1
|
Liu CL, Tu YW, Li MW, Chang KC, Chang CH, Chen CK, Wu CY. Electroencephalogram Alpha Oscillations in Stroke Recovery: Insights into Neural Mechanisms from Combined Transcranial Direct Current Stimulation and Mirror Therapy in Relation to Activities of Daily Life. Bioengineering (Basel) 2024; 11:717. [PMID: 39061800 PMCID: PMC11273914 DOI: 10.3390/bioengineering11070717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
The goal of stroke rehabilitation is to establish a robust protocol for patients to live independently in community. Firstly, we examined the impact of 3 hybridized transcranial direct current stimulation (tDCS)-mirror therapy interventions on activities of daily life (ADL) in stroke patients. Secondly, we explored the underlying therapeutic mechanisms with theory-driven electroencephalography (EEG) indexes in the alpha band. This was achieved by identifying the unique contributions of alpha power in motor production to ADL in relation to the premotor cortex (PMC), primary cortex (M1), and Sham tDCS with mirror therapy. The results showed that, although post-intervention ADL improvement was comparable among the three tDCS groups, one of the EEG indexes differentiated the interventions. Neural-behavioral correlation analyses revealed that different types of ADL improvements consistently corresponded with alpha power in the temporal lobe exclusively in the PMC tDCS group (all rs > 0.39). By contrast, alterations in alpha power in the central-frontal region were found to vary, with ADL primarily in the M1 tDCS group (r = -0.6 or 0.7), with the benefit depending on the complexity of the ADL. In conclusion, this research suggested two potential therapeutic mechanisms and demonstrated the additive benefits of introducing theory-driven neural indexes in explaining ADL.
Collapse
Affiliation(s)
- Chia-Lun Liu
- Department of Occupational Therapy, Chang Gung University, Taoyuan 33302, Taiwan;
| | - Ya-Wen Tu
- Department of Physical Medicine and Rehabilitation, Sijhih Cathay General Hospital, New Taipei 221, Taiwan; (Y.-W.T.); (M.-W.L.)
| | - Ming-Wei Li
- Department of Physical Medicine and Rehabilitation, Sijhih Cathay General Hospital, New Taipei 221, Taiwan; (Y.-W.T.); (M.-W.L.)
| | - Ku-Chou Chang
- Division of Cerebrovascular Diseases, Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 80756, Taiwan;
- Long-Term Care Service Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 80756, Taiwan
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan;
| | - Chih-Hung Chang
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63108, USA;
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63130, USA
| | - Chih-Kuang Chen
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan;
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan 33302, Taiwan
| | - Ching-Yi Wu
- Department of Occupational Therapy, Chang Gung University, Taoyuan 33302, Taiwan;
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan 33302, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan 333, Taiwan
| |
Collapse
|
2
|
Choe DK, Aiello AJ, Spangler JE, Walsh CJ, Awad LN. A Propulsion Neuroprosthesis Improves Overground Walking in Community-Dwelling Individuals After Stroke. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2024; 5:563-572. [PMID: 39157060 PMCID: PMC11329222 DOI: 10.1109/ojemb.2024.3416028] [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] [Received: 01/03/2024] [Revised: 04/19/2024] [Accepted: 06/07/2024] [Indexed: 08/20/2024] Open
Abstract
Functional electrical stimulation (FES) is a common neuromotor intervention whereby electrically evoked dorsiflexor muscle contractions assist foot clearance during walking. Plantarflexor neurostimulation has recently emerged to assist and retrain gait propulsion; however, safe and effective coordination of dorsiflexor and plantarflexor neurostimulation during overground walking has been elusive, restricting propulsion neuroprostheses to harnessed treadmill walking. We present an overground propulsion neuroprosthesis that adaptively coordinates, on a step-by-step basis, neurostimulation to the dorsiflexors and plantarflexors. In 10 individuals post-stroke, we evaluate the immediate effects of plantarflexor neurostimulation delivered with different onset timings, and retention to unassisted walking (NCT06459401). Preferred onset timing differed across individuals. Individualized tuning resulted in a significant 10% increase in paretic propulsion peak (Δ: 1.41 ± 1.52%BW) and an 8% increase in paretic plantarflexor power (Δ: 0.27 ± 0.23 W/kg), compared to unassisted walking. Post-session unassisted walking speed, paretic propulsion peak, and propulsion symmetry all significantly improved by 9% (0.14 ± 0.09 m/s), 28% (2.24 ± 3.00%BW), and 12% (4.5 ± 6.0%), respectively, compared to pre-session measurements. Here we show that an overground propulsion neuroprosthesis can improve overground walking speed and propulsion symmetry in the chronic phase of stroke recovery. Future studies should include a control group to examine the efficacy of gait training augmented by the propulsion neuroprosthesis compared to gait training alone.
Collapse
Affiliation(s)
- Dabin K. Choe
- John A. Paulson School of Engineering and Applied SciencesHarvard UniversityCambridgeMA02138USA
| | - Ashlyn J. Aiello
- Sargent College of Health and Rehabilitation SciencesBoston UniversityBostonMA02215USA
| | - Johanna E. Spangler
- Sargent College of Health and Rehabilitation SciencesBoston UniversityBostonMA02215USA
| | - Conor J. Walsh
- John A. Paulson School of Engineering and Applied SciencesHarvard UniversityCambridgeMA02138USA
| | - Louis N. Awad
- Sargent College of Health and Rehabilitation SciencesBoston UniversityBostonMA02215USA
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Stulberg EL, Sachdev PS, Murray AM, Cramer SC, Sorond FA, Lakshminarayan K, Sabayan B. Post-Stroke Brain Health Monitoring and Optimization: A Narrative Review. J Clin Med 2023; 12:7413. [PMID: 38068464 PMCID: PMC10706919 DOI: 10.3390/jcm12237413] [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: 09/13/2023] [Revised: 11/10/2023] [Accepted: 11/21/2023] [Indexed: 01/22/2024] Open
Abstract
Significant advancements have been made in recent years in the acute treatment and secondary prevention of stroke. However, a large proportion of stroke survivors will go on to have enduring physical, cognitive, and psychological disabilities from suboptimal post-stroke brain health. Impaired brain health following stroke thus warrants increased attention from clinicians and researchers alike. In this narrative review based on an open timeframe search of the PubMed, Scopus, and Web of Science databases, we define post-stroke brain health and appraise the body of research focused on modifiable vascular, lifestyle, and psychosocial factors for optimizing post-stroke brain health. In addition, we make clinical recommendations for the monitoring and management of post-stroke brain health at major post-stroke transition points centered on four key intertwined domains: cognition, psychosocial health, physical functioning, and global vascular health. Finally, we discuss potential future work in the field of post-stroke brain health, including the use of remote monitoring and interventions, neuromodulation, multi-morbidity interventions, enriched environments, and the need to address inequities in post-stroke brain health. As post-stroke brain health is a relatively new, rapidly evolving, and broad clinical and research field, this narrative review aims to identify and summarize the evidence base to help clinicians and researchers tailor their own approach to integrating post-stroke brain health into their practices.
Collapse
Affiliation(s)
- Eric L. Stulberg
- Department of Neurology, University of Utah, Salt Lake City, UT 84112, USA;
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, NSW 2052, Australia;
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, NSW 2031, Australia
| | - Anne M. Murray
- Berman Center for Outcomes and Clinical Research, Minneapolis, MN 55415, USA;
- Department of Medicine, Geriatrics Division, Hennepin Healthcare Research Institute, Minneapolis, MN 55404, USA
| | - Steven C. Cramer
- Department of Neurology, University of California Los Angeles, Los Angeles, CA 90095, USA;
- California Rehabilitation Institute, Los Angeles, CA 90067, USA
| | - Farzaneh A. Sorond
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA;
| | - Kamakshi Lakshminarayan
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Behnam Sabayan
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA;
- Department of Neurology, Hennepin Healthcare Research Institute, Minneapolis, MN 55404, USA
| |
Collapse
|
5
|
Krishnan S, Mandala MA, Wolf SL, Howard A, Kesar TM. Perceptions of stroke survivors regarding factors affecting adoption of technology and exergames for rehabilitation. PM R 2023; 15:1403-1410. [PMID: 36787167 DOI: 10.1002/pmrj.12963] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 11/29/2022] [Accepted: 01/24/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Task-specific motor training and repetitive practice are essential components of clinical rehabilitation. Emerging evidence suggests that incorporating gaming interfaces (also referred to as "exergames"), including virtual reality and augmented reality (VR/AR)-based interfaces for motor training, can enhance the engagement and efficacy of poststroke rehabilitation. OBJECTIVE To investigate perceptions of individuals with stroke regarding technology and exergames for rehabilitation. DESIGN This qualitative phenomenological study included a convenience sample of 11 individuals with stroke (61.7 ± 12.4 years, 6 women and 5 men, 63.5 ± 41.2 months post stroke). SETTING Community. INTERVENTIONS N/A. OUTCOME MEASURES Semistructured open-ended focus-group interviews to understand their perceptions on technology and exergames to improve recovery were coded using thematic content analysis. RESULTS Individuals with stroke were comfortable using smartphones, computers, and rehabilitation technologies but had limited experiences using exergames and VR/AR devices. Individuals with stroke were motivated to use technologies and exergames to improve their functional recovery. Participants identified facilitators (eg, enhancing functional recovery, feedback, therapist supervision) and barriers (eg, safety, inaccessibility, inadequate knowledge) to adopting exergames in their daily lives. Participants wanted the exergames to be customizable, goal oriented, and enjoyable to maintain their engagement. They were willing to use exergames to improve their functional recovery but indicated that these games could not replace the therapist's supervision. CONCLUSIONS Despite having limited experiences with exergames, people post stroke perceived that exergames could promote functional recovery. The perspectives gained from the present study can inform user-centered game design for neurorehabilitation.
Collapse
Affiliation(s)
- Shilpa Krishnan
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mahender A Mandala
- School of Interactive Computing, College of Computing, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Steven L Wolf
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Health Care Center
| | - Ayanna Howard
- School of Interactive Computing, College of Computing, Georgia Institute of Technology, Atlanta, Georgia, USA
- The Ohio State University, College of Engineering, Columbus, Ohio, USA
| | - Trisha M Kesar
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
6
|
Amirbekyan M, Adhikarla V, Cheng JP, Moschonas EH, Bondi CO, Rockne RC, Kline AE, Gutova M. Neuroprotective potential of intranasally delivered L-myc immortalized human neural stem cells in female rats after a controlled cortical impact injury. Sci Rep 2023; 13:17874. [PMID: 37857701 PMCID: PMC10587115 DOI: 10.1038/s41598-023-44426-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/08/2023] [Indexed: 10/21/2023] Open
Abstract
Efficacious stem cell-based therapies for traumatic brain injury (TBI) depend on successful delivery, migration, and engraftment of stem cells to induce neuroprotection. L-myc expressing human neural stem cells (LMNSC008) demonstrate an inherent tropism to injury sites after intranasal (IN) administration. We hypothesize that IN delivered LMNSC008 cells migrate to primary and secondary injury sites and modulate biomarkers associated with neuroprotection and tissue regeneration. To test this hypothesis, immunocompetent adult female rats received either controlled cortical impact injury or sham surgery. LMNSC008 cells or a vehicle were administered IN on postoperative days 7, 9, 11, 13, 15, and 17. The distribution and migration of eGFP-expressing LMNSC008 cells were quantified over 1 mm-thick optically cleared (CLARITY) coronal brain sections from TBI and SHAM controls. NSC migration was observed along white matter tracts projecting toward the hippocampus and regions of TBI. ELISA and Nanostring assays revealed a shift in tissue gene expression in LMNSC008 treated rats relative to controls. LMNSC008 treatment reduced expression of genes and pathways involved in inflammatory response, microglial function, and various cytokines and receptors. Our proof-of-concept studies, although preliminary, support the rationale of using intranasal delivery of LMNSC008 cells for functional studies in preclinical models of TBI and provide support for potential translatability in TBI patients.
Collapse
Affiliation(s)
- Mari Amirbekyan
- Department of Stem Cell Biology and Regenerative Medicine, Beckman Research Institute, City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Vikram Adhikarla
- Division of Mathematical Oncology and Computational Systems Biology, Department of Computational and Quantitative Medicine, Beckman Research Institute, City of Hope, Duarte, CA, USA
| | - Jeffrey P Cheng
- Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15224, USA
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eleni H Moschonas
- Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15224, USA
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
| | - Corina O Bondi
- Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15224, USA
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
- Neurobiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Russell C Rockne
- Division of Mathematical Oncology and Computational Systems Biology, Department of Computational and Quantitative Medicine, Beckman Research Institute, City of Hope, Duarte, CA, USA
| | - Anthony E Kline
- Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15224, USA.
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA.
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA.
- Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA.
- Critical Care Medicine, and Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
- Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Margarita Gutova
- Department of Stem Cell Biology and Regenerative Medicine, Beckman Research Institute, City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA.
| |
Collapse
|
7
|
Amirbekyan M, Cheng JP, Adhikarla V, Moschonas EH, Bondi CO, Rockne RC, Kline AE, Gutova M. Neuroprotective potential of intranasally delivered L-myc immortalized human neural stem cells in female rats after a controlled cortical impact injury. RESEARCH SQUARE 2023:rs.3.rs-3242570. [PMID: 37720043 PMCID: PMC10503851 DOI: 10.21203/rs.3.rs-3242570/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Efficacious stem cell-based therapies for traumatic brain injury (TBI) depend on successful delivery, migration, and engraftment of stem cells to induce neuroprotection. L-myc expressing human neural stem cells (LMNSC008) demonstrate an inherent tropism to injury sites after intranasal (IN) administration. We hypothesize that IN delivered LMNSC008 cells migrate to primary and secondary injury sites and modulate biomarkers associated with neuroprotection and tissue regeneration. To test this, immunocompetent adult female rats received a controlled cortical impact injury (CCI) or sham surgery. LMNSC008 cells or a vehicle (VEH) were administered IN on postoperative days 7, 9, 11, 13, 15, and 17. The distribution and migration of eGFP-expressing LMNSC008 cells were quantified over 1 mm-thick optically cleared (CLARITY) coronal brain sections from TBI and SHAM controls. NSC migration was observed along white matter tracts projecting toward the hippocampus and regions of TBI. ELISA and Nanostring assays revealed a shift in tissue gene expression in LMNSC008 treated rats relative to controls. LMNSC008 treatment reduced expression of genes and pathways involved in inflammatory response, microglial function, and various cytokines and receptors. The data demonstrate a robust proof-of-concept for LMNSC008 therapy for TBI and provides a strong rationale for IN delivery for translation in TBI patients.
Collapse
Affiliation(s)
| | - Jeffrey P Cheng
- University of Pittsburgh School of Medicine Children's Hospital of Pittsburgh John G. Rangos Research Center - Room 6126
| | | | - Eleni H Moschonas
- University of Pittsburgh School of Medicine Children's Hospital of Pittsburgh John G. Rangos Research Center - Room 6126
| | - Corina O Bondi
- University of Pittsburgh School of Medicine Children's Hospital of Pittsburgh John G. Rangos Research Center - Room 6126
| | | | - Anthony E Kline
- University of Pittsburgh School of Medicine Children's Hospital of Pittsburgh John G. Rangos Research Center - Room 6126
| | | |
Collapse
|
8
|
Chu J, Glinsky JV, Liu H, Ben M, Spooren AI, Roberts S, Chen LW, Di Natal F, Tamburella F, Jørgensen V, Gollan EJ, Agostinello J, van Laake-Geelen C, Lincoln C, van der Lede J, Stolwijk JM, Bell C, Paddison S, Rainey D, Scivoletto G, Oostra KM, Jan S, Sherrington C, Harvey LA. Early and Intensive Motor Training for people with spinal cord injuries (the SCI-MT Trial): protocol of the process evaluation. BMJ Open 2023; 13:e072219. [PMID: 37643854 PMCID: PMC10465915 DOI: 10.1136/bmjopen-2023-072219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION People with spinal cord injury receive physical rehabilitation to promote neurological recovery. Physical rehabilitation commences as soon as possible when a person is medically stable. One key component of physical rehabilitation is motor training. There is initial evidence to suggest that motor training can enhance neurological recovery if it is provided soon after injury and in a high dosage. The Early and Intensive Motor Training Trial is a pragmatic randomised controlled trial to determine whether 10 weeks of intensive motor training enhances neurological recovery for people with spinal cord injury. This pragmatic randomised controlled trial will recruit 220 participants from 15 spinal injury units in Australia, Scotland, Italy, Norway, England, Belgium and the Netherlands. This protocol paper describes the process evaluation that will run alongside the Early and Intensive Motor Training Trial. This process evaluation will help to explain the trial results and explore the potential facilitators and barriers to the possible future rollout of the trial intervention. METHODS AND ANALYSIS The UK Medical Research Council process evaluation framework and the Implementation Research Logic Model will be used to explain the trial outcomes and inform future implementation. Key components of the context, implementation and mechanism of impact, as well as the essential elements of the intervention and outcomes, will be identified and analysed. Qualitative and quantitative data will be collected and triangulated with the results of the Early and Intensive Motor Training Trial to strengthen the findings of this process evaluation. ETHICS AND DISSEMINATION Ethical approval for the Early and Intensive Motor Training Trial and process evaluation has been obtained from the Human Research Ethics Committee at the Northern Sydney Local Health District (New South Wales) in Australia (project identifier: 2020/ETH02540). All participants are required to provide written consent after being informed about the trial and the process evaluation. The results of this process evaluation will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trial Registry (ACTRN12621000091808); Universal Trial Number (U1111-1264-1689).
Collapse
Affiliation(s)
- Jackie Chu
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Joanne V Glinsky
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Hueiming Liu
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Marsha Ben
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Sharon Roberts
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Lydia W Chen
- Physiotherapy Department, Roayl North Shore Hospital, St Leonards, New South Wales, Australia
| | - Fernanda Di Natal
- Physiotherapy Department, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | | | - Vivien Jørgensen
- Research Department, Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - Emilie J Gollan
- Physiotherapy Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Jacqui Agostinello
- Physiotherapy Department, Royal Talbot Rehabilitation Centre, Kew, Victoria, Australia
| | - Charlotte van Laake-Geelen
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Claire Lincoln
- Physiotherapy Department, Queen Elizabeth National Spinal Injuries Unit, Glasgow, Scotland
| | - Jessica van der Lede
- Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Janneke M Stolwijk
- Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Chris Bell
- Physiotherapy Department, Repat Health Precinct, Daw Park, South Australia, Australia
| | - Sue Paddison
- London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital Trust, Stanmore, UK
| | - Donna Rainey
- Spinal Injury Unit, Royal Rehab, Ryde, New South Wales, Australia
| | | | - Kristine M Oostra
- Department of Physical Medicine and Rehabilitation, Ghent University Hospital, Ghent, Belgium
| | - Stephen Jan
- The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, University of Sydney, Sydney, New South Wales, Australia
| | - Lisa A Harvey
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| |
Collapse
|
9
|
Kesar T. The Effects of Stroke and Stroke Gait Rehabilitation on Behavioral and Neurophysiological Outcomes:: Challenges and Opportunities for Future Research. Dela J Public Health 2023; 9:76-81. [PMID: 37701480 PMCID: PMC10494801 DOI: 10.32481/djph.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Stroke continues to be a leading cause of adult disability, contributing to immense healthcare costs. Even after discharge from rehabilitation, post-stroke individuals continue to have persistent gait impairments, which in turn adversely affect functional mobility and quality of life. Multiple factors, including biomechanics, energy cost, psychosocial variables, as well as the physiological function of corticospinal neural pathways influence stroke gait function and training-induced gait improvements. As a step toward addressing this challenge, the objective of the current perspective paper is to outline knowledge gaps pertinent to the measurement and retraining of stroke gait dysfunction. The paper also has recommendations for future research directions to address important knowledge gaps, especially related to the measurement and rehabilitation-induced modulation of biomechanical and neural processes underlying stroke gait dysfunction. We posit that there is a need for leveraging emerging technologies to develop innovative, comprehensive, methods to measure gait patterns quantitatively, to provide clinicians with objective measure of gait quality that can supplement conventional clinical outcomes of walking function. Additionally, we posit that there is a need for more research on how the stroke lesion affects multiple parts of the nervous system, and to understand the neuroplasticity correlates of gait training and gait recovery. Multi-modal clinical research studies that can combine clinical, biomechanical, neural, and computational modeling data provide promise for gaining new information about stroke gait dysfunction as well as the multitude of factors affecting recovery and treatment response in people with post-stroke hemiparesis.
Collapse
Affiliation(s)
- Trisha Kesar
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine
| |
Collapse
|
10
|
Baharlouei H, Ali Salehinejad M, Talimkhani A, Nitsche MA. The Effect of Non-invasive Brain Stimulation on Gait in Healthy Young and Older Adults: A Systematic Review of the Literature. Neuroscience 2023; 516:125-140. [PMID: 36720301 DOI: 10.1016/j.neuroscience.2023.01.026] [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: 05/21/2022] [Revised: 12/26/2022] [Accepted: 01/21/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND OBJECTIVES Walking is an important function which requires coordinated activity of sensory-motor neural networks. Noninvasive brain stimulation (NIBS) is a safe neuromodulatory technique with motor function-improving effects. This study aimed to determine the effect of different types of NIBS interventions explored in randomized controlled trials on gait in healthy young and older adults. METHODS Based on the PRISMA approach, we conducted an electronic search in PubMed, Web of Science, Scopus, and PEDro for randomized clinical trials assessing the effect of NIBS on gait in healthy young and older adults and performed a narrative review. RESULTS Fourteen studies were included in this systematic review. According to the outcomes, transcranial direct current stimulation (tDCS) over the motor cortex and transcranial alternating current stimulation (tACS) over the cerebellum seem to be promising for improving gait characteristics such as speed, synchronization, and variability. Furthermore, tDCS over the dorsolateral prefrontal cortex (DLPFC) improved gait speed and reduced gait parameter variability under dual-task conditions. Only one repetitive transcranial magnetic stimulation was available, which showed no effects. No studies were available for transcranial random noise stimulation, and transcranial pulsed current stimulation. Moreover, the intervention parameters of the included studies were heterogeneous, and studies comparing directly specific intervention protocols were missing. CONCLUSION NIBS is a promising approach to improve gait in healthy young and older adults. Anodal tDCS over the motor areas and DLPFC, and tACS over the cerebellum have shown positive effects on gait.
Collapse
Affiliation(s)
- Hamzeh Baharlouei
- Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mohammad Ali Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.
| | - Ailin Talimkhani
- Department of Physical Therapy, School of Rehabilitation Sciences, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany.
| |
Collapse
|
11
|
Latarnik S, Stahl J, Vossel S, Grefkes C, Fink GR, Weiss PH. The impact of apraxia and neglect on early rehabilitation outcome after stroke. Neurol Res Pract 2022; 4:46. [PMID: 36154935 PMCID: PMC9511731 DOI: 10.1186/s42466-022-00211-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 08/03/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
This study aims to characterize the impact of apraxia and visuospatial neglect on stroke patients’ cognitive and functional outcomes during early rehabilitation. Prior work implies an unfavorable effect of visuospatial neglect on rehabilitation; however, previous findings remain ambiguous and primarily considered long-term effects. Even less is known about the impact of apraxia on rehabilitation outcomes. Although clinicians agree on the significance of the first few weeks after stroke for the course of rehabilitation, studies exploring the impact of neglect and apraxia in this early rehabilitation period remain scarce.
Methods
Based on a screening of 515 hospitalized stroke patients from an early rehabilitation ward, 150 stroke patients (75 left-hemispheric strokes, 75 right hemispheric strokes) fulfilled the inclusion criteria and were enrolled in this observational, longitudinal study. The patients’ cognitive and functional statuses were documented at admission to the early rehabilitation ward and discharge. Also, detailed apraxia and neglect assessments were performed at midterm. The predictive values of age and apraxia and neglect severity (as reflected in two components from a principal component analysis of the neglect and apraxia assessments) for cognitive and functional outcomes at discharge were evaluated by multiple regression analyses.
Results
Besides the expected influence of the respective variables at admission, we observed a significant effect of apraxia severity on the cognitive outcome at discharge. Moreover, neglect severity predicted the Early Rehabilitation Barthel Index (Frühreha-Barthel-Index) at discharge. Supplementary moderator analysis revealed a differential effect of neglect severity on the cognitive outcome depending on the affected hemisphere.
Conclusion
Data indicate a strong association between apraxia and visuospatial neglect and early rehabilitation outcomes after stroke.
Collapse
|
12
|
Ranganathan R, Doherty C, Gussert M, Kaplinski E, Koje M, Krishnan C. Scientific basis and active ingredients of current therapeutic interventions for stroke rehabilitation. Restor Neurol Neurosci 2022; 40:97-107. [DOI: 10.3233/rnn-211243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Despite tremendous advances in the treatment and management of stroke, restoring motor and functional outcomes after stroke continues to be a major clinical challenge. Given the wide range of approaches used in motor rehabilitation, several commentaries have highlighted the lack of a clear scientific basis for different interventions as one critical factor that has led to suboptimal study outcomes. Objective: To understand the content of current therapeutic interventions in terms of their active ingredients. Methods: We conducted an analysis of randomized controlled trials in stroke rehabilitation over a 2-year period from 2019-2020. Results: There were three primary findings: (i) consistent with prior reports, most studies did not provide an explicit rationale for why the treatment would be expected to work, (ii) most therapeutic interventions mentioned multiple active ingredients and there was not a close correspondence between the active ingredients mentioned versus the active ingredients measured in the study, and (iii) multimodal approaches that involved more than one therapeutic approach tended to be combined in an ad-hoc fashion, indicating the lack of a targeted approach. Conclusion: These results highlight the need for strengthening cross-disciplinary connections between basic science and clinical studies, and the need for structured development and testing of therapeutic approaches to find more effective treatment interventions.
Collapse
Affiliation(s)
- Rajiv Ranganathan
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, USA
| | - Carson Doherty
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Michael Gussert
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Eva Kaplinski
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Mary Koje
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
13
|
Veerubhotla A, Ehrenberg N, Ibironke O, Pilkar R. Accuracy comparison of machine learning algorithms at various wear-locations for activity identification post stroke: A pilot analysis . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:6106-6109. [PMID: 34892510 DOI: 10.1109/embc46164.2021.9630745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective and accurate activity identification of physical activities in everyday life is an important aspect in assessing the impact of various post-stroke rehabilitation therapies and interventions. Since post-stroke hemiparesis affects gait and balance in individuals with stroke, activity identification algorithms that consider stroke-specific movement irregularities are needed. While wearable physical activity monitors provide the means to detect activities in the free-living, algorithms using their data are specific to the wear location of the device. This pilot study builds, validates, and compares three machine learning algorithms (linear support vector machine, Random Forest, and RUSBoosted trees) at three popular wear locations (wrist, waist, and ankle) to identify and accurately distinguish mobility-related activities (sitting, standing and walking) in individuals with chronic stroke. A total of 102 minutes of data from two lab visits of three-stroke participants was used to build the classifiers. A 5-fold cross-validation technique was used to validate and compare the accuracy of classifiers. RUSBoosted trees using data from waist and ankle activity monitors, with an accuracy of 99.1%, outperformed other classifiers in detecting three activities of interest.Clinical Relevance- One of the major aims of post-stroke rehabilitation is improving mobility, which may be facilitated by understanding the structure and pattern of everyday mobility through real-world, objective outcomes. Accurate activity identification, as shown in this pilot investigation, is an essential first step before developing objective outcomes for monitoring mobility and balance in everyday life of these individuals.
Collapse
|
14
|
Kim DH, Lee Y, Park HS. Bioinspired High-Degrees of Freedom Soft Robotic Glove for Restoring Versatile and Comfortable Manipulation. Soft Robot 2021; 9:734-744. [PMID: 34388039 DOI: 10.1089/soro.2020.0167] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The human hand is one of the most complex and compact grippers that has arisen as a product of natural genetic engineering; it is highly versatile, as it handles power and precision tasks. Since proper contact points and force directions are required to ensure versatility and secure a stable grip on an object, there must be a large workspace and controllable tip force directions for the digits. Although they are important, many individuals with neuromuscular diseases experience loss of these features. Thus, we propose a high-degree-of-freedom (DOF) soft robotic glove inspired by the anatomical features of human hands. The mechanism for adjusting the position and force direction of each tip is based on the structure of the extrinsic and intrinsic muscle-tendon units. The large thumb workspace was achieved by assisting opposition/reposition and flexion/extension to enable various grasping postures. A bidirectional actuation control mechanism with a cable-actuated agonist and an elastomer antagonist increased the assisted DOF and maintained compactness. The kinematic and kinetic performances of our device were evaluated by performing tests with eight stroke survivors. The thumb workspace increased by 43%, 207%, and 248% in the distal-proximal, dorsal-palmar, and radial-ulnar directions, respectively. The pinching shear force decreased by 54% and 45% for the nonthumb digits and thumb, respectively. These device-assisted improvements allowed objects to be stably grasped and manipulated in various postures. The novel device can assist individuals with impaired hand function to improve their grasping performance. Clinical Research Information Service (CRIS) Registration Number: KCT0004855.
Collapse
Affiliation(s)
- Dong Hyun Kim
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Yechan Lee
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Hyung-Soon Park
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| |
Collapse
|
15
|
Olivier GN, Paul SS, Walter CS, Hayes HA, Foreman KB, Duff K, Schaefer SY, Dibble LE. The feasibility and efficacy of a serial reaction time task that measures motor learning of anticipatory stepping. Gait Posture 2021; 86:346-353. [PMID: 33857800 PMCID: PMC8092847 DOI: 10.1016/j.gaitpost.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 03/03/2021] [Accepted: 04/02/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Motor learning has been investigated using various paradigms, including serial reaction time tasks (SRTT) that examine upper extremity reaching and pointing while seated. Few studies have used a stepping SRTT, which could offer additional insights into motor learning involving postural demands. For a task to measure motor learning, naïve participants must demonstrate a) improved performance with task practice, and b) a dose-response relationship to learning the task. RESEARCH QUESTION Is a stepping SRTT feasible and efficacious for measuring motor learning? METHODS In this prospective study, 20 participants stood on an instrumented mat and were presented with stimuli on a computer screen. They stepped to the corresponding positions on the mat as quickly as possible. Presented stimuli included random sequences and a blinded imbedded repeating sequence. Three days after completing the randomly assigned practice dose [high dose group (n = 10) performed 4320 steps; low dose group (n = 10) performed 144 steps], a retention test of 72 steps was performed. Feasibility was measured as the proportion of participants who completed the assigned practice dose without adverse events. Efficacy was measured as within-group performance improvement on the random sequences and on the repeating sequence (paired t-tests), as well as a dose-response relationship to learning both types of sequences (independent t-tests). RESULTS All participants (mean age 26.8 years) completed all practice sessions without adverse events, indicating feasibility. High dose practice resulted in performance improvement while low dose did not; a dose-response relationship was found, with high dose practice resulting in greater learning of the task than low dose practice, indicating efficacy. SIGNIFICANCE This stepping SRTT is a feasible and efficacious way to measure motor learning, which could provide critical insights into anticipatory stepping, postural control, and fall risk. Future research is needed to determine feasibility, efficacy, and optimal practice dosages for older and impaired populations.
Collapse
Affiliation(s)
- Geneviève N Olivier
- Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA.
| | - Serene S Paul
- Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Christopher S Walter
- Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Heather A Hayes
- Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - K Bo Foreman
- Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Kevin Duff
- Neurology, University of Utah, Salt Lake City, UT, USA
| | - Sydney Y Schaefer
- Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Leland E Dibble
- Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
16
|
A System for Neuromotor Based Rehabilitation on a Passive Robotic Aid. SENSORS 2021; 21:s21093130. [PMID: 33946361 PMCID: PMC8124495 DOI: 10.3390/s21093130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 12/23/2022]
Abstract
In the aging world population, the occurrence of neuromotor deficits arising from stroke and other medical conditions is expected to grow, demanding the design of new and more effective approaches to rehabilitation. In this paper, we show how the combination of robotic technologies with progress in exergaming methodologies may lead to the creation of new rehabilitation protocols favoring motor re-learning. To this end, we introduce the Track-Hold system for neuromotor rehabilitation based on a passive robotic arm and integrated software. A special configuration of weights on the robotic arm fully balances the weight of the patients’ arm, allowing them to perform a purely neurological task, overcoming the muscular effort of similar free-hand exercises. A set of adaptive and configurable exercises are proposed to patients through a large display and a graphical user interface. Common everyday tasks are also proposed for patients to learn again the associated actions in a persistent way, thus improving life independence. A data analysis module was also designed to monitor progress and compute indices of post-stroke neurological damage and Parkinsonian-type disorders. The system was tested in the lab and in a pilot project involving five patients in the post-stroke chronic stage with partial paralysis of the right upper limb, showing encouraging preliminary results.
Collapse
|
17
|
Panizzolo FA, Cimino S, Pettenello E, Belfiore A, Petrone N, Marcolin G. Effect of a passive hip exoskeleton on walking distance in neurological patients. Assist Technol 2021; 34:527-532. [PMID: 33481693 DOI: 10.1080/10400435.2021.1880494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Severe neurodegenerative diseases such as Parkinson's disease or multiple sclerosis and acute events like stroke, spinal cord injuries, or other related pathologies have been shown to negatively impact the central and peripheral nervous systems, thus causing severe impairments to mobility. The development and utilization of exoskeletons as rehabilitation devices have shown good potential for improving patients' gait function. Ten older adults (age: 68.9 ± 9.2 yrs; height: 1.65 ± 0.08 m; mass: 71.6 ± 11.0 kg) affected by neurological diseases impacting their gait function completed a 10-session gait training protocol where they walked for 10 minutes wearing a passive exoskeleton assisting hip flexion, namely, Exoband. Results showed that participants walked a significantly longer distance in the last session of training with respect to the first session (453.1 ± 178.8 m vs 392.4 ± 135.1 m, respectively). This study indicates the potential of Exoband as an effective tool for gait rehabilitation in patients with neurological diseases. Wearable, lightweight, and low-cost devices such as the one involved in this work have the potential to improve walking distance in patients.
Collapse
Affiliation(s)
| | - S Cimino
- Department of Industrial Engineering, University of Padova, Padova, Italy
| | | | - A Belfiore
- Centro Medico di Fisioterapia, Padova, Italy
| | - N Petrone
- Department of Industrial Engineering, University of Padova, Padova, Italy
| | - G Marcolin
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| |
Collapse
|
18
|
Cramer SC, Wolf SL, Saver JL, Johnston KC, Mocco J, Lansberg MG, Savitz SI, Liebeskind DS, Smith W, Wintermark M, Elm JJ, Khatri P, Broderick JP, Janis S. The Utility of Domain-Specific End Points in Acute Stroke Trials. Stroke 2021; 52:1154-1161. [PMID: 33563009 DOI: 10.1161/strokeaha.120.031939] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Steven C Cramer
- Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles (S.C.C., J.L.S., D.S.L.).,California Rehabilitation Institute, Los Angeles (S.C.C.)
| | - Steven L Wolf
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA (S.L.W.)
| | - Jeffrey L Saver
- Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles (S.C.C., J.L.S., D.S.L.)
| | - Karen C Johnston
- Department of Neurology, University of Virginia, Charlottesville (K.C.J.)
| | - J Mocco
- Department of Neurosurgery, Mt. Sinai, New York (J.M.)
| | | | - Sean I Savitz
- Institute for Stroke and Cerebrovascular Disease, University of Texas Health Science Center, Houston (S.I.S.)
| | - David S Liebeskind
- Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles (S.C.C., J.L.S., D.S.L.)
| | - Wade Smith
- Department Neurology, University of California, San Francisco (W.S.)
| | | | - Jordan J Elm
- Department of Public Health Sciences, Medical University of South Carolina, Charleston (J.J.E.)
| | - Pooja Khatri
- Department of Neurology, University of Cincinnati (P.K.)
| | - Joseph P Broderick
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute, University of Cincinnati Academic Health Center, OH (J.P.B.)
| | - Scott Janis
- Division of Clinical Research, The National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (S.J.)
| | | |
Collapse
|
19
|
Awad LN, Lewek MD, Kesar TM, Franz JR, Bowden MG. These legs were made for propulsion: advancing the diagnosis and treatment of post-stroke propulsion deficits. J Neuroeng Rehabil 2020; 17:139. [PMID: 33087137 PMCID: PMC7579929 DOI: 10.1186/s12984-020-00747-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 08/19/2020] [Indexed: 12/29/2022] Open
Abstract
Advances in medical diagnosis and treatment have facilitated the emergence of precision medicine. In contrast, locomotor rehabilitation for individuals with acquired neuromotor injuries remains limited by the dearth of (i) diagnostic approaches that can identify the specific neuromuscular, biomechanical, and clinical deficits underlying impaired locomotion and (ii) evidence-based, targeted treatments. In particular, impaired propulsion by the paretic limb is a major contributor to walking-related disability after stroke; however, few interventions have been able to target deficits in propulsion effectively and in a manner that reduces walking disability. Indeed, the weakness and impaired control that is characteristic of post-stroke hemiparesis leads to heterogeneous deficits that impair paretic propulsion and contribute to a slow, metabolically-expensive, and unstable gait. Current rehabilitation paradigms emphasize the rapid attainment of walking independence, not the restoration of normal propulsion function. Although walking independence is an important goal for stroke survivors, independence achieved via compensatory strategies may prevent the recovery of propulsion needed for the fast, economical, and stable gait that is characteristic of healthy bipedal locomotion. We posit that post-stroke rehabilitation should aim to promote independent walking, in part, through the acquisition of enhanced propulsion. In this expert review, we present the biomechanical and functional consequences of post-stroke propulsion deficits, review advances in our understanding of the nature of post-stroke propulsion impairment, and discuss emerging diagnostic and treatment approaches that have the potential to facilitate new rehabilitation paradigms targeting propulsion restoration.
Collapse
Affiliation(s)
- Louis N Awad
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA.
| | - Michael D Lewek
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Trisha M Kesar
- Division of Physical Therapy, Emory University, Atlanta, GA, USA
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - Mark G Bowden
- Division of Physical Therapy, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
20
|
de Oliveira GR, Fabris Vidal M. A normal motor development in congenital hydrocephalus after Cuevas Medek Exercises as early intervention: A case report. Clin Case Rep 2020; 8:1226-1229. [PMID: 32695363 PMCID: PMC7364056 DOI: 10.1002/ccr3.2860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 02/14/2020] [Accepted: 03/20/2020] [Indexed: 11/12/2022] Open
Abstract
Cuevas Medek Exercises (CME) harnesses optimal scientific parameters for rehabilitation programs, and this may explain its neuroplastic outcomes. A normal motor development in a high risk of delay hydrocephalus case after CME as early intervention indicates it may be considered as research subject and treatment option to prevent motor delays.
Collapse
|
21
|
Kato J, Yamada T, Kawaguchi H, Matsuda K, Higo N. Functional near-infrared-spectroscopy-based measurement of changes in cortical activity in macaques during post-infarct recovery of manual dexterity. Sci Rep 2020; 10:6458. [PMID: 32296087 PMCID: PMC7160113 DOI: 10.1038/s41598-020-63617-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/20/2020] [Indexed: 12/19/2022] Open
Abstract
Because compensatory changes in brain activity underlie functional recovery after brain damage, monitoring of these changes will help to improve rehabilitation effectiveness. Functional near-infrared spectroscopy (fNIRS) has the potential to measure brain activity in freely moving subjects. We recently established a macaque model of internal capsule infarcts and an fNIRS system for use in the monkey brain. Here, we used these systems to study motor recovery in two macaques, for which focal infarcts of different sizes were induced in the posterior limb of the internal capsule. Immediately after the injection, flaccid paralysis was observed in the hand contralateral to the injected hemisphere. Thereafter, dexterous hand movements gradually recovered over months. After movement recovery, task-evoked hemodynamic responses increased in the ventral premotor cortex (PMv). The response in the PMv of the infarcted (i.e., ipsilesional) hemisphere increased in the monkey that had received less damage. In contrast, the PMv of the non-infarcted (contralesional) hemisphere was recruited in the monkey with more damage. A pharmacological inactivation experiment with muscimol suggested the involvement of these areas in dexterous hand movements during recovery. These results indicate that fNIRS can be used to evaluate brain activity changes crucial for functional recovery after brain damage.
Collapse
Affiliation(s)
- Junpei Kato
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki, 305-8568, Japan.,Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, 305-8577, Japan
| | - Toru Yamada
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki, 305-8568, Japan
| | - Hiroshi Kawaguchi
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki, 305-8568, Japan
| | - Keiji Matsuda
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki, 305-8568, Japan
| | - Noriyuki Higo
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki, 305-8568, Japan.
| |
Collapse
|
22
|
Wall A, Borg J, Vreede K, Palmcrantz S. A randomized controlled study incorporating an electromechanical gait machine, the Hybrid Assistive Limb, in gait training of patients with severe limitations in walking in the subacute phase after stroke. PLoS One 2020; 15:e0229707. [PMID: 32109255 PMCID: PMC7048283 DOI: 10.1371/journal.pone.0229707] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 02/11/2020] [Indexed: 01/21/2023] Open
Abstract
Early onset, intensive and repetitive, gait training may improve outcome after stroke but for patients with severe limitations in walking, rehabilitation is a challenge. The Hybrid Assistive Limb (HAL) is a gait machine that captures voluntary actions and support gait motions. Previous studies of HAL indicate beneficial effects on walking, but these results need to be confirmed in blinded, randomized controlled studies. This study aimed to explore effects of incorporating gait training with HAL as part of an inpatient rehabilitation program after stroke. Thirty-two subacute stroke patients with severe limitations in walking were randomized to incorporated HAL training (4 days/week for 4 weeks) or conventional gait training only. Blinded assessments were carried out at baseline, after the intervention, and at 6 months post stroke. The primary outcome was walking independence according to the Functional Ambulation Categories. Secondary outcomes were the Fugl-Meyer Assessment, 2-Minute Walk Test, Berg Balance Scale, and the Barthel Index. No significant between-group differences were found regarding any primary or secondary outcomes. At 6 months, two thirds of all patients were independent in walking. Prediction of independent walking at 6 months was not influenced by treatment group, but by age (OR 0.848, CI 0.719-0.998, p = 0.048). This study found no difference between groups for any outcomes despite the extra resources required for the HAL training, but highlights the substantial improvements in walking seen when evidence-based rehabilitation is provided to patients, with severe limitations in walking in the subacute stage after stroke. In future studies potential subgroups of patients who will benefit the most from electromechanically-assisted gait training should be explored.
Collapse
Affiliation(s)
- Anneli Wall
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Jörgen Borg
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Katarina Vreede
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Susanne Palmcrantz
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
23
|
Swank C, Trammell M, Callender L, Bennett M, Patterson K, Gillespie J, Kapoor P, Driver S. The impact of a patient-directed activity program on functional outcomes and activity participation after stroke during inpatient rehabilitation—a randomized controlled trial. Clin Rehabil 2020; 34:504-514. [DOI: 10.1177/0269215519901153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Individuals post stroke are inactive, even during rehabilitation, contributing to ongoing disability and risk of secondary health conditions. Our aims were to (1) conduct a randomized controlled trial to examine the efficacy of a “Patient-Directed Activity Program” on functional outcomes in people post stroke during inpatient rehabilitation and (2) examine differences three months post inpatient rehabilitation discharge. Design: Randomized control trial. Setting: Inpatient rehabilitation facility. Subjects: Patients admitted to inpatient rehabilitation post stroke. Interventions: Patient-Directed Activity Program (PDAP) or control (usual care only). Both groups underwent control (three hours of therapy/day), while PDAP participants were prescribed two additional 30-minute activity sessions/day. Main measures: Outcomes (Stroke Rehabilitation Assessment of Movement Measure, Functional Independence Measure, balance, physical activity, Stroke Impact Scale) were collected at admission and discharge from inpatient rehabilitation and three-month follow-up. Results: Seventy-three patients (PDAP ( n = 37); control ( n = 36)) were included in the primary analysis. Patients in PDAP completed a total of 23.1 ± 16.5 sessions (10.7 ± 8.5 upper extremity; 12.4 ± 8.6 lower extremity) during inpatient rehabilitation. No differences were observed between groups at discharge in functional measures. PDAP completed significantly more steps/day (PDAP = 657.70 ± 655.82, control = 396.17 ± 419.65; P = 0.022). The Stroke Impact Scale showed significantly better memory and thinking (PDAP = 86.2 ± 11.4, control = 80.8 ± 16.7; P = 0.049), communication (PDAP = 93.6 ± 8.3, control = 89.6 ± 12.4; P = 0.042), mobility (PDAP = 62.2 ± 22.5, control = 53.8 ± 21.8; P = 0.038), and overall recovery from stroke (PDAP = 62.1 ± 19.1, control = 52.2 ± 18.7; P = 0.038) for PDAP compared to control. At three months post discharge, PDAP ( n = 11) completed significantly greater physical activity ( P = 0.014; 3586.5 ± 3468.5 steps/day) compared to control ( n = 10; 1760.9 ± 2346.3 steps/day). Conclusion: Functional outcome improvement was comparable between groups; however, PDAP participants completed more steps and perceived greater recovery.
Collapse
Affiliation(s)
- Chad Swank
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, USA
| | - Molly Trammell
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, USA
| | | | | | - Kara Patterson
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, USA
| | - Jaime Gillespie
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, USA
| | - Priyanka Kapoor
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, USA
| | - Simon Driver
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, USA
| |
Collapse
|
24
|
Carey L, Walsh A, Adikari A, Goodin P, Alahakoon D, De Silva D, Ong KL, Nilsson M, Boyd L. Finding the Intersection of Neuroplasticity, Stroke Recovery, and Learning: Scope and Contributions to Stroke Rehabilitation. Neural Plast 2019; 2019:5232374. [PMID: 31191637 PMCID: PMC6525913 DOI: 10.1155/2019/5232374] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 02/04/2019] [Accepted: 03/24/2019] [Indexed: 11/17/2022] Open
Abstract
Aim Neural plastic changes are experience and learning dependent, yet exploiting this knowledge to enhance clinical outcomes after stroke is in its infancy. Our aim was to search the available evidence for the core concepts of neuroplasticity, stroke recovery, and learning; identify links between these concepts; and identify and review the themes that best characterise the intersection of these three concepts. Methods We developed a novel approach to identify the common research topics among the three areas: neuroplasticity, stroke recovery, and learning. A concept map was created a priori, and separate searches were conducted for each concept. The methodology involved three main phases: data collection and filtering, development of a clinical vocabulary, and the development of an automatic clinical text processing engine to aid the process and identify the unique and common topics. The common themes from the intersection of the three concepts were identified. These were then reviewed, with particular reference to the top 30 articles identified as intersecting these concepts. Results The search of the three concepts separately yielded 405,636 publications. Publications were filtered to include only human studies, generating 263,751 publications related to the concepts of neuroplasticity (n = 6,498), stroke recovery (n = 79,060), and learning (n = 178,193). A cluster concept map (network graph) was generated from the results; indicating the concept nodes, strength of link between nodes, and the intersection between all three concepts. We identified 23 common themes (topics) and the top 30 articles that best represent the intersecting themes. A time-linked pattern emerged. Discussion and Conclusions Our novel approach developed for this review allowed the identification of the common themes/topics that intersect the concepts of neuroplasticity, stroke recovery, and learning. These may be synthesised to advance a neuroscience-informed approach to stroke rehabilitation. We also identified gaps in available literature using this approach. These may help guide future targeted research.
Collapse
Affiliation(s)
- Leeanne Carey
- Occupational Therapy, School of Allied Health, Human Sciences and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia
- Neurorehabilitation and Recovery, Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg VIC 3084, Australia
| | - Alistair Walsh
- Occupational Therapy, School of Allied Health, Human Sciences and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia
- Neurorehabilitation and Recovery, Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg VIC 3084, Australia
| | - Achini Adikari
- Research Centre for Data Analytics and Cognition, La Trobe University, Bundoora, VIC 3086, Australia
| | - Peter Goodin
- Neurorehabilitation and Recovery, Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg VIC 3084, Australia
- Department of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, VIC 3050, Australia
| | - Damminda Alahakoon
- Research Centre for Data Analytics and Cognition, La Trobe University, Bundoora, VIC 3086, Australia
| | - Daswin De Silva
- Research Centre for Data Analytics and Cognition, La Trobe University, Bundoora, VIC 3086, Australia
| | - Kok-Leong Ong
- Research Centre for Data Analytics and Cognition, La Trobe University, Bundoora, VIC 3086, Australia
| | - Michael Nilsson
- Occupational Therapy, School of Allied Health, Human Sciences and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia
- Faculty of Health and Medicine and Centre for Rehab Innovations, The University of Newcastle, Callaghan NSW 2308, Australia
- LKC School of Medicine, Nanyang Technological University (NTU), 308232, Singapore
| | - Lara Boyd
- Djavad Mowafaghian Centre for Brain Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada V6T 1Z3
| |
Collapse
|
25
|
Villegas JD, Zapata MC, Jaramillo MC, Orozco E, Suárez JC. A case report of fat embolism syndrome: Treatment and neurological and cognitive rehabilitation. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2019; 39:22-32. [PMID: 31021544 DOI: 10.7705/biomedica.v39i1.4438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Indexed: 06/09/2023]
Abstract
Se reporta el proceso de recuperación y rehabilitación neurológica y cognitiva de una mujer joven que desarrolló un síndrome de embolia grasa con repercusiones neurológicas, después de sufrir un politraumatismo. La paciente era una mujer de 21 años de edad con fractura cerrada de húmero y fémur izquierdos, que presentó un síndrome de embolia grasa, neumotórax izquierdo e hipertensión pulmonar, en las primeras 24 horas después de un accidente. Estuvo hospitalizada un mes y quedó con varios déficits neurológicos centrales, como infartos 'lacunares' y necrosis cortical laminar occipital, así como limitaciones en la bipedestación, la marcha, la visión y las funciones cognitivas. A partir del primer mes después del alta hospitalaria, se comenzó un proceso integral de rehabilitación neurológica y cognitiva en casa, y posteriormente, en una unidad médica de rehabilitación. Durante los primeros dos años después del accidente, la paciente recibió estimulación sensorial, sensoperceptiva y motora, así como rehabilitación motora y visual intensiva. Una vez se recuperó físicamente, se inició un proceso de rehabilitación neuropsicológica. Seis años después del accidente, la paciente terminó sus estudios universitarios y hoy está laboralmente activa. El proceso de rehabilitación neurológica es complejo, individual y difícil, aunque no imposible, y no se puede estandarizar un patrón de recuperación para todos los pacientes. Si bien existe la recuperación espontánea, la cual se da en los primeros seis meses, el caso aquí reportado demuestra que, en la fase crónica, la recuperación se puede lograr, pero requiere de evaluaciones y técnicas coordinadas de rehabilitación neurológica.
Collapse
Affiliation(s)
- José Daniel Villegas
- Línea de Investigación en Discapacidad, Grupo de Investigación en Salud Pública, Facultad de Medicina, Escuela de Ciencias de la Salud, Universidad Pontificia Bolivariana, Medellín, Colombia.
| | | | | | | | | |
Collapse
|
26
|
Thant AA, Wanpen S, Nualnetr N, Puntumetakul R, Chatchawan U, Hla KM, Khin MT. Effects of task-oriented training on upper extremity functional performance in patients with sub-acute stroke: a randomized controlled trial. J Phys Ther Sci 2019; 31:82-87. [PMID: 30774211 PMCID: PMC6348189 DOI: 10.1589/jpts.31.82] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/24/2018] [Indexed: 11/26/2022] Open
Abstract
[Purpose] The present study aimed to determine the effects of a task-oriented training on
paretic upper extremity functional performance in patients with subacute stroke.
[Participants and Methods] Twenty-eight subacute stroke sufferers (mean age: 50.07,
standard deviation 9.31 years; mean time since stroke 11.11, standard deviation 6.73
weeks) were randomly allocated to task-oriented training (n=14) or conventional exercise
program (n=14) group. They were trained as a hospital-based, individualized training 1
hour a session, 5 sessions a week for 4 weeks. Wolf Motor Function Test (primary outcome),
motor portion of Fugl-Meyer assessment upper extremity, and hand function domain of Stroke
Impact Scale were assessed at baseline, after 2 and 4 weeks of training. [Results] All
participants completed their training programs. At all post-training assessments, the
task-oriented training group showed significantly more improvements in all outcomes than
the conventional exercise program group. No serious adverse effects were observed during
or after the training. [Conclusion] Task-oriented training produced statistically
significant and clinically meaningful improvements of paretic upper extremity functional
performance in patients with subacute stroke. These beneficial effects were observed after
2 weeks (10 hours) of training. Future investigation is warranted to confirm and expand
these findings.
Collapse
Affiliation(s)
- Aye Aye Thant
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University: 123 Mittraphap Rd., Mueang District, Khon Kaen, 40002, Thailand.,Department of Physiotherapy, University of Medical Technology-Yangon, Myanmar
| | - Sawitri Wanpen
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University: 123 Mittraphap Rd., Mueang District, Khon Kaen, 40002, Thailand.,Research Center in Back, Neck, Other Joint Pain & Human Performance, Khon Kaen University, Thailand
| | - Nomjit Nualnetr
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University: 123 Mittraphap Rd., Mueang District, Khon Kaen, 40002, Thailand
| | - Rungthip Puntumetakul
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University: 123 Mittraphap Rd., Mueang District, Khon Kaen, 40002, Thailand.,Research Center in Back, Neck, Other Joint Pain & Human Performance, Khon Kaen University, Thailand
| | - Uraiwan Chatchawan
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University: 123 Mittraphap Rd., Mueang District, Khon Kaen, 40002, Thailand.,Research Center in Back, Neck, Other Joint Pain & Human Performance, Khon Kaen University, Thailand
| | - Khin Myo Hla
- Department of Physical Medicine and Rehabilitation, Yangon General Hospital, Myanmar
| | - Myo Thuzar Khin
- Department of Physiotherapy, University of Medical Technology-Yangon, Myanmar
| |
Collapse
|
27
|
Suwanwela NC, Chen CLH, Lee CF, Young SH, Tay SS, Umapathi T, Lao AY, Gan HH, Baroque Ii AC, Navarro JC, Chang HM, Advincula JM, Muengtaweepongsa S, Chan BPL, Chua CL, Wijekoon N, de Silva HA, Hiyadan JHB, Wong KSL, Poungvarin N, Eow GB, Venketasubramanian N. Effect of Combined Treatment with MLC601 (NeuroAiDTM) and Rehabilitation on Post-Stroke Recovery: The CHIMES and CHIMES-E Studies. Cerebrovasc Dis 2018; 46:82-88. [PMID: 30184553 DOI: 10.1159/000492625] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 08/01/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND PURPOSE MLC601 has been shown in preclinical studies to enhance neurorestorative mechanisms after stroke. The aim of this post hoc analysis was to assess whether combining MLC601 and rehabilitation has an effect on improving functional outcomes after stroke. METHODS Data from the CHInese Medicine NeuroAiD Efficacy on Stroke (CHIMES) and CHIMES-Extension (CHIMES-E) studies were analyzed. CHIMES-E was a 24-month follow-up study of subjects included in CHIMES, a multi-centre, double-blind placebo-controlled trial which randomized subjects with acute ischemic stroke, to either MLC601 or placebo for 3 months in addition to standard stroke treatment and rehabilitation. Subjects were stratified according to whether they received or did not receive persistent rehabilitation up to month (M)3 (non- randomized allocation) and by treatment group. The modified Rankin Scale (mRS) and Barthel Index were assessed at month (M) 3, M6, M12, M18, and M24. RESULTS Of 880 subjects in CHIMES-E, data on rehabilitation at M3 were available in 807 (91.7%, mean age 61.8 ± 11.3 years, 36% female). After adjusting for prognostic factors of poor outcome (age, sex, pre-stroke mRS, baseline National Institute of Health Stroke Scale, and stroke onset-to-study-treatment time), subjects who received persistent rehabilitation showed consistently higher treatment effect in favor of MLC601 for all time points on mRS 0-1 dichotomy analysis (ORs 1.85 at M3, 2.18 at M6, 2.42 at M12, 1.94 at M18, 1.87 at M24), mRS ordinal analysis (ORs 1.37 at M3, 1.40 at M6, 1.53 at M12, 1.50 at M18, 1.38 at M24), and BI ≥95 dichotomy analysis (ORs 1.39 at M3, 1.95 at M6, 1.56 at M12, 1.56 at M18, 1.46 at M24) compared to those who did not receive persistent rehabilitation. CONCLUSIONS More subjects on MLC601 improved to functional independence compared to placebo among subjects receiving persistent rehabilitation up to M3. The larger treatment effect of MLC601 was sustained over 2 years which supports the hypothesis that MLC601 combined with rehabilitation might have beneficial and sustained effects on neuro-repair processes after stroke. There is a need for more data on the effect of combining rehabilitation programs with stroke recovery treatments.
Collapse
Affiliation(s)
- Nijasri C Suwanwela
- Chulalongkorn University, Chulalongkorn Stroke Centre, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Christopher L H Chen
- Memory Aging and Cognition Centre, Department of Pharmacology, National University of Singapore, Singapore, Singapore
| | - Chun Fan Lee
- School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong
| | | | - San San Tay
- Changi General Hospital, Singapore, Singapore
| | - Thirugnanam Umapathi
- National Neuroscience Institute, Tan Tock Seng Hospital Campus, Singapore, Singapore
| | | | - Herminigildo H Gan
- Jose Reyes Memorial Medical Center, San Lazaro Compound, Manila, Philippines
| | | | - Jose C Navarro
- Jose R Reyes Medical Center, Neuroscience Institute St Luke's Medical Center, University of Santo Tomas Hospital, Manila, Philippines
| | - Hui Meng Chang
- National Neuroscience Institute, Singapore General Hospital Campus, Singapore, Singapore
| | - Joel M Advincula
- West Visayas State University Medical Center, Iloilo, Philippines
| | | | - Bernard P L Chan
- National University Hospital, National University Health System, Singapore, Singapore
| | - Carlos L Chua
- Philippine General Hospital, University of the Philippines, Manila, Philippines
| | | | - H Asita de Silva
- Clinical Trials Unit, Faculty of Medicine, University of Kelaniya, Annasihena Road, Ragama, Sri Lanka
| | | | | | | | - Gaik Bee Eow
- Penang Hospital, Jalan Residensi, George Town, Malaysia
| | | | | |
Collapse
|
28
|
Yamada T, Kawaguchi H, Kato J, Matsuda K, Higo N. Functional near-infrared spectroscopy for monitoring macaque cerebral motor activity during voluntary movements without head fixation. Sci Rep 2018; 8:11941. [PMID: 30093721 PMCID: PMC6085340 DOI: 10.1038/s41598-018-30416-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/30/2018] [Indexed: 01/20/2023] Open
Abstract
We developed an fNIRS system for monitoring macaque cerebral motor activity during voluntary movements without head fixation. fNIRS data at 27 channels in 7.5 mm spatial interval were calibrated by simulating light propagation through the macaque cranial tissues. The subject was instructed to repeatedly (75 times) retrieve a food pellet with alternating left or right hands from a food well for each session. We detected significant increases in oxygenated hemoglobin (Hb) and decrease in deoxygenated Hb in the primary motor area (M1) contralateral to the hand used. In more rostral and ventral regions in both hemispheres, the hemodynamic similarly changed regardless of used hand. Direct feeding to the mouth eliminated activity in the hand M1 whereas that at bilateral ventral regions (mouth M1 area) remained. Statistical analyses for the hemodynamics between left/right-hand use revealed the location of each hand M1 in either hemisphere. In these regions, the maximum amplitude and time of the maximum amplitude in the hemodynamic response evoked by food retrieval were highly correlated with the time associated with food retrieval. We could assign each channel to an appropriate functional motor area, providing proof of principle for future studies involving brain damage models in freely moving macaque monkeys.
Collapse
Affiliation(s)
- Toru Yamada
- Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan.
| | - Hiroshi Kawaguchi
- Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - Junpei Kato
- Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Keiji Matsuda
- Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - Noriyuki Higo
- Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| |
Collapse
|
29
|
Shen C, Liu F, Yao L, Li Z, Qiu L, Fang S. Effects of MOTOmed movement therapy on the mobility and activities of daily living of stroke patients with hemiplegia: a systematic review and meta-analysis. Clin Rehabil 2018; 32:1569-1580. [PMID: 30088421 DOI: 10.1177/0269215518790782] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE: To estimate the effectiveness of MOTOmed® movement therapy in increasing mobility and activities of daily living in stroke patients with hemiplegia. DESIGN: Systematic review. DATA SOURCES: English- and Chinese-language articles published from the start of database coverage through 20 June 2018 were retrieved from the Embase, Web of Science, PubMed, OVID, Cochrane Central Register of Controlled Trials, Cochrane Systematic Reviews, Wanfang, Chinese National Knowledge Infrastructure, VIP, and Chinese Biomedicine databases. Articles were also retrieved by manual searches of Rehabilitation Medicine and Chinese journals. METHODS: Randomized control trials examining MOTOmed movement therapy interventions for patients with post-stroke hemiplegia were included in this review. The risk of bias assessment tool was utilized in accordance with Cochrane Handbook 5.1.0. All included studies reported mobility effects as primary outcomes. Standardized mean differences or mean differences with the corresponding 95% confidence intervals (CIs) were calculated. Review Manager 5.3 was utilized for meta-analysis. RESULTS: In total, 19 trials involving a total of 1099 patients were included in the analysis. All studies were of moderate quality, based on the Cochrane Handbook for Systematic Reviews of Intervention: Part 2:8.5. MOTOmed movement therapy resulted in a merged mean difference in the Fugl-Meyer Assessment score of 5.51 (95% CI: 4.03 to 6.98). Comparison of groups treated with and without MOTOmed movement therapy yielded the following mean differences: Modified Ashworth Scale, -1.13 (95% CI: -1.37 to -0.89); Berg Balance Scale, 13.66 (95% CI: 10.47-16.85); Functional Ambulation Category Scale, 0.85 (95% CI: 0.68-1.03); 10-m walk test, 10.15 (95% CI: 5.72-14.58); Barthel Index, 14.82 (95% CI: 12.96-16.68); and Modified Barthel Index, 11.49 (95% CI: 8.96-14.03). CONCLUSION: MOTOmed movement therapy combined with standard rehabilitation improves mobility and activities of daily living in stroke patients with hemiplegia.
Collapse
Affiliation(s)
- Cuiling Shen
- 1 Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Fang Liu
- 2 Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Liqun Yao
- 2 Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Zhongyuan Li
- 3 Rehabilitation Hospital, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Li Qiu
- 2 Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Suzhu Fang
- 1 Fujian University of Traditional Chinese Medicine, Fuzhou, China
| |
Collapse
|
30
|
Pavol MA, Bassile CC, Lehman JR, Harmon E, Ferreira N, Shinn B, St James N, Callender J, Stein J. Modified Approach to Stroke Rehabilitation (MAStR): feasibility study of a method to apply procedural memory concepts to transfer training. Top Stroke Rehabil 2018; 25:351-358. [PMID: 29609504 DOI: 10.1080/10749357.2018.1458462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Training and implementation for a multidisciplinary stroke rehabilitation method emphasizing procedural memory. BACKGROUND Current practice in stroke rehabilitation relies on explicit memory, often compromised by stroke, failing to capitalize on better-preserved procedural memory skills. Recruitment of procedural memory requires consistency and practice, characteristics difficulty to promote on inpatient rehabilitation units. We designed a method Modified Approach to Stroke Rehabilitation (MAStR) to maximize consistency and practice for transfer training with stroke patients. DESIGN Phase I, single-group study. MAStR has two innovations: (1) simplification of instructions to only three words, other direction provided non-verbally; (2) having all rehabilitation staff apply the same approach for transfers. Staff training in MAStR included review of written material describing the rationale for MAStR and demonstration of a transfer using MAStR. Enrolled patients completed each transfer with MAStR in addition to standard rehabilitation therapy. RESULTS The MAStR method was taught to a large, multidisciplinary rehabilitation staff (n = 31). Training and certification required 15 min per staff member. Five stroke patients were enrolled. No transfers with MAStR resulted in injury, no negative feedback was received from staff or patients. Staff reported satisfaction with the brief MAStR training and reported transfers were easier to complete with the MAStR method. CONCLUSIONS Feasibility was demonstrated for an innovative application of procedural memory concepts to stroke rehabilitation. All rehabilitation disciplines were successfully trained. MAStR was well-tolerated and liked by rehabilitation staff and patients. These results support pursuit of a Phase II pilot study.
Collapse
Affiliation(s)
- Marykay A Pavol
- a Cerebral Localization Lab, Stroke Division, Department of Neurology, Neurological Institute, Columbia University Medical Center , Columbia University College of Physicians & Surgeons , New York , NY , USA
| | - Clare C Bassile
- b Department of Rehabilitation and Regenerative Medicine , Columbia University College of Physicians & Surgeons , New York , NY , USA
| | - Jennifer R Lehman
- c Department of Rehabilitation Medicine (Physical Therapy) , New York Presbyterian Hospital-Columbia University , New York , NY , USA
| | - Emma Harmon
- d Department of Rehabilitation Medicine (Occupational Therapy) , New York Presbyterian Hospital-Columbia University , New York , NY , USA
| | - Nancy Ferreira
- c Department of Rehabilitation Medicine (Physical Therapy) , New York Presbyterian Hospital-Columbia University , New York , NY , USA
| | - Brittany Shinn
- d Department of Rehabilitation Medicine (Occupational Therapy) , New York Presbyterian Hospital-Columbia University , New York , NY , USA
| | - Nancy St James
- e Department of Nursing (Inpatient Rehabilitation Unit) , New York Presbyterian Hospital-Columbia University , New York , NY , USA
| | - Jacqueline Callender
- f Department of Rehabilitation Medicine (Recreation Therapy) , New York Presbyterian Hospital-Columbia University , New York , NY , USA
| | - Joel Stein
- b Department of Rehabilitation and Regenerative Medicine , Columbia University College of Physicians & Surgeons , New York , NY , USA
| |
Collapse
|
31
|
Kesar TM, Eicholtz S, Lin BJ, Wolf SL, Borich MR. Effects of posture and coactivation on corticomotor excitability of ankle muscles. Restor Neurol Neurosci 2018; 36:131-146. [PMID: 29439363 PMCID: PMC5901671 DOI: 10.3233/rnn-170773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The use of transcranial magnetic stimulation (TMS) to evaluate corticomotor excitability of lower limb (LL) muscles can provide insights about neuroplasticity mechanisms underlying LL rehabilitation. However, to date, a majority of TMS studies have focused on upper limb muscles. Posture-related activation is an important under-investigated factor influencing corticomotor excitability of LL muscles. OBJECTIVE The purpose of this study was to evaluate effects of posture and background activation on corticomotor excitability of ankle muscles. METHODS Fourteen young neurologically-unimpaired participants (26.1±4.1 years) completed the study. TMS-evoked motor evoked potentials (MEPs) were recorded from the tibialis anterior (TA) and soleus during 4 conditions - standing, standing coactivation, sitting, and sitting coactivation. TA and soleus MEP amplitudes were compared during: (1) standing versus sitting;(2) standing coactivation (standing while activating both TA and soleus) versus sitting coactivation; and (3) standing coactivation versus standing. For each comparison, background EMG for TA and soleus were matched. Trial-to-trial coefficient of variation of MEP amplitude and coil-positioning errors were additional dependent variables. RESULTS No differences were observed in TA or soleus MEP amplitudes during standing versus sitting. Compared to sitting coactivation, larger MEPs were observed during standing coactivation for soleus but not TA. Compared to standing, the standing coactivation task demonstrated larger MEPs and reduced trial-to-trial MEP variability. CONCLUSION Our findings suggest that incorporation of measurements in standing in future TMS studies may provide novel insights into neural circuits controlling LL muscles. Standing and standing coactivation tasks may be beneficial for obtaining functionally-relevant neuroplasticity assessments of LL musculature.
Collapse
Affiliation(s)
- Trisha M. Kesar
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, Atlanta, GA, USA
| | - Steven Eicholtz
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, Atlanta, GA, USA
| | - Bethany J. Lin
- Center for Visual and Neuro-cognitive Rehabilitation, Atlanta Veterans Affairs, Atlanta, GA, USA
| | - Steven L. Wolf
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, Atlanta, GA, USA
- Center for Visual and Neuro-cognitive Rehabilitation, Atlanta Veterans Affairs, Atlanta, GA, USA
| | - Michael R. Borich
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, Atlanta, GA, USA
| |
Collapse
|
32
|
Stroke Rehabilitation: Therapy Robots and Assistive Devices. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:579-587. [PMID: 30051408 DOI: 10.1007/978-3-319-77932-4_35] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Motor impairments after stroke are often persistent and disabling, and women are less likely to recover and show poorer functional outcomes. To regain motor function after stroke, rehabilitation robots are increasingly integrated into clinics. The devices fall into two main classes: robots developed to train lost motor function after stroke (therapy devices) and robots designed to compensate for lost skills (i.e., assistive devices). The article provides an overview of therapeutic options with robots for motor rehabilitation after stroke.
Collapse
|
33
|
Abstract
Purpose: (1) To determine the specific functional characteristics of individuals with neurological impairments that may predict successful use of Keeogo™ dermoskeleton and (2) to quantify the specific benefit Keeogo™ provides to a regular user of the device. Methods: Thirteen individuals (seven males; six females; 52 ± 4.6 years old) with mobility impairments due to neurological disease or injury were recruited. Berg Balance Sale (BBS) score and Timed Up and Go (TUG) performance were used to identify baseline characteristics in participants. The 6-min walk test (6MWT) and 25-foot walk test (25FWT) were performed with the participants wearing and not wearing the dermoskeleton; a successful user of Keeogo™ displayed a ≥ 5% improvement in walking performance while wearing the device. A chronic stroke survivor (hemiparesis on left side) completed the stair climb test (SCT) and the 30-second chair stand test (30CST) with and without Keeogo™. Muscle activity, kinetics and postural control were analyzed during the sit-to-stand (sitTS), and compared to an age- and sex-matched healthy control. Results: Successful users of Keeogo™ have a moderate level of functionality (BBS: 46-51 s and/or TUG: 8-12 s). Wearing Keeogo™ improved performance on the 30CST, SCT and improved motor control, postural control and movement kinetics during the sitTS task in a chronic stroke survivor with significant hemiparesis. Conclusion: This is the first study providing data to help to identify which individuals with neurological impairment might benefit from using Keeogo™ dermoskeleton, together with new information quantifying its functional benefit to the user. Implications for Rehabilitation Keeogo™ is a user-initiated dermoskeleton that has been designed to assist individuals with mobility impairments to participate more effectively in activities of daily living (ADLs). Moderately impaired individuals have the greatest potential to benefit from using the device. Benefits of wearing the device include improvements in walking speed and endurance, performance on ADLs, motor control, kinetics, and postural control.
Collapse
Affiliation(s)
- Jonathan C Mcleod
- a Department of Kinesiology, McMaster University , Hamilton , Ontario , Canada
| | - Susie Jm Ward
- a Department of Kinesiology, McMaster University , Hamilton , Ontario , Canada
| | - Audrey L Hicks
- a Department of Kinesiology, McMaster University , Hamilton , Ontario , Canada
| |
Collapse
|
34
|
Marsal C, Gracies JM, Dean C, Mesure S, Bayle N. Beliefs of rehabilitation professionals towards guided self-rehabilitation contracts for post stroke hemiparesis. Top Stroke Rehabil 2017; 24:608-613. [PMID: 28956737 DOI: 10.1080/10749357.2017.1373501] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Purpose To investigate the beliefs of physiotherapy students (ST), professionals (PT) and physicians (MD) about engaging patients with post-stroke hemiparesis into Guided Self-Rehabilitation Contracts (GSC), to increase their exercise intensity and responsibility level. Method A survey examining beliefs about post-stroke rehabilitation was completed by first (n = 95), second (n = 105), and third (n = 48) year STs; PTs (n = 129) and MDs (n = 65) in France. Results The belief about whether a patient may exercise alone varied between the professional groups with more STs and MDs finding it acceptable: 62% of PTs vs. 74% of STs (p = 0.005) and 79% of MDs (p = 0.02). For 93% of therapists (STs and PTs together), the caregiver may take part in physical therapy sessions. The appropriate weekly duration of exercises in chronic hemiparesis should be over 5 h for 19% of PTs, 37% of STs, and 51% of MDs (MDs vs. PTs, p < 0.005). After stroke, functional progress through rehabilitation is possible all lifelong for 11% of STs, 19% of PTs (p < 0.05, STs vs. PTs), and 29% of MDs (MD vs. PT, NS). Conclusions The strategy of asking patients to perform exercises alone, in the practice or at home, is still not accepted by a large proportion of physical therapy professionals as compared with students or with physicians. Most therapists still see a <5-h weekly duration of exercise as sufficient after stroke. Few therapists are ready to utilize the persistence of behavior-induced brain plasticity regardless of age or delay after the lesion.
Collapse
Affiliation(s)
- Claire Marsal
- a Ecole Nationale de Kinésithérapie et de Rééducation , Saint-Maurice, France
| | - Jean-Michel Gracies
- b Laboratoire Analyse et Restauration du Mouvement, Service de Rééducation Neurolocomotrice, EA 7377 BIOTN, AP-HP, Hôpitaux Universitaires Henri Mondor, Université Paris-Est Créteil (UPEC) , Créteil , France
| | - Catherine Dean
- c Faculty of Medicine and Health Sciences, Department of Health Professions , Macquarie University , Sydney , Australia
| | - Serge Mesure
- d UMR 7287 Institut des Sciences du Mouvement , CNRS & Aix Marseille Université Faculté des Sciences du Sport , Marseille , France
| | - Nicolas Bayle
- b Laboratoire Analyse et Restauration du Mouvement, Service de Rééducation Neurolocomotrice, EA 7377 BIOTN, AP-HP, Hôpitaux Universitaires Henri Mondor, Université Paris-Est Créteil (UPEC) , Créteil , France
| |
Collapse
|
35
|
Use of Lower-Limb Robotics to Enhance Practice and Participation in Individuals With Neurological Conditions. Pediatr Phys Ther 2017; 29 Suppl 3:S48-S56. [PMID: 28654477 DOI: 10.1097/pep.0000000000000379] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To review lower-limb technology currently available for people with neurological disorders, such as spinal cord injury, stroke, or other conditions. We focus on 3 emerging technologies: treadmill-based training devices, exoskeletons, and other wearable robots. SUMMARY OF KEY POINTS Efficacy for these devices remains unclear, although preliminary data indicate that specific patient populations may benefit from robotic training used with more traditional physical therapy. Potential benefits include improved lower-limb function and a more typical gait trajectory. STATEMENT OF CONCLUSIONS Use of these devices is limited by insufficient data, cost, and in some cases size of the machine. However, robotic technology is likely to become more prevalent as these machines are enhanced and able to produce targeted physical rehabilitation. RECOMMENDATIONS FOR CLINICAL PRACTICE Therapists should be aware of these technologies as they continue to advance but understand the limitations and challenges posed with therapeutic/mobility robots.
Collapse
|
36
|
Dierick F, Dehas M, Isambert JL, Injeyan S, Bouché AF, Bleyenheuft Y, Portnoy S. Hemorrhagic versus ischemic stroke: Who can best benefit from blended conventional physiotherapy with robotic-assisted gait therapy? PLoS One 2017; 12:e0178636. [PMID: 28575054 PMCID: PMC5456343 DOI: 10.1371/journal.pone.0178636] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 05/16/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Contrary to common belief of clinicians that hemorrhagic stroke survivors have better functional prognoses than ischemic, recent studies show that ischemic survivors could experience similar or even better functional improvements. However, the influence of stroke subtype on gait and posture outcomes following an intervention blending conventional physiotherapy with robotic-assisted gait therapy is missing. OBJECTIVE This study compared gait and posture outcome measures between ambulatory hemorrhagic patients and ischemic patients, who received a similar 4 weeks' intervention blending a conventional bottom-up physiotherapy approach and an exoskeleton top-down robotic-assisted gait training (RAGT) approach with Lokomat. METHODS Forty adult hemiparetic stroke inpatient subjects were recruited: 20 hemorrhagic and 20 ischemic, matched by age, gender, side of hemisphere lesion, stroke severity, and locomotor impairments. Functional Ambulation Category, Postural Assessment Scale for Stroke, Tinetti Performance Oriented Mobility Assessment, 6 Minutes Walk Test, Timed Up and Go and 10-Meter Walk Test were performed before and after a 4-week long intervention. Functional gains were calculated for all tests. RESULTS Hemorrhagic and ischemic subjects showed significant improvements in Functional Ambulation Category (P<0.001 and P = 0.008, respectively), Postural Assessment Scale for Stroke (P<0.001 and P = 0.003), 6 Minutes Walk Test (P = 0.003 and P = 0.015) and 10-Meter Walk Test (P = 0.001 and P = 0.024). Ischemic patients also showed significant improvements in Timed Up and Go. Significantly greater mean Functional Ambulation Category and Tinetti Performance Oriented Mobility Assessment gains were observed for hemorrhagic compared to ischemic, with large (dz = 0.81) and medium (dz = 0.66) effect sizes, respectively. CONCLUSION Overall, both groups exhibited quasi similar functional improvements and benefits from the same type, length and frequency of blended conventional physiotherapy and RAGT protocol. The use of intensive treatment plans blending top-down physiotherapy and bottom-up robotic approaches is promising for post-stroke rehabilitation.
Collapse
Affiliation(s)
- Frédéric Dierick
- Forme & Fonctionnement Humain Research Unit, Department of Physical Therapy, Haute Ecole Louvain en Hainaut, Montignies sur Sambre, Belgium
- Faculty of Motor Sciences, Université catholique de Louvain, Louvain-la-Neuve, Belgium
- * E-mail:
| | - Mélanie Dehas
- Forme & Fonctionnement Humain Research Unit, Department of Physical Therapy, Haute Ecole Louvain en Hainaut, Montignies sur Sambre, Belgium
| | | | - Soizic Injeyan
- « Le Normandy » Rehabilitation Center, Granville, France
| | - Anne-France Bouché
- Forme & Fonctionnement Humain Research Unit, Department of Physical Therapy, Haute Ecole Louvain en Hainaut, Montignies sur Sambre, Belgium
- Rehabilitation Unit, « Le Richemont », Bioul, Belgium
| | - Yannick Bleyenheuft
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Sigal Portnoy
- Department of Occupational Therapy, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
37
|
Yoshikawa K, Mizukami M, Kawamoto H, Sano A, Koseki K, Sano K, Asakawa Y, Kohno Y, Nakai K, Gosho M, Tsurushima H. Gait training with Hybrid Assistive Limb enhances the gait functions in subacute stroke patients: A pilot study. NeuroRehabilitation 2017; 40:87-97. [PMID: 27814305 DOI: 10.3233/nre-161393] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The robotic Hybrid Assistive Limb (HAL) provides motion according to the wearer's voluntary activity. HAL training effects on walking speed and capacity have not been clarified in subacute stroke. OBJECTIVES To determine improvement in walking ability by HAL and the most effective improvement measure for use in future large-scale trials. METHODS Sixteen first-ever hemiplegic stroke patients completed at least 20 sessions over 5 weeks. Per session, the experimental group received no more than 20 min of gait training with HAL (HT) and 40 min of conventional physiotherapy, whereas the control group received at least 60 min of conventional physiotherapy. Primary outcome was maximum walking speed (MWS). RESULTS The change in MWS from baseline at week 5 was 11.6±10.6 m/min (HAL group) and 2.2±4.1 m/min (control group) (adjusted mean difference = 9.24 m/min, 95% confidence interval 0.48-18.01, P = 0.040). In HAL subjects there were significant increases in Self-selected walking speed (SWS; a secondary outcome) and in step length (a secondary outcome) at MWS and SWS compared with controls. CONCLUSIONS HT improved walking speed in hemiplegic sub-acute stroke patients. In future, randomized controlled trials are needed to confirm the utility of HT.
Collapse
Affiliation(s)
- Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami Ibaraki, Japan
| | - Masafumi Mizukami
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ami Ibaraki, Japan
| | - Hiroaki Kawamoto
- Faculty of Systems and Information Engineering, University of Tsukuba, Tsukuba Ibaraki, Japan
| | - Ayumu Sano
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami Ibaraki, Japan
| | - Kazunori Koseki
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami Ibaraki, Japan
| | - Kumiko Sano
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami Ibaraki, Japan
| | - Yasutsugu Asakawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ami Ibaraki, Japan
| | - Yutaka Kohno
- Department of Neurology, Ibaraki Prefectural University of Health Sciences Hospital, Ami Ibaraki, Japan
| | - Kei Nakai
- Department of Neurology, Ibaraki Prefectural University of Health Sciences Hospital, Ami Ibaraki, Japan.,Faculty of Medicine, University of Tsukuba, Tsukuba Ibaraki, Japan
| | - Masahiko Gosho
- Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba Ibaraki, Japan
| | - Hideo Tsurushima
- Faculty of Medicine, University of Tsukuba, Tsukuba Ibaraki, Japan
| |
Collapse
|
38
|
Signal N, McPherson K, Lewis G, Kayes N, Saywell N, Mudge S, Taylor D. What influences acceptability and engagement with a high intensity exercise programme for people with stroke? A qualitative descriptive study. NeuroRehabilitation 2017; 39:507-517. [PMID: 27689610 DOI: 10.3233/nre-161382] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Intensity refers to the amount of effort or rate of work undertaken during exercise. People receiving rehabilitation after stroke frequently do not reach the moderate to high intensity exercise recommended to maximise gains. OBJECTIVE To explore the factors that influence the acceptability of, and engagement with, a high intensity group-based exercise programme for people with stroke. METHODS This qualitative descriptive study included 14 people with stroke who had completed a 12-week, high intensity group-based exercise rehabilitation programme. Semi-structured interviews were used to explore the acceptability of high intensity exercise and the barriers and facilitators to engagement. Interviews were recorded, transcribed and analysed using qualitative content analysis. RESULTS The participants found high intensity exercise rehabilitation acceptable despite describing the exercise intensity as hard and reporting post-exercise fatigue. Participants accepted the fatigue as a normal response to exercise, and it did not appear to negatively influence engagement. The ease with which an individual engaged in high intensity exercise rehabilitation appeared to be mediated by inter-related factors, including: seeing progress, sourcing motivation, working hard, the people involved and the fit with the person and their life. Participants directly related the intensity of their effort to the gains that they made. CONCLUSIONS In this study, people with stroke viewed training at higher intensities as a facilitator, not a barrier, to engagement in exercise rehabilitation. The findings may challenge assumptions about the influence of exercise intensity on engagement.
Collapse
Affiliation(s)
- Nada Signal
- Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand
| | - Kathryn McPherson
- Health Research Council of New Zealand, Auckland, New Zealand.,Centre for Person Centered Research, AUT University, Auckland, New Zealand
| | - Gwyn Lewis
- Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand
| | - Nicola Kayes
- Centre for Person Centered Research, AUT University, Auckland, New Zealand
| | - Nicola Saywell
- Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand
| | - Suzie Mudge
- Centre for Person Centered Research, AUT University, Auckland, New Zealand
| | - Denise Taylor
- Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand
| |
Collapse
|
39
|
Krishnan S, Pappadis MR, Weller SC, Fisher SR, Hay CC, Reistetter TA. Patient-centered mobility outcome preferences according to individuals with stroke and caregivers: a qualitative analysis. Disabil Rehabil 2017; 40:1401-1409. [PMID: 28320217 DOI: 10.1080/09638288.2017.1297855] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To explore the mobility-related preferences among stroke survivors and caregivers following post-acute rehabilitation at inpatient or skilled nursing facilities. METHODS In this cross-sectional study; semi-structured, qualitative interviews of stroke survivors (n = 24) and informal caregivers (n = 15) were conducted. The participants were recruited from the community. RESULTS Comparative content analysis was used to identify themes by two independent coders. The survivors (68 years) and caregivers (58 years) mentioned mobility-related consequences including inability to walk, balance, drive, and transfer; and increased falls. The survivors (63%) and caregivers (73%) also mentioned the use of assistive devices. The common rehabilitation activities included: walking (62%); followed by standing and mobility; strength and balance; and wheelchair skills. Some stroke survivors were dissatisfied as their rehabilitation was not patient-centered. Frequently mentioned outcome preferences by survivors were ability to walk (88%), move, and balance. They also wanted to acquire assistive devices to move independently. Caregivers were concerned with the survivor's safety and wanted them to drive (53%), prevent falls, have home accommodations, and transfer independently. Caregivers (40%) also expressed the importance of receiving realistic information. CONCLUSIONS This study suggests a need to consider the stroke survivors' and caregivers' mobility outcome preferences to improve the patient-centered rehabilitation care. Implications for Rehabilitation Stroke survivors and caregivers tend to differ in their outcome preferences. Caregivers expressed concern for transfers, driving, fall prevention, home modifications, and wished for realistic information. Incorporating stroke survivors and their families' perspectives during rehabilitation may enhance patient-centered outcomes.
Collapse
Affiliation(s)
- Shilpa Krishnan
- a Department of Occupational Therapy , University of Texas Medical Branch , Galveston , TX , USA
| | - Monique R Pappadis
- b Division of Rehabilitation Sciences , University of Texas Medical Branch , Galveston , TX , USA
| | - Susan C Weller
- c Preventive Medicine and Community Health , University of Texas Medical Branch , Galveston , TX , USA
| | - Steve R Fisher
- d Department of Physical Therapy , University of Texas Medical Branch , Galveston , TX , USA
| | - Catherine C Hay
- b Division of Rehabilitation Sciences , University of Texas Medical Branch , Galveston , TX , USA
| | - Timothy A Reistetter
- a Department of Occupational Therapy , University of Texas Medical Branch , Galveston , TX , USA.,b Division of Rehabilitation Sciences , University of Texas Medical Branch , Galveston , TX , USA
| |
Collapse
|
40
|
McCain KJ, Shearin S. The impact of modified standardized task-specific training (MSTT) on gait outcomes in persons with subacute stroke: A case report. COGENT MEDICINE 2017. [DOI: 10.1080/2331205x.2017.1417669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Karen J. McCain
- Department of Physical Therapy, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Mail Code 8876, Dallas, TX, 75390, USA
| | - Staci Shearin
- Department of Physical Therapy, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Mail Code 8876, Dallas, TX, 75390, USA
| |
Collapse
|
41
|
Abstract
In contemporary society, the image of the “flexible brain” and the notion of neuroplasticity are increasingly replacing that of the static mature brain. Brains and neurons are considered to be constantly generated and regenerated. Age cohort comparisons and longitudinal studies introduce a developmental perspective to the field. However, these articulations and investigations occur within a sociopolitical field marked by vested interests and the celebration of all things neural. Utilizing the notion of “the generational brain,” we propose that it is fruitful to exploit the polysemity of the word “generation,” as well as the historicity of scientific concepts and methods, to interrogate and re/formulate questions currently addressed in developmental neuroscience in particular and neuroscience in general. This special issue’s contributions provide an early impression of what a “critical friendship” with developmental neuroscience, aware of its sociocultural and epistemological implications as well as the historicity of concepts, may look like.
Collapse
|
42
|
Miltner WHR, Bauder H, Taub E. Change in Movement-Related Cortical Potentials Following Constraint-Induced Movement Therapy (CIMT) After Stroke. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2016. [DOI: 10.1027/2151-2604/a000245] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Abstract. Patients with chronic stroke were given Constraint-Induced Movement Therapy (CIMT) over an intensive two-week course of treatment. The intervention resulted in a large improvement in use of the more-affected upper extremity in the laboratory and in the real-world environment. High-resolution electroencephalography (EEG) showed that the treatment produced marked changes in cortical activity that correlated with the significant rehabilitative effects. Repetitive unilateral self-paced voluntary movements showed a large increase after treatment in the amplitudes of the late components of the Bereitschaftspotential (BP) both in the hemisphere contralateral to the more-affected arm and in the ipsilateral hemisphere. Simultaneous electromyographic recordings (EMG) and other aspects of the data indicate that the emergence of the movement-related neural source in the healthy hemisphere was not due to mirror movements of the non-test hand and that the increase in BP amplitudes was not the result of an increase in the force or effort of the response pre- to post-treatment. The results are consistent with the rehabilitation treatment having produced a use-dependent cortical reorganization and is a case where the physiological data interdigitates with and provides additional credibility to the clinical data.
Collapse
Affiliation(s)
- Wolfgang H. R. Miltner
- Department of Biological and Clinical Psychology, Friedrich Schiller University, Jena, Germany
| | - Heike Bauder
- Department of Biological and Clinical Psychology, Friedrich Schiller University, Jena, Germany
| | - Edward Taub
- Department of Psychology, University of Alabama at Birmingham, AL, USA
| |
Collapse
|
43
|
Miltner WHR. Plasticity and Reorganization in the Rehabilitation of Stroke. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2016. [DOI: 10.1027/2151-2604/a000243] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Abstract. This paper outlines some actual developments in the behavioral treatment and rehabilitation of stroke and other brain injuries in post-acute and chronic conditions of brain lesion. It points to a number of processes that demonstrate the enormous plasticity and reorganization capacity of the human brain following brain lesion. It also highlights a series of behavioral and neuroscientific studies that indicate that successful behavioral rehabilitation is paralleled by plastic changes of brain structures and by cortical reorganization and that the amount of such plastic changes is obviously significantly determining the overall outcome of rehabilitation.
Collapse
Affiliation(s)
- Wolfgang H. R. Miltner
- Department of Biological and Clinical Psychology, Friedrich Schiller University, Jena, Germany
| |
Collapse
|
44
|
Trammell M, Kapoor P, Swank C, Driver S. Improving practice with integration of patient directed activity during inpatient rehabilitation. Clin Rehabil 2016; 31:3-10. [PMID: 26837432 DOI: 10.1177/0269215515625100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Early initiation of rehabilitation following stroke promotes better long-term outcomes than delayed onset, emphasizing the importance of inpatient therapy. However, literature indicates that following stroke individuals in inpatient rehabilitation spend the majority of their day in their bedroom and inactive. Consequently, since amount of functional activity is posited to relate to outcomes, the current rehabilitation model needs to be challenged with innovative solutions to maximize recovery. RATIONALE In an attempt to promote greater activity and higher doses of therapy during inpatient rehabilitation, we implemented the "Patient Directed Activity Program" to facilitate specific movement and improve outcomes for patients post stroke. Our interdisciplinary activity program was conceptualized on a theoretical model for stroke recovery and principles of experience-dependent neural plasticity. MAIN FEATURES The "Patient Directed Activity Program" includes distinct activity stations designed to increase repetition, stimulation, attention, and activity of the affected upper extremities, lower extremities, and trunk. Each task-specific activity was easily graded to achieve moderate- to high-intensity. The activity program prescribed individuals up to three additional 30-minute bouts of activities daily that were to be completed independently, and in addition to standard of care. Clinical application: After implementing this program in our facility for one year as a quality improvement project, the intervention has been delivered as an Institutional Review Board approved randomized controlled trial (Clinical Trial #NCT02446197). Challenges with people and facilities have been overcome, resulting in a feasible program that can be delivered in an inpatient setting. High satisfaction has been reported by patients and clinicians.
Collapse
Affiliation(s)
- Molly Trammell
- 1 Physical Medicine and Rehabilitation, Baylor Institute for Rehabilitation, Dallas, TX, USA
| | - Priyanka Kapoor
- 1 Physical Medicine and Rehabilitation, Baylor Institute for Rehabilitation, Dallas, TX, USA
| | - Chad Swank
- 1 Physical Medicine and Rehabilitation, Baylor Institute for Rehabilitation, Dallas, TX, USA.,2 Department of Physical Therapy, Texas Woman's University, TX, USA
| | - Simon Driver
- 1 Physical Medicine and Rehabilitation, Baylor Institute for Rehabilitation, Dallas, TX, USA
| |
Collapse
|
45
|
The Effects of Combination of Robot-Assisted Therapy With Task-Specific or Impairment-Oriented Training on Motor Function and Quality of Life in Chronic Stroke. PM R 2016; 8:721-9. [PMID: 26805909 DOI: 10.1016/j.pmrj.2016.01.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 12/14/2015] [Accepted: 01/13/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Robot-assisted therapy (RT) is a promising intervention for stroke rehabilitation. RT hybridized with therapist-mediated therapy (eg, RT plus task-specific or impairment-oriented training) may possibly yield functionally relevant improvements. A comparative study of the different combination regimens is needed. OBJECTIVE To investigate the efficacy of RT combined with task-specific training or impairment-oriented training on motor function and quality of life in patients with chronic stroke. DESIGN A single-blind, randomized comparative efficacy study. SETTING Two medical centers in Taiwan. PARTICIPANTS Twenty-one subjects with chronic stroke. INTERVENTIONS Participants were recruited and randomized into 1 of 2 groups: (1) RT combined with task-specific (RTT) training (enrolled, n = 11; completed, n = 11) or (2) RT combined with impairment-oriented (RTI) training (enrolled, n = 10; completed, n = 9). Participants received 20 intervention sessions (90-100 min/d, 5 d/wk for 4 weeks). OUTCOMES The Fugl-Meyer Motor Assessment Upper Extremity subscale, Stroke Impact Scale, Action Research Arm Test, and Medical Research Council Scale were administered at baseline, posttreatment, and at 3-month follow-up. Two-way repeated-measures analysis of variance was used to investigate the treatment effects. RESULTS The improvements of the RTT group in motor function measured by the Fugl-Meyer Motor Assessment Upper Extremity subscale and quality of life assessed by the Stroke Impact Scale were significantly superior to the RTI group after the interventions. The improvements of the RTT group were maintained for 3 months. Both groups demonstrated significant within-group improvements in motor function, muscle power, and quality of life. CONCLUSIONS RTT may be a more compelling approach to enhance motor function and quality of life for a long-term period than RTI. The combination of RT with task-specific training and with impairment-oriented training had similar benefits on upper limb motor function and muscle strength immediately after the interventions.
Collapse
|
46
|
Ganguly K, Byl NN, Abrams GM. Neurorehabilitation: motor recovery after stroke as an example. Ann Neurol 2015; 74:373-81. [PMID: 25813243 DOI: 10.1002/ana.23994] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 07/31/2013] [Accepted: 07/31/2013] [Indexed: 12/13/2022]
Abstract
The field of neurorehabilitation aims to translate neuroscience research toward the goal of maximizing functional recovery after neurological injury. A growing body of research indicates that the fundamental principles of neurological rehabilitation are applicable to a broad range of congenital, degenerative, and acquired neurological disorders. In this perspective, we will focus on motor recovery after acquired brain injuries such as stroke. Over the past few decades, a large body of basic and clinical research has created an experimental and theoretical foundation for approaches to neurorehabilitation. Recent randomized clinical trials all emphasize the requirement for intense progressive rehabilitation programs to optimally enhance recovery. Moreover, advances in multimodal assessment of patients with neuroimaging and neurophysiological tools suggest the possibility of individualized treatment plans based on recovery potential. There are also promising indications for medical as well as noninvasive brain stimulation paradigms to facilitate recovery. Ongoing or planned clinical studies should provide more definitive evidence. We also highlight unmet needs and potential areas of research. Continued research built upon a robust experimental and theoretical foundation should help to develop novel treatments to improve recovery after neurological injury.
Collapse
Affiliation(s)
- Karunesh Ganguly
- Department of Neurology and Rehabilitation, San Francisco Veterans Administration Medical Center, University of California, San Francisco, San Francisco, CA; Departments of Neurology, University of California, San Francisco, San Francisco, CA
| | | | | |
Collapse
|
47
|
Wall A, Borg J, Palmcrantz S. Clinical application of the Hybrid Assistive Limb (HAL) for gait training-a systematic review. Front Syst Neurosci 2015; 9:48. [PMID: 25859191 PMCID: PMC4373251 DOI: 10.3389/fnsys.2015.00048] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/10/2015] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE The aim of this study was to review the literature on clinical applications of the Hybrid Assistive Limb system for gait training. METHODS A systematic literature search was conducted using Web of Science, PubMed, CINAHL and clinicaltrials.gov and additional search was made using reference lists in identified reports. Abstracts were screened, relevant articles were reviewed and subject to quality assessment. RESULTS Out of 37 studies, 7 studies fulfilled inclusion criteria. Six studies were single group studies and 1 was an explorative randomized controlled trial. In total, these studies involved 140 participants of whom 118 completed the interventions and 107 used HAL for gait training. Five studies concerned gait training after stroke, 1 after spinal cord injury (SCI) and 1 study after stroke, SCI or other diseases affecting walking ability. Minor and transient side effects occurred but no serious adverse events were reported in the studies. Beneficial effects on gait function variables and independence in walking were observed. CONCLUSIONS The accumulated findings demonstrate that the HAL system is feasible when used for gait training of patients with lower extremity paresis in a professional setting. Beneficial effects on gait function and independence in walking were observed but data do not allow conclusions. Further controlled studies are recommended.
Collapse
Affiliation(s)
- Anneli Wall
- Department of Rehabilitation Medicine, Danderyd University Hospital Stockholm, Sweden ; Department of Clinical Sciences, Karolinska Institute Stockholm, Sweden
| | - Jörgen Borg
- Department of Rehabilitation Medicine, Danderyd University Hospital Stockholm, Sweden ; Department of Clinical Sciences, Karolinska Institute Stockholm, Sweden
| | - Susanne Palmcrantz
- Department of Rehabilitation Medicine, Danderyd University Hospital Stockholm, Sweden ; Department of Clinical Sciences, Karolinska Institute Stockholm, Sweden
| |
Collapse
|
48
|
Burdea GC, Polistico K, House GP, Liu RR, Muñiz R, Macaro NA, Slater LM. Novel integrative virtual rehabilitation reduces symptomatology of primary progressive aphasia--a case report. Int J Neurosci 2014; 125:949-58. [PMID: 25485610 PMCID: PMC6710825 DOI: 10.3109/00207454.2014.993392] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE BrightBrainer™ integrative cognitive rehabilitation system evaluation in an Adult Day Program by a subject with Primary Progressive Aphasia (PPA) assumed to be of the mixed nonfluent/logopenic variant, and for determination of potential benefits. METHODS The subject was a 51-year-old Caucasian male diagnosed with PPA who had attended an Adult Day Program for 18 months prior to BrightBrainer training. The subject interacted with therapeutic games using a controller that measured 3D hand movements and flexion of both index fingers. The computer simulations adapted difficulty level based on task performance; results were stored on a remote server. The clinical trial consisted of 16 sessions, twice/week for 8 weeks. The subject was evaluated through neuropsychological measures, therapy notes and caregiver feedback forms. RESULTS Neuropsychological testing indicated no depression (BDI 0) and severe dementia (BIMS 1 and MMSE 3). The 6.5 h of therapy consisted of games targeting Language comprehension; Executive functions; Focusing; Short-term memory; and Immediate/working memory. The subject attained the highest difficulty level in all-but-one game, while averaging 1300-arm task-oriented active movement repetitions and 320 index finger flexion movements per session. While neuropsychological testing showed no benefits, the caregiver reported strong improvements in verbal responses, vocabulary use, speaking in complete sentences, following one-step directions and participating in daily activities. This corroborated well with therapy notes. CONCLUSIONS Preliminary findings demonstrate a meaningful reduction of PPA symptoms for the subject, suggesting follow-up imaging studies to detail neuronal changes induced by BrightBrainer system and controlled studies with a sufficiently large number of PPA subjects.
Collapse
Affiliation(s)
- Grigore C. Burdea
- Bright Cloud International Corp, 29 L’Ambiance Court, Highland Park, NJ 08904, USA
| | - Kevin Polistico
- Bright Cloud International Corp, 29 L’Ambiance Court, Highland Park, NJ 08904, USA
| | - Gregory P. House
- Bright Cloud International Corp, 29 L’Ambiance Court, Highland Park, NJ 08904, USA
| | - Richard R. Liu
- Bright Cloud International Corp, 29 L’Ambiance Court, Highland Park, NJ 08904, USA
| | - Roberto Muñiz
- Francis E. Parker Memorial Home, Inc., 1421 River Road, Piscataway, NJ 08854, USA
| | - Natalie A. Macaro
- Francis E. Parker Memorial Home, Inc., 1421 River Road, Piscataway, NJ 08854, USA
| | - Lisa M. Slater
- Francis E. Parker Memorial Home, Inc., 1421 River Road, Piscataway, NJ 08854, USA
| |
Collapse
|
49
|
Schaefer SY, Dibble LE, Duff K. Efficacy and Feasibility of Functional Upper Extremity Task-Specific Training for Older Adults With and Without Cognitive Impairment. Neurorehabil Neural Repair 2014; 29:636-44. [PMID: 25416739 DOI: 10.1177/1545968314558604] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although functional task-specific training is a viable approach for upper extremity neurorehabilitation, its appropriateness for older populations is unclear. If task-specific training is to be prescribed to older adults, it must be efficacious and feasible, even in patients with cognitive decline due to advancing age. OBJECTIVE This cross-sectional study tested the efficacy and feasibility of upper extremity task-specific training in older adults, including those with lower cognitive scores. METHODS Fifty older adults (age 65-89 years) without any confounding neuromuscular impairment were randomly assigned to a training group or no-training group. The training group completed 3 days (dosage = 2250 repetitions) of a functional upper extremity motor task (simulated feeding) with their nondominant hand; the no-training group completed no form of training at all. Both groups' task performance (measured as trial time) was tested at pre- and posttest, and the training group was retested 1 month later. Efficacy was determined by rate, amount, and retention of training-related improvement, and compared across levels of cognitive status. Feasibility was determined by participants' tolerance of the prescribed training dose. RESULTS The training group was able to complete the training dose without adverse responses and showed a significant rate, amount, and retention of improvement compared with the no-training group. Cognitive status did not alter results, although participants with lower scores on the Montreal Cognitive Assessment were slower overall. CONCLUSIONS Task-specific training may be appropriate for improving upper extremity function in older adults, yet future work in older patients with specific neurological conditions is needed.
Collapse
Affiliation(s)
- Sydney Y Schaefer
- Utah State University, Logan, UT, USA University of Utah, Salt Lake City, UT, USA
| | | | - Kevin Duff
- University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
50
|
Ilg W, Bastian AJ, Boesch S, Burciu RG, Celnik P, Claaßen J, Feil K, Kalla R, Miyai I, Nachbauer W, Schöls L, Strupp M, Synofzik M, Teufel J, Timmann D. Consensus paper: management of degenerative cerebellar disorders. THE CEREBELLUM 2014; 13:248-68. [PMID: 24222635 DOI: 10.1007/s12311-013-0531-6] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Treatment of motor symptoms of degenerative cerebellar ataxia remains difficult. Yet there are recent developments that are likely to lead to significant improvements in the future. Most desirable would be a causative treatment of the underlying cerebellar disease. This is currently available only for a very small subset of cerebellar ataxias with known metabolic dysfunction. However, increasing knowledge of the pathophysiology of hereditary ataxia should lead to an increasing number of medically sensible drug trials. In this paper, data from recent drug trials in patients with recessive and dominant cerebellar ataxias will be summarized. There is consensus that up to date, no medication has been proven effective. Aminopyridines and acetazolamide are the only exception, which are beneficial in patients with episodic ataxia type 2. Aminopyridines are also effective in a subset of patients presenting with downbeat nystagmus. As such, all authors agreed that the mainstays of treatment of degenerative cerebellar ataxia are currently physiotherapy, occupational therapy, and speech therapy. For many years, well-controlled rehabilitation studies in patients with cerebellar ataxia were lacking. Data of recently published studies show that coordinative training improves motor function in both adult and juvenile patients with cerebellar degeneration. Given the well-known contribution of the cerebellum to motor learning, possible mechanisms underlying improvement will be outlined. There is consensus that evidence-based guidelines for the physiotherapy of degenerative cerebellar ataxia need to be developed. Future developments in physiotherapeutical interventions will be discussed including application of non-invasive brain stimulation.
Collapse
Affiliation(s)
- W Ilg
- Department of Cognitive Neurology, Hertie Institute for Clinical Brain Research and Centre for Integrative Neuroscience, Tübingen, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|