[Abstract] A Pneumatic Actuator-Powered Robotic Glove for Hand Rehabilitation – Book Chapter

Abstract

The chapter describes the design, evaluation, and fabrication of a soft wearable glove that can assist people with hand impairments in regaining their ability to perform daily tasks by using operating pneumatic pressure to bend and stress fingers through specially designed actuators to bend and stress fingers. The key element of this research is the development of a streamlined, low-cost electron-pneumatic actuator to support the finger’s motion flexibility. The soft wearable robotics glove described in the following section can bend and activate finger joints when pressurized. The experiment was designed to evaluate the performance of the soft wearable robotic glove actuator, and preliminary results indicated that the actuator was capable of delivering successful extension torques to aid finger joints.

References

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[ARTICLE] Effects of physical therapy-based rehabilitation on recovery of upper limb motor function after stroke in adults: a systematic review and meta-analysis of randomized controlled trials – Full Text

Background: Limb hemiplegia is one of the common sequelae of stroke. Physical therapy-based rehabilitation training can rapidly improve limb functioning and muscle strength. This study investigated the effect of physical therapy on the recovery of upper limb motor function by employing a literature search and meta-analysis.

Methods: We searched Embase, The Cochrane Central Register of Controlled Trials library, Wiley online library, PubMed, Ovid, and Clinicaltrials.org for randomized controlled trial (RCT) studies and performed an electronic search with the keyword combinations ‘physical therapy/rehabilitation’ & ‘stroke/post-stroke’ & ‘upper extremity/upper limb’. After screening the literature for inclusion criteria and assessing the risk of bias, Revman 5.4 software was used for the analysis and to obtain forest and funnel plots.

Results: A total of 15 RCTs with 1,081 patients were included in the quantitative analysis for this study. The meta-analysis results showed that compared with conventional therapy, physical therapy improved the upper limb Fugl-Meyer Assessment for Upper Extremity (FMA) scores in convalescent stroke patients (MD =7.27, 95% CI: 4.23–10.32, Z=4.68, P<0.00001), and increased the Functional Independence Measure (FIM) scores (MD =18.82, 95% CI: 6.34–31.30, Z=2.96, P=0.003), the Action Research Arm Test (ARAT) scores (MD =8.84, 95% CI: 6.53–11.15, Z=7.50, P<0.00001), and the Box and Block Test (BBT) scores (MD =6.11, 95% CI: 1.18–11.04, Z=2.43, P=0.02) of patients during the rehabilitation period.

Discussion: The use of physical therapy-based rehabilitation training in the recovery period for stroke patients with hemiplegia can improve upper limb movement ability, increase muscle strength, reduce limb pain, and improve the quality of life.

Introduction

Stroke is a common disease in neurology, with disability and mortality rates as high as 80% (1). The middle-aged and the elderly are the high incidence population of stroke. The function of tissues and organs of the elderly is declining, the autonomic nerve activity is disordered, the ability to regulate vasomotor and systolic is reduced, the degree of vascular wall sclerosis is aggravated, and the possibility of ischemic stroke is increased (2). After rescuing from death stroke patients nearly always have some kind of sequelae, such as coma, expression disorder, sensory disturbance, and limb hemiplegia, which create a self-care ability decline and affect their quality of life (3). Limb hemiplegia is a common sequela of stroke where patients present with loss of muscle strength and inability to perform free limb movements (4,5). Clinically, the primary treatments for hemiplegia after stroke include drugs and physical therapy. The drugs are mainly used to scavenge free radicals, improve brain function, and promote the recovery of limb function. Rehabilitation training can rapidly improve limb functioning and muscle strength, prevent muscle atrophy and joint stiffness, reduce the disability rate, and improve patients’ quality of life (6). Many different physical therapies are used clinically (7–9), and systematic analysis of these therapies is always focusing on just one kind of therapy. This study used a meta-analysis to quantitatively assess the effect of various physical therapy on limb hemiplegia during stroke rehabilitation. We present the following article in accordance with the PRISMA reporting checklist (available at https://apm.amegroups.com/article/view/10.21037/apm-21-3710/rc). […]

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[Abstract] Activities of Daily Living-based Rehabilitation System for Arm and Hand Motor Function Retraining after Stroke

Abstract

Most stroke survivors have difficulties completing activities of daily living (ADLs) independently. However, few rehabilitation systems have focused on ADLs-related training for gross and fine motor function together. We propose an ADLs-based serious game rehabilitation system for the training of motor function and coordination of both arm and hand movement where the user performs corresponding ADLs movements to interact with the target in the serious game. A multi-sensor fusion model based on electromyographic (EMG), force myographic (FMG), and inertial sensing was developed to estimate users’ natural upper limb movement. Eight healthy subjects and three stroke patients were recruited in an experiment to validate the system’s effectiveness. The performance of different sensor and classifier configurations on hand gesture classification against the arm position variations were analyzed, and qualitative patient questionnaires were conducted. Results showed that elbow extension/flexion has a more significant negative influence on EMG-based, FMG-based, and EMG+FMG-based hand gesture recognition than shoulder abduction/adduction does. In addition, there was no significant difference in the negative influence of shoulder abduction/adduction and shoulder flexion/extension on hand gesture recognition. However, there was a significant interaction between sensor configurations and algorithm configurations in both offline and real-time recognition accuracy. The EMG+FMG-combined multi-position classifier model had the best performance against arm position change. In addition, all the stroke patients reported their ADLs-related ability could be restored by using the system. These results demonstrate that the multi-sensor fusion model could estimate hand gestures and gross movement accurately, and the proposed training system has the potential to improve patients’ ability to perform ADLs.

Published in: IEEE Transactions on Neural Systems and Rehabilitation Engineering ( Early Access )

[Abstract] Ludic Table: a comparative study between playful rehabilitation and kinesiotherapy in restricting upper limb movements in individuals with stroke

Abstract

Stroke is a neurological syndrome resulting from the sudden interruption of blood flow. Among the symptoms/consequences of the stroke are muscle weakness in the lower and/or upper limbs, decreased sensitivity, altered fine motor skills, proprioception, and reflections. The treatment for the motor consequences is orthopedic management, in which the physiotherapist assists the individual in repetitive range of motion exercises, which can be demotivating during the treatment. The Ludic Table (LT), on the other hand, incorporates playfulness into therapy, making it a motivating tool. This research describes the comparative study between kinesiotherapy techniques and exercises using the LT, applied to the development of upper limb movements. For this, fourteen volunteers were divided into groups, submitted to interventions according to the techniques, and evaluated using systems such as goniometry, HAQ-DI, GMFM-88, and neurofunctional assessment. In general, it can be stated that regardless of the intervention, the individuals obtained gain in movements (minimum average of 7 degrees) and that the use of the LT allows the development of the angular amplitude and the reduction of the effects of spasticity. The individuals submitted to the intervention through the LT obtained the development of a greater number of articular movements of the shoulder and elbow.

Graphical abstract

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[ARTICLE] Short-term Effect of Noninvasive Brain Stimulation Techniques on Motor Impairment in Chronic Ischemic Stroke: A Systematic Review with Meta-Analysis – Full Text

Abstract

Background: In recent years, noninvasive brain stimulation (NIBS) has shown promise for stroke rehabilitation as a novel nonpharmaceutical neuromodulatory intervention with attractive neurophysiological theories backing it up.

Objective: To find out the short-term effects of NIBS techniques on motor impairment in chronic ischemic stroke.

Materials and Methods: A systematic review with meta-analysis was performed separately for transcranial direct current stimulation (tDCS), transcranial magnetic stimulation (TMS), and studies that combined both, utilizing various databases for a period spanning from 2001 to 2019. Good-quality randomized controlled trials (RCTs) on chronic ischemic stroke cases with homogeneous clinical upper motor short-term outcome measures were considered for the meta-analysis. RevMan 5.1 software was used for the meta-analysis. Meta-analysis registration: CRD42021196299; https://www.crd.york.ac.uk/PROSPERO

Results: A total of 319 studies were identified initially. After necessary filters to comply with the strict recruitment criteria, only four studies qualified, two each for tDCS and TMS and none qualified for analysis under the combined category. tDCS showed a nonsignificant effect on the upper limb motor function improvement (−0.10 [95% confidence interval {CI}: −0.84 to 0.64; I² 0%; P = 0.8]), whereas the repetitive TMS showed a significant effect (0.75 [95% CI: 0.03–1.48; I² 0%; P = 0.04]). The safety analysis did not reveal any major concerns for several published protocols.

Conclusions: tDCS alone did not significantly benefit motor recovery; rTMS was effective in providing immediate functional benefits in chronic ischemic stroke. While the current stroke rehabilitation protocols with NIBS appear safe, more good-quality stratified RCTs with more innovative experimental protocols are needed to analyze and quantify the efficacy of these techniques in stroke rehabilitation.

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Stroke is a sudden nonconvulsive focal neurological deficit of vascular etiology due to infarction or hemorrhage into brain or spinal cord parenchyma in the anterior or posterior circulation territories. Around 15 million people worldwide suffer from stroke every year. Stroke is the leading cause of adult disability in the elderly, and it leaves around a third of victims permanently disabled. Contingent upon the site and the extent of the brain lesion, post-stroke disabilities vary in survivors, and rehabilitation measures are important to improve the quality of life in stroke survivors. Early rehabilitation is the key for recovery and involves multidisciplinary approaches. However, conventional stroke rehabilitation seldom succeeds in achieving a good recuperation in a vast majority of the cases. Only few rehabilitation techniques have gold standard protocols, and this holds especially true for several newly evolving technologies. Neuromodulation methods such as noninvasive brain stimulation (NIBS) include transcranial electrical stimulation (TES) which in turn can be direct or alternate current stimulation (tDCS/ACS) and transcranial magnetic stimulation (TMS) which all have now been intensively investigated as facilitatory or inhibitory types of stimulations[1] to induce desirable priming effects for routine neurorehabilitation.

A Cochrane review published in 2013 reported unimpressive effects on motor improvement with repetitive transcranial magnetic stimulation rTMS and partly attributed it to the heterogeneity of the trials.^[2] This study covered publications only till 2012, but analysed 19 trials involving a total of 588 participants. It reported meta-analysis of two heterogenous trials with a total of 183 participants which showed rTMS treatment not being associated with any significant increase in the functional status after stroke with a Barthel index score mean difference (MD) of 15.92 with 95% confidence interval (CI) of − 2.11 to 33.95. Four other trials with a total of 73 participants also did not find any statistically significant effect on motor function with MD of 0.51 and 95% CI of − 0.99 to 2.01. Subgroup analyses of different stimulation frequencies or duration of illness also showed no significant difference. But they reported that the adverse events (AEs) in the rTMS groups were mild, with the most common event being transient or mild headaches (2.4%) and local discomfort at the site of the stimulation. They concluded against the routine use of rTMS for the treatment of stroke and recommended further trials with larger sample sizes to determine a suitable rTMS protocol and the long-term functional outcome. Another meta-analysis reported in 2016 covered 23 studies till 2015 and generated 29 comparisons: 14 on tDCS and 15 on rTMS. Using random-effects models, they indicated improvements in paretic limb force after tDCS and rTMS rehabilitation. They reported positive effects on force production with two stimulation protocols, one on increasing cortical activity in the ipsilesional hemisphere and the other on decreasing cortical activity in the contralesional hemisphere. They also reported improved reduction of force across acute, subacute, and chronic phases of stroke with both tDCS and rTMS. While the first meta-analysis was a Cochrane review, the second was a publication in a more technical journal, Brain Stimulation. But the differences between the conclusions are obviously most striking. It is, therefore, important to revisit the studies till date, including those conducted from 2016 till date, and make sense of the reports of quality studies through a fresh systematic review. In order to avoid too much of heterogeneity which makes meta-analysis difficult, we confined our studies to randomized controlled trials (RCTs) of NIBS on upper limb motor rehabilitation in chronic ischemic stroke patients and aimed to determine the effectiveness and safety through a systematic review.[…]

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[Abstract] Decoding hand and Wrist Movement Intention From Chronic Stroke Survivors With Hemiparesis Using A Wearable, User-Centric Neural Interface – Research Poster

Research Objectives

To investigate the use of the NeuroLife® Sleeve to decode hand and wrist movements in chronic stroke survivors with hemiparesis for the eventual control of assistive devices. The NeuroLife Sleeve is a wearable garment worn on the forearm with 150 embedded electrodes spread across the forearm to record high-resolution surface electromyography (sEMG).

Design

Using the NeuroLife Sleeve, EMG activity was recorded while participants attempted 12 hand and wrist movements during three separate 2-hour sessions.

Setting

All studies were conducted at Battelle’s laboratories. Participants were referred from therapists in the Columbus area or recruited from local support groups.

Participants

Six chronic stroke survivors (>6 months after stroke) with upper extremity motor impairment (Upper Extremity Fugl-Meyer: 7-38).

Interventions

Participants followed a series of hand and wrist movements on a computer monitor and performed the shown movement to the best of their ability.

Main Outcome Measures

EMG decoding accuracy to correctly predict movement intention from EMG data recorded from the NeuroLife Sleeve.

Results

We demonstrate that the NeuroLife Sleeve can accurately decode 12 functional hand and wrist movements, including multiple types of grasps with 75% average accuracy across subjects in simulated real-time situations. These results highlight the utility of the NeuroLife Sleeve and decoding algorithms as potential control systems for assistive devices. Collected feedback from stroke survivors who tested the system demonstrate the user-centric design of the NeuroLife Sleeve, including being simple to don and doff, comfortable, portable, and lightweight.

Conclusions

The NeuroLife Sleeve represents a user-centric, platform technology to record and decode high-definition electromyography for the eventual real-time control of assistive devices.

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[Abstract] Is mental practice effective for treating upper extremity deficits in individuals with hemiparesis after stroke? A Cochrane Review summary with commentary

Abstract

Background: Mental practice, which is proposed for the rehabilitation of people post-stroke, is a training method based on the repetition of the internal representation of a movement or a task with the aim of improving the performance.

Objective: The aim of this commentary is to discuss Cochrane evidence on the efficacy of mental practice in improving upper extremity functioning in people with hemiparesis after stroke.

Methods: To summarize and discuss from a rehabilitation perspective the published Cochrane Review “Mental practice for treating upper extremity deficits in individuals with hemiparesis after stroke” by Barclay et al.RESULTS:This Cochrane Review included 25 studies involving 676 people with hemiparesis after stroke. The authors analysed the following two comparisons: mental practice versus conventional therapy and mental practice in addition to other treatment versus other treatment (±placebo).

Conclusions: Mental practice in addition to other treatment, compared with other treatment, probably improves upper extremity activity and function in people with hemiparesis after stroke.

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[Abstract] Treatment of upper limb spasticity with inhibitory repetitive transcranial magnetic stimulation: A randomized placebo-controlled trial

Abstract

BACKGROUND: Upper limb dysfunction is a frequent complication after stroke impairing outcome. Inhibitory repetitive transcranial magnetic stimulation (rTMS) applied over the contralesional hemisphere is supposed to enhance the positive effects of conventional rehabilitative treatment. OBJECTIVE:This double-blind randomized placebo-controlled trial investigated whether inhibitory rTMS as add-on to standard therapy improves upper limb spasticity.

METHODS: Twenty-eight patients (aged 44 to 80 years) with unilateral stroke in the middle cerebral artery territory were analyzed. Participants were randomly assigned to inhibitory, low-frequency (LF-) rTMS (n = 14) or sham-rTMS (n = 14). The primary outcome measure was the spasticity grade, which was assessed with the Modified Ashworth Scale (MAS). In addition, the Fugl-Meyer-Assessment (FMA) for the upper extremity (UE) and a resting-state fMRI were performed to measure motor functions and the sensorimotor network, respectively.

RESULTS: The MAS score was reduced in the LF-rTMS group only, whereas the FMA score improved in both groups over time. Regarding the fMRI data, both groups activated typical regions of the sensorimotor network. In the LF-rTMS group, however, connectivity to the left angular gyrus increased after treatment.

CONCLUSION: Changes in functional connectivity in patients receiving inhibitory rTMS over the contralesional motor cortex suggest that processes of neuronal plasticity are stimulated.

Source: NeuroRehabilitation, vol. 49, no. 3, pp. 425-434, 2021

[Abstract] Impact of the robotic-assistance level on upper extremity function in stroke patients receiving adjunct robotic rehabilitation: sub-analysis of a randomized clinical trial

Background

Robotic therapy has been demonstrated to be effective in treating upper extremity (UE) paresis in stroke survivors. However, it remains unclear whether the level of assistance provided by robotics in UE training could affect the improvement in UE function in stroke survivors. We aimed to exploratorily investigate the impact of robotic assistance level and modes of adjustment on functional improvement in a stroke-affected UE.

Methods

We analyzed the data of 30 subacute stroke survivors with mild-to-severe UE hemiplegia who were randomly assigned to the robotic therapy (using ReoGo System) group in our previous randomized clinical trial. A cluster analysis based on the training results (the percentage of each stroke patient’s five assistance modes of robotics used during the training) was performed. The patients were divided into two groups: high and low robotic assistance groups. Additionally, the two groups were sub-categorized into the following classes based on the severity of UE functional impairment: moderate-to-mild [Fugl-Meyer Assessment (FMA) score ≥ 30] and severe-to-moderate class (FMA < 30). The outcomes were assessed using FMA, FMA-proximal, performance-time in the Wolf motor function test (WMFT), and functional assessment scale (FAS) in WMFT. The outcomes of each class in the two groups were analyzed. A two-way analysis of variance (ANOVA) was conducted with robot assistance level and severity of UE function as explanatory factors and the change in each outcome pre- and post-intervention as the objective factor.

Results

Overall, significant differences of the group × severity interaction were found in most of the outcomes, including FMA-proximal (p = 0.038, η² = 0.13), WMFT-PT (p = 0.021, η² = 0.17), and WMFT-FAS (p = 0.045, η² = 0.14). However, only the FMA score appeared not to be significantly different in each group (p = 0.103, η² = 0.09).

Conclusion

An optimal amount of robotic assistance is a key to maximize improvement in post-stroke UE paralysis. Furthermore, severity of UE paralysis is an important consideration when deciding the amount of assistance in robotic therapy.

Publisher URL: https://link.springer.com/article/10.1186/s12984-022-00986-9

Open URL: https://jneuroengrehab.biomedcentral.com/track/pdf/10.1186/s12984-022-00986-9

[WEB] Myomo’s MyoPro Shows Clinically Significant Gains in Motor Function, Per New Research

by Debbie Overman

New research measuring the benefits of Myomo Inc’s MyoPro myoelectric orthosis found “statistically significant improvements” in a number of motor function measurements, the company announces.

The study, titled “Myoelectric Arm Orthosis in Motor Learning-Based Therapy for Chronic Deficits After Stroke and Traumatic Brain Injury,” was funded by the U.S. Army Medical Research Acquisition Activity, and supported by the Office of Secretary of Defense for Health Affairs, through the Orthotics and Prosthetics Outcomes Research Program.

The research, which adds to the body of evidence supporting the utility of MyoPro in stroke and traumatic brain injury patients, was published in the peer-reviewed journal Frontiers in Neurology.

The study followed 13 individuals with chronic moderate-to-severe arm weakness from stroke or traumatic brain injury. Outcomes were collected from in-therapy sessions and home use. The study was conducted by lead investigator and grant recipient Svetlana Pundik, MD and colleagues at the Louis Stokes Cleveland Veterans Administration Medical Center.

The authors note that “Statistically significant and clinically meaningful improvements were observed on Fugl-Meyer (+7.5 points). Gains were seen at week 3, increased further through the in-clinic phase and were maintained during the home phase. Statistically significant changes in Modified Ashworth Scale, Range of Motion, and Chedoke Arm and Hand Activity Inventory were seen early during the in-clinic phase. The Orthotic and Prosthetic User’s Survey demonstrated satisfaction with the device throughout study participation. Both stroke and TBI participants responded to the intervention.”

“Use of MyoPro in motor learning-based therapy resulted in clinically significant gains with a relatively short duration of in-person treatment,” the authors conclude.

“We are encouraged by the continually increasing body of evidence that demonstrates that the use of MyoPro results in clinically significant gains in a relatively short duration of in-person treatment. We look forward to expanding on these results which may lead to innovations in treatment for patients who suffer from chronic upper extremity weakness. This data supports why the payer community both in the U.S. and Germany continue to expand its reimbursement coverage for patients. We thank the clinicians and patients involved in this study.”

— Harry Kovelman, MD, Chief Medical Officer of Myomo

[Source(s): Myomo Inc, Business Wire]