Posts Tagged ADL

[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] Systematic review with network meta-analysis of randomized controlled trials of robotic-assisted arm training for improving activities of daily living and upper limb function after stroke – Full Text

Abstract

Background

The aim of the present study was to to assess the relative effectiveness of the various types of electromechanical-assisted arm devices and approaches after stroke.

Method

This is a systematic review of randomized controlled trials with network meta-analysis. Our primary endpoints were activities of daily living (measured e.g. with Barthel-Index) and hand-arm function (measured e.g. with the Fugl-Meyer Scale for the upper limb), our secondary endpoints were hand-arm strength (measured e.g. with the Motricity Index) and safety. We used conventional arm training as our reference category and compared it with different intervention categories of electromechanical-assisted arm training depending on the therapy approach. We did indirect comparisons between the type of robotic device. We considered the heterogeneity of the studies by means of confidence and prediction intervals.

Results

Fifty five randomized controlled trials, including 2654 patients with stroke, met our inclusion criteria.

For the primary endpoints activities of daily living and hand-arm function and the secondary endpoint hand-arm strength, none of the interventions achieved statistically significant improvements, taking into account the heterogeneity of the studies.

Safety did not differ with regard to the individual interventions of arm rehabilitation after stroke.

Conclusion

The outcomes of robotic-assisted arm training were comparable with conventional therapy.

Indirect comparisons suggest that no one type of robotic device is any better or worse than any other device, providing no clear evidence to support the selection of specific types of robotic device to promote hand-arm recovery.

Introduction

Stroke is one of the most common diseases worldwide and leads to permanent disability, reduced quality of life and thus to a high burden of disease [1]. A majority of stroke patients have limited hand and arm function and are therefore restricted in their daily activities [2]. The recovery of hand-arm function is therefore an important goal for rehabilitation after stroke [1]. In recent years, interventions such as electromechanical-assisted arm training have been introduced to improve hand and arm functions [34]. It has been argued that use of electromechanical-assisted arm training can support the provision of evidence-based rehabilitation, by facilitating therapy that is intensive, frequent and repetitive [3]. However, while systematic reviews show some beneficial effects of electromechanical-assisted arm training on upper limb motor function, these effects are not clinically relevant [34]. Furthermore, there is also some evidence of a detrimental effect, with one systematic review concluding that muscle tone of the upper limb might be negatively influenced by robotic-assisted arm-training [4].

The devices used in electromechanically-assisted arm therapy target the motor function of either the shoulder/elbow, elbow/wrist, wrist/hand, hand/finger or the entire upper extremity [35]. There are two broad types of electromechanical devices which have been used to enable or assist arm and/or hand movement in a patient with a paretic limb following stroke:

  1. (a)An external robotic arm, known as an exoskeleton, which is designed to control one or more joints of the paretic arm. The exoskeleton uses torque actuators in order to apply rotational forces to move, or assist the movement, at a joint. For example, a robotic arm could support the weight of a patient’s arm in the horizontal plane, and assist combined movement at the shoulder and elbow [5].
  2. (b)A robotic device, known as an end-effector, which assists movement of only the distal part of the paretic arm [34]. These devices generally only have contact with the patient’s hand/fingers; and move – or assist the movement – of the distal part of the arm, which may result in movement at more proximal parts of the arm. End effectors may act to move just the paretic limb, or may act to support bilateral arm movement. For example, an end effector may comprise two handles, which are held by the patient’s hands. Movement of the handles facilitates bilateral pronation/supination of the forearm and flexion/extension of the wrist. Movement of the patient’s affected arm may be passive, either driven entirely by the robot or by active movement of the unaffected arm, or may be active-assisted, supported by the robot or unaffected arm [5].

In addition to generating either passive or assisted movement of a paretic arm, electromechanically assisted arm therapy can give patients feedback about the joint position and the arm power used.

Electromechanical-assisted arm therapy may, alternatively, be classified based on whether the robot acts: more proximally or distally, with a one-sided / unilateral or double-sided / bilateral exercise approach, or to give support to specific joint sections. End effector-based therapy robots generally initiate movement via contact with the patient’s hand, generating movement of more proximal joints from this distal contact; while exoskeletal devices can directly guide and control movement of both proximal and distal joints via series of drive elements.

Furthermore, the torque actuators which can be used within robotic devices may have different mechanisms of action, and there is ongoing debate regarding these different approaches to control of force. For example, it remains unclear whether a compliant actuator (e.g. series elastic actuators, an elastic element attached) is any more beneficial than an assist-as-needed control mechanism (e.g. which encourages patients’ active participation), or an impedance control mechanism (e.g. an end effector that takes into account the kinematics and dynamics of the object being manipulated).

With a rapid growth in new technologies and devices over recent decades, there are now a large number of different electromechanical-assisted arm training devices designed to move, or assist movement of, the arm. The types of therapy provided by different devices differ significantly both in terms of the technologies employed and the therapy provided. There is a growing body of evidence, synthesized within systematic reviews, that demonstrates that electromechanical-assisted arm training may be beneficial for recovery of arm function after stroke, with quality of the evidence judged to be ‘high’ (using the GRADE approach) [34]. However, although the evidence on robotic-assisted arm training after stroke seems robust, there remains a lack of information about the relative effects of different types of devices. The existing systematic reviews are arguably limited by their narrow focus, for example on the effectiveness of robotic-assisted arm training or electromechanical-assisted arm rehabilitation compared to control interventions [346]. Thus, while in practice it is crucial to know which type of robotic device performs most effectively in a given situation, the current evidence base lacks direct comparisons of two or more different types of device. Furthermore, it remains unclear which of the different devices or approaches may be most effective for certain subgroups of patients with stroke, meaning that a treating clinician will encounter difficulties in deciding which specific form of treatment to select and/or apply for a specific patient after stroke. Thus, while systematic reviews have explored the effectiveness of electromechanical-assisted arm rehabilitation [34], these have not directly compared the effects of the different types of devices or therapy provided by devices, in order to determine the optimal type of electromechanical-assisted arm training for individual patients.

An approach to solving this problem is offered by network meta-analyses. These enable quantitative synopsis of an “evidence network” by combining direct and indirect effects of three or more interventions, compared to the same comparative intervention (often a control or a no-treatment intervention), within a randomized controlled trial [7]. This is also called a multiple treatment comparison [8].

In this way, network meta-analyses allow the quantitative synthesis of evidence of effectiveness of interventions directly compared within the same randomised controlled trial (direct comparisons) and interventions from different randomised controlled trials which have a common comparator (indirect comparisons) [7]. Network meta-analyses could therefore provide an efficient method for determining the relative effects of different electromechanical-assisted arm training devices and therapy approaches, without the need for new randomised controlled trials.

The aim of the present study was therefore to provide a systematic overview of current randomised controlled trials of electromechanical-assisted arm training, and to use network meta-analysis to assess the relative effectiveness of the various types of electromechanical-assisted arm devices and approaches. We aimed to evaluate the relative effect of different types of electromechanical-assisted arm training on activities of daily living, hand/arm function and hand/arm strength in patients with stroke, and to explore the safety of these devices.[…]

Continue —-> https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-020-00715-0

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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] Exergames in people with major neurocognitive disorder: a systematic review

Purpose

To systematically evaluate the efficacy of exergames in individuals with major neurocognitive disorder.

Materials and methods

PubMed, EMBASE and PEDro were systematically searched from inception until October 2019 for randomised and clinical controlled trials. Methodological quality of the trials was assessed with the PEDro rating scale or Risk of Bias in Nonrandomised Studies of Interventions-I (ROBINS-I), when appropriate. Grading of Recommendations Assessments, Development and Evaluation (GRADE) was used to assess the overall quality of the evidence.

Results

Eight trials, all of moderate to high methodological quality (i.e., PEDro score of 6 or higher or a Robins-I moderate quality score) were included. The overall quality of evidence was moderate to high according to the GRADE criteria. Improvements in gait, mobility and balance and beneficial effects on activities of daily living performance, cognitive function, fear of falls, quality of life and mood following exergaming were reported. Heterogeneity in outcome measures, intervention characteristics and included participants precluded a meta-analysis.

Conclusions

The current literature is of moderate to high quality and demonstrates that exergames have a wide range of physical and mental benefits in people with major neurocognitive disorder. More controlled trials are however needed to confirm the existing evidence before exergames can be recommended in treatment guidelines for people with major neurocognitive disorder.

Implications for rehabilitation

  • Exergames have many physical and mental benefits in people with major neurocognitive disorder

  • Exergaming can enhance gait, mobility and balance in people with major neurocognitive disorder

  • Evidence for beneficial cognitive effects of exergaming is emerging

via Exergames in people with major neurocognitive disorder: a systematic review: Disability and Rehabilitation: Assistive Technology: Vol 0, No 0

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[VIDEO] Addison: the Virtual Caregiver on Vimeo

The Virtual Caregiver is a next generation Virtual Assistant, bringing chronic care, rehabilitation, mental health support, caregiver support, and support for daily living unlike anything you’ve ever seen. She’s Connected Health, Digital Health, IoT, AI, AR, Natural Language, and amazing UX and UI interfaces in a breakthrough user configuration. EMR integrated, health peripherals, in-home automated exams, gait and balance, fall risk assessment, and more. Addison Care is the future, today.

via Addison: the Virtual Caregiver on Vimeo

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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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