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Kesar T. The Effects of Stroke and Stroke Gait Rehabilitation on Behavioral and Neurophysiological Outcomes:: Challenges and Opportunities for Future Research. Dela J Public Health 2023; 9:76-81. [PMID: 37701480 PMCID: PMC10494801 DOI: 10.32481/djph.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Stroke continues to be a leading cause of adult disability, contributing to immense healthcare costs. Even after discharge from rehabilitation, post-stroke individuals continue to have persistent gait impairments, which in turn adversely affect functional mobility and quality of life. Multiple factors, including biomechanics, energy cost, psychosocial variables, as well as the physiological function of corticospinal neural pathways influence stroke gait function and training-induced gait improvements. As a step toward addressing this challenge, the objective of the current perspective paper is to outline knowledge gaps pertinent to the measurement and retraining of stroke gait dysfunction. The paper also has recommendations for future research directions to address important knowledge gaps, especially related to the measurement and rehabilitation-induced modulation of biomechanical and neural processes underlying stroke gait dysfunction. We posit that there is a need for leveraging emerging technologies to develop innovative, comprehensive, methods to measure gait patterns quantitatively, to provide clinicians with objective measure of gait quality that can supplement conventional clinical outcomes of walking function. Additionally, we posit that there is a need for more research on how the stroke lesion affects multiple parts of the nervous system, and to understand the neuroplasticity correlates of gait training and gait recovery. Multi-modal clinical research studies that can combine clinical, biomechanical, neural, and computational modeling data provide promise for gaining new information about stroke gait dysfunction as well as the multitude of factors affecting recovery and treatment response in people with post-stroke hemiparesis.
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Affiliation(s)
- Trisha Kesar
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine
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2
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Mo L, Nie Y, Wan G, Zhang Y, Zhao M, Wu J, Wang H, Li Q, Liu A. Application of Transcranial Magnetic Stimulation with Electroencephalography in the Evaluation of Brain Function Changes after Stroke. Int J Clin Pract 2023; 2023:3051175. [PMID: 37265838 PMCID: PMC10232191 DOI: 10.1155/2023/3051175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 03/13/2023] [Accepted: 05/09/2023] [Indexed: 06/03/2023] Open
Abstract
Objective Based on transcranial magnetic stimulation (TMS) with electroencephalography technology, this study analyzed the rehabilitation mechanism of patients' motor function reconstruction and nerve remodeling after stroke. It revealed the function of the cerebral cortex network at a deeper level and established a set of prognostic marker evaluation indicators for the reconstruction of motor function after stroke. Methods Twenty-one patients treated at the Beijing Rehabilitation Hospital of Capital Medical University because of ischemic stroke in the territory supplied by the middle cerebral artery were selected as the experimental group. Neurophysiological evaluation, motor function evaluation, and clinical evaluation were performed 30 and 180 d after the onset of ischemic stroke. In the control group, neurophysiological evaluation was also performed as a reference index to evaluate the changes in cortical patterns after stroke. Results The brain topographic map showed the changes in energy or power spectral density (PSD) at 1,000 ms after stimulation as compared with before stimulation, but no difference was detected in these patients. The time-frequency analysis showed that when the left primary motor cortex (M1) area was stimulated using TMS, the PSD values of the left and right M1 and posterior occipital cortex areas produced an 8-40 Hz wave band in patients S1-S11. There was no significant energy change in patients S12-S16. Conclusions For patients with different injury types, degrees of injury, and different onset periods, individualized intervention methods should be adopted. The evaluation methods should be as diverse as possible, and the rehabilitation effects of patients should be assessed from multiple perspectives to avoid the limitations of single factors. Possible mechanism: After brain injury, the nervous system can change its structure and function through different ways and maintain it for a certain period of time. This plasticity change will change with the course of the disease.
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Affiliation(s)
- Linhong Mo
- Neuro-Rehabilitation Center, Capital Medical University, Beijing Rehabilitation Hospital, Beijing 100144, China
| | - Yiqiu Nie
- Neuro-Rehabilitation Center, Capital Medical University, Beijing Rehabilitation Hospital, Beijing 100144, China
| | - Guiling Wan
- Neuro-Rehabilitation Center, Capital Medical University, Beijing Rehabilitation Hospital, Beijing 100144, China
| | - Yingbin Zhang
- Neuro-Rehabilitation Center, Capital Medical University, Beijing Rehabilitation Hospital, Beijing 100144, China
| | - Man Zhao
- Neuro-Rehabilitation Center, Capital Medical University, Beijing Rehabilitation Hospital, Beijing 100144, China
| | - Jiaojiao Wu
- Neuro-Rehabilitation Center, Capital Medical University, Beijing Rehabilitation Hospital, Beijing 100144, China
| | - Huiqi Wang
- Neuro-Rehabilitation Center, Capital Medical University, Beijing Rehabilitation Hospital, Beijing 100144, China
| | - Qing Li
- Neuro-Rehabilitation Center, Capital Medical University, Beijing Rehabilitation Hospital, Beijing 100144, China
| | - Aixian Liu
- Neuro-Rehabilitation Center, Capital Medical University, Beijing Rehabilitation Hospital, Beijing 100144, China
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3
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Zheng J, Ma Q, He W, Huang Y, Shi P, Li S, Yu H. Cognitive and motor cortex activation during robot-assisted multi-sensory interactive motor rehabilitation training: An fNIRS based pilot study. Front Hum Neurosci 2023; 17:1089276. [PMID: 36845877 PMCID: PMC9947243 DOI: 10.3389/fnhum.2023.1089276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
Objective This study aimed to evaluate the effects of multiple virtual reality (VR) interaction modalities based on force-haptic feedback combined with visual or auditory feedback in different ways on cerebral cortical activation by functional near-infrared spectroscopy (fNIRS). Methods: A modular multi-sensory VR interaction system based on a planar upper-limb rehabilitation robot was developed. Twenty healthy participants completed active elbow flexion and extension training in four VR interaction patterns, including haptic (H), haptic + auditory (HA), haptic + visual (HV), and haptic + visual + auditory (HVA). Cortical activation changes in the sensorimotor cortex (SMC), premotor cortex (PMC), and prefrontal cortex (PFC) were measured. Results Four interaction patterns all had significant activation effects on the motor and cognitive regions of the cerebral cortex (p < 0.05). Among them, in the HVA interaction mode, the cortical activation of each ROI was the strongest, followed by HV, HA, and H. The connectivity between channels of SMC and bilateral PFC, as well as the connectivity between channels in PMC, was the strongest under HVA and HV conditions. Besides, the two-way ANOVA of visual and auditory feedback showed that it was difficult for auditory feedback to have a strong impact on activation without visual feedback. In addition, under the condition of visual feedback, the effect of fusion auditory feedback on the activation degree was significantly higher than that of no auditory feedback. Conclusions The interaction mode of visual, auditory, and haptic multi-sensory integration is conducive to stronger cortical activation and cognitive control. Besides, there is an interaction effect between visual and auditory feedback, thus improving the cortical activation level. This research enriches the research on activation and connectivity of cognitive and motor cortex in the process of modular multi-sensory interaction training of rehabilitation robots. These conclusions provide a theoretical basis for the optimal design of the interaction mode of the rehabilitation robot and the possible scheme of clinical VR rehabilitation.
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Affiliation(s)
- Jinyu Zheng
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
| | - Qiqi Ma
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
| | - Wanying He
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
| | - Yanping Huang
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
| | - Ping Shi
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
- Key Laboratory of Neural-Functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Shanghai, China
| | - Sujiao Li
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
- Key Laboratory of Neural-Functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Shanghai, China
| | - Hongliu Yu
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
- Key Laboratory of Neural-Functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Shanghai, China
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Alves T, Gonçalves RS, Carbone G. Serious Games Strategies With Cable-Driven Robots for Bimanual Rehabilitation: A Randomized Controlled Trial With Post-Stroke Patients. Front Robot AI 2022; 9:739088. [PMID: 35252362 PMCID: PMC8892256 DOI: 10.3389/frobt.2022.739088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 01/17/2022] [Indexed: 12/24/2022] Open
Abstract
Cable-driven robots can be an ideal fit for performing post-stroke rehabilitation due to their specific features. For example, they have small and lightweight moving parts and a relatively large workspace. They also allow safe human-robot interactions and can be easily adapted to different patients and training protocols. However, the existing cable-driven robots are mostly unilateral devices that can allow only the rehabilitation of the most affected limb. This leaves unaddressed the rehabilitation of bimanual activities, which are predominant within the common Activities of Daily Living (ADL). Serious games can be integrated with cable-driven robots to further enhance their features by providing an interactive experience and by generating a high level of engagement in patients, while they can turn monotonous and repetitive therapy exercises into entertainment tasks. Additionally, serious game interfaces can collect detailed quantitative treatment information such as exercise time, velocities, and force, which can be very useful to monitor a patient’s progress and adjust the treatment protocols. Given the above-mentioned strong advantages of both cable driven robots, bimanual rehabilitation and serious games, this paper proposes and discusses a combination of them, in particular, for performing bilateral/bimanual rehabilitation tasks. The main design characteristics are analyzed for implementing the design of both the hardware and software components. The hardware design consists of a specifically developed cable-driven robot. The software design consists of a specifically developed serious game for performing bimanual rehabilitation exercises. The developed software also includes BiEval. This specific software allows to quantitatively measure and assess the rehabilitation therapy effects. An experimental validation is reported with 15 healthy subjects and a RCT (Randomized Controlled Trial) has been performed with 10 post-stroke patients at the Physiotherapy’s Clinic of the Federal University of Uberlândia (Minas Gerais, Brazil). The RCT results demonstrate the engineering feasibility and effectiveness of the proposed cable-driven robot in combination with the proposed BiEval software as a valuable tool to augment the conventional physiotherapy protocols and for providing reliable measurements of the patient’s rehabilitation performance and progress. The clinical trial was approved by the Research Ethics Committee of the UFU (Brazil) under the CAAE N° 00914818.5.0000.5152 on plataformabrasil@saude.gov.br.
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Affiliation(s)
- Thiago Alves
- Laboratory of Automation and Robotics, School of Mechanical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
- *Correspondence: Thiago Alves,
| | - Rogério Sales Gonçalves
- Laboratory of Automation and Robotics, School of Mechanical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - Giuseppe Carbone
- Department of Mechanical, Energy and Management Engineering, Università della Calabria, Rende, Italy
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Zhang Z, Prilutsky BI, Butler AJ, Shinohara M, Ghovanloo M. Design and Preliminary Evaluation of a Tongue-Operated Exoskeleton System for Upper Limb Rehabilitation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8708. [PMID: 34444456 PMCID: PMC8393282 DOI: 10.3390/ijerph18168708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 01/17/2023]
Abstract
Stroke is a devastating condition that may cause upper limb paralysis. Robotic rehabilitation with self-initiated and assisted movements is a promising technology that could help restore upper limb function. Previous studies have established that the tongue motion can be used to communicate human intent and control a rehabilitation robot/assistive device. The goal of this study was to evaluate a tongue-operated exoskeleton system (TDS-KA), which we have developed for upper limb rehabilitation. We adopted a tongue-operated assistive technology, called the tongue drive system (TDS), and interfaced it with the exoskeleton KINARM. We also developed arm reaching and tracking tasks, controlled by different tongue operation modes, for training and evaluation of arm motor function. Arm reaching and tracking tasks were tested in 10 healthy participants (seven males and three females, 23-60 years) and two female stroke survivors with upper extremity impairment (32 and 58 years). All healthy and two stroke participants successfully performed the tasks. One stroke subject demonstrated a clinically significant improvement in Fugl-Meyer upper extremity score after practicing the tasks in six 3-h sessions. We conclude that the TDS-KA system can accurately translate tongue commands to exoskeleton arm movements, quantify the function of the arm, and perform rehabilitation training.
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Affiliation(s)
- Zhenxuan Zhang
- School of Electrical & Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30308, USA;
| | - Boris I. Prilutsky
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA 30332, USA;
| | - Andrew J. Butler
- School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Minoru Shinohara
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA 30332, USA;
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Pilla A, Trigili E, McKinney Z, Fanciullacci C, Malasoma C, Posteraro F, Crea S, Vitiello N. Robotic Rehabilitation and Multimodal Instrumented Assessment of Post-stroke Elbow Motor Functions-A Randomized Controlled Trial Protocol. Front Neurol 2020; 11:587293. [PMID: 33193052 PMCID: PMC7643017 DOI: 10.3389/fneur.2020.587293] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 09/22/2020] [Indexed: 12/03/2022] Open
Abstract
Background: The reliable assessment, attribution, and alleviation of upper-limb joint stiffness are essential clinical objectives in the early rehabilitation from stroke and other neurological disorders, to prevent the progression of neuromuscular pathology and enable proactive physiotherapy toward functional recovery. However, the current clinical evaluation and treatment of this stiffness (and underlying muscle spasticity) are severely limited by their dependence on subjective evaluation and manual limb mobilization, thus rendering the evaluation imprecise and the treatment insufficiently tailored to the specific pathologies and residual capabilities of individual patients. Methods: To address these needs, the proposed clinical trial will employ the NEUROExos Elbow Module (NEEM), an active robotic exoskeleton, for the passive mobilization and active training of elbow flexion and extension in 60 sub-acute and chronic stroke patients with motor impairments (hemiparesis and/or spasticity) of the right arm. The study protocol is a randomized controlled trial consisting of a 4-week functional rehabilitation program, with both clinical and robotically instrumented assessments to be conducted at baseline and post-treatment. The primary outcome measures will be a set of standard clinical scales for upper limb spasticity and motor function assessment, including the Modified Ashworth Scale and Fugl-Meyer Index, to confirm the safety and evaluate the efficacy of robotic rehabilitation in reducing elbow stiffness and improving function. Secondary outcomes will include biomechanical, muscular activity, and motor performance parameters extracted from instrumented assessments using the NEEM along with synchronous EMG recordings. Conclusions: This randomized controlled trial aims to validate an innovative instrumented methodology for clinical spasticity assessment and functional rehabilitation, relying on the precision and accuracy of an elbow exoskeleton combined with EMG recordings and the expertise of a physiotherapist, thus complementing and maximizing the benefits of both practices. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT04484571.
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Affiliation(s)
- Alessandro Pilla
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
| | - Emilio Trigili
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
| | - Zach McKinney
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
| | | | - Chiara Malasoma
- Rehabilitation Department, Versilia Hospital, USL Nord Ovest Toscana (AUSLTNO), Lido di Camaiore (LU), Italy
| | - Federico Posteraro
- Rehabilitation Department, Versilia Hospital, USL Nord Ovest Toscana (AUSLTNO), Lido di Camaiore (LU), Italy
| | - Simona Crea
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Firenze, Italy.,Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, Pisa, Italy
| | - Nicola Vitiello
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Firenze, Italy.,Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, Pisa, Italy
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Bae S, Lee Y, Chang P. There is No test-retest reliability of brain activation induced by robotic passive hand movement: A functional NIRS study. Brain Behav 2020; 10:e01788. [PMID: 32794359 PMCID: PMC7559614 DOI: 10.1002/brb3.1788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 06/03/2020] [Accepted: 07/06/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The basic paradigm of rehabilitation is based on the brain plasticity, and for promoting it, test-retest reliability (TRR) of brain activation in which certain area of the brain is repeatedly activated is required. In this study, we investigated whether the robotic passive movement has the TRR of brain activation. While active training has been shown to have TRR, but there still have been arguments over the TRR by passive movement. METHODS In order to test TRR, 10 repetitive sessions and various intervals (1 day, 3 days, 7 days, 23 days, 15 min, and 6 hr) were applied to five subjects, which had the same statistical power as applying two sessions to 50 subjects. In each session, three robot speeds (0.25, 0.5, and 0.75 Hz) were applied to provide passive movement using the robot. The fNIRS signal (oxy-Hb) generated in the primary sensorimotor area (SM1) was measured on a total of 29 channels. At this time, we used activation maps and intraclass correlation coefficient (ICC) values to examine the TRR and the effect of robot speeds and intervals on TRR. RESULTS As a result, activation maps showed prominent variation regardless of robot speeds and interval, and the ICC value (=0.002) showed no TRR of brain activation for robotic passive movement. CONCLUSION The brain activation induced by the robotic passive movement alone has very poor TRR, suggesting that further enhancement is required to strengthen the TRR by complementing active user engagements.
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Affiliation(s)
- Sungjin Bae
- Department of Robotics EngineeringGraduate SchoolDaegu Gyeongbuk Institute of Science & TechnologyDaeguKorea
| | - Yonghee Lee
- Department of StatisticsUniversity of SeoulSeoulKorea
| | - Pyung‐Hun Chang
- Department of Robotics EngineeringGraduate SchoolDaegu Gyeongbuk Institute of Science & TechnologyDaeguKorea
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Sharini H, Riyahi Alam N, Khabiri H, Arabalibeik H, Hashemi H, Azimi AR, Masjoodi S. Novel FMRI-Compatible wrist robotic device for brain activation assessment during rehabilitation exercise. Med Eng Phys 2020; 83:112-122. [PMID: 32507416 DOI: 10.1016/j.medengphy.2020.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 04/26/2020] [Accepted: 05/13/2020] [Indexed: 11/17/2022]
Abstract
Magnetic Resonance Imaging (MRI) can be applied to study the effects of rehabilitation strategies for neuroscience research. An MRI-wrist robot is designed and used as a clinical tool to examine the process of the brain plasticity changes. In this robot, the patient actuation is accomplished with two standard air cylinders, located inside the MRI chamber with two degrees of freedom (flexion-extension and ulna-radial deviation) with pneumatic air transmission, consisting of simple mechanism converting rotary motion to linear independently. A pilot study of brain image aiming at revealing more effective therapeutic strategies carried out to confirm the technical aspects of the development and validation. In a healthy subject, both wrist movement of robot and subject demonstrated brain activity in the contralateral primary somatosensory cortex. Because the robot does not move during the patient's body, a stand was designed to allow the wrist robot and patient to fit comfortably within the MRI machine. While all the parts of the robot were carefully selected with strict MRI compatibility requirements, the robot was tested by presenting some pilot imaging data with null effects on the image quality, as well. Finally, the possible further development of the robot has been introduced for a rehabilitation assessment.
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Affiliation(s)
- H Sharini
- Department of Biomedical Engineering, Faculty of Medicine, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
| | - N Riyahi Alam
- Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran; PERFORM Center, Concordia University, Montreal, QC, Canada; Pharmaceutical Sciences Research Center (PSRC), The institute of Pharmaceutical Sciences, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
| | - H Khabiri
- Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - H Arabalibeik
- Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran; Research Center for Science and Technology in Medicine (RCSTM), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - H Hashemi
- Department of Radiology, Faculty of Medicine, Tehran University of Medical Sciences(TUMS), Tehran, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences(TUMS), Tehran, Iran
| | - A R Azimi
- Sina MS Research Center, Sina Hospital, Faculty of Medicine, Tehran University of Medical Sciences(TUMS), Tehran, Iran
| | - S Masjoodi
- Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Sun J, Yan F, Liu A, Liu T, Wang H. Electrical Stimulation of the Motor Cortex or Paretic Muscles Improves Strength Production in Stroke Patients: A Systematic Review and Meta-Analysis. PM R 2020; 13:171-179. [PMID: 32385898 DOI: 10.1002/pmrj.12399] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Transcranial direct current stimulation (tDCS) and functional electrical stimulation (FES) are two widely applied methods of electrical stimulation for motor recovery among stroke patients. This systematic review and meta-analysis investigated the efficacy of tDCS and FES for strength production in stroke patients. TYPE: Systematic review. LITERATURE SURVEY Studies that explored the effects of tDCS or FES on the strength production of paralyzed muscles in stroke patients were retrieved on a comprehensive set of three databases: (1) Google Scholar, (2) PubMed, and (3) the Cochrane Database of Systematic Reviews until July 2019. METHODOLOGY Systematic study retrieval led to the inclusion of 15 studies that reported on strength production effects after tDCS and FES interventions among stoke patients. A sham control group and randomization were used in each study. The 15 studies included 20 comparisons with sham controls, 7 of which involved tDCS and 13 of which involved FES. SYNTHESIS Random-effects models showed that strength production was improved after tDCS (effect size [ES] = 0.52, 95% confidence interval [CI] = 0.35-0.69, P < .001, Z = 6.05) and FES (ES = 0.47, 95% CI = 0.16-0.78, P < .003, Z = 2.99). Additionally, tDCS was shown to improve strength production in the acute (ES = 0.52, 95% CI = 0.24-0.80, P < .001, Z = 3.65), subacute (ES = 0.85, 95% CI = 0.37-1.32, P < .001, Z = 3.51), but not chronic (ES = 0.06, 95% CI = -0.47-0.60, P = .82, Z = 0.23) phases of stroke recovery. Out of the 13 studies involving FES, 12 investigated strength production in the chronic phase and one investigated in the acute phase, showing a positive effect in these two stages. CONCLUSIONS The results of the meta-analysis showed that tDCS and FES successfully improved strength production in stroke patients.
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Affiliation(s)
- Jinping Sun
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China
| | - Fei Yan
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China
| | - Aili Liu
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China
| | - Tiaotiao Liu
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China
| | - He Wang
- Institute of Biomedical Engineering, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, China
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Vourganas I, Stankovic V, Stankovic L, Kerr A. Factors That Contribute to the Use of Stroke Self-Rehabilitation Technologies: A Review. JMIR BIOMEDICAL ENGINEERING 2019. [DOI: 10.2196/13732] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background
Stroke is increasingly one of the main causes of impairment and disability. Contextual and empirical evidence demonstrate that, mainly due to service delivery constraints, but also due to a move toward personalized health care in the comfort of patients’ homes, more stroke survivors undergo rehabilitation at home with minimal or no supervision. Due to this trend toward telerehabilitation, systems for stroke patient self-rehabilitation have become increasingly popular, with many solutions recently proposed based on technological advances in sensing, machine learning, and visualization. However, by targeting generic patient profiles, these systems often do not provide adequate rehabilitation service, as they are not tailored to specific patients’ needs.
Objective
Our objective was to review state-of-the-art home rehabilitation systems and discuss their effectiveness from a patient-centric perspective. We aimed to analyze engagement enhancement of self-rehabilitation systems, as well as motivation, to identify the challenges in technology uptake.
Methods
We performed a systematic literature search with 307,550 results. Then, through a narrative review, we selected 96 sources of existing home rehabilitation systems and we conducted a critical analysis. Based on the critical analysis, we formulated new criteria to be used when designing future solutions, addressing the need for increased patient involvement and individualism. We categorized the criteria based on (1) motivation, (2) acceptance, and (3) technological aspects affecting the incorporation of the technology in practice. We categorized all reviewed systems based on whether they successfully met each of the proposed criteria.
Results
The criteria we identified were nonintrusive, nonwearable, motivation and engagement enhancing, individualized, supporting daily activities, cost-effective, simple, and transferable. We also examined the motivation method, suitability for elderly patients, and intended use as supplementary criteria. Through the detailed literature review and comparative analysis, we found no system reported in the literature that addressed all the set criteria. Most systems successfully addressed a subset of the criteria, but none successfully addressed all set goals of the ideal self-rehabilitation system for home use.
Conclusions
We identified a gap in the state-of-the-art in telerehabilitation and propose a set of criteria for a novel patient-centric system to enhance patient engagement and motivation and deliver better self-rehabilitation commitment.
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Boehm WL, Gruben KG. Development of KIINCE: A kinetic feedback-based robotic environment for study of neuromuscular coordination and rehabilitation of human standing and walking. J Rehabil Assist Technol Eng 2019; 5:2055668318793585. [PMID: 31191950 PMCID: PMC6453043 DOI: 10.1177/2055668318793585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 07/04/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction The objective of this article is to introduce the robotic platform KIINCE and
its emphasis on the potential of kinetic objectives for studying and
training human walking and standing. The device is motivated by the need to
characterize and train lower limb muscle coordination to address balance
deficits in impaired walking and standing. Methods The device measures the forces between the user and his or her environment,
particularly the force of the ground on the feet (F) that
reflects lower limb joint torque coordination. In an environment that allows
for exploration of the user’s capabilities, various forms of real-time
feedback guide neural training to produce F appropriate for
remaining upright. Control of the foot plate motion is configurable and may
be user driven or prescribed. Design choices are motivated from theory of
motor control and learning as well as empirical observations of
F during walking and standing. Results Preliminary studies of impaired individuals demonstrate the feasibility and
potential utility of patient interaction with kinetic immersive interface
for neuromuscular coordination enhancement. Conclusion Applications include study and rehabilitation of standing and walking after
injury, amputation, and neurological insult, with an initial focus on stroke
discussed here.
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Affiliation(s)
- Wendy L Boehm
- Department of Biomedical Engineering, Northwestern University, Chicago, USA
| | - Kreg G Gruben
- Department of Kinesiology, University of Wisconsin, Madison, USA.,Department of Biomedical Engineering, University of Wisconsin, Madison, USA
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Bulboaca A, Stanescu I, Dogaru G, Boarescu PM, Bulboaca AE. The importance of visuo-motor coordination in upper limb rehabilitation after ischemic stroke by robotic therapy. BALNEO RESEARCH JOURNAL 2019. [DOI: 10.12680/balneo.2019.244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Stroke is an acute hypoperfusion of cerebral parenchyma that most often leads to outstanding motor deficits that can last for the rest of the patient’s life. The purpose of the neurorehabilitation process is to limit, as far is possible for the motor deficits and to bring the patient to an independent life. A modern method consists in robotic neurorehabilitation which is more and more used, associated with functional electrical stimulation (FES). At the lower limb, the use of robotic rehabilitation associated with FES is already considered a success due to relatively stereotypical movements of the lower limb. In opposition, the upper limb is more difficult to rehabilitate due to its more complex movements. Therefore, eye-hand coordination (EHC) constitutes an important factor that is conditioning the rehabilitation progress. The eye-hand coordination can be brutally disturbed by stroke with critical consequences on motor-executive component. The EHC development depends on the interaction between a feedback complex and the prediction of the upper limb motility in the space, and requires the association between visual system, oculomotor system and hand motor system. We analyzed the stroke impact on this sensorial-motor functional integration and looked for a possible solution for the interruption of coordination between eyes and the movements of the superior limb. We consider that our study can contribute to a better understanding and to a faster rehabilitation of the motor deficit in the upper limb after stroke.
Key words: stroke, rehabilitation, eye-hand coordination, robotic neurorehabilitation,
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Affiliation(s)
- Angelo Bulboaca
- 1. "Iuliu-Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania 2. Clinical Rehabilitation Hospital, Cluj-Napoca, Romania
| | - Ioana Stanescu
- 1. "Iuliu-Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania 2. Clinical Rehabilitation Hospital, Cluj-Napoca, Romania
| | - Gabriela Dogaru
- 1. "Iuliu-Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania 2. Clinical Rehabilitation Hospital, Cluj-Napoca, Romania
| | - Paul-Mihai Boarescu
- 1. "Iuliu-Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adriana Elena Bulboaca
- 1. "Iuliu-Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania 2. Clinical Rehabilitation Hospital, Cluj-Napoca, Romania
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Calabrò RS, Accorinti M, Porcari B, Carioti L, Ciatto L, Billeri L, Andronaco VA, Galletti F, Filoni S, Naro A. Does hand robotic rehabilitation improve motor function by rebalancing interhemispheric connectivity after chronic stroke? Encouraging data from a randomised-clinical-trial. Clin Neurophysiol 2019; 130:767-780. [DOI: 10.1016/j.clinph.2019.02.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/28/2019] [Accepted: 02/13/2019] [Indexed: 01/16/2023]
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14
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Sarasola-Sanz A, Irastorza-Landa N, López-Larraz E, Shiman F, Spüler M, Birbaumer N, Ramos-Murguialday A. Design and effectiveness evaluation of mirror myoelectric interfaces: a novel method to restore movement in hemiplegic patients. Sci Rep 2018; 8:16688. [PMID: 30420779 PMCID: PMC6232088 DOI: 10.1038/s41598-018-34785-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 10/22/2018] [Indexed: 12/29/2022] Open
Abstract
The motor impairment occurring after a stroke is characterized by pathological muscle activation patterns or synergies. However, while robot-aided myoelectric interfaces have been proposed for stroke rehabilitation, they do not address this issue, which might result in inefficient interventions. Here, we present a novel paradigm that relies on the correction of the pathological muscle activity as a way to elicit rehabilitation, even in patients with complete paralysis. Previous studies demonstrated that there are no substantial inter-limb differences in the muscle synergy organization of healthy individuals. We propose building a subject-specific model of muscle activity from the healthy limb and mirroring it to use it as a learning tool for the patient to reproduce the same healthy myoelectric patterns on the paretic limb during functional task training. Here, we aim at understanding how this myoelectric model, which translates muscle activity into continuous movements of a 7-degree of freedom upper limb exoskeleton, could transfer between sessions, arms and tasks. The experiments with 8 healthy individuals and 2 chronic stroke patients proved the feasibility and effectiveness of such myoelectric interface. We anticipate the proposed method to become an efficient strategy for the correction of maladaptive muscle activity and the rehabilitation of stroke patients.
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Affiliation(s)
- Andrea Sarasola-Sanz
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany. .,International Max Planck Research School for Cognitive and Systems Neuroscience, Tübingen, Germany. .,Tecnalia, San Sebastián, Spain.
| | - Nerea Irastorza-Landa
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany.,International Max Planck Research School for Cognitive and Systems Neuroscience, Tübingen, Germany.,IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
| | - Eduardo López-Larraz
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Farid Shiman
- Department of Neurology, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Spüler
- Department of Computer Engineering, Wilhelm-Schickard-Institute, University of Tübingen, Tübingen, Germany
| | - Niels Birbaumer
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany.,Wyss Center, Geneve, Switzerland
| | - Ander Ramos-Murguialday
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany.,Tecnalia, San Sebastián, Spain
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Prosser LA, Pierce SR, Dillingham TR, Bernbaum JC, Jawad AF. iMOVE: Intensive Mobility training with Variability and Error compared to conventional rehabilitation for young children with cerebral palsy: the protocol for a single blind randomized controlled trial. BMC Pediatr 2018; 18:329. [PMID: 30326883 PMCID: PMC6192360 DOI: 10.1186/s12887-018-1303-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 10/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebral palsy (CP) is the most common cause of physical disability in children. The best opportunity to maximize lifelong independence is early in motor development when there is the most potential for neuroplastic change, but how best to optimize motor ability during this narrow window remains unknown. We have systematically developed and pilot-tested a novel intervention that incorporates overlapping principles of neurorehabilitation and infant motor learning in a context that promotes upright mobility skill and postural control development. The treatment, called iMOVE therapy, was designed to allow young children with CP to self-initiate motor learning experiences similar to their typically developing peers. This manuscript describes the protocol for a subsequent clinical trial to test the efficacy of iMOVE therapy compared to conventional therapy on gross motor development and other secondary outcomes in young children with CP. METHODS The study is a single-blind randomized controlled trial. Forty-two participants with CP or suspected CP between the ages of 1-3 years will be randomized to receive either the iMOVE or conventional therapy group. Distinguishing characteristics of each group are detailed. Repeated measures of gross motor function will be collected throughout the 12-24 week intervention phase and at three follow-up points over one year post therapy. Secondary outcomes include measures of postural control, physical activity, participation and caregiver satisfaction. DISCUSSION This clinical trial will add to a small, but growing, body of literature on early interventions to optimize the development of motor control in young children with CP. The information learned will inform clinical practice of early treatment strategies and may contribute to improving the trajectory of motor development and reducing lifelong physical disability in individuals with CP. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02340026 . Registered January 16, 2015.
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Affiliation(s)
- Laura A. Prosser
- Division of Rehabilitation Medicine, The Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA 19104 USA
| | - Samuel R. Pierce
- Division of Rehabilitation Medicine, The Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 USA
- Widener University, Institute for Physical Therapy Education, One University Place, Chester, PA 19013 USA
| | - Timothy R. Dillingham
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Judy C. Bernbaum
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA 19104 USA
- Division of General Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104 USA
| | - Abbas F. Jawad
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA 19104 USA
- Division of General Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104 USA
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16
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Bui KD, Johnson MJ. Designing robot-assisted neurorehabilitation strategies for people with both HIV and stroke. J Neuroeng Rehabil 2018; 15:75. [PMID: 30107849 PMCID: PMC6092818 DOI: 10.1186/s12984-018-0418-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 07/27/2018] [Indexed: 01/01/2023] Open
Abstract
There is increasing evidence that HIV is an independent risk factor for stroke, resulting in an emerging population of people living with both HIV and stroke all over the world. However, neurorehabilitation strategies for the HIV-stroke population are distinctly lacking, which poses an enormous global health challenge. In order to address this gap, a better understanding of the HIV-stroke population is needed, as well as potential approaches to design effective neurorehabilitation strategies for this population. This review goes into the mechanisms, manifestations, and treatment options of neurologic injury in stroke and HIV, the additional challenges posed by the HIV-stroke population, and rehabilitation engineering approaches for both high and low resource areas. The aim of this review is to connect the underlying neurologic properties in both HIV and stroke to rehabilitation engineering. It reviews what is currently known about the association between HIV and stroke and gaps in current treatment strategies for the HIV-stroke population. We highlight relevant current areas of research that can help advance neurorehabilitation strategies specifically for the HIV-stroke population. We then explore how robot-assisted rehabilitation combined with community-based rehabilitation could be used as a potential approach to meet the challenges posed by the HIV-stroke population. We include some of our own work exploring a community-based robotic rehabilitation exercise system. The most relevant strategies will be ones that not only take into account the individual status of the patient but also the cultural and economic considerations of their respective environment.
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Affiliation(s)
- Kevin D. Bui
- Department of Bioengineering, University of Pennsylvania, Philadelphia, USA
- Rehabilitation Robotics Lab (a GRASP Lab), University of Pennsylvania, 1800 Lombard Street, Philadelphia, 19146 USA
| | - Michelle J. Johnson
- Department of Bioengineering, University of Pennsylvania, Philadelphia, USA
- Rehabilitation Robotics Lab (a GRASP Lab), University of Pennsylvania, 1800 Lombard Street, Philadelphia, 19146 USA
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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17
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Androwis GJ, Pilkar R, Ramanujam A, Nolan KJ. Electromyography Assessment During Gait in a Robotic Exoskeleton for Acute Stroke. Front Neurol 2018; 9:630. [PMID: 30131756 PMCID: PMC6090052 DOI: 10.3389/fneur.2018.00630] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 07/12/2018] [Indexed: 12/30/2022] Open
Abstract
Background: Robotic exoskeleton (RE) based gait training involves repetitive task-oriented movements and weight shifts to promote functional recovery. To effectively understand the neuromuscular alterations occurring due to hemiplegia as well as due to the utilization of RE in acute stroke, there is a need for electromyography (EMG) techniques that not only quantify the intensity of muscle activations but also quantify and compare activation timings in different gait training environments. Purpose: To examine the applicability of a novel EMG analysis technique, Burst Duration Similarity Index (BDSI) during a single session of inpatient gait training in RE and during traditional overground gait training for individuals with acute stroke. Methods: Surface EMG was collected bilaterally with and without the RE device for five participants with acute stroke during the normalized gait cycle to measure lower limb muscle activations. EMG outcomes included integrated EMG (iEMG) calculated from the root-mean-square profiles, and a novel measure, BDSI derived from activation timing comparisons. Results: EMG data demonstrated volitional although varied levels of muscle activations on the affected and unaffected limbs, during gait with and without the RE. During the stance phase mean iEMG of the soleus (p = 0.019) and rectus femoris (RF) (p = 0.017) on the affected side significantly decreased with RE, as compared to without the RE. The differences in mean BDSI scores on the affected side with RE were significantly higher than without RE for the vastus lateralis (VL) (p = 0.010) and RF (p = 0.019). Conclusions: A traditional amplitude analysis (iEMG) and a novel timing analysis (BDSI) techniques were presented to assess the neuromuscular adaptations resulting in lower extremities muscles during RE assisted hemiplegic gait post acute stroke. The RE gait training environment allowed participants with hemiplegia post acute stroke to preserve their volitional neuromuscular activations during gait iEMG and BDSI analyses showed that the neuromuscular changes occurring in the RE environment were characterized by correctly timed amplitude and temporal adaptations. As a result of these adaptations, VL and RF on the affected side closely matched the activation patterns of healthy gait. Preliminary EMG data suggests that the RE provides an effective gait training environment for in acute stroke rehabilitation.
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Affiliation(s)
- Ghaith J Androwis
- Human Performance and Engineering Research, Kessler Foundation, West Orange, NJ, United States.,Children's Specialized Hospital, Mountainside, NJ, United States
| | - Rakesh Pilkar
- Human Performance and Engineering Research, Kessler Foundation, West Orange, NJ, United States.,Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ, United States
| | - Arvind Ramanujam
- Human Performance and Engineering Research, Kessler Foundation, West Orange, NJ, United States
| | - Karen J Nolan
- Human Performance and Engineering Research, Kessler Foundation, West Orange, NJ, United States.,Children's Specialized Hospital, Mountainside, NJ, United States.,Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ, United States
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18
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Sullivan JL, Bhagat NA, Yozbatiran N, Paranjape R, Losey CG, Grossman RG, Contreras-Vidal JL, Francisco GE, O'Malley MK. Improving robotic stroke rehabilitation by incorporating neural intent detection: Preliminary results from a clinical trial. IEEE Int Conf Rehabil Robot 2018; 2017:122-127. [PMID: 28813805 DOI: 10.1109/icorr.2017.8009233] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper presents the preliminary findings of a multi-year clinical study evaluating the effectiveness of adding a brain-machine interface (BMI) to the MAHI-Exo II, a robotic upper limb exoskeleton, for elbow flexion/extension rehabilitation in chronic stroke survivors. The BMI was used to trigger robot motion when movement intention was detected from subjects' neural signals, thus requiring that subjects be mentally engaged during robotic therapy. The first six subjects to complete the program have shown improvements in both Fugl-Meyer Upper-Extremity scores as well as in kinematic movement quality measures that relate to movement planning, coordination, and control. These results are encouraging and suggest that increasing subject engagement during therapy through the addition of an intent-detecting BMI enhances the effectiveness of standard robotic rehabilitation.
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19
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Zhang X, Elnady AM, Randhawa BK, Boyd LA, Menon C. Combining Mental Training and Physical Training With Goal-Oriented Protocols in Stroke Rehabilitation: A Feasibility Case Study. Front Hum Neurosci 2018; 12:125. [PMID: 29666575 PMCID: PMC5891644 DOI: 10.3389/fnhum.2018.00125] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/16/2018] [Indexed: 12/13/2022] Open
Abstract
Stroke is one of the leading causes of permanent disability in adults. The literature suggests that rehabilitation is key to early motor recovery. However, conventional therapy is labor and cost intensive. Robotic and functional electrical stimulation (FES) devices can provide a high dose of repetitions and as such may provide an alternative, or an adjunct, to conventional rehabilitation therapy. Brain-computer interfaces (BCI) could augment neuroplasticity by introducing mental training. However, mental training alone is not enough; but combining mental with physical training could boost outcomes. In the current case study, a portable rehabilitative platform and goal-oriented supporting training protocols were introduced and tested with a chronic stroke participant. A novel training method was introduced with the proposed rehabilitative platform. A 37-year old individual with chronic stroke participated in 6-weeks of training (18 sessions in total, 3 sessions a week, and 1 h per session). In this case study, we show that an individual with chronic stroke can tolerate a 6-week training bout with our system and protocol. The participant was actively engaged throughout the training. Changes in the Wolf Motor Function Test (WMFT) suggest that the training positively affected arm motor function (12% improvement in WMFT score).
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Affiliation(s)
- Xin Zhang
- MENRVA Research Group, Simon Fraser University, Vancouver, BC, Canada
| | - Ahmed M Elnady
- MENRVA Research Group, Simon Fraser University, Vancouver, BC, Canada
| | | | - Lara A Boyd
- Brain Behaviour Lab, University of British Columbia, Vancouver, BC, Canada
| | - Carlo Menon
- MENRVA Research Group, Simon Fraser University, Vancouver, BC, Canada
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20
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Chen J, Lum PS. Pilot testing of the spring operated wearable enhancer for arm rehabilitation (SpringWear). J Neuroeng Rehabil 2018; 15:13. [PMID: 29499712 PMCID: PMC5833152 DOI: 10.1186/s12984-018-0352-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 02/07/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Robotic devices for neurorehabilitation of movement impairments in persons with stroke have been studied extensively. However, the vast majority of these devices only allow practice of stereotyped components of simulated functional tasks in the clinic. Previously we developed SpringWear, a wearable, spring operated, upper extremity exoskeleton capable of assisting movements during real-life functional activities, potentially in the home. SpringWear assists shoulder flexion, elbow extension and forearm supination/pronation. The assistance profiles were designed to approximate the torque required to move the joint passively through its range. These three assisted DOF are combined with two passive shoulder DOF, allowing complex multi-joint movement patterns. METHODS We performed a cross-sectional study to assess changes in movement patterns when assisted by SpringWear. Thirteen persons with chronic stroke performed range of motion (ROM) and functional tasks, including pick and place tasks with various objects. Sensors on the device measured rotation at all 5 DOF and a kinematic model calculated position of the wrist relative to the shoulder. Within subject t-tests were used to determine changes with assistance from SpringWear. RESULTS Maximum shoulder flexion, elbow extension and forearm pronation/supination angles increased significantly during both ROM and functional tasks (p < 0.002). Elbow flexion/extension ROM also increased significantly (p < 0.001). When the subjects volitionally held up the arm against gravity, extension at the index finger proximal interphalangeal joint increased significantly (p = 0.033) when assisted by SpringWear. The forward reach workspace increased 19% (p = 0.002). Nine subjects could not complete the functional tasks unassisted and only one showed improvement on task completion with SpringWear. CONCLUSIONS SpringWear increased the usable workspace during reaching movements, but there was no consistent improvement in the ability to complete functional tasks. Assistance levels at the shoulder were increased only until the shoulder could be voluntarily held at 90 degrees of flexion. A higher level of assistance may have yielded better results. Also combining SpringWear with HandSOME, an exoskeleton for assisting hand opening, may yield the most dramatic improvements in functional task performance. These low-cost devices can potentially reduce effort and improve performance during task practice, increasing adherence to home training programs for rehabilitation.
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Affiliation(s)
- Ji Chen
- Department of Biomedical Engineering, Catholic University of America, Washington, DC 20064 USA
- Center for Applied Biomechanics and Rehabilitation Research MedStar National Rehabilitation Hospital, Washington, DC 20010 USA
- The Functional & Applied Biomechanics Section Rehabilitation Medicine Department Clinical Center, National Institutes of Health, Bethesda, MD 20892 USA
| | - Peter S. Lum
- Department of Biomedical Engineering, Catholic University of America, Washington, DC 20064 USA
- Center for Applied Biomechanics and Rehabilitation Research MedStar National Rehabilitation Hospital, Washington, DC 20010 USA
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22
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Zhang X, Yong X, Menon C. Evaluating the versatility of EEG models generated from motor imagery tasks: An exploratory investigation on upper-limb elbow-centered motor imagery tasks. PLoS One 2017; 12:e0188293. [PMID: 29186170 PMCID: PMC5706687 DOI: 10.1371/journal.pone.0188293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 11/03/2017] [Indexed: 11/19/2022] Open
Abstract
Electroencephalography (EEG) has recently been considered for use in rehabilitation of people with motor deficits. EEG data from the motor imagery of different body movements have been used, for instance, as an EEG-based control method to send commands to rehabilitation devices that assist people to perform a variety of different motor tasks. However, it is both time and effort consuming to go through data collection and model training for every rehabilitation task. In this paper, we investigate the possibility of using an EEG model from one type of motor imagery (e.g.: elbow extension and flexion) to classify EEG from other types of motor imagery activities (e.g.: open a drawer). In order to study the problem, we focused on the elbow joint. Specifically, nine kinesthetic motor imagery tasks involving the elbow were investigated in twelve healthy individuals who participated in the study. While results reported that models from goal-oriented motor imagery tasks had higher accuracy than models from the simple joint tasks in intra-task testing (e.g., model from elbow extension and flexion task was tested on EEG data collected from elbow extension and flexion task), models from simple joint tasks had higher accuracies than the others in inter-task testing (e.g., model from elbow extension and flexion task tested on EEG data collected from drawer opening task). Simple single joint motor imagery tasks could, therefore, be considered for training models to potentially reduce the number of repetitive data acquisitions and model training in rehabilitation applications.
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Affiliation(s)
- Xin Zhang
- Menrva Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Metro Vancouver, British Columbia, Canada
| | - Xinyi Yong
- Menrva Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Metro Vancouver, British Columbia, Canada
| | - Carlo Menon
- Menrva Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Metro Vancouver, British Columbia, Canada
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Detecting voluntary gait intention of chronic stroke patients towards top-down gait rehabilitation using EEG. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:1560-1563. [PMID: 28268625 DOI: 10.1109/embc.2016.7591009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
One of the recent trends in gait rehabilitation is to incorporate bio-signals, such as electromyography (EMG) or electroencephalography (EEG), for facilitating neuroplasticity, i.e. top-down approach. In this study, we investigated decoding stroke patients' gait intention through a wireless EEG system. To overcome patient-specific EEG patterns due to impaired cerebral cortices, common spatial patterns (CSP) was employed. We demonstrated that CSP filter can be used to maximize the EEG signal variance-ratio of gait and standing conditions. Finally, linear discriminant analysis (LDA) classification was conducted, whereby the average accuracy of 73.2% and the average delay of 0.13 s were achieved for 3 chronic stroke patients. Additionally, we also found out that the inverse CSP matrix topography of stroke patients' EEG showed good agreement with the patients' paretic side.
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Stephenson A, Stephens J. An exploration of physiotherapists’ experiences of robotic therapy in upper limb rehabilitation within a stroke rehabilitation centre. Disabil Rehabil Assist Technol 2017; 13:245-252. [DOI: 10.1080/17483107.2017.1306593] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Andrew Stephenson
- Northumbria Healthcare NHS Foundation Trust, Northumbria Specialist Emergency Care Hospital, Cramlington, UK
| | - John Stephens
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
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25
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Ohmura Y, Yano S, Katsuhira J, Migita M, Yozu A, Kondo T. Inclination of standing posture due to the presentation of tilted view through an immersive head-mounted display. J Phys Ther Sci 2017; 29:228-231. [PMID: 28265145 PMCID: PMC5332976 DOI: 10.1589/jpts.29.228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/02/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of the present study is to clarify whether tilted scenery presented
through an immersive head-mounted display (HMD) causes the inclination of standing
posture. [Subjects and Methods] Eleven healthy young adult males who provided informed
consent participated in the experiment. An immersive HMD and a stereo camera were employed
to develop a visual inclination system. The subjects maintained a standing posture twice
for 5s each while wearing the visual inclination system. They performed this task under
two conditions: normal view and 20° leftward tilted view. A three-dimensional motion
analysis system was used to measure the subjects’ postures, and two force plates were used
to measure the vertical component of the floor reaction force of each leg. [Results] In
the 20° leftward tilted view, the head and trunk angles in the frontal plane were
similarly inclined toward the left, and the vertical component of the floor reaction force
increased in the left leg, whereas it decreased in the right leg. [Conclusion] When the
view in the immersive HMD was tilted, the participants’ trunk side bent toward the same
side as that of the view. This visual inclination system seems to be a simple intervention
for changing standing posture.
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Affiliation(s)
- Yuji Ohmura
- Department of Physical Therapy, School of Nursing and Rehabilitation Sciences at Odawara, International University of Health and Welfare, Japan; Department of Computer and Information Sciences, Graduate School of Engineering, Tokyo University of Agriculture and Technology, Japan
| | - Shiro Yano
- Department of Computer and Information Sciences, Graduate School of Engineering, Tokyo University of Agriculture and Technology, Japan
| | - Junji Katsuhira
- Department of Prosthetics & Orthotics and Assistive Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Japan; Department of Medical Research and Management for Musculoskeletal Pain 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo Hospital, Japan
| | - Masato Migita
- Department of Physical Therapy, School of Nursing and Rehabilitation Sciences at Odawara, International University of Health and Welfare, Japan
| | - Arito Yozu
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, Japan
| | - Toshiyuki Kondo
- Department of Computer and Information Sciences, Graduate School of Engineering, Tokyo University of Agriculture and Technology, Japan
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Non-Invasive Brain Stimulation Improves Paretic Limb Force Production: A Systematic Review and Meta-Analysis. Brain Stimul 2016; 9:662-670. [DOI: 10.1016/j.brs.2016.05.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/28/2016] [Accepted: 05/15/2016] [Indexed: 11/22/2022] Open
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Lee S, Kim Y, Lee BH. Effect of Virtual Reality-based Bilateral Upper Extremity Training on Upper Extremity Function after Stroke: A Randomized Controlled Clinical Trial. Occup Ther Int 2016; 23:357-368. [PMID: 27419927 DOI: 10.1002/oti.1437] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 06/16/2016] [Accepted: 06/20/2016] [Indexed: 11/08/2022] Open
Abstract
In the present study, we aimed to investigate the effect of virtual reality-based bilateral upper extremity training (VRBT) on paretic upper limb function and muscle strength in patients with stroke. Eighteen stroke survivors were assigned to either the VRBT group (n = 10) or the bilateral upper limb training group (BT, n = 8). Patients in the VRBT group performed bilateral upper extremity exercises in a virtual reality environment, whereas those in the BT group performed conventional bilateral upper extremity exercises. All training was conducted for 30 minutes day-1 , 3 days a week, for a period of 6 weeks. Patients were assessed for upper extremity function and hand strength. Compared with the BT group, the VRBT group exhibited significant improvements in upper extremity function and muscle strength (p < 0.05) after the 6-week training programme. The Box and Block test results revealed that upper extremity function and elbow flexion in hand strength were significantly improved in terms of group, time and interaction effect of group by time. Furthermore, the VRBT group demonstrated significant improvements in upper extremity function, as measured by the Jebsen Hand Function Test and Grooved Pegboard test, and in the hand strength test, as measured by elbow extension, grip, palmar pinch, lateral pinch and tip pinch, in both time and the interaction effect of group by time. These results suggest that VRBT is a feasible and beneficial means of improving upper extremity function and muscle strength in individuals following stroke. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Suhyun Lee
- Graduate School of Physical Therapy, Sahmyook University, Seoul, Korea
| | - Yumi Kim
- Graduate School of Physical Therapy, Sahmyook University, Seoul, Korea
| | - Byoung-Hee Lee
- Department of Physical Therapy, Sahmyook University, Seoul, Korea
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Antelis JM, Montesano L, Ramos-Murguialday A, Birbaumer N, Minguez J. Decoding Upper Limb Movement Attempt From EEG Measurements of the Contralesional Motor Cortex in Chronic Stroke Patients. IEEE Trans Biomed Eng 2016; 64:99-111. [PMID: 27046866 DOI: 10.1109/tbme.2016.2541084] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
GOAL Stroke survivors usually require motor rehabilitation therapy as, due to the lesion, they completely or partially loss mobility in the limbs. Brain-computer interface technology offers the possibility of decoding the attempt to move paretic limbs in real time to improve existing motor rehabilitation. However, a major difficulty for the practical application of the BCI to stroke survivors is that the brain rhythms that encode the motor states might be diminished due to the lesion. This study investigates the continuous decoding of natural attempt to move the paralyzed upper limb in stroke survivors from electroencephalographic signals of the unaffected contralesional motor cortex. RESULTS Experiments were carried out with the aid of six severely affected chronic stroke patients performing/attempting self-selected reaching movements of the unaffected/affected upper limb. The electroencephalographic (EEG) analysis showed significant cortical activation on the uninjured motor cortex when moving the contralateral unaffected arm and in the attempt to move the ipsilateral affected arm. Using this activity, significant continuous decoding of movement was obtained in six out of six participants in movements of the unaffected limb, and in four out of six participants in the attempt to move the affected limb. CONCLUSION This study showed that it is possible to construct a decoder of the attempt to move the paretic arm for chronic stroke patients using the EEG activity of the healthy contralesional motor cortex. SIGNIFICANCE This decoding model could provide to stroke survivors with a natural, easy, and intuitive way to achieve control of BCIs or robot-assisted rehabilitation devices.
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Kim JH. Brain-machine Interface in Robot-assisted Neurorehabilitation for Patients with Stroke and Upper Extremity Weakness – the Therapeutic Turning Point. BRAIN & NEUROREHABILITATION 2016. [DOI: 10.12786/bn.2016.9.e5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Jung Hwan Kim
- Rehabilitation Hospital and Research Institute, National Rehabilitation Center, Seoul, Korea
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Abstract
In acute stroke, the major factor for recovery is the early use of thrombolysis aimed at arterial recanalization and reperfusion of ischemic brain tissue. Subsequently, neurorehabilitative training critically improves clinical recovery due to augmention of postlesional plasticity. Neuroimaging and electrophysiology studies have revealed that the location and volume of the stroke lesion, the affection of nerve fiber tracts, as well as functional and structural changes in the perilesional tissue and in large-scale bihemispheric networks are relevant biomarkers of post-stroke recovery. However, associated disorders, such as mood disorders, epilepsy, and neurodegenerative diseases, may induce secondary cerebral changes or aggravate the functional deficits and, thereby, compromise the potential for recovery.
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Affiliation(s)
- Rüdiger J Seitz
- Department of Neurology, Centre of Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Heinrich-Heine-University Düsseldorf , Düsseldorf , Germany ; Biomedical Research Centre, Heinrich-Heine-University Düsseldorf , Düsseldorf , Germany ; Florey Institute of Neuroscience and Mental Health, University of Melbourne , Parkville, VIC , Australia
| | - Geoffrey A Donnan
- Florey Institute of Neuroscience and Mental Health, University of Melbourne , Parkville, VIC , Australia
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Tang Z, Sugano S, Iwata H. A finger exoskeleton for rehabilitation and brain image study. IEEE Int Conf Rehabil Robot 2014; 2013:6650446. [PMID: 24187263 DOI: 10.1109/icorr.2013.6650446] [Citation(s) in RCA: 6] [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
This paper introduces the design, fabrication and evaluation of the second generation prototype of a magnetic resonance compatible finger rehabilitation robot. It can not only be used as a finger rehabilitation training tool after a stroke, but also to study the brain's recovery process during the rehabilitation therapy (ReT). The mechanical design of the current generation has overcome the disadvantage in the previous version[13], which can't provide precise finger trajectories during flexion and extension motion varying with different finger joints' torques. In addition, in order to study the brain activation under different training strategies, three control modes have been developed, compared to only one control mode in the last prototype. The current prototype, like the last version, uses an ultrasonic motor as its actuator to enable the patient to do extension and flexion rehabilitation exercises in two degrees of freedom (DOF) for each finger. Finally, experiments have been carried out to evaluate the performances of this device.
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Current Trends in Robot-Assisted Upper-Limb Stroke Rehabilitation: Promoting Patient Engagement in Therapy. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014; 2:184-195. [PMID: 26005600 DOI: 10.1007/s40141-014-0056-z] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Stroke is one of the leading causes of long-term disability today; therefore, many research efforts are focused on designing maximally effective and efficient treatment methods. In particular, robotic stroke rehabilitation has received significant attention for upper-limb therapy due to its ability to provide high-intensity repetitive movement therapy with less effort than would be required for traditional methods. Recent research has focused on increasing patient engagement in therapy, which has been shown to be important for inducing neural plasticity to facilitate recovery. Robotic therapy devices enable unique methods for promoting patient engagement by providing assistance only as needed and by detecting patient movement intent to drive to the device. Use of these methods has demonstrated improvements in functional outcomes, but careful comparisons between methods remain to be done. Future work should include controlled clinical trials and comparisons of effectiveness of different methods for patients with different abilities and needs in order to inform future development of patient-specific therapeutic protocols.
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Byl NN, Abrams GM, Pitsch E, Fedulow I, Kim H, Simkins M, Nagarajan S, Rosen J. Chronic stroke survivors achieve comparable outcomes following virtual task specific repetitive training guided by a wearable robotic orthosis (UL-EXO7) and actual task specific repetitive training guided by a physical therapist. J Hand Ther 2014; 26:343-52; quiz 352. [PMID: 23911077 DOI: 10.1016/j.jht.2013.06.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 05/23/2013] [Accepted: 06/03/2013] [Indexed: 02/03/2023]
Abstract
Survivors post stroke commonly have upper limb impairments. Patients can drive neural reorganization, brain recovery and return of function with task specific repetitive training (TSRT). Fifteen community independent stroke survivors (25-75 years, >6 months post stroke, Upper Limb Fugl Meyer [ULFM] scores 16-39) participated in this randomized feasibility study to compare outcomes of upper limb TSRT guided by a robotic orthosis (bilateral or unilateral) or a physical therapist. After 6 weeks of training (18 h), across all subjects, there were significant improvements in depression, flexibility, strength, tone, pain and voluntary movement (ULFM) (p < 0.05; effect sizes 0.49-3.53). Each training group significantly improved ULFM scores and range of motion without significant group differences. Virtual or actual TSRT performed with a robotic orthosis or a physical therapist significantly reduced arm impairments around the shoulder and elbow without significant gains in fine motor hand control, activities of daily living or independence.
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Affiliation(s)
- Nancy N Byl
- Department of Physical Therapy and Rehabilitation Medicine, School of Medicine, University of California, San Francisco, USA.
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Cortes M, Elder J, Rykman A, Murray L, Avedissian M, Stampas A, Thickbroom GW, Pascual-Leone A, Krebs HI, Valls-Sole J, Edwards DJ. Improved motor performance in chronic spinal cord injury following upper-limb robotic training. NeuroRehabilitation 2014; 33:57-65. [PMID: 23949034 DOI: 10.3233/nre-130928] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recovering upper-limb motor function has important implications for improving independence of patients with tetraplegia after traumatic spinal cord injury (SCI). OBJECTIVE To evaluate the feasibility, safety and effectiveness of robotic-assisted training of upper limb in a chronic SCI population. METHODS A total of 10 chronic tetraplegic SCI patients (C4 to C6 level of injury, American Spinal Injury Association Impairment Scale, A to D) participated in a 6-week wrist-robot training protocol (1 hour/day 3 times/week). The following outcome measures were recorded at baseline and after the robotic training: a) motor performance, assessed by robot-measured kinematics, b) corticospinal excitability measured by transcranial magnetic stimulation (TMS), and c) changes in clinical scales: motor strength (Upper extremity motor score), pain level (Visual Analog Scale) and spasticity (Modified Ashworth scale). RESULTS No adverse effects were observed during or after the robotic training. Statistically significant improvements were found in motor performance kinematics: aim (pre 1.17 ± 0.11 raduans, post 1.03 ± 0.08 raduans, p = 0.03) and smoothness of movement (pre 0.26 ± 0.03, post 0.31 ± 0.02, p = 0.03). These changes were not accompanied by changes in upper-extremity muscle strength or corticospinal excitability. No changes in pain or spasticity were found. CONCLUSIONS Robotic-assisted training of the upper limb over six weeks is a feasible and safe intervention that can enhance movement kinematics without negatively affecting pain or spasticity in chronic SCI. In addition, robot-assisted devices are an excellent tool to quantify motor performance (kinematics) and can be used to sensitively measure changes after a given rehabilitative intervention.
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Affiliation(s)
- Mar Cortes
- Non-invasive Brain Stimulation and Human Motor Control Laboratory, Burke Medical Research Institute, White Plains, NY, USA.
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Givon-Mayo R, Simons E, Ohry A, Karpin H, Israely S, Carmeli E. A preliminary investigation of error enhancement of the velocity component in stroke patients’ reaching movements. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2014. [DOI: 10.12968/ijtr.2014.21.4.160] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ronit Givon-Mayo
- Physiotherapist at the Faculty of Health Sciences and Biomedical Engineering Department, Ben-Gurion, University of the Negev, Beer-Sheva, Israel
| | - Esther Simons
- Medical Doctor at the Department of Neuroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Avi Ohry
- Reuth is a Medical Doctor at the Rehabilitation Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hana Karpin
- Occupational Therapist at the Occupational Therapy department, Reuth Rehabilitation Center, Tel Aviv, Israel
| | - Sharon Israely
- Physiotherapist at the Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
| | - Eli Carmeli
- Physiotherapist at the Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
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37
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38
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Palsbo SE, Hood-Szivek P. Effect of robotic-assisted three-dimensional repetitive motion to improve hand motor function and control in children with handwriting deficits: a nonrandomized phase 2 device trial. Am J Occup Ther 2014; 66:682-90. [PMID: 23106988 DOI: 10.5014/ajot.2012.004556] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We explored the efficacy of robotic technology in improving handwriting in children with impaired motor skills. METHOD Eighteen participants had impairments arising from cerebral palsy (CP), autism spectrum disorder (ASD), attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), or other disorders. The intervention was robotic-guided three-dimensional repetitive motion in 15-20 daily sessions of 25-30 min each over 4-8 wk. RESULTS Fine motor control improved for the children with learning disabilities and those ages 9 or older but not for those with CP or under age 9. All children with ASD or ADHD referred for slow writing speed were able to increase speed while maintaining legibility. CONCLUSION Three-dimensional, robot-assisted, repetitive motion training improved handwriting fluidity in children with mild to moderate fine motor deficits associated with ASD or ADHD within 10 hr of training. This dosage may not be sufficient for children with CP.
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Affiliation(s)
- Susan E Palsbo
- College of Health and Human Services, George Mason University, Fairfax, VA, USA.
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39
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Antelis JM, Montesano L, Ramos-Murguialday A, Birbaumer N, Minguez J. Continuous decoding of intention to move from contralesional hemisphere brain oscillations in severely affected chronic stroke patients. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2012:4099-103. [PMID: 23366829 DOI: 10.1109/embc.2012.6346868] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Decoding motor information directly from brain activity is essential in robot-assisted rehabilitation systems to promote motor relearning. However, patients who suffered a stroke in the motor cortex have lost brain activity in the injured area, and consequently, mobility in contralateral limbs. Such a loss eliminates the possibility of extracting motor information from brain activity while the patient is undergoing therapy for the affected limb. This work proposes to decode motor information from EEG activity of the contralesional hemisphere in patients who suffered a hemiparetic stroke. Four stroke patients participated in this study and the results proved the feasibility of decoding motor information while patients attempted to move the affected limb.
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Affiliation(s)
- Javier M Antelis
- Instituto de Investigacion en Ingenieria de Aragon (I3A) and Dpto. de Informatica e Ingenieria de Sistemas (DIIS), Universidad de Zaragoza, Spain.
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40
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Ozkul F, Barkana DE. Upper-Extremity Rehabilitation Robot RehabRoby: Methodology, Design, Usability and Validation. INT J ADV ROBOT SYST 2013. [DOI: 10.5772/57261] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
In this study, an exoskeleton type robot-assisted rehabilitation system, called RehabRoby, is developed for rehabilitation purposes. A control architecture, which contains a high-level controller and a low-level controller, is designed so that RehabRoby can complete the given rehabilitation task in a desired and safe manner. A hybrid system modelling technique is used for the high-level controller. An admittance control with an inner robust position control loop is used for the low-level control of the RehabRoby. Real-time experiments are performed to evaluate the control architecture of the robot-assisted rehabilitation system, RehabRoby. Furthermore, the usability of RehabRoby is evaluated.
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Affiliation(s)
| | - Duygun Erol Barkana
- Duygun Erol Barkana, Department of Electrical and Electronics Engineering, Yeditepe University, Istanbul, Turkey
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41
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Ramos-Murguialday A, Schürholz M, Caggiano V, Wildgruber M, Caria A, Hammer EM, Halder S, Birbaumer N. Proprioceptive feedback and brain computer interface (BCI) based neuroprostheses. PLoS One 2012; 7:e47048. [PMID: 23071707 PMCID: PMC3465309 DOI: 10.1371/journal.pone.0047048] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 09/07/2012] [Indexed: 11/18/2022] Open
Abstract
Brain computer interface (BCI) technology has been proposed for motor neurorehabilitation, motor replacement and assistive technologies. It is an open question whether proprioceptive feedback affects the regulation of brain oscillations and therefore BCI control. We developed a BCI coupled on-line with a robotic hand exoskeleton for flexing and extending the fingers. 24 healthy participants performed five different tasks of closing and opening the hand: (1) motor imagery of the hand movement without any overt movement and without feedback, (2) motor imagery with movement as online feedback (participants see and feel their hand, with the exoskeleton moving according to their brain signals, (3) passive (the orthosis passively opens and closes the hand without imagery) and (4) active (overt) movement of the hand and rest. Performance was defined as the difference in power of the sensorimotor rhythm during motor task and rest and calculated offline for different tasks. Participants were divided in three groups depending on the feedback receiving during task 2 (the other tasks were the same for all participants). Group 1 (n = 9) received contingent positive feedback (participants' sensorimotor rhythm (SMR) desynchronization was directly linked to hand orthosis movements), group 2 (n = 8) contingent “negative” feedback (participants' sensorimotor rhythm synchronization was directly linked to hand orthosis movements) and group 3 (n = 7) sham feedback (no link between brain oscillations and orthosis movements). We observed that proprioceptive feedback (feeling and seeing hand movements) improved BCI performance significantly. Furthermore, in the contingent positive group only a significant motor learning effect was observed enhancing SMR desynchronization during motor imagery without feedback in time. Furthermore, we observed a significantly stronger SMR desynchronization in the contingent positive group compared to the other groups during active and passive movements. To summarize, we demonstrated that the use of contingent positive proprioceptive feedback BCI enhanced SMR desynchronization during motor tasks.
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Affiliation(s)
- Ander Ramos-Murguialday
- Institute of Medical Psychology and Behavioral Neurobiology and MEG Center, University of Tubingen, Tübingen, Germany
- TECNALIA, Health Technologies, San Sebastian, Spain
- * E-mail:
| | - Markus Schürholz
- Institute of Medical Psychology and Behavioral Neurobiology and MEG Center, University of Tubingen, Tübingen, Germany
| | - Vittorio Caggiano
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Moritz Wildgruber
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Andrea Caria
- Institute of Medical Psychology and Behavioral Neurobiology and MEG Center, University of Tubingen, Tübingen, Germany
| | - Eva Maria Hammer
- Institute of Medical Psychology and Behavioral Neurobiology and MEG Center, University of Tubingen, Tübingen, Germany
| | - Sebastian Halder
- Institute of Medical Psychology and Behavioral Neurobiology and MEG Center, University of Tubingen, Tübingen, Germany
| | - Niels Birbaumer
- Institute of Medical Psychology and Behavioral Neurobiology and MEG Center, University of Tubingen, Tübingen, Germany
- Ospedale San Camillo, Istituto di Ricovero e Cura a Carattere Scientifico, Venezia Lido, Italy
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Carter AR, Shulman GL, Corbetta M. Why use a connectivity-based approach to study stroke and recovery of function? Neuroimage 2012; 62:2271-80. [PMID: 22414990 PMCID: PMC3733251 DOI: 10.1016/j.neuroimage.2012.02.070] [Citation(s) in RCA: 234] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 12/27/2011] [Accepted: 02/24/2012] [Indexed: 01/19/2023] Open
Abstract
The brain is organized into a set of widely distributed networks. Therefore, although structural damage from stroke is focal, remote dysfunction can occur in regions connected to the area of lesion. Historically, neuroscience has focused on local processing due in part to the absence of tools to study the function of distributed networks. In this article we discuss how a more comprehensive understanding of the effects of stroke can be attained using resting state functional connectivity BOLD magnetic resonance imaging (resting state fcMRI). Resting state fcMRI has a number of advantages over task-evoked fMRI for studying brain network reorganization in response to stroke, including the ability to image subjects with a broad range of impairments and the ability to study multiple networks simultaneously. We describe our rationale for using resting state connectivity as a tool for investigating the neural substrates of stroke recovery in a heterogeneous population of stroke patients and discuss the main questions we hope to answer, in particular whether resting state fcMRI measures in the acute phase of stroke can predict subsequent recovery. Early results suggest that disruption of inter-hemispheric connectivity in the somatomotor network and the dorsal attention network is more strongly associated with behavioral impairment in those domains than is intra-hemispheric connectivity within either the lesioned or unaffected hemisphere. We also observe in the somatomotor network an interesting interaction between corticospinal tract damage and decreased inter-hemispheric connectivity that suggests that both processes combine to contribute to neuromotor impairment after stroke. A connectivity-based approach will provide greater insight into network reorganization in the acute and chronic phases after stroke and will contribute to improving prognostic ability and the development of therapeutic interventions.
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Affiliation(s)
- Alex R Carter
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
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Tanabe S, Kubota S, Itoh N, Kimura T, Muraoka Y, Shimizu A, Kanada Y. Estimation of the kinetic-optimized stimulus intensity envelope for drop foot gait rehabilitation. J Med Eng Technol 2012; 36:210-6. [DOI: 10.3109/03091902.2012.666320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Sung C, O'Malley MK. Effect of progressive visual error amplification on human motor adaptation. IEEE Int Conf Rehabil Robot 2012; 2011:5975399. [PMID: 22275602 DOI: 10.1109/icorr.2011.5975399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Amplification of error has been shown to be an effective technique in increasing the rate and extent of learning for motor tasks and has the potential to accelerate rehabilitation following motor impairment. However, current error amplification methods suffer from reduced effectiveness towards the end of training. In this paper, we propose a new approach, progressive error amplification, in which error gains increase as a trainee's performance improves. We tested this approach against conventional error augmentation in a controlled experiment wherein 30 subjects adapted to a visually distorted environment by performing target-hitting tasks under one of three conditions (control, constant error amplification, progressive error amplification). Our results showed that compared with repeated practice, error amplification does not accelerate learning or result in improved task performance with respect to trajectory error, although progressive error amplification does produce lower trajectory errors when training conditions are in effect. These results indicate a need for further tuning of error augmentation methods in order to determine their true potential as a training method.
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Affiliation(s)
- Cynthia Sung
- Department of Mechanical Engineering and Materials Science, Rice University, Houston, TX 77005, USA.
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Dipietro L, Krebs HI, Volpe BT, Stein J, Bever C, Mernoff ST, Fasoli SE, Hogan N. Learning, not adaptation, characterizes stroke motor recovery: evidence from kinematic changes induced by robot-assisted therapy in trained and untrained task in the same workspace. IEEE Trans Neural Syst Rehabil Eng 2011; 20:48-57. [PMID: 22186963 DOI: 10.1109/tnsre.2011.2175008] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Both the American Heart Association and the VA/DoD endorse upper-extremity robot-mediated rehabilitation therapy for stroke care. However, we do not know yet how to optimize therapy for a particular patient's needs. Here, we explore whether we must train patients for each functional task that they must perform during their activities of daily living or alternatively capacitate patients to perform a class of tasks and have therapists assist them later in translating the observed gains into activities of daily living. The former implies that motor adaptation is a better model for motor recovery. The latter implies that motor learning (which allows for generalization) is a better model for motor recovery. We quantified trained and untrained movements performed by 158 recovering stroke patients via 13 metrics, including movement smoothness and submovements. Improvements were observed both in trained and untrained movements suggesting that generalization occurred. Our findings suggest that, as motor recovery progresses, an internal representation of the task is rebuilt by the brain in a process that better resembles motor learning than motor adaptation. Our findings highlight possible improvements for therapeutic algorithms design, suggesting sparse-activity-set training should suffice over exhaustive sets of task specific training.
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Affiliation(s)
- L Dipietro
- Mechanical Engineering Department, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
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Belda-Lois JM, Mena-del Horno S, Bermejo-Bosch I, Moreno JC, Pons JL, Farina D, Iosa M, Molinari M, Tamburella F, Ramos A, Caria A, Solis-Escalante T, Brunner C, Rea M. Rehabilitation of gait after stroke: a review towards a top-down approach. J Neuroeng Rehabil 2011; 8:66. [PMID: 22165907 PMCID: PMC3261106 DOI: 10.1186/1743-0003-8-66] [Citation(s) in RCA: 263] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 12/13/2011] [Indexed: 01/19/2023] Open
Abstract
This document provides a review of the techniques and therapies used in gait rehabilitation after stroke. It also examines the possible benefits of including assistive robotic devices and brain-computer interfaces in this field, according to a top-down approach, in which rehabilitation is driven by neural plasticity.The methods reviewed comprise classical gait rehabilitation techniques (neurophysiological and motor learning approaches), functional electrical stimulation (FES), robotic devices, and brain-computer interfaces (BCI).From the analysis of these approaches, we can draw the following conclusions. Regarding classical rehabilitation techniques, there is insufficient evidence to state that a particular approach is more effective in promoting gait recovery than other. Combination of different rehabilitation strategies seems to be more effective than over-ground gait training alone. Robotic devices need further research to show their suitability for walking training and their effects on over-ground gait. The use of FES combined with different walking retraining strategies has shown to result in improvements in hemiplegic gait. Reports on non-invasive BCIs for stroke recovery are limited to the rehabilitation of upper limbs; however, some works suggest that there might be a common mechanism which influences upper and lower limb recovery simultaneously, independently of the limb chosen for the rehabilitation therapy. Functional near infrared spectroscopy (fNIRS) enables researchers to detect signals from specific regions of the cortex during performance of motor activities for the development of future BCIs. Future research would make possible to analyze the impact of rehabilitation on brain plasticity, in order to adapt treatment resources to meet the needs of each patient and to optimize the recovery process.
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Affiliation(s)
- Juan-Manuel Belda-Lois
- Instituto de Biomecánica de Valencia, Universitat Politécnica de Valencia, Camino de Vera, s/n ed. 9C, E46022 Valencia, Spain
- Grupo de Tecnología Sanitaria del IBV, CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN). Valencia, Spain
| | - Silvia Mena-del Horno
- Instituto de Biomecánica de Valencia, Universitat Politécnica de Valencia, Camino de Vera, s/n ed. 9C, E46022 Valencia, Spain
| | - Ignacio Bermejo-Bosch
- Instituto de Biomecánica de Valencia, Universitat Politécnica de Valencia, Camino de Vera, s/n ed. 9C, E46022 Valencia, Spain
- Grupo de Tecnología Sanitaria del IBV, CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN). Valencia, Spain
| | - Juan C Moreno
- Bioengineering Group, Center for Automation and Robotics, Spanish National Research Council (CSIC). Madrid, Spain
| | - José L Pons
- Bioengineering Group, Center for Automation and Robotics, Spanish National Research Council (CSIC). Madrid, Spain
| | - Dario Farina
- Department of Neurorehabilitation Engineering, Bernstein Center for Computational Neuroscience University Medical Center Göttingen Georg-August University. Göttingen, Germany
| | | | | | | | - Ander Ramos
- University of Tübingen. Tübingen, Germany
- TECNALIA Research and Innovation Germany. Tübingen, Germany
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Abstract
PURPOSE OF REVIEW The field of new technologies for upper-limb rehabilitation is exploding. The review presents new trends and studies of effectiveness from recent literature regarding robots, virtual reality and telerehabilitation for neurorehabilitation of the upper limb. RECENT FINDINGS There appears to be a greater focus on technological developments than on clinical trials or studies to evaluate the mechanisms behind the effectiveness of these systems. Developments are most abundant in the field of robotics. However, the first well designed and powered randomized-controlled trial on robot rehabilitation has appeared, confirming that the effectiveness of robot therapy lies in the number of repetitions provided. There is a move towards studies in populations other than stroke, particularly cerebral palsy with a few studies on multiple sclerosis and traumatic brain injury. There is also an increasing trend for the use of robotic devices as evaluation tools. SUMMARY Despite the fact that new technologies are based on knowledge from motor control and learning literature and that they provide an exciting potential for varied rehabilitation, recent evidence suggests that the only contribution to clinical practice currently is the provision of intensive, repetitive movements.
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Morrison S. Financial Feasibility of Robotics in Neurorehabilitation. Top Spinal Cord Inj Rehabil 2011. [DOI: 10.1310/sci1701-77] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Whyte E, Skidmore E, Aizenstein H, Ricker J, Butters M. Cognitive impairment in acquired brain injury: a predictor of rehabilitation outcomes and an opportunity for novel interventions. PM R 2011; 3:S45-51. [PMID: 21703580 PMCID: PMC4492523 DOI: 10.1016/j.pmrj.2011.05.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 05/09/2011] [Indexed: 11/16/2022]
Abstract
Cognitive impairment is a common sequela in acquired brain injury and one that predicts rehabilitation outcomes. There is emerging evidence that impairments in cognitive functions can be manipulated by both pharmacologic and nonpharmacologic interventions to improve rehabilitation outcomes. By using stroke as a model for acquired brain injury, we review the evidence that links cognitive impairment to poor rehabilitation outcomes and discuss possible mechanisms to explain this association. Furthermore, we examine nascent promising research that suggests that interventions that target cognitive impairments can lead to better rehabilitation outcomes.
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Affiliation(s)
- Ellen Whyte
- Department of Psychiatry, School of Medicine, WPIC-BT 764, 3811 O'Hara St, Pittsburgh PA 15213, USA
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