Archive for December, 2014

[ARTICLE] Training finger individuation with a mechatronic-virtual reality system leads to improved fine motor control post-stroke

Abstract (provisional)

Background

Dexterous manipulation of the hand, one of the features of human motor control, is often compromised after stroke, to the detriment of basic functions. Despite the importance of independent movement of the digits to activities of daily living, relatively few studies have assessed the impact of specifically targeting individuated movements of the digits on hand rehabilitation. The purpose of this study was to investigate the impact of such finger individuation training, by means of a novel mechatronic-virtual reality system, on fine motor control after stroke.

Methods

An actuated virtual keypad (AVK) system was developed in which the impaired hand controls a virtual hand playing a set of keys. Creation of individuated digit movements is assisted by a pneumatically actuated glove, the PneuGlove. A study examining efficacy of the AVK system was subsequently performed. Participants had chronic, moderate hand impairment resulting from a single stroke incurred at least 6 months prior. Each subject underwent 18 hour-long sessions of extensive therapy (3x per week for 6 weeks) targeted at finger individuation. Subjects were randomly divided into two groups: the first group (Keypad: N = 7) utilized the AVK system while the other group (OT: N = 7) received a similarly intensive dose of occupational therapy; both groups worked directly with a licensed occupational therapist. Outcome measures such as the Jebsen-Taylor Hand Function Test (JTHFT), Action research Arm Test (ARAT), Fugl-Meyer Upper Extremity Motor Assessment/Hand subcomponent (FMUE/FMH), grip and pinch strengths were collected at baseline, post-treatment and one-month post-treatment.

Results

While both groups exhibited some signs of change after the training sessions, only the Keypad group displayed statistically significant improvement both for measures of impairment (FMH: p = 0.048) and measures of task performance (JTHFT: p = 0.021). Additionally, the finger individuation index – a measure of finger independence – improved only for the Keypad group after training (p = 0.05) in the subset (Keypad: N = 4; OT: N = 5) of these participants for which it was measured.

Conclusions

Actively assisted individuation therapy comprised of non task-specific modalities, such as can be achieved with virtual platforms like the AVK described here, may prove to be valuable clinical tools for increasing the effectiveness and efficiency of therapy following stroke.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

via JNER | Abstract | Training finger individuation with a mechatronic-virtual reality system leads to improved fine motor control post-stroke.

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[ARTICLE] Constraint-induced movement therapy: trial sequential analysis applied to Cochrane collaboration systematic review results – Full Text PDF

Abstract (provisional)

Background

Trial sequential analysis (TSA) may establish when firm evidence about the efficacy of interventions is reached in a cumulative meta-analysis, combining a required information size with an adjusted threshold for conservative statistical significance. Our aim was to demonstrate TSA results on randomized controlled trials (RCTs) included in a Cochrane systematic review on the effectiveness of constraint-induced movement therapy (CIMT) for stroke patients.

Methods

We extracted data on the functional independence measure (FIM) and the action research arm test (ARAT) from RCTs that compared CIMT versus other rehabilitative techniques. Mean differences (MD) were analyzed using a random-effects model. We calculated the information size and the cumulative Z-statistic, applying the O’Brien-Fleming monitoring boundaries.

Results

We included data from 14 RCTs. In the conventional meta-analysis (seven trials, 233 patients), the effect of CIMT on FIM was reported as significant (MD 2.88, 95% CI 0.08 to 5.68; P = 0.04). The diversity-adjusted required information size was 142 patients, and the cumulative Z-score did not cross the trial sequential monitoring boundary for benefit (adjusted 95% CI -0.02 to 5.78). The effect of CIMT on ARAT (nine trials, 199 patients) was reported as significant (MD 7.78, 95% CI 1.19 to 14.37; P = 0.02). However, the diversity-adjusted required information size was 252 patients, and the Z-score did not cross the trial sequential monitoring boundary for benefit (adjusted 95% CI -0.06 to 15.62).

Conclusions

Although conventional meta-analyses of CIMT reached statistical significance, their overall results remain inconclusive and might be spurious. Researchers should not be overconfident on CIMT efficacy based on the results of meta-analyses and derived recommendations.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

via Trials | Abstract | Constraint-induced movement therapy: trial sequential analysis applied to Cochrane collaboration systematic review results.

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[ARTICLE] Effect of Static versus Cyclical Stretch on Hand Motor Control in Subacute Stroke – Full Text PDF

Abstract

Background and Purpose: The purpose of this study was to investigate the impact of passive static and cyclical stretching of the fingers on hand function in subacute stroke survivors.

Participants: Thirteen stroke survivors, 2-5 months post-incident, with moderate to severe hand impairment took part in the study.

Method: Each participant completed three separate sessions, separated by at least one week, consisting of 30 minutes of: static stretch of the digits, cyclical stretch, or rest. Stretching was performed by a powered glove orthosis (X-Glove). Outcome measures, comprised of three timed hand-specific tasks from the Graded Wolf Motor Function Test (GWMFT-Time), grip termination time (GTT), grip strength, and lateral pinch strength, were assessed at the beginning and end of each session. Change in outcome score during each session was used for analysis.

Results: Data suggested a trend for improvement following stretching. Reduction in mean completion time for the GWMFT-Time after the cyclic stretching was 5 times greater than for the rest condition (P = 0.010). After the static stretching, GTT was 31% faster than the mean pre-test times (P = 0.055). Improvements in grip and pinch strength were also evident following the stretching interventions, although these changes did not reach statistical significance.

Discussion and Conclusion: While more study is needed, cyclically stretching the finger muscles in the stroke hand appears to be a promising treatment for stroke survivors in the subacute phase of recovery. It may prove especially effective as an adjuvant therapy facilitating subsequent performance of active movement therapy. Future studies exploring the neural correlates of improvement are warranted.

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[WEB SITE] 5 Ways To Get Your Hands On Academic Papers Without Losing Your Mind (And Money)

Have you ever read an academic journal? They’re where scientists and scholars publish all the interesting research that they’ve been working on. Sadly, for a lot of people academic journals are hard to get hold of. Firstly, they’re stunningly expensive. A year’s subscription to the Journal of Co-Ordination Chemistry costs slightly less than a new car, whilst a year’s supply of Biochimica et Biophysica Acta costs an eye-watering $20,000. This means that your university library might not have the article you desperately need for your dissertation.

However, where there’s a will there is indeed a way. With a bit of determination, you can get your hands on any academic journals you want. Here’s how.

via 5 Ways To Get Your Hands On Academic Papers Without Losing Your Mind (And Money).

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[WEB SITE] Brain Stimulation Optimizes Motor Skills Learning for Stroke Patients

Treatment that uses transcranial direct current stimulation may offer a way to optimize the effects of motor skills learning after stroke, especially for patients who are affected by limb paralysis as a result of the stroke. The treatment was the focus of a study team led by Stéphanie Lefebvre, Institute of Neruoscience in Brussels, Belgium.

“Dual transcranial direct current stimulation applied during motor skill learning with a paretic upper limb resulted in prolonged shaping of brain activation,” Stéphanie Lefebvre states in the study’s findings. Details about the study were published December 9 in the journal Brain.

An article published in Neurology Times reports that the study included 19 patients who had chronic hemiparetic stroke. The study consisted of two sessions. The first session was focused on intervention in which dual transcranial direct current stimulation or sham was applied during motor skills learning with the paretic upper limb. The second session, conducted as a follow-up 1 week later, focused on imaging. In that session, the patients performed the learned motor skill. The motor skill learning task, called the “circuit game,” required study subjects to move a pointer controlled by a computer mouse along a complex circuit as quickly and accurately as they could.

According to the Neurology Times article, the patients who had been affected by stroke learned the motor task with the paretic hand in the supine position to match their position in the MRI scanner 1 week later. The following week, they performed the learned motor task in the MRI scanner, and their brain activity was recorded with fMRI.

The study’s abstract notes that relative to the sham series, dual transcranial direct current stimulation applied bilaterally over the primary motor cortex during motor skill learning with the paretic upper limb demonstrated several key results. Chief among those results was enhanced online motor skills learning. Other significant benefits the researchers noted was an enhanced 1-week retention, and superior transfer of performance improvement to an untrained task.

In conclusion, the authors determined that dual transcranial direct current stimulation applied during motor skill learning with a paretic upper limb resulted in a prolonged shaping of brain activation. Furthermore, the researchers conclude, this result supports behavioral enhancements among stroke patients.

[Source: Neurology Times, Brain]

via Brain Stimulation Optimizes Motor Skills Learning for Stroke Patients | Rehab Managment.

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[ARTICLE] Robotic Exoskeleton for Rehabilitation of the Upper Limb – Full Text PDF

Abstract

This paper deals with robotic exoskeletons and their using in rehabilitation of the upper limbs. First part describes application of robotic devices in rehabilitation. In the second part there is described an architecture of rehabilitation robotic system and its main subsystems. Third part of the proposed paper is dedicated to robotic exoskeletons. This section deals with internal and external force action in exoskeletons. In the last part of the paper, there is shown design of robotic exoskeleton for the upper limb.

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[THESIS] Bridge/Adapt: A Systematic Cognitive Rehabilitation Curriculum -Full Text PDF

Abstract

Cognitive impairment, including deficits in memory, attention, visual perception, executive functioning, and self-awareness, is a common consequence of acquired brain injury (ABI). Subsequently, these cognitive impairments result in functional impairments in daily life activities for clients with ABI.

Rehabilitation efforts are categorized under two broad approaches: remediation and adaptation. Computer-assisted cognitive retraining (CACR) is a remediation approach using a computer platform to deliver cognitive exercises. CACR therapy can lead to improvements in memory and attention for adults with chronic ABI. However, memory and attention improvements from CACR may not carry over to functional improvements in occupational performance. Research suggested that therapy using an adaptive approach can yield functional improvements.

The purpose of this project was to design a systematic cognitive retraining curriculum, Bridge/Adapt, to bridge the gap between memory and attention-skill gains from CACR to functional improvements in occupational performance using adaptive strategies. The Bridge/Adapt curriculum incorporates the cognitive orientation of occupational performance (CO-OP) intervention approach, multicontext approach, and goal oriented attentional self-regulation training.

The curriculum includes eight modules that provide grading options so that occupational therapists can choose which difficulty level best suits the client. Clients practice adaptive strategies during simulations of instrumental activities of daily living (IADL), including financial management, appointment scheduling, and grocery shopping, utilizing the three themes in Bridge/Adapt: salience, context, and hierarchy. Clients use salience to choose meaningful goals to work on at home. Context refers to clients working on goals in varying environments. Lastly, clients work on tasks that increase in complexity with the hierarchical theme.

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[THESIS] WRIST (Wrist Resonator for Independent Stroke Training) – Full Text PDF

Abstract

With incidents of stroke becoming increasingly frequent, finding new means of providing more efficient and effective rehabilitation has become a rapidly growing area of research.

While much of the focus has been directed towards robot-based methods, mechanically passive methods capable of providing similar therapeutic benefits in a less expensive and safer package are also being explored. Such devices are more practical for wide-spread use, both in a clinical setting as well as for in-home therapy.

This thesis developed a mechanically passive device for reneuromuscular habilitation after stroke called WRIST (Wrist Resonator for Independent Stroke Training). WRIST incorporates a tone-canceling linkage designed to counteract intrinsic wrist stiffness to ease movement, as well as an appropriately designed mass and superimposed spring stiffness to create a resonant environment that the user can take advantage of to facilitate repetitive wrist flexion and extension.

As a proof of concept, a pilot study with two, chronic, severely impaired stroke subjects was conducted to verify benefits of the linkage and resonant system. The torque profiles of each subject’s wrist, as well as the residual wrist torque with the linkage engaged were measured and verified that the linkage accurately cancelled the intrinsic wrist stiffness. Moreover, the tone-canceling linkage increased active range of motion of the wrist, and superimposing the resonant system further increased it.

These results support the idea that appropriately-designed, mechanically passive devices have the potential to provide therapeutic benefits similar to that of robotic rehabilitation devices.

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[ARTICLE] Training finger individuation with a mechatronic-virtual reality system leads to improved fine motor control post-stroke – Full Text PDF

Abstract (provisional)

Background: Dexterous manipulation of the hand, one of the features of human motor control, is often compromised after stroke, to the detriment of basic functions. Despite the importance of independent movement of the digits to activities of daily living, relatively few studies have assessed the impact of specifically targeting individuated movements of the digits on hand rehabilitation. The purpose of this study was to investigate the impact of such finger individuation training, by means of a novel mechatronic-virtual reality system, on fine motor control after stroke.

Methods: An actuated virtual keypad (AVK) system was developed in which the impaired hand controls a virtual hand playing a set of keys. Creation of individuated digit movements is assisted by a pneumatically actuated glove, the PneuGlove. A study examining efficacy of the AVK system was subsequently performed. Participants had chronic, moderate hand impairment resulting from a single stroke incurred at least 6 months prior. Each subject underwent 18 hour-long sessions of extensive therapy (3x per week for 6 weeks) targeted at finger individuation. Subjects were randomly divided into two groups: the first group (Keypad: N = 7) utilized the AVK system while the other group (OT: N = 7) received a similarly intensive dose of occupational therapy; both groups worked directly with a licensed occupational therapist. Outcome measures such as the Jebsen-Taylor Hand Function Test (JTHFT), Action research Arm Test (ARAT), Fugl-Meyer Upper Extremity Motor Assessment/Hand subcomponent (FMUE/FMH), grip and pinch strengths were collected at baseline, post-treatment and one-month post-treatment.

Results: While both groups exhibited some signs of change after the training sessions, only the Keypad group displayed statistically significant improvement both for measures of impairment (FMH: p = 0.048) and measures of task performance (JTHFT: p = 0.021). Additionally, the finger individuation index – a measure of finger independence – improved only for the Keypad group after training (p = 0.05) in the subset (Keypad: N = 4; OT: N = 5) of these participants for which it was measured.

Conclusions: Actively assisted individuation therapy comprised of non task-specific modalities, such as can be achieved with virtual platforms like the AVK described here, may prove to be valuable clinical tools for increasing the effectiveness and efficiency of therapy following stroke.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

via JNER | Abstract | Training finger individuation with a mechatronic-virtual reality system leads to improved fine motor control post-stroke.

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[WEB SITE] Kinect rehabilitation software – Jintronix

 

 

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Jintronix in 20 words: Jintronix combines evidence-based treatments, virtual games, and motion tracking sensors to offer a fun and effective tool for physical rehabilitation.

Clinically Designed Exercises

Designed with physical and occupational therapists, each exercise and activity is programmed to maximize recovery in a safe environment.

Fun and Engaging Environments

By incorporating gaming aspects into therapy, Jintronix is changing the way patients feel about their daily exercises. We believe that the more fun you have exercising, the more motivated you will be to stay on track.

Anytime Anywhere with Telerehabilitation

Whether doing therapy at the clinic or at home, patients can now feel they are getting the attention they need. Jintronix’s telerehabilitation platform allows clinician to assign new exercises and monitor progress at anytime from anywhere. By using the system at home, patients now receive instant feedback on their performance and clinicians receive the data they need for to improve in-clinic therapy.

via Kinect rehabilitation software – Jintronix.

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