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Wang MH, Wang YX, Xie M, Chen LY, He MF, Lin F, Jiang ZL. Transcutaneous auricular vagus nerve stimulation with task-oriented training improves upper extremity function in patients with subacute stroke: a randomized clinical trial. Front Neurosci 2024; 18:1346634. [PMID: 38525376 PMCID: PMC10957639 DOI: 10.3389/fnins.2024.1346634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/27/2024] [Indexed: 03/26/2024] Open
Abstract
Background Transcutaneous auricular vagus nerve stimulation (taVNS) has emerged as a promising brain stimulation modality in poststroke upper extremity rehabilitation. Although several studies have examined the safety and reliability of taVNS, the mechanisms underlying motor recovery in stroke patients remain unclear. Objectives This study aimed to investigate the effects of taVNS paired with task-oriented training (TOT) on upper extremity function in patients with subacute stroke and explore the potential underlying mechanisms. Methods In this double-blinded, randomized, controlled pilot trial, 40 patients with subacute stroke were randomly assigned to two groups: the VNS group (VG), receiving taVNS during TOT, and the Sham group (SG), receiving sham taVNS during TOT. The intervention was delivered 5 days per week for 4 weeks. Upper extremity function was measured using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), the Action Research Arm Test (ARAT). Activities of daily living were measured by the modified Barthel Index (MBI). Motor-evoked potentials (MEPs) were measured to evaluate cortical excitability. Assessments were administered at baseline and post-intervention. Additionally, the immediate effect of taVNS was detected using functional near-infrared spectroscopy (fNIRS) and heart rate variability (HRV) before intervention. Results The VG showed significant improvements in upper extremity function (FMA-UE, ARAT) and activities of daily living (MBI) compared to the SG at post-intervention. Furthermore, the VG demonstrated a higher rate of elicited ipsilesional MEPs and a shorter latency of MEPs in the contralesional M1. In the VG, improvements in FMA-UE were significantly associated with reduced latency of contralesional MEPs. Additionally, fNIRS revealed increased activation in the contralesional prefrontal cortex and ipsilesional sensorimotor cortex in the VG in contrast to the SG. However, no significant between-group differences were found in HRV. Conclusion The combination of taVNS with TOT effectively improves upper extremity function in patients with subacute stroke, potentially through modulating the bilateral cortex excitability to facilitate task-specific functional recovery.
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Affiliation(s)
- Meng-Huan Wang
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yi-Xiu Wang
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Min Xie
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Li-Yan Chen
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Meng-Fei He
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Feng Lin
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zhong-Li Jiang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
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Martino Cinnera A, Picerno P, Bisirri A, Koch G, Morone G, Vannozzi G. Upper limb assessment with inertial measurement units according to the international classification of functioning in stroke: a systematic review and correlation meta-analysis. Top Stroke Rehabil 2024; 31:66-85. [PMID: 37083139 DOI: 10.1080/10749357.2023.2197278] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 03/24/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE To investigate the usefulness of inertial measurement units (IMUs) in the assessment of motor function of the upper limb (UL) in accordance with the international classification of functioning (ICF). DATA SOURCES PubMed; Scopus; Embase; WoS and PEDro databases were searched from inception to 1 February 2022. METHODS The current systematic review follows PRISMA recommendations. Articles including IMU assessment of UL in stroke individuals have been included and divided into four ICF categories (b710, b735, b760, d445). We used correlation meta-analysis to pool the Fisher Z-score of each correlation between kinematics and clinical assessment. RESULTS A total of 35 articles, involving 475 patients, met the inclusion criteria. In the included studies, IMUs have been employed to assess the mobility of joint functions (n = 6), muscle tone functions (n = 4), control of voluntary movement functions (n = 15), and hand and arm use (n = 15). A significant correlation was found in overall meta-analysis based on 10 studies, involving 213 subjects: (r = 0.69) (95% CI: 0.69/0.98; p < 0.001) as in the d445 (r = 0.71) and b760 (r = 0.64) ICF domains, with no heterogeneity across the studies. CONCLUSION The literature supports the integration of IMUs and conventional clinical assessment in functional evaluation of the UL after a stroke. The use of a limited number of wearable sensors can provide additional kinematic features of UL in all investigated ICF domains, especially in the ADL tasks when a strong correlation with clinical evaluation was found.
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Affiliation(s)
- Alex Martino Cinnera
- Scientific Institute for Research, Hospitalization and Health Care IRCCS Santa Lucia Foundation, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Pietro Picerno
- SMART Engineering Solutions & Technologies (SMARTEST) Research Center, Università Telematica "eCampus", Novedrate, Italy
| | | | - Giacomo Koch
- Department of Neuroscience and Rehabilitation, University of Ferrara, Italy
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giuseppe Vannozzi
- Scientific Institute for Research, Hospitalization and Health Care IRCCS Santa Lucia Foundation, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
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Hwang YT, Tung YQ, Chen CS, Lin BS. B-Spline Modeling of Inertial Measurements for Evaluating Stroke Rehabilitation Effectiveness. IEEE Trans Neural Syst Rehabil Eng 2023; 31:4008-4016. [PMID: 37815972 DOI: 10.1109/tnsre.2023.3323375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
Patients who experience upper-limb paralysis after stroke require continual rehabilitation. Rehabilitation must be evaluated for appropriate treatment adjustment; such evaluation can be performed using inertial measurement units (IMUs) instead of standard scales or subjective evaluations. However, IMUs produce large quantities of discretized data, and using these data directly is challenging. In this study, B-splines were used to estimate IMU trajectory data for objective evaluations of hand function and stability by using machine learning classifiers and mathematical indices. IMU trajectory data from a 2018 study on upper-limb rehabilitation were used to validate the proposed method. Features extracted from B -spline trajectories could be used to classify individuals in the 2018 study with high accuracy, and the proposed indices revealed differences between these groups. Compared with conventional rehabilitation evaluation methods, the proposed method is more objective and effective.
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Swanson VA, Johnson CA, Zondervan DK, Shaw SJ, Reinkensmeyer DJ. Exercise repetition rate measured with simple sensors at home can be used to estimate Upper Extremity Fugl-Meyer score after stroke. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1181766. [PMID: 37404979 PMCID: PMC10315847 DOI: 10.3389/fresc.2023.1181766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/01/2023] [Indexed: 07/06/2023]
Abstract
Introduction It would be valuable if home-based rehabilitation training technologies could automatically assess arm impairment after stroke. Here, we tested whether a simple measure-the repetition rate (or "rep rate") when performing specific exercises as measured with simple sensors-can be used to estimate Upper Extremity Fugl-Meyer (UEFM) score. Methods 41 individuals with arm impairment after stroke performed 12 sensor-guided exercises under therapist supervision using a commercial sensor system comprised of two pucks that use force and motion sensing to measure the start and end of each exercise repetition. 14 of these participants then used the system at home for three weeks. Results Using linear regression, UEFM score was well estimated using the rep rate of one forward-reaching exercise from the set of 12 exercises (r2 = 0.75); this exercise required participants to alternately tap pucks spaced about 20 cm apart (one proximal, one distal) on a table in front of them. UEFM score was even better predicted using an exponential model and forward-reaching rep rate (Leave One Out Cross Validation (LOOCV) r2 = 0.83). We also tested the ability of a nonlinear, multivariate model (a regression tree) to predict UEFM, but such a model did not improve prediction (LOOCV r2 = 0.72). However, the optimal decision tree also used the forward-reaching task along with a pinch grip task to subdivide more and less impaired patients in a way consistent with clinical intuition. At home, rep rate for the forward-reaching exercise well predicted UEFM score using an exponential model (LOOCV r2 = 0.69), but only after we re-estimated coefficients using the home data. Discussion These results show how a simple measure-exercise rep rate measured with simple sensors-can be used to infer an arm impairment score and suggest that prediction models should be tuned separately for the clinic and home environments.
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Affiliation(s)
- Veronica A. Swanson
- Biorobotics Laboratory, Department of Mechanical and Aerospace Engineering, University of California, Irvine, Irvine, CA, United States
| | - Christopher A. Johnson
- Biorobotics Laboratory, Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, United States
| | | | - Susan J. Shaw
- Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States
| | - David J. Reinkensmeyer
- Biorobotics Laboratory, Department of Mechanical and Aerospace Engineering, University of California, Irvine, Irvine, CA, United States
- Department of Anatomy and Neurobiology, UC Irvine School of Medicine, University of California, Irvine, Irvine, CA, United States
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Crecan CM, Morar IA, Lupsan AF, Repciuc CC, Rus MA, Pestean CP. Development of a Novel Approach for Detection of Equine Lameness Based on Inertial Sensors: A Preliminary Study. SENSORS (BASEL, SWITZERLAND) 2022; 22:7082. [PMID: 36146429 PMCID: PMC9505255 DOI: 10.3390/s22187082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/07/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
Both as an aid for less experienced clinicians and to enhance objectivity and sharp clinical skills in professionals, quantitative technologies currently bring the equine lameness diagnostic closer to evidence-based veterinary medicine. The present paper describes an original, inertial sensor-based wireless device system, the Lameness Detector 0.1, used in ten horses with different lameness degrees in one fore- or hind-leg. By recording the impulses on three axes of the incorporated accelerometer in each leg of the assessed horse, and then processing the data using custom-designed software, the device proved its usefulness in lameness identification and severity scoring. Mean impulse values on the horizontal axis calculated for five consecutive steps above 85, regardless of the leg, indicated the slightest subjectively recognizable lameness, increasing to 130 in severe gait impairment. The range recorded on the same axis (between 61.2 and 67.4) in the sound legs allowed a safe cut-off value of 80 impulses for diagnosing a painful limb. The significance of various comparisons and several correlations highlighted the potential of this simple, affordable, and easy-to-use lameness detector device for further standardization as an aid for veterinarians in diagnosing lameness in horses.
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Affiliation(s)
- Cristian Mihaita Crecan
- Department of Surgery and Intensive Care, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, 400372 Cluj-Napoca, Romania
| | - Iancu Adrian Morar
- Department of Obstetrics and Reproduction, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, 400372 Cluj-Napoca, Romania
| | - Alexandru Florin Lupsan
- Department of Surgery and Intensive Care, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, 400372 Cluj-Napoca, Romania
| | - Calin Cosmin Repciuc
- Department of Surgery and Intensive Care, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, 400372 Cluj-Napoca, Romania
| | - Mirela Alexandra Rus
- Department of Obstetrics and Reproduction, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, 400372 Cluj-Napoca, Romania
| | - Cosmin Petru Pestean
- Department of Surgery and Intensive Care, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, 400372 Cluj-Napoca, Romania
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Hughes CML, Tran B, Modan A, Zhang X. Accuracy and Validity of a Single Inertial Measurement Unit-Based System to Determine Upper Limb Kinematics for Medically Underserved Populations. Front Bioeng Biotechnol 2022; 10:918617. [PMID: 35832406 PMCID: PMC9271671 DOI: 10.3389/fbioe.2022.918617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Stroke is one of the leading causes of death and disability worldwide, with a disproportionate burden represented by low- and middle-income countries (LMICs). To improve post-stroke outcomes in LMICs, researchers have sought to leverage emerging technologies that overcome traditional barriers associated with stroke management. One such technology, inertial measurement units (IMUs), exhibit great potential as a low-cost, portable means to evaluate and monitor patient progress during decentralized rehabilitation protocols. As such, the aim of the present study was to determine the ability of a low-cost single IMU sensor-based wearable system (named the T’ena sensor) to reliably and accurately assess movement quality and efficiency in physically and neurologically healthy adults. Upper limb movement kinematics measured by the T’ena sensor were compared to the gold standard reference system during three functional tasks, and root mean square errors, Pearson’s correlation coefficients, intraclass correlation coefficients, and the Bland Altman method were used to compare kinematic variables of interest between the two systems for absolute accuracy and equivalency. The T’ena sensor and the gold standard reference system were significantly correlated for all tasks and measures (r range = 0.648—0.947), although less so for the Finger to Nose task (r range = 0.648—0.894). Results demonstrate that single IMU systems are a valid, reliable, and objective method by which to measure movement kinematics during functional tasks. Context-appropriate enabling technologies specifically designed to address barriers to quality health services in LMICs can accelerate progress towards the United Nations Sustainable Development Goal 3.
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Affiliation(s)
- Charmayne Mary Lee Hughes
- NeuroTech Lab, Health Equity Institute, San Francisco State University, San Francisco, CA, United States
- Department of Kinesiology, San Francisco State University, San Francisco, CA, United States
- *Correspondence: Charmayne Mary Lee Hughes,
| | - Bao Tran
- School of Engineering, San Francisco State University, San Francisco, CA, United States
| | - Amir Modan
- School of Engineering, San Francisco State University, San Francisco, CA, United States
| | - Xiaorong Zhang
- School of Engineering, San Francisco State University, San Francisco, CA, United States
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李 素, 吴 坤, 孟 巧, 喻 洪. [Research progress on intelligent assessment system for upper limb function of stroke patients]. SHENG WU YI XUE GONG CHENG XUE ZA ZHI = JOURNAL OF BIOMEDICAL ENGINEERING = SHENGWU YIXUE GONGCHENGXUE ZAZHI 2022; 39:620-626. [PMID: 35788532 PMCID: PMC10950765 DOI: 10.7507/1001-5515.202112046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/08/2022] [Indexed: 06/15/2023]
Abstract
At present, the upper limb function of stroke patients is often assessed clinically using a scale method, but this method has problems such as time-consuming, poor consistency of assessment results, and high participation of rehabilitation physicians. To overcome the shortcomings of the scale method, intelligent upper limb function assessment systems combining sensors and machine learning algorithms have become one of the hot research topics in recent years. Firstly, the commonly used clinical upper limb functional assessment methods are analyzed and summarized. Then the researches on intelligent assessment systems in recent years are reviewed, focusing on the technologies used in the data acquisition and data processing parts of intelligent assessment systems and their advantages and disadvantages. Lastly, the current challenges and future development directions of intelligent assessment systems are discussed. This review is hoped to provide valuable reference information for researchers in related fields.
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Affiliation(s)
- 素姣 李
- 上海理工大学 康复工程与技术研究所(上海 200093)Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai 200093, P. R. China
- 上海康复器械工程技术研究中心(上海 200093)Shanghai Engineering Research Center of Assistive Devices, Shanghai 200093, P. R. China
- 民政部神经功能信息与康复工程重点实验室(上海 200093)Key Laboratory of Neural-functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Shanghai 200093, P. R. China
| | - 坤 吴
- 上海理工大学 康复工程与技术研究所(上海 200093)Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai 200093, P. R. China
- 上海康复器械工程技术研究中心(上海 200093)Shanghai Engineering Research Center of Assistive Devices, Shanghai 200093, P. R. China
| | - 巧玲 孟
- 上海理工大学 康复工程与技术研究所(上海 200093)Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai 200093, P. R. China
- 上海康复器械工程技术研究中心(上海 200093)Shanghai Engineering Research Center of Assistive Devices, Shanghai 200093, P. R. China
- 民政部神经功能信息与康复工程重点实验室(上海 200093)Key Laboratory of Neural-functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Shanghai 200093, P. R. China
| | - 洪流 喻
- 上海理工大学 康复工程与技术研究所(上海 200093)Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai 200093, P. R. China
- 上海康复器械工程技术研究中心(上海 200093)Shanghai Engineering Research Center of Assistive Devices, Shanghai 200093, P. R. China
- 民政部神经功能信息与康复工程重点实验室(上海 200093)Key Laboratory of Neural-functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Shanghai 200093, P. R. China
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Hwang YT, Lu WA, Lin BS. Use of Functional Data to Model the Trajectory of an IMU and Classify Levels of Motor Impairment for Stroke Patients. IEEE Trans Neural Syst Rehabil Eng 2022; 30:925-935. [PMID: 35333716 DOI: 10.1109/tnsre.2022.3162416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Motor impairment evaluations are key rehabilitation-related assessments for patients with stroke. Currently, such evaluations are subjective; they are based on physicians' judgements regarding the actions performed by patients. This leads to inconsistent clinical results. Many inertial sensing elements for motion detection have been designed. However, to more easily and rapidly evaluate motor impairment, we require a system that can collect data effectively to predict the degree of motor impairment. Lin et al. used data gloves equipped with an inertial measurement unit (IMU) to collect movement trajectories for motor impairment evaluations in patients with stroke. The present study used functional data analysis to model data trajectories to reduce the influence of noise from IMU data and proposed using coefficients of function as features for classifying motor impairment. To verify the appropriateness of feature construction, five classification methods were used to evaluate the extracted features in terms of the overall and sensor-specific ability to classify levels of motor impairment. The results indicated that the features derived from cubic smoothing splines could effectively reflect key data characteristics, and a support vector machine yielded relatively high overall and sensor-specific accuracy for distinguishing between levels of motion impairment in patients with stroke. Future data glove systems can contain cubic smoothing splines to extract hand function features and then classify motion impairment for appropriate rehabilitation programs to be prescribed.
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