[Abstract] Implementing technology enhanced real-time action observation therapy in persons with chronic stroke: A pilot study

ABSTRACT

This pilot study examined a novel technology-enhanced real-time action observation therapy (TERTAOT) of symmetrical bilateral movements in survivors of chronic stroke regardless of their ability to move their paretic limb(s). The TERTAOT used a Kinect XBox One to project mirror images of non-paretic limbs as participants performed symmetrical bilateral motor tasks involving whole-body movements in sitting or standing. The participants received eight weeks of treatment consisting of 30-minutes of conventional physical therapy (balance training, gait training, neuromuscular reeducation, and generalized strength training) and 30-minutes of the TERTAOT protocol per session (three sessions per week for a total of 24 sessions). Ten Meter Walk Test (10MWT), Five Times Sit-to-Stand (5TSTS), Timed Up and Go (TUG), Motor Activity Log – Quality of Movement (QOM) and Amount of Use (AOU) were administered at baseline (pretest), 4 weeks (posttest 1) and 8 weeks (posttest 2) post-TERTAOT, and 3 months after TERTAOT ended (retention). A General Linear Model Repeated Measures (parametric test) or the Friedman Test (non-parametric test) was used to compare outcomes across time points, depending on the normality of data distribution. Bonferroni post-hoc corrections were applied. Seventeen participants completed >80% of TERTAOT sessions without adverse events. The effect of time was significant for 10MWT (p = .001), 5TSTS (p = .001), TUG (p = .005), QOM (p = .001), and AOU (p = .017). TERTAOT may be feasible to be implemented in an outpatient setting. Improvements in functional outcomes including gait, balance, and use of upper limbs were observed after eight weeks of conventional therapy and TERTAOT protocol in survivors of chronic stroke.

Source

[Abstract] The comparative efficacy of theta burst stimulation or functional electrical stimulation when combined with physical therapy after stroke: a randomized controlled trial

Abstract

Objective: To study the long-term effectiveness of Theta Burst Stimulation (TBS) or Functional Electrical Stimulation (FES) combined with Physical therapy (PT) as compared to PT alone for improving arm functions in patients with acute stroke.

Design: Single blind randomized controlled trial.

Setting: Outpatient clinics and inpatient wards at tertiary care neurology center.

Subjects: Adult patients with acute middle cerebral artery territory ischemic stroke.

Interventions: 60 patients were randomized into three groups of 20 each: TBS+PT; FES+PT; and PT alone. TBS group received intermittent TBS of ipsilesional hemisphere and continuous TBS of contralesional hemisphere while FES group received FES of paretic limb, both for four weeks. All groups received supervised physical therapy for four weeks followed by home physiotherapy for one year.

Outcome measures: Fugl Meyer Assessment upper limb score (FMA-UL) was primary outcome measure. Patients were evaluated at baseline and subsequently at one, three and six months and one year.

Results: Compared to PT group, mean FMA-UL scores were higher in TBS and FES groups at all follow-ups (P < 0.001). From baseline to one year, mean (SD) FMA-UL scores increased from 14.9(2.1) to 55.55(2.46) in TBS group, 15.5(1.99) to 55.85(2.46) in FES group, and 14.3(2.2) to 43.3(4.22) in PT group indicating an increase of 273%, 260%, and 203% respectively. There was no difference between FES and TBS groups.

Conclusion: A four-week intervention with TBS or FES combined with PT produces better long-term arm functions as compared to PT alone in patients with acute stroke.

via The comparative efficacy of theta burst stimulation or functional electrical stimulation when combined with physical therapy after stroke: a randomized controlled trial – Fayaz Khan, Chaturbhuj Rathore, Mahesh Kate, Josy Joy, George Zachariah, P C Vincent, Ravi Prasad Varma, Kurupath Radhakrishnan, 2019

[WEB SITE] Study Examines Exoskeleton’s Ability to Improve Walking for Stroke Patients

Conor Walsh and his graduate student, Jaehyun Bae, fine-tune an ankle-assisting exosuit. (Photo courtesy of Rolex Awards/Fred Merz)

A study published recently in Science Translational Medicine suggests that the use of a soft suit exoskeleton system helps aid in the facilitation of walking ability among ambulatory patients following a stroke.

Researchers from Harvard University’s Wyss Institute for Biologically Inspired Engineering, the Harvard John A. Paulson School of Engineering and Applied Sciences (SEAS), and Boston University’s (BU) College of Health & Rehabilitation Sciences: Sargent College developed the lightweight, soft, wearable ankle-assisting exosuit, and they they suggest in the study that it could help reinforce normal gait in people with hemiparesis after stroke.

The study centers on the use of the exosuit among nine participants, each of whom recently experienced a stroke, and examines the immediate improvements in walking capability that could be obtained when wearing the suit, dubbed the Restore system, according to a media release from ReWalk Robotics Ltd.

According to the release, the study concludes that improvements in paretic limb function contributed to a 20 +/- 4% reduction in forward propulsion interlimb asymmetry and a 10 +/- 3% reduction in the energy cost of walking, which is equivalent to a 32+/- 9% reduction in the metabolic burden associated with poststroke walking.  Relatively low assistance (~12% of biological torques) delivered with a lightweight and nonrestrictive exosuit was sufficient to facilitate more normal walking in ambulatory individuals after stroke.

“This foundational study shows that soft wearable robots can have significant positive impact on gait functions in patients post-stroke, and it is the result of a translational-focused multidisciplinary team of engineers, designers, biomechanists, physical therapists, and most importantly patients who volunteered for this study and gave valuable feedback that guided our research,” says Wyss Core Faculty member Conor Walsh, who is also the John L. Loeb Associate Professor of Engineering and Applied Sciences at SEAS and the Founder of the Harvard Biodesign Lab, in the release.

ReWalk is working with the Wyss Institute on the development of lightweight designs to complete clinical studies, pursue regulatory approvals, and commercialize the systems on a global scale. The first commercial application will be for stroke survivors, followed by Multiple Sclerosis patients and then additional applications.

“Exoskeletons are now a commercially available, disruptive technology that have changed the lives of many individuals in the paraplegic community,” states ReWalk CEO Larry Jasinski, in the release. “The ongoing research at the Wyss Institute on soft exosuits adds a new dimension to exoskeletons that can potentially meet the needs of individuals that have had a stroke, as well as for those diagnosed with Multiple Sclerosis, Parkinson’s disease or people who have limitations in walking.”

[Source(s): ReWalk Robotics Ltd, PR Newswire, Science Daily]

Source: Study Examines Exoskeleton’s Ability to Improve Walking for Stroke Patients – Rehab Managment

[Abstract] Strength of knee flexors of the paretic limb as an important determinant of functional status in post-stroke rehabilitation

Abstract

Objective

The purpose of the study was to assess the effectiveness of the multi-modal exercise program (MMEP) in patients after stroke, and to identify muscles that are the best predictors of functional performance and changes in functional status in a 3-week rehabilitation program.

Methods

Thirty-one post-stroke patients (60.6 ± 12.7 years) participating in a 3-week MMEP took part in the study. Measurements of extensor and flexor strength of the knee (F_ext, F_flex) were done. Functional performance was measured using Timed Up & Go test (TUG), 6-Minute Walk Test (6-MWT) and Tinetti Test.

Results

The rehabilitation program improved all the results of functional tests, as well as the values of strength in the patients. Both baseline and post-rehabilitation functional status was associated with knee flexor and extensor muscle strength of paretic but not of non-paretic limbs. At baseline examination muscle strength difference between both F_flex kg⁻¹and F_ext kg⁻¹ had an influence on functional status. After rehabilitation the effect of muscle strength difference on functional status was not evident for F_ext kg⁻¹ and, interestingly, even more prominent for F_flex kg⁻¹.

Conclusions

MMEP can effectively increase muscle strength and functional capacity in post-stroke patients. Knee flexor muscle strength of the paretic limb and the knee flexor difference between the limbs is the best predictor of functional performance in stroke survivors

Source: Strength of knee flexors of the paretic limb as an important determinant of functional status in post-stroke rehabilitation