Posts Tagged post stroke

[WEB PAGE] MEDRhythms Launches Trial of Post-Stroke Walking Device

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MEDRhythms Inc has launched a randomized controlled trial (RCT) at five top rehab hospitals and research centers across the country to examine the impact of a digital therapeutic device on stroke survivors who have post-stroke walking impairments, in support of the company’s eventual FDA submission.

“This clinical trial marks an important milestone toward MEDRhythms’ mission to make this high-quality intervention available to those who need and deserve to have it,” says Brian Harris, Co-Founder and CEO of Portland, Me-based MEDRhythms, in a media release. “As this new industry grows, it is important for digital therapeutics to demonstrate efficacy with the support of rigorous clinical trials, and this RCT is an integral step in MEDRhythms’ evidence generation strategy to do so.”

MEDRhythms’ clinical trial will be conducted at the Shirley Ryan AbilityLab in Chicago, the Kessler Foundation in New Jersey, Mt. Sinai Hospital in New York, Spaulding Rehabilitation Hospital in Boston, and the Boston University Neuromotor Recovery Laboratory in Boston. This trial was launched following completion of a successful feasibility study in the target population, which was conducted at the Boston University Neuromotor Recovery Lab. The results of this feasibility study will be announced at the American Physical Therapy Association’s annual Combined Sections Meeting in February 2020 in Denver, Colorado.

“Right now, the MEDRhythms digital therapeutic technology is a novel treatment for a subset of individuals that have few, if any, effective treatment options,” states David Putrino, the Director of Abilities Research Center (ARC) for the Department of Rehabilitation and Human Performance at the Mount Sinai Health System and the Principal Investigator at MEDRhythms’ Mount Sinai clinical trial site.

“The mission of the ARC is to identify and validate novel technologies that have the potential to significantly enhance the rehabilitation of people who are recovering from brain injuries and neurological conditions, including chronic stroke. The digital therapeutics industry has the potential to transform rehabilitation and disrupt healthcare, and it is imperative for companies in this space to run full-scale, multisite RCTs like MEDRhythms is doing.”

The digital therapeutic for post-stroke walking rehabilitation is one of a full pipeline of products that include therapeutics for indications such as Parkinson’s disease, multiple sclerosis, aging, and fall prevention, for which the company is actively exploring partnerships, per the release.

[Source(s): MEDRhythms, Business Wire]

 

via MEDRhythms Launches Trial of Post-Stroke Walking Device – Rehab Managment

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[ARTICLE] Robot-Assisted Stair Climbing Training on Postural Control and Sensory Integration Processes in Chronic Post-stroke Patients: A Randomized Controlled Clinical Trial – Full Text

Background: Postural control disturbances are one of the important causes of disability in stroke patients affecting balance and mobility. The impairment of sensory input integration from visual, somatosensory and vestibular systems contributes to postural control disorders in post-stroke patients. Robot-assisted gait training may be considered a valuable tool in improving gait and postural control abnormalities.

Objective: The primary aim of the study was to compare the effects of robot-assisted stair climbing training against sensory integration balance training on static and dynamic balance in chronic stroke patients. The secondary aims were to compare the training effects on sensory integration processes and mobility.

Methods: This single-blind, randomized, controlled trial involved 32 chronic stroke outpatients with postural instability. The experimental group (EG, n = 16) received robot-assisted stair climbing training. The control group (n = 16) received sensory integration balance training. Training protocols lasted for 5 weeks (50 min/session, two sessions/week). Before, after, and at 1-month follow-up, a blinded rater evaluated patients using a comprehensive test battery. Primary outcome: Berg Balance Scale (BBS). Secondary outcomes:10-meter walking test, 6-min walking test, Dynamic gait index (DGI), stair climbing test (SCT) up and down, the Time Up and Go, and length of sway and sway area of the Center of Pressure (CoP) assessed using the stabilometric assessment.

Results: There was a non-significant main effect of group on primary and secondary outcomes. A significant Time × Group interaction was measured on 6-min walking test (p = 0.013) and on posturographic outcomes (p = 0.005). Post hoc within-group analysis showed only in the EG a significant reduction of sway area and the CoP length on compliant surface in the eyes-closed and dome conditions.

Conclusion: Postural control disorders in patients with chronic stroke may be ameliorated by robot-assisted stair climbing training and sensory integration balance training. The robot-assisted stair climbing training contributed to improving sensorimotor integration processes on compliant surfaces. Clinical trial registration (NCT03566901).

Introduction

Postural control disturbances are one of the leading causes of disability in stroke patients, leading to problems with transferring, maintaining body position, mobility, and walking (Bruni et al., 2018). Therefore, the recovery of postural control is one of the main goals of post-stroke patients. Various and mixed components (i.e., weakness, joint limitation, alteration of tone, loss of movement coordination and sensory organization components) can affect postural control. Indeed, the challenge is to determine the relative weight placed on each of these factors and their interaction to plan specific rehabilitation programs (Bonan et al., 2004).

The two functional goals of postural control are postural orientation and equilibrium. The former involves the active alignment of the trunk and head to gravity, the base of support, visual surround and an internal reference. The latter involves the coordination of movement strategies to stabilize the center of body mass during self-initiated and externally triggered stability perturbations. Postural control during static and dynamic conditions requires a complex interaction between musculoskeletal and neural systems (Horak, 2006). Musculoskeletal components include biomechanical constraints such as the joint range of motion, muscle properties and limits of stability (Horak, 2006). Neural components include sensory and perceptual processes, motor processes involved in organizing muscles into neuromuscular synergies, and higher-level processes essential to plan and execute actions requiring postural control (Shumway-Cook and Woollacott, 2012). A disorder in any of these systems may affect postural control during static (in quite stance) and dynamic (gait) tasks and increase the risk of falling (Horak, 2006).

Literature emphasized the role of impairments of sensory input integration from visual, somatosensory and vestibular systems in leading to postural control disorders in post-stroke patients (Bonan et al., 2004Smania et al., 2008). Healthy persons rely on somatosensory (70%), vision (10%) and vestibular (20%) information when standing on a firm base of support in a well-lit environment (Peterka, 2002). Conversely, in quite stance on an unstable surface, they increase sensory weighting to vestibular and vision information as they decrease their dependence on surface somatosensory inputs for postural orientation (Peterka, 2002). Bonan et al. (2004) investigate whether post-stroke postural control disturbances may be caused by the inability to select the pertinent somatosensory, vestibular or visual information. Forty patients with hemiplegia after a single hemisphere chronic stroke (at least 12 months) performed computerized dynamic posturography to assess the patient’s ability to use sensory inputs separately and to suppress inaccurate inputs in case of sensory conflict. Six sensory conditions were assessed by an equilibrium score, as a measure of body stability. Results show that patients with hemiplegia seem to rely mostly on visual input. In conditions of altered somatosensory information, with visual deprivation or visuo-vestibular conflict, the patient’s performance was significantly lower than healthy subjects. The mechanism of this excessive visual reliance remains unclear. However, higher-level inability to select the appropriate sensory input rather than to elementary sensory impairment has been advocated as a potential mechanism of action (Bonan et al., 2004).

Sensory strategies and sensory reweighting processes are essential to generate effective movement strategies (ankle, hip, and stepping strategies) which can be resolved through feed-back or feed-forward postural adjustments. The cerebral cortex shapes these postural responses both directly via corticospinal loops and indirectly via the brainstem centers (Jacobs and Horak, 2007). Moreover, the cerebellar- and basal ganglia-cortical loop is responsible for adapting postural responses according to prior experience and for optimizing postural responses, respectively (Jacobs and Horak, 2007).

Rehabilitation is the cornerstone in the management of postural control disorders in post-stroke patients (Pollock et al., 2014). To date, no one physical rehabilitation approach can be considered more effective than any other approach (Pollock et al., 2014). Specific treatments should be chosen according to the individual requirements and the evidence available for that specific treatment. Moreover, it appears to be most beneficial a mixture of different treatment for an individual patient (Pollock et al., 2014). Considering that, rehabilitation involving repetitive, high intensity, task-specific exercises is the pathway for restoring motor function after stroke (Mehrholz et al., 2013Lo et al., 2017) robotic assistive devices for gait training have been progressively being used in neurorehabilitation to Sung et al. (2017). In the current literature, three primary evidence have been reported.

Firstly, a recent literature review highlights that robot-assisted gait training is advantageous as add-on therapy in stroke rehabilitation, as it adds special therapeutic effects that could not be afforded by conventional therapy alone (Morone et al., 2017Sung et al., 2017). Specifically, robot-assisted gait training was beneficial for improving motor recovery, gait function, and postural control in post-stroke patients (Morone et al., 2017Sung et al., 2017). Stroke patients who received physiotherapy treatment in combination with robotic devices were more likely to reach better outcomes compared to patients who received conventional training alone (Bruni et al., 2018).

Second, the systematic review by Swinnen et al. (2014) supported the use of robot-assisted gait therapy to improve postural control in subacute and chronic stroke patients. A wide variability among studies was reported about the robotic-device system and the therapy doses (3–5 times per week, 3–10 weeks, 12–25 sessions). However, significant improvements (Cohen’s d = 0.01 to 3.01) in postural control scores measured with the Berg Balance Scale (BBS), the Tinetti test, postural sway tests, and the Timed Up and Go (TUG) test were found after robot-assisted gait training. Interestingly, in five studies an end-effector device (gait trainer) was used (Peurala et al., 2005Tong et al., 2006Dias et al., 2007Ng et al., 2008Conesa et al., 2012). In two study, the exoskeleton was used (Hidler et al., 2009Westlake and Patten, 2009). In one study, a single joint wearable knee orthosis was used (Wong et al., 2012). Because the limited number of studies available and methodological differences among them, more specific randomized controlled trial in specific populations are necessary to draw stronger conclusions (Swinnen et al., 2014).

Finally, technological and scientific development has led to the implementation of robotic devices specifically designed to overcome the motor limitation in different tasks. With this perspective, the robot-assisted end-effector-based stair climbing (RASC) is a promising approach to facilitate task-specific activity and cardiovascular stress (Hesse et al., 20102012Tomelleri et al., 2011Stoller et al., 20142016Mazzoleni et al., 2017).

To date, no studies have been performed on the effects of RASC training in improving postural control and sensory integration processes in chronic post-stroke patients.

The primary aim of the study was to compare the effects of robot-assisted stair climbing training against sensory integration balance training on static and dynamic balance in chronic stroke patients. The secondary aims were to compare the training effects on sensory integration processes and mobility. The hypothesis was that the task-specific and repetitive robot-assisted stairs climbing training might act as sensory integration balance training, improving postural control because sensorimotor integration processes are essential for balance and walking.[…]

 

Continue —->  Frontiers | Robot-Assisted Stair Climbing Training on Postural Control and Sensory Integration Processes in Chronic Post-stroke Patients: A Randomized Controlled Clinical Trial | Neuroscience

Figure 1. The G-EO system used in the Robot-Assisted Stair-Climbing Training (Written informed consent was obtained from the individual pictured, for the publication of this image).

 

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[WEB SITE] Telerehab vs In-Clinic for Post-Stroke Arm Weakness: Which One Wins?

Old woman training at home

Telerehabilitation was not inferior to in-clinic rehabilitation therapy in helping to improve arm function after stroke but could substantially increase access to therapy for those who are unable to access a rehabilitation clinic, researchers opine.

“Few patients fully recover from arm weakness after a stroke. The remainder demonstrate persistent arm impairments that are directly linked to activity limitations, participation restrictions, reduced quality of life, and decreased well-being,” Steven C. Cramer, MD, from the department of neurology at the University of California, Irvine, and colleagues write, in a study published in JAMA Neurology.

“Some rehabilitation therapies can improve these deficits, with higher doses associated with better outcomes. However, many patients do not receive high doses of rehabilitation therapy, for reasons that include cost, difficulty traveling to the location where therapy is provided, shortage of regional rehabilitation care, and poor adherence with assignments,” they continue, in a media release from Healio.

Cramer and colleagues conducted a randomized, assessor-blinded, noninferiority clinical trial to compare telerehabilitation and in-clinic rehabilitation therapy outcomes for patients who had a stroke that resulted in arm motor deficit.

Patients were enrolled in the study at 4 to 36 weeks after experiencing an ischemic stroke or intracerebral hemorrhage that resulted in arm weakness. After enrollment, participants were randomly assigned to receive intensive arm motor therapy in a rehabilitation clinic or in their home using telerehabilitation delivery services with a computer connected to the internet. Scores on the Fugl-Myer arm motor scale were measured at the baseline and after treatment to determine changes in arm motor function.

All patients received 36 treatment sessions (70 minutes) in a 6- to 8-week period, which included 18 supervised and 18 unsupervised sessions. The content of therapy was carefully matched, with each group using the same exercises and standard exercise equipment.

A total of 124 participants were included in the study. Participants had a mean age of 61 years, a mean baseline Fugl-Meyer score of 43 points and were enrolled for a mean 18.7 weeks following stroke, the release explains.

Patients in the in-clinic group were adherent to 33.6 of 36 therapy sessions (93.3%), and those who received telerehabilitation at home were adherent to 35.4 of 36 therapy sessions (98.3%).

Both groups experienced significant changes in Fugl-Meyer scores from the baseline period to 30 days after treatment, with a mean change of 8.36 points in patients who received in-clinic therapy and 7.86 points in those who received telerehabilitation therapy.

The noninferiority margin was 2.47 and fell outside the 95% confidence interval, suggesting that telerehabilitation was not inferior to in-clinic therapy.

“Our study found that a 6-week course of daily home-based [telerehabilitation] is safe, is rated favorably by patients, is associated with excellent treatment adherence, and produces substantial gains in arm function that were not inferior to dose-matched interventions delivered in the clinic,” Cramer and colleagues conclude, in the release.

[Source: Healio Primary Care]

 

via Telerehab vs In-Clinic for Post-Stroke Arm Weakness: Which One Wins? – Physical Therapy Products

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[WEB SITE] ReStore™ Exo-Suit – ReWalk – More Than Walking

ReStore Soft Exo-Suit – A Revolution in Post-Stroke Gait Training
What is the ReStore?

The ReStore is a powered, lightweight soft exo-suit intended for use in the rehabilitation of persons with lower limb disability due to stroke. It will be a first of its kind gait training solution.

Functional

The ReStore soft design combines natural movements with plantarflexion and dorsiflexion assistance that adaptively synchronize with the patient’s own gait to facilitate functional gait training.

Versatile

Individualized levels of assistance and compatibility with supplemental support aids ensure that ReStore has broad applications for patients across the gait rehabilitation spectrum.

 

Data-Driven

Real time feedback and adjustable levels of assistance enable the therapist to optimize sessions and track each patient’s progress.

How Does ReStore Compare to Other Stroke Rehabilitation Methods?

Click here to contact us for more information and to discuss bringing ReStore to your clinic. Click here to download the ReStore brochure.

via ReStore™ Exo-Suit – ReWalk – More Than Walking

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[JUST ACCEPTED] “Increased Sensorimotor Cortex Activation with Decreased Motor Performance during Functional Upper Extremity Tasks Post-Stroke” – Abstract

The following article has just been accepted for publication in Journal of Neurologic Physical Therapy.

“Increased Sensorimotor Cortex Activation with Decreased Motor Performance during Functional Upper Extremity Tasks Post-Stroke”

By Shannon B Lim, MSc, MPT; Janice J Eng

Provisional Abstract:

Background: Current literature has focused on identifying neuroplastic changes associated with stroke through tasks and in positions that are not representative of functional rehabilitation. Emerging technologies such as functional near-infrared spectroscopy (fNIRS) provide new methods of expanding the area of neuroplasticity within rehabilitation.
Purpose: This study determined the differences in sensorimotor cortex activation during unrestrained reaching and gripping after stroke.
Methods: 11 healthy and 11 chronic post-stroke individuals completed reaching and gripping tasks under three conditions using their 1) stronger, 2) weaker, and 3) both arms together. Performance and sensorimotor cortex activation using fNIRS were collected. Group and arm differences were calculated using mixed ANCOVA (covariate: age). Pairwise comparisons were used for post-hoc analyses. Partial Pearson’s correlations between performance and activation were assessed for each task, group, and hemisphere.
Results: Larger sensorimotor activations in the ipsilesional hemisphere were found for the stroke compared to healthy group for reaching and gripping conditions despite poorer performance. Significant correlations were observed between gripping performance (with the weaker arm and both arms simultaneously) and sensorimotor activation for the stroke group only.
Discussion: Stroke leads to significantly larger sensorimotor activation during functional reaching and gripping despite poorer performance. This may indicate an increased sense of effort, decreased efficiency, or increased difficulty after stroke.
Conclusion: fNIRS can be used for assessing differences in brain activation during movements in functional positions after stroke. This can be a promising tool for investigating possible neuroplastic changes associated with functional rehabilitation interventions in the stroke population.

Supplemental Digital Content 1. Video abstract .mp4

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via JUST ACCEPTED: “Increased Sensorimotor Cortex Activation with Decreased Motor Performance during Functional Upper Extremity Tasks Post-Stroke”

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[NEWS] UTech research provides hope for stroke patients

Published: April 18, 2019 

Research by Professor Felix Akinladejo, recently appointed professor of computer information systems in the Faculty of Engineering and Computing, University of Technology, Jamaica, on computer model and virtual reality technology for post-stroke rehabilitation, is offering hope for stroke patients.

Akinladejo elaborated on his research focusing on the use of the techno-therapy intervention technique to aid in the rehabilitation therapy of post-acute stroke patients to improve movement and/or functional ability in his inaugural professorial lecture titled ‘Computer Model and Virtual Reality Technology for Post -Stroke Rehabilitation: A Techno-Therapy Intervention Technique’, held recently at the university’s Papine campus.

The research follows from Akinladejo’s PhD dissertation, which focused on computer-supported rehabilitation management of post-acute stroke patients.

The techno-therapy rehabilitation system consists of the computer model used to measure the gait variables and the virtual reality technology used to provide the exercise that stroke patients perform for physical therapy.

Akinladejo pointed to World Health Organization data, which showed that stroke deaths in Jamaica reached 2,474 or 14.44 per cent of total deaths in 2017.

Noting that the challenge, especially in developing countries like Jamaica, is the inability to provide and sustain physical rehabilitation therapy, Akinladejo said that his research would augment present treatment options and knowledge for professionals concerned with rehabilitation management, practitioners of physical therapy, bioengineering, and all concerned with human movement. He shared examples of his work done with post-stroke patients to manage plantar flexion and dorsiflexion movements of the ankle and foot in order to approve their range of motion.

Akinladejo is also leading UTech, Jamaica’s collaborative research with the University of Pennsylvania, USA, to investigate rehabilitation after CVDs and stroke.

The partnership has led to a programme that is currently providing third-year engineering students with training in the basic elements of robotics, with a focus on rehabilitative robotics in the Jamaican context.

NCD’S ON THE RISE

Dr Christopher Tufton, minister of health, who brought greetings, highlighted the importance of Akinladejo’s research in the context of the increase in non-communicable diseases such as diabetes and hypertension affecting large segments of the population and which may lead to stroke and the subsequent need for physical rehabilitation. The health minister urged more focus on the type of applied research being done by Akinladejo to find solutions to Jamaica’s health challenges.

“We can’t confront these challenges by confining our efforts to the practitioners directly involved in public health” the minister said, adding that “the new approach to dealing with public health has to be a lot more holistic and collaborative”.

Professor Stephen Vasciannie, president of the UTech, congratulated Akinladejo on his appointment to the rank of professor at the university, noting that over his 25 years of service to the institution, he had been promoted through the various academic ranks.

The president noted that “his promotion is testament to his body of extensive research work and his distinguished teaching career in computer science and engineering, which began in his native Nigeria”.

Professor Nilza Aples, dean, Faculty of Engineering and Computing, in her congratulations to Akinladejo, pointed out that although doctoral research work is expected to provide innovative ideas and solutions to problems, not all have the impact of improving human life or augmenting recovery in post-acute stroke patients as shown from the research work spearheaded by Akinladejo.

The dean noted that the Faculty of Engineering and Computing would continue to “position itself as a source of ‘know-how’ in the areas of engineering and computer science and as a technological provider of solutions that offer national and international impact.”

 

via UTech research provides hope for stroke patients | News | Jamaica Gleaner

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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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[ARTICLE] A modified standardized nine hole peg test for valid and reliable kinematic assessment of dexterity post-stroke – Full Text

Abstract

Background

Impairments in dexterity after stroke are commonly assessed by the Nine Hole Peg Test (NHPT), where the only outcome variable is the time taken to complete the test. We aimed to kinematically quantify and to compare the motor performance of the NHPT in persons post-stroke and controls (discriminant validity), to compare kinematics to clinical assessments of upper extremity function (convergent validity), and to establish the within-session reliability.

Methods

The NHPT was modified and standardized (S-NHPT) by 1) replacing the original peg container with an additional identical nine hole pegboard, 2) adding a specific order of which peg to pick, and 3) specifying to insert the peg taken from the original pegboard into the corresponding hole of the target pegboard. Eight optical cameras registered upper body kinematics of 30 persons post-stroke and 41 controls during the S-NHPT. Four sequential phases of the task were identified and analyzed for kinematic group differences. Clinical assessments were performed.

Results

The stroke group performed the S-NHPT slower (total movement time; mean diff 9.8 s, SE diff 1.4), less smoothly (number of movement units; mean diff 0.4, SE diff 0.1) and less efficiently (path ratio; mean diff 0.05, SE diff 0.02), and used increased scapular/trunk movements (acromion displacement; mean diff 15.7 mm, SE diff 3.5) than controls (P < 0.000, r ≥ 0.32), indicating discriminant validity. The stroke group also spent a significantly longer time grasping and releasing pegs relative to the transfer phases of the task compared to controls. Within the stroke group, kinematics correlated with time to complete the S-NHPT and the Fugl-Meyer Assessment (rs 0.38–0.70), suggesting convergent validity. Within-session reliability for the S-NHPT was generally high to very high for both groups (ICCs 0.71–0.94).

Conclusions

The S-NHPT shows adequate discriminant validity, convergent validity and within-session reliability. Standardization of the test facilitates kinematic analysis of movement performance, which in turn enables identification of differences in movement control between persons post-stroke and controls that may otherwise not be captured through the traditional time-based NHPT. Future research should ascertain further psychometric properties, e.g. sensitivity, of the S-NHPT.

Background

Impaired upper limb dexterity is evident as in many as 45–70% of the stroke victims one year post-stroke [12]. Such impairment is often evaluated in clinics by performance of the Nine Hole Peg Test (NHPT) [3], which is a frequently used dexterity task in many clinical populations [4567]. The NHPT equipment consists of a container with nine small pegs and a target pegboard with nine holes. Performance of the NHPT requires the pegs to be picked up from the container one-by-one unimanually and transferred and inserted into the holes of the pegboard until it is filled, upon which the pegs are returned unimanually to the container. The test is performed as quickly as possible and the only outcome variable is the total time to complete the task. Consequently, motor performance is currently not analyzed during the NHPT despite potentially providing valuable information relating to upper limb dexterity, especially among persons with a neurological dysfunction.

Among persons with stroke, the NHPT is considered reliable [8], valid [7910], and sensitive to change [71011]. Nevertheless, and despite overall good test-retest reliability post-stroke, low test-retest reliability has been found in persons post-stroke who have spasticity in the affected hand [8]. Further, the measurement errors are large; the minimal detectable change of the NHPT is estimated to 33 s for an individual post-stroke, and even doubled in the presence of spasticity [8]. The measurement properties of computer-assisted assessments of NHPT in virtual environments have been investigated with promising results [1213]. However, high intra-subject variation indicates that haptic and virtual reality technologies are more demanding for a stroke population and for instance require more practice trials prior to the actual test than when performing a conventional NHPT.

Advantages of the NHPT include the simple, cheap and easily portable equipment as well as the test being easy to administer and time-efficient [710]. There are, however, some drawbacks when testing persons post-stroke. First, the outcome score of the test is based solely on the time for task accomplishment [14]. Hence, a time reduction of the NHPT in rehabilitation of a person post-stroke may represent either a true motor recovery (i.e. performing movement patterns in a similar way as before the stroke) or compensation (performing different movement patterns than prior to the stroke) [15]. Compensatory strategies are common during upper limb tasks post-stroke, and thus plausible in a fine manipulative task like the NHPT. Secondly, the current NHPT test procedure may provide unreliable results for repeated measures or group comparisons as there is no standardized procedure with regard to the order in which the pegs are inserted into the target holes. To increase the stringency of the NHPT, we modified and standardized the test, which we henceforth refer to as the Standardized Nine Hole Peg test (S-NHPT). The experimental setup with two pegboards was in analogy with that of a study exploring three different methods of completing the NHPT, focusing on comparisons to tests in a virtual setting [12]. However, we have standardized the experimental setup even further by stipulating the order in which the pegs should be transferred.

Kinematic assessments may detect changes in movement performance that are not captured by only considering the time taken to complete the NHPT [14], and provide objective measures that may be more sensitive and not vulnerable to ceiling effects [16]. Recent research calls for parameters indicating quality of movements in persons post-stroke by means of kinematic analysis in order to better understand motor recovery [141517]. However, a test of fine upper limb fine dexterity like the NHPT has not been investigated. Our modifications and standardization enabled our first aim to kinematically characterize S-NHPT performance in a group of persons post-stroke and compare it to that of a non-disabled control group (discriminant validity). A second aim was to determine the convergent validity of the S-NHPT by comparing kinematics (movement time, peak speed, number of movement units, reach-grasp ratio, path ratio, acromion vertical displacement and trunk displacement) to the total movement time and to other clinical assessments (the Fugl-Meyer Assessment, the Stroke Impact Scale and grip strength). A third aim was to establish the within-session reliability of the S-NHPT, i.e., the consistency of the hand trajectories during the nine pick-up and transfer movements of the test.[…]

 

Continue —-> A modified standardized nine hole peg test for valid and reliable kinematic assessment of dexterity post-stroke | Journal of NeuroEngineering and Rehabilitation | Full Text

 

Fig. 1Experimental setup and movement phases. a) Marker positions used for the calculations of the kinematic variables. Markers displayed with a dot in the center of the marker were positioned on the trunk. The enlarged pegboard shows the standardized order of which peg to pick and which hole to fill, referred to as the “vertical row strategy”. The S-NHPT consists of 9 pegs (3.8 cm long, 0.64 cm wide) and two pegboards (12.7 cm × 12.7 cm) with 9 holes (0.70 cm wide) spaced 3.2 cm apart. The two pegboards were attached to a wooden panel with a distance of 18 cm between the center holes of the pegboards. The arrow indicates the direction of the movement. b) The velocity of the index finger marker in the medial direction displays the events defining the transfer phases Peg Transfer (positive curve) and Hand Return (negative curve). The manipulative phases Peg Grip and Peg In Hole are between those transfer movements (see Methods)

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[Abstract] Design a solution and a prototype for hand rehabilitation after trauma injures and post stroke

Abstract

Hand injuries are common but if left untreated, it may result in loss of function. Common causes of upper limb injuries are Post Stroke or Trauma. Trauma include falls, cuts from knives or glass as well as workplace injuries. The impairment of finger movements after injures results in a significant deficit in hands everyday performances.

Rehabilitation helps the patient to regain the hands full functionality. Hand therapy is the art that fills the gap between surgery and practical life. It helps the patient to regain the hands full functionality after a certain injury, surgery or Stroke. Hand therapy could be a very tedious process that implies physical exhaustion. Rehabilitation at home is a long process . And it should be done under therapist control. Also finding appointments with the therapist frequent enough for an efficient healing process, is difficult and costly.

Since trying new technologies is usually exciting to people, using the advancements in the field of artificial intelligence could be a solution to this. Different rehabilitation techniques have been developed, nevertheless, they require the presence of a tutor to be executed. To overcome this issue have been designed several apparatuses that allow the patient to perform the training by itself. Trying new technologies is exciting to people.

Hand exoskeleton was implemented to help the patients do their exercises at home in an engaging gamified environment. The objective is to design a portable, lightweight exoskeleton with adjustment fast assemble system. The device support fingers and excluding second injuries. It reproduce pinch exercise. Thus, an easy to use and effective device is needed to provide the right training and complete the rehabilitation techniques in the best way.

In this paper, a review of state of the art in this field is provided, along with an introduc- tion to the problems caused by a hand injuries and the consequences for the mobility of the hand. Then follows a complete review of the exoskeleton project design. The objective is to design a device that can be used at home, with a lightweight and affordable structure and a fast mounting system. For implementing all these features, many aspects have been analysed, starting from the rehabilitation requirements and the ergonomic issues. This device should be able to reproduce the training movements on an injured hand without the need for assistance by an external tutor.

The control system is based on Arduino UNO board, and the user interface is based on UNITY, the objective is to create an online media that allows the patient to exploit the capabilities of the exoskeleton, following the indication of its medic. On the other side, this interface should provide all the data related to the performances of the patient to allow a more precise therapy.

via Design a solution and a prototype for hand rehabilitation after trauma injures and post stroke | POLITesi – Politecnico di Milano

 

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[Abstract] Design of a Low-Cost Exoskeleton for Hand Tele-Rehabilitation After Stroke

Abstract

The impairment of finger movements after a stroke results in a significant deficit in hands everyday performances. To face this kind of problems different rehabilitation techniques have been developed, nevertheless, they require the presence of a therapist to be executed. To overcome this issue have been designed several apparatuses that allow the patient to perform the training by itself. Thus, an easy to use and effective device is needed to provide the right training and complete the rehabilitation techniques in the best way. In this paper, a review of state of the art in this field is provided, along with an introduction to the problems caused by a stroke and the consequences for the mobility of the hand. Then follows a complete review of the low cost home based exoskeleton project design. The objective is to design a device that can be used at home, with a lightweight and affordable structure and a fast mounting system. For implementing all these features, many aspects have been analysed, starting from the rehabilitation requirements and the ergonomic issues. This device should be able to reproduce the training movements on an injured hand without the need for assistance by an external tutor.

via Design of a Low-Cost Exoskeleton for Hand Tele-Rehabilitation After Stroke | SpringerLink

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