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Tseng KC, Wang L, Hsieh C, Wong AM. Portable robots for upper-limb rehabilitation after stroke: a systematic review and meta-analysis. Ann Med 2024; 56:2337735. [PMID: 38640459 PMCID: PMC11034452 DOI: 10.1080/07853890.2024.2337735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/28/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Robot-assisted upper-limb rehabilitation has been studied for many years, with many randomised controlled trials (RCTs) investigating the effects of robotic-assisted training on affected limbs. The current trend directs towards end-effector devices. However, most studies have focused on the effectiveness of rehabilitation devices, but studies on device sizes are relatively few. GOAL Systematically review the effect of a portable rehabilitation robot (PRR) on the rehabilitation effectiveness of paralysed upper limbs compared with non-robotic therapy. METHODS A meta-analysis was conducted on literature that included the Fugl-Meyer Assessment (FMA) obtained from the PubMed and Web of Science (WoS) electronic databases until June 2023. RESULTS A total of 9 studies, which included RCTs, were completed and a meta-analysis was conducted on 8 of them. The analysis involved 295 patients. The influence on upper-limb function before and after treatment in a clinical environment is analysed by comparing the experimental group using the portable upper-limb rehabilitation robot with the control group using conventional therapy. The result shows that portable robots prove to be effective (FMA: SMD = 0.696, 95% = 0.099 to.293, p < 0.05). DISCUSSION Both robot-assisted and conventional rehabilitation effects are comparable. In some studies, PRR performs better than conventional rehabilitation, but conventional treatments are still irreplaceable. Smaller size with better portability has its advantages, and portable upper-limb rehabilitation robots are feasible in clinical rehabilitation. CONCLUSION Although portable upper-limb rehabilitation robots are clinically beneficial, few studies have focused on portability. Further research should focus on modular design so that rehabilitation robots can be decomposed, which benefits remote rehabilitation and household applications.
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Affiliation(s)
- Kevin C. Tseng
- Department of Industrial Design, National Taipei University of Technology, Taipei, Taiwan, ROC
- Product Design and Development Laboratory, Taoyuan, Taiwan, ROC
| | - Le Wang
- Product Design and Development Laboratory, Taoyuan, Taiwan, ROC
| | - Chunkai Hsieh
- Product Design and Development Laboratory, Taoyuan, Taiwan, ROC
| | - Alice M. Wong
- Product Design and Development Laboratory, Taoyuan, Taiwan, ROC
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan, ROC
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Vora I, Gochyyev P, Engineer N, Wolf SL, Kimberley TJ. Distal Versus Proximal Arm Improvement After Paired Vagus Nerve Stimulation Therapy After Chronic Stroke. Arch Phys Med Rehabil 2024; 105:1709-1717. [PMID: 38815953 PMCID: PMC11374485 DOI: 10.1016/j.apmr.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 05/15/2024] [Accepted: 05/19/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE To evaluate differences in upper-extremity (UE) segment-specific (proximal or distal segment) recovery after vagus nerve stimulation (VNS) paired with UE rehabilitation (Paired-VNS) compared with rehabilitation with sham-VNS (Control). We also assessed whether gains in specific UE segments predicted clinically meaningful improvement. DESIGN This study reports on a secondary analysis of Vagus nerve stimulation paired with rehabilitation for UE motor function after chronic ischemic stroke (VNS-REHAB), a randomized, triple-blinded, sham-controlled pivotal trial. A Rasch latent regression was used to determine differences between Paired-VNS and Controls for distal and proximal UE changes after in-clinic therapy and 3 months later. Subsequently, we ran a random forest model to assess candidate predictors of meaningful improvement. Each item of the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and Wolf Motor Function Test (WMFT) was evaluated as a predictor of response to treatment. SETTING Nineteen stroke rehabilitation centers in the USA and UK. PARTICIPANTS Dataset included 108 participants (N=108) with chronic ischemic stroke and moderate-to-severe UE impairments. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES FMA-UE and WMFT. RESULTS Distal UE improvement was significantly greater in the Paired-VNS group than in Controls immediately after therapy (95% confidence interval, 0.27-0.73; P≤.001) and after 3 months (95% confidence interval, 0.16-0.75; P=.003). Both groups showed similar improvement in proximal UE at both time points. A subset of both distal and proximal items from the FMA-UE and WMFT were predictors of meaningful improvement. CONCLUSIONS Paired-VNS improved distal UE impairment in chronic stroke to a greater degree than intensive rehabilitation alone. Proximal improvements were equally responsive to either treatment. Given that meaningful UE recovery is predicted by improvements across both proximal and distal segments, Paired-VNS may facilitate improvement that is otherwise elusive.
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Affiliation(s)
- Isha Vora
- Department of Rehabilitation Science, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA
| | - Perman Gochyyev
- Department of Rehabilitation Science, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA; Berkeley Evaluation and Assessment Research Center, University of California, Berkeley, Berkeley, CA
| | | | - Steven L Wolf
- Division of Physical Therapy, Center for Physical Therapy and Movement Science, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA
| | - Teresa J Kimberley
- Department of Rehabilitation Science, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA; Department of Physical Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA.
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Shi XQ, Ti CHE, Lu HY, Hu CP, Xie DS, Yuan K, Heung HL, Leung TWH, Li Z, Tong RKY. Task-Oriented Training by a Personalized Electromyography-Driven Soft Robotic Hand in Chronic Stroke: A Randomized Controlled Trial. Neurorehabil Neural Repair 2024; 38:595-606. [PMID: 38812378 DOI: 10.1177/15459683241257519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
BACKGROUND Intensive task-oriented training has shown promise in enhancing distal motor function among patients with chronic stroke. A personalized electromyography (EMG)-driven soft robotic hand was developed to assist task-oriented object-manipulation training effectively. Objective. To compare the effectiveness of task-oriented training using the EMG-driven soft robotic hand. METHODS A single-blinded, randomized controlled trial was conducted with 34 chronic stroke survivors. The subjects were randomly assigned to the Hand Task (HT) group (n = 17) or the control (CON) group (n = 17). The HT group received 45 minutes of task-oriented training by manipulating small objects with the robotic hand for 20 sessions, while the CON group received 45 minutes of hand-functional exercises without objects using the same robot. Fugl-Meyer assessment (FMA-UE), Action Research Arm Test (ARAT), Modified Ashworth Score (MAS), Box and Block test (BBT), Maximum Grip Strength, and active range of motion (AROM) of fingers were assessed at baseline, after intervention, and 3 months follow-up. The muscle co-contraction index (CI) was analyzed to evaluate the session-by-session variation of upper limb EMG patterns. RESULTS The HT group showed more significant improvement in FMA-UE (wrist/hand, shoulder/elbow) compared to the CON group (P < .05). At 3-month follow-up, the HT group demonstrated significant improvements in FMA-UE, ARAT, BBT, MAS (finger), and AROMs (P < .05). The HT group exhibited a more significant decrease in muscle co-contractions compared to the CON group (P < .05). CONCLUSIONS EMG-driven task-oriented training with the personalized soft robotic hand was a practical approach to improving motor function and muscle coordination. CLINICAL TRIAL REGISTRY NAME Soft Robotic Hand System for Stroke Rehabilitation. CLINICAL TRIAL REGISTRATION-URL https://clinicaltrials.gov/. UNIQUE IDENTIFIER NCT03286309.
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Affiliation(s)
- Xiang-Qian Shi
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chun-Hang Eden Ti
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hsuan-Yu Lu
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Cheng-Peng Hu
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Di-Sheng Xie
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kai Yuan
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ho-Lam Heung
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Thomas Wai-Hong Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zheng Li
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Raymond Kai-Yu Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
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Ito D, Fukuda M, Hosoi Y, Hirose R, Teramae T, Kamimoto T, Yamada Y, Tsuji T, Noda T, Kawakami M. Optimizing shoulder elevation assist rate in exoskeletal rehabilitation based on muscular activity indices: a clinical feasibility study. BMC Neurol 2024; 24:144. [PMID: 38724916 PMCID: PMC11080160 DOI: 10.1186/s12883-024-03651-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Restoring shoulder function is critical for upper-extremity rehabilitation following a stroke. The complex musculoskeletal anatomy of the shoulder presents a challenge for safely assisting elevation movements through robotic interventions. The level of shoulder elevation assistance in rehabilitation is often based on clinical judgment. There is no standardized method for deriving an optimal level of assistance, underscoring the importance of addressing abnormal movements during shoulder elevation, such as abnormal synergies and compensatory actions. This study aimed to investigate the effectiveness and safety of a newly developed shoulder elevation exoskeleton robot by applying a novel optimization technique derived from the muscle synergy index. METHODS Twelve chronic stroke participants underwent an intervention consisting of 100 robot-assisted shoulder elevation exercises (10 × 10 times, approximately 40 min) for 10 days (4-5 times/week). The optimal robot assist rate was derived by detecting the change points using the co-contraction index, calculated from electromyogram (EMG) data obtained from the anterior deltoid and biceps brachii muscles during shoulder elevation at the initial evaluation. The primary outcomes were the Fugl-Meyer assessment-upper extremity (FMA-UE) shoulder/elbow/forearm score, kinematic outcomes (maximum angle of voluntary shoulder flexion and elbow flexion ratio during shoulder elevation), and shoulder pain outcomes (pain-free passive shoulder flexion range of motion [ROM] and visual analogue scale for pain severity during shoulder flexion). The effectiveness and safety of robotic therapy were examined using the Wilcoxon signed-rank sum test. RESULTS All 12 patients completed the procedure without any adverse events. Two participants were excluded from the analysis because the EMG of the biceps brachii was not obtained. Ten participants (five men and five women; mean age: 57.0 [5.5] years; mean FMA-UE total score: 18.7 [10.5] points) showed significant improvement in the FMA-UE shoulder/elbow/forearm score, kinematic outcomes, and pain-free passive shoulder flexion ROM (P < 0.05). The shoulder pain outcomes remained unchanged or improved in all patients. CONCLUSIONS The study presents a method for deriving the optimal robotic assist rate. Rehabilitation using a shoulder robot based on this derived optimal assist rate showed the possibility of safely improving the upper-extremity function in patients with severe stroke in the chronic phase.
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Affiliation(s)
- Daisuke Ito
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Mori Fukuda
- Graduate School of Science and Technology, Keio University, Tokyo, Kanagawa, Japan
| | - Yuichiro Hosoi
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Ryotaro Hirose
- Graduate School of Science and Technology, Keio University, Tokyo, Kanagawa, Japan
| | - Tatsuya Teramae
- Department of Brain Robot Interface, Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International, Kyoto, Japan
| | - Takayuki Kamimoto
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuka Yamada
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tomoyuki Noda
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Department of Brain Robot Interface, Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International, Kyoto, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
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Höhler C, Trigili E, Astarita D, Hermsdörfer J, Jahn K, Krewer C. The efficacy of hybrid neuroprostheses in the rehabilitation of upper limb impairment after stroke, a narrative and systematic review with a meta-analysis. Artif Organs 2024; 48:232-253. [PMID: 37548237 DOI: 10.1111/aor.14618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/30/2023] [Accepted: 07/17/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Paresis of the upper limb (UL) is the most frequent impairment after a stroke. Hybrid neuroprostheses, i.e., the combination of robots and electrical stimulation, have emerged as an option to treat these impairments. METHODS To give an overview of existing devices, their features, and how they are linked to clinical metrics, four different databases were systematically searched for studies on hybrid neuroprostheses for UL rehabilitation after stroke. The evidence on the efficacy of hybrid therapies was synthesized. RESULTS Seventy-three studies were identified, introducing 32 hybrid systems. Among the most recent devices (n = 20), most actively reinforce movement (3 passively) and are typical exoskeletons (3 end-effectors). If classified according to the International Classification of Functioning, Disability and Health, systems for proximal support are expected to affect body structures and functions, while the activity and participation level are targeted when applying Functional Electrical Stimulation distally plus the robotic component proximally. The meta-analysis reveals a significant positive effect on UL functions (p < 0.001), evident in a 7.8-point Mdiff between groups in the Fugl-Meyer assessment. This positive effect remains at the 3-month follow-up (Mdiff = 8.4, p < 0.001). CONCLUSIONS Hybrid neuroprostheses have a positive effect on UL recovery after stroke, with effects persisting at least three months after the intervention. Non-significant studies were those with the shortest intervention periods and the oldest patients. Improvements in UL functions are not only present in the subacute phase after stroke but also in long-term chronic stages. In addition to further technical development, more RCTs are needed to make assumptions about the determinants of successful therapy.
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Affiliation(s)
- Chiara Höhler
- Research Department, Schoen Clinic Bad Aibling, Bad Aibling, Germany
- Chair of Human Movement Science, Faculty of Sport and Health Science, Technical University Munich, Munich, Germany
| | - Emilio Trigili
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Davide Astarita
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Joachim Hermsdörfer
- Chair of Human Movement Science, Faculty of Sport and Health Science, Technical University Munich, Munich, Germany
| | - Klaus Jahn
- Research Department, Schoen Clinic Bad Aibling, Bad Aibling, Germany
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich (LMU), Munich, Germany
| | - Carmen Krewer
- Research Department, Schoen Clinic Bad Aibling, Bad Aibling, Germany
- Chair of Human Movement Science, Faculty of Sport and Health Science, Technical University Munich, Munich, Germany
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Huang Y, Yang B, Wong TWL, Ng SSM, Hu X. Personalized robots for long-term telerehabilitation after stroke: a perspective on technological readiness and clinical translation. FRONTIERS IN REHABILITATION SCIENCES 2024; 4:1329927. [PMID: 38259875 PMCID: PMC10800453 DOI: 10.3389/fresc.2023.1329927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024]
Abstract
Stroke rehabilitation, which demands consistent, intensive, and adaptable intervention in the long term, faced significant challenges due to the COVID-19 pandemic. During this time, telerehabilitation emerged as a noteworthy complement to traditional rehabilitation services, offering the convenience of at-home care delivery and overcoming geographical and resource limitations. Self-help rehabilitation robots deliver repetitive and intensive physical assistance, thereby alleviating the labor burden. However, robots have rarely demonstrated long-term readiness for poststroke telerehabilitation services. The transition from research trials to general clinical services presents several challenges that may undermine the rehabilitative gains observed in these studies. This perspective discusses the technological readiness of personal use robots in the context of telerehabilitation and identifies the potential challenges for their clinical translation. The goal is to leverage technology to seamlessly integrate it into standard clinical workflows, ultimately enhancing the outcomes of stroke rehabilitation.
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Affiliation(s)
- Yanhuan Huang
- Department of Biomedical Engineering, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Bibo Yang
- Department of Biomedical Engineering, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Thomson Wai-Lung Wong
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Shamay S. M. Ng
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Xiaoling Hu
- Department of Biomedical Engineering, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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Hsu HY, Koh CL, Yang KC, Lin YC, Hsu CH, Su FC, Kuo LC. Effects of an assist-as-needed equipped Tenodesis-Induced-Grip Exoskeleton Robot (TIGER) on upper limb function in patients with chronic stroke. J Neuroeng Rehabil 2024; 21:5. [PMID: 38173006 PMCID: PMC10765635 DOI: 10.1186/s12984-023-01298-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The original version of the Tenodesis-Induced-Grip Exoskeleton Robot (TIGER) significantly improved the motor and functional performance of the affected upper extremity of chronic stroke patients. The assist-as-needed (AAN) technique in robot-involved therapy is widely favored for promoting patient active involvement, thereby fostering motor recovery. However, the TIGER lacked an AAN control strategy, which limited its use in different clinical applications. The present study aimed to develop and analyze the training effects of an AAN control mode to be integrated into the TIGER, to analyze the impact of baseline patient characteristics and training paradigms on outcomes for individuals with chronic stroke and to compare training effects on the upper limb function between using the AAN-equipped TIGER and using the original prototype. METHODS This was a single-arm prospective interventional study which was conducted at a university hospital. In addition to 20 min of regular task-specific motor training, each participant completed a 20-min robotic training program consisting of 10 min in the AAN control mode and 10 min in the functional mode. The training sessions took place twice a week for 9 weeks. The primary outcome was the change score of the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE), and the secondary outcomes were the change score of the Box and Blocks Test (BBT), the amount of use (AOU) and quality of movement (QOM) scales of the Motor Activity Log (MAL), the Semmes-Weinstein Monofilament (SWM) test, and the Modified Ashworth Scale (MAS) for fingers and wrist joints. The Generalized Estimating Equations (GEE) and stepwise regression model were used as the statistical analysis methods. RESULTS Sixteen chronic stroke patients completed all steps of the study. The time from stroke onset to entry into the trial was 21.7 ± 18.9 months. After completing the training with the AAN-equipped TIGER, they exhibited significant improvements in movement reflected in their total score (pre/post values were 34.6 ± 11.5/38.5 ± 13.4) and all their sub-scores (pre/post values were 21.5 ± 6.0/23.3 ± 6.5, 9.5 ± 6.2/11.3 ± 7.2, and 3.6 ± 1.0/3.9 ± 1.0 for the shoulder, elbow, and forearm sub-category, the wrist and hand sub-category, and the coordination sub-category, respectively) on the FMA-UE (GEE, p < 0.05), as well as their scores on the BBT (pre/post values were 5.9 ± 6.5/9.5 ± 10.1; GEE, p = 0.004) and the AOU (pre/post values were 0.35 ± 0.50/0.48 ± 0.65; GEE, p = 0.02). However, the original TIGER exhibited greater improvements in their performance on the FMA-UE than the participants training with the AAN-equipped TIGER (GEE, p = 0.008). The baseline score for the wrist and hand sub-category of the FMA-UE was clearly the best predictor of TIGER-mediated improvements in hand function during the post-treatment assessment (adjusted R2 = 0.282, p = 0.001). CONCLUSIONS This study developed an AAN-equipped TIGER system and demonstrated its potential effects on improving both the function and activity level of the affected upper extremity of patients with stroke. Nevertheless, its training effects were not found to be advantageous to the original prototype. The baseline score for the FMA-UE sub-category of wrist and hand was the best predictor of improvements in hand function after TIGER rehabilitation. Clinical trial registration ClinicalTrials.gov, identifier NCT03713476; date of registration: October19, 2018. https://clinicaltrials.gov/ct2/show/NCT03713476.
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Affiliation(s)
- Hsiu-Yun Hsu
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan, 701, Taiwan
| | - Chia-Lin Koh
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan, 701, Taiwan
| | - Kang-Chin Yang
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Ching Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chieh-Hsiang Hsu
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan, 701, Taiwan
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Fong-Chin Su
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
- Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Li-Chieh Kuo
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan, 701, Taiwan.
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan.
- Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan.
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Qing W, Nam CY, Shum HMH, Chan MKL, Yu KP, Ng SSW, Yang B, Hu X. The Translation of Mobile-Exoneuromusculoskeleton-Assisted Wrist-Hand Poststroke Telerehabilitation from Laboratory to Clinical Service. Bioengineering (Basel) 2023; 10:976. [PMID: 37627861 PMCID: PMC10451942 DOI: 10.3390/bioengineering10080976] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Rehabilitation robots are helpful in poststroke telerehabilitation; however, their feasibility and rehabilitation effectiveness in clinical settings have not been sufficiently investigated. A non-randomized controlled trial was conducted to investigate the feasibility of translating a telerehabilitation program assisted by a mobile wrist/hand exoneuromusculoskeleton (WH-ENMS) into routine clinical services and to compare the rehabilitative effects achieved in the hospital-service-based group (n = 12, clinic group) with the laboratory-research-based group (n = 12, lab group). Both groups showed significant improvements (p ≤ 0.05) in clinical assessments of behavioral motor functions and in muscular coordination and kinematic evaluations after the training and at the 3-month follow-up, with the lab group demonstrating better motor gains than the clinic group (p ≤ 0.05). The results indicated that the WH-ENMS-assisted tele-program was feasible and effective for upper limb rehabilitation when integrated into routine practice, and the quality of patient-operator interactions physically and remotely affected the rehabilitative outcomes.
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Affiliation(s)
- Wanyi Qing
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Ching-Yi Nam
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Harvey Man-Hok Shum
- Community Rehabilitation Service Support Centre, Queen Elizabeth Hospital, Hong Kong
| | - Marko Ka-Leung Chan
- Community Rehabilitation Service Support Centre, Queen Elizabeth Hospital, Hong Kong
| | - King-Pong Yu
- Community Rehabilitation Service Support Centre, Queen Elizabeth Hospital, Hong Kong
| | - Serena Sin-Wah Ng
- Community Rehabilitation Service Support Centre, Queen Elizabeth Hospital, Hong Kong
| | - Bibo Yang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Xiaoling Hu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
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Li M, Pun SH, Chen F. Impacts of Cortical Regions on EEG-based Classification of Lexical Tones and Vowels in Spoken Speech. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083036 DOI: 10.1109/embc40787.2023.10340428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Speech impairment is one of the most serious problems for patients with communication disorders, e.g., stroke survivors. The brain-computer interface (BCI) systems have shown the potential to alternatively control or rehabilitate the neurological damages in speech production. The effects of different cortical regions in speech-based BCI systems are essential to be studied, which are favorable for improving the performance of speech-based BCI systems. This work aimed to explore the impacts of different speech-related cortical regions in the electroencephalogram (EEG) based classification of seventy spoken Mandarin monosyllables carrying four vowels and four lexical tones. Seven audible speech production-related cortical regions were studied, involving Broca's and Wernicke's areas, auditory cortex, motor cortex, prefrontal cortex, sensory cortex, left brain, right brain, and whole brain. Following the previous studies in which EEG signals were collected from ten subjects during Mandarin speech production, the features of EEG signals were extracted by the Riemannian manifold method, and a linear discriminant analysis (LDA) was regarded as a classifier to classify different vowels and lexical tones. The results showed that when using electrodes from whole brain, the classifier reached the best performances, which were 48.5% for lexical tones and 70.0% for vowels, respectively. The vowel classification results under Broca's and Wernicke's areas, auditory cortex, or prefrontal cortex were higher than those under the motor cortex or sensory cortex. No such differences were observed in the lexical tone classification task.
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Ueda T, Suzumura S, Ito K, Narukawa R, Kondo I. Improved upper extremity function following low-frequency hybrid assistive neuromuscular dynamic stimulation therapy in a patient with hemiplegia: A case report. J Hand Ther 2023; 36:744-749. [PMID: 37012123 DOI: 10.1016/j.jht.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 10/04/2022] [Accepted: 10/09/2022] [Indexed: 04/05/2023]
Abstract
BACKGROUND Although hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy may improve upper extremity functionality in patients with paralysis or paresis due to stroke, it is usually only provided in hospitals as a frequent intervention during the phase of early recovery in stroke. Home-based rehabilitation is limited by frequency and duration of visits. PURPOSE To investigate the effectiveness of low-frequency HANDS therapy using motor function assessment. STUDY DESIGN Case report. METHODS We performed HANDS therapy for 1 month on the patient, who was a woman in her 70s with left-sided hemiplegia. It was initiated on day 183 post the onset of stroke. Movement and motor function were evaluated using the Fugl-Meyer Assessment upper-extremity (FMA-UE) motor items and the Motor Activity Log consisting of Amount of Use (MAL-AOU), as well as Quality of Movement (MAL-QOM) scales. This evaluation was performed before starting HANDS therapy and after its conclusion. RESULTS Following HANDS therapy, there was improvement in the FMA-UE (21 points → 28 points), MAL-AOU (0.17 points → 0.33 points), and MAL-QOM (0.08 points → 0.33 points) scores when compared to the scores before therapy, and the patient was able to use both hands for activities of daily living (ADLs). CONCLUSIONS Low-frequency HANDS therapy combined with encouragement to include the affected hand in ADLs may improve upper extremity function in cases of paralysis.
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Affiliation(s)
- Tomomi Ueda
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shota Suzumura
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Japan; Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan.
| | - Kei Ito
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Rie Narukawa
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Izumi Kondo
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
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11
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Moulaei K, Bahaadinbeigy K, Haghdoostd AA, Nezhad MS, Sheikhtaheri A. Overview of the role of robots in upper limb disabilities rehabilitation: a scoping review. Arch Public Health 2023; 81:84. [PMID: 37158979 PMCID: PMC10169358 DOI: 10.1186/s13690-023-01100-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/29/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Neuromotor rehabilitation and improvement of upper limb functions are necessary to improve the life quality of patients who have experienced injuries or have pathological outcomes. Modern approaches, such as robotic-assisted rehabilitation can help to improve rehabilitation processes and thus improve upper limb functions. Therefore, the aim of this study was to investigate the role of robots in upper limb disability improvement and rehabilitation. METHODS This scoping review was conducted by search in PubMed, Web of Science, Scopus, and IEEE (January 2012- February 2022). Articles related to upper limb rehabilitation robots were selected. The methodological quality of all the included studies will be appraised using the Mixed Methods Appraisal Tool (MMAT). We used an 18-field data extraction form to extract data from articles and extracted the information such as study year, country, type of study, purpose, illness or accident leading to disability, level of disability, assistive technologies, number of participants in the study, sex, age, rehabilitated part of the upper limb using a robot, duration and frequency of treatment, methods of performing rehabilitation exercises, type of evaluation, number of participants in the evaluation process, duration of intervention, study outcomes, and study conclusions. The selection of articles and data extraction was made by three authors based on inclusion and exclusion criteria. Disagreements were resolved through consultation with the fifth author. Inclusion criteria were articles involving upper limb rehabilitation robots, articles about upper limb disability caused by any illness or injury, and articles published in English. Also, articles involving other than upper limb rehabilitation robots, robots related to rehabilitation of diseases other than upper limb, systematic reviews, reviews, and meta-analyses, books, book chapters, letters to the editor, and conference papers were also excluded. Descriptive statistics methods (frequency and percentage) were used to analyses the data. RESULTS We finally included 55 relevant articles. Most of the studies were done in Italy (33.82%). Most robots were used to rehabilitate stroke patients (80%). About 60.52% of the studies used games and virtual reality rehabilitate the upper limb disabilities using robots. Among the 14 types of applied evaluation methods, "evaluation and measurement of upper limb function and dexterity" was the most applied evaluation method. "Improvement in musculoskeletal functions", "no adverse effect on patients", and "Safe and reliable treatment" were the most cited outcomes, respectively. CONCLUSIONS Our findings show that robots can improve musculoskeletal functions (musculoskeletal strength, sensation, perception, vibration, muscle coordination, less spasticity, flexibility, and range of motion) and empower people by providing a variety of rehabilitation capabilities.
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Affiliation(s)
- Khadijeh Moulaei
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Haghdoostd
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mansour Shahabi Nezhad
- Department of Physical Therapy, Faculty of Allied Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Abbas Sheikhtaheri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
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12
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Bressi F, Cricenti L, Campagnola B, Bravi M, Miccinilli S, Santacaterina F, Sterzi S, Straudi S, Agostini M, Paci M, Casanova E, Marino D, La Rosa G, Giansanti D, Perrero L, Battistini A, Filoni S, Sicari M, Petrozzino S, Solaro CM, Gargano S, Benanti P, Boldrini P, Bonaiuti D, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzoleni S, Mazzon S, Molteni F, Petrarca M, Picelli A, Posteraro F, Senatore M, Turchetti G, Morone G, Gallotti M, Germanotta M, Aprile I. Effects of robotic upper limb treatment after stroke on cognitive patterns: A systematic review. NeuroRehabilitation 2022; 51:541-558. [PMID: 36530099 PMCID: PMC9837692 DOI: 10.3233/nre-220149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Robotic therapy (RT) has been internationally recognized for the motor rehabilitation of the upper limb. Although it seems that RT can stimulate and promote neuroplasticity, the effectiveness of robotics in restoring cognitive deficits has been considered only in a few recent studies. OBJECTIVE To verify whether, in the current state of the literature, cognitive measures are used as inclusion or exclusion criteria and/or outcomes measures in robotic upper limb rehabilitation in stroke patients. METHODS The systematic review was conducted according to PRISMA guidelines. Studies eligible were identified through PubMed/MEDLINE and Web of Science from inception to March 2021. RESULTS Eighty-one studies were considered in this systematic review. Seventy-three studies have at least a cognitive inclusion or exclusion criteria, while only seven studies assessed cognitive outcomes. CONCLUSION Despite the high presence of cognitive instruments used for inclusion/exclusion criteria their heterogeneity did not allow the identification of a guideline for the evaluation of patients in different stroke stages. Therefore, although the heterogeneity and the low percentage of studies that included cognitive outcomes, seemed that the latter were positively influenced by RT in post-stroke rehabilitation. Future larger RCTs are needed to outline which cognitive scales are most suitable and their cut-off, as well as what cognitive outcome measures to use in the various stages of post-stroke rehabilitation.
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Affiliation(s)
- Federica Bressi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Laura Cricenti
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Benedetta Campagnola
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy,Address for correspondence: Benedetta Campagnola, Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy. E-mail:
| | - Marco Bravi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Sandra Miccinilli
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Fabio Santacaterina
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Silvia Sterzi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| | | | - Matteo Paci
- AUSL (Unique Sanitary Local Company) District of Central Tuscany, Florence, Italy
| | - Emanuela Casanova
- Unità Operativa di Medicina Riabilitativa e Neuroriabilitazione (SC), IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Dario Marino
- IRCCS Neurolysis Center “Bonino Pulejo”, Messina, Italy
| | | | - Daniele Giansanti
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Luca Perrero
- Neurorehabilitation Unit, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Alberto Battistini
- Unità Operativa di Medicina Riabilitativa e Neuroriabilitazione (SC), IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Serena Filoni
- Padre Pio Onlus Rehabilitation Centers Foundation, San Giovanni Rotondo, Italy
| | - Monica Sicari
- A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | | | | | - Paolo Boldrini
- Società Italiana di Medicina Fisica e Riabilitativa (SIMFER), Rome, Italy
| | | | - Enrico Castelli
- Department of Paediatric Neurorehabilitation, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (Faip Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental, Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy
| | - Stefano Mazzon
- AULSS6 (Unique Sanitary Local Company) Euganea Padova – Distretto 4 “Alta Padovana”, Padua, Italy
| | - Franco Molteni
- Department of Rehabilitation Medicine, Villa Beretta Rehabilitation Center, Valduce Hospital, Lecco, Italy
| | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory (MARlab), IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Posteraro
- Department of Rehabilitation, Versilia Hospital – AUSL12, Viareggio, Italy
| | - Michele Senatore
- Associazione Italiana dei Terapisti Occupazionali (AITO), Rome, Italy
| | | | | | | | | | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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13
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The influence of distal and proximal muscle activation on neural crosstalk. PLoS One 2022; 17:e0275997. [PMID: 36282810 PMCID: PMC9595517 DOI: 10.1371/journal.pone.0275997] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022] Open
Abstract
Previous research has indicated that neural crosstalk is asymmetric, with the dominant effector exerting a stronger influence on the non-dominant effector than vice versa. Recently, it has been hypothesized that this influence is more substantial for proximal than distal effectors. The current investigation was designed to determine the effects of distal ((First Dorsal Interosseous (FDI)) and proximal (triceps brachii (TBI)) muscle activation on neural crosstalk. Twelve right-limb dominant participants (mean age = 21.9) were required to rhythmically coordinate a 1:2 pattern of isometric force guided by Lissajous displays. Participants performed 10, 30 s trials with both distal and proximal effectors. Coherence between the two effector groups were calculated using EMG-EMG wavelet coherence. The results indicated that participants could effectively coordinate the goal coordination pattern regardless of the effectors used. However, spatiotemporal performance was more accurate when performing the task with distal than proximal effectors. Force distortion, quantified by harmonicity, indicated that more perturbations occurred in the non-dominant effector than in the dominant effector. The results also indicated significantly lower harmonicity for the non-dominant proximal effector compared to the distal effectors. The current results support the notion that neural crosstalk is asymmetric in nature and is greater for proximal than distal effectors. Additionally, the EMG-EMG coherence results indicated significant neural crosstalk was occurring in the Alpha bands (5-13 Hz), with higher values observed in the proximal condition. Significant coherence in the Alpha bands suggest that the influence of neural crosstalk is occurring at a subcortical level.
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14
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Munoz-Novoa M, Kristoffersen MB, Sunnerhagen KS, Naber A, Alt Murphy M, Ortiz-Catalan M. Upper Limb Stroke Rehabilitation Using Surface Electromyography: A Systematic Review and Meta-Analysis. Front Hum Neurosci 2022; 16:897870. [PMID: 35669202 PMCID: PMC9163806 DOI: 10.3389/fnhum.2022.897870] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background Upper limb impairment is common after stroke, and many will not regain full upper limb function. Different technologies based on surface electromyography (sEMG) have been used in stroke rehabilitation, but there is no collated evidence on the different sEMG-driven interventions and their effect on upper limb function in people with stroke. Aim Synthesize existing evidence and perform a meta-analysis on the effect of different types of sEMG-driven interventions on upper limb function in people with stroke. Methods PubMed, SCOPUS, and PEDro databases were systematically searched for eligible randomized clinical trials that utilize sEMG-driven interventions to improve upper limb function assessed by Fugl-Meyer Assessment (FMA-UE) in stroke. The PEDro scale was used to evaluate the methodological quality and the risk of bias of the included studies. In addition, a meta-analysis utilizing a random effect model was performed for studies comparing sEMG interventions to non-sEMG interventions and for studies comparing different sEMG interventions protocols. Results Twenty-four studies comprising 808 participants were included in this review. The methodological quality was good to fair. The meta-analysis showed no differences in the total effect, assessed by total FMA-UE score, comparing sEMG interventions to non-sEMG interventions (14 studies, 509 participants, SMD 0.14, P 0.37, 95% CI –0.18 to 0.46, I2 55%). Similarly, no difference in the overall effect was found for the meta-analysis comparing different types of sEMG interventions (7 studies, 213 participants, SMD 0.42, P 0.23, 95% CI –0.34 to 1.18, I2 73%). Twenty out of the twenty-four studies, including participants with varying impairment levels at all stages of stroke recovery, reported statistically significant improvements in upper limb function at post-sEMG intervention compared to baseline. Conclusion This review and meta-analysis could not discern the effect of sEMG in comparison to a non-sEMG intervention or the most effective type of sEMG intervention for improving upper limb function in stroke populations. Current evidence suggests that sEMG is a promising tool to further improve functional recovery, but randomized clinical trials with larger sample sizes are needed to verify whether the effect on upper extremity function of a specific sEMG intervention is superior compared to other non-sEMG or other type of sEMG interventions.
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Affiliation(s)
- Maria Munoz-Novoa
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Center for Bionics and Pain Research, Mölndal, Sweden
| | - Morten B Kristoffersen
- Center for Bionics and Pain Research, Mölndal, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Katharina S Sunnerhagen
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Section of Neurocare, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Autumn Naber
- Center for Bionics and Pain Research, Mölndal, Sweden
| | - Margit Alt Murphy
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Max Ortiz-Catalan
- Center for Bionics and Pain Research, Mölndal, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.,Operational Area 3, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
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15
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Zhao M, Wang G, Wang A, Cheng LJ, Lau Y. Robot-assisted distal training improves upper limb dexterity and function after stroke: a systematic review and meta-regression. Neurol Sci 2022; 43:1641-1657. [PMID: 35089447 DOI: 10.1007/s10072-022-05913-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/23/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Stroke is one of the top 10 causes of death worldwide, and more than half of stroke patients face distal upper extremity dysfunction. Considering that robot-assisted training may be effective in improving distal upper extremity function, the review evaluated the effect of robot-assisted distal training on motor function, hand dexterity, and spasticity after stroke. METHODS Eleven databases were systematically searched for randomised controlled trials (RCTs) from inception until Aug 28, 2021. Meta-analysis and meta-regression were performed to investigate the overall effect and source of heterogeneity, respectively. RESULTS Twenty-two trials involving 758 participants were included in this systematic review. The overall effect of robot-assisted distal training on the motor function of the wrists and hands was significant improvement (MD = 3.92; 95% CI, 3.04-4.80; P < 0.001). The robot-assisted training had a significantly beneficial effect on other motor functions (MD = 2.84; 95% CI, 1.54-4.14; P < 0.001); dexterity (MD = 9.01; 95% CI, -12.07--5.95; P < 0.001), spasticity, upper extremity strength (SMD = 0.42; 95% CI, 0.07-0.78; P = 0.02) and activities of daily living (SMD = 0.70; 95% CI, 0.29-1.23; P < 0.001). A series of subgroup analyses showed preferable design and effective regime of training. Meta-regression indicated the statistically significant effect of the year of trial, country, and duration on the effectiveness of training. CONCLUSION Robot-assisted distal training has a significant effect on motor function, dexterity and spasticity of the upper extremity, compared to conventional therapy.
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Affiliation(s)
- Menglu Zhao
- The Affiliated Hospital of Qingdao University, Shandong, Qingdao, China
| | | | - Aimin Wang
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Ling Jie Cheng
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore.
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16
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HYAKUTAKE K, MORISHITA T, SAITA K, FUKUDA H, ABE H, OGATA T, KAMADA S, INOUE T. Effect of Robot-assisted Rehabilitation to Botulinum Toxin A Injection for Upper Limb Disability in Patients with Chronic Stroke: A Case Series and Systematic Review. Neurol Med Chir (Tokyo) 2022; 62:35-44. [PMID: 34732591 PMCID: PMC8754680 DOI: 10.2176/nmc.oa.2020-0408] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 09/14/2021] [Indexed: 11/20/2022] Open
Abstract
Combining single-joint hybrid assistive limb (HAL-SJ) with botulinum toxin A (BTX-A) therapy is novel and has great therapeutic potential for the rehabilitation of stroke patients with upper limb paralysis. The purpose of this observational case series study was to evaluate the effect of BTX-A and HAL-SJ combination therapy on different exoskeleton robots used for treating upper limb paralysis. The HAL-SJ combination received a BTX-A injection followed by HAL-SJ-assisted rehabilitation for 60 min per session, 10 times per week, during 2 weeks of hospitalization. Clinical evaluations to assess motor function, limb functions used during daily activities, and spasticity were performed prior to injection, at 2-week post-treatment intervention, and at the 4-month follow-up visit. The total Fugl-Meyer assessment-upper limb (FMA-UE), proximal FMA-UE, action research arm test (ARAT), Motor Activity Log (MAL), and Disability Assessment Scale (DAS) showed a statistically significant difference, and a large effect size. However, the FMA distal assessment at 2-week post-treatment intervention showed no significant difference and a moderate effect size. The FMA-UE scores of the extracted systematic review articles showed that our design improved upper limb function. The change in the total FMA-UE score in this study showed that, compared to previous reports in the exoskeletal robotic therapy group, our combination therapy had a higher score than five of the seven references. Our results suggest that BTX-A therapy and HAL-SJ combination therapy may improve upper limb function, similar to other treatment methods in the literature.
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Affiliation(s)
- Koichi HYAKUTAKE
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
- Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Fukuoka, Japan
| | - Takashi MORISHITA
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Kazuya SAITA
- Department of Psychosocial Rehabilitation Graduate School of Biomedical and Health Sciences Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Hiroyuki FUKUDA
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
- Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Fukuoka, Japan
| | - Hiroshi ABE
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Toshiyasu OGATA
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Satoshi KAMADA
- Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Fukuoka, Japan
| | - Tooru INOUE
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
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17
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Hu C, Wang T, Leung KWC, Li L, Tong RKY. Muscle Electrical Impedance Properties and Activation Alteration After Functional Electrical Stimulation-Assisted Cycling Training for Chronic Stroke Survivors: A Longitudinal Pilot Study. Front Neurol 2022; 12:746263. [PMID: 34975713 PMCID: PMC8716001 DOI: 10.3389/fneur.2021.746263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/29/2021] [Indexed: 11/17/2022] Open
Abstract
Electrical impedance myography (EIM) is a sensitive assessment for neuromuscular diseases to detect muscle inherent properties, whereas surface electromyography (sEMG) is a common technique for monitoring muscle activation. However, the application of EIM in detecting training effects on stroke survivors is relatively few. This study aimed to evaluate the muscle inherent properties and muscle activation alteration after functional electrical stimulation (FES)-assisted cycling training to chronic stroke survivors. Fifteen people with chronic stroke were recruited for 20 sessions of FES-assisted cycling training (40 min/session, 3–5 sessions/week). The periodically stimulated and assessed muscle groups were quadriceps (QC), tibialis anterior (TA), hamstrings (HS), and medial head of gastrocnemius (MG) on the paretic lower extremity. EIM parameters [resistance (R), reactance (X), phase angle (θ), and anisotropy ratio (AR)], clinical scales (Fugl-Meyer Lower Extremity (FMA-LE), Berg Balance Scale (BBS), and 6-min walking test (6MWT)] and sEMG parameters [including root-mean square (RMS) and co-contraction index (CI) value] were collected and computed before and after the training. Linear correlation analysis was conducted between EIM and clinical scales as well as between sEMG and clinical scales. The results showed that motor function of the lower extremity, balance, and walking performance of subjects improved after the training. After training, θ value of TA (P = 0.014) and MG (P = 0.017) significantly increased, and AR of X (P = 0.004) value and AR of θ value (P = 0.041) significantly increased on TA. The RMS value of TA decreased (P = 0.022) and a significant reduction of CI was revealed on TA/MG muscle pair (P < 0.001). Significant correlation was found between EIM and clinical assessments (AR of X value of TA and FMA-LE: r = 0.54, P = 0.046; X value of TA and BBS score: 0.628, P = 0.016), and between sEMG and clinical scores (RMS of TA and BBS score: r = −0.582, P = 0.029). This study demonstrated that FES-assisted cycling training improved lower limb function by developing coordinated muscle activation and facilitating an orderly myofiber arrangement. The current study also indicated that EIM can jointly evaluate lower extremity function alteration with sEMG after rehabilitation training. Clinical Trail Registration: The study was registered on the Clinical Trial Registry (trial registration number: NCT 03208439, https://clinicaltrials.gov/ct2/show/NCT03208439).
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Affiliation(s)
- Chengpeng Hu
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tong Wang
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kenry W C Leung
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Le Li
- Institute of Medical Research, Northwestern Polytechnical University, Xi'an, China
| | - Raymond Kai-Yu Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
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18
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Zhou S, Guo Z, Wong K, Zhu H, Huang Y, Hu X, Zheng YP. Pathway-specific cortico-muscular coherence in proximal-to-distal compensation during fine motor control of finger extension after stroke. J Neural Eng 2021; 18. [PMID: 34428752 DOI: 10.1088/1741-2552/ac20bc] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 08/24/2021] [Indexed: 11/12/2022]
Abstract
Objective.Proximal-to-distal compensation is commonly observed in the upper extremity (UE) after a stroke, mainly due to the impaired fine motor control in hand joints. However, little is known about its related neural reorganization. This study investigated the pathway-specific corticomuscular interaction in proximal-to-distal UE compensation during fine motor control of finger extension post-stroke by directed corticomuscular coherence (dCMC).Approach.We recruited 14 chronic stroke participants and 11 unimpaired controls. Electroencephalogram (EEG) from the sensorimotor area was concurrently recorded with electromyography (EMG) from extensor digitorum (ED), flexor digitorum (FD), triceps brachii (TRI) and biceps brachii (BIC) muscles in both sides of the stroke participants and in the dominant (right) side of the controls during the unilateral isometric finger extension at 20% maximal voluntary contractions. The dCMC was analyzed in descending (EEG → EMG) and ascending pathways (EMG → EEG) via the directed coherence. It was also analyzed in stable (segments with higher EMG stability) and less-stable periods (segments with lower EMG stability) subdivided from the whole movement period to investigate the fine motor control. Finally, the corticomuscular conduction time was estimated by dCMC phase delay.Main results.The affected limb had significantly lower descending dCMC in distal UE (ED and FD) than BIC (P< 0.05). It showed the descending dominance (significantly higher descending dCMC than the ascending,P< 0.05) in proximal UE (BIC and TRI) rather than the distal UE as in the controls. In the less-stable period, the affected limb had significantly lower EMG stability but higher ascending dCMC (P< 0.05) in distal UE than the controls. Furthermore, significantly prolonged descending conduction time (∼38.8 ms) was found in ED in the affected limb than the unaffected (∼26.94 ms) and control limbs (∼25.74 ms) (P< 0.05).Significance.The proximal-to-distal UE compensation in fine motor control post-stroke exhibited altered descending dominance from the distal to proximal UE, increased ascending feedbacks from the distal UE for fine motor control, and prolonged descending conduction time in the agonist muscle.
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Affiliation(s)
- Sa Zhou
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.,University Research Facility in Behavioural and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Ziqi Guo
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.,University Research Facility in Behavioural and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Kiufung Wong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.,University Research Facility in Behavioural and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Hanlin Zhu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.,University Research Facility in Behavioural and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Yanhuan Huang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.,University Research Facility in Behavioural and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Xiaoling Hu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.,University Research Facility in Behavioural and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.,The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, People's Republic of China
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.,University Research Facility in Behavioural and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
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19
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Nam C, Zhang B, Chow T, Ye F, Huang Y, Guo Z, Li W, Rong W, Hu X, Poon W. Home-based self-help telerehabilitation of the upper limb assisted by an electromyography-driven wrist/hand exoneuromusculoskeleton after stroke. J Neuroeng Rehabil 2021; 18:137. [PMID: 34526058 PMCID: PMC8442816 DOI: 10.1186/s12984-021-00930-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 08/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most stroke survivors have sustained upper limb impairment in their distal joints. An electromyography (EMG)-driven wrist/hand exoneuromusculoskeleton (WH-ENMS) was developed previously. The present study investigated the feasibility of a home-based self-help telerehabilitation program assisted by the aforementioned EMG-driven WH-ENMS and its rehabilitation effects after stroke. METHODS Persons with chronic stroke (n = 11) were recruited in a single-group trial. The training progress, including the training frequency and duration, was telemonitored. The clinical outcomes were evaluated using the Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), Motor Functional Independence Measure (FIM), and Modified Ashworth Scale (MAS). Improvement in muscle coordination was investigated in terms of the EMG activation level and the Co-contraction Index (CI) of the target muscles, including the abductor pollicis brevis (APB), flexor carpi radialis-flexor digitorum (FCR-FD), extensor carpi ulnaris-extensor digitorum (ECU-ED), biceps brachii (BIC), and triceps brachii (TRI). The movement smoothness and compensatory trunk movement were evaluated in terms of the following two kinematic parameters: number of movement units (NMUs) and maximal trunk displacement (MTD). The above evaluations were conducted before and after the training. RESULTS All of the participants completed the home-based program with an intensity of 63.0 ± 1.90 (mean ± SD) min/session and 3.73 ± 0.75 (mean ± SD) sessions/week. After the training, motor improvements in the entire upper limb were found, as indicated by the significant improvements (P < 0.05) in the FMA, ARAT, WMFT, and MAS; significant decreases (P < 0.05) in the EMG activation levels of the APB and FCR-FD; significant decreases (P < 0.05) in the CI of the ECU-ED/FCR-FD, ECU-ED/BIC, FCR-FD/APB, FCR-FD/BIC, FCR-FD/TRI, APB/BIC and BIC/TRI muscle pairs; and significant reductions (P < 0.05) in the NMUs and MTD. CONCLUSIONS The results suggested that the home-based self-help telerehabilitation program assisted by EMG-driven WH-ENMS is feasible and effective for improving the motor function of the paretic upper limb after stroke. Trial registration ClinicalTrials.gov. NCT03752775; Date of registration: November 20, 2018.
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Affiliation(s)
- Chingyi Nam
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Bingbing Zhang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Tszying Chow
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Fuqiang Ye
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yanhuan Huang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ziqi Guo
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Waiming Li
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Wei Rong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Xiaoling Hu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China. .,The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, 518034, China.
| | - Waisang Poon
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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20
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Ye F, Yang B, Nam C, Xie Y, Chen F, Hu X. A Data-Driven Investigation on Surface Electromyography Based Clinical Assessment in Chronic Stroke. Front Neurorobot 2021; 15:648855. [PMID: 34335219 PMCID: PMC8320436 DOI: 10.3389/fnbot.2021.648855] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 06/14/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Surface electromyography (sEMG) based robot-assisted rehabilitation systems have been adopted for chronic stroke survivors to regain upper limb motor function. However, the evaluation of rehabilitation effects during robot-assisted intervention relies on traditional manual assessments. This study aimed to develop a novel sEMG data-driven model for automated assessment. Method: A data-driven model based on a three-layer backpropagation neural network (BPNN) was constructed to map sEMG data to two widely used clinical scales, i.e., the Fugl-Meyer Assessment (FMA) and the Modified Ashworth Scale (MAS). Twenty-nine stroke participants were recruited in a 20-session sEMG-driven robot-assisted upper limb rehabilitation, which consisted of hand reaching and withdrawing tasks. The sEMG signals from four muscles in the paretic upper limbs, i.e., biceps brachii (BIC), triceps brachii (TRI), flexor digitorum (FD), and extensor digitorum (ED), were recorded before and after the intervention. Meanwhile, the corresponding clinical scales of FMA and MAS were measured manually by a blinded assessor. The sEMG features including Mean Absolute Value (MAV), Zero Crossing (ZC), Slope Sign Change (SSC), Root Mean Square (RMS), and Wavelength (WL) were adopted as the inputs to the data-driven model. The mapped clinical scores from the data-driven model were compared with the manual scores by Pearson correlation. Results: The BPNN, with 15 nodes in the hidden layer and sEMG features, i.e., MAV, ZC, SSC, and RMS, as the inputs to the model, was established to achieve the best mapping performance with significant correlations (r > 0.9, P < 0.001), according to the FMA. Significant correlations were also obtained between the mapped and manual FMA subscores, i.e., FMA-wrist/hand and FMA-shoulder/elbow, before and after the intervention (r > 0.9, P < 0.001). Significant correlations (P < 0.001) between the mapped and manual scores of MASs were achieved, with the correlation coefficients r = 0.91 at the fingers, 0.88 at the wrist, and 0.91 at the elbow after the intervention. Conclusion: An sEMG data-driven BPNN model was successfully developed. It could evaluate upper limb motor functions in chronic stroke and have potential application in automated assessment in post-stroke rehabilitation, once validated with large sample sizes. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02117089.
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Affiliation(s)
- Fuqiang Ye
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Electrical and Electronic Engineering, Southern University of Science and Technology, Shenzhen, China
| | - Bibo Yang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Chingyi Nam
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yunong Xie
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Fei Chen
- Department of Electrical and Electronic Engineering, Southern University of Science and Technology, Shenzhen, China
| | - Xiaoling Hu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
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21
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Gandolfi M, Valè N, Posteraro F, Morone G, Dell'orco A, Botticelli A, Dimitrova E, Gervasoni E, Goffredo M, Zenzeri J, Antonini A, Daniele C, Benanti P, Boldrini P, Bonaiuti D, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzon S, Molteni F, Petrarca M, Picelli A, Senatore M, Turchetti G, Giansanti D, Mazzoleni S. State of the art and challenges for the classification of studies on electromechanical and robotic devices in neurorehabilitation: a scoping review. Eur J Phys Rehabil Med 2021; 57:831-840. [PMID: 34042413 DOI: 10.23736/s1973-9087.21.06922-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The rapid development of electromechanical and robotic devices has profoundly influenced neurorehabilitation. Growth in the scientific and technological aspects thereof is crucial for increasing the number of newly developed devices, and clinicians have welcomed such growth with enthusiasm. Nevertheless, improving the standard for the reporting clinical, technical, and normative aspects of such electromechanical and robotic devices remains an unmet need in neurorehabilitation. Accordingly, this study aimed to analyse the existing literature on electromechanical and robotic devices used in neurorehabilitation, considering the current clinical, technical, and regulatory classification systems. EVIDENCE ACQUISITION Within the CICERONE Consensus Conference framework, studies on electromechanical and robotic devices used for upper- and lower-limb rehabilitation in persons with neurological disabilities in adulthood and childhood were reviewed. We have conducted a literature search using the following databases: MEDLINE, Cochrane Library, PeDro, Institute of Electrical and Electronics Engineers, Science Direct, and Google Scholar. Clinical, technical, and regulatory classification systems were applied to collect information on the electromechanical and robotic devices. The study designs and populations were investigated. EVIDENCE SYNTHESIS Overall, 316 studies were included in the analysis. More than half (52%) of the studies were randomised controlled trials (RCTs). The population investigated the most suffered from strokes, followed by spinal cord injuries, multiple sclerosis, cerebral palsy, and traumatic brain injuries. In total, 100 devices were described; of these, 19% were certified with the CE mark. Overall, the main type of device was an exoskeleton. However, end-effector devices were primarily used for the upper limbs, whereas exoskeletons were used for the lower limbs (for both children and adults). CONCLUSIONS The current literature on robotic neurorehabilitation lacks detailed information regarding the technical characteristics of the devices used. This affects the understanding of the possible mechanisms underlying recovery. Unfortunately, many electromechanical and robotic devices are not provided with CE marks, strongly hindering the research on the clinical outcomes of rehabilitation treatments based on these devices. A more significant effort is needed to improve the description of the robotic devices used in neurorehabilitation in terms of the technical and functional details, along with high-quality RCT studies.
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Affiliation(s)
- Marialuisa Gandolfi
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Neurorehabilitation Unit, University Hospital of Verona, Italy -
| | - Nicola Valè
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Posteraro
- Rehabilitation Department Versilia Hospital, ASL Toscana Nord-Ovest, Italy
| | | | - Antonella Dell'orco
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Neurorehabilitation Unit, University Hospital of Verona, Italy
| | - Anita Botticelli
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Neurorehabilitation Unit, University Hospital of Verona, Italy
| | - Eleonora Dimitrova
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Michela Goffredo
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Jacopo Zenzeri
- Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Genova, Italy
| | | | | | | | - Paolo Boldrini
- Italian Society of Physical Medicine and Rehabilitation (SIMFER), Italy
| | | | - Enrico Castelli
- Pediatric Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Vincenzo Falabella
- President Italian Federation of Persons with Spinal Cord Injuries (Flip Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli, " Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzon
- ULSS 6 (Unique Sanitary Local Company) Euganea Padova - Distretto IV Alta Padovana, Padova, Italy
| | | | - Maurizio Petrarca
- The Movement Analysis and Robotics Laboratory, Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Neurorehabilitation Unit, University Hospital of Verona, Italy
| | | | | | - Daniele Giansanti
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Italy
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22
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Effects of a Soft Robotic Hand for Hand Rehabilitation in Chronic Stroke Survivors. J Stroke Cerebrovasc Dis 2021; 30:105812. [PMID: 33895427 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105812] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 03/11/2021] [Accepted: 04/02/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Soft robotic hands are proposed for stroke rehabilitation in terms of their high compliance and low inherent stiffness. We investigated the clinical efficacy of a soft robotic hand that could actively flex and extend the fingers in chronic stroke subjects with different levels of spasticity. METHODS Sixteen chronic stroke subjects were recruited into this single-group study. Subjects underwent 20 sessions of 1-hour EMG-driven soft robotic hand training. Training effect was evaluated by the pre-training and post-training assessments with the clinical scores: Action Research Arm Test(ARAT), Fugl-Meyer Assessment for Upper Extremity(FMA-UE), Box-and-Block test(BBT), Modified Ashworth Scale(MAS), and maximum voluntary grip strength. RESULTS For all the recruited subjects (n = 16), significant improvement of upper limb function was generally observed in ARAT (increased mean=2.44, P = 0.032), FMA-UE (increased mean=3.31, P = 0.003), BBT (increased mean=1.81, P = 0.024), and maximum voluntary grip strength (increased mean=2.14 kg, P < 0.001). No significant change was observed in terms of spasticity with the MAS (decreased mean=0.11, P = 0.423). Further analysis showed subjects with mild or no finger flexor spasticity (MAS<2, n = 9) at pre-training had significant improvement of upper limb function after 20 sessions of training. However, for subjects with moderate and severe finger flexor spasticity (MAS=2,3, n = 7) at pre-training, no significant change in clinical scores was shown and only maximum voluntary grip strength had significant increase. CONCLUSION EMG-driven rehabilitation training using the soft robotic hand with flexion and extension could be effective for the functional recovery of upper limb in chronic stroke subjects with mild or no spasticity.
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23
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Ranzani R, Eicher L, Viggiano F, Engelbrecht B, Held JPO, Lambercy O, Gassert R. Towards a Platform for Robot-Assisted Minimally-Supervised Therapy of Hand Function: Design and Pilot Usability Evaluation. Front Bioeng Biotechnol 2021; 9:652380. [PMID: 33937218 PMCID: PMC8082072 DOI: 10.3389/fbioe.2021.652380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/15/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Robot-assisted therapy can increase therapy dose after stroke, which is often considered insufficient in clinical practice and after discharge, especially with respect to hand function. Thus far, there has been a focus on rather complex systems that require therapist supervision. To better exploit the potential of robot-assisted therapy, we propose a platform designed for minimal therapist supervision, and present the preliminary evaluation of its immediate usability, one of the main and frequently neglected challenges for real-world application. Such an approach could help increase therapy dose by allowing the training of multiple patients in parallel by a single therapist, as well as independent training in the clinic or at home. METHODS We implemented design changes on a hand rehabilitation robot, considering aspects relevant to enabling minimally-supervised therapy, such as new physical/graphical user interfaces and two functional therapy exercises to train hand motor coordination, somatosensation and memory. Ten participants with chronic stroke assessed the usability of the platform and reported the perceived workload during a single therapy session with minimal supervision. The ability to independently use the platform was evaluated with a checklist. RESULTS Participants were able to independently perform the therapy session after a short familiarization period, requiring assistance in only 13.46 (7.69-19.23)% of the tasks. They assigned good-to-excellent scores on the System Usability Scale to the user-interface and the exercises [85.00 (75.63-86.88) and 73.75 (63.13-83.75) out of 100, respectively]. Nine participants stated that they would use the platform frequently. Perceived workloads lay within desired workload bands. Object grasping with simultaneous control of forearm pronosupination and stiffness discrimination were identified as the most difficult tasks. DISCUSSION Our findings demonstrate that a robot-assisted therapy device can be rendered safely and intuitively usable upon first exposure with minimal supervision through compliance with usability and perceived workload requirements. The preliminary usability evaluation identified usability challenges that should be solved to allow real-world minimally-supervised use. Such a platform could complement conventional therapy, allowing to provide increased dose with the available resources, and establish a continuum of care that progressively increases therapy lead of the patient from the clinic to the home.
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Affiliation(s)
- Raffaele Ranzani
- Rehabilitation Engineering Laboratory, D-HEST, ETH Zürich, Zurich, Switzerland
| | - Lucas Eicher
- Rehabilitation Engineering Laboratory, D-HEST, ETH Zürich, Zurich, Switzerland
| | - Federica Viggiano
- Rehabilitation Engineering Laboratory, D-HEST, ETH Zürich, Zurich, Switzerland
| | | | - Jeremia P. O. Held
- Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, D-HEST, ETH Zürich, Zurich, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, D-HEST, ETH Zürich, Zurich, Switzerland
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24
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Raglio A, Panigazzi M, Colombo R, Tramontano M, Iosa M, Mastrogiacomo S, Baiardi P, Molteni D, Baldissarro E, Imbriani C, Imarisio C, Eretti L, Hamedani M, Pistarini C, Imbriani M, Mancardi GL, Caltagirone C. Hand rehabilitation with sonification techniques in the subacute stage of stroke. Sci Rep 2021; 11:7237. [PMID: 33790343 PMCID: PMC8012636 DOI: 10.1038/s41598-021-86627-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 03/17/2021] [Indexed: 11/25/2022] Open
Abstract
After a stroke event, most survivors suffer from arm paresis, poor motor control and other disabilities that make activities of daily living difficult, severely affecting quality of life and personal independence. This randomized controlled trial aimed at evaluating the efficacy of a music-based sonification approach on upper limbs motor functions, quality of life and pain perceived during rehabilitation. The study involved 65 subacute stroke individuals during inpatient rehabilitation allocated into 2 groups which underwent usual care dayweek) respectively of standard upper extremity motor rehabilitation or upper extremity treatment with sonification techniques. The Fugl-Meyer Upper Extremity Scale, Box and Block Test and the Modified Ashworth Scale were used to perform motor assessment and the McGill Quality of Life-it and the Numerical Pain Rating Scale to assess quality of life and pain. The assessment was performed at baseline, after 2 weeks, at the end of treatment and at follow-up (1 month after the end of treatment). Total scores of the Fugl-Meyer Upper Extremity Scale (primary outcome measure) and hand and wrist sub scores, manual dexterity scores of the affected and unaffected limb in the Box and Block Test, pain scores of the Numerical Pain Rating Scale (secondary outcomes measures) significantly improved in the sonification group compared to the standard of care group (time*group interaction < 0.05). Our findings suggest that music-based sonification sessions can be considered an effective standardized intervention for the upper limb in subacute stroke rehabilitation.
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Affiliation(s)
- Alfredo Raglio
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Istituti Clinici Scientifici Maugeri, Music Therapy Research Laboratory, Scientific Institute of Pavia , Via Maugeri 10, 27100, Pavia, Italy.
| | - Monica Panigazzi
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Istituti Clinici Scientifici Maugeri, Music Therapy Research Laboratory, Scientific Institute of Pavia , Via Maugeri 10, 27100, Pavia, Italy
| | - Roberto Colombo
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Istituti Clinici Scientifici Maugeri, Music Therapy Research Laboratory, Scientific Institute of Pavia , Via Maugeri 10, 27100, Pavia, Italy
| | | | - Marco Iosa
- Fondazione S. Lucia, I.R.C.C.S., Rome, Italy
| | | | - Paola Baiardi
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Istituti Clinici Scientifici Maugeri, Music Therapy Research Laboratory, Scientific Institute of Pavia , Via Maugeri 10, 27100, Pavia, Italy
| | - Daniele Molteni
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Istituti Clinici Scientifici Maugeri, Music Therapy Research Laboratory, Scientific Institute of Pavia , Via Maugeri 10, 27100, Pavia, Italy
| | | | - Chiara Imbriani
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Istituti Clinici Scientifici Maugeri, Music Therapy Research Laboratory, Scientific Institute of Pavia , Via Maugeri 10, 27100, Pavia, Italy
| | - Chiara Imarisio
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Istituti Clinici Scientifici Maugeri, Music Therapy Research Laboratory, Scientific Institute of Pavia , Via Maugeri 10, 27100, Pavia, Italy
| | - Laura Eretti
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S, Montescano, PV, Italy
| | - Mehrnaz Hamedani
- Neurological Clinic, S. Martino Hospital, University of Genoa, Genoa, Italy
| | - Caterina Pistarini
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Nervi (GE), Pavia, Italy
| | - Marcello Imbriani
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Istituti Clinici Scientifici Maugeri, Music Therapy Research Laboratory, Scientific Institute of Pavia , Via Maugeri 10, 27100, Pavia, Italy
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25
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Ambrosini E, Gasperini G, Zajc J, Immick N, Augsten A, Rossini M, Ballarati R, Russold M, Ferrante S, Ferrigno G, Bulgheroni M, Baccinelli W, Schauer T, Wiesener C, Gfoehler M, Puchinger M, Weber M, Weber S, Pedrocchi A, Molteni F, Krakow K. A Robotic System with EMG-Triggered Functional Eletrical Stimulation for Restoring Arm Functions in Stroke Survivors. Neurorehabil Neural Repair 2021; 35:334-345. [PMID: 33655789 DOI: 10.1177/1545968321997769] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Robotic systems combined with Functional Electrical Stimulation (FES) showed promising results on upper-limb motor recovery after stroke, but adequately-sized randomized controlled trials (RCTs) are still missing. OBJECTIVE To evaluate whether arm training supported by RETRAINER, a passive exoskeleton integrated with electromyograph-triggered functional electrical stimulation, is superior to advanced conventional therapy (ACT) of equal intensity in the recovery of arm functions, dexterity, strength, activities of daily living, and quality of life after stroke. METHODS A single-blind RCT recruiting 72 patients was conducted. Patients, randomly allocated to 2 groups, were trained for 9 weeks, 3 times per week: the experimental group performed task-oriented exercises assisted by RETRAINER for 30 minutes plus ACT (60 minutes), whereas the control group performed only ACT (90 minutes). Patients were assessed before, soon after, and 1 month after the end of the intervention. Outcome measures were as follows: Action Research Arm Test (ARAT), Motricity Index, Motor Activity Log, Box and Blocks Test (BBT), Stroke Specific Quality of Life Scale (SSQoL), and Muscle Research Council. RESULTS All outcomes but SSQoL significantly improved over time in both groups (P < .001); a significant interaction effect in favor of the experimental group was found for ARAT and BBT. ARAT showed a between-group change of 11.5 points (P = .010) at the end of the intervention, which increased to 13.6 points 1 month after. Patients considered RETRAINER moderately usable (System Usability Score of 61.5 ± 22.8). CONCLUSIONS Hybrid robotic systems, allowing to perform personalized, intensive, and task-oriented training, with an enriched sensory feedback, was superior to ACT in improving arm functions and dexterity after stroke.
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Affiliation(s)
| | | | | | - Nancy Immick
- Asklepios Neurologische Klinik Falkenstein, Königstein, Germany
| | - Andreas Augsten
- Asklepios Neurologische Klinik Falkenstein, Königstein, Germany
| | - Mauro Rossini
- Villa Beretta Rehabilitation Center, Costamasnaga, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Franco Molteni
- Villa Beretta Rehabilitation Center, Costamasnaga, Italy
| | - Karsten Krakow
- Asklepios Neurologische Klinik Falkenstein, Königstein, Germany
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26
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Lau CCY, Yuan K, Wong PCM, Chu WCW, Leung TW, Wong WW, Tong RKY. Modulation of Functional Connectivity and Low-Frequency Fluctuations After Brain-Computer Interface-Guided Robot Hand Training in Chronic Stroke: A 6-Month Follow-Up Study. Front Hum Neurosci 2021; 14:611064. [PMID: 33551777 PMCID: PMC7855586 DOI: 10.3389/fnhum.2020.611064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/18/2020] [Indexed: 12/12/2022] Open
Abstract
Hand function improvement in stroke survivors in the chronic stage usually plateaus by 6 months. Brain-computer interface (BCI)-guided robot-assisted training has been shown to be effective for facilitating upper-limb motor function recovery in chronic stroke. However, the underlying neuroplasticity change is not well understood. This study aimed to investigate the whole-brain neuroplasticity changes after 20-session BCI-guided robot hand training, and whether the changes could be maintained at the 6-month follow-up. Therefore, the clinical improvement and the neurological changes before, immediately after, and 6 months after training were explored in 14 chronic stroke subjects. The upper-limb motor function was assessed by Action Research Arm Test (ARAT) and Fugl-Meyer Assessment for Upper-Limb (FMA), and the neurological changes were assessed using resting-state functional magnetic resonance imaging. Repeated-measure ANOVAs indicated that long-term motor improvement was found by both FMA (F[2,26] = 6.367, p = 0.006) and ARAT (F[2,26] = 7.230, p = 0.003). Seed-based functional connectivity analysis exhibited that significantly modulated FC was observed between ipsilesional motor regions (primary motor cortex and supplementary motor area) and contralesional areas (supplementary motor area, premotor cortex, and superior parietal lobule), and the effects were sustained after 6 months. The fALFF analysis showed that local neuronal activities significantly increased in central, frontal and parietal regions, and the effects were also sustained after 6 months. Consistent results in FC and fALFF analyses demonstrated the increase of neural activities in sensorimotor and fronto-parietal regions, which were highly involved in the BCI-guided training. Clinical Trial Registration: This study has been registered at ClinicalTrials.gov with clinical trial registration number NCT02323061.
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Affiliation(s)
- Cathy C Y Lau
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Kai Yuan
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Patrick C M Wong
- Brain and Mind Institute, The Chinese University of Hong Kong, Hong Kong, China
| | - Winnie C W Chu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas W Leung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Wan-Wa Wong
- Department of Psychiatry and Biobehavioural Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Raymond K Y Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
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27
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Qian Q, Ling YT, Zhong H, Zheng YP, Alam M. Restoration of arm and hand functions via noninvasive cervical cord neuromodulation after traumatic brain injury: a case study. Brain Inj 2020; 34:1771-1780. [PMID: 33264033 DOI: 10.1080/02699052.2020.1850864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objectives: To investigate the effects of transcutaneous electrical stimulation (tES) on upper limb functional rehabilitation in a patient with traumatic brain injury (TBI), and to identify the optimum stimulation parameters of tES. Design: A preliminary case study. Methods: Two successive interventions: Phase I-voluntary physical training (vPT) and Phase II - tES along with vPT (tES+vPT). tES was delivered at C3 and C6 cervical regions. Clinical assessments presented the variation of muscle tone and motor functions, before and after each training phase, and evaluated at 1-month follow up after the last intervention. Results: Our results indicate that vPT alone contributed to a release of muscle spasticity of both arms of the patient with no significant improvement of hand function, while tES+vPT further reduced the spasticity of the left arm, and improved the voluntary motor function of both arms. The grip forces were also increased after the tES+vPT treatment. We found that 1 ms biphasic tES at 30 Hz produced optimum motor outputs. Conclusion: The study demonstrates, for the first time, the potential benefits of cervical tES in regard to improving upper limb motor functions in a patient with chronic TBI.
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Affiliation(s)
- Qiuyang Qian
- Department of Biomedical Engineering, The Hong Kong Polytechnic University , Hung Hom, Hong Kong
| | - Yan To Ling
- Department of Biomedical Engineering, The Hong Kong Polytechnic University , Hung Hom, Hong Kong
| | - Hui Zhong
- Department of Integrative Biology and Physiology, University of California , Los Angeles, California, United States
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University , Hung Hom, Hong Kong
| | - Monzurul Alam
- Department of Biomedical Engineering, The Hong Kong Polytechnic University , Hung Hom, Hong Kong
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28
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Nam C, Rong W, Li W, Cheung C, Ngai W, Cheung T, Pang M, Li L, Hu J, Wai H, Hu X. An Exoneuromusculoskeleton for Self-Help Upper Limb Rehabilitation After Stroke. Soft Robot 2020; 9:14-35. [PMID: 33271057 PMCID: PMC8885439 DOI: 10.1089/soro.2020.0090] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
This article presents a novel electromyography (EMG)-driven exoneuromusculoskeleton that integrates the neuromuscular electrical stimulation (NMES), soft pneumatic muscle, and exoskeleton techniques, for self-help upper limb training after stroke. The developed system can assist the elbow, wrist, and fingers to perform sequential arm reaching and withdrawing tasks under voluntary effort control through EMG, with a lightweight, compact, and low-power requirement design. The pressure/torque transmission properties of the designed musculoskeletons were quantified, and the assistive capability of the developed system was evaluated on patients with chronic stroke (n = 10). The designed musculoskeletons exerted sufficient mechanical torque to support joint extension for stroke survivors. Compared with the limb performance when no assistance was provided, the limb performance (measured as the range of motion in joint extension) significantly improved when mechanical torque and NMES were provided (p < 0.05). A pilot trial was conducted on patients with chronic stroke (n = 15) to investigate the feasibility of using the developed system in self-help training and the rehabilitation effects of the system. All the participants completed the self-help device-assisted training with minimal professional assistance. After a 20-session training, significant improvements were noted in the voluntary motor function and release of muscle spasticity at the elbow, wrist, and fingers, as indicated by the clinical scores (p < 0.05). The EMG parameters (p < 0.05) indicated that the muscular coordination of the entire upper limb improved significantly after training. The results suggested that the developed system can effectively support self-help upper limb rehabilitation after stroke. ClinicalTrials.gov Register Number NCT03752775.
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Affiliation(s)
- Chingyi Nam
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Wei Rong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Waiming Li
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Chingyee Cheung
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Wingkit Ngai
- Industrial Centre, The Hong Kong Polytechnic University, Hong Kong, China
| | - Tszching Cheung
- Industrial Centre, The Hong Kong Polytechnic University, Hong Kong, China
| | - Mankit Pang
- Industrial Centre, The Hong Kong Polytechnic University, Hong Kong, China
| | - Li Li
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Junyan Hu
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Honwah Wai
- Industrial Centre, The Hong Kong Polytechnic University, Hong Kong, China
| | - Xiaoling Hu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
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29
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Lambelet C, Temiraliuly D, Siegenthaler M, Wirth M, Woolley DG, Lambercy O, Gassert R, Wenderoth N. Characterization and wearability evaluation of a fully portable wrist exoskeleton for unsupervised training after stroke. J Neuroeng Rehabil 2020; 17:132. [PMID: 33028354 PMCID: PMC7541267 DOI: 10.1186/s12984-020-00749-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 08/24/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Chronic hand and wrist impairment are frequently present following stroke and severely limit independence in everyday life. The wrist orientates and stabilizes the hand before and during grasping, and is therefore of critical importance in activities of daily living (ADL). To improve rehabilitation outcomes, classical therapy could be supplemented by novel therapies that can be applied in unsupervised settings. This would enable more distributed practice and could potentially increase overall training dose. Robotic technology offers new possibilities to address this challenge, but it is critical that devices for independent training are easy and appealing to use. Here, we present the development, characterization and wearability evaluation of a fully portable exoskeleton for active wrist extension/flexion support in stroke rehabilitation. METHODS First we defined the requirements, and based on these, constructed the exoskeleton. We then characterized the device with standardized haptic and human-robot interaction metrics. The exoskeleton is composed of two modules placed on the forearm/hand and the upper arm. These modules weigh 238 g and 224 g, respectively. The forearm module actively supports wrist extension and flexion with a torque up to 3.7 Nm and an angular velocity up to 530 deg/s over a range of 154∘. The upper arm module includes the control electronics and battery, which can power the device for about 125 min in normal use. Special emphasis was put on independent donning and doffing of the device, which was tested via a wearability evaluation in 15 healthy participants and 2 stroke survivors using both qualitative and quantitative methods. RESULTS All participants were able to independently don and doff the device after only 4 practice trials. For healthy participants the donning and doffing process took 61 ±15 s and 24 ±6 s, respectively. The two stroke survivors donned and doffed the exoskeleton in 54 s/22 s and 113 s/32 s, respectively. Usability questionnaires revealed that despite minor difficulties, all participants were positive regarding the device. CONCLUSIONS This study describes an actuated wrist exoskeleton which weighs less than 500 g, and which is easy and fast to don and doff with one hand. Our design has put special emphasis on the donning aspect of robotic devices which constitutes the first barrier a user will face in unsupervised settings. The proposed device is a first and intermediate step towards wearable rehabilitation technologies that can be used independently by the patient and in unsupervised settings.
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Affiliation(s)
- Charles Lambelet
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Damir Temiraliuly
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Marc Siegenthaler
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Marc Wirth
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Daniel G. Woolley
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Nicole Wenderoth
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
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30
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Park S, Fraser M, Weber LM, Meeker C, Bishop L, Geller D, Stein J, Ciocarlie M. User-Driven Functional Movement Training With a Wearable Hand Robot After Stroke. IEEE Trans Neural Syst Rehabil Eng 2020; 28:2265-2275. [PMID: 32886611 DOI: 10.1109/tnsre.2020.3021691] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We studied the performance of a robotic orthosis designed to assist the paretic hand after stroke. It is wearable and fully user-controlled, serving two possible roles: as a therapeutic tool that facilitates device-mediated hand exercises to recover neuromuscular function or as an assistive device for use in everyday activities to aid functional use of the hand. We present the clinical outcomes of a pilot study designed as a feasibility test for these hypotheses. 11 chronic stroke (>2 years) patients with moderate muscle tone (Modified Ashworth Scale ≤ 2 in upper extremity) engaged in a month-long training protocol using the orthosis. Individuals were evaluated using standardized outcome measures, both with and without orthosis assistance. Fugl-Meyer post intervention scores without robotic assistance showed improvement focused specifically at the distal joints of the upper limb, suggesting the use of the orthosis as a rehabilitative device for the hand. Action Research Arm Test scores post intervention with robotic assistance showed that the device may serve an assistive role in grasping tasks. These results highlight the potential for wearable and user-driven robotic hand orthoses to extend the use and training of the affected upper limb after stroke.
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31
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Guo Z, Qian Q, Wong K, Zhu H, Huang Y, Hu X, Zheng Y. Altered Corticomuscular Coherence (CMCoh) Pattern in the Upper Limb During Finger Movements After Stroke. Front Neurol 2020; 11:410. [PMID: 32477257 PMCID: PMC7240065 DOI: 10.3389/fneur.2020.00410] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/20/2020] [Indexed: 01/15/2023] Open
Abstract
Background: Proximal compensation to the distal movements is commonly observed in the affected upper extremity (UE) of patients with chronic stroke. However, the cortical origin of this compensation has not been well-understood. In this study, corticomuscular coherence (CMCoh) and electromyography (EMG) analysis were adopted to investigate the corticomuscular coordinating pattern of proximal UE compensatory activities when conducting distal UE movements in chronic stroke. Method: Fourteen chronic stroke subjects and 10 age-matched unimpaired controls conducted isometric finger extensions and flexions at 20 and 40% of maximal voluntary contractions. Electroencephalogram (EEG) data were recorded from the sensorimotor area and EMG signals were captured from extensor digitorum (ED), flexor digitorum (FD), triceps brachii (TRI), and biceps brachii (BIC) to investigate the CMCoh peak values in the Beta band. EMG parameters, i.e., the EMG activation level and co-contraction index (CI), were analyzed to evaluate the compensatory muscular patterns in the upper limb. Result: The peak CMCoh with statistical significance (P < 0.05) was found shifted from the ipsilesional side to the contralesional side in the proximal UE muscles, while to the central regions in the distal UE muscle in chronic strokes. Significant differences (P < 0.05) were observed in both peak ED and FD CMCohs during finger extensions between the two groups. The unimpaired controls exhibited significant intragroup differences between 20 and 40% levels in extensions for peak ED and FD CMCohs (P < 0.05). The stroke subjects showed significant differences in peak TRI and BIC CMCohs (P < 0.01). No significant inter- or intra-group difference was observed in peak CMCoh during finger flexions. EMG parameters showed higher EMG activation levels in TRI and BIC muscles (P < 0.05), and higher CI values in the muscle pairs involving TRI and BIC during all the extension and flexion tasks in the stroke group than those in the control group (P < 0.05). Conclusion: The post-stroke proximal muscular compensations from the elbow to the finger movements were cortically originated, with the center mainly located in the contralesional hemisphere.
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Affiliation(s)
- Ziqi Guo
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Qiuyang Qian
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Kiufung Wong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Hanlin Zhu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Yanhuan Huang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Xiaoling Hu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Yongping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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32
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Serrezuela RR, Quezada MT, Zayas MH, Pedrón AM, Hermosilla DM, Zamora RS. Robotic therapy for the hemiplegic shoulder pain: a pilot study. J Neuroeng Rehabil 2020; 17:54. [PMID: 32321536 PMCID: PMC7178610 DOI: 10.1186/s12984-020-00674-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/01/2020] [Indexed: 11/28/2022] Open
Abstract
Backgrounds Exoskeletons development arises with a leading role in neurorehabilitation technologies; however, very few prototypes for upper limbs have been tested, contrasted and duly certified in terms of their effectiveness in clinical environments in order to incorporate into the health system. The purpose of this pilot study was to determine if robotic therapy of Hemiplegic Shoulder Pain (HSP) could lead to functional improvement in terms of diminishing of pain, spasticity, subluxation, the increasing of tone and muscle strength, and the satisfaction degree. Methods An experimental study was conducted in 16 patients with painful shoulder post- ischemic stroke in two experimental groups: conventional and robotic therapy. At different stages of its evolution, the robotic therapy effectiveness applied with anti-gravitational movements was evaluated. Clinical trial was developed at the Physical Medicine and Rehabilitation Department of the Surgical Clinical Hospital “Dr. Juan Bruno Zayas Alfonso” in Santiago de Cuba, from September 2016 - March 2018. Among other variables: the presence of humeral scapular subluxation (HSS), pain, spasticity, mobility, tone and muscle strength, and the satisfaction degree were recorded. Results with 95% reliability were compared between admission and third months of treatment. The Mann-Whitney U-Test, Chi-Square and Fisher’s Exact Tests were used as comparison criteria. Results Robotic therapy positively influenced in the decrease and annulment of pain and the spasticity degree, reaching a range increase of joint movement and the improvement of muscle tone.
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33
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Zhang JJ, Fong KNK. Effects of priming intermittent theta burst stimulation on upper limb motor recovery after stroke: study protocol for a proof-of-concept randomised controlled trial. BMJ Open 2020; 10:e035348. [PMID: 32152174 PMCID: PMC7064082 DOI: 10.1136/bmjopen-2019-035348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/11/2020] [Accepted: 02/19/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Intermittent theta burst stimulation (iTBS), a form of repetitive transcranial magnetic stimulation (rTMS), delivered to the ipsilesional primary motor cortex (M1), appears to enhance the brain's response to rehabilitative training in patients with stroke. However, its clinical utility is highly subject to variability in different protocols. New evidence has reported that preceding iTBS, with continuous theta burst stimulation (cTBS) may stabilise and even boost the facilitatory effect of iTBS on the stimulated M1, via metaplasticity. The aim of this study is to investigate the effects of iTBS primed with cTBS (ie, priming iTBS), in addition to robot-assisted training (RAT), on the improvement of the hemiparetic upper limb functions of stroke patients and to explore potential sensorimotor neuroplasticity using electroencephalography (EEG). METHODS AND ANALYSIS A three-arm, subjects and assessors-blinded, randomised controlled trial will be performed with patients with chronic stroke. An estimated sample of 36 patients will be needed based on the prior sample size calculation. All participants will be randomly allocated to receive 10 sessions of rTMS with different TBS protocols (cTBS+iTBS, sham cTBS+iTBS and sham cTBS+sham iTBS), three to five sessions per week, for 2-3 weeks. All participants will receive 60 min of RAT after each stimulation session. Primary outcomes will be assessed using Fugl-Meyer Assessment-Upper Extremity scores and Action Research Arm Test. Secondary outcomes will be assessed using kinematic outcomes generated during RAT and EEG. ETHICS AND DISSEMINATION Ethical approval has been obtained from The Human Subjects Ethics Sub-committee, University Research Committee of The Hong Kong Polytechnic University (reference number: HSEARS20190718003). The results yielded from this study will be presented at international conferences and sent to a peer-review journal to be considered for publication. TRIAL REGISTRATION NUMBER NCT04034069.
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Affiliation(s)
- Jack Jiaqi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Kenneth N K Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
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