Archive for category Paretic Hand

[Abstract] Recovery in the Severely Impaired Arm Post-stroke after Mirror Therapy – a Randomized Controlled Study

Abstract

OBJECTIVE:

This study aimed to examine the effectiveness of mirror therapy (MT) on recovery in the severely impaired arm after stroke.

DESIGN:

Using single-blind randomized controlled design, patients with severely impaired arm within 1-month post-stroke were assigned to received MT (n=20) or control therapy (CT) (n=21), 30min. twice daily for 4 weeks in addition to conventional rehabilitation. During MT and CT, subjects practiced similar structured exercises in both arms, except that mirror reflection of the unaffected arm was the visual feedback for MT, but mirror was absent for CT so that subjects could watch both arms in exercise. Fugl-Meyer Assessment (FMA) and Wolf Motor Function Test (WMFT) were the outcome measurements.

RESULTS:

After the intervention, both MT and CT groups had significant arm recovery similarly in FMA (p=0.867), WMFT-Time (p=0.947) and WMFT-Functional Ability Scale (p=0.676).

CONCLUSION:

MT or CT which involved exercises concurrently for the paretic and unaffected arms during subacute stroke promoted similar motor recovery in the severely impaired arm.

 

via Recovery in the Severely Impaired Arm Post-stroke after Mirror Therapy – a Randomized Controlled Study. – PubMed – NCBI

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[Case Report] Case report on the use of a functional electrical orthosis in rehabilitation of upper limb function in a chronic stroke patient – Full Text PDF

Abstract

Introduction. The increasing incidence of strokes and their occurrence in younger active people require the development of solutions that allow participation, despite the debilitating deficit that is not always solved by rehabilitation. The present report shows
such a potential solution.
Objective. In this presentation we will show the effects of using a functional electric orthosis, the high number of repetitions and daily electrostimulation in a young stroke patient with motor deficit in the upper limb, the difficulties encountered in attempting to
use orthosis, the results and the course of its recovery over the years.
Materials and Methods. The present report shows the evolution of a 31-year-old female patient with hemiplegia, resulting from a hemorrhagic stroke, from the moment of surgery to the moment of purchasing a functional electrical orthosis and a few months
later, highlighting a 3-week period when the training method focused on performing a large number of repetitions of a single exercise helped by the orthosis – 3 weekly physical therapy sessions, with a duration of one hour and 15 minutes, plus 2 electrostimulation sessions lasting 20 minutes each and 100 elbow extension, daily, 6 times a week. The patient was evaluated and filmed at the beginning and end of the 3 week period. The patient’s consent was obtained for the use of the data and images presented.
Results. Invalidating motor deficiency and problems specific to the use of upper limb functional electrostimulation in patients with stroke sequelae (flexion synergy, exaggeration of reflex response, wrist position during stimulation, etc.) made it impossible to use orthosis in functional activities within ADL although it allowed the achievement of a single task. Evaluation on the FuglMayer assessment does not show any quantifiable progress, although it is possible to have slightly improved the control of the
shoulder and elbow and increased the speed of task execution.
Conclusions. The use of functional orthoses of this type may be useful in patients who still have a significant functional rest in the shoulder, elbow and hand, and where the orthosis can produce an effective grasp. However for some patients, perhaps those who
would have been desirable to benefit most from this treatment, the benefit of using this orthosis is minimal.[…]

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[Abstract] Activity-based Rehabilitation Interventions of the Neurologically Impaired Upper Extremity: Description of a Scoping Review Protocol

Introduction: A scoping review provides a means to synthesize and present a large body of literature on a broad topic, such as methods for various upper extremity activity-based therapy (ABT) interventions.

Objectives: To describe our scoping review protocol to evaluate peer-reviewed articles focused on ABT interventions for individuals with neurologically impaired upper extremities.

Methods: At Jefferson College of Health Professions and Sidney Kimmel Medical College at Jefferson, Philadelphia, the authors will follow this protocol to conduct a scoping review by establishing a research question and conducting a search of bibliographic databases to identify relevant studies. Using specific inclusion and exclusion criteria, abstracts will be screened and full-text articles will be reviewed for inclusion in charting, summarizing, and reporting results of appropriate studies.

Conclusion: This protocol will guide the scoping review process to develop a framework for establishing a noninvasive ABT intervention informed by evidence for individuals with neurologically impaired upper extremities.

via Activity-based Rehabilitation Interventions of the Neurologically Impaired Upper Extremity: Description of a Scoping Review Protocol | Topics in Spinal Cord Injury Rehabilitation

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[Abstract] Recent Patents on Wrist Rehabilitation Equipment

Abstract

Background: Wrist activity is very frequent in our daily routine, and is under heavy load during the movement such as supporting and push-pull. So wrist can get damaged very easily in daily life. Based on the rehabilitation medicine and ergonomics, the particularity and complexity of human limbs should be considered in the design process. During the treatment process, the wrist joint rehabilitation equipment can provide stable, accurate, safe and comfortable repeated rehabilitation training for patients. The use of rehabilitation training equipment can greatly reduce the cost of treatment and improve the rehabilitation efficiency.

Objective: The related patents of rehabilitation training equipment for wrist joint will be reviewed, and the structure and working principle of these equipments will be illustrated. The results of the analysis provide some meaningful reference for the optimal design of the wrist joint.

Methods: Based on the comparative analysis of the latest patents related to wrist rehabilitation equipment, the key problems and future development of the rehabilitation equipment are put forward.

Results: The patents of the rehabilitation training equipment for the wrist are classified in the paper. Studies show that remarkable improvements have been achieved in the invention of the wrist rehabilitation equipment.

Conclusion: In the future, the mechanical design, control system and rehabilitation strategy of wrist rehabilitation equipment should be further studied.

 

via Recent Patents on Wrist Rehabilitation Equipment: Ingenta Connect

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[Abstract + References] Towards a framework for rehabilitation and assessment of upper limb motor function based on Serious Games – IEEE Conference Publication

Abstract

 Serious Games and Virtual Reality (VR) are being considered at present as an alternative to traditional rehabilitation therapies. In this paper, the ongoing development of a framework focused on rehabilitation and assessment of the upper limb motor function based on serious games as a source of entertainment for physiotherapy patients is described. A set of OpenSource Serious Games for rehabilitation has been developed, using the last version of Microsoft1® Kinect™ as low cost monitoring sensor and the software Unity. These Serious Games captures 3D human body data and it stored them in the patient database to facilitate a later clinical analysis to the therapist. Also, a VR-based system for the automated assessment of motor function based on Fugl-Meyer Assessment Test (FMA) is addressed. The proposed system attempts to be an useful therapeutic tool for tele-rehabilitation in order to reduce the number of patients, time spent and cost to
hospitals.

I. Introduction

Biomechanical analysis is an important feature during the evaluation and clinical diagnosis of motor deficits caused by traumas or neurological diseases. For that reason Motion capture (MoCap) systems are widely used in biomechanical studies, in order to collect position data from anatomical landmarks with high accuracy. Their results are used to estimate joint movements, positions, and muscle forces. These quantitative results improve the tracking of changes in motor functions over time, being more accurately than clinical ratings [1]. For clinical applications, these results are usually transformed into clinically meaningful and interpretable parameters, such as gait speed, motion range of joints and body balance.

References

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O. O’Neil, C. Gatzidis, I. Swain, “A state of the art survey in the use of video games for upper limb stroke rehabilitation” in Virtual Augmented Reality and Serious Games for Healthcare 1, Springer, pp. 345-370, 2014.
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J. A. Gil-Gomez, R. Lloréns, M. Alcafiiz, C. Colomer, “Effectiveness of a wii balance board-based system (ebavir) for balance rehabilitation: a pilot randomized clinical trial in patients with acquired brain injury”, Journal of neuroengineering and rehabilitation, vol. 8, no. 1, pp. 30, 2011.
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E. D. Ofia, C. Balaguer, R. Cano de la Cuerda, S. Collado Vázquez, A. Jardon, “Effectiveness of serious games for leap motion on the functionality of the upper limb in parkinsons disease: A feasibility study”, Computational Intelligence and Neuroscience, vol. 2018, 2018.
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E. D. Ofia, R. Cano de la Cuerda, P. Sanchez-Herrera, C. Balaguer, A. Jardon, “A review of robotics in neurorehabilitation: Towards an automated process for upper limb”, Journal of Healthcare Engineering, vol. 2018, 2018.
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K. Tanaka, J. Parker, G. Baradoy, D. Sheehan, J. R. Holash, L. Katz, “A comparison of exergaming interfaces for use in rehabilitation programs and research”, Loading…, vol. 6, no. 9, 2012.
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J. E. Deutsch, M. Borbely, J. Filler, K. Huhn, P. Guarrera-Bowlby, “Use of a low-cost commercially available gaming console (wii) for rehabilitation of an adolescent with cerebral palsy”, Physical therapy, vol. 88, no. 10, pp. 1196-1207, 2008.
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H. Sin, G. Lee, “Additional virtual reality training using xbox kinect in stroke survivors with hemiplegia”, American Journal of Physical Medicine & Rehabilitation, vol. 92, no. 10, pp. 871-880, 2013.
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J. Wiemeyer, A. Kliem, “Serious games in prevention and rehabil-itationa new panacea for elderly people?”, European Review of Aging and Physical Activity, vol. 9, no. 1, pp. 41, 2011.
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A. Pfister, A. M. West, S. Bronner, J. A. Noah, “Comparative abilities of microsoft kinect and vicon 3d motion capture for gait analysis”, Journal of medical engineering & technology, vol. 38, no. 5, pp. 274-280, 2014.
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S. K. Jun, X. Zhou, D. K. Ramsey, V. N. Krovi, “A comparative study of human motion capture and computational analysis tools”, The 2nd International Digital Human Modeling Symposium, 2003.
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A. M. d. C. Souza, M. A. Gadelha, E. A. Coutinho, S. R. d. Santos, A. Pantoja, A. Pereira, “A video-tracking based serious game for motor rehabilitation of post-stroke hand impairment”, SBC Journal on 3D Interactive Systems, vol. 3, no. 2, pp. 37-46, 2012.
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Z. Luo, C. K. Lim, I. M. Chen, S. H. Yeo, “A virtual reality system for arm and hand rehabilitation”, Frontiers of Mechanical Engineering, vol. 6, no. 1, pp. 23-32, 2011.
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O. Wasenmuller, D. Stricker, “Comparison of kinect v l and v2 depth images in terms of accuracy and precision”, Asian Conference on Computer Vision Workshop (ACCV workshop), 2016.
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J. Van der Putten, J. Hobart, J. Freeman, A. Thompson, “Measuring change in disability after inpatient rehabilitation: comparison of the responsiveness of the barthel index and the functional independencemeasure”, Journal of Neurology Neurosurgery & Psychiatry, vol. 66, no. 4, pp. 480-484, 1999.
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E. D. Ofia, A. Jardon, C. Balaguer, Y. Gao, S. Fallah, Y. Jin, C. Lekakou, “The automated box and blocks test an autonomous assessment method of gross manual dexterity in stroke rehabilitation” in Towards Autonomous Robotic Systems TAROS 2017, Cham: Springer, vol. 10454, pp. 101-114, 2017.
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C. Rodriguez-de Pablo, J. C. Perry, F. I. Cavallaro, H. Zabaleta, T. Keller, “Development of computer games for assessment and training in post-stroke arm telerehabilitation”, Engineering in Medicine and Biology Society (EMBC) 2012 Annual International Conference of the IEEE, pp. 4571-4574, 2012.
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V. Vallejo, P. Wyss, A. Chesham, A. V. Mitache, R. M. Muri, U. P. Mosimann, T. Nef, “Evaluation of a new serious game based multitasking assessment tool for cognition and activities of daily living: Comparison with a real cooking task”, Computers in human behavior, vol. 70, pp. 500-506, 2017.
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B. Bonnechere, V. Sholukha, L. Omelina, M. Van Vooren, B. Jansen, S. V. S. Jan, “Suitability of functional evaluation embedded in serious game rehabilitation exercises to assess motor development across lifespan”, Gait & posture, vol. 57, pp. 35-39, 2017.
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E. van der Meulen, M. A. Cidota, S. G. Lukosch, P. J. Bank, A. J. van der Helm, V. T. Visch, “A haptic serious augmented reality game for motor assessment of parkinson’s disease patients”, Mixed and Augmented Reality (ISMAR-Adjunct) 2016 IEEE International Symposium on, pp. 102-104, 2016.
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C. Bosecker, L. Dipietro, B. Volpe, H. Igo Krebs, “Kinematic robot-based evaluation scales and clinical counterparts to measure upper limb motor performance in patients with chronic stroke”, Neu-rorehabilitation and neural repair, vol. 24, no. 1, pp. 62-69, 2010.
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L. Santisteban, M. Teremetz, J. P. Bleton, J. C. Baron, M. A. Maier, P. G. Lindberg, “Upper limb outcome measures used in stroke rehabilitation studies: a systematic literature review”, PloS one, vol. 11, no. 5, pp. e0154792, 2016.
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J. W. Burke, M. McNeill, D. K. Charles, P. J. Morrow, J. H. Crosbie, S. M. McDonough, “Optimising engagement for stroke rehabilitation using serious games”, The Visual Computer, vol. 25, no. 12, pp. 1085-1099, 2009.
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K. Sathian, L. J. Buxbaum, L. G. Cohen, J. W. Krakauer, C. E. Lang, M. Corbetta, S. M. Fitzpatrick, “Neurological principles and rehabilitation of action disorders common clinical deficits”, Neu-rorehabilitation and neural repair, vol. 25, no. 5 suppl, pp. 21S-32S, 2011.
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J. Sanford, J. Moreland, L. R. Swanson, P. W. Stratford, C. Gow-land, “Reliability of the fugl-meyer assessment for testing motor performance in patients following stroke”, Physical therapy, vol. 73, no. 7, pp. 447-454, 1993.
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A. Deakin, H. Hill, V. M. Pomeroy, “Rough guide to the fugl-meyer assessment: Upper limb section”, Physiotherapy, vol. 89, no. 12, pp. 751-763, 2003.
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D. J. Gladstone, C. J. Danells, S. E. Black, “The fugl-meyer assessment of motor recovery after stroke: a critical review of its measurement properties”, Neurorehabilitation and neural repair, vol. 16, no. 3, pp. 232-240, 2002.
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W. S. Kim, S. Cho, D. Baek, H. Bang, N. J. Paik, “Upper extremity functional evaluation by fugl-meyer assessment scoring using depth-sensing camera in hemiplegic stroke patients”, PloS one, vol. 11, no. 7, pp. e0158640, 2016.

via Towards a framework for rehabilitation and assessment of upper limb motor function based on Serious Games – IEEE Conference Publication

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[Abstract + Related Articles] Adaptive gameplay and difficulty adjustment in a gamified upper-limb rehabilitation – IEEE Conference Publication

 

Abstract

Lack of motivation during physical rehabilitation is a very common problem that worsens the efficacy of rehabilitation, decreasing the recovery rates of the patient. We suggest a gamified upper-limb rehabilitation that incorporates adaptive gameplay and difficulty so as to overcome that issue, emerging as a support tool for physical therapy professionals. The presence of difficulty adjustment in the game allows a higher motivation level for the patients by preserving the trade off between keeping the difficulty low enough to avoid frustration, but high enough to promote motivation and engagement. This rehabilitation game is a home-based system that allows the patient to exercise at home, due to its Kinect-based portable setup. The game aims to increase the motivation of the patients and thus the speed of their recovery. To accomplish that goal, it is key to potentiate a full immersion into the therapeutic activity. Thus gamification elements, gameplay design and adaptive difficulty are explored and incorporated into the concept.

Related Articles

via Adaptive gameplay and difficulty adjustment in a gamified upper-limb rehabilitation – IEEE Conference Publication

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[Abstract] Design of a Low-Cost Exoskeleton for Hand Tele-Rehabilitation After Stroke

Abstract

The impairment of finger movements after a stroke results in a significant deficit in hands everyday performances. To face this kind of problems different rehabilitation techniques have been developed, nevertheless, they require the presence of a therapist to be executed. To overcome this issue have been designed several apparatuses that allow the patient to perform the training by itself. Thus, an easy to use and effective device is needed to provide the right training and complete the rehabilitation techniques in the best way. In this paper, a review of state of the art in this field is provided, along with an introduction to the problems caused by a stroke and the consequences for the mobility of the hand. Then follows a complete review of the low cost home based exoskeleton project design. The objective is to design a device that can be used at home, with a lightweight and affordable structure and a fast mounting system. For implementing all these features, many aspects have been analysed, starting from the rehabilitation requirements and the ergonomic issues. This device should be able to reproduce the training movements on an injured hand without the need for assistance by an external tutor.

via Design of a Low-Cost Exoskeleton for Hand Tele-Rehabilitation After Stroke | SpringerLink

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[Abstract] Bilateral Motor Cortex Plasticity in Individuals With Chronic Stroke, Induced by Paired Associative Stimulation

Background: In the chronic phase after stroke, cortical excitability differs between the cerebral hemispheres; the magnitude of this asymmetry depends on degree of motor impairment. It is unclear whether these asymmetries also affect capacity for plasticity in corticospinal tract excitability or whether hemispheric differences in plasticity are related to chronic sensorimotor impairment.

Methods: Response to paired associative stimulation (PAS) was assessed bilaterally in 22 individuals with chronic hemiparesis. Corticospinal excitability was measured as the area under the motor-evoked potential (MEP) recruitment curve (AUC) at baseline, 5 minutes, and 30 minutes post-PAS. Percentage change in contralesional AUC was calculated and correlated with paretic motor and somatosensory impairment scores.

Results: PAS induced a significant increase in AUC in the contralesional hemisphere (P = .041); in the ipsilesional hemisphere, there was no significant effect of PAS (P = .073). Contralesional AUC showed significantly greater change in individuals without an ipsilesional MEP (P = .029). Percentage change in contralesional AUC between baseline and 5 m post-PAS correlated significantly with FM score (r = −0.443; P = .039) and monofilament thresholds (r = 0.444, P = .044).

Discussion: There are differential responses to PAS within each cerebral hemisphere. Contralesional plasticity was increased in individuals with more severe hemiparesis, indicated by both the absence of an ipsilesional MEP and a greater degree of motor and somatosensory impairment. These data support a body of research showing compensatory changes in the contralesional hemisphere after stroke; new therapies for individuals with chronic stroke could exploit contralesional plasticity to help restore function.

 

via Bilateral Motor Cortex Plasticity in Individuals With Chronic Stroke, Induced by Paired Associative Stimulation – Jennifer K. Ferris, Jason L. Neva, Beatrice A. Francisco, Lara A. Boyd, 2018

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[ARTICLE] Upper Limb Motor Impairment Post Stroke – Full Text

Synopsis

Understanding upper limb impairment after stroke is essential to planning therapeutic efforts to restore function. However determining which upper limb impairment to treat and how is complex for two reasons: 1) the impairments are not static, i.e. as motor recovery proceeds, the type and nature of the impairments may change; therefore the treatment needs to evolve to target the impairment contributing to dysfunction at a given point in time. 2) multiple impairments may be present simultaneously, i.e., a patient may present with weakness of the arm and hand immediately after a stroke, which may not have resolved when spasticity sets in a few weeks or months later; hence there may be a layering of impairments over time making it difficult to decide what to treat first. The most useful way to understand how impairments contribute to upper limb dysfunction may be to examine them from the perspective of their functional consequences. There are three main functional consequences of impairments on upper limb function are: (1) learned nonuse, (2) learned bad-use, and (3) forgetting as determined by behavioral analysis of tasks. The impairments that contribute to each of these functional limitations are described.

The nature of upper limb motor impairment

According to the International Classification of Functioning, Disability and Health model (ICF) (Geyh, Cieza et al. 2004), impairments may be described as (1) impairments of body function such as a significant deviation or loss in neuromusculoskeletal and movement related function related to joint mobility, muscle power, muscle tone and/or involuntary movements, or (2) impairment of body structures such as a significant deviation in structure of the nervous system or structures related to movement, for example the arm and/or hand. A stroke may lead to both types of impairments. Upper limb impairments after stroke are the cause of functional limitations with regard to use of the affected upper limb after stroke, so a clear understanding of the underlying impairments is necessary to provide appropriate treatment. However understanding upper limb impairments in any given patient is complex for two reasons: 1) the impairments are not static, i.e. as motor recovery proceeds, the type and nature of the impairments may change; therefore the treatment needs to evolve to target the impairment contributing to dysfunction at a given point in time. 2) multiple impairments may be present simultaneously, i.e., a patient may present with weakness of the arm and hand immediately after a stroke, which may not have resolved when spasticity sets in a few weeks or months later; hence there may be a layering of impairments over time making it difficult to decide what to treat first. It is useful to review the progression of motor recovery as described by Twitchell (Twitchell 1951) and Brunnstrom (Brunnstom 1956) to understand how impairments may be layered over time (Figure 1).

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Sequential progression of motor recovery as described by Twitchell and Brunstrumm. Note that while recovery is proceeding from one stage to the next, residual impairment from preceding stages may still be present leading to the layering of impairment. Also note the underlying physiological processes that may account for progression from one stage to the next.

Understanding motor impairment from a functional perspective

The most useful way to understand how impairments contribute to upper limb dysfunction may be to examine them from the perspective of their functional consequences. There are three main functional consequences of stroke on the upper limb: (1) learned nonuse, (2) learned bad-use, and (3) forgetting as determined by behavioral analysis of a task such as reaching for a food pellet and bringing it to the mouth in animal models of stroke (Whishaw, Alaverdashvili et al. 2008). These are equally valid for human behavior. Each of the functional consequences and the underlying impairments are elaborated below.[…]

 

Continue —>  Upper Limb Motor Impairment Post Stroke

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[Abstract] A low cost kinect-based virtual rehabilitation system for inpatient rehabilitation of the upper limb in patients with subacute stroke: A randomized, double-blind, sham-controlled pilot trial.

Abstract

BACKGROUND:

We designed this study to prove the efficacy of the low-cost Kinect-based virtual rehabilitation (VR) system for upper limb recovery among patients with subacute stroke.

METHODS:

A double-blind, randomized, sham-controlled trial was performed. A total of 23 subjects with subacute stroke (<3 months) were allocated to sham (n = 11) and real VR group (n = 12). Both groups participated in a daily 30-minute occupational therapy for upper limb recovery for 10 consecutive weekdays. Subjects received an additional daily 30-minute Kinect-based or sham VR. Assessment was performed before the VR, immediately and 1 month after the last session of VR. Fugl-Meyer Assessment (FMA) (primary outcome) and other secondary functional outcomes were measured. Accelerometers were used to measure hemiparetic upper limb movements during the therapy.

RESULTS:

FMA immediately after last VR session was not different between the sham (46.8 ± 16.0) and the real VR group (49.4 ± 14.2) (P = .937 in intention to treat analysis). Significant differences of total activity counts (TAC) were found in hemiparetic upper limb during the therapy between groups (F2,26 = 4.43; P = .22). Real VR group (107,926 ± 68,874) showed significantly more TACs compared with the sham VR group (46,686 ± 25,814) but there was no statistical significance between real VR and control (64,575 ± 27,533).

CONCLUSION:

Low-cost Kinect-based upper limb rehabilitation system was not more efficacious compared with sham VR. However, the compliance in VR was good and VR system induced more arm motion than control and similar activity compared with the conventional therapy, which suggests its utility as an adjuvant additional therapy during inpatient stroke rehabilitation.

PMID:29924029 DOI:10.1097/MD.0000000000011173
 

via A low cost kinect-based virtual rehabilitation system for inpatient rehabilitation of the upper limb in patients with subacute stroke: A randomized… – PubMed – NCBI

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