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Liu H, Xu Y, Jiang W, Hu F, Zhou Y, Pan L, Zhou F, Yin Y, Tan B. Effects of task-based mirror therapy on upper limb motor function in hemiplegia: study protocol for a randomized controlled clinical trial. Trials 2024; 25:254. [PMID: 38605413 PMCID: PMC11010366 DOI: 10.1186/s13063-024-08081-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 03/29/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND AND PURPOSE Research to date has lacked definitive evidence to determine whether mirror therapy promotes the recovery of upper extremity function after stroke. Considering that previous studies did not stratify patients based on structural retention, this may be one of the reasons for the negative results obtained in many trials. The goal evaluates the efficacy of TBMT (utilizing an innovatively designed mirror) versus standard occupational therapy for stroke patient's upper limb functionality. METHODS AND ANALYSIS This single-center randomized controlled trial will involve 50 patients with stroke. All patients will be randomly assigned to either the task-based mirror therapy or the control group. The interventions will be performed 5 days per week for 4 weeks. The primary outcomes will be the mean change in scores on both the FMA-UE and modified Barthel Index (MBI) from baseline to 4 weeks intervention and at 12 weeks follow-up between the two groups and within groups. The other outcomes will include the Action Research Arm Test (ARAT), the Nine Hole Peg Test (9HPT), the Functional Independence Measure, and MRI. DISCUSSION This trial will not only to establish that task-based mirror therapy (TBMT) could improve the recovery of hand function after stroke but also to explore the underlying mechanisms. We expect that this finding will clarify the brain activation and brain network mechanisms underlying the improvement of hand function with task-oriented mirror therapy and lead to new ideas for stroke hand function rehabilitation. TRIAL REGISTRATION URL: https://www.chictr.org.cn ; Unique identifier: ChiCTR2300068855. Registered on March 1, 2023.
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Affiliation(s)
- Hongzhen Liu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Lin Jiang Road, Chongqing, 40010, China
| | - Yangjie Xu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Lin Jiang Road, Chongqing, 40010, China
| | - Wei Jiang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Lin Jiang Road, Chongqing, 40010, China
| | - Fangchao Hu
- Department of Mechanical Engineering, Chongqing University of Technology, No. 69 Hongguang Avenue, Chongqing, 400054, China
| | - Yi Zhou
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Lin Jiang Road, Chongqing, 40010, China
| | - Lu Pan
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Lin Jiang Road, Chongqing, 40010, China
| | - Feng Zhou
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Lin Jiang Road, Chongqing, 40010, China
| | - Ying Yin
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Lin Jiang Road, Chongqing, 40010, China
| | - Botao Tan
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Lin Jiang Road, Chongqing, 40010, China.
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Allen JR, Karri SR, Yang C, Stoykov ME. Spinal Cord Stimulation for Poststroke Hemiparesis: A Scoping Review. Am J Occup Ther 2024; 78:7802180220. [PMID: 38477681 PMCID: PMC11017736 DOI: 10.5014/ajot.2024.050533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
IMPORTANCE Spinal cord stimulation (SCS) is a neuromodulation technique that can improve paresis in individuals with spinal cord injury. SCS is emerging as a technique that can address upper and lower limb hemiparesis. Little is understood about its effectiveness with the poststroke population. OBJECTIVE To summarize the evidence for SCS after stroke and any changes in upper extremity and lower extremity motor function. DATA SOURCES PubMed, Web of Science, Embase, and CINAHL. The reviewers used hand searches and reference searches of retrieved articles. There were no limitations regarding publication year. STUDY SELECTION AND DATA COLLECTION This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The inclusion and exclusion criteria included a broad range of study characteristics. Studies were excluded if the intervention did not meet the definition of SCS intervention, used only animals or healthy participants, did not address upper or lower limb motor function, or examined neurological conditions other than stroke. FINDINGS Fourteen articles met the criteria for this review. Seven studies found a significant improvement in motor function in groups receiving SCS. CONCLUSIONS AND RELEVANCE Results indicate that SCS may provide an alternative means to improve motor function in the poststroke population. Plain-Language Summary: The results of this study show that spinal cord stimulation may provide an alternative way to improve motor function after stroke. Previous neuromodulation methods have targeted the impaired supraspinal circuitry after stroke. Although downregulated, spinal cord circuitry is largely intact and offers new possibilities for motor recovery.
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Affiliation(s)
- Jonathan R Allen
- Jonathan R. Allen, OTD, OTR/L, is Occupational Therapist, Corewell Health, Grand Rapids, MI. At the time of the study, Allen was Doctoral Student, Department of Occupational Therapy, College of Health Sciences, University of Michigan-Flint;
| | - Swathi R Karri
- Swathi R. Karri, is Osteopathic Medical Student II, Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL
| | - Chen Yang
- Chen Yang, PhD, is Postdoctoral Fellow, Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, and Postdoctoral Fellow, Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Mary Ellen Stoykov
- Mary Ellen Stoykov, PhD, OTR/L, is Research Scientist, Arms + Hands Lab, Shirley Ryan AbilityLab, Chicago, IL, and Research Associate Professor, Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Tacchino A, Pedullà L, Podda J, Monti Bragadin M, Battaglia MA, Bisio A, Bove M, Brichetto G. Motor imagery has a priming effect on motor execution in people with multiple sclerosis. Front Hum Neurosci 2023; 17:1179789. [PMID: 37746058 PMCID: PMC10512728 DOI: 10.3389/fnhum.2023.1179789] [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: 03/04/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Priming is a learning process that refers to behavioral changes caused by previous exposure to a similar stimulus. Motor imagery (MI), which involves the mental rehearsal of action representations in working memory without engaging in actual execution, could be a strategy for priming the motor system. This study investigates whether MI primes action execution in Multiple Sclerosis (MS). Here, 17 people with MS (PwMS) and 19 healthy subjects (HS), all right-handed and good imaginers, performed as accurately and quickly as possible, with a pencil, actual or mental pointing movements between targets of small (1.0 × 1.0 cm) or large (1.5 × 1.5 cm) size. In actual trials, they completed five pointing cycles between the left and right targets, whereas in mental trials, the first 4 cycles were imagined while the fifth was actually executed. The fifth cycle was introduced to assess the MI priming effect on actual execution. All conditions, presented randomly, were performed with both dominant (i.e., right) and non-dominant arms. Analysis of the duration of the first 4 cycles in both actual and mental trials confirmed previous findings, showing isochrony in HS with both arms and significantly faster mental than actual movements (anisochrony) in PwMS (p < 0.01) [time (s); HS right: actual: 4.23 ± 0.15, mental: 4.36 ± 0.16; left: actual: 4.32 ± 0.15, mental: 4.43 ± 0.18; PwMS right: actual: 5.85 ± 0.16, mental: 5.99 ± 0.21; left: actual: 6.68 ± 0.20, mental: 5.94 ± 0.23]; anisochrony in PwMS was present when the task was performed with the non-dominant arm. Of note, temporal analysis of the fifth actual cycle showed no differences between actual and mental trials for HS with both arms, whereas in PwMS the fifth actual cycle was significantly faster after the four actual cycles for the non-dominant arm (p < 0.05) [time (s); HS right: actual: 1.03 ± 0.04, mental: 1.03 ± 0.03; left: actual: 1.08 ± 0.04, mental: 1.05 ± 0.03; PwMS right: actual: 1.48 ± 0.04, mental: 1.48 ± 0.06; left: actual: 1.66 ± 0.05, mental: 1.48 ± 0.06]. These results seem to suggest that a few mental repetitions of an action might be sufficient to exert a priming effect on the actual execution of the same action in PwMS. This would indicate further investigation of the potential use of MI as a new motor-cognitive tool for MS neurorehabilitation.
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Affiliation(s)
- Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Ludovico Pedullà
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | | | - Mario Alberto Battaglia
- Department of Physiopathology, Experimental Medicine, and Public Health, University of Siena, Siena, Italy
| | - Ambra Bisio
- Section of Human Physiology, Department of Experimental Medicine, University of Genoa, Genoa, Italy
- Centro Polifunzionale di Scienze Motorie, University of Genoa, Genoa, Italy
| | - Marco Bove
- Section of Human Physiology, Department of Experimental Medicine, University of Genoa, Genoa, Italy
- IRCCS Policlinico San Martino, Genoa, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
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Zhang C, Li X, Wang H. Application of action observation therapy in stroke rehabilitation: A systematic review. Brain Behav 2023; 13:e3157. [PMID: 37480161 PMCID: PMC10454263 DOI: 10.1002/brb3.3157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 06/09/2023] [Accepted: 07/06/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Numerous studies have described the positive effects of action observation therapy (AOT) on motor recovery among patients with stroke. However, there is no standardized procedure for when and how to intervene with AOT. OBJECTIVES Thus, we reviewed and analyzed previous studies to provide a guideline for the application of AOT in stroke rehabilitation. METHOD We searched PubMed, Cochrane Library, and EMBASE from inception to October 31 2022, using title and abstract search terms of "action observation" and "stroke" or "hemiplegia." Of 4108 potential articles, 29 articles (sample size = 429 in AOT groups; sample size = 423 in control groups) that met inclusion criteria were included in final analyses. RESULTS The results suggested starting adjuvant AOT > 23 days after stroke onset and conducting 30-40 min/session, 3-5 times/week for at least 4 weeks. CONCLUSION Based on our results, many factors will impact the effect of AOT on stroke rehabilitation, when to apply (timing) and how to apply (frequency, single, and total duration) should be fully considered when applying AOT as adjuvant therapy in stroke rehabilitation.
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Affiliation(s)
- Chenping Zhang
- Department of Physical EducationShanghai University of Medicine & Health SciencesShanghaiChina
| | - Xiawen Li
- Department of Physical EducationShanghai University of Medicine & Health SciencesShanghaiChina
| | - Hongbiao Wang
- Department of Physical EducationShanghai University of Medicine & Health SciencesShanghaiChina
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Hsu HY, Yang KC, Yeh CH, Lin YC, Lin KR, Su FC, Kuo LC. A Tenodesis-Induced-Grip exoskeleton robot (TIGER) for assisting upper extremity functions in stroke patients: a randomized control study. Disabil Rehabil 2022; 44:7078-7086. [PMID: 34586927 DOI: 10.1080/09638288.2021.1980915] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE This study was aimed toward developing a lightweight assisting tenodesis-induced-grip exoskeleton robot (TIGER) and to examine the performance of the TIGER in stroke patients with hemiplegia. METHODS This was a single-blinded, randomized control trial with pre-treatment, immediate post-treatment, and 12-week follow-up assessments. Thirty-four stroke patients were recruited and randomized to either an experimental or control group, where each participant in both groups underwent 40 min of training. In addition to a 20-min bout of regular task-specific motor training, each participant in the experimental group received 20 min of TIGER training, and the controls received 20 min of traditional occupational therapy in each treatment session. Primary outcomes based on the Fugl-Meyer Motor Assessment of Upper Extremity (FMA-UE) were recorded. RESULTS Thirty-two patients (94.1%) completed the study: 17 and 15 patients in the experimental and control groups, respectively. Significant beneficial effects were found on the total score (ANCOVA, p = 0.006), the wrist score (ANCOVA, p = 0.037), and the hand score (ANCOVA, p = 0.006) for the FMA-UE in the immediate post-treatment assessment of the participants receiving the TIGER training. CONCLUSION The TIGER has beneficial effects on remediating upper limb impairments in chronic stroke patients. Clinical trial registration: ClinicalTrials.gov; identifier NCT03713476Implications for rehabilitationBased on use-dependent plasticity concepts, robot training with the more distal segments of the upper extremities has a beneficial effect in patients with chronic stroke.A novel lightweight assisting tenodesis-induced-grip exoskeleton robot (TIGER) system using a mechanism involving musculotendinous coordination of the wrist and hand was proposed in this study.Between-group differences in changes in the upper limb motor performance were observed in the experimental group as compared to patients in the control group. For patients with chronic stroke, receiving 20 min of TIGER training in conjunction with 20 min of task-specific motor training led to clinically important changes in motor control and functioning of the affected upper limb.
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Affiliation(s)
- Hsiu-Yun Hsu
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kang-Chin Yang
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Hsien Yeh
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Ching Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Keng-Ren Lin
- Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Fong-Chin Su
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan.,Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Li-Chieh Kuo
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan.,Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan
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Montoro-Cárdenas D, Cortés-Pérez I, Ibancos-Losada MDR, Zagalaz-Anula N, Obrero-Gaitán E, Osuna-Pérez MC. Nintendo ® Wii Therapy Improves Upper Extremity Motor Function in Children with Cerebral Palsy: A Systematic Review with Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12343. [PMID: 36231643 PMCID: PMC9566093 DOI: 10.3390/ijerph191912343] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Nintendo® Wii-based therapy (NWT) is a non-immersive virtual reality therapy used to recover upper extremity (UE) motor function in children with cerebral palsy (CP). We aimed primarily to elucidate the effectiveness of NWT in improving UE motor and functional impaired abilities in children with CP, compared to conventional therapy or no intervention. The secondary aim was to assess if NWT is more effective when used alone or combined with conventional therapy. METHODS A systematic review with meta-analysis was conducted from a bibliographic search in PubMed, Scopus, PEDro, Web of Science, and CINHAL, ending in October 2021, in accordance with PRISMA guidelines. We included randomized controlled trials that compared NWT vs. conventional therapy or no intervention in terms of their impact on different UE impaired abilities (grip strength, tip grip strength, UE dissociated movements, functional capacity in daily living activities, gross and fine motor dexterity, and grasping ability) in children with CP. Effect size was calculated with standardized mean difference (SMD) and its 95% confidence interval (95% CI). RESULTS Nine studies (276 participants) were included. NWT is more effective than conventional therapy at improving grip strength (SMD = 0.5, 95% CI 0.08, 0.91), tip grip strength (SMD = 0.95, 95% CI 0.3, 1.61), and grasping ability (SMD = 0.72, 95%CI 0.14, 1.3). NWT is more effective than conventional therapy at improving functional capacity in daily living activities (SMD = 0.83, 95% CI 0.07, 1.56). For fine manual dexterity, NWT was better than no intervention (SMD = 3.12, 95% CI 1.5, 4.7). CONCLUSIONS Our results indicate that NWT is effective at improving various UE impaired motor skills in children with CP.
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Fusco A, Giovannini S, Castelli L, Coraci D, Gatto DM, Reale G, Pastorino R, Padua L. Virtual Reality and Lower Limb Rehabilitation: Effects on Motor and Cognitive Outcome-A Crossover Pilot Study. J Clin Med 2022; 11:jcm11092300. [PMID: 35566424 PMCID: PMC9103855 DOI: 10.3390/jcm11092300] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 02/07/2023] Open
Abstract
The effectiveness of virtual reality (VR) in the motor and cognitive rehabilitation of patients with severe acquired brain injury (sABI) is unclear. This randomized, controlled, crossover, single-blinded, pilot study investigates the cognitive and motor effects of lower limb robotic therapy with and without VR visual feedback in a group of patients with ABI. A total of 23 patients with ABI were randomized into two groups: one group (VR-NVR) underwent a 2-week rehabilitation for the lower limbs training with a robotic device (Omego®) with VR feedback, followed by 2 weeks without VR; the other group (NVR-VR) performed the protocol in the opposite order. Patients were evaluated at baseline, after two and four weeks of treatment using the Level of Cognitive Functioning scale (LCF), Disability Rating Scale (DRS), and Motricity Index for Lower Limb (MI-LL) in the most affected limb. At the end of the intervention, both groups significantly improved in all the outcomes. A significant difference was found between VR treatment versus non-VR treatment for LCF (p = 0.024) and for DRS (p = 0.043) after the second week, while no significant differences were found in the group NVR-VR at T1. Our study indicates how the combination of robotic treatment with VR is effective in enhancing the recovery of cognitive function in patients with ABI, also improving disability and muscular function. Further, VR seems to enhance the early recovery process of motor and cognitive functions.
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Affiliation(s)
- Augusto Fusco
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (D.M.G.); (G.R.); (L.P.)
| | - Silvia Giovannini
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- UOS Riabilitazione Post-Acuzie, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Letizia Castelli
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (D.M.G.); (G.R.); (L.P.)
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-06-3015-4382
| | - Daniele Coraci
- Dipartimento di Neuroscienze, Università di Padova, 35128 Padova, Italy;
| | - Dario Mattia Gatto
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (D.M.G.); (G.R.); (L.P.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Giuseppe Reale
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (D.M.G.); (G.R.); (L.P.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Roberta Pastorino
- Department of Woman and Child Health and Public Health—Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Luca Padua
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (D.M.G.); (G.R.); (L.P.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
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The Effect of Task-Oriented Training on Upper-Limb Function, Visual Perception, and Activities of Daily Living in Acute Stroke Patients: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063186. [PMID: 35328874 PMCID: PMC8954660 DOI: 10.3390/ijerph19063186] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/06/2022] [Accepted: 03/06/2022] [Indexed: 11/17/2022]
Abstract
This pilot study aimed to investigate the effects of task-oriented training on upper-limb functioning, visual perception, and activities of daily living (ADL) in acute stroke patients. Of 20 participants, 10 were randomly assigned in a 1:1 ratio to experimental and control groups. Task-oriented training and table-top activity training were implemented for 6 weeks. Change in upper-limb functioning was assessed with the Manual Function Test (MFT); visual perceptual skill and ADL performance were evaluated using the Motor-Free Visual Perception Test—Vertical (MVPT-V) and Korean Modified Barthel Index (K-MBI), respectively. There was a significant interaction in the MFT and MBI score between the group and time (p < 0.05), but the group effect was not significant (p > 0.05). The MFT and MBI score significantly increased in both groups after the intervention (p < 0.001), but the effect size was greater in the task-oriented training group than the table-top activity training group. No significant interaction with MVPT-V score was found between the group and time (p > 0.05), and no statistical group difference was found either (p > 0.05). Both groups showed significant improvement in their MVPT-V score after the intervention (p < 0.001). The pilot study findings demonstrate that both task-oriented training and table-top activity training are effective in recovering upper-limb function, visual perception, and ADL in acute stroke patients.
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Fitzpatrick SM, Brogan D, Grover P. Hand Transplants, Daily Functioning, and the Human Capacity for Limb Regeneration. Front Cell Dev Biol 2022; 10:812124. [PMID: 35309909 PMCID: PMC8930848 DOI: 10.3389/fcell.2022.812124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/08/2022] [Indexed: 11/24/2022] Open
Abstract
Unlike some of our invertebrate and vertebrate cousins with the capacity to regenerate limbs after traumatic loss, humans do not have the ability to regrow arms or legs lost to injury or disease. For the millions of people worldwide who have lost a limb after birth, the primary route to regaining function and minimizing future complications is via rehabilitation, prosthetic devices, assistive aids, health system robustness, and social safety net structures. The majority of limbs lost are lower limbs (legs), with diabetes and vascular disorders being significant causal contributors. Upper limbs (arms) are lost primarily because of trauma; digits and hands are the most common levels of loss. Even if much of the arm remains intact, upper limb amputation significantly impacts function, largely due to the loss of the hand. Human hands are marvels of evolution and permit a dexterity that enables a wide variety of function not readily replaced by devices. It is not surprising, therefore, for some individuals, dissatisfaction with available prosthetic options coupled with remarkable advances in hand surgery techniques is resulting in patients undertaking the rigors of a hand transplantation. While not “regeneration” in the sense of the enviable ability with which Axolotls can replace a lost limb, hand transplants do require significant regeneration of tissues and nerves. Regaining sophisticated hand functions also depends on “reconnecting” the donated hand with the areas of the human brain responsible for the sensory and motor processing required for complex actions. Human hand transplants are not without controversy and raise interesting challenges regarding the human regenerative capacity and the status of transplants for enabling function. More investigation is needed to address medical and ethical questions prior to expansion of hand transplants to a wider patient population.
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Affiliation(s)
- Susan M. Fitzpatrick
- James S. McDonnell Foundation, St. Louis, MO, United States
- *Correspondence: Susan M. Fitzpatrick,
| | - David Brogan
- Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Prateek Grover
- Division of Neurorehabilitation, Orthopaedic Surgery and Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- The Rehabilitation Institute of St Louis, St. Louis, MO, United States
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Tsakanikas V, Gatsios D, Pardalis A, Tsiouris KM, Georga E, Bamiou DE, Pavlou M, Nikitas C, Kikidis D, Walz I, Maurer C, Fotiadis D. Automated assessment of balance rehabilitation exercises: A data-driven scoring model (Preprint). JMIR Rehabil Assist Technol 2022; 9:e37229. [PMID: 36044258 PMCID: PMC9475421 DOI: 10.2196/37229] [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: 02/11/2022] [Revised: 05/23/2022] [Accepted: 06/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background Balance rehabilitation programs represent the most common treatments for balance disorders. Nonetheless, lack of resources and lack of highly expert physiotherapists are barriers for patients to undergo individualized rehabilitation sessions. Therefore, balance rehabilitation programs are often transferred to the home environment, with a considerable risk of the patient misperforming the exercises or failing to follow the program at all. Holobalance is a persuasive coaching system with the capacity to offer full-scale rehabilitation services at home. Holobalance involves several modules, from rehabilitation program management to augmented reality coach presentation. Objective The aim of this study was to design, implement, test, and evaluate a scoring model for the accurate assessment of balance rehabilitation exercises, based on data-driven techniques. Methods The data-driven scoring module is based on an extensive data set (approximately 1300 rehabilitation exercise sessions) collected during the Holobalance pilot study. It can be used as a training and testing data set for training machine learning (ML) models, which can infer the scoring components of all physical rehabilitation exercises. In that direction, for creating the data set, 2 independent experts monitored (in the clinic) 19 patients performing 1313 balance rehabilitation exercises and scored their performance based on a predefined scoring rubric. On the collected data, preprocessing, data cleansing, and normalization techniques were applied before deploying feature selection techniques. Finally, a wide set of ML algorithms, like random forests and neural networks, were used to identify the most suitable model for each scoring component. Results The results of the trained model improved the performance of the scoring module in terms of more accurate assessment of a performed exercise, when compared with a rule-based scoring model deployed at an early phase of the system (k-statistic value of 15.9% for sitting exercises, 20.8% for standing exercises, and 26.8% for walking exercises). Finally, the resulting performance of the model resembled the threshold of the interobserver variability, enabling trustworthy usage of the scoring module in the closed-loop chain of the Holobalance coaching system. Conclusions The proposed set of ML models can effectively score the balance rehabilitation exercises of the Holobalance system. The models had similar accuracy in terms of Cohen kappa analysis, with interobserver variability, enabling the scoring module to infer the score of an exercise based on the collected signals from sensing devices. More specifically, for sitting exercises, the scoring model had high classification accuracy, ranging from 0.86 to 0.90. Similarly, for standing exercises, the classification accuracy ranged from 0.85 to 0.92, while for walking exercises, it ranged from 0.81 to 0.90. Trial Registration ClinicalTrials.gov NCT04053829; https://clinicaltrials.gov/ct2/show/NCT04053829
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Affiliation(s)
- Vassilios Tsakanikas
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Dimitris Gatsios
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Athanasios Pardalis
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Kostas M Tsiouris
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Eleni Georga
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Doris-Eva Bamiou
- Ear Institute, University College London, London, United Kingdom
- Biomedical Research Centre Hearing and Deafness, University College London Hospitals, London, United Kingdom
| | - Marousa Pavlou
- Centre for Human and Applied Physiological Sciences, King's College London, London, United Kingdom
| | - Christos Nikitas
- First Department of Otolaryngology-Head and Neck Surgery, Hippokrateio General Hospital, National Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Kikidis
- First Department of Otolaryngology-Head and Neck Surgery, Hippokrateio General Hospital, National Kapodistrian University of Athens, Athens, Greece
| | - Isabelle Walz
- Department of Neurology and Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Maurer
- Department of Neurology and Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dimitrios Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
- Biomedical Research Institute, Ioannina, Greece
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11
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Stoykov ME, Heidle C, Kang S, Lodesky L, Maccary LE, Madhavan S. Sensory-Based Priming for Upper Extremity Hemiparesis After Stroke: A Scoping Review. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2021; 42:65-78. [PMID: 34311607 DOI: 10.1177/15394492211032606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sensory priming is a technique to facilitate neuroplasticity and improve motor skills after injury. Common sensory priming modalities include peripheral nerve stimulation/somatosensory electrical stimulation (PNS/SES), transient functional deafferentation (TFD), and vibration. The aim of this study was to determine whether sensory priming with a motor intervention results in improved upper limb motor impairment or function after stroke. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and EMBASE were the databases used to search the literature in July 2020. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and recommendations for the Cochrane collaboration. In total, 30 studies were included in the analysis: three studies examined TFD, 16 examined PNS/SES, 10 studied vibration, and one combined the three stimulation techniques. Most studies reported significant improvements for participants receiving sensory priming. Given the low risk, it may be advantageous to use sensory-based priming prior to or concurrent with upper limb training after stroke.
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Affiliation(s)
- Mary E Stoykov
- Shirley Ryan AbilityLab, Chicago, IL, USA.,Northwestern University, Chicago, IL, USA
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12
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Rong J, Ding L, Xiong L, Zhang W, Wang W, Deng M, Wang Y, Chen Z, Jia J. Mirror Visual Feedback Prior to Robot-Assisted Training Facilitates Rehabilitation After Stroke: A Randomized Controlled Study. Front Neurol 2021; 12:683703. [PMID: 34305792 PMCID: PMC8297738 DOI: 10.3389/fneur.2021.683703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Robot-assisted training has been widely used in neurorehabilitation, but its effect on facilitating recovery after stroke remains controversial. One possible reason might be lacking consideration of the role of embodiment in robotic systems. Mirror visual feedback is an ideal method to approach embodiment. Thus, we hypothesized that mirror visual feedback priming with subsequent robot-assisted training might provide additional treatment benefits in rehabilitation. Method: This is a prospective, assessor-blinded, randomized, controlled study. Forty subacute stroke patients were randomly assigned into an experimental group (N = 20) or a control group (N = 20). They received either mirror visual feedback or sham-mirror visual feedback prior to robot-assisted training for 1.5 h/day, 5 days/week for 4 weeks. Before and after intervention, the Fugl-Meyer Assessment Upper Limb subscale, the Functional Independence Measure, the modified Barthel Index, and grip strength were measured. Scores of four specified games were recorded pre and post one-time mirror visual feedback priming before intervention in the experimental group. Results: All measurements improved significantly in both groups following interventions. Moreover, the Fugl-Meyer Assessment Upper Limb subscale, self-care subscale of the Functional Independence Measure, and the grip strength were improved significantly in the experimental group after a 4-week intervention, compared with the control group. Significantly higher scores of two games were revealed after one-time priming. Conclusions: Mirror visual feedback prior to robot-assisted training could prompt motor recovery, increase ability of self-care, and potentially enhance grip strength in stroke patients, compared to control treatment. Moreover, mirror visual feedback priming might have the capability to improve the patient's performance and engagement during robot-assisted training, which could prompt the design and development of robotic systems. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: ChiCTR1900023356.
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Affiliation(s)
- Jifeng Rong
- The Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Li Ding
- The Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Li Xiong
- The Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Wen Zhang
- The Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Weining Wang
- The Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Meikui Deng
- The Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Yana Wang
- The Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Zhen Chen
- The Neurorehabilitation Centre, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Jie Jia
- The Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China.,The National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
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13
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Aries AM, Pomeroy VM, Sim J, Read S, Hunter SM. Sensory Stimulation of the Foot and Ankle Early Post-stroke: A Pilot and Feasibility Study. Front Neurol 2021; 12:675106. [PMID: 34290663 PMCID: PMC8287025 DOI: 10.3389/fneur.2021.675106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/17/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Somatosensory stimulation of the lower extremity could improve motor recovery and walking post-stroke. This pilot study investigated the feasibility of a subsequent randomized controlled trial (RCT) to determine whether task-specific gait training is more effective following either (a) intensive hands-on somatosensory stimulation or (b) wearing textured insoles. Objectives: Determine recruitment and attrition rates, adherence to intervention, acceptability and viability of interventions and outcome measures, and estimate variance of outcome data to inform sample size for a subsequent RCT. Methods: Design: randomized, single-blinded, mixed-methods pilot study. Setting: In-patient rehabilitation ward and community. Participants: n = 34, 18+years, 42-112 days following anterior or posterior circulation stroke, able to follow simple commands, able to walk independently pre-stroke, and providing informed consent. Intervention: Twenty 30-min sessions of task-specific gait training (TSGT) (delivered over 6 weeks) in addition to either: (a) 30-60 min mobilization and tactile stimulation (MTS); or (b) unlimited textured insole (TI) wearing. Outcomes: Ankle range of movement (electrogoniometer), touch-pressure sensory thresholds (Semmes Weinstein Monofilaments), motor impairment (Lower Extremity Motricity Index), walking ability and speed (Functional Ambulation Category, 5-m walk test, pressure insoles) and function (modified Rivermead Mobility Index), measured before randomization, post-intervention, and 1-month thereafter (follow-up). Adherence to allocated intervention and actual dose delivered (fidelity) were documented in case report forms and daily diaries. Focus groups further explored acceptability of interventions and study experience. Analysis: Recruitment, attrition, and dose adherence rates were calculated as percentages of possible totals. Thematic analysis of daily diaries and focus group data was undertaken. Standard deviations of outcome measures were calculated and used to inform a sample size calculation. Results: Recruitment, attrition, and adherence rates were 48.57, 5.88, and 96.88%, respectively. Focus groups, daily-diaries and case report forms indicated acceptability of interventions and outcome measures to participants. The 5-m walk was selected as primary outcome measure for a future trial [mean (SD) at end of intervention: 16.86 (11.24) MTS group and 21.56 (13.57) TI group]; sample size calculation indicated 60 participants are required per group. Conclusion: Recruitment, attrition and adherence rates and acceptability of interventions and outcomes justify a subsequent powered RCT of MTS+TSGT compared with TI+TSGT.
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Affiliation(s)
- Alison M. Aries
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom
| | - Valerie M. Pomeroy
- Acquired Brain Injury Recovery Alliance (ABIRA), School of Health Sciences, University of East Anglia, Norwich, United Kingdom
- National Institute for Health Research (NIHR) Brain Injury MedTech Co-operative, Cambridge, United Kingdom
| | - Julius Sim
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom
| | - Susan Read
- School of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom
| | - Susan M. Hunter
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom
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14
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Miguel-Cruz A, Guptill C, Gregson G, Ladurner AM, Holmes C, Yeung D, Siebert J, Dziwenko G, Ríos Rincón A. Determining the Effectiveness of a New Device for Hand Therapy (The FEPSim Device): Feasibility Protocol for a Randomized Controlled Trial Study. JMIR Res Protoc 2021; 10:e22145. [PMID: 34042597 PMCID: PMC8193477 DOI: 10.2196/22145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/15/2020] [Accepted: 04/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background Impairments of the forearm, wrist, and hand affect a sizable proportion of individuals and impose a significant economic burden on health care systems. FEPSim is a medical device for hand and wrist rehabilitation. The FEPSim device could be part of the standard of care for upper extremity rehabilitation during therapeutic activities to increase range of motion, dexterity, and strength. FEPSim has not yet been tested in a health care setting; therefore, a trial of the effectiveness of FEPSim in upper extremity rehabilitation is warranted. Objective This study aims to assess the feasibility of conducting a definitive trial in terms of recruitment, eligibility criteria, the type and number of diagnoses included, the length and dosage of the intervention, and data collection methods. This study also aims to gather clinical and statistical information as well as information related to the cost and usability, which allows for an economic evaluation of the device. Methods The trial will use a randomized controlled design comprising 47 intervention participants and 47 control group participants. Participants will be adults (age≥18 years) attending outpatient rehabilitation with limitations in their forearm, wrist, or hand function due to distal radial or ulnar fractures, stroke, or osteoarthritis. This study’s primary outcome variables are related to patients’ range of motion and strength, specifically active and passive wrist flexion and extension range of motion; active and passive forearm pronation and supination range of motion; grip strength; and pinch strength. The secondary outcome variables are related to patients’ perceived wrist pain and disability in activities of daily living. The patients’ perceived wrist pain and disability in activities of daily living will be measured using the patient-rated wrist evaluation questionnaire. The control group will receive the standard of care at each of the 2 hospital facilities (Glenrose Rehabilitation and Royal Alexandra Hospitals). The intervention group will receive the same standard of care as the control group at each facility and will use the FEPSim device for therapeutic activities to increase strength, range of motion, resistance, and dexterity. All the participants will be assessed at baseline (week 0); weeks 2, 4, and 8; and postintervention (week 10). Results The FEPSim study was launched in April 2020. This study is currently on hold because of the global COVID-19 pandemic. The recruitment process is expected to resume by September 2020, and the primary impact analysis is expected to be conducted by December 2020. Conclusions This study will provide valuable information on the measurement of comparative intervention effects, technology acceptance by hand therapists, and how associated treatment and product costs will contribute to the evidence planning process, which will be crucial for the future adoption of FEPSim. Trial Registration International Standard Randomized Controlled Trial Number Registry ISRCTN13656014; https://www.isrctn.com/ISRCTN13656014 International Registered Report Identifier (IRRID) PRR1-10.2196/22145
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Affiliation(s)
- Antonio Miguel-Cruz
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.,Glenrose Rehabilitation Research Innovation and Technology, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Christine Guptill
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Geoffrey Gregson
- Glenrose Rehabilitation Research Innovation and Technology, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Anna-Maria Ladurner
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Daniel Yeung
- Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | | | - Gwen Dziwenko
- Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Adriana Ríos Rincón
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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15
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Chandler EA, Stone T, Pomeroy VM, Clark AB, Kerr A, Rowe P, Ugbolue UC, Smith J, Hancock NJ. Investigating the Relationships Between Three Important Functional Tasks Early After Stroke: Movement Characteristics of Sit-To-Stand, Sit-To-Walk, and Walking. Front Neurol 2021; 12:660383. [PMID: 34054703 PMCID: PMC8160116 DOI: 10.3389/fneur.2021.660383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Walking, sit-to-stand (STS) and sit-to-walk (STW) are all considered important functional tasks in achieving independence after stroke. Despite knowledge that sensitive measurement of movement patterns is crucial to understanding neuromuscular restitution, there is surprisingly little information available about the detailed biomechanical characteristics of, and relationships between, walking, sit-to-stand and sit-to-walk, particularly in the important time window early after stroke. Hence, here, the study aimed to:
Identify the biomechanical characteristics of and determine any differences in both movement fluidity (hesitation, coordination and smoothness) and duration of movement phases, between sit-to-stand (STS) and sit-to-walk (STW) in people early after stroke. Determine whether measures of movement fluidity (hesitation, coordination, and smoothness) and movement phases during sit-to-stand (STS) and/or sit-to-walk (STW) are correlated strongly to commonly used measures of walking speed and/or step length ratio in people early after stroke.
Methods: This study consisted of secondary data analysis from the SWIFT Cast Trial. Specifically, we investigated movement fluidity using established assessments of smoothness, hesitation and coordination and the time duration for specific movement phases in a group of 48 people after stroke. Comparisons were made between STS and STW and relationships to walking measures were explored. Results: Participants spent significantly more time in the initial movement phase, flexion momentum, during STS [mean time (SD) 1.74 ±1.45 s] than they did during STW [mean time (SD) 1.13 ± 1.03 s]. STS was also completed more smoothly but with more hesitation and greater coordination than the task of STW. No strong relationships were found between movement fluidity or duration with walking speed or step length symmetry. Conclusions: Assessment of movement after stroke requires a range of functional tasks and no one task should predominate over another. Seemingly similar or overlapping tasks such as STS and STW create distinct biomechanical characteristics which can be identified using sensitive, objective measures of fluidity and movement phases but there are no strong relationships between the functional tasks of STS and STW with walking speed or with step-length symmetry.
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Affiliation(s)
- Elizabeth Ann Chandler
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Thomas Stone
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom.,Department of Clinical Engineering (Addenbrookes), Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Valerie Moyra Pomeroy
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom.,National Institute for Health Research Brain Injury MedTech Cooperative, Cambridge, United Kingdom
| | - Allan Brian Clark
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Andrew Kerr
- Department of Biomedical Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, United Kingdom
| | - Phillip Rowe
- Department of Biomedical Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, United Kingdom
| | - Ukadike Chris Ugbolue
- School of Science and Sport, University of West of Scotland, Hamilton, United Kingdom
| | - Jessica Smith
- Department of Performance Analysis, English Institute of Sport, Sheffield, United Kingdom
| | - Nicola Joanne Hancock
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
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16
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Cortés-Pérez I, Zagalaz-Anula N, Montoro-Cárdenas D, Lomas-Vega R, Obrero-Gaitán E, Osuna-Pérez MC. Leap Motion Controller Video Game-Based Therapy for Upper Extremity Motor Recovery in Patients with Central Nervous System Diseases. A Systematic Review with Meta-Analysis. SENSORS (BASEL, SWITZERLAND) 2021; 21:2065. [PMID: 33804247 PMCID: PMC7999275 DOI: 10.3390/s21062065] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 12/11/2022]
Abstract
Leap Motion Controller (LMC) is a virtual reality device that can be used in the rehabilitation of central nervous system disease (CNSD) motor impairments. This review aimed to evaluate the effect of video game-based therapy with LMC on the recovery of upper extremity (UE) motor function in patients with CNSD. A systematic review with meta-analysis was performed in PubMed Medline, Web of Science, Scopus, CINAHL, and PEDro. We included five randomized controlled trials (RCTs) of patients with CNSD in which LMC was used as experimental therapy compared to conventional therapy (CT) to restore UE motor function. Pooled effects were estimated with Cohen's standardized mean difference (SMD) and its 95% confidence interval (95% CI). At first, in patients with stroke, LMC showed low-quality evidence of a large effect on UE mobility (SMD = 0.96; 95% CI = 0.47, 1.45). In combination with CT, LMC showed very low-quality evidence of a large effect on UE mobility (SMD = 1.34; 95% CI = 0.49, 2.19) and the UE mobility-oriented task (SMD = 1.26; 95% CI = 0.42, 2.10). Second, in patients with non-acute CNSD (cerebral palsy, multiple sclerosis, and Parkinson's disease), LMC showed low-quality evidence of a medium effect on grip strength (GS) (SMD = 0.47; 95% CI = 0.03, 0.90) and on gross motor dexterity (GMD) (SMD = 0.73; 95% CI = 0.28, 1.17) in the most affected UE. In combination with CT, LMC showed very low-quality evidence of a high effect in the most affected UE on GMD (SMD = 0.80; 95% CI = 0.06, 1.15) and fine motor dexterity (FMD) (SMD = 0.82; 95% CI = 0.07, 1.57). In stroke, LMC improved UE mobility and UE mobility-oriented tasks, and in non-acute CNSD, LMC improved the GS and GMD of the most affected UE and FMD when it was used with CT.
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Affiliation(s)
- Irene Cortés-Pérez
- Centro Médico “Avenida II”, C/Julio Burell 18, 23700 Linares, Spain;
- Department of Health Sciences, University of Jaén, Paraje Las Lagunillas s/n, 23071 Jaén, Spain; (N.Z.-A.); (D.M.-C.); (R.L.-V.); (M.C.O.-P.)
| | - Noelia Zagalaz-Anula
- Department of Health Sciences, University of Jaén, Paraje Las Lagunillas s/n, 23071 Jaén, Spain; (N.Z.-A.); (D.M.-C.); (R.L.-V.); (M.C.O.-P.)
| | - Desirée Montoro-Cárdenas
- Department of Health Sciences, University of Jaén, Paraje Las Lagunillas s/n, 23071 Jaén, Spain; (N.Z.-A.); (D.M.-C.); (R.L.-V.); (M.C.O.-P.)
| | - Rafael Lomas-Vega
- Department of Health Sciences, University of Jaén, Paraje Las Lagunillas s/n, 23071 Jaén, Spain; (N.Z.-A.); (D.M.-C.); (R.L.-V.); (M.C.O.-P.)
| | - Esteban Obrero-Gaitán
- Department of Health Sciences, University of Jaén, Paraje Las Lagunillas s/n, 23071 Jaén, Spain; (N.Z.-A.); (D.M.-C.); (R.L.-V.); (M.C.O.-P.)
| | - María Catalina Osuna-Pérez
- Department of Health Sciences, University of Jaén, Paraje Las Lagunillas s/n, 23071 Jaén, Spain; (N.Z.-A.); (D.M.-C.); (R.L.-V.); (M.C.O.-P.)
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17
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Koch M, Pozsgai É, Soós V, Nagy A, Girán J, Nyisztor N, Martyin T, Müller Z, Fehér M, Hajdú E, Varga C. Identifying risks for severity of neurological symptoms in Hungarian West Nile virus patients. BMC Infect Dis 2021; 21:65. [PMID: 33441090 PMCID: PMC7805165 DOI: 10.1186/s12879-020-05760-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/30/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND West Nile virus (WNV) infections have become increasingly prevalent in certain European countries, including Hungary. Although most human infections do not cause severe symptoms, in approximately 1% of cases WNV infections can lead to severe WNV neuroinvasive disease (WNND) and death. The goal of our study was to assess the neurological status changes of WNV -infected patients admitted to inpatient care and to identify potential risk factors as underlying reasons for severe neurological outcome. METHODS We conducted a retrospective chart review of 66 WNV-infected patients from four Hungarian medical centers. Patients' neurological status at hospital admission and at two follow-up intervals (1st follow-up, within 60-90 days and 2nd follow-up, within 150-180 days, after hospital discharge) were assessed. All of the 66 patients in the initial sample had some type of neurological symptoms and 56 patients were diagnosed with WNND. The modified Rankin Scale (mRS) and the West Nile Virus Neurological Index (WNV-N Index), a scoring system designed for the purpose of this study, were used for neurological status assessment. Patients were dichotomized into two categories, "moderately severe" and "severe" based on their neurological status. Descriptive analysis for sample description, stratified analysis for calculation of odds ratio (OR) and logistic regression for continuous input variables, were performed. RESULTS The average number of days between the onset of neurological symptoms and hospital admission (the neurological symptom interval) was 6.01 days. Complications during the hospital stay arose in almost a fifth of the patients (18.2%) and 5 patients died. Each day's increase in the neurological symptom interval significantly increased the risk for developing a severe neurological status following hospital admission (0.799-fold and 0.688-fold, based on the WNV-N Index and mRS, respectively). Patients' age, comorbidity, presence of complications and symptoms of malaise, and gait uncertainty were shown to be independent risk factors for severe neurological status. CONCLUSIONS Timely hospital admission of patients with neurological symptoms as well as risk assessment by clinicians - possibly with an optimal assessment tool for estimating neurological status- could improve the neurological outcome of WNV-infected patients.
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Affiliation(s)
- Márton Koch
- Department of Emergency Medicine, Somogy County Kaposi Mór Teaching Hospital, Tallián Gyula Street, 20-32, Kaposvár, 7400 Hungary
| | - Éva Pozsgai
- Department of Public Health, Medical School, University of Pécs, Szigeti Street, 12, Pécs, 7624 Hungary
- Institute of Primary Health Care, Medical School, University of Pécs, Rákóczi Street 2, Pécs, 7623 Hungary
| | - Viktor Soós
- Department of Emergency Medicine, Somogy County Kaposi Mór Teaching Hospital, Tallián Gyula Street, 20-32, Kaposvár, 7400 Hungary
| | - Anna Nagy
- National Reference Laboratory for Viral Zoonoses; National Public Health Center, 1097 Albert Flórián Road 2-6, Budapest, Hungary
| | - János Girán
- Department of Public Health, Medical School, University of Pécs, Szigeti Street, 12, Pécs, 7624 Hungary
| | - Norbert Nyisztor
- Department of Infectious Diseases (Hepatology and Immunology), Békés County Central Hospital, Semmelweis Street 1, Gyula, 5700 Hungary
| | - Tibor Martyin
- Department of Infectious Diseases (Hepatology and Immunology), Békés County Central Hospital, Semmelweis Street 1, Gyula, 5700 Hungary
| | - Zsófia Müller
- Department of Infectious Diseases, Fejér County St George Teaching Hospital, Seregélyesi Street 3, Székesfehérvár, 8000 Hungary
| | - Melánia Fehér
- Department of Infectious Diseases, Fejér County St George Teaching Hospital, Seregélyesi Street 3, Székesfehérvár, 8000 Hungary
| | - Edit Hajdú
- Department of Infectology, University of Szeged, Albert Szent-Györgyi Health Center, Kálvária Avenue 57, Szeged, 6725 Hungary
| | - Csaba Varga
- Department of Emergency Medicine, Somogy County Kaposi Mór Teaching Hospital, Tallián Gyula Street, 20-32, Kaposvár, 7400 Hungary
- Institute of Emergency Care and Pedagogy of Health, Faculty of Health Sciences, University of Pécs, Vörösmarty Mihály Street 4, Pécs, 7621 Hungary
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Rodgers H, Bosomworth H, Krebs HI, van Wijck F, Howel D, Wilson N, Finch T, Alvarado N, Ternent L, Fernandez-Garcia C, Aird L, Andole S, Cohen DL, Dawson J, Ford GA, Francis R, Hogg S, Hughes N, Price CI, Turner DL, Vale L, Wilkes S, Shaw L. Robot-assisted training compared with an enhanced upper limb therapy programme and with usual care for upper limb functional limitation after stroke: the RATULS three-group RCT. Health Technol Assess 2020; 24:1-232. [PMID: 33140719 PMCID: PMC7682262 DOI: 10.3310/hta24540] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Loss of arm function is common after stroke. Robot-assisted training may improve arm outcomes. OBJECTIVE The objectives were to determine the clinical effectiveness and cost-effectiveness of robot-assisted training, compared with an enhanced upper limb therapy programme and with usual care. DESIGN This was a pragmatic, observer-blind, multicentre randomised controlled trial with embedded health economic and process evaluations. SETTING The trial was set in four NHS trial centres. PARTICIPANTS Patients with moderate or severe upper limb functional limitation, between 1 week and 5 years following first stroke, were recruited. INTERVENTIONS Robot-assisted training using the Massachusetts Institute of Technology-Manus robotic gym system (InMotion commercial version, Interactive Motion Technologies, Inc., Watertown, MA, USA), an enhanced upper limb therapy programme comprising repetitive functional task practice, and usual care. MAIN OUTCOME MEASURES The primary outcome was upper limb functional recovery 'success' (assessed using the Action Research Arm Test) at 3 months. Secondary outcomes at 3 and 6 months were the Action Research Arm Test results, upper limb impairment (measured using the Fugl-Meyer Assessment), activities of daily living (measured using the Barthel Activities of Daily Living Index), quality of life (measured using the Stroke Impact Scale), resource use costs and quality-adjusted life-years. RESULTS A total of 770 participants were randomised (robot-assisted training, n = 257; enhanced upper limb therapy, n = 259; usual care, n = 254). Upper limb functional recovery 'success' was achieved in the robot-assisted training [103/232 (44%)], enhanced upper limb therapy [118/234 (50%)] and usual care groups [85/203 (42%)]. These differences were not statistically significant; the adjusted odds ratios were as follows: robot-assisted training versus usual care, 1.2 (98.33% confidence interval 0.7 to 2.0); enhanced upper limb therapy versus usual care, 1.5 (98.33% confidence interval 0.9 to 2.5); and robot-assisted training versus enhanced upper limb therapy, 0.8 (98.33% confidence interval 0.5 to 1.3). The robot-assisted training group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale) than the usual care group at 3 and 6 months. The enhanced upper limb therapy group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale), better mobility (as measured by the Stroke Impact Scale mobility domain) and better performance in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the usual care group, at 3 months. The robot-assisted training group performed less well in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the enhanced upper limb therapy group at 3 months. No other differences were clinically important and statistically significant. Participants found the robot-assisted training and the enhanced upper limb therapy group programmes acceptable. Neither intervention, as provided in this trial, was cost-effective at current National Institute for Health and Care Excellence willingness-to-pay thresholds for a quality-adjusted life-year. CONCLUSIONS Robot-assisted training did not improve upper limb function compared with usual care. Although robot-assisted training improved upper limb impairment, this did not translate into improvements in other outcomes. Enhanced upper limb therapy resulted in potentially important improvements on upper limb impairment, in performance of activities of daily living, and in mobility. Neither intervention was cost-effective. FUTURE WORK Further research is needed to find ways to translate the improvements in upper limb impairment seen with robot-assisted training into improvements in upper limb function and activities of daily living. Innovations to make rehabilitation programmes more cost-effective are required. LIMITATIONS Pragmatic inclusion criteria led to the recruitment of some participants with little prospect of recovery. The attrition rate was higher in the usual care group than in the robot-assisted training or enhanced upper limb therapy groups, and differential attrition is a potential source of bias. Obtaining accurate information about the usual care that participants were receiving was a challenge. TRIAL REGISTRATION Current Controlled Trials ISRCTN69371850. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 54. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Helen Rodgers
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Helen Bosomworth
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hermano I Krebs
- Mechanical Engineering Department, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Frederike van Wijck
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Denise Howel
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nina Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tracy Finch
- Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | | | - Laura Ternent
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Lydia Aird
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | - Sreeman Andole
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - David L Cohen
- London North West University Healthcare NHS Trust, London, UK
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Gary A Ford
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Medical Sciences Division, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard Francis
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Steven Hogg
- Lay investigator (contact Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK)
| | | | - Christopher I Price
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | - Duncan L Turner
- School of Health, Sport and Bioscience, University of East London, London, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Scott Wilkes
- School of Medicine, University of Sunderland, Sunderland, UK
| | - Lisa Shaw
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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19
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Fiani B, Siddiqi I, Lee SC, Dhillon L. Telerehabilitation: Development, Application, and Need for Increased Usage in the COVID-19 Era for Patients with Spinal Pathology. Cureus 2020; 12:e10563. [PMID: 33101809 PMCID: PMC7577310 DOI: 10.7759/cureus.10563] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has triggered governments worldwide to implement severe restrictions on physical therapy protocols in order to better control the spread of the virus. One of the mechanisms of providing physical therapy patient care during this era is via telemedicine. Telerehabilitation or telerehab is a technological visual-audio system that serves patients, including those with a spine injury, ailment, or postoperatively, with neurological deficits. In this scoping review, we discuss the development of telerehab, the technological advances in the field, and the usage of telerehab specifically pertaining to spine patients, and comment on the advancement of telerehab in the time of COVID-19. There is preliminary evidence that suggests that the adoption of telerehab in lieu of face-to-face interventions is beneficial for reducing pain and improving physical function in patients afflicted with chronic nonmalignant musculoskeletal pain from low back pain, lumbar stenosis, neck pain, and osteoarthritis. Availability is important, as the necessary technology should be accessible to all participants. Safety and security should be addressed, as the passage of patient data over the Internet requires secure confidentiality. Ease-of-use is crucial to promote practicality, user-friendly operation, and adherence to therapy. The combination of evidence-based methodologies with cost-effective services will serve as a basis for the further expansion of vital telerehab services and increases reimbursement by health insurance providers.
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Affiliation(s)
- Brian Fiani
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Imran Siddiqi
- College of Osteopathic Medicine, Western University of Health Sciences, Pomona, USA
| | - Sharon C Lee
- College of Osteopathic Medicine, Western University of Health Sciences, Pomona, USA
| | - Lovepreet Dhillon
- College of Osteopathic Medicine, Western University of Health Sciences, Pomona, USA
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20
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Segal AD, Lesak MC, Silverman AK, Petruska AJ. A Gesture-Controlled Rehabilitation Robot to Improve Engagement and Quantify Movement Performance. SENSORS (BASEL, SWITZERLAND) 2020; 20:E4269. [PMID: 32751876 PMCID: PMC7435750 DOI: 10.3390/s20154269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 11/17/2022]
Abstract
Rehabilitation requires repetitive and coordinated movements for effective treatment, which are contingent on patient compliance and motivation. However, the monotony, intensity, and expense of most therapy routines do not promote engagement. Gesture-controlled rehabilitation has the potential to quantify performance and provide engaging, cost-effective treatment, leading to better compliance and mobility. We present the design and testing of a gesture-controlled rehabilitation robot (GC-Rebot) to assess its potential for monitoring user performance and providing entertainment while conducting physical therapy. Healthy participants (n = 11) completed a maze with GC-Rebot for six trials. User performance was evaluated through quantitative metrics of movement quality and quantity, and participants rated the system usability with a validated survey. For participants with self-reported video-game experience (n = 10), wrist active range of motion across trials (mean ± standard deviation) was 41.6 ± 13° and 76.8 ± 16° for pitch and roll, respectively. In the course of conducting a single trial with a time duration of 68.3 ± 19 s, these participants performed 27 ± 8 full wrist motion repetitions (i.e., flexion/extension), with a dose-rate of 24.2 ± 5 reps/min. These participants also rated system usability as excellent (score: 86.3 ± 12). Gesture-controlled therapy using the GC-Rebot demonstrated the potential to be an evidence-based rehabilitation tool based on excellent user ratings and the ability to monitor at-home compliance and performance.
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Affiliation(s)
- Ava D Segal
- M3Robotics and Functional Biomechanics Laboratories, Department of Mechanical Engineering Colorado School of Mines, Golden, CO 80401, USA
| | | | - Anne K Silverman
- M3Robotics and Functional Biomechanics Laboratories, Department of Mechanical Engineering Colorado School of Mines, Golden, CO 80401, USA
| | - Andrew J Petruska
- M3Robotics and Functional Biomechanics Laboratories, Department of Mechanical Engineering Colorado School of Mines, Golden, CO 80401, USA
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21
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Caria A, da Rocha JLD, Gallitto G, Birbaumer N, Sitaram R, Murguialday AR. Brain-Machine Interface Induced Morpho-Functional Remodeling of the Neural Motor System in Severe Chronic Stroke. Neurotherapeutics 2020; 17:635-650. [PMID: 31802435 PMCID: PMC7283440 DOI: 10.1007/s13311-019-00816-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Brain-machine interfaces (BMI) permit bypass motor system disruption by coupling contingent neuroelectric signals related to motor activity with prosthetic devices that enhance afferent and proprioceptive feedback to the somatosensory cortex. In this study, we investigated neural plasticity in the motor network of severely impaired chronic stroke patients after an EEG-BMI-based treatment reinforcing sensorimotor contingency of ipsilesional motor commands. Our structural connectivity analysis revealed decreased fractional anisotropy in the splenium and body of the corpus callosum, and in the contralesional hemisphere in the posterior limb of the internal capsule, the posterior thalamic radiation, and the superior corona radiata. Functional connectivity analysis showed decreased negative interhemispheric coupling between contralesional and ipsilesional sensorimotor regions, and decreased positive intrahemispheric coupling among contralesional sensorimotor regions. These findings indicate that BMI reinforcing ipsilesional brain activity and enhancing proprioceptive function of the affected hand elicits reorganization of contralesional and ipsilesional somatosensory and motor-assemblies as well as afferent and efferent connection-related motor circuits that support the partial re-establishment of the original neurophysiology of the motor system even in severe chronic stroke.
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Affiliation(s)
- Andrea Caria
- Department of Psychology and Cognitive Sciences, University of Trento, Corso Bettini 33, 38068, Rovereto, Italy.
- Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Ospedale San Camillo, Venice, Italy.
- Institut für Medizinische Psychologie und Verhaltensneurobiologie, Universität Tübingen, Tübingen, Germany.
| | - Josué Luiz Dalboni da Rocha
- Brain and Language Laboratory, Department of Clinical Neuroscience, University of Geneva, Geneva, Switzerland
| | - Giuseppe Gallitto
- Department of Psychology and Cognitive Sciences, University of Trento, Corso Bettini 33, 38068, Rovereto, Italy
| | - Niels Birbaumer
- Institut für Medizinische Psychologie und Verhaltensneurobiologie, Universität Tübingen, Tübingen, Germany
| | - Ranganatha Sitaram
- Institute of Biological and Medical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Psychiatry, Section of Neuroscience, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Laboratory for Brain-Machine Interfaces and Neuromodulation, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ander Ramos Murguialday
- Institut für Medizinische Psychologie und Verhaltensneurobiologie, Universität Tübingen, Tübingen, Germany
- Health Technologies Department, TECNALIA, San Sebastian, Spain
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22
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Jung YG, Oh DW, Park HJ, Han SH. Comparison of the effects of action observation training of community ambulation with different observational views on walking function in patients with chronic stroke: single-subject experimental study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2019.1645881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Yun-Gu Jung
- Department of Rehabilitation Medicine, CNC Yul-Ryang Hospital, Cheongju-si, Republic of Korea
| | - Duck-Won Oh
- Department of Physical Therapy, College of Health Science, Cheongju University, Republic of Korea
| | - Hyun-Ju Park
- Department of Physical Therapy, College of Health Science, Cheongju University, Republic of Korea
| | - Soo-Hwan Han
- Department of Rehabilitation Medicine, CNC Yul-Ryang Hospital, Cheongju-si, Republic of Korea
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23
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Hancock NJ, Shepstone L, Rowe P, Pomeroy VM. Identification of neuromuscular targets for restoration of walking ability after stroke: Precursor to precision rehabilitation. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 25:e1816. [PMID: 31758747 DOI: 10.1002/pri.1816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/19/2019] [Accepted: 10/03/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Restoration of walking is a priority for stroke survivors and key target for physical therapies. Upright pedalling (UP) can provide functional walking-like activity using a variety of muscle synergies; it is unclear which synergies might be most useful for recovery of walking. Objectives here were as follows: to examine whether neuromuscular measures derived during UP might identify targets for walking rehabilitation after stroke and to determine test-retest repeatability and concurrent validity of the measures. DESIGN This was a prospective correlational study. SETTING The study was carried out in a movement science laboratory. PARTICIPANTS The participants were 18 adults with stroke (StrS) and 10 healthy older adults (HOA). INTERVENTION/MEASUREMENT StrS and HOA took part in two identical measurement sessions. During UP, surface electromyography and kinematic data were recorded and then processed to derive three measures: reciprocal activity of quadriceps and hamstrings; percentage muscle activity "on" according to crank angle; and smoothness of movement. RESULTS HOA and StrS demonstrated differences in reciprocal muscle activity (p = .044) and quadriceps activity according to crank angle (p = .034) but pedalled similarly smoothly (p = .367). For muscle activation according to crank angle in StrS, intraclass correlation coefficients (95% confidence interval) showing acceptable repeatability were 0.46 [0.32, 0.58] affected quadriceps; 0.43 [0.28, 0.56] affected hamstrings; and 0.67 [0.56, 0.75] unaffected quadriceps. CONCLUSION Muscle activation according to crank angle is a promising measure of lower limb impairment during functional activity after stroke; subsequent investigation should determine magnitude of variance between testing sessions. Reciprocal activity of quadriceps and hamstrings muscles and quadriceps activity according to crank angle are both potential targets for physical therapies to improve motor recovery. Further investigations are warranted.
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Affiliation(s)
- Nicola J Hancock
- Acquired Brain Injury Rehabilitation Alliance, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Lee Shepstone
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Philip Rowe
- Biomedical Engineering Department, University of Strathclyde, Glasgow, UK
| | - Valerie M Pomeroy
- Acquired Brain Injury Rehabilitation Alliance, School of Health Sciences, University of East Anglia, Norwich, UK
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24
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Modulation of Motor Cortical Activities by Action Observation and Execution in Patients with Stroke: An MEG Study. Neural Plast 2019; 2019:8481371. [PMID: 31781183 PMCID: PMC6875039 DOI: 10.1155/2019/8481371] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/22/2019] [Accepted: 09/06/2019] [Indexed: 12/18/2022] Open
Abstract
Action observation therapy has recently attracted increasing attention; however, the mechanisms through which action observation and execution (AOE) modulate neural activity in stroke patients remain unclear. This study was aimed at investigating the effects of action observation and two types of AOE on motor cortical activations after stroke using magnetoencephalography. Twenty patients with stroke and 20 healthy controls were recruited for the collection of data on the beta oscillatory activity in the primary motor cortex (M1). All participants performed the conditions of resting, observation only, and video observation combined with execution (video AOE). Stroke patients performed one additional condition of affected hand observation combined with execution (affected hand AOE). The relative change index of beta oscillations was calculated, and nonparametric tests were used to examine the differences in conditions. In stroke patients, the relative change index of M1 beta oscillatory activity under the video AOE condition was significantly lower than that under the observation only and affected hand AOE conditions. Moreover, M1 cortical activity did not significantly differ under the observation only and affected hand AOE conditions. For healthy controls, the relative change index under the video AOE condition was significantly lower than that under the observation only condition. In addition, no significant differences in relative change indices were found under the observation only and video AOE conditions between the 2 groups. This study provides new insight into the neural mechanisms underlying AOE, which supports the use of observing videos of normal movements during action observation therapy in stroke rehabilitation.
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25
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Carson RG, Buick AR. Neuromuscular electrical stimulation-promoted plasticity of the human brain. J Physiol 2019; 599:2375-2399. [PMID: 31495924 DOI: 10.1113/jp278298] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 08/16/2019] [Indexed: 12/21/2022] Open
Abstract
The application of neuromuscular electrical stimulation (NMES) to paretic limbs has demonstrated utility for motor rehabilitation following brain injury. When NMES is delivered to a mixed peripheral nerve, typically both efferent and afferent fibres are recruited. Muscle contractions brought about by the excitation of motor neurons are often used to compensate for disability by assisting actions such as the formation of hand aperture, or by preventing others including foot drop. In this context, exogenous stimulation provides a direct substitute for endogenous neural drive. The goal of the present narrative review is to describe the means through which NMES may also promote sustained adaptations within central motor pathways, leading ultimately to increases in (intrinsic) functional capacity. There is an obvious practical motivation, in that detailed knowledge concerning the mechanisms of adaptation has the potential to inform neurorehabilitation practice. In addition, responses to NMES provide a means of studying CNS plasticity at a systems level in humans. We summarize the fundamental aspects of NMES, focusing on the forms that are employed most commonly in clinical and experimental practice. Specific attention is devoted to adjuvant techniques that further promote adaptive responses to NMES thereby offering the prospect of increased therapeutic potential. The emergent theme is that an association with centrally initiated neural activity, whether this is generated in the context of NMES triggered by efferent drive or via indirect methods such as mental imagery, may in some circumstances promote the physiological changes that can be induced through peripheral electrical stimulation.
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Affiliation(s)
- Richard G Carson
- Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin, Dublin 2, Ireland.,School of Psychology, Queen's University Belfast, Belfast, BT7 1NN, UK.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD 4072, Australia
| | - Alison R Buick
- School of Psychology, Queen's University Belfast, Belfast, BT7 1NN, UK
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26
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Jin M, Zhang Z, Bai Z, Fong KNK. Timing-dependent interaction effects of tDCS with mirror therapy on upper extremity motor recovery in patients with chronic stroke: A randomized controlled pilot study. J Neurol Sci 2019; 405:116436. [PMID: 31493725 DOI: 10.1016/j.jns.2019.116436] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 08/02/2019] [Accepted: 08/26/2019] [Indexed: 10/26/2022]
Abstract
This study was a randomized, controlled pilot trial to investigate the timing-dependent interaction effects of dual transcranial direct current stimulation (tDCS) in mirror therapy (MT) for hemiplegic upper extremity in patients with chronic stroke. Thirty patients with chronic stroke were randomly assigned to three groups: tDCS applied before MT (prior-tDCS group), tDCS applied during MT (concurrent-tDCS group), and sham tDCS applied randomly prior to or concurrent with MT (sham-tDCS group). Dual tDCS at 1 mA was applied bilaterally over the ipsilesional M1 (anodal electrode) and the contralesional M1 (cathodal electrode) for 30 min. The intervention was delivered five days per week for two weeks. Upper extremity motor performance was measured using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), the Action Research Arm Test (ARAT), and the Box and Block Test (BBT). Assessments were administered at baseline, post-intervention, and two weeks follow-up. The results indicated that concurrent-tDCS group showed significant improvements in the ARAT in relation to the prior-tDCS group and sham-tDCS group at post-intervention. Besides, a trend toward greater improvement was also found in the FMA-UE for the concurrent-tDCS group. However, no statistically significant difference in the FMA-UE and BBT was identified among the three groups at either post-intervention or follow-up. The concurrent-tDCS seems to be more advantageous and time-efficient in the context of clinical trials combining with MT. The timing-dependent interaction factor of tDCS to facilitate motor recovery should be considered in future clinical application.
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Affiliation(s)
- Minxia Jin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR; Shanghai Sunshine Rehabilitation Centre, Shanghai, China
| | - Ziwei Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR; Shanghai Sunshine Rehabilitation Centre, Shanghai, China
| | - Zhongfei Bai
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR; Shanghai Sunshine Rehabilitation Centre, Shanghai, China
| | - Kenneth N K Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR.
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27
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Oh SJ, Lee JH, Kim DH. The effects of functional action-observation training on gait function in patients with post-stroke hemiparesis: A randomized controlled trial. Technol Health Care 2019; 27:159-165. [PMID: 30664512 DOI: 10.3233/thc-181388] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Functional action observation (FAO) is likely to activate the corticospinal tract and is likely to increase the potential ability of a functional task. OBJECTIVE The purpose of this study was to investigate the effects of FAO training on gait ability in patients with post-stroke hemiparesis. METHODS Thirty-five patients with hemiparesis caused by stroke participated in this study. All subjects had suffered from stroke for more than 6 months. Subjects received either a FAO or a general action observation (GAO) training for 30 minutes each time, five times per week, for four weeks. The GAITRite was used to measure walking velocities and spatio-temporal variables. The functional gait assessment (FGA) was used to assess gait ability. The independent t-test was used to analyze whether there were significant differences of all dependent variables between groups. RESULTS After four weeks of training, the step length, stride length, cadence, velocity, and FGA score in FAO group were statistically different from GAO group (p< 0.05). CONCLUSION The results of this study suggest that FAO is an effective and easy method for improvement of gait ability in chronic stroke patients.
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Affiliation(s)
- Seung-Jun Oh
- Department of Physical Therapy, Rusk Rehabilitation Center, Seoul, Korea
| | - Je-Hyeok Lee
- Department of Physical Therapy, Rusk Rehabilitation Center, Seoul, Korea
| | - Do-Hyun Kim
- Department of Physical Therapy, Dongguk University Medical Center, Gyeongju, Korea
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28
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Ding L, Wang X, Chen S, Wang H, Tian J, Rong J, Shao P, Tong S, Guo X, Jia J. Camera-Based Mirror Visual Input for Priming Promotes Motor Recovery, Daily Function, and Brain Network Segregation in Subacute Stroke Patients. Neurorehabil Neural Repair 2019; 33:307-318. [PMID: 30909797 DOI: 10.1177/1545968319836207] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Camera technique-based mirror visual feedback (MVF) is an optimal interface for mirror therapy. However, its efficiency for stroke rehabilitation and the underlying neural mechanisms remain unclear. OBJECTIVE To investigate the possible treatment benefits of camera-based MVF (camMVF) for priming prior to hand function exercise in subacute stroke patients, and to reveal topological reorganization of brain network in response to the intervention. METHODS Twenty subacute stroke patients were assigned randomly to the camMVF group (MG, N = 10) or a conventional group (CG, N = 10). Before, and after 2 and 4 weeks of intervention, the Fugl-Meyer Assessment Upper Limb subscale (FMA_UL), the Functional Independence Measure (FIM), the modified Ashworth Scale (MAS), manual muscle testing (MMT), and the Berg Balance Scale (BBS) were measured. Resting-state electroencephalography (EEG) signals were recorded before and after 4-week intervention. RESULTS The MG showed more improvements in the FMA_UL, the FMA_WH (wrist and hand), and the FIM than the CG. The clustering coefficient (CC) of the resting EEG network in the alpha band was increased globally in the MG after intervention but not in the CG. Nodal CC analyses revealed that the CC in the MG tended to increase in the ipsilesional occipital and temporal areas, and the bilateral central and parietal areas, suggesting improved local efficiency of communication in the visual, somatosensory, and motor areas. The changes of nodal CC at TP8 and PO8 were significantly positively correlated with the motor recovery. CONCLUSIONS The camMVF-based priming could improve the motor recovery, daily function, and brain network segregation in subacute stroke patients.
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Affiliation(s)
- Li Ding
- 1 Huashan Hospital, Fudan University, Shanghai, China
| | - Xu Wang
- 2 Shanghai Jiaotong University, Shanghai, China
| | - Shugeng Chen
- 1 Huashan Hospital, Fudan University, Shanghai, China
| | - Hewei Wang
- 1 Huashan Hospital, Fudan University, Shanghai, China
| | - Jing Tian
- 1 Huashan Hospital, Fudan University, Shanghai, China
| | - Jifeng Rong
- 3 The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Peng Shao
- 1 Huashan Hospital, Fudan University, Shanghai, China
| | | | - Xiaoli Guo
- 2 Shanghai Jiaotong University, Shanghai, China
| | - Jie Jia
- 1 Huashan Hospital, Fudan University, Shanghai, China
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Law LLF, Fong KNK, Li RKF. Multisensory stimulation to promote upper extremity motor recovery in stroke: A pilot study. Br J Occup Ther 2018. [DOI: 10.1177/0308022618770141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Occupational therapists have been using various preparatory methods as part of the treatment sessions to prepare clients for occupational performance and participation in occupation. Studies have shown sensory stimulation both activates brain areas inducing cortical reorganization and modulates motor cortical excitability for the stimulated afferents, hence re-establishing the disrupted sensorimotor loop due to stroke. This pilot investigates the potential effects of using multisensory stimulation as a preparatory method prior to conventional training (CT) on upper-extremity motor recovery and self-care function in stroke patients. Method This was a quasi-randomized controlled pilot. Twelve participants (age in years = 67.17 + /−11.29) with upper extremity motor deficits were randomly allocated to multisensory therapy (n = 6) or conventional (n = 6) groups for 12-week training. Assessments were conducted at baseline and post-intervention using Fugl-Meyer Assessment of Motor Recovery after Stroke (FMA), Manual Muscle Testing (MMT), Functional Test for the Hemiplegic Upper Extremity (Hong Kong version FTHUE-HK) and Modified Barthel Index (MBI). Results Significant between-group differences were shown in FMA ( p = 0.003), FTHUE-HK ( p = 0.028) and MMT ( p = 0.034). Conclusion Multisensory stimulation could be used as a preparatory method prior to CT in improving upper extremity motor recovery in stroke rehabilitation. Further well-designed larger scale studies are needed to validate the potential benefits of this application.
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Affiliation(s)
- Lawla LF Law
- Assistant Professor, School of Medical and Health Sciences, Tung Wah College, Hong Kong SAR; Adjunct Senior Lecturer, Occupational Therapy Department, James Cook University, Australia
| | - Kenneth NK Fong
- Associate Professor, Department of Rehabilitation Science, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Ray KF Li
- Adjunct Lecturer, School of Medical and Health Sciences, Tung Wah College, Hong Kong SAR
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Norman SL, McFarland DJ, Miner A, Cramer SC, Wolbrecht ET, Wolpaw JR, Reinkensmeyer DJ. Controlling pre-movement sensorimotor rhythm can improve finger extension after stroke. J Neural Eng 2018; 15:056026. [PMID: 30063219 PMCID: PMC6158016 DOI: 10.1088/1741-2552/aad724] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Brain-computer interface (BCI) technology is attracting increasing interest as a tool for enhancing recovery of motor function after stroke, yet the optimal way to apply this technology is unknown. Here, we studied the immediate and therapeutic effects of BCI-based training to control pre-movement sensorimotor rhythm (SMR) amplitude on robot-assisted finger extension in people with stroke. APPROACH Eight people with moderate to severe hand impairment due to chronic stroke completed a four-week three-phase protocol during which they practiced finger extension with assistance from the FINGER robotic exoskeleton. In Phase 1, we identified spatiospectral SMR features for each person that correlated with the intent to extend the index and/or middle finger(s). In Phase 2, the participants learned to increase or decrease SMR features given visual feedback, without movement. In Phase 3, the participants were cued to increase or decrease their SMR features, and when successful, were then cued to immediately attempt to extend the finger(s) with robot assistance. MAIN RESULTS Of the four participants that achieved SMR control in Phase 2, three initiated finger extensions with a reduced reaction time after decreasing (versus increasing) pre-movement SMR amplitude during Phase 3. Two also extended at least one of their fingers more forcefully after decreasing pre-movement SMR amplitude. Hand function, measured by the box and block test (BBT), improved by 7.3 ± 7.5 blocks versus 3.5 ± 3.1 blocks in those with and without SMR control, respectively. Higher BBT scores at baseline correlated with a larger change in BBT score. SIGNIFICANCE These results suggest that learning to control person-specific pre-movement SMR features associated with finger extension can improve finger extension ability after stroke for some individuals. These results merit further investigation in a rehabilitation context.
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Affiliation(s)
- S L Norman
- University of California Irvine, Irvine, CA, United States of America
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Lewis JW, Silberman MJ, Donai JJ, Frum CA, Brefczynski-Lewis JA. Hearing and orally mimicking different acoustic-semantic categories of natural sound engage distinct left hemisphere cortical regions. BRAIN AND LANGUAGE 2018; 183:64-78. [PMID: 29966815 PMCID: PMC6461214 DOI: 10.1016/j.bandl.2018.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 03/22/2018] [Accepted: 05/06/2018] [Indexed: 05/10/2023]
Abstract
Oral mimicry is thought to represent an essential process for the neurodevelopment of spoken language systems in infants, the evolution of language in hominins, and a process that could possibly aid recovery in stroke patients. Using functional magnetic resonance imaging (fMRI), we previously reported a divergence of auditory cortical pathways mediating perception of specific categories of natural sounds. However, it remained unclear if or how this fundamental sensory organization by the brain might relate to motor output, such as sound mimicry. Here, using fMRI, we revealed a dissociation of activated brain regions preferential for hearing with the intent to imitate and the oral mimicry of animal action sounds versus animal vocalizations as distinct acoustic-semantic categories. This functional dissociation may reflect components of a rudimentary cortical architecture that links systems for processing acoustic-semantic universals of natural sound with motor-related systems mediating oral mimicry at a category level. The observation of different brain regions involved in different aspects of oral mimicry may inform targeted therapies for rehabilitation of functional abilities after stroke.
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Affiliation(s)
- James W Lewis
- Rockefeller Neurosciences Institute, Department of Physiology, Pharmacology & Neuroscience, West Virginia University, Morgantown, WV 26506, USA.
| | - Magenta J Silberman
- Rockefeller Neurosciences Institute, Department of Physiology, Pharmacology & Neuroscience, West Virginia University, Morgantown, WV 26506, USA
| | - Jeremy J Donai
- Rockefeller Neurosciences Institute, Department of Communication Sciences and Disorders, West Virginia University, Morgantown, WV 26506, USA
| | - Chris A Frum
- Rockefeller Neurosciences Institute, Department of Physiology, Pharmacology & Neuroscience, West Virginia University, Morgantown, WV 26506, USA
| | - Julie A Brefczynski-Lewis
- Rockefeller Neurosciences Institute, Department of Physiology, Pharmacology & Neuroscience, West Virginia University, Morgantown, WV 26506, USA
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Norris M, Poltawski L, Calitri R, Shepherd AI, Dean SG. Acceptability and experience of a functional training programme (ReTrain) in community-dwelling stroke survivors in South West England: a qualitative study. BMJ Open 2018; 8:e022175. [PMID: 30049699 PMCID: PMC6067351 DOI: 10.1136/bmjopen-2018-022175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/18/2018] [Accepted: 06/11/2018] [Indexed: 11/10/2022] Open
Abstract
Rehabilitation Training (ReTrain) is a group-based approach to functional training post stroke. ReTrain has recently been evaluated through a pilot randomised controlled trial. OBJECTIVE This article reports on the acceptability of the intervention as described by trial participants. DESIGN A qualitative approach was undertaken. Of the 45 participants recruited into the trial, 23 were randomised to receive ReTrain. Following a sampling strategy, 10 participants undertook 1:1 semistructured audio-recorded interviews. Transcripts were analysed following a modified Framework Approach. RESULTS Six themes were developed including exploration of: the physical and psychological impacts of training,the perceived mechanisms of change, the interaction of the group and approach of the trainer. A further theme considered the reported longer term impact of participation. Overall, the results indicated the acceptability of the intervention, but also key areas for potential modification in the definitive trial. These include a need to consider potential impact on both physical and psychological function, careful consideration of dosing and fatigue and the interpersonal factors that facilitate appropriate level of delivery, the trainer to participant ratio, and enhancing features that support continuation of activity postintervention. CONCLUSION Overall, this study supports the acceptability of ReTrain and the development of a definitive trial evaluation of this intervention to full. TRIAL REGISTRATION NUMBER NCT02429180.
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Affiliation(s)
| | | | | | - Anthony I Shepherd
- Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, UK
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A Review of Robotics in Neurorehabilitation: Towards an Automated Process for Upper Limb. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:9758939. [PMID: 29707189 PMCID: PMC5901488 DOI: 10.1155/2018/9758939] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/26/2018] [Accepted: 02/08/2018] [Indexed: 11/17/2022]
Abstract
Robot-mediated neurorehabilitation is a growing field that seeks to incorporate advances in robotics combined with neuroscience and rehabilitation to define new methods for treating problems related with neurological diseases. In this paper, a systematic literature review is conducted to identify the contribution of robotics for upper limb neurorehabilitation, highlighting its relation with the rehabilitation cycle, and to clarify the prospective research directions in the development of more autonomous rehabilitation processes. With this aim, first, a study and definition of a general rehabilitation process are made, and then, it is particularized for the case of neurorehabilitation, identifying the components involved in the cycle and their degree of interaction between them. Next, this generic process is compared with the current literature in robotics focused on upper limb treatment, analyzing which components of this rehabilitation cycle are being investigated. Finally, the challenges and opportunities to obtain more autonomous rehabilitation processes are discussed. In addition, based on this study, a series of technical requirements that should be taken into account when designing and implementing autonomous robotic systems for rehabilitation is presented and discussed.
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Bolognini N, Russo C, Edwards DJ. The sensory side of post-stroke motor rehabilitation. Restor Neurol Neurosci 2018; 34:571-86. [PMID: 27080070 DOI: 10.3233/rnn-150606] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Contemporary strategies to promote motor recovery following stroke focus on repetitive voluntary movements. Although successful movement relies on efficient sensorimotor integration, functional outcomes often bias motor therapy toward motor-related impairments such as weakness, spasticity and synergies; sensory therapy and reintegration is implied, but seldom targeted. However, the planning and execution of voluntary movement requires that the brain extracts sensory information regarding body position and predicts future positions, by integrating a variety of sensory inputs with ongoing and planned motor activity. Neurological patients who have lost one or more of their senses may show profoundly affected motor functions, even if muscle strength remains unaffected. Following stroke, motor recovery can be dictated by the degree of sensory disruption. Consequently, a thorough account of sensory function might be both prognostic and prescriptive in neurorehabilitation. This review outlines the key sensory components of human voluntary movement, describes how sensory disruption can influence prognosis and expected outcomes in stroke patients, reports on current sensory-based approaches in post-stroke motor rehabilitation, and makes recommendations for optimizing rehabilitation programs based on sensory stimulation.
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Affiliation(s)
- Nadia Bolognini
- Department of Psychology and Milan Center for Neuroscience, University of Milano-Bicocca, Milano, Italy.,Laboratory of Neuropsychology, IRCCS Istituto Auxologico, Milano, Italy
| | - Cristina Russo
- Department of Psychology and Milan Center for Neuroscience, University of Milano-Bicocca, Milano, Italy
| | - Dylan J Edwards
- Burke-Cornell Medical Research Institute, White Plains, New York, NY, USA
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Kim J, Yim J. Effects of an Exercise Protocol for Improving Handgrip Strength and Walking Speed on Cognitive Function in Patients with Chronic Stroke. Med Sci Monit 2017; 23:5402-5409. [PMID: 29131814 PMCID: PMC5699168 DOI: 10.12659/msm.904723] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Handgrip strength and walking speed predict and influence cognitive function. We aimed to investigate an exercise protocol for improving handgrip strength and walking speed, applied to patients with chronic stroke who had cognitive function disorder. Material/Methods Twenty-nine patients with cognitive function disorder participated in this study, and were randomly divided into one of two groups: exercise group (n=14) and control group (n=15). Both groups underwent conventional physical therapy for 60 minutes per day. Additionally, the exercise group followed an exercise protocol for handgrip using the hand exerciser, power web exerciser, Digi-Flex (15 minutes); and treadmill-based weight loading training on their less-affected leg (15 minutes) using a sandbag for 30 minutes, three times per day, for six weeks. Outcomes, including cognitive function and gait ability, were measured before and after the training. Results The Korean version of Montreal Cognitive Assessment (K-MoCA), Stroop test (both simple and interference), Trail Making-B, Timed Up and Go, and 10-Meter Walk tests (p<0.05) yielded improved results for the exercise group compared with the control group. Importantly, the K-MoCA, Timed Up and Go, and 10-Meter Walk test results were significantly different between the two groups (p<0.05). Conclusions The exercise protocol for improving handgrip strength and walking speed had positive effects on cognitive function in patients with chronic stroke.
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Affiliation(s)
- Jaeeun Kim
- Department of Physical Therapy, The Graduate School of Sahmyook University, Seoul, South Korea
| | - Jongeun Yim
- Department of Physical Therapy, Graduate School of Sahmyook University, Seoul, South Korea
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Bisson T, Newsam CJ. Short-duration, high-intensity bouts of physical therapy to increase self-efficacy, confidence, and function in an individual with incomplete spinal cord injury: A case report. Physiother Theory Pract 2017; 33:888-895. [PMID: 28792298 DOI: 10.1080/09593985.2017.1357155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
High intensity and frequency of task-specific practice is required to produce functional change in individuals with neurologic conditions. Self-efficacy is an important predictor of engagement in physical activity in individuals with spinal cord injury. Combining these two rehabilitation concepts has the potential for lasting functional improvement. The purpose of this case report is to describe the management of a patient with incomplete spinal cord injury (iSCI) using a model of concentrated bouts of physical therapy with an emphasis on techniques to increase self-efficacy. The patient is a 70-yr old female who sustained C5/C6 vertebral fractures in a fall, resulting in incomplete tetraplegia. She participated in a pilot program of 1 week of intensive physical therapy every 10-12 weeks over the course of 5.5 months. Interventions included functional activities important to the patient, therapeutic exercise, and home exercise program. Confidence and self-efficacy were shaped using patient-directed discussions and active problem solving. The patient improved on all measures of gait, balance, and participation, and also reported increased confidence and self-management of her condition. A high-intensity, periodic model of care delivery combined with a capacity-building approach may be an effective method to improve confidence, motivation, and function in persons with iSCI.
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Affiliation(s)
- Teresa Bisson
- a Department of Physical Therapy , Rancho Los Amigos National Rehabilitation Center , Downey , CA , USA.,b Program in Physical Therapy, University of Minnesota , Minneapolis , MN , USA
| | - Craig J Newsam
- c Doctor of Physical Therapy, Mount Saint Mary's University , Los Angeles , CA , USA
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Patel J, Qiu Q, Yarossi M, Merians A, Massood S, Tunik E, Adamovich S, Fluet G. Exploring the impact of visual and movement based priming on a motor intervention in the acute phase post-stroke in persons with severe hemiparesis of the upper extremity. Disabil Rehabil 2017; 39:1515-1523. [PMID: 27636200 PMCID: PMC5355001 DOI: 10.1080/09638288.2016.1226419] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Explore the potential benefits of using priming methods prior to an active hand task in the acute phase post-stroke in persons with severe upper extremity hemiparesis. METHODS Five individuals were trained using priming techniques including virtual reality (VR) based visual mirror feedback and contralaterally controlled passive movement strategies prior to training with an active pinch force modulation task. Clinical, kinetic, and neurophysiological measurements were taken pre and post the training period. Clinical measures were taken at six months post training. RESULTS The two priming simulations and active training were well tolerated early after stroke. Priming effects were suggested by increased maximal pinch force immediately after visual and movement based priming. Despite having no clinically observable movement distally, the subjects were able to volitionally coordinate isometric force and muscle activity (EMG) in a pinch tracing task. The Root Mean Square Error (RMSE) of force during the pinch trace task gradually decreased over the training period suggesting learning may have occurred. Changes in motor cortical neurophysiology were seen in the unaffected hemisphere using Transcranial Magnetic Stimulation (TMS) mapping. Significant improvements in motor recovery as measured by the Action Research Arm Test (ARAT) and the Upper Extremity Fugl Meyer Assessment (UEFMA) were demonstrated at six months post training by three of the five subjects. CONCLUSION This study suggests that an early hand-based intervention using visual and movement based priming activities and a scaled motor task allows participation by persons without the motor control required for traditionally presented rehabilitation and testing. Implications for Rehabilitation Rehabilitation of individuals with severely paretic upper extremities after stroke is challenging due to limited movement capacity and few options for therapeutic training. Long-term functional recovery of the arm after stroke depends on early return of active hand control, establishing a need for acute training methods focused distally. This study demonstrates the feasibility of an early hand-based intervention using virtual reality based priming and scaled motor activities which can allow for participation by persons without the motor control required for traditionally presented rehabilitation and testing.
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Affiliation(s)
- Jigna Patel
- Department of Rehabilitation & Movement Sciences, Rutgers The State University of New Jersey, Newark, NJ, USA
| | - Qinyin Qiu
- Department of Rehabilitation & Movement Sciences, Rutgers The State University of New Jersey, Newark, NJ, USA
| | - Mathew Yarossi
- Department of Rehabilitation & Movement Sciences, Rutgers The State University of New Jersey, Newark, NJ, USA
| | - Alma Merians
- Department of Rehabilitation & Movement Sciences, Rutgers The State University of New Jersey, Newark, NJ, USA
| | - Supriya Massood
- Acute Rehabilitation Unit, Saint Joseph’s Wayne Hospital, Wayne, NJ, USA
| | - Eugene Tunik
- Department of Physical Therapy, Movement, and Rehabilitation Science, Bouve College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Sergei Adamovich
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, USA
| | - Gerard Fluet
- Department of Rehabilitation & Movement Sciences, Rutgers The State University of New Jersey, Newark, NJ, USA
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Abstract
Brain-computer interface (BCI) technology can restore communication and control to people who are severely paralyzed. There has been speculation that this technology might also be useful for a variety of diverse therapeutic applications. This survey considers possible ways that BCI technology can be applied to motor rehabilitation following stroke, Parkinson's disease, and psychiatric disorders. We consider potential neural signals as well as the design and goals of BCI-based therapeutic applications. These diverse applications all share a reliance on neuroimaging and signal processing technologies. At the same time, each of these potential applications presents a series of unique challenges.
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Affiliation(s)
| | - Janis Daly
- Brain Rehabilitation Research Program, McKnight Brain Institute, University of Florida, Gainesville, FL
| | - Chadwick Boulay
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Stoykov ME, Corcos DM, Madhavan S. Movement-Based Priming: Clinical Applications and Neural Mechanisms. J Mot Behav 2017; 49:88-97. [PMID: 28277966 DOI: 10.1080/00222895.2016.1250716] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Priming can be described as behavior change generated by preceding stimuli. Although various types of priming have been long studied in the field of psychology, priming that targets motor cortex is a relatively new topic of research in the fields of motor control and rehabilitation. In reference to a rehabilitation intervention, priming is categorized as a restorative approach. There are a myriad of possible priming approaches including noninvasive brain stimulation, motor imagery, and sensory-based priming, to name a few. The authors report on movement-based priming which, compared to other priming types, is less frequently examined and under reported. Movement-based priming includes, but is not limited to, bilateral motor priming, unilateral priming, and aerobic exercise. Clinical and neural mechanistic aspects of movement-based priming techniques are explored.
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Affiliation(s)
| | - Daniel Montie Corcos
- b Department of Physical Therapy & Human Movement Sciences , Northwestern University , Chicago , Illinois
| | - Sangeetha Madhavan
- c Department of Physical Therapy , University of Illinois at Chicago , Chicago , Illinois
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Vaz DV, Silva PL, Mancini MC, Carello C, Kinsella-Shaw J. Towards an ecologically grounded functional practice in rehabilitation. Hum Mov Sci 2017; 52:117-132. [PMID: 28187353 DOI: 10.1016/j.humov.2017.01.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 01/20/2017] [Accepted: 01/21/2017] [Indexed: 01/28/2023]
Abstract
According to the International Classification of Functioning, Disability and Health, effective rehabilitation requires interventions that go beyond minimizing pathological conditions and associated symptoms. The scope of practice must include promoting an individual's activity within relevant contexts. We argue that best practice requires decisions that are not only evidence-based but also theory-based. Perception and action theories are essential for interpreting evidence and clinical phenomena as well as for developing new interventions. It is our contention that rehabilitation goals can best be achieved if inspired by the ecological approach to perception and action, an approach that focuses on the dynamics of interacting constraints of performer, task and environment. This contrasts with organism-limited motor control theories that have important influence in clinical practice. Parallels between such theories and the medical model of care highlight their fundamental inconsistency with the current understanding of functioning. We contend that incorporating ecological principles into rehabilitation research and practice can help advance our understanding of the complexity of action and provide better grounding for the development of effective functional practice. Implications and initial suggestions for an ecologically grounded functional practice are outlined.
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Affiliation(s)
- Daniela Virgínia Vaz
- Departament of Physical Therapy, EEFFTO, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627 Campus - Pampulha, Belo Horizonte, MG CEP 31270-901, Brazil.
| | - Paula Lanna Silva
- Department of Psychology, McMicken College of Arts & Sciences, University of Cincinnati, P.O. Box 210376, 4150M Edwards 1 Bldg, Cincinnati, OH 45221-0376, United States.
| | - Marisa Cotta Mancini
- Department of Occupational Therapy, EEFFTO, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627 Campus - Pampulha, Belo Horizonte, MG CEP 31270-901, Brazil.
| | - Claudia Carello
- Department of Psychology and Center for the Ecological Study of Perception and Action, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269-1020, United States.
| | - Jeffrey Kinsella-Shaw
- Center for the Ecological Study of Perception and Action, University of Connecticut, Doctor of Physical Therapy Program, Dept. of Kinesiology, Neag School of Education, 358 Mansfield Road, Unit 2101, Storrs, CT 06269-2101, United States.
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Martínez-Pernía D, González-Castán Ó, Huepe D. From ancient Greece to the cognitive revolution: A comprehensive view of physical rehabilitation sciences. Physiother Theory Pract 2017; 33:89-102. [DOI: 10.1080/09593985.2016.1266720] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- David Martínez-Pernía
- Center for Social and Cognitive Neuroscience, School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Laboratory of Experimental Psychology and Neuroscience, Institute of Cognitive and Translational Neuroscience, INECO Foundation, Favaloro University, Buenos Aires, Argentina
- Experiential Neurorehabilitation Research Department, Fundación Polibea, Madrid, Spain
| | | | - David Huepe
- Center for Social and Cognitive Neuroscience, School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
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Park HJ, Oh DW, Choi JD, Kim JM, Kim SY, Cha YJ, Jeon SJ. Action observation training of community ambulation for improving walking ability of patients with post-stroke hemiparesis: a randomized controlled pilot trial. Clin Rehabil 2016; 31:1078-1086. [DOI: 10.1177/0269215516671982] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To investigate the effects of action observation training involving community-based ambulation for improving walking ability after stroke. Design: Randomized, controlled pilot study. Setting: Inpatient rehabilitation hospital. Subjects: A total of 25 inpatients with post-stroke hemiparesis were randomly assigned to either the experimental group ( n = 12) or control group ( n = 13). Intervention: Subjects of the experimental group watched video clips demonstrating four-staged ambulation training with a more complex environment factor for 30 minutes, three times a week for four weeks. Meanwhile, subjects of the control group watched video clips, which showed different landscape pictures. Main measures: Walking function was evaluated before and after the four-week intervention using a 10-m walk test, community walk test, activities-specific balance confidence scale, and spatiotemporal gait measures. Results: Changes in the values for the 10-m walk test (0.17 ±0.19 m/s vs. 0.05 ±0.08 m/s), community walk test (–151.42 ±123.82 seconds vs. 67.08 ±176.77 seconds), and activities-specific balance confidence (6.25 ±5.61 scores vs. 0.72 ±2.24 scores) and the spatiotemporal parameters (i.e. stride length (19.00 ±11.34 cm vs. 3.16 ±11.20 cm), single support (5.87 ±5.13% vs. 0.25 ±5.95%), and velocity (15.66 ±12.34 cm/s vs. 2.96 ±10.54 cm/s)) indicated a significant improvement in the experimental group compared with the control group. In the experimental group, walking function and ambulation confidence was significantly different between the pre- and post-intervention, whereas the control group showed a significant difference only in the 10-m walk test. Conclusions: Action observation training of community ambulation may be favorably used for improving walking function of patients with post-stroke hemiparesis.
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Affiliation(s)
- Hyun-Ju Park
- Department of Physical Therapy, Cheongju University, Cheongju-si, Republic of Korea
| | - Duck-Won Oh
- Department of Physical Therapy, Cheongju University, Cheongju-si, Republic of Korea
| | - Jong-Duk Choi
- Department of Physical Therapy, College of Health and Science, Daejeon University, Republic of Korea
| | - Jong-Man Kim
- Department of Occupational Therapy, College of Medical Science, Jeonju University, Republic of Korea
| | - Suhn-Yeop Kim
- Department of Physical Therapy, College of Health and Science, Daejeon University, Republic of Korea
| | - Yong-Jun Cha
- Department of Physical Therapy, College of Health and Science, Daejeon University, Republic of Korea
| | - Su-Jin Jeon
- Department of Physical Therapy, Osan Medical Center, Republic of Korea
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Kirkpatrick E, Pearse J, James P, Basu A. Effect of parent-delivered action observation therapy on upper limb function in unilateral cerebral palsy: a randomized controlled trial. Dev Med Child Neurol 2016; 58:1049-56. [PMID: 27038153 DOI: 10.1111/dmcn.13109] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2016] [Indexed: 11/28/2022]
Abstract
AIM To determine whether home-based, parent-delivered therapy comprising action observation (AO) and repeated practice (RP) improves upper limb function more than RP alone in children with unilateral cerebral palsy (UCP). DESIGN single-blinded parallel-group randomized controlled trial with 1:1 allocation comparing AO+RP (intervention) with RP alone (control). RANDOMIZATION computer-generated, with allocation concealment by opaque sequentially-numbered envelopes. SETTING northern England, August 2011 to September 2013. PARTICIPANTS 70 children with UCP; mean age 5.6 years (SD 2.1), 31 female. INTERVENTION home-based activities were provided, tailored to interests and abilities. DURATION 15 minutes/day, 5 days/week for 3 months. ASSESSMENTS Assisting Hand Assessment (AHA; primary outcome measure), Melbourne Assessment 2 (MA2), and ABILHAND-Kids at baseline, 3 months, and 6 months. RESULTS Outcome data was available at 3 months for 28 children in the AO+RP group and 31 controls, and at 6 months for 26 and 28 children respectively. There were no between-group differences in AHA, MA2, or ABILHAND-Kids at 3 or 6 months versus baseline (all p>0.05). Combined-group improvements (p<0.001), observed in AHA and MA2 at 3 months, were maintained at 6 months. ABILHAND-Kids also showed improvement at 3 months (p=0.003), maintained at 6 months. INTERPRETATION Parent-delivered RP (with or without AO) improves upper limb function and could supplement therapist input.
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Affiliation(s)
- Emma Kirkpatrick
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Janice Pearse
- Paediatric Occupational Therapy Services, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Peter James
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Anna Basu
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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Hétu S, Taschereau-Dumouchel V, Meziane HB, Jackson PL, Mercier C. Behavioral and TMS Markers of Action Observation Might Reflect Distinct Neuronal Processes. Front Hum Neurosci 2016; 10:458. [PMID: 27683548 PMCID: PMC5021688 DOI: 10.3389/fnhum.2016.00458] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 08/30/2016] [Indexed: 11/23/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) studies have shown that observing an action induces muscle-specific changes in corticospinal excitability. From a signal detection theory standpoint, this pattern can be related to sensitivity, which here would measure the capacity to distinguish between two action observation conditions. In parallel to these TMS studies, action observation has also been linked to behavioral effects such as motor priming and interference. It has been hypothesized that behavioral markers of action observation could be related to TMS markers and thus represent a potentially cost-effective mean of assessing the functioning of the action-perception system. However, very few studies have looked at possible relationships between these two measures. The aim of this study was to investigate if individual differences in sensitivity to action observation could be related to the behavioral motor priming and interference effects produced by action observation. To this end, 14 healthy participants observed index and little finger movements during a TMS task and a stimulus-response compatibility task. Index muscle displayed sensitivity to action observation, and action observation resulted in significant motor priming+interference, while no significant effect was observed for the little finger in both task. Nevertheless, our results indicate that the sensitivity measured in TMS was not related to the behavioral changes measured in the stimulus-response compatibility task. Contrary to a widespread assumption, the current results indicate that individual differences in physiological and behavioral markers of action observation may be unrelated. This could have important impacts on the potential use of behavioral markers in place of more costly physiological markers of action observation in clinical settings.
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Affiliation(s)
- Sébastien Hétu
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec, QCCanada
- Human Neuroimaging Laboratory, Virginia Tech Carilion Research Institute, Roanoke, VAUSA
| | - Vincent Taschereau-Dumouchel
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec, QCCanada
- Psychology Department, University of California at Los Angeles, Los Angeles, CAUSA
| | - Hadj Boumediene Meziane
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec, QCCanada
- Institut de psychologie, Université de Lausanne, LausanneSwitzerland
| | - Philip L. Jackson
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec, QCCanada
- Département de Psychologie, Université Laval, Québec, QCCanada
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Québec, Québec, QCCanada
| | - Catherine Mercier
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec, QCCanada
- Département de Réadaptation, Université Laval, Québec, QCCanada
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45
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Chaudhary U, Birbaumer N, Ramos-Murguialday A. Brain-computer interfaces in the completely locked-in state and chronic stroke. PROGRESS IN BRAIN RESEARCH 2016; 228:131-61. [PMID: 27590968 DOI: 10.1016/bs.pbr.2016.04.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Brain-computer interfaces (BCIs) use brain activity to control external devices, facilitating paralyzed patients to interact with the environment. In this chapter, we discuss the historical perspective of development of BCIs and the current advances of noninvasive BCIs for communication in patients with amyotrophic lateral sclerosis and for restoration of motor impairment after severe stroke. Distinct techniques have been explored to control a BCI in patient population especially electroencephalography (EEG) and more recently near-infrared spectroscopy (NIRS) because of their noninvasive nature and low cost. Previous studies demonstrated successful communication of patients with locked-in state (LIS) using EEG- and invasive electrocorticography-BCI and intracortical recordings when patients still showed residual eye control, but not with patients with complete LIS (ie, complete paralysis). Recently, a NIRS-BCI and classical conditioning procedure was introduced, allowing communication in patients in the complete locked-in state (CLIS). In severe chronic stroke without residual hand function first results indicate a possible superior motor rehabilitation to available treatment using BCI training. Here we present an overview of the available studies and recent results, which open new doors for communication, in the completely paralyzed and rehabilitation in severely affected stroke patients. We also reflect on and describe possible neuronal and learning mechanisms responsible for BCI control and perspective for future BMI research for communication in CLIS and stroke motor recovery.
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Affiliation(s)
- U Chaudhary
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany.
| | - N Birbaumer
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany; Wyss-Center for Bio- and Neuro-Engineering, Geneva, Switzerland
| | - A Ramos-Murguialday
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany; TECNALIA, San Sebastian, Spain.
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46
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van Vliet P, Hunter SM, Donaldson C, Pomeroy V. Using the TIDieR Checklist to Standardize the Description of a Functional Strength Training Intervention for the Upper Limb After Stroke. J Neurol Phys Ther 2016; 40:203-8. [PMID: 27187925 PMCID: PMC4915727 DOI: 10.1097/npt.0000000000000133] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Published reports of intervention in randomized controlled trials are often poorly described. The Template for Intervention Description and Replication (TIDieR) checklist has been recently developed to improve the reporting of interventions. The aim of this article is to describe a therapy intervention used in the stroke rehabilitation trial, "Clinical Efficacy of Functional Strength Training for Upper Limb Motor Recovery Early After Stroke: Neural Correlates and Prognostic Indicators" (FAST-INdICATE), using TIDieR. METHODS The functional strength training intervention used in the FAST-INdICATE trial was described using TIDieR so that intervention can be replicated by both clinicians, who may implement it in practice, and researchers, who may deliver it in future research. The usefulness of TIDieR in the context of a complex stroke rehabilitation intervention was then discussed. RESULTS AND DISCUSSION The TIDieR checklist provided a systematic way of describing a treatment intervention used in a clinical trial of stroke rehabilitation. Clarification is needed regarding several aspects of the TIDieR checklist, including in which section to report about the development of the intervention in pilot studies, results of feasibility studies; overlap between training and procedures for assessing fidelity; and where to publish supplementary material so that it remains in the public domain. CONCLUSIONS TIDieR is a systematic way of reporting the intervention delivered in a clinical trial of a complex intervention such as stroke rehabilitation. This approach may also have value for standardizing intervention in clinical practice.Video abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A131).
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Affiliation(s)
- Paulette van Vliet
- School of Health Sciences (P.v.V.), Faculty of Health and Medicine, The University of Newcastle, Australia; School of Health and Rehabilitation (S.U.M.), and Institute for Science and Technology in Medicine, Keele University, Staffordshire, UK; St George's, University of London (C.D.), London, UK; and Acquired Brain Injury Rehabilitation Alliance (V.P.), School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Susan M. Hunter
- School of Health Sciences (P.v.V.), Faculty of Health and Medicine, The University of Newcastle, Australia; School of Health and Rehabilitation (S.U.M.), and Institute for Science and Technology in Medicine, Keele University, Staffordshire, UK; St George's, University of London (C.D.), London, UK; and Acquired Brain Injury Rehabilitation Alliance (V.P.), School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Catherine Donaldson
- School of Health Sciences (P.v.V.), Faculty of Health and Medicine, The University of Newcastle, Australia; School of Health and Rehabilitation (S.U.M.), and Institute for Science and Technology in Medicine, Keele University, Staffordshire, UK; St George's, University of London (C.D.), London, UK; and Acquired Brain Injury Rehabilitation Alliance (V.P.), School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Valerie Pomeroy
- School of Health Sciences (P.v.V.), Faculty of Health and Medicine, The University of Newcastle, Australia; School of Health and Rehabilitation (S.U.M.), and Institute for Science and Technology in Medicine, Keele University, Staffordshire, UK; St George's, University of London (C.D.), London, UK; and Acquired Brain Injury Rehabilitation Alliance (V.P.), School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
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47
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Barrett N, Swain I, Gatzidis C, Mecheraoui C. The use and effect of video game design theory in the creation of game-based systems for upper limb stroke rehabilitation. J Rehabil Assist Technol Eng 2016; 3:2055668316643644. [PMID: 31186903 PMCID: PMC6453078 DOI: 10.1177/2055668316643644] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/04/2016] [Indexed: 12/30/2022] Open
Abstract
Upper limb exercise is often neglected during post-stroke rehabilitation. Video
games have been shown to be useful in providing environments in which patients
can practise repetitive, functionally meaningful movements, and in inducing
neuroplasticity. The design of video games is often focused upon a number of
fundamental principles, such as reward, goals, challenge and the concept of
meaningful play, and these same principles are important in the design of games
for rehabilitation. Further to this, there have been several attempts for the
strengthening of the relationship between commercial game design and
rehabilitative game design, the former providing insight into factors that can
increase motivation and engagement with the latter. In this article, we present
an overview of various game design principles and the theoretical grounding
behind their presence, in addition to attempts made to utilise these principles
in the creation of upper limb stroke rehabilitation systems and the outcomes of
their use. We also present research aiming to move the collaborative efforts of
designers and therapists towards a model for the structured design of these
games and the various steps taken concerning the theoretical classification and
mapping of game design concepts with intended cognitive and motor outcomes.
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Affiliation(s)
- N Barrett
- Odstock Medical Limited, Salisbury District Hospital, Salisbury, UK.,Faculty of Science and Technology, Bournemouth University, Poole, UK
| | - I Swain
- Odstock Medical Limited, Salisbury District Hospital, Salisbury, UK.,Faculty of Science and Technology, Bournemouth University, Poole, UK
| | - C Gatzidis
- Faculty of Science and Technology, Bournemouth University, Poole, UK
| | - C Mecheraoui
- Odstock Medical Limited, Salisbury District Hospital, Salisbury, UK
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Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, Deruyter F, Eng JJ, Fisher B, Harvey RL, Lang CE, MacKay-Lyons M, Ottenbacher KJ, Pugh S, Reeves MJ, Richards LG, Stiers W, Zorowitz RD. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 47:e98-e169. [PMID: 27145936 DOI: 10.1161/str.0000000000000098] [Citation(s) in RCA: 1571] [Impact Index Per Article: 196.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. METHODS Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential. CONCLUSIONS As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts. (Stroke.2016;47:e98-e169. DOI: 10.1161/STR.0000000000000098.).
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Kuk EJ, Kim JM, Oh DW, Hwang HJ. Effects of action observation therapy on hand dexterity and EEG-based cortical activation patterns in patients with post-stroke hemiparesis. Top Stroke Rehabil 2016; 23:318-25. [DOI: 10.1080/10749357.2016.1157972] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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50
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Antelis JM, Montesano L, Ramos-Murguialday A, Birbaumer N, Minguez J. Decoding Upper Limb Movement Attempt From EEG Measurements of the Contralesional Motor Cortex in Chronic Stroke Patients. IEEE Trans Biomed Eng 2016; 64:99-111. [PMID: 27046866 DOI: 10.1109/tbme.2016.2541084] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
GOAL Stroke survivors usually require motor rehabilitation therapy as, due to the lesion, they completely or partially loss mobility in the limbs. Brain-computer interface technology offers the possibility of decoding the attempt to move paretic limbs in real time to improve existing motor rehabilitation. However, a major difficulty for the practical application of the BCI to stroke survivors is that the brain rhythms that encode the motor states might be diminished due to the lesion. This study investigates the continuous decoding of natural attempt to move the paralyzed upper limb in stroke survivors from electroencephalographic signals of the unaffected contralesional motor cortex. RESULTS Experiments were carried out with the aid of six severely affected chronic stroke patients performing/attempting self-selected reaching movements of the unaffected/affected upper limb. The electroencephalographic (EEG) analysis showed significant cortical activation on the uninjured motor cortex when moving the contralateral unaffected arm and in the attempt to move the ipsilateral affected arm. Using this activity, significant continuous decoding of movement was obtained in six out of six participants in movements of the unaffected limb, and in four out of six participants in the attempt to move the affected limb. CONCLUSION This study showed that it is possible to construct a decoder of the attempt to move the paretic arm for chronic stroke patients using the EEG activity of the healthy contralesional motor cortex. SIGNIFICANCE This decoding model could provide to stroke survivors with a natural, easy, and intuitive way to achieve control of BCIs or robot-assisted rehabilitation devices.
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