Bench and cross-sectional study.
Stroke generates dependence on the patients due to the various impairments associated. The use of low-cost technologies for neurological rehabilitation may be beneficial for the treatment of these patients.
To determine whether combined treatment using a semi-immersive virtual reality protocol to an interdisciplinary rehabilitation approach, improve balance and postural control, functional independence, quality of life, motivation, self-esteem and adherence to intervention in stroke patients in subacute stage.
A longitudinal prospective study with pre and post-intervention evaluation was carried out. Fourteen were recruited at La Fuenfria Hospital (Spain) and completed the intervention. Experimental intervention was performed during eight weeks in combination with conventional treatment of physiotherapy and occupational therapy. Each session was increased in time and intensity, using commercial video games linked to Xbox 360° videoconsole and Kinect sensor.
There were statistical significant improvements in modified Rankin scale (p = 0.04), baropodometry (load distribution, p = 0.03; support surface, p = 0.01), Barthel Index (p = 0.01), EQ-5D Questionnaire (p = 0.01), motivation (p = 0.02), self-esteem (p = 0.01) and adherence to the intervention (p = 0.02).
An interdisciplinary rehabilitation approach supplemented with semi-immersive virtual reality seems to be useful for improving balance and postural control, functional independence in basic activities of daily living, quality of life, as well as motivation and self-esteem, with excellent adherence. This intervention modality could be adopted as a therapeutic tool in neurological rehabilitation of stroke patients in subacute stage.
Electromechanical and robot‐assisted arm training devices are used in rehabilitation, and may help to improve arm function after stroke.
To assess the effectiveness of electromechanical and robot‐assisted arm training for improving activities of daily living, arm function, and arm muscle strength in people after stroke. We also assessed the acceptability and safety of the therapy.
We searched the Cochrane Stroke Group’s Trials Register (last searched January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2018, Issue 1), MEDLINE (1950 to January 2018), Embase (1980 to January 2018), CINAHL (1982 to January 2018), AMED (1985 to January 2018), SPORTDiscus (1949 to January 2018), PEDro (searched February 2018), Compendex (1972 to January 2018), and Inspec (1969 to January 2018). We also handsearched relevant conference proceedings, searched trials and research registers, checked reference lists, and contacted trialists, experts, and researchers in our field, as well as manufacturers of commercial devices.
Randomised controlled trials comparing electromechanical and robot‐assisted arm training for recovery of arm function with other rehabilitation or placebo interventions, or no treatment, for people after stroke.
Two review authors independently selected trials for inclusion, assessed trial quality and risk of bias, used the GRADE approach to assess the quality of the body of evidence, and extracted data. We contacted trialists for additional information. We analysed the results as standardised mean differences (SMDs) for continuous variables and risk differences (RDs) for dichotomous variables.
We included 45 trials (involving 1619 participants) in this update of our review. Electromechanical and robot‐assisted arm training improved activities of daily living scores (SMD 0.31, 95% confidence interval (CI) 0.09 to 0.52, P = 0.0005; I² = 59%; 24 studies, 957 participants, high‐quality evidence), arm function (SMD 0.32, 95% CI 0.18 to 0.46, P < 0.0001, I² = 36%, 41 studies, 1452 participants, high‐quality evidence), and arm muscle strength (SMD 0.46, 95% CI 0.16 to 0.77, P = 0.003, I² = 76%, 23 studies, 826 participants, high‐quality evidence). Electromechanical and robot‐assisted arm training did not increase the risk of participant dropout (RD 0.00, 95% CI ‐0.02 to 0.02, P = 0.93, I² = 0%, 45 studies, 1619 participants, high‐quality evidence), and adverse events were rare.
People who receive electromechanical and robot‐assisted arm training after stroke might improve their activities of daily living, arm function, and arm muscle strength. However, the results must be interpreted with caution although the quality of the evidence was high, because there were variations between the trials in: the intensity, duration, and amount of training; type of treatment; participant characteristics; and measurements used.
Electromechanical‐assisted training for improving arm function and disability after stroke
To assess the effects of electromechanical and robot‐assisted arm training for improving arm function in people who have had a stroke.
More than two‐thirds of people who have had a stroke have difficulties with reduced arm function, which can restrict a person’s ability to perform everyday activities, reduce productivity, limit social activities, and lead to economic burden. Electromechanical and robot‐assisted arm training uses specialised machines to assist rehabilitation in supporting shoulder, elbow, or hand movements. However, the role of electromechanical and robot‐assisted arm training for improving arm function after stroke is unclear.
We identified 45 trials (involving 1619 participants) up to January 2018 and included them in our review. Twenty‐four different electromechanical devices were described in the trials, which compared electromechanical and robot‐assisted arm training with a variety of other interventions. Participants were between 21 to 80 years of age, the duration of the trials ranged from two to 12 weeks, the size of the trials was between eight and 127 participants, and the primary outcome (activities of daily living: the most important target variable measured) differed between the included trials.
Electromechanical and robot‐assisted arm training improved activities of daily living in people after stroke, and function and muscle strength of the affected arm. As adverse events, such as injuries and pain, were seldom described, these devices can be applied as a rehabilitation tool, but we still do not know when or how often they should be used.
Quality of the evidence
The quality of the evidence was high.
Stroke is the main cause of permanent and complex long-term disability in adults. RETRAINER S2 is a system able to recover and support person’s ability to perform Activities of Daily Living (ADL) in early stage after stroke. The system is based on exercises for hand and wrist performed using Neuro Muscular Electrical Stimulation (NMES). This work describes the preliminary results of a multi-center Randomized Controlled Trial (RCT) aimed at evaluating effectiveness of the system. The preliminary results were calculated on 18 patients who completed the protocol. Data is promising, the RETRANER S2 system seems to be a good tool for stroke rehabilitation. Data confirms also a general good usability of the system.
The human hand plays an important role in the manipulation and exploration of the environment. Unfortunately, when disease or injury impedes hand function, the consequences are numerous including disrupting quality of life, independence, and financial stability. In this chapter, we present the development of a soft robotic glove designed to support basic hand function. The glove uses soft fluidic actuators programmed to apply assistive forces to support the range of motion of a human hand. More specifically, we present a method of fabrication and characterization of these soft actuators as well as consider an approach for controlling the glove. This analysis concludes with results from preliminary human subjects testing where glove performance was evaluated on a healthy and an impaired subject.
Soft robotics is a branch of robotics that deals with mechatronics and electromechanical systems primarily made of soft materials. This paper presents a summary of a chronicle study of various soft robotic hand exoskeletons, with different electroencephalography (EEG)- and electromyography (EMG)-based instrumentations and controls, for rehabilitation and assistance in activities of daily living. A total of 45 soft robotic hand exoskeletons are reviewed. The study follows two methodological frameworks: a systematic review and a chronological review of the exoskeletons. The first approach summarizes the designs of different soft robotic hand exoskeletons based on their mechanical, electrical and functional attributes, including the degree of freedom, number of fingers, force transmission, actuation mode and control strategy. The second approach discusses the technological trend of soft robotic hand exoskeletons in the past decade. The timeline analysis demonstrates the transformation of the exoskeletons from rigid ferrous materials to soft elastomeric materials. It uncovers recent research, development and integration of their mechanical and electrical components. It also approximates the future of the soft robotic hand exoskeletons and some of their crucial design attributes.
Background. Humans use voluntary eye movements to actively gather visual information during many activities of daily living, such as driving, walking, and preparing meals. Most stroke survivors have difficulties performing these functional motor tasks, and we recently demonstrated that stroke survivors who require many saccades (rapid eye movements) to plan reaching movements exhibit poor motor performance. However, the nature of this relationship remains unclear.
Objective. Here we investigate if saccades interfere with speed and smoothness of reaching movements in stroke survivors, and if excessive saccades are associated with difficulties performing functional tasks.
Methods. We used a robotic device and eye tracking to examine reaching and saccades in stroke survivors and age-matched controls who performed the Trail Making Test, a visuomotor task that uses organized patterns of saccades to plan reaching movements. We also used the Stroke Impact Scale to examine difficulties performing functional tasks.
Results. Compared with controls, stroke survivors made many saccades during ongoing reaching movements, and most of these saccades closely preceded transient decreases in reaching speed. We also found that the number of saccades that stroke survivors made during ongoing reaching movements was strongly associated with slower reaching speed, decreased reaching smoothness, and greater difficulty performing functional tasks.
Conclusions. Our findings indicate that poststroke interference between eye and limb movements may contribute to difficulties performing functional tasks. This suggests that interventions aimed at treating impaired organization of eye movements may improve functional recovery after stroke.
[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.