Posts Tagged Motor function
For stroke patients, observing their own hand movements in a video-assisted therapy – as opposed to someone else’s hand – could enhance brain activity and speed up rehabilitation, according to researchers.
The scientists, from Tokyo University of Agriculture and Technology (TUAT), published their findings in IEEE Transactions on Neural Systems and Rehabilitation Engineering.
Brain plasticity, where a healthy region of the brain fulfills the function of a damaged region of the brain, is a key factor in the recovery of motor functions caused by stroke. Studies have shown that sensory stimulation of the neural pathways that control the sense of touch can promote brain plasticity, essentially rewiring the brain to regain movement and senses.
To promote brain plasticity, stroke patients may incorporate a technique called motor imagery in their therapy. Motor imagery allows a participant to mentally simulate a given action by imagining themselves going through the motions of performing that activity. This therapy may be enhanced by a brain-computer interface technology, which detects and records the patients’ motor intention while they observe the action of their own hand or the hand of another person, a media release from Tokyo University of Agriculture and Technology explains.
“We set out to determine whether it makes a difference if the participant is observing their own hand or that of another person while they’re imagining themselves performing the task,” says co-author Toshihisa Tanaka, a professor in the Department of Electrical and Electrical Engineering at TUAT in Japan and a researcher at the RIKEN Center for Brain Science and the RIKEN Center for Advanced Intelligent Project.
The researchers monitored brain activity of 15 healthy right-handed male participants under three different scenarios. In the first scenario, participants were asked to imagine their hand moving in synchrony with hand movements being displayed in a video clip showing their own hand performing the task, together with corresponding voice cues.
In the second scenario, they were asked to imagine their hand moving in synchrony with hand movements being displayed on a video clip showing another person’s hand performing the task, together with voice cues. In the third scenario, the participants were asked to open and close their hands in response to voice cues only.
Using electroencephalography (EEG), brain activity of the participants was observed as they performed each task.
The team found meaningful differences in EEG measurements when participants were observing their own hand movement and that of another person. The findings suggest that, in order for motor imagery-based therapy to be most effective, video footage of a patient’s own hand should be used.
“Visual tasks where a patient observes their own hand movement can be incorporated into brain-computer interface technology used for stroke rehabilitation that estimates a patient’s motor intention from variations in brain activity, as it can give the patient both visual and sense of movement feedback,” Tanaka explains.
[Source(s): Tokyo University of Agriculture and Technology, EurekAlert]
[Abstract] Efficacy of Home-Based Telerehabilitation vs In-Clinic Therapy for Adults After Stroke: A Randomized Clinical Trial.
Many patients receive suboptimal rehabilitation therapy doses after stroke owing to limited access to therapists and difficulty with transportation, and their knowledge about stroke is often limited. Telehealth can potentially address these issues.
To determine whether treatment targeting arm movement delivered via a home-based telerehabilitation (TR) system has comparable efficacy with dose-matched, intensity-matched therapy delivered in a traditional in-clinic (IC) setting, and to examine whether this system has comparable efficacy for providing stroke education.
DESIGN, SETTING, AND PARTICIPANTS:
In this randomized, assessor-blinded, noninferiority trial across 11 US sites, 124 patients who had experienced stroke 4 to 36 weeks prior and had arm motor deficits (Fugl-Meyer [FM] score, 22-56 of 66) were enrolled between September 18, 2015, and December 28, 2017, to receive telerehabilitation therapy in the home (TR group) or therapy at an outpatient rehabilitation therapy clinic (IC group). Primary efficacy analysis used the intent-to-treat population.
Participants received 36 sessions (70 minutes each) of arm motor therapy plus stroke education, with therapy intensity, duration, and frequency matched across groups.
MAIN OUTCOMES AND MEASURES:
Change in FM score from baseline to 4 weeks after end of therapy and change in stroke knowledge from baseline to end of therapy.
A total of 124 participants (34 women and 90 men) had a mean (SD) age of 61 (14) years, a mean (SD) baseline FM score of 43 (8) points, and were enrolled a mean (SD) of 18.7 (8.9) weeks after experiencing a stroke. Among those treated, patients in the IC group were adherent to 33.6 of the 36 therapy sessions (93.3%) and patients in the TR group were adherent to 35.4 of the 36 assigned therapy sessions (98.3%). Patients in the IC group had a mean (SD) FM score change of 8.36 (7.04) points from baseline to 30 days after therapy (P < .001), while those in the TR group had a mean (SD) change of 7.86 (6.68) points (P < .001). The covariate-adjusted mean FM score change was 0.06 (95% CI, -2.14 to 2.26) points higher in the TR group (P = .96). The noninferiority margin was 2.47 and fell outside the 95% CI, indicating that TR is not inferior to IC therapy. Motor gains remained significant when patients enrolled early (<90 days) or late (≥90 days) after stroke were examined separately.
CONCLUSIONS AND RELEVANCE:
Activity-based training produced substantial gains in arm motor function regardless of whether it was provided via home-based telerehabilitation or traditional in-clinic rehabilitation. The findings of this study suggest that telerehabilitation has the potential to substantially increase access to rehabilitation therapy on a large scale.
[Abstract] Effects of Exergame on Patients’ Balance and Upper Limb Motor Function after Stroke: A Randomized Controlled Trial.
Stroke is a major cause of motor incapacity in adults and the elderly population, requiring effective interventions capable of contributing to rehabilitation. Different interventions such as use of exergames are being adopted in the motor rehabilitation and balance area, as they act as motivating instruments, making therapies more pleasurable.
The aim of this study was to investigate the effects of exergame on patients’ balance and upper limb motor function after stroke.
This study is a randomized controlled trial. Thirty-one participants of both genders, mean age of 76 years, were assigned to the experimental or control groups; the experimental group (n = 16) underwent exergame rehabilitation using Motion Rehab AVE 3D, and the control group (n = 15) underwent conventional physiotherapy. Both EG and GC sessions happened twice a week, for 30 minutes each, over a 12 weeks period, resulting in 24 sessions. All sessions were composed of similar exercises, with same purpose and elapsed time (5 minutes). Instruments applied to verify inclusion criteria were a sociodemographic questionnaire and clinical aspects and a Mini-Mental State Examination. At baseline and after 12 weeks of intervention, the Modified Ashworth Scale, the Fugl-Meyer Assessment, and the Berg Balance Scale were used.
In both groups, patients obtained significant improvement from baseline values in all analyzed variables (shoulder, elbow, and forearm; wrist; hand; and balance) (P < .001). In the intergroup comparison, there were significant differences between the 2 groups for changes in values from preintervention to postintervention of shoulder, elbow and forearm (P = .001), and total (P = .002).
Exergame rehabilitation in poststroke patients can be an efficient alternative for restoring balance and upper limb motor function and might even reduce treatment time.
Results from a clinical trial testing the MyoRegulator device for the non-invasive treatment of spasticity, published recently in Bioelectronic Medicine, suggest evidence for using MyoRegulator to treat upper extremity spasticity in subjects with chronic stroke, PathMaker Neurosystems Inc announces.
PathMaker Neurosystems Inc is a clinical-stage bioelectronic medicine company that develops non-invasive systems for the treatment of patients with spasticity and paralysis. The MyoRegulator is an investigational medical device and is limited by US Federal law to investigational use only.
The device is based on PathMaker’s proprietary DoubleStim technology (combining anodal trans-spinal direct current stimulation (tsDCS) and peripheral nerve direct current stimulation (pDCS)), which provides simultaneous non-invasive stimulation intended to suppress hyperexcitable spinal neurons involved with spasticity, the company explains in a media release.
“Current pharmacological approaches to managing spasticity have, at best, short-term efficacy, are confounded by adverse effects, and are often unpleasant for the patient,” said co-author Zaghloul Ahmed, PhD, professor and chairman, Department of Physical Therapy and Professor, Center for Developmental Neuroscience, CUNY and Scientific Founder of PathMaker Neurosystems.
“The initial study results demonstrate the potential of a novel, non-invasive treatment to reduce spasticity and improve functional recovery in patients with upper motor neuron syndrome after stroke.”
The single-blind, sham-controlled, crossover design study, authored by researchers at Feinstein Institute for Medical Research at Northwell Health (and led by Bruce Volpe, MD, included patients with upper limb hemiparesis and wrist spasticity at least 6 months after their initial stroke to test whether MyoRegulator treatment reduces chronic upper-extremity spasticity.
Twenty subjects received five consecutive 20-minute daily treatments with sham stimulation followed by a 1-week washout period, then five consecutive 20-minute daily treatments with active stimulation. Subjects were told that the order of active or sham stimulation would be randomized.
Clinical and objective measures of spasticity and motor function were collected before the first session of each condition (baseline), immediately following the last session of each condition, and weekly for 5 weeks after the completion of active treatments.
The results demonstrated significant group mean reductions from baseline in both Modified Tardieu Scale scores (summed across the upper limb, P<0.05), and in objectively measured muscle resistance at the wrist flexor (P<0.05) following active treatment as compared to following sham treatment.
Motor function also improved significantly (measured by the Fugl-Meyer and Wolf Motor Function Test; P<0.05 for both tests) after active treatment, even without additional prescribed activity or training. The effect of the active MyoRegulator treatment was durable for the 5-week follow-up period, the release continues.
“We are highly encouraged by these clinical results which demonstrate the potential of MyoRegulator to improve outcomes for patients suffering from spasticity, without the need for surgery or drugs,” says Nader Yaghoubi, MD, PhD, president and chief executive officer of PathMaker.
“Building on these results and our ongoing clinical trial in Europe, we expect to initiate a US multi-center, pivotal, double-blind clinical trial supported by the National Institute of Neurological Disorders and Stroke (NINDS) in early 2020.”
[Source: PathMaker Neurosystems Inc]
[Abstract] Forced, Not Voluntary, Aerobic Exercise Enhances Motor Recovery in Persons With Chronic Stroke
Background. The recovery of motor function following stroke is largely dependent on motor learning–related neuroplasticity. It has been hypothesized that intensive aerobic exercise (AE) training as an antecedent to motor task practice may prime the central nervous system to optimize motor recovery poststroke.
Objective. The objective of this study was to determine the differential effects of forced or voluntary AE combined with upper-extremity repetitive task practice (RTP) on the recovery of motor function in adults with stroke.
Methods. A combined analysis of 2 preliminary randomized clinical trials was conducted in which participants (n = 40) were randomized into 1 of 3 groups: (1) forced exercise and RTP (FE+RTP), (2) voluntary exercise and RTP (VE+RTP), or (3) time-matched stroke-related education and RTP (Edu+RTP). Participants completed 24 training sessions over 8 weeks.
Results. A significant interaction effect was found indicating that improvements in the Fugl-Meyer Assessment (FMA) were greatest for the FE+RTP group (P = .001). All 3 groups improved significantly on the FMA by a mean of 11, 6, and 9 points for the FE+RTP, VE+RTP, and Edu+RTP groups, respectively. No evidence of a treatment-by-time interaction was observed for Wolf Motor Function Test outcomes; however, those in the FE+RTP group did exhibit significant improvement on the total, gross motor, and fine-motor performance times (P ≤ .01 for all observations).
Conclusions. Results indicate that FE administered prior to RTP enhanced motor skill acquisition greater than VE or stroke-related education. AE, FE in particular, should be considered as an effective antecedent to enhance motor recovery poststroke.
via Forced, Not Voluntary, Aerobic Exercise Enhances Motor Recovery in Persons With Chronic Stroke – Susan M. Linder, Anson B. Rosenfeldt, Sara Davidson, Nicole Zimmerman, Amanda Penko, John Lee, Cynthia Clark, Jay L. Alberts, 2019
The BIOMOT project, completed in September 2016, has helped to advance this emerging field by demonstrating that personalised computational models of the human body can effectively be used to control wearable exoskeletons. The project has identified ways of achieving improved flexibility and autonomous performance, which could assist in the use of wearable robots as mobility assistance and rehabilitation tools.
‘An increasing number of researchers in the field of neurorehabilitation are interested in the potential of these robotic technologies for clinical rehabilitation following neurological diseases,’ explains BIOMOT project coordinator Dr. Juan Moreno from the Spanish Council for Scientific Research (CSIC). ‘One reason is that these systems can be optimised to deliver diverse therapeutic interventions at specific points of recuperation or care.’
However, a number of factors have limited the widespread market adoption of wearable robots. Moreno and his team identified a need for wearable equipment to be more compact and lightweight, and better able anticipate and detect the intended movements of the wearer. In addition, robots needed to become more versatile and adaptable in order to aid people in a variety of different situations; walking on uneven ground, for example, or approaching an obstacle.
In order to address these challenges, the project developed robots with real-time adaptability and flexibility by increasing the symbiosis between the robot and the user through dynamic sensorimotor interactions. A hierarchical approach to these interactions was taken, allowing the project team to apply different layers for different purposes. This means in effect that an exoskeleton can be personalised to an individual user.
‘Thanks to this framework, the BIOMOT exoskeleton can rely on mechanical and bioelectric measurements to adapt to a changing user or task condition,’ says Moreno. ‘This leads to improved robotic interventions.’
Following theoretical and practical work, the project team then tested these prototype exoskeletons with volunteers. A key technical challenge was how to combine a robust and open architecture with a novel wearable robotic system that can gather signals from human activity. ‘Nonetheless, we succeeded in investigating for the first time the potential of automatically controlling human-robot interactions in order to enhance user compliance to a motor task,’ says Moreno. ‘Our research with healthy humans showed such positive and promising results that we are keen to continue validation with both stroke and spinal cord injury patients.’
Indeed, Moreno is confident that the success of the project will open up potential new research avenues. For example, the results will help scientists to develop computational models for rehabilitation therapies, and better understand human movement in more detail.
‘In the project we also defined novel techniques to evaluate and benchmark performances of wearable exoskeletons,’ says Moreno. ‘Further innovation projects are planned by consortium members to follow up on this research, and to exploit developments in the field of human motion capture, human-machine interaction and adaptive control.’
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[Abstract + References] Investigation of the effects of mirror therapy on the spasticity, motor function and functionality of impaired upper limbs in chronic stroke patients
Strokes lead to different levels of disability. During the chronic stage, hemiparesis, spasticity and motor deficits may cause loss of functional independence. Mirror therapy aims to reduce deficits and increase functional recovery of the impaired upper limb. This study aimed to evaluate the effects of mirror therapy on upper limb spasticity and motor function, as well as its impact on functional independence in chronic hemiparetic patients.
In this quasi-experimental study, eight chronic hemiparetic patients (age 55.5 ± 10.8 years) were assessed to determine their degree of spasticity (Modified Ashworth Scale), level of upper limb motor function (Fugl-Meyer Assessment) and functionality (Functional Independence Measure). All participants received 12 sessions of mirror therapy delivered three times per week, over a period of 4 weeks. Participants were re-evaluated post-intervention and these results were compared to their pre-intervention scores to determine the impact of mirror therapy.
A decrease in spasticity was observed, with significant improvements in shoulder extensors (P=0.033) and a significant increase in motor function (P=0.002). The therapeutic protocol adopted did not have a significant effect on functional independence (P=0.105).
Mirror therapy led to improvements in upper limb spasticity and motor function in chronic hemiparetic stroke patients. No effects on functional independence were observed. Further research with a larger number of patients is needed to provide more robust evidence of the benefits of mirror therapy in chronic hemiparetic stroke patients.
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via Investigation of the effects of mirror therapy on the spasticity, motor function and functionality of impaired upper limbs in chronic stroke patients | International Journal of Therapy and Rehabilitation
[ARTICLE] Voluntary control of wearable robotic exoskeletons by patients with paresis via neuromechanical modeling – Full Text
Research efforts in neurorehabilitation technologies have been directed towards creating robotic exoskeletons to restore motor function in impaired individuals. However, despite advances in mechatronics and bioelectrical signal processing, current robotic exoskeletons have had only modest clinical impact. A major limitation is the inability to enable exoskeleton voluntary control in neurologically impaired individuals. This hinders the possibility of optimally inducing the activity-driven neuroplastic changes that are required for recovery.
We have developed a patient-specific computational model of the human musculoskeletal system controlled via neural surrogates, i.e., electromyography-derived neural activations to muscles. The electromyography-driven musculoskeletal model was synthesized into a human-machine interface (HMI) that enabled poststroke and incomplete spinal cord injury patients to voluntarily control multiple joints in a multifunctional robotic exoskeleton in real time.
We demonstrated patients’ control accuracy across a wide range of lower-extremity motor tasks. Remarkably, an increased level of exoskeleton assistance always resulted in a reduction in both amplitude and variability in muscle activations as well as in the mechanical moments required to perform a motor task. Since small discrepancies in onset time between human limb movement and that of the parallel exoskeleton would potentially increase human neuromuscular effort, these results demonstrate that the developed HMI precisely synchronizes the device actuation with residual voluntary muscle contraction capacity in neurologically impaired patients.
Continuous voluntary control of robotic exoskeletons (i.e. event-free and task-independent) has never been demonstrated before in populations with paretic and spastic-like muscle activity, such as those investigated in this study. Our proposed methodology may open new avenues for harnessing residual neuromuscular function in neurologically impaired individuals via symbiotic wearable robots.
The ability to walk directly relates to quality of life. Neurological lesions such as those underlying stroke and spinal cord injury (SCI) often result in severe motor impairments (i.e., paresis, spasticity, abnormal joint couplings) that compromise an individual’s motor capacity and health throughout the life span. For several decades, scientific effort in rehabilitation robotics has been directed towards exoskeletons that can help enhance motor capacity in neurologically impaired individuals. However, despite advances in mechatronics and bioelectrical signal processing, current robotic exoskeletons have had limited performance when tested in healthy individuals  and have achieved only modest clinical impact in neurologically impaired patients , e.g., stroke [3, 4], SCI patients . […]
[Abstract] Does hand robotic rehabilitation improve motor function by rebalancing interhemispheric connectivity after chronic stroke? Encouraging data from a randomised-clinical-trial.
The objective of this study was the evaluation of the clinical and neurophysiological effects of intensive robot-assisted hand therapy compared to intensive occupational therapy in the chronic recovery phase after stroke.
50 patients with a first-ever stroke occurred at least six months before, were enrolled and randomised into two groups. The experimental group was provided with the Amadeo™ hand training (AHT), whereas the control group underwent occupational therapist-guided conventional hand training (CHT). Both of the groups received 40 hand training sessions (robotic and conventional, respectively) of 45 min each, 5 times a week, for 8 consecutive weeks. All of the participants underwent a clinical and electrophysiological assessment (task-related coherence, TRCoh, and short-latency afferent inhibition, SAI) at baseline and after the completion of the training.
The AHT group presented improvements in both of the primary outcomes (Fugl-Meyer Assessment for of Upper Extremity and the Nine-Hole Peg Test) greater than CHT (both p < 0.001). These results were paralleled by a larger increase in the frontoparietal TRCoh in the AHT than in the CHT group (p < 0.001) and a greater rebalance between the SAI of both the hemispheres (p < 0.001).
These data suggest a wider remodelling of sensorimotor plasticity and interhemispheric inhibition between sensorimotor cortices in the AHT compared to the CHT group.
These results provide neurophysiological support for the therapeutic impact of intensive robot-assisted treatment on hand function recovery in individuals with chronic stroke.