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Norris TA, Augenstein TE, Rodriguez KM, Claflin ES, Krishnan C. Shaping corticospinal pathways in virtual reality: effects of task complexity and sensory feedback during mirror therapy in neurologically intact individuals. J Neuroeng Rehabil 2024; 21:154. [PMID: 39232841 PMCID: PMC11373181 DOI: 10.1186/s12984-024-01454-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 08/27/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Restoration of limb function for individuals with unilateral weakness typically requires volitional muscle control, which is often not present for individuals with severe impairment. Mirror therapy-interventions using a mirror box to reflect the less-impaired limb onto the more-impaired limb-can facilitate corticospinal excitability, leading to enhanced recovery in severely impaired clinical populations. However, the mirror box applies limitations on mirror therapy, namely that all movements appear bilateral and are confined to a small area, impeding integration of complex activities and multisensory feedback (e.g., visuo-tactile stimulation). These limitations can be addressed with virtual reality, but the resulting effect on corticospinal excitability is unclear. OBJECTIVE Examine how virtual reality-based unilateral mirroring, complex activities during mirroring, and visuo-tactile stimulation prior to mirroring affect corticospinal excitability. MATERIALS AND METHODS Participants with no known neurological conditions (n = 17) donned a virtual reality system (NeuRRoVR) that displayed a first-person perspective of a virtual avatar that matched their motions. Transcranial magnetic stimulation-induced motor evoked potentials in the nondominant hand muscles were used to evaluate corticospinal excitability in four conditions: resting, mirroring, mirroring with prior visuo-tactile stimulation (mirroring + TACT), and control. During mirroring, the movements of each participant's dominant limb were reflected onto the nondominant limb of the virtual avatar, and the avatar's dominant limb was kept immobile (i.e., unilateral mirroring). The mirroring + TACT condition was the same as the mirroring condition, except that mirroring was preceded by visuo-tactile stimulation of the nondominant limb. During the control condition, unilateral mirroring was disabled. During all conditions, participants performed simple (flex/extend fingers) and complex (stack virtual blocks) activities. RESULTS We found that unilateral mirroring increased corticospinal excitability compared to no mirroring (p < 0.001), complex activities increased excitability compared to simple activities during mirroring (p < 0.001), and visuo-tactile stimulation prior to mirroring decreased excitability (p = 0.032). We also found that these features did not interact with each other. DISCUSSIONS The findings of this study shed light onto the neurological mechanisms of mirror therapy and demonstrate the unique ways in which virtual reality can augment mirror therapy. The findings have important implications for rehabilitation for design of virtual reality systems for clinical populations.
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Affiliation(s)
- Trevor A Norris
- Neuromuscular & Rehabilitation Robotics Laboratory (NeuRRo Lab), Michigan Medicine, University of Michigan, 325 E Eisenhower Parkway (Room 3013), Ann Arbor, MI, 48108, USA
| | - Thomas E Augenstein
- Neuromuscular & Rehabilitation Robotics Laboratory (NeuRRo Lab), Michigan Medicine, University of Michigan, 325 E Eisenhower Parkway (Room 3013), Ann Arbor, MI, 48108, USA
- Robotics Department, University of Michigan, Ann Arbor, MI, USA
- Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Kazandra M Rodriguez
- Neuromuscular & Rehabilitation Robotics Laboratory (NeuRRo Lab), Michigan Medicine, University of Michigan, 325 E Eisenhower Parkway (Room 3013), Ann Arbor, MI, 48108, USA
- Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Edward S Claflin
- Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- Neuromuscular & Rehabilitation Robotics Laboratory (NeuRRo Lab), Michigan Medicine, University of Michigan, 325 E Eisenhower Parkway (Room 3013), Ann Arbor, MI, 48108, USA.
- Robotics Department, University of Michigan, Ann Arbor, MI, USA.
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA.
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA.
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
- Department of Physical Therapy, University of Michigan-Flint, Flint, MI, USA.
- Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA.
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Knutson JS, Fu MJ, Cunningham DA, Hisel TZ, Friedl AS, Gunzler DD, Plow EB, Busch RM, Pundik S. Contralaterally controlled functional electrical stimulation video game therapy for hand rehabilitation after stroke: a randomized controlled trial. Disabil Rehabil 2024; 46:4466-4475. [PMID: 37962171 PMCID: PMC11090983 DOI: 10.1080/09638288.2023.2278174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE To estimate the effect of integrating custom-designed hand therapy video games (HTVG) with contralaterally controlled functional electrical stimulation (CCFES) therapy. METHODS Fifty-two stroke survivors with chronic (>6 months) upper limb hemiplegia were randomized to 12 weeks of CCFES or CCFES + HTVG. Treatment involved self-administration of technology-mediated therapy at home plus therapist-administered CCFES-assisted task practice in the lab. Pre- and post-treatment assessments were made of hand dexterity, upper limb impairment and activity limitation, and cognitive function. RESULTS No significant between-group differences were found on any outcome measure, and the average magnitudes of improvement within both groups were small. The incidence of technical problems with study devices at home was greater for the CCFES + HTVG group. This negatively affected adherence and may partially explain the absence of effect of HTVG. At end-of-treatment, large majorities of both treatment groups had positive perceptions of treatment efficacy and expressed enthusiasm for the treatments. CONCLUSION This study makes an important contribution to the research literature on the importance of environmental factors, concomitant impairments, and technology simplification when designing technology-based therapies intended to be self-administered at home. This study failed to show any added benefit of HTVG to CCFES therapy.Clinicaltrials.gov (NCT03058796).
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Affiliation(s)
- Jayme S Knutson
- Research Service, Louis Stokes Cleveland VA Medical Center, Veterans Affairs Northeast OH Healthcare System, Cleveland, OH, USA
- Department of Physical Medicine and Rehabilitation, The MetroHealth System, Cleveland, OH, USA
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH, USA
| | - Michael J Fu
- Department of Physical Medicine and Rehabilitation, The MetroHealth System, Cleveland, OH, USA
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH, USA
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - David A Cunningham
- Department of Physical Medicine and Rehabilitation, The MetroHealth System, Cleveland, OH, USA
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH, USA
| | - Terri Z Hisel
- Department of Physical Medicine and Rehabilitation, The MetroHealth System, Cleveland, OH, USA
| | - Amy S Friedl
- Department of Physical Medicine and Rehabilitation, The MetroHealth System, Cleveland, OH, USA
| | - Douglas D Gunzler
- Center for Healthcare Research and Policy, The MetroHealth System, Cleveland, OH, USA
- Population Health and Equity Research Institute, The MetroHealth System, Cleveland, OH, USA
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Ela B Plow
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Rehabilitation Hospitals, Cleveland, OH, USA
| | - Robyn M Busch
- Departments of Neurology and Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Svetlana Pundik
- Neurology Service, Louis Stokes Cleveland VA Medical Center, Veterans Affairs Northeast OH Healthcare System, Cleveland, OH, USA
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
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Augenstein TE, Nagalla D, Mohacey A, Cubillos LH, Lee MH, Ranganathan R, Krishnan C. A novel virtual robotic platform for controlling six degrees of freedom assistive devices with body-machine interfaces. Comput Biol Med 2024; 178:108778. [PMID: 38925086 DOI: 10.1016/j.compbiomed.2024.108778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 05/14/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024]
Abstract
Body-machine interfaces (BoMIs)-systems that control assistive devices (e.g., a robotic manipulator) with a person's movements-offer a robust and non-invasive alternative to brain-machine interfaces for individuals with neurological injuries. However, commercially-available assistive devices offer more degrees of freedom (DOFs) than can be efficiently controlled with a user's residual motor function. Therefore, BoMIs often rely on nonintuitive mappings between body and device movements. Learning these mappings requires considerable practice time in a lab/clinic, which can be challenging. Virtual environments can potentially address this challenge, but there are limited options for high-DOF assistive devices, and it is unclear if learning with a virtual device is similar to learning with its physical counterpart. We developed a novel virtual robotic platform that replicated a commercially-available 6-DOF robotic manipulator. Participants controlled the physical and virtual robots using four wireless inertial measurement units (IMUs) fixed to the upper torso. Forty-three neurologically unimpaired adults practiced a target-matching task using either the physical (sample size n = 25) or virtual device (sample size n = 18) involving pre-, mid-, and post-tests separated by four training blocks. We found that both groups made similar improvements from pre-test in movement time at mid-test (Δvirtual: 9.9 ± 9.5 s; Δphysical: 11.1 ± 9.9 s) and post-test (Δvirtual: 11.1 ± 9.1 s; Δphysical: 11.8 ± 10.5 s) and in path length at mid-test (Δvirtual: 6.1 ± 6.3 m/m; Δphysical: 3.3 ± 3.5 m/m) and post-test (Δvirtual: 6.6 ± 6.2 m/m; Δphysical: 3.5 ± 4.0 m/m). Our results indicate the feasibility of using virtual environments for learning to control assistive devices. Future work should determine how these findings generalize to clinical populations.
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Affiliation(s)
- Thomas E Augenstein
- Robotics Department, University of Michigan, Ann Arbor, MI, USA; NeuRRo Lab, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Deepak Nagalla
- Robotics Department, University of Michigan, Ann Arbor, MI, USA; NeuRRo Lab, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Alexander Mohacey
- Robotics Department, University of Michigan, Ann Arbor, MI, USA; NeuRRo Lab, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Luis H Cubillos
- Robotics Department, University of Michigan, Ann Arbor, MI, USA; NeuRRo Lab, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Mei-Hua Lee
- Department of Kinesiology, Michigan State University, Lansing, MI, USA
| | - Rajiv Ranganathan
- Department of Kinesiology, Michigan State University, Lansing, MI, USA; Department of Mechanical Engineering, Michigan State University, Lansing, MI, USA
| | - Chandramouli Krishnan
- Robotics Department, University of Michigan, Ann Arbor, MI, USA; NeuRRo Lab, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Physical Therapy, University of Michigan, Flint, MI, USA.
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Olmos-Gómez R, Calvo-Muñoz I, Gómez-Conesa A. Treatment with robot-assisted gait trainer Walkbot along with physiotherapy vs. isolated physiotherapy in children and adolescents with cerebral palsy. Experimental study. BMC Neurol 2024; 24:245. [PMID: 39009990 PMCID: PMC11247728 DOI: 10.1186/s12883-024-03750-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 07/03/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Improving walking ability is a key objective in the treatment of children and adolescents with cerebral palsy, since it directly affects their activity and participation. In recent years, robotic technology has been implemented in gait treatment, which allows training of longer duration and repetition of the movement. To know the effectiveness of a treatment with the robotic-assisted gait trainer Walkbot combined with physiotherapy compared to the isolated physiotherapy treatment in children and adolescents with cerebral palsy, we carried out a clinical trial. METHODS 23 participants, were divided into two groups: experimental and control. During 5 weeks, both groups received their physiotherapy sessions scheduled, in addition experimental group received 4 sessions per week of 40 min of robot. An evaluation of the participants was carried out before the intervention, at the end of the intervention, and at follow-up (two months after the end of the intervention). Gait was assessed with the Gross Motor Function Measure-88 dimensions D and E, strength was measured with a hydraulic dynamometer, and range of motion was assessed using the goniometer. A mixed ANOVA was performed when the assumptions of normality and homoscedasticity were met, and a robust mixed ANOVA was performed when these assumptions were not met. Statistical significance was stipulated at p < 0.05. For the effect size, η2 was calculated. RESULTS Significant differences were found regarding the time x group interaction in the Gross Motor Function Measure-88 in dimension D [η2 = 0.016], in the flexion strength of the left [η2 = 0.128] and right [η2 = 0.142] hips, in the extension strength of the right hip [η2 = 0.035], in the abduction strength of the left hip [η2 = 0.179] and right [η2 = 0.196], in the flexion strength of the left knee [η2 = 0.222] and right [η2 = 0.147], and in the range of motion of left [η2 = 0.071] and right [η2 = 0.053] knee flexion. CONCLUSIONS Compared to treatments without walking robot, physiotherapy treatment including Walkbot improves standing, muscle strength, and knee range of motion in children and adolescents with cerebral palsy. TRIAL REGISTRATION ClinicalTrials.gov: NCT04329793. First posted: April 1, 2020.
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Affiliation(s)
- Raquel Olmos-Gómez
- International Doctoral School of the University of Murcia (EIDUM), University of Murcia, Murcia, 30100, Spain.
| | - Inmaculada Calvo-Muñoz
- Faculty of Physiotherapy, Occupational Therapy and Podiatry, UCAM Catholic University of Murcia, Guadalupe, Murcia, 30107, Spain
| | - Antonia Gómez-Conesa
- Research Group Research Methods and Evaluation in Social Sciences, Mare Nostrum Campus of International Excellence, University of Murcia, Murcia, 30100, Spain
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Takahashi MTC, Balardin JB, Bazán PR, Boasquevisque DDS, Amaro E, Conforto AB. Effect of transcranial direct current stimulation in the initial weeks post-stroke: a pilot randomized study. EINSTEIN-SAO PAULO 2024; 22:eAO0450. [PMID: 38922218 PMCID: PMC11196089 DOI: 10.31744/einstein_journal/2024ao0450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 09/18/2023] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVE This study aimed at assessing the alterations in upper limb motor impairment and connectivity between motor areas following the post-stroke delivery of cathodal transcranial direct current stimulation sessions. METHODS Modifications in the Fugl-Meyer Assessment scores, connectivity between the primary motor cortex of the unaffected and affected hemispheres, and between the primary motor and premotor cortices of the unaffected hemisphere were compared prior to and following six sessions of cathodal transcranial direct current stimulation application in 13 patients (active = 6; sham = 7); this modality targets the primary motor cortex of the unaffected hemisphere early after a stroke. RESULTS Clinically relevant distinctions in Fugl-Meyer Assessment scores (≥9 points) were observed more frequently in the Sham Group than in the Active Group. Between-group differences in the alterations in Fugl-Meyer Assessment scores were not statistically significant (Mann-Whitney test, p=0.133). ROI-to-ROI correlations between the primary motor cortices of the affected and unaffected hemispheres post-therapeutically increased in 5/6 and 2/7 participants in the Active and Sham Groups, respectively. Between-group differences in modifications in connectivity between the aforementioned areas were not statistically significant. Motor performance enhancements were more frequent in the Sham Group compared to the Active Group. CONCLUSION The results of this hypothesis-generating investigation suggest that heightened connectivity may not translate into early clinical benefits following a stroke and will be crucial in designing larger cohort studies to explore mechanisms underlying the impacts of this intervention. ClinicalTrials.gov Identifier: NCT02455427.
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Affiliation(s)
- Marcela Tengler Carvalho Takahashi
- Hospital Municipal da Vila Santa Catarina Dr. Gilson Cássia Marques de CarvalhoHospital Israelita Albert EinsteinSão PauloSPBrazilHospital Municipal da Vila Santa Catarina Dr. Gilson Cássia Marques de Carvalho ; Hospital Israelita Albert Einstein,São Paulo, SP, Brazil.
| | - Joana Bisol Balardin
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Paulo Rodrigo Bazán
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Danielle de Sá Boasquevisque
- Division of NeurologyPopulation Health Research InstitutMcMaster UniversityHamiltonOntarioCanada Division of Neurology, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
| | - Edson Amaro
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Adriana Bastos Conforto
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Palmcrantz S, Cremoux A, Kahan T, Borg J. Effects of different exercise protocols on aerobic capacity, blood pressure, biochemical parameters, and body weight in chronic stroke survivors: a randomized controlled trial. Top Stroke Rehabil 2024:1-10. [PMID: 38825880 DOI: 10.1080/10749357.2024.2359344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/18/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVE To explore the impact on risk factors for recurrent stroke after gait training among persons restricted in walking in the chronic phase after stroke. METHODS In this randomized controlled trial, two groups performed gait training, 1 session/day, 3 days/week for 6 weeks, including electromechanically assisted gait training on a treadmill (EAGT) (n=12) or variable conventional gait training only (n=15); a control group (n=11) continued as usual. Endurance assessed with the 6-minute walk test, blood pressure, weight and blood samples were collected at baseline and after 6 weeks. Total Cholesterol, High Density Lipoprotein Cholesterol, and Triglycerides in plasma, and HbA1c in blood (reflecting glucose levels) were analysed. RESULTS The EAGT group walked more than twice the distance compared to the Conventional training group while the effective training time was similar. Endurance in walking increased most in the Conventional group while the Control group declined. Systolic blood pressure decreased most in the Conventional group, with a moderate effect size (ŋp2) of 0.0921 (95% confidence interval (CI)0.0012-0.2598). Body weight decreased most in the EAGT group with a large effect size (ŋp2) of 0.1406 (95% CI0.0047-0.3452). Lipid levels exhibited non-conclusive changes and HbA1c did not change significantly in any group. CONCLUSIONS Results indicate that six weeks of gait training may change risk factors for recurrent stroke even in persons restricted in mobility and that different training methods may have differential effects. These findings are in agreement with previous studies in less severely disabled persons and should encourage further studies in the current subgroup.
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Affiliation(s)
- Susanne Palmcrantz
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division Rehabilitation Medicine, Stockholm, Sweden
| | - Anna Cremoux
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Thomas Kahan
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden
| | - Jörgen Borg
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division Rehabilitation Medicine, Stockholm, Sweden
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Xiang YT, Wu JJ, Ma J, Xing XX, Zhang JP, Hua XY, Zheng MX, Xu JG. Peripheral nerve transfers for dysfunctions in central nervous system injuries: a systematic review. Int J Surg 2024; 110:3814-3826. [PMID: 38935818 PMCID: PMC11175768 DOI: 10.1097/js9.0000000000001267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/21/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND The review highlights recent advancements and innovative uses of nerve transfer surgery in treating dysfunctions caused by central nervous system (CNS) injuries, with a particular focus on spinal cord injury (SCI), stroke, traumatic brain injury, and cerebral palsy. METHODS A comprehensive literature search was conducted regarding nerve transfer for restoring sensorimotor functions and bladder control following injuries of spinal cord and brain, across PubMed and Web of Science from January 1920 to May 2023. Two independent reviewers undertook article selection, data extraction, and risk of bias assessment with several appraisal tools, including the Cochrane Risk of Bias Tool, the JBI Critical Appraisal Checklist, and SYRCLE's ROB tool. The study protocol has been registered and reported following PRISMA and AMSTAR guidelines. RESULTS Nine hundred six articles were retrieved, of which 35 studies were included (20 on SCI and 15 on brain injury), with 371 participants included in the surgery group and 192 in the control group. These articles were mostly low-risk, with methodological concerns in study types, highlighting the complexity and diversity. For SCI, the strength of target muscle increased by 3.13 of Medical Research Council grade, and the residual urine volume reduced by more than 100 ml in 15 of 20 patients. For unilateral brain injury, the Fugl-Myer motor assessment (FMA) improved 15.14-26 score in upper extremity compared to 2.35-26 in the control group. The overall reduction in Modified Ashworth score was 0.76-2 compared to 0-1 in the control group. Range of motion (ROM) increased 18.4-80° in elbow, 20.4-110° in wrist and 18.8-130° in forearm, while ROM changed -4.03°-20° in elbow, -2.08°-10° in wrist, -2.26°-20° in forearm in the control group. The improvement of FMA in lower extremity was 9 score compared to the presurgery. CONCLUSION Nerve transfer generally improves sensorimotor functions in paralyzed limbs and bladder control following CNS injury. The technique effectively creates a 'bypass' for signals and facilitates functional recovery by leveraging neural plasticity. It suggested a future of surgery, neurorehabilitation and robotic-assistants converge to improve outcomes for CNS.
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Affiliation(s)
- Yun-Ting Xiang
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine
| | - Jia-Jia Wu
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Jie Ma
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Xiang-Xin Xing
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Jun-Peng Zhang
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine
| | - Xu-Yun Hua
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Mou-Xiong Zheng
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Jian-Guang Xu
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
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Sehle A, Salzmann C, Liepert J. Effects of flexor reflex stimulation on gait aspects in stroke patients: randomized clinical trial. J Neuroeng Rehabil 2024; 21:83. [PMID: 38802939 PMCID: PMC11131186 DOI: 10.1186/s12984-024-01377-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/10/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Gait deficits are very common after stroke and therefore an important aspect in poststroke rehabilitation. A currently little used method in gait rehabilitation after stroke is the activation of the flexor reflex (FR) by electrical stimulation of the sole of foot while walking. The aim of this study was to investigate the effect of FR stimulation on gait performance and gait parameters in participants with stroke within a single session of flexor reflex stimulation using Incedo™. METHODS Twenty-five participants with subacute (n = 14) and chronic (n = 11) stroke were enrolled in the study. Motor functions were tested with a 10-m walk test (10mWT), a 2-min walk test (2minWT), and a gait analysis. These tests were performed with and without Incedo™ within a single session in randomized order. RESULTS In the 10mWT, a significant difference was found between walking with Incedo™ (15.0 ± 8.5 s) versus without Incedo™ (17.0 ± 11.4 s, p = 0.01). Similarly, the 2minWT showed a significant improvement with Incedo™ use (90.0 ± 36.4 m) compared to without Incedo™ (86.3 ± 36.8 m, p = 0.03). These results indicate that while the improvements are statistically significant, they are modest and should be considered in the context of their clinical relevance. The gait parameters remained unchanged except for the step length. A subgroup analysis indicated that participants with subacute and chronic stroke responded similarly to the stimulation. There was a correlation between the degree of response to electrostimulation while walking and degree of improvement in 2minWT (r = 0.50, p = 0.01). CONCLUSIONS This study is the first to examine FR activation effects in chronic stroke patients and suggests that stimulation effects are independent of the time since stroke. A larger controlled clinical trial is warranted that addresses issues as the necessary number of therapeutical sessions and for how long stimulation-induced improvements outlast the treatment period. TRIAL REGISTRATION The trial was retrospectively registered in German Clinical Trials Register. CLINICAL TRIAL REGISTRATION NUMBER DRKS00021457. Date of registration: 29 June 2020.
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Affiliation(s)
- Aida Sehle
- Kliniken Schmieder, Allensbach, Germany
- Lurija Institute, Allensbach, Germany
| | - Christian Salzmann
- Kliniken Schmieder, Allensbach, Germany
- Lurija Institute, Allensbach, Germany
| | - Joachim Liepert
- Kliniken Schmieder, Allensbach, Germany.
- Lurija Institute, Allensbach, Germany.
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Mendonca CJ, Kane BL, Smith KA, Mohanraj S, Malone LA, Thirumalai M, Rimmer J, Brown DA. New technology to address affected vs nonaffected arm contributions to ergometer performance in people poststroke. Top Stroke Rehabil 2024:1-10. [PMID: 38785263 DOI: 10.1080/10749357.2024.2356415] [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: 11/08/2023] [Accepted: 04/27/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND When pedaling a coupled-crank arm ergometer, individuals with hemiplegia may experience nonparetic arm overcompensation, and paretic arm resistance, due to neuromechanical deficits. Technologies that foster independent limb contributions may increase the effectiveness of exercise for people poststroke. OBJECTIVE Examine the speed during uncoupled pedaling with the Advanced Virtual Exercise Environment Device among individuals poststroke and non-impaired comparisons. METHODS We recruited 2 groups:Poststroke and Comparison. Participants attended one lab session and performed peak speed tests and a graded exercise repeated for bilateral pedaling, unilateral (left, right). RESULTS Thirty-one participants completed the protocol (16 women, 15 men). Poststroke participants pedaled slower during the bilateral speed test (64 ± 39 RPM, p < .001), and graded exercise, (54 ± 28 RPM, p < .001) versus comparisons (141 ± 19, 104 ± 12 RPM). Poststroke individuals had lower peak RPM during the unilateral speed test with their paretic arm (70 ± 46 RPM, p < .001) and graded exercise (58 ± 33 RPM, p < .001) compared to their unilateral speed test (130 ± 37 RPM) and graded exercise (108 ± 25 RPM) with their nonparetic arm. Comparisons did not differ between arms during speed tests and graded exercise. Poststroke participants demonstrated lower peak speed with their affected arm during the bilateral speed test (52 ± 42 RPM, p < .001) and graded exercise (49 ± 28 RPM, p = .008) compared to the same arm during unilateral speed (70 ± 46 RPM) and graded exercise (58 ± 33 RPM). CONCLUSIONS Poststroke participants pedaled faster with their affected arm unilaterally versus bilateral pedaling, suggesting interhemispheric interference that reduces the ability to recruit the paretic arm during bilateral exercise.
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Affiliation(s)
- Christen J Mendonca
- SHP Research Collaborative, The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Kimberly A Smith
- Department of Family and Community Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sangeetha Mohanraj
- SHP Research Collaborative, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Laurie A Malone
- Department of Occupational Therapy, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mohanraj Thirumalai
- SHP Research Collaborative, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - James Rimmer
- SHP Research Collaborative, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - David A Brown
- The School of Health Professions, The University of Texas Medical Branch, Galveston, TX, USA
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10
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Hwang S, Min KC, Song CS. Assistive technology on upper extremity function for stroke patients: A systematic review with meta-analysis. J Hand Ther 2024:S0894-1130(23)00202-8. [PMID: 38796397 DOI: 10.1016/j.jht.2023.12.014] [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] [Received: 08/04/2023] [Revised: 12/22/2023] [Accepted: 12/30/2023] [Indexed: 05/28/2024]
Abstract
BACKGROUND In stroke rehabilitation, the selection of appropriate assistive devices is of paramount importance for patients. Specifically, the choice of device can significantly influence the functional recovery of the upper limb, impacting their overall activities or functional tasks. OBJECTIVES This review aimed to comprehensively analyze and summarize the clinical evidence from randomized controlled trials (RCTs) regarding the therapeutic effects of commonly used assistive devices on upper extremity function in patients with stroke. METHODS To evaluate assistive devices for patients with stroke, we summarized qualitatively throughout synthesis of results, such as therapeutic intervention, intensity, outcome, and summary of results, and examined risk of bias, heterogeneity, mean difference, 95% confidence interval, and I-squared value. To analyze, we used RoB 2 and RevMan 5.4. RESULTS The qualitative synthesis included 31 RCTs. The randomization process and the reporting of results showed minimal bias, but there were issues with bias from intended interventions, and missing outcome data presented some concerns. The quantitative synthesis included 16 RCTs. There was a significant difference in the Fugl-Meyer assessment-upper extremity functioning (FMA-UE) scores between the groups, with a total mean difference (95% confidence interval) of 2.40 (0.21, 4.60), heterogeneity values were Tau2 = 0.32, chi-square = 8.22, degrees of freedom = 8 (p = 0.41), and I2 = 3% for FMA-UE and the test for the overall effect produced Z = 2.14 (p = 0.03) in patients with chronic stroke. However, there was no significant difference in all other outcome measures. CONCLUSIONS Upper-limb robots did not demonstrate significant superiority over conventional treatments in improving function of upper limbs, with the exception of FMA-UE scores for patients with chronic stroke. The mean difference of FMA-UE was also lower than minimally important difference. Nonetheless, the usage of upper-limb robots may contribute to enhanced function for patients with stroke, as those devices support clinicians and enable a greater number of movement repetitions within specific time frames.
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Affiliation(s)
- Sujin Hwang
- Department of Physical Therapy, Division of Health Science, Baekseok University, Cheonan, Republic of Korea; Graduate School of Health Welfare, Baekseok University, Seoul, Republic of Korea
| | - Kyoung-Chul Min
- Department of Occupational Therpay, Wonkwang University, Republic of Korea
| | - Chiang-Soon Song
- Department of Occupational Therapy, College of Natural Science and Public Health and Safety, Chosun University, Gwangju, Republic of Korea.
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11
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Li S. Patterns and assessment of spastic hemiplegic gait. Muscle Nerve 2024; 69:516-522. [PMID: 38372396 DOI: 10.1002/mus.28052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/15/2024] [Accepted: 01/21/2024] [Indexed: 02/20/2024]
Abstract
Hemiparetic gait disorders are common in stroke survivors. A circumductory gait is often considered the typical hemiparetic gait. In clinical practice, a wide spectrum of abnormal gait patterns is observed, depending on the severity of weakness and spasticity, and the anatomical distribution of spasticity. Muscle strength is the key determinant of gait disorders in hemiparetic stroke survivors. Spasticity and its associated involuntary activation of synergistic spastic muscles often alter posture of involved joint(s) and subsequently the alignment of hip, knee, and ankle joints, resulting in abnormal gait patterns. Due to combinations of various levels of muscle weakness and spasticity and their interactions with ground reaction force, presentations of gait disorders are variable. From a neuromechanical perspective, a stepwise visual gait analysis approach is proposed to identify primary underlying causes. In this approach, the pelvic and hip joint movement is examined first. The pelvic girdle constitutes three kinematic determinants. Its abnormality determines the body vector and compensatory kinetic chain reactions in the knee and ankle joints. The second step is to assess the ankle and foot complex abnormality. The last step is to examine abnormality of the knee joint. Assessment of muscle strength and spasticity of hip, knee, and ankle/foot joints needs to be performed before these steps. Lidocaine nerve blocks can be a useful diagnostic tool. Recognizing different patterns and identifying the primary causes are critical to developing clinical interventions to improve gait functions.
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Affiliation(s)
- Sheng Li
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center-Houston, Houston, Texas, USA
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12
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Jafari-Golestan N, Dalvandi A, Hosseini M, Fallahi-Khoshknab M, Ebadi A, Rahgozar M, Souraya S. Designing and validating of a questionnaire measuring perceived self-care ability (PSCA) in chronic stroke patients at home. BMC Neurol 2024; 24:125. [PMID: 38622553 PMCID: PMC11017699 DOI: 10.1186/s12883-024-03612-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/26/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Patients with a stroke often cannot care for themselves after hospital discharge. Assessment of their self-care ability is the first step in planning post-discharge home care. This study aimed to design and validate a measure of perceived self-care ability (PSCA) in stroke patients. METHODS A sequential-exploratory mixed method was conducted in Tehran, Iran, in 2020-2021. The qualitative phase involved in-depth semi-structured interviews with 12 participants. Transcripts were content analyzed. The results guided the development of 81 items. psychometric properties such as face validity (Impact Score > 1.5), content validity ratio (CVR > 0.63), content validity index (Item Content Validity Index: ICVI > 0.78, Scale Content Validity Index/Average: SCVI/Ave > 0.8) and Kappa value (Kappa > 0.7), internal consistency (Cronbach's alpha > 0.7), relative reliability (ICC: inter class correlation coefficient), absolute reliability (Standard Error of Measurement: SEM and Minimal Detectable Changes: MDC), convergent validity (Correlation Coefficient between 0.4-0.7), interpretability, responsiveness, feasibility, and ceiling and floor effects were assessed. RESULTS Content analysis of the qualitative interviews yielded 5 major categories and 9 subcategories that reflected "Perceptual stability", "Cognitive fluctuations", "Sensory, Motor and Physical health"," The subjective nature" and "The dynamic nature" of PSCA. Results of face and content validity reduced the number of items to 32, capturing three dimensions of PSCA in chronic stroke patients; these dimensions included perceptual ability, threatened health status, and sensory, motor, and cognitive ability. The findings supported the reliability and validity of the measure. CONCLUSIONS The PSCA questionnaire was developed and validated within the Iranian culture. It is useful in assessing the self-care of patients with stroke and in informing practice.
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Affiliation(s)
- Nasrin Jafari-Golestan
- Faculty of Nursing, Department of Nursing Management, Aja University of Medical Sciences, Tehran, IR, Iran
| | - Asghar Dalvandi
- Department of Midwifery, Faculty of Nursing and Midwifery, Islamic Azad University, Tehran, IR, Iran.
- Department of Nursing Education, University of Social Welfare and Rehabilitation Sciences, Tehran, IR, Iran.
| | - Mohammadali Hosseini
- Department of Nursing Education, University of Social Welfare and Rehabilitation Sciences, Tehran, IR, Iran
| | - Masoud Fallahi-Khoshknab
- Department of Nursing Education, University of Social Welfare and Rehabilitation Sciences, Tehran, IR, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, IR, Iran
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, IR, Iran
| | - Mahdi Rahgozar
- Department of Biomedical Statistics, University of Social Welfare and Rehabilitation Sciences, Tehran, IR, Iran
| | - Sidani Souraya
- School of Nursing, Toronto Metropolitan University, Toronto, Canada
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13
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Robinson-Bert K, Woods AB. Effectiveness of synchronous action observation and mental practice on upper extremity motor recovery after stroke. Occup Ther Health Care 2024; 38:196-213. [PMID: 36309807 DOI: 10.1080/07380577.2022.2138675] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 09/02/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023]
Abstract
The purpose of this quasi-experimental pretest-posttest control group study was to examine the effect of group synchronous action observation/mental practice intervention compared to usual rehabilitation care on upper extremity motor recovery after stroke. The intervention group (n = 25) received usual care, consisting of a minimum of 3 hours of rehabilitation services per day, 5 days a week, plus group synchronous action observation/mental practice sessions 3 times per week and the control group (n = 26) received usual care. Outcome measures included the Kinesthetic and Visual Imagery Questionnaire Short Version (KVIQ-10), the Fugl-Meyer Assessment (FMA-UE) of affected upper extremity motor function only and The Box and Block Test (BBT). Although there were no statistically significant differences in upper extremity motor function between the two groups, a subgroup analysis of the intervention group identified statistically significant (FMA-UE: p < .001; BBT: p = .04) and Minimally Important Clinical Differences on upper extremity motor recovery between patients with behaviors demonstrating more versus less commitment to the intervention. Group synchronous action observation/mental practice is a promising intervention for patients demonstrating commitment to actively participating in the intervention to improve outcomes on upper extremity motor recovery after stroke.
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Affiliation(s)
| | - Anne B Woods
- Graduate Program in Nursing, Messiah University, Mechanicsburg, PA, USA
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14
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Moon Y, Yang C, Veit NC, McKenzie KA, Kim J, Aalla S, Yingling L, Buchler K, Hunt J, Jenz S, Shin SY, Kishta A, Edgerton VR, Gerasimenko YP, Roth EJ, Lieber RL, Jayaraman A. Noninvasive spinal stimulation improves walking in chronic stroke survivors: a proof-of-concept case series. Biomed Eng Online 2024; 23:38. [PMID: 38561821 PMCID: PMC10986021 DOI: 10.1186/s12938-024-01231-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/21/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND After stroke, restoring safe, independent, and efficient walking is a top rehabilitation priority. However, in nearly 70% of stroke survivors asymmetrical walking patterns and reduced walking speed persist. This case series study aims to investigate the effectiveness of transcutaneous spinal cord stimulation (tSCS) in enhancing walking ability of persons with chronic stroke. METHODS Eight participants with hemiparesis after a single, chronic stroke were enrolled. Each participant was assigned to either the Stim group (N = 4, gait training + tSCS) or Control group (N = 4, gait training alone). Each participant in the Stim group was matched to a participant in the Control group based on age, time since stroke, and self-selected gait speed. For the Stim group, tSCS was delivered during gait training via electrodes placed on the skin between the spinous processes of C5-C6, T11-T12, and L1-L2. Both groups received 24 sessions of gait training over 8 weeks with a physical therapist providing verbal cueing for improved gait symmetry. Gait speed (measured from 10 m walk test), endurance (measured from 6 min walk test), spatiotemporal gait symmetries (step length and swing time), as well as the neurophysiological outcomes (muscle synergy, resting motor thresholds via spinal motor evoked responses) were collected without tSCS at baseline, completion, and 3 month follow-up. RESULTS All four Stim participants sustained spatiotemporal symmetry improvements at the 3 month follow-up (step length: 17.7%, swing time: 10.1%) compared to the Control group (step length: 1.1%, swing time 3.6%). Additionally, 3 of 4 Stim participants showed increased number of muscle synergies and/or lowered resting motor thresholds compared to the Control group. CONCLUSIONS This study provides promising preliminary evidence that using tSCS as a therapeutic catalyst to gait training may increase the efficacy of gait rehabilitation in individuals with chronic stroke. Trial registration NCT03714282 (clinicaltrials.gov), registration date: 2018-10-18.
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Affiliation(s)
- Yaejin Moon
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
- Department of Exercise Science, Syracuse University, Syracuse, NY, 13057, USA
| | - Chen Yang
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Nicole C Veit
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
- Biomedical Engineering Department, McCormick School of Engineering, Northwestern University, Evanston, IL, 60208, USA
| | - Kelly A McKenzie
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - Jay Kim
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - Shreya Aalla
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - Lindsey Yingling
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - Kristine Buchler
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - Jasmine Hunt
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - Sophia Jenz
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Sung Yul Shin
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Ameen Kishta
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - V Reggie Edgerton
- Rancho Los Amigos National Rehabilitation Center, Broccoli Impossible-to-Possible Lab, Rancho Research Institute, Downy, CA, 90242, USA
- Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Yury P Gerasimenko
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, 40202, USA
- Pavlov Institute of Physiology, St. Petersburg, Russia
| | - Elliot J Roth
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Richard L Lieber
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
- Hines VA Medical Center, Maywood, IL, 60141, USA
| | - Arun Jayaraman
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA.
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA.
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15
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Kim S, Jang S, Lee O. Single fiber curvature for muscle impairment assessment: Phase contrast imaging of stroke-induced animals. Microsc Res Tech 2024; 87:705-715. [PMID: 37983687 DOI: 10.1002/jemt.24459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 10/15/2023] [Accepted: 11/05/2023] [Indexed: 11/22/2023]
Abstract
There are technical challenges in imaging studies that can three-dimensionally (3D) analyze a single fiber (SF) to observe the functionality of the entire muscle after stroke. This study proposes a 3D assessment technique that only segments the SF of the right stroke-induced soleus muscle of a gerbil using synchrotron radiation x-ray microcomputed tomography (SR-μCT), which is capable of muscle structure analysis. Curvature damage in the SF of the left soleus muscle (impaired) progressed at 7-day intervals after the stroke in the control; particularly on the 7 days (1 week) and 14 days (2 weeks), as observed through visualization analysis. At 2 weeks, the SF volume was significantly reduced in the control impaired group (p = .033), and was significantly less than that in the non-impaired group (p = .009). We expect that animal post-stroke studies will improve the basic field of rehabilitation therapy by diagnosing the degree of SF curvature. RESEARCH HIGHLIGHTS: Muscle evaluation after ischemic stroke using synchrotron radiation x-ray microcomputed tomography (SR-μCT). Curvature is measured by segmenting a single fiber (SF) in the muscle. Structural changes in the SF of impaired gerbils at 7-day intervals were assessed.
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Affiliation(s)
- Subok Kim
- Department of Software Convergence, Graduate School, Soonchunhyang University, Asan, Republic of Korea
| | - Sanghun Jang
- Department of Physical Therapy, College of Health and Life Sciences, Korea National University of Transportation, Jeungpyeong-gun, Republic of Korea
| | - Onseok Lee
- Department of Software Convergence, Graduate School, Soonchunhyang University, Asan, Republic of Korea
- Department of Medical IT Engineering, College of Medical Sciences, Soonchunhyang University, Asan, Republic of Korea
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16
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Linder SM, Bischof-Bockbrader A, Davidson S, Li Y, Lapin B, Singh T, Lee J, Bethoux F, Alberts JL. The Utilization of Forced-Rate Cycling to Facilitate Motor Recovery Following Stroke: A Randomized Clinical Trial. Neurorehabil Neural Repair 2024; 38:291-302. [PMID: 38420848 PMCID: PMC11071159 DOI: 10.1177/15459683241233577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND The potential for aerobic exercise (AE) to enhance neuroplasticity post-stroke has been theorized but not systematically investigated. Our aim was to determine the effects of forced-rate AE (FE) paired with upper extremity (UE) repetitive task practice (FE + RTP) compared to time-matched UE RTP (RTP only) on motor recovery. METHODS A single center randomized clinical trial was conducted from April 2019 to December 2022. Sixty individuals ≥6 months post-stroke with UE hemiparesis were randomized to FE + RTP (N = 30) or RTP only (N = 30), completing 90-minute sessions, 3×/week for 8 weeks. The FE + RTP group underwent 45-minute of FE (5-minute warm-up, 35-minute main set, and 5-minute cool down) followed by 45-minute of UE RTP. The RTP only group completed 90-minute of RTP. Primary outcomes were the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT). The 6-minute Walk Test (6MWT, secondary outcome) assessed walking capacity. RESULTS Sixty individuals enrolled and 56 completed the study. The RTP only group completed more RTP in terms of repetitions (411.8 ± 44.4 vs 222.8 ± 28.4, P < .001) and time (72.7 ± 6.7 vs 37.8 ± 2.4 minutes, P < .001) versus FE + RTP. There was no significant difference between groups on the FMA (FE + RTP, 36.2 ± 10.1-44.0 ± 11.8 and RTP only, 34.4 ± 11.0-41.2 ± 13.4, P = .43) or ARAT (FE + RTP, 32.5 ± 16.6-37.7 ± 17.9 and RTP only, 32.8 ± 18.6-36.4 ± 18.5, P = .88). The FE + RTP group demonstrated greater improvements on the 6MWT (274.9 ± 122.0-327.1 ± 141.2 m) versus RTP only (285.5 ± 160.3-316.9 ± 170.0, P = .003). CONCLUSIONS There was no significant difference between groups in the primary outcomes. The FE + RTP improved more on the 6MWT, a secondary outcome. TRIAL REGISTRATION ClinicalTrials.gov: NCT03819764.
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Affiliation(s)
- Susan M. Linder
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Sara Davidson
- Concussion Center, Neurologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yadi Li
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brittany Lapin
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tamanna Singh
- Department of Cardiovascular Medicine; Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John Lee
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, USA
| | - Francois Bethoux
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, USA
| | - Jay L. Alberts
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Concussion Center, Neurologic Institute, Cleveland Clinic, Cleveland, OH, USA
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17
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Lassi M, Dalise S, Bandini A, Spina V, Azzollini V, Vissani M, Micera S, Mazzoni A, Chisari C. Neurophysiological underpinnings of an intensive protocol for upper limb motor recovery in subacute and chronic stroke patients. Eur J Phys Rehabil Med 2024; 60:13-26. [PMID: 37987741 DOI: 10.23736/s1973-9087.23.07922-4] [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: 11/22/2023]
Abstract
BACKGROUND Upper limb (UL) motor impairment following stroke is a leading cause of functional limitations in activities of daily living. Robot-assisted therapy supports rehabilitation, but how its efficacy and the underlying neural mechanisms depend on the time after stroke is yet to be assessed. AIM We investigated the response to an intensive protocol of robot-assisted rehabilitation in sub-acute and chronic stroke patients, by analyzing the underlying changes in clinical scores, electroencephalography (EEG) and end-effector kinematics. We aimed at identifying neural correlates of the participants' upper limb motor function recovery, following an intensive 2-week rehabilitation protocol. DESIGN Prospective cohort study. SETTING Inpatients and outpatients from the Neurorehabilitation Unit of Pisa University Hospital, Italy. POPULATION Sub-acute and chronic stroke survivors. METHODS Thirty-one stroke survivors (14 sub-acute, 17 chronic) with mild-to-moderate UL paresis were enrolled. All participants underwent ten rehabilitative sessions of task-oriented exercises with a planar end-effector robotic device. All patients were evaluated with the Fugl-Meyer Assessment Scale and the Wolf Motor Function Test, at recruitment (T0), end-of-treatment (T1), and one-month follow-up (T2). Along with clinical scales, kinematic parameters and quantitative EEG were collected for each patient. Kinematics metrics were related to velocity, acceleration and smoothness of the movement. Relative power in four frequency bands was extracted from the EEG signals. The evolution over time of kinematic and EEG features was analyzed, in correlation with motor recovery. RESULTS Both groups displayed significant gains in motility after treatment. Sub-acute patients displayed more pronounced clinical improvements, significant changes in kinematic parameters, and a larger increase in Beta-band in the motor area of the affected hemisphere. In both groups these improvements were associated to a decrease in the Delta-band of both hemispheres. Improvements were retained at T2. CONCLUSIONS The intensive two-week rehabilitation protocol was effective in both chronic and sub-acute patients, and improvements in the two groups shared similar dynamics. However, stronger cortical and behavioral changes were observed in sub-acute patients suggesting different reorganizational patterns. CLINICAL REHABILITATION IMPACT This study paves the way to personalized approaches to UL motor rehabilitation after stroke, as highlighted by different neurophysiological modifications following recovery in subacute and chronic stroke patients.
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Affiliation(s)
- Michael Lassi
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Stefania Dalise
- Neurorehabilitation Unit, Pisa University Hospital, Pisa, Italy
| | - Andrea Bandini
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
- Health Science Interdisciplinary Research Center, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Vincenzo Spina
- Neurorehabilitation Unit, Pisa University Hospital, Pisa, Italy
| | | | - Matteo Vissani
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
- Harvard Medical School, Boston, MA, USA
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Silvestro Micera
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
- Bertarelli Foundation Chair in Translational Neural Engineering, Center for Neuroprosthetics and Institute of Bioengineering, École Polytechnique Fèdèrale de Lausanne, Lausanne, Switzerland
| | - Alberto Mazzoni
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Carmelo Chisari
- Neurorehabilitation Unit, Pisa University Hospital, Pisa, Italy -
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Hussain M, Davis NJ, Benn Y. A single tDCS session can enhance numerical competence. Neuropsychologia 2024; 193:108760. [PMID: 38103681 DOI: 10.1016/j.neuropsychologia.2023.108760] [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: 06/16/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
While numerical skills are increasingly important in modern life, few interventions have been developed to support those with numeracy skills difficulties. Previous studies have demonstrated that applying transcranial Direct Current Stimulation (tDCS) can improve numerical skills. However, tDCS interventions designed to induce lasting changes typically involve reapplying brain-stimulation over several days. Repeated tDCS application can increase the risks associated with the procedure, as well as restricts the transferability of the method to a wider population, particularly those who may experience mobility issues, such as stroke survivors with acalculia. The current study investigated whether a single session of tDCS (anodal to right parietal lobe and cathodal to left parietal lobe), followed by four self-practice sessions without tDCS, could result in enhancement of numerical skills. Nineteen healthy adults (n = 10 tDCS, n = 9 sham control) implicitly learnt the magnitude association of nine arbitrary symbols, previously used by Cohen Kadosh et al. (2010). Numerical proficiency was assessed using number-to-space task, while automaticity was assessed with numerical Stroop. Results revealed that single-session tDCS had a significant effect on participants' accuracy on the number-to-space tasks, but not on the numerical Stroop task's congruity effect, implying automaticity may require longer practice. We conclude that a single session of tDCS should be considered as an avenue for interventions.
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Affiliation(s)
- Maryam Hussain
- School of Health Sciences, University of Manchester, Manchester, M13 9PL, United Kingdom; Department of Psychology, Manchester Metropolitan University, Manchester, M15 6GX, United Kingdom
| | - Nick J Davis
- Department of Psychology, Manchester Metropolitan University, Manchester, M15 6GX, United Kingdom
| | - Yael Benn
- Department of Psychology, Manchester Metropolitan University, Manchester, M15 6GX, United Kingdom.
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Proietti T, Nuckols K, Grupper J, Schwerz de Lucena D, Inirio B, Porazinski K, Wagner D, Cole T, Glover C, Mendelowitz S, Herman M, Breen J, Lin D, Walsh C. Combining soft robotics and telerehabilitation for improving motor function after stroke. WEARABLE TECHNOLOGIES 2024; 5:e1. [PMID: 38510985 PMCID: PMC10952055 DOI: 10.1017/wtc.2023.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 11/07/2023] [Accepted: 12/02/2023] [Indexed: 03/22/2024]
Abstract
Telerehabilitation and robotics, either traditional rigid or soft, have been extensively studied and used to improve hand functionality after a stroke. However, a limited number of devices combined these two technologies to such a level of maturity that was possible to use them at the patients' home, unsupervised. Here we present a novel investigation that demonstrates the feasibility of a system that integrates a soft inflatable robotic glove, a cloud-connected software interface, and a telerehabilitation therapy. Ten chronic moderate-to-severe stroke survivors independently used the system at their home for 4 weeks, following a software-led therapy and being in touch with occupational therapists. Data from the therapy, including automatic assessments by the robot, were available to the occupational therapists in real-time, thanks to the cloud-connected capability of the system. The participants used the system intensively (about five times more movements per session than the standard care) for a total of more than 8 hr of therapy on average. We were able to observe improvements in standard clinical metrics (FMA +3.9 ± 4.0, p < .05, COPM-P + 2.5 ± 1.3, p < .05, COPM-S + 2.6 ± 1.9, p < .05, MAL-AOU +6.6 ± 6.5, p < .05) and range of motion (+88%) at the end of the intervention. Despite being small, these improvements sustained at follow-up, 2 weeks after the end of the therapy. These promising results pave the way toward further investigation for the deployment of combined soft robotic/telerehabilitive systems at-home for autonomous usage for stroke rehabilitation.
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Affiliation(s)
- Tommaso Proietti
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Kristin Nuckols
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Jesse Grupper
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Diogo Schwerz de Lucena
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Bianca Inirio
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | | | - Diana Wagner
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Tazzy Cole
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Christina Glover
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Sarah Mendelowitz
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Maxwell Herman
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Joan Breen
- Whittier Rehabilitation Hospital, Bradford, MA, USA
| | - David Lin
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- VA RR&D Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI, USA
| | - Conor Walsh
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
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Rong H, Ramezani S, Ambro A, Lei CH, Choi H. Design and characterization of a variable-stiffness ankle-foot orthosis. Prosthet Orthot Int 2024:00006479-990000000-00213. [PMID: 38180143 DOI: 10.1097/pxr.0000000000000323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 11/17/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Ankle-foot orthoses (AFOs) are a type of assistive device that can improve the walking ability of individuals with neurological disorders. Adjusting stiffness is a common way to customize settings according to individuals' impairment. OBJECTIVE This study aims to design a variable-stiffness AFO by stiffness module and characterize the AFO stiffness range to provide subject-specific settings for the users. METHODS We modeled AFO using bending beams with varying fulcrum positions to adjust the stiffness. To characterize the stiffness range and profile, we used the superposition method to generate the theoretical model to analyze the AFO numerically. The intrinsic deformation of the bending beam in the AFO is considered a combination of 2 bending deformations to replicate actual bending conditions. The corresponding experiments in different fulcrum positions were performed to compare with and optimize the theoretical model. The curve fitting method was applied to tune the theoretical model by adding a fulcrum position-related coefficient. RESULTS The AFO stiffness increased as the fulcrum moved to the proximal position. The maximum stiffness obtained was 1.77 Nm/° at a 6-cm fulcrum position, and the minimum stiffness was 0.82 Nm/° at a 0.5-cm fulcrum position with a 0.43-cm thick fiberglass beam. The corresponding theoretical model had maximum and minimum stiffness of 1.71 and 0.80 Nm/°, respectively. The theoretical model had a 4.08% difference compared with experimental values. CONCLUSIONS The stiffness module can provide adjustable stiffness with the fulcrum position and different kinds of fiberglass bars, especially the thickness and material of the beam. The theoretical model with different fulcrum positions can be used to profile the real-time stiffness of the AFO in a dynamic motion and to determine the appropriate dimensions of the bending beam.
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Affiliation(s)
- Haochen Rong
- Department of Aerospace and Mechanical Engineering, Saint Louis University, St. Louis, MO
| | - Sepehr Ramezani
- Department of Mechanical and Aerospace Engineering, Biionix Cluster, University of Central Florida, Orlando, FL
| | - Alex Ambro
- Department of Aerospace and Mechanical Engineering, Saint Louis University, St. Louis, MO
| | - Chi Hou Lei
- Department of Aerospace and Mechanical Engineering, Saint Louis University, St. Louis, MO
| | - Hwan Choi
- Department of Mechanical and Aerospace Engineering, Biionix Cluster, University of Central Florida, Orlando, FL
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21
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Cumplido-Trasmonte C, Barquín-Santos E, Gor-García-Fogeda MD, Plaza-Flores A, García-Varela D, Ibáñez-Herrán L, González-Alted C, Díaz-Valles P, López-Pascua C, Castrillo-Calvillo A, Molina-Rueda F, Fernandez R, Garcia-Armada E. STELO: A New Modular Robotic Gait Device for Acquired Brain Injury-Exploring Its Usability. SENSORS (BASEL, SWITZERLAND) 2023; 24:198. [PMID: 38203060 PMCID: PMC10781374 DOI: 10.3390/s24010198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
In recent years, the prevalence of acquired brain injury (ABI) has been on the rise, leading to impaired gait functionality in affected individuals. Traditional gait exoskeletons are typically rigid and bilateral and lack adaptability. To address this, the STELO, a pioneering modular gait-assistive device, was developed. This device can be externally configured with joint modules to cater to the diverse impairments of each patient, aiming to enhance adaptability and efficiency. This study aims to assess the safety and usability of the initial functional modular prototype, STELO, in a sample of 14 ABI-diagnosed participants. Adverse events, device adjustment assistance and time, and gait performance were evaluated during three sessions of device use. The results revealed that STELO was safe, with no serious adverse events reported. The need for assistance and time required for device adjustment decreased progressively over the sessions. Although there was no significant improvement in walking speed observed after three sessions of using STELO, participants and therapists reported satisfactory levels of comfort and usability in questionnaires. Overall, this study demonstrates that the STELO modular device offers a safe and adaptable solution for individuals with ABI, with positive user and therapist feedback.
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Affiliation(s)
- Carlos Cumplido-Trasmonte
- International Doctoral School, Rey Juan Carlos University, 28922 Madrid, Spain;
- Marsi Bionics SL, 28521 Madrid, Spain; (E.B.-S.); (A.P.-F.); (D.G.-V.); (L.I.-H.); (E.G.-A.)
| | - Eva Barquín-Santos
- Marsi Bionics SL, 28521 Madrid, Spain; (E.B.-S.); (A.P.-F.); (D.G.-V.); (L.I.-H.); (E.G.-A.)
| | - María Dolores Gor-García-Fogeda
- Marsi Bionics SL, 28521 Madrid, Spain; (E.B.-S.); (A.P.-F.); (D.G.-V.); (L.I.-H.); (E.G.-A.)
- Department of Physical Therapy, Physical Medicine and Rehabilitation, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain;
| | - Alberto Plaza-Flores
- Marsi Bionics SL, 28521 Madrid, Spain; (E.B.-S.); (A.P.-F.); (D.G.-V.); (L.I.-H.); (E.G.-A.)
| | - David García-Varela
- Marsi Bionics SL, 28521 Madrid, Spain; (E.B.-S.); (A.P.-F.); (D.G.-V.); (L.I.-H.); (E.G.-A.)
| | - Leticia Ibáñez-Herrán
- Marsi Bionics SL, 28521 Madrid, Spain; (E.B.-S.); (A.P.-F.); (D.G.-V.); (L.I.-H.); (E.G.-A.)
| | - Carlos González-Alted
- Spanish National Reference Centre for Brain Injury (CEADAC), 28034 Madrid, Spain; (C.G.-A.); (P.D.-V.)
| | - Paola Díaz-Valles
- Spanish National Reference Centre for Brain Injury (CEADAC), 28034 Madrid, Spain; (C.G.-A.); (P.D.-V.)
| | | | | | - Francisco Molina-Rueda
- Department of Physical Therapy, Physical Medicine and Rehabilitation, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain;
| | - Roemi Fernandez
- Centre for Automation and Robotics (CAR), CSIC-UPM, Ctra. Campo Real km 0.2–La Poveda-Arganda del Rey, 28500 Madrid, Spain
| | - Elena Garcia-Armada
- Marsi Bionics SL, 28521 Madrid, Spain; (E.B.-S.); (A.P.-F.); (D.G.-V.); (L.I.-H.); (E.G.-A.)
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22
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Qurat-ul-ain, Ahmad Z, Ilyas S, Ishtiaq S, Tariq I, Nawaz Malik A, Liu T, Wang J. Comparison of a single session of tDCS on cerebellum vs. motor cortex in stroke patients: a randomized sham-controlled trial. Ann Med 2023; 55:2252439. [PMID: 38100750 PMCID: PMC10732189 DOI: 10.1080/07853890.2023.2252439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/20/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE The purpose of this study was to determine whether a single session of trans-cranial direct current stimulation (tDCS) of the cerebellum and M1 has any advantages over one another or sham stimulation in terms of balance, gait and lower limb function. METHODS A total of 66 patients who had experienced their first ever stroke were recruited into three groups for this double-blinded, parallel, randomized, sham-controlled trial: cerebellar stimulation group (CbSG), M1 stimulation group (MSG) and sham stimulation group (SSG). A single session of anodal tDCS with an intensity of 2 mA for a duration of 20 min was administered in addition to gait and balance training based on virtual reality using an Xbox 360 with Kinect. Balance, gait, cognition and risk of fall were assessed using outcome measures before intervention (T0), immediately after intervention (T1) and an hour after intervention (T2). RESULTS Across group analysis of all outcome measures showed statistically non-significant results (p > .05) except for Six Minute Walk Test (p value T0 = .003, p value T1 = .025, p value T2 = .016). The training effect difference showed a significant difference in balance, gait and cognition, as well as cerebral and cerebellar stimulation, in comparison to sham stimulation (p < .05). The risk of falls remained unaffected by any stimulation (p > .05). CONCLUSIONS In addition to Xbox Kinect-based rehabilitation training, a single session of anodal tDCS to the M1 or cerebellum may be beneficial for improving lower limb function, balance and gait performance.
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Affiliation(s)
- Qurat-ul-ain
- School of Life Science and Technology, The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, Xi’an Jiaotong University, Xi’an, PR China
- National Engineering Research Center for Healthcare Devices, Guangzhou, PR China
- The Key Laboratory of Neuro-informatics & Rehabilitation Engineering of Ministry of Civil Affairs, Xi’an, PR China
| | - Zafran Ahmad
- Department of Logistics Engineering, Kunming University of Science & Technology, Kunming, China
| | - Saad Ilyas
- Faculty of Computing, Capital University of Science and Technology, Islamabad, Pakistan
- Department of Computing, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Summaiya Ishtiaq
- Faculty of Rehabilitation & Allied Health Sciences, Riphah College of Rehabilitation & Allied Health Sciences, Islamabad, Pakistan
| | - Iqbal Tariq
- Faculty of Rehabilitation & Allied Health Sciences, Riphah College of Rehabilitation & Allied Health Sciences, Islamabad, Pakistan
| | - Arshad Nawaz Malik
- Faculty of Rehabilitation & Allied Health Sciences, Riphah College of Rehabilitation & Allied Health Sciences, Islamabad, Pakistan
| | - Tian Liu
- School of Life Science and Technology, The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, Xi’an Jiaotong University, Xi’an, PR China
- National Engineering Research Center for Healthcare Devices, Guangzhou, PR China
- The Key Laboratory of Neuro-informatics & Rehabilitation Engineering of Ministry of Civil Affairs, Xi’an, PR China
| | - Jue Wang
- School of Life Science and Technology, The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, Xi’an Jiaotong University, Xi’an, PR China
- National Engineering Research Center for Healthcare Devices, Guangzhou, PR China
- The Key Laboratory of Neuro-informatics & Rehabilitation Engineering of Ministry of Civil Affairs, Xi’an, PR China
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23
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Astrakas LG, Elbach S, Giannopulu I, Li S, Benjafield H, Tzika AA. The role of ventral tegmental area in chronic stroke rehabilitation: an exploratory study. Front Neurol 2023; 14:1270783. [PMID: 38116106 PMCID: PMC10728864 DOI: 10.3389/fneur.2023.1270783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/15/2023] [Indexed: 12/21/2023] Open
Abstract
Introduction The acknowledged role of external rewards in chronic stroke rehabilitation, offering positive reinforcement and motivation, has significantly contributed to patient engagement and perseverance. However, the exploration of self-reward's importance in this context remains limited. This study aims to investigate the functional connectivity of the ventral tegmental area (VTA), a key node in the brain's reward circuitry, during motor task-based rehabilitation and its correlation with the recovery process. Methods Twelve right-handed healthy volunteers (4 men, 8 women, aged 57.4 ± 11.3 years) and twelve chronic stroke patients (5 men, 7 women, aged 48.1 ± 11.1 years) with clinically significant right-sided motor impairment (mean FM-UE score of 27.6 ± 8.7) participated. The analysis employed the CONN toolbox to assess the association between motor tasks and VTA connectivity using psychophysiological interaction (PPI). Results PPI analysis revealed motor-dependent changes in VTA connectivity, particularly with regions within the motor circuitry, cerebellum, and prefrontal cortex. Notably, stronger connectivity between the ipsilesional VTA and cerebellum was observed in healthy controls compared to chronic stroke patients, highlighting the importance of VTA-cerebellum interactions in motor function. Stroke patients' motor performance was associated with VTA modulation in areas related to both motor tasks and reward processing, emphasizing the role of self-reward processes in rehabilitation. Changes in VTA influence on motor circuitry were linked to improvements in motor performance resulting from rehabilitation. Discussion Our findings underscore the potential of neuroimaging techniques in quantifying and predicting rehabilitation outcomes by examining self-reward processes. The observed associations between VTA connectivity and motor performance in both healthy and stroke-affected individuals emphasize the role of psychological factors, particularly self-reward, in the rehabilitation process. This study contributes valuable insights into the intricate interplay between reward circuits and motor function, highlighting the importance of addressing psychological dimensions in neurorehabilitation strategies.
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Affiliation(s)
- Loukas G. Astrakas
- Medical Physics, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Sabrina Elbach
- Athinoula A. Martinos Center of Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- NMR Surgical Laboratory, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | | | - Shasha Li
- Athinoula A. Martinos Center of Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- NMR Surgical Laboratory, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Howard Benjafield
- School of Social Sciences and Professions – Psychology, London Metropolitan University, London, United Kingdom
| | - A. Aria Tzika
- Athinoula A. Martinos Center of Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- NMR Surgical Laboratory, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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24
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Souza FRD, Sales M, Laporte LR, Melo A, Ribeiro NMDS. Discharge outcomes as predictors of social participation in the community after a stroke: a cohort study. Int J Rehabil Res 2023; 46:325-330. [PMID: 37535004 DOI: 10.1097/mrr.0000000000000599] [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: 08/04/2023]
Abstract
The mapping of possible predictors of restrictions in the social participation of people after stroke in the community can be an essential tool to support the development of rehabilitation strategies even in the hospital environment. This study aimed to identify whether mobility, functional balance and dependence on functionality at hospital discharge can predict restrictions on social participation 1 year after stroke in the community. This is a hospital-based cohort study, with individuals over 18 years old admitted with a diagnosis of acute stroke included. People with dementia, previous functional limitations and cancer patients were omitted. Mobility, balance and functional independence were the predictor variables at hospital discharge, and the outcome of interest was social participation assessed 1 year after a stroke in the community. Forty-eight patients were included after a 1-year follow-up. The degree of functional independence at hospital discharge ( β = 0.813; P < 0.01) was the independent predictor of social participation, specifically the locomotion ( β = 0.452; P < 0.001) and social cognition ( β = 0.462; P < 0.001) related to functional independence. Mobility ( β = 0.040; P = 0.777) and functional balance ( β = 0.060; P = 0.652) did not show an independent association. Cognitive functional independence was a predictor of daily activities ( β = 0.786; P < 0.001), social roles ( β = 0.390; P = 0.014) and satisfaction ( β = 0.564; P < 0.001) of social participation. The degree of functional independence of people after a stroke at hospital discharge was able to predict the level of social involvement in the community one year after the stroke.
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Affiliation(s)
- Flaviane Ribeiro de Souza
- Grupo de Pesquisa em Atenção Integral a pessoas com doenças raras e doenças crônicas, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brasil
| | - Matheus Sales
- Grupo de Pesquisa em Atenção Integral a pessoas com doenças raras e doenças crônicas, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brasil
| | | | - Ailton Melo
- Grupo de Pesquisa em Atenção Integral a pessoas com doenças raras e doenças crônicas, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brasil
- Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brasil
| | - Nildo Manoel da Silva Ribeiro
- Grupo de Pesquisa em Atenção Integral a pessoas com doenças raras e doenças crônicas, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brasil
- Departamento de fisioterapia, Instituto Multidisciplinar de Reabilitação e Saúde, Universidade Federal da Bahia, Salvador, Bahia, Brasil
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25
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Huber J, Slone S, Bazrgari B. An evaluation of 3D printable elastics for post stroke dynamic hand bracing: a pilot study. Assist Technol 2023; 35:513-522. [PMID: 36780423 PMCID: PMC10460827 DOI: 10.1080/10400435.2023.2177774] [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] [Accepted: 01/31/2023] [Indexed: 02/15/2023] Open
Abstract
The rise of 3D printing allows unprecedented customization of rehabilitation devices, and with an ever-expanding library of 3D printable (3DP) materials, the spectrum of attenable rehabilitation devices is likewise expanding. The current pilot study explores feasibility of using 3DP elastic materials to create dynamic hand orthoses for stroke survivors. A dynamic orthosis featuring a replaceable finger component was fabricated using 3DP elastic materials. Duplicates of the finger component were printed using different materials ranging from low stiffness (low elastic modulus) to relatively high stiffness (high elastic modulus). Five stroke survivors with predominantly moderate hand impairment were recruited to evaluate usability and impact of orthoses on upper extremity function and biomechanics. No significant differences in usability were found between 3D-printed orthoses and a commercial orthosis. Increases in stiffness of the 3DP material reduced pincer force (p = .0041) and the BBT score (p = .043). In comparison, the commercial orthosis did not reduce pincer force but may reduce BBT score to a degree that is clinically significant (p = .0002). While preliminary, these findings suggest that a dynamic orthosis is a feasible clinical application of 3DP elastic materials, and future study is warranted.
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Affiliation(s)
- Justin Huber
- Department of Physical Medicine and Rehabilitation, Department of Mechanical Engineering, University of Kentucky, Lexington, KY
| | - Stacey Slone
- Department of Statistics, University of Kentucky, Lexington, KY
| | - Babak Bazrgari
- F. Joseph Halcomb III MD Department of Biomedical Engineering, University of Kentucky, Lexington, KY
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26
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Xie R, Zhang Y, Jin H, Yang F, Feng Y, Pan Y. Effects of soft robotic exoskeleton for gait training on clinical and biomechanical gait outcomes in patients with sub-acute stroke: a randomized controlled pilot study. Front Neurol 2023; 14:1296102. [PMID: 38020601 PMCID: PMC10654217 DOI: 10.3389/fneur.2023.1296102] [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: 09/18/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background Ankle function impairment is a critical factor impairing normal walking in survivors of stroke. The soft robotic exoskeleton (SRE) is a novel, portable, lightweight assistive device with promising therapeutic potential for gait recovery during post-stroke rehabilitation. However, whether long-term SRE-assisted walking training influences walking function and gait quality in patients following subacute stroke is unknown. Therefore, the primary objective of this study was to assess the therapeutic effects of SRE-assisted walking training on clinical and biomechanical gait outcomes in the rehabilitation of patients with subacute stroke. Methods A group patients who had experienced subacute stroke received conventional rehabilitation (CR) training combined with 10-session SRE-assisted overground walking training (30 min per session, 5 sessions/week, 2 weeks) (SRE group, n = 15) compared with the control group that received CR training only (CR group, n = 15). Clinical assessments and biomechanical gait quality measures were performed pre-and post-10-session intervention, with the 10-Minute Walk Test (10MWT) and 6-Minute Walk Test (6MWT) used to define the primary clinical outcome measures and the Functional Ambulation Category, Fugl-Meyer Assessment for Lower Extremity (FMA-LE) subscale, and Berg Balance Scale defined the secondary outcome measures. The gait quality outcome measures included spatiotemporal and symmetrical parameters during walking. Results After the 10-session intervention, the SRE and CR groups exhibited significant within-group improvements in all clinical outcome measures (p < 0.05). Between-comparison using covariance analyses demonstrated that the SRE group showed greater improvement in walking speed during the 10MWT (p < 0.01), distance walked during the 6MWT (p < 0.05), and FMA-LE scores (p < 0.05). Gait analyses showed that the SRE group exhibited significantly improved spatiotemporal symmetry (p < 0.001) after 10-session training, with no significant changes observed in the CR group. Conclusion Compared with CR training, SRE-assisted walking training led to greater improvements in walking speed, endurance, and motor recovery. Our findings provide preliminary evidence that SRE may be considered for inclusion in intensive gait training clinical rehabilitation programs to further improve walking function in patients who have experienced stroke.
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Affiliation(s)
- Ruimou Xie
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, Beijing, China
- School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yanlin Zhang
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, Beijing, China
- School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Hainan Jin
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, Beijing, China
- School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Fei Yang
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, Beijing, China
- School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yutong Feng
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, Beijing, China
- School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yu Pan
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, Beijing, China
- School of Clinical Medicine, Tsinghua University, Beijing, China
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27
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Tsai MF, Wang RH, Zariffa J. Recognizing hand use and hand role at home after stroke from egocentric video. PLOS DIGITAL HEALTH 2023; 2:e0000361. [PMID: 37819878 PMCID: PMC10566743 DOI: 10.1371/journal.pdig.0000361] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/31/2023] [Indexed: 10/13/2023]
Abstract
Hand function is a central determinant of independence after stroke. Measuring hand use in the home environment is necessary to evaluate the impact of new interventions, and calls for novel wearable technologies. Egocentric video can capture hand-object interactions in context, as well as show how more-affected hands are used during bilateral tasks (for stabilization or manipulation). Automated methods are required to extract this information. The objective of this study was to use artificial intelligence-based computer vision to classify hand use and hand role from egocentric videos recorded at home after stroke. Twenty-one stroke survivors participated in the study. A random forest classifier, a SlowFast neural network, and the Hand Object Detector neural network were applied to identify hand use and hand role at home. Leave-One-Subject-Out-Cross-Validation (LOSOCV) was used to evaluate the performance of the three models. Between-group differences of the models were calculated based on the Mathews correlation coefficient (MCC). For hand use detection, the Hand Object Detector had significantly higher performance than the other models. The macro average MCCs using this model in the LOSOCV were 0.50 ± 0.23 for the more-affected hands and 0.58 ± 0.18 for the less-affected hands. Hand role classification had macro average MCCs in the LOSOCV that were close to zero for all models. Using egocentric video to capture the hand use of stroke survivors at home is technically feasible. Pose estimation to track finger movements may be beneficial to classifying hand roles in the future.
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Affiliation(s)
- Meng-Fen Tsai
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Robotics Institute, University of Toronto, Toronto, Ontario, Canada
| | - Rosalie H. Wang
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Robotics Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - José Zariffa
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Robotics Institute, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario, Canada
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De Keersmaecker E, Van Bladel A, Zaccardi S, Lefeber N, Rodriguez-Guerrero C, Kerckhofs E, Jansen B, Swinnen E. Virtual reality-enhanced walking in people post-stroke: effect of optic flow speed and level of immersion on the gait biomechanics. J Neuroeng Rehabil 2023; 20:124. [PMID: 37749566 PMCID: PMC10518929 DOI: 10.1186/s12984-023-01254-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 09/18/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Optic flow-the apparent visual motion experienced while moving-is absent during treadmill walking. With virtual reality (VR), optic flow can be controlled to mediate alterations in human walking. The aim of this study was to investigate (1) the effects of fully immersive VR and optic flow speed manipulation on gait biomechanics, simulator sickness, and enjoyment in people post-stroke and healthy people, and (2) the effects of the level of immersion on optic flow speed and sense of presence. METHODS Sixteen people post-stroke and 16 healthy controls performed two VR-enhanced treadmill walking sessions: the semi-immersive GRAIL session and fully immersive head-mounted display (HMD) session. Both consisted of five walking trials. After two habituation trials (without and with VR), participants walked three more trials under the following conditions: matched, slow, and fast optic flow. Primary outcome measures were spatiotemporal parameters and lower limb kinematics. Secondary outcomes (simulator sickness, enjoyment, and sense of presence) were assessed with the Simulator Sickness Questionnaire, Visual Analogue Scales, and Igroup Presence Questionnaire. RESULTS When walking with the immersive HMD, the stroke group walked with a significantly slower cadence (-3.69strides/min, p = 0.006), longer stride time (+ 0.10 s, p = 0.017) and stance time for the unaffected leg (+ 1.47%, p = 0.001) and reduced swing time for the unaffected leg (- 1.47%, p = 0.001). Both groups responded to the optic flow speed manipulation such that people accelerated with a slow optic flow and decelerated with a fast optic flow. Compared to the semi-immersive GRAIL session, manipulating the optic flow speed with the fully immersive HMD had a greater effect on gait biomechanics whilst also eliciting a higher sense of presence. CONCLUSION Adding fully immersive VR while walking on a self-paced treadmill led to a more cautious gait pattern in people post-stroke. However, walking with the HMD was well tolerated and enjoyable. People post-stroke altered their gait parameters when optic flow speed was manipulated and showed greater alterations with the fully-immersive HMD. Further work is needed to determine the most effective type of optic flow speed manipulation as well as which other principles need to be implemented to positively influence the gait pattern of people post-stroke. TRIAL REGISTRATION NUMBER The study was pre-registered at ClinicalTrials.gov (NCT04521829).
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Affiliation(s)
- Emma De Keersmaecker
- Rehabilitation Research, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium.
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium.
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium.
- Alliance research group REBI (Rehabilitation technology for people with a brain injury), Vrije Universiteit Brussel & Ghent University, Brussels, Belgium.
| | - Anke Van Bladel
- Alliance research group REBI (Rehabilitation technology for people with a brain injury), Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
- Faculty of Medicine and Health Sciences, Department Rehabilitation Sciences, Campus UZ Gent, Ghent, Belgium
| | - Silvia Zaccardi
- Rehabilitation Research, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Electronics and Informatics, Engineering Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nina Lefeber
- Rehabilitation Research, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Movement and Nutrition for Health and Performance, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Eric Kerckhofs
- Rehabilitation Research, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Bart Jansen
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Electronics and Informatics, Engineering Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Imec, Leuven, Belgium
| | - Eva Swinnen
- Rehabilitation Research, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
- Alliance research group REBI (Rehabilitation technology for people with a brain injury), Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
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Barth J, Geed S, Mitchell A, Brady KP, Giannetti ML, Dromerick AW, Edwards DF. The Critical Period After Stroke Study (CPASS) Upper Extremity Treatment Protocol. Arch Rehabil Res Clin Transl 2023; 5:100282. [PMID: 37744191 PMCID: PMC10517370 DOI: 10.1016/j.arrct.2023.100282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Objective To present the development of a novel upper extremity (UE) treatment and assess how it was delivered in the Critical Periods After Stroke Study (CPASS), a phase II randomized controlled trial (RCT). Design Secondary analysis of data from the RCT. Setting Inpatient and outpatient settings the first year after stroke. Participants Of the 72 participants enrolled in CPASS (N=72), 53 were in the study groups eligible to receive the treatment initiated at ≤30 days (acute), 2-3 months (subacute), or ≥6 months (chronic) poststroke. Individuals were 65.1±10.5 years of age, 55% were women, and had mild to moderate UE motor capacity (Action Research Arm Test=17.2±14.3) at baseline. Intervention The additional 20 hours of treatment began using the Activity Card Sort (ACS), a standardized assessment of activities and participation after stroke, to identify UE treatment goals selected by the participants that were meaningful to them. Treatment activities were broken down into smaller components from a standardized protocol and process that operationalized the treatments essential elements. Main Outcome Measures Feasibility of performing the treatment in a variety of clinical settings in an RCT and contextual factors that influenced adherence. Results A total of 49/53 participants fully adhered to the CPASS treatment. The duration and location of the treatment sessions and the UE activities practiced during therapy are presented for the total sample (n=49) and per study group as an assessment of feasibility and the contextual factors that influenced adherence. Conclusions The CPASS treatment and therapy goals were explicitly based on the meaningful activities identified by the participants using the ACS as a treatment planning tool. This approach provided flexibility to customize UE motor therapy without sacrificing standardization or quantification of the data regardless of the location and UE impairments of participants within the first year poststroke.
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Affiliation(s)
- Jessica Barth
- Veterans Affairs Medical Center, Center of Innovation for Long-Term Supports and Services, Providence, RI
- MedStar National Rehabilitation Hospital, Washington, DC
- Center for Brain Plasticity and Recovery, Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
| | - Shashwati Geed
- MedStar National Rehabilitation Hospital, Washington, DC
- Center for Brain Plasticity and Recovery, Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
| | - Abigail Mitchell
- MedStar National Rehabilitation Hospital, Washington, DC
- Center for Brain Plasticity and Recovery, Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
| | - Kathaleen P. Brady
- MedStar National Rehabilitation Hospital, Washington, DC
- Center for Brain Plasticity and Recovery, Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
| | - Margot L. Giannetti
- MedStar National Rehabilitation Hospital, Washington, DC
- Center for Brain Plasticity and Recovery, Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
| | - Alexander W. Dromerick
- MedStar National Rehabilitation Hospital, Washington, DC
- Center for Brain Plasticity and Recovery, Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
| | - Dorothy F. Edwards
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
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Wolbrecht E, Ketkar V, Perry JC. Impedance Control of a 2-DOF Spherical 5-Bar Exoskeleton for Physical Human-Robot Interaction During Rehabilitation and Assessment. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941197 DOI: 10.1109/icorr58425.2023.10304762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
This paper presents a novel impedance controller for THINGER (THumb INdividuating Grasp Exercise Robot), a 2-degree-of-freedom (DOF) spherical 5-bar exoskeleton designed to augment FINGER (Finger INdividuating Grasp Exercise Robot). Many rehabilitation and assessment tasks, for which THINGER is designed, are improved by rendering near-zero impedance during physical human-robot interaction (pHRI). To achieve this goal, the presented impedance controller includes several novel features. First, a reference trajectory is omitted, allowing free movements. Second, force-feedback gains are reduced near actuator limits and a saturation function limits the maximum commanded force; both allow more responsive (higher) force-feedback gains within the workspace and mitigate transient oscillations caused by external disturbances. Finally, manipulability-based directional force-feedback gains help improve rendered impedance isotropy. Validation experiments included free exploration of the workspace, following a prescribed circular thumb motion, and intentional exposure to external disturbances. The experimental results show that the presented impedance controller significantly reduces impedance to subject-initiated motion and accurately renders the desired isotropic low-impedance environment.
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Lee JE, Akimoto T, Chang J, Lee HS. Effects of joint mobilization combined with acupuncture on pain, physical function, and depression in stroke patients with chronic neuropathic pain: A randomized controlled trial. PLoS One 2023; 18:e0281968. [PMID: 37616239 PMCID: PMC10449141 DOI: 10.1371/journal.pone.0281968] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/04/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVE To investigate the effectiveness of joint mobilization (JM) combined with acupuncture (AC) for the treatment of pain, physical function and depression in poststroke patients. METHODS A total of 69 poststroke patients were randomly assigned to the JM+AC group (n = 23), the JM group (n = 23), and the control group (n = 23). Patients in the JM+AC group and the JM group received JM for 30 minutes, twice a week for 12 weeks, and the JM+AC group received AC for 30 minutes separately once a week. The control group did not receive JM or AC. Pain (visual analog scale, shoulder pain and disability index, Western Ontario and McMaster universities osteoarthritis index), physical function (range of motion, 10-m walking speed test, functional gait assessment, manual function test, activities of daily living scale, instrumental activities of daily living scale), and depression (center for epidemiologic studies depression scale, Beck depression inventory) were assessed for each patient before and after the 12 weeks of intervention. RESULTS Pain and physical function were improved significantly in the JM+AC group compared with the JM and control groups. Physical function and depression were improved significantly in the JM+AC and JM groups compared with the control group. CONCLUSION The treatment of JM combined with AC improved pain, depression, and physical function of poststroke patients with chronic neuropathic pain in this study. This valuable finding provides empirical evidence for the designing therapeutic interventions and identifying potential therapeutic targets.
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Affiliation(s)
- Ji-Eun Lee
- Department of Exercise and Medical Science, Dankook University, Cheonan, Republic of Korea
| | - Takayuki Akimoto
- Laboratory of Muscle Biology, Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Jisuk Chang
- Department of Sports Management, Dankook University, Cheonan, Republic of Korea
| | - Ho-Seong Lee
- Department of Exercise and Medical Science, Dankook University, Cheonan, Republic of Korea
- Institute of Medical-Sports, Dankook University, Cheonan, Republic of Korea
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Watanabe H, Mathis BJ, Ueno T, Taketomi M, Kubota S, Marushima A, Kawamoto H, Sankai Y, Matsumura A, Hada Y. Safety and Feasibility Study of the Medical Care Pit Walking Support System for Rehabilitation of Acute Stroke Patients. J Clin Med 2023; 12:5389. [PMID: 37629438 PMCID: PMC10455835 DOI: 10.3390/jcm12165389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/10/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Stroke rehabilitation with mechanical assistance improves outcomes by facilitating repetition and relieving the care burden of therapy staff. Here, we tested the Medical Care Pit (MCP) walking assistance training device in the rehabilitation of eight acute stroke patients (median age 60.7 ± 16.3 years) who had recently suffered ischemic (three) or hemorrhagic (five) stroke (14.1 ± 6.5 days). Patients received standard rehabilitation approximately 5 days per week (weekdays only), plus MCP therapy twice a week, totaling four MCP sessions over 2 weeks. Fugl-Meyer Assessment-Lower Extremities (FMA-LE), Functional Ambulation Category (FAC), and other gait-associated parameters were measured. Over the 10.5 ± 1.6 days of therapy, MCP qualitatively assisted in gait analysis and real-time patient feedback while independent walking scores significantly improved (FAC 2.2 ± 0.8 to 3.1 ± 1.3, p = 0.020). FMA-LE scores also slightly improved but not to significance (p = 0.106). Objective burden on patients, as measured by modified Borg scale, was significantly improved (2.7 ± 1.6 to 2.0 ± 1.6, p = 0.014). In terms of questionnaires, anxiety scores for the physical therapist regarding gait training and falling with MCP significantly decreased (3.8 ± 2.3 to 1.0 ± 1.6; p = 0.027 and 3.1 ± 2.2 to 0.8 ± 1.3; p = 0.045) from the first to fourth sessions. Taken together, MCP, in addition to the usual rehabilitation program, was effective in gait rehabilitation for independent walking and relieved burdens on the patients. Such walking support systems may be an important part of acute stroke rehabilitation.
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Affiliation(s)
- Hiroki Watanabe
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Ibaraki, Japan; (H.W.)
| | - Bryan J. Mathis
- International Medical Center, University of Tsukuba Hospital, Tsukuba 305-8576, Ibaraki, Japan
| | - Tomoyuki Ueno
- Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Ibaraki, Japan
| | - Masakazu Taketomi
- Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Ibaraki, Japan
| | - Shigeki Kubota
- Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences, Ami 300-0394, Ibaraki, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Ibaraki, Japan; (H.W.)
| | - Hiroaki Kawamoto
- Institute of Systems and Information Engineering, University of Tsukuba, Tsukuba 305-8573, Ibaraki, Japan
| | - Yoshiyuki Sankai
- Institute of Systems and Information Engineering, University of Tsukuba, Tsukuba 305-8573, Ibaraki, Japan
| | - Akira Matsumura
- Ibaraki Prefectural University of Health Sciences, Ami 300-0394, Ibaraki, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Ibaraki, Japan
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Sakakibara BM, Wiley E, Barclay R, Bayley M, Davis JC, Eng JJ, Harris A, Inness EL, MacKay-Lyons M, Monaghan J, Pollock C, Pooyania S, Schneeberg A, Teasell R, Yao J, Tang A. TeleRehabilitation with Aims to Improve Lower extremity recovery in community-dwelling individuals who have had a stroke: protocol for a multisite, parallel group, assessor-blinded, randomised attention-controlled trial. BMJ Open 2023; 13:e076723. [PMID: 37474180 PMCID: PMC10357752 DOI: 10.1136/bmjopen-2023-076723] [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: 07/22/2023] Open
Abstract
INTRODUCTION Telerehabilitation is an accessible service delivery model that may support innovative lower extremity rehabilitation programmes that extend the stroke recovery continuum into the community. Unfortunately, there is limited evidence on the provision of exercises for lower extremity recovery after stroke delivered using telerehabilitation. In response, we developed the TeleRehabilitation with Aims to Improve Lower extremity recovery poststroke (TRAIL) programme, a 4-week progressive exercise and self-management intervention delivered synchronously using video-conferencing technology. Our primary hypothesis is that individual within 1-year poststroke who participate in TRAIL will experience significantly greater improvements in functional mobility than individuals in an attention-controlled education programme (EDUCATION). METHODS AND ANALYSIS In this multisite, parallel group, assessor-blinded randomised attention-controlled trial, 96 community-living stroke survivors within 1-year poststroke will be recruited from five sites (Vancouver, Winnipeg, Toronto, London and Halifax, Canada) from the CanStroke Recovery Trials Platform which is a network of Canadian hospital sites that are affiliated with academic institutions to facilitate participant recruitment and quality trial practices. Participants will be randomised on a 1:1 basis to TRAIL or EDUCATION. Participants randomised to TRAIL will receive eight telerehabilitation sessions where they will perform exercises and receive self-management support to improve lower extremity recovery from a TRAIL physical therapist. The primary outcome will be measured using the Timed Up and Go. Secondary outcomes include lower extremity muscle strength, functional balance, motor impairment, balance self-efficacy, health-related quality of life and health service use for our economic evaluation. Measurements will be taken at baseline, immediately after the intervention, 3-month and 6-month postintervention. ETHICS AND DISSEMINATION Ethics approval for this research has been obtained by all participating sites. All study participants will provide their informed consent prior to enrolling them in the study. Findings from this trial will be disseminated in peer-reviewed journals and presentations at international scientific meetings. TRIAL REGISTRATION NUMBER ClinicalTrials.gov, NCT04908241.
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Affiliation(s)
- Brodie M Sakakibara
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Chronic Disease Prevention and Management, The University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Elise Wiley
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Ruth Barclay
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mark Bayley
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer C Davis
- Faculty of Management, The University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Janice J Eng
- Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Anne Harris
- GF Strong Rehabilitation Centre, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Elizabeth L Inness
- Mobility Innovations Centre, Toronto Rehabiltiation Institute, Toronto, Ontario, Canada
| | | | - Jennifer Monaghan
- Centre for Chronic Disease Prevention and Management, The University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Courtney Pollock
- Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Sepideh Pooyania
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amy Schneeberg
- Consultant, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Teasell
- Lawson Health Research Unit, Parkwood Hospital, London, Ontario, Canada
- Physical Medicine and Rehabiliation, University of Western Ontario, London, Ontario, Canada
| | - Jennifer Yao
- GF Strong Rehabilitation Centre, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Ada Tang
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
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Li M, Scronce G, Finetto C, Coupland K, Zhong M, Lambert ME, Baker A, Luo F, Seo NJ. Application of Deep Learning Algorithm to Monitor Upper Extremity Task Practice. SENSORS (BASEL, SWITZERLAND) 2023; 23:6110. [PMID: 37447958 DOI: 10.3390/s23136110] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/25/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023]
Abstract
Upper extremity hemiplegia is a serious problem affecting the lives of many people post-stroke. Motor recovery requires high repetitions and quality of task-specific practice. Sufficient practice cannot be completed during therapy sessions, requiring patients to perform additional task practices at home on their own. Adherence to and quality of these home task practices are often limited, which is likely a factor reducing rehabilitation effectiveness post-stroke. However, home adherence is typically measured by self-reports that are known to be inconsistent with objective measurement. The objective of this study was to develop algorithms to enable the objective identification of task type and quality. Twenty neurotypical participants wore an IMU sensor on the wrist and performed four representative tasks in prescribed fashions that mimicked correct, compensatory, and incomplete movement qualities typically seen in stroke survivors. LSTM classifiers were trained to identify the task being performed and its movement quality. Our models achieved an accuracy of 90.8% for task identification and 84.9%, 81.1%, 58.4%, and 73.2% for movement quality classification for the four tasks for unseen participants. The results warrant further investigation to determine the classification performance for stroke survivors and if quantity and quality feedback from objective monitoring facilitates effective task practice at home, thereby improving motor recovery.
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Affiliation(s)
- Mingqi Li
- Department of Computer Science, School of Computing, Clemson University, Clemson, SC 29634, USA
| | - Gabrielle Scronce
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA
- Ralph H. Johnson VA Health Care System, Charleston, SC 29401, USA
| | - Christian Finetto
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Kristen Coupland
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA
- Ralph H. Johnson VA Health Care System, Charleston, SC 29401, USA
| | - Matthew Zhong
- Department of Computer Science, School of Computing, Clemson University, Clemson, SC 29634, USA
- Summer Intern, Research Experience for Undergraduates, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Melanie E Lambert
- Department of Computer Science, School of Computing, Clemson University, Clemson, SC 29634, USA
| | - Adam Baker
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA
- Ralph H. Johnson VA Health Care System, Charleston, SC 29401, USA
| | - Feng Luo
- Department of Computer Science, School of Computing, Clemson University, Clemson, SC 29634, USA
| | - Na Jin Seo
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA
- Ralph H. Johnson VA Health Care System, Charleston, SC 29401, USA
- Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA
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Ito D, Kawakami M, Kuwahara W, Yamada Y, Kondo K, Tsuji T. Parameter mapping of hemiplegic shoulder electrical stimulation for motor function: A scoping review. NeuroRehabilitation 2023:NRE220301. [PMID: 37424478 DOI: 10.3233/nre-220301] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
BACKGROUND Electrical stimulation (ES) of the shoulder is effective in treating subluxation and shoulder pain. However, few studies have reported on ES of the hemiplegic shoulder with motor function as an outcome; thus, the method remains unclear. OBJECTIVE We aimed to map the existing evidence and identify the parameters for ES of the hemiplegic shoulder for motor function in stroke patients. METHODS A literature search was performed through PubMed and Scopus to retrieve original articles from 1975 to March 2023 using the terms "stroke", "shoulder", and "electricity". We selected studies in which ES was performed on hemiplegic shoulders after stroke, parameters were described, and upper extremity motor functional assessment was included as an outcome. The extracted data included study design, phase, sample size, electrode position, parameters, intervention period, evaluation frequency, outcomes, and results. RESULTS Of the 449 titles identified, 25 fulfilled the inclusion and exclusion criteria. Nineteen were randomized controlled trials. The most common electrode positions and parameters (frequency and pulse width) were over the posterior deltoid and the supraspinatus (upper trapezius) muscles, 30 Hz, and 250μs, respectively. The intervention period was 30-60 minutes per day, 5-7 days per week, for 4-5 weeks in over half of the studies. CONCLUSION Stimulation positions and parameters for electrical stimulation of the hemiplegic shoulder are inconsistent. Whether ES represents a significant treatment option remains unclear. Establishing universal ES methods is necessary to improve the motor function of hemiplegic shoulders.
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Affiliation(s)
- Daisuke Ito
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Wataru Kuwahara
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yuka Yamada
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kunitsugu Kondo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
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Takebayashi T, Uchiyama Y, Okita Y, Domen K. Development of a program to determine optimal settings for robot-assisted rehabilitation of the post-stroke paretic upper extremity: a simulation study. Sci Rep 2023; 13:9217. [PMID: 37280304 DOI: 10.1038/s41598-023-34556-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 05/03/2023] [Indexed: 06/08/2023] Open
Abstract
Robot-assisted therapy can effectively treat upper extremity (UE) paralysis in patients who experience a stroke. Presently, UE, as a training item, is selected according to the severity of the paralysis based on a clinician's experience. The possibility of objectively selecting robot-assisted training items based on the severity of paralysis was simulated using the two-parameter logistic model item response theory (2PLM-IRT). Sample data were generated using the Monte Carlo method with 300 random cases. This simulation analyzed sample data (categorical data with three difficulty values of 0, 1, and 2 [0: too easy, 1: adequate, and 2: too difficult]) with 71 items per case. First, the most appropriate method was selected to ensure the local independence of the sample data necessary to use 2PLM-IRT. The method was to exclude items with low response probability (maximum response probability) within a pair in the Quality of Compensatory Movement Score (QCM) 1-point item difficulty curve, items with low item information content within a pair in the QCM 1-point item difficulty curve, and items with low item discrimination. Second, 300 cases were analyzed to determine the most appropriate model (one-parameter or two-parameter item response therapy) to be used and the most favored method to establish local independence. We also examined whether robotic training items could be selected according to the severity of paralysis based on the ability of a person (θ) in the sample data as calculated by 2PLM-IRT. Excluding items with low response probability (maximum response probability) in a pair in the categorical data 1-point item difficulty curve was effective in ensuring local independence. Additionally, to ensure local independence, the number of items should be reduced to 61 from 71, indicating that the 2PLM-IRT was an appropriate model. The ability of a person (θ) calculated by 2PLM-IRT suggested that seven training items could be estimated from 300 cases according to severity. This simulation made it possible to objectively estimate the training items according to the severity of paralysis in a sample of approximately 300 cases using this model.
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Affiliation(s)
- Takashi Takebayashi
- Department of Rehabilitation Science, School of Medicine, Osaka Metropolitan University, 3-7-30, Habikino, Osaka, 583-8555, Japan.
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yuho Okita
- School of Health Science, Swinburne University of Technology, Melbourne, Australia
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Blackwood J, Carpentier S, Deng W, Van de Winckel A. Preliminary Rasch analysis of the multidimensional assessment of interoceptive awareness in adults with stroke. PLoS One 2023; 18:e0286657. [PMID: 37267348 DOI: 10.1371/journal.pone.0286657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/21/2023] [Indexed: 06/04/2023] Open
Abstract
PURPOSE The Multidimensional Assessment of Interoceptive Awareness (MAIA) measures interoceptive body awareness, which includes aspects such as attention regulation, self-regulation, and body listening. Our purpose was to perform a preliminary validation of the MAIA in adults with stroke using Rasch Measurement Theory. METHODS The original MAIA has 32 items that measure interoceptive sensibility, which is an aspect of body awareness. We performed a preliminary analysis with Rasch Measurement Theory to evaluate the unidimensionality and structural validity of the scale. We investigated overall fit to assess unidimensionality, person and item fit, person separation reliability, targeting, local item dependence, and principal components analysis of residuals. RESULTS Forty-one adults with chronic stroke (average 3.8 years post-stroke, 13 women, average age 57±13 years) participated in the study. Overall fit (χ 2 = 62.26, p = 0.26) and item fit were obtained after deleting 3 items and rescoring 26 items. One participant did not fit the model (2.44%). There were no floor (0.00%) or ceiling effects (0.00%). Local item dependence was found in 42 pairs. The person separation reliability was 0.91, and the person mean location was 0.06±1.12 logits. CONCLUSIONS The preliminary structural validity of the MAIA demonstrated good targeting and reliability, as well as unidimensionality, and good item and person fit in adults with chronic stroke. A study with a larger sample size is needed to validate our findings.
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Affiliation(s)
- Jena Blackwood
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Sydney Carpentier
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Wei Deng
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Ann Van de Winckel
- Division of Physical Therapy, Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota, United States of America
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Ketkar VD, Wolbrecht ET, Perry JC, Farrens A. Design and Development of a Spherical 5-Bar Thumb Exoskeleton Mechanism for Poststroke Rehabilitation. J Med Device 2023; 17:021002. [PMID: 37152413 PMCID: PMC10158975 DOI: 10.1115/1.4056864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
This paper presents the kinematic design and development of a two degree-of-freedom (2DOF) spherical 5-bar thumb exoskeleton to augment the finger individuating grasp exercise robot (FINGER) rehabilitation robot, which assists the index and middle fingers individually in naturalistic grasping. The thumb module expands the capabilities of FINGER, allowing for broader proprioceptive training and assessment of hand function. The design process started by digitizing thumb-grasping motions to the index and the middle fingers separately, recorded from multiple healthy subjects utilizing a motion capture system. Fitting spheres to trajectory data of each subject allowed normalization of all subjects' data to a common center and radius. A two-revolute joint serial-chain mechanism was synthesized (intermediate optimization step) to reach the normalized trajectories. Next, the two resulting grasping trajectories were spatially sampled as targets for the 2DOF spherical 5-bar synthesis. Optimization of the spherical 5-bar included symmetry constraints and cost-function penalties for poor manipulability. The resulting exoskeleton assists both flexion/extension and abduction/adduction of the thumb enabling a wide range of motions. Consistent with FINGER, the parallel structure of the spherical 5-bar places the actuators at the base of the module, allowing for desirable characteristics, including high backdrivability, high controllable bandwidth, and low mechanical impedance. The mechanical design was developed from the kinematic solution, including an adjustable thumb cuff to accommodate different hand sizes. Fit and function of the device were tested on multiple subjects, including survivors of stroke. A proportional-derivative force controller with gravity and friction compensation was implemented to reduce resistance to motion during subject testing.
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Affiliation(s)
- Vishwanath D. Ketkar
- Department of Electrical Engineering, University of Idaho, Moscow, ID 83844-0902
| | - Eric T. Wolbrecht
- Department of Mechanical Engineering, University of Idaho, Moscow, ID 83844-0902
| | - Joel C. Perry
- Department of Mechanical Engineering, University of Idaho, Moscow, ID 83844-0902
| | - Andria Farrens
- Department of Biomedical Engineering, University of California, Irvine, CA 92697
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Lee EY, Na Y, Cho M, Hwang YM, Kim HS, An H, Pyun SB. Short-term and long-term predictors of balance function in stroke patients: a 6-month follow-up study. Int J Rehabil Res 2023; 46:163-169. [PMID: 36867012 DOI: 10.1097/mrr.0000000000000573] [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: 03/04/2023]
Abstract
We aimed to determine early predictors of balance function (Berg Balance Scale, BBS) at 3 and 6 months after stroke using clinical, neurophysiological, and neuroimaging variables. Seventy-nine patients with hemiparesis after a stroke were included. Demographics, stroke characteristics, and clinical variables [Mini-Mental State Examination, BBS, strength in the hemiparetic hip, knee, and ankle muscles, and Fugl-Meyer Assessment Lower Extremity (FMA-LE)] were evaluated 2 weeks post-stroke, on average. Somatosensory-evoked potentials (SEP) from both tibial nerves and diffusion tensor imaging data were collected respectively within 3 weeks and 4 weeks post-onset to calculate the SEP amplitude ratio and the laterality index of fractional anisotropy of the corticospinal tract. In multiple linear regression analysis, younger age, higher FMA-LE score, and stronger hemiparetic hip extensors were independent predictors of higher BBS at 3 months post-stroke (adjusted R2 = 0.563, P < 0.001). At 6 months post-stroke, significant predictors of higher BBS were younger age, higher FMA-LE, stronger hemiparetic hip extensors, and larger SEP amplitude ratio (adjusted R2 = 0.552, P < 0.001), although the incremental contribution of the latter was rather small ( R2 = 0.019). We conclude that age and the initial motor impairment of the affected lower limb can inform the state of balance function at 3 and 6 months after stroke.
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Affiliation(s)
- Eun Young Lee
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine
- Brain Convergence Research Center, Korea University
| | - Yoonhye Na
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine
- Brain Convergence Research Center, Korea University
| | - Minjae Cho
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine
- Brain Convergence Research Center, Korea University
| | - Yu Mi Hwang
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine
- Brain Convergence Research Center, Korea University
| | - Hyun-Soo Kim
- Department of Anatomy, Korea University College of Medicine
| | - Hyonggin An
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sung-Bom Pyun
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine
- Brain Convergence Research Center, Korea University
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40
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Schwab SM, Mayr R, Davis TJ, Silva PL, Riley MA. Precision aiming performance with the paretic upper limb is associated with center of pressure patterns in individuals with chronic stroke. Gait Posture 2023; 103:133-139. [PMID: 37159986 DOI: 10.1016/j.gaitpost.2023.05.002] [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] [Received: 06/13/2022] [Revised: 01/31/2023] [Accepted: 05/03/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Individuals with stroke commonly demonstrate upper-limb sensorimotor impairments. Upper-limb tasks occur against a background level of postural control and thus require a flexible postural control system to facilitate performance. Anterior precision aiming tasks, for example, benefit from lower medial-lateral (ML) center of pressure (COP) fluctuations (where increased fluctuations erode performance) relative to anterior-posterior (AP) fluctuations (where increased fluctuations do not strongly influence performance). After stroke, individuals may compensate for upper-limb impairments by increasing trunk movement which increases overall COP fluctuations and thus may make it more difficult to modulate COP in a task-sensitive manner. RESEARCH QUESTION Do upper-limb task demands modulate COP movement patterns after stroke? METHODS In this cross-sectional study, adults with chronic stroke (n = 23) and unilateral upper-limb impairments were immersed in a virtual environment displaying an anterior target. Participants aimed to maintain the position of a virtual laser pointer (via handheld controller) in the target with each hand. COP was concurrently recorded. Mixed effects models and correlations were used to detect differences in COP patterns between limbs and movement planes and evaluate associations between task performance and COP patterns, respectively. RESULTS Participants showed greater COP standard deviation and regularity in the AP compared to the ML direction. The magnitude of difference between AP and ML COP metrics was greater using the nonparetic limb. Task performance was moderately and positively associated with task-sensitive COP patterns (i.e., higher AP:ML ratios of COP metrics) using the paretic upper limb. Participants consistently demonstrated high levels of task performance and task-sensitive COP movement patterns using the nonparetic limb. SIGNIFICANCE Impairments in postural control after stroke may be related to the upper limb used. It is important to recognize the role of directional COP variability and regularity in the context of a task goal after stroke.
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Affiliation(s)
- Sarah M Schwab
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, OH, USA.
| | - Riley Mayr
- Center for Cognition, Action, & Perception, Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - Tehran J Davis
- Center for Cognition, Action, & Perception, Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - Paula L Silva
- Center for Cognition, Action, & Perception, Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - Michael A Riley
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, OH, USA
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Rodríguez-Hernández M, Polonio-López B, Corregidor-Sánchez AI, Martín-Conty JL, Mohedano-Moriano A, Criado-Álvarez JJ. Can specific virtual reality combined with conventional rehabilitation improve poststroke hand motor function? A randomized clinical trial. J Neuroeng Rehabil 2023; 20:38. [PMID: 37016408 PMCID: PMC10071242 DOI: 10.1186/s12984-023-01170-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/30/2023] [Indexed: 04/06/2023] Open
Abstract
TRIAL OBJECTIVE To verify whether conventional rehabilitation combined with specific virtual reality is more effective than conventional therapy alone in restoring hand motor function and muscle tone after stroke. TRIAL DESIGN This prospective single-blind randomized controlled trial compared conventional rehabilitation based on physiotherapy and occupational therapy (control group) with the combination of conventional rehabilitation and specific virtual reality technology (experimental group). Participants were allocated to these groups in a ratio of 1:1. The conventional rehabilitation therapists were blinded to the study, but neither the participants nor the therapist who applied the virtual reality-based therapy could be blinded to the intervention. PARTICIPANTS Forty-six patients (43 of whom completed the intervention period and follow-up evaluation) were recruited from the Neurology and Rehabilitation units of the Hospital General Universitario of Talavera de la Reina, Spain. INTERVENTION Each participant completed 15 treatment sessions lasting 150 min/session; the sessions took place five consecutive days/week over the course of three weeks. The experimental group received conventional upper-limb strength and motor training (100 min/session) combined with specific virtual reality technology devices (50 min/session); the control group received only conventional training (150 min/session). RESULTS As measured by the Ashworth Scale, a decrease in wrist muscle tone was observed in both groups (control and experimental), with a notably larger decrease in the experimental group (baseline mean/postintervention mean: 1.22/0.39; difference between baseline and follow-up: 0.78; 95% confidence interval: 0.38-1.18; effect size = 0.206). Fugl-Meyer Assessment scores were observed to increase in both groups, with a notably larger increase in the experimental group (total motor function: effect size = 0.300; mean: - 35.5; 95% confidence interval: - 38.9 to - 32.0; wrist: effect size = 0.290; mean: - 5.6; 95% confidence interval: - 6.4 to - 4.8; hand: effect size = 0.299; mean: - -8.9; 95% confidence interval: - 10.1 to - 7.6). On the Action Research Arm Test, the experimental group quadrupled its score after the combined intervention (effect size = 0.321; mean: - 32.8; 95% confidence interval: - 40.1 to - 25.5). CONCLUSION The outcomes of the study suggest that conventional rehabilitation combined with a specific virtual reality technology system can be more effective than conventional programs alone in improving hand motor function and voluntary movement and in normalizing muscle tone in subacute stroke patients. With combined treatment, hand and wrist functionality and motion increase; resistance to movement (spasticity) decreases and remains at a reduced level. TRIALS REGISTRY International Clinical Trials Registry Platform: ISRCTN27760662 (15/06/2020; retrospectively registered).
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Affiliation(s)
- Marta Rodríguez-Hernández
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600, Talavera de la Reina, Spain
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | - Begoña Polonio-López
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600, Talavera de la Reina, Spain.
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain.
| | - Ana-Isabel Corregidor-Sánchez
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600, Talavera de la Reina, Spain
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | - José L Martín-Conty
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600, Talavera de la Reina, Spain
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | - Alicia Mohedano-Moriano
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600, Talavera de la Reina, Spain
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | - Juan-José Criado-Álvarez
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600, Talavera de la Reina, Spain
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
- Institute of Health Sciences, Talavera de la Reina, Spain
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Khokale R, S Mathew G, Ahmed S, Maheen S, Fawad M, Bandaru P, Zerin A, Nazir Z, Khawaja I, Sharif I, Abdin ZU, Akbar A. Virtual and Augmented Reality in Post-stroke Rehabilitation: A Narrative Review. Cureus 2023; 15:e37559. [PMID: 37193429 PMCID: PMC10183111 DOI: 10.7759/cureus.37559] [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] [Accepted: 04/14/2023] [Indexed: 05/18/2023] Open
Abstract
Virtual reality (VR) and augmented reality (AR) are noble adjunctive technologies currently being studied for the neuro-rehabilitation of post-stroke patients, potentially enhancing conventional therapy. We explored the literature to find if VR/AR improves neuroplasticity in stroke rehabilitation for a better quality of life. This modality can lay the foundation for telerehabilitation services in remote areas. We analyzed four databases, namely Cochrane Library, PubMed, Google Scholar, and Science Direct, by searching the following keywords: ("Stroke Rehabilitation" [Majr]) AND ("Augmented Reality" [Majr]), Virtual Augmented Reality in Stroke Rehabilitation. All the available open articles were reviewed and outlined. The studies conclude that VR/AR can help in early rehabilitation and yield better results in post-stroke patients in adjunct to conventional therapy. However, due to the limited research on this subject, we cannot conclude that this information is absolute. Moreover, VR/AR was seldom customized according to the needs of stroke survivors, which would have given us the full extent of its application. Around the world, stroke survivors are being studied to verify the accessibility and practicality of these innovative technologies. Observations conclude that further exploration of the extent of the implementations and efficacy of VR and AR, combined with conventional rehabilitation, is fundamental.
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Affiliation(s)
- Rhutuja Khokale
- Neurology, California Institute of Behavioral Neurosciences & Psychology LLC, Fairfield, USA
| | | | - Somi Ahmed
- Intensive Care Unit, Sumeru City Hospital, Lalitpur, NPL
| | - Sara Maheen
- General Medicine, Odessa National Medical University, Odessa, UKR
| | - Moiz Fawad
- Neurological Surgery, King Saud Medical City, Riyadh, SAU
| | | | - Annu Zerin
- Internal Medicine, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Zahra Nazir
- Internal Medicine, Combined Military Hospital, Quetta, PAK
| | - Imran Khawaja
- Internal Medicine, Ayub Medical Institute, Abottabad, PAK
| | - Imtenan Sharif
- Community Medicine, Quetta Institute of Medical Sciences, Quetta, PAK
| | - Zain U Abdin
- Medicine, District Head Quarter Hospital, Faisalabad, PAK
| | - Anum Akbar
- Pediatrics, University of Nebraska Medical Center, Omaha, USA
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Boyne P, Billinger SA, Reisman DS, Awosika OO, Buckley S, Burson J, Carl D, DeLange M, Doren S, Earnest M, Gerson M, Henry M, Horning A, Khoury JC, Kissela BM, Laughlin A, McCartney K, McQuaid T, Miller A, Moores A, Palmer JA, Sucharew H, Thompson ED, Wagner E, Ward J, Wasik EP, Whitaker AA, Wright H, Dunning K. Optimal Intensity and Duration of Walking Rehabilitation in Patients With Chronic Stroke: A Randomized Clinical Trial. JAMA Neurol 2023; 80:342-351. [PMID: 36822187 PMCID: PMC9951105 DOI: 10.1001/jamaneurol.2023.0033] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/08/2022] [Indexed: 02/25/2023]
Abstract
Importance For walking rehabilitation after stroke, training intensity and duration are critical dosing parameters that lack optimization. Objective To assess the optimal training intensity (vigorous vs moderate) and minimum training duration (4, 8, or 12 weeks) needed to maximize immediate improvement in walking capacity in patients with chronic stroke. Design, Setting, and Participants This multicenter randomized clinical trial using an intent-to-treat analysis was conducted from January 2019 to April 2022 at rehabilitation and exercise research laboratories. Survivors of a single stroke who were aged 40 to 80 years and had persistent walking limitations 6 months or more after the stroke were enrolled. Interventions Participants were randomized 1:1 to high-intensity interval training (HIIT) or moderate-intensity aerobic training (MAT), each involving 45 minutes of walking practice 3 times per week for 12 weeks. The HIIT protocol used repeated 30-second bursts of walking at maximum safe speed, alternated with 30- to 60-second rest periods, targeting a mean aerobic intensity above 60% of the heart rate reserve (HRR). The MAT protocol used continuous walking with speed adjusted to maintain an initial target of 40% of the HRR, progressing up to 60% of the HRR as tolerated. Main Outcomes and Measures The main outcome was 6-minute walk test distance. Outcomes were assessed by blinded raters after 4, 8, and 12 weeks of training. Results Of 55 participants (mean [SD] age, 63 [10] years; 36 male [65.5%]), 27 were randomized to HIIT and 28 to MAT. The mean (SD) time since stroke was 2.5 (1.3) years, and mean (SD) 6-minute walk test distance at baseline was 239 (132) m. Participants attended 1675 of 1980 planned treatment visits (84.6%) and 197 of 220 planned testing visits (89.5%). No serious adverse events related to study procedures occurred. Groups had similar 6-minute walk test distance changes after 4 weeks (HIIT, 27 m [95% CI, 6-48 m]; MAT, 12 m [95% CI, -9 to 33 m]; mean difference, 15 m [95% CI, -13 to 42 m]; P = .28), but HIIT elicited greater gains after 8 weeks (58 m [95% CI, 39-76 m] vs 29 m [95% CI, 9-48 m]; mean difference, 29 m [95% CI, 5-54 m]; P = .02) and 12 weeks (71 m [95% CI, 49-94 m] vs 27 m [95% CI, 3-50 m]; mean difference, 44 m [95% CI, 14-74 m]; P = .005) of training; HIIT also showed greater improvements than MAT on some secondary measures of gait speed and fatigue. Conclusions and Relevance These findings show proof of concept that vigorous training intensity is a critical dosing parameter for walking rehabilitation. In patients with chronic stroke, vigorous walking exercise produced significant and meaningful gains in walking capacity with only 4 weeks of training, but at least 12 weeks were needed to maximize immediate gains. Trial Registration ClinicalTrials.gov Identifier: NCT03760016.
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Affiliation(s)
- Pierce Boyne
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Sandra A. Billinger
- Department of Neurology, School of Medicine, University of Kansas Medical Center, Kansas City
- Department of Cell Biology and Integrative Physiology, School of Medicine, University of Kansas Medical Center, Kansas City
- University of Kansas Alzheimer’s Research Disease Center, Fairway
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Kansas Medical Center, Kansas City
| | - Darcy S. Reisman
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark
| | - Oluwole O. Awosika
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Sofia Buckley
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Jamiah Burson
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Daniel Carl
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Matthew DeLange
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Sarah Doren
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Melinda Earnest
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Myron Gerson
- Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
- Department of Cardiology, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Madison Henry
- Department of Physical Therapy, Rehabilitation Sciences, and Athletic Training, School of Health Professions, University of Kansas Medical Center, Kansas City
| | - Alli Horning
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Jane C. Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Brett M. Kissela
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Abigail Laughlin
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Kiersten McCartney
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark
| | - Thomas McQuaid
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Allison Miller
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark
| | - Alexandra Moores
- Department of Neurology, School of Medicine, University of Kansas Medical Center, Kansas City
| | - Jacqueline A. Palmer
- Department of Neurology, School of Medicine, University of Kansas Medical Center, Kansas City
| | - Heidi Sucharew
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Elizabeth D. Thompson
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark
| | - Erin Wagner
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Jaimie Ward
- Department of Neurology, School of Medicine, University of Kansas Medical Center, Kansas City
| | - Emily Patton Wasik
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Alicen A. Whitaker
- Department of Physical Therapy, Rehabilitation Sciences, and Athletic Training, School of Health Professions, University of Kansas Medical Center, Kansas City
| | - Henry Wright
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark
| | - Kari Dunning
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
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Zhang M, Guo M, Wang Z, Liu H, Bai X, Cui S, Guo X, Gao L, Gao L, Liao A, Xing B, Wang Y. Predictive model for early functional outcomes following acute care after traumatic brain injuries: A machine learning-based development and validation study. Injury 2023; 54:896-903. [PMID: 36732148 DOI: 10.1016/j.injury.2023.01.004] [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] [Received: 08/15/2022] [Revised: 12/14/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Few studies on early functional outcomes following acute care after traumatic brain injury (TBI) are available. The aim of this study was to develop and validate a predictive model for functional outcomes at discharge for TBI patients using machine learning methods. PATIENTS AND METHODS In this retrospective study, data from 5281 TBI patients admitted for acute care who were identified in the Beijing hospital discharge abstract database were analysed. Data from 4181 patients in 52 tertiary hospitals were used for model derivation and internal validation. Data from 1100 patients in 21 secondary hospitals were used for external validation. A poor outcome was defined as a Barthel Index (BI) score ≤ 60 at discharge. Logistic regression, XGBoost, random forest, decision tree, and back propagation neural network models were used to fit classification models. Performance was evaluated by the area under the receiver operating characteristic curve (AUC), the area under the precision-recall curve (AP), calibration plots, sensitivity/recall, specificity, positive predictive value (PPV)/precision, negative predictive value (NPV) and F1-score. RESULTS Compared to the other models, the random forest model demonstrated superior performance in internal validation (AUC of 0.856, AP of 0.786, and F1-score of 0.724) and external validation (AUC of 0.779, AP of 0.630, and F1-score of 0.604). The sensitivity/recall, specificity, PPV/precision, and NPV of the model were 71.8%, 69.2%, 52.2%, and 84.0%, respectively, in external validation. The BI score at admission, age, use of nonsurgical treatment, neurosurgery status, and modified Charlson Comorbidity Index were identified as the top 5 predictors for functional outcome at discharge. CONCLUSIONS We established a random forest model that performed well in predicting early functional outcomes following acute care after TBI. The model has utility for informing decision-making regarding patient management and discharge planning and for facilitating health care quality assessment and resource allocation for TBI treatment.
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Affiliation(s)
- Meng Zhang
- Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China; National Center for Quality Control of Medical Records, Beijing 100730, China
| | - Moning Guo
- Beijing Municipal Health Big Data and Policy Research Center, Beijing 100034, China; Beijing Institute of Hospital Management, Beijing 100034, China
| | - Zihao Wang
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Haimin Liu
- Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China; National Center for Quality Control of Medical Records, Beijing 100730, China
| | - Xue Bai
- Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China; National Center for Quality Control of Medical Records, Beijing 100730, China
| | - Shengnan Cui
- Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China; National Center for Quality Control of Medical Records, Beijing 100730, China
| | - Xiaopeng Guo
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Lu Gao
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Lingling Gao
- Peking University Clinical Research Institute, Beijing 100191, China
| | - Aimin Liao
- Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China; National Center for Quality Control of Medical Records, Beijing 100730, China
| | - Bing Xing
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
| | - Yi Wang
- Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China; National Center for Quality Control of Medical Records, Beijing 100730, China.
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Maje AU, Ibrahim AA. Effectiveness of an 8-week overground walking with paretic lower limb loading on spatiotemporal gait parameters and motor function among chronic stroke survivors: a protocol for randomised controlled trial. Trials 2023; 24:124. [PMID: 36803399 PMCID: PMC9942389 DOI: 10.1186/s13063-022-07057-3] [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: 10/06/2022] [Accepted: 12/28/2022] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Post-stroke gait deviations contribute to significant functional disability, impaired walking ability and poor quality of life. Prior studies suggest that gait training with paretic lower limb loading may improve gait parameters and walking ability in post-stroke. However, most gait training methods used in these studies are not readily available, and studies using cheaper methods are limited. OBJECTIVE The purpose of this study is to describe a protocol for a randomised controlled trial on the effectiveness of an 8-week overground walking with paretic lower limb loading on spatiotemporal gait parameters and motor function among chronic stroke survivors. METHODS This is a two-center, single-blind, two-arm parallel randomised controlled trial. Forty-eight stroke survivors with mild to moderate disability will be recruited from two tertiary facilities and randomly assigned into two intervention arms; overground walking with paretic lower limb loading or overground walking without paretic lower limb loading in a 1:1 ratio. All interventions will be administered thrice weekly for 8 weeks. Primary outcomes will be step length and gait speed whereas the secondary outcomes will include step length symmetry ratio, stride length, stride length symmetry ratio, stride width, cadence and motor function. All outcomes will be assessed at baseline, 4, 8 and 20 weeks after the start of intervention. DISCUSSION This will be the first randomised controlled trial to report the effects of overground walking with paretic lower limb loading on spatiotemporal gait parameters and motor function among chronic stroke survivors from low-resource setting. TRIAL REGISTRATION ClinicalTrials.gov NCT05097391. Registered on 27 October 2021.
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Affiliation(s)
- Abdulhamid U. Maje
- Department of Physiotherapy, Muhammadu Abdullahi Wase Teaching Hospital, Hospitals Management Board, P.M.B 3160, Kano, Kano State Nigeria ,grid.411585.c0000 0001 2288 989XDepartment of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, P.M.B 3011, Kano, Kano State Nigeria
| | - Aminu A. Ibrahim
- grid.510479.eDepartment of Physiotherapy, School of Basic Medical Sciences, Skyline University Nigeria, Kano, Kano State Nigeria
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Park CB, Park HS. Portable 3D-printed hand orthosis with spatial stiffness distribution personalized for assisting grasping in daily living. Front Bioeng Biotechnol 2023; 11:895745. [PMID: 36815899 PMCID: PMC9932545 DOI: 10.3389/fbioe.2023.895745] [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: 03/14/2022] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
Stroke survivors having limited finger coordination require an active hand orthosis to assist them with grasping tasks for daily activities. The orthosis should be portable for constant use; however, portability imposes constraints on the number, size, and weight of the actuators, which increase the difficulty of the design process. Therefore, a tradeoff exists between portability and the assistive force. In this study, a personalized spatial stiffness distribution design is presented for a portable and strengthful hand orthosis. The spatial stiffness distribution of the orthosis was optimized based on measurements of individual hand parameters to satisfy the functional requirements of achieving sufficient grip aperture in the pre-grasping phase and minimal assistive force in the grasping phase. Ten stroke survivors were recruited to evaluate the system. Sufficient grip aperture and high grip strength-to-weight ratio were achieved by the orthosis via a single motor. Moreover, the orthosis significantly restored the range of motion and improved the performance of daily activities. The proposed spatial stiffness distribution can suggest a design solution to make strengthful hand orthoses with reduced weight.
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Affiliation(s)
| | - Hyung-Soon Park
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
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Pedlow K, McDonough S, Klempel N, Hylands J, Hughes N, Campbell Z, Eng JJ, Stephenson A, Kennedy N. PREP Plus combined postrehabilitation programme to support upper limb recovery in community-dwelling stroke survivors: protocol for a mixed-methods, cluster-assigned feasibility study. BMJ Open 2023; 13:e069016. [PMID: 36669847 PMCID: PMC9872469 DOI: 10.1136/bmjopen-2022-069016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/03/2022] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Poor recovery of the upper limb following a stroke has been recognised as a significant problem in the UK. Although there is good evidence that early, intense rehabilitation can lead to upper limb recovery, often this is not maintained, with less than 50% of people regaining the ability to use their upper limb for independent function at 6 months. Upper limb recovery potential is reported for many years poststroke, yet current long-term provision is insufficient. METHODS AND ANALYSIS 60 participants will be recruited into this feasibility study, with 30 allocated to a Post Rehabilitation Enablement Programme (PREP) alone and 30 allocated to a combined programme, PREP Plus, consisting of PREP and the Graded Repetitive Arm Supplementary Programme (GRASP). We will aim to complete four iterative waves. Within each wave, the intervention design will be refined, based on participant feedback. Within each wave, there will be one cluster unit (one intervention group ;PREP Plus) and one control group ;PREP alone)). A total of five PREP sites within Northern Ireland Health and Social Care Trusts will be used for this study. PREP Plus will have a home exercise component along with exercises logs and a behaviour contract. Qualitative and quantitative measures will evaluate the acceptability and feasibility to determine how feasible it is to embed the intervention into practice, as well as to determine the feasibility of a larger, mixed-methods, randomised controlled trial to assess intervention efficacy. Clinical endpoints will also be explored. ETHICS AND DISSEMINATION This study has been approved by the Health and Social Care Research Ethics Committee A, IRAS project ID (278620). Participants will provide informed consent prior to participating in the study. Information outlining the purpose of the study, what data will be collected and how the data will be managed will be provided. Results will be published in peer-reviewed journals and any published data will be available on the university data repository. The project management group will advise on different avenues for dissemination to ensure it reaches appropriate audiences. TRIAL REGISTRATION NUMBER NCT05090163.
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Affiliation(s)
- Katy Pedlow
- School of Health Sciences, Ulster University, Londonderry, UK
| | | | - Natalie Klempel
- School of Health Sciences, Ulster University, Londonderry, UK
| | - Jenny Hylands
- School of Health Sciences, Ulster University, Londonderry, UK
| | | | - Zoe Campbell
- Northern Ireland Chest Heart and Stroke, Belfast, UK
| | - Janice J Eng
- Physical Therapy, University of British Columbia, Vancouver, Columbia, Canada
| | | | - Niamh Kennedy
- School of Psychology, Ulster University, Coleraine, UK
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Kourtidou-Papadeli C, Frantzidis C, Machairas I, Giantsios C, Dermitzakis E, Kantouris N, Konstantinids E, Bamidis P, Vernikos J. Rehabilitation assisted by Space technology-A SAHC approach in immobilized patients-A case of stroke. Front Physiol 2023; 13:1024389. [PMID: 36741804 PMCID: PMC9890276 DOI: 10.3389/fphys.2022.1024389] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 12/21/2022] [Indexed: 01/19/2023] Open
Abstract
Introduction: The idea behind the presentation of this case relates to utilizing space technology in earth applications with mutual benefit for both patients confined to bed and astronauts. Deconditioning and the progressiveness of skeletal muscle loss in the absence of adequate gravity stimulus have been of physiological concern. A robust countermeasure to muscle disuse is still a challenge for both immobilized patients and astronauts in long duration space missions. Researchers in the space medicine field concluded that artificial gravity (AG) produced by short-radius centrifugation on a passive movement therapy device, combined with exercise, has been a robust multi-system countermeasure as it re-introduces an acceleration field and gravity load. Methods: A short-arm human centrifuge (SAHC) alone or combined with exercise was evaluated as a novel, artificial gravity device for an effective rehabilitation strategy in the case of a stroke patient with disability. The results reveal valuable information on an individualized rehabilitation strategy against physiological deconditioning. A 73-year-old woman was suddenly unable to speak, follow directions or move her left arm and leg. She could not walk, and self-care tasks required maximal assistance. Her condition was getting worse over the years, also she was receiving conventional rehabilitation treatment. Intermittent short-arm human centrifuge individualized protocols were applied for 5 months, three times a week, 60 treatments in total. Results: It resulted in significant improvement in her gait, decreased atrophy with less spasticity on the left body side, and ability to walk at least 100 m with a cane. Balance and muscle strength were improved significantly. Cardiovascular parameters improved responding to adaptations to aerobic exercise. Electroencephalography (EEG) showed brain reorganization/plasticity evidenced through functional connectivity alterations and activation in the cortical regions, especially of the precentral and postcentral gyrus. Stroke immobility-related disability was also improved. Discussion: These alterations were attributed to the short-arm human centrifuge intervention. This case study provides novel evidence supporting the use of the short-arm human centrifuge as a promising therapeutic strategy in patients with restricted mobility, with application to astronauts with long-term muscle disuse in space.
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Affiliation(s)
- Chrysoula Kourtidou-Papadeli
- Laboratory of Medical Physics, Biomedical Engineering & Aerospace Neuroscience (BEAN), School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Greek Aerospace Medical Association and Space Research (GASMA-SR), Thessaloniki, Greece
- Aeromedical Center of Thessaloniki (AeMC), Kalamaria, Greece
| | - Christos Frantzidis
- Laboratory of Medical Physics, Biomedical Engineering & Aerospace Neuroscience (BEAN), School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Greek Aerospace Medical Association and Space Research (GASMA-SR), Thessaloniki, Greece
- School of Computer Science, University of Lincoln, Lincoln, United Kingdom
| | - Ilias Machairas
- Laboratory of Medical Physics, Biomedical Engineering & Aerospace Neuroscience (BEAN), School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Giantsios
- Laboratory of Medical Physics, Biomedical Engineering & Aerospace Neuroscience (BEAN), School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanouil Dermitzakis
- Greek Aerospace Medical Association and Space Research (GASMA-SR), Thessaloniki, Greece
- Aeromedical Center of Thessaloniki (AeMC), Kalamaria, Greece
| | - Nikolaos Kantouris
- Greek Aerospace Medical Association and Space Research (GASMA-SR), Thessaloniki, Greece
| | | | - Panagiotis Bamidis
- Laboratory of Medical Physics, Biomedical Engineering & Aerospace Neuroscience (BEAN), School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Greek Aerospace Medical Association and Space Research (GASMA-SR), Thessaloniki, Greece
| | - Joan Vernikos
- Greek Aerospace Medical Association and Space Research (GASMA-SR), Thessaloniki, Greece
- Thirdage LLC., New York, NY, United States
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Huber J, Elwert N, Powell ES, Westgate PM, Hines E, Sawaki L. Effects of dynamic body weight support on functional independence measures in acute ischemic stroke: a retrospective cohort study. J Neuroeng Rehabil 2023; 20:6. [PMID: 36647043 PMCID: PMC9843865 DOI: 10.1186/s12984-023-01132-9] [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: 04/14/2022] [Accepted: 01/07/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Stroke remains a major public health concern in the United States and a leading cause of long-term disability in adults. Dynamic body weight support (DBWS) systems are popular technology available for use in clinical settings such inpatient rehabilitation. However, there remains limited studies in such inpatient settings that compare DBWS to standard of care (SOC) using real world outcome measures. For survivors of acute ischemic stroke, we determine if incorporating a dynamic body weight support (DBWS) system into inpatient therapy offers greater improvement than standard of care (SOC). METHODS A retrospective chart review included 52 individuals with an acute ischemic stroke admitted to an inpatient rehabilitation facility. Functional Independence Measure (FIM) data, specifically changes in FIM at discharge, served as the primary outcome measure. Patient cohorts received either therapies per SOC or therapies incorporating DBWS. Regardless of cohort group, all patients underwent therapies for 3 h per day for 5 days a week. RESULTS For both groups, a statistically and clinically significant increase in total FIM (P < 0.0001) was observed at discharge compared to at admission. Improvements for the DBWS group were significantly greater than the SOC group as evidenced by higher gains in total FIM (p = 0.04) and this corresponded to a medium effect size (Cohen's d = 0.58). Among FIM subscores, the DBWS group achieved a significant increase in sphincter control while all other subscore changes remained non-significant. CONCLUSIONS This preliminary evidence supports the benefit of using DBWS during inpatient rehabilitation in individuals who have experienced an acute ischemic stroke. This may be due to the greater intensity and repetitions of tasks allowed by DBWS. These preliminary findings warrant further investigations on the use of DBWS in inpatient settings.
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Affiliation(s)
- Justin Huber
- Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, KY, USA. .,Department of Mechanical Engineering, University of Kentucky, Lexington, KY, USA.
| | - Nicholas Elwert
- grid.266539.d0000 0004 1936 8438Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, KY USA
| | - Elizabeth Salmon Powell
- grid.266539.d0000 0004 1936 8438Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, KY USA
| | - Philip M. Westgate
- grid.266539.d0000 0004 1936 8438Department of Biostatistics, University of Kentucky, Lexington, KY USA
| | - Emily Hines
- grid.266539.d0000 0004 1936 8438College of Medicine, University of Kentucky, Lexington, KY USA ,grid.66875.3a0000 0004 0459 167XDepartment of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN USA
| | - Lumy Sawaki
- grid.266539.d0000 0004 1936 8438Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, KY USA
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Pournajaf S, Calabrò RS, Naro A, Goffredo M, Aprile I, Tamburella F, Filoni S, Waldner A, Mazzoleni S, Focacci A, Ferraro F, Bonaiuti D, Franceschini M. Robotic versus Conventional Overground Gait Training in Subacute Stroke Survivors: A Multicenter Controlled Clinical Trial. J Clin Med 2023; 12:jcm12020439. [PMID: 36675371 PMCID: PMC9861649 DOI: 10.3390/jcm12020439] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 12/25/2022] [Accepted: 12/29/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Although stroke survivors can benefit from robotic gait rehabilitation, stationary robot-assisted gait training needs further investigation. In this paper, we investigated the efficacy of this approach (with an exoskeleton or an end-effector robot) in comparison to the conventional overground gait training in subacute stroke survivors. METHODS In a multicenter controlled clinical trial, 89 subacute stroke survivors conducted twenty sessions of robot-assisted gait training (Robotic Group) or overground gait training (Control Group) in addition to the standard daily therapy. The robotic training was performed with an exoskeleton (RobotEXO-group) or an end-effector (RobotEND-group). Clinical outcomes were assessed before (T0) and after (T1) the treatment. The walking speed during the 10-Meter Walk Test (10 MWT) was the primary outcome of this study, and secondary outcomes were the 6-Minute Walk Test (6 MWT), Timed Up and Go test (TUG), and the modified Barthel Index (mBI). RESULTS The main characteristics assessed in the Robotic and Control groups did not differ at baseline. A significant benefit was detected from the 10 MWT in the Robotic Group at the end of the study period (primary endpoint). A benefit was also observed from the following parameters: 6 MWT, TUG, and mBI. Moreover, patients belonging to the Robot Group outperformed the Control Group in gait speed, endurance, balance, and ADL. The RobotEND-group improved their walking speed more than the RobotEXO-group. CONCLUSION The stationary robot-assisted training improved walking ability better than the conventional training in subacute stroke survivors. These results suggest that people with subacute stroke may benefit from Robot-Assisted training in potentiating gait speed and endurance. Our results also support that end-effector robots would be superior to exoskeleton robots for improving gait speed enhancement.
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Affiliation(s)
- Sanaz Pournajaf
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, 00163 Rome, Italy
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy
- Correspondence: (R.S.C.); (M.G.); Tel.: +39-0652252319 (M.G.)
| | - Antonino Naro
- Stroke Unit, Policlinico Universitario G. Martino, 98123 Messina, Italy
| | - Michela Goffredo
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, 00163 Rome, Italy
- Correspondence: (R.S.C.); (M.G.); Tel.: +39-0652252319 (M.G.)
| | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy
| | - Federica Tamburella
- Laboratory of Robotic Neurorehabilitation (NeuroRobot Lab.), Spinal Rehabilitation Laboratory (SPIRE Lab.), Neurorehabilitation 1 Department, IRCCS Fondazione Santa Lucia, 00124 Rome, Italy
| | - Serena Filoni
- Fondazione Centri di Riabilitazione Padre Pio Onlus, 71013 San Giovani Rotondo, Italy
| | - Andreas Waldner
- Department of Neurorehabilitation, Melittaklinik Hospital, 39100 Bolzano, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, 70121 Bari, Italy
| | - Antonella Focacci
- S.C. Medicina Fisica e Riabilitazione, ASL 4 Ospedale di Sestri Levante, 16124 Genova, Italy
| | - Francesco Ferraro
- Struttura Complessa di Riabilitazione Neuromotoria ASST Mantova Presidio di Bozzolo, 46012 Bozzolo, Italy
| | - Donatella Bonaiuti
- Italian Scientific Society of Physical Medicine and Rehabilitation (SIMFER), 00198 Rome, Italy
| | - Marco Franceschini
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, 00163 Rome, Italy
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, 00123 Rome, Italy
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