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Valkenborghs SR, Callister R, Visser MM, Nilsson M, van Vliet P. Interventions combined with task-specific training to improve upper limb motor recovery following stroke: a systematic review with meta-analyses. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1597439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Sarah R. Valkenborghs
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, NSW, Australia
- Centre for Research Excellence in Stroke Rehabilitation and Recovery, Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Biomedical Science and Pharmacy, Faculty of Health, University of Newcastle, Newcastle, NSW, Australia
| | - Robin Callister
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, NSW, Australia
- Centre for Research Excellence in Stroke Rehabilitation and Recovery, Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Biomedical Science and Pharmacy, Faculty of Health, University of Newcastle, Newcastle, NSW, Australia
| | - Milanka M. Visser
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Michael Nilsson
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, NSW, Australia
- Centre for Research Excellence in Stroke Rehabilitation and Recovery, Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Paulette van Vliet
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, NSW, Australia
- Centre for Research Excellence in Stroke Rehabilitation and Recovery, Hunter Medical Research Institute, Newcastle, NSW, Australia
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Cheung VCK, Niu CM, Li S, Xie Q, Lan N. A Novel FES Strategy for Poststroke Rehabilitation Based on the Natural Organization of Neuromuscular Control. IEEE Rev Biomed Eng 2019; 12:154-167. [DOI: 10.1109/rbme.2018.2874132] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Page SJ, Levine PG, Basobas BA. “Reps” Aren't Enough: Augmenting Functional Electrical Stimulation With Behavioral Supports Significantly Reduces Impairment in Moderately Impaired Stroke. Arch Phys Med Rehabil 2016; 97:747-52. [DOI: 10.1016/j.apmr.2016.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 12/23/2015] [Accepted: 01/02/2016] [Indexed: 11/30/2022]
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De Marchis C, Santos Monteiro T, Simon-Martinez C, Conforto S, Gharabaghi A. Multi-contact functional electrical stimulation for hand opening: electrophysiologically driven identification of the optimal stimulation site. J Neuroeng Rehabil 2016; 13:22. [PMID: 26955873 PMCID: PMC4782521 DOI: 10.1186/s12984-016-0129-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 02/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Functional Electrical Stimulation (FES) is increasingly applied in neurorehabilitation. Particularly, the use of electrode arrays may allow for selective muscle recruitment. However, detecting the best electrode configuration constitutes still a challenge. METHODS A multi-contact set-up with thirty electrodes was applied for combined FES and electromyography (EMG) recording of the forearm. A search procedure scanned all electrode configurations by applying single, sub-threshold stimulation pulses while recording M-waves of the extensor digitorum communis (EDC), extensor carpi radialis (ECR) and extensor carpi ulnaris (ECU) muscles. The electrode contacts with the best electrophysiological response were then selected for stimulation with FES bursts while capturing finger/wrist extension and radial/ulnar deviation with a kinematic glove. RESULTS The stimulation electrodes chosen on the basis of M-waves of the EDC/ECR/ECU muscles were able to effectively elicit the respective finger/wrist movements for the targeted extension and/or deviation with high specificity in two different hand postures. CONCLUSIONS A subset of functionally relevant stimulation electrodes could be selected fast, automatic and non-painful from a multi-contact array on the basis of muscle responses to subthreshold stimulation pulses. The selectivity of muscle recruitment predicted the kinematic pattern. This electrophysiologically driven approach would thus allow for an operator-independent positioning of the electrode array in neurorehabilitation.
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Affiliation(s)
- Cristiano De Marchis
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Eberhard Karls University, Otfried-Mueller-Str.45, 72076, Tübingen, Germany. .,Neuroprosthetics Research, Centre for Integrative Neuroscience, Eberhard Karls University, Tübingen, Germany. .,Laboratory of Bioengineering BioLab3, Department of Engineering, University Roma TRE, Via Vito Volterra 62, 00146, Rome, Italy.
| | - Thiago Santos Monteiro
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Eberhard Karls University, Otfried-Mueller-Str.45, 72076, Tübingen, Germany.,Neuroprosthetics Research, Centre for Integrative Neuroscience, Eberhard Karls University, Tübingen, Germany
| | - Cristina Simon-Martinez
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Eberhard Karls University, Otfried-Mueller-Str.45, 72076, Tübingen, Germany.,Neuroprosthetics Research, Centre for Integrative Neuroscience, Eberhard Karls University, Tübingen, Germany
| | - Silvia Conforto
- Laboratory of Bioengineering BioLab3, Department of Engineering, University Roma TRE, Via Vito Volterra 62, 00146, Rome, Italy
| | - Alireza Gharabaghi
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Eberhard Karls University, Otfried-Mueller-Str.45, 72076, Tübingen, Germany. .,Neuroprosthetics Research, Centre for Integrative Neuroscience, Eberhard Karls University, Tübingen, Germany.
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Integrating Mental Practice with Task-specific Training and Behavioral Supports in Poststroke Rehabilitation. Phys Med Rehabil Clin N Am 2015; 26:715-27. [DOI: 10.1016/j.pmr.2015.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Therapy incorporating a dynamic wrist-hand orthosis versus manual assistance in chronic stroke: a pilot study. J Neurol Phys Ther 2012; 36:17-24. [PMID: 22354108 DOI: 10.1097/npt.0b013e318246203e] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to compare the effect of therapy using a wrist-hand orthosis (WHO) versus manual-assisted therapy (MAT) for individuals with chronic, moderate-to-severe hemiparesis. The relationship between the repetitions during therapy and functional change was also examined. METHODS Nineteen participants were randomly assigned to either the WHO group (n = 10) or the MAT group (n = 9). The WHO group performed therapy while wearing a dynamic WHO (SaeboFlex), the MAT group performed therapy with manual assistance of a therapist. Both groups participated in 1 hour of therapy per week for 6 weeks and were prescribed exercises to perform at home 4 days per week. Pre- and posttraining assessments included grip strength, the Action Research Arm Test (ARAT), Box and Blocks (B&B) test, and Stroke Impact Scale (SIS). RESULTS There were no significant between-group differences for any of the measures. Within-group differences showed that the WHO group had a significant improvement in the ARAT score (mean = 2.2; P = 0.04). The MAT group had a significant improvement on the percent recovery on the SIS (mean = 9.3%; P = 0.03) and approached a significant improvement on the ARAT (mean = 1.4; P = 0.08). When analyzing all participants together, the relationship between the number of exercise repetitions and functional improvement was moderate for the ARAT and the B&B test (r = 0.55, P = 0.02, and r = 0.30, P = 0.10, respectively). DISCUSSION AND CONCLUSIONS Small improvements in function and perception of recovery were observed in both groups, with no definite advantage of the WHO. This study adds to the evidence that individuals with chronic stroke can improve arm use with therapy incorporating functional hand training, and that there is a relationship between amount of change and amount of practice.
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Page SJ, Levin L, Hermann V, Dunning K, Levine P. Longer Versus Shorter Daily Durations of Electrical Stimulation During Task-Specific Practice in Moderately Impaired Stroke. Arch Phys Med Rehabil 2012; 93:200-6. [DOI: 10.1016/j.apmr.2011.09.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 08/08/2011] [Accepted: 09/13/2011] [Indexed: 10/14/2022]
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Mean diffusivity as a potential diffusion tensor biomarker of motor rehabilitation after electrical stimulation incorporating task specific exercise in stroke: a pilot study. Brain Imaging Behav 2011; 8:359-69. [DOI: 10.1007/s11682-011-9144-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Harvey RL. Improving poststroke recovery: neuroplasticity and task-oriented training. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2011; 11:251-9. [PMID: 19433020 DOI: 10.1007/s11936-009-0026-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Neurorehabilitation is a critical part of the overall process to achieve optimal outcome after stroke. Presently, the field of neurorehabilitation is in transition. New research suggesting novel approaches to optimize functional recovery after stroke is on the horizon, but clear knowledge of the underlying mechanisms of this recovery is still being unraveled. In practice, many rehabilitation centers continue to provide traditional compensatory rehabilitation training while many others are practicing newer, "task-oriented" approaches. A few centers are incorporating new technology, such as computer-based training devices or robotics, into rehabilitation care. This transition is happening because neuroscientific research has shown that neuroplastic changes in the cerebral cortex and in other parts of the central nervous system (CNS) are necessarily linked to motor skill retraining in the affected limbs. Task-oriented training that focuses on the practice of skilled motor performance is the critical link to facilitating neural reorganization and "rewiring" in the CNS. Therefore, whenever possible, task-oriented training at an intense level should be incorporated into the rehabilitation program of any patient with stroke-related motor deficits. Two such task-oriented therapies that should be available at all neurorehabilitation centers are constraint-induced movement therapy and body weight-supported treadmill training. The optimal intensity of training (frequency and duration) is still not clear but is certainly greater than that available in clinical programs. Therefore, the incorporation of automated training devices will be necessary in the future. However, the engineering necessary to make these devices effective, easy to use, affordable, and portable remains a challenge for the next decade of neurologic bioengineering research.
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Affiliation(s)
- Richard L Harvey
- Richard L. Harvey, MD Stroke Rehabilitation Center, The Rehabilitation Institute of Chicago, 345 East Superior Street, Chicago, IL 60611, USA.
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Boyne P, Dunning K, Levine P, Hermann VH, Page SJ. Orthotic functional electrical stimulation following botulinum toxin for a young adult with severe hand impairment due to childhood stroke. Physiother Theory Pract 2010; 26:267-74. [DOI: 10.3109/09593980902967188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Page SJ, Harnish SM, Lamy M, Eliassen JC, Szaflarski JP. Affected arm use and cortical change in stroke patients exhibiting minimal hand movement. Neurorehabil Neural Repair 2010; 24:195-203. [PMID: 20107135 DOI: 10.1177/1545968309360501] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND PURPOSE Conventional electrical stimulation modalities are limited by their lack of opportunities for motor learning and, consequently, their impact on function. Other rehabilitative regimens necessitate affected hand and wrist movement for patients to be included, making them implausible for most patients. In light of these challenges, the current study examined the efficacy of a repetitive task-specific training (RTP) regimen using an electrical stimulation neuroprosthesis in stroke patients exhibiting no affected wrist or hand movement. METHOD Eight chronic stroke patients (mean = 46.5 months) with moderately affected arm motor deficits participated in 30-minute therapy sessions occurring every weekday for 8 weeks. During the sessions, they wore the neuroprosthesis to enable performance of valued activities identified largely by the patients. To ensure transfer to their real-world environments, most sessions were home based, with the patients coming to the clinic for "tune-up" sessions (eg, adjusting the stimulation parameters, exercises, and/or fit of the device) twice every other week (a total of 8 clinical visits). Outcomes were evaluated using the Action Research Arm Test (ARAT) and the upper extremity section of the Fugl-Meyer Assessment (FM), the amount of use scale of the Motor Activity Log (MAL), and high-field functional magnetic resonance imaging (fMRI). RESULTS Before the intervention, patients exhibited stable motor deficits. After the intervention, they exhibited ARAT and FM score increases (+2.85 and +2.2, respectively). Postintervention fMRI revealed significant increases in cortical activation, possibly brought about by markedly increased affected arm use patterns on the MAL (+0.97). CONCLUSIONS An affected arm RTP program incorporating NEURSTIM appears to increase affected arm use and elicit neural changes in more impaired patients. These factors may conspire to produce motor changes, although motor changes are smaller in this population than with less impaired patients. The program may act as a "bridge" to other promising regimens.
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On "a four-week, task-specific neuroprosthesis program..." Dunning K, et al. Phys Ther. 2008;88:397-405. Phys Ther 2008; 88:970; author reply 970-2. [PMID: 18676380 DOI: 10.2522/ptj.2008.88.8.970.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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