Archive for March, 2016

[WEB SITE] Exoskeleton: Get Up And Walk Again! 

March 20, 2016

exoskeleton

Ever hope to walk again was too strong. In the year 2016, numerous clinical trials worldwide, involving new techniques are being developed. And high-tech equipment are entering rehabilitation centers for paraplegic patients recover upright.

Ever hope to walk again was too strong. In the year 2016, numerous clinical trials worldwide, involving new techniques are being developed. And high-tech equipment are entering rehabilitation centers for paraplegic patients recover upright.

Exoskeletons, brain-machine interface, stimulation of the spinal cord …, many promising avenues seem to open, not to mention the spectacular, cell therapy that has already begun to prove itself. A Polish firefighter 40 years was able to walk again a few months ago thanks to a revolutionary treatment based on olfactory cells … (read S. and A. No. 815, January 2015). Today, the patient “feels good and continues to recover functionally,” says her surgeon Pawel Tabakov, associate professor at the Medical University of Wroclaw (Poland). “We are in intense preparation for the next step. “Geoffrey Raisman, researcher at the Institute of Neurology at University College London (UCL) and co-author of this essay promises:” Further clinical trials will be conducted this year. ”

Walking again is possible

With new patients, but always the same ingenious procedure. Walking again is possible. This is already the case in mutual center of functional rehabilitation Kerpape in Ploemeur (Morbihan). This seaside center which deals, among others, the trauma of the spinal cord, invested two years ago in “exoskeletons”. This term originally booked the hard shell of arthropods, now refers to the external robotic devices that attach to the patient’s body to support them and enable them to move forward. The legs are inserted in two grooves provided engines ankles and knees, powered by batteries carried in a backpack. The paraplegic rises relying on crutches and advance the basin. This single pulse then instructs the robotic legs to make a step forward, then another. Two models are in operation in the center of Kerpape, one developed by the Israeli company ReWalk, the other by the American company Ekso Bionics. “We are not magicians, though tempers Philippe Labarthe, director of rehabilitation care. Do not give false hopes. Nonetheless, this mobility aid could develop in five to ten years out of rehabilitation centers. “The major obstacle is the cost (about € 80,000), unaffordable for most patients.” For now, the work of verticality offered by these exoskeletons used to re train the patient to the effort, work and improve his cardiac, respiratory and muscle strength, “added Philippe Labarthe.

The benefit of such an exercise e? As to remuscler and e? Avoid the conse? Quences of a permanent sitting position in a wheelchair (ULCE? Res, troubles me? Taboliques, oste? Oporose …). Still, the exoskeletons of assistance are not has? their infancy. The idea? S would indeed can happen to be? Skittles to gain freedom? movement, pro- ject which has attele? e the socie? you? franc? Wandercraft comfortable. But the date of the first test does not cease for the time e? Be rejected? Seen before 2017.

A new route bypassing the spinal cord

The idea pursued by lighthouse researchers would also give back to reach the “voluntary” walking paraplegic. Indeed, victims of spinal cord no longer have control of their lower limbs because the transmission between the brain and the lower body is interrupted. Recall that the role of the spinal cord is to route the information to the brain of the various parts of the body through the nerves, which carry actuators but also sensory information from the body. When the leads that form the spinal cord is severed or crushed, the nerve fibers in the spinal cord do not grow back, preventing electrical controls the brain to play their role and paralyzing a number of functions.

At the University of California at Irvine (USA), the team of Dr. Christine King and has just reached a crucial stage. She found a way to restore that link brain-legs’ round the problem “in some way. And reconnecting the commands of the brain directly to the muscles, bypassing the spinal cord through a brain-computer interface. To do this it was first necessary to check a key point: “People with spinal cord injury-they retain the neurological signal the walk? And if so, can they still use it to control their locomotion? “Was first interviewed Christine King. To answer, the team turned to virtual reality, this digital universe that replaces the physical reality in which to submerge. She asked Paraplegic subjects to control an avatar (virtual character) via electrical signals from the brain, recorded by an electrode headset (electroencephalogram, EEG). And the device worked! “Patients whose spinal cord was injured therefore retain this neurological signal,” says the researcher.

Algorithms for processing brain signals

The next step was for patients to take control, always through these brain signals, an exoskeleton. Supported by a harness suspended – for security reasons – a paraplegic equipped with an EEG headset to focus his mind on the controls “on” or “idle”. Algorithms have immediately treated the brain signals recorded before transmitting, by the computer, the robotic legs of the system. “This is the first demonstration to the world that a person whose spinal cord is injured can recover a guided stroll through the brain and again perform a directed walking task, “are then excited researchers.

An additional step was taken in 2015. Finished the exoskeleton! This time, the patient’s legs have been equipped with an electrical stimulation system placed on the femoral and peroneal nerves. Still hanging on his harness, the patient can again adjust his thinking brain signals controlling “on” or “idle”. But the order was this time directly transmitted by the computer, to the electrodes of electrical stimulation of the muscles. Thirty workouts and nineteen weeks later, the patient was able to travel a distance of three meters. Never seen ! Now, “we are trying to miniaturize the system and reduce the number of electrodes needed to record brain signals,” said Christine King. The system does not suit all patients. “They must have retained the use of their arms and trunk movements. Those with a weakness or paralysis in the arms, as quadriplegics, are not able to maintain an upright posture during electrical stimulation. ”

Walk again is not a priority elsewhere quadriplegics according to experts. Regaining control of arm and hand grip is especially more important. “This would greatly improve their quality of life because it is probably more important to be able to eat alone than walking,” comments Christine King. For the future, the dream researcher systems controlled by sensors implanted directly into the brain. The University of Melbourne (Australia) is in the process of grant. The first test of an exoskeleton control by an electrode inserted into a brain artery, called “stentrode” is indeed announced for 2017. Elsewhere at the Federal Polytechnic School of Lausanne (Switzerland), we are preparing for a another first: repair spinal cord, rather than overcome its deficiencies. The team of French researcher Gregoire Courtine has already caused a sensation in 2014 by showing that it was possible to walk again paralyzed rats by stimulating electrically and chemically part of the severed spinal cord. The “Courtine” method showed that the neural circuits that control the operation can thus be reactivated. The results of an experiment conducted in monkeys should be published shortly. And already looming the first trial in humans. Expected results in 2017 … impatiently.

Source: Exoskeleton: Get Up And Walk Again! | The Siver Times

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[Abstract] Characterisation and evaluation of soft elastomeric actuators for hand assistive and rehabilitation applications – Journal of Medical Engineering & Technology

 

Abstract

Various hand exoskeletons have been proposed for the purposes of providing assistance in activities of daily living and rehabilitation exercises. However, traditional exoskeletons are made of rigid components that impede the natural movement of joints and cause discomfort to the user.
This paper evaluated a soft wearable exoskeleton using soft elastomeric actuators. The actuators could generate the desired actuation of the finger joints with a simple design. The actuators were characterised in terms of their radius of curvature and force output during actuation. Additionally, the device was evaluated on five healthy subjects in terms of its assisted finger joint range of motion.
Results demonstrated that the subjects were able to perform the grasping actions with the assistance of the device and the range of motion of individual finger joints varied from subject to subject. This work evaluated the performance of a soft wearable exoskeleton and highlighted the importance of customisability of the device. It demonstrated the possibility of replacing traditional rigid exoskeletons with soft exoskeletons that are more wearable and customisable.

Source: Characterisation and evaluation of soft elastomeric actuators for hand assistive and rehabilitation applications – Journal of Medical Engineering & Technology –

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[Abstract] Transcranial Electrical Stimulation in Post-Stroke Cognitive Rehabilitation: European Psychologist: Vol 21, No 1

Source: Transcranial Electrical Stimulation in Post-Stroke Cognitive Rehabilitation: Transcranial Electrical Stimulation in Post-Stroke Cognitive Rehabilitation: European Psychologist: Vol 21, No 1

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[Abstract] Transcranial direct current stimulation (tDCS) for improving activities of daily living, and physical and cognitive functioning, in people after stroke. – PubMed

Abstract

BACKGROUND:

Stroke is one of the leading causes of disability worldwide. Functional impairment, resulting in poor performance in activities of daily living (ADLs) among stroke survivors is common. Current rehabilitation approaches have limited effectiveness in improving ADL performance, function, muscle strength and cognitive abilities (including spatial neglect) after stroke, but a possible adjunct to stroke rehabilitation might be non-invasive brain stimulation by transcranial direct current stimulation (tDCS) to modulate cortical excitability, and hence to improve ADL performance, arm and leg function, muscle strength and cognitive abilities (including spatial neglect), dropouts and adverse events in people after stroke.

OBJECTIVES:

To assess the effects of tDCS on ADLs, arm and leg function, muscle strength and cognitive abilities (including spatial neglect), dropouts and adverse events in people after stroke.

SEARCH METHODS:

We searched the Cochrane Stroke Group Trials Register (February 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library; 2015, Issue 2), MEDLINE (1948 to February 2015), EMBASE (1980 to February 2015), CINAHL (1982 to February 2015), AMED (1985 to February 2015), Science Citation Index (1899 to February 2015) and four additional databases. In an effort to identify further published, unpublished and ongoing trials, we searched trials registers and reference lists, handsearched conference proceedings and contacted authors and equipment manufacturers.

SELECTION CRITERIA:

This is the update of an existing review. In the previous version of this review we focused on the effects of tDCS on ADLs and function. In this update, we broadened our inclusion criteria to compare any kind of active tDCS for improving ADLs, function, muscle strength and cognitive abilities (including spatial neglect) versus any kind of placebo or control intervention.

DATA COLLECTION AND ANALYSIS:

Two review authors independently assessed trial quality and risk of bias (JM and MP) and extracted data (BE and JM). If necessary, we contacted study authors to ask for additional information. We collected information on dropouts and adverse events from the trial reports.

MAIN RESULTS:

We included 32 studies involving a total of 748 participants aged above 18 with acute, postacute or chronic ischaemic or haemorrhagic stroke. We also identified 55 ongoing studies. The risk of bias did not differ substantially for different comparisons and outcomes.We found nine studies with 396 participants examining the effects of tDCS versus sham tDCS (or any other passive intervention) on our primary outcome measure, ADLs after stroke. We found evidence of effect regarding ADL performance at the end of the intervention period (standardised mean difference (SMD) 0.24, 95% confidence interval (CI) 0.03 to 0.44; inverse variance method with random-effects model; moderate quality evidence). Six studies with 269 participants assessed the effects of tDCS on ADLs at the end of follow-up, and found improved ADL performance (SMD 0.31, 95% CI 0.01 to 0.62; inverse variance method with random-effects model; moderate quality evidence). However, the results did not persist in a sensitivity analysis including only trials of good methodological quality.One of our secondary outcome measures was upper extremity function: 12 trials with a total of 431 participants measured upper extremity function at the end of the intervention period, revealing no evidence of an effect in favour of tDCS (SMD 0.01, 95% CI -0.48 to 0.50 for studies presenting absolute values (low quality evidence) and SMD 0.32, 95% CI -0.51 to 1.15 (low quality evidence) for studies presenting change values; inverse variance method with random-effects model). Regarding the effects of tDCS on upper extremity function at the end of follow-up, we identified four studies with a total of 187 participants (absolute values) that showed no evidence of an effect (SMD 0.01, 95% CI -0.48 to 0.50; inverse variance method with random-effects model; low quality evidence). Ten studies with 313 participants reported outcome data for muscle strength at the end of the intervention period, but in the corresponding meta-analysis there was no evidence of an effect. Three studies with 156 participants reported outcome data on muscle strength at follow-up, but there was no evidence of an effect.In six of 23 studies (26%), dropouts, adverse events or deaths that occurred during the intervention period were reported, and the proportions of dropouts and adverse events were comparable between groups (risk difference (RD) 0.01, 95% CI -0.02 to 0.03; Mantel-Haenszel method with random-effects model; low quality evidence; analysis based only on studies that reported either on dropouts, or on adverse events, or on both). However, this effect may be underestimated due to reporting bias.

AUTHORS’ CONCLUSIONS:

At the moment, evidence of very low to moderate quality is available on the effectiveness of tDCS (anodal/cathodal/dual) versus control (sham/any other intervention) for improving ADL performance after stroke. However, there are many ongoing randomised trials that could change the quality of evidence in the future. Future studies should particularly engage those who may benefit most from tDCS after stroke and in the effects of tDCS on upper and lower limb function, muscle strength and cognitive abilities (including spatial neglect). Dropouts and adverse events should be routinely monitored and presented as secondary outcomes. They should also address methodological issues by adhering to the Consolidated Standards of Reporting Trials (CONSORT) statement.

Source: Transcranial direct current stimulation (tDCS) for improving activities of daily living, and physical and cognitive functioning, in people after st… – PubMed – NCBI

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[ARTICLE] Role of Brain-Derived Neurotrophic Factor in Beneficial Effects of Repetitive Transcranial Magnetic Stimulation for Upper Limb Hemiparesis after Stroke.

Abstract

Background

Repetitive transcranial magnetic stimulation (rTMS) can improve upper limb hemiparesis after stroke but the mechanism underlying its efficacy remains elusive. rTMS seems to alter brain-derived neurotrophic factor (BDNF) and such effect is influenced by BDNF gene polymorphism.

Objectives

To investigate the molecular effects of rTMS on serum levels of BDNF, its precursor proBDNF and matrix metalloproteinase-9 (MMP-9) in poststroke patients with upper limb hemiparesis.

Methods

Poststroke patients with upper limb hemiparesis were studied. Sixty-two patients underwent rehabilitation plus rTMS combination therapy and 33 patients underwent rehabilitation monotherapy without rTMS for 14 days at our hospital. One Hz rTMS was applied over the motor representation of the first dorsal interosseous muscle on the non-lesional hemisphere. Fugl-Meyer Assessment and Wolf Motor Function (WMFT) were used to evaluate motor function on the affected upper limb before and after intervention. Blood samples were collected for analysis of BDNF polymorphism and measurement of BDNF, proBDNF and MMP-9 levels.

Results

Two-week combination therapy increased BDNF and MMP-9 serum levels, but not serum proBDNF. Serum BDNF and MMP-9 levels did not correlate with motor function improvement, though baseline serum proBDNF levels correlated negatively and significantly with improvement in WMFT (ρ = -0.422, p = 0.002). The outcome of rTMS therapy was not altered by BDNFgene polymorphism.

Conclusions

The combination therapy of rehabilitation plus low-frequency rTMS seems to improve motor function in the affected limb, by activating BDNF processing. BDNF and its precursor proBDNF could be potentially suitable biomarkers for poststroke motor recovery.

Continue —> PLOS ONE: Role of Brain-Derived Neurotrophic Factor in Beneficial Effects of Repetitive Transcranial Magnetic Stimulation for Upper Limb Hemiparesis after Stroke

 

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[Abstract] H-GRASP: the feasibility of an upper limb home exercise program monitored by phone for individuals post stroke

Abstract

Purpose: To investigate the feasibility of a phone-monitored home exercise program for the upper limb following stroke.
Methods: A pre-post double baseline repeated measures design was used. Participants completed an 8-week home exercise program that included behavioural strategies to promote greater use of the affected upper limb. Participants were monitored weekly by therapists over the phone. The following feasibility outcomes were collected: Process (e.g. recruitment rate); Resources (e.g. exercise adherence rate); Management (e.g. therapist monitoring) and Scientific (e.g. safety, effect sizes). Clinical outcomes included: The Chedoke Arm and Hand Inventory, Motor Activity Log, grip strength and the Canadian Occupational Performance Measure.
Results: Eight individuals with stroke were recruited and six participants completed the exercise program. All but one of the six participants met the exercise target of 60 minutes/day, 6 days/week. Participants were stable across the baseline period. The following post-treatment effect sizes were observed: CAHAI (0.944, p = 0.046); MALQ (0.789, p = 0.03) grip strength (0.947, p = 0.046); COPM (0.789, p = 0.03). Improvements were maintained at three and six month follow ups.
Conclusions: Community dwelling individuals with stroke may benefit from a phone-monitored upper limb home exercise program that includes behavioural strategies that promote transfer of exercise gains into daily upper limb use.

  • Implications for Rehabilitation

  • A repetitive, task-oriented home exercise program that utilizes telephone supervision may be an effective method for the treatment of the upper limb following stroke

  • This program is best suited for individuals with mild to moderate level impairment and experience a sufficient level of challenge from the exercises

  • An exercise program that includes behavioural strategies may promote transfer of exercise gains into greater use of the affected upper limb during daily activities

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[Bachelor’s Thesis] Human-centred research for fine motor control rehabilitation after stroke in the Netherlands – March 2016 – Full Text PDF

Abstract

Stroke disables people globally every day. The rehabilitation process focuses mainly on the big muscle groups and re-learning walking. This is why the upper extremity and fine motor control rehabilitation after a stroke is usually left without significant focus. The dexterity rehabilitation after a stroke is lacking an unambiguous method and the guidelines for stroke rehabilitation present multiple recommendations.

SilverFit is a Dutch wellness technology company, whose focus is to motivate people in rehabilitation and maintain their activity by gamification. The thesis was a part of an international product development project for finding a solution for fine motor control rehabilitation after a stroke. Thesis work focused on an iterative project trying to solve the most effective way for rehabiliating fine motor control after a stroke based on the most recent evidence-based studies and understanding the requirements and problems of the users. The human-centred research was conducted using a Design Thinking -process with methods of online ethnography, interviews and observation.

The results from the evidence-based research and the human-centred research were compared through a theme analysis. The thesis showed that the most problematic thing in fine motor control rehabiliation after a stroke is the lack of knowledge, motivation and time, which together cause feelings of insecurity in the therapists and the stroke survivors.

The recommendation for solving the current situation is to create a technological solution, which is always accessible for the stroke survivor, supports the decisions of the therapists based on the most recent evidence-based studies, gives supportive feedback during the therapy and provides realistic results about the progress of the rehabilitation. The thesis provides the first stage of an iterative product development process.

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[WEB SITE] Electrical brain stimulation could boost benefits of stroke rehabilitation. | Science | The Guardian

Research indicates that transcranial direct current stimulation (tCDS) during rehabilitation therapy might help stroke patients recover more movement

Scans showing the effects of hemorrhagic and ischemic stroke.

Scans showing the effects of hemorrhagic and ischemic stroke on the brain. Photograph: Alamy

Electrical brain stimulation could benefit stroke patients by boosting the effects of rehabilitation therapy, new research suggests.

Writing in the journal Science Translational Medicine, the authors reveal that patients who were given electrical brain stimulation during a rehabilitation programme performed better on a range of tasks than those taking part in the rehabilitation programme.

“It is an exciting message because there is so much frustration about people not reaching their true recovery potential,” said Professor Heidi Johansen-Berg, an author of the study from the University of Oxford, highlighting the fact that the cost of programmes and limited availability of therapists often restricts the amount of rehabilitation offered to patients.

To probe the effects of brain stimulation, the researchers chose 24 patients who had experienced a stroke at least six months before, and who had difficulties with moving one hand. The participants were then split into two groups.

The first group underwent nine consecutive days of rehabilitation training, with each session lasting an hour. For the first 20 minutes, the patients had two electrodes placed on their heads and a direct current applied, a process known as anodal transcranial direct current stimulation (tDCS). This is stimulation is thought to prime the brain for learning.

The second group also underwent the nine-day programme, but while they too had electrodes placed on their head for the first 20 minutes, the current was turned off after the first 10 seconds, leading to a placebo trial.

The results indicate that brain stimulation bolstered the effect of the rehabilitation therapy, with patients who underwent the stimulation scoring appreciably higher on two of the tests – those related to carrying out particular tasks with the hand such as picking up a paper-clip – in assessments carried out three months after the therapy. For third test, which measured effects such as the strength of grip, brain stimulation was not linked to improvements.

“If we take at face value what the results are telling us, it is that the stimulation doesn’t completely change the way that the brain can produce a movement, in that it doesn’t make you stronger, but it makes the brain better at being able to carry out a particular task like lifting up an object,” said Johansen-Berg.

However not everyone is convinced. Jane Burridge, professor of restorative neuroscience at the University of Southampton, who was not involved with the study, said the smaller effect for the third test could simply be down to the small size of the study. “You do need to have bigger trials to be certain of the results,” she said.

The research also found that patients who underwent the brain stimulation had larger increases in activity in regions of the brain associated with movement than those who had been given the placebo treatment – an effect that was seen from fMRI scans taken immediately after the nine-day programme and one month later.

“What is particularly important about [the study] is that it does relate the functional improvements with the neuroimaging changes – and that is very encouraging,” said Burridge.

But Burridge also cautions that the results should not be taken as a sign that brain stimulation will benefit all stroke patients. “One has to remember that this is one quite small study,” she said. “The overall view at the moment of when we put all the data [from many studies] together is that there is no clear benefit.”

Johansen-Berg also admits the new research has its limitations. “One thing it doesn’t allow us to do at all is get at the question of variability ,” she says. “We wouldn’t expect this to work for everybody, there will be some people it will work well for and some people who it won’t and we haven’t got anything like the numbers you’d need to tease that apart.”

The results were welcomed by health charities. “This study is an important step toward larger trials to test the effectiveness of non-invasive, electrical brain stimulation to improve the motor recovery of stroke survivors and support their rehabilitation after stroke,” said Dr Shamim Quadir of the Stroke Association. “Stroke is one of the largest causes of disability, and more than half of stroke survivors are left dependent on others for help with everyday activities. It is crucial that we find alternative ways to help improve the recovery rates from this devastating condition.”

But Dr Nick Ward from University College London warns that the study is unlikely to lead to a change in treatment programmes any time soon. “I would call this a proof of principle study,” he said. “This is not something that you can translate into the NHS or any other clinical service immediately.”

For Ward, the most interesting revelation is the level of improvement shown by the patients who did not receive brain stimulation, calling the results “dramatic”. While he cautions that the size of the effect might be down to the very selective nature of the group, if shown to apply more generally it would support the idea that “doing more physical therapy is a good thing.”

Johansen-Berg also believes the research offers a wider message of hope. “With the two weeks of intense therapy, both groups show significant improvement, it is just that they are slightly boosting that with the tDCS,” she said. “ What this shows is if you do two weeks of intensive practice with your bad hand, you will get much better.”

Source: Electrical brain stimulation could boost benefits of stroke rehabilitation | Science | The Guardian

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[WEB SITE] Don’t Overdo Stroke Rehab

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Stroke Recovery: More Rehab Isn’t Better, Study Says

BY JAMIE TALAN

A new study testing the benefits of a task-oriented rehabilitation program to strengthen hand and arm weakness post-stroke suggests that more hours of an intensive program are not necessarily better than usual occupational therapy. Patients who received intensive upper-body training–30 one-hour sessions over a 10-week period–fared no better than those who received a more standard type of rehabilitation, or the usual therapy with significantly fewer hours.

Study Parameters

Researchers at the University of Southern California (USC) randomly assigned  361 stroke patients from seven hospitals around the country to receive either one-hour intensive, structured upper-extremity training three times a week; 30 hours of usual occupational therapy; or occupational therapy that was monitored but with no prescribed amount of hours. The rehabilitation services were delivered in an outpatient setting and the patients’ upper extremity motor function and recovery were measured over the course of a year

Results

As reported in the Journal of the American Medical Association, there were no differences between the groups in upper extremity motor performance. The group undergoing intensive, task-oriented rehabilitation did not have better arm or hand strength than the groups who had usual occupational therapy or monitored-only standard rehabilitation practice. In other words, a more intensive treatment protocol wasn’t better at restoring motor performance. “These findings do not support superiority of this task-oriented rehabilitation program for patients with motor stroke and moderate upper extremity impairment,” the study authors wrote.

Unexpected Findings

The study counters recent research that suggested that more hours of task-oriented upper-extremity training are better for stroke patients than standard occupational and physical therapy. The USC researchers acknowledged that changing practices among physical and occupational therapists could have accounted for the similar motor outcome identified in the study. Also, the variability in the hours of rehabilitation patients received in the control arm of the study could have skewed the results, they said.

Less May Be More

Still, the researchers concluded: “The findings from this study provide important new guidance to clinicians who must choose the best treatment for stroke patients. The results suggest that usual community-based therapy, provided during the typical outpatient rehabilitation time window by licensed therapists, improves upper extremity motor function and that more than doubling the dose of therapy does not lead to meaningful differences in motor outcomes.”

Read the full story from which this post was adapted in Neurology Today at bit.ly/NT-StrokeRehab.

Source: Neurology Now

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[Abstract] Ipsilesional anodal tDCS enhances the functional benefits of rehabilitation in patients after stroke.

Stimulating motor recovery in stroke

Rehabilitation of movement after stroke requires repeated practice and involves learning and brain changes. In a new study, Allman et al. tested whether delivering brain stimulation during a 9-day course of hand and arm training improved movement in patients after stroke. The authors found greater improvements in movement in patients who received real compared to sham (placebo) brain stimulation. Better scores in patients who received real stimulation were still present 3 months after training ended. These findings suggest that brain stimulation could be added to rehabilitative training to improve outcomes in stroke patients.

Abstract

Anodal transcranial direct current stimulation (tDCS) can boost the effects of motor training and facilitate plasticity in the healthy human brain. Motor rehabilitation depends on learning and plasticity, and motor learning can occur after stroke.

We tested whether brain stimulation using anodal tDCS added to motor training could improve rehabilitation outcomes in patients after stroke. We performed a randomized, controlled trial in 24 patients at least 6 months after a first unilateral stroke not directly involving the primary motor cortex. Patients received either anodal tDCS (n = 11) or sham treatment (n = 13) paired with daily motor training for 9 days. We observed improvements that persisted for at least 3 months post-intervention after anodal tDCS compared to sham treatment on the Action Research Arm Test (ARAT) and Wolf Motor Function Test (WMFT) but not on the Upper Extremity Fugl-Meyer (UEFM) score.

Functional magnetic resonance imaging (MRI) showed increased activity during movement of the affected hand in the ipsilesional motor and premotor cortex in the anodal tDCS group compared to the sham treatment group. Structural MRI revealed intervention-related increases in gray matter volume in cortical areas, including ipsilesional motor and premotor cortex after anodal tDCS but not sham treatment. The addition of ipsilesional anodal tDCS to a 9-day motor training program improved long-term clinical outcomes relative to sham treatment in patients after stroke.

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