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Kim YS, Song JY, Park SH, Lee MM. Effect of functional electrical stimulation-based mirror therapy using gesture recognition biofeedback on upper extremity function in patients with chronic stroke: A randomized controlled trial. Medicine (Baltimore) 2023; 102:e36546. [PMID: 38206692 PMCID: PMC10754587 DOI: 10.1097/md.0000000000036546] [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: 05/05/2023] [Accepted: 11/17/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Mirror therapy (MT) is an intervention used for upper extremity rehabilitation in stroke patients and has been studied in various fields. Recently, effective MT methods have been introduced in combination with neuromuscular electrical stimulation or with electromyography (EMG)-triggered biofeedback. The purpose of this study was to investigate the effects of functional electrical stimulation (FES)-based MT incorporating a motion recognition biofeedback device on upper extremity motor recovery to chronic stroke patients. METHODS Twenty-six chronic stroke patients with onset of more than 6 months were randomly assigned into experimental group (n = 13) and control group (n = 13). Both groups participated in conventional rehabilitation program, while the control group received conventional MT intervention and the experimental group received FES-based MT with motion recognition biofeedback device. All interventions were conducted for 30 min/d, 5 d/wk, for 4 weeks. Upper limb motor recovery, upper limb function, active-range of motion (ROM), and activities of daily living independence were measured before and after the intervention and compared between the 2 groups. RESULTS The Fugl-Meyer assessment (FMA), manual function test (MFT), K-MBI, and active-ROM (excluding deviation) were significantly improved in both groups (P < .05). Only the experimental group showed significant improvement in upper extremity recovery, ulnar and radial deviation (P < .05). There was a significant difference of change in Brunstrom's recovery level, FMA, MFT, and active-ROM in the experimental group compared to the control group (P < .05). CONCLUSION FES-based MT using gesture recognition biofeedback is an effective intervention method for improving upper extremity motor recovery and function, active-ROM in patients with chronic stroke. This study suggests that incorporating gesture-recognition biofeedback into FES-based MT can provide additional benefits to patients with chronic stroke.
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Affiliation(s)
- Young-Soung Kim
- Department of Physical Therapy, Graduate School, Daejeon University, Daejeon, Republic of Korea
| | - Jun-Young Song
- Department of Physical Therapy, Graduate School, Daejeon University, Daejeon, Republic of Korea
| | - Sam-Ho Park
- Department of Physical Therapy, Daejeon University, Daejeon, Republic of Korea
| | - Myung-Mo Lee
- Department of Physical Therapy, Daejeon University, Daejeon, Republic of Korea
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Kuroda MM, Iwasaki N, Yoshikawa K, Takeuchi R, Mataki Y, Nakayama T, Nakayama J, Ohguro H, Tokeji K, Mutsuzaki H. Voluntary-assisted Upper Limb Training for Severe Cerebral Palsy Using Robotics Devices and Neuromuscular Electrical Stimulation: Three Case Reports. Prog Rehabil Med 2022; 7:20220050. [PMID: 36188138 PMCID: PMC9475054 DOI: 10.2490/prm.20220050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 08/23/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Constraint-induced movement therapy (CIMT) improves the motor function of paralyzed
upper limbs of adults after stroke. However, in patients with severe spastic cerebral
palsy (CP), the use of CIMT is not warranted. Our aim was to investigate the feasibility
and effectiveness of repetitive voluntary-assisted upper limb training (VAUT) for three
patients with severe CP using a combination of robotics [Hybrid Assistive Limb (HAL)]
and functional electrical stimulation [Integrated Volitional Control Electrical
Stimulation (IVES)]. Case: Three patients with CP were enrolled. Patients 1, 2, and 3 were 8-, 19-, and
18-year-old males, respectively. Patient 1 had spastic hemiplegia, while patients 2 and
3 had spastic quadriplegia. VAUT using single-joint HAL was performed for 1 or 2
sessions/month for 50 min/session over an 8-month period for 9–13 sessions in total. One
patient’s voluntary hand movement was insufficient, affecting his upper limb exercise
performance; therefore, IVES was required in addition to HAL. Outcome measures included
motor function of the upper limbs and use of paralyzed hands, which were measured before
and after intervention. No adverse events were observed during VAUT. After intervention,
the Action Research Arm Test scores showed improvements in all three patients. The
Children’s Hand-use Experience Questionnaire showed improvements in two patients. Discussion: The use of VAUT, together with new systems such as HAL and IVES, for severe CP is safe
and may be effective. Our study suggested that upper limb function can be improved for
patients with severe CP.
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Affiliation(s)
- Mayumi Matsuda Kuroda
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Nobuaki Iwasaki
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Ryoko Takeuchi
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Yuki Mataki
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Tomohiro Nakayama
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Junko Nakayama
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Haruka Ohguro
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Kayo Tokeji
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Hirotaka Mutsuzaki
- Center for Medical Science, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
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Kinugawa K, Mano T, Wada H, Ozaki M, Shirai D, Imura T, Kido A. Improvement in lower extremity hemiplegia in a post-operative brain tumor patient by applying an integrated volitional control electrical stimulator. J Phys Ther Sci 2022; 34:473-477. [PMID: 35698557 PMCID: PMC9170483 DOI: 10.1589/jpts.34.473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/06/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to evaluate the improvement in lower extremity hemiplegia
following brain tumor operation with an integrated volitional control electrical
stimulator (IVES). [Participant and Methods] A 40 year-old male with anaplasic
oligodendroglioma in the right frontal lobe underwent IVES in the rectus femoris and
tibialis anterior muscles using the power-assist and sensor-trigger modes. Lower extremity
motor function was assessed before and after the therapy sessions. An assessment was
conducted using various techniques, including static posturography and surface
electromyography. [Results] Static posturography showed an improvement in the center of
pressure and sway area after IVES gait training. Based on a time-series statistical
parametric mapping analysis, the activation pattern of each muscle after the treatment was
different. Muscle synergy analysis revealed decreased total variance accounted for by a
single synergy in the affected and normal sides after the treatment. [Conclusion] Patients
with chronic hemiplegic lower extremity impairment responded well to IVES gait training.
Electromyography-triggered functional electrical stimulation may enhance sensory-motor
integration. Proprioceptive feedback plays a crucial role in improving motor control.
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Affiliation(s)
- Kaoru Kinugawa
- Department of Neurology, Nara Medical University: 840 Shijo-cho, Kashihara, Nara 634-8521, Japan
| | - Tomoo Mano
- Department of Rehabilitation Medicine, Nara Medical University, Japan
| | - Hiroki Wada
- Medical Technology Center Division, Nara Medical University Hospital, Japan
| | - Maki Ozaki
- Department of Neurology, Nara Medical University: 840 Shijo-cho, Kashihara, Nara 634-8521, Japan
| | - Daisuke Shirai
- Medical Technology Center Division, Nara Medical University Hospital, Japan
| | - Tadashi Imura
- Medical Technology Center Division, Nara Medical University Hospital, Japan
| | - Akira Kido
- Department of Rehabilitation Medicine, Nara Medical University, Japan
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Gutierrez-Martinez J, Mercado-Gutierrez JA, Carvajal-Gámez BE, Rosas-Trigueros JL, Contreras-Martinez AE. Artificial Intelligence Algorithms in Visual Evoked Potential-Based Brain-Computer Interfaces for Motor Rehabilitation Applications: Systematic Review and Future Directions. Front Hum Neurosci 2021; 15:772837. [PMID: 34899220 PMCID: PMC8656949 DOI: 10.3389/fnhum.2021.772837] [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: 09/08/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
Brain-Computer Interface (BCI) is a technology that uses electroencephalographic (EEG) signals to control external devices, such as Functional Electrical Stimulation (FES). Visual BCI paradigms based on P300 and Steady State Visually Evoked potentials (SSVEP) have shown high potential for clinical purposes. Numerous studies have been published on P300- and SSVEP-based non-invasive BCIs, but many of them present two shortcomings: (1) they are not aimed for motor rehabilitation applications, and (2) they do not report in detail the artificial intelligence (AI) methods used for classification, or their performance metrics. To address this gap, in this paper the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology was applied to prepare a systematic literature review (SLR). Papers older than 10 years, repeated or not related to a motor rehabilitation application, were excluded. Of all the studies, 51.02% referred to theoretical analysis of classification algorithms. Of the remaining, 28.48% were for spelling, 12.73% for diverse applications (control of wheelchair or home appliances), and only 7.77% were focused on motor rehabilitation. After the inclusion and exclusion criteria were applied and quality screening was performed, 34 articles were selected. Of them, 26.47% used the P300 and 55.8% the SSVEP signal. Five applications categories were established: Rehabilitation Systems (17.64%), Virtual Reality environments (23.52%), FES (17.64%), Orthosis (29.41%), and Prosthesis (11.76%). Of all the works, only four performed tests with patients. The most reported machine learning (ML) algorithms used for classification were linear discriminant analysis (LDA) (48.64%) and support vector machine (16.21%), while only one study used a deep learning algorithm: a Convolutional Neural Network (CNN). The reported accuracy ranged from 38.02 to 100%, and the Information Transfer Rate from 1.55 to 49.25 bits per minute. While LDA is still the most used AI algorithm, CNN has shown promising results, but due to their high technical implementation requirements, many researchers do not justify its implementation as worthwile. To achieve quick and accurate online BCIs for motor rehabilitation applications, future works on SSVEP-, P300-based and hybrid BCIs should focus on optimizing the visual stimulation module and the training stage of ML and DL algorithms.
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Affiliation(s)
- Josefina Gutierrez-Martinez
- División de Investigación en Ingeniería Médica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Jorge A. Mercado-Gutierrez
- División de Investigación en Ingeniería Médica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
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Khan MA, Saibene M, Das R, Brunner IC, Puthusserypady S. Emergence of flexible technology in developing advanced systems for post-stroke rehabilitation: a comprehensive review. J Neural Eng 2021; 18. [PMID: 34736239 DOI: 10.1088/1741-2552/ac36aa] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 11/04/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Stroke is one of the most common neural disorders, which causes physical disabilities and motor impairments among its survivors. Several technologies have been developed for providing stroke rehabilitation and to assist the survivors in performing their daily life activities. Currently, the use of flexible technology (FT) for stroke rehabilitation systems is on a rise that allows the development of more compact and lightweight wearable systems, which stroke survivors can easily use for long-term activities. APPROACH For stroke applications, FT mainly includes the "flexible/stretchable electronics", "e-textile (electronic textile)" and "soft robotics". Thus, a thorough literature review has been performed to report the practical implementation of FT for post-stroke application. MAIN RESULTS In this review, the highlights of the advancement of FT in stroke rehabilitation systems are dealt with. Such systems mainly involve the "biosignal acquisition unit", "rehabilitation devices" and "assistive systems". In terms of biosignals acquisition, electroencephalography (EEG) and electromyography (EMG) are comprehensively described. For rehabilitation/assistive systems, the application of functional electrical stimulation (FES) and robotics units (exoskeleton, orthosis, etc.) have been explained. SIGNIFICANCE This is the first review article that compiles the different studies regarding flexible technology based post-stroke systems. Furthermore, the technological advantages, limitations, and possible future implications are also discussed to help improve and advance the flexible systems for the betterment of the stroke community.
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Affiliation(s)
- Muhammad Ahmed Khan
- Technical University of Denmark, Ørsteds Plads Building 345C, Room 215, Lyngby, 2800, DENMARK
| | - Matteo Saibene
- Technical University of Denmark, Ørsteds Plads, Building 345C, Lyngby, 2800, DENMARK
| | - Rig Das
- Technical University of Denmark, Ørsteds Plads Building 345C, Room 214, Lyngby, 2800, DENMARK
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Converging Robotic Technologies in Targeted Neural Rehabilitation: A Review of Emerging Solutions and Challenges. SENSORS 2021; 21:s21062084. [PMID: 33809721 PMCID: PMC8002299 DOI: 10.3390/s21062084] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/05/2021] [Accepted: 03/11/2021] [Indexed: 11/17/2022]
Abstract
Recent advances in the field of neural rehabilitation, facilitated through technological innovation and improved neurophysiological knowledge of impaired motor control, have opened up new research directions. Such advances increase the relevance of existing interventions, as well as allow novel methodologies and technological synergies. New approaches attempt to partially overcome long-term disability caused by spinal cord injury, using either invasive bridging technologies or noninvasive human-machine interfaces. Muscular dystrophies benefit from electromyography and novel sensors that shed light on underlying neuromotor mechanisms in people with Duchenne. Novel wearable robotics devices are being tailored to specific patient populations, such as traumatic brain injury, stroke, and amputated individuals. In addition, developments in robot-assisted rehabilitation may enhance motor learning and generate movement repetitions by decoding the brain activity of patients during therapy. This is further facilitated by artificial intelligence algorithms coupled with faster electronics. The practical impact of integrating such technologies with neural rehabilitation treatment can be substantial. They can potentially empower nontechnically trained individuals-namely, family members and professional carers-to alter the programming of neural rehabilitation robotic setups, to actively get involved and intervene promptly at the point of care. This narrative review considers existing and emerging neural rehabilitation technologies through the perspective of replacing or restoring functions, enhancing, or improving natural neural output, as well as promoting or recruiting dormant neuroplasticity. Upon conclusion, we discuss the future directions for neural rehabilitation research, diagnosis, and treatment based on the discussed technologies and their major roadblocks. This future may eventually become possible through technological evolution and convergence of mutually beneficial technologies to create hybrid solutions.
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Ullah I, Arsh A, Zahir A, Jan S. Motor relearning program along with electrical stimulation for improving upper limb function in stroke patients: A quasi experimental study. Pak J Med Sci 2020; 36:1613-1617. [PMID: 33235584 PMCID: PMC7674909 DOI: 10.12669/pjms.36.7.2351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To determine the effectiveness of motor relearning program along with electrical stimulation for improving upper limb function in patients with sub-acute stroke. Methods: A quasi experimental study was conducted at Physiotherapy Department of SAIDU Group of Teaching Hospitals Swat Khyber Pakhtunkhwa from January to June 2019. Forty four subjects with post stroke duration of 3-9 months (sub-acute) participated in the study. Subjects received electrical stimulations for the effected arm for 15 minutes along with motor relearning programme for an hour five days a week for six weeks. The upper limb sub scales of motor assessment scale were used to collect pre and post treatment data. SPSS version 20 was used to analyze the data. Results: The mean age of the participants was 54.95±13.2 years. Out of 44 participants 31(70.5%) were male and 13 (29.5%) were female. Pretreatment upper arm function, hand movement and advance hand activities scores were 1.36 ± 0.49, 1.18 ± 0.39 and 1.04 ± 0.21 respectively while their post treatment scores were 5.18 ± 0.96, 4.77 ± 1.02 and 3.95 ± 1.21 respectively. There was significant differences (P<0.05) between pre and post treatment scores of upper arm function, hand movement and advance hand activities. Conclusion: Motor relearning program along with electrical stimulation significantly improves upper limb function in patients with sub-acute stroke.
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Affiliation(s)
- Ikram Ullah
- Ikram Ullah, BSPT, PP-DPT, MSPT. Physiotherapist, Saidu Group of Teaching Hospitals Swat, Pakistan
| | - Aatik Arsh
- Aatik Arsh, DPT, MSPT. Lecturer, Institute of Physical Medicine and Rehabilitation, Khyber Medical University Peshawar, Pakistan
| | - Aneela Zahir
- Aneel Zahir, DPT. Lecturer, Department of Health Sciences, NCS University System Peshawar, Pakistan
| | - Shafqatullah Jan
- Shafqatullah Jan, BSPT, MSPT. Physiotherapist, Pakistan Institute of Prosthetics and Orthotic Sciences Peshawar, Peshawar, Pakista
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Functional Electrical Stimulation Controlled by Motor Imagery Brain-Computer Interface for Rehabilitation. Brain Sci 2020; 10:brainsci10080512. [PMID: 32748888 PMCID: PMC7465702 DOI: 10.3390/brainsci10080512] [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: 06/23/2020] [Revised: 07/23/2020] [Accepted: 07/31/2020] [Indexed: 11/17/2022] Open
Abstract
Sensorimotor rhythm (SMR)-based brain–computer interface (BCI) controlled Functional Electrical Stimulation (FES) has gained importance in recent years for the rehabilitation of motor deficits. However, there still remain many research questions to be addressed, such as unstructured Motor Imagery (MI) training procedures; a lack of methods to classify different MI tasks in a single hand, such as grasping and opening; and difficulty in decoding voluntary MI-evoked SMRs compared to FES-driven passive-movement-evoked SMRs. To address these issues, a study that is composed of two phases was conducted to develop and validate an SMR-based BCI-FES system with 2-class MI tasks in a single hand (Phase 1), and investigate the feasibility of the system with stroke and traumatic brain injury (TBI) patients (Phase 2). The results of Phase 1 showed that the accuracy of classifying 2-class MIs (approximately 71.25%) was significantly higher than the true chance level, while that of distinguishing voluntary and passive SMRs was not. In Phase 2, where the patients performed goal-oriented tasks in a semi-asynchronous mode, the effects of the FES existence type and adaptive learning on task performance were evaluated. The results showed that adaptive learning significantly increased the accuracy, and the accuracy after applying adaptive learning under the No-FES condition (61.9%) was significantly higher than the true chance level. The outcomes of the present research would provide insight into SMR-based BCI-controlled FES systems that can connect those with motor disabilities (e.g., stroke and TBI patients) to other people by greatly improving their quality of life. Recommendations for future work with a larger sample size and kinesthetic MI were also presented.
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Au CY, Mehra P, Leung KW, Tong RK. Effects of Electromyographically-driven Neuromuscular Stimulatio Cycling System on the Lower-Limb of Stroke Survivors. IEEE Int Conf Rehabil Robot 2019; 2019:300-304. [PMID: 31374646 DOI: 10.1109/icorr.2019.8779541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper describes the design of an Electromyographically(EMG)-driven Neuromuscular Electrical Stimulation (NMES) cycling system. It utilises real-time EMG from actively participating stroke survivors as feedback control to drive the cycling system for rehabilitation. The user controls the speed of the cycling system using muscle activities of the side affected recorded by EMG electrodes. Additionally, adaptable NMES stimulations; also EMG based, were provided in cyclic pattern to the respective muscle groups in order to improve muscle coordination. The targeted muscle groups used to control the system were the Hamstring (HS), Tibialis Anterior (TA), Quadriceps (QC), Gastrocnemius Lateralis (GL) of the leg on the affected side. Using the system, 20 30-minutes sessions were conducted with chronic stroke survivors (n=10) at frequency of 2-4 sessions per week. Clinical assessment scores, namely FMA_LE, BBS and 6MWT were calculated before the first session and after the completion of 20 sessions. All the assessment scores showed significant improvement after using the system; FMA_LE(P=0.0244), BBS(P=0.0156), 6MWT(P=0.0112), and SI (P=0.0258), showing that the EMG-driven NMES cycling system provides effective rehabilitation for stroke survivors in terms of muscle strength and balance.
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Nizamis K, Stienen AHA, Kamper DG, Keller T, Plettenburg DH, Rouse EJ, Farina D, Koopman BFJM, Sartori M. Transferrable Expertise From Bionic Arms to Robotic Exoskeletons: Perspectives for Stroke and Duchenne Muscular Dystrophy. ACTA ACUST UNITED AC 2019. [DOI: 10.1109/tmrb.2019.2912453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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ROUX-OLIVEIRA TIAGO, COSTA LUIZR, PINO ALEXANDREV, PAZ PAULO. Extremum Seeking-based Adaptive PID Control applied to Neuromuscular Electrical Stimulation. AN ACAD BRAS CIENC 2019; 91:e20180544. [DOI: 10.1590/0001-3765201820180544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/13/2018] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | - PAULO PAZ
- State University of Rio de Janeiro (UERJ), Brazil
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Wang X, Leung KW, Fang Y, Chen S, Tong RK. Design of Functional Electrical Stimulation Cycling System for Lower-Limb Rehabilitation of Stroke Patients. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:2337-2340. [PMID: 30440875 DOI: 10.1109/embc.2018.8512869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The active participation of the stroke survivor during Functional Electrical Stimulation (FES) cycling system is an interesting question that we would like to investigate, since active rehabilitation can promote a better motor function recovery than passive training. In this pilot study, a smart FES cycling system which can assess the participants cycling effort was proposed to record real-time Electromyography (EMG) and torque during lower limb training for chronic stroke survivors. The rehabilitation goals were to increase the lower-limb muscle strength and enhance the muscle coordination. Chronic stroke patients (n=6) with gait impairment and moderate motor disability were recruited to evaluate the functionality of the system. The system was composed of a modified station bike with an adjustable chair, a programmable functional electrical stimulator, a step motor, a torque sensor, and a surface electromyography (EMG) amplifier. Four-channel FES and EMG electrodes were placed at quadriceps (QC), hamstrings (HS), tibialis anterior (TA) and gastrocnemius (GL) to exert stimulation. We adopted two measurements, clinical assessment scores and symmetric index (SI), to evaluate the training effects. The experimental results showed the proposed cycling system could improve the participants walking ability (p=.046) and enhance balance of the muscle coordination (p=.042) after training.
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The Effects of Early Exercise on Motor, Sense, and Memory Recovery in Rats With Stroke. Am J Phys Med Rehabil 2017; 96:e36-e43. [PMID: 27977432 DOI: 10.1097/phm.0000000000000670] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Exercise is an effective, inexpensive, home-based, and accessible intervention strategy for stroke treatment, and early exercise after stroke has attracted a great deal of attention in recent years. However, the effects of early exercise on comprehensive functional recovery remain poorly understood. The present study investigated the effect of early exercise on motor, sense, balance, and spatial memory recovery. DESIGN Adult Sprague-Dawley rats were subjected to unilateral middle cerebral artery occlusion (MCAO) and were randomly divided into early exercise group (EE), non-exercise group (NE), and sham group. EE group received 2 weeks of exercise training initiated at 24 hours after operation. The recovery of motor, sense, and balance function was evaluated every 3 days after MCAO. Spatial memory recovery was detected from 21 to 25 days after MCAO. RESULTS The results showed that early exercise significantly promoted the motor and spatial memory recovery with statistical differences. The rats in EE group have a better recovery in sense and balance function, but there is no statistically significant difference about these results. CONCLUSION Our results showed that early moderate exercise can significantly promote motor and spatial memory recovery, but not the sense and balance functions.
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Oliveira TR, Costa LR, Catunda JMY, Pino AV, Barbosa W, Souza MND. Time-scaling based sliding mode control for Neuromuscular Electrical Stimulation under uncertain relative degrees. Med Eng Phys 2017; 44:53-62. [PMID: 28363767 DOI: 10.1016/j.medengphy.2017.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 03/01/2017] [Accepted: 03/05/2017] [Indexed: 11/17/2022]
Abstract
This paper addresses the application of the sliding mode approach to control the arm movements by artificial recruitment of muscles using Neuromuscular Electrical Stimulation (NMES). Such a technique allows the activation of motor nerves using surface electrodes. The goal of the proposed control system is to move the upper limbs of subjects through electrical stimulation to achieve a desired elbow angular displacement. Since the human neuro-motor system has individual characteristics, being time-varying, nonlinear and subject to uncertainties, the use of advanced robust control schemes may represent a better solution than classical Proportional-Integral (PI) controllers and model-based approaches, being simpler than more sophisticated strategies using fuzzy logic or neural networks usually applied in this control problem. The objective is the introduction of a new time-scaling base sliding mode control (SMC) strategy for NMES and its experimental evaluation. The main qualitative advantages of the proposed controller via time-scaling procedure are its independence of the knowledge of the plant relative degree and the design/tuning simplicity. The developed sliding mode strategy allows for chattering alleviation due to the impact of the integrator in smoothing the control signal. In addition, no differentiator is applied to construct the sliding surface. The stability analysis of the closed-loop system is also carried out by using singular perturbation methods. Experimental results are conducted with healthy volunteers as well as stroke patients. Quantitative results show a reduction of 45% in terms of root mean square (RMS) error (from 5.9° to [Formula: see text] ) in comparison with PI control scheme, which is similar to that obtained in the literature.
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Affiliation(s)
- Tiago Roux Oliveira
- Department of Electronics and Telecommunication Engineering, State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ 20550-900, Brazil.
| | - Luiz Rennó Costa
- Biomedical Engineering Program, Federal University of Rio de Janeiro (COPPE/UFRJ), P.O. Box 68510, Rio de Janeiro, RJ 21945-970, Brazil
| | - João Marcos Yamasaki Catunda
- Biomedical Engineering Program, Federal University of Rio de Janeiro (COPPE/UFRJ), P.O. Box 68510, Rio de Janeiro, RJ 21945-970, Brazil
| | - Alexandre Visintainer Pino
- Biomedical Engineering Program, Federal University of Rio de Janeiro (COPPE/UFRJ), P.O. Box 68510, Rio de Janeiro, RJ 21945-970, Brazil
| | - William Barbosa
- Department of Electronics and Telecommunication Engineering, State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ 20550-900, Brazil
| | - Márcio Nogueira de Souza
- Biomedical Engineering Program, Federal University of Rio de Janeiro (COPPE/UFRJ), P.O. Box 68510, Rio de Janeiro, RJ 21945-970, Brazil
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Moon SH, Choi JH, Park SE. The effects of functional electrical stimulation on muscle tone and stiffness of stroke patients. J Phys Ther Sci 2017; 29:238-241. [PMID: 28265148 PMCID: PMC5332979 DOI: 10.1589/jpts.29.238] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 11/02/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to determine the effects of functional electrical
stimulation on muscle tone and stiffness in stroke patients. [Subjects and Methods] Ten
patients who had suffered from stroke were recruited. The intervention was functional
electrical stimulation on ankle dorsiflexor muscle (tibialis anterior). The duration of
functional electrical stimulation was 30 minutes, 5 times a week for 6 weeks. The Myoton
was used a measure the muscle tone and stiffness of the gastrocnemius muscle (medial and
lateral part) on paretic side. [Results] In the assessment of muscle tone, medial and
lateral part of gastrocnemius muscle showed differences before and after the experiment.
Muscle stiffness of medial gastrocnemius muscle showed differences, and lateral
gastrocnemius muscle showed differences before and after the experiment. The changes were
greater in stiffness scores than muscle tone. [Conclusion] These results suggest that FES
on ankle dorsiflexor muscle had a positive effect on muscle tone and stiffness of stroke
patients.
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Affiliation(s)
- Sang-Hyun Moon
- Department of Physical Therapy, Dream Hospital, Republic of Korea
| | - Jung-Hyun Choi
- Department of Physical Therapy, Institute for Elderly Health and Welfare, Namseoul University, Republic of Korea
| | - Si-Eun Park
- Department of Physical Therapy, Pohang College, Republic of Korea
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Varga M, Wolff P, Wolter KJ. Biocompatibility study of three distinct carbon pastes for application as electrode material in neural stimulations and recordings. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:30. [PMID: 28108958 DOI: 10.1007/s10856-016-5840-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 12/29/2016] [Indexed: 06/06/2023]
Abstract
Neural interfaces hold great promise for research and treatment of a wide variety of neurological diseases. Medical electrodes are designed to interface with the nervous system and provide control signals for neural prostheses. We fabricated previously a hook-up neural electrode. Here we investigate the in vitro cytotoxicity of three commercial carbon pastes used for printing the conductor tracks of this electrode. At first, the carbon pastes were characterized with respect to their microstructure and chemical composition. SEM images showed a grainy texture that is associated to the carbon/graphite microparticles dispersed by the polymeric binder. All the three pastes contained in major proportions carbon and in different proportions other elements. The surface roughness analysis evidenced differences in the smoothness of the carbon paste surfaces. Sterilization procedures did not alter the microstructure or surface morphology of the pastes. Finally, cell viability based on -(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) test and fluorescence staining experiments proved non-cytotoxicity and suitability of the studied carbon pastes as electrode material for measuring neural activity during surgeries (up to a certain time period).
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Affiliation(s)
- Melinda Varga
- Department of Electrical Engineering and Information Technology, Technische Universität Dresden, Electronics Packaging Laboratory, Dresden, D-01069, Germany.
| | - Paul Wolff
- Department of Electrical Engineering and Information Technology, Technische Universität Dresden, Electronics Packaging Laboratory, Dresden, D-01069, Germany
| | - Klaus-Juergen Wolter
- Department of Electrical Engineering and Information Technology, Technische Universität Dresden, Electronics Packaging Laboratory, Dresden, D-01069, Germany
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Does the Length of Elbow Flexors and Visual Feedback Have Effect on Accuracy of Isometric Muscle Contraction in Men after Stroke? BIOMED RESEARCH INTERNATIONAL 2016; 2016:7641705. [PMID: 27042670 PMCID: PMC4793147 DOI: 10.1155/2016/7641705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 12/28/2015] [Accepted: 01/26/2016] [Indexed: 11/17/2022]
Abstract
UNLABELLED The aim of the study was to determine the effect of different muscle length and visual feedback information (VFI) on accuracy of isometric contraction of elbow flexors in men after an ischemic stroke (IS). MATERIALS AND METHODS Maximum voluntary muscle contraction force (MVMCF) and accurate determinate muscle force (20% of MVMCF) developed during an isometric contraction of elbow flexors in 90° and 60° of elbow flexion were measured by an isokinetic dynamometer in healthy subjects (MH, n = 20) and subjects after an IS during their postrehabilitation period (MS, n = 20). RESULTS In order to evaluate the accuracy of the isometric contraction of the elbow flexors absolute errors were calculated. The absolute errors provided information about the difference between determinate and achieved muscle force. CONCLUSIONS There is a tendency that greater absolute errors generating determinate force are made by MH and MS subjects in case of a greater elbow flexors length despite presence of VFI. Absolute errors also increase in both groups in case of a greater elbow flexors length without VFI. MS subjects make greater absolute errors generating determinate force without VFI in comparison with MH in shorter elbow flexors length.
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De Marchis C, Santos Monteiro T, Simon-Martinez C, Conforto S, Gharabaghi A. Multi-contact functional electrical stimulation for hand opening: electrophysiologically driven identification of the optimal stimulation site. J Neuroeng Rehabil 2016; 13:22. [PMID: 26955873 PMCID: PMC4782521 DOI: 10.1186/s12984-016-0129-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 02/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Functional Electrical Stimulation (FES) is increasingly applied in neurorehabilitation. Particularly, the use of electrode arrays may allow for selective muscle recruitment. However, detecting the best electrode configuration constitutes still a challenge. METHODS A multi-contact set-up with thirty electrodes was applied for combined FES and electromyography (EMG) recording of the forearm. A search procedure scanned all electrode configurations by applying single, sub-threshold stimulation pulses while recording M-waves of the extensor digitorum communis (EDC), extensor carpi radialis (ECR) and extensor carpi ulnaris (ECU) muscles. The electrode contacts with the best electrophysiological response were then selected for stimulation with FES bursts while capturing finger/wrist extension and radial/ulnar deviation with a kinematic glove. RESULTS The stimulation electrodes chosen on the basis of M-waves of the EDC/ECR/ECU muscles were able to effectively elicit the respective finger/wrist movements for the targeted extension and/or deviation with high specificity in two different hand postures. CONCLUSIONS A subset of functionally relevant stimulation electrodes could be selected fast, automatic and non-painful from a multi-contact array on the basis of muscle responses to subthreshold stimulation pulses. The selectivity of muscle recruitment predicted the kinematic pattern. This electrophysiologically driven approach would thus allow for an operator-independent positioning of the electrode array in neurorehabilitation.
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Affiliation(s)
- Cristiano De Marchis
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Eberhard Karls University, Otfried-Mueller-Str.45, 72076, Tübingen, Germany. .,Neuroprosthetics Research, Centre for Integrative Neuroscience, Eberhard Karls University, Tübingen, Germany. .,Laboratory of Bioengineering BioLab3, Department of Engineering, University Roma TRE, Via Vito Volterra 62, 00146, Rome, Italy.
| | - Thiago Santos Monteiro
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Eberhard Karls University, Otfried-Mueller-Str.45, 72076, Tübingen, Germany.,Neuroprosthetics Research, Centre for Integrative Neuroscience, Eberhard Karls University, Tübingen, Germany
| | - Cristina Simon-Martinez
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Eberhard Karls University, Otfried-Mueller-Str.45, 72076, Tübingen, Germany.,Neuroprosthetics Research, Centre for Integrative Neuroscience, Eberhard Karls University, Tübingen, Germany
| | - Silvia Conforto
- Laboratory of Bioengineering BioLab3, Department of Engineering, University Roma TRE, Via Vito Volterra 62, 00146, Rome, Italy
| | - Alireza Gharabaghi
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Eberhard Karls University, Otfried-Mueller-Str.45, 72076, Tübingen, Germany. .,Neuroprosthetics Research, Centre for Integrative Neuroscience, Eberhard Karls University, Tübingen, Germany.
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19
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Lin TY, Wu JS, Lin LL, Ho TC, Lin PY, Chen JJJ. Assessments of Muscle Oxygenation and Cortical Activity Using Functional Near-infrared Spectroscopy in Healthy Adults During Hybrid Activation. IEEE Trans Neural Syst Rehabil Eng 2016; 24:1-9. [DOI: 10.1109/tnsre.2015.2429655] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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20
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Laffont I, Bakhti K, Coroian F, van Dokkum L, Mottet D, Schweighofer N, Froger J. Innovative technologies applied to sensorimotor rehabilitation after stroke. Ann Phys Rehabil Med 2014; 57:543-551. [PMID: 25261273 DOI: 10.1016/j.rehab.2014.08.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 08/10/2014] [Indexed: 10/24/2022]
Abstract
Innovative technologies for sensorimotor rehabilitation after stroke have dramatically increased these past 20 years. Based on a review of the literature on "Medline" and "Web of Science" between 1990 and 2013, we offer an overview of available tools and their current level of validation. Neuromuscular electric stimulation and/or functional electric stimulation are widely used and highly suspected of being effective in upper or lower limb stroke rehabilitation. Robotic rehabilitation has yielded various results in the literature. It seems to have some effect on functional capacities when used for the upper limb. Its effectiveness in gait training is more controversial. Virtual reality is widely used in the rehabilitation of cognitive and motor impairments, as well as posture, with admitted benefits. Non-invasive brain stimulation (rTMS and TDCS) are promising in this indication but clinical evidence of their effectiveness is still lacking. In the same manner, these past five years, neurofeedback techniques based on brain signal recordings have emerged with a special focus on their therapeutic relevance in rehabilitation. Technological devices applied to rehabilitation are revolutionizing our clinical practices. Most of them are based on advances in neurosciences allowing us to better understand the phenomenon of brain plasticity, which underlies the effectiveness of rehabilitation. The acceptation and "real use" of those devices is still an issue since most of them are not easily available in current practice.
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Affiliation(s)
- I Laffont
- Département de médecine physique et de réadaptation, hôpital Lapeyronie, CHU de Montpellier, 191, boulevard du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France; Movement to Health, Euromov, université Montpellier 1, 700, avenue du Pic-Saint-Loup, 34090 Montpellier, France.
| | - K Bakhti
- Département de médecine physique et de réadaptation, hôpital Lapeyronie, CHU de Montpellier, 191, boulevard du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France; Movement to Health, Euromov, université Montpellier 1, 700, avenue du Pic-Saint-Loup, 34090 Montpellier, France
| | - F Coroian
- Département de médecine physique et de réadaptation, hôpital Lapeyronie, CHU de Montpellier, 191, boulevard du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France; Movement to Health, Euromov, université Montpellier 1, 700, avenue du Pic-Saint-Loup, 34090 Montpellier, France
| | - L van Dokkum
- Département de médecine physique et de réadaptation, hôpital Lapeyronie, CHU de Montpellier, 191, boulevard du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France; Movement to Health, Euromov, université Montpellier 1, 700, avenue du Pic-Saint-Loup, 34090 Montpellier, France
| | - D Mottet
- Movement to Health, Euromov, université Montpellier 1, 700, avenue du Pic-Saint-Loup, 34090 Montpellier, France
| | - N Schweighofer
- Movement to Health, Euromov, université Montpellier 1, 700, avenue du Pic-Saint-Loup, 34090 Montpellier, France; Computational Neuro-Rehabilitation Laboratory, University of Southern California, 1540 Alcazar Street, CHP 155, Los Angeles, CA 90089-9006, USA
| | - J Froger
- Movement to Health, Euromov, université Montpellier 1, 700, avenue du Pic-Saint-Loup, 34090 Montpellier, France; Département de médecine physique et de réadaptation, hôpital universitaire de rééducation et de réadaptation, CHU de Nîmes, Le Boucanet, 30240 Le-Grau-du-Roi, France
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Kang N, Cauraugh JH. Force frequency structure below 1Hz in chronic stroke: Paretic arm control. Brain Res 2014; 1569:32-40. [DOI: 10.1016/j.brainres.2014.04.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 04/26/2014] [Accepted: 04/28/2014] [Indexed: 11/28/2022]
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Ji SG, Cha HG, Kim MK, Lee CR. The effect of mirror therapy integrating functional electrical stimulation on the gait of stroke patients. J Phys Ther Sci 2014; 26:497-9. [PMID: 24764619 PMCID: PMC3996407 DOI: 10.1589/jpts.26.497] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 10/21/2013] [Indexed: 11/25/2022] Open
Abstract
[Purpose] The aim of the present study was to examine whether mirror therapy in
conjunction with FES in stroke patients can improve gait ability. [Subjects] This study
was conducted with 30 subjects who were diagnosed with hemiparesis due to stroke.
[Methods] Experimental group I contained 10 subjects who received mirror therapy in
conjunction with functional electrical stimulation, experimental group II contained 10
subjects who received mirror therapy, and the control group contained 10 subjects who
received a sham therapy. A gait analysis was performed using a three-dimensional motion
capture system, which was a real-time tracking device that delivers data in an infrared
mode via reflective markers using six cameras. [Results] The results showed a significant
difference in gait velocity between groups after the experiment, and post hoc analysis
revealed significant differences between experimental group I and the control group and
between experimental group II and the control group, respectively. There were also
significant differences in step length and stride length between the groups after the
experiment, and post hoc analysis revealed significant differences between experimental
group I and control group. [Conclusion] The present study showed that mirror therapy in
conjunction with FES is more effective for improving gait ability than mirror therapy
alone.
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Affiliation(s)
- Sang-Goo Ji
- Department of Physical Therapy, Eulji University Hospital, Republic of Korea
| | - Hyun-Gyu Cha
- Department of Physical Therapy, Eulji University Hospital, Republic of Korea
| | - Myoung-Kwon Kim
- Department of Physical Therapy, Youngsan University, Republic of Korea
| | - Chang-Ryeol Lee
- Department of Physical Therapy, Korea Nazarene University, Republic of Korea
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Kang N, Idica J, Amitoj B, Cauraugh JH. Motor recovery patterns in arm muscles: coupled bilateral training and neuromuscular stimulation. J Neuroeng Rehabil 2014; 11:57. [PMID: 24725731 PMCID: PMC3990036 DOI: 10.1186/1743-0003-11-57] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 04/01/2014] [Indexed: 11/30/2022] Open
Abstract
Background Neuromuscular stimulation coupled with bilateral movements facilitates functional motor recovery of the upper extremities post stroke. This study investigated electromyography activation patterns during training. The leading question asked: Do EMG activation patterns show rehabilitative effects of coupled bilateral movement training on wrist and fingers extension, elbow extension, and shoulder abduction? Methods Twelve stroke volunteers completed nine hours of coupled bilateral movement training on three sets of joints in their arms. Neuromuscular stimulation on the impaired limb assisted wrist and fingers extension, elbow extension, and shoulder abduction. Mean activation level data were analyzed in a three-way completely within-subjects ANOVA (Training Day × Movement Type × Trial Block: 3 × 3 × 3). Results The analysis revealed three important findings: (a) activation levels in Days 5 and 6 were significantly higher than Days 1 and 2, (b) muscle activation patterns increased across trial blocks, and (c) movements for the shoulder joint/girdle as well as wrist and fingers demonstrated higher activation than the elbow joint. Further analysis indicated that the muscle activation patterns for shoulder abduction were positively associated with force stabilization (ratio of good variability relative to bad variability) during bilateral force production. Conclusions The findings indicate that capability to increase muscle activity during the three joint movements was improved after training. There appears to be higher muscle activation in the primary proximal and distal muscles necessary for motor control improvement.
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Affiliation(s)
| | | | | | - James H Cauraugh
- Motor Behavior Laboratory, Applied Physiology and Kinesiology Department, University of Florida, Gainesville, FL 32611-8206, USA.
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Jang SH, Jang WH, Chang PH, Lee SH, Jin SH, Kim YG, Yeo SS. Cortical activation change induced by neuromuscular electrical stimulation during hand movements: a functional NIRS study. J Neuroeng Rehabil 2014; 11:29. [PMID: 24597550 PMCID: PMC3973889 DOI: 10.1186/1743-0003-11-29] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 02/20/2014] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Neuromuscular electrical stimulation (NMES) has been used in the field of rehabilitation for a long time. Previous studies on NMES have focused on the peripheral effect, in contrast, relatively little is known about the effect on the cerebral cortex. In the current study, we attempted to investigate the change of cortical activation pattern induced by NMES during execution of hand movements in normal subjects, using functional near infrared spectroscopy (fNIRS). METHODS Twelve healthy normal subjects were randomly assigned to the NMES group (six subjects) and the sham group (six subjects). We measured oxy-hemoglobin (HbO) in six regions of interest (ROI) during pre-NMES and post-NMES motor phase; the left dorsolateral and ventrolateral prefrontal cortex, premotor cortex, primary sensory-motor cortex (SM1), hand somatotopic area of SM1, and posterior parietal cortex. Between the pre-NMES and the post-NMES motor phases, real or sham NMES was applied on finger and wrist extensors of all subjects during a period of 5 minutes. RESULTS In all groups, during the pre-NMES motor phase, the HbO value in the hand somatotopic area of the left SM1 was higher than those of other ROIs. In the NMES group, during the post-NMES motor phase, HbO value variation in the hand somatotopic area of the left SM1 showed a significant decrease, compared with that of sham group (p < 0.05). However, in the sham group, similar aspect of results in HbO values of all ROIs was observed between pre-NMES and post-NMES motor phases (p > 0.05). CONCLUSIONS Results of this study showed that NMES induced a decrease of cortical activation during execution of hand movements. This finding appears to indicate that application of NMES can increase the efficiency of the cerebral cortex during execution of motor tasks.
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Affiliation(s)
| | | | | | | | | | | | - Sang Seok Yeo
- Department of Physical Therapy, College of Health Sciences, Dankook University, 119, Dandae-ro, Dongnam-gu, Cheonan-si, Chungnam 330-714, Republic of Korea.
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The Effects of Body Weight Support Treadmill Training with Power-Assisted Functional Electrical Stimulation on Functional Movement and Gait in Stroke Patients. Am J Phys Med Rehabil 2013; 92:1051-9. [DOI: 10.1097/phm.0000000000000040] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Adrienne C, Manigandan C. Inpatient occupational therapists hand-splinting practice for clients with stroke: A cross-sectional survey from Ireland. J Neurosci Rural Pract 2013; 2:141-9. [PMID: 21897676 PMCID: PMC3159349 DOI: 10.4103/0976-3147.83579] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: Hand splinting after stroke is a common practice despite inadequate evidence. This warrants a better understanding of the therapists’ splinting practice, to develop clinically meaningful treatment options. Aims: The study examined the nature and prevalence of the factors associated with therapists’ hand splinting practice and their perceived splinting efficacy. Settings and Design: A cross-sectional national survey of hand-splinting practice among inpatient occupational therapists (OTs) in Ireland. Materials and Methods: Sixty-two therapists participated in this national survey. Statistical analysis used A number of factors were analyzed to explore their relationship with therapists’ perception of splint efficacy using Spearman's rank order correlation. Results: 53(85.5%) out of 62 survey respondents prescribed splints to their clients at the time of taking the survey. To reduce spasticity, to correct contractures and thus increase range of motion (ROM) were the commonly used splinting goals. These were the goals that were significantly associated with the therapists’ splinting efficacy too. Conclusions: Hand-splint prescription following stroke was found to be a common practice among OTs who perceive splints to be quite effective. A custom-made, volar forearm-based wrist-hand splint is the preferred splint among therapists to achieve a number of clinical aims such as improving ROM, stretching soft tissue contractures and reducing spasticity in the upper extremity. A wide variety of splinting regimens is currently practiced, reflecting the lack of a universally accepted and comprehensive practice guideline to regulate therapy. Methodologically valid clinical trials evaluating the efficacy of therapist-preferred splints in achieving their favored outcomes are needed. Development of common, universally accepted therapeutic guidelines based on comprehensive scientific review of such studies is thus needed.
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Affiliation(s)
- Cormican Adrienne
- Occupational Therapy Discipline, School of Health Sciences, National University of Ireland, Galway, Ireland
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Krabben T, Buurke JH, Prange GB, Rietman JS. A feasibility study of the effect of multichannel electrical stimulation and gravity compensation on hand function in stroke patients: a pilot study. IEEE Int Conf Rehabil Robot 2013; 2013:6650370. [PMID: 24187189 DOI: 10.1109/icorr.2013.6650370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Many stroke patients have to cope with impaired arm and hand function. As a feasibility study, gravity compensation (GC) and multichannel electrical stimulation (ES) were applied to the forearm of eight stroke patients to study potential effects on dexterity. ES was triggered by positional data of the subject's hand relative to the objects that had to be grasped. Dexterity was evaluated by means of the Box and Blocks Test (BBT). The BBT was performed with four combinations of support; with and without GC and with and without ES. In all patients, it was possible to induce sufficient hand opening for grasping a block of the BBT by means of ES. There was no significant increase in dexterity as measured with the BBT. GC and/or ES did not improve instantaneous dexterity in a small sample of stroke patients although sufficient hand opening was reached in all patients. More research in a larger sample of stroke patients with more specific and more sophisticated control algorithms is needed to explore beneficial effects of GC and ES on hand function in post stroke rehabilitation.
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Inobe JI, Kato T. Effectiveness of finger-equipped electrode (FEE)-triggered electrical stimulation improving chronic stroke patients with severe hemiplegia. Brain Inj 2013; 27:114-9. [PMID: 23252442 PMCID: PMC3545545 DOI: 10.3109/02699052.2012.729283] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background: Electric stimulation (ES) has been recognized as an effective method to improve motor function to paralysed patients with stroke. It is important for ES to synchronize with voluntary movement. To enhance this co-ordination, the finger-equipped electrode (FEE) was developed. The purpose of this study was to evaluate FEE in improving motor function of upper extremities (UEs) in patients with chronic stroke. Methods and subjects: The study participants included four patients with chronic stroke who received FEE electronic stimulation (FEE-ES) plus passive and active training and three control patients who underwent training without FEE-ES. The patients were treated five times weekly for 4 weeks. UE motor function was evaluated before and after treatment using Fugl-Meyer Assessment (FMA) and Brunnstrom recovery staging. Results: The mean age of patients in each group was 60-years and there was a mean of 49 months since the onset of symptoms. All patients had severe UE weakness. The patients receiving FEE-ES had greater improvement in UE function than control patients (total, proximal and distal FMA, p < 0.05; Brunnstrom staging of UE, p < 0.05). Discussion: The results indicate that FEE-ES may be an effective treatment for patients with chronic stroke.
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Affiliation(s)
- Jun-ichi Inobe
- Rehabilitation Centre, Inobe Hospital, Nakao, Oita, Japan.
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ACHARYA URAJENDRA, YU WENWEI, CHATTOPADHYAY SUBHAGATA, ZHU KUANYI, NG EYK, SWAPNA G. RECURRENCE QUANTIFICATION ANALYSIS OF BODY RESPONSE TO FUNCTIONAL ELECTRICAL STIMULATION ON HEMIPLEGIC SUBJECTS. J MECH MED BIOL 2012. [DOI: 10.1142/s0219519411004770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Hemiplegia means paralysis of half of the body. It commonly occurs following "stroke", which is due to impedance of blood supply to the brain, hence also termed as "cerebrovascular accident" (CVA). As a consequence of this, the brain tissues suffer from ischemic damage resulting in several symptoms, such as mere weakness, numbness to complete loss of power (paralysis). In order to restore or improve the lost functional movement of the body of the stroke-affected and hemiplegic subjects, a method called functional electrical stimulation (FES) has often been employed as the measure of rehabilitation. FES makes use of low levels of electrical current to activate the nerves and then the muscles, affected. The response of the body to this electrically triggered nervous stimulation could be recorded through different bio-signals. In our work, we measured the accelerometers of hemiplegic patient in two states; with FES and without FES. The nonlinear and nonstationary walking-function-related accelerometers are analyzed using recurrence plots (RP), which helps to visualize the dynamic behavior of the signals. The RPs of electromyography (EMG) signals with stimulation showed distinct periodicity and rhythm when compared to that without stimulation. In addition, we extracted recurrence quantification analysis (RQA) parameters from RP to quantify the obtained information from the RP. Lower values were observed for most of the RQA parameters with FES than obtained without FES. This also confirmed the fact that FES is very useful in bringing more order, rhythm and better control in the physical activities of hemiplegic people.
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Affiliation(s)
- U. RAJENDRA ACHARYA
- Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore 599489, Singapore
| | | | - SUBHAGATA CHATTOPADHYAY
- Department of Computer Science and Engineering, National Institute of Science and Technology, Berhampur 761008 Orissa, India
| | - KUANYI ZHU
- Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore 599489, Singapore
| | - E. Y. K. NG
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
| | - G. SWAPNA
- Department of Applied Electronics and Instrumentation, Government Engineering College, Kozhikode, Kerala 673005, India
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Chaiyawat P, Kulkantrakorn K. Randomized controlled trial of home rehabilitation for patients with ischemic stroke: impact upon disability and elderly depression. Psychogeriatrics 2012; 12:193-9. [PMID: 22994618 DOI: 10.1111/j.1479-8301.2012.00412.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Patients with major stroke are often left with disability and may have depression and dementia during the recovery phase. Rehabilitation programmes have been shown to improve short-term physical outcome, but their long-term effectiveness and impact on dementia and depression are uncertain. METHODS We performed a 6-month randomized controlled trial of a home rehabilitation programme and compared it with the standard care patients with recent ischemic stroke receive. The intervention group received home-based physical therapy once a month for 6 months, along with educational support, counselling and audiovisual materials. The control group received rehabilitation as prescribed by a physician and educational materials upon discharge from hospital. The primary measurement was a change in Barthel Index. Secondary measurements were the Hospital Anxiety and Depression Scale (HADS) and Thai Mini-Mental State Examination. RESULTS Of the 68 screened patients, 60 patients were enrolled. At baseline, there was no significant difference in patient characteristics between the two groups. Over 2 years, the mean Barthel Index and Hospital Anxiety and Depression Scale were significantly improved in the intervention group compared to the control group (Barthel Index mean: from 31.7 ± 5.9 to 97.2 ± 2.8 vs from 33.2 ± 4.8 to 76.4 ± 9.4, P < 0.001; Hospital Anxiety and Depression Scale mean: from 16.1 ± 7.6 to 9.1 ± 0.3 vs 16.4 ± 4.9 to 9.1 ± 0.3, P= 0.003). Depression was strongly associated with being dependent on others. However, the Thai Mini-Mental State Examination in both groups did not significantly differ (Thai Mini-Mental State Examination mean: from 24.4 ± 2.0 to 24.6 vs 23.8 ± 1.9 to 24.1 ± 0.3, P= 0.068). There was no significant interaction between baseline characteristics and treatment outcome. CONCLUSIONS At 2 years follow-up, it was evident that a 6-month home rehabilitation programme after ischemic stroke improved functional outcome and reduced incidence of depression, but not dementia.
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Thompson A, Morishita T, Okun MS. DBS and electrical neuro-network modulation to treat neurological disorders. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2012. [PMID: 23206686 DOI: 10.1016/b978-0-12-404706-8.00014-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The use of neuromodulatory techniques in the treatment of neurological disorders is expanding and now includes devices targeting the motor cortex, basal ganglia, spinal cord, peripheral nervous system, and autonomic nervous system. In this chapter, we review and discuss the current and past literature as well as review indications for each of these devices in the ongoing management of many common neurological diseases including chronic pain, Parkinson's disease, tremor, dystonia, and epilepsy. We also discuss and update mechanisms of deep brain stimulation and electrical neuro-network modulation.
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Affiliation(s)
- Amanda Thompson
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Florida, USA
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Westerveld AJ, Schouten AC, Veltink PH, van der Kooij H. Selectivity and Resolution of Surface Electrical Stimulation for Grasp and Release. IEEE Trans Neural Syst Rehabil Eng 2012; 20:94-101. [DOI: 10.1109/tnsre.2011.2178749] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Obrig H, Steinbrink J. Non-invasive optical imaging of stroke. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2011; 369:4470-94. [PMID: 22006902 DOI: 10.1098/rsta.2011.0252] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
The acute onset of a neurological deficit is the key clinical feature of stroke. In most cases, however, pathophysiological changes in the cerebral vasculature precede the event, often by many years. Persisting neurological deficits may also require long-term rehabilitation. Hence, stroke may be considered a chronic disease, and diagnostic and therapeutic efforts must include identification of specific risk factors, and the monitoring of and interventions in the acute and subacute stages, and should aim at a pathophysiologically based approach to optimize the rehabilitative effort. Non-invasive optical techniques have been experimentally used in all three stages of the disease and may complement the established diagnostic and monitoring tools. Here, we provide an overview of studies using the methodology in the context of stroke, and we sketch perspectives of how they may be integrated into the assessment of the highly dynamic pathophysiological processes during the acute and subacute stages of the disease and also during rehabilitation and (secondary) prevention of stroke.
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Affiliation(s)
- Hellmuth Obrig
- Department of Cognitive Neurology, University Hospital Leipzig, Liebigstraße 16, 04103 Leipzig, Germany.
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Hara Y. [Neuro-rehabilitation for neurological disease]. Rinsho Shinkeigaku 2011; 51:1063-1065. [PMID: 22277478 DOI: 10.5692/clinicalneurol.51.1063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Our understanding of motor learning, neuro-plasticity and functional recovery after the occurrence of brain lesion has grown significantly. New findings in basic neuroscience provided stimuli for research in motor rehabilitation. Electrical stimulation can be applied in a variety of ways to the neurological impairment. Especially, electromyography (EMG) initiated electrical muscle stimulation improves motor dysfunction of the hemiparetic arm and hand. Triggered electrical stimulation is reported to be more effective than non-triggered electrical stimulation in facilitating upper extremity motor recovery. Power-assisted FES induces greater muscle contraction by electrical stimulation in proportion to the voluntary integrated EMG signal picked up. Daily power-assisted FES home program therapy with the novel equipment has been able to improve wrist, finger extension and shoulder flexion effectively. Combined modulation of voluntary movement, proprioceptional sensory feedback and electrical stimulation might play an important role to facilitate impaired sensory-motor integration in power-assisted FES therapy. It is recognized that increased cerebral blood flow in the sensory-motor cortex area on the injured side during power-assisted FES session compared to simple active movement or simple electrical stimulation in a multi-channels Near-infrared spectroscopy (NIRS) study to non-invasively and dynamically measure hemoglobin levels in the brain during functional activity.
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Millán JDR, Rupp R, Müller-Putz GR, Murray-Smith R, Giugliemma C, Tangermann M, Vidaurre C, Cincotti F, Kübler A, Leeb R, Neuper C, Müller KR, Mattia D. Combining Brain-Computer Interfaces and Assistive Technologies: State-of-the-Art and Challenges. Front Neurosci 2010; 4. [PMID: 20877434 PMCID: PMC2944670 DOI: 10.3389/fnins.2010.00161] [Citation(s) in RCA: 245] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Accepted: 08/01/2010] [Indexed: 11/29/2022] Open
Abstract
In recent years, new research has brought the field of electroencephalogram (EEG)-based brain–computer interfacing (BCI) out of its infancy and into a phase of relative maturity through many demonstrated prototypes such as brain-controlled wheelchairs, keyboards, and computer games. With this proof-of-concept phase in the past, the time is now ripe to focus on the development of practical BCI technologies that can be brought out of the lab and into real-world applications. In particular, we focus on the prospect of improving the lives of countless disabled individuals through a combination of BCI technology with existing assistive technologies (AT). In pursuit of more practical BCIs for use outside of the lab, in this paper, we identify four application areas where disabled individuals could greatly benefit from advancements in BCI technology, namely, “Communication and Control”, “Motor Substitution”, “Entertainment”, and “Motor Recovery”. We review the current state of the art and possible future developments, while discussing the main research issues in these four areas. In particular, we expect the most progress in the development of technologies such as hybrid BCI architectures, user–machine adaptation algorithms, the exploitation of users’ mental states for BCI reliability and confidence measures, the incorporation of principles in human–computer interaction (HCI) to improve BCI usability, and the development of novel BCI technology including better EEG devices.
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Affiliation(s)
- J D R Millán
- Defitech Chair in Non-Invasive Brain-Machine Interface, Center for Neuroprosthetics, School of Engineering, Ecole Polytechnique Fédérale de Lausanne Lausanne, Switzerland
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Oujamaa L, Relave I, Froger J, Mottet D, Pelissier JY. Rehabilitation of arm function after stroke. Literature review. Ann Phys Rehabil Med 2009; 52:269-93. [DOI: 10.1016/j.rehab.2008.10.003] [Citation(s) in RCA: 231] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2008] [Accepted: 10/06/2008] [Indexed: 11/27/2022]
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