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Hu Y, Meng J, Li G, Zhao D, Feng G, Zuo G, Liu Y, Zhang J, Shi C. Fuzzy Adaptive Passive Control Strategy Design for Upper-Limb End-Effector Rehabilitation Robot. SENSORS (BASEL, SWITZERLAND) 2023; 23:4042. [PMID: 37112385 PMCID: PMC10146308 DOI: 10.3390/s23084042] [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: 03/21/2023] [Revised: 04/07/2023] [Accepted: 04/15/2023] [Indexed: 06/19/2023]
Abstract
Robot-assisted rehabilitation therapy has been proven to effectively improve upper-limb motor function in stroke patients. However, most current rehabilitation robotic controllers will provide too much assistance force and focus only on the patient's position tracking performance while ignoring the patient's interactive force situation, resulting in the inability to accurately assess the patient's true motor intention and difficulty stimulating the patient's initiative, thus negatively affecting the patient's rehabilitation outcome. Therefore, this paper proposes a fuzzy adaptive passive (FAP) control strategy based on subjects' task performance and impulse. To ensure the safety of subjects, a passive controller based on the potential field is designed to guide and assist patients in their movements, and the stability of the controller is demonstrated in a passive formalism. Then, using the subject's task performance and impulse as evaluation indicators, fuzzy logic rules were designed and used as an evaluation algorithm to quantitively assess the subject's motor ability and to adaptively modify the stiffness coefficient of the potential field and thus change the magnitude of the assistance force to stimulate the subject's initiative. Through experiments, this control strategy has been shown to not only improve the subject's initiative during the training process and ensure their safety during training but also enhance the subject's motor learning ability.
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Affiliation(s)
- Yang Hu
- School of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, China; (Y.H.); (J.M.); (D.Z.); (Y.L.)
- Ningbo Cixi Institute of Biomedical Engineering, Ningbo 315300, China; (G.L.); (G.F.); (G.Z.); (J.Z.)
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, China
| | - Jingyan Meng
- School of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, China; (Y.H.); (J.M.); (D.Z.); (Y.L.)
- Ningbo Cixi Institute of Biomedical Engineering, Ningbo 315300, China; (G.L.); (G.F.); (G.Z.); (J.Z.)
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, China
| | - Guoning Li
- Ningbo Cixi Institute of Biomedical Engineering, Ningbo 315300, China; (G.L.); (G.F.); (G.Z.); (J.Z.)
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, China
| | - Dazheng Zhao
- School of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, China; (Y.H.); (J.M.); (D.Z.); (Y.L.)
- Ningbo Cixi Institute of Biomedical Engineering, Ningbo 315300, China; (G.L.); (G.F.); (G.Z.); (J.Z.)
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, China
| | - Guang Feng
- Ningbo Cixi Institute of Biomedical Engineering, Ningbo 315300, China; (G.L.); (G.F.); (G.Z.); (J.Z.)
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, China
| | - Guokun Zuo
- Ningbo Cixi Institute of Biomedical Engineering, Ningbo 315300, China; (G.L.); (G.F.); (G.Z.); (J.Z.)
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, China
| | - Yunfeng Liu
- School of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, China; (Y.H.); (J.M.); (D.Z.); (Y.L.)
| | - Jiaji Zhang
- Ningbo Cixi Institute of Biomedical Engineering, Ningbo 315300, China; (G.L.); (G.F.); (G.Z.); (J.Z.)
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, China
| | - Changcheng Shi
- Ningbo Cixi Institute of Biomedical Engineering, Ningbo 315300, China; (G.L.); (G.F.); (G.Z.); (J.Z.)
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, China
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Kosugi A, Saga Y, Kudo M, Koizumi M, Umeda T, Seki K. Time course of recovery of different motor functions following a reproducible cortical infarction in non-human primates. Front Neurol 2023; 14:1094774. [PMID: 36846141 PMCID: PMC9947718 DOI: 10.3389/fneur.2023.1094774] [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: 11/10/2022] [Accepted: 01/12/2023] [Indexed: 02/11/2023] Open
Abstract
A major challenge in human stroke research is interpatient variability in the extent of sensorimotor deficits and determining the time course of recovery following stroke. Although the relationship between the extent of the lesion and the degree of sensorimotor deficits is well established, the factors determining the speed of recovery remain uncertain. To test these experimentally, we created a cortical lesion over the motor cortex using a reproducible approach in four common marmosets, and characterized the time course of recovery by systematically applying several behavioral tests before and up to 8 weeks after creation of the lesion. Evaluation of in-cage behavior and reach-to-grasp movement revealed consistent motor impairments across the animals. In particular, performance in reaching and grasping movements continued to deteriorate until 4 weeks after creation of the lesion. We also found consistent time courses of recovery across animals for in-cage and grasping movements. For example, in all animals, the score for in-cage behaviors showed full recovery at 3 weeks after creation of the lesion, and the performance of grasping movement partially recovered from 4 to 8 weeks. In addition, we observed longer time courses of recovery for reaching movement, which may rely more on cortically initiated control in this species. These results suggest that different recovery speeds for each movement could be influenced by what extent the cortical control is required to properly execute each movement.
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Affiliation(s)
- Akito Kosugi
- Department of Neurophysiology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yosuke Saga
- Department of Neurophysiology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Moeko Kudo
- Department of Neurophysiology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masashi Koizumi
- Department of Neurophysiology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tatsuya Umeda
- Department of Neurophysiology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan,Department of Integrated Neuroanatomy and Neuroimaging, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuhiko Seki
- Department of Neurophysiology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan,*Correspondence: Kazuhiko Seki ✉
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Grosmaire AG, Pila O, Breuckmann P, Duret C. Robot-assisted therapy for upper limb paresis after stroke: Use of robotic algorithms in advanced practice. NeuroRehabilitation 2022; 51:577-593. [PMID: 36530096 DOI: 10.3233/nre-220025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Rehabilitation of stroke-related upper limb paresis is a major public health issue. OBJECTIVE Robotic systems have been developed to facilitate neurorehabilitation by providing key elements required to stimulate brain plasticity and motor recovery, namely repetitive, intensive, adaptative training with feedback. Although the positive effect of robot-assisted therapy on motor impairments has been well demonstrated, the effect on functional capacity is less certain. METHOD This narrative review outlines the principles of robot-assisted therapy for the rehabilitation of post-stroke upper limb paresis. RESULTS A paradigm is proposed to promote not only recovery of impairment but also function. CONCLUSION Further studies that would integrate some principles of the paradigm described in this paper are needed.
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Affiliation(s)
- Anne-Gaëlle Grosmaire
- Unité de Neurorééducation, Médecine Physique et de Réadaptation, Centre de Rééducation Fonctionnelle Les Trois Soleils, Boissise-Le-Roi, France
| | - Ophélie Pila
- Unité de Neurorééducation, Médecine Physique et de Réadaptation, Centre de Rééducation Fonctionnelle Les Trois Soleils, Boissise-Le-Roi, France
| | - Petra Breuckmann
- Unité de Neurorééducation, Médecine Physique et de Réadaptation, Centre de Rééducation Fonctionnelle Les Trois Soleils, Boissise-Le-Roi, France
| | - Christophe Duret
- Unité de Neurorééducation, Médecine Physique et de Réadaptation, Centre de Rééducation Fonctionnelle Les Trois Soleils, Boissise-Le-Roi, France
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Elango S, Francis AJA, Chakravarthy VS. Interaction of network and rehabilitation therapy parameters in defining recovery after stroke in a Bilateral Neural Network. J Neuroeng Rehabil 2022; 19:142. [PMID: 36536385 PMCID: PMC9762011 DOI: 10.1186/s12984-022-01106-3] [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: 10/22/2021] [Accepted: 10/27/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Restoring movement after hemiparesis caused by stroke is an ongoing challenge in the field of rehabilitation. With several therapies in use, there is no definitive prescription that optimally maps parameters of rehabilitation with patient condition. Recovery gets further complicated once patients enter chronic phase. In this paper, we propose a rehabilitation framework based on computational modeling, capable of mapping patient characteristics to parameters of rehabilitation therapy. METHOD To build such a system, we used a simple convolutional neural network capable of performing bilateral reaching movements in 3D space using stereovision. The network was designed to have bilateral symmetry to reflect the bilaterality of the cerebral hemispheres with the two halves joined by cross-connections. This network was then modified according to 3 chosen patient characteristics-lesion size, stage of recovery (acute or chronic) and structural integrity of cross-connections (analogous to Corpus Callosum). Similarly, 3 parameters were used to define rehabilitation paradigms-movement complexity (Exploratory vs Stereotypic), hand selection mode (move only affected arm, CIMT vs move both arms, BMT), and extent of plasticity (local vs global). For each stroke condition, performance under each setting of the rehabilitation parameters was measured and results were analyzed to find the corresponding optimal rehabilitation protocol. RESULTS Upon analysis, we found that regardless of patient characteristics network showed better recovery when high complexity movements were used and no significant difference was found between the two hand selection modes. Contrary to these two parameters, optimal extent of plasticity was influenced by patient characteristics. For acute stroke, global plasticity is preferred only for larger lesions. However, for chronic, plasticity varies with structural integrity of cross-connections. Under high integrity, chronic prefers global plasticity regardless of lesion size, but with low integrity local plasticity is preferred. CONCLUSION Clinically translating the results obtained, optimal recovery may be observed when paretic arm explores the available workspace irrespective of the hand selection mode adopted. However, the extent of plasticity to be used depends on characteristics of the patient mainly stage of stroke and structural integrity. By using systems as developed in this study and modifying rehabilitation paradigms accordingly it is expected post-stroke recovery can be maximized.
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Affiliation(s)
- Sundari Elango
- grid.417969.40000 0001 2315 1926Computational Neuroscience Laboratory, Department of Biotechnology, Indian Institute of Technology, Madras, India
| | - Amal Jude Ashwin Francis
- grid.417969.40000 0001 2315 1926Computational Neuroscience Laboratory, Department of Biotechnology, Indian Institute of Technology, Madras, India
| | - V. Srinivasa Chakravarthy
- grid.417969.40000 0001 2315 1926Computational Neuroscience Laboratory, Department of Biotechnology, Indian Institute of Technology, Madras, India
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Goffredo M, Proietti S, Pournajaf S, Galafate D, Cioeta M, Le Pera D, Posteraro F, Franceschini M. Baseline robot-measured kinematic metrics predict discharge rehabilitation outcomes in individuals with subacute stroke. Front Bioeng Biotechnol 2022; 10:1012544. [PMID: 36561043 PMCID: PMC9763272 DOI: 10.3389/fbioe.2022.1012544] [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: 08/05/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Background: The literature on upper limb robot-assisted therapy showed that robot-measured metrics can simultaneously predict registered clinical outcomes. However, only a limited number of studies correlated pre-treatment kinematics with discharge motor recovery. Given the importance of predicting rehabilitation outcomes for optimizing physical therapy, a predictive model for motor recovery that incorporates multidirectional indicators of a patient's upper limb abilities is needed. Objective: The aim of this study was to develop a predictive model for rehabilitation outcome at discharge (i.e., muscle strength assessed by the Motricity Index of the affected upper limb) based on multidirectional 2D robot-measured kinematics. Methods: Re-analysis of data from 66 subjects with subacute stroke who underwent upper limb robot-assisted therapy with an end-effector robot was performed. Two least squares error multiple linear regression models for outcome prediction were developed and differ in terms of validation procedure: the Split Sample Validation (SSV) model and the Leave-One-Out Cross-Validation (LOOCV) model. In both models, the outputs were the discharge Motricity Index of the affected upper limb and its sub-items assessing elbow flexion and shoulder abduction, while the inputs were the admission robot-measured metrics. Results: The extracted robot-measured features explained the 54% and 71% of the variance in clinical scores at discharge in the SSV and LOOCV validation procedures respectively. Normalized errors ranged from 22% to 35% in the SSV models and from 20% to 24% in the LOOCV models. In all models, the movement path error of the trajectories characterized by elbow flexion and shoulder extension was the significant predictor, and all correlations were significant. Conclusion: This study highlights that motor patterns assessed with multidirectional 2D robot-measured metrics are able to predict clinical evalutation of upper limb muscle strength and may be useful for clinicians to assess, manage, and program a more specific and appropriate rehabilitation in subacute stroke patients.
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Affiliation(s)
- Michela Goffredo
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
| | - Stefania Proietti
- Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Roma, Rome, Italy,Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, Rome, Italy
| | - Sanaz Pournajaf
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy,*Correspondence: Sanaz Pournajaf,
| | - Daniele Galafate
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
| | - Matteo Cioeta
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
| | - Domenica Le Pera
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
| | | | - Marco Franceschini
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy,Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, Rome, Italy
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Jamin P, Duret C, Hutin E, Bayle N, Koeppel T, Gracies JM, Pila O. Using Robot-Based Variables during Upper Limb Robot-Assisted Training in Subacute Stroke Patients to Quantify Treatment Dose. SENSORS 2022; 22:s22082989. [PMID: 35458975 PMCID: PMC9026756 DOI: 10.3390/s22082989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 12/10/2022]
Abstract
In post-stroke motor rehabilitation, treatment dose description is estimated approximately. The aim of this retrospective study was to quantify the treatment dose using robot-measured variables during robot-assisted training in patients with subacute stroke. Thirty-six patients performed fifteen 60 min sessions (Session 1−Session 15) of planar, target-directed movements in addition to occupational therapy over 4 (SD 2) weeks. Fugl−Meyer Assessment (FMA) was carried out pre- and post-treatment. The actual time practiced (percentage of a 60 min session), the number of repeated movements, and the total distance traveled were analyzed across sessions for each training modality: assist as needed, unassisted, and against resistance. The FMA score improved post-treatment by 11 (10) points (Session 1 vs. Session 15, p < 0.001). In Session 6, all modalities pooled, the number of repeated movements increased by 129 (252) (vs. Session 1, p = 0.043), the total distance traveled increased by 1743 (3345) cm (vs. Session 1, p = 0.045), and the actual time practiced remained unchanged. In Session 15, the actual time practiced showed changes only in the assist-as-needed modality: −13 (23) % (vs. Session 1, p = 0.013). This description of changes in quantitative-practice-related variables when using different robotic training modalities provides comprehensive information related to the treatment dose in rehabilitation. The treatment dose intensity may be enhanced by increasing both the number of movements and the motor difficulty of performing each movement.
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Affiliation(s)
- Pascal Jamin
- Institut Robert Merle d’Aubigné, Rééducation et Appareillage, 94460 Valenton, France;
| | - Christophe Duret
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, 77310 Boissise-Le-Roi, France; (C.D.); (T.K.)
| | - Emilie Hutin
- Laboratoire Analyse et Restauration Du Mouvement (ARM), Hôpital Henri MONDOR, Université Paris-Est, 94000 Créteil, France; (E.H.); (N.B.); (J.-M.G.)
- Bioingénierie, Tissus et Neuroplasticité (BIOTN), Université Paris-Est Créteil, 94000 Créteil, France
| | - Nicolas Bayle
- Laboratoire Analyse et Restauration Du Mouvement (ARM), Hôpital Henri MONDOR, Université Paris-Est, 94000 Créteil, France; (E.H.); (N.B.); (J.-M.G.)
- Bioingénierie, Tissus et Neuroplasticité (BIOTN), Université Paris-Est Créteil, 94000 Créteil, France
| | - Typhaine Koeppel
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, 77310 Boissise-Le-Roi, France; (C.D.); (T.K.)
| | - Jean-Michel Gracies
- Laboratoire Analyse et Restauration Du Mouvement (ARM), Hôpital Henri MONDOR, Université Paris-Est, 94000 Créteil, France; (E.H.); (N.B.); (J.-M.G.)
- Bioingénierie, Tissus et Neuroplasticité (BIOTN), Université Paris-Est Créteil, 94000 Créteil, France
| | - Ophélie Pila
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, 77310 Boissise-Le-Roi, France; (C.D.); (T.K.)
- Correspondence:
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Hernandez A, Bubyr L, Archambault PS, Higgins J, Levin MF, Kairy D. VR-based rehabilitation as a Feasible and Engaging Tool for the Management of Chronic Post-Stroke Upper Extremity Function Recovery: A Randomized Controlled Trial (Preprint). JMIR Serious Games 2022; 10:e37506. [PMID: 36166289 PMCID: PMC9555337 DOI: 10.2196/37506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/27/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alejandro Hernandez
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, QC, Canada
| | | | - Philippe S Archambault
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, QC, Canada
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Johanne Higgins
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, QC, Canada
- Ecole de sciences de la réadaptation, Université de Montréal, Montreal, QC, Canada
| | - Mindy F Levin
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, QC, Canada
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Dahlia Kairy
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, QC, Canada
- Ecole de sciences de la réadaptation, Université de Montréal, Montreal, QC, Canada
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8
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Saes M, Mohamed Refai MI, van Beijnum BJF, Bussmann JBJ, Jansma EP, Veltink PH, Buurke JH, van Wegen EEH, Meskers CGM, Krakauer JW, Kwakkel G. Quantifying Quality of Reaching Movements Longitudinally Post-Stroke: A Systematic Review. Neurorehabil Neural Repair 2022; 36:183-207. [PMID: 35100897 PMCID: PMC8902693 DOI: 10.1177/15459683211062890] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Disambiguation of behavioral restitution from compensation is important to better understand recovery of upper limb motor control post-stroke and subsequently design better interventions. Measuring quality of movement (QoM) during standardized performance assays and functional tasks using kinematic and kinetic metrics potentially allows for this disambiguation. Objectives To identify longitudinal studies that used kinematic and/or kinetic metrics to investigate post-stroke recovery of reaching and assess whether these studies distinguish behavioral restitution from compensation. Methods A systematic literature search was conducted using the databases PubMed, Embase, Scopus, and Wiley/Cochrane Library up to July 1st, 2020. Studies were identified if they performed longitudinal kinematic and/or kinetic measurements during reaching, starting within the first 6 months post-stroke. Results Thirty-two longitudinal studies were identified, which reported a total of forty-six different kinematic metrics. Although the majority investigated improvements in kinetics or kinematics to quantify recovery of QoM, none of these studies explicitly addressed the distinction between behavioral restitution and compensation. One study obtained kinematic metrics for both performance assays and a functional task. Conclusions Despite the growing number of kinematic and kinetic studies on post-stroke recovery, longitudinal studies that explicitly seek to delineate between behavioral restitution and compensation are still lacking in the literature. To rectify this situation, future studies should measure kinematics and/or kinetics during performance assays to isolate restitution and during a standardized functional task to determine the contributions of restitution and compensation.
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Affiliation(s)
- M Saes
- Department of Rehabilitation Medicine, 1209Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - M I Mohamed Refai
- Department of Biomedical Signals & Systems, Technical Medical Centre, 214825University of Twente, Enschede, Netherlands
| | - B J F van Beijnum
- Department of Biomedical Signals & Systems, Technical Medical Centre, 214825University of Twente, Enschede, Netherlands
| | - J B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - E P Jansma
- Medical Library, 1190Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUmcAmsterdam, The Netherlands
| | - P H Veltink
- Department of Biomedical Signals & Systems, Technical Medical Centre, 214825University of Twente, Enschede, Netherlands
| | - J H Buurke
- Department of Biomedical Signals & Systems, Technical Medical Centre, 214825University of Twente, Enschede, Netherlands.,Rehabilitation Technology, Roessingh Research and Development, Enschede, Netherlands.,Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, 12244Northwestern University, Chicago, Il, USA
| | - E E H van Wegen
- Department of Rehabilitation Medicine, 1209Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - C G M Meskers
- Department of Rehabilitation Medicine, 1209Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, Netherlands.,Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, 12244Northwestern University, Chicago, Il, USA
| | - J W Krakauer
- Departments of Neurology, Neuroscience and Physical Medicine and Rehabilitation, 1500Johns Hopkins University, Baltimore, MD, United States
| | - G Kwakkel
- Department of Rehabilitation Medicine, 1209Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, Netherlands.,Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, 12244Northwestern University, Chicago, Il, USA.,Department of Neurorehabilitation, 522567Amsterdam Rehabilitation Research Centre, Amsterdam, Netherlands
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9
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Jiang YC, Ma R, Qi S, Ge S, Sun Z, Li Y, Song J, Zhang M. Characterization of Bimanual Cyclical Tasks from Single-trial EEG-fNIRS Measurements. IEEE Trans Neural Syst Rehabil Eng 2022; 30:146-156. [PMID: 35041608 DOI: 10.1109/tnsre.2022.3144216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Robot-assisted bimanual training is promising to improve motor function and cortical reorganization for hemiparetic stroke patients. Closing the rehabilitation training loop with neurofeedback can help refine training protocols in time for better engagements and outcomes. However, due to the low signal-to- noise ratio (SNR) and non-stationary properties of neural signals, reliable characterization of bimanual training-induced neural activities from single-trial measurement is challenging. In this study, ten human participants were recruited conducting robot-assisted bimanual cyclical tasks (in-phase, 90° out-of-phase, and anti-phase) when concurrent electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) were recorded. A unified EEG-fNIRS bimodal signal processing framework was proposed to characterize neural activities induced by three types of bimanual cyclical tasks. In this framework, novel artifact removal methods were used to improve the SNR and the task-related component analysis (TRCA) was introduced to increase the reproducibility of EEG-fNIRS bimodal features. The optimized features were transformed into low-dimensional indicators to reliably characterize bimanual training-induced neural activation. The SVM classification results of three bimanual cyclical tasks revealed a good discrimination ability of EEG-fNIRS bimodal indicators (90.1%), which was higher than that using EEG (74.8%) or fNIRS (82.2%) alone, supporting the proposed method as a feasible technique to characterize neural activities during robot-assisted bimanual training.
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10
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Hwang D, Shin JH, Kwon S. Kinematic Assessment to Measure Change in Impairment during Active and Active-Assisted Type of Robotic Rehabilitation for Patients with Stroke. SENSORS 2021; 21:s21217055. [PMID: 34770362 PMCID: PMC8587557 DOI: 10.3390/s21217055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/14/2021] [Accepted: 10/21/2021] [Indexed: 11/20/2022]
Abstract
Analysis of kinematic features related to clinical assessment scales may qualitatively improve the evaluation of upper extremity movements of stroke patients. We aimed to investigate kinematic features that could correlate the change in the Fugl-Meyer Assessment (FMA) score of stroke survivors through upper extremity robotic rehabilitation. We also analyzed whether changes in kinematic features by active and active-assisted robotic rehabilitation correlated differently with changes in FMA scores. Fifteen stroke patients participated in the upper extremity robotic rehabilitation program, and nine kinematic features were calculated from reach tasks for assessment. Simple and multiple linear regression analyses were used to characterize correlations. Features representing movement speed were associated with changes in FMA scores for the group that used an active rehabilitation robot. In contrast, in the group that used an active-assisted rehabilitation robot, features representing movement smoothness were associated with changes in the FMA score. These estimates can be an important basis for kinematic analysis to complement clinical scales.
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Affiliation(s)
- Donghwan Hwang
- Department of Rehabilitation & Assistive Technology, National Rehabilitation Center, Ministry of Health and Welfare, Seoul 01022, Korea; or
- Translational Research Program for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul 01022, Korea
| | - Joon-Ho Shin
- Translational Research Program for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul 01022, Korea
- Department of Neurorehabilitation, National Rehabilitation Center, Ministry of Health and Welfare, Seoul 01022, Korea
- Correspondence: or (J.-H.S.); or (S.K.)
| | - Suncheol Kwon
- Department of Rehabilitation & Assistive Technology, National Rehabilitation Center, Ministry of Health and Welfare, Seoul 01022, Korea; or
- Translational Research Program for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul 01022, Korea
- Correspondence: or (J.-H.S.); or (S.K.)
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Saes M, Mohamed Refai MI, van Kordelaar J, Scheltinga BL, van Beijnum BJF, Bussmann JBJ, Buurke JH, Veltink PH, Meskers CGM, van Wegen EEH, Kwakkel G. Smoothness metric during reach-to-grasp after stroke: part 2. longitudinal association with motor impairment. J Neuroeng Rehabil 2021; 18:144. [PMID: 34560898 PMCID: PMC8461930 DOI: 10.1186/s12984-021-00937-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 09/08/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The cause of smoothness deficits as a proxy for quality of movement post stroke is currently unclear. Previous simulation analyses showed that spectral arc length (SPARC) is a valid metric for investigating smoothness during a multi-joint goal-directed reaching task. The goal of this observational study was to investigate how SPARC values change over time, and whether SPARC is longitudinally associated with the recovery from motor impairments reflected by the Fugl-Meyer motor assessment of the upper extremity (FM-UE) in the first 6 months after stroke. METHODS Forty patients who suffered a first-ever unilateral ischemic stroke (22 males, aged 58.6 ± 12.5 years) with upper extremity paresis underwent kinematic and clinical measurements in weeks 1, 2, 3, 4, 5, 8, 12, and 26 post stroke. Clinical measures included amongst others FM-UE. SPARC was obtained by three-dimensional kinematic measurements using an electromagnetic motion tracking system during a reach-to-grasp movement. Kinematic assessments of 12 healthy, age-matched individuals served as reference. Longitudinal linear mixed model analyses were performed to determine SPARC change over time, compare smoothness in patients with reference values of healthy individuals, and establish the longitudinal association between SPARC and FM-UE scores. RESULTS SPARC showed a significant positive longitudinal association with FM-UE (B: 31.73, 95%-CI: [27.27 36.20], P < 0.001), which encompassed significant within- and between-subject effects (B: 30.85, 95%-CI: [26.28 35.41], P < 0.001 and B: 50.59, 95%-CI: [29.97 71.21], P < 0.001, respectively). Until 5 weeks post stroke, progress of time contributed significantly to the increase in SPARC and FM-UE scores (P < 0.05), whereafter they levelled off. At group level, smoothness was lower in patients who suffered a stroke compared to healthy subjects at all time points (P < 0.05). CONCLUSIONS The present findings show that, after stroke, recovery of smoothness in a multi-joint reaching task and recovery from motor impairments are longitudinally associated and follow a similar time course. This suggests that the reduction of smoothness deficits quantified by SPARC is a proper objective reflection of recovery from motor impairment, as reflected by FM-UE, probably driven by a common underlying process of spontaneous neurological recovery early post stroke.
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Affiliation(s)
- Mique Saes
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, de Boelelaan 1117, Location VUmc, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Mohamed Irfan Mohamed Refai
- Department of Biomedical Signals & Systems, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Joost van Kordelaar
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, de Boelelaan 1117, Location VUmc, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Bouke L Scheltinga
- Department of Biomedical Signals & Systems, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Bert-Jan F van Beijnum
- Department of Biomedical Signals & Systems, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Johannes B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jaap H Buurke
- Department of Biomedical Signals & Systems, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Il, USA
- Rehabilitation Technology, Roessingh Research and Development, Enschede, The Netherlands
| | - Peter H Veltink
- Department of Biomedical Signals & Systems, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, de Boelelaan 1117, Location VUmc, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Il, USA
| | - Erwin E H van Wegen
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, de Boelelaan 1117, Location VUmc, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, de Boelelaan 1117, Location VUmc, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Il, USA.
- Department of Neurorehabilitation, Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands.
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12
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Kinematic Evaluation via Inertial Measurement Unit Associated with Upper Extremity Motor Function in Subacute Stroke: A Cross-Sectional Study. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:4071645. [PMID: 34457217 PMCID: PMC8397559 DOI: 10.1155/2021/4071645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/04/2021] [Accepted: 08/11/2021] [Indexed: 12/25/2022]
Abstract
Kinematic evaluation via portable sensor system has been increasingly applied in neurological sciences and clinical practice. However, conventional kinematic evaluation rarely extends the context beyond the motor impairment level. In addition, kinematic tasks with numerous items could be complex and time consuming that pose a burden to test applications and data processing. The study aimed to explore the correlation of finger-to-nose task (FNT) kinematics via Inertial Measurement Unit with upper limb motor function in subacute stroke. In this study, six FNT kinematic variables were used to measure movement time, smoothness, and velocity in 37 participants with subacute stroke. Upper limb motor function was evaluated with the Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), and modified Barthel Index (MBI). As a result, mean velocity, peak velocity, and the number of movement units were associated with the clinical assessments. The multivariable linear regression models could estimate 55%, 51%, and 32% of variance in FMA-UE, ARAT, and MBI, respectively. In addition, age, gender, type of stroke, and paretic side had no significant effects on these associations. Results show that FNT kinematic variables measured via Inertial Measurement Unit are associated with upper extremity motor function in individuals with subacute stroke. The objective kinematic evaluation may be suitable for predicting clinical measures of motor impairment and capacity to understand upper extremity motor recovery and clinical decision making after stroke. This trial is registered with ChiCTR1900026656.
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13
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Bhagubai MMC, Wolterink G, Schwarz A, Held JPO, Van Beijnum BJF, Veltink PH. Quantifying Pathological Synergies in the Upper Extremity of Stroke Subjects With the Use of Inertial Measurement Units: A Pilot Study. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2020; 9:2100211. [PMID: 33344099 PMCID: PMC7742824 DOI: 10.1109/jtehm.2020.3042931] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/06/2020] [Accepted: 11/24/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Stroke is one of the main causes of disability in the world, causing loss of motor function on mainly one side of the body. A proper assessment of motor function is required to help to direct and evaluate therapy. Assessment is currently performed by therapists using observer-based standardized clinical assessment protocols. Sensor-based technologies can be used to objectively quantify the presence and severity of motor impairments in stroke patients. METHODS In this work, a minimally obstructive distributed inertial sensing system, intended to measure kinematics of the upper extremity, was developed and tested in a pilot study, where 10 chronic stroke subjects performed the arm-related tasks from the Fugl-Meyer Assessment protocol with the affected and non-affected side. RESULTS The pilot study showed that the developed distributed measurement system was adequately sensitive to show significant differences in stroke subjects' arm postures between the affected and non-affected side. The presence of pathological synergies can be analysed using the measured joint angles of the upper limb segments, that describe the movement patterns of the subject. CONCLUSION Features measured by the system vary from the assessed FMA-UE sub-score showing its potential to provide more detailed clinical information.
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Affiliation(s)
- Miguel M C Bhagubai
- Biomedical Signals and Systems~(BSS) Research GroupUniversity of Twente7522LWEnschedeThe Netherlands
| | - Gerjan Wolterink
- Biomedical Signals and Systems~(BSS) Research GroupUniversity of Twente7522LWEnschedeThe Netherlands.,Robotics and Mechatronics GroupUniversity of Twente7522NHEnschedeThe Netherlands
| | - Anne Schwarz
- Biomedical Signals and Systems~(BSS) Research GroupUniversity of Twente7522LWEnschedeThe Netherlands.,Division of Vascular Neurology and NeurorehabilitationDepartment of NeurologyUniversity Hospital Zürich, University of Zürich8091ZürichSwitzerland
| | - Jeremia P O Held
- Division of Vascular Neurology and NeurorehabilitationDepartment of NeurologyUniversity Hospital Zürich, University of Zürich8091ZürichSwitzerland
| | - Bert-Jan F Van Beijnum
- Biomedical Signals and Systems~(BSS) Research GroupUniversity of Twente7522LWEnschedeThe Netherlands
| | - Peter H Veltink
- Biomedical Signals and Systems~(BSS) Research GroupUniversity of Twente7522LWEnschedeThe Netherlands
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14
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Cho KH, Song WK. Effects of two different robot-assisted arm training on upper limb motor function and kinematics in chronic stroke survivors: A randomized controlled trial. Top Stroke Rehabil 2020; 28:241-250. [PMID: 32791945 DOI: 10.1080/10749357.2020.1804699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Comparative studies of different robotic types are warranted to tailor robot-assisted upper limb training to patient's functional level. OBJECTIVES This study aimed to directly compare the effects of high inertia robot arm (whole arm manipulator, WAM) and low inertia robot arm (Proficio) on upper limb motor function in chronic stroke patients. METHODS In this randomized controlled trial, 40 chronic stroke survivors were randomized into robot-assisted arm training with WAM (RAT-WAM) and robot-assisted arm training with Proficio (RAT-P) groups. The RAT-WAM and RAT-P groups participated in the robot-assisted arm training with WAM and robot-assisted arm training with Proficio, respectively, for 40 min daily, three times weekly over a four week. Upper limb motor function was measured before and after the intervention using the Fugl-Meyer assessment (FMA), action research arm test, and box and block test (BBT). Curvilinearity ratio (the length ratio of a straight line from the start to the target) was also measured as an index for upper limb kinematic performance. RESULTS The RAT-WAM and RAT-P groups showed significant improvements in FMA-total and -proximal (shoulder/elbow units), BBT, and ARAT after the intervention (P < .05). Also, the RAT-P group showed significantly more improvement than the RAT-WAM group in FMA-distal (hand/wrist units) (P < .05). CONCLUSIONS Improvements of upper limb motor function occurred during robot-assisted arm training with robotic systems. Low inertia robot arm was more effective in improving the motor function of the hand and wrist. The results may be useful for robot-assisted training for upper limb impairment.
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Affiliation(s)
- Ki-Hun Cho
- Department of Physical Therapy, Korea National University of Transportation, Chungbuk, Republic of Korea
| | - Won-Kyung Song
- Department of Rehabilitative & Assistive Technology, National Rehabilitation Research Institute, National Rehabilitation Center, Seoul, Republic of Korea
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15
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Adans-Dester C, Fasoli SE, Fabara E, Menard N, Fox AB, Severini G, Bonato P. Can kinematic parameters of 3D reach-to-target movements be used as a proxy for clinical outcome measures in chronic stroke rehabilitation? An exploratory study. J Neuroeng Rehabil 2020; 17:106. [PMID: 32771020 PMCID: PMC7414659 DOI: 10.1186/s12984-020-00730-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 07/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite numerous trials investigating robot-assisted therapy (RT) effects on upper-extremity (UE) function after stroke, few have explored the relationship between three-dimensional (3D) reach-to-target kinematics and clinical outcomes. The objectives of this study were to 1) investigate the correlation between kinematic parameters of 3D reach-to-target movements and UE clinical outcome measures, and 2) examine the degree to which differences in kinematic parameters across individuals can account for differences in clinical outcomes in response to RT. METHODS Ten chronic stroke survivors participated in a pilot RT intervention (eighteen 1-h sessions) integrating cognitive skills training and a home-action program. Clinical outcome measures and kinematic parameters of 3D reach-to-target movements were collected pre- and post-intervention. The correlation between clinical outcomes and kinematic parameters was investigated both cross-sectionally and longitudinally (i.e., changes in response to the intervention). Changes in clinical outcomes and kinematic parameters were tested for significance in both group and subject-by-subject analyses. Potential associations between individual differences in kinematic parameters and differences in clinical outcomes were examined. RESULTS Moderate-to-strong correlation was found between clinical measures and specific kinematic parameters when examined cross-sectionally. Weaker correlation coefficients were found longitudinally. Group analyses revealed significant changes in clinical outcome measures in response to the intervention; no significant group changes were observed in kinematic parameters. Subject-by-subject analyses revealed changes with moderate-to-large effect size in the kinematics of 3D reach-to-target movements pre- vs. post-intervention. Changes in clinical outcomes and kinematic parameters varied widely across participants. CONCLUSIONS Large variability was observed across subjects in response to the intervention. The correlation between changes in kinematic parameters and clinical outcomes in response to the intervention was variable and not strong across parameters, suggesting no consistent change in UE motor strategies across participants. These results highlight the need to investigate the response to interventions at the individual level. This would enable the identification of clusters of individuals with common patterns of change in response to an intervention, providing an opportunity to use cluster-specific kinematic parameters as a proxy of clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov, NCT02747433 . Registered on April 21st, 2016.
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Affiliation(s)
- Catherine Adans-Dester
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, 300 First Ave, Charlestown, Boston, MA, 02129, USA
- School of Health & Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - Susan E Fasoli
- School of Health & Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - Eric Fabara
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, 300 First Ave, Charlestown, Boston, MA, 02129, USA
| | - Nicolas Menard
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Annie B Fox
- School of Health & Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - Giacomo Severini
- School of Electrical and Electronic Engineering, University College Dublin, Dublin, Ireland
- Centre for Biomedical Engineering, University College Dublin, Dublin, Ireland
| | - Paolo Bonato
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, 300 First Ave, Charlestown, Boston, MA, 02129, USA.
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA.
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16
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Gomes CLA, Cacho RO, Nobrega VTB, de A Confessor EM, de Farias EEM, Neto JLF, de Araújo DS, de S Medeiros AL, Barreto RL, Cacho EWA. Low-cost equipment for the evaluation of reach and grasp in post-stroke individuals: a pilot study. Biomed Eng Online 2020; 19:14. [PMID: 32131840 PMCID: PMC7057550 DOI: 10.1186/s12938-020-0758-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/22/2020] [Indexed: 11/24/2022] Open
Abstract
Background Reach–grasp movements are motor components commonly affected after stroke and directly related to the independence of these individuals. Evaluations of these activities can be performed using clinical instruments and assessed by detailed and costly kinematic analyses. The aim of this study was to develop an analysis of reach–grasp movements in post-stroke patients using a simple, inexpensive, and manageable instrument. Results A Mann–Whitney test was used to compare paretic and non-paretic limb motor performance. A statistically significant difference was found between the variables of total time (p = 0.02) and speed to reach target 3 (p = 0.04) for task 1, while in task 2 significance was found only in the aspect of speed to reach target 2 (p = 0.04). The correlation between clinical tests and variables of tasks was then performed using Spearman’s rank correlation coefficient. At task 1, when compared with the REACH instrument, the close target sub-item; there was a high positive correlation between the parameters of total time (p = 0.028), target velocity 3 (p = 0.028), and target acceleration 3 (p = 0.028). Another instrument that showed a high positive correlation with the target time 3 (p = 0.01) and target acceleration 3 (p = 0.028) variables was the Box and Block Test. When correlated, the data between the task 2 variables and clinical instruments did not present statistically significant data. Conclusion Our instrument—the Temporal Data Acquisition Instrument—TDAI—fulfilled the expected objectives and can be used as an option to evaluate the movements of reach and grasp of upper limb post-stroke, using an easy and fast application, without the need for calibration. Trial registration Trial Registration: Research Ethics Committee of the Trairi School of Health Sciences—Number 2.625.609, approved on April 13, 2018; Brazilian Registry of Clinical Trials—RBR-4995cr approved on July 4, 2019 retrospectively registered (http://www.ensaiosclinicos.gov.br/rg/RBR-4995cr/)
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Affiliation(s)
- Camila L A Gomes
- School of Health Sciences, Federal University of Rio Grande do Norte (UFRN), Santa Cruz, RN, Brazil.
| | - Roberta O Cacho
- School of Health Sciences, Federal University of Rio Grande do Norte (UFRN), Santa Cruz, RN, Brazil
| | - Viviane T B Nobrega
- School of Health Sciences, Federal University of Rio Grande do Norte (UFRN), Santa Cruz, RN, Brazil
| | | | | | | | - Denise S de Araújo
- School of Health Sciences, Federal University of Rio Grande do Norte (UFRN), Santa Cruz, RN, Brazil
| | - Ana Loyse de S Medeiros
- School of Health Sciences, Federal University of Rio Grande do Norte (UFRN), Santa Cruz, RN, Brazil
| | - Rodrigo L Barreto
- Research Department, Federal Institute of Rio Grande do Norte Campus, Santa Cruz, RN, Brazil
| | - Enio W A Cacho
- School of Health Sciences, Federal University of Rio Grande do Norte (UFRN), Santa Cruz, RN, Brazil
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17
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Germanotta M, Gower V, Papadopoulou D, Cruciani A, Pecchioli C, Mosca R, Speranza G, Falsini C, Cecchi F, Vannetti F, Montesano A, Galeri S, Gramatica F, Aprile I. Reliability, validity and discriminant ability of a robotic device for finger training in patients with subacute stroke. J Neuroeng Rehabil 2020; 17:1. [PMID: 31900169 PMCID: PMC6942416 DOI: 10.1186/s12984-019-0634-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 12/12/2019] [Indexed: 02/14/2023] Open
Abstract
Background The majority of stroke survivors experiences significant hand impairments, as weakness and spasticity, with a severe impact on the activity of daily living. To objectively evaluate hand deficits, quantitative measures are needed. The aim of this study is to assess the reliability, the validity and the discriminant ability of the instrumental measures provided by a robotic device for hand rehabilitation, in a sample of patients with subacute stroke. Material and methods In this study, 120 patients with stroke and 40 controls were enrolled. Clinical evaluation included finger flexion and extension strength (using the Medical Research Council, MRC), finger spasticity (using the Modified Ashworth Scale, MAS) and motor control and dexterity during ADL performance (by means of the Frenchay Arm Test, FAT). Robotic evaluations included finger flexion and extension strength, muscle tone at rest, and instrumented MAS and Modified Tardieu Scale. Subjects were evaluated twice, one day apart, to assess the test-retest reliability of the robotic measures, using the Intraclass Correlation Coefficient (ICC). To estimate the response stability, the standard errors of measurement and the minimum detectable change (MDC) were also calculated. Validity was assessed by analyzing the correlations between the robotic metrics and the clinical scales, using the Spearman’s Correlation Coefficient (r). Finally, we investigated the ability of the robotic measures to distinguish between patients with stroke and healthy subjects, by means of Mann-Whitney U tests. Results All the investigated measures were able to discriminate patients with stroke from healthy subjects (p < 0.001). Test-retest reliability was found to be excellent for finger strength (in both flexion and extension) and muscle tone, with ICCs higher than 0.9. MDCs were equal to 10.6 N for finger flexion, 3.4 N for finger extension, and 14.3 N for muscle tone. Conversely, test-retest reliability of the spasticity measures was poor. Finally, finger strength (in both flexion and extension) was correlated with the clinical scales (r of about 0.7 with MRC, and about 0.5 with FAT). Discussion Finger strength (in both flexion and extension) and muscle tone, as provided by a robotic device for hand rehabilitation, are reliable and sensitive measures. Moreover, finger strength is strongly correlated with clinical scales. Changes higher than the obtained MDC in these robotic measures could be considered as clinically relevant and used to assess the effect of a rehabilitation treatment in patients with subacute stroke.
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Affiliation(s)
- Marco Germanotta
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci, 269, 50143, Florence, Italy.
| | - Valerio Gower
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy
| | | | - Arianna Cruciani
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy
| | | | - Rita Mosca
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy
| | - Gabriele Speranza
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy
| | - Catuscia Falsini
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci, 269, 50143, Florence, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci, 269, 50143, Florence, Italy
| | - Federica Vannetti
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci, 269, 50143, Florence, Italy
| | - Angelo Montesano
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy
| | - Silvia Galeri
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy
| | - Furio Gramatica
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy
| | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy
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18
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Goffredo M, Mazzoleni S, Gison A, Infarinato F, Pournajaf S, Galafate D, Agosti M, Posteraro F, Franceschini M. Kinematic Parameters for Tracking Patient Progress during Upper Limb Robot-Assisted Rehabilitation: An Observational Study on Subacute Stroke Subjects. Appl Bionics Biomech 2019; 2019:4251089. [PMID: 31772604 PMCID: PMC6854217 DOI: 10.1155/2019/4251089] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 08/02/2019] [Accepted: 08/14/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Upper limb robot-assisted therapy (RT) provides intensive, repetitive, and task-specific treatment, and its efficacy for stroke survivors is well established in literature. Biomechanical data from robotic devices has been widely employed for patient's assessment, but rarely it has been analysed for tracking patient progress during RT. The goal of this retrospective study is to analyse built-in kinematic data registered by a planar end-effector robot for assessing the time course of motor recovery and patient's workspace exploration skills. A comparison of subjects having mild and severe motor impairment has been also conducted. For that purpose, kinematic data recorded by a planar end-effector robot have been processed for investigating how motor performance in executing point-to-point trajectories with different directions changes during RT. METHODS Observational retrospective study of 68 subacute stroke patients who conducted 20 daily sessions of upper limb RT with the InMotion 2.0 (Bionik Laboratories, USA): planar point-to-point reaching tasks with an "assist as needed" strategy. The following kinematic parameters (KPs) were computed for each subject and for each point-to-point trajectory executed during RT: movement accuracy, movement speed, number of peak speed, and task completion time. The Wilcoxon signed-rank tests were used with clinical outcomes. the Friedman test and post hoc Conover's test (Bonferroni's correction) were applied to KPs. A secondary data analysis has been conducted by comparing patients having different severities of motor impairment. The level of significance was set at p value < 0.05. RESULTS At the RT onset, the movements were less accurate and smoothed, and showed higher times of execution than those executed at the end of treatment. The analysis of the time course of KPs highlighted that RT seems to improve the motor function mainly in the first sessions of treatment: most KPs show significant intersession differences during the first 5/10 sessions. Afterwards, no further significant variations occurred. The ability to perform movements away from the body and from the hemiparetic side remains more challenging. The results obtained from the data stratification show significant differences between subjects with mild and severe motor impairment. CONCLUSION Significant improvements in motor performance were registered during the time course of upper limb RT in subacute stroke patients. The outcomes depend on movement direction and motor impairment and pave the way to optimize healthcare resources and to design patient-tailored rehabilitative protocols.
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Affiliation(s)
- Michela Goffredo
- Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Rome, Italy
| | - Stefano Mazzoleni
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Rehabilitation Bioengineering Laboratory, Volterra, Italy
| | - Annalisa Gison
- Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Rome, Italy
| | | | - Sanaz Pournajaf
- Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Rome, Italy
| | - Daniele Galafate
- Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Rome, Italy
| | - Maurizio Agosti
- Rehabilitation Medicine Service, NHS-University Hospital of Parma, Parma, Italy
| | - Federico Posteraro
- Rehabilitation Department, Versilia Hospital, AUSL Tuscany North West, Camaiore, Italy
| | - Marco Franceschini
- Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Rome, Italy
- San Raffaele University, Rome, Italy
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19
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Duret C, Pila O, Grosmaire AG, Koeppel T. Can robot-based measurements improve prediction of motor performance after robot-assisted upper-limb rehabilitation in patients with moderate-to-severe sub-acute stroke? Restor Neurol Neurosci 2019; 37:119-129. [PMID: 30909254 DOI: 10.3233/rnn-180892] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Patients with moderate-to-severe stroke-related upper limb impairment can benefit from repetitive robot-assisted training. However, predicting motor performance in these patients from baseline measurements, including robot-based parameters would help clinicians to provide optimal treatments for each individual. METHODS Forty-six patients with sub-acute stroke underwent a 16-session upper limb rehabilitation combining usual care and robotic therapy. Motor outcomes (Fugl-Meyer Assessment Upper Extremity (FMA) score) were retrospectively analysed and potential predictors of motor outcome (including baseline FMA scores, kinematics and number of repetitions performed in the first session etc.) were determined. RESULTS The 16-sessions upper limb combined training program led to significantly improved clinical outcomes (gains of 13.8±11.2 for total FMA score and 7.3±6.7 for FMA Shoulder/Elbow score). For the prediction model, time since stroke poorly explained the FMA total score (R2 < 35%). The model however found that time since stroke and initial value of FMA Shoulder/Elbow score were predictors of the FMA Shoulder/Elbow score: (R2 = 59.6%). CONCLUSION This study found that clinical prediction of motor outcomes after moderate-to-severe upper-limb paresis is limited. However, initial proximal motor impairment severity predicted proximal motor performance. The value of baselines kinematics and of the number of repeated movements at initiation in the prediction would need further studies.
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Affiliation(s)
- Christophe Duret
- CRF Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Rééducation Neurologique, Boissise-Le-Roi (77), France.,Centre Hospitalier Sud Francilien, Neurologie, Corbeil-Essonnes (91), France
| | - Ophélie Pila
- CRF Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Rééducation Neurologique, Boissise-Le-Roi (77), France.,EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement (ARM), Université Paris-Est Créteil, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil (94), France
| | - Anne-Gaëlle Grosmaire
- CRF Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Rééducation Neurologique, Boissise-Le-Roi (77), France
| | - Typhaine Koeppel
- CRF Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Rééducation Neurologique, Boissise-Le-Roi (77), France
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20
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Duret C, Grosmaire AG, Krebs HI. Robot-Assisted Therapy in Upper Extremity Hemiparesis: Overview of an Evidence-Based Approach. Front Neurol 2019; 10:412. [PMID: 31068898 PMCID: PMC6491567 DOI: 10.3389/fneur.2019.00412] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/04/2019] [Indexed: 01/15/2023] Open
Abstract
Robot-mediated therapy is an innovative form of rehabilitation that enables highly repetitive, intensive, adaptive, and quantifiable physical training. It has been increasingly used to restore loss of motor function, mainly in stroke survivors suffering from an upper limb paresis. Multiple studies collated in a growing number of review articles showed the positive effects on motor impairment, less clearly on functional limitations. After describing the current status of robotic therapy after upper limb paresis due to stroke, this overview addresses basic principles related to robotic therapy applied to upper limb paresis. We demonstrate how this innovation is an evidence-based approach in that it meets both the improved clinical and more fundamental knowledge-base about regaining effective motor function after stroke and the need of more objective, flexible and controlled therapeutic paradigms.
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Affiliation(s)
- Christophe Duret
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, Boissise-Le-Roi, France.,Centre Hospitalier Sud Francilien, Neurologie, Corbeil-Essonnes, France
| | - Anne-Gaëlle Grosmaire
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, Boissise-Le-Roi, France
| | - Hermano Igo Krebs
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Neurology, University of Maryland, Baltimore, MD, United States.,Department of Physical Medicine and Rehabilitation, Fujita Health University, Nagoya, Japan.,Institute of Neuroscience, University of Newcastle, Newcastle upon Tyne, United Kingdom.,Department of Mechanical Sciences and Bioengineering, Osaka University, Osaka, Japan.,Wolfson School of Mechanical, Electrical, and Manufacturing Engineering, Loughborough University, Loughborough, United Kingdom
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21
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Mazzoleni S, Battini E, Galgani M, Tenucci M, Dario P, Calvosa G. Motion Tracking for Quantitative and Qualitative Assessment of Upper Limb Movements Following Acromioclavicular Joint Ligament Reconstruction: A Pilot Study. Open Biomed Eng J 2018. [DOI: 10.2174/1874120701812010135] [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
Background:
Technological tools as robotic devices and wearable sensors can provide accurate and repeatable measurements of physical variables (e.g., position, velocities, forces) which can be used for quantitative and qualitative assessment of movement analysis and upper limb motor performance.
Objective:
The study aims to propose a quantitative and qualitative assessment of upper limb motor performance by means of seven kinematic parameters recorded by a passive mechatronic device in patients who underwent a surgical procedure for ligament reconstruction following acromioclavicular joint dislocation.
Method:
Five patients (mean age: 40 ± 12 years) with acromioclavicular joint dislocation were enrolled.
A passive end-effector mechatronic device characterized by 7 degrees of freedom and designed for the assessment of upper limb motor performance - especially for measuring the hand position in three-dimensional space - was used.
The Constant-Murley score and seven kinematic parameters were used as clinical outcome measure and quantitative and qualitative assessment, respectively.
Results:
The preliminary results of this study show no significant differences between the impaired arm and unimpaired arm: the end-effector passive mechatronic device used in this study is able to provide an overall assessment of the upper limb motor performance following shoulder impairment.
Conclusion:
The motion tracker can be easily used as effective tool for quantitative and qualitative assessment of upper limb motor performance, even several years after the surgical operation.
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Pila O, Duret C, Gracies JM, Francisco GE, Bayle N, Hutin É. Evolution of upper limb kinematics four years after subacute robot-assisted rehabilitation in stroke patients. Int J Neurosci 2018; 128:1030-1039. [PMID: 29619890 DOI: 10.1080/00207454.2018.1461626] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Purpose: To assess functional status and robot-based kinematic measures four years after subacute robot-assisted rehabilitation in hemiparesis. Materials and methods: Twenty-two patients with stroke-induced hemiparesis underwent a ≥3-month upper limb combined program of robot-assisted and occupational therapy from two months post-stroke, and received community-based therapy after discharge. Four years later, 19 (86%) participated in this follow-up study. Assessments 2, 5 and 54 months post-stroke included Fugl-Meyer (FM), Modified Frenchay Scale (MFS, at Month 54) and robot-based kinematic measures of targeting tasks in three directions, north, paretic and non-paretic: distance covered, velocity, accuracy (root mean square (RMS) error from straight line) and smoothness (number of velocity peaks; upward changes in accuracy and smoothness represent worsening). Analysis was stratified by FM score at two months: ≥17 (Group 1) or <17 (Group 2). Correlation between impairment (FM) and function (MFS) was explored at 54 months. Results: FM scores were stable from 5 to 54 months (+1[-2;4], median [1st; 3rd quartiles], ns). Kinematic changes (three directions pooled) were: distance -1[-17;2]% (ns); velocity, -8[-32;28]% (ns); accuracy, +6[-13;98]% (ns); smoothness, +44[-6;126]% (p < 0.05). Group 2 showed decline vs. Group 1 (p < 0.001) in FM (Group 1, +3[1;5], p < 0.01; Group 2, -7[-11;-1], ns) and accuracy (Group 1, -3[-27;38]%, ns; Group 2, +29[17;140]%, p < 0.001). At 54 months, FM and MFS were highly correlated (Pearson's rho = 0.89; p < 0.001). Conclusions: While impairment appeared stable four years after robot-assisted upper limb training during subacute post-stroke phase, movement kinematics deteriorated despite community-based therapy, especially in more severely impaired patients. Trial registration: EudraCT 2016-005121-36. Registration: 2016-12-20. Date of enrolment of the first participant to the trial: 2009-11-24.
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Affiliation(s)
- Ophélie Pila
- a Centre De Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique Et De Réadaptation , Boissise-Le-Roi , France.,b EA 7377 BIOTN, Laboratoire Analyse Et Restauration du Mouvement (ARM) , Université Paris-Est Créteil, Hôpitaux Universitaires Henri Mondor , Créteil , France
| | - Christophe Duret
- a Centre De Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique Et De Réadaptation , Boissise-Le-Roi , France.,c Centre Hospitalier Sud Francilien, Neurologie , Corbeil-Essonnes , France
| | - Jean-Michel Gracies
- b EA 7377 BIOTN, Laboratoire Analyse Et Restauration du Mouvement (ARM) , Université Paris-Est Créteil, Hôpitaux Universitaires Henri Mondor , Créteil , France
| | - Gerard E Francisco
- d Department of Physical Medicine and Rehabilitation , University of Texas Health Science Center McGovern Medical School and TIRR Memorial Hermann Hospital , Houston , TX , USA
| | - Nicolas Bayle
- b EA 7377 BIOTN, Laboratoire Analyse Et Restauration du Mouvement (ARM) , Université Paris-Est Créteil, Hôpitaux Universitaires Henri Mondor , Créteil , France
| | - Émilie Hutin
- b EA 7377 BIOTN, Laboratoire Analyse Et Restauration du Mouvement (ARM) , Université Paris-Est Créteil, Hôpitaux Universitaires Henri Mondor , Créteil , France
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Combining Upper Limb Robotic Rehabilitation with Other Therapeutic Approaches after Stroke: Current Status, Rationale, and Challenges. BIOMED RESEARCH INTERNATIONAL 2017; 2017:8905637. [PMID: 29057269 PMCID: PMC5615953 DOI: 10.1155/2017/8905637] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 07/12/2017] [Accepted: 08/10/2017] [Indexed: 01/19/2023]
Abstract
A better understanding of the neural substrates that underlie motor recovery after stroke has led to the development of innovative rehabilitation strategies and tools that incorporate key elements of motor skill relearning, that is, intensive motor training involving goal-oriented repeated movements. Robotic devices for the upper limb are increasingly used in rehabilitation. Studies have demonstrated the effectiveness of these devices in reducing motor impairments, but less so for the improvement of upper limb function. Other studies have begun to investigate the benefits of combined approaches that target muscle function (functional electrical stimulation and botulinum toxin injections), modulate neural activity (noninvasive brain stimulation), and enhance motivation (virtual reality) in an attempt to potentialize the benefits of robot-mediated training. The aim of this paper is to overview the current status of such combined treatments and to analyze the rationale behind them.
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