The aim of this study was to explore the feasibility of conducting a randomized controlled trial of dynamic Lycra® orthoses as an adjunct to arm rehabilitation after stroke and to explore the magnitude and direction of change on arm outcomes.
This is a single-blind, two-arm parallel group, feasibility randomized controlled trial.
The study participants were stroke survivors with arm hemiparesis two to four weeks after stroke receiving in-patient rehabilitation.
Participants were randomized 2:1 to wear Lycra® gauntlets for eight hours daily for eight weeks, plus usual rehabilitation (n = 27), or to usual rehabilitation only (n = 16).
Recruitment, retention, fidelity, adverse events and completeness of data collection were examined at 8 and 16 weeks; arm function (activity limitation; Action Research Arm Test, Motor Activity Log) and impairment (Nine-hole Peg Test, Motricity Index, Modified Tardieu Scale). Structured interviews explored acceptability.
Of the target of 51, 43 (84%) participants were recruited. Retention at 8 weeks was 32 (79%) and 24 (56%) at 16 weeks. In total, 11 (52%) intervention group participants and 6 (50%) control group participants (odds ratio = 1.3, 95% confidence interval = 0.2 to 7.8) had improved Action Research Arm Test level by 8 weeks; at 16 weeks, this was 8 (61%) intervention and 6 (75.0%) control participants (odds ratio = 1.1, 95% confidence interval = 0.1 to 13.1). Change on other measures favoured control participants. Acceptability was influenced by 26 adverse reactions.
Recruitment and retention were low, and adverse reactions were problematic. There were no indications of clinically relevant effects, but the small sample means definitive conclusions cannot be made. A definitive trial is not warranted without orthoses adaptation.
Studies with children who have spastic hemiplegia caused by cerebral palsy suggest that wearing dynamic Lycra® orthoses as an adjunct to goal-directed training may improve movement and functional goal achievement.1 This evidence raises the question of whether the orthoses may be effective as an adjunct to rehabilitation in adults with arm impairments after stroke. Arm impairments, which include weakness and sensory loss, restrict independence in activities of daily living and affect stroke survivors’ quality of life.2
Dynamic Lycra® orthoses are commercially available dynamic braces that use tensile properties of Lycra® to generate torsion, correct muscle force imbalances across joints, optimize muscle length and functional positioning, and provide compression to enhance proprioception and sensory awareness.3,4 However, effectiveness in stroke rehabilitation has not been fully evaluated, despite anecdotal evidence that they are already in use in clinical practice. One single case study of 6 weeks wear in a survivor with long-standing stroke4 and a crossover trial with 16 stroke survivors 3–36 weeks after stroke onset3 involving only 3 hours orthosis wear have shown improvements in arm impairment, sensation and functional outcomes after orthosis wear. Evidence is therefore limited to low-quality study designs, and rigorous effectiveness studies are required.
The aim of this feasibility randomized controlled trial was to examine recruitment, retention, adverse events, intervention fidelity, magnitude and direction of difference in outcomes in stroke survivors receiving Lycra® orthoses as an adjunct to usual rehabilitation, compared to those receiving usual rehabilitation only. It also aimed to explore survivor and carer perceptions of acceptability, to inform decisions about a future definitive randomized controlled trial.[…]
Continue —-> Dynamic Lycra® orthoses as an adjunct to arm rehabilitation after stroke: a single-blind, two-arm parallel group, randomized controlled feasibility trial – Jacqui H Morris, Alexandra John, Lucy Wedderburn, Petra Rauchhaus, Peter T Donnan, 2019
Figure 1. Example of Lycra® gauntlet used in the study.
Rehabilitation is important treatment for post stroke patient to regain their muscle strength and motor coordination as well as to retrain their nervous system. Electromyography (EMG) has been used by researcher to enhance conventional rehabilitation method as a tool to monitor muscle electrical activity however EMG signal is very stochastic in nature and contains some noise. Special technique is yet to be researched in processing EMG signal to make it useful and effective both to researcher and to patient in general. Feature extraction is among the signal processing technique involved and the best method for specific EMG study needs to be applied. In this works, nine feature extractions techniques are applied to EMG signals recorder from subjects performing upper limb rehabilitation activity based on suggested movement sequence pattern. Three healthy subjects perform the experiment with three trials each and EMG data were recorded from their bicep and deltoid muscle. The applied features for every trials of each subject were analyzed statistically using student T-Test their significant of p-value. The results were then totaled up and compared between the nine features applied and Auto Regressive coefficient (AR) present the best result and consistent with each subjects’ data. This feature will be used later in our future research work of Upper-limb Virtual Reality Rehabilitation.
via EMG Feature Extractions for Upper-Limb Functional Movement During Rehabilitation – IEEE Conference Publication
Robotic rehabilitation is a growing field. Robots facilitate repetitive therapies, which have positive effects on the rehabilitation of patients who lack arm control because of central nervous system lesions. However, the use of such rehabilitation robots is rare due to high costs and low acceptance among patients. Therefore, this study is focused on the development and control of a novel low-cost omnidirectional interactive mobile robotic platform with force feedback to assist and guide a patient’s hand during therapy. The primary goals for such a mobile robot are to minimize its weight and dimensions, which are significant factors in patient acceptance. Position-based stiffness control was employed with a proportional derivative controller to control the position of the robot and to assist the patient during motion. A user interface with given tasks was built to manage tasks, obtain test results and set control variables. Test results showed that the developed experimental mobile robot successfully assisted and guided the user during the test period.
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Source: A Low-Cost and Lightweight Alternative to Rehabilitation Robots: Omnidirectional Interactive Mobile Robot for Arm Rehabilitation | SpringerLink
In the rehabilitation training and assessment of upper limbs, the conventional kinematic model treats the arm as a serial manipulator and maps the rotations in the joint space to movements in the Cartesian space. While this model brings simplicity and convenience, and thus has been overwhelming used, its accuracy is limited, especially for the distal parts of the upper limb that execute dexterous movements.
In this paper, a novel kinematic model of the arm has been proposed, which has been inspired by the biomechanical analysis of the forearm and wrist anatomy. One additional parameter is introduced into the conventional arm model, and then both the forward and inverse kinematic models of five parameters are derived for the motion of upper arm medial/lateral rotation, elbow flexion/extension, forearm pronation/supination, wrist flexion/extension and ulnar/radial deviation. Then, experiments with an advanced haptic interface have been designed and performed to examine the presented arm kinematic model. Data analysis revealed that accuracy and robustness can be significantly improved with the new model.
This extended arm kinematic model will help device development, movement training and assessment of upper limb rehabilitation.
Published in: Advanced Robotics and Mechatronics (ICARM), International Conference on
Source: An extended kinematic model for arm rehabilitation training and assessment – IEEE Xplore Document