULS three-group RCT. Health Technol Assess 2020; 24:1-232. [PMID: 33140719 PMCID: PMC7682262 DOI: 10.3310/hta24540] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Loss of arm function is common after stroke. Robot-assisted training may improve arm outcomes. OBJECTIVE The objectives were to determine the clinical effectiveness and cost-effectiveness of robot-assisted training, compared with an enhanced upper limb therapy programme and with usual care. DESIGN This was a pragmatic, observer-blind, multicentre randomised controlled trial with embedded health economic and process evaluations. SETTING The trial was set in four NHS trial centres. PARTICIPANTS Patients with moderate or severe upper limb functional limitation, between 1 week and 5 years following first stroke, were recruited. INTERVENTIONS Robot-assisted training using the Massachusetts Institute of Technology-Manus robotic gym system (InMotion commercial version, Interactive Motion Technologies, Inc., Watertown, MA, USA), an enhanced upper limb therapy programme comprising repetitive functional task practice, and usual care. MAIN OUTCOME MEASURES The primary outcome was upper limb functional recovery 'success' (assessed using the Action Research Arm Test) at 3 months. Secondary outcomes at 3 and 6 months were the Action Research Arm Test results, upper limb impairment (measured using the Fugl-Meyer Assessment), activities of daily living (measured using the Barthel Activities of Daily Living Index), quality of life (measured using the Stroke Impact Scale), resource use costs and quality-adjusted life-years. RESULTS A total of 770 participants were randomised (robot-assisted training, n = 257; enhanced upper limb therapy, n = 259; usual care, n = 254). Upper limb functional recovery 'success' was achieved in the robot-assisted training [103/232 (44%)], enhanced upper limb therapy [118/234 (50%)] and usual care groups [85/203 (42%)]. These differences were not statistically significant; the adjusted odds ratios were as follows: robot-assisted training versus usual care, 1.2 (98.33% confidence interval 0.7 to 2.0); enhanced upper limb therapy versus usual care, 1.5 (98.33% confidence interval 0.9 to 2.5); and robot-assisted training versus enhanced upper limb therapy, 0.8 (98.33% confidence interval 0.5 to 1.3). The robot-assisted training group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale) than the usual care group at 3 and 6 months. The enhanced upper limb therapy group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale), better mobility (as measured by the Stroke Impact Scale mobility domain) and better performance in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the usual care group, at 3 months. The robot-assisted training group performed less well in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the enhanced upper limb therapy group at 3 months. No other differences were clinically important and statistically significant. Participants found the robot-assisted training and the enhanced upper limb therapy group programmes acceptable. Neither intervention, as provided in this trial, was cost-effective at current National Institute for Health and Care Excellence willingness-to-pay thresholds for a quality-adjusted life-year. CONCLUSIONS Robot-assisted training did not improve upper limb function compared with usual care. Although robot-assisted training improved upper limb impairment, this did not translate into improvements in other outcomes. Enhanced upper limb therapy resulted in potentially important improvements on upper limb impairment, in performance of activities of daily living, and in mobility. Neither intervention was cost-effective. FUTURE WORK Further research is needed to find ways to translate the improvements in upper limb impairment seen with robot-assisted training into improvements in upper limb function and activities of daily living. Innovations to make rehabilitation programmes more cost-effective are required. LIMITATIONS Pragmatic inclusion criteria led to the recruitment of some participants with little prospect of recovery. The attrition rate was higher in the usual care group than in the robot-assisted training or enhanced upper limb therapy groups, and differential attrition is a potential source of bias. Obtaining accurate information about the usual care that participants were receiving was a challenge. TRIAL REGISTRATION Current Controlled Trials ISRCTN69371850. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 54. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Helen Rodgers
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Helen Bosomworth
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hermano I Krebs
- Mechanical Engineering Department, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Frederike van Wijck
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Denise Howel
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nina Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tracy Finch
- Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | | | - Laura Ternent
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Lydia Aird
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | - Sreeman Andole
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - David L Cohen
- London North West University Healthcare NHS Trust, London, UK
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Gary A Ford
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Medical Sciences Division, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard Francis
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Steven Hogg
- Lay investigator (contact Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK)
| | | | - Christopher I Price
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | - Duncan L Turner
- School of Health, Sport and Bioscience, University of East London, London, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Scott Wilkes
- School of Medicine, University of Sunderland, Sunderland, UK
| | - Lisa Shaw
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Abstract
OBJECTIVES To survey the reported content, frequency and duration of upper limb treatment provided by occupational and physiotherapists for people after stroke in the UK. DESIGN A cross-sectional online survey was used. Description and analysis of the data were based on items from the Template for Intervention Description and Replication (Who, Where, What and How much). SETTING The online survey was distributed via professional and social networks to UK-based therapists. PARTICIPANTS Respondents were occupational or physiotherapists currently working clinically in the UK with people after stroke. Over the 6 week data collection period, 156 respondents opened the survey, and 154 completed it. Respondents comprised 85 physiotherapists and 69 occupational therapists. RESULTS Respondents reported treating the upper limb a median of three times a week (range: 1 to 7) for a mean of 29 min (SD: 18). Most (n=110) stated this was supplemented by rehabilitation assistants, family and/or carers providing additional therapy a median of three times a week (range 1 to 7). Functional training was the most commonly reported treatment for people with mild and moderate upper limb deficits (>40%). There was much less consistency in treatments reported for people with severe upper limb deficits with less than 20% (n=28) reporting the same treatments. CONCLUSIONS This study provides a contemporaneous description of reported therapy in the UK for people with upper limb deficits after stroke and a detailed template to inform standard therapy interventions in future research. Several evidence-based therapies were reported to be used by respondents (eg, constraint induced movement therapy), but others were not (eg, mental imagery). The findings also highlight that the current reported provision of upper limb therapy is markedly less than what is likely to be effective. This underlines an urgent need to configure and fund services to empower therapists to deliver greater amounts of evidence-based treatment for people with upper limb deficits after stroke.
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Affiliation(s)
- Rachel Stockley
- School of Nursing, University of Central Lancashire, Preston, UK
| | - Rosemary Peel
- School of Health Sciences, University of Central Lancashire, Preston, UK
| | - Kathryn Jarvis
- School of Health Sciences, University of Central Lancashire, Preston, UK
| | - Louise Connell
- School of Health Sciences, University of Central Lancashire, Preston, UK
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Stucki G, Pollock A, Engkasan JP, Selb M. How to use the International Classification of Functioning, Disability and Health as a reference system for comparative evaluation and standardized reporting of rehabilitation interventions. Eur J Phys Rehabil Med 2019; 55:384-394. [PMID: 30990004 DOI: 10.23736/s1973-9087.19.05808-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Rehabilitation aims to optimize functioning of persons experiencing functioning limitations. As such the comparative evaluation of rehabilitation interventions relies on the analysis of the differences between the change in patient functioning after a specific rehabilitation intervention versus the change following another intervention. A robust health information reference system that can facilitate the comparative evaluation of changes in functioning in rehabilitation studies and the standardized reporting of rehabilitation interventions is the International Classification of Functioning, Disability and Health (ICF). The objective of this paper is to present recommendations that Cochrane Rehabilitation could adopt for using the ICF in rehabilitation studies by: 1) defining the functioning categories to be included in a rehabilitation study; 2) specifying selected functioning categories and selecting suitable data collection instruments; 3) examining aspects of functioning that have been documented in a study; 4) reporting functioning data collected with various data collection instruments; and 5) communicating results in an accessible, meaningful and easily understandable way. The authors provide examples of concrete studies that underscore these recommendations, whereby also emphasizing the need for future research on the implementation of specific recommendations, e.g. in meta-analysis in systematic literature reviews. Furthermore, the paper outlines how the ICF can complement or be integrated in established Cochrane and rehabilitation research structures and methods, e.g. use of standard mean difference to compare cross-study data collected using different measures, in developing core outcome sets for rehabilitation, and the use of the PICO model.
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Affiliation(s)
- Gerold Stucki
- Department of Health Sciences and Health Policy, University of Luzern, Luzern, Switzerland.,ICF Research Branch, a Cooperation Partner within the WHO Collaborating Center for the Family of International Classifications in Germany, Nottwil, Switzerland.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Alex Pollock
- Unit of Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Julia P Engkasan
- Department of Rehabilitation Medicine, University of Malaya, Kuala Lumpur, Malaysia.,University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Melissa Selb
- ICF Research Branch, a Cooperation Partner within the WHO Collaborating Center for the Family of International Classifications in Germany, Nottwil, Switzerland - .,Swiss Paraplegic Research, Nottwil, Switzerland
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Sun M, Smith C, Howard D, Kenney L, Luckie H, Waring K, Taylor P, Merson E, Finn S. FES-UPP: A Flexible Functional Electrical Stimulation System to Support Upper Limb Functional Activity Practice. Front Neurosci 2018; 12:449. [PMID: 30026683 PMCID: PMC6041417 DOI: 10.3389/fnins.2018.00449] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/12/2018] [Indexed: 11/13/2022] Open
Abstract
There is good evidence supporting highly intensive, repetitive, activity-focused, voluntary-initiated practice as a key to driving recovery of upper limb function following stroke. Functional electrical stimulation (FES) offers a potential mechanism to efficiently deliver this type of therapy, but current commercial devices are too inflexible and/or insufficiently automated, in some cases requiring engineering support. In this paper, we report a new, flexible upper limb FES system, FES-UPP, which addresses the issues above. The FES-UPP system consists of a 5-channel stimulator running a flexible FES finite state machine (FSM) controller, the associated setup software that guides therapists through the setup of FSM controllers via five setup stages, and finally the Session Manager used to guide the patient in repeated attempts at the activities(s) and provide feedback on their performance. The FSM controller represents a functional activity as a sequence of movement phases. The output for each phase implements the stimulations to one or more muscles. Progression between movement phases is governed by user-defined rules. As part of a clinical investigation of the system, nine therapists used the FES-UPP system to set up FES-supported activities with twenty two patient participants with impaired upper-limbs. Therapists with little or no FES experience and without any programming skills could use the system in their usual clinical settings, without engineering support. Different functional activities, tailored to suit the upper limb impairment levels of each participant were used, in up to 8 sessions of FES-supported therapy per participant. The efficiency of delivery of the therapy using FES-UPP was promising when compared with published data on traditional face-face therapy. The FES-UPP system described in this paper has been shown to allow therapists with little or no FES experience and without any programming skills to set up state-machine FES controllers bespoke to the patient's impairment patterns and activity requirements, without engineering support. The clinical results demonstrated that the system can be used to efficiently deliver high intensity, activity-focused therapy. Nevertheless, further work to reduce setup time is still required.
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Affiliation(s)
- Mingxu Sun
- Centre for Health Sciences Research, University of Salford, Salford, United Kingdom
| | - Christine Smith
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, United Kingdom
| | - David Howard
- Centre for Health Sciences Research, University of Salford, Salford, United Kingdom
- School of Computing, Science and Engineering, University of Salford, Salford, United Kingdom
| | - Laurence Kenney
- Centre for Health Sciences Research, University of Salford, Salford, United Kingdom
| | - Helen Luckie
- Centre for Health Sciences Research, University of Salford, Salford, United Kingdom
| | - Karen Waring
- Centre for Health Sciences Research, University of Salford, Salford, United Kingdom
| | - Paul Taylor
- The National Clinical FES Centre, Salisbury District Hospital, Salisbury, United Kingdom
| | - Earl Merson
- The National Clinical FES Centre, Salisbury District Hospital, Salisbury, United Kingdom
| | - Stacey Finn
- The National Clinical FES Centre, Salisbury District Hospital, Salisbury, United Kingdom
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