Posts Tagged motor imagery

[ARTICLE] Immediate and long-term effects of BCI-based rehabilitation of the upper extremity after stroke: a systematic review and meta-analysis – Full Text

Abstract

Background

A substantial number of clinical studies have demonstrated the functional recovery induced by the use of brain-computer interface (BCI) technology in patients after stroke. The objective of this review is to evaluate the effect sizes of clinical studies investigating the use of BCIs in restoring upper extremity function after stroke and the potentiating effect of transcranial direct current stimulation (tDCS) on BCI training for motor recovery.

Methods

The databases (PubMed, Medline, EMBASE, CINAHL, CENTRAL, PsycINFO, and PEDro) were systematically searched for eligible single-group or clinical controlled studies regarding the effects of BCIs in hemiparetic upper extremity recovery after stroke. Single-group studies were qualitatively described, but only controlled-trial studies were included in the meta-analysis. The PEDro scale was used to assess the methodological quality of the controlled studies. A meta-analysis of upper extremity function was performed by pooling the standardized mean difference (SMD). Subgroup meta-analyses regarding the use of external devices in combination with the application of BCIs were also carried out. We summarized the neural mechanism of the use of BCIs on stroke.

Results

A total of 1015 records were screened. Eighteen single-group studies and 15 controlled studies were included. The studies showed that BCIs seem to be safe for patients with stroke. The single-group studies consistently showed a trend that suggested BCIs were effective in improving upper extremity function. The meta-analysis (of 12 studies) showed a medium effect size favoring BCIs for improving upper extremity function after intervention (SMD = 0.42; 95% CI = 0.18–0.66; I2 = 48%; P < 0.001; fixed-effects model), while the long-term effect (five studies) was not significant (SMD = 0.12; 95% CI = − 0.28 – 0.52; I2 = 0%; P = 0.540; fixed-effects model). A subgroup meta-analysis indicated that using functional electrical stimulation as the external device in BCI training was more effective than using other devices (P = 0.010). Using movement attempts as the trigger task in BCI training appears to be more effective than using motor imagery (P = 0.070). The use of tDCS (two studies) could not further facilitate the effects of BCI training to restore upper extremity motor function (SMD = − 0.30; 95% CI = − 0.96 – 0.36; I2 = 0%; P = 0.370; fixed-effects model).

Conclusion

The use of BCIs has significant immediate effects on the improvement of hemiparetic upper extremity function in patients after stroke, but the limited number of studies does not support its long-term effects. BCIs combined with functional electrical stimulation may be a better combination for functional recovery than other kinds of neural feedback. The mechanism for functional recovery may be attributed to the activation of the ipsilesional premotor and sensorimotor cortical network.

Background

Motor deficit is the most common sequela after stroke, resulting in severe negative impacts on activities of daily living and social participation for patients [1]. Spontaneous recovery usually occurs within the first 3 months after the onset of stroke; however, there exists a great deal of variability in recovery across patients, particularly patients with severe deficits, who tend to recover less and more slowly [2]. With regard to the importance of motor training in facilitating motor recovery after stroke, various rehabilitation training protocols, such as task-specific training and constrained-induced motor training have been applied in regard to stroke [34]. However, these protocols are limited in patients with severe motor function deficit, due to the voluntary participation of hemiparetic hands. On the other hand, brain-computer interface (BCI) technology does not involve the direct volitional control of hemiparetic hands in training; therefore, it may be promising for these patients.

The term “BCIs” refers to systems that capture the features of brain activity and translate them into computerized commands to control external devices, which can be communication devices [5], functional electrical stimulation (FES) [6], or exoskeleton robots [7], among others. To acquire brain activity signals, either invasive or non-invasive strategies can be used. Invasive BCIs can acquire spatiotemporal signals and have a great capacity to distinguish more dimensions of patients’ intent through implants in the brain cortex [8]. However, non-invasive BCIs, using signals collected from electroencephalography (EEG), magnetoencephalography (MEG), functional near-infrared spectroscopy (fNIRS), or functional magnetic resonance imaging (fMRI), may be more promising than the invasive strategy in reality, due to safety and ethical issues [9]. Among them, the EEG signal-based BCI is the most commonly used system because of its relatively simple and inexpensive equipment requirements, as well as rich sources regarding its temporal resolution (e.g., visually evoked potential, P300, slow cortical potential) and frequency (e.g., power in given frequency bands) domains, the information can be extracted as the feature for controlling external devices [10]. The EEG signal-based BCI captures the signal of the event-related and time-locked decrease or increase in the oscillatory power in given frequency bands; in other words, the event-related desynchronization (ERD) or event-related synchronization (ERS), respectively [1112]. At present, hybrid BCI systems that combine more than one signal can provide more efficient natural control of external devices [13].[…]

Contimue —–> https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-020-00686-2

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[ARTICLE] A randomized controlled trial of motor imagery combined with structured progressive circuit class therapy on gait in stroke survivors – Full Text

Abstract

Structured Progressive Circuit Class Therapy (SPCCT) was developed based on task-oriented therapy, providing benefits to patients’ motivation and motor function. Training with Motor Imagery (MI) alone can improve gait performance in stroke survivors, but a greater effect may be observed when combined with SPCCT. Health education (HE) is a basic component of stroke rehabilitation and can reduce depression and emotional distress. Thus, this study aimed to investigate the effect of MI with SPCCT against HE with SPCCT on gait in stroke survivors. Two hundred and ninety stroke survivors from 3 hospitals in Yangon, Myanmar enrolled in the study. Of these, 40 stroke survivors who passed the selection criteria were randomized into an experimental (n = 20) or control (n = 20) group. The experimental group received MI training whereas the control group received HE for 25 minutes prior to having the same 65 minutes SPCCT program, with both groups receiving training 3 times a week over 4 weeks. Temporo-spatial gait variables and lower limb muscle strength of the affected side were assessed at baseline, 2 weeks, and 4 weeks after intervention. After 4 weeks of training, the experimental group showed greater improvement than the control group in all temporospatial gait variables, except for the unaffected step length and step time symmetry which showed no difference. In addition, greater improvements of the affected hip flexor and knee extensor muscle strength were found in the experimental group. In conclusion, a combination of MI with SPCCT provided a greater therapeutic effect on gait and lower limb muscle strengths in stroke survivors.

Introduction

Stroke is one of the top causes of long-term disability and mortality in many countries throughout the world1,2, with a high potential of this population increasing further due to the ageing population3. According to the disability-adjusted life years, stroke disease stands in fourth place among the disease burden. In 2005, there were 5.7 million deaths globally and 87% of them came from developing countries4.

Gait is one of the most important functions after stroke5. Stroke survivors usually exhibit gait alterations with longer stride time and lower gait speed and cadence when compared to aged matched healthy individuals6. Gait asymmetry is shown as one of the common characteristics in stroke survivors. It has been reported that 33.3% and 55.5% of ambulating stroke survivors had significant asymmetries in the temporal and spatial variables of gait7. Asymmetry of gait is clinically important and has been related to increases in energy expenditure, reduced balance control, and risk of unaffected limb injury8. The most important factor attributing to gait asymmetry is the reduction in muscle strength in the affected side. Previous studies exploring the relationship between lower limb muscle strength and walking ability, found significant associations in all muscle groups, especially in the hip flexors and ankle plantar flexors which showed the largest contribution to gait speed9. A review article reported that muscle weakness was one of the causation factors of falls, it is therefore considered to be the primary objective of promoting mobility ability in stroke survivors10.

Task-oriented training is one of several training techniques that has been used to improve motor function in stroke survivors1114. This technique has been reported to improve functional tasks, allowing the patients to participate actively, and allows easy progression in the training levels and task adaptability15. The Structure Progressive Circuit Class Training (SPCCT) was developed based on the task-oriented training concept. The key components of this method are to provide group therapy with a minimum of 2 participants under 1 therapist supervisor and encouraging repeated practice exercises with continual progression16. This has advantages over other techniques and has been shown to increase therapy dosage and reduce treatment costs. This treatment technique may be suitable for a large number of patients, however, a limited number of therapists implement these techniques within the clinical setting.

Motor imagery (MI) is a cognitive function paradigm that involves the mental imitation of the movement without actual execution. MI has been used as part of training programs for a number of clinical conditions to improve motor ability, and has been shown to produce similar brain activity to real movement actions17,18. Imagination and motor planning are key parts of the brain’s capability to perform movement effectively. The purpose of MI training is to improve learning ability by repetitive practice of particular tasks19. Although studies support the practice with MI alone to improve lower limb function20,21, better results have been reported when MI was combined with physical training2224. However, the previous studies have been conducted on upper limb function and only a few studies have reported its use in the lower limb14,25.

For a conservative treatment, health education (HE) is one of the crucial elements in stroke management. Stroke awareness is administered in the context of the national stroke policies in countries worldwide26,27. This provides knowledge about the disease and other necessary information for the patients and caregivers, and helps to inform patients how to take care of themselves as well as to prevent recurrence. This present study aimed to investigate the effect of the combined techniques of MI and SPCCT on gait and lower limb muscle strength on the affected side in stroke survivors. We hypothesized that the intervention of MI with SPCCT would show greater improvements when compared to HE with SPCCT.[…]

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[ARTICLE] Functional Electrical Stimulation Controlled by Motor Imagery Brain-Computer Interface for Rehabilitation – Full Text HTML

Abstract

Sensorimotor rhythm (SMR)-based brain–computer interface (BCI) controlled Functional Electrical Stimulation (FES) has gained importance in recent years for the rehabilitation of motor deficits. However, there still remain many research questions to be addressed, such as unstructured Motor Imagery (MI) training procedures; a lack of methods to classify different MI tasks in a single hand, such as grasping and opening; and difficulty in decoding voluntary MI-evoked SMRs compared to FES-driven passive-movement-evoked SMRs. To address these issues, a study that is composed of two phases was conducted to develop and validate an SMR-based BCI-FES system with 2-class MI tasks in a single hand (Phase 1), and investigate the feasibility of the system with stroke and traumatic brain injury (TBI) patients (Phase 2). The results of Phase 1 showed that the accuracy of classifying 2-class MIs (approximately 71.25%) was significantly higher than the true chance level, while that of distinguishing voluntary and passive SMRs was not. In Phase 2, where the patients performed goal-oriented tasks in a semi-asynchronous mode, the effects of the FES existence type and adaptive learning on task performance were evaluated. The results showed that adaptive learning significantly increased the accuracy, and the accuracy after applying adaptive learning under the No-FES condition (61.9%) was significantly higher than the true chance level. The outcomes of the present research would provide insight into SMR-based BCI-controlled FES systems that can connect those with motor disabilities (e.g., stroke and TBI patients) to other people by greatly improving their quality of life. Recommendations for future work with a larger sample size and kinesthetic MI were also presented.

1. Introduction

Healthy individuals whose brains and neuromuscular systems enable normal motor functions can naturally perform Activities of Daily Living (ADLs). Nonetheless, for some people who have disabilities in these functions due to injury or disease, simple tasks become very difficult or impossible to do. To assist this population, researchers in many fields, from physical therapy to engineering, have developed various rehabilitation technologies that help them perform ADLs [1,2]. One such technology, Functional Electrical Stimulation (FES), delivers electrical impulses to either paralyzed or impaired limbs to generate artificial muscle contraction [3,4]. In this way, FES helps disabled people perform ADLs such as walking, reaching, and grasping [5,6]. Some FES devices are controlled by brain–computer interfaces (BCIs), sometimes called brain–machine interfaces.
In general, BCIs can help people communicate and control devices and applications without using peripheral nerves and muscle pathways [7]. BCIs are also a potential method to promote the independence of physically disabled people by means of the BCI’s ability to bypass non-functional neural pathways [8]. A sensorimotor rhythm (SMR)-based BCI-controlled FES system is a novel technology that combines the advantages of FES and BCI systems, and allows severely disabled patients to restore motor functions through the FES system by translating voluntary Motor Imagery (MI) to physical action [9]. There are many potential benefits of combining SMR-based BCIs and FES systems, such as the promotion of neuroplasticity [10], the restoration of motor functions by using voluntary motor intentions [9,11], and providing proprioceptive sensory feedback as a result of their intentions [12].
Although SMR-based BCI-controlled FES methods seem promising, current studies still have central issues: (1) ambiguous instruction of MI tasks during training under SMR-based BCI systems, and (2) difficulties in classifying voluntary MI-evoked SMRs and FES-driven passive-movement-evoked SMRs when FES is activated. Moreover, (3) only a few studies have examined the feasibility of classifying two different MI tasks of a single hand, such as grasping and opening, and (4) few studies have examined human factors and ergonomics (HF/E) perspectives such as subjective mental workload and user satisfaction in the use of SMR-based BCI-controlled FES systems. This research that is composed of two phases was conducted to address these issues by developing a new SMR-based BCI system with visual guidance during training to classify a 2-class MI task in a single hand, as well as voluntary and passive SMRs (Phase 1), and evaluating the feasibility of the proposed BCI-controlled FES system by performing sequential goal-oriented tasks with stroke and TBI patients (Phase 2).
The remainder of this article consists of five more sections (this introduction being Section 1): Section 2 describes a survey of current SMR-based BCI studies for FES systems to identify the limitations of current research and clarifies the current state of BCI-controlled FES technologies. Section 3 presents Phase 1, where an SMR-based BCI system to control FES was developed and validated to address the issues on current research studies. Section 4 describes Phase 2, which assessed the feasibility of the proposed BCI-FES system by conducting a sequential task with fixed order under a semi-asynchronous mode. Section 5 discusses the findings of the present research along with implications and future directions.[…]

Continue —-> Brain Sciences | Free Full-Text | Functional Electrical Stimulation Controlled by Motor Imagery Brain-Computer Interface for Rehabilitation | HTML

Figure 1. Schematic illustration of the experiment procedure. Text in the blue box indicates the auditory cue that played at the beginning of each period, and INI is an abbreviation of the Functional Electrical Stimulation (FES) initiation period. MI: Motor Imagery.

 

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[BLOG POST] Hand Rehab after Stroke: The Top 5 Evidenced-Based Methods

After a stroke, it’s challenging enough to navigate the medical system to find what services you need, let alone the right treatment approach for you.

You’ve probably heard a lot of recommendations on how to recover hand function after stroke, and everyone seems to give different advice. That’s why we sifted through the research for you. We’ll explain the top 5 evidence-based methods for hand rehabilitation, why they work, and who they work for.

The top 5 evidence-based treatments for improving hand function after stroke:

  1. Constraint‐induced movement therapy (CIMT)
  2. Mental practice
  3. Mirror therapy
  4. Virtual reality
  5. High dose repetitive task practice

Constraint-Induced Movement Therapy

Unaffected arm wearing oven mitt for at-home constraint therapy.
You can restrict your unaffected side at home by wearing an oven mitt or placing it inside your pants or sweatshirt pocket. This will help remind you to rely on your affected side when completing therapy tasks.

What it is:

Constraint-Induced Movement Therapy (CIMT) is a neuro-rehabilitation method where the non-affected hand is constrained or restricted in order to force the brain to use the affected hand, thereby increasing neuroplasticity.

There are two key components: constraint and shaping.

Constraint refers to the way in which the hand is restricted. Therapists have used casts, splints, and mitts to restrict the use of the non-affected hand. None of them have been shown to be more effective than the other.

Shaping involves repetitive movements or activities at the patient’s ability level which become progressively harder. Therapists use shaping techniques to avoid overwhelming the motor system.

Why it works:

Our brain automatically completes a task in the easiest way possible. Our brain is more interested in completing a task than in how it is accomplished.

After a stroke, it’s easier for our brain to do tasks one-handed. This leads to “learned non-use”.

When we constrain our non-affected hand, suddenly our stronger hand becomes the weaker, less functional hand and we’re forced to use our affected hand. Our affected hand might not have much movement, but to our brain any movement is better than no movement, and the brain is highly motivated to figure out how to accomplish a task.

This is where the “shaping” piece is so important. If you are presented with rehab tasks that overwhelm the motor system or are higher level than your affected hand can functionally do, you’ll be more likely to knock the table over than to participate in picking up pennies from the table.

If you knock the table over with your affected hand, your occupational therapist might actually be excited about it; but in practical life finding that balance of not being too easy and not being so hard that you give up is an important lesson for every human being, not just those after stroke.

Who it’s for:

This approach is used for people who have at least 10 degrees of active wrist and finger extension, as well as 10 degrees of thumb abduction (the ability of the thumb to move out of the palm).

It’s been shown to be effective even years after stroke. Lower intensity CIMT is better than higher intensity in the very early stages after stroke.

Mental Practice

Man in headphones listening to mental practice recordings.
You might listen to an audio recording describing the sequence of throwing a ball, imagining yourself doing it. After listening, actually practice throwing the ball the way you envisioned!

What it is:

Mental practice, sometimes called motor imagery or mental imagery, is a training method for improving your hand and arm function without moving a muscle!

Mental practice is typically done by listening to pre-recorded audio that describes in detail the motor movement of a specific task. The listener imagines their hand and arm moving in a “typical” way, and the instructor provides cues to extend their arm or open their fingers, as well as the entire sensory experience of the task.

While it’s true that you can do mental practice on its own, it’s best combined with physical practice immediately following.

Why it works:

Brain scans show that similar parts of the brain are activated whether movement is actual, observed or imagined.

It’s a separate area of the brain that’s responsible for actually triggering the muscle movement, but it goes to show that there’s a lot more required of the brain to complete a task than just sending a signal to the muscle.

Who it’s for:

Mental practice has been shown to improve arm movement and functional use in patients after stroke of all levels of abilities and as a treatment approach for people months or years after stroke!

Mirror Therapy

Unaffected hand and its mirror image reflected in mirror box.
It is critical to stay focused on the reflected image of your hand during mirror therapy, imagining that it is your affected side performing the target movements.

What it is:

Mirror therapy is another voodoo-seeming approach that has a lot of scientific evidence to back it up. It essentially tricks your brain into thinking your affected hand is moving.

You position a mirror to reflect your non-affected hand, while hiding your affected hand. Any movement of your non-affected hand will be reflected in the mirror and make it seem as though you are actually moving your affected hand.

Why it works:

The approach is centered around mirror neurons, which fire in your brain when you see your arm move. Typically, we think about motor neurons being sent from the brain to the muscle, but we don’t realize that mirror neurons are connected to the motor neurons.

After a stroke you lose the ability to access your motor neurons, but not your mirror neurons. By accessing your mirror neurons through seeing your movement (even if the movement is fake), you are tapping into the network between the neurons.

It’s like trying to reconnect with an old friend on Facebook by finding the friends they’re connected with. It might not be the most direct approach in a real life situation, but in stroke rehab that friend of a friend might be your strongest connection.

Who it’s for:

Mirror therapy can be used for people with no movement of the hand or smaller movements of the hand and shoulder, but not functional movement of the hand.

If you have functional movement of your hand, meaning individual finger movement and wrist movement, you have surpassed the benefit that mirror therapy can provide.

It can be used early after stroke, as well as in the chronic stages of stroke.

Virtual Reality

Neofect Smart Board virtual reality arm exercise system.
The Neofect Smart Board is a non-immersive virtual reality rehabilitation system.

What it is:

Virtual reality uses a computer interface to simulate a real life objects and events. It’s become an increasingly more prevalent rehabilitation technique to provide motivation and engagement in therapy.

There are two types:

  1. Immersive: goggles are placed over the eyes and the patient is visually in a different environment than their actual physical one
  2. Non-immersive: sensors are placed on the body and track the movement of the body and the movements are shown on a screen

Why it works:

Virtual reality works best when paired with traditional therapy. It’s theorized to provide more motivation and engagement for the intensity of therapeutic exercise needed for neuroplasticity. It’s been shown to beneficial in high doses, meaning more than 20 hours.

Another possible factor of why virtual reality works are the same mechanisms that make mirror therapy effective (tapping into the mirror neurons) could be similar.

Virtual reality also creates a biofeedback loop: your brain sends a signal to the muscle, the brain receives a signal back in the form of visual or auditory input. Basically, you get rewarded for your effort.

Who it’s for:

Virtual reality can be used with people who have mild to severe impairments, and from early after stroke to years out.

When deciding what’s right for you, it’s important to look at the adjustability of the device to meet you where you’re at and also to increase in difficulty as you improve.

If you have minimal movements, you’ll want a virtual reality tool specifically for stroke rehabilitation. If you have more movement, it’s possible to use gaming systems not specifically designed for rehab, but make sure you have the support to optimize it for rehab.

High Dose Repetitive Task Practice

Putting coins in a piggy bank during repetitive task practice.
There are many ways to do task-specific training at home. Placing coins into a piggy bank is just one of them!

What it is:

Repetitive Task Practice is when you practice a task or a part of a task over and over. Task-specific training is a type of repetitive task practice, and refers to the task we complete that is relevant to our daily life.

“Reach to grasp, transport and release” is a type of task-specific training because it is one of the common motor requirements for many functional daily tasks.

The keys for repetitive task practice:

  • Task must be meaningful
  • Participant must be an active problem-solver
  • Real life objects are used
  • Difficulty level is not too high and not too low
  • Repetition is key

Why it works:

Repetitive Task Practice is based on motor learning theory. Our brains are driven by function. We’re able to achieve neuroplasticity with development of skills, as our brain processes the demands of the task, which have motor and cognitive components.

It’s often used with other treatments, such as virtual reality, to increase the 15 hour dosage that has been shown to be beneficial.

Who it’s for:

Task-specific practice is generally used and is studied in people who have some functional ability of their hand. It’s been shown to be beneficial throughout the rehabilitation process.

Even though the research has been focused on “functional ability” of the hand by practicing reach, grasp, transport, release; there’s potential for recovery by using the same principles of task-specific practice: real life objects, functional tasks, and problem-solving even without the ability to grasp.

Functionally, we can use our affected upper extremity as a stabilizer, an assist, or for manipulation. There are lots of ways to get that side involved to prevent “learned non-use” and to improve your problem-solving skills.

Now what?

There are two key factors to any hand recovery method: support and meaning.

Neofect aims to support and inspire you to live your best life with virtual reality tools that can be used as part of a constraint-induced movement therapy program or with repetitive task practice.

Our comprehensive recovery and wellness app: Neofect Connect and our YouTube Channel: Find What Works are based on the principles of repetitive task practice and aim to give you the tools to live your best life.

Now the only question is, what are you waiting for?

Pollock  A, Farmer  SE, Brady  MC, Langhorne  P, Mead  GE, Mehrholz  J, van Wijck  F. Interventions for improving upper limb function after stroke. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD010820. DOI: 10.1002/14651858.CD010820.pub2.

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[BLOG POST] Hand Rehab after Stroke: The Top 5 Evidenced-Based Methods

You’ve probably heard a lot of recommendations on how to recover hand function after stroke. We sifted through the research for you to explain the top 5 medically proven methods for hand rehabilitation, why they work, and who they work for.

by CLARICE TORREY, 3 JUN 2020 • 8 MIN READ

Hand Rehab after Stroke: The Top 5 Evidenced-Based Methods

After a stroke, it’s challenging enough to navigate the medical system to find what services you need, let alone the right treatment approach for you.

You’ve probably heard a lot of recommendations on how to recover hand function after stroke, and everyone seems to give different advice. That’s why we sifted through the research for you. We’ll explain the top 5 evidence-based methods for hand rehabilitation, why they work, and who they work for.

The top 5 evidence-based treatments for improving hand function after stroke:

  1. Constraint‐induced movement therapy (CIMT)
  2. Mental practice
  3. Mirror therapy
  4. Virtual reality
  5. High dose repetitive task practice

Constraint-Induced Movement Therapy

Unaffected arm wearing oven mitt for at-home constraint therapy.
You can restrict your unaffected side at home by wearing an oven mitt or placing it inside your pants or sweatshirt pocket. This will help remind you to rely on your affected side when completing therapy tasks.


What it is:

Constraint-Induced Movement Therapy (CIMT) is a neuro-rehabilitation method where the non-affected hand is constrained or restricted in order to force the brain to use the affected hand, thereby increasing neuroplasticity.

There are two key components: constraint and shaping.

Constraint refers to the way in which the hand is restricted. Therapists have used casts, splints, and mitts to restrict the use of the non-affected hand. None of them have been shown to be more effective than the other.

Shaping involves repetitive movements or activities at the patient’s ability level which become progressively harder. Therapists use shaping techniques to avoid overwhelming the motor system.

Why it works:

Our brain automatically completes a task in the easiest way possible. Our brain is more interested in completing a task than in how it is accomplished.

After a stroke, it’s easier for our brain to do tasks one-handed. This leads to “learned non-use”.

When we constrain our non-affected hand, suddenly our stronger hand becomes the weaker, less functional hand and we’re forced to use our affected hand. Our affected hand might not have much movement, but to our brain any movement is better than no movement, and the brain is highly motivated to figure out how to accomplish a task.

This is where the “shaping” piece is so important. If you are presented with rehab tasks that overwhelm the motor system or are higher level than your affected hand can functionally do, you’ll be more likely to knock the table over than to participate in picking up pennies from the table.

If you knock the table over with your affected hand, your occupational therapist might actually be excited about it; but in practical life finding that balance of not being too easy and not being so hard that you give up is an important lesson for every human being, not just those after stroke.

Who it’s for:

This approach is used for people who have at least 10 degrees of active wrist and finger extension, as well as 10 degrees of thumb abduction (the ability of the thumb to move out of the palm).

It’s been shown to be effective even years after stroke. Lower intensity CIMT is better than higher intensity in the very early stages after stroke.

Mental Practice

Man in headphones listening to mental practice recordings.
You might listen to an audio recording describing the sequence of throwing a ball, imagining yourself doing it. After listening, actually practice throwing the ball the way you envisioned!


What it is:

Mental practice, sometimes called motor imagery or mental imagery, is a training method for improving your hand and arm function without moving a muscle!

Mental practice is typically done by listening to pre-recorded audio that describes in detail the motor movement of a specific task. The listener imagines their hand and arm moving in a “typical” way, and the instructor provides cues to extend their arm or open their fingers, as well as the entire sensory experience of the task.

While it’s true that you can do mental practice on its own, it’s best combined with physical practice immediately following.

Why it works:

Brain scans show that similar parts of the brain are activated whether movement is actual, observed or imagined.

It’s a separate area of the brain that’s responsible for actually triggering the muscle movement, but it goes to show that there’s a lot more required of the brain to complete a task than just sending a signal to the muscle.

Who it’s for:

Mental practice has been shown to improve arm movement and functional use in patients after stroke of all levels of abilities and as a treatment approach for people months or years after stroke!

Mirror Therapy

Unaffected hand and its mirror image reflected in mirror box.
It is critical to stay focused on the reflected image of your hand during mirror therapy, imagining that it is your affected side performing the target movements.


What it is:

Mirror therapy is another voodoo-seeming approach that has a lot of scientific evidence to back it up. It essentially tricks your brain into thinking your affected hand is moving.

You position a mirror to reflect your non-affected hand, while hiding your affected hand. Any movement of your non-affected hand will be reflected in the mirror and make it seem as though you are actually moving your affected hand.

Why it works:

The approach is centered around mirror neurons, which fire in your brain when you see your arm move. Typically, we think about motor neurons being sent from the brain to the muscle, but we don’t realize that mirror neurons are connected to the motor neurons.

After a stroke you lose the ability to access your motor neurons, but not your mirror neurons. By accessing your mirror neurons through seeing your movement (even if the movement is fake), you are tapping into the network between the neurons.

It’s like trying to reconnect with an old friend on Facebook by finding the friends they’re connected with. It might not be the most direct approach in a real life situation, but in stroke rehab that friend of a friend might be your strongest connection.

Who it’s for:

Mirror therapy can be used for people with no movement of the hand or smaller movements of the hand and shoulder, but not functional movement of the hand.

If you have functional movement of your hand, meaning individual finger movement and wrist movement, you have surpassed the benefit that mirror therapy can provide.

It can be used early after stroke, as well as in the chronic stages of stroke.

Virtual Reality

Neofect Smart Board virtual reality arm exercise system.
The Neofect Smart Board is a non-immersive virtual reality rehabilitation system.


What it is:

Virtual reality uses a computer interface to simulate a real life objects and events. It’s become an increasingly more prevalent rehabilitation technique to provide motivation and engagement in therapy.

There are two types:  

  1. Immersive: goggles are placed over the eyes and the patient is visually in a different environment than their actual physical one
  2. Non-immersive: sensors are placed on the body and track the movement of the body and the movements are shown on a screen

Why it works:

Virtual reality works best when paired with traditional therapy. It’s theorized to provide more motivation and engagement for the intensity of therapeutic exercise needed for neuroplasticity. It’s been shown to beneficial in high doses, meaning more than 20 hours.

Another possible factor of why virtual reality works are the same mechanisms that make mirror therapy effective (tapping into the mirror neurons) could be similar.

Virtual reality also creates a biofeedback loop: your brain sends a signal to the muscle, the brain receives a signal back in the form of visual or auditory input. Basically, you get rewarded for your effort.

Who it’s for:

Virtual reality can be used with people who have mild to severe impairments, and from early after stroke to years out.

When deciding what’s right for you, it’s important to look at the adjustability of the device to meet you where you’re at and also to increase in difficulty as you improve.

If you have minimal movements, you’ll want a virtual reality tool specifically for stroke rehabilitation. If you have more movement, it’s possible to use gaming systems not specifically designed for rehab, but make sure you have the support to optimize it for rehab.

High Dose Repetitive Task Practice

Putting coins in a piggy bank during repetitive task practice.
There are many ways to do task-specific training at home. Placing coins into a piggy bank is just one of them!


What it is:

Repetitive Task Practice is when you practice a task or a part of a task over and over. Task-specific training is a type of repetitive task practice, and refers to the task we complete that is relevant to our daily life.

“Reach to grasp, transport and release” is a type of task-specific training because it is one of the common motor requirements for many functional daily tasks.

The keys for repetitive task practice:

  • Task must be meaningful
  • Participant must be an active problem-solver
  • Real life objects are used
  • Difficulty level is not too high and not too low
  • Repetition is key

Why it works:

Repetitive Task Practice is based on motor learning theory. Our brains are driven by function. We’re able to achieve neuroplasticity with development of skills, as our brain processes the demands of the task, which have motor and cognitive components.

It’s often used with other treatments, such as virtual reality, to increase the 15 hour dosage that has been shown to be beneficial.

Who it’s for:

Task-specific practice is generally used and is studied in people who have some functional ability of their hand. It’s been shown to be beneficial throughout the rehabilitation process.

Even though the research has been focused on “functional ability” of the hand by practicing reach, grasp, transport, release; there’s potential for recovery by using the same principles of task-specific practice: real life objects, functional tasks, and problem-solving even without the ability to grasp.

Functionally, we can use our affected upper extremity as a stabilizer, an assist, or for manipulation. There are lots of ways to get that side involved to prevent “learned non-use” and to improve your problem-solving skills.

Now What?

There are two key factors to any hand recovery method: support and meaning.

Neofect aims to support and inspire you to live your best life with virtual reality tools that can be used as part of a constraint-induced movement therapy program or with repetitive task practice.

Our comprehensive recovery and wellness app: Neofect Connect and our YouTube Channel: Find What Works are based on the principles of repetitive task practice and aim to give you the tools to live your best life.

Now the only question is, what are you waiting for?

Pollock  A, Farmer  SE, Brady  MC, Langhorne  P, Mead  GE, Mehrholz  J, van Wijck  F. Interventions for improving upper limb function after stroke. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD010820. DOI: 10.1002/14651858.CD010820.pub2.

Source: https://us.blog.neofect.com/the-top-5-evidence-based-treatments-for-improving-hand-function-after-stroke/

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[ARTICLE] Immediate and long-term effects of BCI-based rehabilitation of the upper extremity after stroke: a systematic review and meta-analysis – Full Text

Abstract

Background

A substantial number of clinical studies have demonstrated the functional recovery induced by the use of brain-computer interface (BCI) technology in patients after stroke. The objective of this review is to evaluate the effect sizes of clinical studies investigating the use of BCIs in restoring upper extremity function after stroke and the potentiating effect of transcranial direct current stimulation (tDCS) on BCI training for motor recovery.

Methods

The databases (PubMed, Medline, EMBASE, CINAHL, CENTRAL, PsycINFO, and PEDro) were systematically searched for eligible single-group or clinical controlled studies regarding the effects of BCIs in hemiparetic upper extremity recovery after stroke. Single-group studies were qualitatively described, but only controlled-trial studies were included in the meta-analysis. The PEDro scale was used to assess the methodological quality of the controlled studies. A meta-analysis of upper extremity function was performed by pooling the standardized mean difference (SMD). Subgroup meta-analyses regarding the use of external devices in combination with the application of BCIs were also carried out. We summarized the neural mechanism of the use of BCIs on stroke.

Results

A total of 1015 records were screened. Eighteen single-group studies and 15 controlled studies were included. The studies showed that BCIs seem to be safe for patients with stroke. The single-group studies consistently showed a trend that suggested BCIs were effective in improving upper extremity function. The meta-analysis (of 12 studies) showed a medium effect size favoring BCIs for improving upper extremity function after intervention (SMD = 0.42; 95% CI = 0.18–0.66; I2 = 48%; P < 0.001; fixed-effects model), while the long-term effect (five studies) was not significant (SMD = 0.12; 95% CI = − 0.28 – 0.52; I2 = 0%; P = 0.540; fixed-effects model). A subgroup meta-analysis indicated that using functional electrical stimulation as the external device in BCI training was more effective than using other devices (P = 0.010). Using movement attempts as the trigger task in BCI training appears to be more effective than using motor imagery (P = 0.070). The use of tDCS (two studies) could not further facilitate the effects of BCI training to restore upper extremity motor function (SMD = − 0.30; 95% CI = − 0.96 – 0.36; I2 = 0%; P = 0.370; fixed-effects model).

Conclusion

The use of BCIs has significant immediate effects on the improvement of hemiparetic upper extremity function in patients after stroke, but the limited number of studies does not support its long-term effects. BCIs combined with functional electrical stimulation may be a better combination for functional recovery than other kinds of neural feedback. The mechanism for functional recovery may be attributed to the activation of the ipsilesional premotor and sensorimotor cortical network.

Background

Motor deficit is the most common sequela after stroke, resulting in severe negative impacts on activities of daily living and social participation for patients [1]. Spontaneous recovery usually occurs within the first 3 months after the onset of stroke; however, there exists a great deal of variability in recovery across patients, particularly patients with severe deficits, who tend to recover less and more slowly [2]. With regard to the importance of motor training in facilitating motor recovery after stroke, various rehabilitation training protocols, such as task-specific training and constrained-induced motor training have been applied in regard to stroke [34]. However, these protocols are limited in patients with severe motor function deficit, due to the voluntary participation of hemiparetic hands. On the other hand, brain-computer interface (BCI) technology does not involve the direct volitional control of hemiparetic hands in training; therefore, it may be promising for these patients.

The term “BCIs” refers to systems that capture the features of brain activity and translate them into computerized commands to control external devices, which can be communication devices [5], functional electrical stimulation (FES) [6], or exoskeleton robots [7], among others. To acquire brain activity signals, either invasive or non-invasive strategies can be used. Invasive BCIs can acquire spatiotemporal signals and have a great capacity to distinguish more dimensions of patients’ intent through implants in the brain cortex [8]. However, non-invasive BCIs, using signals collected from electroencephalography (EEG), magnetoencephalography (MEG), functional near-infrared spectroscopy (fNIRS), or functional magnetic resonance imaging (fMRI), may be more promising than the invasive strategy in reality, due to safety and ethical issues [9]. Among them, the EEG signal-based BCI is the most commonly used system because of its relatively simple and inexpensive equipment requirements, as well as rich sources regarding its temporal resolution (e.g., visually evoked potential, P300, slow cortical potential) and frequency (e.g., power in given frequency bands) domains, the information can be extracted as the feature for controlling external devices [10]. The EEG signal-based BCI captures the signal of the event-related and time-locked decrease or increase in the oscillatory power in given frequency bands; in other words, the event-related desynchronization (ERD) or event-related synchronization (ERS), respectively [1112]. At present, hybrid BCI systems that combine more than one signal can provide more efficient natural control of external devices [13].

In 2009, Daly et al. [14] reported the first case study concerning the feasibility of an EEG signal-based BCI combined with FES in regard to stroke rehabilitation. After a three-week training period, the patient under study regained volitional isolated index finger extension, suggesting the potential immediate effects of this method on motor recovery [14]. In subsequent well-designed studies, the immediate effects of BCIs on motor function were confirmed [1516] and researchers also explored the immediate effects on improvements in spasticity [15], muscle strength [16], and activities of daily living [1617]. However, many well-known rehabilitation strategies, such as virtual reality [18] and mirror therapy [19], which showed superior immediate effects, might not have long-term effects across time. The latest meta-analysis summarized the immediate clinical effects of BCIs based on nine studies; the overall results support the effectiveness of BCI training on the improvement of upper extremity motor function in stroke [20]. However, the evidence related to the immediate effects of BCIs in other aspects (e.g., spasticity, strength, etc.) and corresponding long-term effects were not certain.

At present, brain activity during motor imagery (MI) and movement attempts can be used to trigger external devices. However, it is believed that these two mental tasks have different mechanisms in regard to promoting neural plasticity. MI is a mental rehearsal of movements without any real movement. The neural substrates of MI have been extensively studied with neuroimaging techniques and have been found to possess substantial overlapping with the neural network of motor execution, such as in the contralateral supplementary motor area (SMA), contralateral postcentral gyrus, contralateral superior parietal lobe, and ipsilateral prefrontal cortex [2122]. On the other hand, it is well known that the mu (8–13 Hz) and beta (13–30 Hz) rhythms over the primary motor cortex (M1) and bilaterally across the precentral motor cortex desynchronize during motor execution, movement attempts, and MI [2324]. A study using electrocorticography shows that both motor execution and MI induced ERD in mu and beta bands accompanied by ERS at high frequencies (76–100 Hz) over contralateral M1, but the former had larger changes than the latter [8]. Transcranial magnetic stimulation (TMS) further proved the enhanced cortical excitability of M1 during MI, as measured by increased motor-evoked potential (MEP) [25]. In 2010, Prasad et al. reported on the use of an MI-based BCI system in regard to five patients with chronic stroke; their results show the proof-of-concept of BCI training in regard to improving motor function [26].

In addition to MI, movement attempts (i.e., patients attempt to move their paretic hands, even though they have completely lost voluntary movements) have been proposed for BCIs in stroke [14]. A previous neuroimaging study indicated that the cortical activity of movement attempts closely followed the somatotopic organization of motor execution in patients after spinal cord injuries [27]. The neural mechanism of movement attempt-based BCIs refers to Hebbian plasticity, which is different from that of MI. Hebbian plasticity explains a form of enhanced synaptic plasticity if a close timing order of pre- and post-synaptic activity occurs [28]. Post-synaptic spiking after presynaptic firing can result in short-term potentiation, which is largely dependent on the N-methyl-D-aspartate receptor [29]; the sensorimotor loop is disrupted in patients with stroke due to the loss of voluntary movements, but the capacity of motor planning may still be retained. A previous study indicated that movement attempts could be extracted from EEGs for patients with complete hand paralysis [30] and can be used to trigger external devices (e.g., robot arms), potentially restoring the normal timing order of motor preparation, execution, and peripheral muscle effectors [30]. Therefore, through this form of BCI training, patients could learn to control the brain oscillatory activity induced by movement attempts through immediate and correct somatosensory feedback, and a new sensorimotor loop could be established [1516]. Recently, researchers have argued that movement attempts are more informative than MI, because patients have to actively suppress the movement of extremities in MI, while it is more natural to attempt movement [31].

To establish a closed sensorimotor loop, BCIs are combined with different external devices to achieve feedback regarding self-regulated brain activity. FES has been used in BCI systems to elicit muscle contraction in the paretic arm, by delivering electrical stimulation [32]. It has been proven that FES is able to facilitate the efficacy of closed sensorimotor loop during BCI training, by increasing the patient’s movement awareness during motor training and by enhancing corticospinal excitability [33]. Robots (e.g., exoskeletons and orthosis) have also been integrated in BCI systems to provide proprioceptive feedback. The clinical effects of robot-assisted therapy were found to be modest in comparison with conventional rehabilitation, according to the results of a large-scale study [34]. However, when integrated with BCI training, patients can control their movements with the assistance of robotic devices more voluntarily, thus improving their participation [15]. In addition, visual feedback is used in BCI training to provide simple and fast feedback regarding brain activity [35]. As indicated in the review conducted by van Dokkum et al. [36], different external devices appear to play different roles in the closed sensorimotor loop. For instance, BCIs combined with FES can link movement intention with muscle contraction, turning the bottom-up approach of FES into a top-down approach. Moreover, a study carried out by Ono et al. [37] indicated that the external device providing proprioceptive feedback tended to be more effective than visual feedback in clinical outcomes, suggesting that external devices may significantly boost the effects of BCIs. To the best of our knowledge, there have been no studies directly comparing the effects of different external devices combined with BCI training in clinical outcomes.

Anodal stimulation of transcranial direct current stimulation (tDCS), is capable of exciting the cortex [38]. Recent studies have found it effective in increasing the ERD of mu rhythm during MI [39], and thereby improved motor performance when combined with BCI training based on MI tasks [40]. Although the clinical effects of BCIs in stroke can be potentiated by a preceding tDCS to the cortex, the effects of tDCS in facilitating BCI applications, in regard to restoring motor function for stroke, have not been reviewed before.

A recent meta-analysis by Cervera et al. [20] evaluated the immediate effects of BCIs on the improvement of upper extremity motor function for stroke. The current study aims: (1) to investigate both the immediate and long-term clinical effects of BCI training on the improvement of hemiparetic upper extremity function, and the related neural plasticity changes elicited by BCIs in patients after stroke; (2) to study the potential differences in treatment effects caused by different training paradigms for BCIs measuring signals from the motor cortex (e.g., MI-based BCIs and movement attempt-based BCIs); (3) to explore the potential differential effects of BCIs when combined with different kinds of external devices; and (4) to explore the potentiating effect of tDCS on BCI training.[…]

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[Abstract] Review on motor imagery based BCI systems for upper limb post-stroke neurorehabilitation: From designing to application

Highlights

• BCI methods are among the most effective tool for designing rehabilitation systems

.• Use of virtual reality (VR) can increase the efficiency of BCI rehab systems

.• “FES,” “Robotics Assistance,” and “Hybrid VR based Models” are main BCI approaches.

• In the future, flexible electronics can be used for designing stroke rehab systems.

Abstract

Strokes are a growing cause of mortality and many stroke survivors suffer from motor impairment as well as other types of disabilities in their daily life activities. To treat these sequelae, motor imagery (MI) based brain-computer interface (BCI) systems have shown potential to serve as an effective neurorehabilitation tool for post-stroke rehabilitation therapy. In this review, different MI-BCI based strategies, including “Functional Electric Stimulation, Robotics Assistance and Hybrid Virtual Reality based Models,” have been comprehensively reported for upper-limb neurorehabilitation. Each of these approaches have been presented to illustrate the in-depth advantages and challenges of the respective BCI systems. Additionally, the current state-of-the-art and main concerns regarding BCI based post-stroke neurorehabilitation devices have also been discussed. Finally, recommendations for future developments have been proposed while discussing the BCI neurorehabilitation systems.

Source: https://www.sciencedirect.com/science/article/abs/pii/S0010482520302031?dgcid=rss_sd_all&utm_campaign=RESR_MRKT_Researcher_inbound&utm_medium=referral&utm_source=researcher_app

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[BLOG POST] Yes! There is Hope for Chronic Stroke!

A stroke is usually considered chronic at the six-month mark. This article reviews research on chronic stroke recovery and promising therapy treatment approaches that target improving limb function, even for an “old” stroke.

By Natalie Miller, Clinical Manager / Occupational Therapist. More posts by Natalie Miller.

27 MAR 2020 • 5 MIN READ

Yes! There is Hope for Chronic Stroke

What is a chronic stroke?

The term chronic stroke typically refers to a time frame of at least six months after the initial stroke incident occurred. As a person enters this stage and moves onward to years of stroke survival, he may start to encounter all new frustrations related to recovery, especially regarding motor recovery and use of the affected arm.

In the medical world, “most significant” recovery of movement is generally considered to happen within the first six months, with spontaneous recovery slowing after that time. There is a push for high-intensity and high-frequency of therapy while the stroke is still fairly fresh, in order to capitalize on the “critical window” of the highest responsiveness to treatment.

That doesn’t mean we should stop addressing motor recovery after six months. What if we still focus on intensive therapy early on in stroke rehab, but also find ways to promote motor recovery six or more months later? What if we don’t stop searching for new strategies to improve, or at the very least, not lose function of the weaker arm?

chronic

Can I still improve function if I am in the chronic stage of stroke?

Our understanding of the brain and its capabilities is constantly evolving. We used to think that adult brains couldn’t change at all after a certain age! Emerging research evidence suggests there are ways to challenge and improve the chronic stroke brain months and even years down the road. One large-scale study involving outcomes from 219 stroke survivors suggested the critical window for motor recovery may be as long as 18 months! Another recent case study highlighted motor recovery in a stroke survivor who was 23 years post-stroke!

What types of rehabilitation are effective for people with chronic stroke?

Stroke research suggests the following treatments are promising for individuals who are at least six months post-stroke:

  1. Mental Practice with Motor Imagery
  2. Constraint Induced Movement Therapy (CIMT)
  3. Virtual Reality (VR)
  4. Preventing Learned Non-Use

Mental Practice with Motor Imagery

This is a type of treatment where a specific movement is rehearsed mentally. Done best with a pre-recorded audio set, the person listens carefully as a task is described in detail. The details usually include every aspect of that task, including how the five senses may be experienced while performing it, as well as the exact movements that would be needed to complete the task. For example, if the task were “drinking a cup of water,” the recording would describe how to reach out with the arm, extend the fingers, feel the weight of the cup, experience the temperature and the liquid as it touches the mouth, and the exactness of the motion to set it back down gently.

Studies have shown that with this type of repetitive visualization and practice, actual movement and functional use of the arm can improve, such that an arm that was once fairly “useless” can now actually pick up a water cup and bring it to the mouth. The best part is, research also shows that this can be an effective treatment 12 months and beyond since when the stroke actually happened!

reach-for-glass

Constraint Induced Movement Therapy (CIMT)

This is a type of treatment that involves blocking the stronger arm (usually with a cast or mitt) to promote engagement of the hemiplegic, or weaker arm. The more a person uses the weaker arm, the less they are at risk of “learned non-use.” By “forcing” the weaker arm to participate more, and even to be the primary or only source of function, it has a lot more chance to stay the same or get better, even years after the stroke happened. In fact, patients in Constraint Induced studies reported and showed increased use of their arms during normal activities, even if their strokes happened years before!

Virtual Reality (VR)

Virtual reality is another name for video games! This type of treatment may be immersive (using a headset) or non-immersive, with a participant engaging in a game on a screen. VR technology focusing on strengthening and improving limb function is becoming more prevalent in clinics and in homes. These programs are able to quantify arm or leg movement to control gameplay and provide immediate performance feedback.

Research supports the use of VR therapy to enhance motor recovery for adults with acute and chronic stroke. Virtual reality technology can also improve motivation in addition to movement outcomes, helping users stick with their self-training programs and continue using their affected side. Research shows that chronic stroke patients often find self-training programs that use video games to be user friendly and enjoyable.

weight

Avoiding “learned non-use.”

We now know more about this phenomenon that affects many stroke survivors – especially those who are years out from a stroke. The stronger arm starts to take over to just get things accomplished, probably because there is a lot of positive feedback for using the stronger arm (It’s faster! It’s easier! I can just get it done!) and a lot of negative feedback for using the stroke-affected arm (It’s so frustrating! It takes me forever using it!). Research is showing that if people can still find motivation and dedication to actually trying to use the weaker arm, it is possible to still regain function – even years later.

The bottom line: don’t give up!

There IS hope. We can’t predict the exact amount of movement or strength that could come back, or what exactly you will be able to do with your affected arm or hand. But we are producing more research that is pointing us in the direction of believing recovery is still possible after that six month critical window. Don’t give up!

References:

Ballester, BR, et al. (2019). A critical time window for recovery extends beyond one-year post-stroke. Journal of Neurophysiology, 122: 350-357. doi: 10.1152/jn.00762.2018
Soros, P, et al. (2017). Motor recovery beginning 23 years after ischemic stroke. Journal of Neurophysiology, 118(2): 778-781. doi: 10.1152/jn.00868.2016
Page, S, Levine, P, and Leonard, A. (2007). Mental practice in chronic stroke: results of a randomized, placebo-controlled trial. Stroke, 38(4): 1293-1297. doi: 10.1161/01.STR.0000260205.67348.2b
Kunkel, A, et al. (1999). Constraint-induced movement therapy for motor recovery in chronic stroke patients. Archives of Physical Medicine and Rehabilitation, 80, 624-628. doi:10.1016/s0003-9993(99)90163-6
5. Taub, E, et al. (1993). Technique to improve chronic motor deficit after stroke. Archives of Physical Medicine and Rehabilitation, 74, 347-354.
Subramanian, SK, et al. (2013). Arm motor recovery using a virtual reality intervention in chronic stroke: Randomized control trial. Neurorehabilitation and Neural Repair, 27(1), 13-23. doi: 10.1177/1545968312449695.

Source: https://us.blog.neofect.com/chronic-stroke-is-there-any-hope/

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[Review] Immediate and long-term effects of BCIbased rehabilitation of the upper extremity after stroke: a systematic review and metaanalysis – Full Text PDF

Abstract

Background: A substantial number of clinical studies have demonstrated the functional recovery induced by the use of brain-computer interface (BCI) technology in patients after stroke. The objective of this review is to evaluate the effect sizes of clinical studies investigating the use of BCIs in restoring upper extremity function after stroke and
the potentiating effect of transcranial direct current stimulation (tDCS) on BCI training for motor recovery.

Methods: The databases (PubMed, Medline, EMBASE, CINAHL, CENTRAL, PsycINFO, and PEDro) were systematically searched for eligible single-group or clinical controlled studies regarding the effects of BCIs in hemiparetic upper extremity recovery after stroke. Single-group studies were qualitatively described, but only controlled-trial studies were included in the meta-analysis. The PEDro scale was used to assess the methodological quality of the controlled studies. A meta-analysis of upper extremity function was performed by pooling the standardized mean difference (SMD). Subgroup meta-analyses regarding the use of external devices in combination with the application of BCIs were also carried out. We summarized the neural mechanism of the use of BCIs on stroke.

Results: A total of 1015 records were screened. Eighteen single-group studies and 15 controlled studies were included. The studies showed that BCIs seem to be safe for patients with stroke. The single-group studies consistently showed a
trend that suggested BCIs were effective in improving upper extremity function. The meta-analysis (of 12 studies) showed a medium effect size favoring BCIs for improving upper extremity function after intervention (SMD = 0.42; 95% CI = 0.18–0.66; I2 = 48%; P < 0.001; fixed-effects model), while the long-term effect (five studies) was not significant (SMD = 0.12; 95% CI = − 0.28 – 0.52; I2 = 0%; P = 0.540; fixed-effects model). A subgroup meta-analysis indicated that using functional electrical stimulation as the external device in BCI training was more effective than using other devices (P = 0.010). Using movement attempts as the trigger task in BCI training appears to be more effective than using motor
imagery (P = 0.070). The use of tDCS (two studies) could not further facilitate the effects of BCI training to restore upper extremity motor function (SMD = − 0.30; 95% CI = − 0.96 – 0.36; I2 = 0%; P = 0.370; fixed-effects model).

Conclusion: The use of BCIs has significant immediate effects on the improvement of hemiparetic upper extremity function in patients after stroke, but the limited number of studies does not support its long-term effects. BCIs combined with functional electrical stimulation may be a better combination for functional recovery than other kinds
of neural feedback. The mechanism for functional recovery may be attributed to the activation of the ipsilesional premotor and sensorimotor cortical network.

Full Text PDF

 

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[Abstract] An Upper Limb Rehabilitation Training and Evaluation System for Stroke Patients

ABSTRACT

This system combines information technology and rehabilitation medicine. It adopts Motor Imagery (MI) intervention and mental rotation training mode in order to change the traditional inefficient mode of clinical stroke rehabilitation. We developed multi-functional side recognition rehabilitation and evaluation peripheral to evaluate the rehabilitation effect of stroke patients accurately and quantitatively. The healing effect, which reveals the degree of recovery to the patients, will no longer depend on the personal experience of the rehabilitation therapist. Based on the psychological hint and a client designed with Unity 3D, it makes the treatment less boring to stimulate the patients’ initiative during the training. This system confirms that the MI Intervention can to a certain degree improve function of limb motor and sensory feedback by analyzing 38 volunteer patients’ data in Huashan Hospital and Shanghai Jing’an District Central Hospital. Precise and quantitative evaluation results are given for the further treatment.

via An Upper Limb Rehabilitation Training and Evaluation System for Stroke Patients | ZHAO | DEStech Transactions on Computer Science and Engineering

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