Posts Tagged stroke rehabilitation

[Abstract+References] Does Stroke Rehabilitation Really Matter? Part A: Proportional Stroke Recovery in the Rat

Abstract

Background. In human upper-limb stroke, initial level of functional impairment or corticospinal tract injury can accurately predict the degree of poststroke recovery, independent of rehabilitation practices. This proportional recovery rule implies that current rehabilitation practices may play little or no role in brain repair, with recovery largely a result of spontaneous biological recovery processes.

Objective. The present study sought to determine if similar biomarkers predict recovery of poststroke function in rats, indicating that an endogenous biological recovery process might be preserved across mammalian species.

Methods. Using a cohort of 593 male Sprague-Dawley rats, we predicted poststroke change in pellet retrieval in the Montoya staircase-reaching task based on initial impairment alone. Stratification of the sample into “fitters” and “nonfitters” of the proportional recovery rule using hierarchical cluster analysis allowed identification of distinguishing characteristics of these subgroups.

Results. Approximately 30% of subjects were identified as fitters of the rule. These rats showed recovery in proportion to their initial level of impairment of 66% (95% CI = 62%-70%). This interval overlaps with those of multiple human clinical trials. A number of variables, including less severe infarct volumes and initial poststroke impairments distinguished fitters of the rule from nonfitters.

Conclusions. These findings suggest that proportional recovery is a cross-species phenomenon that can be used to uncover biological mechanisms contributing to stroke recovery.

1. Prabhakaran, S, Zarahn, E, Riley, C. Inter-individual variability in the capacity for motor recovery after ischemic stroke. Neurorehabil Neural Repair. 2008;22:6471Google ScholarLink
2. Winters, C, van Wegen, EEH, Daffertshofer, A, Kwakkel, G. Generalizability of the proportional recovery model for the upper extremity after an ischemic stroke. Neurorehabil Neural Repair. 2015;29:614622Google ScholarLinkISI
3. Byblow, WD, Stinear, CM, Barber, PA, Petoe, MA, Ackerley, SJ. Proportional recovery after stroke depends on corticomotor integrity. Ann Neurol. 2015;78:848859Google ScholarCrossrefMedline
4. Feng, W, Wang, J, Chhatbar, PY. Corticospinal tract lesion load: an imaging biomarker for stroke motor outcomes. Ann Neurol. 2015;78:860870Google ScholarCrossrefMedline
5. Stinear, CM, Byblow, WD, Ackerley, SJ, Smith, MC, Borges, VM, Barber, PA. Proportional motor recovery after stroke: implications for trial design. Stroke. 2017;48:795798Google ScholarCrossrefMedline
6. Smith, MC, Byblow, WD, Barber, PA, Stinear, CM. Proportional recovery from lower limb motor impairment after stroke. Stroke. 2017;48:14001403Google ScholarCrossrefMedline
7. Winters, C, van Wegen, EEH, Daffertshofer, A, Kwakkel, G. Generalizability of the maximum proportional recovery rule to visuospatial neglect early poststroke. Neurorehabil Neural Repair. 2017;31:334342Google ScholarLink
8. Lazar, RM, Minzer, B, Antoniello, D, Festa, JR, Krakauer, JW, Marshall, RS. Improvement in aphasia scores after stroke is well predicted by initial severity. Stroke. 2010;41:14851488Google ScholarCrossrefMedline
9. Krakauer, JW, Marshall, RS. The proportional recovery rule for stroke revisited. Ann Neurol. 2015;78:845847Google ScholarCrossrefMedline
10. Gladstone, DJ, Danells, CJ, Black, SE. The Fugl-Meyer assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair. 2002;16:232240Google ScholarLink
11. Carmichael, ST. Rodent models of focal stroke: size, mechanism, and purpose. NeuroRx. 2005;2:396409Google ScholarCrossrefMedline

via Does Stroke Rehabilitation Really Matter? Part A: Proportional Stroke Recovery in the RatNeurorehabilitation and Neural Repair – Matthew Strider Jeffers, Sudhir Karthikeyan, Dale Corbett, 2018

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[ARTICLE] Effectiveness of a multimodal exercise rehabilitation program on walking capacity and functionality after a stroke – Full Text

Abstract

The aim of this study was to determine the effectiveness of a 12-week multimodal exercise rehabilitation program on walking speed, walking ability and activities of daily living (ADLs) among people who had suffered a stroke. Thirty-one stroke survivors who had completed a conventional rehabilitation program voluntarily participated in the study. Twenty-six participants completed the multimodal exercise rehabilitation program (2 days/wk, 1 hr/session). Physical outcome measures were: walking speed (10-m walking test), walking ability (6-min walking test and functional ambulation classification) and ADLs (Barthel Index). The program consisted on: aerobic exercise; task oriented exercises; balance and postural tonic activities; and stretching. Participants also followed a program of progressive ambulation at home. They were evaluated at baseline, postintervention and at the end of a 6-month follow-up period. After the intervention there were significant improvements in all outcomes measures that were maintained 6 months later. Comfortable and fast walking speed increased an average of 0.16 and 0.40 m/sec, respectively. The walking distance in the 6-min walking test increased an average of 59.8 m. At the end of the intervention, participants had achieved independent ambulation both indoors and outdoors. In ADLs, 40% were independent at baseline vs. 64% at the end of the intervention. Our study demonstrates that a multimodal exercise rehabilitation program adapted to stroke survivors has benefits on walking speed, walking ability and independence in ADLs.
Keywords: Exercise, Physical activity, Stroke rehabilitation, Walking speed, Activities of daily living

INTRODUCTION

As life expectancy increases, a larger number of persons may suffer from stroke. Stroke mortality rates have decreased, but the burden of stroke is increasing in terms of stroke survivors per year, correlated deaths and disability-adjusted life-years lost. These deficiencies are further highlighted by a trend towards more strokes in younger people (Feigin et al., 2014). Stroke not only causes permanent neurological deficits, but also a profound degradation of physical condition, which worsens disability and increases cardiovascular risk. Stroke survivors are likely to suffer functional decline due to reduction of aerobic capacity. This may involve further secondary complications such as progressive muscular atrophy, osteoporosis, peripheral circulation worsening and increased cardiovascular risk (Ivey et al., 2006). All these factors cause increased dependency, need of assistance from third parties in activities of daily living (ADLs) and a restriction on participation that can have a profound psychosocial impact (Carod-Artal and Egido, 2009). Gait capacity is one of the main priorities of persons who have suffered a stroke, but is often limited due to the high energy demands of hemiplegic gait and the poor physical condition of these persons (Ivey et al., 2006). Gait speed is a commonly used measure in patients who have suffered a stroke to differentiate the functional capacity to walk indoors or outdoors. Gait speed has been classified as: allowing indoor ambulation (<0.4 m/sec), limited outdoor ambulation (0.4–0.8 m/sec), and outdoor functional ambulation (>0.8 m/sec) (Perry et al., 1995). Gait speed can also help to establish the functional prognosis of the patient. It has been stated that improvements in walking speed correlate with improved function and quality of life (QoL) (Schmid et al., 2007). It is essential to achieve a proper gait speed for outdoors functional ambulation.
Falls are common among stroke survivors and are associated with a worsening of disability and QoL. Balance is a complex process that involves the reception and integration of afferent inputs and the planning and execution of movement. Stroke can impact on different systems involved in postural control. Multifactorial falls risk assessment and management, combined with fitness programs, are effective in reducing risk of falls and fear of falling (Stroke Foundation of New Zealand and New Zealand Guidelines Group, 2010). Falls often occur when getting in and out of a chair (Brunt et al., 2002). The 2013 Cochrane review (Saunders et al., 2013) recommends the repetitive practice of sit-to-stand in order to promote an ergonomic and automatic pattern of this movement. Recent studies demonstrate that exercises that improve trunk stability and balance provide a solid base for body and leg movements that entail an improved gait in people affected by stroke (Sharma and Kaur, 2017). Conventional rehabilitation programs after stroke focus on the subacute period. The aim is to recover basic ADLs, but they do not provide maintenance exercises to provide long-term health gains. Cardiac monitoring demonstrates that conventional physiotherapy exercises do not regularly provide adequate exercise intensity to modify the physical deconditioning, nor sufficient exercise repetition to improve motor learning (Ivey et al., 2006). Therapeutic physical exercise to optimize function, physical condition and cardiovascular health after a stroke is an emerging field within neurorehabilitation (Teasell et al., 2009). The wide range of difficulties experienced by stroke survivors justify the need to explore rehabilitation programs designed to promote an overall improvement and to maintain the gains obtained after rehabilitation programs. Numerous studies have demonstrated the efficacy of aerobic exercise (Saunders et al., 2016), but there are few data on the long term effects of multimodal programs that incorporate aerobic exercise, complemented by task-oriented training and balance exercises. Consequently, the aim of this study is to analyse the impact of a multimodal exercise rehabilitation program tailored to stroke survivors on walking speed, walking ability and ADLs. […]

Continue —> Effectiveness of a multimodal exercise rehabilitation program on walking capacity and functionality after a stroke

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[ARTICLE] Adaptive hybrid robotic system for rehabilitation of reaching movement after a brain injury: a usability study – Full Text

Abstract

Background

Brain injury survivors often present upper-limb motor impairment affecting the execution of functional activities such as reaching. A currently active research line seeking to maximize upper-limb motor recovery after a brain injury, deals with the combined use of functional electrical stimulation (FES) and mechanical supporting devices, in what has been previously termed hybrid robotic systems. This study evaluates from the technical and clinical perspectives the usability of an integrated hybrid robotic system for the rehabilitation of upper-limb reaching movements after a brain lesion affecting the motor function.

Methods

The presented system is comprised of four main components. The hybrid assistance is given by a passive exoskeleton to support the arm weight against gravity and a functional electrical stimulation device to assist the execution of the reaching task. The feedback error learning (FEL) controller was implemented to adjust the intensity of the electrical stimuli delivered on target muscles according to the performance of the users. This control strategy is based on a proportional-integral-derivative feedback controller and an artificial neural network as the feedforward controller. Two experiments were carried out in this evaluation. First, the technical viability and the performance of the implemented FEL controller was evaluated in healthy subjects (N = 12). Second, a small cohort of patients with a brain injury (N = 4) participated in two experimental session to evaluate the system performance. Also, the overall satisfaction and emotional response of the users after they used the system was assessed.

Results

In the experiment with healthy subjects, a significant reduction of the tracking error was found during the execution of reaching movements. In the experiment with patients, a decreasing trend of the error trajectory was found together with an increasing trend in the task performance as the movement was repeated. Brain injury patients expressed a great acceptance in using the system as a rehabilitation tool.

Conclusions

The study demonstrates the technical feasibility of using the hybrid robotic system for reaching rehabilitation. Patients’ reports on the received intervention reveal a great satisfaction and acceptance of the hybrid robotic system.

Background

Upper limb hemiparesis is one of the most common consequences after a brain injury accident [1]. This motor impairment has an adverse impact on the quality of life of survivors since it hinders the execution of activities of daily living. From the rehabilitation perspective, it is widely accepted that high-intensity and repetitive task-specific practice is the most effective principle to promote motor recovery after a brain injury [12]. However, traditional rehabilitation treatment offers a dose of movement repetition that is in most cases insufficient to facilitate neural reorganization [3]. In response to these current clinical shortcomings, there is a clear interest in alternative rehabilitation methods that improve the arm motor functionality of brain injury survivors.

Hybrid robotic systems for motor rehabilitation are a promising approach that combine the advantages of robotic support or assistive devices and functional electrical stimulation (FES) technologies to overcome their individual limitations and to offer more robust rehabilitation interventions [4]. Despite the potential benefits of using hybrid robotic systems for arm rehabilitation, a recent published review shows that only a few hybrid systems presented in the literature were tested with stroke patients [4]. Possible reasons could be the difficulties arising from the integration of both assistive technologies or the lack of integrated platforms that can be easily setup and used.

End-effector robotic devices combined with FES represent the most typical hybrid systems used to train reaching tasks under constrained conditions [567]. With these systems, patients’ forearms are typically restricted to the horizontal plane to isolate the training of the elbow extension movement. The main advantage of this approach is the simplicity of the setup, with only 1 Degree of Freedom (DoF). However, to maximize the treatment’s outcomes and achieve functional improvement it is necessary to train actions with higher range of motion (> 1 DoF) and functional connotations [89]. Yet, the complexity for driving a successful movement execution in such scenarios requires the implementation of a robust and reliable FES controller.

The appropriate design and implementation of FES controllers play a key role to achieve stable and robust motion control in hybrid robotic systems. The control strategy must be able to drive all the necessary joints to realize the desired movement, and compensate any disturbances to the motion, i.e. muscle fatigue onset as well as the strong nonlinear and time-varying response of the musculoskeletal system to FES [1011]. Consequently, open-loop and simple feedback controllers (e.g. proportional-integral-derivative -PID-) are not robust enough to cope with these disturbances [812]. Meadmore et al. presented a more suitable hybrid robotic system for functional rehabilitation scenarios [13]. They implemented a model-based iterative learning controller (ILC) that adjusts the FES intensity based on the tracking error of the previously executed movement (see [1314] for a detail description of the system). This iterative adjustment allows compensating for disturbances caused by FES. Although this approach addresses some of the issues regarding motion control with FES, it requires a detailed mathematical description of the musculoskeletal system to work properly. In this context, unmodeled dynamics and the linearization of the model can reduce the robustness of the controller performance. Also, the identification of the model’s parameters is complex and time consuming, which limits its applicability in clinical settings [1112].

The Feedback Error Learning (FEL) scheme proposed by Kawato [15] can be considered as an alternative to ILC. This scheme was developed to describe how the central nervous system acquires an internal model of the body to improve the motor control. Under this scheme, the motor control command of a feedback controller is used to train a feedforward controller to learn implicitly the inverse dynamics of the controlled system on-line (i.e. the arm). Complementary, this on-line learning procedure also allows the controller to adapt and compensate for disturbances. In contrast with the ILC, the main advantage of this strategy is that the controller does not require an explicit model of the controlled system to work correctly and that it can directly learn the non-linear characteristic of the controlled system. Therefore, using the FEL control strategy to control a hybrid robotic system can simplify the setup of the system considerably, which makes easier to deploy it in clinical settings as well as personalize its response according to each patient’s musculoskeletal characteristics and movement capabilities. The FEL has been used previously to control the wrist [16] and the lower limb [17] motion with FES in healthy subjects; but it has not been tested on brain injury patients. In a previous pilot study, we partially showed the suitability of the FEL scheme in hybrid robotic systems for reaching rehabilitation with healthy subjects [18]. However, a rigorous and robust analysis has not been presented neither this concept has not been tested with motor impaired patients.

The main objective of this study is to verify the usability of a fully integrated hybrid robotic system based on an FEL scheme for rehabilitation of reaching movement in brain injury patients. To attain such objective two-step experimentation was followed. The first part consists of demonstrating the technical viability and learning capability of the developed FEL controller to drive the execution of a coordinated shoulder-elbow joint movement. The second part consists of testing the usability of the platform with brain injury patients in a more realistic rehabilitation scenario. For this purpose, we assessed the patients’ performance and overall satisfaction and emotional response after using the system.

Methods

In this section, we present the hybrid robotic system for the rehabilitation of reaching movement in patients with a brain injury. The system focuses on aiding users to move their paretic arm towards specific distal directions in the space. During the execution of the reaching task, the FEL controller adjusts the intensities of the electrical stimuli delivered to target muscles in order to aid the subjects in tracking accurately the target paths.

Description of the hybrid rehabilitation platform for reaching rehabilitation

Figure 1 shows the general overview of the developed platform. This rehabilitation platform is composed of four main components: the hybrid assistive device (upper limb exoskeleton + FES device); the high-level controller (HLC); the visual feedback and; the user interface. […]

Fig. 1 a General overview of the presented hybrid robotic platform for reaching rehabilitation. bVisual feedback provided to the users. The green ball represents the actual arm position, the blue cross is the reference trajectory, the initial and final position are represented by the gray ball and red square respectively. c Interface for system configuration

Source: Adaptive hybrid robotic system for rehabilitation of reaching movement after a brain injury: a usability study | Journal of NeuroEngineering and Rehabilitation | Full Text

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[Abstract] Motor Imagery Training After Stroke: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Abstract

Background and Purpose: A number of studies have suggested that imagery training (motor imagery [MI]) has value for improving motor function in persons with neurologic conditions. We performed a systematic review and meta-analysis to assess the available literature related to efficacy of MI in the recovery of individuals after stroke.

Methods: We searched the following databases: PubMed, Web of Knowledge, Scopus, Cochrane, and PEDro. Two reviewers independently selected clinical trials that investigated the effect of MI on outcomes commonly investigated in studies of stroke recovery. Quality and risk of bias of each study were assessed.

Results: Of the 1156 articles found, 32 articles were included. There was a high heterogeneity of protocols among studies. Most studies showed benefits of MI, albeit with a large proportion of low-quality studies. The meta-analysis of all studies, regardless of quality, revealed significant differences on overall analysis for outcomes related to balance, lower limb/gait, and upper limb. However, when only high-quality studies were included, no significant difference was found. On subgroup analyses, MI was associated with balance gains on the Functional Reach Test and improved performance on the Timed Up and Go, gait speed, Action Research Arm Test, and the Fugl-Meyer Upper Limb subscale.

Discussion and Conclusions: Our review reported a high heterogeneity in methodological quality of the studies and conflicting results. More high-quality studies and greater standardization of interventions are needed to determine the value of MI for persons with stroke.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A188).

Source: Motor Imagery Training After Stroke: A Systematic Review an… : Journal of Neurologic Physical Therapy

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[ARTICLE] SITAR: a system for independent task-oriented assessment and rehabilitation

Over recent years, task-oriented training has emerged as a dominant approach in neurorehabilitation. This article presents a novel, sensor-based system for independent task-oriented assessment and rehabilitation (SITAR) of the upper limb.

The SITAR is an ecosystem of interactive devices including a touch and force–sensitive tabletop and a set of intelligent objects enabling functional interaction. In contrast to most existing sensor-based systems, SITAR provides natural training of visuomotor coordination through collocated visual and haptic workspaces alongside multimodal feedback, facilitating learning and its transfer to real tasks. We illustrate the possibilities offered by the SITAR for sensorimotor assessment and therapy through pilot assessment and usability studies.

The pilot data from the assessment study demonstrates how the system can be used to assess different aspects of upper limb reaching, pick-and-place and sensory tactile resolution tasks. The pilot usability study indicates that patients are able to train arm-reaching movements independently using the SITAR with minimal involvement of the therapist and that they were motivated to pursue the SITAR-based therapy.

SITAR is a versatile, non-robotic tool that can be used to implement a range of therapeutic exercises and assessments for different types of patients, which is particularly well-suited for task-oriented training.

The increasing demand for intense, task-specific neurorehabilitation following neurological conditions such as stroke and spinal cord injury has stimulated extensive research into rehabilitation technology over the last two decades.1,2 In particular, robotic devices have been developed to deliver a high dose of engaging repetitive therapy in a controlled manner, decrease the therapist’s workload and facilitate learning. Current evidence from clinical interventions using these rehabilitation robots generally show results comparable to intensity-matched, conventional, one-to-one training with a therapist.35 Assuming the correct movements are being trained, the primary factor driving this recovery appears to be the intensity of voluntary practice during robotic therapy rather than any other factor such as physical assistance required.6,7 Moreover, most existing robotic devices to train the upper limb (UL) tend to be bulky and expensive, raising further questions on the use of complex, motorised systems for neurorehabilitation.

Recently, simpler, non-actuated devices, equipped with sensors to measure patients’ movement or interaction, have been designed to provide performance feedback, motivation and coaching during training.812 Research in haptics13,14 and human motor control15,16 has shown how visual, auditory and haptic feedback can be used to induce learning of a skill in a virtual or real dynamic environment. For example, simple force sensors (or even electromyography) can be used to infer motion control17and provide feedback on the required and actual performances, which can allow subjects to learn a desired task. Therefore, an appropriate therapy regime using passive devices that provide essential and engaging feedback can enhance learning of improved arm and hand use.

Such passive sensor-based systems can be used for both impairment-based training (e.g. gripAble18) and task-oriented training (ToT) (e.g. AutoCITE8,9, ReJoyce11). ToT views the patient as an active problem-solver, focusing rehabilitation on the acquisition of skills for performance of meaningful and relevant tasks rather than on isolated remediation of impairments.19,20 ToT has proven to be beneficial for participants and is currently considered as a dominant and effective approach for training.20,21

Sensor-based systems are ideal for delivering task-oriented therapy in an automated and engaging fashion. For instance, the AutoCITE system is a workstation containing various instrumented devices for training some of the tasks used in constraint-induced movement therapy.8 The ReJoyce uses a passive manipulandum with a composite instrumented object having various functionally shaped components to allow sensing and training of gross and fine hand functions.11 Timmermans et al.22reported how stroke survivors can carry out ToT by using objects on a tabletop with inertial measurement units (IMU) to record their movement. However, this system does not include force sensors, critical in assessing motor function.

In all these systems, subjects perform tasks such as reach or object manipulation at the tabletop level, while receiving visual feedback from a monitor placed in front of them. This dislocation of the visual and haptic workspaces may affect the transfer of skills learned in this virtual environment to real-world tasks. Furthermore, there is little work on using these systems for the quantitative task-oriented assessment of functional tasks. One exception to this is the ReJoyce arm and hand function test (RAHFT)23 to quantitatively assess arm and hand function. However, the RAHFT primarily focuses on range-of-movement in different arm and hand functions and does not assess the movement quality, which is essential for skilled action.2428

To address these limitations, this article introduces a novel, sensor-based System for Independent Task-Oriented Assessment and Rehabilitation (SITAR). The SITAR consists of an ecosystem of different modular devices capable of interacting with each other to provide an engaging interface with appropriate real-world context for both training and assessment of UL. The current realisation of the SITAR is an interactive tabletop with visual display as well as touch and force sensing capabilities and a set of intelligent objects. This system provides direct interaction with collocation of visual and haptic workspaces and a rich multisensory feedback through a mixed reality environment for neurorehabilitation.

The primary aim of this study is to present the SITAR concept, the current realisation of the system, together with preliminary data demonstrating the SITAR’s capabilities for UL assessment and training. The following section introduces the SITAR concept, providing the motivation and rationale for its design and specifications. Subsequently, we describe the current realisation of the SITAR, its different components and their capabilities. Finally, preliminary data from two pilot clinical studies are presented, which demonstrate the SITAR’s functionalities for ToT and assessment of the UL. […]

Continue —> SITAR: a system for independent task-oriented assessment and rehabilitation Journal of Rehabilitation and Assistive Technologies Engineering – Asif Hussain, Sivakumar Balasubramanian, Nick Roach, Julius Klein, Nathanael Jarrassé, Michael Mace, Ann David, Sarah Guy, Etienne Burdet, 2017

Figure 1. The SITAR concept with (a) the interactive table-top alongside some examples of intelligent objects developed including (b) iJar to train bimanual control, (c) iPen for drawing, and (d) iBox for manipulation and pick-and-place.

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[Abstract] The Combined Effects of Adaptive Control and Virtual Reality on Robot-Assisted Fine Hand Motion Rehabilitation in Chronic Stroke Patients: A Case Study

Robot-assisted therapy is regarded as an effective and reliable method for the delivery of highly repetitive training that is needed to trigger neuroplasticity following a stroke. However, the lack of fully adaptive assist-as-needed control of the robotic devices and an inadequate immersive virtual environment that can promote active participation during training are obstacles hindering the achievement of better training results with fewer training sessions required. This study thus focuses on these research gaps by combining these 2 key components into a rehabilitation system, with special attention on the rehabilitation of fine hand motion skills. The effectiveness of the proposed system is tested by conducting clinical trials on a chronic stroke patient and verified through clinical evaluation methods by measuring the key kinematic features such as active range of motion (ROM), finger strength, and velocity. By comparing the pretraining and post-training results, the study demonstrates that the proposed method can further enhance the effectiveness of fine hand motion rehabilitation training by improving finger ROM, strength, and coordination.

Source: The Combined Effects of Adaptive Control and Virtual Reality on Robot-Assisted Fine Hand Motion Rehabilitation in Chronic Stroke Patients: A Case Study

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[WEB SITE] Stroke rehabilitation gets personalised and interactive – CORDIS

Stroke rehabilitation gets personalised and interactive

The significant socioeconomic costs of stroke coupled with the rise in Europe’s ageing population highlights the need for effective but affordable stroke rehabilitation programmes. EU researchers made considerable headway in this regard through novel rehabilitation paradigms.
Stroke rehabilitation gets personalised and interactive
Computer-mediated rehabilitation tools require a high degree of motor control and are therefore inadequate for patients with significant impairment in motor control. Consequently, many stroke survivors are unable to benefit. The REHABNET (REHABNET: Neuroscience based interactive systems for motor rehabilitation) project came up with an innovative approach to address this critical need.

Researchers successfully developed a hybrid brain-computer interface (BCI)-virtual reality (VR) system that assesses user capability and dynamically adjusts its difficulty level. This motor imagery-based BCI system is tailored to meet the needs of patients using a VR environment for game training coupled with neurofeedback through multimodal sensing technologies.

The game training scenarios address both cognitive and motor abilities. The four rehabilitation scenarios include bimanual motor training, dual motor cognitive-motor training and a simulated city for training on daily living activities.

Pilot and longitudinal studies demonstrated the benefits of longitudinal VR training as compared to existing rehabilitation regimens. The self-report questionnaires also revealed a high user acceptance of the novel system.

Designed for at-home use, the REHABNET toolset is platform-independent and freely available globally as an app (Reh@Mote). Besides deeper insight on factors affecting stroke recovery, this could aid in further improvement of rehabilitation strategies. More importantly, these low-cost toolsets could also address the needs of patients with severe motor and cognitive deficits. Efforts are ongoing to facilitate future commercial exploitation through a technology transfer agreement.

Related information

Source: European Commission : CORDIS : Projects and Results : Stroke rehabilitation gets personalised and interactive

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[Abstract] Preliminary results of testing the recoveriX system on stroke patients 

Abstract

Motor imagery based brain-computer interfaces (BCI) extract the movement intentions of subjects in real-time and can be used to control a cursor or medical devices. In the last years, the control of functional electrical stimulation (FES) devices drew researchers’ attention for the post-stroke rehabilitation field. In here, a patient can use the movement imagery to artificially induce movements of the paretic arms through FES in real-time.

Five patients who had a stroke that affected the motor system participated in the current study, and were trained across 10 to 24 sessions lasting about 40 min each with the recoveriX® system. The patients had to imagine 80 left and 80 right hand movements. The electroencephalogram (EEG) data was analyzed with Common Spatial Patterns (CSP) and linear discriminant analysis (LDA) and a feedback was provided in form of a cursor on a computer screen. If the correct imagination was classified, the FES device was also activated to induce the right or left hand movement.

In at least one session, all patients were able to achieve a maximum accuracy above 96%. Moreover, all patients exhibited improvements in motor function. On one hand, the high accuracies achieved within the study show that the patients are highly motivated to participate into a study to improve their lost motor functions. On the other hand, this study reflects the efficacy of combining motor imagination, visual feedback and real hand movement that activates tactile and proprioceptive systems.

Source: O174 Preliminary results of testing the recoveriX system on stroke patients – Clinical Neurophysiology

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[BLOG POST] Tyromotion Introduces Virtual Reality to Robotic Therapy to Facilitate Stroke Recovery

Rehabilitation technology leader Tyromotion has developed a rehabilitation device that combines virtual reality with robotic therapy to make stroke rehabilitation faster and more efficient.

Tyromotion has created a rehabilitation device that uses a bilateral 3D arm robot and virtual reality glasses to fully immerse stroke patients in virtual worlds where both the visual and physical environments can be shaped. The device is designed to help patients with limited arm function perform daily tasks by challenging and encouraging them to increase their range of motion and the number of repetitions during their therapy sessions. Both these elements are vital to motor learning.

The introduction of virtual reality into therapy delivers a 3D training environment that can be adapted to each individual patient’s abilities. The virtual setting has a gaming element to it, which helps motivate patients to keep repeating their exercises.

Tyromotion’s device is currently being tested by leading rehabilitation facilities in Europe and the United States. The initial reports from therapists and doctors have been very positive, indicating that the new approach to therapy has a strong potential to transform it by increasing patient motivation and making therapy programs more cost effective across the board.

Diego, the robot-assisted arm rehabilitation device used to deliver VR therapy, is the world’s most versatile arm-shoulder rehabilitation device, one that combines robotics with intelligent gravity compensation (IGC) and virtual reality to help patients regain lost arm function. The device offers passive, active and assistive, uni- and bilateral applications that are easily adapted to meet the needs of each patient.

The gravity compensation feature makes heavy arms lighter, allowing physiological movement of the arms in every phase of rehabilitation. The device gives patients more room and more freedom to move and is particularly well suited for task-oriented training with real objects.

Diego offers a versatile range of therapy options with interactive therapy modules that provide haptic and audiovisual feedback, immersing patients in motion in the virtual environment. The therapy modules have different levels of difficulty, which motivates patients to keep making progress. Their progress is then recorded to make their achievements visible.

Diego is suitable for patients of all ages and can be used in all phases of arm rehabilitation. Watch the video below to learn more about its features and benefits.

Related news:

Tyrostation Offers Versatile Range of Therapy Options

Source: Tyromotion Introduces Virtual Reality to Robotic Therapy to Facilitate Stroke Recovery | Fitness Gaming

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[REVIEW] Robotic Devices and Brain Machine Interfaces for Hand Rehabilitation Post-stroke: Current State and Future Potentials – Full Text PDF

Abstract

This paper reviews the current state of the art in robotic-aided hand physiotherapy for post-stroke rehabilitation, including the use of brain machine interfaces (BMI). The main focus is on the technical specifications required for these devices to achieve their goals. From the literature reviewed, it is clear that these rehabilitation devices can increase the functionality of the human hand post-stroke. However, there are still several challenges to be overcome before they can be fully deployed. Further clinical trials are needed to ensure that substantial improvement can be made in limb functionality for stroke survivors, particularly as part of a programme of frequent at-home high-intensity training over an extended period.

This review serves the purpose of providing valuable insights into robotics rehabilitation techniques in particular for those that could explore the synergy between BMI and the novel area of soft robotics.

Introduction

Strokes are a global issue affecting people of all ethnicities, genders and ages [1]; approximately 20 million people per year worldwide suffer a stroke [2, 3]. Five million of those patients remain severely handicapped and dependent on assistance in daily life [4]. Once a stroke has occurred the patient may be left with mild to severe disabilities, depending on the type and severity of the stroke. This paper will focus on the primary issues experienced which are the clawing of the hand and stiffening of the wrist. In recent years, several new forms of rehabilitation have been proposed using robot-aided therapy. This work reviews the current state-ofthe-art robotic devices and brain-machine interfaces (BMI) for post-stroke hand rehabilitation, analysing current challenges, highlighting the future potential and addressing any inherent ethical issues.[…]

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