Posts Tagged Bilateral training
[ARTICLE] The effect of bilateral trainings on upper extremities muscle activation on level of motor function in stroke patients – Full Text PDF
[Purpose] This study was conducted in order to compare muscle activation level on the affected and unaffected limb according to the recovery level of upper limb between bilateral activity with hands clasped and bilateral activity with pilates ring.
[Subjects and Methods] Twenty inpatient who have had a stroke were recruited. Subjects were divided into two groups by the Fugl-Meyer Assessment of Motor Function score of moderately recovered group and well recovered group. The muscles activation of upper extremity and Co-Contraction Ratio (CCR) were analyzed.
[Results] In the muscles activation of the well group, trapezius, anterior deltoid, and triceps muscles of affected side and biceps muscles of both sides were significantly higher when activity with pilates ring than activity with hands clasped. CCR of both side in the well group was significantly decreased during activity with pilates ring and in the moderate group, CCR of affected side was significantly decreased during activity with pilates ring.
[Conclusion] Bilateral activity with a pilates ring is more effective than activity with hands clasped for the facilitation of muscle activation and coordination in stroke patients.
Functional limitation imposed due to a paretic upper limb affects more than 80% of stroke survivors1) . Upper limb impairment is the leading cause of limitation of motor function. Therefore, restoration of upper limb function is an essential aspect of stroke rehabilitation for regaining functional independency2) . An abnormal pattern of upper limb movement may occur caused by the compensation for muscle paralysis and imbalance. By training to perform a functional task, movement re-education is used to treat the abnormal pattern of muscle weakness3) . Although rehabilitation specialists are trying various approaches to facilitate the restoration of upper limb function, rehabilitation of upper limb function remains a challenge. Consequently, a number of researchers and therapists are seeking more effective therapeutic techniques of upper limb rehabilitation to restore voluntary motor control. Bilateral training (BT) is a therapeutic technique of upper limb rehabilitation. A recent meta-analysis revealed that BT has a positive effect on poststroke upper limb rehabilitation4) . BT induces motor synergy between limbs to activate the motor capacity of the affected limb. In other words, voluntary movements of the unaffected limb facilitate voluntary movements of the affected limb5) . Activation of the primary and supplementary motor cortex for the unaffected limb increases voluntary muscle contraction of the affected limb during symmetrical movements6) . Even though BT is performed by using both the unaffected and the affected limbs simultaneously, most studies have reported the effect of BT on the affected limb. Morris & Wijck reported one randomized controlled trial that investigated the effect of BT on the unaffected limb. In that report, subjects were classified into two groups, the bilateral group and unilateral group divided who scored ≤6 on the motor assessment7) . However, no study has addressed the effect of upper limb muscle activation on the unaffected limb during bilateral activity and the comparison of change in activity between the affected and unaffected limbs. The effect of BT on the recovery level of the upper limb remains unclear. BT includes various activities such as targeted reaching activity using a peg, grasping and bringing a glass to the mouth, picking up and placing a towel, and manipulating and playing cards. While various activities are used, it is important to ensure that the movements involve both the upper limbs4) . For assessing bilateral activity, movements involving hand clasped or grasping and lifting up an instrument such as a rod are used. However, no study has investigated the difference in amounts of upper limb muscle activation between bilateral activity with hands clasped and bilateral activity while lifting an instrument. Therefore, the purpose of the present study was to compare the muscle activation level on the affected and unaffected limbs according to the recovery level of the upper limb between bilateral activity with hands clasped and bilateral activity with a pilates ring.
Bilateral training for neuromotor rehabilitation of the upper limb. Thanks to Gloreha Sinfonia, healthy hand movement can be replied on affected hand. Even a hemiplegic patient with total motor deficit can become an active player during treatment:
– patient voluntarily moves healthy hand
– Gloreha robotic glove replies the same movement on the affected hand
A first-of-its kind robotic exoskeleton may provide the first glimpse into the future of rehabilitation for people suffering from spinal and neurological injuries.
The exoskeleton, dubbed HARMONY, is the result of years of research and development by the ReNeu Robotics Lab at the Cockrell School of Engineering at The University of Texas at Austin. Ashish Deshpande, PhD, and colleagues designed the two-armed, robotic device to deliver full upper-body rehabilitative therapy using natural motion and customizable pressure and force. As a result, the device feels weightless to patients, and allows physicians and therapists to provide personalized, precise therapy and track and analyze data.
“[HARMONY] was specially designed to offer customized therapy for optimal efficacy,” said Deshpande, assistant professor in the Department of Mechanical Engineering. “Not only does the exoskeleton adjust to patient size, it can also be programmed to be gentle or firm based on the individual’s therapy needs.”
Unlike currently available robotic devices for rehabilitation, HARMONY encompasses the entire upper body, allowing for bilateral training. The device, which was created with help from Meka Robotics, connects to patients at three points on each side of the upper body and features 14 axes, which allow for a wide, natural range of motion.
Active data collection, which happens 2,000 times per second, is fed back into the device’s programming so that it can consistently provide personalized feedback through changes in force and torque. If a patient’s motion ventures off course, for instance, the device can gently correct that motion. The device is able to mimic key natural motions, including the scapulohumeral rhythm, which could help patients reestablish natural range of motion after injury or stroke. Therapists can also program HARMONY to gradually increase exercise difficulty, and data collected during that process can be used to track a patients’ progress.
A trial of the device will begin in June on healthy subjects, followed by a study with stroke and spinal cord injury patients to evaluate the robot’s efficacy compared to that of conventional therapy.
In the future, the researchers hope to incorporate a gaming element to the device which could simulate daily activities and help patients relearn the basic motions necessary to complete them.
[ARTICLE] Unilateral and Bilateral Upper-Limb Training Interventions After Stroke Have Similar Effects on Bimanual Coupling Strength
Background: Bilateral training in poststroke upper-limb rehabilitation is based on the premise that simultaneous movements of the nonparetic upper limb facilitate performance and recovery of paretic upper-limb function through neural coupling effects.
Objective: To determine whether the degree of coupling between both hands is higher after bilateral than after unilateral training and control treatment.
Methods: In a single-blinded randomized controlled trial, we investigated rhythmic interlimb coordination after unilateral (mCIMT) and bilateral (mBATRAC) upper-limb training and a dose-matched control treatment (DMCT) in 60 patients suffering from stroke. To this end, we used a series of tasks to discern intended and unintended coupling effects between the hands. In addition, we investigated the control over the paretic hand as reflected by movement harmonicity and amplitude. All tasks were performed before and after a 6-week intervention period and at follow-up 6 weeks later.
Results: There were no significant between-group differences in change scores from baseline to postintervention and from postintervention to follow-up with regard to interlimb coupling. However, the mBATRAC group showed greater movement harmonicity and larger amplitudes with the paretic hand after training than the mCIMT and DMCT groups.
Conclusions: The degree of coupling between both hands was not significantly higher after bilateral than after unilateral training and control treatment. Although improvements in movement harmonicity and amplitude following mBATRAC may indicate a beneficial influence of the interlimb coupling, those effects were more likely due to the particular type of limb movements employed during this training protocol.