Posts Tagged chronic stroke

[ARTICLE] Mirror Therapy Using Gesture Recognition for Upper Limb Function, Neck Discomfort, and Quality of Life After Chronic Stroke: A Single-Blind Randomized Controlled Trial – Full Text

Abstract

Background

Mirror therapy for stroke patients was reported to be effective in improving upper-extremity motor function and daily life activity performance. In addition, game-based virtual reality can be realized using a gesture recognition (GR) device, and various tasks can be presented. Therefore, this study investigated changes in upper-extremity motor function, quality of life, and neck discomfort when using a GR device for mirror therapy to observe the upper extremities reflected in the mirror.

Material/Methods

A total of 36 subjects with chronic stroke were randomly divided into 3 groups: GR mirror therapy (n=12), conventional mirror therapy (n=12), and control (n=12) groups. The GR therapy group performed 3D motion input device-based mirror therapy, the conventional mirror therapy group underwent general mirror therapy, and the control group underwent sham therapy. Each group underwent 15 (30 min/d) intervention sessions (3 d/wk for 5 weeks). All subjects were assessed by manual function test, neck discomfort score, and Short-Form 8 in pre- and post-test.

Results

Upper-extremity function, depression, and quality of life in the GR mirror therapy group were significantly better than in the control group. The changes of neck discomfort in the conventional mirror therapy and control groups were significantly greater than in the GR mirror therapy group.

Conclusions

We found that GR device-based mirror therapy is an intervention that improves upper-extremity function, neck discomfort, and quality of life in patients with chronic stroke.

Background

In patients with acute stroke that occurred >6 months previously, 85% have upper-limb disorders, and 55% to 75% have upper-limb disorders []. The upper-limb movement function is decreased due to weakening of upper-limb muscles, which is primarily caused by changes in the central nervous system and secondarily by weakness due to inactivity and reduced activity [,].

Activities of daily living are limited due to body dysfunction, and most stroke patients have limited social interaction; these disorders reduce the quality of life []. In addition, stroke patients may experience depression due to reduced motivation []. Depression results in loss of interest and joy, anxiety, fear, hostility, sadness, and anger, which negatively affect functional recovery and rehabilitation in stroke patients [].

Constraint-induced movement therapy, action observation training, and mirror therapy have been recently studied as therapies for upper-extremity motor function []. These interventions are used to increase the use of paralyzed limbs to overcome disuse syndromes, observe and imitate movement, and change the neural network involved in movement. Providing various tasks in upper-extremity rehabilitation is necessary and virtual reality is used as a method for providing various tasks [,].

Interventions using virtual reality require cognitive factors, such as judgment and memory, as the task progresses. It can use visual and auditory stimuli, and can induce interest and motivation, helping stroke patients to be mentally stable and motivated []. Gesture recognition (GR) is a topic that studies the reading of these movements using algorithms. These GR algorithms mainly focus on the movement of arm, hands, eyes, legs, and other body parts. The main idea is to capture body movements using capture devices and send the acquired data to a computer []. A remarkable example is shown in physical rehabilitation, where the low-cost hardware and algorithms accomplish outstanding results in therapy of patients with mobility issues. A 3D motion input device is required for upper-body rehabilitation in virtual reality. The Leap motion controller, a GR input device, has been recently released, which monitors hand and finger movements and reflects them on the monitor []. In addition, game-based virtual reality can be realized using a GR device, and various tasks can be presented.

Mirror therapy has been used as a therapeutic intervention for phantom pain in amputees. The painful and paralyzed body parts are covered with a mirror. The mirror is placed in the center of the body, and the movement of the paralyzed body is viewed through the mirror. The patient has a visual illusion that the paralyzed side is normally moving []. Mirror therapy for stroke patients was reported to be effective in upper-extremity motor function and daily life activity performance []. However, conventional mirror therapy methods require high concentration and can become tedious, making active participation difficult []. In addition, conventional mirror therapy differs from the actual situation wherein a mirror positioned at the center of the body should be viewed with the head sideways. Because patients are in a suboptimal posture, they may have neck discomfort after mirror therapy. The body has muscle strength disproportion when maintaining poor posture for a long time. This results in inadequate tension on adjacent muscles and joints, resulting in movement restriction, reduced flexibility, pain, and changes in bone and soft tissue [].

This study investigated the effect on upper-extremity motor function, quality of life, and neck discomfort by using GR device mirror therapy in patients with chronic stroke, and evaluated the efficacy of this technique.

[…]

 

Continue —>  Mirror Therapy Using Gesture Recognition for Upper Limb Function, Neck Discomfort, and Quality of Life After Chronic Stroke: A Single-Blind Randomized Controlled Trial

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Figure 2
(A) Gesture recognition mirror therapy group, (B) Conventional mirror therapy, (C) Control group.

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[BLOG POST] PathMaker Neurosystems – Publication of First Clinical Trial Results for MyoRegulator® Device for Non-Invasive Treatment of Spasticity

PathMaker Neurosystems Inc. (“PathMaker”), a clinical-stage bioelectronic medicine company developing breakthrough non-invasive systems for the treatment of patients with spasticity and paralysis has announced the first publication of clinical trial results for its MyoRegulator® device for the non-invasive treatment of spasticity. Published in Bioelectronic Medicine, the results provide the first clinical evidence using MyoRegulator to treat upper extremity spasticity in subjects with chronic stroke. MyoRegulator is an investigational medical device and is limited by US Federal law to investigational use only.

Spasticity is a chronic condition characterised by painful muscle contractions and is common in patients suffering from stroke, cerebral palsy, multiple sclerosis, spinal cord injury, traumatic brain injury and other neurological disorders. Management of spasticity is a difficult challenge and is currently managed primarily by pharmacological agents and injected botulinum neurotoxins, and there is tremendous unmet medical need.  MyoRegulator is a first-in-class non-invasive device based on PathMaker’s proprietary DoubleStim™ technology (combining anodal trans-spinal direct current stimulation (tsDCS) and peripheral nerve direct current stimulation (pDCS)), which provides simultaneous non-invasive stimulation intended to suppress hyperexcitable spinal neurons involved with spasticity.

“Current pharmacological approaches to managing spasticity have, at best, short-term efficacy, are confounded by adverse effects, and are often unpleasant for the patient,” said co-author Zaghloul Ahmed, Ph.D., Professor and Chairman, Department of Physical Therapy and Professor, Center for Developmental Neuroscience, CUNY and Scientific Founder of PathMaker Neurosystems. “The initial study results demonstrate the potential of a novel, non-invasive treatment to reduce spasticity and improve functional recovery in patients with upper motor neuron syndrome after stroke.”

The publication, Non-Invasive Treatment of Patients with Upper Extremity Spasticity Following Stroke Using Paired Trans-spinal and Peripheral Direct Current Stimulation, was authored by researchers at Feinstein Institute for Medical Research at Northwell Health (Manhasset, NY) led by Bruce Volpe, M.D. The study included patients with upper limb hemiparesis and wrist spasticity at least 6 months after their initial stroke in a single-blind, sham-controlled, crossover design study to test whether MyoRegulator treatment reduces chronic upper-extremity spasticity.

Twenty subjects received five consecutive 20-minute daily treatments with sham stimulation followed by a 1-week washout period, then five consecutive 20-minute daily treatments with active stimulation. Subjects were told that the order of active or sham stimulation would be randomized. Clinical and objective measures of spasticity and motor function were collected before the first session of each condition (baseline), immediately following the last session of each condition, and weekly for 5 weeks after the completion of active treatments. The results demonstrated significant group mean reductions from baseline in both Modified Tardieu Scale scores (summed across the upper limb, P<0.05), and in objectively measured muscle resistance at the wrist flexor (P<0.05) following active treatment as compared to following sham treatment. Motor function also improved significantly (measured by the Fugl-Meyer and Wolf Motor Function Test; P<0.05 for both tests) after active treatment, even without additional prescribed activity or training. The effect of the active MyoRegulator treatment was durable for the 5-week follow-up period.

We are highly encouraged by these clinical results which demonstrate the potential of MyoRegulator to improve outcomes for patients suffering from spasticity, without the need for surgery or drugs. Building on these results and our ongoing clinical trial in Europe, we expect to initiate a US multi-center, pivotal, double-blind clinical trial supported by the National Institute of Neurological Disorders and Stroke (NINDS) in early 2020.

Nader Yaghoubi, M.D., Ph.D., President and Chief Executive Officer of PathMaker

 

About PathMaker Neurosystems Inc.

PathMaker Neurosystems is a clinical stage bioelectronic medicine company developing breakthrough non-invasive systems for the treatment of patients with chronic neuromotor conditions. With offices in Boston (US) and Paris (France), we are collaborating with world-class institutions to rapidly bring to market disruptive products for treating spasticity, paralysis and muscle weakness. In January 2019, we announced a collaboration and distribution agreement with WeHealth Digital Medicine to commercialise the MyoRegulator® device worldwide, excluding US and Japan territories retained by PathMaker.  More than 48 million patients in the US, Europe and China suffer disabilities due to stroke, cerebral palsy, multiple sclerosis, spinal cord injury, traumatic brain injury, Parkinson’s disease and other neurological disorders. At PathMaker, we are opening up a new era of non-invasive neurotherapy for patients suffering from chronic neuromotor conditions. For more information, please visit the company website at www.pmneuro.com.

Source: PathMaker Neurosystems Inc.

via PathMaker Neurosystems – Publication of First Clinical Trial Results for MyoRegulator® Device for Non-Invasive Treatment of Spasticity | ACNR | Online Neurology Journal

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[WEB SITE] Research work in Neurotechnology directs efforts towards treating chronic stroke

Scientific work undertaken at Wyss Center for Bio and Neuroengineering in Geneva, Switzerland has developed a rehabilitation arm in order to improve recovery during severe chronic strokes in patients.

Stroke is regarded as one of the major health problems among people today. A common symptom observed among cases of stroke is the long-term impairment of upper arm function. This results in complications in daily life chores and hampers the quality of life.

The Neurotechnology includes a host of therapies, like robotics, brain stimulation, brain-machine interfaces, etc. According to experts, these will in return be fruitful in treating patients, centering on their individual needs. Moreover, the new study also sheds light on longitudinal clinical studies in order to understand the rehabilitation benefits of individual therapies. Furthermore, the study also focuses on various combinations of complementary therapies used over a period of time.

“Our findings show that neurotechnology-aided upper limb rehabilitation is promising for severe chronic stroke patients. However, we also found that the ‘one size fits all’ approach doesn’t lead to the best outcome. We suggest a move towards a personalized combination of neurotechnology-based stroke rehabilitation therapies, ideally in a home-based environment where prolonged therapy is more feasible than in a clinic. We believe that by sequentially introducing stroke therapies according to individual progress, we could allow patients to continue their recovery beyond what is possible today,” says Dr. Martina Coscia, lead author and Staff Engineer at Wyss Center.

As per experts, rehabilitation therapies show the best results within the first three months after the incidence of stroke. After the first three months, the scope of natural recovery is limited and patients are considered chronic, commonly observed scenario, especially among patients who are severely affected.

For the study, authors reportedly compared data from 64 cases of clinical studies based on upper limb neurotechnology treatments among stroke patients. The findings mainly centered on brain stimulation, electrical stimulation of muscles, and brain-computer interfaces, in addition to a combination of these.

Further reports suggest the team is directing efforts towards undertaking clinical traits in order to test the results. For the trial, experimental design such as robotics, functional electrical stimulation, brain-computer interfaces is used to monitor the after-effects of treatment in individual patients. Scientists believe to use a combination of neurotechnological and new personalized therapies in order to improve recovery among patients. The study published in the journal Brain alleges that the trial will begin in Switzerland in summer 2019.

via Research work in Neurotechnology directs efforts towards treating chronic stroke – Xaralite

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[WEB PAGE] Results from MyoRegulator for Spasticity Trial Published

myoregulator

Results from a clinical trial testing the MyoRegulator device for the non-invasive treatment of spasticity, published recently in Bioelectronic Medicine, suggest evidence for using MyoRegulator to treat upper extremity spasticity in subjects with chronic stroke, PathMaker Neurosystems Inc announces.

PathMaker Neurosystems Inc is a clinical-stage bioelectronic medicine company that develops non-invasive systems for the treatment of patients with spasticity and paralysis. The MyoRegulator is an investigational medical device and is limited by US Federal law to investigational use only.

The device is based on PathMaker’s proprietary DoubleStim technology (combining anodal trans-spinal direct current stimulation (tsDCS) and peripheral nerve direct current stimulation (pDCS)), which provides simultaneous non-invasive stimulation intended to suppress hyperexcitable spinal neurons involved with spasticity, the company explains in a media release.

“Current pharmacological approaches to managing spasticity have, at best, short-term efficacy, are confounded by adverse effects, and are often unpleasant for the patient,” said co-author Zaghloul Ahmed, PhD, professor and chairman, Department of Physical Therapy and Professor, Center for Developmental Neuroscience, CUNY and Scientific Founder of PathMaker Neurosystems.

“The initial study results demonstrate the potential of a novel, non-invasive treatment to reduce spasticity and improve functional recovery in patients with upper motor neuron syndrome after stroke.”

The single-blind, sham-controlled, crossover design study, authored by researchers at Feinstein Institute for Medical Research at Northwell Health (and led by Bruce Volpe, MD, included patients with upper limb hemiparesis and wrist spasticity at least 6 months after their initial stroke to test whether MyoRegulator treatment reduces chronic upper-extremity spasticity.

Twenty subjects received five consecutive 20-minute daily treatments with sham stimulation followed by a 1-week washout period, then five consecutive 20-minute daily treatments with active stimulation. Subjects were told that the order of active or sham stimulation would be randomized.

Clinical and objective measures of spasticity and motor function were collected before the first session of each condition (baseline), immediately following the last session of each condition, and weekly for 5 weeks after the completion of active treatments.

The results demonstrated significant group mean reductions from baseline in both Modified Tardieu Scale scores (summed across the upper limb, P<0.05), and in objectively measured muscle resistance at the wrist flexor (P<0.05) following active treatment as compared to following sham treatment.

Motor function also improved significantly (measured by the Fugl-Meyer and Wolf Motor Function Test; P<0.05 for both tests) after active treatment, even without additional prescribed activity or training. The effect of the active MyoRegulator treatment was durable for the 5-week follow-up period, the release continues.

“We are highly encouraged by these clinical results which demonstrate the potential of MyoRegulator to improve outcomes for patients suffering from spasticity, without the need for surgery or drugs,” says Nader Yaghoubi, MD, PhD, president and chief executive officer of PathMaker.

“Building on these results and our ongoing clinical trial in Europe, we expect to initiate a US multi-center, pivotal, double-blind clinical trial supported by the National Institute of Neurological Disorders and Stroke (NINDS) in early 2020.”

[Source: PathMaker Neurosystems Inc]

 

via Results from MyoRegulator for Spasticity Trial Published – Rehab Managment

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[Abstract] Does hand robotic rehabilitation improve motor function by rebalancing interhemispheric connectivity after chronic stroke? Encouraging data from a randomised-clinical-trial.

Abstract

OBJECTIVE:

The objective of this study was the evaluation of the clinical and neurophysiological effects of intensive robot-assisted hand therapy compared to intensive occupational therapy in the chronic recovery phase after stroke.

METHODS:

50 patients with a first-ever stroke occurred at least six months before, were enrolled and randomised into two groups. The experimental group was provided with the Amadeo™ hand training (AHT), whereas the control group underwent occupational therapist-guided conventional hand training (CHT). Both of the groups received 40 hand training sessions (robotic and conventional, respectively) of 45 min each, 5 times a week, for 8 consecutive weeks. All of the participants underwent a clinical and electrophysiological assessment (task-related coherence, TRCoh, and short-latency afferent inhibition, SAI) at baseline and after the completion of the training.

RESULTS:

The AHT group presented improvements in both of the primary outcomes (Fugl-Meyer Assessment for of Upper Extremity and the Nine-Hole Peg Test) greater than CHT (both p < 0.001). These results were paralleled by a larger increase in the frontoparietal TRCoh in the AHT than in the CHT group (p < 0.001) and a greater rebalance between the SAI of both the hemispheres (p < 0.001).

CONCLUSIONS:

These data suggest a wider remodelling of sensorimotor plasticity and interhemispheric inhibition between sensorimotor cortices in the AHT compared to the CHT group.

SIGNIFICANCE:

These results provide neurophysiological support for the therapeutic impact of intensive robot-assisted treatment on hand function recovery in individuals with chronic stroke.

 

via Does hand robotic rehabilitation improve motor function by rebalancing interhemispheric connectivity after chronic stroke? Encouraging data from a … – PubMed – NCBI

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[Abstract] Backward walking observational training improves gait ability in patients with chronic stroke: randomised controlled pilot study.

Abstract

Backward walking has a positive effect on gait ability. Action observational training is an effective treatment method for stroke neurological disorders. This randomised comparator-controlled pilot study aimed to evaluate the feasibility of backward walking observational training on the gait ability of chronic stroke patients. Fourteen chronic stroke participants were randomly allocated to the experimental group (backward walking observation; n = 7) and control group (landscape observation; n = 7). Both groups performed conventional therapy 5 days/week; then the backward walking observation and landscape observation + backward walking training groups performed the observational training 3 days/week for 4 weeks. The primary outcome was measured dynamic gait index, 10-m walking test, and timed up and go test time. Both groups showed significant increases in dynamic gait index, 10-m walking test, and timed up and go test time. The experimental group showed more significant improvements in dynamic gait index (P = 0.04, η = 0.336), 10-m walking test (P = 0.04, η = 0.306), and timed up and go test time (P = 0.03, η = 0.334) than the control group. This pilot study demonstrated that conventional therapy with backward walking observational training improves gait ability. Our findings suggest that observing an action may have a positive effect on chronic stroke patients.

 

via Backward walking observational training improves gait ability in patients with chronic stroke: randomised controlled pilot study. – PubMed – NCBI

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[WEB SITE] Neurotechnology-Aided Rehab Holds Promise for Chronic Stroke Patients

Published on 

neurotechnol

Personalized neurotechnology-aided rehabilitation of the arm could improve recovery in severe chronic stroke patients, according to a study published recently in the journal Brain.

Neurotechnology-based therapies, including brain-machine interfaces, robotics, and brain stimulation among others, will lead to largest treatment effects and success if they are tailored to the needs of individual patients, and used in combination, according to the authors from the Wyss Center for Bio and Neuroengineering, Swiss Federal Institute of Technology Lausanne (EPFL), Scuola Superiore Sant’Anna, University of Geneva Faculty of Medicine and Clinique Romande de Réadaptation.

In their study, they call for longitudinal clinical studies to show the rehabilitation benefits of individual therapies as well as the use of multiple complementary therapies used in combination over long time periods.

“Our findings show that neurotechnology-aided upper limb rehabilitation is promising for severe chronic stroke patients,” says lead author Dr. Martina Coscia, Staff Engineer at the Wyss Center, in a media release.

“However, we also found that the ‘one size fits all’ approach doesn’t lead to the best outcome. We suggest a move towards a personalized combination of neurotechnology-based stroke rehabilitation therapies, ideally in a home-based environment where prolonged therapy is more feasible than in a clinic.

“We believe that by sequentially introducing stroke therapies according to individual progress, we could allow patients to continue their recovery beyond what is possible today.”

One of the most common consequences of stroke is impaired upper arm function, which has a direct impact on daily tasks and quality of life. Rehabilitation therapies generally have the largest effect in the first three months after stroke. After this time, patients are considered chronic and the likelihood of further natural recovery is limited; this is especially true for those most severely affected.

“What we would like to see in the future are long-term trials in which multiple neurotechnology-based therapies are used within the same patient,”  Professor Friedhelm Hummel from EPFL (Director, Defitech Chair of Clinical Neuroengineering) and the University of Geneva Medical School, shares in the release.

“We believe that this synergistic approach could uncover previously undiscovered treatment pathways for chronic stroke patients.”

In their study, the authors compared effectiveness data from 64 clinical studies on upper limb neurotechnology-aided treatments in chronic stroke patients. The interventions analyzed in the paper included robotics, functional electrical stimulation of muscles, brain stimulation, and brain-computer interfaces as well as their use in combination.

The interdisciplinary research team is now starting a clinical trial to test these ideas. The trial uses a new experimental design with a personalized therapy approach using brain-computer interfaces, robotics, functional electrical stimulation, and brain stimulation specifically chosen to maximize treatment effects in each individual patient. The goal is to keep incrementally improving recovery by using new personalized, neurotechnology-based therapies in combination. The trial will start in Switzerland in summer 2019.

[Source(s): Wyss Center for Bio and Neuroengineering, Science Daily]

 

via Neurotechnology-Aided Rehab Holds Promise for Chronic Stroke Patients – Rehab Managment

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[ARTICLE] The Effects of Virtual Reality Training on Function in Chronic Stroke Patients: A Systematic Review and Meta-Analysis – Full Text

Abstract

Objective. The aim of this study was to perform a meta-analysis to examine whether virtual reality (VR) training is effective for lower limb function as well as upper limb and overall function in chronic stroke patients. Methods. Three databases, OVID, PubMed, and EMBASE, were used to collect articles. The search terms used were “cerebrovascular accident (CVA),” “stroke”, and “virtual reality”. Consequently, twenty-one studies were selected in the second screening of meta-analyses. The PEDro scale was used to assess the quality of the selected studies. Results. The total effect size for VR rehabilitation programs was 0.440. The effect size for upper limb function was 0.431, for lower limb function it was 0.424, and for overall function it was 0.545. The effects of VR programs on specific outcomes were most effective for improving muscle tension, followed by muscle strength, activities of daily living (ADL), joint range of motion, gait, balance, and kinematics.Conclusion. The VR training was effective in improving the function in chronic stroke patients, corresponding to a moderate effect size. Moreover, VR training showed a similar effect for improving lower limb function as it did for upper limb function.

1. Introduction

Stroke is a major cause of death in the modern world; it also causes sensory, motor, cognitive, and visual impairments and restricts performance of activities of daily living (ADL) [1]. Motor impairments are observed in 80% of stroke patients, and these can include loss of balance and gait [2]. These problems are important targets of rehabilitation, because they reduce the ability of individuals to perform ADL and this result in impaired community activities [34].

Most studies on balance and gait rehabilitation have shown positive effects. However, training-based methods often become tiresome are resource-intensive and require specialized facilities or equipment. Therefore, there is a demand for economical and safe methods of rehabilitation [2].

Virtual reality (VR) is defined by “the use of interactive simulations created with computer hardware and software to present users with opportunities to engage in environments that appear and feel similar to real world objects and events.” Participants interact with projected images, maneuver virtual objects and perform activities programmed into the task, giving the user a sense of immersion in the simulated environment. Various forms of feedback are provided through the environment, the most common being visual and auditory, to enhance enjoyment and motor learning through real-time feedback and immediate results [5]. VR training using these features has recently been widely used in the field of stroke rehabilitation [3]. VR training aims to improve neural plasticity by providing a safe and enriched environment to perform functional task-specific activities with increased repetitions, intensity of practice, and motivation to comply with the intervention [1].

In the field of stroke rehabilitation, VR training is reported to be mostly effective at increasing upper limb joint range of motion, improving sensation, muscle strengthening, reducing pain, and improving functional processesRecently, various VR programs have been developed and implemented for the lower limbs as well as the upper limbs, and their effects are being tested. VR training for stroke patients has been shown to be safe and cost-effective at improving lower limb function, specifically improving balance, stair climbing speed, ankle muscle strength, range of motion, and gait speed [1]. Compared with existing treatment methods, it may be more effective at improving dynamic balance control and preventing falls in subacute and chronic stroke patients [6].

Treatment methods using VR provide a virtual environment for ADLs that are difficult to perform in a hospital, and therefore, it could be very effective at improving both upper limb and lower limb function. However, because the lower limbs have to support the weight of the body, various elements are required, including muscle strength and balance to control body weight, joint movements, and cognitive ability to integrate these other elements. Although studies related to VR training have been increasing in recent years, VR intervention has been used more extensively to improve upper limb function, which is relatively easier to apply than lower limb function.

Furthermore, doubts could be raised as to whether VR treatment methods for the lower limbs can improve these elements; these doubts related to lack of VR equipment or programs, as well as safety issues or dizziness during treatment. For this reason, we aimed to perform a meta-analysis as a scientific method to test the effects of uncertain treatment methods using statistical methods, in order to examine whether VR training is effective for lower limb function as well as upper limb function. […]

Continue —>  The Effects of Virtual Reality Training on Function in Chronic Stroke Patients: A Systematic Review and Meta-Analysis

 

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[Abstract + Related Articles] Combining Virtual Reality Motor Rehabilitation With Cognitive Strategy Use in Chronic Stroke

Abstract

Importance: Rehabilitation interventions for chronic stroke are largely impairment based, with results confined to the level of impairment instead of function. In contrast, cognitive strategy training interventions have demonstrated clinically meaningful improvements in functional outcomes. Integration of these approaches has yet to be explored.

Objective: To evaluate acceptability, recruitment, and retention rate and determine which outcome measures best capture the effect of the intervention.

Design: Single-group, pre–post design.

Setting: Research laboratory.

Participants: Adults with chronic stroke and hemiparesis (N = 10).

Intervention: A 12-wk intervention integrating cognitive strategy training with upper extremity motor training. Two weekly sessions used Kinect-based virtual reality to encourage high numbers of upper extremity movement repetitions. The third weekly session focused on the use of cognitive strategies with practice of client-centered goals.

Outcomes and Measures: Upper extremity motor performance was measured with the Fugl–Meyer Assessment. Occupational performance on trained and untrained goals was measured via the Performance Quality Rating Scale and the Canadian Occupational Performance Measure. Outcome data were gathered preintervention, postintervention, and at 3-mo follow-up.

Results: The intervention was perceived as acceptable. Recruitment rate was 15%, and retention rate was 100%. Large effects were found on outcomes of upper extremity motor performance, occupational performance, and participation at follow-up.

Conclusion and Relevance: MetacogVR is feasible for adults with chronic stroke. The effect of MetacogVR is best captured through measures of upper extremity motor performance, occupational performance, and participation.

What This Articles Adds: Traditional, impairment-based approaches to chronic stroke rehabilitation may require integration with cognitive-strategy training to affect performance on meaningful goals.

Related Articles

 

via Combining Virtual Reality Motor Rehabilitation With Cognitive Strategy Use in Chronic Stroke | American Journal of Occupational Therapy

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[ARTICLE] Intensive upper limb neurorehabilitation in chronic stroke: outcomes from the Queen Square programme – Full Text

Abstract

Objective Persistent difficulty in using the upper limb remains a major contributor to physical disability post-stroke. There is a nihilistic view about what clinically relevant changes are possible after the early post-stroke phase. The Queen Square Upper Limb Neurorehabilitation programme delivers high-quality, high-dose, high-intensity upper limb neurorehabilitation during a 3-week (90 hours) programme. Here, we report clinical changes made by the chronic stroke patients treated on the programme, factors that might predict responsiveness to therapy and the relationship between changes in impairment and activity.

Methods Upper limb impairment and activity were assessed on admission, discharge, 6 weeks and 6 months after treatment, with modified upper limb Fugl-Meyer (FM-UL, max-54), Action Research Arm Test (ARAT, max-57) and Chedoke Arm and Hand Activity Inventory (CAHAI, max-91). Patient-reported outcome measures were recorded with the Arm Activity Measure (ArmA) parts A (0–32) and B (0–52), where lower scores are better.

Results 224 patients (median time post-stroke 18 months) completed the 6-month programme. Median scores on admission were as follows: FM-UL = 26 (IQR 16–37), ARAT=18 (IQR 7–33), CAHAI=40 (28-55), ArmA-A=8 (IQR 4.5–12) and ArmA-B=38 (IQR 24–46). The median scores 6 months after the programme were as follows: FM-UL=37 (IQR 24–48), ARAT=27 (IQR 12–45), CAHAI=52 (IQR 35–77), ArmA-A=3 (IQR 1–6.5) and ArmA-B=19 (IQR 8.5–32). We found no predictors of treatment response beyond admission scores.

Conclusion With intensive upper limb rehabilitation, chronic stroke patients can change by clinically important differences in measures of impairment and activity. Crucially, clinical gains continued during the 6-month follow-up period.

Introduction

Stroke remains common1 and persistent difficulty in using the upper limb is a major contributor to ongoing physical disability.2 The general consensus remains that most spontaneous recovery of the upper limb occurs over the first 3 months after stroke and current levels of rehabilitation result in little improvement after that, particularly at the level of impairment.3 Improving outcomes through higher dose (time in rehabilitation or number of repetitions) and intensity (dose per session) of rehabilitation is an attractive option.4 However, clinical trials of higher dose upper limb rehabilitation have generally not produced the magnitude of improvement that will change clinical practice,5 whether delivered in the early6 or chronic stages post-stroke.7–9 A common factor in these trials is that the dose (in hours) of additional therapy remained relatively low (18–36 hours). Despite scepticism that stroke patients could tolerate much higher doses,8 one study managed to deliver 300 hours of upper limb therapy to chronic stroke patients over 12 weeks and reported changes in measures of both impairment and activity that were far greater than those in lower dose studies.10 Three hundred hours represents an order of magnitude higher than any dose of rehabilitation offered in previous upper limb rehabilitation trials and deserves further consideration. However, this idea is challenging because of the logistics of setting up such a trial in healthcare settings where the ethic of high-dose, high-intensity rehabilitation is not supported. In this context, it is important to report the findings of clinical services that are able to deliver higher doses than conventionally seen. The Queen Square Upper Limb (QSUL) Neurorehabilitation programme is a single-centre clinical service that provides 90 hours of timetabled treatment focusing on the post-stroke upper limb in chronic (>6 months post-stroke) stroke patients. Here, we report (i) outcomes for patients admitted to this programme at the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust (UCLH), including 6-month follow-up data to look at whether any clinical benefits were maintained, (ii) the characteristics of the patients admitted and any predictors of response and (iii) the relationship between changes in impairment and activity.[…]

Continue —> https://jnnp.bmj.com/content/90/5/498

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