Posts Tagged rehabilitation

[ARTICLE] Effect of Robot-Assisted Game Training on Upper Extremity Function in Stroke Patients – Full Text

ObjectiveTo determine the effects of combining robot-assisted game training with conventional upper extremity rehabilitation training (RCT) on motor and daily functions in comparison with conventional upper extremity rehabilitation training (OCT) in stroke patients.

MethodsSubjects were eligible if they were able to perform the robot-assisted game training and were divided randomly into a RCT and an OCT group. The RCT group performed one daily session of 30 minutes of robot-assisted game training with a rehabilitation robot, plus one daily session of 30 minutes of conventional rehabilitation training, 5 days a week for 2 weeks. The OCT group performed two daily sessions of 30 minutes of conventional rehabilitation training. The effects of training were measured by a Manual Function Test (MFT), Manual Muscle Test (MMT), Korean version of the Modified Barthel Index (K-MBI) and a questionnaire about satisfaction with training. These measurements were taken before and after the 2-week training.

ResultsBoth groups contained 25 subjects. After training, both groups showed significant improvements in motor and daily functions measured by MFT, MMT, and K-MBI compared to the baseline. Both groups demonstrated similar training effects, except motor power of wrist flexion. Patients in the RCT group were more satisfied than those in the OCT group.

ConclusionThere were no significant differences in changes in most of the motor and daily functions between the two types of training. However, patients in the RCT group were more satisfied than those in the OCT group. Therefore, RCT could be a useful upper extremity rehabilitation training method.

INTRODUCTION

stroke is a central nervous system disease caused by cerebrovascular problems such as infarction or hemorrhage. Stroke may lead to impairment of various physical functions, including hemiplegia, language disorder, swallowing disorder or cognitive disorder, according to the location and degree of morbidity [1]. Among these, hemiplegia is a common symptom occurring in 85% of stroke patients. In particular, upper extremity paralysis is more frequent and requires longer recovery time than lower extremity paralysis [23]. To maintain the basic functions of ordinary life, the use of the upper extremities is essential; therefore, upper extremity paralysis commonly causes problems in performing the activities of daily living [2].

Robot-assisted rehabilitation treatment has recently been widely investigated as an effective neurorehabilitation approach that may augment the effects of physical therapy and facilitate motor recovery [4]. Robot-assisted rehabilitation treatments have been developed in recent decades to reduce the expenditure of therapists’ effort and time, to reproduce accurate repetitive motions and to interact with force feedback [56]. The most important advantage of using robot-assisted rehabilitation treatment is the ability to deliver high-dosage and high-intensity training [7].

In rehabilitation patients may find such exercises monotonous and boring, and may lose motivation over time [8]. Upper extremity rehabilitation training using video games, such as Nintendo Wii games and the PlayStation EyeToy games, enhanced upper extremity functions and resulted in greater patient satisfaction than conventional rehabilitation treatment [910111213].

The objective of this study was to determine the effects of combining robot-assisted game training with conventional upper extremity rehabilitation training (RCT) on motor and daily functions in comparison to conventional upper extremity rehabilitation training (OCT) in stroke patients. This study was a randomized controlled trial and we evaluated motor power, upper extremity motor function, daily function and satisfaction. […]

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Fig. 1. (A) Neuro-X, an upper extremity rehabilitation robot, consisting of a video monitor, a robot arm and a computer. (B) The patient performing robot-assisted game training with the upper extremity rehabilitation robot.

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[ARTICLE] The Efficacy of a Haptic-enhanced Virtual Reality System for Precision Grasp Acquisition in Stroke Rehabilitation – Full Text PDF

ABSTRACT
Stroke is a leading cause of long-term disability, and virtual reality (VR)-based stroke rehabilitation is effective in increasing motivation and the functional performance in people with stroke. Although much of the functional reach and grasp capabilities of the upper extremities is regained, the pinch
movement remains impaired following stroke. In this study, we developed a haptic-enhanced VR system to simulate haptic pinch tasks to assist in long-term post-stroke recovery of upper-extremity fine motor function. We recruited 16 adults with stroke to verify the efficacy of this new VR system.
Each patient received 30-min VR training sessions 3 times per week for 8 weeks; all participants attended all 24 training sessions. Outcome measures, Fugl Meyer Assessment (FMA), Test Evaluant les Membres superieurs des Personnes Agees (TEMPA), Wolf Motor Function Test (WMFT), Box and
Block Test (BBT), and Jamar Grip Dynamometer, showed statistically significant progress from pretest to posttest and follow-up, indicating that the proposed system effectively promoted fine motor recovery of function. Additionally, our evidence suggests that this system was also effective under certain challenging conditions such as being in the chronic stroke phase or a co-side of lesion and dominant hand (non- dominant hand impaired). System usability assessment indicated the participants strongly intended to continue using this VR-based system in rehabilitation.

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[ARTICLE] Post-stroke Rehabilitation Training with a Motor-Imagery-Based Brain-Computer Interface (BCI)-Controlled Hand Exoskeleton: A Randomized Controlled Multicenter Trial – Full Text

Repeated use of brain-computer interfaces (BCIs) providing contingent sensory feedback of brain activity was recently proposed as a rehabilitation approach to restore motor function after stroke or spinal cord lesions. However, there are only a few clinical studies that investigate feasibility and effectiveness of such an approach. Here we report on a placebo-controlled, multicenter clinical trial that investigated whether stroke survivors with severe upper limb (UL) paralysis benefit from 10 BCI training sessions each lasting up to 40 min. A total of 74 patients participated: median time since stroke is 8 months, 25 and 75% quartiles [3.0; 13.0]; median severity of UL paralysis is 4.5 points [0.0; 30.0] as measured by the Action Research Arm Test, ARAT, and 19.5 points [11.0; 40.0] as measured by the Fugl-Meyer Motor Assessment, FMMA. Patients in the BCI group (n = 55) performed motor imagery of opening their affected hand. Motor imagery-related brain electroencephalographic activity was translated into contingent hand exoskeleton-driven opening movements of the affected hand. In a control group (n = 19), hand exoskeleton-driven opening movements of the affected hand were independent of brain electroencephalographic activity. Evaluation of the UL clinical assessments indicated that both groups improved, but only the BCI group showed an improvement in the ARAT’s grasp score from 0 [0.0; 14.0] to 3.0 [0.0; 15.0] points (p < 0.01) and pinch scores from 0.0 [0.0; 7.0] to 1.0 [0.0; 12.0] points (p < 0.01). Upon training completion, 21.8% and 36.4% of the patients in the BCI group improved their ARAT and FMMA scores respectively. The corresponding numbers for the control group were 5.1% (ARAT) and 15.8% (FMMA). These results suggests that adding BCI control to exoskeleton-assisted physical therapy can improve post-stroke rehabilitation outcomes. Both maximum and mean values of the percentage of successfully decoded imagery-related EEG activity, were higher than chance level. A correlation between the classification accuracy and the improvement in the upper extremity function was found. An improvement of motor function was found for patients with different duration, severity and location of the stroke.

Introduction

Motor imagery (Page et al., 2001), or mental practice, attracted considerable interest as a potential neurorehabilitation technique improving motor recovery following stroke (Jackson et al., 2001). According to the Guidelines for adult stroke rehabilitation and recovery (Winstein et al., 2016), mental practice may proof beneficial as an adjunct to upper extremity rehabilitation services (Winstein et al., 2016). Several studies suggest that motor imagery can trigger neuroplasticity in ipsilesional motor cortical areas despite severe paralysis after stroke (Grosse-Wentrup et al., 2011Shih et al., 2012Mokienko et al., 2013bSoekadar et al., 2015).

The effect of motor imagery on motor function and neuroplasticity has been demonstrated in numerous neurophysiological studies in healthy subjects. Motor imagery has been shown to activate the primary motor cortex (M1) and brain structures involved in planning and control of voluntary movements (Shih et al., 2012Mokienko et al., 2013a,bFrolov et al., 2014). For example, it was shown that motor imagery of fist clenching reduces the excitation threshold of motor evoked potentials (MEP) elicited by transcranial magnetic stimulation (TMS) delivered to M1 (Mokienko et al., 2013b).

As motor imagery results in specific modulations of brain electroencephalographic (EEG) signals, e.g., sensorimotor rhythms (SMR) (Pfurtscheller and Aranibar, 1979), it can be used to voluntarily control an external device, e.g., a robot or exoskeleton using a brain-computer interface (BCI) (Nicolas-Alonso and Gomez-Gil, 2012). Such system allowing for voluntary control of an exoskeleton moving a paralyzed limb can be used as an assistive device restoring lost function (Maciejasz et al., 2014). Besides receiving visual feedback, the user receives haptic and kinesthetic feedback which is contingent upon the imagination of a specific movement.

Several BCI studies involving this type of haptic and kinesthetic feedback have demonstrated improvements in clinical parameters of post-stroke motor recovery (Ramos-Murguialday et al., 2013Ang et al., 20142015Ono et al., 2014). The number of subjects with post-stroke upper extremity paresis included in these studies was, however, relatively low [from 12 (Ono et al., 2014) to 32 (Ramos-Murguialday et al., 2013) patients]. As BCI-driven external devices, a haptic knob (Ang et al., 2014), MIT-Manus (Ang et al., 2015), or a custom-made orthotic device (Ramos-Murguialday et al., 2013Ono et al., 2014) were used. Furthermore, several other studies reported on using BCI-driven exoskeletons in patients with post-stroke hand paresis (Biryukova et al., 2016Kotov et al., 2016Mokienko et al., 2016), but these reports did not test for clinical efficacy and did not include a control group. While very promising, it still remains unclear whether BCI training is an effective tool to facilitate motor recovery after stroke or other lesions of the central nervous system (CNS) (Teo and Chew, 2014).

Here we report a randomized and controlled multicenter study investigating whether 10 sessions of BCI-controlled hand-exoskeleton active training after subacute and chronic stroke yields a better clinical outcome than 10 sessions in which hand-exoskeleton induced passive movements were not controlled by motor imagery-related modulations of brain activity. Besides assessing the effect of BCI training on clinical scores such as the ARAT and FMMA, we tested whether improvements in the upper extremity function correlates with the patient’s ability to generate motor imagery-related modulations of EEG activity.[…]

Continue —> Frontiers | Post-stroke Rehabilitation Training with a Motor-Imagery-Based Brain-Computer Interface (BCI)-Controlled Hand Exoskeleton: A Randomized Controlled Multicenter Trial | Neuroscience

 

Figure 1. The subject flow diagram from recruitment through analysis (Consolidated Standards of Reporting Trials flow diagram).

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[Guideline] Stroke Rehabilitation – Long term rehabilitation after stroke – National Clinical Guideline Centre UK – PDF 591 pages

Stroke is a major health problem in the UK. Each year in England, approximately 110,000 people 230, in Wales 11,000 and in Northern Ireland 4,000 people have a first or recurrent stroke 250. Most people survive a first stroke, but often have significant morbidity. More than 900,000 people in England are living with the effects of stroke. Stroke mortality rates in the UK have been falling steadily since the late 1960s25. The development of stroke units following the publication of the Stroke Unit Trialists Collaboration meta analysis of stroke unit care 1 , and the further reorganisation of services following the advent of thrombolysis have resulted in further significant improvements in mortality and morbidity from stroke (as documented in the National Sentinel Audit for Stroke 123). However, the burden of stroke may increase in the future as a consequence of the ageing population.

Despite improvements in mortality and morbidity, stroke survivors need access to effective rehabilitation services. Over 30% of people have persisting disability and they need access to stroke services long term. Stroke rehabilitation is a multidimensional process, which is designed to facilitate restoration of, or adaptation to, the loss of physiological or psychological function when reversal of the underlying pathological process is incomplete. Rehabilitation aims to enhance functional activities and participation in society and thus improve quality of life.

A stroke rehabilitation service comprises a multidisciplinary team of people who work together towards goals for each patient, involve and educate the patient and family, have relevant knowledge and skills to help address most common problems faced by their patients276 Key aspects of rehabilitation care include multidisciplinary assessment, identification of functional difficulties and their measurement, treatment planning through goal setting, delivery of interventions which may either effect change or support the individual in managing persisting change, and evaluation of effectiveness. […]

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[Abstract+References] Rehabilitation in Subacute and Chronic Stage After Stroke

Abstract

Despite advancing rehabilitation programs, stroke is the most prevalent disease to cause disablement. With the increase of the elderly population, the number of stroke patients increases as well. Although stroke patients at an early stage depend on a stroke unit in the acute hospital, their functional recovery and long-term health status are more affected by subacute rehabilitation hospital. Moreover, a stroke patient’s initial evaluation is crucial for prognosis and establishment of rehabilitation training strategies. The earlier stroke patients start their rehabilitation treatment, the better results they can attain; the recovery from stroke occurs within 3 months after the onset of stroke. Similarly, while neurological and functional recovery occurs in the acute and subacute stages, sometimes, it occurs 6 months after the onset of stroke or in the chronic stage. There are two main mechanisms of neurological recovery. The first is activity-dependent neuroplasticity in the injured cortical representation area, and second is vicariation, which is an operating mechanism as a substitute for the injured brain function in the remnant cortical area, outside of the damaged brain area. This stroke recovery is affected by many factors that influence reorganization of the damaged brain and early rehabilitation; furthermore, intensive rehabilitation and organized enriched environments also significantly affect recovery. In addition, there are substantial researches about new rehabilitation treatment, likely rTMS, tDCT, robotic therapies, mirror therapy, virtual reality, and drug augmentation; therefore, the results of these studies are expected to highlight promising rehabilitation treatments for stroke in the future.

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Source: Rehabilitation in Subacute and Chronic Stage After Stroke | SpringerLink

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[ARTICLE] Feasibility and Effectiveness of Virtual Reality Training on Balance and Gait Recovery Early after Stroke: A Pilot Study – Full Text

Abstract

Objective: To investigate the feasibility and effectiveness of virtual reality training for improving balance and/or gait during inpatient rehabilitation of patients within 12 weeks after stroke.

Methods: Sixteen patients within 12 weeks after stroke and dependent gait as categorised with a Functional Ambulation Category score of 2 or 3 were included in this longitudinal pilot study. Participants received eight 30-min sessions of virtual reality training during four weeks as part of the regular inpatient rehabilitation program. Feasibility was assessed using compliance with the training, adverse events, experiences of the participants and the physiotherapists; and effectiveness with the Berg Balance Scale, centre of pressure velocity, Functional Ambulation Category and 10-meter walking test.

Results: Participants positively evaluated the intervention and enjoyed the training sessions. Also, physiotherapists observed the training as feasible and beneficial for improving balance or gait. Compliance with the training was 88% and no serious adverse events occurred. The Berg Balance Scale, anterior-posterior centre of pressure velocity, Functional Ambulation Category and 10-meter walking test showed significant improvement after four weeks of training (p<0.05).

Conclusion: This study demonstrates that virtual reality training in patients early after stroke is feasible and may be effective in improving balance and/or gait ability.

Introduction

Balance and gait recovery are considered as key aspects in stroke rehabilitation [13]. To date, physiotherapy and occupational therapy focus on high intensity, repetitive and task-specific practice, which are important principles of motor learning, to elicit improvements in the early rehabilitation phase [1,4,5]. In addition to high intensity, repetitive and task-specific training, variability in practice is important for motor learning. Also, cognitive involvement, functional relevance and the presence of feedback enhance learning [5]. In current physiotherapy or occupational therapy it is difficult to meet all of these above-mentioned training characteristics as therapy may be tedious and resource-intensive [69]. In addition, the frequency and intensity of current therapies have been indicated as insufficient to achieve maximum recovery in the early phase of rehabilitation [8,10]. There is need for engaging, motivating and varied therapy that achieves maximal recovery [11].

In recent years, virtual reality (VR) is introduced in the field of balance and gait rehabilitation after stroke [12]. Since VR training is characterised by individualised, high intensity training in a variety of virtual environments with a high amount of real-time feedback [1315] it might be valuable in stroke rehabilitation. This is confirmed by recent studies [12,1518]. However, almost all studies on the effect of VR on balance and/or gait ability were conducted in the chronic phase after brain injury [9,12,16,17,1923]. Because of the potential relevant characteristics of VR for motor learning and neuroplasticity [14], VR may be of even more added value during the earlier rehabilitation phase. Three studies [2426] that investigated the effect of VR in this time period after stroke indicated a positive effect of commercially available VR systems (Nintendo Wii Fit or IREX) on balance and/or gait recovery. However, the results of these studies cannot be generalised to the whole population of patients with stroke because included participants had a relatively high functional level regarding balance and gait at the start of the VR intervention. A lack of studies including patients with lower functional status after stroke might be caused by the idea that the feasibility of using advanced VR technology may be restricted because of visual, cognitive and/or endurance impairments. These impairments are more often present in the more impaired patients early after stroke [2729]. Because of the expected promising effects of VR training for the recovery of balance and gait in patients with low functional level early after stroke, it is important to investigate the feasibility of this innovative form of training and to determine whether the above-mentioned impairments interfere with the use of VR training early after stroke.

Therefore, the aim of the present study was to investigate the feasibility and effectiveness of VR training for improving balance and/or gait during the inpatient rehabilitation of patients with stroke. The specific research questions were:

• What is the feasibility, from the perspective of patients and physiotherapists, of VR training aimed to improve balance and gait ability?

• What is the effectiveness of VR training, embedded within an inpatient rehabilitation program, on balance and gait ability in people with impaired balance and dependent gait within 12 weeks after stroke?

Methods

Study design

This longitudinal pilot study involved two assessments, one before and one after a four-week VR training intervention, performed within the inpatient rehabilitation program of patients with stroke at (Revant Rehabilitation Centres, Breda, the Netherlands).

Participants

Patients with stroke who were following an inpatient rehabilitation program with a treatment goal to improve balance and/or gait. They received balance and/or gait training with VR as part of their regular rehabilitation program. Besides the VR training, the regular rehabilitation program could include therapy given by a physiotherapist, occupational therapist, speech therapist, psychomotor therapist, psychologist and social worker, depending on the goals of the patient with stroke. Inclusion criteria consisted of hemiplegia resulting from a stroke, a time since stroke of less than 12 weeks, a Berg Balance Scale (BBS) score of at least 20, i.e. the minimum level of balance deemed safe for balance interventions [30], and a Functional Ambulation Category (FAC) score of 2 or 3 out of 5 [31]. Exclusion criteria were patients with stroke with terminal diseases, lower-limb impairments not related to stroke, severe cognitive impairments, severe types of expressive or receptive aphasia, visual impairments, age over 80 years and experiencing epileptic seizures. All participants provided written consent to use data obtained during the rehabilitation program for research, and anonymity was assured. The study procedures follow the principles of the Declaration of Helsinki.

VR training intervention

The intervention consisted of balance and gait training using the recently developed treadmill based Gait Real-time Analysis Interactive Lab (GRAIL, Motekforce Link, Amsterdam, The Netherlands). The GRAIL comprises a dual-belt treadmill with force platform, a motion-capture system (Vicon, Oxford, UK) and speed-matched virtual environments projected on a 180° semi-cylindrical screen (Figure 1) [32].

[…]

Continue —> Feasibility and Effectiveness of Virtual Reality Training on Balance and Gait Recovery Early after Stroke: A Pilot Study | Open Access Journals

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[ARTICLE] Neural Patterns of Reorganization after Intensive Robot-Assisted Virtual Reality Therapy and Repetitive Task Practice in Patients with Chronic Stroke – Full Text

Several approaches to rehabilitation of the hand following a stroke have emerged over the last two decades. These treatments, including repetitive task practice, robotically assisted rehabilitation and virtual rehabilitation activities, produce improvements in hand function, but have yet to reinstate function to pre-stroke levels— which likely depends on developing the therapies to impact cortical reorganization in a manner that favors or supports recovery. Understanding cortical reorganization that underlies the above interventions is therefore critical to inform how such therapies can be utilized and improved, and is the focus of the current investigation. Specifically, we compare neural reorganization elicited in stroke patients participating in two interventions: a hybrid of robot-assisted virtual reality rehabilitation training (RAVR), and a program of repetitive task practice training (RTP).
Ten chronic stroke subjects participated in eight, three-hour sessions of RAVR therapy. Another group of 9 stroke subjects participated in eight sessions of matched RTP therapy. Functional Magnetic Resonance Imagining (fMRI) data were acquired during paretic hand movement, before and after training. We compared the difference between groups and sessions (before and after training) in terms of BOLD intensity, laterality index of activation in sensorimotor areas, and the effective connectivity between ipsilesional motor cortex (iMC), contralesional motor cortex (cMC), ipsilesional primary somatosensory cortex (iS1), ventral premotor area (iPMv), and supplementary motor area (iSMA). Last, we analyzed the relationship between changes in fMRI data and functional improvement measured by the Jebsen Taylor Hand Function Test (JTHFT), in an attempt to identify how neurophysiological changes are related to motor improvement.
Subjects in both groups demonstrated motor recovery after training, but fMRI data revealed RAVR-specific changes in neural reorganization patterns. First, BOLD signal in multiple regions of interest was reduced and re-lateralized to the ipsilesional side. Second, these changes correlated with improvement in JTHFT scores. Our findings suggest that RAVR training may lead to different neurophysiological changes when compared to traditional therapy. This effect may be attributed to the influence that augmented visual and haptic feedback during RAVR training exerts over higher-order somatosensory and visuomotor areas.

Introduction

Recovery of hand function is challenging after stroke. Empirical data suggest that treatment can be beneficial if it includes many repetitions of challenging and meaningful tasks (13). Several approaches to delivering high volume, intense, and salient rehabilitation activities have emerged over the last two decades. These treatments, which include repetitive task practice (RTP), robotically assisted rehabilitation, and virtual rehabilitation activities, produce improvements in hand function that exceed the standard of care in the US (45).

Although a strong case has been made that virtual reality (VR) and robotics can be useful technologies for delivering challenging, meaningful, and mass practice, outcome studies investigating the true benefits of VR/robotics as compared to dose-matched RTP remain mixed (67). For example, we have shown significant group-level improvement in hand and arm function of chronic stroke survivors in response to RTP and robot-assisted VR (RAVR) training to be similar for both groups (8), a finding that agrees with group-level effects in other clinical studies (910). However, whether the underlying neural patterns of reorganization that are induced by the different training regimes are also similar remains unknown. This becomes important to understand because it may inform researchers and clinicians whether RAVR versus RTP may preferentially facilitate distinct neural patterns of reorganization. If so, then perhaps the therapy choice can be tailored more appropriately to individuals to elicit optimal benefits.

The goal of this study was to compare the effect of RAVR- and RTP-based interventions on neural pattern reorganization. Because neural reorganization likely reflects complex processes that include the formation of new connections and/or re-weighting of existing connections, the patterns that emerge are unlikely to be reliably captured using one proxy of activation. For example, while numerous studies have shown training-induced changes in the extent of brain activity, the results of those studies conflict in terms of whether the changes reflect an increase or a decrease in brain activity (1115). Second, there seems to be a relationship between the pattern of reorganization (increase or decrease in ipsilesional somatosensory activation) and intactness of the hand knob area of M1 and its descending motor fibers (16), and a dependence on whether the lesion is cortical or subcortical (17). Connectivity measures may be a complementary way to understand neural reorganization patterns underlying stroke recovery (18) by providing additional information about dynamic network-level changes above and beyond what can be inferred from extent and laterality of activation (1920).

In this study, we therefore characterize the pattern of neural reorganization using multiple measures that included the magnitude of change in brain activation, the extent of activation, the re-lateralization of brain activation in a set of homologous interhemispheric regions of interest, and interactions between multiple regions of interest based on measures of functional and effective connectivity. To our knowledge, this is the first study to characterize brain reorganization at the ROI and network interaction level with multiple functional magnetic resonance imaging (fMRI) measures before and after RAVR and RTP training. In order to delineate the relevance of brain reorganization after training, we also correlated the brain activation outcomes with clinical outcome measures.

We hypothesized that both treatments might have similar effects on the magnitude and laterality of activation in a given region of interest. However, because RAVR training provides a training environment that is enriched and augmented with visual and haptic feedback, we expected that the functional and effective connectivity between motor/premotor cortices and visuomotor areas like the superior parietal lobule may show stronger effects in the RAVR group, as compared to the RTP-based training group (2125). We propose that identifying the neurophysiologic correlates of behavioral motor function improvement might allow strategic refinement of existing training approaches and the development of individually tailored interventions. […]

 

Continue —>  Frontiers | Neural Patterns of Reorganization after Intensive Robot-Assisted Virtual Reality Therapy and Repetitive Task Practice in Patients with Chronic Stroke | Neurology

Figure 1(A,B) The robotic arm, a data glove and force-reflecting hand system used in the robot-assisted virtual reality therapy. (C) Virtual reality feedback during the fMRI movement task. For each hand, one arrow points to the starting position of the hand (open) and another arrow defines the magnitude of finger flexion during the task.

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[Abstract] Motion Rehab AVE 3D: A VR-based exergame for post-stroke rehabilitation

Abstract

Background and objective

Recent researches about games for post-stroke rehabilitation have been increasing, focusing in upper limb, lower limb and balance situations, and showing good experiences and results. With this in mind, this paper presents Motion Rehab AVE 3D, a serious game for post-stroke rehabilitation of patients with mild stroke. The aim is offer a new technology in order to assist the traditional therapy and motivate the patient to execute his/her rehabilitation program, under health professional supervision.

Methods

The game was developed with Unity game engine, supporting Kinect motion sensing input device and display devices like Smart TV 3D and Oculus Rift. It contemplates six activities considering exercises in a tridimensional space: flexion, abduction, shoulder adduction, horizontal shoulder adduction and abduction, elbow extension, wrist extension, knee flexion, and hip flexion and abduction. Motion Rehab AVE 3D also report about hits and errors to the physiotherapist evaluate the patient’s progress.

Results

A pilot study with 10 healthy participants (61–75 years old) tested one of the game levels. They experienced the 3D user interface in third-person. Our initial goal was to map a basic and comfortable setup of equipment in order to adopt later. All the participants (100%) classified the interaction process as interesting and amazing for the age, presenting a good acceptance.

Conclusions

Our evaluation showed that the game could be used as a useful tool to motivate the patients during rehabilitation sessions. Next step is to evaluate its effectiveness for stroke patients, in order to verify if the interface and game exercises contribute into the motor rehabilitation treatment progress.

Source: Motion Rehab AVE 3D: A VR-based exergame for post-stroke rehabilitation – ScienceDirect

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[Abstract] Immediate Effects of Mirror Therapy in Patients With Shoulder Pain and Decreased Range of Motion 

Abstract

Objective

To determine the effects of a brief single component of the graded motor imagery (GMI) sequence (mirror therapy) on active range of motion (AROM), pain, fear avoidance, and pain catastrophization in patients with shoulder pain.

Design

Single-blind case series.

Setting

Three outpatient physical therapy clinics.

Participants

Patients with shoulder pain and limited AROM (N=69).

Intervention

Patients moved their unaffected shoulder through comfortable AROM in front of a mirror so that it appeared that they were moving their affected shoulder.

Main Outcome Measures

We measured pain, pain catastrophization, fear avoidance, and AROM in 69 consecutive patients with shoulder pain and limited AROM before and immediately after mirror therapy.

Results

There were significant differences in self-reported pain (P=.014), pain catastrophization (P<.001), and the Tampa Scale of Kinesiophobia (P=.012) immediately after mirror therapy; however, the means did not meet or exceed the minimal detectable change (MDC) for each outcome measure. There was a significant increase (mean, 14.5°) in affected shoulder flexion AROM immediately postmirror therapy (P<.001), which exceeded the MDC of 8°.

Conclusions

A brief mirror therapy intervention can result in statistically significant improvements in pain, pain catastrophization, fear avoidance, and shoulder flexion AROM in patients presenting with shoulder pain with limited AROM. The immediate changes may allow a quicker transition to multimodal treatment, including manual therapy and exercise in these patients. Further studies, including randomized controlled trials, are needed to investigate these findings and determine longer-term effects.

Source: Immediate Effects of Mirror Therapy in Patients With Shoulder Pain and Decreased Range of Motion – Archives of Physical Medicine and Rehabilitation

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[Abstract] From cortical blindness to conscious visual perception: Theories on neuronal networks and visual training strategies

Homonymous hemianopia (HH) is the most common cortical visual impairment leading to blindness in the contralateral hemifield. It is associated with many inconveniences and daily restrictions such as exploration and visual orientation difficulties. However, patients with HH can preserve the remarkable ability to unconsciously perceive visual stimuli presented in their blindfield, a phenomenon known as blindsight. Unfortunately, the nature of this captivating residual ability is still misunderstood and the rehabilitation strategies have been insufficiently exploited. This paper discusses type I and type II blindsight in a neuronal framework of altered global workspace, resulting from inefficient perception, attention and conscious networks. To enhance synchronisation and create global availability for residual abilities to reach visual consciousness, rehabilitation tools need to stimulate subcortical extrastriate pathways through V5/MT. Multisensory bottom-up compensation combined with top-down restitution training could target pre-existing and new neuronal mechanisms to recreate a framework for potential functionality.

Source: Frontiers | From cortical blindness to conscious visual perception: Theories on neuronal networks and visual training strategies | Frontiers in Systems Neuroscience

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