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Jin L, Yang Z, Zou Z, Wu T, Pan H. A biomedical decision support system for meta-analysis of bilateral upper-limb training in stroke patients with hemiplegia. Open Life Sci 2023; 18:20220607. [PMID: 37528885 PMCID: PMC10389679 DOI: 10.1515/biol-2022-0607] [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: 02/10/2023] [Revised: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 08/03/2023] Open
Abstract
The purpose of this study is to investigate the efficacy of bilateral upper-limb training (BULT) in helping people with upper-limb impairments due to stroke or brain illness regain their previous level of function. Patients recuperating from a stroke or cerebral disease were given the option of undergoing BULT or conventional training to enhance their upper-limb function. Participants were randomly allocated to one of the several different fitness programs. Results from the action research arm test, Box and block test, Wolf motor function test, Fugal-Meyer evaluation, and any other tests administered were taken into account. Some researchers have found that exercising with BULT for just 30 min per day for 6 weeks yields significant results. There were a total of 1,411 individuals from 10 randomized controlled trials included in this meta-analysis. Meta-analysis findings revealed that biofeedback treatment outperformed conventional rehabilitation therapy in reducing lower leg muscular strain, complete spasm scale score, electromyography score, and inactive ankle joint range of motion. An analysis of the literature found that BULT improved limb use in people who had suffered a stroke and hemiplegia but it did not provide any additional benefit over unilateral training.
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Affiliation(s)
- Linna Jin
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun East Road, Hangzhou, Zhejiang, 310020, China
| | - Zhe Yang
- Department of Sleep Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun East Road, Hangzhou, Zhejiang, 310020, China
| | - Zhaojun Zou
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun East Road, Hangzhou, Zhejiang, 310020, China
| | - Tao Wu
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun East Road, Hangzhou, Zhejiang, 310020, China
| | - Hongying Pan
- Department of Nursing, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun East Road, Hangzhou, Zhejiang, 310020, China
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2
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Gnanaprakasam A, Karthikbabu S, Ravishankar N, Solomon JM. Effect of task-based bilateral arm training on upper limb recovery after stroke: A systematic review and meta-analysis. J Stroke Cerebrovasc Dis 2023; 32:107131. [PMID: 37148628 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107131] [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: 01/11/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 05/08/2023] Open
Abstract
OBJECTIVE Upper limb recovery is a crucial component of stroke rehabilitation aimed to maximize functional activities and reduce disability. Using both arms post stroke is essential to carry out many functional activities but the evidence on bilateral arm training (BAT) is understudied. To investigate the evidence for efficacy of task-based BAT on upper limb recovery, function, and participation post stroke. METHODS We included 13 randomized controlled trials, and methodological quality was assessed using Cochrane risk of bias tool and the PEDro scale. The outcome measures such as Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), Box and Block Test (BBT), Modified Barthel Index (MBI), Functional Independence Measure (FIM), and Stroke Impact Scale (SIS) were synthesized and analysed based on ICF. RESULTS When comparing BAT with control group, BAT showed improvement in the pooled standard mean difference (SMD) of FMA-UE (SMD= 0.62, 95% confidence interval (CI), 0.12 to 1.12, p = 0.01; I2=83%). The control group showed significant improvement in MAL-QOM (SMD= -0.10, 95%CI, -0.77 to 0.58, p = 0.78; I2=89%). Compared to conventional group, BAT showed a significant improvement in BBT (SMD= 0.52, 95%CI, 0.04 to 1.00, p = 0.03; I2=0%). When compared with BAT, unimanual training yielded a significant improvement (SMD= -0.60, 95%CI, -0.98 to -0.22, p = 0.002; I2=0%) in MAL-QOM. In real-life participation, the control group showed improvement in SIS (SMD= -0.17, 95% (CI), -0.70 to 0.37, p = 0.54; I2=48%) over BAT. CONCLUSIONS Task-based BAT appears to improve upper limb motor function post stroke. The benefits of task-based BAT on activity performance and participation in real life are not statistically significant.
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Affiliation(s)
- Alexander Gnanaprakasam
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Suruliraj Karthikbabu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India; KMCH College of Physiotherapy, Kovai Medical Center Research and Educational Trust, Coimbatore, The Tamil Nadu Dr. M.G.R. Medical University, India.
| | - N Ravishankar
- Department of Biostatistics, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India; Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, India.
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3
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Alaca N, Öcal NM. Proprioceptive based training or modified constraint-induced movement therapy on upper extremity motor functions in chronic stroke patients: A randomized controlled study. NeuroRehabilitation 2022; 51:271-282. [DOI: 10.3233/nre-220009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: The Modified Constraint-Induced Movement Therapy (mCIMT) method is a unilateral training that respectively avoids and activates less affected and affected sides of upper extremities; however, the selected options are not typically ideal. Proprioceptive based training (PT) includes bilateral training methods and influencing proprioceptive receptors. OBJECTIVE: The primary purpose was to determine if conventional therapy and PT or conventional therapy and mCIMT therapy show similar improvement in patients with chronic stroke. The secondary purpose was to investigate the effectiveness of conventional therapy and PT or mCIMT therapy in patients with chronic stroke and to compare which of the two interventions is more effective. METHODS: Forty patients with chronic stroke were randomly allocated to only conventional therapy (PTR, n = 14), conventional therapy plus proprioception training (PTR-PT, n = 13), and mCIMT (PTR-mCIMT, n = 13) groups. Evaluations were assessed before and 6 weeks after treatment. RESULTS: Intragroup evaluations revealeda significant improvement in the all scores in the PTR-PT and PTR-mCMIT groups (p = 0.006 < 0.001). Intergroup comparisons demonstrated that the PTR-mCIMT group had a significant improvement in spasticity and motor function scores compared to the PTR (p < 0.001) and the PTR-PT groups (p = 0.006–0.015). CONCLUSIONS: PT and mCMIT applied in addition to conventional therapy in patients with chronic stroke were more effective than only conventional therapy. Additionally, mCMIT showed greater improvement in spasticity and motor function scales than PT.
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Affiliation(s)
- Nuray Alaca
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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4
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Ma D, Li X, Xu Q, Yang F, Feng Y, Wang W, Huang JJ, Pei YC, Pan Y. Robot-Assisted Bimanual Training Improves Hand Function in Patients With Subacute Stroke: A Randomized Controlled Pilot Study. Front Neurol 2022; 13:884261. [PMID: 35873779 PMCID: PMC9298653 DOI: 10.3389/fneur.2022.884261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 06/08/2022] [Indexed: 11/25/2022] Open
Abstract
Study Design A randomized controlled pilot study. Background Bimanual therapy (BMT) is an effective neurorehabilitation therapy for the upper limb, but its application to the distal upper limb is limited due to methodological difficulties. Therefore, we applied an exoskeleton hand to perform robot-assisted task-oriented bimanual training (RBMT) in patients with stroke. Objective To characterize the effectiveness of RBMT in patients with hemiplegic stroke with upper limb motor impairment. Interventions A total of 19 patients with subacute stroke (1–6 months from onset) were randomized and allocated to RBMT and conventional therapy (CT) groups. The RBMT and CT groups received 90 min of training/day (RBMT: 60 min RBMT + 30 min CT; CT: 60 min CT for hand functional training + 30 min regular CT), 5 days/week, for 4 weeks (20 sessions during the experimental period). Assessments Clinical assessments, including the Fugl–Meyer assessment of the upper extremity (FMA-UE), action research arm test (ARAT), and wolf motor arm function test (WMFT), were conducted before and after the intervention. Results Within-group analysis showed a significant improvement in the FMA-UE and WMFT in both the CT and RBMT groups. A significant improvement in the Fugl–Meyer assessment (FMA) of the wrist and hand for the distal part in the RBMT group occurred earlier than that in the CT group. A significant improvement in WMFT time was found in both groups, but the WMFT functional ability assessment was only found in the RBMT group. No significant improvements in ARAT assessment were observed in either the CT or RBMT groups. Compared with CT, significant improvements were found in terms of the proportion of minimally clinically important differences after RBMT in FMA-UE (χ2 = 4.34, p = 0.037). No adverse events were reported by any of the participants across all sessions. Conclusions This study is the first to apply RBMT to the distal part of the upper limb. Both RBMT and CT are effective in improving the upper limb function in patients with subacute stroke. RBMT shows superior potential efficacy in facilitating recovery of the distal part of upper extremity (UE) motor function in the early stage. Future randomized control studies with a large sample size and follow-up assessments are needed to validate the present conclusions.
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Affiliation(s)
- Di Ma
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xin Li
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Quan Xu
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Fei Yang
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yutong Feng
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Wenxu Wang
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jian-Jia Huang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Graduate School of Science Design Program in Innovation for Smart Medicine, Chang Gung University, Taoyuan, Taiwan.,Center of Vascularized Tissue Allograft, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yu-Cheng Pei
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate School of Science Design Program in Innovation for Smart Medicine, Chang Gung University, Taoyuan, Taiwan.,Center of Vascularized Tissue Allograft, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yu Pan
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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5
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Lee YC, Li YC, Lin KC, Yao G, Chang YJ, Lee YY, Liu CT, Hsu WL, Wu YH, Chu HT, Liu TX, Yeh YP, Chang C. Effects of robotic priming of bilateral arm training, mirror therapy, and impairment-oriented training on sensorimotor and daily functions in patients with chronic stroke: study protocol of a single-blind, randomized controlled trial. Trials 2022; 23:566. [PMID: 35841056 PMCID: PMC9287972 DOI: 10.1186/s13063-022-06498-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 06/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Combining robotic therapy (RT) with task-oriented therapy is an emerging strategy to facilitate motor relearning in stroke rehabilitation. This study protocol will compare novel rehabilitation regimens that use bilateral RT as a priming technique to augment two task-oriented therapies: mirror therapy (MT) and bilateral arm training (BAT) with a control intervention: RT combined with impairment-oriented training (IOT). METHODS This single-blind, randomized, comparative efficacy study will involve 96 participants with chronic stroke. Participants will be randomized into bilateral RT+MT, bilateral RT+BAT, and bilateral RT+IOT groups and receive 18 intervention sessions (90 min/day, 3 d/week for 6 weeks). The outcomes will include the Fugl-Meyer Assessment, Stroke Impact Scale version 3.0, Medical Research Council scale, Revised Nottingham Sensory Assessment, ABILHAND Questionnaire, and accelerometer and will be assessed at baseline, after treatment, and at the 3-month follow-up. Analysis of covariance and the chi-square automatic interaction detector method will be used to examine the comparative efficacy and predictors of outcome, respectively, after bilateral RT+MT, bilateral RT+BAT, and bilateral RT+IOT. DISCUSSION The findings are expected to contribute to the research and development of robotic devices, to update the evidence-based protocols in postacute stroke care programs, and to investigate the use of accelerometers for monitoring activity level in real-life situations, which may in turn promote home-based practice by the patients and their caregivers. Directions for further studies and empirical implications for clinical practice will be further discussed in upper-extremity rehabilitation after stroke. TRIAL REGISTRATION This trial was registered December 12, 2018, at www. CLINICALTRIALS gov ( NCT03773653 ).
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Affiliation(s)
- Yi-Chen Lee
- School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xu Zhou Road, Taipei, Taiwan
| | - Yi-Chun Li
- School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xu Zhou Road, Taipei, Taiwan
| | - Keh-Chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xu Zhou Road, Taipei, Taiwan. .,Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, 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 Rehabilitation, Taipei Tzu Chi Hospital, the Buddhist Tzu-Chi Medical Foundation, Taipei, Taiwan
| | - Wan-Ling Hsu
- Department of Rehabilitation, Taipei Tzu Chi Hospital, the Buddhist Tzu-Chi Medical Foundation, Taipei, Taiwan
| | - Yi-Hsuan Wu
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Ho-Ta Chu
- Rehabilitation Department, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Ting-Xuan Liu
- School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xu Zhou Road, Taipei, Taiwan
| | - Yi-Ping Yeh
- School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xu Zhou Road, Taipei, Taiwan
| | - Chieh Chang
- School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xu Zhou Road, Taipei, Taiwan
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6
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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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7
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Schwarz A, Bhagubai MMC, Nies SHG, Held JPO, Veltink PH, Buurke JH, Luft AR. Characterization of stroke-related upper limb motor impairments across various upper limb activities by use of kinematic core set measures. J Neuroeng Rehabil 2022; 19:2. [PMID: 35016694 PMCID: PMC8753836 DOI: 10.1186/s12984-021-00979-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background Upper limb kinematic assessments provide quantifiable information on qualitative movement behavior and limitations after stroke. A comprehensive characterization of spatiotemporal kinematics of stroke subjects during upper limb daily living activities is lacking. Herein, kinematic expressions were investigated with respect to different movement types and impairment levels for the entire task as well as for motion subphases. Method Chronic stroke subjects with upper limb movement impairments and healthy subjects performed a set of daily living activities including gesture and grasp movements. Kinematic measures of trunk displacement, shoulder flexion/extension, shoulder abduction/adduction, elbow flexion/extension, forearm pronation/supination, wrist flexion/extension, movement time, hand peak velocity, number of velocity peaks (NVP), and spectral arc length (SPARC) were extracted for the whole movement as well as the subphases of reaching distally and proximally. The effects of the factors gesture versus grasp movements, and the impairment level on the kinematics of the whole task were tested. Similarities considering the metrics expressions and relations were investigated for the subphases of reaching proximally and distally between tasks and subgroups. Results Data of 26 stroke and 5 healthy subjects were included. Gesture and grasp movements were differently expressed across subjects. Gestures were performed with larger shoulder motions besides higher peak velocity. Grasp movements were expressed by larger trunk, forearm, and wrist motions. Trunk displacement, movement time, and NVP increased and shoulder flexion/extension decreased significantly with increased impairment level. Across tasks, phases of reaching distally were comparable in terms of trunk displacement, shoulder motions and peak velocity, while reaching proximally showed comparable expressions in trunk motions. Consistent metric relations during reaching distally were found between shoulder flexion/extension, elbow flexion/extension, peak velocity, and between movement time, NVP, and SPARC. Reaching proximally revealed reproducible correlations between forearm pronation/supination and wrist flexion/extension, movement time and NVP. Conclusion Spatiotemporal differences between gestures versus grasp movements and between different impairment levels were confirmed. The consistencies of metric expressions during movement subphases across tasks can be useful for linking kinematic assessment standards and daily living measures in future research and performing task and study comparisons. Trial registration: ClinicalTrials.gov Identifier NCT03135093. Registered 26 April 2017, https://clinicaltrials.gov/ct2/show/NCT03135093.
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Affiliation(s)
- Anne Schwarz
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. .,Biomedical Signals and Systems (BSS), University of Twente, Enschede, The Netherlands.
| | - Miguel M C Bhagubai
- Biomedical Signals and Systems (BSS), University of Twente, Enschede, The Netherlands
| | - Saskia H G Nies
- Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Jeremia P O Held
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Peter H Veltink
- Biomedical Signals and Systems (BSS), University of Twente, Enschede, The Netherlands
| | - Jaap H Buurke
- Biomedical Signals and Systems (BSS), University of Twente, Enschede, The Netherlands.,Roessingh Research and Development B.V., Enschede, The Netherlands
| | - Andreas R Luft
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
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8
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Liu M, Wilder S, Sanford S, Saleh S, Harel NY, Nataraj R. Training with Agency-Inspired Feedback from an Instrumented Glove to Improve Functional Grasp Performance. SENSORS (BASEL, SWITZERLAND) 2021; 21:1173. [PMID: 33562342 PMCID: PMC7915039 DOI: 10.3390/s21041173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/27/2021] [Accepted: 02/03/2021] [Indexed: 12/01/2022]
Abstract
Sensory feedback from wearables can be effective to learn better movement through enhanced information and engagement. Facilitating greater user cognition during movement practice is critical to accelerate gains in motor function during rehabilitation following brain or spinal cord trauma. This preliminary study presents an approach using an instrumented glove to leverage sense of agency, or perception of control, to provide training feedback for functional grasp. Seventeen able-bodied subjects underwent training and testing with a custom-built sensor glove prototype from our laboratory. The glove utilizes onboard force and flex sensors to provide inputs to an artificial neural network that predicts achievement of "secure" grasp. Onboard visual and audio feedback was provided during training with progressively shorter time delay to induce greater agency by intentional binding, or perceived compression in time between an action (grasp) and sensory consequence (feedback). After training, subjects demonstrated a significant reduction (p < 0.05) in movement pathlength and completion time for a functional task involving grasp-move-place of a small object. Future work will include a model-based algorithm to compute secure grasp, virtual reality immersion, and testing with clinical populations.
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Affiliation(s)
- Mingxiao Liu
- Department of Biomedical Engineering, Stevens Institute of Technology, Hoboken, NJ 07030, USA; (M.L.); (S.W.); (S.S.)
- Movement Control Rehabilitation (MOCORE) Laboratory, Altorfer Complex, Stevens Institute of Technology, Hoboken, NJ 07030, USA
| | - Samuel Wilder
- Department of Biomedical Engineering, Stevens Institute of Technology, Hoboken, NJ 07030, USA; (M.L.); (S.W.); (S.S.)
- Movement Control Rehabilitation (MOCORE) Laboratory, Altorfer Complex, Stevens Institute of Technology, Hoboken, NJ 07030, USA
| | - Sean Sanford
- Department of Biomedical Engineering, Stevens Institute of Technology, Hoboken, NJ 07030, USA; (M.L.); (S.W.); (S.S.)
- Movement Control Rehabilitation (MOCORE) Laboratory, Altorfer Complex, Stevens Institute of Technology, Hoboken, NJ 07030, USA
| | - Soha Saleh
- Center for Mobility and Rehabilitation Engineering Research, Advanced Rehabilitation Neuroimaging Laboratory, Kessler Foundation, East Hanover, NJ 07936, USA;
| | - Noam Y. Harel
- Spinal Cord Damage Research Center, James J. Peters VA Medical Center, Bronx, NY 10468, USA;
- Departments of Neurology and Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Raviraj Nataraj
- Department of Biomedical Engineering, Stevens Institute of Technology, Hoboken, NJ 07030, USA; (M.L.); (S.W.); (S.S.)
- Movement Control Rehabilitation (MOCORE) Laboratory, Altorfer Complex, Stevens Institute of Technology, Hoboken, NJ 07030, USA
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9
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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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10
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Yeganeh Doost M, Herman B, Denis A, Sapin J, Galinski D, Riga A, Laloux P, Bihin B, Vandermeeren Y. Bimanual motor skill learning and robotic assistance for chronic hemiparetic stroke: a randomized controlled trial. Neural Regen Res 2021; 16:1566-1573. [PMID: 33433485 PMCID: PMC8323667 DOI: 10.4103/1673-5374.301030] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Using robotic devices might improve recovery post-stroke, but the optimal way to apply robotic assistance has yet to be determined. The current study aimed to investigate whether training under the robotic active-assisted mode improves bimanual motor skill learning (biMSkL) more than training under the active mode in stroke patients. Twenty-six healthy individuals (HI) and 23 chronic hemiparetic stroke patients with a detectable lesion on MRI or CT scan, who demonstrated motor deficits in the upper limb, were randomly allocated to two parallel groups. The protocol included a two-day training on a new bimanual cooperative task, LIFT-THE-TRAY, under either the active or active-assisted modes (where assistance decreased in a pre-determined stepwise fashion) with the bimanual version of the REAplan® robotic device. The hypothesis was that the active-assisted mode would result in greater biMSkL than the active mode. The biMSkL was quantified by a speed-accuracy trade-off (SAT) before (T1) and immediately after (T2) training on days 1 and 2 (T3 and T4). The change in SAT after 2 days of training (T4/T1) indicated that both HI and stroke patients learned and retained the bimanual cooperative task. After 2 days of training, the active-assisted mode did not improve biMSkL more than the active mode (T4/T1) in HI nor stroke patients. Whereas HI generalized the learned bimanual skill to different execution speeds in both the active and active-assisted subgroups, the stroke patients generalized the learned skill only in the active subgroup. Taken together, the active-assisted mode, applied in a pre-determined stepwise decreasing fashion, did not improve biMSkL more than the active mode in HI and stroke subjects. Stroke subjects might benefit more from robotic assistance when applied “as-needed.” This study was approved by the local ethical committee (Comité d’éthique médicale, CHU UCL Namur, Mont-Godinne, Yvoir, Belgium; Internal number: 54/2010, EudraCT number: NUB B039201317382) on July 14, 2016 and was registered with ClinicalTrials.gov (Identifier: NCT03974750) on June 5, 2019.
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Affiliation(s)
- Maral Yeganeh Doost
- UCLouvain, CHU UCL Namur - site Mont-Godinne, Department of Neurology, Stroke Unit, Yvoir; UCLouvain, Institute of NeuroScience (IoNS), Clinical neuroscience division (NEUR) division, Brussels; UCLouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Benoît Herman
- UCLouvain, Louvain Bionics; UCLouvain, Institute of Mechanics, Materials and Civil Engineering (iMMC), Louvain-la-Neuve, Belgium
| | - Adrien Denis
- UCLouvain, Institute of Mechanics, Materials and Civil Engineering (iMMC), Louvain-la-Neuve, Belgium
| | | | | | - Audrey Riga
- UCLouvain, CHU UCL Namur - site Mont-Godinne, Department of Neurology, Stroke Unit, Yvoir; UCLouvain, Institute of NeuroScience (IoNS), Clinical neuroscience division (NEUR) division, Brussels; UCLouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Patrice Laloux
- UCLouvain, CHU UCL Namur - site Mont-Godinne, Department of Neurology, Stroke Unit, Yvoir; UCLouvain, Institute of NeuroScience (IoNS), Clinical neuroscience division (NEUR) division, Brussels, Belgium
| | - Benoît Bihin
- Scientific Support Unit, CHU UCL Namur - site Mont-Godinne, Yvoir, Belgium
| | - Yves Vandermeeren
- UCLouvain, CHU UCL Namur - site Mont-Godinne, Department of Neurology, Stroke Unit, Yvoir; UCLouvain, Institute of NeuroScience (IoNS), Clinical neuroscience division (NEUR) division, Brussels; UCLouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
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11
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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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12
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Renner CI, Brendel C, Hummelsheim H. Bilateral Arm Training vs Unilateral Arm Training for Severely Affected Patients With Stroke: Exploratory Single-Blinded Randomized Controlled Trial. Arch Phys Med Rehabil 2020; 101:1120-1130. [DOI: 10.1016/j.apmr.2020.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/01/2020] [Accepted: 02/03/2020] [Indexed: 12/01/2022]
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13
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Effects of different types of sensory signals on reaching performance in persons with chronic schizophrenia. PLoS One 2020; 15:e0234976. [PMID: 32579579 PMCID: PMC7314021 DOI: 10.1371/journal.pone.0234976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 06/06/2020] [Indexed: 11/19/2022] Open
Abstract
Previous studies have reported movement abnormalities in persons with schizophrenia. This study aimed to examine the differences between persons with chronic schizophrenia and healthy control participants in reaching movement and the effects of sensory signals on reaching performance in persons with chronic schizophrenia. A counter-balanced repeated-measures design was employed. Twenty persons with schizophrenia and 20 age- and gender-matched control participants were recruited in this study. Reaching performance was measured in three types of sensory signal conditions (visual, auditory, and no signal), i.e., two externally triggered and one self-initiated movement were assessed in reaction time/inter-response interval, movement time, peak velocity, percentage of time in which peak velocity occurred, and movement units. The results revealed significant main effects of group in reaction time/inter-response interval (p = 0.003), movement time (p < 0.001), peak velocity (p < 0.001), and movement units (p < 0.001). The persons with chronic schizophrenia demonstrated slower response to signals and in self-initiated movement, increased movement time, and less forceful and less smooth movement compared to healthy control participants when performing the reaching task. The interaction effect between group and signal in reaction time/inter-response interval was also significant (p < 0.001). The inter-response interval for self-initiated reaching was the shortest in healthy controls. Conversely, the inter-response interval for self-initiated reaching was the longest in persons with schizophrenia. The main effect of the signal on movement time was significant (p < 0.001). The movement time of reaching was longer in response to the auditory signal than in response to visual or self-initiated. The differences in percentages of time in which peak velocity occurred between persons with schizophrenia and healthy controls (p > 0.01) and across the three conditions (p > 0.01) were non-significant. Neither duration of illness nor antipsychotic dosage was significantly associated with reaching performance (all p > 0.01). In conclusion, these findings indicate that reaching movement in persons with chronic schizophrenia is slower, less forceful, and less coordinated compared to healthy control participants. In addition, persons with chronic schizophrenia also had shorter inter-response interval for self-initiated movement and shorter movement time in auditory signal condition, independent of duration of illness and antipsychotic dosage.
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14
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Lee JH, Hong I, Park JH, Shin JH. Validation of Yonsei-Bilateral Activity Test (Y-BAT)-Bilateral Upper Extremity Inventory Using Rasch Analysis. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2020; 40:277-286. [PMID: 32458733 DOI: 10.1177/1539449220920732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is little assessment to provide specific information about quality of bilateral upper extremity movement specifically. This study examined the psychometric properties of the Yonsei-Bilateral Activity Test (Y-BAT). An observational cross-sectional design was used with 100 stroke survivors. Unidimensionality was examined using factor analyses, and Rasch analysis was used to test rating scale structure, fit statistics, and precision of the Y-BAT. The Y-BAT demonstrated a unidimensional measurement construct, and 19 of the 27 items fit the Rasch model. The instrument demonstrated good precision, including person reliability and person strata. The Y-BAT estimated person measures within a wide range of theta values with a reliability of .9 with good precision. Our results indicate that a revised, 19-item version of the Y-BAT demonstrates sound internal validity and may be a useful instrument for clinicians to measure upper extremity function with good precision following stroke.
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Affiliation(s)
| | - Ickpyo Hong
- The University of Texas Medical Branch at Galveston, USA
| | | | - Joon-Ho Shin
- National Rehabilitation Center, Seoul, Republic of Korea
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15
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Villepinte C, Verma A, Dimeglio C, De Boissezon X, Gasq D. Responsiveness of kinematic and clinical measures of upper-limb motor function after stroke: A systematic review and meta-analysis. Ann Phys Rehabil Med 2020; 64:101366. [PMID: 32156646 DOI: 10.1016/j.rehab.2020.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 02/11/2020] [Accepted: 02/15/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Kinematic analysis and clinical outcome measures with established responsiveness contribute to the quantified assessment of upper-limb function post-stroke, the selection of interventions and the differentiation of motor recovery patterns. OBJECTIVE This systematic review and meta-analysis aimed to report trends in use and compare the responsiveness of kinematic and clinical measures in studies measuring the effectiveness of constraint-induced movement, trunk restraint and bilateral arm therapies for upper-limb function after stroke. METHODS In this systematic review, randomised controlled trials implementing kinematic analysis and clinical outcome measures to evaluate the effects of therapies in post-stroke adults were eligible. We searched 8 electronic databases (MEDLINE, EMBASE, Web of Science, Scopus, CINAHL, CENTRAL, OTseeker and Pedro). Risk of bias was assessed according to the Cochrane Risk of Bias domains. A meta-analysis was conducted for repeated design measures of pre- and post-test data providing estimated standardised mean differences (SMDs). RESULTS We included reports of 12 studies (191 participants) reporting kinematic smoothness, movement duration and efficiency, trunk and shoulder range of motion, control strategy and velocity variables in conjunction with assessment by Motor Activity Log, Fugl-Meyer Assessment and Wolf Motor Function Test. Responsiveness was higher (i.e., non-overlap of 95% confidence intervals [CIs]) for Motor Activity Log score (SMD for amount of use 1.0, 95% CI 0.75-1.25, P<0.001; SMD for quality of movement 0.96, 95% CI 0.72-1.20, P<0.001) than movement efficiency, trunk and shoulder range of motion, control strategy and peak velocity. CONCLUSION These results are consistent with current literature supporting the use of combined kinematic and clinical measures for comprehensive and accurate evaluation of upper-limb function post-stroke. Future research should include other design trials and rehabilitation types to confirm these findings, focusing on subgroup analysis of type of rehabilitation intervention and functional levels.
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Affiliation(s)
- Claire Villepinte
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France; Toulouse University Hospital, School of Occupational Therapy, PREFMS, Toulouse, France; Department of Physiological Explorations, University Hospital of Toulouse, Toulouse, France.
| | - Arpana Verma
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, United Kingdom
| | - Chloe Dimeglio
- LEASP - UMR 1027 Inserm - University of Toulouse III Paul Sabatier, Toulouse, France; Department of Epidemiology, University Hospital of Toulouse, Toulouse, France
| | - Xavier De Boissezon
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France; Department of Physical Medicine and Rehabilitation, University Hospital of Toulouse, Toulouse, France
| | - David Gasq
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France; Department of Physiological Explorations, University Hospital of Toulouse, Toulouse, France
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16
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Anaya-Reyes F, Narayan A, Aguirre-Ollinger G, Cheng HJ, Yu H. An Omnidirectional Assistive Platform Integrated With Functional Electrical Stimulation for Gait Rehabilitation: A Case Study. IEEE Trans Neural Syst Rehabil Eng 2020; 28:710-719. [DOI: 10.1109/tnsre.2020.2972008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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17
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The Priming Effects of Mirror Visual Feedback on Bilateral Task Practice: A Randomized Controlled Study. Occup Ther Int 2019; 2019:3180306. [PMID: 31824233 PMCID: PMC6899317 DOI: 10.1155/2019/3180306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/23/2019] [Indexed: 11/18/2022] Open
Abstract
The priming effect of mirror visual feedback can be simply provided by inexpensive mirror therapy (MT), which exhibits beneficial effects on sensorimotor recovery in stroke. The present study was a single-blind pretest-posttest study that examined whether the priming effect of mirror visual feedback on bilateral task practice would render better outcomes. Twenty-three patients with chronic stroke were randomized to receive hospital-based task-oriented MT or bilateral arm training (BAT) for 4 weeks at 90 minutes/day, 3 days/week and a home practice for 30-40 minutes/day, 5 days/week. There was the potential trend for MT to improve temperature sense as measured by the revised Nottingham Sensory Assessment (Cohen's d = 1.00; 95% confidence interval, -0.09 to 2.09), and MT increased the Stroke Impact Scale 3.0 total score (d = 0.89; 0.003 to 1.71). MT also showed a trend for greater improvements in the Motor Activity Log (amount of use: d = 0.62; -0.24 to 1.44; quality of movement: d = 0.50; -0.35 to 1.31). MT involving bilateral movement practice with the priming effect of mirror visual feedback may render beneficial effects. The unilateral approach or MT augmented by extra feedback might be appropriate modifications.
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18
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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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19
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Daly JJ, McCabe JP, Holcomb J, Monkiewicz M, Gansen J, Pundik S. Long-Dose Intensive Therapy Is Necessary for Strong, Clinically Significant, Upper Limb Functional Gains and Retained Gains in Severe/Moderate Chronic Stroke. Neurorehabil Neural Repair 2019; 33:523-537. [PMID: 31131743 PMCID: PMC6625035 DOI: 10.1177/1545968319846120] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background. Effective treatment methods are needed for moderate/severely impairment chronic stroke. Objective. The questions were the following: (1) Is there need for long-dose therapy or is there a mid-treatment plateau? (2) Are the observed gains from the prior-studied protocol retained after treatment? Methods. Single-blind, stratified/randomized design, with 3 applied technology treatment groups, combined with motor learning, for long-duration treatment (300 hours of treatment). Measures were Arm Motor Ability Test time and coordination-function (AMAT-T, AMAT-F, respectively), acquired pre-/posttreatment and 3-month follow-up (3moF/U); Fugl-Meyer (FM), acquired similarly with addition of mid-treatment. Findings. There was no group difference in treatment response (P ≥ .16), therefore data were combined for remaining analyses (n = 31; except for FM pre/mid/post, n = 36). Pre-to-Mid-treatment and Mid-to-Posttreatment gains of FM were statistically and clinically significant (P < .0001; 4.7 points and P < .001; 5.1 points, respectively), indicating no plateau at 150 hours and benefit of second half of treatment. From baseline to 3moF/U: (1) FM gains were twice the clinically significant benchmark, (2) AMAT-F gains were greater than clinically significant benchmark, and (3) there was statistically significant improvement in FM (P < .0001); AMAT-F (P < .0001); AMAT-T (P < .0001). These gains indicate retained clinically and statistically significant gains at 3moFU. From posttreatment to 3moF/U, gains on FM were maintained. There were statistically significant gains in AMAT-F (P = .0379) and AMAT-T P = .003.
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Affiliation(s)
- Janis J. Daly
- Malcom Randall Gainesville DVA Medical
Center, Gainesville, FL, USA
- College of Medicine, University of
Florida, Gainesville, FL, USA
| | | | | | | | - Jennifer Gansen
- Louis Stokes Cleveland VA Medical
Center, Cleveland, OH, USA
| | - Svetlana Pundik
- Louis Stokes Cleveland VA Medical
Center, Cleveland, OH, USA
- Case Western Reserve University School
of Medicine, Cleveland, OH, USA
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20
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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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21
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Fitzsimons K, Acosta AM, Dewald JPA, Murphey TD. Ergodicity Reveals Assistance and Learning from Physical Human-Robot Interaction. Sci Robot 2019; 4:eaav6079. [PMID: 31531410 PMCID: PMC6748650 DOI: 10.1126/scirobotics.aav6079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
This paper applies information theoretic principles to the investigation of physical human-robot interaction. Drawing from the study of human perception and neural encoding, information theoretic approaches offer a perspective that enables quantitatively interpreting the body as an information channel, and bodily motion as an information-carrying signal. We show that ergodicity, which can be interpreted as the degree to which a trajectory encodes information about a task, correctly predicts changes due to reduction of a person's existing deficit or the addition of algorithmic assistance. The measure also captures changes from training with robotic assistance. Other common measures for assessment failed to capture at least one of these effects. This information-based interpretation of motion can be applied broadly, in the evaluation and design of human-machine interactions, in learning by demonstration paradigms, or in human motion analysis.
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Affiliation(s)
| | - Ana Maria Acosta
- Physical Therapy and Human Movement Science, Northwestern University, Chicago, IL 60611, USA
| | - Julius P A Dewald
- Physical Therapy and Human Movement Science, Northwestern University, Chicago, IL 60611, USA
- Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL 60611, USA
- Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Todd D Murphey
- Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
- Physical Therapy and Human Movement Science, Northwestern University, Chicago, IL 60611, USA
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22
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McCabe JP, Henniger D, Perkins J, Skelly M, Tatsuoka C, Pundik S. Feasibility and clinical experience of implementing a myoelectric upper limb orthosis in the rehabilitation of chronic stroke patients: A clinical case series report. PLoS One 2019; 14:e0215311. [PMID: 30978249 PMCID: PMC6461279 DOI: 10.1371/journal.pone.0215311] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/30/2019] [Indexed: 01/07/2023] Open
Abstract
Individuals with stroke are often left with persistent upper limb dysfunction, even after treatment with traditional rehabilitation methods. The purpose of this retrospective study is to demonstrate feasibility of the implementation of an upper limb myoelectric orthosis for the treatment of persistent moderate upper limb impairment following stroke (>6 months). Methods: Nine patients (>6 months post stroke) participated in treatment at an outpatient Occupational Therapy department utilizing the MyoPro myoelectric orthotic device. Group therapy was provided at a frequency of 1–2 sessions per week (60–90 minutes per session). Patients were instructed to perform training with the device at home on non-therapy days and to continue with use of the device after completion of the group training period. Outcome measures included Fugl-Meyer Upper Limb Assessment (FM) and modified Ashworth Scale (MAS). Results: Patients demonstrated clinically important and statistically significant improvement of 9.0±4.8 points (p = 0.0005) on a measure of motor control impairment (FM) during participation in group training. It was feasible to administer the training in a group setting with the MyoPro, using a 1:4 ratio (therapist to patients). Muscle tone improved for muscles with MAS >1.5 at baseline. Discussion: Myoelectric orthosis use is feasible in a group clinic setting and in home-use structure for chronic stroke survivors. Clinically important motor control gains were observed on FM in 7 of 9 patients who participated in training.
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Affiliation(s)
- Jessica P. McCabe
- Brain Plasticity and NeuroRecovery Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
| | - Dennyse Henniger
- Department of Physical Medicine and Rehabilitation, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
| | - Jessica Perkins
- Department of Physical Medicine and Rehabilitation, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
| | - Margaret Skelly
- Brain Plasticity and NeuroRecovery Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
| | - Curtis Tatsuoka
- Department of Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Svetlana Pundik
- Brain Plasticity and NeuroRecovery Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
- Neurology Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
- * E-mail:
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23
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Washabaugh EP, Treadway E, Gillespie RB, Remy CD, Krishnan C. Self-powered robots to reduce motor slacking during upper-extremity rehabilitation: a proof of concept study. Restor Neurol Neurosci 2019; 36:693-708. [PMID: 30400120 DOI: 10.3233/rnn-180830] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Robotic rehabilitation is a highly promising approach to recover lost functions after stroke or other neurological disorders. Unfortunately, robotic rehabilitation currently suffers from "motor slacking", a phenomenon in which the human motor system reduces muscle activation levels and movement excursions, ostensibly to minimize metabolic- and movement-related costs. Consequently, the patient remains passive and is not fully engaged during therapy. To overcome this limitation, we envision a new class of body-powered robots and hypothesize that motor slacking could be reduced if individuals must provide the power to move their impaired limbs via their own body (i.e., through the motion of a healthy limb). OBJECTIVE To test whether a body-powered exoskeleton (i.e. robot) could reduce motor slacking during robotic training. METHODS We developed a body-powered robot that mechanically coupled the motions of the user's elbow joints. We tested this passive robot in two groups of subjects (stroke and able-bodied) during four exercise conditions in which we controlled whether the robotic device was powered by the subject or by the experimenter, and whether the subject's driven arm was engaged or at rest. Motor slacking was quantified by computing the muscle activation changes of the elbow flexor and extensor muscles using surface electromyography. RESULTS Subjects had higher levels of muscle activation in their driven arm during self-powered conditions compared to externally-powered conditions. Most notably, subjects unintentionally activated their driven arm even when explicitly told to relax when the device was self-powered. This behavior was persistent throughout the trial and did not wane after the initiation of the trial. CONCLUSIONS Our findings provide novel evidence indicating that motor slacking can be reduced by self-powered robots; thus demonstrating promise for rehabilitation of impaired subjects using this new class of wearable system. The results also serve as a foundation to develop more sophisticated body-powered robots (e.g., with controllable transmissions) for rehabilitation purposes.
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Affiliation(s)
- Edward P Washabaugh
- NeuRRo Lab, Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Emma Treadway
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - R Brent Gillespie
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA.,Michigan Robotics Institute, University of Michigan, Ann Arbor, MI, USA
| | - C David Remy
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA.,Michigan Robotics Institute, University of Michigan, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- NeuRRo Lab, Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,Michigan Robotics Institute, University of Michigan, Ann Arbor, MI, USA
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24
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Hung CS, Hsieh YW, Wu CY, Chen YJ, Lin KC, Chen CL, Yao KG, Liu CT, Horng YS. Hybrid Rehabilitation Therapies on Upper-Limb Function and Goal Attainment in Chronic Stroke. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2019; 39:116-123. [PMID: 30834812 DOI: 10.1177/1539449218825438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined the treatment effects between unilateral hybrid therapy (UHT; unilateral robot-assisted therapy [RT] + modified constraint-induced movement therapy) and bilateral hybrid therapy (BHT; bilateral RT + bilateral arm training) compared with RT. Thirty patients with chronic stroke were randomized to UHT, BHT, or RT groups. Preliminary efficacy was assessed using the Fugl-Meyer Assessment (FMA), the Chedoke Arm and Hand Activity Inventory (CAHAI), and the goal attainment scaling (GAS). Possible adverse effects of abnormal muscle tone, pain, and fatigue were recorded. All groups showed large improvements in motor recovery and individual goals. Significant between-group differences were found on GAS favoring the hybrid groups but not on FMA and CAHAI. No adverse effects were reported. Hybrid therapies are safe and applicable interventions for chronic stroke and favorable for improving individual functional goals. Treatment effects on motor recovery and functional activity might be similar among the three groups.
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Affiliation(s)
| | - Yu-Wei Hsieh
- 2 Chang Gung University, Taoyuan.,3 Chang Gung Memorial Hospital, Linkou
| | - Ching-Yi Wu
- 2 Chang Gung University, Taoyuan.,3 Chang Gung Memorial Hospital, Linkou
| | | | - Keh-Chung Lin
- 5 National Taiwan University, Taipei.,6 National Taiwan University Hospital, Taipei
| | - Chia-Ling Chen
- 2 Chang Gung University, Taoyuan.,3 Chang Gung Memorial Hospital, Linkou
| | | | - Chien-Ting Liu
- 7 Taipei Tzu Chi Hospital, Taipei.,8 Tzu Chi University, Hualien
| | - Yi-Shiung Horng
- 7 Taipei Tzu Chi Hospital, Taipei.,8 Tzu Chi University, Hualien
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25
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Kelly KM, Borstad AL, Kline D, Gauthier LV. Improved quality of life following constraint-induced movement therapy is associated with gains in arm use, but not motor improvement. Top Stroke Rehabil 2018; 25:467-474. [PMID: 30246613 PMCID: PMC6359892 DOI: 10.1080/10749357.2018.1481605] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 05/19/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Constraint-induced movement therapy (CI therapy) is one of few treatments for upper extremity (UE) hemiparesis that has been shown to result in motor recovery and improved quality of life in chronic stroke. However, the extent to which treatment-induced improvements in motor function versus daily use of the more affected arm independently contribute to improved quality of life remains largely unexplored. OBJECTIVE The objective of this study is to identify whether motor function or daily use of a hemiparetic arm has a greater influence on quality of life after CI therapy. METHODS Two cohorts of participants with chronic stroke received either in-person CI therapy (n = 29) or video-game home-based CI therapy (n = 16). The two cohorts were combined and the motor-related outcomes (Wolf Motor Function Test, Action Research Arm Test, Motor Activity Log [MAL]) and quality of life (Stroke-Specific Quality of Life) were jointly modeled to assess the associations between outcomes. RESULTS The only outcome associated with improved quality of life was the MAL. Improvements in quality of life were not restricted to motor domains, but generalized to psychosocial domains as well. CONCLUSIONS Results suggest that improved arm use during everyday activities is integral to maximizing quality of life gains during motor rehabilitation for chronic post-stroke UE hemiparesis. In contrast, gains in motor function were not associated with increases in quality of life. These findings further support the need to implement techniques into clinical practice that promote arm use during daily life if improving quality of life is a main goal of treatment. ClinicalTrials.gov Registration Numbers: NCT01725919 and NCT03005457.
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Affiliation(s)
- Kristina M. Kelly
- Post-doctoral Researcher at The Ohio State University, 480 Medical Center Drive, Columbus, OH 43210
| | - Alexandra L. Borstad
- Assistant Professor at The Ohio State University, 453 W 10 Avenue, Columbus, OH 43210,
, (218) 625-4938
| | - David Kline
- Research Scientist at The Ohio State University, 1800 Canon Drive, Columbus, OH 43210,
, (614) 688-9676
| | - Lynne V. Gauthier
- Assistant Professor at The Ohio State University, 480 Medical Center Drive, Columbus, OH 43210,
, (614) 293-3830
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26
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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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27
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Wang SM, Kuo LC, Ouyang WC, Hsu HM, Ma HI. Effects of object size and distance on reaching kinematics in patients with schizophrenia. Hong Kong J Occup Ther 2018; 31:22-29. [PMID: 30186083 PMCID: PMC6091986 DOI: 10.1177/1569186118759610] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND/OBJECTIVE Patients with schizophrenia not only have psychiatric symptoms, but also have movement problems, which might also be associated with their reduced quality of life. Little is known about how to improve their movement performance for patients. Manipulating object size and distance is common in occupational therapy practice to evaluate and optimize reaching performance in patients with physical disabilities, but effects of the manipulation in patients with schizophrenia remain unclear. The purpose of this study was to examine whether object size and distance could change performance of reaching kinematics in patients with mild schizophrenia. METHODS Twenty-nine patients with mild schizophrenia and 15 age- and gender-matched healthy controls were required to reach for, as quickly as possible, a small or large object that was placed at a near or far distance. We measured movement time, peak velocity, path length ratio, percentage of time to peak velocity, and movement units to infer movement speed, forcefulness, spatial efficiency (directness), control strategies, and smoothness. RESULTS Patients' reaching movements were slower (p = .017) and less direct (p = .007) than those of controls. A larger object induced faster (p = .016), more preprogrammed (p = .018), and more forceful (p = .010) movements in patients. A farther object induced slower, more feedback dependent, but more forceful and more direct movements (all p < .001). CONCLUSION The results of kinematic deficiencies suggest the need of movement training for patients with mild schizophrenia. Occupational therapists may grade or adapt reaching activities by changing object size and distance to enhance movement performance in patients with schizophrenia.
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28
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Kwong PWH, Ng GYF, Chung RCK, Ng SSM. Bilateral Transcutaneous Electrical Nerve Stimulation Improves Lower-Limb Motor Function in Subjects With Chronic Stroke: A Randomized Controlled Trial. J Am Heart Assoc 2018; 7:e007341. [PMID: 29437598 PMCID: PMC5850185 DOI: 10.1161/jaha.117.007341] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 01/10/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Transcutaneous electrical nerve stimulation (TENS) has been used to augment the efficacy of task-oriented training (TOT) after stroke. Bilateral intervention approaches have also been shown to be effective in augmenting motor function after stroke. The purpose of this study was to compare the efficacy of bilateral TENS combined with TOT versus unilateral TENS combined with TOT in improving lower-limb motor function in subjects with chronic stroke. METHODS AND RESULTS Eighty subjects were randomly assigned to bilateral TENS+TOT or to unilateral TENS+TOT and underwent 20 sessions of training over a 10-week period. The outcome measures included the maximal strength of the lower-limb muscles and the results of the Lower Extremity Motor Coordination Test, Berg Balance Scale, Step Test, and Timed Up and Go test. Each participant was assessed at baseline, after 10 and 20 sessions of training and 3 months after the cessation of training. The subjects in the bilateral TENS+TOT group showed greater improvement in paretic ankle dorsiflexion strength (β=1.32; P=0.032) and in the completion time for the Timed Up and Go test (β=-1.54; P=0.004) than those in the unilateral TENS+TOT group. However, there were no significant between-group differences for other outcome measures. CONCLUSIONS The application of bilateral TENS over the common peroneal nerve combined with TOT was superior to the application of unilateral TENS combined with TOT in improving paretic ankle dorsiflexion strength after 10 sessions of training and in improving the completion time for the Timed Up and Go test after 20 sessions of training. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02152813.
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Affiliation(s)
- Patrick W H Kwong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Gabriel Y F Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Raymond C K Chung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Shamay S M Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
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29
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30
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Chuang LL, Chen YL, Chen CC, Li YC, Wong AMK, Hsu AL, Chang YJ. Effect of EMG-triggered neuromuscular electrical stimulation with bilateral arm training on hemiplegic shoulder pain and arm function after stroke: a randomized controlled trial. J Neuroeng Rehabil 2017; 14:122. [PMID: 29183339 PMCID: PMC5706163 DOI: 10.1186/s12984-017-0332-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 11/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hemiplegic shoulder pain is a frequent complication after stroke, leading to limited use of the affected arm. Neuromuscular electrical stimulation (NMES) and transcutaneous electrical nerve stimulation (TENS) are two widely used interventions to reduce pain, but the comparative efficacy of these two modalities remains uncertain. The purpose of this research was to compare the immediate and retained effects of EMG-triggered NMES and TENS, both in combination with bilateral arm training, on hemiplegic shoulder pain and arm function of stroke patients. METHODS A single-blind, randomized controlled trial was conducted at two medical centers. Thirty-eight patients (25 males and 13 females, 60.75 ± 10.84 years old, post stroke duration 32.68 ± 53.07 months) who had experienced a stroke more than 3 months ago at the time of recruitment and hemiplegic shoulder pain were randomized to EMG-triggered NMES or TENS. Both groups received electrical stimulation followed by bilateral arm training 3 times a week for 4 weeks. The primary outcome measures included a vertical Numerical Rating Scale supplemented with a Faces Rating Scale, and the short form of the Brief Pain Inventory. The secondary outcome measures were the upper-limb subscale of the Fugl-Meyer Assessment, and pain-free passive shoulder range of motion. All outcomes were measured pretreatment, post-treatment, and at 1-month after post-treatment. Two-way mixed repeated measures ANOVAs were used to examine treatment effects. RESULTS Compared to TENS with bilateral arm training, the EMG-triggered NMES with bilateral arm training was associated with lower pain intensity during active and passive shoulder movement (P =0.007, P =0.008), lower worst pain intensity (P = 0.003), and greater pain-free passive shoulder abduction (P =0.001) and internal rotation (P =0.004) at follow-up. Both groups improved in pain at rest (P =0.02), pain interference with daily activities, the Fugl-Meyer Assessment, and pain-free passive shoulder flexion and external rotation post-treatment (P < 0.001) and maintained the improvement at follow-up (P < 0.001), except for resting pain (P =0.08). CONCLUSIONS EMG-triggered NMES with bilateral arm training exhibited greater immediate and retained effects than TENS with bilateral arm training with respect to pain and shoulder impairment for chronic and subacute stroke patients with hemiplegic shoulder pain. TRIAL REGISTRATION NCT01913509 .
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Affiliation(s)
- Li-Ling Chuang
- Department 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.,Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - You-Lin Chen
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Chung Chen
- Department 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.,Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Yen-Chen Li
- Physical therapy, Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Alice May-Kuen Wong
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - An-Lun Hsu
- Department of Physical Therapy, Mackay Memorial Hospital, Taipei, Taiwan.
| | - Ya-Ju Chang
- Department 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. .,Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan. .,, No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 33302, Taiwan.
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31
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Yeh TT, Hsieh YW, Wu CY, Wang JS, Lin KC, Chen CL. A Preliminary Investigation of the Association of Sleep With Inflammation and Oxidative Stress Biomarkers and Functional Outcomes After Stroke Rehabilitation. Sci Rep 2017; 7:8634. [PMID: 28819157 PMCID: PMC5561026 DOI: 10.1038/s41598-017-08931-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/19/2017] [Indexed: 11/09/2022] Open
Abstract
This study examined the association of sleep with inflammation and oxidative stress biomarkers, and with functional outcomes, after stroke rehabilitation. The rehabilitation effects on biomarkers and functional outcomes were also evaluated. Twenty subacute stroke survivors received 4 weeks of upper limb rehabilitation. Baseline inflammatory (i.e., soluble intercellular adhesion molecule-1, sICAM-1) and oxidative stress biomarkers (i.e., glutathione peroxidase, GPx and malondialdehyde, MDA) were assessed, as were sleep outcomes. Positive correlations were observed between baseline level of sICAM-1 and number of awakenings at post-treatment (ρ = 0.51, p < 0.05) as well as between baseline level of MDA and post-performance time of the Wolf Motor Function Test (WMFT-time) (ρ = 0.46, p < 0.05). In addition, MDA levels were significantly decreased, and functional outcomes of the modified Rankin Scale (mRS), functional ability scale of the WMFT, and Stroke Impact Scale (SIS-total, and SIS-physical function) were improved after the rehabilitation. This pilot study emphasizes the relationship among biomarkers, sleep, and functional outcomes after stroke rehabilitation. Oxidative stress markers may be useful predictors of functional outcomes in subacute stroke survivors.
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Affiliation(s)
- Ting-Ting Yeh
- School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xu Zhou Road, Taipei, Taiwan
| | - Yu-Wei Hsieh
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, 259 Wenhua 1st Rd., Guishan Dist., Taoyuan City, Taiwan
- Healthy Aging Research Center, Chang Gung University, 259 Wenhua 1st Rd., Guishan Dist., Taoyuan City, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, 5 Fuxing St., Guishan Dist., Taoyuan City, Taiwan
| | - Ching-Yi Wu
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, 259 Wenhua 1st Rd., Guishan Dist., Taoyuan City, Taiwan
- Healthy Aging Research Center, Chang Gung University, 259 Wenhua 1st Rd., Guishan Dist., Taoyuan City, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, 5 Fuxing St., Guishan Dist., Taoyuan City, Taiwan
| | - Jong-Shyan Wang
- Healthy Aging Research Center, Chang Gung University, 259 Wenhua 1st Rd., Guishan Dist., Taoyuan City, Taiwan
- Graduate Institute of Rehabilitation Science, Chang Gung University, 259 Wenhua 1st Rd., Guishan Dist., Taoyuan City, Taiwan
| | - Keh-Chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xu Zhou Road, Taipei, Taiwan.
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, 7 Chung Shan South Rd., Taipei, Taiwan.
| | - Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, 5 Fuxing St., Guishan Dist., Taoyuan City, Taiwan
- Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, 259 Wenhua 1st Rd., Guishan Dist., Taoyuan City, Taiwan
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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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Kiper P, Szczudlik A, Venneri A, Stozek J, Luque-Moreno C, Opara J, Baba A, Agostini M, Turolla A. Computational models and motor learning paradigms: Could they provide insights for neuroplasticity after stroke? An overview. J Neurol Sci 2016; 369:141-148. [PMID: 27653881 DOI: 10.1016/j.jns.2016.08.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 08/08/2016] [Accepted: 08/09/2016] [Indexed: 01/08/2023]
Abstract
Computational approaches for modelling the central nervous system (CNS) aim to develop theories on processes occurring in the brain that allow the transformation of all information needed for the execution of motor acts. Computational models have been proposed in several fields, to interpret not only the CNS functioning, but also its efferent behaviour. Computational model theories can provide insights into neuromuscular and brain function allowing us to reach a deeper understanding of neuroplasticity. Neuroplasticity is the process occurring in the CNS that is able to permanently change both structure and function due to interaction with the external environment. To understand such a complex process several paradigms related to motor learning and computational modeling have been put forward. These paradigms have been explained through several internal model concepts, and supported by neurophysiological and neuroimaging studies. Therefore, it has been possible to make theories about the basis of different learning paradigms according to known computational models. Here we review the computational models and motor learning paradigms used to describe the CNS and neuromuscular functions, as well as their role in the recovery process. These theories have the potential to provide a way to rigorously explain all the potential of CNS learning, providing a basis for future clinical studies.
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Affiliation(s)
- Pawel Kiper
- Laboratory of Kinematics and Robotics, IRCCS San Camillo Hospital Foundation, via Alberoni 70, 30126 Venice, Italy.
| | - Andrzej Szczudlik
- Jagiellonian University Medical College, ul. Sw. Anny 12, 31-008 Krakow, Poland
| | - Annalena Venneri
- Laboratory of Kinematics and Robotics, IRCCS San Camillo Hospital Foundation, via Alberoni 70, 30126 Venice, Italy; Department of Neuroscience, The University of Sheffield, 385a Glossop Road, S10 2HQ Sheffield, UK
| | - Joanna Stozek
- The University of Physical Education, Al. Jana Pawla II 78, 31-571 Krakow, Poland
| | - Carlos Luque-Moreno
- Department of Physical Therapy, The University of Seville, C/Avicena S/N, 41009 Seville, Spain; Motion Analysis Laboratory, Virgen del Rocio Hospital, Avda. Manuel Siurot S/N, 41013 Seville, Spain
| | - Jozef Opara
- Academy of Physical Education, ul. Mikolowska 72a, 40-065 Katowice, Poland
| | - Alfonc Baba
- Laboratory of Kinematics and Robotics, IRCCS San Camillo Hospital Foundation, via Alberoni 70, 30126 Venice, Italy
| | - Michela Agostini
- Laboratory of Kinematics and Robotics, IRCCS San Camillo Hospital Foundation, via Alberoni 70, 30126 Venice, Italy
| | - Andrea Turolla
- Laboratory of Kinematics and Robotics, IRCCS San Camillo Hospital Foundation, via Alberoni 70, 30126 Venice, Italy; Department of Neuroscience, The University of Sheffield, 385a Glossop Road, S10 2HQ Sheffield, UK
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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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Wu CY, Chuang IC, Ma HI, Lin KC, Chen CL. Validity and Responsiveness of the Revised Nottingham Sensation Assessment for Outcome Evaluation in Stroke Rehabilitation. Am J Occup Ther 2016; 70:7002290040p1-8. [DOI: 10.5014/ajot.2016.018390] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. This study establishes the concurrent validity, predictive validity, and responsiveness of the Revised Nottingham Sensation Assessment (rNSA) during rehabilitation for people with stroke.
METHOD. The study recruited 147 patients with stroke. The main assessment used was the rNSA, and outcome measures were the Fugl-Meyer Assessment sensory subscale (FMA–S) and motor subscale (FMA–M) and the Nottingham Extended Activities of Daily Living (NEADL) scale.
RESULTS. Correlation coefficients were good to excellent between the rNSA and the FMA–S. The rNSA proprioception measure was a predictor for the FMA–S. The rNSA stereognosis and tactile-pinprick measures for the proximal upper limb were predictors for the FMA–M and the NEADL scale, respectively. Responsiveness was moderate to large for three subscales of the rNSA (standardized response mean = .51–.83).
CONCLUSION. This study may support the concurrent validity, predictive validity, and responsiveness of the rNSA for people with stroke.
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Affiliation(s)
- Ching-yi Wu
- Ching-yi Wu, ScD, is Professor and Chair, Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - I-ching Chuang
- I-ching Chuang, PhD, is Postdoctoral Fellow, Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hui-ing Ma
- Hui-ing Ma, ScD, is Professor, School of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Keh-chung Lin
- Keh-chung Lin, ScD, is Professor, School of Occupational Therapy, and Director, Division of General Affairs, College of Medicine, National Taiwan University, and Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan;
| | - Chia-ling Chen
- Chia-ling Chen, MD, PhD, is Professor, Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, and Chair, Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Fan YT, Wu CY, Liu HL, Lin KC, Wai YY, Chen YL. Neuroplastic changes in resting-state functional connectivity after stroke rehabilitation. Front Hum Neurosci 2015; 9:546. [PMID: 26557065 PMCID: PMC4617387 DOI: 10.3389/fnhum.2015.00546] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 09/17/2015] [Indexed: 01/19/2023] Open
Abstract
Most neuroimaging research in stroke rehabilitation mainly focuses on the neural mechanisms underlying the natural history of post-stroke recovery. However, connectivity mapping from resting-state fMRI is well suited for different neurological conditions and provides a promising method to explore plastic changes for treatment-induced recovery from stroke. We examined the changes in resting-state functional connectivity (RS-FC) of the ipsilesional primary motor cortex (M1) in 10 post-acute stroke patients before and immediately after 4 weeks of robot-assisted bilateral arm therapy (RBAT). Motor performance, functional use of the affected arm, and daily function improved in all participants. Reduced interhemispheric RS-FC between the ipsilesional and contralesional M1 (M1-M1) and the contralesional-lateralized connections were noted before treatment. In contrast, greater M1-M1 functional connectivity and disturbed resting-state networks were observed after RBAT relative to pre-treatment. Increased changes in M1-M1 RS-FC after RBAT were coupled with better motor and functional improvements. Mediation analysis showed the pre-to-post difference in M1-M1 RS-FC was a significant mediator for the relationship between motor and functional recovery. These results show neuroplastic changes and functional recoveries induced by RBAT in post-acute stroke survivors and suggest that interhemispheric functional connectivity in the motor cortex may be a neurobiological marker for recovery after stroke rehabilitation.
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Affiliation(s)
- Yang-Teng Fan
- School of Occupational Therapy, College of Medicine, National Taiwan University and Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Taipei, Taiwan
| | - Ching-Yi Wu
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University Taoyuan, Taiwan ; Healthy Aging Research Center, Chang Gung University Taoyuan, Taiwan
| | - Ho-Ling Liu
- Department of Imaging Physics, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center Houston, TX, USA ; Department of Medical Imaging and Radiological Sciences, Chang Gung University Taoyuan, Taiwan
| | - Keh-Chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University and Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Taipei, Taiwan ; Department of Physical Medicine and Rehabilitation, Division of Occupational Therapy, National Taiwan University Hospital Taipei, Taiwan
| | - Yau-Yau Wai
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Keelung, Taiwan ; MRI Center, Chang Gung Memorial Hospital Taoyuan, Taiwan
| | - Yao-Liang Chen
- MRI Center, Chang Gung Memorial Hospital Taoyuan, Taiwan
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Bushnell C, Bettger JP, Cockroft KM, Cramer SC, Edelen MO, Hanley D, Katzan IL, Mattke S, Nilsen DM, Piquado T, Skidmore ER, Wing K, Yenokyan G. Chronic Stroke Outcome Measures for Motor Function Intervention Trials: Expert Panel Recommendations. Circ Cardiovasc Qual Outcomes 2015; 8:S163-9. [PMID: 26515205 PMCID: PMC5289112 DOI: 10.1161/circoutcomes.115.002098] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/25/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND About half of survivors with stroke experience severe and significant long-term disability. The purpose of this article is to review the state of the science and to make recommendations for measuring patient-centric outcomes in interventions for motor improvement in the chronic stroke phase. METHODS AND RESULTS A 9-member expert panel reviewed evidence to identify measures of upper and lower extremity function used to date as outcomes in trials with patients who experienced a stroke ≥6 months before assessment. Outcome measures were screened using StrokEDGE consensus panel recommendations, and evaluated for availability of a published minimal clinically important difference. Measures meeting these criteria were further evaluated with regard to their level of measurement, psychometric properties, and ability of minimal clinically important difference to capture gains associated with improved function and clinical relevance to patients, to arrive at recommendations. A systematic literature review yielded 115 clinical trials of upper and lower extremity function in chronic stroke that used a total of 34 outcome measures. Seven of these had published minimal clinically important differences and were recommended or highly recommended by StrokEDGE. Those are the Fugl-Meyer Upper Extremity and Lower Extremity scales, Wolf Motor Function Test, Action Research Arm Test, Ten-Meter and Six-Minute Walk Tests, and the Stroke Impact Scale. All had evidence for their psychometric performance, although the strength of evidence for validity varied, especially in populations with chronic stroke Fugl-Meyer Upper and Lower Extremity scales showing the strongest evidence for validity. CONCLUSIONS The panel recommends that the Fugl-Meyer Upper and Lower Extremity scales be used as primary outcomes in intervention trials targeting motor function in populations with chronic stroke. The other 6 measures are recommended as secondary outcomes.
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Affiliation(s)
- Cheryl Bushnell
- From the Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.B.); Duke University School of Nursing, Durham, NC (J.P.B.); Department of Neurosurgery, Radiology and Public Health Sciences, Pennsylvania State University, Hershey (K.M.C.); Department of Neurology (S.C.C.) and Anatomy and Neurobiology (S.C.C.), University of California, Irvine; RAND Health Advisory Services, RAND Corporation, Boston, MA (M.O.E., S.M.); Department of Neurology (D.H.) and Department of Biostatistics, Bloomberg School of Public Health (G.Y.), Johns Hopkins University Medical Center, Baltimore, MD; Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH (I.K.); Department of Rehabilitation and Regenerative Medicine (Occupational Therapy), Columbia University Medical Center, New York, NY (D.M.N.); RAND Health Advisory Services, RAND Corporation, Santa Monica, CA (T.P.); Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA (E.R.S.); and South West Advanced Neurological Rehabilitation, LLC, Phoenix, AZ (K.W.)
| | - Janet Prvu Bettger
- From the Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.B.); Duke University School of Nursing, Durham, NC (J.P.B.); Department of Neurosurgery, Radiology and Public Health Sciences, Pennsylvania State University, Hershey (K.M.C.); Department of Neurology (S.C.C.) and Anatomy and Neurobiology (S.C.C.), University of California, Irvine; RAND Health Advisory Services, RAND Corporation, Boston, MA (M.O.E., S.M.); Department of Neurology (D.H.) and Department of Biostatistics, Bloomberg School of Public Health (G.Y.), Johns Hopkins University Medical Center, Baltimore, MD; Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH (I.K.); Department of Rehabilitation and Regenerative Medicine (Occupational Therapy), Columbia University Medical Center, New York, NY (D.M.N.); RAND Health Advisory Services, RAND Corporation, Santa Monica, CA (T.P.); Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA (E.R.S.); and South West Advanced Neurological Rehabilitation, LLC, Phoenix, AZ (K.W.)
| | - Kevin M Cockroft
- From the Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.B.); Duke University School of Nursing, Durham, NC (J.P.B.); Department of Neurosurgery, Radiology and Public Health Sciences, Pennsylvania State University, Hershey (K.M.C.); Department of Neurology (S.C.C.) and Anatomy and Neurobiology (S.C.C.), University of California, Irvine; RAND Health Advisory Services, RAND Corporation, Boston, MA (M.O.E., S.M.); Department of Neurology (D.H.) and Department of Biostatistics, Bloomberg School of Public Health (G.Y.), Johns Hopkins University Medical Center, Baltimore, MD; Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH (I.K.); Department of Rehabilitation and Regenerative Medicine (Occupational Therapy), Columbia University Medical Center, New York, NY (D.M.N.); RAND Health Advisory Services, RAND Corporation, Santa Monica, CA (T.P.); Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA (E.R.S.); and South West Advanced Neurological Rehabilitation, LLC, Phoenix, AZ (K.W.)
| | - Steven C Cramer
- From the Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.B.); Duke University School of Nursing, Durham, NC (J.P.B.); Department of Neurosurgery, Radiology and Public Health Sciences, Pennsylvania State University, Hershey (K.M.C.); Department of Neurology (S.C.C.) and Anatomy and Neurobiology (S.C.C.), University of California, Irvine; RAND Health Advisory Services, RAND Corporation, Boston, MA (M.O.E., S.M.); Department of Neurology (D.H.) and Department of Biostatistics, Bloomberg School of Public Health (G.Y.), Johns Hopkins University Medical Center, Baltimore, MD; Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH (I.K.); Department of Rehabilitation and Regenerative Medicine (Occupational Therapy), Columbia University Medical Center, New York, NY (D.M.N.); RAND Health Advisory Services, RAND Corporation, Santa Monica, CA (T.P.); Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA (E.R.S.); and South West Advanced Neurological Rehabilitation, LLC, Phoenix, AZ (K.W.)
| | - Maria Orlando Edelen
- From the Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.B.); Duke University School of Nursing, Durham, NC (J.P.B.); Department of Neurosurgery, Radiology and Public Health Sciences, Pennsylvania State University, Hershey (K.M.C.); Department of Neurology (S.C.C.) and Anatomy and Neurobiology (S.C.C.), University of California, Irvine; RAND Health Advisory Services, RAND Corporation, Boston, MA (M.O.E., S.M.); Department of Neurology (D.H.) and Department of Biostatistics, Bloomberg School of Public Health (G.Y.), Johns Hopkins University Medical Center, Baltimore, MD; Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH (I.K.); Department of Rehabilitation and Regenerative Medicine (Occupational Therapy), Columbia University Medical Center, New York, NY (D.M.N.); RAND Health Advisory Services, RAND Corporation, Santa Monica, CA (T.P.); Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA (E.R.S.); and South West Advanced Neurological Rehabilitation, LLC, Phoenix, AZ (K.W.).
| | - Daniel Hanley
- From the Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.B.); Duke University School of Nursing, Durham, NC (J.P.B.); Department of Neurosurgery, Radiology and Public Health Sciences, Pennsylvania State University, Hershey (K.M.C.); Department of Neurology (S.C.C.) and Anatomy and Neurobiology (S.C.C.), University of California, Irvine; RAND Health Advisory Services, RAND Corporation, Boston, MA (M.O.E., S.M.); Department of Neurology (D.H.) and Department of Biostatistics, Bloomberg School of Public Health (G.Y.), Johns Hopkins University Medical Center, Baltimore, MD; Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH (I.K.); Department of Rehabilitation and Regenerative Medicine (Occupational Therapy), Columbia University Medical Center, New York, NY (D.M.N.); RAND Health Advisory Services, RAND Corporation, Santa Monica, CA (T.P.); Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA (E.R.S.); and South West Advanced Neurological Rehabilitation, LLC, Phoenix, AZ (K.W.)
| | - Irene L Katzan
- From the Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.B.); Duke University School of Nursing, Durham, NC (J.P.B.); Department of Neurosurgery, Radiology and Public Health Sciences, Pennsylvania State University, Hershey (K.M.C.); Department of Neurology (S.C.C.) and Anatomy and Neurobiology (S.C.C.), University of California, Irvine; RAND Health Advisory Services, RAND Corporation, Boston, MA (M.O.E., S.M.); Department of Neurology (D.H.) and Department of Biostatistics, Bloomberg School of Public Health (G.Y.), Johns Hopkins University Medical Center, Baltimore, MD; Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH (I.K.); Department of Rehabilitation and Regenerative Medicine (Occupational Therapy), Columbia University Medical Center, New York, NY (D.M.N.); RAND Health Advisory Services, RAND Corporation, Santa Monica, CA (T.P.); Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA (E.R.S.); and South West Advanced Neurological Rehabilitation, LLC, Phoenix, AZ (K.W.)
| | - Soeren Mattke
- From the Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.B.); Duke University School of Nursing, Durham, NC (J.P.B.); Department of Neurosurgery, Radiology and Public Health Sciences, Pennsylvania State University, Hershey (K.M.C.); Department of Neurology (S.C.C.) and Anatomy and Neurobiology (S.C.C.), University of California, Irvine; RAND Health Advisory Services, RAND Corporation, Boston, MA (M.O.E., S.M.); Department of Neurology (D.H.) and Department of Biostatistics, Bloomberg School of Public Health (G.Y.), Johns Hopkins University Medical Center, Baltimore, MD; Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH (I.K.); Department of Rehabilitation and Regenerative Medicine (Occupational Therapy), Columbia University Medical Center, New York, NY (D.M.N.); RAND Health Advisory Services, RAND Corporation, Santa Monica, CA (T.P.); Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA (E.R.S.); and South West Advanced Neurological Rehabilitation, LLC, Phoenix, AZ (K.W.)
| | - Dawn M Nilsen
- From the Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.B.); Duke University School of Nursing, Durham, NC (J.P.B.); Department of Neurosurgery, Radiology and Public Health Sciences, Pennsylvania State University, Hershey (K.M.C.); Department of Neurology (S.C.C.) and Anatomy and Neurobiology (S.C.C.), University of California, Irvine; RAND Health Advisory Services, RAND Corporation, Boston, MA (M.O.E., S.M.); Department of Neurology (D.H.) and Department of Biostatistics, Bloomberg School of Public Health (G.Y.), Johns Hopkins University Medical Center, Baltimore, MD; Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH (I.K.); Department of Rehabilitation and Regenerative Medicine (Occupational Therapy), Columbia University Medical Center, New York, NY (D.M.N.); RAND Health Advisory Services, RAND Corporation, Santa Monica, CA (T.P.); Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA (E.R.S.); and South West Advanced Neurological Rehabilitation, LLC, Phoenix, AZ (K.W.)
| | - Tepring Piquado
- From the Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.B.); Duke University School of Nursing, Durham, NC (J.P.B.); Department of Neurosurgery, Radiology and Public Health Sciences, Pennsylvania State University, Hershey (K.M.C.); Department of Neurology (S.C.C.) and Anatomy and Neurobiology (S.C.C.), University of California, Irvine; RAND Health Advisory Services, RAND Corporation, Boston, MA (M.O.E., S.M.); Department of Neurology (D.H.) and Department of Biostatistics, Bloomberg School of Public Health (G.Y.), Johns Hopkins University Medical Center, Baltimore, MD; Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH (I.K.); Department of Rehabilitation and Regenerative Medicine (Occupational Therapy), Columbia University Medical Center, New York, NY (D.M.N.); RAND Health Advisory Services, RAND Corporation, Santa Monica, CA (T.P.); Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA (E.R.S.); and South West Advanced Neurological Rehabilitation, LLC, Phoenix, AZ (K.W.)
| | - Elizabeth R Skidmore
- From the Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.B.); Duke University School of Nursing, Durham, NC (J.P.B.); Department of Neurosurgery, Radiology and Public Health Sciences, Pennsylvania State University, Hershey (K.M.C.); Department of Neurology (S.C.C.) and Anatomy and Neurobiology (S.C.C.), University of California, Irvine; RAND Health Advisory Services, RAND Corporation, Boston, MA (M.O.E., S.M.); Department of Neurology (D.H.) and Department of Biostatistics, Bloomberg School of Public Health (G.Y.), Johns Hopkins University Medical Center, Baltimore, MD; Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH (I.K.); Department of Rehabilitation and Regenerative Medicine (Occupational Therapy), Columbia University Medical Center, New York, NY (D.M.N.); RAND Health Advisory Services, RAND Corporation, Santa Monica, CA (T.P.); Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA (E.R.S.); and South West Advanced Neurological Rehabilitation, LLC, Phoenix, AZ (K.W.)
| | - Kay Wing
- From the Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.B.); Duke University School of Nursing, Durham, NC (J.P.B.); Department of Neurosurgery, Radiology and Public Health Sciences, Pennsylvania State University, Hershey (K.M.C.); Department of Neurology (S.C.C.) and Anatomy and Neurobiology (S.C.C.), University of California, Irvine; RAND Health Advisory Services, RAND Corporation, Boston, MA (M.O.E., S.M.); Department of Neurology (D.H.) and Department of Biostatistics, Bloomberg School of Public Health (G.Y.), Johns Hopkins University Medical Center, Baltimore, MD; Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH (I.K.); Department of Rehabilitation and Regenerative Medicine (Occupational Therapy), Columbia University Medical Center, New York, NY (D.M.N.); RAND Health Advisory Services, RAND Corporation, Santa Monica, CA (T.P.); Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA (E.R.S.); and South West Advanced Neurological Rehabilitation, LLC, Phoenix, AZ (K.W.)
| | - Gayane Yenokyan
- From the Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.B.); Duke University School of Nursing, Durham, NC (J.P.B.); Department of Neurosurgery, Radiology and Public Health Sciences, Pennsylvania State University, Hershey (K.M.C.); Department of Neurology (S.C.C.) and Anatomy and Neurobiology (S.C.C.), University of California, Irvine; RAND Health Advisory Services, RAND Corporation, Boston, MA (M.O.E., S.M.); Department of Neurology (D.H.) and Department of Biostatistics, Bloomberg School of Public Health (G.Y.), Johns Hopkins University Medical Center, Baltimore, MD; Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH (I.K.); Department of Rehabilitation and Regenerative Medicine (Occupational Therapy), Columbia University Medical Center, New York, NY (D.M.N.); RAND Health Advisory Services, RAND Corporation, Santa Monica, CA (T.P.); Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA (E.R.S.); and South West Advanced Neurological Rehabilitation, LLC, Phoenix, AZ (K.W.)
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Chen HL, Lin KC, Liing RJ, Wu CY, Chen CL. Kinematic measures of Arm-trunk movements during unilateral and bilateral reaching predict clinically important change in perceived arm use in daily activities after intensive stroke rehabilitation. J Neuroeng Rehabil 2015; 12:84. [PMID: 26392271 PMCID: PMC4578333 DOI: 10.1186/s12984-015-0075-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 09/11/2015] [Indexed: 11/16/2022] Open
Abstract
Background Kinematic analysis has been used to objectively evaluate movement patterns, quality, and strategies during reaching tasks. However, no study has investigated whether kinematic variables during unilateral and bilateral reaching tasks predict a patient’s perceived arm use during activities of daily living (ADL) after an intensive intervention. Therefore, this study investigated whether kinematic measures during unilateral and bilateral reaching tasks before an intervention can predict clinically meaningful improvement in perceived arm use during ADL after intensive poststroke rehabilitation. Methods The study was a secondary analysis of 120 subjects with chronic stroke who received 90–120 min of intensive intervention every weekday for 3–4 weeks. Reaching kinematics during unilateral and bilateral tasks and the Motor Activity Log (MAL) were evaluated before and after the intervention. Results Kinematic variables explained 22 and 11 % of the variance in actual amount of use (AOU) and quality of movement (QOM), respectively, of MAL improvement during unilateral reaching tasks. Kinematic variables also explained 21 and 31 % of the variance in MAL-AOU and MAL-QOM, respectively, during bilateral reaching tasks. Selected kinematic variables, including endpoint variables, trunk involvement, and joint recruitment and interjoint coordination, were significant predictors for improvement in perceived arm use during ADL (P < 0.05). Conclusions Arm–trunk kinematics may be used to predict clinically meaningful improvement in perceived arm use during ADL after intensive rehabilitation. Involvement of interjoint coordination and trunk control variables as predictors in bilateral reaching models indicates that a high level of motor control (i.e., multijoint coordination) and trunk stability may be important in obtaining treatment gains in arm use, especially for bilateral daily activities, in intensive rehabilitation after stroke.
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Affiliation(s)
- Hao-ling Chen
- 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.
| | - 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.
| | - Rong-jiuan Liing
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Ching-yi Wu
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Healthy Ageing Research Center, Chang Gung University, Taoyuan, Taiwan.
| | - Chia-ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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Delafontaine A, Honeine JL, Do MC, Gagey O, Chong RK. Comparative gait initiation kinematics between simulated unilateral and bilateral ankle hypomobility: Does bilateral constraint improve speed performance? Neurosci Lett 2015. [PMID: 26197055 DOI: 10.1016/j.neulet.2015.07.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Improvement of motor performance in unilateral upper limb motor disability has been shown when utilizing inter-limb coupling strategies during physical rehabilitation. This suggests that 'default' bilateral central motor commands are facilitated. Here, we tested whether this bilateral motor control principle may be generalized to the lower limbs during gait initiation, which involves alternate bilateral actions. Disability was simulated by strapping to produce ankle hypomobility. Healthy adult subjects initiated gait at a self-paced speed with no ankle constraint (control), or with the stance, swing or bilateral ankles strapped. The duration of the anticipatory postural adjustments lengthened and the center of mass instantaneous progression velocity at foot-off decreased when the ankle was strapped. During the step execution phase, progression velocity at foot-contact was higher when both ankles were strapped compared to unilateral strapping of the stance ankle. These findings suggest that bilateral central motor commands are favored during walking tasks. Indeed, unilateral constraint of the stance ankle should compel the central nervous system to adapt specific commands to the constraint and normal sides whereas the 'default' bilateral motor commands would be utilized when both ankles are strapped leading to better kinematics performance. Bilateral in-phase upper limb coordination and bilateral alternating lower limb locomotor movements may share similar control mechanisms.
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Affiliation(s)
- A Delafontaine
- CIAMS Laboratory, UFR-STAPS, University Paris-Sud, Orsay, France.
| | - J-L Honeine
- CIAMS Laboratory, UFR-STAPS, University Paris-Sud, Orsay, France
| | - M-C Do
- CIAMS Laboratory, UFR-STAPS, University Paris-Sud, Orsay, France
| | - O Gagey
- CIAMS Laboratory, UFR-STAPS, University Paris-Sud, Orsay, France; Service de chirurgie orthopédique, C.H.U Kremlin Bicêtre, Kremlin Bicêtre, France
| | - R K Chong
- Department of Physical Therapy, Georgia Regents University, Augusta, GA, USA
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Alt Murphy M, Häger CK. Kinematic analysis of the upper extremity after stroke – how far have we reached and what have we grasped? PHYSICAL THERAPY REVIEWS 2015. [DOI: 10.1179/1743288x15y.0000000002] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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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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Concurrent and Predictive Validity of Arm Kinematics With and Without a Trunk Restraint During a Reaching Task in Individuals With Stroke. Arch Phys Med Rehabil 2015; 96:1666-75. [PMID: 25940684 DOI: 10.1016/j.apmr.2015.04.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/18/2015] [Accepted: 04/21/2015] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To examine the concurrent and predictive validity of measurements of kinematic variables during reaching tasks with and without a trunk constraint in individuals with stroke. DESIGN Randomized controlled trials. SETTINGS Hospitals and a laboratory. PARTICIPANTS Individuals with stroke (N=95) enrolled in previous and ongoing clinical trials. INTERVENTIONS Upper limb training protocols were 90 to 120 minutes of intervention every weekday for 3 to 4 weeks. MAIN OUTCOME MEASURES Functional capacity was assessed using the Action Research Arm Test and motor impairment using the Fugl-Meyer Assessment for the Upper Extremity. Movement kinematics were measured during a reaching task with and without a trunk constraint. We derived 5 endpoint control variables and 3 joint recruitment variables for estimating concurrent and predictive validity. RESULTS The adjusted R(2) values for the constraint tasks ranged from .24 to .38 and for the unconstraint tasks from .29 to .40. Movement time was the most prominent kinematic variable for the Fugl-Meyer Assessment for the Upper Extremity before and after the intervention (P<.05). For the Action Research Arm Test, movement time and endpoint displacement were the most significant variables before and after the intervention, respectively (P<.05). CONCLUSIONS Measuring kinematic performance during an unconstrained task is appropriate and possibly sufficient to represent motor impairment and functional capacity of individuals with stroke. Movement time is the dominant variable associated with motor impairment and functional capacity, and endpoint displacement is unique in reflecting functional capacity of individuals with stroke.
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Huang Z, Wang Z, Lv X, Zhou Y, Wang H, Zong S. A novel functional electrical stimulation-control system for restoring motor function of post-stroke hemiplegic patients. Neural Regen Res 2014; 9:2102-10. [PMID: 25657728 PMCID: PMC4316476 DOI: 10.4103/1673-5374.147938] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2014] [Indexed: 11/12/2022] Open
Abstract
Hemiparesis is one of the most common consequences of stroke. Advanced rehabilitation techniques are essential for restoring motor function in hemiplegic patients. Functional electrical stimulation applied to the affected limb based on myoelectric signal from the unaffected limb is a promising therapy for hemiplegia. In this study, we developed a prototype system for evaluating this novel functional electrical stimulation-control strategy. Based on surface electromyography and a vector machine model, a self-administered, multi-movement, force-modulation functional electrical stimulation-prototype system for hemiplegia was implemented. This paper discusses the hardware design, the algorithm of the system, and key points of the self-oscillation-prone system. The experimental results demonstrate the feasibility of the prototype system for further clinical trials, which is being conducted to evaluate the efficacy of the proposed rehabilitation technique.
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Affiliation(s)
- Zonghao Huang
- Institute of RF- & OE-ICs, Southeast University, Nanjing, Jiangsu Province, China
| | - Zhigong Wang
- Institute of RF- & OE-ICs, Southeast University, Nanjing, Jiangsu Province, China ; Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu Province, China
| | - Xiaoying Lv
- State Key Lab of Bioelectronics, Southeast University, Nanjing, Jiangsu Province, China ; Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu Province, China
| | - Yuxuan Zhou
- State Key Lab of Bioelectronics, Southeast University, Nanjing, Jiangsu Province, China
| | - Haipeng Wang
- Institute of RF- & OE-ICs, Southeast University, Nanjing, Jiangsu Province, China
| | - Sihao Zong
- Institute of RF- & OE-ICs, Southeast University, Nanjing, Jiangsu Province, China
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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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Kolb B, Muhammad A. Harnessing the power of neuroplasticity for intervention. Front Hum Neurosci 2014; 8:377. [PMID: 25018713 PMCID: PMC4072970 DOI: 10.3389/fnhum.2014.00377] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 05/14/2014] [Indexed: 01/06/2023] Open
Abstract
A fundamental property of the brain is its capacity to change with a wide variety of experiences, including injury. Although there are spontaneous reparative changes following injury, these changes are rarely sufficient to support significant functional recovery. Research on the basic principles of brain plasticity is leading to new approaches to treating the injured brain. We review factors that affect synaptic organization in the normal brain, evidence of spontaneous neuroplasticity after injury, and the evidence that factors including postinjury experience, pharmacotherapy, and cell-based therapies, can form the basis of rehabilitation strategies after brain injuries early in life and in adulthood.
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Affiliation(s)
- Bryan Kolb
- Canadian Centre for Behavioural Neuroscience, University of Lethbridge Lethbridge, AB, Canada
| | - Arif Muhammad
- Canadian Centre for Behavioural Neuroscience, University of Lethbridge Lethbridge, AB, Canada
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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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Arm and trunk movement kinematics during seated reaching within and beyond arm's length in people with stroke: a validity study. Phys Ther 2014; 94:845-56. [PMID: 24481598 DOI: 10.2522/ptj.20130101] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Kinematic analysis is commonly used to objectively measure upper extremity movement performance after stroke. However, the concurrent validity and predictive validity of arm-trunk kinematics during reaching within and beyond arm's length have not been studied. OBJECTIVE The aim of this study was to estimate the concurrent validity of kinematic measures before and after treatment and the predictive validity for reaching within and beyond arm's length after stroke. DESIGN This was a secondary analysis study. METHODS Ninety-seven participants with stroke (mean age=55.9 years [SD=10.9]) received intensive treatment every weekday for 3 to 4 weeks. Kinematic reaching tasks and the Wolf Motor Function Test (WMFT) were used before and after treatment. The validity of the kinematic measures was estimated in relation to WMFT scores. RESULTS Of the 8 kinematic variables that were measured, index movement time before treatment (R2=.227-.362) and trunk movement time and trunk displacement after treatment (R2=.095-.346) had the strongest association with the WMFT at both reaching distances. Trunk movement time and trunk displacement before treatment explained 6.9% to 14.9% of the variance in the WMFT after treatment. Kinematic variables explained 6.9% to 49.3% and 9.4% to 38.7% of the variance in the WMFT during a task within arm's length and beyond arm's length, respectively. LIMITATIONS The study has limited generalizability. CONCLUSIONS Different kinematic variables may partially reflect motor function before and after treatment to a limited degree. Although the predictive validity was modest, trunk movement may be considered a prognostic determinant of motor function after treatment. A reaching task within arm's length may be a more suitable measure of kinematic performance for describing motor function than a reaching task beyond arm's length.
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Shiner CT, Byblow WD, McNulty PA. Bilateral priming before wii-based movement therapy enhances upper limb rehabilitation and its retention after stroke: a case-controlled study. Neurorehabil Neural Repair 2014; 28:828-38. [PMID: 24627333 DOI: 10.1177/1545968314523679] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Motor deficits after a stroke are thought to be compounded by the development of asymmetric interhemispheric inhibition. Bilateral priming was developed to rebalance this asymmetry and thus improve therapy efficacy. OBJECTIVE This study investigated the effect of bilateral priming before Wii-based Movement Therapy to improve rehabilitation after stroke. METHODS Ten patients who had suffered a stroke (age, 23-77 years; 3-123 months after stroke) underwent a 14-day program of Wii-based Movement Therapy for upper limb rehabilitation. Formal Wii-based Movement Therapy sessions were immediately preceded by 15 minutes of bilateral priming, whereby active flexion-extension of the less affected wrist drove mirror-symmetric passive movements of the more affected wrist through a custom device. Functional movement was assessed at weeks 0 (before therapy), 3 (after therapy), and 28 (follow-up) using the Wolf Motor Function Test (WMFT), upper limb Fugl-Meyer Assessment (FMA), upper limb range of motion, and Motor Activity Log (MAL). Case-matched controls were patients who had suffered a stroke who received Wii-based Movement Therapy but not bilateral priming. RESULTS Upper limb functional ability improved for both groups on all measures tested. Posttherapy improvement on the FMA for primed patients was twice that of the unprimed patients (37.3% vs 14.6%, respectively) and was significantly better maintained at 28 weeks (P = .02). Improvements on the WMFT and MAL were similar for both groups, but the pattern of change in range of motion was strikingly different. CONCLUSIONS Bilateral priming before Wii-based Movement Therapy led to a greater magnitude and retention of improvement compared to control, especially measured with the FMA. These data suggest that bilateral priming can enhance the efficacy of Wii-based Movement Therapy, particularly for patients with low motor function after a stroke.
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Affiliation(s)
- Christine T Shiner
- Neuroscience Research Australia and the University of New South Wales, Sydney, Australia
| | - Winston D Byblow
- Centre for Brain Research, The University of Auckland, Auckland, New Zealand
| | - Penelope A McNulty
- Neuroscience Research Australia and the University of New South Wales, Sydney, Australia
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Veerbeek JM, van Wegen E, van Peppen R, van der Wees PJ, Hendriks E, Rietberg M, Kwakkel G. What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PLoS One 2014; 9:e87987. [PMID: 24505342 PMCID: PMC3913786 DOI: 10.1371/journal.pone.0087987] [Citation(s) in RCA: 686] [Impact Index Per Article: 68.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 12/30/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Physical therapy (PT) is one of the key disciplines in interdisciplinary stroke rehabilitation. The aim of this systematic review was to provide an update of the evidence for stroke rehabilitation interventions in the domain of PT. METHODS AND FINDINGS Randomized controlled trials (RCTs) regarding PT in stroke rehabilitation were retrieved through a systematic search. Outcomes were classified according to the ICF. RCTs with a low risk of bias were quantitatively analyzed. Differences between phases poststroke were explored in subgroup analyses. A best evidence synthesis was performed for neurological treatment approaches. The search yielded 467 RCTs (N = 25373; median PEDro score 6 [IQR 5-7]), identifying 53 interventions. No adverse events were reported. Strong evidence was found for significant positive effects of 13 interventions related to gait, 11 interventions related to arm-hand activities, 1 intervention for ADL, and 3 interventions for physical fitness. Summary Effect Sizes (SESs) ranged from 0.17 (95%CI 0.03-0.70; I(2) = 0%) for therapeutic positioning of the paretic arm to 2.47 (95%CI 0.84-4.11; I(2) = 77%) for training of sitting balance. There is strong evidence that a higher dose of practice is better, with SESs ranging from 0.21 (95%CI 0.02-0.39; I(2) = 6%) for motor function of the paretic arm to 0.61 (95%CI 0.41-0.82; I(2) = 41%) for muscle strength of the paretic leg. Subgroup analyses yielded significant differences with respect to timing poststroke for 10 interventions. Neurological treatment approaches to training of body functions and activities showed equal or unfavorable effects when compared to other training interventions. Main limitations of the present review are not using individual patient data for meta-analyses and absence of correction for multiple testing. CONCLUSIONS There is strong evidence for PT interventions favoring intensive high repetitive task-oriented and task-specific training in all phases poststroke. Effects are mostly restricted to the actually trained functions and activities. Suggestions for prioritizing PT stroke research are given.
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Affiliation(s)
- Janne Marieke Veerbeek
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Erwin van Wegen
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Roland van Peppen
- Department of Physiotherapy, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Philip Jan van der Wees
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Erik Hendriks
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Marc Rietberg
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
- Department of Neurorehabilitation, Reade Center for Rehabilitation and Rheumatology, Amsterdam, The Netherlands
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Shahine EM, Shafshak TS. The effect of repetitive bilateral arm training with rhythmic auditory cueing on motor performance and central motor changes in patients with chronic stroke. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2014. [DOI: 10.4103/1110-161x.128128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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