Posts Tagged Stroke
• We examined the role of bimanual force coordination in bimanual dexterity after stroke.
• Stroke group showed impaired dexterity in a bimanual task with a shared goal.
• Stroke group had poor bimanual coordination of forces during dynamic force modulation.
• Reduced bimanual force coordination predicted impaired dexterity in a bimanual task.
The ability to coordinate forces with both hands is crucial for manipulating objects in bimanual tasks. The purpose of this study was to determine the influence of bimanual force coordination on collaborative hand use for dexterous tasks in chronic stroke survivors.
Fourteen stroke survivors (63.03 ± 15.33 years) and 14 healthy controls (68.85 ± 8.16) performed two bimanual tasks: 1) Pegboard assembly task, and 2) dynamic force tracking task using bilateral index fingers. The Pegboard assembly task required collaborative use of both hands to construct a structure with pins, collars, and washers. We quantified bimanual dexterity with Pegboard assembly score as the total number of pins, collars, and washers assembled in one minute. The force tracking task involved controlled force increment and decrement while tracking a trapezoid trajectory. The task goal was to match the target force with the total force, i.e., sum of forces produced by both hands as accurately as possible. We quantified bimanual force coordination by computing time-series cross-correlation coefficient, time-lag, amplitude of coherence in 0 – 0.5 Hz, and 0.5 – 1 Hz for force increment and decrement phases.
In the Pegboard assembly task, the stroke group assembled fewer items relative to the control group (p = 0.004). In the bimanual force tracking task, the stroke group showed reduced cross-correlation coefficient (p = 0.01), increased time-lag (p = 0.00), and reduced amplitude of coherence in 0 – 0.5 Hz (p = 0.03) and in 0.5 – 1 Hz (p = 0.00). Multiple regression analysis in the stroke group revealed that performance on Pegboard assembly task was explained by cross-correlation coefficient and coherence in 0.5 – 1 Hz during force increment (R2 = 0.52, p = 0.00).
Individuals with stroke show impaired bimanual dexterity and diminished bimanual force coordination. Importantly, stroke-related deterioration in bimanual force coordination is associated with poor performance on dexterous bimanual tasks that require collaboration between hands. Re-training bimanual force coordination in stroke survivors could facilitate a higher degree of participation in daily activities through improved bimanual dexterity.
Experiencing a stroke or a brain injury is a huge, life-altering event. But even after the rehab, the outpatient therapy, and the lifestyle modifications, there can be another fear- will having a stroke or brain injury lead to dementia in the future?
In this article
- What is the link between stroke or brain injury and dementia?
- Why might a stroke or brain injury lead to dementia?
- Who is at risk of developing dementia post-stroke?
- What can be done to reduce the risk of developing dementia?
- Resources for people with dementia
What is the link between stroke/brain injury and dementia?
Dementia is an umbrella term for a collection of cognitive and communicative deficits. Memory loss, executive functioning deficits, communication impairments and challenging behavior are the hallmarks of a dementia diagnosis. This can be extremely difficult for the person and their family, who have already endured a stroke or brain injury.
The link between stroke/brain injury and dementia is clear. Dementia affects 50 million people worldwide, and studies show that people who sustain an injury to the brain are twice as likely to develop dementia post-injury.
Why might a stroke or brain injury lead to dementia?
Why certain injury to the brain can cause dementia in older age is not always clear, though there are many working theories.
Alzheimer’s disease (AD) is the most common form of dementia, estimated to affect 5.5 million people in America today. AD accounts for between 60-80% of all cases of dementia, and is caused by an abnormal buildup of proteins in the brain, which interrupt and disrupt the messages being sent within the brain itself.
Some research shows that injury to the blood-brain-barrier, a membrane that selectively filters nutrients from the bloodstream into the brain, has a strong link to subsequent development of Alzheimer’s. The blood brain barrier can be damaged by hypoxia- oxygen deprivation that may be caused by a blockage- or by a traumatic brain injury.
Vascular dementia (VD), the second most commonly experienced dementia, is a step-wise decline in function as a result of several strokes. Strokes often cause temporary or long-lasting damage to the tissues in the brain, and the amount of recovery to these tissues may vary. When multiple strokes or brain injuries occur, the brain is not be able to heal fully, in time leading to VD.
Chronic Traumatic Encephalopathy (CTE), is a brain condition associated with multiple blows to the head and sometimes experienced by football players, boxers, or those with repeated falls. CTE has been linked with early onset of dementia, likely owing to some of the reasons above- non-healing injuries, and disruption to the BBB leading to accumulations of protein tangles in the brain.
Who is at risk of developing dementia post-stroke?
The incidence of those who develop dementia after a stroke or brain injury is estimated to be about two-fold of those in the general population. The risk factors that may make someone more susceptible to dementia include:
- a Hemorrhagic versus Ischemic stroke (a bleed versus a blockage). This may be linked to the diffuse nature of a bleed, and the possible disruption of the blood-brain-barrier.
- a stroke occurring at a younger age; regardless of type of stroke, people who sustain a stroke at a younger age are at an increased risk of developing dementia over the course of their lifespan.
Persons are also at the highest risk of dementia one year post-injury. After the one year mark, the increased risk persists across all types of stroke/brain injury, but at lower levels than before.
What can be done to reduce the risk of developing dementia?
Decreasing the risk of developing dementia when a stroke or brain injury has occurred is all about working on brain health and recovery. Keeping the brain healthy and allowing the damaged tissues to repair to their fullest extent may delay or even arrest later development of dementia.
The gold standard of dementia risk reduction includes physical activity, healthy living, cognitive engagement, and taking control of the reasons that a stroke or brain injury may have occurred in the first place.
Physical rehabilitation post-stroke/brain injury is essential to make sure that physical and medical issues are addressed. It is so important to be able to operate at the highest level possible, to live as healthfully as possible, even after a stroke/brain injury. Regular cardiovascular exercise will increase oxygenation in the body, which is necessary to help heal and improve brain health.
Eating more healthfully and avoiding overly fatty and processed foods will also improve brain health. Some research shows supplementation with vitamins, especially Vitamin K and Omega-3s, can help reduce risk of developing dementia.
Challenging your cognition, and maintaining engagement with cognitive tasks will also help to strengthen your brain. The process of learning may increase neural connections in the brain, essential for communication, memory, and other cognitive functions.
Meditation and mindfulness has been shown to increase grey matter in the brain, unequivocally improving cognition and brain health.
Resources for those at risk
Family conflict abounds in the diagnosis of dementia- seek out support groups through the Alzheimer’s Association.
Looking for cognitive solutions for someone with a stroke, brain injury or dementia? Check out Neofect Cognition and the Neofect Smart Pegboard.
Karen Nolan, PhD, of Kessler Foundation, is site investigator for a multi-site trial of a music-based digital therapeutic device with the potential to improve mobility after stroke
East Hanover, NJ. September 16, 2020. Karen Nolan, PhD, of Kessler Foundation, received a grant from MedRhythms to test the company’s investigational digital therapeutic device, the Stride Plus, in individuals striving to recover mobility after stroke. Dr. Nolan, a senior research scientist in the Center for Mobility and Rehabilitation Engineering Research, specializes in the study of new technologies with potential applications in rehabilitation research for deficits in gait and balance that impair mobility.
Kessler Foundation is one of six sites participating in the randomized controlled study, “Post-stroke walking speed and community ambulation conversion: A pivotal study.” The other sites are the Shirley Ryan AbilityLab in Chicago, The Mount Sinai Hospital in New York, Spaulding Rehabilitation Hospital in Boston, Boston University Neuromotor Recovery Laboratory, and Atrium Health in Charlotte, North Carolina.
The study’s objective is to help individuals whose walking ability is affected by stroke to improve their walking speed and advance from limited community ambulation to community ambulation. The data collected from the six sites will support MedRhythm’s application for FDA approval of the device, which received Breakthrough Device Designation from the FDA in June 2020.
The Stride Plus device, which relies on internet connectivity, includes: 1) mobile device that provides rhythmic auditory stimulation in the form of music and rhythmic cues to facilitate the speed and quality of walking; 2) sensors that attach to each shoe to measure biomechanics; and 3) headphones that deliver the auditory cues. Feedback from the sensors is used to augment the music to encourage stable gait patterns and faster walking speed. The sensors also allow for monitoring and recording of the individual’s progress.
A total of 78 participants, including stroke survivors and controls, will be randomized to treatment and control groups. The treatment group will train in the Stride Plus three times a week for five weeks.
“Loss of mobility after stroke exerts a huge toll on individuals, their caregivers, our healthcare system, and society,” said Dr. Nolan, site investigator for the Kessler site. “Stroke rehabilitation is an area where we need to test new technologies to change the outlook for recovery. Applying digital therapeutics is a promising approach for restoring lost mobility,” she noted, “which may foster greater independence and better quality of life in this population.”
As stroke survival rates increase and the population ages, the population of stroke survivors in the U.S. is growing, according to Brian Harris, founder and CEO of MedRhythms. “Progress in stroke rehabilitation has lagged the needs of this growing population. Randomized controlled trials like this pivotal study will help us determine the potential for digital therapeutics in filling these unmet needs for rehabilitation that improves outcomes,” Harris added. “We are encouraged by the FDA’s Breakthrough Device Designation for Stride Plus, which supports our efforts to raise the standard of care for chronic stroke.”
[Abstract + References] Move-IT: A Virtual Reality Game for Upper Limb Stroke Rehabilitation Patients – Conference paper
Stroke rehabilitation plays an important role in recovering the lifestyle of stroke survivors. Although existing research proved the effectiveness and engagement of Non-immersive Virtual Reality (VR) based rehabilitation systems, however, limited research is available on the applicability of fully immersive VR-based rehabilitation systems. In this paper, we present the development and evaluation of “Move-IT” game designed for domestic upper limb stroke patients. The game incorporates the use of Oculus Rift Head Mounted Display (HMD) and the Leap Motion hand tracker. A user study of five upper limb stroke patients was performed to evaluate the application. The results showed that the participants were pleased with the system, enjoyed the game and found it was exciting and easy to play. Moreover, all the participants agreed that the game was very motivating to perform rehabilitation exercises.
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[Abstract + References] Multi-modal Intent Recognition Method for the Soft Hand Rehabilitation Exoskeleton
Stroke has become the second most disabling disease in the world. Due to the intensive demand for physical therapists and the severe dependence on hospitals, the cost for the treatment of stroke patients is huge. As the most flexible limb of the human body, the hand faces more severe challenges, which has a much lower degree of recovery than the upper and lower limbs. In the face of these challenges, a new treatment, exoskeleton-based rehabilitation, has demonstrated new vitality. This paper proposes a novel design of the soft hand exoskeleton based on bionics and anatomy and the exoskeleton could help the users bend and extend their fingers, which would greatly improve the motor ability of stroke patients. Through the control of the six drive motors, the exoskeleton could achieve most of the hand’s freedom of training. At the same time, we propose a multi-modal intent recognition method based on machine vision and machine speech. Under specific rehabilitation training scenarios, both healthy subjects and patients could complete grasping tasks in the wearing of the exoskeleton, overcoming potential security risks caused by misidentification due to using the single-modal intent understanding method.
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[Abstract] Motiv’Handed, a New Gamified Approach for Home-Based Hand Rehabilitation for Post-stroke Hemiparetic Patients – Conference paper
This document summarizes a master thesis project trying to bring a new solution to hemiplegia rehabilitation, one of the numerous consequences of strokes. A hemiplegic patients observe paralysis on one side of their body, and as so, loses autonomy and their quality of life decreases. In this study, we decided to only focus on the hand rehabilitation aspect. However, there is a clear tendency in stroke patients to stop training regularly when returning home from the hospital and the first part of their rehabilitation is over. They often experience demotivation, having the feeling that they will never get back to a fully autonomous person ever again and tend to put their training aside, especially when they do not see clear and visible results anymore. This is also due to the supervised training becoming sparser. All of this results in patients stagnating or even worse, regressing. Thus, we decided to offer a motivating solution for hand rehabilitation at home through gamification.
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September 14, 2020 By Annette Boyle
B-Temia Inc.’s Keeogo mobility device is on the move in the U.S. now that it has received 510(k) clearance from the U.S. FDA. Unlike currently available exoskeletons that move for patients, the Keeogo (keep on going) Dermoskeleton system amplifies signals from patients who can initiate movement but need additional assistance.
“This U.S. market clearance is the biggest milestone of our global regulatory expansion, as the USA is the largest medical device market. It also gives us great confidence for the other regulatory approvals we are currently completing for additional territories,” said B-Temia’s president and CEO Stéphane Bédard.
The U.S. action specifically covers use of the device for stroke patients in rehabilitation settings. “Stroke is just the entry door,” Bédard told BioWorld. “We want to extend U.S. authorization for other indications in the future. We’ve done very well for stroke patients and want to do the same for those with multiple sclerosis, osteoarthritis of the knee, Parkinson’s disease, and partial spinal cord injuries.”
The company also hopes to gain clearance for patients to use the device on a day-to-day basis, not just during rehab sessions. “Keeogo has as its main purpose providing the person the ability to regain their activity on a daily basis walking, shopping, out in the yard. That’s why we invented it,” Bédard added. “We will reach that level in the U.S., but with the FDA, you have to go step-by-step for each indication.”
Keeogo already has much broader authorization in Europe where it received CE mark authorization in December 2019. In the 28 European countries covered by the CE mark, Quebec-based B-Temia can market the system to provide additional strength and stability to users with musculoskeletal weakness or lower limb instability both at home and in clinics. The system has been approved by Health Canada since 2015 for a range of indications as well.
Keeogo is a lightweight motorized walking assistive device that boosts leg power. Its dermoskeleton technology employs artificial intelligence (AI) to help individuals with impaired mobility walk, run, sit, and climb. Underpinned by a model of human biomechanics and the basics elements of gait, the AI uses additional mathematical equations to intervene properly in the movement.
The AI, housed on a belt worn at the waist, interprets information transmitted by sensors strapped to the leg to understand the user’s intent and then provides the compensation needed so they can achieve their goal. It is unique in that it does not replace an individual’s motion, only augments it. “If you don’t walk, it won’t move,” said Bédard. “It will add its response to your own characteristic speed and cadence and is fully customizable to the specifics of a disease and person. We’re only able to achieve this level of sophistication with AI.”
By augmenting the user’s motions, Keeogo works to help them regain or retain their autonomy and mobility. “When you go in the lab with Keeogo, you extend your range of motion, augment stride length, and increase the biomechanical ability to walk,” explained Bédard. “When you repeat recursive exercises, you build your capacity. You extend what you’ve done in the past– the body has a memory of that – and Keeogo synchronizes the motions, extends the gait, so that day after day you regain capacity.” In Parkinson’s and other degenerative diseases, the system helps patients hold onto their independence and not fall into a pattern of doing less and less as the disease progresses and movement becomes more challenging.
Notably, the system is not tied to an idealized motion. “We’re not trying to perfect the individual’s gait, just to improve it. We want to keep the individual’s natural gait. They will improve themselves as they use the system,” Bédard said.
Aside from its clinical applications, B-Temia also continues to develop its military version of Keeogo, the Onyx exoskeleton, for the U.S. Army. It has worked with Lockheed Martin since 2017 to support soldiers tasked with carrying loads of more than 100 pounds. Under that weight, people naturally change their gait. In addition, the weight puts such pressure on the joints that it often leads to both acute and chronic musculoskeletal injuries.
“The approval also confers additional credibility for the corporation that will open a lot of doors in terms of investors, financing, and partnerships,” Bédard said.
He plans to spend the next several weeks determining how to execute properly on commercialization in the U.S. and elsewhere so that the device can be easily acquired by individuals who could benefit. “Our next challenge is to establish a good strategy. There are many options on the table and we want to make sure we choose the right structure, partners and channels.
[ARTICLE] Virtual reality-based treatment for regaining upper extremity function induces cortex grey matter changes in persons with acquired brain injury – Full Text
Individuals with acquired brain injuries (ABI) are in need of neurorehabilitation and neurorepair. Virtual anatomical interactivity (VAI) presents a digital game-like format in which ABI survivors with upper limb paresis use an unaffected limb to control a standard input device and a commonplace computer mouse to control virtual limb movements and tasks in a virtual world.
In a prospective cohort study, 35 ambulatory survivors of ABI (25/71% stroke, 10/29% traumatic brain injury) were enrolled. The subjects were divided into three groups: group A received VAI therapy only, group B received VAI and physical/occupational therapy (P/OT), and group C received P/OT only. Motor skills were evaluated by muscle strength (hand key pinch strength, grasp, and three-jaw chuck pinch) and active range of motion (AROM) of the shoulder, elbow, and wrist. Changes were analyzed by ANOVA, ANCOVA, and one-tailed Pearson correlation analysis. MRI data was acquired for group A, and volumetric changes in grey matter were analyzed using voxel-based morphometry (VBM) and correlated with quantified motor skills.
AROM of the shoulder, elbow, and wrist improved in all three groups. VBM revealed grey matter increases in five brain areas: the tail of the hippocampus, the left caudate, the rostral cingulate zone, the depth of the central sulcus, and the visual cortex. A positive correlation between the grey matter volumes in three cortical regions (motor and premotor and supplementary motor areas) and motor test results (power and AROM) was detected.
Our findings suggest that the VAI rehabilitation program significantly improved motor function and skills in the affected upper extremities of subjects with acquired brain injuries. Significant increases in grey matter volume in the motor and premotor regions of affected hemisphere and correlations of motor skills and volume in nonaffected brain regions were present, suggesting marked changes in structural brain plasticity.
Neurological disorders, including acquired brain injuries (ABIs) are important causes of disability and death worldwide [1, 2]. Although age-standardized mortality rates for ischemic and hemorrhagic strokes have decreased in the past two decades, the absolute number of stroke survivors is increasing, with most of the burden in low- and middle-income countries . Another major issue is that trends toward increasing stroke incidence at younger ages has been observed . Moreover, this type of ABI is the leading cause of long-term disability in the United States, with an estimated incidence of 795,000 strokes yearly .
In more than 80% of stroke survivors, impairments are seen in at least one of the upper limbs. Six months after a stroke, 38% of patients recover some dexterity in the paretic arm, though only 12% recover substantial function even in spite of having received physical/occupational therapy (P/OT) . Only a few survivors are able to regain some useful function of the upper limb. Failing to achieve useful function has highly negative impacts on the performance of daily living activities [6, 7]. Regaining control and improving upper limb motor function after ABIs are therefore crucial goals of motor system rehabilitation. In left-sided limb impairment, neglect syndrome can contribute to a worsened clinical state, making the alleviation of symptoms even more difficult to achieve. Mirror therapy has been reported as a promising approach to improve neglect symptoms [8, 9].
MRI has been used to track changes in brain connectivity related to rehabilitation , and several studies of healthy individuals playing off-the-shelf video games have demonstrated changes in the human brain resulting from interactions in a virtual world (VW) [11, 12]. Furthermore, playing video games results in brain changes associated with regaining improved, purposeful physical movements [13, 14]. The socio-cultural relevance of virtual reality (VR) and VW applications lies, more generally, in the fact that these technologies offer interactive environments to users. These interactive environments are actually present in the users’ experiences while less so in the world they share as biological creatures . The way in which we engage with VWs allows for rehabilitation exercises and activities that feel similar to their actual physical world counterparts . In the past two decades, researchers have demonstrated the potential for the interactive experiences of VWs to provide engaging, motivating, less physically demanding, and effective environments for ABI rehabilitation [9, 16,17,18].
One of the suitable rehabilitation methods seems to be exercises and tasks in VW called virtual anatomical interactivity (VAI) . This method provides sensory stimulation / afferent feedback and allows the independent control of an anatomically realistic virtual upper extremity capable of simulating human movements with a true range of motion. ABI survivors are able to relearn purposeful physical movements and regain movement in their disabled upper extremities . Contrary to conventional therapy, which exercises impaired upper limbs to improve limb movement, the general VAI hypothesis is that brain exercises alone (or combined with traditional therapy) may positively influence neuroplastic functions. In the VW, subjects can move their virtual impaired limbs using their healthy hands, meaning simulated physical movements are survivor-authored. Virtual visuomotor feedback may help regain functional connectivity between the brain and the impaired limb, therefore also regaining voluntary control of the limb.
The aim of the study was to test if the shoulder, elbow, and wrist movement; hand pinch strength; and grip strength of the paretic side improved through the use of VAI exclusively or combined with P/OT for upper extremities and how these approaches improved functional outcomes measured by the Action Reach Arm Test . The relationship between changes in abilities to control upper extremities and volumetric changes in cortex grey matter measured by VBM and using MRI was also explored.[…]
[Abstract] Experiences of augmented arm rehabilitation including supported self-management after stroke: a qualitative investigation
To explore the experiences of stroke survivors and their carers of augmented arm rehabilitation including supported self-management in terms of its acceptability, appropriateness and relevance.
A qualitative design, nested within a larger, multi-centre randomized controlled feasibility trial that compared augmented arm rehabilitation starting at three or nine weeks after stroke, with usual care. Semi-structured interviews were conducted with participants in both augmented arm rehabilitation groups. Normalization Process Theory was used to inform the topic guide and map the findings. Framework analysis was applied.
Interviews were conducted in stroke survivors’ homes, at Glasgow Caledonian University and in hospital.
17 stroke survivors and five carers were interviewed after completion of augmented arm rehabilitation.
Evidence-based augmented arm rehabilitation (27 additional hours over six weeks), including therapist-led sessions and supported self-management.
Three main themes were identified: (1) acceptability of the intervention (2) supported self-management and (3) coping with the intervention. All stroke survivors coped well with the intensity of the augmented arm rehabilitation programme. The majority of stroke survivors engaged in supported self-management and implemented activities into their daily routine. However, the findings suggest that some stroke survivors (male >70 years) had difficulties with self-management, needing a higher level of support.
Augmented arm rehabilitation commencing within nine weeks post stroke was reported to be well tolerated. The findings suggested that supported self-management seemed acceptable and appropriate to those who saw the relevance of the rehabilitation activities for their daily lives, and embedded them into their daily routines.
Telemedicine seemed like a new idea at the outset of the COVID-19 pandemic. However, it now appears to be part of the new norm and might be paving the way to the future.
In a recent review paper published in Telemedicine and e-Health, Brodie Sakakibara, along with the Centre for Chronic Disease Prevention and Management (CCDPM), suggest that virtual appointments, in the form of telerehabilitation, could also work for people recovering from a stroke.
After a stroke, a client is provided with a therapy program to help re-gain loss of skills or motion — this can range from speech and memory, strength, balance and endurance. While not initially introduced for disease outbreaks, Sakakibara, a UBCO assistant professor, suggests that research shows remote therapy can be effective during stroke recovery, a media release from University of British Columbia Okanagan campus notes.
“Telerehabilitation has been promoted as a more efficient means of delivering rehabilitation services to stroke patients while also providing care options to those unable to attend conventional therapy. These services can be provided to remote locations through information and communication technologies and can be accessed by patients in their homes.”
— Brodie Sakakibara
HOW EFFECTIVE IS IT?
To learn how effective telerehabilitation can be, six different clinical trials — examining stroke telerehabilitation programs — were launched across Canada as part of a Heart and Stroke Foundation initiative. People recovering from a stroke were provided with interventions ranging from lifestyle coaching to memory, speech skills and physical-exercise training.
Researchers from each of the six trials came together to write a review paper describing their experiences conducting a telerehabilitation study, and to report on the facilitators and barriers to the implementation of telerehab services within a research context, Sakakibara shares in the release.
Going forward with telerehabilitation as a new reality, Sakakibara says the study authors determined there are important lessons learned from each of the six trials. Most notably, the efficacy and cost of telerehabilitation is similar to that of traditional face-to-face management.
He also notes patients mostly reported satisfaction with the telerehabilitation when therapists were trained appropriately, and when there was some social interaction. Overall, clinicians prefer face-to-face interactions but will use telerehabilitation when face-to-face is not feasible.
And finally, since seniors are a key target group for stroke rehabilitation — as stroke is associated with aging — the technology needs to be easy to use and suit the needs of the end users, the release continues.
“The older adult of today, in terms of technology comfort and use, is different than the older adult of tomorrow. While there might be some hesitation of current older adults using technology to receive health and rehab services, the older adult of tomorrow likely is very comfortable using technology. This represents a large opportunity to develop and establish the telehealth/rehabilitation model of care.”
— Brodie Sakakibara
[Source(s): University of British Columbia Okanagan campus, Science Daily]