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Azzollini V, Fragapane N, Baster Z, Carozzo S, Dalise S, Chisari C. Focal muscle vibration and action observation: a combined approach for muscle strengthening. Eur J Transl Myol 2024; 34. [PMID: 39228230 DOI: 10.4081/ejtm.2024.12366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/22/2024] [Indexed: 09/05/2024] Open
Abstract
Muscle strength is essential for autonomy in daily activities and performance in sports activities. Yet, conventional strength training is challenging during recovery from pathological conditions. This study investigates a novel combined intervention employing Focal Muscle Vibration (FMV) and Action Observation (AO) to enhance muscle strength. Twenty-seven healthy volunteers (18 females and 9 males, aged 22 to 42 years) were enrolled for an intervention-control study comparing 2 groups: the intervention group received AO treatment with FMV on the right leg, and the control group underwent only FMV on the right leg. This design allowed the comparison of four conditions: FMV+AO (intervention group, right leg), AO alone (intervention group, left leg), FMV alone (control group, right leg), and no-treatment NT (control group, left leg). The treatment, conducted five times a week (Mon-Fri) for two weeks, involved a 20-minute session of FMV on the right quadriceps, coupled, for the intervention group, with the observation of a gym training video. The assessments of Maximum Voluntary Contraction (MVC), and fatigue coefficient (FC) expressed at knee extension bilaterally were measured at the beginning (T0), after the first week (T1), at the end of treatment (T2), and one-week post-intervention for the follow-up (T3). The FMV+AO group demonstrated a significant improvement in MVC over time, reaching statistical significance at T2 and maintaining the gain at T3. In contrast, all the other conditions demonstrated milder MVC increases without statistical significance. FC did not differ significantly in any condition. The combination of FMV and AO optimized muscle strengthening, offering insights for targeted treatments in various settings.
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Affiliation(s)
- Valentina Azzollini
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Neurorehabilitation, University of Pisa, Pisa.
| | - Noemi Fragapane
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Neurorehabilitation, University of Pisa, Pisa.
| | | | - Simone Carozzo
- Research in Advanced Neurorehabilitation (RAN), Sant'Anna Crotone Institute, Crotone.
| | - Stefania Dalise
- Unit of Neurorehabilitation, Department of Neuroscience, University Hospital of Pisa, Pisa.
| | - Carmelo Chisari
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Neurorehabilitation, University of Pisa, Pisa, Italy; Unit of Neurorehabilitation, Department of Neuroscience, University Hospital of Pisa, Pisa.
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Quattrocelli S, Russo EF, Gatta MT, Filoni S, Pellegrino R, Cangelmi L, Cardone D, Merla A, Perpetuini D. Integrating Machine Learning with Robotic Rehabilitation May Support Prediction of Recovery of the Upper Limb Motor Function in Stroke Survivors. Brain Sci 2024; 14:759. [PMID: 39199453 PMCID: PMC11352886 DOI: 10.3390/brainsci14080759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/24/2024] [Accepted: 07/26/2024] [Indexed: 09/01/2024] Open
Abstract
Motor impairment is a common issue in stroke patients, often affecting the upper limbs. To this standpoint, robotic neurorehabilitation has shown to be highly effective for motor function recovery. Notably, Machine learning (ML) may be a powerful technique able to identify the optimal kind and intensity of rehabilitation treatments to maximize the outcomes. This retrospective observational research aims to assess the efficacy of robotic devices in facilitating the functional rehabilitation of upper limbs in stroke patients through ML models. Specifically, clinical scales, such as the Fugl-Meyer Assessment (A-D) (FMA), the Frenchay Arm Test (FAT), and the Barthel Index (BI), were used to assess the patients' condition before and after robotic therapy. The values of these scales were predicted based on the patients' clinical and demographic data obtained before the treatment. The findings showed that ML models have high accuracy in predicting the FMA, FAT, and BI, with R-squared (R2) values of 0.79, 0.57, and 0.74, respectively. The findings of this study suggest that integrating ML into robotic therapy may have the capacity to establish a personalized and streamlined clinical practice, leading to significant improvements in patients' quality of life and the long-term sustainability of the healthcare system.
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Affiliation(s)
- Sara Quattrocelli
- Department of Engineering and Geology, University “G. d’Annunzio” of Chieti-Pescara, 65127 Pescara, Italy; (S.Q.); (L.C.); (D.C.); (A.M.)
| | - Emanuele Francesco Russo
- Padre Pio Foundation and Rehabilitation Centers, 71013 San Giovanni Rotondo, Italy; (E.F.R.); (M.T.G.)
| | - Maria Teresa Gatta
- Padre Pio Foundation and Rehabilitation Centers, 71013 San Giovanni Rotondo, Italy; (E.F.R.); (M.T.G.)
| | - Serena Filoni
- I.R.R.C.S. Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy;
| | - Raffaello Pellegrino
- Department of Scientific Research, Campus Ludes, Off-Campus Semmelweis University, 6912 Lugano-Pazzallo, Switzerland;
- Santa Chiara Institute, 73100 Lecce, Italy
| | - Leonardo Cangelmi
- Department of Engineering and Geology, University “G. d’Annunzio” of Chieti-Pescara, 65127 Pescara, Italy; (S.Q.); (L.C.); (D.C.); (A.M.)
| | - Daniela Cardone
- Department of Engineering and Geology, University “G. d’Annunzio” of Chieti-Pescara, 65127 Pescara, Italy; (S.Q.); (L.C.); (D.C.); (A.M.)
| | - Arcangelo Merla
- Department of Engineering and Geology, University “G. d’Annunzio” of Chieti-Pescara, 65127 Pescara, Italy; (S.Q.); (L.C.); (D.C.); (A.M.)
| | - David Perpetuini
- Department of Engineering and Geology, University “G. d’Annunzio” of Chieti-Pescara, 65127 Pescara, Italy; (S.Q.); (L.C.); (D.C.); (A.M.)
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Villar Ortega E, Buetler KA, Aksöz EA, Marchal-Crespo L. Enhancing touch sensibility with sensory electrical stimulation and sensory retraining. J Neuroeng Rehabil 2024; 21:79. [PMID: 38750521 PMCID: PMC11096118 DOI: 10.1186/s12984-024-01371-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 05/08/2024] [Indexed: 05/18/2024] Open
Abstract
A large proportion of stroke survivors suffer from sensory loss, negatively impacting their independence, quality of life, and neurorehabilitation prognosis. Despite the high prevalence of somatosensory impairments, our understanding of somatosensory interventions such as sensory electrical stimulation (SES) in neurorehabilitation is limited. We aimed to study the effectiveness of SES combined with a sensory discrimination task in a well-controlled virtual environment in healthy participants, setting a foundation for its potential application in stroke rehabilitation. We employed electroencephalography (EEG) to gain a better understanding of the underlying neural mechanisms and dynamics associated with sensory training and SES. We conducted a single-session experiment with 26 healthy participants who explored a set of three visually identical virtual textures-haptically rendered by a robotic device and that differed in their spatial period-while physically guided by the robot to identify the odd texture. The experiment consisted of three phases: pre-intervention, intervention, and post-intervention. Half the participants received subthreshold whole-hand SES during the intervention, while the other half received sham stimulation. We evaluated changes in task performance-assessed by the probability of correct responses-before and after intervention and between groups. We also evaluated differences in the exploration behavior, e.g., scanning speed. EEG was employed to examine the effects of the intervention on brain activity, particularly in the alpha frequency band (8-13 Hz) associated with sensory processing. We found that participants in the SES group improved their task performance after intervention and their scanning speed during and after intervention, while the sham group did not improve their task performance. However, the differences in task performance improvements between groups only approached significance. Furthermore, we found that alpha power was sensitive to the effects of SES; participants in the stimulation group exhibited enhanced brain signals associated with improved touch sensitivity likely due to the effects of SES on the central nervous system, while the increase in alpha power for the sham group was less pronounced. Our findings suggest that SES enhances texture discrimination after training and has a positive effect on sensory-related brain areas. Further research involving brain-injured patients is needed to confirm the potential benefit of our solution in neurorehabilitation.
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Affiliation(s)
- Eduardo Villar Ortega
- Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Karin A Buetler
- Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Efe Anil Aksöz
- rehaLab-The Laboratory for Rehabilitation Engineering, Institute for Human Centred Engineering HuCE, Division of Mechatronics and Systems Engineering, Department of Engineering and Information Technology, Bern University of Applied Sciences, Biel, Switzerland
| | - Laura Marchal-Crespo
- Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.
- Department of Cognitive Robotics, Delft University of Technology, Delft, The Netherlands.
- Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Lin L, Qing W, Huang Y, Ye F, Rong W, Li W, Jiao J, Hu X. Comparison of Immediate Neuromodulatory Effects between Focal Vibratory and Electrical Sensory Stimulations after Stroke. Bioengineering (Basel) 2024; 11:286. [PMID: 38534560 DOI: 10.3390/bioengineering11030286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 03/28/2024] Open
Abstract
Focal vibratory stimulation (FVS) and neuromuscular electrical stimulation (NMES) are promising technologies for sensory rehabilitation after stroke. However, the differences between these techniques in immediate neuromodulatory effects on the poststroke cortex are not yet fully understood. In this research, cortical responses in persons with chronic stroke (n = 15) and unimpaired controls (n = 15) were measured by whole-brain electroencephalography (EEG) when FVS and NMES at different intensities were applied transcutaneously to the forearm muscles. Both FVS and sensory-level NMES induced alpha and beta oscillations in the sensorimotor cortex after stroke, significantly exceeding baseline levels (p < 0.05). These oscillations exhibited bilateral sensory deficiency, early adaptation, and contralesional compensation compared to the control group. FVS resulted in a significantly faster P300 response (p < 0.05) and higher theta oscillation (p < 0.05) compared to NMES. The beta desynchronization over the contralesional frontal-parietal area remained during NMES (p > 0.05), but it was significantly weakened during FVS (p < 0.05) after stroke. The results indicated that both FVS and NMES effectively activated the sensorimotor cortex after stroke. However, FVS was particularly effective in eliciting transient involuntary attention, while NMES primarily fostered the cortical responses of the targeted muscles in the contralesional motor cortex.
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Affiliation(s)
- Legeng Lin
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Smart Ageing (RISA), The Hong Kong Polytechnic University, Hong Kong, China
| | - Wanyi Qing
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Smart Ageing (RISA), The Hong Kong Polytechnic University, Hong Kong, China
| | - Yanhuan Huang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Smart Ageing (RISA), The Hong Kong Polytechnic University, Hong Kong, China
| | - Fuqiang Ye
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Smart Ageing (RISA), The Hong Kong Polytechnic University, Hong Kong, China
| | - Wei Rong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Waiming Li
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jiao Jiao
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China
| | - Xiaoling Hu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Smart Ageing (RISA), The Hong Kong Polytechnic University, Hong Kong, China
- University Research Facility in Behavioral and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong, China
- Joint Research Centre for Biosensing and Precision Theranostics, The Hong Kong Polytechnic University, Hong Kong, China
- Research Centre on Data Science and Artificial Intelligence, The Hong Kong Polytechnic University, Hong Kong, China
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Julliand S, Papaxanthis C, Delphin C, Mock A, Raumel MA, Gueugnon M, Ornetti P, Laroche D. IMPROVE study protocol, investigating post-stroke local muscle vibrations to promote cerebral plasticity and functional recovery: a single-blind randomised controlled trial. BMJ Open 2024; 14:e079918. [PMID: 38490651 PMCID: PMC10946362 DOI: 10.1136/bmjopen-2023-079918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/27/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Spasticity is a frequent disabling consequence following a stroke. Local muscle vibrations (LMVs) have been proposed as a treatment to address this problem. However, little is known about their clinical and neurophysiological impacts when used repeatedly during the subacute phase post-stroke. This project aims to evaluate the effects of a 6-week LMV protocol on the paretic limb on spasticity development in a post-stroke subacute population. METHODS AND ANALYSIS This is an interventional, controlled, randomised, single-blind (patient) trial. 100 participants over 18 years old will be recruited, within 6 weeks following a first stroke with hemiparesis or hemiplegia. All participants will receive a conventional rehabilitation programme, plus 18 sessions of LMV (ie, continuously for 30 min) on relaxed wrist and elbow flexors: either (1) at 80 Hz for the interventional group or (2) at 40 Hz plus a foam band between the skin and the device for the control group.Participants will be evaluated at baseline, at 3 weeks and 6 weeks, and at 6 months after the end of the intervention. Spasticity will be measured by the modified Ashworth scale and with an isokinetic dynamometer. Sensorimotor function will be assessed with the Fugl-Meyer assessment of the upper extremity. Corticospinal and spinal excitabilities will be measured each time. ETHICS AND DISSEMINATION This study was recorded in a clinical trial and obtained approval from the institutional review board (Comité de protection des personnes Ile de France IV, 2021-A03219-32). All participants will be required to provide informed consent. The results of this trial will be published in peer-reviewed journals to disseminate information to clinicians and impact their practice for an improved patient's care. TRIAL REGISTRATION NUMBER Clinical Trial: NCT05315726 DATASET: EUDRAct.
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Affiliation(s)
- Sophie Julliand
- INSERM CIC 1432, Plateforme d'Investigation Technologique, CHU Dijon, Dijon, Bourgogne-Franche-Comté, France
- INSERM U1093, Dijon, France
| | | | - Corentin Delphin
- INSERM CIC 1432, Plateforme d'Investigation Technologique, CHU Dijon, Dijon, Bourgogne-Franche-Comté, France
| | - Anne Mock
- Physical Medicine and Rehabilitation, CHU Dijon, Dijon, Bourgogne-Franche-Comté, France
| | - Marc-Antoine Raumel
- Physical Medicine and Rehabilitation, Hospital Centre Chalon-sur-Saône, Chalon-sur-Saône, France
| | - Mathieu Gueugnon
- INSERM CIC 1432, Plateforme d'Investigation Technologique, CHU Dijon, Dijon, Bourgogne-Franche-Comté, France
- INSERM U1093, Dijon, France
| | - Paul Ornetti
- INSERM CIC 1432, Plateforme d'Investigation Technologique, CHU Dijon, Dijon, Bourgogne-Franche-Comté, France
- INSERM U1093, Dijon, France
| | - Davy Laroche
- INSERM CIC 1432, Plateforme d'Investigation Technologique, CHU Dijon, Dijon, Bourgogne-Franche-Comté, France
- INSERM U1093, Dijon, France
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Hong R, Li B, Bao Y, Liu L, Jin L. Therapeutic robots for post-stroke rehabilitation. MEDICAL REVIEW (2021) 2024; 4:55-67. [PMID: 38515779 PMCID: PMC10954296 DOI: 10.1515/mr-2023-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/25/2024] [Indexed: 03/23/2024]
Abstract
Stroke is a prevalent, severe, and disabling health-care issue on a global scale, inevitably leading to motor and cognitive deficits. It has become one of the most significant challenges in China, resulting in substantial social and economic burdens. In addition to the medication and surgical interventions during the acute phase, rehabilitation treatment plays a crucial role in stroke care. Robotic technology takes distinct advantages over traditional physical therapy, occupational therapy, and speech therapy, and is increasingly gaining popularity in post-stroke rehabilitation. The use of rehabilitation robots not only alleviates the workload of healthcare professionals but also enhances the prognosis for specific stroke patients. This review presents a concise overview of the application of therapeutic robots in post-stroke rehabilitation, with particular emphasis on the recovery of motor and cognitive function.
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Affiliation(s)
- Ronghua Hong
- Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons’ Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
- Neurotoxin Research Center, Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Bingyu Li
- Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons’ Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Yunjun Bao
- Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons’ Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Lingyu Liu
- Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons’ Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Lingjing Jin
- Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons’ Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
- Neurotoxin Research Center, Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Collaborative Innovation Center for Brain Science, Tongji University, Shanghai, China
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Huang L, Yi L, Huang H, Zhan S, Chen R, Yue Z. Corticospinal tract: a new hope for the treatment of post-stroke spasticity. Acta Neurol Belg 2024; 124:25-36. [PMID: 37704780 PMCID: PMC10874326 DOI: 10.1007/s13760-023-02377-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023]
Abstract
Stroke is the third leading cause of death and disability worldwide. Post-stroke spasticity (PSS) is the most common complication of stroke but represents only one of the many manifestations of upper motor neuron syndrome. As an upper motor neuron, the corticospinal tract (CST) is the only direct descending motor pathway that innervates the spinal motor neurons and is closely related to the recovery of limb function in patients with PSS. Therefore, promoting axonal remodeling in the CST may help identify new therapeutic strategies for PSS. In this review, we outline the pathological mechanisms of PSS, specifically their relationship with CST, and therapeutic strategies for axonal regeneration of the CST after stroke. We found it to be closely associated with astroglial scarring produced by astrocyte activation and its secretion of neurotrophic factors, mainly after the onset of cerebral ischemia. We hope that this review offers insight into the relationship between CST and PSS and provides a basis for further studies.
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Affiliation(s)
- Linxing Huang
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Lizhen Yi
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Huiyuan Huang
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Sheng Zhan
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Ruixue Chen
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Zenghui Yue
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China.
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Li W, Li C, Liu A, Lin PJ, Mo L, Zhao H, Xu Q, Meng X, Ji L. Lesion-specific cortical activation following sensory stimulation in patients with subacute stroke. J Neuroeng Rehabil 2023; 20:155. [PMID: 37957755 PMCID: PMC10644526 DOI: 10.1186/s12984-023-01276-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Sensory stimulation can play a fundamental role in the activation of the primary sensorimotor cortex (S1-M1), which can promote motor learning and M1 plasticity in stroke patients. However, studies have focused mainly on investigating the influence of brain lesion profiles on the activation patterns of S1-M1 during motor tasks instead of sensory tasks. Therefore, the objective of this study is to explore the lesion-specific activation patterns due to different brain lesion profiles and types during focal vibration (FV). METHODS In total 52 subacute stroke patients were recruited in this clinical experiment, including patients with basal ganglia hemorrhage/ischemia, brainstem ischemia, other subcortical ischemia, cortical ischemia, and mixed cortical-subcortical ischemia. Electroencephalograms (EEG) were recorded following a resting state lasting for 4 min and three sessions of FV. FV was applied over the muscle belly of the affected limb's biceps for 3 min each session. Beta motor-related EEG power desynchronization overlying S1-M1 was used to indicate the activation of S1-M1, while the laterality coefficient (LC) of the activation of S1-M1 was used to assess the interhemispheric asymmetry of brain activation. RESULTS (1) Regarding brain lesion profiles, FV could lead to the significant activation of bilateral S1-M1 in patients with basal ganglia ischemia and other subcortical ischemia. The activation of ipsilesional S1-M1 in patients with brainstem ischemia was higher than that in patients with cortical ischemia. No activation of S1-M1 was observed in patients with lesions involving cortical regions. (2) Regarding brain lesion types, FV could induce the activation of bilateral S1-M1 in patients with basal ganglia hemorrhage, which was significantly higher than that in patients with basal ganglia ischemia. Additionally, LC showed no significant correlation with the modified Barthel index (MBI) in all patients, but a positive correlation with MBI in patients with basal ganglia lesions. CONCLUSIONS These results reveal that sensory stimulation can induce lesion-specific activation patterns of S1-M1. This indicates FV could be applied in a personalized manner based on the lesion-specific activation of S1-M1 in stroke patients with different lesion profiles and types. Our study may contribute to a better understanding of the underlying mechanisms of cortical reorganization.
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Affiliation(s)
- Wei Li
- Division of Intelligent and Biomechanical System, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China
- State Key Laboratory of Multimodal Artificial Intelligence Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Chong Li
- Division of Intelligent and Biomechanical System, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China.
- School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China.
- Medical Research Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China.
| | - Aixian Liu
- Neurological Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Ping-Ju Lin
- Division of Intelligent and Biomechanical System, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China
| | - Linhong Mo
- Neurological Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Hongliang Zhao
- Department of Radiology, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Quan Xu
- Division of Intelligent and Biomechanical System, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China.
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China.
| | - Xiangzun Meng
- Division of Intelligent and Biomechanical System, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China
| | - Linhong Ji
- Division of Intelligent and Biomechanical System, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China
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Pournajaf S, Morone G, Straudi S, Goffredo M, Leo MR, Calabrò RS, Felzani G, Paolucci S, Filoni S, Santamato A, Franceschini M. Neurophysiological and Clinical Effects of Upper Limb Robot-Assisted Rehabilitation on Motor Recovery in Patients with Subacute Stroke: A Multicenter Randomized Controlled Trial Study Protocol. Brain Sci 2023; 13:brainsci13040700. [PMID: 37190665 DOI: 10.3390/brainsci13040700] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/16/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND The efficacy of upper limb (UL) robot-assisted therapy (RAT) on functional improvement after stroke remains unclear. However, recently published randomized controlled trials have supported its potential benefits in enhancing the activities of daily living, arm and hand function, and muscle strength. Task-specific and high-intensity exercises are key points in facilitating motor re-learning in neurorehabilitation since RAT can provide an assisted-as-needed approach. This study aims to investigate the clinical effects of an exoskeleton robotic system for UL rehabilitation compared with conventional therapy (CT) in people with subacute stroke. As a secondary aim, we seek to identify patients' characteristics, which can predict better recovery after UL-RAT and detects whether it could elicit greater brain stimulation. METHODS A total of 84 subacute stroke patients will be recruited from 7 Italian rehabilitation centers over 3 years. The patients will be randomly allocated to either CT (control group, CG) or CT plus UL-RT through an Armeo®Power (Hocoma AG, CH, Volketswil, Switzerland) exoskeleton (experimental group, EG). A sample stratification based on distance since onset, DSO (DSO ≤ 30; DSO > 30), and Fugl-Meyer Assessment (FM)-UL (FM-UL ≤ 22; 22 < FM-UL ≤ 44) will be considered for the randomization. The outcomes will be recorded at baseline (T0), after 25 + 3 sessions of intervention (T1), and at 6 months post-stroke (T2). The motor functioning assessed by the FM-UL (0-66) will be considered the primary outcome. The clinical assessments will be set based on the International Classification of Function, Disability and Health (ICF). A patient satisfaction questionnaire will be evaluated in the EG at T1. A subgroup of patients will be evaluated at T0 and T1 via electroencephalography. Their brain electrical activity will be recorded during rest conditions with their eyes closed and open (5 min each). CONCLUSION The results of this trial will provide an in-depth understanding of the efficacy of early UL-RAT through a whole arm exoskeleton and how it may relate to the neural plasticity process. The trial was registered at ClinicalTrial.gov with the registration identifier NCT04697368.
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Affiliation(s)
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
- San Raffaele Istitute of Sulmona, 67039 Sulmona, Italy
| | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, 44121 Ferrara, Italy
| | | | | | | | | | | | - Serena Filoni
- Fondazione Centri di Riabilitazione Padre Pio Onlus, San Giovani Rotondo, 71013 Foggia, Italy
| | - Andrea Santamato
- Physical Medicine and Rehabilitative Unit-Riuniti Hospital, University of Foggia, 71100 Foggia, Italy
| | - Marco Franceschini
- IRCSS San Raffaele Roma, 000163 Rome, Italy
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, 00166 Rome, Italy
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10
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Castelli L, Iacovelli C, Fusco A, Amoruso V, Cuccagna C, Loreti C, Giovannini S, Padua L. The Role of Technological Rehabilitation in Patients with Intensive Care Unit Weakness: A Randomized Controlled Pilot Study. J Clin Med 2023; 12:jcm12072612. [PMID: 37048695 PMCID: PMC10095108 DOI: 10.3390/jcm12072612] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/23/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Intensive-Care-Unit-Acquired Weakness (ICU-AW) is the most common neuromuscular impairment in critically ill patients and can have a significant impact on long-term disability. Early rehabilitation has been suggested to facilitate the natural recovery process. This is a pilot, randomized, single-blind study that aimed to evaluate the effectiveness of intensive combined technological rehabilitation treatment including focal muscle vibration and non-immersive virtual reality for patients with severe acquired brain injury (sABI) and ICU-AW. Twenty-four patients were randomized into the conventional group, which performed only conventional rehabilitation, and the experimental group, which also performed technological treatment. At baseline and after 3 weeks of treatment, assessments of motor function, autonomy, disability and quality of life were conducted. At the end of the intervention, both groups showed significant improvements. However, patients in the experimental group achieved greater improvements in disability (p = 0.001) and quality of life (p = 0.001). The results show that intensive structured rehabilitation is effective in improving the motor function, disability and quality of life of patients with severe acquired brain injury and acquired weakness. The combination of non-immersive virtual reality training and focal muscle vibration can result in a significant improvement in overall disability and quality of life compared with conventional treatment alone.
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Affiliation(s)
- Letizia Castelli
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Chiara Iacovelli
- Department of Emergency, Anaesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Augusto Fusco
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Vincenza Amoruso
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Cristina Cuccagna
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Claudia Loreti
- Department of Emergency, Anaesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Silvia Giovannini
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOS Riabilitazione Post-Acuzie, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-(0)-6-3015-4382
| | - Luca Padua
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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11
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Roman N, Miclaus RS, Necula R, Dumistracel A, Cheregi C, Grigorescu OD. Physiotherapy Efficiency in Post-stroke Upper Extremity Spasticity: TENS vs. Ultrasound vs. Paraffin. In Vivo 2023; 37:916-923. [PMID: 36881086 PMCID: PMC10026645 DOI: 10.21873/invivo.13163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/11/2023] [Accepted: 02/15/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND/AIM Post-stroke spasticity is a significant debilitating condition with negative consequences on individual functional independence and quality of life. This study aimed to identify the differences between transcutaneous electrical stimulation (TENS), ultrasound therapy and paraffin procedures on post-stroke upper extremity spasticity and dexterity. PATIENTS AND METHODS Twenty-six patients were enrolled in the study, divided into three therapy groups: TENS (n=9), paraffin (n=10) and ultrasound therapy (n=7). For 10 days, the patients received specific group therapy and conventional physical therapy exercises for upper extremities. Modified Ashworth Scale, Functional Independence Measure, Functional Coefficient, Stroke Specific Quality of Life Scale, Activities of Daily Living score and ABILHAND questionnaire were used to assess the participants before and after therapy. RESULTS The results of the group comparisons by analysis of variance showed no significant difference between outcomes by the applied treatments. In contrast, one-way analysis of variance suggested significant improvements in patients in all three groups after therapy. Step-wise regression results on functional independence measure and quality-of-life scales suggested that functional range of motion values for elbow and wrist influence individual independence and quality of life. CONCLUSION TENS, ultrasound, and paraffin therapy bring equal benefits in the management of post-stroke spasticity.
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Affiliation(s)
- Nadinne Roman
- Faculty of Medicine, Transilvania University of Brasov, Brasov, Romania
| | | | - Radu Necula
- Faculty of Medicine, Transilvania University of Brasov, Brasov, Romania;
| | - Andrei Dumistracel
- Jura Bernois Hospital, Center of Mental Health in Moutier, Moutier, Switzerland
| | - Cornel Cheregi
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
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12
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Johansen T, Sørensen L, Kolskår KK, Strøm V, Wouda MF. Effectiveness of robot-assisted arm exercise on arm and hand function in stroke survivors - A systematic review and meta-analysis. J Rehabil Assist Technol Eng 2023; 10:20556683231183639. [PMID: 37426037 PMCID: PMC10327418 DOI: 10.1177/20556683231183639] [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] [Received: 02/13/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Objective: To examine the treatment effect of commercially available robotic-assisted devices, compared to traditional occupational- and physiotherapy on arm and hand function in persons with stroke. Methods: A systematic literature search was conducted in Medline, EMBASE, CINAHL and Cochrane Central Register of Controlled Trials up to January 2022. Randomized controlled trials (RCT's) involving persons with stroke of all ages and robot-assisted exercise as method for arm and hand function, compared to traditional therapy methods were included. Three authors performed the selection independently. The quality of evidence across studies was assessed using GRADE. Results: Eighteen RCT's were included in the study. A random effects meta-analysis showed a statistically significantly higher treatment effect in the robotic-assisted exercise group (p=<0.0001) compared to the traditional treatment group, with a total effect size of 0.44 (CI = 0.22-0.65). Heterogeneity was high, measured with I2 of 65%). Subgroup analyses showed no significant effects of the type of robotic device, treatment frequency or duration of intervention. Discussion and conclusion: Even though the analysis showed significant improvement in arm and hand function in favor of the robotic-assisted exercise group, the results in this systematic review should be interpreted with caution. This is due to high heterogeneity among the studies included and the presence of possible publication bias. Results of this study highlight the need for larger and more methodological robust RCT's, with a focus on reporting training intensity during robotic exercise.
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Affiliation(s)
- Truls Johansen
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Linda Sørensen
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
- Department of Innovation, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Knut K Kolskår
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Vegard Strøm
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Matthijs F Wouda
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
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13
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Chen YL, Jiang LJ, Cheng YY, Chen C, Hu J, Zhang AJ, Hua Y, Bai YL. Focal vibration of the plantarflexor and dorsiflexor muscles improves poststroke spasticity: a randomized single-blind controlled trial. Ann Phys Rehabil Med 2022; 66:101670. [PMID: 35940478 DOI: 10.1016/j.rehab.2022.101670] [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: 09/24/2021] [Revised: 01/23/2022] [Accepted: 02/15/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Post-stroke spasticity is a cause of gait dysfunction and disability. Focal vibration (FV) of agonist-antagonist upper limb muscle pairs reduces flexor spasticity; however, its effects on ankle plantarflexor spasticity are uncertain. OBJECTIVE To assess the effects of focal vibration administered by a trained operator to the ankle plantarflexor and dorsiflexor muscles on post-stroke lower limb spasticity. METHODS A randomized, single-blind controlled trial of 64 participants with stroke and plantarflexor spasticity assigned to 3 groups by centralized, computer-generated randomization (1:1:1): 1) physiotherapy alone (CON), 2) physiotherapy+gastrocnemius vibration (FV_GM) and 3) physiotherapy+tibialis anterior vibration (FV_TA). Physiotherapists and assessors were blinded to group assignment. The experimental groups underwent 15, 20-min vibration sessions at 40 Hz. We performed evaluations at baseline and after the final treatment: Modified Ashworth Scale (MAS), Clonus scale, Functional Ambulation Categories (FAC), Fugl-Meyer Assessment - Lower Extremity (FMA_LE), Modified Barthel Index (MBI), and electromyography and ultrasound elastography. Primary outcome was remission rate (number and proportion of participants) of the MAS. RESULTS MAS remission rate was higher in FV_GM and FV_TA than CON groups (CON vs. FV_GM: p=0.009, odds ratio 0.15 [95% confidence interval 0.03-0.67]; CON vs. FV_TA: p=0.002, 0.12 [0.03-0.51]). Remission rate was higher in the experimental than CON groups for the Clonus scale (CON vs. FV_GM: p<0.001, OR 0.07 [95% CI 0.01-0.31]; CON vs. FV_TA: p=0.006, 0.14 [95% CI 0.03-0.61]). FAC remission rate was higher in the FV_TA than the CON (p=0.009, 0.18 [0.05-0.68]) and FV_GM (p=0.014, 0.27 [0.07-0.99]) groups. Ultrasound variables of the paretic medial gastrocnemius decreased more in FV_GM than CON and FV_TA groups (shear modulus: p=0.006; shear wave velocity: p=0.008). CONCLUSIONS Focal vibration reduced post-stroke spasticity of the plantarflexor muscles. Vibration of the tibialis anterior improved ambulation more than vibration of the gastrocnemius or physiotherapy alone. Gastrocnemius vibration may reduce spasticity by changing muscle stiffness.
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Affiliation(s)
- Ying-Lun Chen
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China; Department of Rehabilitation Medicine, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Liu-Jun Jiang
- Department of Rehabilitation Medicine, Huashan North Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yang-Yang Cheng
- Department of Rehabilitation Medicine, Huashan North Hospital, Fudan University, Shanghai, People's Republic of China
| | - Chan Chen
- Department of Rehabilitation Medicine, Huashan North Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jian Hu
- Department of Rehabilitation Medicine, Huashan North Hospital, Fudan University, Shanghai, People's Republic of China
| | - An-Jing Zhang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yan Hua
- Department of Rehabilitation Medicine, Huashan North Hospital, Fudan University, Shanghai, People's Republic of China.
| | - Yu-Long Bai
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.
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14
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Chockalingam M, Vasanthan LT, Balasubramanian S, Sriram V. Experiences of patients who had a stroke and rehabilitation professionals with upper limb rehabilitation robots: a qualitative systematic review protocol. BMJ Open 2022; 12:e065177. [PMID: 36123077 PMCID: PMC9486398 DOI: 10.1136/bmjopen-2022-065177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Emerging evidence suggests that robotic devices for upper limb rehabilitation after a stroke may improve upper limb function. For robotic upper limb rehabilitation in stroke to be successful, patients' experiences and those of the rehabilitation professionals must be considered. Therefore, this review aims to synthesise the available evidence on experiences of patients after a stroke with rehabilitation robots for upper limb rehabilitation and the experiences of rehabilitation professionals with rehabilitation robots for upper limb stroke rehabilitation. METHODS AND ANALYSIS Database search will include MEDLINE (Ovid), EMBASE (Elsevier), Cochrane CENTRAL, PsycINFO, Scopus, Web of Science, IEEE and CINAHL (EBSCOhost). Grey literature from Open Grey, PsyArXiv, bioRxiv, medRxiv and Google Scholar will also be searched. Qualitative studies or results from mixed-method studies that include adult patients after a stroke who use upper limb rehabilitation robots, either supervised by rehabilitation professionals or by patients themselves, at any stage of their rehabilitation and/or stroke professionals who use upper limb rehabilitation robots will be included. Robotic upper limb rehabilitation provided by students, healthcare assistants, technicians, non-professional caregivers, family caregivers, volunteer caregivers or other informal caregivers will be excluded. Articles published in English will be considered regardless of date of publication. Studies will be screened and critically appraised for methodological quality by two independent reviewers. A standardised tool from JBI System for the Unified Management, Assessment and Review of Information for data extraction, the meta-aggregation approach for data synthesis and the ConQual approach for confidence evaluation will be followed. ETHICS AND DISSEMINATION As this systematic review is based on previously published research, no informed consent or ethical approval is required. It is anticipated that this systematic review will highlight the experiences of patients after a stroke and perceived facilitators and barriers for rehabilitation professionals on this topic, which will be disseminated through peer-reviewed publications and national and international conferences. PROSPERO REGISTRATION NUMBER CRD42022321402.
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Affiliation(s)
| | - Lenny Thinagaran Vasanthan
- Physiotherapy, Physical Medicine and Rehabilitation, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | | | - Vimal Sriram
- Head of Allied Health Professionals, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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15
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Wang H, Ghazi M, Chandrashekhar R, Rippetoe J, Duginski GA, Lepak LV, Milhan LR, James SA. User Participatory Design of a Wearable Focal Vibration Device for Home-Based Stroke Rehabilitation. SENSORS (BASEL, SWITZERLAND) 2022; 22:3308. [PMID: 35590997 PMCID: PMC9105527 DOI: 10.3390/s22093308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/22/2022] [Accepted: 04/22/2022] [Indexed: 06/15/2023]
Abstract
Stroke often leads to the significant impairment of upper limb function and is associated with a decreased quality of life. Despite study results from several interventions for muscle activation and motor coordination, wide-scale adoption remains largely elusive due to under-doses and low user compliance and participation. Recent studies have shown that focal vibration has a greater potential to increase and coordinate muscle recruitment and build muscle strength and endurance. This form of treatment could widely benefit stroke survivors and therapists. Thus, this study aimed to design and develop a novel wearable focal vibration device for upper limb rehabilitation in stroke survivors. A user participatory design approach was used for the design and development. Five stroke survivors, three physical therapists, and two occupational therapists were recruited and participated. This pilot study may help to develop a novel sustainable wearable system providing vibration-based muscle activation for upper limb function rehabilitation. It may allow users to apply the prescribed vibratory stimuli in-home and/or in community settings. It may also allow therapists to monitor treatment usage and user performance and adjust the treatment doses based on progression.
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Affiliation(s)
- Hongwu Wang
- Department of Occupational Therapy, University of Florida, Gainesville, FL 32603, USA
| | - Mustafa Ghazi
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA
| | | | - Josiah Rippetoe
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA
| | - Grace A Duginski
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Louis V Lepak
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA
| | - Lisa R Milhan
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA
| | - Shirley A James
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA
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16
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When Two Is Better Than One: A Pilot Study on Transcranial Magnetic Stimulation Plus Muscle Vibration in Treating Chronic Pelvic Pain in Women. Brain Sci 2022; 12:brainsci12030396. [PMID: 35326352 PMCID: PMC8946237 DOI: 10.3390/brainsci12030396] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 02/04/2023] Open
Abstract
Chronic pelvic pain syndrome (CPPS) affects about 4–16% of adult women, and about one-third of them require medical assistance due to severe symptoms. Repetitive transcranial magnetic stimulation (rTMS) over the supplementary motor area (SMA) has been shown to manage pain in refractory CPPS. Focal muscle vibration (FMV) has also been reported to relieve pelvic pain. The objective of this study was to assess the feasibility and effect of rTMS coupled with FMV to reduce pain in seven adult women with refractory CPPS. This pilot, open-labeled, prospective trial examined treatment by 5 Hz rTMS over SMA and 150 Hz FMV over the perineum, suprapubic, and sacrococcygeal areas, with one daily session for five consecutive days for three weeks. We assessed tolerance and subjective pain changes (as per visual analog scale, VAS) until one month post-treatment, with a primary endpoint at day 7. No patients experienced serious adverse effects or a significant increase in pain. Six out of seven patients experienced a VAS improvement of at least 10% at T7; three of these individuals experienced a VAS improvement of more than 30%. Overall, we found a significant VAS reduction of 15 points (95% CI 8.4–21.6) at T7 (t = 6.3, p = 0.001; ES = 2.3 (1.1–3.9)). Three of the women who demonstrated a significant VAS reduction at T7 retained such VAS improvement at T30. VAS decreased by six points (95% CI 1.3–10.7) at T30 (t = 3.1, p = 0.02; ES = 1.5 (0.2–2.6)). This coupled approach seems promising for pain management in adult women with refractory CPPS and paves the way for future randomized controlled trials.
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17
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Serrano-Lopez-Terradas PA, Seco-Rubio R. Effectiveness of robotic therapy in the proximal and distal rehabilitation of the upper limb in patients after stroke using the Amadeo® and Armeo® devices: a systematic review of randomized clinical trials (Efectividad de la terapia robótica en la rehabilitación proximal y distal del miembro superior en personas tras un ictus con los dispositivos Amadeo® y Armeo®: una revisión sistemática de ensayos clínicos aleatorizados). STUDIES IN PSYCHOLOGY 2022. [DOI: 10.1080/02109395.2021.2009677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Pedro-Amalio Serrano-Lopez-Terradas
- Unidad de Daño Cerebral, Hospital Beata María Ana
- Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle
- Occupational Thinks Research Group, Centro Superior de Estudios Universitarios La Salle
| | - Rafael Seco-Rubio
- Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle
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18
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Mirecki MR, Callahan S, Condon KM, Field-Fote EC. Acceptability and impact on spasticity of a single session of upper extremity vibration in individuals with tetraplegia. Spinal Cord Ser Cases 2022; 8:17. [PMID: 35124692 PMCID: PMC8818045 DOI: 10.1038/s41394-022-00483-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 02/07/2023] Open
Abstract
STUDY DESIGN Pre-post design; before and after vibration intervention. OBJECTIVES To explore effect of a focal, self-applied upper extremity (UE) vibration intervention on UE spasticity for individuals with tetraplegia. The secondary objectives were to explore the acceptability and ease of use of this intervention. SETTING Specialty rehabilitation center in Georgia, USA. METHODS Eleven participants each completed one session of focal, self-applied vibration to the UEs. UE spasticity was measured using the Modified Ashworth Scale (MAS). UE function was measured using the Box & Block (B&B) test which measures the effectiveness of grasp, transport, and release. These measurements were taken pre-intervention, immediately post-intervention, and 20 min post-intervention. Participants also self-reported the acceptability and usability of the intervention, their perception of change in their spasticity and completed the Qualities of Spasticity Questionnaire. RESULTS In the full group analysis of the spasticity measures, no significant effects were found. Subgroup analysis, however, indicated participants with higher spasticity demonstrated significantly more change on the MAS than the lower spasticity group. Analysis did not reveal any impact of the intervention on UE function as measured by the B&B. Ten out of eleven participants indicated that they agreed or strongly agreed that the intervention would be valuable to have at home. CONCLUSIONS Participants with higher spasticity demonstrated decreased spasticity after focal UE vibration, although there was no clear effect on grasp, transport and release function. Participants were satisfied with the intervention; most were able to use it independently and indicated it would be a valuable home intervention.
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Affiliation(s)
| | | | - Kyle M Condon
- Shepherd Center- Crawford Research Institute, Atlanta, GA, USA
| | - Edelle C Field-Fote
- Shepherd Center- Crawford Research Institute, Atlanta, GA, USA
- Division of Physical Therapy, Emory University- School of Medicine, Atlanta, GA, USA
- Program in Applied Physiology, Georgia Institute of Technology- School of Biological Sciences, Atlanta, GA, USA
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19
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Miyara K, Etoh S, Kawamura K, Maruyama A, Kuronita T, Ohwatashi A, Shimodozono M. Effects of lower limb segmental muscle vibration on primary motor cortex short-latency intracortical inhibition and spinal excitability in healthy humans. Exp Brain Res 2021; 240:311-320. [PMID: 34724095 DOI: 10.1007/s00221-021-06257-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 10/23/2021] [Indexed: 12/19/2022]
Abstract
We examined the effects of lower limb segmental muscle vibration (SMV) on intracortical and spinal excitability in 13 healthy participants (mean age: 34.9 ± 7.8 years, 12 males, 1 female). SMV at 30 Hz was applied to the hamstrings, gastrocnemius, and soleus muscles for 5 min. Paired-pulse transcranial magnetic stimulation protocols were used to investigate motor-evoked potential (MEP) amplitude, short-interval intracortical inhibition (SICI) and short-interval intracortical facilitation (SICF) from the abductor hallucis muscle (AbdH). These assessments were compared to the results of a control experiment (i.e., non-vibration) in the same participants. F-waves were evaluated from the AbdH on the right (vibration side) and left (non-vibration side) sides, and we calculated the ratio of the F-wave amplitude to the M-response amplitude (F/M ratio). These assessments were obtained before, immediately after, and 10, 20, and 30 min after SMV. For SICI, there was no change immediately after SMV, but there was a decrease over time (before vs. 30 min after, p = 0.021; immediately after vs. 30 min after, p = 0.015). There were no changes in test MEP amplitude, SICF, or the F/M ratio. SMV causes a gradual decrease in SICI over time perhaps owing to long-term potentiation. The present results may have implications for the treatment of spasticity.
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Affiliation(s)
- Kodai Miyara
- Department of Rehabilitation, Kagoshima University Hospital, 8-35-1, Sakuragaoka, Kagoshima-city, Kagoshima, 890-8520, Japan. .,Doctoral Program, Graduate School of Health Sciences, Kagoshima University, Kagoshima, Japan.
| | - Seiji Etoh
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kentaro Kawamura
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Atsuo Maruyama
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takehiro Kuronita
- Master's Program, Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Akihiko Ohwatashi
- Faculty of Medicine, Course of Physical Therapy, School of Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Megumi Shimodozono
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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20
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Stoykov ME, Heidle C, Kang S, Lodesky L, Maccary LE, Madhavan S. Sensory-Based Priming for Upper Extremity Hemiparesis After Stroke: A Scoping Review. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2021; 42:65-78. [PMID: 34311607 DOI: 10.1177/15394492211032606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sensory priming is a technique to facilitate neuroplasticity and improve motor skills after injury. Common sensory priming modalities include peripheral nerve stimulation/somatosensory electrical stimulation (PNS/SES), transient functional deafferentation (TFD), and vibration. The aim of this study was to determine whether sensory priming with a motor intervention results in improved upper limb motor impairment or function after stroke. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and EMBASE were the databases used to search the literature in July 2020. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and recommendations for the Cochrane collaboration. In total, 30 studies were included in the analysis: three studies examined TFD, 16 examined PNS/SES, 10 studied vibration, and one combined the three stimulation techniques. Most studies reported significant improvements for participants receiving sensory priming. Given the low risk, it may be advantageous to use sensory-based priming prior to or concurrent with upper limb training after stroke.
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Affiliation(s)
- Mary E Stoykov
- Shirley Ryan AbilityLab, Chicago, IL, USA.,Northwestern University, Chicago, IL, USA
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21
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Barss TS, Collins DF, Miller D, Pujari AN. Indirect Vibration of the Upper Limbs Alters Transmission Along Spinal but Not Corticospinal Pathways. Front Hum Neurosci 2021; 15:617669. [PMID: 34079443 PMCID: PMC8165249 DOI: 10.3389/fnhum.2021.617669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 04/19/2021] [Indexed: 01/15/2023] Open
Abstract
The use of upper limb vibration (ULV) during exercise and rehabilitation continues to gain popularity as a modality to improve function and performance. Currently, a lack of knowledge of the pathways being altered during ULV limits its effective implementation. Therefore, the aim of this study was to investigate whether indirect ULV modulates transmission along spinal and corticospinal pathways that control the human forearm. All measures were assessed under CONTROL (no vibration) and ULV (30 Hz; 0.4 mm displacement) conditions while participants maintained a small contraction of the right flexor carpi radialis (FCR) muscle. To assess spinal pathways, Hoffmann reflexes (H-reflexes) elicited by stimulation of the median nerve were recorded from FCR with motor response (M-wave) amplitudes matched between conditions. An H-reflex conditioning paradigm was also used to assess changes in presynaptic inhibition by stimulating the superficial radial (SR) nerve (5 pulses at 300Hz) 37 ms prior to median nerve stimulation. Cutaneous reflexes in FCR elicited by stimulation of the SR nerve at the wrist were also recorded. To assess corticospinal pathways, motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation of the contralateral motor cortex were recorded from the right FCR and biceps brachii (BB). ULV significantly reduced H-reflex amplitude by 15.7% for both conditioned and unconditioned reflexes (24.0 ± 15.7 vs. 18.4 ± 11.2% M max ; p < 0.05). Middle latency cutaneous reflexes were also significantly reduced by 20.0% from CONTROL (-1.50 ± 2.1% Mmax) to ULV (-1.73 ± 2.2% Mmax; p < 0.05). There was no significant effect of ULV on MEP amplitude (p > 0.05). Therefore, ULV inhibits cutaneous and H-reflex transmission without influencing corticospinal excitability of the forearm flexors suggesting increased presynaptic inhibition of afferent transmission as a likely mechanism. A general increase in inhibition of spinal pathways with ULV may have important implications for improving rehabilitation for individuals with spasticity (SCI, stroke, MS, etc.).
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Affiliation(s)
- Trevor S. Barss
- Human Neurophysiology Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - David F. Collins
- Human Neurophysiology Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Dylan Miller
- Human Neurophysiology Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Amit N. Pujari
- School of Engineering and Computer Science, University of Hertfordshire, Hatfield, United Kingdom
- Biomedical Engineering Laboratory, School of Engineering, University of Aberdeen, Aberdeen, United Kingdom
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Li W, Li C, Liu P, Li Y, Xiang Y, Jia T, Xu Q, Ji L. Development and Preliminary Validation of a Pneumatic Focal Vibration System to the Mitigation of Post-Stroke Spasticity. IEEE Trans Neural Syst Rehabil Eng 2021; 29:380-388. [PMID: 33460383 DOI: 10.1109/tnsre.2021.3052187] [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: 11/10/2022]
Abstract
Some evidence has demonstrated that focal vibration (FV) plays an important role in the mitigation of spasticity. However, the research on developing the FV system to mitigate the spasticity effectively has been seldom reported. To relieve post-stroke spasticity, a new pneumatic FV system has been proposed in this paper. An image processing approach, in which the edge of vibration actuator was identified by the Canny edge detector, was utilized to quantify this system's parameters: the frequency ranging from 44 Hz to 128 Hz and the corresponding amplitude. Taking one FV protocol with the frequency of 87 Hz and the amplitude 0.28 mm of this system as an example, a clinical experiment was carried out. In the clinical experiment, FV was applied over the muscle belly of the antagonist of spastic muscle for twelve chronic spastic stroke patients. Spasticity was quantified by the muscle compliance and area under the curve for muscle (AUC_muscle). The result has demonstrated that, in the state of flexion of spastic muscle, the AUC_muscle and muscle compliance of the spastic muscle significantly increased immediately after FV compared with before-FV, illustrating the mitigation of the spasticity. This study will not only provide a potential tool to relieve post-stroke spasticity, but also contribute to improving the sensory and motor function of patients with other neurological diseases, e.g. spinal cord injury, multiple sclerosis, Parkinson and dystonia, etc.
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Effect of a Novel Perturbation-Based Pinch Task Training on Sensorimotor Performance of Upper Extremity for Patients With Chronic Stroke: A Pilot Randomized Controlled Trial. Arch Phys Med Rehabil 2020; 102:811-818. [PMID: 33278364 DOI: 10.1016/j.apmr.2020.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 10/23/2020] [Accepted: 11/06/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the effects of perturbation-based pinch task training on the sensorimotor performance of the upper extremities of patients with chronic stroke via a novel vibrotactile therapy system. DESIGN A single-blinded randomized controlled trial. SETTING A university hospital. PARTICIPANTS Patients with chronic stroke (N=19) randomly assigned into either an experimental group or a control group completed the study. INTERVENTIONS In addition to 10 minutes of traditional sensorimotor facilitation, each participant in the experimental group received 20 minutes of perturbation-based pinch task training in each treatment session, and the controls received 20 minutes of task-specific motor training twice a week for 6 weeks. MAIN OUTCOME MEASURES The scores for the primary outcome, Semmes-Weinstein monofilament (SWM), and those for the secondary outcomes, Fugl-Meyer Assessment (FMA), amount of use, quality of movement (QOM) on the Motor Activity Log (MAL) scale, and box and block test (BBT), were recorded. All outcome measures were recorded at pretreatment, post treatment, and 12-week follow-up. RESULTS There were statistically significant between-group differences in the training-induced improvements revealed in the SWM results (P=.04) immediately after training and in the BBT results (P=.05) at the 12-week follow-up. The changes in muscle tone and in the QOM, SWM, and BBT scores indicated statistically significant improvements after 12 sessions of treatment for the experimental group. For the control group, a significant statistical improvement was found in the wrist (P<.001) and coordination (P=.01) component of the FMA score. CONCLUSIONS This study indicated that the perturbation-based pinch task training has beneficial effects on sensory restoration of the affected thumb in patients with chronic stroke.
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Avvantaggiato C, Casale R, Cinone N, Facciorusso S, Turitto A, Stuppiello L, Picelli A, Ranieri M, Intiso D, Fiore P, Ciritella C, Santamato A. Localized muscle vibration in the treatment of motor impairment and spasticity in post-stroke patients: a systematic review. Eur J Phys Rehabil Med 2020; 57:44-60. [PMID: 33111513 DOI: 10.23736/s1973-9087.20.06390-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION During the last decades, many studies have been carried out to understand the possible positive effects of vibration therapy in post-stroke rehabilitation. In particular, the use of localized muscle vibration (LMV) seems to have promising results. The aim of this systematic review was to describe the use of LMV in post-stroke patients to improve motor recovery, reducing spasticity and disability in both upper and lower limb. EVIDENCE ACQUISITION A search was conducted on PubMed, Scopus, Pedro and REHABDATA electronic database. Only randomized controlled trials have been included, excluding no-localized vibratory treatments and other pathological conditions. Fourteen studies met the inclusion criteria and were included in this review. EVIDENCE SYNTHESIS Collectively, the studies involved 425 stroke patients. Most studies included chronic stroke patients (ten) and treated only the upper limb (eleven). There is evidence that LMV therapy is effective in reducing spasticity and improving motor recovery, especially when associated with conventional physical therapy. CONCLUSIONS LMV may be a feasible and safe tool to be integrated into traditional and conventional neurorehabilitation programs for post-stroke patients to reduce spasticity. Analysis of the available clinical trials do not allow us to indicate vibration therapy as effective in functional motor recovery, despite some studies showed encouraging results. Further studies, with larger size of homogeneous patients and with a shared methodology are needed to produce more reliable data, especially on the lower limb.
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Affiliation(s)
- Christian Avvantaggiato
- Unit of Spasticity and Movement Disorders, Division of Physical Medicine and Rehabilitation, University Hospital of Foggia, Foggia, Italy.,Istituti Clinici Scientifici Maugeri, IRCCS Institute of Bari, Bari, Italy
| | - Roberto Casale
- OPUS Medica Persons, Care and Research (PC&R), Piacenza, Italy
| | - Nicoletta Cinone
- Unit of Spasticity and Movement Disorders, Division of Physical Medicine and Rehabilitation, University Hospital of Foggia, Foggia, Italy
| | - Salvatore Facciorusso
- Unit of Spasticity and Movement Disorders, Division of Physical Medicine and Rehabilitation, University Hospital of Foggia, Foggia, Italy
| | - Antonio Turitto
- Unit of Spasticity and Movement Disorders, Division of Physical Medicine and Rehabilitation, University Hospital of Foggia, Foggia, Italy
| | - Lucia Stuppiello
- Unit of Spasticity and Movement Disorders, Division of Physical Medicine and Rehabilitation, University Hospital of Foggia, Foggia, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, Neuromotor and Cognitive Rehabilitation Research Center, University of Verona, Verona, Italy
| | - Maurizio Ranieri
- Department of Basic Sciences, Neuroscience and Sense Organs, Aldo Moro University, Bari, Italy
| | - Domenico Intiso
- Department of Neuro-Rehabilitation IRCCS, Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, Foggia, Italy
| | - Pietro Fiore
- Istituti Clinici Scientifici Maugeri, IRCCS Institute of Bari, Bari, Italy.,Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Chiara Ciritella
- Unit of Spasticity and Movement Disorders, Division of Physical Medicine and Rehabilitation, University Hospital of Foggia, Foggia, Italy
| | - Andrea Santamato
- Unit of Spasticity and Movement Disorders, Division of Physical Medicine and Rehabilitation, University Hospital of Foggia, Foggia, Italy -
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Characterization of the stimulation output of four devices for focal muscle vibration. Med Eng Phys 2020; 85:97-103. [PMID: 33081969 DOI: 10.1016/j.medengphy.2020.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/18/2020] [Accepted: 10/04/2020] [Indexed: 11/20/2022]
Abstract
Different devices for mechano-acoustic muscle vibration became available on the market in the last ten years. Although the use of these vibrators is increasing in research and clinical settings, the features of their stimulation output were never described in literature. In this study we aimed to quantify and compare the stimulation output of the four most widespread pneumatic devices for focal muscle vibration available on the market. A piezoelectric pressure sensor was used to measure the pressure profile generated by the four selected devices in the following experimental conditions: i) measurement of the output changes associated with variations of the stimulation amplitude for three stimulation frequencies (100 Hz, 200 Hz, and 300 Hz); ii) measurement of the output changes during a 20-min long stimulation at constant frequency (300 Hz) and amplitude; iii) measurement of the output changes associated with the progressive activation of all stimulation channels at constant frequency (200 Hz) for different amplitudes. The maximum peak-to-peak amplitudes of the pressure waves were in the range 102 mbar - 369 mbar (below the maximum values declared by the different manufacturers). The shape of the pressure waves generated by the four devices was quasi-sinusoidal and asymmetric with respect to the atmospheric pressure. All output features had a remarkable intra- and inter-device variability. Further studies are required to support the technological improvement of the currently available devices and to focus the issues of vibration effectiveness, limitations, proper protocols, modalities of its application and assessment in neuromuscular training and rehabilitation.
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de-la-Torre R, Oña ED, Balaguer C, Jardón A. Robot-Aided Systems for Improving the Assessment of Upper Limb Spasticity: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2020; 20:E5251. [PMID: 32937973 PMCID: PMC7570987 DOI: 10.3390/s20185251] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/02/2020] [Accepted: 09/12/2020] [Indexed: 12/13/2022]
Abstract
Spasticity is a motor disorder that causes stiffness or tightness of the muscles and can interfere with normal movement, speech, and gait. Traditionally, the spasticity assessment is carried out by clinicians using standardized procedures for objective evaluation. However, these procedures are manually performed and, thereby, they could be influenced by the clinician's subjectivity or expertise. The automation of such traditional methods for spasticity evaluation is an interesting and emerging field in neurorehabilitation. One of the most promising approaches is the use of robot-aided systems. In this paper, a systematic review of systems focused on the assessment of upper limb (UL) spasticity using robotic technology is presented. A systematic search and review of related articles in the literature were conducted. The chosen works were analyzed according to the morphology of devices, the data acquisition systems, the outcome generation method, and the focus of intervention (assessment and/or training). Finally, a series of guidelines and challenges that must be considered when designing and implementing fully-automated robot-aided systems for the assessment of UL spasticity are summarized.
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Affiliation(s)
| | | | | | - Alberto Jardón
- Department of Systems Engineering and Automation, University Carlos III of Madrid, Avda. de la Universidad 30, 28911 Leganés, Spain; (R.d.-l.-T.); (E.D.O.); (C.B.)
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Calabrò RS, Russo M, Naro A, Ciurleo R, D'Aleo G, Rifici C, Balletta T, La Via C, Destro M, Bramanti P, Sessa E. Nabiximols plus robotic assisted gait training in improving motor performances in people with Multiple Sclerosis. Mult Scler Relat Disord 2020; 43:102177. [PMID: 32447249 DOI: 10.1016/j.msard.2020.102177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/03/2020] [Accepted: 05/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is an autoimmune demyelinating disease of the central nervous system, affecting ambulation even in people with only mild neurological signs. Patients with MS frequently experience spasticity, which contributes significantly to impair their motor functions, including ambulation, owing to muscle stiffness, spasms, and pain. OBJECTIVES To clarify the role of delta-9-tetrahydrocannabinol(THC):cannabidiol(CBD) oromucosal spray, coupled to robot-aided gait training (RAGT) using the Lokomat©Pro to improve functional ambulation in patients with MS. METHODS We compared 20 patients with MS, who were treated with THC:CBD oromucosal spray in add-on to the ongoing oral antispastic therapy (OAT) (group A), with 20 individuals with MS (matched for clinical-demographic characteristics) who were treated only with OAT (group B). Both the groups underwent RAGT using the Lokomat-Pro (three 45-minute sessions per week). Our primary outcome measures were the Functional Independence Measure (FIM) and the 10 meters walking test (10MWT). As secondary outcome measures we evaluated the brain cortical excitability by using Transcranial Magnetic Stimulation. Both parameters were taken before and after the end of the RAGT. RESULTS FIM improved in group A more than in group B (p<0.001). Moreover, 10MWT decreased in group A more than in group B (p<0.001). These clinical findings were paralleled by a more evident reshape of intracortical excitability in both upper and lower limbs, as suggested by motor evoked potential amplitude increase (p<0.001), intracortical inhibition strengthening (p<0.001), and intracortical facilitation decrease (p=0.01) in group A as compared to group B. CONCLUSIONS Our results suggest that the combined THC:CBD-RAGT approach could be useful in improving gait performance in patients with MS.
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Affiliation(s)
- Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino Pulejo, Via Palermo, SS 113, Ctr. Casazza; 98124, Messina, Italy.
| | - Margherita Russo
- IRCCS Centro Neurolesi Bonino Pulejo, Via Palermo, SS 113, Ctr. Casazza; 98124, Messina, Italy
| | - Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo, Via Palermo, SS 113, Ctr. Casazza; 98124, Messina, Italy
| | - Rossella Ciurleo
- IRCCS Centro Neurolesi Bonino Pulejo, Via Palermo, SS 113, Ctr. Casazza; 98124, Messina, Italy
| | - Giangaetano D'Aleo
- IRCCS Centro Neurolesi Bonino Pulejo, Via Palermo, SS 113, Ctr. Casazza; 98124, Messina, Italy
| | - Carmela Rifici
- IRCCS Centro Neurolesi Bonino Pulejo, Via Palermo, SS 113, Ctr. Casazza; 98124, Messina, Italy
| | - Tina Balletta
- IRCCS Centro Neurolesi Bonino Pulejo, Via Palermo, SS 113, Ctr. Casazza; 98124, Messina, Italy
| | - Cristian La Via
- IRCCS Centro Neurolesi Bonino Pulejo, Via Palermo, SS 113, Ctr. Casazza; 98124, Messina, Italy
| | - Massimo Destro
- IRCCS Centro Neurolesi Bonino Pulejo, Via Palermo, SS 113, Ctr. Casazza; 98124, Messina, Italy
| | - Placido Bramanti
- IRCCS Centro Neurolesi Bonino Pulejo, Via Palermo, SS 113, Ctr. Casazza; 98124, Messina, Italy
| | - Edoardo Sessa
- IRCCS Centro Neurolesi Bonino Pulejo, Via Palermo, SS 113, Ctr. Casazza; 98124, Messina, Italy
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Morone G, Cocchi I, Paolucci S, Iosa M. Robot-assisted therapy for arm recovery for stroke patients: state of the art and clinical implication. Expert Rev Med Devices 2020; 17:223-233. [PMID: 32107946 DOI: 10.1080/17434440.2020.1733408] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Robot-assisted therapy is an emerging approach that performs highly repetitive, intensive, task oriented and quantifiable neuro-rehabilitation. In the last decades, it has been increasingly used in a wide range of neurological central nervous system conditions implying an upper limb paresis. Results from the studies are controversial, for the many types of robots and their features often not accompanied by specific clinical indications about the target functions, fundamental for the individualized neurorehabilitation program.Areas covered: This article reviews the state of the art and perspectives of robotics in post-stroke rehabilitation for upper limb recovery. Classifications and features of robots have been reported in accordance with technological and clinical contents, together with the definition of determinants specific for each patient, that could modify the efficacy of robotic treatments. The possibility of combining robotic intervention with other therapies has also been discussed.Expert commentary: The recent wide diffusion of robots in neurorehabilitation has generated a confusion due to the commingling of technical and clinical aspects not previously clarified. Our critical review provides a possible hypothesis about how to match a robot with subject's upper limb functional abilities, but also highlights the need of organizing a clinical consensus conference about the robotic therapy.
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Affiliation(s)
- Giovanni Morone
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Ilaria Cocchi
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Stefano Paolucci
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Marco Iosa
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy
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Long-term analyses of spastic muscle behavior in chronic poststroke patients after near-infrared low-level laser therapy (808 nm): a double-blinded placebo-controlled clinical trial. Lasers Med Sci 2019; 35:1459-1467. [DOI: 10.1007/s10103-019-02920-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/12/2019] [Indexed: 12/29/2022]
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Li W, Li C, Xiang Y, Ji L, Hu H, Liu Y. Study of the activation in sensorimotor cortex and topological properties of functional brain network following focal vibration on healthy subjects and subacute stroke patients: An EEG study. Brain Res 2019; 1722:146338. [PMID: 31323197 DOI: 10.1016/j.brainres.2019.146338] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/12/2019] [Accepted: 07/15/2019] [Indexed: 12/16/2022]
Abstract
Modulation on cerebral cortex and cerebral networks can induce reorganization of the brain, which contributes to rehabilitation. Previous studies have proved that focal vibration (FV) on limb muscles can modulate the activities of sensorimotor cortex in healthy subjects (HS). The objective of this paper is to study the modulatory effects of FV on the sensorimotor cortex and cerebral network in HS and subacute stroke patients (SP). An experiment was designed and conducted, during which FV of 75 Hz was applied over biceps muscle of right limb of 10 HS and 10 SP with right hemiplegia. Electroencephalography (EEG) was recorded in the following phases: before FV, control condition and three sessions of FV. EEG analysis showed a significant decrease in motor-related power desynchronization (MRPD) of contralesional primary sensorimotor cortex (contralesional S1-M1) in the beta2 band (18-21 Hz) for SP during FV sessions, as well as in MRPD of bilateral S1-M1 in the beta1 (13-18 Hz) and the beta2 band for HS. Moreover, MRPD of contralesional S1-M1 was significantly lower than MRPD of ipsilesional S1-M1 during FV. Besides, a significant increase of global efficiency (E) and decrease of characteristic path length (L) were identified in the beta1 band for SP, whereas a significant increase of L was identified for HS. The results indicated that FV could enhance the excitability of contralesional S1-M1 and alter topological properties of functional brain network for SP, which was different in HS. This indication can contribute to understanding the modulatory effects of FV on cerebral cortex and cerebral network.
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Affiliation(s)
- Wei Li
- Division of Intelligent and Biomechanical System, State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China.
| | - Chong Li
- Division of Intelligent and Biomechanical System, State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China.
| | - Yun Xiang
- Department of Rehabilitation Medicine, Shenzhen Nanshan People's Hospital and the 6th Affiliated Hospital of Shenzhen University Health Science Center, China
| | - Linhong Ji
- Division of Intelligent and Biomechanical System, State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China.
| | - Hui Hu
- Department of Rehabilitation Medicine, Shenzhen Nanshan People's Hospital and the 6th Affiliated Hospital of Shenzhen University Health Science Center, China
| | - Yali Liu
- Department of Mechanical and Electrical Engineering, Beijing Institute of Technology, Haidian, Beijing, China
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Vojinovic TJ, Linley E, Zivanovic A, Rui Loureiro CV. Effects of Focal Vibration and Robotic Assistive Therapy on Upper Limb Spasticity in incomplete Spinal Cord Injury. IEEE Int Conf Rehabil Robot 2019; 2019:542-547. [PMID: 31374686 DOI: 10.1109/icorr.2019.8779566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Vibration stimulation seems to be an affordable easy-to-use rehabilitation tool. Focal muscle vibration (FV) has potential to reduce spasticity and enhance muscle strength and performance. Combined with robotic assisted movement therapy, the rehabilitation can benefit from improvement of more than one aspect. For example, FV could firstly decrease abnormally increased muscle tone and joint rigidity by tackling volitional control for easier robotic movement exercise. Exactly this approach is evaluated within a clinical trial presented in this paper. FV were applied to relaxed spastic wrist flexor and extensor muscles for 15min. Subsequently, the wrist was engaged in a robotic-assisted game-playing. Results from two cases who completed the trial showed short-term decrease in wrist stiffness as assessed by clinical spasticity measurement Modified Ashworth Scale (MAS). Active range of motion (AROM) and engineering joint stiffness (JS) measurements were estimated using a robotic apparatus and the results complemented previous observations. The AROM increased and JS decreased for both cases when compared at the beginning and at the end of each interventional session. These results are a part of an ongoing clinical trial but show promise for reducing repercussions of spasticity in incomplete spinal cord injury.
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The effects of robotic gait neurorehabilitation and focal vibration combined treatment in adult cerebral palsy. Neurol Sci 2019; 40:2633-2634. [DOI: 10.1007/s10072-019-03965-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 06/05/2019] [Indexed: 11/29/2022]
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Effects of Focal Vibration over Upper Limb Muscles on the Activation of Sensorimotor Cortex Network: An EEG Study. JOURNAL OF HEALTHCARE ENGINEERING 2019; 2019:9167028. [PMID: 31263527 PMCID: PMC6556786 DOI: 10.1155/2019/9167028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 04/08/2019] [Accepted: 05/12/2019] [Indexed: 12/19/2022]
Abstract
Studying the therapeutic effects of focal vibration (FV) in neurorehabilitation is the focus of current research. However, it is still not fully understood how FV on upper limb muscles affects the sensorimotor cortex in healthy subjects. To explore this problem, this experiment was designed and conducted, in which FV was applied to the muscle belly of biceps brachii in the left arm. During the experiment, electroencephalography (EEG) was recorded in the following three phases: before FV, during FV, and two minutes after FV. During FV, a significant lower relative power at C3 and C4 electrodes and a significant higher connection strength between five channel pairs (Cz-FC1, Cz-C3, Cz-CP6, C4-FC6, and FC6-CP2) in the alpha band were observed compared to those before FV. After FV, the relative power at C4 in the beta band showed a significant increase compared to its value before FV. The changes of the relative power at C4 in the alpha band had a negative correlation with the relative power of the beta band during FV and with that after FV. The results showed that FV on upper limb muscles could activate the bilateral primary somatosensory cortex and strengthen functional connectivity of the ipsilateral central area (FC1, C3, and Cz) and contralateral central area (CP2, Cz, C4, FC6, and CP6). These results contribute to understanding the effect of FV over upper limb muscles on the brain cortical network.
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Calabrò RS, Naro A, Pullia M, Porcari B, Torrisi M, La Rosa G, Manuli A, Billeri L, Bramanti P, Quattrini F. Improving Sexual Function by Using Focal Vibrations in Men with Spinal Cord Injury: Encouraging Findings from a Feasibility Study. J Clin Med 2019; 8:E658. [PMID: 31083543 PMCID: PMC6571747 DOI: 10.3390/jcm8050658] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/08/2019] [Accepted: 05/10/2019] [Indexed: 12/18/2022] Open
Abstract
Erectile dysfunction (ED) is a frequent and disabling condition in patients with spinal cord injury (SCI). Spasticity can negatively affect sexual intercourse, as it may interfere with positioning, mobility, and muscle activation and strength, leading to ED. The aim of our study was to evaluate the feasibility and efficacy of muscle vibration (MV) applied to the pelvic muscles in improving ED in men with SCI. Ten adult men with traumatic SCI were submitted to 15 sessions of MV, applied on the perineum and the suprapubic and sacrococcygeal areas, using a pneumatic vibrator. MV was performed three times a week for five consecutive weeks, each session lasting 30 min. Muscle tone and sexual function were assessed before and after MV using the Modified Ashworth Scale (MAS) and International Index of Erectile Function (IIEF). We assessed the cremasteric and bulbocavernosus reflexes, as well as the electrophysiological bulbocavernosus reflex (eBCR) and pudendal nerve somatosensory-evoked potential (PSEP). MV was safe and well tolerated. All the patients reported an improvement in MAS and IIEF, with better reflexive responses, and a significant increase in eBCR and PSEP amplitude. In conclusion, MV of the pelvic floor is a promising method to reduce segmental spasticity and improve ED in men with incomplete SCI. However, our findings require confirmation through a randomized clinical trial with a larger sample size and longer trial period to examine long-term after effects.
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Affiliation(s)
- Rocco Salvatore Calabrò
- Department of Robotic Neurorehabilitation, IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy.
| | - Antonino Naro
- Department of Robotic Neurorehabilitation, IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy.
| | - Massimo Pullia
- Department of Robotic Neurorehabilitation, IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy.
| | - Bruno Porcari
- Department of Robotic Neurorehabilitation, IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy.
| | - Michele Torrisi
- Department of Robotic Neurorehabilitation, IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy.
| | - Gianluca La Rosa
- Department of Robotic Neurorehabilitation, IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy.
| | - Alfredo Manuli
- Department of Robotic Neurorehabilitation, IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy.
| | - Luana Billeri
- Department of Robotic Neurorehabilitation, IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy.
| | - Placido Bramanti
- Department of Robotic Neurorehabilitation, IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy.
| | - Fabrizio Quattrini
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100 L'Aquila, Italy.
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Lotze M, Ladda AM, Stephan KM. Cerebral plasticity as the basis for upper limb recovery following brain damage. Neurosci Biobehav Rev 2019; 99:49-58. [DOI: 10.1016/j.neubiorev.2019.01.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 01/05/2023]
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Bonanno L, Russo M, Bramanti A, Calabrò RS, Marino S. Functional connectivity in multiple sclerosis after robotic rehabilitative treatment: A case report. Medicine (Baltimore) 2019; 98:e15047. [PMID: 31027053 PMCID: PMC6831415 DOI: 10.1097/md.0000000000015047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Multiple sclerosis (MS) is an inflammatory demyelinating disease of central nervous system and it is associated with an impaired motor function status. The efficacy of rehabilitation in promoting functional recovery and increasing quality of life in MS patients has been demonstrated. PATIENT CONCERNS A 47-year-old woman was diagnosed with relapsing-remitting multiple sclerosis (RRMS) in November 2014 because of left upper limb hypoesthesia and weakness with difficulty in hand manipulation skills (there was a 1-point Expanded Disability Status Scale (EDSS) progression, i.e., 2.5 vs 1.5). Magnetic resonance image (MRI) showed a new frontal right cortical high-signal-intensity lesion. DIAGNOSIS Neurological and MRI examination were suggestive of MS diagnosis. INTERVENTIONS Patient was treated with robotic rehabilitation and evaluated by a Glove Analyzer for fMRI system (GAF). Functional MRI (fMRI) was acquired before and at the end of rehabilitative treatment performed with robotic device (Armeo-power). OUTCOMES At the end of the rehabilitation program, most of the behavioral parameters, GAF and fMRI evaluation, showed a significative improvement. Moreover, fMRI showed a significantly increased functional activation within the sensory-motor network in the active, motor task. LESSONS Our findings suggest a possible restorative effect of robotics on brain networks. Moreover, we may argue that GAF may be a valuable tool in assessing functional recovery after upper limb rehabilitation, especially of associated to fMRI examination.
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Affiliation(s)
- Lilla Bonanno
- Scientific Institute of medical Research (IRCCS) Centro Neurolesi Bonino-Pulejo
| | - Margherita Russo
- Scientific Institute of medical Research (IRCCS) Centro Neurolesi Bonino-Pulejo
| | - Alessia Bramanti
- Institute of Applied Science and Intelligent System “ISASI Eduardo Caianiello”, National Research Council (CNR), Messina, Italy
| | | | - Silvia Marino
- Scientific Institute of medical Research (IRCCS) Centro Neurolesi Bonino-Pulejo
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Russo EF, Calabrò RS, Sale P, Vergura F, De Cola MC, Militi A, Bramanti P, Portaro S, Filoni S. Can muscle vibration be the future in the treatment of cerebral palsy-related drooling? A feasibility study. Int J Med Sci 2019; 16:1447-1452. [PMID: 31673235 PMCID: PMC6818199 DOI: 10.7150/ijms.34850] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/05/2019] [Indexed: 01/20/2023] Open
Abstract
Background: Drooling is an involuntary loss of saliva from the mouth, and it is a common problem for children with cerebral palsy (CP). The treatment may be pharmacological, surgical, or speech-related. Repeated Muscle Vibration (rMV) is a proprioceptive impulse that activates fibers Ia reaching the somatosensory and motor cortex. Aim: The aim of the study is to evaluate the effectiveness of rMV in the treatment of drooling in CP. Design, setting and population: This was a rater blinded prospective feasibility study, performed at the "Gli Angeli di Padre Pio" Foundation, Rehabilitation Centers (Foggia, Italy), involving twenty-two CP patients affected by drooling (aged 5-15, mean 9,28 ± 3,62). Children were evaluated at baseline (T0), 10 days (T1), 1 month (T2) and 3 months (T3) after the treatment. Methods: The degree and impact of drooling was assessed by using the Drooling Impact Scale (DIS), the Drooling Frequency and Severity Scale (DFSS), Visual Analogue Scale (VAS) and Drooling Quotient (DQ). An rMV stimulus under the chin symphysis was applied with a 30 min protocol for 3 consecutive days. Results: The statistical analysis shows that DIS, DFSS, VAS, DQ improved with significant differences in the multiple comparisons between T1 vs T2, T1 vs T3 and T1 vs T4 (p≤0.001). Conclusion This study demonstrates that rMV might be a safe and effective tool in reducing drooling in patients with CP. The vibrations can improve the swallowing mechanisms and favor the acquisition of the maturity of the oral motor control in children with CP.
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Affiliation(s)
- Emanuele F Russo
- Padre Pio Foundation and Rehabilitation Centers, San Giovanni Rotondo, Foggia, Italy
| | | | - Patrizio Sale
- Rehabilitation Unit, Department of Neurosciences, University of Padua
| | - Filomena Vergura
- Padre Pio Foundation and Rehabilitation Centers, San Giovanni Rotondo, Foggia, Italy
| | - Maria C De Cola
- Padre Pio Foundation and Rehabilitation Centers, San Giovanni Rotondo, Foggia, Italy
| | - Angela Militi
- Dipartimento di Scienze Biomediche odontoiatriche e delle immagini Morfologiche e Funzionali, University of Messina, Italy
| | | | | | - Serena Filoni
- Padre Pio Foundation and Rehabilitation Centers, San Giovanni Rotondo, Foggia, Italy
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Canu MH, Fourneau J, Coq JO, Dannhoffer L, Cieniewski-Bernard C, Stevens L, Bastide B, Dupont E. Interplay between hypoactivity, muscle properties and motor command: How to escape the vicious deconditioning circle? Ann Phys Rehabil Med 2018; 62:122-127. [PMID: 30394346 DOI: 10.1016/j.rehab.2018.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 09/24/2018] [Accepted: 09/30/2018] [Indexed: 10/28/2022]
Abstract
Activity-dependent processes addressing the central nervous system (CNS) and musculoskeletal structures are critical for maintaining motor performance. Chronic reduction in activity, whether due to a sedentary lifestyle or extended bed rest, results in impaired performance in motor tasks and thus decreased quality of life. In the first part of this paper, we give a narrative review of the effects of hypoactivity on the neuromuscular system and behavioral outcomes. Motor impairments arise from a combination of factors including altered muscle properties, impaired afferent input, and plastic changes in neural structure and function throughout the nervous system. There is a reciprocal interplay between the CNS and muscle properties, and these sensorimotor loops are essential for controlling posture and movement. As a result, patients under hypoactivity experience a self-perpetuating cycle, in with sedentarity leading to decreased motor activity and thus a progressive worsening of a situation, and finally deconditioning. Various rehabilitation strategies have been studied to slow down or reverse muscle alteration and altered motor performance. In the second part of the paper, we review representative protocols directed toward the muscle, the sensory input and/or the cerebral cortex. Improving an understanding of the loss of motor function under conditions of disuse (such as extended bed rest) as well as identifying means to slow this decline may lead to therapeutic strategies to preserve quality of life for a range of individuals. The most efficient strategies seem multifactorial, using a combination of approaches targeting different levels of the neuromuscular system.
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Affiliation(s)
- Marie-Hélène Canu
- EA 7369 "activité physique, muscle et santé", unité de recherche pluridisciplinaire sport santé société (URePSSS), université de Lille, 59000 Lille, France.
| | - Julie Fourneau
- EA 7369 "activité physique, muscle et santé", unité de recherche pluridisciplinaire sport santé société (URePSSS), université de Lille, 59000 Lille, France
| | - Jacques-Olivier Coq
- UMR 7289, CNRS, institut de neurosciences de la Timone, Aix-Marseille université, 13385 Marseille, France
| | - Luc Dannhoffer
- EA 7369 "activité physique, muscle et santé", unité de recherche pluridisciplinaire sport santé société (URePSSS), université de Lille, 59000 Lille, France
| | - Caroline Cieniewski-Bernard
- EA 7369 "activité physique, muscle et santé", unité de recherche pluridisciplinaire sport santé société (URePSSS), université de Lille, 59000 Lille, France
| | - Laurence Stevens
- EA 7369 "activité physique, muscle et santé", unité de recherche pluridisciplinaire sport santé société (URePSSS), université de Lille, 59000 Lille, France
| | - Bruno Bastide
- EA 7369 "activité physique, muscle et santé", unité de recherche pluridisciplinaire sport santé société (URePSSS), université de Lille, 59000 Lille, France
| | - Erwan Dupont
- EA 7369 "activité physique, muscle et santé", unité de recherche pluridisciplinaire sport santé société (URePSSS), université de Lille, 59000 Lille, France
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Picelli A, Santamato A, Chemello E, Cinone N, Cisari C, Gandolfi M, Ranieri M, Smania N, Baricich A. Adjuvant treatments associated with botulinum toxin injection for managing spasticity: An overview of the literature. Ann Phys Rehabil Med 2018; 62:291-296. [PMID: 30219307 DOI: 10.1016/j.rehab.2018.08.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 08/20/2018] [Accepted: 08/20/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE A wide range of adjunct therapies after botulinum toxin administration have been proposed. The aim of the present paper is to provide an overview of major writings dealing with adjuvant (non-pharmacological) treatments associated with botulinum toxin for managing spasticity in order to provide some up-to-date information about the usefulness of the most commonly used procedures. METHODS The literature in PubMed was searched with the MeSH terms botulinum toxins, muscle spasticity, physical therapy modalities, and rehabilitation. The results were limited to studies focusing on adjuvant treatments associated with botulinum toxin for managing spasticity. We excluded papers on the use of non-drug treatments for spasticity not associated with botulinum toxin serotype A (BoNT-A) injection. Relevant literature known to the authors along with this complementary search represented the basis for this overview of the literature. RESULTS Adhesive taping and casting effectively improved the botulinum toxin effect in patients with upper- and lower-limb spasticity. There is level 1 evidence that casting is better than taping for outcomes including spasticity, range of motion and gait. However, consensus about their most appropriate timing, duration, target and material is lacking. In terms of physical modalities combined with botulinum toxin injection, we found level 1 evidence that extracorporeal shock wave therapy is better than electrical stimulation for some post-injection outcomes including spasticity and pain. Furthermore, electrical stimulation of injected muscles might be useful to boost the toxin effect. However, the best stimulation protocol has not been defined. In addition, we found level 2b evidence that whole-body vibration therapy might reduce spasticity with cerebral palsy. CONCLUSION Future research in this field should focus on investigating the most appropriate post-injection treatment protocol for each goal to achieve.
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Affiliation(s)
- Alessandro Picelli
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neurorehabilitation Unit, Department of Neurosciences, Hospital Trust of Verona, Verona, Italy.
| | - Andrea Santamato
- Physical Medicine & Rehabilitation Section, 'OORR' Hospital, University of Foggia, Foggia, Italy
| | - Elena Chemello
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Nicoletta Cinone
- Physical Medicine & Rehabilitation Section, 'OORR' Hospital, University of Foggia, Foggia, Italy
| | - Carlo Cisari
- Health Sciences Department, Università del Piemonte Orientale, Novara, Italy
| | - Marialuisa Gandolfi
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neurorehabilitation Unit, Department of Neurosciences, Hospital Trust of Verona, Verona, Italy
| | - Maurizio Ranieri
- Physical Medicine & Rehabilitation Section, 'OORR' Hospital, University of Foggia, Foggia, Italy
| | - Nicola Smania
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neurorehabilitation Unit, Department of Neurosciences, Hospital Trust of Verona, Verona, Italy
| | - Alessio Baricich
- Health Sciences Department, Università del Piemonte Orientale, Novara, Italy
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Barbosa DD, Trojahn MR, Porto DVG, Hentschke GS, Hentschke VS. Strength training protocols in hemiparetic individuals post stroke: a systematic review. FISIOTERAPIA EM MOVIMENTO 2018. [DOI: 10.1590/1980-5918.031.ao27] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Hemiparesis is one of the main sequels of stroke. Evidence suggests that muscle strength exercises are important in rehabilitation programs for hemiparetic patients, but wide variation in previously studied protocols makes the most suitable choice difficult in clinical practice. Objective: The aim of this study was to investigate strength training protocols for people with hemiparesis after stroke. Methods: A systematic review of literature was performed in the PubMed, PEDro (Physiotherapy Evidence Database), SciELO (Scientific Electronic Library Online), and LILACS (Latin American and Caribbean Literature in Health Science) databases. Only controlled clinical studies that contained strength training protocols for hemiparesis after stroke were selected. Results: In total, 562 articles were found. Of them, 12 were accepted for the systematic review. Although strength training protocols are effective in hemiparetic patients, we did not found a standard method for strength training. Conclusion: This systematic revision highlights the lack of a standard protocol for strength training, considering the following training parameters: volume, intensity, frequency, series, and repetitions. Isotonic exercises are most commonly used.
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