Bench and cross-sectional study.
[Purpose] This study aimed to assess whether robotic rehabilitation can improve upper limb function, activities of daily living performance, and kinematic performance of chronic stroke survivors.
[Subjects and Methods] Participants were 21 chronic stroke survivors (19 men; 60.8 years; Mini-Mental State Examination score: 28; onset duration: 10.2 years). Training exercises were performed with a Whole Arm Manipulator and a 120-inch projective display to provide visual and auditory feedback. Once the training began, red and grey balls appeared on the projective display, and participants performed reaching movements, in the assist-as-needed mode, toward 6 directional targets in a 3-dimensional space. All participants received training for 40 minutes per day, thrice per
week, for 6 weeks. Main outcome measures were upper limb function (Fugl-Meyer Assessment, Action Research Arm Test, and Box and Blocks Test scores), activities of daily living performance (Modified Barthel Index), and kinematic performance (movement velocity) in 6 directions.
[Results] After 6 weeks, significant improvement was observed in upper limb function, activities of daily living performance, and kinematic performance.
This study demonstrated the positive effects of robotic rehabilitation on upper limb function, activities of daily living performance, and kinematic performance in chronic stroke survivors.
Bench and cross-sectional study.
Information obtained from dexterity tests is an important component of a comprehensive examination of the hand.
To analyze and compare finger interdependencies during the performance of the Purdue Pegboard Test (PBT) and comparative daily tasks.
A method based on the optoelectronic kinematic analysis of the precision grip style and on the calculation of cross-correlation coefficients between relevant joint angles, which provided measures of the degree of finger coordination, was conducted on 10 healthy participants performing the PBT and 2 comparative daily living tasks.
Daily tasks showed identifiable interdependencies patterns between the metacarpophalangeal joints of the fingers involved in the grip. Tasks related to activities of daily living resulted in significantly higher cross-correlation coefficients across subjects and movements during the formation and manipulation phases of the tasks (0.7-0.9), whereas the release stage produced significantly lower movement correlation values (0.3-0.7). Contrarily, the formation and manipulation stages of the PBT showed low finger correlation across most subjects (0.2-0.6), whereas the release stage resulted in the highest values for all relevant movements (0.65-0.9).
Interdependencies patterns were consistent for the activities of daily living but differ from the patterns observed from the PBT.
The PBT does not compare well with the whole range of finger movements that account for hand performance during daily tasks.
The debilitating effects on hand function from a number of a neurologic disorders has given rise to the development of rehabilitative robotic devices aimed at restoring hand function in these patients. To combat the shortcomings of previous traditional robotics, soft robotics are rapidly emerging as an alternative due to their inherent safety, less complex designs, and increased potential for portability and efficacy. While several groups have begun designing devices, there are few devices that have progressed enough to provide clinical evidence of their design’s therapeutic abilities. Therefore, a global review of devices that have been previously attempted could facilitate the development of new and improved devices in the next step towards obtaining clinical proof of the rehabilitative effects of soft robotics in hand dysfunction.
A literature search was performed in SportDiscus, Pubmed, Scopus, and Web of Science for articles related to the design of soft robotic devices for hand rehabilitation. A framework of the key design elements of the devices was developed to ease the comparison of the various approaches to building them. This framework includes an analysis of the trends in portability, safety features, user intent detection methods, actuation systems, total DOF, number of independent actuators, device weight, evaluation metrics, and modes of rehabilitation.
In this study, a total of 62 articles representing 44 unique devices were identified and summarized according to the framework we developed to compare different design aspects. By far, the most common type of device was that which used a pneumatic actuator to guide finger flexion/extension. However, the remainder of our framework elements yielded more heterogeneous results. Consequently, those results are summarized and the advantages and disadvantages of many design choices as well as their rationales were highlighted.
The past 3 years has seen a rapid increase in the development of soft robotic devices for hand rehabilitative applications. These mostly preclinical research prototypes display a wide range of technical solutions which have been highlighted in the framework developed in this analysis. More work needs to be done in actuator design, safety, and implementation in order for these devices to progress to clinical trials. It is our goal that this review will guide future developers through the various design considerations in order to develop better devices for patients with hand impairments.
Imagine tying your shoes or putting on a pair of pants while having limited use of your hands. Now imagine the impact on your daily life if that limitation was permanent. The ability to perform activities of daily living (ADL) is highly dependent on hand function, leaving those suffering with hand impairments less capable of executing ADLs and with a reduced quality of life. Unfortunately, the hand is often the last part of the body to receive rehabilitation.
The purpose of this education is to help you understand how to screen, refer and treat patients related to functional performance.
WE DO NOT DIAGNOSE!
Objectives for Today
■ Identify signs and symptoms that indicate a potential vision problem.
■ Identify the differences amongst the variety of vision problems that can occur
following a neurological event and how it impacts functional performance with
■ Identify how to accurately screen for potential vision problems and when to refer to
an eye specialist.
■ Identify therapeutic approaches used to treat and compensate for problems,
allowing for improved function.
Purpose: To investigate the feasibility of using a virtual rehabilitation system with intuitive user interface and force feedback to improve the skills in activities of daily living (ADL).
Method: A virtual training system equipped with haptic devices was developed for the rehabilitation of three ADL tasks – door unlocking, water pouring and meat cutting. Twenty subjects with upper limb disabilities, supervised by two occupational therapists, received a four-session training using the system. The task completion time and the amount of water poured into a virtual glass were recorded. The performance of the three tasks in reality was assessed before and after the virtual training. Feedback of the participants was collected with questionnaires after the study.
Results: The completion time of the virtual tasks decreased during the training (p < 0.01) while the percentage of water successfully poured increased (p = 0.051). The score of the Borg scale of perceived exertion was 1.05 (SD = 1.85; 95% CI = 0.18–1.92) and that of the task specific feedback questionnaire was 31 (SD = 4.85; 95% CI = 28.66–33.34). The feedback of the therapists suggested a positive rehabilitation effect. The participants had positive perception towards the system.
Conclusions: The system can potentially be used as a tool to complement conventional rehabilitation approaches of ADL.
Rehabilitation of activities of daily living can be facilitated using computer-assisted approaches.
The existing approaches focus on cognitive training rather than the manual skills.
A virtual training system with intuitive user interface and force feedback was designed to improve the learning of the manual skills.
The study shows that system could be used as a training tool to complement conventional rehabilitation approaches.
BACKGROUND: Repetitive peripheral magnetic stimulation (rPMS) is a form of therapy that creates painless stimulation of deep muscle structures to improve motor function in people with physical impairment from brain or nerve disorders. Use of rPMS for people after stroke has been identified as a feasible approach to improve activities of daily living and functional ability. However, no systematic reviews have assessed the findings of available trials. The effect and safety of this intervention for people after stroke currently remain uncertain.
OBJECTIVES: To assess the effect of rPMS for improving activities of daily living and functional ability in people after stroke. SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (August 2016), the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, issue 8) in the Cochrane Library (August 2016), Medline OVID (November 2016), Embase OVID (August 2016), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) in Ebsco (August 2016), PsycINFO OVID (August 2016), the Allied and Complementary Medicine Database (AMED) OVID (August 2016), Occupational Therapy Systematic Evaluation of Evidence (OTseeker) (August 2016), the Physiotherapy Evidence Database (PEDro) (October 2016), and ICHUSHI Web (October 2016). We also searched five ongoing trial registries, screened reference lists, and contacted experts in the field. We placed no restrictions on the language or date of publication when searching the electronic databases.
SELECTION CRITERIA: We included randomised controlled trials (RCTs) conducted to assess the therapeutic effect of rPMS for people after stroke. Comparisons eligible for inclusion were (1) active rPMS only compared with ‘sham’ rPMS (a very weak form of stimulation or a sound only); (2) active rPMS only compared with no intervention; (3) active rPMS plus rehabilitation compared with sham rPMS plus rehabilitation; and (4) active rPMS plus rehabilitation compared with rehabilitation only.
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion. The same review authors assessed methods and risk of bias and extracted data. We contacted trial authors to ask for unpublished information if necessary. We resolved all disagreements through discussion.
MAIN RESULTS: We included three trials (two RCTs and one cross-over trial) involving 121 participants. Blinding of participants and physicians was well reported in all trials, and overall risk of bias was low. We found no clear effect of rPMS on activities of daily living at the end of treatment (mean difference (MD) -3.00, 95% confidence interval (CI) -16.35 to 10.35; low-quality evidence) and at the end of follow-up (MD -2.00, 95% CI -14.86 to 10.86; low-quality evidence). Investigators in one study with 63 participants observed no statistical difference in improvement of upper limb function at the end of treatment (MD 2.00, 95% CI -4.91 to 8.91) and at the end of follow-up (MD 4.00, 95% CI -2.92 to 10.92). One trial with 18 participants showed that rPMS treatment was not associated with improved muscle strength at the end of treatment (MD 3.00, 95% CI -2.44 to 8.44). Another study reported a significant decrease in spasticity of the elbow at the end of follow-up (MD -0.48, 95% CI -0.93 to -0.03). No studies provided information on lower limb function and death. Based on the GRADE approach, we judged the certainty of evidence related to the primary outcome as low owing to the small sample size of one study.
AUTHORS’ CONCLUSIONS: Available trials provided inadequate evidence to permit any conclusions about routine use of rPMS for people after stroke. Additional trials with large sample sizes are needed to determine an appropriate rPMS protocol as well as long-term effects. We identified three ongoing trials and will include these trials in the next review update.
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Objective: The purpose of this study was to determine the effect of upper extremity coordination exercise (UECE) during standing on the paretic side on balance, gait ability and activities of daily living (ADL) in persons with stroke.
Design: A randomized controlled trial.
Methods: A total of 27 patients with hemiplegic diagnosis after stroke were divided into two groups. Fourteen patients were in the study group and 13 patients were in the control group. The study group received conventional physical therapy and UECE during standing on the paretic side. The control group received conventional physical therapy and simple upper extremity exercise (SUEE). Subjects in both groups were given upper extremity training for 30 minutes per day, five times a week for 4 weeks. Initial evaluation was performed before treatment and reevaluated 4 weeks later to compare the changes of balance, gait ability and ADL (Korean version of modified Barthel index, K-MBI).
Results: Both groups showed a significant effect for balance, gait ability and ADL (p<0.05). In the Independent t-test, between both groups showed a significant effect for balance and gait ability except ADL (p<0.05).
Conclusions: In this paper, we investigated the changes in balance, walking, and ADL through UECE. We found significant changes in the study group and the control group. Results of the present study indicated that UECE during standing on the paretic side for 4 weeks had an effect on balance, gait ability and ADL (K-MBI) in persons with hemiplegia after stroke.
[Purpose] Investigation of the efficacy of robot-mediated therapy of the upper limb in patients with chronic stroke, in task-oriented training activities of daily living in real environment.
[Subjects and Methods] 20 patients, each more than one year post-stroke (13–71 months) received 20 sessions of upper limb robot-mediated therapy. No other treatment was given. Each therapy session consisted of a passive motion and an active task therapy. During the active therapy, subjects exercised 5 activities of daily living. Assessments of the subjects were blind, and conducted one month prior to, at the start, at the end, and three months after the therapy course. The following outcome measures were recorded: Fugl-Meyer Scale—upper extremity subsection, Modified Ashworth Scale, Action Research Arm Test, Functional Independence Measure, Barthel Index.
[Results] Significant improvements were observed between the start and the end of the therapy, except for Modified Ashworth Scale and Barthel Index. Results still held up at the follow-up visit three months later.
[Conclusion] Practicing activities of daily living in real environment with robot-mediated physical therapy can improve the motor and functional ability of patients, even with relatively good initial functions, and even years post-stroke.