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Li Y, Lian Y, Chen X, Zhang H, Xu G, Duan H, Xie X, Li Z. Effect of task-oriented training assisted by force feedback hand rehabilitation robot on finger grasping function in stroke patients with hemiplegia: a randomised controlled trial. J Neuroeng Rehabil 2024; 21:77. [PMID: 38745227 PMCID: PMC11092254 DOI: 10.1186/s12984-024-01372-3] [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: 05/23/2023] [Accepted: 05/08/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Over 80% of patients with stroke experience finger grasping dysfunction, affecting independence in activities of daily living and quality of life. In routine training, task-oriented training is usually used for functional hand training, which may improve finger grasping performance after stroke, while augmented therapy may lead to a better treatment outcome. As a new technology-supported training, the hand rehabilitation robot provides opportunities to improve the therapeutic effect by increasing the training intensity. However, most hand rehabilitation robots commonly applied in clinics are based on a passive training mode and lack the sensory feedback function of fingers, which is not conducive to patients completing more accurate grasping movements. A force feedback hand rehabilitation robot can compensate for these defects. However, its clinical efficacy in patients with stroke remains unknown. This study aimed to investigate the effectiveness and added value of a force feedback hand rehabilitation robot combined with task-oriented training in stroke patients with hemiplegia. METHODS In this single-blinded randomised controlled trial, 44 stroke patients with hemiplegia were randomly divided into experimental (n = 22) and control (n = 22) groups. Both groups received 40 min/day of conventional upper limb rehabilitation training. The experimental group received 20 min/day of task-oriented training assisted by a force feedback rehabilitation robot, and the control group received 20 min/day of task-oriented training assisted by therapists. Training was provided for 4 weeks, 5 times/week. The Fugl-Meyer motor function assessment of the hand part (FMA-Hand), Action Research Arm Test (ARAT), grip strength, Modified Ashworth scale (MAS), range of motion (ROM), Brunnstrom recovery stages of the hand (BRS-H), and Barthel index (BI) were used to evaluate the effect of two groups before and after treatment. RESULTS Intra-group comparison: In both groups, the FMA-Hand, ARAT, grip strength, AROM, BRS-H, and BI scores after 4 weeks of treatment were significantly higher than those before treatment (p < 0.05), whereas there was no significant difference in finger flexor MAS scores before and after treatment (p > 0.05). Inter-group comparison: After 4 weeks of treatment, the experimental group's FMA-Hand total score, ARAT, grip strength, and AROM were significantly better than those of the control group (p < 0.05). However, there were no statistically significant differences in the scores of each sub-item of the FMA-Hand after Bonferroni correction (p > 0.007). In addition, there were no statistically significant differences in MAS, BRS-H, and BI scores (p > 0.05). CONCLUSION Hand performance improved in patients with stroke after 4 weeks of task-oriented training. The use of a force feedback hand rehabilitation robot to support task-oriented training showed additional value over conventional task-oriented training in stroke patients with hand dysfunction. CLINICAL TRIAL REGISTRATION INFORMATION NCT05841108.
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Affiliation(s)
- Yinghua Li
- Department of Rehabilitation Medicine, First Hospital of Jilin University, Changchun, China
| | - Yawen Lian
- Department of Rehabilitation Medicine, First Hospital of Jilin University, Changchun, China
| | - Xiaowei Chen
- Department of Rehabilitation Medicine, First Hospital of Jilin University, Changchun, China
| | - Hong Zhang
- Department of Rehabilitation Medicine, First Hospital of Jilin University, Changchun, China
| | - Guoxing Xu
- Department of Rehabilitation Medicine, First Hospital of Jilin University, Changchun, China
| | - Haoyang Duan
- Department of Rehabilitation Medicine, First Hospital of Jilin University, Changchun, China
| | - Xixi Xie
- Department of Rehabilitation Medicine, First Hospital of Jilin University, Changchun, China
| | - Zhenlan Li
- Department of Rehabilitation Medicine, First Hospital of Jilin University, Changchun, China.
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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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Moulaei K, Bahaadinbeigy K, Haghdoostd AA, Nezhad MS, Sheikhtaheri A. Overview of the role of robots in upper limb disabilities rehabilitation: a scoping review. Arch Public Health 2023; 81:84. [PMID: 37158979 PMCID: PMC10169358 DOI: 10.1186/s13690-023-01100-8] [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: 11/25/2022] [Accepted: 04/29/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Neuromotor rehabilitation and improvement of upper limb functions are necessary to improve the life quality of patients who have experienced injuries or have pathological outcomes. Modern approaches, such as robotic-assisted rehabilitation can help to improve rehabilitation processes and thus improve upper limb functions. Therefore, the aim of this study was to investigate the role of robots in upper limb disability improvement and rehabilitation. METHODS This scoping review was conducted by search in PubMed, Web of Science, Scopus, and IEEE (January 2012- February 2022). Articles related to upper limb rehabilitation robots were selected. The methodological quality of all the included studies will be appraised using the Mixed Methods Appraisal Tool (MMAT). We used an 18-field data extraction form to extract data from articles and extracted the information such as study year, country, type of study, purpose, illness or accident leading to disability, level of disability, assistive technologies, number of participants in the study, sex, age, rehabilitated part of the upper limb using a robot, duration and frequency of treatment, methods of performing rehabilitation exercises, type of evaluation, number of participants in the evaluation process, duration of intervention, study outcomes, and study conclusions. The selection of articles and data extraction was made by three authors based on inclusion and exclusion criteria. Disagreements were resolved through consultation with the fifth author. Inclusion criteria were articles involving upper limb rehabilitation robots, articles about upper limb disability caused by any illness or injury, and articles published in English. Also, articles involving other than upper limb rehabilitation robots, robots related to rehabilitation of diseases other than upper limb, systematic reviews, reviews, and meta-analyses, books, book chapters, letters to the editor, and conference papers were also excluded. Descriptive statistics methods (frequency and percentage) were used to analyses the data. RESULTS We finally included 55 relevant articles. Most of the studies were done in Italy (33.82%). Most robots were used to rehabilitate stroke patients (80%). About 60.52% of the studies used games and virtual reality rehabilitate the upper limb disabilities using robots. Among the 14 types of applied evaluation methods, "evaluation and measurement of upper limb function and dexterity" was the most applied evaluation method. "Improvement in musculoskeletal functions", "no adverse effect on patients", and "Safe and reliable treatment" were the most cited outcomes, respectively. CONCLUSIONS Our findings show that robots can improve musculoskeletal functions (musculoskeletal strength, sensation, perception, vibration, muscle coordination, less spasticity, flexibility, and range of motion) and empower people by providing a variety of rehabilitation capabilities.
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Affiliation(s)
- Khadijeh Moulaei
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Haghdoostd
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mansour Shahabi Nezhad
- Department of Physical Therapy, Faculty of Allied Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Abbas Sheikhtaheri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
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Zhou ZQ, Hua XY, Wu JJ, Xu JJ, Ren M, Shan CL, Xu JG. Combined robot motor assistance with neural circuit-based virtual reality (NeuCir-VR) lower extremity rehabilitation training in patients after stroke: a study protocol for a single-centre randomised controlled trial. BMJ Open 2022; 12:e064926. [PMID: 36564112 PMCID: PMC9791407 DOI: 10.1136/bmjopen-2022-064926] [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] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Improving lower extremity motor function is the focus and difficulty of post-stroke rehabilitation treatment. More recently, robot-assisted and virtual reality (VR) training are commonly used in post-stroke rehabilitation and are considered feasible treatment methods. Here, we developed a rehabilitation system combining robot motor assistance with neural circuit-based VR (NeuCir-VR) rehabilitation programme involving procedural lower extremity rehabilitation with reward mechanisms, from muscle strength training, posture control and balance training to simple and complex ground walking training. The study aims to explore the effectiveness and neurological mechanisms of combining robot motor assistance and NeuCir-VR lower extremity rehabilitation training in patients after stroke. METHODS AND ANALYSIS This is a single-centre, observer-blinded, randomised controlled trial. 40 patients with lower extremity hemiparesis after stroke will be recruited and randomly divided into a control group (combined robot assistance and VR training) and an intervention group (combined robot assistance and NeuCir-VR training) by the ratio of 1:1. Each group will receive five 30 min sessions per week for 4 weeks. The primary outcome will be Fugl-Meyer assessment of the lower extremity. Secondary outcomes will include Berg Balance Scale, Modified Ashworth Scale and functional connectivity measured by resting-state functional MRI. Outcomes will be measured at baseline (T0), post-intervention (T1) and follow-ups (T2-T4). ETHICS, REGISTRATION AND DISSEMINATION The trial was approved by the Ethics Committee of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Chinese Traditional Medicine (Grant No. 2019-014). The results will be submitted to a peer-reviewed journal or at a conference. TRIAL REGISTRATION NUMBER ChiCTR2100052133.
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Affiliation(s)
- Zhi-Qing Zhou
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xu-Yun Hua
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jia-Jia Wu
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jing-Jing Xu
- Guangzhou Xinhua College, Guangzhou, China
- Guangzhou Xuguan Clinic of Traditional Chinese Medicine, Guangzhou, China
| | - Meng Ren
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chun-Lei Shan
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
| | - Jian-Guang Xu
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
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Gustavsson M, Kjörk EK, Erhardsson M, Alt Murphy M. Virtual reality gaming in rehabilitation after stroke - user experiences and perceptions. Disabil Rehabil 2022; 44:6759-6765. [PMID: 34465269 DOI: 10.1080/09638288.2021.1972351] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE The present study explored participants' experiences with and perceptions of using fully immersive head-mounted virtual reality (VR) gaming as rehabilitation after stroke. METHODS Four men and three women (median age 64 years) with chronic stroke and varying motor impairment (mild to severe) were interviewed after 10 weeks of VR training on the commercial HTC Vive system, focusing on the upper extremities. Inductive qualitative thematic analysis was performed. RESULTS The analysis revealed three main themes: playing the game, benefits and effects, and personalizing the game. Playing the game encompasses both the feeling of being immersed in the game and descriptions of the gaming being motivating and fun. Benefits and effects describe the participants' expectations of potential benefits, the importance of getting feed-back, and the impact in daily life. Personalizing the game includes finding the right game and level, and the participants' need for support to achieve full use of the training. CONCLUSIONS Participants with chronic stroke described the fully immersive VR gaming intervention as a fun and motivating way to improve their functioning in everyday life. Qualitative studies are needed to explore how people with stroke perceive VR gaming when it is implemented in real clinical environments.Clinical implicationsVR gaming was perceived as a positive and motivating rehabilitation after stroke.Getting feedback and perceiving benefits are essential parts of VR rehabilitation.Commercial fully immersive VR-games might be an option for stroke rehabilitation when the game can be personalized and support is available.
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Affiliation(s)
- Martha Gustavsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Occupational Therapy, Linköping University, Linköping, Sweden
| | - Emma K Kjörk
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mattias Erhardsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margit Alt Murphy
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Wearable Immersive Virtual Reality Device for Promoting Physical Activity in Parkinson's Disease Patients. SENSORS 2022; 22:s22093302. [PMID: 35590992 PMCID: PMC9104114 DOI: 10.3390/s22093302] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/18/2022] [Accepted: 04/24/2022] [Indexed: 02/04/2023]
Abstract
Parkinson’s disease (PD) is a neurological disorder that usually appears in the 6th decade of life and affects up to 2% of older people (65 years and older). Its therapeutic management is complex and includes not only pharmacological therapies but also physiotherapy. Exercise therapies have shown good results in disease management in terms of rehabilitation and/or maintenance of physical and functional capacities, which is important in PD. Virtual reality (VR) could promote physical activity in this population. We explore whether a commercial wearable head-mounted display (HMD) and the selected VR exergame could be suitable for people with mild–moderate PD. In all, 32 patients (78.1% men; 71.50 ± 11.80 years) were a part of the study. Outcomes were evaluated using the Simulator Sickness Questionnaire (SSQ), the System Usability Scale (SUS), the Game Experience Questionnaire (GEQ post-game module), an ad hoc satisfaction questionnaire, and perceived effort. A total of 60 sessions were completed safely (without adverse effects (no SSQ symptoms) and with low scores in the negative experiences of the GEQ (0.01–0.09/4)), satisfaction opinions were positive (88% considered the training “good” or “very good”), and the average usability of the wearable HMD was good (75.16/100). Our outcomes support the feasibility of a boxing exergame combined with a wearable commercial HMD as a suitable physical activity for PD and its applicability in different environments due to its safety, usability, low cost, and small size. Future research is needed focusing on postural instability, because it seems to be a symptom that could have an impact on the success of exergaming programs aimed at PD.
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Stipancic KL, Kuo YL, Miller A, Ventresca HM, Sternad D, Kimberley TJ, Green JR. The effects of continuous oromotor activity on speech motor learning: speech biomechanics and neurophysiologic correlates. Exp Brain Res 2021; 239:3487-3505. [PMID: 34524491 PMCID: PMC8599312 DOI: 10.1007/s00221-021-06206-5] [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] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/25/2021] [Indexed: 11/26/2022]
Abstract
Sustained limb motor activity has been used as a therapeutic tool for improving rehabilitation outcomes and is thought to be mediated by neuroplastic changes associated with activity-induced cortical excitability. Although prior research has reported enhancing effects of continuous chewing and swallowing activity on learning, the potential beneficial effects of sustained oromotor activity on speech improvements is not well-documented. This exploratory study was designed to examine the effects of continuous oromotor activity on subsequent speech learning. Twenty neurologically healthy young adults engaged in periods of continuous chewing and speech after which they completed a novel speech motor learning task. The motor learning task was designed to elicit improvements in accuracy and efficiency of speech performance across repetitions of eight-syllable nonwords. In addition, transcranial magnetic stimulation was used to measure the cortical silent period (cSP) of the lip motor cortex before and after the periods of continuous oromotor behaviors. All repetitions of the nonword task were recorded acoustically and kinematically using a three-dimensional motion capture system. Productions were analyzed for accuracy and duration, as well as lip movement distance and speed. A control condition estimated baseline improvement rates in speech performance. Results revealed improved speech performance following 10 min of chewing. In contrast, speech performance following 10 min of continuous speech was degraded. There was no change in the cSP as a result of either oromotor activity. The clinical implications of these findings are discussed in the context of speech rehabilitation and neuromodulation.
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Affiliation(s)
- Kaila L Stipancic
- Department of Communicative Disorders and Sciences, University at Buffalo, Buffalo, NY, USA
| | - Yi-Ling Kuo
- Department of Physical Therapy, Upstate Medical University, Syracuse, NY, USA
| | - Amanda Miller
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA, USA
| | - Hayden M Ventresca
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Building 79/96, 2nd Floor 13th Street, Boston, MA, 02129, USA
| | - Dagmar Sternad
- Department of Biology, Northeastern University, Boston, MA, USA
| | - Teresa J Kimberley
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Building 79/96, 2nd Floor 13th Street, Boston, MA, 02129, USA
| | - Jordan R Green
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Building 79/96, 2nd Floor 13th Street, Boston, MA, 02129, USA.
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Lee SI, Adans-Dester CP, OBrien AT, Vergara-Diaz GP, Black-Schaffer R, Zafonte R, Dy JG, Bonato P. Predicting and Monitoring Upper-Limb Rehabilitation Outcomes Using Clinical and Wearable Sensor Data in Brain Injury Survivors. IEEE Trans Biomed Eng 2021; 68:1871-1881. [PMID: 32997621 PMCID: PMC8723794 DOI: 10.1109/tbme.2020.3027853] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Rehabilitation specialists have shown considerable interest for the development of models, based on clinical data, to predict the response to rehabilitation interventions in stroke and traumatic brain injury survivors. However, accurate predictions are difficult to obtain due to the variability in patients' response to rehabilitation interventions. This study aimed to investigate the use of wearable technology in combination with clinical data to predict and monitor the recovery process and assess the responsiveness to treatment on an individual basis. METHODS Gaussian Process Regression-based algorithms were developed to estimate rehabilitation outcomes (i.e., Functional Ability Scale scores) using either clinical or wearable sensor data or a combination of the two. RESULTS The algorithm based on clinical data predicted rehabilitation outcomes with a Pearson's correlation of 0.79 compared to actual clinical scores provided by clinicians but failed to model the variability in responsiveness to the intervention observed across individuals. In contrast, the algorithm based on wearable sensor data generated rehabilitation outcome estimates with a Pearson's correlation of 0.91 and modeled the individual responses to rehabilitation more accurately. Furthermore, we developed a novel approach to combine estimates derived from the clinical data and the sensor data using a constrained linear model. This approach resulted in a Pearson's correlation of 0.94 between estimated and clinician-provided scores. CONCLUSION This algorithm could enable the design of patient-specific interventions based on predictions of rehabilitation outcomes relying on clinical and wearable sensor data. SIGNIFICANCE This is important in the context of developing precision rehabilitation interventions.
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Conti S, Spalletti C, Pasquini M, Giordano N, Barsotti N, Mainardi M, Lai S, Giorgi A, Pasqualetti M, Micera S, Caleo M. Combining robotics with enhanced serotonin-driven cortical plasticity improves post-stroke motor recovery. Prog Neurobiol 2021; 203:102073. [PMID: 33984455 DOI: 10.1016/j.pneurobio.2021.102073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/22/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
Despite recent progresses in robotic rehabilitation technologies, their efficacy for post-stroke motor recovery is still limited. Such limitations might stem from the insufficient enhancement of plasticity mechanisms, crucial for functional recovery. Here, we designed a clinically relevant strategy that combines robotic rehabilitation with chemogenetic stimulation of serotonin release to boost plasticity. These two approaches acted synergistically to enhance post-stroke motor performance. Indeed, mice treated with our combined therapy showed substantial functional gains that persisted beyond the treatment period and generalized to non-trained tasks. Motor recovery was associated with a reduction in electrophysiological and neuroanatomical markers of GABAergic neurotransmission, suggesting disinhibition in perilesional areas. To unveil the translational potentialities of our approach, we specifically targeted the serotonin 1A receptor by delivering Buspirone, a clinically approved drug, in stroke mice undergoing robotic rehabilitation. Administration of Buspirone restored motor impairments similarly to what observed with chemogenetic stimulation, showing the immediate translational potential of this combined approach to significantly improve motor recovery after stroke.
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Affiliation(s)
- S Conti
- Translational Neural Engineering Area, The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - C Spalletti
- Institute of Neuroscience, National Research Council (CNR), Pisa, Italy
| | - M Pasquini
- Translational Neural Engineering Area, The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - N Giordano
- Institute of Neuroscience, National Research Council (CNR), Pisa, Italy
| | - N Barsotti
- Unit of Cell and Developmental Biology, Department of Biology, University of Pisa, Italy
| | - M Mainardi
- Institute of Neuroscience, National Research Council (CNR), Pisa, Italy
| | - S Lai
- Translational Neural Engineering Area, The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - A Giorgi
- Unit of Cell and Developmental Biology, Department of Biology, University of Pisa, Italy
| | - M Pasqualetti
- Unit of Cell and Developmental Biology, Department of Biology, University of Pisa, Italy; Center for Neuroscience and Cognitive Systems, Istituto Italiano di Tecnologia, Rovereto, Italy
| | - S Micera
- Translational Neural Engineering Area, The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; Bertarelli Foundation Chair in Translational NeuroEngineering Laboratory, École Polytechnique Fédérale de Lausanne (EPFL), Centre for Neuroprosthetics and Institute of Bioengineering, Lausanne, Switzerland.
| | - M Caleo
- Institute of Neuroscience, National Research Council (CNR), Pisa, Italy; Department of Biomedical Sciences, University of Padova, Italy.
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Erhardsson M, Alt Murphy M, Sunnerhagen KS. Commercial head-mounted display virtual reality for upper extremity rehabilitation in chronic stroke: a single-case design study. J Neuroeng Rehabil 2020; 17:154. [PMID: 33228710 PMCID: PMC7686731 DOI: 10.1186/s12984-020-00788-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/13/2020] [Indexed: 12/22/2022] Open
Abstract
Background Rehabilitation is crucial for maximizing recovery after stroke. Rehabilitation activities that are fun and rewarding by themselves can be more effective than those who are not. Gamification with virtual reality (VR) exploits this principle. This single-case design study probes the potential for using commercial off-the-shelf, room-scale head-mounted virtual reality for upper extremity rehabilitation in individuals with chronic stroke, the insights of which can inform further research. Methods A heterogeneous volunteer sample of seven participants living with stroke were recruited through advertisement. A single-case design was employed with a 5-week baseline (A), followed by a 10-week intervention (B) and a 6-month follow-up. Upper extremity motor function was assessed with validated kinematic analysis of drinking task. Activity capacity was assessed with Action Research Arm Test, Box and Block Test and ABILHAND questionnaire. Assessments were done weekly and at follow-up. Playing games on a VR-system with head-mounted display (HTC Vive) was used as rehabilitation intervention. Approximately 300 games were screened and 6 tested. Visual analysis and Tau-U statistics were used to interpret the results. Results Visual analysis of trend, level shift and overlap as well as Tau-U statistics indicated improvement of Action Research Arm Test in six participants. Four of these had at least a moderate Tau-U score (0.50–0.92), in at least half of the assessed outcomes. These four participants trained a total of 361 to 935 min. Two out of four participants who were able to perform the drinking task, had the highest training dose (> 900 min) and showed also improvements in kinematics. The predominant game played was Beat Saber. No serious adverse effects related to the study were observed, one participant interrupted the intervention phase due to a fall at home. Conclusions This first study of combining commercial games, a commercial head-mounted VR, and commercial haptic hand controls, showed promising results for upper extremity rehabilitation in individuals with chronic stroke. By being affordable yet having high production values, as well as being an easily accessible off-the-shelf product, this variant of VR technology might facilitate widespread adaption. Insights garnered in this study can facilitate the execution of future studies. Trial registration The study was registered at researchweb.org (project number 262331, registered 2019-01-30, https://www.researchweb.org/is/vgr/project/262331) prior to participant enrolment.
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Affiliation(s)
- Mattias Erhardsson
- Institute of Neuroscience and Physiology, Clinical Neuroscience, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Per Dubbsgatan 14, 3rd Floor, 41345, Gothenburg, Sweden.,Institute of Biomedicine, Medical Biochemistry and Cell Biology, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 9 A, 413 90, Gothenburg, Sweden
| | - Margit Alt Murphy
- Institute of Neuroscience and Physiology, Clinical Neuroscience, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Per Dubbsgatan 14, 3rd Floor, 41345, Gothenburg, Sweden.
| | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, Clinical Neuroscience, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Per Dubbsgatan 14, 3rd Floor, 41345, Gothenburg, Sweden
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11
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Adans-Dester C, Hankov N, O’Brien A, Vergara-Diaz G, Black-Schaffer R, Zafonte R, Dy J, Lee SI, Bonato P. Enabling precision rehabilitation interventions using wearable sensors and machine learning to track motor recovery. NPJ Digit Med 2020; 3:121. [PMID: 33024831 PMCID: PMC7506010 DOI: 10.1038/s41746-020-00328-w] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 08/12/2020] [Indexed: 01/19/2023] Open
Abstract
The need to develop patient-specific interventions is apparent when one considers that clinical studies often report satisfactory motor gains only in a portion of participants. This observation provides the foundation for "precision rehabilitation". Tracking and predicting outcomes defining the recovery trajectory is key in this context. Data collected using wearable sensors provide clinicians with the opportunity to do so with little burden on clinicians and patients. The approach proposed in this paper relies on machine learning-based algorithms to derive clinical score estimates from wearable sensor data collected during functional motor tasks. Sensor-based score estimates showed strong agreement with those generated by clinicians. Score estimates of upper-limb impairment severity and movement quality were marked by a coefficient of determination of 0.86 and 0.79, respectively. The application of the proposed approach to monitoring patients' responsiveness to rehabilitation is expected to contribute to the development of patient-specific interventions, aiming to maximize motor gains.
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Affiliation(s)
- Catherine Adans-Dester
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA USA
- School of Health & Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA USA
| | - Nicolas Hankov
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA USA
| | - Anne O’Brien
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA USA
| | - Gloria Vergara-Diaz
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA USA
| | - Randie Black-Schaffer
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA USA
| | - Ross Zafonte
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA USA
| | - Jennifer Dy
- Department of Electrical and Computer Engineering, Northeastern University, Boston, MA USA
| | - Sunghoon I. Lee
- College of Information and Computer Sciences, University of Massachusetts Amherst, Amherst, MA USA
| | - Paolo Bonato
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA USA
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12
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Coscia M, Wessel MJ, Chaudary U, Millán JDR, Micera S, Guggisberg A, Vuadens P, Donoghue J, Birbaumer N, Hummel FC. Neurotechnology-aided interventions for upper limb motor rehabilitation in severe chronic stroke. Brain 2020; 142:2182-2197. [PMID: 31257411 PMCID: PMC6658861 DOI: 10.1093/brain/awz181] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/14/2019] [Accepted: 05/12/2019] [Indexed: 01/27/2023] Open
Abstract
Upper limb motor deficits in severe stroke survivors often remain unresolved over extended time periods. Novel neurotechnologies have the potential to significantly support upper limb motor restoration in severely impaired stroke individuals. Here, we review recent controlled clinical studies and reviews focusing on the mechanisms of action and effectiveness of single and combined technology-aided interventions for upper limb motor rehabilitation after stroke, including robotics, muscular electrical stimulation, brain stimulation and brain computer/machine interfaces. We aim at identifying possible guidance for the optimal use of these new technologies to enhance upper limb motor recovery especially in severe chronic stroke patients. We found that the current literature does not provide enough evidence to support strict guidelines, because of the variability of the procedures for each intervention and of the heterogeneity of the stroke population. The present results confirm that neurotechnology-aided upper limb rehabilitation is promising for severe chronic stroke patients, but the combination of interventions often lacks understanding of single intervention mechanisms of action, which may not reflect the summation of single intervention’s effectiveness. Stroke rehabilitation is a long and complex process, and one single intervention administrated in a short time interval cannot have a large impact for motor recovery, especially in severely impaired patients. To design personalized interventions combining or proposing different interventions in sequence, it is necessary to have an excellent understanding of the mechanisms determining the effectiveness of a single treatment in this heterogeneous population of stroke patients. We encourage the identification of objective biomarkers for stroke recovery for patients’ stratification and to tailor treatments. Furthermore, the advantage of longitudinal personalized trial designs compared to classical double-blind placebo-controlled clinical trials as the basis for precise personalized stroke rehabilitation medicine is discussed. Finally, we also promote the necessary conceptual change from ‘one-suits-all’ treatments within in-patient clinical rehabilitation set-ups towards personalized home-based treatment strategies, by adopting novel technologies merging rehabilitation and motor assistance, including implantable ones.
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Affiliation(s)
- Martina Coscia
- Wyss Center for Bio and Neuroengineering, Chemin des Mines 9, 1202 Geneva, Switzerland
| | - Maximilian J Wessel
- Defitech Chair in Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), School of Life Sciences, Swiss Federal Institute of Technology (EPFL), 1202 Geneva, Switzerland.,Defitech Chair in Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), School of Life Sciences, Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland
| | - Ujwal Chaudary
- Wyss Center for Bio and Neuroengineering, Chemin des Mines 9, 1202 Geneva, Switzerland
| | - José Del R Millán
- Defitech Chair in Brain-Machine Interface, Center for Neuroprosthetics, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, 1015, Switzerland
| | - Silvestro Micera
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, 1015, Switzerland.,Translational Neural Engineering Area, The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, 56025, Italy
| | - Adrian Guggisberg
- Clinical Neuroscience, University of Geneva Medical School, 1202 Geneva, Switzerland
| | | | - John Donoghue
- Wyss Center for Bio and Neuroengineering, Chemin des Mines 9, 1202 Geneva, Switzerland.,Department of Neuroscience, Brown University, Providence, RI 02906, USA
| | - Niels Birbaumer
- Wyss Center for Bio and Neuroengineering, Chemin des Mines 9, 1202 Geneva, Switzerland.,Institute of Medical Psychology and Behavioral Neurobiology, University Tuebingen, Germany
| | - Friedhelm C Hummel
- Defitech Chair in Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), School of Life Sciences, Swiss Federal Institute of Technology (EPFL), 1202 Geneva, Switzerland.,Defitech Chair in Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), School of Life Sciences, Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland.,Clinical Neuroscience, University of Geneva Medical School, 1202 Geneva, Switzerland
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13
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Pharmacological Dopamine Manipulation Does Not Alter Reward-Based Improvements in Memory Retention during a Visuomotor Adaptation Task. eNeuro 2018; 5:eN-NRS-0453-17. [PMID: 30027109 PMCID: PMC6051592 DOI: 10.1523/eneuro.0453-17.2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 04/14/2018] [Accepted: 05/10/2018] [Indexed: 11/30/2022] Open
Abstract
Motor adaptation tasks investigate our ability to adjust motor behaviors to an ever-changing and unpredictable world. Previous work has shown that punishment-based feedback delivered during a visuomotor adaptation task enhances error-reduction, whereas reward increases memory retention. While the neural underpinnings of the influence of punishment on the adaptation phase remain unclear, reward has been hypothesized to increase retention through dopaminergic mechanisms. We directly tested this hypothesis through pharmacological manipulation of the dopaminergic system. A total of 96 young healthy human participants were tested in a placebo-controlled double-blind between-subjects design in which they adapted to a 40° visuomotor rotation under reward or punishment conditions. We confirmed previous evidence that reward enhances retention, but the dopamine (DA) precursor levodopa (LD) or the DA antagonist haloperidol failed to influence performance. We reason that such a negative result could be due to experimental limitations or it may suggest that the effect of reward on motor memory retention is not driven by dopaminergic processes. This provides further insight regarding the role of motivational feedback in optimizing motor learning, and the basis for further decomposing the effect of reward on the subprocesses known to underlie motor adaptation paradigms.
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14
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Gower A, Tiberi M. The Intersection of Central Dopamine System and Stroke: Potential Avenues Aiming at Enhancement of Motor Recovery. Front Synaptic Neurosci 2018; 10:18. [PMID: 30034335 PMCID: PMC6043669 DOI: 10.3389/fnsyn.2018.00018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 06/13/2018] [Indexed: 12/12/2022] Open
Abstract
Dopamine, a major neurotransmitter, plays a role in a wide range of brain sensorimotor functions. Parkinson's disease and schizophrenia are two major human neuropsychiatric disorders typically associated with dysfunctional dopamine activity levels, which can be alleviated through the druggability of the dopaminergic systems. Meanwhile, several studies suggest that optimal brain dopamine activity levels are also significantly impacted in other serious neurological conditions, notably stroke, but this has yet to be fully appreciated at both basic and clinical research levels. This is of utmost importance as there is a need for better treatments to improve recovery from stroke. Here, we discuss the state of knowledge regarding the modulation of dopaminergic systems following stroke, and the use of dopamine boosting therapies in animal stroke models to improve stroke recovery. Indeed, studies in animals and humans show stroke leads to changes in dopamine functioning. Moreover, evidence from animal stroke models suggests stimulation of dopamine receptors may be a promising therapeutic approach for enhancing motor recovery from stroke. With respect to the latter, we discuss the evidence for several possible receptor-linked mechanisms by which improved motor recovery may be mediated. One avenue of particular promise is the subtype-selective stimulation of dopamine receptors in conjunction with physical therapy. However, results from clinical trials so far have been more mixed due to a number of potential reasons including, targeting of the wrong patient populations and use of drugs which modulate a wide array of receptors. Notwithstanding these issues, it is hoped that future research endeavors will assist in the development of more refined dopaminergic therapeutic approaches to enhance stroke recovery.
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Affiliation(s)
- Annette Gower
- Ottawa Hospital Research Institute (Neuroscience Program), Ottawa, ON, Canada.,University of Ottawa Brain and Mind Institute, Ottawa, ON, Canada.,Departments of Medicine, Cellular and Molecular Medicine, and Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Mario Tiberi
- Ottawa Hospital Research Institute (Neuroscience Program), Ottawa, ON, Canada.,University of Ottawa Brain and Mind Institute, Ottawa, ON, Canada.,Departments of Medicine, Cellular and Molecular Medicine, and Psychiatry, University of Ottawa, Ottawa, ON, Canada
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15
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Zhao LR, Willing A. Enhancing endogenous capacity to repair a stroke-damaged brain: An evolving field for stroke research. Prog Neurobiol 2018; 163-164:5-26. [PMID: 29476785 PMCID: PMC6075953 DOI: 10.1016/j.pneurobio.2018.01.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 01/11/2018] [Accepted: 01/30/2018] [Indexed: 02/07/2023]
Abstract
Stroke represents a severe medical condition that causes stroke survivors to suffer from long-term and even lifelong disability. Over the past several decades, a vast majority of stroke research targets neuroprotection in the acute phase, while little work has been done to enhance stroke recovery at the later stage. Through reviewing current understanding of brain plasticity, stroke pathology, and emerging preclinical and clinical restorative approaches, this review aims to provide new insights to advance the research field for stroke recovery. Lifelong brain plasticity offers the long-lasting possibility to repair a stroke-damaged brain. Stroke impairs the structural and functional integrity of entire brain networks; the restorative approaches containing multi-components have great potential to maximize stroke recovery by rebuilding and normalizing the stroke-disrupted entire brain networks and brain functioning. The restorative window for stroke recovery is much longer than previously thought. The optimal time for brain repair appears to be at later stage of stroke rather than the earlier stage. It is expected that these new insights will advance our understanding of stroke recovery and assist in developing the next generation of restorative approaches for enhancing brain repair after stroke.
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Affiliation(s)
- Li-Ru Zhao
- Department of Neurosurgery, State University of New York, Upstate Medical University, Syracuse, NY, 13210, USA.
| | - Alison Willing
- Center for Excellence in Aging and Brain Repair, Department of Neurosurgery and Brain Repair, University of South Florida, Morsani College of Medicine, Tampa, FL, 33612, USA.
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16
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Spalletti C, Alia C, Lai S, Panarese A, Conti S, Micera S, Caleo M. Combining robotic training and inactivation of the healthy hemisphere restores pre-stroke motor patterns in mice. eLife 2017; 6:28662. [PMID: 29280732 PMCID: PMC5762156 DOI: 10.7554/elife.28662] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 12/22/2017] [Indexed: 11/13/2022] Open
Abstract
Focal cortical stroke often leads to persistent motor deficits, prompting the need for more effective interventions. The efficacy of rehabilitation can be increased by ‘plasticity-stimulating’ treatments that enhance experience-dependent modifications in spared areas. Transcallosal pathways represent a promising therapeutic target, but their role in post-stroke recovery remains controversial. Here, we demonstrate that the contralesional cortex exerts an enhanced interhemispheric inhibition over the perilesional tissue after focal cortical stroke in mouse forelimb motor cortex. Accordingly, we designed a rehabilitation protocol combining intensive, repeatable exercises on a robotic platform with reversible inactivation of the contralesional cortex. This treatment promoted recovery in general motor tests and in manual dexterity with remarkable restoration of pre-lesion movement patterns, evaluated by kinematic analysis. Recovery was accompanied by a reduction of transcallosal inhibition and ‘plasticity brakes’ over the perilesional tissue. Our data support the use of combinatorial clinical therapies exploiting robotic devices and modulation of interhemispheric connectivity.
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Affiliation(s)
| | - Claudia Alia
- CNR Neuroscience Institute, Pisa, Italy.,Scuola Normale Superiore, Pisa, Italy
| | - Stefano Lai
- Scuola Superiore Sant'Anna, Translational Neural Engineering Area, The BioRobotics Institute, Pontedera, Italy
| | - Alessandro Panarese
- Scuola Superiore Sant'Anna, Translational Neural Engineering Area, The BioRobotics Institute, Pontedera, Italy
| | - Sara Conti
- Scuola Superiore Sant'Anna, Translational Neural Engineering Area, The BioRobotics Institute, Pontedera, Italy
| | - Silvestro Micera
- Scuola Superiore Sant'Anna, Translational Neural Engineering Area, The BioRobotics Institute, Pontedera, Italy.,Bertarelli Foundation Chair in Translational NeuroEngineering Laboratory, Ecole Polytechnique Federale de Lausanne (EPFL), Center for Neuroprosthetics and Institute of Bioengineering, Lausanne, Switzerland
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17
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Augmented reality for personalized nanomedicines. Biotechnol Adv 2017; 36:335-343. [PMID: 29248686 DOI: 10.1016/j.biotechadv.2017.12.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 12/12/2017] [Accepted: 12/13/2017] [Indexed: 12/26/2022]
Abstract
As our understanding of onset and progress of diseases at the genetic and molecular level rapidly progresses, the potential of advanced technologies, such as 3D-printing, Socially-Assistive Robots (SARs) or augmented reality (AR), that are applied to personalized nanomedicines (PNMs) to alleviate pathological conditions, has become more prominent. Among advanced technologies, AR in particular has the greatest potential to address those challenges and facilitate the translation of PNMs into formidable clinical application of personalized therapy. As AR is about to adapt additional new methods, such as speech, voice recognition, eye tracing and motion tracking, to enable interaction with host response or biological systems in 3-D space, a combination of multiple approaches to accommodate varying environmental conditions, such as public noise and atmosphere brightness, will be explored to improve its therapeutic outcomes in clinical applications. For instance, AR glasses still being developed by Facebook or Microsoft will serve as new platform that can provide people with the health information they are interested in or various measures through which they can interact with medical services. This review has addressed the current progress and impact of AR on PNMs and its application to the biomedical field. Special emphasis is placed on the application of AR based PNMs to the treatment strategies against senior care, drug addiction and medication adherence.
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18
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Straudi S, Severini G, Sabbagh Charabati A, Pavarelli C, Gamberini G, Scotti A, Basaglia N. The effects of video game therapy on balance and attention in chronic ambulatory traumatic brain injury: an exploratory study. BMC Neurol 2017; 17:86. [PMID: 28490322 PMCID: PMC5424286 DOI: 10.1186/s12883-017-0871-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 05/04/2017] [Indexed: 12/03/2022] Open
Abstract
Background Patients with traumatic brain injury often have balance and attentive disorders. Video game therapy (VGT) has been proposed as a new intervention to improve mobility and attention through a reward-learning approach. In this pilot randomized, controlled trial, we tested the effects of VGT, compared with a balance platform therapy (BPT), on balance, mobility and selective attention in chronic traumatic brain injury patients. Methods We enrolled chronic traumatic brain injury patients (n = 21) that randomly received VGT or BPT for 3 sessions per week for 6 weeks. The clinical outcome measures included: i) the Community Balance & Mobility Scale (CB&M); ii) the Unified Balance Scale (UBS); iii) the Timed Up and Go test (TUG); iv) static balance and v) selective visual attention evaluation (Go/Nogo task). Results Both groups improved in CB&M scores, but only the VGT group increased on the UBS and TUG with a between-group significance (p < 0.05). Selective attention improved significantly in the VGT group (p < 0.01). Conclusions Video game therapy is an option for the management of chronic traumatic brain injury patients to ameliorate balance and attention deficits. Trial registration NCT01883830, April 5 2013.
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Affiliation(s)
- Sofia Straudi
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Ferrara, Italy.
| | - Giacomo Severini
- School of Electrical and Electronic Engineering, University College Dublin, Dublin, Ireland
| | | | - Claudia Pavarelli
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Ferrara, Italy
| | - Giulia Gamberini
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Ferrara, Italy
| | - Anna Scotti
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Ferrara, Italy
| | - Nino Basaglia
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Ferrara, Italy
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