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Tseng KC, Wang L, Hsieh C, Wong AM. Portable robots for upper-limb rehabilitation after stroke: a systematic review and meta-analysis. Ann Med 2024; 56:2337735. [PMID: 38640459 PMCID: PMC11034452 DOI: 10.1080/07853890.2024.2337735] [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: 10/18/2023] [Accepted: 02/28/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Robot-assisted upper-limb rehabilitation has been studied for many years, with many randomised controlled trials (RCTs) investigating the effects of robotic-assisted training on affected limbs. The current trend directs towards end-effector devices. However, most studies have focused on the effectiveness of rehabilitation devices, but studies on device sizes are relatively few. GOAL Systematically review the effect of a portable rehabilitation robot (PRR) on the rehabilitation effectiveness of paralysed upper limbs compared with non-robotic therapy. METHODS A meta-analysis was conducted on literature that included the Fugl-Meyer Assessment (FMA) obtained from the PubMed and Web of Science (WoS) electronic databases until June 2023. RESULTS A total of 9 studies, which included RCTs, were completed and a meta-analysis was conducted on 8 of them. The analysis involved 295 patients. The influence on upper-limb function before and after treatment in a clinical environment is analysed by comparing the experimental group using the portable upper-limb rehabilitation robot with the control group using conventional therapy. The result shows that portable robots prove to be effective (FMA: SMD = 0.696, 95% = 0.099 to.293, p < 0.05). DISCUSSION Both robot-assisted and conventional rehabilitation effects are comparable. In some studies, PRR performs better than conventional rehabilitation, but conventional treatments are still irreplaceable. Smaller size with better portability has its advantages, and portable upper-limb rehabilitation robots are feasible in clinical rehabilitation. CONCLUSION Although portable upper-limb rehabilitation robots are clinically beneficial, few studies have focused on portability. Further research should focus on modular design so that rehabilitation robots can be decomposed, which benefits remote rehabilitation and household applications.
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Affiliation(s)
- Kevin C. Tseng
- Department of Industrial Design, National Taipei University of Technology, Taipei, Taiwan, ROC
- Product Design and Development Laboratory, Taoyuan, Taiwan, ROC
| | - Le Wang
- Product Design and Development Laboratory, Taoyuan, Taiwan, ROC
| | - Chunkai Hsieh
- Product Design and Development Laboratory, Taoyuan, Taiwan, ROC
| | - Alice M. Wong
- Product Design and Development Laboratory, Taoyuan, Taiwan, ROC
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan, ROC
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Morrow C, Woodbury M, Simpson AN, Almallouhi E, Simpson KN. Differences in rehabilitation evaluation access for rural and socially disadvantaged stroke survivors. Top Stroke Rehabil 2024; 31:625-631. [PMID: 38369788 PMCID: PMC11269038 DOI: 10.1080/10749357.2024.2312638] [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: 08/08/2023] [Accepted: 01/27/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Most stroke survivors have ongoing deficits and report unmet needs. Despite evidence that rehabilitation improves stroke survivors' function, access to occupational and physical therapy is limited. Describing access to care for disadvantaged communities for different levels of stroke severity will provide proportions used to create Markov economic models to demonstrate the value of rehabilitation. OBJECTIVES The objective of this study was to explore differences in the frequency of rehabilitation evaluations via outpatient therapy and home health for Medicare Part B ischemic stroke survivors in rural and socially disadvantaged locations. METHODS We completed a retrospective, descriptive cohort analysis using the 2018 and 2019 5% Medicare Limited Data Sets (LDS) from the Centers for Medicare and Medicaid Services using STROBE guidelines for observational studies. We extracted rehabilitation Current Procedural Terminology (CPT) codes for those who received occupational or physical therapy to examine differences in therapy evaluations for rural and socially disadvantaged populations. RESULTS Of the 9,076 stroke survivors in this cohort, 44.2% did not receive any home health or outpatient therapy. Of these, 64.7% had a moderate or severe stroke, indicating an unmet need for therapy. Only 2.0% of stroke survivors received outpatient occupational therapy within the first year Rural and socially disadvantaged communities accessed rehabilitation evaluations at lower rates than general stroke survivors. CONCLUSIONS These findings describe the poor access to home health and outpatient rehabilitation for stroke survivors, particularly in traditionally underserved populations. These results will influence future economic evaluations of interventions aimed at improving access to care.
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Affiliation(s)
- Corey Morrow
- College of Health Professions, Medical University of South Carolina
| | | | - Annie N Simpson
- College of Health Professions, Medical University of South Carolina
| | | | - Kit N Simpson
- College of Health Professions, Medical University of South Carolina
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Fluet G, Qiu Q, Gross A, Gorin H, Patel J, Merians A, Adamovich S. The influence of scaffolding on intrinsic motivation and autonomous adherence to a game-based, sparsely supervised home rehabilitation program for people with upper extremity hemiparesis due to stroke. A randomized controlled trial. J Neuroeng Rehabil 2024; 21:143. [PMID: 39138516 PMCID: PMC11321133 DOI: 10.1186/s12984-024-01441-7] [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: 05/17/2024] [Accepted: 08/08/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND This parallel, randomized controlled trial examined intrinsic motivation, adherence and motor function improvement demonstrated by two groups of subjects that performed a 12-week, home-based upper extremity rehabilitation program. Seventeen subjects played scaffolded games, presenting eight to twelve discrete levels of increasing difficulty. Sixteen subjects performed the same activities controlled by success algorithms that modify game difficulty incrementally. METHODS 33 persons 20-80 years of age, at least 6 months post stroke with moderate to mild hemiparesis were randomized using a random number generator into the two groups. They were tested using the Action Research Arm Test, Upper Extremity Fugl Meyer Assessment, Stroke Impact Scale and Intrinsic Motivation Inventory pre and post training. Adherence was measured using timestamps generated by the gaming system. Subjects had the Home Virtual Rehabilitation System (Qiu in J Neuroeng Rehabil 17: 1-10, 2020) placed in their homes and were taught to perform rehabilitation games using it. Subjects were instructed to train twenty minutes per day but were allowed to train as much as they chose. Subjects trained for 12 weeks without appointments and received intermittent support from study staff. Group outcomes were compared using ANOVA. Correlations between subject demographics and adherence, as well as motor outcome, were evaluated using Pearson Correlation Coefficients. RESULTS There were 5 dropouts and no adverse events. The main effect of time was statistically significant for four of the five clinical outcome measures. There were no significant training group by time interactions. Measures of adherence did not differ significantly between groups. The combined groups improved their UEFMA scores on average by 5.85 (95% CI 4.73-6.98). 21 subjects from both groups demonstrating improvements in UEFMA scores of at least 5 points, exceeding the minimal clinically important difference of 4.25. IMI scores were stable pre to post training. CONCLUSIONS Scaffolding challenges during game based rehabilitation did not elicit higher levels of adherence when compared to algorithm control of game difficulty. Both sparsely supervised programs of game-based treatment in the home were sufficient to elicit statistically significant, clinically meaningful improvements in motor function and activities of daily living. TRIAL REGISTRATION Clinical Trials.gov-NCT03985761, Registered June 14, 2019.
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Affiliation(s)
- Gerard Fluet
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers The State University of New Jersey, 65 Bergen St, Newark, NJ, 07101, USA.
| | - Qinyin Qiu
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers The State University of New Jersey, 65 Bergen St, Newark, NJ, 07101, USA
| | - Amanda Gross
- Department of Biomedical Engineering, New Jersey Institute of Technology, University Heights, Newark, NJ, 07015, USA
| | - Holly Gorin
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers The State University of New Jersey, 65 Bergen St, Newark, NJ, 07101, USA
| | - Jigna Patel
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers The State University of New Jersey, 65 Bergen St, Newark, NJ, 07101, USA
| | - Alma Merians
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers The State University of New Jersey, 65 Bergen St, Newark, NJ, 07101, USA
| | - Sergei Adamovich
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers The State University of New Jersey, 65 Bergen St, Newark, NJ, 07101, USA
- Department of Biomedical Engineering, New Jersey Institute of Technology, University Heights, Newark, NJ, 07015, USA
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Fluet G, Qiu Q, Gross A, Gorin H, Patel J, Merians A, Adamovich S. The influence of scaffolding on intrinsic motivation and autonomous adherence to a game-based, unsupervised home rehabilitation program for people with upper extremity hemiparesis due to stroke. A randomized controlled trial. RESEARCH SQUARE 2024:rs.3.rs-4438077. [PMID: 38883760 PMCID: PMC11177982 DOI: 10.21203/rs.3.rs-4438077/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background This parallel, randomized controlled trial examines intrinsic motivation, adherence and motor function improvement demonstrated by two groups of subjects that performed a twelve-week, home-based upper extremity rehabilitation program. Seventeen subjects played games presenting eight to twelve discrete levels of increasing difficulty. Sixteen subjects performed the same activities controlled by success algorithms that modify game difficulty incrementally. Methods 33 persons 20 to 80 years of age, at least six months post stroke with moderate to mild hemiparesis were randomized using a random number generator into the two groups. They were tested using the Action Research Arm Test, Upper Extremity Fugl Meyer Assessment, Stroke Impact Scale and Intrinsic Motivation Inventory pre and post training. Adherence was measured using timestamps generated by the system. Subjects had the Home Virtual Rehabilitation System [1]systems placed in their homes and were taught to perform rehabilitation games using it. Subjects were instructed to train twenty minutes per day but were allowed to train as much as they chose. Subjects trained for twelve weeks without appointments and received intermittent support from study staff. Group outcomes were compared using ANOVA. Correlations between subject demographics and adherence, as well as motor outcome, were evaluated using Pearson Correlation Coefficients. Classification and Regression Tree (CART) models were generated to predict responders using demographics and baseline measures. Results There were 5 dropouts and no adverse events. The main effect of time was statistically significant for four of the five clinical outcome measures. There were no significant training group by time interactions. Measures of adherence did not differ between groups. 21 subjects from both groups, demonstrated clinically important improvements in UEFMA score of at least 4.25 points. Subjects with pre training UEFMA scores below 53.5 averaged a seven-point UEFMA increase. IMI scores were stable pre to post training. Conclusions Scaffolding did not have a meaningful impact on adherence or motor function improvement. A sparsely supervised program of game-based treatment in the home was sufficient to elicit meaningful improvements in motor function and activities of daily living. Common factors considered barriers to the utilization of telerehabilitation did not impact adherence or motor outcome. Trial registration Clinical Trials.gov - NCT03985761, Registered June 14, 2019.
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Affiliation(s)
| | - Qinyin Qiu
- Rutgers, The State University of New Jersey
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Hwang S, Min KC, Song CS. Assistive technology on upper extremity function for stroke patients: A systematic review with meta-analysis. J Hand Ther 2024:S0894-1130(23)00202-8. [PMID: 38796397 DOI: 10.1016/j.jht.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/22/2023] [Accepted: 12/30/2023] [Indexed: 05/28/2024]
Abstract
BACKGROUND In stroke rehabilitation, the selection of appropriate assistive devices is of paramount importance for patients. Specifically, the choice of device can significantly influence the functional recovery of the upper limb, impacting their overall activities or functional tasks. OBJECTIVES This review aimed to comprehensively analyze and summarize the clinical evidence from randomized controlled trials (RCTs) regarding the therapeutic effects of commonly used assistive devices on upper extremity function in patients with stroke. METHODS To evaluate assistive devices for patients with stroke, we summarized qualitatively throughout synthesis of results, such as therapeutic intervention, intensity, outcome, and summary of results, and examined risk of bias, heterogeneity, mean difference, 95% confidence interval, and I-squared value. To analyze, we used RoB 2 and RevMan 5.4. RESULTS The qualitative synthesis included 31 RCTs. The randomization process and the reporting of results showed minimal bias, but there were issues with bias from intended interventions, and missing outcome data presented some concerns. The quantitative synthesis included 16 RCTs. There was a significant difference in the Fugl-Meyer assessment-upper extremity functioning (FMA-UE) scores between the groups, with a total mean difference (95% confidence interval) of 2.40 (0.21, 4.60), heterogeneity values were Tau2 = 0.32, chi-square = 8.22, degrees of freedom = 8 (p = 0.41), and I2 = 3% for FMA-UE and the test for the overall effect produced Z = 2.14 (p = 0.03) in patients with chronic stroke. However, there was no significant difference in all other outcome measures. CONCLUSIONS Upper-limb robots did not demonstrate significant superiority over conventional treatments in improving function of upper limbs, with the exception of FMA-UE scores for patients with chronic stroke. The mean difference of FMA-UE was also lower than minimally important difference. Nonetheless, the usage of upper-limb robots may contribute to enhanced function for patients with stroke, as those devices support clinicians and enable a greater number of movement repetitions within specific time frames.
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Affiliation(s)
- Sujin Hwang
- Department of Physical Therapy, Division of Health Science, Baekseok University, Cheonan, Republic of Korea; Graduate School of Health Welfare, Baekseok University, Seoul, Republic of Korea
| | - Kyoung-Chul Min
- Department of Occupational Therpay, Wonkwang University, Republic of Korea
| | - Chiang-Soon Song
- Department of Occupational Therapy, College of Natural Science and Public Health and Safety, Chosun University, Gwangju, Republic of Korea.
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Mohan M, Nunez CM, Kuchenbecker KJ. Closing the loop in minimally supervised human-robot interaction: formative and summative feedback. Sci Rep 2024; 14:10564. [PMID: 38719859 PMCID: PMC11079071 DOI: 10.1038/s41598-024-60905-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
Human instructors fluidly communicate with hand gestures, head and body movements, and facial expressions, but robots rarely leverage these complementary cues. A minimally supervised social robot with such skills could help people exercise and learn new activities. Thus, we investigated how nonverbal feedback from a humanoid robot affects human behavior. Inspired by the education literature, we evaluated formative feedback (real-time corrections) and summative feedback (post-task scores) for three distinct tasks: positioning in the room, mimicking the robot's arm pose, and contacting the robot's hands. Twenty-eight adults completed seventy-five 30-s-long trials with no explicit instructions or experimenter help. Motion-capture data analysis shows that both formative and summative feedback from the robot significantly aided user performance. Additionally, formative feedback improved task understanding. These results show the power of nonverbal cues based on human movement and the utility of viewing feedback through formative and summative lenses.
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Affiliation(s)
- Mayumi Mohan
- Haptic Intelligence Department, Max Planck Institute for Intelligent Systems, 70569, Stuttgart, Germany.
| | - Cara M Nunez
- Haptic Intelligence Department, Max Planck Institute for Intelligent Systems, 70569, Stuttgart, Germany
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, 14853, USA
| | - Katherine J Kuchenbecker
- Haptic Intelligence Department, Max Planck Institute for Intelligent Systems, 70569, Stuttgart, Germany.
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Devittori G, Dinacci D, Romiti D, Califfi A, Petrillo C, Rossi P, Ranzani R, Gassert R, Lambercy O. Unsupervised robot-assisted rehabilitation after stroke: feasibility, effect on therapy dose, and user experience. J Neuroeng Rehabil 2024; 21:52. [PMID: 38594727 PMCID: PMC11005116 DOI: 10.1186/s12984-024-01347-4] [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: 12/20/2023] [Accepted: 03/22/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Unsupervised robot-assisted rehabilitation is a promising approach to increase the dose of therapy after stroke, which may help promote sensorimotor recovery without requiring significant additional resources and manpower. However, the unsupervised use of robotic technologies is not yet a standard, as rehabilitation robots often show low usability or are considered unsafe to be used by patients independently. In this paper we explore the feasibility of unsupervised therapy with an upper limb rehabilitation robot in a clinical setting, evaluate the effect on the overall therapy dose, and assess user experience during unsupervised use of the robot and its usability. METHODS Subacute stroke patients underwent a four-week protocol composed of daily 45 min-sessions of robot-assisted therapy. The first week consisted of supervised therapy, where a therapist explained how to interact with the device. The second week was minimally supervised, i.e., the therapist was present but intervened only if needed. After this phase, if participants learnt how to use the device, they proceeded to two weeks of fully unsupervised training. Feasibility, dose of robot-assisted therapy achieved during unsupervised use, user experience, and usability of the device were evaluated. Questionnaires to evaluate usability and user experience were performed after the minimally supervised week and at the end of the study, to evaluate the impact of therapists' absence. RESULTS Unsupervised robot-assisted therapy was found to be feasible, as 12 out of the 13 recruited participants could progress to unsupervised training. During the two weeks of unsupervised therapy participants on average performed an additional 360 min of robot-assisted rehabilitation. Participants were satisfied with the device usability (mean System Usability Scale scores > 79), and no adverse events or device deficiencies occurred. CONCLUSIONS We demonstrated that unsupervised robot-assisted therapy in a clinical setting with an actuated device for the upper limb was feasible and can lead to a meaningful increase in therapy dose. These results support the application of unsupervised robot-assisted therapy as a complement to usual care in clinical settings and pave the way to its application in home settings. TRIAL REGISTRATION Registered on 13.05.2020 on clinicaltrials.gov (NCT04388891).
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Affiliation(s)
- Giada Devittori
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland.
| | - Daria Dinacci
- Clinica Hildebrand Centro di riabilitazione Brissago, Brissago, Switzerland
| | - Davide Romiti
- Clinica Hildebrand Centro di riabilitazione Brissago, Brissago, Switzerland
| | - Antonella Califfi
- Clinica Hildebrand Centro di riabilitazione Brissago, Brissago, Switzerland
| | - Claudio Petrillo
- Clinica Hildebrand Centro di riabilitazione Brissago, Brissago, Switzerland
| | - Paolo Rossi
- Clinica Hildebrand Centro di riabilitazione Brissago, Brissago, Switzerland
| | - Raffaele Ranzani
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland
- Future Health Technologies programme, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland
- Future Health Technologies programme, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
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Rätz R, Ratschat AL, Cividanes-Garcia N, Ribbers GM, Marchal-Crespo L. Designing for usability: development and evaluation of a portable minimally-actuated haptic hand and forearm trainer for unsupervised stroke rehabilitation. Front Neurorobot 2024; 18:1351700. [PMID: 38638360 PMCID: PMC11024237 DOI: 10.3389/fnbot.2024.1351700] [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: 12/06/2023] [Accepted: 03/20/2024] [Indexed: 04/20/2024] Open
Abstract
In stroke rehabilitation, simple robotic devices hold the potential to increase the training dosage in group therapies and to enable continued therapy at home after hospital discharge. However, we identified a lack of portable and cost-effective devices that not only focus on improving motor functions but also address sensory deficits. Thus, we designed a minimally-actuated hand training device that incorporates active grasping movements and passive pronosupination, complemented by a rehabilitative game with meaningful haptic feedback. Following a human-centered design approach, we conducted a usability study with 13 healthy participants, including three therapists. In a simulated unsupervised environment, the naive participants had to set up and use the device based on written instructions. Our mixed-methods approach included quantitative data from performance metrics, standardized questionnaires, and eye tracking, alongside qualitative feedback from semi-structured interviews. The study results highlighted the device's overall ease of setup and use, as well as its realistic haptic feedback. The eye-tracking analysis further suggested that participants felt safe during usage. Moreover, the study provided crucial insights for future improvements such as a more intuitive and comfortable wrist fixation, more natural pronosupination movements, and easier-to-follow instructions. Our research underscores the importance of continuous testing in the development process and offers significant contributions to the design of user-friendly, unsupervised neurorehabilitation technologies to improve sensorimotor stroke rehabilitation.
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Affiliation(s)
- Raphael Rätz
- Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Cognitive Robotics, Delft University of Technology, Delft, Netherlands
| | - Alexandre L. Ratschat
- Department of Cognitive Robotics, Delft University of Technology, Delft, Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | | | - Gerard M. Ribbers
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Rijndam Rehabilitation Center, Rotterdam, Netherlands
| | - Laura Marchal-Crespo
- Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Cognitive Robotics, Delft University of Technology, Delft, Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
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Proietti T, Nuckols K, Grupper J, Schwerz de Lucena D, Inirio B, Porazinski K, Wagner D, Cole T, Glover C, Mendelowitz S, Herman M, Breen J, Lin D, Walsh C. Combining soft robotics and telerehabilitation for improving motor function after stroke. WEARABLE TECHNOLOGIES 2024; 5:e1. [PMID: 38510985 PMCID: PMC10952055 DOI: 10.1017/wtc.2023.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 11/07/2023] [Accepted: 12/02/2023] [Indexed: 03/22/2024]
Abstract
Telerehabilitation and robotics, either traditional rigid or soft, have been extensively studied and used to improve hand functionality after a stroke. However, a limited number of devices combined these two technologies to such a level of maturity that was possible to use them at the patients' home, unsupervised. Here we present a novel investigation that demonstrates the feasibility of a system that integrates a soft inflatable robotic glove, a cloud-connected software interface, and a telerehabilitation therapy. Ten chronic moderate-to-severe stroke survivors independently used the system at their home for 4 weeks, following a software-led therapy and being in touch with occupational therapists. Data from the therapy, including automatic assessments by the robot, were available to the occupational therapists in real-time, thanks to the cloud-connected capability of the system. The participants used the system intensively (about five times more movements per session than the standard care) for a total of more than 8 hr of therapy on average. We were able to observe improvements in standard clinical metrics (FMA +3.9 ± 4.0, p < .05, COPM-P + 2.5 ± 1.3, p < .05, COPM-S + 2.6 ± 1.9, p < .05, MAL-AOU +6.6 ± 6.5, p < .05) and range of motion (+88%) at the end of the intervention. Despite being small, these improvements sustained at follow-up, 2 weeks after the end of the therapy. These promising results pave the way toward further investigation for the deployment of combined soft robotic/telerehabilitive systems at-home for autonomous usage for stroke rehabilitation.
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Affiliation(s)
- Tommaso Proietti
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Kristin Nuckols
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Jesse Grupper
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Diogo Schwerz de Lucena
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Bianca Inirio
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | | | - Diana Wagner
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Tazzy Cole
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Christina Glover
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Sarah Mendelowitz
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Maxwell Herman
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Joan Breen
- Whittier Rehabilitation Hospital, Bradford, MA, USA
| | - David Lin
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- VA RR&D Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI, USA
| | - Conor Walsh
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
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10
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Gebreheat G, Goman A, Porter-Armstrong A. The use of home-based digital technology to support post-stroke upper limb rehabilitation: A scoping review. Clin Rehabil 2024; 38:60-71. [PMID: 37469176 PMCID: PMC10631286 DOI: 10.1177/02692155231189257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/05/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To identify, map and synthesize the extent and nature of existing studies on the use of home-based digital technology to support post-stroke upper limb rehabilitation. DATA SOURCES A comprehensive literature search was completed between 30 May 2022 and 05 April 2023, from seven online databases (CINAHL, Cochrane Library, PubMed, ScienceDirect, IEEExplore, Web of Science and PEDro), Google Scholar and the reference lists of already identified articles. METHODS A scoping review was conducted according to Arksey and O'Malley (2005), and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. All English-language studies reporting on the use of home-based digital technology to support upper limb post-stroke rehabilitation were eligible for inclusion. RESULTS The search generated a total of 1895 records, of which 76 articles met the inclusion criteria. Of these, 52 were experimental studies and the rest, qualitative, case series and case studies. Of the overall 2149 participants, 2028 were stroke survivors with upper limb impairment. The majority of studies were aimed at developing, designing and/or assessing the feasibility, acceptability and efficacy of a digital system for poststroke upper limb rehabilitation in home settings. The thematic analysis found six major categories: Tele-rehabilitation (n = 29), games (n = 45), virtual reality (n = 26), sensor (n = 22), mobile technology (n = 22), and robotics (n = 8). CONCLUSION The digital technologies used in post-stroke upper limb rehabilitation were multimodal, and system-based comprising telerehabilitation, gamification, virtual reality, mobile technology, sensors and robotics. Furthermore, future research should focus to determine the effectiveness of these modalities.
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Affiliation(s)
- Gdiom Gebreheat
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Adele Goman
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
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Kim SH, Ji DM, Hwang IS, Ryu J, Jin S, Kim SA, Kim MS. Three-Dimensional Magnetic Rehabilitation, Robot-Enhanced Hand-Motor Recovery after Subacute Stroke: A Randomized Controlled Trial. Brain Sci 2023; 13:1685. [PMID: 38137133 PMCID: PMC10742112 DOI: 10.3390/brainsci13121685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/02/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
We developed an end-effector-type rehabilitation robot that can uses electro- and permanent magnets to generate a three-way magnetic field to assist hand movements and perform rehabilitation therapy. This study aimed to investigate the therapeutic effect of a rehabilitation program using a three-dimensional (3D) magnetic force-based hand rehabilitation robot on the motor function recovery of the paralyzed hands of patients with stroke. This was a double-blind randomized controlled trial in which 36 patients with subacute stroke were assigned to intervention and control groups of 18 patients each. The intervention group received 30 min of rehabilitation therapy per day for a month using a 3D magnetic force-driven hand rehabilitation robot, whereas the control group received 30 min of conventional occupational therapy to restore upper-limb function. The patients underwent three behavioral assessments at three time points: before starting treatment (T0), after 1 month of treatment (T1), and at the follow-up 1-month after treatment completion (T2). The primary outcome measure was the Wolf Motor Function Test (WMFT), and secondary outcome measures included the Fugl-Meyer Assessment of the Upper Limb (FMA_U), Modified Barthel Index (MBI), and European Quality of Life Five Dimensions (EQ-5D) questionnaire. No participant safety issues were reported during the intervention. Analysis using repeated measures analysis of variance showed significant interaction effects between time and group for both the WMFT score (p = 0.012) and time (p = 0.010). In post hoc analysis, the WMFT scores and time improved significantly more in the patients who received robotic rehabilitation at T1 than in the controls (p = 0.018 and p = 0.012). At T2, we also consistently found improvements in both the WMFT scores and times for the intervention group that were superior to those in the control group (p = 0.024 and p = 0.018, respectively). Similar results were observed for FMA_U, MBI, and EQ-5D. Rehabilitation using the 3D hand-rehabilitation robot effectively restored hand function in the patients with subacute stroke, contributing to improvement in daily independence and quality of life.
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Affiliation(s)
- Sung-Hoon Kim
- Department of Electronics & Information Engineering, Korea University, Sejong 30019, Republic of Korea;
| | - Dong-Min Ji
- Department of Electronics Convergence Engineering, Wonkwang University, Iksan 54538, Republic of Korea;
| | - In-Su Hwang
- Department of Rehabilitation Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (I.-S.H.); (J.R.); (S.J.); (S.-A.K.)
| | - Jinwhan Ryu
- Department of Rehabilitation Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (I.-S.H.); (J.R.); (S.J.); (S.-A.K.)
| | - Sol Jin
- Department of Rehabilitation Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (I.-S.H.); (J.R.); (S.J.); (S.-A.K.)
| | - Soo-A Kim
- Department of Rehabilitation Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (I.-S.H.); (J.R.); (S.J.); (S.-A.K.)
| | - Min-Su Kim
- Department of Rehabilitation Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (I.-S.H.); (J.R.); (S.J.); (S.-A.K.)
- Department of Regenerative Medicine, College of Medicine, Soonchunhyang University, Cheonan 31151, Republic of Korea
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12
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Saragih ID, Everard G, Tzeng HM, Saragih IS, Lee BO. Efficacy of Robots-Assisted Therapy in Patients With Stroke: A Meta-analysis Update. J Cardiovasc Nurs 2023; 38:E192-E217. [PMID: 37816087 DOI: 10.1097/jcn.0000000000000945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Robot-assisted therapy (RAT) could address an unmet need to relieve the strain on healthcare providers and intensify treatment in the context of an increasing stroke incidence. A comprehensive meta-analysis could provide firmer data about the topic by considering methodology limitations discovered in previous reviews and providing more rigorous evidence. OBJECTIVE This meta-analysis study identifies RAT's efficacy for patients with stroke. METHODS A systematic search of the 7 databases from January 10 to February 1, 2022, located relevant publications. We used the updated Cochrane risk-of-bias checklist for 52 trials to assess the methodologic quality of the included studies. The efficacy of RAT for patients with stroke was estimated using a pooled random-effects model in the Stata 16 software application. RESULTS The final analysis included 2774 patients with stroke from 52 trials. In those patients, RAT was proven to improve quality of movement (mean difference, 0.15; 95% confidence interval, 0.03-0.28) and to reduce balance disturbances (mean difference, -1.28; 95% confidence interval, -2.48 to -0.09) and pain (standardized mean difference, -0.34; 95% confidence interval, -0.58 to -0.09). CONCLUSIONS Robot-assisted therapy seems to improve the quality of mobility and reduce balance disturbances and pain for patients with stroke. These findings will help develop advanced rehabilitation robots and could improve health outcomes by facilitating health services for healthcare providers and patients with stroke.
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13
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Li S. Stroke Recovery Is a Journey: Prediction and Potentials of Motor Recovery after a Stroke from a Practical Perspective. Life (Basel) 2023; 13:2061. [PMID: 37895442 PMCID: PMC10608684 DOI: 10.3390/life13102061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/01/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
Stroke recovery is a journey. Stroke survivors can face many consequences that may last the rest of their lives. Assessment of initial impairments allows reasonable prediction of biological spontaneous recovery at 3 to 6 months for a majority of survivors. In real-world clinical practice, stroke survivors continue to improve their motor function beyond the spontaneous recovery period, but management plans for maximal recovery are not well understood. A model within the international classification of functioning (ICF) theoretical framework is proposed to systematically identify opportunities and potential barriers to maximize and realize the potentials of functional recovery from the acute to chronic stages and to maintain their function in the chronic stages. Health conditions of individuals, medical and neurological complications can be optimized under the care of specialized physicians. This permits stroke survivors to participate in various therapeutic interventions. Sufficient doses of appropriate interventions at the right time is critical for stroke motor rehabilitation. It is important to highlight that combining interventions is likely to yield better clinical outcomes. Caregivers, including family members, can assist and facilitate targeted therapeutic exercises for these individuals and can help stroke survivors comply with medical plans (medications, visits), and provide emotional support. With health optimization, comprehensive rehabilitation, support from family and caregivers and a commitment to a healthy lifestyle, many stroke survivors can overcome barriers and achieve potentials of maximum recovery and maintain their motor function in chronic stages. This ICF recovery model is likely to provide a guidance through the journey to best achieve stroke recovery potentials.
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Affiliation(s)
- Sheng Li
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center—Houston, Houston, TX 77025, USA;
- TIRR Memorial Hermann Hospital, Houston, TX 77030, USA
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14
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Jackson G, Abdullah HA. Development and Testing of a Soft Exoskeleton Robotic Hand Training Device. SENSORS (BASEL, SWITZERLAND) 2023; 23:8395. [PMID: 37896489 PMCID: PMC10610659 DOI: 10.3390/s23208395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
Hand-function recovery is often a goal for stroke survivors undergoing therapy. This work aimed to design, build, and verify a pneumatic hand training device for its eventual use in post-stroke rehabilitation. The system was built considering prior research in the field of robotic hand rehabilitation as well as specifications and design constraints developed with physiotherapists. The system contained pneumatic airbag actuators for the fingers and thumb of the hand, a set of flex, pressure, and flow sensors, and software and hardware controls. An experiment with the system was carried out on 30 healthy individuals. The sensor readings were analyzed for repeatability and reliability. Position sensors and an approximate biomechanical model of the index finger were used to estimate joint angles during operation. A survey was also issued to the users to evaluate their comfort levels with the device. It was found that the system was safe and comfortable when moving the fingers of the hand into an extension.
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Affiliation(s)
| | - Hussein A. Abdullah
- The Robotics Institute, School of Engineering, University of Guelph, Guelph, ON N1G 2W1, Canada;
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15
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Proffitt R, Ma M, Skubic M. Development and Testing of a Daily Activity Recognition System for Post-Stroke Rehabilitation. SENSORS (BASEL, SWITZERLAND) 2023; 23:7872. [PMID: 37765929 PMCID: PMC10534764 DOI: 10.3390/s23187872] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/21/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023]
Abstract
Those who survive the initial incidence of a stroke experience impacts on daily function. As a part of the rehabilitation process, it is essential for clinicians to monitor patients' health status and recovery progress accurately and consistently; however, little is known about how patients function in their own homes. Therefore, the goal of this study was to develop, train, and test an algorithm within an ambient, in-home depth sensor system that can classify and quantify home activities of individuals post-stroke. We developed the Daily Activity Recognition and Assessment System (DARAS). A daily action logger was implemented with a Foresite Healthcare depth sensor. Daily activity data were collected from seventeen post-stroke participants' homes over three months. Given the extensive amount of data, only a portion of the participants' data was used for this specific analysis. An ensemble network for activity recognition and temporal localization was developed to detect and segment the clinically relevant actions from the recorded data. The ensemble network, which learns rich spatial-temporal features from both depth and skeletal joint data, fuses the prediction outputs from a customized 3D convolutional-de-convolutional network, customized region convolutional 3D network, and a proposed region hierarchical co-occurrence network. The per-frame precision and per-action precision were 0.819 and 0.838, respectively, on the test set. The outcomes from the DARAS can help clinicians to provide more personalized rehabilitation plans that benefit patients.
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Affiliation(s)
- Rachel Proffitt
- Department of Occupational Therapy, University of Missouri, Columbia, MO 65211, USA
| | | | - Marjorie Skubic
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO 65211, USA;
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16
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Bok SK, Song Y, Lim A, Jin S, Kim N, Ko G. High-Tech Home-Based Rehabilitation after Stroke: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12072668. [PMID: 37048751 PMCID: PMC10095213 DOI: 10.3390/jcm12072668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/02/2023] [Accepted: 03/30/2023] [Indexed: 04/14/2023] Open
Abstract
(1) Background: To improve existing rehabilitation technologies, we conducted a systematic review and meta-analysis to identify the effect size of home-based rehabilitation using robotic, virtual reality, and game devices on physical function for stroke survivors. (2) Methods: Embase, PubMed, Cochrane Library, ProQuest, and CINAHL were used to search the randomized controlled trials that applied technologies via home-based rehabilitation, such as virtual reality, robot-assisted devices, and games. The effect size (Hedges's g) of technology type and affected limb on physical function were calculated. (3) Results: Ten studies were included. The effect size of home-based rehabilitation in virtual reality had the greatest value (Hedges's g, 0.850; 95% CI, 0.314-1.385), followed by robot-assisted devices (Hedges's g, 0.120; 95% CI, 0.003-0.017) and games (Hedges's g, -0.162; 95% CI, -0.036 to -0.534). The effect size was larger in the upper limbs (Hedges's g, 0.287; 95% CI, 0.128-0.447) than in the lower limbs (Hedges's g, -0.113; 95% CI, -0.547 to 0.321). (4) Conclusions: Virtual reality home rehabilitation was highly effective for physical function compared to other rehabilitation technologies. Interventions that consisted of a pre-structured and tailored program applied to the upper limbs were effective for physical function and psychological outcomes.
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Affiliation(s)
- Soo-Kyung Bok
- Department of Rehabilitation, College of Medicine, Chungnam National University, Daejeon 35015, Republic of Korea
| | - Youngshin Song
- Department of Nursing, College of Nursing, Chungnam National University, Daejeon 35015, Republic of Korea
| | - Ancho Lim
- Department of Nursing, College of Nursing, Chungnam National University, Daejeon 35015, Republic of Korea
| | - Sohyun Jin
- Department of Nursing, College of Nursing, Chungnam National University, Daejeon 35015, Republic of Korea
| | - Nagyeong Kim
- Department of Nursing, College of Nursing, Chungnam National University, Daejeon 35015, Republic of Korea
| | - Geumbo Ko
- Department of Nursing, College of Nursing, Chungnam National University, Daejeon 35015, Republic of Korea
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17
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Sheng B, Zhao J, Zhang Y, Xie S, Tao J. Commercial device-based hand rehabilitation systems for stroke patients: State of the art and future prospects. Heliyon 2023; 9:e13588. [PMID: 36873497 PMCID: PMC9982629 DOI: 10.1016/j.heliyon.2023.e13588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/26/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023] Open
Abstract
Various hand rehabilitation systems have recently been developed for stroke patients, particularly commercial devices. Articles from 10 electronic databases from 2010 to 2022 were extracted to conduct a systematic review to explore the existing commercial training systems (hardware and software) and evaluate their clinical effectiveness. This review divided the rehabilitation equipment into contact and non-contact types. Game-based training protocols were further classified into two types: immersion and non-immersion. The results of the review indicated that the majority of the devices included were effective in improving hand function. Users who underwent rehabilitation training with these devices reported improvements in their hand function. Game-based training protocols were particularly appealing as they helped reduce boredom during rehabilitation training sessions. However, the review also identified some common technical drawbacks in the devices, particularly in non-contact devices, such as their vulnerability to the effects of light. Additionally, it was found that currently, there is no commercially available game-based training protocol that specifically targets hand rehabilitation. Given the ongoing COVID-19 pandemic, there is a need to develop safer non-contact rehabilitation equipment and more engaging training protocols for community and home-based rehabilitation. Additionally, the review suggests the need for revisions or the development of new clinical scales for hand rehabilitation evaluation that consider the current scenario, where in-person interactions might be limited.
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Affiliation(s)
- Bo Sheng
- School of Mechatronic Engineering and Automation, Shanghai University, 99 Shangda Road, Baoshan, Shanghai, China
| | - Jianyu Zhao
- School of Mechatronic Engineering and Automation, Shanghai University, 99 Shangda Road, Baoshan, Shanghai, China
| | - Yanxin Zhang
- Department of Exercise Sciences, The University of Auckland, 4703906, Newmarket, Auckland, New Zealand
| | - Shengquan Xie
- School of Electronic and Electrical Engineering, University of Leeds, 3 LS2 9JT, Leeds, United Kingdom
| | - Jing Tao
- School of Mechatronic Engineering and Automation, Shanghai University, 99 Shangda Road, Baoshan, Shanghai, China
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18
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Ranzani R, Chiriatti G, Schwarz A, Devittori G, Gassert R, Lambercy O. An online method to monitor hand muscle tone during robot-assisted rehabilitation. Front Robot AI 2023; 10:1093124. [PMID: 36814447 PMCID: PMC9939644 DOI: 10.3389/frobt.2023.1093124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/24/2023] [Indexed: 02/08/2023] Open
Abstract
Introduction: Robot-assisted neurorehabilitation is becoming an established method to complement conventional therapy after stroke and provide intensive therapy regimes in unsupervised settings (e.g., home rehabilitation). Intensive therapies may temporarily contribute to increasing muscle tone and spasticity, especially in stroke patients presenting tone alterations. If sustained without supervision, such an increase in muscle tone could have negative effects (e.g., functional disability, pain). We propose an online perturbation-based method that monitors finger muscle tone during unsupervised robot-assisted hand therapy exercises. Methods: We used the ReHandyBot, a novel 2 degrees of freedom (DOF) haptic device to perform robot-assisted therapy exercises training hand grasping (i.e., flexion-extension of the fingers) and forearm pronosupination. The tone estimation method consisted of fast (150 ms) and slow (250 ms) 20 mm ramp-and-hold perturbations on the grasping DOF, which were applied during the exercises to stretch the finger flexors. The perturbation-induced peak force at the finger pads was used to compute tone. In this work, we evaluated the method performance in a stiffness identification experiment with springs (0.97 and 1.57 N/mm), which simulated the stiffness of a human hand, and in a pilot study with subjects with increased muscle tone after stroke and unimpaired, which performed one active sensorimotor exercise embedding the tone monitoring method. Results: The method accurately estimates forces with root mean square percentage errors of 3.8% and 11.3% for the soft and stiff spring, respectively. In the pilot study, six chronic ischemic stroke patients [141.8 (56.7) months after stroke, 64.3 (9.5) years old, expressed as mean (std)] and ten unimpaired subjects [59.9 (6.1) years old] were tested without adverse events. The average reaction force at the level of the fingertip during slow and fast perturbations in the exercise were respectively 10.7 (5.6) N and 13.7 (5.6) N for the patients and 5.8 (4.2) N and 6.8 (5.1) N for the unimpaired subjects. Discussion: The proposed method estimates reaction forces of physical springs accurately, and captures online increased reaction forces in persons with stroke compared to unimpaired subjects within unsupervised human-robot interactions. In the future, the identified range of muscle tone increase after stroke could be used to customize therapy for each subject and maintain safety during intensive robot-assisted rehabilitation.
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Affiliation(s)
- Raffaele Ranzani
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Giorgia Chiriatti
- Department of Industrial Engineering and Mathematical Science, Polytechnic University of Marche, Ancona, Italy
| | - Anne Schwarz
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Giada Devittori
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore—ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore—ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore
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Westlake K, Akinlosotu R, Udo J, Goldstein Shipper A, Waller SM, Whitall J. Some home-based self-managed rehabilitation interventions can improve arm activity after stroke: A systematic review and narrative synthesis. Front Neurol 2023; 14:1035256. [PMID: 36816549 PMCID: PMC9932529 DOI: 10.3389/fneur.2023.1035256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/06/2023] [Indexed: 02/05/2023] Open
Abstract
Background There is an increased need for home-based, self-managed, and low maintenance stroke rehabilitation as well as interest in targeting the arm, which often lags behind leg recovery. Previous reviews have not controlled for concurrent standard of care and the ratio of self-managed care to therapist input. Objectives To determine the effectiveness of home-based, self-managed and low maintenance programs for upper-limb motor recovery in individuals after stroke. A secondary objective explored the adherence to home-based self-managed programs. Data sources We searched PubMed (1809-present), Embase (embase.com, 1974-present), Cochrane CENTRAL Register of Controlled Trials (Wiley), CINAHL (EBSCOhost, 1937-present), Physiotherapy Evidence Database (pedro.org.au), OTseeker (otseeker.com), and REHABDATA (National Rehabilitation Information Center). All searches were completed on June 9, 2022. Bibliographic references of included articles also were searched. Eligibility criteria Randomized controlled trials (RCT) in adults after stroke, where both intervention and control were home-based, at least 75% self-managed and did not involve concurrent therapy as a confounding factor. Primary outcome was performance in functional motor activities after training. Secondary outcome was sensorimotor impairment. All outcomes after a retention period were also considered secondary outcomes. Data collection and analysis Two review authors independently screened titles/abstracts, three review authors screened full papers and extracted data, and two review authors undertook assessment of risk of bias (i.e., allocation bias, measurement bias, confounding factors) using the NHLBI Study Quality Assessment Tool. Main results We identified seven heterogenous studies, including five with fair to good quality. All studies had an alternative treatment, dose-equivalent control. Only one trial reported a positive, sustained, between-group effect on activity for the experimental group. The remaining studies reported seven interventions having a within-group training effect with three interventions having sustained effects at follow up. One study reported a between group effect on an impairment measure with no follow-up. Overall adherence rates were high, but three studies reported differential group rates. Compliance with daily logs was higher when the logs were collected on a weekly basis. Limitations By excluding studies that allowed concurrent therapy, we likely minimized the number of studies that included participants in the early sub-acute post-stroke stage. By focusing on RCTs, we are unable to comment on other potentially promising home-based, self-managed single cohort programs. By including only published and English language studies, we may have included publication bias. Conclusions and implications There is some evidence that a variety of home-based, self-managed training program can be beneficial after stroke. Future research could compare such programs with natural history controls. Clinicians might utilize home exercise programs with explicit directions and some form of weekly contact to aid compliance.
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Affiliation(s)
- Kelly Westlake
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States
| | - Ruth Akinlosotu
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States
| | - Jean Udo
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States
| | - Andrea Goldstein Shipper
- Health Sciences and Human Services Library, University of Maryland, Baltimore, MD, United States
| | - Sandy McCombe Waller
- Division of Health, Business, Technology, and Science, Frederick Community College, Frederick, MD, United States
| | - Jill Whitall
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States
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Zhu Y, Wang C, Li J, Zeng L, Zhang P. Effect of different modalities of artificial intelligence rehabilitation techniques on patients with upper limb dysfunction after stroke-A network meta-analysis of randomized controlled trials. Front Neurol 2023; 14:1125172. [PMID: 37139055 PMCID: PMC10150552 DOI: 10.3389/fneur.2023.1125172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/21/2023] [Indexed: 05/05/2023] Open
Abstract
Background This study aimed to observe the effects of six different types of AI rehabilitation techniques (RR, IR, RT, RT + VR, VR and BCI) on upper limb shoulder-elbow and wrist motor function, overall upper limb function (grip, grasp, pinch and gross motor) and daily living ability in subjects with stroke. Direct and indirect comparisons were drawn to conclude which AI rehabilitation techniques were most effective in improving the above functions. Methods From establishment to 5 September 2022, we systematically searched PubMed, EMBASE, the Cochrane Library, Web of Science, CNKI, VIP and Wanfang. Only randomized controlled trials (RCTs) that met the inclusion criteria were included. The risk of bias in studies was evaluated using the Cochrane Collaborative Risk of Bias Assessment Tool. A cumulative ranking analysis by SUCRA was performed to compare the effectiveness of different AI rehabilitation techniques for patients with stroke and upper limb dysfunction. Results We included 101 publications involving 4,702 subjects. According to the results of the SUCRA curves, RT + VR (SUCRA = 84.8%, 74.1%, 99.6%) was most effective in improving FMA-UE-Distal, FMA-UE-Proximal and ARAT function for subjects with upper limb dysfunction and stroke, respectively. IR (SUCRA = 70.5%) ranked highest in improving FMA-UE-Total with upper limb motor function amongst subjects with stroke. The BCI (SUCRA = 73.6%) also had the most significant advantage in improving their MBI daily living ability. Conclusions The network meta-analysis (NMA) results and SUCRA rankings suggest RT + VR appears to have a greater advantage compared with other interventions in improving upper limb motor function amongst subjects with stroke in FMA-UE-Proximal and FMA-UE-Distal and ARAT. Similarly, IR had shown the most significant advantage over other interventions in improving the FMA-UE-Total upper limb motor function score of subjects with stroke. The BCI also had the most significant advantage in improving their MBI daily living ability. Future studies should consider and report on key patient characteristics, such as stroke severity, degree of upper limb impairment, and treatment intensity/frequency and duration. Systematic review registration www.crd.york.ac.uk/prospero/#recordDetail, identifier: CRD42022337776.
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Affiliation(s)
- Yu Zhu
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
- Linfen Central Hospital, Linfen, Shanxi, China
| | - Chen Wang
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Jin Li
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Liqing Zeng
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Peizhen Zhang
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
- *Correspondence: Peizhen Zhang
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21
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Bressi F, Cricenti L, Campagnola B, Bravi M, Miccinilli S, Santacaterina F, Sterzi S, Straudi S, Agostini M, Paci M, Casanova E, Marino D, La Rosa G, Giansanti D, Perrero L, Battistini A, Filoni S, Sicari M, Petrozzino S, Solaro CM, Gargano S, Benanti P, Boldrini P, Bonaiuti D, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzoleni S, Mazzon S, Molteni F, Petrarca M, Picelli A, Posteraro F, Senatore M, Turchetti G, Morone G, Gallotti M, Germanotta M, Aprile I. Effects of robotic upper limb treatment after stroke on cognitive patterns: A systematic review. NeuroRehabilitation 2022; 51:541-558. [PMID: 36530099 PMCID: PMC9837692 DOI: 10.3233/nre-220149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Robotic therapy (RT) has been internationally recognized for the motor rehabilitation of the upper limb. Although it seems that RT can stimulate and promote neuroplasticity, the effectiveness of robotics in restoring cognitive deficits has been considered only in a few recent studies. OBJECTIVE To verify whether, in the current state of the literature, cognitive measures are used as inclusion or exclusion criteria and/or outcomes measures in robotic upper limb rehabilitation in stroke patients. METHODS The systematic review was conducted according to PRISMA guidelines. Studies eligible were identified through PubMed/MEDLINE and Web of Science from inception to March 2021. RESULTS Eighty-one studies were considered in this systematic review. Seventy-three studies have at least a cognitive inclusion or exclusion criteria, while only seven studies assessed cognitive outcomes. CONCLUSION Despite the high presence of cognitive instruments used for inclusion/exclusion criteria their heterogeneity did not allow the identification of a guideline for the evaluation of patients in different stroke stages. Therefore, although the heterogeneity and the low percentage of studies that included cognitive outcomes, seemed that the latter were positively influenced by RT in post-stroke rehabilitation. Future larger RCTs are needed to outline which cognitive scales are most suitable and their cut-off, as well as what cognitive outcome measures to use in the various stages of post-stroke rehabilitation.
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Affiliation(s)
- Federica Bressi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Laura Cricenti
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Benedetta Campagnola
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy,Address for correspondence: Benedetta Campagnola, Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy. E-mail:
| | - Marco Bravi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Sandra Miccinilli
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Fabio Santacaterina
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Silvia Sterzi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| | | | - Matteo Paci
- AUSL (Unique Sanitary Local Company) District of Central Tuscany, Florence, Italy
| | - Emanuela Casanova
- Unità Operativa di Medicina Riabilitativa e Neuroriabilitazione (SC), IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Dario Marino
- IRCCS Neurolysis Center “Bonino Pulejo”, Messina, Italy
| | | | - Daniele Giansanti
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Luca Perrero
- Neurorehabilitation Unit, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Alberto Battistini
- Unità Operativa di Medicina Riabilitativa e Neuroriabilitazione (SC), IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Serena Filoni
- Padre Pio Onlus Rehabilitation Centers Foundation, San Giovanni Rotondo, Italy
| | - Monica Sicari
- A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | | | | | - Paolo Boldrini
- Società Italiana di Medicina Fisica e Riabilitativa (SIMFER), Rome, Italy
| | | | - Enrico Castelli
- Department of Paediatric Neurorehabilitation, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (Faip Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental, Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy
| | - Stefano Mazzon
- AULSS6 (Unique Sanitary Local Company) Euganea Padova – Distretto 4 “Alta Padovana”, Padua, Italy
| | - Franco Molteni
- Department of Rehabilitation Medicine, Villa Beretta Rehabilitation Center, Valduce Hospital, Lecco, Italy
| | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory (MARlab), IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Posteraro
- Department of Rehabilitation, Versilia Hospital – AUSL12, Viareggio, Italy
| | - Michele Senatore
- Associazione Italiana dei Terapisti Occupazionali (AITO), Rome, Italy
| | | | | | | | | | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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Feldhacker DR, Jewell VD, Jung LeSage S, Collins H, Lohman H, Russell M. Telehealth Interventions Within the Scope of Occupational Therapy Practice: A Systematic Review. Am J Occup Ther 2022; 76:23960. [DOI: 10.5014/ajot.2022.049417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract
Importance: With the increasing use of telehealth, it is imperative to synthesize the existing evidence to examine the effectiveness of telehealth interventions and inform practitioners and reimbursement entities.
Objective: To examine the effectiveness of telehealth occupational therapy interventions across the lifespan, delivered either independently or as part of an interdisciplinary team.
Data Sources: MEDLINE, CINAHL, SAGE, PsycInfo, Cochrane Database of Systematic Reviews, OTseeker, and OT Search and hand searches of systematic reviews, relevant journals, and known occupational therapy telehealth research.
Study Selection and Data Collection: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we screened and appraised articles that included an occupational therapy intervention delivered via telehealth and that were peer reviewed, written in English, published between 2009 and 2019, and Levels 1b to 3b evidence.
Findings: Twenty full-text articles (8 Level 1b, 9 Level 2b, and 3 Level 3b) met the inclusion criteria. Strong strength of evidence supports the use of telehealth approaches for occupational therapy interventions for people with neurological and pain conditions. Moderate strength of evidence supports the use of telehealth interventions to support education outcomes. Low strength of evidence was found for other outcomes for children with developmental disorders and additional conditions.
Conclusions and Relevance: There is evidence to support that occupational therapy interventions delivered via telehealth are similarly effective as those delivered face-to-face, especially for neurological and pain conditions.
What This Article Adds: The findings include an updated synthesis of telehealth occupational therapy interventions provided separately and with interdisciplinary health care teams. They expand occupational therapy’s scope of practice to include interventions provided across the lifespan for rehabilitation and habilitation needs and include effectiveness by conditions.
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Affiliation(s)
- Diana R. Feldhacker
- Diana R. Feldhacker, PhD, OTD, OTR/L, BCPR, is Program Director, Department Chair, and Assistant Professor, Department of Occupational Therapy, Des Moines University, Des Moines, IA;
| | - Vanessa D. Jewell
- Vanessa D. Jewell, PhD, OTR/L, is Research Associate Professor, Division of Occupational Science and Occupational Therapy, University of North Carolina at Chapel Hill
| | - Sadie Jung LeSage
- Sadie Jung LeSage, OTD, OTR/L, is Occupational Therapist, Monkey Mouths LLC, Hurst, TX
| | - Haley Collins
- Haley Collins, OTD, OTR/L, is Occupational Therapist, Milestone Pediatric Therapy Services, Denver, CO
| | - Helene Lohman
- Helene Lohman, OTD, OTR/L, FAOTA, is Professor, Department of Occupational Therapy, Creighton University, Omaha, NE
| | - Marion Russell
- Marion Russell, OTD, MOTR/L, SCFES, is Assistant Professor, Department of Occupational Therapy, Creighton University, Omaha, NE
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Zhi JF, Liao QH, He YB, Xu WW, Zhu DW, Shao LH. Superior treatment efficacy of neuromodulation rehabilitation for upper limb recovery after stroke: a meta-analysis. Expert Rev Neurother 2022; 22:875-888. [PMID: 36242781 DOI: 10.1080/14737175.2022.2137405] [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: 12/13/2022]
Abstract
BACKGROUND This study aims to explore the treatment efficacy of different motor rehabilitation interventions for upper limb impairment recovery. RESEARCH DESIGN & METHODS Publications were searched in PubMed and Embase. 4 grouped motor rehabilitation treatments (training, technological intervention, pharmacological intervention, and neuromodulation) were compared. The change of the Fugl-Meyer Assessment Scale for Upper Extremity (FMA-UE) was applied to assess upper limb function after stroke. RESULTS 56 studies including 5292 patients were identified. A significant difference was found among the 4 groups (P = 0.02). Neuromodulation interventions had the best treatment efficacy among the 4 types of interventions (P < 0.01). Among neuromodulation interventions, acupuncture, electric, or magnetic intervention all had therapeutic efficacy for stroke upper limb recovery, without significant subgroup difference (P = 0.34). Stroke patients with mild upper limb impairment might not benefit from motor rehabilitation (P = 0.14). CONCLUSION Neuromodulation interventions might have the best therapeutic efficacy among motor rehabilitation treatments for upper limb impairment after stroke. It is a potential treatment direction for upper limb recovery among stroke patients. However, since a large proportion of the original studies are low to very low-quality evidence, large-scale RCTs should be conducted in the future to validate current findings and assess treatment effects based on patient characteristics.
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Affiliation(s)
- Jian-Feng Zhi
- Department of Rehabilitation Medicine, the First People's Hospital of Jiashan/Jiashan Branch of the Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Qing-Hong Liao
- Department of Rehabilitation Medicine, the First People's Hospital of Jiashan/Jiashan Branch of the Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Yu-Bo He
- Department of Rehabilitation Medicine, the First People's Hospital of Jiashan/Jiashan Branch of the Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Wen-Wen Xu
- Department of Rehabilitation Medicine, the First People's Hospital of Jiashan/Jiashan Branch of the Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Dan-Wei Zhu
- Department of Rehabilitation Medicine, the First People's Hospital of Jiashan/Jiashan Branch of the Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Lin-Hong Shao
- Department of Rehabilitation Medicine, the First People's Hospital of Jiashan/Jiashan Branch of the Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
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24
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Newcomer V, Metzinger M, Vick S, Robertson C, Lawrence T, Glass A, Elliott L, Williams A. A Stroke Rehabilitation Educational Program for Occupational Therapy Students and Practitioners: Usability Study. JMIR MEDICAL EDUCATION 2022; 8:e35637. [PMID: 36178717 PMCID: PMC9568821 DOI: 10.2196/35637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/12/2022] [Accepted: 09/02/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND There are gaps in knowledge translation (KT) of current evidence-based practices regarding stroke assessment and rehabilitation delivered through teletherapy. A lack of this knowledge can prevent occupational therapy (OT) students and practitioners from implementing current research findings. OBJECTIVE The aim of this pilot study was to create an educational program to translate knowledge into practice regarding the remote delivery of stroke assessment and rehabilitation to OT students and practitioners. Four areas of focus were addressed in the educational program, including KT, task-oriented training, stroke assessments, and telerehabilitation. METHODS Two pilot studies were conducted to assess the knowledge gained via pretests and posttests of knowledge, followed by a System Usability Scale and general feedback questionnaire. Participants in study 1 were 5 OT practitioners and 1 OT assistant. Participants in study 2 were 9 current OT students. Four 1-hour modules were emailed weekly to participants over the course of 4 weeks, with each module covering a different topic (KT, task-oriented training, stroke assessments, and telerehabilitation). Preliminary results were reviewed using descriptive statistics. RESULTS Statistically significant results were found with increased scores of knowledge for both students and practitioners. Most of the educational modules had an above-average score regarding value and positive feedback for the educational program as a whole from the participants. CONCLUSIONS Overall, the results of this pilot study indicate that a web-based educational program is a valuable, informational method of increasing the translation of knowledge in the remote delivery of stroke assessment and rehabilitation. OT students and practitioners found the information presented to be valuable and relevant to their future profession and current practice.
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Affiliation(s)
- Valerie Newcomer
- Department of Occupational Therapy, Georgia State University, Atlanta, GA, United States
| | - Megan Metzinger
- Department of Occupational Therapy, Georgia State University, Atlanta, GA, United States
| | - Sydney Vick
- Department of Occupational Therapy, Georgia State University, Atlanta, GA, United States
| | - Caroline Robertson
- Department of Occupational Therapy, Georgia State University, Atlanta, GA, United States
| | - Taylor Lawrence
- Department of Occupational Therapy, Georgia State University, Atlanta, GA, United States
| | - Amanda Glass
- Department of Occupational Therapy, Georgia State University, Atlanta, GA, United States
| | - Lauren Elliott
- Department of Occupational Therapy, Georgia State University, Atlanta, GA, United States
| | - Ansleigh Williams
- Department of Occupational Therapy, Georgia State University, Atlanta, GA, United States
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25
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Toh SFM, Chia PF, Fong KNK. Effectiveness of home-based upper limb rehabilitation in stroke survivors: A systematic review and meta-analysis. Front Neurol 2022; 13:964196. [PMID: 36188398 PMCID: PMC9521568 DOI: 10.3389/fneur.2022.964196] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/08/2022] [Indexed: 12/04/2022] Open
Abstract
Background Home-based training is an alternative option to provide intensive rehabilitation without costly supervised therapy. Though several studies support the effectiveness of home-based rehabilitation in improving hemiparetic upper limb function in stroke survivors, a collective evaluation of the evidence remains scarce. Objectives This study aims to determine the effects of home-based upper limb rehabilitation for hemiparetic upper limb recovery in stroke survivors. Methods The databases of the Cochrane Library, MEDLINE, CINAHL, and Web of Science were systematically searched from January 2000 to September 2020. Only randomized, controlled, and cross-over trials that evaluated the effects of home-based upper limb interventions were selected. The Pedro scale was used to assess the methodological quality of the studies. A meta-analysis of the upper limb function outcomes was performed by calculating the mean difference/standardized mean difference using a fixed/random effect model. Results An initial search yielded 1,049 articles. Twenty-six articles were included in the review. The pooled evidence of the meta-analysis showed that home-based upper limb intervention was more effective in improving upper limb function [SMD: 0.28, 95% CI (0.12, 0.44), I2 = 0%, p < 0.001, fixed effect model] than conventional therapy. When comparing two types of home-based interventions, subgroup analysis revealed that home-based technology treatment—electrical stimulation—provided more significant improvement in upper limb function than treatment without the use of technology (SMD: 0.64, 95% CI (0.21, 1.07), I2 = 0%, p = 0.003, random effect model). Conclusion The beneficial effects of home-based upper limb interventions were superior to conventional therapy in improving function and perceived use of the hemiparetic upper limb in daily activities. Among the home-based interventions, home-based electrical stimulation seemed to provide the most optimal benefits.
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Affiliation(s)
- Sharon Fong Mei Toh
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Department of Rehabilitation, Yishun Community Hospital, Singapore, Singapore
| | - Pei Fen Chia
- Department of Occupational Therapy, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kenneth N. K. Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- *Correspondence: Kenneth N. K. Fong
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26
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Gelineau A, Perrochon A, Robin L, Daviet JC, Mandigout S. Measured and Perceived Effects of Upper Limb Home-Based Exergaming Interventions on Activity after Stroke: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9112. [PMID: 35897472 PMCID: PMC9329711 DOI: 10.3390/ijerph19159112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 01/25/2023]
Abstract
After discharge from the hospital to home, stroke patients may experience weakness and reduced movement in their hemiparetic arms that limits their ability to perform daily activities. Therapists can use exercise games (exergames) to maintain functional abilities and daily use of the arm at home. A systematic review and meta-analysis was conducted to determine the efficiency of upper limb home-based rehabilitation, using exergaming on activity abilities in stroke. Randomized controlled trials were reviewed in the CENTRAL, MEDLINE, CINAHL, EMBASE, and SCOPUS online databases. Clinical measures of observation and self-reporting were studied in post-intervention and follow-up. Nine studies were included in this systematic review (535 participants). The Physiotherapy Evidence Database (PEDro) score was 6.6/10 (SD 1.0, range 5-8), indicating good quality. This systematic review and meta-analysis showed that upper limb home-based exergaming interventions were no more effective in terms of activity than conventional therapy after stroke, according to the observational and subjective assessments in post-intervention and follow-up. Using this same approach, future studies should focus on evaluating home-based exergames through subgroup analysis to be able to propose recommendations.
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Affiliation(s)
- Axelle Gelineau
- HAVAE Laboratory UR 20217, University of Limoges, 87000 Limoges, France; (A.P.); (L.R.); (J.-C.D.); (S.M.)
| | - Anaick Perrochon
- HAVAE Laboratory UR 20217, University of Limoges, 87000 Limoges, France; (A.P.); (L.R.); (J.-C.D.); (S.M.)
| | - Louise Robin
- HAVAE Laboratory UR 20217, University of Limoges, 87000 Limoges, France; (A.P.); (L.R.); (J.-C.D.); (S.M.)
| | - Jean-Christophe Daviet
- HAVAE Laboratory UR 20217, University of Limoges, 87000 Limoges, France; (A.P.); (L.R.); (J.-C.D.); (S.M.)
- Department of Physical Medicine and Rehabilitation, University Hospital Center, 87000 Limoges, France
| | - Stéphane Mandigout
- HAVAE Laboratory UR 20217, University of Limoges, 87000 Limoges, France; (A.P.); (L.R.); (J.-C.D.); (S.M.)
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Zhao M, Wang G, Wang A, Cheng LJ, Lau Y. Robot-assisted distal training improves upper limb dexterity and function after stroke: a systematic review and meta-regression. Neurol Sci 2022; 43:1641-1657. [PMID: 35089447 DOI: 10.1007/s10072-022-05913-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/23/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Stroke is one of the top 10 causes of death worldwide, and more than half of stroke patients face distal upper extremity dysfunction. Considering that robot-assisted training may be effective in improving distal upper extremity function, the review evaluated the effect of robot-assisted distal training on motor function, hand dexterity, and spasticity after stroke. METHODS Eleven databases were systematically searched for randomised controlled trials (RCTs) from inception until Aug 28, 2021. Meta-analysis and meta-regression were performed to investigate the overall effect and source of heterogeneity, respectively. RESULTS Twenty-two trials involving 758 participants were included in this systematic review. The overall effect of robot-assisted distal training on the motor function of the wrists and hands was significant improvement (MD = 3.92; 95% CI, 3.04-4.80; P < 0.001). The robot-assisted training had a significantly beneficial effect on other motor functions (MD = 2.84; 95% CI, 1.54-4.14; P < 0.001); dexterity (MD = 9.01; 95% CI, -12.07--5.95; P < 0.001), spasticity, upper extremity strength (SMD = 0.42; 95% CI, 0.07-0.78; P = 0.02) and activities of daily living (SMD = 0.70; 95% CI, 0.29-1.23; P < 0.001). A series of subgroup analyses showed preferable design and effective regime of training. Meta-regression indicated the statistically significant effect of the year of trial, country, and duration on the effectiveness of training. CONCLUSION Robot-assisted distal training has a significant effect on motor function, dexterity and spasticity of the upper extremity, compared to conventional therapy.
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Affiliation(s)
- Menglu Zhao
- The Affiliated Hospital of Qingdao University, Shandong, Qingdao, China
| | | | - Aimin Wang
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Ling Jie Cheng
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore.
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Telerehabilitation in response to constrained physical distance: an opportunity to rethink neurorehabilitative routines. J Neurol 2022. [PMID: 33449202 DOI: 10.1007/s00415-021-10397-w/tables/2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Ensuring proper dosage of treatment and repetition over time is a major challenge in neurorehabilitation. However, a requirement of physical distancing to date compromises their achievement. While mostly associated to COVID-19, physical distancing is not only required in a pandemic scenario, but also advised for several clinical conditions (e.g. immunocompromised individuals) or forced for specific social contexts (e.g. people living in remote areas worldwide). All these contexts advocate for the implementation of alternative healthcare models. The objective of this perspective is to highlight the benefits of remote administration of rehabilitative treatment, namely telerehabilitation, in counteracting physical distancing barriers in neurorehabilitation. Sustaining boosters of treatment outcome, such as compliance, sustainability, as well as motivation, telerehabilitation may adapt to multiple neurological conditions, with the further advantage of a high potential for individualization to patient's or pathology's specificities. The effectiveness of telerehabilitation can be potentiated by several technologies available to date: virtual reality can recreate realistic environments in which patients may bodily operate, wearable sensors allow to quantitatively monitor the patient's performance, and signal processing may contribute to the prediction of long-term dynamics of patient recovery. Telerehabilitation might spark its advantages far beyond the mere limitation of physical distancing effects, mitigating criticalities of daily neurorehabilitative practice, and thus paving the way to the envision of mixed models of care, where hospital-based procedures are complementarily integrated with telerehabilitative ones.
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29
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Everard G, Luc A, Doumas I, Ajana K, Stoquart G, Edwards MG, Lejeune T. Self-Rehabilitation for Post-Stroke Motor Function and Activity-A Systematic Review and Meta-Analysis. Neurorehabil Neural Repair 2021; 35:1043-1058. [PMID: 34696645 DOI: 10.1177/15459683211048773] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Due to an increasing stroke incidence, a lack of resources to implement effective rehabilitation and a significant proportion of patients with remaining impairments after treatment, there is a rise in demand for effective and prolonged rehabilitation. Development of self-rehabilitation programs provides an opportunity to meet these increasing demands.Objective. The primary aim of this meta-analysis was to determine the effect of self-rehabilitation on motor outcomes, in comparison to conventional rehabilitation, among patients with stroke. The secondary aim was to assess the influence of trial location (continent), technology, time since stroke (acute/subacute vs chronic), dose (total training duration > vs ≤ 15 hours), and intervention design (self-rehabilitation in addition/substitution to conventional therapy) on effect of self-rehabilitation.Methods. Studies were selected if participants were adults with stroke; the intervention consisted of a self-rehabilitation program defined as a tailored program where for most of the time, the patient performed rehabilitation exercises independently; the control group received conventional therapy; outcomes included motor function and activity; and the study was a randomized controlled trial with a PEDro score ≥5.Results. Thirty-five trials were selected (2225 participants) and included in quantitative synthesis regarding motor outcomes. Trials had a median PEDro Score of 7 [6-8]. Self-rehabilitation programs were shown to be as effective as conventional therapy. Trial location, use of technology, stroke stage, and intervention design did not appear to have a significant influence on outcomes.Conclusion. This meta-analysis showed low to moderate evidence that self-rehabilitation and conventional therapy efficacy was equally valuable for post-stroke motor function and activity.
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Affiliation(s)
- Gauthier Everard
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, 193391Université catholique de Louvain, Brussels, Belgium.,Louvain Bionics, 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Alexandre Luc
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, 193391Université catholique de Louvain, Brussels, Belgium
| | - Ioannis Doumas
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, 193391Université catholique de Louvain, Brussels, Belgium.,Louvain Bionics, 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium.,Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Khawla Ajana
- Psychological Sciences Research Institute (IPSY), 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Gaëtan Stoquart
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, 193391Université catholique de Louvain, Brussels, Belgium.,Louvain Bionics, 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium.,Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Martin Gareth Edwards
- Louvain Bionics, 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium.,Psychological Sciences Research Institute (IPSY), 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Thierry Lejeune
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, 193391Université catholique de Louvain, Brussels, Belgium.,Louvain Bionics, 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium.,Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium
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30
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Uswatte G, Taub E, Lum P, Brennan D, Barman J, Bowman MH, Taylor A, McKay S, Sloman SB, Morris DM, Mark VW. Tele-rehabilitation of upper-extremity hemiparesis after stroke: Proof-of-concept randomized controlled trial of in-home Constraint-Induced Movement therapy. Restor Neurol Neurosci 2021; 39:303-318. [PMID: 34459426 DOI: 10.3233/rnn-201100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although Constraint-Induced Movement therapy (CIMT) has been deemed efficacious for adults with persistent, mild-to-moderate, post-stroke upper-extremity hemiparesis, CIMT is not available on a widespread clinical basis. Impediments include its cost and travel to multiple therapy appointments. To overcome these barriers, we developed an automated, tele-health form of CIMT. OBJECTIVE Determine whether in-home, tele-health CIMT has outcomes as good as in-clinic, face-to-face CIMT in adults ≥1-year post-stroke with mild-to-moderate upper-extremity hemiparesis. METHODS Twenty-four stroke patients with chronic upper-arm extremity hemiparesis were randomly assigned to tele-health CIMT (Tele-AutoCITE) or in-lab CIMT. All received 35 hours of treatment. In the tele-health group, an automated, upper-extremity workstation with built-in sensors and video cameras was set-up in participants' homes. Internet-based audio-visual and data links permitted supervision of treatment by a trainer in the lab. RESULTS Ten patients in each group completed treatment. All twenty, on average, showed very large improvements immediately afterwards in everyday use of the more-affected arm (mean change on Motor Activity Log Arm Use scale = 2.5 points, p < 0.001, d' = 3.1). After one-year, a large improvement from baseline was still present (mean change = 1.8, p < 0.001, d' = 2). Post-treatment outcomes in the tele-health group were not inferior to those in the in-lab group. Neither were participants' perceptions of satisfaction with and difficulty of the interventions. Although everyday arm use was similar in the two groups after one-year (mean difference = -0.1, 95% CI = -1.3-1.0), reductions in the precision of the estimates of this parameter due to drop-out over follow-up did not permit ruling out that the tele-health group had an inferior long-term outcome. CONCLUSIONS This proof-of-concept study suggests that Tele-AutoCITE produces immediate benefits that are equivalent to those after in-lab CIMT in stroke survivors with chronic upper-arm extremity hemiparesis. Cost savings possible with this tele-health approach remain to be evaluated.
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Affiliation(s)
- Gitendra Uswatte
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,Department of Physical Therapy, UAB, Birmingham, AL, USA
| | - Edward Taub
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Peter Lum
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC, USA
| | - David Brennan
- MedStar Telehealth Innovation Center, MedStar Institute for Innovations, Washington, DC, USA
| | - Joydip Barman
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Mary H Bowman
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Andrea Taylor
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Staci McKay
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Samantha B Sloman
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - David M Morris
- Department of Physical Therapy, UAB, Birmingham, AL, USA
| | - Victor W Mark
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,Department of Physical Medicine & Rehabilitation, UAB, Birmingham, AL, USA.,Department of Neurology, UAB, Birmingham, AL, USA
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31
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Hung NT, Paul V, Prakash P, Kovach T, Tacy G, Tomic G, Park S, Jacobson T, Jampol A, Patel P, Chappel A, King E, Slutzky MW. Wearable myoelectric interface enables high-dose, home-based training in severely impaired chronic stroke survivors. Ann Clin Transl Neurol 2021; 8:1895-1905. [PMID: 34415114 PMCID: PMC8419406 DOI: 10.1002/acn3.51442] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/21/2022] Open
Abstract
Background High‐intensity occupational therapy can improve arm function after stroke, but many people lack access to such therapy. Home‐based therapies could address this need, but they don’t typically address abnormal muscle co‐activation, an important aspect of arm impairment. An earlier study using lab‐based, myoelectric computer interface game training enabled chronic stroke survivors to reduce abnormal co‐activation and improve arm function. Here, we assess feasibility of doing this training at home using a novel, wearable, myoelectric interface for neurorehabilitation training (MINT) paradigm. Objective Assess tolerability and feasibility of home‐based, high‐dose MINT therapy in severely impaired chronic stroke survivors. Methods Twenty‐three participants were instructed to train with the MINT and game for 90 min/day, 36 days over 6 weeks. We assessed feasibility using amount of time trained and game performance. We assessed tolerability (enjoyment and effort) using a customized version of the Intrinsic Motivation Inventory at the conclusion of training. Results Participants displayed high adherence to near‐daily therapy at home (mean of 82 min/day of training; 96% trained at least 60 min/day) and enjoyed the therapy. Training performance improved and co‐activation decreased with training. Although a substantial number of participants stopped training, most dropouts were due to reasons unrelated to the training paradigm itself. Interpretation Home‐based therapy with MINT is feasible and tolerable in severely impaired stroke survivors. This affordable, enjoyable, and mobile health paradigm has potential to improve recovery from stroke in a variety of settings. Clinicaltrials.gov: NCT03401762.
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Affiliation(s)
- Na-Teng Hung
- Department of Neurology, Northwestern University, Chicago, Illinois, 60611, USA
| | - Vivek Paul
- Department of Neurology, Northwestern University, Chicago, Illinois, 60611, USA
| | - Prashanth Prakash
- Department of Neurology, Northwestern University, Chicago, Illinois, 60611, USA
| | - Torin Kovach
- Department of Neurology, Northwestern University, Chicago, Illinois, 60611, USA
| | - Gene Tacy
- Myomo, Inc., Cambridge, Massachusetts, 02142, USA
| | - Goran Tomic
- Department of Neurology, Northwestern University, Chicago, Illinois, 60611, USA
| | - Sangsoo Park
- Department of Neurology, Northwestern University, Chicago, Illinois, 60611, USA
| | - Tyler Jacobson
- Department of Neurology, Northwestern University, Chicago, Illinois, 60611, USA
| | - Alix Jampol
- Department of Occupational Therapy, Northwestern Medicine, Chicago, Illinois, 60611, USA
| | - Pooja Patel
- Department of Occupational Therapy, Northwestern Medicine, Chicago, Illinois, 60611, USA
| | - Anya Chappel
- Department of Occupational Therapy, Northwestern Medicine, Chicago, Illinois, 60611, USA
| | - Erin King
- Department of Occupational Therapy, Northwestern Medicine, Chicago, Illinois, 60611, USA
| | - Marc W Slutzky
- Department of Neurology, Northwestern University, Chicago, Illinois, 60611, USA.,Departments of Physiology, Northwestern University, Chicago, Illinois, 60611, USA.,Departments of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, 60611, USA.,Departments of Biomedical Engineering, Northwestern University, Chicago, Illinois, 60611, USA
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32
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Singh N, Saini M, Kumar N, Srivastava MVP, Kumaran SS, Mehndiratta A. A Case Report: Effect of Robotic Exoskeleton Based Therapy on Neurological and Functional Recovery of a Patient With Chronic Stroke. Front Neurol 2021; 12:680733. [PMID: 34322080 PMCID: PMC8313089 DOI: 10.3389/fneur.2021.680733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background: In this study, a novel electromechanical robotic exoskeleton was developed for the rehabilitation of distal joints. The objective was to explore the functional MRI and the neurophysiological changes in cortical-excitability in response to exoskeleton training for a 9-year chronic stroke patient. Case-Report: The study involved a 52-year old female patient with a 9-year chronic stroke of the right hemisphere, who underwent 20 therapy sessions of 45 min each. Cortical-excitability and clinical-scales: Fugl-Mayer (FM), Modified Ashworth Scale (MAS), Brunnstrom-Stage (BS), Barthel-Index (BI), Range of Motion (ROM), were assessed pre-and post-therapy to quantitatively assess the motor recovery. Clinical Rehabilitation Impact: Increase in FM wrist/hand by 6, BI by 10, and decrease in MAS by 1 were reported. Ipsilesional Motor Evoked Potential (MEP) (obtained using Transcranial Magnetic Stimulation) was increased by 98 μV with a decrease in RMT by 6% and contralesional MEP was increased by 43 μV with a decrease in RMT by 4%. Laterality Index of Sensorimotor Cortex (SMC) reduced in precentral- gyrus (from 0.152 to -0.707) and in postcentral-gyrus (from 0.203 to -0.632). Conclusion: The novel exoskeleton-based training showed improved motor outcomes, cortical excitability, and neuronal activation. The research encourages the further investigation of the potential of exoskeleton training.
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Affiliation(s)
- Neha Singh
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi, India
| | - Megha Saini
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi, India
| | - Nand Kumar
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - M. V. Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - S. Senthil Kumaran
- Department of Nuclear Medicine and Resonance, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Amit Mehndiratta
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi, India
- Department of Biomedical Engineering, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Akbari A, Haghverd F, Behbahani S. Robotic Home-Based Rehabilitation Systems Design: From a Literature Review to a Conceptual Framework for Community-Based Remote Therapy During COVID-19 Pandemic. Front Robot AI 2021; 8:612331. [PMID: 34239898 PMCID: PMC8258116 DOI: 10.3389/frobt.2021.612331] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 06/01/2021] [Indexed: 01/24/2023] Open
Abstract
During the COVID-19 pandemic, the higher susceptibility of post-stroke patients to infection calls for extra safety precautions. Despite the imposed restrictions, early neurorehabilitation cannot be postponed due to its paramount importance for improving motor and functional recovery chances. Utilizing accessible state-of-the-art technologies, home-based rehabilitation devices are proposed as a sustainable solution in the current crisis. In this paper, a comprehensive review on developed home-based rehabilitation technologies of the last 10 years (2011-2020), categorizing them into upper and lower limb devices and considering both commercialized and state-of-the-art realms. Mechatronic, control, and software aspects of the system are discussed to provide a classified roadmap for home-based systems development. Subsequently, a conceptual framework on the development of smart and intelligent community-based home rehabilitation systems based on novel mechatronic technologies is proposed. In this framework, each rehabilitation device acts as an agent in the network, using the internet of things (IoT) technologies, which facilitates learning from the recorded data of the other agents, as well as the tele-supervision of the treatment by an expert. The presented design paradigm based on the above-mentioned leading technologies could lead to the development of promising home rehabilitation systems, which encourage stroke survivors to engage in under-supervised or unsupervised therapeutic activities.
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Affiliation(s)
| | | | - Saeed Behbahani
- Department of Mechanical Engineering, Isfahan University of Technology, Isfahan, Iran
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Doumas I, Everard G, Dehem S, Lejeune T. Serious games for upper limb rehabilitation after stroke: a meta-analysis. J Neuroeng Rehabil 2021; 18:100. [PMID: 34130713 PMCID: PMC8204490 DOI: 10.1186/s12984-021-00889-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 05/31/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Approximately two thirds of stroke survivors maintain upper limb (UL) impairments and few among them attain complete UL recovery 6 months after stroke. Technological progress and gamification of interventions aim for better outcomes and constitute opportunities in self- and tele-rehabilitation. OBJECTIVES Our objective was to assess the efficacy of serious games, implemented on diverse technological systems, targeting UL recovery after stroke. In addition, we investigated whether adherence to neurorehabilitation principles influenced efficacy of games specifically designed for rehabilitation, regardless of the device used. METHOD This systematic review was conducted according to PRISMA guidelines (PROSPERO registration number: 156589). Two independent reviewers searched PubMed, EMBASE, SCOPUS and Cochrane Central Register of Controlled Trials for eligible randomized controlled trials (PEDro score ≥ 5). Meta-analysis, using a random effects model, was performed to compare effects of interventions using serious games, to conventional treatment, for UL rehabilitation in adult stroke patients. In addition, we conducted subgroup analysis, according to adherence of included studies to a consolidated set of 11 neurorehabilitation principles. RESULTS Meta-analysis of 42 trials, including 1760 participants, showed better improvements in favor of interventions using serious games when compared to conventional therapies, regarding UL function (SMD = 0.47; 95% CI = 0.24 to 0.70; P < 0.0001), activity (SMD = 0.25; 95% CI = 0.05 to 0.46; P = 0.02) and participation (SMD = 0.66; 95% CI = 0.29 to 1.03; P = 0.0005). Additionally, long term effect retention was observed for UL function (SMD = 0.42; 95% CI = 0.05 to 0.79; P = 0.03). Interventions using serious games that complied with at least 8 neurorehabilitation principles showed better overall effects. Although heterogeneity levels remained moderate, results were little affected by changes in methods or outliers indicating robustness. CONCLUSION This meta-analysis showed that rehabilitation through serious games, targeting UL recovery after stroke, leads to better improvements, compared to conventional treatment, in three ICF-WHO components. Irrespective of the technological device used, higher adherence to a consolidated set of neurorehabilitation principles enhances efficacy of serious games. Future development of stroke-specific rehabilitation interventions should further take into consideration the consolidated set of neurorehabilitation principles.
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Affiliation(s)
- Ioannis Doumas
- Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Secteur des Sciences de la Santé, Université Catholique de Louvain, Avenue Mounier 53, 1200, Brussels, Belgium
- Service de Médecine Physique et Réadaptation, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
- Université Catholique de Louvain, Louvain Bionics, 1348, Louvain-la-Neuve, Belgium
| | - Gauthier Everard
- Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Secteur des Sciences de la Santé, Université Catholique de Louvain, Avenue Mounier 53, 1200, Brussels, Belgium
- Université Catholique de Louvain, Louvain Bionics, 1348, Louvain-la-Neuve, Belgium
| | - Stéphanie Dehem
- Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Secteur des Sciences de la Santé, Université Catholique de Louvain, Avenue Mounier 53, 1200, Brussels, Belgium
- Service de Médecine Physique et Réadaptation, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
- Université Catholique de Louvain, Louvain Bionics, 1348, Louvain-la-Neuve, Belgium
| | - Thierry Lejeune
- Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Secteur des Sciences de la Santé, Université Catholique de Louvain, Avenue Mounier 53, 1200, Brussels, Belgium.
- Service de Médecine Physique et Réadaptation, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
- Université Catholique de Louvain, Louvain Bionics, 1348, Louvain-la-Neuve, Belgium.
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35
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Singh N, Saini M, Kumar N, Srivastava MVP, Mehndiratta A. Evidence of neuroplasticity with robotic hand exoskeleton for post-stroke rehabilitation: a randomized controlled trial. J Neuroeng Rehabil 2021; 18:76. [PMID: 33957937 PMCID: PMC8101163 DOI: 10.1186/s12984-021-00867-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 04/20/2021] [Indexed: 01/09/2023] Open
Abstract
Background A novel electromechanical robotic-exoskeleton was designed in-house for the rehabilitation of wrist joint and Metacarpophalangeal (MCP) joint. Objective The objective was to compare the rehabilitation effectiveness (clinical-scales and neurophysiological-measures) of robotic-therapy training sessions with dose-matched conventional therapy in patients with stroke. Methods A pilot prospective parallel randomized controlled study at clinical settings was designed for patients with stroke within 2 years of chronicity. Patients were randomly assigned to receive an intervention of 20 sessions of 45 min each, five days a week for four weeks, in Robotic-therapy Group (RG) (n = 12) and conventional upper-limb rehabilitation in Control-Group (CG) (n = 11). We intended to evaluate the effects of a novel exoskeleton based therapy on the functional rehabilitation outcomes of upper-limb and cortical-excitability in patients with stroke as compared to the conventional-rehabilitation. Clinical-scales– Modified Ashworth Scale, Active Range of Motion, Barthel-Index, Brunnstrom-stage and Fugl-Meyer (FM) scale and neurophysiological measures of cortical-excitability (using Transcranial Magnetic Stimulation) –Motor Evoked Potential and Resting Motor threshold, were acquired pre- and post-therapy. Results No side effects were noticed in any of the patients. Both RG and CG showed significant (p < 0.05) improvement in all clinical motor-outcomes except Modified Ashworth Scale in CG. RG showed significantly (p < 0.05) higher improvement over CG in Modified Ashworth Scale, Active Range of Motion and Fugl-Meyer scale and FM Wrist-/Hand component. An increase in cortical-excitability in ipsilesional-hemisphere was found to be statistically significant (p < 0.05) in RG over CG, as indexed by a decrease in Resting Motor Threshold and increase in the amplitude of Motor Evoked Potential. No significant changes were shown by the contralesional-hemisphere. Interhemispheric RMT-asymmetry evidenced significant (p < 0.05) changes in RG over CG indicating increased cortical-excitability in ipsilesional-hemisphere along with interhemispheric changes. Conclusion Robotic-exoskeleton training showed improvement in motor outcomes and cortical-excitability in patients with stroke. Neurophysiological changes in RG could most likely be a consequence of plastic reorganization and use-dependent plasticity. Trial registry number: ISRCTN95291802 Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00867-7.
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Affiliation(s)
- Neha Singh
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), New Delhi, India
| | - Megha Saini
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), New Delhi, India
| | - Nand Kumar
- Department of Psychiatry, All Indian Institute of Medical Sciences (AIIMS), New Delhi, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Amit Mehndiratta
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), New Delhi, India. .,Department of Biomedical Engineering, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
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36
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Lambercy O, Lehner R, Chua K, Wee SK, Rajeswaran DK, Kuah CWK, Ang WT, Liang P, Campolo D, Hussain A, Aguirre-Ollinger G, Guan C, Kanzler CM, Wenderoth N, Gassert R. Neurorehabilitation From a Distance: Can Intelligent Technology Support Decentralized Access to Quality Therapy? Front Robot AI 2021; 8:612415. [PMID: 34026855 PMCID: PMC8132098 DOI: 10.3389/frobt.2021.612415] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 04/20/2021] [Indexed: 12/18/2022] Open
Abstract
Current neurorehabilitation models primarily rely on extended hospital stays and regular therapy sessions requiring close physical interactions between rehabilitation professionals and patients. The current COVID-19 pandemic has challenged this model, as strict physical distancing rules and a shift in the allocation of hospital resources resulted in many neurological patients not receiving essential therapy. Accordingly, a recent survey revealed that the majority of European healthcare professionals involved in stroke care are concerned that this lack of care will have a noticeable negative impact on functional outcomes. COVID-19 highlights an urgent need to rethink conventional neurorehabilitation and develop alternative approaches to provide high-quality therapy while minimizing hospital stays and visits. Technology-based solutions, such as, robotics bear high potential to enable such a paradigm shift. While robot-assisted therapy is already established in clinics, the future challenge is to enable physically assisted therapy and assessments in a minimally supervized and decentralized manner, ideally at the patient’s home. Key enablers are new rehabilitation devices that are portable, scalable and equipped with clinical intelligence, remote monitoring and coaching capabilities. In this perspective article, we discuss clinical and technological requirements for the development and deployment of minimally supervized, robot-assisted neurorehabilitation technologies in patient’s homes. We elaborate on key principles to ensure feasibility and acceptance, and on how artificial intelligence can be leveraged for embedding clinical knowledge for safe use and personalized therapy adaptation. Such new models are likely to impact neurorehabilitation beyond COVID-19, by providing broad access to sustained, high-quality and high-dose therapy maximizing long-term functional outcomes.
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Affiliation(s)
- Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Rea Lehner
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore.,Neural Control of Movement Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Karen Chua
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore.,Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore.,Rehabilitation Research Institute Singapore, Nanyang Technological University, Singapore, Singapore
| | - Seng Kwee Wee
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore.,Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore.,Singapore Institute of Technology (SIT), Singapore, Singapore
| | - Deshan Kumar Rajeswaran
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore.,Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Christopher Wee Keong Kuah
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore.,Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Wei Tech Ang
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore.,Rehabilitation Research Institute Singapore, Nanyang Technological University, Singapore, Singapore.,School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Phyllis Liang
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore.,Rehabilitation Research Institute Singapore, Nanyang Technological University, Singapore, Singapore
| | - Domenico Campolo
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore.,School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Asif Hussain
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore.,School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore.,Articares Pte Ltd, Singapore, Singapore
| | | | - Cuntai Guan
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore.,School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Christoph M Kanzler
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Nicole Wenderoth
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore.,Neural Control of Movement Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
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37
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Ranzani R, Eicher L, Viggiano F, Engelbrecht B, Held JPO, Lambercy O, Gassert R. Towards a Platform for Robot-Assisted Minimally-Supervised Therapy of Hand Function: Design and Pilot Usability Evaluation. Front Bioeng Biotechnol 2021; 9:652380. [PMID: 33937218 PMCID: PMC8082072 DOI: 10.3389/fbioe.2021.652380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/15/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Robot-assisted therapy can increase therapy dose after stroke, which is often considered insufficient in clinical practice and after discharge, especially with respect to hand function. Thus far, there has been a focus on rather complex systems that require therapist supervision. To better exploit the potential of robot-assisted therapy, we propose a platform designed for minimal therapist supervision, and present the preliminary evaluation of its immediate usability, one of the main and frequently neglected challenges for real-world application. Such an approach could help increase therapy dose by allowing the training of multiple patients in parallel by a single therapist, as well as independent training in the clinic or at home. METHODS We implemented design changes on a hand rehabilitation robot, considering aspects relevant to enabling minimally-supervised therapy, such as new physical/graphical user interfaces and two functional therapy exercises to train hand motor coordination, somatosensation and memory. Ten participants with chronic stroke assessed the usability of the platform and reported the perceived workload during a single therapy session with minimal supervision. The ability to independently use the platform was evaluated with a checklist. RESULTS Participants were able to independently perform the therapy session after a short familiarization period, requiring assistance in only 13.46 (7.69-19.23)% of the tasks. They assigned good-to-excellent scores on the System Usability Scale to the user-interface and the exercises [85.00 (75.63-86.88) and 73.75 (63.13-83.75) out of 100, respectively]. Nine participants stated that they would use the platform frequently. Perceived workloads lay within desired workload bands. Object grasping with simultaneous control of forearm pronosupination and stiffness discrimination were identified as the most difficult tasks. DISCUSSION Our findings demonstrate that a robot-assisted therapy device can be rendered safely and intuitively usable upon first exposure with minimal supervision through compliance with usability and perceived workload requirements. The preliminary usability evaluation identified usability challenges that should be solved to allow real-world minimally-supervised use. Such a platform could complement conventional therapy, allowing to provide increased dose with the available resources, and establish a continuum of care that progressively increases therapy lead of the patient from the clinic to the home.
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Affiliation(s)
- Raffaele Ranzani
- Rehabilitation Engineering Laboratory, D-HEST, ETH Zürich, Zurich, Switzerland
| | - Lucas Eicher
- Rehabilitation Engineering Laboratory, D-HEST, ETH Zürich, Zurich, Switzerland
| | - Federica Viggiano
- Rehabilitation Engineering Laboratory, D-HEST, ETH Zürich, Zurich, Switzerland
| | | | - Jeremia P. O. Held
- Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, D-HEST, ETH Zürich, Zurich, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, D-HEST, ETH Zürich, Zurich, Switzerland
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Wu J, Cheng H, Zhang J, Yang S, Cai S. Robot-Assisted Therapy for Upper Extremity Motor Impairment After Stroke: A Systematic Review and Meta-Analysis. Phys Ther 2021; 101:6103015. [PMID: 33454787 DOI: 10.1093/ptj/pzab010] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/31/2020] [Accepted: 12/06/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The purpose of this study was to review the effects of robot-assisted therapy (RT) for improving poststroke upper extremity motor impairment. METHODS The PubMed, Embase, Medline, and Web of Science databases were searched from inception to April 8, 2020. Randomized controlled trials that were conducted to evaluate the effects of RT on upper extremity motor impairment poststroke and that used Fugl-Meyer assessment for upper extremity scores as an outcome were included. Two authors independently screened articles, extracted data, and assessed the methodological quality of the included studies using the Physiotherapy Evidence Database (PEDro) scale. A random-effects meta-analysis was performed to pool the effect sizes across the studies. RESULTS Forty-one randomized controlled trials with 1916 stroke patients were included. Compared with dose-matched conventional rehabilitation, RT significantly improved the Fugl-Meyer assessment for upper extremity scores of the patients with stroke, with a small effect size (Hedges g = 0.25; 95% CI, 0.11-0.38; I2 = 45.9%). The subgroup analysis revealed that the effects of unilateral RT, but not that of bilateral RT, were superior to conventional rehabilitation (Hedges g = 0.32; 95% CI, 0.15-0.50; I2 = 55.9%). Regarding the type of robot devices, the effects of the end effector device (Hedges g = 0.22; 95% CI, 0.09-0.36; I2 = 35.4%), but not the exoskeleton device, were superior to conventional rehabilitation. Regarding the stroke stage, the between-group difference (ie, RT vs convention rehabilitation) was significant only for people with late subacute or chronic stroke (Hedges g = 0.33; 95% CI, 0.16-0.50; I2 = 34.2%). CONCLUSION RT might be superior to conventional rehabilitation in improving upper extremity motor impairment in people after stroke with notable upper extremity hemiplegia and limited potential for spontaneous recovery.
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Affiliation(s)
- Jingyi Wu
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China
| | - Hao Cheng
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China
| | - Jiaqi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Shanli Yang
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China
| | - Sufang Cai
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China
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39
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Rozevink SG, van der Sluis CK, Garzo A, Keller T, Hijmans JM. HoMEcare aRm rehabiLItatioN (MERLIN): telerehabilitation using an unactuated device based on serious games improves the upper limb function in chronic stroke. J Neuroeng Rehabil 2021; 18:48. [PMID: 33726801 PMCID: PMC7961165 DOI: 10.1186/s12984-021-00841-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/18/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND HoMEcare aRm rehabiLItatioN (MERLIN) is an unactuated version of the robotic device ArmAssist combined with a telecare platform. Stroke patients are able to train the upper limb function using serious games at home. The aim of this study is to investigate the effect of MERLIN training on the upper limb function of patients with unilateral upper limb paresis in the chronic phase of stroke (> 6 months post stroke). METHODS Patients trained task specific serious games for three hours per week during six weeks using an unactuated version of a robotic device. Progress was monitored and game settings were tailored through telerehabilitation. Measurements were performed six weeks pre-intervention (T0), at the start (T1), end (T2) and six weeks post-intervention (T3). Primary outcome was the Wolf Motor Function Test (WMFT). Secondary outcomes were other arm function tests, quality of life, user satisfaction and motivation. RESULTS Twelve patients were included, ten completed the training. From start of the intervention to six weeks follow up, WMFT improved significantly with 3.8 points (p = .006), which is also clinically relevant. No significant changes in quality of life were observed. Patients were overall satisfied with the usability of the device. Comfort and the robustness of the system need further improvements. CONCLUSION Patients in the chronic phase of stroke significantly improved their upper limb function with the MERLIN training at home. Trial registration This study is registered at the Netherlands Trial Register (NL7535). Registered 18-02-2019, https://www.trialregister.nl/trial/7535 .
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Affiliation(s)
- Samantha G Rozevink
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Corry K van der Sluis
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ainara Garzo
- Neurorehabilitation Area, Health Division of TECNALIA, Basque Research and Technology Alliance (BRTA), San Sebastian, Spain
| | - Thierry Keller
- Neurorehabilitation Area, Health Division of TECNALIA, Basque Research and Technology Alliance (BRTA), San Sebastian, Spain
| | - Juha M Hijmans
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Perseverance with technology-facilitated home-based upper limb practice after stroke: a systematic mixed studies review. J Neuroeng Rehabil 2021; 18:43. [PMID: 33627126 PMCID: PMC7905577 DOI: 10.1186/s12984-021-00819-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 01/12/2021] [Indexed: 12/20/2022] Open
Abstract
Background Technology is being increasingly investigated as an option to allow stroke survivors to exploit their full potential for recovery by facilitating home-based upper limb practice. This review seeks to explore the factors that influence perseverance with technology-facilitated home-based upper limb practice after stroke. Methods A systematic mixed studies review with sequential exploratory synthesis was undertaken. Studies investigating adult stroke survivors with upper limb disability undertaking technology-facilitated home-based upper limb practice administered ≥ 3 times/week over a period of ≥ 4 weeks were included. Qualitative outcomes were stroke survivors’ and family members’ perceptions of their experience utilising technology to facilitate home-based upper limb practice. Quantitative outcomes were adherence and dropouts, as surrogate measures of perseverance. The Mixed Methods Appraisal Tool was used to assess quality of included studies. Results Forty-two studies were included. Six studies were qualitative and of high quality; 28 studies were quantitative and eight were mixed methods studies, all moderate to low quality. A conceptual framework of perseverance with three stages was formed: (1) getting in the game; (2) sticking with it, and; (3) continuing or moving on. Conditions perceived to influence perseverance, and factors mediating these conditions were identified at each stage. Adherence with prescribed dose ranged from 13 to 140%. Participants were found to be less likely to adhere when prescribed sessions were more frequent (6–7 days/week) or of longer duration (≥ 12 weeks). Conclusion From the mixed methods findings, we propose a framework for perseverance with technology-facilitated home-based upper limb practice. The framework offers opportunities for clinicians and researchers to design strategies targeting factors that influence perseverance with practice, in both the clinical prescription of practice and technology design. To confirm the clinical utility of this framework, further research is required to explore perseverance and the factors influencing perseverance. Registration: PROSPERO CRD42017072799—https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=72799
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Nuara A, Fabbri-Destro M, Scalona E, Lenzi SE, Rizzolatti G, Avanzini P. Telerehabilitation in response to constrained physical distance: an opportunity to rethink neurorehabilitative routines. J Neurol 2021; 269:627-638. [PMID: 33449202 PMCID: PMC7809551 DOI: 10.1007/s00415-021-10397-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 02/07/2023]
Abstract
Ensuring proper dosage of treatment and repetition over time is a major challenge in neurorehabilitation. However, a requirement of physical distancing to date compromises their achievement. While mostly associated to COVID-19, physical distancing is not only required in a pandemic scenario, but also advised for several clinical conditions (e.g. immunocompromised individuals) or forced for specific social contexts (e.g. people living in remote areas worldwide). All these contexts advocate for the implementation of alternative healthcare models. The objective of this perspective is to highlight the benefits of remote administration of rehabilitative treatment, namely telerehabilitation, in counteracting physical distancing barriers in neurorehabilitation. Sustaining boosters of treatment outcome, such as compliance, sustainability, as well as motivation, telerehabilitation may adapt to multiple neurological conditions, with the further advantage of a high potential for individualization to patient's or pathology's specificities. The effectiveness of telerehabilitation can be potentiated by several technologies available to date: virtual reality can recreate realistic environments in which patients may bodily operate, wearable sensors allow to quantitatively monitor the patient's performance, and signal processing may contribute to the prediction of long-term dynamics of patient recovery. Telerehabilitation might spark its advantages far beyond the mere limitation of physical distancing effects, mitigating criticalities of daily neurorehabilitative practice, and thus paving the way to the envision of mixed models of care, where hospital-based procedures are complementarily integrated with telerehabilitative ones.
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Affiliation(s)
- Arturo Nuara
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy. .,Department of Biomedical, Metabolic, and Neuronal Sciences, University of Modena and Reggio Emilia, Modena, Italy. .,Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Maddalena Fabbri-Destro
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy
| | - Emilia Scalona
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy
| | - Stefano Elio Lenzi
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy
| | - Giacomo Rizzolatti
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Pietro Avanzini
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy.,Istituto Clinico Humanitas, Rozzano, Italy
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Carswell C, Rea PM. What the Tech? The Management of Neurological Dysfunction Through the Use of Digital Technology. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1317:131-145. [PMID: 33945135 DOI: 10.1007/978-3-030-61125-5_7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Worldwide, it is estimated that millions of individuals suffer from a neurological disorder which can be the result of head injuries, ischaemic events such as a stroke, or neurodegenerative disorders such as Parkinson's disease (PD) and multiple sclerosis (MS). Problems with mobility and hemiparesis are common for these patients, making daily life, social factors and independence heavily affected. Current therapies aimed at improving such conditions are often tedious in nature, with patients often losing vital motivation and positive outlook towards their rehabilitation. The interest in the use of digital technology in neuro-rehabilitation has skyrocketed in the past decade. To gain insight, a systematic review of the literature in the field was conducting following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines for three categories: stroke, Parkinson's disease and multiple sclerosis. It was found that the majority of the literature (84%) was in favour of the use of digital technologies in the management of neurological dysfunction; with some papers taking a "neutral" or "against" standpoint. It was found that the use of technologies such as virtual reality (VR), robotics, wearable sensors and telehealth was highly accepted by patients, helped to improve function, reduced anxiety and make therapy more accessible to patients living in more remote areas. The most successful therapies were those that used a combination of conventional therapies and new digital technologies.
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Affiliation(s)
- Caitlin Carswell
- Anatomy Facility, School of Life Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Paul M Rea
- School of Life Sciences, University of Glasgow, Glasgow, UK.
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Conroy SS, Harcum S, Keldsen L, Bever CT. Novel use of existing technology: A preliminary study of patient portal use for telerehabilitation. J Telemed Telecare 2020; 28:380-388. [PMID: 32869689 DOI: 10.1177/1357633x20950172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
CLINICALTRIALS.GOV IDENTIFIER NCT02665052. Registered 27 January 2016. https://clinicaltrials.gov/ct2/show/NCT02665052.
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Affiliation(s)
- Susan S Conroy
- VA Maryland Health Care System, Rehabilitation Research and Development Service, USA.,University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Science, USA
| | - Stacey Harcum
- VA Maryland Health Care System, Rehabilitation Research and Development Service, USA
| | - Linda Keldsen
- Veterans Health Administration Office of Education, USA
| | - Christopher T Bever
- VA Central Office, USA.,University of Maryland School of Medicine, Department of Neurology, USA
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44
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Lu R, Lloyd-Randolfi D, Jones H, Connor LT, AlHeresh R. Assessing adherence to physical activity programs post-stroke at home: A systematic review of randomized controlled trials. Top Stroke Rehabil 2020; 28:207-218. [PMID: 32787644 DOI: 10.1080/10749357.2020.1803573] [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: 10/23/2022]
Abstract
BACKGROUND Physical activity at home provides significant benefits post-stroke. Adherence assessments contribute to objective evaluation of treatment effectiveness across settings. OBJECTIVES The aims of this study were to (1) conduct a systematic review with focus on analyzing the reporting quality of RCTs that incorporate home physical activity interventions among people post-stroke, and utilize a physical activity adherence assessment and to: (2) identify, group, and critically appraise physical activity adherence assessments within the identified studies. METHODS A literature search for RCTs was conducted. Articles needed to (1) study adult, post-stroke participants, (2) include a physical activity intervention at home, (3) utilize a physical activity adherence assessment, (4) be published in English in a peer reviewed journal. Two independent reviewers assessed the reporting quality of each RCT for conformity to 39 Consolidated Standards of Reporting Trials (CONSORT) items, followed by an evaluation of adherence assessment methods. RESULTS Eleven studies met the inclusion criteria and none of them reported all CONSORT items. The median number of "fully reported" items was 7 out of 39. Ten of the 11 RCTs employed the adherence diary as an assessment method. The adherence parameters of frequency and duration were applied with greater frequency than intensity and accuracy. No evidence of an objective method of adherence assessment was found. CONCLUSIONS This systematic review revealed suboptimal reporting of RCTs of physical activity interventions. The use of a diary with the post-stroke population at home was common, despite the lack of an objective method of adherence assessment. Stricter compliance to CONSORT guidelines and complementary direct adherence measurement is advised to improve activity adherence research.
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Affiliation(s)
- Richard Lu
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - Dominic Lloyd-Randolfi
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - Heather Jones
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - Lisa Tabor Connor
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - Rawan AlHeresh
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, USA
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Chien WT, Chong YY, Tse MK, Chien CW, Cheng HY. Robot-assisted therapy for upper-limb rehabilitation in subacute stroke patients: A systematic review and meta-analysis. Brain Behav 2020; 10:e01742. [PMID: 32592282 PMCID: PMC7428503 DOI: 10.1002/brb3.1742] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Stroke survivors often experience upper-limb motor deficits and achieve limited motor recovery within six months after the onset of stroke. We aimed to systematically review the effects of robot-assisted therapy (RT) in comparison to usual care on the functional and health outcomes of subacute stroke survivors. METHODS Randomized controlled trials (RCTs) published between January 1, 2000 and December 31, 2019 were identified from six electronic databases. Pooled estimates of standardized mean differences for five outcomes, including motor control (primary outcome), functional independence, upper extremity performance, muscle tone, and quality of life were derived by random effects meta-analyses. Assessments of risk of bias in the included RCTs and the quality of evidence for every individual outcomes were conducted following the guidelines of the Cochrane Collaboration. RESULTS Eleven RCTs involving 493 participants were included for review. At post-treatment, the effects of RT when compared to usual care on motor control, functional independence, upper extremity performance, muscle tone, and quality of life were nonsignificant (all ps ranged .16 to .86). The quality of this evidence was generally rated as low-to-moderate. Less than three RCTs assessed the treatment effects beyond post-treatment and the results remained nonsignificant. CONCLUSION Robot-assisted therapy produced benefits similar, but not significantly superior, to those from usual care for improving functioning and disability in patients diagnosed with stroke within six months. Apart from using head-to-head comparison to determine the effects of RT in subacute stroke survivors, future studies may explore the possibility of conducting noninferiority or equivalence trials, given that the less labor-intensive RT may offer important advantages over currently available standard care, in terms of improved convenience, better adherence, and lower manpower cost.
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Affiliation(s)
- Wai-Tong Chien
- The Nethersole School of Nursing, The Chinese University of Hong Kond, New Territories, Hong Kong
| | - Yuen-Yu Chong
- The Nethersole School of Nursing, The Chinese University of Hong Kond, New Territories, Hong Kong
| | - Man-Kei Tse
- The Nethersole School of Nursing, The Chinese University of Hong Kond, New Territories, Hong Kong
| | | | - Ho-Yu Cheng
- The Nethersole School of Nursing, The Chinese University of Hong Kond, New Territories, Hong Kong
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Knepley KD, Mao JZ, Wieczorek P, Okoye FO, Jain AP, Harel NY. Impact of Telerehabilitation for Stroke-Related Deficits. Telemed J E Health 2020; 27:239-246. [PMID: 32326849 DOI: 10.1089/tmj.2020.0019] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Stroke is the leading cause of serious long-term disability in the United States. Barriers to rehabilitation include cost, transportation, lack of trained personnel, and equipment. Telerehabilitation (TR) has emerged as a promising modality to reduce costs, improve accessibility, and retain patient independence. TR allows providers to remotely administer therapy, potentially increasing access to underserved regions. Objectives: To describe types of stroke rehabilitation therapy delivered through TR and to evaluate whether TR is as effective as traditional in-person outpatient therapy in improving satisfaction and poststroke residual deficits such as motor function, speech, and disability. Methods: A literature search of the term "telerehabilitation and stroke" was conducted across three databases. Full-text articles with results pertaining to TR interventions were reviewed. Articles were scored for methodological quality using the PEDro scale. Results: Thirty-four articles with 1,025 patients were included. Types of TR included speech therapy, virtual reality (VR), robotic, community-based, goal setting, and motor training exercises. Frequently measured outcomes included motor function, speech, disability, and satisfaction. All 34 studies reported improvement from baseline after TR therapy. PEDro scores ranged from 2 to 8 with a mean of 4.59 ± 1.94 (on a scale of 0-10). Studies with control interventions, randomized allocation, and blinded assessment had significantly higher PEDro scores. All 15 studies that compared TR with traditional therapy showed equivalent or better functional outcomes. Home-based robotic therapy and VR were less costly than in-person therapy. Patient satisfaction with TR and in-person clinical therapy was similar. Conclusions: TR is less costly and equally as effective as clinic-based rehabilitation at improving functional outcomes in stroke patients. TR produces similar patient satisfaction. TR can be combined with other therapies, including VR, speech, and robotic assistance, or used as an adjuvant to direct in-person care.
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Affiliation(s)
- Kurt D Knepley
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Jennifer Z Mao
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA.,Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.,Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Peter Wieczorek
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Frederick O Okoye
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Abhi P Jain
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Noam Y Harel
- James J. Peters VA Medical Center Neurology, New York, New York, USA.,Neurology and Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Morone G, Cocchi I, Paolucci S, Iosa M. Robot-assisted therapy for arm recovery for stroke patients: state of the art and clinical implication. Expert Rev Med Devices 2020; 17:223-233. [PMID: 32107946 DOI: 10.1080/17434440.2020.1733408] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Robot-assisted therapy is an emerging approach that performs highly repetitive, intensive, task oriented and quantifiable neuro-rehabilitation. In the last decades, it has been increasingly used in a wide range of neurological central nervous system conditions implying an upper limb paresis. Results from the studies are controversial, for the many types of robots and their features often not accompanied by specific clinical indications about the target functions, fundamental for the individualized neurorehabilitation program.Areas covered: This article reviews the state of the art and perspectives of robotics in post-stroke rehabilitation for upper limb recovery. Classifications and features of robots have been reported in accordance with technological and clinical contents, together with the definition of determinants specific for each patient, that could modify the efficacy of robotic treatments. The possibility of combining robotic intervention with other therapies has also been discussed.Expert commentary: The recent wide diffusion of robots in neurorehabilitation has generated a confusion due to the commingling of technical and clinical aspects not previously clarified. Our critical review provides a possible hypothesis about how to match a robot with subject's upper limb functional abilities, but also highlights the need of organizing a clinical consensus conference about the robotic therapy.
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Affiliation(s)
- Giovanni Morone
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Ilaria Cocchi
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Stefano Paolucci
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Marco Iosa
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy
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Parker J, Powell L, Mawson S. Effectiveness of Upper Limb Wearable Technology for Improving Activity and Participation in Adult Stroke Survivors: Systematic Review. J Med Internet Res 2020; 22:e15981. [PMID: 31913131 PMCID: PMC6996755 DOI: 10.2196/15981] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/16/2019] [Accepted: 10/22/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND With advances in technology, the adoption of wearable devices has become a viable adjunct in poststroke rehabilitation. Upper limb (UL) impairment affects up to 77% of stroke survivors impacting on their ability to carry out everyday activities. However, despite an increase in research exploring these devices for UL rehabilitation, little is known of their effectiveness. OBJECTIVE This review aimed to assess the effectiveness of UL wearable technology for improving activity and participation in adult stroke survivors. METHODS Randomized controlled trials (RCTs) and randomized comparable trials of UL wearable technology for poststroke rehabilitation were included. Primary outcome measures were validated measures of activity and participation as defined by the International Classification of Functioning, Disability, and Health. Databases searched were MEDLINE, Web of Science (Core collection), CINAHL, and the Cochrane Library. The Cochrane Risk of Bias Tool was used to assess the methodological quality of the RCTs and the Downs and Black Instrument for the quality of non RCTs. RESULTS In the review, we included 11 studies with collectively 354 participants at baseline and 323 participants at final follow-up including control groups and participants poststroke. Participants' stroke type and severity varied. Only 1 study found significant between-group differences for systems functioning and activity (P≤.02). The 11 included studies in this review had small sample sizes ranging from 5 to 99 participants at an average (mean) age of 57 years. CONCLUSIONS This review has highlighted a number of reasons for insignificant findings in this area including low sample sizes and the appropriateness of the methodology for complex interventions. However, technology has the potential to measure outcomes, provide feedback, and engage users outside of clinical sessions. This could provide a platform for motivating stroke survivors to carry out more rehabilitation in the absence of a therapist, which could maximize recovery. TRIAL REGISTRATION PROSPERO CRD42017057715; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=57715.
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49
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Donoso Brown EV, Nolfi D, Wallace SE, Eskander J, Hoffman JM. Home program practices for supporting and measuring adherence in post-stroke rehabilitation: a scoping review. Top Stroke Rehabil 2019; 27:377-400. [PMID: 31891554 DOI: 10.1080/10749357.2019.1707950] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND After stroke, individuals face a variety of impairments that impact function. Increasingly, rehabilitation for these impairments has moved into the community and home settings through the use of home programs. However, adherence to these programs is often low, limiting effectiveness. OBJECTIVE This scoping review investigated home program implementation and measurement of adherence with persons post-stroke to identify commonly reported practices and determine areas for further research. METHODS The electronic databases of PubMed, CINAHL, Scopus, Cochrane Database of Systematic Reviews, and PEDro were searched. Studies focused on post-stroke rehabilitation with an independent home program were selected. Qualitative studies, commentaries, and single-case studies were excluded. Title and abstract screenings were completed by two reviewers with a third for tie-breaking. The full-text review was completed by two reviewers using consensus to resolve any differences. Of the 1,197 articles initially found only 6% (n = 70) met criteria for data extraction. Elements for data extraction included: type of study, area of intervention, description of home program, presence of strategies to support adherence, methods to measure adherence and reported adherence. RESULTS Most commonly reported strategies to support home practice were the use of technology, personalization, and written directions. Only 20 studies reported achieving adherence at or greater than 75% and 18 studies did not report adherence outcomes. CONCLUSIONS Future investigations that directly compare and identify the most effective strategies to support adherence to home programs for this population are warranted. The implementation of guidelines for reporting adherence to home programs is recommended.
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Affiliation(s)
| | - David Nolfi
- Gumberg Library, Duquesne University , Pittsburgh, USA
| | - Sarah E Wallace
- Department of Speech Language Pathology, Duquesne University , Pittsburgh, PA, USA
| | - Joanna Eskander
- Department of Occupational Therapy, Duquesne University , Pittsburgh, PA, USA
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington , Seattle, WA, USA
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Kloek CJJ, Janssen J, Veenhof C. Development of a Checklist to Assist Physiotherapists in Determination of Patients' Suitability for a Blended Treatment. Telemed J E Health 2019; 26:1051-1065. [PMID: 31804904 DOI: 10.1089/tmj.2019.0143] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The integration of digital applications within health care is called blended care. Introduction: Despite its potential, physiotherapists experience difficulty in determining which patients are suitable for blended care. This study aimed to develop a checklist to support physiotherapists while setting up a blended treatment. Therefore, we aimed to investigate which patient characteristics predict patients' suitability for blended physiotherapy and which patient characteristics need to be taken into account while determining the ratio between therapeutic guidance and a digital application. Methods: A scoping review was conducted consisting of (1) literature search in PubMed and PEDro up to December 2017: studies were eligible if they focused on blended physiotherapy consisting of contact at least twice with a physiotherapist complemented by a digital application, and characteristics related to patients' suitability for blended physiotherapy were extracted and categorized in themes; (2) a checklist item for each theme formulated by the authors, which resulted in a first version of the Dutch Blended Physiotherapy Checklist; and (3) expert opinion and feedback on clinical relevance by six experts. The checklist was adapted accordingly. Results: The final Dutch Blended Physiotherapy Checklist consists of eight items: motivation, safety, equipment, digital skills, health literacy, self-management, time, and financial factors. Discussion: The next step is to investigate the feasibility and predictive validity of the checklist, that is, whether this checklist is actually able to predict patients' suitability for blended physiotherapy. Conclusions: This study provides the final version of the Dutch Blended Physiotherapy Checklist, which is supposed to guide physiotherapists in their clinical reasoning process while setting up a personalized, blended physiotherapy treatment.
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Affiliation(s)
- Corelien J J Kloek
- Research Group Innovation of Human Movement Care, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Joep Janssen
- Research Group Innovation of Human Movement Care, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands.,Department of Pediatrics, De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Center of Excellence for Rehabilitation Medicine, Utrecht, The Netherlands
| | - Cindy Veenhof
- Research Group Innovation of Human Movement Care, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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