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Levin MF, Berman S, Weiss N, Parmet Y, Baniña MC, Frenkel-Toledo S, Soroker N, Solomon JM, Liebermann DG. ENHANCE proof-of-concept three-arm randomized trial: effects of reaching training of the hemiparetic upper limb restricted to the spasticity-free elbow range. Sci Rep 2023; 13:22934. [PMID: 38129527 PMCID: PMC10739929 DOI: 10.1038/s41598-023-49974-6] [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: 01/28/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
Post-stroke motor recovery processes remain unknown. Timescales and patterns of upper-limb (UL) recovery suggest a major impact of biological factors, with modest contributions from rehabilitation. We assessed a novel impairment-based training motivated by motor control theory where reaching occurs within the spasticity-free elbow range. Patients with subacute stroke (≤ 6 month; n = 46) and elbow flexor spasticity were randomly allocated to a 10-day UL training protocol, either personalized by restricting reaching to the spasticity-free elbow range defined by the tonic stretch reflex threshold (TSRT) or non-personalized (non-restricted) and with/without anodal transcranial direct current stimulation. Outcomes assessed before, after, and 1 month post-intervention were elbow flexor TSRT angle and reach-to-grasp arm kinematics (primary) and stretch reflex velocity sensitivity, clinical impairment, and activity (secondary). Results were analyzed for 3 groups as well as those of the effects of impairment-based training. Clinical measures improved in both groups. Spasticity-free range training resulted in faster and smoother reaches, smaller (i.e., better) arm-plane path length, and closer-to-normal shoulder/elbow movement patterns. Non-personalized training improved clinical scores without improving arm kinematics, suggesting that clinical measures do not account for movement quality. Impairment-based training within a spasticity-free elbow range is promising since it may improve clinical scores together with arm movement quality.Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique Identifier: NCT02725853; Initial registration date: 01/04/2016.
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Affiliation(s)
- Mindy F Levin
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal, QC, H3G 1Y5, Canada.
- Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, QC, Canada.
| | - Sigal Berman
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- The Zlotowski Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Neta Weiss
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yisrael Parmet
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Melanie C Baniña
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal, QC, H3G 1Y5, Canada
- Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, QC, Canada
| | - Silvi Frenkel-Toledo
- Department of Physical Therapy, Ariel University, Ariel, Israel
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Hospital, Ra'anana, Israel
| | - Nachum Soroker
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Hospital, Ra'anana, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Dario G Liebermann
- Department of Physical Therapy, Faculty of Medicine, Stanley Steyer School of Health Professions, Tel Aviv University, POB 39040, 61390, Ramat Aviv, Tel Aviv, Israel.
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Rozevink SG, Hijmans JM, Horstink KA, van der Sluis CK. Effectiveness of task-specific training using assistive devices and task-specific usual care on upper limb performance after stroke: a systematic review and meta-analysis. Disabil Rehabil Assist Technol 2023; 18:1245-1258. [PMID: 34788166 DOI: 10.1080/17483107.2021.2001061] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Task-specific rehabilitation is a key indicator for successful rehabilitation to improve the upper limb performance after stroke. Assistive robotic and non-robotic devices are emerging to provide rehabilitation therapy; however, the effectiveness of task-specific training programs using assistive training devices compared with task-specific usual care training has not been summarized yet. Therefore, the effectiveness of task-specific training using assistive arm devices (TST-AAD) compared with task-specific usual care (TSUC) on the upper limb performance of patients with a stroke was investigated. To assess task specificity, a set of criteria was proposed: participation, program, relevant, repeated, randomized, reconstruction and reinforced. MATERIALS AND METHODS Out of 855 articles, 17 fulfilled the selection criteria. A meta-analysis was performed on the Fugl-Meyer Assessment scores in the subacute and chronic stages after stroke and during follow-up. RESULTS AND CONCLUSION Both TST-AAD and TSUC improved the upper limb performance after stroke. In the sub-acute phase after stroke, TST-AAD was more effective than TSUC in reducing the upper limb impairment, although findings were based on only three studies. In the chronic phase, TST-AAD and TSUC showed similar effectiveness. No differences between the two types of training were found at the follow-up measurements. Future studies should describe training, device usage and criteria of task specificity in a standardized way to ease comparison.Implications for rehabilitationArm or hand function is often undertreated in stroke patients, assistive training devices may be able to improve the upper limb performance.Task-specific training using assistive devices is effective in improving the upper limb performance after stroke.Task-specific training using assistive devices seems to be more effective in reducing impairment compared with task specific usual care in the subacute phase after stroke, but they are equally effective in the chronic phase of stroke.
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Affiliation(s)
- Samantha G Rozevink
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - Juha M Hijmans
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - Koen A Horstink
- University of Groningen, University Medical Center Groningen, Department of Human Movement Sciences, Groningen, The Netherlands
| | - Corry K van der Sluis
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
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Khan A, Podlasek A, Somaa F. Virtual reality in post-stroke neurorehabilitation - a systematic review and meta-analysis. Top Stroke Rehabil 2023; 30:53-72. [PMID: 34747351 DOI: 10.1080/10749357.2021.1990468] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Stroke is a neurological disorder and one of the leading causes of disability worldwide. The patient may lose the ability to adequately move the extremities, perceive sensations, or ambulate independently. Recent experimental studies have reported the beneficial influence of virtual reality training strategies on improving overall functional abilities for stroke survivors. METHODS Conducted a systematic review of the literature using the following keywords to retrieve the data: stroke, virtual reality, motor deficits, neurorehabilitation, cognitive impairments, and sensory deficits. A random-effect meta-analysis was performed for seven scales - one cognitive (MMSE) and six motor (Fugl-Meyer, Berg Balance Scale, Time up and go, Wolf motor function, 10 m walk, Brunnstrom score). OBJECTIVE To organize and compare all the available data regarding the effectiveness of virtual reality for stroke rehabilitation. RESULTS This literature reviewed 150 studies and included 46 for qualitative and 27 for quantitative analysis. There was no statistically significant difference between groups in MMSE score (MD = 0.24, 95%CI = ((-0.42) -(0.9)), p = .47, I2 = 0%) and Fugl-Meyer score (MD = (-0.38), 95%CI = ((-12.88)-(12.11)), p = .95, I2 = 98%) . The statistical significance was not reached in any of the other outcomes. CONCLUSIONS This review supports that stroke rehabilitation programs incorporating virtual reality are associated with improved functional outcomes, but there is no statistically significant difference compared to standard therapy.
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Affiliation(s)
- Azka Khan
- Faculty of Rehabilitation and Allied Health Sciences Islamabad, Riphah International University, Rawalpindi, Pakistan
| | - Anna Podlasek
- Neuroscience and Vascular Simulation, School of Medicine, Anglia Ruskin University, Chelmsford, Essex, UK.,Nihr Nottingham Brc, University of Nottingham, Nottingham, UK.,Clinical Radiology,Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Fahad Somaa
- King Abdulaziz University,Occupational Therapy Department, Faculty of Medical Rehabilitation Sciences, King AbdulAziz University Jeddah, Saudi, Arabia
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Donnellan-Fernandez K, Ioakim A, Hordacre B. Revisiting dose and intensity of training: Opportunities to enhance recovery following stroke. J Stroke Cerebrovasc Dis 2022; 31:106789. [PMID: 36162377 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106789] [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: 07/28/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 10/31/2022] Open
Abstract
PURPOSE Stroke is a global leading cause of adult disability with survivors often enduring persistent impairments and loss of function. Both intensity and dosage of training appear to be important factors to help restore behavior. However, current practice fails to achieve sufficient intensity and dose of training to promote meaningful recovery. The purpose of this review is to propose therapeutic solutions that can help achieve a higher dose and/or intensity of therapy. Raising awareness of these intensive, high-dose, treatment strategies might encourage clinicians to re-evaluate current practice and optimize delivery of stroke rehabilitation for maximal recovery. METHODS Literature that tested and evaluated solutions to increase dose or intensity of training was reviewed. For each therapeutic strategy, we outline evidence of clinical benefit, supporting neurophysiological data (where available) and discuss feasibility of clinical implementation. RESULTS Possible therapeutic solutions included constraint induced movement therapy, robotics, circuit therapy, bursts of training, gaming technologies, goal-oriented instructions, and cardiovascular exercise. CONCLUSION Our view is that clinicians should evaluate current practice to determine how intensive high-dose training can be implemented to promote greater recovery after stroke.
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Affiliation(s)
| | - Andrew Ioakim
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Brenton Hordacre
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, Australia.
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Wang X, Fu Y, Ye B, Babineau J, Ding Y, Mihailidis A. Technology-Based Compensation Assessment and Detection of Upper Extremity Activities of Stroke Survivors: Systematic Review. J Med Internet Res 2022; 24:e34307. [PMID: 35699982 PMCID: PMC9237771 DOI: 10.2196/34307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 03/25/2022] [Accepted: 04/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background Upper extremity (UE) impairment affects up to 80% of stroke survivors and accounts for most of the rehabilitation after discharge from the hospital release. Compensation, commonly used by stroke survivors during UE rehabilitation, is applied to adapt to the loss of motor function and may impede the rehabilitation process in the long term and lead to new orthopedic problems. Intensive monitoring of compensatory movements is critical for improving the functional outcomes during rehabilitation. Objective This review analyzes how technology-based methods have been applied to assess and detect compensation during stroke UE rehabilitation. Methods We conducted a wide database search. All studies were independently screened by 2 reviewers (XW and YF), with a third reviewer (BY) involved in resolving discrepancies. The final included studies were rated according to their level of clinical evidence based on their correlation with clinical scales (with the same tasks or the same evaluation criteria). One reviewer (XW) extracted data on publication, demographic information, compensation types, sensors used for compensation assessment, compensation measurements, and statistical or artificial intelligence methods. Accuracy was checked by another reviewer (YF). Four research questions were presented. For each question, the data were synthesized and tabulated, and a descriptive summary of the findings was provided. The data were synthesized and tabulated based on each research question. Results A total of 72 studies were included in this review. In all, 2 types of compensation were identified: disuse of the affected upper limb and awkward use of the affected upper limb to adjust for limited strength, mobility, and motor control. Various models and quantitative measurements have been proposed to characterize compensation. Body-worn technology (25/72, 35% studies) was the most used sensor technology to assess compensation, followed by marker-based motion capture system (24/72, 33% studies) and marker-free vision sensor technology (16/72, 22% studies). Most studies (56/72, 78% studies) used statistical methods for compensation assessment, whereas heterogeneous machine learning algorithms (15/72, 21% studies) were also applied for automatic detection of compensatory movements and postures. Conclusions This systematic review provides insights for future research on technology-based compensation assessment and detection in stroke UE rehabilitation. Technology-based compensation assessment and detection have the capacity to augment rehabilitation independent of the constant care of therapists. The drawbacks of each sensor in compensation assessment and detection are discussed, and future research could focus on methods to overcome these disadvantages. It is advised that open data together with multilabel classification algorithms or deep learning algorithms could benefit from automatic real time compensation detection. It is also recommended that technology-based compensation predictions be explored.
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Affiliation(s)
- Xiaoyi Wang
- School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Fu
- School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, China
| | - Bing Ye
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Jessica Babineau
- Library and Information Services, University Health Network, Toronto, ON, Canada
| | - Yong Ding
- Department of Rehabilitation Medicine, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Alex Mihailidis
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
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Exoskeleton-Assisted Anthropomorphic Movement Training (EAMT) for Poststroke Upper Limb Rehabilitation: A Pilot Randomized Controlled Trial. Arch Phys Med Rehabil 2021; 102:2074-2082. [PMID: 34174225 DOI: 10.1016/j.apmr.2021.06.001] [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] [Received: 11/25/2020] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the feasibility of exoskeleton-assisted anthropomorphic movement training (EAMT) and its effects on upper extremity motor impairment, function, and kinematics after stroke. DESIGN A single-blind pilot randomized controlled trial. SETTING Stroke rehabilitation inpatient unit. PARTICIPANTS Participants with a hemiplegia (N=20) due to a first-ever, unilateral, subacute stroke who had a score of 8-47 on the Fugl-Meyer Assessment for Upper Extremity (FMA-UE). INTERVENTIONS The exoskeleton group received EAMT therapy that provided task-specific training under anthropomorphic trajectories and postures. The control group received conventional upper limb therapy. For both groups, therapy was delivered at the same intensity, frequency, and duration: 45 minutes daily, 5 days per week, for 4 weeks. MAIN OUTCOME MEASURES Primary outcome: feasibility analysis. SECONDARY OUTCOMES FMA-UE, Action Research Arm Test (ARAT), modified Barthel Index (MBI), and kinematic metrics during exoskeleton therapy. RESULTS Twenty participants with subacute stroke were recruited and completed all therapy sessions. EAMT therapy was feasible and acceptable for the participants. The recruitment rate, retention rate, and number of therapists required for EAMT therapy were acceptable compared with other robotic trials. EAMT was determined to be safe, as no adverse event occurred except tolerable muscle fatigue in 2 participants. There were significant between-group differences in the change scores of FMA-UE (difference, 4.30 points; P=.04) and MBI (difference, 8.70 points; P=.03) in favor of EAMT therapy. No significant between-group difference was demonstrated for the change scores of ARAT (P=.18). Participants receiving EAMT showed significant improvements in kinematic metrics after treatment (P<.01). CONCLUSIONS Our results indicate that EAMT is a feasible approach and may improve upper extremity motor impairment, activities of daily living, and kinematics after stroke. However, fully powered randomized controlled trials are warranted to confirm the results of this pilot study and explore the underlying mechanisms by which EAMT therapy might work.
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Fluet G, Qiu Q, Patel J, Mont A, Cronce A, Yarossi M, Merians A, Adamovich S. Virtual Rehabilitation of the Paretic Hand and Arm in Persons With Stroke: Translation From Laboratory to Rehabilitation Centers and the Patient's Home. Front Neurol 2021; 12:623261. [PMID: 33584529 PMCID: PMC7876436 DOI: 10.3389/fneur.2021.623261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/04/2021] [Indexed: 12/18/2022] Open
Abstract
The anatomical and physiological heterogeneity of strokes and persons with stroke, along with the complexity of normal upper extremity movement make the possibility that any single treatment approach will become the definitive solution for all persons with upper extremity hemiparesis due to stroke unlikely. This situation and the non-inferiority level outcomes identified by many studies of virtual rehabilitation are considered by some to indicate that it is time to consider other treatment modalities. Our group, among others, has endeavored to build on the initial positive outcomes in studies of virtual rehabilitation by identifying patient populations, treatment settings and training schedules that will best leverage virtual rehabilitation's strengths. We feel that data generated by our lab and others suggest that (1) persons with stroke may adapt to virtual rehabilitation of hand function differently based on their level of impairment and stage of recovery and (2) that less expensive, more accessible home based equipment seems to be an effective alternative to clinic based treatment that justifies continued optimism and study.
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Affiliation(s)
- Gerard Fluet
- Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Qinyin Qiu
- Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Jigna Patel
- Rutgers Biomedical and Health Sciences, Newark, NJ, United States
- New Jersey Institute of Technology, Newark, NJ, United States
| | - Ashley Mont
- New Jersey Institute of Technology, Newark, NJ, United States
| | - Amanda Cronce
- New Jersey Institute of Technology, Newark, NJ, United States
| | - Mathew Yarossi
- Department of Physical Therapy, Movement and Rehabilitation Science, Northeastern University, Boston, MA, United States
| | - Alma Merians
- Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Sergei Adamovich
- Rutgers Biomedical and Health Sciences, Newark, NJ, United States
- New Jersey Institute of Technology, Newark, NJ, United States
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Szczepańska-Gieracha J, Cieślik B, Rutkowski S, Kiper P, Turolla A. What can virtual reality offer to stroke patients? A narrative review of the literature. NeuroRehabilitation 2021; 47:109-120. [PMID: 32741792 DOI: 10.3233/nre-203209] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Studies demonstrated the efficacy of virtual reality (VR) as a method supporting the post-stroke neuro-rehabilitation process by activating motor learning processes. Nevertheless, stroke is frequently accompanied by serious psychological problems including depression, which is associated with an increased risk of mortality, lower post-stroke physical activity, and higher disability in stroke patients. OBJECTIVES To explore the current use of VR as a method supporting the neuro-rehabilitation process, both in physical and psychological dimensions. METHODS An exploratory review was conducted with a narrative synthesis. PubMed was used for literature search. Search includes the use of VR in physical rehabilitation, and as support therapy in psychiatric disorders. Both primary research and systematic reviews were included. RESULTS In neurological disorders rehabilitation, out of 22 studies, 16 concerned stroke survivors. In psychiatric disorders, 44 literature reviews were included. CONCLUSION The studies confirmed the effectiveness of various forms of VR treatment in the alleviation of psychological and behavioral problems and psychiatric disorders. There is a shortage of VR-based technological solutions that would, besides physical rehabilitation, offer stroke patients therapeutic tools to alleviate psychological disturbance and improve the patient's mood and motivation. Such solutions will most likely become a field of intensive research in the coming years.
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Affiliation(s)
| | - Błażej Cieślik
- Jan Dlugosz University in Czestochowa, Czestochowa, Poland
| | | | - Paweł Kiper
- Laboratory of Neurorehabilitation Technologies, San Camillo IRCCS S.r.l., Venice, Italy
| | - Andrea Turolla
- Laboratory of Neurorehabilitation Technologies, San Camillo IRCCS S.r.l., Venice, Italy
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Drew SA, Awad MF, Armendariz JA, Gabay B, Lachica IJ, Hinkel-Lipsker JW. The Trade-Off of Virtual Reality Training for Dart Throwing: A Facilitation of Perceptual-Motor Learning With a Detriment to Performance. Front Sports Act Living 2020; 2:59. [PMID: 33345050 PMCID: PMC7739782 DOI: 10.3389/fspor.2020.00059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 04/24/2020] [Indexed: 12/31/2022] Open
Abstract
Advancements in virtual reality (VR) technology now allow for the creation of highly immersive virtual environments and for systems to be commercially available at an affordable price. Despite increased availability, this access does not ensure that VR is appropriate for training for all motor skills. Before the implementation of VR for training sport-related skills takes place, it must first be established whether VR utilization is appropriate. To this end, it is crucial to better understand the mechanisms that drive learning in these new environments which will allow for optimization of VR to best facilitate transfer of learned skills to the real world. In this study we sought to examine how a skill acquired in VR compares to one acquired in the real world (RW), utilizing training to complete a dart-throwing task in either a virtual or real environment. We adopted a perceptual-motor approach in this study, employing measures of task performance (i.e., accuracy), as well as of perception (i.e., visual symptoms and oculomotor behavior) and motor behaviors (i.e., throwing kinematics and coordination). Critically, the VR-trained group performed significantly worse in terms of throwing accuracy compared to both the RW-trained group and their own baseline performance. In terms of perception, the VR-trained group reported greater acute visual symptoms compared to the RW-trained group, though oculomotor behaviors were largely the same across groups. In terms of motor behaviors, the VR-trained group exhibited different dart-throwing kinematics during training, but in the follow-up test adapted their throwing pattern to one similar to the RW-trained group. In total, VR training impaired real-world task performance, suggesting that virtual environments may offer different learning constraints compared to the real world. These results thus emphasize the need to better understand how some elements of virtual learning environments detract from transfer of an acquired sport skill to the real world. Additional work is warranted to further understand how perceptual-motor behaviors are acquired differently in virtual spaces.
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Affiliation(s)
- Stefanie A Drew
- Visual Information Sciences and Neuroscience Laboratory, Department of Psychology, California State University, Northridge, CA, United States
| | - Madeline F Awad
- Visual Information Sciences and Neuroscience Laboratory, Department of Psychology, California State University, Northridge, CA, United States
| | - Jazlyn A Armendariz
- Visual Information Sciences and Neuroscience Laboratory, Department of Psychology, California State University, Northridge, CA, United States
| | - Bar Gabay
- Visual Information Sciences and Neuroscience Laboratory, Department of Psychology, California State University, Northridge, CA, United States
| | - Isaiah J Lachica
- Move-Learn Laboratory, Department of Kinesiology, California State University, Northridge, CA, United States
| | - Jacob W Hinkel-Lipsker
- Move-Learn Laboratory, Department of Kinesiology, California State University, Northridge, CA, United States
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Carpinella I, Lencioni T, Bowman T, Bertoni R, Turolla A, Ferrarin M, Jonsdottir J. Effects of robot therapy on upper body kinematics and arm function in persons post stroke: a pilot randomized controlled trial. J Neuroeng Rehabil 2020; 17:10. [PMID: 32000790 PMCID: PMC6990497 DOI: 10.1186/s12984-020-0646-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 01/20/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Robot-based rehabilitation for persons post-stroke may improve arm function and daily-life activities as measured by clinical scales, but its effects on motor strategies during functional tasks are still poorly investigated. This study aimed at assessing the effects of robot-therapy versus arm-specific physiotherapy in persons post-stroke on motor strategies derived from upper body instrumented kinematic analysis, and on arm function measured by clinical scales. METHODS Forty persons in the sub-acute and chronic stage post-stroke were recruited. This sample included all those subjects, enrolled in a larger bi-center study, who underwent instrumented kinematic analysis and who were randomized in Center 2 into Robot (R_Group) and Control Group (C_Group). R_Group received robot-assisted training. C_Group received arm-specific treatment delivered by a physiotherapist. Pre- and post-training assessment included clinical scales and instrumented kinematic analysis of arm and trunk during a virtual untrained task simulating the transport of an object onto a shelf. Instrumented outcomes included shoulder/elbow coordination, elbow extension and trunk sagittal compensation. Clinical outcomes included Fugl-Meyer Motor Assessment of Upper Extremity (FM-UE), modified Ashworth Scale (MAS) and Functional Independence Measure (FIM). RESULTS R_Group showed larger post-training improvements of shoulder/elbow coordination (Cohen's d = - 0.81, p = 0.019), elbow extension (Cohen's d = - 0.71, p = 0.038), and trunk movement (Cohen's d = - 1.12, p = 0.002). Both groups showed comparable improvements in clinical scales, except proximal muscles MAS that decreased more in R_Group (Cohen's d = - 0.83, p = 0.018). Ancillary analyses on chronic subjects confirmed these results and revealed larger improvements after robot-therapy in the proximal portion of FM-UE (Cohen's d = 1.16, p = 0.019). CONCLUSIONS Robot-assisted rehabilitation was as effective as arm-specific physiotherapy in reducing arm impairment (FM-UE) in persons post-stroke, but it was more effective in improving motor control strategies adopted during an untrained task involving vertical movements not practiced during training. Specifically, robot therapy induced larger improvements of shoulder/elbow coordination and greater reduction of abnormal trunk sagittal movements. The beneficial effects of robot therapy seemed more pronounced in chronic subjects. Future studies on a larger sample should be performed to corroborate present findings. TRIAL REGISTRATION www.ClinicalTrials.gov NCT03530358. Registered 21 May 2018. Retrospectively registered.
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Affiliation(s)
- Ilaria Carpinella
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro 66, 20148, Milan, Italy
| | - Tiziana Lencioni
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro 66, 20148, Milan, Italy.
| | - Thomas Bowman
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro 66, 20148, Milan, Italy
| | - Rita Bertoni
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro 66, 20148, Milan, Italy
| | - Andrea Turolla
- Movement Neuroscience Research Group, IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venezia, Lido, Italy
| | - Maurizio Ferrarin
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro 66, 20148, Milan, Italy
| | - Johanna Jonsdottir
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro 66, 20148, Milan, Italy
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The Effects of Virtual Reality Training on Function in Chronic Stroke Patients: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7595639. [PMID: 31317037 PMCID: PMC6604476 DOI: 10.1155/2019/7595639] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/20/2019] [Accepted: 05/28/2019] [Indexed: 12/17/2022]
Abstract
Objective The aim of this study was to perform a meta-analysis to examine whether virtual reality (VR) training is effective for lower limb function as well as upper limb and overall function in chronic stroke patients. Methods Three databases, OVID, PubMed, and EMBASE, were used to collect articles. The search terms used were “cerebrovascular accident (CVA),” “stroke”, and “virtual reality”. Consequently, twenty-one studies were selected in the second screening of meta-analyses. The PEDro scale was used to assess the quality of the selected studies. Results The total effect size for VR rehabilitation programs was 0.440. The effect size for upper limb function was 0.431, for lower limb function it was 0.424, and for overall function it was 0.545. The effects of VR programs on specific outcomes were most effective for improving muscle tension, followed by muscle strength, activities of daily living (ADL), joint range of motion, gait, balance, and kinematics. Conclusion The VR training was effective in improving the function in chronic stroke patients, corresponding to a moderate effect size. Moreover, VR training showed a similar effect for improving lower limb function as it did for upper limb function.
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Norouzi-Gheidari N, Archambault PS, Fung J. Robot-Assisted Reaching Performance of Chronic Stroke and Healthy Individuals in a Virtual Versus a Physical Environment: A Pilot Study. IEEE Trans Neural Syst Rehabil Eng 2019; 27:1273-1281. [PMID: 31056500 DOI: 10.1109/tnsre.2019.2914015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aim of the current study was to examine the role of environment, whether virtual or physical, on robot-assisted reaching movements in chronic stroke and healthy individuals, within a single session. Twenty-three subjects participated in the current study divided into three groups: nine chronic stroke individuals able to perform a reaching task with no need for the robot assistance, nine chronic stroke individuals who needed robot assistance to complete the reaching task, and five healthy individuals. The task was to reach six target buttons in two identical physical and virtual environments. The outcomes consisted of specific kinematic measures (amount of movement completion without robot assistance, mean speed, peak speed, straightness, and shakiness) and a custom questionnaire to assess how the stroke subjects perceived and experienced the reaching task in both environments. The results showed no differences between the two environments in terms of the outcome measures in any of the groups. Our findings suggest that the choice of environment, whether physical or virtual, is not a key factor in designing a simple robot-assisted reaching task for stroke survivors. Further studies are required for more complex environments and tasks as well as robot-assisted training protocols.
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Massetti T, da Silva TD, Crocetta TB, Guarnieri R, de Freitas BL, Bianchi Lopes P, Watson S, Tonks J, de Mello Monteiro CB. The Clinical Utility of Virtual Reality in Neurorehabilitation: A Systematic Review. J Cent Nerv Syst Dis 2018; 10:1179573518813541. [PMID: 30515028 PMCID: PMC6262495 DOI: 10.1177/1179573518813541] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 10/19/2018] [Indexed: 12/22/2022] Open
Abstract
Background: Virtual reality (VR) experiences (through games and virtual environments) are increasingly being used in physical, cognitive, and psychological interventions. However, the impact of VR as an approach to rehabilitation is not fully understood, and its advantages over traditional rehabilitation techniques are yet to be established. Method: We present a systematic review which was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). During February and March of 2018, we conducted searches on PubMed (Medline), Virtual Health Library Search Portal databases (BVS), Web of Science (WOS), and Embase for all VR-related publications in the past 4 years (2015, 2016, 2017, and 2018). The keywords used in the search were “neurorehabilitation” AND “Virtual Reality” AND “devices.” Results: We summarize the literature which highlights that a range of effective VR approaches are available. Studies identified were conducted with poststroke patients, patients with cerebral palsy, spinal cord injuries, and other pathologies. Healthy populations have been used in the development and testing of VR approaches meant to be used in the future by people with neurological disorders. A range of benefits were associated with VR interventions, including improvement in motor functions, greater community participation, and improved psychological and cognitive function. Conclusions: The results from this review provide support for the use of VR as part of a neurorehabilitation program in maximizing recovery.
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Affiliation(s)
- Thais Massetti
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Talita Dias da Silva
- School of Arts, Sciences and Humanities (EACH), University of São Paulo (USP), São Paulo, Brazil
| | | | | | - Bruna Leal de Freitas
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Israelite Hospital Albert Einstein, São Paulo, Brazil
| | | | - Suzanna Watson
- The Cambridge Centre for Paediatric Neurorehabilitation, Cambridge, UK
| | - James Tonks
- Medical School, University of Exeter, Exeter, UK.,Haven Clinical Psychology Practice, Cornwall, UK
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Skurvydas A, Juodzbaliene V, Darbutas T, Brazaitis M. One year after ischemic stroke: Changes in leg movement path stability in a speed-accuracy task but no major effects on the hands. Hum Mov Sci 2017; 57:50-58. [PMID: 29149655 DOI: 10.1016/j.humov.2017.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 11/29/2022]
Abstract
First year after the stroke is essential for motor recovery. The main motor control strategy (i.e., faster movement production at the expense of lower movement accuracy and stability, or greater movement accuracy and stability at the expense of slower movement) selected by poststroke patients during a unilateral speed-accuracy task (SAT) remains unclear. We aimed to investigate the poststroke (12 months after stroke) effects on the trade-off between movement speed and accuracy, and intraindividual variability during a motor performance task. Healthy right-handed men (n = 20; age ∼ 66 years) and right-handed men after ischemic stroke during their post rehabilitation period (n = 20; age ∼ 69 years) were asked to perform a simple reaction task, a maximal velocity performance task and a SAT with the right and left hand, and with the right and left leg. In the hand movement trial, reaction time and movement velocity (Vmax) in the SAT were slower and time to Vmax in the SAT was longer in the poststroke group (P < .01). In the leg movement trial, poststroke participants reached a greater Vmax in the SAT than the healthy participants (P < .01). The greatest poststroke effect on intraindividual variability in movements was found for movement path in the SAT, which was significantly greater in the legs than in the hands. Poststroke patients in the first year after stroke mainly selected an impulsive strategy for speed over hand and leg motor control, but at the expense of lower movement accuracy and greater variability in movement.
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Affiliation(s)
- Albertas Skurvydas
- Institute of Sports Science and Innovation, Lithuanian Sports University, Sporto St. 6, LT-44221 Kaunas, Lithuania; Department of Applied Biology and Rehabilitation, Lithuanian Sports University, Sporto Street 6, LT-44221 Kaunas, Lithuania
| | - Vilma Juodzbaliene
- Department of Applied Biology and Rehabilitation, Lithuanian Sports University, Sporto Street 6, LT-44221 Kaunas, Lithuania
| | - Tomas Darbutas
- Department of Applied Biology and Rehabilitation, Lithuanian Sports University, Sporto Street 6, LT-44221 Kaunas, Lithuania
| | - Marius Brazaitis
- Institute of Sports Science and Innovation, Lithuanian Sports University, Sporto St. 6, LT-44221 Kaunas, Lithuania; Department of Applied Biology and Rehabilitation, Lithuanian Sports University, Sporto Street 6, LT-44221 Kaunas, Lithuania.
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Saleh S, Fluet G, Qiu Q, Merians A, Adamovich SV, Tunik E. Neural Patterns of Reorganization after Intensive Robot-Assisted Virtual Reality Therapy and Repetitive Task Practice in Patients with Chronic Stroke. Front Neurol 2017; 8:452. [PMID: 28928708 PMCID: PMC5591400 DOI: 10.3389/fneur.2017.00452] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 08/15/2017] [Indexed: 12/13/2022] Open
Abstract
Several approaches to rehabilitation of the hand following a stroke have emerged over the last two decades. These treatments, including repetitive task practice (RTP), robotically assisted rehabilitation and virtual rehabilitation activities, produce improvements in hand function but have yet to reinstate function to pre-stroke levels-which likely depends on developing the therapies to impact cortical reorganization in a manner that favors or supports recovery. Understanding cortical reorganization that underlies the above interventions is therefore critical to inform how such therapies can be utilized and improved and is the focus of the current investigation. Specifically, we compare neural reorganization elicited in stroke patients participating in two interventions: a hybrid of robot-assisted virtual reality (RAVR) rehabilitation training and a program of RTP training. Ten chronic stroke subjects participated in eight 3-h sessions of RAVR therapy. Another group of nine stroke subjects participated in eight sessions of matched RTP therapy. Functional magnetic resonance imaging (fMRI) data were acquired during paretic hand movement, before and after training. We compared the difference between groups and sessions (before and after training) in terms of BOLD intensity, laterality index of activation in sensorimotor areas, and the effective connectivity between ipsilesional motor cortex (iMC), contralesional motor cortex, ipsilesional primary somatosensory cortex (iS1), ipsilesional ventral premotor area (iPMv), and ipsilesional supplementary motor area. Last, we analyzed the relationship between changes in fMRI data and functional improvement measured by the Jebsen Taylor Hand Function Test (JTHFT), in an attempt to identify how neurophysiological changes are related to motor improvement. Subjects in both groups demonstrated motor recovery after training, but fMRI data revealed RAVR-specific changes in neural reorganization patterns. First, BOLD signal in multiple regions of interest was reduced and re-lateralized to the ipsilesional side. Second, these changes correlated with improvement in JTHFT scores. Our findings suggest that RAVR training may lead to different neurophysiological changes when compared with traditional therapy. This effect may be attributed to the influence that augmented visual and haptic feedback during RAVR training exerts over higher-order somatosensory and visuomotor areas.
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Affiliation(s)
- Soha Saleh
- Human Performance and Engineering Research, Kessler Foundation, West Orange, NJ, United States
| | - Gerard Fluet
- Department of Rehabilitation and Movement Science, Rutgers University, Newark, NJ, United States
| | - Qinyin Qiu
- Department of Rehabilitation and Movement Science, Rutgers University, Newark, NJ, United States
| | - Alma Merians
- Department of Rehabilitation and Movement Science, Rutgers University, Newark, NJ, United States
| | - Sergei V. Adamovich
- Department of Rehabilitation and Movement Science, Rutgers University, Newark, NJ, United States
- Department of Biomedical Engineering, NJIT, Newark, NJ, United States
| | - Eugene Tunik
- Department of Physical Therapy, Movement, and Rehabilitation Science, Northeastern University, Boston, MA, United States
- Department of Bioengineering, Northeastern University, Boston, MA, United States
- Department of Biology, Northeastern University, Boston, MA, United States
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