Posts Tagged motor performance

[WEB PAGE] In-Home Piano Therapy Shows Promise for Stroke Rehabilitation

Posted by Debbie Overman      

In-Home Piano Therapy Shows Promise for Stroke Rehabilitation

Homebound stroke patients practicing piano therapy at home demonstrated positive motor performance results, according to a pilot study conducted by Georgia State University researchers.

The stroke survivors, who had impairment of upper extremity motor function and the ability to follow instructions, participated in the 3-week study using a portable electric piano and a commercial iPad app, Yousician. Participants were encouraged to play the piano assisted by the app for at least 1 hour per day. At the end of the study, the participants showed good training compliance and gave positive feedback, according to a media release from Georgia State University.

The study, led by Dr. Yi-An Chen, assistant professor of occupational therapy in the Byrdine F. Lewis College of Nursing and Health Professions, and Dr. Martin Norgaard, associate professor of music education in the School of Music, may help improve outcomes in homebound patients.

Chen and Norgaard shared their initial findings via a conference abstract in the American Journal of Occupational Therapy. The researchers found participants enjoyed the piano therapy, and when interviewed, 80% said they were motivated for rehabilitation by playing the piano. Also, 40% indicated they wanted to keep playing, if possible. Chen and Norgaard will present further results and details in a poster session at the Georgia Occupational Therapy Association virtual conference in October, the release continues.

“We are pleased with the positive results of this pilot study, which demonstrate the feasibility and the effects of in-home piano therapy using a mobile app for individuals with stroke.”

— Dr Martin Norgaard, associate professor of music education, School of Music, Georgia State University

According to Chen, the team is applying for additional grants to test the therapy and app with a larger group of stroke survivors and to examine opportunities to extend the therapy to other types of patients such as those with Parkinson’s disease or multiple sclerosis. The researchers also want to create a training app specifically for this project.

“We are currently working on applying for a few different grants to develop our own app, which will allow us to better tailor the rehab piano training for patients, allow telecommunication between patients and therapists, and will be more patient-friendly.”

— Dr Yi-An Chen, assistant professor of occupational therapy in the Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University

[Source: Georgia State University]

Source: https://www.rehabpub.com/conditions/neurological/stroke-neurological/in-home-piano-therapy-shows-promise-for-stroke-rehabilitation/

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[Abstract] Neuroplasticity of Cortical Planning for Initiating Stepping Poststroke – A Case Report

Abstract

Background and Purpose:

Therapeutic exercise improves balance and walking ability in individuals after stroke. The extent to which motor planning improves with therapeutic exercise is unknown. This case series examined how outpatient physical therapy affects motor planning and motor performance for stepping.

Case Description:

Individuals poststroke performed self-initiated stepping before (baseline), after (postintervention), and 1 month after (retention) intervention. Amplitude and duration of the movement-related cortical potential (MRCP) was measured using an electroencephalograph from the Cz electrode. Electromyography (EMG) of biceps femoris (BF) was collected. Additionally, clinical measures of motor impairment and function were evaluated at all 3 time points by a blinded assessor.

Intervention:

Two types of outpatient physical therapy were performed for 6 weeks: CONVENTIONAL (n = 3) and FAST (n = 4, Fast muscle Activation and Stepping Training).

Outcomes:

All 7 participants reduced MRCP duration, irrespective of the type of physical therapy. The MRCP amplitude and BF EMG onset changes were more variable. Clinical outcomes improved or were maintained for all participants. The extent of motor impairment was associated with MRCP amplitude.

Discussion:

Changes in MRCP duration suggest that outpatient physical therapy may promote neuroplasticity of motor planning of stepping movements after stroke; however, a larger sample is needed to determine whether this finding is valid.

This case series suggests motor planning for initiating stepping may improve after 6 weeks of outpatient physical therapy for persons with stroke.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A307).

via Neuroplasticity of Cortical Planning for Initiating Stepping… : Journal of Neurologic Physical Therapy

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[WEB PAGE] Big Thumbs Up: Robotic Finger Controlled by Feet Tested by UK Scientists

Robot hand

“Sometimes five fingers per hand is just not enough, this is when an extra thumb idea comes quite handy” said UK researchers who have attempted to improve human motor performance.

 

Dani Clode, a designer and researcher at University College London’s Plasticity Lab, has developed a 3D-printed prosthetic that is controlled with pressure exerted with the big toes.

The robotic finger, which the scientists call the Third Thumb, was designed to extend the natural repertoire of hand movements. A group of people wore the Third Thumb during an observed augmentation test and were studied for changes in motor control and embodiment of the prosthetic.

The scientists also examined how the sensorimotor and body representation of the Thumb changed following the training.

During the 5 days of using the robotic finger, the participants were tasked with picking up wine glasses and building Jenga towers. Another task included holding a plastic cup while extracting a marble with a spoon.

The findings of the study showed that after training, those using the thumb would show fewer differences in brain activity patterns for individual fingers. In other words, the part of the brain – activated when people move their fingers – has a weakened representation of the hand after training with the thumb.

The scientists concluded that technologies designed to augment human motor abilities hold a promise for both disabled and healthy communities.

“Here, we demonstrate that successful integration of motor augmentation can be achieved, with potential for flexible use, reduced cognitive reliance and increased sense of embodiment. Importantly, though, such successful human-robot integration may have consequences on some aspect of body representation and motor control which need to be considered and explored further,” the study said.

 

via Big Thumbs Up: Robotic Finger Controlled by Feet Tested by UK Scientists – Sputnik International

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[Abstract] Effects of kinesio taping on hemiplegic hand in patients with upper limb post-stroke spasticity: a randomized controlled pilot study

Abstract

BACKGROUND: Post-stroke spasticity is a common complication in patients with stroke and a key contributor to impaired hand function after stroke.
AIM: The purpose of this study was to investigate the effects of kinesio taping on managing spasticity of upper extremity and motor performance in patients with subacute stroke.
DESIGN: A randomized controlled pilot study.
SETTING: A hospital center.
POPULATION: Participants with stroke within six months.
METHODS: Thirty-one participants were enrolled. Patients were randomly allocated into kinesio taping (KT) group or control group. In KT group, Kinesio Tape was applied as an add-on treatment over the dorsal side of the affected hand during the intervention. Both groups received regular rehabilitation 5 days a week for 3 weeks. The primary outcome was muscle spasticity measured by modified Ashworth Scale (MAS). Secondary outcomes were functional performances of affected limb measured by using Fugl-Meyer assessment for upper extremity (FMA-UE), Brunnstrom stage, and the Simple Test for Evaluating Hand Function (STEF). Measures were taken before intervention, right after intervention (the third week) and two weeks later (the fifth week).
RESULTS: Within-group comparisons yielded significant differences in FMA-UE and Brunnstrom stages at the third and fifth week in the control group (P=0.003-0.019). In the KT group, significant differences were noted in FMA-UE, Brunnstrom stage, and MAS at the third and fifth week (P=0.001-0.035), and in the proximal part of FMA-UE between the third and fifth week (P=0.005). Between-group comparisons showed a significant difference in the distal part of FMA-UE at the fifth week (P=0.037).
CONCLUSIONS: Kinesio taping could provide some benefits in reducing spasticity and in improving motor performance on the affected hand in patients with subacute stroke.
CLINICAL REHABILITATION IMPACT: Kinesio taping could be a choice for clinical practitioners to use for effectively managing post-stroke spasticity.

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via Effects of kinesio taping on hemiplegic hand in patients with upper limb post-stroke spasticity: a randomized controlled pilot study – European Journal of Physical and Rehabilitation Medicine 2019 October;55(5):551-7 – Minerva Medica – Journals

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[ARTICLE] What do randomized controlled trials say about virtual rehabilitation in stroke? A systematic literature review and meta-analysis of upper-limb and cognitive outcomes – Full Text

Abstract

Background

Virtual-reality based rehabilitation (VR) shows potential as an engaging and effective way to improve upper-limb function and cognitive abilities following a stroke. However, an updated synthesis of the literature is needed to capture growth in recent research and address gaps in our understanding of factors that may optimize training parameters and treatment effects.

Methods

Published randomized controlled trials comparing VR to conventional therapy were retrieved from seven electronic databases. Treatment effects (Hedge’s g) were estimated using a random effects model, with motor and functional outcomes between different protocols compared at the Body Structure/FunctionActivity, and Participation levels of the International Classification of Functioning.

Results

Thirty-three studies were identified, including 971 participants (492 VR participants). VR produced small to medium overall effects (g = 0.46; 95% CI: 0.33–0.59, p < 0.01), above and beyond conventional therapies. Small to medium effects were observed on Body Structure/Function (g = 0.41; 95% CI: 0.28–0.55; p < 0.01) and Activity outcomes (g = 0.47; 95% CI: 0.34–0.60, p < 0.01), while Participation outcomes failed to reach significance (g = 0.38; 95% CI: -0.29-1.04, p = 0.27). Superior benefits for Body Structure/Function (g = 0.56) and Activity outcomes (g = 0.62) were observed when examining outcomes only from purpose-designed VR systems. Preliminary results (k = 4) suggested small to medium effects for cognitive outcomes (g = 0.41; 95% CI: 0.28–0.55; p < 0.01). Moderator analysis found no advantage for higher doses of VR, massed practice training schedules, or greater time since injury.

Conclusion

VR can effect significant gains on Body Structure/Function and Activity level outcomes, including improvements in cognitive function, for individuals who have sustained a stroke. The evidence supports the use of VR as an adjunct for stroke rehabilitation, with effectiveness evident for a variety of platforms, training parameters, and stages of recovery.

Background

Stroke is one of the leading global causes of disability [], with over 17 million individuals worldwide sustaining a stroke each year []. Although stroke mortality is decreasing with improvements in medical technology [], the neurological trauma resulting from stroke can be devastating, and the majority of stroke survivors have substantial motor [], cognitive [] and functional rehabilitation needs [], and much reduced quality of life []. Targeted rehabilitation can help address some of these post-stroke deficits, however, historically, many individuals, in particular patients with cognitive impairment, have difficulty engaging in standard therapies [] at a level that will produce meaningful and lasting improvements []. Enriched and interactive rehabilitation programs are clearly needed to minimize functional disability [], increase participation in age-appropriate roles and activities [], lead to greater motivation and treatment compliance [], and reduce the long-term expense of care in stroke survivors [].

Virtual reality

Virtual reality refers to simulated interactions with environments and events that are presented to the performer with the aid of technology. These so-called virtual environments may mirror aspects of the real world or represent spaces that are far removed from it, while allowing various forms of user interaction through movement and/or speech []. Virtual reality based rehabilitation, or Virtual Rehabilitation (VR), shows considerable promise as a safe, engaging, interactive, patient-centered and relatively inexpensive medium for rehabilitation training []. VR has the potential to target a wide range of motor, functional, and cognitive issues [], affords methods that automatically record and track patient performance [], and offers a high level of flexibility and control over therapeutic tasks []. This scalability allows patients to train at the highest intensity that would be possible for their individual ability [], while keeping the experience of interaction with therapeutic tasks enjoyable and compelling []. At the same time, VR may enable patients with a neurodisability (like stroke) to practice without excessive physical fatigue [] which otherwise may deter continued effort and engagement in therapy [].

Currently, there are two main types of VR: purpose-designed Virtual Environments (VE) and Commercial Gaming (CG) systems. Both types of systems can provide augmented feedback, additional forms of sensory feedback about the patient’s movement over and above the feedback that is provided as a natural consequence of the movement itself []. VE systems are often designed by rehabilitation scientists (and others) to enhance the delivery of augmented feedback in order to develop the patient’s sense of position in space [], to reinforce different movement parameters (like trajectory and endpoint) and reduce extraneous movements (e.g. excessive trunk displacement) [].

VE systems are also more likely to involve specially designed tangible user interfaces used in mixed reality rehabilitation systems [] or training of daily functional activities []. By comparison, CG rehabilitation systems are typically “off-the-shelf” devices such as Wii (Nintendo), Xbox (Microsoft) and PlayStation (Sony), which have the advantage of being readily available and relatively inexpensive when compared with VE systems []. On the other hand, CG systems are typically designed for able-bodied participants and may not consider the physiological, motor, and cognitive aspects of recovery in rehabilitation, and may lack the scalability of purpose-designed VE systems [].

Systematic reviews comparing VE and CG systems

There is conflicting evidence about the relative effectiveness of VE- and CG-based VR systems. In a recent Cochrane review of VR following stroke [], VE systems demonstrated a significant treatment effect on upper-limb function when compared to controls (d = 0.42; 95%CI: 0.07–0.76), while the effect for CG systems failed to reach significance (d = 0.50; 95%CI: -0.04-1.04); a caveat, however, was that only two of nine studies (22%) in these comparisons were CG-based. In contrast, a meta-analysis by Lohse and colleagues of VR following stroke [] found no significant difference between VE (g = 0.43, based on 13 studies) and CG interventions (g = 0.76, based on three studies) on Body Structure/Function level outcomes. For Activity level outcomes, CG interventions showed a large but non-significant effect (g = 0.76, p = 0.14), but was based on only four of 26 studies (15%); VE interventions, however, showed a significant treatment effect (g = 0.54, p < .001). Taken together, these two reviews suggest benefits of VE systems, while previous analyses of CG treatment effects have been underpowered and inconclusive.

Cognition and VR

Cognitive impairments, including difficulties in attention, language, visuospatial skills, memory, and executive function are common and persistent sequelae of stroke [] and exert considerable influence on rehabilitation outcomes []. Cognitive dysfunction may reduce the ability to (re-)acquire motor [] and functional skills [], and decrease engagement and participation in rehabilitation program []. While the important role of cognition in both conventional and VR-based rehabilitation is increasingly recognized [] the impact of VR on cognitive function has not yet been formally evaluated in a quantitative review.

Analysis of individual domains of functioning

The World Health Organization’s International Classification of Functioning, Disability, and Health (ICF-WHO []) is currently one of the most widely used classification systems. It is a foundation for understanding outcome effects in clinical practice [] and the preferred means for translating clinical findings in a patient-centered manner []. Under the ICF-WHO, disability and functioning are seen to arise by the interaction of the health condition, the environment, and personal factors, and can be measured at three main levels: (i) Body Structure/Function, (ii) Activity (or skill), and (iii) Participation. The ICF-WHO has been used to classify outcome measures in studies of VR (for example []) and in recent systematic reviews []. A brief critique of these reviews reveals a number of important conclusions, but also some significant gaps in the research.

An early systematic review by Crosbie and colleagues [] examined the efficacy of VR for stroke upon motor and cognitive outcomes. Of the 11 studies reviewed (up to 2005), only five addressed upper-limb function and two addressed cognitive outcomes. Overall, the review reported significant benefits of VR, but only three studies were RCTs and no effect size estimates were reported. At around the same time, a systematic review by Henderson and colleagues [] showed that there was very good evidence that immersive VR was more beneficial than no therapy for upper-limb rehabilitation in adult stroke, but insufficient evidence for non-immersive VR. Comparisons with traditional physical therapy were less impressive, however.

A 2016 systematic review by Vinas-Diz and colleagues [] included both controlled clinical trials and randomized controlled trials (RCTs) in stroke, and spanned 2009–2014. The review included 25 papers: four systematic reviews [] and 21 original trials. Evidence for treatment efficacy on upper-limb function was strong on a mix of measures like the Fugl-Meyer Test, Wolf Motor Function Test, and Motricity Index. However, a quantitative analysis of the effects was not undertaken, and important aspects of treatment implementation like dose and session scheduling were not formally examined.

A recent systematic review by Santos-Palma and colleagues [] examined the efficacy of VR on motor outcomes for stroke using the ICF-WHO framework, covering work published up to June 2015. Of the studies deemed high quality, 20 examined outcomes at the Body Structure/Function level, 17 at the Activity level, and eight examined Participation. Intriguingly, positive outcomes were evident only at the Body Structure/Function level, while results for Activity and Participation were not conclusive. Unfortunately, only three studies addressed manual ability at the Activity level, which severely limited any evaluation of skill-specific effects.

In a combined systematic review and meta-analysis of 37 RCTs published between 2004 and 2013, Laver and colleagues [] present a more comprehensive examination of the effects of VR on upper-limb function. As well, they classified outcomes broadly into upper-limb function, Activities of Daily Living (ADLs) and other aspects of motor function. In general, study quality was low, and the risk of bias high, in roughly one-half of the studies. Outcomes were significant for upper-limb function (d = 0.28) and ADLs (d = 0.43), but somewhat smaller than those reported by Lohse and colleagues []. Results for other aspects of motor function, including several at what may be considered the Body Structure/Function level, were non-significant. Dose varied considerably between studies, ranging from less than 5 h to more than 21 h in total. In general, studies that used higher doses (> 15 h of therapy) were reported as more effective. Unfortunately, results could not be pooled for cognitive outcomes, and the importance of additional treatment implementation parameters like training frequency and duration, and the impact of specific study design factors including the recovery stage of participants and type of control group (i.e. active vs passive) were not determined.

An updated systematic review by Laver and colleagues [], included an additional 35 studies that reported outcomes for upper limb function and activity. A subset of only 22 studies that compared VR with conventional therapy showed no significant effect of VR on upper-limb function (d = 0.07). As well, there was no significant difference between higher (> 15 h of therapy), and lower levels of dose. However, when VR was used in addition to usual care (10 studies; 210 participants), there was a significant effect on upper-limb outcomes (d = 0.49). As before, no significant difference was shown between high and low dose studies. Unfortunately, analysis of cognitive outcomes, and moderator analyses including study quality, and implementation parameters (e.g., daily intensity, weekly intensity, treatment frequency, and total number of sessions) were not included in the updated review. As well, the assessment of study quality was limited to the 5-item GRADE system, the ICF classification system was not given full consideration, and no distinction was drawn between treatment as usual (TAU) and active control groups (TAU + some form of additional therapy).

Taken together, recent reviews on the use of VR for adult stroke show encouraging evidence of efficacy at the level of Body Structure/Function, but mixed results for Activity and ADLs, and a paucity of evidence bearing on Participation. The impact and effectiveness of VR on cognitive outcomes also remains poorly understood, despite the important role of cognitive dysfunction in learning and rehabilitation [], and increased evidence of interconnection between cognitive function and motor deficits at the Body Structure/Function, Activity and Participation levels of the ICF []. VE-based platforms have been suggested to be superior to CG approaches [] in promoting motor function, but until recently there have been few CG studies available for analysis. As well, other design factors that may moderate treatment effects (like stage of recovery, control group type) have either not been explored or are too few in number to draw firm conclusions. There has been considerable variation in the total dose of VR therapy [], and no analysis has yet tested the dose-response relationship in moderator analyses. Finally, the bulk of conclusions have relied on qualitative synthesis, and there is a paucity of quantitative analysis of empirical data to inform opinion.

In view of limitations in past reviews and continued acceleration in VR the aim of our review was to conduct a systematic literature review and meta-analysis to re-evaluate the strength of evidence bearing on VR of upper-limb function and cognition in stroke. This review is critical given evidence that stroke rehabilitation needs to better optimize intervention techniques during the recovery windows that exist in the acute phase [] and beyond. Focusing only on RCTs, we consider outcomes across levels of the ICF-WHO, and analyze the moderating effect of design factors and dose-related parameters.

Methods

The current review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [], it should be noted that the protocol was not registered.

Data sources and search strategy

Scopus, Cochrane Database, CINAHL, The Allied and Complementary Medicine Database, Web of Science, MEDLINE, Pre-Medline, PsycEXTRA, and PsycINFO databases were systematically searched from inception until 28 June 2017. Boolean search terms included the following: “strokecerebrovascular disease, or cerebrovascular attack” and “Virtual realityAugmentrealityvirtual gam*” (see Appendix for an example of the full MEDLINE search strategy).

Inclusion and exclusion criteria

RCT studies published in English in peer-reviewed journals, utilizing a VR intervention to address either motor (upper-limb), cognitive, or activities of daily living in stroke patients were included in the current review (see Fig. 1). VR was defined as a type of user-computer interface that involves real-time simulation of an activity/environment, enabling the user to interact with the environment using motor actions and sensory systems. Comparison groups included “usual care”, “standard care” or “conventional therapy”, involving physical therapy and/or occupational therapy. Studies were excluded that applied a “hybrid” approach combining virtual reality with exogenous stimulation or robotics, targeted lower limb function, recruited a mixed study cohort including non-stroke participants, or did not utilize motor, cognitive, or participation outcome measures.

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Fig. 1
Population, Intervention, Comparison, Outcome (PICO) Question and the main variables included in the systematic literature review and meta-analysis

[…]

Continue —-> What do randomized controlled trials say about virtual rehabilitation in stroke? A systematic literature review and meta-analysis of upper-limb and cognitive outcomes

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[SlideShare] Theories of motor learning

Published on Apr 11, 2018

Motor learning is the understanding of acquisition and/or modification of movement. 
As applied to patients, motor learning involves the reacquisition of previously learned movement skills that are lost due to pathology or sensory, motor, or cognitive impairments. This process is often referred to as recovery of function. 

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[ARTICLE] What do randomized controlled trials say about virtual rehabilitation in stroke? A systematic literature review and meta-analysis of upper-limb and cognitive outcomes – Full Text

Abstract

Background

Virtual-reality based rehabilitation (VR) shows potential as an engaging and effective way to improve upper-limb function and cognitive abilities following a stroke. However, an updated synthesis of the literature is needed to capture growth in recent research and address gaps in our understanding of factors that may optimize training parameters and treatment effects.

Methods

Published randomized controlled trials comparing VR to conventional therapy were retrieved from seven electronic databases. Treatment effects (Hedge’s g) were estimated using a random effects model, with motor and functional outcomes between different protocols compared at the Body Structure/FunctionActivity, and Participation levels of the International Classification of Functioning.

Results

Thirty-three studies were identified, including 971 participants (492 VR participants). VR produced small to medium overall effects (g = 0.46; 95% CI: 0.33–0.59, p < 0.01), above and beyond conventional therapies. Small to medium effects were observed on Body Structure/Function (g = 0.41; 95% CI: 0.28–0.55; p < 0.01) and Activityoutcomes (g = 0.47; 95% CI: 0.34–0.60, p < 0.01), while Participationoutcomes failed to reach significance (g = 0.38; 95% CI: -0.29-1.04, p = 0.27). Superior benefits for Body Structure/Function (g = 0.56) and Activity outcomes (g = 0.62) were observed when examining outcomes only from purpose-designed VR systems. Preliminary results (k = 4) suggested small to medium effects for cognitive outcomes (g = 0.41; 95% CI: 0.28–0.55; p < 0.01). Moderator analysis found no advantage for higher doses of VR, massed practice training schedules, or greater time since injury.

Conclusion

VR can effect significant gains on Body Structure/Function and Activity level outcomes, including improvements in cognitive function, for individuals who have sustained a stroke. The evidence supports the use of VR as an adjunct for stroke rehabilitation, with effectiveness evident for a variety of platforms, training parameters, and stages of recovery.

Background

Stroke is one of the leading global causes of disability [12], with over 17 million individuals worldwide sustaining a stroke each year [2]. Although stroke mortality is decreasing with improvements in medical technology [3], the neurological trauma resulting from stroke can be devastating, and the majority of stroke survivors have substantial motor [45], cognitive [6789] and functional rehabilitation needs [31011], and much reduced quality of life [31213]. Targeted rehabilitation can help address some of these post-stroke deficits, however, historically, many individuals, in particular patients with cognitive impairment, have difficulty engaging in standard therapies [141516] at a level that will produce meaningful and lasting improvements [16171819]. Enriched and interactive rehabilitation programs are clearly needed to minimize functional disability [1320], increase participation in age-appropriate roles and activities [21], lead to greater motivation and treatment compliance [1722], and reduce the long-term expense of care in stroke survivors [202324].[…]

 

Continue —> What do randomized controlled trials say about virtual rehabilitation in stroke? A systematic literature review and meta-analysis of upper-limb and cognitive outcomes | Journal of NeuroEngineering and Rehabilitation | Full Text

 

Fig. 1 Population, Intervention, Comparison, Outcome (PICO) Question and the main variables included in the systematic literature review and meta-analysis

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[ARTICLE] Comparison of proximal versus distal upper-limb robotic rehabilitation on motor performance after stroke: a cluster controlled trial – Full Text

 

Abstract

This study examined the treatment efficacy of proximal-emphasized robotic rehabilitation by using the InMotion ARM (P-IMT) versus distal-emphasized robotic rehabilitation by using the InMotion WRIST (D-IMT) in patients with stroke. A total of 40 patients with stroke completed the study. They received P-IMT, D-IMT, or control treatment (CT) for 20 training sessions. Primary outcomes were the Fugl-Meyer Assessment (FMA) and Medical Research Council (MRC) scale. Secondary outcomes were the Motor Activity Log (MAL) and wrist-worn accelerometers. The differences on the distal FMA, total MRC, distal MRC, and MAL quality of movement scores among the 3 groups were statistically significant (P = 0.02 to 0.05). Post hoc comparisons revealed that the D-IMT group significantly improved more than the P-IMT group on the total MRC and distal MRC. Furthermore, the distal FMA and distal MRC improved more in the D-IMT group than in the CT group. Our findings suggest that distal upper-limb robotic rehabilitation using the InMotion WRIST system had superior effects on distal muscle strength. Further research based on a larger sample is needed to confirm long-term treatment effects of proximal versus distal upper-limb robotic rehabilitation.

Introduction

Most stroke survivors are burdened with significant physical dysfunction, and approximately 60% to 80% continue to have upper-limb (UL) motor deficits into the chronic phase of stroke that have a large effect on their daily life1,2. Developing effective rehabilitation interventions to maxmize UL motor recovery and functional independence of patients with stroke is therefore one of the top priorities in clinical practice and research3,4.

Robot-assisted therapy (RT) has emerged during the last decade as a novel rehabilitation approach to intensify UL motor function5,6,7,8. RT helps provide intensive, repetitive, and interactive training in a controlled environment to promote motor control and recovery of patients9,10,11,12,13,14. Although positive results of RT on motor outcomes have been noted13,14,15, there are disparate effects and heterogeneities between trials depending on the robotic types (eg, exoskeleton versus end-effector, or proximal versus distal approach), protocols, dosages, and problems of patients15,16.

Very few studies have directly compared the relative effects of different robotic devices. A recent systematic review15 investigated the effect of robotic types and reported a trend favoring end-effector rather than exoskeleton robotic devices on motor function. However, the superiority of treatment effect on the UL joints targeted by robotics remains unknown, especially for distal robotics15. Thus, comparative trials of different robotic types (eg, proximal versus distal robots) are warranted to tailor robot-aided UL rehabilitation to patient’s needs.

This study mainly compared the treatment effects of the InMotion ARM versus the InMotion WRIST robotic systems. The major difference between the 2 robotic devices is that the InMotion ARM focuses on training shoulder and elbow movements (ie, proximal UL), and the InMotion WRIST targets wrist and forearm movements (ie, distal UL). The proximal UL segments are critical for stability and transport of the arm, and the distal UL joints are mainly responsible for object manipulation and are important for performing daily activities17,18.

Motor control of the proximal UL and distal UL might be driven by different descending pathways19. The dorsolateral pathways (eg, corticospinal and rubrospinal tracts) are important for control of distal UL movements, and the ventromedial pathways (eg, reticulospinal, vestibulospinal, and tectospinal tracts) act more on the axial and proximal UL muscles and movements20,21. Although the neural bases act on proximal and distal UL segments and their functional roles appear to be different, direct comparisons of the clinical efficacy of proximal versus distal UL training in stroke patients are lacking.

Mazzeloni et al.22 used the same robotic systems to evaluate the treatment effects of proximal RT versus distal RT and proximal RT combined in 2 groups. However, the study goals of Mazzeloni et al. and this work are different. The effects of RT directly related to the UL segments specifically treated could not be drawn from the study findings of Mazzeloni et al. The 2 RT systems, InMotion ARM and InMotion WRIST, allow us to directly compare the outcomes affected by the proximal versus distal UL training.

In addition, recent reviews of RT have shown non-significant improvements or small effects on daily function after UL robotic rehabilitation in patients with stroke14,15,23. Major goals of stroke rehabilitation are to improve not only motor function but also functional performance on daily activities. Moreover, many patients were unable to translate the improvements of motor function and muscle strength to daily activity performance, which led to persistent functional dependence24. Therefore, this study provided functional task practice after RT to enhance the gains from proximal and distal UL robotic rehabilitation on motor function and muscle strength transfer into the patients’ daily functional performance.

The study purposes were to investigate the treatment effects of proximal-emphasized RT by using the InMotion ARM (P-IMT) versus distal-emphasized RT by using the InMotion WRIST (D-IMT) compared with a control treatment (CT) in patients with stroke. We designed a conventional rehabilitation program as the CT to provide a higher-level of clinical evidence, which decreased the influence of nondirective research environment and participant factors on treatment efficacy (eg, the Hawthorne effect), and to pose a more ethical approach instead of no treatment or placebo.[…]

Continue —>  Comparison of proximal versus distal upper-limb robotic rehabilitation on motor performance after stroke: a cluster controlled trial | Scientific Reports

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[Abstract] Transcranial direct current stimulation over multiple days enhances motor performance of a grip task

Abstract

Background

Recovery of handgrip is critical after stroke since it is positively related to upper limb function. To boost motor recovery, transcranial direct current stimulation (tDCS) is a promising, non-invasive brain stimulation technique for the rehabilitation of persons with stroke. When applied over the primary motor cortex (M1), tDCS has been shown to modulate neural processes involved in motor learning. However, no studies have looked at the impact of tDCS on the learning of a grip task in both stroke and healthy individuals.

Objective

To assess the use of tDCS over multiple days to promote motor learning of a grip task using a learning paradigm involving a speed-accuracy tradeoff in healthy individuals.

Methods

In a double-blinded experiment, 30 right-handed subjects (mean age: 22.1 ± 3.3 years) participated in the study and were randomly assigned to an anodal (n = 15) or sham (n = 15) stimulation group. First, subjects performed the grip task with their dominant hand while following the pace of a metronome. Afterwards, subjects trained on the task, at their own pace, over 5 consecutive days while receiving sham or anodal tDCS over M1. After training, subjects performed de novo the metronome-assisted task. The change in performance between the pre and post metronome-assisted task was used to assess the impact of the grip task and tDCS on learning.

Results

Anodal tDCS over M1 had a significant effect on the speed-accuracy tradeoff function. The anodal tDCS group showed significantly greater improvement in performance (39.28 ± 15.92%) than the sham tDCS group (24.06 ± 16.35%) on the metronome-assisted task, t(28) = 2.583, P = 0.015 (effect size d = 0.94).

Conclusions

Anodal tDCS is effective in promoting grip motor learning in healthy individuals. Further studies are warranted to test its potential use for the rehabilitation of fine motor skills in stroke patients.

Source: Transcranial direct current stimulation over multiple days enhances motor performance of a grip task – ScienceDirect

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[Abstract+References] Predicting Motor Sequence Learning in Individuals With Chronic Stroke

Background. Conventionally, change in motor performance is quantified with discrete measures of behavior taken pre- and postpractice. As a high degree of movement variability exists in motor performance after stroke, pre- and posttesting of motor skill may lack sensitivity to predict potential for motor recovery.

Objective. Evaluate the use of predictive models of motor learning based on individual performance curves and clinical characteristics of motor function in individuals with stroke.

Methods. Ten healthy and fourteen individuals with chronic stroke performed a continuous joystick-based tracking task over 6 days, and at a 24-hour delayed retention test, to assess implicit motor sequence learning.

Results. Individuals with chronic stroke demonstrated significantly slower rates of improvements in implicit sequence-specific motor performance compared with a healthy control (HC) group when root mean squared error performance data were fit to an exponential function. The HC group showed a positive relationship between a faster rate of change in implicit sequence-specific motor performance during practice and superior performance at the delayed retention test. The same relationship was shown for individuals with stroke only after accounting for overall motor function by including Wolf Motor Function Test rate in our model.

Conclusion. Nonlinear information extracted from multiple time points across practice, specifically the rate of motor skill acquisition during practice, relates strongly with changes in motor behavior at the retention test following practice and could be used to predict optimal doses of practice on an individual basis.

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Source: Predicting Motor Sequence Learning in Individuals With Chronic Stroke – Aug 10, 2016

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