Lost in Translation: Simple Steps in Experimental Design of Neurorehabilitation-Based Research Interventions to Promote Motor Recovery Post-Stroke

Clinician perceptions of a novel wearable robotic hand orthosis for post-stroke hemiparesis

PURPOSE

Wearable robotic devices are currently being developed to improve upper limb function for individuals with hemiparesis after stroke. Incorporating the views of clinicians during the development of new technologies can help ensure that end products meet clinical needs and can be adopted for patient care.

METHODS

In this cross-sectional mixed-methods study, an anonymous online survey was used to gather clinicians' perceptions of a wearable robotic hand orthosis for post-stroke hemiparesis. Participants were asked about their clinical experience and provided feedback on the prototype device after viewing a video.

RESULTS

154 participants completed the survey. Only 18.8% had previous experience with robotic technology. The majority of participants (64.9%) reported that they would use the device for both rehabilitative and assistive purposes. Participants perceived that the device could be used in supervised clinical settings with all phases of stroke. Participants also indicated a need for insurance coverage and quick setup time.

CONCLUSIONS

Engaging clinicians early in the design process can help guide the development of wearable robotic devices. Both rehabilitative and assistive functions are valued by clinicians and should be considered during device development. Future research is needed to understand a broader set of stakeholders' perspectives on utility and design.

Motor Learning Following Stroke: Mechanisms of Learning and Techniques to Augment Neuroplasticity

Sensorimotor impairments are common after stroke requiring stroke survivors to relearn lost motor skills or acquire new ones in order to engage in daily activities. Thus, motor skill learning is a cornerstone of stroke rehabilitation. This article provides an overview of motor control and learning theories that inform stroke rehabilitation interventions, discusses principles of neuroplasticity, and provides a summary of practice conditions and techniques that can be used to augment motor learning and neuroplasticity in stroke rehabilitation.

The feasibility of the adapted H-GRASP program for perceived and actual daily-life upper limb activity in the chronic phase post-stroke

(Purpose: Assessing feasibility and initial impact of the Home-Graded Repetitive Arm Supplementary Program combined with in-home accelerometer-based feedback (AH-GRASP) on perceived and actual daily-life upper limb (UL) activity in stroke survivors during the chronic phase with good UL motor function but low perceived daily-life activity. Material and methods: A 4-week intervention program (4 contact hours, 48 h self-practice) encompassing task-oriented training, behavioral techniques, phone-based support, monitoring, and weekly feedback sessions using wrist-worn accelerometery was implemented using a pre-post double baseline repeated measures design. Feasibility, clinical assessments, patient-reported outcomes, and accelerometer data were investigated. Results: Of the 34 individuals approached, nineteen were included (recruitment rate 56%). Two dropped out, one due to increased UL pain (retention rate 89%). Seven (41%) achieved the prescribed exercise target (120 min/day, six days/week). Positive patient experiences and improvements in UL capacity, self-efficacy, and contribution of the affected UL to overall activity (p < 0.05, small to large effect sizes) were observed. Additionally, seven participants (41%) surpassed the minimal clinically important difference in perceived UL activity.Conclusions: A home-based UL exercise program with accelerometer-based feedback holds promise for enhancing perceived and actual daily-life UL activity for our subgroup of chronic stroke survivors.

Concepts and Application of Tai Ji in Stroke Rehabilitation: A Narrative Review

Stroke remains a leading cause of adult disability, and it decreases the health-related quality of life due to functional disability and poor functional recovery in stroke. Tai Ji has been recently introduced to overcome disabilities. This review aims to explain the effects of Tai Ji on functional recovery in stroke patients, linking it to current approaches, concepts and therapies such as Bobath and proprioceptive neuromuscular facilitation techniques. A compilation of recent literature on Tai Ji's use in stroke rehabilitation from Google scholar and PubMed Central (2018 to 2022). The benefits of Tai Ji in stroke functional recovery were studied and explained based on its similarity in concepts to current conventional stroke rehabilitation approaches. There were few randomized controlled trials on Tai Ji in functional recovery among stroke patients. However, all literature identified Tai Ji as beneficial in stroke rehabilitation. However, there was no literature on explaining the Tai Ji movement based on current conventional stroke rehabilitation approaches. Tai Ji carries similar theories to the current neurorehabilitation approach. Tai Ji can be modified and incorporated into stroke rehabilitation programs based on patients' needs to produce promising outcomes.

Assessment of Agreement Between a New Application to Compute the Wisconsin Gait Score and 3-Dimensional Gait Analysis, and Reliability of the Application in Stroke Patients

Currently, there are no computerized tools enabling objective interpretation of observational gait assessment based on Wisconsin Gait Scale (WGS), which is a reliable and well-tested tool. The solution envisaged by us may provide a practical tool for assessing gait deviations in patients with hemiparesis after stroke. The present study assessed agreement between a new application software for computerized WGS and 3-dimensional gait analysis (3DGA), and reliability of the application. The study involved 33 individuals with hemiparesis after stroke. The software was developed based on a model designed taking into account components of the WGS and incorporating auxiliary lines passing through the relevant anthropometric points on the patient’s body, as well as measurements of angular values, distances and duration of the specific gait phases, which make it possible to substantiate assessment based on this scale. Series of videos were made to record gait of the qualified patients. After the gait evaluation was carried out using the app, the data were retrieved from the software. The gait assessment was performed separately by three independent examiners who reviewed the video recording using the new app twice (two weeks apart). Additionally, 3DGA was carried out for all the subjects, and the results of the app-aided assessment were compared to those acquired using 3DGA. The findings show statistically significant correlations (p &lt; 0.05) between majority of the WGS items measured using the new app, and the relevant spatiotemporal and kinematic parameters identified by 3DGA. Agreement between the scores reported by the three examiners was high in both measurements, as reflected by Cronbach’s alpha exceeding 0.8. The findings reflect very good intra-observer reliability (as reflected by kappa coefficients from 0.847 to 1) and inter-observer reliability (as reflected by kappa coefficients from 0.634 to 1) of the new application software for computerized WGS. The opportunities offered by the observational gait scale objectified through our new software for computerized WGS result from the fact that the tool provides a useful low-cost and time-effective feedback to monitor ongoing treatments or formulate hypotheses.