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Mansilla Navarro P, Copaci D, Arias J, Blanco Rojas D. Design of an SMA-Based Actuator for Replicating Normal Gait Patterns in Pediatric Patients with Cerebral Palsy. Biomimetics (Basel) 2024; 9:376. [PMID: 39056817 PMCID: PMC11275206 DOI: 10.3390/biomimetics9070376] [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: 06/03/2024] [Revised: 06/19/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024] Open
Abstract
Cerebral Palsy refers to a group of incurable motor disorders affecting 0.22% of the global population. Symptoms are managed by physiotherapists, often using rehabilitation robotics. Exoskeletons, offering advantages over conventional therapies, are evolving to be more wearable and biomimetic, requiring new flexible actuators that mimic human tissue. The main objective behind this article is the design of a flexible exosuit based on shape-memory-alloy-based artificial muscles for pediatric patients that replicate the walking cycle pattern in the ankle joint. Thus, four shape-memory-alloy-based actuators were sewn to an exosuit at the desired actuation points and controlled by a two-level controller. The loop is closed through six inertial sensors that estimate the real angular position of both ankles. Different frequencies of actuation have been tested, along with the response of the actuators to different walking cycle patterns. These tests have been performed over long periods of time, comparing the reference created by a reference generator based on pediatric walking patterns and the response measured by the inertial sensors. The results provide important measurements concerning errors, working frequencies and cooling times, proving that this technology could be used in this and similar applications and highlighting its limitations.
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Affiliation(s)
- Paloma Mansilla Navarro
- Department of Systems Engineering and Automation, Universidad Carlos III de Madrid, 28911 Leganes, Spain; (D.C.); (J.A.); (D.B.R.)
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Mansilla Navarro P, Copaci D, Blanco Rojas D. Design and Control of a Soft Knee Exoskeleton for Pediatric Patients at Early Stages of the Walking Learning Process. Bioengineering (Basel) 2024; 11:188. [PMID: 38391674 PMCID: PMC10886139 DOI: 10.3390/bioengineering11020188] [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: 01/23/2024] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 02/24/2024] Open
Abstract
Pediatric patients can suffer from different motor disorders that limit their neurological and motor development and hinder their independence. If treated at the very early stages of development, those limitations can be palliated or even removed. However, manual interventions are not completely effective due to the restrictions in terms of time, force, or tracking experienced by the physiotherapists. The knee flexo-extension is crucial for walking and often affected by disorders such as spasticity or lack of force in the posterior chain. This article focuses on the development of a knee exosuit to follow angular trajectories mimicking the maximum and minimum peaks present in the knee flexo-extension profiles of healthy individuals during walking. The proposed exosuit is based on shape memory alloy actuators along with four inertial sensors that close the control loop. The whole device is controlled through a two-level controller and has an hybrid rigid-flexible design to overcome the different issues present in the literature. The device was proven to be feasible for this type of application, with replicable and consistent behavior, reducing the price and weight of existing exosuits and enhancing patient comfort.
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Affiliation(s)
- Paloma Mansilla Navarro
- Department of Systems Engineering and Automation, Universidad Carlos III de Madrid, 28015 Leganes, Spain
| | - Dorin Copaci
- Department of Systems Engineering and Automation, Universidad Carlos III de Madrid, 28015 Leganes, Spain
| | - Dolores Blanco Rojas
- Department of Systems Engineering and Automation, Universidad Carlos III de Madrid, 28015 Leganes, Spain
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Hayes HA, McFadden M, Gerace L, Brusseau TA. Agreement of activity monitors for assessment of patients with sub-acute stroke in an inpatient rehabilitation facility. Disabil Rehabil Assist Technol 2023:1-7. [PMID: 38055316 DOI: 10.1080/17483107.2023.2290637] [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: 12/22/2022] [Accepted: 11/28/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE Determine the level of agreement of three activity monitors compared with the gold standard (video review) on the activity level of patients with stroke. METHODS A prospective, observational, agreement study was performed on 47 individuals with sub-acute stroke in an inpatient rehabilitation facility. Data was collected during one physical therapy session. Individuals wore three device types; Actigraph (AG), Activpal (AP), and stepwatch activity monitor (SAM). Variables assessed were step counts for each limb (hemiparetic and non-hemiparetic) and percent time standing and other. ANALYSIS Results from the activity monitors were compared to the video review and assessed for agreement using the intraclass correlation coefficient (ICC) and accuracy of mean difference from video observation. RESULTS The step counts with the SAM on the non-hemiparetic limb had the highest ICC for step counts (ICC = 0.98, p < 0.001) and were overestimated with 21% accuracy. The SAM on the hemiparetic limb had 9.7% accuracy (ICC = 0.92, p < 0.001). For percent standing time all devices overestimated with poor reliability. For percent other activity time, the AP had the best accuracy and underestimated for both the hemiparetic limb (9.9% accuracy; ICC = 0.90, p < 0.001) and non-hemiparetic limb (8.3% accuracy; ICC = 0.84, p < 0.001). CONCLUSIONS The use of multiple devices may be warranted to capture an accurate understanding of activity levels in this population of individuals with sub-acute stroke. There are concerns with all monitors and clinicians and researchers should be aware of what measures they are wanting to understand about their population.
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Affiliation(s)
- H A Hayes
- Department of Physical Therapy and Athletic Training, University of UT, Salt Lake City, UT, USA
| | - M McFadden
- Study Design and Biostatistics Center, University of Utah, Salt Lake City, UT, USA
| | - L Gerace
- Department of Physical Therapy and Athletic Training, University of UT, Salt Lake City, UT, USA
| | - T A Brusseau
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
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Hegazy RG, Abdel-Aziem AA. Effect of Whole-Body Vibration Exercise on Hamstrings-to-Quadriceps Ratio, Walking Performance, and Postural Control in Children With Hemiparetic Cerebral Palsy: A Randomized Controlled Trial. J Manipulative Physiol Ther 2022; 45:660-670. [PMID: 37318391 DOI: 10.1016/j.jmpt.2023.04.011] [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: 10/06/2022] [Revised: 03/23/2023] [Accepted: 04/12/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the effect of whole-body vibration (WBV) exercises combined with traditional physiotherapy on the hamstrings-to-quadriceps (H:Q) ratio, walking ability, and control of posture in children with hemiparetic cerebral palsy (CP). METHODS A total of 34 children with spastic hemiparetic CP (boys and girls) participated in this 2-arm, parallel, randomized controlled trial. The inclusion criteria were spasticity ranging from 1 to 1+, gross level skills (I and II), at least 1 meter tall, standing alone, and walking forward and backward. They were randomly allocated to the control group (traditional physiotherapy) and study group and were treated by the same physiotherapy program combined with WBV training (3 times per week for 2 successive months). Quadriceps and hamstring muscle strength, walking performance, and postural control were evaluated before and after intervention by a blinded assessor. RESULTS The post-intervention values of the hamstring and quadriceps muscle force, gross motor function, and stability indices of the 2 groups were higher than the pre-values (P < .05). In addition, the post-values of the study group were higher than those of the control group (P < .05). Regarding the H:Q ratio, there was no significant difference between pre-values or the post-values of both groups (P = .948 and P = .397, respectively). There were no significant differences between the pre- and post-values of each group (P = .500 and P = .195, respectively). CONCLUSION Eight weeks of WBV training combined with traditional physiotherapy was more effective than traditional physiotherapy alone in improving walking ability and postural control. Furthermore, the combined intervention strengthened the quadriceps and hamstring muscles, with no change in the H:Q ratio in children with hemiparetic CP.
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Affiliation(s)
- Rania G Hegazy
- Department of Pediatric Physical Therapy, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Amr A Abdel-Aziem
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza, Egypt.
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Borges LR, Fernandes AB, Oliveira Dos Passos J, Rego IAO, Campos TF. Action observation for upper limb rehabilitation after stroke. Cochrane Database Syst Rev 2022; 8:CD011887. [PMID: 35930301 PMCID: PMC9354942 DOI: 10.1002/14651858.cd011887.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Action observation (AO) is a physical rehabilitation approach that facilitates the occurrence of neural plasticity through the activation of the mirror-neural system, promoting motor recovery in people with stroke. OBJECTIVES To assess whether AO enhances upper limb motor function in people with stroke. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched 18 May 2021), the Cochrane Central Register of Controlled Trials (18 May 2021), MEDLINE (1946 to 18 May 2021), Embase (1974 to 18 May 2021), and five additional databases. We also searched trial registries and reference lists. SELECTION CRITERIA Randomized controlled trials (RCTs) of AO alone or associated with physical practice in adults after stroke. The primary outcome was upper limb (arm and hand) motor function. Secondary outcomes included dependence on activities of daily living (ADL), motor performance, cortical activation, quality of life, and adverse effects. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials according to the predefined inclusion criteria, extracted data, assessed risk of bias using RoB 1, and applied the GRADE approach to assess the certainty of the evidence. The reviews authors contacted trial authors for clarification and missing information. MAIN RESULTS We included 16 trials involving 574 individuals. Most trials provided AO followed by the practice of motor actions. Training varied between 1 day and 8 weeks of therapy, 10 to 90 minutes per session. The time of AO ranged from 1 minute to 10 minutes for each motor action, task or movement observed. The total number of motor actions ranged from 1 to 3. Control comparisons included sham observation, physical therapy, and functional activity practice. PRIMARY OUTCOMES AO improved arm function (standardized mean difference (SMD) 0.39, 95% confidence interval (CI) 0.17 to 0.61; 11 trials, 373 participants; low-certainty evidence); and improved hand function (mean difference (MD) 2.76, 95% CI 1.04 to 4.49; 5 trials, 178 participants; low-certainty evidence). SECONDARY OUTCOMES AO did not improve ADL performance (SMD 0.37, 95% CI -0.34 to 1.08; 7 trials, 302 participants; very low-certainty evidence), or quality of life (MD 5.52, 95% CI -30.74 to 41.78; 2 trials, 30 participants; very low-certainty evidence). We were unable to pool the other secondary outcomes (motor performance and cortical activation). Only two trials reported adverse events without significant adverse effects. AUTHORS' CONCLUSIONS The effects of AO are small for arm function compared to any control group; for hand function the effects are large, but not clinically significant. For both, the certainty of evidence is low. There is no evidence of benefit or detriment from AO on ADL and quality of life of people with stroke; however, the certainty of evidence is very low. As such, our confidence in the effect estimate is limited because it will likely change with future research.
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Affiliation(s)
- Lorenna Rdm Borges
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Aline Bgs Fernandes
- Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | | | - Tania F Campos
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
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A Pilot Randomized Controlled Trial of Botulinum Toxin Treatment Combined with Robot-Assisted Therapy, Mirror Therapy, or Active Control Treatment in Patients with Spasticity Following Stroke. Toxins (Basel) 2022; 14:toxins14060415. [PMID: 35737076 PMCID: PMC9228472 DOI: 10.3390/toxins14060415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/12/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022] Open
Abstract
Effects of the combined task-oriented trainings with botulinum toxin A (BoNT-A) injection on improving motor functions and reducing spasticity remains unclear. This study aims to investigate effects of 3 task-oriented trainings (robot-assisted therapy (RT), mirror therapy (MT), and active control treatment (AC)) in patients with stroke after BoNT-A injection. Thirty-seven patients with chronic spastic hemiplegic stroke were randomly assigned to receive RT, MT, or AC following BoNT-A injection over spastic upper extremity muscles. Each session of RT, MT, and AC was 75 min, 3 times weekly, for 8 weeks. Outcome measures were assessed at pretreatment, post-treatment, and 3-month follow-up, involving the Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Motor Activity Log (MAL), including amount of use (AOU) and quality of movement (QOM), and arm activity level. All 3 combined treatments improved FMA, MAS, and MAL. The AC induced a greater effect on QOM in MAL at the 3-month follow-up than RT or MT. All 3 combined trainings induced minimal effect on arm activity level. Our findings suggest that for patients with stroke who received BoNT-A injection over spastic UE muscles, the RT, MT, or AC UE training that followed was effective in improving motor functions, reducing spasticity, and enhancing daily function.
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Washabaugh EP, Krishnan C. Functional resistance training methods for targeting patient-specific gait deficits: A review of devices and their effects on muscle activation, neural control, and gait mechanics. Clin Biomech (Bristol, Avon) 2022; 94:105629. [PMID: 35344781 DOI: 10.1016/j.clinbiomech.2022.105629] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Injuries to the neuromusculoskeletal system often result in weakness and gait impairments. Functional resistance training during walking-where patients walk while a device increases loading on the leg-is an emerging approach to combat these symptoms. However, there are many methods that can be used to resist the patient, which may alter the biomechanics of the training. Thus, all methods may not address patient-specific deficits. METHODS We performed a comprehensive electronic database search to identify articles that acutely (i.e., after a single training session) examined how functional resistance training during walking alters muscle activation, gait biomechanics, and neural plasticity. Only articles that examined these effects during training or following the removal of resistance (i.e., aftereffects) were included. FINDINGS We found 41 studies that matched these criteria. Most studies (24) used passive devices (e.g., weighted cuffs or resistance bands) while the remainder used robotic devices. Devices varied on if they were wearable (14) or externally tethered, and the type of resistance they applied (i.e., inertial [14], elastic [8], viscous [7], or customized [12]). Notably, these methods provided device-specific changes in muscle activation, biomechanics, and spatiotemporal and kinematic aftereffects. Some evidence suggests this training results in task-specific increases in neural excitability. INTERPRETATION These findings suggest that careful selection of resistive strategies could help target patient-specific strength deficits and gait impairments. Also, many approaches are low-cost and feasible for clinical or in-home use. The results provide new insights for clinicians on selecting an appropriate functional resistance training strategy to target patient-specific needs.
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Affiliation(s)
- Edward P Washabaugh
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA; Michigan Medicine Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- Michigan Medicine Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA; Michigan Robotics, University of Michigan, Ann Arbor, MI, USA.
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Malick WH, Butt R, Awan WA, Ashfaq M, Mahmood Q. Effects of Augmented Reality Intervention on the Range of Motion and Muscle Strength of Upper Extremity in Children with Spastic Hemiplegic Cerebral Palsy: A Randomized Clinical Trial. Games Health J 2022; 11:168-176. [PMID: 35285674 DOI: 10.1089/g4h.2021.0128] [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] [Indexed: 02/02/2023] Open
Abstract
Objective: To determine the effects of augmented reality (AR) interventions on the upper extremity's (UE's) range of motion (ROM) and muscle strength in children with spastic hemiplegic cerebral palsy (SHCP). Materials and Methods: Thirty children with SHCP, aged 6 to 12 years, were randomly divided into three interventional groups. Each group received an AR game that is, Balance It, Bubble Pop, or Scoop'd (WonderTree, Pakistan). The UE's ROM and muscle strength were assessed at the baseline and after 8 weeks of intervention through goniometer and manual muscle testing, respectively. Paired-sample t-test and Wilcoxon signed-rank test were used for analyzing the changes in ROM and muscle strength within the groups respectively. One-way analysis of variance (ANOVA) and Tukey's test were used for the differences in ROM, whereas the Kruskal-Wallis test was used for the differences in muscle strength, between the groups. Results: Within-group analysis revealed that all the groups significantly improved in ROM of the majority of joints and in the strength of various muscles of UE (P < 0.05). The elbow extension ROM was significantly different when a comparison was made between the interventional groups (P < 0.05). Balance It group showed more significant improvement in the elbow extension ROM as compared with the Scoop'd group. However, the comparison between the groups showed no significant difference in the muscle strength of UE (P > 0.05). Conclusion: The AR games intervention was beneficial and effective for improving the ROM of majority of the joints and strength of various muscles of UE in children with SHCP. Clinical Trial Registration number: NCT04171232.
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Affiliation(s)
| | - Rizwana Butt
- Physiotherapy Department, Institute of Medical Rehabilitation, Islamabad, Pakistan
| | - Waqar Ahmed Awan
- Riphah College of Rehabilitation and Allied Health Sciences, Riphah International University, Islamabad, Pakistan
| | - Muhammad Ashfaq
- Physiotherapy Department, National Institute of Rehabilitation Medicine (NIRM), Islamabad, Pakistan
| | - Qamar Mahmood
- Physiotherapy Department, National Institute of Rehabilitation Medicine (NIRM), Islamabad, Pakistan
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The Effectiveness of Robot- vs. Virtual Reality-Based Gait Rehabilitation: A Propensity Score Matched Cohort. Life (Basel) 2021; 11:life11060548. [PMID: 34208009 PMCID: PMC8230650 DOI: 10.3390/life11060548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 01/05/2023] Open
Abstract
Robot assisted gait training (RAGT) and virtual reality plus treadmill training (VRTT) are two technologies that can support locomotion rehabilitation in children and adolescents affected by acquired brain injury (ABI). The literature provides evidence of their effectiveness in this population. However, a comparison between these methods is not available. This study aims at comparing the effectiveness of RAGT and VRTT for the gait rehabilitation of children and adolescents suffering from ABI. This is a prospective cohort study with propensity score matching. Between October 2016 and September 2018, all patients undergoing an intensive gait rehabilitation treatment based on RAGT or VRTT were prospectively observed. To minimize selection bias associated with the study design, patients who underwent RAGT or VRTT were retrospectively matched for age, gender, time elapsed from injury, level of impairment, and motor impairment using propensity score in a matching ratio of 1:1. Outcome measures were Gross Motor Function Mesure-88 (GMFM-88), six-min walking test (6MWT), Gillette Functional Assessment Questionnaire (FAQ), and three-dimensional gait analysis (GA). The FAQ and the GMFM-88 had a statistically significant increase in both groups while the 6MWT improved in the RAGT group only. GA highlighted changes at the proximal level in the RAGT group, and at the distal district in the VRTT group. Although preliminary, this work suggests that RAGT and VRTT protocols foster different motor improvements, thus recommending to couple the two therapies in the paediatric population with ABI.
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Head-Mounted Display-Based Therapies for Adults Post-Stroke: A Systematic Review and Meta-Analysis. SENSORS 2021; 21:s21041111. [PMID: 33562657 PMCID: PMC7915338 DOI: 10.3390/s21041111] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/14/2022]
Abstract
Immersive virtual reality techniques have been applied to the rehabilitation of patients after stroke, but evidence of its clinical effectiveness is scarce. The present review aims to find studies that evaluate the effects of immersive virtual reality (VR) therapies intended for motor function rehabilitation compared to conventional rehabilitation in people after stroke and make recommendations for future studies. Data from different databases were searched from inception until October 2020. Studies that investigated the effects of immersive VR interventions on post-stroke adult subjects via a head-mounted display (HMD) were included. These studies included a control group that received conventional therapy or another non-immersive VR intervention. The studies reported statistical data for the groups involved in at least the posttest as well as relevant outcomes measuring functional or motor recovery of either lower or upper limbs. Most of the studies found significant improvements in some outcomes after the intervention in favor of the virtual rehabilitation group. Although evidence is limited, immersive VR therapies constitute an interesting tool to improve motor learning when used in conjunction with traditional rehabilitation therapies, providing a non-pharmacological therapeutic pathway for people after stroke.
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Önal B, Karaca G, Sertel M. Immediate Effects of Plantar Vibration on Fall Risk and Postural Stability in Stroke Patients: A Randomized Controlled Trial. J Stroke Cerebrovasc Dis 2020; 29:105324. [PMID: 32992184 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105324] [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: 06/05/2020] [Revised: 08/31/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Local vibration can improve balance problems of individuals with stroke when applied to the plantar region. AIMS This study aimed to determine the immediate effect of local vibration applied to the plantar region on fall risk and postural stability in patients with stroke. STUDY DESIGN Randomized controlled study. METHODS 30 patients (23 male,7 female) with stroke were randomized to either vibration (n = 15; 58.47 ± 8.23 years) or control (n = 15; 58.27 ± 9.50 years) groups. Before and after the intervention, the patients were evaluated using a Biodex Balance System. Local vibration was applied to the plantar region of two feet in the supine position using a vibration device for a total of 15 min to the individuals in the vibration group. While the patients in the placebo group were in the supine position, the device was brought into contact and no vibration was applied to the plantar region of two feet for 15 min. RESULTS While significant improvements were observed in the postural stability and fall risk of the vibration group (p < 0.05), no significant change was observed in the placebo group (p > 0.05). Furthermore, significant improvements occurred in the SD values of the postural stability expressing postural oscillation in the vibration group (p < 0.05). CONCLUSION As a result of local vibration applied to the plantar region, immediate (within 5 min) significant improvements in postural stability and fall risk values were detected.
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Affiliation(s)
- Birol Önal
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey.
| | - Gülten Karaca
- Department of Physical Therapy and Rehabilitation, Ankara Memorial Hospital, Ankara, Turkey.
| | - Meral Sertel
- Department of Physiotherapy and Rehabilitation, Kırıkkale University Faculty of Health Sciences, Kırıkkale, Turkey.
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Maier M, Ballester BR, Verschure PFMJ. Principles of Neurorehabilitation After Stroke Based on Motor Learning and Brain Plasticity Mechanisms. Front Syst Neurosci 2019; 13:74. [PMID: 31920570 PMCID: PMC6928101 DOI: 10.3389/fnsys.2019.00074] [Citation(s) in RCA: 162] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 11/19/2019] [Indexed: 01/19/2023] Open
Abstract
What are the principles underlying effective neurorehabilitation? The aim of neurorehabilitation is to exploit interventions based on human and animal studies about learning and adaptation, as well as to show that the activation of experience-dependent neuronal plasticity augments functional recovery after stroke. Instead of teaching compensatory strategies that do not reduce impairment but allow the patient to return home as soon as possible, functional recovery might be more sustainable as it ensures a long-term reduction in impairment and an improvement in quality of life. At the same time, neurorehabilitation permits the scientific community to collect valuable data, which allows inferring about the principles of brain organization. Hence neuroscience sheds light on the mechanisms of learning new functions or relearning lost ones. However, current rehabilitation methods lack the exact operationalization of evidence gained from skill learning literature, leading to an urgent need to bridge motor learning theory and present clinical work in order to identify a set of ingredients and practical applications that could guide future interventions. This work aims to unify the neuroscientific literature relevant to the recovery process and rehabilitation practice in order to provide a synthesis of the principles that constitute an effective neurorehabilitation approach. Previous attempts to achieve this goal either focused on a subset of principles or did not link clinical application to the principles of motor learning and recovery. We identified 15 principles of motor learning based on existing literature: massed practice, spaced practice, dosage, task-specific practice, goal-oriented practice, variable practice, increasing difficulty, multisensory stimulation, rhythmic cueing, explicit feedback/knowledge of results, implicit feedback/knowledge of performance, modulate effector selection, action observation/embodied practice, motor imagery, and social interaction. We comment on trials that successfully implemented these principles and report evidence from experiments with healthy individuals as well as clinical work.
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Affiliation(s)
- Martina Maier
- Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems, Institute for Bioengineering of Catalonia, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Belén Rubio Ballester
- Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems, Institute for Bioengineering of Catalonia, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Paul F. M. J. Verschure
- Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems, Institute for Bioengineering of Catalonia, The Barcelona Institute of Science and Technology, Barcelona, Spain
- Institucio Catalana de Recerca I Estudis Avançats, Barcelona, Spain
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Rabinowitch I. What would a synthetic connectome look like? Phys Life Rev 2019; 33:1-15. [PMID: 31296448 DOI: 10.1016/j.plrev.2019.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/25/2019] [Indexed: 02/07/2023]
Abstract
A major challenge of contemporary neuroscience is to unravel the structure of the connectome, the ensemble of neural connections that link between different functional units of the brain, and to reveal how this structure relates to brain function. This thriving area of research largely follows the general tradition in biology of reverse-engineering, which consists of first observing and characterizing a biological system or process, and then deconstructing it into its fundamental building blocks in order to infer its modes of operation. However, a complementary form of biology has emerged, synthetic biology, which emphasizes construction-based forward-engineering. The synthetic biology approach comprises the assembly of new biological systems out of elementary biological parts. The rationale is that the act of building a system can be a powerful method for gaining deep understanding of how that system works. As the fields of connectomics and synthetic biology are independently growing, I propose to consider the benefits of combining the two, to create synthetic connectomics, a new form of neuroscience and a new form of synthetic biology. The goal of synthetic connectomics would be to artificially design and construct the connectomes of live behaving organisms. Synthetic connectomics could serve as a unifying platform for unraveling the complexities of brain operation and perhaps also for generating new forms of artificial life, and, in general, could provide a valuable opportunity for empirically exploring theoretical predictions about network function. What would a synthetic connectome look like? What purposes would it serve? How could it be constructed? This review delineates the novel notion of a synthetic connectome and aims to lay out the initial steps towards its implementation, contemplating its impact on science and society.
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Affiliation(s)
- Ithai Rabinowitch
- Department of Medical Neurobiology, IMRIC - Institute for Medical Research Israel-Canada, Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem Campus, Jerusalem, 9112002, Israel.
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Buchmann I, Finkel L, Dangel M, Erz D, Maren Harscher K, Kaupp-Merkle M, Liepert J, Rockstroh B, Randerath J. A combined therapy for limb apraxia and related anosognosia. Neuropsychol Rehabil 2019; 30:2016-2034. [DOI: 10.1080/09602011.2019.1628075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Ilka Buchmann
- Department of Psychology, University of Konstanz, Konstanz, Germany
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
| | - Lisa Finkel
- Department of Psychology, University of Konstanz, Konstanz, Germany
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
| | - Mareike Dangel
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Dorothee Erz
- Department of Psychology, University of Konstanz, Konstanz, Germany
- Department of Psychology, Johannes Gutenberg University Mainz, Mainz, Germany
| | | | | | - Joachim Liepert
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
- Kliniken Schmieder, Allensbach, Germany
| | - Brigitte Rockstroh
- Department of Psychology, University of Konstanz, Konstanz, Germany
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
| | - Jennifer Randerath
- Department of Psychology, University of Konstanz, Konstanz, Germany
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
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15
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Abd El Rhm A, El Sayed S K, Mosaad Abd G, Hassan Abo M. Influence of Biofeedback and Task Oriented Training on Hand Skills in Children with Spastic Cerebral Palsy. JOURNAL OF MEDICAL SCIENCES 2019. [DOI: 10.3923/jms.2019.63.68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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16
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Boehm WL, Gruben KG. Development of KIINCE: A kinetic feedback-based robotic environment for study of neuromuscular coordination and rehabilitation of human standing and walking. J Rehabil Assist Technol Eng 2019; 5:2055668318793585. [PMID: 31191950 PMCID: PMC6453043 DOI: 10.1177/2055668318793585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 07/04/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction The objective of this article is to introduce the robotic platform KIINCE and
its emphasis on the potential of kinetic objectives for studying and
training human walking and standing. The device is motivated by the need to
characterize and train lower limb muscle coordination to address balance
deficits in impaired walking and standing. Methods The device measures the forces between the user and his or her environment,
particularly the force of the ground on the feet (F) that
reflects lower limb joint torque coordination. In an environment that allows
for exploration of the user’s capabilities, various forms of real-time
feedback guide neural training to produce F appropriate for
remaining upright. Control of the foot plate motion is configurable and may
be user driven or prescribed. Design choices are motivated from theory of
motor control and learning as well as empirical observations of
F during walking and standing. Results Preliminary studies of impaired individuals demonstrate the feasibility and
potential utility of patient interaction with kinetic immersive interface
for neuromuscular coordination enhancement. Conclusion Applications include study and rehabilitation of standing and walking after
injury, amputation, and neurological insult, with an initial focus on stroke
discussed here.
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Affiliation(s)
- Wendy L Boehm
- Department of Biomedical Engineering, Northwestern University, Chicago, USA
| | - Kreg G Gruben
- Department of Kinesiology, University of Wisconsin, Madison, USA.,Department of Biomedical Engineering, University of Wisconsin, Madison, USA
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17
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Park J, Chung Y. The effects of robot-assisted gait training using virtual reality and auditory stimulation on balance and gait abilities in persons with stroke. NeuroRehabilitation 2018; 43:227-235. [PMID: 30040760 DOI: 10.3233/nre-172415] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Robot-assisted gait training provide a big therapeutic advantage in functional mobility for postural control. OBJECTIVES The purpose of this study was investigate the effects of robot-assisted gait training using virtual reality and auditory stimulation on balance and gait abilities in stroke patients. METHODS All subjects were randomly divided into three groups where twelve subjects were in the Virtual reality robot-assisted gait training group (VRGT), twelve subjects in the auditory stimulation robot-assisted gait training group (ARGT), and sixteen subjects in the control group. Subjects received virtual reality and auditory stimulation while undergoing robot-assisted gait training for 45 minutes, three times a week for 6 weeks, and all subjects had undergone general physical therapy for 30 minutes, five times a week for 6 weeks. All subjects were assessed with the Medical Research Council (MRC), Berg balance scale (BBS), timed up and go test (TUG), 10-meter walk test (10MWT), Fugl-Myer Assessment (FMA) and Modified Barthel Index (MBI) pre- and post-intervention. RESULTS Results showed that BBS, TUG, and 10MWT scores significantly improved post-intervention (p < 0.05), and the control group also had significantly improved in all areas post-treatment (p < 0.05). In addition, it has been confirmed that VRGT had significantly improved in MRC and FMA scores compared with the auditory stimulation. Also, it has significantly improved in MRC, BBS, TUG, 10MWT and FMA compared with control group (p < 0.05). CONCLUSIONS The results of this study showed improve balance and gait abilities after VRGT compared with general physical therapy and were found to be effective in enhancing the functional activity of persons with stroke.
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Affiliation(s)
- Jaeho Park
- Department of Physical Therapy, The Graduate School, Sahmyook University, Seoul, Republic of Korea
| | - Yijung Chung
- Department of Physical Therapy, College of Health Science and Social Welfare, Sahmyook University, Seoul, Republic of Korea
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18
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Hussain A, Budhota A, Contu S, Kager S, Vishwanath DA, Kuah CWK, Yam LHL, Chua KSG, Masia L, Campolo D. Quantitative assessment of motor functions post-stroke: Responsiveness of upper-extremity robotic measures and its task dependence. IEEE Int Conf Rehabil Robot 2018; 2017:1037-1042. [PMID: 28813958 DOI: 10.1109/icorr.2017.8009386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Technology aided measures offer a sensitive, accurate and time-efflcient approach for the assessment of sensorimotor function after neurological impairment compared to standard clinical assessments. This preliminary study investigated the relationship between task definition and its effect on robotic measures using a planar, two degree of freedom, robotic-manipulator (H-Man). Four chronic stroke participants (49.5±11.95 years, 2 Female, FMA: 37.5±13.96) and eight healthy control participants (26.25± 4.70 years, 2 Female) participated in the study. Motor functions were evaluated using line tracing and circle tracing tasks with dominant and nondominant hand of healthy and affected vs. non affected hand of stroke participants. The results show significant dependence of quantitative measures on investigated tasks.
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19
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Functional Electrical Stimulation and Its Use During Cycling for the Rehabilitation of Individuals with Stroke. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/978-3-319-72736-3_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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20
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Chaturvedi P, Singh AK, Kulshreshtha D, Maurya PK, Thacker AK. Proprioceptive neuromuscular facilitation (PNF) vs. task specific training in acute stroke: the effects on neuroplasticity. ACTA ACUST UNITED AC 2018. [DOI: 10.15406/mojap.2018.05.00181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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21
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Stephenson A, Stephens J. An exploration of physiotherapists’ experiences of robotic therapy in upper limb rehabilitation within a stroke rehabilitation centre. Disabil Rehabil Assist Technol 2017; 13:245-252. [DOI: 10.1080/17483107.2017.1306593] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Andrew Stephenson
- Northumbria Healthcare NHS Foundation Trust, Northumbria Specialist Emergency Care Hospital, Cramlington, UK
| | - John Stephens
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
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22
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Hussain A, Balasubramanian S, Roach N, Klein J, Jarrassé N, Mace M, David A, Guy S, Burdet E. SITAR: a system for independent task-oriented assessment and rehabilitation. J Rehabil Assist Technol Eng 2017; 4:2055668317729637. [PMID: 31186936 PMCID: PMC6453030 DOI: 10.1177/2055668317729637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 06/30/2017] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Over recent years, task-oriented training has emerged as a dominant approach in neurorehabilitation. This article presents a novel, sensor-based system for independent task-oriented assessment and rehabilitation (SITAR) of the upper limb. METHODS The SITAR is an ecosystem of interactive devices including a touch and force-sensitive tabletop and a set of intelligent objects enabling functional interaction. In contrast to most existing sensor-based systems, SITAR provides natural training of visuomotor coordination through collocated visual and haptic workspaces alongside multimodal feedback, facilitating learning and its transfer to real tasks. We illustrate the possibilities offered by the SITAR for sensorimotor assessment and therapy through pilot assessment and usability studies. RESULTS The pilot data from the assessment study demonstrates how the system can be used to assess different aspects of upper limb reaching, pick-and-place and sensory tactile resolution tasks. The pilot usability study indicates that patients are able to train arm-reaching movements independently using the SITAR with minimal involvement of the therapist and that they were motivated to pursue the SITAR-based therapy. CONCLUSION SITAR is a versatile, non-robotic tool that can be used to implement a range of therapeutic exercises and assessments for different types of patients, which is particularly well-suited for task-oriented training.
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Affiliation(s)
- Asif Hussain
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK
- School of Mechanical and Aerospace
Engineering, Nanyang Technological
University, Singapore
| | - Sivakumar Balasubramanian
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK
- Department of Bioengineering, Christian Medical College, Vellore, India
| | - Nick Roach
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK
| | - Julius Klein
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK
- Tecnalia Research and Innovation, San
Sebastian, Spain
| | - Nathanael Jarrassé
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK
- CNRS, Institut des Systèmes Intelligents et de Robotique, Université Pierre et Marie Curie, Paris, France
| | - Michael Mace
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK
| | - Ann David
- Department of Bioengineering, Christian Medical College, Vellore, India
| | - Sarah Guy
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK
| | - Etienne Burdet
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK
- School of Mechanical and Aerospace
Engineering, Nanyang Technological
University, Singapore
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23
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Hussain A, Budhota A, Hughes CML, Dailey WD, Vishwanath DA, Kuah CWK, Yam LHL, Loh YJ, Xiang L, Chua KSG, Burdet E, Campolo D. Self-Paced Reaching after Stroke: A Quantitative Assessment of Longitudinal and Directional Sensitivity Using the H-Man Planar Robot for Upper Limb Neurorehabilitation. Front Neurosci 2016; 10:477. [PMID: 27826223 PMCID: PMC5078476 DOI: 10.3389/fnins.2016.00477] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 10/05/2016] [Indexed: 11/13/2022] Open
Abstract
Technology aided measures offer a sensitive, accurate and time-efficient approach for the assessment of sensorimotor function after neurological insult compared to standard clinical assessments. This study investigated the sensitivity of robotic measures to capture differences in planar reaching movements as a function of neurological status (stroke, healthy), direction (front, ipsilateral, contralateral), movement segment (outbound, inbound), and time (baseline, post-training, 2-week follow-up) using a planar, two-degrees of freedom, robotic-manipulator (H-Man). Twelve chronic stroke (age: 55 ± 10.0 years, 5 female, 7 male, time since stroke: 11.2 ± 6.0 months) and nine aged-matched healthy participants (age: 53 ± 4.3 years, 5 female, 4 male) participated in this study. Both healthy and stroke participants performed planar reaching movements in contralateral, ipsilateral and front directions with the H-Man, and the robotic measures, spectral arc length (SAL), normalized time to peak velocities (TpeakN), and root-mean square error (RMSE) were evaluated. Healthy participants went through a one-off session of assessment to investigate the baseline. Stroke participants completed a 2-week intensive robotic training plus standard arm therapy (8 × 90 min sessions). Motor function for stroke participants was evaluated prior to training (baseline, week-0), immediately following training (post-training, week-2), and 2-weeks after training (follow-up, week-4) using robotic assessment and the clinical measures Fugl-Meyer Assessment (FMA), Activity-Research-Arm Test (ARAT), and grip-strength. Robotic assessments were able to capture differences due to neurological status, movement direction, and movement segment. Movements performed by stroke participants were less-smooth, featured longer TpeakN, and larger RMSE values, compared to healthy controls. Significant movement direction differences were observed, with improved reaching performance for the front, compared to ipsilateral and contralateral movement directions. There were group differences depending on movement segment. Outbound reaching movements were smoother and featured longer TpeakN values than inbound movements for control participants, whereas SAL, TpeakN, and RMSE values were similar regardless of movement segment for stroke patients. Significant change in performance was observed between initial and post-assessments using H-Man in stroke participants, compared to conventional scales which showed no significant difference. Results of the study indicate the potential of H-Man as a sensitive tool for tracking changes in performance compared to ordinal scales (i.e., FM, ARAT).
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Affiliation(s)
- Asif Hussain
- Robotics Research Centre, School of Mechanical and Aerospace Engineering, Nanyang Technological University Singapore, Singapore
| | - Aamani Budhota
- Robotics Research Centre, School of Mechanical and Aerospace Engineering, Nanyang Technological UniversitySingapore, Singapore; Interdisciplinary Graduate School, Nanyang Technological UniversitySingapore, Singapore
| | - Charmayne Mary Lee Hughes
- Robotics Research Centre, School of Mechanical and Aerospace Engineering, Nanyang Technological UniversitySingapore, Singapore; Department of Kinesiology, San Francisco State UniversitySan Francisco, CA, USA; Health Equity Institute, San Francisco State UniversitySan Francisco, CA, USA
| | - Wayne D Dailey
- Robotics Research Centre, School of Mechanical and Aerospace Engineering, Nanyang Technological UniversitySingapore, Singapore; Department of Bioengineering, Imperial College of Science, Technology and MedicineLondon, UK
| | - Deshmukh A Vishwanath
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre Singapore, Singapore
| | - Christopher W K Kuah
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre Singapore, Singapore
| | - Lester H L Yam
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre Singapore, Singapore
| | - Yong J Loh
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre Singapore, Singapore
| | - Liming Xiang
- School of Physical and Mathematical Sciences, Nanyang Technological University Singapore, Singapore
| | - Karen S G Chua
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre Singapore, Singapore
| | - Etienne Burdet
- Department of Bioengineering, Imperial College of Science, Technology and Medicine London, UK
| | - Domenico Campolo
- Robotics Research Centre, School of Mechanical and Aerospace Engineering, Nanyang Technological University Singapore, Singapore
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24
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Park JH, Chung Y. The effects of providing visual feedback and auditory stimulation using a robotic device on balance and gait abilities in persons with stroke: a pilot study. ACTA ACUST UNITED AC 2016. [DOI: 10.14474/ptrs.2016.5.3.125] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jae Ho Park
- Department of Physical Therapy, The Graduate School, Sahmyook University, Seoul, Republic of Korea
| | - Yijung Chung
- Department of Physical Therapy, College of Health and Welfare, Sahmyook University, Seoul, Republic of Korea
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25
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Hsieh YW, Wu CY, Wang WE, Lin KC, Chang KC, Chen CC, Liu CT. Bilateral robotic priming before task-oriented approach in subacute stroke rehabilitation: a pilot randomized controlled trial. Clin Rehabil 2016; 31:225-233. [PMID: 26893457 DOI: 10.1177/0269215516633275] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate the treatment effects of bilateral robotic priming combined with the task-oriented approach on motor impairment, disability, daily function, and quality of life in patients with subacute stroke. DESIGN A randomized controlled trial. SETTING Occupational therapy clinics in medical centers. SUBJECTS Thirty-one subacute stroke patients were recruited. INTERVENTIONS Participants were randomly assigned to receive bilateral priming combined with the task-oriented approach (i.e., primed group) or to the task-oriented approach alone (i.e., unprimed group) for 90 minutes/day, 5 days/week for 4 weeks. The primed group began with the bilateral priming technique by using a bimanual robot-aided device. MAIN MEASURES Motor impairments were assessed by the Fugal-Meyer Assessment, grip strength, and the Box and Block Test. Disability and daily function were measured by the modified Rankin Scale, the Functional Independence Measure, and actigraphy. Quality of life was examined by the Stroke Impact Scale. RESULTS The primed and unprimed groups improved significantly on most outcomes over time. The primed group demonstrated significantly better improvement on the Stroke Impact Scale strength subscale ( p = 0.012) and a trend for greater improvement on the modified Rankin Scale ( p = 0.065) than the unprimed group. CONCLUSION Bilateral priming combined with the task-oriented approach elicited more improvements in self-reported strength and disability degrees than the task-oriented approach by itself. Further large-scale research with at least 31 participants in each intervention group is suggested to confirm the study findings.
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Affiliation(s)
- Yu-Wei Hsieh
- 1 Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,2 Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Yi Wu
- 1 Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,2 Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Wei-En Wang
- 1 Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Keh-Chung Lin
- 3 School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,4 Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Ku-Chou Chang
- 5 Division of Cerebrovascular Diseases, Department of Neurology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,6 Department of Senior Citizen Service Management, Yuh-Ing Junior College, Kaohsiung, Taiwan.,7 Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Chi Chen
- 7 Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,8 Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Ting Liu
- 9 Department of Physical Medicine and Rehabilitation, Taipei Tzuchi Hospital, Buddhist Tzuchi Medical Foundation, New Taipei City, Taiwan
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26
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Alavi N, Herrnstadt G, Randhawa BK, Boyd LA, Menon C. Bimanual elbow exoskeleton: Force based protocol and rehabilitation quantification. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:4643-6. [PMID: 26737329 DOI: 10.1109/embc.2015.7319429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
An aging population, along with the increase in cardiovascular disease incidence that accompanies this demographic shift, is likely to increase both the economic and medical burden associated with stroke in western societies. Rehabilitation, the standard treatment for stroke, can be expanded and augmented with state of the art technologies, such as robotic therapy. This paper expands upon a recent work involving a force-feedback master-slave bimanual exoskeleton for elbow rehabilitation, named a Bimanual Wearable Robotic Device (BWRD). Elbow force data acquired during the execution of custom tasks is analyzed to demonstrate the feasibility of tracking patient progress. Two training tasks that focus on applied forces are examined. The first is called "slave arm follow", which uses the absolute angular impulse as a metric; the second is called "conditional arm static", which uses the rise time to target as a metric, both presented here. The outcomes of these metrics are observed over three days.
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27
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Lawal IU, Hillier SL, Hamzat TK, Rhoda A. Effectiveness of a structured circuit class therapy model in stroke rehabilitation: a protocol for a randomised controlled trial. BMC Neurol 2015; 15:88. [PMID: 26055635 PMCID: PMC4460628 DOI: 10.1186/s12883-015-0348-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 05/29/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Currently, the key advocacy in neuroscientific studies for stroke rehabilitation is that therapy should be directed towards task specificity performed with multiple repetitions. Circuit Class Therapy (CCT) is well suited to accomplish multiple task-specific activities. However, while repetitive task practice is achievable with circuit class therapy, in stroke survivors repetitive activities may be affected by poor neurologic inputs to motor units, resulting in decreases in discharging rates which consequently may reduce the efficiency of muscular contraction. To accomplish multiple repetitions, stroke survivors may require augmented duration of practice. To date, no study has examined the effect of augmented duration of CCT in stroke rehabilitation, and specifically what duration of CCT is more effective in influencing functional capacity among stroke survivors. METHODS/DESIGN Using a randomised controlled trial with blinded outcome assessment, this study is aimed at determining the effectiveness of structured augmented CCT in stroke rehabilitation. Sixty-eight stroke survivors (to be recruited from a tertiary health institution in Kano, Northwest, Nigeria) will be randomised into one of four groups: three intervention groups of differing CCT durations namely: 60 min, 90 min, and 120 minuntes respectively, and a control group. Participants will take part in an 8-week structured intensive CCT intervention. Participants will be assessed at baseline, post-intervention, and six-month follow-up for the effectiveness of the varied durations of therapy, using standardised tools. Based on the WHO-ICF model, the outcomes are body structure/function, activity limitation, and participation restriction measures. DISCUSSION It is expected that the outcome of this study will clarify whether increasing CCT duration leads to better recovery of motor function in stroke survivors. TRIAL REGISTRATION Pan African Clinical Trial Registry (PACTR): PACTR201311000701191.
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Affiliation(s)
- Isa U Lawal
- Department of Physiotherapy, Faculty Community and Health Sciences, University of the Western Cape, Private Bag X17, Bellville, 7535, South Africa.
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Private Mail Bag 3011, Nigeria.
| | - Susan L Hillier
- International Centre for Allied Health Evidence, School of Health Sciences, University of South Australia (City East), Adelaide, 5000, Australia.
| | - Talhatu K Hamzat
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine University of Ibadan, Queen Elizabeth Road, Private Mail Bag 5017, GPO Dugbe, Ibadan, Nigeria.
| | - Anthea Rhoda
- Department of Physiotherapy, Faculty Community and Health Sciences, University of the Western Cape, Private Bag X17, Bellville, 7535, South Africa.
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Herrnstadt G, Alavi N, Randhawa BK, Boyd LA, Menon C. Bimanual elbow robotic orthoses: preliminary investigations on an impairment force-feedback rehabilitation method. Front Hum Neurosci 2015; 9:169. [PMID: 25870555 PMCID: PMC4378290 DOI: 10.3389/fnhum.2015.00169] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 03/11/2015] [Indexed: 11/13/2022] Open
Abstract
Modern rehabilitation practices have begun integrating robots, recognizing their significant role in recovery. New and alternative stroke rehabilitation treatments are essential to enhance efficacy and mitigate associated health costs. Today's robotic interventions can play a significant role in advancing rehabilitation. In addition, robots have an inherent ability to perform tasks accurately and reliably and are typically well suited to measure and quantify performance. Most rehabilitation strategies predominantly target activation of the paretic arm. However, bimanual upper-limb rehabilitation research suggests potential in enhancing functional recovery. Moreover, studies suggest that limb coordination and synchronization can improve treatment efficacy. In this preliminary study, we aimed to investigate and validate our user-driven bimanual system in a reduced intensity rehab practice. A bimanual wearable robotic device (BWRD) with a Master-Slave configuration for the elbow joint was developed to carry out the investigation. The BWRD incorporates position and force sensors for which respective control loops are implemented, and offers varying modes of operation ranging from passive to active training. The proposed system enables the perception of the movements, as well as the forces applied by the hemiparetic arm, with the non-hemiparetic arm. Eight participants with chronic unilateral stroke were recruited to participate in a total of three 1-h sessions per participant, delivered in a week. Participants underwent pre- and post-training functional assessments along with proprioceptive measures. The post-assessment was performed at the end of the last training session. The protocol was designed to engage the user in an assortment of static and dynamic arm matching and opposing tasks. The training incorporates force-feedback movements, force-feedback positioning, and force matching tasks with same and opposite direction movements. We are able to suggest identification of impairment patterns in the position-force plot results. In addition, we performed a proprioception evaluation with the system. We set out to design innovative and user immersive training tasks that utilize the BWRD capabilities, and we demonstrate that the subjects were able to cooperate and accomplish the protocol. We found that the Fugl-Meyer and Wolf Motor Function Test (pre to post) measured improvements (15 and 19%, respectively). Recognizing the brevity of the training, we focus our report primarily on the proprioception testing (32% significant improvement, p prop = 0.033) and protocol distinctive features and results. This paper presents the electromechanical features and performance of the BWRD, the testing protocol, and the assessments utilized. Outcome measures and results are presented and demonstrate the successful application and operation of the system.
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Affiliation(s)
- Gil Herrnstadt
- MENRVA Laboratory, School of Engineering Science, Simon Fraser University , Burnaby, BC , Canada
| | - Nezam Alavi
- MENRVA Laboratory, School of Engineering Science, Simon Fraser University , Burnaby, BC , Canada
| | | | - Lara A Boyd
- Brain Behavior Laboratory, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada
| | - Carlo Menon
- MENRVA Laboratory, School of Engineering Science, Simon Fraser University , Burnaby, BC , Canada
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Souza WC, Conforto AB, Orsini M, Stern A, André C. Similar Effects of Two Modified Constraint-Induced Therapy Protocols on Motor Impairment, Motor Function and Quality of Life in Patients with Chronic Stroke. Neurol Int 2015; 7:5430. [PMID: 26294941 PMCID: PMC4508540 DOI: 10.4081/ni.2015.5430] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 01/03/2015] [Indexed: 01/05/2023] Open
Abstract
Modified constraint-induced movement therapy (CIMT) protocols show motor function and real-world arm use improvement. Meanwhile it usually requires constant supervision by physiotherapists and is therefore more expensive than customary care. This study compared the preliminary efficacy of two modified CIMT protocols. A two-group randomized controlled trial with pre and post treatment measures and six months follow-up was conducted. Nineteen patients with chronic stroke received 10 treatment sessions distributed three to four times a week over 22 days. CIMT3h_direct group received 3 hours of CIMT supervised by a therapist (n=10) while CIMT1.5h_direct group had 1.5 hours of supervised CIMT+1.5 hours home exercises supervised by a caregiver (n=9). Outcome measures were the Fugl-Meyer Assessment, the Motor Activity Log, and the Stroke Specific Quality of Life Scale. The modified CIMT protocols were feasible and well tolerated. Improvements in motor function, real-world arm use and quality of life did not differ significantly between treated groups receiving either 3 or 1.5 hours mCIMT supervised by a therapist.
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Affiliation(s)
- Wilma Costa Souza
- Federal University of Rio de Janeiro, Rehabilitation Center of Rio de Janeiro, Brazil
| | - Adriana B. Conforto
- Neurostimulation Laboratory, Hospital das Cĺinicas/São Paulo University, Brazil
| | - Marco Orsini
- Neurology Department, Centro Universitário Augusto Mottta, UNISUAM, Bonsucesso, Brazil
| | - Annette Stern
- School of Psychology, University of Surrey, Guildford, UK
| | - Charles André
- Department of Neurology, School of Medicine, Federal University of Rio de Janeiro, Brazil
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Narayan Arya K, Verma R, Garg R, Sharma V, Agarwal M, Aggarwal G. Meaningful Task-Specific Training (MTST) for Stroke Rehabilitation: A Randomized Controlled Trial. Top Stroke Rehabil 2015; 19:193-211. [DOI: 10.1310/tsr1903-193] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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El-Basatiny HMY, Abdel-Aziem AA. Effect of backward walking training on postural balance in children with hemiparetic cerebral palsy: a randomized controlled study. Clin Rehabil 2014; 29:457-67. [PMID: 25258425 DOI: 10.1177/0269215514547654] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 07/26/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To study the effect of additional backward walking training on postural control in children with hemiparetic cerebral palsy. DESIGN Randomized controlled study. SETTING Physical therapy clinics. SUBJECTS Thirty spastic hemiparetic cerebral palsied children of both sexes (10-14 years, 14 girls and 16 boys). INTERVENTION Children were randomly assigned into two equal groups: experimental and control groups. Both groups received a traditional physical therapy program for 12 weeks. Experimental group additionally received backward walking training which was provided 25 min/day, 3 days/week for 3 successive months. OUTCOME MEASURES Baseline and post-treatment assessment for overall, anteroposterior, and mediolateral stability indices were evaluated by using Biodex balance system. RESULTS After treatment; two way ANOVA revealed significant improvement in overall, anteroposterior and mediolateral stability indices of experimental group at the most stable level (level 12) and moderately unstable level (level 7) (1.40 ± 0.44 and 1.73 ± 0.51; 1.11 ± 0.34 and 2.13 ± 0.52; 1.93 ± 0.51 and 2.68 ± 0.52) respectively, than control group (1.77 ± 0.44 and 2.17 ± 0.56; 1.44 ± 0.44 and 2.54 ± 0.49; 2.39 ± 0.65 and 3.11 ± 0.49) respectively, (P < 0.05). There were significant improvement in all measured variables for both groups at both levels (P < 0.05). CONCLUSION Additional backward walking training to traditional physical therapy program yields improvement in postural stability indices in children with spastic hemiparetic cerebral palsy than traditional physical therapy alone.
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Affiliation(s)
- Heba M Youssr El-Basatiny
- Department of Physical Therapy for Growth and Developmental Disorders in Children and its Surgery, Faculty of Physical Therapy, Cairo University, Egypt Physical Therapy Department, College of Applied Medical Sciences, University of Dammam, Saudi Arabia
| | - Amr Almaz Abdel-Aziem
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Kim JY, Kim JM, Ko EY. The effect of the action observation physical training on the upper extremity function in children with cerebral palsy. J Exerc Rehabil 2014; 10:176-83. [PMID: 25061598 PMCID: PMC4106773 DOI: 10.12965/jer.140114] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 06/19/2014] [Indexed: 11/22/2022] Open
Abstract
The purpose this study was to investigate the effect of action observation physical training (AOPT) on the functioning of the upper extremities in children with cerebral palsy (CP), using an evaluation framework based on that of the International Classification of Functioning, Disability and Health (ICF). The subjects were divided into an AOPT group and a physical training (PT) group. AOPT group practiced repeatedly the actions they observed on video clips, in which normal child performed an action with their upper extremities. PT group performed the same actions as the AOPT group did after observing landscape photographs. The subjects participated in twelve 30-min sessions, 3 days a week, for 4 weeks. Evaluation of upper extremity function using the following: the power of grasp and Modified Ashworth Scale for body functions and structures, a Box and Block test, an ABILHAND-Kids questionnaire, and the WeeFIM scale for activity and participation. Measurements were performed before and after the training, and 2 weeks after the end of training. The results of this study showed that, in comparison with the PT group, the functioning of the upper extremities in the AOPT group was significantly improved in body functions and activity and participation according to the ICF framework. This study demonstrates that AOPT has a positive influence on the functioning of the upper extremities in children with CP. It is suggested that this alternative approach for functioning of the upper extremities could be an effective method for rehabilitation in children with CP.
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Affiliation(s)
- Jin-Young Kim
- Department of Occupational Therapy, Howon University, Gunsan, Korea
| | - Jong-Man Kim
- Department of Occupational Therapy, Jeonju University, Jeonju, Korea
| | - Eun-Young Ko
- Department of Physical Therapy, Singa Hospital, Gwangju, Korea
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Jung J, Yu J, Kang H. Effects of Virtual Reality Treadmill Training on Balance and Balance Self-efficacy in Stroke Patients with a History of Falling. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.1133] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jinhwa Jung
- Department of Occupational Therapy, Semyung University
| | - Jaeho Yu
- Department of Physical Therapy, Kangwon National University
| | - Hyungkyu Kang
- Department of Physical Therapy, Graduate School, Sahmyook University
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Shim S, Yu J, Jung J, Kang H, Cho K. Effects of Motor Dual Task Training on Spatio-temporal Gait Parameters of Post-stroke Patients. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.845] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sunhwa Shim
- Department of Occupational Therapy, Graduate School of Health Science, Yonsei University
| | - Jaeho Yu
- Department of Physical Therapy, Kangwon National University
| | - Jinhwa Jung
- Department of Occupational Therapy, Semyung University
| | | | - Kihun Cho
- Department of Physical Therapy, Seoul BukBu Hospital
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DePaul VG, Wishart LR, Richardson J, Lee TD, Thabane L. Varied overground walking-task practice versus body-weight-supported treadmill training in ambulatory adults within one year of stroke: a randomized controlled trial protocol. BMC Neurol 2011; 11:129. [PMID: 22018267 PMCID: PMC3229453 DOI: 10.1186/1471-2377-11-129] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 10/21/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although task-oriented training has been shown to improve walking outcomes after stroke, it is not yet clear whether one task-oriented approach is superior to another. The purpose of this study is to compare the effectiveness of the Motor Learning Walking Program (MLWP), a varied overground walking task program consistent with key motor learning principles, to body-weight-supported treadmill training (BWSTT) in community-dwelling, ambulatory, adults within 1 year of stroke. METHODS/DESIGN A parallel, randomized controlled trial with stratification by baseline gait speed will be conducted. Allocation will be controlled by a central randomization service and participants will be allocated to the two active intervention groups (1:1) using a permuted block randomization process. Seventy participants will be assigned to one of two 15-session training programs. In MLWP, one physiotherapist will supervise practice of various overground walking tasks. Instructions, feedback, and guidance will be provided in a manner that facilitates self-evaluation and problem solving. In BWSTT, training will emphasize repetition of the normal gait cycle while supported over a treadmill, assisted by up to three physiotherapists. Outcomes will be assessed by a blinded assessor at baseline, post-intervention and at 2-month follow-up. The primary outcome will be post-intervention comfortable gait speed. Secondary outcomes include fast gait speed, walking endurance, balance self-efficacy, participation in community mobility, health-related quality of life, and goal attainment. Groups will be compared using analysis of covariance with baseline gait speed strata as the single covariate. Intention-to-treat analysis will be used. DISCUSSION In order to direct clinicians, patients, and other health decision-makers, there is a need for a head-to-head comparison of different approaches to active, task-related walking training after stroke. We hypothesize that outcomes will be optimized through the application of a task-related training program that is consistent with key motor learning principles related to practice, guidance and feedback. TRIAL REGISTRATION ClinicalTrials.gov # NCT00561405.
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Affiliation(s)
- Vincent G DePaul
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
- Physiotherapy Department, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Laurie R Wishart
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Julie Richardson
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Timothy D Lee
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare - Hamilton, Hamilton Ontario, Canada
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Kang HK, Kim Y, Chung Y, Hwang S. Effects of treadmill training with optic flow on balance and gait in individuals following stroke: randomized controlled trials. Clin Rehabil 2011; 26:246-55. [PMID: 21971754 DOI: 10.1177/0269215511419383] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study examined the effects of treadmill training with optic flow on the functional recovery of balance and gait in stroke patients. DESIGN Randomized controlled experimental study. PARTICIPANTS Thirty patients following stroke were divided randomly into the treadmill with optic flow group (n = 10), treadmill group (n = 10) and control group (n = 10). INTERVENTIONS The subjects in the experimental group wore a head-mounted display to receive speed-modulated optic flow during treadmill training for 30 minutes, while those in the treadmill group and control group received treadmill training and regular therapy for the same time, three times a week for four weeks. MAIN MEASURES The data were collected using timed up-and-go test, functional reach test, 10-m walk test, and six-minute walk test before and after treatment. RESULTS The timed up-and-go test in the treadmill with optic flow group (5.55 ± 2.04) improved significantly greater than the treadmill (1.50 ± 0.93) and control (0.40 ± 0.84) groups. The functional reach test in the treadmill with optic flow group (2.78 ± 1.44) was significantly higher than the control group (0.20 ± 0.16) only. The gait velocity in the treadmill with optic flow group (0.21 ± 0.06) showed a significant decrease compared to the treadmill (0.03 ± 0.02) and control (0.01 ± 0.02) groups. Finally, the six-minute walk test in the treadmill with optic flow group (24.49 ± 11.00) showed significant improvement compared to the treadmill training (4.65 ± 3.25) and control (1.79 ± 3.08) groups. CONCLUSION Treadmill using optic flow speed modulation improves the balance and gait significantly in patients with stroke who are able to participate in physical gait training.
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Affiliation(s)
- Hyung-Kyu Kang
- Department of Physical Therapy, The Graduate School, Sahmyook University, Seoul, Republic of Korea
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Gharib NM, El-Maksoud GMA, Rezk-Allah SS. Efficacy of gait trainer as an adjunct to traditional physical therapy on walking performance in hemiparetic cerebral palsied children: a randomized controlled trial. Clin Rehabil 2011; 25:924-34. [PMID: 21427153 DOI: 10.1177/0269215511400768] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the effects of additional gait trainer assisted walking exercises on walking performance in children with hemiparetic cerebral palsy. DESIGN A randomized controlled study. SETTING Paediatric physical therapy outpatient clinic. SUBJECTS Thirty spastic hemiparetic cerebral palsied children of both sexes (10-13 years - 19 girls and 11 boys). METHODS Children were randomly assigned into two equal groups; experimental and control groups. Participants in both groups received a traditional physical therapy exercise programme. Those in the experimental group received additional gait trainer based walking exercises which aimed to improve walking performance. Treatment was provided three times per week for three successive months. MAIN MEASURES Children received baseline and post-treatment assessments using Biodex Gait Trainer 2 assessment device to evaluate gait parameters including: average step length, walking speed, time on each foot (% of gait cycle) and ambulation index. RESULTS Children in the experimental group showed a significant improvement as compared with those in the control group. The ambulation index was 75.53±7.36 (11.93 ± 2.89 change score) for the experimental group and 66.06 ± 5.48 (2.13 ± 4.43 change score) for the control group (t = 3.99 and P = 0.0001). Time of support for the affected side was 42.4 ± 3.37 (7 ± 2.20 change score) for the experimental group and 38.06 ± 4.63 (3.33 ± 6.25 change score) for the control group (t = 2.92 and P = 0.007). Also, there was a significant improvement in step length and walking speed in both groups. CONCLUSION Gait trainer combined with traditional physiotherapy increase the chance of improving gait performance in children with spastic hemiparetic cerebral palsy.
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Affiliation(s)
- Nevein Mm Gharib
- Department of Physical Therapy for Neuromuscular Disorders and its Surgery, Cairo University, Giza, Egypt.
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Movement therapy induced neural reorganization and motor recovery in stroke: a review. J Bodyw Mov Ther 2011; 15:528-37. [PMID: 21943628 DOI: 10.1016/j.jbmt.2011.01.023] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 01/22/2011] [Accepted: 01/29/2011] [Indexed: 11/22/2022]
Abstract
This paper is a review conducted to provide an overview of accumulated evidence on contemporary rehabilitation methods for stroke survivors. Loss of functional movement is a common consequence of stroke for which a wide range of interventions has been developed. Traditional therapeutic approaches have shown limited results for motor deficits as well as lack evidence for their effectiveness. Stroke rehabilitation is now based on the evidence of neuroplasticity, which is responsible for recovery following stroke. The neuroplastic changes in the structure and function of relevant brain areas are induced primarily by specific rehabilitation methods. The therapeutic method which induces neuroplastic changes, leads to greater motor and functional recovery than traditional methods. Further, the recovery is permanent in nature. During the last decade various novel stroke rehabilitative methods for motor recovery have been developed. This review focuses on the methods that have evidence of associated cortical level reorganization, namely task-specific training, constraint-induced movement therapy, robotic training, mental imaging, and virtual training. All of these methods utilize principles of motor learning. The findings from this review demonstrated convincing evidence both at the neural and functional level in response to such therapies. The main aim of the review was to determine the evidence for these methods and their application into clinical practice.
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