- Motor imagery (MI) is a beneficial intervention for stroke rehabilitation.
- MI shows superior to routine methods of treatment or training in improving walking and motor function.
- Effects of MI on walking and motor function are not affected by treatment duration.
Posts Tagged systematic review
[ARTICLE] Markerless motion capture systems as training device in neurological rehabilitation: a systematic review of their use, application, target population and efficacy – Full Text
Client-centred task-oriented training is important in neurological rehabilitation but is time consuming and costly in clinical practice. The use of technology, especially motion capture systems (MCS) which are low cost and easy to apply in clinical practice, may be used to support this kind of training, but knowledge and evidence of their use for training is scarce. The present review aims to investigate 1) which motion capture systems are used as training devices in neurological rehabilitation, 2) how they are applied, 3) in which target population, 4) what the content of the training and 5) efficacy of training with MCS is.
A computerised systematic literature review was conducted in four databases (PubMed, Cinahl, Cochrane Database and IEEE). The following MeSH terms and key words were used: Motion, Movement, Detection, Capture, Kinect, Rehabilitation, Nervous System Diseases, Multiple Sclerosis, Stroke, Spinal Cord, Parkinson Disease, Cerebral Palsy and Traumatic Brain Injury. The Van Tulder’s Quality assessment was used to score the methodological quality of the selected studies. The descriptive analysis is reported by MCS, target population, training parameters and training efficacy.
Eighteen studies were selected (mean Van Tulder score = 8.06 ± 3.67). Based on methodological quality, six studies were selected for analysis of training efficacy. Most commonly used MCS was Microsoft Kinect, training was mostly conducted in upper limb stroke rehabilitation. Training programs varied in intensity, frequency and content. None of the studies reported an individualised training program based on client-centred approach.
Motion capture systems are training devices with potential in neurological rehabilitation to increase the motivation during training and may assist improvement on one or more International Classification of Functioning, Disability and Health (ICF) levels. Although client-centred task-oriented training is important in neurological rehabilitation, the client-centred approach was not included. Future technological developments should take up the challenge to combine MCS with the principles of a client-centred task-oriented approach and prove efficacy using randomised controlled trials with long-term follow-up.
People with central nervous system diseases such as multiple sclerosis (MS), stroke and spinal cord injury (SCI), demonstrate among others loss of motor and sensory function in the upper and lower limbs. Due to motor impairment in upper limbs, the performance of activities of daily life, sports and leisure activities is affected. Motor impairment in the lower limbs, affects mobility in general and balance control during reaching movement. The impairments of both upper and lower limbs reduce functional independence and thus the quality of life of the individual [1, 2, 3, 4, 5, 6]. Exercise therapy has proven to improve impairments [7, 8, 9], therefore rehabilitation is very important for these patients.
In neurological rehabilitation, training should be challenging, repetitive, task-specific, motivating, salient and intensive to activate neuroplasticity . Moreover, studies have shown the importance and benefits of client-centred task-oriented rehabilitation [10, 11]. The concept of client-centredness not only incorporates patient’s wishes and needs in their rehabilitation, but also actively involves the patient in selecting goals for their own rehabilitation process. Definitions of task-oriented training are still very diverse, but it incorporates that training is directed to a specific, functional, task [10, 12]. Task-oriented training has been proven to be effective in arm-hand skilled performance in stroke patients [12, 13], spinal cord  and MS . Spooren et al.  demonstrated the importance of specificity of training and inclusion of ‘client-centred training’ and ‘exercise progression’. Timmermans et al.  concluded that training components, such as random and distributed practice, together with feedback and clear functional goals, should be incorporated in order to enhance the outcomes of task-oriented training. Despite the advantages of a client-centred task-oriented approach with regard to training outcome and motor learning, this approach requires individualised training schemes and guidance of a therapist. Therefore a client-centred and task-oriented approach is more time consuming and costly for therapists and rehabilitation centres. Hence a new approach is needed where client-centred task-oriented rehabilitation can be administered without extra costs and effort of therapists.
Technology-based rehabilitation systems such as robotics and virtual reality (VR) are promising and may be able to deliver a client-centred task-oriented rehabilitation without extra costs and effort of therapists. Several studies addressed the positive effects of robotics and VR systems as additional therapy in neurological rehabilitation [4, 15, 16, 17, 18, 19]. Robotics have shown positive effects such as the enhancement of function and activity of affected limb and increased motivation, but the costs of the devices is high [3, 20]. In addition, the devices are often uncomfortable as the user needs to wear apparatuses on the body and patients have difficulty using such devices . Although a few studies include some aspects of a client-centred approach in robotic rehabilitation, it remains very difficult to incorporate a full client-centred approach because of the wide variety of choices that can be made (e.g. difficult to select individual parameters, specific movements or activities, to use objects, etc. [19, 20]. VR, on the other hand, is a computer-based technology that allows users to interact with simulated environments and receive feedback on performance. VR also stimulates the increase of intensity of movements, therefore it may facilitate motor learning and neuroplasticity through repetition and increased intensity during task-oriented training [2, 3, 4]. Compared to the traditional methods used in motor rehabilitation of patients with neurological disorders, VR has some advantages: 1) patients can perform different rehabilitation exercises, recreated in a virtual way (i.e. virtual rehabilitation exercises), 2) VR can set up the features of the exercises, control their performance and acquire relevant data from the patient’s performance, and 3) VR can facilitate the interaction between patient and system through a variety of available devices, such as MIT-Manus, RemoviEM, etc. [21, 22]. Non-immersive video games are also a form of VR. They are developed by the entertainment industry for healthy population and home use making it less costly and more acceptable. Markerless (i.e. without markers or sensors on the body) motion capture systems (MCS) such as Nintendo Wii and Playstation Move, make use of non-immersive video games and have been used in VR rehabilitation. Studies showed an increase in motivation for rehabilitation as well as improvement in motor function and correctness of movement after training. Although the results are positive, these commercially available MCS systems with VR have to date limited utility in rehabilitation for impaired populations [1, 3, 4]: the standard games are too difficult or progress too quickly, they do not provide impairment-focused training (e.g. no treatment towards flexion synergies), and do not specifically address independent home usability and safety . Only a few studies have looked into customising Kinect games for stroke, but no specific focus was payed to the coordination patterns which are important in stroke recovery, reducing compensation strategies, or usability and safety for independent home use [1, 23]. At present, validity and accuracy of the Microsoft Kinect in clinical assessment is strong regarding postural control and standing balance [24, 25]. The reproducibility of Kinect when analysing planar motions is similar to traditional marker-based stereophotogrammetry systems . Although there is an increasing number of studies involving markerless motion capture systems in neurological rehabilitation, the knowledge and evidence of training content and training efficacy with Kinect or other markerless motion capture systems is scarce [24, 27].
Because little is known about the various markerless MCS used in neurological rehabilitation, their implementation in rehabilitation training, and effectiveness as a potential device in client-centred task-oriented training, the present study aims to investigate 1) which (markerless) motion capture systems are used as training devices in neurological rehabilitation, 2) how they are applied, 3) in which target population, 4) what the content of the training is and 5) what the efficacy of training with MCS is.
Continue —> Markerless motion capture systems as training device in neurological rehabilitation: a systematic review of their use, application, target population and efficacy | Journal of NeuroEngineering and Rehabilitation | Full Text
[Abstract] Changes in transcranial magnetic stimulation outcome measures in response to upper-limb physical training in stroke: A systematic review of randomized controlled trials
Physical training is known to be an effective intervention to improve sensorimotor impairments after stroke. However, the link between brain plastic changes, assessed by transcranial magnetic stimulation (TMS), and sensorimotor recovery in response to physical training is still misunderstood. We systematically reviewed reports of randomized controlled trials (RCTs) involving the use of TMS over the primary motor cortex (M1) to probe brain plasticity after upper-limb physical training interventions in people with stroke.
We searched 5 databases for articles published up to October 2016, with additional studies identified by hand-searching. RCTs had to investigate pre/post-intervention changes in at least one TMS outcome measure. Two independent raters assessed the eligibility of potential studies and reviewed the selected articles’ quality by using 2 critical appraisal scales.
In total, 14 reports of RCTs (pooled participants = 358; mean 26 ± 12 per study) met the selection criteria. Overall, 11 studies detected plastic changes with TMS in the presence of clinical improvements after training, and these changes were more often detected in the affected hemisphere by using map area and motor evoked potential (MEP) latency outcome measures. Plastic changes mostly pointed to increased M1/corticospinal excitability and potential interhemispheric rebalancing of M1 excitability, despite sometimes controversial results among studies. Also, the strength of the review observations was affected by heterogeneous TMS methods and upper-limb interventions across studies as well as several sources of bias within the selected studies.
The current evidence encourages the use of TMS outcome measures, especially MEP latency and map area to investigate plastic changes in the brain after upper-limb physical training post-stroke. However, more studies involving rigorous and standardized TMS procedures are needed to validate these observations.
- Transcranial magnetic stimulation,
- Upper-limb physical training,
- Systematic review,
- Brain plasticity,
- Clinical outcome
Source: Elsevier: Article Locator
[ARTICLE] Complementary and alternative interventions for fatigue management after traumatic brain injury: a systematic review – Full Text
We systematically reviewed randomized controlled trials (RCTs) of complementary and alternative interventions for fatigue after traumatic brain injury (TBI).
We searched multiple online sources including ClinicalTrials.gov, the Cochrane Library database, MEDLINE, CINAHL, Embase, the Web of Science, AMED, PsychINFO, Toxline, ProQuest Digital Dissertations, PEDro, PsycBite, and the World Health Organization (WHO) trial registry, in addition to hand searching of grey literature. The methodological quality of each included study was assessed using the Jadad scale, and the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. A descriptive review was performed.
Ten RCTs of interventions for post-TBI fatigue (PTBIF) that included 10 types of complementary and alternative interventions were assessed in our study. There were four types of physical interventions including aquatic physical activity, fitness-center-based exercise, Tai Chi, and aerobic training. The three types of cognitive and behavioral interventions (CBIs) were cognitive behavioral therapy (CBT), mindfulness-based stress reduction (MBSR), and computerized working-memory training. The Flexyx Neurotherapy System (FNS) and cranial electrotherapy were the two types of biofeedback therapy, and finally, one type of light therapy was included. Although the four types of intervention included aquatic physical activity, MBSR, computerized working-memory training and blue-light therapy showed unequivocally effective results, the quality of evidence was low/very low according to the GRADE system.
The present systematic review of existing RCTs suggests that aquatic physical activity, MBSR, computerized working-memory training, and blue-light therapy may be beneficial treatments for PTBIF. Due to the many flaws and limitations in these studies, further controlled trials using these interventions for PTBIF are necessary.
Fatigue is a common phenomenon following traumatic brain injury (TBI), with a reported prevalence ranging from 21% to 80% [Ouellet and Morin, 2006; Bushnik et al. 2007; Dijkers and Bushnik, 2008; Cantor et al. 2012; Ponsford et al. 2012], regardless of TBI severity [Ouellet and Morin, 2006; Ponsford et al. 2012]. Post-TBI fatigue (PTBIF) refers to fatigue that occurs secondary to TBI, which is generally viewed as a manifestation of ‘central fatigue’. Associated PTBIF symptoms include mental or physical exhaustion and inability to perform voluntary activities, and can be accompanied by cognitive dysfunction, sensory overstimulation, pain, and sleepiness [Cantor et al. 2013]. PTBIF appears to be persistent, affects most TBI patients daily, negatively impacts quality of life, and decreases life satisfaction [Olver et al. 1996; Cantor et al.2008, 2012; Bay and De-Leon, 2010]. Given the ubiquitous presence of PTBIF, treatment or management of fatigue is important to improve the patient’s quality of life after TBI. However, the effectiveness of currently available treatments is limited.
Although pharmacological interventions such as piracetam, creatine, monoaminergic stabilizer OSU6162, and methylphenidate can alleviate fatigue, adverse effects limit their usage and further research is needed to clarify their effects [Hakkarainen and Hakamies, 1978; Sakellaris et al.2008; Johansson et al. 2012b, 2014]. Therefore, many researchers have attempted to identify complementary and alternative interventions to relieve PTBIF [Bateman et al. 2001; Hodgson et al. 2005; Gemmell and Leathem, 2006; Hassett et al. 2009; Johansson et al. 2012a; Björkdahl et al. 2013; Sinclair et al. 2014]. In this study, we aimed to systematically review randomized controlled trials (RCTs) that evaluated treatment of PTBIF using complementary and alternative medicine (CAM) to provide practical recommendations for this syndrome.
Continue —> Complementary and alternative interventions for fatigue management after traumatic brain injury: a systematic reviewTherapeutic Advances in Neurological Disorders – Gang-Zhu Xu, Yan-Feng Li, Mao-De Wang, Dong-Yuan Cao, 2017