Posts Tagged function

[Abstract] Myoelectric Computer Interface Training for Reducing Co-Activation and Enhancing Arm Movement in Chronic Stroke Survivors: A Randomized Trial

Background. Abnormal muscle co-activation contributes to impairment after stroke. We developed a myoelectric computer interface (MyoCI) training paradigm to reduce abnormal co-activation. MyoCI provides intuitive feedback about muscle activation patterns, enabling decoupling of these muscles.

Objective. To investigate tolerability and effects of MyoCI training of 3 muscle pairs on arm motor recovery after stroke, including effects of training dose and isometric versus movement-based training.

Methods. We randomized chronic stroke survivors with moderate-to-severe arm impairment to 3 groups. Two groups tested different doses of isometric MyoCI (60 vs 90 minutes), and one group tested MyoCI without arm restraint (90 minutes), over 6 weeks. Primary outcome was arm impairment (Fugl-Meyer Assessment). Secondary outcomes included function, spasticity, and elbow range-of-motion at weeks 6 and 10.

Results. Over all 32 subjects, MyoCI training of 3 muscle pairs significantly reduced impairment (Fugl-Meyer Assessment) by 3.3 ± 0.6 and 3.1 ± 0.7 (P < 10−4) at weeks 6 and 10, respectively. Each group improved significantly from baseline; no significant differences were seen between groups. Participants’ lab-based and home-based function also improved at weeks 6 and 10 (P ≤ .01). Spasticity also decreased over all subjects, and elbow range-of-motion improved. Both moderately and severely impaired patients showed significant improvement. No participants had training-related adverse events. MyoCI reduced abnormal co-activation, which appeared to transfer to reaching in the movement group.

Conclusions. MyoCI is a well-tolerated, novel rehabilitation tool that enables stroke survivors to reduce abnormal co-activation. It may reduce impairment and spasticity and improve arm function, even in severely impaired patients.

 

via Myoelectric Computer Interface Training for Reducing Co-Activation and Enhancing Arm Movement in Chronic Stroke Survivors: A Randomized Trial – Emily M. Mugler, Goran Tomic, Aparna Singh, Saad Hameed, Eric W. Lindberg, Jon Gaide, Murad Alqadi, Elizabeth Robinson, Katherine Dalzotto, Camila Limoli, Tyler Jacobson, Jungwha Lee, Marc W. Slutzky, 2019

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[ARTICLE] Long-Dose Intensive Therapy Is Necessary for Strong, Clinically Significant, Upper Limb Functional Gains and Retained Gains in Severe/Moderate Chronic Stroke – Full Text

Background. Effective treatment methods are needed for moderate/severely impairment chronic stroke.

Objective. The questions were the following: (1) Is there need for long-dose therapy or is there a mid-treatment plateau? (2) Are the observed gains from the prior-studied protocol retained after treatment?

Methods. Single-blind, stratified/randomized design, with 3 applied technology treatment groups, combined with motor learning, for long-duration treatment (300 hours of treatment). Measures were Arm Motor Ability Test time and coordination-function (AMAT-T, AMAT-F, respectively), acquired pre-/posttreatment and 3-month follow-up (3moF/U); Fugl-Meyer (FM), acquired similarly with addition of mid-treatment.

Findings. There was no group difference in treatment response (P ≥ .16), therefore data were combined for remaining analyses (n = 31; except for FM pre/mid/post, n = 36). Pre-to-Mid-treatment and Mid-to-Posttreatment gains of FM were statistically and clinically significant (P < .0001; 4.7 points and P < .001; 5.1 points, respectively), indicating no plateau at 150 hours and benefit of second half of treatment. From baseline to 3moF/U: (1) FM gains were twice the clinically significant benchmark, (2) AMAT-F gains were greater than clinically significant benchmark, and (3) there was statistically significant improvement in FM (P < .0001); AMAT-F (P < .0001); AMAT-T (P < .0001). These gains indicate retained clinically and statistically significant gains at 3moFU. From posttreatment to 3moF/U, gains on FM were maintained. There were statistically significant gains in AMAT-F (P = .0379) and AMAT-T P = .003.

Many stroke survivors do not fully recover upper limb function following stroke, leading to significant disability and diminished quality of life.1 Effective treatments are needed for chronic, severely impaired stroke survivors.2 Other studies showed improved upper limb motor function in chronic stroke for mild/moderately impaired,313 with traditional “constraint induced” treatment studies enrolling only those with preserved wrist and finger extension (acceptance rate, 10%).14 However, for those with moderate/severe impairment after stroke, improvement in function has been more difficult to realize. A recent study of constraint-induced movement therapy in more severe stroke reported no clinically significant change in upper limb Fugl-Meyer assessment scores.15 Others have also tested the application of technologies and devices, in moderately/severely impaired chronic stroke survivors, with the following: functional electrical stimulation (FES),1618 sequenced bilateral and unilateral task orientated training,19 mirror therapy,20 progressive abduction loading therapy,21 contralaterally controlled FES,22 and robotics.2327 Limitations included small sample size,1618,2223 lacking control group,16,23 lacking statistically significant gains on impairment or functional measures,23 lacking clinically significant change,20,21,2325,27 lacking retention of clinically significant gains,16,19,25,26 or lacking study of retention.20,23 Furthermore, many studies do not include both a measure of impairment and an array of actual everyday functional tasks. Our work has focused on moderately/severely impaired chronic stroke survivors, and in prior work we developed and tested a protocol that combines technology applications and motor learning.28,29 We found clinically and statistically significant gains for those with moderate/severe stroke considerably beyond that reported by others (eg, gains in coordination, Fugl-Myer coordination scale [FM], and gains on the Arm Motor Ability Test [AMAT; 13 complex functional tasks]).

Others have cited this work stating that “a change in impairment of this magnitude was previously considered almost impossible in chronic stroke patients,”30 and that this is important first evidence for use of high dose neurorehabilitation.31 Therefore, we considered it important to replicate the administration of the upper limb motor learning protocol in a follow-on study and again quantify response. Another consideration was that we had not given technology a full chance in application to the “whole arm,” that is, both distal and proximal upper limb regions. Therefore, a first purpose was to replicate administration of the upper limb motor learning protocol and to include a treatment group that would receive technology applications to both distal and proximal limb regions. In addition, there were 2 important and unanswered questions regarding the dose and efficacy of this new treatment protocol.

The first question is whether a shorter treatment duration (ie, <300 hours) could produce the same degree of recovery, given that the existing protocol was tested in the paradigm of long-duration dose of 300 hours of therapy. Therefore, in the current work, we administered the same protocol as in prior work,28 and acquired mid-treatment (at 150 hours of treatment) data on the Fugl-Meyer impairment measure, which underlies complex functional task performance. We studied whether a mid-treatment plateau occurred or whether significant recovery occurred in response to the second half of treatment (mid-treatment to posttreatment).

The second question is whether the observed gains can be retained after cessation of treatment. Therefore, we studied retention of gains at 3 months after treatment ended.[…]

 

Continue —> Long-Dose Intensive Therapy Is Necessary for Strong, Clinically Significant, Upper Limb Functional Gains and Retained Gains in Severe/Moderate Chronic Stroke – Janis J. Daly, Jessica P. McCabe, John Holcomb, Michelle Monkiewicz, Jennifer Gansen, Svetlana Pundik, 2019

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[Abstract] Adding electrical stimulation during standard rehabilitation after stroke to improve motor function. A systematic review and meta-analysis

Abstract

Background

Clinical studies have shown that sensory input improves motor function when added to active training after neurological injuries in the spinal cord.

Objective

We aimed to determine the effect on motor function of extremities of adding an electrical sensory modality without motor recruitment before or with routine rehabilitation for hemiparesis after stroke by a comprehensive systematic review and meta-analysis.

Methods

We searched databases including MEDLINE via PubMed and the Cochrane Central Register of Controlled Trials from 1978 to the end of November 2017 for reports of randomized controlled trials or controlled studies of patients with a clinical diagnosis of stroke who underwent 1) transcutaneous electrical nerve stimulation (TENS) or peripheral electromyography-triggered sensory stimulation over a peripheral nerve and associated muscles or 2) acupuncture to areas that produced sensory effects, without motor recruitment, along with routine rehabilitation. Outcome measures were motor impairment, activity, and participation outcomes defined by the International Classification of Functioning, Disability and Health.

Results

The search yielded 11 studies with data that could be included in a meta-analysis. Electrical sensory inputs, when paired with routine therapy, improved peak torque dorsiflexion (mean difference [MD] 2.44 Nm, 95% confidence interval [CI] 0.26–4.63). On subgroup analysis, the combined therapy yielded a significant difference in terms of sensory stimulation without motor recruitment only on the Timed Up and Go test in the chronic phase of stroke (MD 3.51 sec, 95% CI 3.05–3.98). The spasticity score was reduced but not significantly (MD − 0.83 points, 95% CI -1.77 − 0.10).

Conclusion

Electrical sensory input can contribute to routine rehabilitation to improve early post-stroke lower-extremity impairment and late motor function, with no change in spasticity. Prolonged periods of sensory stimulation such as TENS combined with activity can have beneficial effects on impairment and function after stroke.

via Adding electrical stimulation during standard rehabilitation after stroke to improve motor function. A systematic review and meta-analysis – ScienceDirect

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[ARTICLE] Biomarkers of stroke recovery: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable – Full Text

In practical terms, biomarkers should improve our ability to predict long-term outcomes after stroke across multiple domains. This is beneficial for: (a) patients, caregivers and clinicians; (b) planning subsequent clinical pathways and goal setting; and (c) identifying whom and when to target, and in some instances at which dose, with interventions for promoting stroke recovery.2 This last point is particularly important as methods for accurate prediction of long-term outcome would allow clinical trials of restorative and rehabilitation interventions to be stratified based on the potential for neurobiological recovery in a way that is currently not possible when trials are performed in the absence of valid biomarkers. Unpredictable outcomes after stroke, particularly in those who present with the most severe impairment3 mean that clinical trials of rehabilitation interventions need hundreds of patients to be appropriately powered. Use of biomarkers would allow incorporation of accurate information about the underlying impairment, and thus the size of these intervention trials could be considerably reduced,4 with obvious benefits. These principles are no different in the context of stroke recovery as compared to general medical research.5

Interventions fall into two broad mechanistic categories: (1) behavioural interventions that take advantage of experience and learning-dependent plasticity (e.g. motor, sensory, cognitive, and speech and language therapy), and (2) treatments that enhance the potential for experience and learning-dependent plasticity to maximise the effects of behavioural interventions (e.g. pharmacotherapy or non-invasive brain stimulation).6 To identify in whom and when to intervene, we need biomarkers that reflect the underlying biological mechanisms being targeted therapeutically.

Our goal is to provide a consensus statement regarding the evidence for SRBs that are helpful in outcome prediction and therefore identifying subgroups for stratification to be used in trials.7 We focused on SRBs that can investigate the structure or function of the brain (Table 1). Four functional domains (motor, somatosensation, cognition, and language (Table 2)) were considered according to recovery phase post stroke (hyperacute: <24 h; acute: 1 to 7 days; early subacute: 1 week to 3 months; late subacute: 3 months to 6 months; chronic: > 6 months8). For each functional domain, we provide recommendations for biomarkers that either are: (1) ready to guide stratification of subgroups of patients for clinical trials and/or to predict outcome, or (2) are a developmental priority (Table 3). Finally, we provide an example of how inclusion of a clinical trial-ready biomarker might have benefitted a recent phase III trial. As there is generally limited evidence at this time for blood or genetic biomarkers, we do not discuss these, but recommend they are a developmental priority.912 We also recognize that many other functional domains exist, but focus here on the four that have the most developed science. […]

Continue —> Biomarkers of stroke recovery: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation RoundtableInternational Journal of Stroke – Lara A Boyd, Kathryn S Hayward, Nick S Ward, Cathy M Stinear, Charlotte Rosso, Rebecca J Fisher, Alexandre R Carter, Alex P Leff, David A Copland, Leeanne M Carey, Leonardo G Cohen, D Michele Basso, Jane M Maguire, Steven C Cramer, 2017

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[ARTICLE] Repetitive reaching training combined with transcranial Random Noise Stimulation in stroke survivors with chronic and severe arm paresis is feasible: a pilot, triple-blind, randomised case series – Full Text

Abstract

Background

Therapy that combines repetitive training with non-invasive brain stimulation is a potential avenue to enhance upper limb recovery after stroke. This study aimed to investigate the feasibility of transcranial Random Noise Stimulation (tRNS), timed to coincide with the generation of voluntary motor commands, during reaching training.

Methods

A triple-blind pilot RCT was completed. Four stroke survivors with chronic (6-months to 5-years) and severe arm paresis, not taking any medications that had the potential to alter cortical excitability, and no contraindications to tRNS or MRI were recruited. Participants were randomly allocated to 12 sessions of reaching training over 4-weeks with active or sham tRNS delivered over the lesioned hemisphere motor representation. tRNS was triggered to coincide with a voluntary movement attempt, ceasing after 5-s. At this point, peripheral nerve stimulation enabled full range reaching. To determine feasibility, we considered adverse events, training outcomes, clinical outcomes, corticospinal tract (CST) structural integrity, and reflections on training through in-depth interviews from each individual case.

Results

Two participants received active and two sham tRNS. There were no adverse events. All training sessions were completed, repetitive practice performed and clinically relevant improvements across motor outcomes demonstrated. The amount of improvement varied across individuals and appeared to be independent of group allocation and CST integrity.

Conclusion

Reaching training that includes tRNS timed to coincide with generation of voluntary motor commands is feasible. Clinical improvements were possible even in the most severely affected individuals as evidenced by CST integrity.

Trial registration

This study was registered on the Australian and New Zealand Clinical Trials Registry (ANZCTR) http://www.ANZCTR.org.au/ACTRN12614000952640.aspx. Registration date 4 September 2014, first participant date 9 September 2014

Background

It is estimated that 30% of stroke survivors have severe upper limb impairment [1], whereby the functional capacity of the paretic arm is diminished to the extent that it cannot be moved against gravity [2]. For these individuals, who do not have sufficient movement with which to work, the provision of effective therapy can be challenging. The associated consequences are poor prospects for recovery [3], limited rehabilitation opportunities [4], and ultimately reduced quality of life (QoL) [5]. Yet, if task-oriented practice can be made possible by some means, there exists the potential to promote motor recovery, and in turn make a significant positive impact upon individual QoL and alleviate burden of care. In seeking to achieve levels of task-oriented practice beyond those that are possible through traditional therapy alone, attention has therefore turned to enabling technologies, including “assistive” devices, and adjuvant methods such as peripheral nerve and brain stimulation.

Best evidence syntheses [67] suggest that goal-directed movements can be assisted by minimizing the mechanical degrees of freedom to be controlled, in combination with the augmentation of voluntary muscle activity via peripheral nerve stimulation of target muscles, or the use of mechanical actuators. To encourage positive changes in motor performance, the capacity to increase task difficulty through small, yet incremental progressions and provision of meaningful real-time visual and auditory feedback have also been highlighted [89]. The authors have previously sought to implement these principles, using the Sensorimotor Active Rehabilitation Training of the Arm (SMART Arm) device to promote functional recovery in severely impaired stroke survivors [8910]. It has been shown that 4-weeks (12-h) of community-based training of reaching in people greater than 6-months post stroke improved upper limb function (and increased reaching distance) [8], enhanced the specificity of muscle recruitment (elevated ratio of biceps to triceps activation during reaching) [11], and accentuated corticospinal reactivity (decreased motor evoked potential [MEP] onset latency) [12]. Of particular interest in the context of the current study is the observation that not all individuals achieved functional gains. In these cases, the intrinsic neurobiological reserve of the injured brain may have been insufficient for repetitive training alone to drive recovery of motor function.

A variety of non-invasive brain stimulation (NIBS) techniques are now being used with the aim of altering the excitability of brain networks that have the potential to be engaged during the execution of motor tasks. The most commonly applied NIBS techniques are transcranial-direct current stimulation (tDCS) and repetitive-transcranial magnetic stimulation (rTMS) [13]. In general, the application of these techniques is predicated on the assumption that by altering the state of circuits within (contralateral) primary motor cortex (M1) in a manner that produces sustained increases in the excitability of corticospinal projections to the impaired limb (or by decreasing the excitability of circuits in the M1 ipsilateral to the impaired limb), therapeutic gains will be realised. The fact that these approaches have limited efficacy in severely impaired stroke survivors notwithstanding [14], there exist other forms of therapeutic NIBS that are motivated by a different premise.

It is well established that in some circumstances, the addition of random interference or noise, enhances the detection of weak stimuli, or the information content of a signal (e.g., trains of action potentials) [15]. In light of this phenomenon, it has been proposed that the application of transcranial random noise stimulation (tRNS) may boost the adaptive potential of cortical tissue [16]. The present investigation is motivated by the conjecture that: if the delivery of random noise stimulation is timed to occur simultaneously with the generation of voluntary motor commands, it may serve to amplify functional adaptations invoked by the intrinsic neural activity.

Implemented through a triple-blind pilot randomised control design, the specific aim of this study was to establish the feasibility of delivering tRNS, timed to coincide with the generation of the voluntary motor commands, in the context of reaching movements performed by individuals with chronic and severe upper limb paresis after stroke. Recognising that the response to any therapeutic intervention is constrained by the state of pathways that can convey signals from the brain to the periphery, diffusion-weighted magnetic resonance imaging (DW-MRI) was performed to characterize the structural integrity of the descending corticospinal tract (CST) projections for each participant.

Continue —>  Repetitive reaching training combined with transcranial Random Noise Stimulation in stroke survivors with chronic and severe arm paresis is feasible: a pilot, triple-blind, randomised case series | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 1 Representation of the training setup including horizontal reaching track, trunk restraint, visual feedback, transcranial random noise stimulation application, and electrical stimulation application to lateral head of triceps

 

Fig. 2 Corticospinal tract streamline reconstructions: the corticospinal tract is indicated for each of the four participants, displayed on coronal (x view) slices of T1 weighted anatomical scans with direction encoded fractional anisotropy (FA) colour maps superimposed. Images are shown in radiological format (ie. right on the image is the patient’s left side). The reconstructed streamlines for the corticospinal tract are also superimposed, and indicated by red circles. The posterior limb of the internal capsule (PLIC) within the corticospinal tract was the region of interest that was delineated manually for each scan, using anatomical landmarks. No tracts were detected in the PLIC region in the right hemisphere for P03, or the left hemisphere for P04

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[Executive Summary] Rehabilitation Research at the National Institutes of Health: Moving the Field Forward

Article Outline

Approximately 53 million Americans live with a disability. For decades, the National Institutes of Health (NIH) has been conducting and supporting research to discover new ways to minimize disability and enhance the quality of life of people with disabilities. After the passage of the American With Disabilities Act, the NIH established the National Center for Medical Rehabilitation Research with the goal of developing and implementing a rehabilitation research agenda. Currently, a total of 17 institutes and centers at NIH invest more than $500 million per year in rehabilitation research. Recently, the director of NIH, Dr Francis Collins, appointed a Blue Ribbon Panel to evaluate the status of rehabilitation research across institutes and centers. As a follow-up to the work of that panel, NIH recently organized a conference under the title “Rehabilitation Research at NIH: Moving the Field Forward.” This report is a summary of the discussions and proposals that will help guide rehabilitation research at NIH in the near future.

The conference took place at the NIH Campus on May 25 and 26, 2016. It was cosponsored by The Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute of Biomedical Imaging and Bioengineering, the National Institute of Neurological Diseases and Stroke, the National Institute of Nursing Research, the National Institute on Deafness and other Communication Disorders, the National Center for Complementary and Integrative Health, and the Office of Disease Prevention. The main objectives of the Conference were to (1) discuss the current NIH portfolio in rehabilitation research, (2) highlight advances in rehabilitation research supported by NIH, and (3) provide an opportunity for scientists and the general public to comment on gaps in knowledge, opportunities for training, and infrastructure needs. The program included a total of 13 expert panels, four remarks by NIH leaders, a consumer keynote, a town hall, a poster session, and the use of social media to disseminate information in real time. The following is a summary of the discussion and the subheadings correspond to the title of the expert panels.

REHABILITATION ACROSS THE LIFESPAN

(Moderator: Alan Jette, PhD, Boston University; Panelists: Andrea Cheville, MD, Mayo Clinic; Jonathan Bean, MD, Boston University; Shari Wade, PhD, Cincinnati Children’s Hospital Medical Center)

The theme of this session was moving rehabilitation interventions from a traditional “one-and-done” isolated model of care to one where rehabilitation interventions are integrated into the mainstream of health care. The speakers addressed integrated care approaches in cancer care, primary care, and pediatric rehabilitation.

Barriers to integrating function-directed care into the comprehensive management of progressive diseases, particularly those with a heavy treatment burden, were identified. Cancer was used an exemplar of the simultaneously dynamic and insidious nature of disablement in chronic illness. Collaborative care approaches, including telecare, validated for pain and depression management, was considered a promising means to proactively and patient-centrically address cancer-related disablement. Current research in cancer rehabilitation suggests that challenges revolve around issues such as patient selection and timing, when and how to intervene, limitations of linear impairment-to-disability models (with multiple mild impairments the norm), and competition with disease-modifying therapies. Although functional limitations are prevalent (seen in 65% of all cancer patients), rehabilitation intervention remains underused. In contrast to ischemic and traumatic injuries, rehabilitation interventions in patients with cancer are less prescriptive, more negotiable, and subject to patient preferences. Current care delivery overwhelmingly emphasizes primary disease management.

Another presentation focused on limitations with mobility tasks, such as walking, rising from a chair, or climbing stairs, as a signal condition identifying older adult primary care patients at an increased risk for disability, morbidity, and death. It was discussed how rehabilitative care can play a critical role with older adult primary care patients by developing integrated care paradigms between primary and rehabilitative care providers focused on prevention of mobility decline among older adults. Prevention of adverse health outcomes represents a new conceptual role for rehabilitative care. Research priorities include determining the optimal content and design of preventative rehabilitative care; the potential benefits for patients, families, and health care organizations; and the cost/benefit of such approaches to care.

Traumatic brain injury (TBI) was used as a case example to discuss the need for further research on ways to integrate pediatric rehabilitation into the broader framework of child development. TBI is currently viewed as a discrete event with time-limited consequences while evidence from the TBI Model Systems suggests lifelong physical and cognitive consequences. Long-term pediatric studies are lacking, but existing evidence suggests long-term effects on educational attainment and vocational and social success. However, after the post–acute recovery phase, children with TBI receive little ongoing rehabilitation. TBI-related problems that emerge with shifting developmental demands may go unrecognized or be inaccurately characterized. Families and schools constitute powerful contexts for ongoing rehabilitation and later habilitation. How families function and interact with the child exerts a powerful influence on the recovery trajectory. Interventions need to be developmentally tailored and address the current developmental and neural context. Challenges remain in framing rehabilitation/habilitation as an ongoing process with tune-ups at various developmental stages rather than a one and done model. A better understanding of adult outcome metrics (e.g., education and employment) and long-term burden (disability and life quality) is needed. To reduce heterogeneity and improve prediction, research is needed to better categorize the initial injury/insult along with better understanding of effects on neurodevelopment and how this relates to long-term functional outcomes. Multicenter consortiums are urgently needed to support larger-scale outcome studies and provide an infrastructure to link school and medical data as well as study interventions and management practices more efficiently.

Continue —> Rehabilitation Research at the National Institutes of Health… : American Journal of Physical Medicine & Rehabilitation

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[Abstract] Pilot randomized controlled trial to assess a physical therapy program on upper extremity function to counteract inactivity in chronic stroke.

Background: In chronic stroke, feasible physical therapy (PT) programs are needed to promote function throughout life.

Objective: This randomized controlled pilot trial investigated the feasibility and effect of a PT program composed of strengthening exercises with elastic bands and bimanual functional training, with clearly defined doses based on the rate of perceived exertion (Borg scale), to counteract inactivity in chronic stroke.

Methods: Fifteen subjects > 6 month post-stroke were randomized to three-month of UE function training (UE group), or to lower extremity function training (LE group). At baseline (T0), post-intervention (T1) and three-month follow-up (T2) assessment included the Fugl-Meyer Assessment scale (FMA), Wolf Motor Function test (WMFT), grip strength, and muscle tone. Feasibility was also evaluated.

Results: The mixed-model ANOVAs revealed a significant interaction between the time and group factors for FMA (p < .001) and WMFT (p = .009). The UE group improved upper extremity function and motor recovery significantly more than the LE group. There was no significant interaction between treatment group and change in grip strength over time (p = .217). No between-group differences (p > .05) were found in muscle tone. In the UE group, the attendance rate was ≥85% for 71.4% of subjects and 85.7% showed high satisfaction. No adverse events were recorded. After treatment, adherence to the program was higher in the UE group.

Conclusions: The suggested PT program may be useful to improve the paretic UE function and motor recovery in chronic stroke. Moreover, it may be helpful to facilitate lifelong active involvement of stroke subjects in exercise.

Source: Pilot randomized controlled trial to assess a physical therapy program on upper extremity function to counteract inactivity in chronic stroke: Topics in Stroke Rehabilitation: Vol 0, No 0

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[Abstract] Hand rehabilitation after stroke using a wearable, high DOF, spring powered exoskeleton.

Abstract:

Stroke patients often have inappropriate finger flexor activation and finger extensor weakness, which makes it difficult to open their affected hand for functional grasp. The goal was to develop a passive, lightweight, wearable device to enable improved hand function during performance of activities of daily living. The device, HandSOME II, assists with opening the patient’s hand using 11 elastic actuators that apply extension torques to finger and thumb joints. Device design and initial testing are described. A novel mechanical design applies forces orthogonal to the finger segments despite the fact that all of the device DOFs are not aligned with human joint DOF. In initial testing with seven stroke subjects with impaired hand function, use of HandSOME II significantly increased maximum extension angles and range of motion in all of the index finger joints (P<0.05). HandSOME II allows performance of all the grip patterns used in daily activities and can be used as part of home-based therapy programs.

Source: IEEE Xplore Document – Hand rehabilitation after stroke using a wearable, high DOF, spring powered exoskeleton

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[Abstract] Upper-Limb Recovery After Stroke. A Randomized Controlled Trial Comparing EMG-Triggered, Cyclic, and Sensory Electrical Stimulation – 

Abstract

Background and purpose. This study compared the effect of cyclic neuromuscular electrical stimulation (NMES), electromyographically (EMG)-triggered NMES, and sensory stimulation on motor impairment and activity limitations in patients with upper-limb hemiplegia.

Methods. This was a multicenter, single-blind, multiarm parallel-group study of nonhospitalized hemiplegic stroke survivors within 6 months of stroke. A total of 122 individuals were randomized to receive either cyclic NMES, EMG-triggered NMES, or sensory stimulation twice every weekday in 40-minute sessions, over an 8 week-period. Patients were followed for 6 months after treatment concluded.

Results. There were significant increases in the Fugl-Meyer Assessment [F(1, 111) = 92.6, P < .001], FMA Wrist and Hand [F(1, 111) = 66.7, P < .001], and modified Arm Motor Ability Test [mAMAT; time effect: F(1, 111) = 91.0, P < .001] for all 3 groups. There was no significant difference in the improvement among groups in the FMA [F(2, 384) = 0.2, P = .83], FMA Wrist and Hand [F(2, 384) = 0.4, P = .70], or the mAMAT [F(2, 379) = 1.2, P = .31].

Conclusions. All groups exhibited significant improvement of impairment and functional limitation with electrical stimulation therapy applied within 6 months of stroke. Improvements were likely a result of spontaneous recovery. There was no difference based on the type of electrical stimulation that was administered.

 

Source: Upper-Limb Recovery After Stroke

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[ARTICLE] Participant perceptions of use of CyWee Z as adjunct to rehabilitation of upper-limb function following stroke – Full Text PDF

Abstract

This article reports on the perceptions of 14 adults with chronic stroke who participated in a pilot study to determine the utility, acceptability, and potential efficacy of using an adapted CyWee Z handheld game controller to play a variety of computer games aimed at improving upper-limb function. Four qualitative in-depth interviews and two focus groups explored participant perceptions. Data were thematically analyzed with the general inductive approach. Participants enjoyed playing the computer games with the technology. The perceived benefits included improved upper-limb function, concentration, and balance; however, six participants reported shoulder and/or arm pain or discomfort, which presented while they were engaged in play but appeared to ease during rest. Participants suggested changes to the games and provided opinions on the use of computer games in rehabilitation. Using an adapted CyWee Z controller and computer games in upper-limb rehabilitation for people with chronic stroke is an acceptable and potentially beneficial adjunct to rehabilitation. The development of shoulder pain was a negative side effect for some participants and requires further investigation.

INTRODUCTION

Stroke is the third leading cause of death in New Zealand and a major cause of adult disability for those who experience it [1]. Approximately 85 percent of patients with stroke do not regain upper-limb function and remain dependent on caregivers [2–3], with motor impairments accounting for most poststroke disability [4]. Loss of upper-limb function is a major cause of poor perception of well-being following stroke [5].

Most recovery of upper-limb function occurs in the first 3 months following a stroke; however, significant gains in dexterity, strength, and function with rehabilitation 6 months poststroke have been reported [6–7]. This subacute recovery in motor function can be explained in part by neural reorganization caused by rehabilitation training [8–12]. It is suggested that key factors to upperlimb stroke rehabilitation training are attention, repetition, intensity of practice, reward, progression of complexity, and skill acquisition and that this training should be task-oriented.

Full Text PDF 

 

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