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Nisar H, Annamraju S, Deka SA, Horowitz A, Stipanović DM. Robotic mirror therapy for stroke rehabilitation through virtual activities of daily living. Comput Struct Biotechnol J 2024; 24:126-135. [PMID: 38352631 PMCID: PMC10862404 DOI: 10.1016/j.csbj.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 02/16/2024] Open
Abstract
Mirror therapy is a standard technique of rehabilitation for recovering motor and vision abilities of stroke patients, especially in the case of asymmetric limb function. To enhance traditional mirror therapy, robotic mirror therapy (RMT) has been proposed over the past decade, allowing for assisted bimanual coordination of paretic (affected) and contralateral (healthy) limbs. However, state-of-the-art RMT platforms predominantly target mirrored motions of trajectories, largely limited to 2-D motions. In this paper, an RMT platform is proposed, which can facilitate the patient to practice virtual activities of daily living (ADL) and thus enhance their independence. Two similar (but mirrored) 3D virtual environments are created in which the patients operate robots with both their limbs to complete ADL (such as writing and eating) with the assistance of the therapist. The recovery level of the patient is continuously assessed by monitoring their ability to track assigned trajectories. The patient's robots are programmed to assist the patient in following these trajectories based on this recovery level. In this paper, the framework to dynamically monitor recovery level and accordingly provide assistance is developed along with the nonlinear controller design to ensure position tracking, force control, and stability. Proof-of-concept studies are conducted with both 3D trajectory tracking and ADL. The results demonstrate the potential use of the proposed system to enhance the recovery of the patients.
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Affiliation(s)
- Harris Nisar
- Health Care Engineering Systems Center, University of Illinois Urbana Champaign, 1206 W Clark St, Urbana 61801, IL, USA
| | - Srikar Annamraju
- Coordinated Science Laboratory, University of Illinois Urbana Champaign, 1308 W Main St, Urbana 61801, IL, USA
| | - Shankar A. Deka
- Division of Decision and Control Systems at KTH Royal Institute of Technology, Brinellvägen 8, 114 28 Stockholm, Sweden
| | - Anne Horowitz
- Outpatient Rehabilitation, OSF Healthcare Saint Francis Medical Center, 6501 N Sheridan Rd, Peoria, IL, USA
| | - Dušan M. Stipanović
- Coordinated Science Laboratory, University of Illinois Urbana Champaign, 1308 W Main St, Urbana 61801, IL, USA
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Cheng HJ, Chin LF, Kanzler CM, Lehner R, Kuah CWK, Kager S, Josse E, Samkharadze T, Sidarta A, Gonzalez PC, Lie E, Zbytniewska-Mégret M, Wee SK, Liang P, Gassert R, Chua K, Lambercy O, Wenderoth N. Upper limb sensorimotor recovery in Asian stroke survivors: a study protocol for the development and implementation of a Technology-Assisted dIgitaL biOmaRker (TAILOR) platform. Front Neurol 2023; 14:1246888. [PMID: 38107648 PMCID: PMC10722087 DOI: 10.3389/fneur.2023.1246888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/06/2023] [Indexed: 12/19/2023] Open
Abstract
Background Stroke is a leading cause of lifelong disability worldwide, partially driven by a reduced ability to use the upper limb in daily life causing increased dependence on caregivers. However, post-stroke functional impairments have only been investigated using limited clinical scores, during short-term longitudinal studies in relatively small patient cohorts. With the addition of technology-based assessments, we propose to complement clinical assessments with more sensitive and objective measures that could more holistically inform on upper limb impairment recovery after stroke, its impact on upper limb use in daily life, and on overall quality of life. This paper describes a pragmatic, longitudinal, observational study protocol aiming to gather a uniquely rich multimodal database to comprehensively describe the time course of upper limb recovery in a representative cohort of 400 Asian adults after stroke. Particularly, we will characterize the longitudinal relationship between upper limb recovery, common post-stroke impairments, functional independence and quality of life. Methods Participants with stroke will be tested at up to eight time points, from within a month to 3 years post-stroke, to capture the influence of transitioning from hospital to community settings. We will perform a battery of established clinical assessments to describe the factors most likely to influence upper limb recovery. Further, we will gather digital health biomarkers from robotic or wearable sensing technology-assisted assessments to sensitively characterize motor and somatosensory impairments and upper limb use in daily life. We will also use both quantitative and qualitative measures to understand health-related quality of life. Lastly, we will describe neurophysiological motor status using transcranial magnetic stimulation. Statistics Descriptive analyses will be first performed to understand post-stroke upper limb impairments and recovery at various time points. The relationships between digital biomarkers and various domains will be explored to inform key aspects of upper limb recovery and its dynamics using correlation matrices. Multiple statistical models will be constructed to characterize the time course of upper limb recovery post-stroke. Subgroups of stroke survivors exhibiting distinct recovery profiles will be identified. Conclusion This is the first study complementing clinical assessments with technology-assisted digital biomarkers to investigate upper limb sensorimotor recovery in Asian stroke survivors. Overall, this study will yield a multimodal data set that longitudinally characterizes post-stroke upper limb recovery in functional impairments, daily-life upper limb use, and health-related quality of life in a large cohort of Asian stroke survivors. This data set generates valuable information on post-stroke upper limb recovery and potentially allows researchers to identify different recovery profiles of subgroups of Asian stroke survivors. This enables the comparisons between the characteristics and recovery profiles of stroke survivors in different regions. Thus, this study lays out the basis to identify early predictors for upper limb recovery, inform clinical decision-making in Asian stroke survivors and establish tailored therapy programs. Clinical trial registration ClinicalTrials.gov, identifier: NCT05322837.
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Affiliation(s)
- Hsiao-Ju Cheng
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
| | - Lay Fong Chin
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Institute of Rehabilitation Excellence (IREx), Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Christoph M Kanzler
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Rea Lehner
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
| | - Christopher W K Kuah
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Institute of Rehabilitation Excellence (IREx), Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Simone Kager
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Eva Josse
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Tengiz Samkharadze
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
| | - Ananda Sidarta
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Pablo Cruz Gonzalez
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Eloise Lie
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Monika Zbytniewska-Mégret
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Seng Kwee Wee
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Institute of Rehabilitation Excellence (IREx), Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
- Singapore Institute of Technology (SIT), Singapore, Singapore
| | - Phyllis Liang
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Roger Gassert
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Karen Chua
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Institute of Rehabilitation Excellence (IREx), Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Olivier Lambercy
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Nicole Wenderoth
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Neural Control of Movement Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
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Li S. Stroke Recovery Is a Journey: Prediction and Potentials of Motor Recovery after a Stroke from a Practical Perspective. Life (Basel) 2023; 13:2061. [PMID: 37895442 PMCID: PMC10608684 DOI: 10.3390/life13102061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/01/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
Stroke recovery is a journey. Stroke survivors can face many consequences that may last the rest of their lives. Assessment of initial impairments allows reasonable prediction of biological spontaneous recovery at 3 to 6 months for a majority of survivors. In real-world clinical practice, stroke survivors continue to improve their motor function beyond the spontaneous recovery period, but management plans for maximal recovery are not well understood. A model within the international classification of functioning (ICF) theoretical framework is proposed to systematically identify opportunities and potential barriers to maximize and realize the potentials of functional recovery from the acute to chronic stages and to maintain their function in the chronic stages. Health conditions of individuals, medical and neurological complications can be optimized under the care of specialized physicians. This permits stroke survivors to participate in various therapeutic interventions. Sufficient doses of appropriate interventions at the right time is critical for stroke motor rehabilitation. It is important to highlight that combining interventions is likely to yield better clinical outcomes. Caregivers, including family members, can assist and facilitate targeted therapeutic exercises for these individuals and can help stroke survivors comply with medical plans (medications, visits), and provide emotional support. With health optimization, comprehensive rehabilitation, support from family and caregivers and a commitment to a healthy lifestyle, many stroke survivors can overcome barriers and achieve potentials of maximum recovery and maintain their motor function in chronic stages. This ICF recovery model is likely to provide a guidance through the journey to best achieve stroke recovery potentials.
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Affiliation(s)
- Sheng Li
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center—Houston, Houston, TX 77025, USA;
- TIRR Memorial Hermann Hospital, Houston, TX 77030, USA
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Abdullahi A, Wong TWL, Ng SSM. Variation in the rate of recovery in motor function between the upper and lower limbs in patients with stroke: some proposed hypotheses and their implications for research and practice. Front Neurol 2023; 14:1225924. [PMID: 37602245 PMCID: PMC10435271 DOI: 10.3389/fneur.2023.1225924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
Background Stroke results in impairment of motor function of both the upper and lower limbs. However, although it is debatable, motor function of the lower limb is believed to recover faster than that of the upper limb. The aim of this paper is to propose some hypotheses to explain the reasons for that, and discuss their implications for research and practice. Method We searched PubMED, Web of Science, Scopus, Embase and CENTRAL using the key words, stroke, cerebrovascular accident, upper extremity, lower extremity, and motor recovery for relevant literature. Result The search generated a total of 2,551 hits. However, out of this number, 51 duplicates were removed. Following review of the relevant literature, we proposed four hypotheses: natural instinct for walking hypothesis, bipedal locomotion hypothesis, central pattern generators (CPGs) hypothesis and role of spasticity hypothesis on the subject matter. Conclusion We opine that, what may eventually account for the difference, is the frequency of use of the affected limb or intensity of the rehabilitation intervention. This is because, from the above hypotheses, the lower limb seems to be used more frequently. When limbs are used frequently, this will result in use-dependent plasticity and eventual recovery. Thus, rehabilitation techniques that involve high repetitive tasks practice such as robotic rehabilitation, Wii gaming and constraint induced movement therapy should be used during upper limb rehabilitation.
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Asogbon MG, Huai Y, Samuel OW, Jing Z, Ma Y, Liu J, Jiang Y, Fu Y, Li G, Li Y. Analysis of Artifactual Components Rejection Threshold towards Enhanced Characterization of Neural Activity in Post-Stroke Survivor. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-5. [PMID: 38083733 DOI: 10.1109/embc40787.2023.10340688] [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
Research advancement has spurred the usage of electroencephalography (EEG)-based neural oscillatory rhythms as a biomarker to complement clinical rehabilitation strategies for the recovery of motor functions in stroke survivors. However, the inevitable contamination of EEG signals with artifacts from various sources limits its utilization and effectiveness. Thus, the integration of Independent Component Analysis (ICA) and Independent Component Label (ICLabel) has been widely employed to separate neural activity from artifacts. A crucial step in the ICLabel preprocessing pipeline is the artifactual ICs rejection threshold (TH) parameter, which determines the overall signal's quality. For instance, selecting a high TH will cause many ICs to be rejected, thereby leading to signal over-cleaning, and choosing a low TH may result in under-cleaning of the signal. Toward determining the optimal TH parameter, this study investigates the effect of six different TH groups (NO-TH and TH1-TH6) on EEG signals recorded from post-stroke patients who performed four distinct motor imagery (MI) tasks including wrist and grasping movements. Utilizing the EEG-beta band signal at the brain's sensorimotor cortex, the performance of the TH groups was evaluated using three notable EEG quantifiers. Overall, the obtained result shows that the considered THs will significantly alter neural oscillatory patterns. Comparing the performance of the TH-groups, TH-3 with a confidence level of 60% showed consistently stronger signal desynchronization and lateralization. The correlation result shows that most of the electrode pairs with high correlation values are replicable across all the MI tasks. It also revealed that brain activity correlates linearly with distance, and a strong correlation between electrode pairs is independent of the different brain cortices. The study outcome may facilitate adequate therapeutic intervention for stroke rehab.Clinical Relevance: This study indicated that optimal selection of the ICLabel artifactual rejection threshold is essential for EEG enhancement for adequate signal characterization. Thus, a TH-values with a confidence level between 50% - 70% would be suggested for artifactual ICs rejection in MI-EEG.
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Zbesko JC, Stokes J, Becktel DA, Doyle KP. Targeting foam cell formation to improve recovery from ischemic stroke. Neurobiol Dis 2023; 181:106130. [PMID: 37068641 PMCID: PMC10993857 DOI: 10.1016/j.nbd.2023.106130] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/31/2023] [Accepted: 04/14/2023] [Indexed: 04/19/2023] Open
Abstract
Inflammation is a crucial part of the healing process after an ischemic stroke and is required to restore tissue homeostasis. However, the inflammatory response to stroke also worsens neurodegeneration and creates a tissue environment that is unfavorable to regeneration for several months, thereby postponing recovery. In animal models, inflammation can also contribute to the development of delayed cognitive deficits. Myeloid cells that take on a foamy appearance are one of the most prominent immune cell types within chronic stroke infarcts. Emerging evidence indicates that they form as a result of mechanisms of myelin lipid clearance becoming overwhelmed, and that they are a key driver of the chronic inflammatory response to stroke. Therefore, targeting lipid accumulation in foam cells may be a promising strategy for improving recovery. The aim of this review is to provide an overview of current knowledge regarding inflammation and foam cell formation in the brain in the weeks and months following ischemic stroke and identify targets that may be amenable to therapeutic intervention.
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Affiliation(s)
- Jacob C Zbesko
- Department of Immunobiology, University of Arizona, United States
| | - Jessica Stokes
- Department of Pediatrics, University of Arizona, United States
| | | | - Kristian P Doyle
- Department of Immunobiology, University of Arizona, United States; Departments of Neurology, Neurosurgery, Psychology, Arizona Center on Aging, and the BIO5 Institute, University of Arizona, United States.
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Rodríguez-Pérez MP, Sánchez-Herrera-Baeza P, Montes-Montes R, Cano-de-la-Cuerda R, Martínez-Piédrola RM, Serrada-Tejeda S, Obeso-Benítez P, Pérez-de-Heredia-Torres M. How Do Motor and Sensory Function Correlate with Daily Performance Recovery after Post-Stroke Robotic Intervention? A Secondary Analysis of a Non-Randomized Controlled Trial. Biomedicines 2023; 11:biomedicines11030853. [PMID: 36979832 PMCID: PMC10045811 DOI: 10.3390/biomedicines11030853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/02/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023] Open
Abstract
New technologies have been developed to complement conventional interventions to better target the specific needs of people with stroke, and they have been shown to improve both function and performance. However, it is unknown whether the baseline levels of sensorimotor function and performance interrelate with the improvement in upper limb and daily performance. Thus, the aim of this study was to examine the relationship between baseline levels of sensorimotor function and daily performance and its impact on post-intervention improvement in people with stroke following a robotic intervention. A single-blind, non-randomized, controlled clinical trial was conducted. Participants in the experimental group (n = 9) received a robotic intervention in addition to conventional treatment. Sensorimotor function was measured with Semmes-Weinstein Monofilaments® and the Fugl-Meyer Assessment Upper Extremity Scale. Upper limb and daily performance were measured with the MAL and SIS-16 scales. The multivariate regression models showed that baseline levels of upper limb performance and motor function predicted >95% of the variance in upper limb performance (p < 0.001), while pre-intervention levels of daily performance explained >75% of the post-intervention variance (p < 0.05). These findings indicate that basal upper limb motor function is associated with improved performance following a combined intervention of conventional treatment and robotic intervention.
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Forbrigger S, Liblong M, Davies TC, DePaul V, Morin E, Hashtrudi-Zaad K. Considerations for at-home upper-limb rehabilitation technology following stroke: Perspectives of stroke survivors and therapists. J Rehabil Assist Technol Eng 2023; 10:20556683231171840. [PMID: 37124709 PMCID: PMC10134106 DOI: 10.1177/20556683231171840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Introduction This study investigated the needs of stroke survivors and therapists, and how they may contrast, for the design of robots for at-home post stroke rehabilitation therapy, in the Ontario, Canada, context. Methods Individual interviews were conducted with stroke survivors (n = 10) and therapists (n = 6). The transcripts were coded using thematic analysis inspired by the WHO International Classification of Functioning, Disability, and Health. Results Design recommendations, potential features, and barriers were identified from the interviews. Stroke survivors and therapists agreed on many of the needs for at-home robotic rehabilitation; however, stroke survivors had more insights into their home environment, barriers, and needs relating to technology, while therapists had more insights into therapy methodology and patient safety and interaction. Both groups felt a one-size-fits-all approach to rehabilitation robot design is inappropriate. Designs could address a broader range of impairments by incorporating household items and breaking activities down into their component motions. Designs should incorporate hand and wrist supports and activities. Designs should monitor trunk and shoulder motion and consider incorporating group activities. Conclusion While therapists can provide insight in the early stages of design of rehabilitation technology, stroke survivors' perspectives are crucial to designing for the home environment.
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Affiliation(s)
- Shane Forbrigger
- Department of Electrical and Computer Engineering, Queen’s University, Kingston, ON, Canada
- Keyvan Hashtrudi-Zaad, Department of Electrical and Computer Engineering, Queen’s University, 19 Union St, Kingston, ON K7L 3N9, Canada. Email:
| | - Madeleine Liblong
- Department of Mechanical Engineering, Queen’s University, Kingston, ON, Canada
| | - TC Davies
- Department of Mechanical Engineering, Queen’s University, Kingston, ON, Canada
| | - Vincent DePaul
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
| | - Evelyn Morin
- Department of Electrical and Computer Engineering, Queen’s University, Kingston, ON, Canada
| | - Keyvan Hashtrudi-Zaad
- Department of Electrical and Computer Engineering, Queen’s University, Kingston, ON, Canada
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Ma D, Li X, Xu Q, Yang F, Feng Y, Wang W, Huang JJ, Pei YC, Pan Y. Robot-Assisted Bimanual Training Improves Hand Function in Patients With Subacute Stroke: A Randomized Controlled Pilot Study. Front Neurol 2022; 13:884261. [PMID: 35873779 PMCID: PMC9298653 DOI: 10.3389/fneur.2022.884261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 06/08/2022] [Indexed: 11/25/2022] Open
Abstract
Study Design A randomized controlled pilot study. Background Bimanual therapy (BMT) is an effective neurorehabilitation therapy for the upper limb, but its application to the distal upper limb is limited due to methodological difficulties. Therefore, we applied an exoskeleton hand to perform robot-assisted task-oriented bimanual training (RBMT) in patients with stroke. Objective To characterize the effectiveness of RBMT in patients with hemiplegic stroke with upper limb motor impairment. Interventions A total of 19 patients with subacute stroke (1–6 months from onset) were randomized and allocated to RBMT and conventional therapy (CT) groups. The RBMT and CT groups received 90 min of training/day (RBMT: 60 min RBMT + 30 min CT; CT: 60 min CT for hand functional training + 30 min regular CT), 5 days/week, for 4 weeks (20 sessions during the experimental period). Assessments Clinical assessments, including the Fugl–Meyer assessment of the upper extremity (FMA-UE), action research arm test (ARAT), and wolf motor arm function test (WMFT), were conducted before and after the intervention. Results Within-group analysis showed a significant improvement in the FMA-UE and WMFT in both the CT and RBMT groups. A significant improvement in the Fugl–Meyer assessment (FMA) of the wrist and hand for the distal part in the RBMT group occurred earlier than that in the CT group. A significant improvement in WMFT time was found in both groups, but the WMFT functional ability assessment was only found in the RBMT group. No significant improvements in ARAT assessment were observed in either the CT or RBMT groups. Compared with CT, significant improvements were found in terms of the proportion of minimally clinically important differences after RBMT in FMA-UE (χ2 = 4.34, p = 0.037). No adverse events were reported by any of the participants across all sessions. Conclusions This study is the first to apply RBMT to the distal part of the upper limb. Both RBMT and CT are effective in improving the upper limb function in patients with subacute stroke. RBMT shows superior potential efficacy in facilitating recovery of the distal part of upper extremity (UE) motor function in the early stage. Future randomized control studies with a large sample size and follow-up assessments are needed to validate the present conclusions.
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Affiliation(s)
- Di Ma
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xin Li
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Quan Xu
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Fei Yang
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yutong Feng
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Wenxu Wang
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jian-Jia Huang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Graduate School of Science Design Program in Innovation for Smart Medicine, Chang Gung University, Taoyuan, Taiwan.,Center of Vascularized Tissue Allograft, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yu-Cheng Pei
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate School of Science Design Program in Innovation for Smart Medicine, Chang Gung University, Taoyuan, Taiwan.,Center of Vascularized Tissue Allograft, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yu Pan
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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10
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Miryutova NF, Minchenko NN, Samoilova IM, Tsekhmeystruk EA, Mikhailova LV. [Functional and activity limitations in patients after a stroke]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2022; 99:20-29. [PMID: 36538400 DOI: 10.17116/kurort20229906120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
UNLABELLED One of the main characteristics of the goal of rehabilitation after a stroke is the focus on restoring a certain level of functioning. The formation of the goal of rehabilitation and the implementation of effective rehabilitation are possible when taking into account not only the clinical diagnosis, but also the problems and possibilities of the patient in the categories of the International Classification of Functioning, Disabilities and Health (ICF). PURPOSE OF THE STUDY To assess the types and degree of functional limitations and activity limitations in patients after ischemic and hemorrhagic strokes in the early recovery period, taking into account the type of stroke and the affected vascular pool. MATERIAL AND METHODS 528 patients after a stroke were examined. Functional limitations and activity limitations were assessed in ICF categories, taking into account the type of stroke (hemorrhagic, ischemic) and the affected vascular system (carotid, vertebrobasilar), including dysfunctions (motor, global and specific mental functions, balance function, functions of the cardiovascular system), activity restrictions (limitations of paretic limbs mobility, functional independence from others). To quantify the degree of limitation, generally accepted rating scales were used (Medical Research Council Scale, Modified Ashworth Scale of muscle spasticity, Frenchay arm test, Hauser ambulation index, Rivermead mobility index, Functional Independence Measure, «Memory for images», «Learning 10 words», «Red-black Schulte-Platonov tables», Luscher color test, The hospital Anxiety and Depression Scale, Recovery Locus of Control), stabilography method, registration of office and outpatient blood pressure. RESULTS Limitations of the functions of paretic limbs and activity associated with maintaining body position, walking, movement, transfer, manipulation of objects and self-care, dependence on others in everyday life were found in most patients after hemorrhagic stroke (in 94-95%) and ischemic (in 88-93%) stroke in the carotid pool, while more severe disorders were recorded in cases of hemorrhagic type of stroke. Violation of global mental functions was recorded in ¼ of patients, specific mental functions - in 60-75% of patients after hemorrhagic stroke and ischemic stroke in the carotid pool. In ischemic stroke happens in the vertebrobasilar basin, the limitations of the daily activity of patients were determined by the violation of static and dynamic balance; a mild degree of impairment of specific mental functions and limitation of activity (self-service) were also recorded. CONCLUSION After a stroke, motor function disorders, mobility limitations of paretic limbs and self-service, postural disorders are recorded. After an ischemic stroke in the vertebrobasilar basin, the restrictions on the activity of patients are determined by postural disorders. Taking into account the identified features of functional limitations and activity limitations in patients after a stroke will allow developing a differentiated approach not only to the formation of goals and objectives of rehabilitation, but also to the choice of rehabilitation methods.
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Affiliation(s)
- N F Miryutova
- Federal Scientific and Clinical Center of Medical Rehabilitation and Balneology of the Federal Medical and Biological Agency of Russia, Moscow, Russia
| | - N N Minchenko
- Federal Scientific and Clinical Center of Medical Rehabilitation and Balneology of the Federal Medical and Biological Agency of Russia, Moscow, Russia
| | - I M Samoilova
- Federal Scientific and Clinical Center of Medical Rehabilitation and Balneology of the Federal Medical and Biological Agency of Russia, Moscow, Russia
| | - E A Tsekhmeystruk
- Federal Scientific and Clinical Center of Medical Rehabilitation and Balneology of the Federal Medical and Biological Agency of Russia, Moscow, Russia
| | - L V Mikhailova
- Federal Scientific and Clinical Center of Medical Rehabilitation and Balneology of the Federal Medical and Biological Agency of Russia, Moscow, Russia
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