Posts Tagged Training

[Abstract] sEMG Bias-driven Functional Electrical Stimulation System for Upper Limb Stroke Rehabilitation

Abstract:

It is evident that the dominant therapy of functional electrical stimulation (FES) for stroke rehabilitation suffers from heavy dependency on therapists experience and lack of feedback from patients status, which decrease the patients’ voluntary participation, reducing the rehabilitation efficacy. This paper proposes a closed loop FES system using surface electromyography (sEMG) bias feedback from bilateral arms for enhancing upper-limb stroke rehabilitation. This wireless portable system consists of sEMG data acquisition and FES modules, the former is used to measure and analyze the subject’s bilateral arm motion intention and neuromuscular states in terms of their sEMG, the latter of multi-channel FES output is controlled via the sEMG bias of the bilateral arms. The system has been evaluated with experiments proving that the system can achieve 39.9 dB signal-to-noise ratio (SNR) in the lab environment, outperforming existing similar systems. The results also show that voluntary and active participation can be effectively employed to achieve different FES intensity for FES-assisted hand motions, demonstrating the potential for active stroke rehabilitation.
Published in: IEEE Sensors Journal ( Early Access ) Date of Publication: 18 June 2018

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via sEMG Bias-driven Functional Electrical Stimulation System for Upper-Limb Stroke Rehabilitation – IEEE Journals & Magazine

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[Abstract] A Portable Passive Rehabilitation Robot for Upper-Extremity Functional Resistance Training

Abstract:

Objective: Loss of arm function is common in individuals with neurological damage, such as stroke or cerebral palsy. Robotic devices that address muscle strength deficits in a task-specific manner can assist in the recovery of arm function; however, current devices are typically large, bulky, and expensive to be routinely used in the clinic or at home. This study sought to address this issue by developing a portable planar passive rehabilitation robot, PaRRo. Methods: We designed PaRRo with a mechanical layout that incorporated kinematic redundancies to generate forces that directly oppose the user’s movement. Cost-efficient eddy current brakes were used to provide scalable resistances. The lengths of the robot’s linkages were optimized to have a reasonably large workspace for human planar reaching. We then performed theoretical analysis of the robot’s resistive force generating capacity and steerable workspace using MATLAB simulations. We also validated the device by having a subject move the end-effector along different paths at a set velocity using a metronome while simultaneously collecting surface electromyography (EMG) and end-effector forces felt by the user. Results: Results from simulation experiments indicated that the robot was capable of producing sufficient end-effector forces for functional resistance training. We also found the endpoint forces from the user were similar to the theoretical forces expected at any direction of motion. EMG results indicated that the device was capable of providing adjustable resistances based on subjects’ ability levels, as the muscle activation levels scaled with increasing magnet exposures. Conclusion: These results indicate that PaRRo is a feasible approach to provide functional resistance training to the muscles along the upper extremity. Significance: The proposed robotic device could provide a technological breakthrough that will make rehabilitation robots accessible for small outpatient rehabilitation centers and in-home therapy.

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[White Book] White Book on Physical and Rehabilitation Medicine (PRM) in Europe. Chapter 9. Education and continuous professional development: shaping the future of PRM – Full Text PDF

In the context of the White Book of Physical and Rehabilitation Medicine (PRM), this paper deals with the education of PRM physicians in Europe. To acquire the wide field of competence needed, specialists in Physical and Rehabilitation Medicine have to undergo a well organised and appropriately structured training of adequate duration. In fact they are required to develop not only medical knowledge, but also competence in patient care, specific procedural skills, and attitudes towards interpersonal relationship and communication, profound understanding of the main principles of medical ethics and public health, ability to apply policies of care and prevention for disabled people, capacity to master strategies for reintegration of disabled people into society, apply principles of quality assurance and promote a practice-based continuous professional development. This paper provides updated detailed information about the education and training of specialists, delivers recommendations concerning the standards required at a European level, in agreement with the UEMS rules of creating a Common Training Framework, that consists of a common set of knowledge, skills and competencies for postgraduate training. The role of the European PRM Board is highlighted as a body aimed at ensuring the highest standards of medical training and health care across Europe and the harmonization of PRM physicians’ qualifications. To this scope, the theoretical knowledge necessary for the practice of PRM specialty and the core competencies (training outcomes) to be achieved at the end of training have been established and the postgraduate PRM core curriculum has been added. Undergraduate training of medical students is also focused, being considered a mandatory element for the growth of both PRM specialty and the medical community as a whole, mainly in front of the future challenges of the ageing population and the increase of disability in our continent. Finally, the problems of continuing professional development and medical education are faced in a PRM European perspective, and the role of the European Accreditation Council of Continuous Medical Education (EACCME) of UEMS is outlined.

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via White Book on Physical and Rehabilitation Medicine (PRM) in Europe. Chapter 9. Education and continuous professional development: shaping the future of PRM – European Journal of Physical and Rehabilitation Medicine 2018 April;54(2):279-86 – Minerva Medica – Journals

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[Abstract] Modelling and control of a novel walker robot for post-stroke gait rehabilitation

Abstract:

In this paper, a novel walker robot is proposed for post-stroke gait rehabilitation. It consists of an omni-directional mobile platform which provides high mobility in horizontal motion, a linear motor that moves in vertical direction to support the body weight of a patient and a 6-axis force/torque sensor to measure interaction force/torque between the robot and patient. The proposed novel walker robot improves the mobility of pelvis so it can provide more natural gait patterns in rehabilitation. This paper analytically derives the kinematic and dynamic models of the novel walker robot. Simulation results are given to validate the proposed kinematic and dynamic models.

I. Introduction

Stroke is one of the leading causes of death overall the world [1]. According to a report from the American Heart Association, around 8 million population experience stroke onset every year worldwide [2]. It remains many sequalae including a pathological walking pattern. Impaired walking function refrains stroke survivors from not only activities of daily living but also social participation, which causes poststroke depression in stroke survivors [3]. Unfortunately, the depressed mood also negatively influences on the recovery of daily functions [4]–[6]. Moreover, decreased mobility is associated with other diseases such as obesity which leads to comorbidity then raise the possibility to get recurrent strokes [7], [8]. This might become a vicious circle and form a huge economic burden for governments [9].

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[Abstract+References] Evidence for Training-Dependent Structural Neuroplasticity in Brain-Injured Patients: A Critical Review

Acquired brain injury (ABI) is associated with a range of cognitive and motor deficits, and poses a significant personal, societal, and economic burden. Rehabilitation programs are available that target motor skills or cognitive functioning. In this review, we summarize the existing evidence that training may enhance structural neuroplasticity in patients with ABI, as assessed using structural magnetic resonance imaging (MRI)–based techniques that probe microstructure or morphology. Twenty-five research articles met key inclusion criteria. Most trials measured relevant outcomes and had treatment benefits that would justify the risk of potential harm. The rehabilitation program included a variety of task-oriented movement exercises (such as facilitation therapy, postural control training), neurorehabilitation techniques (such as constraint-induced movement therapy) or computer-assisted training programs (eg, Cogmed program). The reviewed studies describe regional alterations in white matter architecture and/or gray matter volume with training. Only weak-to-moderate correlations were observed between improved behavioral function and structural changes. While structural MRI is a powerful tool for detection of longitudinal structural changes, specific measures about the underlying biological mechanisms are lacking. Continued work in this field may potentially see structural MRI metrics used as biomarkers to help guide treatment at the individual patient level.

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via Evidence for Training-Dependent Structural Neuroplasticity in Brain-Injured Patients: A Critical Review – Karen Caeyenberghs, Adam Clemente, Phoebe Imms, Gary Egan, Darren R. Hocking, Alexander Leemans, Claudia Metzler-Baddeley, Derek K. Jones, Peter H. Wilson, 2018

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[Abstract+References] SMART Arm Training With Outcome-Triggered Electrical Stimulation in Subacute Stroke Survivors With Severe Arm Disability: A Randomized Controlled Trial.

Background. Stroke survivors with severe upper limb disability need opportunities to engage in task-oriented practice to achieve meaningful recovery. Objective. To compare the effect of SMART Arm training, with or without outcome-triggered electrical stimulation to usual therapy, on arm function for stroke survivors with severe upper limb disability undergoing inpatient rehabilitation. Methods. A prospective, multicenter, randomized controlled trial was conducted with 3 parallel groups, concealed allocation, assessor blinding and intention-to-treat analysis. Fifty inpatients within 4 months of stroke with severe upper limb disability were randomly allocated to 60 min/d, 5 days a week for 4 weeks of (1) SMART Arm with outcome-triggered electrical stimulation and usual therapy, (2) SMART Arm alone and usual therapy, or (3) usual therapy. Assessment occurred at baseline (0 weeks), posttraining (4 weeks), and follow-up (26 and 52 weeks). The primary outcome measure was Motor Assessment Scale item 6 (MAS6) at posttraining. Results. All groups demonstrated a statistically (P < .001) and clinically significant improvement in arm function at posttraining (MAS6 change ≥1 point) and at 52 weeks (MAS6 change ≥2 points). There were no differences in improvement in arm function between groups (P= .367). There were greater odds of a higher MAS6 score in SMART Arm groups as compared with usual therapy alone posttraining (SMART Arm stimulation generalized odds ratio [GenOR] = 1.47, 95%CI = 1.23-1.71) and at 26 weeks (SMART Arm alone GenOR = 1.31, 95% CI = 1.05-1.57). Conclusion. SMART Arm training supported a clinically significant improvement in arm function, which was similar to usual therapy. All groups maintained gains at 12 months.

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via SMART Arm Training With Outcome-Triggered Electrical Stimulation in Subacute Stroke Survivors With Severe Arm Disability: A Randomized Controlled TrialNeurorehabilitation and Neural Repair – Ruth N. Barker, Kathryn S. Hayward, Richard G. Carson, David Lloyd, Sandra G. Brauer, 2017

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[Abstract] Development of a Minimal-Intervention-Based Admittance Control Strategy for Upper Extremity Rehabilitation Exoskeleton

Abstract:

The applications of robotics to the rehabilitation training of neuromuscular impairments have received increasing attention due to their promising prospects. The effectiveness of robot-assisted training directly depends on the control strategy applied in the therapy program. This paper presents an upper extremity exoskeleton for the functional recovery training of disabled patients. A minimal-intervention-based admittance control strategy is developed to induce the active participation of patients and maximize the use of recovered motor functions during training. The proposed control strategy can transit among three control modes, including human-conduct mode, robot-assist mode, and motion-restricted mode, based on the real-time position tracking errors of the end-effector. The human-robot interaction in different working areas can be modulated according to the motion intention of patient. Graphical guidance developed in Unity-3-D environment is introduced to provide visual training instructions. Furthermore, to improve training performance, the controller parameters should be adjusted in accordance with the hemiplegia degree of patients. For the patients with severe paralysis, robotic assistance should be increased to guarantee the accomplishment of training. For the patients recovering parts of motor functions, robotic assistance should be reduced to enhance the training intensity of effected limb and improve therapeutic effectiveness. The feasibility and effectiveness of the proposed control scheme are validated via training experiments with two healthy subjects and six stroke patients with different degrees of hemiplegia.

via Development of a Minimal-Intervention-Based Admittance Control Strategy for Upper Extremity Rehabilitation Exoskeleton – IEEE Journals & Magazine

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[Abstract] EEG-guided robotic mirror therapy system for lower limb rehabilitation – IEEE Conference Publication

Abstract:

Lower extremity function recovery is one of the most important goals in stroke rehabilitation. Many paradigms and technologies have been introduced for the lower limb rehabilitation over the past decades, but their outcomes indicate a need to develop a complementary approach. One attempt to accomplish a better functional recovery is to combine bottom-up and top-down approaches by means of brain-computer interfaces (BCIs). In this study, a BCI-controlled robotic mirror therapy system is proposed for lower limb recovery following stroke. An experimental paradigm including four states is introduced to combine robotic training (bottom-up) and mirror therapy (top-down) approaches. A BCI system is presented to classify the electroencephalography (EEG) evidence. In addition, a probabilistic model is presented to assist patients in transition across the experiment states based on their intent. To demonstrate the feasibility of the system, both offline and online analyses are performed for five healthy subjects. The experiment results show a promising performance for the system, with average accuracy of 94% in offline and 75% in online sessions.

Source: EEG-guided robotic mirror therapy system for lower limb rehabilitation – IEEE Conference Publication

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[BLOG POST] Strength training improves the nervous system’s ability to drive muscles

Imagine that the New Year has just begun. You’ve made a resolution to improve your physical fitness. In particular, you want to improve your muscle strength. You’ve heard that people with stronger muscles live longer and have less difficulty standing, walking, and using the toilet when they get older (Rantanen et al. 1999; Ruiz et al. 2008). So, you join a fitness centre and hire a personal trainer. The trainer assesses your maximal strength, and then guides you through a 4-week program that involves lifting weights which are about 80% of your maximum.

Sure enough, after the program, you become stronger (probably around 20% stronger) (Carroll et al. 2011). You think this is great – and it is! You are so excited, you decide to stand in front of your mirror, flex your biceps, and take a selfie (your plan is to post the picture to Facebook to show your friends how much bigger your muscles got). However, after examining the picture, you realise your muscles did not get bigger. Or perhaps they did get a little bigger, but not enough to explain your substantial improvement in strength. You are somewhat disappointed in this, but then you remember your goal was to get stronger, not necessarily bigger, so you post the picture, anyway.

Magnetic stimulation of the brain can be used to test how well a person can voluntarily drive their muscles.

Interestingly, the observations you made are completely consistent with the scientific literature. Within the first weeks of strength training, muscle strength can improve without a change in the size or architecture of the muscle (e.g., Blazevich et al. 2007). Consequently, researchers have speculated that initial improvements in muscle strength from strength training are due primarily to changes in the central nervous system. One hypothesis has been that strength training helps the nervous system learn how to better “drive” or communicate with muscles. This ability is termed voluntary activation, and it can be tested by stimulating the motor area of an individual’s brain while they perform a maximal contraction (Todd et al. 2003). If the stimulation produces extra muscle force, it means that the individual’s nervous system was not maximally activating their muscles. Currently, there is no consensus as to whether voluntary activation can actually be improved by strength training.

Therefore, we conducted a randomised, controlled trial in which one group of participants completed four weeks of strength training, while a control group did not complete the training (Nuzzo et al. in press). For the group who performed the training, each exercise session consisted of four sets of strong contractions of the elbow flexor muscles (i.e., the muscles that bend the elbow, such as the biceps). Before and after the four week intervention, both groups were tested for muscle strength, voluntary activation, and several other measures. The participants were healthy, university-aged, and they had limited or no experience with strength training.

WHAT DID WE FIND?

Prior to the intervention, the strength training and control groups had similar levels of muscle strength and activation of the elbow flexor muscles. After the intervention, the group who performed the strength training improved their strength by 13%. They also improved their voluntary activation from 88.7% to 93.4%. The control group did not improve muscle strength or voluntary activation.

SIGNIFICANCE AND IMPLICATIONS

The results from our study show that four weeks of strength training improves the brain’s ability to “drive” the elbow flexor muscles to produce their maximal force. This helps to explain how muscles can become stronger, without a change in muscle size or architecture. Moreover, the results suggest that clinicians should consider strength training as a treatment for patients with motor impairments (e.g., stroke), as these individuals are likely to have poor voluntary activation (Bowden et al. 2014).

PUBLICATION

Nuzzo JL, Barry BK, Jones MD, Gandevia SC, Taylor JL. Effects of four weeks of strength training on the corticomotoneuronal pathway. Med Sci Sports Exerc,  doi: 10.1249/MSS.0000000000001367.

KEY REFERENCES

Blazevich AJ, Gill ND, Deans N, Zhou S. Lack of human muscle architectural adaptation after short-term strength training. Muscle Nerve 35: 78-86.

Bowden JL, Taylor JL, McNulty PA. Voluntary activation is reduced in both the more- and less-affected upper limbs after unilateral stroke.Front Neurol 5: 239, 2014.

Carroll TJ, Selvanayagam VS, Riek S, Semmler RG. Neural adaptations to strength training: moving beyond transcranial magnetic stimulation and reflex studies. Acta Physiol 202: 119-140, 2011.

Rantanen T, Guralnik JM, Foley D, Masaki K, Leveille S, Curb JD, White L. Midline hand grip strength as a predictor of old age disability.JAMA 281: 558-560, 1999.

Ruiz JR, Sui X, Lobelo F, Morrow Jr. JR, Jackson AW, Sjöström M, Blair SN. Association between muscular strength and mortality in men: prospective cohort study. BMJ 337: a439, 2008.

Todd G, Taylor JL, Gandevia SC. Measurement of voluntary activation of fresh and fatigued human muscles using transcranial magnetic stimulation. J Physiol 555: 661-671, 2003.

AUTHOR BIO

Jim Nuzzo is a Postdoctoral Fellow at Neuroscience Research Australia (NeuRA). His research investigates how strength training alters the neural connections between the brain and muscles. Click here to read Jim’s other blogs.

Source: Strength training improves the nervous system’s ability to drive muscles – Motor Impairment

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[Abstract] Robot-assisted arm training in physical and virtual environments: A case study of long-term chronic stroke

Abstract:

Robot-assisted training (RT) is a novel technique with promising results for stroke rehabilitation. However, benefits of RT on individuals with long-term chronic stroke have not been well studied. For this case study, we developed an arm-based RT protocol for reaching practice in physical and virtual environments and tracked the outcomes in an individual with a long-term chronic stroke (20+ years) over 10 half-hour sessions. We analyzed the performance of the reaching movement with kinematic measures and the arm motor function using the Fugl-Meyer Assessment-Upper Extremity scale (FMA-UE). The results showed significant improvements in the subject’s reaching performance accompanied by a small increase in FMA-UE score from 18 to 21. The improvements were also transferred into real life activities, as reported by the subject. This case study shows that even in long-term chronic stroke, improvements in motor function are still possible with RT, while the underlying mechanisms of motor learning capacity or neuroplastic changes need to be further investigated.

Source: Robot-assisted arm training in physical and virtual environments: A case study of long-term chronic stroke – IEEE Xplore Document

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