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Navakkode S, Kennedy BK. Neural ageing and synaptic plasticity: prioritizing brain health in healthy longevity. Front Aging Neurosci 2024; 16:1428244. [PMID: 39161341 PMCID: PMC11330810 DOI: 10.3389/fnagi.2024.1428244] [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: 05/06/2024] [Accepted: 07/24/2024] [Indexed: 08/21/2024] Open
Abstract
Ageing is characterized by a gradual decline in the efficiency of physiological functions and increased vulnerability to diseases. Ageing affects the entire body, including physical, mental, and social well-being, but its impact on the brain and cognition can have a particularly significant effect on an individual's overall quality of life. Therefore, enhancing lifespan and physical health in longevity studies will be incomplete if cognitive ageing is over looked. Promoting successful cognitive ageing encompasses the objectives of mitigating cognitive decline, as well as simultaneously enhancing brain function and cognitive reserve. Studies in both humans and animal models indicate that cognitive decline related to normal ageing and age-associated brain disorders are more likely linked to changes in synaptic connections that form the basis of learning and memory. This activity-dependent synaptic plasticity reorganises the structure and function of neurons not only to adapt to new environments, but also to remain robust and stable over time. Therefore, understanding the neural mechanisms that are responsible for age-related cognitive decline becomes increasingly important. In this review, we explore the multifaceted aspects of healthy brain ageing with emphasis on synaptic plasticity, its adaptive mechanisms and the various factors affecting the decline in cognitive functions during ageing. We will also explore the dynamic brain and neuroplasticity, and the role of lifestyle in shaping neuronal plasticity.
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Affiliation(s)
- Sheeja Navakkode
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, Centre for Healthy Longevity, National University Health System, National University of Singapore, Singapore, Singapore
- Life Sciences Institute Neurobiology Programme, Centre for Life Sciences, National University of Singapore, Singapore, Singapore
| | - Brian K. Kennedy
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, Centre for Healthy Longevity, National University Health System, National University of Singapore, Singapore, Singapore
- Life Sciences Institute Neurobiology Programme, Centre for Life Sciences, National University of Singapore, Singapore, Singapore
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Departments of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Buck Institute for Research on Ageing, Novato, CA, United States
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Alashram AR. Combined robot-assisted therapy virtual reality for upper limb rehabilitation in stroke survivors: a systematic review of randomized controlled trials. Neurol Sci 2024:10.1007/s10072-024-07628-z. [PMID: 38837113 DOI: 10.1007/s10072-024-07628-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Upper limb impairments are among the most common consequences following a stroke. Recently, robot-assisted therapy (RT) and virtual reality (VR) have been used to improve upper limb function in stroke survivors. OBJECTIVES This review aims to investigate the effects of combined RT and VR on upper limb function in stroke survivors and to provide recommendations for researchers and clinicians in the medical field. METHODS We searched PubMed, SCOPUS, REHABDATA, PEDro, EMBASE, and Web of Science from inception to March 28, 2024. Randomized controlled trials (RCTs) involving stroke survivors that compared combined RT and VR interventions with either passive (i.e., sham, rest) or active (i.e., traditional therapy, VR, RT) interventions and assessed outcomes related to upper limb function (e.g., strength, muscle tone, or overall function) were included. The Cochrane Collaboration tool was used to evaluate the methodological quality of the included studies. RESULTS Six studies were included in this review. In total, 201 patients with stroke (mean age 57.84 years) were involved in this review. Four studies were considered 'high quality', while two were considered as 'moderate quality' on the Cochrane Collaboration tool. The findings showed inconsistent results for the effects of combined RT and VR interventions on upper limb function poststroke. CONCLUSION In conclusion, there are potential effects of combined RT and VR interventions on improving upper limb function, but further research is needed to confirm these findings, understand the underlying mechanisms, and assess the consistency and generalizability of the results.
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Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Ammam, Jordan.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.
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Alashram AR. Combined noninvasive brain stimulation virtual reality for upper limb rehabilitation poststroke: A systematic review of randomized controlled trials. Neurol Sci 2024; 45:2523-2537. [PMID: 38286919 DOI: 10.1007/s10072-024-07360-8] [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: 12/12/2023] [Accepted: 01/22/2024] [Indexed: 01/31/2024]
Abstract
Upper limb impairments are common consequences of stroke. Noninvasive brain stimulation (NIBS) and virtual reality (VR) play crucial roles in improving upper limb function poststroke. This review aims to evaluate the effects of combined NIBS and VR interventions on upper limb function post-stroke and to provide recommendations for future studies in the rehabilitation field. PubMed, MEDLINE, PEDro, SCOPUS, REHABDATA, EMBASE, and Web of Science were searched from inception to November 2023. Randomized controlled trials (RCTs) encompassed patients with a confirmed stroke diagnosis, administrated combined NIBS and VR compared with passive (i.e., rest) or active (conventional therapy), and included at least one outcome assessing upper limb function (i.e., strength, spasticity, function) were selected. The quality of the included studies was assessed using the Cochrane Collaboration tool. Seven studies met the eligibility criteria. In total, 303 stroke survivors (Mean age: 61.74 years) were included in this review. According to the Cochrane Collaboration tool, five studies were classified as "high quality," while two were categorized as "moderate quality". There are mixed findings for the effects of combined NIBS and VR on upper limb function in stroke survivors. The evidence for the effects of combined transcranial direct current stimulation and VR on upper limb function post-stroke is promising. However, the evidence regarding the effects of combined repetitive transcranial magnetic stimulation and VR on upper limb function is limited. Further randomized controlled trials with long-term follow-up are strongly warranted.
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Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Amman, Jordan.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.
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Nikolaidou A, Mougkogiannis P, Adamatzky A. Electroactive composite biofilms integrating Kombucha, Chlorella and synthetic proteinoid Proto-Brains. ROYAL SOCIETY OPEN SCIENCE 2024; 11:240238. [PMID: 39076784 PMCID: PMC11285679 DOI: 10.1098/rsos.240238] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
In this study, we present electroactive biofilms made from a combination of Kombucha zoogleal mats and thermal proteinoids. These biofilms have potential applications in unconventional computing and robotic skin. Proteinoids are synthesized by thermally polymerizing amino acids, resulting in the formation of synthetic protocells that display electrical signalling similar to neurons. By incorporating proteinoids into Kombucha zoogleal cellulose mats, hydrogel biofilms can be created that have the ability to efficiently transfer charges, perform sensory transduction and undergo processing. We conducted a study on the memfractance and memristance behaviours of composite biofilms, showcasing their capacity to carry out unconventional computing operations. The porous nanostructure and electroactivity of the biofilm create a biocompatible interface that can be used to record and stimulate neuronal networks. In addition to in vitro neuronal interfaces, these soft electroactive biofilms show potential as components for bioinspired robotics, smart wearables, unconventional computing devices and adaptive biorobotic systems. Kombucha-proteinoids composite films are a highly customizable material that can be synthesized to suit specific needs. These films belong to a unique category of 'living' materials, as they have the ability to support cellular systems and improve bioelectronic functionality. This makes them an exciting prospect in various applications. Ongoing efforts are currently being directed towards enhancing the compositional tuning of conductivity, signal processing and integration within hybrid bioelectronic circuits.
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Affiliation(s)
- Anna Nikolaidou
- Unconventional Computing Laboratory, University of the West of England, Bristol, UK
- School of Architecture and Environment, University of the West of England, Bristol, UK
| | | | - Andrew Adamatzky
- Unconventional Computing Laboratory, University of the West of England, Bristol, UK
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Meng H, Houston M, Zhang Y, Li S. Exploring the Prospects of Transcranial Electrical Stimulation (tES) as a Therapeutic Intervention for Post-Stroke Motor Recovery: A Narrative Review. Brain Sci 2024; 14:322. [PMID: 38671974 PMCID: PMC11047964 DOI: 10.3390/brainsci14040322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/12/2024] [Accepted: 03/23/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Stroke survivors often have motor impairments and related functional deficits. Transcranial Electrical Stimulation (tES) is a rapidly evolving field that offers a wide range of capabilities for modulating brain function, and it is safe and inexpensive. It has the potential for widespread use for post-stroke motor recovery. Transcranial Direct Current Stimulation (tDCS), Transcranial Alternating Current Stimulation (tACS), and Transcranial Random Noise Stimulation (tRNS) are three recognized tES techniques that have gained substantial attention in recent years but have different mechanisms of action. tDCS has been widely used in stroke motor rehabilitation, while applications of tACS and tRNS are very limited. The tDCS protocols could vary significantly, and outcomes are heterogeneous. PURPOSE the current review attempted to explore the mechanisms underlying commonly employed tES techniques and evaluate their prospective advantages and challenges for their applications in motor recovery after stroke. CONCLUSION tDCS could depolarize and hyperpolarize the potentials of cortical motor neurons, while tACS and tRNS could target specific brain rhythms and entrain neural networks. Despite the extensive use of tDCS, the complexity of neural networks calls for more sophisticated modifications like tACS and tRNS.
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Affiliation(s)
- Hao Meng
- Department of Physical Medicine & Rehabilitation, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Michael Houston
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204, USA;
| | - Yingchun Zhang
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL 33146, USA;
| | - Sheng Li
- Department of Physical Medicine & Rehabilitation, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- TIRR Memorial Hermann Hospital, Houston, TX 77030, USA
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Ti CHE, Hu C, Yuan K, Chu WCW, Tong RKY. Uncovering the Neural Mechanisms of Inter-Hemispheric Balance Restoration in Chronic Stroke Through EMG-Driven Robot Hand Training: Insights From Dynamic Causal Modeling. IEEE Trans Neural Syst Rehabil Eng 2024; 32:1-11. [PMID: 38051622 DOI: 10.1109/tnsre.2023.3339756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
EMG-driven robot hand training can facilitate motor recovery in chronic stroke patients by restoring the interhemispheric balance between motor networks. However, the underlying mechanisms of reorganization between interhemispheric regions remain unclear. This study investigated the effective connectivity (EC) between the ventral premotor cortex (PMv), supplementary motor area (SMA), and primary motor cortex (M1) using Dynamic Causal Modeling (DCM) during motor tasks with the paretic hand. Nineteen chronic stroke subjects underwent 20 sessions of EMG-driven robot hand training, and their Action Reach Arm Test (ARAT) showed significant improvement ( β =3.56, [Formula: see text]). The improvement was correlated with the reduction of inhibitory coupling from the contralesional M1 to the ipsilesional M1 (r=0.58, p=0.014). An increase in the laterality index was only observed in homotopic M1, but not in the premotor area. Additionally, we identified an increase in resting-state functional connectivity (FC) between bilateral M1 ( β =0.11, p=0.01). Inter-M1 FC demonstrated marginal positive relationships with ARAT scores (r=0.402, p=0.110), but its changes did not correlate with ARAT improvements. These findings suggest that the improvement of hand functions brought about by EMG-driven robot hand training was driven explicitly by task-specific reorganization of motor networks. Particularly, the restoration of interhemispheric balance was induced by a reduction in interhemispheric inhibition from the contralesional M1 during motor tasks of the paretic hand. This finding sheds light on the mechanistic understanding of interhemispheric balance and functional recovery induced by EMG-driven robot training.
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Chen YF, Mao MC, Zhu GY, Sun CC, Zhao JW, He HX, Chen YH, Xu DS. The changes of neuroactivity of Tui Na (Chinese massage) at Hegu acupoint on sensorimotor cortex in stroke patients with upper limb motor dysfunction: a fNIRS study. BMC Complement Med Ther 2023; 23:334. [PMID: 37735652 PMCID: PMC10512523 DOI: 10.1186/s12906-023-04143-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 08/27/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Tui Na (Chinese massage) is a relatively simple, inexpensive, and non-invasive intervention, and has been used to treat stroke patients for many years in China. Tui Na acts on specific parts of the body which are called meridians and acupoints to achieve the role of treating diseases. Yet the underlying neural mechanism associated with Tui Na is not clear due to the lack of detection methods. OBJECTIVE Functional near-infrared spectroscopy (fNIRS) was used to explore the changes of sensorimotor cortical neural activity in patients with upper limb motor dysfunction of stroke and healthy control groups during Tui Na Hegu Point. METHODS Ten patients with unilateral upper limb motor dysfunction after stroke and eight healthy subjects received Tui Na. fNIRS was used to record the hemodynamic data in the sensorimotor cortex and the changes in blood flow were calculated based on oxygenated hemoglobin (Oxy-Hb), the task session involved repetitive Tui Na on Hegu acupoint, using a block design [six cycles: rest (20 seconds); Tui Na (20 seconds); rest (30 seconds)]. The changes in neural activity in sensorimotor cortex could be inferred according to the principle of neurovascular coupling, and the number of activated channels in the bilateral hemisphere was used to calculate the lateralization index. RESULT 1. For hemodynamic response induced by Hegu acupoint Tui Na, a dominant increase in the contralesional primary sensorimotor cortex during Hegu point Tui Na of the less affected arm in stroke patients was observed, as well as that in healthy controls, while this contralateral pattern was absent during Hegu point Tui Na of the affected arm in stroke patients. 2. Concerning the lateralization index in stroke patients, a significant difference was observed between lateralization index values for the affected arm and the less affected arm (P < 0.05). Wilcoxon tests showed a significant difference between lateralization index values for the affected arm in stroke patients and lateralization index values for the dominant upper limb in healthy controls (P < 0.05), and no significant difference between lateralization index values for the less affected arm in stroke patients and that in healthy controls (P = 0.36). CONCLUSION The combination of Tui Na and fNIRS has the potential to reflect the functional status of sensorimotor neural circuits. The changes of neuroactivity in the sensorimotor cortex when Tui Na Hegu acupoint indicate that there is a certain correlation between acupoints in traditional Chinese medicine and neural circuits.
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Affiliation(s)
- Yu-Feng Chen
- Department of Massage, Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Meng-Chai Mao
- School 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
- The Second Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Guang-Yue Zhu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Cheng-Cheng Sun
- Rehabilitation Medical Center, Tongji Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Jing-Wang Zhao
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hao-Xiang He
- Department of Intensive Rehabilitation, Shanghai Third Rehabilitation Hospital, Shanghai, China
| | - Yu-Hui Chen
- Department of Internal Neurology, Tongji Hospital, Tongji University, Shanghai, China.
| | - Dong-Sheng Xu
- School 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, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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Thompson ED, Bhat S, French MA, Morton S, Pohlig RT, Reisman DS. Effects of an Acute High Intensity Exercise Bout on Retention of Explicit, Strategic Locomotor Learning in Individuals With Chronic Stroke. Neurorehabil Neural Repair 2023; 37:628-639. [PMID: 37646138 PMCID: PMC10529423 DOI: 10.1177/15459683231195039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND Exercise priming, pairing high intensity exercise with a motor learning task, improves retention of upper extremity tasks in individuals after stroke, but has shown no benefit to locomotor learning. This difference may relate to the type of learning studied. Upper extremity studies used explicit, strategic tasks; locomotor studies used implicit sensorimotor adaptation (split-belt treadmill). Since walking is an important rehabilitation goal, it is crucial to understand under which circumstances exercise priming may improve retention of a newly learned walking pattern. OBJECTIVE Determine the impact of exercise priming on explicit, strategic locomotor learning task retention in chronic stroke survivors. METHODS Chronic stroke survivors (>6 months) performed 2 treadmill walking sessions. Visual feedback was used to train increased step length. Participants were assigned to control group (no exercise), continuous exercise (5 minutes high intensity), or long-interval exercise (15 minutes high/moderate intervals). After day 1 learning, participants either rested or performed exercise. On day 2, retention of the learned walking pattern was tested. RESULTS All groups learned on day 1 (P < .001). The 2 priming groups showed significant changes in blood lactate and heart rate after exercise priming, the resting control group did not (P < .001). On day 2, there was no significant between-group difference in cued or un-cued task retention (P = .963 and .287, respectively). CONCLUSIONS Exercise priming did not affect retention of an explicit locomotor task in chronic stroke survivors. Further work should explore subgroups of individuals for whom priming may have selective clinical benefit to locomotor learning.ClinicalTrials.gov Identifier: NCT03726047.
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Affiliation(s)
| | - Soumya Bhat
- University of Delaware, Department of Physical Therapy
- University of Delaware, Biomechanics and Movement Science (BIOMS) program
| | - Margaret A. French
- Johns Hopkins University, Department of Physical Medicine and Rehabilitation
| | - Susanne Morton
- University of Delaware, Department of Physical Therapy
- University of Delaware, Biomechanics and Movement Science (BIOMS) program
| | | | - Darcy S. Reisman
- University of Delaware, Department of Physical Therapy
- University of Delaware, Biomechanics and Movement Science (BIOMS) program
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Widanage KND, Sheng Z, Chen HL, Li Y. Multi-Objective Optimization-Based Assist-as-Needed Controller for Improved Quality of Assistance in Rehabilitation Robotics. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941209 DOI: 10.1109/icorr58425.2023.10304734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Assist-as-needed (AAN) is a paradigm in rehabilitation robotics based on the fact that more active participation from human users promotes faster recovery of motor functions. Moreover, the patients and public engaged and involved in our research design stressed that in order to provide safe and patient-friendly assistance, rehabilitation robotics should be equipped with different constraints while giving minimal assistance where required. Most of the current constraint-based AAN methods are only capable of providing position or velocity constraints which limit the quality of assistance that the robotic systems could provide. In this paper, we propose a multi-objective optimization (MOO) based controller which can implement both linear and non-linear constraints to improve the quality of assistance. This MOO-based proposed controller includes not only position and velocity constraints but also a vibration constraint to subside the tremors common in rehabilitation patients. The performance of this controller is compared with a Barrier Lyapunov Function (BLF) based controller with task-space constraints in a simulation. The results indicate that the MOO-based controller behaves similarly to the BLF-based controller in terms of position constraints. It also shows that the MOO-based controller can improve the quality of assistance by constraining the velocity and subsiding the simulated tremors.
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Pila O, Duret C, Koeppel T, Jamin P. Performance-Based Robotic Training in Individuals with Subacute Stroke: Differences between Responders and Non-Responders. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23094304. [PMID: 37177508 PMCID: PMC10181678 DOI: 10.3390/s23094304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/17/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023]
Abstract
The high variability of upper limb motor recovery with robotic training (RT) in subacute stroke underscores the need to explore differences in responses to RT. We explored differences in baseline characteristics and the RT dose between responders (ΔFugl-Meyer Assessment (FMA) score ≥ 9 points; n = 20) and non-responders (n = 16) in people with subacute stroke (mean [SD] poststroke time at baseline, 54 (26) days, baseline FMA score, 23 (17) points) who underwent 16 RT sessions combined with conventional therapies. Baseline characteristics were compared between groups. During RT sessions, the actual practice time (%), number of movements performed, and total distance covered (cm) in assisted and unassisted modalities were compared between groups. At baseline, participant characteristics and FMA scores did not differ between groups. During the RT, non-responders increased practice time (+15%; p = 0.02), performed more movements (+285; p = 0.004), and covered more distance (+4037 cm; p < 10-3), with no difference between physical modalities. In contrast, responders decreased practice time (-21%; p = 0.01) and performed fewer movements (-338; p = 0.03) in the assisted modality while performing more movements (+328; p < 0.05) and covering a greater distance (+4779 cm; p = 0.01) in unassisted modalities. Despite a large amount of motor practice, motor outcomes did not improve in non-responders compared to responders: the difficulty level in RT may have been too low for them. Future studies should combine robot-based parameters to describe the treatment dose, especially in people with severe-to-moderate arm paresis, to optimize the RT and improve the recovery prognosis.
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Affiliation(s)
- Ophélie Pila
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, 77310 Boissise-Le-Roi, France
| | - Christophe Duret
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, 77310 Boissise-Le-Roi, France
| | - Typhaine Koeppel
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, 77310 Boissise-Le-Roi, France
| | - Pascal Jamin
- Institut Robert Merle d'Aubigné, Rééducation et Appareillage, 94460 Valenton, France
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Sokratous D, Charalambous CC, Papanicolaou EZ, Michailidou K, Konstantinou N. Investigation of in-phase bilateral exercise effects on corticospinal plasticity in relapsing remitting multiple sclerosis: A registered report single-case concurrent multiple baseline design across five subjects. PLoS One 2023; 18:e0272114. [PMID: 36862693 PMCID: PMC9980831 DOI: 10.1371/journal.pone.0272114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/24/2023] [Indexed: 03/03/2023] Open
Abstract
Relapsing-remitting Multiple Sclerosis is the most common demyelinating neurodegenerative disease and is characterized by periods of relapses and generation of various motor symptoms. These symptoms are associated with the corticospinal tract integrity, which is quantified by means of corticospinal plasticity which can be probed via transcranial magnetic stimulation and assessed with corticospinal excitability measures. Several factors, such as exercise and interlimb coordination, can influence corticospinal plasticity. Previous work in healthy and in chronic stroke survivors showed that the greatest improvement in corticospinal plasticity occurred during in-phase bilateral exercises of the upper limbs. During in-phase bilateral movement, both upper limbs are moving simultaneously, activating the same muscle groups and triggering the same brain region respectively. Altered corticospinal plasticity due to bilateral cortical lesions is common in MS, yet, the impact of these type of exercises in this cohort is unclear. The aim of this concurrent multiple baseline design study is to investigate the effects of in-phase bilateral exercises on corticospinal plasticity and on clinical measures using transcranial magnetic stimulation and standardized clinical assessment in five people with relapsing-remitting MS. The intervention protocol will last for 12 consecutive weeks (30-60 minutes /session x 3 sessions/week) and include in-phase bilateral movements of the upper limbs, adapted to different sports activities and to functional training. To define functional relation between the intervention and the results on corticospinal plasticity (central motor conduction time, resting motor threshold, motor evoked potential amplitude and latency) and on clinical measures (balance, gait, bilateral hand dexterity and strength, cognitive function), we will perform a visual analysis and if there is a potential sizeable effect, we will perform statistical analysis. A possible effect from our study, will introduce a proof-of-concept for this type of exercise that will be effective during disease progression. Trial registration: ClinicalTrials.gov NCT05367947.
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Affiliation(s)
- Dimitris Sokratous
- Faculty of Health Sciences, Department of Rehabilitation Sciences, Cyprus University of Technology, Limassol, Cyprus
- Physiotherapy Unit, Neurology Clinics, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
- * E-mail:
| | - Charalambos C. Charalambous
- Department of Basic and Clinical Sciences, Medical School, University of Nicosia, Nicosia, Cyprus
- Centre for Neuroscience and Integrative Brain Research (CENIBRE), University of Nicosia Medical School, Nicosia, Cyprus
| | | | - Kyriaki Michailidou
- Biostatistics Unit, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Nikos Konstantinou
- Faculty of Health Sciences, Department of Rehabilitation Sciences, Cyprus University of Technology, Limassol, Cyprus
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Segal AD, Petruska AJ, Adamczyk PG, Silverman AK. Age-specific biomechanical challenges and engagement in dynamic balance training with robotic or virtual real-time visual feedback. J Biomech 2023; 152:111574. [PMID: 37043927 DOI: 10.1016/j.jbiomech.2023.111574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/24/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023]
Abstract
Challenging balance training that targets age-related neuromuscular and motor coordination deficits is needed for effective fall prevention therapy. Goal-directed training can provide intrinsically motivating balance activities but may not equally challenge balance for all age groups. Therefore, the purpose of this research was to quantify age-specific effects of dynamic balance training with real-time visual feedback. Kinematics, muscle activity, and user perceptions were collected for forty healthy adults (20 younger, 18-39 years; 20 older, 58-74 years), who performed a single balance training session with or without real-time visual feedback. Feedback involved controlling either a physical mobile robot or screen-based virtual ball through a course with standing tilt motions from an instrumented wobble board. Dynamic balance training was more challenging for older compared to younger adults, as measured by significantly higher dorsiflexor and knee extensor muscle activity and ankle co-contractions (50%-80%, p<0.05). Older participants also performed more motion while training without feedback compared to younger adults (22%-65%, p<0.05). Robotic and virtual real-time visual feedback elicited similar biomechanical adaptations in older adults, reducing motions to similar levels as younger adults and increasing ankle co-contractions (p<0.05). Despite higher muscular demand, perceived physical exertion and high enjoyment levels (Intrinsic Motivation Inventory >0.80) were consistent across groups. However, robotic visual feedback may be more challenging than virtual feedback based on more frequent balance corrections, lower perceived competence, and lower game scores for older compared to younger adults. These findings collectively support the feedback system's potential to provide engaging and challenging at-home balance training across the lifespan.
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Champagne PL, Blanchette AK, Schneider C. Continuous, and not intermittent, theta-burst stimulation of the unlesioned hemisphere improved brain and hand function in chronic stroke: A case study. BRAIN DISORDERS 2023. [DOI: 10.1016/j.dscb.2022.100062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Michiels L, Thijs L, Mertens N, Coremans M, Vandenbulcke M, Verheyden G, Koole M, Van Laere K, Lemmens R. Longitudinal Synaptic Density PET with 11 C-UCB-J 6 Months After Ischemic Stroke. Ann Neurol 2022; 93:911-921. [PMID: 36585914 DOI: 10.1002/ana.26593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/30/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The purpose of this study was to explore longitudinal changes in synaptic density after ischemic stroke in vivo with synaptic vesicle protein 2A (SV2A) positron emission tomography (PET). METHODS We recruited patients with an ischemic stroke to undergo 11 C-UCB-J PET/MR within the first month and 6 months after the stroke. We investigated longitudinal changes of partial volume corrected 11 C-UCB-J standardized uptake value ratio (SUVR; relative to centrum semiovale) within the ischemic lesion, peri-ischemic area and unaffected ipsilesional and contralesional grey matter. We also explored crossed cerebellar diaschisis at 6 months. Additionally, we defined brain regions potentially influencing upper limb motor recovery after stroke and studied 11 C-UCB-J SUVR evolution in comparison to baseline. RESULTS In 13 patients (age = 67 ± 15 years) we observed decreasing 11 C-UCB-J SUVR in the ischemic lesion (ΔSUVR = -1.0, p = 0.001) and peri-ischemic area (ΔSUVR = -0.31, p = 0.02) at 6 months after stroke compared to baseline. Crossed cerebellar diaschisis as measured with 11 C-UCB-J SUVR was present in 11 of 13 (85%) patients at 6 months. The 11 C-UCB-J SUVR did not augment in ipsilesional or contralesional brain regions associated with motor recovery. On the contrary, there was an overall trend of declining 11 C-UCB-J SUVR in these brain regions, reaching statistical significance only in the nonlesioned part of the ipsilesional supplementary motor area (ΔSUVR = -0.83, p = 0.046). INTERPRETATION At 6 months after stroke, synaptic density further declined in the ischemic lesion and peri-ischemic area compared to baseline. Brain regions previously demonstrated to be associated with motor recovery after stroke did not show increases in synaptic density. ANN NEUROL 2023.
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Affiliation(s)
- Laura Michiels
- Department of Neurosciences, KU Leuven, Leuven, Belgium.,Laboratory of Neurobiology, VIB, Center for Brain & Disease Research, Leuven, Belgium.,Department of Neurology, University Hospitals Leuven, Leuven, Belgium.,Leuven Brain Institute, Leuven, Belgium
| | - Liselot Thijs
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Nathalie Mertens
- Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Marjan Coremans
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Mathieu Vandenbulcke
- Department of Neurosciences, KU Leuven, Leuven, Belgium.,Leuven Brain Institute, Leuven, Belgium.,Department of Geriatric Psychiatry, University Psychiatric Centre, Leuven, Belgium
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Michel Koole
- Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Koen Van Laere
- Leuven Brain Institute, Leuven, Belgium.,Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Department of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Robin Lemmens
- Department of Neurosciences, KU Leuven, Leuven, Belgium.,Laboratory of Neurobiology, VIB, Center for Brain & Disease Research, Leuven, Belgium.,Department of Neurology, University Hospitals Leuven, Leuven, Belgium.,Leuven Brain Institute, Leuven, Belgium
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15
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Yang R, Zheng J, Song R. Continuous mode adaptation for cable-driven rehabilitation robot using reinforcement learning. Front Neurorobot 2022; 16:1068706. [PMID: 36620486 PMCID: PMC9813438 DOI: 10.3389/fnbot.2022.1068706] [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: 10/13/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Continuous mode adaptation is very important and useful to satisfy the different user rehabilitation needs and improve human-robot interaction (HRI) performance for rehabilitation robots. Hence, we propose a reinforcement-learning-based optimal admittance control (RLOAC) strategy for a cable-driven rehabilitation robot (CDRR), which can realize continuous mode adaptation between passive and active working mode. To obviate the requirement of the knowledge of human and robot dynamics model, a reinforcement learning algorithm was employed to obtain the optimal admittance parameters by minimizing a cost function composed of trajectory error and human voluntary force. Secondly, the contribution weights of the cost function were modulated according to the human voluntary force, which enabled the CDRR to achieve continuous mode adaptation between passive and active working mode. Finally, simulation and experiments were conducted with 10 subjects to investigate the feasibility and effectiveness of the RLOAC strategy. The experimental results indicated that the desired performances could be obtained; further, the tracking error and energy per unit distance of the RLOAC strategy were notably lower than those of the traditional admittance control method. The RLOAC strategy is effective in improving the tracking accuracy and robot compliance. Based on its performance, we believe that the proposed RLOAC strategy has potential for use in rehabilitation robots.
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Affiliation(s)
- Renyu Yang
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, China,School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen, China
| | - Jianlin Zheng
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, China,School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen, China
| | - Rong Song
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, China,School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen, China,*Correspondence: Rong Song,
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16
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Ulanov M, Shtyrov Y. Oscillatory beta/alpha band modulations: A potential biomarker of functional language and motor recovery in chronic stroke? Front Hum Neurosci 2022; 16:940845. [PMID: 36226263 PMCID: PMC9549964 DOI: 10.3389/fnhum.2022.940845] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
Stroke remains one of the leading causes of various disabilities, including debilitating motor and language impairments. Though various treatments exist, post-stroke impairments frequently become chronic, dramatically reducing daily life quality, and requiring specific rehabilitation. A critical goal of chronic stroke rehabilitation is to induce, usually through behavioral training, experience-dependent plasticity processes in order to promote functional recovery. However, the efficiency of such interventions is typically modest, and very little is known regarding the neural dynamics underpinning recovery processes and possible biomarkers of their efficiency. Some studies have emphasized specific alterations of excitatory–inhibitory balance within distributed neural networks as an important recovery correlate. Neural processes sensitive to these alterations, such as task-dependent oscillatory activity in beta as well as alpha bands, may be candidate biomarkers of chronic stroke functional recovery. In this review, we discuss the results of studies on motor and language recovery with a focus on oscillatory processes centered around the beta band and their modulations during functional recovery in chronic stroke. The discussion is based on a framework where task-dependent modulations of beta and alpha oscillatory activity, generated by the deep cortical excitatory–inhibitory microcircuits, serve as a neural mechanism of domain-general top-down control processes. We discuss the findings, their limitations, and possible directions for future research.
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Affiliation(s)
- Maxim Ulanov
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, HSE University, Moscow, Russia
- *Correspondence: Maxim Ulanov,
| | - Yury Shtyrov
- Center of Functionally Integrative Neuroscience (CFIN), Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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17
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Lissom LO, Lamberti N, Lavezzi S, Basaglia N, Manfredini F, Straudi S. Is robot-assisted gait training intensity a determinant of functional recovery early after stroke? A pragmatic observational study of clinical care. Int J Rehabil Res 2022; 45:189-194. [PMID: 35131979 DOI: 10.1097/mrr.0000000000000518] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Gait rehabilitation is a critical factor in functional recovery after a stroke. The aim of this pragmatic observational study was to identify the optimal dose and timing of robot-assisted gait training (RAGT) that can lead to a favourable outcome in a sample of subacute stroke survivors. Subacute patients with stroke who underwent a RAGT within a multidisciplinary rehabilitation program were enrolled. A set of clinical (i.e. age, type of stroke and time since stroke) and rehabilitation stay outcomes (length of stay and RAGT number of sessions) were recorded to evaluate their impact on functional outcome measures by functional independence measure (FIM) or functional ambulation category (FAC). We included 236 patients (62.73 ± 11.82 year old); 38.44% were females, and 59.32% were ischaemic stroke patients. Patients that received at least 14 RAGT sessions, had 15.83% more chance to be responders compared to those that receive less sessions (P = 0.006). Similarly, younger patients (≤60 years) were more prone to be responders (+15.1%). Lastly, an early rehabilitation (<6 weeks) was found to be more efficient (+21.09%) in determining responsiveness (P < 0.001). Becoming newly independent for gait, that refers to a FAC score ≥4, was related with age and RAGT sessions (P = 0.001). In conclusion, a younger age (≤60 years), an early rehabilitation (<6 weeks since stroke) and a higher RAGT dose (at least 14 sessions) were related to a favourable outcome in patients with subacute stroke.
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Affiliation(s)
- Luc Oscar Lissom
- Department of Neuroscience and Rehabilitation, University of Ferrara, Doctoral Program in Translational Neurosciences and Neurotechnologies
| | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara
| | - Susanna Lavezzi
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Ferrara, Italy
| | - Nino Basaglia
- Department of Neuroscience and Rehabilitation, University of Ferrara
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Ferrara, Italy
| | - Fabio Manfredini
- Department of Neuroscience and Rehabilitation, University of Ferrara
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Ferrara, Italy
| | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, University of Ferrara
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Ferrara, Italy
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18
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Kumar A, Gao L, Li J, Ma J, Fu J, Gu X, Mahmoud SS, Fang Q. Error-Related Negativity-Based Robot-Assisted Stroke Rehabilitation System: Design and Proof-of-Concept. Front Neurorobot 2022; 16:837119. [PMID: 35548781 PMCID: PMC9085417 DOI: 10.3389/fnbot.2022.837119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/04/2022] [Indexed: 12/02/2022] Open
Abstract
Conventional rehabilitation systems typically execute a fixed set of programs that most motor-impaired stroke patients undergo. In these systems, the brain, which is embodied in the body, is often left out. Including the brains of stroke patients in the control loop of a rehabilitation system can be worthwhile as the system can be tailored to each participant and, thus, be more effective. Here, we propose a novel brain-computer interface (BCI)-based robot-assisted stroke rehabilitation system (RASRS), which takes inputs from the patient's intrinsic feedback mechanism to adapt the assistance level of the RASRS. The proposed system will utilize the patients' consciousness about their performance decoded through their error-related negativity signals. As a proof-of-concept, we experimented on 12 healthy people in which we recorded their electroencephalogram (EEG) signals while performing a standard rehabilitation exercise. We set the performance requirements beforehand and observed participants' neural responses when they failed/met the set requirements and found a statistically significant (p < 0.05) difference in their neural responses in the two conditions. The feasibility of the proposed BCI-based RASRS was demonstrated through a use-case description with a timing diagram and meeting the crucial requirements for developing the proposed rehabilitation system. The use of a patient's intrinsic feedback mechanism will have significant implications for the development of human-in-the-loop stroke rehabilitation systems.
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Affiliation(s)
- Akshay Kumar
- Department of Biomedical Engineering, College of Engineering, Shantou University, Shantou, China
| | - Lin Gao
- Department of Biomedical Engineering, College of Engineering, Shantou University, Shantou, China
| | - Jiaming Li
- Department of Biomedical Engineering, College of Engineering, Shantou University, Shantou, China
| | - Jiaxin Ma
- OMRON SINIC X Corporation, Tokyo, Japan
| | | | - Xudong Gu
- 2nd Hospital of Jiaxing, Jiaxing, China
| | - Seedahmed S. Mahmoud
- Department of Biomedical Engineering, College of Engineering, Shantou University, Shantou, China
| | - Qiang Fang
- Department of Biomedical Engineering, College of Engineering, Shantou University, Shantou, China
- *Correspondence: Qiang Fang
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19
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Jamin P, Duret C, Hutin E, Bayle N, Koeppel T, Gracies JM, Pila O. Using Robot-Based Variables during Upper Limb Robot-Assisted Training in Subacute Stroke Patients to Quantify Treatment Dose. SENSORS 2022; 22:s22082989. [PMID: 35458975 PMCID: PMC9026756 DOI: 10.3390/s22082989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 12/10/2022]
Abstract
In post-stroke motor rehabilitation, treatment dose description is estimated approximately. The aim of this retrospective study was to quantify the treatment dose using robot-measured variables during robot-assisted training in patients with subacute stroke. Thirty-six patients performed fifteen 60 min sessions (Session 1−Session 15) of planar, target-directed movements in addition to occupational therapy over 4 (SD 2) weeks. Fugl−Meyer Assessment (FMA) was carried out pre- and post-treatment. The actual time practiced (percentage of a 60 min session), the number of repeated movements, and the total distance traveled were analyzed across sessions for each training modality: assist as needed, unassisted, and against resistance. The FMA score improved post-treatment by 11 (10) points (Session 1 vs. Session 15, p < 0.001). In Session 6, all modalities pooled, the number of repeated movements increased by 129 (252) (vs. Session 1, p = 0.043), the total distance traveled increased by 1743 (3345) cm (vs. Session 1, p = 0.045), and the actual time practiced remained unchanged. In Session 15, the actual time practiced showed changes only in the assist-as-needed modality: −13 (23) % (vs. Session 1, p = 0.013). This description of changes in quantitative-practice-related variables when using different robotic training modalities provides comprehensive information related to the treatment dose in rehabilitation. The treatment dose intensity may be enhanced by increasing both the number of movements and the motor difficulty of performing each movement.
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Affiliation(s)
- Pascal Jamin
- Institut Robert Merle d’Aubigné, Rééducation et Appareillage, 94460 Valenton, France;
| | - Christophe Duret
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, 77310 Boissise-Le-Roi, France; (C.D.); (T.K.)
| | - Emilie Hutin
- Laboratoire Analyse et Restauration Du Mouvement (ARM), Hôpital Henri MONDOR, Université Paris-Est, 94000 Créteil, France; (E.H.); (N.B.); (J.-M.G.)
- Bioingénierie, Tissus et Neuroplasticité (BIOTN), Université Paris-Est Créteil, 94000 Créteil, France
| | - Nicolas Bayle
- Laboratoire Analyse et Restauration Du Mouvement (ARM), Hôpital Henri MONDOR, Université Paris-Est, 94000 Créteil, France; (E.H.); (N.B.); (J.-M.G.)
- Bioingénierie, Tissus et Neuroplasticité (BIOTN), Université Paris-Est Créteil, 94000 Créteil, France
| | - Typhaine Koeppel
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, 77310 Boissise-Le-Roi, France; (C.D.); (T.K.)
| | - Jean-Michel Gracies
- Laboratoire Analyse et Restauration Du Mouvement (ARM), Hôpital Henri MONDOR, Université Paris-Est, 94000 Créteil, France; (E.H.); (N.B.); (J.-M.G.)
- Bioingénierie, Tissus et Neuroplasticité (BIOTN), Université Paris-Est Créteil, 94000 Créteil, France
| | - Ophélie Pila
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, 77310 Boissise-Le-Roi, France; (C.D.); (T.K.)
- Correspondence:
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20
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Comeau N, Monetta L, Schneider C. Noninvasive stimulation of the unlesioned hemisphere and phonological treatment in a case of chronic anomia post-stroke. Neurocase 2022; 28:206-217. [PMID: 35580361 DOI: 10.1080/13554794.2022.2068374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Chronic lexical anomia after left hemisphere (LH) stroke improves under personalized phonological treatment (PT). Cortical linking between language and hand motor areas (hand_M1) questioned whether PT-related improvement relies on the unlesioned hemisphere (UH) plasticity when LH is dysfunctional. Our 70-yo-woman case study showed that 10 sessions of excitatory stimulation of UH_hand-M1 combined with PT hastened oral picture naming improvement as compared to sham+PT and changes were maintained together with changes of untrained items andcorticomotor excitability increase. This supports a role of stimulation-induced plasticity of UH_hand M1 in language recovery, at least in the improvement of lexical anomia in chronic stroke.
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Affiliation(s)
- Noémie Comeau
- Neuroscience Division, Noninvasive Neurostimulation Laboratory, Research Center of CHU de Québec - Université Laval, Québec, Canada
| | - Laura Monetta
- Faculty of Medicine Université Laval, Quebec, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Canada.,CIRRIS Research Center, Quebec, Canada
| | - Cyril Schneider
- Neuroscience Division, Noninvasive Neurostimulation Laboratory, Research Center of CHU de Québec - Université Laval, Québec, Canada.,Faculty of Medicine Université Laval, Quebec, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Canada
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21
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Li X, Zeng H, Zhang J, Song A. Engagement Enhancement Based on Bayesian Optimization for Adaptive Assist-as-Needed Controller. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2021.3118473] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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22
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Vose AK, Welch JF, Nair J, Dale EA, Fox EJ, Muir GD, Trumbower RD, Mitchell GS. Therapeutic acute intermittent hypoxia: A translational roadmap for spinal cord injury and neuromuscular disease. Exp Neurol 2022; 347:113891. [PMID: 34637802 PMCID: PMC8820239 DOI: 10.1016/j.expneurol.2021.113891] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/29/2021] [Accepted: 10/03/2021] [Indexed: 01/03/2023]
Abstract
We review progress towards greater mechanistic understanding and clinical translation of a strategy to improve respiratory and non-respiratory motor function in people with neuromuscular disorders, therapeutic acute intermittent hypoxia (tAIH). In 2016 and 2020, workshops to create and update a "road map to clinical translation" were held to help guide future research and development of tAIH to restore movement in people living with chronic, incomplete spinal cord injuries. After briefly discussing the pioneering, non-targeted basic research inspiring this novel therapeutic approach, we then summarize workshop recommendations, emphasizing critical knowledge gaps, priorities for future research effort, and steps needed to accelerate progress as we evaluate the potential of tAIH for routine clinical use. Highlighted areas include: 1) greater mechanistic understanding, particularly in non-respiratory motor systems; 2) optimization of tAIH protocols to maximize benefits; 3) identification of combinatorial treatments that amplify plasticity or remove plasticity constraints, including task-specific training; 4) identification of biomarkers for individuals most/least likely to benefit from tAIH; 5) assessment of long-term tAIH safety; and 6) development of a simple, safe and effective device to administer tAIH in clinical and home settings. Finally, we update ongoing clinical trials and recent investigations of tAIH in SCI and other clinical disorders that compromise motor function, including ALS, multiple sclerosis, and stroke.
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Affiliation(s)
- Alicia K Vose
- Breathing Research and Therapeutics Center, Department of Physical Therapy and McKnight Brain Institute, University of Florida, Gainesville, FL 32610, USA; Brooks Rehabilitation, Jacksonville, FL 32216, USA
| | - Joseph F Welch
- Breathing Research and Therapeutics Center, Department of Physical Therapy and McKnight Brain Institute, University of Florida, Gainesville, FL 32610, USA; Brooks Rehabilitation, Jacksonville, FL 32216, USA
| | - Jayakrishnan Nair
- Breathing Research and Therapeutics Center, Department of Physical Therapy and McKnight Brain Institute, University of Florida, Gainesville, FL 32610, USA
| | - Erica A Dale
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL 32610, USA
| | - Emily J Fox
- Breathing Research and Therapeutics Center, Department of Physical Therapy and McKnight Brain Institute, University of Florida, Gainesville, FL 32610, USA; Brooks Rehabilitation, Jacksonville, FL 32216, USA
| | - Gillian D Muir
- Department of Biomedical Sciences, WCVM, University of Saskatchewan, Saskatoon, SK S7N 5B4, Canada
| | - Randy D Trumbower
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Gordon S Mitchell
- Breathing Research and Therapeutics Center, Department of Physical Therapy and McKnight Brain Institute, University of Florida, Gainesville, FL 32610, USA.
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23
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Branscheidt M, Ejaz N, Xu J, Widmer M, Harran MD, Cortés JC, Kitago T, Celnik PA, Hernandez-Castillo C, Diedrichsen J, Luft AR, Krakauer JW. No evidence for motor recovery-related cortical connectivity changes after stroke using resting-state fMRI. J Neurophysiol 2021; 127:637-650. [PMID: 34965743 PMCID: PMC8896990 DOI: 10.1152/jn.00148.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
It has been proposed that a form of cortical reorganization (changes in functional connectivity between brain areas) can be assessed with resting-state (rs) fMRI. Here we report a longitudinal data-set collected from 19 patients with subcortical stroke and 11 controls. Patients were imaged up to five times over one year. We found no evidence, using rs-fMRI, for post-stroke cortical connectivity changes despite substantial behavioral recovery. These results could be construed as questioning the value of resting-state imaging. Here we argue instead that they are consistent with other emerging reasons to challenge the idea of motor recovery-related cortical reorganization post-stroke when conceived of as changes in connectivity between cortical areas.
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Affiliation(s)
- Meret Branscheidt
- Brain Physiology and Stimulation Laboratory, Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, United States.,Department of Neurology, University Hospital Zurich, Zürich, Switzerland.,Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Naveed Ejaz
- Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Jing Xu
- Department of Neuroscience, Johns Hopkins University, Baltimore, MD, United States.,Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, MD, United States
| | - Mario Widmer
- Department of Neurology, University Hospital Zurich, Zürich, Switzerland
| | - Michelle D Harran
- Department of Neuroscience, Johns Hopkins University, Baltimore, MD, United States
| | - Juan Camilo Cortés
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Tomoko Kitago
- Burke Neurological Institute and Weill Cornell Medicine, White Plains, NY, United States
| | - Pablo A Celnik
- Brain Physiology and Stimulation Laboratory, Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, United States
| | | | - Jörn Diedrichsen
- Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Andreas R Luft
- Department of Neurology, University Hospital Zurich, Zürich, Switzerland.,Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - John W Krakauer
- Department of Neuroscience, Johns Hopkins University, Baltimore, MD, United States.,Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, MD, United States.,Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
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24
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Abstract
PURPOSE OF REVIEW This article provides a definition of and introduction to cognitive rehabilitation. It discusses different approaches to cognitive rehabilitation (ie, restorative, compensatory, and metacognitive). It also reviews types of memory impairment and how they can be distinguished to improve treatment design and implementation. RECENT FINDINGS Neural plasticity as a biological substrate for functional changes from cognitive rehabilitation is an exciting new area of research. SUMMARY This article provides a high-level review of cognitive rehabilitation and presents a complex case example.
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25
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Yang Z, Guo S, Hirata H, Kawanishi M. A Mirror Bilateral Neuro-Rehabilitation Robot System with the sEMG-Based Real-Time Patient Active Participant Assessment. Life (Basel) 2021; 11:life11121290. [PMID: 34947820 PMCID: PMC8707631 DOI: 10.3390/life11121290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
In this paper, a novel mirror visual feedback-based (MVF) bilateral neurorehabilitation system with surface electromyography (sEMG)-based patient active force assessment was proposed for upper limb motor recovery and improvement of limb inter-coordination. A mirror visual feedback-based human–robot interface was designed to facilitate the bilateral isometric force output training task. To achieve patient active participant assessment, an sEMG signals-based elbow joint isometric force estimation method was implemented into the proposed system for real-time affected side force assessment and participation evaluation. To assist the affected side limb efficiently and precisely, a mirror bilateral control framework was presented for bilateral limb coordination. Preliminary experiments were conducted to evaluate the estimation accuracy of force estimation method and force tracking accuracy of system performance. The experimental results show the proposed force estimation method can efficiently calculate the elbow joint force in real-time, and the affected side limb of patients can be assisted to track output force of the non-paretic side limb for better limb coordination by the proposed bilateral rehabilitation system.
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Affiliation(s)
- Ziyi Yang
- Graduate School of Engineering, Kagawa University, Takamatsu 761-0396, Japan;
| | - Shuxiang Guo
- Key Laboratory of Convergence Medical Engineering System and Healthcare Technology, The Ministry of Industry and Information Technology, Beijing Institute of Technology, Beijing 100081, China
- Department of Intelligent Mechanical Systems Engineering, Kagawa University, Takamatsu 761-0396, Japan;
- Correspondence: ; Tel.: +81-087-864-2333
| | - Hideyuki Hirata
- Department of Intelligent Mechanical Systems Engineering, Kagawa University, Takamatsu 761-0396, Japan;
| | - Masahiko Kawanishi
- Department of Neurological Surgery, Faculty of Medicine, Kagawa University, Takamatsu 761-0793, Japan;
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26
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Gilmore N, Katz DI, Kiran S. Acquired Brain Injury in Adults: A Review of Pathophysiology, Recovery, and Rehabilitation. ACTA ACUST UNITED AC 2021; 6:714-727. [PMID: 34746412 DOI: 10.1044/2021_persp-21-00013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose To summarize existing literature from a range of fields (i.e., neurology, neuropsychology, neuroscience, neuroimaging, rehabilitation, speech-language pathology) that is relevant to the development and/or revision of cognitive rehabilitation programs for individuals with acquired brain injury (ABI) and in particular, for young adults. Method This paper reviews a range of ABI-associated topics including: 1) mechanisms of injury; 2) biological, individual-specific, and behavioral drivers of recovery; and 3) current methods of cognitive rehabilitation. It then narrows focus to young adults, a frequently affected and growing population to sustain ABI. The paper concludes by providing: 1) suggestions for key components of cognitive rehabilitation for young adults with ABI; 2) an example from our own research providing intensive academically-focused cognitive rehabilitation for young adults with ABI pursuing college; and 3) recommendations for future behavioral and neuroimaging studies in this area. Conclusions ABI is on the rise in the United States. Young adults have been sustaining ABI at higher rates over the past several decades. These injuries occur when they would otherwise be advancing their academic and career goals, making the cognitive deficits that often accompany ABI especially devastating for this group. Review of existing literature suggests cognitive rehabilitation programs that combine aspects of restorative, comprehensive, and contextualized approaches could promote recovery for young adults with ABI. Future intervention studies may benefit from including both behavioral and neural outcomes to best understand how principles of neuroplasticity- naturally embedded within many cognitive rehabilitation approaches-could be manipulated to promote cognitive recovery and long-lasting brain reorganization in this group.
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Affiliation(s)
- Natalie Gilmore
- Speech, Language and Hearing Sciences, Boston University, Boston, USA
| | - Douglas I Katz
- Neurology, Boston University School of Medicine, Boston, USA
| | - Swathi Kiran
- Speech, Language and Hearing Sciences, Boston University, Boston, USA
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Lamberti N, Manfredini F, Lissom LO, Lavezzi S, Basaglia N, Straudi S. Beneficial Effects of Robot-Assisted Gait Training on Functional Recovery in Women after Stroke: A Cohort Study. Medicina (B Aires) 2021; 57:medicina57111200. [PMID: 34833418 PMCID: PMC8618864 DOI: 10.3390/medicina57111200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Robot-assisted gait training (RAGT) could be a rehabilitation option for patients after experiencing a stroke. This study aims to determine the sex-related response to robot-assisted gait training in a cohort of subacute stroke patients considering mixed results previously reported. Materials and Methods: In this study, 236 participants (145 males, 91 females) were admitted to a rehabilitation facility after experiencing a stroke and performed RAGT within a multidisciplinary rehabilitation program. Functional Independence Measure (FIM) and Functional Ambulatory Category (FAC) were assessed at admission and discharge to determine sex-related outcomes. Results: At the baseline, no significant difference among sexes was observed. At the end of rehabilitation, both males and females exhibited significant improvements in FIM (71% of males and 80% of females reaching the MCID cut-off value) and FAC (∆score: men 1.9 ± 1.0; women 2.1 ± 1.1). A more remarkable improvement was observed in women of the whole population during the study, but statistical significance was not reached. When analysing the FAC variations with respect to the total number of RAGT sessions, a more significant improvement was observed in women than men (p = 0.025). Conclusion: In conclusion, among subacute stroke patients, benefits were observed following RAGT during a multidisciplinary rehabilitation program in both sexes. A greater significant recovery for women with an ischemic stroke or concerning the number of sessions attended was also highlighted. The use of gait robotics for female patients may favour a selective functional recovery after stroke.
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Affiliation(s)
- Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (N.B.); (S.S.)
- Correspondence: ; Tel.: +39-05-3223-6187
| | - Fabio Manfredini
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (N.B.); (S.S.)
- Unit of Rehabilitation Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy;
| | - Luc Oscar Lissom
- Doctoral Program in Translational Neurosciences and Neurotechnologies, University of Ferrara, 44121 Ferrara, Italy;
| | - Susanna Lavezzi
- Unit of Rehabilitation Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy;
| | - Nino Basaglia
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (N.B.); (S.S.)
| | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (N.B.); (S.S.)
- Unit of Rehabilitation Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy;
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Mang CS, Peters S. Advancing motor rehabilitation for adults with chronic neurological conditions through increased involvement of kinesiologists: a perspective review. BMC Sports Sci Med Rehabil 2021; 13:132. [PMID: 34689800 PMCID: PMC8542408 DOI: 10.1186/s13102-021-00361-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/18/2021] [Indexed: 11/10/2022]
Abstract
Many people with neurological conditions experience challenges with movement. Although rehabilitation is often provided acutely and sub-acutely following the onset of a condition, motor deficits commonly persist in the long-term and are exacerbated by disuse and inactivity. Notably, motor rehabilitation approaches that incorporate exercise and physical activity can support gains in motor function even in the chronic stages of many neurological conditions. However, delivering motor rehabilitation on a long-term basis to people with chronic neurological conditions is a challenge within health care systems, and the onus is often placed on patients to find and pay for services. While neurological motor rehabilitation is largely the domain of physical and occupational therapists, kinesiologists may be able to complement existing care and support delivery of long-term neurological motor rehabilitation, specifically through provision of supported exercise and physical activity programs. In this perspective style review article, we discuss potential contributions of kinesiologists to advancing the field through exercise programming, focusing on community-based interventions that increase physical activity levels. We conclude with recommendations on how kinesiologists' role might be further optimized towards improving long-term outcomes for people with chronic neurological conditions, considering issues related to professional regulation and models of care.
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Affiliation(s)
- Cameron S Mang
- Faculty of Kinesiology and Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada.
| | - Sue Peters
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Canada
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Cardoso LRL, Pedro LM, Forner-Cordero A. Handlebar Robotic System for Bimanual Motor Control and Learning Research. SENSORS (BASEL, SWITZERLAND) 2021; 21:5991. [PMID: 34577199 PMCID: PMC8472032 DOI: 10.3390/s21185991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022]
Abstract
Robotic devices can be used for motor control and learning research. In this work, we present the construction, modeling and experimental validation of a bimanual robotic device. We tested some hypotheses that may help to better understand the motor learning processes involved in the interlimb coordination function. The system emulates a bicycle handlebar with rotational motion, thus requiring bilateral upper limb control and a coordinated sequence of joint sub-movements. The robotic handlebar is compact and portable and can register in a fast rate both position and forces independently from arms, including prehension forces. An impedance control system was implemented in order to promote a safer environment for human interaction and the system is able to generate force fields, suitable for implementing motor learning paradigms. The novelty of the system is the decoupling of prehension and manipulation forces of each hand, thus paving the way for the investigation of hand dominance function in a bimanual task. Experiments were conducted with ten healthy subjects, kinematic and dynamic variables were measured during a rotational set of movements. Statistical analyses showed that movement velocity decreased with practice along with an increase in reaction time. This suggests an increase of the task planning time. Prehension force decreased with practice. However, an unexpected result was that the dominant hand did not lead the bimanual task, but helped to correct the movement, suggesting different roles for each hand during a cooperative bimanual task.
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Affiliation(s)
- Lucas R. L. Cardoso
- Programa de Pós-Graduação Interunidades em Bioengenharia (EESC/FMRP/IQSC), University of São Paulo, São Carlos 13566-590, Brazil
| | - Leonardo M. Pedro
- Department of Mechanical Engineering, Federal University of São Carlos, São Carlos 13565-905, Brazil;
| | - Arturo Forner-Cordero
- Biomechatronics Laboratory—Escola Politecnica, University of São Paulo, São Paulo 05508-010, Brazil;
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Kumar A, Pirogova E, Mahmoud SS, Fang Q. Classification of error-related potentials evoked during stroke rehabilitation training. J Neural Eng 2021; 18. [PMID: 34384052 DOI: 10.1088/1741-2552/ac1d32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 08/12/2021] [Indexed: 01/22/2023]
Abstract
Objective.Error-related potentials (ErrPs) are elicited in the human brain following an error's perception. Recently, ErrPs have been observed in a novel task situation, i.e. when stroke patients perform upper-limb rehabilitation exercises. These ErrPs can be used to developassist-as-needed(AAN) robotic stroke rehabilitation systems. However, to date, there is no reported research on assessing the feasibility of using the ErrPs to implement the AAN approach. Hence, in this study, we evaluated and compared the single-trial classification of novel ErrPs using various classical machine learning and deep learning approaches.Approach.Electroencephalogram data of 13 stroke patients recorded while performing an upper-limb physical rehabilitation exercise were used. Two classification approaches, one combining the xDAWN spatial filtering and support vector machines, and the other using a convolutional neural network-based double transfer learning, were utilized.Main results.Results showed that the ErrPs could be detected with a mean area under the receiver operating characteristics curve of 0.838, and a mean accuracy of 0.842, 0.257 above the chance level (p< 0.05), for a within-subject classification. The results indicated the feasibility of using ErrP signals in real-time AAN robot therapy with evidence from the conducted latency analysis, cross-subject classification, and three-class asynchronous classification.Significance.The findings presented support our proposed approach of using ErrPs as a measure to trigger and/or modulate as required the robotic assistance in a real-timehuman-in-the-looprobotic stroke rehabilitation system.
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Affiliation(s)
- Akshay Kumar
- Department of Biomedical Engineering, College of Engineering, Shantou University, Guangdong, People's Republic of China
| | - Elena Pirogova
- School of Engineering, Royal Melbourne Institute of Technology University, Melbourne, Australia
| | - Seedahmed S Mahmoud
- Department of Biomedical Engineering, College of Engineering, Shantou University, Guangdong, People's Republic of China
| | - Qiang Fang
- Department of Biomedical Engineering, College of Engineering, Shantou University, Guangdong, People's Republic of China
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Chang AJ, Wilmskoetter J, Fridriksson J, McKinnon ET, Johnson LP, Basilakos A, Jensen JH, Rorden C, Bonilha L. Cortical microstructural changes associated with treated aphasia recovery. Ann Clin Transl Neurol 2021; 8:1884-1894. [PMID: 34406705 PMCID: PMC8419405 DOI: 10.1002/acn3.51445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 01/17/2023] Open
Abstract
Objectives To investigate the hypothesis that language recovery in post‐stroke aphasia is associated with structural brain changes. Methods We evaluated whether treatment‐induced improvement in naming is associated with reorganization of tissue microstructure within residual cortical regions. To this end, we performed a retrospective longitudinal treatment study using comprehensive language‐linguistic assessments and diffusion MRI sequences optimized for the assessment of complex microstructure (diffusional kurtosis imaging) to evaluate the relationship between language treatment response and cortical changes in 26 individuals with chronic stroke‐induced aphasia. We employed elastic net statistical models controlling for baseline factors including age, sex, and time since the stroke, as well as lesion volume. Results We observed that improved naming accuracy (Philadelphia Naming Test) was statistically associated with increased post‐treatment microstructural integrity in the left posterior superior temporal gyrus. Moreover, increase in microstructural integrity in the left middle temporal gyrus and left inferior temporal gyrus was specifically associated with a decrease in semantic paraphasias. This longitudinal relationship between brain tissue integrity and language improvement was not observed in other non‐language related brain regions. Interpretation Our findings provide evidence that structural brain changes in the preserved left hemisphere regions are associated with treatment‐induced language recovery in aphasia and are part of the mechanisms supporting language and brain injury recovery.
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Affiliation(s)
- Allen J Chang
- College of Graduate Studies, Neuroscience Institute, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Janina Wilmskoetter
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, South Carolina, USA
| | - Emilie T McKinnon
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lorelei P Johnson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, South Carolina, USA
| | - Alexandra Basilakos
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, South Carolina, USA
| | - Jens H Jensen
- Department of Neuroscience, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
| | - Leonardo Bonilha
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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Russo C, Veronelli L, Casati C, Monti A, Perucca L, Ferraro F, Corbo M, Vallar G, Bolognini N. Explicit motor sequence learning after stroke: a neuropsychological study. Exp Brain Res 2021; 239:2303-2316. [PMID: 34091696 PMCID: PMC8282572 DOI: 10.1007/s00221-021-06141-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 05/23/2021] [Indexed: 11/30/2022]
Abstract
Motor learning interacts with and shapes experience-dependent cerebral plasticity. In stroke patients with paresis of the upper limb, motor recovery was proposed to reflect a process of re-learning the lost/impaired skill, which interacts with rehabilitation. However, to what extent stroke patients with hemiparesis may retain the ability of learning with their affected limb remains an unsolved issue, that was addressed by this study. Nineteen patients, with a cerebrovascular lesion affecting the right or the left hemisphere, underwent an explicit motor learning task (finger tapping task, FTT), which was performed with the paretic hand. Eighteen age-matched healthy participants served as controls. Motor performance was assessed during the learning phase (i.e., online learning), as well as immediately at the end of practice, and after 90 min and 24 h (i.e., retention). Results show that overall, as compared to the control group, stroke patients, regardless of the side (left/right) of the hemispheric lesion, do not show a reliable practice-dependent improvement; consequently, no retention could be detected in the long-term (after 90 min and 24 h). The motor learning impairment was associated with subcortical damage, predominantly affecting the basal ganglia; conversely, it was not associated with age, time elapsed from stroke, severity of upper-limb motor and sensory deficits, and the general neurological condition. This evidence expands our understanding regarding the potential of post-stroke motor recovery through motor practice, suggesting a potential key role of basal ganglia, not only in implicit motor learning as previously pointed out, but also in explicit finger tapping motor tasks.
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Affiliation(s)
- Cristina Russo
- Department of Psychology and Milan Center for Neuroscience-NeuroMi, University of Milano-Bicocca, Milan, Italy.
| | - Laura Veronelli
- Department of Neurorehabilitation Sciences, Casa di Cura Policlinico, Milan, Italy
| | - Carlotta Casati
- Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Alessia Monti
- Department of Neurorehabilitation Sciences, Casa di Cura Policlinico, Milan, Italy
| | - Laura Perucca
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy
| | - Francesco Ferraro
- Riabilitazione Specialistica Neuromotoria - Dipartimento di Neuroscienze, ASST "Carlo Poma" di Mantova - Presidio di Riabilitazione Multifunzionale di Bozzolo, Mantua, Italy
| | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa di Cura Policlinico, Milan, Italy
| | - Giuseppe Vallar
- Department of Psychology and Milan Center for Neuroscience-NeuroMi, University of Milano-Bicocca, Milan, Italy.,Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Nadia Bolognini
- Department of Psychology and Milan Center for Neuroscience-NeuroMi, University of Milano-Bicocca, Milan, Italy.,Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy
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Pastorino R, Loreti C, Giovannini S, Ricciardi W, Padua L, Boccia S. Challenges of Prevention for a Sustainable Personalized Medicine. J Pers Med 2021; 11:jpm11040311. [PMID: 33923579 PMCID: PMC8073054 DOI: 10.3390/jpm11040311] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 02/07/2023] Open
Abstract
The development and implementation of the approaches of personalized medicine for disease prevention are still at infancy, although preventive activities in healthcare represent a key pillar to guarantee health system sustainability. There is an increasing interest in finding informative markers that indicate the disease risk before the manifestation of the disease (primary prevention) or for early disease detection (secondary prevention). Recently, the systematic collection and study of clinical phenotypes and biomarkers consented to the advance of Rehabilomics in tertiary prevention. It consents to identify relevant molecular and physiological factors that can be linked to plasticity, treatment response, and natural recovery. Implementation of these approaches would open avenues to identify people at high risk and enable new preventive lifestyle interventions or early treatments targeted to their individual genomic profile, personalizing prevention and rehabilitation. The integration of personalized medicine into prevention may benefit citizens, patients, healthcare professionals, healthcare authorities, and industry, and ultimately will seek to contribute to better health and quality of life for Europe’s citizens.
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Affiliation(s)
- Roberta Pastorino
- Department of Woman and Child Health and Public Health—Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.P.); (S.B.)
| | - Claudia Loreti
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.G.); (L.P.)
- Correspondence:
| | - Silvia Giovannini
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.G.); (L.P.)
| | - Walter Ricciardi
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Luca Padua
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.G.); (L.P.)
- Dipartimento di Scienze Geriatriche e Ortopediche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Stefania Boccia
- Department of Woman and Child Health and Public Health—Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.P.); (S.B.)
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
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Kumar A, Fang Q, Pirogova E. The influence of psychological and cognitive states on error-related negativity evoked during post-stroke rehabilitation movements. Biomed Eng Online 2021; 20:13. [PMID: 33531009 PMCID: PMC7852291 DOI: 10.1186/s12938-021-00850-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recently, error-related negativity (ERN) signals are proposed to develop an assist-as-needed robotic stroke rehabilitation program. Stroke patients' state-of-mind, such as motivation to participate and active involvement in the rehabilitation program, affects their rate of recovery from motor disability. If the characteristics of the robotic stroke rehabilitation program can be altered based on the state-of-mind of the patients, such that the patients remain engaged in the program, the rate of recovery from their motor disability can be improved. However, before that, it is imperative to understand how the states-of-mind of a participant affect their ERN signal. METHODS This study aimed to determine the association between the ERN signal and the psychological and cognitive states of the participants. Experiments were conducted on stroke patients, which involved performing a physical rehabilitation exercise and a questionnaire to measure participants' subjective experience on four factors: motivation in participating in the experiment, perceived effort, perceived pressure, awareness of uncompleted exercise trials while performing the rehabilitation exercise. Statistical correlation analysis, EEG time-series and topographical analysis were used to assess the association between the ERN signals and the psychological and cognitive states of the participants. RESULTS A strong correlation between the amplitude of the ERN signal and the psychological and cognitive states of the participants was observed, which indicate the possibility of estimating the said states using the amplitudes of the novel ERN signal. CONCLUSIONS The findings pave the way for the development of an ERN based dynamically adaptive assist-as-needed robotic stroke rehabilitation program of which characteristics can be altered to keep the participants' motivation, effort, engagement in the rehabilitation program high. In future, the single-trial prediction ability of the novel ERN signals to predict the state-of-mind of stroke patients will be evaluated.
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Affiliation(s)
- Akshay Kumar
- School of Engineering, Royal Melbourne Institute of Technology University, Melbourne, Australia
- Department of Biomedical Engineering, College of Engineering, Shantou University, Guangdong, China
| | - Qiang Fang
- Department of Biomedical Engineering, College of Engineering, Shantou University, Guangdong, China.
| | - Elena Pirogova
- School of Engineering, Royal Melbourne Institute of Technology University, Melbourne, Australia
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Crampton A, Teel E, Chevignard M, Gagnon I. Vestibular-ocular reflex dysfunction following mild traumatic brain injury: A narrative review. Neurochirurgie 2021; 67:231-237. [PMID: 33482235 DOI: 10.1016/j.neuchi.2021.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/10/2021] [Indexed: 12/28/2022]
Abstract
Mild traumatic brain injury (mTBI) is a prevalent injury which occurs across many populations, including children and adolescents, athletes, military personnel, and the elderly. mTBI can result in various subjective symptoms and clinical deficits, such as abnormalities to the vestibulo-ocular reflex (VOR). Over 50% of individuals with mTBI are reported to have VOR abnormalities, which strongly contribute to feelings of dizziness and unsteadiness. Dizziness is a strong predictor for prolonged recovery following mTBI and is additionally linked with mental health difficulties and functional limitations affecting likelihood of return to work. Early diagnosis, and subsequent treatment, of VOR deficits following mTBI may greatly improve recovery outcomes and a patient's quality of life, but a thorough comprehension of the related pathophysiology is necessary to understand the assessments used to diagnose VOR abnormalities. Therefore, the purpose of this article is i) provide readers with an introduction on the VOR physiology to facilitate understanding about mTBI-related abnormalities, and ii) to discuss current assessments that are commonly used to measure VOR function following mTBI. As the VOR and oculomotor (OM) systems are heavily linked and often work in tandem, discussion of the relevant aspects of the OM system is also provided.
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Affiliation(s)
- Adrienne Crampton
- School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada.
| | - Elizabeth Teel
- School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada
| | - Mathilde Chevignard
- Rehabilitation Department for Children with Acquired Neurological Injury and Outreach Team for Children and Adolescents with Acquired Brain Injury, Saint Maurice Hospitals, Paris, France; Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Paris, France; GRC 24 HaMCRe, Handicap Moteur et Cognitif et Réadaptation, Sorbonne Université, Paris, France
| | - Isabelle Gagnon
- School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada; Montreal Children Hospital, McGill University Health Center, Montreal, QC, Canada
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Sharif N, Calzolari F, Berninger B. Direct In Vitro Reprogramming of Astrocytes into Induced Neurons. Methods Mol Biol 2021; 2352:13-29. [PMID: 34324177 DOI: 10.1007/978-1-0716-1601-7_2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Spontaneous neuronal replacement is almost absent in the postnatal mammalian nervous system. However, several studies have shown that both early postnatal and adult astroglia can be reprogrammed in vitro or in vivo by forced expression of proneural transcription factors, such as Neurogenin-2 or Achaete-scute homolog 1 (Ascl1), to acquire a neuronal fate. The reprogramming process stably induces properties such as distinctly neuronal morphology, expression of neuron-specific proteins, and the gain of mature neuronal functional features. Direct conversion of astroglia into neurons thus possesses potential as a basis for cell-based strategies against neurological diseases. In this chapter, we describe a well-established protocol used for direct reprogramming of postnatal cortical astrocytes into functional neurons in vitro and discuss available tools and approaches to dissect molecular and cell biological mechanisms underlying the reprogramming process.
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Affiliation(s)
- Nesrin Sharif
- Institute of Physiological Chemistry, University Medical Center Johannes Gutenberg University Mainz, Mainz, Germany
- International PhD Programme on Gene Regulation, Epigenetics and Genome Stability, Mainz, Germany
| | - Filippo Calzolari
- Institute of Physiological Chemistry, University Medical Center Johannes Gutenberg University Mainz, Mainz, Germany
| | - Benedikt Berninger
- Institute of Physiological Chemistry, University Medical Center Johannes Gutenberg University Mainz, Mainz, Germany.
- Institute of Psychiatry, Psychology, and Neuroscience, Centre for Developmental Neurobiology, King's College London, London, UK.
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK.
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An Assist-as-Needed Controller for Passive, Assistant, Active, and Resistive Robot-Aided Rehabilitation Training of the Upper Extremity. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app11010340] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Clinical studies have demonstrated that robot-involved therapy can effectively improve the rehabilitation training effect of motor ability and daily behavior ability of subjects with an upper limb motor dysfunction. This paper presents an impedance-based assist-as-needed controller that can be used in robot-aided rehabilitation training for subjects with an upper extremity dysfunction. Then, the controller is implemented on an end-effector upper extremity rehabilitation robot which could assist subjects in performing training with a spatial trajectory. The proposed controller enables subjects’ arms to have motion freedom by building a fault-tolerant region around the rehabilitation trajectory. Subjects could move their upper limb without any assistance within the fault-tolerant region while the robot would provide assistance according to the subjects’ functional ability when deviating from the fault-tolerant region. Besides, we also put forward the stiffness field around the fault-tolerant region to increase the robot’s assistance when subjects’ hand is moving outside the fault-tolerant region. A series of columnar rigid walls would be constructed in the controller according to the subjects’ functional ability, and the stiffness of the wall increases as the motion performance deteriorates. Furthermore, the controller contains five adjustable parameters. The controller would show different performances by adjusting these parameters and satisfy the requirement of robot-aided rehabilitation training at different rehabilitation stages such as passive, assistant, active, and resistant training. Finally, the controller was tested with an elderly female participant with different controller parameters, and experimental results verified the correctness of the controller and its potential ability to satisfy the training requirements at different rehabilitation stages. In the close future, the proposed controller in this work is planned to be applied on more subjects and also patients who have upper limb motor dysfunctions to demonstrate performance of the controller with different parameters.
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Nicolini C, Fahnestock M, Gibala MJ, Nelson AJ. Understanding the Neurophysiological and Molecular Mechanisms of Exercise-Induced Neuroplasticity in Cortical and Descending Motor Pathways: Where Do We Stand? Neuroscience 2020; 457:259-282. [PMID: 33359477 DOI: 10.1016/j.neuroscience.2020.12.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 02/07/2023]
Abstract
Exercise is a promising, cost-effective intervention to augment successful aging and neurorehabilitation. Decline of gray and white matter accompanies physiological aging and contributes to motor deficits in older adults. Exercise is believed to reduce atrophy within the motor system and induce neuroplasticity which, in turn, helps preserve motor function during aging and promote re-learning of motor skills, for example after stroke. To fully exploit the benefits of exercise, it is crucial to gain a greater understanding of the neurophysiological and molecular mechanisms underlying exercise-induced brain changes that prime neuroplasticity and thus contribute to postponing, slowing, and ameliorating age- and disease-related impairments in motor function. This knowledge will allow us to develop more effective, personalized exercise protocols that meet individual needs, thereby increasing the utility of exercise strategies in clinical and non-clinical settings. Here, we review findings from studies that investigated neurophysiological and molecular changes associated with acute or long-term exercise in healthy, young adults and in healthy, postmenopausal women.
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Affiliation(s)
- Chiara Nicolini
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Margaret Fahnestock
- Department of Psychiatry & Behavioral Neurosciences, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Martin J Gibala
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Aimee J Nelson
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada.
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O'Neal CM, Stephens TM, Briggs RG, Sughrue ME, Conner AK. Navigated transcranial magnetic stimulation following awake craniotomy for resection of glioma: Description of two cases. Surg Neurol Int 2020; 11:433. [PMID: 33365195 PMCID: PMC7749929 DOI: 10.25259/sni_628_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/19/2020] [Indexed: 01/23/2023] Open
Abstract
Background Although transcranial magnetic stimulation (TMS) has been indicated as a potential therapy for several neurologic conditions, there is little known regarding its use during the postoperative rehabilitation period in patients with brain tumors. Furthermore, seizures, a common presentation in these patients, are regarded as a major contraindication for TMS therapy. Case Description We demonstrate that postoperative continuous theta burst stimulation (cTBS), a patterned form of repetitive TMS, was safely tolerated in addition to current neurorehabilitation techniques in two brain tumor patients, including one patient with a history of tumor-related epilepsy. We administered navigated 5 Hz cTBS to two patients within 48 h following awake craniotomy for tumor resection. Active motor thresholds were measured in both patients before TBS administration to determine stimulus intensity. We used resting-state fMRI to identify likely damaged networks based on postoperative deficits. This aided in TMS planning and allowed deficit targeted therapy contralateral to the lesioned network node. Both patients tolerated TBS therapy well and had no adverse effects, including posttreatment seizures, despite one patient having a history of tumor-related epilepsy. Conclusion TBS may be safe in the immediate postoperative period for patients following brain tumor resection. Additional studies are needed to quantify the efficacy of TMS in improving neurologic deficits following tumor resection.
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Affiliation(s)
- Christen M O'Neal
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma, United States
| | - Tressie M Stephens
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma, United States
| | - Robert G Briggs
- Department of Neurosurgery, University of Southern California, Los Angeles, California, United States
| | - Michael E Sughrue
- Center for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Andrew K Conner
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma, United States
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Wang J, Wang W, Hou ZG. Toward Improving Engagement in Neural Rehabilitation: Attention Enhancement Based on Brain–Computer Interface and Audiovisual Feedback. IEEE Trans Cogn Dev Syst 2020. [DOI: 10.1109/tcds.2019.2959055] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Mahmoud SS, Kumar A, Tang Y, Li Y, Gu X, Fu J, Fang Q. An Efficient Deep Learning Based Method for Speech Assessment of Mandarin-Speaking Aphasic Patients. IEEE J Biomed Health Inform 2020; 24:3191-3202. [DOI: 10.1109/jbhi.2020.3011104] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bae S, Lee Y, Chang P. There is No test-retest reliability of brain activation induced by robotic passive hand movement: A functional NIRS study. Brain Behav 2020; 10:e01788. [PMID: 32794359 PMCID: PMC7559614 DOI: 10.1002/brb3.1788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 06/03/2020] [Accepted: 07/06/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The basic paradigm of rehabilitation is based on the brain plasticity, and for promoting it, test-retest reliability (TRR) of brain activation in which certain area of the brain is repeatedly activated is required. In this study, we investigated whether the robotic passive movement has the TRR of brain activation. While active training has been shown to have TRR, but there still have been arguments over the TRR by passive movement. METHODS In order to test TRR, 10 repetitive sessions and various intervals (1 day, 3 days, 7 days, 23 days, 15 min, and 6 hr) were applied to five subjects, which had the same statistical power as applying two sessions to 50 subjects. In each session, three robot speeds (0.25, 0.5, and 0.75 Hz) were applied to provide passive movement using the robot. The fNIRS signal (oxy-Hb) generated in the primary sensorimotor area (SM1) was measured on a total of 29 channels. At this time, we used activation maps and intraclass correlation coefficient (ICC) values to examine the TRR and the effect of robot speeds and intervals on TRR. RESULTS As a result, activation maps showed prominent variation regardless of robot speeds and interval, and the ICC value (=0.002) showed no TRR of brain activation for robotic passive movement. CONCLUSION The brain activation induced by the robotic passive movement alone has very poor TRR, suggesting that further enhancement is required to strengthen the TRR by complementing active user engagements.
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Affiliation(s)
- Sungjin Bae
- Department of Robotics EngineeringGraduate SchoolDaegu Gyeongbuk Institute of Science & TechnologyDaeguKorea
| | - Yonghee Lee
- Department of StatisticsUniversity of SeoulSeoulKorea
| | - Pyung‐Hun Chang
- Department of Robotics EngineeringGraduate SchoolDaegu Gyeongbuk Institute of Science & TechnologyDaeguKorea
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Wang J, Zhang J, Zuo G, Shi C, Guo S. A reward–punishment feedback control strategy based on energy information for wrist rehabilitation. INT J ADV ROBOT SYST 2020. [DOI: 10.1177/1729881420940651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Based on evidence from the previous research in rehabilitation robot control strategies, we found that the common feature of the effective control strategies to promote subjects’ engagement is creating a reward–punishment feedback mechanism. This article proposes a reward–punishment feedback control strategy based on energy information. Firstly, an engagement estimated approach based on energy information is developed to evaluate subjects’ performance. Secondly, the estimated result forms a reward–punishment term, which is introduced into a standard model-based adaptive controller. This modified adaptive controller is capable of giving the reward–punishment feedback to subjects according to their engagement. Finally, several experiments are implemented using a wrist rehabilitation robot to evaluate the proposed control strategy with 10 healthy subjects who have not cardiovascular and cerebrovascular diseases. The results of these experiments show that the mean coefficient of determination ( R 2) of the data obtained by the proposed approach and the classical approach is 0.7988, which illustrate the reliability of the engagement estimated approach based on energy information. And the results also demonstrate that the proposed controller has great potential to promote patients’ engagement for wrist rehabilitation.
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Affiliation(s)
- Jiajin Wang
- Cixi Institute of BioMedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Science, Ningbo, Zhejiang, China
- Department of Mechanical Automation Engineering, School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
| | - Jiaji Zhang
- Cixi Institute of BioMedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Science, Ningbo, Zhejiang, China
| | - Guokun Zuo
- Cixi Institute of BioMedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Science, Ningbo, Zhejiang, China
| | - Changcheng Shi
- Cixi Institute of BioMedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Science, Ningbo, Zhejiang, China
| | - Shuai Guo
- Department of Mechanical Automation Engineering, School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
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Zhuang Y, Leng Y, Zhou J, Song R, Li L, Su SW. Voluntary Control of an Ankle Joint Exoskeleton by Able-Bodied Individuals and Stroke Survivors Using EMG-Based Admittance Control Scheme. IEEE Trans Biomed Eng 2020; 68:695-705. [PMID: 32746072 DOI: 10.1109/tbme.2020.3012296] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Control schemes based on electromyography (EMG) have demonstrated their superiority in human-robot cooperation due to the fact that motion intention can be well estimated by EMG signals. However, there are several limitations due to the noisy nature of EMG signals and the inaccuracy of EMG-force/torque estimation, which might deteriorate the stability of human-robot cooperation movement. To improve the movement stability, an EMG-based admittance control scheme (EACS) was proposed, comprised of an EMG-driven musculoskeletal model (EDMM), an admittance filter and an inner position controller. To investigate the performance of EACS, a series of sinusoidal tracking tasks were conducted with 12 healthy participants and 4 stroke survivors in an ankle exoskeleton in comparison with the EMG-based open-loop control scheme (EOCS). The experimental results indicated that both EACS and EOCS could improve stroke survivors' ankle range of motion (ROM). The experimental results of both healthy participants and stroke survivors showed that the assistance torque, tracking error and jerk values of EACS were lower than those of EOCS. The interaction torque of EACS decreased towards the increasing assistance ratio while that of EOCS increased. Moreover, the EMG levels of tibialis anterior (TA) decreased towards the increasing assistance ratio but were higher than those of EOCS. EACS was effective in improving movements stability, and had the potential to be applied in robot-assisted rehabilitation training to address the foot-drop problem.
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Segal AD, Lesak MC, Silverman AK, Petruska AJ. A Gesture-Controlled Rehabilitation Robot to Improve Engagement and Quantify Movement Performance. SENSORS (BASEL, SWITZERLAND) 2020; 20:E4269. [PMID: 32751876 PMCID: PMC7435750 DOI: 10.3390/s20154269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 11/17/2022]
Abstract
Rehabilitation requires repetitive and coordinated movements for effective treatment, which are contingent on patient compliance and motivation. However, the monotony, intensity, and expense of most therapy routines do not promote engagement. Gesture-controlled rehabilitation has the potential to quantify performance and provide engaging, cost-effective treatment, leading to better compliance and mobility. We present the design and testing of a gesture-controlled rehabilitation robot (GC-Rebot) to assess its potential for monitoring user performance and providing entertainment while conducting physical therapy. Healthy participants (n = 11) completed a maze with GC-Rebot for six trials. User performance was evaluated through quantitative metrics of movement quality and quantity, and participants rated the system usability with a validated survey. For participants with self-reported video-game experience (n = 10), wrist active range of motion across trials (mean ± standard deviation) was 41.6 ± 13° and 76.8 ± 16° for pitch and roll, respectively. In the course of conducting a single trial with a time duration of 68.3 ± 19 s, these participants performed 27 ± 8 full wrist motion repetitions (i.e., flexion/extension), with a dose-rate of 24.2 ± 5 reps/min. These participants also rated system usability as excellent (score: 86.3 ± 12). Gesture-controlled therapy using the GC-Rebot demonstrated the potential to be an evidence-based rehabilitation tool based on excellent user ratings and the ability to monitor at-home compliance and performance.
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Affiliation(s)
- Ava D Segal
- M3Robotics and Functional Biomechanics Laboratories, Department of Mechanical Engineering Colorado School of Mines, Golden, CO 80401, USA
| | | | - Anne K Silverman
- M3Robotics and Functional Biomechanics Laboratories, Department of Mechanical Engineering Colorado School of Mines, Golden, CO 80401, USA
| | - Andrew J Petruska
- M3Robotics and Functional Biomechanics Laboratories, Department of Mechanical Engineering Colorado School of Mines, Golden, CO 80401, USA
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Wilmskoetter J, Daniels SK, Miller AJ. Cortical and Subcortical Control of Swallowing-Can We Use Information From Lesion Locations to Improve Diagnosis and Treatment for Patients With Stroke? AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1030-1043. [PMID: 32650664 PMCID: PMC7844337 DOI: 10.1044/2019_ajslp-19-00068] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/24/2019] [Accepted: 11/04/2019] [Indexed: 05/30/2023]
Abstract
Purpose Swallowing is a complex process, mediated by a broad bilateral neural network that spans from the brainstem to subcortical and cortical brain structures. Although the cortex's role in swallowing was historically neglected, we now understand, especially through clinical observations and research of patients with stroke, that it substantially contributes to swallowing control. Neuroimaging techniques (e.g., magnetic resonance imaging) have helped significantly to elucidate the role of cortical and subcortical brain areas, in general, and the importance of specific areas in swallowing control in healthy individuals and patients with stroke. We will review recent discoveries in cortical and subcortical neuroimaging research studies and their generalizability across patients to discuss their potential implications and translation to dysphagia diagnosis and treatment in clinical practice. Conclusions Stroke lesion locations have been identified that are commonly associated across patients with the occurrence and recovery of dysphagia, suggesting that clinical brain scans provide useful information for improving the diagnosis and treatment of patients with stroke. However, individual differences in brain structure and function limit the generalizability of these relationships and emphasize that the extent of the motor and sensory pathology in swallowing, and how the patient recovers, also depends on a patient's individual brain constitution. The involvement of the damaged brain tissue in swallowing control before the stroke and the health of the residual, undamaged brain tissue are crucial factors that can differ between individuals.
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Affiliation(s)
- Janina Wilmskoetter
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston
| | | | - Arthur J. Miller
- Department of Orofacial Sciences, University of California, San Francisco
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Matamala-Gomez M, Maisto M, Montana JI, Mavrodiev PA, Baglio F, Rossetto F, Mantovani F, Riva G, Realdon O. The Role of Engagement in Teleneurorehabilitation: A Systematic Review. Front Neurol 2020; 11:354. [PMID: 32435227 PMCID: PMC7218051 DOI: 10.3389/fneur.2020.00354] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/09/2020] [Indexed: 01/04/2023] Open
Abstract
The growing understanding of the importance of involving patients with neurological diseases in their healthcare routine either for at-home management of their chronic conditions or after the hospitalization period has opened the research for new rehabilitation strategies to enhance patient engagement in neurorehabilitation. In addition, the use of new digital technologies in the neurorehabilitation field enables the implementation of telerehabilitation systems such as virtual reality interventions, video games, web-based interventions, mobile applications, web-based or telephonic telecoach programs, in order to facilitate the relationship between clinicians and patients, and to motivate and activate patients to continue with the rehabilitation process at home. Here we present a systematic review that aims at reviewing the effectiveness of different engagement strategies and the different engagement assessments while using telerehabilitation systems in patients with neurological disorders. We used PICO's format to define the question of the review, and the systematic review protocol was designed following the Preferred Reported Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Bibliographical data was collected by using the following bibliographic databases: PubMed, EMBASE, Scopus, and Web of Science. Eighteen studies were included in this systematic review for full-text analyses. Overall, the reviewed studies using engagement strategies through telerehabilitation systems in patients with neurological disorders were mainly focused on patient self-management and self-awareness, patient motivation, and patient adherence subcomponents of engagement, that are involved in by the behavioral, cognitive, and emotional dimensions of engagement. Conclusion: The studies commented throughout this systematic review pave the way for the design of new telerehabilitation protocols, not only focusing on measuring quantitative or qualitative measures but measuring both of them through a mixed model intervention design (1). The future clinical studies with a mixed model design will provide more abundant data regarding the role of engagement in telerehabilitation, leading to a possibly greater understanding of its underlying components.
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Affiliation(s)
- Marta Matamala-Gomez
- "Riccardo Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
| | - Marta Maisto
- "Riccardo Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
| | - Jessica Isbely Montana
- "Riccardo Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
| | | | | | | | - Fabrizia Mantovani
- "Riccardo Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
| | - Giuseppe Riva
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Olivia Realdon
- "Riccardo Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
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The development of vision between nature and nurture: clinical implications from visual neuroscience. Childs Nerv Syst 2020; 36:911-917. [PMID: 32140777 DOI: 10.1007/s00381-020-04554-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 02/27/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Vision is an adaptive function and should be considered a prerequisite for neurodevelopment because it permits the organization and the comprehension of the sensory data collected by the visual system during daily life. For this reason, the influence of visual functions on neuromotor, cognitive, and emotional development has been investigated by several studies that have highlighted how visual functions can drive the organization and maturation of human behavior. Recent studies on animals and human models have indicated that visual functions mature gradually during post-natal life, and its development is closely linked to environment and experience. DISCUSSION The role of vision in early brain development and some of the neuroplasticity mechanisms that have been described in the presence of cerebral damage during childhood are analyzed in this review, according to a neurorehabilitation prospective.
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Asl HJ, Narikiyo T. An Assistive Control Strategy for Rehabilitation Robots Using Velocity Field and Force Field. IEEE Int Conf Rehabil Robot 2020; 2019:790-795. [PMID: 31374727 DOI: 10.1109/icorr.2019.8779551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In this paper, we address the problem of assist-as-needed (AAN) control of rehabilitation robots. The objective is to develop a path tracking control scheme with the minimized intervention of the robot to gain active participation of impaired subjects while avoiding large position errors. We achieve these properties by constructing a velocity field encoding the desired path, and by considering a force field around the path. In particular, the proposed controller includes a normal force term to keep the robot position arbitrarily close to the path, and also contains velocity tracking components, which adaptively adjust the contribution of the controller by monitoring the tracking error. As a result, we gain the AAN property with adequate freedom in the timing of movement, which is a key factor in reducing the robot intervention. The performance of the controller is examined on a lower-limb robotic exoskeleton in following the gait pattern.
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Kafri M, Atun-Einy O. From Motor Learning Theory to Practice: A Scoping Review of Conceptual Frameworks for Applying Knowledge in Motor Learning to Physical Therapist Practice. Phys Ther 2019; 99:1628-1643. [PMID: 31407003 DOI: 10.1093/ptj/pzz118] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/13/2018] [Accepted: 05/05/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND The importance of motor learning knowledge for physical therapist practice is well known; however, its application is lacking. Conceptual frameworks that place motor learning knowledge within a clinical context are a potential mediator to overcome this gap. PURPOSE This study aimed to conduct a scoping review of the literature to identify and describe the content of such conceptual frameworks in physical therapy/rehabilitation, including the approaches taken in their development and the "elements" or building blocks of motor learning-based interventions within each conceptual framework. DATA SOURCES The data sources used were PubMed, CINAHL, and PsychInfo databases. STUDY SELECTION Articles that were selected had a primary focus on motor learning and its application in physical therapy/rehabilitation and were published between 2000 and 2017. DATA EXTRACTION Twelve of 62 relevant articles met the inclusion criteria. DATA SYNTHESIS Papers attempted to translate theoretical knowledge into a coherent, clinically accessible conceptual framework via 3 main approaches: synthesizing selected motor learning elements into original new conceptual frameworks, mapping motor learning elements in current clinical practices, and assembling selected motor learning elements. The elements of motor learning that were common across papers included theoretical concepts (such as "meaningful goal setting" and "active involvement"); practice variables (including the type, frequency, and timing of feedback; the focus of instructions; task breakdown; and the amount, variability, and order of practice); and intervention strategies (task specific and mental practice). Psychological aspects related to self-efficacy and motivation were also considered integral. LIMITATIONS Papers published before the year 2000 were excluded. CONCLUSION The scoping review revealed that the presentation of motor learning elements in a coherent framework encompassed very diverse approaches and used different categorization systems. In addition, to fully grasp the complexity of clinical practice, motor learning should be coupled with other fields of knowledge.
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Affiliation(s)
- Michal Kafri
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel
| | - Osnat Atun-Einy
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel
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