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Goikoetxea-Sotelo G, van Hedel HJA. Defining, quantifying, and reporting intensity, dose, and dosage of neurorehabilitative interventions focusing on motor outcomes. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1139251. [PMID: 37637933 PMCID: PMC10457006 DOI: 10.3389/fresc.2023.1139251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 07/21/2023] [Indexed: 08/29/2023]
Abstract
Introduction Determining the minimal amount of therapy needed for positive neurorehabilitative outcomes is important for optimizing active treatment interventions to improve motor outcomes. However, there are various challenges when quantifying these relationships: first, several consensuses on the definition and usage of the terms intensity, dose, and dosage of motor interventions have been proposed, but there seems to be no agreement, and the terms are still used inconsistently. Second, randomized controlled trials frequently underreport items relevant to determining the intensity, dose, and dosage of the interventions. Third, there is no universal measure to quantify therapy intensity accurately. This "perspectives" paper aims to increase awareness of these topics among neurorehabilitation specialists. Defining quantifying and reporting We searched the literature for definitions of intensity, dose, and dosage and adapted the ones we considered the most appropriate to fit the needs of neurorehabilitative interventions. Furthermore, we suggest refining the template for intervention description and replication (TIDieR) to enhance the reporting of randomized controlled trials. Finally, we performed a systematic literature search to provide a list of intensity measures and complemented these with some novel candidate measures. Discussion The proposed definitions of intensity, dose, and dosage could improve the communication between neurorehabilitation specialists and the reporting of dose and dosage in interventional studies. Quantifying intensity is necessary to improve our understanding of the minimal intensity, dose, and dosage of therapy needed to improve motor outcomes in neurorehabilitation. We consider the lack of appropriate intensity measures a significant gap in knowledge requiring future research.
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Affiliation(s)
- Gaizka Goikoetxea-Sotelo
- Swiss Children’s Rehab, University Children’s Hospital Zurich, University of Zurich, Affoltern am Albis, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Hubertus J. A. van Hedel
- Swiss Children’s Rehab, University Children’s Hospital Zurich, University of Zurich, Affoltern am Albis, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
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Action Observation Therapy for Arm Recovery after Stroke: A Preliminary Investigation on a Novel Protocol with EEG Monitoring. J Clin Med 2023; 12:jcm12041327. [PMID: 36835865 PMCID: PMC9961867 DOI: 10.3390/jcm12041327] [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: 12/19/2022] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
This preliminary study introduces a novel action observation therapy (AOT) protocol associated with electroencephalographic (EEG) monitoring to be used in the future as a rehabilitation strategy for the upper limb in patients with subacute stroke. To provide initial evidence on the usefulness of this method, we compared the outcome of 11 patients who received daily AOT for three weeks with that of patients who undertook two other approaches recently investigated by our group, namely intensive conventional therapy (ICT), and robot-assisted therapy combined with functional electrical stimulation (RAT-FES). The three rehabilitative interventions showed similar arm motor recovery as indexed by Fugl-Meyer's assessment of the upper extremity (FMA_UE) and box and block test (BBT). The improvement in the FMA_UE was yet more favourable in patients with mild/moderate motor impairments who received AOT, in contrast with patients carrying similar disabilities who received the other two treatments. This suggests that AOT might be more effective in this subgroup of patients, perhaps because the integrity of their mirror neurons system (MNS) was more preserved, as indexed by EEG recording from central electrodes during action observation. In conclusion, AOT may reveal an effective rehabilitative tool in patients with subacute stroke; the EEG evaluation of MNS integrity may help to select patients who could maximally benefit from this intervention.
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Errante A, Saviola D, Cantoni M, Iannuzzelli K, Ziccarelli S, Togni F, Simonini M, Malchiodi C, Bertoni D, Inzaghi MG, Bozzetti F, Menozzi R, Quarenghi A, Quarenghi P, Bosone D, Fogassi L, Salvi GP, De Tanti A. Effectiveness of action observation therapy based on virtual reality technology in the motor rehabilitation of paretic stroke patients: a randomized clinical trial. BMC Neurol 2022; 22:109. [PMID: 35317736 PMCID: PMC8939064 DOI: 10.1186/s12883-022-02640-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rehabilitation of paretic stroke patients uses a wide range of intervention programs to improve the function of impaired upper limb. A new rehabilitative approach, called action observation therapy (AOT) is based on the discovery of mirror neurons and has been used to improve the motor functions of adult stroke patients and children with cerebral palsy. Recently, virtual reality (VR) has provided the potential to increase the frequency and effectiveness of rehabilitation treatment by offering challenging and motivating tasks. METHODS: The purpose of the present project is to design a randomized controlled six-month follow-up trial (RCT) to evaluate whether action observation (AO) added to standard VR (AO + VR) is effective in improving upper limb function in patients with stroke, compared with a control treatment consisting of observation of naturalistic scenes (CO) without any action content, followed by VR training (CO + VR). DISCUSSION AO + VR treatment may provide an addition to the rehabilitative interventions currently available for recovery after stroke and could be utilized within standard sensorimotor training or in individualized tele-rehabilitation. TRIAL REGISTRATION The trial has been prospectively registered on ClinicalTrials.gov. NCT05163210 . 17 December 2021.
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Affiliation(s)
- Antonino Errante
- Diagnostic Department, Neuroradiology Unit, University Hospital of Parma, Via Volturno 39, 43125, Parma, Italy. .,Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Donatella Saviola
- Cardinal Ferrari Center, S. Stefano Riabilitazione, Fontanellato, Parma, Italy
| | - Matteo Cantoni
- Cardinal Ferrari Center, S. Stefano Riabilitazione, Fontanellato, Parma, Italy
| | - Katia Iannuzzelli
- Cardinal Ferrari Center, S. Stefano Riabilitazione, Fontanellato, Parma, Italy
| | | | - Fabrizio Togni
- Quarenghi Clinical Institute, San Pellegrino Terme, Bergamo, Italy
| | | | - Carolina Malchiodi
- Cardinal Ferrari Center, S. Stefano Riabilitazione, Fontanellato, Parma, Italy
| | - Debora Bertoni
- Cardinal Ferrari Center, S. Stefano Riabilitazione, Fontanellato, Parma, Italy
| | | | - Francesca Bozzetti
- Diagnostic Department, Neuroradiology Unit, University Hospital of Parma, Via Volturno 39, 43125, Parma, Italy
| | - Roberto Menozzi
- Diagnostic Department, Neuroradiology Unit, University Hospital of Parma, Via Volturno 39, 43125, Parma, Italy
| | | | - Paola Quarenghi
- Quarenghi Clinical Institute, San Pellegrino Terme, Bergamo, Italy
| | - Daniele Bosone
- Quarenghi Clinical Institute, San Pellegrino Terme, Bergamo, Italy
| | - Leonardo Fogassi
- Diagnostic Department, Neuroradiology Unit, University Hospital of Parma, Via Volturno 39, 43125, Parma, Italy
| | - Gian Piero Salvi
- Quarenghi Clinical Institute, San Pellegrino Terme, Bergamo, Italy
| | - Antonio De Tanti
- Cardinal Ferrari Center, S. Stefano Riabilitazione, Fontanellato, Parma, Italy
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Gvion A, Shahaf G. Real-time monitoring of barriers to patient engagement for improved rehabilitation: a protocol and representative case reports. Disabil Rehabil Assist Technol 2021; 18:1-13. [PMID: 34033726 DOI: 10.1080/17483107.2021.1929513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE There is ample evidence that patient engagement is of major clinical importance in rehabilitation, and it seems this engagement is based upon effective allocation of attention to the tasks during the rehabilitation session. It is possible to discern two types of barriers which hinder attentive engagement: (1) dysfunctional affective coping and (2) limited cognitive recruitment and specifically attention deficit. These barriers might be general for a given patient, due to pre-morbid or co-morbid dysfunctions. But more often they are evoked by tasks or challenges during the rehabilitation session which might be too complicated or stressing for the specific patient who copes with potentially grave impairments. These barriers hinder rehabilitation progress and should be monitored and overcome, by the therapist, throughout the session. METHODS We have developed an easy-to-use tool for monitoring a patient's attentive engagement in real-time throughout a rehabilitation session based on analysing the electrophysiological signal sampled from a simple headset. The tool then analyzes the dynamics of the marker over time to identify cognitive and affective barriers during the session. It enables the therapist to insert feedback regarding the patient's functional performance and to combine it with the analysed barriers, in order to derive automatic recommendations for overcoming the cognitive and affective barriers (if identified) for significant enhancement of the rehabilitation session. RESULTS AND CONCLUSIONS In this work we present the principles of the tool as well as three detailed case reports to demonstrate its potential usefulness.IMPLICATIONS FOR REHABILITATIONCognitive and affective barriers hinder patient engagment and rehabilitation success.In this work we present an easy to use electrophysiology-based tool which monitors these barriers.Based on the measured barriers and patient's performance, the tool derives treatment suggestions.
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Affiliation(s)
- Aviah Gvion
- Reuth Rehabilitation Center, Tel-Aviv, Israel
- Ono Academic College, Kiryat Ono, Israel
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Hayward KS, Churilov L, Dalton EJ, Brodtmann A, Campbell BCV, Copland D, Dancause N, Godecke E, Hoffmann TC, Lannin NA, McDonald MW, Corbett D, Bernhardt J. Advancing Stroke Recovery Through Improved Articulation of Nonpharmacological Intervention Dose. Stroke 2021; 52:761-769. [PMID: 33430635 DOI: 10.1161/strokeaha.120.032496] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Dose articulation is a universal issue of intervention development and testing. In stroke recovery, dose of a nonpharmaceutical intervention appears to influence outcome but is often poorly reported. The challenges of articulating dose in nonpharmacological stroke recovery research include: (1) the absence of specific internationally agreed dose reporting guidelines; (2) inadequate conceptualization of dose, which is multidimensional; and (3) unclear and inconsistent terminology that incorporates the multiple dose dimensions. To address these challenges, we need a well-conceptualized and consistent approach to dose articulation that can be applied across stroke recovery domains to stimulate critical thinking about dose during intervention development, as well as promote reporting of planned intervention dose versus actually delivered dose. We followed the Design Research Paradigm to develop a framework that guides how to articulate dose, conceptualizes the multidimensional nature and systemic linkages between dose dimensions, and provides reference terminology for the field. Our framework recognizes that dose is multidimensional and comprised of a duration of days that contain individual sessions and episodes that can be active (time on task) or inactive (time off task), and each individual episode can be made up of information about length, intensity, and difficulty. Clinical utility of this framework was demonstrated via hypothetical application to preclinical and clinical domains of stroke recovery. The suitability of the framework to address dose articulation challenges was confirmed with an international expert advisory group. This novel framework provides a pathway for better articulation of nonpharmacological dose that will enable transparent and accurate description, implementation, monitoring, and reporting, in stroke recovery research.
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Affiliation(s)
- Kathryn S Hayward
- Melbourne School of Health Sciences, Florey Institute of Neuroscience and Mental Health and NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery (K.S.H.), University of Melbourne, Heidelberg, Australia
| | - Leonid Churilov
- Melbourne Medical School (L.C.), University of Melbourne, Parkville, Australia
| | - Emily J Dalton
- Melbourne School of Health Sciences (E.J.D.), University of Melbourne, Heidelberg, Australia
| | - Amy Brodtmann
- Florey Institute of Neuroscience and Mental Health (A.B.), University of Melbourne, Heidelberg, Australia
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital (B.C.V.C.), University of Melbourne, Parkville, Australia
| | - David Copland
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research Centre and UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia (D. Copland).,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia (D. Copland, E.G.)
| | - Numa Dancause
- Département de Neurosciences, Université de Montréal, Canada (N.D.)
| | - Erin Godecke
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia (D. Copland, E.G.).,School of Medical and Health Sciences, Edith Cowan University, and Speech Pathology Department, Sir Charles Gairdner Hospital, Perth, Australia (E.G.)
| | - Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Bond University, Robina, Australia (T.C.H.)
| | - Natasha A Lannin
- Department of Neurosciences, Central Clinical School, Alfred Health, Monash University, Melbourne, Australia (N.A.L.)
| | - Matthew W McDonald
- Cellular and Molecular Medicine and Canadian Partnership for Stroke Recovery, University of Ottawa, Canada (M.W.M., D. Corbett)
| | - Dale Corbett
- Cellular and Molecular Medicine and Canadian Partnership for Stroke Recovery, University of Ottawa, Canada (M.W.M., D. Corbett)
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health and NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery (J.B.), University of Melbourne, Heidelberg, Australia
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Martins JC, Nadeau S, Aguiar LT, Scianni AA, Teixeira-Salmela LF, De Morais Faria CDC. Efficacy of task-specific circuit training on physical activity levels and mobility of stroke patients: A randomized controlled trial. NeuroRehabilitation 2020; 47:451-462. [PMID: 33136078 DOI: 10.3233/nre-203207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Impaired mobility is related to low physical activity (PA) levels observed after stroke. Therapeutic approaches, such as task-specific circuit training (TSCT), used to improve mobility in individuals with stroke, could also improve PA levels. OBJECTIVE To investigate the efficacy of TSCT, focused on both upper (UL) and lower (LL) limbs, in improving PA levels and mobility (primary outcomes), as well as muscle strength, exercise capacity, and quality of life (secondary outcomes) in subjects with stroke. METHODS A randomized controlled trial with 36 subjects with chronic stroke was conducted. Experimental group: TSCT, involving both UL and LL. CONTROL GROUP global stretching, memory exercises, and education sessions. Both groups received 60 minute sessions/week over 12 weeks. Outcomes were measured at baseline, post-intervention and 16 week follow-up. RESULTS No changes were found for primary and secondary outcomes (0.11≤p≤0.99), except for quality of life, which improved in the experimental group post-intervention and 16 week follow-up (p = 0.02). CONCLUSION TSCT focused on both UL and LL was not effective on PA levels and mobility of individuals with chronic stroke, however, improvements in quality of life were observed. Since this is the first study to investigate this combined training aimed at improving PA levels, future studies are necessary to better understand the impact of this type of intervention.
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Affiliation(s)
- Júlia Caetano Martins
- Universidade Federal de Minas Gerais (UFMG), Department of Physical Therapy, Belo Horizonte, Brazil
| | - Sylvie Nadeau
- Université de Montreal (UdeM), Centre de recherche interdisciplinaire en réadaptation (CRIR), Institut de réadaptation Gingras-Lindsay de Montréal (IRGLM), CIUSSS Centre-Sud-de-l'île-de-Montréal, Montréal, Canada
| | - Larissa Tavares Aguiar
- Universidade Federal de Minas Gerais (UFMG), Department of Physical Therapy, Belo Horizonte, Brazil
| | - Aline Alvim Scianni
- Universidade Federal de Minas Gerais (UFMG), Department of Physical Therapy, Belo Horizonte, Brazil
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Wallace AC, Talelli P, Crook L, Austin D, Farrell R, Hoad D, O'Keeffe AG, Marsden JF, Fitzpatrick R, Greenwood R, Rothwell JC, Werring DJ. Exploratory Randomized Double-Blind Placebo-Controlled Trial of Botulinum Therapy on Grasp Release After Stroke (PrOMBiS). Neurorehabil Neural Repair 2019; 34:51-60. [PMID: 31747825 DOI: 10.1177/1545968319887682] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. OnabotulinumtoxinA injections improve upper-limb spasticity after stroke, but their effect on arm function remains uncertain. Objective. To determine whether a single treatment with onabotulinumtoxinA injections combined with upper-limb physiotherapy improves grasp release compared with physiotherapy alone after stroke. Methods. A total of 28 patients, at least 1 month poststroke, were randomized to receive either onabotulinumtoxinA or placebo injections to the affected upper limb followed by standardized upper-limb physiotherapy (10 sessions over 4 weeks). The primary outcome was time to release grasp during a functionally relevant standardized task. Secondary outcomes included measures of wrist and finger spasticity and strength using a customized servomotor, clinical assessments of stiffness (modified Ashworth Scale), arm function (Action Research Arm Test [ARAT], Nine Hole Peg Test), arm use (Arm Measure of Activity), Goal Attainment Scale, and quality of life (EQ5D). Results. There was no significant difference between treatment groups in grasp release time 5 weeks post injection (placebo median = 3.0 s, treatment median = 2.0 s; t(24) = 1.20; P = .24; treatment effect = -0.44, 95% CI = -1.19 to 0.31). None of the secondary measures passed significance after correcting for multiple comparisons. Both groups achieved their treatment goals (placebo = 65%; treatment = 71%), and made improvements on the ARAT (placebo +3, treatment +5) and in active wrist extension (placebo +9°, treatment +11°). Conclusions. In this group of stroke patients with mild to moderate spastic hemiparesis, a single treatment with onabotulinumtoxinA did not augment the improvements seen in grasp release time after a standardized upper-limb physiotherapy program.
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Affiliation(s)
| | | | - Lucinda Crook
- UCL Institute of Neurology, Queen Square, London, UK
| | - Duncan Austin
- UCL Institute of Neurology, Queen Square, London, UK
| | - Rachel Farrell
- UCL Institute of Neurology, Queen Square, London, UK.,National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Damon Hoad
- UCL Institute of Neurology, Queen Square, London, UK
| | | | | | | | - Richard Greenwood
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | | | - David J Werring
- UCL Institute of Neurology, Queen Square, London, UK.,National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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Effects of a tailored strength training program of the upper limb combined with transcranial direct current stimulation (tDCS) in chronic stroke patients: study protocol for a randomised, double-blind, controlled trial. BMC Sports Sci Med Rehabil 2019; 11:8. [PMID: 31139420 PMCID: PMC6534822 DOI: 10.1186/s13102-019-0120-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 05/17/2019] [Indexed: 11/17/2022]
Abstract
Background A significant proportion of individuals are left with poor residual functioning of the affected arm after a stroke. This has a great impact on the quality of life and the ability for stroke survivors to live independently. While strengthening exercises have been recommended to improve arm function, their benefits are generally far from optimal due to the lack of appropriate dosing in terms of intensity. One way to address this problem is to develop better tools that could predict an individual’s potential for recovery and then adjust the intensity of exercise accordingly. In this study, we aim at determining whether an individualized strengthening program based on the integrity of the corticospinal tract, as reflected in the amplitude of motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS), in conjunction with transcranial direct current stimulation (tDCS), could lead to more optimal outcomes in terms of arm function in chronic stroke patients. Methods This multicentre, double-blinded, randomised controlled trial will aim to recruit 84 chronic stroke patients. Before and after training, participants will undergo a clinical evaluation, assessing motor recovery of the affected arm (Fugl-Meyer Stroke Assessment-FMA) and a TMS evaluation to assess the integrity of the corticospinal tract, as reflected in MEP amplitude. Based on their baseline MEPs amplitude, participants will be stratified into three groups of training intensity levels determined by the one-repetition maximum (1RM); 1) low: 35–50% 1 RM (MEPs < 50 μV); 2) moderate: 50–65% 1RM (MEPs 50-120 μV); and 3) high: 70–80% 1RM (MEPs > 120 μV). Training will target the affected arm (3 times/week for 4 weeks). In addition, participants will be randomly allocated into two tDCS groups (real vs. sham) and tDCS will be applied in an anodal montage during the exercise. Discussion This study will determine whether an individualized strength training intervention in chronic stroke survivors can lead to improved arm function. In addition, we will also determine whether combining anodal tDCS over the lesioned hemisphere with strength training can lead to further improvement in arm function, when compared to sham tDCS. Trial registration ClinicalTrials.gov Identifier: NCT02915185. Registered September 21 2016.
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Milot MH, Léonard G, Corriveau H, Desrosiers J. Using the Borg rating of perceived exertion scale to grade the intensity of a functional training program of the affected upper limb after a stroke: a feasibility study. Clin Interv Aging 2018; 14:9-16. [PMID: 30587949 PMCID: PMC6304074 DOI: 10.2147/cia.s179691] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Purpose Intensity of a training program is a critical variable in treatment gains poststroke, but there are no guidelines to adequately dose the intensity of functional training (FT); the recommended type of training to promote poststroke recovery. Such guidelines are made available for strength training (ST) using the 1 repetition maximum (1RM), which has been linked to individuals’ self-rated level of exertion using the Borg rating of perceived exertion (BRPE) scale. The BRPE could be a valuable tool for clinicians to dose FT intensity after a stroke, but this remains to be tested. The main objective of the study was to evaluate the feasibility of the BRPE at grading FT intensity of the affected upper limb in older adults with a chronic stroke and secondarily to explore the clinical changes between FT and ST when the intensity is regulated with BRPE. Patients and methods Twelve participants were randomized into a FT or ST group and trained their affected upper limb (3 times/week for 4 weeks) with the intensity standardized with BRPE. Feasibility was assessed by adherence, occurrence of adverse events, and comparison of BRPE ratings between groups. Clinical changes were defined as improvements on the Fugl-Meyer motor assessment (FMA) and Wolf motor function test (WMFT). Results All participants adhered to FT/ST without adverse effects, and comparable BRPE ratings were noted between groups throughout the training (P≥0.42). Both groups showed significant gains at the FMA (ST: 5±4 points/FT: 6±4 points; P=0.04) and WMFT (ST: 0.4±0.3 points/FT: 0.6±0.4 points; P=0.05), which were comparable between groups (P≥0.47). Conclusion The results suggest that it is feasible to use the BRPE scale to adjust FT intensity. Gains in motor function in both groups suggest that undergoing therapy, regardless of its type, might be a sufficient stimulus to produce gains when intensity is adequately adjusted. Further studies are needed to validate the current observations.
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Affiliation(s)
- Marie-Hélène Milot
- University of Sherbrooke, School of Medicine and Health Sciences, School of Rehabilitation, Research Center on Aging, Sherbrooke, Québec, Canada,
| | - Guillaume Léonard
- University of Sherbrooke, School of Medicine and Health Sciences, School of Rehabilitation, Research Center on Aging, Sherbrooke, Québec, Canada,
| | - Hélène Corriveau
- University of Sherbrooke, School of Medicine and Health Sciences, School of Rehabilitation, Research Center on Aging, Sherbrooke, Québec, Canada,
| | - Johanne Desrosiers
- University of Sherbrooke, School of Medicine and Health Sciences, School of Rehabilitation, Research Center on Aging, Sherbrooke, Québec, Canada,
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Franck JA, Smeets RJEM, Seelen HAM. Changes in arm-hand function and arm-hand skill performance in patients after stroke during and after rehabilitation. PLoS One 2017; 12:e0179453. [PMID: 28614403 PMCID: PMC5470733 DOI: 10.1371/journal.pone.0179453] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 05/29/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Arm-hand rehabilitation programs applied in stroke rehabilitation frequently target specific populations and thus are less applicable in heterogeneous patient populations. Besides, changes in arm-hand function (AHF) and arm-hand skill performance (AHSP) during and after a specific and well-described rehabilitation treatment are often not well evaluated. METHOD This single-armed prospective cohort study featured three subgroups of stroke patients with either a severely, moderately or mildly impaired AHF. Rehabilitation treatment consisted of a Concise_Arm_and_hand_ Rehabilitation_Approach_in_Stroke (CARAS). Measurements at function and activity level were performed at admission, clinical discharge, 3, 6, 9 and 12 months after clinical discharge. RESULTS Eighty-nine stroke patients (M/F:63/23; mean age:57.6yr (+/-10.6); post-stroke time:29.8 days (+/-20.1)) participated. All patients improved on AHF and arm-hand capacity during and after rehabilitation, except on grip strength in the severely affected subgroup. Largest gains occurred in patients with a moderately affected AHF. As to self-perceived AHSP, on average, all subgroups improved over time. A small percentage of patients declined regarding self-perceived AHSP post-rehabilitation. CONCLUSIONS A majority of stroke patients across the whole arm-hand impairment severity spectrum significantly improved on AHF, arm-hand capacity and self-perceived AHSP. These were maintained up to one year post-rehabilitation. Results may serve as a control condition in future studies.
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Affiliation(s)
- Johan Anton Franck
- Adelante Rehabilitation Centre, dept. of brain Injury Rehabilitation, Hoensbroek, the Netherlands
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | | | - Henk Alexander Maria Seelen
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
- Maastricht University, Research School CAPHRI, dept. of Rehabilitation Medicine, Maastricht, the Netherlands
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Milot MH, Hamel M, Provost PO, Bernier-Ouellet J, Dupuis M, Letourneau D, Briere S, Michaud F. Exerciser for rehabilitation of the Arm (ERA): Development and unique features of a 3D end-effector robot. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:5833-5836. [PMID: 28269581 DOI: 10.1109/embc.2016.7592054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Stroke is one of the leading causes of disability worldwide. Consequently, many stroke survivors exhibit difficulties undergoing voluntary movement in their affected upper limb, compromising their functional performance and level of independence. To minimize the negative impact of stroke disabilities, exercises are recognized as a key element in post-stroke rehabilitation. In order to provide the practice of exercises in a uniform and controlled manner as well as increasing the efficiency of therapists' interventions, robotic training has been found, and continues to prove itself, as an innovative intervention for post-stroke rehabilitation. However, the complexity as well as the limited degrees of freedom and workspace of currently commercially available robots can limit their use in clinical settings. Up to now, user-friendly robots covering a sufficiently large workspace for training of the upper limb in its full range of motion are lacking. This paper presents the design and implementation of ERA, an upper-limb 3-DOF force-controlled exerciser robot, which presents a workspace covering the entire range of motion of the upper limb. The ERA robot provides 3D reaching movements in a haptic virtual environment. A description of the hardware and software components of the ERA robot is also presented along with a demonstration of its capabilities in one of the three operational modes that were developed.
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Moore SA, Da Silva R, Balaam M, Brkic L, Jackson D, Jamieson D, Ploetz T, Rodgers H, Shaw L, van Wijck F, Price C. Wristband Accelerometers to motiVate arm Exercise after Stroke (WAVES): study protocol for a pilot randomized controlled trial. Trials 2016; 17:508. [PMID: 27769310 PMCID: PMC5073848 DOI: 10.1186/s13063-016-1628-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/23/2016] [Indexed: 11/23/2022] Open
Abstract
Background Loss of upper limb function affects up to 85 % of acute stroke patients. Recovery of upper limb function requires regular intensive practise of specific upper limb tasks. To enhance intensity of practice interventions are being developed to encourage patients to undertake self-directed exercise practice. Most interventions do not translate well into everyday activities and stroke patients continue to find it difficult remembering integration of upper limb movements into daily activities. A wrist-worn device has been developed that monitors and provides ‘live’ upper limb activity feedback to remind patients to use their stroke arm in daily activities (The CueS wristband). The aim of this trial is to assess the feasibility of a multi-centre, observer blind, pilot randomised controlled trial of the CueS wristband in clinical stroke services. Methods/design This pilot randomised controlled feasibility trial aims to recruit 60 participants over 15 months from North East England. Participants will be within 3 months of stroke which has caused new reduced upper limb function and will still be receiving therapy. Each participant will be randomised to an intervention or control group. Intervention participants will wear a CueS wristband (between 8 am and 8 pm) providing “live” feedback towards pre-set movement goals through a simple visual display and vibration prompts whilst undertaking a 4-week upper limb therapy programme (reviewed twice weekly by an occupational/physiotherapist). Control participants will also complete the 4-week upper limb therapy programme but will wear a ‘sham’ CueS wristband that monitors upper limb activity but provides no feedback. Outcomes will determine study feasibility in terms of recruitment, retention, adverse events, adherence and collection of descriptive clinical and accelerometer motor performance data at baseline, 4 weeks and 8 weeks. Discussion The WAVES study will address an important gap in the evidence base by reporting the feasibility of undertaking an evaluation of emerging and affordable technology to encourage impaired upper limb activity after stroke. The study will establish whether the study protocol can be supported by clinical stroke services, thereby informing the design of a future multi-centre randomised controlled trial of clinical and cost-effectiveness. Trial registration ISRCTN:82306027. Registered 12 July 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1628-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah A Moore
- Institute of Neuroscience (Stroke Research Group), Newcastle University, 3-4 Claremont Terrace, Newcastle upon Tyne, NE2 4AE, England, UK
| | - Ruth Da Silva
- Institute of Neuroscience (Stroke Research Group), Newcastle University, 3-4 Claremont Terrace, Newcastle upon Tyne, NE2 4AE, England, UK
| | - Madelaine Balaam
- School of Computing Science (Open Lab), Newcastle University, Newcastle upon Tyne, NE1 7RU, England, UK
| | - Lianne Brkic
- Institute of Neuroscience (Stroke Research Group), Newcastle University, 3-4 Claremont Terrace, Newcastle upon Tyne, NE2 4AE, England, UK
| | - Dan Jackson
- School of Computing Science (Open Lab), Newcastle University, Newcastle upon Tyne, NE1 7RU, England, UK
| | - Dan Jamieson
- School of Computing Science (Open Lab), Newcastle University, Newcastle upon Tyne, NE1 7RU, England, UK
| | - Thomas Ploetz
- School of Computing Science (Open Lab), Newcastle University, Newcastle upon Tyne, NE1 7RU, England, UK
| | - Helen Rodgers
- Institute of Neuroscience (Stroke Research Group), Newcastle University, 3-4 Claremont Terrace, Newcastle upon Tyne, NE2 4AE, England, UK
| | - Lisa Shaw
- Institute of Neuroscience (Stroke Research Group), Newcastle University, 3-4 Claremont Terrace, Newcastle upon Tyne, NE2 4AE, England, UK
| | - Frederike van Wijck
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Christopher Price
- Institute of Neuroscience (Stroke Research Group), Newcastle University, 3-4 Claremont Terrace, Newcastle upon Tyne, NE2 4AE, England, UK.
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Sánchez-Sánchez ML, Ruescas-Nicolau MA, Pérez-Miralles JA, Marqués-Sulé E, Espí-López GV. Pilot randomized controlled trial to assess a physical therapy program on upper extremity function to counteract inactivity in chronic stroke. Top Stroke Rehabil 2016; 24:183-193. [DOI: 10.1080/10749357.2016.1245395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M. Luz Sánchez-Sánchez
- Faculty of Physical Therapy, Department of Physical Therapy, University of Valencia, Valencia, Spain
| | | | - José-Antonio Pérez-Miralles
- Faculty of Physical Therapy, Department of Physical Therapy, University of Valencia, Valencia, Spain
- Nueva Opción – Brain Damage Association, Valencia, Spain
| | - Elena Marqués-Sulé
- Faculty of Physical Therapy, Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Gemma-Victoria Espí-López
- Faculty of Physical Therapy, Department of Physical Therapy, University of Valencia, Valencia, Spain
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Graef P, Michaelsen SM, Dadalt MLR, Rodrigues DAMS, Pereira F, Pagnussat AS. Effects of functional and analytical strength training on upper-extremity activity after stroke: a randomized controlled trial. Braz J Phys Ther 2016; 20:543-552. [PMID: 27683837 PMCID: PMC5176200 DOI: 10.1590/bjpt-rbf.2014.0187] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 03/14/2016] [Indexed: 11/25/2022] Open
Abstract
Objective To investigate the effects of functional strengthening (using functional movements) and analytical strengthening (using repetitive movements) on level of activity and muscular strength gain in patients with chronic hemiparesis after stroke. Method A randomized, assessor-blinded trial was conducted in a therapist-supervised home rehabilitation program. Twenty-seven patients with chronic stroke were randomly allocated one of two groups: functional strengthening (FS) (n=13) and analytical strengthening (AS) (n=14). Each group received a five-week muscle strengthening protocol (30 minutes per day, three times per week) including functional movements or analytical movements, respectively. Pre-, post-, and ten-month follow-up outcomes included the Upper-Extremity Performance Test (primary outcome), Shoulder and Grip Strength, Active Shoulder Range of Motion (ROM), the Fugl-Meyer Assessment, and the Modified Ashworth Scale (MAS) (secondary outcomes). Results There was significant improvement in the Upper-Extremity Performance Test for the combined unilateral and bilateral task scores in the FS Group (mean difference 2.4; 95% CI=0.14 to 4.6) in the 10-month follow-up. No significant difference was observed between groups in the other outcomes (p>0.05). Conclusion A five-week home-based functional muscle strengthening induced positive results for the upper-extremity level of activity of patients with moderate impairment after chronic stroke.
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Affiliation(s)
- Patrícia Graef
- Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.,Escola da Saúde, Centro Universitário Ritter dos Reis (UNIRITTER), Porto Alegre, RS, Brazil.,Programa de Pós-graduação em Ciências da Saúde, UFCSPA, Porto Alegre, RS, Brazil
| | - Stella M Michaelsen
- Programa de Pós-graduação em Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil
| | | | | | - Franciele Pereira
- Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Aline S Pagnussat
- Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.,Programa de Pós-graduação em Ciências da Saúde, UFCSPA, Porto Alegre, RS, Brazil.,Departamento de Fisioterapia, UFCSPA, Porto Alegre, RS, Brazil
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15
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White CM, Hadden RD, Robert-Lewis SF, McCrone PR, Petty JL. Observer blind randomised controlled trial of a tailored home exercise programme versus usual care in people with stable inflammatory immune mediated neuropathy. BMC Neurol 2015; 15:147. [PMID: 26293925 PMCID: PMC4546217 DOI: 10.1186/s12883-015-0398-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 08/04/2015] [Indexed: 11/10/2022] Open
Abstract
Background Inflammatory neuropathies such as Guillain-Barré syndrome, chronic inflammatory demyelinating polyradiculoneuropathy and paraproteinaemic demyelinating neuropathy are a heterogenous group of peripheral nerve disorders that affect around one to two people per 100,000. Whilst treatments such as intravenous immunoglobulin, plasma exchange and corticosteroids have generally positive results, long-term residual symptoms and associated activity limitations are common. There is currently no standardised care for patients with ongoing activity limitation and participation restriction as a result of inflammatory neuropathy IN but data from observational studies and a randomised controlled trial suggest that exercise either alone or as part of a multidisciplinary rehabilitation programme may be beneficial in improving activity limitation. Tailoring the intervention for participants following physiotherapy assessment and incorporating patient preference for type and location of exercise may be important. Methods/Design The current study is a pragmatic, prospective, parallel observer-blind, randomised controlled trial to evaluate the efficacy and cost-effectiveness of a twelve week tailored home exercise programme versus advice and usual care. Seventy adults with stable immune mediated inflammatory neuropathy IN will be recruited to the study from two main sources: patients attending selected specialist peripheral nerve clinics in the South East and West Midlands of England and people with who access the GAIN charity website or newsletter. Participants will be randomised to receive either advice about exercise and usual care or a 12 week tailored home exercise programme. The primary outcome of activity limitation and secondary outcomes of fatigue, quality of life, self-efficacy, illness beliefs, mood and physical activity will be assessed via self-report questionnaire at baseline, 12 weeks and 12 months post intervention. Cost effectiveness and cost utility will be assessed via interview at baseline and 12 months post intervention. Intention to treat analysis will be our primary model for efficacy analysis. Semi-structured interviews will be conducted with a selected sample of participants in order to explore the acceptability of the intervention and factors affecting adherence to the exercise programme. Discussion This is the first randomised controlled trial to compare the efficacy and cost-effectiveness of tailored home exercise with advice about exercise and usual care for adults with inflammatory neuropathy. Trial registration Current Controlled Trials ISRCTN13311697
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Affiliation(s)
- Claire M White
- Division of Health and Social Care, King's College London, London, SE1 1UL, UK.
| | - Robert D Hadden
- Department of Neurology, King's College Hospital, London, UK.
| | | | - Paul R McCrone
- Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, King's College London, London, UK.
| | - Jane L Petty
- Division of Health and Social Care, King's College London, London, SE1 1UL, UK.
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16
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Recovery of hand function with robot-assisted therapy in acute stroke patients: a randomized-controlled trial. Int J Rehabil Res 2015; 37:236-42. [PMID: 24769557 DOI: 10.1097/mrr.0000000000000059] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In the last few years, not many studies on the use of robot-assisted therapy to recover hand function in acute stroke patients have been carried out. This randomized-controlled observer trial is aimed at evaluating the effects of intensive robot-assisted hand therapy compared with intensive occupational therapy in the early recovery phases after stroke with a 3-month follow-up. Twenty acute stroke patients at their first-ever stroke were enrolled and randomized into two groups. The experimental treatment was performed using the Amadeo Robotic System. Control treatment, instead, was carried out using occupational therapy executed by a trained physiotherapist. All participants received 20 sessions of treatment for 4 consecutive weeks (5 days/week). The following clinical scales, Fugl-Meyer Scale (FM), Medical Research Council Scale for Muscle Strength (hand flexor and extensor muscles) (MRC), Motricity Index (MI) and modified Ashworth Scale for wrist and hand muscles (MAS), were performed at baseline (T0), after 20 sessions (end of treatment) (T1) and at the 3-month follow-up (T2). The Barthel Index was assessed only at T0 and T1. Evidence of a significant improvement was shown by the Friedman test for the FM [experimental group (EG): P=0.0039, control group (CG): P<0.0001], Box and Block Test (EG: P=0.0185, CG: P=0.0086), MI (EG: P<0.0001, CG: P=0.0303) and MRC (EG: P<0.0001, CG: P=0.001) scales. These results provide further support to the generalized therapeutic impact of intensive robot-assisted treatment on hand recovery functions in individuals with acute stroke. The robotic rehabilitation treatment may contribute toward the recovery of hand motor function in acute stroke patients. The positive results obtained through the safe and reliable robotic rehabilitation treatment reinforce the recommendation to extend it to a larger clinical practice.
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Pichiorri F, Morone G, Petti M, Toppi J, Pisotta I, Molinari M, Paolucci S, Inghilleri M, Astolfi L, Cincotti F, Mattia D. Brain-computer interface boosts motor imagery practice during stroke recovery. Ann Neurol 2015; 77:851-65. [PMID: 25712802 DOI: 10.1002/ana.24390] [Citation(s) in RCA: 295] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 02/13/2015] [Accepted: 02/13/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Motor imagery (MI) is assumed to enhance poststroke motor recovery, yet its benefits are debatable. Brain-computer interfaces (BCIs) can provide instantaneous and quantitative measure of cerebral functions modulated by MI. The efficacy of BCI-monitored MI practice as add-on intervention to usual rehabilitation care was evaluated in a randomized controlled pilot study in subacute stroke patients. METHODS Twenty-eight hospitalized subacute stroke patients with severe motor deficits were randomized into 2 intervention groups: 1-month BCI-supported MI training (BCI group, n = 14) and 1-month MI training without BCI support (control group; n = 14). Functional and neurophysiological assessments were performed before and after the interventions, including evaluation of the upper limbs by Fugl-Meyer Assessment (FMA; primary outcome measure) and analysis of oscillatory activity and connectivity at rest, based on high-density electroencephalographic (EEG) recordings. RESULTS Better functional outcome was observed in the BCI group, including a significantly higher probability of achieving a clinically relevant increase in the FMA score (p < 0.03). Post-BCI training changes in EEG sensorimotor power spectra (ie, stronger desynchronization in the alpha and beta bands) occurred with greater involvement of the ipsilesional hemisphere in response to MI of the paralyzed trained hand. Also, FMA improvements (effectiveness of FMA) correlated with the changes (ie, post-training increase) at rest in ipsilesional intrahemispheric connectivity in the same bands (p < 0.05). INTERPRETATION The introduction of BCI technology in assisting MI practice demonstrates the rehabilitative potential of MI, contributing to significantly better motor functional outcomes in subacute stroke patients with severe motor impairments.
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Affiliation(s)
- Floriana Pichiorri
- Santa Lucia Foundation Institute of Hospitalization and Scientific Care; Department of Neurology and Psychiatry, Sapienza University of Rome
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18
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Liew SL, Santarnecchi E, Buch ER, Cohen LG. Non-invasive brain stimulation in neurorehabilitation: local and distant effects for motor recovery. Front Hum Neurosci 2014; 8:378. [PMID: 25018714 PMCID: PMC4072967 DOI: 10.3389/fnhum.2014.00378] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 05/14/2014] [Indexed: 01/01/2023] Open
Abstract
Non-invasive brain stimulation (NIBS) may enhance motor recovery after neurological injury through the causal induction of plasticity processes. Neurological injury, such as stroke, often results in serious long-term physical disabilities, and despite intensive therapy, a large majority of brain injury survivors fail to regain full motor function. Emerging research suggests that NIBS techniques, such as transcranial magnetic (TMS) and direct current (tDCS) stimulation, in association with customarily used neurorehabilitative treatments, may enhance motor recovery. This paper provides a general review on TMS and tDCS paradigms, the mechanisms by which they operate and the stimulation techniques used in neurorehabilitation, specifically stroke. TMS and tDCS influence regional neural activity underlying the stimulation location and also distant interconnected network activity throughout the brain. We discuss recent studies that document NIBS effects on global brain activity measured with various neuroimaging techniques, which help to characterize better strategies for more accurate NIBS stimulation. These rapidly growing areas of inquiry may hold potential for improving the effectiveness of NIBS-based interventions for clinical rehabilitation.
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Affiliation(s)
- Sook-Lei Liew
- Human Cortical Physiology and Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, NIH Bethesda, MD, USA
| | | | - Ethan R Buch
- Human Cortical Physiology and Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, NIH Bethesda, MD, USA ; Center for Neuroscience and Regenerative Medicine, Uniformed Services University of Health Sciences Bethesda, MD, USA
| | - Leonardo G Cohen
- Human Cortical Physiology and Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, NIH Bethesda, MD, USA ; Center for Neuroscience and Regenerative Medicine, Uniformed Services University of Health Sciences Bethesda, MD, USA
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19
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Action observation therapy in the subacute phase promotes dexterity recovery in right-hemisphere stroke patients. BIOMED RESEARCH INTERNATIONAL 2014; 2014:457538. [PMID: 24967372 PMCID: PMC4054881 DOI: 10.1155/2014/457538] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 04/28/2014] [Accepted: 04/28/2014] [Indexed: 11/17/2022]
Abstract
The clinical impact of action observation (AO) on upper limb functional recovery in subacute stroke patients is recent evidence. We sought to test the hypothesis that training everyday life activities through AO coupled with task execution might activate the left hemisphere different from the right one. Sixty-seven first-ever ischemic stroke subjects were randomly assigned to receive upper limb training coupled with AO tasks or standard rehabilitation. The groups were matched by age and gender, Bamford category, and interval from stroke and lesion side. Fugl-Meyer (FM) and Box and Block Test (BBT) were used to measure hand function recovery at the end (T1) and 4-5 months after the treatment (T2). At T1, FM was increased by 31% (±26%), of maximum achievable recovery, whereas BBT was increased by 17% (±18%); at T2, FM had reached 43% (±45%) of maximum recovery, while BBT had reached 25% (±22%). Combining the effects of treatment to those of lesion side revealed significantly higher gains, in both FM and BBT scores, in left hemiparetic subjects when exposed to AO as compared to standard rehabilitation alone (P < .01). The findings lead to recommend the use of AO in addition to motor training in left hemiparetic patients.
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20
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Does Task-Oriented Practice Improve Upper Extremity Motor Recovery after Stroke? A Systematic Review. ACTA ACUST UNITED AC 2014. [DOI: 10.1155/2014/504910] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Stroke commonly affects upper extremity motor abilities, yet there has been very limited success in developing effective rehabilitation interventions to remediate motor impairments, particularly for the upper extremity. Objective. To determine if task-oriented practice administered soon after stroke is more effective than usual care in improving poststroke upper extremity motor recovery and to explore the optimal amount of practice. Methods. A systematic review of the literature was performed from 1950 to November 2012, to identify randomized controlled trials of task-oriented practice compared to usual care, or to different amounts of task-oriented practice to improve motor impairment and activity. Studies were excluded if specific types of interventions were used as comparators or if they were of poor methodological quality. Results. Six studies met the review criteria. Three of the six studies demonstrated a statistically significant effect of task-oriented practice. Study results could not be pooled because of a lack of homogeneity in populations and intervention. Conclusions. The results demonstrate that an increase in the amount of task-oriented practice after stroke may result in less upper extremity impairment; further research on both effect and required dosage is needed as results are inconsistent.
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Starkey ML, Bleul C, Kasper H, Mosberger AC, Zörner B, Giger S, Gullo M, Buschmann F, Schwab ME. High-Impact, Self-Motivated Training Within an Enriched Environment With Single Animal Tracking Dose-Dependently Promotes Motor Skill Acquisition and Functional Recovery. Neurorehabil Neural Repair 2014; 28:594-605. [PMID: 24519022 DOI: 10.1177/1545968314520721] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Functional recovery following central nervous system injuries is strongly influenced by rehabilitative training. In the clinical setting, the intensity of training and the level of motivation for a particular task are known to play important roles. With increasing neuroscience studies investigating the effects of training and rehabilitation, it is important to understand how the amount and type of training of individuals influences outcome. However, little is known about the influence of spontaneous "self-training" during daily life as it is often uncontrolled, not recorded, and mostly disregarded. Here, we investigated the effects of the intensity of self-training on motor skill acquisition in normal, intact rats and on the recovery of functional motor behavior following spinal cord injury in adult rats. We used a custom-designed small animal tracking system, "RatTrack," to continuously record the activity of multiple rats, simultaneously in a complex Natural Habitat-enriched environment. Naïve, adult rats performed high-intensity, self-motivated motor training, which resulted in them out-performing rats that were conventionally housed and trained on skilled movement tasks, for example, skilled prehension (grasping) and ladder walking. Following spinal cord injury the amount of self-training was correlated with improved functional recovery. These data suggest that high-impact, self-motivated training leads to superior skill acquisition and functional recovery than conventional training paradigms. These findings have important implications for the design of animal studies investigating rehabilitation and for the planning of human rehabilitation programs.
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Affiliation(s)
- Michelle L Starkey
- Brain Research Institute, University of Zurich, Zurich, Switzerland ETH Zurich, Zurich, Switzerland
| | - Christiane Bleul
- Brain Research Institute, University of Zurich, Zurich, Switzerland ETH Zurich, Zurich, Switzerland
| | - Hansjörg Kasper
- Brain Research Institute, University of Zurich, Zurich, Switzerland ETH Zurich, Zurich, Switzerland
| | - Alice C Mosberger
- Brain Research Institute, University of Zurich, Zurich, Switzerland ETH Zurich, Zurich, Switzerland
| | - Björn Zörner
- Brain Research Institute, University of Zurich, Zurich, Switzerland ETH Zurich, Zurich, Switzerland
| | - Stefan Giger
- Brain Research Institute, University of Zurich, Zurich, Switzerland ETH Zurich, Zurich, Switzerland
| | - Miriam Gullo
- Brain Research Institute, University of Zurich, Zurich, Switzerland ETH Zurich, Zurich, Switzerland
| | | | - Martin E Schwab
- Brain Research Institute, University of Zurich, Zurich, Switzerland ETH Zurich, Zurich, Switzerland
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Santos-Couto-Paz CC, Teixeira-Salmela LF, Tierra-Criollo CJ. The addition of functional task-oriented mental practice to conventional physical therapy improves motor skills in daily functions after stroke. Braz J Phys Ther 2013; 17:564-71. [PMID: 24271094 PMCID: PMC4207145 DOI: 10.1590/s1413-35552012005000123] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 06/18/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Mental practice (MP) is a cognitive strategy which may improve the acquisition of motor skills and functional performance of athletes and individuals with neurological injuries. OBJECTIVE To determine whether an individualized, specific functional task-oriented MP, when added to conventional physical therapy (PT), promoted better learning of motor skills in daily functions in individuals with chronic stroke (13 ± 6.5 months post-stroke). METHOD Nine individuals with stable mild and moderate upper limb impairments participated, by employing an A1-B-A2 single-case design. Phases A1 and A2 included one month of conventional PT, and phase B the addition of MP training to PT. The motor activity log (MAL-Brazil) was used to assess the amount of use (AOU) and quality of movement (QOM) of the paretic upper limb; the revised motor imagery questionnaire (MIQ-RS) to assess the abilities in kinesthetic and visual motor imagery; the Minnesota manual dexterity test to assess manual dexterity; and gait speed to assess mobility. RESULTS After phase A1, no significant changes were observed for any of the outcome measures. However, after phase B, significant improvements were observed for the MAL, AOU and QOM scores (p<0.0001), and MIQ-RS kinesthetic and visual scores (p=0.003; p=0.007, respectively). The significant gains in manual dexterity (p=0.002) and gait speed (p=0.019) were maintained after phase A2. CONCLUSIONS Specific functional task-oriented MP, when added to conventional PT, led to improvements in motor imagery abilities combined with increases in the AOU and QOM in daily functions, manual dexterity, and gait speed.
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Affiliation(s)
| | | | - Carlos J Tierra-Criollo
- Universidade Federal de Minas Gerais, Institute of Biological Sciences, Belo HorizonteMG, Brazil
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23
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Di Lazzaro V, Rothwell JC, Talelli P, Capone F, Ranieri F, Wallace AC, Musumeci G, Dileone M. Inhibitory theta burst stimulation of affected hemisphere in chronic stroke: A proof of principle, sham-controlled study. Neurosci Lett 2013; 553:148-52. [DOI: 10.1016/j.neulet.2013.08.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 06/22/2013] [Accepted: 08/08/2013] [Indexed: 10/26/2022]
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Hsieh YW, Wu CY, Lin KC, Yao G, Wu KY, Chang YJ. Dose-response relationship of robot-assisted stroke motor rehabilitation: the impact of initial motor status. Stroke 2012; 43:2729-34. [PMID: 22895994 DOI: 10.1161/strokeaha.112.658807] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE The increasing availability of robot-assisted therapy (RT), which provides quantifiable, reproducible, interactive, and intensive practice, holds promise for stroke rehabilitation, but data on its dose-response relation are scanty. This study used 2 different intensities of RT to examine the treatment effects of RT and the effect on outcomes of the severity of initial motor deficits. METHODS Fifty-four patients with stroke were randomized to a 4-week intervention of higher-intensity RT, lower-intensity RT, or control treatment. The primary outcome, the Fugl-Meyer Assessment, was administered at baseline, midterm, and posttreatment. Secondary outcomes included the Medical Research Council scale, the Motor Activity Log, and the physical domains of the Stroke Impact Scale. RESULTS The higher-intensity RT group showed significantly greater improvements on the Fugl-Meyer Assessment than the lower-intensity RT and control treatment groups at midterm (P=0.003 and P=0.02) and at posttreatment (P=0.04 and P=0.02). Within-group gains on the secondary outcomes were significant, but the differences among the 3 groups did not reach significance. Recovery rates of the higher-intensity RT group were higher than those of the lower-intensity RT group, particularly on the Fugl-Meyer Assessment. Scatterplots with curve fitting showed that patients with moderate motor deficits gained more improvements than those with severe or mild deficits after the higher-intensity RT. CONCLUSIONS This study demonstrated the higher treatment intensity provided by RT was associated with better motor outcome for patients with stroke, which may shape further stroke rehabilitation. Clinical Trial Registration- URL: http://clinicaltrials.gov. Unique identifier: NCT00917605.
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Affiliation(s)
- Yu-wei Hsieh
- School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xu Zhou Road, Taipei, Taiwan
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25
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Han C, Wang Q, Meng PP, Qi MZ. Effects of intensity of arm training on hemiplegic upper extremity motor recovery in stroke patients: a randomized controlled trial. Clin Rehabil 2012; 27:75-81. [PMID: 22801472 DOI: 10.1177/0269215512447223] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the effects of different intensities of arm rehabilitation training on the functional recovery of hemiplegic upper extremity. DESIGN A randomized controlled trial. INTERVENTIONS Thirty-two stroke patients meeting the enrolment criteria were randomly divided into three groups: group A (n = 11), group B (n = 10) and group C (n = 11). Each group received arm training for 1 hour, 2 hours and 3 hours a day respectively, 5 days per week, for a period of six weeks. MAIN MEASURES Motor function was assessed by Fugl-Meyer Assessment, Action Research Arm Test and Barthel Index, carried out before treatment, two weeks, four weeks and six weeks after treatment. RESULTS When comparing the three groups, the Fugl-Meyer Assessment improvement was more significant in group C (20.50 ± 7.84) than that in group A (11.90 ± 6.52 ) and group B (13.80 ± 6.41) after four weeks of treatment (P < 0.05). The Action Research Arm Test score improvement was more significant in group C (7.30 ± 2.95) than in group A (3.30 ± 2.91 ) (P < 0.05). After six weeks of treatment, the Fugl-Meyer Assessment and Action Research Arm Test score improvements were more significant in group C (24.50 ± 7.96, 10.90 ± 3.60) and group B (19.70 ± 7.09, 8.70 ± 4.62) than in group A (13.00 ± 6.38, 5.30 ± 3.40) (P < 0.05). There were no significant differences of Barthel Index among the three groups (P > 0.05). In each group, Fugl-Meyer Assessment, Action Research Arm Test and Barthel Index scores increased significantly after six weeks of treatment (P < 0.05). CONCLUSIONS An increase in the intensity of arm training might improve the motor function of the arm after stroke.
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Affiliation(s)
- Chao Han
- Affiliated Hospital of Qingdao University Medical College, Shandong, China
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Talelli P, Wallace A, Dileone M, Hoad D, Cheeran B, Oliver R, VandenBos M, Hammerbeck U, Barratt K, Gillini C, Musumeci G, Boudrias MH, Cloud GC, Ball J, Marsden JF, Ward NS, Di Lazzaro V, Greenwood RG, Rothwell JC. Theta burst stimulation in the rehabilitation of the upper limb: a semirandomized, placebo-controlled trial in chronic stroke patients. Neurorehabil Neural Repair 2012; 26:976-87. [PMID: 22412171 DOI: 10.1177/1545968312437940] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Noninvasive cortical stimulation could represent an add-on treatment to enhance motor recovery after stroke. However, its clinical value, including anticipated size and duration of the treatment effects, remains largely unknown. OBJECTIVE The authors designed a small semi-randomized clinical trial to explore whether long-lasting clinically important gains can be achieved by adding theta burst stimulation (TBS), a form of repetitive transcranial magnetic stimulation (TMS), to a rehabilitation program for the hand. METHODS A total of 41 chronic stroke patients received excitatory TBS to the ipsilesional hemisphere or inhibitory TBS to the contralesional hemisphere in 2 centers; each active group was compared with a group receiving sham TBS. TBS was followed by physical therapy for 10 working days. Patients and therapists were blinded to the type of TBS. Primary outcome measures (9-hole Peg Test [9HPT], Jebsen Taylor Test [JTT], and grip and pinch-grip dynamometry) were assessed 4, 30, and 90 days post treatment. The clinically important difference was defined as 10% of the maximum score. RESULTS There were no differences between the active treatment and sham groups in any of the outcome measures. All patients achieved small sustainable improvements--9HPT, 5% of maximum (confidence interval [CI] = 3%-7%); JTT, 5.7% (CI = 3%-8%); and grip strength, 6% (CI = 2%-10%)--all below the defined clinically important level. CONCLUSIONS Cortical stimulation did not augment the gains from a late rehabilitation program. The effect size anticipated by the authors was overestimated. These results can improve the design of future work on therapeutic uses of TMS.
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Affiliation(s)
- Penelope Talelli
- Sobell Department, UCL Institute of Neurology, London WC1N 3BG, UK.
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27
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Franceschini M, Ceravolo MG, Agosti M, Cavallini P, Bonassi S, Dall’Armi V, Massucci M, Schifini F, Sale P. Clinical Relevance of Action Observation in Upper-Limb Stroke Rehabilitation. Neurorehabil Neural Repair 2012; 26:456-62. [PMID: 22235059 DOI: 10.1177/1545968311427406] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective. A randomized controlled observer-blind trial was designed to evaluate the effectiveness of action observation as an add-on treatment to the standard rehabilitation of upper-limb function, early after stroke. Methods. Stroke survivors (N = 102) were consecutively recruited from 13 centers 30 days (±7) after a first-ever stroke and randomly assigned to the experimental (EG) or control group (CG). EG participants watched video footage of daily routine tasks (actions) carried out with the upper limb in order to prepare to imitate the presented action. At the end of each sequence, a therapist prompted the patient to perform the same movement for 2 minutes, providing help when needed. Static images without animals or human beings were shown to the CG. At the end of each sequence, the CG executed movements that simulated the shoulder and elbow joint mobilization activities performed by the EG. Results for the Fugl-Meyer test, Frenchay Arm test, Box and Block test (BBT), Modified Ashworth Scale, and Functional Independence Measure Motor items were recorded before treatment (T0), after 4 weeks of treatment (T1), and at the follow-up visit 4 to 5 months after the conclusion of treatment (T2). Results. An improvement over time was appreciated on all measures of impairment and functional ability with both treatment programs. A Time × Treatment interaction emerged from the generalized estimating equations analysis of BBT, showing significant T0–T1 and T0–T2 differences in favor of EG. Conclusion. This multicenter trial endorses the use of action observation in upper-extremity rehabilitation, along with a role for the mirror neuron system in poststroke recovery.
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Affiliation(s)
- Marco Franceschini
- Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Rome, Italy
| | | | | | | | - Stefano Bonassi
- Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Rome, Italy
| | - Valentina Dall’Armi
- Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Rome, Italy
| | | | | | - Patrizio Sale
- Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Rome, Italy
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