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Nazarahari M, Ajami S, Jeon S, Arami A. Visual feedback decoding during bimanual circle drawing. J Neurophysiol 2023; 130:1200-1213. [PMID: 37820018 DOI: 10.1152/jn.00372.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023] Open
Abstract
The between-hand interference during bimanual tasks is a consequence of the connection between the neural controllers of movement. Previous studies showed the existence of an asymmetric between-hand interference (caused by neural cross talk) when different kinematics plans were to be executed by each hand or when only one was visually guided and received perturbed visual feedback. Here, in continuous bimanual circle drawing tasks, we investigated if the central nervous system (CNS) can benefit from visual composite feedback, i.e., a weighted sum of hands' positions presented for the visually guided hand, to control the nonvisible hand. Our results demonstrated improvement in the nonvisible nondominant hand (NDH) performance in the presence of the composite feedback. When NDH was visually guided, the dominant hand's (DH) performance during asymmetric drawing deteriorated, whereas its performance during symmetric drawing improved. This indicates that the CNS's ability to leverage composite feedback, which can be the result of decoding the nonvisible hand positional information from the composite feedback, is task-dependent and can be asymmetric. Also, the nonvisible hand's performance degraded when DH or NDH was visually guided with amplified error feedback. The results of the amplified feedback condition do not strongly support the asymmetry of the interference during asymmetric circle drawing. Comparing muscle activations in the asymmetric experiment, we concluded that the observed kinematic differences were not due to alternation in muscle co-contractions.NEW & NOTEWORTHY Many daily activities involve bimanual coordination while simultaneous movement of the hands may result in interference with their movements. Here, we studied whether the central nervous system could use the relevant information in composite feedback, i.e., a weighted sum of positional information of nonvisible and visible hands, to improve the movement of the nonvisible hand. Our results suggest the ability to decode and associate task-relevant information from the composite feedback.
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Affiliation(s)
- Milad Nazarahari
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Sahand Ajami
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Soo Jeon
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Arash Arami
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, Ontario, Canada
- KITE Institute, University Health Network (UHN), Toronto, Ontario, Canada
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Nguyen H, Phan T, Shadmehr R, Lee SW. Impact of unilateral and bilateral impairments on bimanual force production following stroke. J Neurophysiol 2023; 130:608-618. [PMID: 37529847 DOI: 10.1152/jn.00125.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/03/2023] Open
Abstract
Large bilateral asymmetry and task deficits are typically observed during bimanual actions of stroke survivors. Do these abnormalities originate from unilateral impairments affecting their more-impaired limb, such as weakness and abnormal synergy, or from bilateral impairments such as incoordination of two limbs? To answer this question, 23 subjects including 10 chronic stroke survivors and 13 neurologically intact subjects participated in an experiment where they produced bimanual forces at different hand locations. The force magnitude and directional deviation of the more-impaired arm were measured for unilateral impairments and bimanual coordination across locations for bilateral impairments. Force asymmetry and task error were used to define task performance. Significant unilateral impairments were observed in subjects with stroke; the maximal force capacity of their more-impaired arm was significantly lower than that of their less-impaired arm, with a higher degree of force deviation. However, its force contribution during submaximal tasks was greater than its relative force capacity. Significant bilateral impairments were also observed, as stroke survivors modulated two forces to a larger degree across hand locations but in a less coordinated manner than control subjects did. But only unilateral, not bilateral, impairments explained a significant amount of between-subject variability in force asymmetry across subjects with stroke. Task error, in contrast, was correlated with neither unilateral nor bilateral impairments. Our results suggest that unilateral impairments of the more-impaired arm of stroke survivors mainly contribute to its reduced recruitment, but that the degree of its participation in bimanual task may be greater than their capacity as they attempt to achieve symmetry.NEW & NOTEWORTHY We studied how unilateral and bilateral impairments in stroke survivors affect their bimanual task performance. Unilateral impairments of the more-impaired limb, both weakness and loss of directional control, mainly contribute to bimanual asymmetry, but stroke survivors generally produce higher force with their more-impaired limb than their relative capacity. Bilateral force coordination was significantly impaired in stroke survivors, but its degree of impairment was not related to their unilateral impairments.
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Affiliation(s)
- Hien Nguyen
- Department of Biomedical Engineering, Catholic University of America, Washington, District of Columbia, United States
- Center for Applied Biomechanics and Rehabilitation Research, MedStar National Rehabilitation Hospital, Washington, District of Columbia, United States
| | - Thanh Phan
- Department of Biomedical Engineering, Catholic University of America, Washington, District of Columbia, United States
- Center for Applied Biomechanics and Rehabilitation Research, MedStar National Rehabilitation Hospital, Washington, District of Columbia, United States
| | - Reza Shadmehr
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, United States
| | - Sang Wook Lee
- Department of Biomedical Engineering, Catholic University of America, Washington, District of Columbia, United States
- Center for Applied Biomechanics and Rehabilitation Research, MedStar National Rehabilitation Hospital, Washington, District of Columbia, United States
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
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Huo C, Xu G, Xie H, Zhao H, Zhang X, Li W, Zhang S, Huo J, Li H, Sun A, Li Z. Effect of High-Frequency rTMS Combined with Bilateral Arm Training on Brain Functional Network in Patients with Chronic Stroke: An fNIRS study. Brain Res 2023; 1809:148357. [PMID: 37011721 DOI: 10.1016/j.brainres.2023.148357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/06/2023] [Accepted: 03/31/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE Neurological evidence for the combinational intervention coupling rTMS with motor training for stroke rehabilitation remains limited. This study aimed to investigate the effects of rTMS combined with bilateral arm training (BAT) on the brain functional reorganization in patients with chronic stroke via functional near-infrared spectroscopy (fNIRS). METHODS Fifteen stroke patients and fifteen age-matched healthy participants were enrolled and underwent single BAT session (s-BAT) and BAT immediately after 5-Hz rTMS over the ipsilesional M1 (rTMS-BAT), measured cerebral haemodynamics by fNIRS. Functional connectivity (FC), the clustering coefficient (Ccoef), and local efficiency (Eloc) were applied to evaluate the functional response to the training paradigms. RESULTS The differences in FC responses to the two training paradigms were more pronounced in stroke patients than in healthy controls. In the resting state, stroke patients exhibited significantly lower FC than controls in both hemispheres. rTMS-BAT induced no significant difference in FC between groups. Compared to the resting state, rTMS-BAT induced significant decreases in Ccoef and Eloc of the contralesional M1 and significant increases in Eloc of the ipsilesional M1 in stroke patients. Additionally, these above two network metrics of the ipsilesional motor area were significantly positively correlated with the motor function of stroke patients. CONCLUSIONS These results suggest that the rTMS-BAT paradigm had additional effects on task-dependent brain functional reorganization. The engagement of the ipsilesional motor area in the functional network was associated with the motor impairment severity of stroke patients. fNIRS-based assessments may provide information about the neural mechanisms underlying combination interventions for stroke rehabilitation.
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Huo C, Xu G, Sun A, Xie H, Hu X, Li W, Li Z, Fan Y. Cortical response induced by task-oriented training of the upper limb in subacute stroke patients as assessed by functional near-infrared spectroscopy. JOURNAL OF BIOPHOTONICS 2023; 16:e202200228. [PMID: 36222197 DOI: 10.1002/jbio.202200228] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/28/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
Despite the popularity of task-oriented training for stroke, the cortical reorganization associated with this type of therapy remains to be fully elucidated due to the lack of dynamic assessment tools. A good tolerance for motion artifacts makes functional near-infrared spectroscopy (fNIRS) suitable for investigating task-induced cortical responses in stroke patients. Here, patients were randomly assigned to receive task oriented (n = 25) or cyclic rotary training (n = 25) with simultaneous cortical activation and effective connectivity network analysis between prefrontal and motor cortices (PFC/MC). Compared with cyclic rotary training, task-oriented training induced significantly increased activation in both hemispheres and enhanced influence of PFC on MC. In addition, significantly decreased activation lateralization and increased betweenness centrality of the contralesional MC suggested widespread involvement of the contralesional hemisphere during task-oriented training. This study verifies the feasibility of fNIRS combined with motor paradigms for assessing neural responses associated with stroke rehabilitation in real time.
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Affiliation(s)
- Congcong Huo
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Gongcheng Xu
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Aiping Sun
- Department of Neurological Rehabilitation, National Rehabilitation Hospital of National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Hui Xie
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Xiaoling Hu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Wenhao Li
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Zengyong Li
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China
- Key Laboratory of Neuro-Functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Beijing, China
| | - Yubo Fan
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
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Elango S, Francis AJA, Chakravarthy VS. Interaction of network and rehabilitation therapy parameters in defining recovery after stroke in a Bilateral Neural Network. J Neuroeng Rehabil 2022; 19:142. [PMID: 36536385 PMCID: PMC9762011 DOI: 10.1186/s12984-022-01106-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/27/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Restoring movement after hemiparesis caused by stroke is an ongoing challenge in the field of rehabilitation. With several therapies in use, there is no definitive prescription that optimally maps parameters of rehabilitation with patient condition. Recovery gets further complicated once patients enter chronic phase. In this paper, we propose a rehabilitation framework based on computational modeling, capable of mapping patient characteristics to parameters of rehabilitation therapy. METHOD To build such a system, we used a simple convolutional neural network capable of performing bilateral reaching movements in 3D space using stereovision. The network was designed to have bilateral symmetry to reflect the bilaterality of the cerebral hemispheres with the two halves joined by cross-connections. This network was then modified according to 3 chosen patient characteristics-lesion size, stage of recovery (acute or chronic) and structural integrity of cross-connections (analogous to Corpus Callosum). Similarly, 3 parameters were used to define rehabilitation paradigms-movement complexity (Exploratory vs Stereotypic), hand selection mode (move only affected arm, CIMT vs move both arms, BMT), and extent of plasticity (local vs global). For each stroke condition, performance under each setting of the rehabilitation parameters was measured and results were analyzed to find the corresponding optimal rehabilitation protocol. RESULTS Upon analysis, we found that regardless of patient characteristics network showed better recovery when high complexity movements were used and no significant difference was found between the two hand selection modes. Contrary to these two parameters, optimal extent of plasticity was influenced by patient characteristics. For acute stroke, global plasticity is preferred only for larger lesions. However, for chronic, plasticity varies with structural integrity of cross-connections. Under high integrity, chronic prefers global plasticity regardless of lesion size, but with low integrity local plasticity is preferred. CONCLUSION Clinically translating the results obtained, optimal recovery may be observed when paretic arm explores the available workspace irrespective of the hand selection mode adopted. However, the extent of plasticity to be used depends on characteristics of the patient mainly stage of stroke and structural integrity. By using systems as developed in this study and modifying rehabilitation paradigms accordingly it is expected post-stroke recovery can be maximized.
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Affiliation(s)
- Sundari Elango
- grid.417969.40000 0001 2315 1926Computational Neuroscience Laboratory, Department of Biotechnology, Indian Institute of Technology, Madras, India
| | - Amal Jude Ashwin Francis
- grid.417969.40000 0001 2315 1926Computational Neuroscience Laboratory, Department of Biotechnology, Indian Institute of Technology, Madras, India
| | - V. Srinivasa Chakravarthy
- grid.417969.40000 0001 2315 1926Computational Neuroscience Laboratory, Department of Biotechnology, Indian Institute of Technology, Madras, India
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Huo C, Sun Z, Xu G, Li X, Xie H, Song Y, Li Z, Wang Y. fNIRS-based brain functional response to robot-assisted training for upper-limb in stroke patients with hemiplegia. Front Aging Neurosci 2022; 14:1060734. [PMID: 36583188 PMCID: PMC9793407 DOI: 10.3389/fnagi.2022.1060734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
Background Robot-assisted therapy (RAT) has received considerable attention in stroke motor rehabilitation. Characteristics of brain functional response associated with RAT would provide a theoretical basis for choosing the appropriate protocol for a patient. However, the cortical response induced by RAT remains to be fully elucidated due to the lack of dynamic brain functional assessment tools. Objective To guide the implementation of clinical therapy, this study focused on the brain functional responses induced by RAT in patients with different degrees of motor impairment. Methods A total of 32 stroke patients were classified into a low score group (severe impairment, n = 16) and a high score group (moderate impairment, n = 16) according to the motor function of the upper limb and then underwent RAT training in assistive mode with simultaneous cerebral haemodynamic measurement by functional near-infrared spectroscopy (fNIRS). Functional connectivity (FC) and the hemisphere autonomy index (HAI) were calculated based on the wavelet phase coherence among fNIRS signals covering bilateral prefrontal, motor and occipital areas. Results Specific cortical network response related to RAT was observed in patients with unilateral moderate-to-severe motor deficits in the subacute stage. Compared with patients with moderate dysfunction, patients with severe impairment showed a wide range of significant FC responses in the bilateral hemispheres induced by RAT with the assistive mode, especially task-related involvement of ipsilesional supplementary motor areas. Conclusion Under assisted mode, RAT-related extensive cortical response in patients with severe dysfunction might contribute to brain functional organization during motor performance, which is considered the basic neural substrate of motor-related processes. In contrast, the limited cortical response related to RAT in patients with moderate dysfunction may indicate that the training intensity needs to be adjusted in time according to the brain functional state. fNIRS-based assessment of brain functional response assumes great importance for the customization of an appropriate protocol training in the clinical practice.
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Affiliation(s)
- Congcong Huo
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, Shandong, China,Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China,Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Zhifang Sun
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Gongcheng Xu
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, Shandong, China,Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xinglou Li
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Hui Xie
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, Shandong, China,Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Ying Song
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Zengyong Li
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China,Key Laboratory of Rehabilitation Aids Technology and System of the Ministry of Civil Affairs, Beijing, China,*Correspondence: Zengyong Li,
| | - Yonghui Wang
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, Shandong, China,Yonghui Wang,
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Johnson BP, Whitall J, McCombe Waller S, Westlake KP. Development and Psychometric Testing of the Bimanual Assessment Measure for People With Chronic Stroke. Am J Occup Ther 2022; 76:23287. [PMID: 35671509 DOI: 10.5014/ajot.2022.048995] [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 Few tools are available to assess bimanual deficits after stroke. OBJECTIVE To develop the Bimanual Assessment Measure (BAM), which assesses a person's hand coordination in both preferred and prestroke roles (i.e., stabilizer or manipulator). DESIGN Development and psychometric testing of the BAM. SETTING Research laboratory. PARTICIPANTS People with chronic stroke (n = 24), age-matched controls (n = 23), and occupational therapists (n = 40). OUTCOMES AND MEASURES We assessed the BAM's internal consistency, reliability, and face and known-groups validity. RESULTS Items were selected as meaningful tasks that represented a range of bimanual coordination requirements (e.g., symmetrical forces and timing, asymmetrical forces and timing, time-limited reactive movement). Focus groups of people with stroke and occupational therapists provided input into BAM development. The BAM was found to have excellent reliability and internal consistency and face and known-groups validity. CONCLUSIONS AND RELEVANCE The BAM is a valid, reliable measure for people with chronic stroke that identifies bimanual coordination deficits beyond unimanual impairments and the potential capacity for people to return to prestroke hand roles (i.e., as a manipulator). What This Article Adds: This article introduces the BAM as a new assessment measure of bimanual functioning with the potential capacity to restore prestroke hand roles as either a manipulator or a stabilizer among people with chronic stroke.
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Affiliation(s)
- Brian P Johnson
- Brian P. Johnson, PhD, OTR/L, is Postdoctoral Fellow, Human Cortical Physiology and Neurorehabilitation Section, National Institute on Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Jill Whitall
- Jill Whitall, PhD, is Professor Emerita, Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore
| | - Sandy McCombe Waller
- Sandy McCombe Waller, PhD, PT, is Associate Vice President and Dean of Health, Business, Technology, and Science, Frederick Community College, Frederick, MD
| | - Kelly P Westlake
- Kelly P. Westlake, PhD, PT, is Associate Professor, Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore;
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Chen S, Qiu Y, Bassile CC, Lee A, Chen R, Xu D. Effectiveness and Success Factors of Bilateral Arm Training After Stroke: A Systematic Review and Meta-Analysis. Front Aging Neurosci 2022; 14:875794. [PMID: 35547621 PMCID: PMC9082277 DOI: 10.3389/fnagi.2022.875794] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/28/2022] [Indexed: 12/05/2022] Open
Abstract
Bilateral arm training (BAT) presents as a promising approach in upper extremity (UE) rehabilitation after a stroke as it may facilitate neuroplasticity. However, the effectiveness of BAT is inconclusive, and no systematic reviews and meta-analyses have investigated the impact of different factors on the outcomes of BAT. This systematic review and meta-analysis aimed to (1) compare the effects of bilateral arm training (BAT) with unilateral arm training (UAT) and conventional therapy (CT) on the upper limb (UL) motor impairments and functional performance post-stroke, and (2) investigate the different contributing factors that may influence the success of BAT. A comprehensive literature search was performed in five databases. Randomized control trials (RCTs) that met inclusion criteria were selected and assessed for methodological qualities. Data relating to outcome measures, characteristics of participants (stroke chronicity and severity), and features of intervention (type of BAT and dose) were extracted for meta-analysis. With 25 RCTs meeting the inclusion criteria, BAT demonstrated significantly greater improvements in motor impairments as measured by Fugl-Meyer Assessment of Upper Extremity (FMA-UE) than CT (MD = 3.94, p = < 0.001), but not in functional performance as measured by the pooled outcomes of Action Research Arm Test (ARAT), Box and Block Test (BBT), and the time component of Motor Function Test (WMFT-time) (SMD = 0.28, p = 0.313). The superior motor impairment effects of BAT were associated with recruiting mildly impaired individuals in the chronic phase of stroke (MD = 6.71, p < 0.001), and applying a higher dose of intervention (MD = 6.52, p < 0.001). Subgroup analysis showed that bilateral functional task training (BFTT) improves both motor impairments (MD = 7.84, p < 0.001) and functional performance (SMD = 1.02, p = 0.049). No significant differences were detected between BAT and UAT for motor impairment (MD = -0.90, p = 0.681) or functional performance (SMD = -0.09, p = 0.457). Thus, our meta-analysis indicates that BAT may be more beneficial than CT in addressing post-stroke UL motor impairment, particularly in the chronic phase with mild UL paresis. The success of BAT may be dose-dependent, and higher doses of intervention may be required. BFTT appears to be a valuable form of BAT that could be integrated into stroke rehabilitation programs. BAT and UAT are generally equivalent in improving UL motor impairments and functional performance.
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Affiliation(s)
- Siyun Chen
- College of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Yuqi Qiu
- School of Statistics, East China Normal University, Shanghai, China
- Division of Biostatistics and Bioinformatics, University of California, San Diego, La Jolla, CA, United States
| | - Clare C. Bassile
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Anita Lee
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Ruifeng Chen
- Division of Biostatistics and Bioinformatics, University of California, San Diego, La Jolla, CA, United States
| | - Dongsheng Xu
- College of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
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Andrushko JW, Gould L, Renshaw DW, Forrester S, Kelly ME, Linassi G, Mickleborough M, Oates A, Hunter G, Borowsky R, Farthing JP. Ipsilesional Motor Cortex Activation with High-force Unimanual Handgrip Contractions of the Less-affected Limb in Participants with Stroke. Neuroscience 2021; 483:82-94. [PMID: 34920023 DOI: 10.1016/j.neuroscience.2021.12.011] [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: 08/11/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 11/27/2022]
Abstract
Stroke is a leading cause of severe disability that often presents with unilateral motor impairment. Conventional rehabilitation approaches focus on motor practice of the affected limb and aim to suppress brain activity in the contralesional hemisphere. Conversely, exercise of the less-affected limb promotes contralesional brain activity which is typically viewed as contraindicated in stroke recovery due to the interhemispheric inhibitory influence onto the ipsilesional hemisphere. Yet, high-force unimanual handgrip contractions are known to increase ipsilateral brain activation in control participants, and it remains to be determined if high-force contractions with the less-affected limb would promote ipsilateral brain activation in participants with stroke (i.e., the ipsilesional hemisphere). Therefore, this study aimed to determine how parametric increases in handgrip force during repeated contractions with the less-affected limb impacts brain activity bilaterally in participants with stroke and in a cohort of neurologically intact controls. Participants performed repeated submaximal contractions at 25%, 50%, and 75% of their maximum voluntary contraction during separate functional magnetic resonance imaging brain scans. Brain activation during the tasks was quantified as the present change from resting levels. In this study, higher force contractions were found to increase brain activation in the ipsilesional (stroke)/ipsilateral (controls) hemisphere in both groups (p = .002), but no between group differences were observed. These data suggest that high-force exercise with the less-affected limb may promote ipsilesional cortical plasticity to promote motor recovery of the affected-limb in participants with stroke.
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Affiliation(s)
- Justin W Andrushko
- College of Kinesiology, University of Saskatchewan, Saskatchewan, Canada
| | - Layla Gould
- Department of Surgery, Division of Neurosurgery, College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Doug W Renshaw
- College of Kinesiology, University of Saskatchewan, Saskatchewan, Canada
| | - Shannon Forrester
- College of Kinesiology, University of Saskatchewan, Saskatchewan, Canada
| | - Michael E Kelly
- Department of Surgery, Division of Neurosurgery, College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Gary Linassi
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Marla Mickleborough
- Department of Psychology, College of Arts and Science, University of Saskatchewan, Saskatchewan, Canada
| | - Alison Oates
- College of Kinesiology, University of Saskatchewan, Saskatchewan, Canada
| | - Gary Hunter
- Department of Medicine, Division of Neurology, College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Ron Borowsky
- Department of Psychology, College of Arts and Science, University of Saskatchewan, Saskatchewan, Canada
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Yang SH, Koh CL, Hsu CH, Chen PC, Chen JW, Lan YH, Yang Y, Lin YD, Wu CH, Liu HK, Lo YC, Liu GT, Kuo CH, Chen YY. An Instrumented Glove-Controlled Portable Hand-Exoskeleton for Bilateral Hand Rehabilitation. BIOSENSORS 2021; 11:bios11120495. [PMID: 34940252 PMCID: PMC8699525 DOI: 10.3390/bios11120495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022]
Abstract
Effective bilateral hand training is desired in rehabilitation programs to restore hand function for people with unilateral hemiplegia, so that they can perform daily activities independently. However, owing to limited human resources, the hand function training available in current clinical settings is significantly less than the adequate amount needed to drive optimal neural reorganization. In this study, we designed a lightweight and portable hand exoskeleton with a hand-sensing glove for bilateral hand training and home-based rehabilitation. The hand-sensing glove measures the hand movement of the less-affected hand using a flex sensor. Thereafter, the affected hand is driven by the hand exoskeleton using the measured hand movements. Compared with the existing hand exoskeletons, our hand exoskeleton improves the flexible mechanism for the back of the hand for better wearing experience and the thumb mechanism to make the pinch gesture possible. We designed a virtual reality game to increase the willingness of repeated movement practice for rehabilitation. Our system not only facilitates bilateral hand training but also assists in activities of daily living. This system could be beneficial for patients with hemiplegia for starting correct and sufficient hand function training in the early stages to optimize their recovery.
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Affiliation(s)
- Shih-Hung Yang
- Department of Mechanical Engineering, National Cheng Kung University, Tainan 70101, Taiwan;
| | - Chia-Lin Koh
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan;
| | - Chun-Hang Hsu
- Department of Electrical Engineering, National Chung Cheng University, Taichung 40227, Taiwan;
| | - Po-Chuan Chen
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA;
| | - Jia-Wei Chen
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan; (J.-W.C.); (Y.-H.L.); (Y.Y.); (C.-H.K.)
| | - Yu-Hao Lan
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan; (J.-W.C.); (Y.-H.L.); (Y.Y.); (C.-H.K.)
| | - Yi Yang
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan; (J.-W.C.); (Y.-H.L.); (Y.Y.); (C.-H.K.)
| | - Yi-De Lin
- Department of Mechanical and Computer-Aided Engineering, Feng Chia University, Taichung 40724, Taiwan; (Y.-D.L.); (C.-H.W.); (H.-K.L.)
| | - Chun-Hung Wu
- Department of Mechanical and Computer-Aided Engineering, Feng Chia University, Taichung 40724, Taiwan; (Y.-D.L.); (C.-H.W.); (H.-K.L.)
| | - Hsien-Kuang Liu
- Department of Mechanical and Computer-Aided Engineering, Feng Chia University, Taichung 40724, Taiwan; (Y.-D.L.); (C.-H.W.); (H.-K.L.)
| | - Yu-Chun Lo
- College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan;
| | - Guan-Tze Liu
- Department of Medical Education, Taipei Veterans General Hospital, Taipei 112201, Taiwan;
| | - Chao-Hung Kuo
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan; (J.-W.C.); (Y.-H.L.); (Y.Y.); (C.-H.K.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Department of Neurological Surgery, Neurological Institute, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Department of Neurological Surgery, University of Washington, Seattle, WA 98195-6470, USA
| | - You-Yin Chen
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan; (J.-W.C.); (Y.-H.L.); (Y.Y.); (C.-H.K.)
- College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan;
- Correspondence: (Y.-Y.C.)
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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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12
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Jayasinghe SAL, Maenza C, Good DC, Sainburg RL. Deficits in Performance on a Mechanically Coupled Asymmetrical Bilateral Task in Chronic Stroke Survivors with Mild Unilateral Paresis. Symmetry (Basel) 2021; 13:1366. [PMID: 38332947 PMCID: PMC10852351 DOI: 10.3390/sym13081366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
Typical upper limb-mediated activities of daily living involve coordination of both arms, often requiring distributed contributions to mechanically coupled tasks, such as stabilizing a loaf of bread with one hand while slicing with the other. We sought to examine whether mild paresis in one arm results in deficits in performance on a bilateral mechanically coupled task. We designed a virtual reality-based task requiring one hand to stabilize against a spring load that varies with displacement of the other arm. We recruited 15 chronic stroke survivors with mild hemiparesis and 7 age-matched neurologically intact adults. We found that stroke survivors produced less linear reaching movements and larger initial direction errors compared to controls (p < 0.05), and that contralesional hand performance was less linear than that of ipsilesional hand. We found a hand × group interaction (p < 0.05) for peak acceleration of the stabilizing hand, such that the dominant right hand of controls stabilized less effectively than the nondominant left hand while stroke survivors showed no differences between the hands. Our results indicate that chronic stroke survivors with mild hemiparesis show significant deficits in reaching aspects of bilateral coordination, but no deficits in stabilizing against a movement-dependent spring load in this task.
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Affiliation(s)
- Shanie A. L. Jayasinghe
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Candice Maenza
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Department of Kinesiology, Pennsylvania State University, State College, PA 16802, USA
| | - David C. Good
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Robert L. Sainburg
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Department of Kinesiology, Pennsylvania State University, State College, PA 16802, USA
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13
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Li YC, Lin KC, Chen CL, Yao G, Chang YJ, Lee YY, Liu CT. A Comparative Efficacy Study of Robotic Priming of Bilateral Approach in Stroke Rehabilitation. Front Neurol 2021; 12:658567. [PMID: 34322077 PMCID: PMC8310953 DOI: 10.3389/fneur.2021.658567] [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] [Received: 01/26/2021] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Stroke survivors can remain impaired in body functions, activity, and participation. A novel rehabilitation regimen is required to obtain scientific evidence and to help clinicians determine effective interventions for stroke. Mirror therapy (MT) and bilateral upper limb training (BULT) are based on the tenet of bilateral movement practice; however, the additional effect of bilateral robotic priming combined with these two therapies is unclear. Objectives: This study examined the effects of two hybrid therapies, robotic priming combined with MT and robotic priming combined with BULT, in stroke survivors. Methodology: The study randomized 31 participants to groups that received robotic priming combined with MT (n = 15) or robotic priming combined with BULT (n = 16). Outcome measures included the Fugl-Meyer Assessment (FMA), the revised Nottingham Sensory Assessment (rNSA), the Chedoke Arm and Hand Activity Inventory (CAHAI), and accelerometer data. Results: Both groups showed statistically significant within-group improvements in most outcome measures. Significant between-group differences and medium-to-large effect sizes were found in favor of the group that received robotic priming combined with MT based on the FMA distal part subscale scores, FMA total scores, and accelerometer data. Conclusion: Robotic priming combined with MT may have beneficial effects for patients in the improvements of overall and distal arm motor impairment as well as affected arm use in real life. Additional follow-up, a larger sample size, and consideration of the effect of lesion location or different levels of cognitive impairment are warranted to validate our findings in future studies. Clinical trial registration: www.ClinicalTrials.gov, identifier NCT03773653.
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Affiliation(s)
- Yi-chun Li
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, 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
| | - Chia-ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Grace Yao
- Department of Psychology, National Taiwan University, Taipei, Taiwan
| | - Ya-ju Chang
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Ya-yun Lee
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-ting Liu
- Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
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14
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Richardson MC, Tears C, Morris A, Alexanders J. The Effects of Unilateral Versus Bilateral Motor Training on Upper Limb Function in Adults with Chronic Stroke: A Systematic Review. J Stroke Cerebrovasc Dis 2021; 30:105617. [PMID: 33516068 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/06/2021] [Accepted: 01/10/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Rehabilitation goals for chronic stroke patients are largely focused around regaining functional ability and independence, with particular focus on upper limb motor function. Unilateral and Bilateral motor training may help achieve this. Our objective was to evaluate and compare the effects of unilateral and bilateral motor training on upper limb motor function in chronic stroke patients. MATERIALS AND METHODS A comprehensive literature search was conducted until June 2020 through several electronic databases (CENTRAL, Medline, CINAHL, EBSCO, AMED and PEDro) to identify relevant studies. Studies that used the Fugl Meyer Assessment (FMA) as a minimum, to assess upper limb motor function following unilateral versus bilateral training in chronic stroke patients, qualified for inclusion within the review. Randomised controlled trial (RCT), cohort study and cross-sectional study designs were considered. The Cochrane risk of bias tool was used to assess Randomised Controlled Trials (RCTs). The findings were qualitatively synthesised. RESULTS From a total of 838 studies identified, 7 RCTs were included in this review. All except one of the studies included reported an unclear risk of bias, with one low risk of bias reported. Overall, the studies reported that unilateral and bilateral training improved upper limb function in chronic stroke patients. Improvements between interventions were equivocal. Bilateral upper limb training however may be more efficacious for increasing upper limb strength and quality of movement, with unilateral training more beneficial for recovering functional ability for activities of daily living. CONCLUSION While the findings of the included studies support the use of unilateral and bilateral motor training post chronic stroke, the seven studies that were included methodologically all presented with limitations, hence strong conclusions cannot be drawn and further research is warranted.
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Affiliation(s)
- Mark C Richardson
- Department of Allied Health Professions, Teesside University, Middlesbrough, United Kingdom.
| | - Craig Tears
- Department of Allied Health Professions, Teesside University, Middlesbrough, United Kingdom
| | - Anna Morris
- Department of Allied Health Professions, Teesside University, Middlesbrough, United Kingdom
| | - Jenny Alexanders
- Department of Allied Health Professions, Teesside University, Middlesbrough, United Kingdom
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15
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Chen Y, Yang Z, Wen Y. A Soft Exoskeleton Glove for Hand Bilateral Training via Surface EMG. SENSORS (BASEL, SWITZERLAND) 2021; 21:E578. [PMID: 33467452 PMCID: PMC7830700 DOI: 10.3390/s21020578] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/31/2020] [Accepted: 01/13/2021] [Indexed: 11/17/2022]
Abstract
Traditional rigid exoskeletons can be challenging to the comfort of wearers and can have large pressure, which can even alter natural hand motion patterns. In this paper, we propose a low-cost soft exoskeleton glove (SExoG) system driven by surface electromyography (sEMG) signals from non-paretic hand for bilateral training. A customization method of geometrical parameters of soft actuators was presented, and their structure was redesigned. Then, the corresponding pressure values of air-pump to generate different angles of actuators were determined to support four hand motions (extension, rest, spherical grip, and fist). A two-step hybrid model combining the neural network and the state exclusion algorithm was proposed to recognize four hand motions via sEMG signals from the healthy limb. Four subjects were recruited to participate in the experiments. The experimental results show that the pressure values for the four hand motions were about -2, 0, 40, and 70 KPa, and the hybrid model can yield a mean accuracy of 98.7% across four hand motions. It can be concluded that the novel SExoG system can mirror the hand motions of non-paretic hand with good performance.
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Affiliation(s)
- Yumiao Chen
- School of Art, Design and Media, East China University of Science and Technology, Shanghai 200237, China
| | - Zhongliang Yang
- College of Mechanical Engineering, Donghua University, Shanghai 201620, China; (Z.Y.); (Y.W.)
| | - Yangliang Wen
- College of Mechanical Engineering, Donghua University, Shanghai 201620, China; (Z.Y.); (Y.W.)
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16
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Nel HW, Mudzi W, van Vuuren ECJ, Musenge E. Biodex© training post-stroke for postural stability in the upper trunk: A pilot study. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2020; 76:1416. [PMID: 33102886 PMCID: PMC7565172 DOI: 10.4102/sajp.v76i1.1416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 06/26/2020] [Indexed: 11/16/2022] Open
Abstract
Background Stroke affects upper trunk postural stability and upper limb function in approximately 85% of stroke survivors. Upper trunk postural stability is essential for functioning of the upper limb and is a prerequisite for hand function. The rehabilitation of the upper limb and upper trunk post-stroke remains a challenge because of poor recovery of motor and sensory function. Objectives To determine the effect of Biodex© upper limb weight-bearing training on upper trunk postural stability in patients post-stroke. Method A longitudinal randomised control pilot trial with single blinding was undertaken to assess postural stability on the Biodex© at baseline and 1-month post-baseline. In addition to standard rehabilitative care, upper limb weight-bearing training on the Biodex© was added for participants in the experimental group. Descriptive data analysis and the Mann–Whitney test for group comparisons were done using STATA (p < 0.05). Results Fifteen participants took part, seven in the control and eight in the experimental group, with an overall median age of 55 years. At baseline there were statistically significant lower scores in the experimental group on overall (p = 0.02) and anterior/posterior (p = 0.009) stability level 6 (moderately unstable base of support) in the upper trunk postural stability scores. No statistically significant improvements were noted between groups on any of the Biodex© stability levels at 1-month post-baseline testing (p > 0.05). Conclusion Upper limb weight-bearing training with the addition of Biodex© training did not result in improvements in upper trunk postural stability. Clinical implications The findings suggest that exercising on a moderately unstable base of support may improve upper trunk postural stability in patients post-stroke. The addition of Biodex© training to standard rehabilitative care for retraining and exercising upper trunk postural control in a weight-bearing position does not lead to better outcomes than standard care.
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Affiliation(s)
- Helena W Nel
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Physiotherapy, School of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Witness Mudzi
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Post-graduate School, University of the Free State, Bloemfontein, South Africa
| | - Elizabeth C Janse van Vuuren
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Eustasius Musenge
- Department of Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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17
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Dutcher AM, Truong KV, Miller DD, Allred RP, Nudi E, Jones TA. Training in a cooperative bimanual skilled reaching task, the popcorn retrieval task, improves unimanual function after motor cortical infarcts in rats. Behav Brain Res 2020; 396:112900. [PMID: 32941880 DOI: 10.1016/j.bbr.2020.112900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
Disuse of the paretic hand after stroke is encouraged by compensatory reliance on the nonparetic hand, to exacerbate impairment and potentially constrain motor rehabilitation efficacy. Rodent stroke model findings support that learning new unimanual skills with the nonparetic forelimb diminishes functional improvements that can be driven by rehabilitative training of the paretic forelimb. The influence of learning new ways of skillfully using the two hands together on paretic side function is much less clear. To begin to explore this, we developed a new cooperative bimanual skilled reaching task for rats, the Popcorn Retrieval Task. After motor cortical infarcts impaired an established unimanual reaching skill in the paretic forelimb, rats underwent a 7 week period of de novo bimanual training (BiT) or no-training control procedures (Cont). Probes of paretic forelimb unimanual performance revealed significant improvements during and after the training period in BiT vs. Cont. We additionally observed a striking change in the bimanual task strategy over training days: a switch from the paretic to the nonparetic forelimb for initiating reach-to-grasp sequences. This motivated another study to test whether rats that established the bimanual skill prior to the infarcts would similarly switch handedness, which they did not, though paretic paw use for manipulative movements diminished. These results indicate that unimanual function of the paretic side can be improved by novel bimanual skill practice, even when it involves compensatory reliance on the nonparetic hand. They further support the suitability of the Popcorn Retrieval Task for studying bimanual skill learning effects in rats.
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Affiliation(s)
| | | | | | | | - Evan Nudi
- Psychology Department, United States
| | - Theresa A Jones
- Institute for Neuroscience, United States; Psychology Department, United States.
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18
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LEE JOOHYUN, JUNG YOUNGJIN. FUNCTIONAL NEAR-INFRARED SPECTROSCOPY-BASED UPPER EXTREMITY FUNCTION REHABILITATION FOR STROKE SURVIVOR: A REVIEW. J MECH MED BIOL 2020. [DOI: 10.1142/s0219519420500013] [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
Recently, the functional near-infrared spectroscopy (600–900[Formula: see text]nm electromagnetic wave) ([Formula: see text]-NIRS)-based rehabilitation researches have been studied for understanding the human brain. Although [Formula: see text]-NIRS can successfully measure the relative blood concentration changes of oxy-hemoglobin (HbO) and deoxy-hemoglobin (HbR) as an assessment tool to identify significant clinical intervention during pre- and post-rehabilitation therapy for stroke survivors, there is insufficient information particularly on the use of [Formula: see text]-NIRS as a clinical translation in upper extremity function rehabilitation. In order to widely utilize the [Formula: see text]-NIRS for upper extremity rehabilitation, device information, experiment design, measurement procedure, and analyzing method are described for clinician aspect in this study. In addition, further research trend was introduced from previous studies for stroke survivor rehabilitation. The authors believed that the information provided in this study can be a useful guideline to encourage future researchers to focus on upper extremity function rehabilitation of stroke survivors.
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Affiliation(s)
- JOO-HYUN LEE
- Department of Occupational Therapy, Baekseok University, Cheonan 31065, Republic of Korea
| | - YOUNG-JIN JUNG
- Department of Radiological Science, Dongseo University, Busan 47011, Republic of Korea
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19
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A Cortico- Basal Ganglia Model for choosing an optimal rehabilitation strategy in Hemiparetic Stroke. Sci Rep 2019; 9:13472. [PMID: 31530821 PMCID: PMC6748960 DOI: 10.1038/s41598-019-49670-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/12/2019] [Indexed: 11/16/2022] Open
Abstract
To facilitate the selection of an optimal therapy for a stroke patient with upper extremity hemiparesis, we propose a cortico-basal ganglia model capable of performing reaching tasks under normal and stroke conditions. The model contains two hemispherical systems, each organized into an outer sensory-motor cortical loop and an inner basal ganglia (BG) loop, controlling their respective hands. The model is trained to simulate two therapeutic approaches: the constraint induced movement therapy (CIMT) in which the intact is arrested, and Bimanual Reaching in which the movements of the intact arm are found to aid the affected arm. Which of these apparently mutually conflicting approaches is right for a given patient? Based on our study on the effect of lesion size on arm performance, we hypothesize that the choice of the therapy depends on the lesion size. Whereas bimanual reaching is more suitable for smaller lesion size, CIMT is preferred in case of larger lesion sizes. By virtue of the model’s ability to capture the experimental results effectively, we believe that it can serve as a benchmark for the development and testing of various rehabilitation strategies for stroke.
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20
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The Effect of Occupation-Based Bilateral Upper Extremity Training in a Medical Setting for Stroke Patients: A Single-Blinded, Pilot Randomized Controlled Trial. J Stroke Cerebrovasc Dis 2019; 28:104335. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/17/2019] [Accepted: 07/30/2019] [Indexed: 11/23/2022] Open
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21
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Tashiro S, Mizuno K, Kawakami M, Takahashi O, Nakamura T, Suda M, Haruyama K, Otaka Y, Tsuji T, Liu M. Neuromuscular electrical stimulation-enhanced rehabilitation is associated with not only motor but also somatosensory cortical plasticity in chronic stroke patients: an interventional study. Ther Adv Chronic Dis 2019; 10:2040622319889259. [PMID: 31798821 PMCID: PMC6868577 DOI: 10.1177/2040622319889259] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 10/09/2019] [Indexed: 12/02/2022] Open
Abstract
Background: Somatosensory function has been frequently overlooked in clinics and research
in the field of chronic stroke. The effects of neurorehabilitation
interventions on sensory processing have still to be investigated using
electrophysiological means. This study investigated the effect of hybrid assistive neuromuscular dynamic
stimulation (HANDS) therapy utilizing closed-loop
electromyography-controlled neuromuscular electrical stimulation (NMES), on
sensory changes and cortical plasticity among patients with chronic
stroke. Methods: This study was a prespecified analysis of 23 participants involved in an
ongoing large interventional study. Patients with severe upper limb
hemiplegia dues to chronic stroke underwent 3 weeks of inpatient HANDS
therapy, where daily treatment consisted of 8 h of NMES combined with wrist
splinting, 90 min of comprehensive occupational therapy, and the practice of
bimanual activities of daily living. Somatosensory evoked potentials (SEPs)
and functional sensory assessments, including the Semmes–Weinstein
monofilament test (SWMT) and thumb localizing test (TLT), were compared pre
and post-treatment. Results: While no significant recovery of tactile sensation was observed, significant
improvements in proprioception and motor function were induced. The number
of cortical peaks significantly increased in the median nerve, but not in
the tibial nerve. A total of 9 out of 11 participants who initially lacked
certain peaks responded to treatment. Further analysis revealed a
significant improvement in latency and amplitude of SEP peaks. Conclusions: Our results suggest that NMES-based neurorehabilitation induces certain
plastic changes in the primary sensory cortex and in cortices associated
with sensorimotor processing in people with chronic stroke sequelae, which
may explain the observed improvements in proprioception.
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Affiliation(s)
- Syoichi Tashiro
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Katsuhiro Mizuno
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinano-machi, Shinjuku, Tokyo, 160-8582, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Osamu Takahashi
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takuya Nakamura
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Mabu Suda
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Koshiro Haruyama
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
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Hsu H, Chiu H, Kuan T, Tsai C, Su F, Kuo L. Robotic‐assisted therapy with bilateral practice improves task and motor performance in the upper extremities of chronic stroke patients: A randomised controlled trial. Aust Occup Ther J 2019; 66:637-647. [DOI: 10.1111/1440-1630.12602] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/15/2019] [Accepted: 06/16/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Hsiu‐Yun Hsu
- Department of Physical Medicine and Rehabilitation National Cheng Kung University Hospital College of Medicine National Cheng Kung University
- Department of Occupational Therapy College of Medicine National Cheng Kung University
- Medical Device Innovation Center National Cheng Kung University
| | - Haw‐Yen Chiu
- Section of Plastic Surgery, Department of Surgery ChiMei Medical Center
| | - Ta‐Shen Kuan
- Department of Physical Medicine and Rehabilitation National Cheng Kung University Hospital College of Medicine National Cheng Kung University
| | - Ching‐Liang Tsai
- Department of Physical Medicine and Rehabilitation National Cheng Kung University Hospital College of Medicine National Cheng Kung University
| | - Fong‐Chin Su
- Medical Device Innovation Center National Cheng Kung University
- Department of Biomedical Engineering College of Engineering National Cheng Kung University
| | - Li‐Chieh Kuo
- Department of Occupational Therapy College of Medicine National Cheng Kung University
- Medical Device Innovation Center National Cheng Kung University
- Institute of Allied Health Sciences, College of Medicine National Cheng Kung University Tainan Taiwan
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23
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Chen PM, Kwong PWH, Lai CKY, Ng SSM. Comparison of bilateral and unilateral upper limb training in people with stroke: A systematic review and meta-analysis. PLoS One 2019; 14:e0216357. [PMID: 31120910 PMCID: PMC6532847 DOI: 10.1371/journal.pone.0216357] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 04/12/2019] [Indexed: 12/21/2022] Open
Abstract
Background and objectives Bilateral upper limb training (BULT) and unilateral upper limb training (UULT) are two effective strategies for the recovery of upper limb motor function after stroke. This meta-analysis aimed to compare the improvements in motor impairment and functional performances of people with stroke after BULT and UULT. Research design and methods This systematic review and meta-analysis identified 21 randomized controlled trials (RCTs) met the eligibility criteria from CINAHL, Medline, Embase, Cochrane Library and PubMed. The outcome measures were the Fugl-Meyer Assessment of Upper Extremity (FMA-UE), Wolf Motor Function Test (WMFT), Action Research Arm Test (ARAT) and Box and Block Test (BBT), which are validated measures of upper limb function. Results Twenty-one studies involving 842 subjects with stroke were included. Compared with UULT, BULT yielded a significantly greater mean difference (MD) in the FMA-UE (MD = 2.21, 95% Confidence Interval (CI), 0.12 to 4.30, p = 0.04; I2 = 86%, p<0.001). However, a comparison of BULT and UULT yielded insignificant mean difference (MD) in terms of the time required to complete the WMFT (MD = 0.44; 95%CI, -2.22 to 3.10, p = 0.75; I2 = 55%, p = 0.06) and standard mean difference (SMD) in terms of the functional ability scores on the WMFT, ARAT and BBT (SMD = 0.25; 95%CI, -0.02 to 0.52, p = 0.07; I2 = 54%, p = 0.02). Discussion and implications Compared to UULT, BULT yielded superior improvements in the improving motor impairment of people with stroke, as measured by the FMA-UE. However, these strategies did not yield significant differences in terms of the functional performance of people with stroke, as measured by the WMFT, ARAT and BBT. More comparative studies of the effects of BULT and UULT are needed to increase the reliability of these conclusions.
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Affiliation(s)
- Pei-ming Chen
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China (SAR)
| | - Patrick W. H. Kwong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China (SAR)
| | - Claudia K. Y. Lai
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (SAR)
| | - Shamay S. M. Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China (SAR)
- * E-mail:
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Abstract
OBJECTIVES To investigate whether the relationship between arm use and motor impairment post-stroke is influenced by the hemisphere of damage. METHODS Right-handed patients with unilateral left hemisphere damage (LHD) or right (RHD) (n=58; 28 LHD, 30 RHD) were recruited for this study. The Arm Motor Ability Test and Functional Impact Assessment were used to derive arm use patterns. The Fugl-Meyer motor assessment scale was used to quantify the level of motor impairment. RESULTS A significant interaction between patient group and impairment level was observed for contralesional, but not ipsilesional arm use. For lower impairment levels, contralesional (right arm for LHD and left arm for RHD) arm use was greater in LHD than RHD patients. In contrast, for greater levels of impairment, there were no arm use differences between the two patient groups. CONCLUSIONS When motor impairment is significant, it overrides potential effects of stroke laterality on the patterns of arm use. However, a robust influence of hemisphere of damage on the patterns of arm use is evident at lower impairment levels. This may be attributed to previously described arm preference effects. These findings suggest adoption of distinct strategies for rehabilitation following left versus right hemisphere damage in right-handers, at least when the impairment is moderate to low. (JINS, 2019, 25, 470-478).
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Ghai S. Effects of Real-Time (Sonification) and Rhythmic Auditory Stimuli on Recovering Arm Function Post Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2018; 9:488. [PMID: 30057563 PMCID: PMC6053522 DOI: 10.3389/fneur.2018.00488] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 06/05/2018] [Indexed: 01/15/2023] Open
Abstract
Background: External auditory stimuli have been widely used for recovering arm function post-stroke. Rhythmic and real-time auditory stimuli have been reported to enhance motor recovery by facilitating perceptuomotor representation, cross-modal processing, and neural plasticity. However, a consensus as to their influence for recovering arm function post-stroke is still warranted because of high variability noted in research methods. Objective: A systematic review and meta-analysis was carried out to analyze the effects of rhythmic and real-time auditory stimuli on arm recovery post stroke. Method: Systematic identification of published literature was performed according to PRISMA guidelines, from inception until December 2017, on online databases: Web of science, PEDro, EBSCO, MEDLINE, Cochrane, EMBASE, and PROQUEST. Studies were critically appraised using PEDro scale. Results: Of 1,889 records, 23 studies which involved 585 (226 females/359 males) patients met our inclusion criteria. The meta-analysis revealed beneficial effects of training with both types of auditory inputs for Fugl-Meyer assessment (Hedge's g: 0.79), Stroke impact scale (0.95), elbow range of motion (0.37), and reduction in wolf motor function time test (-0.55). Upon further comparison, a beneficial effect of real-time auditory feedback was found over rhythmic auditory cueing for Fugl-meyer assessment (1.3 as compared to 0.6). Moreover, the findings suggest a training dosage of 30 min to 1 h for at least 3-5 sessions per week with either of the auditory stimuli. Conclusion: This review suggests the application of external auditory stimuli for recovering arm functioning post-stroke.
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Affiliation(s)
- Shashank Ghai
- Institute for Sports Science, Leibniz University Hannover, Hannover, Germany
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Adebisi HI, Monikhe AS, Okey AE. Alterations in gait velocity and grip strength of stroke survivors following a 12-week structured therapeutic exercise programme. BIOMEDICAL HUMAN KINETICS 2018. [DOI: 10.1515/bhk-2018-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Summary
Study aim: This study investigated the alterations in gait velocity and grip strength of stroke survivors following a structured therapeutic exercise programme (STEP). Material and methods: This was a pre-test, post-test experimental study of the effectiveness of a 12-week STEP on gait velocity and grip strength of stroke survivors. A total of 30 hemiparetic stroke survivors participated in the study. The instrument for this study was an adaptation of a training protocol for the training and assessment of gait velocity and grip strength. The participants underwent a 12-week STEP of a frequency of 3 times per week and the training programme focused on exercises aimed at improving the gait velocity and grip strength of the participants. The gait velocity and grip strength were measured before and after the training. Data generated were analysed using descriptive statistics of mean and standard deviation to summarize the profile of the participants. The analysis of variance for repeated measures (ANOVA) was used to test the hypotheses. Statistical significance was accepted for a p value of <0.05. Results: The outcome of this study showed that the STEP had significant (p < 0.05) effects on the gait velocity and grip strength of stroke survivors. Meanwhile, there was no significant (p > 0.05) effect of haemorrhagic and ischaemic groups of stroke survivors on gait velocity and grip strength.
Conclusion: It was therefore concluded that the use of the STEP can substantially improve the gait velocity and grip strength of stroke survivors.
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Affiliation(s)
- Hammed I. Adebisi
- Department of Physiotherapy, University of Benin Teaching Hospital, Benin City , Nigeria
| | - Adodo S. Monikhe
- Department of Human Kinetics and Sports Science, University of Benin, Benin City , Nigeria
| | - Agwubike E. Okey
- Department of Human Kinetics and Sports Science, University of Benin, Benin City , Nigeria
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Gassert R, Dietz V. Rehabilitation robots for the treatment of sensorimotor deficits: a neurophysiological perspective. J Neuroeng Rehabil 2018; 15:46. [PMID: 29866106 PMCID: PMC5987585 DOI: 10.1186/s12984-018-0383-x] [Citation(s) in RCA: 145] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 05/07/2018] [Indexed: 11/30/2022] Open
Abstract
The past decades have seen rapid and vast developments of robots for the rehabilitation of sensorimotor deficits after damage to the central nervous system (CNS). Many of these innovations were technology-driven, limiting their clinical application and impact. Yet, rehabilitation robots should be designed on the basis of neurophysiological insights underlying normal and impaired sensorimotor functions, which requires interdisciplinary collaboration and background knowledge. Recovery of sensorimotor function after CNS damage is based on the exploitation of neuroplasticity, with a focus on the rehabilitation of movements needed for self-independence. This requires a physiological limb muscle activation that can be achieved through functional arm/hand and leg movement exercises and the activation of appropriate peripheral receptors. Such considerations have already led to the development of innovative rehabilitation robots with advanced interaction control schemes and the use of integrated sensors to continuously monitor and adapt the support to the actual state of patients, but many challenges remain. For a positive impact on outcome of function, rehabilitation approaches should be based on neurophysiological and clinical insights, keeping in mind that recovery of function is limited. Consequently, the design of rehabilitation robots requires a combination of specialized engineering and neurophysiological knowledge. When appropriately applied, robot-assisted therapy can provide a number of advantages over conventional approaches, including a standardized training environment, adaptable support and the ability to increase therapy intensity and dose, while reducing the physical burden on therapists. Rehabilitation robots are thus an ideal means to complement conventional therapy in the clinic, and bear great potential for continued therapy and assistance at home using simpler devices. This review summarizes the evolution of the field of rehabilitation robotics, as well as the current state of clinical evidence. It highlights fundamental neurophysiological factors influencing the recovery of sensorimotor function after a stroke or spinal cord injury, and discusses their implications for the development of effective rehabilitation robots. It thus provides insights on essential neurophysiological mechanisms to be considered for a successful development and clinical inclusion of robots in rehabilitation.
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Affiliation(s)
- Roger Gassert
- Department of Health Sciences and Technology, ETH Zurich, 8092, Zurich, Switzerland.
| | - Volker Dietz
- Spinal Cord Injury Center, Balgrist University Hospital, 8008, Zurich, Switzerland
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Kantak S, Jax S, Wittenberg G. Bimanual coordination: A missing piece of arm rehabilitation after stroke. Restor Neurol Neurosci 2018; 35:347-364. [PMID: 28697575 DOI: 10.3233/rnn-170737] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Inability to use the arm in daily actions significantly lowers quality of life after stroke. Most contemporary post-stroke arm rehabilitation strategies that aspire to re-engage the weaker arm in functional activities have been greatly limited in their effectiveness. Most actions of daily life engage the two arms in a highly coordinated manner. In contrast, most rehabilitation approaches predominantly focus on restitution of the impairments and unilateral practice of the weaker hand alone. We present a perspective that this misalignment between real world requirements and intervention strategies may limit the transfer of unimanual capability to spontaneous arm use and functional recovery. We propose that if improving spontaneous engagement and use of the weaker arm in real life is the goal, arm rehabilitation research and treatment need to address the coordinated interaction between arms in targeted theory-guided interventions. Current narrow focus on unimanual deficits alone, difficulty in quantifying bimanual coordination in real-world actions and limited theory-guided focus on control and remediation of different coordination modes are some of the biggest obstacles to successful implementation of effective interventions to improve bimanual coordination in the real world. We present a theory-guided taxonomy of bimanual actions that will facilitate quantification of coordination for different real-world tasks and provide treatment targets for addressing coordination deficits. We then present evidence in the literature that points to bimanual coordination deficits in stroke survivors and demonstrate how current rehabilitation approaches are limited in their impact on bimanual coordination. Importantly, we suggest theory-based areas of future investigation that may assist quantification, identification of neural mechanisms and scientifically-based training/remediation approaches for bimanual coordination deficits post-stroke. Advancing the science and practice of arm rehabilitation to incorporate bimanual coordination will lead to a more complete functional recovery of the weaker arm, thus improving the effectiveness of rehabilitation interventions and augmenting quality of life after stroke.
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Affiliation(s)
- Shailesh Kantak
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA.,Department of Physical Therapy, Arcadia University, Elkins Park, PA, USA
| | - Steven Jax
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
| | - George Wittenberg
- Department of Neurology, Baltimore VAMC, University of Maryland, Glenside, PA, USA
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Schick T, Schlake HP, Kallusky J, Hohlfeld G, Steinmetz M, Tripp F, Krakow K, Pinter M, Dohle C. Synergy effects of combined multichannel EMG-triggered electrical stimulation and mirror therapy in subacute stroke patients with severe or very severe arm/hand paresis. Restor Neurol Neurosci 2018; 35:319-332. [PMID: 28506003 DOI: 10.3233/rnn-160710] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neurorehabilitation requires the development of severity-dependent and successful therapies for arm/hand rehabilitation in stroke patients. OBJECTIVE To evaluate the effectiveness of adding mirror therapy to bilateral EMG-triggered multi-channel electrostimulation for the treatment of severe arm/hand paresis in stroke patients. METHODS The subjects of this randomized, controlled, multicentre study were stroke patients who had suffered their first insult between 1 and 6 months before study start and had severe or very severe arm/hand paresis, as classified by Fugl-Meyer-Assessment. Subjects were randomly allocated to an intervention group (n = 16) or control group (n = 17). Both groups were treated for 3 weeks (5x week, 30 minutes) with bilateral EMG-triggered multi-channel electrostimulation. The intervention group additionally received mirror feedback of the unaffected limb. The primary outcome measure was motor recovery of the upper extremities, as measured by the Fugl-Meyer Assessment. RESULTS The Intervention Group with very severe paresis had significantly better motor recovery in total Fugl-Meyer Assessment (p = 0.017) at a medium effect size (Cohen) of d = 0.7, due to a significant recovery of shoulder and elbow function (p = 0.003) in the Fugl-Meyer Assessment Part A subtest. For subjects with severe paresis, additional mirror therapy did not significantly influence outcome. CONCLUSION Additional mirror therapy in combination with EMG-triggered multi-channel electrostimulation is therapeutically beneficial for post-acute stroke patients with very severe arm/hand paresis.
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Affiliation(s)
- Thomas Schick
- Department of Neurology and Neurological Rehabilitation, Rehab Center Wilhelmshaven, Wilhelmshaven, Germany.,MED-EL Medical Electronics, Business Unit Neurorehabilitation STIWELL, Innsbruck, Austria
| | - Hans-Peter Schlake
- Department of Neurology and Neurological Rehabilitation, Rehab Center Wilhelmshaven, Wilhelmshaven, Germany
| | | | - Günter Hohlfeld
- Department of Empirical Educational Research, FernUniversität in Hagen, Hagen, Germany
| | - Maria Steinmetz
- Department of Neurology and Neurological Rehabilitation, Rehab Center Wilhelmshaven, Wilhelmshaven, Germany
| | - Florian Tripp
- Department of Neurology and Neurological Rehabilitation, Asklepios Neurological Hospital Falkenstein, Königstein/Taunus, Germany
| | - Karsten Krakow
- Department of Neurology and Neurological Rehabilitation, Asklepios Neurological Hospital Falkenstein, Königstein/Taunus, Germany
| | - Michaela Pinter
- Department of Clinical Neurosciences and Preventive Medicine, Center for Neurorehabilitation, Danube University Krems, Krems, Austria
| | - Christian Dohle
- MEDIAN Klinik Berlin-Kladow, Berlin, Germany.,Center for Stroke Research Berlin, Charité-University Medicine Berlin, Berlin, Germany
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30
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Lee Y, Kim MY, Park JH, Park HY. Comparison of the effects of bilateral and unilateral training after stroke: A meta-analysis. NeuroRehabilitation 2017; 40:301-313. [PMID: 28211818 DOI: 10.3233/nre-161418] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The differential effects of bilateral and unilateral training on upper extremity (UE) function remain unclear. OBJECTIVE To compare the effectiveness of bilateral and unilateral training on UE function and activities of daily living (ADL) after stroke. METHODS Randomized controlled trials (RCTs) were selected for inclusion by two reviewers after searching the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and KoreaMed. Methodological qualities were assessed using the PEDro scale. Effect size was estimated by calculating the standardized mean difference (SMD). RESULTS Eleven RCTs of sufficient quality were included in our meta-analysis. The effect size on UE capacity was statistically significant in favor of the Constraint-Induced Movement Therapy (CIMT) groups (SMD [fixed], g: - 0.34; 95% CI: - 0.59-0.08; p = 0.01; I2 = 0%). No other SMDs were significant. CONCLUSION The CIMT tasks were more effective than bilateral training with regard to increased UE capacity; however, this result should be cautiously interpreted since the evaluation tools were designed for assessment of unilateral UE function, not bilateral UE function. Further, the effect of the CIMT tasks on UE capacity was not translated into ADL. Considering the disadvantages of CIMT such as fatigue, bilateral training may be more appropriate for improving ADL.
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Calabrò RS, Naro A, Russo M, Milardi D, Leo A, Filoni S, Trinchera A, Bramanti P. Is two better than one? Muscle vibration plus robotic rehabilitation to improve upper limb spasticity and function: A pilot randomized controlled trial. PLoS One 2017; 12:e0185936. [PMID: 28973024 PMCID: PMC5626518 DOI: 10.1371/journal.pone.0185936] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 09/19/2017] [Indexed: 12/20/2022] Open
Abstract
Even though robotic rehabilitation is very useful to improve motor function, there is no conclusive evidence on its role in reducing post-stroke spasticity. Focal muscle vibration (MV) is instead very useful to reduce segmental spasticity, with a consequent positive effect on motor function. Therefore, it could be possible to strengthen the effects of robotic rehabilitation by coupling MV. To this end, we designed a pilot randomized controlled trial (Clinical Trial NCT03110718) that included twenty patients suffering from unilateral post-stroke upper limb spasticity. Patients underwent 40 daily sessions of Armeo-Power training (1 hour/session, 5 sessions/week, for 8 weeks) with or without spastic antagonist MV. They were randomized into two groups of 10 individuals, which received (group-A) or not (group-B) MV. The intensity of MV, represented by the peak acceleration (a-peak), was calculated by the formula (2πf)2A, where f is the frequency of MV and A is the amplitude. Modified Ashworth Scale (MAS), short intracortical inhibition (SICI), and Hmax/Mmax ratio (HMR) were the primary outcomes measured before and after (immediately and 4 weeks later) the end of the treatment. In all patients of group-A, we observed a greater reduction of MAS (p = 0.007, d = 0.6) and HMR (p<0.001, d = 0.7), and a more evident increase of SICI (p<0.001, d = 0.7) up to 4 weeks after the end of the treatment, as compared to group-B. Likewise, group-A showed a greater function outcome of upper limb (Functional Independence Measure p = 0.1, d = 0.7; Fugl-Meyer Assessment of the Upper Extremity p = 0.007, d = 0.4) up to 4 weeks after the end of the treatment. A significant correlation was found between the degree of MAS reduction and SICI increase in the agonist spastic muscles (p = 0.004). Our data show that this combined rehabilitative approach could be a promising option in improving upper limb spasticity and motor function. We could hypothesize that the greater rehabilitative outcome improvement may depend on a reshape of corticospinal plasticity induced by a sort of associative plasticity between Armeo-Power and MV.
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Affiliation(s)
| | - Antonino Naro
- IRCCS Centro Neurolesi “Bonino-Pulejo” Messina; Messina, Italy
| | | | - Demetrio Milardi
- IRCCS Centro Neurolesi “Bonino-Pulejo” Messina; Messina, Italy
- Department of Biomedical, Dental Sciences, and Morphological and Functional Images, University of Messina; Messina, Italy
| | - Antonino Leo
- IRCCS Centro Neurolesi “Bonino-Pulejo” Messina; Messina, Italy
| | - Serena Filoni
- Fondazione Centri di Riabilitazione Padre Pio Onlus; San Giovanni Rotondo, Italy
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Pei YC, Chen JL, Wong AMK, Tseng KC. An Evaluation of the Design and Usability of a Novel Robotic Bilateral Arm Rehabilitation Device for Patients with Stroke. Front Neurorobot 2017; 11:36. [PMID: 28804454 PMCID: PMC5532391 DOI: 10.3389/fnbot.2017.00036] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 07/11/2017] [Indexed: 11/13/2022] Open
Abstract
STUDY DESIGN Case series. EVIDENCE LEVEL IV (case series). INTRODUCTION Robot-assisted therapy for upper limb rehabilitation is an emerging research topic and its design process must integrate engineering, neurological pathophysiology, and clinical needs. PURPOSE OF THE STUDY This study developed/evaluated the usefulness of a novel rehabilitation device, the MirrorPath, designed for the upper limb rehabilitation of patients with hemiplegic stroke. METHODS The process follows Tseng's methodology for innovative product design and development, namely two stages, device development and usability assessment. During the development process, the design was guided by patients' rehabilitation needs as defined by patients and their therapists. The design applied synchronic movement of the bilateral upper limbs, an approach that is compatible with the bilateral movement therapy and proprioceptive neuromuscular facilitation theories. MirrorPath consists of a robotic device that guides upper limb movement linked to a control module containing software controlling the robotic movement. RESULTS Five healthy subjects were recruited in the pretest, and 4 patients, 4 caregivers, and 4 therapists were recruited in the formal test for usability. All recruited subjects were allocated to the test group, completed the evaluation, and their data were all analyzed. The total system usability scale score obtained from the patients, caregivers, and therapists was 71.8 ± 11.9, indicating a high level of usability and product acceptance. DISCUSSION AND CONCLUSION Following a standard development process, we could yield a design that meets clinical needs. This low-cost device provides a feasible platform for carrying out robot-assisted bilateral movement therapy of patients with hemiplegic stroke. CLINICAL TRIAL REGISTRATION identifier NCT02698605.
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Affiliation(s)
- Yu-Cheng Pei
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Jean-Lon Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Alice M K Wong
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kevin C Tseng
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Product Design and Development Laboratory, Department of Industrial Design, College of Management, Chang Gung University, Taoyuan, Taiwan.,Department of Design, National Taiwan Normal University, Taipei City, Taiwan
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Kinematic Manifestation of Arm-Trunk Performance during Symmetric Bilateral Reaching After Stroke. Am J Phys Med Rehabil 2017; 96:146-151. [DOI: 10.1097/phm.0000000000000554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stoykov ME, Corcos DM, Madhavan S. Movement-Based Priming: Clinical Applications and Neural Mechanisms. J Mot Behav 2017; 49:88-97. [PMID: 28277966 DOI: 10.1080/00222895.2016.1250716] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Priming can be described as behavior change generated by preceding stimuli. Although various types of priming have been long studied in the field of psychology, priming that targets motor cortex is a relatively new topic of research in the fields of motor control and rehabilitation. In reference to a rehabilitation intervention, priming is categorized as a restorative approach. There are a myriad of possible priming approaches including noninvasive brain stimulation, motor imagery, and sensory-based priming, to name a few. The authors report on movement-based priming which, compared to other priming types, is less frequently examined and under reported. Movement-based priming includes, but is not limited to, bilateral motor priming, unilateral priming, and aerobic exercise. Clinical and neural mechanistic aspects of movement-based priming techniques are explored.
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Affiliation(s)
| | - Daniel Montie Corcos
- b Department of Physical Therapy & Human Movement Sciences , Northwestern University , Chicago , Illinois
| | - Sangeetha Madhavan
- c Department of Physical Therapy , University of Illinois at Chicago , Chicago , Illinois
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Nguyen HB, Lee SW, Harris-Love ML, Lum PS. Neural coupling between homologous muscles during bimanual tasks: effects of visual and somatosensory feedback. J Neurophysiol 2017; 117:655-664. [PMID: 27852730 DOI: 10.1152/jn.00269.2016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 11/10/2016] [Indexed: 01/15/2023] Open
Abstract
While the effects of sensory feedback on bimanual tasks have been studied extensively at two ends of the motor control hierarchy, the cortical and behavioral levels, much less is known about how it affects the intermediate levels, including neural control of homologous muscle groups. We investigated the effects of somatosensory input on the neural coupling between homologous arm muscles during bimanual tasks. Twelve subjects performed symmetric elbow flexion/extension tasks under different types of sensory feedback. The first two types involve visual feedback, with one imposing stricter force symmetry than the other. The third incorporated somatosensory feedback via a balancing apparatus that forced the two limbs to produce equal force levels. Although the force error did not differ between feedback conditions, the somatosensory feedback significantly increased temporal coupling of bilateral force production, indicated by a high correlation between left/right force profiles (P < 0.001). More importantly, intermuscular coherence between biceps brachii muscles was significantly higher with somatosensory feedback than others (P = 0.001). Coherence values also significantly differed between tasks (flexion/extension). Notably, whereas feedback type mainly modulated coherence in the α- and γ-bands, task type only affected β-band coherence. Similar feedback effects were observed for triceps brachii muscles, but there was also a strong phase effect on the coherence values (P < 0.001) that could have diluted feedback effects. These results suggest that somatosensory feedback can significantly increase neural coupling between homologous muscles. Additionally, the between-task difference in β-band coherence may reflect different neural control strategies for the elbow flexor and extensor muscles. NEW & NOTEWORTHY This study investigated the effects of somatosensory feedback during bimanual tasks on the neural coupling between arm muscles, which remains largely unexplored. Somatosensory feedback using a balancing apparatus, compared with visual feedback, significantly increased neural coupling between homologous muscles (indicated by intermuscular coherence values) and improved temporal correlation of bilateral force production. Notably, feedback type modulated coherence in the α- and γ-bands (more subcortical pathways), whereas task type mainly affected β-band coherence (corticospinal pathway).
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Affiliation(s)
- Hoi B Nguyen
- Center for Applied Biomechanics and Rehabilitation Research, MedStar National Rehabilitation Hospital, Washington, District of Columbia.,Department of Biomedical Engineering, Catholic University of America, Washington, District of Columbia
| | - Sang Wook Lee
- Center for Applied Biomechanics and Rehabilitation Research, MedStar National Rehabilitation Hospital, Washington, District of Columbia; .,Department of Biomedical Engineering, Catholic University of America, Washington, District of Columbia.,Center for Brain Plasticity and Recovery, Georgetown University, Washington, District of Columbia; and
| | - Michelle L Harris-Love
- Center for Brain Plasticity and Recovery, Georgetown University, Washington, District of Columbia; and.,Department of Rehabilitation Science, George Mason University, Fairfax, Virginia
| | - Peter S Lum
- Center for Applied Biomechanics and Rehabilitation Research, MedStar National Rehabilitation Hospital, Washington, District of Columbia.,Department of Biomedical Engineering, Catholic University of America, Washington, District of Columbia.,Center for Brain Plasticity and Recovery, Georgetown University, Washington, District of Columbia; and
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Kim DY, Kim YH, Lee J, Chang WH, Kim MW, Pyun SB, Yoo WK, Ohn SH, Park KD, Oh BM, Lim SH, Jung KJ, Ryu BJ, Im S, Jee SJ, Seo HG, Rah UW, Park JH, Sohn MK, Chun MH, Shin HS, Lee SJ, Lee YS, Park SW, Park YG, Paik NJ, Lee SG, Lee JK, Koh SE, Kim DK, Park GY, Shin YI, Ko MH, Kim YW, Yoo SD, Kim EJ, Oh MK, Chang JH, Jung SH, Kim TW, Kim WS, Kim DH, Park TH, Lee KS, Hwang BY, Song YJ. Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016. BRAIN & NEUROREHABILITATION 2017. [DOI: 10.12786/bn.2017.10.e11] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Deog Young Kim
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Min-Wook Kim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Sung-Bom Pyun
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Korea
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University College of Medicine, Korea
| | - Suk Hoon Ohn
- Department of Physical Medicine and Rehabilitation, Hallym University College of Medicine, Korea
| | - Ki Deok Park
- Department of Rehabilitation Medicine, Gachon University College of Medicine, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Kang Jae Jung
- Department of Physical Medicine and Rehabilitation, Eulji University Hospital & Eulji University School of Medicine, Korea
| | - Byung-Ju Ryu
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Korea
| | - Sun Im
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Sung Ju Jee
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Ueon Woo Rah
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Korea
| | - Joo Hyun Park
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Hee Suk Shin
- Department of Rehabilitation Medicine and Institute of Health Sciences, Gyeongsang National University College of Medicine, Korea
| | - Seong Jae Lee
- Department of Rehabilitation Medicine, College of Medicine Dankook University, Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Korea
| | - Si-Woon Park
- Department of Rehabilitation Medicine, Catholic Kwandong University International St Mary's Hospital, Korea
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Korea
| | - Nam Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Sam-Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Korea
| | - Ju Kang Lee
- Department of Rehabilitation Medicine, Gachon University College of Medicine, Korea
| | - Seong-Eun Koh
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Korea
| | - Don-Kyu Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Korea
| | - Geun-Young Park
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Yong Il Shin
- Department of Rehabilitation Medicine, Pusan National University Hospital, Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Korea
| | - Yong Wook Kim
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Korea
| | - Seung Don Yoo
- Department of Physical Medicine and Rehabilitation, Kyung Hee University College of Medicine, Korea
| | - Eun Joo Kim
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Hospital, Korea
| | - Min-Kyun Oh
- Department of Rehabilitation Medicine and Institute of Health Sciences, Gyeongsang National University College of Medicine, Korea
| | - Jae Hyeok Chang
- Department of Rehabilitation Medicine, Pusan National University Hospital, Korea
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Tae-Woo Kim
- TBI rehabilitation center, National Traffic Injury Rehabilitation Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Dae Hyun Kim
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Korea
| | - Kwan-Sung Lee
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Byong-Yong Hwang
- Department of Physical Therapy, Yong-In University College of Health & Welfare, Korea
| | - Young Jin Song
- Department of Rehabilitation Medicine, Asan Medical Center, Korea
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A Further Step to Develop Patient-Friendly Implementation Strategies for Virtual Reality-Based Rehabilitation in Patients With Acute Stroke. Phys Ther 2016; 96:1554-1564. [PMID: 27149961 DOI: 10.2522/ptj.20150271] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 04/28/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Virtual reality (VR)-based rehabilitation is gaining attention as a way to promote early mobilization in patients with acute stroke. However, given the motor weakness and cognitive impairment associated with acute stroke, implementation strategies for overcoming patient-perceived difficulty need to be developed to enhance their motivation for training. OBJECTIVE The purpose of this study was to explore patient-perceived difficulty and enjoyment during VR-based rehabilitation and the factors affecting those experiences. DESIGN An exploratory mixed-method design was used in this study. METHODS Eight individuals with acute stroke participated in 2 training modes of VR-based rehabilitation (ie, workout and game modes) 20 to 30 minutes per day for 5 to 8 sessions. A visual analog scale was used to assess patient-perceived difficulty and enjoyment at every session. Then semistructured interviews were conducted to explore the factors affecting those experiences. RESULTS Levels of difficulty and enjoyment varied depending on the training mode and participants' phases of recovery. Five major factors were identified as affecting those varied experiences: (1) ease of following the directions, (2) experience of pain, (3) scores achieved, (4) novelty and immediate feedback, and (5) self-perceived effectiveness. CONCLUSIONS Levels of difficulty and enjoyment during VR-based rehabilitation differed depending on the phases of recovery and training mode. Therefore, graded implementation strategies for VR-based rehabilitation are necessary for overcoming patient-perceived difficulty and enhancing enjoyment. Ease of following the directions might be best considered in the very early stage, whereas multisensory feedback may be more necessary in the later stage. Health professionals also should find a way for patients to avoid pain during training. Feedback, such as knowledge of results and performance, should be used appropriately.
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Comparison of individualized virtual reality- and group-based rehabilitation in older adults with chronic stroke in community settings: a pilot randomized controlled trial. Eur J Integr Med 2016. [DOI: 10.1016/j.eujim.2016.08.166] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Hatem SM, Saussez G, Della Faille M, Prist V, Zhang X, Dispa D, Bleyenheuft Y. Rehabilitation of Motor Function after Stroke: A Multiple Systematic Review Focused on Techniques to Stimulate Upper Extremity Recovery. Front Hum Neurosci 2016; 10:442. [PMID: 27679565 PMCID: PMC5020059 DOI: 10.3389/fnhum.2016.00442] [Citation(s) in RCA: 395] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 08/18/2016] [Indexed: 12/27/2022] Open
Abstract
Stroke is one of the leading causes for disability worldwide. Motor function deficits due to stroke affect the patients' mobility, their limitation in daily life activities, their participation in society and their odds of returning to professional activities. All of these factors contribute to a low overall quality of life. Rehabilitation training is the most effective way to reduce motor impairments in stroke patients. This multiple systematic review focuses both on standard treatment methods and on innovating rehabilitation techniques used to promote upper extremity motor function in stroke patients. A total number of 5712 publications on stroke rehabilitation was systematically reviewed for relevance and quality with regards to upper extremity motor outcome. This procedure yielded 270 publications corresponding to the inclusion criteria of the systematic review. Recent technology-based interventions in stroke rehabilitation including non-invasive brain stimulation, robot-assisted training, and virtual reality immersion are addressed. Finally, a decisional tree based on evidence from the literature and characteristics of stroke patients is proposed. At present, the stroke rehabilitation field faces the challenge to tailor evidence-based treatment strategies to the needs of the individual stroke patient. Interventions can be combined in order to achieve the maximal motor function recovery for each patient. Though the efficacy of some interventions may be under debate, motor skill learning, and some new technological approaches give promising outcome prognosis in stroke motor rehabilitation.
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Affiliation(s)
- Samar M Hatem
- Physical and Rehabilitation Medicine, Brugmann University HospitalBrussels, Belgium; Systems and Cognitive Neuroscience, Institute of Neuroscience, Université Catholique de LouvainBrussels, Belgium; Faculty of Medicine and Pharmacy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit BrusselBrussels, Belgium
| | - Geoffroy Saussez
- Systems and Cognitive Neuroscience, Institute of Neuroscience, Université Catholique de Louvain Brussels, Belgium
| | - Margaux Della Faille
- Systems and Cognitive Neuroscience, Institute of Neuroscience, Université Catholique de Louvain Brussels, Belgium
| | - Vincent Prist
- Physical and Rehabilitation Medicine, Centre Hospitalier de l'Ardenne Libramont, Belgium
| | - Xue Zhang
- Movement Control and Neuroplasticity Research Group, Motor Control Laboratory, Department of Kinesiology, Katholieke Universiteit Leuven Leuven, Belgium
| | - Delphine Dispa
- Systems and Cognitive Neuroscience, Institute of Neuroscience, Université Catholique de LouvainBrussels, Belgium; Physical Medicine and Rehabilitation, Cliniques Universitaires Saint-Luc, Université Catholique de LouvainBrussels, Belgium
| | - Yannick Bleyenheuft
- Systems and Cognitive Neuroscience, Institute of Neuroscience, Université Catholique de Louvain Brussels, Belgium
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Control of functional movements in healthy and post-stroke subjects: Role of neural interlimb coupling. Clin Neurophysiol 2016; 127:2286-93. [DOI: 10.1016/j.clinph.2016.02.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 02/08/2016] [Accepted: 02/19/2016] [Indexed: 11/21/2022]
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Yoo GE, Kim SJ. Rhythmic Auditory Cueing in Motor Rehabilitation for Stroke Patients: Systematic Review and Meta-Analysis. J Music Ther 2016; 53:149-77. [PMID: 27084833 DOI: 10.1093/jmt/thw003] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 01/14/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Given the increasing evidence demonstrating the effects of rhythmic auditory cueing for motor rehabilitation of stroke patients, this synthesized analysis is needed in order to improve rehabilitative practice and maximize clinical effectiveness. OBJECTIVE This study aimed to systematically analyze the literature on rhythmic auditory cueing for motor rehabilitation of stroke patients by highlighting the outcome variables, type of cueing, and stage of stroke. METHODS A systematic review with meta-analysis of randomized controlled or clinically controlled trials was conducted. Electronic databases and music therapy journals were searched for studies including stroke, the use of rhythmic auditory cueing, and motor outcomes, such as gait and upper-extremity function. RESULTS A total of 10 studies (RCT or CCT) with 356 individuals were included for meta-analysis. There were large effect sizes (Hedges's g = 0.984 for walking velocity; Hedges's g = 0.840 for cadence; Hedges's g = 0.760 for stride length; and Hedges's g = 0.456 for Fugl-Meyer test scores) in the use of rhythmic auditory cueing. Additional subgroup analysis demonstrated that although the type of rhythmic cueing and stage of stroke did not lead to statistically substantial group differences, the effect sizes and heterogeneity values in each subgroup implied possible differences in treatment effect. CONCLUSIONS This study corroborates the beneficial effects of rhythmic auditory cueing, supporting its expanded application to broadened areas of rehabilitation for stroke patients. Also, it suggests the future investigation of the differential outcomes depending on how rhythmic auditory cueing is provided in terms of type and intensity implemented.
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Affiliation(s)
- Ga Eul Yoo
- Ewha Womans University Ewha Womans University
| | - Soo Ji Kim
- Ewha Womans University Ewha Womans University
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Yu N, Xu C, Li H, Wang K, Wang L, Liu J. Fusion of Haptic and Gesture Sensors for Rehabilitation of Bimanual Coordination and Dexterous Manipulation. SENSORS (BASEL, SWITZERLAND) 2016; 16:E395. [PMID: 26999149 PMCID: PMC4813970 DOI: 10.3390/s16030395] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 03/10/2016] [Accepted: 03/11/2016] [Indexed: 01/29/2023]
Abstract
Disabilities after neural injury, such as stroke, bring tremendous burden to patients, families and society. Besides the conventional constrained-induced training with a paretic arm, bilateral rehabilitation training involves both the ipsilateral and contralateral sides of the neural injury, fitting well with the fact that both arms are needed in common activities of daily living (ADLs), and can promote good functional recovery. In this work, the fusion of a gesture sensor and a haptic sensor with force feedback capabilities has enabled a bilateral rehabilitation training therapy. The Leap Motion gesture sensor detects the motion of the healthy hand, and the omega.7 device can detect and assist the paretic hand, according to the designed cooperative task paradigm, as much as needed, with active force feedback to accomplish the manipulation task. A virtual scenario has been built up, and the motion and force data facilitate instantaneous visual and audio feedback, as well as further analysis of the functional capabilities of the patient. This task-oriented bimanual training paradigm recruits the sensory, motor and cognitive aspects of the patient into one loop, encourages the active involvement of the patients into rehabilitation training, strengthens the cooperation of both the healthy and impaired hands, challenges the dexterous manipulation capability of the paretic hand, suits easy of use at home or centralized institutions and, thus, promises effective potentials for rehabilitation training.
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Affiliation(s)
- Ningbo Yu
- Institute of Robotics and Automatic Information Systems, Nankai University, Tianjin 300353, China.
- Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin 300353, China.
| | - Chang Xu
- Institute of Robotics and Automatic Information Systems, Nankai University, Tianjin 300353, China.
- Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin 300353, China.
| | - Huanshuai Li
- Institute of Robotics and Automatic Information Systems, Nankai University, Tianjin 300353, China.
- Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin 300353, China.
| | - Kui Wang
- Institute of Robotics and Automatic Information Systems, Nankai University, Tianjin 300353, China.
- Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin 300353, China.
| | - Liancheng Wang
- Rehabilitation Center, Tianjin Hospital, Tianjin 300211, China.
| | - Jingtai Liu
- Institute of Robotics and Automatic Information Systems, Nankai University, Tianjin 300353, China.
- Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin 300353, China.
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Abstract
Priming is a type of implicit learning wherein a stimulus prompts a change in behavior. Priming has been long studied in the field of psychology. More recently, rehabilitation researchers have studied motor priming as a possible way to facilitate motor learning. For example, priming of the motor cortex is associated with changes in neuroplasticity that are associated with improvements in motor performance. Of the numerous motor priming paradigms under investigation, only a few are practical for the current clinical environment, and the optimal priming modalities for specific clinical presentations are not known. Accordingly, developing an understanding of the various types of motor priming paradigms and their underlying neural mechanisms is an important step for therapists in neurorehabilitation. Most importantly, an understanding of the methods and their underlying mechanisms is essential for optimizing rehabilitation outcomes. The future of neurorehabilitation is likely to include these priming methods, which are delivered prior to or in conjunction with primary neurorehabilitation therapies. In this Special Interest article, we discuss those priming paradigms that are supported by the greatest amount of evidence, including (i) stimulation-based priming, (ii) motor imagery and action observation, (iii) sensory priming, (iv) movement-based priming, and (v) pharmacological priming.Video Abstract available. (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A86) for more insights from the authors.
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Proximal Fugl-Meyer Assessment Scores Predict Clinically Important Upper Limb Improvement After 3 Stroke Rehabilitative Interventions. Arch Phys Med Rehabil 2015; 96:2137-44. [PMID: 26260019 DOI: 10.1016/j.apmr.2015.07.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 07/27/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To identify the baseline motor characteristics of the patients who responded to 3 prominent intervention programs. DESIGN Observational cohort study. SETTING Outpatient rehabilitation clinics. PARTICIPANTS Individuals with chronic stroke (N=174). INTERVENTIONS Participants received 30 hours of constraint-induced movement therapy (CIMT), robot-assisted therapy, or mirror therapy (MT). MAIN OUTCOME MEASURES The primary outcome measure was the change score of the Upper Extremity Fugl-Meyer Assessment (UE-FMA). The potential predicting variables were baseline proximal, distal, and total UE-FMA and Action Research Arm Test scores. We combined polynomial regression analyses and the minimal clinically important difference to stratify the patients as responders and nonresponders for each intervention approach. RESULTS Baseline proximal UE-FMA scores significantly predicted clinically important improvement on the primary outcome measure after all 3 interventions. Participants with baseline proximal UE-FMA scores of approximately <30 benefited significantly from CIMT and robot-assisted therapy, whereas participants with scores between 21 and 35 demonstrated significant improvement after MT. Baseline distal and total UE-FMA and Action Research Arm Test scores could also predict upper limb improvement after CIMT and MT, but not after robot-assisted therapy. CONCLUSIONS This study could inform clinicians about the selection of suitable rehabilitation approaches to help patients achieve clinically meaningful improvement in upper extremity function.
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Shim S, Jung J. Effects of bilateral training on motor function, amount of activity and activity intensity measured with an accelerometer of patients with stroke. J Phys Ther Sci 2015; 27:751-4. [PMID: 25931723 PMCID: PMC4395707 DOI: 10.1589/jpts.27.751] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 10/21/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study investigated the recovery of arm function and the functional use of
the affected limb in real life of stroke patients after bilateral arm training. [Subjects]
Twenty patients with stroke were randomly allocated to the BT (bilateral training group,
n=10) and UT (unilateral training group, n=10) groups. [Methods] The BT group performed
functional tasks with both hand symmetrically, the UT group performed tasks with only the
affected hand for 30 minutes a session 5 times a week over 6 weeks. Before and after the
intervention, accelerometers (Actisleep), functional independence measure (FIM) and manual
function test (MFT) were used to assess subjects’ abilities. [Results] The BT group showed
a significant improvement in FIM total score, motor subtotal score and MFT score of
affected side compared to the UT group. The BT group showed a more quantitative increase
in the amount of activity of the affected side than the UT group. Regarding activity
intensity, the BT group showed a decrease in the sedentary level and an increase of the
moderate level on the affected side compared to the UT group. [Conclusion] We found that
programs tailored to the characteristics of stroke patients and continuous monitoring of
physical activity using an accelerometer minimized possible future disability and improved
the patients’ quality of life.
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Affiliation(s)
- Sunhwa Shim
- Department of Occupational Therapy, Yonsei University, Republic of Korea
| | - Jinhwa Jung
- Department of Occupational Therapy, Semyung University, Republic of Korea
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Martins JC, Teixeira-Salmela LF, Aguiar LT, Souza LACE, Lara EM, Faria CDCDM. Assessment of the strength of the trunk and upper limb muscles in stroke subjects with portable dynamometry: a literature review. FISIOTERAPIA EM MOVIMENTO 2015. [DOI: 10.1590/0103-5150.028.001.ar02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction Clinical measurements of strength in stroke subjects are usually performed and portable dynamometers are one of the most employed instruments. Objective To verify the standardization procedures of the methods used to assess the strength of the trunk and upper limb muscles with portable dynamometers in stroke subjects, as well as to assess the psychometric properties which were already investigated. Materials and methods An extensive search was performed on the MEDLINE, SciELO, LILACS, and PEDro databases, by combining specific key words, followed by active manual searches by two independent researchers. Results and discussion Fifty-eight studies were included: three related to the trunk and 55 to the upper limb muscles, including handgrip and pinch strength assessments. The most investigated muscular groups were handgrip, elbow flexors/extensors, wrist extensors, and lateral pinch. Nine studies reported adequate reliability levels and the seated position was employed in the majority of the studies which assessed trunk, handgrip, and pinch strength, while the supine position was used for the other muscular groups. The number of trials most used was three, while the reported contractions and rest times were variable. Final considerations Most studies reported the positioning and/or the data collection protocols; however, there was no consensus on the standardization procedures. The only investigated psychometric property was reliability. Few studies evaluated the trunk muscles and other psychometric properties.
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Wolf A, Scheiderer R, Napolitan N, Belden C, Shaub L, Whitford M. Efficacy and task structure of bimanual training post stroke: a systematic review. Top Stroke Rehabil 2014; 21:181-96. [PMID: 24985386 DOI: 10.1310/tsr2103-181] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Bimanual training has been shown to be as effective as, but not superior to, unimanual paretic upper extremity (UE) training interventions in improving paretic UE function and use post stroke. However, it is still unclear whether different training interventions or task structures within bimanual interventions may differentially affect the outcomes. OBJECTIVE The objectives of this review were to (1) systematically determine the efficacy of bimanual training in relation to the International Classification of Functioning, Disability and Health model components and (2) explore the structure of current bimanual training interventions. METHOD A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eleven studies were accepted for review. RESULTS Three main types of bimanual training emerged: functional task training (FTT), bilateral training with rhythmic auditory cues (BATRAC), and robot-assisted training (RAT). Bimanual training is generally efficacious overall in improving paretic UE movement in individuals with subacute and/or chronic stroke as compared with other interventions. FTT, BATRAC, and RAT showed no significant differences compared with conventional therapy. Bimanual training may have greater proximal control benefits but fewer benefits in terms of subjects' perceived amount and quality of use as compared with constraint-induced movement therapy. CONCLUSION There were not enough data to draw any conclusions about the effects of bimanual task symmetry or commonality of goal.
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Affiliation(s)
- Angela Wolf
- Department of Physical Therapy, Walsh University, North Canton, Ohio
| | - Rachel Scheiderer
- Department of Physical Therapy, Walsh University, North Canton, Ohio
| | | | - Courtney Belden
- Department of Physical Therapy, Walsh University, North Canton, Ohio
| | - Lauren Shaub
- Department of Physical Therapy, Walsh University, North Canton, Ohio
| | - Maureen Whitford
- Department of Physical Therapy, Walsh University, North Canton, Ohio
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Byl NN, Abrams GM, Pitsch E, Fedulow I, Kim H, Simkins M, Nagarajan S, Rosen J. Chronic stroke survivors achieve comparable outcomes following virtual task specific repetitive training guided by a wearable robotic orthosis (UL-EXO7) and actual task specific repetitive training guided by a physical therapist. J Hand Ther 2014; 26:343-52; quiz 352. [PMID: 23911077 DOI: 10.1016/j.jht.2013.06.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 05/23/2013] [Accepted: 06/03/2013] [Indexed: 02/03/2023]
Abstract
Survivors post stroke commonly have upper limb impairments. Patients can drive neural reorganization, brain recovery and return of function with task specific repetitive training (TSRT). Fifteen community independent stroke survivors (25-75 years, >6 months post stroke, Upper Limb Fugl Meyer [ULFM] scores 16-39) participated in this randomized feasibility study to compare outcomes of upper limb TSRT guided by a robotic orthosis (bilateral or unilateral) or a physical therapist. After 6 weeks of training (18 h), across all subjects, there were significant improvements in depression, flexibility, strength, tone, pain and voluntary movement (ULFM) (p < 0.05; effect sizes 0.49-3.53). Each training group significantly improved ULFM scores and range of motion without significant group differences. Virtual or actual TSRT performed with a robotic orthosis or a physical therapist significantly reduced arm impairments around the shoulder and elbow without significant gains in fine motor hand control, activities of daily living or independence.
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Affiliation(s)
- Nancy N Byl
- Department of Physical Therapy and Rehabilitation Medicine, School of Medicine, University of California, San Francisco, USA.
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Kang N, Cauraugh JH. Force frequency structure below 1Hz in chronic stroke: Paretic arm control. Brain Res 2014; 1569:32-40. [DOI: 10.1016/j.brainres.2014.04.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 04/26/2014] [Accepted: 04/28/2014] [Indexed: 11/28/2022]
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Slijper A, Svensson KE, Backlund P, Engström H, Sunnerhagen KS. Computer game-based upper extremity training in the home environment in stroke persons: a single subject design. J Neuroeng Rehabil 2014; 11:35. [PMID: 24625289 PMCID: PMC3995595 DOI: 10.1186/1743-0003-11-35] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Accepted: 03/04/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of the present study was to assess whether computer game-based training in the home setting in the late phase after stroke could improve upper extremity motor function. METHODS Twelve subjects with prior stroke were recruited; 11 completed the study. DESIGN The study had a single subject design; there was a baseline test (A1), a during intervention test (B) once a week, a post-test (A2) measured directly after the treatment phase, plus a follow-up (C) 16-18 weeks after the treatment phase. Information on motor function (Fugl-Meyer), grip force (GrippitR) and arm function in activity (ARAT, ABILHAND) was gathered at A1, A2 and C. During B, only Fugl-Meyer and ARAT were measured. The intervention comprised five weeks of game-based computer training in the home environment. All games were designed to be controlled by either the affected arm alone or by both arms. Conventional formulae were used to calculate the mean, median and standard deviations. Wilcoxon's signed rank test was used for tests of dependent samples. Continuous data were analyzed by methods for repeated measures and ordinal data were analyzed by methods for ordered multinomial data using cumulative logistic models. A p-value of < 0.05 was considered statistically significant. RESULTS Six females and five males, participated in the study with an average age of 58 years (range 26-66). FMA-UE A-D (motor function), ARAT, the maximal grip force and the mean grip force on the affected side show significant improvements at post-test and follow-up compared to baseline. No significant correlation was found between the amount of game time and changes in the outcomes investigated in this study. CONCLUSION The results indicate that computer game-based training could be a promising approach to improve upper extremity function in the late phase after stroke, since in this study, changes were achieved in motor function and activity capacity.
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Affiliation(s)
| | | | | | | | - Katharina Stibrant Sunnerhagen
- Rehabilitation Medicine, The Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Per Dubbsgatan 14 3rd floor, SU/Sahlgrenska, Göteborg SE-413 45, Sweden.
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