Posts Tagged home-based

[Abstract + References] A Preliminary Analysis of a Home-Based Stroke Rehabilitation Program in Windsor, Ontario

Abstract

Community stroke rehabilitation (CSR) is an effective program for survivors to recover at home supported by a multidisciplinary team. A home-based, specialized CSR program was delivered in Windsor, Ontario, to stroke patients who faced barriers to accessing outpatient services following inpatient rehabilitation. Preliminary results show program patients made significant functional improvements from baseline to program discharge. A subgroup analysis revealed that, after adjusting for age and resource intensity, moderate to severe stroke patients made greater functional gains compared to mild stroke patients. The individualized focus of CSR delivered in the home provides an effective model of rehabilitation for continued stroke care in the community.

References 

1. Hebert, D, Lindsay, MP, McIntyre, A, et al. Canadian stroke best practice recommendations: stroke rehabilitation practice guidelines, update 2015. Int J Stroke. 2016;11:459–84.CrossRef | Google Scholar | PubMed

2. Langstaff, C, Martin, C, Brown, G, et al. Enhancing community-based rehabilitation for stroke survivors: creating a discharge link. Top Stroke Rehabil. 2014;21:510–9.CrossRef | Google Scholar | PubMed

3. Passalent, LA, Landry, MD, Cott, CA. Wait times for publically funded outpatient and community physiotherapy and occupational therapy services: implications for the increasing number of persons with chronic conditions in Ontario, Canada. Physiother Can. 2009;61:5–14.CrossRef | Google Scholar

4. Pereira, S, Foley, N, Salter, K, et al. Discharge destination of individuals with severe stroke undergoing rehabilitation: a predicative model. Disabil Rehabil. 2014;36(6):727–31.CrossRef | Google Scholar

5. Pereira, S, Ross Graham, J, Shahabaz, A, et al. Rehablitation of individuals with severe stroke: Synthesis of best evidence and challenges in implementation. Topics Stroke Rehabil. 2012;19:122–31.CrossRef | Google Scholar

6. Windsor Essex County Health Unit. Community needs assessment report. Windsor, Ontario; 2016.Google Scholar

7. Hall, RE, Kahn, F, Levi, J, et al. Ontario and LHIN 2015/2016 stroke report cards and progress reports: setting the bar higher. Toronto, ON: Institute for Clinical Evaluative Science; 2017.Google Scholar

8. Allen, L, Richardson, A, McIntyre, S, et al. Community stroke rehabilitation teams: providing home-based stroke rehabilitation in Ontario, Canada. Can J Neurol Sci. 2014;41:697–703.Google Scholar | PubMed

9. Allen, L, McIntyre, A, Janzen, S, et al. Community stroke rehabilitation: how do rural residents fare compared with their urban counterparts? Can J Neurol Sci. 2016;43:98–104.CrossRef | Google Scholar | PubMed

10. Canadian Institute for Health Information. Pathways of care for people with stroke in Ontario; 2012. Available at: https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC1695.Google Scholar

11. Keith, RA, Granger, CV, Hamilton, BB, et al. The functional independence measure: a new tool for rehabilitation. Adv Clin Rehabil. 1987;1:6–18.Google Scholar | PubMed

12. Teasell, R, Hussein, N, Foley, N. Evidence-based review of stroke rehabilitation (EBRSR), 18th ed. London, ON; EBRSR: 2018. Available at: https://www.ebrsr.com.Google Scholar

Canadian Journal of Neurological Sciences | Cambridge Core

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[Abstract] Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized Crossover Trial

Abstract

OBJECTIVE:

We investigated the treatment effects of a home-based rehabilitation program compared with clinic-based rehabilitation in patients with stroke.

DESIGN:

A single-blinded, 2-sequence, 2-period, crossover-designed study.

SETTING:

Rehabilitation clinics and participant’s home environment.

PARTICIPANTS:

Individuals with disabilities poststroke.

INTERVENTIONS:

During each intervention period, each participant received 12 training sessions, with a 4-week washout phase between the 2 periods. Participants were randomly allocated to home-based rehabilitation first or clinic-based rehabilitation first. Intervention protocols included mirror therapy and task-specific training.

MAIN OUTCOME MEASURES:

Outcome measures were selected based on the International Classification of Functioning, Disability and Health. Outcomes of impairment level were the Fugl-Meyer Assessment, Box and Block Test, and Revised Nottingham Sensory Assessment. Outcomes of activity and participation levels included the Motor Activity Log, 10-meter walk test, sit-to-stand test, Canadian Occupational Performance Measure, and EuroQoL-5D Questionnaire.

RESULTS:

Pretest analyses showed no significant evidence of carryover effect. Home-based rehabilitation resulted in significantly greater improvements on the Motor Activity Log amount of use subscale (P=.01) and the sit-to-stand test (P=.03) than clinic-based rehabilitation. The clinic-based rehabilitation group had better benefits on the health index measured by the EuroQoL-5D Questionnaire (P=.02) than the home-based rehabilitation group. Differences between the 2 groups on the other outcomes were not statistically significant.

CONCLUSIONS:

The home-based and clinic-based rehabilitation groups had comparable benefits in the outcomes of impairment level but showed differential effects in the outcomes of activity and participation levels.

 

via Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized… – PubMed – NCBI

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[NEWS] Telemedicine-Delivered Arm Rehab Results on Par with In-Person Clinic

Published on 

Rehab muscle training for elbow joint

 

Post-stroke arm motor function recovery progressed just as well, whether the exercises were performed via home-based telemedicine or in an office environment, according to a randomized trial discussed recently at the International Stroke Conference.

Improvement in arm motor function on the Fugl-Meyer scale was 7.86 points with telerehab versus 8.36 points at day 30, which met noninferiority criteria, Steven Cramer, MD, of the University of California Irvine, reports, in a media release from Medpage Today.

Arm recovery exceeded the minimal clinically important difference in both groups and didn’t differ between rehab strategies by aphasia status.

“What we’re trying to do with home-based telehealth does not compete with or replace traditional rehab medicine. It is expanding tools,” Cramer adds.

ISC session moderator Louise McCullough, MD, PhD, of the University of Texas Health Science Center at Houston, agreed but noted some advantages to rehab from home.

“If we can optimize it… there could be huge cost savings,” she comments, “and especially for people in rural areas, like lots of Texas does not have access to rehab. It might be 2 hours away. This gives more options for people.”

The NIH StrokeNet trial included 124 adults who were 4 to 36 weeks post-ischemic or hemorrhagic stroke and had a baseline arm motor Fugl-Meyer score of 22 to 56 on the 66-point scale.

Treatment consisted of 36 sessions (18 supervised) of 70 minutes each, over 6 to 8 weeks. Intensity, duration, and frequency of therapy were matched between groups. Participants were randomized to therapy at home via telemedicine or in a traditional clinic setting with the same Accelerated Skill Acquisition program (impairment focused, task specific, and with intensive engagement), the release explains.

Telerehab patients started their supervised sessions with a video conference where they worked with the therapist.

For the 15 minutes of the session that was functional training, the in-clinic group got functional tasks whereas the home-based group got functional games. “This is not your father’s Wii game,” Cramer notes, in the release.

The games could be set to emphasize targets in specific parts of the visual field and could vary in speed, range of motion, target size, and cognitive demand. Input devices to play the games ranged from a squeezing device to a “whack-a-mole” mallet and a gun.

Patients’ preference to go to clinic appears to be because of that live social interaction. McCullough continues. “We now know social isolation is very common. But if you have low vision or you live alone, it’s really difficult to get to clinic. So now we have to get it so the preference is to do it at home.”

“I think that social interaction is going to be really important to fold into our telemedicine and telehealth platforms for whatever disease,” she adds.

[Source: Medpage Today]

 

via Telemedicine-Delivered Arm Rehab Results on Par with In-Person Clinic – Rehab Managment

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[Poster Abstract] GameBall: the development of a novel platform to provide enjoyable and affordable hand and arm rehabilitation following stroke

Purpose: Poor arm recovery post-stroke can lead to increased dependence, reduced quality of life, and is a strong predictor of lower psychological well being following stroke. Effective treatment interventions are characterised by repetitive practice. This repetitive nature can make doing exercises boring, and coupled with a lack of community resources ongoing rehabilitation of the arm is challenging. Therefore effective home-based stroke rehabilitation devices that are motivating and enjoyable to use, and affordable are needed.

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via GameBall: the development of a novel platform to provide enjoyable and affordable hand and arm rehabilitation following stroke – Physiotherapy

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[Abstract + References] Monitoring System for Home-Based Hand Rehabilitation – IEEE Conference Publication

Abstract

The paper proposes a solution for monitoring of cardiovascular parameters during home-based hand rehabilitation. The most important cause of long-term disability in Europe is cerebral vascular accident (CVA) or stroke. The effects of stroke can vanish after a short period or can remain for the rest of the life depending on therapeutic program. The system developed for this study is not only therapeutically devices that allow the movement of hand for physical exercises controlled by electromyography (EMG) but also record one or more biomedical parameters such as: electromyogram (EMG), electrocardiogram (ECG), pulse wave, heart rate (HR), temperature, respiration rate, non-invasive blood pressure (NIBP) or oxygen concentration in the blood (SpO2). These physiological parameters are selected according to the physician’s prescription and the patient needs. In this paper it is presented an application that refers to the hand rehabilitation of post-stroke. It was observed the cardiovascular system status, analyzing the heart rate variability. During therapeutic procedure it was recorded ECG (1 lead) and pulse wave (using an ear lobe sensor). After that HRV was calculated for each signal. The results were used to determine the stress level induced by the rehabilitation program.
1. I.I. Costache, E. Miftode, O. Petriş, A.D. Popa, D. Iliescu, E.G. Botnariu, “Associations between Area of residence and Cardiovascular risk”, Revista de cercetare şi intervenţie socială, vol. 49, pp. 68-79, May 2015.

2. V.L. Roger, A.S. Go, D.M. Lloyd-Jones, E.J. Benjamin, J.D. Berry, W.B. Borden, D.M. Bravata, S. Dai, E.S. Ford, C.S. Fox, H.J. Fullerton, C. Gillespie, S.M. Hailpern, J.A. Heit, V.J. Howard, B.M. Kissela, S.J. Kittner, D.T. Lackland, J.H. Lichtman, L.D. Lisabeth, D.M. Makuc, G.M. Marcus, A. Marelli, D.B. Matchar, C.S. Moy, D. Mozaffarian, M.E. Mussolino, G. Nichol, N.P. Paynter, E.Z. Soliman et al., “Heart disease and stroke statistics–2012 update: a report from the American Heart Association”, Circulation, vol. 125, pp. e2-e220, 2012.

3. P.U. Heuschmann, A. Di Carlo, Y. Bejot, D. Rastenyte, D. Ryglewicz, C. Sarti, M. Torrent, C.D. Wolfe, “Incidence of stroke in Europe at the beginning of the 21st century”, Stroke, vol. 40, pp. 1557-1563, May 2009.

4. I.I. Costache, E. Miftode, O. Mitu, V. Aursulesei, “Sex differences in cardiovascular risk factors in a rural community from north Romania region”, Revista de cercetare şi intervenţie socială, vol. 55, pp. 204-214, 2016.

5. E. Stevens, C. McKevitt, E. Emmett, C. Wolfe, Y. Wang, “The Burden of Stroke in Europe”, report for Stroke Alliance for Europe, 2017.

6. J. Chen, D. Nichols, E.B. Brokaw, P.S. Lum, “Home-Based Therapy After Stroke Using the Hand Spring Operated Movement Enhancer (HandSOME)”, IEEE Transactions on Neural Systems and Rehabilitation Engineering, vol. 25, no. 12, pp. 2305-2312, 2017.

7. M. Ciorap, M. Munteanu, D. Andritoi, R. Ciorap, “Low Cost Device for “at Home” Rehabilitation After a Stroke Event”, International conference KNOWLEDGE-BASED ORGANIZATION, vol. 24, pp. 26-31, 2018, [online] Available: http://doi.org/10.1515/kbo-20180132.

8. A. Basteris, S.M. Nijenhuis, A.HA. Stienen, J.H. Buurke, G.B Prange, F. Amirabdollahian, “Training modalities in robot-mediated upper limb rehabilitation in stroke: a framework for classification based on a systematic review”, Journal of NeuroEngineering and Rehabilitation, vol. 11, no. 111, 2014.

9. S.M. Hunter, H. Johansen-Berg, N. Ward, N.C. Kennedy, E. Chandler, C.J. Weir, J. Rothwell, A.M. Wing, M.J. Grey, G. Barton, N.M. Leavey, C. Havis, R.N. Lemon, J. Burridge, A. Dymond, V.M. Pomeroy, “Functional Strength Training and Movement Performance Therapy for Upper Limb Recovery Early Poststroke-Efficacy Neural Correlates Predictive Markers and Cost-Effectiveness: FAST-INdiCATE Trial”, FRONTIERS IN NEUROLOGY, vol. 8, 2018.

10. A. Pollock, B. St George, M. Fenton, L. Firkins, “Top ten research priorities relating to life after stroke”, Lancet Neurology, vol. 11, no. 3, pp. 209, 2012.

11. M.T. Schultheis, A.A. Rizzo, “The application of virtual reality technology in rehabilitation”, Rehabil Psychol, vol. 46, no. 3, pp. 296-311, 2001.

12. H. Sveistrup, “Motor rehabilitation using virtual reality”, Journal of Neuro Engineering and Rehabilitation, vol. 1, no. 10, 2004.

13. R. Ciorap, D. Arotariţei, F. Topoliceanu, R. Lupu, C. Corciovă, M. Ungureanu, “E-health application for home monitoring of neuromuscular rehabilitation”, [Aplicaţie e-Health pentru monitorizarea la domiciliu a recuperării neuro-musculare] Revista Medico-Chirurgicală a Societăţii de Medici şi Naturalişti din Iaşi, vol. 109, no. 2, pp. 440-444, 2005.

14. F. Wittmann, J.P. Held, O. Lambercy, M.L. Starkey, A. Curt, R. Hover, R. Gassert, A.R. Luft, R.R. Gonzenbach, “Self-directed arm therapy at home after stroke with a sensor-based virtual reality training system”, Journal of Neuroengineering and Rehabilitation, vol. 13, 2016.

15. F. Muri, C. Carbajal, A.M. Echenique, H. Fernandez, M. Lopez, “Virtual reality upper limb model controlled by EMG signals”, Journal of Physics Conference Series 477 19th Argentinean Bioengineering Society Congress (SABI 2013).

16. R. Ciorap, C. Hritcu-Luca, C. Corciova, A. Stan, D. Zaharia, “Home Monitoring Device for Cardiovascular Diseases”, International Conference on Advancements of Medicine and Health Care through Technology, pp. 49-52, 23-26 Septembrie, 2009.

17. A.J. Meyer, C. Patten, B.J. Fregly, “Lower extremity EMG-driven modeling of walking with automated adjustment of musculoskeletal geometry”, PLOS ONE, vol. 12, no. 7, 2017.

18. R. Ciorap, D. Andritoi, V. Pomazan, L. Petcu, F. Ungureanu, D. Zaharia, “E-health system for monitoring of chronic diseases”, World Congress on Medical Physics and Biomedical Engineering, vol. 25, no. 5, pp. 259-262, 7 – 12 September 2009.

19. V. David, A. Salceanu, R. Ciorap, “Acquisition and Analysis of Biomedical Signals in Case of Peoples Exposed to Electromagnetic Fields” in Pervasive and Mobile Sensing and Computing for Healthcare Subhas Chandra Mukhopadhyay and O. A. Postolache, Springer, pp. 269-295, 2012.

20. V.M. Pomazan, L.C. Petcu, S.R. Sintea, R. Ciorap, “Active Data Transportation and Processing for Chronic Diseases Remote Monitoring”, International Conference on Signal Processing Systems (ICSPS 2009), pp. 853-857, 15-17 May, 2009.

21. R. Ciorap, C. Corciova, M. Ciorap, D. Zaharia, “Optimization of the Treatment for Chronic Disease Using an e-Health System”, 7th International Symposium on ADVANCED TOPICS IN ELECTRICAL ENGINEERING 2011 Bucureşti, pp. 143-146, 12-14 Mai, 2011.

22. D. Andriţoi, V. David, R. Ciorap, “An Portable Device for ECG and Photoplethysmographic Signal Acquisition”, 2014 International Conference and Exposition on Electrical and Power Engineering (EPE2014), 16-18 October 2014.

23. M. Ciorap, M. Munteanu, D. Andritoi, R. Ciorap, “Low Cost Device for at Home Rehabilitation After a Stroke Event”, International conference KNOWLEDGE-BASED ORGANIZATION, vol. 24, no. 3, pp. 26-31, [online] Available: http://doi.org/10.1515/kbo-2018-0132.

24. I.I. Costache, M.C. Ungureanu, D. Iliescu, A. Petriş, G. Botnariu, “Electrocardiographic changes in the most frequent endocrine disorders associated with cardiovascular diseases. Review of the literature”, Revista Medico-Chirurgicală a Societăţii de Medici şi Naturalişti din Iaşi, vol. 119, no. 1, pp. 9-13, 2015.

25. I.I. Costache, R. Al Namat, F. Mitu, M. Ciocoiu, V. Aursulesei, O. Mitu, A.D. Costache, D. Marcu, A.M. Buburuz, “The Prognostic Value of Left Bundle Branch Block and Biochemical Parameters in Alcoholic Dilated Cardiomyopathy”, REV. CHIM., vol. 68, no. 12, pp. 2967-2969, 2017.

26. D. Andriţoi, C. Corciovă, C. Luca, D. Matei, R. Ciorap, “Heart Rate dynamics study on the impact of “Mirror therapy” in patients with stroke”, International Conference Advancements of Medicine and Health Care Through Technology MEDITECH 2016, 12th – 15th October 2016.

27. D. Andritoi, V. David, R. Ciorap, M. Branzila, “Recording and processing electrocardiography signals during magneto therapy procedures”, Environmental Engineering and Management Journal, vol. 12, no. 6, pp. 1231-1238, 2013.

 

via Monitoring System for Home-Based Hand Rehabilitation – IEEE Conference Publication

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[Abstract] Home-based Technologies for Stroke Rehabilitation: A Systematic Review

Highlights

-The types of technology of reviewed articles include games, telerehabilitation, robotic devices, virtual reality devices, sensors, and tablets.

-Two main human factors in designing home-based technologies for stroke rehabilitation are discussed: designing for engagement (including external and internal motivation) and designing for the home environment (including understanding the social context, practical challenges, and technical proficiency).

Abstract

Background

Many forms of home-based technology targeting stroke rehabilitation have been devised, and a number of human factors are important to their application, suggesting the need to examine this information in a comprehensive review.

Objective

The systematic review aims to synthesize the current knowledge of technologies and human factors in home-based technologies for stroke rehabilitation.

Methods

We conducted a systematic literature search in three electronic databases (IEEE, ACM, PubMed), including secondary citations from the literature search. We included articles that used technological means to help stroke patients conduct rehabilitation at home, reported empirical studies that evaluated the technologies with patients in the home environment, and were published in English. Three authors independently conducted the content analysis of searched articles using a list of interactively defined factors.

Results

The search yielded 832 potentially relevant articles, leading to 31 articles that were included for in-depth analysis. The types of technology of reviewed articles included games, telerehabilitation, robotic devices, virtual reality devices, sensors, and tablets. We present the merits and limitations of each type of technology. We then derive two main human factors in designing home-based technologies for stroke rehabilitation: designing for engagement (including external and internal motivation) and designing for the home environment (including understanding the social context, practical challenges, and technical proficiency).

Conclusion

This systematic review presents an overview of key technologies and human factors for designing home-based technologies for stroke rehabilitation.

 

via Home-based Technologies for Stroke Rehabilitation: A Systematic Review – ScienceDirect

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[Abstract] Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized Crossover Trial

Abstract

Objective

We investigated the treatment effects of a home-based rehabilitation program compared with clinic-based rehabilitation in patients with stroke.

Design

A single-blinded, 2-sequence, 2-period, crossover-designed study.

Setting

Rehabilitation clinics and participant’s home environment.

Participants

Individuals with disabilities poststroke.

Interventions

During each intervention period, each participant received 12 training sessions, with a 4-week washout phase between the 2 periods. Participants were randomly allocated to home-based rehabilitation first or clinic-based rehabilitation first. Intervention protocols included mirror therapy and task-specific training.

Main Outcome Measures

Outcome measures were selected based on the International Classification of Functioning, Disability and Health. Outcomes of impairment level were the Fugl-Meyer Assessment, Box and Block Test, and Revised Nottingham Sensory Assessment. Outcomes of activity and participation levels included the Motor Activity Log, 10-meter walk test, sit-to-stand test, Canadian Occupational Performance Measure, and EuroQoL-5D Questionnaire.

Results

Pretest analyses showed no significant evidence of carryover effect. Home-based rehabilitation resulted in significantly greater improvements on the Motor Activity Log amount of use subscale (P=.01) and the sit-to-stand test (P=.03) than clinic-based rehabilitation. The clinic-based rehabilitation group had better benefits on the health index measured by the EuroQoL-5D Questionnaire (P=.02) than the home-based rehabilitation group. Differences between the 2 groups on the other outcomes were not statistically significant.

Conclusions

The home-based and clinic-based rehabilitation groups had comparable benefits in the outcomes of impairment level but showed differential effects in the outcomes of activity and participation levels.

via Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized Crossover Trial – Archives of Physical Medicine and Rehabilitation

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[ARTICLE] Home-based transcranial direct current stimulation plus tracking training therapy in people with stroke: an open-label feasibility study – Full Text

Abstract

Background

Transcranial direct current stimulation (tDCS) is an effective neuromodulation adjunct to repetitive motor training in promoting motor recovery post-stroke. Finger tracking training is motor training whereby people with stroke use the impaired index finger to trace waveform-shaped lines on a monitor. Our aims were to assess the feasibility and safety of a telerehabilitation program consisting of tDCS and finger tracking training through questionnaires on ease of use, adverse symptoms, and quantitative assessments of motor function and cognition. We believe this telerehabilitation program will be safe and feasible, and may reduce patient and clinic costs.

Methods

Six participants with hemiplegia post-stroke [mean (SD) age was 61 (10) years; 3 women; mean (SD) time post-stroke was 5.5 (6.5) years] received five 20-min tDCS sessions and finger tracking training provided through telecommunication. Safety measurements included the Digit Span Forward Test for memory, a survey of symptoms, and the Box and Block test for motor function. We assessed feasibility by adherence to treatment and by a questionnaire on ease of equipment use. We reported descriptive statistics on all outcome measures.

Results

Participants completed all treatment sessions with no adverse events. Also, 83.33% of participants found the set-up easy, and all were comfortable with the devices. There was 100% adherence to the sessions and all recommended telerehabilitation.

Conclusions

tDCS with finger tracking training delivered through telerehabilitation was safe, feasible, and has the potential to be a cost-effective home-based therapy for post-stroke motor rehabilitation.

Background

Post-stroke motor function deficits stem not only from neurons killed by the stroke, but also from down-regulated excitability in surviving neurons remote from the infarct [1]. This down-regulation results from deafferentation [2], exaggerated interhemispheric inhibition [3], and learned non-use [4]. Current evidence suggests that post-stroke motor rehabilitation therapies should encourage upregulating neurons and should target neuroplasticity through intensive repetitive motor practice [56]. Previously, our group has examined the feasibility and efficacy of a custom finger tracking training program as a way of providing people with stroke with an engaging repetitive motor practice [789]. In this program, the impaired index finger is attached to an electro-goniometer, and participants repeatedly move the finger up and down to follow a target line that is drawn on the display screen. In successive runs, the shape, frequency and amplitude of target line is varied, which forces the participant to focus on the tracking task. In one study, we demonstrated a 23% improvement in hand function (as measured by the Box and Block test; minimal detectable change is 18% [10]) after participants with stroke completed the tracking training program [9]. While our study did not evaluate changes in activity in daily life (ADL) or quality of life (because efficacy of the treatment was not the study objective), the Box and Block test is moderately correlated (r = 0.52) to activities in daily life and quality of life (r = 0.59) [11]. In addition, using fMRI, we showed that training resulted in an activation transition from ipsilateral to contralateral cortical activation in the supplementary motor area, primary motor and sensory areas, and the premotor cortex [9].

Recently, others have shown that anodal transcranial direct current stimulation (tDCS) can boost the beneficial effects of motor rehabilitation, with the boost lasting for at least 3 months post-training [12]. Also, bihemispheric tDCS stimulation (anodal stimulation to excite the ipsilateral side and cathodal stimulation to downregulate the contralateral side) in combination with physical or occupational therapy has been shown to provide a significant improvement in motor function (as measured by Fugl-Meyer and Wolf Motor Function) compared to a sham group [13]. Further, a recent meta-analysis of randomized-controlled trials comparing different forms of tDCS shows that cathodal tDCS is a promising treatment option to improve ADL capacity in people with stroke [14]. Compared to transcutaneous magnetic stimulation (TMS), tDCS devices are inexpensive and easier to operate. Improvement in upper limb motor function can appear after only five tDCS sessions [15], and there are no reports of serious adverse events when tDCS has been used in human trials for periods of less than 40 min at amplitudes of less than 4 mA [16].

Moreover, tDCS stimulation task also seems beneficial for other impairments commonly seen in people post-stroke. Stimulation with tDCS applied for 20 sessions of 30 min over a 4-week period has been shown to decrease depression and improve quality of life in people after a stroke [1718]. Four tDCS sessions for 10 min applied over the primary and sensory cortex in eight patients with sensory impairments more than 10 months post-stroke enhanced tactile discriminative performance [19]. Breathing exercises with tDCS stimulation seems to be more effective than without stimulation in patient with chronic stroke [20], and tDCS has shown promise in treating central post-stroke pain [21]. Finally, preliminary research on the effect of tDCS combined with training on resting-state functional connectivity shows promise to better understand the mechanisms behind inter-subject variability regarding tDCS stimulation [22].

Motor functional outcomes in stroke have declined at discharge from inpatient rehabilitation facilities [2324], likely a result of the pressures to reduce the length of stay at inpatient rehabilitation facilities as part of a changing and increasingly complex health care climate [2526]. Researchers, clinicians, and administrators continue to search for solutions to facilitate and post-stroke rehabilitation after discharge. Specifically, there has been considerable interest in low-cost stroke therapies than can be administered in the home with only a modest level of supervision by clinical professionals.

Home telerehabilitation is a strategy in which rehabilitation in the patient’s home is guided remotely by the therapist using telecommunication technology. If patients can safely apply tDCS to themselves at home, combining telerehabilitation with tDCS would be an easy way to boost therapy without costly therapeutic face-to-face supervision. For people with multiple sclerosis, the study of Charvet et al. (2017) provided tDCS combined with cognitive training, delivered through home telerehabilitation, and demonstrated greater improvement on cognitive measures compared to those who received just the cognitive training [27]. The authors demonstrated the feasibility of remotely supervised, at-home tDCS and established a protocol for safe and reliable delivery of tDCS for clinical studies [28]. Some evidence shows that telerehabilitation approaches are comparable to conventional rehabilitation in improving activities of daily living and motor function for stroke survivors [2930], and that telemedicine for stroke is cost-effective [3132]. A study in 99 people with stroke receiving training using telerehabilitation (either with home exercise program or robot assisted therapy with home program) demonstrated significant improvements in quality of life and depression [33].

A recent search of the literature suggests that to date, no studies combine tDCS with repetitive tracking training in a home telerehabilitation setting to determine whether the combination leads to improved motor rehabilitation in people with stroke. Therefore, the aim of this pilot project was to explore the safety, usability and feasibility of the combined system. For the tDCS treatment, we used a bihemispheric montage with cathodal tDCS stimulation to suppress the unaffected hemisphere in order to promote stroke recovery [34353637]. For the repetitive tracking training therapy, we used a finger tracking task that targets dexterity because 70% of people post-stroke are unable to use their hand with full effectiveness after stroke [38]. Safety was assessed by noting any decline of 2 points or more in the cognitive testing that persists over more than 3 days. We expect day to day variations of 1 digit. Motor decline is defined by a decline of 6 blocks on the Box and Block test due to muscle weakness. This is based on the minimal detectable change (5.5 blocks/min) [10]. The standard error of measurement is at least 2 blocks for the paretic and stronger side. We expect possible variations in muscle tone that could influence the scoring of the test. Usability was assessed through a questionnaire and by observing whether the participant, under remote supervision, could don the apparatus and complete the therapy sessions. Our intent was to set the stage for a future clinical trial to determine the efficacy of this approach.

Methods

Participants

Participants were recruited from a database of people with chronic stroke who had volunteered for previous post-stroke motor therapy research studies at the University of Minnesota. Inclusion criteria were: at least 6 months post-stroke; at least 10 degrees of active flexion and extension motion at the index finger; awareness of tactile sensation on the scalp; and a score of greater than or equal to 24 (normal cognition) on the Mini-Mental State Examination (MMSE) to be cognitively able to understand instructions to don and use the devices [39]. We excluded those who had a seizure within past 2 years, carried implanted medical devices incompatible with tDCS, were pregnant, had non-dental metal in the head or were not able to understand instructions on how to don and use the devices. The study was approved by the University of Minnesota IRB and all enrolled participants consented to be in the study.

Apparatus

tDCS was applied using the StarStim Home Research Kit (NeuroElectrics, Barcelona, Spain). The StarStim system consists of a Neoprene head cap with marked positions for electrode placement, a wireless cap-mounted stimulator and a laptop control computer. Saline-soaked, 5 cm diameter sponge electrodes were used. For electrode placement, we followed a bihemispheric montage [14] involving cathodal stimulation on the unaffected hemisphere with the anode positioned at C3 and the cathode at C4 for participants with left hemisphere stroke, and vice versa for participants with right hemisphere stroke. Stimulation protocols were set by the investigator on a web-based application that communicated with the tDCS control computer. A remote access application (TeamViewer) was also installed on the control computer, as was a video conferencing application (Skype).

The repetitive finger tracking training system was a copy of what we used in our previous stroke studies [789]. The apparatus included an angle sensor mounted to a lightweight brace and aligned with the metacarpophalangeal (MCP) joint of the index finger, a sensor signal conditioning circuit, and a target tracking application loaded on a table computer. Figure 1 shows a participant using the apparatus during a treatment session.

Fig. 1

Fig. 1Participant with right hemiparesis receiving transcranial direct current magnetic stimulation (tDCS) in their home simultaneous while performing the finger movement tracking task on the tracking computer (left). The tDCS computer (right) shows the supervising investigator, located off-site, who communicated with the participant through the video conferencing application, controlled the tDCS stimulator through web-based software, and controlled the tracking protocols. (Permission was obtained from the participant for the publication of this picture)

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Continue —>  Home-based transcranial direct current stimulation plus tracking training therapy in people with stroke: an open-label feasibility study | Journal of NeuroEngineering and Rehabilitation | Full Text

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[ARTICLE] Unobtrusive Sensing for Home-Based PostStroke Rehabilitation – Full Text PDF

This paper proposes the fusion of low-cost unobtrusive heterogeneous sensors (MEMS thermal and radar sensors) to monitor the rehabilitation activities of post-stroke sufferers within home-based settings. Results of the proposed approach are planned to be compared with a standard EMG sensor to ascertain the authenticity, validity and repeatability of the newly introduced sensing solution.

MEMS, unobtrusive, Radar, Thermal, Sensing, Post-stroke

1. INTRODUCTION

Stroke is a cerebrovascular disease which interrupts
the flow of oxygenated blood to certain regions of the
brain. This often results in sudden loss of
neurological functions making it difficult for the
sufferer to carry out certain activities of daily living
(ADL) (D’Aliberti et al., 2017).
Post-stroke rehabilitation has witnessed the use of
Isokinetic dynamometers, low-frequency
transcutaneous electrical nerve stimulation, and
EMG devices, amongst others, to assist in retraining
the affected muscles group(s). This is often
performed within a laboratory setting, a hospital
facility or through the use of wearable sensors at
home. While the lab and hospital environments may
seem rigorous to post-stroke patients and pose a
range of logistical complexities, wearable sensors
suffer from a range of problems relating to battery
life, wearability and adoption. The resultant effect of
these being the discontinuation of the rehabilitation
process (Igual et al., 2013).
Opportunities therefore exist for the use of
alternative and unobtrusive sensing solutions that
can be used within home based settings. These
have the potential to avoid the aforementioned
issues of wearable technologies and also offer the
added advantage of being able to be used within the
home environment avoiding logistical issues for post
stroke sufferers.

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[Abstract] Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized Crossover Trial

Abstract

Objective

We investigated the treatment effects of a home-based rehabilitation program compared with clinic-based rehabilitation in patients with stroke.

Design

A single-blinded, 2-sequence, 2-period, crossover-designed study.

Setting

Rehabilitation clinics and participant’s home environment.

Participants

Individuals with disabilities poststroke.

Interventions

During each intervention period, each participant received 12 training sessions, with a 4-week washout phase between the 2 periods. Participants were randomly allocated to home-based rehabilitation first or clinic-based rehabilitation first. Intervention protocols included mirror therapy and task-specific training.

Main Outcome Measures

Outcome measures were selected based on the International Classification of Functioning, Disability and Health. Outcomes of impairment level were the Fugl-Meyer Assessment, Box and Block Test, and Revised Nottingham Sensory Assessment. Outcomes of activity and participation levels included the Motor Activity Log, 10-meter walk test, sit-to-stand test, Canadian Occupational Performance Measure, and EuroQoL-5D Questionnaire.

Results

Pretest analyses showed no significant evidence of carryover effect. Home-based rehabilitation resulted in significantly greater improvements on the Motor Activity Log amount of use subscale (P=.01) and the sit-to-stand test (P=.03) than clinic-based rehabilitation. The clinic-based rehabilitation group had better benefits on the health index measured by the EuroQoL-5D Questionnaire (P=.02) than the home-based rehabilitation group. Differences between the 2 groups on the other outcomes were not statistically significant.

Conclusions

The home-based and clinic-based rehabilitation groups had comparable benefits in the outcomes of impairment level but showed differential effects in the outcomes of activity and participation levels.

via Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized Crossover Trial – Archives of Physical Medicine and Rehabilitation

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