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Rozevink SG, Hijmans JM, Horstink KA, van der Sluis CK. Effectiveness of task-specific training using assistive devices and task-specific usual care on upper limb performance after stroke: a systematic review and meta-analysis. Disabil Rehabil Assist Technol 2023; 18:1245-1258. [PMID: 34788166 DOI: 10.1080/17483107.2021.2001061] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Task-specific rehabilitation is a key indicator for successful rehabilitation to improve the upper limb performance after stroke. Assistive robotic and non-robotic devices are emerging to provide rehabilitation therapy; however, the effectiveness of task-specific training programs using assistive training devices compared with task-specific usual care training has not been summarized yet. Therefore, the effectiveness of task-specific training using assistive arm devices (TST-AAD) compared with task-specific usual care (TSUC) on the upper limb performance of patients with a stroke was investigated. To assess task specificity, a set of criteria was proposed: participation, program, relevant, repeated, randomized, reconstruction and reinforced. MATERIALS AND METHODS Out of 855 articles, 17 fulfilled the selection criteria. A meta-analysis was performed on the Fugl-Meyer Assessment scores in the subacute and chronic stages after stroke and during follow-up. RESULTS AND CONCLUSION Both TST-AAD and TSUC improved the upper limb performance after stroke. In the sub-acute phase after stroke, TST-AAD was more effective than TSUC in reducing the upper limb impairment, although findings were based on only three studies. In the chronic phase, TST-AAD and TSUC showed similar effectiveness. No differences between the two types of training were found at the follow-up measurements. Future studies should describe training, device usage and criteria of task specificity in a standardized way to ease comparison.Implications for rehabilitationArm or hand function is often undertreated in stroke patients, assistive training devices may be able to improve the upper limb performance.Task-specific training using assistive devices is effective in improving the upper limb performance after stroke.Task-specific training using assistive devices seems to be more effective in reducing impairment compared with task specific usual care in the subacute phase after stroke, but they are equally effective in the chronic phase of stroke.
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Affiliation(s)
- Samantha G Rozevink
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - Juha M Hijmans
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - Koen A Horstink
- University of Groningen, University Medical Center Groningen, Department of Human Movement Sciences, Groningen, The Netherlands
| | - Corry K van der Sluis
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
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Maura RM, Rueda Parra S, Stevens RE, Weeks DL, Wolbrecht ET, Perry JC. Literature review of stroke assessment for upper-extremity physical function via EEG, EMG, kinematic, and kinetic measurements and their reliability. J Neuroeng Rehabil 2023; 20:21. [PMID: 36793077 PMCID: PMC9930366 DOI: 10.1186/s12984-023-01142-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 01/19/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Significant clinician training is required to mitigate the subjective nature and achieve useful reliability between measurement occasions and therapists. Previous research supports that robotic instruments can improve quantitative biomechanical assessments of the upper limb, offering reliable and more sensitive measures. Furthermore, combining kinematic and kinetic measurements with electrophysiological measurements offers new insights to unlock targeted impairment-specific therapy. This review presents common methods for analyzing biomechanical and neuromuscular data by describing their validity and reporting their reliability measures. METHODS This paper reviews literature (2000-2021) on sensor-based measures and metrics for upper-limb biomechanical and electrophysiological (neurological) assessment, which have been shown to correlate with clinical test outcomes for motor assessment. The search terms targeted robotic and passive devices developed for movement therapy. Journal and conference papers on stroke assessment metrics were selected using PRISMA guidelines. Intra-class correlation values of some of the metrics are recorded, along with model, type of agreement, and confidence intervals, when reported. RESULTS A total of 60 articles are identified. The sensor-based metrics assess various aspects of movement performance, such as smoothness, spasticity, efficiency, planning, efficacy, accuracy, coordination, range of motion, and strength. Additional metrics assess abnormal activation patterns of cortical activity and interconnections between brain regions and muscle groups; aiming to characterize differences between the population who had a stroke and the healthy population. CONCLUSION Range of motion, mean speed, mean distance, normal path length, spectral arc length, number of peaks, and task time metrics have all demonstrated good to excellent reliability, as well as provide a finer resolution compared to discrete clinical assessment tests. EEG power features for multiple frequency bands of interest, specifically the bands relating to slow and fast frequencies comparing affected and non-affected hemispheres, demonstrate good to excellent reliability for populations at various stages of stroke recovery. Further investigation is needed to evaluate the metrics missing reliability information. In the few studies combining biomechanical measures with neuroelectric signals, the multi-domain approaches demonstrated agreement with clinical assessments and provide further information during the relearning phase. Combining the reliable sensor-based metrics in the clinical assessment process will provide a more objective approach, relying less on therapist expertise. This paper suggests future work on analyzing the reliability of metrics to prevent biasedness and selecting the appropriate analysis.
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Affiliation(s)
- Rene M. Maura
- Mechanical Engineering Department, University of Idaho, Moscow, ID USA
| | | | - Richard E. Stevens
- Engineering and Physics Department, Whitworth University, Spokane, WA USA
| | - Douglas L. Weeks
- College of Medicine, Washington State University, Spokane, WA USA
| | - Eric T. Wolbrecht
- Mechanical Engineering Department, University of Idaho, Moscow, ID USA
| | - Joel C. Perry
- Mechanical Engineering Department, University of Idaho, Moscow, ID USA
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Kosugi A, Saga Y, Kudo M, Koizumi M, Umeda T, Seki K. Time course of recovery of different motor functions following a reproducible cortical infarction in non-human primates. Front Neurol 2023; 14:1094774. [PMID: 36846141 PMCID: PMC9947718 DOI: 10.3389/fneur.2023.1094774] [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: 11/10/2022] [Accepted: 01/12/2023] [Indexed: 02/11/2023] Open
Abstract
A major challenge in human stroke research is interpatient variability in the extent of sensorimotor deficits and determining the time course of recovery following stroke. Although the relationship between the extent of the lesion and the degree of sensorimotor deficits is well established, the factors determining the speed of recovery remain uncertain. To test these experimentally, we created a cortical lesion over the motor cortex using a reproducible approach in four common marmosets, and characterized the time course of recovery by systematically applying several behavioral tests before and up to 8 weeks after creation of the lesion. Evaluation of in-cage behavior and reach-to-grasp movement revealed consistent motor impairments across the animals. In particular, performance in reaching and grasping movements continued to deteriorate until 4 weeks after creation of the lesion. We also found consistent time courses of recovery across animals for in-cage and grasping movements. For example, in all animals, the score for in-cage behaviors showed full recovery at 3 weeks after creation of the lesion, and the performance of grasping movement partially recovered from 4 to 8 weeks. In addition, we observed longer time courses of recovery for reaching movement, which may rely more on cortically initiated control in this species. These results suggest that different recovery speeds for each movement could be influenced by what extent the cortical control is required to properly execute each movement.
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Affiliation(s)
- Akito Kosugi
- Department of Neurophysiology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yosuke Saga
- Department of Neurophysiology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Moeko Kudo
- Department of Neurophysiology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masashi Koizumi
- Department of Neurophysiology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tatsuya Umeda
- Department of Neurophysiology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan,Department of Integrated Neuroanatomy and Neuroimaging, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuhiko Seki
- Department of Neurophysiology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan,*Correspondence: Kazuhiko Seki ✉
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Hajihosseinali M, Behzadipour S, Taghizadeh G, Farahmand F. Direction-dependency of the kinematic indices in upper extremities motor assessment of stroke patients. Med Eng Phys 2022; 108:103880. [DOI: 10.1016/j.medengphy.2022.103880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 10/15/2022]
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Zhang L, Jia G, Ma J, Wang S, Cheng L. Short and long-term effects of robot-assisted therapy on upper limb motor function and activity of daily living in patients post-stroke: a meta-analysis of randomized controlled trials. J Neuroeng Rehabil 2022; 19:76. [PMID: 35864524 PMCID: PMC9306153 DOI: 10.1186/s12984-022-01058-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/14/2022] [Indexed: 11/27/2022] Open
Abstract
Objective To investigate the effect of robot-assisted therapy (RAT) on upper limb motor control and activity function in poststroke patients compared with that of non-robotic therapy. Methods We searched PubMed, EMBASE, Cochrane Library, Google Scholar and Scopus. Randomized controlled trials published from 2010 to nowadays comparing the effect of RAT and control treatment on upper limb function of poststroke patients aged 18 or older were included. Researchers extracted all relevant data from the included studies, assessed the heterogeneity with inconsistency statistics (I2 statistics), evaluated the risk of bias of individual studies and performed data analysis. Result Forty-six studies were included. Meta-analysis showed that the outcome of the Fugl-Meyer Upper Extremity assessment (FM-UE) (SMD = 0.20, P = 0.001) and activity function post intervention was significantly higher (SMD = 0.32, P < 0.001) in the RAT group than in the control group. Differences in outcomes of the FM-UE and activity function between the RAT group and control group were observed at the end of treatment and were not found at the follow-up. Additionally, the outcomes of the FM-UE (SMD = 0.15, P = 0.005) and activity function (SMD = 0.32, P = 0.002) were significantly different between the RAT and control groups only with a total training time of more than 15 h. Moreover, the differences in outcomes of FM-UE and activity post intervention were not significant when the arm robots were applied to patients with severe impairments (FM-UE: SMD = 0.14, P = 0.08; activity: SMD = 0.21, P = 0.06) or when patients were provided with patient-passive training (FM-UE: SMD = − 0.09, P = 0.85; activity: SMD = 0.70, P = 0.16). Conclusion RAT has the significant immediate benefits for motor control and activity function of hemiparetic upper limb in patients after stroke compared with controls, but there is no evidence to support its long-term additional benefits. The superiority of RAT in improving motor control and activity function is limited by the amount of training time and the patients' active participation. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-022-01058-8.
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Affiliation(s)
- Liping Zhang
- Department of Rehabilitation, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong, Chongqing, 400010, China
| | - Gongwei Jia
- Department of Rehabilitation, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong, Chongqing, 400010, China
| | - Jingxi Ma
- Department of Neurology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, 400013, China.,Chongqing Key Laboratory of Neurodegenerative Diseases, Chongqing, 400013, China
| | - Sanrong Wang
- Department of Rehabilitation, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong, Chongqing, 400010, China
| | - Li Cheng
- Department of Health Management, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong, Chongqing, 400010, China.
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Hwang D, Shin JH, Kwon S. Kinematic Assessment to Measure Change in Impairment during Active and Active-Assisted Type of Robotic Rehabilitation for Patients with Stroke. SENSORS 2021; 21:s21217055. [PMID: 34770362 PMCID: PMC8587557 DOI: 10.3390/s21217055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/14/2021] [Accepted: 10/21/2021] [Indexed: 11/20/2022]
Abstract
Analysis of kinematic features related to clinical assessment scales may qualitatively improve the evaluation of upper extremity movements of stroke patients. We aimed to investigate kinematic features that could correlate the change in the Fugl-Meyer Assessment (FMA) score of stroke survivors through upper extremity robotic rehabilitation. We also analyzed whether changes in kinematic features by active and active-assisted robotic rehabilitation correlated differently with changes in FMA scores. Fifteen stroke patients participated in the upper extremity robotic rehabilitation program, and nine kinematic features were calculated from reach tasks for assessment. Simple and multiple linear regression analyses were used to characterize correlations. Features representing movement speed were associated with changes in FMA scores for the group that used an active rehabilitation robot. In contrast, in the group that used an active-assisted rehabilitation robot, features representing movement smoothness were associated with changes in the FMA score. These estimates can be an important basis for kinematic analysis to complement clinical scales.
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Affiliation(s)
- Donghwan Hwang
- Department of Rehabilitation & Assistive Technology, National Rehabilitation Center, Ministry of Health and Welfare, Seoul 01022, Korea; or
- Translational Research Program for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul 01022, Korea
| | - Joon-Ho Shin
- Translational Research Program for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul 01022, Korea
- Department of Neurorehabilitation, National Rehabilitation Center, Ministry of Health and Welfare, Seoul 01022, Korea
- Correspondence: or (J.-H.S.); or (S.K.)
| | - Suncheol Kwon
- Department of Rehabilitation & Assistive Technology, National Rehabilitation Center, Ministry of Health and Welfare, Seoul 01022, Korea; or
- Translational Research Program for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul 01022, Korea
- Correspondence: or (J.-H.S.); or (S.K.)
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Zbytniewska M, Kanzler CM, Jordan L, Salzmann C, Liepert J, Lambercy O, Gassert R. Reliable and valid robot-assisted assessments of hand proprioceptive, motor and sensorimotor impairments after stroke. J Neuroeng Rehabil 2021; 18:115. [PMID: 34271954 PMCID: PMC8283922 DOI: 10.1186/s12984-021-00904-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 06/24/2021] [Indexed: 11/18/2022] Open
Abstract
Background Neurological injuries such as stroke often differentially impair hand motor and somatosensory function, as well as the interplay between the two, which leads to limitations in performing activities of daily living. However, it is challenging to identify which specific aspects of sensorimotor function are impaired based on conventional clinical assessments that are often insensitive and subjective. In this work we propose and validate a set of robot-assisted assessments aiming at disentangling hand proprioceptive from motor impairments, and capturing their interrelation (sensorimotor impairments). Methods A battery of five complementary assessment tasks was implemented on a one degree-of-freedom end-effector robotic platform acting on the index finger metacarpophalangeal joint. Specifically, proprioceptive impairments were assessed using a position matching paradigm. Fast target reaching, range of motion and maximum fingertip force tasks characterized motor function deficits. Finally, sensorimotor impairments were assessed using a dexterous trajectory following task. Clinical feasibility (duration), reliability (intra-class correlation coefficient ICC, smallest real difference SRD) and validity (Kruskal-Wallis test, Spearman correlations \documentclass[12pt]{minimal}
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\begin{document}$$\rho$$\end{document}ρ with Fugl-Meyer Upper Limb Motor Assessment, kinesthetic Up-Down Test, Box & Block Test) of robotic tasks were evaluated with 36 sub-acute stroke subjects and 31 age-matched neurologically intact controls. Results Eighty-three percent of stroke survivors with varied impairment severity (mild to severe) could complete all robotic tasks (duration: <15 min per tested hand). Further, the study demonstrated good to excellent reliability of the robotic tasks in the stroke population (ICC>0.7, SRD<30%), as well as discriminant validity, as indicated by significant differences (p-value<0.001) between stroke and control subjects. Concurrent validity was shown through moderate to strong correlations (\documentclass[12pt]{minimal}
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\begin{document}$$\rho$$\end{document}ρ=0.4-0.8) between robotic outcome measures and clinical scales. Finally, robotic tasks targeting different deficits (motor, sensory) were not strongly correlated with each other (\documentclass[12pt]{minimal}
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\begin{document}$$\rho \le$$\end{document}ρ≤0.32, p-value>0.1), thereby presenting complementary information about a patient’s impairment profile. Conclusions The proposed robot-assisted assessments provide a clinically feasible, reliable, and valid approach to distinctly characterize impairments in hand proprioceptive and motor function, along with the interaction between the two. This opens new avenues to help unravel the contributions of unique aspects of sensorimotor function in post-stroke recovery, as well as to contribute to future developments towards personalized, assessment-driven therapies. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00904-5.
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Affiliation(s)
- Monika Zbytniewska
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - Christoph M Kanzler
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore
| | - Lisa Jordan
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Christian Salzmann
- Kliniken Schmieder Allensbach, Zum Tafelholz 8, 78476, Allensbach, Germany
| | - Joachim Liepert
- Kliniken Schmieder Allensbach, Zum Tafelholz 8, 78476, Allensbach, Germany
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore
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A New Approach to the Study of Two-Joint Upper Limb Movements in Humans: Independent Programming of the Positioning and Force. NEUROPHYSIOLOGY+ 2021. [DOI: 10.1007/s11062-021-09896-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Effects of Hemispheric Stroke Localization on the Reorganization of Arm Movements within Different Mechanical Environments. Life (Basel) 2021; 11:life11050383. [PMID: 33922668 PMCID: PMC8145329 DOI: 10.3390/life11050383] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 01/24/2023] Open
Abstract
This study investigated how stroke’s hemispheric localization affects motor performance, spinal maps and muscle synergies while performing planar reaching with and without assistive or resistive forces. A lesion of the right hemisphere affected performance, reducing average speed and smoothness and augmenting lateral deviation in both arms. Instead, a lesion of the left hemisphere affected the aiming error, impairing the feedforward control of the ipsilesional arm. The structure of the muscle synergies had alterations dependent on the lesion side in both arms. The applied force fields reduced the differences in performance and in muscle activations between arms and among populations. These results support the hypotheses of hemispheric specialization in movement control and identify potential significant biomarkers for the design of more effective and personalized rehabilitation protocols.
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Chou CH, Wang T, Sun X, Niu CM, Hao M, Xie Q, Lan N. Automated functional electrical stimulation training system for upper-limb function recovery in poststroke patients. Med Eng Phys 2020; 84:174-183. [PMID: 32977916 DOI: 10.1016/j.medengphy.2020.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/24/2020] [Accepted: 09/02/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND This paper describes the design and test of an automated functional electrical stimulation (FES) system for poststroke rehabilitation training. The aim of automated FES is to synchronize electrically induced movements to assist residual movements of patients. METHODS In the design of the FES system, an accelerometry module detected movement initiation and movement performed by post-stroke patients. The desired movement was displayed in visual game module. Synergy-based FES patterns were formulated using a normal pattern of muscle synergies from a healthy subject. Experiment 1 evaluated how different levels of trigger threshold or timing affected the variability of compound movements for forward reaching (FR) and lateral reaching (LR). Experiment 2 explored the effect of FES duration on compound movements. RESULTS Synchronizing FES-assisted movements with residual voluntary movements produced more consistent compound movements. Matching the duration of synergy-based FES to that of patients could assist slower movements of patients with reduced RMS errors. CONCLUSIONS Evidence indicated that synchronization and matching duration with residual voluntary movements of patients could improve the consistency of FES assisted movements. Automated FES training can reduce the burden of therapists to monitor the training process, which may encourage patients to complete the training.
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Affiliation(s)
- Chih-Hong Chou
- Laboratory of Neurorehabilitaiton Engineering, School of Biomedical Engineering, Shanghai Jiao Tong University, China
| | - Tong Wang
- Laboratory of Neurorehabilitaiton Engineering, School of Biomedical Engineering, Shanghai Jiao Tong University, China
| | - Xiaopei Sun
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chuanxin M Niu
- Laboratory of Neurorehabilitaiton Engineering, School of Biomedical Engineering, Shanghai Jiao Tong University, China; Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Manzhao Hao
- Laboratory of Neurorehabilitaiton Engineering, School of Biomedical Engineering, Shanghai Jiao Tong University, China
| | - Qing Xie
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Ning Lan
- Laboratory of Neurorehabilitaiton Engineering, School of Biomedical Engineering, Shanghai Jiao Tong University, China.
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Adans-Dester C, Fasoli SE, Fabara E, Menard N, Fox AB, Severini G, Bonato P. Can kinematic parameters of 3D reach-to-target movements be used as a proxy for clinical outcome measures in chronic stroke rehabilitation? An exploratory study. J Neuroeng Rehabil 2020; 17:106. [PMID: 32771020 PMCID: PMC7414659 DOI: 10.1186/s12984-020-00730-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 07/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite numerous trials investigating robot-assisted therapy (RT) effects on upper-extremity (UE) function after stroke, few have explored the relationship between three-dimensional (3D) reach-to-target kinematics and clinical outcomes. The objectives of this study were to 1) investigate the correlation between kinematic parameters of 3D reach-to-target movements and UE clinical outcome measures, and 2) examine the degree to which differences in kinematic parameters across individuals can account for differences in clinical outcomes in response to RT. METHODS Ten chronic stroke survivors participated in a pilot RT intervention (eighteen 1-h sessions) integrating cognitive skills training and a home-action program. Clinical outcome measures and kinematic parameters of 3D reach-to-target movements were collected pre- and post-intervention. The correlation between clinical outcomes and kinematic parameters was investigated both cross-sectionally and longitudinally (i.e., changes in response to the intervention). Changes in clinical outcomes and kinematic parameters were tested for significance in both group and subject-by-subject analyses. Potential associations between individual differences in kinematic parameters and differences in clinical outcomes were examined. RESULTS Moderate-to-strong correlation was found between clinical measures and specific kinematic parameters when examined cross-sectionally. Weaker correlation coefficients were found longitudinally. Group analyses revealed significant changes in clinical outcome measures in response to the intervention; no significant group changes were observed in kinematic parameters. Subject-by-subject analyses revealed changes with moderate-to-large effect size in the kinematics of 3D reach-to-target movements pre- vs. post-intervention. Changes in clinical outcomes and kinematic parameters varied widely across participants. CONCLUSIONS Large variability was observed across subjects in response to the intervention. The correlation between changes in kinematic parameters and clinical outcomes in response to the intervention was variable and not strong across parameters, suggesting no consistent change in UE motor strategies across participants. These results highlight the need to investigate the response to interventions at the individual level. This would enable the identification of clusters of individuals with common patterns of change in response to an intervention, providing an opportunity to use cluster-specific kinematic parameters as a proxy of clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov, NCT02747433 . Registered on April 21st, 2016.
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Affiliation(s)
- Catherine Adans-Dester
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, 300 First Ave, Charlestown, Boston, MA, 02129, USA
- School of Health & Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - Susan E Fasoli
- School of Health & Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - Eric Fabara
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, 300 First Ave, Charlestown, Boston, MA, 02129, USA
| | - Nicolas Menard
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Annie B Fox
- School of Health & Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - Giacomo Severini
- School of Electrical and Electronic Engineering, University College Dublin, Dublin, Ireland
- Centre for Biomedical Engineering, University College Dublin, Dublin, Ireland
| | - Paolo Bonato
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, 300 First Ave, Charlestown, Boston, MA, 02129, USA.
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA.
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Kanzler CM, Rinderknecht MD, Schwarz A, Lamers I, Gagnon C, Held JPO, Feys P, Luft AR, Gassert R, Lambercy O. A data-driven framework for selecting and validating digital health metrics: use-case in neurological sensorimotor impairments. NPJ Digit Med 2020; 3:80. [PMID: 32529042 PMCID: PMC7260375 DOI: 10.1038/s41746-020-0286-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/28/2020] [Indexed: 01/29/2023] Open
Abstract
Digital health metrics promise to advance the understanding of impaired body functions, for example in neurological disorders. However, their clinical integration is challenged by an insufficient validation of the many existing and often abstract metrics. Here, we propose a data-driven framework to select and validate a clinically relevant core set of digital health metrics extracted from a technology-aided assessment. As an exemplary use-case, the framework is applied to the Virtual Peg Insertion Test (VPIT), a technology-aided assessment of upper limb sensorimotor impairments. The framework builds on a use-case-specific pathophysiological motivation of metrics, models demographic confounds, and evaluates the most important clinimetric properties (discriminant validity, structural validity, reliability, measurement error, learning effects). Applied to 77 metrics of the VPIT collected from 120 neurologically intact and 89 affected individuals, the framework allowed selecting 10 clinically relevant core metrics. These assessed the severity of multiple sensorimotor impairments in a valid, reliable, and informative manner. These metrics provided added clinical value by detecting impairments in neurological subjects that did not show any deficits according to conventional scales, and by covering sensorimotor impairments of the arm and hand with a single assessment. The proposed framework provides a transparent, step-by-step selection procedure based on clinically relevant evidence. This creates an interesting alternative to established selection algorithms that optimize mathematical loss functions and are not always intuitive to retrace. This could help addressing the insufficient clinical integration of digital health metrics. For the VPIT, it allowed establishing validated core metrics, paving the way for their integration into neurorehabilitation trials.
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Affiliation(s)
- Christoph M. Kanzler
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Mike D. Rinderknecht
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Anne Schwarz
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital and University of Zürich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Ilse Lamers
- REVAL, Rehabilitation Research Center, BIOMED, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Rehabilitation and MS Center, Pelt, Belgium
| | - Cynthia Gagnon
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Québec, Canada
| | - Jeremia P. O. Held
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital and University of Zürich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Peter Feys
- REVAL, Rehabilitation Research Center, BIOMED, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Andreas R. Luft
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital and University of Zürich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
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13
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Giang C, Pirondini E, Kinany N, Pierella C, Panarese A, Coscia M, Miehlbradt J, Magnin C, Nicolo P, Guggisberg A, Micera S. Motor improvement estimation and task adaptation for personalized robot-aided therapy: a feasibility study. Biomed Eng Online 2020; 19:33. [PMID: 32410617 PMCID: PMC7227346 DOI: 10.1186/s12938-020-00779-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 05/08/2020] [Indexed: 02/07/2023] Open
Abstract
Background In the past years, robotic systems have become increasingly popular in upper limb rehabilitation. Nevertheless, clinical studies have so far not been able to confirm superior efficacy of robotic therapy over conventional methods. The personalization of robot-aided therapy according to the patients’ individual motor deficits has been suggested as a pivotal step to improve the clinical outcome of such approaches. Methods Here, we present a model-based approach to personalize robot-aided rehabilitation therapy within training sessions. The proposed method combines the information from different motor performance measures recorded from the robot to continuously estimate patients’ motor improvement for a series of point-to-point reaching movements in different directions. Additionally, it comprises a personalization routine to automatically adapt the rehabilitation training. We engineered our approach using an upper-limb exoskeleton. The implementation was tested with 17 healthy subjects, who underwent a motor-adaptation paradigm, and two subacute stroke patients, exhibiting different degrees of motor impairment, who participated in a pilot test undergoing rehabilitative motor training. Results The results of the exploratory study with healthy subjects showed that the participants divided into fast and slow adapters. The model was able to correctly estimate distinct motor improvement progressions between the two groups of participants while proposing individual training protocols. For the two pilot patients, an analysis of the selected motor performance measures showed that both patients were able to retain the improvements gained during training when reaching movements were reintroduced at a later stage. These results suggest that the automated training adaptation was appropriately timed and specifically tailored to the abilities of each individual. Conclusions The results of our exploratory study demonstrated the feasibility of the proposed model-based approach for the personalization of robot-aided rehabilitation therapy. The pilot test with two subacute stroke patients further supported our approach, while providing encouraging results for the applicability in clinical settings. Trial registration This study is registered in ClinicalTrials.gov (NCT02770300, registered 30 March 2016, https://clinicaltrials.gov/ct2/show/NCT02770300)
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Affiliation(s)
- Christian Giang
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland.
| | - Elvira Pirondini
- Institute of Bioengineering/Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
| | - Nawal Kinany
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland.,Institute of Bioengineering/Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
| | - Camilla Pierella
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland
| | - Alessandro Panarese
- Translational Neural Engineering Area, The Biorobotics Institute, Scuola Superiore Sant'Anna, 56025, Pisa, Italy
| | - Martina Coscia
- Wyss Center for Bio- and Neuro-Engineering, 1202, Geneva, Switzerland
| | - Jenifer Miehlbradt
- Brain Electrophysiology Attention Movement Laboratory, Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| | - Cécile Magnin
- Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospital Geneva, Geneva, Switzerland
| | - Pierre Nicolo
- Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospital Geneva, Geneva, Switzerland.,Laboratory of Cognitive Neurorehabilitation, Department of Clinical Neurosciences, Medical School, University of Geneva, Geneva, Switzerland
| | - Adrian Guggisberg
- Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospital Geneva, Geneva, Switzerland.,Laboratory of Cognitive Neurorehabilitation, Department of Clinical Neurosciences, Medical School, University of Geneva, Geneva, Switzerland
| | - Silvestro Micera
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland.,Translational Neural Engineering Area, The Biorobotics Institute, Scuola Superiore Sant'Anna, 56025, Pisa, Italy
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14
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Amano Y, Noma T, Etoh S, Miyata R, Kawamura K, Shimodozono M. Reaching exercise for chronic paretic upper extremity after stroke using a novel rehabilitation robot with arm-weight support and concomitant electrical stimulation and vibration: before-and-after feasibility trial. Biomed Eng Online 2020; 19:28. [PMID: 32375788 PMCID: PMC7203976 DOI: 10.1186/s12938-020-00774-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/25/2020] [Indexed: 12/03/2022] Open
Abstract
Background Our group developed a rehabilitation robot to assist with repetitive, active reaching movement of a paretic upper extremity. The robot is equipped with a servo motor-controlled arm-weight support and works in conjunction with neuromuscular electrical stimulation and vibratory stimulation to facilitate agonist-muscle contraction. In this before-and-after pilot study, we assessed the feasibility of applying the robot to improve motor control and function of the hemiparetic upper extremity in patients who suffered chronic stroke. Methods We enrolled 6 patients with chronic stroke and hemiparesis who, while sitting and without assistance, could reach 10 cm both sagitally and vertically (from a starting position located 10 cm forward from the patient’s navel level) with the affected upper extremity. The patients were assigned to receive reaching exercise intervention with the robot (Yaskawa Electric Co., Ltd. Fukuoka, Japan) for 2 weeks at 15 min/day in addition to regular occupational therapy for 40 min/day. Outcomes assessed before and after 2 weeks of intervention included the upper extremity component of the Fugl-Meyer Assessment (UE-FMA), the Action Research Arm Test (ARAT), and, during reaching movement, kinematic analysis. Results None of the patients experienced adverse events. The mean score of UE-FMA increased from 44.8 [SD 14.4] to 48.0 [SD 14.4] (p = 0.026, r = 0.91), and both the shoulder–elbow and wrist–hand scores increased after 2-week intervention. An increase was also observed in ARAT score, from mean 29.8 [SD 16.3] to 36.2 [SD 18.1] (p = 0.042, r = 0.83). Kinematic analysis during the reaching movement revealed a significant increase in active range of motion (AROM) at the elbow, and movement time tended to decrease. Furthermore, trajectory length for the wrist (“hand path”) and the acromion (“trunk compensatory movement”) showed a decreasing trend. Conclusions This robot-assisted modality is feasible and our preliminary findings suggest it improved motor control and motor function of the hemiparetic upper extremity in patients with chronic stroke. Training with this robot might induce greater AROM for the elbow and decrease compensatory trunk movement, thus contributing to movement efficacy and efficiency. Trial registration UMIN Clinical Trial Registry, as UMIN000018132, on June 30, 2015. https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000020398
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Affiliation(s)
- Yumeko Amano
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Tomokazu Noma
- Kagoshima University Hospital Kirishima Rehabilitation Center, Kagoshima, Japan.,Department of Rehabilitation, Faculty of Health Science, Nihon Fukushi University, Higashi-nukumi-cho 26-2, Handa, Aichi, 475-0012, Japan
| | - Seiji Etoh
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Ryuji Miyata
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Kentaro Kawamura
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Megumi Shimodozono
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
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15
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Quantitative Assessment of Motor Function for Patients with a Stroke by an End-Effector Upper Limb Rehabilitation Robot. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5425741. [PMID: 32462001 PMCID: PMC7224306 DOI: 10.1155/2020/5425741] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/15/2020] [Accepted: 02/15/2020] [Indexed: 11/17/2022]
Abstract
With the popularization of rehabilitation robots, it is necessary to develop quantitative motor function assessment methods for patients with a stroke. To make the assessment equipment easier to use in clinics and combine the assessment methods with the rehabilitation training process, this paper proposes an anthropomorphic rehabilitation robot based on the basic movement patterns of the upper limb, point-to-point reaching and circle drawing movement. This paper analyzes patients' movement characteristics in aspects of movement range, movement accuracy, and movement smoothness and the output force characteristics by involving 8 patients. Besides, a quantitative assessment method is also proposed based on multivariate fitting methods. It can be concluded that the area of the real trajectory and movement accuracy during circle drawing movement as well as the ratio of force along the sagittal axis in backward point-to-point movement are the unique parameters that are different remarkably between stroke patients and healthy subjects. The fitting function has a high goodness of fit with the Fugl-Meyer scores for the upper limb (R 2 = 0.91, p = 0.015), which demonstrates that the fitting function can be used to assess patients' upper limb movement function. The indicators are recorded during training movement, and the fitting function can calculate the scores immediately, which makes the functional assessment quantitative and timely. Combining the training process and assessment, the quantitative assessment method will farther expand the application of rehabilitation robots.
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16
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Bloomer C, Wang S, Kontson K. Kinematic analysis of motor learning in upper limb body-powered bypass prosthesis training. PLoS One 2020; 15:e0226563. [PMID: 31978051 PMCID: PMC6980621 DOI: 10.1371/journal.pone.0226563] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 11/28/2019] [Indexed: 12/03/2022] Open
Abstract
Motor learning and compensatory movement are important aspects of prosthesis training yet relatively little quantitative evidence supports our current understanding of how motor control and compensation develop in the novel body-powered prosthesis user. The goal of this study is to assess these aspects of prosthesis training through functional, kinematic, and kinetic analyses using a within-subject paradigm compared across two training time points. The joints evaluated include the left and right shoulders, torso, and right elbow. Six abled-bodied subjects (age 27 ± 3) using a body-powered bypass prosthesis completed the Jebsen-Taylor Hand Function Test and the targeted Box and Blocks Test after five training sessions and again after ten sessions. Significant differences in movement parameters included reduced times to complete tasks, reduced normalized jerk for most joints and tasks, and more variable changes in efficiency and compensation parameters for individual tasks and joints measured as range of motion, maximum angle, and average moment. Normalized jerk, joint specific path length, range of motion, maximum angle, and average moment are presented for the first time in this unique training context and for this specific device type. These findings quantitatively describe numerous aspects of motor learning and control in able-bodied subjects that may be useful in guiding future rehabilitation and training of body-powered prosthesis users.
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Affiliation(s)
- Conor Bloomer
- Division of Biomedical Physics, Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Sophie Wang
- Division of Biomedical Physics, Food and Drug Administration, Silver Spring, Maryland, United States of America
- Department of Bioengineering, University of Maryland, College Park, Maryland, United States of America
| | - Kimberly Kontson
- Division of Biomedical Physics, Food and Drug Administration, Silver Spring, Maryland, United States of America
- * E-mail:
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17
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Goffredo M, Mazzoleni S, Gison A, Infarinato F, Pournajaf S, Galafate D, Agosti M, Posteraro F, Franceschini M. Kinematic Parameters for Tracking Patient Progress during Upper Limb Robot-Assisted Rehabilitation: An Observational Study on Subacute Stroke Subjects. Appl Bionics Biomech 2019; 2019:4251089. [PMID: 31772604 PMCID: PMC6854217 DOI: 10.1155/2019/4251089] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 08/02/2019] [Accepted: 08/14/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Upper limb robot-assisted therapy (RT) provides intensive, repetitive, and task-specific treatment, and its efficacy for stroke survivors is well established in literature. Biomechanical data from robotic devices has been widely employed for patient's assessment, but rarely it has been analysed for tracking patient progress during RT. The goal of this retrospective study is to analyse built-in kinematic data registered by a planar end-effector robot for assessing the time course of motor recovery and patient's workspace exploration skills. A comparison of subjects having mild and severe motor impairment has been also conducted. For that purpose, kinematic data recorded by a planar end-effector robot have been processed for investigating how motor performance in executing point-to-point trajectories with different directions changes during RT. METHODS Observational retrospective study of 68 subacute stroke patients who conducted 20 daily sessions of upper limb RT with the InMotion 2.0 (Bionik Laboratories, USA): planar point-to-point reaching tasks with an "assist as needed" strategy. The following kinematic parameters (KPs) were computed for each subject and for each point-to-point trajectory executed during RT: movement accuracy, movement speed, number of peak speed, and task completion time. The Wilcoxon signed-rank tests were used with clinical outcomes. the Friedman test and post hoc Conover's test (Bonferroni's correction) were applied to KPs. A secondary data analysis has been conducted by comparing patients having different severities of motor impairment. The level of significance was set at p value < 0.05. RESULTS At the RT onset, the movements were less accurate and smoothed, and showed higher times of execution than those executed at the end of treatment. The analysis of the time course of KPs highlighted that RT seems to improve the motor function mainly in the first sessions of treatment: most KPs show significant intersession differences during the first 5/10 sessions. Afterwards, no further significant variations occurred. The ability to perform movements away from the body and from the hemiparetic side remains more challenging. The results obtained from the data stratification show significant differences between subjects with mild and severe motor impairment. CONCLUSION Significant improvements in motor performance were registered during the time course of upper limb RT in subacute stroke patients. The outcomes depend on movement direction and motor impairment and pave the way to optimize healthcare resources and to design patient-tailored rehabilitative protocols.
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Affiliation(s)
- Michela Goffredo
- Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Rome, Italy
| | - Stefano Mazzoleni
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Rehabilitation Bioengineering Laboratory, Volterra, Italy
| | - Annalisa Gison
- Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Rome, Italy
| | | | - Sanaz Pournajaf
- Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Rome, Italy
| | - Daniele Galafate
- Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Rome, Italy
| | - Maurizio Agosti
- Rehabilitation Medicine Service, NHS-University Hospital of Parma, Parma, Italy
| | - Federico Posteraro
- Rehabilitation Department, Versilia Hospital, AUSL Tuscany North West, Camaiore, Italy
| | - Marco Franceschini
- Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Rome, Italy
- San Raffaele University, Rome, Italy
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18
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Isaković MS, Savić AM, Konstantinović LM, Popović MB. Validation of computerized square-drawing based evaluation of motor function in patients with stroke. Med Eng Phys 2019; 71:114-120. [PMID: 31345670 DOI: 10.1016/j.medengphy.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 04/04/2019] [Accepted: 06/07/2019] [Indexed: 12/01/2022]
Abstract
Human-administered clinical scales are commonly used for quantifying motor performance and determining the course of therapy in post-stroke individuals. Computerized methods aim to improve consistency, resolution and duration of patients' evaluation. The objective of this study was to test the validity of computerized square-drawing test (DT) for assessment of shoulder and elbow function by using novel set of DT-based kinematic measures and explore their relation with Wolf Motor Function Test (WMFT) scoring. Forty-seven stroke survivors were tested before and after the rehabilitation program. DT involved drawing a square in horizontal plane using a mechanical manipulandum and a digitizing board. Depending on the initial classification of patients into low or high performance groups, the two different outcome metrics were derived from DT kinematic data for evaluation of each group. Linear regression models applied to map DT outcome values to WMFT scores for both groups resulted with high correlation coefficients and low mean absolute prediction error. In conclusion, we have identified a set of kinematic measures suitable for fast and objective motor function evaluation and functional classification, strongly correlating with WMFT score in post-stroke individuals. The results support validation of square-drawing motor function assessment, encouraging its use in clinical settings.
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Affiliation(s)
- Milica S Isaković
- School of Electrical Engineering, University of Belgrade, Bulevar kralja Aleksandra 73, 11000 Belgrade, Serbia; Tecnalia, Health Division, Mikeletegi Pasealekua 1-3, 20009 Donostia-San Sebastian, Spain.
| | - Andrej M Savić
- School of Electrical Engineering, University of Belgrade, Bulevar kralja Aleksandra 73, 11000 Belgrade, Serbia; Tecnalia, Health Division, Mikeletegi Pasealekua 1-3, 20009 Donostia-San Sebastian, Spain
| | - Ljubica M Konstantinović
- Faculty of Medicine, University of Belgrade, Dr Subotića 8, 11000 Belgrade, Serbia; Clinic for Rehabilitation "Dr Miroslav Zotović", Sokobanjska 13, 11000 Belgrade, Serbia
| | - Mirjana B Popović
- School of Electrical Engineering, University of Belgrade, Bulevar kralja Aleksandra 73, 11000 Belgrade, Serbia; Institute for Medical Research, University of Belgrade, Dr Subotića 4, 11000 Belgrade, Serbia
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19
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Kim DH, Kim KH, Lee SM. The effects of Virtual Reality Training with Upper Limb Sensory
Exercise Stimulation on the AROM of Upper Limb Joints, Function, and
Concentration in Chronic Stroke Patients. PHYSIKALISCHE MEDIZIN, REHABILITATIONSMEDIZIN, KURORTMEDIZIN 2019. [DOI: 10.1055/a-0917-4604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Abstract
Objective We investigated the effect of upper limb sensory stimulation
and virtual reality rehabilitation (SMVR) on upper extremity active joint angle,
function and cognitive ability in chronic stroke patients.
Methods A total of 30 patients were randomly divided into SMVR group and
CON group. SMVR group was performed 60 min three times a week for 8
weeks in upper limb sensory stimulation and robot virtual reality
rehabilitation. CON group performed conservative treatment and peripheral joint
movement for 60 min. The upper limb function was measured by the
Jebsen-Taylor hand function test (JTT) and the cognitive ability test was
performed by the Stroop test (ST) and Trail making test (TMT).
Results There was a significant difference (P<0.05) between
before and after training in both groups, and SMVR group showed significant
improvement in both groups.
Conclusions In this study, we confirmed that robot virtual reality
training in combination with limb motion stimulation for stroke patients
positively affects the angle, function, and concentration of upper extremity
active joints in chronic stroke patients.
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Affiliation(s)
- Dong Hoon Kim
- Bundang Jesaeng Hospital, RM, Seongnam, Korea (the Republic
of)
| | - Kyung-Hun Kim
- Physical Therapy, Gimcheon University, Gimcheon, Korea (the Republic
of)
| | - Suk-Min Lee
- Physical Therapy, Sahmyook University, Nowon-gu, Korea (the Republic
of)
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20
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Hussain N, Sunnerhagen KS, Alt Murphy M. End-point kinematics using virtual reality explaining upper limb impairment and activity capacity in stroke. J Neuroeng Rehabil 2019; 16:82. [PMID: 31262320 PMCID: PMC6604147 DOI: 10.1186/s12984-019-0551-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 06/12/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND For evaluation of upper limb impairment and activity capacity, Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT) are recommended to be included in stroke trials. To improve the understanding of mechanisms of motor recovery, and differentiate between restitution and compensation, kinematic analysis is also recommended for assessment of upper limb function after stroke. AIM To determine the extent to which end-point kinematic variables obtained from the target-to-target pointing task were associated with upper limb impairment or activity limitation as assessed by traditional clinical scales in individuals with stroke. METHODS Sixty-four individuals, from acute stage up to one year after stroke, were included from the Stroke Arm Longitudinal study at the University of Gothenburg (SALGOT) cohort. They performed a target-to-target pointing task in a virtual environment using a haptic stylus which also captured the kinematic parameters. Multiple linear regression was done to determine the amount of variance explained by kinematic variables on FMA-UE and ARAT scores after controlling for confounding variables. RESULTS Mean velocity and number of velocity peaks explained 11 and 9% of the FMA-UE score uniquely and 16% when taken together. Movement time and number of velocity peaks explained 13 and 10% of the ARAT score respectively. CONCLUSION The kinematic variables of movement time, velocity and smoothness explain only a part of the variance captured by using clinical observational scales, reinforcing the importance of multi-level assessment using both kinematic analysis and clinical scales in upper limb evaluation after stroke. TRIAL REGISTRATION The trial was registered with register number NCT01115348 at clinicaltrials.gov , on May 4, 2010. URL: https://clinicaltrials.gov/ct2/show/NCT01115348 .
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Affiliation(s)
- Netha Hussain
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Per Dubbsgatan 14, 3rd Floor, SE-41345, Gothenburg, Sweden.
| | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Per Dubbsgatan 14, 3rd Floor, SE-41345, Gothenburg, Sweden
| | - Margit Alt Murphy
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Per Dubbsgatan 14, 3rd Floor, SE-41345, Gothenburg, Sweden
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21
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Chowdhury A, Nishad SS, Meena YK, Dutta A, Prasad G. Hand-Exoskeleton Assisted Progressive Neurorehabilitation using Impedance Adaptation based Challenge Level Adjustment Method. IEEE TRANSACTIONS ON HAPTICS 2018; 12:128-140. [PMID: 30371388 DOI: 10.1109/toh.2018.2878232] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This paper presents an underactuated design of a robotic hand exoskeleton and a challenge based neurorehabilitation strategy. The exoskeleton is designed to reproduce natural human fingertip paths during extension and grasping, keeping minimal kinematic complexity. It facilitates an impedance adaptation based trigged assistance control strategy by a switching between active non-assist and passive assistance modes. In active non-assist mode, the exoskeleton motion follows the applied fingertip forces based on an impedance model. If the applied fingertip forces are inadequate, the passive assistance mode is triggered. The impedance parameters are updated at regular intervals based on the user performance, to implement a challenge based rehabilitation strategy. A six-week long hand therapy, conducted on four chronic stroke patients results in significant (p-value<0.05) increase in force generation capacity and decrease (p-value<0.05) in the required assistance. Also, there was a significant (p-value<0.05) increase in the system impedance parameters which adequately challenged the patients. The change in the Action-Research-Arm-Test (ARAT) scores from baseline are also found to be significant (p-value<0.05) and beyond the minimal clinically important difference (MCID) limit. Thus the results prove that the proposed control strategy with has the potential to be a clinically effective solution for personalized rehabilitation of poststroke hand functionality.
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22
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Zariffa J, Myers M, Coahran M, Wang RH. Smallest real differences for robotic measures of upper extremity function after stroke: Implications for tracking recovery. J Rehabil Assist Technol Eng 2018; 5:2055668318788036. [PMID: 31191947 PMCID: PMC6453062 DOI: 10.1177/2055668318788036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/14/2018] [Indexed: 01/23/2023] Open
Abstract
Introduction Measurements from upper limb rehabilitation robots could guide therapy
progression, if a robotic assessment’s measurement error was small enough to
detect changes occurring on a time scale of a few days. To guide this
determination, this study evaluated the smallest real differences of robotic
measures, and of clinical outcome assessments predicted from these
measures. Methods A total of nine older chronic stroke survivors took part in 12-week study
with an upper-limb end-effector robot. Fourteen robotic measures were
extracted, and used to predict Fugl-Meyer Assessment-Upper Extremity
(FMA-UE) and Action Research Arm Test (ARAT) scores using multilinear
regression. Smallest real differences and intraclass correlation
coefficients were computed for the robotic measures and predicted clinical
outcomes, using data from seven baseline sessions. Results Smallest real differences of robotic measures ranged from 8.8% to 26.9% of
the available range. Smallest real differences of predicted clinical
assessments varied widely depending on the regression model (1.3 to 36.2 for
FMA-UE, 1.8 to 59.7 for ARAT), and were not strongly related to a model’s
predictive performance or to the smallest real differences of the model
inputs. Models with acceptable predictive performance as well as low
smallest real differences were identified. Conclusions Smallest real difference evaluations suggest that using robotic assessments
to guide therapy progression is feasible.
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Affiliation(s)
- José Zariffa
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Myers
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Marge Coahran
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
| | - Rosalie H Wang
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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Development of an E-Health App for Lower Limb Postoperative Rehabilitation Based on Plantar Pressure Analysis. APPLIED SCIENCES-BASEL 2018. [DOI: 10.3390/app8050766] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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24
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Hussain N, Alt Murphy M, Sunnerhagen KS. Upper Limb Kinematics in Stroke and Healthy Controls Using Target-to-Target Task in Virtual Reality. Front Neurol 2018; 9:300. [PMID: 29867717 PMCID: PMC5954035 DOI: 10.3389/fneur.2018.00300] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/18/2018] [Indexed: 11/13/2022] Open
Abstract
Background Kinematic analysis using virtual reality (VR) environment provides quantitative assessment of upper limb movements. This technique has rarely been used in evaluating motor function in stroke despite its availability in stroke rehabilitation. Objective To determine the discriminative validity of VR-based kinematics during target-to-target pointing task in individuals with mild or moderate arm impairment following stroke and in healthy controls. Methods Sixty-seven participants with moderate (32–57 points) or mild (58–65 points) stroke impairment as assessed with Fugl-Meyer Assessment for Upper Extremity were included from the Stroke Arm Longitudinal study at the University of Gothenburg—SALGOT cohort of non-selected individuals within the first year of stroke. The stroke groups and 43 healthy controls performed the target-to-target pointing task, where 32 circular targets appear one after the other and disappear when pointed at by the haptic handheld stylus in a three-dimensional VR environment. The kinematic parameters captured by the stylus included movement time, velocities, and smoothness of movement. Results The movement time, mean velocity, and peak velocity were discriminative between groups with moderate and mild stroke impairment and healthy controls. The movement time was longer and mean and peak velocity were lower for individuals with stroke. The number of velocity peaks, representing smoothness, was also discriminative and significantly higher in both stroke groups (mild, moderate) compared to controls. Movement trajectories in stroke more frequently showed clustering (spider’s web) close to the target indicating deficits in movement precision. Conclusion The target-to-target pointing task can provide valuable and specific information about sensorimotor impairment of the upper limb following stroke that might not be captured using traditional clinical scale. Trial registration details The trial was registered with register number NCT01115348 at clinicaltrials.gov, on May 4, 2010. URL: https://clinicaltrials.gov/ct2/show/NCT01115348.
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Affiliation(s)
- Netha Hussain
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margit Alt Murphy
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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25
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Cortes M, Medeiros AH, Gandhi A, Lee P, Krebs HI, Thickbroom G, Edwards D. Improved grasp function with transcranial direct current stimulation in chronic spinal cord injury. NeuroRehabilitation 2018; 41:51-59. [PMID: 28505987 DOI: 10.3233/nre-171456] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Recovering hand function has important implications for improving independence of patients with tetraplegia after traumatic spinal cord injury (SCI). Transcranial direct current stimulation (tDCS) is a noninvasive neuromodulation technique that has potential to improve motor function. OBJECTIVE To investigate the effects of one session of 1 mA, 2 mA, and sham anodal tDCS (a-tDCS) in the upper extremity (hand) motor performance (grasp and lease) in patients with chronic cervical SCI. METHODS Eleven participants with incomplete SCI were randomized to receive 20 minutes of 1 mA, 2 mA, or sham stimulation over the targeted motor cortex over three separated sessions. Hand motor performance was measured by a hand robotic evaluation (kinematics) and the Box and Blocks (BB) test before and after the stimulation period. RESULTS A significant improvement on the grasp mean to peak speed ratio (GMP) was observed in the 2 mA group (pre: 0.38±0.02; post: 0.43±0.03; mean±SEM; p = 0.031). There was no statistically significant difference in BB test results, however the 2 mA intervention showed a positive trend for improvement. CONCLUSIONS A single session of 2 mA of a-tDCS showed gains in hand motor function in patients with chronic SCI that were not observed in functional clinical scales. The use of robotic kinematics showed promising results in assessing small changes in motor performance. Further studies are necessary to determine whether tDCS can be an effective long-term rehabilitation strategy for individuals with SCI.
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Affiliation(s)
- Mar Cortes
- Burke Medical Research Institute, White Plains, NY, USA.,Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA.,Universitat de Barcelona, Barcelona, Spain
| | - Ana Heloisa Medeiros
- Nervous System Electric Stimulation Laboratory, Rio de Janeiro State University, Brazil
| | - Aasta Gandhi
- Burke Medical Research Institute, White Plains, NY, USA
| | - Peter Lee
- Burke Medical Research Institute, White Plains, NY, USA
| | - Hermano Igo Krebs
- Newman Laboratory for Biomechanics and Human Rehabilitation, Massachusetts Institute of Technology (MIT), Cambridge, MA, USA
| | - Gary Thickbroom
- Burke Medical Research Institute, White Plains, NY, USA.,Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Dylan Edwards
- Burke Medical Research Institute, White Plains, NY, USA.,Department of Neurology, Weill Cornell Medicine, New York, NY, USA.,School of Medical and Health sciences, Edith Cowan University, Joondalup, WA, Australia
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26
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Development of a System Architecture for Evaluation and Training of Proprioceptive Deficits of the Upper Limb. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2018; 2018:4132820. [PMID: 29552031 PMCID: PMC5818916 DOI: 10.1155/2018/4132820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/07/2017] [Indexed: 11/17/2022]
Abstract
Proprioception plays a fundamental role in maintaining posture and executing movement, and the quantitative evaluation of proprioceptive deficits in poststroke patients is important. But currently it is not widely performed due to the complexity of the evaluation tools required for a reliable assessment. The aims of this pilot study were to (a) develop a system architecture for upper limb evaluation and training of proximal and distal sense of position in the horizontal plane and (b) test the system in healthy and pathological subjects. Two robotic devices for evaluation and training of, respectively, wrist flexion/extension and shoulder-elbow manipulation were employed. The system we developed was applied in a group of 12 healthy subjects and 10 patients after stroke. It was able to quantitatively evaluate upper limb sense of position in the horizontal plane thanks to a set of quantitative parameters assessing position estimation errors, variability, and gain. In addition, it was able to distinguish healthy from pathological conditions. The system could thus be a reliable method to detect changes in the sense of position of patients with sensory deficits after stroke and could enable the implementation of novel training approaches for the recovery of normal proprioception.
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27
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Tran VD, Dario P, Mazzoleni S. Kinematic measures for upper limb robot-assisted therapy following stroke and correlations with clinical outcome measures: A review. Med Eng Phys 2018; 53:13-31. [PMID: 29361407 DOI: 10.1016/j.medengphy.2017.12.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 11/10/2017] [Accepted: 12/24/2017] [Indexed: 10/18/2022]
Abstract
AIM OF THE STUDY This review classifies the kinematic measures used to evaluate post-stroke motor impairment following upper limb robot-assisted rehabilitation and investigates their correlations with clinical outcome measures. METHODS An online literature search was carried out in PubMed, MEDLINE, Scopus and IEEE-Xplore databases. Kinematic parameters mentioned in the studies included were categorized into the International Classification of Functioning, Disability and Health (ICF) domains. The correlations between these parameters and the clinical scales were summarized. RESULTS Forty-nine kinematic parameters were identified from 67 articles involving 1750 patients. The most frequently used parameters were: movement speed, movement accuracy, peak speed, number of speed peaks, and movement distance and duration. According to the ICF domains, 44 kinematic parameters were categorized into Body Functions and Structure, 5 into Activities and no parameters were categorized into Participation and Personal and Environmental Factors. Thirteen articles investigated the correlations between kinematic parameters and clinical outcome measures. Some kinematic measures showed a significant correlation coefficient with clinical scores, but most were weak or moderate. CONCLUSIONS The proposed classification of kinematic measures into ICF domains and their correlations with clinical scales could contribute to identifying the most relevant ones for an integrated assessment of upper limb robot-assisted rehabilitation treatments following stroke. Increasing the assessment frequency by means of kinematic parameters could optimize clinical assessment procedures and enhance the effectiveness of rehabilitation treatments.
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Affiliation(s)
- Vi Do Tran
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Polo Sant'Anna Valdera, V.le R. Piaggio 34-56025 Pontedera, Italy; Rehabilitation Bioengineering Laboratory, Volterra, Italy
| | - Paolo Dario
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Polo Sant'Anna Valdera, V.le R. Piaggio 34-56025 Pontedera, Italy
| | - Stefano Mazzoleni
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Polo Sant'Anna Valdera, V.le R. Piaggio 34-56025 Pontedera, Italy; Rehabilitation Bioengineering Laboratory, Volterra, Italy.
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28
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Pila O, Duret C, Laborne FX, Gracies JM, Bayle N, Hutin E. Pattern of improvement in upper limb pointing task kinematics after a 3-month training program with robotic assistance in stroke. J Neuroeng Rehabil 2017; 14:105. [PMID: 29029633 PMCID: PMC5640903 DOI: 10.1186/s12984-017-0315-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 10/03/2017] [Indexed: 01/19/2023] Open
Abstract
Background When exploring changes in upper limb kinematics and motor impairment associated with motor recovery in subacute post stroke during intensive therapies involving robot-assisted training, it is not known whether trained joints improve before non-trained joints and whether target reaching capacity improves before movement accuracy. Methods Twenty-two subacute stroke patients (mean delay post-stroke at program onset 63 ± 29 days, M2) underwent 50 ± 17 (mean ± SD) 45-min sessions of robot-assisted (InMotion™) shoulder/elbow training over 3 months, in addition to conventional occupational therapy. Monthly evaluations (M2 to M5) included Fugl-Meyer Assessment (FM), with subscores per joint, and four robot-based kinematic measures: mean target distance covered, mean velocity, direction accuracy (inverse of root mean square error from straight line) and movement smoothness (inverse of mean number of zero-crossings in the velocity profile). We assessed delays to reach statistically significant improvement for each outcome measure. Results At M5, all clinical and kinematic parameters had markedly improved: Fugl-Meyer, +65% (median); distance covered, +87%; mean velocity, +101%; accuracy, +134%; and smoothness, +96%. Delays to reach statistical significance were M3 for the shoulder/elbow Fugl-Meyer subscore (+43%), M4 for the hand (+80%) and M5 for the wrist (+133%) subscores. For kinematic parameters, delays to significant improvements were M3 for distance (+68%), velocity (+65%) and smoothness (+50%), and M5 for accuracy (+134%). Conclusions An intensive rehabilitation program combining robot-assisted shoulder/elbow training and conventional occupational therapy was associated with improvement in shoulder and elbow movements first, which suggests focal behavior-related brain plasticity. Findings also suggested that recovery of movement quantity related parameters (range of motion, velocity and smoothness) might precede that of movement quality (accuracy). Trial registration EudraCT 2016–005121-36. Date of Registration: 2016–12-20. Date of enrolment of the first participant to the trial: 2009–11-24 (retrospective data).
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Affiliation(s)
- Ophélie Pila
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, 19 rue du Château, Boissise-Le-Roi, 77310, France. .,EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement (ARM), Université Paris-Est Créteil, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France.
| | - Christophe Duret
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, 19 rue du Château, Boissise-Le-Roi, 77310, France
| | - François-Xavier Laborne
- SAMU 91, Centre Hospitalier Sud Francilien, 116 Boulevard Jean Jaurès, Corbeil-Essonnes, 91100, France
| | - Jean-Michel Gracies
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement (ARM), Université Paris-Est Créteil, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France
| | - Nicolas Bayle
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement (ARM), Université Paris-Est Créteil, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France
| | - Emilie Hutin
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement (ARM), Université Paris-Est Créteil, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France
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29
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Grosmaire AG, Duret C. Does assist-as-needed upper limb robotic therapy promote participation in repetitive activity-based motor training in sub-acute stroke patients with severe paresis? NeuroRehabilitation 2017; 41:31-39. [DOI: 10.3233/nre-171454] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Anne-Gaëlle Grosmaire
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, Boissise-Le-Roi, France
| | - Christophe Duret
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, Boissise-Le-Roi, France
- Centre Hospitalier Sud Francilien, Neurologie, Corbeil-Essonnes, France
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Shishov N, Melzer I, Bar-Haim S. Parameters and Measures in Assessment of Motor Learning in Neurorehabilitation; A Systematic Review of the Literature. Front Hum Neurosci 2017; 11:82. [PMID: 28286474 PMCID: PMC5324661 DOI: 10.3389/fnhum.2017.00082] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/09/2017] [Indexed: 12/21/2022] Open
Abstract
Upper limb function, essential for daily life, is often impaired in individuals after stroke and cerebral palsy (CP). For an improved upper limb function, learning should occur, and therefore training with motor learning principles is included in many rehabilitation interventions. Despite accurate measurement being an important aspect for examination and optimization of treatment outcomes, there are no standard algorithms for outcome measures selection. Moreover, the ability of the chosen measures to identify learning is not well established. We aimed to review and categorize the parameters and measures utilized for identification of motor learning in stroke and CP populations. PubMed, Pedro, and Web of Science databases were systematically searched between January 2000 and March 2016 for studies assessing a form of motor learning following upper extremity training using motor control measures. Thirty-two studies in persons after stroke and 10 studies in CP of any methodological quality were included. Identified outcome measures were sorted into two categories, “parameters,” defined as identifying a form of learning, and “measures,” as tools measuring the parameter. Review's results were organized as a narrative synthesis focusing on the outcome measures. The included studies were heterogeneous in their study designs, parameters and measures. Parameters included adaptation (n = 6), anticipatory control (n = 2), after-effects (n = 3), de-adaptation (n = 4), performance (n = 24), acquisition (n = 8), retention (n = 8), and transfer (n = 14). Despite motor learning theory's emphasis on long-lasting changes and generalization, the majority of studies did not assess the retention and transfer parameters. Underlying measures included kinematic analyses in terms of speed, geometry or both (n = 39), dynamic metrics, measures of accuracy, consistency, and coordination. There is no exclusivity of measures to a specific parameter. Many factors affect task performance and the ability to measure it—necessitating the use of several metrics to examine different features of movement and learning. Motor learning measures' applicability to clinical setting can benefit from a treatment-focused approach, currently lacking. The complexity of motor learning results in various metrics, utilized to assess its occurrence, making it difficult to synthesize findings across studies. Further research is desirable for development of an outcome measures selection algorithm, while considering the quality of such measurements.
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Affiliation(s)
- Nataliya Shishov
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev Beer-Sheva, Israel
| | - Itshak Melzer
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev Beer-Sheva, Israel
| | - Simona Bar-Haim
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev Beer-Sheva, Israel
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Orihuela-Espina F, Roldán GF, Sánchez-Villavicencio I, Palafox L, Leder R, Sucar LE, Hernández-Franco J. Robot training for hand motor recovery in subacute stroke patients: A randomized controlled trial. J Hand Ther 2016; 29:51-7; quiz 57. [PMID: 26847320 DOI: 10.1016/j.jht.2015.11.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 10/17/2015] [Accepted: 11/15/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Evidence of superiority of robot training for the hand over classical therapies in stroke patients remains controversial. During the subacute stage, hand training is likely to be the most useful. AIM To establish whether robot active assisted therapies provides any additional motor recovery for the hand when administered during the subacute stage (<4 months from event) in a Mexican adult population diagnosed with stroke. HYPOTHESIS Compared to classical occupational therapy, robot based therapies for hand recovery will show significant differences at subacute stages. TRIAL DESIGN A randomized clinical trial. METHODS A between subjects randomized controlled trial was carried out on subacute stroke patients (n = 17) comparing robot active assisted therapy (RT) with a classical occupational therapy (OT). Both groups received 40 sessions ensuring at least 300 repetitions per session. Treatment duration was (mean ± std) 2.18 ± 1.25 months for the control group and 2.44 ± 0.88 months for the study group. The primary outcome was motor dexterity changes assessed with the Fugl-Meyer (FMA) and the Motricity Index (MI). RESULTS Both groups (OT: n = 8; RT: n = 9) exhibited significant improvements over time (Non-parametric Cliff's delta-within effect sizes: dwOT-FMA = 0.5, dwOT-MI = 0.5, dwRT-FMA = 1, dwRT-MI = 1). Regarding differences between the therapies; the Fugl-Meyer score indicated a significant advantage for the hand training with the robot (FMA hand: WRS: W = 8, p <0.01), whilst the Motricity index suggested a greater improvement (size effect) in hand prehension for RT with respect to OT but failed to reach significance (MI prehension: W = 17.5, p = 0.080). No harm occurred. CONCLUSIONS Robotic therapies may be useful during the subacute stages of stroke - both endpoints (FM hand and MI prehension) showed the expected trend with bigger effect size for the robotic intervention. Additional benefit of the robotic therapy over the control therapy was only significant when the difference was measured with FM, demanding further investigation with larger samples. Implications of this study are important for decision making during therapy administration and resource allocation.
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Affiliation(s)
| | | | | | - Lorena Palafox
- National Institute of Neurology and Neurosurgery (INNN), Mexico City, Mexico
| | - Ronald Leder
- National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Luis Enrique Sucar
- National Institute for Astrophysics, Optics and Electronics (INAOE), Puebla, Mexico
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Panarese A, Pirondini E, Tropea P, Cesqui B, Posteraro F, Micera S. Model-based variables for the kinematic assessment of upper-extremity impairments in post-stroke patients. J Neuroeng Rehabil 2016; 13:81. [PMID: 27609062 PMCID: PMC5016877 DOI: 10.1186/s12984-016-0187-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 08/26/2016] [Indexed: 11/22/2022] Open
Abstract
Background Common scales for clinical evaluation of post-stroke upper-limb motor recovery are often complemented with kinematic parameters extracted from movement trajectories. However, there is no a general consensus on which parameters to use. Moreover, the selected variables may be redundant and highly correlated or, conversely, may incompletely sample the kinematic information from the trajectories. Here we sought to identify a set of clinically useful variables for an exhaustive but yet economical kinematic characterization of upper limb movements performed by post-stroke hemiparetic subjects. Methods For this purpose, we pursued a top-down model-driven approach, seeking which kinematic parameters were pivotal for a computational model to generate trajectories of point-to-point planar movements similar to those made by post-stroke subjects at different levels of impairment. Results The set of kinematic variables used in the model allowed for the generation of trajectories significantly similar to those of either sub-acute or chronic post-stroke patients at different time points during the therapy. Simulated trajectories also correctly reproduced many kinematic features of real movements, as assessed by an extensive set of kinematic metrics computed on both real and simulated curves. When inspected for redundancy, we found that variations in the variables used in the model were explained by three different underlying and unobserved factors related to movement efficiency, speed, and accuracy, possibly revealing different working mechanisms of recovery. Conclusion This study identified a set of measures capable of extensively characterizing the kinematics of upper limb movements performed by post-stroke subjects and of tracking changes of different motor improvement aspects throughout the rehabilitation process. Electronic supplementary material The online version of this article (doi:10.1186/s12984-016-0187-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alessandro Panarese
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale R. Piaggio 34, 56025, Pontedera, Pisa, Italy.
| | - Elvira Pirondini
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
| | - Peppino Tropea
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale R. Piaggio 34, 56025, Pontedera, Pisa, Italy
| | - Benedetta Cesqui
- Centre of Space Bio-medicine, University of Rome Tor Vergata, Rome, Italy.,Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Federico Posteraro
- Rehabilitation Department Versilia Hospital, AUSL 12, Viareggio, Italy.,Bioengineering Rehabilitation Laboratory, Auxilium Vitae Rehabilitation Centre, Volterra, Italy
| | - Silvestro Micera
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale R. Piaggio 34, 56025, Pontedera, Pisa, Italy.,Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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33
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de los Reyes-Guzmán A, Dimbwadyo-Terrer I, Pérez-Nombela S, Monasterio-Huelin F, Torricelli D, Pons JL, Gil-Agudo A. Novel kinematic indices for quantifying upper limb ability and dexterity after cervical spinal cord injury. Med Biol Eng Comput 2016; 55:833-844. [DOI: 10.1007/s11517-016-1555-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 07/30/2016] [Indexed: 12/17/2022]
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34
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Longhi M, Merlo A, Prati P, Giacobbi M, Mazzoli D. Instrumental indices for upper limb function assessment in stroke patients: a validation study. J Neuroeng Rehabil 2016; 13:52. [PMID: 27278277 PMCID: PMC4898355 DOI: 10.1186/s12984-016-0163-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 06/03/2016] [Indexed: 01/17/2023] Open
Abstract
Background Robotic exoskeletons are increasingly being used in objective and quantitative assessment of upper limb (UL) movements. A set of instrumental indices computed during robot-assisted reaching tasks with the Armeo®Spring has been proven to assess UL functionality. The aim of this study was to test the construct validity of this indices-based UL assessment when used with patients who have had a stroke. Methods Forty-four 45- to 79-year-old stroke patients with a Wolf Motor Function Test ability score (WMFT-FAS) ranging from 10 to 75 and a Motricity Index (MI) ranging from 14 to 33 at shoulder and elbow were enrolled, thus covering a wide range of impairments. Residual UL function was assessed by both the WMFT-FAS and the WMFT-TIME, as well as by a set of 9 numerical indices assessing movement accuracy, velocity and smoothness computed from a 3D endpoint trajectory obtained during the “Vertical Capture” task of the Armeo®Spring device. To explore which variables better represented motor control deficits, the Mann-Whitney U Test was used to compare patients’ indices to those obtained from 25 healthy individuals. To explore the inner relationships between indices and construct validity in assessing accuracy, velocity and smoothness, a factor analysis was carried out. To verify the indices concurrent validity, they were compared to both WMFT-FAS and WMFT-TIME by the Spearman’s correlation coefficient. Results Seven indices of stroke subjects were significantly different from those of healthy controls, with effect sizes in the range 0.35–0.74. Factor analysis confirmed that specific subsets of indices belonged to the domains of accuracy, velocity and smoothness (discriminant validity). One accuracy index, both velocity indices and two smoothness indices were significantly correlated with WMFT-FAS and WMFT-TIME (|rho| = 0.31–0.50) (concurrent validity). One index for each of the assessed movement domains was proven to have construct validity (discriminant and concurrent) and was selected. Moreover, the indices were able to detect differences in accuracy, velocity and/or smoothness in patients with the same WMFT level. Conclusions The proposed index-based UL assessment can be used to integrate and support clinical evaluation of UL function in stroke patients.
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Affiliation(s)
- Maria Longhi
- Gait & Motion Analysis Laboratory, Sol et Salus Hospital, viale San Salvador 204, Rimini, 47922, Torre Pedrera di Rimini, Italy
| | - Andrea Merlo
- Gait & Motion Analysis Laboratory, Sol et Salus Hospital, viale San Salvador 204, Rimini, 47922, Torre Pedrera di Rimini, Italy. .,Rehabilitation Department, Motion Analysis Laboratory, AUSL of Reggio Emilia, via Mandriolo Superiore 11, Correggio, 42015, Reggio Emilia, Italy.
| | - Paolo Prati
- Gait & Motion Analysis Laboratory, Sol et Salus Hospital, viale San Salvador 204, Rimini, 47922, Torre Pedrera di Rimini, Italy
| | - Meris Giacobbi
- Gait & Motion Analysis Laboratory, Sol et Salus Hospital, viale San Salvador 204, Rimini, 47922, Torre Pedrera di Rimini, Italy
| | - Davide Mazzoli
- Gait & Motion Analysis Laboratory, Sol et Salus Hospital, viale San Salvador 204, Rimini, 47922, Torre Pedrera di Rimini, Italy
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Duret C, Courtial O, Grosmaire AG. Kinematic measures for upper limb motor assessment during robot-mediated training in patients with severe sub-acute stroke. Restor Neurol Neurosci 2016; 34:237-45. [DOI: 10.3233/rnn-150565] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Christophe Duret
- CRF Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Rééducation Neurologique, Boissise-Le-Roi, France
- Centre Hospitalier Sud Francilien, Neurologie, Corbeil-Essonnes, France
| | - Ophélie Courtial
- CRF Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Rééducation Neurologique, Boissise-Le-Roi, France
| | - Anne Gaelle Grosmaire
- CRF Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Rééducation Neurologique, Boissise-Le-Roi, France
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Di Lazzaro V, Capone F, Di Pino G, Pellegrino G, Florio L, Zollo L, Simonetti D, Ranieri F, Brunelli N, Corbetto M, Miccinilli S, Bravi M, Milighetti S, Guglielmelli E, Sterzi S. Combining Robotic Training and Non-Invasive Brain Stimulation in Severe Upper Limb-Impaired Chronic Stroke Patients. Front Neurosci 2016; 10:88. [PMID: 27013950 PMCID: PMC4782015 DOI: 10.3389/fnins.2016.00088] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 02/22/2016] [Indexed: 11/18/2022] Open
Abstract
Previous studies suggested that both robot-assisted rehabilitation and non-invasive brain stimulation can produce a slight improvement in severe chronic stroke patients. It is still unknown whether their combination can produce synergistic and more consistent improvements. Safety and efficacy of this combination has been assessed within a proof-of-principle, double-blinded, semi-randomized, sham-controlled trial. Inhibitory continuous Theta Burst Stimulation (cTBS) was delivered on the affected hemisphere, in order to improve the response to the following robot-assisted therapy via a homeostatic increase of learning capacity. Twenty severe upper limb-impaired chronic stroke patients were randomized to robot-assisted therapy associated with real or sham cTBS, delivered for 10 working days. Eight real and nine sham patients completed the study. Change in Fugl-Meyer was chosen as primary outcome, while changes in several quantitative indicators of motor performance extracted by the robot as secondary outcomes. The treatment was well-tolerated by the patients and there were no adverse events. All patients achieved a small, but significant, Fugl-Meyer improvement (about 5%). The difference between the real and the sham cTBS groups was not significant. Among several secondary end points, only the Success Rate (percentage of targets reached by the patient) improved more in the real than in the sham cTBS group. This study shows that a short intensive robot-assisted rehabilitation produces a slight improvement in severe upper-limb impaired, even years after the stroke. The association with homeostatic metaplasticity-promoting non-invasive brain stimulation does not augment the clinical gain in patients with severe stroke.
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Affiliation(s)
- Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di RomaRome, Italy; Fondazione Alberto Sordi - Research Institute for AgeingRome, Italy
| | - Fioravante Capone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di RomaRome, Italy; Fondazione Alberto Sordi - Research Institute for AgeingRome, Italy
| | - Giovanni Di Pino
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di RomaRome, Italy; Fondazione Alberto Sordi - Research Institute for AgeingRome, Italy
| | - Giovanni Pellegrino
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma Rome, Italy
| | - Lucia Florio
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma Rome, Italy
| | - Loredana Zollo
- Unit of Biomedical Robotics and Biomicrosystems, Department of Engineering, Università Campus Bio-Medico di Roma Rome, Italy
| | - Davide Simonetti
- Unit of Biomedical Robotics and Biomicrosystems, Department of Engineering, Università Campus Bio-Medico di Roma Rome, Italy
| | - Federico Ranieri
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di RomaRome, Italy; Fondazione Alberto Sordi - Research Institute for AgeingRome, Italy
| | - Nicoletta Brunelli
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di RomaRome, Italy; Fondazione Alberto Sordi - Research Institute for AgeingRome, Italy
| | - Marzia Corbetto
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di RomaRome, Italy; Fondazione Alberto Sordi - Research Institute for AgeingRome, Italy
| | - Sandra Miccinilli
- Unit of Physical and Rehabilitation Medicine, Department of Medicine, Università Campus Bio-Medico di Roma Rome, Italy
| | - Marco Bravi
- Unit of Physical and Rehabilitation Medicine, Department of Medicine, Università Campus Bio-Medico di Roma Rome, Italy
| | - Stefano Milighetti
- Unit of Physical and Rehabilitation Medicine, Department of Medicine, Università Campus Bio-Medico di Roma Rome, Italy
| | - Eugenio Guglielmelli
- Unit of Biomedical Robotics and Biomicrosystems, Department of Engineering, Università Campus Bio-Medico di Roma Rome, Italy
| | - Silvia Sterzi
- Unit of Physical and Rehabilitation Medicine, Department of Medicine, Università Campus Bio-Medico di Roma Rome, Italy
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De los Reyes-Guzmán A, Dimbwadyo-Terrer I, Pérez-Nombela S, Monasterio-Huelin F, Torricelli D, Pons JL, Gil-Agudo A. Novel kinematic indices for quantifying movement agility and smoothness after cervical Spinal Cord Injury. NeuroRehabilitation 2016; 38:199-209. [PMID: 26923358 DOI: 10.3233/nre-161311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND After cervical Spinal Cord Injury (SCI), upper limb movements made by patients have a lack of smoothness and a hand velocity profile characterized by a high number of velocity peaks. OBJECTIVE The aim of the present paper is to propose three novel kinematic indices for quantifying movement agility and smoothness, and to analyze their discriminative capability between healthy and pathological people. METHODS 18 people, healthy and two groups of patients with cervical SCI, participated in the study. Kinematic indices in relation to movement agility and smoothness were computed from hand trajectories and velocity profiles during the performance of the ADL of drinking from a glass. RESULTS The proposed indices discriminated between healthy and SCI people. The results are greater in healthy than SCI people. Both smoothness indices detected significant differences between healthy and both SCI groups. Moreover, the Agility index showed capacity for discriminating between both patients groups. CONCLUSIONS The main contribution of this research consists on the proposal of kinematic indices from experimental data, whose results are dimensionless and relative to a pattern of healthy subjects. We hope that kinematic indices proposed are a step toward the standardization of the quantitative assessment of movement characteristics and functional impairments.
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Affiliation(s)
- Ana De los Reyes-Guzmán
- Department of Biomechanics and Technical Aids. National Hospital for Spinal Cord Injury (SESCAM), Finca La Peraleda, Toledo, Spain
| | - Iris Dimbwadyo-Terrer
- Occupational Thinks Research Group, Centro Superior de Estudios La Salle (UAM), C/La Salle, Madrid, Spain
| | - Soraya Pérez-Nombela
- Department of Biomechanics and Technical Aids. National Hospital for Spinal Cord Injury (SESCAM), Finca La Peraleda, Toledo, Spain
| | - Félix Monasterio-Huelin
- Department of Special Technologies Applied to Telecommunication. Higher Technical School of Telecommunications Engineering, Technical University of Madrid, University City, Madrid, Spain
| | - Diego Torricelli
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), C/Doctor Arce, Madrid, Spain
| | - José Luis Pons
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), C/Doctor Arce, Madrid, Spain
| | - Angel Gil-Agudo
- Department of Biomechanics and Technical Aids. National Hospital for Spinal Cord Injury (SESCAM), Finca La Peraleda, Toledo, Spain
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Colombo R, Sterpi I, Mazzone A, Delconte C, Pisano F. Improving proprioceptive deficits after stroke through robot-assisted training of the upper limb: a pilot case report study. Neurocase 2016; 22:191-200. [PMID: 26565132 DOI: 10.1080/13554794.2015.1109667] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The purpose of this study was to determine whether a conventional robot-assisted therapy of the upper limb was able to improve proprioception and motor recovery of an individual after stroke who exhibited proprioceptive deficits. After robotic sensorimotor training, significant changes were observed in kinematic performance variables. Two quantitative parameters evaluating position sense improved after training. Range of motion during shoulder and wrist flexion improved, but only wrist flexion remained improved at 3-month follow-up. These preliminary results suggest that intensive robot-aided rehabilitation may play an important role in the recovery of sensory function. However, further studies are required to confirm these data.
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Affiliation(s)
- R Colombo
- a Service of Bioengineering , "Salvatore Maugeri" Foundation, IRCCS , Pavia , Italy.,b Service of Bioengineering , "Salvatore Maugeri" Foundation, IRCCS , Veruno , NO , Italy
| | - I Sterpi
- a Service of Bioengineering , "Salvatore Maugeri" Foundation, IRCCS , Pavia , Italy
| | - A Mazzone
- b Service of Bioengineering , "Salvatore Maugeri" Foundation, IRCCS , Veruno , NO , Italy
| | - C Delconte
- c Neurologic Rehabilitation Division , "Salvatore Maugeri" Foundation, IRCCS , Veruno , NO , Italy
| | - F Pisano
- c Neurologic Rehabilitation Division , "Salvatore Maugeri" Foundation, IRCCS , Veruno , NO , Italy
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Randomized, Placebo-Controlled, Double-Blind Pilot Study of D-Cycloserine in Chronic Stroke. Rehabil Res Pract 2015; 2015:534239. [PMID: 26587287 PMCID: PMC4637506 DOI: 10.1155/2015/534239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/02/2015] [Accepted: 10/05/2015] [Indexed: 11/17/2022] Open
Abstract
Stroke is a leading cause of death and disability in the USA. Up to 60% of patients do not fully recover despite intensive physical therapy treatment. N-Methyl-D-aspartate receptors (NMDA-R) have been shown to play a role in synaptic plasticity when activated. D-Cycloserine promotes NMDA receptor function by binding to receptors with unoccupied glycine sites. These receptors are involved in learning and memory. We hypothesized that D-cycloserine, when combined with robotic-assisted physiotherapy (RAP), would result in greater gains compared with placebo + RAP in stroke survivors. Participants (n = 14) were randomized to D-cycloserine plus RAP or placebo plus RAP. Functional, cognitive, and quality-of-life measures were used to assess recovery. There was significant improvement in grip strength of the affected hand within both groups from baseline to 3 weeks (95% confidence interval for mean change, 3.95 ± 2.96 to 4.90 ± 3.56 N for D-cycloserine and 5.72 ± 3.98 to 8.44 ± 4.90 N for control). SIS mood domain showed improvement for both groups (95% confidence interval for mean change, 72.6 ± 16.3 to 82.9 ± 10.9 for D-cycloserine and 82.9 ± 13.5 to 90.3 ± 9.9 for control). This preliminary study does not provide evidence that D-cycloserine can provide greater gains in learning compared with placebo for stroke survivors.
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Otaka E, Otaka Y, Kasuga S, Nishimoto A, Yamazaki K, Kawakami M, Ushiba J, Liu M. Clinical usefulness and validity of robotic measures of reaching movement in hemiparetic stroke patients. J Neuroeng Rehabil 2015; 12:66. [PMID: 26265327 PMCID: PMC4533801 DOI: 10.1186/s12984-015-0059-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 08/03/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Various robotic technologies have been developed recently for objective and quantitative assessment of movement. Among them, robotic measures derived from a reaching task in the KINARM Exoskeleton device are characterized by their potential to reveal underlying motor control in reaching movements. The aim of this study was to examine the clinical usefulness and validity of these robot-derived measures in hemiparetic stroke patients. METHODS Fifty-six participants with a hemiparetic arm due to chronic stroke were enrolled. The robotic assessment was performed using the Visually Guided Reaching (VGR) task in the KINARM Exoskeleton, which allows free arm movements in the horizontal plane. Twelve parameters were derived based on motor control theory. The following clinical assessments were also administered: the proximal upper limb section in the Fugl-Meyer Assessment (FMA-UE(A)), the proximal upper limb part in the Stroke Impairment Assessment Set (SIAS-KM), the Modified Ashworth Scale for the affected elbow flexor muscles (MAS elbow), and seven proximal upper limb tasks in the Wolf Motor Function Test (WMFT). To explore which robotic measures represent deficits of motor control in the affected arm, the VGR parameters in the paretic arm were compared with those in the non-paretic arm using the Wilcoxon signed rank test. Then, to explore which VGR parameters were related to overall motor control regardless of the paresis, correlations between the paretic and non-paretic arms were examined. Finally, to investigate the relationships between the robotic measures and the clinical scales, correlations between the VGR parameters and clinical scales were investigated. Spearman's rank correlation coefficients were used for all correlational analyses. RESULTS Eleven VGR parameters on the paretic side were significantly different from those on the non-paretic side with large effect sizes (|effect size| = 0.76-0.87). Ten VGR parameters correlated significantly with FMA-UE(A) (|r| = 0.32-0.60). Eight VGR parameters also showed significant correlations with SIAS-KM (|r| = 0.42-0.49), MAS elbow (|r| = 0.44-0.48), and the Functional Ability Scale of the WMFT (|r| = 0.52-0.64). CONCLUSIONS The robot-derived measures could successfully differentiate between the paretic arm and the non-paretic arm and were valid in comparison to the well-established clinical scales.
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Affiliation(s)
- Eri Otaka
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Yohei Otaka
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Shoko Kasuga
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Atsuko Nishimoto
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Kotaro Yamazaki
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Junichi Ushiba
- Department of Biosciences and Informatics, Faculty of Science and Technology, Keio University, Kanagawa, Japan.
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
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Keller U, Schölch S, Albisser U, Rudhe C, Curt A, Riener R, Klamroth-Marganska V. Robot-assisted arm assessments in spinal cord injured patients: a consideration of concept study. PLoS One 2015; 10:e0126948. [PMID: 25996374 PMCID: PMC4440615 DOI: 10.1371/journal.pone.0126948] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/09/2015] [Indexed: 11/19/2022] Open
Abstract
Robotic assistance is increasingly used in neurological rehabilitation for enhanced training. Furthermore, therapy robots have the potential for accurate assessment of motor function in order to diagnose the patient status, to measure therapy progress or to feedback the movement performance to the patient and therapist in real time. We investigated whether a set of robot-based assessments that encompasses kinematic, kinetic and timing metrics is applicable, safe, reliable and comparable to clinical metrics for measurement of arm motor function. Twenty-four healthy subjects and five patients after spinal cord injury underwent robot-based assessments using the exoskeleton robot ARMin. Five different tasks were performed with aid of a visual display. Ten kinematic, kinetic and timing assessment parameters were extracted on joint- and end-effector level (active and passive range of motion, cubic reaching volume, movement time, distance-path ratio, precision, smoothness, reaction time, joint torques and joint stiffness). For cubic volume, joint torques and the range of motion for most joints, good inter- and intra-rater reliability were found whereas precision, movement time, distance-path ratio and smoothness showed weak to moderate reliability. A comparison with clinical scores revealed good correlations between robot-based joint torques and the Manual Muscle Test. Reaction time and distance-path ratio showed good correlation with the “Graded and Redefined Assessment of Strength, Sensibility and Prehension” (GRASSP) and the Van Lieshout Test (VLT) for movements towards a predefined position in the center of the frontal plane. In conclusion, the therapy robot ARMin provides a comprehensive set of assessments that are applicable and safe. The first results with spinal cord injured patients and healthy subjects suggest that the measurements are widely reliable and comparable to clinical scales for arm motor function. The methods applied and results can serve as a basis for the future development of end-effector and exoskeleton-based robotic assessments.
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Affiliation(s)
- Urs Keller
- Sensory-Motor Systems Lab, Department of Health Sciences and Technology ETH Zurich, Zurich, Switzerland
- Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- * E-mail:
| | - Sabine Schölch
- Sensory-Motor Systems Lab, Department of Health Sciences and Technology ETH Zurich, Zurich, Switzerland
- Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Urs Albisser
- Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Claudia Rudhe
- Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Armin Curt
- Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Robert Riener
- Sensory-Motor Systems Lab, Department of Health Sciences and Technology ETH Zurich, Zurich, Switzerland
- Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Verena Klamroth-Marganska
- Sensory-Motor Systems Lab, Department of Health Sciences and Technology ETH Zurich, Zurich, Switzerland
- Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Papaleo E, Zollo L, Garcia-Aracil N, Badesa FJ, Morales R, Mazzoleni S, Sterzi S, Guglielmelli E. Upper-limb kinematic reconstruction during stroke robot-aided therapy. Med Biol Eng Comput 2015; 53:815-28. [PMID: 25861746 DOI: 10.1007/s11517-015-1276-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 03/07/2015] [Indexed: 11/27/2022]
Abstract
The paper proposes a novel method for an accurate and unobtrusive reconstruction of the upper-limb kinematics of stroke patients during robot-aided rehabilitation tasks with end-effector machines. The method is based on a robust analytic procedure for inverse kinematics that simply uses, in addition to hand pose data provided by the robot, upper arm acceleration measurements for computing a constraint on elbow position; it is exploited for task space augmentation. The proposed method can enable in-depth comprehension of planning strategy of stroke patients in the joint space and, consequently, allow developing therapies tailored for their residual motor capabilities. The experimental validation has a twofold purpose: (1) a comparative analysis with an optoelectronic motion capturing system is used to assess the method capability to reconstruct joint motion; (2) the application of the method to healthy and stroke subjects during circle-drawing tasks with InMotion2 robot is used to evaluate its efficacy in discriminating stroke from healthy behavior. The experimental results have shown that arm angles are reconstructed with a RMSE of 8.3 × 10(-3) rad. Moreover, the comparison between healthy and stroke subjects has revealed different features in the joint space in terms of mean values and standard deviations, which also allow assessing inter- and intra-subject variability. The findings of this study contribute to the investigation of motor performance in the joint space and Cartesian space of stroke patients undergoing robot-aided therapy, thus allowing: (1) evaluating the outcomes of the therapeutic approach, (2) re-planning the robotic treatment based on patient needs, and (3) understanding pathology-related motor strategies.
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Affiliation(s)
- E Papaleo
- Laboratory of Biomedical Robotics and Biomicrosystems, Università Campus Bio-Medico di Roma, Rome, Italy.
| | - L Zollo
- Laboratory of Biomedical Robotics and Biomicrosystems, Università Campus Bio-Medico di Roma, Rome, Italy.
| | - N Garcia-Aracil
- Virtual Reality and Robotics Lab, Universidad Miguel Hernandez de Elche, Elche, Spain.
| | - F J Badesa
- Virtual Reality and Robotics Lab, Universidad Miguel Hernandez de Elche, Elche, Spain.
| | - R Morales
- Virtual Reality and Robotics Lab, Universidad Miguel Hernandez de Elche, Elche, Spain.
| | - S Mazzoleni
- BioRobotics Institute, Scuola Superiore Sant'Anna Pisa, Pisa, Italy.
| | - S Sterzi
- Operative Unit of Physical Medicine and Rehabilitation, Università Campus Bio-Medico di Roma, Rome, Italy.
| | - E Guglielmelli
- Laboratory of Biomedical Robotics and Biomicrosystems, Università Campus Bio-Medico di Roma, Rome, Italy.
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Yoo DH, Kim SY. Effects of upper limb robot-assisted therapy in the rehabilitation of stroke patients. J Phys Ther Sci 2015; 27:677-9. [PMID: 25931706 PMCID: PMC4395690 DOI: 10.1589/jpts.27.677] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 10/10/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to examine the effects of upper limb robot-assisted
therapy in the rehabilitation of stroke patients. [Subjects and Methods] Fifteen stroke
patients with no visual or cognitive problems were enrolled. All subjects received
robot-assisted therapy and comprehensive rehabilitation therapy for 30 minutes each. The
experimental group received a conventional therapy and an additional half hour per weekday
of robot therapy. The patients participated in a total of 20 sessions, each lasting 60
minutes (conventional therapy 30 min, robot-assisted therapy 30 min), which were held 5
days a week for 4 weeks. [Result] The patients showed a significant difference in
smoothness and reach error of the point to point test, circle size and independence of the
circle in the circle test, and hold deviation of the playback static test between before
and after the intervention. On the other hand, no significant difference was observed in
the displacement of the round dynamic test. The patients also showed significant
improvement in the Fugl-Meyer Assessment and Modified Barthel Index after the
intervention. [Conclusion] These kinematic factors can provide good information when
analyzing the upper limb function of stroke patients in robot-assisted therapy.
Nevertheless, further research on technology-based kinematic information will be
necessary.
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Affiliation(s)
- Doo Han Yoo
- Department of Occupational Therapy, Konyang University, Republic of Korea
| | - Se Yun Kim
- Department of Occupational Therapy, Woosuk University, Republic of Korea
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Use of a robotic device for the rehabilitation of severe upper limb paresis in subacute stroke: exploration of patient/robot interactions and the motor recovery process. BIOMED RESEARCH INTERNATIONAL 2015; 2015:482389. [PMID: 25821804 PMCID: PMC4363505 DOI: 10.1155/2015/482389] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 09/28/2014] [Accepted: 10/04/2014] [Indexed: 01/19/2023]
Abstract
This pioneering observational study explored the interaction between subacute stroke inpatients and a rehabilitation robot during upper limb training. 25 stroke survivors (age 55 ± 17 years; time since stroke, 52 ± 21 days) with severe upper limb paresis carried out 16 sessions of robot-assisted shoulder/elbow training (InMotion 2.0, IMT, Inc., MA, USA) combined with standard therapy. The values of 3 patient/robot interaction parameters (a guidance parameter: Stiffness, a velocity-related parameter: Slottime, and Robotic Power) were compared between sessions 1 (S1), 4 (S4), 8 (S8), 12 (S12), and 16 (S16). Pre/post Fugl-Meyer Assessment (FMA) scores were compared in 18 patients. Correlations between interaction parameters and clinical and kinematic outcome measures were evaluated. Slottime decreased at S8 (P = 0.003), while Guidance decreased at S12 (P = 0.008). Robotic Power tended to decrease until S16. FMA scores improved from S1 to S16 (+49%, P = 0.002). Changes in FMA score were correlated with the Stiffness parameter (R = 0.4, P = 0.003). Slottime was correlated with movement velocity. This novel approach demonstrated that a robotic device is a useful and reliable tool for the quantification of interaction parameters. Moreover, changes in these parameters were correlated with clinical and kinematic changes. These results suggested that robot-based recordings can provide new insights into the motor recovery process.
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Turchetti G, Vitiello N, Trieste L, Romiti S, Geisler E, Micera S. Why effectiveness of robot-mediated neurorehabilitation does not necessarily influence its adoption. IEEE Rev Biomed Eng 2014; 7:143-53. [PMID: 24803207 DOI: 10.1109/rbme.2014.2300234] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This paper discusses the reasons why evidence of clinical effectiveness is not enough to facilitate adequate adoption of robotic technologies for upper-limb neurorehabilitation. The paper also provides a short review of the state of the art technologies. In particular, the paper highlights the barriers to the adoption of these technologies by the markets in which they are, or should be, deployed. On the other hand, the paper explores how low rates of adoption may depend on communication biases between the producers of the technologies and potential adopters. Finally, it is shown that, although technology-efficacy issues are usually well-documented, barriers to adoption also originate from the lack of solid evidence of the economic implications of the new technologies.
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Assessment of movement quality in robot- assisted upper limb rehabilitation after stroke: a review. J Neuroeng Rehabil 2014; 11:137. [PMID: 25217124 PMCID: PMC4180322 DOI: 10.1186/1743-0003-11-137] [Citation(s) in RCA: 166] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 08/27/2014] [Indexed: 11/10/2022] Open
Abstract
Studies of stroke patients undergoing robot-assisted rehabilitation have revealed various kinematic parameters describing movement quality of the upper limb. However, due to the different level of stroke impairment and different assessment criteria and interventions, the evaluation of the effectiveness of rehabilitation program is undermined. This paper presents a systematic review of kinematic assessments of movement quality of the upper limb and identifies the suitable parameters describing impairments in stroke patients. A total of 41 different clinical and pilot studies on different phases of stroke recovery utilizing kinematic parameters are evaluated. Kinematic parameters describing movement accuracy are mostly reported for chronic patients with statistically significant outcomes and correlate strongly with clinical assessments. Meanwhile, parameters describing feed-forward sensorimotor control are the most frequently reported in studies on sub-acute patients with significant outcomes albeit without correlation to any clinical assessments. However, lack of measures in coordinated movement and proximal component of upper limb enunciate the difficulties to distinguish the exploitation of joint redundancies exhibited by stroke patients in completing the movement. A further study on overall measures of coordinated movement is recommended.
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de los Reyes-Guzmán A, Dimbwadyo-Terrer I, Trincado-Alonso F, Monasterio-Huelin F, Torricelli D, Gil-Agudo A. Quantitative assessment based on kinematic measures of functional impairments during upper extremity movements: A review. Clin Biomech (Bristol, Avon) 2014; 29:719-27. [PMID: 25017296 DOI: 10.1016/j.clinbiomech.2014.06.013] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 05/14/2014] [Accepted: 06/10/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Quantitative measures of human movement quality are important for discriminating healthy and pathological conditions and for expressing the outcomes and clinically important changes in subjects' functional state. However the most frequently used instruments for the upper extremity functional assessment are clinical scales, that previously have been standardized and validated, but have a high subjective component depending on the observer who scores the test. But they are not enough to assess motor strategies used during movements, and their use in combination with other more objective measures is necessary. The objective of the present review is to provide an overview on objective metrics found in literature with the aim of quantifying the upper extremity performance during functional tasks, regardless of the equipment or system used for registering kinematic data. METHODS A search in Medline, Google Scholar and IEEE Xplore databases was performed following a combination of a series of keywords. The full scientific papers that fulfilled the inclusion criteria were included in the review. FINDINGS A set of kinematic metrics was found in literature in relation to joint displacements, analysis of hand trajectories and velocity profiles. These metrics were classified into different categories according to the movement characteristic that was being measured. INTERPRETATION These kinematic metrics provide the starting point for a proposed objective metrics for the functional assessment of the upper extremity in people with movement disorders as a consequence of neurological injuries. Potential areas of future and further research are presented in the Discussion section.
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Affiliation(s)
- Ana de los Reyes-Guzmán
- Biomechanics and Technical Aids Department, National Hospital for Spinal Cord Injury (SESCAM), Toledo, Spain.
| | - Iris Dimbwadyo-Terrer
- Biomechanics and Technical Aids Department, National Hospital for Spinal Cord Injury (SESCAM), Toledo, Spain
| | - Fernando Trincado-Alonso
- Biomechanics and Technical Aids Department, National Hospital for Spinal Cord Injury (SESCAM), Toledo, Spain
| | - Félix Monasterio-Huelin
- Special Technologies Applied to Telecommunication Department, Higher Technical School of Telecommunications Engineering, Technical University of Madrid (UPM), Avenida Complutense, 30, University City, 28040 Madrid, Spain
| | - Diego Torricelli
- Bioengineering Group, Centre of Automatics and Robotics, Spanish National Research Council (CSIC), Ctra. Campo Real, Km 0.2, Arganda del Rey, 28500 Madrid, Spain
| | - Angel Gil-Agudo
- Biomechanics and Technical Aids Department, National Hospital for Spinal Cord Injury (SESCAM), Toledo, Spain
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Basteris A, Nijenhuis SM, Stienen AHA, Buurke JH, Prange GB, Amirabdollahian F. Training modalities in robot-mediated upper limb rehabilitation in stroke: a framework for classification based on a systematic review. J Neuroeng Rehabil 2014; 11:111. [PMID: 25012864 PMCID: PMC4108977 DOI: 10.1186/1743-0003-11-111] [Citation(s) in RCA: 173] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 06/23/2014] [Indexed: 01/19/2023] Open
Abstract
Robot-mediated post-stroke therapy for the upper-extremity dates back to the 1990s. Since then, a number of robotic devices have become commercially available. There is clear evidence that robotic interventions improve upper limb motor scores and strength, but these improvements are often not transferred to performance of activities of daily living. We wish to better understand why. Our systematic review of 74 papers focuses on the targeted stage of recovery, the part of the limb trained, the different modalities used, and the effectiveness of each. The review shows that most of the studies so far focus on training of the proximal arm for chronic stroke patients. About the training modalities, studies typically refer to active, active-assisted and passive interaction. Robot-therapy in active assisted mode was associated with consistent improvements in arm function. More specifically, the use of HRI features stressing active contribution by the patient, such as EMG-modulated forces or a pushing force in combination with spring-damper guidance, may be beneficial.Our work also highlights that current literature frequently lacks information regarding the mechanism about the physical human-robot interaction (HRI). It is often unclear how the different modalities are implemented by different research groups (using different robots and platforms). In order to have a better and more reliable evidence of usefulness for these technologies, it is recommended that the HRI is better described and documented so that work of various teams can be considered in the same group and categories, allowing to infer for more suitable approaches. We propose a framework for categorisation of HRI modalities and features that will allow comparing their therapeutic benefits.
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Affiliation(s)
- Angelo Basteris
- Adaptive Systems Research Group, School of Computer Science, University of Hertfordshire, College Lane, AL95HX Hatfield, United Kingdom.
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Kinematic metrics based on the virtual reality system Toyra as an assessment of the upper limb rehabilitation in people with spinal cord injury. BIOMED RESEARCH INTERNATIONAL 2014; 2014:904985. [PMID: 24895627 PMCID: PMC4017839 DOI: 10.1155/2014/904985] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 02/11/2014] [Accepted: 02/20/2014] [Indexed: 11/18/2022]
Abstract
The aim of this study was to develop new strategies based on virtual reality that can provide additional information to clinicians for the rehabilitation assessment. Virtual reality system Toyra has been used to record kinematic information of 15 patients with cervical spinal cord injury (SCI) while performing evaluation sessions using the mentioned system. Positive correlation, with a moderate and very strong association, has been found between clinical scales and kinematic data, considering only the subscales more closely related to the upper limb function. A set of metrics was defined combining these kinematic data to obtain parameters of reaching amplitude, joint amplitude, agility, accuracy, and repeatability during the evaluation sessions of the virtual reality system Toyra. Strong and moderate correlations have been also found between the metrics reaching and joint amplitude and the clinical scales.
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Mazzoleni S, Puzzolante L, Zollo L, Dario P, Posteraro F. Mechanisms of motor recovery in chronic and subacute stroke patients following a robot-aided training. IEEE TRANSACTIONS ON HAPTICS 2014; 7:175-180. [PMID: 24968381 DOI: 10.1109/toh.2013.73] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The aim of this article is to propose a methodology for analyzing different recovery mechanisms in subacute and chronic patients through evaluation of biomechanical parameters. Twenty-five post-stroke subjects, eight subacute and seventeen chronic, participated in the study. A 2-DoF robotic system was used for upper limb training. Two clinical scales were used for assessment. Forces and velocities at the robot's end-effector during the execution of upper limb planar reaching movements were measured. Clinical outcome measures show a significant decrease in motor impairment after the treatment both in chronic and subacute patients (MSS-SE, p<0.001; FM, p<0.05). Movement velocity increases after the robot-aided treatment in both groups. Mean values of forces exerted by subacute patients are lower than those observed in chronic patients, both at the beginning and at the end of robotic treatment, as in the latter the pathological pattern is already structured. Our results demonstrate that the monitoring of the forces exerted on the end-effector during robot-aided treatment can identify the specific motor recovery mechanisms at different stages. If the pathological pattern is not yet structured, rehabilitative interventions should be addressed toward the use of motor re-learning procedures; on the other hand, if the force analysis shows a strong pathological pattern, mechanisms of compensation should be encouraged.
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