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Blanco-Diaz CF, Guerrero-Mendez CD, de Andrade RM, Badue C, De Souza AF, Delisle-Rodriguez D, Bastos-Filho T. Decoding lower-limb kinematic parameters during pedaling tasks using deep learning approaches and EEG. Med Biol Eng Comput 2024:10.1007/s11517-024-03147-3. [PMID: 39028484 DOI: 10.1007/s11517-024-03147-3] [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: 09/18/2023] [Accepted: 05/29/2024] [Indexed: 07/20/2024]
Abstract
Stroke is a neurological condition that usually results in the loss of voluntary control of body movements, making it difficult for individuals to perform activities of daily living (ADLs). Brain-computer interfaces (BCIs) integrated into robotic systems, such as motorized mini exercise bikes (MMEBs), have been demonstrated to be suitable for restoring gait-related functions. However, kinematic estimation of continuous motion in BCI systems based on electroencephalography (EEG) remains a challenge for the scientific community. This study proposes a comparative analysis to evaluate two artificial neural network (ANN)-based decoders to estimate three lower-limb kinematic parameters: x- and y-axis position of the ankle and knee joint angle during pedaling tasks. Long short-term memory (LSTM) was used as a recurrent neural network (RNN), which reached Pearson correlation coefficient (PCC) scores close to 0.58 by reconstructing kinematic parameters from the EEG features on the delta band using a time window of 250 ms. These estimates were evaluated through kinematic variance analysis, where our proposed algorithm showed promising results for identifying pedaling and rest periods, which could increase the usability of classification tasks. Additionally, negative linear correlations were found between pedaling speed and decoder performance, thereby indicating that kinematic parameters between slower speeds may be easier to estimate. The results allow concluding that the use of deep learning (DL)-based methods is feasible for the estimation of lower-limb kinematic parameters during pedaling tasks using EEG signals. This study opens new possibilities for implementing controllers most robust for MMEBs and BCIs based on continuous decoding, which may allow for maximizing the degrees of freedom and personalized rehabilitation.
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Affiliation(s)
| | | | | | - Claudine Badue
- Department of Informatics, Federal University of Espirito Santo, Vitoria, Brazil
| | | | - Denis Delisle-Rodriguez
- Edmond and Lily Safra International Institute of Neurosciences, Santos Dumont Institute, Macaiba, RN, Brazil
| | - Teodiano Bastos-Filho
- Postgraduate Program in Electrical Engineering, Federal University of Espirito Santo, Vitoria, Brazil
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Diller F, Scheuermann G, Wiebel A. Visual Cue Based Corrective Feedback for Motor Skill Training in Mixed Reality: A Survey. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2024; 30:3121-3134. [PMID: 37015488 DOI: 10.1109/tvcg.2022.3227999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
When learning a motor skill it is helpful to get corrective feedback from an instructor. This will support the learner to execute the movement correctly. With modern technology, it is possible to provide this feedback via mixed reality. In most cases, this involves visual cues to help the user understand the corrective feedback. We analyzed recent research approaches utilizing visual cues for feedback in mixed reality. The scope of this article is visual feedback for motor skill learning, which involves physical therapy, exercise, rehabilitation etc. While some of the surveyed literature discusses therapeutic effects of the training, this article focuses on visualization techniques. We categorized the literature from a visualization standpoint, including visual cues, technology and characteristics of the feedback. This provided insights into how visual feedback in mixed reality is applied in the literature and how different aspects of the feedback are related. The insights obtained can help to better adjust future feedback systems to the target group and their needs. This article also provides a deeper understanding of the characteristics of the visual cues in general and promotes future, more detailed research on this topic.
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Nath D, Singh N, Saini M, Banduni O, Kumar N, Srivastava MVP, Mehndiratta A. Clinical potential and neuroplastic effect of targeted virtual reality based intervention for distal upper limb in post-stroke rehabilitation: a pilot observational study. Disabil Rehabil 2024; 46:2640-2649. [PMID: 37383015 DOI: 10.1080/09638288.2023.2228690] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/18/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE A library of Virtual Reality (VR) tasks has been developed for targeted post-stroke rehabilitation of distal upper extremities. The objective of this pilot study was to evaluate the clinical potential of the targeted VR-based therapeutic intervention in a small cohort of patients specifically with chronic stroke. Furthermore, our aim was to explore the possible neuronal reorganizations in corticospinal pathways in response to the distal upper limb targeted VR-intervention. METHODOLOGY Five patients with chronic stroke were enrolled in this study and were given VR-intervention of 20 sessions of 45 min each. Clinical Scales, cortical-excitability measures (using Transcranial Magnetic Stimulation): Resting Motor Threshold (RMT), and Motor Evoked Potential (MEP) amplitude, task-specific performance metrics i.e., Time taken to complete the task (TCT), smoothness of trajectory, relative % error were evaluated pre- and post-intervention to evaluate the intervention-induced improvements. RESULTS Pre-to post-intervention improvements were observed in Fugl-Meyer Assessment (both total and wrist/hand component), Modified Barthel Index, Stroke Impact Scale, Motor Assessment Scale, active range of motion at wrist, and task-specific outcome metrics. Pre-to post-intervention ipsilesional RMT reduced (mean ∼9%) and MEP amplitude increased (mean ∼29µV), indicating increased cortical excitability at post-intervention. CONCLUSION VR-training exhibited improved motor outcomes and cortical-excitability in patients with stroke. Neurophysiological changes observed in terms of improved cortical-excitability might be a consequence of plastic reorganization induced by VR-intervention.
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Affiliation(s)
- Debasish Nath
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi, India
| | - Neha Singh
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi, India
| | - Megha Saini
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi, India
| | - Onika Banduni
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi, India
| | - Nand Kumar
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Amit Mehndiratta
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi, India
- Department of Biomedical Engineering, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Curiel RC, Nakamura T, Kuzuoka H, Kanaya T, Prahm C, Matsumoto K. Virtual Reality Self Co-Embodiment: An Alternative to Mirror Therapy for Post-Stroke Upper Limb Rehabilitation. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2024; 30:2390-2399. [PMID: 38437102 DOI: 10.1109/tvcg.2024.3372035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
We present Virtual Reality Self Co-embodiment, a new method for post-stroke upper limb rehabilitation. It is inspired by mirror therapy, where the patient's healthy arm is involved in recovering the affected arm's motion. By tracking the user's head, wrists, and fingers' positions, our new approach allows the handicapped arm to control a digital avatar in order to pursue a reaching task. We apply the concept of virtual co-embodiment to use the information from the unaffected arm and complete the affected limb's impaired motion, which is our added unique feature. This requires users to mechanically involve the incapacitated area as much as possible, prioritizing actual movement rather than the sole imagination of it. As a result, subjects will see a seemingly normally functional virtual arm primarily controlled by their handicapped extremity, but with the constant support of their healthy limb's motion. Our experiment compares the task execution performance and embodiment perceived when interacting with both mirror therapy and our proposed technique. We found that our approach's provided sense of ownership is mildly impacted by users' motion planning response times, which mirror therapy does not exhibit. We also observed that mirror therapy's sense of ownership is moderately affected by the subject's proficiency while executing the assigned task, which our new method did not display. The results indicate that our proposed method provides similar embodiment and rehabilitation capabilities to those perceived from existing mirror therapy. This experiment was performed in healthy individuals to have an unbiased comparison of how mirror therapy's and VRSelfCo's task performance and degree of virtual embodiment compare, but future work explores the possibility of applying this new approach to actual post-stroke patients.
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Jo S, Jang H, Kim H, Song C. 360° immersive virtual reality-based mirror therapy for upper extremity function and satisfaction among stroke patients: a randomized controlled trial. Eur J Phys Rehabil Med 2024; 60:207-215. [PMID: 38483333 PMCID: PMC11114156 DOI: 10.23736/s1973-9087.24.08275-3] [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: 10/13/2023] [Revised: 01/24/2024] [Accepted: 02/19/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Stroke is a leading cause of long-term disability worldwide; therefore, an effective rehabilitation strategy is fundamental. Mirror therapy (MT) has been a popular approach for upper extremity rehabilitation, but it presents some limitations. Recent advancements in virtual reality (VR) technology have introduced immersive VR-based MT, potentially overcoming these limitations and enhancing rehabilitation outcomes. AIM This study aimed to evaluate the effectiveness of a novel 360° immersive virtual reality-based MT (360MT) in upper extremity rehabilitation for stroke patients, comparing it to traditional MT (TMT) and conventional physical therapy control group (CG). DESIGN A prospective, active control, assessor blinded, parallel groups, randomized controlled trial. POPULATION Forty-five participants with chronic stroke within six months of onset. METHODS The participants were randomly allocated to 360MT, TMT, or CG groups. Outcome measures included Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Box and Block Test (BBT), and Manual Function Test (MFT). Additionally, patient experience and satisfaction in the groups of 360MT and TMT were assessed through questionnaires and interviews. RESULTS Results revealed that the 360MT group showed significantly greater improvements in FMA-UE, MFT and BBT compared to TMT (P<0.05) and CG (P<0.001) groups. Patient experience and satisfaction were more favorable in the 360MT group, with participants reporting higher engagement and motivation. CONCLUSIONS 360MT appears to be a promising approach for upper extremity rehabilitation in stroke patients, providing better outcomes and higher patient satisfaction. However, further research is needed to confirm these findings and strengthen the evidence base for 360MT in stroke rehabilitation. CLINICAL REHABILITATION IMPACT 360MT demonstrated notably enhanced upper extremity rehabilitation outcomes as well as better patient satisfaction among chronic stroke patients within six months of onset compared to traditional MT and conventional physical therapy. This novel approach not only fostered functional improvements but also elevated levels of engagement and motivation among participants, suggesting a promising future application in stroke rehabilitation framework.
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Affiliation(s)
- Sungbae Jo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Hoon Jang
- Department of Physical Therapy, Graduate School of Sahmyook University, Seoul, South Korea
| | - Hyunjin Kim
- Department of Rehabilitation Medicine, Hanyang University Guri Hospital, Gyeonggi-do, South Korea
| | - Changho Song
- Department of Physical Therapy, College of Health Science, Sahmyook University, Seoul, South Korea -
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Mollà-Casanova S, Page Á, López-Pascual J, Inglés M, Sempere-Rubio N, Aguilar-Rodríguez M, Muñoz-Gómez E, Serra-Añó P. Effects of mirror neuron activation therapies on functionality in older adults: Systematic review and meta-analysis. Geriatr Nurs 2024; 56:115-123. [PMID: 38346365 DOI: 10.1016/j.gerinurse.2024.02.006] [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: 12/13/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE To identify the effects of mirror neuron activation (MNAT) combined or not with physical exercise (PE) in healthy older adults, on functionality, balance, gait velocity and risk of falls. METHODS A systematic electronic search was performed in PubMed/MEDLINE, Cochrane, and Embase databases. RESULTS Thirteen randomized controlled trials were included in the qualitative analysis, and eleven in the quantitative analysis. All studies showed fair to high quality and the most frequent high-risk bias was "Blinding of participants and personnel". Compared to the control condition, higher improvement was shown in older people who received MNAT, on functionality (1.57 [0.57, 2.62], balance (1.95 [1.32, 2.572]), and gait velocity (1.20 [0.30, 2.11]). Compared to PE, MNAT combined with PE does not improve functionality. More studies are needed to assess MNAT effectiveness in the rest of the outcomes. CONCLUSIONS Neuron system activation through MNAT improves relevant abilities in older adults, with better results when including functional activities. However, the beneficial effects on these variables of adding MNAT to a PE program are controversial.
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Affiliation(s)
- Sara Mollà-Casanova
- UBIC research group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Álvaro Page
- Instituto Universitario de Ingeniería Mecánica y Biomecánica, Universitat Politècnica de València, Camino de Vera s/n E46022, Valencia, Spain
| | - Juan López-Pascual
- Instituto de Biomecánica de Valencia, Universitat Politècnica de València, Camino de Vera s/n E46022, Valencia, Spain
| | - Marta Inglés
- UBIC research group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Núria Sempere-Rubio
- UBIC research group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Marta Aguilar-Rodríguez
- UBIC research group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Elena Muñoz-Gómez
- UBIC research group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain.
| | - Pilar Serra-Añó
- UBIC research group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
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Sousa DL, Teixeira S, Fontenele JE, Santos RM, Pereira L, Baluz R, Bastos VH, Teles AS. Health Care Professional-Supported Co-Design of a Mime Therapy-Based Serious Game for Facial Rehabilitation. JMIR Serious Games 2024; 12:e52661. [PMID: 38265856 PMCID: PMC10851117 DOI: 10.2196/52661] [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: 09/11/2023] [Revised: 11/09/2023] [Accepted: 12/29/2023] [Indexed: 01/25/2024] Open
Abstract
This research letter presents the co-design process for RG4Face, a mime therapy-based serious game that uses computer vision for human facial movement recognition and estimation to help health care professionals and patients in the facial rehabilitation process.
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Affiliation(s)
| | | | | | | | | | - Rodrigo Baluz
- Parnaíba Delta Federal University, Parnaíba, Brazil
- State University of Piauí, Campus Parnaíba, Parnaíba, Brazil
| | | | - Ariel Soares Teles
- Parnaíba Delta Federal University, Parnaíba, Brazil
- Federal Institute of Maranhão, Campus Araioses, Araioses, Brazil
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Sparling T, Iyer L, Pasquina P, Petrus E. Cortical Reorganization after Limb Loss: Bridging the Gap between Basic Science and Clinical Recovery. J Neurosci 2024; 44:e1051232024. [PMID: 38171645 PMCID: PMC10851691 DOI: 10.1523/jneurosci.1051-23.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/28/2023] [Accepted: 09/29/2023] [Indexed: 01/05/2024] Open
Abstract
Despite the increasing incidence and prevalence of amputation across the globe, individuals with acquired limb loss continue to struggle with functional recovery and chronic pain. A more complete understanding of the motor and sensory remodeling of the peripheral and central nervous system that occurs postamputation may help advance clinical interventions to improve the quality of life for individuals with acquired limb loss. The purpose of this article is to first provide background clinical context on individuals with acquired limb loss and then to provide a comprehensive review of the known motor and sensory neural adaptations from both animal models and human clinical trials. Finally, the article bridges the gap between basic science researchers and clinicians that treat individuals with limb loss by explaining how current clinical treatments may restore function and modulate phantom limb pain using the underlying neural adaptations described above. This review should encourage the further development of novel treatments with known neurological targets to improve the recovery of individuals postamputation.Significance Statement In the United States, 1.6 million people live with limb loss; this number is expected to more than double by 2050. Improved surgical procedures enhance recovery, and new prosthetics and neural interfaces can replace missing limbs with those that communicate bidirectionally with the brain. These advances have been fairly successful, but still most patients experience persistent problems like phantom limb pain, and others discontinue prostheses instead of learning to use them daily. These problematic patient outcomes may be due in part to the lack of consensus among basic and clinical researchers regarding the plasticity mechanisms that occur in the brain after amputation injuries. Here we review results from clinical and animal model studies to bridge this clinical-basic science gap.
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Affiliation(s)
- Tawnee Sparling
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814
| | - Laxmi Iyer
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland 20817
| | - Paul Pasquina
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814
| | - Emily Petrus
- Department of Anatomy, Physiology and Genetics, Uniformed Services University, Bethesda, Maryland 20814
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Lee MT, Chen CC, Lu HL, Hsieh YW. Comparisons of three different modes of digital mirror therapy for post-stroke rehabilitation: Preliminary results of randomized controlled trial. Digit Health 2024; 10:20552076241260536. [PMID: 38846366 PMCID: PMC11155361 DOI: 10.1177/20552076241260536] [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: 11/15/2023] [Accepted: 05/23/2024] [Indexed: 06/09/2024] Open
Abstract
Objective Technologically adapted mirror therapy shows promising results in improving motor function for stroke survivors. The treatment effects of a newly developed multi-mode stroke rehabilitation system offering multiple training modes in digital mirror therapy remain unknown. This study aimed to examine the effects of unilateral mirror visual feedback (MVF) with unimanual training (UM-UT), unilateral MVF with bimanual training (UM-BT), and bilateral MVF with bimanual training (BM-BT) on clinical outcomes in stroke survivors, compared to classical mirror therapy (CMT). Methods Thirty-five participants were randomly assigned to one of four groups receiving fifteen 60-minute training sessions for 3-4 weeks. The Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Chedoke Arm and Hand Activity Inventory (CAHAI), Revised Nottingham Sensory Assessment (rNSA), Motor Activity Log (MAL), and EQ-5D-5L were administered at pre- and post-intervention and at 1-month follow-up. Results After intervention and follow-up, significant within-group treatment efficacies were found on most primary outcomes of the FMA-UE and CAHAI scores in all four groups. Significant within-group improvements in the secondary outcomes were found on the MAL and EQ-5D-5L index in the UM-BT group, and the rNSA tactile sensation and MAL quality of movement subscales in the BM-BT group. No significant between-group treatment efficacies were found. Conclusions UM-UT, UM-BT, BM-BT, and CMT led to similar clinical effects on the FMA-UE and can be considered effective alternative interventions for post-stroke upper-limb motor rehabilitation. UM-BT and BM-BT showed within-group improvements in functional performance in the patients' affected upper limbs in real-life activities.
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Affiliation(s)
- Meng-Ta Lee
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Chi Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsuan-Lun Lu
- Department of Biomedical Engineering, Da-Yeh University, Changhua County, Taiwan
| | - Yu-Wei Hsieh
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
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Abbate G, Giusti A, Randazzo L, Paolillo A. A mirror therapy system using virtual reality and an actuated exoskeleton for the recovery of hand motor impairments: a study of acceptability, usability, and embodiment. Sci Rep 2023; 13:22881. [PMID: 38129489 PMCID: PMC10739894 DOI: 10.1038/s41598-023-49571-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023] Open
Abstract
Hand motor impairments are one of the main causes of disabilities worldwide. Rehabilitation procedures like mirror therapy are given crucial importance. In the traditional setup, the patient moves the healthy hand in front of a mirror; the view of the mirrored motion tricks the brain into thinking that the impaired hand is moving as well, stimulating the recovery of the lost hand functionalities. We propose an innovative mirror therapy system that leverages and couples cutting-edge technologies. Virtual reality recreates an immersive and effective mirroring effect; a soft hand exoskeleton accompanies the virtual visual perception by physically inducing the mirrored motion to the real hand. Three working modes of our system have been tested with 21 healthy users. The system is ranked as acceptable by the system usability scale; it does not provoke adverse events or sickness in the users, according to the simulator sickness questionnaire; the three execution modes are also compared w.r.t. the sense of embodiment, evaluated through another customized questionnaire. The achieved results show the potential of our system as a clinical tool and reveal its social and economic impact.
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Affiliation(s)
- Gabriele Abbate
- Dalle Molle Institute for Artificial Intelligence (IDSIA), USI-SUPSI, Lugano, Switzerland.
| | - Alessandro Giusti
- Dalle Molle Institute for Artificial Intelligence (IDSIA), USI-SUPSI, Lugano, Switzerland
| | - Luca Randazzo
- Emovo Care, EPFL Innovation Park, Lausanne, Switzerland
| | - Antonio Paolillo
- Dalle Molle Institute for Artificial Intelligence (IDSIA), USI-SUPSI, Lugano, Switzerland
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He YZ, Huang ZM, Deng HY, Huang J, Wu JH, Wu JS. Feasibility, safety, and efficacy of task-oriented mirrored robotic training on upper-limb functions and activities of daily living in subacute poststroke patients: a pilot study. Eur J Phys Rehabil Med 2023; 59:660-668. [PMID: 37869761 PMCID: PMC10795073 DOI: 10.23736/s1973-9087.23.08018-8] [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: 04/30/2023] [Revised: 09/04/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Robotic training with high repetitions facilitates upper-limb movements but provides fewer benefits for activities of daily living. Integrating activities of daily living training tasks and mirror therapy into a robot may enhance the functional gains of robotic training. AIM The aim of this study was to investigate the feasibility, safety, and efficacy of the task-oriented mirrored upper-limb robotic training on the upper-limb functions and activities of daily living of subacute poststroke patients. DESIGN This study is a single-blinded, active-controlled pilot study. SETTING The study was carried out at rehabilitation outpatient clinic and ward. POPULATION A total of 32 subacute poststroke patients were enrolled in the study. METHODS The enrolled patients were allocated into two groups in a ratio of 1:1. The experimental group received 4 weeks of task-oriented mirrored upper-limb robotic training, consisting of five sessions of 30-minute duration, along with 30 minutes of conventional training. The control group only received 60 minutes of conventional training. The outcome measures were the Fugl-Meyer Assessment Scale for Upper Extremity, Modified Barthel Index, Stroke Self-Efficacy Scale, System Usability Scale, and Quebec User Evaluation with Assistive Technology. RESULTS All patients completed the full training sessions without significant adverse events related to robotic training. The task-oriented mirrored upper-limb robotic training led to increased Fugl-Meyer Assessment Scale for Upper Extremity (difference: 10.38 points, P<0.001) and Modified Barthel Index (difference: 18.38 points, P<0.001) scores, both of which exceeded the minimal clinically important difference. Intergroup analysis showed significantly higher improvements in the Fugl-Meyer Assessment Scale for Upper Extremity total scores, shoulder, wrist, and hand scores; and Modified Barthel Index scores in the experimental group than in conventional training (all P<0.05). Both groups showed significant improvements in Stroke Self-Efficacy Scale scores after the intervention (both P<0.001), but without a statistically significant intergroup difference (P>0.05). Participants in the experimental group scored an average usability perception score of 74.74 (good) and an average satisfaction score of four or more out of five. CONCLUSIONS In general, task-oriented mirrored upper-limb robotic training appears feasible and safe for subacute poststroke rehabilitation, facilitating the recovery of upper-limb functions and activities of daily living. CLINICAL REHABILITATION IMPACT Task-oriented mirrored upper-limb robotic training shows promise for future clinical rehabilitation and clinical trials involving subacute poststroke patients.
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Affiliation(s)
- You-Ze He
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Fujian Collaborative Innovation Center for Rehabilitation Technology, Fuzhou, China
| | - Zhen-Ming Huang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Hai-Yin Deng
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jia Huang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Fujian Collaborative Innovation Center for Rehabilitation Technology, Fuzhou, China
| | - Jian-Huang Wu
- Shenzhen Wisemen Medical Technologies Co., Ltd, Shenzhen, China
| | - Jing-Song Wu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China -
- Fujian Collaborative Innovation Center for Rehabilitation Technology, Fuzhou, China
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12
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Li X, Xing X, Yao N. Critical quality appraisal and algorithm development of clinical practice guidelines for management of poststroke sensory loss: a systematic review. BMJ Open 2023; 13:e074082. [PMID: 37977862 PMCID: PMC10660658 DOI: 10.1136/bmjopen-2023-074082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/17/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES This study aimed to assess the methodological quality of clinical practice guidelines (CPGs) associated with the management of poststroke sensory loss and develop an algorithm for health professionals. METHODS We conducted a systematic review for relevant CPGs published between 2017 and 2022 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Checklist. Appraisal of Guidelines for Research and Evaluation II instrument was used to assess methodological quality. Recommendations for managing poststroke sensory loss from high and average-quality CPGs were summarised and developed into an algorithm. RESULTS First, 1458 records were identified from the database searches and other sources. Finally, four CPGs were included: three were rated as high quality and one as average quality. Twenty-two recommendations were summarised from these CPGs and used to develop a draft algorithm. Then, we revised the draft algorithm developed by the authors based on expert feedback to form the final version. CONCLUSIONS The four CPGs included in this study had good quality. Based on these CPGs, we developed an algorithm to facilitate health professionals' adherence to CPGs and contribute to evidence-based medicine. In the future, more high-quality CPGs are required to give further scientific and convincing evidence to manage poststroke sensory loss.
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Affiliation(s)
- Xiao Li
- Intensive Care Unit, Nanjing Drum Tower Hospital, Nanjing, China
| | - Xingmin Xing
- Intensive Care Unit, Nanjing Drum Tower Hospital, Nanjing, China
| | - Nannan Yao
- Operating Theatre, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
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13
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Wei X, Zhang W, Zhang X, Sui Y, Yu W, Yuan Y. Effects of contralateral controlled functional electrical stimulation combined with mirror therapy on motor recovery and negative mood in stroke patients. Am J Transl Res 2023; 15:6159-6169. [PMID: 37969189 PMCID: PMC10641359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/08/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVE To investigate the effect of contralateral controlled functional electrical stimulation (CCFES) combined with mirror therapy on motor function and negative mood in stroke patients. METHODS Medical records of 94 stroke patients in Baoji Central Hospital admitted from April 2020 to October 2022 were retrospectively analyzed. Among them, 45 patients receiving routine rehabilitation training combined with mirror therapy were included in a control group, and 49 patients receiving CCFES combined with mirror therapy were in an observation group. Observation indexes included changes in Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS), Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD), Stroke Specific Quality of Life Scale (SS-QoL) score, and Barthel Index score before and after treatment. Patients with HAMA score >14 and HAMD score ≥20 after the treatment were included in a negative mood group, and logistics regression was used to analyze the risk factors for negative mood. RESULTS The observation group had a significantly higher overall response rate after treatment compared to the control group. In addition, the observation group exhibited significantly higher scores in the FMA and BBS after treatment, indicating better physical function (P<0.001). Furthermore, the observation group showed lower HAMA and HAMD scores after treatment, suggesting reduced anxiety and depression levels (P<0.001). The quality-of-life scores measured by the SS-QoL and the Barthel Index score were both increased in the observation group after treatment, indicating better overall well-being and functional independence (P<0.001). Logistic regression analysis revealed that age, post-treatment SS-QoL scores, and post-treatment Barthel Index were identified as influencing factors for the onset of adverse emotions in patients (P<0.05). CONCLUSION CCFES plus mirror therapy can effectively ameliorate limb function and lessen anxiety and depression in stroke patients, exerting beneficial effects on rehabilitation.
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Affiliation(s)
- Xiaoli Wei
- Department of Rehabilitation Medicine, Baoji Central Hospital No. 8 Jiangtan Road, Weibin District, Baoji 721008, Shaanxi, China
| | - Weizhou Zhang
- Department of Rehabilitation Medicine, Baoji Central Hospital No. 8 Jiangtan Road, Weibin District, Baoji 721008, Shaanxi, China
| | - Xingnan Zhang
- Department of Rehabilitation Medicine, Baoji Central Hospital No. 8 Jiangtan Road, Weibin District, Baoji 721008, Shaanxi, China
| | - Ying Sui
- Department of Rehabilitation Medicine, Baoji Central Hospital No. 8 Jiangtan Road, Weibin District, Baoji 721008, Shaanxi, China
| | - Wenjing Yu
- Department of Rehabilitation Medicine, Baoji Central Hospital No. 8 Jiangtan Road, Weibin District, Baoji 721008, Shaanxi, China
| | - Yuan Yuan
- Department of Rehabilitation Medicine, Baoji Central Hospital No. 8 Jiangtan Road, Weibin District, Baoji 721008, Shaanxi, China
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14
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Sari Hİ, Yigit S, Turhan B. Is mirror therapy combined with a routine physiotherapy protocol effective for children with obstetrical upper brachial plexus palsy? J Hand Ther 2023; 36:895-902. [PMID: 36697310 DOI: 10.1016/j.jht.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 01/25/2023]
Abstract
STUDY DESIGN Randomized controlled study. INTRODUCTION Mirror therapy is a rehabilitation strategy based on the repeated use of the mirror illusion and also one of the treatment choice of brachial plexus injuries. PURPOSE We aimed to determine the effects of mirror therapy combined with a routine rehabilitation program on upper limb motor function in children with obstetric brachial plexus injury. METHODS Twenty children with obstetric brachial palsy were included in this study. They were randomly allocated to either control (n = 10) or mirror therapy (n = 10) group. The following clinical tools were used to assess the upper extremity function: Active Movement Scale (AMS), Modified Mallet Scale (MMS), Hand Grip Strength (HGS) Test, Finger Grip Strength (FGSM) Test, Box and Block Test (BBT), Nine Hole Peg Test (9-HPT), and goniometric measurement. Both groups received the same routine physiotherapy program for 8 weeks. The study group underwent mirror therapy in addition to the rehabilitation program. RESULTS The mean age of the study population was 11.35 ± 4.12 years. There was no change in the goniometric values, AMS and MMS scores after the treatment in both groups (p > 0.05), except for the improvement of the wrist extension in the study group (p < 0.05). There was an increase in both HGS and FGS scores in the study group. Only FGS scores improved in the control group after the intervention (p < 0.05). 9-HPT and BBT scores improved in both groups (p < 0.05). All other parameters tested were comparable between the two groups after the treatment. CONCLUSIONS The results of this study did not show any additional benefits of mirror therapy combined with a rehabilitation protocol compared to routine physiotherapy treatment, but was not adequately powered to do so.
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Affiliation(s)
- Halil İbrahim Sari
- Department of Physical Therapy and Rehabilitation, Institue of Health Sciences, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Sedat Yigit
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Gaziantep University, Gaziantep, Turkey
| | - Begumhan Turhan
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Hasan Kalyoncu University, Gaziantep, Turkey; Department of Anatomy, Faculty of Medicine, Baskent University, Ankara, Turkey.
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15
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Hatwar V, Samal S, Harjpal P, Udhoji SP. Integrative Approach for Rehabilitation of an 11-Year-Old Child With Bilateral Hemiplegia. Cureus 2023; 15:e47950. [PMID: 38034158 PMCID: PMC10685993 DOI: 10.7759/cureus.47950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 10/29/2023] [Indexed: 12/02/2023] Open
Abstract
Over 80% of stroke patients suffer from the most frequent form, ischemic stroke. It is rare in the pediatric age group, with an estimated frequency of 1.6 per 100,000 per year. In this case report, we reviewed a case of an 11-year-old female child with bilateral hemiplegia. Motor impairments are defined as weakness or paralysis on the opposite side of the body from the lesion (hemiplegia or hemiparesis). Complications and impairments include difficulty swallowing or eating, communication difficulties (both receptive and expressive), emotional changes, loss of bladder or bowel control, muscle and nerve diseases, and language, speech, and memory problems. A patient-centered approach to rehabilitation interventions was given. The patient's functional ability was greatly enhanced due to the physiotherapy rehabilitation we used. Effective rehabilitation has taken advantage of the brain's capacity for repair and recovery. A patient-centered approach to rehabilitation interventions promotes healing and independence through restitution, compensation, and prevention. Task-oriented training using motor learning constructs, coupled with exercise science, forms the basis of the intervention. Every outcome measure that was used showed improvement in the patient.
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Affiliation(s)
- Vaishnavi Hatwar
- Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Snehal Samal
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Pallavi Harjpal
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Swadha P Udhoji
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Wardha, IND
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16
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Sun Z, Mu A, Wang C, Liu Q, Hao F, Wei J, Li W. Research on an ankle rehabilitation robot for hemiplegic patients after stroke. Proc Inst Mech Eng H 2023; 237:1177-1189. [PMID: 37706474 DOI: 10.1177/09544119231197082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
This paper proposes an ankle rehabilitation robot to assist hemiplegic patients with movement training. The robot consists of two symmetric mechanisms, allowing stroke survivors to execute ankle rehabilitation training based on physiological differences. LPMS-B sensors measure the range of movement (ROM) of the human ankle joint, and the results are used for control parameters of the robot. Control strategies for constant speed training mode, constant torque training mode, and combination training mode are put forth based on the hardware system of the robot. Experiments verify the feasibility of the robot for ankle rehabilitation training. Results show a maximum mean error of 0.3364° between the trajectory of the intact side and the affected side, a maximum mean error of 0.0335°/s between target speed and experimental speed, and a maximum mean error of 0.0775 N m between target torque and experimental torque. The ankle joint rehabilitation robot proposed in this paper can help patients complete the training well under the three control modes.
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Affiliation(s)
- Zhengdi Sun
- School of Mechanical and Precision Instrument Engineering, Xi'an University of Technology, Xi'an, Shaanxi, P.R. China
| | - Anle Mu
- School of Mechanical and Precision Instrument Engineering, Xi'an University of Technology, Xi'an, Shaanxi, P.R. China
| | - Chunbao Wang
- Department of Neurology, Shenzhen Second People's Hospital, Shenzhen, Guangdong, P.R. China
- Shenzhen Institute of Geriatrics, P.R. China
- MK Smart Robotics Co., LTD, P.R. China
| | - Quanquan Liu
- Department of Neurology, Shenzhen Second People's Hospital, Shenzhen, Guangdong, P.R. China
- Shenzhen Institute of Geriatrics, P.R. China
- MK Smart Robotics Co., LTD, P.R. China
| | - Fuxiang Hao
- School of Mechanical and Precision Instrument Engineering, Xi'an University of Technology, Xi'an, Shaanxi, P.R. China
| | - Jianjun Wei
- School of Mechanical and Transportation Engineering, Guangxi University of Science and Technology, Liuzhou, Guangxi, P.R. China
| | - Wei Li
- School of Mechanical Engineering, Zhengzhou University of Science and Technology, Zhenghzou, P.R.China
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17
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Quintana D, Rodríguez A, Boada I. Limitations and solutions of low cost virtual reality mirror therapy for post-stroke patients. Sci Rep 2023; 13:14780. [PMID: 37679388 PMCID: PMC10484971 DOI: 10.1038/s41598-023-40546-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/12/2023] [Indexed: 09/09/2023] Open
Abstract
Mirror therapy is applied to reduce phantom pain and as a rehabilitation technique in post-stroke patients. Using Virtual Reality and head-mounted displays this therapy can be performed in virtual scenarios. However, for its efficient use in clinical settings, some hardware limitations need to be solved. A new system to perform mirror therapy in virtual scenarios for post-stroke patients is proposed. The system requires the patient a standalone virtual reality headset with hand-tracking features and for the rehabilitator an external computer or tablet device. The system provides functionalities for the rehabilitator to prepare and follow-up rehabilitation sessions and a virtual scenario for the patient to perform rehabilitation. The system has been tested on a real scenario with the support of three experienced rehabilitators and considering ten post-stroke patients in individual sessions focused on upper limb motor rehabilitation. The development team observed all the sessions and took note of detected errors regarding technological aspects. Solutions to solve detected problems will be proposed and evaluated in terms of feasibility, performance cost, additional system cost, number of solved issues, new limitations, or advantages for the patient. Three types of errors were detected and solved. The first error is related to the position of the hands relative to the head-mounted display. To solve it the exercise area can be limited to avoid objectives that require turning the head too far. The second error is related to the interaction between the hands and the virtual objects. It can be solved making the main hand non-interactive. The last type of error is due to patient limitations and can be mitigated by having a virtual hand play out an example motion to bring the patient's attention back to the exercise. Other solutions have been evaluated positively and can be used in addition or instead of the selected ones. For mirror therapy based on virtual reality to be efficient in post-stroke rehabilitation the current head-mounted display-based solutions need to be complemented with specific strategies that avoid or mitigate the limitations of the technology and the patient. Solutions that help with the most common issues have been proposed.
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Affiliation(s)
- David Quintana
- Graphics and Imaging Laboratory, Institut Informàtica i Aplicacions, Universitat de Girona, Campus de Montilivi, 17003, Girona, Catalunya, Spain
| | - Antonio Rodríguez
- Graphics and Imaging Laboratory, Institut Informàtica i Aplicacions, Universitat de Girona, Campus de Montilivi, 17003, Girona, Catalunya, Spain
| | - Imma Boada
- Graphics and Imaging Laboratory, Institut Informàtica i Aplicacions, Universitat de Girona, Campus de Montilivi, 17003, Girona, Catalunya, Spain.
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18
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Gnocco M, Catalano MG, Grioli G, Trompetto C, Bicchi A. EMG-Based Control Strategies of a Supernumerary Robotic Hand for the Rehabilitation of Sub-Acute Stroke Patients: Proof of Concept. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941211 DOI: 10.1109/icorr58425.2023.10304688] [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: 11/10/2023]
Abstract
One of the most frequent and severe aftermaths of a stroke is the loss of upper limb functionality. Therapy started in the sub-acute phase proved more effective, mainly when the patient participates actively. Recently, a novel set of rehabilitation and support robotic devices, known as supernumerary robotic limbs, have been introduced. This work investigates how a surface electromyography (sEMG) based control strategy would improve their usability in rehabilitation, limited so far by input interfaces requiring to subjects some level of residual mobility. After briefly introducing the phenomena hindering post-stroke sEMG and its use to control robotic hands, we describe a framework to acquire and interpret muscle signals of the forearm extensors. We applied it to drive a supernumerary robotic limb, the SoftHand-X, to provide Task-Specific Training (TST) in patients with sub-acute stroke. We propose and describe two algorithms to control the opening and closing of the robotic hand, with different levels of user agency and therapist control. We experimentally tested the feasibility of the proposed approach on four patients, followed by a therapist, to check their ability to operate the hand. The promising preliminary results indicate sEMG-based control as a viable solution to extend TST to sub-acute post-stroke patients.
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19
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Chang WK, Lim H, Park SH, Lim C, Paik NJ, Kim WS, Ku J. Effect of immersive virtual mirror visual feedback on Mu suppression and coherence in motor and parietal cortex in stroke. Sci Rep 2023; 13:12514. [PMID: 37532803 PMCID: PMC10397282 DOI: 10.1038/s41598-023-38749-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/14/2023] [Indexed: 08/04/2023] Open
Abstract
We investigated the activation pattern of the motor cortex (M1) and parietal cortex during immersive virtual reality (VR)-based mirror visual feedback (MVF) of the upper limb in 14 patients with chronic stroke and severe upper limb hemiparesis and in 21 healthy controls. Participants performed wrist extension with unaffected wrists (dominant side in controls). In the MVF condition, movement of the affected hand was synchronized with that of the unaffected hand. In the no-MVF condition, only the movement of unaffected hand was shown. Mu suppression in bilateral M1 and parietal cortex and mu coherence were analyzed. In patients with stroke, MVF induced significant mu suppression in both the ipsilesional M1 and parietal lobes (p = 0.006 and p = 0.009, respectively), while mu suppression was observed in the bilateral M1 (p = 0.003 for ipsilesional and p = 0.041 for contralesional M1, respectively) and contralesional parietal lobes in the controls (p = 0.036). The ipsilesional mu coherence between the M1 and parietal cortex in patients with stroke was stronger than controls, regardless of MVF condition (p < 0.001), while mu coherence between interhemispheric M1 cortices was significantly weaker in patients with stroke (p = 0.032). Our findings provide evidence of the neural mechanism of MVF using immersive VR in patients with stroke.
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Affiliation(s)
- Won Kee Chang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyunmi Lim
- Department of Biomedical Engineering, College of Medicine, Keimyung University, 1095, Dalgubeol-daero, Dalseo-gu, Daegu, Republic of Korea
| | - Seo Hyun Park
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chaiyoung Lim
- Bundang Rusk Rehabilitation Speciality Hospital, Seongnam, Republic of Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
| | - Jeonghun Ku
- Department of Biomedical Engineering, College of Medicine, Keimyung University, 1095, Dalgubeol-daero, Dalseo-gu, Daegu, Republic of Korea.
- Department of Biomedical Engineering, School of Medicine, Keimyung University, Daegu, Republic of Korea.
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20
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Germanova K, Panidi K, Ivanov T, Novikov P, Ivanova GE, Villringer A, Nikulin VV, Nazarova M. Motor Decision-Making as a Common Denominator in Motor Pathology and a Possible Rehabilitation Target. Neurorehabil Neural Repair 2023; 37:577-586. [PMID: 37476957 DOI: 10.1177/15459683231186986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Despite the substantial progress in motor rehabilitation, patient involvement and motivation remain major challenges. They are typically addressed with communicational and environmental strategies, as well as with improved goal-setting procedures. Here we suggest a new research direction and framework involving Neuroeconomics principles to investigate the role of Motor Decision-Making (MDM) parameters in motivational component and motor performance in rehabilitation. We argue that investigating NE principles could bring new approaches aimed at increasing active patient engagement in the rehabilitation process by introducing more movement choice, and adapting existing goal-setting procedures. We discuss possible MDM implementation strategies and illustrate possible research directions using examples of stroke and psychiatric disorders.
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Affiliation(s)
- K Germanova
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, HSE University, Russian Federation
- Laboratory of the neurovisceral integration and neuromodulation, National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - K Panidi
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, HSE University, Russian Federation
| | - T Ivanov
- FSBI "Federal Center for Brain and Neurotechnologies" of FMBA of Russian Federation, Moscow, Russia
| | - P Novikov
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, HSE University, Russian Federation
| | - G E Ivanova
- FSBI "Federal Center for Brain and Neurotechnologies" of FMBA of Russian Federation, Moscow, Russia
| | - A Villringer
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - V V Nikulin
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - M Nazarova
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, HSE University, Russian Federation
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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21
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Yuan R, Wei X, Ye Y, Wang M, Jiang J, Li K, Zhu W, Zheng W, Wu C. The effects of the mirror therapy on shoulder function in patients with breast cancer following surgery: a randomized controlled trial. J Cancer Surviv 2023:10.1007/s11764-023-01398-x. [PMID: 37329478 DOI: 10.1007/s11764-023-01398-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 05/01/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE Shoulder dysfunction is one of the most bothersome questions for breast cancer survivors. Studies show that mirror therapy can improve shoulder function in patients with a limited shoulder range of motion and shoulder pain. Here, this article reports the results of a randomized controlled trial investigating the effects of the mirror therapy on shoulder function in patients with breast cancer following surgical treatments. METHODS Totally, 79 participants were divided to two groups receiving active range-of-motion upper limb exercise based on the mirror therapy or active range-of-motion upper limb exercise respectively for 8 weeks. Shoulder range of motion, Constant-Murley Score, Disabilities of Arm, Shoulder, and Hand Questionnaire, Tampa Scale of Kinesiophobia, Visual analog scale, and grip strength were measured at baseline (T0), 2 weeks (T1), 4 weeks (T2), and 8 weeks (T3). The effects of the intervention on shoulder function were analyzed in generalized estimation equation, from group, time, and the interactions between group and time based on the data from participants who completed at least one post-baseline observation RESULTS: At least one post-baseline observation was performed by 69 participants (n=34 mirror group, n=35 control group). 28(82.35%) participants in the mirror group adhered to the exercise compared to 30(85.71%) in the control group. Generalized estimation equation model showed group had main effects on forward flexion (Waldχ²=6.476, P=0.011), with the Cohen's d=0.54. The effects of the group on abduction, Constant-Murley Score, and Disabilities of Arm, Shoulder, and Hand Questionnaire were significant when fix the effects of the time. At 8 weeks, participants in the mirror group showed an improvement in abduction compared to the control group (P=0.005), the Cohen's d was 0.70. At 8 weeks, participants in the mirror group had a higher Constant-Murley Score than control group (P=0.009), with Cohen's effect size value of d=0.64. The mirror group showed a greater improvement on the Disability of Arm, Shoulder, and Hand Questionnaire than control group at 2 weeks, 4 weeks, and 8 weeks (P≤0.032), but with a weak effect size value of all (r≤0.32). Group had main effects on Tampa Scale of Kinesiophobia (Waldχ²=6.631, P=0.010), with the Cohen's effect size value of d=0.56. CONCLUSIONS Mirror therapy improved shoulder flexion, abduction, shoulder function in daily life, and arm function and symptom of the affected shoulder in patients with breast cancer following surgical treatment, while decreasing fear of movement/(re)injury. Mirror configuration needs to be improved in further research to increase its feasibility. IMPLICATIONS FOR CANCER SURVIVORS Breast cancer survivors can try mirror therapy as a practical and effective method in shoulder rehabilitation for a promotion on effects. TRIAL REGISTRATION ClinicalTrial.gov Identifier: ChiCTR2000033080.
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Affiliation(s)
- Ruzhen Yuan
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaolin Wei
- Obstetrics And Gynecology Hospital, Fudan University, Shanghai, China
| | - Yi Ye
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mingyue Wang
- Huadong Hospital Affiliated To Fudan University, Shanghai, China
| | - Jieting Jiang
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Kunpeng Li
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wei Zhu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Zheng
- Department of Galactophore, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Caiqin Wu
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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22
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Yao WX, Ge S, Zhang JQ, Hemmat P, Jiang BY, Liu XJ, Lu X, Yaghi Z, Yue GH. Bilateral transfer of motor performance as a function of motor imagery training: a systematic review and meta-analysis. Front Psychol 2023; 14:1187175. [PMID: 37333595 PMCID: PMC10273842 DOI: 10.3389/fpsyg.2023.1187175] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Objective The objective of this review was to evaluate the efficacy of mental imagery training (MIT) in promoting bilateral transfer (BT) of motor performance for healthy subjects. Data sources We searched 6 online-databases (Jul-Dec 2022) using terms: "mental practice," "motor imagery training," "motor imagery practice," "mental training," "movement imagery," "cognitive training," "bilateral transfer," "interlimb transfer," "cross education," "motor learning," "strength," "force" and "motor performance." Study selection and data extraction We selected randomized-controlled studies that examined the effect of MIT on BT. Two reviewers independently determined if each study met the inclusion criteria for the review. Disagreements were resolved through discussion and, if necessary, by a third reviewer. A total of 9 articles out of 728 initially identified studies were chosen for the meta-analysis. Data synthesis The meta-analysis included 14 studies for the comparison between MIT and no-exercise control (CTR) and 15 studies for the comparison between MIT and physical training (PT). Results MIT showed significant benefit in inducing BT compared to CTR (ES = 0.78, 95% CI = 0.57-0.98). The effect of MIT on BT was similar to that of PT (ES = -0.02, 95% CI = -0.15-0.17). Subgroup analyses showed that internal MIT (IMIT) was more effective (ES = 2.17, 95% CI = 1.57-2.76) than external MIT (EMIT) (ES = 0.95, 95% CI = 0.74-1.17), and mixed-task (ES = 1.68, 95% CI = 1.26-2.11) was more effective than mirror-task (ES = 0.46, 95% CI = 0.14-0.78) and normal-task (ES = 0.56, 95% CI = 0.23-0.90). No significant difference was found between transfer from dominant limb (DL) to non-dominant limb (NDL) (ES = 0.67, 95% CI = 0.37-0.97) and NDL to DL (ES = 0.87, 95% CI = 0.59-1.15). Conclusion This review concludes that MIT can serve as a valuable alternative or supplement to PT in facilitating BT effects. Notably, IMIT is preferable to EMIT, and interventions incorporating tasks that have access to both intrinsic and extrinsic coordinates (mixed-task) are preferred over those that involve only one of the two coordinates (mirror-task or normal-task). These findings have implications for rehabilitation of patients such as stroke survivors.
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Affiliation(s)
- Wan X. Yao
- Department of Kinesiology, College for Health, Community, and Policy, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Sha Ge
- College of Sports Science, Tianjin Normal University, Tianjin, China
| | - John Q. Zhang
- Department of Kinesiology, College for Health, Community, and Policy, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Parisa Hemmat
- Department of Kinesiology, College for Health, Community, and Policy, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Bo Y. Jiang
- School of Public Health, Jilin Medical University, Jilin, China
| | - Xiao J. Liu
- College of Art, Beijing Sport University, Beijing, China
| | - Xing Lu
- College of Art, Beijing Sport University, Beijing, China
| | - Zayd Yaghi
- Department of Kinesiology, College for Health, Community, and Policy, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Guang H. Yue
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States
- Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, United States
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23
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Mollà-Casanova S, Muñoz-Gómez E, Sempere-Rubio N, Inglés M, Aguilar-Rodríguez M, Page Á, López-Pascual J, Serra-Añó P. Effect of virtual running with exercise on functionality in pre-frail and frail elderly people: randomized clinical trial. Aging Clin Exp Res 2023:10.1007/s40520-023-02414-x. [PMID: 37188994 DOI: 10.1007/s40520-023-02414-x] [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: 02/07/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Virtual mirror therapies could increase the results of exercise, since the mirror neuron system produces an activation of motor execution cortical areas by observing actions performed by others. In this way, pre-frail and frail people could use this system to reach an exercise capacity threshold and obtain health benefits. AIM The aim of this study is to evaluate the effects of a virtual running (VR) treatment combined with specific physical gait exercise (PE) compared to placebo VR treatment combined with PE on functionality, pain, and muscular tone in pre-frail and frail older persons. METHODS A single blinded, two-arm, randomised controlled trial design was employed. Thirty-eight participants were divided into two intervention arms: Experimental Intervention (EI) group, in which VR and gait-specific physical exercises were administered and Control Intervention (CI) group, in which a placebo virtual gait and the same exercise programme was administered. Functionality, pain, and tone were assessed. RESULTS EI group improved in aerobic capacity, functional lower-limb strength, reaction time, and pain, while CI group remained the same. Regarding static balance and muscle tone, no differences were found for either group. Further analysis is needed to asses VR effectiveness for improving gait, stand-up and sit-down performance and velocity. CONCLUSIONS Virtual running therapy appears to enhance capacities related with voluntary movements (i.e., aerobic capacity, functional lower-limb strength, and reaction time) and reduce pain.
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Affiliation(s)
- Sara Mollà-Casanova
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag, 5, Valencia, Spain
| | - Elena Muñoz-Gómez
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag, 5, Valencia, Spain
| | - Núria Sempere-Rubio
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag, 5, Valencia, Spain.
| | - Marta Inglés
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag, 5, Valencia, Spain
| | - Marta Aguilar-Rodríguez
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag, 5, Valencia, Spain
| | - Álvaro Page
- Instituto Universitario de Ingeniería Mecánica y Biomecánica, Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain
| | - Juan López-Pascual
- Instituto de Biomecánica de Valencia, Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain
| | - Pilar Serra-Añó
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag, 5, Valencia, Spain
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Türkmen C, Konca M, Yetim B. Prioritization of neurologic rehabilitation interventions by ELECTRE-III analysis in subacute stroke patients. Acta Neurol Belg 2023; 123:181-189. [PMID: 35639258 DOI: 10.1007/s13760-022-01982-5] [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: 04/04/2022] [Accepted: 05/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Elimination and Choice Translating Reality (ELECTRE) III is a commonly used multicriteria decision-making (MCDM) method when alternatives are being prioritized in health sciences. The selection of the rehabilitation approach is the key factor to improve the upper extremity functions of stroke patients. Thus, choosing a reasonably good treatment approach will directly reduce the patient's cost to the government and caregivers, while also improving quality of life. The aim of our study was to prioritize the six different methods used in the rehabilitation of stroke patients with mild or moderate upper extremity dysfunction, using one of the MCDM methods based on experts' opinions. METHODS A three-stage face-to-face interview across Turkey, based on the ELECTRE-III method, was conducted with 18 physiotherapists specializing in the rehabilitation of mild or moderate stroke-induced upper extremity disorders. RESULTS According to ELECTRE-III, Circuit Class Therapy (CCT) is the best choice for treating upper extremity functional loss in general. It is also the best alternative in both the ascending and descending distillation processes of ELECTRE-III. On the other hand, Bobath neurodevelopmental treatment (NDT) has a similar success level according to ascending distillation. Mirror therapy and constraint-induced movement therapy are the third-best methods in the analysis. However, robotic rehabilitation is the least preferable treatment method according to the experts' judgments. CONCLUSIONS The results showed that rehabilitation interventions such as Bobath-NDT and proprioceptive neuromuscular facilitation, which are frequently used in developing countries, are still useful, and CCT is the most appropriate intervention for the transition from conventional methods to innovative models in these countries.
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Affiliation(s)
- Ceyhun Türkmen
- Faculty of Health Sciences, Çankırı Karatekin University, 18200 Sıhhiye st, Çankırı, Turkey.
| | - Murat Konca
- Faculty of Health Sciences, Çankırı Karatekin University, 18200 Sıhhiye st, Çankırı, Turkey
| | - Birol Yetim
- Faculty of Economics and Administrative Sciences, Hacettepe University, Beytepe, 06800, Ankara, Turkey
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Marek K, Zubrycki I, Miller E. Immersion Therapy with Head-Mounted Display for Rehabilitation of the Upper Limb after Stroke-Review. SENSORS (BASEL, SWITZERLAND) 2022; 22:9962. [PMID: 36560328 PMCID: PMC9785384 DOI: 10.3390/s22249962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/08/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
Immersive virtual therapy technology is a new method that uses head-mounted displays for rehabilitation purposes. It offers a realistic experience that puts the user in a virtual reality. This new type of therapy is used in the rehabilitation of stroke patients. Many patients after this disease have complications related to the upper extremities that limit independence in their everyday life, which affects the functioning of society. Conventional neurological rehabilitation can be supplemented by the use of immersive virtual therapy. The system allows patients with upper limb dysfunction to perform a motor and task-oriented training in virtual reality that is individually tailored to their performance. The complete immersion therapy itself is researched and evaluated by medical teams to determine the suitability for rehabilitation of the upper limb after a stroke. The purpose of this article is to provide an overview of the latest research (2019-2022) on immersive virtual reality with head-mounted displays using in rehabilitation of the upper extremities of stroke patients.
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Affiliation(s)
- Klaudia Marek
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa 14, 93-113 Lodz, Poland
| | - Igor Zubrycki
- Institute of Automatic Control, Lodz University of Technology, Stefanowskiego 18, 90-537 Lodz, Poland
| | - Elżbieta Miller
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa 14, 93-113 Lodz, Poland
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Examining the Effects of Mirror Therapy on Psychological Readiness and Perception of Pain in ACL-Injured Female Football Players. J Funct Morphol Kinesiol 2022; 7:jfmk7040113. [PMID: 36547659 PMCID: PMC9788338 DOI: 10.3390/jfmk7040113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Virtual reality-guided imagery (VRGI) and mirror therapy (MT) have been used in isolation to treat patients suffering from different injuries. However, no attempts have been made to understand the effects of combined VRGI and MT added to conventional physical therapy, and no information exists regarding perceptual responses to these rehabilitation strategies in female football players. Thus, this study aimed to examine the effect of MT added to conventional rehabilitation on psychological readiness and perception of pain in ACL-injured female football players. Thirty ACL-injured female football players competing in the 2nd and 3rd Italian tier who underwent an ACL rehabilitation program from the same clinic participated in this study. Players were randomly distributed in an MT group (n = 15) and a CON group (n = 15). All participants reported their perception of pain on a VAS before and after the interventions and their psychological readiness to return to sport after ACL injury and reconstruction surgery on the ACL-RSI scale after the intervention. An independent-sample t-test was performed to assess between-group differences in post-intervention ACL-RSI, and a further independent-sample t-test to assume non-significant differences between VAS values before the intervention. A two-way repeated-measures analysis of variance was used to test the null hypothesis of no different change in VAS over time between groups. After the intervention, the MT group perceived largely greater psychological readiness (p < 0.01). MT and CON groups experienced a large reduction in VAS after the intervention (p < 0.001). However, a small time × group interaction was observed (p = 0.023). MT reported a greater perception of the psychological readiness of the soccer players and a lower perception of pain than those who performed conventional therapy.
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Trompetto C, Catalano MG, Farina A, Grioli G, Mori L, Ciullo A, Pittaluga M, Rossero M, Puce L, Bicchi A. A soft supernumerary hand for rehabilitation in sub-acute stroke: a pilot study. Sci Rep 2022; 12:21504. [PMID: 36513775 PMCID: PMC9747903 DOI: 10.1038/s41598-022-25029-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/23/2022] [Indexed: 12/15/2022] Open
Abstract
In patients with subacute stroke, task specific training (TST) has been shown to accelerate functional recovery of the upper limb. However, many patients do not have sufficient active extension of the fingers to perform this treatment. In these patients, here we propose a new rehabilitation technique in which TST is performed through a soft robotic hand (SoftHand-X). In short, the extension of the robotic fingers is controlled by the patient through his residual, albeit minimal, active extension of the fingers or wrist, while the patient was required to relax the muscles to achieve full flexion of the robotic fingers. TST with SoftHand-X was attempted in 27 subacute stroke patients unable to perform TST due to insufficient active extension of the fingers. Four patients (14.8%) were able to perform the proposed treatment (10 daily sessions of 60 min each). They reported an excellent level of participation. After the treatment, both clinical score of spasticity and its electromyographic correlate (stretch reflex) decreased. In subacute stroke patients, TST using SoftHand-X is a well-accepted treatment, resulting in a decrease of spasticity. At present, it can be applied only in a small proportion of the patients who cannot perform conventional TST, though extensions are possible.
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Affiliation(s)
- Carlo Trompetto
- grid.5606.50000 0001 2151 3065Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, 16132 Genova, Italy ,grid.410345.70000 0004 1756 7871Neurorehabilitation Unit, Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genova, 16132 Genova, Italy
| | - Manuel G. Catalano
- grid.25786.3e0000 0004 1764 2907Soft Robotics for Human Cooperation, and Rehabilitation Lab, Fondazione Istituto Italiano di Tecnologia, 16163 Genova, Italy
| | - Alessandro Farina
- grid.410345.70000 0004 1756 7871Neurorehabilitation Unit, Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genova, 16132 Genova, Italy
| | - Giorgio Grioli
- grid.25786.3e0000 0004 1764 2907Soft Robotics for Human Cooperation, and Rehabilitation Lab, Fondazione Istituto Italiano di Tecnologia, 16163 Genova, Italy ,grid.5395.a0000 0004 1757 3729Centro di Ricerca “Enrico Piaggio” and Dipartimento di Ingegneria dell’Informazione, Università di Pisa, 56122 Pisa, Italy
| | - Laura Mori
- grid.5606.50000 0001 2151 3065Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, 16132 Genova, Italy ,grid.410345.70000 0004 1756 7871Neurorehabilitation Unit, Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genova, 16132 Genova, Italy
| | - Andrea Ciullo
- grid.25786.3e0000 0004 1764 2907Soft Robotics for Human Cooperation, and Rehabilitation Lab, Fondazione Istituto Italiano di Tecnologia, 16163 Genova, Italy
| | - Matteo Pittaluga
- grid.410345.70000 0004 1756 7871Neurorehabilitation Unit, Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genova, 16132 Genova, Italy
| | - Martina Rossero
- grid.25786.3e0000 0004 1764 2907Soft Robotics for Human Cooperation, and Rehabilitation Lab, Fondazione Istituto Italiano di Tecnologia, 16163 Genova, Italy
| | - Luca Puce
- grid.5606.50000 0001 2151 3065Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, 16132 Genova, Italy
| | - Antonio Bicchi
- grid.25786.3e0000 0004 1764 2907Soft Robotics for Human Cooperation, and Rehabilitation Lab, Fondazione Istituto Italiano di Tecnologia, 16163 Genova, Italy ,grid.5395.a0000 0004 1757 3729Centro di Ricerca “Enrico Piaggio” and Dipartimento di Ingegneria dell’Informazione, Università di Pisa, 56122 Pisa, Italy
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Martono M, Isnaeni A, Hartono H. Assessment of the Effectiveness of Facial Expression Exercises Stimulation Using Mirror Media in Increasing Facial Muscle Strength in Hemiparetic Stroke Patients. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND: Stroke can cause facial muscle weakness that can affect mobility, limitations in daily activities, and quality of life. One alternative solution that is non-invasive to restore facial muscle paralysis in post-stroke patients is facial expression exercises using mirror media.
AIM: This study aimed to assess the effectiveness of facial muscle expression exercises stimulation using mirror media and without a mirror as media in increasing facial muscle strength in hemiparetic stroke patients.
METHODS: This study used an experimental quantitative design, in which two groups of subjects who met the inclusion criteria were randomly assigned. The number of subjects who participated in this research was 60 samples divided into the intervention group (n = 30) with a mirror for facial muscle expression exercises and the control group (n = 30) without a mirror for five weeks. The research data were collected using the Fisch Facial Grading System sheet. The statistical analysis procedure of the data consisted of One-Way ANOVA, paired-samples T-test, and N-Gain score test with 95% significance.
RESULTS: The difference in facial muscle strength increase was significantly greater in the intervention group (mean difference 19.4; p = 0.000). The intervention group was more effective in increasing facial muscle strength than the control group (N-Gain score 56.31%).
CONCLUSION: The facial muscle expression exercise procedure using a mirror was more effective in increasing muscle strength than the group without a mirror.
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Using Mirror Therapy to Optimize the Efficacy of Balance Programs for Older Adults With Poststroke Balance Impairment. Rehabil Nurs 2022; 47:202-209. [PMID: 36210496 DOI: 10.1097/rnj.0000000000000389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Poststroke rehabilitation is an inevitable element of the treatment for stroke survivors. This study aimed to investigate the effect of balance training with mirror therapy in older adults with poststroke balance impairment. DESIGN/METHODS The study adopted a two-arm randomized clinical trial and included 38 older adults with poststroke balance impairment. The intervention group received balance exercises with mirror therapy, whereas the control group received the same balance exercises without mirror therapy (a nonreflective plate was used instead). The patient outcome, the balance score, was measured using the Berg Balance Scale. Analysis of covariance was used for statistical analysis. RESULTS Results showed that balance exercises combined with mirror therapy were significantly more effective than balance exercises without mirror therapy in improving balance in the stroke survivors (p < .001). CONCLUSION Mirror therapy combined with regular balance exercises is an effective and practical method for enhancing balance in older adults suffering from balance impairment. CLINICAL RELEVANCE Balance training combined with containing mirror therapy may be included in the rehabilitation programs of older adults with poststroke balance impairment.
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Solomons CD, Shanmugasundaram V, Balasubramanian S. Encoder-Controlled Functional Electrical Stimulator for Bilateral Wrist Activities—Design and Evaluation. Bioengineering (Basel) 2022; 9:bioengineering9100501. [PMID: 36290469 PMCID: PMC9598413 DOI: 10.3390/bioengineering9100501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/04/2022] [Accepted: 09/11/2022] [Indexed: 11/16/2022] Open
Abstract
Upper limb impairment following stroke is often characterized by limited voluntary control in the affected arm. In addition, significant motor coordination problems occur on the unaffected arm due to avoidance of performing bilateral symmetrical activities. Rehabilitation strategies should, therefore, not only aim at improving voluntary control on the affected arm, but also contribute to synchronizing activity from both upper limbs. The encoder-controlled functional electrical stimulator, described in this paper, implements precise contralateral control of wrist flexion and extension with electrical stimulation. The stimulator is calibrated for each individual to obtain a table of stimulation parameters versus wrist angle. This table is used to set stimulation parameters dynamically, based on the difference in wrist angle between the set and stimulated side, which is continuously monitored. This allows the wrist on the stimulated side to follow flexion and extension patterns on the set side, thereby mirroring wrist movements of the normal side. This device also gives real-time graphical feedback on how the stimulated wrist is performing in comparison to the normal side. A study was performed on 25 normal volunteers to determine how closely wrist movements on the set side were being followed on the stimulated side. Graphical results show that there were minor differences, which were quantified by considering the peak angles of flexion and extension on the set and stimulated side for each participant. The mean difference in peak flexion and extension range of movement was 2.3 degrees and 1.9 degrees, respectively, with a mean time lag of 1 s between the set and the stimulated angle graphs.
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Affiliation(s)
- Cassandra D. Solomons
- Department of Instrumentation and Control, School of Electrical Engineering, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India
| | - Vivekanandan Shanmugasundaram
- Department of Instrumentation and Control, School of Electrical Engineering, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India
- Correspondence:
| | - Sivakumar Balasubramanian
- Department of Bioengineering, Christian Medical College and Hospital, Bagayam, Vellore 632002, Tamil Nadu, India
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Xiong F, Liao X, Xiao J, Bai X, Huang J, Zhang B, Li F, Li P. Emerging Limb Rehabilitation Therapy After Post-stroke Motor Recovery. Front Aging Neurosci 2022; 14:863379. [PMID: 35401147 PMCID: PMC8984121 DOI: 10.3389/fnagi.2022.863379] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
Stroke, including hemorrhagic and ischemic stroke, refers to the blood supply disorder in the local brain tissue for various reasons (aneurysm, occlusion, etc.). It leads to regional brain circulation imbalance, neurological complications, limb motor dysfunction, aphasia, and depression. As the second-leading cause of death worldwide, stroke poses a significant threat to human life characterized by high mortality, disability, and recurrence. Therefore, the clinician has to care about the symptoms of stroke patients in the acute stage and formulate an effective postoperative rehabilitation plan to facilitate the recovery in patients. We summarize a novel application and update of the rehabilitation therapy in limb motor rehabilitation of stroke patients to provide a potential future stroke rehabilitation strategy.
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Affiliation(s)
- Fei Xiong
- Department of Operation Room, The First People’s Hospital of Jiande, Hangzhou, China
| | - Xin Liao
- Department of Orthopedics, The First People’s Hospital of Jiande, Hangzhou, China
| | - Jie Xiao
- Department of Orthopedics, The First People’s Hospital of Jiande, Hangzhou, China
| | - Xin Bai
- Department of Orthopedics, The First People’s Hospital of Jiande, Hangzhou, China
| | - Jiaqi Huang
- Department of Orthopedics, The First People’s Hospital of Jiande, Hangzhou, China
| | - Bi Zhang
- Department of Orthopedics, The First People’s Hospital of Jiande, Hangzhou, China
| | - Fang Li
- Department of Orthopedics, The First People’s Hospital of Jiande, Hangzhou, China
| | - Pengfei Li
- Department of Orthopedics, The First People’s Hospital of Jiande, Hangzhou, China
- *Correspondence: Pengfei Li,
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Rey B, Oliver A, Monzo JM, Riquelme I. Development and Testing of a Portable Virtual Reality-Based Mirror Visual Feedback System with Behavioral Measures Monitoring. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042276. [PMID: 35206464 PMCID: PMC8872630 DOI: 10.3390/ijerph19042276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 02/04/2023]
Abstract
Virtual Reality (VR) is a technology that has been used to provide the Mirror Visual Feedback (MVF) illusion to patients with promising results. In the present work, the goal is to design, develop and test a portable VR-based MVF system that monitors behavioral information about the performance of a simple motor task. The developed application runs in a stand-alone VR system and allows the researcher to select the real and virtual hands used to perform the motor task. The system was evaluated with a group of twenty healthy volunteers (12 men and 8 women) with ages between 18 and 66 years. Participants had to repetitively perform a motor task in four different experimental conditions: two mirror conditions (performing real movements with the dominant and with the non-dominant hand) and two non-mirror conditions. A significant effect of the experimental condition on embodiment score (p < 0.001), response time (p < 0.001), performance time (p < 0.001), trajectory length (p < 0.004) and trajectory maximum horizontal deviation (p < 0.001) was observed. Furthermore, a significant effect of the experimental moment (initial, middle and final parts of the training) on the performance time was observed (p < 0.001). These results show that the monitored parameters provide relevant information to evaluate the participant’s task performance in different experimental conditions.
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Affiliation(s)
- Beatriz Rey
- Departamento de Ingeniería Gráfica, Universitat Politècnica de València, 46022 Valencia, Spain;
- Correspondence:
| | - Alejandro Oliver
- Departamento de Ingeniería Gráfica, Universitat Politècnica de València, 46022 Valencia, Spain;
| | - Jose M. Monzo
- Instituto de Instrumentación para Imagen Molecular (I3M), Centro Mixto CSIC-Universitat Politècnica de València, 46022 Valencia, Spain;
| | - Inmaculada Riquelme
- Department of Nursing and Physiotherapy, University of the Balearic Islands, 07122 Palma, Spain;
- Institute of Health Sciences Research (IUNICS-IdISBa), University of the Balearic Islands, 07122 Palma, Spain
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O'Donoghue M, Leahy S, Boland P, Galvin R, McManus J, Hayes S. Rehabilitation of Cognitive Deficits Poststroke: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Stroke 2022; 53:1700-1710. [PMID: 35109684 DOI: 10.1161/strokeaha.121.034218] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite the prevalence of cognitive impairment poststroke, there is uncertainty regarding interventions to improve cognitive function poststroke. This systematic review and meta-analysis evaluate the effectiveness of rehabilitation interventions across multiple domains of cognitive function. METHODS Five databases were searched from inception to August 2019. Eligible studies included randomized controlled trials of rehabilitation interventions for people with stroke when compared with other active interventions or standard care where cognitive function was an outcome. RESULTS Sixty-four randomized controlled trials (n=4005 participants) were included. Multiple component interventions improved general cognitive functioning (MD, 1.56 [95% CI, 0.69-2.43]) and memory (standardized MD, 0.49 [95% CI, 0.27-0.72]) compared with standard care. Physical activity interventions improved neglect (MD, 13.99 [95% CI, 12.67-15.32]) and balance (MD, 2.97 [95% CI, 0.71-5.23]) compared with active controls. Noninvasive brain stimulation impacted neglect (MD, 20.79 [95% CI, 14.53-27.04) and functional status (MD, 14.02 [95% CI, 8.41-19.62]) compared with active controls. Neither cognitive rehabilitation (MD, 0.37 [95% CI, -0.94 to 1.69]) nor occupational-based interventions (MD, 0.45 [95% CI, -1.33 to 2.23]) had a significant effect on cognitive function compared with standard care. CONCLUSIONS There is some evidence to support multiple component interventions, physical activity interventions, and noninvasive brain stimulation improving cognitive function poststroke. Findings must be interpreted with caution given the overall moderate to high risk of bias, heterogeneity of interventions, and outcome measures across studies.
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Affiliation(s)
- Mairead O'Donoghue
- School of Allied Health, Ageing Research Centre, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Ireland (M.O.D., S.L., P.B., R.G., S.H.)
| | - Siobhan Leahy
- School of Allied Health, Ageing Research Centre, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Ireland (M.O.D., S.L., P.B., R.G., S.H.)
| | - Pauline Boland
- School of Allied Health, Ageing Research Centre, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Ireland (M.O.D., S.L., P.B., R.G., S.H.)
| | - Rose Galvin
- School of Allied Health, Ageing Research Centre, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Ireland (M.O.D., S.L., P.B., R.G., S.H.)
| | - John McManus
- Geriatric and Stroke Medicine, University Hospital Limerick, Ireland (J.M.)
| | - Sara Hayes
- School of Allied Health, Ageing Research Centre, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Ireland (M.O.D., S.L., P.B., R.G., S.H.)
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Quantitative Evaluation System of Upper Limb Motor Function of Stroke Patients Based on Desktop Rehabilitation Robot. SENSORS 2022; 22:s22031170. [PMID: 35161913 PMCID: PMC8838252 DOI: 10.3390/s22031170] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 12/12/2022]
Abstract
Rehabilitation training and movement evaluation after stroke have become a research hotspot as stroke has become a very common and harmful disease. However, traditional rehabilitation training and evaluation are mainly conducted under the guidance of rehabilitation doctors. The evaluation process is time-consuming and the evaluation results are greatly influenced by doctors. In this study, a desktop upper limb rehabilitation robot was designed and a quantitative evaluation system of upper limb motor function for stroke patients was proposed. The kinematics and dynamics data of stroke patients during active training were collected by sensors. Combined with the scores of patients' upper limb motor function by rehabilitation doctors using the Wolf Motor Function Test (WMFT) scale, three different quantitative evaluation models of upper limb motor function based on Back Propagation Neural Network (BPNN), K-Nearest Neighbors (KNN), and Support Vector Regression (SVR) algorithms were established. To verify the effectiveness of the quantitative evaluation system, 10 healthy subjects and 21 stroke patients were recruited for experiments. The experimental results show that the BPNN model has the best evaluation performance among the three quantitative evaluation models. The scoring accuracy of the BPNN model reached up to 87.1%. Moreover, there was a significant correlation between the models' scores and the doctors' scores. The proposed system can help doctors to quantitatively evaluate the upper limb motor function of stroke patients and accurately master the rehabilitation progress of patients.
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Varalta V, Munari D, Fonte C, Evangelista E, Picelli A, Smania N. Rehabilitation of somatic sensation and related deficit of motor control by Mirror Box Therapy: a case report. Neurocase 2022; 28:42-47. [PMID: 34983309 DOI: 10.1080/13554794.2021.2023193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Somatosensory disorders are often present after cerebral stroke. These deficits are associated with patients' disability. Therefore, their rehabilitation takes an importance in recovery program. However, the treatment of sensation remains poorly considered during neurorehabilitation and evidence for active sensory training is limited. Mirror Box Therapy is a simple training used to treat upper extremity motor deficits and pain also in patients with stroke. However, the effects of Mirror Box Therapy on somatosensory impairments in post-stroke patients are not deeply investigated and often exclusively motor exercises are provided during therapy.The aim of the present study was to investigate the effects of Mirror Box Therapy sensory training on somatosensory deficits in a stroke patient presenting upper limb impairment.The patient underwent to four weeks of training, five days a week. Before, during and after the Mirror Box Therapy treatment, the patient was assessed by Rivermead Assessment of Somatosensory Performance. Before and after training also upper limb motor function and performance in activities of daily living were assessed.After training patient showed an improvement in somatosensory performance. The gain was maintained at follow-up.This case report shows the effects of Mirror Box Therapy sensory training on the upper extremity for the improvement of sensation and movement in a patient with a thalamo-capsular hemorrhagic stroke during the subacute phase.
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Affiliation(s)
- Valentina Varalta
- Neuromotor and Cognitive Rehabilitation Research Center - Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy
| | - Daniele Munari
- Neuromotor and Cognitive Rehabilitation Research Center - Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Cristina Fonte
- Neuromotor and Cognitive Rehabilitation Research Center - Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Elisa Evangelista
- Neuromotor and Cognitive Rehabilitation Research Center - Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alessandro Picelli
- Neuromotor and Cognitive Rehabilitation Research Center - Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy
| | - Nicola Smania
- Neuromotor and Cognitive Rehabilitation Research Center - Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy
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Arfianti L, Rochman F, Hidayati HB, Subadi I. The addition of mirror therapy improved upper limb motor recovery and level of independence after stroke: a randomized controlled trial. CADERNOS BRASILEIROS DE TERAPIA OCUPACIONAL 2022. [DOI: 10.1590/2526-8910.ctoao245932182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction In stroke survivors, the prevalence of upper motor disability remains high. There has not been much report on the success of post-stroke mirror therapy, especially in developing countries. Objective The focus of this research is to see how mirror therapy, in addition to standard rehabilitation for hand paresis, affects upper limb motor recovery and level of independence in self-care after stroke at an Indonesian teaching hospital. Method This was a randomized controlled trial with no assessor blinding. The study included 18 subacute stroke patients who did not have cognitive or visual impairment. The mirror group received a 20-minute mirror therapy session in addition to conventional rehabilitation, while the control group received only the standard program for 5 weeks (2 times per week). The Brunnstrom score and self-care level of independence elements of the Functional Independence Measure (FIM) were used as outcome measures. Results Baseline comparisons of lesion type and Brunnstrom score showed significant between-group differences. The ANACOVA test showed the difference had no effect on the FIM change in scores (P > 0.05). One patient (mirror group) was dropped out from the study. After 5 weeks (n=17), the mirror group showed improvement in both the Brunnstrom and FIM scores (P < 0.05) compared to the control group. Conclusions Mirror treatment improves upper limb motor recovery and level of independence in self-care after stroke when combined with standard hand paresis rehabilitation 2 times a week for 5 weeks.
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Kostenko EV, Petrova LV, Pogonchenkova IV, Neprintseva NV, Shurupova ST, Kopasheva VD, Rylsky AV. [Innovative technologies and multimodal correction in medical rehabilitation of motor and neuropsychological disturbances due to stroke]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2022; 99:67-78. [PMID: 36538406 DOI: 10.17116/kurort20229906167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The article presents an overview of innovative technologies based on the methods of sensorimotor retraining of the patient using various types of biofeedback (BFB) as the most promising in the medical rehabilitation (MR) of patients with cerebral stroke (CS). The works of a high level of evidence (RCTs, national and international clinical guidelines, meta-analyses, systematic reviews) of the Medline, Pubmed, PubMed Cochrane Library databases are analyzed, ClinicalTrials.gov. It is emphasized that training with multisensory effects on visual, auditory, vestibular and kinesthetic analyzers have a beneficial effect on cognitive-motor training and retraining, neuropsychological status of the patient and increase the level of motivation to achieve success in the rehabilitation process. The synergy of multimodal effects of digital technologies, BFB, virtual reality, and the brain-computer interface will expand the capabilities and improve the efficiency of MR of after stroke-patients.
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Affiliation(s)
- E V Kostenko
- Moscow scientific and practical center of medical rehabilitation, restorative and sports medicine of the Department of health of the city of Moscow, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - L V Petrova
- Moscow scientific and practical center of medical rehabilitation, restorative and sports medicine of the Department of health of the city of Moscow, Moscow, Russia
| | - I V Pogonchenkova
- Moscow scientific and practical center of medical rehabilitation, restorative and sports medicine of the Department of health of the city of Moscow, Moscow, Russia
| | - N V Neprintseva
- Moscow scientific and practical center of medical rehabilitation, restorative and sports medicine of the Department of health of the city of Moscow, Moscow, Russia
| | - S T Shurupova
- Moscow scientific and practical center of medical rehabilitation, restorative and sports medicine of the Department of health of the city of Moscow, Moscow, Russia
| | - V D Kopasheva
- Moscow scientific and practical center of medical rehabilitation, restorative and sports medicine of the Department of health of the city of Moscow, Moscow, Russia
| | - A V Rylsky
- Moscow scientific and practical center of medical rehabilitation, restorative and sports medicine of the Department of health of the city of Moscow, Moscow, Russia
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Ramaswamy D, Parimala S. Role of mirror therapy in management of stroke – Current and future perspectives. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2022. [DOI: 10.4103/amhs.amhs_182_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Postural Difference between the Interventions Reflecting the Concept of Mirror Therapy in Healthy Subjects. Brain Sci 2021; 11:brainsci11121567. [PMID: 34942869 PMCID: PMC8699750 DOI: 10.3390/brainsci11121567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Mirror therapy is one of the promising interventions for the upper limb rehabilitation of stroke patients. Postural asymmetry during mirror therapy was pointed out as a possibility to influence stroke patients’ rehabilitation negatively. However, it is still difficult to find studies on the postural changes in mirror therapy concept interventions. This study compared three methods of postural differences as follows: traditional mirror therapy (mirror); displaying the real-time movement of the unaffected side on the screen above the affected side (screen); and playing a pre-recorded movement of the unaffected side on a tablet placed on a movable box where the affected hand is put inside (movable). (2) Methods: to observe a kinematic difference, we recruited 16 healthy volunteers to go through three different interventions (mirror, screen, movable). The motion capture system made observations on the postures before and during interventions, then compared and analyzed. (3) Results: while using the mirror, the sitting posture was observed to become asymmetric, and the following unique posture was observed where the target hand went further from the trunk while performing tasks. In addition, the shoulder of the target side came forward, and the difference between both elbow flexion angles was also observed. On the other hand, the screen or movable device did not cause a significant change in the sitting posture, and no additional postural differences were observed either. (4) Conclusions: mirror therapy showed a tendency to cause lateral flexion opposite the target hand, thus, creating additional postural change. However, developed methods controlled spine tilt, and enabled the keeping of the midline while sitting during the intervention.
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Meidian AC, Yige S, Irfan M, Rahayu UB, Amimoto K. Immediate effect of adding mirror visual feedback to lateral weight-shifting training on the standing balance control of the unilateral spatial neglect model. J Phys Ther Sci 2021; 33:809-817. [PMID: 34776614 PMCID: PMC8575481 DOI: 10.1589/jpts.33.809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022] Open
Abstract
[Purpose] This study aimed to clarify the immediate effect of adding mirror visual feedback to lateral weight-shifting training on the standing balance control of the left unilateral spatial neglect model. [Participants and Methods] We included 64 healthy participants to create left unilateral spatial neglect models and divided them into four subgroups. Each subgroup received opposite lateral weight-shifting training with or without mirror visual feedback. We then evaluated the static and dynamic standing balance by measuring the center of pressure point alterations in the medial-lateral and anterior-posterior planes. We further evaluated the center of pressure length and bilateral load ratio. [Results] The center of pressure was significantly stable upon performing the eyes-open static standing balance test in the left weight-shifting training subgroup with mirror visual feedback. When participants performed the left dynamic standing balance test, the center of pressure moved significantly rightward and became significantly stable in the right weight-shifting training subgroup with mirror visual feedback. The left load ratio significantly decreased in the right weight-shifting training of subgroups that either did or did not receive mirror visual feedback upon performing the left dynamic standing balance test. [Conclusion] We concluded that adding mirror visual feedback to lateral weight-shifting training affected some measurements of standing balance control of the left unilateral spatial neglect model.
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Affiliation(s)
- Abdul Chalik Meidian
- Department of Physical Therapy, Graduate School of Human
Health Sciences, Tokyo Metropolitan University: 7-2-10 Higashi-Ogu, Arakawa-Ku, Tokyo
116-8551, Japan
- Faculty of Physiotherapy, Esa Unggul University,
Indonesia
| | - Song Yige
- Department of Physical Therapy, Graduate School of Human
Health Sciences, Tokyo Metropolitan University: 7-2-10 Higashi-Ogu, Arakawa-Ku, Tokyo
116-8551, Japan
| | - Muhammad Irfan
- Department of Physiotherapy, Faculty of Health Sciences,
Universitas Aisyiyah Yogyakarta, Indonesia
| | - Umi Budi Rahayu
- Department of Physiotherapy, Faculty of Health Sciences,
Universitas Muhammadiyah Surakarta, Indonesia
| | - Kazu Amimoto
- Department of Physical Therapy, Graduate School of Human
Health Sciences, Tokyo Metropolitan University: 7-2-10 Higashi-Ogu, Arakawa-Ku, Tokyo
116-8551, Japan
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Tai RY, Zhu JD, Chen CC, Hsieh YW, Cheng CH. Modulation of Functional Connectivity in Response to Mirror Visual Feedback in Stroke Survivors: An MEG Study. Brain Sci 2021; 11:brainsci11101284. [PMID: 34679347 PMCID: PMC8533793 DOI: 10.3390/brainsci11101284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/15/2021] [Accepted: 09/25/2021] [Indexed: 11/21/2022] Open
Abstract
Background. Several brain regions are activated in response to mirror visual feedback (MVF). However, less is known about how these brain areas and their connectivity are modulated in stroke patients. This study aimed to explore the effects of MVF on brain functional connectivity in stroke patients. Materials and Methods. We enrolled 15 stroke patients who executed Bilateral-No mirror, Bilateral-Mirror, and Unilateral-Mirror conditions. The coherence values among five brain regions of interest in four different frequency bands were calculated from magnetoencephalographic signals. We examined the differences in functional connectivity of each two brain areas between the Bilateral-No mirror and Bilateral-Mirror conditions and between the Bilateral-Mirror and Unilateral-Mirror conditions. Results. The functional connectivity analyses revealed significantly stronger connectivity between the posterior cingulate cortex and primary motor cortex in the beta band (adjusted p = 0.04) and possibly stronger connectivity between the precuneus and primary visual cortex in the theta band (adjusted p = 0.08) in the Bilateral-Mirror condition than those in the Bilateral-No mirror condition. However, the comparisons between the Bilateral-Mirror and Unilateral-Mirror conditions revealed no significant differences in cortical coherence in all frequency bands. Conclusions. Providing MVF to stroke patients may modulate the lesioned primary motor cortex through visuospatial and attentional cortical networks.
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Affiliation(s)
- Ruei-Yi Tai
- Department of Neurology, Taipei Medical University Hospital, Taipei 110, Taiwan;
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 110, Taiwan
| | - Jun-Ding Zhu
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;
| | - Chih-Chi Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou 333, Taiwan;
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yu-Wei Hsieh
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou 333, Taiwan;
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan 333, Taiwan
- Correspondence: (Y.-W.H.); (C.-H.C.); Tel.: +8863-211-8800 (ext. 3820) (Y.-W.H.); +8863-211-8800 (ext. 3854) (C.-H.C.)
| | - Chia-Hsiung Cheng
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan 333, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou 333, Taiwan
- Correspondence: (Y.-W.H.); (C.-H.C.); Tel.: +8863-211-8800 (ext. 3820) (Y.-W.H.); +8863-211-8800 (ext. 3854) (C.-H.C.)
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Zhang Y, Xing Y, Li C, Hua Y, Hu J, Wang Y, Ya R, Meng Q, Bai Y. Mirror therapy for unilateral neglect after stroke: A systematic review. Eur J Neurol 2021; 29:358-371. [PMID: 34558762 DOI: 10.1111/ene.15122] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND PURPOSE The effect of mirror therapy for unilateral neglect after stroke currently remains uncertain. METHODS This systematic review investigated the effect of mirror therapy on neglect and daily living activities in patients with unilateral neglect after stroke when compared with no treatment, sham mirror therapy, or routinely applied therapies only. We performed a systematic electronic search of PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Wanfang Data to identify relevant randomized control trials (RCTs). RESULTS We included five RCTs in the data synthesis. Mirror therapy (combined or not with other treatments) was more effective in improving neglect as compared with sham mirror therapy or no treatment (combined or not with the other therapies; standard mean difference [SMD] = 1.62, 95% confidence interval [CI] = 1.03-2.21, p < 0.00001). Mirror therapy (combined or not with other therapies) was effective in improving daily living activities as compared with sham mirror therapy or no treatment (combined or not with the other therapies; SMD = 2.09, 95% CI = 0.63-3.56, p = 0.005). CONCLUSIONS Our results show that mirror therapy effectively improves neglect and daily living activities in patients with unilateral neglect after stroke. Future trials with high methodological quality and larger sample sizes are needed to determine the immediate and long-term effect of appropriate mirror therapy protocol for unilateral neglect.
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Affiliation(s)
- Yuqian Zhang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ying Xing
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Congqin Li
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan Hua
- Department of Rehabilitation Medicine, Huashan Hospital North, Fudan University, Shanghai, China
| | - Jian Hu
- Department of Rehabilitation Medicine, Huashan Hospital North, Fudan University, Shanghai, China
| | - Yuyuan Wang
- Department of Rehabilitation Medicine, Huashan Hospital North, Fudan University, Shanghai, China
| | - Ru Ya
- Department of Rehabilitation Medicine, Shanghai No. 3 Rehabilitation Hospital, Shanghai, China
| | - Qiong Meng
- Department of Internal Medicine, Shanghai No. 3 Rehabilitation Hospital, Shanghai, China
| | - Yulong Bai
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Raciti L, Calabrò RS. Neurological complications of COVID-19: from pathophysiology to rehabilitation. An overview. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021317. [PMID: 34487099 PMCID: PMC8477084 DOI: 10.23750/abm.v92i4.10620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/12/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate how the SARS-COV2 is able to affect the nervous system, the main neurological manifestation, and the treatment used, including neurorehabilitation. METHODS Studies performed during the current year that fulfilled inclusion criteria were selected from PubMed, Scopus, Cochrane, and Web of Sciences databases. The search combined the terms "Covid 19," "rehabilitation/treatment," and "neurological complications." RESULTS The exact route by which SARS-CoV-2 can penetrate the CNS is still unknown, although a possible retrograde transynaptic pathway from peripheral nerve endings, and/or through the olfactory bulb, have been suggested. An early management of COVID-19 by a multiprofessional team is fundamental to avoid long term sequaele. Rehabilitation is recommended to improve respiratory and cardiac function, as well as to avoid long term neurological complications. CONCLUSIONS As no specific conclusions in term of prognosis and treatment could be done, research and consensus paper are needed to provide NeuroCovid patients with the best treatment options, including neurorehabilitation.
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Qu Q, Lin Y, He Z, Fu J, Zou F, Jiang Z, Guo F, Jia J. The Effect of Applying Robot-Assisted Task-Oriented Training Using Human-Robot Collaborative Interaction Force Control Technology on Upper Limb Function in Stroke Patients: Preliminary Findings. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9916492. [PMID: 34368358 PMCID: PMC8342143 DOI: 10.1155/2021/9916492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/13/2021] [Accepted: 07/11/2021] [Indexed: 02/08/2023]
Abstract
Stroke is one of the leading causes of death and the primary cause of acquired disability worldwide. Many stroke survivors have difficulty using their upper limbs, which have important functional roles in the performance of daily life activities. Consequently, the independence and quality of life of most stroke patients are reduced. Robot-assisted therapy is an effective intervention for improving the upper limb function of individuals with stroke. Human-robot collaborative interaction force control technology is critical for improving the flexibility and followability of the robot's motion, thereby improving rehabilitation training outcomes. However, there are few reports on the effect of robot-assisted rehabilitative training on upper limb function. We applied this technology using a robot to assist patients with task-oriented training. Posttreatment changes in Fugl-Meyer and modified Barthel index (MBI) scores were assessed to determine whether this technology could improve the upper limb function of stroke patients. One healthy adult and five stroke patients, respectively, participated in functional and clinical experiments. The MBI and Fugl-Meyer scores of the five patients in the clinical experiments showed significant improvements after the intervention. The experimental results indicate that human-robot collaborative interaction force control technology is valuable for improving robots' properties and patients' recovery. This trial was registered in the Chinese clinical trial registry (ChiCTR2000038676).
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Affiliation(s)
- Qingming Qu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, China
| | - Yingnan Lin
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, China
| | - Zhijie He
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, China
| | - Jianghong Fu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, China
| | - Fei Zou
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, China
| | - Zewu Jiang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, China
| | - Fengxian Guo
- Shanghai Electric GeniKIT Medical Science and Technology Co. Ltd., Shanghai, China
| | - Jie Jia
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, China
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Miclaus RS, Roman N, Henter R, Caloian S. Lower Extremity Rehabilitation in Patients with Post-Stroke Sequelae through Virtual Reality Associated with Mirror Therapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2654. [PMID: 33800775 PMCID: PMC7967355 DOI: 10.3390/ijerph18052654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/26/2021] [Accepted: 03/03/2021] [Indexed: 11/17/2022]
Abstract
More innovative technologies are used worldwide in patient's rehabilitation after stroke, as it represents a significant cause of disability. The majority of the studies use a single type of therapy in therapeutic protocols. We aimed to identify if the association of virtual reality (VR) therapy and mirror therapy (MT) exercises have better outcomes in lower extremity rehabilitation in post-stroke patients compared to standard physiotherapy. Fifty-nine inpatients from 76 initially identified were included in the research. One experimental group (n = 31) received VR therapy and MT, while the control group (n = 28) received standard physiotherapy. Each group performed seventy minutes of therapy per day for ten days. Statistical analysis was performed with nonparametric tests. Wilcoxon Signed-Rank test showed that both groups registered significant differences between pre-and post-therapy clinical status for the range of motion and muscle strength (p < 0.001 and Cohen's d between 0.324 and 0.645). Motor Fugl Meyer Lower Extremity Assessment also suggested significant differences pre-and post-therapy for both groups (p < 0.05 and Cohen's d 0.254 for the control group and 0.685 for the experimental group). Mann-Whitney results suggested that VR and MT as a therapeutic intervention have better outcomes than standard physiotherapy in range of motion (p < 0.05, Cohen's d 0.693), muscle strength (p < 0.05, Cohen's d 0.924), lower extremity functionality (p < 0.05, Cohen's d 0.984) and postural balance (p < 0.05, Cohen's d 0.936). Our research suggests that VR therapy associated with MT may successfully substitute classic physiotherapy in lower extremity rehabilitation after stroke.
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Affiliation(s)
- Roxana Steliana Miclaus
- Faculty of Medicine, Transilvania University of Brașov, 500036 Brașov, Romania; (R.S.M.); (S.C.)
| | - Nadinne Roman
- Faculty of Medicine, Transilvania University of Brașov, 500036 Brașov, Romania; (R.S.M.); (S.C.)
| | - Ramona Henter
- Faculty of Psychology and Education Sciences, Transilvania University of Brașov, Str. N. Bălcescu 56, 500368 Brașov, Romania;
| | - Silviu Caloian
- Faculty of Medicine, Transilvania University of Brașov, 500036 Brașov, Romania; (R.S.M.); (S.C.)
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Rodríguez-León JF, Chaparro-Rico BDM, Russo M, Cafolla D. An Autotuning Cable-Driven Device for Home Rehabilitation. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6680762. [PMID: 33628406 PMCID: PMC7895582 DOI: 10.1155/2021/6680762] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/04/2021] [Accepted: 01/28/2021] [Indexed: 11/24/2022]
Abstract
Out of all the changes to our daily life brought by the COVID-19 pandemic, one of the most significant ones has been the limited access to health services that we used to take for granted. Thus, in order to prevent temporary injuries from having lingering or permanent effects, the need for home rehabilitation device is urgent. For this reason, this paper proposes a cable-driven device for limb rehabilitation, CUBE2, with a novel end-effector (EE) design and autotuning capabilities to enable autonomous use. The proposed design is presented as an evolution of the previous CUBE design. In this paper, the proposed device is modelled and analyzed with finite element analysis. Then, a novel vision-based control strategy is described. Furthermore, a prototype has been manufactured and validated experimentally. Preliminary test to estimate home position repeatability has been carried out.
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Affiliation(s)
| | | | - Matteo Russo
- Faculty of Engineering, University of Nottingham, Nottingham NG81BB, UK
| | - Daniele Cafolla
- Biomechatronics Lab, IRCCS Neuromed, Pozzilli (IS) 86077, Italy
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Wang CC, Chao JK, Wang ML, Yang YP, Chien CS, Lai WY, Yang YC, Chang YH, Chou CL, Kao CL. Care for Patients with Stroke During the COVID-19 Pandemic: Physical Therapy and Rehabilitation Suggestions for Preventing Secondary Stroke. J Stroke Cerebrovasc Dis 2020; 29:105182. [PMID: 33066878 PMCID: PMC7375317 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105182] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/17/2020] [Accepted: 07/18/2020] [Indexed: 12/14/2022] Open
Abstract
Infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes the development of the novel 2019 coronavirus disease (COVID-19) and associated clinical symptoms, which typically presents as an upper respiratory syndrome such as pneumonia. Growing evidence indicates an increased prevalence of neurological involvement (e.g., in the form of stroke) during virus infection. COVID-19 has been suggested to be more than a lung infection because it affects the vasculature of the lungs and other organs and increases the risk of thrombosis. Patients with stroke are vulnerable to secondary events as a result not only of their poor vascular condition but also of their lack of access to rehabilitation resources. Herein, we review current knowledge regarding the pathophysiology of COVID-19, its possible association with neurological involvement, and current drug therapies. Suggestions are also offered regarding the potential for current neurorehabilitation therapies to be taught and practiced at home.
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Affiliation(s)
- Chien-Chih Wang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital Yuli Branch, Hualien, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jian-Kang Chao
- Department of Social Work, National Pingtung University of Science & Technology, Pingtung, Taiwan; Department of psychiatry, Taipei Veterans General Hospital Yuli Branch, Hualien, Taiwan
| | - Mong-Lien Wang
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taiwan
| | - Yi-Ping Yang
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taiwan
| | - Chien-Shiu Chien
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taiwan
| | - Wei-Yi Lai
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taiwan
| | - Yi-Chiang Yang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Hui Chang
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Liang Chou
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan; Department of physical medicine and rehabilitation, School of medicine, National Yang Ming university
| | - Chung-Lan Kao
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan; Department of physical medicine and rehabilitation, School of medicine, National Yang Ming university; Center For Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Chiao Tung University, Hsinchu, Taiwan.
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