Posts Tagged Activities of daily living

[Abstract] Sensory interventions on motor function, activities of daily living, and spasticity of the upper limb in people with stroke: A randomized clinical trial

Highlights

• Sensory function after stroke is a prognostic factor in the achievement of functional performance.

• Sensory stimulation can be helpful technique in the chronic phase of cerebrovascular accident.

• Motor function, ADL, and spasticity can be improved through sensory stimulation.

Abstract

Introduction

Stroke is the second cause of death around the world. Motor and sensory problems are common complications of the stroke. These defects in the upper limb cause reduced use of the affected limb and consequently a decrease in the quality of life.

Purpose of the Study

The purpose of this study was to examine the effect of exteroceptive and proprioceptive stimulations on motor function, spasticity of the upper limb, and activities of daily living in people who have had stroke.

Methods

Sixty people with chronic stroke selected by convenience sampling. Before the intervention, Modified Ashworth Scale, Fugl-Meyer assessment of Motor Recovery after Stroke, and Barthel Index were measured and then the intervention phase was started. Exteroceptive and proprioceptive sensory stimulations were performed for 6 weeks. Independent t-test was used to compare groups.

Results

The intervention group made improvement in motor function (P = .0001, Cohen’s d = 2.14), activities of daily living of upper limb (P = .0001, Cohen’s d = 1.32), and spasticity (P = .002, Cohen’s d = −0.94).

Discussion

Motor function and activities of daily living and spasticity of the upper limb can be improved through exteroceptive and proprioceptive stimulations. In this study, this type of intervention had the most impact on motor function compared with the rest.

Conclusion

Exteroceptive and proprioceptive stimulations in upper limb can be used in chronic phase of stroke. Improvement in motor function and activities of daily living and reducing spasticity are the results of these stimulations.

Source: https://www.sciencedirect.com/science/article/abs/pii/S0894113020300764?dgcid=rss_sd_all

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[Abstract + References] Sensory interventions on motor function, activities of daily living, and spasticity of the upper limb in people with stroke: A randomized clinical trial

Highlights

  • Sensory function after stroke is a prognostic factor in the achievement of functional performance.
  • Sensory stimulation can be helpful technique in the chronic phase of cerebrovascular accident.
  • Motor function, ADL, and spasticity can be improved through sensory stimulation.

Abstract

Introduction

Stroke is the second cause of death around the world. Motor and sensory problems are common complications of the stroke. These defects in the upper limb cause reduced use of the affected limb and consequently a decrease in the quality of life.

Purpose of the Study

The purpose of this study was to examine the effect of exteroceptive and proprioceptive stimulations on motor function, spasticity of the upper limb, and activities of daily living in people who have had stroke.

Methods

Sixty people with chronic stroke selected by convenience sampling. Before the intervention, Modified Ashworth Scale, Fugl-Meyer assessment of Motor Recovery after Stroke, and Barthel Index were measured and then the intervention phase was started. Exteroceptive and proprioceptive sensory stimulations were performed for 6 weeks. Independent t-test was used to compare groups.

Results

The intervention group made improvement in motor function ( P = .0001, Cohen’s d = 2.14), activities of daily living of upper limb ( P = .0001, Cohen’s d = 1.32), and spasticity ( P = .002, Cohen’s d = −0.94).

Discussion

Motor function and activities of daily living and spasticity of the upper limb can be improved through exteroceptive and proprioceptive stimulations. In this study, this type of intervention had the most impact on motor function compared with the rest.

Conclusion

Exteroceptive and proprioceptive stimulations in upper limb can be used in chronic phase of stroke. Improvement in motor function and activities of daily living and reducing spasticity are the results of these stimulations.

Source: https://www.jhandtherapy.org/article/S0894-1130(20)30076-4/fulltext?rss=yes

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[ARTICLE] Timing-dependent effects of transcranial direct current stimulation with mirror therapy on daily function and motor control in chronic stroke: a randomized controlled pilot study – Full Text

Abstract

Background

The timing of transcranial direct current stimulation (tDCS) with neurorehabilitation interventions may affect its modulatory effects. Motor function has been reported to be modulated by the timing of tDCS; however, whether the timing of tDCS would also affect restoration of daily function and upper extremity motor control with neurorehabilitation in stroke patients remains largely unexplored. Mirror therapy (MT) is a potentially effective neurorehabilitation approach for improving paretic arm function in stroke patients. This study aimed to determine whether the timing of tDCS with MT would influence treatment effects on daily function, motor function and motor control in individuals with chronic stroke.

Methods

This study was a double-blinded randomized controlled trial. Twenty-eight individuals with chronic stroke received one of the following three interventions: (1) sequentially combined tDCS with MT (SEQ), (2) concurrently combined tDCS with MT (CON), and (3) sham tDCS with MT (SHAM). Participants received interventions for 90 min/day, 5 days/week for 4 weeks. Daily function was assessed using the Nottingham Extended Activities of Daily Living Scale. Upper extremity motor function was assessed using the Fugl-Meyer Assessment Scale. Upper extremity motor control was evaluated using movement kinematic assessments.

Results

There were significant differences in daily function between the three groups. The SEQ group had greater improvement in daily function than the CON and SHAM groups. Kinematic analyses showed that movement time of the paretic hand significantly reduced in the SEQ group after interventions. All three groups had significant improvement in motor function from pre-intervention to post-intervention.

Conclusion

The timing of tDCS with MT may influence restoration of daily function and movement efficiency of the paretic hand in chronic stroke patients. Sequentially applying tDCS prior to MT seems to be advantageous for enhancing daily function and hand movement control, and may be considered as a potentially useful strategy in future clinical application.

Introduction

Stroke remains one of the leading causes of long-term disability [1]. Most stroke patients have difficulties performing every day activities due to paresis of upper limbs, which results in impaired activities of daily living (ADL) and reduced quality of life [23]. Identifying strategies that can facilitate functional recovery is thus an important goal for stroke rehabilitation. In recent years, several neurorehabilitation approaches have been developed to augment functional recovery, for example repetitive, task-oriented training and non-invasive brain stimulation (NIBS) [45]. Repetitive, task-oriented training emphasizes repetitive practice of task-related arm movements to facilitate motor relearning and restore correct movement patterns [6]. On the other hand, non-invasive brain simulation aims to maximize brain plasticity by externally applying electrical stimulation to modulate cortical excitability [7]. Since these two types of approaches individually have been shown to improve stroke recovery, it has been proposed that a synergistic approach that combines both of them may further augment overall treatment effects [89].

Mirror therapy (MT) is one type of repetitive task-oriented training that has been widely used in clinical and research settings [10]. During MT training, a mirror is positioned in between the paretic and non-paretic arm. The paretic arm is behind the mirror and participants can only see the non-paretic arm and its mirror reflection. Participants are required to focus their attention on the mirror reflection and imagine it is the paretic arm while performing bilateral movements as simultaneously as possible. This mirrored visual feedback is hypothesized to restore the efferent-afferent loop that is damaged after stroke and facilitate re-learning of correct movement patterns [11]. MT has been demonstrated to reduce arm impairment and improve sensorimotor function and quality of life in individuals with stroke [10,11,12,13].

Transcranial direct current stimulation (tDCS) is a commonly used NIBS technique in stroke rehabilitation. tDCS applies weak direct current to the scalp to modulate brain excitability [14]. This weak direct current gradually changes neural membrane potentials to facilitate depolarization (excitation) or hyper-polarization (inhibition) of the neurons to enhance plasticity of the brain [15]. tDCS has been demonstrated to modulate neural networks and enhance motor learning in stroke patients [716,17,18]. Although tDCS can be used alone, it is often combined with other rehabilitation approaches to boost responses of the brain to therapies [81920]. A recent meta-analysis further showed that combining tDCS with rehabilitation interventions could produce greater treatment effects on recovery of motor function than tDCS alone in stroke patients [21].

Combining tDCS with MT is a potentially promising approach to not only augment neural responses of the brain but also increase treatment benefits of MT. Nevertheless, one crucial factor that needs to be considered when combining tDCS with MT is the timing of tDCS [22]. tDCS can be applied prior to MT (i.e., offline tDCS) or concurrently with MT (i.e., online tDCS). To our knowledge, only two studies have examined the synergistic effects of combined tDCS with MT in chronic stroke patients [2324]. Cho et al. (2015) applied tDCS prior to MT or motor training without mirror reflection. They found significant improvements in manual dexterity and grip strength in the combined tDCS with MT group, suggesting that sequentially applying tDCS prior to MT could improve motor function. By contrast, Jin et al. (2019) delivered tDCS prior to or concurrently with MT and found advantageous effects on hand function in the concurrent tDCS with MT group. The conflicting results between these two studies indicated further needs to explore the interaction effects of the timing of tDCS with MT to determine the optimal combination strategy.

The important factor to consider when examining the effects of combined tDCS with MT is the treatment outcomes, especially for outcomes that are related to daily activities. ADL such as the basic ADL and complex instrumental ADL (IADL) are essential for independent living and well-being of stroke patients. Therefore, restoring daily function should be one of the priority goals of stroke rehabilitation. However, the previous two studies only examined the effects of combined tDCS with MT on motor function [2324]. No studies to date have examined the timing-dependent effects of tDCS with MT on daily function in chronic stroke patients. Whether the timing of tDCS can affect restoration of daily function with MT remains uncertain.

In addition to daily function, investigating arm movement kinematics changes with respect to the timing of tDCS with MT is also critical for determining the optimal combination strategy. Movement kinematics of the arms can provide information of whether true behavioral changes or compensation strategies occur during training [2526]. However, the two previous studies included only clinical motor function measurements [2324]. While these clinical measurements can inform clinicians/researchers of motor function changes, they may not necessarily capture spatial and temporal characteristics of movement as well as motor control strategies changes after the combined interventions [2627]. Assessing movement kinematics changes with respect to the timing of tDCS with MT would help to unravel the benefits of combined approach on motor control of the paretic arm.

The purpose of this study was to examine the timing-dependent effects of tDCS with MT on daily function, upper extremity motor function and motor control in chronic stroke patients. The tDCS was applied sequentially prior to MT (i.e., sequentially combined tDCS with MT group, SEQ) or concurrently with MT (i.e., concurrently combined tDCS with MT, CON). The sham tDCS with MT was used as the control condition. In addition to motor function outcomes, we further included the ADL/IADL measurement and movement kinematics assessments. We hypothesized that the SEQ and COM groups would demonstrate differential improvements in daily function, motor function and motor control.[…]

Full Text

Source: https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-020-00722-1

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[Abstract] Effects of Exoskeletal Lower Limb Robot Training on the Activities of Daily Living in Stroke Patients: Retrospective Pre-Post Comparison Using Propensity Score Matched Analysis

Abstract

Purpose

There is limited evidence of gait training using newly developed exoskeletal lower limb robot called Hybrid Assistive Limb (HAL) on the function and ability to perform ADL in stroke patients. In clinical settings, we frequently find it challenging to conduct a randomized controlled trial; thus, a large-scale observational study using propensity score analysis methods is a feasible alternative. The present study aimed to determine whether exoskeletal lower limb robot training improved the ability to perform ADL in stroke patients.

Materials and methods

Acute stroke patients who were admitted to our facility from April 2016 to March 2017 were evaluated in the conventional rehabilitation period (CRP) and those admitted from April 2017 to June 2019 were evaluated in the HAL rehabilitation period (HRP). We started a new gait rehabilitation program using HAL at the midpoint of these two periods. The functional outcomes or ADL ability outcomes of the patients in the CRP and the subsequent HRP were compared using propensity score matched analyses.

Results

Propensity score matching analysis was performed for 108 stroke patients (63 from the CRP and 45 from the HRP), and 36 pairs were matched. The ADL ability, defined by the FIM scores and FIM score change, was significantly higher in patients admitted during the HRP. In addition, more stroke patients obtained practical walking ability during hospitalization in the HRP.

Conclusion

Gait training using HAL affects the ADL ability and obtaining of practical walking ability of stroke patients.

via Effects of Exoskeletal Lower Limb Robot Training on the Activities of Daily Living in Stroke Patients: Retrospective Pre-Post Comparison Using Propensity Score Matched Analysis – ScienceDirect

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[Abstract] Effects of transcranial magnetic stimulation on the performance of the activities of daily living and attention function after stroke: a randomized controlled trial

We aimed to interrogate the effects of transcranial magnetic stimulation (TMS) on the performance in activities of daily living (ADL) and attention function after stroke.

Randomized controlled trial.

Inpatient rehabilitation hospital.

We randomized 62 stroke patients with attention dysfunction who were randomly assigned into two groups, and two dropped out from each group. The TMS group (n = 29) and a sham group (n = 29), whose mean (SD) was 58.12 (6.72) years. A total of 33 (56.9%) patients had right hemisphere lesion while the rest 25 (43.1%) patients had left hemisphere lesion.

Patients in the TMS group received 10 Hz, 700 pulses of TMS, while those in the sham group received sham TMS for four weeks. All the participants underwent comprehensive cognitive training.

At baseline, and end of the four-week treatment, the performance in the activities of daily living was assessed by Functional Independence Measure (FIM). On the other side, attention dysfunction was screened by Mini-Mental State Examination (MMSE), while the attention function was assessed by the Trail Making Test-A (TMT-A), Digit Symbol Test (DST) and Digital Span Test (DS).

Our data showed a significant difference in the post-treatment gains in motor of Functional Independence Measure (13.00 SD 1.69 vs 4.21 SD 2.96), cognition of Functional Independence Measure (4.69 SD 1.56 vs 1.52 SD 1.02), total of Functional Independence Measure (17.69 SD 2.36 vs 5.72 SD 3.12), Mini-Mental State Examination (3.07 SD 1.36 vs 1.21 SD 0.62), time taken in Trail Making Test-A (96.67 SD 25.18 vs 44.28 SD 19.45), errors number in Trail Making Test-A (2.72 SD 1.03 vs 0.86 SD 1.03), Digit Symbol Test (3.76 SD 1.09 vs 0.76 SD 0.87) or Digital Span Test (1.69 SD 0.54 vs 0.90 SD 0.72) between the TMS group and the sham group (P < 0.05).

Taken together, we demonstrate that TMS improves the performance in the activities of daily living and attention function in patients with stroke.

via Effects of transcranial magnetic stimulation on the performance of the activities of daily living and attention function after stroke: a randomized controlled trial – Yuanwen Liu, Mingyu Yin, Jing Luo, Li Huang, Shuxian Zhang, Cuihuan Pan, Xiquan Hu, 2020

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[Abstract] The use of augmented reality for rehabilitation after stroke: a narrative review

Purpose

To explore research relating to the use of Augmented Reality (AR) technology for rehabilitation after stroke in order to better understand the current, and potential future application of this technology to enhance stroke rehabilitation.

Methods

Database searches and reference list screening were conducted to identify studies relating to the use of AR for stroke rehabilitation. These studies were then reviewed and summarised.

Results

Eighteen studies were identified where AR was used for upper or lower limb rehabilitation following stroke. The findings of these studies indicate the technology is in the early stages of development and application. No clear definition of AR was established, with some confusion between virtual and augmented reality identified. Most AR systems engaged users in rote exercises which lacked an occupational focus and contextual relevance. User experience was mostly positive, however the poor quality of the studies limits generalisability of these findings to the greater stroke survivor population.

Conclusion

AR systems are currently being used for stroke rehabilitation in a variety of ways however the technology is in its infancy and warrants further investigation. A consistent definition of AR must be developed and further research is required to determine the possibilities of using AR to promote practice of occupations in a more contextually relevant environment to enhance motor learning and generalisation to other tasks. This could include using AR to bring the home environment into the hospital setting to enhance practice of prioritised occupations before returning home.

  • IMPLICATIONS FOR REHABILITATION

  • There is a developing body of evidence evaluating the use of various forms of AR technology for stroke rehabilitation.

  • User motivation and engagement in rehabilitation may improve with the use of AR.

  • A clear and consistent definition for AR must be developed.

  • Ongoing work could explore how AR systems support engagement in, and promote motor learning that links to, meaningful occupations.

via The use of augmented reality for rehabilitation after stroke: a narrative review: Disability and Rehabilitation: Assistive Technology: Vol 0, No 0

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[ARTICLE] Hand Extension Robot Orthosis (HERO) Grip Glove: enabling independence amongst persons with severe hand impairments after stroke – Full Text

Abstract

Background

The Hand Extension Robot Orthosis (HERO) Grip Glove was iteratively designed to meet requests from therapists and persons after a stroke who have severe hand impairment to create a device that extends all five fingers, enhances grip strength and is portable, lightweight, easy to put on, comfortable and affordable.

Methods

Eleven persons who have minimal or no active finger extension (Chedoke McMaster Stage of Hand 1–4) post-stroke were recruited to evaluate how well they could perform activities of daily living and finger function assessments with and without wearing the HERO Grip Glove.

Results

The 11 participants showed statistically significant improvements (p < 0.01), while wearing the HERO Grip Glove, in the water bottle grasp and manipulation task (increase of 2.3 points, SD 1.2, scored using the Chedoke Hand and Arm Inventory scale from 1 to 7) and in index finger extension (increase of 147o, SD 44) and range of motion (increase of 145o, SD 36). The HERO Grip Glove provided 12.7 N (SD 8.9 N) of grip force and 11.0 N (SD 4.8) of pinch force to their affected hands, which enabled those without grip strength to grasp and manipulate blocks, a fork and a water bottle, as well as write with a pen. The participants were ‘more or less satisfied’ with the HERO Grip Glove as an assistive device (average of 3.3 out of 5 on the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 Scale). The highest satisfaction scores were given for safety and security (4.6) and ease of use (3.8) and the lowest satisfaction scores were given for ease of donning (2.3), which required under 5 min with assistance. The most common requests were for greater grip strength and a smaller glove size for small hands.

Conclusions

The HERO Grip Glove is a safe and effective tool for enabling persons with a stroke that have severe hand impairment to incorporate their affected hand into activities of daily living, which may motivate greater use of the affected upper extremity in daily life to stimulate neuromuscular recovery.

Background

Fifteen million individuals worldwide experience a stroke each year with 50,000 of these cases occurring in Canada [1]. Approximately two-thirds of these individuals will experience neurological deficit [2] and half will never fully recover the hand function required to perform activities of daily living independently [3]. Stroke survivors with severe hand impairment have difficulty producing hand motion and grip force and their increased muscle tone, spasticity and contractures keep their hand clenched in a fist. These stroke survivors have the potential to attain functional improvements years after their stroke by constantly incorporating the affected hand into activities of daily living (ADLs) and additional goal-directed tasks during their therapy exercises and daily routines [4,5,6].

There are many barriers to incorporating the affected hand into exercises and daily routines including time, discomfort, safety risks and mental and physical effort. Personalized, high-intensity, coaching and motion assistance is required to overcome these barriers but is often inaccessible to stroke survivors. The time and resource commitments are too substantial for many clinics to supply at a sufficient intensity and additional rehabilitation technologies and services can be inaccessible due to high cost, location and availability [78]. As a result, stroke survivors often do not regain the hand range of motion (ROM), strength and coordination required to perform ADLs independently. Affordable and accessible rehabilitation technologies and services that enable stroke survivors with severe hand impairment to incorporate their affected hand into ADLs are needed to maximize neuromuscular recovery and daily independence.

Design targets for wearable hand robots

A main goal for wearable hand robots is to provide the hand function assistance and rehabilitation required to enable people after stroke to perform ADLs independently. Able-bodied individuals move their fingers through a ROM of 164o during activities of daily living, as calculated by summing the differences between the extension and flexion joint angles of the distal interphalangeal (DIP), proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints [9]. The thumb moves through a ROM of 40o, as calculated by summing the differences between the extension and flexion joint angles of the thumb’s interphalangeal (IP) and MCP joints [9]. Grip forces averaging 67 N are exerted [10] and a combination of hand postures are used (i.e. a tripod pinch was used during 38% of the activities of daily living evaluated, extended hand (13%), cylindrical grasp (12%), lumbrical grasp (10%), lateral pinch (9%)) [11].

Capabilities of wearable hand robots

Wearable hand robots have manipulated able-bodied participants’ relaxed hands to provide 129o of index finger ROM, 83 N of grip strength as measured using a hand dynamometer, and 7 hand postures in Rose et al. [10]. However, when these robots are evaluated with impaired hands the assistive capabilities have been much lower. For studies by Cappello et al. and Soekadar et al. with six and nine persons with impaired hands following a spinal cord injury, wearable hand robots have increased grip strength to 4 N [12] and ADL performance to 5.5 out of 7 on the Toronto Rehabilitation Institute – Hand Function Test by assisting pinch and palmar grasp postures [1213]. For a study by Yurkewich et al. with five persons with severely impaired hands following stroke (no voluntary index finger extension), a previous version of the HERO Grip Glove named the HERO Glove increased ROM to 79o and improved water bottle and block grasping performance [14]. Refer to [14] for a supplementary table detailing recently developed wearable hand robots, their capabilities and their evaluation results. Hand robots need to be improved to generate strong extension and grip forces that overcome muscle tone and securely stabilize various object geometries, such as a water bottle and a fork. These robots should also be easy to put on clenched hands, comfortable during multiple hours of use, lightweight so as not to affect the motion of weak arms and affordable so they are accessible to people with limited income even though these considerations create design tradeoffs that sacrifice assistive capabilities [1415].

A number of sensor types (i.e. button [121416], electromyography [1718], motion [1014], force [19], voice [20], vision [2122] and electroencephalography [13] have been selected to control robot assistance based on varied motivations such as robust operation or motivating neuromuscular activation. However, other than button control, these control strategies are still in an experimental stage that requires experts to manually tune each user’s orthosis [17].

A single study evaluating two stroke survivors’ satisfaction with a wearable hand robot was completed by Yap et al. [16] to understand their needs and preferences in wearable hand robot design. More rigorous studies would further inform designers on how to adapt their wearable hand robots to maximize the intended users’ satisfaction and arm and hand use.

This article presents the portable Hand Extension Robot Orthosis (HERO) Grip Glove, including its novel design features and the evaluation of its assistive capabilities and usability with 11 stroke survivors with severe hand impairments. The HERO Grip Glove, shown in Fig. 1, assists five-finger extension, thumb abduction and tripod pinch grasping using particular cable materials and routing patterns and only two linear actuators. A fold-over wrist brace is used to mount the electronic components, support the wrist, and ease donning. The robot is controlled by hand motion or a button. The robot is open source for broad access, untethered and lightweight for unencumbered use throughout daily routines, and soft to conform to hands and objects of varying geometries. The HERO Grip Glove increases range of motion and ADL performance with large and small objects and increases grip strength for those without grip strength. The participants’ quantitative and qualitative feedback from their user satisfaction questionnaires provides guidance for assistive technology developers and motivation for deploying the HERO Grip Glove to stroke survivors for use throughout their daily routines.

 

figure1

The HERO Grip Glove assists finger and thumb extension and flexion to enable users to grasp large and small objects. The HERO Grip Glove consists of (a) cable tie guides, (b) an open-palm glove, (c) cable tie tendons for extension, (d) a 9 V battery case with the battery inside and the microcontroller with an inertial measurement unit mounted between the case and the glove, (e) buttons to control the manual mode and select between the manual and automatic modes used in [14], (f) a linear actuator, (g) a foldable wrist brace, (h) cable tie pawls for pre-tensioning, (i) fishing wire tendons for flexion, (j) tendon anchor points on the wrist brace and (k) Velcro straps to secure the glove. The glove folds open to ease donning. The dorsal and palmar tendons’ routing paths are highlighted in yellow

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[ARTICLE] Upper Extremity Function Assessment Using a Glove Orthosis and Virtual Reality System – Full Text

Abstract

Hand motor control deficits following stroke can diminish the ability of patients to participate in daily activities. This study investigated the criterion validity of upper extremity (UE) performance measures automatically derived from sensor data during manual practice of simulated instrumental activities of daily living (IADLs) within a virtual environment. A commercial glove orthosis was specially instrumented with motion tracking sensors to enable patients to interact, through functional UE movements, with a computer-generated virtual world using the SaeboVR software system. Fifteen stroke patients completed four virtual IADL practice sessions, as well as a battery of gold-standard assessments of UE motor and hand function. Statistical analysis using the nonparametric Spearman rank correlation reveals high and significant correlation between virtual world-derived measures and the gold-standard assessments. The results provide evidence that performance measures generated during manual interactions with a virtual environment can provide a valid indicator of UE motor status.

Introduction

Virtual world-based games, when combined with human motion sensing, can enable a neurorehabilitation patient to engage in realistic occupations that involve repetitive practice of functional tasks (). An important component of such a system is the ability to automatically track patient movements and use those data to produce indices related to movement quality (). Before these technology-derived measures can be considered relevant to clinical outcomes, criterion validity must be established. If validated, measures of virtual task performance may reasonably be interpreted as reflective of real-world functional status.

The objective of the study described in this article was to investigate the criterion validity of upper extremity (UE) performance measures automatically derived from sensor data collected during practice of simulated instrumental activities of daily living (IADLs) in a virtual environment. A commercially available SaeboGlove orthosis () was specially instrumented to enable tracking of finger and thumb movements. This instrumented glove was employed with an enhanced version of the Kinect sensor-based SaeboVR software system () to enable employment of the hand, elbow, and shoulder in functional interactions with a virtual world. Performance measures were automatically generated during patient use through a combination of arm tracking data from the Kinect and the glove’s finger and thumb sensors. The primary investigational objective was to determine whether performance indices produced by this system for practice of virtual IADLs are valid indicators of a stroke patient’s UE motor status.

Previous investigations into combining hand tracking with video games to animate UE therapy have produced evidence for the efficacy of such interventions. A recent study compared a 15-session hand therapy intervention using a smart glove system and video games with a usual care regimen (). Stroke patients using the smart glove system realized greater gains in Wolf Motor Function Test (WMFT) score compared with dosage-balanced conventional therapy. Another study investigating a similar glove-based device found significantly greater improvements in Fugl-Meyer and Box and Blocks test results for stroke patients who performed 15 sessions that included the technology-aided therapy compared with subjects receiving traditional therapy only (). An instrumented glove has also been used to support video game therapy that incorporates gripping-like movements and thumb-finger opposition ().

Past research into the use of human motion tracking (sometimes referred to as motion capture) technologies for assessment of UE function has produced encouraging results. One group of researchers compared naturalistic point-to-point reaching movements with standardized reaching movements embedded in a virtual reality system, and established concurrent validity between the two (). An investigation involving a device that incorporates handgrip strength and pinch force measurement into virtual reality exercises provided support for system use as an objective evaluation of hand function, and for the potential of replacing conventional goniometry and dynamometry (). In another study, researchers employed a Kinect sensor in a software system that attempts to emulate a subset of the Fugl-Meyer Upper Extremity (FMUE) assessment (). Pearson correlation analysis between the Kinect-derived scores and traditionally administered FMUE test results for 41 hemiparetic stroke patients revealed a high correlation. Previous research involving the SaeboVR system established a moderate and statistically significant correlation between virtual IADL performance scores and the WMFT (). Due to limitations of the Kinect optical tracking system, this previous work involving the SaeboVR system did not include tracking of grasp-release manual interactions with virtual objects (). The present research addresses this limitation by fusing data from the Kinect sensor with data from finger- and wrist-mounted sensors on the SaeboGlove orthosis to reconstruct the kinematic pose of the patient’s UE.

The use of an assistive glove orthosis in the present work fills an important clinical need. Inability to bring the hand and wrist into a neutral position due to weakness and/or lack of finger extension can prevent participation in occupation-oriented functional practice (). A common technique to enable stroke patients to achieve a functional hand position (and thus participate in rehabilitation) is a dynamic splint that supports finger and/or wrist extension. When larger forces are necessary (e.g., to overcome abnormal muscle tone), an outrigger-type splint may be employed. For patients with no more than mild hypertonicity, a lower-profile device such as the SaeboGlove orthosis () can be used. Employment of an assistive glove orthosis in the context of virtual IADLs practice thus addresses some of the leading causes of hand motor control deficits following stroke and their adverse impact on ability to participate in daily activities ().

Method

Participants

Candidates were recruited from a population of stroke patients receiving in-patient rehabilitation care, outpatient rehabilitation, or who had been previously discharged from rehabilitative care at the UVA Encompass Health Rehabilitation Hospital (Charlottesville, VA, USA). Table 1 includes the study characteristics. Of 17 patients enrolled in the study, 15 completed the protocol. One subject dropped out due to unrelated illness. A second subject was disenrolled due to an inability to adequately express an understanding of consent during re-verification at the beginning of the first post-consent study session.

Table 1.

Patient Characteristics (n = 17).

Age, years, median (range) 67 (25-83)
Time since stroke onset in months, median (range) 12 (1-72)
Sex, M/F, n (%) 10 (59)/7 (41)
Race category, Black/White, n (%) 3 (18)/14 (82)
Ethnic category, Hispanic/non-Hispanic, n (%) 0 (0)/17 (100)
Side of hemiplegia, L/R, n (%) 10 (59)/7 (41)
Affected side dominance, dominant/nondominant, n (%) 9 (53)/8 (47)

All study activities were conducted under the auspices of the University of Virginia Institutional Review Board for Health Sciences Research (IRB-HSR). All study sessions took place in a private room within the UVA Encompass Health outpatient clinic between October 20, 2017, and February 9, 2018. Licensed Occupational Therapists trained in study procedures and registered with the IRB-HSR were responsible for all patient contact, recruitment, consent, and protocol administration.

Verification of inclusion/exclusion criteria was through a three-step process including an initial medical record review prior to recruitment, verbal confirmation prior to administration of consent, and an evaluation screen conducted by a study therapist following consent. Inclusion criteria included history of stroke with hemiplegia, ongoing stroke-related hand impairment, sufficient active finger flexion at the metacarpal phalangeal joint in at least one finger to be detected by visual observation by a study therapist, antigravity strength at the elbow to at least 45° of active flexion, antigravity shoulder strength to at least 30° each in active flexion and abduction/adduction, and 15° in active shoulder rotation from an upright seated position. Participants had visual acuity with corrective lenses of 20/50 or better and were able to understand and follow verbal directions. The study excluded patients with visual field deficit in either eye that would impair ability to view the computer monitor and/or with hemispatial neglect that would impair an individual’s ability to process and perceive visual stimuli. The study also excluded individuals with motor limb apraxia, significant muscle spasticity, or contractures of the muscles, joints, tendons, ligaments, or skin that would restrict normal UE movement.

Materials

A commercial SaeboGlove orthosis was fitted with wrist and finger motion sensors to permit tracking of finger joint angles during grasp-release interactions with a virtual environment. The instrumented glove orthosis is shown in Figure 1. The sensors were attached to the existing tensioner band hooks on the dorsal side of each glove finger. An electronics enclosure mounted to the palmar side of the SaeboGlove’s plastic wrist splint processes the sensor data and transmits information to a personal computer (PC) that hosts the modified SaeboVR software. Data from both the SaeboGlove-integrated sensors and from a Kinect sensor were used by a custom motion capture algorithm, which employs a human UE kinematics model to produce real-time estimates of arm, wrist, and finger joint angles.

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Figure 1.
SaeboGlove orthosis with sensors to track grasp interactions.

[…]

 

Continue —->  Upper Extremity Function Assessment Using a Glove Orthosis and Virtual Reality System

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[Abstract] A Review on Surface Electromyography-Controlled Hand Robotic Devices Used for Rehabilitation and Assistance in Activities of Daily Living

Abstract

Introduction

Spinal cord injuries, traumas, natural aging, and strokes are the main causes of arm impairment or even a chronic disability for an increasing part of the population. Therefore, robotic devices can be essential tools to help individuals afflicted with hand deficit with the activities of daily living in addition to the possibility of restoring hand functions by rehabilitation. Because the surface electromyography (sEMG) control paradigm has recently emerged as an interesting intention control method in devices applied to rehabilitation, the concentration in this study has been devoted to sEMG-controlled hand robotic devices, including gloves and exoskeletons that are used for rehabilitation and for assistance in daily activities.

Materials and Methods

A brief description is given to the previous reviews and studies that have surveyed the robotic devices used for rehabilitation; a comparison is conducted among these studies with respect to the targeted part of the body and the device’s control method. Important issues about controlling by sEMG signal are accentuated, and a review of sEMG-controlled hand robotic devices is presented with an abbreviated description for each endeavor. Some criteria related to sEMG control are specifically emphasized, for instance, the muscles used for control, the number of sEMG channels, and the type of sEMG sensor used.

Discussion

It is noted that most of the sEMG-based controls for the devices included in this study have used the nonpattern recognition scheme due to the weak sEMG signals and abnormal pattern of muscle activation for stroke patients. In addition to sEMG-based control, additional control paradigms have been used in many of the listed robotic devices to increase the efficacy of the system; this cooperation is required because of the difficulty in dealing with the sEMG signals of stroke patients. Most of the listed studies have conducted the experiments on a healthy subject to evaluate the efficacy of the systems, whereas the studies that have recruited stroke patients for system assessment were predominately using additional control schemes.

Conclusions

This article highlights the important issues about the sEMG control method and accentuates the weaknesses associated with this type of control to assist researchers in overcoming problems that impede sEMG-controlled robotic devices to be feasible and practical tools for people afflicted with hand impairment.

via A Review on Surface Electromyography-Controlled Hand Robotic… : JPO: Journal of Prosthetics and Orthotics

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[Abstract] Robotic-assisted therapy with bilateral practice improves task and motor performance in the upper extremities of chronic stroke patients: A randomised controlled trial.

Abstract

BACKGROUND/AIM:

Task-specific repetitive training, a usual care in occupational therapy practice, and robotic-aided rehabilitation with bilateral practice are used to improve upper limb motor and task performance. The difference in effects of two strategies requires exploration. This study compared the impact of robotic-assisted therapy with bilateral practice (RTBP) and usual task-specific training facilitated by therapists on task and motor performance for stroke survivors.

METHODS:

Forty-three community-dwelling stroke survivors (20 males; 23 females; 53.3 ± 13.1 years; post-stroke duration 14.2 ± 10.9 months) were randomised into RTBP and usual care. All participants received a 10-minute per-protocol sensorimotor stimulation session prior to interventions as part of usual care. Primary outcome was different in the amount of use (AOU) and quality of movement (QOM) on the Motor Activity Log (MAL) scale at endpoint. Secondary outcomes were AOU and QOM scores at follow-up, and pre-post and follow-up score differences on the Fugl-Meyer Assessment (FMA) and surface electromyography (sEMG). Friedman and Mann-Whitney U tests were used to calculate difference.

RESULTS:

There were no baseline differences between groups. Both conditions demonstrated significant within-group improvements in AOU-MAL and FMA scores following treatment (P < 0.05) and improvements in FMA scores at follow-up (P < 0.05). The training-induced improvement in AOU (30.0%) following treatment was greater than the minimal detectable change (16.8%) in the RTBP group. RTBP demonstrated better outcomes in FMA wrist score (P = 0.003) and sEMG of wrist extensor (P = 0.043) following treatment and in AOU (P < 0.001), FMA total score (P = 0.006), FMA wrist score (P < 0.001) and sEMG of wrist extensor (P = 0.017) at follow-up compared to the control group. Control group boost more beneficial effects on FMA hand score (P = 0.049) following treatment.

CONCLUSIONS:

RTBP demonstrated superior upper limb motor and task performance outcomes compared to therapists-facilitated task training when both were preceded by a 10-minute sensorimotor stimulation session.

 

via Robotic-assisted therapy with bilateral practice improves task and motor performance in the upper extremities of chronic stroke patients: A randomi… – PubMed – NCBI

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