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Hejazi-Shirmard M, Taghizadeh G, Rassafiani M, Cheraghifard M, Yousefi M, Hosseini SH, Askary Kachoosangy R, Lajevardi L. Bottom-up versus Top-down designed rehabilitation sessions in chronic stroke survivors: a pilot randomized controlled trial. Disabil Rehabil 2024:1-10. [PMID: 39078078 DOI: 10.1080/09638288.2024.2384622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 07/13/2024] [Accepted: 07/14/2024] [Indexed: 07/31/2024]
Abstract
PURPOSE The present study aimed to compare the effectiveness of Top-down and Bottom-up approaches on levels of the International Classification of Functioning, Disability and Health Framework (ICF), including impairments, activities, and participation. MATERIALS AND METHODS Thirty-nine chronic stroke survivors were recruited for this single-blinded randomized clinical trial. Participants were assigned to Top-down, Bottom-up interventions, or control group, and received a 6-week intervention. They were assessed before/after treatments and at follow-up (6 weeks later). Impairments were measured through kinematic analysis, Trail Making Tests (TMT), and Fugl-Meyer Assessment (FMA). Activity and participation were evaluated via Box and Block Test, Motor Activity Log (MAL), and Canadian Occupational Performance Measure (COPM), respectively. RESULTS We found significant improvements in impairment (FMA) and participation (COPM) in all groups, however, COPM scores improved beyond the MCID only in the Top-down, and FMA scores exceeded the MCID in Top-down and Bottom-up groups. Use of the upper limb in daily activities (MAL) enhanced in the Top-down group, although was not clinically significant. CONCLUSION In most of the outcome measures, no significant difference was observed between groups. It seems that Top-down, Bottom-up, and traditional interventions have relatively comparable effectiveness in chronic stroke survivors. TRIAL REGISTRATION IRCT20150721023277N2.
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Affiliation(s)
- Mahnaz Hejazi-Shirmard
- Department of Occupational Therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghorban Taghizadeh
- Geriatric Mental Health Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Rassafiani
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Australia
- Neurorehabilitation Research Center, the University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Moslem Cheraghifard
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mahin Yousefi
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Hossein Hosseini
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Reihaneh Askary Kachoosangy
- Department of Occupational Therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Laleh Lajevardi
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Sakamoto D, Hamaguchi T, Kanemura N, Yasojima T, Kubota K, Suwabe R, Nakayama Y, Abo M. Feature analysis of joint motion in paralyzed and non-paralyzed upper limbs while reaching the occiput: A cross-sectional study in patients with mild hemiplegia. PLoS One 2024; 19:e0295101. [PMID: 38781257 PMCID: PMC11115294 DOI: 10.1371/journal.pone.0295101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
The reaching motion to the back of the head with the hand is an important movement for daily living. The scores of upper limb function tests used in clinical practice alone are difficult to use as a reference when planning exercises for movement improvements. This cross-sectional study aimed to clarify in patients with mild hemiplegia the kinematic characteristics of paralyzed and non-paralyzed upper limbs reaching the occiput. Ten patients with post-stroke hemiplegia who attended the Department of Rehabilitation Medicine of the Jikei University Hospital and met the eligibility criteria were included. Reaching motion to the back of the head by the participants' paralyzed and non-paralyzed upper limbs was measured using three-dimensional motion analysis, and the motor time, joint angles, and angular velocities were calculated. Repeated measures multivariate analysis of covariance was performed on these data. After confirming the fit to the binomial logistic regression model, the cutoff values were calculated using receiver operating characteristic curves. Pattern identification using random forest clustering was performed to analyze the pattern of motor time and joint angles. The cutoff values for the movement until the hand reached the back of the head were 1.6 s for the motor time, 55° for the maximum shoulder joint flexion angle, and 145° for the maximum elbow joint flexion angle. The cutoff values for the movement from the back of the head to the hand being returned to its original position were 1.6 s for the motor time, 145° for the maximum elbow joint flexion angle, 53°/s for the maximum angular velocity of shoulder joint abduction, and 62°/s for the maximum angular velocity of elbow joint flexion. The numbers of clusters were three, four, and four for the outward non-paralyzed side, outward and return paralyzed side, and return non-paralyzed side, respectively. The findings obtained by this study can be used for practice planning in patients with mild hemiplegia who aim to improve the reaching motion to the occiput.
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Affiliation(s)
- Daigo Sakamoto
- Department of Rehabilitation Medicine, The Jikei University School of Medicine Hospital, Tokyo, Japan
- Department of Rehabilitation, Graduate School of Health Science, Saitama Prefectural University, Saitama, Japan
| | - Toyohiro Hamaguchi
- Department of Rehabilitation, Graduate School of Health Science, Saitama Prefectural University, Saitama, Japan
| | - Naohiko Kanemura
- Department of Rehabilitation, Graduate School of Health Science, Saitama Prefectural University, Saitama, Japan
| | - Takashi Yasojima
- Department of Rehabilitation, Graduate School of Health Science, Saitama Prefectural University, Saitama, Japan
| | - Keisuke Kubota
- Research Development Center, Saitama Prefectural University, Saitama, Japan
| | - Ryota Suwabe
- Department of Rehabilitation Medicine, The Jikei University School of Medicine Hospital, Tokyo, Japan
| | - Yasuhide Nakayama
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Sakamoto D, Hamaguchi T, Nakayama Y, Hada T, Abo M. Upper-Limb Functional Recovery in Chronic Stroke Patients after COVID-19-Interrupted Rehabilitation: An Observational Study. J Clin Med 2024; 13:2212. [PMID: 38673485 PMCID: PMC11050468 DOI: 10.3390/jcm13082212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/03/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Background/Objectives: Upper-limb function of chronic stroke patients declined when outpatient rehabilitation was interrupted and outings restricted, owing to the novel coronavirus infection (COVID-19) pandemic. We investigated whether these patients recovered upper-limb function post-resumption of outpatient rehabilitation. Methods: In this observational study, 43 chronic stroke hemiparesis patients with impaired upper extremity function were scored for limb function via the Fugl-Meyer assessment of the upper extremity (FMA-UE) and the Action Research Arm Test (ARAT) after a structured interview, evaluation, and intervention. Scores at 6 and 3 months pre- and 3 months post-rehabilitation interruption were examined retrospectively; scores immediately and at 3 and 6 months post-resumption of care were examined prospectively. The amount of change for each time period and an analysis of covariance were performed with time as a factor, changes in the FMA-UE and the ARAT scores as dependent variables, and statistical significance at 5%. Results: The time of evaluation significantly impacted the total score, as well as part C and part D of FMA-UE and total, pinch, and gross movement of the ARAT. Post-hoc tests showed that the magnitude of change in limb-function scores from immediately to 3 months post-resumption was significantly higher than the change from 3 months pre- to immediately post-interruption for the total score and part D of the FMA-UE, as well as grip and gross movement of the ARAT (p < 0.05). Conclusions: Upper-limb functional decline in chronic stroke patients, caused by the COVID-19 pandemic-related therapy interruption and outing restrictions, was resolved approximately 3 months post-resumption of rehabilitation therapy. Our data can serve as reference standards for planning and evaluating treatment for chronic stroke patients with inactivity-related impaired upper-limb function.
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Affiliation(s)
- Daigo Sakamoto
- Department of Rehabilitation Medicine, The Jikei University School of Medicine Hospital, Tokyo 105-8471, Japan;
- Department of Rehabilitation, Graduate School of Health Science, Saitama Prefectural University, Saitama 343-8540, Japan
| | - Toyohiro Hamaguchi
- Department of Rehabilitation, Graduate School of Health Science, Saitama Prefectural University, Saitama 343-8540, Japan
| | - Yasuhide Nakayama
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan; (Y.N.); (T.H.)
| | - Takuya Hada
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan; (Y.N.); (T.H.)
| | - Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan; (Y.N.); (T.H.)
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Lin HP, Xu Y, Zhang X, Woolley D, Zhao L, Liang W, Huang M, Cheng HJ, Zhang L, Wenderoth N. A usability study on mobile EMG-guided wrist extension training in subacute stroke patients-MyoGuide. J Neuroeng Rehabil 2024; 21:39. [PMID: 38515192 PMCID: PMC10956308 DOI: 10.1186/s12984-024-01334-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/07/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Effective stroke rehabilitation requires high-dose, repetitive-task training, especially during the early recovery phase. However, the usability of upper-limb rehabilitation technology in acute and subacute stroke survivors remains relatively unexplored. In this study, we introduce subacute stroke survivors to MyoGuide, a mobile training platform that employs surface electromyography (sEMG)-guided neurofeedback training that specifically targets wrist extension. Notably, the study emphasizes evaluating the platform's usability within clinical contexts. METHODS Seven subacute post-stroke patients (1 female, mean age 53.7 years, mean time post-stroke 58.9 days, mean duration per training session 48.9 min) and three therapists (one for eligibility screening, two for conducting training) participated in the study. Participants underwent ten days of supervised one-on-one wrist extension training with MyoGuide, which encompassed calibration, stability assessment, and dynamic tasks. All training records including the Level of Difficulty (LoD) and Stability Assessment Scores were recorded within the application. Usability was assessed through the System Usability Scale (SUS) and participants' willingness to continue home-based training was gauged through a self-developed survey post-training. Therapists also documented the daily performance of participants and the extent of support required. RESULTS The usability analysis yielded positive results, with a median SUS score of 82.5. Compared to the first session, participants significantly improved their performance at the final session as indicated by both the Stability Assessment Scores (p = 0.010, mean = 229.43, CI = [25.74-433.11]) and the LoD (p < 0.001; mean: 45.43, CI: [25.56-65.29]). The rate of progression differed based on the initial impairment levels of the patient. After training, participants expressed a keen interest in continuing home-based training. However, they also acknowledged challenges related to independently using the Myo armband and software. CONCLUSIONS This study introduces the MyoGuide training platform and demonstrates its usability in a clinical setting for stroke rehabilitation, with the assistance of a therapist. The findings support the potential of MyoGuide for wrist extension training in patients across a wide range of impairment levels. However, certain usability challenges, such as donning/doffing the armband and navigating the application, need to be addressed to enable independent MyoGuide training requiring only minimal supervision by a therapist.
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Affiliation(s)
- Hao-Ping Lin
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE campus, 1 Create Way, CREATE Tower, #06-01, Singapore, 138602, Singapore
| | - Yang Xu
- Department of Rehabilitation, Shengjing Hospital of China Medical University, 16 Puhe Road, Shenyang, Liaoning, 110134, China
| | - Xue Zhang
- Department of Health Sciences and Technology, Neural Control of Movement Lab, ETH Zurich, Gloriastrasse 37/39 GLC G17.2, Zurich, 8092, Switzerland
| | - Daniel Woolley
- Department of Health Sciences and Technology, Neural Control of Movement Lab, ETH Zurich, Gloriastrasse 37/39 GLC G17.2, Zurich, 8092, Switzerland
| | - Lina Zhao
- Department of Rehabilitation, Shengjing Hospital of China Medical University, 16 Puhe Road, Shenyang, Liaoning, 110134, China
| | - Weidi Liang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, 16 Puhe Road, Shenyang, Liaoning, 110134, China
| | - Mengdi Huang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, 16 Puhe Road, Shenyang, Liaoning, 110134, China
| | - Hsiao-Ju Cheng
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE campus, 1 Create Way, CREATE Tower, #06-01, Singapore, 138602, Singapore
| | - Lixin Zhang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, 16 Puhe Road, Shenyang, Liaoning, 110134, China
| | - Nicole Wenderoth
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE campus, 1 Create Way, CREATE Tower, #06-01, Singapore, 138602, Singapore.
- Department of Health Sciences and Technology, Neural Control of Movement Lab, ETH Zurich, Gloriastrasse 37/39 GLC G17.2, Zurich, 8092, Switzerland.
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Peng RHT, He D, James SA, Williamson JN, Skadden C, Jain S, Hassaneen W, Miranpuri A, Kaur A, Sarol JN, Yang Y. Determining the effects of targeted high-definition transcranial direct current stimulation on reducing post-stroke upper limb motor impairments-a randomized cross-over study. Trials 2024; 25:34. [PMID: 38195605 PMCID: PMC10775560 DOI: 10.1186/s13063-023-07886-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/15/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Stroke is one of the leading causes of death in the USA and is a major cause of serious disability for adults. This randomized crossover study examines the effect of targeted high-definition transcranial direct current transcranial brain stimulation (tDCS) on upper extremity motor recovery in patients in the post-acute phase of stroke recovery. METHODS This randomized double-blinded cross-over study includes four intervention arms: anodal, cathodal, and bilateral brain stimulation, as well as a placebo stimulation. Participants receive each intervention in a randomized order, with a 2-week washout period between each intervention. The primary outcome measure is change in Motor Evoked Potential. Secondary outcome measures include the Fugl-Meyer Upper Extremity (FM-UE) score, a subset of FM-UE (A), related to the muscle synergies, and the Modified Ashworth Scale. DISCUSSION We hypothesize that anodal stimulation to the ipsilesional primary motor cortex will increase the excitability of the damaged cortico-spinal tract, reducing the UE flexion synergy and enhancing UE motor function. We further hypothesize that targeted cathodal stimulation to the contralesional premotor cortex will decrease activation of the cortico-reticulospinal tract (CRST) and the expression of the upper extremity (UE) flexion synergy and spasticity. Finally, we hypothesize bilateral stimulation will achieve both results simultaneously. Results from this study could improve understanding of the mechanism behind motor impairment and recovery in stroke and perfect the targeting of tDCS as a potential stroke intervention. With the use of appropriate screening, we anticipate no ethical or safety concerns. We plan to disseminate these research results to journals related to stroke recovery, engineering, and medicine. TRIAL REGISTRATION ClinicalTrials.gov NCT05479006 . Registered on 26 July 2022.
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Affiliation(s)
- Rita Huan-Ting Peng
- Department of Bioengineering, Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA
- Carle Foundation Hospital, Urbana, IL, USA
| | - Dorothy He
- The University of Oklahoma College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shirley A James
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jordan N Williamson
- Department of Bioengineering, Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | | | - Sanjiv Jain
- Carle Foundation Hospital, Urbana, IL, USA
- Carle Illinois College of Medicine, Urbana, IL, USA
| | - Wael Hassaneen
- Carle Foundation Hospital, Urbana, IL, USA
- Carle Illinois College of Medicine, Urbana, IL, USA
| | - Amrendra Miranpuri
- Carle Foundation Hospital, Urbana, IL, USA
- Carle Illinois College of Medicine, Urbana, IL, USA
| | - Amandeep Kaur
- Interdisciplinary Health Sciences Institute, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Jesus N Sarol
- Interdisciplinary Health Sciences Institute, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Yuan Yang
- Department of Bioengineering, Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA.
- Carle Foundation Hospital, Urbana, IL, USA.
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, USA.
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA.
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Hsu HY, Koh CL, Yang KC, Lin YC, Hsu CH, Su FC, Kuo LC. Effects of an assist-as-needed equipped Tenodesis-Induced-Grip Exoskeleton Robot (TIGER) on upper limb function in patients with chronic stroke. J Neuroeng Rehabil 2024; 21:5. [PMID: 38173006 PMCID: PMC10765635 DOI: 10.1186/s12984-023-01298-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The original version of the Tenodesis-Induced-Grip Exoskeleton Robot (TIGER) significantly improved the motor and functional performance of the affected upper extremity of chronic stroke patients. The assist-as-needed (AAN) technique in robot-involved therapy is widely favored for promoting patient active involvement, thereby fostering motor recovery. However, the TIGER lacked an AAN control strategy, which limited its use in different clinical applications. The present study aimed to develop and analyze the training effects of an AAN control mode to be integrated into the TIGER, to analyze the impact of baseline patient characteristics and training paradigms on outcomes for individuals with chronic stroke and to compare training effects on the upper limb function between using the AAN-equipped TIGER and using the original prototype. METHODS This was a single-arm prospective interventional study which was conducted at a university hospital. In addition to 20 min of regular task-specific motor training, each participant completed a 20-min robotic training program consisting of 10 min in the AAN control mode and 10 min in the functional mode. The training sessions took place twice a week for 9 weeks. The primary outcome was the change score of the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE), and the secondary outcomes were the change score of the Box and Blocks Test (BBT), the amount of use (AOU) and quality of movement (QOM) scales of the Motor Activity Log (MAL), the Semmes-Weinstein Monofilament (SWM) test, and the Modified Ashworth Scale (MAS) for fingers and wrist joints. The Generalized Estimating Equations (GEE) and stepwise regression model were used as the statistical analysis methods. RESULTS Sixteen chronic stroke patients completed all steps of the study. The time from stroke onset to entry into the trial was 21.7 ± 18.9 months. After completing the training with the AAN-equipped TIGER, they exhibited significant improvements in movement reflected in their total score (pre/post values were 34.6 ± 11.5/38.5 ± 13.4) and all their sub-scores (pre/post values were 21.5 ± 6.0/23.3 ± 6.5, 9.5 ± 6.2/11.3 ± 7.2, and 3.6 ± 1.0/3.9 ± 1.0 for the shoulder, elbow, and forearm sub-category, the wrist and hand sub-category, and the coordination sub-category, respectively) on the FMA-UE (GEE, p < 0.05), as well as their scores on the BBT (pre/post values were 5.9 ± 6.5/9.5 ± 10.1; GEE, p = 0.004) and the AOU (pre/post values were 0.35 ± 0.50/0.48 ± 0.65; GEE, p = 0.02). However, the original TIGER exhibited greater improvements in their performance on the FMA-UE than the participants training with the AAN-equipped TIGER (GEE, p = 0.008). The baseline score for the wrist and hand sub-category of the FMA-UE was clearly the best predictor of TIGER-mediated improvements in hand function during the post-treatment assessment (adjusted R2 = 0.282, p = 0.001). CONCLUSIONS This study developed an AAN-equipped TIGER system and demonstrated its potential effects on improving both the function and activity level of the affected upper extremity of patients with stroke. Nevertheless, its training effects were not found to be advantageous to the original prototype. The baseline score for the FMA-UE sub-category of wrist and hand was the best predictor of improvements in hand function after TIGER rehabilitation. Clinical trial registration ClinicalTrials.gov, identifier NCT03713476; date of registration: October19, 2018. https://clinicaltrials.gov/ct2/show/NCT03713476.
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Affiliation(s)
- Hsiu-Yun Hsu
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan, 701, Taiwan
| | - Chia-Lin Koh
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan, 701, Taiwan
| | - Kang-Chin Yang
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Ching Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chieh-Hsiang Hsu
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan, 701, Taiwan
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Fong-Chin Su
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
- Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Li-Chieh Kuo
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan, 701, Taiwan.
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan.
- Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan.
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Boz Sönmez D, Giray E, Atıcı A, Illeez ÖG, Akpınar P, Ünlü Özkan F, Aktaş I. Validity and reliability of selective control of upper extremity scale (SCUES) in patients with chronic stroke. Disabil Rehabil 2023:1-13. [PMID: 38140918 DOI: 10.1080/09638288.2023.2291551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE The aim of this study is to investigate the validity and reliability of the Selective Control of Upper Extremity Scale (SCUES) in patients with stroke. MATERIALS AND METHODS Forty-two patients with stroke aged 18-75 years, were included in the study. Patients were video-recorded while SCUES was administered. The videos were scored to determine the intrarater and inter-rater reliability. Fugl Meyer Assessment of Upper Extremity (FMA-UE), Box and Block test (BBT) and Brunnstrom Stages of Motor Recovery were measured to evaluate validity of SCUES. Spearman correlation analysis was used to assess the validity of SCUES. Intraclass correlation coefficient (ICC), Kappa (κ) and weighted Kappa (κw) were calculated to determine intrarater and inter-rater reliability. RESULTS There were significant positive high correlations between SCUES and FMA-UE and BBT and Brunnstrom upper extremity proximal and distal values (rho = 0.944, p = 0.01; rho = 0,875, p = 0.01; rho = 0.84, p = 0.01, rho = 0.82, p = 0.01; respectively) showing validity of SCUES. The ICC value of inter-rater reliability of SCUES was 0,99 (%95 CI: 0,989-0,997, p = 0,001) showing excellent reliability. κ and κ w values for inter-rater and intrarater reliability of individual SCUES items were above 0.7 indicating excellent reliability. ICC of SCUES and FMA-UE indicated excellent intrarater reliability (ICC = 0,99; %95 CI: 0,989-0,997, p = 0,001; ICC = 0.943; %95 CI: 0.9-0.97, p = 0,0001, consecutively). CONCLUSIONS SCUES showed similar validity and reliability with FMA-UE and SCUES can be used in the evaluation of upper extremity selective motor control in patients with stroke.
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Affiliation(s)
- Didem Boz Sönmez
- Department of Physical Medicine and Rehabilitation, Hamidiye School of Medicine, Hamidiye International School of Medicine, University of Health Sciences, Fatih Sultan Mehmet Health Application and Research Center, Istanbul, Türkiye
| | - Esra Giray
- Department of Physical Medicine and Rehabilitation, Hamidiye School of Medicine, Hamidiye International School of Medicine, University of Health Sciences, Fatih Sultan Mehmet Health Application and Research Center, Istanbul, Türkiye
| | - Arzu Atıcı
- Physical Medicine and Rehabilitation Clinic, University of Health Sciences Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Türkiye
| | - Özge Gülsüm Illeez
- Physical Medicine and Rehabilitation Clinic, University of Health Sciences Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Türkiye
| | - Pınar Akpınar
- Department of Physical Medicine and Rehabilitation, Hamidiye School of Medicine, Hamidiye International School of Medicine, University of Health Sciences, Fatih Sultan Mehmet Health Application and Research Center, Istanbul, Türkiye
| | - Feyza Ünlü Özkan
- Department of Physical Medicine and Rehabilitation, Hamidiye School of Medicine, Hamidiye International School of Medicine, University of Health Sciences, Fatih Sultan Mehmet Health Application and Research Center, Istanbul, Türkiye
| | - Ilknur Aktaş
- Department of Physical Medicine and Rehabilitation, Hamidiye School of Medicine, Hamidiye International School of Medicine, University of Health Sciences, Fatih Sultan Mehmet Health Application and Research Center, Istanbul, Türkiye
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de Menezes KKP, Scianni AA, Avelino PR, de Faria-Fortini I, Teixeira-Salmela LF, Faria CDCDM. Balance deficit is the domain of the Fugl-Meyer scale that best explain limitations in functional independence during hospitalization after a stroke. J Stroke Cerebrovasc Dis 2023; 32:107386. [PMID: 37797412 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/07/2023] Open
Abstract
PURPOSE To investigate which of the residual sensorimotor impairments, assessed by the Fugl-Meyer scale, would best explain functional independence during hospitalization after a stroke. METHODS This cross-sectional study retrieved data from medical records between January 2014 to December 2021. Explanatory independent variables were the following domains of the Fugl-Meyer scale: joint pain, joint range of motion, balance, sensory function, and motor function of the upper and lower limbs. Functional independence was measured by the Functional Independence Measure (FIM). Step-wise multiple linear regression analysis was used to identify which measures would explain functional independence (α=5%). RESULTS Data from 1,344 individuals, who had a mean age of 64 years, were retrieved. All included explanatory variables were significantly correlated with the FIM scores (0.24 ≤ r ≤ 0.87). Balance alone explained 76 % (F=4.24; p<0.001) of the variance in the FIM scores. When sensory function and upper-limb motor function scores were included in the model, the explained variance increased to 82 % (F = 1.935; p < 0.001). CONCLUSIONS Balance, which is important for carrying-out self-care activities, is the domain of the Fugl-Meyer scale that best explained functional independence during hospitalization after a stroke. Although sensory function and motor function of the upper limb added little to the explained variance, they should not be underlooked. Future research is needed to determine whether progressive balance training interventions would enhance functional independence after a stroke.
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Affiliation(s)
| | - Aline Alvim Scianni
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Avenida Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, MG 31270-901, Brazil
| | - Patrick Roberto Avelino
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Iza de Faria-Fortini
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Luci Fuscaldi Teixeira-Salmela
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Avenida Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, MG 31270-901, Brazil
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Woodbury M, Grattan ES, Li CY. Development of a Short Form Assessment Combining the Fugl-Meyer Assessment-Upper Extremity and the Wolf Motor Function Test for Evaluating Stroke Recovery. Arch Phys Med Rehabil 2023; 104:1661-1668. [PMID: 37245692 PMCID: PMC10543466 DOI: 10.1016/j.apmr.2023.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/14/2023] [Accepted: 04/26/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To use Rasch methodologies to combine the items of the Fugl-Meyer Assessment-Upper Extremity (FMA-UE, motor skill) and the Wolf Motor Function Test (WMFT, motor function) onto a single measurement metric and create an FMA-UE+WMFT short form. DESIGN Secondary analysis of preintervention data from 2 upper extremity stroke rehabilitation trials. Confirmatory factor analysis and Rasch rating scale analysis were first applied to examine the properties of the pooled item bank and then item response theory methodologies were used to develop the short form. Confirmatory factor analysis and Rasch analysis were then applied to the short form to examine the dimensionality and measurement properties. SETTING Outpatient academic medical research center. PARTICIPANTS Data from 167 participants who completed the FMA-UE and WMFT (rating scale score) were pooled (N=167). Participants were eligible if they had a stroke ≥3 months prior and had upper extremity (UE) hemiparesis and excluded if they had severe UE hemiparesis, severe UE spasticity, or UE pain. INTERVENTION Not applicable. MAIN OUTCOME MEASURES The dimensionality and measurement properties of the pooled 30-item FMA-UE and the 15-item WMFT and short form were examined. RESULTS Five items from the pool of 45 items were misfit and were removed. The 40-item pool demonstrated adequate measurement properties. A 15-item short form was then developed and met rating diagnostic scale criteria. All items on the 15-item short form met the Rasch fit criteria, and the assessment met criteria for reliability (Cronbach alpha=.94), separation (person separation = 3.7), and strata (number of strata = 5). CONCLUSIONS Items from the FMA-UE and WMFT can be pooled to create a psychometrically sound 15-item short form.
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Affiliation(s)
- Michelle Woodbury
- Department of Health Sciences & Research & Division of Occupational Therapy, Medical University of South Carolina, Charleston, SC.
| | - Emily S Grattan
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA; Pittsburgh VA Medical Center, Human Engineering Research Laboratories, Pittsburgh, PA
| | - Chih-Ying Li
- Department of Occupational Therapy, University of Texas Medical Branch, Galveston, TX
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10
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Lim DYL, Lai HS, Yeow RCH. A bidirectional fabric-based soft robotic glove for hand function assistance in patients with chronic stroke. J Neuroeng Rehabil 2023; 20:120. [PMID: 37735679 PMCID: PMC10512630 DOI: 10.1186/s12984-023-01250-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 09/13/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Chronic stroke patients usually experience reduced hand functions, impeding their ability to perform activities of daily living (ADLs) independently. Additionally, improvements in hand functions by physical therapy beyond six months after the initial onset of stroke are much slower than in the earlier months. As such, chronic stroke patients could benefit from an assistive device to enhance their hand functions, allowing them to perform ADLs independently daily. In recent years, soft robotics has provided a novel approach to assistive devices for motor impaired individuals, offering more compliant and lightweight alternatives to traditional robotic devices. The scope of this study is to demonstrate the viability of a fabric-based soft robotic (SR) glove with bidirectional actuators in assisting chronic stroke study participants with hand impairments in performing ADLs. METHODS Force and torque measurement tests were conducted to characterize the SR Glove, and hand functional tasks were given to eight chronic stroke patients to assess the efficacy of the SR Glove as an assistive device. The tasks involved object manipulation tasks that simulate ADLs, and the series of tasks was done by the participants once without assistance for baseline data, and once while using the SR Glove. A usability questionnaire was also given to each participant after the tasks were done to gain insight into how the SR Glove impacts their confidence and reliance on support while performing ADLs. RESULTS The SR Glove improved the participants' manipulation of objects in ADL tasks. The difference in mean scores between the unassisted and assisted conditions was significant across all participants. Additionally, the usability questionnaire showed the participants felt more confident and less reliant on support while using the SR Glove to perform ADLs than without the SR Glove. CONCLUSIONS The results from this study demonstrated that the SR Glove is a viable option to assist hand function in chronic stroke patients who suffer from hand motor impairments.
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Affiliation(s)
- Daniel Yuan-Lee Lim
- Evolution Innovation Lab, Advanced Robotics Centre, National University of Singapore, Singapore, Singapore
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Hwa-Sen Lai
- Evolution Innovation Lab, Advanced Robotics Centre, National University of Singapore, Singapore, Singapore
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Raye Chen-Hua Yeow
- Evolution Innovation Lab, Advanced Robotics Centre, National University of Singapore, Singapore, Singapore.
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore.
- Computer Science & Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, USA.
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11
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Swanson VA, Johnson CA, Zondervan DK, Shaw SJ, Reinkensmeyer DJ. Exercise repetition rate measured with simple sensors at home can be used to estimate Upper Extremity Fugl-Meyer score after stroke. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1181766. [PMID: 37404979 PMCID: PMC10315847 DOI: 10.3389/fresc.2023.1181766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/01/2023] [Indexed: 07/06/2023]
Abstract
Introduction It would be valuable if home-based rehabilitation training technologies could automatically assess arm impairment after stroke. Here, we tested whether a simple measure-the repetition rate (or "rep rate") when performing specific exercises as measured with simple sensors-can be used to estimate Upper Extremity Fugl-Meyer (UEFM) score. Methods 41 individuals with arm impairment after stroke performed 12 sensor-guided exercises under therapist supervision using a commercial sensor system comprised of two pucks that use force and motion sensing to measure the start and end of each exercise repetition. 14 of these participants then used the system at home for three weeks. Results Using linear regression, UEFM score was well estimated using the rep rate of one forward-reaching exercise from the set of 12 exercises (r2 = 0.75); this exercise required participants to alternately tap pucks spaced about 20 cm apart (one proximal, one distal) on a table in front of them. UEFM score was even better predicted using an exponential model and forward-reaching rep rate (Leave One Out Cross Validation (LOOCV) r2 = 0.83). We also tested the ability of a nonlinear, multivariate model (a regression tree) to predict UEFM, but such a model did not improve prediction (LOOCV r2 = 0.72). However, the optimal decision tree also used the forward-reaching task along with a pinch grip task to subdivide more and less impaired patients in a way consistent with clinical intuition. At home, rep rate for the forward-reaching exercise well predicted UEFM score using an exponential model (LOOCV r2 = 0.69), but only after we re-estimated coefficients using the home data. Discussion These results show how a simple measure-exercise rep rate measured with simple sensors-can be used to infer an arm impairment score and suggest that prediction models should be tuned separately for the clinic and home environments.
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Affiliation(s)
- Veronica A. Swanson
- Biorobotics Laboratory, Department of Mechanical and Aerospace Engineering, University of California, Irvine, Irvine, CA, United States
| | - Christopher A. Johnson
- Biorobotics Laboratory, Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, United States
| | | | - Susan J. Shaw
- Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States
| | - David J. Reinkensmeyer
- Biorobotics Laboratory, Department of Mechanical and Aerospace Engineering, University of California, Irvine, Irvine, CA, United States
- Department of Anatomy and Neurobiology, UC Irvine School of Medicine, University of California, Irvine, Irvine, CA, United States
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12
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Błaszczyszyn M, Szczęsna A, Konieczny M, Pakosz P, Balko S, Borysiuk Z. Quantitative Assessment of Upper Limb Movement in Post-Stroke Adults for Identification of Sensitive Measures in Reaching and Lifting Activities. J Clin Med 2023; 12:jcm12093333. [PMID: 37176773 PMCID: PMC10179564 DOI: 10.3390/jcm12093333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 04/27/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The assumption of this work is the achievement of objective results of the movement structure, which forms the basis for in-depth analysis and, consequently, for determining the upper limb movements that are most affected by stroke compared to healthy people. METHODS An analysis of relevant and systematically identified features of upper limb movement in post-stroke adults is presented based on scalable hypothesis tests. The basic features were calculated using movements defined by the x, y, and z coordinates (i.e., 3D trajectory time series) and compared to the results of post-stroke patients with healthy controls of similar age. RESULTS After automatic feature selection, out of the 1004 common features of upper limb movement, the most differentiated were the upper arm movements in reaching kinematics. In terms of movement type, movements in the frontal plane (shoulder abduction and adduction) were the most sensitive to changes. The largest number of discriminating features was determined on the basis of acceleration time series. CONCLUSIONS In the 3D assessment of functional activities of the upper limb, the upper arm turned out to be the most differentiated body segment, especially during abduction and adduction movements. The results indicate a special need to pay attention to abduction and adduction movements to improve the activities of daily living of the upper limbs after a stroke.
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Affiliation(s)
- Monika Błaszczyszyn
- Department of Physical Education and Sport, Faculty of Physical Education and Physiotherapy, Opole University of Technology, Prószkowska 76, 45-758 Opole, Poland
| | - Agnieszka Szczęsna
- Department of Computer Graphics, Vision and Digital Systems, Faculty of Automatic Control, Electronics and Computer Science, Silesian University of Technology, Akademicka 16, 44-100 Gliwice, Poland
| | - Mariusz Konieczny
- Department of Physical Education and Sport, Faculty of Physical Education and Physiotherapy, Opole University of Technology, Prószkowska 76, 45-758 Opole, Poland
| | - Paweł Pakosz
- Department of Physical Education and Sport, Faculty of Physical Education and Physiotherapy, Opole University of Technology, Prószkowska 76, 45-758 Opole, Poland
| | - Stefan Balko
- Department of Physical Education and Sport, Faculty of Education, J.E. Purkyne University, 400 96 Usti nad Labem, Czech Republic
| | - Zbigniew Borysiuk
- Department of Physical Education and Sport, Faculty of Physical Education and Physiotherapy, Opole University of Technology, Prószkowska 76, 45-758 Opole, Poland
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Karakis R, Gurkahraman K, Mitsis GD, Boudrias MH. DEEP LEARNING PREDICTION OF MOTOR PERFORMANCE IN STROKE INDIVIDUALS USING NEUROIMAGING DATA. J Biomed Inform 2023; 141:104357. [PMID: 37031755 DOI: 10.1016/j.jbi.2023.104357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/24/2023] [Accepted: 04/01/2023] [Indexed: 04/11/2023]
Abstract
The degree of motor impairment and profile of recovery after stroke are difficult to predict for each individual. Measures obtained from clinical assessments, as well as neurophysiological and neuroimaging techniques have been used as potential biomarkers of motor recovery, with limited accuracy up to date. To address this, the present study aimed to develop a deep learning model based on structural brain images obtained from stroke participants and healthy volunteers. The following inputs were used in a multi-channel 3D convolutional neural network (CNN) model: fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity maps obtained from Diffusion Tensor Imaging (DTI) images, white and gray matter intensity values obtained from Magnetic Resonance Imaging, as well as demographic data (e.g., age, gender). Upper limb motor function was classified into "Poor" and "Good" categories. To assess the performance of the DL model, we compared it to more standard machine learning (ML) classifiers including k-nearest neighbor, support vector machines (SVM), Decision Trees, Random Forests, Ada Boosting, and Naïve Bayes, whereby the inputs of these classifiers were the features taken from the fully connected layer of the CNN model. The highest accuracy and area under the curve values were 0.92 and 0.92 for the 3D-CNN and 0.91 and 0.91 for the SVM, respectively. The multi-channel 3D-CNN with residual blocks and SVM supported by DL was more accurate than traditional ML methods to classify upper limb motor impairment in the stroke population. These results suggest that combining volumetric DTI maps and measures of white and gray matter integrity can improve the prediction of the degree of motor impairment after stroke. Identifying the potential of recovery early on after a stroke could promote the allocation of resources to optimize the functional independence of these individuals and their quality of life.
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Affiliation(s)
- Rukiye Karakis
- Department of Software Engineering, Faculty of Technology, Sivas Cumhuriyet University, Turkey
| | - Kali Gurkahraman
- Department of Computer Engineering, Faculty of Engineering, Sivas Cumhuriyet University, Turkey
| | - Georgios D Mitsis
- Department of Bioengineering, Faculty of Engineering, McGill University, Montreal, QC, Canada
| | - Marie-Hélène Boudrias
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; BRAIN Laboratory, Jewish Rehabilitation Hospital, Site of Centre for Interdisciplinary Research of Greater Montreal (CRIR) and CISSS-Laval, QC, Canada.
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Upper Limb Function Recovery by Combined Repetitive Transcranial Magnetic Stimulation and Occupational Therapy in Patients with Chronic Stroke According to Paralysis Severity. Brain Sci 2023; 13:brainsci13020284. [PMID: 36831827 PMCID: PMC9953939 DOI: 10.3390/brainsci13020284] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) with intensive occupational therapy improves upper limb motor paralysis and activities of daily living after stroke; however, the degree of improvement according to paralysis severity remains unverified. Target activities of daily living using upper limb functions can be established by predicting the amount of change after treatment for each paralysis severity level to further aid practice planning. We estimated post-treatment score changes for each severity level of motor paralysis (no, poor, limited, notable, and full), stratified according to Action Research Arm Test (ARAT) scores before combined rTMS and intensive occupational therapy. Motor paralysis severity was the fixed factor for the analysis of covariance; the delta (post-pre) of the scores was the dependent variable. Ordinal logistic regression analysis was used to compare changes in ARAT subscores according to paralysis severity before treatment. We implemented a longitudinal, prospective, interventional, uncontrolled, and multicenter cohort design and analyzed a dataset of 907 patients with stroke hemiplegia. The largest treatment-related changes were observed in the Limited recovery group for upper limb motor paralysis and the Full recovery group for quality-of-life activities using the paralyzed upper limb. These results will help predict treatment effects and determine exercises and goal movements for occupational therapy after rTMS.
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15
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Ni J, Jiang W, Gong X, Fan Y, Qiu H, Dou J, Zhang J, Wang H, Li C, Su M. Effect of rTMS intervention on upper limb motor function after stroke: A study based on fNIRS. Front Aging Neurosci 2023; 14:1077218. [PMID: 36711205 PMCID: PMC9880218 DOI: 10.3389/fnagi.2022.1077218] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/19/2022] [Indexed: 01/15/2023] Open
Abstract
Background Stroke is a disease with a high fatality rate worldwide and a major cause of long-term disability. In the rehabilitation of limb motor function after stroke, the rehabilitation of upper limb function takes a long time and the recovery progress is slow, which seriously affects the patients' self-care ability in daily life. Repeated transcranial magnetic stimulation (rTMS) has been increasingly used to improve limb dysfunction in patients with stroke. However, a standardized reference for selecting a magnetic stimulation regimen is not available. Whether to increase the inhibition of the contralateral hemispheric motor cortex remains controversial. This study has evaluated the effects of different rTMS stimulation programs on upper limb function and corresponding brain functional network characteristics of patients with stroke and sought a new objective standard based on changes in brain network parameters to guide accurate rTMS stimulation programs. Method Thirty-six patients with stroke were selected and divided into control group and treatment group by number table method, with 18 patients in each group, and 3 patients in the control group were turned out and lost due to changes in disease condition. The treatment group was divided into two groups. TMS1 group was given 1 Hz magnetic stimulation in the M1 region of the contralesional hemisphere +10 Hz magnetic stimulation in the M1 region of the affected hemisphere, and the TMS2 group was given 10 Hz magnetic stimulation in the M1 region of the affected hemisphere. The control group was given false stimulation. The treatment course was once a day for 5 days a week for 4 weeks. The Fugl-Meyer Assessment for upper extremity (FMA-UE) sand near-infrared brain function were collected before treatment, 2 weeks after treatment, and 4 weeks after treatment, and the brain function network was constructed. Changes in brain oxygenated hemoglobin concentration and brain network parameters were analyzed with the recovery of motor function (i.e., increased FMA score). Meanwhile, according to the average increment of brain network parameters, the rTMS stimulation group was divided into two groups with good efficacy and poor efficacy. Network parameters of the two groups before and after rTMS treatment were analyzed statistically. Results (1) Before treatment, there was no statistical difference in Fugl-Meyer score between the control group and the magnetic stimulation group (p = 0.178).Compared with before treatment, Fugl-Meyer scores of 2 and 4 weeks after treatment were significantly increased in both groups (p <0.001), and FMA scores of 4 weeks after treatment were significantly improved compared with 2 weeks after treatment (p < 0.001). FMA scores increased faster in the magnetic stimulation group at 2 and 4 weeks compared with the control group at the same time point (p <0.001).TMS1 and TMS2 were compared at the same time point, FMA score in TMS2 group increased more significantly after 4 weeks of treatment (p = 0.010). (2) Before treatment, HbO2 content in healthy sensory motor cortex (SMC) area of magnetic stimulation group and control group was higher than that in other region of interest (ROI) area, but there was no significant difference in ROI between the two groups. After 4 weeks of treatment, the HbO2 content in the healthy SMC area was significantly decreased (p < 0.001), while the HbO2 content in the affected SMC area was significantly increased, and the change was more significant in the magnetic stimulation group (p < 0.001). (3) In-depth study found that with the recovery of motor function (FMA upper limb score increase ≥4 points) after magnetic stimulation intervention, brain network parameters were significantly improved. The mean increment of network parameters in TMS1 group and TMS2 group was significantly different (χ 2 = 5.844, p = 0.016). TMS2 group was more advantageous than TMS1 group in improving the mean increment of brain network parameters. Conclusion (1) The rTMS treatment is beneficial to the recovery of upper limb motor function in stroke patients, and can significantly improve the intensity of brain network connection and reduce the island area. The island area refers to an isolated activated brain area that cannot transmit excitation to other related brain areas. (2) When the node degree of M1_Healthy region less than 0.52, it is suggested to perform promotion therapy only in the affected hemisphere. While the node degree greater than 0.52, and much larger than that in the M1_affected region. it is suggested that both inhibition in the contralesional hemisphere and high-frequency excitatory magnetic stimulation in the affected hemisphere can be performed. (3) In different brain functional network connection states, corresponding adjustment should be made to the treatment plan of rTMS to achieve optimal therapeutic effect and precise rehabilitation treatment.
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Affiliation(s)
- Jing Ni
- Department of Physical Medicine and Rehabilitation, Dushu Lake Hospital Affiliated of Soochow University, Suzhou, Jiangsu, China,Department of Physical Medicine and Rehabilitation, Jiangsu Rongjun Hospital, Wuxi, Jiangsu, China
| | - Wei Jiang
- Department of Physical Medicine and Rehabilitation, Dushu Lake Hospital Affiliated of Soochow University, Suzhou, Jiangsu, China,Department of Physical Medicine and Rehabilitation, Jiangsu Rongjun Hospital, Wuxi, Jiangsu, China
| | - Xueyang Gong
- Department of Physical Medicine and Rehabilitation, Dushu Lake Hospital Affiliated of Soochow University, Suzhou, Jiangsu, China,Department of Physical Medicine and Rehabilitation, Wuxi International Tongren Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Yingjie Fan
- Department of Physical Medicine and Rehabilitation, Dushu Lake Hospital Affiliated of Soochow University, Suzhou, Jiangsu, China,Institute of Rehabilitation Soochow University, Suzhou, Jiangsu, China
| | - Hao Qiu
- Department of Physical Medicine and Rehabilitation, Dushu Lake Hospital Affiliated of Soochow University, Suzhou, Jiangsu, China,Institute of Rehabilitation Soochow University, Suzhou, Jiangsu, China
| | - Jiaming Dou
- Department of Physical Medicine and Rehabilitation, Dushu Lake Hospital Affiliated of Soochow University, Suzhou, Jiangsu, China,Department of Physical Medicine and Rehabilitation, Wuxi International Tongren Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Juan Zhang
- Department of Physical Medicine and Rehabilitation, Dushu Lake Hospital Affiliated of Soochow University, Suzhou, Jiangsu, China,First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Hongxing Wang
- Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing, Jiangsu, China,*Correspondence: Hongxing Wang, ✉
| | - Chunguang Li
- The Key Laboratory of Robotics and System of Jiangsu Province, School of Mechanical and Electric Engineering, Soochow University, Suzhou, Jiangsu, China,Chunguang Li, ✉
| | - Min Su
- Department of Physical Medicine and Rehabilitation, Dushu Lake Hospital Affiliated of Soochow University, Suzhou, Jiangsu, China,Institute of Rehabilitation Soochow University, Suzhou, Jiangsu, China,First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China,Min Su, ✉
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Wang T, Liu Z, Gu J, Tan J, Hu T. Effectiveness of soft robotic glove versus repetitive transcranial magnetic stimulation in post-stroke patients with severe upper limb dysfunction: A randomised controlled trial. Front Neurol 2023; 13:887205. [PMID: 36712422 PMCID: PMC9874667 DOI: 10.3389/fneur.2022.887205] [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: 03/02/2022] [Accepted: 12/16/2022] [Indexed: 01/12/2023] Open
Abstract
Purpose To explore the difference in rehabilitation effect between soft robot gloves and repetitive transcranial magnetic stimulation (rTMS) in patients with severe upper limb motor dysfunction after a stroke. Methods A total of 69 post-stroke patients with severe upper limb dysfunction were randomly assigned to a repetitive transcranial magnetic group, a soft robotic glove group, and a conventional treatment group. The primary outcomes were the Fugl-Meyer Upper Extremity Assessment (FMA-UE) and the Modified Barthel Index (MBI). The secondary endpoints were the amplitude surface electromyogram of the extensor wrist muscle (sEMG) and the cerebral hemispheric resting motor threshold (RMT). Results The change of FMA-UE score in the soft robotic glove group was significantly better than that in the conventional treatment group (median difference: 2 points; 95% confidence interval [1, 3]; P < 0.05), but there was no significant difference compared with the repetitive transcranial magnetic stimulation group (median difference: 0 points; 95% confidence interval [-1, 2]; P [0.547] > 0.05). There was no significant difference in the change of MBI score between the soft robotic glove group and the conventional treatment and repetitive transcranial magnetic treatment groups [F = 2.458, P [0.093] > 0.05]. There was no significant difference in the change of sEMG score between the soft robotic glove group and the conventional treatment and repetitive transcranial magnetic treatment groups [H = 0.042, P [0.980] > 0.05]. Additionally, the change of RMT score in the soft robotic glove group was significantly inferior to that in the repetitive transcranial magnetic treatment group [difference: -1.09; 95% confidence interval [-2.048, 0.048]; P < 0.05], but there was no significant difference compared with the conventional treatment group [difference: 0.31 points; 95% confidence interval [-0.879, 0.358]; P [0.495] > 0.05]. Conclusion For patients with severe dyskinesia after a stroke, soft robotic gloves are as effective as repetitive transcranial magnetic stimulation and may be a good choice for home rehabilitation. In addition, conventional treatment combined with repetitive transcranial magnetic stimulation (rTMS) or a soft robotic glove produced better rehabilitation outcomes than conventional treatment alone.
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Affiliation(s)
- Taotao Wang
- Zhongshan People's Hospital, Zhongshan, China,*Correspondence: Taotao Wang ✉
| | | | - Jianxiong Gu
- Affiliated Hospital of Guangdong Medical University, Zhanjiang, China,Jianxiong Gu ✉
| | - Jizhi Tan
- Guangdong Medical University, Zhanjiang, China
| | - Tian Hu
- Guangdong Medical University, Zhanjiang, China
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Study Protocol for a Multicenter, Randomized Controlled Trial to Improve Upper Extremity Hemiparesis in Chronic Stroke Patients by One-to-One Training (NEURO ®) with Repetitive Transcranial Magnetic Stimulation. J Clin Med 2022; 11:jcm11226835. [PMID: 36431312 PMCID: PMC9695575 DOI: 10.3390/jcm11226835] [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: 10/04/2022] [Revised: 11/11/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
During recovery from upper limb motor paralysis after stroke, it is important to (1) set the exercise difficulty level according to the motor paralysis severity, (2) provide adequate exercises, and (3) motivate the patient to achieve the goal. However, these factors have not been well-formulated. This multicenter, randomized controlled trial study aims to examine the therapeutic effects of these three factors on patients undergoing a novel intervention using repetitive transcranial magnetic stimulation and intensive one-to-one training (NEURO®) and to formulate a corresponding research protocol. The control group will receive conventional NEURO® occupational therapy. In the intervention group, four practice plans will be selected according to the Fugl-Meyer assessment (FMA-UE) scores of the upper extremity. The goal is to predict the post-treatment outcomes based on the pre-treatment FMA-UE scores. Based on the degree of difficulty and amount of practice required, we can formulate a practice plan to promote upper limb motor recovery. This occupational therapy plan will be less influenced by the therapist's skill, facilitating effective rehabilitation. The study findings may be utilized to promote upper limb motor paralysis recovery and provide a basis for proposing activities of daily living adapted to upper limb function.
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Zhou J, Fan L, Hu H, Shen K, Wu L, Lin X, Gao H. The Efficacy of Integrated Rehabilitation for Post-Stroke Anxiety: Study Protocol for a Prospective, Multicenter, Randomized Controlled Trial. Int J Gen Med 2022; 15:7101-7111. [PMID: 36097565 PMCID: PMC9464039 DOI: 10.2147/ijgm.s381434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background Methods Conclusion Trial Registration
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Affiliation(s)
- Jie Zhou
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Lijuan Fan
- The Third Clinical College of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Hantong Hu
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Ke Shen
- The Third Clinical College of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Liya Wu
- The Third Clinical College of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Xiaoqi Lin
- The Third Clinical College of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Hong Gao
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
- Correspondence: Hong Gao, Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, No. 219 Moganshan Road, Hangzhou, People’s Republic of China, Email
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Bonanno M, De Luca R, Torregrossa W, Tonin P, Calabrò RS. Moving toward Appropriate Motor Assessment Tools in People Affected by Severe Acquired Brain Injury: A Scoping Review with Clinical Advices. Healthcare (Basel) 2022; 10:healthcare10061115. [PMID: 35742166 PMCID: PMC9223221 DOI: 10.3390/healthcare10061115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/30/2022] [Accepted: 06/13/2022] [Indexed: 01/03/2023] Open
Abstract
Severe acquired brain injury (SABI) is among the leading causes of death and disability worldwide. Patients following SABI may develop motor, sensory and cognitive disorders, alone or in combination. This review aims to point out the most used scales to assess motor function in SABI patients, also attempting to give some indications on their applicability in clinical practice. Studies were identified by searching on PubMed, Web of Science, PeDro and Cochrane databases between January and March 2022. We found that motor assessment tools are currently used by researchers/clinicians either in the acute/post-acute phase (for prognosis and rehabilitation purposes) or in the chronic phase (when functional items may also be considered). Moreover, specific scales exist only for patients with disorders of consciousness, whereas regarding motor function, SABI is mainly assessed by adapting the tools commonly used for stroke. Although some doubts remain about the validity of some of these assessment tools in SABI, to investigate motor outcomes is fundamental to establish a correct prognosis and plan a tailored rehabilitation training in these very frail and vulnerable patients.
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Affiliation(s)
- Mirjam Bonanno
- Neurorehabilitation Unit, IRCCS Centro Neurolesi “Bonino-Pulejo”, 98121 Messina, Italy; (M.B.); (R.D.L.); (W.T.)
| | - Rosaria De Luca
- Neurorehabilitation Unit, IRCCS Centro Neurolesi “Bonino-Pulejo”, 98121 Messina, Italy; (M.B.); (R.D.L.); (W.T.)
| | - William Torregrossa
- Neurorehabilitation Unit, IRCCS Centro Neurolesi “Bonino-Pulejo”, 98121 Messina, Italy; (M.B.); (R.D.L.); (W.T.)
| | | | - Rocco Salvatore Calabrò
- Neurorehabilitation Unit, IRCCS Centro Neurolesi “Bonino-Pulejo”, 98121 Messina, Italy; (M.B.); (R.D.L.); (W.T.)
- Correspondence:
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Comparison of transcallosal inhibition between hemispheres and its relationship with motor behavior in patients with severe upper extremity impairment after subacute stroke. J Stroke Cerebrovasc Dis 2022; 31:106469. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/20/2022] [Indexed: 10/18/2022] Open
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Tauchi Y, Kyougoku M, Okita Y, Takebayashi T. Structural validity and internal consistency of a hypothesized factor structure of the Fugl-Meyer Assessment of the upper extremity. Top Stroke Rehabil 2022; 30:501-511. [PMID: 35491995 DOI: 10.1080/10749357.2022.2070361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Many studies have confirmed the psychometric properties of Fugl-Meyer Assessment of the upper extremity (FMA-UE). Although several modified versions of the FMA-UE form exist, their structural validity has not been fully established. OBJECTIVES To assess the structural validity and internal consistency of the original, short, and hypothesized FMA-UE forms. METHODS In this cross-sectional, multicenter, observational study, the factor structure was assessed using confirmatory factor analysis (CFA) to evaluate the adequate model of each hypothetical FMA-UE form (original, 30-item, 27-item, and 6-item forms). The internal consistency of each FMA-UE form and subscale was assessed using Cronbach's alpha after factor structure evaluation. RESULTS We recruited 363 patients with first-episode stroke (median age = 70.0, median days = 75.0). The results of the original form models were not estimated by CFA. Of all FMA-UE forms, the 30-item form lacked three reflex items (4-factor, 30-item model) and the 27-item form lacked three reflex and three coordination items (3-factor, 27-item, second-order model); these forms demonstrated an adequate model fitness (root mean square error of approximation = 0.056/0.059, comparative fit index = 0.995/0.996, Tucker-Lewis index = 0.995/0.995). The 6-item form demonstrated a poor model fit. All FMA-UE forms and subscales showed a high internal consistency (Cronbach's alpha>0.91). CONCLUSIONS Both 30- and 27-item FMA-UE forms showed a good factor structure; therefore, these forms are eligible for use in clinical practice. However, future studies should define the factor structure of the 6-item form.
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Affiliation(s)
- Yuta Tauchi
- Graduate School of Comprehensive Rehabilitation, Osaka Metropolitan University, Osaka, Japan
| | - Makoto Kyougoku
- Department of Occupational Therapy, School of Health Sciences, Kibi International University, Okayama, Japan
| | - Yuho Okita
- Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - Takashi Takebayashi
- Graduate School of Comprehensive Rehabilitation, Osaka Metropolitan University, Osaka, Japan
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Yang W, Zhang X, Li Z, Zhang Q, Xue C, Huai Y. The Effect of Brain–Computer Interface Training on Rehabilitation of Upper Limb Dysfunction After Stroke: A Meta-Analysis of Randomized Controlled Trials. Front Neurosci 2022; 15:766879. [PMID: 35197817 PMCID: PMC8859107 DOI: 10.3389/fnins.2021.766879] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background Upper limb motor dysfunction caused by stroke greatly affects the daily life of patients, significantly reduces their quality of life, and places serious burdens on society. As an emerging rehabilitation training method, brain–computer interface (BCI)–based training can provide closed-loop rehabilitation and is currently being applied to the restoration of upper limb function following stroke. However, because of the differences in the type of experimental clinical research, the quality of the literature varies greatly, and debate around the efficacy of BCI for the rehabilitation of upper limb dysfunction after stroke has continued. Objective We aimed to provide medical evidence-based support for BCI in the treatment of upper limb dysfunction after stroke by conducting a meta-analysis of relevant clinical studies. Methods The search terms used to retrieve related articles included “brain-computer interface,” “stroke,” and “upper extremity.” A total of 13 randomized controlled trials involving 258 participants were retrieved from five databases (PubMed, Cochrane Library, Science Direct, MEDLINE, and Web of Science), and RevMan 5.3 was used for data analysis. Results The total effect size for BCI training on upper limb motor function of post-stroke patients was 0.56 (95% CI: 0.29–0.83). Subgroup analysis indicated that the standard mean differences of BCI training on upper limb motor function of subacute stroke patients and chronic stroke patients were 1.10 (95% CI: 0.20–2.01) and 0.51 (95% CI: 0.09–0.92), respectively (p = 0.24). Conclusion Brain–computer interface training was shown to be effective in promoting upper limb motor function recovery in post-stroke patients, and the effect size was moderate.
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