Posts Tagged hemiparesis

[ARTICLE] Active rehabilitation training system for upper limb based on virtual reality – Full Text

 

In this article, an active rehabilitation training system based on the virtual reality technology is designed for patients with the upper-limb hemiparesis. The six-axis inertial measurement unit sensors are used to acquire the range of motion of both shoulder and elbow joints. In order to enhance the effect of rehabilitation training, several virtual rehabilitation training games based on the Unity3D engine are designed to complete different tasks from simple level to complicated level. The purpose is to increase the patients’ interest during the rehabilitation training. The basic functions of the virtual rehabilitation task scenes are tested and verified through the single-joint training and the multi-joint compounding training experiments. The experimental results show that the ranges of motion of both shoulder and elbow joints can reach the required ranges of a normal human in the rehabilitation training games. Therefore, the system which is easy to wear, low cost, wireless communication, real-time data acquisition, and interesting virtual rehabilitation task games can provide an effective rehabilitation training process for the upper-limb hemiparesis at home.

The upper limb has many degrees of freedom, and it is also a complex part of the human body by which people can accomplish fine movements during their activities in daily life. With the intensification of the aging problem in the world, the amount of stroke hemiparesis has shown a growing trend, especially in China, which has an enormous population.1 Approximately 30%–50% of these stroke survivors will suffer from chronic hemiparesis, especially involving their hands. In addition, spinal cord injury (SCI) and traffic accident survivors may also find limb movements’ disorder. Injury within the cervical region of the cord leads to tetraplegia, which leads to impairment of all four limbs. An estimated result shows that 55% of new cases will result in tetraplegia, while the other 45% will experience paraplegia due to injury below the cervical level.2Limb hemiparesis which is caused by stroke, SCI, or traffic accidents not only gives the patient’s daily life a great deal of inconvenience and even more makes the patient suffer from great mental pain but also brings a heavy stress and medical burden for the patient’s family and society. Technology has been developed in an effort to facilitate rehabilitation for the patient. Upper-limb rehabilitation is one of the fastest growing areas in modern neurorehabilitation. Quality of life can be improved with efficient therapy.3 At present, rehabilitation therapy of upper limb with traditional rehabilitation therapy is commonly used, that is, rehabilitation therapists perform rehabilitation trainings on individuals. Now with the development of robot technology, the rehabilitation of robot-assisted training is also rising up. The MIT-Manus4 is an example of end-effector-based and arm-rehabilitation robotic device, while the ARMin device5 is an example of arm-rehabilitation exoskeletons which also allows pronation/supination of the lower arm and wrist flexion/extension. It could be operated in three modes: passive mobilization, active game-supported arm therapy, and active training of activities of daily living (ADLs). The end-effector-based robots have practical advantages (usability, simplicity, and cost-effectiveness), and exoskeleton robots have biomechanical advantages (better guidance). Currently, the automatic rehabilitation devices on market as mentioned above are mostly complex and expensive, which are often used in the hospitals and clinics are not affordable to ordinary patients. Therefore, one of the research objectives aims to develop the upper-limb rehabilitation training system with minimal structure and low cost and can be used in patient’s home. But in China, it can be seen that patients with upper-limb orthosis in home is only for fixing the arm and just move autonomously according to the setting angle. The researches on intelligent domestic rehabilitation device just begins, most of which are in the experimental stage and not yet market oriented.6,7

Another problem is that the patients are treated with low initiative and dull training process which does not motivate them, while the treatment effect is not obvious.8,9 Computer games based on virtual reality (VR) are a good way to mobilize the patients’ initiative in the training, so the rehabilitation effect on a particular movement task will be greatly improved.10 VR environments provide an excellent method to manipulate task conditions in training. The effects and the intensity of training can be enhanced and designed more challenging, since the implementation of VR can build a channel both visual and haptic communication can be involved in. The research on VR system which is applied to rehabilitation training was initiated a few years ago. Mazzone et al.11 made a study on the effect of rehabilitation training for patients with shoulder joints training using VR technology. This study aimed to determine whether performance of shoulder exercises in virtual reality gaming (VRG) results in similar muscle activation as non-VRG exercise. The conclusion was drawn that exercise with VRG should be effective to reduce shoulder pain caused by spinal injury. Fischer et al.12 conducted a preliminary study claim that stroke patients could assist themselves in training their hands in the virtual environment. The purpose of this pilot study was to investigate the impact of assisted motor training in a virtual environment on hand function for the stroke survivors. Participants had 6 weeks of training in reach-to-grasp of both virtual and actual objects. After the training period, participants in all three groups demonstrated a decrease in time to perform some of the functional tasks. These designs based on VR have achieved some success and then the second research objective is to add the VR technology to the intelligent domestic rehabilitation device. These studies are mainly designed for the single joint of the upper-limb rehabilitation training. Therefore, it is necessary to carry out the research on multi-joint combined training device for patients who can just stay home by training with VR tasks of adjustable game levels.

Another important element which needs to be considered as an ultimate success using at home is its ease of use. Therefore, simple active rehabilitation device should be developed. The setup time of such device should be fast, besides measurement, treatment approaches, and incorporating gaming, and should provide intuitive interfaces that can be directly utilized by the individuals. This study will introduce an active rehabilitation training system for upper limb based on VR technology, which has some advantages such as simple structure, easy to manipulate, and portable for household. It also mobilizes patients’ initiative with adjustable difficulty level of VR tasks so that the individuals’ rehabilitation effect of the upper limb is obviously improved.

The active rehabilitation training system for upper limb based on VR is designed for the pronation/supination and flexion movement trainings of the elbow joint and the extension/flexion and abduction exercises of the shoulder joint. By adding the games in training processes, the patients may actively participate in rehabilitation trainings, while the efficiency will be greatly improved. The portable and easy-to-use design of this system can effectively reduce the problem of the medical resources shortage in the rehabilitation field.

Overall scheme of the system

The system is composed of two parts: the upper-limb posture detection system and the virtual rehabilitation training task scene, as shown in Figure 1.

figure

Figure 1. Schematic diagram of an active rehabilitation training system for upper limb based on VR.

 

Continue —> Active rehabilitation training system for upper limb based on virtual realityAdvances in Mechanical Engineering – Jianhai Han, Shujun Lian, Bingjing Guo, Xiangpan Li, Aimin You, 2017

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[ARTICLE] The spasticity in the motor and functional disability in adults with post-stroke hemiparetic

Abstract

Introduction: Spasticity acts as a limiting factor in motor and functional recovery after Stroke, impairing the performance of daily living activities.

Objective: To analyze the influence of spasticity on main muscle groups and to associate it with motor impairment and functional level of chronic hemiparetic patients after stroke.

Methods: Twenty-seven chronic hemiparetic patients of both sexes were selected at the Physical Therapy and Occupational Therapy Service of the Unicamp Clinics Hospital. Assessments were carried out in two sessions, in the first one the motor impairment (Fugl-Meyer Assessment – FM) and functional impairment (Barthel Index – BI) were evaluated, and in the second, the degree of spasticity of the main muscle groups (Modified Ashworth Scale – MAS).

Results: A negative correlation was detected between upper limb spasticity and motor and functional impairment. No muscle group evaluated in the lower limbs showed correlation between muscle tone and the level of impairment of the lower extremity on FM and the functional level measured by BI.

Conclusion: Spasticity has been shown to be a negative influence factor in the level of motor and functional impairment of the upper limbs of chronic hemiparetic patients after stroke.

Full Text PDF

via The spasticity in the motor and functional disability in adults with post-stroke hemiparetic | de Oliveira Cacho | Fisioterapia em Movimento

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[Abstract] Neurotech: Robotic Assist Devices Show Gains in Walking for Crouch Gait in Cerebral Palsy and Post-Stroke Hemiparesis

via Neurotech: Robotic Assist Devices Show Gains in Walking for… : Neurology Today

ARTICLE IN BRIEF

Figure

Developers of robotic devices discuss advances in the technologies to help people improve walking post-stroke and improve couch gait in cerebral palsy. Independent experts in neurorehabilitation review the potential and possible caveats of these devices.

Three novel robotic assistance devices, one for hemiparetic gait following stroke, and two for crouch gait in children with cerebral palsy, have each demonstrated improved walking in preliminary clinical trials.

For stroke patients, a robotic exosuit made of a soft, clothing-like anchor attached to motorized cables was shown to increase the paretic limb’s forward propulsion and the paretic ankle’s swing phase dorsiflexion in both treadmill and over-ground walking.

For children with crouch gait due to cerebral palsy, one trial used a cable-driven robot called a Tethered Pelvic Assist Device, or TPAD. The laboratory-based device is designed to strengthen the extensor muscles, especially the soleus in the calves, by putting downward pressure on them during training. After six weeks of practice with the device, the children’s posture was more upright, with greater step length and toe clearance, when walking without it.

Also for children with crouch gait, the third study examined the use of a wearable exoskeleton that provides a burst of knee extension assistance at just the right moment when a child or adolescent is walking. None of the seven participants, age 5 to 17, fell while using it, and six of the seven showed postural improvements equivalent to those previously reported from surgery.

While promising, the devices will require far more testing in randomized trials before their true value can be known, said a leading specialist in neurological rehabilitation.

“These are foundational studies; they’re just beginning to get started,” said Bruce H. Dobkin, MD, FRCP, distinguished professor of clinical neurology and director of the Neurological Rehabilitation and Research Program at the Geffen School of Medicine at the University of California, Los Angeles. “The cost, safety, user-friendliness, and ability to use at differing levels of disability severity — all those are major challenges.”

Even so, each of the three devices employs a new kind of robotic assistance unlike any existing on the market.

“Most robotics for neurological injuries are heavy, power-hungry exosuits for people with spinal cord injuries who can’t walk at all,” said a coauthor of the study for stroke patients, Terry D. Ellis, PT, PhD, NCS, director of the Center for Neurorehabilitation at Boston University. “But there’s a whole bunch of people who have disabilities, who can walk, but don’t walk well. They need facilitation or augmentation to restore some of the normal components of walking.”

A ROBOT POST-STROKE

Published in the July 26 edition of Science Translational Medicine, the study of a robotic exosuit tested in nine post-stroke patients used what it called “garment-like, functional textile anchors” rather than a hard, metallic exterior. Worn on only the paretic limb, the suit was designed to be as unobtrusive as possible.

“It’s much more compatible with the real world than a rigid device would be,” said the first author of the paper, Louis N. Awad, PT, DPT, PhD, an assistant professor of physical therapy at Boston University, and a research faculty member at Spaulding Rehabilitation Hospital. “Ordinary clothes are made of soft material. We don’t don a metallic pair of pants and walk out the door. That’s our goal — robotic clothing that helps people with difficulty walking.”

Attached to cables tethered to a belt worn around the hips, the exosuit functioned in synchrony with a wearer’s paretic limb to facilitate an immediate increase in the paretic ankle’s swing phase dorsiflexion and forward propulsion (p< 0.05), according to the paper.

The improved movements resulted in a 20 percent reduction in forward propulsion interlimb asymmetry and a 10 percent reduction in the energy cost of walking, which together were equivalent to a nearly one-third lower metabolic burden — a 32 percent reduction — while walking.

Although the study did include some over-ground walking, it was not designed to test whether the exosuit had any therapeutic effects that might carry over to when patients are not wearing it.

“This is a proof of concept paper,” said Dr. Ellis. “Down the road we need to conduct trials in more ecologically valid environments, and to see if it has therapeutic value. For now we wanted to demonstrate that the device can facilitate more normal walking.”

While applauding the study as “clever,” Dr. Dobkin said it remained to be seen whether the robotic exosuit would prove to have significant therapeutic effects that would stand up in randomized trials in natural environments. He pointed to randomized trials published in recent years showing that peroneal nerve functional electrical stimulators have no greater therapeutic effect than do standard ankle-foot orthoses.

“It’s similar to all the work that was done using the electrical stimulation of the ankle,” Dr. Dobkin said. “The real question is whether it will lead to improved function when you walk over-ground. Walking on a treadmill is not terribly natural.”

He also pointed out that the nine patients in the study were able to walk on average at about two miles per hour. “That’s already pretty fast,” he said. In addition, he said, the 20 percent reduction in interlimb asymmetry is relatively modest.

But, said Dr. Dobkin, people can improve their gait by 20 percent just by sustained practice. “When you see modest changes like this with the device, you wonder if the same changes couldn’t have been achieved without it,” he said.

Steven L. Wolf, PhD, PT, FAPTA, FAHA, professor in the department of rehabilitation medicine at Emory University School of Medicine, pointed out that existing robotic devices to help people who are completely unable to walk can cost patients up to $250,000. Perhaps the exosuit might become an improvement over what presently exists both in terms of function and cost, he said.

“Most existing devices are beautiful but incredibly expensive,” Dr. Wolf said. “Is the bang in the buck? Not as yet, in my opinion. The evidence for persistent benefit from these device is just not there.”

IMPROVING CROUCH GAIT IN CP

The first of the two studies using robotic devices to improve crouch gait in children with cerebral palsy was published on July 26 in Science Robotics, led by senior author Sunil K. Agrawal, PhD, professor of mechanical engineering and rehabilitation medicine at Columbia University.

Rather than directly straighten the children’s posture, Dr. Agrawal’s seemingly contradictory approach was to increase the downward force on their pelvis as they attempted to walk on a treadmill. The tension in each wire, attached to a belt on the pelvis, is modulated in real time by a motor placed around the treadmill in response to motion capture data from cameras. Unlike other robotic devices that have been tested for treating crouch gait, the TPAD has no rigid links to the body, permitting free movement of the legs.

After training in the device for 15 sessions of 16 minutes each over the course of six weeks, the six participants showed enhanced upright posture, improved muscle coordination, increased step length, range of motion of the lower limb angles, toe clearance, and heel-to-toe pattern.

“You can see a marked difference before and after,” Dr. Agrawal said. “We heard from families and the children themselves that they were walking faster, with better posture. Now we have to see if we should use a higher magnitude of downward pull, how long each training session should be, and for how many sessions.”

Commenting on the TPAD study, Dr. Dobkin said, “The kids who were selected for inclusion were not necessarily the kind who get surgery. They had less of a crouch, a little bit more of a push-off. The question is whether training like this will lead to good over-ground walking. They got a hint of that.”

The second crouch-gait study, published on August 23 in Science Translational Medicine, involved a wearable exoskeleton designed for over-land use, and was described by the authors as the first robotic device designed specifically to treat a gait disorder in children and adolescents. Rather than force the lower limb to move in a particular way, “the exoskeleton dynamically changed the posture by introducing bursts of knee extension assistance during discrete portions of the walking cycle, a perturbation that resulted in maintained or increase knee extensor muscle activity during exoskeleton use,” the paper stated.

“In the last decade, there’s been a groundswell of work on exoskeletons, but a majority of them are designed to permit mobility after spinal injury in adults who have lost the ability to walk,” said senior author Thomas Bulea, PhD, a staff scientist in the functional and applied biomechanics section of the rehabilitation medicine department at the National Institutes of Health Clinical Center in Bethesda, MD. “There hasn’t been much done for the pediatric population who just need to improve their walking.”

A coauthor of the paper, Diane L. Damiano, PT, PhD, chief of the section in which Dr. Bulea works, said the purpose of the wearable exoskeleton is different than that of the TPAD device developed by Dr. Agrawal.

“His device is designed to strengthen the calf muscles by increasing the resistance on them,” she said. “His results were good, but this is very different from what we are doing. We have a wearable device. It’s not meant to be used in a lab for training. We’re not necessarily trying to strengthen them, although that would be a desired outcome; we are instead trying to assist their abilities to help them practice being more upright while they walk. This is something that they would wear throughout the day for several months with the goal that their posture will ultimately be improved without the device.”

A surprising observation, she added, was that some children saw it as something cool to wear.

LINK UP FOR MORE INFORMATION:

•. Awad LN, Bae J, O’Donnell K, et al A soft robotic exosuit improves walking in patients after stroke http://stm.sciencemag.org/content/9/400/eaai9084. Sci Transl Med 2017; 9 (400). pii: eaai9084.

•. Video of the soft robotic exosuit for stroke patients: http://www.sciencetranslationalmedicine.org/cgi/content/full/9/400/eaai9084/DC1

•. Kang J, Martelli D, Vashista V, et al Robot-driven downward pelvic pull to improve crouch gait in children with cerebral palsy http://robotics.sciencemag.org/content/2/8/eaan2634. Sci Robot 2017;2(8): eaan2634.

•. Video of the robot-driven downward pelvic pull device can be seen at http://engineering.columbia.edu/news/sunil-agrawal-cerebral-palsy-crouch-gait

•. Lerner ZF, Damiano DL, Bulea TC. A lower-extremity exoskeleton improves knee extension in children with crouch gait from cerebral palsy http://stm.sciencemag.org/content/9/404/eaam9145. Sci Transl Med 2017; 9 (404). pii: eaam9145.

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[Abstract] Proposition of a classification of adult patients with hemiparesis in chronic phase

Objective

Patients who have developed hemiparesis after central nervous system lesion often experience reduced walking capacity. Related gaitabnormalities at hip, knee, and ankle joints during swing induce decreased foot clearance and increased risk of falls, and thus need a meticulous management. This study aimed to (1) propose a classification focusing on these abnormalities for adult patients with hemiparesis, (2) evaluate its discriminatory capacity using clinical gait analysis (CGA).

Material/patients and methods

Twenty-six patients (10 women, 16 men) with hemiparesis (13 left, 13 right) in chronic phase (i.e. hemiparesis more than 6 months old) were included in this study. Clinical examination (i.e. passive range of motion, muscle weakness, and spasticity) and video records were conducted on each patient. The following classification was then applied: group I (GI) was mainly characterized by a decreased ankle dorsiflexion during swing, group II (GII) and group III (GIII) by a decreased knee flexion during swing, completed by a reduced range of hip motion and a hip flexors weakness in GIII. Subdivisions were also applied on each group to describe (a) absence or (b) presence of genu recurvatum during stance. The discriminatory capacity of the classification was then evaluated. For that, all patients were instrumented with cutaneous reflective markers and at least 5 gait cycles were recorded using optoelectronic cameras (OQUS, Qualisys, Sweden). A statistical analysis (ANOVA) was then performed between each group and subgroup on 24 kinematic parameters and walking speed.

Results

Only one patient could not be classified, 5 were classified in GI (1 GIa, 4 GIb), 15 in GII (7 GIIa, 8 GIIb), and 5 in GIII (1 GIIIa, 4 GIIIb). When subgroups (a) and (b) were combined, 16 of the 25 assessed parameters revealed a statistically significant difference (P-level < 0.05) between at least two groups. In particular, the maximum knee flexion in swing and the total amplitude of hip flexion-extension were significantly different between groups.

Discussion – conclusion

This classification can be performed in regular clinical practice (using clinical evaluation and video records). It should thus ease the development of clinical management algorithms and the efficiency assessment of related therapies.

Source: Proposition of a classification of adult patients with hemiparesis in chronic phase – ScienceDirect

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[Abstract] Robot-assisted mirroring exercise as a physical therapy for hemiparesis rehabilitation

Abstract:

The paper suggests a therapeutic device for hemiparesis that combines robot-assisted rehabilitation and mirror therapy. The robot, which consists of a motor, a position sensor, and a torque sensor, is provided not only to the paralyzed wrist, but also to the unaffected wrist to induce a symmetric movement between the joints. As a user rotates his healthy wrist to the direction of either flexion or extension, the motor on the damaged side rotates and reflects the motion of the normal side to the symmetric angular position. To verify performance of the device, five stroke patients joined a clinical experiment to practice a 10-minute mirroring exercise. Subjects on Brunnstrom stage 3 had shown relatively high repulsive torques due to severe spasticity toward their neutral wrist positions with a maximum magnitude of 0.300kgfm, which was reduced to 0.161kgfm after the exercise. Subjects on stage 5 practiced active bilateral exercises using both wrists with a small repulsive torque of 0.052kgfm only at the extreme extensional angle. The range of motion of affected wrist increased as a result of decrease in spasticity. The therapeutic device not only guided a voluntary exercise to loose spasticity and increase ROM of affected wrist, but also helped distinguish patients with different Brunnstrom stages according to the size of repulsive torque and phase difference between the torque and the wrist position.

Source: Robot-assisted mirroring exercise as a physical therapy for hemiparesis rehabilitation – IEEE Conference Publication

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[Abstract] Virtual reality and non-invasive brain stimulation in stroke: How effective is their combination for upper limb motor improvement?

Abstract:

Upper limb (UL) hemiparesis is frequently a disabling consequence of stroke. The ability to improve UL functioning is associated with motor relearning and experience dependent neuroplasticity. Interventions such as non-invasive brain stimulation (NIBS) and task-practice in virtual environments (VEs) can influence motor relearning as well as adaptive plasticity. However, the effectiveness of a combination of NIBS and task-practice in VEs on UL motor improvement has not been systematically examined. The objective of this review was to examine the evidence regarding the effectiveness of combining NIBS with task-practice in VEs on UL motor impairment and activity levels. A systematic review of the published literature was conducted using standard methodology. Study quality was assessed using the PEDro scale and Down’s and Black checklist. Four studies examining the effects of a combination of NIBS (involving transcranial direct current stimulation; tDCS and repetitive transcranial magnetic stimulation; rTMS) were retrieved. Of these, three studies were randomized controlled trials (RCTs) and one was a cross-sectional study. There was 1a level evidence that the combination of NIBS and task-practice in a VE was beneficial in the sub-acute stage. A combination of training in a VE with rTMS as well as tDCS was beneficial for motor improvements in the UL in sub-acute stage of stroke (1b level). The combination was not found to be superior compared to task practice in VEs alone in the chronic stage (1b level). The results suggest that people with stroke may be capable of improving levels of motor impairment and activity in the sub-acute stage if their rehabilitation program involves a combination on NIBS and VE training. Emergent questions regarding the use of more sensitive outcomes, different types of stimulation parameters, locations and training environments still need to be addressed.

Source: Virtual reality and non-invasive brain stimulation in stroke: How effective is their combination for upper limb motor improvement? – IEEE Xplore Document

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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] Wearable Rehabilitation Training System for Upper Limbs Based on Virtual Reality – Conference paper

Abstract

In this paper, wearable rehabilitation training system for the upper limb based on virtual reality is designed for patients with upper extremity hemiparesis. The six-axis IMU sensor is used to collect the joint training angles of the shoulder and elbow. In view of the patient’s shoulder and elbow joint active rehabilitation training, the virtual rehabilitation training games based on the Unity3D engine are designed to complete different tasks. Its purpose is to increase the interest of rehabilitation training. The data obtained from the experiment showed that the movement ranges of the shoulder and elbow joint reached the required ranges in the rehabilitation training game. The basic function of the system is verified by the experiments, which can provide effective rehabilitation training for patients with upper extremity hemiparesis.

References

 

 

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Source: Wearable Rehabilitation Training System for Upper Limbs Based on Virtual Reality | SpringerLink

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[Conference paper] Hand Robotic Rehabilitation: From Hospital to Home – Abstract+References

Abstract

Stroke patients are often affected by hemiparesis. In the rehabilitation of these patients the function of the hand is often neglected. Thus in this work we propose a robotic approach to the rehabilitation of the hand of a stroke patient in hospital and also at home. Some experimental results can be presented here especially for inpatients. Further experimental results on home-patients must be acquired through a telemedicine platform, designed for this application. 

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Source: Hand Robotic Rehabilitation: From Hospital to Home | SpringerLink

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[ARTICLE] Home-based neurologic music therapy for arm hemiparesis following stroke: results from a pilot, feasibility randomized controlled trial – Full Text

 

Continue —> Home-based neurologic music therapy for arm hemiparesis following stroke: results from a pilot, feasibility randomized controlled trialClinical Rehabilitation – Alexander J Street, Wendy L Magee, Andrew Bateman, Michael Parker, Helen Odell-Miller, Jorg Fachner, 2017

figure

Figure 1. Study flow diagram. Data collection occurred at weeks 1, 6, 9, 15 and 18. Cross-over analysis required data from weeks 1, 6, 9 and 15.

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