Posts Tagged hemiplegia

[Abstract] Assessment of the Efficacy of ReoGo-J Robotic training against other rehabilitation therapies for Upper-Limb Hemiplegia after Stroke: Protocol for a Randomized Controlled Trial

Background: Stroke patients experience chronic hemiparesis in their upper extremities leaving negative effects on quality of life. Robotic therapy is one method to recover arm function, but its research is still in its infancy. Research questions of this study is to investigate how to maximize the benefit of robotic therapy using ReoGo-J for arm hemiplegia in chronic stroke patients.

Method: Design of this study is a multi-center parallel group trial following the prospective, randomized, open-label, blinded endpoint (PROBE) study model. Participants and setting will be 120 chronic stroke patients (over 6 months post-stroke) will be randomly allocated to three different rehabilitation protocols. In this study, the control group will receive 20 minutes of standard rehabilitation (conventional occupational therapy) and 40 minutes of self-training (i.e., sanding, placing and stretching). The robotic therapy group will receive 20 minutes of standard rehabilitation and 40 minutes of robotic therapy using ReoGo®-J device. The combined therapy group will receive 40 minutes of robotic therapy and 20 minutes of constraint-induced movement therapy (protocol to improve upper-limb use in ADL suggests). This study employs the Fugl-Meyer Assessment upper-limb score (primary outcome), other arm function measures and the Stroke Impact Scale score will be measured at baseline, 5 weeks, and 10 weeks of the treatment phase. In analysis of this study, we use the mixed effects model for repeated measures to compare changes in outcomes between groups at Week 5 and 10. The registration number of this study is UMIN000022509.

Conclusion: This study is a feasible, multi-site randomized controlled trial to examine our hypothesis that combined training protocol could maximize the benefit of robotic therapy and best effective therapeutic strategy for patients with upper-limb hemiparesis.

via Frontiers | Assessment of the Efficacy of ReoGo-J Robotic training against other rehabilitation therapies for Upper-Limb Hemiplegia after Stroke: Protocol for a Randomized Controlled Trial | Neurology

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[Abstract] Effects of MOTOmed movement therapy on the mobility and activities of daily living of stroke patients with hemiplegia: a systematic review and meta-analysis

To estimate the effectiveness of MOTOmed® movement therapy in increasing mobility and activities of daily living in stroke patients with hemiplegia.

Systematic review.

English- and Chinese-language articles published from the start of database coverage through 20 June 2018 were retrieved from the Embase, Web of Science, PubMed, OVID, Cochrane Central Register of Controlled Trials, Cochrane Systematic Reviews, Wanfang, Chinese National Knowledge Infrastructure, VIP, and Chinese Biomedicine databases. Articles were also retrieved by manual searches of Rehabilitation Medicine and Chinese journals.

Randomized control trials examining MOTOmed movement therapy interventions for patients with post-stroke hemiplegia were included in this review. The risk of bias assessment tool was utilized in accordance with Cochrane Handbook 5.1.0. All included studies reported mobility effects as primary outcomes. Standardized mean differences or mean differences with the corresponding 95% confidence intervals (CIs) were calculated. Review Manager 5.3 was utilized for meta-analysis.

In total, 19 trials involving a total of 1099 patients were included in the analysis. All studies were of moderate quality, based on the Cochrane Handbook for Systematic Reviews of Intervention: Part 2:8.5. MOTOmed movement therapy resulted in a merged mean difference in the Fugl-Meyer Assessment score of 5.51 (95% CI: 4.03 to 6.98). Comparison of groups treated with and without MOTOmed movement therapy yielded the following mean differences: Modified Ashworth Scale, −1.13 (95% CI: −1.37 to −0.89); Berg Balance Scale, 13.66 (95% CI: 10.47–16.85); Functional Ambulation Category Scale, 0.85 (95% CI: 0.68–1.03); 10-m walk test, 10.15 (95% CI: 5.72–14.58); Barthel Index, 14.82 (95% CI: 12.96–16.68); and Modified Barthel Index, 11.49 (95% CI: 8.96–14.03).

MOTOmed movement therapy combined with standard rehabilitation improves mobility and activities of daily living in stroke patients with hemiplegia.


via Effects of MOTOmed movement therapy on the mobility and activities of daily living of stroke patients with hemiplegia: a systematic review and meta-analysis – Cuiling Shen, Fang Liu, Liqun Yao, Zhongyuan Li, Li Qiu, Suzhu Fang, 2018

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[ARTICLE] Effects of Real-Time (Sonification) and Rhythmic Auditory Stimuli on Recovering Arm Function Post Stroke: A Systematic Review and Meta-Analysis – Full Text

Background: External auditory stimuli have been widely used for recovering arm function post-stroke. Rhythmic and real-time auditory stimuli have been reported to enhance motor recovery by facilitating perceptuomotor representation, cross-modal processing, and neural plasticity. However, a consensus as to their influence for recovering arm function post-stroke is still warranted because of high variability noted in research methods.

Objective: A systematic review and meta-analysis was carried out to analyze the effects of rhythmic and real-time auditory stimuli on arm recovery post stroke.

Method: Systematic identification of published literature was performed according to PRISMA guidelines, from inception until December 2017, on online databases: Web of science, PEDro, EBSCO, MEDLINE, Cochrane, EMBASE, and PROQUEST. Studies were critically appraised using PEDro scale.

Results: Of 1,889 records, 23 studies which involved 585 (226 females/359 males) patients met our inclusion criteria. The meta-analysis revealed beneficial effects of training with both types of auditory inputs for Fugl-Meyer assessment (Hedge’s g: 0.79), Stroke impact scale (0.95), elbow range of motion (0.37), and reduction in wolf motor function time test (−0.55). Upon further comparison, a beneficial effect of real-time auditory feedback was found over rhythmic auditory cueing for Fugl-meyer assessment (1.3 as compared to 0.6). Moreover, the findings suggest a training dosage of 30 min to 1 h for at least 3–5 sessions per week with either of the auditory stimuli.

Conclusion: This review suggests the application of external auditory stimuli for recovering arm functioning post-stroke.


According to World health organization, stroke accounts as the third main cause of disability across the world (1). The incidence of stroke related disability have almost doubled in the developing countries in the past decade (23). The disability affects basic day to day life activities (4), which further increase dependency (5), anxiety, depression (6), social isolation (7), and promote a poor quality of life (89). Moreover, the disability inflicts substantial economic burden on patients (10).

Typically, patients affected from stroke exhibit sensorimotor dysfunctions on the contralateral side of the affected brain region (11). These deficits can be exhibited focally, segmentally, unilaterally, or bilaterally (12). The symptoms are typically characterized by progressive inefficient movement synergy patterns (13), abnormal muscle tone (14), force production (15), compromised dexterity (16), poor coordination (17), and more (18). Moreover, hyper/hypokinetic movement disorders are also common [see Handley et al.,(12)]. Additionally, cognitive and sensory dysfunctions are also common in patients with stroke (19). Despite advancements in rehabilitation, poor prognosis in stroke is still prevalent, especially for recovering arm function (520). Studies suggest that upper limb recovery is an important predictor for determining the health status outcome, and quality of life for stroke patients (2122).

The poor gross and fine motor performance in upper extremities can be due to abnormal co-contraction of antagonists/agonists (23), disruptions in force production/adaptation (24), and regulation of stretch reflex (1525). Besides, these musculoskeletal dysfunctions can considerably impair joint kinematics (2627). According to Hara et al. (28) impaired activation of motor units in terms of firing rate and synchronization might result in such deficits. Furthermore, as the disease progresses, these changes increase fatigue (29), reduce coordination (30), and with the progression of time promote development of joint contractures (31), and subluxations/dislocations (32). Likewise, discrepancies in sensory perceptions, memory, cognition, and behavior further impact the prognostic outcome of a stroke patient (3335).

Neuroimaging studies suggest site specific lesions and silent infarcts at medial temporal lobe (36), gray (37), and white matter (38), further leading to a wide array of cognitive dysfunctions (39) [see Makin, (40) and Sperber and Karnath (41).] Similarly, deficits in corticospinal (4243), thalamocortical (44), superior occipito-frontal (41), and superior-longitudinal pathways (45), might overload the already impaired cognitive-motor pathways. Such a constraining impact on the impaired cognitive pathways might increase “internal” conscious monitoring by the patients to control their movements [see movement re-investment 4648)]. This increase in attention is aimed to safeguard the stability of a movement (4950), it retrospectively impairs autonomic execution of a movement and promotes movement failure (4648). Likewise, dysfunctions in sensory perception could affect perceptuomotor representations in the brain, thereby affecting motor planning and execution (35). Together, these cognitive and sensorimotor dysfunctions affect the prognosis of a stroke patient.

Common treatment strategies to curb cognitive motor dysfunctions in stroke patients include training with virtual-reality (51), mental imagery (52), biofeedback (53), physical therapy (54), exercise (55), prosthesis (5658), dual-task priority training, and more (59). Recently studies have tried to enhance the stroke recovery by simultaneously addressing the sensory deficits with motor rehabilitation by applying external sensory stimulation as a neuro-prosthetic (5962). Studies have analyzed the effects of different sensory stimuli in auditory, visual and tactile domain on motor performance (596162). However, the literature predominantly supports the beneficial role of auditory stimuli (506364). The main reasons which underlie the beneficial effects are thought to be multifaceted. Firstly, rich neuroanatomical interconnectivity has been reported between auditory and motor cortex (6567). Here, inference can be drawn from literature evaluating auditory startle reflex on animal models (6869). Studies using Double-labeling experiments have revealed that cochlear root neurons in the auditory nerve can project bilaterally to sensorimotor paths, including synapsing on reticulospinal neurons (656870). Likewise, patterns of thalamocortical and corticocortical inputs unique to auditory cortex have also been reported [for a detailed review see (71)]. In humans, neuroimaging data confirms the presence of cortico-subcortical network involving putamen, supplementary motor area, premotor cortex, and the auditory cortex especially for perceiving and processing rhythmic auditory stimuli (7275). Secondly, the human auditory system can consistently perceive auditory cues 20–50 ms faster as compared to its visual and tactile counterparts (7678). Thirdly, the auditory system has a strong bias to identify temporal patterns of periodicity and structure as compared to other sensory perceptual systems (7880). For instance, auditory rhythmic perception has been reported to exist well beyond the limits of temporal resolution of visual modalities i.e., when periodicities are presented at a rate of ~300–900 ms (8081).

In the literature, however, rhythmic auditory cueing (67), and real-time kinematic auditory feedback (82), also termed as sonification, are the most widely studied approaches in upper limb stroke rehabilitation. Both the methods possess differential influence over neurophysiological and musculoskeletal domains. Firstly, rhythmic auditory cueing can be defined as repetitive isosynchronous stimulations applied with an aim to simultaneously synchronize motor execution (8384). Here, neuroimaging data for rhythmic auditory stimuli suggests facilitated activations in premotor cortex, insula, cuneus, supplementary motor area, cerebellum, and basal ganglia (73808587). Moreover, training with rhythmic auditory cueing has been reported to modulate neuromagnetic β oscillations (8889), biological motion perception (8290), auditory-motor imagery (9193), shape variability in musculoskeletal activation patterns (94), cortical reorganization, neural-plasticity (9596), and also movement specific re-investment (97). Real-time kinematic auditory feedback on the other hand is a comparatively new approach. Such type of an intervention involves mapping of movement parameters on to the sound components, such as pitch, amplitude with a very minimal or no latency (82). The feedback has been reported to alleviate sensory perceptions like proprioception (98), by enhancing sensorimotor representation while facilitating activations in action observation system (90), and inducing neural plasticity (99). Moreover, the feedback has been reported by Effenberg et al. (82) to extend the benefits of discrete rhythmic auditory cueing stimuli. Here, the authors suggest that the continuous flow of information might allow a participant to better perceive their movement amplitudes and positioning, thereby resulting in development of both feedback and feed-forward models (82). Moreover, by allowing additional influence over the action observation system the real-time auditory stimuli might also enrich the internal stimulation of the executed movement (508290). This methodology involves delivering action relevant auditory feedback, where the characteristics of stimuli (e.g., frequency, amplitude) are mapped to the specific joint kinematics in real-time, for an example see (98). Schmitz et al. (90) in a neuroimaging study reported that observation of a convergent audio (sonification)-visual feedback led to enhanced activations in fronto-parietal networks, action observation system i.e., superior temporal sulcus, Broadman area 44, 6, insula, precentral gyrus, cerebellum, thalamus and basal ganglia (90). The authors mentioned that the multimodal nature of the stimuli can enhance the activation in areas associated with biological motion perception and in sub-cortical structures involving striatal-thalamic frontal motor loop. This then might improve perceptual analysis of a movement thereby resulting in efficient motor planning and execution (90).

Till date, no study has analyzed the influence of real-time auditory feedback on upper limb recovery post-stroke. Moreover, no study has compared the influence of rhythmic and real-time auditory stimuli on upper limb recovery post stroke. This information might serve to be an important source of information for future research and for developing efficient rehabilitation protocols in stroke community. Only four systematic reviews have analyzed the influence of rhythmic auditory stimulations on arm recovery post stroke (100101103), in which only two reviews included a statistical meta-analysis (102103). In these studies limitations persisted in terms of meta-analysis approach i.e., no heterogeneity analysis. Therefore, interpretation of results from the statistical analyses might indicate biasing. Therefore, the aim of the present systematic review and meta-analysis is to develop a state of knowledge where both qualitative and quantitative data for different auditory stimuli delivery methods can be interpreted for the use of stroke patients and medical practitioners alike. Moreover, a meta-analysis approach will be used to determine specific training dosage for auditory stimuli in recovering arm function post-stroke.[…]


Continue —>  Frontiers | Effects of Real-Time (Sonification) and Rhythmic Auditory Stimuli on Recovering Arm Function Post Stroke: A Systematic Review and Meta-Analysis | Neurology

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[Abstract] How effective is physical therapy for gait muscle activity in hemiparetic patients who receive botulinum toxin injections?

BACKGROUND: Administration of botulinum neurotoxin A (BoNT-A) to the ankle plantar flexors in patients with hemiplegia reduces the strength of knee extension, which may decrease their walking ability. Studies have reported improvements in walking ability with physical therapy following BoNT-A administration. However, no previous studies have evaluated from an exercise physiology perspective the efficacy of physical therapy after BoNT-A administration for adult patients with hemiplegia.

AIM: To investigate the effects of physical therapy following BoNT-A administration on gait electromyography for patients with hemiparesis secondary to stroke.

DESIGN: Non-randomized controlled trial.

SETTING: Single center.

POPULATION: Thirty-five patients with chronic stroke with spasticity were assigned to BoNT-A monotherapy (n=18) or BoNT-A plus physical therapy (PT) (n=17).
METHODS: On the paralyzed side of the body, 300 single doses of BoNT-A were administered intramuscularly to the ankle plantar flexors. Physical therapy was performed for 2 weeks, starting from the day after administration. Gait electromyography was performed and gait parameters were measured immediately before and 2 weeks after BoNT- A administration. Relative muscle activity, co-activation indices, and walking time/distance were calculated for each phase.

RESULTS: For patients who received BoNT-A monotherapy, soleus activity during the loading response decreased 2 weeks after the intervention (p<0.01). For those who received BoNT-A+PT, biceps femoris activity and knee co-activation index during the loading response and tibialis anterior activity during the pre-swing phases increased, whereas soleus and rectus femoris activities during the swing phase decreased 2 weeks after the intervention (p<0.05). These rates of change were significantly greater than those for patients who received BoNT-A monotherapy (p<0.05).

CONCLUSIONS: Following BoNT-A monotherapy, soleus activity during the stance phase decreased and walking ability either remained unchanged or deteriorated. Following BoNT-A+PT, muscle activity and knee joint stability increased during the stance phase, and abnormal muscle activity during the swing phase was suppressed.

CLINICAL REHABILITATION IMPACT: If botulinum treatment of the ankle plantar flexors in stroke patients is targeted to those with low knee extension strength, or if it aims to improve leg swing on the paralyzed side of the body, then physical therapy following BoNT-A administration could be an essential part of the treatment strategy.


via How effective is physical therapy for gait muscle activity in hemiparetic patients who receive botulinum toxin injections? – European Journal of Physical and Rehabilitation Medicine 2018 Jun 11 – Minerva Medica – Journals

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[ARTICLE] The impact of ankle–foot orthoses on toe clearance strategy in hemiparetic gait: a cross-sectional study – Full Text



Ankle–foot orthoses (AFOs) are frequently used to improve gait stability, toe clearance, and gait efficiency in individuals with hemiparesis. During the swing phase, AFOs enhance lower limb advancement by facilitating the improvement of toe clearance and the reduction of compensatory movements. Clinical monitoring via kinematic analysis would further clarify the changes in biomechanical factors that lead to the beneficial effects of AFOs. The purpose of this study was to investigate the actual impact of AFOs on toe clearance, and determine the best strategy to achieve toe clearance (including compensatory movements) during the swing phase.


This study included 24 patients with hemiparesis due to stroke. The gait performance of these patients with and without AFOs was compared using three-dimensional treadmill gait analysis. A kinematic analysis of the paretic limb was performed to quantify the contribution of the extent of lower limb shortening and compensatory movements (such as hip elevation and circumduction) to toe clearance. The impact of each movement related to toe clearance was assessed by analyzing the change in the vertical direction.


Using AFOs significantly increased toe clearance (p = 0.038). The quantified limb shortening and pelvic obliquity significantly differed between gaits performed with versus without AFOs. Among the movement indices related to toe clearance, limb shortening was increased by the use of AFOs (p < 0.0001), while hip elevation due to pelvic obliquity (representing compensatory strategies) was diminished by the use of AFOs (p = 0.003). The toe clearance strategy was not significantly affected by the stage of the hemiparetic condition (acute versus chronic) or the type of AFO (thermoplastic AFOs versus adjustable posterior strut AFOs).


Simplified three-dimensional gait analysis was successfully used to quantify and visualize the impact of AFOs on the toe clearance strategy of hemiparetic patients. AFO use increased the extent of toe clearance and limb shortening during the swing phase, while reducing compensatory movements. This approach to visualization of the gait strategy possibly contributes to clinical decision-making in the real clinical settings.


Impaired paretic limb advancement is a clearly observable manifestation of gait pathology in individuals with hemiparesis due to stroke [123]. Previous studies have reported specific gait changes following hemiparesis, such as decreased knee flexion, hip flexion, and ankle dorsiflexion during the swing phase, which can negatively influence the achievement of toe clearance [123456]. Reduction in toe clearance of the affected limb leads to tripping while walking, which is a major cause of falls [78]. In healthy individuals, toe clearance is mainly achieved by limb shortening, which is affected by hip flexion, knee flexion, and ankle dorsiflexion. On the other hand, to obtain sufficient toe clearance during the swing phase, individuals with hemiparesis often require compensatory strategies that modify the kinematic pattern, including hip hiking and circumduction, which are common gait deviations [39]. These changes during the swing phase have a reciprocal relationship. When the limb shortening is reduced due to paresis, the compensatory movements will be increased to contribute to toe clearance; hence, they are in a trade-off relationship [10].

Ankle–foot orthoses (AFOs) are frequently prescribed to improve walking ability in hemiparetic patients, as they provide passive or dynamic support of ankle movement. AFOs provide support not only during the stance phase of gait by encouraging lateral stability or improving early stance knee moments, but also in the swing phase to maintain ankle dorsiflexion and facilitate toe clearance [11121314151617]. The effect of AFOs on the swing phase is additionally reflected in the compensatory movements. Cruz et al. [18] demonstrated that the compensatory pelvic obliquity observed in response to impaired ankle dorsiflexion in hemiplegic patients was minimized when the patients wore an AFO. Improved joint motions and decreased compensatory movement when using AFOs could potentially contribute to an efficient gait and promote walking activity in hemiparetic patients.

Clarification of the mechanical effect of AFOs on these gait parameters, and quantifications of compensatory movements would be helpful for clinical decision-making in rehabilitation clinics. For example, understanding the influence of rehabilitative training and the use of AFOs on gait indices (i.e., ankle angle, knee angle, hip elevation, or toe clearance) would help to determine the best rehabilitative strategy and to identify the need for AFO use in individual patients.

The aim of this study was to clarify the mechanical effect of AFOs and to quantify the impact of AFO use on hemiparetic gait pattern during the swing phase, as this information would be helpful for clinical decision-making in rehabilitation clinics. For example, understanding the influence of rehabilitative training and the AFO and its types on gait indices (i.e., ankle angle, knee angle, hip elevation, or toe clearance) would help to determine the best rehabilitative strategy and to investigate the need for AFO use in individual patients. Based on a prior study showing the relationship between limb shortening and compensatory movements [10], we hypothesized that the AFOs would positively affect functional limb shortening in a way that would consequently impact on toe clearance and compensatory maneuvers, particularly represented by hip elevation. Previous studies have shown the effects of AFOs and a relationship between limb shortening and compensatory movements. In the normal gait pattern, functional limb shortening (representing lower limb joint movement) is a main strategy for toe clearance. However, patients with hemiparesis have impaired lower limb function, and thus require compensatory strategies (e.g., hip hiking, circumduction of the paretic limb) to promote swing phase propulsion [1920]. Additionally, the extent of toe clearance is mainly determined by the extent of functional limb shortening and hip elevation as compensatory movements, which are in a trade-off relationship [10]. AFO usage reduces the gait pattern deviation and increases the walking ability, thereby reducing energy costs [2122]. In this study, we hypothesized that the AFOs would positively affect functional limb shortening in a way that would consequently impact on toe clearance and compensatory maneuvers, particularly represented by hip elevation. To determine the actual impact of limb shortening and compensatory movements on toe clearance, the vertical component of the movements that comprised toe clearance was calculated using three-dimensional kinematic motion analysis. The changes in joint angles were also investigated.[…]

Continue —> The impact of ankle–foot orthoses on toe clearance strategy in hemiparetic gait: a cross-sectional study | Journal of NeuroEngineering and Rehabilitation | Full Text

Figure 1

Fig. 1 Marker placement. The positions of 12 measurement markers (bilateral acromion, iliac crest, hip, knee, ankle and toe)

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[Abstract] The feasibility, acceptability and preliminary efficacy of a low-cost, virtual-reality based, upper-limb stroke rehabilitation device: a mixed methods study.



To establish feasibility, acceptability, and preliminary efficacy of an adapted version of a commercially available, virtual-reality gaming system (the Personalised Stroke Therapy system) for upper-limb rehabilitation with community dwelling stroke-survivors.


Twelve stroke-survivors (nine females, mean age 58 years, [standard deviation 7.1], median stroke chronicity 42 months [interquartile range 34.7], Motricity index 14-25 for shoulder and elbow) were asked to complete nine, 40-min intervention sessions using two activities on the system over 3 weeks. Feasibility and acceptability were assessed through a semi-structured interview, recording of adverse effects, adherence, enjoyment (using an 11-point Likert scale), and perceived exertion (using the BORG scale). Assessments of impairment (Fugl-Meyer Assessment Upper extremity), activity (ABILHAND, Action Research Arm Test, Motor Activity Log-28), and participation (Subjective Index of Physical and Social Outcome) were completed at baseline, following intervention, and at 4-week follow-up. Data were analysed using Thematic Analysis of interview and intervention field-notes and Wilcoxon Signed Ranks. Side-by-side displays were used to integrate findings.


Participants received between 175 and 336 min of intervention. Thirteen non-serious adverse effects were reported by five participants. Participants reported a high level of enjoyment (8.1 and 6.8 out of 10) and rated exertion between 11.6 and 12.9 out of 20. Themes of improvements in impairments and increased spontaneous use in functional activities were identified and supported by improvements in all outcome measures between baseline and post-intervention (p < 0.05 for all measures).


Integrated findings suggested that the system is feasible and acceptable for use with a group of community-dwelling stroke-survivors including those with moderately-severe disability. Implications for rehabilitation To ensure feasibility of use and maintenance of an appropriate level of challenge, gaming technologies for use in upper-limb stroke rehabilitation should be personalised, dependent on individual need. Through the use of hands-free systems and personalisation, stroke survivors with moderate and moderately-severe levels of upper-limb impairment following stroke are able to use gaming technologies as a means of delivering upper-limb rehabilitation. Future studies should address issues of acceptability, feasibility, and efficacy of personalised gaming technologies for delivery of upper-limb stroke rehabilitation in the home environment. Findings from this study can be used to develop future games and activities suitable for use in stroke rehabilitation.


via The feasibility, acceptability and preliminary efficacy of a low-cost, virtual-reality based, upper-limb stroke rehabilitation device: a mixed meth… – PubMed – NCBI

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[Abstract] Application of Commercial Games for Home-Based Rehabilitation for People with Hemiparesis: Challenges and Lessons Learned

Objective: To identify the factors that influence the use of an at-home virtual rehabilitation gaming system from the perspective of therapists, engineers, and adults and adolescents with hemiparesis secondary to stroke, brain injury, and cerebral palsy.

Materials and Methods: This study reports on qualitative findings from a study, involving seven adults (two female; mean age: 65 ± 8 years) and three adolescents (one female; mean age: 15 ± 2 years) with hemiparesis, evaluating the feasibility and clinical effectiveness of a home-based custom-designed virtual rehabilitation system over 2 months. Thematic analysis was used to analyze qualitative data from therapists’ weekly telephone interview notes, research team documentation regarding issues raised during technical support interactions, and the transcript of a poststudy debriefing session involving research team members and collaborators.

Results: Qualitative themes that emerged suggested that system use was associated with three key factors as follows: (1) the technology itself (e.g., characteristics of the games and their clinical implications, system accessibility, and hardware and software design); (2) communication processes (e.g., preferences and effectiveness of methods used during the study); and (3) knowledge and training of participants and therapists on the technology’s use (e.g., familiarity with Facebook, time required to gain competence with the system, and need for clinical observations during remote therapy). Strategies to address these factors are proposed.

Conclusion: Lessons learned from this study can inform future clinical and implementation research using commercial videogames and social media platforms. The capacity to track compensatory movements, clinical considerations in game selection, the provision of kinematic and treatment progress reports to participants, and effective communication and training for therapists and participants may enhance research success, system usability, and adoption.


via Application of Commercial Games for Home-Based Rehabilitation for People with Hemiparesis: Challenges and Lessons Learned | Games for Health Journal

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[Conference Paper] Design and Implementation study of Remote Home Rehabilitation Training Operating System based on Internet – Full Text PDF


The proportion of rehabilitation doctors and patients mismatch is very grim in the context of social aging. The Family Rehabilitation System captures the profound information of the trainer’s movements through the kinect bone tracing technique, allowing the doctor to remotely master the patient’s training progress. With the help of computers and the Internet, the patient can consult a physician, while the physician can remotely guide and launch the training “prescription” through the Internet according to the training effect. Patients can have rehabilitated training at home. The results of the test showed that the system has a positive effect on the rehabilitation of the patient.

1. Introduction

The number of patients with motor dysfunction caused by hemiplegia and stroke increased. In order to promote better recovery of their body muscles, patients are still required to perform rehabilitation exercises in the community or family after the treatment of discharge. However, there are still some difficulties in community rehabilitation for patients with motor dysfunction:

  • (1) The number of therapists on-site services is scarce and expensive;
  • (2) In the absence of standard and systematic action guidance, the patients ‘ own training is not only the science is not high and the effect is limited.
  • (3) Patients need to be trained in special environments such as rehabilitation centers, and wearing complex training equipment is inconvenient for them.

The family rehabilitation system collects the depth information of the trainer’s movements through the Kinect skeletal tracking technique; With the help of computers and the Internet, patients can consult physicians, and the doctor through the Internet remote guidance and open training action “prescription” according to the training effect so that patients at home can be rehabilitation training. This liberated the physician’s labour force and formed a network community that was closely linked to the hospital and regularly received “training prescriptions” to improve patient rehabilitation. […]

 Full Text Article PDF

via Design and Implementation study of Remote Home Rehabilitation Training Operating System based on Internet – IOPscience

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[ARTICLE] Effectiveness of Mirror Therapy in Rehabilitation of Hand Function in Sub-Acute Stroke – Full Text


Aim: Three quarters of strokes occur in the region supplied by the middle cerebral artery. As a consequence, the upper limb will be affected in a large number of patients. Purpose of the study is to examine the effectiveness of mirror therapy in rehabilitation of hand function in sub-acute stroke.

Methodology: An experimental study design, 30 subjects with sub-acute stroke with impaired hand function randomly allocated 15 subjects into each experimental group and conventional group. Both groups received conventional physiotherapy. The experimental group in addition, received Mirror Therapy program of 30 repetition of each exercises per day for 5 days in a week for 4 weeks (total = 20 sessions). Hand functions were measured using Upper extremity motor activity log (UE MAL) and Action research arm test (ARAT) before and after 4 week of intervention.

Results: Results of the study suggested that both the experimental and conventional group had a significant improvement in hand function (AROM, functional task with objects, object manipulation), however experimental group showed significantly more improvement than conventional group, providing Mirror Therapy with conventional treatment is more effective than conventional treatment alone.

Conclusion: Mirror therapy with conventional physiotherapy brings more improvement in hand function than conventional physiotherapy alone.


World Health Organization [WHO; Stroke; 1989] defines the clinical syndrome of stroke as ‘rapidly developed clinical signs of focal (or global) distribution of cerebral function with symptoms lasting more than 24 hours or longer or leading to death, with no apparent cause other than vascular origin’.

Prevalence rates reported for stroke or CerebroVascular Accident (CVA) worldwide vary between 500 to 800 per 100,000 population [N.K. Sehi et al 2007] with about 20 million people suffer from stroke each year; out of that 5 million will die as a consequences and 15 million will survive with long term disabilities of varied spectrum. Many surviving stroke patients will often depends on other people‘s continuous support to survive.

Stroke is the most common cause of chronic disability [1]. Of survivors, an estimated one third will be functionally dependent after 1 year experiencing difficulty with activities of daily living (ADL), ambulation, speech, and so forth [2]. Cognitive impairment occurs frequently after stroke, commonly involving memory, orientation, language, and attention. The presence of cognitive impairment in patients with stroke has important functional consequences, independent of the effects of physical impairment (T K Tatemichi et al 1994).

Recovery of function after stroke may occur, but it is unclear whether interventions can improve function beyond the spontaneous process. In particular, recovery of hand function plateaus in about 1 year, and common knowledge is that the patient will remain at that level for the rest of his or her life [3,4]. Typically in such situations, upper arm function is better than that in the hand [5]. An emerging concept in neural plasticity is that there is competition among body parts for territory in the brain [6-11].

Several studies have been conducted to examine the recovery of the hemiplegic arm in stroke patients. Up to 85% of patients show an initial deficit in the arm. Three to six months later, problems remain in 55% to 75% of patients [12-15]. While recovery of arm function is poor in a significant number of patients. Three quarters of strokes occur in the region supplied by the middle cerebral artery [16]. As a consequence, the upper limb will be affected in a large number of patients. Functional recovery of the arm includes grasping, holding, and manipulating objects, which requires the recruitment and complex integration of muscle activity from shoulder to fingers.

Functional brain imaging studies of healthy subjects suggest that excitability of the primary motor cortex ipsilateral to a unilateral hand movement is facilitated by viewing a mirror reflection of the moving hand [17]. Reorganization of motor functions immediately around the stroke site (ipsilesional) is likely to be important in motor recovery after stroke, and a contribution of other brain areas in the affected hemisphere is also possible. Activation when a subject is doing motor tasks can also occur in the bilateral inferior parietal area, the supplementary motor area, and in the premotor cortex. Furthermore, central adaptations occur in networks controlling the paretic as well as the nonparetic lower limb after stroke [18].

The aim of this study is to find the effect of mirror therapy in rehabilitation of hand function in sub-acute stroke. […]


Continue —> Effectiveness of Mirror Therapy in Rehabilitation of Hand Function in Sub-Acute Stroke

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[Abstract+References] Effect of Mirror Therapy on Upper Limb Function: A Single Subject Study.


Objectives: Mirror therapy is a unique treatment with a touch of modality that is purported to improve the motor function of the affected limb in individuals with hemiplegia. Previous studies have focused on the neuro-physiological factors underlying the mechanism of the clinical effect of this technique. The present study aims to understand the mechanism using the rehabilitation method and neuro-occupation model as well as analyze the effects of mirror therapy on the upper limb function of subjects with spastic hemiplegic cerebral palsy.
Methods: Single subject design known as withdrawal design was used by a convenience sample of four subjects. The study involved three observational phases known as baseline, treatment, and withdrawal phases that took place during a 10 week period. The study contained a home-based mirror therapy protocol whereby the participants were instructed to do some exercises on a daily basis. The improvement of the hand function of the hemiplegic side was examined by Box and Block test along with two more activities including Threading Beads and Stacking Rings.
Results: The ability to perform the Box and Block test, Threading Beads, and Stacking Rings tended to remain steady in the baseline phase, whereas there was a noticeable improvement during the treatment phase and a decline in the withdrawal phase.
Discussion: From the perspective of visual feedback neuro-occupation model, it could be hypothesized that alterations to the sensory system caused by the mirror reflection of non affected hand may have led to the destabilization of the sensory cortices that changed the participants’ intention, meaning, and perception, thereby improving the subject’s motor control.

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