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Saragih ID, Everard G, Tzeng HM, Saragih IS, Lee BO. Efficacy of Robots-Assisted Therapy in Patients With Stroke: A Meta-analysis Update. J Cardiovasc Nurs 2023; 38:E192-E217. [PMID: 37816087 DOI: 10.1097/jcn.0000000000000945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Robot-assisted therapy (RAT) could address an unmet need to relieve the strain on healthcare providers and intensify treatment in the context of an increasing stroke incidence. A comprehensive meta-analysis could provide firmer data about the topic by considering methodology limitations discovered in previous reviews and providing more rigorous evidence. OBJECTIVE This meta-analysis study identifies RAT's efficacy for patients with stroke. METHODS A systematic search of the 7 databases from January 10 to February 1, 2022, located relevant publications. We used the updated Cochrane risk-of-bias checklist for 52 trials to assess the methodologic quality of the included studies. The efficacy of RAT for patients with stroke was estimated using a pooled random-effects model in the Stata 16 software application. RESULTS The final analysis included 2774 patients with stroke from 52 trials. In those patients, RAT was proven to improve quality of movement (mean difference, 0.15; 95% confidence interval, 0.03-0.28) and to reduce balance disturbances (mean difference, -1.28; 95% confidence interval, -2.48 to -0.09) and pain (standardized mean difference, -0.34; 95% confidence interval, -0.58 to -0.09). CONCLUSIONS Robot-assisted therapy seems to improve the quality of mobility and reduce balance disturbances and pain for patients with stroke. These findings will help develop advanced rehabilitation robots and could improve health outcomes by facilitating health services for healthcare providers and patients with stroke.
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Wang J, Li Y, Qi L, Mamtilahun M, Liu C, Liu Z, Shi R, Wu S, Yang GY. Advanced rehabilitation in ischaemic stroke research. Stroke Vasc Neurol 2023:svn-2022-002285. [PMID: 37788912 DOI: 10.1136/svn-2022-002285] [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: 12/30/2022] [Accepted: 03/20/2023] [Indexed: 10/05/2023] Open
Abstract
At present, due to the rapid progress of treatment technology in the acute phase of ischaemic stroke, the mortality of patients has been greatly reduced but the number of disabled survivors is increasing, and most of them are elderly patients. Physicians and rehabilitation therapists pay attention to develop all kinds of therapist techniques including physical therapy techniques, robot-assisted technology and artificial intelligence technology, and study the molecular, cellular or synergistic mechanisms of rehabilitation therapies to promote the effect of rehabilitation therapy. Here, we discussed different animal and in vitro models of ischaemic stroke for rehabilitation studies; the compound concept and technology of neurological rehabilitation; all kinds of biological mechanisms of physical therapy; the significance, assessment and efficacy of neurological rehabilitation; the application of brain-computer interface, rehabilitation robotic and non-invasive brain stimulation technology in stroke rehabilitation.
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Affiliation(s)
- Jixian Wang
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medical, Shanghai, China
| | - Yongfang Li
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medical, Shanghai, China
| | - Lin Qi
- Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Muyassar Mamtilahun
- Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chang Liu
- Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Ze Liu
- Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Rubing Shi
- Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Shengju Wu
- Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Guo-Yuan Yang
- Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
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Bressi F, Campagnola B, Cricenti L, Santacaterina F, Miccinilli S, Di Pino G, Fiori F, D'Alonzo M, Di Lazzaro V, Ricci L, Capone F, Pacilli A, Sterzi S, Bravi M. Upper limb home-based robotic rehabilitation in chronic stroke patients: A pilot study. Front Neurorobot 2023; 17:1130770. [PMID: 37009638 PMCID: PMC10061073 DOI: 10.3389/fnbot.2023.1130770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
IntroductionRobotic therapy allow to propose sessions of controlled and identical exercises, customizing settings, and characteristics on the individual patient. The effectiveness of robotic assisted therapy is still under study and the use of robots in clinical practice is still limited. Moreover, the possibility of treatment at home allows to reduce the economic costs and time to be borne by the patient and the caregiver and is a valid tool during periods of pandemic such as covid. The aim of this study is to assess whether a robotic home-based treatment rehabilitation using the iCONE robotic device has effects on a stroke population, despite the chronic condition of patients involved and the absence of a therapist next to the patient while performing the exercises.Materials and methodsAll patients underwent an initial (T0) and final (T1) assessment with the iCONE robotic device and clinical scales. After T0 evaluation, the robot was delivered to the patient's home for 10 days of at-home treatment (5 days a week for 2 weeks).ResultsComparison between T0 and T1 evaluations revealed some significant improvements in robot-evaluated indices such as Independence and Size for the Circle Drawing exercise and Movement Duration for Point-to-Point exercise, but also in the MAS of the elbow. From the analysis of the acceptability questionnaire, a general appreciation of the robot emerged: patients spontaneously asked for the addition of further sessions and to continue therapy.DiscussionTelerehabilitation of patients suffering from a chronic stroke is an area that is still little explored. From our experience, this is one of the first studies to carry out a telerehabilitation with these characteristics. The use of robots can become a method to reduce the rehabilitation health costs, to ensure continuity of care, and to arrive in more distant places or where the availability of resources is limited.ConclusionFrom the data obtained, this rehabilitation seems to be promising for this population. Moreover, promoting the recovery of the upper limb, iCONE can improve patient's quality of life. It would be interesting to conduct RCT studies to compare a conventional treatment in structure with a robotic telematics treatment.
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Affiliation(s)
- Federica Bressi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Benedetta Campagnola
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Laura Cricenti
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University of Rome, Rome, Italy
- *Correspondence: Laura Cricenti
| | - Fabio Santacaterina
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sandra Miccinilli
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Giovanni Di Pino
- Research Unit of Neurology, Neurophysiology and Neurobiology and Biomedical Robotics and Biomicrosystems, Campus Bio-Medico University of Rome, Rome, Italy
| | - Francesca Fiori
- Research Unit of Neurology, Neurophysiology and Neurobiology and Biomedical Robotics and Biomicrosystems, Campus Bio-Medico University of Rome, Rome, Italy
| | - Marco D'Alonzo
- Research Unit of Neurology, Neurophysiology and Neurobiology and Biomedical Robotics and Biomicrosystems, Campus Bio-Medico University of Rome, Rome, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Lorenzo Ricci
- Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Fioravante Capone
- Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | | | - Silvia Sterzi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Marco Bravi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University of Rome, Rome, Italy
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Johansen T, Sørensen L, Kolskår KK, Strøm V, Wouda MF. Effectiveness of robot-assisted arm exercise on arm and hand function in stroke survivors - A systematic review and meta-analysis. J Rehabil Assist Technol Eng 2023; 10:20556683231183639. [PMID: 37426037 PMCID: PMC10327418 DOI: 10.1177/20556683231183639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Objective: To examine the treatment effect of commercially available robotic-assisted devices, compared to traditional occupational- and physiotherapy on arm and hand function in persons with stroke. Methods: A systematic literature search was conducted in Medline, EMBASE, CINAHL and Cochrane Central Register of Controlled Trials up to January 2022. Randomized controlled trials (RCT's) involving persons with stroke of all ages and robot-assisted exercise as method for arm and hand function, compared to traditional therapy methods were included. Three authors performed the selection independently. The quality of evidence across studies was assessed using GRADE. Results: Eighteen RCT's were included in the study. A random effects meta-analysis showed a statistically significantly higher treatment effect in the robotic-assisted exercise group (p=<0.0001) compared to the traditional treatment group, with a total effect size of 0.44 (CI = 0.22-0.65). Heterogeneity was high, measured with I2 of 65%). Subgroup analyses showed no significant effects of the type of robotic device, treatment frequency or duration of intervention. Discussion and conclusion: Even though the analysis showed significant improvement in arm and hand function in favor of the robotic-assisted exercise group, the results in this systematic review should be interpreted with caution. This is due to high heterogeneity among the studies included and the presence of possible publication bias. Results of this study highlight the need for larger and more methodological robust RCT's, with a focus on reporting training intensity during robotic exercise.
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Affiliation(s)
- Truls Johansen
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Linda Sørensen
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
- Department of Innovation, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Knut K Kolskår
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Vegard Strøm
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Matthijs F Wouda
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
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Moore RT, Piitz MA, Singh N, Dukelow SP, Cluff T. Assessing Impairments in Visuomotor Adaptation After Stroke. Neurorehabil Neural Repair 2022; 36:415-425. [PMID: 35616370 PMCID: PMC9198391 DOI: 10.1177/15459683221095166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Motor impairment in the arms is common after stroke and many individuals participate in therapy to improve function. It is assumed that individuals with stroke can adapt and improve their movements using feedback that arises from movement or is provided by a therapist. Here we investigated visuomotor adaptation in individuals with sub-acute and chronic stroke. Objective: We examined the impact of the stroke-affected arm (dominant or non-dominant), time post-stroke, and relationships with clinical measures of motor impairment and functional independence. Methods: Participants performed reaching movements with their arm supported in a robotic exoskeleton. We rotated the relationship between the motion of the participant’s hand and a feedback cursor displayed in their workspace. Outcome measures included the amount that participants adapted their arm movements and the number of trials they required to adapt. Results: Participants with stroke (n = 36) adapted less and required more trials to adapt than controls (n = 29). Stroke affecting the dominant arm impaired the amount of adaptation more than stroke affecting the non-dominant arm. Overall, 53% of participants with stroke were impaired in one or more measures of visuomotor adaptation. Initial adaptation was weakly correlated with time post-stroke, and the amount of adaptation correlated moderately with clinical measures of motor impairment and functional independence. Conclusion: Our findings reveal impairments in visuomotor adaptation that are associated with motor impairment and function after stroke. Longitudinal studies are needed to understand the relationship between adaptation and recovery attained in a therapy setting.
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Affiliation(s)
- Robert T Moore
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Faculty of Kinesiology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Mark A Piitz
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Faculty of Kinesiology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Nishita Singh
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Faculty of Kinesiology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Faculty of Kinesiology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Tyler Cluff
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Faculty of Kinesiology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
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Pila O, Koeppel T, Grosmaire AG, Duret C. Impact of Dose of Combined Conventional and Robotic Therapy on Upper Limb Motor Impairments and Costs in Subacute Stroke Patients: A Retrospective Study. Front Neurol 2022; 13:770259. [PMID: 35222240 PMCID: PMC8869251 DOI: 10.3389/fneur.2022.770259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/19/2022] [Indexed: 01/16/2023] Open
Abstract
Introduction Robot-based training integrated into usual care might optimize therapy productivity and increase treatment dose. This retrospective study compared two doses of an upper limb rehabilitation program combining robot-assisted therapy and occupational therapy on motor recovery and costs after stroke. Methods Thirty-six subacute stroke patients [Fugl-Meyer Assessment (FMA) score 32 ± 12 points; mean ± SD] underwent a combined program of 29 ± 3 sessions of robot-assisted therapy and occupational therapy. Scheduled session time for the higher dose group (HG) was 90 min (two 45-min sessions; n = 14) and for the lower dose group (LG) was 60 min (two 30-min sessions; n = 22). Pre-/post-treatment change in FMA score (ΔFMA, %), actual active time (min), number of movements and number of movements per minute per robot-assisted therapy session were compared between groups. The costs of the combined programs were also analyzed. Results ΔFMA did not differ significantly between groups; the HG improved by 16 ± 13 % and the LG by 11 ± 8%. A between-group difference was found for actual active time (p = 1.06E−13) and number of movements (p = 4.42E−2) but not for number of movements per minute during robot-assisted therapy: the HG performed 1,023 ± 344 movements over 36 ± 3 min and the LG performed 796 ± 301 movements over 29 ± 1 min. Both groups performed 28 movements per minute. The combined program cost was €2017 and €1162 for HG and LG, respectively. Conclusions Similar motor improvements were observed following two doses of movement-based training. The reduction in scheduled session time did not affect the intensity of the practice and met economic constraints.
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Affiliation(s)
- Ophélie Pila
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Unité de Neurorééducation, Boissise-Le-Roi, France
| | - Typhaine Koeppel
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Unité de Neurorééducation, Boissise-Le-Roi, France
| | - Anne-Gaëlle Grosmaire
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Unité de Neurorééducation, Boissise-Le-Roi, France
| | - Christophe Duret
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Unité de Neurorééducation, Boissise-Le-Roi, France
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Chen YW, Chiang WC, Chang CL, Lo SM, Wu CY. Comparative effects of EMG-driven robot-assisted therapy versus task-oriented training on motor and daily function in patients with stroke: a randomized cross-over trial. J Neuroeng Rehabil 2022; 19:6. [PMID: 35034664 PMCID: PMC8762925 DOI: 10.1186/s12984-021-00961-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/17/2021] [Indexed: 11/24/2022] Open
Abstract
Background Robot-assisted hand training has shown positive effects on promoting neuromuscular control. Since both robot-assisted therapy and task-oriented training are often used in post-stroke rehabilitation, we raised the question of whether two interventions engender differential effects in different domains. Methods The study was conducted using a randomized, two-period crossover design. Twenty-four chronic stroke survivors received a 12-session robot-assisted intervention followed by a 12-session task-oriented intervention or vice versa. A 1-month washout period between each intervention was implemented. Outcome measures were evaluated before the intervention, after the first 12-session intervention, and after the second 12-session intervention. Clinical assessments included Fugl-Meyer Assessment for Upper Extremity, Wolf Motor Function Test, Action Research Arm Test and Motor Activity Log. Results Our findings suggested that EMG-driven robot-assisted therapy was as effective as task-oriented training in terms of improving upper limbs functional performance in activity domain, and robot-assisted therapy was more effective in improving movement duration during functional tasks. Task-oriented training showed better improvement in body function domain and activity and participation domain, especially in improving spontaneous use of affected arm during daily activities. Conclusions Both intervention protocol had their own advantages in different domains, and robot-assisted therapy may save manpower and be considered as an alternative intervention to task-oriented training. Combining the two approaches could yield results greater than either alone, which awaits further study. Trial registration: ClinicalTrials.gov Identifier: NCT03624153. Registered on 9th August 2018, https://clinicaltrials.gov/ct2/show/NCT03624153.
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Affiliation(s)
- Yen-Wei Chen
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan
| | - Wei-Chi Chiang
- Department of Occupational Therapy, I-Shou University, No.8, Yida Rd., Yanchao Dist., Kaohsiung City, 82445, Taiwan
| | - Chia-Ling Chang
- Chang Gung Memorial Hospital, Taipei Branch, No.199, Tung Hwa North Road, Taipei City, 10507, Taiwan
| | - Shih-Ming Lo
- Chang Gung Memorial Hospital, Taipei Branch, No.199, Tung Hwa North Road, Taipei City, 10507, Taiwan
| | - Ching-Yi Wu
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan. .,Healthy Aging Research Center, Chang Gung University, Taoyüan, Taiwan. .,Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyüan, Taiwan.
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Porta F, Celian C, Patton JL. Upper Extremity Functional Rehabilitation for Stroke Survivors Using Error-Augmented Visual Feedback: Interim Results. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:1318-1324. [PMID: 34891528 DOI: 10.1109/embc46164.2021.9630799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Stroke rehabilitation is often terminated once a plateau in motor recovery is observed, but new training modalities have demonstrated that further functional improvement is possible after the onset of the chronic phase. In particular, feedback technologies augmenting error proved to foster the relearning process. Here we explore the possibility of a robot-free implementation of Error-Augmentation (EA), where only visual feedback is distorted. We present the interim results from our ongoing blinded, randomized, controlled clinical trial testing the efficacy of parallel bimanual reaching with visual EA. Subjects trained in the virtual environment in 45-minute sessions, three times a week, for three weeks, half with and half without EA. A blinded therapist performed clinical evaluations before, 1 week after, and two months after training. Available results showed that both groups significantly improved. An advantage in the treatment group could be tracked at all time points, but no statistical significance was detectable between groups. Gains in the two groups were found to be compatible with the results of previous studies using robots and may prove to have similar effectiveness without the need for a costly and complicated robotic device. One new finding was that EA caused significantly higher inter-trial variability.
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Page SJ, Levine P. Multimodal Mental Practice Versus Repetitive Task Practice Only to Treat Chronic Stroke: A Randomized Controlled Pilot Study. Am J Occup Ther 2021; 75:23083. [PMID: 34817599 DOI: 10.5014/ajot.2021.044925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Occupational therapists are the primary clinicians tasked with management of the more affected upper extremity (UE) after stroke. However, there is a paucity of efficacious, easy-to-use, inexpensive interventions to increase poststroke UE function. OBJECTIVE To compare the effect of a multimodal mental practice (MMMP) regimen with a repetitive task practice (RTP)-only regimen on paretic UE functional limitation. DESIGN Secondary analysis of randomized controlled pilot study data. SETTING Outpatient clinical rehabilitation laboratory. PARTICIPANTS Eighteen chronic stroke survivors exhibiting moderate, stable UE impairment. INTERVENTION Participants administered RTP only participated in 45-min, one-on-one occupational therapy sessions 3 times per week for 10 wk; participants administered MMMP completed time-matched UE training sessions consisting of action observation, RTP, and mental practice, delivered in 15-min increments. Outcomes and Measures: The Action Research Arm Test, the UE section of the Fugl-Meyer Scale, and the Hand subscale of the Stroke Impact Scale (Version 3.0) were administered 1 wk before and 1 wk after intervention. RESULTS The MMMP group exhibited significantly larger (p < .01) increases on all three outcome measures compared with the RTP group and surpassed minimal clinically important difference standards for all three UE outcome measures. CONCLUSIONS AND RELEVANCE Because of the time-matched duration of MMMP and RTP, findings suggest that MMMP may be just as feasible as RTP to implement in clinical settings. Efforts to replicate results of this study in a large-scale trial are warranted. What This Article Adds: This study shows the efficacy of an easy-to-use protocol that significantly increased affected arm function even years after stroke.
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Affiliation(s)
- Stephen J Page
- Stephen J. Page, PhD, OT/L, MSMOT, is Director, RehabLab, and President, Neurorecovery Unlimited, Columbus, OH;
| | - Peter Levine
- Peter Levine, BAA, PTA, is Instructor, Physical Therapy Program, Sinclair Community College, Dayton, OH
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YOON DAESEOK, LEE SEUNGBOK, CHO SANGHYUN, PARK HAEYEAN, KIM JONGBAE. A RANDOMIZED CONTROLLED TRIAL ON THE EFFECTS OF OCCUPATIONAL THERAPY INTERVENTIONS USING PATIENT-CENTERED ROBOT-ASSISTED REHABILITATION FOR FUNCTIONAL IMPROVEMENT IN SUBACUTE STROKE PATIENTS. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421400406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of this research study was to investigate the effect of patient-centered robot-assisted intervention for upper limb function improvement in stroke patients. Design: A double-blind randomized controlled trial. Intervention: Subjectively preferred areas of need for performing daily activities were identified by pre-interviewing and applied as target goals in the experimental group using a robotic device. Control-1 underwent a program focused on the robot system involving movements of upper limb joints. Control-2 participated in a conventional rehabilitation program. Methods: Forty-five participants engaged in 60 min of daily therapy, five times weekly for 3 weeks. The experimental group used the Canadian occupational performance measure (COPM) to identify subjectively preferred “patient-centered” focus needed areas to perform robotic device aided daily activities. Control-1 used a robot device-focused rehabilitation involving upper limb joint movements. Control-2 participated in conventional rehabilitation. Pre-post intervention measurements of hand, grip, power, and upper limb ROM were acquired by FMA-UE, MFT, and K-MBI. Results: A significant increase of function in the experimental group was observed in each subclass of function and activities of daily living (ADL) performance. Control-1 showed an increase in function without ADL improvement. Control-2 showed an increase in ADL and proximal areas of upper limb function without an increase in other areas. Conclusion: The “patient-centered” approach significantly improved upper limb function and ADL performance compared to “robot-centered” rehabilitation. Further studies are warranted to confirm these results and for generalizability in clinical application.
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Affiliation(s)
- DAESEOK YOON
- Department of Occupational Therapy, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital, Seoul KS013, Republic of Korea
| | - SEUNGBOK LEE
- Yonsei Enabling Science and Technology Research Center, Yonsei University, Wonju KS007, Republic of Korea
| | - SANG-HYUN CHO
- Department of Physical Therapy, Yonsei University, College of Health Sciences, Wonju KS007, Republic of Korea
| | - HAEYEAN PARK
- Department of Occupational Therapy, Yonsei University, College of Health Sciences, Wonju KS007, Republic of Korea
| | - JONGBAE KIM
- Department of Occupational Therapy, Yonsei University, College of Health Sciences, Wonju KS007, Republic of Korea
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YOON DAESEOK, LEE SEUNGBOK, CHO SANGHYUN, PARK HAEYEAN, KIM JONGBAE. A RANDOMIZED CONTROLLED TRIAL ON THE EFFECTS OF OCCUPATIONAL THERAPY INTERVENTIONS USING PATIENT-CENTERED ROBOT-ASSISTED REHABILITATION FOR FUNCTIONAL IMPROVEMENT IN SUBACUTE STROKE PATIENTS. J MECH MED BIOL 2021; 21. [DOI: https:/doi.org/10.1142/s0219519421400406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2023]
Abstract
The objective of this research study was to investigate the effect of patient-centered robot-assisted intervention for upper limb function improvement in stroke patients. Design: A double-blind randomized controlled trial. Intervention: Subjectively preferred areas of need for performing daily activities were identified by pre-interviewing and applied as target goals in the experimental group using a robotic device. Control-1 underwent a program focused on the robot system involving movements of upper limb joints. Control-2 participated in a conventional rehabilitation program. Methods: Forty-five participants engaged in 60 min of daily therapy, five times weekly for 3 weeks. The experimental group used the Canadian occupational performance measure (COPM) to identify subjectively preferred “patient-centered” focus needed areas to perform robotic device aided daily activities. Control-1 used a robot device-focused rehabilitation involving upper limb joint movements. Control-2 participated in conventional rehabilitation. Pre-post intervention measurements of hand, grip, power, and upper limb ROM were acquired by FMA-UE, MFT, and K-MBI. Results: A significant increase of function in the experimental group was observed in each subclass of function and activities of daily living (ADL) performance. Control-1 showed an increase in function without ADL improvement. Control-2 showed an increase in ADL and proximal areas of upper limb function without an increase in other areas. Conclusion: The “patient-centered” approach significantly improved upper limb function and ADL performance compared to “robot-centered” rehabilitation. Further studies are warranted to confirm these results and for generalizability in clinical application.
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Affiliation(s)
- DAESEOK YOON
- Department of Occupational Therapy, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital, Seoul KS013, Republic of Korea
| | - SEUNGBOK LEE
- Yonsei Enabling Science and Technology Research Center, Yonsei University, Wonju KS007, Republic of Korea
| | - SANG-HYUN CHO
- Department of Physical Therapy, Yonsei University, College of Health Sciences, Wonju KS007, Republic of Korea
| | - HAEYEAN PARK
- Department of Occupational Therapy, Yonsei University, College of Health Sciences, Wonju KS007, Republic of Korea
| | - JONGBAE KIM
- Department of Occupational Therapy, Yonsei University, College of Health Sciences, Wonju KS007, Republic of Korea
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Nam C, Zhang B, Chow T, Ye F, Huang Y, Guo Z, Li W, Rong W, Hu X, Poon W. Home-based self-help telerehabilitation of the upper limb assisted by an electromyography-driven wrist/hand exoneuromusculoskeleton after stroke. J Neuroeng Rehabil 2021; 18:137. [PMID: 34526058 PMCID: PMC8442816 DOI: 10.1186/s12984-021-00930-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 08/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most stroke survivors have sustained upper limb impairment in their distal joints. An electromyography (EMG)-driven wrist/hand exoneuromusculoskeleton (WH-ENMS) was developed previously. The present study investigated the feasibility of a home-based self-help telerehabilitation program assisted by the aforementioned EMG-driven WH-ENMS and its rehabilitation effects after stroke. METHODS Persons with chronic stroke (n = 11) were recruited in a single-group trial. The training progress, including the training frequency and duration, was telemonitored. The clinical outcomes were evaluated using the Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), Motor Functional Independence Measure (FIM), and Modified Ashworth Scale (MAS). Improvement in muscle coordination was investigated in terms of the EMG activation level and the Co-contraction Index (CI) of the target muscles, including the abductor pollicis brevis (APB), flexor carpi radialis-flexor digitorum (FCR-FD), extensor carpi ulnaris-extensor digitorum (ECU-ED), biceps brachii (BIC), and triceps brachii (TRI). The movement smoothness and compensatory trunk movement were evaluated in terms of the following two kinematic parameters: number of movement units (NMUs) and maximal trunk displacement (MTD). The above evaluations were conducted before and after the training. RESULTS All of the participants completed the home-based program with an intensity of 63.0 ± 1.90 (mean ± SD) min/session and 3.73 ± 0.75 (mean ± SD) sessions/week. After the training, motor improvements in the entire upper limb were found, as indicated by the significant improvements (P < 0.05) in the FMA, ARAT, WMFT, and MAS; significant decreases (P < 0.05) in the EMG activation levels of the APB and FCR-FD; significant decreases (P < 0.05) in the CI of the ECU-ED/FCR-FD, ECU-ED/BIC, FCR-FD/APB, FCR-FD/BIC, FCR-FD/TRI, APB/BIC and BIC/TRI muscle pairs; and significant reductions (P < 0.05) in the NMUs and MTD. CONCLUSIONS The results suggested that the home-based self-help telerehabilitation program assisted by EMG-driven WH-ENMS is feasible and effective for improving the motor function of the paretic upper limb after stroke. Trial registration ClinicalTrials.gov. NCT03752775; Date of registration: November 20, 2018.
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Affiliation(s)
- Chingyi Nam
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Bingbing Zhang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Tszying Chow
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Fuqiang Ye
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yanhuan Huang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ziqi Guo
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Waiming Li
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Wei Rong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Xiaoling Hu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China. .,The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, 518034, China.
| | - Waisang Poon
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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Effect of Robot-Assisted Therapy on Participation of People with Limited Upper Limb Functioning: A Systematic Review with GRADE Recommendations. Occup Ther Int 2021; 2021:6649549. [PMID: 34393681 PMCID: PMC8349462 DOI: 10.1155/2021/6649549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 07/18/2021] [Indexed: 12/29/2022] Open
Abstract
Background Previous studies have suggested that robot-assisted therapy (RT) is effective in treating impairment and that it may also improve individuals' participation. Objective To investigate the effect of RT on the participation of individuals with limited upper limb functioning (PROSPERO: CRD42019133880). Data Sources: PEDro, Embase, MEDLINE, CINAHL, Cochrane, AMED, and Compendex. Inclusion Criteria. We selected randomized or quasirandomized controlled studies comparing the effects of RT with minimal or other interventions on participation of individuals with limited upper limb functioning. Data Extraction and Synthesis. Methodological quality of the included studies was assessed using the 0-10 PEDro scale, and effect estimates were reported using standardized mean differences (SMDs) with 95% confidence intervals (CIs), and the certainty of the current evidence was assessed using the GRADE. Results Twelve randomized controlled studies involving 845 participants were included. The estimates of medium effects between RT and minimal intervention (MI) at a short-term follow-up were pooled, but there are no short-term effects between RT and OI. Standardized differences in means were as follows: 0.6 (95% CI 0.1 to 1.2) and 0.2 (95% CI -0.0 to 0.4). There were also no effects of additional RT in the short- or medium-term follow-up periods. Standardized differences in means were as follows: -0.6 (95% CI -1.1 to -0.1) and 0.2 (95% CI -0.3 to 0.8). The methodological quality of the included studies potentially compromised the effect estimates of RT. The existing evidence was very low-quality with many confounding variables between studies. Conclusions For patients with upper limb neurological dysfunction, low-quality evidence supports RT over MI in terms of improving individual participation in the short term. The existing low- to very low-quality evidence does not support RT over OI in either the short- or medium-term follow-up periods with respect to community participation.
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14
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Terranova TT, Simis M, Santos ACA, Alfieri FM, Imamura M, Fregni F, Battistella LR. Robot-Assisted Therapy and Constraint-Induced Movement Therapy for Motor Recovery in Stroke: Results From a Randomized Clinical Trial. Front Neurorobot 2021; 15:684019. [PMID: 34366819 PMCID: PMC8335542 DOI: 10.3389/fnbot.2021.684019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Stroke is one of the leading causes of adult disability, and up to 80% of stroke survivors undergo upper extremity motor dysfunction. Constraint-Induced Movement Therapy (CIMT) and Robot-Assisted Therapy (RT) are used for upper limb stroke rehabilitation. Although CIMT and RT are different techniques, both are beneficial; however, their results must be compared. The objective is to establish the difference between RT and CIMT after a rehabilitation program for chronic stroke patients. Method: This is a randomized clinical trial, registered at ClinicalTrials.gov (ID number NCT02700061), in which patients with stroke received sessions of RT or CIMT protocol, combined with a conventional rehabilitation program for 12 weeks. The primary outcome was measured by Wolf Motor Function Test (WMFT) and Fugl-Meyer Assessment—Upper Limb (FMA-UL). Activities of daily living were also assessed. Results: Fifty one patients with mild to moderate upper limb impairment were enrolled in this trial, 25 women and 26 men, mean age of 60,02 years old (SD 14,48), with 6 to 36 months after stroke onset. Function significantly improved regardless of the treatment group. However, no statistical difference was found between both groups as p-values of the median change of function measured by WMFT and FMA were 0.293 and 0.187, respectively. Conclusion: This study showed that Robotic Therapy (RT) was not different from Constraint-Induced Movement Therapy (CIMT) regardless of the analyzed variables. There was an overall upper limb function, motor recovery, functionality, and activities of daily living improvement regardless of the interventions. At last, the combination of both techniques should be considered in future studies.
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Affiliation(s)
- Thais Tavares Terranova
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marcel Simis
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Artur César Aquino Santos
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Fábio Marcon Alfieri
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marta Imamura
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Felipe Fregni
- Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
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Budhota A, Chua KSG, Hussain A, Kager S, Cherpin A, Contu S, Vishwanath D, Kuah CWK, Ng CY, Yam LHL, Loh YJ, Rajeswaran DK, Xiang L, Burdet E, Campolo D. Robotic Assisted Upper Limb Training Post Stroke: A Randomized Control Trial Using Combinatory Approach Toward Reducing Workforce Demands. Front Neurol 2021; 12:622014. [PMID: 34149587 PMCID: PMC8206540 DOI: 10.3389/fneur.2021.622014] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/23/2021] [Indexed: 01/31/2023] Open
Abstract
Post stroke upper limb rehabilitation is a challenging problem with poor outcomes as 40% of survivors have functionally useless upper limbs. Robot-aided therapy (RAT) is a potential method to alleviate the effort of intensive, task-specific, repetitive upper limb exercises for both patients and therapists. The present study aims to investigate how a time matched combinatory training scheme that incorporates conventional and RAT, using H-Man, compares with conventional training toward reducing workforce demands. In a randomized control trial (NCT02188628, www.clinicaltrials.gov), 44 subacute to chronic stroke survivors with first-ever clinical stroke and predominant arm motor function deficits were recruited and randomized into two groups of 22 subjects: Robotic Therapy (RT) and Conventional Therapy (CT). Both groups received 18 sessions of 90 min; three sessions per week over 6 weeks. In each session, participants of the CT group received 90 min of 1:1 therapist-supervised conventional therapy while participants of the RT group underwent combinatory training which consisted of 60 min of minimally-supervised H-Man therapy followed by 30 min of conventional therapy. The clinical outcomes [Fugl-Meyer (FMA), Action Research Arm Test and, Grip Strength] and the quantitative measures (smoothness, time efficiency, and task error, derived from two robotic assessment tasks) were independently evaluated prior to therapy intervention (week 0), at mid-training (week 3), at the end of training (week 6), and post therapy (week 12 and 24). Significant differences within group were observed at the end of training for all clinical scales compared with baseline [mean and standard deviation of FMA score changes between baseline and week 6; RT: Δ4.41 (3.46) and CT: Δ3.0 (4.0); p < 0.01]. FMA gains were retained 18 weeks post-training [week 24; RT: Δ5.38 (4.67) and week 24 CT: Δ4.50 (5.35); p < 0.01]. The RT group clinical scores improved similarly when compared to CT group with no significant inter-group at all time points although the conventional therapy time was reduced to one third in RT group. There were no training-related adverse side effects. In conclusion, time matched combinatory training incorporating H-Man RAT produced similar outcomes compared to conventional therapy alone. Hence, this study supports a combinatory approach to improve motor function in post-stroke arm paresis. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02188628.
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Affiliation(s)
- Aamani Budhota
- Interdisciplinary Graduate School, Nanyang Technological University, Singapore, Singapore.,Robotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Karen S G Chua
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Asif Hussain
- Robotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Simone Kager
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore, Singapore
| | - Adèle Cherpin
- Robotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Sara Contu
- Robotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Deshmukh Vishwanath
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Christopher W K Kuah
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Chwee Yin Ng
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Lester H L Yam
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Yong Joo Loh
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Deshan Kumar Rajeswaran
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Liming Xiang
- School of Physical and Mathematical Sciences, Nanyang Technological University, Singapore, Singapore
| | - Etienne Burdet
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, United Kingdom
| | - Domenico Campolo
- Robotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
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16
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Wu J, Cheng H, Zhang J, Yang S, Cai S. Robot-Assisted Therapy for Upper Extremity Motor Impairment After Stroke: A Systematic Review and Meta-Analysis. Phys Ther 2021; 101:6103015. [PMID: 33454787 DOI: 10.1093/ptj/pzab010] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/31/2020] [Accepted: 12/06/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The purpose of this study was to review the effects of robot-assisted therapy (RT) for improving poststroke upper extremity motor impairment. METHODS The PubMed, Embase, Medline, and Web of Science databases were searched from inception to April 8, 2020. Randomized controlled trials that were conducted to evaluate the effects of RT on upper extremity motor impairment poststroke and that used Fugl-Meyer assessment for upper extremity scores as an outcome were included. Two authors independently screened articles, extracted data, and assessed the methodological quality of the included studies using the Physiotherapy Evidence Database (PEDro) scale. A random-effects meta-analysis was performed to pool the effect sizes across the studies. RESULTS Forty-one randomized controlled trials with 1916 stroke patients were included. Compared with dose-matched conventional rehabilitation, RT significantly improved the Fugl-Meyer assessment for upper extremity scores of the patients with stroke, with a small effect size (Hedges g = 0.25; 95% CI, 0.11-0.38; I2 = 45.9%). The subgroup analysis revealed that the effects of unilateral RT, but not that of bilateral RT, were superior to conventional rehabilitation (Hedges g = 0.32; 95% CI, 0.15-0.50; I2 = 55.9%). Regarding the type of robot devices, the effects of the end effector device (Hedges g = 0.22; 95% CI, 0.09-0.36; I2 = 35.4%), but not the exoskeleton device, were superior to conventional rehabilitation. Regarding the stroke stage, the between-group difference (ie, RT vs convention rehabilitation) was significant only for people with late subacute or chronic stroke (Hedges g = 0.33; 95% CI, 0.16-0.50; I2 = 34.2%). CONCLUSION RT might be superior to conventional rehabilitation in improving upper extremity motor impairment in people after stroke with notable upper extremity hemiplegia and limited potential for spontaneous recovery.
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Affiliation(s)
- Jingyi Wu
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China
| | - Hao Cheng
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China
| | - Jiaqi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Shanli Yang
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China
| | - Sufang Cai
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China
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17
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TAŞAR BEYDA, TATAR AHMETBURAK, TANYILDIZI ALPERKADIR, YAKUT OGUZ. DESIGN, DYNAMIC MODELING AND CONTROL OF WEARABLE FINGER ORTHOSIS. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421500068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Human hands and fingers are of significant importance in people’s capacity to perform daily tasks (touching, feeling, holding, gripping, writing). However, about 1.5 million people around the world are suffering from injuries, muscle and neurological disorders, a loss of hand function, or a few fingers due to stroke. This paper focuses on newly developed finger orthotics, which is thin, adaptable to the length of each finger and low energy costs. The aim of the study is to design and control a new robotic orthosis using for daily rehabilitation therapy. Kinematic and dynamic analysis of orthosis was calculated and the joint regulation of orthosis was obtained. The Lagrange method was used to obtain dynamics, and the Denavit–Hartenberg (D–H) method was used for kinematic analysis of hand. In order to understand its behavior, the robotic finger orthotics model was simulated in MatLab/Simulink. The simulation results show that the efficiency and robustness of proportional integral derivative (PID) controller are appropriate for the use of robotic finger orthotics.
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Affiliation(s)
- BEYDA TAŞAR
- Department of Mechatronics Engineering, Faculty of Engineering, Firat University, Elazig, Turkey
| | - AHMET BURAK TATAR
- Department of Mechatronics Engineering, Faculty of Engineering, Firat University, Elazig, Turkey
| | - ALPER KADIR TANYILDIZI
- Department of Mechatronics Engineering, Faculty of Engineering, Firat University, Elazig, Turkey
| | - OGUZ YAKUT
- Department of Mechatronics Engineering, Faculty of Engineering, Firat University, Elazig, Turkey
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18
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Rodgers H, Bosomworth H, Krebs HI, van Wijck F, Howel D, Wilson N, Finch T, Alvarado N, Ternent L, Fernandez-Garcia C, Aird L, Andole S, Cohen DL, Dawson J, Ford GA, Francis R, Hogg S, Hughes N, Price CI, Turner DL, Vale L, Wilkes S, Shaw L. Robot-assisted training compared with an enhanced upper limb therapy programme and with usual care for upper limb functional limitation after stroke: the RATULS three-group RCT. Health Technol Assess 2020; 24:1-232. [PMID: 33140719 PMCID: PMC7682262 DOI: 10.3310/hta24540] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Loss of arm function is common after stroke. Robot-assisted training may improve arm outcomes. OBJECTIVE The objectives were to determine the clinical effectiveness and cost-effectiveness of robot-assisted training, compared with an enhanced upper limb therapy programme and with usual care. DESIGN This was a pragmatic, observer-blind, multicentre randomised controlled trial with embedded health economic and process evaluations. SETTING The trial was set in four NHS trial centres. PARTICIPANTS Patients with moderate or severe upper limb functional limitation, between 1 week and 5 years following first stroke, were recruited. INTERVENTIONS Robot-assisted training using the Massachusetts Institute of Technology-Manus robotic gym system (InMotion commercial version, Interactive Motion Technologies, Inc., Watertown, MA, USA), an enhanced upper limb therapy programme comprising repetitive functional task practice, and usual care. MAIN OUTCOME MEASURES The primary outcome was upper limb functional recovery 'success' (assessed using the Action Research Arm Test) at 3 months. Secondary outcomes at 3 and 6 months were the Action Research Arm Test results, upper limb impairment (measured using the Fugl-Meyer Assessment), activities of daily living (measured using the Barthel Activities of Daily Living Index), quality of life (measured using the Stroke Impact Scale), resource use costs and quality-adjusted life-years. RESULTS A total of 770 participants were randomised (robot-assisted training, n = 257; enhanced upper limb therapy, n = 259; usual care, n = 254). Upper limb functional recovery 'success' was achieved in the robot-assisted training [103/232 (44%)], enhanced upper limb therapy [118/234 (50%)] and usual care groups [85/203 (42%)]. These differences were not statistically significant; the adjusted odds ratios were as follows: robot-assisted training versus usual care, 1.2 (98.33% confidence interval 0.7 to 2.0); enhanced upper limb therapy versus usual care, 1.5 (98.33% confidence interval 0.9 to 2.5); and robot-assisted training versus enhanced upper limb therapy, 0.8 (98.33% confidence interval 0.5 to 1.3). The robot-assisted training group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale) than the usual care group at 3 and 6 months. The enhanced upper limb therapy group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale), better mobility (as measured by the Stroke Impact Scale mobility domain) and better performance in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the usual care group, at 3 months. The robot-assisted training group performed less well in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the enhanced upper limb therapy group at 3 months. No other differences were clinically important and statistically significant. Participants found the robot-assisted training and the enhanced upper limb therapy group programmes acceptable. Neither intervention, as provided in this trial, was cost-effective at current National Institute for Health and Care Excellence willingness-to-pay thresholds for a quality-adjusted life-year. CONCLUSIONS Robot-assisted training did not improve upper limb function compared with usual care. Although robot-assisted training improved upper limb impairment, this did not translate into improvements in other outcomes. Enhanced upper limb therapy resulted in potentially important improvements on upper limb impairment, in performance of activities of daily living, and in mobility. Neither intervention was cost-effective. FUTURE WORK Further research is needed to find ways to translate the improvements in upper limb impairment seen with robot-assisted training into improvements in upper limb function and activities of daily living. Innovations to make rehabilitation programmes more cost-effective are required. LIMITATIONS Pragmatic inclusion criteria led to the recruitment of some participants with little prospect of recovery. The attrition rate was higher in the usual care group than in the robot-assisted training or enhanced upper limb therapy groups, and differential attrition is a potential source of bias. Obtaining accurate information about the usual care that participants were receiving was a challenge. TRIAL REGISTRATION Current Controlled Trials ISRCTN69371850. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 54. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Helen Rodgers
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Helen Bosomworth
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hermano I Krebs
- Mechanical Engineering Department, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Frederike van Wijck
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Denise Howel
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nina Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tracy Finch
- Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | | | - Laura Ternent
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Lydia Aird
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | - Sreeman Andole
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - David L Cohen
- London North West University Healthcare NHS Trust, London, UK
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Gary A Ford
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Medical Sciences Division, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard Francis
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Steven Hogg
- Lay investigator (contact Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK)
| | | | - Christopher I Price
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | - Duncan L Turner
- School of Health, Sport and Bioscience, University of East London, London, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Scott Wilkes
- School of Medicine, University of Sunderland, Sunderland, UK
| | - Lisa Shaw
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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de-la-Torre R, Oña ED, Balaguer C, Jardón A. Robot-Aided Systems for Improving the Assessment of Upper Limb Spasticity: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2020; 20:E5251. [PMID: 32937973 PMCID: PMC7570987 DOI: 10.3390/s20185251] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/02/2020] [Accepted: 09/12/2020] [Indexed: 12/13/2022]
Abstract
Spasticity is a motor disorder that causes stiffness or tightness of the muscles and can interfere with normal movement, speech, and gait. Traditionally, the spasticity assessment is carried out by clinicians using standardized procedures for objective evaluation. However, these procedures are manually performed and, thereby, they could be influenced by the clinician's subjectivity or expertise. The automation of such traditional methods for spasticity evaluation is an interesting and emerging field in neurorehabilitation. One of the most promising approaches is the use of robot-aided systems. In this paper, a systematic review of systems focused on the assessment of upper limb (UL) spasticity using robotic technology is presented. A systematic search and review of related articles in the literature were conducted. The chosen works were analyzed according to the morphology of devices, the data acquisition systems, the outcome generation method, and the focus of intervention (assessment and/or training). Finally, a series of guidelines and challenges that must be considered when designing and implementing fully-automated robot-aided systems for the assessment of UL spasticity are summarized.
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Affiliation(s)
| | | | | | - Alberto Jardón
- Department of Systems Engineering and Automation, University Carlos III of Madrid, Avda. de la Universidad 30, 28911 Leganés, Spain; (R.d.-l.-T.); (E.D.O.); (C.B.)
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20
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A Control Software Framework for Wearable Mechatronic Devices. J INTELL ROBOT SYST 2020. [DOI: 10.1007/s10846-019-01144-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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21
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Zhao S, Liu J, Gong Z, Lei Y, OuYang X, Chan CC, Ruan S. Wearable Physiological Monitoring System Based on Electrocardiography and Electromyography for Upper Limb Rehabilitation Training. SENSORS (BASEL, SWITZERLAND) 2020; 20:E4861. [PMID: 32872111 PMCID: PMC7506771 DOI: 10.3390/s20174861] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 01/16/2023]
Abstract
Secondary injuries are common during upper limb rehabilitation training because of uncontrollable physical force and overexciting activities, and long-time training may cause fatigue and reduce the training effect. This study proposes a wearable monitoring device for upper limb rehabilitation by integrating electrocardiogram and electromyogram (ECG/EMG) sensors and using data acquisition boards to obtain accurate signals during robotic glove assisting training. The collected ECG/EMG signals were filtered, amplified, digitized, and then transmitted to a remote receiver (smart phone or laptop) via a low-energy Bluetooth module. A software platform was developed for data analysis to visualize ECG/EMG information, and integrated into the robotic glove control module. In the training progress, various hand activities (i.e., hand closing, forearm pronation, finger flexion, and wrist extension) were monitored by the EMG sensor, and the changes in the physiological status of people (from excited to fatigue) were monitored by the ECG sensor. The functionality and feasibility of the developed physiological monitoring system was demonstrated by the assisting robotic glove with an adaptive strategy for upper limb rehabilitation training improvement. The feasible results provided a novel technique to monitor individual ECG and EMG information holistically and practically, and a technical reference to improve upper limb rehabilitation according to specific treatment conditions and the users' demands. On the basis of this wearable monitoring system prototype for upper limb rehabilitation, many ECG-/EMG-based mobile healthcare applications could be built avoiding some complicated implementation issues such as sensors management and feature extraction.
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Affiliation(s)
- Shumi Zhao
- Sino-German College of Intelligent Manufacturing, Shenzhen Technology University, Shenzhen 518118, China; (J.L.); (Y.L.); (C.C.C.); (S.R.)
| | - Jianxun Liu
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong 999077, China;
| | - Zidan Gong
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong 999077, China;
| | - Yisong Lei
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong 999077, China;
| | - Xia OuYang
- Department of Electrical Engineering, The Hong Kong Polytechnic University, Hong Kong 518118, China;
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Chi Chiu Chan
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong 999077, China;
| | - Shuangchen Ruan
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong 999077, China;
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22
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Ekechukwu END, Olowoyo P, Nwankwo KO, Olaleye OA, Ogbodo VE, Hamzat TK, Owolabi MO. Pragmatic Solutions for Stroke Recovery and Improved Quality of Life in Low- and Middle-Income Countries-A Systematic Review. Front Neurol 2020; 11:337. [PMID: 32695058 PMCID: PMC7336355 DOI: 10.3389/fneur.2020.00337] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/07/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Given the limited healthcare resources in low and middle income countries (LMICs), effective rehabilitation strategies that can be realistically adopted in such settings are required. Objective: A systematic review of literature was conducted to identify pragmatic solutions and outcomes capable of enhancing stroke recovery and quality of life of stroke survivors for low- and middle- income countries. Methods: PubMed, HINARI, and Directory of Open Access Journals databases were searched for published Randomized Controlled Trials (RCTs) till November 2018. Only completed trials published in English with non-pharmacological interventions on adult stroke survivors were included in the review while published protocols, pilot studies and feasibility analysis of trials were excluded. Obtained data were synthesized thematically and descriptively analyzed. Results: One thousand nine hundred and ninety six studies were identified while 347 (65.22% high quality) RCTs were found to be eligible for the review. The most commonly assessed variables (and outcome measure utility) were activities of daily living [75.79% of the studies, with Barthel Index (37.02%)], motor function [66.57%; with Fugl Meyer scale (71.88%)], and gait [31.12%; with 6 min walk test (38.67%)]. Majority of the innovatively high technology interventions such as robot therapy (95.24%), virtual reality (94.44%), transcranial direct current stimulation (78.95%), transcranial magnetic stimulation (88.0%) and functional electrical stimulation (85.00%) were conducted in high income countries. Several traditional and low-cost interventions such as constraint-induced movement therapy (CIMT), resistant and aerobic exercises (R&AE), task oriented therapy (TOT), body weight supported treadmill training (BWSTT) were reported to significantly contribute to the recovery of motor function, activity, participation, and improvement of quality of life after stroke. Conclusion: Several pragmatic, in terms of affordability, accessibility and utility, stroke rehabilitation solutions, and outcome measures that can be used in resource-limited settings were found to be effective in facilitating and enhancing post-stroke recovery and quality of life.
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Affiliation(s)
- Echezona Nelson Dominic Ekechukwu
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu, Nigeria
- LANCET Physiotherapy and Wellness and Research Centre, Enugu, Nigeria
| | - Paul Olowoyo
- Department of Medicine, Federal Teaching Hospital, Ido Ekiti, Nigeria
- College of Medicine and Health Sciences, Afe Babalola University, Ado Ekiti, Nigeria
| | - Kingsley Obumneme Nwankwo
- Stroke Control Innovations Initiative of Nigeria, Abuja, Nigeria
- Fitness Global Consult Physiotherapy Clinic, Abuja, Nigeria
| | - Olubukola A Olaleye
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Talhatu Kolapo Hamzat
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mayowa Ojo Owolabi
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
- University College Hospital, Ibadan, Nigeria
- Blossom Specialist Medical Centre, Ibadan, Nigeria
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23
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Khan MA, Das R, Iversen HK, Puthusserypady S. Review on motor imagery based BCI systems for upper limb post-stroke neurorehabilitation: From designing to application. Comput Biol Med 2020; 123:103843. [PMID: 32768038 DOI: 10.1016/j.compbiomed.2020.103843] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/18/2020] [Accepted: 06/02/2020] [Indexed: 12/21/2022]
Abstract
Strokes are a growing cause of mortality and many stroke survivors suffer from motor impairment as well as other types of disabilities in their daily life activities. To treat these sequelae, motor imagery (MI) based brain-computer interface (BCI) systems have shown potential to serve as an effective neurorehabilitation tool for post-stroke rehabilitation therapy. In this review, different MI-BCI based strategies, including "Functional Electric Stimulation, Robotics Assistance and Hybrid Virtual Reality based Models," have been comprehensively reported for upper-limb neurorehabilitation. Each of these approaches have been presented to illustrate the in-depth advantages and challenges of the respective BCI systems. Additionally, the current state-of-the-art and main concerns regarding BCI based post-stroke neurorehabilitation devices have also been discussed. Finally, recommendations for future developments have been proposed while discussing the BCI neurorehabilitation systems.
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Affiliation(s)
- Muhammad Ahmed Khan
- Department of Health Technology, Technical University of Denmark, 2800, Kgs. Lyngby, Denmark.
| | - Rig Das
- Department of Health Technology, Technical University of Denmark, 2800, Kgs. Lyngby, Denmark
| | - Helle K Iversen
- Department of Neurology, University of Copenhagen, Rigshospitalet, 2600, Glostrup, Denmark
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Cirillo D, Catuara-Solarz S, Morey C, Guney E, Subirats L, Mellino S, Gigante A, Valencia A, Rementeria MJ, Chadha AS, Mavridis N. Sex and gender differences and biases in artificial intelligence for biomedicine and healthcare. NPJ Digit Med 2020; 3:81. [PMID: 32529043 PMCID: PMC7264169 DOI: 10.1038/s41746-020-0288-5] [Citation(s) in RCA: 144] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 04/28/2020] [Indexed: 01/10/2023] Open
Abstract
Precision Medicine implies a deep understanding of inter-individual differences in health and disease that are due to genetic and environmental factors. To acquire such understanding there is a need for the implementation of different types of technologies based on artificial intelligence (AI) that enable the identification of biomedically relevant patterns, facilitating progress towards individually tailored preventative and therapeutic interventions. Despite the significant scientific advances achieved so far, most of the currently used biomedical AI technologies do not account for bias detection. Furthermore, the design of the majority of algorithms ignore the sex and gender dimension and its contribution to health and disease differences among individuals. Failure in accounting for these differences will generate sub-optimal results and produce mistakes as well as discriminatory outcomes. In this review we examine the current sex and gender gaps in a subset of biomedical technologies used in relation to Precision Medicine. In addition, we provide recommendations to optimize their utilization to improve the global health and disease landscape and decrease inequalities.
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Affiliation(s)
- Davide Cirillo
- Barcelona Supercomputing Center (BSC), C/ Jordi Girona, 29, 08034 Barcelona, Spain
| | - Silvina Catuara-Solarz
- Telefonica Innovation Alpha Health, Torre Telefonica, Plaça d’Ernest Lluch i Martin, 5, 08019 Barcelona, Spain
- The Women’s Brain Project (WBP), Guntershausen, Switzerland
| | - Czuee Morey
- The Women’s Brain Project (WBP), Guntershausen, Switzerland
- Wega Informatik AG, Aeschengraben 20, CH-4051 Basel, Switzerland
| | - Emre Guney
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute and Pompeu Fabra University, Dr. Aiguader, 88, 08003 Barcelona, Spain
| | - Laia Subirats
- Eurecat - Centre Tecnològic de Catalunya, C/ Bilbao, 72, Edifici A, 08005 Barcelona, Spain
- eHealth Center, Universitat Oberta de Catalunya, Rambla del Poblenou, 156, 08018 Barcelona, Spain
| | - Simona Mellino
- The Women’s Brain Project (WBP), Guntershausen, Switzerland
| | | | - Alfonso Valencia
- Barcelona Supercomputing Center (BSC), C/ Jordi Girona, 29, 08034 Barcelona, Spain
- ICREA, Pg. Lluís Companys 23, 08010 Barcelona, Spain
| | | | | | - Nikolaos Mavridis
- The Women’s Brain Project (WBP), Guntershausen, Switzerland
- Interactive Robots and Media Laboratory (IRML), Abu Dhabi, United Arab Emirates
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Desplenter T, Zhou Y, Edmonds BP, Lidka M, Goldman A, Trejos AL. Rehabilitative and assistive wearable mechatronic upper-limb devices: A review. J Rehabil Assist Technol Eng 2020; 7:2055668320917870. [PMID: 32435505 PMCID: PMC7223206 DOI: 10.1177/2055668320917870] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/11/2020] [Indexed: 11/17/2022] Open
Abstract
Recently, there has been a trend toward assistive mechatronic devices that are wearable. These devices provide the ability to assist without tethering the user to a specific location. However, there are characteristics of these devices that are limiting their ability to perform motion tasks and the adoption rate of these devices into clinical settings. The objective of this research is to perform a review of the existing wearable assistive devices that are used to assist with musculoskeletal and neurological disorders affecting the upper limb. A review of the existing literature was conducted on devices that are wearable, assistive, and mechatronic, and that provide motion assistance to the upper limb. Five areas were examined, including sensors, actuators, control techniques, computer systems, and intended applications. Fifty-three devices were reviewed that either assist with musculoskeletal disorders or suppress tremor. The general trends found in this review show a lack of requirements, device details, and standardization of reporting and evaluation. Two areas to accelerate the evolution of these devices were identified, including the standardization of research, clinical, and engineering details, and the promotion of multidisciplinary culture. Adoption of these devices into their intended application domains relies on the continued efforts of the community.
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Affiliation(s)
- Tyler Desplenter
- Department of Electrical and Computer Engineering, University of Western Ontario, London, Canada
| | - Yue Zhou
- School of Biomedical Engineering, University of Western Ontario, London, Canada
| | - Brandon Pr Edmonds
- School of Biomedical Engineering, University of Western Ontario, London, Canada
| | - Myles Lidka
- Department of Electrical and Computer Engineering, University of Western Ontario, London, Canada
| | - Allison Goldman
- Department of Electrical and Computer Engineering, University of Western Ontario, London, Canada
| | - Ana Luisa Trejos
- Department of Electrical and Computer Engineering, University of Western Ontario, London, Canada.,School of Biomedical Engineering, University of Western Ontario, London, Canada.,Lawson Health Research Institute, London, Canada
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26
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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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27
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Barak Ventura R, Rizzo A, Nov O, Porfiri M. A 3D printing approach toward targeted intervention in telerehabilitation. Sci Rep 2020; 10:3694. [PMID: 32111880 PMCID: PMC7048757 DOI: 10.1038/s41598-020-59927-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 02/05/2020] [Indexed: 01/11/2023] Open
Abstract
Neuromuscular impairment requires adherence to a rehabilitation regimen for maximum recovery of motor function. Consumer-grade game controllers have emerged as a viable means to relay supervised physical therapy to patients' homes, thereby increasing their accessibility to healthcare. These controllers allow patients to perform exercise frequently and improve their rehabilitation outcomes. However, the non-universal design of game controllers targets healthy people and does not always accommodate people with disability. Consequently, many patients experience considerable difficulty assuming certain hand postures and performing the prescribed exercise correctly. Here, we explore the feasibility of improving rehabilitation outcomes through a 3D printing approach that enhances off-the-shelf game controllers in home therapy. Specifically, a custom attachment was 3D printed for a commercial haptic device that mediates fine motor rehabilitation. In an experimental study, 25 healthy subjects performed a navigation task, with the retrofit attachment and without it, while simulating disability of the upper limb. When using the attachment, subjects extended their wrist range of motion, yet maintained their level of compensation. The subjects also showed higher motivation to repeat the exercise with the enhanced device. The results bring forward evidence for the potential of this approach in transforming game controllers toward targeted interventions in home therapy.
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Affiliation(s)
- Roni Barak Ventura
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, New York, 11201, USA
| | - Alessandro Rizzo
- Dipartimento di Elettronica e Telecomunicazioni, Politecnico di Torino, Corso Duca degli Abruzzi 24, Torino, 10129, Italy.,Office of Innovation, New York University Tandon School of Engineering, Brooklyn, New York, 11201, USA
| | - Oded Nov
- Department of Technology Management and Innovation, New York University Tandon School of Engineering, 5 MetroTech Center, Brooklyn, New York, 11201, USA
| | - Maurizio Porfiri
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, New York, 11201, USA. .,Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, New York, 11201, USA.
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28
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McGlinchey MP, James J, McKevitt C, Douiri A, Sackley C. The effect of rehabilitation interventions on physical function and immobility-related complications in severe stroke: a systematic review. BMJ Open 2020; 10:e033642. [PMID: 32029489 PMCID: PMC7045156 DOI: 10.1136/bmjopen-2019-033642] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of rehabilitation interventions on physical function and immobility-related complications in severe stroke. DESIGN Systematic review of electronic databases (Medline, Excerpta Medica database, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Physiotherapy Evidence Database, Database of Research in Stroke, Cochrane Central Register of Controlled Trials) searched between January 1987 and November 2018. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guided the review. Randomised controlled trials comparing the effect of one type of rehabilitation intervention to another intervention, usual care or no intervention on physical function and immobility-related complications for patients with severe stroke were included. Studies that recruited participants with all levels of stroke severity were included only if subgroup analysis based on stroke severity was performed. Two reviewers screened search results, selected studies using predefined selection criteria, extracted data and assessed risk of bias for selected studies using piloted proformas. Marked heterogeneity prevented meta-analysis and a descriptive review was performed. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess evidence strength. RESULTS 28 studies (n=2677, mean age 72.7 years, 49.3% males) were included in the review. 24 studies were rated low or very low quality due to high risk of bias and small sample sizes. There was high-quality evidence that very early mobilisation (ie, mobilisation with 24 hours poststroke) and occupational therapy in care homes were no more effective than usual care. There was moderate quality evidence supporting short-term benefits of wrist and finger neuromuscular electrical stimulation in improving wrist extensor and grip strength, additional upper limb training on improving upper limb function and additional lower limb training on improving upper limb function, independence in activities of daily living, gait speed and gait independence. CONCLUSIONS There is a paucity of high-quality evidence to support the use of rehabilitation interventions to improve physical function and reduce immobility-related complications after severe stroke. Future research investigating more commonly used rehabilitation interventions, particularly to reduce poststroke complications, is required. PROSPERO REGISTRATION NUMBER CRD42017077737.
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Affiliation(s)
- Mark P McGlinchey
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College School, London, UK
- Physiotherapy Department, Guy's and Saint Thomas' NHS Foundation Trust, London, London, UK
| | - Jimmy James
- Physiotherapy Department, Guy's and Saint Thomas' NHS Foundation Trust, London, London, UK
| | - Christopher McKevitt
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College School, London, UK
| | - Abdel Douiri
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College School, London, UK
| | - Catherine Sackley
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College School, London, UK
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A comparison of the rehabilitation effectiveness of neuromuscular electrical stimulation robotic hand training and pure robotic hand training after stroke: A randomized controlled trial. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2019.101723] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Desplenter T, Chinchalkar S, Trejos AL. Enhancing the Therapist-Device Relationship: Software Requirements for Digital Collection and Analysis of Patient Data. IEEE Int Conf Rehabil Robot 2020; 2019:1091-1096. [PMID: 31374775 DOI: 10.1109/icorr.2019.8779528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Improving upon the therapist-device relationship is an important aspect that will increase the number of upper-limb robotic rehabilitation devices being used for therapy. One path to strengthen this relationship is for these devices to generate large data sets that rehabilitation therapists can use to enhance their patient assessment procedures. In this article, a national survey of Canadian therapists was conducted in order to learn about their data collection and analysis methods. A total of 33 responses were gathered from an online survey. These results show that there is a demand for the collection and visualization of various patient data, some of which cannot be easily collected with existing methods. It was also seen that there exists a large variation between therapists about which major steps constitute the general rehabilitation process. From these results, a set of fourteen general software requirements has been created. Insights from the survey regarding influences on software designs are briefly discussed. This research helps to enable the development of software systems that increase the interaction potential between therapists and robotic devices.
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31
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Zhou Y, Desplenter T, Chinchalkar S, Trejos AL. A Wearable Mechatronic Glove for Resistive Hand Therapy Exercises. IEEE Int Conf Rehabil Robot 2020; 2019:1097-1102. [PMID: 31374776 DOI: 10.1109/icorr.2019.8779502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recent technological improvements are consistently improving the efficacy of wearable mechatronic devices designed to support rehabilitation. However, it has been identified that there is currently a limited number of devices that can perform resistive motion tasks. To address this limitation, a Wearable Mechatronics-Enabled (WearME) Glove has been developed to support rehabilitative motion tasks. Using the WearME Glove, a control system was developed to enable the performance of resistive finger and wrist motion tasks. An initial evaluation of the device applied to rehabilitation tasks shows that average control errors of 2.4% and 1.5% were achieved for a resistive finger task and a resistive wrist flexion-extension task, respectively. In addition, an analysis of each task showed that for the index finger, the thumb and the wrist motion, an average of 69%, 76% and 83% of the duration, respectively, were being resisted by the WearME Glove. The results of this study show that the WearME glove can provide consistent resistance to the finger and wrist for different rehabilitation tasks.
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Parker J, Powell L, Mawson S. Effectiveness of Upper Limb Wearable Technology for Improving Activity and Participation in Adult Stroke Survivors: Systematic Review. J Med Internet Res 2020; 22:e15981. [PMID: 31913131 PMCID: PMC6996755 DOI: 10.2196/15981] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/16/2019] [Accepted: 10/22/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND With advances in technology, the adoption of wearable devices has become a viable adjunct in poststroke rehabilitation. Upper limb (UL) impairment affects up to 77% of stroke survivors impacting on their ability to carry out everyday activities. However, despite an increase in research exploring these devices for UL rehabilitation, little is known of their effectiveness. OBJECTIVE This review aimed to assess the effectiveness of UL wearable technology for improving activity and participation in adult stroke survivors. METHODS Randomized controlled trials (RCTs) and randomized comparable trials of UL wearable technology for poststroke rehabilitation were included. Primary outcome measures were validated measures of activity and participation as defined by the International Classification of Functioning, Disability, and Health. Databases searched were MEDLINE, Web of Science (Core collection), CINAHL, and the Cochrane Library. The Cochrane Risk of Bias Tool was used to assess the methodological quality of the RCTs and the Downs and Black Instrument for the quality of non RCTs. RESULTS In the review, we included 11 studies with collectively 354 participants at baseline and 323 participants at final follow-up including control groups and participants poststroke. Participants' stroke type and severity varied. Only 1 study found significant between-group differences for systems functioning and activity (P≤.02). The 11 included studies in this review had small sample sizes ranging from 5 to 99 participants at an average (mean) age of 57 years. CONCLUSIONS This review has highlighted a number of reasons for insignificant findings in this area including low sample sizes and the appropriateness of the methodology for complex interventions. However, technology has the potential to measure outcomes, provide feedback, and engage users outside of clinical sessions. This could provide a platform for motivating stroke survivors to carry out more rehabilitation in the absence of a therapist, which could maximize recovery. TRIAL REGISTRATION PROSPERO CRD42017057715; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=57715.
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Role of Instruction Adherence During Highly Structured Robotic Arm Training on Motor Outcomes for Individuals After Chronic Stroke. Am J Phys Med Rehabil 2019; 99:353-356. [PMID: 31688011 DOI: 10.1097/phm.0000000000001333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to examine the effects of instruction adherence on upper limb motor outcomes after highly structured intervention. A secondary data analysis was completed using mixed linear modeling design. Thirty chronic stroke survivors with moderate-to-severe arm impairment were assigned explicit movement instructions and completed 12 robotic therapy sessions for 4 wks. Instruction adherence was measured weekly using the Manipulation Check Questionnaire. Motor outcomes were measured at baseline, discharge, and at 4-wk follow-up using the Fugl-Meyer Assessment-Upper Extremity and Wolf Motor Function Test-Functional Ability Scale. There were no effects of adherence-related variables on upper limb motor outcomes (P > 0.2). Participant scores improved for both Fugl-Meyer Assessment-Upper Extremity and Wolf Motor Function Test-Functional Ability Scale from baseline to follow-up (P < 0.001). Participants improved motor function after 12 wks of robotic training; however, instruction adherence did not affect motor improvement. Adherence to explicit information may play a limited role in motor learning for stroke survivors with moderate-to-severe arm impairment during highly structured training protocols.
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Bouton CE. Restoring Movement in Paralysis with a Bioelectronic Neural Bypass Approach: Current State and Future Directions. Cold Spring Harb Perspect Med 2019; 9:a034306. [PMID: 30745288 PMCID: PMC6824398 DOI: 10.1101/cshperspect.a034306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Bioelectronic medicine is a rapidly growing field that explores targeted neuromodulation in new treatment options addressing both disease and injury. New bioelectronic methods are being developed to monitor and modulate neural activity directly. The therapeutic benefit of these approaches has been validated in recent clinical studies in various conditions, including paralysis. By using decoding and modulation strategies together, it is possible to restore lost function to those living with paralysis and other debilitating conditions by interpreting and rerouting signals around the affected portion of the nervous system. This, in effect, creates a bioelectronic "neural bypass" to serve the function of the damaged/degenerated network. By learning the language of neurons and using neural interface technology to tap into critical networks, new approaches to repairing or restoring function in areas impacted by disease or injury may become a reality.
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Affiliation(s)
- Chad E Bouton
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York 11030
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Abstract
People with hemiparesis after stroke appear to recover 70% to 80% of the difference between their baseline and the maximum upper extremity Fugl-Meyer (UEFM) score, a phenomenon called proportional recovery (PR). Two recent commentaries explained that PR should be expected because of mathematical coupling between the baseline and change score. Here we ask, If mathematical coupling encourages PR, why do a fraction of stroke patients (the "nonfitters") not exhibit PR? At the neuroanatomical level of analysis, this question was answered by Byblow et al-nonfitters lack corticospinal tract (CST) integrity at baseline-but here we address the mathematical and behavioral causes. We first derive a new interpretation of the slope of PR: It is the average probability of scoring across remaining scale items at follow-up. PR therefore breaks when enough test items are discretely more difficult for a patient at follow-up, flattening the slope of recovery. For the UEFM, we show that nonfitters are most unlikely to recover the ability to score on the test items related to wrist/hand dexterity, shoulder flexion without bending the elbow, and finger-to-nose movement, supporting the finding that nonfitters lack CST integrity. However, we also show that a subset of nonfitters respond better to robotic movement training in the chronic phase of stroke. These persons are just able to move the arm out of the flexion synergy and pick up small blocks, both markers of CST integrity. Nonfitters therefore raise interesting questions about CST function and the basis for response to intensive movement training.
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Conroy SS, Wittenberg GF, Krebs HI, Zhan M, Bever CT, Whitall J. Robot-Assisted Arm Training in Chronic Stroke: Addition of Transition-to-Task Practice. Neurorehabil Neural Repair 2019; 33:751-761. [PMID: 31328671 DOI: 10.1177/1545968319862558] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Robot-assisted therapy provides high-intensity arm rehabilitation that can significantly reduce stroke-related upper extremity (UE) deficits. Motor improvement has been shown at the joints trained, but generalization to real-world function has not been profound. Objective. To investigate the efficacy of robot-assisted therapy combined with therapist-assisted task training versus robot-assisted therapy alone on motor outcomes and use in participants with moderate to severe chronic stroke-related arm disability. Methods. This was a single-blind randomized controlled trial of two 12-week robot-assisted interventions; 45 participants were stratified by Fugl-Meyer (FMA) impairment (mean 21 ± 1.36) to 60 minutes of robot therapy (RT; n = 22) or 45 minutes of RT combined with 15 minutes therapist-assisted transition-to-task training (TTT; n = 23). The primary outcome was the mean FMA change at week 12 using a linear mixed-model analysis. A subanalysis included the Wolf Motor Function Test (WMFT) and Stroke Impact Scale (SIS), with significance P <.05. Results. There was no significant 12-week difference in FMA change between groups, and mean FMA gains were 2.87 ± 0.70 and 4.81 ± 0.68 for RT and TTT, respectively. TTT had greater 12-week secondary outcome improvements in the log WMFT (-0.52 ± 0.06 vs -0.18 ± 0.06; P = .01) and SIS hand (20.52 ± 2.94 vs 8.27 ± 3.03; P = .03). Conclusion. Chronic UE motor deficits are responsive to intensive robot-assisted therapy of 45 or 60 minutes per session duration. The replacement of part of the robotic training with nonrobotic tasks did not reduce treatment effect and may benefit stroke-affected hand use and motor task performance.
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Affiliation(s)
| | - George F Wittenberg
- 2 University of Maryland School of Medicine, Baltimore, MD, USA.,3 VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,4 University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Min Zhan
- 2 University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christopher T Bever
- 1 Baltimore VA Medical Center, Baltimore, MD, USA.,2 University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jill Whitall
- 2 University of Maryland School of Medicine, Baltimore, MD, USA
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Durandau G, Farina D, Asín-Prieto G, Dimbwadyo-Terrer I, Lerma-Lara S, Pons JL, Moreno JC, Sartori M. Voluntary control of wearable robotic exoskeletons by patients with paresis via neuromechanical modeling. J Neuroeng Rehabil 2019; 16:91. [PMID: 31315633 PMCID: PMC6637518 DOI: 10.1186/s12984-019-0559-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 06/26/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Research efforts in neurorehabilitation technologies have been directed towards creating robotic exoskeletons to restore motor function in impaired individuals. However, despite advances in mechatronics and bioelectrical signal processing, current robotic exoskeletons have had only modest clinical impact. A major limitation is the inability to enable exoskeleton voluntary control in neurologically impaired individuals. This hinders the possibility of optimally inducing the activity-driven neuroplastic changes that are required for recovery. METHODS We have developed a patient-specific computational model of the human musculoskeletal system controlled via neural surrogates, i.e., electromyography-derived neural activations to muscles. The electromyography-driven musculoskeletal model was synthesized into a human-machine interface (HMI) that enabled poststroke and incomplete spinal cord injury patients to voluntarily control multiple joints in a multifunctional robotic exoskeleton in real time. RESULTS We demonstrated patients' control accuracy across a wide range of lower-extremity motor tasks. Remarkably, an increased level of exoskeleton assistance always resulted in a reduction in both amplitude and variability in muscle activations as well as in the mechanical moments required to perform a motor task. Since small discrepancies in onset time between human limb movement and that of the parallel exoskeleton would potentially increase human neuromuscular effort, these results demonstrate that the developed HMI precisely synchronizes the device actuation with residual voluntary muscle contraction capacity in neurologically impaired patients. CONCLUSIONS Continuous voluntary control of robotic exoskeletons (i.e. event-free and task-independent) has never been demonstrated before in populations with paretic and spastic-like muscle activity, such as those investigated in this study. Our proposed methodology may open new avenues for harnessing residual neuromuscular function in neurologically impaired individuals via symbiotic wearable robots.
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Affiliation(s)
- Guillaume Durandau
- Faculty of Engineering Technology, Department of Biomechanical Engineering, University of Twente, Technical Medical Centre, Building: Horsting. Room: W106, P.O. Box: 217, 7500 AE Enschede, The Netherlands
| | - Dario Farina
- Department of Bioengineering, Imperial College London, London, UK
| | - Guillermo Asín-Prieto
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council, Madrid, Spain
| | - Iris Dimbwadyo-Terrer
- Occupational Thinks Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Sergio Lerma-Lara
- Occupational Thinks Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Jose L. Pons
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council, Madrid, Spain
| | - Juan C. Moreno
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council, Madrid, Spain
| | - Massimo Sartori
- Faculty of Engineering Technology, Department of Biomechanical Engineering, University of Twente, Technical Medical Centre, Building: Horsting. Room: W106, P.O. Box: 217, 7500 AE Enschede, The Netherlands
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Barak Ventura R, Nakayama S, Raghavan P, Nov O, Porfiri M. The Role of Social Interactions in Motor Performance: Feasibility Study Toward Enhanced Motivation in Telerehabilitation. J Med Internet Res 2019; 21:e12708. [PMID: 31094338 PMCID: PMC6540723 DOI: 10.2196/12708] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/12/2019] [Accepted: 02/17/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Robot-mediated telerehabilitation has the potential to provide patient-tailored cost-effective rehabilitation. However, compliance with therapy can be a problem that undermines the prospective advantages of telerehabilitation technologies. Lack of motivation has been identified as a major factor that hampers compliance. Exploring various motivational interventions, the integration of citizen science activities in robotics-based rehabilitation has been shown to increase patients' motivation to engage in otherwise tedious exercises by tapping into a vast array of intrinsic motivational drivers. Patient engagement can be further enhanced by the incorporation of social interactions. OBJECTIVE Herein, we explored the possibility of bolstering engagement in physical therapy by leveraging cooperation among users in an environmental citizen science project. Specifically, we studied how the integration of cooperation into citizen science influences user engagement, enjoyment, and motor performance. Furthermore, we investigated how the degree of interdependence among users, such that is imposed through independent or joint termination (JT), affects participation in citizen science-based telerehabilitation. METHODS We developed a Web-based citizen science platform in which users work in pairs to classify images collected by an aquatic robot in a polluted water canal. The classification was carried out by labeling objects that appear in the images and trashing irrelevant labels. The system was interfaced by a haptic device for fine motor rehabilitation. We recruited 120 healthy volunteers to operate the platform. Of these volunteers, 98 were cooperating in pairs, with 1 user tagging images and the other trashing labels. The other 22 volunteers performed both tasks alone. To vary the degree of interdependence within cooperation, we implemented independent and JTs. RESULTS We found that users' engagement and motor performance are modulated by their assigned task and the degree of interdependence. Motor performance increased when users were subjected to independent termination (P=.02), yet enjoyment decreased when users were subjected to JT (P=.005). A significant interaction between the type of termination and the task was found to influence productivity (P<.001) as well as mean speed, peak speed, and path length of the controller (P=.01, P=.006, and P<.001, respectively). CONCLUSIONS Depending on the type of termination, cooperation was not always positively associated with engagement, enjoyment, and motor performance. Therefore, enhancing user engagement, satisfaction, and motor performance through cooperative citizen science tasks relies on both the degree of interdependence among users and the perceived nature of the task. Cooperative citizen science may enhance motivation in robotics-based telerehabilitation, if designed attentively.
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Affiliation(s)
- Roni Barak Ventura
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Shinnosuke Nakayama
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Preeti Raghavan
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, United States
| | - Oded Nov
- Department of Technology Management and Innovation, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Maurizio Porfiri
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States.,Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
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Yozbatiran N, Francisco GE. Robot-assisted Therapy for the Upper Limb after Cervical Spinal Cord Injury. Phys Med Rehabil Clin N Am 2019; 30:367-384. [DOI: 10.1016/j.pmr.2018.12.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Combination of Exoskeletal Upper Limb Robot and Occupational Therapy Improve Activities of Daily Living Function in Acute Stroke Patients. J Stroke Cerebrovasc Dis 2019; 28:2018-2025. [PMID: 31047819 DOI: 10.1016/j.jstrokecerebrovasdis.2019.03.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/19/2019] [Accepted: 03/01/2019] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Previous studies have suggested that upper limb rehabilitation using therapeutic robots improves motor function of stroke patients. However, the effect of upper limb robotic rehabilitation on improving functioning in activities of daily living (ADL) remains unclear. The present study aimed to determine whether upper limb rehabilitation using single joint Hybrid Assistive Limb (HAL-SJ) affects ADL function and the use of a hemiparetic arm in ADLs of acute stroke patients. MATERIALS AND METHODS Twelve acute stroke patients participated in the study and were randomly divided into group A or group B. The patients in group A followed an A-B-A-B design and those in group B followed a B-A-B-A design. The patients received combination HAL-SJ and occupational therapy during A and conventional occupational therapy during B. RESULTS Upper limb motor function and ADLs, in particular, dressing the upper body, were improved during combination HAL-SJ and occupational therapy. Interestingly, the use of a hemiparetic arm in daily life evaluated using the motor activity log was also significantly improved during A in group A. CONCLUSIONS Combination HAL-SJ and occupational therapy affects ADL function and real use of a hemiparetic arm in the daily life of acute stroke patients.
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Duret C, Grosmaire AG, Krebs HI. Robot-Assisted Therapy in Upper Extremity Hemiparesis: Overview of an Evidence-Based Approach. Front Neurol 2019; 10:412. [PMID: 31068898 PMCID: PMC6491567 DOI: 10.3389/fneur.2019.00412] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/04/2019] [Indexed: 01/15/2023] Open
Abstract
Robot-mediated therapy is an innovative form of rehabilitation that enables highly repetitive, intensive, adaptive, and quantifiable physical training. It has been increasingly used to restore loss of motor function, mainly in stroke survivors suffering from an upper limb paresis. Multiple studies collated in a growing number of review articles showed the positive effects on motor impairment, less clearly on functional limitations. After describing the current status of robotic therapy after upper limb paresis due to stroke, this overview addresses basic principles related to robotic therapy applied to upper limb paresis. We demonstrate how this innovation is an evidence-based approach in that it meets both the improved clinical and more fundamental knowledge-base about regaining effective motor function after stroke and the need of more objective, flexible and controlled therapeutic paradigms.
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Affiliation(s)
- 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
| | - Anne-Gaëlle Grosmaire
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, Boissise-Le-Roi, France
| | - Hermano Igo Krebs
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Neurology, University of Maryland, Baltimore, MD, United States.,Department of Physical Medicine and Rehabilitation, Fujita Health University, Nagoya, Japan.,Institute of Neuroscience, University of Newcastle, Newcastle upon Tyne, United Kingdom.,Department of Mechanical Sciences and Bioengineering, Osaka University, Osaka, Japan.,Wolfson School of Mechanical, Electrical, and Manufacturing Engineering, Loughborough University, Loughborough, United Kingdom
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Abstract
SummaryIn this work we present NEUROExos, a novel generation of upper-limb exoskeletons developed in recent years at The BioRobotics Institute of Scuola Superiore Sant’Anna (Italy). Specifically, we present our attempts to progressively (i) improve the ergonomics and safety (ii) reduce the encumbrance and weight, and (iii) develop more intuitive human–robot cognitive interfaces. Our latest prototype, described here for the first time, extends the field of application to assistance in activities of daily living, thanks to its compact and portable design. The experimental studies carried out on these devices are summarized, and a perspective on future developments is presented.
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Affiliation(s)
- David J. Lin
- Center for Neurotechnology and Neurorecovery, Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Seth P. Finklestein
- Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA
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Abdollahi F, Corrigan M, Lazzaro EDC, Kenyon RV, Patton JL. Error-augmented bimanual therapy for stroke survivors. NeuroRehabilitation 2018; 43:51-61. [PMID: 30040762 DOI: 10.3233/nre-182413] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Stroke recovery studies have shown the efficacy of bimanual training on upper limb functional recovery and others have shown the efficacy of feedback technology that augments error. OBJECTIVE In a double-blinded randomized controlled study (N = 26), we evaluated the short-term effects of bilateral arm training to foster functional recovery of a hemiparetic arm, with half of our subjects unknowingly also receiving error augmentation (where errors were visually and haptically enhanced by a robot). METHODS Twenty-six individuals with chronic stroke were randomly assigned to practice an equivalent amount of bimanual reaching either with or without error augmentation. Participants were instructed to coordinate both arms while reaching to two targets (one for each arm) in three 45-minute treatments per week for two weeks, with a follow-up visit after one week without treatment. RESULTS Subjects' 2-week gains in Fugl-Meyer score averaged 2.92, and we also observed improvements Wolf Motor Functional Ability Scale average 0.21, and Motor Activity Log of 0.58 for quantity and 0.63 for quality of life scores. The extra benefit of error augmentation over the three weeks became apparent in Fugl-Meyer score only after removing an outlier from consideration. CONCLUSIONS This modest advantage of error augmentation was detectable over a short interval encouraging further research in interactive self-rehabilitation systems that can enhance error motor recovery.
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Affiliation(s)
- Farnaz Abdollahi
- University of Illinois at Chicago, Chicago, IL, USA.,Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Molly Corrigan
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Emily D C Lazzaro
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Robert V Kenyon
- University of Illinois at Chicago, Chicago, IL, USA.,Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - James L Patton
- University of Illinois at Chicago, Chicago, IL, USA.,Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL, USA
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Mehrholz J, Pohl M, Platz T, Kugler J, Elsner B. Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke. Cochrane Database Syst Rev 2018; 9:CD006876. [PMID: 30175845 PMCID: PMC6513114 DOI: 10.1002/14651858.cd006876.pub5] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Electromechanical and robot-assisted arm training devices are used in rehabilitation, and may help to improve arm function after stroke. OBJECTIVES To assess the effectiveness of electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength in people after stroke. We also assessed the acceptability and safety of the therapy. SEARCH METHODS We searched the Cochrane Stroke Group's Trials Register (last searched January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2018, Issue 1), MEDLINE (1950 to January 2018), Embase (1980 to January 2018), CINAHL (1982 to January 2018), AMED (1985 to January 2018), SPORTDiscus (1949 to January 2018), PEDro (searched February 2018), Compendex (1972 to January 2018), and Inspec (1969 to January 2018). We also handsearched relevant conference proceedings, searched trials and research registers, checked reference lists, and contacted trialists, experts, and researchers in our field, as well as manufacturers of commercial devices. SELECTION CRITERIA Randomised controlled trials comparing electromechanical and robot-assisted arm training for recovery of arm function with other rehabilitation or placebo interventions, or no treatment, for people after stroke. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, assessed trial quality and risk of bias, used the GRADE approach to assess the quality of the body of evidence, and extracted data. We contacted trialists for additional information. We analysed the results as standardised mean differences (SMDs) for continuous variables and risk differences (RDs) for dichotomous variables. MAIN RESULTS We included 45 trials (involving 1619 participants) in this update of our review. Electromechanical and robot-assisted arm training improved activities of daily living scores (SMD 0.31, 95% confidence interval (CI) 0.09 to 0.52, P = 0.0005; I² = 59%; 24 studies, 957 participants, high-quality evidence), arm function (SMD 0.32, 95% CI 0.18 to 0.46, P < 0.0001, I² = 36%, 41 studies, 1452 participants, high-quality evidence), and arm muscle strength (SMD 0.46, 95% CI 0.16 to 0.77, P = 0.003, I² = 76%, 23 studies, 826 participants, high-quality evidence). Electromechanical and robot-assisted arm training did not increase the risk of participant dropout (RD 0.00, 95% CI -0.02 to 0.02, P = 0.93, I² = 0%, 45 studies, 1619 participants, high-quality evidence), and adverse events were rare. AUTHORS' CONCLUSIONS People who receive electromechanical and robot-assisted arm training after stroke might improve their activities of daily living, arm function, and arm muscle strength. However, the results must be interpreted with caution although the quality of the evidence was high, because there were variations between the trials in: the intensity, duration, and amount of training; type of treatment; participant characteristics; and measurements used.
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Affiliation(s)
- Jan Mehrholz
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolFetscherstr. 74DresdenGermany01307
| | - Marcus Pohl
- Helios Klinik Schloss PulsnitzNeurological RehabilitationWittgensteiner Str. 1PulsnitzSaxonyGermany01896
| | - Thomas Platz
- Ernst‐Moritz‐Arndt‐Universität GreifswaldNeurorehabilitation Centre and Spinal Cord Injury Unit, BDH‐Klinik GreifswaldKarl‐Liebknecht‐Ring 26aGreifswaldGermany17491
- Ernst‐Moritz‐Arndt‐UniversitätNeurowissenschaftenGreifswaldGermany
| | - Joachim Kugler
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolFetscherstr. 74DresdenGermany01307
| | - Bernhard Elsner
- Dresden Medical School, Technical University DresdenDepartment of Public HealthFetscherstr. 74DresdenSachsenGermany01307
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Ferreira FMRM, Chaves MEA, Oliveira VC, Van Petten AMVN, Vimieiro CBS. Effectiveness of robot therapy on body function and structure in people with limited upper limb function: A systematic review and meta-analysis. PLoS One 2018; 13:e0200330. [PMID: 30001417 PMCID: PMC6042733 DOI: 10.1371/journal.pone.0200330] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 06/25/2018] [Indexed: 11/30/2022] Open
Abstract
Robot-Assisted Therapy (RT) is an innovative approach to neurological rehabilitation that uses intensive, repetitive, interactive, and individualized practice. This systematic review aimed to investigate the effectiveness of RT on the body function and structure of people with upper limb impairments (PROSPERO registration: CRD42017054982). A search strategy conducted on seven databases identified randomized controlled studies. Methodological quality was assessed using the PEDro scale. When possible, the data were pooled, the strength of evidence was assessed using the GRADE system, and the effect sizes were assessed using Cohen coefficient. Subgroup analyses investigated the impact on the estimated effects of the following parameters: methodological quality; portion of the assessed upper limb; duration of stroke; and intervention dose and duration. Thirty-eight studies involving 1174 participants were included. Pooled estimates revealed small effects of RT on motor control and medium effects on strength compared with other intervention (OI) at a short-term follow-up. Standardized differences in means were as follows: 0.3 (95% CI 0.1 to 0.4) and 0.5 (95% CI 0.2 to 0.8). Effects at other time points and on other investigated outcomes related to body function and structure were not found (p>0.05). The strength of the current evidence was usually low quality. Subgroup analyses suggested that the methodological quality, and duration and dose of RT may influence the estimated effects. In conclusion, RT has small effects on motor control and medium effects on strength in people with limited upper limb function. Poor methodological quality, and lower treatment dose and duration may impact negatively the estimated effects.
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Affiliation(s)
| | - Maria Emília Abreu Chaves
- Bioengineering Laboratory, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Vinícius Cunha Oliveira
- Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | | | - Claysson Bruno Santos Vimieiro
- Graduate Program in Mechanical Engineering, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Graduate Program in Mechanical Engineering, Pontifícia Universidade Católica de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Pila O, Duret C, Gracies JM, Francisco GE, Bayle N, Hutin É. Evolution of upper limb kinematics four years after subacute robot-assisted rehabilitation in stroke patients. Int J Neurosci 2018; 128:1030-1039. [PMID: 29619890 DOI: 10.1080/00207454.2018.1461626] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Purpose: To assess functional status and robot-based kinematic measures four years after subacute robot-assisted rehabilitation in hemiparesis. Materials and methods: Twenty-two patients with stroke-induced hemiparesis underwent a ≥3-month upper limb combined program of robot-assisted and occupational therapy from two months post-stroke, and received community-based therapy after discharge. Four years later, 19 (86%) participated in this follow-up study. Assessments 2, 5 and 54 months post-stroke included Fugl-Meyer (FM), Modified Frenchay Scale (MFS, at Month 54) and robot-based kinematic measures of targeting tasks in three directions, north, paretic and non-paretic: distance covered, velocity, accuracy (root mean square (RMS) error from straight line) and smoothness (number of velocity peaks; upward changes in accuracy and smoothness represent worsening). Analysis was stratified by FM score at two months: ≥17 (Group 1) or <17 (Group 2). Correlation between impairment (FM) and function (MFS) was explored at 54 months. Results: FM scores were stable from 5 to 54 months (+1[-2;4], median [1st; 3rd quartiles], ns). Kinematic changes (three directions pooled) were: distance -1[-17;2]% (ns); velocity, -8[-32;28]% (ns); accuracy, +6[-13;98]% (ns); smoothness, +44[-6;126]% (p < 0.05). Group 2 showed decline vs. Group 1 (p < 0.001) in FM (Group 1, +3[1;5], p < 0.01; Group 2, -7[-11;-1], ns) and accuracy (Group 1, -3[-27;38]%, ns; Group 2, +29[17;140]%, p < 0.001). At 54 months, FM and MFS were highly correlated (Pearson's rho = 0.89; p < 0.001). Conclusions: While impairment appeared stable four years after robot-assisted upper limb training during subacute post-stroke phase, movement kinematics deteriorated despite community-based therapy, especially in more severely impaired patients. Trial registration: EudraCT 2016-005121-36. Registration: 2016-12-20. Date of enrolment of the first participant to the trial: 2009-11-24.
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Affiliation(s)
- Ophélie Pila
- a Centre De Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique Et De Réadaptation , Boissise-Le-Roi , France.,b EA 7377 BIOTN, Laboratoire Analyse Et Restauration du Mouvement (ARM) , Université Paris-Est Créteil, Hôpitaux Universitaires Henri Mondor , Créteil , France
| | - Christophe Duret
- a Centre De Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique Et De Réadaptation , Boissise-Le-Roi , France.,c Centre Hospitalier Sud Francilien, Neurologie , Corbeil-Essonnes , France
| | - Jean-Michel Gracies
- b EA 7377 BIOTN, Laboratoire Analyse Et Restauration du Mouvement (ARM) , Université Paris-Est Créteil, Hôpitaux Universitaires Henri Mondor , Créteil , France
| | - Gerard E Francisco
- d Department of Physical Medicine and Rehabilitation , University of Texas Health Science Center McGovern Medical School and TIRR Memorial Hermann Hospital , Houston , TX , USA
| | - Nicolas Bayle
- b EA 7377 BIOTN, Laboratoire Analyse Et Restauration du Mouvement (ARM) , Université Paris-Est Créteil, Hôpitaux Universitaires Henri Mondor , Créteil , France
| | - Émilie Hutin
- b EA 7377 BIOTN, Laboratoire Analyse Et Restauration du Mouvement (ARM) , Université Paris-Est Créteil, Hôpitaux Universitaires Henri Mondor , Créteil , France
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Majeed YA, Abdollahi F, Awadalla S, Patton J. Multivariate outcomes in a three week bimanual self-telerehabilitation with error augmentation post-stroke. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2015:1425-31. [PMID: 26736537 DOI: 10.1109/embc.2015.7318637] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We present the outcomes of a study on stroke patients in a 3-week intervention of bimanual self-telerehabilitation. This training is similar to an upper-extremity treadmill in that patients can make use of their healthy arm to provide a cue for the more impaired arm. We further inspected a cohort that covertly received error augmentation training while they practiced. Finally, we focused here on the many quantitative measures available from the robotic device, testing if these measures collectively can predict outcome on the final day. We found in a cross-validation study that predictions are possible, yielding median r-squared values over 99%. Several particular measures were found to dominate their contribution to the prediction of recoverability. These results show that interactive self-rehabilitation may be a viable method for motor restoration, and the quantitative metrics available can be used to predict the eventual state of recovery.
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Hsieh YW, Lin KC, Wu CY, Shih TY, Li MW, Chen CL. Comparison of proximal versus distal upper-limb robotic rehabilitation on motor performance after stroke: a cluster controlled trial. Sci Rep 2018; 8:2091. [PMID: 29391492 PMCID: PMC5794971 DOI: 10.1038/s41598-018-20330-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/15/2018] [Indexed: 12/17/2022] Open
Abstract
This study examined the treatment efficacy of proximal-emphasized robotic rehabilitation by using the InMotion ARM (P-IMT) versus distal-emphasized robotic rehabilitation by using the InMotion WRIST (D-IMT) in patients with stroke. A total of 40 patients with stroke completed the study. They received P-IMT, D-IMT, or control treatment (CT) for 20 training sessions. Primary outcomes were the Fugl-Meyer Assessment (FMA) and Medical Research Council (MRC) scale. Secondary outcomes were the Motor Activity Log (MAL) and wrist-worn accelerometers. The differences on the distal FMA, total MRC, distal MRC, and MAL quality of movement scores among the 3 groups were statistically significant (P = 0.02 to 0.05). Post hoc comparisons revealed that the D-IMT group significantly improved more than the P-IMT group on the total MRC and distal MRC. Furthermore, the distal FMA and distal MRC improved more in the D-IMT group than in the CT group. Our findings suggest that distal upper-limb robotic rehabilitation using the InMotion WRIST system had superior effects on distal muscle strength. Further research based on a larger sample is needed to confirm long-term treatment effects of proximal versus distal upper-limb robotic rehabilitation.
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Affiliation(s)
- Yu-Wei Hsieh
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Keh-Chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Yi Wu
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan. .,Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - Tsai-Yu Shih
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Wei Li
- Department of Physical Medicine and Rehabilitation, Sijhih Cathay General Hospital, New Taipei City, Taiwan
| | - Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan.,Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Nam C, Rong W, Li W, Xie Y, Hu X, Zheng Y. The Effects of Upper-Limb Training Assisted with an Electromyography-Driven Neuromuscular Electrical Stimulation Robotic Hand on Chronic Stroke. Front Neurol 2017; 8:679. [PMID: 29312116 PMCID: PMC5735084 DOI: 10.3389/fneur.2017.00679] [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: 09/18/2017] [Accepted: 11/29/2017] [Indexed: 01/03/2023] Open
Abstract
Background Impaired hand dexterity is a major disability of the upper limb after stroke. An electromyography (EMG)-driven neuromuscular electrical stimulation (NMES) robotic hand was designed previously, whereas its rehabilitation effects were not investigated. Objectives This study aims to investigate the rehabilitation effectiveness of the EMG-driven NMES-robotic hand-assisted upper-limb training on persons with chronic stroke. Method A clinical trial with single-group design was conducted on chronic stroke participants (n = 15) who received 20 sessions of EMG-driven NMES-robotic hand-assisted upper-limb training. The training effects were evaluated by pretraining, posttraining, and 3-month follow-up assessments with the clinical scores of the Fugl-Meyer Assessment (FMA), the Action Research Arm Test (ARAT), the Wolf Motor Function Test, the Motor Functional Independence Measure, and the Modified Ashworth Scale (MAS). Improvements in the muscle coordination across the sessions were investigated by EMG parameters, including EMG activation level and Co-contraction Indexes (CIs) of the target muscles in the upper limb. Results Significant improvements in the FMA shoulder/elbow and wrist/hand scores (P < 0.05), the ARAT (P < 0.05), and in the MAS (P < 0.05) were observed after the training and sustained 3 months later. The EMG parameters indicated a significant decrease of the muscle activation level in flexor digitorum (FD) and biceps brachii (P < 0.05), as well as a significant reduction of CIs in the muscle pairs of FD and triceps brachii and biceps brachii and triceps brachii (P < 0.05). Conclusion The upper-limb training integrated with the assistance from the EMG-driven NMES-robotic hand is effective for the improvements of the voluntary motor functions and the muscle coordination in the proximal and distal joints. Furthermore, the motor improvement after the training could be maintained till 3 months later. Trial registration ClinicalTrials.gov. NCT02117089; date of registration: April 10, 2014.
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Affiliation(s)
- Chingyi Nam
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Wei Rong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Waiming Li
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Yunong Xie
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Xiaoling Hu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Yongping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
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