Posts Tagged chronic

[Abstract] The eWrist — A wearable wrist exoskeleton with sEMG-based force control for stroke rehabilitation.

Abstract:

Chronic wrist impairment is frequent following stroke and negatively impacts everyday life. Rehabilitation of the dysfunctional limb is possible but requires extensive training and motivation. Wearable training devices might offer new opportunities for rehabilitation. However, few devices are available to train wrist extension even though this movement is highly relevant for many upper limb activities of daily living. As a proof of concept, we developed the eWrist, a wearable one degree-of-freedom powered exoskeleton which supports wrist extension training. Conceptually one might think of an electric bike which provides mechanical support only when the rider moves the pedals, i.e. it enhances motor activity but does not replace it. Stroke patients may not have the ability to produce overt movements, but they might still be able to produce weak muscle activation that can be measured via surface electromyography (sEMG). By combining force and sEMG-based control in an assist-as-needed support strategy, we aim at providing a training device which enhances activity of the wrist extensor muscles in the context of daily life activities, thereby, driving cortical reorganization and recovery. Preliminary results show that the integration of sEMG signals in the control strategy allow for adjustable assistance with respect to a proxy measurement of corticomotor drive.

Source: The eWrist — A wearable wrist exoskeleton with sEMG-based force control for stroke rehabilitation – IEEE Xplore Document

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[Abstract] Applying a soft-robotic glove as assistive device and training tool with games to support hand function after stroke: Preliminary results on feasibility and potential clinical impact

Published in: Rehabilitation Robotics (ICORR), 2017 International Conference on

Abstract:

Recent technological developments regarding wearable soft-robotic devices extend beyond the current application of rehabilitation robotics and enable unobtrusive support of the arms and hands during daily activities. In this light, the HandinMind (HiM) system was developed, comprising a soft-robotic, grip supporting glove with an added computer gaming environment. The present study aims to gain first insight into the feasibility of clinical application of the HiM system and its potential impact. In order to do so, both the direct influence of the HiM system on hand function as assistive device and its therapeutic potential, of either assistive or therapeutic use, were explored. A pilot randomized clinical trial was combined with a cross-sectional measurement (comparing performance with and without glove) at baseline in 5 chronic stroke patients, to investigate both the direct assistive and potential therapeutic effects of the HiM system. Extended use of the soft-robotic glove as assistive device at home or with dedicated gaming exercises in a clinical setting was applicable and feasible. A positive assistive effect of the soft-robotic glove was proposed for pinch strength and functional task performance ‘lifting full cans’ in most of the five participants. A potential therapeutic impact was suggested with predominantly improved hand strength in both participants with assistive use, and faster functional task performance in both participants with therapeutic application.

Source: Applying a soft-robotic glove as assistive device and training tool with games to support hand function after stroke: Preliminary results on feasibility and potential clinical impact – IEEE Xplore Document

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[ARTICLE] Late physiotherapy rehabilitation changes gait patterns in post-stroke patients – Full Text PDF

Summary
Study aim: To determine whether a physiotherapy protocol improves the electromyographic activation (EA) during the hemiparetic gait in patients with delayed access to rehabilitation. Material and methods: 40 post-stroke patients underwent clinical evaluation and gait assessment at the time of admission and at the end of treatment.

Results: The anterior leg muscles tibialis anterior and rectus femoris had earlier onset (p = 0.0001).

Conclusion: Electromyographic findings showed altered patterns during the hemiparetic gait cycle, even in patients with delayed access to treatment.

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[ARTICLE] Domiciliary VR-Based Therapy for Functional Recovery and Cortical Reorganization: Randomized Controlled Trial in Participants at the Chronic Stage Post Stroke – Full Text

ABSTRACT

Background: Most stroke survivors continue to experience motor impairments even after hospital discharge. Virtual reality-based techniques have shown potential for rehabilitative training of these motor impairments. Here we assess the impact of at-home VR-based motor training on functional motor recovery, corticospinal excitability and cortical reorganization.

Objective: The aim of this study was to identify the effects of home-based VR-based motor rehabilitation on (1) cortical reorganization, (2) corticospinal tract, and (3) functional recovery after stroke in comparison to home-based occupational therapy.

Methods: We conducted a parallel-group, controlled trial to compare the effectiveness of domiciliary VR-based therapy with occupational therapy in inducing motor recovery of the upper extremities. A total of 35 participants with chronic stroke underwent 3 weeks of home-based treatment. A group of subjects was trained using a VR-based system for motor rehabilitation, while the control group followed a conventional therapy. Motor function was evaluated at baseline, after the intervention, and at 12-weeks follow-up. In a subgroup of subjects, we used Navigated Brain Stimulation (NBS) procedures to measure the effect of the interventions on corticospinal excitability and cortical reorganization.

Results: Results from the system’s recordings and clinical evaluation showed significantly greater functional recovery for the experimental group when compared with the control group (1.53, SD 2.4 in Chedoke Arm and Hand Activity Inventory). However, functional improvements did not reach clinical significance. After the therapy, physiological measures obtained from a subgroup of subjects revealed an increased corticospinal excitability for distal muscles driven by the pathological hemisphere, that is, abductor pollicis brevis. We also observed a displacement of the centroid of the cortical map for each tested muscle in the damaged hemisphere, which strongly correlated with improvements in clinical scales.

Conclusions: These findings suggest that, in chronic stages, remote delivery of customized VR-based motor training promotes functional gains that are accompanied by neuroplastic changes.

Introduction

After initial hospitalization, many stroke patients return home relatively soon despite still suffering from impairments that require continuous rehabilitation [1]. Therefore, ¼ to ¾ of patients display persistent functional limitations for a period of 3 to 6 months after stroke [2]. Although clinicians may prescribe a home exercise regimen, reports indicate that only one-third of patients actually accomplish it [3]. Consequently, substantial gains in health-related quality of life during inpatient stroke rehabilitation may be followed by equally substantial declines in the 6 months after discharge [4]. Multiple studies have shown, however, that supported discharge combined with at home rehabilitation services does not compromise clinical inpatient outcomes [57] and may enhance recovery in subacute stroke patients [8]. Hence, it is essential that new approaches are deployed that help to manage chronic conditions associated with stroke, including domiciliary interventions [9] and the augmentation of current rehabilitation approaches in order to enhance their efficiency. There should be increased provision of home-based rehabilitation services for community-based adults following stroke, taking cost-effectiveness, and a quick family and social reintegration into account [10].

One of the latest approaches in rehabilitation science is based on the use of robotics and virtual reality (VR), which allow remote delivery of customized treatment by combining dedicated interface devices with automatized training scenarios [1012]. Several studies have tested the acceptability of VR-based setups as an intervention and evaluation tool for rehabilitation [1315]. One example of this technology is the, so called, Rehabilitation Gaming System (RGS) [16], which has been shown to be effective in the rehabilitation of the upper extremities in the acute and the chronic phases of stroke [13]. However, so far little work exists on the quantitative assessment of the clinical impact of VR based approaches and their effects on neural reorganization that can directly inform the design of these systems and their application in the domiciliary context. The main objective of this paper is to further explore the potential and limitations of VR technologies in domiciliary settings. Specifically, we examine the efficacy of a VR-based therapy when used at home for (1) assessing functional improvement, (2) facilitating functional recovery of the upper-limbs, and (3) inducing cortical reorganization. This is the first study testing the effects of VR-based therapy on cortical reorganization and corticospinal integrity using NBS.

Methods

Design

We conducted a parallel-group, controlled trial in order to compare the effectiveness of domiciliary VR-based therapy versus domiciliary occupational therapy (OT) in inducing functional recovery and cortical reorganization in chronic stroke patients.

Participants

Participants were first approached by an occupational therapist from the rehabilitation units of Hospital Esperanza and Hospital Vall d’Hebron from Barcelona to determine their interest in participating in a research project. Recruited participants met the following inclusion criteria: (1) mild-to-moderate upper-limbs hemiparesis (Proximal MRC>2) secondary to a first-ever stroke (>12 months post-stroke), (2) age between 45 and 85 years old, (3) absence of any major cognitive impairment (Mini-Mental State Evaluation, MMSE>22), and (4) previous experience with RGS in the clinic. The ethics committee of clinical research of the Parc de Salut Mar and Vall d’Hebron Research Institute approved the experimental guidelines. Thirty-nine participants at the chronic stage post-stroke were recruited for the study by two occupational therapists, between October 2011 and January 2012, and were assigned to a RGS (n=20) or a control group (n=19) using stratified permuted block randomization methods for balancing the participants’ demographics and clinical scores at baseline (Table 1). One participant in the RGS group refused to participate. Prior to the experiment, participants signed informed consent forms. This trial was not registered at or before the onset of participants’ enrollment because it is a pilot study that evaluates the feasibility of a prototype device. However, this study was registered retrospectively in ClinicalTrials.gov and has the identifier NCT02699398.

Instrumentation

Description of the Rehabilitation Gaming System

The RGS integrates a paradigm of goal-directed action execution and motor imagery [17], allowing the user to control a virtual body (avatar) through an image capture device (Figure 1). For this study, we developed training and evaluation scenarios within the RGS framework. In the Spheroids training scenario (Figure 1), the user has to perform bilateral reaching movements to intercept and grasp a maximum number of spheres moving towards him [16]. RGS captures only joint flexion and extension and filters out the participant’s trunk movements, therefore preventing the execution of compensatory body movements [18]. This task was defined by three difficulty parameters, each of them associated with a specific performance descriptor: (1) different trajectories of the spheres require different ranges of joint motion for elbow and shoulder, (2) the size of the spheres require different hand and grasp precision and perceptual abilities, and (3) the velocity of the spheres require different movement speeds and timing. All these parameters, also including the range of finger flexion and extension required to grasp and release spheroids, were dynamically modulated by the RGS Adaptive Difficulty Controller [19] to maintain the performance ratio (ie, successful trials over the total trials) above 0.6 and below 0.8, optimizing effort and reinforcement during training [20]. […]

Figure 1. Experimental setup and protocol: (A) Movements of the user’s upper limbs are captured and mapped onto an avatar displayed on a screen in first person perspective so that the user sees the movements of the virtual upper extremities. A pair of data gloves equipped with bend sensors captures finger flexion. (B) The Spheroids is divided into three subtasks: hit, grasp, and place. A white separator line divides the workspace in a paretic and non-paretic zone only allowing for ipsilateral movements.(C) The experimental protocol. Evaluation periods (Eval.) indicate clinical evaluations using standard clinical scales and Navigated Brain Stimulation procedures (NBS). These evaluations took place before the first session (W0), after the last session of the treatment (day 15, W3), and at follow-up (week 12, W12).

Continue —>  JSG-Domiciliary VR-Based Therapy for Functional Recovery and Cortical Reorganization: Randomized Controlled Trial in Participants at the Chronic Stage Post Stroke | Ballester | JMIR Serious Games

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[Abstract+References] Neuroplastic Changes Induced by Cognitive Rehabilitation in Traumatic Brain Injury: A Review 

Background. Cognitive deficits are among the most disabling consequences of traumatic brain injury (TBI), leading to long-term outcomes and interfering with the individual’s recovery. One of the most effective ways to reduce the impact of cognitive disturbance in everyday life is cognitive rehabilitation, which is based on the principles of brain neuroplasticity and restoration. Although there are many studies in the literature focusing on the effectiveness of cognitive interventions in reducing cognitive deficits following TBI, only a few of them focus on neural modifications induced by cognitive treatment. The use of neuroimaging or neurophysiological measures to evaluate brain changes induced by cognitive rehabilitation may have relevant clinical implications, since they could add individualized elements to cognitive assessment. Nevertheless, there are no review studies in the literature investigating neuroplastic changes induced by cognitive training in TBI individuals.

Objective. Due to lack of data, the goal of this article is to review what is currently known on the cerebral modifications following rehabilitation programs in chronic TBI.

Methods. Studies investigating both the functional and structural neural modifications induced by cognitive training in TBI subjects were identified from the results of database searches. Forty-five published articles were initially selected. Of these, 34 were excluded because they did not meet the inclusion criteria.

Results. Eleven studies were found that focused solely on the functional and neurophysiological changes induced by cognitive rehabilitation.

Conclusions. Outcomes showed that cerebral activation may be significantly modified by cognitive rehabilitation, in spite of the severity of the injury.

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Source: Neuroplastic Changes Induced by Cognitive Rehabilitation in Traumatic Brain Injury: A ReviewNeurorehabilitation and Neural Repair – Valentina Galetto, Katiuscia Sacco, 2017

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[Abstract] Case Report on the Use of a Custom Myoelectric Elbow–Wrist–Hand Orthosis for the Remediation of Upper Extremity Paresis and Loss of Function in Chronic Stroke.

Abstract:

Introduction: This case study describes the application of a commercially available, custom myoelectric elbow–wrist–hand orthosis (MEWHO), on a veteran diagnosed with chronic stroke with residual left hemiparesis. The MEWHO provides powered active assistance for elbow flexion/extension and 3 jaw chuck grip. It is a noninvasive orthosis that is driven by the user’s electromyographic signal. Experience with the MEWHO and associated outcomes are reported.

Materials and Methods: The participant completed 21 outpatient occupational therapy sessions that incorporated the use of a custom MEWHO without grasp capability into traditional occupational therapy interventions. He then upgraded to an advanced version of that MEWHO that incorporated grasp capability and completed an additional 14 sessions. Range of motion, strength, spasticity (Modified Ashworth Scale [MAS]), the Box and Blocks test, the Fugl–Meyer assessment and observation of functional tasks were used to track progress. The participant also completed a home log and a manufacturers’ survey to track usage and user satisfaction over a 6-month period.

Results: Active left upper extremity range of motion and strength increased significantly (both with and without the MEWHO) and tone decreased, demonstrating both a training and an assistive effect. The participant also demonstrated an improved ability to incorporate his affected extremity (with the MEWHO) into a wide variety of bilateral, gross motor activities of daily living such as carrying a laundry basket, lifting heavy objects (e.g. a chair), using a tape measure, meal preparation, and opening doors.

Conclusion: Custom myoelectric orthoses offer an exciting opportunity for individuals diagnosed with a variety of neurological conditions to make advancements toward their recovery and independence, and warrant further research into their training effects as well as their use as assistive devices.

Source: EBSCOhost | 123998452 | Case Report on the Use of a Custom Myoelectric Elbow–Wrist–Hand Orthosis for the Remediation of Upper Extremity Paresis and Loss of Function in Chronic Stroke.

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[ARTICLE] A soft robotic exosuit improves walking in patients after stroke – Full Text

A softer recovery after stroke

Passive assistance devices such as canes and braces are often used by people after stroke, but mobility remains limited for some patients. Awad et al. studied the effects of active assistance (delivery of supportive force) during walking in nine patients in the chronic phase of stroke recovery. A soft robotic exosuit worn on the partially paralyzed lower limb reduced interlimb propulsion asymmetry, increased ankle dorsiflexion, and reduced the energy required to walk when powered on during treadmill and overground walking tests. The exosuit could be adjusted to deliver supportive force during the early or late phase of the gait cycle depending on the patient’s needs. Although long-term therapeutic studies are necessary, the immediate improvement in walking performance observed using the powered exosuit makes this a promising approach for neurorehabilitation.

Abstract

Stroke-induced hemiparetic gait is characteristically slow and metabolically expensive. Passive assistive devices such as ankle-foot orthoses are often prescribed to increase function and independence after stroke; however, walking remains highly impaired despite—and perhaps because of—their use. We sought to determine whether a soft wearable robot (exosuit) designed to supplement the paretic limb’s residual ability to generate both forward propulsion and ground clearance could facilitate more normal walking after stroke. Exosuits transmit mechanical power generated by actuators to a wearer through the interaction of garment-like, functional textile anchors and cable-based transmissions. We evaluated the immediate effects of an exosuit actively assisting the paretic limb of individuals in the chronic phase of stroke recovery during treadmill and overground walking. Using controlled, treadmill-based biomechanical investigation, we demonstrate that exosuits can function in synchrony with a wearer’s paretic limb to facilitate an immediate 5.33 ± 0.91° increase in the paretic ankle’s swing phase dorsiflexion and 11 ± 3% increase in the paretic limb’s generation of forward propulsion (P < 0.05). These improvements in paretic limb function contributed to a 20 ± 4% reduction in forward propulsion interlimb asymmetry and a 10 ± 3% reduction in the energy cost of walking, which is equivalent to a 32 ± 9% reduction in the metabolic burden associated with poststroke walking. Relatively low assistance (~12% of biological torques) delivered with a lightweight and nonrestrictive exosuit was sufficient to facilitate more normal walking in ambulatory individuals after stroke. Future work will focus on understanding how exosuit-induced improvements in walking performance may be leveraged to improve mobility after stroke.

INTRODUCTION

Bipedal locomotion is a defining trait of the human lineage, with a key evolutionary advantage being a low energetic cost of transport (1). However, the economy of bipedal gait may be lost because of neurological injury with disabling consequences. Hemiparetic walking (27) is characterized by a slow and highly inefficient gait that is a major contributor to disability after stroke (8, 9), which is a leading cause of disability among Americans (10). Despite rehabilitation, the vast majority of stroke survivors retain neuromotor deficits that prevent walking at speeds suitable for normal, economical, and safe community ambulation (11). Impaired motor coordination (12), muscle weakness and spasticity (13), and reduced ankle dorsiflexion (DF; drop foot) and knee flexion during walking are examples of typical deficits after stroke that limit walking speed and contribute to gait compensations such as hip circumduction and hiking (1418), increase the risk of falls, and reduce fitness reserve and endurance (3, 4, 9, 12, 1921). Even those able to achieve near-normal walking speeds present with gait deficits (22, 23) that hinder community reintegration and limit participation to well below what is observed in even the most sedentary older adults (24, 25), ultimately contributing to reduced health and quality of life (10, 26, 27).

Walking independence is an important short-term goal for survivors of a stroke; however, independence can be achieved via compensatory mechanisms. The persistence of neuromotor deficits after rehabilitation often necessitates the prescription of passive assistive devices such as canes, walkers, and orthoses to enable walking at home and in the community (2830). Unfortunately, commonly prescribed devices compensate for poststroke neuromotor impairments in a manner that prevents normal gait function. For example, ankle-foot orthoses (AFOs) inhibit normal push-off during walking (31) and reduce gait adaptability (32). The stigma associated with the use of these devices is also important to consider, especially for the growing population of young adult survivors of stroke (33, 34). The major personal and societal costs of stroke-induced walking difficulty and the limitations of the existing intervention paradigm motivate the development of rehabilitation interventions and technologies that enable the rapid attainment of more normal walking behavior.

Recent years have seen the development of powered exoskeletal devices designed to enable walking in individuals who are unable to walk (35, 36). Central to this remarkable engineering achievement is a rigid structure that can support its own weight and provide high amounts of assistance; however, these powerful machines may not always be necessary to restore more normal gait function in individuals who retain the ability to walk after neurological injury, such as the majority of those after stroke. To address this opportunity, our team developed a lightweight, soft wearable robot (exosuit) that interfaces to the paretic limb of persons after stroke via garment-like, functional textile anchors. Exosuits produce gait-restorative joint torques by transmitting mechanical power from waist-mounted body-worn (37) or off-board (38, 39) actuators to the wearer through the interaction of the textile anchors and a cable-based transmission.

Several factors, such as the compliance of the exosuit-human system (40), prevent exosuits from providing the assistance necessary to enable nonambulatory individuals to walk again (41); however, for ambulatory individuals, the lightweight and nonrestrictive nature of this technology has the potential to facilitate a more natural interaction with the wearer and minimize disruption of the natural dynamics of walking (42). Our first efforts developing exosuits led to the creation of systems that could comfortably deliver assistive forces to healthy users during walking (39, 40, 4347). Recently, we demonstrated that assistive forces delivered through the exosuit interface produce marked reductions in the energy cost of healthy walking (37, 48). Thus, although exosuits can only augment, not replace, a wearer’s existing gait functions, we posit that they have the potential to work synergistically with the residual abilities of individuals with impaired gait to improve walking function.

The primary objective of this foundational study was to evaluate the potential of using the exosuit technology to restore healthy walking behavior in individuals after stroke. Toward this end, we evaluated the effects on hemiparetic gait of actively assisting the paretic limb during treadmill walking using a tethered, unilateral (worn on only one side of the body) exosuit designed to supplement the wearer’s generation of paretic ankle plantarflexion (PF) during stance phase and DF during swing phase. We posited that this targeted assistance of the paretic ankle’s gait functions would facilitate more symmetrical propulsive force generation by the paretic and nonparetic limbs and reduce the energetic burden associated with poststroke walking, which previous work has shown can be more than 60% more costly (49). Previous work on wearable assistive robots for persons after stroke has suggested that the timing of PF force delivery during walking could be an important contributor to positive outcomes in this heterogeneous population (50). Hence, we also evaluated different onset timings of PF force delivery for each individual, hypothesizing that this timing would need to be individualized to optimize outcomes.

Designed to be unobtrusive to the wearer when not powered, the exosuit’s mass of ~0.9 kg is distributed along the length of the paretic limb similar to a pair of pants. Nonetheless, to understand the net effect of walking with an exosuit powered and assisting the paretic limb, it is necessary to evaluate whether there are effects because of simply wearing the exosuit passively (worn but unpowered). A secondary objective was thus to evaluate the effects of walking with the passive exosuit relative to walking with the exosuit not worn. Moreover, because one of the compelling aspects of soft wearable robots, such as exosuits, is their potential to provide gait assistance and, potentially, rehabilitation benefit during community-based walking activities, in addition to treadmill-based biomechanical investigation into the effects of a tethered exosuit, our final objective was to evaluate the effects of exosuit assistance delivered from a first-generation, body-worn (untethered) exosuit during overground walking. Ultimately, by investigating how individuals with poststroke hemiparesis respond to exosuit-generated active assistance of ankle PF and DF during treadmill and overground walking, this study serves to define the technology’s potential for improving mobility and enabling more effective neurorehabilitation after stroke. […]

Continue —> A soft robotic exosuit improves walking in patients after stroke | Science Translational Medicine

 

Fig. 1. Overview of a soft wearable robot (exosuit) designed to augment paretic limb function during hemiparetic walking. Exosuits (A) use garment-like functional textile anchors worn around the waist and calf (B) and Bowden cable-based mechanical power transmissions to generate assistive joint torques as a function of the paretic gait cycle (C). Integrated sensors (load cells and gyroscopes) are used to detect gait events and in a cable position–based force controller that modulates force delivery. The contractile elements of the exosuit are the Bowden cables located posterior and anterior to the ankle joint. Exosuit-generated PF and DF forces are designed to restore the paretic limb’s contribution to forward propulsion (GRF) and ground clearance (ankle DF angle during swing phase)—subtasks of walking that are impaired after stroke. Poststroke deficits in these variables are demonstrated through a comparison of paretic (black) and nonparetic (gray) limbs. Means across participants are presented (n = 7).

 

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[Abstract] Determining the potential benefits of yoga in chronic stroke care: a systematic review and meta-analysis

Abstract

Background: Survivors of stroke have long-term physical and psychological consequences that impact their quality of life. Few interventions are available in the community to address these problems. Yoga, a type of mindfulness-based intervention, is shown to be effective in people with other chronic illnesses and may have the potential to address many of the problems reported by survivors of stroke.

Objectives: To date only narrative reviews have been published. We sought to perform, the first systematic review with meta-analyses of randomized controlled trials (RCTs) that investigated yoga for its potential benefit for chronic survivors of stroke.

Methods: Ovid Medline, CINHAL plus, AMED, PubMed, PsychINFO, PeDro, Cochrane database, Sport Discuss, and Google Scholar were searched for papers published between January 1950 and August 2016. Reference lists of included papers, review articles and OpenGrey for Grey literature were also searched. We used a modified Cochrane tool to evaluate risk of bias. The methodological quality of RCTs was assessed using the GRADE approach, results were collated, and random effects meta-analyses performed where appropriate.

Results: The search yielded five eligible papers from four RCTs with small sample sizes (n = 17–47). Quality of RCTs was rated as low to moderate. Yoga is beneficial in reducing state anxiety symptoms and depression in the intervention group compared to the control group (mean differences for state anxiety 6.05, 95% CI:−0.02 to 12.12; p = 0.05 and standardized mean differences for depression: 0.50, 95% CI:−0.01 to 1.02; p = 0.05). Consistent but nonsignificant improvements were demonstrated for balance, trait anxiety, and overall quality of life.

Conclusions: Yoga may be effective for ameliorating some of the long-term consequences of stroke. Large well-designed RCTs are needed to confirm these findings.

Source: Determining the potential benefits of yoga in chronic stroke care: a systematic review and meta-analysis: Topics in Stroke Rehabilitation: Vol 24, No 4

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[Abstract] Gross Motor AbiLity predictS Response to upper extremity rehabilitation in chronic stroke  

Abstract

The majority of rehabilitation research focuses on the comparative effectiveness of different interventions in groups of patients, while much less is currently known regarding individual factors that predict response to rehabilitation. In a recent article, authors presented a prognostic model to identify the sensorimotor characteristics predictive of the extent of motor recovery after Constraint-Induced Movement (CI) therapy amongst individuals with chronic mild-to-moderate motor deficit using the enhanced probabilistic neural network (EPNN). This follow-up paper examines which participant characteristics are robust predictors of rehabilitation response irrespective of the training modality. To accomplish this, EPNN was first applied to predict treatment response amongst individuals who received a virtual-reality gaming intervention (utilizing the same enrollment criteria as the prior study). The combinations of predictors that yield high predictive validity for both therapies, using their respective datasets, were then identified. High predictive classification accuracy was achieved for both the gaming (94.7%) and combined datasets (94.5%). Though CI therapy employed primarily fine-motor training tasks and the gaming intervention emphasized gross-motor practice, larger improvements in gross motor function were observed within both datasets. Poorer gross motor ability at pre-treatment predicted better rehabilitation response in both the gaming and combined datasets. The conclusion of this research is that for individuals with chronic mild-to-moderate upper extremity hemiparesis, residual deficits in gross motor function are highly responsive to motor restorative interventions, irrespective of the modality of training.

Source: Gross Motor AbiLity predictS Response to upper extremity rehabilitation in chronic stroke – ScienceDirect

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[Abstract+References] High-Intensity Chronic Stroke Motor Imagery Neurofeedback Training at Home: Three Case Reports 

Motor imagery (MI) with neurofeedback has been suggested as promising for motor recovery after stroke. Evidence suggests that regular training facilitates compensatory plasticity, but frequent training is difficult to integrate into everyday life. Using a wireless electroencephalogram (EEG) system, we implemented a frequent and efficient neurofeedback training at the patients’ home. Aiming to overcome maladaptive changes in cortical lateralization patterns we presented a visual feedback, representing the degree of contralateral sensorimotor cortical activity and the degree of sensorimotor cortex lateralization. Three stroke patients practiced every other day, over a period of 4 weeks. Training-related changes were evaluated on behavioral, functional, and structural levels. All 3 patients indicated that they enjoyed the training and were highly motivated throughout the entire training regime. EEG activity induced by MI of the affected hand became more lateralized over the course of training in all three patients. The patient with a significant functional change also showed increased white matter integrity as revealed by diffusion tensor imaging, and a substantial clinical improvement of upper limb motor functions. Our study provides evidence that regular, home-based practice of MI neurofeedback has the potential to facilitate cortical reorganization and may also increase associated improvements of upper limb motor function in chronic stroke patients.

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Source: High-Intensity Chronic Stroke Motor Imagery Neurofeedback Training at Home: Three Case ReportsClinical EEG and Neuroscience – Catharina Zich, Stefan Debener, Clara Schweinitz, Annette Sterr, Joost Meekes, Cornelia Kranczioch, 2017

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