Biomechanical Assessment of Post-Stroke Patients' Upper Limb before and after Rehabilitation Therapy Based on FES and VR

Effect of Forward Reaching With a Modified Sitting Position on Muscle Contraction in the Paretic Lower Extremity of Individuals in the Early Sub-Acute Phase of Stroke: A Randomized Control Trial

Introduction Forward reaching in sitting has been shown to facilitate muscle contraction in the paretic lower limb of stroke survivors. Change in the sitting surface has been shown to alter the contribution of lower extremity muscles to maintain postural control. This study investigated the effect of forward reaching in a modified sitting position on the paretic lower extremity muscles of patients with stroke. Methods First-time cerebral stroke survivors in their early sub-acute phase were randomly allocated to the experimental or control group. The experimental group engaged in training sessions focusing on reaching a target while seated with only the paretic foot placed on a support, whereas the control group performed the same task with both feet supported on the surface. Each group completed three sets of 10 repetitions of forward reaching for eight days as a part of the training. Quadriceps and tibialis anterior muscle activity in the paretic leg were measured using surface electromyography before the first and after the last session of intervention. Statistical analysis was conducted using parametric tests with a significance level set at p < 0.05. Results Sixty-three subjects completed the study, with 31 in the experimental group and 32 in the control group. The results of the post-intervention analysis indicated a statistically significant increase in the EMG activity of the tibialis anterior and quadriceps muscle surfaces in both groups (p < 0.001). Notably, the experimental group exhibited significantly higher muscle activity in both quadriceps and tibialis anterior compared to the control group (p < 0.001). Conclusion Forward reaching with only the paretic lower limb grounded effectively improves quadriceps and tibialis anterior muscle recruitment in the early sub-acute phase of stroke.

Exercise Responses During Outdoor Versus Virtual Reality Indoor Arm+FES-Leg Cycling in Individuals with Spinal Cord Injury

Background: Virtual reality (VR)-enhanced indoor hybrid cycling in people with spinal cord injury (SCI) can be comparable to outdoor hybrid cycling. Method: Eight individuals with chronic thoracic-lesion SCI performed voluntary arm and electrically assisted leg cycling on a hybrid recumbent tricycle. Exercises were conducted outdoors and indoors incorporating VR technology in which the outdoor environment was simulated on a large flat screen monitor. Electrical stimulation was applied bilaterally to the leg muscle groups. Oxygen uptake (VO2), heart rate, energy expenditures, and Ratings of Perceived Exertion were measured over a 30-minute outdoor test course that was also VR-simulated indoors. Immediately after each exercise, participants completed questionnaires to document their perceptual-psychological responses. Results: Mean 30-minute VO2 was higher for indoor VR exercise (average VO2-indoor VR-exercise: 1316 ± mL/min vs. outdoor cycling: 1255 ± 53 mL/min; highest VO2-indoor VR-exercise: 1615 ± 67 mL/min vs. outdoor cycling: 1725 ± 67 mL/min). Arm and leg activity counts were significantly higher during indoor VR-assisted hybrid functional electrical stimulation (FES) cycling than outdoors; 42% greater for the arms and 23% higher for the legs (P < 0.05). Similar responses were reported for exercise effort and perceptual-psychological outcomes during both modes. Conclusion: This study proposes that combining FES and VR technology provides new opportunities for physical activity promotion or exercise rehabilitation in the SCI population, since these modes have similar "dose-potency" and self-perceived effort. Human Research Ethics Committee of the University of Sydney Ref. No. 01-2010/12385.

A Novel Procrustes Analysis Method to Quantify Multi-Joint Coordination of the Upper Extremity after Stroke

Upper extremity motor impairment affects about 80% of persons after strokes. For stroke rehabilitation, upper limb kinematic assessments have increasingly been used as primary or secondary outcome measures. There is currently no universal standardized scale for categorizing multi-joint upper extremity movement. We propose a modified Procrustes statistical shape method as a quantitative analysis that can recognize segments of movement where multiple limb segments are coordinating movement. Rather than rely solely on discrete kinematic values to contrast movement, this method allows evaluation of how movement progresses. The Procrustes analysis of able-bodied movement showed that the hand and forearm segments moved in a more coordinated manner during initiation. The shoulder and elbow become more coordinated during movement completion. In impaired movement, this coordination between the hand and forearm is disrupted as the arm decelerates. The utilization of Procrustes analysis may be a step towards developing a comprehensive and universal quantitative tool that does not require changes to existing treatments or increase patient burden.Clinical relevance- This modified Procrustes Shape Analysis method can be applied by clinicians to motion capture data from patients suffering upper extremity movement deficits to objectively identify multi-joint coordination and recovery.

Telerehabilitation for upper limb disabilities: a scoping review on functions, outcomes, and evaluation methods

Background

Upper limb (UL) disabilities have attracted worldwide attention due to the high economic costs of health care and the negative effects on the quality of life of patients with these disabilities. Telerehabilitation technologies are one of the most important ways to reduce rehabilitation costs and increase the quality of life of patients. Therefore, the aim of this study was to investigate the role of telerehabilitation in improving the health status of patients with upper limb disabilities.

Methods

This scoping review was conducted by searching the Web of Science, PubMed, and Scopus until July 30, 2021. We used a data extraction form with 18 fields to extract data from primary studies. The selection of articles and data extraction was made by four researchers using a data collection form based on inclusion and exclusion criteria. Disagreements were resolved through consultation with the fifth and sixth researchers.Inclusion criteria were studies published in English, studies on upper limb disability, and telerehabilitation based on any technology (synchronous telerehabilitation, asynchronous, or both). Exclusion criteria were articles that did not focus on telerehabilitation and upper limb disabilities. Also, books, book chapters, letters to the editor, and conference abstracts were also removed.

Results

A total of 458 articles were retrieved, and after removing irrelevant and duplicate articles, 29 articles were finally included in this review. Most telerehabilitation was performed for patients with stroke (65%). Among the 15 different services provided with telerehabilitation technologies, "Evaluation of exercises and also a musculoskeletal function of patients by the therapist","Recording of patients' rehabilitation exercises and sending them to the therapist” and "Prescribing new rehabilitation exercises by the therapist" were the most widely used services, respectively. Virtual reality technologies, smart wearables, and robots were used to provide telerehabilitation services. Among the 13 types of evaluation used for telerehabilitation systems, “Evaluation and measurement of upper limb function” was the most used evaluation in the studies. "Improvement in musculoskeletal functions”, "Increasing patients' interest and motivation to perform rehabilitation exercises", and "Increasing adherence to rehabilitation exercises and greater participation in treatment processes" were the most important outcomes, respectively.

Conclusion

Our findings indicate that telerehabilitation provides individuals with equitable access to rehabilitation services, improves musculoskeletal function, and empowers individuals by providing a variety of rehabilitation capabilities.