Upper-Limb Robot-Assisted Therapy Based on Visual Error Augmentation in Virtual Reality for Motor Recovery and Kinematics after Chronic Hemiparetic Stroke: A Feasibility Study

Spiral strapping for improving upper extremity motor functions in individuals with stroke: A randomized controlled trial

BACKGROUND

The rehabilitation process for the upper extremities of individuals with stroke requires therapists to use splints for supportive and corrective purposes. The aim of this study was to assess the effectiveness of spiral strapping in inhibiting spasticity and improving the upper extremity motor functions of individuals with chronic stroke.

METHODS

Forty Saudi individuals aged 50-60 years with chronic stroke participated in this study. Their degrees of spasticity according to the Modified Ashworth Scale ranged across grades 1, 1+, and 2. Participants were randomly assigned to experimental and control groups. Participants in both groups received 1 h of conventional physical therapy for 3 d/wk to improve the motor functions of their upper extremities. In addition, participants in the experimental group wore an upper-limb spiral strapping with a hand splint 10 h/d for 6 d/wk. The treatment program for both groups was delivered for 4 weeks. Changes in the scores of Action Research Arm Test for elbow joint spasticity, active range of motion of the shoulder, elbow, and forearm joints, and hand grip strength were evaluated before and after treatment in both groups.

RESULTS

Significant improvements in all measured variables after treatment were reported in both groups, except for elbow joint spasticity in the control group. The experimental group showed significant post-treatment improvement in the scores for all measured variables compared with the control group.

CONCLUSIONS

Spiral strapping was beneficial in inhibiting mild degrees of spasticity and improving the motor functions of the upper extremities of stroke patients.

Action observation therapy impact on mirror neurons combined with acupuncture for upper limb motor impairment rehabilitation in stroke patients

OBJECTIVE

Upper limb (UL) dysfunction rehabilitation in stroke patients is complicated in the clinic. Action observation therapy's (AOT) impact on mirror neurons (MNs) has been observed and made applications in related brain disease treatment. Acupuncture mentioned in the present study mainly stimulates peripheral nerves for neuronal plasticity. However, the clinical effect of AOT impact on MNs and acupuncture irritate afferent nerve fibers in combination for UL motor impairment rehabilitation after stroke is still unclear. In the present study, we investigate the central and peripheral neural stimulation meanwhile for UL recovery with stroke patients.

METHODS

In this clinical study, 82 stroke patients recruited with impaired UL were randomly assigned to three groups. Twenty-four cases were in the AOT group, 28 cases were in the AOT combined acupuncture treatment group, and 30 cases were in the acupuncture treatment group. All volunteers were scored for limb function through the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE), the Action Research Arm Test, and the modified Barthel Index (BI) before and after a systematic treatment according to the groups. Meanwhile, conventional physical therapy was also implemented for all cases.

RESULTS

Before the specific intervention, the scores of FMA-UE, FMA-UE, and BI with all stroke patients have no significant statistical difference (P > 0.05). After the corresponding treatment, we assessed UL function again at 4 and 8 weeks. At 4 weeks, the patients with AOT showed a significant increase in BI scores compared to the acupuncture group (P < 0.05). At 8 weeks, the FMA-UE scores of the patients with AOT combined with acupuncture were significantly increased than acupuncture alone (P < 0.05). We also observed that the BI scores of the combination and the AOT group both were improved compared to the acupuncture group with significant statistical analysis (P < 0.05).

CONCLUSIONS

Based on the MNs theory, we adopted AOT impact on MNs which would be a promising rehabilitation technique, especially combined with acupuncture treatment in UL recovery of stroke. Mirror therapy seems to be effective for central neuronal plasticity, but for action or AOT, there is still insufficient evidence to recommend its optimal strategy and neuromodulation mechanism. Here, research on the MNs-based AOT technique with acupuncture in UL dysfunction with stroke patients is recommended.TRIAL REGISTRATION: http://www.chictr.org.cn (identifier: ChiCTR2300077010).

Mitigating Trunk Compensatory Movements in Post-Stroke Survivors through Visual Feedback during Robotic-Assisted Arm Reaching Exercises

Trunk compensatory movements frequently manifest during robotic-assisted arm reaching exercises for upper limb rehabilitation following a stroke, potentially impeding functional recovery. These aberrant movements are prevalent among stroke survivors and can hinder their progress in rehabilitation, making it crucial to address this issue. This study evaluated the efficacy of visual feedback, facilitated by an RGB-D camera, in reducing trunk compensation. In total, 17 able-bodied individuals and 18 stroke survivors performed reaching tasks under unrestricted trunk conditions and visual feedback conditions. In the visual feedback modalities, the target position was synchronized with trunk movement at ratios where the target moved at the same speed, double, and triple the trunk's motion speed, providing real-time feedback to the participants. Notably, trunk compensatory movements were significantly diminished when the target moved at the same speed and double the trunk's motion speed. Furthermore, these conditions exhibited an increase in the task completion time and perceived exertion among stroke survivors. This outcome suggests that visual feedback effectively heightened the task difficulty, thereby discouraging unnecessary trunk motion. The findings underscore the pivotal role of customized visual feedback in correcting aberrant upper limb movements among stroke survivors, potentially contributing to the advancement of robotic-assisted rehabilitation strategies. These insights advocate for the integration of visual feedback into rehabilitation exercises, highlighting its potential to foster more effective recovery pathways for post-stroke individuals by minimizing undesired compensatory motions.

Effectiveness of Visual Feedback in Reducing Trunk Compensation During Arm Reaching for Home-Based Stroke Rehabilitation

This study investigates the effectiveness of visual feedback in reducing trunk compensation during one-arm reaching exercises using an end-effector robot. Results suggest that visual feedback is more effective than verbal feedback in suppressing trunk compensation, as evidenced by lower trunk movements. Synchronized target position with respect to trunk motion exhibited a suppressive effect on trunk motion, as observed by a reduction in trunk standard deviation, trunk root mean square, and trunk difference between the starting and ending positions. These findings have important implications for developing feedback techniques to address unnatural upper limb reach movements in stroke survivors during rehabilitation programs. However, the study's limitations, such as small sample size, should be considered. Future research should explore feedback techniques in different patient populations and exercise types and evaluate their long-term effects.

A Comprehensive Review of Physical Therapy Interventions for Stroke Rehabilitation: Impairment-Based Approaches and Functional Goals

Stroke is the fourth leading cause of mortality and is estimated to be one of the major reasons for long-lasting disability worldwide. There are limited studies that describe the application of physical therapy interventions to prevent disabilities in stroke survivors and promote recovery after a stroke. In this review, we have described a wide range of interventions based on impairments, activity limitations, and goals in recovery during different stages of a stroke. This article mainly focuses on stroke rehabilitation tactics, including those for sensory function impairments, motor learning programs, hemianopia and unilateral neglect, flexibility and joint integrity, strength training, hypertonicity, postural control, and gait training. We conclude that, aside from medicine, stroke rehabilitation must address specific functional limitations to allow for group activities and superior use of a hemiparetic extremity. Medical doctors are often surprised by the variety of physiotherapeutic techniques available; they are unfamiliar with the approaches of researchers such as Bobath, Coulter, and Brunnstrom, among others, as well as the scientific reasoning behind these techniques.