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Nisar H, Annamraju S, Deka SA, Horowitz A, Stipanović DM. Robotic mirror therapy for stroke rehabilitation through virtual activities of daily living. Comput Struct Biotechnol J 2024; 24:126-135. [PMID: 38352631 PMCID: PMC10862404 DOI: 10.1016/j.csbj.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 02/16/2024] Open
Abstract
Mirror therapy is a standard technique of rehabilitation for recovering motor and vision abilities of stroke patients, especially in the case of asymmetric limb function. To enhance traditional mirror therapy, robotic mirror therapy (RMT) has been proposed over the past decade, allowing for assisted bimanual coordination of paretic (affected) and contralateral (healthy) limbs. However, state-of-the-art RMT platforms predominantly target mirrored motions of trajectories, largely limited to 2-D motions. In this paper, an RMT platform is proposed, which can facilitate the patient to practice virtual activities of daily living (ADL) and thus enhance their independence. Two similar (but mirrored) 3D virtual environments are created in which the patients operate robots with both their limbs to complete ADL (such as writing and eating) with the assistance of the therapist. The recovery level of the patient is continuously assessed by monitoring their ability to track assigned trajectories. The patient's robots are programmed to assist the patient in following these trajectories based on this recovery level. In this paper, the framework to dynamically monitor recovery level and accordingly provide assistance is developed along with the nonlinear controller design to ensure position tracking, force control, and stability. Proof-of-concept studies are conducted with both 3D trajectory tracking and ADL. The results demonstrate the potential use of the proposed system to enhance the recovery of the patients.
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Affiliation(s)
- Harris Nisar
- Health Care Engineering Systems Center, University of Illinois Urbana Champaign, 1206 W Clark St, Urbana 61801, IL, USA
| | - Srikar Annamraju
- Coordinated Science Laboratory, University of Illinois Urbana Champaign, 1308 W Main St, Urbana 61801, IL, USA
| | - Shankar A. Deka
- Division of Decision and Control Systems at KTH Royal Institute of Technology, Brinellvägen 8, 114 28 Stockholm, Sweden
| | - Anne Horowitz
- Outpatient Rehabilitation, OSF Healthcare Saint Francis Medical Center, 6501 N Sheridan Rd, Peoria, IL, USA
| | - Dušan M. Stipanović
- Coordinated Science Laboratory, University of Illinois Urbana Champaign, 1308 W Main St, Urbana 61801, IL, USA
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Hu C, Ti CHE, Shi X, Yuan K, Leung TWH, Tong RKY. Development and External Validation of a Motor Intention-Integrated Prediction Model for Upper Extremity Motor Recovery After Intention-Driven Robotic Hand Training for Chronic Stroke. Arch Phys Med Rehabil 2024:S0003-9993(24)01194-8. [PMID: 39218244 DOI: 10.1016/j.apmr.2024.08.015] [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: 06/21/2024] [Revised: 07/19/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To derive and validate a prediction model for minimal clinically important differences (MCIDs) in upper extremity (UE) motor function after intention-driven robotic hand training using residual voluntary electromyography (EMG) signals from affected UE. DESIGN A prospective longitudinal multicenter cohort study. We collected preintervention candidate predictors: demographics, clinical characteristics, Fugl-Meyer assessment of UE (FMAUE), Action Research Arm Test scores, and motor intention of flexor digitorum and extensor digitorum (ED) measured by EMG during maximal voluntary contraction (MVC). For EMG measures, recognizing challenges for stroke survivors to move paralyzed hand, peak signals were extracted from 8 time windows during MVC-EMG (0.1-5s) to identify subjects' motor intention. Classification and regression tree algorithm was employed to predict survivors with MCID of FMAUE. Relationship between predictors and motor improvements was further investigated. SETTING Nine rehabilitation centers. PARTICIPANTS Chronic stroke survivors (N=131), including 87 for derivation sample, and 44 for validation sample. INTERVENTIONS All participants underwent 20-session robotic hand training (40min/session, 3-5sessions/wk). MAIN OUTCOME MEASURES Prediction efficacies of models were assessed by area under the receiver operating characteristic curve (AUC). The best effective model was final model and validated using AUC and overall accuracy. RESULTS The best model comprised FMAUE (cutoff score, 46) and peak activity of ED from 1-second MVC-EMG (MVC-EMG 4.604 times higher than resting EMG), which demonstrated significantly higher prediction accuracy (AUC, 0.807) than other time windows or solely using clinical scores (AUC, 0.595). In external validation, this model displayed robust prediction (AUC, 0.916). Significant quadratic relationship was observed between ED-EMG and FMAUE increases. CONCLUSIONS This study presents a prediction model for intention-driven robotic hand training in chronic stroke survivors. It highlights significance of capturing motor intention through 1-second EMG window as a predictor for MCID improvement in UE motor function after 20-session robotic training. Survivors in 2 conditions showed high percentage of clinical motor improvement: moderate-to-high motor intention and low-to-moderate function; as well as high intention and high function.
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Affiliation(s)
- Chengpeng Hu
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Chun Hang Eden Ti
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Xiangqian Shi
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kai Yuan
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Thomas W H Leung
- Division of Neurology, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Raymond Kai-Yu Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
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Alashram AR. Task-oriented training for gait rehabilitation in people with multiple sclerosis: A systematic review. J Bodyw Mov Ther 2024; 39:87-96. [PMID: 38876706 DOI: 10.1016/j.jbmt.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 01/14/2024] [Accepted: 02/25/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVES This systematic review aims to examine the effects of task-oriented (TO) training on gait function in people with multiple sclerosis (MS) and to determine the most effective TO training protocol. METHODS We searched PubMed, Web of Science, Scopus, EMBASE, REHABDATA, and PEDro for studies that examined the effects of TO on gait ability (i.e., gait velocity, gait endurance, functional mobility) in people with MS from 1971 to October 2022. The quality of the selected studies was estimated using the Physiotherapy Evidence Database (PEDro) scale. RESULTS Nine studies met the eligibility criteria. A total of 199 people with MS, 58.79% of whom were women, were included. Five studies revealed "good" quality, one revealed "fair", and three exhibited "poor" quality. Four studies administered TO training alone, and five combined TO training with conventional physiotherapy. The selected studies showed varied results for the influences of TO training on gait ability in people with MS. CONCLUSIONS The evidence for the impact of TO training on people with MS was limited. The optimal TO training protocol stills vague. Further studies with larger sample sizes are needed.
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Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Amman, Jordan; Applied Science Research Center, Applied Science Private University, Amman, Jordan; Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.
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Li Y, Lian Y, Chen X, Zhang H, Xu G, Duan H, Xie X, Li Z. Effect of task-oriented training assisted by force feedback hand rehabilitation robot on finger grasping function in stroke patients with hemiplegia: a randomised controlled trial. J Neuroeng Rehabil 2024; 21:77. [PMID: 38745227 PMCID: PMC11092254 DOI: 10.1186/s12984-024-01372-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 05/08/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Over 80% of patients with stroke experience finger grasping dysfunction, affecting independence in activities of daily living and quality of life. In routine training, task-oriented training is usually used for functional hand training, which may improve finger grasping performance after stroke, while augmented therapy may lead to a better treatment outcome. As a new technology-supported training, the hand rehabilitation robot provides opportunities to improve the therapeutic effect by increasing the training intensity. However, most hand rehabilitation robots commonly applied in clinics are based on a passive training mode and lack the sensory feedback function of fingers, which is not conducive to patients completing more accurate grasping movements. A force feedback hand rehabilitation robot can compensate for these defects. However, its clinical efficacy in patients with stroke remains unknown. This study aimed to investigate the effectiveness and added value of a force feedback hand rehabilitation robot combined with task-oriented training in stroke patients with hemiplegia. METHODS In this single-blinded randomised controlled trial, 44 stroke patients with hemiplegia were randomly divided into experimental (n = 22) and control (n = 22) groups. Both groups received 40 min/day of conventional upper limb rehabilitation training. The experimental group received 20 min/day of task-oriented training assisted by a force feedback rehabilitation robot, and the control group received 20 min/day of task-oriented training assisted by therapists. Training was provided for 4 weeks, 5 times/week. The Fugl-Meyer motor function assessment of the hand part (FMA-Hand), Action Research Arm Test (ARAT), grip strength, Modified Ashworth scale (MAS), range of motion (ROM), Brunnstrom recovery stages of the hand (BRS-H), and Barthel index (BI) were used to evaluate the effect of two groups before and after treatment. RESULTS Intra-group comparison: In both groups, the FMA-Hand, ARAT, grip strength, AROM, BRS-H, and BI scores after 4 weeks of treatment were significantly higher than those before treatment (p < 0.05), whereas there was no significant difference in finger flexor MAS scores before and after treatment (p > 0.05). Inter-group comparison: After 4 weeks of treatment, the experimental group's FMA-Hand total score, ARAT, grip strength, and AROM were significantly better than those of the control group (p < 0.05). However, there were no statistically significant differences in the scores of each sub-item of the FMA-Hand after Bonferroni correction (p > 0.007). In addition, there were no statistically significant differences in MAS, BRS-H, and BI scores (p > 0.05). CONCLUSION Hand performance improved in patients with stroke after 4 weeks of task-oriented training. The use of a force feedback hand rehabilitation robot to support task-oriented training showed additional value over conventional task-oriented training in stroke patients with hand dysfunction. CLINICAL TRIAL REGISTRATION INFORMATION NCT05841108.
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Affiliation(s)
- Yinghua Li
- Department of Rehabilitation Medicine, First Hospital of Jilin University, Changchun, China
| | - Yawen Lian
- Department of Rehabilitation Medicine, First Hospital of Jilin University, Changchun, China
| | - Xiaowei Chen
- Department of Rehabilitation Medicine, First Hospital of Jilin University, Changchun, China
| | - Hong Zhang
- Department of Rehabilitation Medicine, First Hospital of Jilin University, Changchun, China
| | - Guoxing Xu
- Department of Rehabilitation Medicine, First Hospital of Jilin University, Changchun, China
| | - Haoyang Duan
- Department of Rehabilitation Medicine, First Hospital of Jilin University, Changchun, China
| | - Xixi Xie
- Department of Rehabilitation Medicine, First Hospital of Jilin University, Changchun, China
| | - Zhenlan Li
- Department of Rehabilitation Medicine, First Hospital of Jilin University, Changchun, China.
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Rodrigues PSM, Shimano MM, de Oliveira E, Kawamura FM, Silveira AF, José Luvizutto G, de Souza LAPS. Adaptation and clinical application of assistive device chair for bedside sitting in acute stroke phase: two case reports. Disabil Rehabil Assist Technol 2024; 19:1272-1278. [PMID: 36630593 DOI: 10.1080/17483107.2023.2166600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 11/16/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
PURPOSE This report presents the adaptation of an assistive device chair for bedside sitting and its application in two patients with trunk control impairment in the acute stroke phase. MATERIALS AND METHODS The device was built with polyvinylchloride (PVC) pipes and designed by a team of mechanical engineers and physiotherapists to maintain a prolonged sitting position with less demand from therapists. To test the device, two patients were followed up during the acute phase of stroke. Both patients underwent an early mobilization program (30 min, twice a day, for three days) with an assistive device chair for bedside sitting. Patients were evaluated using the National Institutes of Health Stroke Scale (NIHSS), Trunk Impairment Scale (TIS), and International Classification of Functioning, Disability, and Health (ICF) checklist (b: body function; d: activity and participation). RESULTS The adaptations generated the following equipment: 1) foldable, 2) three levels of backrest inclination, and 3) a safety anterior support or an activity table. Both patients showed clinical improvement after the intervention period, with NIHSS score reduction, TIS improvement, and greater functionality and independence on the ICF framework. CONCLUSION The equipment with adaptations seems to be functional, easy to handle, and can potentially contribute to clinical and functional improvements in patients with trunk control deficits after stroke.
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Affiliation(s)
| | - Marcos Massao Shimano
- Department of Mechanical Engineering, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Edimar de Oliveira
- Student of the Mechanical Engineering, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Fábio Masao Kawamura
- Student of the Mechanical Engineering, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Ana Flávia Silveira
- Doctorate Student in Physiotherapy, Federal University of São Carlos, São Carlos, Brazil
| | - Gustavo José Luvizutto
- Department of Applied Physiotherapy, Federal University of Triângulo Mineiro, Uberaba, Brazil
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Traxler K, Baum E, Klotz E, Reindl M, Schinabeck F, Seebacher B. Combining specific task-oriented training with manual therapy to improve balance and mobility in patients after stroke: a mixed methods pilot randomised controlled trial. Disabil Rehabil 2024; 46:1318-1329. [PMID: 37051907 DOI: 10.1080/09638288.2023.2193432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 03/16/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE In absence of existing studies, to describe changes in balance and mobility, following specific task-oriented training (TOT), its combination with talocrural manual therapy (MT-TOT) or no intervention, in chronic stroke patients. To explore the feasibility of a full-scale randomised controlled trial (RCT) based on criteria of recruitment, retention and adherence rates, adverse events, falls and acceptability of the intervention. MATERIALS AND METHODS Using an assessor-blinded pilot RCT, 36 stroke patients were allocated to either MT-TOT, TOT, or controls. Supervised interventions were performed 45 min, 2×/weekly, for 4 weeks, and home-based practice 20 min, 4x/weekly for 4 weeks. Qualitative interviews evaluated intervention acceptability. Outcomes of balance, mobility, ankle dorsiflexion range of motion (ROM), falls and health-related quality of life (HRQoL) were assessed at baseline, post-intervention and 4-week follow-up. RESULTS Preliminary efficacy of MT-TOT and TOT was shown in improving balance (effect size 0.714), walking speed (0.683), mobility (0.265), dual-tasking mobility (0.595), falls (0.037), active and passive talocrural ROM (0.603; 0.751) and activities and social participation related HRQoL domains (0.332-0.784) in stroke patients. The feasibility of a larger RCT was confirmed. CONCLUSIONS Specific MT-TOT and TOT appeared effective and are feasible in stroke patients. A larger RCT is needed to validate the results.Trial Registration: German Clinical Trials Register, DRKS00023068. Registered on 21.09.2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023068.
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Affiliation(s)
- Kristina Traxler
- Therapiezentrum Kinema, Neukirchen b. hl. Blut, Germany
- Department for Health Sciences, Medicine and Research, Danube University Krems, Austria
| | - Eva Baum
- Therapiezentrum Kinema, Neukirchen b. hl. Blut, Germany
| | | | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Austria
| | - Franz Schinabeck
- Überörtliche Gemeinschaftspraxis Hohenwarth/Lam, Hohenwarth, Germany
| | - Barbara Seebacher
- Clinical Department of Neurology, Medical University of Innsbruck, Austria
- VASCage, Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
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Lee Y, Park HS. Design Optimization of a Soft Robotic Rehabilitation Glove Based on Finger Workspace Analysis. Biomimetics (Basel) 2024; 9:172. [PMID: 38534857 DOI: 10.3390/biomimetics9030172] [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: 01/25/2024] [Revised: 03/08/2024] [Accepted: 03/10/2024] [Indexed: 03/28/2024] Open
Abstract
The finger workspace is crucial for performing various grasping tasks. Thus, various soft rehabilitation gloves have been developed to assist individuals with paralyzed hands in activities of daily living (ADLs) or rehabilitation training. However, most soft robotic glove designs are insufficient to assist with various hand postures because most of them use an underactuated mechanism for design simplicity. Therefore, this paper presents a methodology for optimizing the design of a high-degree-of-freedom soft robotic glove while not increasing the design complexity. We defined the required functional workspace of the index finger based on ten frequently used grasping postures in ADLs. The design optimization was achieved by simulating the proposed finger-robot model to obtain a comparable workspace to the functional workspace. In particular, the moment arm length for extension was optimized to facilitate the grasping of large objects (precision disk and power sphere), whereas a torque-amplifying routing design was implemented to aid the grasping of small objects (lateral pinch and thumb-two-finger pinch). The effectiveness of the optimized design was validated through testing with a stroke survivor and comparing the assistive workspace. The observed workspace demonstrated that the optimized glove design could assist with nine out of the ten targeted grasping posture functional workspaces. Furthermore, the assessment of the grasping speed and force highlighted the glove's usability for various rehabilitation activities. We also present and discuss a generalized methodology to optimize the design parameters of a soft robotic glove that uses an underactuated mechanism to assist the targeted workspace. Overall, the proposed design optimization methodology serves as a tool for developing advanced hand rehabilitation robots, as it offers insight regarding the importance of routing optimization in terms of the workspace.
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Affiliation(s)
- Yechan Lee
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| | - Hyung-Soon Park
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
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Moslemi Z, Toledo-Aldana EA, Baldwin B, Donkers SJ, Eng JJ, Mondal P, de Zepetnek JOT, Buttigieg J, Levin MC, Mang CS. Task-oriented exercise effects on walking and corticospinal excitability in multiple sclerosis: protocol for a randomized controlled trial. BMC Sports Sci Med Rehabil 2023; 15:175. [PMID: 38129896 PMCID: PMC10734154 DOI: 10.1186/s13102-023-00790-5] [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: 08/24/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a degenerative disease of the central nervous system (CNS) that disrupts walking function and results in other debilitating symptoms. This study compares the effects of 'task-oriented exercise' against 'generalized resistance and aerobic exercise' and a 'stretching control' on walking and CNS function in people with MS (PwMS). We hypothesize that task-oriented exercise will enhance walking speed and related neural changes to a greater extent than other exercise approaches. METHODS This study is a single-blinded, three-arm randomized controlled trial conducted in Saskatchewan, Canada. Eligible participants are those older than 18 years of age with a diagnosis of MS and an expanded Patient-Determined Disease Steps (PDDS) score between 3 ('gait disability') and 6 ('bilateral support'). Exercise interventions are delivered for 12 weeks (3 × 60-min per week) in-person under the supervision of a qualified exercise professional. Interventions differ in exercise approach, such that task-oriented exercise involves weight-bearing, walking-specific activities, while generalized resistance and aerobic exercise uses seated machine-based resistance training of major upper and lower body muscle groups and recumbent cycling, and the stretching control exercise involves seated flexibility and relaxation activities. Participants are allocated to interventions using blocked randomization that stratifies by PDDS (mild: 3-4; moderate: 5-6). Assessments are conducted at baseline, post-intervention, and at a six-week retention time point. The primary and secondary outcome measures are the Timed 25-Foot Walk Test and corticospinal excitability for the tibialis anterior muscles determined using transcranial magnetic stimulation (TMS), respectively. Tertiary outcomes include assessments of balance, additional TMS measures, blood biomarkers of neural health and inflammation, and measures of cardiorespiratory and musculoskeletal fitness. DISCUSSION A paradigm shift in MS healthcare towards the use of "exercise as medicine" was recently proposed to improve outcomes and alleviate the economic burden of MS. Findings will support this shift by informing the development of specialized exercise programming that targets walking and changes in corticospinal excitability in PwMS. TRIAL REGISTRATION ClinicalTrials.gov, NCT05496881, Registered August 11, 2022. https://classic. CLINICALTRIALS gov/ct2/show/NCT05496881 . Protocol amendment number: 01; Issue date: August 1, 2023; Primary reason for amendment: Expand eligibility to include people with all forms of MS rather than progressive forms of MS only.
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Affiliation(s)
- Zahra Moslemi
- Faculty of Kinesiology and Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A1, Canada
| | - Eduardo A Toledo-Aldana
- Faculty of Kinesiology and Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A1, Canada
| | - Bruce Baldwin
- Faculty of Kinesiology and Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A1, Canada
| | - Sarah J Donkers
- School of Rehabilitation Sciences, College of Medicine, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada
| | - Janice J Eng
- Centre for Aging SMART at Vancouver Coastal Health, Department of Physical Therapy, University of British Columbia, 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Prosanta Mondal
- Clinical Research Support Unit, University of Saskatchewan, 3200 Health Science E-wing, Saskatoon, SK, S7N 5B5, Canada
| | - Julia O Totosy de Zepetnek
- Faculty of Kinesiology and Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A1, Canada
| | - Josef Buttigieg
- Department of Biology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A1, Canada
| | - Michael C Levin
- Department of Neurology and Anatomy and Cell Biology, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Cameron S Mang
- Faculty of Kinesiology and Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A1, Canada.
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Dennler N, Cain A, De Guzman E, Chiu C, Winstein CJ, Nikolaidis S, Matarić MJ. A metric for characterizing the arm nonuse workspace in poststroke individuals using a robot arm. Sci Robot 2023; 8:eadf7723. [PMID: 37967205 DOI: 10.1126/scirobotics.adf7723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 10/19/2023] [Indexed: 11/17/2023]
Abstract
An overreliance on the less-affected limb for functional tasks at the expense of the paretic limb and in spite of recovered capacity is an often-observed phenomenon in survivors of hemispheric stroke. The difference between capacity for use and actual spontaneous use is referred to as arm nonuse. Obtaining an ecologically valid evaluation of arm nonuse is challenging because it requires the observation of spontaneous arm choice for different tasks, which can easily be influenced by instructions, presumed expectations, and awareness that one is being tested. To better quantify arm nonuse, we developed the bimanual arm reaching test with a robot (BARTR) for quantitatively assessing arm nonuse in chronic stroke survivors. The BARTR is an instrument that uses a robot arm as a means of remote and unbiased data collection of nuanced spatial data for clinical evaluations of arm nonuse. This approach shows promise for determining the efficacy of interventions designed to reduce paretic arm nonuse and enhance functional recovery after stroke. We show that the BARTR satisfies the criteria of an appropriate metric for neurorehabilitative contexts: It is valid, reliable, and simple to use.
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Affiliation(s)
- Nathaniel Dennler
- Department of Computer Science, University of Southern California, Los Angeles, CA, USA
| | - Amelia Cain
- Department of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Erica De Guzman
- Department of Computer Science, University of Southern California, Los Angeles, CA, USA
| | - Claudia Chiu
- Department of Computer Science, University of Southern California, Los Angeles, CA, USA
| | - Carolee J Winstein
- Department of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Stefanos Nikolaidis
- Department of Computer Science, University of Southern California, Los Angeles, CA, USA
| | - Maja J Matarić
- Department of Computer Science, University of Southern California, Los Angeles, CA, USA
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Rozevink SG, Beerepoot CM, van der Sluis CK, Hijmans JM. Standardized circuit class group training versus individualized goal-directed group training to improve upper limb function in stroke survivors during in-patient rehabilitation: a pragmatic trial. Disabil Rehabil 2023:1-13. [PMID: 37728092 DOI: 10.1080/09638288.2023.2255135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 08/31/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE To investigate the usability and effectiveness of standardized circuit class group training (CCT) compared to individualized goal-directed group training (GDT) in subacute stroke survivors. MATERIALS AND METHODS This study consists of three parts. Part 1 involved a pragmatic, non-randomized controlled trial with subacute participants and their therapists, who participated in four weeks either CCT or GDT. Superiority of the intervention was defined as significantly larger improvement on the Motor Activity Log for patients and lower workload for therapists. In Part 2, six additional workstations were developed for CCT. Part 3 replicated the study of Part 1 with the expanded CCT. RESULTS Part 1 showed no difference in effectiveness between training methods. CCT did not match the rehabilitation goals of the patient sufficiently, however mental workload seemed lower for therapists. An expansion of CCT could improve the match between the patient's goals and the training (Part 2). Results of Part 3 showed again no difference in effectiveness between methods. CCT was however perceived as less engaging compared to GDT, but mental load for therapists remained lower. CONCLUSIONS A standardized training could reduce the mental workload for therapists, but patients seemed less engaged. A combination of both might be most beneficial.Trial registration: Dutch Trial Register: NL8844 and NL9471IMPLICATIONS FOR REHABILITATIONProviding a standardized training program after stroke reduces therapists' mental workload.Individualized goal-directed group training results in the best achievement of rehabilitation goals.A combination of standardized and individual training would use best of both intervention modalities.Patients should be involved in the co-creation developing process of training programs.
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Affiliation(s)
- S G Rozevink
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - C M Beerepoot
- Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - C K van der Sluis
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J M Hijmans
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Coias AR, Lee MH, Bernardino A, Smailagic A. Skeleton Tracking Solutions for a Low-Cost Stroke Rehabilitation Support System. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941267 DOI: 10.1109/icorr58425.2023.10304749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Computer systems based on motion assessment are promising solutions to support stroke survivors' autonomous rehabilitation exercises. In this regard, researchers keep trying to achieve engaging and low-cost solutions suitable mainly for home use. Aiming to achieve a system with a minimal technical setup, we compare Microsoft Kinect, OpenPose, and MediaPipe skeleton tracking approaches for upper extremity quality of movement assessment after stroke. We determine if classification models assess accurately exercise performance with OpenPose and MediaPipe data against Kinect, using a dataset of 15 stroke survivors. We compute Root Mean Squared Error to determine the alignment of trajectories and kinematic variables. MediaPipe World Landmarks revealed high alignment with Kinect, revealing to be a potential alternative method.
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Das N, Endo S, Patel S, Krewer C, Hirche S. Online detection of compensatory strategies in human movement with supervised classification: a pilot study. Front Neurorobot 2023; 17:1155826. [PMID: 37520678 PMCID: PMC10382178 DOI: 10.3389/fnbot.2023.1155826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/19/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Stroke survivors often compensate for the loss of motor function in their distal joints by altered use of more proximal joints and body segments. Since this can be detrimental to the rehabilitation process in the long-term, it is imperative that such movements are indicated to the patients and their caregiver. This is a difficult task since compensation strategies are varied and multi-faceted. Recent works that have focused on supervised machine learning methods for compensation detection often require a large training dataset of motions with compensation location annotations for each time-step of the recorded motion. In contrast, this study proposed a novel approach that learned a linear classifier from energy-based features to discriminate between healthy and compensatory movements and identify the compensating joints without the need for dense and explicit annotations. Methods Six healthy physiotherapists performed five different tasks using healthy movements and acted compensations. The resulting motion capture data was transformed into joint kinematic and dynamic trajectories. Inspired by works in bio-mechanics, energy-based features were extracted from this dataset. Support vector machine (SVM) and logistic regression (LR) algorithms were then applied for detection of compensatory movements. For compensating joint identification, an additional condition enforcing the independence of the feature calculation for each observable degree of freedom was imposed. Results Using leave-one-out cross validation, low values of mean brier score (<0.15), mis-classification rate (<0.2) and false discovery rate (<0.2) were obtained for both SVM and LR classifiers. These methods were found to outperform deep learning classifiers that did not use energy-based features. Additionally, online classification performance by our methods were also shown to outperform deep learning baselines. Furthermore, qualitative results obtained from the compensation joint identification experiment indicated that the method could successfully identify compensating joints. Discussion Results from this study indicated that including prior bio-mechanical information in the form of energy based features can improve classification performance even when linear classifiers are used, both for offline and online classification. Furthermore, evaluation compensation joint identification algorithm indicated that it could potentially provide a straightforward and interpretable way of identifying compensating joints, as well as the degree of compensation being performed.
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Affiliation(s)
- Neha Das
- Information-Oriented Control, TUM School of Computation, Information and Technology, Technical University of Munich, Munich, Germany
| | - Satoshi Endo
- Information-Oriented Control, TUM School of Computation, Information and Technology, Technical University of Munich, Munich, Germany
| | - Sabrina Patel
- Human Movement Science, Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
| | - Carmen Krewer
- Human Movement Science, Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
- Department of Neurology, Research Group, Schoen Clinic Bad Aibling, Bad Aibling, Germany
| | - Sandra Hirche
- Information-Oriented Control, TUM School of Computation, Information and Technology, Technical University of Munich, Munich, Germany
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Pouplin S, Bonnyaud C, Bouchigny S, Mégard C, Bertholier L, Goulamhoussen R, Foulon P, Bensmail D, Barbot F, Roche N. Feasibility of a serious game system including a tangible object for post stroke upper limb rehabilitation: a pilot randomized clinical study. Front Neurol 2023; 14:1176071. [PMID: 37360348 PMCID: PMC10289014 DOI: 10.3389/fneur.2023.1176071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/03/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Serious games can be used to provide intensive rehabilitation through attractive exercises as part of post-stroke rehabilitation. However, currently available commercial and serious games systems primarily train shoulder and elbow movements. These games lack the grasping and displacement components that are essential to improve upper limb function. For this reason, we developed a tabletop device that encompassed a serious game with a tangible object to rehabilitate combined reaching and displacement movements: the Ergotact system. Objectives The aim of this pilot study was to assess the feasibility and the short-term effects of a training program using the Ergotact prototype in individuals with chronic stroke. Methods Participants were assigned to one of two groups: a serious game training group (Ergotact) or a control training group (Self). Results Twenty-eight individuals were included. Upper limb function increased after the Ergotact training program, although not statistically significantly, and the program did not induce pain or fatigue, demonstrating its safety. Conclusion The Ergotact system for upper limb rehabilitation was well accepted and induced participant satisfaction. It complies with current recommendations for people with stroke to autonomously perform intensive active exercises in a fun context, in addition to conventional rehabilitation sessions with therapists. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT03166020?term=NCT03166020&draw=2&rank=1, identifier NCT03166020.
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Affiliation(s)
- Samuel Pouplin
- New Technologies Platform, Raymond-Poincaré Hospital, AP–HP, Université Paris Saclay, Garches, France
- Paris-Saclay University, UVSQ, Research Unit ERPHAN, Versailles, France
| | - Céline Bonnyaud
- Paris-Saclay University, UVSQ, Research Unit ERPHAN, Versailles, France
- Physiology and Functional Exploration Department, Raymond-Poincaré Hospital, AP–HP, Université Paris Saclay, Garches, France
| | | | | | | | | | - Pierre Foulon
- Genious Healthcare, Groupe MindMaze, Montpellier, France
| | - Djamel Bensmail
- Physical and Rehabilitation Medicine Department, Raymond-Poincaré Hospital, AP–HP, Université Paris Saclay, Garches, France
- End: icap Laboratory, Inserm Unit 1179, UVSQ, Montigny-le-Bretonneux, France
| | - Frédéric Barbot
- CIC 1429 INSERM, Raymond-Poincaré Hospital, AP–HP, Université Paris Saclay, Garches, France
| | - Nicolas Roche
- Physiology and Functional Exploration Department, Raymond-Poincaré Hospital, AP–HP, Université Paris Saclay, Garches, France
- CIC 1429 INSERM, Raymond-Poincaré Hospital, AP–HP, Université Paris Saclay, Garches, France
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Shahid J, Kashif A, Shahid MK. A Comprehensive Review of Physical Therapy Interventions for Stroke Rehabilitation: Impairment-Based Approaches and Functional Goals. Brain Sci 2023; 13:717. [PMID: 37239189 PMCID: PMC10216461 DOI: 10.3390/brainsci13050717] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
Stroke is the fourth leading cause of mortality and is estimated to be one of the major reasons for long-lasting disability worldwide. There are limited studies that describe the application of physical therapy interventions to prevent disabilities in stroke survivors and promote recovery after a stroke. In this review, we have described a wide range of interventions based on impairments, activity limitations, and goals in recovery during different stages of a stroke. This article mainly focuses on stroke rehabilitation tactics, including those for sensory function impairments, motor learning programs, hemianopia and unilateral neglect, flexibility and joint integrity, strength training, hypertonicity, postural control, and gait training. We conclude that, aside from medicine, stroke rehabilitation must address specific functional limitations to allow for group activities and superior use of a hemiparetic extremity. Medical doctors are often surprised by the variety of physiotherapeutic techniques available; they are unfamiliar with the approaches of researchers such as Bobath, Coulter, and Brunnstrom, among others, as well as the scientific reasoning behind these techniques.
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Affiliation(s)
- Jawaria Shahid
- Department of Physical Therapy, Ikram Hospital, Gujrat 50700, Pakistan;
- Center of Physical Therapy, Rayan Medical Center, Gujrat 50700, Pakistan
| | - Ayesha Kashif
- Department of Senior Health Care, Eulji University, Uijeongbu 11759, Republic of Korea
| | - Muhammad Kashif Shahid
- Research Institute of Environment & Biosystem, Chungnam National University, Daejeon 34134, Republic of Korea;
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Zhu Z, Martinez-Luna C, Li J, McDonald BE, Huang X, Farrell TR, Clancy EA. Force/moment tracking performance during constant-pose, force-varying, bilaterally symmetric, hand-wrist tasks. J Electromyogr Kinesiol 2023; 69:102753. [PMID: 36731399 DOI: 10.1016/j.jelekin.2023.102753] [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: 08/04/2022] [Revised: 12/20/2022] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
Bilateral movement is widely used for calibration of myoelectric prosthesis controllers, and is also relevant as rehabilitation therapy for patients with motor impairment and for athletic training. Target tracking and/or force matching tasks can be used to elicit such bilateral movement. Limited descriptive accuracy data exist in able-bodied subjects for bilateral target tracking or dominant vs non-dominant dynamic force matching tasks requiring more than one degree of freedom (DoF). We examined dynamic trajectory (0.75 Hz band-limited, white, uniform random) constant-posture, hand open-close, wrist pronation-supination target tracking and matching tasks. Tasks were normalized to maximum voluntary contraction (MVC), spanning a ± 30% MVC force range, in four 1-DoF and 2-DoF tasks: (1, 2) unilateral dominant limb tracking with/without visual feedback, and (3, 4) bilateral dominant/non-dominant limb tracking with mirror visual feedback. In 12 able-bodied subjects, unilateral tracking error with visual feedback averaged 10-15 %MVC, but up to 30 %MVC without visual feedback. Bilateral matching error averaged ∼10 %MVC and was affected little by visual feedback type, so long as feedback was provided. In 1-DoF bilateral tracking, the dominant side had statistically lower error than the non-dominant side. In 2-DoF bilateral tracking, the side providing mirror visual feedback exhibited lower error than the opposite side. In 2-DoF tasks (assumed to be more challenging than their constituent 1-DoF tracking tasks), hand grip force errors grew disproportionately larger than those of each wrist DoF. In unilateral 1-DoF tasks, both hand vs target and wrist vs target latency averaged 250-350 ms. In unilateral 2-DoF tasks, wrist vs target latency also averaged 250-350 ms, while hand vs target latency averaged > 500 ms. These results provide guidance on bilateral 2-DoF hand-wrist performance in target tracking, and dominant vs non-dominant force matching tasks.
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Affiliation(s)
- Ziling Zhu
- Worcester Polytechnic Institute, Worcester, MA, USA.
| | | | - Jianan Li
- Worcester Polytechnic Institute, Worcester, MA, USA
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Choy J, Pourkazemi F, Anderson C, Bogaardt H. Dosages of Swallowing Exercises Prescribed in Stroke Rehabilitation: A Medical Record Audit. Dysphagia 2023; 38:686-699. [PMID: 35951119 PMCID: PMC10006267 DOI: 10.1007/s00455-022-10500-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 07/13/2022] [Indexed: 01/19/2023]
Abstract
This study investigated how swallowing exercise dosage is recorded, and what swallowing exercise dosages are reported in a stroke rehabilitation setting. We additionally explored the relation between mean daily swallowing repetitions and likelihood of improvement in functional swallowing status and considered how swallowing exercise dosages in practice compared to evidence-based principles of neural plasticity and strength training. We audited medical records for 42 patients with post-stroke dysphagia admitted to an inpatient rehabilitation unit over 18 months. Data were collected on participant characteristics, swallowing exercises and dosages, and clinical outcomes. The relation between dosage and outcomes was investigated using logistic regression analysis. On average, patients were seen for a median of 2.4 swallowing intervention sessions per week (IQR: 1.7) over 21 days (IQR: 16) and received a median 44.5 swallowing exercise repetitions per session (IQR: 39.6). Results indicated variable reporting of swallowing exercise dosages. Frequency, intervention duration, exercise type, and number of repetitions were routinely recorded in medical records, while intensity, session length, content, and adherence to home exercise programs were not. Frequency of swallowing intervention was lower in practice compared to research studies, and swallowing exercises did not follow specificity or progressive resistance principles. Likelihood of improvement in swallowing status was partially explained by age (B = -.015, p = .007) but not by mean daily swallowing exercise repetitions. This study illustrates dosages of swallowing exercises used in clinical practice. Results highlight the need for improved consideration and reporting of dosage, and application of evidence-based principles to swallowing exercise dosages.
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Affiliation(s)
- Jacinda Choy
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia.
- HammondCare Braeside Hospital, 340 Prairie Vale Road, Prairiewood, NSW, 2176, Australia.
| | - Fereshteh Pourkazemi
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Caitlin Anderson
- HammondCare Braeside Hospital, 340 Prairie Vale Road, Prairiewood, NSW, 2176, Australia
| | - Hans Bogaardt
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, SA, 5005, Australia
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Impact of a Bedside Activity Device on the Functional Status of Hospitalized Older Adults: A Randomized Controlled Trial. Am J Nurs 2023; 123:22-29. [PMID: 36752738 DOI: 10.1097/01.naj.0000920992.97182.ab] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Older adults may have difficulty maintaining their functional capabilities during hospitalization. This pilot study aimed to investigate the impact of a bedside activity device on the functional status of hospitalized older adults. METHODS For this single-site randomized controlled trial, 48 participants were recruited between July 2019 and March 2021. Participants were randomized into one of two groups: the intervention group, which was given the use of a bedside activity device plus standard care, and the control group, which received standard care. Katz Index of Independence in Activities of Daily Living (Katz ADL) scores and Timed Up and Go (TUG) test times were used as indicators of functional status and were collected on admission (baseline) and at discharge.Mann-Whitney U and χ 2 tests were used to test for baseline similarities between groups. The Wilcoxon signed rank test was used to determine within-group pre-post changes in TUG and Katz ADL scores. The Mann-Whitney U test was used to determine between-group differences in TUG and Katz ADL change scores. RESULTS Within-group pre-post analysis showed significant increases in Katz ADL scores in the intervention group and no significant changes in the control group. TUG times decreased significantly in the intervention group and increased significantly in the control group. Between-group analyses showed significant differences in both TUG and Katz ADL change scores. CONCLUSION The use of the bedside activity device in addition to standard care may prevent functional decline and increase independence in performing basic ADLs.
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Alatawi SF. A Comparison of Three Common Rehabilitation Interventions Used to Improve Cardiovascular Fitness after Stroke: An Overview of the Literature. BIOMED RESEARCH INTERNATIONAL 2023; 2023:4350851. [PMID: 37082188 PMCID: PMC10113054 DOI: 10.1155/2023/4350851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/16/2023] [Accepted: 02/18/2023] [Indexed: 04/22/2023]
Abstract
Background One of the most frequent consequences of stroke is a reduction in heart function. After a stroke, one of the main aims of physiotherapy practice is to improve cardiovascular fitness (CVF). This paper is aimed at identifying the best effective intervention of improving the cardiovascular fitness (CVF) after stroke while focusing on body weight-supported treadmill training (BWSTT), over gait training (OGT), and therapeutic exercise. Methods Different electronic databases were searched until July 2022. Controlled randomized trials examining the effects of BWSTT, OGT, and therapeutic exercise to improve CVF on an ambulatory person with stroke, written in English and reporting cardiovascular fitness or at least one of its indicators, such as peak oxygen consumption (VO2), gait speed, gait energy expenditure, and functional independence measure for locomotion (FIM-L), were included. The quality of the methodology was evaluated using the Physiotherapy Evidence Database (PEDro) scale. Results The research yielded 3854 relevant studies, of which 22 met the eligibility criteria. The primary indicators of the CVF, VO2 and energy expenditure, were used to examine the CVF in only three studies, while the rest used other indicators of the CVF. There was a lack of sufficient evidence to establish the superiority of one intervention over another. However, it appears that utilizing BWSTT to improve the CVF after stroke is effective. Conclusion Physiotherapy has the potential to enhance the CVF of stroke patients. However, effective interventions and long-term effects remain debatable.
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Affiliation(s)
- Salem F. Alatawi
- Department of Physical Therapy, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk City, Saudi Arabia
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Wang D, Li L, Pan H, Huang L, Sun X, He C, Wei Q. Comparison of the Effects of Constraint-Induced Movement Therapy and Unconstraint Exercise on Oxidative Stress and Limb Function-A Study on Human Patients and Rats with Cerebral Infarction. Brain Sci 2022; 13:brainsci13010004. [PMID: 36671986 PMCID: PMC9856592 DOI: 10.3390/brainsci13010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/25/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Most conventional post-stroke rehabilitation treatments do not involve imposed constraints of the unaffected limb. In contrast, Constraint-Induced Movement Therapy (CIMT) is comprised of massed task practice with the affected limb and constraint of the unaffected limb. CIMT is a promising rehabilitation technique used for motor recovery of affected limbs after stroke, but its effectiveness and mechanism are not fully understood. We compared the effects of the two exercise modes on limb function post-stroke in animal models and human subjects, and investigated whether oxidative stress response was involved in regulating the effects. We first conducted a randomized controlled trial (RCT), in which 84 subjects with cerebral infarction were assigned to dose-matched constraint-induced movement therapy (CIMT), or unconstraint exercise (UE), or conventional rehabilitation treatment. Motor functions of the limb are primary outcomes of the RCT measured using Brief Fugl-Meyer upper extremity score (FMA-UE), Ashworth score, and Barthel scale. Psychological influence of CIMT and UE was also examined using Self-Rating Depression Scale (SDS). Next, we investigated the effects of CIMT and UE in rats undergoing middle cerebral artery occlusion and reperfusion (MCAO/R). Motor function, infarct volume, and pathohistological changes were investigated by mNSS, MRI, and histological studies. The role of Keap1-Nrf2-ARE was investigated using qRT-PCR, Western blot, immunochemistry, immunofluorescence, and ELISA experiments. In RCT, patients taking CIMT had a higher score in FMA-UE, Barthel index, and SDS, and a lower score in modified Ashworth, compared to those taking UE. In rats receiving CIMT, motor function was increased, and infarct volume was decreased compared to those receiving UE. The expression of Keap1 protein and mRNA in the peri-infarct tissue was decreased, and Nrf2 and ARE protein and mRNA were increased in rats receiving CIMT compared with UE. Nrf2 agonist t-BHQ increased the benefits of CIMT. In conclusion, CIMT is more effective than UE in improving upper limb motor function, reducing muscle spasm in patients with cerebral infarction compared to UE, but patients receiving CIMT may feel depressed. Moreover, both CIMT and UE are beneficial to limb function recovery and limit the infarct expansion in MCAO/R rats, but CIMT was more effective than UE. Oxidative stress reaction has an essential role in regulating the CIMT induced benefits.
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Affiliation(s)
- Dong Wang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
- Department of Rehabilitation Medicine, Affiliated Hospital of Chengdu University, Chengdu 610081, China
| | - Lijuan Li
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
| | - Hongxia Pan
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
| | - Liyi Huang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
| | - Xin Sun
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
| | - Chengqi He
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
| | - Quan Wei
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
- Correspondence: ; Tel.: +86-2885422847
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Elango S, Francis AJA, Chakravarthy VS. Interaction of network and rehabilitation therapy parameters in defining recovery after stroke in a Bilateral Neural Network. J Neuroeng Rehabil 2022; 19:142. [PMID: 36536385 PMCID: PMC9762011 DOI: 10.1186/s12984-022-01106-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/27/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Restoring movement after hemiparesis caused by stroke is an ongoing challenge in the field of rehabilitation. With several therapies in use, there is no definitive prescription that optimally maps parameters of rehabilitation with patient condition. Recovery gets further complicated once patients enter chronic phase. In this paper, we propose a rehabilitation framework based on computational modeling, capable of mapping patient characteristics to parameters of rehabilitation therapy. METHOD To build such a system, we used a simple convolutional neural network capable of performing bilateral reaching movements in 3D space using stereovision. The network was designed to have bilateral symmetry to reflect the bilaterality of the cerebral hemispheres with the two halves joined by cross-connections. This network was then modified according to 3 chosen patient characteristics-lesion size, stage of recovery (acute or chronic) and structural integrity of cross-connections (analogous to Corpus Callosum). Similarly, 3 parameters were used to define rehabilitation paradigms-movement complexity (Exploratory vs Stereotypic), hand selection mode (move only affected arm, CIMT vs move both arms, BMT), and extent of plasticity (local vs global). For each stroke condition, performance under each setting of the rehabilitation parameters was measured and results were analyzed to find the corresponding optimal rehabilitation protocol. RESULTS Upon analysis, we found that regardless of patient characteristics network showed better recovery when high complexity movements were used and no significant difference was found between the two hand selection modes. Contrary to these two parameters, optimal extent of plasticity was influenced by patient characteristics. For acute stroke, global plasticity is preferred only for larger lesions. However, for chronic, plasticity varies with structural integrity of cross-connections. Under high integrity, chronic prefers global plasticity regardless of lesion size, but with low integrity local plasticity is preferred. CONCLUSION Clinically translating the results obtained, optimal recovery may be observed when paretic arm explores the available workspace irrespective of the hand selection mode adopted. However, the extent of plasticity to be used depends on characteristics of the patient mainly stage of stroke and structural integrity. By using systems as developed in this study and modifying rehabilitation paradigms accordingly it is expected post-stroke recovery can be maximized.
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Affiliation(s)
- Sundari Elango
- grid.417969.40000 0001 2315 1926Computational Neuroscience Laboratory, Department of Biotechnology, Indian Institute of Technology, Madras, India
| | - Amal Jude Ashwin Francis
- grid.417969.40000 0001 2315 1926Computational Neuroscience Laboratory, Department of Biotechnology, Indian Institute of Technology, Madras, India
| | - V. Srinivasa Chakravarthy
- grid.417969.40000 0001 2315 1926Computational Neuroscience Laboratory, Department of Biotechnology, Indian Institute of Technology, Madras, India
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Gaboury I, Dostie R, Corriveau H, Demoustier A, Tousignant M. Use of a Telerehabilitation Platform in a Stroke Continuum: A Qualitative Study of Patient and Therapist Acceptability. Int J Telerehabil 2022; 14:e6453. [PMID: 38026556 PMCID: PMC10681045 DOI: 10.5195/ijt.2022.6453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
The purpose of this study was to describe the acceptability of a stroke telerehabilitation platform from the perspective of both patients and therapists. Two public rehabilitation centers participated in a pilot telerehabilitation trial. A theoretical framework was used to conceptualize acceptability. Semi-structured individual interviews with patients and focus groups of therapists were conducted. Most participants and therapists were satisfied with the intervention. Participants emphasized the advantages of staying at home to get their treatments. Therapists were more skeptical at first about their self-efficacy to deliver therapy remotely. There was a consensus among therapists about the need for a combination of telerehabilitation and in-person visits to optimize treatments. While we found overall good acceptability, effectiveness of this technology could be improved via an accessible user interface, complementary rehabilitation material, and ongoing training and technical just-in-time support with therapists.
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Affiliation(s)
- Isabelle Gaboury
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Rosalie Dostie
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Hélène Corriveau
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Arnaud Demoustier
- School of Nursing, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Michel Tousignant
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Québec, Canada
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Zai W, Xu N, Wu W, Wang Y, Wang R. Effect of task-oriented training on gross motor function, balance and activities of daily living in children with cerebral palsy: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e31565. [PMID: 36343029 PMCID: PMC9646623 DOI: 10.1097/md.0000000000031565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To systematically evaluate task-oriented training (TOT) on the improvement of gross motor function, balance and activities of daily living in children with cerebral palsy (CP). METHODS A number of randomized controlled trials (RCTs) of TOT in children with CP were searched from Pubmed, Cochrane Library, Web of Science, EmBase, China National Knowledge Infrastructure, Chinese Biology Medicine, Chinese Scientific Journals Database and Wanfang data from the establishment of database to March 2022. The methodological quality of the included studies was evaluated, and meta-analysis was performed by RevMan5.4 software. RESULTS A total of 16 studies were included in the systematic review (n = 893). Meta-analysis showed that the gross motor function measure (GMFM) (MD = 11.05, 95%CI [8.26, 13.83], P < .00001), dimension D (MD = 3.05, 95%CI [1.58, 4.53], P < .0001) of the GMFM, dimension E (MD = 7.36, 95%CI [5.88, 8.84], P < .00001) of the GMFM, the Berg Balance Scale (BBS) (MD = 6.23, 95%CI [3.31, 9.15], P < .0001), the pediatric evaluation of disability inventory (PEDI) mobile function (MD = 6.44, 95%CI [3.85, 9.02], P < .00001) score improved significantly in the TOT group compared with the control group. CONCLUSIONS Current evidence shows that TOT could effectively improve gross motor function, balance and activities of daily living in children with CP. Due to the limitations of the number and quality of the included studies, the above conclusions need to be verified by more high-quality studies.
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Affiliation(s)
- Weiyi Zai
- School of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Ning Xu
- School of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- * Correspondence: Ning Xu, School of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250355, China (e-mail: ) and Wei Wu, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China (e-mail: )
| | - Wei Wu
- Qilu Hospital of Shandong University, Jinan, Shandong, China
- * Correspondence: Ning Xu, School of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250355, China (e-mail: ) and Wei Wu, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China (e-mail: )
| | - Yueying Wang
- School of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Runfang Wang
- School of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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Muacevic A, Adler JR. Effectiveness of Pelvic Proprioceptive Neuromuscular Facilitation Techniques on Balance and Gait Parameters in Chronic Stroke Patients: A Randomized Clinical Trial. Cureus 2022; 14:e30630. [PMID: 36426303 PMCID: PMC9682972 DOI: 10.7759/cureus.30630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background Stroke is the second leading reason for death and the third most common reason for disability. Stroke is a source of possible substantial harm and is often more disabling than lethal. Common stroke defects include stiffness, tiredness, loss of balance on the afflicted side, as well as gait impairment, resulting in an inability to sustain postural alignment. Pelvic proprioceptive neuromuscular facilitation (PNF) is a physical rehabilitation that combines functionally dependent diagonal activity patterns with neuromuscular facilitator strategies to improve motor behaviour, endurance, and muscle activity and control. This protocol was created to describe the experimental study design for evaluating the combined impact of pelvic PNF and task-oriented exercises in chronic stroke patients to improve balance and gait parameters. Aim and objective The purpose of our study is to investigate the effectiveness of pelvic PNF as well as task-oriented exercises on balance, gait parameters, and in pelvic asymmetry. Methods The participants (n=30) were stroke survivors who fulfilled the inclusion criteria for research and were divided into two groups. The regimen lasted four weeks and took 30 minutes each day. Patients were evaluated at the beginning and end of their treatment. In both groups, pre- and post-intervention outcome measures were recorded and the data was analyzed. Result Following four weeks of rehabilitation, subjects showed remarkable improvement in balance, gait parameters, and pelvic inclination in both groups, i.e., pelvic PNF and task-oriented exercises in group A and task-oriented exercises in group B, but Group A showed a major improvement in outcome measures. A p-value of less than 0.05 was considered significant. Despite the fact that both treatment regimens were successful for the patient, pelvic PNF combined with task-oriented exercises exhibits a statistically significant difference from task-oriented exercises. Conclusion Pelvic PNF along with task-oriented exercises proved to be beneficial and can help in the restoration of balance and gait parameters as a result of normalisation in the geometry and symmetry of the pelvis in stroke patients. The pelvis, which is a connecting link between the trunk and lower limbs, plays a crucial role in balance and also in lower limb performance exclusively in gait.
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Xie H, Li X, Huang W, Yin J, Luo C, Li Z, Dou Z. Effects of robot-assisted task-oriented upper limb motor training on neuroplasticity in stroke patients with different degrees of motor dysfunction: A neuroimaging motor evaluation index. Front Neurosci 2022; 16:957972. [PMID: 36188465 PMCID: PMC9523102 DOI: 10.3389/fnins.2022.957972] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionAlthough robot-assisted task-oriented upper limb (UL) motor training had been shown to be effective for UL functional rehabilitation after stroke, it did not improve UL motor function more than conventional therapy. Due to the lack of evaluation of neurological indicators, it was difficult to confirm the robot treatment parameters and clinical efficacy in a timely manner. This study aimed to explore the changes in neuroplasticity induced by robot-assisted task-oriented UL motor training in different degrees of dysfunction patients and extract neurological evaluation indicators to provide the robot with additional parameter information.Materials and methodsA total of 33 adult patients with hemiplegic motor impairment after stroke were recruited as participants in this study, and a manual muscle test divided patients into muscle strength 0–1 level (severe group, n = 10), 2–3 level (moderate group, n = 14), and 4 or above level (mild group, n = 9). Tissue concentration of oxyhemoglobin and deoxyhemoglobin oscillations in the bilateral prefrontal cortex, dorsolateral prefrontal cortex (DLPFC), superior frontal cortex (SFC), premotor cortex, primary motor cortex (M1), primary somatosensory cortex (S1), and occipital cortex were measured by functional near-infrared spectroscopy (fNIRS) in resting and motor training state. The phase information of a 0.01 −0.08 Hz signal was identified by the wavelet transform method. The wavelet amplitude, lateralization index, and wavelet phase coherence (WPCO) were calculated to describe the frequency-specific cortical changes.ResultsCompared with the resting state, significant increased cortical activation was observed in ipsilesional SFC in the mild group and bilateral SFC in the moderate group during UL motor training. Patients in the mild group demonstrated significantly decreased lateralization of activation in motor training than resting state. Moreover, the WPCO value of motor training between contralesional DLPFC and ipsilesional SFC, bilateral SFC, contralesional, S1, and ipsilesional M1 showed a significant decrease compared with the resting state in the mild group.ConclusionRobot-assisted task-oriented UL motor training could modify the neuroplasticity of SFC and contribute to control movements and continuous learning motor regularity for patients. fNIRS could provide a variety of real-time sensitive neural evaluation indicators for the robot, which was beneficial to formulating more reasonable and effective personalized prescriptions during motor training.
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Affiliation(s)
- Hui Xie
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xin Li
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wenhao Huang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiahui Yin
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Cailing Luo
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zengyong Li
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China
- *Correspondence: Zengyong Li
| | - Zulin Dou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Zulin Dou
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25
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Li C, Wong Y, Langhammer B, Huang F, Du X, Wang Y, Zhang H, Zhang T. A study of dynamic hand orthosis combined with unilateral task-oriented training in subacute stroke: A functional near-infrared spectroscopy case series. Front Neurol 2022; 13:907186. [PMID: 36034313 PMCID: PMC9410701 DOI: 10.3389/fneur.2022.907186] [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: 03/29/2022] [Accepted: 06/14/2022] [Indexed: 12/03/2022] Open
Abstract
Background Motor dysfunction in the upper extremities after stroke prohibits people with stroke from being independent in daily living. The application of fNIRS to explore brain activity under rehabilitation intervention is a research focus on neurorehabilitation. Objective The purpose of this study was to explore, using a grip-release ring motor task, the activated changes of regions of interest and changes in motor function utilizing fNIRS technology and test scales on persons with stroke who received unilateral task-oriented therapy with a hand orthosis in the early subacute stroke period before and after intervention. The study aimed to find a sensitive motor task and region of interest first, then to evaluate the feasibility and mechanism of this rehabilitation method by utilizing fNIRS technology in the next randomized controlled trial. Methods In this case series, eight right-handed, right hemiplegia subacute stroke persons (6 males,2 females from age 47 to 72) were enrolled. They received 30 min of unilateral task-oriented therapy without orthosis and 30 min of unilateral task-oriented therapy with orthosis (5 days/week) for 4 weeks. Activated channel numbers and beta values based on oxygenated hemoglobin concentration change using a grip-release ring motor task were estimated with fNIRS. Clinical outcome measures, including grip strength evaluation, action research arm test, and Fugl-Meyer assessment of the arm, were evaluated at the same time. Results Individual activation analysis showed that, after intervention, Subjects 1, 2, 6, 7, and 8 had the maximum mean beta value located in the left premotor cortex, while Subjects 4 and 5 had the maximum mean beta value located in the left sensorimotor cortex. The activation analysis of Subject 3 showed the maximum mean beta value located in the right premotor cortex. Deactivations of left sensorimotor cortex, left premotor cortex, and bilateral prefrontal cortex were observed after intervention which were different from other cases. Group activation analysis showed that bilateral cerebral hemispheres were activated in all eight participants, with right hemisphere and right supplementary motor cortex activated dominantly. After the intervention, the activation of bilateral hemispheres decreased but in different brain regions; there was a trend that the activation intensity of left sensorimotor cortex, right premotor cortex, and right prefrontal cortex decreased while activation intensity of left premotor cortex and left prefrontal cortex increased. Each participant demonstrated improvements in all the clinical test scales after intervention. Conclusions Left premotor cortex, left sensorimotor cortex, and right supplementary motor cortex may be the primary regions of interest. Grasp-release ring task was not appropriate to achieve our fNIRS research objective and a more sensitive motor task or more sensitive evaluating indicator should be used in further studies.
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Affiliation(s)
- ChaoJinZi Li
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Neurological Rehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Yih Wong
- Department of Research, Sunnaas Rehabilitation Hospital, Bjornemyr, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Birgitta Langhammer
- Department of Research, Sunnaas Rehabilitation Hospital, Bjornemyr, Norway
- Department of Physiotherapy, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - FuBiao Huang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Occupational Therapy, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - XiaoXia Du
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Neurological Rehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - YunLei Wang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Neurological Rehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - HaoJie Zhang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Tong Zhang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Neurological Rehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
- *Correspondence: Tong Zhang
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Cóias AR, Lee MH, Bernardino A. A low-cost virtual coach for 2D video-based compensation assessment of upper extremity rehabilitation exercises. J Neuroeng Rehabil 2022; 19:83. [PMID: 35902897 PMCID: PMC9336113 DOI: 10.1186/s12984-022-01053-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/06/2022] [Indexed: 11/20/2022] Open
Abstract
Background The increasing demands concerning stroke rehabilitation and in-home exercise promotion grew the need for affordable and accessible assistive systems to promote patients’ compliance in therapy. These assistive systems require quantitative methods to assess patients’ quality of movement and provide feedback on their performance. However, state-of-the-art quantitative assessment approaches require expensive motion-capture devices, which might be a barrier to the development of low-cost systems. Methods In this work, we develop a low-cost virtual coach (VC) that requires only a laptop with a webcam to monitor three upper extremity rehabilitation exercises and provide real-time visual and audio feedback on compensatory motion patterns exclusively from image 2D positional data analysis. To assess compensation patterns quantitatively, we propose a Rule-based (RB) and a Neural Network (NN) based approaches. Using the dataset of 15 post-stroke patients, we evaluated these methods with Leave-One-Subject-Out (LOSO) and Leave-One-Exercise-Out (LOEO) cross-validation and the \documentclass[12pt]{minimal}
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\begin{document}$$F_1$$\end{document}F1 score that measures the accuracy (geometric mean of precision and recall) of a model to assess compensation motions. In addition, we conducted a pilot study with seven volunteers to evaluate system performance and usability. Results For exercise 1, the RB approach assessed four compensation patterns with a \documentclass[12pt]{minimal}
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\begin{document}$$79.87 \%$$\end{document}79.87%, respectively. Concerning the user study, they found that the system is enjoyable (hedonic value of 4.54/5) and relevant (utilitarian value of 4.86/5) for rehabilitation administration. Additionally, volunteers’ enjoyment and interest (Hedonic value perception) were correlated with their perceived VC performance (\documentclass[12pt]{minimal}
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\begin{document}$$\rho = 0.53$$\end{document}ρ=0.53). Conclusions The VC performs analysis on 2D videos from a built-in webcam of a laptop and accurately identifies compensatory movement patterns to provide corrective feedback. In addition, we discuss some findings concerning system performance and usability.
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Affiliation(s)
- Ana Rita Cóias
- Institute for Systems and Robotics, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal.
| | - Min Hun Lee
- Singapore Management University, Singapore, Singapore
| | - Alexandre Bernardino
- Institute for Systems and Robotics, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
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Enabling AI and Robotic Coaches for Physical Rehabilitation Therapy: Iterative Design and Evaluation with Therapists and Post-stroke Survivors. Int J Soc Robot 2022. [DOI: 10.1007/s12369-022-00883-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AbstractArtificial intelligence (AI) and robotic coaches promise the improved engagement of patients on rehabilitation exercises through social interaction. While previous work explored the potential of automatically monitoring exercises for AI and robotic coaches, the deployment of these systems remains a challenge. Previous work described the lack of involving stakeholders to design such functionalities as one of the major causes. In this paper, we present our efforts on eliciting the detailed design specifications on how AI and robotic coaches could interact with and guide patient’s exercises in an effective and acceptable way with four therapists and five post-stroke survivors. Through iterative questionnaires and interviews, we found that both post-stroke survivors and therapists appreciated the potential benefits of AI and robotic coaches to achieve more systematic management and improve their self-efficacy and motivation on rehabilitation therapy. In addition, our evaluation sheds light on several practical concerns (e.g. a possible difficulty with the interaction for people with cognitive impairment, system failures, etc.). We discuss the value of early involvement of stakeholders and interactive techniques that complement system failures, but also support a personalized therapy session for the better deployment of AI and robotic exercise coaches.
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Zheng Y, Tian B, Zhuang Z, Zhang Y, Wang D. fNIRS-based adaptive visuomotor task improves sensorimotor cortical activation. J Neural Eng 2022; 19. [PMID: 35853431 DOI: 10.1088/1741-2552/ac823f] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 07/19/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Investigating how to promote the functional activation of the central sensorimotor system is an important goal in the neurorehabilitation research domain. We aim to validate the effectiveness of facilitating cortical excitability using a closed-loop visuomotor task, in which the task difficulty is adaptively adjusted based on an individual's sensorimotor cortical activation. APPROACH We developed a novel visuomotor task, in which subjects moved a handle of a haptic device along a specific path while exerting a constant force against a virtual surface under visual feedback. The difficulty levels of the task were adapted with the aim of increasing the activation of sensorimotor areas, measured non-invasively by functional near-infrared spectroscopy. The changes in brain activation of the bilateral prefrontal cortex, sensorimotor cortex, and the occipital cortex obtained during the adaptive visuomotor task (adaptive group), were compared to the brain activation pattern elicited by the same duration of task with random difficulties in a control group. MAIN RESULTS During one intervention session, the adaptive group showed significantly increased activation in the bilateral sensorimotor cortex, also enhanced effective connectivity between the prefrontal and sensorimotor areas compared to the control group. SIGNIFICANCE Our findings demonstrated that the fNIRS-based adaptive visuomotor task with high ecological validity can facilitate the neural activity in sensorimotor areas and thus has the potential to improve hand motor functions.
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Affiliation(s)
- Yilei Zheng
- Beihang University, State Key Laboratory of Virtual Reality Technology and Systems, 37 Xueyuan Road, Haidian District, Beijing, P.R. China, 100191, Beijing, 100191, CHINA
| | - Bohao Tian
- State Key Laboratory of Virtual Reality Technology and Systems, 37 Xueyuan Road, Haidian District, Beijing, P.R. China, 100191, Beijing, 100191, CHINA
| | - Zhiqi Zhuang
- Beihang University, 37 Xueyuan Road, Haidian District, Beijing, P.R. China, 100191, Beijing, 100191, CHINA
| | - Yuru Zhang
- State Key Laboratory of Virtual Reality Technology and Systems, 37 Xueyuan Road, Haidian District, Beijing, P.R. China, 100191, Beijing, 100191, CHINA
| | - Dangxiao Wang
- State Key Laboratory of Virtual Reality Technology and Systems, 37 Xueyuan Road, Haidian District, Beijing, P.R. China, 100191, Beijing, 100191, CHINA
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Zhang M, Wei J, Wu X. Effects of whole-body vibration training on lower limb motor function and neural plasticity in patients with stroke: protocol for a randomised controlled clinical trial. BMJ Open 2022; 12:e060796. [PMID: 35768103 PMCID: PMC9240887 DOI: 10.1136/bmjopen-2022-060796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Lower limb motor dysfunction is common in patients with stroke, and usually caused by brain neural connectivity disorder. Previous studies have shown that the whole-body vibration training (WBVT) significantly improves the lower limb motor function in patients with stroke and may promote nerve remodelling. The prior purpose of this study is to explore effects of WBVT on lower limb motor function and neuroplasticity in patients with stroke. METHODS A single-blind randomised controlled trial will be conducted. Sixty patients with stroke will be recruited and allocated randomly to WBVT, routine rehabilitation training (RRT) and control group (CG). The WBVT and RRT interventions will be implemented as five 25 min sessions weekly for continuous 12 weeks; the CG will remain daily habitual living styles and routine treatments, in community or hospital, and will also receive telephone follow-up and health-related lectures. Transcranial magnetic stimulation will be used to assess neural plasticity while lower limb motor function is assessed using indicators of strength, walking ability and joint activity. The assessments will be conducted at the period of baseline, week 6, week 12 as well as on 4 and 8 weeks, respectively, after intervention completion. ETHICS AND DISSEMINATION This study has been approved by the Shanghai University of Sport Research Ethics Committee (102772021RT067) and will provide data on the effects of WBVT relative to RRT in terms of the improvement of stroke patients' lower limb motor function and neural plasticity. The results of this study will be disseminated via publications in peer-reviewed journals and presentations at international conference. TRIAL REGISTRATION NUMBER ChiCTR2200055143.
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Affiliation(s)
| | - Jianing Wei
- School of Psychology, Shanghai University of Sport, Shanghai, China
| | - Xueping Wu
- Shanghai University of Sport, Shanghai, China
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30
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Therapist-Patient Interactions in Task-Oriented Stroke Therapy can Guide Robot-Patient Interactions. Int J Soc Robot 2022. [DOI: 10.1007/s12369-022-00881-2] [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]
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31
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Aravind G, Bashir K, Cameron JI, Howe JA, Jaglal SB, Bayley MT, Teasell RW, Moineddin R, Zee J, Wodchis WP, Tee A, Hunter S, Salbach NM. Community-based exercise programs incorporating healthcare-community partnerships to improve function post-stroke: feasibility of a 2-group randomized controlled trial. Pilot Feasibility Stud 2022; 8:88. [PMID: 35459194 PMCID: PMC9028093 DOI: 10.1186/s40814-022-01037-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 03/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Despite the potential for community-based exercise programs supported through healthcare-community partnerships (CBEP-HCPs) to improve function post-stroke, insufficient trial evidence limits widespread program implementation and funding. We evaluated the feasibility and acceptability of a CBEP-HCP compared to a waitlist control group to improve everyday function among people post-stroke. Methods We conducted a 3-site, pilot randomized trial with blinded follow-up evaluations at 3, 6, and 10 months. Community-dwelling adults able to walk 10 m were stratified by site and gait speed and randomized (1:1) to a CBEP-HCP or waitlist control group. The CBEP-HCP involved a 1-h, group exercise class, with repetitive and progressive practice of functional balance and mobility tasks, twice a week for 12 weeks. We offered the exercise program to the waitlist group at 10 months. We interviewed 13 participants and 9 caregivers post-intervention and triangulated quantitative and qualitative results. Study outcomes included feasibility of recruitment, interventions, retention, and data collection, and potential effect on everyday function. Results Thirty-three people with stroke were randomized to the intervention (n = 16) or waitlist group (n = 17). We recruited 1–2 participants/month at each site. Participants preferred being recruited by a familiar healthcare professional. Participants described a 10- or 12-month wait in the control group as too long. The exercise program was implemented per protocol across sites. Five participants (31%) in the intervention group attended fewer than 50% of classes for health reasons. In the intervention and waitlist group, retention was 88% and 82%, respectively, and attendance at 10-month evaluations was 63% and 71%, respectively. Participants described inclement weather, availability of transportation, and long commutes as barriers to attending exercise classes and evaluations. Among participants in the CBEP-HCP who attended ≥ 50% of classes, quantitative and qualitative results suggested an immediate effect of the intervention on balance, balance self-efficacy, lower limb strength, everyday function, and overall health. Conclusion The CBEP-HCP appears feasible and potentially beneficial. Findings will inform protocol revisions to optimize recruitment, and program and evaluation attendance in a future trial. Trial registration ClinicalTrials.gov, NCT03122626. Registered April 21, 2017 — retrospectively registered.
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Affiliation(s)
- Gayatri Aravind
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Kainat Bashir
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Jill I Cameron
- Department of Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Jo-Anne Howe
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.,Toronto Rehabilitation Institute, University Health Network, University of Toronto, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Susan B Jaglal
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.,The KITE Research Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Mark T Bayley
- Toronto Rehabilitation Institute, University Health Network, University of Toronto, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.,The KITE Research Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.,Department of Medicine, University of Toronto, C. David Naylor Building, 6 Queen's Park Crescent West, Third Floor, London, ON, M5S 3H2, Canada
| | - Robert W Teasell
- Schulich School of Medicine and Dentistry, Western University, St Joseph's Health Care London - Parkwood Institute, 550 Wellington Rd, London, ON, N6C 0A7, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, 160‑500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Joanne Zee
- Toronto General Hospital, University Health Network, 585 University Avenue, Toronto, ON, M5G 2N2, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - Alda Tee
- Central East Stroke Network, Royal Victoria Regional Health Centre, 201 Georgian Drive, Barrie, ON, L4M6M2, Canada
| | - Susan Hunter
- School of Physical Therapy, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Nancy M Salbach
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada. .,The KITE Research Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
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Almasi S, Ahmadi H, Asadi F, Shahmoradi L, Arji G, Alizadeh M, Kolivand H. Kinect-Based Rehabilitation Systems for Stroke Patients: A Scoping Review. BIOMED RESEARCH INTERNATIONAL 2022; 2022:4339054. [PMID: 35386303 PMCID: PMC8977286 DOI: 10.1155/2022/4339054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/04/2022] [Indexed: 01/01/2023]
Abstract
Method This study was conducted according to Arksey and O'Malley's framework. To investigate the evidence on the effects of Kinect-based rehabilitation, a search was executed in five databases (Web of Science, PubMed, Cochrane Library, Scopus, and IEEE) from 2010 to 2020. Results Thirty-three articles were finally selected by the inclusion criteria. Most of the studies had been conducted in the US (22%). In terms of the application of Kinect-based rehabilitation for stroke patients, most studies had focused on the rehabilitation of upper extremities (55%), followed by balance (27%). The majority of the studies had developed customized rehabilitation programs (36%) for the rehabilitation of stroke patients. Most of these studies had noted that the simultaneous use of Kinect-based rehabilitation and other physiotherapy methods has a more noticeable effect on performance improvement in patients. Conclusion The simultaneous application of Kinect-based rehabilitation and other physiotherapy methods has a stronger effect on the performance improvement of stroke patients. Better effects can be achieved by designing Kinect-based rehabilitation programs tailored to the characteristics and abilities of stroke patients.
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Affiliation(s)
- Sohrab Almasi
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Ahmadi
- Centre for Health Technology, University of Plymouth, Plymouth, UK
| | - Farkhondeh Asadi
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Shahmoradi
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Goli Arji
- Department of Health Information Technology, School of Nursing and Midwifery, Saveh University of Medical Sciences, Markaz, Iran
| | - Mojtaba Alizadeh
- Department of Computer Engineering, Lorestan University, Khorramabad, Iran
| | - Hoshang Kolivand
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, UK
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Evaluating and Characterizing an Individually-Tailored Community Exercise Program for Older Adults With Chronic Neurological Conditions: A Mixed-Methods Study. J Aging Phys Act 2022; 30:1047-1060. [PMID: 35294924 DOI: 10.1123/japa.2021-0292] [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: 07/28/2021] [Revised: 01/10/2022] [Accepted: 02/04/2022] [Indexed: 11/18/2022]
Abstract
A mixed-methods approach was used to study an individually-tailored community exercise program for people with a range of chronic neurological conditions (e.g., stroke, spinal cord injury, brain injury, multiple sclerosis, Parkinson's disease) and abilities. The program was delivered to older adults (mean age: 62 ± 9 years) with chronic neurological conditions across a 12-week and an 8-week term. Participants attended 88% of sessions and completed 89% of prescribed exercises in those sessions. There were no adverse events. Clinically important improvements were achieved by all evaluated participants (n = 8) in at least one testing domain (grip strength, lower-extremity strength, aerobic endurance, and balance). Interviews with participants identified key program elements as support through supervision, social connection, individualized programming, and experiential learning. Findings provide insight into elements that enable a community exercise program to meet the needs of a complex and varied group. Further study will support positive long-term outcomes for people aging with neurological conditions.
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Park J. The effects of task-oriented mental practice on upper limb function and coordination in chronic stroke patients—Randomized controlled trial design. Br J Occup Ther 2022. [DOI: 10.1177/03080226211057838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective This study is a randomized experimental design study conducted to investigate the effect of task-oriented mental practice (TOMP) on upper limb function and coordination in chronic stroke patients. Methods A total of 34 chronic stroke patients participated in this study and were randomly divided into an experimental group (EG) of 17 patients (TOMP) and a control group (CG) of 17 patients (task-oriented training). To measure the subject’s upper extremity function and coordination, the results of Fugl-Meyer assessment (FMA) of motor function (U/E) and co-coordination ratio (CCR) values calculated from the measurements of the BTS FreeEMG 300 were used. Results In the comparison before and after group intervention in terms of FMA, the EG showed significant changes in all items of FMA, but the CG showed significant changes only in the shoulder items ( p < 0.05). In the comparison between groups, significant differences were observed only in the total score of FMA ( p < 0.05). In terms of the CCR value, positive changes were found in the EG in all items except for the shoulder flexion, but negative changes were observed in all items in the CG. Conclusion It was confirmed that the TOMP applied in this study can have a positive effect on upper limb function and coordination in chronic stroke patients.
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Affiliation(s)
- JuHyung Park
- Department of Occupational Therapy, College of Health and Medical Sciences, Cheongju University, Cheongju, Korea
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The Effect of Task-Oriented Training on Upper-Limb Function, Visual Perception, and Activities of Daily Living in Acute Stroke Patients: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063186. [PMID: 35328874 PMCID: PMC8954660 DOI: 10.3390/ijerph19063186] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/06/2022] [Accepted: 03/06/2022] [Indexed: 11/17/2022]
Abstract
This pilot study aimed to investigate the effects of task-oriented training on upper-limb functioning, visual perception, and activities of daily living (ADL) in acute stroke patients. Of 20 participants, 10 were randomly assigned in a 1:1 ratio to experimental and control groups. Task-oriented training and table-top activity training were implemented for 6 weeks. Change in upper-limb functioning was assessed with the Manual Function Test (MFT); visual perceptual skill and ADL performance were evaluated using the Motor-Free Visual Perception Test—Vertical (MVPT-V) and Korean Modified Barthel Index (K-MBI), respectively. There was a significant interaction in the MFT and MBI score between the group and time (p < 0.05), but the group effect was not significant (p > 0.05). The MFT and MBI score significantly increased in both groups after the intervention (p < 0.001), but the effect size was greater in the task-oriented training group than the table-top activity training group. No significant interaction with MVPT-V score was found between the group and time (p > 0.05), and no statistical group difference was found either (p > 0.05). Both groups showed significant improvement in their MVPT-V score after the intervention (p < 0.001). The pilot study findings demonstrate that both task-oriented training and table-top activity training are effective in recovering upper-limb function, visual perception, and ADL in acute stroke patients.
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Kreider CM, Hale-Gallardo J, Kramer JC, Mburu S, Slamka MR, Findley KE, Myers KJ, Romero S. Providers' Shift to Telerehabilitation at the U.S. Veterans Health Administration During COVID-19: Practical Applications. Front Public Health 2022; 10:831762. [PMID: 35309184 PMCID: PMC8931404 DOI: 10.3389/fpubh.2022.831762] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/18/2022] [Indexed: 11/16/2022] Open
Abstract
Telerehabilitation provides Veteran patients with necessary rehabilitation treatment. It enhances care continuity and reduces travel time for Veterans who face long distances to receive care at a Veterans Health Administration (VHA) medical facility. The onset of the COVID-19 pandemic necessitated a sudden shift to telehealth–including telerehabilitation, where a paucity of data-driven guidelines exist that are specific to the practicalities entailed in telerehabilitation implementation. This paper explicates gains in practical knowledge for implementing telerehabilitation that were accelerated during the rapid shift of VHA healthcare from out-patient rehabilitation services to telerehabilitation during the COVID-19 pandemic. Group and individual interviews with 12 VHA rehabilitation providers were conducted to examine, in-depth, the providers' implementation of telerehabilitation. Thematic analysis yielded nine themes: (i) Willingness to Give Telerehabilitation a Chance: A Key Ingredient; (ii) Creativity and Adaptability: Critical Attributes for Telerehabilitation Providers; (iii) Adapting Assessments; (iv) Adapting Interventions; (v) Role and Workflow Adaptations; (vi) Appraising for Self the Feasibility of the Telerehabilitation Modality; (vii) Availability of Informal, In-Person Support Improves Feasibility of Telerehabilitation; (viii) Shifts in the Expectations by the Patients and by the Provider; and (ix) Benefit and Anticipated Future of Telerehabilitation. This paper contributes an in-depth understanding of clinical reasoning considerations, supportive strategies, and practical approaches for engaging Veterans in telerehabilitation.
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Affiliation(s)
- Consuelo M. Kreider
- Department of Occupational Therapy, University of Florida, Gainesville, FL, United States
| | - Jennifer Hale-Gallardo
- Veterans Rural Health Resource Center-Salt Lake City (VRHRC-SLC), Office of Rural Health, Veterans Health Administration, Salt Lake City, UT, United States
| | - John C. Kramer
- Department of Occupational Therapy, University of Florida, Gainesville, FL, United States
| | - Sharon Mburu
- Department of Occupational Therapy, University of Florida, Gainesville, FL, United States
| | - Mackenzi R. Slamka
- Department of Occupational Therapy, University of Florida, Gainesville, FL, United States
| | - Kimberly E. Findley
- Department of Veterans Affairs, North Florida/South Georgia Veterans Health System, Research Service, Gainesville, FL, United States
- *Correspondence: Kimberly E. Findley
| | - Keith J. Myers
- Veterans Rural Health Resource Center-Gainesville (VRHRC-GNV), Office of Rural Health, Veterans Health Administration, Gainesville, FL, United States
| | - Sergio Romero
- Veterans Rural Health Resource Center-Gainesville (VRHRC-GNV), Office of Rural Health, Veterans Health Administration, Gainesville, FL, United States
- Sergio Romero
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Barak Ventura R, Stewart Hughes K, Nov O, Raghavan P, Ruiz Marín M, Porfiri M. Data-Driven Classification of Human Movements in Virtual Reality-Based Serious Games: Preclinical Rehabilitation Study in Citizen Science. JMIR Serious Games 2022; 10:e27597. [PMID: 35142629 PMCID: PMC8874800 DOI: 10.2196/27597] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/14/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sustained engagement is essential for the success of telerehabilitation programs. However, patients' lack of motivation and adherence could undermine these goals. To overcome this challenge, physical exercises have often been gamified. Building on the advantages of serious games, we propose a citizen science-based approach in which patients perform scientific tasks by using interactive interfaces and help advance scientific causes of their choice. This approach capitalizes on human intellect and benevolence while promoting learning. To further enhance engagement, we propose performing citizen science activities in immersive media, such as virtual reality (VR). OBJECTIVE This study aims to present a novel methodology to facilitate the remote identification and classification of human movements for the automatic assessment of motor performance in telerehabilitation. The data-driven approach is presented in the context of a citizen science software dedicated to bimanual training in VR. Specifically, users interact with the interface and make contributions to an environmental citizen science project while moving both arms in concert. METHODS In all, 9 healthy individuals interacted with the citizen science software by using a commercial VR gaming device. The software included a calibration phase to evaluate the users' range of motion along the 3 anatomical planes of motion and to adapt the sensitivity of the software's response to their movements. During calibration, the time series of the users' movements were recorded by the sensors embedded in the device. We performed principal component analysis to identify salient features of movements and then applied a bagged trees ensemble classifier to classify the movements. RESULTS The classification achieved high performance, reaching 99.9% accuracy. Among the movements, elbow flexion was the most accurately classified movement (99.2%), and horizontal shoulder abduction to the right side of the body was the most misclassified movement (98.8%). CONCLUSIONS Coordinated bimanual movements in VR can be classified with high accuracy. Our findings lay the foundation for the development of motion analysis algorithms in VR-mediated telerehabilitation.
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Affiliation(s)
- Roni Barak Ventura
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Kora Stewart Hughes
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Oded Nov
- Department of Technology Management and Innovation, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Preeti Raghavan
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Manuel Ruiz Marín
- Department of Quantitative Methods, Law and Modern Languages, Technical University of Cartagena, Cartagena, Spain
- Murcia Bio-Health Institute (IMIB-Arrixaca), Health Science Campus, Cartagena, Spain
| | - Maurizio Porfiri
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
- Center for Urban Science and Progress, New York University, Brooklyn, NY, United States
- Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
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Anwer S, Waris A, Gilani SO, Iqbal J, Shaikh N, Pujari AN, Niazi IK. Rehabilitation of Upper Limb Motor Impairment in Stroke: A Narrative Review on the Prevalence, Risk Factors, and Economic Statistics of Stroke and State of the Art Therapies. Healthcare (Basel) 2022; 10:healthcare10020190. [PMID: 35206805 PMCID: PMC8872602 DOI: 10.3390/healthcare10020190] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/05/2022] [Accepted: 01/13/2022] [Indexed: 02/04/2023] Open
Abstract
Stroke has been one of the leading causes of disability worldwide and is still a social health issue. Keeping in view the importance of physical rehabilitation of stroke patients, an analytical review has been compiled in which different therapies have been reviewed for their effectiveness, such as functional electric stimulation (FES), noninvasive brain stimulation (NIBS) including transcranial direct current stimulation (t-DCS) and transcranial magnetic stimulation (t-MS), invasive epidural cortical stimulation, virtual reality (VR) rehabilitation, task-oriented therapy, robot-assisted training, tele rehabilitation, and cerebral plasticity for the rehabilitation of upper extremity motor impairment. New therapeutic rehabilitation techniques are also being investigated, such as VR. This literature review mainly focuses on the randomized controlled studies, reviews, and statistical meta-analyses associated with motor rehabilitation after stroke. Moreover, with the increasing prevalence rate and the adverse socio-economic consequences of stroke, a statistical analysis covering its economic factors such as treatment, medication and post-stroke care services, and risk factors (modifiable and non-modifiable) have also been discussed. This review suggests that if the prevalence rate of the disease remains persistent, a considerable increase in the stroke population is expected by 2025, causing a substantial economic burden on society, as the survival rate of stroke is high compared to other diseases. Compared to all the other therapies, VR has now emerged as the modern approach towards rehabilitation motor activity of impaired limbs. A range of randomized controlled studies and experimental trials were reviewed to analyse the effectiveness of VR as a rehabilitative treatment with considerable satisfactory results. However, more clinical controlled trials are required to establish a strong evidence base for VR to be widely accepted as a preferred rehabilitation therapy for stroke.
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Affiliation(s)
- Saba Anwer
- School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 45200, Pakistan; (S.A.); (A.W.); (S.O.G.); (J.I.)
| | - Asim Waris
- School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 45200, Pakistan; (S.A.); (A.W.); (S.O.G.); (J.I.)
| | - Syed Omer Gilani
- School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 45200, Pakistan; (S.A.); (A.W.); (S.O.G.); (J.I.)
| | - Javaid Iqbal
- School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 45200, Pakistan; (S.A.); (A.W.); (S.O.G.); (J.I.)
| | - Nusratnaaz Shaikh
- Faculty of Health & Environmental Sciences, Health & Rehabilitation Research Institute, AUT University, Auckland 0627, New Zealand;
| | - Amit N. Pujari
- School of Physics, Engineering and Computer Science, University of Hertfordshire, Hatfield AL10 9AB, UK;
- School of Engineering, University of Aberdeen, Aberdeen AB24 3FX, UK
| | - Imran Khan Niazi
- Faculty of Health & Environmental Sciences, Health & Rehabilitation Research Institute, AUT University, Auckland 0627, New Zealand;
- Center of Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand
- Center for Sensory-Motor Interaction, Department of Health Science & Technology, Aalborg University, 9000 Alborg, Denmark
- Correspondence:
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Peniche PDC, Pinto APDS, Ribeiro RLMN, Martins JC, Faria CDCDM. Recruitment, retention, attendance, and adherence of a randomized controlled trial to evaluate the effects of task-specific training with individuals post stroke. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/20008529012022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Individuals who suffered stroke benefit from different therapeutic strategies whose efficacy has been proved by well-designed randomized controlled trials (RCTs). Understanding study steps may assist researchers in conducting future RCTs. Thus, the objective of this study was to describe the process of recruitment, retention, attendance, and adherence in conducting RCTs with individuals in the chronic phase of stroke in the municipality of Belo Horizonte/MG/Brazil, with the purpose of investigating the efficacy of specific task training for both lower and upper limbs in improving patients’ physical activity and mobility. Results showed that, of the 674 potential participants, it was impossible to contact 240 individuals and 384 were excluded from our sample for failing to meet eligibility criteria. In total, 50 individuals participated in clinical evaluations and 14 were excluded from the study for the same reason. Overall, 36 individuals started the interventions, a 5.3% recruitment rate. An 80.6% retention rate was observed. In total, seven individuals left the study, mainly due to lack of interest in the activities. We found an 80.9% attendance rate, and the main reason for missing medical appointments was incompatibility with treatment schedule. We also observed an 82.7% adherence rate. Of these, 180 interrupted sessions were mainly due to patients leaving early. These results indicate some difficulties found in conducting RCTs with individuals in the chronic phase of stroke, especially regarding specific task training. Despite these difficulties, the proposed intervention can be considered feasible.
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Feldhacker DR, Lucas Molitor W, Jensen L, Lohman H, Lampe AM. Occupational Therapy and the IMPACT Act: Part 2. A Systematic Review of Evidence for Functional Status, Medication Reconciliation, and Skin Integrity Interventions. Am J Occup Ther 2022; 76:23147. [PMID: 35019969 DOI: 10.5014/ajot.2022.049324] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Interventions that promote function, medication reconciliation, and skin integrity assist occupational therapy practitioners in demonstrating professional value, improving quality, and reducing health care costs. OBJECTIVE In this systematic review, we focus on three outcome areas of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014: functional status, medication reconciliation, and skin integrity. DATA SOURCES We conducted a search of the literature published between 2009 and 2019 in CINAHL, Cochrane, MEDLINE, PsycINFO, OTseeker, and Scopus. We also hand searched the systematic reviews and meta-analyses in our search results for articles that met our inclusion criteria. Study Selection and Data Collection: This study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. FINDINGS We found 47 articles that address the three outcome areas. Regarding functional status, low strength of evidence is available for cognition and functional mobility interventions to support functional performance, moderate strength of evidence supports interventions for vision, and moderate evidence supports task-oriented and individualized interventions to promote activities of daily living (ADL) outcomes among people with neurological conditions. Strong strength of evidence supports individualized occupational therapy interventions focusing on medication adherence. Low strength of evidence was found for occupational therapy interventions to reduce pressure ulcers and promote skin integrity. Conclusion and Relevance: The evidence supports occupational therapy interventions to improve functional status in ADLs and medication management. Additional research is needed that examines the outcomes of occupational therapy interventions for other areas of function and skin integrity. What This Article Adds: We found evidence to support occupational therapy interventions that align with value-based measures in the three outcome areas of interest. The effectiveness of these interventions highlights the viability of occupational therapy as an essential profession and the worth of occupational therapy to the public, potential clients, and payers.
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Affiliation(s)
- Diana R Feldhacker
- Diana R. Feldhacker, OTD, OTR/L, BCPR, is Department Chair and Assistant Professor in Occupational Therapy, Department of Occupational Therapy, Des Moines University, Des Moines, IA;
| | - Whitney Lucas Molitor
- Whitney Lucas Molitor, PhD, OTD, OTR/L, BCG, is Assistant Professor, Department of Occupational Therapy, and Undergraduate Public Health Program Director, University of South Dakota, Vermillion
| | - Lou Jensen
- Lou Jensen, OTD, OTR/L, is Associate Professor, Department of Occupational Therapy, Creighton University, Omaha, NE
| | - Helene Lohman
- Helene Lohman, OTD, OTR/L, is Professor, Department of Occupational Therapy, Creighton University, Omaha, NE
| | - Angela M Lampe
- Angela M. Lampe, OTD, OTR/L, is Associate Professor, Department of Occupational Therapy, Creighton University, Omaha, NE
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Peniche PDC, Pinto APDS, Ribeiro RLMN, Martins JC, Faria CDCDM. Recrutamento, retenção, presença e adesão de um ensaio clínico aleatorizado para avaliar os efeitos do treino específico da tarefa em indivíduos pós-acidente vascular encefálico. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/20008529012022pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Indivíduos acometidos pelo acidente vascular encefálico (AVE) se beneficiam de diferentes estratégias terapêuticas que apresentam comprovação da eficácia por meio da condução de ensaios clínicos aleatorizados (ECA) bem delineados. Compreender as etapas do estudo pode auxiliar os pesquisadores na realização de futuros ensaios clínicos. Dessa forma, o objetivo deste estudo foi descrever o processo de recrutamento, retenção, presença e adesão na condução de um ECA realizado com indivíduos pós-AVE na fase crônica na cidade de Belo Horizonte (MG), Brasil, com o propósito de investigar a eficácia do treino específico da tarefa para membros superiores e inferiores na melhora do nível de atividade física e mobilidade. Nos resultados, foi observado que dos 674 potenciais participantes, não foi possível contatar 240; 384 não foram avaliados por não atenderem aos critérios de elegibilidade. Participaram da avaliação presencial 50 indivíduos e 14 não fizeram parte do estudo pelo mesmo motivo. Apenas 36 indivíduos iniciaram as intervenções (taxa de recrutamento de 5,3%). Uma taxa de retenção de 80,6% foi observada. Sete indivíduos abandonaram o estudo, principalmente por desinteresse pelas atividades. A taxa de presença foi de 80,9%, e o principal motivo para ausência nas sessões foi incompatibilidade de horário com as consultas médicas. A taxa de adesão foi de 82,7%, com 180 interrupções durante as sessões, sendo sair mais cedo o motivo mais comum. Esses resultados indicam algumas dificuldades no processo de condução do ECA com indivíduos na fase crônica do AVE envolvendo treino específico da tarefa. Apesar dessas dificuldades, a intervenção proposta pode ser considerada viável.
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Chen P, Liu TW, Kwong PWH, Lai CKY, Chung RCK, Tsoh J, Ng SSM. Bilateral Transcutaneous Electrical Nerve Stimulation Improves Upper Limb Motor Recovery in Stroke: A Randomized Controlled Trial. Stroke 2021; 53:1134-1140. [PMID: 34852645 DOI: 10.1161/strokeaha.121.036895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Recent evidence has shown bilateral transcutaneous electrical nerve stimulation (Bi-TENS) combined with task-oriented training (TOT) to be superior to unilateral transcutaneous electrical nerve stimulation (Uni-TENS)+TOT in improving lower limb motor functioning following stroke. However, no research explored the effect of Bi-TENS+TOT in improving upper limb motor recovery. This study aimed to compare Bi-TENS+TOT with Uni-TENS+TOT, Placebo transcutaneous electrical nerve stimulation (Placebo-TENS)+TOT, and no treatment (Control) groups in upper limb motor recovery. METHODS This is a 4-group parallel design. One hundred and twenty subjects were given either Bi-TENS+TOT, Uni-TENS+TOT, Placebo-TENS+TOT, or Control without treatment in this randomized controlled trial. Twenty 60-minute sessions were administered 3× per week for 7 weeks. The outcome measure was the Fugl-Meyer Assessment of Upper Extremity, which was assessed at baseline, after 10 sessions (mid-intervention) and 20 sessions (post-intervention) of intervention, and at 1- and 3-month follow-up. RESULTS Patients in the Bi-TENS+TOT group showed greater improvement in the Fugl-Meyer Assessment of Upper Extremity scores than Uni-TENS+TOT (mean difference, 2.13; P=0.004), Placebo-TENS+TOT (mean difference, 2.63; P<0.001), and Control groups (mean difference, 3.11; P<0.001) at post-intervention. Both Bi-TENS+TOT (mean difference, 3.39; P<0.001) and Uni-TENS+TOT (mean difference, 1.26; P=0.018) showed significant within-group improvement in the Fugl-Meyer Assessment of Upper Extremity scores. Patients in the Bi-TENS+TOT group showed earlier within-group improvement in the Fugl-Meyer Assessment of Upper Extremity scores at mid-intervention than Uni-TENS+TOT. These improvements were maintained at the 3-month follow-up assessment. CONCLUSIONS Bi-TENS combined with TOT is an effective therapy for improving upper limb motor recovery following stroke. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03112473.
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Affiliation(s)
- Peiming Chen
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, China. (P.C., P.W.H.K., R.C.K.C., S.S.M.N.)
| | - Tai-Wa Liu
- School of Nursing & Health Studies, Hong Kong Metropolitan University, Ho Man Tin, China (T.-W.L.)
| | - Patrick W H Kwong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, China. (P.C., P.W.H.K., R.C.K.C., S.S.M.N.)
| | - Claudia K Y Lai
- School of Nursing, The Hong Kong Polytechnic University, China. (C.K.Y.L.)
| | - Raymond C K Chung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, China. (P.C., P.W.H.K., R.C.K.C., S.S.M.N.)
| | - Joshua Tsoh
- Department of Psychiatry, Prince of Wales Hospital and Shatin Hospital, Hong Kong SAR, China (J.T.)
| | - Shamay S M Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, China. (P.C., P.W.H.K., R.C.K.C., S.S.M.N.)
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Effects of Task-Specific Training after Cognitive Sensorimotor Exercise on Proprioception, Spasticity, and Gait Speed in Stroke Patients: A Randomized Controlled Study. ACTA ACUST UNITED AC 2021; 57:medicina57101098. [PMID: 34684135 PMCID: PMC8541560 DOI: 10.3390/medicina57101098] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 09/29/2021] [Accepted: 10/11/2021] [Indexed: 11/23/2022]
Abstract
Background and objectives: Common problems in stroke patients include loss of proprioception, spasticity, and impaired gait. The purpose of this study was to examine the effects of task-specific training (TST) combined with cognitive sensorimotor exercise (CSE) on proprioception, spasticity and gait speed in stroke patients. Materials andMethods: Thirty-seven subjects were randomly divided into three groups; (1) the TST after CSE group (Experimental I, n = 13); (2) the TST group (Experimental II, n = 12), and (3) a conventional physical therapy training group (control group, n = 12). Evaluations were performed before the commencement of training and again eight weeks after training was initiated. An electrogoniometer was used to evaluate proprioception variation. The composite spasticity score (CSS) and MyotonePRO were used to evaluate spasticity. In addition, 10 m walk test was used to assess gait speed. Results: After training, the Experimental I group showed significant improvement in proprioception compared to the Experimental II and control group (p < 0.05). In CSS, gastrocnemius muscle tone (GMT) and gait speed among three groups, Experimental I group differed significantly after eight weeks of training compared to the control group (p < 0.05). Conclusions: These findings suggest that the TST combined with CSE provided significant improvements in proprioception, spasticity, and gait speed.
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Vanoglio F, Olivares A, Bonometti GP, Damiani S, Gaiani M, Comini L, Luisa A. A decision making algorithm for rehabilitation after stroke: A guide to choose an appropriate and safe treadmill training. NeuroRehabilitation 2021; 49:75-85. [PMID: 34057102 DOI: 10.3233/nre-210065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Walking independently after a stroke can be difficult or impossible, and walking reeducation is vital. But the approach used is often arbitrary, relying on the devices available and subjective evaluations by the doctor/physiotherapist. Objective decision making tools could be useful. OBJECTIVES To develop a decision making algorithm able to select for post-stroke patients, based on their motor skills, an appropriate mode of treadmill training (TT), including type of physiotherapist support/supervision required and safety conditions necessary. METHODS We retrospectively analyzed data from 97 post-stroke inpatients admitted to a NeuroRehabilitation unit. Patients attended TT with body weight support (BWSTT group) or without support (FreeTT group), depending on clinical judgment. Patients' sociodemographic and clinical characteristics, including the Cumulative Illness Rating Scale (CIRS) plus measures of walking ability (Functional Ambulation Classification [FAC], total Functional Independence Measure [FIM] and Tinetti Performance-Oriented Mobility Assessment [Tinetti]) and fall risk profile (Morse and Stratify) were retrieved from institutional database. RESULTS No significant differences emerged between the two groups regarding sociodemographic and clinical characteristics. Regarding walking ability, FAC, total FIM and its Motor component and the Tinetti scale differed significantly between groups (for all, p < 0.001). FAC and Tinetti scores were used to elaborate a decision making algorithm classifying patients into 4 risk/safety (RS) classes. As expected, a strong association (Pearson chi-squared, p < 0.0001) was found between RS classes and the initial BWSTT/FreeTT classification. CONCLUSION This decision making algorithm provides an objective tool to direct post-stroke patients, on admission to the rehabilitation facility, to the most appropriate form of TT.
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Affiliation(s)
- Fabio Vanoglio
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of the Institute of Lumezzane, Brescia, Italy
| | - Adriana Olivares
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Direction of the Institute of Lumezzane, Brescia, Italy
| | - Gian Pietro Bonometti
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of the Institute of Lumezzane, Brescia, Italy
| | - Silvia Damiani
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of the Institute of Lumezzane, Brescia, Italy
| | - Marta Gaiani
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of the Institute of Lumezzane, Brescia, Italy
| | - Laura Comini
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Direction of the Institute of Lumezzane, Brescia, Italy
| | - Alberto Luisa
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of the Institute of Lumezzane, Brescia, Italy
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45
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Traxler K, Schinabeck F, Baum E, Klotz E, Seebacher B. Feasibility of a specific task-oriented training versus its combination with manual therapy on balance and mobility in people post stroke at the chronic stage: study protocol for a pilot randomised controlled trial. Pilot Feasibility Stud 2021; 7:146. [PMID: 34311772 PMCID: PMC8313417 DOI: 10.1186/s40814-021-00886-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 07/09/2021] [Indexed: 11/28/2022] Open
Abstract
Background Large studies have shown that stroke is among the most relevant causes of acquired adult disability. Walking and balance impairment in stroke survivors often contribute to a restriction in daily activities and social participation. Task-oriented training (TOT) is an effective treatment strategy and manual therapy (MT) is used successfully to enhance ankle joint flexibility in this population. No study, however, has compared TOT against its combination with MT in a randomised controlled trial. Aims of this pilot study are therefore to explore the feasibility of a full-scale RCT using predefined feasibility criteria. Secondary aims are to explore the preliminary effects of specific TOT with a combined specific TOT-MT versus a control group in people post stroke. Methods This is a protocol of a 4-week prospective randomised controlled parallel pilot trial in people post stroke at the chronic stage with limited upper ankle joint mobility and an impairment in balance and mobility. At a German outpatient therapy centre using 1:1:1 allocation, 36 patients will be randomised into one of three groups: 15-min talocrural joint MT plus 30-min specific TOT (group A), 45-min specific TOT (group B), and controls (group C). Training will be goal-oriented including tasks that are based on daily activities and increased in difficulty utilising predefined progression criteria based on patients’ skill levels. Interventions will be provided face-to-face 2 times per week, for 4 weeks, in addition to 20-min concurrent x4 weekly home-based training sessions. Data will be collected by blinded assessors at baseline, post-intervention and 4-week follow-up. The primary outcome will be feasibility assessed by recruitment, retention and adherence rates, compliance, adverse events, falls and the acceptability of the intervention. Secondary outcomes will be walking speed, single and dual tasking functional mobility, ankle range of motion, disability and health-related quality of life. Discussion Feasibility provided, results from this study will be used to calculate the sample size of a larger randomised controlled trial to investigate the effects of specific TOT and specific TOT-MT compared to a post stroke control group. Trial registration German Clinical Trials Register, DRKS00023068. Registered on 21.09.2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023068. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00886-0.
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Affiliation(s)
- Kristina Traxler
- Therapiezentrum "Kinema", Neukirchen b. hl. Blut, Germany.,Department for Health Sciences, Medicine and Research, Faculty of Health and Medicine, Danube University Krems, Krems an der Donau, Austria
| | - Franz Schinabeck
- Überörtliche Gemeinschaftspraxis Hohenwarth/ Lam, Hohenwarth, Germany
| | - Eva Baum
- Therapiezentrum "Kinema", Neukirchen b. hl. Blut, Germany
| | - Edith Klotz
- Praxis Mittelpunkt Mensch, Furth im Wald, Germany
| | - Barbara Seebacher
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria. .,VASCAGE GmbH, Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria.
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Vázquez-Guimaraens M, Caamaño-Ponte JL, Seoane-Pillado T, Cudeiro J. Factors Related to Greater Functional Recovery after Suffering a Stroke. Brain Sci 2021; 11:802. [PMID: 34204420 PMCID: PMC8234682 DOI: 10.3390/brainsci11060802] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In a stroke, the importance of initial functional status is fundamental for prognosis. The aim of the current study was to investigate functional status, assessed by the Functional Independence Measure (FIM) scale, and possible predictors of functional outcome at discharge from inpatient rehabilitation. METHODS This is a retrospective study that was carried out at the Physical Medicine and Rehabilitation Service in A Coruña (Spain). A total of 365 consecutive patients with primary diagnosis of stroke were enrolled. The functional assessments of all patients were performed through the FIM. A descriptive and a bivariate analysis of the variables included in the study was made and a succession of linear regression models was used to determine which variables were associated with the total FIM at discharge. RESULTS Prior to having the stroke, 76.7% were totally independent in activities of daily living. The FIM scale score was 52.5 ± 25.5 points at admission and 83.4 ± 26.3 at hospital discharge. The multivariate analysis showed that FIM scores on admission were the most important predictors of FIM outcomes. CONCLUSIONS Our study indicates that the degree of independence prior to admission after suffering a stroke is the factor that will determine the functionality of patients at hospital discharge.
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Affiliation(s)
| | - José L. Caamaño-Ponte
- CTX a Veiga (Láncara), 27360 Lugo, Spain;
- Universitat Oberta de Catalunya, 08018 Barcelona, Spain
| | - Teresa Seoane-Pillado
- Área de Medicina Preventiva y Salud Pública, Departamento de Ciencias de la Salud, Universidad de A Coruña–INIBIC, 15403 A Coruña, Spain;
| | - Javier Cudeiro
- Neuroscience and Motor Control Group (NEUROcom)-Instituto Biomédico de A Coruña (INIBIC), Universidad de A Coruña, 15006 Oza, Spain;
- Centro de Estimulación Cerebral de Galicia, 15009 A Coruña, Spain
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47
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Sakabe N, Altukhaim S, Hayashi Y, Sakurada T, Yano S, Kondo T. Enhanced Visual Feedback Using Immersive VR Affects Decision Making Regarding Hand Use With a Simulated Impaired Limb. Front Hum Neurosci 2021; 15:677578. [PMID: 34177496 PMCID: PMC8232051 DOI: 10.3389/fnhum.2021.677578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/18/2021] [Indexed: 11/23/2022] Open
Abstract
The long-term effects of impairment have a negative impact on the quality of life of stroke patients in terms of not using the affected limb even after some recovery (i.e., learned non-use). Immersive virtual reality (IVR) has been introduced as a new approach for the treatment of stroke rehabilitation. We propose an IVR-based therapeutic approach to incorporate positive reinforcement components in motor coordination as opposed to constraint-induced movement therapy (CIMT). This study aimed to investigate the effect of IVR-reinforced physical therapy that incorporates positive reinforcement components in motor coordination. To simulate affected upper limb function loss in patients, a wrist weight was attached to the dominant hand of participant. Participants were asked to choose their right or left hand to reach toward a randomly allocated target. The movement of the virtual image of the upper limb was reinforced by visual feedback to participants, that is, the participants perceived their motor coordination as if their upper limb was moving to a greater degree than what was occurring in everyday life. We found that the use of the simulated affected limb was increased after the visual feedback enhancement intervention, and importantly, the effect was maintained even after gradual withdrawal of the visual amplification. The results suggest that positive reinforcement within the IVR could induce an effect on decision making in hand usage.
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Affiliation(s)
- Naoko Sakabe
- Department of Computer and Information Sciences, Graduate School of Engineering, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Samirah Altukhaim
- Biomedical Science and Biomedical Engineering, School of Biological Sciences, University of Reading, Reading, United Kingdom.,Physiotherapy Group in Stroke Unit, Alamiri Hospital, Kuwait City, Kuwait
| | - Yoshikatsu Hayashi
- Biomedical Science and Biomedical Engineering, School of Biological Sciences, University of Reading, Reading, United Kingdom
| | - Takeshi Sakurada
- College of Science and Engineering, Ritsumeikan University, Shiga, Japan
| | - Shiro Yano
- Department of Computer and Information Sciences, Graduate School of Engineering, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Toshiyuki Kondo
- Department of Computer and Information Sciences, Graduate School of Engineering, Tokyo University of Agriculture and Technology, Tokyo, Japan
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48
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Yang SH, Chung EJ, Lee J, Lee SH, Lee BH. The Effect of Trunk Stability Training Based on Visual Feedback on Trunk Stability, Balance, and Upper Limb Function in Stroke Patients: A Randomized Control Trial. Healthcare (Basel) 2021; 9:healthcare9050532. [PMID: 34063280 PMCID: PMC8147414 DOI: 10.3390/healthcare9050532] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 11/18/2022] Open
Abstract
This study aimed to investigate the effects of trunk stability training based on visual feedback on trunk stability, balance, and upper limb function in patients with stroke. Twenty-eight patients with chronic stroke were randomly assigned to either a trunk support group (n = 14) or a trunk restraint group (n = 14) that practiced upper limb training with trunk support and trunk restraint, respectively, based on visual feedback for 30 min per day, three times per week, for 4 weeks. The postural assessment scale for stroke (PASS) was used to assess the stability of patients, and the functional reaching test (FRT) was performed to assess balance. To assess upper extremity function, a range of motion (ROM) test, manual muscle testing (MMT), and Fugl–Meyer assessment-upper limb (FMA-upper limb) were performed. Consequently, both groups showed significant differences before and after training in the PASS, FRT, shoulder flexion ROM, triceps brachii MMT, and FMA-upper limb (p < 0.05), while the trunk support group showed more significant improvements than the trunk restraint group in the PASS, FRT, and FMA-upper limb (p < 0.05). Trunk support-based upper limb training effectively improved trunk stability, balance, and upper limb function and is beneficial as an upper limb training method. Providing trunk support is more effective than restricting the trunk; trunk support-based upper limb training is expected to promote voluntary participation when combined with visual feedback.
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Affiliation(s)
- Seok-Hui Yang
- Graduate School of Physical Therapy, Sahmyook University, Seoul 01795, Korea;
| | - Eun-Jung Chung
- Department of Physical Therapy, Andong Science College, Andong 36616, Korea;
| | - Jin Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Korea; (J.L.); (S.-H.L.)
| | - Su-Hyun Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Korea; (J.L.); (S.-H.L.)
| | - Byoung-Hee Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Korea; (J.L.); (S.-H.L.)
- Correspondence: ; Tel.: +82-2-3399-1634
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De Angelis S, Princi AA, Dal Farra F, Morone G, Caltagirone C, Tramontano M. Vibrotactile-Based Rehabilitation on Balance and Gait in Patients with Neurological Diseases: A Systematic Review and Metanalysis. Brain Sci 2021; 11:518. [PMID: 33921655 PMCID: PMC8072538 DOI: 10.3390/brainsci11040518] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/10/2021] [Accepted: 04/14/2021] [Indexed: 01/06/2023] Open
Abstract
Postural instability and fear of falling represent two major causes of decreased mobility and quality of life in cerebrovascular and neurologic diseases. In recent years, rehabilitation strategies were carried out considering a combined sensorimotor intervention and an active involvement of the patients during the rehabilitation sessions. Accordingly, new technological devices and paradigms have been developed to increase the effectiveness of rehabilitation by integrating multisensory information and augmented feedback promoting the involvement of the cognitive paradigm in neurorehabilitation. In this context, the vibrotactile feedback (VF) could represent a peripheral therapeutic input, in order to provide spatial proprioceptive information to guide the patient during task-oriented exercises. The present systematic review and metanalysis aimed to explore the effectiveness of the VF on balance and gait rehabilitation in patients with neurological and cerebrovascular diseases. A total of 18 studies met the inclusion criteria and were included. Due to the lack of high-quality studies and heterogeneity of treatments protocols, clinical practice recommendations on the efficacy of VF cannot be made. Results show that VF-based intervention could be a safe complementary sensory-motor approach for balance and gait rehabilitation in patients with neurological and cerebrovascular diseases. More high-quality randomized controlled trials are needed.
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Affiliation(s)
- Sara De Angelis
- Fondazione Santa Lucia IRCCS, 00179 Rome, Italy; (S.D.A.); (A.A.P.); (G.M.); (C.C.)
| | | | | | - Giovanni Morone
- Fondazione Santa Lucia IRCCS, 00179 Rome, Italy; (S.D.A.); (A.A.P.); (G.M.); (C.C.)
| | - Carlo Caltagirone
- Fondazione Santa Lucia IRCCS, 00179 Rome, Italy; (S.D.A.); (A.A.P.); (G.M.); (C.C.)
| | - Marco Tramontano
- Fondazione Santa Lucia IRCCS, 00179 Rome, Italy; (S.D.A.); (A.A.P.); (G.M.); (C.C.)
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00185 Rome, Italy
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50
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Shahmoradi L, Almasi S, Ahmadi H, Bashiri A, Azadi T, Mirbagherie A, Ansari NN, Honarpishe R. Virtual reality games for rehabilitation of upper extremities in stroke patients. J Bodyw Mov Ther 2021; 26:113-122. [PMID: 33992230 DOI: 10.1016/j.jbmt.2020.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 09/15/2020] [Accepted: 10/03/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Stroke is one of the main causes of physical disability in which doing frequent and early exercise is imperative for rehabilitation. Virtual reality gaming has a high potential in rehabilitation leading to increased performance of patients. This study aimed to develop, validate and examine virtual reality games in chronic stroke patients. METHODS This was a single before-after study. To determine the movements and content of games, 9 physiotherapists and 11 game designers were asked to participate in a questionnaire-based survey. Then, to evaluate the impact of games on rehabilitation, patients (N = 10; mean age = 52 ± 4.38) with chronic stroke were asked to play the games three times a week for four weeks. Outcomes included measurement of the ability to perform shoulder, elbow and wrist movements was performed using goniometric instrument, Modified Motor Assessment Scale (MMAS) was used to assess the functional ability of patients and muscle spasticity, and brunnstrom's stages of recovery test was also used to assess spastic and involuntary muscle movement. RESULTS Games have positive effects on the horizontal abduction of shoulder (16.26 ± 23.94, P = 0.02), horizontal adduction of shoulder (59.24 ± 74.76, P = 0.00), supination of wrist (10.68 ± 53.52, P = 0.02), elbow flexion (0.1 ± 1.5, P = 0.00), and wrist flexion (0.06 ± 1.34, P = 0.03). However, they had no effects on the flexion of shoulder, flexion of elbow, extension of elbow, and extension of wrist (p-value> 0.05). CONCLUSIONS The results showed that games improve the range of motion of the participants in terms of horizontal abduction and abduction of the shoulder, elbow flexion, and supination and flexion of the wrist. Due to the small sample size in this study, we recommend more studies with larger samples and a control group.
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Affiliation(s)
- Leila Shahmoradi
- Halal Research Center of IRI, FDA, Tehran, Iran; Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Sohrab Almasi
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran; Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Ahmadi
- OIM Department, Aston Business School, Aston University, Birmingham, B4 7ET, United Kingdom.
| | - Azadeh Bashiri
- Department of Health Information Management, School of Management and Medical Information Sciences, Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tania Azadi
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Iran
| | - Alireza Mirbagherie
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Co-affiliated with the Research Center for Biomedical Technologies and Robotics, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Iran; Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Iran; Neuromusculoskeletal Research Center, Iran University of Medical Sciences. Vali-e Asr Sq., Firoozgar Hospital, Tehran, Iran
| | - Roshanak Honarpishe
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Iran
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