Posts Tagged plasticity

[ARTICLE] Guided Self-rehabilitation Contract vs conventional therapy in chronic stroke-induced hemiparesis: NEURORESTORE, a multicenter randomized controlled trial – Full Text

Abstract

Background

After discharge from hospital following a stroke, prescriptions of community-based rehabilitation are often downgraded to “maintenance” rehabilitation or discontinued. This classic therapeutic behavior stems from persistent confusion between lesion-induced plasticity, which lasts for the first 6 months essentially, and behavior-induced plasticity, of indefinite duration, through which intense rehabilitation might remain effective. This prospective, randomized, multicenter, single-blind study in subjects with chronic stroke-induced hemiparesis evaluates changes in active function with a Guided Self-rehabilitation Contract vs conventional therapy alone, pursued for a year.

Methods

One hundred and twenty four adult subjects with chronic hemiparesis (> 1 year since first stroke) will be included in six tertiary rehabilitation centers. For each patient, two treatments will be compared over a 1-year period, preceded and followed by an observational 6-month phase of conventional rehabilitation. In the experimental group, the therapist will implement the diary-based and antagonist-targeting Guided Self-rehabilitation Contract method using two monthly home visits. The method involves: i) prescribing a daily antagonist-targeting self-rehabilitation program, ii) teaching the techniques involved in the program, iii) motivating and guiding the patient over time, by requesting a diary of the work achieved to be brought back by the patient at each visit. In the control group, participants will benefit from conventional therapy only, as per their physician’s prescription.

The two co-primary outcome measures are the maximal ambulation speed barefoot over 10 m for the lower limb, and the Modified Frenchay Scale for the upper limb. Secondary outcome measures include total cost of care from the medical insurance point of view, physiological cost index in the 2-min walking test, quality of life (SF 36) and measures of the psychological impact of the two treatment modalities. Participants will be evaluated every 6 months (D1/M6/M12/M18/M24) by a blinded investigator, the experimental period being between M6 and M18. Each patient will be allowed to receive any medications deemed necessary to their attending physician, including botulinum toxin injections.

Discussion

This study will increase the level of knowledge on the effects of Guided Self-rehabilitation Contracts in patients with chronic stroke-induced hemiparesis.

Background

The most common motor deficit following stroke is spastic hemiparesis [1]. More than 90% of patients with hemiparesis recover some lower limb function after a stroke, but rarely with a level of ease or speed that would allow for independent and comfortable ambulation in everyday life, outdoors in particular [123]. In the upper limb, the proportion of patients that recover daily use of the arm is estimated between 10 and 30% [45678]. Consequently, around half of stroke survivors do not resume professional activities, and two thirds remain chronically disabled [9].

In parallel, most patients in chronic stages have their rehabilitation discontinued or converted into “maintenance” therapy, as professionals often estimate that they might no longer progress [7101112131415]. Others benefit from reinduction periods, prescribed according to subjective or ill-defined criteria. It has not been demonstrated that this conventional rehabilitation system now fits current knowledge on behavior-induced brain plasticity and on the potential for motor recovery in chronic spastic paresis [161718]. Indeed, a significant body of evidence demonstrates that high intensity of rehabilitation (the opposite of “maintenance therapy”) correlates with motor function improvement in chronic stages [161920]. One way to achieve sufficient amounts of physical treatment might be to adequately guide and motivate the patient into practicing self-rehabilitation [1820]. It has been confirmed that programs of exercises given by the therapist to be performed at home are appreciated by patients not only for the structure they give to everyday life, but also as they represent in themselves a source of motivation and hope, particularly when these programs are associated with ongoing professional support [2122].

We hypothesize that there is confusion between the lesion-induced plasticity of the central nervous system – essentially during the first 6 months post-lesion – and the behavior-induced plasticity, which lasts indefinitely [16172324252627]. The latter justifies initiatives to organize chronic and intense physical rehabilitation work [1718232425262728]. Even though previous, short-term open studies evaluating self-rehabilitation programs in spastic hemiparesis suggested the possibility of functional improvement, to our knowledge there are no large-scale prospective randomized controlled protocols that test the effectiveness of long term self-rehabilitation programs in spastic hemiparesis as against conventional rehabilitation systems, especially in chronic stages [2930313233343536].

Technically, which home rehabilitation exercises might be recommended? From a neurophysiological point of view, muscle overactivity chronologically emerges as the third fundamental feature of motor impairment that begins in the subacute phase in hemiparesis, following paresis and soft tissue contracture that appear in the acute phase [373839]. One recognizable form of muscle overactivity is spasticity (hyper-reflectivity to phasic stretch), which is potentiated by muscle shortening [3738]. Hypersensitivity to stretch in an antagonist muscle also impedes voluntary motoneurone recruitment for the agonist muscle, a phenomenon called “stretch-sensitive paresis” [40]. As none of the three fundamental mechanisms of motor impairment (paresis, muscle shortening, and muscle overactivity) is distributed symmetrically between agonists and antagonists, there are force imbalances around joints, hindering active movements and deforming body postures [41]. Each of these three mechanisms of impairment, particularly the two most important, which are muscle shortening and muscle overactivity, can be specifically targeted with local treatment, muscle by muscle, aiming to rebalance forces, joint by joint [28]. For the less overactive muscles around each joint, an intensive motor training will aim to break the vicious cycle Paresis-Disuse-Paresis [37]. For their shortened and more overactive antagonists most importantly, a daily program of self-stretch postures at high load combined with a program of maximal amplitude rapid alternating movements, potentially associated with botulinum toxin injections, will aim to increase muscle extensibility and reduce cocontraction, breaking the vicious cycle: Muscle shortening-Overactivity-Muscle shortening [284243] (www.i-gsc.com). Significant preliminary results obtained using prescription and teaching of self-rehabilitation programs within a Guided Self-rehabilitation Contract (GSC) led us to hypothesize that this method practiced over the long term might enhance active motor function in chronic hemiparesis beyond 1 year following stroke [184445464748].

From a social point of view, stroke is the leading cause of acquired disability in Western countries. For the Steering Committee on Stroke Prevention and Management in France, the yearly cost of stroke is €5.9 billions, the cost of care in medical and social facilities is €2.4 billions and the cost of daily allowances and disability pensions is €125.8 millions [49]. Additionally, several studies have shown that indirect costs were proportional to direct costs [50]. Stroke thus accounts for a large share of health expenditures. In that regard as well, devising a feasible and effective guided self-rehabilitation program might offer financial advantages for our health systems.[…]

 

Continue —> Guided Self-rehabilitation Contract vs conventional therapy in chronic stroke-induced hemiparesis: NEURORESTORE, a multicenter randomized controlled trial | BMC Neurology | Full Text

Fig. 2

Fig. 2Template of diary in Guided Self-rehabilitation Contract

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[WEB SITE] Electrical stimulation in brain bypasses senses, instructs movement

Date:December 7, 2017
Source:University of Rochester Medical Center
Summary:The brain’s complex network of neurons enables us to interpret and effortlessly navigate and interact with the world around us. But when these links are damaged due to injury or stroke, critical tasks like perception and movement can be disrupted. New research is helping scientists figure out how to harness the brain’s plasticity to rewire these lost connections, an advance that could accelerate the development of neuro-prosthetics.
FULL STORY

The brain’s complex network of neurons enables us to interpret and effortlessly navigate and interact with the world around us. But when these links are damaged due to injury or stroke, critical tasks like perception and movement can be disrupted. New research is helping scientists figure out how to harness the brain’s plasticity to rewire these lost connections, an advance that could accelerate the development of neuro-prosthetics.

A new study authored by Marc Schieber, M.D., Ph.D., and Kevin Mazurek, Ph.D. with the University of Rochester Medical Center Department of Neurology and the Del Monte Institute for Neuroscience, which appears in the journal Neuron, shows that very low levels of electrical stimulation delivered directly to an area of the brain responsible for motor function can instruct an appropriate response or action, essentially replacing the signals we would normally receive from the parts of the brain that process what we hear, see, and feel.

“The analogy is what happens when we approach a red light,” said Schieber. “The light itself does not cause us to step on the brake, rather our brain has been trained to process this visual cue and send signals to another parts of the brain that control movement. In this study, what we describe is akin to replacing the red light with an electrical stimulation which the brain has learned to associate with the need to take an action that stops the car.”

The findings could have significant implications for the development of brain-computer interfaces and neuro-prosthetics, which would allow a person to control a prosthetic device by tapping into the electrical activity of their brain.

To be effective, these technologies must not only receive output from the brain but also deliver input. For example, can a mechanical arm tell the user that the object they are holding is hot or cold? However, delivering this information to the part of the brain responsible for processing sensory inputs does not work if this part of the brain is injured or the connections between it and the motor cortex are lost. In these instances, some form of input needs to be generated that replaces the signals that combine sensory perception with motor control and the brain needs to “learn” what these new signals mean.

“Researchers have been interested primarily in stimulating the primary sensory cortices to input information into the brain,” said Schieber. “What we have shown in this study is that you don’t have to be in a sensory-receiving area in order for the subject to have an experience they can identify.”

A similar approach is employed with cochlear implants for hearing loss which translate sounds into electrical stimulation of the inner ear and, over time, the brain learns to interpret these inputs as sound.

In the new study, the researchers detail a set of experiments in which monkeys were trained to perform a task when presented with a visual cue, either turning, pushing, or pulling specific objects when prompted by different lights. While this occurred, the animals simultaneously received a very mild electrical stimulus called a micro-stimulation in different areas of the premotor cortex — the part of the brain that initiates movement — depending upon the task and light combination.

The researchers then replicated the experiments, but this time omitted the visual cue of the lights and instead only delivered the micro-stimulation. The animals were able to successfully identify and perform the tasks they had learned to associate with the different electrical inputs. When the pairing of micro-stimulation with a particular action was reshuffled, the animals were able to adjust, indicating that the association between stimulation and a specific movement was learned and not fixed.

“Most work on the development of inputs to the brain for use with brain-computer interfaces has focused primarily on the sensory areas of the brain,” said Mazurek. “In this study, we show you can expand the neural real estate that can be targeted for therapies. This could be very important for people who have lost function in areas of their brain due to stroke, injury, or other diseases. We can potentially bypass the damaged part of the brain where connections have been lost and deliver information to an intact part of the brain.”

Story Source:

Materials provided by University of Rochester Medical CenterNote: Content may be edited for style and length.

 

via Electrical stimulation in brain bypasses senses, instructs movement — ScienceDaily

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[VIDEO] Post Stroke Foot Dorsiflexion: Using Electrical Stimulation to Reduce Tone & Promote Plasticity – YouTube

Further reading on electrophysiology and muscle contractions: http://strokemed.com/motor-behaviour-…

via  Post Stroke Foot Dorsiflexion: Using Electrical Stimulation to Reduce Tone & Promote Plasticity – YouTube

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[BLOG POST] Home After a Stroke: ADLs Are Where the Repetitions Are

ADLs Are Where the Repetitions Are

Brain plasticity is amazing, but rewiring the brain requires thousands of repetitions (reps).   Activities of Daily Living (ADLs) are a great way to get the reps needed to retrain the brain.
Four examples show why three sets of ten each day cannot compete with ADLs.

1) Twice a day I open my hemiplegic (paralyzed) hand to grasp a tube of toothpaste so my sound hand can remove the cap.  My hand opens again to hold the tube while I put the cap back on.  In nine years I have opened my hand over 5000 times before brushing my teeth.

2)  I have to turn 14 times to prepare cereal with a sliced banana.  I have made this same breakfast for nine years so I have made over 45,000 turns.  Add making a sandwich for lunch and preparing a hot meal for dinner and the number of turns I have made in the kitchen are in the hundreds of thousands.

3)  Shopping is therapy for my hand.  I open my hemiplegic hand to let go of the cart and reach for items with my sound hand.  My hemiplegic hand opens a 2nd time when I grab the cart to move on. My hemiplegic hand opens a 3rd time so I can let go of the cart so I can maneuver to empty the cart in the check-out lane and again to load food into my car.  Pick up 30 items + empty cart + load car means I open my hand 60 + 2 + 2 = 64 times.  64 x 2 visits a week x 9 years means I have opened my hemiplegic hand 59,904 times in the grocery store.

4)  The distance I have walked at the grocery store is huge.  I step away from the shopping cart and bend down or reach up to get items I want.  The S-shaped curves I make to detour around people and other carts require more steps than walking in a straight line.  According to my pedometer I walk 2,000+ steps each time I visit the grocery store.  2,000 x 2 visits a week x nine years = 1,872,000 steps!

via Home After a Stroke: ADLs Are Where the Repetitions Are

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[ARTICLE] Arm Ability Training (AAT) Promotes Dexterity Recovery After a Stroke—a Review of Its Design, Clinical Effectiveness, and the Neurobiology of the Actions – Full Text

Arm Ability Training (AAT) has been specifically designed to promote manual dexterity recovery for stroke patients who have mild to moderate arm paresis. The motor control problems that these patients suffer from relate to a lack of efficiency in terms of the sensorimotor integration needed for dexterity. Various sensorimotor arm and hand abilities such as speed of selective movements, the capacity to make precise goal-directed arm movements, coordinated visually guided movements, steadiness, and finger dexterity all contribute to our “dexterity” in daily life. All these abilities are deficient in stroke patients who have mild to moderate paresis causing focal disability. The AAT explicitly and repetitively trains all these sensorimotor abilities at the individual’s performance limit with eight different tasks; it further implements various task difficulty levels and integrates augmented feedback in the form of intermittent knowledge of results. The evidence from two randomized controlled trials indicates the clinical effectiveness of the AAT with regard to the promotion of “dexterity” recovery and the reduction of focal disability in stroke patients with mild to moderate arm paresis. In addition, the effects have been shown to be superior to time-equivalent “best conventional therapy.” Further, studies in healthy subjects showed that the AAT induced substantial sensorimotor learning. The observed learning dynamics indicate that different underlying sensorimotor arm and hand abilities are trained. Capacities strengthened by the training can, in part, be used by both arms. Non-invasive brain stimulation experiments and functional magnetic resonance imaging data documented that at an early stage in the training cortical sensorimotor network areas are involved in learning induced by the AAT, yet differentially for the tasks trained. With prolonged training over 2 to 3 weeks, subcortical structures seem to take over. While behavioral similarities in training responses have been observed in healthy volunteers and patients, training-induced functional re-organization in survivors of a subcortical stroke uniquely involved the ipsilesional premotor cortex as an adaptive recruitment of this secondary motor area. Thus, training-induced plasticity in healthy and brain-damaged subjects are not necessarily the same.

Motor Deficits of Stroke Survivors With Mild to Moderate Arm Paresis

Arm paresis post stroke shows a bi-modal distribution. Many stroke survivors have either severe arm paresis and are only able to use their arms functionally in everyday life to a very limited extent, if at all, or mild to moderate arm paresis with the ability to use their paretic arm for functional tasks, yet with a lack of dexterity (12). Thus, the motor control deficits of these subgroups are quite different and hence so too are their therapeutic needs.

Clinically, stroke survivors with mild to moderate arm paresis have reduced strength and endurance of their paretic arm and are functionally limited by a lack of speed, accuracy and co-ordination of arm, hand, and finger movements and a lack of dexterity when handling objects. Key to understanding any functional deficits and the need and opportunities to improve function by training is a focused analysis of the specific motor control deficits involved in this clinical syndrome. A way to do this is to test various domains of sensorimotor control that have been shown to be independent by factorial analysis (34).

When motor performance of healthy people across various tasks has been analyzed by factorial analysis certain independent arm motor abilities have been documented. These are different independent sensorimotor capacities that together contribute to our skilfulness in everyday life. What are these abilities? They are our ability to make fast selective wrist and finger movements (wrist-finger speed), to manipulate small objects (finger dexterity) or larger objects (manual dexterity) efficiently, our ability to keep our arm steady (steadiness), to move our arm quickly and precisely to an intended target (aiming), or to move it under constant visual control along a line (tracking) (5).

When tested among stroke survivors with mild to moderate arm paresis all these abilities are deficient, indicating the complex nature of sensorimotor control deficits in this clinical condition (67).

The Arm Ability Training as a “Tailor-Made training” to Meet Specific Rehabilitation Demands

The Arm Ability Training (AAT) was designed to train all these sensorimotor abilities and thus to meet the specific rehabilitation demands of this subgroup of stroke survivors (89). The eight training tasks collectively cover these affordances (Figure 1).

Figure 1. Training tasks of the Arm Ability Training. Description of the eight training tasks of the Arm Ability Training (AAT) that are repetitively exercised daily. Together they train various independent arm and hand sensorimotor abilities. During the AAT sensorimotor performance is trained at its individual limit. Further aspects thought to promote motor learning are a high repetition rate of trained tasks, variation in the difficulty of training tasks, and the augmented feedback provided in the form of intermittent knowledge of the results.

[…]

Continue —->  Frontiers | Arm Ability Training (AAT) Promotes Dexterity Recovery After a Stroke—a Review of Its Design, Clinical Effectiveness, and the Neurobiology of the Actions | Neurology

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[BLOG POST] 6 Ways to Get Past Plateau After Stroke

Past Plateau After Stroke

The road to recovery after stroke is not always a straight line. Oftentimes there is rapid recovery during the first three months, but then the progress slows down. This eventually leads to a plateau in recovery after about six months.

In a scenario where varying levels of paralysis are common, a shift in mindset and making little changes to lifestyle is all it takes to break the plateau. This blog offers few tips that can help you dissect that plateau and get past it.

1. Understand the root-cause

In order to break out of the plateau, it helps to understand what causes it to begin with. Some of the most significant functional improvements often occur during the early days, reflecting the initial plasticity of the brain. However, after few days, you may feel that the initial spike in progress was the end of rehabilitation and that there is no further improvement possible. But for many stroke survivors, the plateau phase is quite common and even to be expected. Understanding this will help both the stroke survivor and caregiver to avoid losing hope and persistence during this difficult time.

2. Revise your workout regime

If you aren’t making any progress, you might need something new and different to jump-start it back into rehabilitation mode. Traditional therapy that isn’t evidence-based can be ineffective and can actually cause a plateau. Thus, familiar exercises must be altered and adjusted. Try switching up your workout intensity, duration, frequency or exercises you do. For that, you will be needing your therapist’s expert guidance.

3. Find the right therapist

If the therapist isn’t modifying the treatment to your specific needs and incorporating the latest proven interventions because he hasn’t been trained in them, perhaps, it’s time to try a new therapist. Your new therapist should be able to prescribe a new evidence-based technique.

With the help of your therapist, learn to set SMART goal(s): specific, measurable, achievable, relevant, and time-bound. When you’re working systematically toward something, your motivation will stay high. After all, the recently damaged brain is taking the necessary time to heal and regrow. And, this requires setting relevant, short-term goals.

4. Learn and try new things

Along with making changes to your regimen (as recommended by the therapist, of course), pick a new skill you want to learn (like playing piano) and practice that. Simple changes like this will initiate Neuroplasticity and help you get past Plateau.

blog cta

Be part of the relevant research studies (only if your therapist allows you). It may not always work, but you may just luck out with a great new treatment. It’s also not a bad idea to join a stroke group.

5. Track your progress

Tracking everything is essential to making the stroke rehabilitation work for you. Take your current measurements to get a more accurate view of the progress made. Track these measures and compare them to your most recent stats. Apart from tracking your functional performance, it’s also wise to keep track of your:

  1. Daily meals (breakfast, lunch, and dinner) and snacks
  2. Exercise and activity
  3. BMI (Body Mass Index)
  4. Water/hydration

6. Handle emotional changes

Stroke recovery is a long (and often slow) process. Hence, frustration, anger, and depression are understandable obstacles to encounter. If you’re tired, sick, overwhelmed, or stressed, your speech or mobility may suffer.

Don’t give up hope. Many studies show that it is possible to break plateau after stroke. Everyone recovers at different rates. It’s best not to compare your recovery to others. Hope is the most powerful drug, hold onto it.

via 6 Ways to Get Past Plateau After Stroke – 9zest

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[Abstract] Vagus nerve stimulation intensity influences motor cortex plasticity

Highlights

Recovery after neurological injury is thought to be dependent on plasticity.

Moderate intensity VNS paired with motor training enhances motor cortex plasticity.

Low and high intensity VNS paired with motor training fail to enhance plasticity.

The intensity of stimulation is a critical factor in VNS-dependent plasticity.

Optimizing stimulation paradigms may enhance VNS efficacy in clinical populations.

Abstract

Background

Vagus nerve stimulation (VNS) paired with forelimb motor training enhances reorganization of movement representations in the motor cortex. Previous studies have shown an inverted-U relationship between VNS intensity and plasticity in other brain areas, such that moderate intensity VNS yields greater cortical plasticity than low or high intensity VNS. However, the relationship between VNS intensity and plasticity in the motor cortex is unknown.

Objective

In this study we sought to test the hypothesis that VNS intensity exhibits an inverted-U relationship with the degree of motor cortex plasticity in rats.

Methods

Rats were taught to perform a lever pressing task emphasizing use of the proximal forelimb musculature. Once proficient, rats underwent five additional days of behavioral training in which low intensity VNS (0.4 mA), moderate intensity VNS (0.8 mA), high intensity VNS (1.6 mA), or sham stimulation was paired with forelimb movement. 24 h after the completion of behavioral training, intracortical microstimulation (ICMS) was used to document movement representations in the motor cortex.

Results

VNS delivered at 0.8 mA caused a significant increase in motor cortex proximal forelimb representation compared to training alone. VNS delivered at 0.4 mA and 1.6 mA failed to cause a significant expansion of proximal forelimb representation.

Conclusion

Moderate intensity 0.8 mA VNS optimally enhances motor cortex plasticity while low intensity 0.4 mA and high intensity 1.6 mA VNS fail to enhance plasticity. Plasticity in the motor cortex exhibits an inverted-U function of VNS intensity similar to previous findings in auditory cortex.

via Vagus nerve stimulation intensity influences motor cortex plasticity – Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation

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[WEB SITE] Technology helps stroke patients get moving again

Electronic devices are helping stroke patients walk and move their hands again.
Provided

Electronic devices are helping stroke patients walk and move their hands again.

This may bode well for the 20 percent of survivors that have foot drop, and 87 percent of stroke survivors that have lost the use of their hands.

When a person has a stroke, multiple sclerosis or brain injury, most of the neurons that help signal muscles to move are broken. This keeps the brain from being able to send signals to certain muscle groups telling them to move.

A stroke, for example, can destroy millions of brain cells that you need to tie your shoes, pick up a grandchild or reach into your closet. To gain lost function, rehabilitation used to focus on teaching patients how to compensate for their physical deficits.

Today, research shows that neural plasticity (the ability of the brain to repair itself) can be applied effectively for improved outcomes and enhanced functional abilities.

To do this successfully, the central nervous system must seek other neural pathways and find new connections that bypass the damaged areas. With a little help from functional electrical stimulation (FES), which is low energy electrical pulses, the process to find the new connections is a bit easier.

New electrical orthotics target muscles with FES and can help accelerate muscle-nerve recovery. The electronic orthosis and its control unit transmit synchronized electric pulses to the peripheral nerves through electrodes built into the orthosis — these pulses are driven in precise sequence and accurately activate five muscles in the forearm.

“Muscles relearn when electrical stimulation provides feedback to the brain that can facilitate neuro re-education and promote neuroplasticity, which is the ability of the central nervous system to remodel itself,” says physical therapist Imelda Ungos, director of rehabilitation for Melbourne Terrace, a facility that specializes in the active and aging population. “And patients can learn a better way to function just by having new input, regardless of age.”

Ungos reports that the ultimate goal with this method of therapy is to restore voluntary movement. Patients with a history of brain lesions, such as stroke conditions and movement disorders, may have the most to gain with the neuro-orthotics and the rehab to learn how to use them.

“The latest therapy equipment from Bioness can drive the brain to new connections, and newer technology and techniques encourage the neuronal changes necessary for improved function,” says Ungos. “This kind of therapy is very specialized, and we’re the only sub-acute facility in the Space Coast area with the Bioness FES technologies,” says Ungos.

For improved hand function, the orthosis fits to the forearm and wrist, and communicates wirelessly with the control unit. Inside the orthosis, electrodes deliver mild pulses to stimulate muscle contraction.

The level of stimulation can be adjusted toward each function. With an intuitive interface, clinicians are better able to help their patients obtain simple control of desired hand activation.

The wireless device is portable and allows for quick detection of the best electrode position for each individual. A control unit enables easy programming of functional modes and training regimens.

For patients with poor safety and balance due to foot drop, which is the inability to lift the foot during walking, there’s an electronic orthosis that fits below the knee. The unit has stimulating electrodes placed over the correct nerve and fits below the knee. A heel sensor sends a muscle-contracting signal during the correct step phase to enable the foot to lift.

After the initial custom fitting of the orthosis, patients can enhance their abilities to perform daily activities, and the carry-over results from continued use will improve voluntary movement.

Ungos adds that the other benefits of interacting with the device include a reduction in muscle spasm, an increase in range of motion, and improved blood circulation. “That all goes towards retarding disuse atrophy,” she says.

“Efforts must be directed towards preventing complications and learning how to use affected limb along with active rehabilitation… especially when the use is started early in post stroke rehabilitation,” says online Bioness reports from Harold Weingarden, MD, Director of Rehabilitation Day Hospital Sheba Medical Center in Israel.

“An early start to rehab gives patients hope of what is possible in terms of present and future improvement,” says Ungos. She adds that the devices allow patients to move in more natural ways.

Feeling “normal” again can improve mood, function, and quality of life.

For more information, call Melbourne Terrace Rehabilitation Center at 321-725-3990. They offer comprehensive rehabilitative outpatient and inpatient services for short or long term care located at 251 East Florida Ave., Melbourne, FL 32901

via Technology helps stroke patients get moving again

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[WEB SITE] ‘Smart’ robotic system could offer home-based rehabilitation

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IMAGE: EARLY PROTOTYPES OF ROBOTIC REHABILITATION SYSTEMS CONTROLLED BY THE USER’S OWN BRAIN REQUIRED THE USE OF SKULLCAPS EMBEDDED WITH SENSORS, BUT RESEARCHERS ARE DEVELOPING A SIMPLER VERSION THAT CAN BE… view more 
CREDIT: UNIVERSITY OF HOUSTON

Researchers in Houston and elsewhere have shown that robotic systems controlled by the user’s own brain activity can help patients recovering from stroke and other disabling injuries. But the demonstrations have taken place in highly controlled settings, and none of the systems have been approved for use in clinics or patient’s homes.

An engineer from the University of Houston is leading a team of researchers, health care providers and industry to fast-track the commercialization of a groundbreaking robotic rehabilitation system. Backed by a $750,000 grant from the National Science Foundation’s Partnerships for Innovation program (PFI), the goal is to build a system that can be approved by the U.S. Food and Drug Administration and is sturdy, simple and inexpensive enough for stroke patients to use at home.

“We want to break that wall between the lab and home,” said Jose Luis Contreras-Vidal, professor of electrical and computer engineering at UH and co-director of the Building Reliable Advances and Innovation in Neurotechnology (BRAIN) Center, a NSF-supported Industry/University Collaborative Research Center based at UH and Arizona State University. “We want to build a system that can be used at home with FDA approval.”

The NSF PFI program allows academic innovators to advance prior NSF-funded research by further developing technologies that show promise for commercialization and societal impact. Such technology development efforts benefit from industry-academic collaborations that are needed to accelerate the transition of technology from the academic lab to the marketplace.

The rehabilitation systems work by capturing electrical activity in the brain, which can be translated into movement through the use of algorithms that decode movement intent from patterned brain activity. Early versions of this brain-computer interface relied upon a skull cap embedded with the sensors, but Contreras-Vidal said any system intended for home use will have to be far simpler for patients to use.

He has worked for years with TIRR Memorial Hermann, a nationally ranked rehabilitation hospital, in a quest to design medical systems that can assist in recovery from strokes and other injuries and illnesses.

Other partners in the project are National Instruments Corp. and Harmonic Bionics, both based in Austin, and TIRR Memorial Hermann. The UH Office of Intellectual Property Management will help with commercialization, and Jeff Feng, associate professor for the UH Gerald D. Hines College of Architecture and Design who has a background in the design of medical devices, will work with Contreras-Vidal on the headset design to optimize usability and form factor.

“It has to be very user friendly,” Contreras-Vidal said. The idea is that use of the device – it will be modeled on a simple rowing machine and at least initially will focus on the upper limbs – will promote plasticity in the brain and the restoration of motor function. Contreras-Vidal said the same concept could apply to the lower limbs to restore a patient’s ability to walk.

While the work also has applications for virtual reality, gaming and consumer electronics, he said the researchers are focused on using it to help people recover from stroke. It will be tested in the clinic at TIRR before being sent home with patients.

“The research team of the physical medicine and rehabilitation department is fortunate to be a part of this project, which will make a difference and improve the quality of life in stroke survivors,” said Dr. Gerard Francisco, chairman and professor of physical medicine & rehabilitation with McGovern Medical School at the University of Texas Health Science Center at Houston and chief medical officer and director of the NeuroRecovery Research Center at TIRR Memorial Hermann.

“Each year, thousands suffer a stroke which can leave them facing a long road of rehabilitation. By developing this device for use at home, it can be an added and convenient component to their rehabilitation journey.”

Harmony Bionics will produce the robotic device, while National Instruments will provide a compact, embedded, hardware solution for the brain-computer interface system and provide technical assistance.

“There is a growing need for accelerating the transition to practice of the discoveries and innovations that start at universities,” said Igor Alvarado, business development manager for academic research at National Instruments. “This project allows us to help advance new at-home rehab technologies for stroke patients by providing the data acquisition and control platform to be used in prototyping, testing and deploying the new rehab device.”

National Instruments also will oversee a national competition, which will release the researchers’ datasets and encourage people elsewhere to suggest improvements in the decoding algorithms.

“That’s STEM outreach,” Contreras-Vidal said. “But it’s also citizen-science and advancing the state of the art.”

 

via ‘Smart’ robotic system could offer home-based rehabilitation | EurekAlert! Science News

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[ARTICLE] Vagus Nerve Stimulation Paired With Upper Limb Rehabilitation After Chronic Stroke – Full Text PDF

A Blinded Randomized Pilot Study

Background and Purpose

We assessed safety, feasibility, and potential effects of vagus nerve stimulation (VNS) paired with rehabilitation for improving arm function after chronic stroke.

Methods

We performed a randomized, multisite, double-blinded, sham-controlled pilot study. All participants were implanted with a VNS device and received 6-week in-clinic rehabilitation followed by a home exercise program. Randomization was to active VNS (n=8) or control VNS (n=9) paired with rehabilitation. Outcomes were assessed at days 1, 30, and 90 post-completion of in-clinic therapy.

Results

All participants completed the course of therapy. There were 3 serious adverse events related to surgery. Average FMA-UE scores increased 7.6 with active VNS and 5.3 points with control at day 1 post–in-clinic therapy (difference, 2.3 points; CI, −1.8 to 6.4; P=0.20). At day 90, mean scores increased 9.5 points from baseline with active VNS, and the control scores improved by 3.8 (difference, 5.7 points; CI, −1.4 to 11.5; P=0.055). The clinically meaningful response rate of FMA-UE at day 90 was 88% with active VNS and 33% with control VNS (P<0.05).

Conclusions

VNS paired with rehabilitation was acceptably safe and feasible in participants with upper limb motor deficit after chronic ischemic stroke. A pivotal study of this therapy is justified.

 

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via Vagus Nerve Stimulation Paired With Upper Limb Rehabilitation After Chronic Stroke | Stroke

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