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Tseng KC, Wang L, Hsieh C, Wong AM. Portable robots for upper-limb rehabilitation after stroke: a systematic review and meta-analysis. Ann Med 2024; 56:2337735. [PMID: 38640459 PMCID: PMC11034452 DOI: 10.1080/07853890.2024.2337735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/28/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Robot-assisted upper-limb rehabilitation has been studied for many years, with many randomised controlled trials (RCTs) investigating the effects of robotic-assisted training on affected limbs. The current trend directs towards end-effector devices. However, most studies have focused on the effectiveness of rehabilitation devices, but studies on device sizes are relatively few. GOAL Systematically review the effect of a portable rehabilitation robot (PRR) on the rehabilitation effectiveness of paralysed upper limbs compared with non-robotic therapy. METHODS A meta-analysis was conducted on literature that included the Fugl-Meyer Assessment (FMA) obtained from the PubMed and Web of Science (WoS) electronic databases until June 2023. RESULTS A total of 9 studies, which included RCTs, were completed and a meta-analysis was conducted on 8 of them. The analysis involved 295 patients. The influence on upper-limb function before and after treatment in a clinical environment is analysed by comparing the experimental group using the portable upper-limb rehabilitation robot with the control group using conventional therapy. The result shows that portable robots prove to be effective (FMA: SMD = 0.696, 95% = 0.099 to.293, p < 0.05). DISCUSSION Both robot-assisted and conventional rehabilitation effects are comparable. In some studies, PRR performs better than conventional rehabilitation, but conventional treatments are still irreplaceable. Smaller size with better portability has its advantages, and portable upper-limb rehabilitation robots are feasible in clinical rehabilitation. CONCLUSION Although portable upper-limb rehabilitation robots are clinically beneficial, few studies have focused on portability. Further research should focus on modular design so that rehabilitation robots can be decomposed, which benefits remote rehabilitation and household applications.
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Affiliation(s)
- Kevin C. Tseng
- Department of Industrial Design, National Taipei University of Technology, Taipei, Taiwan, ROC
- Product Design and Development Laboratory, Taoyuan, Taiwan, ROC
| | - Le Wang
- Product Design and Development Laboratory, Taoyuan, Taiwan, ROC
| | - Chunkai Hsieh
- Product Design and Development Laboratory, Taoyuan, Taiwan, ROC
| | - Alice M. Wong
- Product Design and Development Laboratory, Taoyuan, Taiwan, ROC
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan, ROC
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Tsai HT, Lau HY, Lin KC, Li YC, Lin CJ, Yao G, Lee YY, Chen WS, Chen CL, Chang YJ, Horng YS. Responsiveness and construct validity of two outcome measures of bilateral upper limb function in patients with chronic stroke. Front Neurol 2024; 15:1352365. [PMID: 38846043 PMCID: PMC11153685 DOI: 10.3389/fneur.2024.1352365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 05/07/2024] [Indexed: 06/09/2024] Open
Abstract
Background Stroke is a leading cause of long-term disability among stroke survivors. Despite the availability of numerous stroke rehabilitative therapies, such as mirror therapy, bilateral arm training, and robot-assisted therapy, the recovery of motor function after stroke remains incomplete. Bilateral arm function is a key component in stroke patients to perform activities of daily living and to reflect their functional autonomy. Objective This clinimetric study investigated and compared the construct validity and responsiveness of 2 bimanual activity outcome measures, the Chedoke Arm and Hand Activity Inventory (CAHAI) and the ABILHAND Questionnaire, in individuals receiving stroke rehabilitation. Methods The present study is a secondary analysis following the framework of the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). Individuals with chronic stroke (N = 113) were recruited from outpatient rehabilitation settings. Participants received 18 to 20 sessions of robot-assisted therapy, mirror therapy, combined therapy, or conventional rehabilitation for 4 to 6 weeks. The CAHAI, ABILHAND Questionnaire, and a comparison instrument, the Motor Activity Log (MAL), were administered twice at a 4- to 6-week interval to all participants. ABILHAND scores, in logits, were converted from raw ordinal scores into a linear measure. Results There was medium to large correlation of the CAHAI and the MAL (ρ = 0.60-0.62, p < 0.01) as well as the ABILHAND Questionnaire and the MAL (ρ = 0.44-0.51, p < 0.01). Change scores from the initial measurement to the post-intervention measurement demonstrated small to medium correlation of the CAHAI and the MAL (ρ = 0.27-0.31, p < 0.01) and medium to large correlation of the ABILHAND Questionnaire and the MAL (ρ = 0.37-0.41, p < 0.01). Overall, 7 of 8 hypotheses were supported. The hypothesis testing regarding the construct validity and responsiveness of the CAHAI and ABILHAND Questionnaire was confirmed. Conclusion The CAHAI and ABILHAND Questionnaire are both responsive and suitable to detect changes in bilateral arm functional daily activities in individuals with chronic stroke. Patient-reported outcome measures are recommended to use along with therapist-rated outcome measures for upper limb capacity evaluation in stroke rehabilitation. Further study with a prospective study design to capture specific clinical features of participants and the use of body-worn sensors, such as the arm accelerometer, is suggested.
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Affiliation(s)
- Han-ting Tsai
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hiu-ying Lau
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Keh-chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-chun Li
- Department of Occupational Therapy, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chia-jung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Grace Yao
- Department of Psychology, National Taiwan University, Taipei, Taiwan
| | - Ya-yun Lee
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-shiang Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chia-ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ya-ju Chang
- Neuroscience Research Center, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Yi-shiung Horng
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Tzuchi Hospital, Buddhist Tzuchi Medical Foundation, New Taipei City, Taiwan
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Halawani A, Aljabri A, Bahathiq DM, Morya RE, Alghamdi S, Makkawi S. The efficacy of contralaterally controlled functional electrical stimulation compared to conventional neuromuscular electrical stimulation for recovery of limb function following a stroke: a systematic review and meta-analysis. Front Neurol 2024; 15:1340248. [PMID: 38450065 PMCID: PMC10915254 DOI: 10.3389/fneur.2024.1340248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/30/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction Limb paresis following a stroke is a common sequela that can impact patients' quality of life. Many rehabilitation strategies targeting the restoration of motor function exist. This systematic review and meta-analysis aim to evaluate the effects of contralaterally controlled functional electrical stimulation (CCFES) as a modality for limb rehabilitation. Unlike conventional neuromuscular electrical simulation (NMES), the contra-laterality in CCFES is achieved by two methods a bend angle sensor or an electromyographic bridge (EMGB) method, both of which targets signals from the unaffected limb. Method This review study was performed following the preferred reporting item for systematic review and meta-analysis (PRISMA) guidelines. Records that met the inclusion criteria were extracted from the following databases: Medline, Embase, and Cochrane Register of Controlled Trials (CENTRAL). Additional articles were also retrieved from clinicaltrials.gov and China/Asia on Demand (CAOD). Only randomized controlled studies (RCTs) were included. Results Sixteen RCTs met the inclusion criteria, and 14 of which were included in the quantitative analysis (meta-analysis). The results of the analysis show that when compared to conventional NMES, CCFES displayed a better improvement in the upper extremity Fugl-Meyer assessment (UEFMA) (SMD = 0.41, 95% CI: 0.21, 0.62, p-value <0.0001, I2 = 15%, GRADE: moderate), box and blocks test (BBT) (SMD = 0.48, 95% CI: 0.10, 0.86, p-value = 0.01, I2 = 0%, GRADE: very low), modified Barthel index (mBI) (SMD = 0.44, 95% CI: 0.16, 0.71, p-value = 0.002, I2 = 0%, GRADE: moderate), active range of motion (AROM) (SMD = 0.61, 95% CI: 0.29, 0.94, p-value = 0.0002, I2 = 23%, GRADE: moderate), and surface electromyography (sEMG) scores (SMD = 0.52, 95% CI: 0.14, 0.90, p-value = 0.008, I2 = 0%, GRADE: low). The results of the subgroup analysis for the type of sensor used in CCFES shows that an EMGB (SMD = 0.58, 95% CI: 0.33, 0.84, p-value <0.00001, I2 = 7%) is more effective than a bend angle sensor (SMD = 0.17, 95% CI: -0.12, 0.45, p-value = 0.25, I2 = 0%). Conclusion The results of this study provide strong evidence that shows CCFES being a better electrical stimulation modality compared to conventional NMES. This could be explained by the fact that CCFES is bilateral in nature which offers a platform for better neuroplasticity following a stroke. There is still a need for high-quality studies with a standardized approach comparing CCFES to other treatment modalities. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=342670, identifier CRD42022342670.
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Affiliation(s)
- Alhussain Halawani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ammar Aljabri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Dena M. Bahathiq
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Roaa E. Morya
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Saeed Alghamdi
- Neuroscience Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Seraj Makkawi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Neuroscience, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia
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Rogojin A, Gorbet DJ, Sergio LE. Sex differences in the neural underpinnings of unimanual and bimanual control in adults. Exp Brain Res 2023; 241:793-806. [PMID: 36738359 DOI: 10.1007/s00221-023-06561-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023]
Abstract
While many of the movements we make throughout our day involve just one upper limb, most daily movements require a certain degree of coordination between both upper limbs. Historically, sex differences in eye-hand coordination have been observed. As well, there are demonstrated sex-specific differences in hemisphere symmetry, interhemispheric connectivity, and motor cortex organization. While it has been suggested that these anatomical differences may underlie sex-related differences in performance, sex differences in the functional neural correlate underlying bimanual performance have not been explicitly investigated. In the current study we tested the hypothesis that the functional connectivity underlying bimanual movement control differed depending on the sex of an individual. Participants underwent MRI scanning to acquire anatomical and functional brain images. During the functional runs, participants performed unimanual and bimanual coordination tasks using two button boxes. The tasks included pressing the buttons in time to an auditory cue with either their left or their right hand individually (unimanual), or with both hands simultaneously (bimanual). The bimanual task was further divided into either an in-phase (mirror/symmetrical) or anti-phase (parallel/asymmetrical) condition. Participants were provided with extensive training to ensure task comprehension, and performance error rates were found to be equivalent between men and women. A generalized psychophysiological interaction (gPPI) analysis was implemented to examine how functional connectivity in each condition was modulated by sex. In support of our hypothesis, women and men demonstrated differences in the neural correlates underlying unimanual and bimanual movements. In line with previous literature, functional connectivity patterns showed sex-related differences for right- vs left-hand movements. Sex-specific functional connectivity during bimanual movements was not a sum of the functional connectivity underlying right- and left-hand unimanual movements. Further, women generally showed greater interhemispheric functional connectivity across all conditions compared to men and had greater connectivity between task-related cortical areas, while men had greater connectivity involving the cerebellum. Sex differences in brain connectivity were associated with both unimanual and bimanual movement control. Not only do these findings provide novel insight into the fundamentals of how the brain controls bimanual movements in both women and men, they also present potential clinical implications on how bimanual movement training used in rehabilitation can best be tailored to the needs of individuals.
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Affiliation(s)
- Alica Rogojin
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
- Centre for Vision Research, York University, Toronto, ON, Canada
- Vision: Science to Applications (VISTA) Program, York University, Toronto, ON, Canada
| | - Diana J Gorbet
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
- Centre for Vision Research, York University, Toronto, ON, Canada
- Vision: Science to Applications (VISTA) Program, York University, Toronto, ON, Canada
| | - Lauren E Sergio
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
- Centre for Vision Research, York University, Toronto, ON, Canada.
- Vision: Science to Applications (VISTA) Program, York University, Toronto, ON, Canada.
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Li M, Wang J, Yang S, Xie J, Xu G, Luo S. A CNN-LSTM model for six human ankle movements classification on different loads. Front Hum Neurosci 2023; 17:1101938. [PMID: 36968785 PMCID: PMC10030731 DOI: 10.3389/fnhum.2023.1101938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/14/2023] [Indexed: 03/29/2023] Open
Abstract
This study aims to address three problems in current studies in decoding the ankle movement intention for robot-assisted bilateral rehabilitation using surface electromyogram (sEMG) signals: (1) only up to four ankle movements could be identified while six ankle movements should be classified to provide better training; (2) feeding the raw sEMG signals directly into the neural network leads to high computational cost; and (3) load variation has large influence on classification accuracy. To achieve this, a convolutional neural network (CNN)-long short-term memory (LSTM) model, a time-domain feature selection method of the sEMG, and a two-step method are proposed. For the first time, the Boruta algorithm is used to select time-domain features of sEMG. The selected features, rather than raw sEMG signals are fed into the CNN-LSTM model. Hence, the number of model's parameters is reduced from 331,938 to 155,042, by half. Experiments are conducted to validate the proposed method. The results show that our method could classify six ankle movements with relatively good accuracy (95.73%). The accuracy of CNN-LSTM, CNN, and LSTM models with sEMG features as input are all higher than that of corresponding models with raw sEMG as input. The overall accuracy is improved from 73.23% to 93.50% using our two-step method for identifying the ankle movements with different loads. Our proposed CNN-LSTM model have the highest accuracy for ankle movements classification compared with CNN, LSTM, and Support Vector Machine (SVM).
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Affiliation(s)
- Min Li
- Department of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Min Li
| | - Jiale Wang
- Department of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Shiqi Yang
- Department of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Jun Xie
- Department of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Guanghua Xu
- Department of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Shan Luo
- Department of Engineering, King’s College London, London, United Kingdom
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The influence of distal and proximal muscle activation on neural crosstalk. PLoS One 2022; 17:e0275997. [PMID: 36282810 PMCID: PMC9595517 DOI: 10.1371/journal.pone.0275997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022] Open
Abstract
Previous research has indicated that neural crosstalk is asymmetric, with the dominant effector exerting a stronger influence on the non-dominant effector than vice versa. Recently, it has been hypothesized that this influence is more substantial for proximal than distal effectors. The current investigation was designed to determine the effects of distal ((First Dorsal Interosseous (FDI)) and proximal (triceps brachii (TBI)) muscle activation on neural crosstalk. Twelve right-limb dominant participants (mean age = 21.9) were required to rhythmically coordinate a 1:2 pattern of isometric force guided by Lissajous displays. Participants performed 10, 30 s trials with both distal and proximal effectors. Coherence between the two effector groups were calculated using EMG-EMG wavelet coherence. The results indicated that participants could effectively coordinate the goal coordination pattern regardless of the effectors used. However, spatiotemporal performance was more accurate when performing the task with distal than proximal effectors. Force distortion, quantified by harmonicity, indicated that more perturbations occurred in the non-dominant effector than in the dominant effector. The results also indicated significantly lower harmonicity for the non-dominant proximal effector compared to the distal effectors. The current results support the notion that neural crosstalk is asymmetric in nature and is greater for proximal than distal effectors. Additionally, the EMG-EMG coherence results indicated significant neural crosstalk was occurring in the Alpha bands (5-13 Hz), with higher values observed in the proximal condition. Significant coherence in the Alpha bands suggest that the influence of neural crosstalk is occurring at a subcortical level.
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Zhao Q, Jia G, Jia L, Wang Y, Jiang W, Feng Y, Jiang H, Yu L, Yu J, Tan B. Effects of Electromyography Bridge on Upper Limb Motor Functions in Stroke Participants: An Exploratory Randomized Controlled Trial. Brain Sci 2022; 12:brainsci12070870. [PMID: 35884677 PMCID: PMC9312916 DOI: 10.3390/brainsci12070870] [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: 05/30/2022] [Revised: 06/25/2022] [Accepted: 06/28/2022] [Indexed: 01/27/2023] Open
Abstract
The electromyography bridge (EMGB) plays an important role in promoting the recovery of wrist joint function in stroke patients. We investigated the effects of the EMGB on promoting the recovery of upper limb function in hemiplegia. Twenty-four stroke patients with wrist dorsal extension dysfunction were recruited. Participants were randomized to undergo EMGB treatment or neuromuscular electrical stimulation (NMES). Treatments to wrist extensors were conducted for 25 min, twice a day, 5 days per week, for 1 month. Outcome measures: active range of motion (AROM) of wrist dorsal extension; Fugl-Meyer assessment for upper extremity (FMA-UE); Barthel index (BI); and muscle strength of wrist extensors. After interventions, patients in the NMES group had significantly greater improvement in the AROM of wrist dorsal extension at the 4th week and 1st month follow-up (p < 0.05). However, patients in the EMGB group had a statistically significant increase in AROM only at the follow-up assessment. No significant differences were observed in the AROM between the EMGB group and the NMES group (p > 0.05). For secondary outcomes in the EMGB group, compared to baseline measurements, FMA-UE, BI, extensor carpi radialis and extensor carpi ulnaris muscle strength were significantly different as early as the 4th week (p < 0.05). The muscle strength of the extensor digitorum communis muscle showed significant differences at the follow-up (p < 0.05). There were no statistically significant differences between patients in the two groups in any of the parameters evaluated (p > 0.05). The combination of EMGB or NMES with conventional treatment had similar effects on the improvement of the hemiplegic upper limb as assessed by wrist dorsal extension, FMA-UE, and activities of daily living. The improvement in both groups was maintained until 1 month after the intervention.
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Affiliation(s)
- Qin Zhao
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (Q.Z.); (G.J.); (L.J.); (Y.W.); (W.J.); (Y.F.); (H.J.); (L.Y.)
| | - Gongwei Jia
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (Q.Z.); (G.J.); (L.J.); (Y.W.); (W.J.); (Y.F.); (H.J.); (L.Y.)
| | - Lang Jia
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (Q.Z.); (G.J.); (L.J.); (Y.W.); (W.J.); (Y.F.); (H.J.); (L.Y.)
| | - Yule Wang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (Q.Z.); (G.J.); (L.J.); (Y.W.); (W.J.); (Y.F.); (H.J.); (L.Y.)
| | - Wei Jiang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (Q.Z.); (G.J.); (L.J.); (Y.W.); (W.J.); (Y.F.); (H.J.); (L.Y.)
| | - Yali Feng
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (Q.Z.); (G.J.); (L.J.); (Y.W.); (W.J.); (Y.F.); (H.J.); (L.Y.)
| | - Hang Jiang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (Q.Z.); (G.J.); (L.J.); (Y.W.); (W.J.); (Y.F.); (H.J.); (L.Y.)
| | - Lehua Yu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (Q.Z.); (G.J.); (L.J.); (Y.W.); (W.J.); (Y.F.); (H.J.); (L.Y.)
| | - Jing Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China
- Correspondence: (J.Y.); (B.T.)
| | - Botao Tan
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (Q.Z.); (G.J.); (L.J.); (Y.W.); (W.J.); (Y.F.); (H.J.); (L.Y.)
- Correspondence: (J.Y.); (B.T.)
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Differences in motor unit recruitment patterns and low frequency oscillation of discharge rates between unilateral and bilateral isometric muscle contractions. Hum Mov Sci 2022; 83:102952. [DOI: 10.1016/j.humov.2022.102952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 11/20/2022]
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Chen S, Qiu Y, Bassile CC, Lee A, Chen R, Xu D. Effectiveness and Success Factors of Bilateral Arm Training After Stroke: A Systematic Review and Meta-Analysis. Front Aging Neurosci 2022; 14:875794. [PMID: 35547621 PMCID: PMC9082277 DOI: 10.3389/fnagi.2022.875794] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/28/2022] [Indexed: 12/05/2022] Open
Abstract
Bilateral arm training (BAT) presents as a promising approach in upper extremity (UE) rehabilitation after a stroke as it may facilitate neuroplasticity. However, the effectiveness of BAT is inconclusive, and no systematic reviews and meta-analyses have investigated the impact of different factors on the outcomes of BAT. This systematic review and meta-analysis aimed to (1) compare the effects of bilateral arm training (BAT) with unilateral arm training (UAT) and conventional therapy (CT) on the upper limb (UL) motor impairments and functional performance post-stroke, and (2) investigate the different contributing factors that may influence the success of BAT. A comprehensive literature search was performed in five databases. Randomized control trials (RCTs) that met inclusion criteria were selected and assessed for methodological qualities. Data relating to outcome measures, characteristics of participants (stroke chronicity and severity), and features of intervention (type of BAT and dose) were extracted for meta-analysis. With 25 RCTs meeting the inclusion criteria, BAT demonstrated significantly greater improvements in motor impairments as measured by Fugl-Meyer Assessment of Upper Extremity (FMA-UE) than CT (MD = 3.94, p = < 0.001), but not in functional performance as measured by the pooled outcomes of Action Research Arm Test (ARAT), Box and Block Test (BBT), and the time component of Motor Function Test (WMFT-time) (SMD = 0.28, p = 0.313). The superior motor impairment effects of BAT were associated with recruiting mildly impaired individuals in the chronic phase of stroke (MD = 6.71, p < 0.001), and applying a higher dose of intervention (MD = 6.52, p < 0.001). Subgroup analysis showed that bilateral functional task training (BFTT) improves both motor impairments (MD = 7.84, p < 0.001) and functional performance (SMD = 1.02, p = 0.049). No significant differences were detected between BAT and UAT for motor impairment (MD = -0.90, p = 0.681) or functional performance (SMD = -0.09, p = 0.457). Thus, our meta-analysis indicates that BAT may be more beneficial than CT in addressing post-stroke UL motor impairment, particularly in the chronic phase with mild UL paresis. The success of BAT may be dose-dependent, and higher doses of intervention may be required. BFTT appears to be a valuable form of BAT that could be integrated into stroke rehabilitation programs. BAT and UAT are generally equivalent in improving UL motor impairments and functional performance.
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Affiliation(s)
- Siyun Chen
- College of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Yuqi Qiu
- School of Statistics, East China Normal University, Shanghai, China
- Division of Biostatistics and Bioinformatics, University of California, San Diego, La Jolla, CA, United States
| | - Clare C. Bassile
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Anita Lee
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Ruifeng Chen
- Division of Biostatistics and Bioinformatics, University of California, San Diego, La Jolla, CA, United States
| | - Dongsheng Xu
- College of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
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Barak Ventura R, Stewart Hughes K, Nov O, Raghavan P, Ruiz Marín M, Porfiri M. Data-Driven Classification of Human Movements in Virtual Reality-Based Serious Games: Preclinical Rehabilitation Study in Citizen Science. JMIR Serious Games 2022; 10:e27597. [PMID: 35142629 PMCID: PMC8874800 DOI: 10.2196/27597] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/14/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background Sustained engagement is essential for the success of telerehabilitation programs. However, patients’ lack of motivation and adherence could undermine these goals. To overcome this challenge, physical exercises have often been gamified. Building on the advantages of serious games, we propose a citizen science–based approach in which patients perform scientific tasks by using interactive interfaces and help advance scientific causes of their choice. This approach capitalizes on human intellect and benevolence while promoting learning. To further enhance engagement, we propose performing citizen science activities in immersive media, such as virtual reality (VR). Objective This study aims to present a novel methodology to facilitate the remote identification and classification of human movements for the automatic assessment of motor performance in telerehabilitation. The data-driven approach is presented in the context of a citizen science software dedicated to bimanual training in VR. Specifically, users interact with the interface and make contributions to an environmental citizen science project while moving both arms in concert. Methods In all, 9 healthy individuals interacted with the citizen science software by using a commercial VR gaming device. The software included a calibration phase to evaluate the users’ range of motion along the 3 anatomical planes of motion and to adapt the sensitivity of the software’s response to their movements. During calibration, the time series of the users’ movements were recorded by the sensors embedded in the device. We performed principal component analysis to identify salient features of movements and then applied a bagged trees ensemble classifier to classify the movements. Results The classification achieved high performance, reaching 99.9% accuracy. Among the movements, elbow flexion was the most accurately classified movement (99.2%), and horizontal shoulder abduction to the right side of the body was the most misclassified movement (98.8%). Conclusions Coordinated bimanual movements in VR can be classified with high accuracy. Our findings lay the foundation for the development of motion analysis algorithms in VR-mediated telerehabilitation.
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Affiliation(s)
- Roni Barak Ventura
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Kora Stewart Hughes
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Oded Nov
- Department of Technology Management and Innovation, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Preeti Raghavan
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Manuel Ruiz Marín
- Department of Quantitative Methods, Law and Modern Languages, Technical University of Cartagena, Cartagena, Spain.,Murcia Bio-Health Institute (IMIB-Arrixaca), Health Science Campus, Cartagena, Spain
| | - Maurizio Porfiri
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States.,Center for Urban Science and Progress, New York University, Brooklyn, NY, United States.,Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
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11
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Motor Cortical Plasticity Induced by Volitional Muscle Activity-Triggered Transcranial Magnetic Stimulation and Median Nerve Stimulation. Brain Sci 2021; 12:brainsci12010061. [PMID: 35053805 PMCID: PMC8774239 DOI: 10.3390/brainsci12010061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022] Open
Abstract
Bilateral motor training is a useful method for modifying corticospinal excitability. The effects of bilateral movement that are caused by artificial stimulation on corticospinal excitability have not been reported. We compared motor-evoked potentials (MEPs) of the primary motor cortex (M1) after conventional bilateral motor training and artificial bilateral movements generated by electromyogram activity of abductor pollicis brevis (APB) muscle-triggered peripheral nerve stimulation (c-MNS) and transcranial magnetic stimulation of the ipsilateral M1 (i-TMS). A total of three protocols with different interventions—bilateral finger training, APB-triggered c-MNS, and APB-triggered i-TMS—were administered to 12 healthy participants. Each protocol consisted of 360 trials of 30 min for each trial. MEPs that were induced by single-pulse TMS, short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF) that were induced by paired-pulse TMS were assessed as outcome measures at baseline and at 0, 20, 40, and 60 min after intervention. MEP amplitude significantly increased up to 40 min post-intervention in all protocols compared to that at the baseline, although there were some differences in the changing pattern of ICF and SICI in each protocol. These findings suggest that artificial bilateral movement has the potential to increase the ipsilateral cortical excitability of the moving finger.
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12
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ZHANG LEIGANG, GUO SHUAI, SUN QING. DEVELOPMENT AND ANALYSIS OF A BILATERAL END-EFFECTER UPPER LIMB REHABILITATION ROBOT. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421500329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Studies have shown that rehabilitation training with the unaffected side guiding affected side is more consistent with the natural movement pattern of human upper limb compared with unilateral rehabilitation training, which is conducive to improve rehabilitation effect of the affected limb motor function. In this paper, a bilateral end-effector upper limb rehabilitation robot (BEULRR) based on two modern commercial manipulators is developed first, then the kinematics, reachability, and dexterity analysis of BEULRR are performed, respectively. Finally, a bilateral symmetric training protocol with the unaffected side guiding the affected side is proposed and evaluated through healthy human subject experiment testing based on BEULRR. The simulation results show that the developed BEULRR could perform spatial rehabilitation training and its rehabilitation training workspace can fully cover the physiological workspace of human upper limb. The preliminary experiment results from the healthy human subject show that the BEULRR system could provide reliable bilateral symmetric training protocol. These simulation and experiment results demonstrated that the developed BEULRR system could be used in bilateral rehabilitation training application, and also show that the BEULRR system has the potential to be applied to clinical rehabilitation training in the further step. In the close future, the proposed BEULRR and bilateral symmetric training protocol are planned to be applied in elderly volunteers and patients with upper limb motor dysfunction for further evaluating.
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Affiliation(s)
- LEIGANG ZHANG
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai 200444, P. R. China
| | - SHUAI GUO
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai 200444, P. R. China
| | - QING SUN
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai 200444, P. R. China
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13
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Lench DH, Hutchinson S, Woodbury ML, Hanlon CA. Kinematic Measures of Bimanual Performance are Associated With Callosum White Matter Change in People With Chronic Stroke. Arch Rehabil Res Clin Transl 2021; 2:100075. [PMID: 33543100 PMCID: PMC7853365 DOI: 10.1016/j.arrct.2020.100075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objectives To investigate the relationship between bimanual performance deficits measured using kinematics and callosum (CC) white matter changes that occur in people with chronic stroke. Design Cross-sectional, observational study of participants with chronic stroke and age-matched controls. Setting Recruitment and assessments occurred at a stroke recovery research center. Behavioral assessments were performed in a controlled laboratory setting. Magnetic resonance imaging scans were performed at the Center for Biomedical Imaging. Participants Individuals were enrolled and completed the study (N=39; 21 participants with chronic stroke; 18 age-matched controls with at least 2 stroke risk factors). Main Outcome Measures Diffusion imaging metrics were obtained for each individual’s CC and corticospinal tract (CST), including mean kurtosis (MK) and fractional anisotropy (FA). A battery of motor assessments, including bimanual kinematics, were collected from individuals while performing bimanual reaching. Results Participants with stroke had lower FA and MK in the CST of the lesioned hemisphere when compared with the non-lesioned hemisphere. The FA and MK values in the CST were correlated with measures of unimanual hand performance. In addition, participants with stroke had significantly lower FA and MK in the CC than matched controls. CC diffusion metrics positively correlated with hand asymmetry and trunk displacement during bimanual performance, even when correcting for age and lesion volume. Conclusions These data confirm previous studies that linked CST integrity to unimanual performance and provide new data demonstrating a link between CC integrity and both bimanual motor deficits and compensatory movements. Fractional anisotropy and mean kurtosis in the corpus callosum are lower in participants with stroke. Hand position symmetry and trunk displacement are disrupted during bimanual tasks. Corpus callosum white matter correlated with bimanual kinematics in participants with stroke.
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Key Words
- ANOVA, analysis of variance
- ARAT, Action Research Arm Test
- CC, corpus callosum
- CST, corticospinal tract
- DKI, diffusion kurtosis imaging
- DTI, diffusion tensor imaging
- Diffusion
- FA, fractional anisotropy
- FMA, Fugl-Meyer Assessment
- M1, primary motor cortex
- MK, mean kurtosis
- MRI, magnetic resonance imaging
- Motor Activity
- Pyramidal Tracts
- ROI, region of interest
- Rehabilitation
- SMA, supplementary motor area
- Stroke
- UE, upper extremity
- WMFT, Wolf Motor Function Test
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Affiliation(s)
- Daniel H. Lench
- Departments of Psychiatry and Neurosciences, College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Scott Hutchinson
- Department of Health Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Michelle L. Woodbury
- Department of Health Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Colleen A. Hanlon
- Departments of Psychiatry and Neurosciences, College of Medicine, Medical University of South Carolina, Charleston, SC
- Department of Health Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
- Department of Cancer Biology, College of Medicine, Wake Forest Health Sciences, Winston-Salem, NC
- Corresponding author Colleen A. Hanlon, PhD, 1 Medical Center Blvd, Wake Forest School of Medicine, Winston-Salem, NC 27157.
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14
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Wu J, Cheng H, Zhang J, Bai Z, Cai S. The modulatory effects of bilateral arm training (BAT) on the brain in stroke patients: a systematic review. Neurol Sci 2020; 42:501-511. [PMID: 33180209 DOI: 10.1007/s10072-020-04854-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 10/22/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To systematically review the modulatory effects of bilateral arm training (BAT) on the brain of stroke patients in contrast to unilateral arm training (UAT) or regular motor training. METHODS We conducted a literature search using PubMed, EMBASE, MEDLINE, and Science Citation Index Expanded databases from the inception to March 2019 for identifying any relevant studies. Two authors independently screened the literature, extracted data, and qualitatively described the included studies. RESULTS Eleven studies with a total of 225 stroke patients were included in this review. 156 out of those participants received neuroimaging or neurophysiological examinations. Six studies reported enhanced activation of the ipsilesional primary motor area (M1) induced by BAT, as measured by MEP and fMRI. Beyond the M1, three studies showed that supplementary motor area (SMA) was activated, and three studies found the primary sensory cortex area (S1) was activated by BAT in stroke patients, as measured by fMRI. One article showed that the inter-/intra-hemispheric functional connections of the sensorimotor network were more highly strengthened after BAT than regular motor training, in particular the functional connectivity between the SMA and the M1 in the bi-hemispheres. Three studies reported that BAT increased the inhibitory flow from the ipsilesional hemisphere to the contralesional hemisphere, as measured by interhemispheric transcallosal inhibition (IHI). However, the superiority of BAT in inducing a symmetric IHI than UAT was controversial. CONCLUSION BAT is potentially more effective than UAT in improving upper limb recovery after stroke by activating the ipsilesional primary motor area (M1), supplementary motor area (SMA), and primary sensory cortex (S1) and enhancing the intra-hemispheric and interhemispheric connectivity within the sensorimotor network and the cortical motor system.
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Affiliation(s)
- Jingyi Wu
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China
| | - Hao Cheng
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China
| | - Jiaqi Zhang
- The Hong Kong Polytechnic University, Hong Kong, China
| | - Zhongfei Bai
- The Hong Kong Polytechnic University, Hong Kong, China.,Department of Occupational Therapy, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Shanghai, China
| | - Sufang Cai
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China. .,Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China.
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15
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SADE I, AKSU M, ÇEKMECE Ç. Kronik İnmeli Hastalarda Ritmik İşitsel Uyarı İle Bilateral Kol Eğitim Tedavisinin Üst Ekstremite Fonksiyonlarına ve Günlük Yaşam Aktivitelerine Etkisinin Araştırılması. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2020. [DOI: 10.30934/kusbed.784411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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16
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The Effect of Occupation-Based Bilateral Upper Extremity Training in a Medical Setting for Stroke Patients: A Single-Blinded, Pilot Randomized Controlled Trial. J Stroke Cerebrovasc Dis 2019; 28:104335. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/17/2019] [Accepted: 07/30/2019] [Indexed: 11/23/2022] Open
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17
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Chen Y, Chen Y, Zheng K, Dodakian L, See J, Zhou R, Chiu N, Augsburger R, McKenzie A, Cramer SC. A qualitative study on user acceptance of a home-based stroke telerehabilitation system. Top Stroke Rehabil 2019; 27:81-92. [PMID: 31682789 DOI: 10.1080/10749357.2019.1683792] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: This paper reports a qualitative study of a home-based stroke telerehabilitation system. The telerehabilitation system delivers treatment sessions in the form of daily guided rehabilitation games, exercises, and stroke education in the patient's home. The aims of the current report are to investigate patient perceived benefits of and barriers to using the telerehabilitation system at home.Methods: We used a qualitative study design that involved in-depth semi-structured interviews with 13 participants who were patients in the subacute phase after stroke and had completed a six-week intervention using the home-based telerehabilitation system. Thematic analysis was conducted to analyze the data.Results: Participants mostly reported positive experiences with the telerehabilitation system. Benefits included observed improvements in limb functions, cognitive abilities, and emotional well-being. They also perceived the system easy to use due to the engaging experience and the convenience of conducting sessions at home. Meanwhile, participants pointed out the importance of considering technical support and physical environment at home. Further, family members' support helped them sustain in their rehabilitation. Finally, adjusting difficulty levels and visualizing patients' rehabilitation progress might help them in continued use of the telerehabilitation system.Conclusion: Telerehabilitation systems can be used as an efficient and user-friendly tool to deliver home-based stroke rehabilitation that enhance patients' physical recovery and mental and social-emotional wellbeing. Such systems need to be designed to offer engaging experience, display of recovery progress, and flexibility of schedule and location, with consideration of facilitating and social factors.
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Affiliation(s)
- Yu Chen
- School of Information Systems and Technology, San Jose State University, San Jose, CA, USA
| | - Yunan Chen
- Department of Informatics, University of California, Irvine, USA
| | - Kai Zheng
- Department of Informatics, University of California, Irvine, USA
| | - Lucy Dodakian
- Department of Neurology, University of California, Irvine, USA
| | - Jill See
- Department of Neurology, University of California, Irvine, USA
| | - Robert Zhou
- Department of Neurology, University of California, Irvine, USA
| | - Nina Chiu
- Department of Neurology, University of California, Irvine, USA
| | | | - Alison McKenzie
- Department of Physical Therapy, Chapman University, Orange, USA
| | - Steven C Cramer
- Department of Neurology, University of California, Irvine, USA
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18
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Orand A, Erdal Aksoy E, Miyasaka H, Weeks Levy C, Zhang X, Menon C. Bilateral Tactile Feedback-Enabled Training for Stroke Survivors Using Microsoft Kinect TM. SENSORS 2019; 19:s19163474. [PMID: 31398957 PMCID: PMC6719092 DOI: 10.3390/s19163474] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 02/06/2023]
Abstract
Rehabilitation and mobility training of post-stroke patients is crucial for their functional recovery. While traditional methods can still help patients, new rehabilitation and mobility training methods are necessary to facilitate better recovery at lower costs. In this work, our objective was to design and develop a rehabilitation training system targeting the functional recovery of post-stroke users with high efficiency. To accomplish this goal, we applied a bilateral training method, which proved to be effective in enhancing motor recovery using tactile feedback for the training. One participant with hemiparesis underwent six weeks of training. Two protocols, “contralateral arm matching” and “both arms moving together”, were carried out by the participant. Each of the protocols consisted of “shoulder abduction” and “shoulder flexion” at angles close to 30 and 60 degrees. The participant carried out 15 repetitions at each angle for each task. For example, in the “contralateral arm matching” protocol, the unaffected arm of the participant was set to an angle close to 30 degrees. He was then requested to keep the unaffected arm at the specified angle while trying to match the position with the affected arm. Whenever the two arms matched, a vibration was given on both brachialis muscles. For the “both arms moving together” protocol, the two arms were first set approximately to an angle of either 30 or 60 degrees. The participant was asked to return both arms to a relaxed position before moving both arms back to the remembered specified angle. The arm that was slower in moving to the specified angle received a vibration. We performed clinical assessments before, midway through, and after the training period using a Fugl-Meyer assessment (FMA), a Wolf motor function test (WMFT), and a proprioceptive assessment. For the assessments, two ipsilateral and contralateral arm matching tasks, each consisting of three movements (shoulder abduction, shoulder flexion, and elbow flexion), were used. Movements were performed at two angles, 30 and 60 degrees. For both tasks, the same procedure was used. For example, in the case of the ipsilateral arm matching task, an experimenter positioned the affected arm of the participant at 30 degrees of shoulder abduction. The participant was requested to keep the arm in that position for ~5 s before returning to a relaxed initial position. Then, after another ~5-s delay, the participant moved the affected arm back to the remembered position. An experimenter measured this shoulder abduction angle manually using a goniometer. The same procedure was repeated for the 60 degree angle and for the other two movements. We applied a low-cost Kinect to extract the participant’s body joint position data. Tactile feedback was given based on the arm position detected by the Kinect sensor. By using a Kinect sensor, we demonstrated the feasibility of the system for the training of a post-stroke user. The proposed system can further be employed for self-training of patients at home. The results of the FMA, WMFT, and goniometer angle measurements showed improvements in several tasks, suggesting a positive effect of the training system and its feasibility for further application for stroke survivors’ rehabilitation.
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Affiliation(s)
- Abbas Orand
- Department of Intelligent Systems and Digital Design, School of Information Technology, Halmstad University, Spetsvinkelgatan 29, 30250 Halmstad, Sweden
| | - Eren Erdal Aksoy
- Department of Intelligent Systems and Digital Design, School of Information Technology, Halmstad University, Spetsvinkelgatan 29, 30250 Halmstad, Sweden
| | - Hiroyuki Miyasaka
- Department of Rehabilitation, Fujita Health University Nanakuri Memorial Hospital, 424-1 Oodori-cho, Tsu, Mie 514-1296, Japan
| | - Carolyn Weeks Levy
- Schools of Mechatronics Systems Engineering and Engineering Science, Simon Fraser University, 250-13450 102 Avenue, Surrey, BC V3T 0A3, Canada
| | - Xin Zhang
- Schools of Mechatronics Systems Engineering and Engineering Science, Simon Fraser University, 250-13450 102 Avenue, Surrey, BC V3T 0A3, Canada
| | - Carlo Menon
- Schools of Mechatronics Systems Engineering and Engineering Science, Simon Fraser University, 250-13450 102 Avenue, Surrey, BC V3T 0A3, Canada.
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19
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Colli-Alfaro JG, Ibrahim A, Trejos AL. Design of User-Independent Hand Gesture Recognition Using Multilayer Perceptron Networks and Sensor Fusion Techniques. IEEE Int Conf Rehabil Robot 2019; 2019:1103-1108. [PMID: 31374777 DOI: 10.1109/icorr.2019.8779533] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
According to the World Health Organization, stroke is the third leading cause of disability. A common consequence of stroke is hemiparesis, which leads to the impairment of one side of the body and affects the performance of activities of daily living. It has been proven that targeting the motor impairments as early as possible while using wearable mechatronic devices as a robot assisted therapy, and letting the patient be in control of the robotic system, can improve the rehabilitation outcomes. However, despite the increased progress on control methods for wearable mechatronic devices, a need for a more natural interface that allows for better control remains. In this work, a user-independent gesture classification method based on a sensor fusion technique using surface electromyography (EMG) and an inertial measurement unit (IMU) is presented. The Myo Armband was used to extract EMG and IMU data from healthy subjects. Participants were asked to perform 10 types of gestures in 4 different arm positions while using the Myo on their dominant limb. Data obtained from 14 participants were used to classify the gestures using a Multilayer Perceptron Network. Finally, the classification algorithm was tested on 5 novel users, obtaining an average accuracy of 78.94%. These results demonstrate that by using the proposed approach, it is possible to achieve a more natural human machine interface that allows better control of wearable mechatronic devices during robot assisted therapies.
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20
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Buccellato KH, Nordstrom M, Murphy JM, Burdea GC, Polistico K, House G, Kim N, Grampurohit N, Sorensen J, Isaacson BM, Pasquina PF. A Randomized Feasibility Trial of a Novel, Integrative, and Intensive Virtual Rehabilitation Program for Service Members Post-Acquired Brain Injury. Mil Med 2019; 185:e203-e211. [DOI: 10.1093/milmed/usz150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/10/2019] [Accepted: 06/05/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Acquired Brain Injury, whether resulting from Traumatic brain injury (TBI) or Cerebral Vascular Accident (CVA), represent major health concerns for the Department of Defense and the nation. TBI has been referred to as the “signature” injury of recent U.S. military conflicts in Iraq and Afghanistan – affecting approximately 380,000 service members from 2000 to 2017; whereas CVA has been estimated to effect 795,000 individuals each year in the United States. TBI and CVA often present with similar motor, cognitive, and emotional deficits; therefore the treatment interventions for both often overlap. The Defense Health Agency and Veterans Health Administration would benefit from enhanced rehabilitation solutions to treat deficits resulting from acquired brain injuries (ABI), including both TBI and CVA. The purpose of this study was to evaluate the feasibility of implementing a novel, integrative, and intensive virtual rehabilitation system for treating symptoms of ABI in an outpatient clinic. The secondary aim was to evaluate the system’s clinical effectiveness.
Materials and Methods
Military healthcare beneficiaries with ABI diagnoses completed a 6-week randomized feasibility study of the BrightBrainer Virtual Rehabilitation (BBVR) system in an outpatient military hospital clinic. Twenty-six candidates were screened, consented and randomized, 21 of whom completed the study. The BBVR system is an experimental adjunct ABI therapy program which utilizes virtual reality and repetitive bilateral upper extremity training. Four self-report questionnaires measured participant and provider acceptance of the system. Seven clinical outcomes included the Fugl-Meyer Assessment of Upper Extremity, Box and Blocks Test, Jebsen-Taylor Hand Function Test, Automated Neuropsychological Assessment Metrics, Neurobehavioral Symptom Inventory, Quick Inventory of Depressive Symptomatology-Self-Report, and Post Traumatic Stress Disorder Checklist- Civilian Version. The statistical analyses used bootstrapping, non-parametric statistics, and multilevel/hierarchical modeling as appropriate. This research was approved by the Walter Reed National Military Medical Center and Uniformed Services University of the Health Sciences Institutional Review Boards.
Results
All of the participants and providers reported moderate to high levels of utility, ease of use and satisfaction with the BBVR system (x̄ = 73–86%). Adjunct therapy with the BBVR system trended towards statistical significance for the measure of cognitive function (ANAM [x̄ = −1.07, 95% CI −2.27 to 0.13, p = 0.074]); however, none of the other effects approached significance.
Conclusion
This research provides evidence for the feasibility of implementing the BBVR system into an outpatient military setting for treatment of ABI symptoms. It is believed these data justify conducting a larger, randomized trial of the clinical effectiveness of the BBVR system.
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Affiliation(s)
- Kiara H Buccellato
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720 A Rockledge Dr, Bethesda, MD
- The Center for Rehabilitation Sciences Research 4301 Jones Bridge Rd, Bethesda, MD
| | - Michelle Nordstrom
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720 A Rockledge Dr, Bethesda, MD
- The Center for Rehabilitation Sciences Research 4301 Jones Bridge Rd, Bethesda, MD
- Department of Rehabilitation Medicine, Uniformed Services University of Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD
- Department of Rehabilitation Medicine, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD
| | - Justin M Murphy
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720 A Rockledge Dr, Bethesda, MD
- The Center for Rehabilitation Sciences Research 4301 Jones Bridge Rd, Bethesda, MD
| | - Grigore C Burdea
- Bright Cloud International Corp, 675 US Hwy 1, North Brunswick, NJ
| | - Kevin Polistico
- Bright Cloud International Corp, 675 US Hwy 1, North Brunswick, NJ
| | - Gregory House
- Bright Cloud International Corp, 675 US Hwy 1, North Brunswick, NJ
| | - Nam Kim
- Bright Cloud International Corp, 675 US Hwy 1, North Brunswick, NJ
| | | | - Jeff Sorensen
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720 A Rockledge Dr, Bethesda, MD
- The Center for Rehabilitation Sciences Research 4301 Jones Bridge Rd, Bethesda, MD
| | - Brad M Isaacson
- The Center for Rehabilitation Sciences Research 4301 Jones Bridge Rd, Bethesda, MD
- Department of Rehabilitation Medicine, Uniformed Services University of Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD
- The Geneva Foundation, 917 Pacific Ave, Tacoma, WA
| | - Paul F Pasquina
- Department of Rehabilitation Medicine, Uniformed Services University of Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD
- Department of Rehabilitation Medicine, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD
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21
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Chen PM, Kwong PWH, Lai CKY, Ng SSM. Comparison of bilateral and unilateral upper limb training in people with stroke: A systematic review and meta-analysis. PLoS One 2019; 14:e0216357. [PMID: 31120910 PMCID: PMC6532847 DOI: 10.1371/journal.pone.0216357] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 04/12/2019] [Indexed: 12/21/2022] Open
Abstract
Background and objectives Bilateral upper limb training (BULT) and unilateral upper limb training (UULT) are two effective strategies for the recovery of upper limb motor function after stroke. This meta-analysis aimed to compare the improvements in motor impairment and functional performances of people with stroke after BULT and UULT. Research design and methods This systematic review and meta-analysis identified 21 randomized controlled trials (RCTs) met the eligibility criteria from CINAHL, Medline, Embase, Cochrane Library and PubMed. The outcome measures were the Fugl-Meyer Assessment of Upper Extremity (FMA-UE), Wolf Motor Function Test (WMFT), Action Research Arm Test (ARAT) and Box and Block Test (BBT), which are validated measures of upper limb function. Results Twenty-one studies involving 842 subjects with stroke were included. Compared with UULT, BULT yielded a significantly greater mean difference (MD) in the FMA-UE (MD = 2.21, 95% Confidence Interval (CI), 0.12 to 4.30, p = 0.04; I2 = 86%, p<0.001). However, a comparison of BULT and UULT yielded insignificant mean difference (MD) in terms of the time required to complete the WMFT (MD = 0.44; 95%CI, -2.22 to 3.10, p = 0.75; I2 = 55%, p = 0.06) and standard mean difference (SMD) in terms of the functional ability scores on the WMFT, ARAT and BBT (SMD = 0.25; 95%CI, -0.02 to 0.52, p = 0.07; I2 = 54%, p = 0.02). Discussion and implications Compared to UULT, BULT yielded superior improvements in the improving motor impairment of people with stroke, as measured by the FMA-UE. However, these strategies did not yield significant differences in terms of the functional performance of people with stroke, as measured by the WMFT, ARAT and BBT. More comparative studies of the effects of BULT and UULT are needed to increase the reliability of these conclusions.
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Affiliation(s)
- Pei-ming Chen
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China (SAR)
| | - Patrick W. H. Kwong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China (SAR)
| | - Claudia K. Y. Lai
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (SAR)
| | - Shamay S. M. Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China (SAR)
- * E-mail:
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22
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Doost MY, Orban de Xivry JJ, Herman B, Vanthournhout L, Riga A, Bihin B, Jamart J, Laloux P, Raymackers JM, Vandermeeren Y. Learning a Bimanual Cooperative Skill in Chronic Stroke Under Noninvasive Brain Stimulation: A Randomized Controlled Trial. Neurorehabil Neural Repair 2019; 33:486-498. [PMID: 31088342 DOI: 10.1177/1545968319847963] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background. Transcranial direct current stimulation (tDCS) has been suggested to improve poststroke recovery. However, its effects on bimanual motor learning after stroke have not previously been explored. Objective. We investigated whether dual-tDCS of the primary motor cortex (M1), with cathodal and anodal tDCS applied over undamaged and damaged hemispheres, respectively, improves learning and retention of a new bimanual cooperative motor skill in stroke patients. Method. Twenty-one chronic hemiparetic patients were recruited for a randomized, double-blinded, cross-over, sham-controlled trial. While receiving real or sham dual-tDCS, they trained on a bimanual cooperative task called CIRCUIT. Changes in performance were quantified via bimanual speed/accuracy trade-off (Bi-SAT) and bimanual coordination factor (Bi-Co) before, during, and 0, 30, and 60 minutes after dual-tDCS, as well as one week later to measure retention. A generalization test then followed, where patients were asked to complete a new CIRCUIT layout. Results. The patients were able to learn and retain the bimanual cooperative skill. However, a general linear mixed model did not detect a significant difference in retention between the real and sham dual-tDCS conditions for either Bi-SAT or Bi-Co. Similarly, no difference in generalization was detected for Bi-SAT or Bi-Co. Conclusion. The chronic hemiparetic stroke patients learned and retained the complex bimanual cooperative task and generalized the newly acquired skills to other tasks, indicating that bimanual CIRCUIT training is promising as a neurorehabilitation approach. However, bimanual motor skill learning was not enhanced by dual-tDCS in these patients.
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Affiliation(s)
- Maral Yeganeh Doost
- 1 Université catholique de Louvain (UCLouvain), CHU UCL Namur (Mont-Godinne), Yvoir, Belgium.,2 Université catholique de Louvain (UCLouvain), Institute of NeuroScience (IoNS), NEUR division, Brussels, Belgium.,3 Université catholique de Louvain (UCLouvain), Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Jean-Jacques Orban de Xivry
- 4 Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Belgium.,5 Leuven Brain Institute, KU Leuven, Belgium
| | - Benoît Herman
- 3 Université catholique de Louvain (UCLouvain), Louvain Bionics, Louvain-la-Neuve, Belgium.,6 Université catholique de Louvain (UCLouvain), Institute of Mechanics, Materials and Civil Engineering (iMMC), Louvain-la-Neuve, Belgium
| | - Léna Vanthournhout
- 3 Université catholique de Louvain (UCLouvain), Louvain Bionics, Louvain-la-Neuve, Belgium.,6 Université catholique de Louvain (UCLouvain), Institute of Mechanics, Materials and Civil Engineering (iMMC), Louvain-la-Neuve, Belgium
| | - Audrey Riga
- 1 Université catholique de Louvain (UCLouvain), CHU UCL Namur (Mont-Godinne), Yvoir, Belgium.,2 Université catholique de Louvain (UCLouvain), Institute of NeuroScience (IoNS), NEUR division, Brussels, Belgium.,3 Université catholique de Louvain (UCLouvain), Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Benoît Bihin
- 1 Université catholique de Louvain (UCLouvain), CHU UCL Namur (Mont-Godinne), Yvoir, Belgium
| | - Jacques Jamart
- 1 Université catholique de Louvain (UCLouvain), CHU UCL Namur (Mont-Godinne), Yvoir, Belgium
| | - Patrice Laloux
- 1 Université catholique de Louvain (UCLouvain), CHU UCL Namur (Mont-Godinne), Yvoir, Belgium.,2 Université catholique de Louvain (UCLouvain), Institute of NeuroScience (IoNS), NEUR division, Brussels, Belgium
| | | | - Yves Vandermeeren
- 1 Université catholique de Louvain (UCLouvain), CHU UCL Namur (Mont-Godinne), Yvoir, Belgium.,2 Université catholique de Louvain (UCLouvain), Institute of NeuroScience (IoNS), NEUR division, Brussels, Belgium.,3 Université catholique de Louvain (UCLouvain), Louvain Bionics, Louvain-la-Neuve, Belgium
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23
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Zhang K, Chen X, Liu F, Tang H, Wang J, Wen W. System Framework of Robotics in Upper Limb Rehabilitation on Poststroke Motor Recovery. Behav Neurol 2018; 2018:6737056. [PMID: 30651892 PMCID: PMC6311736 DOI: 10.1155/2018/6737056] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 08/04/2018] [Accepted: 08/28/2018] [Indexed: 11/24/2022] Open
Abstract
Neurological impairments such as stroke cause damage to the functional mobility of survivors and affect their ability to perform activities of daily living. Recently, robotic treatment for upper limb stroke rehabilitation has received significant attention because it can provide high-intensity and repetitive movement therapy. In this review, the current status of upper limb rehabilitation robots is explored. Firstly, an overview of mechanical design of robotics for upper-limb rehabilitation and clinical effects of part robots are provided. Then, the comparisons of human-machine interactions, control strategies, driving modes, and training modes are described. Finally, the development and the possible future directions of the upper limb rehabilitation robot are discussed.
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Affiliation(s)
- Kai Zhang
- Institute of Robotics and Intelligent System, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an 710049, China
- Shaanxi Key Laboratory of Intelligent Robots, Xi'an 710049, China
| | | | - Fei Liu
- Baoxing Hospital, Shenzhen 518100, China
| | - Haili Tang
- Baoxing Hospital, Shenzhen 518100, China
| | - Jing Wang
- Institute of Robotics and Intelligent System, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an 710049, China
- Shaanxi Key Laboratory of Intelligent Robots, Xi'an 710049, China
| | - Weina Wen
- Baoxing Hospital, Shenzhen 518100, China
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24
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Abstract
There are many nonsurgical treatment options for patients with upper limb spasticity. This article presents an algorithmic approach to management, encompassing evidence-based rehabilitation therapies, medications, and promising new orthotic and robotic innovations.
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Affiliation(s)
- Laura Black
- Shirley Ryan AbilityLab, Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, 355 East Erie Street, 21st Floor, Suite 2127, Chicago, IL 60601, USA.
| | - Deborah Gaebler-Spira
- Shirley Ryan AbilityLab, Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, 355 East Erie Street, Chicago, IL 60601, USA
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25
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Liao WW, Whitall J, Barton JE, McCombe Waller S. Neural motor control differs between bimanual common-goal vs. bimanual dual-goal tasks. Exp Brain Res 2018; 236:1789-1800. [PMID: 29663024 DOI: 10.1007/s00221-018-5261-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 04/10/2018] [Indexed: 10/17/2022]
Abstract
Coordinating bimanual movements is essential for everyday activities. Two common types of bimanual tasks are common goal, where two arms share a united goal, and dual goal, which involves independent goals for each arm. Here, we examine how the neural control mechanisms differ between these two types of bimanual tasks. Ten non-disabled individuals performed isometric force tasks of the elbow at 10% of their maximal voluntary force in both bimanual common and dual goals as well as unimanual conditions. Using transcranial magnetic stimulation, we concurrently examined the intracortical inhibitory modulation (short-interval intracortical inhibition, SICI) as well as the interlimb coordination strategies utilized between common- vs. dual-goal tasks. Results showed a reduction of SICI in both hemispheres during dual-goal compared to common-goal tasks (dominant hemisphere: P = 0.04, non-dominant hemisphere: P = 0.03) and unimanual tasks (dominant hemisphere: P = 0.001, non-dominant hemisphere: P = 0.001). For the common-goal task, a reduction of SICI was only seen in the dominant hemisphere compared to unimanual tasks (P = 0.03). Behaviorally, two interlimb coordination patterns were identified. For the common-goal task, both arms were organized into a cooperative "give and take" movement pattern. Control of the non-dominant arm affected stabilization of bimanual force (R2 = 0.74, P = 0.001). In contrast, for the dual-goal task, both arms were coupled together in a positive fashion and neither arm affected stabilization of bimanual force (R2 = 0.31, P = 0.1). The finding that intracortical inhibition and interlimb coordination patterns were different based on the goal conceptualization of bimanual tasks has implications for future research.
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Affiliation(s)
- Wan-Wen Liao
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland Baltimore, 100 Penn Street, Allied Health Building, Baltimore, MD, 21201, USA
| | - Jill Whitall
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland Baltimore, 100 Penn Street, Allied Health Building, Baltimore, MD, 21201, USA.,Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Joseph E Barton
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland Baltimore, 100 Penn Street, Allied Health Building, Baltimore, MD, 21201, USA.,Department of Neurology, School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA
| | - Sandy McCombe Waller
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland Baltimore, 100 Penn Street, Allied Health Building, Baltimore, MD, 21201, USA.
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26
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Quantification of Upper Limb Motor Recovery and EEG Power Changes after Robot-Assisted Bilateral Arm Training in Chronic Stroke Patients: A Prospective Pilot Study. Neural Plast 2018; 2018:8105480. [PMID: 29780410 PMCID: PMC5892248 DOI: 10.1155/2018/8105480] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 09/01/2017] [Accepted: 11/20/2017] [Indexed: 11/17/2022] Open
Abstract
Background Bilateral arm training (BAT) has shown promise in expediting progress toward upper limb recovery in chronic stroke patients, but its neural correlates are poorly understood. Objective To evaluate changes in upper limb function and EEG power after a robot-assisted BAT in chronic stroke patients. Methods In a within-subject design, seven right-handed chronic stroke patients with upper limb paresis received 21 sessions (3 days/week) of the robot-assisted BAT. The outcomes were changes in score on the upper limb section of the Fugl-Meyer assessment (FM), Motricity Index (MI), and Modified Ashworth Scale (MAS) evaluated at the baseline (T0), posttraining (T1), and 1-month follow-up (T2). Event-related desynchronization/synchronization were calculated in the upper alpha and the beta frequency ranges. Results Significant improvement in all outcomes was measured over the course of the study. Changes in FM were significant at T2, and in MAS at T1 and T2. After training, desynchronization on the ipsilesional sensorimotor areas increased during passive and active movement, as compared with T0. Conclusions A repetitive robotic-assisted BAT program may improve upper limb motor function and reduce spasticity in the chronically impaired paretic arm. Effects on spasticity were associated with EEG changes over the ipsilesional sensorimotor network.
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27
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Kwong PWH, Ng GYF, Chung RCK, Ng SSM. Bilateral Transcutaneous Electrical Nerve Stimulation Improves Lower-Limb Motor Function in Subjects With Chronic Stroke: A Randomized Controlled Trial. J Am Heart Assoc 2018; 7:e007341. [PMID: 29437598 PMCID: PMC5850185 DOI: 10.1161/jaha.117.007341] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 01/10/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Transcutaneous electrical nerve stimulation (TENS) has been used to augment the efficacy of task-oriented training (TOT) after stroke. Bilateral intervention approaches have also been shown to be effective in augmenting motor function after stroke. The purpose of this study was to compare the efficacy of bilateral TENS combined with TOT versus unilateral TENS combined with TOT in improving lower-limb motor function in subjects with chronic stroke. METHODS AND RESULTS Eighty subjects were randomly assigned to bilateral TENS+TOT or to unilateral TENS+TOT and underwent 20 sessions of training over a 10-week period. The outcome measures included the maximal strength of the lower-limb muscles and the results of the Lower Extremity Motor Coordination Test, Berg Balance Scale, Step Test, and Timed Up and Go test. Each participant was assessed at baseline, after 10 and 20 sessions of training and 3 months after the cessation of training. The subjects in the bilateral TENS+TOT group showed greater improvement in paretic ankle dorsiflexion strength (β=1.32; P=0.032) and in the completion time for the Timed Up and Go test (β=-1.54; P=0.004) than those in the unilateral TENS+TOT group. However, there were no significant between-group differences for other outcome measures. CONCLUSIONS The application of bilateral TENS over the common peroneal nerve combined with TOT was superior to the application of unilateral TENS combined with TOT in improving paretic ankle dorsiflexion strength after 10 sessions of training and in improving the completion time for the Timed Up and Go test after 20 sessions of training. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02152813.
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Affiliation(s)
- Patrick W H Kwong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Gabriel Y F Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Raymond C K Chung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Shamay S M Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
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28
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Huang X, Naghdy F, Naghdy G, Du H, Todd C. The Combined Effects of Adaptive Control and Virtual Reality on Robot-Assisted Fine Hand Motion Rehabilitation in Chronic Stroke Patients: A Case Study. J Stroke Cerebrovasc Dis 2018; 27:221-228. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.08.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 08/16/2017] [Indexed: 10/18/2022] Open
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29
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Pan S, Kairy D, Corriveau H, Tousignant M. Adapting Tai Chi for Upper Limb Rehabilitation Post Stroke: A Feasibility Study. MEDICINES (BASEL, SWITZERLAND) 2017; 4:E72. [PMID: 28973961 PMCID: PMC5750596 DOI: 10.3390/medicines4040072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 09/25/2017] [Accepted: 09/27/2017] [Indexed: 11/16/2022]
Abstract
Background: Tai chi (TC) has been reported as being beneficial for improving balance post stroke, yet its utility in upper limb rehabilitation remains unknown. Methods: Twelve chronic stroke survivors with persistent paresis of an upper limb underwent 60 minutes of adapted TC twice a week for eight weeks, with a 4-week follow up. A 10-min TC home program was recommended for the days without sessions. TC level of performance, attendance to the sessions, duration of self-practice at home, and adapted TC movements used were recorded. Results: Eleven participants completed the study. A clinical reasoning algorithm underlying the adaptation of TC was elaborated throughout the trial. Participants with varying profiles including a severely impaired upper limb, poor balance, shoulder pain, and severe spasticity were not only capable of practicing the adapted TC, but attended all 16 sessions and practiced TC at home for a total of 16.51 ± 9.21 h. The degree of self-practice for subgroups with low upper limb function, shoulder pain, or moderate-to-severe spasticity was similar to that of subgroups with greater upper limb function, no shoulder pain, and minimal-to-no spasticity. Conclusion: Adapted TC seems feasible for upper limb rehabilitation post stroke. Although the study was based on a small sample size and requires confirmation, low upper limb function, insufficient balance, spasticity, and shoulder pain do not appear to hinder the practice of TC.
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Affiliation(s)
- Shujuan Pan
- School of Rehabilitation, Université de Montréal, Montréal, QC H3N 1X7, Canada.
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal-IRGLM Site, Montreal, QC H3S 2J4, Canada.
| | - Dahlia Kairy
- School of Rehabilitation, Université de Montréal, Montréal, QC H3N 1X7, Canada.
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal-IRGLM Site, Montreal, QC H3S 2J4, Canada.
| | - Hélène Corriveau
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada.
- Research Center on Aging, Centre intégré universitaire de santé et des services sociaux de l'Estrie-CHUS, Sherbrooke, QC J1H 4C4, Canada.
| | - Michel Tousignant
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada.
- Research Center on Aging, Centre intégré universitaire de santé et des services sociaux de l'Estrie-CHUS, Sherbrooke, QC J1H 4C4, Canada.
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30
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Huang X, Naghdy F, Naghdy G, Du H. Clinical effectiveness of combined virtual reality and robot assisted fine hand motion rehabilitation in subacute stroke patients. IEEE Int Conf Rehabil Robot 2017; 2017:511-515. [PMID: 28813871 DOI: 10.1109/icorr.2017.8009299] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Robot-assisted therapy is regarded as an effective and reliable method for the delivery of highly repetitive rehabilitation training in restoring motor skills after a stroke. This study focuses on the rehabilitation of fine hand motion skills due to their vital role in performing delicate activities of daily living (ADL) tasks. The proposed rehabilitation system combines an adaptive assist-as-needed (AAN) control algorithm and a Virtual Reality (VR) based rehabilitation gaming system (RGS). The developed system is described and its effectiveness is validated through clinical trials on a group of eight subacute stroke patients for a period of six weeks. The impact of the training is verified through standard clinical evaluation methods and measuring key kinematic parameters. A comparison of the pre- and post-training results indicates that the method proposed in this study can improve fine hand motion rehabilitation training effectiveness.
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31
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Huang X, Naghdy F, Du H, Naghdy G, Murray G. Design of adaptive control and virtual reality-based fine hand motion rehabilitation system and its effects in subacute stroke patients. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING: IMAGING & VISUALIZATION 2017. [DOI: 10.1080/21681163.2017.1343687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Xianwei Huang
- School of Electrical, Computer and Telecommunications Engineering (SECTE), University of Wollongong, Wollongong, Australia
| | - Fazel Naghdy
- School of Electrical, Computer and Telecommunications Engineering (SECTE), University of Wollongong, Wollongong, Australia
| | - Haiping Du
- School of Electrical, Computer and Telecommunications Engineering (SECTE), University of Wollongong, Wollongong, Australia
| | - Golshah Naghdy
- School of Electrical, Computer and Telecommunications Engineering (SECTE), University of Wollongong, Wollongong, Australia
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32
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Kim B, Deshpande AD. An upper-body rehabilitation exoskeleton Harmony with an anatomical shoulder mechanism: Design, modeling, control, and performance evaluation. Int J Rob Res 2017. [DOI: 10.1177/0278364917706743] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present an upper-body exoskeleton for rehabilitation, called Harmony, that provides natural coordinated motions on the shoulder with a wide range of motion, and force and impedance controllability. The exoskeleton consists of an anatomical shoulder mechanism with five active degrees of freedom, and one degree of freedom elbow and wrist mechanisms powered by series elastic actuators. The dynamic model of the exoskeleton is formulated using a recursive Newton–Euler algorithm with spatial dynamics representation. A baseline control algorithm is developed to achieve dynamic transparency and scapulohumeral rhythm assistance, and the coupled stability of the robot–human system at the baseline control is investigated. Experiments were conducted to evaluate the kinematic and dynamic characteristics of the exoskeleton. The results show that the exoskeleton exhibits good kinematic compatibility to the human body with a wide range of motion and performs task-space force and impedance control behaviors reliably.
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33
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Palermo E, Laut J, Nov O, Cappa P, Porfiri M. A natural user interface to integrate citizen science and physical exercise. PLoS One 2017; 12:e0172587. [PMID: 28231261 PMCID: PMC5322974 DOI: 10.1371/journal.pone.0172587] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 02/07/2017] [Indexed: 11/25/2022] Open
Abstract
Citizen science enables volunteers to contribute to scientific projects, where massive data collection and analysis are often required. Volunteers participate in citizen science activities online from their homes or in the field and are motivated by both intrinsic and extrinsic factors. Here, we investigated the possibility of integrating citizen science tasks within physical exercises envisaged as part of a potential rehabilitation therapy session. The citizen science activity entailed environmental mapping of a polluted body of water using a miniature instrumented boat, which was remotely controlled by the participants through their physical gesture tracked by a low-cost markerless motion capture system. Our findings demonstrate that the natural user interface offers an engaging and effective means for performing environmental monitoring tasks. At the same time, the citizen science activity increases the commitment of the participants, leading to a better motion performance, quantified through an array of objective indices. The study constitutes a first and necessary step toward rehabilitative treatments of the upper limb through citizen science and low-cost markerless optical systems.
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Affiliation(s)
- Eduardo Palermo
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States of America
- Department of Mechanical and Aerospace Engineering, “Sapienza” University of Rome, Rome, Italy
| | - Jeffrey Laut
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States of America
| | - Oded Nov
- Department of Technology Management and Innovation, New York University Tandon School of Engineering, Brooklyn, NY, United States of America
| | - Paolo Cappa
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States of America
- Department of Mechanical and Aerospace Engineering, “Sapienza” University of Rome, Rome, Italy
| | - Maurizio Porfiri
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States of America
- * E-mail:
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34
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Huang X, Naghdy F, Naghdy G, Du H, Todd C. Robot-assisted post-stroke motion rehabilitation in upper extremities: a survey. ACTA ACUST UNITED AC 2017. [DOI: 10.1515/ijdhd-2016-0035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractRecent neurological research indicates that the impaired motor skills of post-stroke patients can be enhanced and possibly restored through task-oriented repetitive training. This is due to neuroplasticity – the ability of the brain to change through adulthood. Various rehabilitation processes have been developed to take advantage of neuroplasticity to retrain neural pathways and restore or improve motor skills lost as a result of stroke or spinal cord injuries (SCI). Research in this area over the last few decades has resulted in a better understanding of the dynamics of rehabilitation in post-stroke patients and development of auxiliary devices and tools to induce repeated targeted body movements. With the growing number of stroke rehabilitation therapies, the application of robotics within the rehabilitation process has received much attention. As such, numerous mechanical and robot-assisted upper limb and hand function training devices have been proposed. A systematic review of robotic-assisted upper extremity (UE) motion rehabilitation therapies was carried out in this study. The strengths and limitations of each method and its effectiveness in arm and hand function recovery were evaluated. The study provides a comparative analysis of the latest developments and trends in this field, and assists in identifying research gaps and potential future work.
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35
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Preparation and execution of teeth clenching and foot muscle contraction influence on corticospinal hand-muscle excitability. Sci Rep 2017; 7:41249. [PMID: 28117368 PMCID: PMC5259748 DOI: 10.1038/srep41249] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 12/20/2016] [Indexed: 11/30/2022] Open
Abstract
Contraction of a muscle modulates not only the corticospinal excitability (CSE) of the contracting muscle but also that of different muscles. We investigated to what extent the CSE of a hand muscle is modulated during preparation and execution of teeth clenching and ipsilateral foot dorsiflexion either separately or in combination. Hand-muscle CSE was estimated based on motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) and recorded from the first dorsal interosseous (FDI) muscle. We found higher excitability during both preparation and execution of all the motor tasks than during mere observation of a fixation cross. As expected, the excitability was greater during the execution phase than the preparation one. Furthermore, both execution and preparation of combined motor tasks led to higher excitability than individual tasks. These results extend our current understanding of the neural interactions underlying simultaneous contraction of muscles in different body parts.
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Christopher SM, Johnson MJ. Task-oriented robot-assisted stroke therapy of paretic limb improves control in a unilateral and bilateral functional drink task: a case study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2014:1194-7. [PMID: 25570178 DOI: 10.1109/embc.2014.6943810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The purpose of this paper is to evaluate the functional, temporal and spatial effect of a unilateral task-oriented, robot-assisted training on unilateral and bilateral task performance of a drinking task using a real object. Two chronic stroke survivors experienced task-oriented robot assisted therapy, in which the paretic arm was trained using reaching and grasping tasks over 4 weeks. Both subjects experienced improvement in motor control as measured by Fugl-Meyer. The paretic arm was evaluated using movement smoothness (MS) and time to completion (TCT) measures before and after therapy. From the results, we found that the unilateral robotassisted training improved paretic arm control in the unilateral and the bilateral drink task. However, the influence of the non-paretic movement on the temporal and spatial paretic arm control was evident both pre and post therapy suggesting inter-limb coupling aids in the transfer of unilateral improvements in motor control to improvements in bilateral motor control.
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Carey LM, Seitz RJ. Functional Neuroimaging in Stroke Recovery and Neurorehabilitation: Conceptual Issues and Perspectives. Int J Stroke 2016; 2:245-64. [DOI: 10.1111/j.1747-4949.2007.00164.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background In stroke, functional neuroimaging has become a potent diagnostic tool; opened new insights into the pathophysiology of ischaemic damage in the human brain; and made possible the assessment of functional–structural relationships in postlesion recovery. Summary of review Here, we give a critical account on the potential and limitation of functional neuroimaging and discuss concepts related to the use of neuroimaging for exploring the neurobiological and neuroanatomical mechanisms of poststroke recovery and neurorehabilitation. We identify and provide evidence for five hypotheses that functional neuroimaging can provide new insights into: adaptation occurs at the level of functional brain systems; the brain–behaviour relationship varies with recovery and over time; functional neuroimaging can improve our ability to predict recovery and select individuals for rehabilitation; mechanisms of recovery reflect different pathophysiological phases; and brain adaptation may be modulated by experience and specific rehabilitation. The significance and application of this new evidence is discussed, and recommendations made for investigations in the field. Conclusion Functional neuroimaging is an important tool to explore the mechanisms underlying brain plasticity and, thereby, to guide clinical research in neurorehabilitation.
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Affiliation(s)
- Leeanne M. Carey
- National Stroke Research Institute, Neurosciences Building, Heidelberg Heights, Vic., Australia
- School of Occupational Therapy, LaTrobe University, Bundoora, Vic., Australia
| | - Rüdiger J. Seitz
- National Stroke Research Institute, Neurosciences Building, Heidelberg Heights, Vic., Australia
- Institute of Advanced Study, La Trobe University, Bundoora, Vic., Australia
- Department of Neurology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Sheng B, Zhang Y, Meng W, Deng C, Xie S. Bilateral robots for upper-limb stroke rehabilitation: State of the art and future prospects. Med Eng Phys 2016; 38:587-606. [PMID: 27117423 DOI: 10.1016/j.medengphy.2016.04.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/18/2016] [Accepted: 04/03/2016] [Indexed: 10/21/2022]
Abstract
Robot-assisted bilateral upper-limb training grows abundantly for stroke rehabilitation in recent years and an increasing number of devices and robots have been developed. This paper aims to provide a systematic overview and evaluation of existing bilateral upper-limb rehabilitation devices and robots based on their mechanisms and clinical-outcomes. Most of the articles studied here were searched from nine online databases and the China National Knowledge Infrastructure (CNKI) from year 1993 to 2015. Devices and robots were categorized as end-effectors, exoskeletons and industrial robots. Totally ten end-effectors, one exoskeleton and one industrial robot were evaluated in terms of their mechanical characteristics, degrees of freedom (DOF), supported control modes, clinical applicability and outcomes. Preliminary clinical results of these studies showed that all participants could gain certain improvements in terms of range of motion, strength or physical function after training. Only four studies supported that bilateral training was better than unilateral training. However, most of clinical results cannot definitely verify the effectiveness of mechanisms and clinical protocols used in robotic therapies. To explore the actual value of these robots and devices, further research on ingenious mechanisms, dose-matched clinical protocols and universal evaluation criteria should be conducted in the future.
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Yoo GE, Kim SJ. Rhythmic Auditory Cueing in Motor Rehabilitation for Stroke Patients: Systematic Review and Meta-Analysis. J Music Ther 2016; 53:149-77. [PMID: 27084833 DOI: 10.1093/jmt/thw003] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 01/14/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Given the increasing evidence demonstrating the effects of rhythmic auditory cueing for motor rehabilitation of stroke patients, this synthesized analysis is needed in order to improve rehabilitative practice and maximize clinical effectiveness. OBJECTIVE This study aimed to systematically analyze the literature on rhythmic auditory cueing for motor rehabilitation of stroke patients by highlighting the outcome variables, type of cueing, and stage of stroke. METHODS A systematic review with meta-analysis of randomized controlled or clinically controlled trials was conducted. Electronic databases and music therapy journals were searched for studies including stroke, the use of rhythmic auditory cueing, and motor outcomes, such as gait and upper-extremity function. RESULTS A total of 10 studies (RCT or CCT) with 356 individuals were included for meta-analysis. There were large effect sizes (Hedges's g = 0.984 for walking velocity; Hedges's g = 0.840 for cadence; Hedges's g = 0.760 for stride length; and Hedges's g = 0.456 for Fugl-Meyer test scores) in the use of rhythmic auditory cueing. Additional subgroup analysis demonstrated that although the type of rhythmic cueing and stage of stroke did not lead to statistically substantial group differences, the effect sizes and heterogeneity values in each subgroup implied possible differences in treatment effect. CONCLUSIONS This study corroborates the beneficial effects of rhythmic auditory cueing, supporting its expanded application to broadened areas of rehabilitation for stroke patients. Also, it suggests the future investigation of the differential outcomes depending on how rhythmic auditory cueing is provided in terms of type and intensity implemented.
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Affiliation(s)
- Ga Eul Yoo
- Ewha Womans University Ewha Womans University
| | - Soo Ji Kim
- Ewha Womans University Ewha Womans University
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Do JH, Yoo EY, Jung MY, Park HY. The effects of virtual reality-based bilateral arm training on hemiplegic children’s upper limb motor skills. NeuroRehabilitation 2016; 38:115-27. [DOI: 10.3233/nre-161302] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ji-Hye Do
- Department of Occupational Therapy, The Graduate School, Yonsei University, Kangwon-do, Republic of Korea
| | - Eun-Young Yoo
- Department of Occupational Therapy, College of Health Science, Yonsei University, Kangwon-do, Republic of Korea
| | - Min-Ye Jung
- Department of Occupational Therapy, College of Health Science, Yonsei University, Kangwon-do, Republic of Korea
| | - Hae Yean Park
- Department of Occupational Therapy, College of Health Science, Yonsei University, Kangwon-do, Republic of Korea
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Lim KM, Jung J, Shim S. The effect of bilateral trainings on upper extremities muscle activation on level of motor function in stroke patients. J Phys Ther Sci 2016; 28:3427-3431. [PMID: 28174466 PMCID: PMC5276775 DOI: 10.1589/jpts.28.3427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 08/23/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study was conducted in order to compare muscle activation level on the
affected and unaffected limb according to the recovery level of upper limb between
bilateral activity with hands clasped and bilateral activity with pilates ring. [Subjects
and Methods] Twenty inpatient who have had a stroke were recruited. Subjects were divided
into two groups by the Fugl-Meyer Assessment of Motor Function score of moderately
recovered group and well recovered group. The muscles activation of upper extremity and
Co-Contraction Ratio (CCR) were analyzed. [Results] In the muscles activation of the well
group, trapezius, anterior deltoid, and triceps muscles of affected side and biceps
muscles of both sides were significantly higher when activity with pilates ring than
activity with hands clasped. CCR of both side in the well group was significantly
decreased during activity with pilates ring and in the moderate group, CCR of affected
side was significantly decreased during activity with pilates ring. [Conclusion] Bilateral
activity with a pilates ring is more effective than activity with hands clasped for the
facilitation of muscle activation and coordination in stroke patients.
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Affiliation(s)
- Kyung Min Lim
- Department of Occupational Therapy, Yonsei University, Republic of Korea
| | - Jinhwa Jung
- Department of Occupational Therapy, Semyung University: 65 Semyung-ro, Jecheon-si, Chungbuk 390-711, Republic of Korea
| | - Sunhwa Shim
- Department of Occupational Therapy, College of Medical Science, Jeonju University: 303 Cheonjam-ro, Wansan-gu, Jeonju-si 55069, Republic of Korea
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Choo PL, Gallagher HL, Morris J, Pomeroy VM, van Wijck F. Correlations between arm motor behavior and brain function following bilateral arm training after stroke: a systematic review. Brain Behav 2015; 5:e00411. [PMID: 26807338 PMCID: PMC4714643 DOI: 10.1002/brb3.411] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 08/22/2015] [Accepted: 09/02/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Bilateral training (BT) of the upper limb (UL) might enhance recovery of arm function after stroke. To better understand the therapeutic potential of BT, this study aimed to determine the correlation between arm motor behavior and brain structure/function as a result of bilateral arm training poststroke. METHODS A systematic review of quantitative studies of BT evaluating both UL motor behavior and neuroplasticity was conducted. Eleven electronic databases were searched. Two reviewers independently selected studies, extracted data and assessed methodological quality, using the Effective Public Health Practice Project (EPHPP) tool. RESULTS Eight studies comprising 164 participants met the inclusion criteria. Only two studies rated "strong" on the EPHPP tool. Considerable heterogeneity of participants, BT modes, comparator interventions and measures contraindicated pooled outcome analysis. Modes of BT included: in-phase and anti-phase; functional movements involving objects; and movements only. Movements were mechanically coupled, free, auditory-cued, or self-paced. The Fugl-Meyer Assessment (UL section) was used in six of eight studies, however, different subsections were used by different studies. Neural correlates were measured using fMRI and TMS in three and five studies, respectively, using a wide variety of variables. Associations between changes in UL function and neural plasticity were inconsistent and only two studies reported a statistical correlation following BT. CONCLUSIONS No clear pattern of association between UL motor and neural response to BT was apparent from this review, indicating that the neural correlates of motor behavior response to BT after stroke remain unknown. To understand the full therapeutic potential of BT and its different modes, further investigation is required.
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Affiliation(s)
- Pei Ling Choo
- School of Health and Life SciencesGlasgow Caledonian UniversityGlasgowUK
| | - Helen L. Gallagher
- School of Health and Life SciencesGlasgow Caledonian UniversityGlasgowUK
| | - Jacqui Morris
- Nursing, Midwifery and Allied Health Professions Research UnitGlasgow Caledonian UniversityGlasgowUK
| | - Valerie M. Pomeroy
- Acquired Brain Injury Rehabilitation Alliance (ABIRA)NorwichUK
- University of East AngliaNorwichUK
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Muraoka T, Sakamoto M, Mizuguchi N, Nakagawa K, Kanosue K. Corticospinal excitability modulation in resting digit muscles during cyclical movement of the digits of the ipsilateral limb. Front Hum Neurosci 2015; 9:607. [PMID: 26582985 PMCID: PMC4631817 DOI: 10.3389/fnhum.2015.00607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 10/22/2015] [Indexed: 11/13/2022] Open
Abstract
We investigated how corticospinal excitability of the resting digit muscles was modulated by the digit movement in the ipsilateral limb. Subjects performed cyclical extension-flexion movements of either the right toes or fingers. To determine whether corticospinal excitability of the resting digit muscles was modulated on the basis of movement direction or action coupling between ipsilateral digits, the right forearm was maintained in either the pronated or supinated position. During the movement, the motor evoked potential (MEP) elicited by transcranial magnetic stimulation (TMS) was measured from either the resting right finger extensor and flexor, or toe extensor and flexor. For both finger and toe muscles, independent of forearm position, MEP amplitude of the flexor was greater during ipsilateral digit flexion as compared to extension, and MEP amplitude of the extensor was greater during ipsilateral digit extension as compared to flexion. An exception was that MEP amplitude of the toe flexor with the supinated forearm did not differ between during finger extension and flexion. These findings suggest that digit movement modulates corticospinal excitability of the digits of the ipsilateral limb such that the same action is preferred. Our results provide evidence for a better understanding of neural interactions between ipsilateral limbs, and may thus contribute to neurorehabilitation after a stroke or incomplete spinal cord injury.
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Affiliation(s)
| | - Masanori Sakamoto
- Faculty of Education, Department of Physical Education, Kumamoto University Kumamoto, Japan
| | | | - Kento Nakagawa
- Graduate School of Sport Sciences, Waseda University Saitama, Japan
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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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Richards L, Hanson C, Wellborn M, Sethi A. Driving Motor Recovery After Stroke. Top Stroke Rehabil 2015; 15:397-411. [DOI: 10.1310/tsr1505-397] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Pulman J, Buckley E. Assessing the Efficacy of Different Upper Limb Hemiparesis Interventions on Improving Health-Related Quality of Life in Stroke Patients: A Systematic Review. Top Stroke Rehabil 2015; 20:171-88. [DOI: 10.1310/tsr2002-171] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Pollock A, Farmer SE, Brady MC, Langhorne P, Mead GE, Mehrholz J, van Wijck F. Interventions for improving upper limb function after stroke. Cochrane Database Syst Rev 2014; 2014:CD010820. [PMID: 25387001 PMCID: PMC6469541 DOI: 10.1002/14651858.cd010820.pub2] [Citation(s) in RCA: 341] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Improving upper limb function is a core element of stroke rehabilitation needed to maximise patient outcomes and reduce disability. Evidence about effects of individual treatment techniques and modalities is synthesised within many reviews. For selection of effective rehabilitation treatment, the relative effectiveness of interventions must be known. However, a comprehensive overview of systematic reviews in this area is currently lacking. OBJECTIVES To carry out a Cochrane overview by synthesising systematic reviews of interventions provided to improve upper limb function after stroke. METHODS SEARCH METHODS We comprehensively searched the Cochrane Database of Systematic Reviews; the Database of Reviews of Effects; and PROSPERO (an international prospective register of systematic reviews) (June 2013). We also contacted review authors in an effort to identify further relevant reviews. SELECTION CRITERIA We included Cochrane and non-Cochrane reviews of randomised controlled trials (RCTs) of patients with stroke comparing upper limb interventions with no treatment, usual care or alternative treatments. Our primary outcome of interest was upper limb function; secondary outcomes included motor impairment and performance of activities of daily living. When we identified overlapping reviews, we systematically identified the most up-to-date and comprehensive review and excluded reviews that overlapped with this. DATA COLLECTION AND ANALYSIS Two overview authors independently applied the selection criteria, excluding reviews that were superseded by more up-to-date reviews including the same (or similar) studies. Two overview authors independently assessed the methodological quality of reviews (using a modified version of the AMSTAR tool) and extracted data. Quality of evidence within each comparison in each review was determined using objective criteria (based on numbers of participants, risk of bias, heterogeneity and review quality) to apply GRADE (Grades of Recommendation, Assessment, Development and Evaluation) levels of evidence. We resolved disagreements through discussion. We systematically tabulated the effects of interventions and used quality of evidence to determine implications for clinical practice and to make recommendations for future research. MAIN RESULTS Our searches identified 1840 records, from which we included 40 completed reviews (19 Cochrane; 21 non-Cochrane), covering 18 individual interventions and dose and setting of interventions. The 40 reviews contain 503 studies (18,078 participants). We extracted pooled data from 31 reviews related to 127 comparisons. We judged the quality of evidence to be high for 1/127 comparisons (transcranial direct current stimulation (tDCS) demonstrating no benefit for outcomes of activities of daily living (ADLs)); moderate for 49/127 comparisons (covering seven individual interventions) and low or very low for 77/127 comparisons.Moderate-quality evidence showed a beneficial effect of constraint-induced movement therapy (CIMT), mental practice, mirror therapy, interventions for sensory impairment, virtual reality and a relatively high dose of repetitive task practice, suggesting that these may be effective interventions; moderate-quality evidence also indicated that unilateral arm training may be more effective than bilateral arm training. Information was insufficient to reveal the relative effectiveness of different interventions.Moderate-quality evidence from subgroup analyses comparing greater and lesser doses of mental practice, repetitive task training and virtual reality demonstrates a beneficial effect for the group given the greater dose, although not for the group given the smaller dose; however tests for subgroup differences do not suggest a statistically significant difference between these groups. Future research related to dose is essential.Specific recommendations for future research are derived from current evidence. These recommendations include but are not limited to adequately powered, high-quality RCTs to confirm the benefit of CIMT, mental practice, mirror therapy, virtual reality and a relatively high dose of repetitive task practice; high-quality RCTs to explore the effects of repetitive transcranial magnetic stimulation (rTMS), tDCS, hands-on therapy, music therapy, pharmacological interventions and interventions for sensory impairment; and up-to-date reviews related to biofeedback, Bobath therapy, electrical stimulation, reach-to-grasp exercise, repetitive task training, strength training and stretching and positioning. AUTHORS' CONCLUSIONS Large numbers of overlapping reviews related to interventions to improve upper limb function following stroke have been identified, and this overview serves to signpost clinicians and policy makers toward relevant systematic reviews to support clinical decisions, providing one accessible, comprehensive document, which should support clinicians and policy makers in clinical decision making for stroke rehabilitation.Currently, no high-quality evidence can be found for any interventions that are currently used as part of routine practice, and evidence is insufficient to enable comparison of the relative effectiveness of interventions. Effective collaboration is urgently needed to support large, robust RCTs of interventions currently used routinely within clinical practice. Evidence related to dose of interventions is particularly needed, as this information has widespread clinical and research implications.
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Affiliation(s)
- Alex Pollock
- Glasgow Caledonian UniversityNursing, Midwifery and Allied Health Professions Research UnitBuchanan HouseCowcaddens RoadGlasgowUKG4 0BA
| | - Sybil E Farmer
- Glasgow Caledonian UniversityNursing, Midwifery and Allied Health Professions Research UnitBuchanan HouseCowcaddens RoadGlasgowUKG4 0BA
| | - Marian C Brady
- Glasgow Caledonian UniversityNursing, Midwifery and Allied Health Professions Research UnitBuchanan HouseCowcaddens RoadGlasgowUKG4 0BA
| | - Peter Langhorne
- University of GlasgowAcademic Section of Geriatric MedicineLevel 2, New Lister BuildingGlasgow Royal InfirmaryGlasgowUKG31 2ER
| | - Gillian E Mead
- University of EdinburghCentre for Clinical Brain SciencesRoom S1642, Royal InfirmaryLittle France CrescentEdinburghUKEH16 4SA
| | - Jan Mehrholz
- Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa GmbHWissenschaftliches InstitutAn der Wolfsschlucht 1‐2KreischaGermany01731
| | - Frederike van Wijck
- Glasgow Caledonian UniversityInstitute for Applied Health Research and the School of Health and Life SciencesGlasgowUK
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Video games and rehabilitation: using design principles to enhance engagement in physical therapy. J Neurol Phys Ther 2014; 37:166-75. [PMID: 24232363 DOI: 10.1097/npt.0000000000000017] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patient nonadherence with therapy is a major barrier to rehabilitation. Recovery is often limited and requires prolonged, intensive rehabilitation that is time-consuming, expensive, and difficult. We review evidence for the potential use of video games in rehabilitation with respect to the behavioral, physiological, and motivational effects of gameplay. In this Special Interest article, we offer a method to evaluate effects of video game play on motor learning and their potential to increase patient engagement with therapy, particularly commercial games that can be interfaced with adapted control systems. We take the novel approach of integrating research across game design, motor learning, neurophysiology changes, and rehabilitation science to provide criteria by which therapists can assist patients in choosing games appropriate for rehabilitation. Research suggests that video games are beneficial for cognitive and motor skill learning in both rehabilitation science and experimental studies with healthy subjects. Physiological data suggest that gameplay can induce neuroplastic reorganization that leads to long-term retention and transfer of skill; however, more clinical research in this area is needed. There is interdisciplinary evidence suggesting that key factors in game design, including choice, reward, and goals, lead to increased motivation and engagement. We maintain that video game play could be an effective supplement to traditional therapy. Motion controllers can be used to practice rehabilitation-relevant movements, and well-designed game mechanics can augment patient engagement and motivation in rehabilitation. We recommend future research and development exploring rehabilitation-relevant motions to control games and increase time in therapy through gameplay.Video Abstract available (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A61) for more insights from the authors.
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Fritz SL, Butts RJ, Wolf SL. Constraint-induced movement therapy: from history to plasticity. Expert Rev Neurother 2014; 12:191-8. [DOI: 10.1586/ern.11.201] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Shahine EM, Shafshak TS. The effect of repetitive bilateral arm training with rhythmic auditory cueing on motor performance and central motor changes in patients with chronic stroke. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2014. [DOI: 10.4103/1110-161x.128128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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