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Zhang Q, Zheng S, Li S, Zeng Y, Chen L, Li G, Li S, He L, Chen S, Zheng X, Zou J, Zeng Q. Efficacy and safety of whole-body vibration therapy for post-stroke spasticity: A systematic review and meta-analysis. Front Neurol 2023; 14:1074922. [PMID: 36779051 PMCID: PMC9909105 DOI: 10.3389/fneur.2023.1074922] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/04/2023] [Indexed: 01/27/2023] Open
Abstract
Background One of the main objectives of stroke rehabilitation is to alleviate post-stroke spasticity. Over the recent years, many studies have explored the potential benefits of whole-body vibration (WBV) treatment for post-stroke spasticity, but it is still controversial. Objective The current study aims to assess the efficacy and safety of WBV for post-stroke spasticity and determine the appropriate application situation. Methods From their establishment until August 2022, the following databases were searched: PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Medline, China National Knowledge Infrastructure (CNKI), and Wanfang. Only randomized controlled trials (RCTs) that were published in either English or Chinese were taken into consideration. We independently filtered the research, gathered the data from the studies, and evaluated the research quality (Cochrane RoB tool) and the overall evidence quality (GRADE). Rev Man 5.4 software was utilized to conduct statistical analysis. Results In this analysis, 11 RCTs with 475 patients that reported on the effectiveness of WBV therapy for post-stroke spasticity were taken into account. Compared to the control groups, the results revealed that WBV combined with conventional rehabilitation at a vibration frequency lower than 20 Hz (SMD = -0.58, 95% CI: -0.98 to -0.19, P = 0.004) was more effective in relieving upper (SMD = -0.53, 95% CI: -1.04 to 0.03, P = 0.03) and lower limb spasticity (SMD = -0.21, 95% CI: -0.40 to -0.01, P = 0.04); similarly, it was superior for patients aged under 60 years (SMD = -0.41, 95% CI: -0.66 to -0.17, P = 0.0008) with acute and subacute stroke (SMD = -0.39, 95% CI: -0.68 to -0.09, P = 0.01). The valid vibration for reducing spasticity was found to last for 10 min (SMD = -0.41, 95% CI: -0.75 to -0.07, P = 0.02). None of the included studies revealed any serious adverse impact. Conclusion Moderate-quality evidence demonstrated when WBV was used as an adjuvant, vibration <20 Hz for 10 min was effective and secure in treating upper and lower limb spasticity in patients with acute and subacute stroke under the age of 60 years. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022293951.
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Affiliation(s)
- Qi Zhang
- School of Rehabilitation Sciences, Southern Medical University, Guangzhou, China,Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shuqi Zheng
- School of Rehabilitation Sciences, Southern Medical University, Guangzhou, China,Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shuiyan Li
- School of Rehabilitation Sciences, Southern Medical University, Guangzhou, China,Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yuting Zeng
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Ling Chen
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Gege Li
- School of Rehabilitation Sciences, Southern Medical University, Guangzhou, China,Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shilin Li
- School of Rehabilitation Sciences, Southern Medical University, Guangzhou, China,Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Longlong He
- School of Rehabilitation Sciences, Southern Medical University, Guangzhou, China,Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shuping Chen
- School of Rehabilitation Sciences, Southern Medical University, Guangzhou, China,Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoyan Zheng
- School of Rehabilitation Sciences, Southern Medical University, Guangzhou, China,*Correspondence: Xiaoyan Zheng ✉
| | - Jihua Zou
- School of Rehabilitation Sciences, Southern Medical University, Guangzhou, China,Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China,Jihua Zou ✉
| | - Qing Zeng
- School of Rehabilitation Sciences, Southern Medical University, Guangzhou, China,Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,Qing Zeng ✉
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Martono M, Isnaeni A, Hartono H. Assessment of the Effectiveness of Facial Expression Exercises Stimulation Using Mirror Media in Increasing Facial Muscle Strength in Hemiparetic Stroke Patients. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND: Stroke can cause facial muscle weakness that can affect mobility, limitations in daily activities, and quality of life. One alternative solution that is non-invasive to restore facial muscle paralysis in post-stroke patients is facial expression exercises using mirror media.
AIM: This study aimed to assess the effectiveness of facial muscle expression exercises stimulation using mirror media and without a mirror as media in increasing facial muscle strength in hemiparetic stroke patients.
METHODS: This study used an experimental quantitative design, in which two groups of subjects who met the inclusion criteria were randomly assigned. The number of subjects who participated in this research was 60 samples divided into the intervention group (n = 30) with a mirror for facial muscle expression exercises and the control group (n = 30) without a mirror for five weeks. The research data were collected using the Fisch Facial Grading System sheet. The statistical analysis procedure of the data consisted of One-Way ANOVA, paired-samples T-test, and N-Gain score test with 95% significance.
RESULTS: The difference in facial muscle strength increase was significantly greater in the intervention group (mean difference 19.4; p = 0.000). The intervention group was more effective in increasing facial muscle strength than the control group (N-Gain score 56.31%).
CONCLUSION: The facial muscle expression exercise procedure using a mirror was more effective in increasing muscle strength than the group without a mirror.
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Ras J, Kengne AP, Smith D, Soteriades ES, Leach L. Effects of cardiovascular health, musculoskeletal health and physical fitness on occupational performance of firefighters: protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e061435. [PMID: 35863825 PMCID: PMC9310163 DOI: 10.1136/bmjopen-2022-061435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Firefighting is a hazardous occupation, where firefighters are involved in life-threatening situations, being placed under tremendous physical strain, while wearing heavy and insulated equipment to protect them from chemicals, fumes and high temperatures. This necessitates that firefighter stay in good physical condition and maintain adequate cardiovascular fitness to cope with these stressors and perform their duties with minimal health risks. The aim of this systematic review and meta-analysis is to determine the effect of cardiovascular health, musculoskeletal health and physical fitness on the occupational performance of firefighters. METHODS AND ANALYSIS All study types and designs will be included and appraised. The following electronic databases will be searched: PubMed/Medline, Scopus, Web of Science, Embase, EBSCOHost and CINAHL, with no restrictions on publication date. The literature search will be conducted comprehensively to enable the capturing of as many relevant articles as possible but will be limited to English-language papers only. A combination of the appropriate terms (search string) will be used to ensure the inclusion of the relevant components of the participants, exposure, comparison and outcome. A researcher-generated form with the key characteristics of each study will be used to retrieve all relevant details from the selected studies for initial eligibility screening. The Rayyan Intelligent Systematic Review tool will be used to screen and select studies for inclusion, and information from the included studies will be captured on the researcher-generated data extraction form. The The appraisal tool for cross-sectional studies (AXIS) checklist and the Critical Appraisal Skills Programme toolkit will be used to conduct the methodological assessment of each study. Data will be analysed using Review Manager V.5.3. Generated results will be presented using a combination of figures, graphs and tables. The synthesis of quantitative data (using a meta-analysis methodology) will involve the integration of quantitative findings from multiple studies to achieve coherence. ETHICS AND DISSEMINATION This study obtained ethical clearance from the University of the Western Cape Biomedical Research Ethics Committee (BM21/10/9). We will disseminate the findings of in peer-reviewed journals and at national and international conferences. The protocol will form part of a chapter for a doctoral thesis. PROSPERO REGISTRATION NUMBER CRD42021258898.
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Affiliation(s)
- Jaron Ras
- Department of Sport, Recreation and Exercise Science, University of the Western Cape, Cape Town, Western Cape, South Africa
| | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, Western Cape, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Denise Smith
- Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, New York, USA
| | - Elpidoforos Soterakis Soteriades
- School of Economics and Management, Healthcare Management Program, Open University of Cyprus, Nicosia, Cyprus
- Department of Environmental Health, Environmental and Occupational Medicine and Epidemiology (EOME), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Lloyd Leach
- Department of Sport, Recreation and Exercise Science, University of the Western Cape, Bellville, South Africa
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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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Weng SC, Hsu CY, Shen CC, Huang JA, Chen PL, Lin SY. Combined Functional Assessment for Predicting Clinical Outcomes in Stroke Patients After Post-acute Care: A Retrospective Multi-Center Cohort in Central Taiwan. Front Aging Neurosci 2022; 14:834273. [PMID: 35783145 PMCID: PMC9247545 DOI: 10.3389/fnagi.2022.834273] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/30/2022] [Indexed: 11/30/2022] Open
Abstract
Background and Objective In 2014, Taiwan’s National Health Insurance administration launched a post-acute care (PAC) program for patients to improve their functions after acute stroke. The present study was aimed to determine PAC assessment parameters, either alone or in combination, for predicting clinical outcomes. Methods We retrospectively enrolled stroke adult patients through one PAC network in central Taiwan between January 2014 and December 2020. We collected data on post-stroke patients’ functional ability at baseline and after PAC stay. The comprehensive assessment included the following: Modified Rankin Scale (MRS), Functional Oral Intake Scale (FOIS), Mini-Nutritional Assessment (MNA), Berg Balance Scale (BBS), Fugl-Meyer Assessment (FMA), Mini-Mental State Examination (MMSE), aphasia test, and quality of life. The above items were assessed first at baseline and again at discharge from PAC. Logistic regression was used to determine factors that were associated with PAC length of stay (LOS), 14-day hospital readmission, and 1-year mortality. Results A total of 267 adults (mean age 67.2 ± 14.7 years) with completed data were analyzed. MRS, activities of daily living (ADLs), instrumental activities of daily living (IADLs), BBS, and MMSE all had improved between disease onset and PAC discharge. Higher baseline and greater improvement of physical and cognitive functions between initial and final PAC assessments were significantly associated with less readmission, and lower mortality. Furthermore, the improved ADLs, FOIS, MNA, FMA-motor, and MMSE scores were related to LOS during PAC. Using logistic regression, we found that functional improvements ≥5 items [adjusted odds ratio (aOR) = 0.16; 95% confidence interval (CI) = 0.05–0.45] and improved MMSE (aOR = 0.19; 95% CI = 0.05–0.68) were significantly associated with reduced post-PAC mortality or readmission. Whereas, functional improvements ≥7 items, improved FOIS, and MNA significantly prolonged LOS during PAC. Conclusion Physical performance parameters of patients with acute stroke improved after PAC. PAC assessment with multiple parameters better predicted clinical outcomes. These parameters could provide information on rehabilitation therapy for acute stroke patients receiving PAC.
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Affiliation(s)
- Shuo-Chun Weng
- Department of Post-baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Clinical Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chiann-Yi Hsu
- Biostatistics Task Force of Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chiung-Chyi Shen
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jin-An Huang
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Po-Lin Chen
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Brain Science, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Yi Lin
- Institute of Clinical Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
- *Correspondence: Shih-Yi Lin,
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Mirror Therapy Rehabilitation in Stroke: A Scoping Review of Upper Limb Recovery and Brain Activities. Rehabil Res Pract 2022; 2021:9487319. [PMID: 35003808 PMCID: PMC8741383 DOI: 10.1155/2021/9487319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background Mirror therapy (MT) has been used as a treatment for various neurological disorders. Recent application of electroencephalogram (EEG) to the MT study allows researchers to gain insight into the changes in brain activity during the therapy. Objective This scoping review is aimed at mapping existing evidence and identifying knowledge gaps about the effects of MT on upper limb recovery and its application for individuals with chronic stroke. Methods and Materials A scoping review through a systematic literature search was conducted using PubMed, CINAHL, PsycINFO, and Scopus databases. Twenty articles published between 2010 and 2020 met the inclusion criteria. The efficacy of MT on upper limb recovery and brain activity during MT were discussed according to the International Classification of Functioning, Disability and Health (ICF). Results A majority of the studies indicated positive effects of MT on upper limb recovery from the body structure/functional domain. All studies used EEG to indicate brain activation during MT. Conclusion MT is a promising intervention for improving upper limb function for individuals with chronic stroke. This review also highlights the need to incorporate EEG into the MT study to capture brain activity and understand the mechanism underlying the therapy.
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Barss TS, Collins DF, Miller D, Pujari AN. Indirect Vibration of the Upper Limbs Alters Transmission Along Spinal but Not Corticospinal Pathways. Front Hum Neurosci 2021; 15:617669. [PMID: 34079443 PMCID: PMC8165249 DOI: 10.3389/fnhum.2021.617669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 04/19/2021] [Indexed: 01/15/2023] Open
Abstract
The use of upper limb vibration (ULV) during exercise and rehabilitation continues to gain popularity as a modality to improve function and performance. Currently, a lack of knowledge of the pathways being altered during ULV limits its effective implementation. Therefore, the aim of this study was to investigate whether indirect ULV modulates transmission along spinal and corticospinal pathways that control the human forearm. All measures were assessed under CONTROL (no vibration) and ULV (30 Hz; 0.4 mm displacement) conditions while participants maintained a small contraction of the right flexor carpi radialis (FCR) muscle. To assess spinal pathways, Hoffmann reflexes (H-reflexes) elicited by stimulation of the median nerve were recorded from FCR with motor response (M-wave) amplitudes matched between conditions. An H-reflex conditioning paradigm was also used to assess changes in presynaptic inhibition by stimulating the superficial radial (SR) nerve (5 pulses at 300Hz) 37 ms prior to median nerve stimulation. Cutaneous reflexes in FCR elicited by stimulation of the SR nerve at the wrist were also recorded. To assess corticospinal pathways, motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation of the contralateral motor cortex were recorded from the right FCR and biceps brachii (BB). ULV significantly reduced H-reflex amplitude by 15.7% for both conditioned and unconditioned reflexes (24.0 ± 15.7 vs. 18.4 ± 11.2% M max ; p < 0.05). Middle latency cutaneous reflexes were also significantly reduced by 20.0% from CONTROL (-1.50 ± 2.1% Mmax) to ULV (-1.73 ± 2.2% Mmax; p < 0.05). There was no significant effect of ULV on MEP amplitude (p > 0.05). Therefore, ULV inhibits cutaneous and H-reflex transmission without influencing corticospinal excitability of the forearm flexors suggesting increased presynaptic inhibition of afferent transmission as a likely mechanism. A general increase in inhibition of spinal pathways with ULV may have important implications for improving rehabilitation for individuals with spasticity (SCI, stroke, MS, etc.).
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Affiliation(s)
- Trevor S. Barss
- Human Neurophysiology Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - David F. Collins
- Human Neurophysiology Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Dylan Miller
- Human Neurophysiology Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Amit N. Pujari
- School of Engineering and Computer Science, University of Hertfordshire, Hatfield, United Kingdom
- Biomedical Engineering Laboratory, School of Engineering, University of Aberdeen, Aberdeen, United Kingdom
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Le Franc S, Fleury M, Cogne M, Butet S, Barillot C, Lecuyer A, Bonan I. Influence of virtual reality visual feedback on the illusion of movement induced by tendon vibration of wrist in healthy participants. PLoS One 2020; 15:e0242416. [PMID: 33216756 PMCID: PMC7678999 DOI: 10.1371/journal.pone.0242416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 11/02/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction Illusion of movement induced by tendon vibration is an effective approach for motor and sensory rehabilitation in case of neurological impairments. The aim of our study was to investigate which modality of visual feedback in Virtual Reality (VR) associated with tendon vibration of the wrist could induce the best illusion of movement. Methods We included 30 healthy participants in the experiment. Tendon vibration inducing illusion of movement (wrist extension, 100Hz) was applied on their wrist during 3 VR visual conditions (10 times each): a moving virtual hand corresponding to the movement that the participants could feel during the tendon vibration (Moving condition), a static virtual hand (Static condition), or no virtual hand at all (Hidden condition). After each trial, the participants had to quantify the intensity of the illusory movement on a Likert scale, the subjective degree of extension of their wrist and afterwards they answered a questionnaire. Results There was a significant difference between the 3 visual feedback conditions concerning the Likert scale ranking and the degree of wrist’s extension (p<0.001). The Moving condition induced a higher intensity of illusion of movement and a higher sensation of wrist’s extension than the Hidden condition (p<0.001 and p<0.001 respectively) than that of the Static condition (p<0.001 and p<0.001 respectively). The Hidden condition also induced a higher intensity of illusion of movement and a higher sensation of wrist’s extension than the Static condition (p<0.01 and p<0.01 respectively). The preferred condition to facilitate movement’s illusion was the Moving condition (63.3%). Conclusions This study demonstrated the importance of carefully selecting a visual feedback to improve the illusion of movement induced by tendon vibration, and the increase of illusion by adding VR visual cues congruent to the illusion of movement. Further work will consist in testing the same hypothesis with stroke patients.
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Affiliation(s)
- Salomé Le Franc
- Rehabilitation Medicine Unit, University Hospital of Rennes, Rennes, France
- * E-mail:
| | - Mathis Fleury
- Inria, Rennes, France
- Empenn Unity U1228, Inserm, Inria, University of Rennes, Irisa, Umr Cnrs 6074, Rennes, France
| | - Mélanie Cogne
- Rehabilitation Medicine Unit, University Hospital of Rennes, Rennes, France
| | - Simon Butet
- Rehabilitation Medicine Unit, University Hospital of Rennes, Rennes, France
| | - Christian Barillot
- Empenn Unity U1228, Inserm, Inria, University of Rennes, Irisa, Umr Cnrs 6074, Rennes, France
| | | | - Isabelle Bonan
- Rehabilitation Medicine Unit, University Hospital of Rennes, Rennes, France
- Empenn Unity U1228, Inserm, Inria, University of Rennes, Irisa, Umr Cnrs 6074, Rennes, France
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