Posts Tagged limb

[Abstract] The effect and optimal parameters of repetitive transcranial magnetic stimulation on motor recovery in stroke patients: a systematic review and meta-analysis of randomized controlled trials

The primary aim of this meta-analysis was to evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) on limb movement recovery post-stroke and cortex excitability, to explore the optimal parameters of rTMS and suitable stroke population. Second, adverse events were also included.

The databases of PubMed, EBSCO, MEDLINE, the Cochrane Central Register of Controlled Trials, EBM Reviews-Cochrane Database, the Chinese National Knowledge Infrastructure, and the Chinese Science and Technology Journals Database were searched for randomized controlled trials exploring the effects of rTMS on limb motor function recovery post-stroke before December 2018.

The effect sizes of rTMS on limb motor recovery, the effect size of rTMS stimulation parameters, and different stroke population were summarized by calculating the standardized mean difference (SMD) and the 95% confidence interval using fixed/random effect models as appropriate.

For the motor function assessment, 42 eligible studies involving 1168 stroke patients were identified. The summary effect size indicated that rTMS had positive effects on limb motor recovery (SMD = 0.50, P < 0.00001) and activities of daily living (SMD = 0.82, P < 0.00001), and motor-evoked potentials of the stimulated hemisphere differed according to the stimulation frequency, that is, the high-frequency group (SMD = 0.57, P = 0.0006), except the low-frequency group (SMD = –0.27, P = 0.05). No significant differences were observed among the stimulation parameter subgroups except for the sessions subgroup (P = 0.02). Only 10 included articles reported transient mild discomfort after rTMS.

rTMS promoted the recovery of limb motor function and changed the cortex excitability. rTMS may be better for early and pure subcortical stroke patients. Regarding different stimulation parameters, the number of stimulation sessions has an impact on the effect of rTMS.

via The effect and optimal parameters of repetitive transcranial magnetic stimulation on motor recovery in stroke patients: a systematic review and meta-analysis of randomized controlled trials – Huifang Xiang, Jing Sun, Xiang Tang, Kebin Zeng, Xiushu Wu, 2019

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[Abstract] Eye Movements Interfere With Limb Motor Control in Stroke Survivors

Background. Humans use voluntary eye movements to actively gather visual information during many activities of daily living, such as driving, walking, and preparing meals. Most stroke survivors have difficulties performing these functional motor tasks, and we recently demonstrated that stroke survivors who require many saccades (rapid eye movements) to plan reaching movements exhibit poor motor performance. However, the nature of this relationship remains unclear.

Objective. Here we investigate if saccades interfere with speed and smoothness of reaching movements in stroke survivors, and if excessive saccades are associated with difficulties performing functional tasks.

Methods. We used a robotic device and eye tracking to examine reaching and saccades in stroke survivors and age-matched controls who performed the Trail Making Test, a visuomotor task that uses organized patterns of saccades to plan reaching movements. We also used the Stroke Impact Scale to examine difficulties performing functional tasks.

Results. Compared with controls, stroke survivors made many saccades during ongoing reaching movements, and most of these saccades closely preceded transient decreases in reaching speed. We also found that the number of saccades that stroke survivors made during ongoing reaching movements was strongly associated with slower reaching speed, decreased reaching smoothness, and greater difficulty performing functional tasks.

Conclusions. Our findings indicate that poststroke interference between eye and limb movements may contribute to difficulties performing functional tasks. This suggests that interventions aimed at treating impaired organization of eye movements may improve functional recovery after stroke.

via Eye Movements Interfere With Limb Motor Control in Stroke Survivors – Tarkeshwar Singh, Christopher M. Perry, Stacy L. Fritz, Julius Fridriksson, Troy M. Herter, 2018

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[WEB SITE] Study: Stroke victims regain more limb use with dual-therapy approach

By

Allen Cone

Scientists found a dual-therapy approach — a brain-computer interface and functional electrical stimulation — helped stroke victims regain use of their arms better than a single therapy. Photo courtesy of Federal Institute of Technology

June 20 (UPI) — Stroke victims regain greater use of their paralyzed limbs with a dual-therapy approach than a single method, according to a study in Europe.

Scientists at Federal Institute of Technology in Lausanne, Switzerland, studied the effects of utilizing a brain-computer interface and functional electrical stimulation on people who had strokes. Their findings were published Wednesday in the journal Nature Communications.

After a stroke, patients are often partially or totally unable to move the whole side of the body or just one arm or leg. A variety of therapies are used to bring this movement back, nerve stimulation being among them.

“The key is to stimulate the nerves of the paralyzed arm precisely when the stroke-affected part of the brain activates to move the limb, even if the patient can’t actually carry out the movement,” Dr. Jose del R. Millan, who holds the Defitech Chair at the institute, said in a press release. “That helps reestablish the link between the two nerve pathways where the signal comes in and goes out.”

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In the clinical trial, 27 patients aged 36 to 76 were recruited between September 2012 and August 2015. They all had a similar lesion that resulted in moderate to severe arm paralysis after a stroke at least 10 months earlier.

Half the patients, who were treated with the dual-therapy approach, reported significant improvements. The other half were only treated functional electrical stimulation as a control group and the results were not as noticeable.

“Patients who received the BCI treatment showed more activity in the neural tissue surrounding the affected area,” Mill said. “Due to their plasticity, they could help make up for the functioning of the damaged tissue.”

RELATED Brain stimulation restores movement in rats after stroke

The BCI system was linked the patients’ brains to computers using electrodes. Each time the electrical activity was identified, the system stimulated the arm muscle that controls wrist and finger movements.

After 10 one-hour sessions, scientists noted a significant improvement in arm mobility. After the full round of treatment, test scores were more than twice as high as those of the second group.

In the second group, patients also had their arm muscles stimulated, but randomly. As with the control group, the researchers found how much additional motor-function improvement could be attributed to the BCI system.

RELATED Blacks, Hispanics suffer second bleeding strokes more often

EEGs indicated an increase in connections among the motor cortex regions of their damaged brain hemisphere, the researchers said, which was linked to increased ease in movements.

Most importantly, the patients didn’t lose any of their recovered mobility in follow-ups six to 12 months later, the researchers report.

“BCI-FES therapy resulted in a statistically significant, clinically important, and lasting reduction of impairment in chronic moderate-to-severe stroke patients,” researchers wrote in the study. “In particular, the preservation of clinically relevant improvements at least six months after end of therapy is remarkable.”

 

via Study: Stroke victims regain more limb use with dual-therapy approach – UPI.com

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[REVIEW] Development of Upper Limb Assistive Robotic Devices for Arm Functionality Rehabilitation- Full Text PDF

ABSTRACT

Use of assistive robotic devices and exoskeletons help to achieve the main purpose of
rehabilitation and increased functionality in medical sector. In order to treat patients after stroke or with a condition of myasthenia, physiotherapy is needed for rehabilitating the weakened set of muscles. The exoskeleton devices not only treat the patient well but also help them to relearn the basic movements of the affected limb. They help strengthen the weak part/limb of a person withcondition of partial paralysis / myasthenia with the help of assistive exoskeleton rehabilitation device via training sessions to improve daily primary activities.

I. Introduction

In our country, every year there are almost a million people affected with paralysis and
myasthenia. According to social security disability (S.S.D.) myasthenia is a disability and there is no cure. But it can be treated with medication, physiotherapy and sometimes surgery. To avoid the surgery stage, in this condition the affected patient needs to take specific treatment to give considerable strength to the affected limb. Myasthenia is the state in which abnormal weakening of muscles takes place. It is caused due to severe strokes & accidental nerve damage. In most of the cases severe strokes & nerve damage leads to weakening of arm muscles & it becomes necessary to get expensive physiotherapies in rehabilitation centers or hospitals. Here a particular device that is perfectly designed to impart confidence in the patient to exercise by themselves and
work efficiently to strengthen the muscles of affected limb is beneficial, under the guidance of a physiotherapist. In this paper, we will discuss different devices/exoskeleton which are used for rehabilitation of weak muscles to find the most effective device and ways by which they achieve their objective of strengthening the weakened part or a limb and regain its functionality.

Full Text PDF

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[ARTICLE] Bioelectronic Medicine and the Dawn of Robotic Training to Improve Motor Outcome in Chronic Stroke – Full Text PDF

Engineers and clinicians have cooperated to produce and test new classes of bioelectronics that have altered motor impairment that occurs after stroke. The rationale that increased intensity of training alters outcome derives from past clinical and preclinical work. Now several studies have demonstrated that interactive robotic devices are a potent tool for the therapist to deliver effortlessly, reproducible high intensity movement training. These robots are safe and can provide a platform so that recovery might be influenced by a combination of noninvasive novel treatment programs. Also, these robotic devices provide a continuous objective history of movement parameters that will open the horizon for their use in generating novel movement biomarkers to understand, predict and measure the influence of new treatments on motor outcome after neurological injury.

INTRODUCTION

The enormous personal and societal burden caused by diseases of the brain and spinal cord make imperative innovative attempts to reduce illness and alter permanent disability. Colleagues at MIT, HI Krebs and N Hogan, developed an array of interactive robotic devices that we have used to aid and abet treatment programs for neurological recovery of motor function of the limbs in patients who have had a stroke (1–4).

These interactive robots move a patient’s paretic arm and when the patient begins to move, these robots “get out of the way” so the patient can execute the movement with very little resistance from the device. With these robots, a therapist can generate training sessions that are intensity controlled (a single one-hour session requires over 1,000 to and fro movements of a limb segment). The robots are tireless agents that produce reliable, reproducible movement sequences. In addition, the controllers on these robotic devices can be tuned to individual patients so that the robot can present different physical challenges at the point when a patient is moving the robot arm, so that training can focus, for example, on the speed, trajectory (aiming) or force of a movement (5,6). The success of controlled multicenter randomized studies that used robotic protocols to improve the outcome of upper limb motor recovery in patients with chronic stroke prompted the American Heart Association to make robotic training standard care (5,7–9).

This work will review the continued relationship between rehabilitation robotics for the paretic upper extremity after chronic stroke and focus on frequent questions that arise in clinical practice: Can intensive training alter the dreaded “performance plateau”? Can the human–robot interaction be optimized for an individual patient? Can explicit training of the affected limb generalize to improvement on untrained motor tasks? Can the control group be trained in an intensive manner to mimic the robot training? Can the robot-derived measurements of movement provide an objective biomarker for studies of other treatments, especially new pharmacology for acute stroke? Can the robot training emerge as a platform for combination therapy?

 Full Text PDF

 

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