Posts Tagged Motor recovery

[ARTICLE] Assist-as-needed control strategy for upper-limb rehabilitation based on subject’s functional ability – Full Text

The assist-as-needed technique in robotic rehabilitation is a popular technique that encourages patients’ active participation to promote motor recovery. It has been proven beneficial for patients with functional motor disability. However, its application in robotic therapy has been hindered by a poor estimation method of subjects’ functional or movement ability which is required for setting the appropriate robotic assistance. Moreover, there is also the need for consistency and repeatability of the functional ability estimation in line with the clinical procedure to facilitate a wider clinical adoption. In this study, we propose a new technique of estimation of subject’s functional ability based on the Wolf Motor Function Test. We called this estimation the functional ability index. The functional ability index enables the modulation of robotic assistance and gives a more consistent indication of subjects’ upper-limb movement ability during therapy session. Our baseline controller is an adaptive inertia-related controller, which is integrated with the functional ability index algorithm to provide movement assistance as when needed. Experimental studies are conducted on three hemiplegic patients with different levels of upper-limb impairments. Each patient is requested to perform reaching task of lifting a can from table-to-mouth according to the guidelines stipulated in the Wolf Motor Function Test. Data were collected using two inertial measurement unit sensors installed at the flexion/extension joints, and the functional ability score of each patient was rated by an experienced therapist. Results showed that the proposed functional ability index algorithm can estimate patients’ functional ability level consistently with clinical procedure and can modify generated robotic assistance in accordance with patients’ functional movement ability.

The assist-as-needed (AAN) robotic strategy is a popular strategy for encouraging patients’ active participation in robot-assisted rehabilitation therapy. Numerous clinical outcomes have suggested the effectiveness of the AAN scheme to induce neuroplasticity in patients with neurological impairment.1 The AAN strategy focuses on providing the minimal amount of robotic assistance necessary for a patient to complete a movement,2 thus a significant effort is required from the patient. If the patient can perform the task flawlessly, robotic assistance is withdrawn. However, if the patient cannot complete the given task, assistance is offered only as much as it is needed.3

Deploying robotic assistance in accordance with the AAN strategy still come with many shortcomings.3,4 One major issue is how to appropriately estimate patients’ functional ability to set the correct level of robotic assistance. Another issue is the consistency of the estimated subject’s functional ability with clinical data and the repeatability across a wide range of subjects. An appropriate estimation of subject’s functional ability consistent with clinical data can give a realistic basis for deploying robotic assistance, since it gives a measure of subject’s actual disability level or recovery progress.5,6

A few strategies of AAN have been proposed recently which have attempted to address the challenges in the scheme. Wolbrecht et al.7 proposed a model-based robotic assistance strategy which can enable a robot to learn the patients’ ability in real time based on a radial-basis function (RBF). The RBF is applied under an adaptive control framework.

Another AAN strategy was proposed by Pehlivan et al.3 The authors introduced a minimal assist-as-needed (mAAN) strategy which uses a Kalman filter to estimate subjects’ functional inputs instead of the RBF technique that is a sensor-less force estimation strategy. Under the scheme, the ANN strategy is achieved in the following two ways: (1) by updating the derivative feedback gain to modify the bounds of allowable error on the desired trajectory and (2) by decaying a feed-forward disturbance rejection term which reduces the constraint on allowable quick movements. The combined effect could vary the robotic assistance according to the subjects’ capability.8 The potential limitation of this approach is the reliance on the robot model for the estimation of subject’s capability. It is well known that model errors always exist and can significantly excite the disturbance term making it difficult to accurately estimate the subject’s input. There is the implication that different robot models would produce different functional ability estimates which will hinder an appropriate standardization or deployment of robotic assistance for clinical purpose.9,10

Pérez-Rodríguez et al.11 also introduced an AAN strategy called anticipatory assistance-as-needed control algorithm capable of ensuring that the deviation from a patients’ desired trajectory is restored by giving an anticipated force assistance. This way, robotic assistance is always given as a restoring force to maintain the subject on the reference (desired) trajectory. With regards to the validity of this strategy, there are however no experimental studies till date.

Other noteworthy AAN strategies include the rule-based assistive strategy proposed by Wang et al.,12 which is applied in Physiotherabot; the hybrid impedance control for wrist and forearm rehabilitation proposed by Akdoğan and Adli,13 which is applied on a 3-degree-of-freedom (3-DOF) upper-limb rehabilitation robot; and the visual error augmentation-based AAN proposed by Akdoğan et al.,14 which can provide robotic assistance as needed by amplifying tracking error to heighten the participant’s motivation.

Efforts in developing an appropriate estimation strategy for AAN robotic assistance are still on course;15 however, there has been less focus on developing appropriate estimation techniques of subject’s functional ability that are consistent with the clinical procedure and that can be integrated in the control loop to provide robotic assistance.15,16

In this paper, we propose an ANN strategy to direct robotic assistance based on a novel functional ability index (FAI). The main originality of this work is the derivation of the new FAI estimation algorithm in accordance with the clinical procedure for the estimation of subject’s motor ability in movement task. As a preliminary investigation, we derive our FAI following the Wolf Motor Function Test (WMFT), a popular motor function test with consistency over a wide range of neurologically impaired patients. The FAI serves as input to a decay algorithm under the adaptive control law which consequently varies the robotic assistance according to the subject’s functional ability. The FAI is independent on the robot model or controller adaptation law and thus it is unaffected by modelling uncertainties.

The rest of the paper is organized as follows: section ‘System dynamic and control’ presents the dynamics for the robotic rehabilitation system, the proposed FAI, and the proposed control algorithm. Section ‘Experimental study’ presents the data collection and simulation study; section ‘Results’ describes the results; section ‘Discussion’ presents the discussion; and section ‘Conclusion’ concludes the paper.

The mechanical system

The proposed prototype of the exoskeleton system is shown in Figure 1. The system is an upper-limb rehabilitation robotic device with two active degrees of freedom (DOFs) at the shoulder and elbow joint, respectively. If actively controlled, the exoskeleton can permit abduction/adduction (AA) movement of the shoulder joint and flexion/extension (FE) movement of the elbow, thus allowing the possibility of performing the table to mouth reaching task.


                        figure

Figure 1. Exoskeleton device is of 2 degrees of freedom (DOFs).

Continue —> Assist-as-needed control strategy for upper-limb rehabilitation based on subject’s functional ability – Shawgi Younis Ahmed Mounis, Norsinnira Zainul Azlan, Fatai Sado,

, , , , , , , , , , ,

Leave a comment

[Abstract + References] A Wireless BCI-FES Based on Motor Intent for Lower Limb Rehabilitation

Abstract

Recent investigations have proposed brain computer interfaces combined with functional electrical stimulation as a novel approach for upper limb motor recovery. These systems could detect motor intention movement as a power decrease of the sensorimotor rhythms in the electroencephalography signal, even in people with damaged brain cortex. However, these systems use a large number of electrodes and wired communication to be employed for gait rehabilitation. In this paper, the design and development of a wireless brain computer interface combined with functional electrical stimulation aimed at lower limb motor recovery is presented. The design requirements also account the dynamic of a rehabilitation therapy by allowing the therapist to adapt the system during the session. A preliminary evaluation of the system in a subject with right lower limb motor impairment due to multiple sclerosis was conducted and as a performance metric, the true positive rate was computed. The developed system evidenced a robust wireless communication and was able to detect lower limb motor intention. The mean of the performance metric was 75%. The results encouraged the possibility of testing the developed system in a gait rehabilitation clinical study.

References

  1. 1.
    Pfurtscheller, G., Mcfarland, D.: BCIs that use sensorimotor rhythms. In: Wolpaw, J.R., Wolpaw, E. (eds.) Brain-Computer Interfaces: Principles and Practice, pp. 227–240. Oxford University Press (2012)Google Scholar
  2. 2.
    Carrere, L.C., Tabernig, C.B.: Detection of foot motor imagery using the coefficient of determination for neurorehabilitation based on BCI technology. IFMBE Proc. 49, 944–947 (2015).  https://doi.org/10.1007/978-3-319-13117-7_239CrossRefGoogle Scholar
  3. 3.
    Sannelli, C., Vidaurre, C., Müller, K.R., Blankertz, B.: A large scale screening study with a SMR-based BCI: categorization of BCI users and differences in their SMR activity (2019)Google Scholar
  4. 4.
    Do, A.H., Wang, P.T., King, C.E., Schombs, A., Cramer, S.C., Nenadic, Z.: Brain-computer interface controlled functional electrical stimulation device for foot drop due to stroke, pp. 6414–6417 (2012)Google Scholar
  5. 5.
    Ramos-Murguialday, A., Broetz, D., Rea, M., Yilmaz, Ö., Brasil, F.L., Liberati, G., Marco, R., Garcia-cossio, E., Vyziotis, A., Cho, W., Cohen, L.G., Birbaumer, N.: Brain-Machine-interface in chronic stroke rehabilitation: a controlled study. Ann. Neurol. 74, 100–108 (2014).  https://doi.org/10.1002/ana.23879.Brain-Machine-InterfaceCrossRefGoogle Scholar
  6. 6.
    Biasiucci, A., Leeb, R., Iturrate, I., Perdikis, S., Al-Khodairy, A., Corbet, T., Schnider, A., Schmidlin, T., Zhang, H., Bassolino, M., Viceic, D., Vuadens, P., Guggisberg, A.G., Millán, J.D.R.: Brain-actuated functional electrical stimulation elicits lasting arm motor recovery after stroke. Nat. Commun. 9, 1–13 (2018).  https://doi.org/10.1038/s41467-018-04673-zCrossRefGoogle Scholar
  7. 7.
    Tabernig, C.B., Lopez, C.A., Carrere, L.C., Spaich, E.G., Ballario, C.H.: Neurorehabilitation therapy of patients with severe stroke based on functional electrical stimulation commanded by a brain computer interface. J. Rehabil. Assist. Technol. Eng. 5, 205566831878928 (2018).  https://doi.org/10.1177/2055668318789280CrossRefGoogle Scholar
  8. 8.
    McCrimmon, C.M., King, C.E., Wang, P.T., Cramer, S.C., Nenadic, Z., Do, A.H.: Brain-controlled functional electrical stimulation therapy for gait rehabilitation after stroke: a safety study. J. Neuroeng. Rehabil. 12 (2015).  https://doi.org/10.1186/s12984-015-0050-4
  9. 9.
    g.Nautilus wireless biosignal acquisition Homepage. http://www.gtec.at/Products/Hardware-and-Accessories/g.Nautilus-Specs-Features
  10. 10.
    Emotiv EpocFlex flexible wireless EEG system Homepage. https://www.emotiv.com/epoc-flex/
  11. 11.
    Vuckovic, A., Wallace, L., Allan, D.: Hybrid brain-computer interface and functional electrical stimulation for sensorimotor training in participants with tetraplegia: a proof-of-concept study. J. Neurol. Phys. Ther. 39, 3–14 (2015)CrossRefGoogle Scholar
  12. 12.
    Schalk, G., McFarland, D.J., Hinterberger, T., Birbaumer, N., Wolpaw, J.R.: BCI2000: a general-purpose brain-computer interface (BCI) system. IEEE Trans. Biomed. Eng. 51, 1034–1043 (2004).  https://doi.org/10.1109/TBME.2004.827072CrossRefGoogle Scholar
  13. 13.
    McCrimmon, C.M., Fu, J.L., Wang, M., Lopes, L.S., Wang, P.T., Karimi-Bidhendi, A., Liu, C.Y., Heydari, P., Nenadic, Z., Do, A.H.: Performance assessment of a custom, portable, and low-cost brain-computer interface platform. IEEE Trans. Biomed. Eng. 64, 2313–2320 (2017).  https://doi.org/10.1109/TBME.2017.2667579CrossRefGoogle Scholar

via A Wireless BCI-FES Based on Motor Intent for Lower Limb Rehabilitation | SpringerLink

, , , , , , ,

Leave a comment

[Abstract + References] Motor stroke recovery after tDCS: a systematic review

Abstract

The purpose of the present study was to investigate the effects of transcranial direct current stimulation (tDCS) on motor recovery in adult patients with stroke, taking into account the parameters that could influence the motor recovery responses. The second aim was to identify the best tDCS parameters and recommendations available based on the enhanced motor recovery demonstrated by the analyzed studies. Our systematic review was performed by searching full-text articles published before February 18, 2019 in the PubMed database. Different methods of applying tDCS in association with several complementary therapies were identified. Studies investigating the motor recovery effects of tDCS in adult patients with stroke were considered. Studies investigating different neurologic conditions and psychiatric disorders or those not meeting our methodologic criteria were excluded. The main parameters and outcomes of tDCS treatments are reported. There is not a robust concordance among the study outcomes with regard to the enhancement of motor recovery associated with the clinical application of tDCS. This is mainly due to the heterogeneity of clinical data, tDCS approaches, combined interventions, and outcome measurements. tDCS could be an effective approach to promote adaptive plasticity in the stroke population with significant positive premotor and postmotor rehabilitation effects. Future studies with larger sample sizes and high-quality studies with a better standardization of stimulation protocols are needed to improve the study quality, further corroborate our results, and identify the optimal tDCS protocols.

References

  • Allman, C., Amadi, U., Winkler, A.M., Wilkins, L., Filippini, N., Kischka, U., Stagg, C.J., and Johansen-Berg, H. (2016). Ipsilesional anodal tDCS enhances the functional benefits of rehabilitation in patients after stroke. Sci. Transl. Med. 8, 330re1.PubMedCrossrefGoogle Scholar
  • Ameli, M., Grefkes, C., Kemper, F., Riegg, F.P., Rehme, A.K., Karbe, H., Fink, G.R., and Nowak, D.A. (2009). Differential effects of high-frequency repetitive transcranial magnetic stimulation over ipsilesional primary motor cortex in cortical and subcortical middle cerebral artery stroke. Ann. Neurol. 66, 298–309.PubMedCrossrefGoogle Scholar
  • Andrade, S.M., Batista, L.M., Nogueira, L.L., de Oliveira, E.A., de Carvalho, A.G., Lima, S.S., Santana, J.R., de Lima, E.C., and Fernández-Calvo, B. (2017a). Constraint-induced movement therapy combined with transcranial direct current stimulation over premotor cortex improves motor function in severe stroke: a pilot randomized controlled trial. Rehab. Res. Pract. 2017, 6842549.Google Scholar
  • Andrade, S.M., Ferreira, J.J.A., Rufino, T.S., Medeiros, G., Brito, J.D., da Silva, M.A., and Moreira, R.N. (2017b). Effects of different montages of transcranial direct current stimulation on the risk of falls and lower limb function after stroke. Neurol. Res. 39, 1037–1043.CrossrefGoogle Scholar
  • Bikson, M., Grossman, P., Thomas, C., Zannou, A.L., Jiang, J., Adnan, T., Mourdoukoutas, A.P., Kronberg, G., Truong, D., Boggio, P., et al. (2016). Safety of transcranial direct current stimulation: evidence based update 2016. Brain Stimul. 9, 641–661.CrossrefPubMedGoogle Scholar
  • Bolognini, N. and Vallar, G. (2015). Stimolare il cervello. Manuale di stimolazione cerebrale non invasiva (pp. 1–224). il Mulino.Google Scholar
  • Bolognini, N., Pascual-Leone, A., and Fregni, F. (2009). Using non-invasive brain stimulation to augment motor training-induced plasticity. J. Neuroeng. Rehab. 6, 8.CrossrefGoogle Scholar
  • Bolognini, N., Vallar, G., Casati, C., Latif, L.A., El-Nazer, R., Williams, J., Banco, E., Macea, D.D., Tesio, L., Chessa, C., et al. (2011). Neurophysiological and behavioral effects of tDC combined with constraint-induced movement therapy in post stroke patients. Neurorehab. Neural Rep. 25, 819–829.CrossrefGoogle Scholar
  • Bortoletto, M., Rodella, C., Salvador, R., Miranda, P.C., and Miniussi, C. (2016). Reduced current spread by concentric electrodes in transcranial electrical stimulation (tES). Brain Stimul. 9, 525–528.CrossrefPubMedGoogle Scholar
  • Bradnam, L.V., Stinear, C.M., Barber, P.A., and Byblow, W.D. (2012). Contralesional hemisphere control of the proximal paretic upper limb following stroke. Cereb. Cortex 22, 2662–2671.PubMedCrossrefGoogle Scholar
  • Brunelin, J., Mondino, M., Gassab, L., Haesebaert, F., Gaha, L., Suaud-Chagny, M.F., Saoud, M., Mechri, A., and Poulet, E. (2012a). Examining transcranial direct current stimulation (tDCS) as a treatment for hallucinations in schizophrenia. Am. J. Psychiatry 169, 719–724.CrossrefGoogle Scholar
  • Brunoni, A.R., Zanao, T.A., Ferrucci, R., Priori, A., Valiengo, L., de Oliveira, J.F., Boggio, P.S., Lotufo, P.A., Benseñor, I.M., and Fregni, F. (2013c). Bifrontal tDCS prevents implicit learning acquisition in antidepressant-free patients with major depressive disorder. Prog. Neuro-Psychopharmacol. Biol. Psychiatry 43, 146–150.CrossrefGoogle Scholar
  • Burke Quinlan, E., Dodakian, L., See, J., McKenzie, A., Le, V., Wojnowicz, M., Shahbaba, B., and Cramer, S.C. (2015). Neural function, injury, and stroke subtype predict treatment gains after stroke. Ann. Neurol. 77, 132–145.CrossrefPubMedGoogle Scholar
  • Byblow, W.D., Stinear, C.M., Barber, P.A., Petoe, M.A., and Ackerley, S.J. (2015). Proportional recovery after stroke depends on corticomotor integrity. Ann. Neurol. 78, 848–859.CrossrefPubMedGoogle Scholar
  • Chang, M.C., Kim, D.Y., and Park, D.H. (2015). Enhancement of cortical excitability and lower limb motor function in patients with stroke by transcranial direct current stimulation. Brain Stimul. 8, 561–566.CrossrefPubMedGoogle Scholar
  • Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences. 2nd ed. (Hillsdale, NJ: Erlbaum).Google Scholar
  • Coin, A., Najjar, M., Catanzaro, S., Orru, G., Sampietro, S., Sergi, G., Manzato, E., Perissinotto, E., Rinaldi, G., Sarti, S., et al. (2009). A retrospective pilot study on the development of cognitive, behavioral and functional disorders in a sample of patients with early dementia of Alzheimer type. Arch. Gerontol. Geriatr. 49, 35–38.CrossrefGoogle Scholar
  • Conti, C.L. and Nakamura-Palacios, E.M. (2013). Bilateral transcranial direct current stimulation over dorsolateral prefrontal cortex changes the drug-cued reactivity in the anterior cingulate cortex of crack-cocaine addicts. Brain Stimul. 7, 130–132.PubMedGoogle Scholar
  • Da Costa Santos, C.M., de Mattos Pimenta, C.A., and Nobre, M.R. (2007). The PICO strategy for the research question construction and evidence search. Rev. Lat. Am. Enfermagem. 15, 508–511.PubMedCrossrefGoogle Scholar
  • De Vries, M.H., Barth, A.C., Maiworm, S., Knecht, S., Zwitserlood, P., and Flöel, A. (2010). Electrical stimulation of Broca’s area enhances implicit learning of an artificial grammar. J. Cognit. Neurosci. 22, 2427–2436.CrossrefGoogle Scholar
  • Di Lazzaro, V., Dileone, M., Capone, F., Pellegrino, G., Ranieri, F., Musumeci, G., Florio, L., Di Pino, G., and Fregni, F. (2014). Immediate and late modulation of interhemispheric imbalance with bilateral transcranial direct current stimulation in acute stroke. Brain Stimul. 7, 841–848.CrossrefGoogle Scholar
  • Feng, W., Wang, J., Chhatbar, P.Y., Doughty, C., Landsittel, D., Lioutas, V.A., and Schlaug, G. (2015). Corticospinal tract lesion load: an imaging biomarker for stroke motor outcomes. Ann. Neurol. 78, 860–870.CrossrefPubMedGoogle Scholar
  • Ferrucci, R., Mameli, F., Guidi, I., Mrakic-Sposta, S., Vergari, M., Marceglia, S., Cogiamanian, F., Barbieri, S., Scarpini, E., and Priori, A. (2008). Transcranial direct current stimulation improves recognition memory in Alzheimer disease. Neurology 71, 493–498.CrossrefPubMedGoogle Scholar
  • Figlewski, K., Blicher, J.U., Mortensen, J., Severinsen, K.E., Nielsen, J.F., and Andersen, H. (2017). Transcranial direct current stimulation potentiates improvements in functional ability in patients with chronic stroke receiving constraint-induced movement therapy. Stroke 48, 229–232.PubMedCrossrefGoogle Scholar
  • Fregni, F., Boggio, P.S., Nitsche, M., Bermpohl, F., Antal, A., Feredoes, E., Marcolin, M.A., Rigonatt, S.P., Silva, M.T., and Pascual-Leone, A. (2005). Anodal transcranial direct current stimulation of prefrontal cortex enhances working memory. Exp. Brain Res. 166, 23–30.PubMedCrossrefGoogle Scholar
  • Fregni, F., Boggio, P.S., Lima, M.C., Ferreira, M.J., Wagner, T., Rigonatti, S.P., Castro, A.W., Souza, D.R., Riberto, M., Freedman, S.D., et al. (2006a). A sham controlled, phase II trial of transcranial direct current stimulation for the treatment of central pain in traumatic spinal cord injury. Pain 122, 197–209.CrossrefGoogle Scholar
  • Fregni, F., Boggio, P.S., Santos, M.C., Lima, M., Vieira, A.L., Rigonatti, S.P., Silva, M.T., Barbosa, E.R., Nitsche, M.A., and Pascual-Leone, A. (2006b). Non invasive cortical stimulation with transcranial direct current stimulation in Parkinson’s disease. Mov. Disord. 21, 1693–1702.CrossrefGoogle Scholar
  • Fregni, F., Gimenes, R., Valle, A.C., Ferreira, M.J., Rocha, R.R., Natalle, L., Bravo, R., Rigonatti, S.P., Freedman, S.D., Nitsche, M.A., et al. (2006c). A randomized, sham-controlled, proof of principle study of transcranial direct current stimulation for the treatment of pain in fibromyalgia. Arthritis Rheum 54, 3988–3998.CrossrefGoogle Scholar
  • Fusco, A., Assenza, F., Iosa, M., Izzo, S., Altavilla, R., Paolucci, S., and Vernieri, F. (2014). The ineffective role of cathodal tDCS in enhancing the functional motor outcomes in early phase of stroke rehabilitation: an experimental trial. BioMed Res. Int. 2014, 547290.PubMedGoogle Scholar
  • Geroin, C., Picelli, A., Munari, D., Waldner, A., Tomelleri, C., and Smania, N. (2011). Combined transcranial direct current stimulation and robot-assisted gait training in patients with chronic stroke: a preliminary comparison. Clin. Rehabil. 25, 537–548.PubMedCrossrefGoogle Scholar
  • Gladwin, T.E., den Uyl, T.E., Fregni, F.F., and Wiers, R.W. (2012). Enhancement of selective attention by tDCS: interaction with interference in a Sternberg task. Neurosci. Lett. 512, 33–37.CrossrefGoogle Scholar
  • Grefkes, C. and Fink, G.R. (2014). Connectivity-based approaches in stroke and recovery of function. Lancet Neurol. 13, 206–216.CrossrefPubMedGoogle Scholar
  • Hamoudi, M., Schambra, H.M., Fritsch, B., Schoechlin-Marx, A., Weiller, C., Cohen, L.G., and Reis, J. (2018). Transcranial direct current stimulation enhances motor skill learning but not generalization in chronic stroke. Neurorehabil. Neural Repair 32, 295–308.PubMedCrossrefGoogle Scholar
  • Hattie, J. (2009). Visible Learning: A Synthesis of Over 800 Meta-analyses Relating to Achievement (Park Square, Oxford: Rutledge).Google Scholar
  • Herrmann, C.S., Rach, S., Neuling, T., and Strüber, D. (2013). Transcranial alternating current stimulation: a review of the underlying mechanisms and modulation of cognitive processes. Front. Hum. Neurosci. 7, 279.PubMedGoogle Scholar
  • Hesse, S., Waldner, A., Mehrholz, J., Tomelleri, C., Pohl, M., and Werner, C. (2011). Combined transcranial direct current stimulation and robot-assisted arm training in subacute stroke patients: an exploratory, randomized multicenter trial. Neurorehabil. Neural Repair 25, 838–846.PubMedCrossrefGoogle Scholar
  • Holman, L., Head, M.L., Lanfear, R., and Jennions, M.D. (2015). Evidence of experimental bias in the life sciences: why we need blind data recording. PLoS Biol. 13, e1002190.CrossrefPubMedGoogle Scholar
  • Horn, S.D., DeJong, G., Smout, R.J., Gassaway, J., James, R., and Conroy, B. (2005). Stroke rehabilitation patients, practice, and outcomes: is earlier and more aggressive therapy better? Arch. Phys. Med. Rehab. 86, 101–114.CrossrefGoogle Scholar
  • Horvath, J.C., Forte, J.D., and Carter, O. (2015a). Quantitative review finds no evidence of cognitive effects in healthy populations from single-session transcranial direct current stimulation (tDCS). Brain Stimul. 8, 535–550.CrossrefGoogle Scholar
  • Horvath, J.C., Forte, J.D., and Carter, O. (2015b). Evidence that transcranial direct current stimulation (tDCS) generates little-to-no reliable neurophysiologic effect beyond MEP amplitude modulation in healthy human subjects: a systematic review. Neuropsychologia 66, 213–236.CrossrefGoogle Scholar
  • Hoyer, E.H. and Celnik, P.A. (2011). Understanding and enhancing motor recovery after stroke using transcranial magnetic stimulation. Restor. Neurol. Neurosci. 29, 395–409.PubMedGoogle Scholar
  • Hummel, F.C. and Cohen, L.G. (2006). Non-invasive brain stimulation: a new strategy to improve neurorehabilitation after stroke? Lancet Neurol. 5, 708–712.CrossrefPubMedGoogle Scholar
  • Hummel, F., Celnik, P., Giraux, P., Floel, A., Wu, W.H., Gerloff, C., and Cohen, L.G. (2005). Effects of non-invasive cortical stimulation on skilled motor function in chronic stroke. Brain 128, 490–499.PubMedCrossrefGoogle Scholar
  • Hummel, F.C., Voller, B., Celnik, P., Floel, A., Giraux, P., Gerloff, C., and Cohen, L.G. (2006). Effects of brain polarization on reaction times and pinch force in chronic stroke. BMC Neurosci. 7, 73.CrossrefPubMedGoogle Scholar
  • Ilić, N.V., Dubljanin-Raspopović, E., Nedeljković, U., Tomanović-Vujadinović, S., Milanović, S.D., Petronić-Marković, I., and Ilić, T.V. (2016). Effects of anodal tDCS and occupational therapy on fine motor skill deficits in patients with chronic stroke. Restor. Neurol. Neurosci. 34, 935–945.PubMedGoogle Scholar
  • Ivanenko, Y.P., Poppele, R.E., and Lacquaniti, F. (2009). Distributed neural networks for controlling human locomotion: lessons from normal and SCI subjects. Brain Res. Bull. 78, 13–21.CrossrefPubMedGoogle Scholar
  • Khedr, E.M., Shawky, O.A., El-Hammady, D.H., Rothwell, J.C., Darwish, E.S., Mostafa, O.M., and Tohamy, A.M. (2013). Effect of anodal versus cathodal transcranial direct current stimulation on stroke rehabilitation: a pilot randomized controlled trial. Neurorehab. Neural Rep. 7, 592–601.Google Scholar
  • Kim, D.Y., Lim, J.Y., Kang, E.K., You, D.S., Oh, M.K., Oh, B.M., and Paik, N.J. (2010). Effect of transcranial direct current stimulation on motor recovery in patients with subacute stroke. Am. J. Phys. Med. Rehabil. 89, 879–886.PubMedCrossrefGoogle Scholar
  • Koo, W.R., Jang, B.H., and Kim, C.R. (2018). Effects of anodal transcranial direct current stimulation on somatosensory recovery after stroke: a randomized controlled trial. Am. J. Phys. Med. Rehabil. 97, 507–513.CrossrefPubMedGoogle Scholar
  • Kwakkel, G. and Kollen, B.J. (2013). Predicting activities after stroke: what is clinically relevant? Int. J. Stroke 8, 25–32.CrossrefPubMedGoogle Scholar
  • Langhorne, P., Coupar, F., and Pollock, A. (2009). Motor recovery after stroke: a systematic review. Lancet Neurol. 8, 741–754.CrossrefPubMedGoogle Scholar
  • Lee, S.J. and Chun, M.H. (2014). Combination transcranial direct current stimulation and virtual reality therapy for upper extremity training in patients with subacute stroke. Arch. Phys. Med. Rehab. 95, 431–438.CrossrefGoogle Scholar
  • Lefaucheur, J.P., Antal, A., Ayache, S.S., Benninger, D.H., Brunelin, J., Cogiamanian, F., Cotelli, M., De Ridder, D., Ferrucci, R., Langguth, B., et al. (2017). Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). Clin. Neurophysiol. 128, 56–92.CrossrefPubMedGoogle Scholar
  • Leon, D., Cortes, M., Elder, J., Kumru, H., Laxe, S., Edwards, D.J., Tormos, J.M., Bernabeu, M., and Pascual-Leone, A. (2017). tDCS does not enhance the effects of robot-assisted gait training in patients with subacute stroke. Restor. Neurol. Neurosci. 35, 377–384.PubMedGoogle Scholar
  • Liew, S.L., Santarnecchi, E., Buch, E.R., and Cohen, L.G. (2014). Non-invasive brain stimulation in neurorehabilitation: local and distant effects for motor recovery. Front. Hum. Neurosci. 8, 378.PubMedGoogle Scholar
  • Lindenberg, R., Renga, V., Zhu, L.L., Nair, D., and Schlaug, G. (2010). Bihemispheric brain stimulation facilitates motor recovery in chronic stroke patients. Neurology 75, 2176–2184.PubMedCrossrefGoogle Scholar
  • Lopez-Espuela, F., Zamorano, J.D.P., Ramírez-Moreno, J.M., Jiménez-Caballero, P.E., Portilla-Cuenca, J.C., Lavado-García, J.M., and Casado-Naranjo, I. (2015). Determinants of quality of life in stroke survivors after 6 months, from a comprehensive stroke unit: a longitudinal study. Biol. Res. Nurs. 17, 461–468.CrossrefGoogle Scholar
  • Lüdemann-Podubecká, J., Bösl, K., Rothhardt, S., Verheyden, G., and Nowak, D.A. (2014). Transcranial direct current stimulation for motor recovery of upper limb function after stroke. Neurosci. Biobehav. Rev. 47, 245–259.PubMedCrossrefGoogle Scholar
  • Marshall, L., Molle, M., Hallschmid, M., and Born, J. (2004). Transcranial direct current stimulation during sleep improves declarative memory. J. Neurosci. 24, 9985.CrossrefPubMedGoogle Scholar
  • Mazzoleni, S., Tran, V.D., Iardella, L., Dario, P., and Posteraro, F. (2017). Randomized, sham-controlled trial based on transcranial direct current stimulation and wrist robot-assisted integrated treatment on subacute stroke patients: intermediate results. In: 2017 International Conference on Rehabilitation Robotics (ICORR). IEEE, 555–560. doi:10.1109/icorr.2017.8009306.Google Scholar
  • Menezes, I.S., Cohen, L.G., Mello, E.A., Machado, A.G., Peckham, P.H., Anjos, S.M., Siqueira, I.L., Conti, J., Plow, E.B., and Conforto, A.B. (2018). Combined brain and peripheral nerve stimulation in chronic stroke patients with moderate to severe motor impairment. Neuromodulation 21, 176–183.CrossrefPubMedGoogle Scholar
  • Miranda, P.C., Lomarev, M., and Hallett, M. (2006). Modeling the current distribution during transcranial direct current stimulation. Clin. Neurophysiol. 117, 1623–1629.PubMedCrossrefGoogle Scholar
  • Moher, D., Liberati, A., Tetzlaff, J., and Altman, D.G. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann. Int. Med. 151, 264–269.CrossrefGoogle Scholar
  • Nicolo, P., Magnin, C., Pedrazzini, E., Plomp, G., Mottaz, A., Schnider, A., and Guggisberg, A.G. (2018). Comparison of neuroplastic responses to cathodal transcranial direct current stimulation and continuous theta burst stimulation in subacute stroke. Arch. Phys. Med. Rehab. 99, 862–872.CrossrefGoogle Scholar
  • Nitsche, M.A. and Paulus, W. (2000). Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J. Physiol. 527, 633–639.CrossrefPubMedGoogle Scholar
  • Nitsche, M.A. and Paulus, W. (2001). Sustained excitability elevations induced by transcranial DC motor cortex stimulation in humans. Neurology 57, 1899–1901.PubMedCrossrefGoogle Scholar
  • Nitsche, M.A., Schauenburg, A., Lang, N., Liebetanz, D., Exner, C., Paulus, W., and Tergau, F. (2003). Facilitation of implicit motor learning by weak transcranial direct current stimulation of the primary motor cortex in the human. J. Cogn. Neurosci. 15, 619–626.PubMedCrossrefGoogle Scholar
  • Nitsche, M.A., Seeber, A., Frommann, K., Klein, C.C., Rochford, C., Nitsche, M.S., Fricke, K., Liebetanz, D., Lang, N., Antal, A., et al. (2005). Modulating parameters of excitability during and after transcranial direct current stimulation of the human motor cortex. J. Physiol. 568, 291–303.CrossrefPubMedGoogle Scholar
  • Nitsche, M.A., Kuo, M.F., Karrasch, R., Wächter, B., Liebetanz, D., and Paulus, W. (2009). Serotonin affects transcranial direct current-induced neuroplasticity in humans. Biol. Psychiatry 66, 503–508.CrossrefPubMedGoogle Scholar
  • Nowak, D.A., Bösl, K., Podubeckà, J., and Carey, J.R. (2010). Noninvasive brain stimulation and motor recovery after stroke. Restor. Neurol. Neurosci. 28, 531–544.PubMedGoogle Scholar
  • Nudo, R.J. and Milliken, G.W. (1996). Reorganization of movement representations in primary motor cortex following focal ischemic infarcts in adult squirrel monkeys. J. Neurophysiol. 75, 2144–2149.PubMedCrossrefGoogle Scholar
  • Platz, T. (2004). Impairment-oriented training (IOT): scientific concept and evidence-based treatment strategies. Restor. Neurol. Neurosci. 22, 301–315.PubMedGoogle Scholar
  • Plow, E.B., Carey, J.R., Nudo, R.J., and Pascual-Leone, A. (2009). Invasive cortical stimulation to promote recovery of function after stroke: a critical appraisal. Stroke 40, 1926–1931.PubMedCrossrefGoogle Scholar
  • Polanía, R., Nitsche, M.A., and Paulus, W. (2011). Modulating functional connectivity patterns and topological functional organization of the human brain with transcranial direct current stimulation. Hum. Brain Mapping 32, 1236–1249.CrossrefGoogle Scholar
  • Priori, A., Berardelli, A., Rona, S., Accornero, N., and Manfredi, M. (1998). Polarization of the human motor cortex through the scalp. Neuroreport 9, 2257–2260.CrossrefPubMedGoogle Scholar
  • Rossi, C., Sallustio, F., Di Legge, S., Stanzione, P., and Koch, G. (2013). Transcranial direct current stimulation of the affected hemisphere does not accelerate recovery of acute stroke patients. Eur. J. Neurol. 20, 202–204.CrossrefPubMedGoogle Scholar
  • Saeys, W., Vereeck, L., Lafosse, C., Truijen, S., Wuyts, F., and Van De Heyning, P. (2015). Transcranial direct current stimulation in the recovery of postural control after stroke: a pilot study. Disabil. Rehabil. 37, 1–7.Google Scholar
  • Sattler, V., Acket, B., Raposo, N., Thalamas, C., Loubinoux, I., Chollet, F., and Simonetta-Moreau, M. (2015). Anodal tDCS combined with radial nerve stimulation promotes hand motor recovery in the acute phase after ischemic stroke. Neurorehab. Neural Rep. 29, 743–754.CrossrefGoogle Scholar
  • Seo, H.G., Lee, W.H., Lee, S.H., Yi, Y., Kim, K.D., and Oh, B.M. (2017). Robotic-assisted gait training combined with transcranial direct current stimulation in chronic stroke patients: a pilot double-blind, randomized controlled trial. Restor. Neurol. Neurosci. 35, 527–536.PubMedGoogle Scholar
  • Shekhawat, G.S., Searchfield, G.D., and Stinear, C.M. (2013a). Randomized trial of transcranial direct current stimulation and hearing aids for tinnitus management. Neurorehab. Neural Rep. 28, 410–419.Google Scholar
  • Simonetti, D., Zollo, L., Milighetti, S., Miccinilli, S., Bravi, M., Ranieri, F., Magrone, G., Guglielmelli, E., Di Lazzaro, V., and Sterzi, S. (2017). Literature review on the effects of tDCS coupled with robotic therapy in post stroke upper limb rehabilitation. Front. Hum. Neurosci. 11, 268.CrossrefPubMedGoogle Scholar
  • Stinear, C.M. and Byblow, W.D. (2014). Predicting and accelerating motor recovery after stroke. Curr. Opin. Neurol. 27, 624–630.PubMedGoogle Scholar
  • Straudi, S., Fregni, F., Martinuzzi, C., Pavarelli, C., Salvioli, S., and Basaglia, N. (2016). tDCS and robotics on upper limb stroke rehabilitation: effect modification by stroke duration and type of stroke. BioMed Res. Int. 2016, 8.Google Scholar
  • Suzuki, Y., and Naito, E. (2012). Neuro-modulation in dorsal premotor cortex facilitates human multi-task ability. J. Behav. Brain Sci. 2, 372.CrossrefGoogle Scholar
  • Terney, D., Chaieb, L., Moliadze, V., Antal, A., and Paulus, W. (2008). Increasing human brain excitability by transcranial high-frequency random noise stimulation. J. Neurosci. 28, 14147–14155.CrossrefPubMedGoogle Scholar
  • Viana, R.T., Laurentino, G.E., Souza, R.J., Fonseca, J.B., Silva Filho, E.M., Dias, S.N., Teixeira-Salmela, L.F., and Monte-Silva, K.K. (2014). Effects of the addition of transcranial direct current stimulation to virtual reality therapy after stroke: a pilot randomized controlled trial. Neurorehabilitation 34, 437–446.PubMedGoogle Scholar
  • Wang, Y., Shen, Y., Cao, X., Shan, C., Pan, J., He, H., Ma, Y., and Yuan, T.F. (2016). Transcranial direct current stimulation of the frontal-parietal-temporal area attenuates cue-induced craving for heroin. J. Psychiatry Res. 79, 1–3.CrossrefGoogle Scholar
  • Wu, D., Qian, L., Zorowitz, R.D., Zhang, L., Qu, Y., and Yuan, Y. (2013). Effects on decreasing upper-limb post stroke muscle tone using transcranial direct current stimulation: a randomized sham-controlled study. Arch. Phys. Med. Rehab. 94, 1–8.CrossrefGoogle Scholar
  • Zehr, E.P. (2005). Neural control of rhythmic human movement: the common core hypothesis. Exercise Sport Sci. Rev. 33, 54–60.Google Scholar
  • Ziemann, U., Paulus, W., Nitsche, M.A., Pascual-Leone, A., Byblow, W.D., Berardelli, A., Siebner, H.R., Classen, J., Cohen, L.G., and Rothwell, J.C. (2008). Consensus: motor cortex plasticity protocols. Brain Stimul. 1, 164–182.CrossrefPubMedGoogle Scholar

via Motor stroke recovery after tDCS: a systematic review : Reviews in the Neurosciences

, , , , , ,

Leave a comment

[Abstract] Task-oriented Motor Learning in Upper Extremity Rehabilitation Post Stroke

Abstract

Background: Upper extremity deficits are the most popular symptoms following stroke. Task-oriented training has the ability to increase motor area excitability in the brain, which can stimulate the recovery of motor control.

Objective: This study was aimed to examine the efficiency of the task-oriented approach on paretic upper extremity following a stroke, and to identify efficient treatment dosage in those populations.

Method: We searched through PubMed, Scopus, Physiotherapy Evidence Database (PEDro), National Rehabilitation Information (REHABDATA), and Web of Science databases. Randomized clinical trials (RCTs) and pseudo-RCTs those investigating upper extremity in patients with stroke published in English language were selected. Different scales and measurement methods to assess range of motion, strength, spasticity, and upper extremity function were considered. The quality assessment of included articles was evaluated utilizing the PEDro scale. Effect sizes were calculated.

Results: Six RCTs were included in the present study. The quality assessment for included studies ranged from 6 to 8 with 6.5 as a median. A total of 456 post-stroke patients, 41.66% of which were women, were included in all studies. The included studies demonstrated a meaningful influence of task-oriented training intervention on the hemiplegic upper limb motor functions but not spasticity post-stroke.

Conclusion: Task-oriented training does not produce a superior effect than other conventional physical therapy interventions in treating upper extremity in patients with stroke. There is no evidence supporting the beneficial effect of task-oriented on spasticity. Task-oriented training with the following dosage 30 to 90 minutes/session, 2 to 3 sessions weekly for 6 to 10 weeks may improve motor function and strength of paretic upper extremity post-stroke.

via Task-oriented Motor Learning in Upper Extremity Rehabilitation Post Stroke – Anas R. Alashram, Giuseppe Annino, Nicola Biagio Mercuri,

, , , , , , ,

Leave a comment

[Abstract] Forced, Not Voluntary, Aerobic Exercise Enhances Motor Recovery in Persons With Chronic Stroke

Background. The recovery of motor function following stroke is largely dependent on motor learning–related neuroplasticity. It has been hypothesized that intensive aerobic exercise (AE) training as an antecedent to motor task practice may prime the central nervous system to optimize motor recovery poststroke.

Objective. The objective of this study was to determine the differential effects of forced or voluntary AE combined with upper-extremity repetitive task practice (RTP) on the recovery of motor function in adults with stroke.

Methods. A combined analysis of 2 preliminary randomized clinical trials was conducted in which participants (n = 40) were randomized into 1 of 3 groups: (1) forced exercise and RTP (FE+RTP), (2) voluntary exercise and RTP (VE+RTP), or (3) time-matched stroke-related education and RTP (Edu+RTP). Participants completed 24 training sessions over 8 weeks.

Results. A significant interaction effect was found indicating that improvements in the Fugl-Meyer Assessment (FMA) were greatest for the FE+RTP group (P = .001). All 3 groups improved significantly on the FMA by a mean of 11, 6, and 9 points for the FE+RTP, VE+RTP, and Edu+RTP groups, respectively. No evidence of a treatment-by-time interaction was observed for Wolf Motor Function Test outcomes; however, those in the FE+RTP group did exhibit significant improvement on the total, gross motor, and fine-motor performance times (P ≤ .01 for all observations).

Conclusions. Results indicate that FE administered prior to RTP enhanced motor skill acquisition greater than VE or stroke-related education. AE, FE in particular, should be considered as an effective antecedent to enhance motor recovery poststroke.

via Forced, Not Voluntary, Aerobic Exercise Enhances Motor Recovery in Persons With Chronic Stroke – Susan M. Linder, Anson B. Rosenfeldt, Sara Davidson, Nicole Zimmerman, Amanda Penko, John Lee, Cynthia Clark, Jay L. Alberts, 2019

, , , , , , , , , ,

Leave a comment

[Abstract] Forced, Not Voluntary, Aerobic Exercise Enhances Motor Recovery in Persons With Chronic Stroke

Background. The recovery of motor function following stroke is largely dependent on motor learning–related neuroplasticity. It has been hypothesized that intensive aerobic exercise (AE) training as an antecedent to motor task practice may prime the central nervous system to optimize motor recovery poststroke.

Objective. The objective of this study was to determine the differential effects of forced or voluntary AE combined with upper-extremity repetitive task practice (RTP) on the recovery of motor function in adults with stroke.

Methods. A combined analysis of 2 preliminary randomized clinical trials was conducted in which participants (n = 40) were randomized into 1 of 3 groups: (1) forced exercise and RTP (FE+RTP), (2) voluntary exercise and RTP (VE+RTP), or (3) time-matched stroke-related education and RTP (Edu+RTP). Participants completed 24 training sessions over 8 weeks.

Results. A significant interaction effect was found indicating that improvements in the Fugl-Meyer Assessment (FMA) were greatest for the FE+RTP group (P = .001). All 3 groups improved significantly on the FMA by a mean of 11, 6, and 9 points for the FE+RTP, VE+RTP, and Edu+RTP groups, respectively. No evidence of a treatment-by-time interaction was observed for Wolf Motor Function Test outcomes; however, those in the FE+RTP group did exhibit significant improvement on the total, gross motor, and fine-motor performance times (P ≤ .01 for all observations).

Conclusions. Results indicate that FE administered prior to RTP enhanced motor skill acquisition greater than VE or stroke-related education. AE, FE in particular, should be considered as an effective antecedent to enhance motor recovery poststroke.

via Forced, Not Voluntary, Aerobic Exercise Enhances Motor Recovery in Persons With Chronic Stroke – Susan M. Linder, Anson B. Rosenfeldt, Sara Davidson, Nicole Zimmerman, Amanda Penko, John Lee, Cynthia Clark, Jay L. Alberts,

, , , , , ,

Leave a comment

[ARTICLE] Searching for the optimal tDCS target for motor rehabilitation – Full Text

Abstract

Background

Transcranial direct current stimulation (tDCS) has been investigated over the years due to its short and also long-term effects on cortical excitability and neuroplasticity. Although its mechanisms to improve motor function are not fully understood, this technique has been suggested as an alternative therapeutic method for motor rehabilitation, especially those with motor function deficits. When applied to the primary motor cortex, tDCS has shown to improve motor function in healthy individuals, as well as in patients with neurological disorders. Based on its potential effects on motor recovery, identifying optimal targets for tDCS stimulation is essential to improve knowledge regarding neuromodulation as well as to advance the use of tDCS in clinical motor rehabilitation.

Methods and results

Therefore, this review discusses the existing evidence on the application of four different tDCS montages to promote and enhance motor rehabilitation: (1) anodal ipsilesional and cathodal contralesional primary motor cortex tDCS, (2) combination of central tDCS and peripheral electrical stimulation, (3) prefrontal tDCS montage and (4) cerebellar tDCS stimulation. Although there is a significant amount of data testing primary motor cortex tDCS for motor recovery, other targets and strategies have not been sufficiently tested. This review then presents the potential mechanisms and available evidence of these other tDCS strategies to promote motor recovery.

Conclusions

In spite of the large amount of data showing that tDCS is a promising adjuvant tool for motor rehabilitation, the diversity of parameters, associated with different characteristics of the clinical populations, has generated studies with heterogeneous methodologies and controversial results. The ideal montage for motor rehabilitation should be based on a patient-tailored approach that takes into account aspects related to the safety of the technique and the quality of the available evidence.

Introduction

Transcranial Direct Current Stimulation (tDCS) is a non-invasive brain stimulation technique which delivers a constant electric current over the scalp to modulate cortical excitability [1,2,3]. Different montages of tDCS may induce diverse effects on brain networks, which are directly dependent on the electrodes positioning and polarity. While anodal tDCS is believed to enhance cortical excitability, cathodal tDCS diminishes the excitation of stimulated areas, and these electrodes montages define the polarity-specific effects of the stimulation [4,5,6]. Due to the effects of tDCS on modulating cortical excitability, especially when applied to the primary motor cortex [2], this method of brain stimulation has been intensively investigated for motor function improvement both in healthy subjects [78] and in various neurological pathologies [910]. Neurological conditions that may obtain benefits from the use of tDCS include Stroke [11,12,13,14], Parkinson’s disease [15], Multiple Sclerosis [1617], among others.

The mechanisms of action underlying the modulation of neuronal activity induced by tDCS are still not completely understood. However, studies have demonstrated that the electric current generated by tDCS interferes in the resting membrane potential of neuronal cells, which modulates spontaneous brain circuits activity [1,2,3]. Some studies have suggested that tDCS could have an effect on neuronal synapsis’ strength, altering the activity of NMDA and GABA receptors, thus triggering plasticity process, such as long-term potentiation (LTP) and long-term depression (LTD) [1819]. The long-term effects of tDCS are also thought to be associated to changes in protein synthesis and gene expression [2021]. Additionally, neuroimaging study showed blood flow changes following stimulation, which may be related to a direct effect of tDCS over blood flow, with an increase in oxygen supply on cortical areas and subsequent enhancement of neuronal excitability [22]. Given these mechanisms, tDCS seems to be a potential valuable tool to stimulate brain activity and plasticity following a brain damage.

The advantages of using tDCS include its low cost, ease of application, and safety. To date, there is no evidence of severe adverse events following tDCS in healthy individuals, as well as in patients with neurological conditions, such as stroke [2324]. Among the potential side effects presented after this type of stimulation, the most common ones consist of burn sensation, itching, transient skin irritation, tingling under the electrode, headache, and low intensity discomfort [25]. As serious and irreversible side effects have not been reported, tDCS is considered a relatively safe and tolerable strategy of non-invasive brain stimulation.

The modifications of physiological and clinical responses induced by tDCS are extremely variable, as this type of stimulation can induce both adaptive or maladaptive plastic changes, and a wide spectrum of tDCS parameters influence the effects of this technique. Electrodes combination, montage and shape can easily interfere in the enhancement or inhibition of cortical excitability [626]. Other parameters that may influence these outcomes include current intensity, current flow direction, skin preparation, and stimulation intervals [32728] . In addition, in clinical populations, the heterogeneity of the brain lesions can also influence the inconsistency in tDCS effects [29]. Despite the goal of tDCS of modulating cortical areas by using different parameters, some studies have showed that, by altering cortical excitability, the electrical field could reach subcortical structures, such as basal ganglia, due to brain connections between cortical and subcortical areas [30,31,32,33]. This potential effect on deeper brain structure has supported the broad investigation of tDCS in various disorders, even if the cortical region under stimulating electrode is not directly linked to the neurological condition being investigated. Indeed, the current variable and moderate effect sizes from clinical tDCS studies in stroke encourage researchers to test alternative targets to promote motor recovery in this condition.

In this review, we discuss evidence on the application of four different tDCS montages to promote and enhance motor rehabilitation: [1] anodal tDCS ipsilateral and cathodal tDCS bilateral, [2] combination of central and peripheral stimulation, [3] prefrontal montage and [4] cerebellar stimulation.[…]

 

Continue —> Searching for the optimal tDCS target for motor rehabilitation | Journal of NeuroEngineering and Rehabilitation | Full Text

figure1

Fig. 1 Motor cortex stimulation in a scenario where the left hemisphere was lesioned. Figure a Anodal stimulation of left primary motor cortex: anode over the left M1 and cathode over the right supraorbital region. Figure b Cathodal stimulation of right primary motor cortex: cathode over the right M1 and anode over the left supraorbital region. Figure c Bilateral stimulation: anode over the affected hemisphere (left) and cathode over the non-affected hemisphere (right)

 

, , , , , , ,

Leave a comment

[NEWS] Brain-controlled, non-invasive muscle stimulation allows chronic paraplegics to walk

Brain-controlled, non-invasive muscle stimulation allows chronic paraplegics to walk again and exhibit partial motor recovery

IMAGE

IMAGE: THE NON-INVASIVE CLOSED-LOOP NEUROREHABILITATION PROTOCOL: I) EEG: ELECTROENCEPHALOGRAPHY, NON-INVASIVE BRAIN-RECORDING. II) BRAIN-MACHINE INTERFACE: REAL-TIME DECODING OF MOTOR INTENTIONS. III) THE LEFT OR RIGHT LEG MUSCLES ARE STIMULATED TO TRIGGER THE… view more 
CREDIT: WALK AGAIN PROJECT – ASSOCIAÇÃO ALBERTO SANTOS DUMONT PARA APOIO À PESQUISA

In another major clinical breakthrough of the Walk Again Project, a non-profit international consortium aimed at developing new neuro-rehabilitation protocols, technologies and therapies for spinal cord injury, two patients with paraplegia regained the ability to walk with minimal assistance, through the employment of a fully non-invasive brain-machine interface that does not require the use of any invasive spinal cord surgical procedure. The results of this study appeared on the May 1 issue of the journal Scientific Reports.

The two patients with paraplegia (AIS C) used their own brain activity to control the non-invasive delivery of electrical pulses to a total of 16 muscles (eight in each leg), allowing them to produce a more physiological walk than previously reported, requiring only a conventional walker and a body weight support system as assistive devices. Overall, the two patients were able to produce more than 4,500 steps using this new technology, which combines a non-invasive brain-machine interface, based on a 16-channel EEG, to control a multi-channel functional electrical stimulation system (FES), tailored to produce a much smoother gait pattern than the state of the art of this technique.

“What surprised us was that, in addition to allowing these patients to walk with little help, one of them displayed a clear motor improvement by practicing with this new approach. Patients required approximatively 25 sessions to master the training before they were able to walk using this apparatus,” said Solaiman Shokur one of the authors of the study.

The two patients that used this new rehabilitation approach had previously participated in the long-term neurorehabilitation study carried out using the Walk Again Project Neurorehabilitation (WANR) protocol. As reported in a recent publication from the same team (Shokur et al., PLoS One, Nov. 2018), all seven patients who participated in that protocol for a period of 28 months improved their clinical status, from complete paraplegia (AIS A or B, meaning no motor functions below the level of the injury, according to the ASIA classification) to partial paraplegia (AIS C, meaning partial recovery of sensory and motor function below the injury level). This significant neurological recovery included major clinical improvements in sensory discrimination (tactile, nociception, vibration, and pressure), voluntary motor control of abdomen and leg muscles, and important gains in autonomic control, such as bladder, bowel, and sexual functions.

“The last two studies published by the Walk Again Project clearly indicate that partial neurological and functional recovery can be induced in chronic spinal cord injury patients by combining multiple non-invasive technologies that are based around the concept of using a brain-machine interface to control different types of actuators, like virtual avatars, robotic walkers, or muscle stimulating devices, to allow the total involvement of patients in their own rehabilitation routine,” said Miguel Nicolelis, scientific director of the Walk Again Project and one of the authors of the study.

In a recent report by another group, one AIS C and two AIS D patients were able to walk thanks to the employment of an invasive method for spinal cord electrical stimulation, which required a spinal surgical procedure. In contrast, in the present study two AIS C patients – which originally were AIS A (see Supplemental Material below)- and a third AIS B subject, who recently achieved similar results, were able to regain a significant degree of autonomous walking without the need for such invasive treatments. Instead, these patients only received electrical stimulation patterns delivered to the skin surface of their legs, so that a total of eight muscles in each limb could be electrically stimulated in a physiologically accurate sequence. This was done in order to produce a smoother and more natural pattern of locomotion.

“Crucial for this implementation was the development of a closed-loop controller that allowed real-time correction of the patients’ walking pattern, taking into account muscle fatigue and external perturbations, in order to produce a predefined gait trajectory. Another major component of our approach was the use of a wearable haptic display to deliver tactile feedback to the patients´ forearms in order to provide them with a continuous source of proprioceptive feedback related to their walking,” said Solaiman Shokur.

To control the pattern of electrical muscle stimulation in each leg, these patients utilized an EEG-based brain-machine interface. In this setup, patients learned to alternate the generation of “stepping motor imagery” activity in their right and left motor cortices, in order to create alternated movements of their left and right legs.

According to the authors, the patients exhibited not only “less dependency on walking assistance, but also partial neurological recovery, with substantial rates of motor improvement in one of them.” The improvement in motor control in this last AIS C patient was 9 points in the lower extremity motor score (LEMS), which was comparable with that observed using invasive spinal cord stimulation.

Based on the results obtained over the past 5 years, the WAP now intends to combine all its neurorehabilitation tools into a single integrated, non-invasive platform to treat spinal cord injury patients. This platform will allow patients to begin training soon after the injury occurs. It will also allow the employment of a multi-dimensional integrated brain-machine interface capable of simultaneously controlling virtual and robotic actuators (like a lowerlimb exoskeleton), a multi-channel non-invasive electrical muscle stimulation system (like the FES used in the present study), and a novel non-invasive spinal cord stimulation approach. In this final configuration, this WAP platform will incorporate all these technologies together in order to maximize neurological and functional recovery in the shortest possible time, without the need of any invasive procedure.

According to Dr. Nicolelis, “there is no silver bullet to treat spinal cord injuries. More and more, it looks like we need to implement multiple techniques simultaneously to achieve the best neurorehabilitation results. In this context, it is also imperative to consider the occurrence of cortical plasticity as a major component in the planning of our rehabilitation approach.”

###

The other authors of this paper are Aurelie Selfslagh, Debora S.F. Campos, Ana R. C. Donati, Sabrina Almeida, Seidi Y. Yamauti, Daniel B. Coelho and Mohamed Bouri. This project was developed through a collaboration between the Neurorehabilitation Laboratory of the Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), the headquarters of the Walk Again Project, the Biomechanics and Motor Control Laboratory at the Federal University of ABC (UFABC), and the Laboratory of Robotic System at the Swiss Institute of Technology of Lausanne (EPFL). It was funded by a grant from the Brazilian Financing Agency for Studies and Projects (FINEP) 01.12.0514.00, Ministry of Science, Technology, Innovation and Communications (MCTIC), to AASDAP.

Supplemental Material:

https://www.youtube.com/watch?v=AZbQeuJiSOI

Supporting Research Studies:

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0206464

https://www.nature.com/articles/s41598-019-43041-9

 

via Brain-controlled, non-invasive muscle stimulation allows chronic paraplegics to walk | EurekAlert! Science News

 

, , , , , , , , , ,

Leave a comment

[ARTICLE] Hand Rehabilitation Robotics on Poststroke Motor Recovery – Full Text

Abstract

The recovery of hand function is one of the most challenging topics in stroke rehabilitation. Although the robot-assisted therapy has got some good results in the latest decades, the development of hand rehabilitation robotics is left behind. Existing reviews of hand rehabilitation robotics focus either on the mechanical design on designers’ view or on the training paradigms on the clinicians’ view, while these two parts are interconnected and both important for designers and clinicians. In this review, we explore the current literature surrounding hand rehabilitation robots, to help designers make better choices among varied components and thus promoting the application of hand rehabilitation robots. An overview of hand rehabilitation robotics is provided in this paper firstly, to give a general view of the relationship between subjects, rehabilitation theories, hand rehabilitation robots, and its evaluation. Secondly, the state of the art hand rehabilitation robotics is introduced in detail according to the classification of the hardware system and the training paradigm. As a result, the discussion gives available arguments behind the classification and comprehensive overview of hand rehabilitation robotics.

1. Background

Stroke, caused by death of brain cells as a result of blockage of a blood vessel supplying the brain (ischemic stroke) or bleeding into or around the brain (hemorrhagic stroke), is a serious medical emergency []. Stroke can result in death or substantial neural damage and is a principal contributor to long-term disabilities []. According to the World Health Organization estimates, 15 million people suffer stroke worldwide each year []. Although technology advances in health care, the incidence of stroke is expected to rise over the next decades []. The expense on both caring and rehabilitation is enormous which reaches $34 billion per year in the US []. More than half of stroke survivors experience some level of lasting hemiparesis or hemiplegia resulting from the damage to neural tissues. These patients are not able to perform daily activities independently and thus have to rely on human assistance for basic activities of daily living (ADL) like feeding, self-care, and mobility [].

The human hands are very complex and versatile. Researches show that the relationship between the distal upper limb (i.e., hand) function and the ability to perform ADL is stronger than the other limbs []. The deficit in hand function would seriously impact the quality of patients’ life, which means more demand is needed on the hand motor recovery. However, although most patients get reasonable motor recovery of proximal upper extremity according to relevant research findings, recovery at distal upper extremity has been limited due to low effectivity []. There are two main reasons for challenges facing the recovery of the hand. First, in movement, the hand has more than 20 degree of freedom (DOF) which makes it flexible, thus being difficult for therapist or training devices to meet the needs of satiety and varied movements []. Second, in function, the area of cortex in correspondence with the hand is much larger than the other motor cortex, which means a considerable amount of flexibility in generating a variety of hand postures and in the control of the individual joints of the hand. However, to date, most researches have focused on the contrary, lacking of individuation in finger movements []. Better rehabilitation therapies are desperately needed.

Robot-assisted therapy for poststroke rehabilitation is a new kind of physical therapy, through which patients practice their paretic limb by resorting to or resisting the force offered by the robots []. For example, the MIT-Manus robot uses the massed training approach by practicing reaching movements to train the upper limbs []; the Mirror Image Movement Enabler (MIME) uses the bilateral training approach to train the paretic limb while reducing abnormal synergies []. Robot-assisted therapy has been greatly developed over the past three decades with the advances in robotic technology such as the exoskeleton and bioengineering, which has become a significant supplement to traditional physical therapy []. For example, compared with the therapist exhausted in training patients with manual labor, the hand exoskeleton designed by Wege et al. can move the fingers of patients dexterously and repeatedly []. Besides, some robots can also be controlled by a patient’s own intention extracted from biosignals such as electromyography (EMG) and electroencephalograph (EEG) signals []. These make it possible to form a closed-loop rehabilitation system with the robotic technology, which cannot be achieved by any conventional rehabilitation therapy [].

Existing reviews of hand rehabilitation robotics on poststroke motor recovery are insufficient, for most studies research on the application of robot-assisted therapy on other limbs instead of the hand []. Furthermore, current reviews focus on either the hardware design of the robots or the application of specific training paradigms [], while both of them are indispensable to an efficient hand rehabilitation robot. The hardware system makes the foundation of the robots’ function, while the training paradigm serves as the real functional parts in the motor recovery that decides the effect of rehabilitation training. These two parts are closely related to each other.

This paper focuses on the application of robot-assisted therapy on hand rehabilitation, giving an overview of hand rehabilitation robotics from the hardware systems to the training paradigms in current designs, for a comprehensive understanding is pretty meaningful to the development of an effective rehabilitation robotic system. The second section provides a general view of the robots in the entire rehabilitation robotic system. Then, the third section sums up and classifies hardware systems and the training paradigms in several crucial aspects on the author’s view. Last, the state of the art hand rehabilitation robotics is discussed and possible direction of future robotics in hand rehabilitation is predicted.[…]

Continue —-> Hand Rehabilitation Robotics on Poststroke Motor Recovery

 

An external file that holds a picture, illustration, etc.Object name is BN2017-3908135.003.jpg

Figure 3
Examples of different kinds of robots [].

, , , , , , , ,

Leave a comment

[Abstract + References] Effectiveness and Superiority of Rehabilitative Treatments in Enhancing Motor Recovery Within 6 Months Poststroke: A Systemic Review

Abstract

Objective

To investigate the effects of various rehabilitative interventions aimed at enhancing poststroke motor recovery by assessing their effectiveness when compared with no treatment or placebo and their superiority when compared with conventional training program (CTP).

Data Source

A literature search was based on 19 Cochrane reviews and 26 other reviews. We also updated the searches in PubMed up to September 30, 2017.

Study Selection

Randomized controlled trials associated with 18 experimented training programs (ETP) were included if they evaluated the effects of the programs on either upper extremity (UE) or lower extremity (LE) motor recovery among adults within 6 months poststroke; included ≥10 participants in each arm; and had an intervention duration of ≥10 consecutive weekdays.

Data Extraction

Four reviewers evaluated the eligibility and quality of literature. Methodological quality was assessed using the PEDro scale.

Data Synthesis

Among the 178 included studies, 129 including 7450 participants were analyzed in this meta-analysis. Six ETPs were significantly effective in enhancing UE motor recovery, with the standard mean differences (SMDs) and 95% confidence intervals outlined as follow: constraint-induced movement therapy (0.82, 0.45-1.19), electrostimulation (ES)-motor (0.42, 0.22-0.63), mirror therapy (0.71, 0.22-1.20), mixed approach (0.21, 0.01-0.41), robot-assisted training (0.51, 0.22-0.80), and task-oriented training (0.57, 0.16-0.99). Six ETPs were significantly effective in enhancing LE motor recovery: body-weight-supported treadmill training (0.27, 0.01-0.52), caregiver-mediated training (0.64, 0.20-1.08), ES-motor (0.55, 0.27-0.83), mixed approach (0.35, 0.15-0.54), mirror therapy (0.56, 0.13-1.00), and virtual reality (0.60, 0.15-1.05). However, compared with CTPs, almost none of the ETPs exhibited significant SMDs for superiority.

Conclusions

Certain experimented interventions were effective in enhancing poststroke motor recovery, but little evidence supported the superiority of experimented interventions over conventional rehabilitation.

References

  1. Langhorne, P., Bernhardt, J., Kwakkel, G. Stroke rehabilitation. Lancet2011;377:1693–1702
  2. Langhorne, P., Coupar, F., Pollock, A. Motor recovery after stroke: a systematic review. Lancet Neurol2009;8:741–754
  3. Veerbeek, J.M., van Wegen, E., van Peppen, R. et al, What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PLoS One2014;9e87987
  4. Pollock, A., Farmer, S.E., Brady, M.C. et al, Interventions for improving upper limb function after stroke. Cochrane Database Syst Rev2014;:Cd010820
  5. Lohse, K.R., Lang, C.E., Boyd, L.A. Is more better? Using metadata to explore dose-response relationships in stroke rehabilitation. Stroke2014;45:2053–2058
  6. Cooke, E.V., Mares, K., Clark, A., Tallis, R.C., Pomeroy, V.M. The effects of increased dose of exercise-based therapies to enhance motor recovery after stroke: a systematic review and meta-analysis. BMC Med2010;8:60
  7. Schneider, E.J., Lannin, N.A., Ada, L., Schmidt, J. Increasing the amount of usual rehabilitation improves activity after stroke: a systematic review. J Physiother2016;62:182–187
  8. Chang, K.H., Chen, H.C., Lin, Y., Chen, S.C., Chiou, H.Y., Liou, T.H. Developing an ICF core set for post-stroke disability assessment and verification in Taiwan: a preliminary study. Disabil Rehabil2012;34:1254–1261
  9. Kwakkel, G., Kollen, B., Twisk, J. Impact of time on improvement of outcome after stroke. Stroke2006;37:2348–2353
  10. Coupar, F., Pollock, A., van Wijck, F., Morris, J., Langhorne, P. Simultaneous bilateral training for improving arm function after stroke. Cochrane Database Syst Rev2010;:Cd006432
  11. Mehrholz, J., Thomas, S., Elsner, B. Treadmill training and body weight support for walking after stroke. Cochrane Database Syst Rev2017;8:Cd002840
  12. Vloothuis, J.D., Mulder, M., Veerbeek, J.M. et al, Caregiver-mediated exercises for improving outcomes after stroke. Cochrane Database Syst Rev2016;12:Cd011058
  13. Coupar, F., Pollock, A., Legg, L.A., Sackley, C., van Vliet, P. Home-based therapy programmes for upper limb functional recovery following stroke. Cochrane Database Syst Rev2012;:Cd006755
  14. Corbetta, D., Sirtori, V., Castellini, G., Moja, L., Gatti, R. Constraint-induced movement therapy for upper extremities in people with stroke. Cochrane Database Syst Rev2015;:Cd004433
  15. Woodford, H., Price, C. EMG biofeedback for the recovery of motor function after stroke. Cochrane Database Syst Rev2007;:Cd004585
  16. Pomeroy, V.M., King, L., Pollock, A., Baily-Hallam, A., Langhorne, P. Electrostimulation for promoting recovery of movement or functional ability after stroke. Cochrane Database Syst Rev2006;:Cd003241
  17. Barclay-Goddard, R., Stevenson, T., Poluha, W., Moffatt, M.E., Taback, S.P. Force platform feedback for standing balance training after stroke. Cochrane Database Syst Rev2004;:Cd004129
  18. Barclay-Goddard, R.E., Stevenson, T.J., Poluha, W., Thalman, L. Mental practice for treating upper extremity deficits in individuals with hemiparesis after stroke. Cochrane Database Syst Rev2011;:Cd005950
  19. Thieme, H., Mehrholz, J., Pohl, M., Behrens, J., Dohle, C. Mirror therapy for improving motor function after stroke. Cochrane Database Syst Rev2012;:Cd008449
  20. Pollock, A., Baer, G., Campbell, P. et al, Physical rehabilitation approaches for the recovery of function and mobility following stroke. Cochrane Database Syst Rev2014;:Cd001920
  21. Legg, L.A., Drummond, A.E., Langhorne, P. Occupational therapy for patients with problems in activities of daily living after stroke. Cochrane Database Syst Rev2006;:Cd003585
  22. Pollock, A., Gray, C., Culham, E., Durward, B.R., Langhorne, P. Interventions for improving sit-to-stand ability following stroke. Cochrane Database Syst Rev2014;:Cd007232
  23. Magee, W.L., Clark, I., Tamplin, J., Bradt, J. Music interventions for acquired brain injury. Cochrane Database Syst Rev2017;1:Cd006787
  24. Mehrholz, J., Pohl, M., Platz, T., Kugler, J., Elsner, B. Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke.Cochrane Database Syst Rev2015;:Cd006876
  25. Mehrholz, J., Thomas, S., Werner, C., Kugler, J., Pohl, M., Elsner, B. Electromechanical-assisted training for walking after stroke. Cochrane Database Syst Rev2017;5:Cd006185
  26. French, B., Thomas, L.H., Coupe, J. et al, Repetitive task training for improving functional ability after stroke. Cochrane Database Syst Rev2016;11:Cd006073
  27. Laver, K.E., Lange, B., George, S., Deutsch, J.E., Saposnik, G., Crotty, M. Virtual reality for stroke rehabilitation. Cochrane Database Syst Rev2017;11:Cd008349
  28. Kwakkel, G., Veerbeek, J.M., van Wegen, E.E., Wolf, S.L. Constraint-induced movement therapy after stroke. Lancet Neurol2015;14:224–234
  29. Etoom, M., Hawamdeh, M., Hawamdeh, Z. et al, Constraint-induced movement therapy as a rehabilitation intervention for upper extremity in stroke patients: systematic review and meta-analysis. Int J Rehabil Res2016;39:197–210
  30. Plummer, P., Eskes, G., Wallace, S. et al, Cognitive-motor interference during functional mobility after stroke: state of the science and implications for future research. Arch Phys Med Rehabil2013;94:2565–2574.e6
  31. Wang, X.Q., Pi, Y.L., Chen, B.L. et al, Cognitive motor interference for gait and balance in stroke: a systematic review and meta-analysis. Eur J Neurol2015;22:555–e37
  32. Ghai, S., Ghai, I., Effenberg, A.O. Effects of dual tasks and dual-task training on postural stability: a systematic review and meta-analysis. Clin Interv Aging2017;12:557–577
  33. Stanton, R., Ada, L., Dean, C.M., Preston, E. Biofeedback improves performance in lower limb activities more than usual therapy in people following stroke: a systematic review. J Physiother2017;63:11–16
  34. Howlett, O.A., Lannin, N.A., Ada, L., McKinstry, C. Functional electrical stimulation improves activity after stroke: a systematic review with meta-analysis. Arch Phys Med Rehabil2015;96:934–943
  35. Laufer, Y., Elboim-Gabyzon, M. Does sensory transcutaneous electrical stimulation enhance motor recovery following a stroke? A systematic review. Neurorehabil Neural Repair2011;25:799–809
  36. Kho, A.Y., Liu, K.P., Chung, R.C. Meta-analysis on the effect of mental imagery on motor recovery of the hemiplegic upper extremity function. Aust Occup Ther J2014;61:38–48
  37. Li, R.Q., Li, Z.M., Tan, J.Y., Chen, G.L., Lin, W.Y. Effects of motor imagery on walking function and balance in patients after stroke: A quantitative synthesis of randomized controlled trials. Complement Ther Clin Pract2017;28:75–84
  38. Tong, Y., Pendy, J.T. Jr., Li, W.A. et al, Motor imagery-based rehabilitation: potential neural correlates and clinical application for functional recovery of motor deficits after stroke. Aging Dis2017;8:364–371
  39. Perez-Cruzado, D., Merchan-Baeza, J.A., Gonzalez-Sanchez, M., Cuesta-Vargas, A.I. Systematic review of mirror therapy compared with conventional rehabilitation in upper extremity function in stroke survivors. Aust Occup Ther J2017;64:91–112
  40. Deconinck, F.J., Smorenburg, A.R., Benham, A., Ledebt, A., Feltham, M.G., Savelsbergh, G.J.Reflections on mirror therapy: a systematic review of the effect of mirror visual feedback on the brain. Neurorehabil Neural Repair2015;29:349–361
  41. Resquin, F., Cuesta Gomez, A., Gonzalez-Vargas, J. et al, Hybrid robotic systems for upper limb rehabilitation after stroke: a review. Med Eng Phys2016;38:1279–1288
  42. Veerbeek, J.M., Langbroek-Amersfoort, A.C., van Wegen, E.E., Meskers, C.G., Kwakkel, G. Effects of robot-assisted therapy for the upper limb after stroke. Neurorehabil Neural Repair2017;31:107–121
  43. Bertani, R., Melegari, C., De Cola, M.C., Bramanti, A., Bramanti, P., Calabro, R.S. Effects of robot-assisted upper limb rehabilitation in stroke patients: a systematic review with meta-analysis. Neurol Sci2017;38:1561–1569
  44. Zhang, X., Yue, Z. Robotics in Lower-Limb Rehabilitation after Stroke. Behav Neurol2017;2017:3731802
  45. Ada, L., Dorsch, S., Canning, C.G. Strengthening interventions increase strength and improve activity after stroke: a systematic review. Aust J Physiother2006;52:241–248
  46. Harris, J.E., Eng, J.J. Strength training improves upper-limb function in individuals with stroke: a meta-analysis. Stroke2010;41:136–140
  47. Yang, X., Wang, P., Liu, C., He, C., Reinhardt, J.D. The effect of whole body vibration on balance, gait performance and mobility in people with stroke: a systematic review and meta-analysis. Clin Rehabil2015;29:627–638
  48. van Delden, A.E., Peper, C.E., Beek, P.J., Kwakkel, G. Unilateral versus bilateral upper limb exercise therapy after stroke: a systematic review. J Rehabil Med2012;44:106–117
  49. Wattchow, K.A., McDonnell, M.N., Hillier, S.L. Rehabilitation interventions for upper limb function in the first four weeks following stroke: a systematic review and meta-analysis of the evidence. Arch Phys Med Rehabil2018;99:367–382
  50. de Morton, N.A. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother2009;55:129–133
  51. Lang, C.E., Lohse, K.R., Birkenmeier, R.L. Dose and timing in neurorehabilitation: prescribing motor therapy after stroke. Curr Opin Neurol2015;28:549–555
  52. Marquez-Chin, C., Bagher, S., Zivanovic, V., Popovic, M.R. Functional electrical stimulation therapy for severe hemiplegia: randomized control trial revisited. Can J Occup Ther2017;84:87–97
  53. Kwakkel, G., Winters, C., van Wegen, E.E. et al, Effects of unilateral upper limb training in two distinct prognostic groups early after stroke: the EXPLICIT-stroke randomized clinical trial.Neurorehabil Neural Repair2016;30:804–816
  54. Morris, J.H., van Wijck, F., Joice, S., Ogston, S.A., Cole, I., MacWalter, R.S. A comparison of bilateral and unilateral upper-limb task training in early poststroke rehabilitation: a randomized controlled trial. Arch Phys Med Rehabil2008;89:1237–1245
  55. van Delden, A.L., Peper, C.L., Nienhuys, K.N., Zijp, N.I., Beek, P.J., Kwakkel, G. Unilateral versus bilateral upper limb training after stroke. the Upper Limb Training After Stroke clinical trial. Stroke2013;44:2613–2616
  56. Brunner, I.C., Skouen, J.S., Strand, L.I. Is modified constraint-induced movement therapy more effective than bimanual training in improving arm motor function in the subacute phase post stroke? A randomized controlled trial. Clin Rehabil2012;26:1078–1086
  57. Ozdemir, F., Birtane, M., Tabatabaei, R., Kokino, S., Ekuklu, G. Comparing stroke rehabilitation outcomes between acute in-patient and non-intense home settings. Arch Phys Med Rehabil2001;82:1375–1379
  58. Ploughman, M., Corbett, D. Can forced-use therapy be clinically applied after stroke? An exploratory randomized controlled trial. Arch Phys Med Rehabil2004;85:1414–1423
  59. Hammer, A.M., Lindmark, B. Effects of forced use on arm function in the subacute phase after stroke: a randomized, clinical pilot study. Phys Ther2009;89:526–539
  60. Boake, C., Noser, E.A., Ro, T. et al, Constraint-induced movement therapy during early stroke rehabilitation. Neurorehabil Neural Repair2007;21:14–24
  61. Dromerick, A.W., Edwards, D.F., Hahn, M., Dromerick, A.W., Edwards, D.F., Hahn, M. Does the application of constraint-induced movement therapy during acute rehabilitation reduce arm impairment after ischemic stroke?. Stroke2000;31:2984–2988
  62. Dromerick, A.W., Lang, C.E., Birkenmeier, R.L. et al, Very early constraint-induced movement during stroke rehabilitation (VECTORS): a single-center RCT. Neurology2009;73:195–201
  63. Liu, K.P., Balderi, K., Leung, T.L. et al, A randomized controlled trial of self-regulated modified constraint-induced movement therapy in sub-acute stroke patients. Eur J Neurol2016;23:1351–1360
  64. Myint, J.M., Yuen, G.F., Yu, T.K. et al, A study of constraint-induced movement therapy in subacute stroke patients in Hong Kong. Clin Rehabil2008;22:112–124
  65. Singh, P., Pradhan, B. Study to assess the effectiveness of modified constraint-induced movement therapy in stroke subjects: a randomized controlled trial. Ann Indian Acad Neurol2013;16:180–184
  66. Stock, R., Thrane, G., Anke, A., Gjone, R., Askim, T. Early versus late-applied constraint-induced movement therapy: a multisite, randomized controlled trial with a 12-month follow-up. Physiother Res Int2018;23
  67. Yu, C., Wang, W., Zhang, Y. et al, The effects of modified constraint-induced movement therapy in acute subcortical cerebral infarction. Front Hum Neurosci2017;11:265
  68. El-Helow, M.R., Zamzam, M.L., Fathalla, M.M. et al, Efficacy of modified constraint-induced movement therapy in acute stroke. Eur J Phys Rehabil Med2015;51:371–379
  69. Thrane, G., Askim, T., Stock, R. et al, Efficacy of constraint-induced movement therapy in early stroke rehabilitation: a randomized controlled multisite trial. Neurorehabil Neural Repair2015;29:517–525
  70. Seok, H., Lee, S.Y., Kim, J., Yeo, J., Kang, H. Can short-term constraint-induced movement therapy combined with visual biofeedback training improve hemiplegic upper limb function of subacute stroke patients?. Ann Rehabil Med2016;40:998–1009
  71. Armagan, O., Tascioglu, F., Oner, C. Electromyographic biofeedback in the treatment of the hemiplegic hand: a placebo-controlled study. Am J Phys Med Rehabil2003;82:856–861
  72. Crow, J.L., Lincoln, N.B., Nouri, F.M., de Weerdt, W. The effectiveness of EMG biofeedback in the treatment of arm function after stroke. Int Disabil Stud1989;11:155–160
  73. Hemmen, B., Seelen, H.A. Effects of movement imagery and electromyography-triggered feedback on arm hand function in stroke patients in the subacute phase. Clin Rehabil2007;21:587–594
  74. Chae, J., Bethoux, F., Bohinc, T., Dobos, L., Davis, T., Friedl, A. Neuromuscular stimulation for upper extremity motor and functional recovery in acute hemiplegia. Stroke1998;29:975–979
  75. Dorsch, S., Ada, L., Canning, C.G. EMG-triggered electrical stimulation is a feasible intervention to apply to multiple arm muscles in people early after stroke, but does not improve strength and activity more than usual therapy: a randomized feasibility trial. Clin Rehabil2014;28:482–490
  76. Heckmann, J., Mokrusch, T., Krockel, A., Warnke, S., von Stockert, W.T., Neundorfer, B. EMG-triggered electrical muscle stimulation in the treatment of central hemiparesis after a stroke. Eur J Phys Rehabil Med1997;7:138–141
  77. Hsu, S.S., Hu, M.H., Wang, Y.H., Yip, P.K., Chiu, J.W., Hsieh, C.L. Dose-response relation between neuromuscular electrical stimulation and upper-extremity function in patients with stroke. Stroke2010;41:821–824
  78. Lin, Z., Yan, T. Long-term effectiveness of neuromuscular electrical stimulation for promoting motor recovery of the upper extremity after stroke. J Rehabil Med2011;43:506–510
  79. Powell, J.P.A., Granat, M., Cameron, M., Stott, D.J. Electrical stimulation of wrist extensors in poststroke hemiplegia. Stroke1999;30:1384–1389
  80. Rosewilliam, S., Malhotra, S., Roffe, C., Jones, P., Pandyan, A.D. Can surface neuromuscular electrical stimulation of the wrist and hand combined with routine therapy facilitate recovery of arm function in patients with stroke?. Arch Phys Med Rehabil2012;93:1715–1721 (.e1)
  81. Shindo, K., Fujiwara, T., Hara, J. et al, Effectiveness of hybrid assistive neuromuscular dynamic stimulation therapy in patients with subacute stroke: a randomized controlled pilot trial. Neurorehabil Neural Repair2011;25:830–837
  82. Wilson, R.D., Page, S.J., Delahanty, M. et al, Upper-limb recovery after stroke: a randomized controlled trial comparing EMG-triggered, cyclic, and sensory electrical stimulation. Neurorehabil Neural Repair2016;30:978–987
  83. Yozbatiran, N., Donmez, B., Kayak, N., Bozan, O. Electrical stimulation of wrist and fingers for sensory and functional recovery in acute hemiplegia. Clin Rehabil2006;20:4–11
  84. Conforto, A.B., Ferreiro, K.N., Tomasi, C. et al, Effects of somatosensory stimulation on motor function after subacute stroke. Neurorehabil Neural Repair2010;24:263–272
  85. Miyasaka, H., Orand, A., Ohnishi, H., Tanino, G., Takeda, K., Sonoda, S. Ability of electrical stimulation therapy to improve the effectiveness of robotic training for paretic upper limbs in patients with stroke. Med Eng Phys2016;38:1172–1175
  86. Ietswaart, M., Johnston, M., Dijkerman, H.C. et al, Mental practice with motor imagery in stroke recovery: randomized controlled trial of efficacy. Brain2011;134:1373–1386
  87. Riccio, I., Iolascon, G., Barillari, M.R., Gimigliano, R., Gimigliano, F. Mental practice is effective in upper limb recovery after stroke: a randomized single-blind cross-over study. Eur J Phys Rehabil Med2010;46:19–25
  88. Liu, H., Song, L.P., Zhang, T. Mental practice combined with physical practice to enhance hand recovery in stroke patients. Behav Neurol2014;2014:876416
  89. Braun, S.M., Beurskens, A.J., Kleynen, M., Oudelaar, B., Schols, J.M., Wade, D.T. A multicenter randomized controlled trial to compare subacute ‘treatment as usual’ with and without mental practice among persons with stroke in Dutch nursing homes. J Am Med Dir Assoc2012;13:85.e1–85.e7
  90. Liu, K.P. Use of mental imagery to improve task generalisation after a stroke. Hong Kong Med J2009;15:37–41
  91. Invernizzi, M., Negrini, S., Carda, S., Lanzotti, L., Cisari, C., Baricich, A. The value of adding mirror therapy for upper limb motor recovery of subacute stroke patients: a randomized controlled trial. Eur J Phys Rehabil Med2013;49:311–317
  92. Lee, M.M., Cho, H.Y., Song, C.H. The mirror therapy program enhances upper-limb motor recovery and motor function in acute stroke patients. Am J Phys Med Rehabil2012;91:689–696
  93. Gurbuz, N., Afsar, S.I., Ayas, S., Cosar, S.N. Effect of mirror therapy on upper extremity motor function in stroke patients: a randomized controlled trial. J Phys Ther Sci2016;28:2501–2506
  94. Radajewska, A., Opara, J., Bilinski, G. et al, Effectiveness of mirror therapy for subacute stroke in relation to chosen factors. Rehabil Nurs2017;42:223–229
  95. Samuelkamaleshkumar, S., Reethajanetsureka, S., Pauljebaraj, P., Benshamir, B., Padankatti, S.M., David, J.A. Mirror therapy enhances motor performance in the paretic upper limb after stroke: a pilot randomized controlled trial. Arch Phys Med Rehabil2014;95:2000–2005
  96. Tyson, S., Wilkinson, J., Thomas, N. et al, Phase II pragmatic randomized controlled trial of patient-led therapies (mirror therapy and lower-limb exercises) during inpatient stroke rehabilitation.Neurorehabil Neural Repair2015;29:818–826
  97. Thieme, H., Bayn, M., Wurg, M., Zange, C., Pohl, M., Behrens, J. Mirror therapy for patients with severe arm paresis after stroke – a randomized controlled trial. Clin Rehabil2013;27:314–324
  98. Dohle, C., Pullen, J., Nakaten, A., Kust, J., Rietz, C., Karbe, H. Mirror therapy promotes recovery from severe hemiparesis: a randomized controlled trial. Neurorehabil Neural Repair2009;23:209–217
  99. Kim, H., Lee, G., Song, C. Effect of functional electrical stimulation with mirror therapy on upper extremity motor function in poststroke patients. J Stroke Cerebrovasc Dis2014;23:655–661
  100. Schick, T., Schlake, H.P., Kallusky, J. et al, Synergy effects of combined multichannel EMG-triggered electrical stimulation and mirror therapy in subacute stroke patients with severe or very severe arm/hand paresis. Restor Neurol Neurosci2017;
  101. Lim, K.B., Lee, H.J., Yoo, J., Yun, H.J., Hwang, H.J. Efficacy of mirror therapy containing functional tasks in poststroke patients. Ann Rehabil Med2016;40:629–636
  102. Donaldson, C., Tallis, R., Miller, S., Sunderland, A., Lemon, R., Pomeroy, V. Effects of conventional physical therapy and functional strength training on upper limb motor recovery after stroke: a randomized phase II study. Neurorehabil Neural Repair2009;23:389–397
  103. Han, C., Wang, Q., Meng, P.P., Qi, M.Z. Effects of intensity of arm training on hemiplegic upper extremity motor recovery in stroke patients: a randomized controlled trial. Clin Rehabil2013;27:75–81
  104. Harris, J.E., Eng, J.J., Miller, W.C., Dawson, A.S. A self-administered Graded Repetitive Arm Supplementary Program (GRASP) improves arm function during inpatient stroke rehabilitation: a multi-site randomized controlled trial. Stroke2009;40:2123–2128
  105. Kong, K.H., Loh, Y.J., Thia, E. et al, Efficacy of a virtual reality commercial gaming device in upper limb recovery after stroke: a randomized, controlled study. Top Stroke Rehabil2016;23:333–340
  106. Kwakkel, G., Wagenaar, R.C., Twisk, J.W., Lankhorst, G.J., Koetsier, J.C. Intensity of leg and arm training after primary middle-cerebral-artery stroke: a randomised trial. Lancet1999;354:191–196
  107. Glasgow Augmented Physiotherapy Study (GAPS) Group. Can augmented physiotherapy input enhance recovery of mobility after stroke? A randomized controlled trial. Clin Rehabil2004;18:529–537
  108. Yelnik, A.P., Quintaine, V., Andriantsifanetra, C. et al, AMOBES (Active Mobility Very Early After Stroke): a randomized controlled trial. Stroke2017;48:400–405
  109. Platz, T., van Kaick, S., Mehrholz, J., Leidner, O., Eickhof, C., Pohl, M. Best conventional therapy versus modular impairment-oriented training for arm paresis after stroke: a single-blind, multicenter randomized controlled trial. Neurorehabil Neural Repair2009;23:706–716
  110. Schneider, S., Schonle, P.W., Altenmuller, E., Munte, T.F. Using musical instruments to improve motor skill recovery following a stroke. J Neurol2007;254:1339–1346
  111. Schneider, S., Münte, T., Rodriguez-Fornells, A., Sailer, M., Altenmuller, E. Music-supported training is more efficient than functional motor training for recovery of fine motor skills in stroke patients.Music Perception2010;27:271–280
  112. Jun, E.M., Roh, Y.H., Kim, M.J. The effect of music-movement therapy on physical and psychological states of stroke patients. J Clin Nurs2013;22:22–31
  113. Masiero, S., Celia, A., Rosati, G., Armani, M. Robotic-assisted rehabilitation of the upper limb after acute stroke. Arch Phys Med Rehabil2007;88:142–149
  114. Fasoli, S.E., Krebs, H.I., Ferraro, M., Hogan, N., Volpe, B.T. Does shorter rehabilitation limit potential recovery poststroke?. Neurorehabil Neural Repair2004;18:88–94
  115. Masiero, S., Celia, A., Armani, M., Rosati, G. A novel robot device in rehabilitation of post-stroke hemiplegic upper limbs. Aging Clin Exp Res2006;18:531–535
  116. Aisen, M.L., Krebs, H.I., Hogan, N., McDowell, F., Volpe, B.T. The effect of robot-assisted therapy and rehabilitative training on motor recovery following stroke. Arch Neurol1997;54:443–446
  117. Volpe, B., Krebs, H., Hogan, N., Edelstein, L., Diels, C., Aisen, M. A novel approach to stroke rehabilitation robot-aided sensorimotor stimulation. Neurology2000;54:1938–1944
  118. Burgar, C.G., Lum, P.S., Scremin, A.M. et al, Robot-assisted upper-limb therapy in acute rehabilitation setting following stroke: Department of Veterans Affairs multisite clinical trial. J Rehabil Res Dev2011;48:445–458
  119. Hesse, S., Heß, A., Werner, C.C., Kabbert, N., Buschfort, R. Effect on arm function and cost of robot-assisted group therapy in subacute patients with stroke and a moderately to severely affected arm: a randomized controlled trial. Clin Rehabil2014;28:637–647
  120. Hsieh, Y.W., Wu, C.Y., Wang, W.E. et al, Bilateral robotic priming before task-oriented approach in subacute stroke rehabilitation: a pilot randomized controlled trial. Clin Rehabil2017;31:225–233
  121. Lee, K.W., Kim, S.B., Lee, J.H., Lee, S.J., Yoo, S.W. Effect of upper extremity robot-assisted exercise on spasticity in stroke patients. Ann Rehabil Med2016;40:961–971
  122. Masiero, S., Armani, M., Rosati, G. Upper-limb robot-assisted therapy in rehabilitation of acute stroke patients: focused review and results of new randomized controlled trial. J Rehabil Res Dev2011;48:355–366
  123. Rabadi, M., Galgano, M., Lynch, D., Akerman, M., Lesser, M., Volpe, B. A pilot study of activity-based therapy in the arm motor recovery post stroke: a randomized controlled trial. Clin Rehabil2008;22:1071–1082
  124. Sale, P., Franceschini, M., Mazzoleni, S., Palma, E., Agosti, M., Posteraro, F. Effects of upper limb robot-assisted therapy on motor recovery in subacute stroke patients. J Neuroeng Rehabil2014;11:104
  125. Takahashi, K., Domen, K., Sakamoto, T. et al, Efficacy of upper extremity robotic therapy in subacute poststroke hemiplegia: an exploratory randomized trial. Stroke2016;47:1385–1388
  126. Wolf, S.L., Sahu, K., Bay, R.C. et al, The HAAPI (Home Arm Assistance Progression Initiative) Trial: a novel robotics delivery approach in stroke rehabilitation. Neurorehabil Neural Repair2015;29:958–968
  127. Qian, Q., Hu, X., Lai, Q., Ng, S.C., Zheng, Y., Poon, W. Early stroke rehabilitation of the upper limb assisted with an electromyography-driven neuromuscular electrical stimulation-robotic arm. Front Neurol2017;8:447
  128. Winstein, C.J., Rose, D.K., Tan, S.M., Lewthwaite, R., Chui, H.C., Azen, S.P. A randomized controlled comparison of upper-extremity rehabilitation strategies in acute stroke: a pilot study of immediate and long-term outcomes. Arch Phys Med Rehabil2004;85:620–628
  129. Blennerhassett, J., Dite, W. Additional task-related practice improves mobility and upper limb function early after stroke: a randomised controlled trial. Aust J Physiother2004;50:219–224
  130. Hubbard, I.J., Carey, L.M., Budd, T.W. et al, A randomized controlled trial of the effect of early upper-limb training on stroke recovery and brain activation. Neurorehabil Neural Repair2015;29:703–713
  131. Arya, K., Verma, R., Garg, R., Sharma, V., Agarwal, M., Aggarwal, G. Meaningful task-specific training (MTST) for stroke rehabilitation: a randomized controlled trial. Top Stroke Rehabil2012;19:193–211
  132. Desrosiers, J., Bourbonnais, D., Corriveau, H., Gosselin, S., Bravo, G. Effectiveness of unilateral and symmetrical bilateral task training for arm during the subacute phase after stroke: a randomized controlled trial. Clin Rehabil2005;19:581–593
  133. Gelber, D.A., Josefczyk, P.B., Herrman, D., Good, D.C., Verhulst, S.J. Comparison of two therapy approaches in the rehabilitation of the pure motor hemiparetic stroke patient. Neurorehabil Neural Repair1995;9:191–196
  134. Langhammer, B., Stanghelle, J.K. Bobath or motor relearning programme? A comparison of two different approaches of physiotherapy in stroke rehabilitation: a randomized controlled study. Clin Rehabil2000;14:361–369
  135. van Vliet, P.M., Lincoln, N.B., Foxall, A. Comparison of Bobath based and movement science based treatment for stroke: a randomised controlled trial. J Neurol Neurosurg Psychiatry2005;76:503–508
  136. Winstein, C.J., Wolf, S.L., Dromerick, A.W. et al, Effect of a task-oriented rehabilitation program on upper extremity recovery following motor stroke: the ICARE randomized clinical trial. JAMA2016;315:571–581
  137. Kwon, J.-S., Park, M.-J., Yoon, I.-J., Park, S.-H. Effects of virtual reality on upper extremity function and activities of daily living performance in acute stroke: a double-blind randomized clinical trial.NeuroRehabilitation2012;31:379–385
  138. Bower, K.J., Clark, R.A., McGinley, J.L., Martin, C.L., Miller, K.J. Clinical feasibility of the Nintendo Wii for balance training post-stroke: a phase II randomized controlled trial in an inpatient setting. Clin Rehabil2014;28:912–923
  139. Choi, J.H., Han, E.Y., Kim, B.R. et al, Effectiveness of commercial gaming-based virtual reality movement therapy on functional recovery of upper extremity in subacute stroke patients. Ann Rehabil Med2014;38:485–493
  140. Adie, K., Schofield, C., Berrow, M. et al, Does the use of Nintendo Wii Sports(TM) improve arm function? Trial of Wii(TM) in Stroke: a randomized controlled trial and economics analysis. Clin Rehabil2017;31:173–185
  141. Saposnik, G., Cohen, L.G., Mamdani, M. et al, Efficacy and safety of non-immersive virtual reality exercising in stroke rehabilitation (EVREST): a randomised, multicentre, single-blind, controlled trial.Lancet Neurol2016;15:1019–1027
  142. Saposnik, G., Teasell, R., Mamdani, M. et al, Effectiveness of virtual reality using Wii gaming technology in stroke rehabilitation. Stroke2010;41:1477–1484
  143. Prange, G.B., Kottink, A.I., Buurke, J.H. et al, The effect of arm support combined with rehabilitation games on upper-extremity function in subacute stroke: a randomized controlled trial.Neurorehabil Neural Repair2015;29:174–182
  144. Duncan, P.W., Sullivan, K.J., Behrman, A.L. et al, Body-weight–supported treadmill rehabilitation after stroke. N Engl J Med2011;364:2026–2036
  145. Mackay-Lyons, M., McDonald, A., Matheson, J., Eskes, G., Klus, M.A. Dual effects of body-weight supported treadmill training on cardiovascular fitness and walking ability early after stroke: a randomized controlled trial. Neurorehabil Neural Repair2013;27:644–653
  146. Mao, Y.R., Lo, W.L., Lin, Q. et al, The effect of body weight support treadmill training on gait recovery, proximal lower limb motor pattern, and balance in patients with subacute stroke. Biomed Res Int2015;2015:175719
  147. Nilsson, L., Carlsson, J., Danielsson, A. et al, Walking training of patients with hemiparesis at an early stage after stroke: a comparison of walking training on a treadmill with body weight support and walking training on the ground. Clin Rehabil2001;15:515–527
  148. Galvin, R., Cusack, T., O’Grady, E., Murphy, T.B., Stokes, E. Family-mediated exercise intervention (FAME): evaluation of a novel form of exercise delivery after stroke. Stroke2011;42:681–686
  149. van den Berg, M., Crotty, M.P., Liu, E., Killington, M., Kwakkel, G.P., van Wegen, E. Early supported discharge by caregiver-mediated exercises and e-health support after stroke: a proof-of-concept trial. Stroke2016;47:1885–1892
  150. Choi, J.H., Kim, B.R., Han, E.Y., Kim, S.M. The effect of dual-task training on balance and cognition in patients with subacute post-stroke. Ann Rehabil Med2015;39:81–90
  151. Wang, Y.H., Meng, F., Zhang, Y., Xu, M.Y., Yue, S.W. Full-movement neuromuscular electrical stimulation improves plantar flexor spasticity and ankle active dorsiflexion in stroke patients: a randomized controlled study. Clin Rehabil2016;30:577–586
  152. Winchester, P., Montgomery, J., Bowman, B., Hislop, H. Effects of feedback stimulation training and cyclical electrical stimulation on knee extension in hemiparetic patients. Phys Ther1983;63:1096–1103
  153. Yan, T., Hui-Chan, C.W., Li, L.S. Functional electrical stimulation improves motor recovery of the lower extremity and walking ability of subjects with first acute stroke: a randomized placebo-controlled trial. Stroke2005;36:80–85
  154. Ambrosini, E., Ferrante, S., Pedrocchi, A., Ferrigno, G., Molteni, F. Cycling induced by electrical stimulation improves motor recovery in postacute hemiparetic patients: a randomized controlled trial. Stroke2011;42:1068–1073
  155. Ferrante, S., Pedrocchi, A., Ferrigno, G., Molteni, F. Cycling induced by functional electrical stimulation improves the muscular strength and the motor control of individuals with post-acute stroke. Europa Medicophysica-SIMFER 2007 Award Winner. Eur J Phys Rehabil Med2008;44:159–167
  156. Yavuzer, G., Geler-Kulcu, D., Sonel-Tur, B., Kutlay, S., Ergin, S., Stam, H.J. Neuromuscular electric stimulation effect on lower-extremity motor recovery and gait kinematics of patients with stroke: a randomized controlled trial. Arch Phys Med Rehabil2006;87:536–540
  157. Lee, H.J., Cho, K.H., Lee, W.H. The effects of body weight support treadmill training with power-assisted functional electrical stimulation on functional movement and gait in stroke patients. Am J Phys Med Rehabil2013;92:1051–1059
  158. Bauer, P., Krewer, C., Golaszewski, S., Koenig, E., Muller, F. Functional electrical stimulation-assisted active cycling–therapeutic effects in patients with hemiparesis from 7 days to 6 months after stroke: a randomized controlled pilot study. Arch Phys Med Rehabil2015;96:188–196
  159. Macdonell, R.A., Triggs, W.J., Leikauskas, J. et al, Functional electrical stimulation to the affected lower limb and recovery after cerebral infarction. J Stroke Cerebrovasc Dis1994;4:155–160
  160. Morone, G., Fusco, A., Di Capua, P., Coiro, P., Pratesi, L. Walking training with foot drop stimulator controlled by a tilt sensor to improve walking outcomes: a randomized controlled pilot study in patients with stroke in subacute phase. Stroke Res Treat2012;2012:523564
  161. Ng, M.F., Tong, R.K., Li, L.S. A pilot study of randomized clinical controlled trial of gait training in subacute stroke patients with partial body-weight support electromechanical gait trainer and functional electrical stimulation. Stroke2008;39:154–160
  162. Xu, Q., Guo, F., Salem, H.M.A., Chen, H., Huang, X. Effects of mirror therapy combined with neuromuscular electrical stimulation on motor recovery of lower limbs and walking ability of patients with stroke: a randomized controlled study. Clin Rehabil2017;31:1583–1591
  163. Yan, T., Hui-Chan, C.W. Transcutaneous electrical stimulation on acupuncture points improves muscle function in subjects after acute stroke: a randomized controlled trial. J Rehabil Med2009;41:312–316
  164. Yavuzer, G., Oken, O., Atay, M.B., Stam, H.J. Effect of sensory-amplitude electric stimulation on motor recovery and gait kinematics after stroke: a randomized controlled study. Arch Phys Med Rehabil2007;88:710–714
  165. Cooke, E.V., Tallis, R.C., Clark, A., Pomeroy, V.M. Efficacy of functional strength training on restoration of lower-limb motor function early after stroke: phase I randomized controlled trial.Neurorehabil Neural Repair2010;24:88–96
  166. Kerr, A., Clark, A., Cooke, E.V., Rowe, P., Pomeroy, V.M. Functional strength training and movement performance therapy produce analogous improvement in sit-to-stand early after stroke: early-phase randomised controlled trial. Physiotherapy2017;103:259–265
  167. Wang, R., Chen, H., Chen, C., Yang, Y. Efficacy of Bobath versus orthopaedic approach on impairment and function at different motor recovery stages after stroke: a randomized controlled study. Clin Rehabil2005;19:155–164
  168. Mohan, U., Babu, S.K., Kumar, K.V., Suresh, B.V., Misri, Z.K., Chakrapani, M. Effectiveness of mirror therapy on lower extremity motor recovery, balance and mobility in patients with acute stroke: a randomized sham-controlled pilot trial. Ann Indian Acad Neurol2013;16:634–639
  169. Sutbeyaz, S., Yavuzer, G., Sezer, N., Koseoglu, B.F. Mirror therapy enhances lower-extremity motor recovery and motor functioning after stroke: a randomized controlled trial. Arch Phys Med Rehabil2007;88:555–559
  170. Forrester, L.W., Roy, A., Krywonis, A., Kehs, G., Krebs, H.I., Macko, R.F. Modular ankle robotics training in early subacute stroke: a randomized controlled pilot study. Neurorehabil Neural Repair2014;28:678–687
  171. Chang, W.H., Kim, M.S., Huh, J.P., Lee, P.K., Kim, Y.-H. Effects of robot-assisted gait training on cardiopulmonary fitness in subacute stroke patients: a randomized controlled study. Neurorehabil Neural Repair2012;26:318–324
  172. Han, E.Y., Im, S.H., Kim, B.R., Seo, M.J., Kim, M.O. Robot-assisted gait training improves brachial–ankle pulse wave velocity and peak aerobic capacity in subacute stroke patients with totally dependent ambulation: randomized controlled trial. Medicine2016;95
  173. Morone, G., Bragoni, M., Iosa, M. et al, Who may benefit from robotic-assisted gait training? A randomized clinical trial in patients with subacute stroke. Neurorehabil Neural Repair2011;25:636–644
  174. Pohl, M., Werner, C., Holzgraefe, M. et al, Repetitive locomotor training and physiotherapy improve walking and basic activities of daily living after stroke: a single-blind, randomized multicentre trial (DEutsche GAngtrainerStudie, DEGAS). Clin Rehabil2007;21:17–27
  175. van Nunen, M.P., Gerrits, K.H., Konijnenbelt, M., Janssen, T.W., de Haan, A. Recovery of walking ability using a robotic device in subacute stroke patients: a randomized controlled study. Disabil Rehabil Assist Technol2015;10:141–148
  176. Watanabe, H., Tanaka, N., Inuta, T., Saitou, H., Yanagi, H. Locomotion improvement using a hybrid assistive limb in recovery phase stroke patients: a randomized controlled pilot study. Arch Phys Med Rehabil2014;95:2006–2012
  177. Kim, C.Y., Lee, J.S., Kim, H.D., Kim, J., Lee, I.H. Lower extremity muscle activation and function in progressive task-oriented training on the supplementary tilt table during stepping-like movements in patients with acute stroke hemiparesis. J Electromyogr Kinesiol2015;25:522–530
  178. McEwen, D., Taillon-Hobson, A., Bilodeau, M., Sveistrup, H., Finestone, H. Virtual reality exercise improves mobility after stroke an inpatient randomized controlled trial. Stroke2014;45:1853–1855
  179. Guo, C., Mi, X., Liu, S. et al, Whole body vibration training improves walking performance of stroke patients with knee hyperextension: a randomized controlled pilot study. CNS Neurol Disord Drug Targets2015;14:1110–1115
  180. van Nes, I.J., Latour, H., Schils, F., Meijer, R., van Kuijk, A., Geurts, A.C. Long-term effects of 6-week whole-body vibration on balance recovery and activities of daily living in the postacute phase of stroke: a randomized, controlled trial. Stroke2006;37:2331–2335

via Effectiveness and Superiority of Rehabilitative Treatments in Enhancing Motor Recovery Within 6 Months Poststroke: A Systemic Review – Archives of Physical Medicine and Rehabilitation

, , , , , ,

Leave a comment

%d bloggers like this: