1
|
Felix Brown D, Quan Xie S. Effectiveness of Intelligent Control Strategies in Robot-Assisted Rehabilitation-A Systematic Review. IEEE Trans Neural Syst Rehabil Eng 2024; 32:1828-1840. [PMID: 38696295 DOI: 10.1109/tnsre.2024.3396065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
This review aims to provide a systematic analysis of the literature focused on the use of intelligent control systems in robotics for physical rehabilitation, identifying trends in recent research and comparing the effectiveness of intelligence used in control, with the aim of determining important factors in robot-assisted rehabilitation and how intelligent controller design can improve them. Seven electronic research databases were searched for articles published in the years 2015 - 2022 with articles selected based on relevance to the subject area of intelligent control systems in rehabilitation robotics. It was found that the most common use of intelligent algorithms for control is improving traditional control strategies with optimization and learning techniques. Intelligent algorithms are also commonly used in sensor output mapping, model construction, and for various data learning purposes. Experimental results show that intelligent controllers consistently outperform non-intelligent controllers in terms of transparency, tracking accuracy, and adaptability. Active participation of the patients and lowered interaction forces are consistently mentioned as important factors in improving the rehabilitation outcome as well as the patient experience. However, there are limited examples of studies presenting experimental results with impaired participants suffering limited range of motion, so the effectiveness of therapy provided by these systems is often difficult to quantify. A lack of universal evaluation criteria also makes it difficult to compare control systems outside of articles which use their own comparison criteria.
Collapse
|
2
|
Bernal-Jiménez JJ, Polonio-López B, Sanz-García A, Martín-Conty JL, Lerín-Calvo A, Segura-Fragoso A, Martín-Rodríguez F, Cantero-Garlito PA, Corregidor-Sánchez AI, Mordillo-Mateos L. Is the Combination of Robot-Assisted Therapy and Transcranial Direct Current Stimulation Useful for Upper Limb Motor Recovery? A Systematic Review with Meta-Analysis. Healthcare (Basel) 2024; 12:337. [PMID: 38338223 PMCID: PMC10855329 DOI: 10.3390/healthcare12030337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/18/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
Stroke is the third leading cause of disability in the world, and effective rehabilitation is needed to improve lost functionality post-stroke. In this regard, robot-assisted therapy (RAT) and transcranial direct current stimulation (tDCS) are promising rehabilitative approaches that have been shown to be effective in motor recovery. In the past decade, they have been combined to study whether their combination produces adjuvant and greater effects on stroke recovery. The aim of this study was to estimate the effectiveness of the combined use of RATs and tDCS in the motor recovery of the upper extremities after stroke. After reviewing 227 studies, we included nine randomised clinical trials (RCTs) in this study. We analysed the methodological quality of all nine RCTs in the meta-analysis. The analysed outcomes were deficit severity, hand dexterity, spasticity, and activity. The addition of tDCS to RAT produced a negligible additional benefit on the effects of upper limb function (SMD -0.09, 95% CI -0.31 to 0.12), hand dexterity (SMD 0.12, 95% CI -0.22 to 0.46), spasticity (SMD 0.04, 95% CI -0.24 to 0.32), and activity (SMD 0.66, 95% CI -1.82 to 3.14). There is no evidence of an additional effect when adding tDCS to RAT for upper limb recovery after stroke. Combining tDCS with RAT does not improve upper limb motor function, spasticity, and/or hand dexterity. Future research should focus on the use of RAT protocols in which the patient is given an active role, focusing on the intensity and dosage, and determining how certain variables influence the success of RAT.
Collapse
Affiliation(s)
- Juan J. Bernal-Jiménez
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Begoña Polonio-López
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Ancor Sanz-García
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - José L. Martín-Conty
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Alfredo Lerín-Calvo
- Neruon Neurobotic S.L., 28015 Madrid, Spain;
- Department of Physiotherapy, Faculty of Health Sciences, University La Salle, 28023 Madrid, Spain
| | - Antonio Segura-Fragoso
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Francisco Martín-Rodríguez
- Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain;
- Advanced Life Support, Emergency Medical Services (SACYL), 47007 Valladolid, Spain
| | - Pablo A. Cantero-Garlito
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Ana-Isabel Corregidor-Sánchez
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Laura Mordillo-Mateos
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| |
Collapse
|
3
|
Alashram AR. Effects of robotic therapy associated with noninvasive brain stimulation on motor function in individuals with incomplete spinal cord injury: A systematic review of randomized controlled trials. J Spinal Cord Med 2024:1-16. [PMID: 38265422 DOI: 10.1080/10790268.2024.2304921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
CONTEXT Motor deficits are among the most common consequences of incomplete spinal cord injury (SCI). These impairments can affect patients' levels of functioning and quality of life. Combined robotic therapy and non-invasive brain stimulation (NIBS) have been used to improve motor impairments in patients with corticospinal tract lesions. OBJECTIVES To examine the effects of combined robotic therapy and NIBS on motor function post incomplete SCI. METHODS PubMed, SCOPUS, MEDLINE, PEDro, Web of Science, REHABDATA, CINAHL, and EMBASE were searched from inception until July 2023. The Physiotherapy Evidence Database (PEDro) scale was employed to evaluate the selected studies quality. RESULTS Of 557 studies, five randomized trials (n = 122), with 25% of participants being females, were included in this review. The PEDro scores ranged from eight to nine, with a median score of nine. There were variations in treatment protocols and outcome measures, resulting in heterogeneous findings. The findings showed revealed evidence for the impacts of combined robotic therapy and NIBS on motor function in individuals with incomplete SCI. CONCLUSIONS Combined robotic training and NIBS may be safe for individuals with incomplete SCI. The existing evidence concerning its effects on motor outcomes in individuals with SCI is limited. Further experimental studies are needed to understand the effects of combined robotic training and NIBS on motor impairments in SCI populations.
Collapse
Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Amman, Jordan
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
| |
Collapse
|
4
|
Ho JC, Grigsby EM, Damiani A, Liang L, Balaguer JM, Kallakuri S, Barrios-Martinez J, Karapetyan V, Fields D, Gerszten PC, Kevin Hitchens T, Constantine T, Adams GM, Crammond DJ, Capogrosso M, Gonzalez-Martinez JA, Pirondini E. POTENTIATION OF CORTICO-SPINAL OUTPUT VIA TARGETED ELECTRICAL STIMULATION OF THE MOTOR THALAMUS. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.08.23286720. [PMID: 36945514 PMCID: PMC10029067 DOI: 10.1101/2023.03.08.23286720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Cerebral white matter lesions prevent cortico-spinal descending inputs from effectively activating spinal motoneurons, leading to loss of motor control. However, in most cases, the damage to cortico-spinal axons is incomplete offering a potential target for new therapies aimed at improving volitional muscle activation. Here we hypothesized that, by engaging direct excitatory connections to cortico-spinal motoneurons, stimulation of the motor thalamus could facilitate activation of surviving cortico-spinal fibers thereby potentiating motor output. To test this hypothesis, we identified optimal thalamic targets and stimulation parameters that enhanced upper-limb motor evoked potentials and grip forces in anesthetized monkeys. This potentiation persisted after white matter lesions. We replicated these results in humans during intra-operative testing. We then designed a stimulation protocol that immediately improved voluntary grip force control in a patient with a chronic white matter lesion. Our results show that electrical stimulation targeting surviving neural pathways can improve motor control after white matter lesions.
Collapse
Affiliation(s)
- Jonathan C. Ho
- School of Medicine, University of Pittsburgh, 3550 Terrace St, Pittsburgh, PA, USA 15213
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
| | - Erinn M. Grigsby
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, 3471 Fifth Avenue, Suite 910, Pittsburgh, PA, USA, 15213
| | - Arianna Damiani
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
- Department of Bioengineering, University of Pittsburgh, 151 Benedum Hall, Pittsburgh, PA, USA, 15261
- Center for the Neural Basis of Cognition, 4400 Fifth Avenue, Suite 115, Pittsburgh, PA, USA, 15213
| | - Lucy Liang
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
- Department of Bioengineering, University of Pittsburgh, 151 Benedum Hall, Pittsburgh, PA, USA, 15261
- Center for the Neural Basis of Cognition, 4400 Fifth Avenue, Suite 115, Pittsburgh, PA, USA, 15213
| | - Josep-Maria Balaguer
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
- Department of Bioengineering, University of Pittsburgh, 151 Benedum Hall, Pittsburgh, PA, USA, 15261
- Center for the Neural Basis of Cognition, 4400 Fifth Avenue, Suite 115, Pittsburgh, PA, USA, 15213
| | - Sridula Kallakuri
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
- Department of Neuroscience, University of Pittsburgh, A210 Langley Hall, Pittsburgh, PA, USA, 15260
| | - Jessica Barrios-Martinez
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, suite b-400, Pittsburgh, PA, USA, 15213
| | - Vahagn Karapetyan
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
- Department of Bioengineering, University of Pittsburgh, 151 Benedum Hall, Pittsburgh, PA, USA, 15261
- Center for the Neural Basis of Cognition, 4400 Fifth Avenue, Suite 115, Pittsburgh, PA, USA, 15213
| | - Daryl Fields
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, suite b-400, Pittsburgh, PA, USA, 15213
| | - Peter C. Gerszten
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, suite b-400, Pittsburgh, PA, USA, 15213
| | - T. Kevin Hitchens
- Department of Neurobiology, University of Pittsburgh, 200 Lothrop Street, Room E1440, Pittsburgh, PA, USA, 15213
| | - Theodora Constantine
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, suite b-400, Pittsburgh, PA, USA, 15213
| | - Gregory M. Adams
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, suite b-400, Pittsburgh, PA, USA, 15213
| | - Donald J. Crammond
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, suite b-400, Pittsburgh, PA, USA, 15213
| | - Marco Capogrosso
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
- Department of Bioengineering, University of Pittsburgh, 151 Benedum Hall, Pittsburgh, PA, USA, 15261
- Center for the Neural Basis of Cognition, 4400 Fifth Avenue, Suite 115, Pittsburgh, PA, USA, 15213
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, suite b-400, Pittsburgh, PA, USA, 15213
| | - Jorge A. Gonzalez-Martinez
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, suite b-400, Pittsburgh, PA, USA, 15213
- Department of Neurobiology, University of Pittsburgh, 200 Lothrop Street, Room E1440, Pittsburgh, PA, USA, 15213
| | - Elvira Pirondini
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, 3471 Fifth Avenue, Suite 910, Pittsburgh, PA, USA, 15213
- Department of Bioengineering, University of Pittsburgh, 151 Benedum Hall, Pittsburgh, PA, USA, 15261
- Center for the Neural Basis of Cognition, 4400 Fifth Avenue, Suite 115, Pittsburgh, PA, USA, 15213
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, suite b-400, Pittsburgh, PA, USA, 15213
- Department of Neurobiology, University of Pittsburgh, 200 Lothrop Street, Room E1440, Pittsburgh, PA, USA, 15213
| |
Collapse
|
5
|
Kashoo FZ, Al-Baradie RS, Alzahrani M, Alanazi A, Manzar MD, Gugnani A, Sidiq M, Shaphe MA, Sirajudeen MS, Ahmad M, Althumayri B, Aljandal A, Almansour A, Alshewaier SA, Chahal A. Effect of Transcranial Direct Current Stimulation Augmented with Motor Imagery and Upper-Limb Functional Training for Upper-Limb Stroke Rehabilitation: A Prospective Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15199. [PMID: 36429924 PMCID: PMC9690138 DOI: 10.3390/ijerph192215199] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/12/2022] [Accepted: 11/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Combining transcranial direct current stimulation (tDCS) with other therapies is reported to produce promising results in patients with stroke. The purpose of the study was to determine the effect of combining tDCS with motor imagery (MI) and upper-limb functional training for upper-limb rehabilitation among patients with chronic stroke. METHODS A single-center, prospective, randomized controlled trial was conducted among 64 patients with chronic stroke. The control group received sham tDCS with MI, while the experimental group received real tDCS with MI. Both groups performed five different upper-limb functional training exercises coupled with tDCS for 30 min, five times per week for two weeks. Fugl-Meyer's scale (FMA) and the Action Research Arm Test (ARAT) were used to measure the outcome measures at baseline and after the completion of the 10th session. RESULTS Analysis of covariance showed significant improvements in the post-test mean scores for FMA (F (414.4) = 35.79, p < 0.001; η2 = 0.37) and ARAT (F (440.09) = 37.46, p < 0.001; η2 = 0.38) in the experimental group compared to the control group while controlling for baseline scores. CONCLUSIONS Anodal tDCS stimulation over the affected primary motor cortex coupled with MI and upper-limb functional training reduces impairment and disability of the upper limbs among patients with chronic stroke.
Collapse
Affiliation(s)
- Faizan Zaffar Kashoo
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Raid Saleem Al-Baradie
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Msaad Alzahrani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Ahmad Alanazi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Md Dilshad Manzar
- Department of Nursing, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Anchit Gugnani
- NIMS College of Physiotherapy and Occupational Therapy, NIMS University Jaipur, Jaipur 303121, Rajasthan, India
| | - Mohammad Sidiq
- NIMS College of Physiotherapy and Occupational Therapy, NIMS University Jaipur, Jaipur 303121, Rajasthan, India
| | - Mohammad Abu Shaphe
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan 82511, Saudi Arabia
| | - Mohamed Sherif Sirajudeen
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Mehrunnisha Ahmad
- Department of Nursing, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Bader Althumayri
- Department of Physical Therapy, Security Forces Hospital, Riyadh 11564, Saudi Arabia
| | - Abdullah Aljandal
- Department of Physical Therapy and Rehabilitation, Al Fayha Club, Al Majmmah 11952, Saudi Arabia
| | - Ahmed Almansour
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Shady Abdullah Alshewaier
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Aksh Chahal
- Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar, Mullana 133207, Haryana, India
| |
Collapse
|
6
|
Dadgar H, Majidi H, Aghaei S. Biological and Neurobiological Mechanisms of Transcranial Direct Current Stimulation. IRANIAN JOURNAL OF PSYCHIATRY 2022; 17:350-355. [PMID: 36474694 PMCID: PMC9699813 DOI: 10.18502/ijps.v17i3.9735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/02/2021] [Accepted: 03/16/2022] [Indexed: 06/17/2023]
Abstract
Objective: Changes in cortical excitability and neuroplasticity are important parts of the neuropathology and pathophysiology of many neuropsychiatric disorders. Noninvasive brain stimulation is a high-potential therapeutic approach to modify cortical activities. One of the most popular of these techniques is transcranial direct current stimulation (tDCS). However, the biological and neurobiological effects of tDCS should be better clarified to enable its optimal use in clinical and therapeutic practices. In this paper, we summarize the neurophysiological and physiological effects and mechanisms of action of tDCS. Method : An update literature review was conducted on the biological responses of tDCS reported in human, in vitro and in vivo studies, with a focus on cellular cascades related to neuroplasticity, neuronal reorganization and inflammation caused by applied direct current electric fields. Results: The regulatory mechanisms of tDCS on motor and cognitive functions can be described by membrane polarization and transmembrane potential with a main subsequent effect on neurotransmission systems, neuronal excitability, synaptic microenvironment and neuronal connectivity to neuronal reorganization and neurogenesis in association with synaptic plasticity as well as inflammatory processes. In general, the effects of tDCS may include acute- or after-effects and direct or indirect effects and can be examined at different levels including the neurochemical, the neuroelectrical and the brain oscillatory levels. Conclusion: A deep understanding of the molecular and cellular responses to tDCS is very important and crucial. This therapeutic technique can be utilized in various clinical trials with a perspective of being routinely suggested and presented to patients with different pathological conditions influencing the central or peripheral nervous system.
Collapse
Affiliation(s)
- Hooshang Dadgar
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Majidi
- Department of Electrical Engineering, Technical and Vocational University, Tehran, Iran
| | - Setareh Aghaei
- School of Psychology, Islamic Azad University, Ayatollah Amoli Branch, Amol, Iran
| |
Collapse
|
7
|
Kabir R, Sunny MSH, Ahmed HU, Rahman MH. Hand Rehabilitation Devices: A Comprehensive Systematic Review. MICROMACHINES 2022; 13:mi13071033. [PMID: 35888850 PMCID: PMC9325203 DOI: 10.3390/mi13071033] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/23/2022] [Accepted: 06/25/2022] [Indexed: 12/20/2022]
Abstract
A cerebrovascular accident, or a stroke, can cause significant neurological damage, inflicting the patient with loss of motor function in their hands. Standard rehabilitation therapy for the hand increases demands on clinics, creating an avenue for powered hand rehabilitation devices. Hand rehabilitation devices (HRDs) are devices designed to provide the hand with passive, active, and active-assisted rehabilitation therapy; however, HRDs do not have any standards in terms of development or design. Although the categorization of an injury’s severity can guide a patient into seeking proper assistance, rehabilitation devices do not have a set standard to provide a solution from the beginning to the end stages of recovery. In this paper, HRDs are defined and compared by their mechanical designs, actuation mechanisms, control systems, and therapeutic strategies. Furthermore, devices with conducted clinical trials are used to determine the future development of HRDs. After evaluating the abilities of 35 devices, it is inferred that standard characteristics for HRDs should include an exoskeleton design, the incorporation of challenge-based and coaching therapeutic strategies, and the implementation of surface electromyogram signals (sEMG) based control.
Collapse
Affiliation(s)
- Ryan Kabir
- Department of Mechanical Engineering, BioRobotics Lab, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA; (H.U.A.); (M.H.R.)
- Correspondence:
| | - Md Samiul Haque Sunny
- Department of Computer Science, BioRobotics Lab, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA;
| | - Helal Uddin Ahmed
- Department of Mechanical Engineering, BioRobotics Lab, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA; (H.U.A.); (M.H.R.)
| | - Mohammad Habibur Rahman
- Department of Mechanical Engineering, BioRobotics Lab, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA; (H.U.A.); (M.H.R.)
- Department of Computer Science, BioRobotics Lab, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA;
| |
Collapse
|
8
|
Msigwa SS, Li Y, Cheng XL, Cao F. Combining electroacupuncture and transcranial direct current stimulation as an adjuvant therapy enhances spontaneous conversation and naming in subacute vascular aphasia: A retrospective analysis. JOURNAL OF INTEGRATIVE MEDICINE 2022; 20:244-251. [PMID: 35318944 DOI: 10.1016/j.joim.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Emerging evidence shows the effectiveness of speech and language therapy (SLT); however, precise therapeutic parameters remain unclear. Evidence for the use of adjunctive transcranial direct current stimulation (tDCS) to treat post-stroke aphasia (PSA) is promising; however, the utility of combining tDCS and electroacupuncture (EA) has not yet been analyzed. This study assessed the therapeutic consequences of EA and tDCS coupled with SLT in subacute PSA patients who were also undergoing hyperbaric oxygen therapy (HBOT). METHODS A retrospective analysis was conducted on subacute (< 6 months) PSA patients who were divided into three groups: patients who received EA plus tDCS (acupuncture group), patients who underwent tDCS (tDCS group), and patients who experienced conventional therapy (HBOT + SLT). All subjects underwent 21 days of treatment and also received conventional treatment. The aphasia battery of Chinese (ABC) was used to score pre- and post-intervention status. RESULTS The analysis comprised 238 patients. Cerebral infarction was the most frequent stroke type (137 [57.6%]), while motor (66 [27.7%]) and global aphasia (60 [25.2%]) were the most common types of aphasia. After 21 days of intervention, the ABC scores of all patients were improved. The acupuncture group had the highest ABC scores, but only repetition, naming, and spontaneous speech were statistically improved (P < 0.01). Post-hoc tests revealed significant improvement in word retrieval in the acupuncture and tDCS groups (P < 0.01, P = 0.037), while the acupuncture group had additional significant improvement in spontaneous conversation (P < 0.01). CONCLUSION Combining acupuncture and tDCS as an adjuvant therapy for subacute PSA led to significant spontaneous speech and word retrieval improvements. Future prospective, multi-ethnic, multi-center trials are warranted.
Collapse
Affiliation(s)
- Samwel Sylvester Msigwa
- Department of Neurology, the Clinical Medicine School of Yangtze University, the First Affiliated Hospital of Yangtze University, Jingzhou 424023, Hubei Province, China; Department of Research and Training, Mirembe National Mental Health Hospital, P. O. Box 910, Dodoma, Tanzania
| | - Yan Li
- Department of Neurology, the Clinical Medicine School of Yangtze University, the First Affiliated Hospital of Yangtze University, Jingzhou 424023, Hubei Province, China
| | - Xiang-Lin Cheng
- Department of Neurology, the Clinical Medicine School of Yangtze University, the First Affiliated Hospital of Yangtze University, Jingzhou 424023, Hubei Province, China; Department of Rehabilitation, The First Affiliated Hospital of Yangtze University, Jingzhou 424023, Hubei Province, China.
| | - Fen Cao
- Department of Neurology, the Clinical Medicine School of Yangtze University, the First Affiliated Hospital of Yangtze University, Jingzhou 424023, Hubei Province, China; Department of Rehabilitation, The First Affiliated Hospital of Yangtze University, Jingzhou 424023, Hubei Province, China.
| |
Collapse
|
9
|
Modification of Hand Muscular Synergies in Stroke Patients after Robot-Aided Rehabilitation. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12063146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The central nervous system (CNS) is able to control a very high number of degrees of freedom to perform complex movements of both upper and lower limbs. However, what strategies the CNS adopts to perform complex tasks are not completely clear and are still being studied. Recent studies confirm that stroke subjects with mild and moderate impairment show altered upper limb muscle patterns, but the muscular patterns of the hand have not completely investigated, although the hand represents a paramount tool for performing activities of daily living (ADLs) and stroke can significantly alter the mobilization of this part of the body. In this context, this study aims at investigating hand muscular synergies in chronic stroke patients and evaluating some possible benefits in the robot-aided rehabilitation treatment of the hand in these subjects. Seven chronic stroke patients with mild-to-moderate impairment (FM>30) were involved in this study. They received a 5-week robot-aided rehabilitation treatment with the Gloreha hand exoskeleton, and muscle synergies of both the healthy and injured hand were evaluated at the beginning and at the end of the treatment. The performed analysis showed a very high degree of similarity of the involved synergies between the healthy and the injured limb both before and after the rehabilitation treatment (mean similarity index values: H-BR: 0.88±0.03, H-AR: 0.94±0.03, BR-AR: 0.89±0.05). The increasing similarity is regarded as an effect of the robot-aided rehabilitation treatment and future activities will be performed to increase the population involved in the study.
Collapse
|
10
|
Fonte C, Varalta V, Rocco A, Munari D, Filippetti M, Evangelista E, Modenese A, Smania N, Picelli A. Combined transcranial Direct Current Stimulation and robot-assisted arm training in patients with stroke: a systematic review. Restor Neurol Neurosci 2022; 39:435-446. [PMID: 34974446 DOI: 10.3233/rnn-211218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Upper limb motor deficits in patients with severe stroke often remain unresolved over time. Combining transcranial Direct Current Stimulation with robotic therapy is an innovative neurorehabilitation approach that holds promise to improve upper limb impairment after stroke. OBJECTIVE To investigate the effects of robotic training in combination with transcranial Direct Current Stimulation for treating poststroke upper limb impairment. METHODS PubMed, MEDLINE, Cochrane Library, and EMBASE electronic databases were searched using keywords, MeSH terms, and strings: "Stroke"[MeSH] AND ("Upper Extremity"[MeSH] OR "upper limb") AND ("Transcranial Direct Current Stimulation" [MeSH] OR "tDCS") AND ("robotics" OR "robotic therapy"). Full-text articles published in English up to October 2020 were included. Each was rated for quality according to the Physiotherapy Database (PEDro) score: eight out of eleven scored more than 8 points; their results were considered reliable for this review. RESULTS Of the total of 171 publications retrieved, 11 met the inclusion criteria. The results of studies that examined the same outcome measures were pooled to draw conclusions on the effectiveness of transcranial Direct Current Stimulation and robot-assisted training in corticomotor excitability, upper limb kinematics, muscle strength and tone, function, disability, and quality of life after stroke. CONCLUSIONS To date, there is insufficient evidence to support the hypothesis that transcranial Direct Current Stimulation enhances the effects of robot-assisted arm training in poststroke patients. Further studies with more accurate, comparable and standardized methodology are needed in order to better define the effects of robotic training in combination with transcranial Direct Current Stimulation on poststroke upper limb impairment. Therefore, given the scarce resources available to rehabilitation researches, other, more promising approaches should be given attention.
Collapse
Affiliation(s)
- Cristina Fonte
- Neuromotor and Cognitive Rehabilitation Research Center, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy
| | - Valentina Varalta
- Neuromotor and Cognitive Rehabilitation Research Center, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy
| | - Arianna Rocco
- Neuromotor and Cognitive Rehabilitation Research Center, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Daniele Munari
- Neuromotor and Cognitive Rehabilitation Research Center, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mirko Filippetti
- Neuromotor and Cognitive Rehabilitation Research Center, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Elisa Evangelista
- Neuromotor and Cognitive Rehabilitation Research Center, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Angela Modenese
- Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy
| | - Nicola Smania
- Neuromotor and Cognitive Rehabilitation Research Center, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy
| | - Alessandro Picelli
- Neuromotor and Cognitive Rehabilitation Research Center, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy.,Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, ON, Canada
| |
Collapse
|
11
|
Conti E, Scaglione A, de Vito G, Calugi F, Pasquini M, Pizzorusso T, Micera S, Allegra Mascaro AL, Pavone FS. Combining Optogenetic Stimulation and Motor Training Improves Functional Recovery and Perilesional Cortical Activity. Neurorehabil Neural Repair 2021; 36:107-118. [PMID: 34761714 DOI: 10.1177/15459683211056656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. An ischemic stroke is followed by the remapping of motor representation and extensive changes in cortical excitability involving both hemispheres. Although stimulation of the ipsilesional motor cortex, especially when paired with motor training, facilitates plasticity and functional restoration, the remapping of motor representation of the single and combined treatments is largely unexplored. Objective. We investigated if spatio-temporal features of motor-related cortical activity and the new motor representations are related to the rehabilitative treatment or if they can be specifically associated to functional recovery. Methods. We designed a novel rehabilitative treatment that combines neuro-plasticizing intervention with motor training. In detail, optogenetic stimulation of peri-infarct excitatory neurons expressing Channelrhodopsin 2 was associated with daily motor training on a robotic device. The effectiveness of the combined therapy was compared with spontaneous recovery and with the single treatments (ie optogenetic stimulation or motor training). Results. We found that the extension and localization of the new motor representations are specific to the treatment, where most treatments promote segregation of the motor representation to the peri-infarct region. Interestingly, only the combined therapy promotes both the recovery of forelimb functionality and the rescue of spatio-temporal features of motor-related activity. Functional recovery results from a new excitatory/inhibitory balance between hemispheres as revealed by the augmented motor response flanked by the increased expression of parvalbumin positive neurons in the peri-infarct area. Conclusions. Our findings highlight that functional recovery and restoration of motor-related neuronal activity are not necessarily coupled during post-stroke recovery. Indeed the reestablishment of cortical activation features of calcium transient is distinctive of the most effective therapeutic approach, the combined therapy.
Collapse
Affiliation(s)
- Emilia Conti
- Neuroscience Institute, 9327National Research Council, Pisa, Italy.,226476European Laboratory for Non-linear Spectroscopy University of Florence, Florence, Italy.,Department of Physics and Astronomy, 9300University of Florence, Florence, Italy
| | - Alessandro Scaglione
- 226476European Laboratory for Non-linear Spectroscopy University of Florence, Florence, Italy.,Department of Physics and Astronomy, 9300University of Florence, Florence, Italy
| | - Giuseppe de Vito
- 226476European Laboratory for Non-linear Spectroscopy University of Florence, Florence, Italy.,Department of Neuroscience, Psychology, Drug Research and Child Health, 9300University of Florence, Florence, Italy
| | - Francesco Calugi
- Neuroscience Institute, 9327National Research Council, Pisa, Italy.,Department of Neuroscience, Psychology, Drug Research and Child Health, 9300University of Florence, Florence, Italy
| | - Maria Pasquini
- The BioRobotics Institute and Department of Excellence in Robotics and AI, 19005Scuola Superiore Sant'Anna, Pisa, Italy.,Center for Neuroprosthetics and Institute of Bioengineering, 454629Bertarelli Foundation Chair in Translational NeuroEngineering, Ecole Polytechnique Federale de Lausanne (EPFL), Lausanne, Switzerland
| | - Tommaso Pizzorusso
- Neuroscience Institute, 9327National Research Council, Pisa, Italy.,Department of Neuroscience, Psychology, Drug Research and Child Health, 9300University of Florence, Florence, Italy
| | - Silvestro Micera
- The BioRobotics Institute and Department of Excellence in Robotics and AI, 19005Scuola Superiore Sant'Anna, Pisa, Italy.,Center for Neuroprosthetics and Institute of Bioengineering, 454629Bertarelli Foundation Chair in Translational NeuroEngineering, Ecole Polytechnique Federale de Lausanne (EPFL), Lausanne, Switzerland
| | - Anna Letizia Allegra Mascaro
- Neuroscience Institute, 9327National Research Council, Pisa, Italy.,226476European Laboratory for Non-linear Spectroscopy University of Florence, Florence, Italy
| | - Francesco Saverio Pavone
- 226476European Laboratory for Non-linear Spectroscopy University of Florence, Florence, Italy.,Department of Physics and Astronomy, 9300University of Florence, Florence, Italy.,National Institute of Optics, 9327National Research Council, Florence, Italy
| |
Collapse
|
12
|
Orrù G, Conversano C, Hitchcott PK, Gemignani A. Motor stroke recovery after tDCS: a systematic review. Rev Neurosci 2021; 31:201-218. [PMID: 31472070 DOI: 10.1515/revneuro-2019-0047] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/04/2019] [Indexed: 02/03/2023]
Abstract
The purpose of the present study was to investigate the effects of transcranial direct current stimulation (tDCS) on motor recovery in adult patients with stroke, taking into account the parameters that could influence the motor recovery responses. The second aim was to identify the best tDCS parameters and recommendations available based on the enhanced motor recovery demonstrated by the analyzed studies. Our systematic review was performed by searching full-text articles published before February 18, 2019 in the PubMed database. Different methods of applying tDCS in association with several complementary therapies were identified. Studies investigating the motor recovery effects of tDCS in adult patients with stroke were considered. Studies investigating different neurologic conditions and psychiatric disorders or those not meeting our methodologic criteria were excluded. The main parameters and outcomes of tDCS treatments are reported. There is not a robust concordance among the study outcomes with regard to the enhancement of motor recovery associated with the clinical application of tDCS. This is mainly due to the heterogeneity of clinical data, tDCS approaches, combined interventions, and outcome measurements. tDCS could be an effective approach to promote adaptive plasticity in the stroke population with significant positive premotor and postmotor rehabilitation effects. Future studies with larger sample sizes and high-quality studies with a better standardization of stimulation protocols are needed to improve the study quality, further corroborate our results, and identify the optimal tDCS protocols.
Collapse
Affiliation(s)
- Graziella Orrù
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - Ciro Conversano
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - Paul Kenneth Hitchcott
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - Angelo Gemignani
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| |
Collapse
|
13
|
Marotta N, Demeco A, Moggio L, Ammendolia A. The adjunct of transcranial direct current stimulation to Robot-assisted therapy in upper limb post-stroke treatment. J Med Eng Technol 2021; 45:494-501. [PMID: 34038313 DOI: 10.1080/03091902.2021.1922527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Transcranial direct current stimulation (TDCS) and robot-assisted therapy (RAT) proved to be promising interventions in post-stroke rehabilitation. However, the effects of combining the two treatments are not significantly clear. To determine the effects of combined therapy using transcranial direct current stimulation (tDCS) with robot-assisted therapy (RAT) in the impairment of the upper limb in stroke rehabilitation. The Cochrane Library, MEDLINE, Embase, Google Scholar, and Trial Registries were systematically searched for randomised controlled trials in May 2020. As the outcome, the Fugl-Meyer Assessment score (FMS) was used. A pairwise and a network meta-analysis were performed. 5 RCTs with RAT versus RAT + tDCS groups and 21 RCTs with RAT versus the control group with 892 people were analysed. Of these studies, 10 RCTs evaluated acute-subacute (<8 weeks) people, while 16 chronic people. By analysing the FMS with a pair-wise meta-analysis, we demonstrate significant improvements only in the RAT alone compared to the control (acute-subacute, SMD:4.09 (1.31, 6.87) and chronic, SMD:2.22 (0.99, 3.45)). Instead, performing a network meta-analysis, through an analysis of the surface under the cumulative ranking curve (SUCRA) we report a ranking of the effectiveness of the interventions. We assess SUCRA in acute-subacute stroke: Control:0.23, RAT + tDCS:0.31, RAT:0.96 and in chronic stroke: Control:0.06, RAT + tDCS:0.62, RAT:0.82. RAT is, respectively, 96% and 82% likely to be the best-ranked treatment. Despite the limitations, this network meta-analysis appears to demonstrate through the rank of interventions that adding tDCS to RAT is not useful in upper-limb stroke rehabilitation.
Collapse
Affiliation(s)
- Nicola Marotta
- Department of Surgical and Medical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Andrea Demeco
- Department of Surgical and Medical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Lucrezia Moggio
- Department of Surgical and Medical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Antonio Ammendolia
- Department of Surgical and Medical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| |
Collapse
|
14
|
Discussion on the Rehabilitation of Stroke Hemiplegia Based on Interdisciplinary Combination of Medicine and Engineering. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:6631835. [PMID: 33815554 PMCID: PMC7990546 DOI: 10.1155/2021/6631835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/21/2021] [Accepted: 02/20/2021] [Indexed: 11/25/2022]
Abstract
Interdisciplinary combinations of medicine and engineering are part of the strategic plan of many universities aiming to be world-class institutions. One area in which these interactions have been prominent is rehabilitation of stroke hemiplegia. This article reviews advances in the last five years of stroke hemiplegia rehabilitation via interdisciplinary combination of medicine and engineering. Examples of these technologies include VR, RT, mHealth, BCI, tDCS, rTMS, and TCM rehabilitation. In this article, we will summarize the latest research in these areas and discuss the advantages and disadvantages of each to examine the frontiers of interdisciplinary medicine and engineering advances.
Collapse
|
15
|
Additional Effects of Xbox Kinect Training on Upper Limb Function in Chronic Stroke Patients: A Randomized Control Trial. Healthcare (Basel) 2021; 9:healthcare9030242. [PMID: 33668355 PMCID: PMC7996301 DOI: 10.3390/healthcare9030242] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 01/01/2023] Open
Abstract
Background: Xbox Kinect-based virtual reality, being a novel approach, has therapeutic benefits in rehabilitation and its use is encouraged in stroke rehabilitation of upper extremities. Objective: Primary aim of the current study is to investigate the additional effects of Xbox Kinect training in combination with routine physiotherapy exercises based on each component of Fugl-Meyer Assessment Scale for Upper Extremity (FMA-UE). Moreover, effect of upper limb rehabilitation on cognitive functions was also assessed. Methods: This study was a parallel arm randomized control trial. Fifty-six participants were recruited and randomly allocated to either an Xbox Kinect training group (XKGT) or exercise training group (ETG). Measures of concern were recorded using FMA-UE, Box and Block Test (BBT), and Montreal Cognitive Assessment (MOCA). Evaluation was conducted at baseline and after completion of intervention at the sixth week. Results: There were significant differences from pre- to post-intervention scores of FMA-UE and BBT (p < 0.001) in both groups, whereas no difference was observed for MOCA (XKTG p value 0.417, ETG p value 0.113). At six-week follow-up there were significant differences between both groups in FMA-UE total score (p < 0.001), volitional movement within synergies (p < 0.001), wrist (p = 0.021), hand (p = 0.047), grasp (p = 0.006) and coordination/speed (p = 0.004), favoring the Xbox Kinect training group. Conclusion: To conclude, results indicate repetitive use of the hemiparetic upper extremity by Xbox Kinect-based upper limb rehabilitation training in addition to conventional therapy has a promising potential to enhance upper limb motor function for stroke patients.
Collapse
|
16
|
Reis SB, Bernardo WM, Oshiro CA, Krebs HI, Conforto AB. Effects of Robotic Therapy Associated With Noninvasive Brain Stimulation on Upper-Limb Rehabilitation After Stroke: Systematic Review and Meta-analysis of Randomized Clinical Trials. Neurorehabil Neural Repair 2021; 35:256-266. [PMID: 33522417 DOI: 10.1177/1545968321989353] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Robot-assisted therapy and noninvasive brain stimulation (NIBS) are promising strategies for stroke rehabilitation. OBJECTIVE This systematic review and meta-analysis aims to evaluate the evidence of NIBS as an add-on intervention to robotic therapy in order to improve outcomes of upper-limb motor impairment or activity in individuals with stroke. METHODS This study was performed according to the PRISMA Protocol and was previously registered on the PROSPERO Platform (CRD42017054563). Seven databases and gray literature were systematically searched by 2 reviewers, and 1176 registers were accessed. Eight randomized clinical trials with upper-limb body structure/function or activity limitation outcome measures were included. Subgroup analyses were performed according to phase poststroke, device characteristics (ie, arm support, joints involved, unimanual or bimanual training), NIBS paradigm, timing of stimulation, and number of sessions. The Grade-Pro Software was used to assess quality of the evidence. RESULTS A nonsignificant homogeneous summary effect size was found both for body structure function domain (mean difference [MD] = 0.15; 95% CI = -3.10 to 3.40; P = 0.93; I2 = 0%) and activity limitation domain (standard MD = 0.03; 95% CI = -0.28 to 0.33; P = 0.87; I2 = 0%). CONCLUSIONS According to this systematic review and meta-analysis, at the moment, there are not enough data about the benefits of NIBS as an add-on intervention to robot-assisted therapy on upper-limb motor function or activity in individuals with stroke.
Collapse
|
17
|
Elsner B, Kugler J, Mehrholz J. Transcranial direct current stimulation (tDCS) for improving aphasia after stroke: a systematic review with network meta-analysis of randomized controlled trials. J Neuroeng Rehabil 2020; 17:88. [PMID: 32641152 PMCID: PMC7346463 DOI: 10.1186/s12984-020-00708-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/11/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Transcranial Direct Current Stimulation (tDCS) is an emerging approach for improving aphasia after stroke. However, it remains unclear what type of tDCS stimulation is most effective. Our aim was to give an overview of the evidence network regarding the efficacy and safety of tDCS and to estimate the effectiveness of the different stimulation types. METHODS This is a systematic review of randomized controlled trials with network meta-analysis (NMA). We searched the following databases until 4 February 2020: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, Web of Science, and four other databases. We included studies with adult people with stroke. We compared any kind of active tDCS (anodal, cathodal, or dual, that is applying anodal and cathodal tDCS concurrently) regarding improvement of our primary outcome of functional communication, versus control, after stroke. PROSPERO ID CRD42019135696. RESULTS We included 25 studies with 471 participants. Our NMA showed that tDCS did not improve our primary outcome, that of functional communication. There was evidence of an effect of anodal tDCS, particularly over the left inferior frontal gyrus, in improving our secondary outcome, that of performance in naming nouns (SMD = 0.51; 95% CI 0.11 to 0.90). There was no difference in safety between tDCS and its control interventions, measured by the number of dropouts and adverse events. CONCLUSION Comparing different application/protocols of tDCS shows that the anodal application, particularly over the left inferior frontal gyrus, seems to be the most promising tDCS treatment option to improve performance in naming in people with stroke.
Collapse
Affiliation(s)
- Bernhard Elsner
- Department of Public Health, Dresden Medical School, Technical University Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
- Physiotherapy and Neurorehabilitation, SRH University of Applied Health Sciences Gera, Gera, Germany.
| | - Joachim Kugler
- Department of Public Health, Dresden Medical School, Technical University Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Jan Mehrholz
- Department of Public Health, Dresden Medical School, Technical University Dresden, Fetscherstr. 74, 01307, Dresden, Germany
- Physiotherapy and Neurorehabilitation, SRH University of Applied Health Sciences Gera, Gera, Germany
- Wissenschaftliches Institut, Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa GmbH, Kreischa, Germany
| |
Collapse
|
18
|
Coscia M, Wessel MJ, Chaudary U, Millán JDR, Micera S, Guggisberg A, Vuadens P, Donoghue J, Birbaumer N, Hummel FC. Neurotechnology-aided interventions for upper limb motor rehabilitation in severe chronic stroke. Brain 2020; 142:2182-2197. [PMID: 31257411 PMCID: PMC6658861 DOI: 10.1093/brain/awz181] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/14/2019] [Accepted: 05/12/2019] [Indexed: 01/27/2023] Open
Abstract
Upper limb motor deficits in severe stroke survivors often remain unresolved over extended time periods. Novel neurotechnologies have the potential to significantly support upper limb motor restoration in severely impaired stroke individuals. Here, we review recent controlled clinical studies and reviews focusing on the mechanisms of action and effectiveness of single and combined technology-aided interventions for upper limb motor rehabilitation after stroke, including robotics, muscular electrical stimulation, brain stimulation and brain computer/machine interfaces. We aim at identifying possible guidance for the optimal use of these new technologies to enhance upper limb motor recovery especially in severe chronic stroke patients. We found that the current literature does not provide enough evidence to support strict guidelines, because of the variability of the procedures for each intervention and of the heterogeneity of the stroke population. The present results confirm that neurotechnology-aided upper limb rehabilitation is promising for severe chronic stroke patients, but the combination of interventions often lacks understanding of single intervention mechanisms of action, which may not reflect the summation of single intervention’s effectiveness. Stroke rehabilitation is a long and complex process, and one single intervention administrated in a short time interval cannot have a large impact for motor recovery, especially in severely impaired patients. To design personalized interventions combining or proposing different interventions in sequence, it is necessary to have an excellent understanding of the mechanisms determining the effectiveness of a single treatment in this heterogeneous population of stroke patients. We encourage the identification of objective biomarkers for stroke recovery for patients’ stratification and to tailor treatments. Furthermore, the advantage of longitudinal personalized trial designs compared to classical double-blind placebo-controlled clinical trials as the basis for precise personalized stroke rehabilitation medicine is discussed. Finally, we also promote the necessary conceptual change from ‘one-suits-all’ treatments within in-patient clinical rehabilitation set-ups towards personalized home-based treatment strategies, by adopting novel technologies merging rehabilitation and motor assistance, including implantable ones.
Collapse
Affiliation(s)
- Martina Coscia
- Wyss Center for Bio and Neuroengineering, Chemin des Mines 9, 1202 Geneva, Switzerland
| | - Maximilian J Wessel
- Defitech Chair in Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), School of Life Sciences, Swiss Federal Institute of Technology (EPFL), 1202 Geneva, Switzerland.,Defitech Chair in Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), School of Life Sciences, Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland
| | - Ujwal Chaudary
- Wyss Center for Bio and Neuroengineering, Chemin des Mines 9, 1202 Geneva, Switzerland
| | - José Del R Millán
- Defitech Chair in Brain-Machine Interface, Center for Neuroprosthetics, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, 1015, Switzerland
| | - Silvestro Micera
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, 1015, Switzerland.,Translational Neural Engineering Area, The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, 56025, Italy
| | - Adrian Guggisberg
- Clinical Neuroscience, University of Geneva Medical School, 1202 Geneva, Switzerland
| | | | - John Donoghue
- Wyss Center for Bio and Neuroengineering, Chemin des Mines 9, 1202 Geneva, Switzerland.,Department of Neuroscience, Brown University, Providence, RI 02906, USA
| | - Niels Birbaumer
- Wyss Center for Bio and Neuroengineering, Chemin des Mines 9, 1202 Geneva, Switzerland.,Institute of Medical Psychology and Behavioral Neurobiology, University Tuebingen, Germany
| | - Friedhelm C Hummel
- Defitech Chair in Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), School of Life Sciences, Swiss Federal Institute of Technology (EPFL), 1202 Geneva, Switzerland.,Defitech Chair in Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), School of Life Sciences, Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland.,Clinical Neuroscience, University of Geneva Medical School, 1202 Geneva, Switzerland
| |
Collapse
|
19
|
Micera S, Caleo M, Chisari C, Hummel FC, Pedrocchi A. Advanced Neurotechnologies for the Restoration of Motor Function. Neuron 2020; 105:604-620. [PMID: 32078796 DOI: 10.1016/j.neuron.2020.01.039] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/15/2019] [Accepted: 01/27/2020] [Indexed: 01/23/2023]
Abstract
Stroke is one of the leading causes of long-term disability. Advanced technological solutions ("neurotechnologies") exploiting robotic systems and electrodes that stimulate the nervous system can increase the efficacy of stroke rehabilitation. Recent studies on these approaches have shown promising results. However, a paradigm shift in the development of new approaches must be made to significantly improve the clinical outcomes of neurotechnologies compared with those of traditional therapies. An "evolutionary" change can occur only by understanding in great detail the basic mechanisms of natural stroke recovery and technology-assisted neurorehabilitation. In this review, we first describe the results achieved by existing neurotechnologies and highlight their current limitations. In parallel, we summarize the data available on the mechanisms of recovery from electrophysiological, behavioral, and anatomical studies in humans and rodent models. Finally, we propose new approaches for the effective use of neurotechnologies in stroke survivors, as well as in people with other neurological disorders.
Collapse
Affiliation(s)
- Silvestro Micera
- The Biorobotics Institute and Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy; Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
| | - Matteo Caleo
- Department of Biomedical Sciences, University of Padova, Padova, Italy; Institute of Neuroscience, National Research Council (CNR), Pisa, Italy
| | - Carmelo Chisari
- Neurorehabilitation Section, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Friedhelm C Hummel
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland; Clinical Neuroscience, University of Geneva Medical School, 1202 Geneva, Switzerland
| | - Alessandra Pedrocchi
- Neuroengineering and Medical Robotics Laboratory NearLab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy
| |
Collapse
|
20
|
Morone G, Cocchi I, Paolucci S, Iosa M. Robot-assisted therapy for arm recovery for stroke patients: state of the art and clinical implication. Expert Rev Med Devices 2020; 17:223-233. [PMID: 32107946 DOI: 10.1080/17434440.2020.1733408] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Robot-assisted therapy is an emerging approach that performs highly repetitive, intensive, task oriented and quantifiable neuro-rehabilitation. In the last decades, it has been increasingly used in a wide range of neurological central nervous system conditions implying an upper limb paresis. Results from the studies are controversial, for the many types of robots and their features often not accompanied by specific clinical indications about the target functions, fundamental for the individualized neurorehabilitation program.Areas covered: This article reviews the state of the art and perspectives of robotics in post-stroke rehabilitation for upper limb recovery. Classifications and features of robots have been reported in accordance with technological and clinical contents, together with the definition of determinants specific for each patient, that could modify the efficacy of robotic treatments. The possibility of combining robotic intervention with other therapies has also been discussed.Expert commentary: The recent wide diffusion of robots in neurorehabilitation has generated a confusion due to the commingling of technical and clinical aspects not previously clarified. Our critical review provides a possible hypothesis about how to match a robot with subject's upper limb functional abilities, but also highlights the need of organizing a clinical consensus conference about the robotic therapy.
Collapse
Affiliation(s)
- Giovanni Morone
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Ilaria Cocchi
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Stefano Paolucci
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Marco Iosa
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy
| |
Collapse
|
21
|
Lefaucheur JP, Wendling F. Mechanisms of action of tDCS: A brief and practical overview. Neurophysiol Clin 2019; 49:269-275. [PMID: 31350060 DOI: 10.1016/j.neucli.2019.07.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- Jean-Pascal Lefaucheur
- Unité de neurophysiologie clinique, EA4391, Henri-Mondor Hospital, Paris-Est Créteil University,, 94000 Créteil, France.
| | | |
Collapse
|
22
|
Mazzoleni S, Tran VD, Dario P, Posteraro F. Effects of Transcranial Direct Current Stimulation (tDCS) Combined With Wrist Robot-Assisted Rehabilitation on Motor Recovery in Subacute Stroke Patients: A Randomized Controlled Trial. IEEE Trans Neural Syst Rehabil Eng 2019; 27:1458-1466. [PMID: 31170077 DOI: 10.1109/tnsre.2019.2920576] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Both transcranial direct current stimulation (tDCS) and wrist robot-assisted training have demonstrated to be promising approaches for stroke rehabilitation. However, the effects of the combination of the two treatments in subacute stroke patients are not clear yet. To investigate the effectiveness of combining tDCS and wrist robot-assisted rehabilitation in subacute stroke patients in comparison with the wrist robotic training only, a single-blind, randomized, sham-controlled trial was performed with 40 subacute stroke patients (25 ± 7 days from stroke onset time). Patients were randomly assigned to experimental group (EG, n = 20 ) where patients receive real tDCS [2 mA, 20 min, and the anodal electrode on the primary motor cortex-M1-area of the affected hemisphere (C3/C4 in the 10-20 EEG system and the cathodal electrode on the contralateral orbit bone)] or control group (CG, n = 20 ) where patients receive sham tDCS (5 s) during wrist robotic rehabilitation training. The effects of the treatment were evaluated by means of the upper extremity, shoulder-elbow, and wrist subsections of the Fugl-Meyer assessment scale, Modified Ashworth Scale, Motricity Index and Box and Block Test together with kinematic parameters. One out of 20 patients in the CG did not complete the treatment. All the clinical outcome measures except the Modified Ashworth Scale showed a significant increase after the treatment in both groups. However, no significant difference in the average changes after treatment between groups was observed. The movement velocity and smoothness showed significant increases after the training, even though no significant difference between groups was observed. The combination of wrist robot-assisted training and tDCS did not show additional effects in comparison with wrist robot-assisted training only in subacute stroke patients. The negative results found in this paper are specific for the specific intervention. The timing of delivering the tDCS and the robot-assisted therapy has to be deeply investigated to enhance the effectiveness of the training.
Collapse
|
23
|
Krauth R, Schwertner J, Vogt S, Lindquist S, Sailer M, Sickert A, Lamprecht J, Perdikis S, Corbet T, Millán JDR, Hinrichs H, Heinze HJ, Sweeney-Reed CM. Cortico-Muscular Coherence Is Reduced Acutely Post-stroke and Increases Bilaterally During Motor Recovery: A Pilot Study. Front Neurol 2019; 10:126. [PMID: 30842752 PMCID: PMC6391349 DOI: 10.3389/fneur.2019.00126] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/30/2019] [Indexed: 12/11/2022] Open
Abstract
Motor recovery following stroke is believed to necessitate alteration in functional connectivity between cortex and muscle. Cortico-muscular coherence has been proposed as a potential biomarker for post-stroke motor deficits, enabling a quantification of recovery, as well as potentially indicating the regions of cortex involved in recovery of function. We recorded simultaneous EEG and EMG during wrist extension from healthy participants and patients following ischaemic stroke, evaluating function at three time points post-stroke. EEG–EMG coherence increased over time, as wrist mobility recovered clinically, and by the final evaluation, coherence was higher in the patient group than in the healthy controls. Moreover, the cortical distribution differed between the groups, with coherence involving larger and more bilaterally scattered areas of cortex in the patients than in the healthy participants. The findings suggest that EEG–EMG coherence has the potential to serve as a biomarker for motor recovery and to provide information about the cortical regions that should be targeted in rehabilitation therapies based on real-time EEG.
Collapse
Affiliation(s)
- Richard Krauth
- Neurocybernetics and Rehabilitation, Department of Neurology and Stereotactic Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Johanna Schwertner
- Neurocybernetics and Rehabilitation, Department of Neurology and Stereotactic Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Susanne Vogt
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | | | - Michael Sailer
- MEDIAN Klinik, Neurological Rehabilitation Center, Magdeburg, Germany.,Institute for Neurorehabilitation, Affiliated Institute of the Otto-von-Guericke University, Magdeburg, Germany
| | - Almut Sickert
- MEDIAN Klinik, Neurological Rehabilitation Center, Magdeburg, Germany
| | - Juliane Lamprecht
- Institute for Neurorehabilitation, Affiliated Institute of the Otto-von-Guericke University, Magdeburg, Germany
| | - Serafeim Perdikis
- Defitech Chair in Brain-Machine Interface, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland.,Brain-Computer Interfaces and Neural Engineering Laboratory, School of Computer Science and Electronic Engineering, University of Essex, Colchester, United Kingdom
| | - Tiffany Corbet
- Defitech Chair in Brain-Machine Interface, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - José Del R Millán
- Defitech Chair in Brain-Machine Interface, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Hermann Hinrichs
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany.,German Centre for Neurodegenerative Diseases, Magdeburg, Germany
| | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany.,German Centre for Neurodegenerative Diseases, Magdeburg, Germany
| | - Catherine M Sweeney-Reed
- Neurocybernetics and Rehabilitation, Department of Neurology and Stereotactic Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| |
Collapse
|
24
|
Fuentes Calderón MA, Miralles AN, Pimienta MJ, Estella JMG, Ledesma MJS. Analysis of the Factors Related to the Effectiveness of Transcranial Current Stimulation in Upper Limb Motor Function Recovery after Stroke: a Systematic Review. J Med Syst 2019; 43:69. [PMID: 30737601 DOI: 10.1007/s10916-019-1193-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 01/30/2019] [Indexed: 02/08/2023]
Abstract
Transcranial direct current stimulation is one of the non-invasive techniques whose main mechanism of action is based on its modulation of cortical excitability. The objective of this study is to analyze the variables (i.e, demographics, clinicals, stimulation parameters) that could influence into the responses during rehabilitation of the upper extremity in patients with stroke. Our systematic review has been performed by searching full-text articles published from January 2008 to December 2018 in Embase, Medline, PubMed and Cochrane Library databases. Studies with adult patients with ischemic or hemorrhagic stroke at any stage of evolution were included. We compared interventions with any type of transcranial direct current stimulation (anodal, cathodal or bihemispheric, also known as dual) regarding improvement of upper extremity motor function. We included 14 studies with 368 patients, of whom almost 89% have ischemic etiology and more than half are males. Most patients were considered subacute or chronic, while only two studies were selected with patients in the acute phase. Different methods of using transcranial direct current stimulation with several complementary therapies were identified, such as virtual reality, robot therapy, Occupational Therapy, Physiotherapy, Constraint Induced Movement Therapy or Peripheral Nerve Stimulation. In conclusion, there is not significant evidence due to heterogeneity of clinical data and therapies. Clinical studies with greater number of participants and protocols standardized could outline this assessment in future studies.
Collapse
Affiliation(s)
| | | | - Mauricio Jaramillo Pimienta
- Departament of Neurosurgery, Universitary Hospital of Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
| | - Jesús María Gonçalves Estella
- Departament of Neurosurgery, Universitary Hospital of Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
| | - María José Sánchez Ledesma
- Departament of Surgery, University of Salamanca, Alfonso X el Sabio s/n, 37007, Salamanca, Spain.,VisualMed Systems Group, University of Salamanca, Patio Escuelas 1, 37008, Salamanca, Spain
| |
Collapse
|
25
|
Bao SC, Wong WW, Leung TWH, Tong KY. Cortico-Muscular Coherence Modulated by High-Definition Transcranial Direct Current Stimulation in People With Chronic Stroke. IEEE Trans Neural Syst Rehabil Eng 2018; 27:304-313. [PMID: 30596581 DOI: 10.1109/tnsre.2018.2890001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
High-definition transcranial direct current stimulation (HD-tDCS) is a potential neuromodulation apparatus for stroke rehabilitation. However, its modulatory effects in stroke subjects is still not well understood. In this paper, the offline modulatory effects of HD-tDCS on the ipsilesional primary motor cortex were investigated by performing wrist isometric contraction tasks before and after HD-tDCS in eleven unilateral chronic stroke subjects using a synchronized HD-tDCS and electroencephalogram/electromyography measurement system. This paper is a randomized, single blinded, and sham-controlled crossover study. Each subject randomly received three HD-tDCS (anode, cathode, and sham) with at least one-week washout period. Online feedback-guided medium-level wrist isometric contraction tasks were conducted for the affected upper limbs before stimulation and 10, 30, and 50 min after the end of 10-min 1-mA HD-tDCS. The characteristics of corticomuscular coherence (CMC), cortical oscillation power spectral density, and power spectral entropy were analyzed during tasks and compared across all sessions and stimulation conditions. Anode HD-tDCS induced significant CMC changes in stroke subjects, while cathode and sham stimulation did not induce significant CMC changes. The largest neuromodulation effects were observed at 10 min immediately after anodal HD-tDCS.
Collapse
|
26
|
Mekki M, Delgado AD, Fry A, Putrino D, Huang V. Robotic Rehabilitation and Spinal Cord Injury: a Narrative Review. Neurotherapeutics 2018; 15:604-617. [PMID: 29987763 PMCID: PMC6095795 DOI: 10.1007/s13311-018-0642-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Mobility after spinal cord injury (SCI) is among the top goals of recovery and improvement in quality of life. Those with tetraplegia rank hand function as the most important area of recovery in their lives, and those with paraplegia, walking. Without hand function, emphasis in rehabilitation is placed on accessing one's environment through technology. However, there is still much reliance on caretakers for many activities of daily living. For those with paraplegia, if incomplete, orthoses exist to augment walking function, but they require a significant amount of baseline strength and significant energy expenditure to use. Options for those with motor complete paraplegia have traditionally been limited to the wheelchair. While wheelchairs provide a modified level of independence, wheelchair users continue to face difficulties in access and mobility. In the past decade, research in SCI rehabilitation has expanded to include external motorized or robotic devices that initiate or augment movement. These robotic devices are used with 2 goals: to enhance recovery through repetitive, functional movement and increased neural plasticity and to act as a mobility aid beyond orthoses and wheelchairs. In addition, lower extremity exoskeletons have been shown to provide benefits to the secondary medical conditions after SCI such as pain, spasticity, decreased bone density, and neurogenic bowel. In this review, we discuss advances in robot-guided rehabilitation after SCI for the upper and lower extremities, as well as potential adjuncts to robotics.
Collapse
Affiliation(s)
- Marwa Mekki
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew D Delgado
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adam Fry
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Putrino
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vincent Huang
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| |
Collapse
|
27
|
Effectiveness of a single session of dual-transcranial direct current stimulation in combination with upper limb robotic-assisted rehabilitation in chronic stroke patients: a randomized, double-blind, cross-over study. Int J Rehabil Res 2018; 41:138-145. [DOI: 10.1097/mrr.0000000000000274] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
28
|
Semprini M, Laffranchi M, Sanguineti V, Avanzino L, De Icco R, De Michieli L, Chiappalone M. Technological Approaches for Neurorehabilitation: From Robotic Devices to Brain Stimulation and Beyond. Front Neurol 2018; 9:212. [PMID: 29686644 PMCID: PMC5900382 DOI: 10.3389/fneur.2018.00212] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/16/2018] [Indexed: 12/30/2022] Open
Abstract
Neurological diseases causing motor/cognitive impairments are among the most common causes of adult-onset disability. More than one billion of people are affected worldwide, and this number is expected to increase in upcoming years, because of the rapidly aging population. The frequent lack of complete recovery makes it desirable to develop novel neurorehabilitative treatments, suited to the patients, and better targeting the specific disability. To date, rehabilitation therapy can be aided by the technological support of robotic-based therapy, non-invasive brain stimulation, and neural interfaces. In this perspective, we will review the above methods by referring to the most recent advances in each field. Then, we propose and discuss current and future approaches based on the combination of the above. As pointed out in the recent literature, by combining traditional rehabilitation techniques with neuromodulation, biofeedback recordings and/or novel robotic and wearable assistive devices, several studies have proven it is possible to sensibly improve the amount of recovery with respect to traditional treatments. We will then discuss the possible applied research directions to maximize the outcome of a neurorehabilitation therapy, which should include the personalization of the therapy based on patient and clinician needs and preferences.
Collapse
Affiliation(s)
| | | | - Vittorio Sanguineti
- Department of Informatics, Bioengineering, Robotics and Systems Engineering (DIBRIS), University of Genova, Genova, Italy
| | - Laura Avanzino
- Section of Human Physiology, Department of Experimental Medicine (DIMES), University of Genova, Genova, Italy
| | - Roberto De Icco
- Department of Neurology and Neurorehabilitation, Istituto Neurologico Nazionale C. Mondino, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | | |
Collapse
|
29
|
Ku J, Kang YJ. Novel Virtual Reality Application in Field of Neurorehabilitation. BRAIN & NEUROREHABILITATION 2018. [DOI: 10.12786/bn.2018.11.e5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Jeonghun Ku
- Department of Biomedical Engineering, College of Medicine, Keimyung University, Daegu, Korea
| | - Youn Joo Kang
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| |
Collapse
|
30
|
Bashir S, Al-Hussain F, Wasay M, Yoo WK. The Effect of Repetitive Arm Cycling Training Priming with Transcranial Direct Current Stimulation on Post-Stroke: Pilot Study. BRAIN & NEUROREHABILITATION 2018. [DOI: 10.12786/bn.2018.11.e10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Shahid Bashir
- Neurophysiology department, Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Fawaz Al-Hussain
- Department of Neurology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Wasay
- Section of Neurology, Department of Medicine, Aga Khan University Hospital Karachi, Karachi, Pakistan
- Department of Neurology, Aga Khan University, Karachi, Pakistan
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| |
Collapse
|
31
|
Manji A, Amimoto K, Matsuda T, Wada Y, Inaba A, Ko S. Effects of transcranial direct current stimulation over the supplementary motor area body weight-supported treadmill gait training in hemiparetic patients after stroke. Neurosci Lett 2017; 662:302-305. [PMID: 29107706 DOI: 10.1016/j.neulet.2017.10.049] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/26/2017] [Accepted: 10/25/2017] [Indexed: 11/19/2022]
Abstract
Transcranial direct current stimulation (tDCS) is used in a variety of disorders after stroke including upper limb motor dysfunctions, hemispatial neglect, aphasia, and apraxia, and its effectiveness has been demonstrated. Although gait ability is important for daily living, there were few reports of the use of tDCS to improve balance and gait ability. The supplementary motor area (SMA) was reported to play a potentially important role in balance recovery after stroke. We aimed to investigate the effect of combined therapy body weight-supported treadmill training (BWSTT) and tDCS on gait function recovery of stroke patients. Thirty stroke inpatients participated in this study. The two BWSTT periods of 1weeks each, with real tDCS (anode: front of Cz, cathode: inion, 1mA, 20min) on SMA and sham stimulation, were randomized in a double-blind crossover design. We measured the time required for the 10m Walk Test (10MWT) and Timed Up and Go (TUG) test before and after each period. We found that the real tDCS with BWSTT significantly improved gait speed (10MWT) and applicative walking ability (TUG), compared with BWSTT+sham stimulation periods (p<0.05). Our findings demonstrated the feasibility and efficacy of tDCS in gait training after stroke. The facilitative effects of tDCS on SMA possibly improved postural control during BWSTT. The results indicated the implications for the use of tDCS in balance and gait training rehabilitation after stroke.
Collapse
Affiliation(s)
- Atsushi Manji
- Department of Human Health Science, Tokyo Metropolitan University, 7-2-2-10 Higashi-Ogu, Arakawa-ku, Tokyo 116-0012, Japan; Department of Rehabilitation, Saitama Misato Sogo Rehabilitation Hospital, Japan.
| | - Kazu Amimoto
- Department of Human Health Science, Tokyo Metropolitan University, 7-2-2-10 Higashi-Ogu, Arakawa-ku, Tokyo 116-0012, Japan
| | - Tadamitsu Matsuda
- Department of Physical Therapy, Faculty of Health Sciences, Josai International University, Japan
| | - Yoshiaki Wada
- Nissan Tamagawa Hospital Rehabilitation Center, Japan
| | - Akira Inaba
- Department of Neurology, Kanto Central Hospital, Japan
| | - Sangkyun Ko
- Department of internal medicine, Saitama Misato Sogo Rehabilitation Hospital, Japan
| |
Collapse
|
32
|
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.
Collapse
|
33
|
Elsner B, Kwakkel G, Kugler J, Mehrholz J. Transcranial direct current stimulation (tDCS) for improving capacity in activities and arm function after stroke: a network meta-analysis of randomised controlled trials. J Neuroeng Rehabil 2017; 14:95. [PMID: 28903772 PMCID: PMC5598049 DOI: 10.1186/s12984-017-0301-7] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 08/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transcranial Direct Current Stimulation (tDCS) is an emerging approach for improving capacity in activities of daily living (ADL) and upper limb function after stroke. However, it remains unclear what type of tDCS stimulation is most effective. Our aim was to give an overview of the evidence network regarding the efficacy and safety of tDCS and to estimate the effectiveness of the different stimulation types. METHODS We performed a systematic review of randomised trials using network meta-analysis (NMA), searching the following databases until 5 July 2016: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, Web of Science, and four other databases. We included studies with adult people with stroke. We compared any kind of active tDCS (anodal, cathodal, or dual, that is applying anodal and cathodal tDCS concurrently) regarding improvement of our primary outcome of ADL capacity, versus control, after stroke. PROSPERO ID CRD42016042055. RESULTS We included 26 studies with 754 participants. Our NMA showed evidence of an effect of cathodal tDCS in improving our primary outcome, that of ADL capacity (standardized mean difference, SMD = 0.42; 95% CI 0.14 to 0.70). tDCS did not improve our secondary outcome, that of arm function, measured by the Fugl-Meyer upper extremity assessment (FM-UE). There was no difference in safety between tDCS and its control interventions, measured by the number of dropouts and adverse events. CONCLUSION Comparing different forms of tDCS shows that cathodal tDCS is the most promising treatment option to improve ADL capacity in people with stroke.
Collapse
Affiliation(s)
- Bernhard Elsner
- Department of Public Health, Dresden Medical School, Technical University Dresden, Fetscherstr. 74, 01307, Dresden, Germany. .,Physiotherapy, SRH University of Applied Health Sciences Gera, Gera, Germany.
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, VU University Medical Center, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands.,Neurorehabilitation, Amsterdam Rehabilitation Research Center Reade, Amsterdam, The Netherlands.,Neuroscience Campus Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Evanston, IL, USA
| | - Joachim Kugler
- Department of Public Health, Dresden Medical School, Technical University Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Jan Mehrholz
- Department of Public Health, Dresden Medical School, Technical University Dresden, Fetscherstr. 74, 01307, Dresden, Germany.,Physiotherapy, SRH University of Applied Health Sciences Gera, Gera, Germany.,Wissenschaftliches Institut, Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa GmbH, Kreischa, Germany
| |
Collapse
|