Archive for category spasticity

[ARTICLE] Spasticity, Motor Recovery, and Neural Plasticity after Stroke – Full Text

Spasticity and weakness (spastic paresis) are the primary motor impairments after stroke and impose significant challenges for treatment and patient care. Spasticity emerges and disappears in the course of complete motor recovery. Spasticity and motor recovery are both related to neural plasticity after stroke. However, the relation between the two remains poorly understood among clinicians and researchers. Recovery of strength and motor function is mainly attributed to cortical plastic reorganization in the early recovery phase, while reticulospinal (RS) hyperexcitability as a result of maladaptive plasticity, is the most plausible mechanism for post-stroke spasticity. It is important to differentiate and understand that motor recovery and spasticity have different underlying mechanisms. Facilitation and modulation of neural plasticity through rehabilitative strategies, such as early interventions with repetitive goal-oriented intensive therapy, appropriate non-invasive brain stimulation, and pharmacological agents, are the key to promote motor recovery. Individualized rehabilitation protocols could be developed to utilize or avoid the maladaptive plasticity, such as RS hyperexcitability, in the course of motor recovery. Aggressive and appropriate spasticity management with botulinum toxin therapy is an example of how to create a transient plastic state of the neuromotor system that allows motor re-learning and recovery in chronic stages.

Introduction

According to the CDC, approximately 800,000 people have a stroke every year in the United States. The continued care of seven million stroke survivors costs the nation approximately $38.6 billion annually. Spasticity and weakness (i.e., spastic paresis) are the primary motor impairments and impose significant challenges for patient care. Weakness is the primary contributor to impairment in chronic stroke (1). Spasticity is present in about 20–40% stroke survivors (2). Spasticity not only has downstream effects on the patient’s quality of life but also lays substantial burdens on the caregivers and society (2).

Clinically, poststroke spasticity is easily recognized as a phenomenon of velocity-dependent increase in tonic stretch reflexes (“muscle tone”) with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex (3). Though underlying mechanisms of spasticity remain poorly understood, it is well accepted that there is hyperexcitability of the stretch reflex in spasticity (47). Accumulated evidence from animal (8) and human studies (918) supports supraspinal origins of stretch reflex hyperexcitability. In particular, reticulospinal (RS) hyperexcitability resulted from loss of balanced inhibitory, and excitatory descending RS projections after stroke is the most plausible mechanism for poststroke spasticity (19). On the other hand, animal studies have strongly supported the possible role of RS pathways in motor recovery (2036), while recent studies with stroke survivors have demonstrated that RS pathways may not always be beneficial (37, 38). The relation between spasticity and motor recovery and the role of plastic changes after stroke in this relation, particularly RS hyperexcitability, remain poorly understood among clinicians and researchers. Thus, management of spasticity and facilitation of motor recovery remain clinical challenges. This review is organized into the following sessions to understand this relation and its implication in clinical management.

• Poststroke spasticity and motor recovery are mediated by different mechanisms

• Motor recovery are mediated by cortical plastic reorganizations (spontaneous or via intervention)

• Reticulospinal hyperexcitability as a result of maladaptive plastic changes is the most plausible mechanism for spasticity

• Possible roles of RS hyperexcitability in motor recovery

• An example of spasticity reduction for facilitation of motor recovery

Continue —> Frontiers | Spasticity, Motor Recovery, and Neural Plasticity after Stroke | Stroke

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[ARTICLE] Quantifying spasticity in individual muscles using shear wave elastography – Full Text

Abstract

Spasticity is common following stroke; however, high subject variability and unreliable measurement techniques limit research and treatment advances. Our objective was to investigate the use of shear wave elastography (SWE) to characterize the spastic reflex in the biceps brachii during passive elbow extension in an individual with spasticity. The patient was a 42-year-old right-hand-dominant male with history of right middle cerebral artery-distribution ischemic infarction causing spastic left hemiparesis. We compared Fugl-Meyer scores (numerical evaluation of motor function, sensation, motion, and pain), Modified Ashworth scores (most commonly used clinical assessment of spasticity), and SWE measures of bilateral biceps brachii during passive elbow extension. We detected a catch that featured markedly increased stiffness of the brachialis muscle during several trials of the contralateral limb, especially at higher extension velocities. SWE was able to detect velocity-related increases in stiffness with extension of the contralateral limb, likely indicative of the spastic reflex. This study offers optimism that SWE can provide a rapid, real-time, quantitative technique that is readily accessible to clinicians for evaluating spasticity.

Introduction

An estimated 795,000 Americans experience stroke every year [1], and stroke incidence is expected to increase as the population ages [2]. It is estimated that the prevalence of spasticity after stroke ranges from 18% to 39% [3], [4] and [5], and spasticity-associated functional limitations create significant burdens on survivors and caregivers [6]. Health care costs for individuals with stroke who develop spasticity are estimated to be fourfold higher than those without spasticity [7]. However, high subject variability and indeterminate measurement techniques limit research investigation and treatment advances [8] and [9].

Though classically considered to have increased stiffness resulting solely from the over-active velocity-dependent stretch reflex, chronically spastic muscles associated with stroke appear to also have increased nonreflex stiffness when compared to the side of the body ipsilateral to the lesioned hemisphere, as well as healthy controls [9] and [10]. Clinically, spasticity is diagnosed and monitored using the 5-point Modified Ashworth Scale (MAS): a simple technique that requires no equipment, though is subjective, qualitative, and varies widely with muscle groups [11] and [12]. Though the precise mechanism behind spasticity is not known, we now recognize a variety of biomechanical changes within skeletal muscle connective tissue that likely limit the effectiveness of a simplistic tool, such as the MAS, for evaluating spasticity in chronic stroke [13] and [14]. Electromyography or biomechanical measures may offer more reliable, quantitative information, though are impractical for routine clinical use [14], [15] and [16]. Furthermore, elevated muscle tone in persons with spasticity may not be related to activation of the muscle groups in question [17] and [18].

A variety of imaging-based elastography techniques have emerged with great promise for skeletal muscle evaluation, including ultrasound elastography and magnetic resonance elastography [18], [19], [20], [21] and [22]. Strain elastography, a qualitative measure of relative stiffness, is also available but offers little advantage over the MAS, as neither offers a quantitative, objective measure [21], [23] and [24]. The two quantitative imaging modalities, magnetic resonance elastography and ultrasound shear wave elastography (SWE), show good agreement in both phantoms and tissues, though SWE is especially promising for its flexibility, accessibility, and real-time results [25], [26] and [27]. For this reason, SWE may be uniquely suited for evaluating pathologic alterations in stiffness of individual muscles, especially for quantifying spasticity [18], [28], [29], [30] and [31].

This study evaluated the feasibility of using SWE to characterize the spastic reflex during passive elbow extension in an individual with spasticity caused by stroke. We hypothesized that SWE would capture heightened skeletal muscle stiffness, representing the spastic reflex, during passive elbow range of motion.

Continue —> Quantifying spasticity in individual muscles using shear wave elastography

Fig. 1. Shear wave speeds, ultrasound images, and elastograms for 60°/s ipsilateral elbow extension trials. (A) Ipsilateral biceps; (B) ipsilateral brachialis; (C) ultrasound images and elastograms from trial 1 with sample regions of interest demonstrated in the first panel.

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[Abstract] Effects of sit-to-stand training combined with transcutaneous electrical stimulation on spasticity, muscle strength and balance ability in patients with stroke: a randomized controlled study

Highlights

  • The effect of sit-to-stand training combined with TENS was evaluated in stroke patients with spastic plantar flexor.
  • TENS followed by sit-to-stand training may improve spasticity, muscle strength and balance.
  • Clinician should consider TENS application prior to sit to stand training for stroke patients with spastic plantar flexor.

Abstract

Sit-to-stand is a fundamental movement of human being for performing mobility and independent activity. However, Stroke people symptoms experience difficulty in conducting the sit-to-stand due to paralysis and especially ankle spasticity. Recently, transcutaneous electrical- stimulation (TENS) is used to reduce pain but also to manage spasticity.

The purpose of this study was to determine

  1. whether TENS would lead to ankle spasticity reduction and (
  2. whether sit-to-stand training combined with TENS would improve spasticity, muscle strength and balance ability in stroke patients.

Forty-stroke patients were recruited and were randomly divided into two groups: TENS group (n = 20) and sham group (n = 20). All participants underwent 30-sessions of sit-to-stand training (for 15-minutes, five-times per week for 6-weeks). Prior to each training session, 30-minutes of TENS over the peroneal nerve was given in TENS group, whereas sham group received non-electrically stimulated TENS for the same amount of time. Composite-Spasticity-Score was used to assess spasticity level of ankle plantar-flexors. Isometric strength in the extensor of hip, knee and ankle were measured by handhelddynamometer. Postural-sway distance was measured using a force platform.

The spasticity score in the TENS group (2.6 ± 0.8) improved significantly greater than the sham group (0.7 ± 0.8, p < 0.05). The muscle strength of hip extensor in the TENS group (2.7 ± 1.1 kg) was significantly higher than the sham group (1.0 ± 0.8 kg, p < 0.05). Significant improvement in postural-sway was observed in the TENS group compared to the sham group (p < 0.05).

Thus, sit-to-stand training combined with TENS may be used to improve the spasticity, balance function and muscle strength in stroke patients.

Source: Effects of sit-to-stand training combined with transcutaneous electrical stimulation on spasticity, muscle strength and balance ability in patients with stroke: a randomized controlled study – Gait & Posture

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[Abstract] Combined Effect Of Botulinum Toxin And Splinting On Motor Components And Function Of People With Stroke  

Abstract

Background and objective: Spasticity is one of the problems following stroke. Due to this increase in muscle tone, patients are confronted to problems in motor control and difficulties in activities of daily living and complications such as shortness and contracture. The aim of this study was to examine the effects of Simultaneous use of both splint and botulinum toxin-A (BTX-A) injection on spasticity, range of motion and upper extremity function in a 3-month period.

Methods: The design of this study was a comparison between 3 groups of interventions, conducted in rehabilitation clinics in Tehran. Sixty people with chronic stroke were recruited. Based on the inclusion criteria, a total of 39 stroke patients after completing the consent forms were entered to intervention groups; splint or botulinum toxin injection or combined splint/botulinum toxin injection. They were followed up about 3 months and the evaluations were done monthly. Goniometry was the method to measure range of motion, and Modified Ashworth scale was used to examine the spasticity and the upper extremity function was scored based on Fugl-Meyer assessment.   Statistical analysis was done using SPSS 17. And ANOVAs was used for comparison between groups and times.  Significance was set at 0.05.

Results: All outcome measures improved within each group but the differences between splint group and BTX-A group and the BTX-A-splint group was not significant in most outcomes during 3 periods (first evaluation until end of the first month, the end of first month until the end of second month, the end of second month until the end of the third month) (p> 0 / 05). The results also showed that the changes in elbow`s spasticity {p= 0.05} and wrist`s spasticity {p= 0.007} and upper extremity function { p = 0.04} were obvious between the three groups over the 3-months and the difference in the group of combined use of botulinum toxin and splint was more than other groups.

Conclusion: In this study, the effects of botulinum toxin injection and Volar-Dorsal Wrist/Hand Immobilization splint and the combined use of botulinum injection and splint were obvious in all groups but was not significantly different between the interventions in a 3-month follow-up.

Source: Combined Effect Of Botulinum Toxin And Splinting On Motor Components And Function Of People With Stroke | Shamili | Advances in Bioscience and Clinical Medicine

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[Abstract] Breakthroughs in the spasticity management: Are non-pharmacological treatments the future?

Highlights

  • Spasticity can cause a severe disability and challenge the rehabilitation process.
  • A successful treatment of spasticity depends on a pathophysiologic assessment.
  • The main therapeutic options include physiotherapy and pharmacological treatments.
  • Non-pharmacologic approaches may reduce spasticity and improve quality of life.

Abstract

The present paper aims at providing an objective narrative review of the existing non-pharmacological treatments for spasticity. Whereas pharmacologic and conventional physiotherapy approaches result well effective in managing spasticity due to stroke, multiple sclerosis, traumatic brain injury, cerebral palsy and incomplete spinal cord injury, the real usefulness of the non-pharmacological ones is still debated. We performed a narrative literature review of the contribution of non-pharmacological treatments to spasticity management, focusing on the role of non-invasive neurostimulation protocols (NINM). Spasticity therapeutic options available to the physicians include various pharmacological and non-pharmacological approaches (including NINM and vibration therapy), aimed at achieving functional goals for patients and their caregivers. A successful treatment of spasticity depends on a clear comprehension of the underlying pathophysiology, the natural history, and the impact on patient’s performances. Even though further studies aimed at validating non-pharmacological treatments for spasticity should be fostered, there is growing evidence supporting the usefulness of non-pharmacologic approaches in significantly helping conventional treatments (physiotherapy and drugs) to reduce spasticity and improving patient’s quality of life. Hence, non-pharmacological treatments should be considered as a crucial part of an effective management of spasticity.

Source: Breakthroughs in the spasticity management: Are non-pharmacological treatments the future? – Journal of Clinical Neuroscience

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[Poster] A Toolkit for Objective Clinical Outcome Measures of Muscle Tone – Archives of Physical Medicine and Rehabilitation

To evaluate a wearable sensor-based toolkit for quantifying muscle tone in patients with upper motor neuron syndrome (UMNS).

Source: A Toolkit for Objective Clinical Outcome Measures of Muscle Tone – Archives of Physical Medicine and Rehabilitation

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[Abstract] Breakthroughs in the spasticity management: Are non-pharmacological treatments the future?

 

Highlights

    Spasticity can cause a severe disability and challenge the rehabilitation process.
    A successful treatment of spasticity depends on a pathophysiologic assessment.
    The main therapeutic options include physiotherapy and pharmacological treatments.
    Non-pharmacologic approaches may reduce spasticity and improve quality of life.

Abstract

The present paper aims at providing an objective narrative review of the existing non-pharmacological treatments for spasticity. Whereas pharmacologic and conventional physiotherapy approaches result well effective in managing spasticity due to stroke, multiple sclerosis, traumatic brain injury, cerebral palsy and incomplete spinal cord injury, the real usefulness of the non-pharmacological ones is still debated.

We performed a narrative literature review of the contribution of non-pharmacological treatments to spasticity management, focusing on the role of non-invasive neurostimulation protocols (NINM). Spasticity therapeutic options available to the physicians include various pharmacological and non-pharmacological approaches (including NINM and vibration therapy), aimed at achieving functional goals for patients and their caregivers. A successful treatment of spasticity depends on a clear comprehension of the underlying pathophysiology, the natural history, and the impact on patient’s performances.

Even though further studies aimed at validating non-pharmacological treatments for spasticity should be fostered, there is growing evidence supporting the usefulness of non-pharmacologic approaches in significantly helping conventional treatments (physiotherapy and drugs) to reduce spasticity and improving patient’s quality of life.

Hence, non-pharmacological treatments should be considered as a crucial part of an effective management of spasticity.

Source: Breakthroughs in the spasticity management: Are non-pharmacological treatments the future?

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[ARTICLE] Efficacy and safety of oral baclofen in the management of spasticity: A rationale for intrathecal baclofen – Full Text

Abstract

Oral baclofen has long been a mainstay in the management of spasticity. This review looks at the clinical evidence for the efficacy and safety of oral baclofen in patients with spasticity of any origin or severity, to determine whether there is a rationale for the use of intrathecal baclofen. Results suggest that oral baclofen may be effective in many patients with spasticity, regardless of the underlying disease or severity, and that it is at least comparable with other antispasmodic agents. However, adverse effects, such as muscle weakness, nausea, somnolence and paraesthesia, are common with oral baclofen, affecting between 25% and 75% of patients, and limiting its usefulness. Intrathecal baclofen may be an effective alternative as the drug is delivered directly into the cerebrospinal fluid, thus bypassing the blood-brain barrier and thereby optimizing the efficacy of baclofen while minimizing drug-related side-effects. Intrathecal baclofen is a viable option in patients who experience intolerable side-effects or who fail to respond to the maximum recommended dose of oral baclofen.

Introduction

Although the exact prevalence is unknown, it is estimated that more than 12 million people worldwide could be affected by spasticity (1), and that 12–27% of these have disabling spasticity, depending on the aetiology (2). Substantial evidence demonstrates that spasticity has a negative impact on patients, causing physical impairment (e.g. pain, pressure sores, contractures), limitation of activities, dependence on caregivers, restricted participation in family and social life, and decreased overall quality of life (3, 4).

Numerous definitions for spasticity exist (5), although that provided by Pandyan et al. (6) has been advocated during recent years: “disordered sensorimotor control resulting from an upper motor neuron lesion, presenting as intermittent or sustained involuntary activation of muscles”. Spasticity is a common complication of upper motor neurone syndrome, and can occur when areas controlling movement are damaged, most often by brain injury disorders, such as or cerebral palsy (CP), traumatic brain injury (BI) or stroke, or by spinal cord disorders, such as spinal cord injury (SCI) or multiple sclerosis (MS) (7). Although heterogeneous, the causes of spasticity share a common pathophysiology, in that the damage disrupts the pathways that regulate activity in alpha motor neurones, causing a change in the balance of signals between the nervous system and the muscles. This imbalance leads to increased activity (excitability) in the muscles, resulting in overactive segmental reflexes. Normally when a muscle is rapidly stretched out, a stretch reflex is triggered and the muscle contracts to maintain muscle length and limb position. To allow smooth, non-jerky, coordinated movement, the segmental reflexes must be inhibited to allow the muscle to relax (i.e. stretch). The main neurotransmitter to achieve this is gamma aminobutyric acid (GABA), which is released by neurones in the spinal cord via descending inhibitory impulses from the brain. However, if the descending inhibitory impulses from the brain (and thus GABA) are cut off through disease or injury, inhibition becomes insufficient; instead, excessive muscular contraction during the muscle stretch takes place, resulting in abnormal muscle tone (hypertonicity).

The severity of spasticity varies from mild to severe according to the level of muscle tone (measured by the Ashworth scale or a modified Ashworth scale in most studies) and the level of disability in performing daily activities (8–10). The use of oral medication to treat spasticity is indicated when spasticity interferes with daily functioning, i.e. causes pain, disturbs sleep or affects activities of daily life. In addition, persistent muscular stiffness and spasms can lead to contracture (permanent stiffness of the muscle, tendon or joint, with decreased range of motion) that can be painful and disabling. Thus, treatment aims to reduce muscle tone in order to facilitate movement and limit contracture. However, some patients rely on excess muscle tone when transferring or ambulating, or to maintain posture. Therefore, the use of antispasmodic drugs needs to be tailored to each patient’s specific needs, to find the correct balance. Commonly-used oral drugs include baclofen, tizanidine, diazepam, and dantrolene, which have differing modes of action, but all are aimed at reducing muscle tone and/or spasms (11).

Oral baclofen is used more frequently than other antispasmodic agents to treat spasticity (8). Baclofen is a GABA-agonist that is thought to selectively bind to presynaptic GABA-B receptors, resulting in hyperpolarization of motor horn cells (12) and a subsequent reduction in the hyperactivity of muscle stretch reflexes, clonus, and cutaneous reflexes that elicit muscle spasms (13). Although widely used, baclofen is mainly water soluble and so does not readily cross the blood-brain barrier (14). As a result, patients may require a high dose to treat their spasticity effectively, which can cause intolerable side-effects (15). As an alternative, baclofen can be delivered directly to the cerebrospinal fluid (CSF) in the intrathecal space, bypassing the blood-brain barrier entirely. This allows a much lower dose to be used to achieve similar CSF concentrations as oral baclofen; it has been determined that the intrathecal baclofen (ITB) dose is 100–1,000 times smaller than the oral daily dose (16), which means that a higher CSF concentration can be achieved at a lower plasma concentration than would be achieved with an oral medication (17, 18). As a result, the central nervous system side-effects of oral baclofen (e.g. sedation, drowsiness, headache) may be reduced (12). The fact that baclofen is only slightly lipid soluble means that baclofen remains in the CSF after ITB therapy, with a relatively long half-life (90 min) (19). There is a 4:1 gradient in drug distribution between the caudal and rostral parts of the spinal cord, favouring high levels of action at the spinal level vs the brain and thus further decreasing cerebral side-effects (20). In addition, animal studies have shown that there is a steep gradient of baclofen along the spinal axis, meaning that during slow intrathecal infusion (20 µl/h) most of the baclofen seems to remain around the catheter tip used for the CSF delivery (21). The clinical implication of this is that the catheter position in relation to the targeted spinal cord segment may be critical to efficacy.

This review aims to systematically evaluate the available evidence for oral baclofen,in order to determine: (i) the efficacy of oral baclofen in spasticity treatment in comparison with placebo or active comparators; (ii) the associated complications or adverse events of oral baclofen; (iii) whether the dosage of oral baclofen changes with the disease severity and duration of spasticity. The results are expected to provide a useful overview of the role of oral baclofen in the management of spasticity, no matter the origin or severity of the condition, and could indicate when intrathecal administration should be considered….

Continue —> Journal of Rehabilitation Medicine – Efficacy and safety of oral baclofen in the management of spasticity: A rationale for intrathecal baclofen – HTML

Fig. 1. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram of included/excluded studies.

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[Report] A smart brace to support spasticity management in poststroke rehabilitation – Full Text PDF by Max Lammers

Executive Summary

This report covers the design of a product to help stroke survivors who are suffering from chronic spasticity manage their everyday activities.

In the Netherlands alone, 44.000 people suffer from a Cerebro-Vascular Accident (CVA) each year. A CVA, more commonly known as a stroke, results in brain trauma with afflictions such as paralysis, fatigue and spasticity. It is possible to recover some, if not all, motor function though intensive physiotherapy, which requires longterm stay at a rehabilitation clinic in severe cases. Due to limited room and staff, only 12% of stroke survivors end up rehabilitating in a clinic. The remaining survivors are sent home, and will to travel to the clinic 3-5 times per week for therapy as part of the outpatient rehabilitation.

Adjuvo Motion, a young start-up, aims to improve the situation of stroke survivors by bringing the rehabilitation center to their home through the Adjuvo Platform, which allows them to perform exercises in the context of virtual tasks. They proposed an assignment to extend their product portfolio with a Range of Motion assessment device that is suited for those suffering from spasticity.

Spasticity occurs in roughly 60% of stroke survivors with varying degrees of intensity. It is caused by the damaged parts of the brain sending conflicting signals to the muscles, causing them to contract. This inhibits the survivor’s ability to perform daily tasks, but can be solved temporarily with stretching exercises. A solution to compensate for these spastic forces using a passiveassist device was proposed at the start of this project. The project was divided into four stages: Analysis, Synthesis, Embodiment and Evaluation.

During the Analysis stage, interviews with a Physiotherapist and stroke survivor and literature studies regarding anatomy, the state of the art and relevant technologies were used to create a framework for the design of a smart passive-assist glove. Looking at competing products, there is a demand for passive assist and Range of Motion assessment functionalities, yet a combination of these in a single device is not yet present in the market.

During the Synthesis stage, the design problem of the passive assist device was split into three groups: Orthoses; the connections to the body, Passive Assist; the compensation medium, and RoM measurement; the sensing mechanism(s). These three groups were further split into sub-problems, the solutions to which were compiled into a Morphological Chart. By combining the solution within this chart, three promising concept designs were created: One upgrade to the existing sensor glove, one full integration of sensing and passive assist, and one passive assist glove with removable sensors.

To evaluate these concepts, eight criteria were established and weighted with the help of a physiotherapist. In order to create an objective assessment, the criteria were kept strictly quantitative and the three designs were first scored against the Raphael Smart Glove by Neofect using early prototypes. These scores were then used to evaluate the designs relative to each other, which resulted in an overall higher score for the concept with separable electronics. Making the sensor part of the brace removable allowed the product to be used during daily life as well as physiotherapy exercises, and proved a key benefit in keeping the product clean.

Based on the chosen design, four iterations of prototypes were made, which were tested with healthy subject. During this stage, it became clear that flex sensors are be best suited to create a range of motion assessment for spastic stroke patients, since it is less important to know how well they perform a task, and more important to know if they can actually perform it.

Based on a quantified use case, the four sub-assemblies; the Wrist Wrap, Finger Modules and Sensor Module, and their connections were materialized in the Embodiment design stage. When selecting production methods, the main challenge was a small batch size of 1000 units, which made conventional techniques for mass production, such as Injection Molding, less attractive. This stage ended in an assessment of the product’s production price and durability: The product would cost €250 to make, and would last for 2.5 years before the Velcro connection on the Wrist Wrap would become too weak to sustain the spasticity forces.

In the Evaluation stage, the product was evaluated on the seven most important requirements established during the analysis stage. For several of these, a user test was performed, again with healthy subject. While the Adjuvo Auxilius passed most theoretical requirements, the user tests on healthy subjects could not be used to draw any conclusions regarding its effectiveness on spastic stroke patients. However, since the product’s working principle is based on that of existing spasticity compensation products, the prediction is that the Auxilius will be an effective therapy supplement.

The result of this project is the Adjuvo Auxilius; a spasticitycompensation glove with modular sensors, which can be added to allow virtual (stretching) exercises through the Adjuvo Motion’s platform. The results of these exercises are used to create a remote assessment of the patients motor skills, and to adjust the therapy if needed.

Full Text PDF

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[ARTICLE] Efficacy of Short-Term Robot-Assisted Rehabilitation in Patients With Hand Paralysis After Stroke – Full Text

Background: We evaluated the effectiveness of robot-assisted motion and activity in additional to physiotherapy (PT) and occupational therapy (OT) on stroke patients with hand paralysis. Methods: A randomized controlled trial was conducted. Thirty-two patients, 34.4% female (mean ± SD age: 68.9 ± 11.6 years), with hand paralysis after stroke participated. The experimental group received 30 minutes of passive mobilization of the hand through the robotic device Gloreha (Brescia, Italy), and the control group received an additional 30 minutes of PT and OT for 3 consecutive weeks (3 d/wk) in addition to traditional rehabilitation. Outcomes included the National Institutes of Health Stroke Scale (NIHSS), Modified Ashworth Scale (MAS), Barthel Index (BI), Motricity Index (MI), short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), and the visual analog scale (VAS) measurements. All measures were collected at baseline and end of the intervention (3 weeks). Results: A significant effect of time interaction existed for NIHSS, BI, MI, and QuickDASH, after stroke immediately after the interventions (all, P < .001). The experimental group had a greater reduction in pain compared with the control group at the end of the intervention, a reduction of 11.3 mm compared with 3.7 mm, using the 100-mm VAS scale. Conclusions: In the treatment of pain and spasticity in hand paralysis after stroke, robot-assisted mobilization performed in conjunction with traditional PT and OT is as effective as traditional rehabilitation.

Stroke (or cerebrovascular accident) is a sudden ischemic or hemorrhagic episode which causes a disturbed generation and integration of neural commands from the sensorimotor31 areas of the cortex. As a consequence, the ability to selectively activate muscle tissues for performing movement is reduced.26 Sixty percent of those individuals who survive a stroke exhibit a sensorimotor deficit of one or both hands and may benefit from rehabilitation to maximize recovery of the upper extremity.23,25 Restoration of arm and hand motility is essential for the independent performance of daily activities.23,26 A prompt and effective rehabilitation approach is essential28 to obtain recovery of an impaired limb to prevent tendon shortening, spasticity, and pain.2

Recent technologies have facilitated the use of robots as tools to assist patients in the rehabilitation process, thus maximizing patient outcomes.4 Several groups have developed robotic tools for upper limb rehabilitation of the shoulder and elbow.27 These robotic tools assist the patient with carrying out exercise protocols and may help restore upper limb mobility.22,26 The complexity of wrist and finger articulations had delayed the development of dedicated rehabilitation robots until 2003 when the first tool based on continuous passive motion (CPM) was presented followed by several other solutions, with various levels of complexity and functionality.3

A recent review on the mechanisms for motor relearning reported factors such as attention and stimuli (reinforcement) are crucial during learning which indicates that motor relearning can take place with patients with neurological disorders even when only the sensorial passive stimulation is applied.30 In addition, another review reported the benefits of CPM for stretching and upper limb passive mobilization for patients with stroke but that CPM treatment requires further research.40

Among robotic devices, Gloreha (Figure 1),5,10 with its compliant mechanical transmission, may represent an easily applied innovative solution to rehabilitation, because the hand can perform grasp and release activities wearing the device by mean of a flexible and light orthosis. Our objective of this study was to determine the efficacy of robot-assisted motion in addition to traditional physiotherapy (PT) and occupational therapy (OT) compared with additional time spent in PT and OT on stroke patients with hand paralysis on function, motor strength, spasticity, and pain.

Figure 1. Wearable glove/orthosis.

Continue —> Efficacy of Short-Term Robot-Assisted Rehabilitation in Patients With Hand Paralysis After Stroke – Feb 16, 2017

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