Posts Tagged Training

[ARTICLE] Arm Ability Training (AAT) Promotes Dexterity Recovery After a Stroke—a Review of Its Design, Clinical Effectiveness, and the Neurobiology of the Actions – Full Text

Arm Ability Training (AAT) has been specifically designed to promote manual dexterity recovery for stroke patients who have mild to moderate arm paresis. The motor control problems that these patients suffer from relate to a lack of efficiency in terms of the sensorimotor integration needed for dexterity. Various sensorimotor arm and hand abilities such as speed of selective movements, the capacity to make precise goal-directed arm movements, coordinated visually guided movements, steadiness, and finger dexterity all contribute to our “dexterity” in daily life. All these abilities are deficient in stroke patients who have mild to moderate paresis causing focal disability. The AAT explicitly and repetitively trains all these sensorimotor abilities at the individual’s performance limit with eight different tasks; it further implements various task difficulty levels and integrates augmented feedback in the form of intermittent knowledge of results. The evidence from two randomized controlled trials indicates the clinical effectiveness of the AAT with regard to the promotion of “dexterity” recovery and the reduction of focal disability in stroke patients with mild to moderate arm paresis. In addition, the effects have been shown to be superior to time-equivalent “best conventional therapy.” Further, studies in healthy subjects showed that the AAT induced substantial sensorimotor learning. The observed learning dynamics indicate that different underlying sensorimotor arm and hand abilities are trained. Capacities strengthened by the training can, in part, be used by both arms. Non-invasive brain stimulation experiments and functional magnetic resonance imaging data documented that at an early stage in the training cortical sensorimotor network areas are involved in learning induced by the AAT, yet differentially for the tasks trained. With prolonged training over 2 to 3 weeks, subcortical structures seem to take over. While behavioral similarities in training responses have been observed in healthy volunteers and patients, training-induced functional re-organization in survivors of a subcortical stroke uniquely involved the ipsilesional premotor cortex as an adaptive recruitment of this secondary motor area. Thus, training-induced plasticity in healthy and brain-damaged subjects are not necessarily the same.

Motor Deficits of Stroke Survivors With Mild to Moderate Arm Paresis

Arm paresis post stroke shows a bi-modal distribution. Many stroke survivors have either severe arm paresis and are only able to use their arms functionally in everyday life to a very limited extent, if at all, or mild to moderate arm paresis with the ability to use their paretic arm for functional tasks, yet with a lack of dexterity (12). Thus, the motor control deficits of these subgroups are quite different and hence so too are their therapeutic needs.

Clinically, stroke survivors with mild to moderate arm paresis have reduced strength and endurance of their paretic arm and are functionally limited by a lack of speed, accuracy and co-ordination of arm, hand, and finger movements and a lack of dexterity when handling objects. Key to understanding any functional deficits and the need and opportunities to improve function by training is a focused analysis of the specific motor control deficits involved in this clinical syndrome. A way to do this is to test various domains of sensorimotor control that have been shown to be independent by factorial analysis (34).

When motor performance of healthy people across various tasks has been analyzed by factorial analysis certain independent arm motor abilities have been documented. These are different independent sensorimotor capacities that together contribute to our skilfulness in everyday life. What are these abilities? They are our ability to make fast selective wrist and finger movements (wrist-finger speed), to manipulate small objects (finger dexterity) or larger objects (manual dexterity) efficiently, our ability to keep our arm steady (steadiness), to move our arm quickly and precisely to an intended target (aiming), or to move it under constant visual control along a line (tracking) (5).

When tested among stroke survivors with mild to moderate arm paresis all these abilities are deficient, indicating the complex nature of sensorimotor control deficits in this clinical condition (67).

The Arm Ability Training as a “Tailor-Made training” to Meet Specific Rehabilitation Demands

The Arm Ability Training (AAT) was designed to train all these sensorimotor abilities and thus to meet the specific rehabilitation demands of this subgroup of stroke survivors (89). The eight training tasks collectively cover these affordances (Figure 1).

Figure 1. Training tasks of the Arm Ability Training. Description of the eight training tasks of the Arm Ability Training (AAT) that are repetitively exercised daily. Together they train various independent arm and hand sensorimotor abilities. During the AAT sensorimotor performance is trained at its individual limit. Further aspects thought to promote motor learning are a high repetition rate of trained tasks, variation in the difficulty of training tasks, and the augmented feedback provided in the form of intermittent knowledge of the results.


Continue —->  Frontiers | Arm Ability Training (AAT) Promotes Dexterity Recovery After a Stroke—a Review of Its Design, Clinical Effectiveness, and the Neurobiology of the Actions | Neurology

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[Abstract] EMG Feature Extractions for Upper-Limb Functional Movement During Rehabilitation


Rehabilitation is important treatment for post stroke patient to regain their muscle strength and motor coordination as well as to retrain their nervous system. Electromyography (EMG) has been used by researcher to enhance conventional rehabilitation method as a tool to monitor muscle electrical activity however EMG signal is very stochastic in nature and contains some noise. Special technique is yet to be researched in processing EMG signal to make it useful and effective both to researcher and to patient in general. Feature extraction is among the signal processing technique involved and the best method for specific EMG study needs to be applied. In this works, nine feature extractions techniques are applied to EMG signals recorder from subjects performing upper limb rehabilitation activity based on suggested movement sequence pattern. Three healthy subjects perform the experiment with three trials each and EMG data were recorded from their bicep and deltoid muscle. The applied features for every trials of each subject were analyzed statistically using student T-Test their significant of p-value. The results were then totaled up and compared between the nine features applied and Auto Regressive coefficient (AR) present the best result and consistent with each subjects’ data. This feature will be used later in our future research work of Upper-limb Virtual Reality Rehabilitation.

via EMG Feature Extractions for Upper-Limb Functional Movement During Rehabilitation – IEEE Conference Publication

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[Abstract] 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.

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] Hand Rehabilitation via Gesture Recognition Using Leap Motion Controller – Conference Paper

I. Introduction

Nowadays, a stroke is the fourth leading cause of death in the United States. In fact, every 40 seconds, someone in the US is having a stroke. Moreover, around 50% of stroke survivors suffer damage to the upper extremity [1]–[3]. Many actions of treating and recovering from a stroke have been developed over the years, but recent studies show that combining the recovery process with the existing rehabilitation plan provides better results and a raise in the patients quality of life [4]–[6]. Part of the stroke recovery process is a rehabilitation plan [7]. The process can be difficult, intensive and long depending on how adverse the stroke and which parts of the brain were damaged. These processes usually involve working with a team of health care providers in a full extensive rehabilitation plan, which includes hospital care and home exercises.


1. D. Tsoupikova, N. S. Stoykov, M. Corrigan, K. Thielbar, R. Vick, Y. Li, K. Triandafilou, F. Preuss, D. Kamper, “Virtual immersion for poststroke hand rehabilitation therapy”, Annals of biomedical engineering, vol. 43, no. 2, pp. 467-477, 2015.

2. J. E. Pompeu, T. H. Alonso, I. B. Masson, S. M. A. A. Pompeu, C. Torriani-Pasin, “The effects of virtual reality on stroke rehabilitation: a systematic review”, Motricidade, vol. 10, no. 4, pp. 111-122, 2014.

3. J.-H. Shin, S. B. Park, S. H. Jang, “Effects of game-based virtual reality on health-related quality of life in chronic stroke patients: A randomized controlled study”, Computers in biology and medicine, vol. 63, pp. 92-98, 2015.

4. R. W. Teasell, L. Kalra, “Whats new in stroke rehabilitation”, Stroke, vol. 35, no. 2, pp. 383-385, 2004.

5. E. McDade, S. Kittner, “Ischemic stroke in young adults” in Stroke Essentials for Primary Care, Springer, pp. 123-146, 2009.

6. P. Langhorne, J. Bernhardt, G. Kwakkel, “Stroke rehabilitation”, The Lancet, vol. 377, no. 9778, pp. 1693-1702, 2011.

7. C. J. Winstein, J. Stein, R. Arena, B. Bates, L. R. Cherney, S. C. Cramer, F. Deruyter, J. J. Eng, B. Fisher, R. L. Harvey et al., “Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the american heart association/american stroke association”, Stroke, vol. 47, no. 6, pp. e98-e169, 2016.

8. R. Ibanez, A. Soria, A. Teyseyre, M. Campo, “Easy gesture recognition for kinect”, Advances in Engineering Software, vol. 76, pp. 171-180, 2014.

9. R. Ibañez, A. Soria, A. R. Teyseyre, L. Berdun, M. R. Campo, “A comparative study of machine learning techniques for gesture recognition using kinect”, Handbook of Research on Human-Computer Interfaces Developments and Applications, pp. 1-22, 2016.

10. S. Bhattacharya, B. Czejdo, N. Perez, “Gesture classification with machine learning using kinect sensor data”, Emerging Applications of Information Technology (EAIT) 2012 Third International Conference on, pp. 348-351, 2012.

11. K. Laver, S. George, S. Thomas, J. E. Deutsch, M. Crotty, “Virtual reality for stroke rehabilitation”, Stroke, vol. 43, no. 2, pp. e20-e21, 2012.

12. G. Saposnik, M. Levin, S. O. R. C. S. W. Group et al., “Virtual reality in stroke rehabilitation: a meta-analysis and implications for clinicians”, Stroke, vol. 42, no. 5, pp. 1380-1386, 2011.

13. K. R. Anderson, M. L. Woodbury, K. Phillips, L. V. Gauthier, “Virtual reality video games to promote movement recovery in stroke rehabilitation: a guide for clinicians”, Archives of physical medicine and rehabilitation, vol. 96, no. 5, pp. 973-976, 2015.

14. A. Estepa, S. S. Piriz, E. Albornoz, C. Martínez, “Development of a kinect-based exergaming system for motor rehabilitation in neurological disorders”, Journal of Physics: Conference Series, vol. 705, pp. 012060, 2016.

15. E. Chang, X. Zhao, S. C. Cramer et al., “Home-based hand rehabilitation after chronic stroke: Randomized controlled single-blind trial comparing the musicglove with a conventional exercise program”, Journal of rehabilitation research and development, vol. 53, no. 4, pp. 457, 2016.

16. L. Ebert, P. Flach, M. Thali, S. Ross, “Out of touch-a plugin for controlling osirix with gestures using the leap controller”, Journal of Forensic Radiology and Imaging, vol. 2, no. 3, pp. 126-128, 2014.

17. W.-J. Li, C.-Y. Hsieh, L.-F. Lin, W.-C. Chu, “Hand gesture recognition for post-stroke rehabilitation using leap motion”, Applied System Innovation (ICASI) 2017 International Conference on, pp. 386-388, 2017.

18. K. Vamsikrishna, D. P. Dogra, M. S. Desarkar, “Computer-vision-assisted palm rehabilitation with supervised learning”, IEEE Transactions on Biomedical Engineering, vol. 63, no. 5, pp. 991-1001, 2016.

19. A. Butt, E. Rovini, C. Dolciotti, P. Bongioanni, G. De Petris, F. Cavallo, “Leap motion evaluation for assessment of upper limb motor skills in parkinson’s disease”, Rehabilitation Robotics (ICORR) 2017 International Conference on, pp. 116-121, 2017.

20. L. Di Tommaso, S. Aubry, J. Godard, H. Katranji, J. Pauchot, “A new human machine interface in neurosurgery: The leap motion (®). technical note regarding a new touchless interface”, Neuro-Chirurgie, vol. 62, no. 3, pp. 178-181, 2016.

21. O. Chapelle, “Training a support vector machine in the primal”, Neural computation, vol. 19, no. 5, pp. 1155-1178, 2007.

22. Y. Ma, G. Guo, Support vector machines applications, Springer, 2014.

23. J. Guna, G. Jakus, M. Pogačnik, S. Tomažič, J. Sodnik, “An analysis of the precision and reliability of the leap motion sensor and its suitability for static and dynamic tracking”, Sensors, vol. 14, no. 2, pp. 3702-3720, 2014.

24. T. DOrazio, R. Marani, V. Renó, G. Cicirelli, “Recent trends in gesture recognition: how depth data has improved classical approaches”, Image and Vision Computing, vol. 52, pp. 56-72, 2016.

25. L. Motion, Leap motion sdk, 2015.


via Hand Rehabilitation via Gesture Recognition Using Leap Motion Controller – IEEE Conference Publication

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[Abstract] Electromyography Based Orthotic Arm and Finger Rehabilitation System


Electromyography (EMG), a technique used to analyze and record electric current produced by skeletal muscles, has been used to control replacement limbs, and diagnose muscle irregularities. In this work, an EMG based system comprising of an orthotic arm and finger device to aid in muscle rehabilitation, is presented. As the user attempts to contract their bicep or forearm muscles, the system senses the change in the EMG signals and in turn triggers the motors to assist with flexion and extension of the arm and fingers. As brain is a major factor for muscle growth, mental training using motor imagery was incorporated into the system. Subjects underwent mental training to show the capability of muscle growth. The measured data reveals that the subjects were able to compensate for the loss of muscle growth, due to shorter physical training sessions, with mental training. Subjects were then tested using the orthotic arm and finger rehabilitation device with motor imagery. The findings also showed a positive increase in muscle growth using the rehabilitation system. Based on the experimental results, the EMG rehabilitation system presented in this paper has the potential to increase muscle strength and improve the recovery rate for muscle injuries, partial paralysis, or muscle irregularities.

via Electromyography Based Orthotic Arm and Finger Rehabilitation System – IEEE Conference Publication

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


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


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.

via A Portable Passive Rehabilitation Robot for Upper-Extremity Functional Resistance Training – IEEE Journals & Magazine

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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


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].

via Modelling and control of a novel walker robot for post-stroke gait rehabilitation – IEEE Conference Publication

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