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Winterbottom L, Chen A, Mendonca R, Nilsen DM, Ciocarlie M, Stein J. Clinician perceptions of a novel wearable robotic hand orthosis for post-stroke hemiparesis. Disabil Rehabil 2024:1-10. [PMID: 38975689 DOI: 10.1080/09638288.2024.2375056] [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: 10/19/2023] [Accepted: 06/27/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE Wearable robotic devices are currently being developed to improve upper limb function for individuals with hemiparesis after stroke. Incorporating the views of clinicians during the development of new technologies can help ensure that end products meet clinical needs and can be adopted for patient care. METHODS In this cross-sectional mixed-methods study, an anonymous online survey was used to gather clinicians' perceptions of a wearable robotic hand orthosis for post-stroke hemiparesis. Participants were asked about their clinical experience and provided feedback on the prototype device after viewing a video. RESULTS 154 participants completed the survey. Only 18.8% had previous experience with robotic technology. The majority of participants (64.9%) reported that they would use the device for both rehabilitative and assistive purposes. Participants perceived that the device could be used in supervised clinical settings with all phases of stroke. Participants also indicated a need for insurance coverage and quick setup time. CONCLUSIONS Engaging clinicians early in the design process can help guide the development of wearable robotic devices. Both rehabilitative and assistive functions are valued by clinicians and should be considered during device development. Future research is needed to understand a broader set of stakeholders' perspectives on utility and design.
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Affiliation(s)
- Lauren Winterbottom
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USA
| | - Ava Chen
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Rochelle Mendonca
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USA
| | - Dawn M Nilsen
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Matei Ciocarlie
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Joel Stein
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
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Lindberg PG, AmirShemiraniha N, Krewer C, Maier MA, Hermsdörfer J. Increased dual-task interference during upper limb movements in stroke exceeding that found in aging - a systematic review and meta-analysis. Front Neurol 2024; 15:1375152. [PMID: 39036633 PMCID: PMC11258041 DOI: 10.3389/fneur.2024.1375152] [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: 01/23/2024] [Accepted: 05/07/2024] [Indexed: 07/23/2024] Open
Abstract
Objective To determine whether dual-task interference during upper limb tasks is increased in patients after stroke compared to healthy older subjects and to compare magnitude of stroke-induced change in interference to that explained by aging. Methods We conducted a systematic literature search in MEDLINE, CINAHL, Google Scholar and PEDro databases up to October 2023 for studies on upper limb dual-tasks in stroke and elderly healthy subjects. Eleven upper limb dual-task studies in stroke patients and 11 studies in healthy older subjects were identified and systematically reviewed. A meta-analysis was performed on seven stroke studies and on five studies in healthy older subjects that included control groups. Results Most stroke studies investigated proximal arm movements with kinematic measures, but few studies evaluated manual dexterity. In contrast, studies in healthy older subjects used more distal (finger tapping) tasks. The meta-analysis showed that stroke patients had on average a 19% (CI 95% = 1.0-37.3) increase in dual-task interference compared to age-matched healthy controls (Z = 2.06, p = 0.04). Older healthy subjects showed greater dual-task interference compared to younger subjects (19% greater, CI 95% = 6.5-31.2, Z = 2.98, p = 0.003). Conclusion Meta-analysis revealed an increase in dual-task interference during upper limb movements in stroke patients, exceeding age-related changes, supporting the presence of subclinical impairments in divided attention post-stroke that may impede motor recovery.
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Affiliation(s)
- Påvel G. Lindberg
- Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université Paris Cité, Paris, France
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Nadia AmirShemiraniha
- Chair of Human Movement Science, Department Health and Sport Sciences, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Carmen Krewer
- Chair of Human Movement Science, Department Health and Sport Sciences, School of Medicine and Health, Technical University of Munich, Munich, Germany
- Department of Neurology, Research Group, Schoen Clinic Bad Aibling, Bad Aibling, Germany
| | - Marc A. Maier
- INCC UMR 8002, CNRS, Université Paris Cité, Paris, France
| | - Joachim Hermsdörfer
- Chair of Human Movement Science, Department Health and Sport Sciences, School of Medicine and Health, Technical University of Munich, Munich, Germany
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Xu J, Mawase F, Schieber MH. Evolution, biomechanics, and neurobiology converge to explain selective finger motor control. Physiol Rev 2024; 104:983-1020. [PMID: 38385888 DOI: 10.1152/physrev.00030.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/16/2024] [Accepted: 02/15/2024] [Indexed: 02/23/2024] Open
Abstract
Humans use their fingers to perform a variety of tasks, from simple grasping to manipulating objects, to typing and playing musical instruments, a variety wider than any other species. The more sophisticated the task, the more it involves individuated finger movements, those in which one or more selected fingers perform an intended action while the motion of other digits is constrained. Here we review the neurobiology of such individuated finger movements. We consider their evolutionary origins, the extent to which finger movements are in fact individuated, and the evolved features of neuromuscular control that both enable and limit individuation. We go on to discuss other features of motor control that combine with individuation to create dexterity, the impairment of individuation by disease, and the broad extent of capabilities that individuation confers on humans. We comment on the challenges facing the development of a truly dexterous bionic hand. We conclude by identifying topics for future investigation that will advance our understanding of how neural networks interact across multiple regions of the central nervous system to create individuated movements for the skills humans use to express their cognitive activity.
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Affiliation(s)
- Jing Xu
- Department of Kinesiology, University of Georgia, Athens, Georgia, United States
| | - Firas Mawase
- Department of Biomedical Engineering, Israel Institute of Technology, Haifa, Israel
| | - Marc H Schieber
- Departments of Neurology and Neuroscience, University of Rochester, Rochester, New York, United States
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Zaman T, Mukhtar T, Waseem Zaman M, Shahid MN, Bibi S, Fatima A. Effects of task-oriented training on dexterous movements of hands in post stroke patients. Int J Neurosci 2024; 134:175-183. [PMID: 35881414 DOI: 10.1080/00207454.2022.2095272] [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: 05/17/2022] [Accepted: 06/10/2022] [Indexed: 10/16/2022]
Abstract
Objective: The objective of the study was to determine the effect of task-oriented training on the dexterous movements of hands in Hemiplegic post-stroke patients.Methods: This study has been registered on site ClinicalTrial.gov with clinical trial number NCT05201196. The study was Randomized controlled trial, 18 patients were recruited that meet the inclusion criteria, randomly allocated to task-oriented training Group A (n = 9) and Conventional Therapy Group B (n = 9). Both exercise trainings were applied for 45 min/session, 5 times/week for 6 weeks. Fugl-Meyer Assessment Scale Motor, sensory and coordination portion, Wolf Motor Function Scale and Barthel Index were used as outcome measures, assessed patients at Baseline, after 3 weeks and 6 weeks after training. Data were analyzed by SPSS version 23.Results: The results suggested the mean Age was 60.78 ± 9.08 and 61.33 ± 6.78 for Group A and Group B, respectively. Average BMI was 23.66 ± 2.66 for Task-oriented group and 21.36 ± 2.46 for Conventional group. Fugl-Meyer scale shows significant P-value 0.03 post treatment compare to pre-treatment which was .283, Wolf Motor Function test and Barthel Index also showed significant P-values as 0.023 and 0.007, respectively, indicating that Task-oriented training shows more significant improvements than conventional group.Conclusion: Task-based training produced statistically significant as well as clinically meaningful enhancement in the dexterous hand movements of acute and subacute stroke patients than conventional therapy and ultimately improves the functional independence in their daily activities such as feeding, bathing and hygiene.
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Affiliation(s)
- Tahreem Zaman
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University Lahore, Jauharabad, Pakistan
| | - Tehreem Mukhtar
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University Lahore, Jauharabad, Pakistan
| | | | - Mummad Nadeem Shahid
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University Lahore, Jauharabad, Pakistan
| | - Sajida Bibi
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University Lahore, Jauharabad, Pakistan
| | - Amal Fatima
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University Lahore, Faisalabad, Pakistan
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Urbina J, Abarca VE, Elias DA. Integration of music-based game approaches with wearable devices for hand neurorehabilitation: a narrative review. J Neuroeng Rehabil 2024; 21:89. [PMID: 38811987 PMCID: PMC11134927 DOI: 10.1186/s12984-024-01379-w] [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: 01/19/2024] [Accepted: 05/10/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Restoring hand functionality is critical for fostering independence in individuals with neurological disorders. Various therapeutic approaches have emerged to address motor function restoration, with music-based therapies demonstrating notable advantages in enhancing neuroplasticity, an integral component of neurorehabilitation. Despite the positive effects observed, there remains a gap in the literature regarding implementing music treatments in neurorehabilitation, such as Neurologic Music Therapy (NMT), especially in conjunction with emerging fields like wearable devices and game-based therapies. METHODS A literature search was conducted in various databases, including PubMed, Scopus, IEEE Xplore, and ACM Digital Library. The search was performed using a literature search methodology based on keywords. Information collected from the studies pertained to the approach used in music therapy, the design of the video games, and the types of wearable devices utilized. RESULTS A total of 158 articles were found, including 39 from PubMed, 34 from IEEE Xplore, 48 from Scopus, 37 from ACM Digital Library, and 35 from other sources. Duplicate entries, of which there were 41, were eliminated. In the first screening phase, 152 papers were screened for title and abstract. Subsequently, 89 articles were removed if they contained at least one exclusion criterion. Sixteen studies were considered after 63 papers had their full texts verified. CONCLUSIONS The convergence of NMT with emerging fields, such as gamification and wearable devices designed for hand functionality, not only expands therapeutic horizons but also lays the groundwork for innovative, personalized approaches to neurorehabilitation. However, challenges persist in effectively incorporating NMT into rehabilitation programs, potentially hindering its effectiveness.
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Affiliation(s)
- Javier Urbina
- Biomechanics and Applied Robotics Research Laboratory, Pontificia Universidad Católica del Perú, 15008, Lima, Peru
| | - Victoria E Abarca
- Biomechanics and Applied Robotics Research Laboratory, Pontificia Universidad Católica del Perú, 15008, Lima, Peru.
| | - Dante A Elias
- Biomechanics and Applied Robotics Research Laboratory, Pontificia Universidad Católica del Perú, 15008, Lima, Peru
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Térémetz M, Hamdoun S, Colle F, Gerardin E, Desvilles C, Carment L, Charron S, Cuenca M, Calvet D, Baron JC, Turc G, Maier MA, Rosso C, Mas JL, Lindberg PG. Efficacy of interactive manual dexterity training after stroke: a pilot single-blinded randomized controlled trial. J Neuroeng Rehabil 2023; 20:93. [PMID: 37464404 PMCID: PMC10355015 DOI: 10.1186/s12984-023-01213-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 07/10/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE To compare the efficacy of Dextrain Manipulandum™ training of dexterity components such as force control and independent finger movements, to dose-matched conventional therapy (CT) post-stroke. METHODS A prospective, single-blind, pilot randomized clinical trial was conducted. Chronic-phase post-stroke patients with mild-to-moderate dexterity impairment (Box and Block Test (BBT) > 1) received 12 sessions of Dextrain or CT. Blinded measures were obtained before and after training and at 3-months follow-up. Primary outcome was BBT-change (after-before training). Secondary outcomes included changes in motor impairments, activity limitations and dexterity components. Corticospinal excitability and short intracortical inhibition (SICI) were measured using transcranial magnetic stimulation. RESULTS BBT-change after training did not differ between the Dextrain (N = 21) vs CT group (N = 21) (median [IQR] = 5[2-7] vs 4[2-7], respectively; P = 0.36). Gains in BBT were maintained at the 3-month post-training follow-up, with a non-significant trend for enhanced BBT-change in the Dextrain group (median [IQR] = 3[- 1-7.0], P = 0.06). Several secondary outcomes showed significantly larger changes in the Dextrain group: finger tracking precision (mean ± SD = 0.3 ± 0.3N vs - 0.1 ± 0.33N; P < 0.0018), independent finger movements (34.7 ± 25.1 ms vs 7.7 ± 18.5 ms, P = 0.02) and maximal finger tapping speed (8.4 ± 7.1 vs 4.5 ± 4.9, P = 0.045). At follow-up, Dextrain group showed significantly greater improvement in Motor Activity Log (median/IQR = 0.7/0.2-0.8 vs 0.2/0.1-0.6, P = 0.05). Across both groups SICI increased in patients with greater BBT-change (Rho = 0.80, P = 0.006). Comparing Dextrain subgroups with maximal grip force higher/lower than median (61.2%), BBT-change was significantly larger in patients with low vs high grip force (7.5 ± 5.6 vs 2.9 ± 2.8; respectively, P = 0.015). CONCLUSIONS Although immediate improvements in gross dexterity post-stroke did not significantly differ between Dextrain training and CT, our findings suggest that Dextrain enhances recovery of several dexterity components and reported hand-use, particularly when motor impairment is moderate (low initial grip force). Findings need to be confirmed in a larger trial. Trial registration ClinicalTrials.gov NCT03934073 (retrospectively registered).
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Affiliation(s)
- Maxime Térémetz
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
| | - Sonia Hamdoun
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
- Service de Médecine Physique et de Réadaptation, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
| | - Florence Colle
- SSR Neurologique, Hôpitaux de Saint-Maurice, 12/14 Rue du Val d'Osne, 94410, Saint-Maurice, France
| | - Eloïse Gerardin
- Neurology Department, Stroke Unit, UCLouvain/CHU UCL Namur (Godinne), Yvoir, Belgium
| | - Claire Desvilles
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
| | - Loïc Carment
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
| | - Sylvain Charron
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
| | - Macarena Cuenca
- Centre de Recherche Clinique, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
| | - David Calvet
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
- Service de Neurologie, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
- FHU NeuroVasc, Paris, France
| | - Jean-Claude Baron
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
- Service de Neurologie, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
- FHU NeuroVasc, Paris, France
| | - Guillaume Turc
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
- Service de Neurologie, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
- FHU NeuroVasc, Paris, France
| | - Marc A Maier
- Université Paris Cité, CNRS, Integrative Neuroscience and Cognition Center, 75006, Paris, France
| | - Charlotte Rosso
- Institut du Cerveau et de la Moelle Épinière, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
| | - Jean-Louis Mas
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
- Service de Neurologie, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
- FHU NeuroVasc, Paris, France
| | - Påvel G Lindberg
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France.
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Bates M, Sunderam S. Hand-worn devices for assessment and rehabilitation of motor function and their potential use in BCI protocols: a review. Front Hum Neurosci 2023; 17:1121481. [PMID: 37484920 PMCID: PMC10357516 DOI: 10.3389/fnhum.2023.1121481] [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: 12/11/2022] [Accepted: 06/01/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Various neurological conditions can impair hand function. Affected individuals cannot fully participate in activities of daily living due to the lack of fine motor control. Neurorehabilitation emphasizes repetitive movement and subjective clinical assessments that require clinical experience to administer. Methods Here, we perform a review of literature focused on the use of hand-worn devices for rehabilitation and assessment of hand function. We paid particular attention to protocols that involve brain-computer interfaces (BCIs) since BCIs are gaining ground as a means for detecting volitional signals as the basis for interactive motor training protocols to augment recovery. All devices reviewed either monitor, assist, stimulate, or support hand and finger movement. Results A majority of studies reviewed here test or validate devices through clinical trials, especially for stroke. Even though sensor gloves are the most commonly employed type of device in this domain, they have certain limitations. Many such gloves use bend or inertial sensors to monitor the movement of individual digits, but few monitor both movement and applied pressure. The use of such devices in BCI protocols is also uncommon. Discussion We conclude that hand-worn devices that monitor both flexion and grip will benefit both clinical diagnostic assessment of function during treatment and closed-loop BCI protocols aimed at rehabilitation.
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Generalization indicates asymmetric and interactive control networks for multi-finger dexterous movements. Cell Rep 2023; 42:112214. [PMID: 36924500 DOI: 10.1016/j.celrep.2023.112214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/24/2022] [Accepted: 02/16/2023] [Indexed: 03/15/2023] Open
Abstract
Finger dexterity is manifested by coordinated patterns of muscle activity and generalization of learning across contexts. Some fingers flex, others extend, and some are immobile. Whether or not the neural control processes of these direction-specific actions are independent remains unclear. We characterized behavioral principles underlying learning and generalization of dexterous flexion and extension movements, within and across hands, using an isometric dexterity task that precisely measured finger individuation, force accuracy, and temporal synchronization. Two cohorts of participants trained for 3 days in either the flexion or extension direction. All dexterity measures in both groups showed post-training improvement, although finger extension exhibited inferior dexterity. Surprisingly, learning of finger extension generalized to the untrained flexion direction, but not vice versa. This flexion bias was also evident in the untrained hand. Our study indicates direction-specific control circuits for learning of finger flexion and extension that interact by partially, but asymmetrically, transferring between directions.
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A Unified Model for Stroke Recovery and Rehabilitation: Why Now? Am J Phys Med Rehabil 2023; 102:S3-S9. [PMID: 36634323 DOI: 10.1097/phm.0000000000002141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
ABSTRACT The current model of stroke care delivery in the United States and in many parts of the world is fragmented, resulting in lack of continuity of care, inability to track recovery meaningfully across the continuum, and lack of access to the frequency, intensity, and duration of high-quality rehabilitation necessary to optimally harness recovery processes. The process of recovery itself has been overshadowed by a focus on length of stay and the movement of patients across levels of care. Here, we describe the rationale behind the recent efforts at the Johns Hopkins Sheikh Khalifa Stroke Institute to define and coordinate an intensive, strategic effort to develop effective stroke systems of care across the continuum through the development of a unified Sheikh Khalifa Stroke Institute model of recovery and rehabilitation.
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Addressing the Operational Challenges for Outpatient Stroke Rehabilitation. Am J Phys Med Rehabil 2023; 102:S61-S67. [PMID: 36634333 DOI: 10.1097/phm.0000000000002145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
ABSTRACT The traditional model of rehabilitation services includes clear requirements for provision of services in the acute inpatient rehabilitation setting. However, there are fewer guidelines on the frequency and duration of rehabilitation services beyond the acute setting. Recent research has suggested that neurorehabilitation interventions that are provided frequently enough upon discharge from acute inpatient rehabilitation to facilitate repeated practice and feedback improve long-term stroke outcomes. However, it is challenging to provide high-frequency outpatient rehabilitation, as the logistics of scheduling and insurance limitations often do not allow it. The Sheikh Khalifa Stroke Institute at Johns Hopkins Medicine innovated a new model to provide the appropriate frequency of therapy for stroke rehabilitation in the outpatient setting. This article describes the restructured operational infrastructure for outpatient stroke rehabilitation to facilitate high-frequency transdisciplinary stroke rehabilitation in the real world, including the development of the outpatient postacute therapy programs and the identification of appropriate patients for each program, the development of scheduling matrices and treating teams to deliver the postacute therapy programs, the implementation of transdisciplinary neurorehabilitation, and the steps taken to empower patients to engage in rehabilitation at home and address barriers to accessing the programs. We assessed the effect of the operational restructuring on schedule utilization, no-show rates, and cancellation rates in the 3 mos before and after implementation of the program and show that it increased schedule utilization and reduced no-show rates and cancellation rates, suggesting that it may increase compliance with rehabilitation. It is possible to create the infrastructure needed to bridge the continuum of care for poststroke recovery and rehabilitation.
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Cherry-Allen KM, French MA, Stenum J, Xu J, Roemmich RT. Opportunities for Improving Motor Assessment and Rehabilitation After Stroke by Leveraging Video-Based Pose Estimation. Am J Phys Med Rehabil 2023; 102:S68-S74. [PMID: 36634334 DOI: 10.1097/phm.0000000000002131] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
ABSTRACT Stroke is a leading cause of long-term disability in adults in the United States. As the healthcare system moves further into an era of digital medicine and remote monitoring, technology continues to play an increasingly important role in post-stroke care. In this Analysis and Perspective article, opportunities for using human pose estimation-an emerging technology that uses artificial intelligence to track human movement kinematics from simple videos recorded using household devices (e.g., smartphones, tablets)-to improve motor assessment and rehabilitation after stroke are discussed. The focus is on the potential of two key applications: (1) improving access to quantitative, objective motor assessment and (2) advancing telerehabilitation for persons post-stroke.
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Affiliation(s)
- Kendra M Cherry-Allen
- From the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland (KMC-A, MAF, JS, RTR); Department of Physical Therapy Education, Western University of Health Sciences, Lebanon, Oregon (KMC-A); Center for Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland (JS, RTR); and Department of Kinesiology, University of Georgia, Athens, Georgia (JX)
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Lee HS, Schreiner L, Jo SH, Sieghartsleitner S, Jordan M, Pretl H, Guger C, Park HS. Individual finger movement decoding using a novel ultra-high-density electroencephalography-based brain-computer interface system. Front Neurosci 2022; 16:1009878. [PMID: 36340769 PMCID: PMC9627315 DOI: 10.3389/fnins.2022.1009878] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022] Open
Abstract
Brain-Computer Interface (BCI) technology enables users to operate external devices without physical movement. Electroencephalography (EEG) based BCI systems are being actively studied due to their high temporal resolution, convenient usage, and portability. However, fewer studies have been conducted to investigate the impact of high spatial resolution of EEG on decoding precise body motions, such as finger movements, which are essential in activities of daily living. Low spatial sensor resolution, as found in common EEG systems, can be improved by omitting the conventional standard of EEG electrode distribution (the international 10-20 system) and ordinary mounting structures (e.g., flexible caps). In this study, we used newly proposed flexible electrode grids attached directly to the scalp, which provided ultra-high-density EEG (uHD EEG). We explored the performance of the novel system by decoding individual finger movements using a total of 256 channels distributed over the contralateral sensorimotor cortex. Dense distribution and small-sized electrodes result in an inter-electrode distance of 8.6 mm (uHD EEG), while that of conventional EEG is 60 to 65 mm on average. Five healthy subjects participated in the experiment, performed single finger extensions according to a visual cue, and received avatar feedback. This study exploits mu (8-12 Hz) and beta (13-25 Hz) band power features for classification and topography plots. 3D ERD/S activation plots for each frequency band were generated using the MNI-152 template head. A linear support vector machine (SVM) was used for pairwise finger classification. The topography plots showed regular and focal post-cue activation, especially in subjects with optimal signal quality. The average classification accuracy over subjects was 64.8 (6.3)%, with the middle versus ring finger resulting in the highest average accuracy of 70.6 (9.4)%. Further studies are required using the uHD EEG system with real-time feedback and motor imagery tasks to enhance classification performance and establish the basis for BCI finger movement control of external devices.
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Affiliation(s)
- Hyemin S. Lee
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
| | - Leonhard Schreiner
- g.tec Medical Engineering GmbH, Schiedlberg, Upper Austria, Austria
- Institute for Integrated Circuits, Johannes Kepler University, Linz, Austria
| | - Seong-Hyeon Jo
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
| | | | - Michael Jordan
- g.tec Medical Engineering GmbH, Schiedlberg, Upper Austria, Austria
| | - Harald Pretl
- Institute for Integrated Circuits, Johannes Kepler University, Linz, Austria
| | - Christoph Guger
- g.tec Medical Engineering GmbH, Schiedlberg, Upper Austria, Austria
| | - Hyung-Soon Park
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
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Carducci J, Olds K, Krakauer JW, Xu J, Brown JD. Novel Planar Strain Sensor Design for Capturing 3-Dimensional Fingertip Forces from Patients Affected by Hand Paralysis. SENSORS (BASEL, SWITZERLAND) 2022; 22:7441. [PMID: 36236539 PMCID: PMC9571685 DOI: 10.3390/s22197441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
Assessment and therapy for individuals who have hand paresis requires force sensing approaches that can measure a wide range of finger forces in multiple dimensions. Here we present a novel strain-gauge force sensor with 3 degrees of freedom (DOF) designed for use in a hand assessment and rehabilitation device. The sensor features a fiberglass printed circuit board substrate to which eight strain gauges are bonded. All circuity for the sensor is routed directly through the board, which is secured to a larger rehabilitative device via an aluminum frame. After design, the sensing package was characterized for weight, capacity, and resolution requirements. Furthermore, a test sensor was calibrated in a three-axis configuration and validated in the larger spherical workspace to understand how accurate and precise the sensor is, while the sensor has slight shortcomings with validation error, it does satisfy the precision, calibration accuracy, and fine sensing requirements in orthogonal loading, and all structural specifications are met. The sensor is therefore a great candidate for sensing technology in rehabilitation devices that assess dexterity in patients with impaired hand function.
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Affiliation(s)
- Jacob Carducci
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Kevin Olds
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD 21287, USA
| | - John W. Krakauer
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD 21287, USA
| | - Jing Xu
- Department of Kinesiology, University of Georgia, Athens, GA 30602, USA
| | - Jeremy D. Brown
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
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14
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Sanders ZB, Fleming MK, Smejka T, Marzolla MC, Zich C, Rieger SW, Lührs M, Goebel R, Sampaio-Baptista C, Johansen-Berg H. Self-modulation of motor cortex activity after stroke: a randomized controlled trial. Brain 2022; 145:3391-3404. [PMID: 35960166 PMCID: PMC9586541 DOI: 10.1093/brain/awac239] [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: 10/08/2021] [Revised: 06/01/2022] [Accepted: 06/20/2022] [Indexed: 11/14/2022] Open
Abstract
Real-time functional MRI neurofeedback allows individuals to self-modulate their ongoing brain activity. This may be a useful tool in clinical disorders that are associated with altered brain activity patterns. Motor impairment after stroke has previously been associated with decreased laterality of motor cortex activity. Here we examined whether chronic stroke survivors were able to use real-time fMRI neurofeedback to increase laterality of motor cortex activity and assessed effects on motor performance and on brain structure and function. We carried out a randomized, double-blind, sham-controlled trial (ClinicalTrials.gov: NCT03775915) in which 24 chronic stroke survivors with mild to moderate upper limb impairment experienced three training days of either Real (n = 12) or Sham (n = 12) neurofeedback. Assessments of brain structure, brain function and measures of upper-limb function were carried out before and 1 week after neurofeedback training. Additionally, measures of upper-limb function were repeated 1 month after neurofeedback training. Primary outcome measures were (i) changes in lateralization of motor cortex activity during movements of the stroke-affected hand throughout neurofeedback training days; and (ii) changes in motor performance of the affected limb on the Jebsen Taylor Test (JTT). Stroke survivors were able to use Real neurofeedback to increase laterality of motor cortex activity within (P = 0.019), but not across, training days. There was no group effect on the primary behavioural outcome measure, which was average JTT performance across all subtasks (P = 0.116). Secondary analysis found improvements in the performance of the gross motor subtasks of the JTT in the Real neurofeedback group compared to Sham (P = 0.010). However, there were no improvements on the Action Research Arm Test or the Upper Extremity Fugl–Meyer score (both P > 0.5). Additionally, decreased white-matter asymmetry of the corticospinal tracts was detected 1 week after neurofeedback training (P = 0.008), indicating that the tracts become more similar with Real neurofeedback. Changes in the affected corticospinal tract were positively correlated with participants neurofeedback performance (P = 0.002). Therefore, here we demonstrate that chronic stroke survivors are able to use functional MRI neurofeedback to self-modulate motor cortex activity in comparison to a Sham control, and that training is associated with improvements in gross hand motor performance and with white matter structural changes.
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Affiliation(s)
- Zeena Britt Sanders
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford OX3 9DU, UK
| | - Melanie K Fleming
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford OX3 9DU, UK
| | - Tom Smejka
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford OX3 9DU, UK
| | - Marilien C Marzolla
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford OX3 9DU, UK
| | - Catharina Zich
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford OX3 9DU, UK
| | - Sebastian W Rieger
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford OX3 9DU, UK
| | - Michael Lührs
- Department of Cognitive Neuroscience, Maastricht University, 6229 EV Maastricht, The Netherlands.,Research Department, Brain Innovation B.V., 6229 EV Maastricht, The Netherlands
| | - Rainer Goebel
- Department of Cognitive Neuroscience, Maastricht University, 6229 EV Maastricht, The Netherlands.,Research Department, Brain Innovation B.V., 6229 EV Maastricht, The Netherlands
| | - Cassandra Sampaio-Baptista
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford OX3 9DU, UK.,Institute of Neuroscience and Psychology, University of Glasgow, Glasgow G61 1QH, UK
| | - Heidi Johansen-Berg
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford OX3 9DU, UK
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15
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Demers M, Varghese R, Winstein C. Retrospective Analysis of Task-Specific Effects on Brain Activity After Stroke: A Pilot Study. Front Hum Neurosci 2022; 16:871239. [PMID: 35721357 PMCID: PMC9201099 DOI: 10.3389/fnhum.2022.871239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundEvidence supports cortical reorganization in sensorimotor areas induced by constraint-induced movement therapy (CIMT). However, only a few studies examined the neural plastic changes as a function of task specificity. This retrospective analysis aims to evaluate the functional brain activation changes during a precision and a power grasp task in chronic stroke survivors who received 2-weeks of CIMT compared to a no-treatment control group.MethodsFourteen chronic stroke survivors, randomized to CIMT (n = 8) or non-CIMT (n = 6), underwent functional MRI (fMRI) before and after a 2-week period. Two behavioral measures, the 6-item Wolf Motor Function Test (WMFT-6) and the Motor Activity Log (MAL), and fMRI brain scans were collected before and after a 2-week period. During scan runs, participants performed two different grasp tasks (precision, power). Pre to post changes in laterality index (LI) were compared by group and task for two predetermined motor regions of interest: dorsal premotor cortex (PMd) and primary motor cortex (MI).ResultsIn contrast to the control group, the CIMT group showed significant improvements in the WMFT-6. For the MAL, both groups showed a trend toward greater improvements from baseline. Two weeks of CIMT resulted in a relative increase in activity in a key region of the motor network, PMd of the lesioned hemisphere, under precision grasp task conditions compared to the non-treatment control group. No changes in LI were observed in MI for either task or group.ConclusionThese findings provide preliminary evidence for task-specific effects of CIMT in the promotion of recovery-supportive cortical reorganization in chronic stroke survivors.
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Affiliation(s)
- Marika Demers
- Motor Behavior and Neurorehabilitation Laboratory, Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, United States
| | - Rini Varghese
- Motor Behavior and Neurorehabilitation Laboratory, Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, United States
| | - Carolee Winstein
- Motor Behavior and Neurorehabilitation Laboratory, Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, United States
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- *Correspondence: Carolee Winstein,
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16
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Design of a 3D-Printed Hand Exoskeleton Based on Force-Myography Control for Assistance and Rehabilitation. MACHINES 2022. [DOI: 10.3390/machines10010057] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Voluntary hand movements are usually impaired after a cerebral stroke, affecting millions of people per year worldwide. Recently, the use of hand exoskeletons for assistance and motor rehabilitation has become increasingly widespread. This study presents a novel hand exoskeleton, designed to be low cost, wearable, easily adaptable and suitable for home use. Most of the components of the exoskeleton are 3D printed, allowing for easy replication, customization and maintenance at a low cost. A strongly underactuated mechanical system allows one to synergically move the four fingers by means of a single actuator through a rigid transmission, while the thumb is kept in an adduction or abduction position. The exoskeleton’s ability to extend a typical hypertonic paretic hand of stroke patients was firstly tested using the SimScape Multibody simulation environment; this helped in the choice of a proper electric actuator. Force-myography was used instead of the standard electromyography to voluntarily control the exoskeleton with more simplicity. The user can activate the flexion/extension of the exoskeleton by a weak contraction of two antagonist muscles. A symmetrical master–slave motion strategy (i.e., the paretic hand motion is activated by the healthy hand) is also available for patients with severe muscle atrophy. An inexpensive microcontroller board was used to implement the electronic control of the exoskeleton and provide feedback to the user. The entire exoskeleton including batteries can be worn on the patient’s arm. The ability to provide a fluid and safe grip, like that of a healthy hand, was verified through kinematic analyses obtained by processing high-framerate videos. The trajectories described by the phalanges of the natural and the exoskeleton finger were compared by means of cross-correlation coefficients; a similarity of about 80% was found. The time required for both closing and opening of the hand exoskeleton was about 0.9 s. A rigid cylindric handlebar containing a load cell measured an average power grasp force of 94.61 N, enough to assist the user in performing most of the activities of daily living. The exoskeleton can be used as an aid and to promote motor function recovery during patient’s neurorehabilitation therapy.
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17
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Russo M, Ozeri-Engelhard N, Hupfeld K, Nettekoven C, Thibault S, Sedaghat-Nejad E, Buchwald D, Xing D, Zobeiri O, Kilteni K, Albert ST, Ariani G. Highlights from the 30th Annual Meeting of the Society for the Neural Control of Movement. J Neurophysiol 2021; 126:967-975. [PMID: 34406885 PMCID: PMC8560412 DOI: 10.1152/jn.00334.2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/10/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Marta Russo
- Department of Neurology, Tor Vergata Polyclinic, Rome, Italy
- Department of Biology, Northeastern University, Boston, Massachusetts
| | - Nofar Ozeri-Engelhard
- WM Keck Center for Collaborative Neuroscience, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Kathleen Hupfeld
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Caroline Nettekoven
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Simon Thibault
- ImpAct team, Lyon Neuroscience Research Center, Inserm U1028, CNRS UMR5292, University of Lyon 1, Lyon, France
| | - Ehsan Sedaghat-Nejad
- Laboratory for Computational Motor Control, Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Daniela Buchwald
- Ottobock SE & Co. KGaA, Software & Electronics Engineering, Duderstadt, Germany
| | - David Xing
- Department of Neurobiology, Northwestern University, Evanston, Illinois
| | - Omid Zobeiri
- Department of Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | | | - Scott T Albert
- Laboratory for Computational Motor Control, Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Giacomo Ariani
- The Brain and Mind Institute, Western University, London, Ontario, Canada
- Department of Computer Science, Western University, London, Ontario, Canada
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18
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Broderick M, Almedom L, Burdet E, Burridge J, Bentley P. Self-Directed Exergaming for Stroke Upper Limb Impairment Increases Exercise Dose Compared to Standard Care. Neurorehabil Neural Repair 2021; 35:974-985. [PMID: 34449290 PMCID: PMC8593287 DOI: 10.1177/15459683211041313] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background. One of the strongest modifiable determinants of rehabilitation outcome is exercise dose. Technologies enabling self-directed exercise offer a pragmatic means to increase dose, but the extent to which they achieve this in unselected cohorts, under real-world constraints, is poorly understood. Objective. Here we quantify the exercise dose achieved by inpatient stroke survivors using an adapted upper limb (UL) exercise gaming (exergaming) device and compare this with conventional (supervised) therapy. Methods. Over 4 months, patients presenting with acute stroke and associated UL impairment were screened at a single stroke centre. Participants were trained in a single session and provided with the device for unsupervised use during their inpatient admission. Results. From 75 patients referred for inpatient UL therapy, we recruited 30 (40%), of whom 26 (35%) were able to use the device meaningfully with their affected UL. Over a median enrolment time of 8 days (IQR: 5–14), self-directed UL exercise duration using the device was 26 minutes per day (median; IQR: 16–31), in addition to 25 minutes daily conventional UL therapy (IQR: 12–34; same cohort plus standard care audit; joint n = 50); thereby doubling total exercise duration (51 minutes; IQR: 32–64) relative to standard care (Z = 4.0, P <.001). The device enabled 104 UL repetitions per day (IQR: 38–393), whereas conventional therapy achieved 15 UL repetitions per day (IQR: 11–23; Z = 4.3, P <.001). Conclusion. Self-directed adapted exergaming enabled participants in our stroke inpatient cohort to increase exercise duration 2-fold, and repetitions 8-fold, compared to standard care, without requiring additional professional supervision.
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Affiliation(s)
- Michelle Broderick
- Department of Brain Sciences, 4615Imperial College London, Charing Cross Hospital Campus, London, UK
| | - Leeza Almedom
- Department of Brain Sciences, 4615Imperial College London, Charing Cross Hospital Campus, London, UK
| | - Etienne Burdet
- Department. of Bioengineering, Human Robotics Group, Imperial College, South Kensington Campus, London, UK
| | - Jane Burridge
- Department of Restorative Neuroscience, University of Southampton, Southampton, UK
| | - Paul Bentley
- Department of Brain Sciences, 4615Imperial College London, Charing Cross Hospital Campus, London, UK
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19
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Roby-Brami A, Jarrassé N, Parry R. Impairment and Compensation in Dexterous Upper-Limb Function After Stroke. From the Direct Consequences of Pyramidal Tract Lesions to Behavioral Involvement of Both Upper-Limbs in Daily Activities. Front Hum Neurosci 2021; 15:662006. [PMID: 34234659 PMCID: PMC8255798 DOI: 10.3389/fnhum.2021.662006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/27/2021] [Indexed: 01/02/2023] Open
Abstract
Impairments in dexterous upper limb function are a significant cause of disability following stroke. While the physiological basis of movement deficits consequent to a lesion in the pyramidal tract is well demonstrated, specific mechanisms contributing to optimal recovery are less apparent. Various upper limb interventions (motor learning methods, neurostimulation techniques, robotics, virtual reality, and serious games) are associated with improvements in motor performance, but many patients continue to experience significant limitations with object handling in everyday activities. Exactly how we go about consolidating adaptive motor behaviors through the rehabilitation process thus remains a considerable challenge. An important part of this problem is the ability to successfully distinguish the extent to which a given gesture is determined by the neuromotor impairment and that which is determined by a compensatory mechanism. This question is particularly complicated in tasks involving manual dexterity where prehensile movements are contingent upon the task (individual digit movement, grasping, and manipulation…) and its objective (placing, two step actions…), as well as personal factors (motivation, acquired skills, and life habits…) and contextual cues related to the environment (presence of tools or assistive devices…). Presently, there remains a lack of integrative studies which differentiate processes related to structural changes associated with the neurological lesion and those related to behavioral change in response to situational constraints. In this text, we shall question the link between impairments, motor strategies and individual performance in object handling tasks. This scoping review will be based on clinical studies, and discussed in relation to more general findings about hand and upper limb function (manipulation of objects, tool use in daily life activity). We shall discuss how further quantitative studies on human manipulation in ecological contexts may provide greater insight into compensatory motor behavior in patients with a neurological impairment of dexterous upper-limb function.
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Affiliation(s)
- Agnès Roby-Brami
- ISIR Institute of Intelligent Systems and Robotics, AGATHE Team, CNRS UMR 7222, INSERM U 1150, Sorbonne University, Paris, France
| | - Nathanaël Jarrassé
- ISIR Institute of Intelligent Systems and Robotics, AGATHE Team, CNRS UMR 7222, INSERM U 1150, Sorbonne University, Paris, France
| | - Ross Parry
- ISIR Institute of Intelligent Systems and Robotics, AGATHE Team, CNRS UMR 7222, INSERM U 1150, Sorbonne University, Paris, France.,LINP2-AAPS Laboratoire Interdisciplinaire en Neurosciences, Physiologie et Psychologie: Activité Physique, Santé et Apprentissages, UPL, Paris Nanterre University, Nanterre, France
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20
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Johnstone A, Brander F, Kelly K, Bestmann S, Ward N. Differences in outcomes following an intensive upper-limb rehabilitation program for patients with common central nervous system-acting drug prescriptions. Int J Stroke 2021; 17:269-281. [PMID: 33724107 PMCID: PMC8864335 DOI: 10.1177/17474930211006287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: Difficulty using the upper-limb is a major barrier to
independence for many patients post-stroke or brain injury. High dose rehabilitation can
result in clinically significant improvements in function even years after the incident;
however, there is still high variability in patient responsiveness to such interventions
that cannot be explained by age, sex, or time since stroke. Methods: This
retrospective study investigated whether patients prescribed certain classes of central
nervous system-acting drugs—γ-aminobutyric acid (GABA) agonists, antiepileptics, and
antidepressants—differed in their outcomes on the three-week intensive Queen Square
Upper-Limb program. For 277 stroke or brain injury patients (167 male, median age 52 years
(IQR: 21), median time since incident 20 months (IQR: 26)) upper-limb impairment and
activity was assessed at admission to the program and at six months post-discharge, using
the upper limb component of the Fugl-Meyer, Action Research Arm Test, and Chedoke Arm and
Hand Activity Inventory. Drug prescriptions were obtained from primary care physicians at
referral. Specification curve analysis was used to protect against selective reporting
results and add robustness to the conclusions of this retrospective study.
Results: Patients with GABA agonist prescriptions had significantly worse
upper-limb scores at admission but no evidence for a significant difference in
program-induced improvements was found. Additionally, no evidence of significant
differences in patients with or without antiepileptic drug prescriptions on either
admission to, or improvement on, the program was found in this study. Although no evidence
was found for differences in admission scores, patients with antidepressant prescriptions
experienced reduced improvement in upper-limb function, even when accounting for anxiety
and depression scores. Conclusions: These results demonstrate that, when
prescribed typically, there was no evidence that patients prescribed GABA agonists
performed worse on this high-intensity rehabilitation program. Patients prescribed
antidepressants, however, performed poorer than expected on the Queen Square Upper-Limb
rehabilitation program. While the reasons for these differences are unclear, identifying
these patients prior to admission may allow for better accommodation of differences in
their rehabilitation needs.
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Affiliation(s)
- Ainslie Johnstone
- Department for Clinical and Movement Neuroscience, 4919UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Fran Brander
- The 98546National Hospital for Neurology and Neurosurgery, London, UK.,4919UCLP Centre for Neurorehabilitation, London, UK
| | - Kate Kelly
- The 98546National Hospital for Neurology and Neurosurgery, London, UK.,4919UCLP Centre for Neurorehabilitation, London, UK
| | - Sven Bestmann
- Department for Clinical and Movement Neuroscience, 4919UCL Queen Square Institute of Neurology, University College London, London, UK.,Wellcome Centre for Human Neuroimaging, 4919UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Nick Ward
- Department for Clinical and Movement Neuroscience, 4919UCL Queen Square Institute of Neurology, University College London, London, UK.,The 98546National Hospital for Neurology and Neurosurgery, London, UK.,4919UCLP Centre for Neurorehabilitation, London, UK
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21
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Krakauer JW, Kitago T, Goldsmith J, Ahmad O, Roy P, Stein J, Bishop L, Casey K, Valladares B, Harran MD, Cortés JC, Forrence A, Xu J, DeLuzio S, Held JP, Schwarz A, Steiner L, Widmer M, Jordan K, Ludwig D, Moore M, Barbera M, Vora I, Stockley R, Celnik P, Zeiler S, Branscheidt M, Kwakkel G, Luft AR. Comparing a Novel Neuroanimation Experience to Conventional Therapy for High-Dose Intensive Upper-Limb Training in Subacute Stroke: The SMARTS2 Randomized Trial. Neurorehabil Neural Repair 2021; 35:393-405. [PMID: 33745372 DOI: 10.1177/15459683211000730] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Evidence from animal studies suggests that greater reductions in poststroke motor impairment can be attained with significantly higher doses and intensities of therapy focused on movement quality. These studies also indicate a dose-timing interaction, with more pronounced effects if high-intensity therapy is delivered in the acute/subacute, rather than chronic, poststroke period. OBJECTIVE To compare 2 approaches of delivering high-intensity, high-dose upper-limb therapy in patients with subacute stroke: a novel exploratory neuroanimation therapy (NAT) and modified conventional occupational therapy (COT). METHODS A total of 24 patients were randomized to NAT or COT and underwent 30 sessions of 60 minutes time-on-task in addition to standard care. The primary outcome was the Fugl-Meyer Upper Extremity motor score (FM-UE). Secondary outcomes included Action Research Arm Test (ARAT), grip strength, Stroke Impact Scale hand domain, and upper-limb kinematics. Outcomes were assessed at baseline, and days 3, 90, and 180 posttraining. Both groups were compared to a matched historical cohort (HC), which received only 30 minutes of upper-limb therapy per day. RESULTS There were no significant between-group differences in FM-UE change or any of the secondary outcomes at any timepoint. Both high-dose groups showed greater recovery on the ARAT (7.3 ± 2.9 points; P = .011) but not the FM-UE (1.4 ± 2.6 points; P = .564) when compared with the HC. CONCLUSIONS Neuroanimation may offer a new, enjoyable, efficient, and scalable way to deliver high-dose and intensive upper-limb therapy.
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Affiliation(s)
| | - Tomoko Kitago
- Burke Neurological Institute, White Plains, NY, USA.,Weill Cornell Medicine, New York, NY, USA.,Columbia University, New York, NY, USA
| | - Jeff Goldsmith
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Omar Ahmad
- Johns Hopkins University, Baltimore, MD, USA
| | - Promit Roy
- Johns Hopkins University, Baltimore, MD, USA
| | - Joel Stein
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Lauri Bishop
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Kelly Casey
- Johns Hopkins University, Baltimore, MD, USA
| | - Belen Valladares
- cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland.,University Hospital and University of Zurich, Switzerland
| | | | - Juan Camilo Cortés
- Johns Hopkins University, Baltimore, MD, USA.,Columbia University, New York, NY, USA
| | | | - Jing Xu
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Jeremia P Held
- University Hospital and University of Zurich, Switzerland
| | - Anne Schwarz
- University Hospital and University of Zurich, Switzerland
| | - Levke Steiner
- University Hospital and University of Zurich, Switzerland
| | - Mario Widmer
- cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | | | | | | | | | - Isha Vora
- Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | - Gert Kwakkel
- Vrije Universiteit Amsterdam, Netherlands.,Amsterdam Rehabilitation Research Centre, Reade, Netherlands
| | - Andreas R Luft
- cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland.,University Hospital and University of Zurich, Switzerland
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22
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Meyer S, Verheyden G, Kempeneers K, Michielsen M. Arm-Hand Boost Therapy During Inpatient Stroke Rehabilitation: A Pilot Randomized Controlled Trial. Front Neurol 2021; 12:652042. [PMID: 33716948 PMCID: PMC7952763 DOI: 10.3389/fneur.2021.652042] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/05/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: It was the aim to assess feasibility, safety, and potential efficacy of a new intensive, focused arm-hand BOOST program and to investigate whether there is a difference between early vs. late delivery of the program in the sub-acute phase post stroke. Methods: In this pilot RCT, patients with stroke were randomized to the immediate group (IG): 4 weeks (4 w) BOOST +4 w CONTROL or the delayed group (DG): 4 w CONTROL +4 w BOOST, on top of their usual inpatient care program. The focused arm-hand BOOST program (1 h/day, 5x/week, 4 weeks) consisted of group exercises with focus on scapula-setting, core-stability, manipulation and complex ADL tasks. Additionally, 1 h per week the Armeo®Power (Hocoma AG, Switzerland) was used. The CONTROL intervention comprised a dose-matched program (24 one-hour sessions in 4 w) of lower limb strengthening exercises and general reconditioning. At baseline, after 4 and 8 weeks of training, the Fugl-Meyer assessment upper extremity (FMA-UE), action research arm test (ARAT), and stroke upper limb capacity scale (SULCS) were administered. Results: Eighteen participants (IG: n = 10, DG: n = 8) were included, with a median (IQR) time post stroke of 8.6 weeks (5-12). No adverse events were experienced. After 4 weeks of training, significant between-group differences were found for FMA-UE (p = 0.003) and SULCS (p = 0.033) and a trend for ARAT (p = 0.075) with median (IQR) change scores for the IG of 9 (7-16), 2 (1-3), and 12.5 (1-18), respectively, and for the DG of 0.5 (-3 to 3), 1 (0-1), and 1.5 (-1 to 9), respectively. In the IG, 80% of patients improved beyond the minimal clinical important difference of FMA-UE after 4 weeks, compared to none of the DG patients. Between 4 and 8 weeks of training, patients in the DG tend to show larger improvements when compared to the IG, however, between-group comparisons did not reach significance. Conclusions: Results of this pilot RCT showed that an intensive, specific arm-hand BOOST program, on top of usual care, is feasible and safe in the sub-acute phase post stroke and suggests positive, clinical meaningful effects on upper limb function, especially when delivered in the early sub-acute phase post stroke. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT04584177.
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Affiliation(s)
- Sarah Meyer
- Jessa Hospital, Rehabilitation Centre, Campus Sint-Ursula, Herk-de-Stad, Belgium
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Kristof Kempeneers
- Jessa Hospital, Rehabilitation Centre, Campus Sint-Ursula, Herk-de-Stad, Belgium
| | - Marc Michielsen
- Jessa Hospital, Rehabilitation Centre, Campus Sint-Ursula, Herk-de-Stad, Belgium
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