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Ketkar VD, Wolbrecht ET, Perry JC, Farrens A. Design and Development of a Spherical 5-Bar Thumb Exoskeleton Mechanism for Poststroke Rehabilitation. J Med Device 2023; 17:021002. [PMID: 37152413 PMCID: PMC10158975 DOI: 10.1115/1.4056864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
This paper presents the kinematic design and development of a two degree-of-freedom (2DOF) spherical 5-bar thumb exoskeleton to augment the finger individuating grasp exercise robot (FINGER) rehabilitation robot, which assists the index and middle fingers individually in naturalistic grasping. The thumb module expands the capabilities of FINGER, allowing for broader proprioceptive training and assessment of hand function. The design process started by digitizing thumb-grasping motions to the index and the middle fingers separately, recorded from multiple healthy subjects utilizing a motion capture system. Fitting spheres to trajectory data of each subject allowed normalization of all subjects' data to a common center and radius. A two-revolute joint serial-chain mechanism was synthesized (intermediate optimization step) to reach the normalized trajectories. Next, the two resulting grasping trajectories were spatially sampled as targets for the 2DOF spherical 5-bar synthesis. Optimization of the spherical 5-bar included symmetry constraints and cost-function penalties for poor manipulability. The resulting exoskeleton assists both flexion/extension and abduction/adduction of the thumb enabling a wide range of motions. Consistent with FINGER, the parallel structure of the spherical 5-bar places the actuators at the base of the module, allowing for desirable characteristics, including high backdrivability, high controllable bandwidth, and low mechanical impedance. The mechanical design was developed from the kinematic solution, including an adjustable thumb cuff to accommodate different hand sizes. Fit and function of the device were tested on multiple subjects, including survivors of stroke. A proportional-derivative force controller with gravity and friction compensation was implemented to reduce resistance to motion during subject testing.
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Affiliation(s)
- Vishwanath D. Ketkar
- Department of Electrical Engineering, University of Idaho, Moscow, ID 83844-0902
| | - Eric T. Wolbrecht
- Department of Mechanical Engineering, University of Idaho, Moscow, ID 83844-0902
| | - Joel C. Perry
- Department of Mechanical Engineering, University of Idaho, Moscow, ID 83844-0902
| | - Andria Farrens
- Department of Biomedical Engineering, University of California, Irvine, CA 92697
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Lee Friesen C, Lawrence M, Ingram TGJ, Boe SG. Home-based portable fNIRS-derived cortical laterality correlates with impairment and function in chronic stroke. Front Hum Neurosci 2022; 16:1023246. [PMID: 36569472 PMCID: PMC9780676 DOI: 10.3389/fnhum.2022.1023246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction Improved understanding of the relationship between post-stroke rehabilitation interventions and functional motor outcomes could result in improvements in the efficacy of post-stroke physical rehabilitation. The laterality of motor cortex activity (M1-LAT) during paretic upper-extremity movement has been documented as a useful biomarker of post-stroke motor recovery. However, the expensive, labor intensive, and laboratory-based equipment required to take measurements of M1-LAT limit its potential clinical utility in improving post-stroke physical rehabilitation. The present study tested the ability of a mobile functional near-infrared spectroscopy (fNIRS) system (designed to enable independent measurement by stroke survivors) to measure cerebral hemodynamics at the motor cortex in the homes of chronic stroke survivors. Methods Eleven chronic stroke survivors, ranging widely in their level of upper-extremity motor deficit, used their stroke-affected upper-extremity to perform a simple unilateral movement protocol in their homes while a wireless prototype fNIRS headband took measurements at the motor cortex. Measures of participants' upper-extremity impairment and function were taken. Results Participants demonstrated either a typically lateralized response, with an increase in contralateral relative oxyhemoglobin (ΔHbO), or response showing a bilateral pattern of increase in ΔHbO during the motor task. During the simple unilateral task, M1-LAT correlated significantly with measures of both upper-extremity impairment and function, indicating that participants with more severe motor deficits had more a more atypical (i.e., bilateral) pattern of lateralization. Discussion These results indicate it is feasible to gain M1-LAT measures from stroke survivors in their homes using fNIRS. These findings represent a preliminary step toward the goals of using ergonomic functional neuroimaging to improve post-stroke rehabilitative care, via the capture of neural biomarkers of post-stroke motor recovery, and/or via use as part of an accessible rehabilitation brain-computer-interface.
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Affiliation(s)
- Christopher Lee Friesen
- Laboratory for Brain Recovery and Function, Dalhousie University, Halifax, NS, Canada
- Axem Neurotechnology, Halifax, NS, Canada
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Michael Lawrence
- Laboratory for Brain Recovery and Function, Dalhousie University, Halifax, NS, Canada
- Axem Neurotechnology, Halifax, NS, Canada
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Tony Gerald Joseph Ingram
- Laboratory for Brain Recovery and Function, Dalhousie University, Halifax, NS, Canada
- Axem Neurotechnology, Halifax, NS, Canada
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Shaun Gregory Boe
- Laboratory for Brain Recovery and Function, Dalhousie University, Halifax, NS, Canada
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
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Yu J, Zhang X, Yang J, Wang Z, Zhao H, Yuan X, Fan Z, Liu H. A functional near-infrared spectroscopy study of the effects of video game-based bilateral upper limb training on brain cortical activation and functional connectivity. Exp Gerontol 2022; 169:111962. [PMID: 36162532 DOI: 10.1016/j.exger.2022.111962] [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: 06/24/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 12/15/2022]
Abstract
Video game-based therapies are widely used in rehabilitation. Compared with conventional bilateral upper limb training (CBULT), the effects of video game-based bilateral upper limb training (VGBULT) on brain cortical activation and functional connectivity, still not fully clear. We have developed a VGBULT system, and measured the brain activity of 20 elderly subjects (10 male, mean age = 62.4 ± 5.8) while performing CBULT and VGBULT tasks by using functional near infrared spectroscopy (fNIRS). The results showed that the cerebral cortex of the two groups both showed significant activation (p < 0.05), compared with the baseline; In the VGBLUT group, the activation of motor cortex (MC) and prefrontal cortex (PFC) was stronger, and the functional connectivity between PFC and MC was also enhanced. This study showed that VGBULT is potentially more beneficial for the elderly neural activities and cognitive control, and provides a theoretical basis for future research and development of such rehabilitation products. Moreover, fNIRS is a reliable tool for tracking brain activation in the evaluation of retraining regimens.
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Affiliation(s)
- Jiulong Yu
- School of Mechanical Engineering, Shandong University, Jinan 250061, People's Republic of China
| | - Xin Zhang
- Institute of Medical Biology, Chinese Academy of Medical Science and Peking Union Medical College, Kunming 650118, People's Republic of China
| | - Jie Yang
- School of Mechanical Engineering, Shandong University, Jinan 250061, People's Republic of China
| | - Zilin Wang
- School of Mechanical Engineering, Shandong University, Jinan 250061, People's Republic of China
| | - HuaChao Zhao
- School of Mechanical Engineering, Shandong University, Jinan 250061, People's Republic of China
| | - Xin Yuan
- School of Mechanical Engineering, Shandong University, Jinan 250061, People's Republic of China
| | - Zhijun Fan
- School of Mechanical Engineering, Shandong University, Jinan 250061, People's Republic of China
| | - Heshan Liu
- School of Mechanical Engineering, Shandong University, Jinan 250061, People's Republic of China.
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Li H, Han Y, Sheng F, Kong F, Dong J. Influence and significance of bilateral upper-extremity training on recovery of upper-extremity motor function for hemiplegic patients with mild-moderate cerebral apoplexy: a randomised controlled study. Afr Health Sci 2022; 22:375-382. [PMID: 36910402 PMCID: PMC9993293 DOI: 10.4314/ahs.v22i3.40] [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] Open
Abstract
Background The recovery of coordination ability of both hands is conductive to improving the activity of daily living for hemiplegic patients. Objective To explore the influence and significance of bilateral upper-extremity training on recovery of upper-extremity motor function for hemiplegic patients with mild-moderate cerebral apoplexy. Methods Patients were divided into control group and experimental group. The patients in the control group only exercised the upper limbs on the affected side, while the patients in the experimental group exercised the upper limbs on both sides. The Fugl Mayer Assessment Upper Extremity Scale (FMA-UE), Upper Extermities Functional Test (UEFT), modified Barthel index (MBI) and Brunnstrom scores were evaluated in the two groups before and after treatment. Results After four weeks, six weeks and eight weeks of treatment, scores of FMA-UE, UEFT, MBI and Brunnstrom for patients increased with the extension of training time, and FMA-UE, UEFT, MBI and Brunnstrom scores for patients of the two groups after four weeks six weeks and eight weeks of treatment showed a significant difference (P<0.05). Conclusion The improvement of upper-extremity motor function can be facilitated via relatively conventional training of bilateral upper-extremity training adopted by hemiplegic patients with mild-moderate cerebral apoplexy.
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Affiliation(s)
- Hongmei Li
- Department of Rehabilitation Medicine, Affiliated Hospital of Jilin Medical College, Jilin, China
| | - Yuanyuan Han
- Department of Rehabilitation Medicine, Affiliated Hospital of Jilin Medical College, Jilin, China
| | - Feng Sheng
- Department of Rehabilitation Medicine, Affiliated Hospital of Jilin Medical College, Jilin, China
| | - Fanliang Kong
- Department of Rehabilitation Medicine, Affiliated Hospital of Jilin Medical College, Jilin, China
| | - Jing Dong
- Department of Rehabilitation Medicine, Affiliated Hospital of Jilin Medical College, Jilin, China
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Wei D, Hua XY, Zheng MX, Wu JJ, Xu JG. Effectiveness of robot-assisted virtual reality mirror therapy for upper limb motor dysfunction after stroke: study protocol for a single-center randomized controlled clinical trial. BMC Neurol 2022; 22:307. [PMID: 35996106 PMCID: PMC9396805 DOI: 10.1186/s12883-022-02836-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background Upper limb motor dysfunction is a common sequela of stroke, and its clinical efficacy needs to be improved. This protocol describes a trial to verify the clinical efficacy of robot-assisted virtual reality mirror therapy (RAVRMT) in improving upper limb motor dysfunction in stroke patients, and to explore the central mechanism by using functional magnetic resonance imaging (fMRI). Methods This trial will be a single-center, assessor-blinded, randomized controlled clinical study. Thirty-two eligible patients will be randomly divided into 2 groups according to the ratio of 1:1, namely virtual reality mirror therapy (VRMT) group and robot-assisted virtual reality mirror therapy (RAVRMT) group. The interventions will be performed once a day for 4 weeks. Primary outcome is Fugl–Meyer motor function assessment-Upper Extremity (FMA-UE), secondary outcomes are the Montreal Cognitive Assessment (MoCA), activities of daily living (ADL), quality of life (QOL), the pain visual analogue scale (VAS-pain) and fMRI. Adverse events will be recorded, and severe adverse events will be used as criteria to discontinue the intervention. Discussion Combined application of robot-assisted therapy and virtual reality mirror therapy could theoretically activate mirror neuron system and reward circuits to a greater extent, but further high-quality research is needed. The results of this trial will determine whether RAVRMT could better improve upper limb motor dysfunction after stroke and explore its central mechanism using fMRI. Trial registration This trial was prospectively registered at ClinicalTrials.gov (ChiCTR2200061721; 01 July 2022).
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Affiliation(s)
- Dong Wei
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Xu-Yun Hua
- Shanghai University of Traditional Chinese Medicine Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200437, China
| | - Mou-Xiong Zheng
- Shanghai University of Traditional Chinese Medicine Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200437, China
| | - Jia-Jia Wu
- Shanghai University of Traditional Chinese Medicine Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200437, China
| | - Jian-Guang Xu
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
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The Neurophysiological Impact of Subacute Stroke: Changes in Cortical Oscillations Evoked by Bimanual Finger Movement. Stroke Res Treat 2022; 2022:9772147. [PMID: 35154632 PMCID: PMC8831071 DOI: 10.1155/2022/9772147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 12/08/2021] [Accepted: 12/29/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction. To design more effective interventions, such as neurostimulation, for stroke rehabilitation, there is a need to understand early physiological changes that take place that may be relevant for clinical monitoring. We aimed to study changes in neurophysiology following recent ischemic stroke, both at rest and with motor planning and execution. Materials and Methods. We included 10 poststroke patients, between 7 and 10 days after stroke, and 20 age-matched controls to assess changes in cortical motor output via transcranial magnetic stimulation and in dynamics of oscillations, as recorded using electroencephalography (EEG). Results. We found significant differences in cortical oscillatory patterns comparing stroke patients with healthy participants, particularly in the beta rhythm during motor planning (
) and execution (
) of a complex movement with fingers from both hands simultaneously. Discussion. The stroke lesion induced a decrease in event-related desynchronization in patients, in comparison to controls, providing evidence for decreased disinhibition. Conclusions. After a stroke lesion, the dynamics of cortical oscillations is changed, with an increasing neural beta synchronization in the course of motor preparation and performance of complex bimanual finger tasks. The observed patterns may provide a potential functional measure that could be used to monitor and design interventional approaches in subacute stages.
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EEG as a marker of brain plasticity in clinical applications. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:91-104. [PMID: 35034760 DOI: 10.1016/b978-0-12-819410-2.00029-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Neural networks are dynamic, and the brain has the capacity to reorganize itself. This capacity is named neuroplasticity and is fundamental for many processes ranging from learning and adaptation to new environments to the response to brain injuries. Measures of brain plasticity involve several techniques, including neuroimaging and neurophysiology. Electroencephalography, often used together with other techniques, is a common tool for prognostic and diagnostic purposes, and cortical reorganization is reflected by EEG measurements. Changes of power bands in different cortical areas occur with fatigue and in response to training stimuli leading to learning processes. Sleep has a fundamental role in brain plasticity, restoring EEG bands alterations and promoting consolidation of learning. Exercise and physical inactivity have been extensively studied as both strongly impact brain plasticity. Indeed, EEG studies showed the importance of the physical activity to promote learning and the effects of inactivity or microgravity on cortical reorganization to cope with absent or altered sensorimotor stimuli. Finally, this chapter will describe some of the EEG changes as markers of neural plasticity in neurologic conditions, focusing on cerebrovascular and neurodegenerative diseases. In conclusion, neuroplasticity is the fundamental mechanism necessary to ensure adaptation to new stimuli and situations, as part of the dynamicity of life.
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Jiang YC, Ma R, Qi S, Ge S, Sun Z, Li Y, Song J, Zhang M. Characterization of Bimanual Cyclical Tasks from Single-trial EEG-fNIRS Measurements. IEEE Trans Neural Syst Rehabil Eng 2022; 30:146-156. [PMID: 35041608 DOI: 10.1109/tnsre.2022.3144216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Robot-assisted bimanual training is promising to improve motor function and cortical reorganization for hemiparetic stroke patients. Closing the rehabilitation training loop with neurofeedback can help refine training protocols in time for better engagements and outcomes. However, due to the low signal-to- noise ratio (SNR) and non-stationary properties of neural signals, reliable characterization of bimanual training-induced neural activities from single-trial measurement is challenging. In this study, ten human participants were recruited conducting robot-assisted bimanual cyclical tasks (in-phase, 90° out-of-phase, and anti-phase) when concurrent electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) were recorded. A unified EEG-fNIRS bimodal signal processing framework was proposed to characterize neural activities induced by three types of bimanual cyclical tasks. In this framework, novel artifact removal methods were used to improve the SNR and the task-related component analysis (TRCA) was introduced to increase the reproducibility of EEG-fNIRS bimodal features. The optimized features were transformed into low-dimensional indicators to reliably characterize bimanual training-induced neural activation. The SVM classification results of three bimanual cyclical tasks revealed a good discrimination ability of EEG-fNIRS bimodal indicators (90.1%), which was higher than that using EEG (74.8%) or fNIRS (82.2%) alone, supporting the proposed method as a feasible technique to characterize neural activities during robot-assisted bimanual training.
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9
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Electromechanical and Robotic Devices for Gait and Balance Rehabilitation of Children with Neurological Disability: A Systematic Review. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app112412061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the last two decades, a growing interest has been focused on gait and balance robot-assisted rehabilitation in children with neurological disabilities. Robotic devices allow the implementation of intensive, task-specific training fostering functional recovery and neuroplasticity phenomena. However, limited attention has been paid to the protocols used in this research framework. This systematic review aims to provide an overview of the existing literature on robotic systems for the rehabilitation of gait and balance in children with neurological disabilities and their rehabilitation applications. The literature search was carried out independently and synchronously by three authors on the following databases: MEDLINE, Cochrane Library, PeDro, Institute of Electrical and Electronics Engineers, ScienceDirect, and Google Scholar. The data collected included three subsections referring to clinical, technical, and regulatory aspects. Thirty-one articles out of 81 found on the primary literature search were included in the systematic review. Most studies involved children with cerebral palsy. Only one-third of the studies were randomized controlled trials. Overall, 17 devices (nine end-effector systems and eight exoskeletons) were investigated, among which only 4 (24%) were bore the CE mark. Studies differ on rehabilitation protocols duration, intensity, and outcome measures. Future research should improve both rehabilitation protocols’ and devices’ descriptions.
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Garro F, Chiappalone M, Buccelli S, De Michieli L, Semprini M. Neuromechanical Biomarkers for Robotic Neurorehabilitation. Front Neurorobot 2021; 15:742163. [PMID: 34776920 PMCID: PMC8579108 DOI: 10.3389/fnbot.2021.742163] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/22/2021] [Indexed: 02/06/2023] Open
Abstract
One of the current challenges for translational rehabilitation research is to develop the strategies to deliver accurate evaluation, prediction, patient selection, and decision-making in the clinical practice. In this regard, the robot-assisted interventions have gained popularity as they can provide the objective and quantifiable assessment of the motor performance by taking the kinematics parameters into the account. Neurophysiological parameters have also been proposed for this purpose due to the novel advances in the non-invasive signal processing techniques. In addition, other parameters linked to the motor learning and brain plasticity occurring during the rehabilitation have been explored, looking for a more holistic rehabilitation approach. However, the majority of the research done in this area is still exploratory. These parameters have shown the capability to become the “biomarkers” that are defined as the quantifiable indicators of the physiological/pathological processes and the responses to the therapeutical interventions. In this view, they could be finally used for enhancing the robot-assisted treatments. While the research on the biomarkers has been growing in the last years, there is a current need for a better comprehension and quantification of the neuromechanical processes involved in the rehabilitation. In particular, there is a lack of operationalization of the potential neuromechanical biomarkers into the clinical algorithms. In this scenario, a new framework called the “Rehabilomics” has been proposed to account for the rehabilitation research that exploits the biomarkers in its design. This study provides an overview of the state-of-the-art of the biomarkers related to the robotic neurorehabilitation, focusing on the translational studies, and underlying the need to create the comprehensive approaches that have the potential to take the research on the biomarkers into the clinical practice. We then summarize some promising biomarkers that are being under investigation in the current literature and provide some examples of their current and/or potential applications in the neurorehabilitation. Finally, we outline the main challenges and future directions in the field, briefly discussing their potential evolution and prospective.
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Affiliation(s)
- Florencia Garro
- Rehab Technologies, Istituto Italiano di Tecnologia, Genoa, Italy.,Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
| | - Michela Chiappalone
- Rehab Technologies, Istituto Italiano di Tecnologia, Genoa, Italy.,Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
| | - Stefano Buccelli
- Rehab Technologies, Istituto Italiano di Tecnologia, Genoa, Italy
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Pignolo L, Servidio R, Basta G, Carozzo S, Tonin P, Calabrò RS, Cerasa A. The Route of Motor Recovery in Stroke Patients Driven by Exoskeleton-Robot-Assisted Therapy: A Path-Analysis. Med Sci (Basel) 2021; 9:medsci9040064. [PMID: 34842770 PMCID: PMC8628926 DOI: 10.3390/medsci9040064] [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] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/18/2021] [Accepted: 10/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Exoskeleton-robot-assisted therapy is known to positively affect the recovery of arm functions in stroke patients. However, there is a lack of evidence regarding which variables might favor a better outcome and how this can be modulated by other factors. Methods: In this within-subject study, we evaluated the efficacy of a robot-assisted rehabilitation system in the recovery of upper limb functions. We performed a path analysis using a structural equation modeling approach in a large sample of 102 stroke patients (age 63.6 ± 13.1 years; 61% men) in the post-acute phase. They underwent 7 weeks of bilateral arm training assisted by an exoskeleton robot combined with a conventional treatment (consisting of simple physical activity together with occupational therapy). The upper extremity section of the Fugl–Meyer (FM-UE) scale at admission was used as a predictor of outcome, whereas age, gender, side of the lesion, days from the event, pain scale, duration of treatment, and number of sessions as mediators. Results: FM-UE at admission was a direct predictor of outcome, as measured by the motricity index of the contralateral upper limb and trunk control test, without any other mediating factors. Age, gender, days from the event, side of lesion, and pain scales were independently associated with outcomes. Conclusions: To the best of our knowledge, this is the first study assessing the relationship between clinical variables and outcomes induced by robot-assisted rehabilitation with a path-analysis model. We define a new route for motor recovery of stroke patients driven by exoskeleton-robot-assisted therapy, highlighting the role of FM-UE at admission as a useful predictor of outcome, although other variables need to be considered in the time-course of disease.
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Affiliation(s)
- Loris Pignolo
- S’Anna Institute, 88900 Crotone, Italy; (G.B.); (S.C.); (P.T.); (A.C.)
- Correspondence:
| | - Rocco Servidio
- Department of Cultures, Education and Society, University of Calabria, 87036 Rende, Italy;
| | - Giuseppina Basta
- S’Anna Institute, 88900 Crotone, Italy; (G.B.); (S.C.); (P.T.); (A.C.)
| | - Simone Carozzo
- S’Anna Institute, 88900 Crotone, Italy; (G.B.); (S.C.); (P.T.); (A.C.)
| | - Paolo Tonin
- S’Anna Institute, 88900 Crotone, Italy; (G.B.); (S.C.); (P.T.); (A.C.)
| | | | - Antonio Cerasa
- S’Anna Institute, 88900 Crotone, Italy; (G.B.); (S.C.); (P.T.); (A.C.)
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, 87036 Rende, Italy
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12
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Lin PJ, Jia T, Li C, Li T, Qian C, Li Z, Pan Y, Ji L. CNN-Based Prognosis of BCI Rehabilitation Using EEG From First Session BCI Training. IEEE Trans Neural Syst Rehabil Eng 2021; 29:1936-1943. [PMID: 34516378 DOI: 10.1109/tnsre.2021.3112167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Stroke is a world-leading disease for causing disability. Brain-computer interaction (BCI) training has been proved to be a promising method in facilitating motor recovery. However, due to differences in each patient's neural-clinical profile, the potential of recovery for different patients can vary significantly by conducting BCI training, which remains a major problem in clinical rehabilitation practice. To address this issue, the objective of this study is to prognosticate the outcome of BCI training using motor state electroencephalographic (EEG) collected during the first session of BCI tasks, with the aim of prescribing BCI training accordingly. A Convolution Neural Network (CNN) based prognosis model was developed to predict the outcome of 11 stroke patients' recovery following a 2-week rehabilitation training with BCI. In our study, functional connectivity and power spectrum have been evaluated and applied as the inputs of CNN to regress patients' recovery rate. A saliency map was used to identify the correlation between EEG channels with the recovery outcome. The performance of our model was assessed using the leave-one-out cross-validation. Overall, the proposed model predicted patients' recovery with R2 0.98 and MSE 0.89. According to the saliency map, the highest functional connectivity occurred in Fp2/Fpz-AF8, Fp2/F4/F8-P3, P1/PO7-PO5 and AF3-AF4. Our results demonstrated that deep learning method has the potential to predict the recovery rate of BCI training, which contributes to guiding individualized prescription in the early stage of clinical rehabilitation.
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13
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Hung JW, Chen YW, Chen YJ, Pong YP, Wu WC, Chang KC, Wu CY. The Effects of Distributed vs. Condensed Schedule for Robot-Assisted Training with Botulinum Toxin A Injection for Spastic Upper Limbs in Chronic Post-Stroke Subjects. Toxins (Basel) 2021; 13:toxins13080539. [PMID: 34437410 PMCID: PMC8402581 DOI: 10.3390/toxins13080539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/14/2021] [Accepted: 07/29/2021] [Indexed: 11/16/2022] Open
Abstract
Robot-assisted training (RT) combined with a Botulinum toxin A (BoNT-A) injection has been suggested as a means to optimize spasticity treatment outcomes. The optimal schedule of applying RT after a BoNT-A injection has not been defined. This single-blind, randomized controlled trial compared the effects of two predefined RT approaches as an adjunct to BoNT-A injections of spastic upper limbs in chronic post-stroke subjects. Thirty-six patients received a BoNT-A injection in the affected upper extremity and were randomly assigned to the condensed or distributed RT group. The condensed group received an intervention of four sessions/week for six consecutive weeks. The distributed group attended two sessions/week for 12 consecutive weeks. Each session included 45 min of RT using the InMotion 2.0 robot, followed by 30 min of functional training. The Fugl-Meyer Assessment, Modified Ashworth Scale, Wolf Motor Function Test, Motor Activity Log, and Stroke Self-Efficacy Questionnaire were assessed at pre-training, mid-term, post-training, and at 6 week follow-up, with the exception of the Motor Activity Log, which did not include mid-term measures. After the intervention, both groups had significant improvements in all outcome measures (within-group effects, p < 0.05), with the exception of the Wolf Motor Function Test time score. There were no significant differences between groups and interaction effects in all outcome measures. Our findings suggest that RT provided in a fixed dosage as an adjunct to a BoNT-A injection has a positive effect on participants' impairment and activity levels, regardless of treatment frequency. (ClinicalTrials.gov: NCT03321097).
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Affiliation(s)
- Jen-Wen Hung
- Department of Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan; (J.-W.H.); (Y.-J.C.); (Y.-P.P.); (W.-C.W.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
| | - Yen-Wei Chen
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Taoyuan 33302, Taiwan;
- Healthy Aging Research Center, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yi-Ju Chen
- Department of Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan; (J.-W.H.); (Y.-J.C.); (Y.-P.P.); (W.-C.W.)
| | - Ya-Ping Pong
- Department of Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan; (J.-W.H.); (Y.-J.C.); (Y.-P.P.); (W.-C.W.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
| | - Wen-Chi Wu
- Department of Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan; (J.-W.H.); (Y.-J.C.); (Y.-P.P.); (W.-C.W.)
| | - Ku-Chou Chang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
- Division of Cerebrovascular Diseases, Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan
| | - Ching-Yi Wu
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Taoyuan 33302, Taiwan;
- Healthy Aging Research Center, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
- Correspondence:
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14
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Di Marco R, Rubega M, Lennon O, Formaggio E, Sutaj N, Dazzi G, Venturin C, Bonini I, Ortner R, Cerrel Bazo HA, Tonin L, Tortora S, Masiero S, Del Felice A. Experimental Protocol to Assess Neuromuscular Plasticity Induced by an Exoskeleton Training Session. Methods Protoc 2021; 4:48. [PMID: 34287357 PMCID: PMC8293335 DOI: 10.3390/mps4030048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/01/2021] [Accepted: 07/07/2021] [Indexed: 12/13/2022] Open
Abstract
Exoskeleton gait rehabilitation is an emerging area of research, with potential applications in the elderly and in people with central nervous system lesions, e.g., stroke, traumatic brain/spinal cord injury. However, adaptability of such technologies to the user is still an unmet goal. Despite important technological advances, these robotic systems still lack the fine tuning necessary to adapt to the physiological modification of the user and are not yet capable of a proper human-machine interaction. Interfaces based on physiological signals, e.g., recorded by electroencephalography (EEG) and/or electromyography (EMG), could contribute to solving this technological challenge. This protocol aims to: (1) quantify neuro-muscular plasticity induced by a single training session with a robotic exoskeleton on post-stroke people and on a group of age and sex-matched controls; (2) test the feasibility of predicting lower limb motor trajectory from physiological signals for future use as control signal for the robot. An active exoskeleton that can be set in full mode (i.e., the robot fully replaces and drives the user motion), adaptive mode (i.e., assistance to the user can be tuned according to his/her needs), and free mode (i.e., the robot completely follows the user movements) will be used. Participants will undergo a preparation session, i.e., EMG sensors and EEG cap placement and inertial sensors attachment to measure, respectively, muscular and cortical activity, and motion. They will then be asked to walk in a 15 m corridor: (i) self-paced without the exoskeleton (pre-training session); (ii) wearing the exoskeleton and walking with the three modes of use; (iii) self-paced without the exoskeleton (post-training session). From this dataset, we will: (1) quantitatively estimate short-term neuroplasticity of brain connectivity in chronic stroke survivors after a single session of gait training; (2) compare muscle activation patterns during exoskeleton-gait between stroke survivors and age and sex-matched controls; and (3) perform a feasibility analysis on the use of physiological signals to decode gait intentions.
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Affiliation(s)
- Roberto Di Marco
- Department of Neurosciences, Section of Rehabilitation, University of Padova, via Belzoni, 160, 35121 Padova, Italy; (E.F.); (G.D.); (C.V.); (S.M.); (A.D.F.)
| | - Maria Rubega
- Department of Neurosciences, Section of Rehabilitation, University of Padova, via Belzoni, 160, 35121 Padova, Italy; (E.F.); (G.D.); (C.V.); (S.M.); (A.D.F.)
| | - Olive Lennon
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, 4 Dublin, Ireland;
| | - Emanuela Formaggio
- Department of Neurosciences, Section of Rehabilitation, University of Padova, via Belzoni, 160, 35121 Padova, Italy; (E.F.); (G.D.); (C.V.); (S.M.); (A.D.F.)
| | - Ngadhnjim Sutaj
- g.tec Medical Engineering GmbH, 4521 Schiedlberg, Austria; (N.S.); (R.O.)
| | - Giacomo Dazzi
- Department of Neurosciences, Section of Rehabilitation, University of Padova, via Belzoni, 160, 35121 Padova, Italy; (E.F.); (G.D.); (C.V.); (S.M.); (A.D.F.)
| | - Chiara Venturin
- Department of Neurosciences, Section of Rehabilitation, University of Padova, via Belzoni, 160, 35121 Padova, Italy; (E.F.); (G.D.); (C.V.); (S.M.); (A.D.F.)
| | - Ilenia Bonini
- Ospedale Riabilitativo di Alta Specializzazione di Motta di Livenza, 31045 Treviso, Italy; (I.B.); (H.A.C.B.)
| | - Rupert Ortner
- g.tec Medical Engineering GmbH, 4521 Schiedlberg, Austria; (N.S.); (R.O.)
| | | | - Luca Tonin
- Department of Information Engineering, University of Padova, 35131 Padova, Italy; (L.T.); (S.T.)
| | - Stefano Tortora
- Department of Information Engineering, University of Padova, 35131 Padova, Italy; (L.T.); (S.T.)
| | - Stefano Masiero
- Department of Neurosciences, Section of Rehabilitation, University of Padova, via Belzoni, 160, 35121 Padova, Italy; (E.F.); (G.D.); (C.V.); (S.M.); (A.D.F.)
- Padova Neuroscience Center, University of Padova, 35129 Padova, Italy
| | - Alessandra Del Felice
- Department of Neurosciences, Section of Rehabilitation, University of Padova, via Belzoni, 160, 35121 Padova, Italy; (E.F.); (G.D.); (C.V.); (S.M.); (A.D.F.)
- Padova Neuroscience Center, University of Padova, 35129 Padova, Italy
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15
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Gandolfi M, Valè N, Posteraro F, Morone G, Dell'orco A, Botticelli A, Dimitrova E, Gervasoni E, Goffredo M, Zenzeri J, Antonini A, Daniele C, Benanti P, Boldrini P, Bonaiuti D, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzon S, Molteni F, Petrarca M, Picelli A, Senatore M, Turchetti G, Giansanti D, Mazzoleni S. State of the art and challenges for the classification of studies on electromechanical and robotic devices in neurorehabilitation: a scoping review. Eur J Phys Rehabil Med 2021; 57:831-840. [PMID: 34042413 DOI: 10.23736/s1973-9087.21.06922-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The rapid development of electromechanical and robotic devices has profoundly influenced neurorehabilitation. Growth in the scientific and technological aspects thereof is crucial for increasing the number of newly developed devices, and clinicians have welcomed such growth with enthusiasm. Nevertheless, improving the standard for the reporting clinical, technical, and normative aspects of such electromechanical and robotic devices remains an unmet need in neurorehabilitation. Accordingly, this study aimed to analyse the existing literature on electromechanical and robotic devices used in neurorehabilitation, considering the current clinical, technical, and regulatory classification systems. EVIDENCE ACQUISITION Within the CICERONE Consensus Conference framework, studies on electromechanical and robotic devices used for upper- and lower-limb rehabilitation in persons with neurological disabilities in adulthood and childhood were reviewed. We have conducted a literature search using the following databases: MEDLINE, Cochrane Library, PeDro, Institute of Electrical and Electronics Engineers, Science Direct, and Google Scholar. Clinical, technical, and regulatory classification systems were applied to collect information on the electromechanical and robotic devices. The study designs and populations were investigated. EVIDENCE SYNTHESIS Overall, 316 studies were included in the analysis. More than half (52%) of the studies were randomised controlled trials (RCTs). The population investigated the most suffered from strokes, followed by spinal cord injuries, multiple sclerosis, cerebral palsy, and traumatic brain injuries. In total, 100 devices were described; of these, 19% were certified with the CE mark. Overall, the main type of device was an exoskeleton. However, end-effector devices were primarily used for the upper limbs, whereas exoskeletons were used for the lower limbs (for both children and adults). CONCLUSIONS The current literature on robotic neurorehabilitation lacks detailed information regarding the technical characteristics of the devices used. This affects the understanding of the possible mechanisms underlying recovery. Unfortunately, many electromechanical and robotic devices are not provided with CE marks, strongly hindering the research on the clinical outcomes of rehabilitation treatments based on these devices. A more significant effort is needed to improve the description of the robotic devices used in neurorehabilitation in terms of the technical and functional details, along with high-quality RCT studies.
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Affiliation(s)
- Marialuisa Gandolfi
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Neurorehabilitation Unit, University Hospital of Verona, Italy -
| | - Nicola Valè
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Posteraro
- Rehabilitation Department Versilia Hospital, ASL Toscana Nord-Ovest, Italy
| | | | - Antonella Dell'orco
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Neurorehabilitation Unit, University Hospital of Verona, Italy
| | - Anita Botticelli
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Neurorehabilitation Unit, University Hospital of Verona, Italy
| | - Eleonora Dimitrova
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Michela Goffredo
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Jacopo Zenzeri
- Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Genova, Italy
| | | | | | | | - Paolo Boldrini
- Italian Society of Physical Medicine and Rehabilitation (SIMFER), Italy
| | | | - Enrico Castelli
- Pediatric Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Vincenzo Falabella
- President Italian Federation of Persons with Spinal Cord Injuries (Flip Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli, " Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzon
- ULSS 6 (Unique Sanitary Local Company) Euganea Padova - Distretto IV Alta Padovana, Padova, Italy
| | | | - Maurizio Petrarca
- The Movement Analysis and Robotics Laboratory, Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Neurorehabilitation Unit, University Hospital of Verona, Italy
| | | | | | - Daniele Giansanti
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Italy
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16
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Rubega M, Formaggio E, Molteni F, Guanziroli E, Di Marco R, Baracchini C, Ermani M, Ward NS, Masiero S, Del Felice A. EEG Fractal Analysis Reflects Brain Impairment after Stroke. ENTROPY (BASEL, SWITZERLAND) 2021; 23:592. [PMID: 34064732 PMCID: PMC8150817 DOI: 10.3390/e23050592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/30/2021] [Accepted: 05/07/2021] [Indexed: 12/12/2022]
Abstract
Stroke is the commonest cause of disability. Novel treatments require an improved understanding of the underlying mechanisms of recovery. Fractal approaches have demonstrated that a single metric can describe the complexity of seemingly random fluctuations of physiological signals. We hypothesize that fractal algorithms applied to electroencephalographic (EEG) signals may track brain impairment after stroke. Sixteen stroke survivors were studied in the hyperacute (<48 h) and in the acute phase (∼1 week after stroke), and 35 stroke survivors during the early subacute phase (from 8 days to 32 days and after ∼2 months after stroke): We compared resting-state EEG fractal changes using fractal measures (i.e., Higuchi Index, Tortuosity) with 11 healthy controls. Both Higuchi index and Tortuosity values were significantly lower after a stroke throughout the acute and early subacute stage compared to healthy subjects, reflecting a brain activity which is significantly less complex. These indices may be promising metrics to track behavioral changes in the very early stage after stroke. Our findings might contribute to the neurorehabilitation quest in identifying reliable biomarkers for a better tailoring of rehabilitation pathways.
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Affiliation(s)
- Maria Rubega
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Giustiniani 3, 35128 Padova, PD, Italy; (E.F.); (R.D.M.); (S.M.); (A.D.F.)
| | - Emanuela Formaggio
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Giustiniani 3, 35128 Padova, PD, Italy; (E.F.); (R.D.M.); (S.M.); (A.D.F.)
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Via N. Sauro 17, 23845 Costa Masnaga, LC, Italy; (F.M.); (E.G.)
| | - Eleonora Guanziroli
- Villa Beretta Rehabilitation Center, Valduce Hospital, Via N. Sauro 17, 23845 Costa Masnaga, LC, Italy; (F.M.); (E.G.)
| | - Roberto Di Marco
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Giustiniani 3, 35128 Padova, PD, Italy; (E.F.); (R.D.M.); (S.M.); (A.D.F.)
| | - Claudio Baracchini
- Stroke Unit and Neurosonology Laboratory, Padova University Hospital, Via Giustiniani 3, 35128 Padova, PD, Italy; (C.B.); (M.E.)
| | - Mario Ermani
- Stroke Unit and Neurosonology Laboratory, Padova University Hospital, Via Giustiniani 3, 35128 Padova, PD, Italy; (C.B.); (M.E.)
| | - Nick S. Ward
- Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, 33 Queen Square, London WC1N 3BG, UK;
| | - Stefano Masiero
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Giustiniani 3, 35128 Padova, PD, Italy; (E.F.); (R.D.M.); (S.M.); (A.D.F.)
- Padova Neuroscience Center, University of Padova, Via Orus, 35128 Padova, PD, Italy
| | - Alessandra Del Felice
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Giustiniani 3, 35128 Padova, PD, Italy; (E.F.); (R.D.M.); (S.M.); (A.D.F.)
- Padova Neuroscience Center, University of Padova, Via Orus, 35128 Padova, PD, Italy
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17
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Stoykov ME, King E, David FJ, Vatinno A, Fogg L, Corcos DM. Bilateral motor priming for post stroke upper extremity hemiparesis: A randomized pilot study. Restor Neurol Neurosci 2021; 38:11-22. [PMID: 31609714 DOI: 10.3233/rnn-190943] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Bilateral priming, device assisted bilateral symmetrical wrist flexion/extension, is a noninvasive neuromodulation technique that can be used in the clinic. OBJECTIVE We examined the additive effect of bilateral motor priming and task specific training in individuals with severe upper limb hemiparesis. METHODS This is a parallel assignment, single-masked, randomized exploratory pilot study with three timepoints (pre-/post-intervention and follow up). Participants received either bilateral motor priming or health care education followed by task specific training. Sixteen participants who were at least 6 months post-stroke and had a Fugl Meyer Upper Extremity (FMUE) score between 23 and 38 were randomized. Our primary and secondary measures were Chedoke Arm & Hand Activity Index 9 (CAHAI-9) and the FMUE respectively. We determined changes in interhemispheric inhibition using transcranial magnetic stimulation. We hypothesized that improvement in the priming group would persist at follow up. RESULTS There was no between-group difference in the CAHAI. The improvement in the FMUE was significantly greater in the experimental group at follow up (t = 2.241, p = 0.045). CONCLUSIONS Both groups improved in the CAHAI. There was a significant between-group difference in the secondary outcome measure (FMUE) where the bilateral priming group had an average increase of 10 points from pre-intervention to follow up.
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Affiliation(s)
- Mary Ellen Stoykov
- Shirley Ryan Ability Lab, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Erin King
- Interdepartmental Neuroscience Program, Northwestern University, Chicago, IL, USA
| | - Fabian J David
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Amanda Vatinno
- Department of Health Sciences and Research, Medical College of South Carolina, Charleston, SC, USA
| | - Louis Fogg
- Department of Nursing, Rush University Medical Center, Chicago, IL, USA
| | - Daniel M Corcos
- Interdepartmental Neuroscience Program, Northwestern University, Chicago, IL, USA.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
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18
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Yuan K, Chen C, Wang X, Chu WCW, Tong RKY. BCI Training Effects on Chronic Stroke Correlate with Functional Reorganization in Motor-Related Regions: A Concurrent EEG and fMRI Study. Brain Sci 2021; 11:brainsci11010056. [PMID: 33418846 PMCID: PMC7824842 DOI: 10.3390/brainsci11010056] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/26/2020] [Accepted: 01/01/2021] [Indexed: 11/16/2022] Open
Abstract
Brain–computer interface (BCI)-guided robot-assisted training strategy has been increasingly applied to stroke rehabilitation, while few studies have investigated the neuroplasticity change and functional reorganization after intervention from multimodality neuroimaging perspective. The present study aims to investigate the hemodynamic and electrophysical changes induced by BCI training using functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) respectively, as well as the relationship between the neurological changes and motor function improvement. Fourteen chronic stroke subjects received 20 sessions of BCI-guided robot hand training. Simultaneous EEG and fMRI data were acquired before and immediately after the intervention. Seed-based functional connectivity for resting-state fMRI data and effective connectivity analysis for EEG were processed to reveal the neuroplasticity changes and interaction between different brain regions. Moreover, the relationship among motor function improvement, hemodynamic changes, and electrophysical changes derived from the two neuroimaging modalities was also investigated. This work suggested that (a) significant motor function improvement could be obtained after BCI training therapy, (b) training effect significantly correlated with functional connectivity change between ipsilesional M1 (iM1) and contralesional Brodmann area 6 (including premotor area (cPMA) and supplementary motor area (SMA)) derived from fMRI, (c) training effect significantly correlated with information flow change from cPMA to iM1 and strongly correlated with information flow change from SMA to iM1 derived from EEG, and (d) consistency of fMRI and EEG results illustrated by the correlation between functional connectivity change and information flow change. Our study showed changes in the brain after the BCI training therapy from chronic stroke survivors and provided a better understanding of neural mechanisms, especially the interaction among motor-related brain regions during stroke recovery. Besides, our finding demonstrated the feasibility and consistency of combining multiple neuroimaging modalities to investigate the neuroplasticity change.
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Affiliation(s)
- Kai Yuan
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, Hong Kong; (K.Y.); (C.C.); (X.W.)
| | - Cheng Chen
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, Hong Kong; (K.Y.); (C.C.); (X.W.)
| | - Xin Wang
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, Hong Kong; (K.Y.); (C.C.); (X.W.)
| | - Winnie Chiu-wing Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Hong Kong;
| | - Raymond Kai-yu Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, Hong Kong; (K.Y.); (C.C.); (X.W.)
- Correspondence:
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19
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Khaliq Fard M, Fallah A, Maleki A. Neural decoding of continuous upper limb movements: a meta-analysis. Disabil Rehabil Assist Technol 2020; 17:731-737. [PMID: 33186068 DOI: 10.1080/17483107.2020.1842919] [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: 10/23/2022]
Abstract
OBJECTIVE EEG-based motion trajectory decoding makes a promising approach for neurotechnology which can be used for neural control of motion reconstruction and neurorehabilitation tools. However, the feasibility and validity of continuous motion decoding by non-invasive brain activity are not clear. The main aim of this study was to perform a meta-analysis across studies that examined the ability of EEG-based continuous motion decoding of upper limb movements. APPROACH Pearson's correlation coefficient (CC) was used to evaluate the model performance of the studies and considered as an effect size. To estimate the overall effect size of neural decoding of motion trajectory across studies, characteristics of included studies were addressed and the random effect model was applied to the heterogeneous studies which estimated overall effect size distribution. Furthermore, the significant difference between the two subgroups of imagined and executed movements was analysed. MAIN RESULTS The mean of the overall effect size was computed 0.46 across the nonhomogeneous studies. The results showed no significant difference between imagined and executed movements (Chi2=0.28, df = 1, p = 0.60). SIGNIFICANCE Meta-analysis results confirm that imagination like execution movements can be used for neural decoding of motion trajectory in neural motor control systems. Also, nonlinear compare with linear model statistically confirmed to be more beneficial for complex movements. Furthermore, a new approach of synergy-based motion decoding can be significantly effective to increase model performance and more research needs to evaluate this method for different levels of complexity of movements.IMPLICATIONS FOR REHABILITATIONNeural decoding methods base on EEG as a non-invasive brain activity, are more user friendly for neurorehabilitation than invasive methods that developing of it makes it more applicable for reconstructing activities of daily living.Neurotechnology for neural control of motion reconstruction, makes the rehabilitation tools to be more synchrony with human intentional movement that can be used to improve the brain neuroplastisity in stroke or other paralysed people.The feasibility and validity of imagined movements equal with executed movements show that amputee people also can benefit EEG-based motion decoding for controling rehabilitation tools just by imagination of their intentional movements.For neurorehabilitation tools, comparing the study outcomes illucidate that the approach of synergy-based motor control in brain activities concluded significantly high performance that highlighted the need it to more investigated in future research.
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Affiliation(s)
- Mahdie Khaliq Fard
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Ali Fallah
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
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20
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Chen S, Li Y, Shu X, Wang C, Wang H, Ding L, Jia J. Electroencephalography Mu Rhythm Changes and Decreased Spasticity After Repetitive Peripheral Magnetic Stimulation in Patients Following Stroke. Front Neurol 2020; 11:546599. [PMID: 33133002 PMCID: PMC7550716 DOI: 10.3389/fneur.2020.546599] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/17/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Spasticity is common among patients with stroke. Repetitive peripheral magnetic stimulation (rPMS) is a painless and noninvasive therapy that is a promising approach to reducing spasticity. However, the central mechanism of this therapy remains unclear. Changes in cortical activity and decreased spasticity after rPMS intervention require further exploration. The aim of this study was to explore the electroencephalography (EEG) mu rhythm change and decrease in spasticity after rPMS intervention in patients with stroke. Materials and methods: A total of 32 patients with spasticity following stroke were recruited in this study and assigned to the rPMS group (n = 16) or sham group (n = 16). The modified Ashworth scale, modified Tardieu scale, and Fugl-Meyer assessment of the upper extremity were used to assess changes in upper limb spasticity and motor function. Before and after the rPMS intervention, EEG evaluation was performed to detect EEG mu rhythm changes in the brain. Results: After one session of rPMS intervention, spasticity was reduced in elbow flexors (p < 0.05) and wrist flexors (p < 0.05). Upper limb motor function measured according to the Fugl-Meyer assessment was improved (p < 0.05). In the rPMS group, the power of event-related desynchronization decreased in the mu rhythm band (8-12 Hz) in the contralesional hemisphere (p < 0.05). Conclusions: The results indicate that rPMS intervention reduced spasticity. Cortical activity changes may suggest this favorable change in terms of its neurological effects on the central nervous system.
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Affiliation(s)
- Shugeng Chen
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yang Li
- Department of Rehabilitation Medicine, Shanghai Jing'an District Central Hospital, Shanghai, China
| | - Xiaokang Shu
- School of Mechanical Engineering, Shanghai Jiaotong University, Shanghai, China
| | - Chuankai Wang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Hewei Wang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Li Ding
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Jia
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
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21
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Park T, Lee M, Jeong T, Shin YI, Park SM. Quantitative Analysis of EEG Power Spectrum and EMG Median Power Frequency Changes after Continuous Passive Motion Mirror Therapy System. SENSORS 2020; 20:s20082354. [PMID: 32326195 PMCID: PMC7219252 DOI: 10.3390/s20082354] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 11/16/2022]
Abstract
Robotic mirror therapy (MT), which allows movement of the affected limb, is proposed as a more effective method than conventional MT (CMT). To improve the rehabilitation effectiveness of post-stroke patients, we developed a sensory stimulation-based continuous passive motion (CPM)-MT system with two different operating protocols, that is, asynchronous and synchronous modes. To evaluate their effectiveness, we measured brain activation through relative and absolute power spectral density (PSD) changes of electroencephalogram (EEG) mu rhythm in three cases with CMT and CPM-MT with asynchronous and synchronous modes. We also monitored changes in muscle fatigue, which is one of the negative effects of the CPM device, based on median power frequency (MPF) and root mean square (RMS). Relative PSD was most suppressed when subjects used the CPM-MT system under synchronous control: 22.11%, 15.31%, and 16.48% on Cz, C3, and C4, respectively. The absolute average changes in MPF and RMS were 1.59% and 9.78%, respectively, with CPM-MT. Synchronous mode CPM-MT is the most effective method for brain activation, and muscle fatigue caused by the CPM-MT system was negligible. This study suggests the more effective combination rehabilitation system for MT by utilizing CPM and magnetic-based MT task to add action execution and sensory stimulation compared with CMT.
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Affiliation(s)
- Taewoong Park
- Department of Creative IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang 37673, Korea; (T.P.); (M.L.); (T.J.)
| | - Mina Lee
- Department of Creative IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang 37673, Korea; (T.P.); (M.L.); (T.J.)
| | - Taejong Jeong
- Department of Creative IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang 37673, Korea; (T.P.); (M.L.); (T.J.)
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan 50612, Korea;
| | - Sung-Min Park
- Department of Creative IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang 37673, Korea; (T.P.); (M.L.); (T.J.)
- Correspondence:
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22
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Pignolo L, Serra S, Basta G, Carozzo S, Arcuri F, Pignataro LM, Ciancarelli I, Tonin P, Cerasa A. Data on a new neurorehabilitation approach targeting functional recovery in stroke patients. Data Brief 2019; 27:104685. [PMID: 31737755 PMCID: PMC6849111 DOI: 10.1016/j.dib.2019.104685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/23/2019] [Accepted: 10/11/2019] [Indexed: 11/28/2022] Open
Abstract
Robotic-assisted devices are known to positively affect the recovery of one specific motor effector after stroke. However, it has widely been reported that the functional status of patients is only partially ameliorated after application of this kind of advanced treatment. Here, data about the effect of a new rehabilitation approach has been described in a large population of stroke patients. We sought to validate an integrated rehabilitation system for stroke (IRSS) patients, which is composed of a set of robotic-assisted tools aimed at recovering the entire body. We evaluated the motor recovery in 84 stroke patients equally divided into experimental and control groups to assess the difference between IRSS approach and conventional rehabilitation treatment. We found that IRSS induced a significant improvement as measured by functional neurological scales, such as the barthel index and functional independence measure. The data provided in this article will assist therapists and physicians working for developing new rehabilitation protocols more focused on a holistic functional recovery approach. The data are available at Mendeley Data, https://doi.org/10.17632/wptmgm7zk2.1.
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Affiliation(s)
- Loris Pignolo
- S. Anna Institute, Research in Advanced Neurorehabilitation (RAN), 88900, Crotone, Italy
| | - Sebastiano Serra
- S. Anna Institute, Research in Advanced Neurorehabilitation (RAN), 88900, Crotone, Italy
| | - Giuseppina Basta
- S. Anna Institute, Research in Advanced Neurorehabilitation (RAN), 88900, Crotone, Italy
| | - Simone Carozzo
- S. Anna Institute, Research in Advanced Neurorehabilitation (RAN), 88900, Crotone, Italy
| | - Francesco Arcuri
- S. Anna Institute, Research in Advanced Neurorehabilitation (RAN), 88900, Crotone, Italy
| | | | - Irene Ciancarelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Nova Salus S.r.l., L'Aquila, Italy
| | - Paolo Tonin
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Nova Salus S.r.l., L'Aquila, Italy
| | - Antonio Cerasa
- S. Anna Institute, Research in Advanced Neurorehabilitation (RAN), 88900, Crotone, Italy
- IBFM, National Research Council, 88100, Catanzaro, Italy
- Corresponding author. Neuroimaging Unit, IBFM-CNR, 88100, Catanzaro, Italy.
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23
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Abstract
The development of robotic devices for rehabilitation is a fast-growing field. Nowadays, thanks to novel technologies that have improved robots’ capabilities and offered more cost-effective solutions, robotic devices are increasingly being employed during clinical practice, with the goal of boosting patients’ recovery. Robotic rehabilitation is also widely used in the context of neurological disorders, where it is often provided in a variety of different fashions, depending on the specific function to be restored. Indeed, the effect of robot-aided neurorehabilitation can be maximized when used in combination with a proper training regimen (based on motor control paradigms) or with non-invasive brain machine interfaces. Therapy-induced changes in neural activity and behavioral performance, which may suggest underlying changes in neural plasticity, can be quantified by multimodal assessments of both sensorimotor performance and brain/muscular activity pre/post or during intervention. Here, we provide an overview of the most common robotic devices for upper and lower limb rehabilitation and we describe the aforementioned neurorehabilitation scenarios. We also review assessment techniques for the evaluation of robotic therapy. Additional exploitation of these research areas will highlight the crucial contribution of rehabilitation robotics for promoting recovery and answering questions about reorganization of brain functions in response to disease.
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Hsu H, Chiu H, Kuan T, Tsai C, Su F, Kuo L. Robotic‐assisted therapy with bilateral practice improves task and motor performance in the upper extremities of chronic stroke patients: A randomised controlled trial. Aust Occup Ther J 2019; 66:637-647. [DOI: 10.1111/1440-1630.12602] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/15/2019] [Accepted: 06/16/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Hsiu‐Yun Hsu
- Department of Physical Medicine and Rehabilitation National Cheng Kung University Hospital College of Medicine National Cheng Kung University
- Department of Occupational Therapy College of Medicine National Cheng Kung University
- Medical Device Innovation Center National Cheng Kung University
| | - Haw‐Yen Chiu
- Section of Plastic Surgery, Department of Surgery ChiMei Medical Center
| | - Ta‐Shen Kuan
- Department of Physical Medicine and Rehabilitation National Cheng Kung University Hospital College of Medicine National Cheng Kung University
| | - Ching‐Liang Tsai
- Department of Physical Medicine and Rehabilitation National Cheng Kung University Hospital College of Medicine National Cheng Kung University
| | - Fong‐Chin Su
- Medical Device Innovation Center National Cheng Kung University
- Department of Biomedical Engineering College of Engineering National Cheng Kung University
| | - Li‐Chieh Kuo
- Department of Occupational Therapy College of Medicine National Cheng Kung University
- Medical Device Innovation Center National Cheng Kung University
- Institute of Allied Health Sciences, College of Medicine National Cheng Kung University Tainan Taiwan
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Zhang X, D’Arcy R, Menon C. Scoring upper-extremity motor function from EEG with artificial neural networks: a preliminary study. J Neural Eng 2019; 16:036013. [DOI: 10.1088/1741-2552/ab0b82] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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27
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A Multiparameter Approach to Evaluate Post-Stroke Patients: An Application on Robotic Rehabilitation. APPLIED SCIENCES-BASEL 2018. [DOI: 10.3390/app8112248] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Multidomain instrumental evaluation of post-stroke chronic patients, coupled with standard clinical assessments, has rarely been exploited in the literature. Such an approach may be valuable to provide comprehensive insight regarding patients’ status, as well as orienting the rehabilitation therapies. Therefore, we propose a multidomain analysis including clinically compliant methods as electroencephalography (EEG), electromyography (EMG), kinematics, and clinical scales. The framework of upper-limb robot-assisted rehabilitation is selected as a challenging and promising scenario to test the multi-parameter evaluation, with the aim to assess whether and in which domains modifications may take place. Instrumental recordings and clinical scales were administered before and after a month of intensive robotic therapy of the impaired upper limb, on five post-stroke chronic hemiparetic patients. After therapy, all patients showed clinical improvement and presented pre/post modifications in one or several of the other domains as well. All patients performed the motor task in a smoother way; two of them appeared to change their muscle synergies activation strategies, and most subjects showed variations in their brain activity, both in the ipsi- and contralateral hemispheres. Changes highlighted by the new multiparametric instrumental approach suggest a recovery trend in agreement with clinical scales. In addition, by jointly demonstrating lateralization of brain activations, changes in muscle recruitment and the execution of smoother trajectories, the new approach may help distinguish between true functional recovery and the adoption of suboptimal compensatory strategies. In the light of these premises, the multi-domain approach may allow a finer patient characterization, providing a deeper insight into the mechanisms underlying the relearning procedure and the level (neuro/muscular) at which it occurred, at a relatively low expenditure. The role of this quantitative description in defining a personalized treatment strategy is of great interest and should be addressed in future studies.
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28
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Cerasa A, Pignolo L, Gramigna V, Serra S, Olivadese G, Rocca F, Perrotta P, Dolce G, Quattrone A, Tonin P. Exoskeleton-Robot Assisted Therapy in Stroke Patients: A Lesion Mapping Study. Front Neuroinform 2018; 12:44. [PMID: 30065642 PMCID: PMC6056631 DOI: 10.3389/fninf.2018.00044] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/21/2018] [Indexed: 02/02/2023] Open
Abstract
Background: Technology-supported rehabilitation is emerging as a solution to support therapists in providing a high-intensity, repetitive and task-specific treatment, aimed at improving stroke recovery. End-effector robotic devices are known to positively affect the recovery of arm functions, however there is a lack of evidence regarding exoskeletons. This paper evaluates the impact of cerebral lesion load on the response to a validated robotic-assisted rehabilitation protocol. Methods: Fourteen hemiparetic patients were assessed in a within-subject design (age 66.9 ± 11.3 years; 10 men and 4 women). Patients, in post-acute phase, underwent 7 weeks of bilateral arm training assisted by an exoskeleton robot combined with a conventional treatment (consisting of simple physical activity together with occupational therapy). Clinical and neuroimaging evaluations were performed immediately before and after rehabilitation treatments. Fugl-Meyer (FM) and Motricity Index (MI) were selected to measure primary outcomes, i.e., motor function and strength. Functional independance measure (FIM) and Barthel Index were selected to measure secondary outcomes, i.e., daily living activities. Voxel-based lesion symptom mapping (VLSM) was used to determine the degree of cerebral lesions associated with motor recovery. Results: Robot-assisted rehabilitation was effective in improving upper limb motor function recovery, considering both primary and secondary outcomes. VLSM detected that lesion load in the superior region of the corona radiata, internal capsule and putamen were significantly associated with recovery of the upper limb as defined by the FM scores (p-level < 0.01). Conclusions: The probability of functional recovery from stroke by means of exoskeleton robotic rehabilitation relies on the integrity of specific subcortical regions involved in the primary motor pathway. This is consistent with previous evidence obtained with conventional neurorehabilitation approaches.
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Affiliation(s)
- Antonio Cerasa
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN) Crotone, Crotone, Italy.,Neuroimaging Unit, IBFM-CNR, Catanzaro, Italy
| | - Loris Pignolo
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN) Crotone, Crotone, Italy
| | | | - Sebastiano Serra
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN) Crotone, Crotone, Italy
| | | | | | | | - Giuliano Dolce
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN) Crotone, Crotone, Italy
| | - Aldo Quattrone
- Neuroimaging Unit, IBFM-CNR, Catanzaro, Italy.,Neuroscience Research Centre, University Magna Græcia, Catanzaro, Italy
| | - Paolo Tonin
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN) Crotone, Crotone, Italy
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