Posts Tagged UE
[Abstract] Neurostimulation for treatment of post-stroke impairments
Posted by Kostas Pantremenos in Epilepsy on April 8, 2024
Abstract
Neurostimulation, the use of electrical stimulation to modulate the activity of the nervous system, is now commonly used for the treatment of chronic pain, movement disorders and epilepsy. Many neurostimulation techniques have now shown promise for the treatment of physical impairments in people with stroke. In 2021, vagus nerve stimulation was approved by the FDA as an adjunct to intensive rehabilitation therapy for the treatment of chronic upper extremity deficits after ischaemic stroke. In 2024, pharyngeal electrical stimulation was conditionally approved by the UK National Institute for Health and Care Excellence for neurogenic dysphagia in people with stroke who have a tracheostomy. Many other approaches have also been tested in pivotal device trials and a number of approaches are in early-phase study. Typically, neurostimulation techniques aim to increase neuroplasticity in response to training and rehabilitation, although the putative mechanisms of action differ and are not fully understood. Neurostimulation techniques offer a number of practical advantages for use after stroke, such as precise dosing and timing, but can be invasive and costly to implement. This Review focuses on neurostimulation techniques that are now in clinical use or that have reached the stage of pivotal trials and show considerable promise for the treatment of post-stroke impairments.
Key points
- Neurostimulation techniques are ideally suited for use during stroke recovery owing to their ability to target anatomical structures or neuronal networks, alongside precise timing and dosing.
- Paired invasive vagus nerve stimulation has been shown to increase the number of people who achieve clinically important improvements in upper extremity impairment and performance of functional tasks following stroke. The treatment is now in clinical use in the USA.
- Several other neurostimulation techniques show promise for post-stroke impairments but definitive data from adequately powered trials are lacking.
- Pharyngeal electrical stimulation increases the odds of decannulation following tracheostomy and is under investigation as a treatment for post-stroke dysphagia.
[ARTICLE] Feasibility of a Self-directed Upper Extremity Training Program to Promote Actual Arm Use for Individuals Living in the Community With Chronic Stroke – Full Text
Posted by Kostas Pantremenos in Paretic Hand on March 1, 2024
Highlights
- Feasibility of a self-directed upper extremity training program to promote actual arm use for individuals living in the community with chronic stroke
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- •Distinct from clinic-based rehabilitation, self-directed rehabilitation approaches must address unique challenges related to decreased client motivation and adherence.
- •Shared decision making and behavior change frameworks can support the implementation of UE self-directed rehabilitation.
- •The Use My Arm-Remote program was feasible and safe to implement for individuals living in the community with chronic stroke.
Abstract
Objective
To determine the feasibility of a self-directed training protocol to promote actual arm use in everyday life. The secondary aim was to explore the initial efficacy on upper extremity (UE) outcome measures.
Design
Feasibility study using multiple methods.
Setting
Home and outpatient research lab.
Participants
Fifteen adults (6 women, 9 men, mean age=53.08 years) with chronic stroke living in the community. There was wide range of UE functional levels, ranging from dependent stabilizer (limited function) to functional assist (high function).
Intervention
Use My Arm-Remote protocol. Phase 1 consisted of clinician training on motivational interviewing (MI). Phase 2 consisted of MI sessions with participants to determine participant generated goals, training activities, and training schedules. Phase 3 consisted of UE task-oriented training (60 minutes/day, 5 days/week, for 4 weeks). Participants received daily surveys through an app to monitor arm training behavior and weekly virtual check-ins with clinicians to problem-solve challenges and adjust treatment plans.
Outcome Measures
Primary outcome measures were feasibility domains after intervention, measured by quantitative study data and qualitative semi-structured interviews. Secondary outcomes included the Canadian Occupational Performance Measure (COPM), Motor Activity Log (MAL), Fugl-Meyer Assessment (FMA), and accelerometry-based duration of use metric measured at baseline, discharge, and 4-week follow-up.
Results
The UMA-R was feasible in the following domains: recruitment rate, retention rate, intervention acceptance, intervention delivery, adherence frequency, and safety. Adherence to duration of daily practice did not meet our criteria. Improvements in UE outcomes were achieved at discharge and maintained at follow-up as measured by COPM-Performance subscale (F[1.42, 19.83]=17.72, P<.001) and COPM-Satisfaction subscale (F[2, 28]=14.73, P<.001), MAL (F[1.31, 18.30]=12.05, P<.01) and the FMA (F[2, 28]=16.62, P<.001).
Conclusion
The UMA-R was feasible and safe to implement for individuals living in the community with chronic stroke. Adherence duration was identified as area of refinement. Participants demonstrated improvements in standardized UE outcomes to support initial efficacy of the UMA-R. Shared decision-making and behavior change frameworks can support the implementation of UE self-directed rehabilitation. Our results warrant the refinement and further testing of the UMA-R.
Stroke is the leading cause of disability in adults in the United States.1,2 Approximately 50% of stroke survivors experience upper extremity (UE) impairment,3,4 and of those, over 60% have continued impairment after 6 months.5,6 Based on the International Classification of Functioning, Disability, and Health, impairment is defined as limitations in body function and structures.7 Limited UE functional use after stroke can affect performance with activities of daily living, return to work, and quality of life.8, 9, 10 Chronic UE disability and subsequent effect on participation and independence highlights the need for continued therapy beyond acute and subacute periods of recovery as individuals re-integrate back into the community.11
Evidence suggests that UE improvements achieved in the clinic do not automatically generalize to actual use of the affected UE in the home and community.12, 13, 14, 15, 16 In other words, what clients do in the clinic is different from what they do at home. Actual arm use, defined as the use of the affected UE in everyday activities in real world settings,17 was first introduced into the stroke literature as a key outcome for Constraint Induced Movement Therapy (CIMT) measured by the Motor Activity Log (MAL). Despite the widespread research on CIMT, actual arm use as a construct has been largely understudied. Distinct from motor capacity or functional ability, emerging literature suggests that actual arm use is a complex behavior informed by multiple factors related to the person, their environment, and the task itself.18 Therefore, interventional approaches that target actual arm use likely require self-directed training in daily activities completed in real-world settings.19
We define self-directed rehabilitation as structured motor or functional training program with clear patient objectives completed remotely in the client’s home under indirect supervision of a clinician.20,21 Evidence comparing the effectiveness of home-based vs clinic-based rehabilitation has consistently demonstrated no differences in physical and motor outcomes for older adult populations with general chronic health conditions.20,22, 23, 24 Similarly, home-based UE interventions in stroke are comparable with clinic-based interventions for UE activity performance and dexterity.25 Self-directed training approaches are also effective in post stroke rehabilitation. There is a wide range of self-directed training approaches with studies using robotics, interactive gaming, CIMT, and electrical stimulation (e-stim) with CIMT and e-stim approaches demonstrating most robust improvements in UE functional ability and daily use.26 While CIMT is the most established self-directed training approach, common limitations include the narrow inclusion criteria 27,28 and limited ecological validity of constraining the less affected hand because individuals complete most daily tasks bilaterally.29,30 Additionally, no differences were reported between structured vs non-structured approaches within self-directed rehabilitation studies.19 The literature on the effectiveness of self-directed UE rehabilitation in stroke is emerging and the available evidence is mixed.19,24 More work is needed in this area to delineate key components of self-directed UE rehabilitation that effectively maximize actual arm use in daily life.
To address the need to better understand and develop effective home-based, self-directed rehabilitation approaches, Use My Arm-Remote (UMA-R) was adapted with permission from the original Use My Arm.31,32 UMA-R is a self-directed rehabilitation program informed by both motor learning principles and health behavior change frameworks. UMA-R combines several evidence-based approaches (eg, task-oriented practice, motivational interviewing (MI), ecological momentary assessments [EMAs]) to target actual arm use. Distinct from clinic-based rehabilitation, self-directed rehabilitation in the home setting must address unique challenges related to decreased motivation and adherence, because clients must self-initiate training and complete the recommended tasks with indirect therapist supervision. UMA-R uses shared decision-making (SDM) approach and EMAs to maximize intrinsic motivation and adherence.
The task-oriented approach, also referred to as task specific training in the literature, is based on the principles of neuroplasticity and the systems model of motor control.33 Task-oriented approach emphasizes the importance of selecting tasks that are meaningful to the client, training in real-world environments outside of therapy settings, and the use of motor learning principles (eg, repetition and practice, adaptation).33 UE training using a task-oriented approach can be implemented by having clients select and practice meaningful everyday tasks that require UE use. Emphasis is placed on using the client’s own materials within the context of daily routines (eg, practicing brushing their hair using their own brush during their self-care routine).
SDM is a collaborative process between patients, families, and clinicians when patient values and preferences are prioritized along with existing evidence when making decisions about a specific scenario.34 MI can be used to implement an SDM approach. MI is a counseling approach based on the guiding principle that behavior change is contingent on the client- rather than the clinician-driving decision and expressing the reasons for change.35 MI has been integrated into cognitive and behavioral interventions to maximize self-initiated action and encourage activity engagement.35
EMA produces real-time data about an individual’s behavior, mood, or experiences in their natural settings.36,37 EMA has been used extensively to target health behavior change such as smoking cessation, diabetes management, and weight loss.36 EMA in stroke has been used to measure caregiver burden,38 predictors of depression,39,40 and fatigue.41 The emergence and use of mobile technologies (ie, text messages or phone app) has greatly increased the ability to implement EMA successfully in a variety of clinical populations and is well-suited to capture client’s daily activities in the context of their routines at home.
UMA-R addresses the unique challenges for self-directed UE training and bridges the gap between gains made in the clinic and generalized arm use in real world settings. As an initial step in intervention development and testing, the primary aim of the study was to examine the feasibility of the UMA-R protocol by addressing the following domains: recruitment and retention rates, intervention delivery, intervention acceptance, intervention adherence, and safety. The secondary aim of the study was to report initial efficacy of the UMA-R as measured by UE outcomes. […]
[Abstract] A Review on Soft Exoskeletons for Hand Rehabilitation
Posted by Kostas Pantremenos in Paretic Hand, Rehabilitation robotics on February 24, 2024
Background: How to enhance the quality of life for the elderly has emerged as a key issue in many nations due to the ageing population. Stroke is the most prevalent disease among the elderly; specifically, the hand dysfunction caused by stroke is also a powerful obstacle to the daily life of the elderly. Soft Exoskeletons for Hand Rehabilitation (SEHRs) have become a major trend for the future due to the increasing demand for hand rehabilitation.
Objective: To provide a reference for readers in this field by introducing the most recent research developments in the field of SEHR, including their classification and properties.
Methods: By reviewing different types of hand rehabilitation exoskeleton research papers and patents, the advantages and disadvantages, differences, and applications of various SEHRs were summarized.
Results: According to the driving mode and realizing the function of SEHRs, the structure characteristics of SEHRs are analyzed and compared. The key problems and future development trends of SEHRs were expounded.
Conclusion: According to the driving method, the research shows that SEHRs can be divided into Air-Driven Soft Exoskeletons for Hand Rehabilitation (ADSEHRs), Motor-Driven Soft Exoskeletons for Hand Rehabilitation (MDSEHRs), and Hybrid-Driven Soft Exoskeletons for Hand Rehabilitation (HDSEHRs). Future research is required to further optimize the flexibility and adaptability of soft exoskeletons, improve their accuracy and sensitivity, and enhance human-machine interaction with the human hand.
[Abstract + References] Research progress and development trend of flexible hand rehabilitation gloves
Posted by Kostas Pantremenos in Paretic Hand, REHABILITATION, Rehabilitation robotics on February 20, 2024
Abstract
The flexible hand rehabilitation glove is proposed to solve the problems of long rehabilitation training time for patients and high workload for doctors, and to make the treatment more effective. With the advances in robotics, robotic-assisted therapy has developed rapidly and has become an essential complement to conventional treatment. To understand flexible hand rehabilitation glove devices, with the different construction types of actuators and drive methods as the mainline, the corresponding study of these structures as the auxiliary lines. The characteristics and the current state of research have been discussed. A brief introduction to manufacturing actuators and rehabilitation systems is also given. Through the analysis of hand rehabilitation gloves, some current advantages and disadvantages are summarized, and future directions and functional diversification are envisaged. Certain feasible research suggestions have been proposed for future development regarding structure, functional diversity, and a combination of driving methods. These include that there will be more combinations of pneumatic and motor driven, combining the advantages of both methods to overcome the disadvantages of each. The structural design will be more in line with anatomy and ergonomics, make it more esthetically pleasing. More innovative controls methods will be adopted to achieve more complex rehabilitation functions.
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[Abstract] Vagus Nerve Stimulation Paired With Rehabilitation for Post-Stroke Arm Impairment: One Year Follow-Up of the VNS-REHAB Pivotal Trial
Posted by Kostas Pantremenos in Neuroplasticity, Paretic Hand, REHABILITATION on February 19, 2024
Abstract
Background: Persistent post-stroke impairment of the arm and hand is debilitating after stroke. Pairing vagus nerve stimulation (VNS) with upper extremity (UE) rehabilitation improves such deficits after 5 months and was approved by the FDA in 2021. Here, we present 1-year outcomes from the VNS-REHAB pivotal trial.
Methods: Stroke participants with moderate-to-severe UE impairment were randomized to task-specific rehabilitation plus either active VNS (n=53, VNS) or sham VNS (n=55, Control). After baseline assessment (Pre-therapy), both groups did 6 wk. of in-clinic therapy followed by a 3-mo. home exercise program combined with active or sham VNS (post90). Controls then crossed over to receive 6 wk. of active VNS followed by a 3-mo. home exercise program (Cross-over post90). Both groups continued active VNS with a home exercise program through 1 year, after which change from Pre-therapy baseline in Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and Wolf Motor Function Test (WMFT) scores were obtained. To determine whether participants made additional gains, 1 year outcome scores (n=70) were also compared to post90 (n=38, VNS) and Cross-over post90 (n=32, Control) scores. Data was available from 74 participants at one year, with others not available mainly due to COVID-19.
Results: At 1-year, both FMA-UE and WMFT scores improved from Pre-therapy baseline by 5.3±6.9 (CI=3.7-6.9, p<0.001) and 0.51±0.52 (CI=0.39-0.63, p<0.001) points, respectively. FMA-UE change at 1-year was not significantly different from the post90 (VNS) and Cross-over post90 (control) timepoints (n=70, mean difference: -0.3±4.1, CI=-1.3-0.67, p=0.52), but WMFT was, by an additional 0.09 points (n=70, mean difference: 0.09±0.35, CI=0.01-0.18, p=0.03), indicating that participants either improved or maintained motor gains through 1 year.
Conclusion: Improvements in arm and hand function with VNS were maintained at 1-year follow-up, supporting use of VNS paired with rehabilitation as a long-term treatment option for individuals with post-stroke UE impairment. Limitations include sample size and lack of details of therapeutic regimens over the long term. Future studies and an ongoing clinical registry will explore the long-term impact of active VNS in real-world settings.
[ARTICLE] Stroke patients’ motivation for home-based upper extremity rehabilitation with eHealth tools – Full Text
Posted by Kostas Pantremenos in Paretic Hand, REHABILITATION, Tele/Home Rehabilitation on February 18, 2024
Abstract
Purpose
eHealth-based exercise therapies were developed to increase stroke patients’ adherence to home-based motor rehabilitation. However, these eHealth tools face a rapid decrease in use after a couple of weeks. This study investigates stroke patients’ motivation for home-based upper extremity rehabilitation with eHealth tools and their relation with Basic Psychological Needs.
Materials and methods
This is a qualitative study using thematic analysis. We conducted semi-structured interviews with stroke patients with upper extremity motor impairments, who were discharged home from a rehabilitation centre, after they interacted with a novel eHealth coach demonstrator in their homes for five consecutive days.
Results
We included ten stroke patients. Thematic analysis resulted in eight themes for home-based rehabilitation motivation: Curiosity, Rationale, Choice, Optimal challenge, Reference, Encouragement, Social Support and Trustworthiness. Those themes are embedded into three Basic Psychological Needs: “Autonomy”, “Competence”, and “Relatedness”.
Conclusion
Eight motivational themes related to the three Basic Psychological Needs describe stroke patients’ motivation for home-based upper extremity rehabilitation. We recommend considering those themes when developing a home-based eHealth intervention for stroke patients to increase the alignment of eHealth tools to the patient’s needs and reduce motivational decreases in home-based rehabilitation.
Implications for rehabilitation
- Stroke patients show motivational decreases and decreased use of eHealth tools in home-based rehabilitation after a couple of weeks.
- Eight motivational themes describe home-based rehabilitation motivation in stroke patients: Curiosity, Rationale, Choice, Optimal challenge, Reference, Encouragement, Social Support and Trustworthiness.
- Those themes are embedded into three Basic Psychological Needs: “Autonomy”, “Competence”, and “Relatedness”.
- Those themes should be considered when developing a home-based eHealth intervention for stroke patients to increase the alignment of eHealth tools to the patient’s needs and reduce motivational decreases in home-based rehabilitation.
Introduction
Over two-thirds of stroke survivors experience upper extremity (UE) motor impairment, limiting capacity and resulting in significant daily functioning limitations and decreased quality of life [Citation1]. Rehabilitation programs involve stimulation of UE use and intensive UE exercises (e.g. a high number of repetitions per time unit) [Citation2]. Adherence to intensive daily UE use and exercise is essential to optimise UE capacity and daily life functioning [Citation3–5]. Exercise adherence may be specifically challenging for patients discharged from the controlled and supportive environment of a rehabilitation facility and expected to continue exercising at home [Citation6–8].
One of the most common perceived barriers to adherence to rehabilitation exercises and physical activity in stroke patients is a lack of motivation [Citation9]. Motivation can be generally explained as a fundamental “drive” towards change. According to Deci and Ryan’s Self Determination Theory (SDT), motivation has three underlying Basic Psychosocial Needs (BPNs): Autonomy, Competence and Relatedness (10). The need for autonomy refers to the belief in being agentic and volitional in your actions, and it implies self-initiation and a choice over your behaviour. The need for competence refers to feeling capable and effective in the physical and social environment. The need for relatedness refers to connecting to a community or group and having a secure relational base [Citation10]. These three BPNs are critical resources for psychological well-being and autonomous, self-determined motivation and satisfying them increases motivation to pursue desired behaviour [Citation10]. Literature shows that higher motivation levels positively correlate with higher adherence to a rehabilitation program [Citation11,Citation12] and better rehabilitation outcomes [Citation3,Citation4,Citation13].
Various motivational strategies targeting at least one of the three BPNs are used in face-to-face sessions between therapists and patients [Citation14,Citation15]. Examples of this are the application of patients’ preferences (increasing autonomy), control of task difficulty (increasing competence) and involvement of a family member (increasing relatedness) [Citation14,Citation15]. During home-based rehabilitation, patients’ motivational needs are expected to differ from inpatient rehabilitation since there is no direct supervision, less face-to-face contact between patients and therapists and more distraction from the physical and social environment. Besides, stroke often affects the social relationships and roles of the patient in their home environment, for example, family members may become informal caregivers, and patients are less involved in community activities [Citation16,Citation17].
Recently, a Delphi study was conducted to identify strategies to facilitate adherence to home-based exercises after a stroke [Citation18]. Multiple strategies were classified, including using eHealth applications to prescribe exercises, provide feedback and motivate patients to follow home-based rehabilitation. However, the expert panel in this study did not include stroke survivors, and the study does not provide insights into patients’ needs [Citation18]. Since many eHealth applications face a rapid decrease in use and low adherence in the home environment [Citation19], a better understanding of their motivational needs regarding using home-based rehabilitation eHealth tools is needed.
To increase the understanding of motivation in stroke patients, evaluating the BPNs in combination with patient-specific contextual and personal factors that influence motivation is important. Multiple studies documented motivation as the interplay of individual characteristics, including individual factors such as personality, psychological attributes and health status, and contextual factors, which are the social context and the culturally enforced norms [Citation11,Citation14,Citation20,Citation21]. BPNs, as described by Deci and Ryan, are generic and do not specifically take into account these personal and contextual factors. Moreover, the feeling of autonomy, competence, and social roles and relationships change due to a chronic disabling condition, such as stroke [Citation22]. Thus, a specific patient population’s characteristics and home environment should not be neglected when providing or developing home-based rehabilitation.
This study investigates stroke patients’ motivation for home-based UE rehabilitation using eHealth tools and how this is embedded in the three BPNs. To account for the specific personal and contextual factors, we choose a qualitative study design, allowing us to acquire rich personal and contextual data conducted within a representative group of stroke patients at their own homes. With this knowledge, we expect to better align eHealth tools to the patient’s needs, resulting in increased therapy adherence. […]
Figure 1. The interactive demonstrator “EDO” and the three exercises included in the interface: (a) cylinder grasp, (b) pinch grasp, and (c) lifting and tilting movement.
A three-panel figure shows a tablet, a cylindrical-shaped object, and the arm and hand of a person performing three different exercises. In panel a), the person’s hand holds the object with a cylindrical grasp, and the object turns orange. Panel b) shows the person’s hand performing a pinch grip on top of the cylindrical object while the object turns green. In panel c), the person’s hand holds the object in a horizontal position without ground support, while the object turns green.
[Abstract] Effects of Circuit Class Training Versus Individual, Task Specific Training on Upper Extremity Function in Chronic Stroke Patients
Posted by Kostas Pantremenos in Paretic Hand, Spasticity on February 15, 2024
Abstract
Background: Stroke is a leading contributor to disability globally, emphasizing the need for effective rehabilitation techniques. Circuit class training (CCT) and individual, task-specific training (ITST) have emerged as potential approaches for enhancing upper extremity function in stroke survivors. Comparative analyses of their efficacy, especially among chronic stroke patients, are scant.
Objective: This study aimed to evaluate and compare the impacts of CCT and ITST on upper extremity spasticity, motor function, and quality of life in individuals with chronic stroke.
Methods: In a randomized controlled trial, 36 chronic stroke patients were allocated to either CCT or ITST groups. Participants were aged 45-70 years, had experienced a single stroke episode, and were at least 6 months post-stroke, with specific inclusion criteria regarding spasticity and motor function levels. The interventions were delivered for 1.5 hours daily, five days a week, over eight weeks. Outcomes were measured using the Modified Ashworth Scale (MAS) for spasticity, Functional Independence Measure for Upper Extremity (FMA-UE) for motor function, and Stroke-Specific Quality of Life (SS-QOL) scale for quality of life, analyzed using SPSS version 25.
Results: Post-intervention, both CCT and ITST participants exhibited significant improvements in their outcomes. MAS scores showed a reduction in spasticity, with average improvements not significantly differing between the groups. FMA-UE scores increased by an average of 10 points in both groups, indicating enhanced motor function without a significant difference between the groups (p > 0.05). SS-QOL scores improved by an average of 20 points in each group, reflecting better quality of life, with no significant intergroup difference observed.
Conclusion: The study concludes that CCT and ITST are equally effective in ameliorating upper extremity spasticity, motor function, and quality of life among chronic stroke patients. The selection between CCT and ITST can thus be personalized based on patient preferences, available resources, and logistical considerations, maintaining rehabilitation efficacy.
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[WEB] Enspire announces publication of trial evaluating DBS plus rehab for stroke patients
Posted by Kostas Pantremenos in Paretic Hand, REHABILITATION on February 12, 2024
Enspire DBS Therapy has announced the publication of the results of the EDEN trial—an early feasibility study led by Cleveland Clinic (Cleveland, USA) researchers assessing electrical stimulation of the dentate nucleus for upper-extremity hemiparesis due to ischaemic stroke—in Nature Medicine.
The EDEN study was designed to evaluate whether deep brain stimulation (DBS) plus rehabilitation therapy (DBS plus rehab) would improve motor function in post-ischaemic stroke patients more effectively than rehab alone.
The study demonstrated that the majority of participants (9/12) showed the most significant improvements in both motor impairment and function during the combination therapy, DBS plus rehab. Importantly, an Enspire press release notes, participants with at least minimal preservation of distal motor function at enrolment showed clinically significant gains. The safety profile of this therapy is similar to other approved DBS therapies, the release adds.
These findings build on more than a decade of preclinical work led by principal investigators Andre Machado and Kenneth Baker (both Cleveland Clinic, Cleveland, USA). Machado patented the DBS method in stroke recovery to which Enspire has an exclusive license. He also holds stock options and equity ownership rights with Enspire, and serves as the company’s chief scientific officer.
“We saw patients in the study regain levels of function and independence they did not have before enrolling in the research,” Machado said. “We look forward to expanding as we have begun the next phase of clinical investigation.”
Enspire has also launched RESTORE, a pivotal study continuing to investigate the safety and effectiveness of DBS plus rehab in patients with chronic upper-extremity impairment due to stroke. The study has received investigational device exemption (IDE) approval from the US Food and Drug Administration (FDA) and is actively recruiting patients.
[WEB] This woman just created a robotic third thumb and it’s a total gamechanger
Posted by Kostas Pantremenos in Assistive Technology, Rehabilitation robotics on February 11, 2024
If you could have an extra body part, what would it be?
An augmentation designer has chosen a third thumb.
Sounds mad – and it looks it too – but it turns out an extra thumb would be pretty useful.
READ MORE! ‘World’s most advanced humanoid robot’ reveals what life will look like in 100 years
Designer Dani Clode developed a device called the ‘Third Thumb’ as part of a project at the Royal College of Art.
Clode wears the 3D-printed device on the side of the hand opposite her actual thumb near the pinky finger.
She then controls it with pressure sensors attached to her feet on the underside of the big toes.
Connected wirelessly, both toe sensors control different movements of the Third Thumb by immediately responding to subtle changes of pressure from the wearer.
To test the Third Thumb’s capability, a team from University College London were trained to use the device.
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This involved focusing on tasks that helped increase the cooperation between their hand and the Third Thumb, such as picking up multiple balls or wine glasses with one hand.
They learned the basics of using the device very quickly, while the training enabled them to successfully improve their motor control, dexterity and hand-thumb coordination.
Participants were even able to use the device when distracted – building a wooden block tower while solving math problems – or while blindfolded.
So, it felt natural super quickly.
The project challenges the conventional idea of prosthetics by considering them as extensions rather than mere replacements.
A video posted to TikTok of the Third Thumb in action shows not everyone’s convinced, though.
“If we were meant to have six fingers, we would’ve been born with six fingers,” one user said.
“We’ve been fine without one for centuries. Why now?” another asked.
“People today don’t even know how to use their brain. What will they do with an extra finger?” another posted.
Some social media users suggested other body parts that would be more useful, like another pair or arms of even a tail.
Perhaps they’re projects for Clode to consider next.
[Abstract + References] Repetitive peripheral magnetic stimulation combined with transcranial magnetic stimulation in rehabilitation of upper extremity hemiparesis following stroke: a pilot study
Posted by Kostas Pantremenos in Paretic Hand, REHABILITATION on February 11, 2024
ABSTRACT
Objective: To investigate the effect of combined repetitive peripheral magnetic stimulation and transcranial magnetic stimulation on upper extremity function in subacute stroke patients.
Design: Pilot study.
Subjects: Subacute stroke patients.
Methods: Included patients were randomized into 3 groups: a central-associated peripheral stimulation (CPS) group, a central-stimulation-only (CS) group, and a control (C) group. The CPS group underwent a new paired associative stimulation (combined repetitive peripheral magnetic stimulation and transcranial magnetic stimulation), the CS group underwent repetitive transcranial magnetic stimulation, and the C group underwent sham stimulation. All 3 groups received physiotherapy after the stimulation or sham stimulation. The treatment comprised 20 once-daily sessions. Primary outcome was the Fugl-Meyer Assessment Upper Extremity (FMA-UE) score, and secondary outcomes were the Barthel Index and Comprehensive Functional Assessment scores, and neurophysiological assessments were mainly short-interval intracortical inhibition. A 3-group (CPS, CS, C) × 2-time (before, after intervention) repeated measures analysis of variance was conducted to determine whether changes in scores were significantly different between the 3 groups.
Results: A total of 45 patients were included in the analysis. Between-group comparisons on the FMA-UE demonstrated a significant improvement (group × time interaction, F2,42 = 4.86; p = 0.013; C vs CS, p = 0.020; C vs CPS, p = 0.016; CS vs CPS, p = 0.955). Correlation analysis did not find any substantial positive correlation between changes in FMA-UE and short-interval intracortical inhibition variables (C, r = –0.196, p = 0.483; CS, r = –0.169, p = 0.546; CPS, r = –0.424, p = 0.115).
Conclusion: This study suggests that the real-stimulus (CS and CPS) groups had better outcomes than the control (C) group. In addition, the CPS group showed a better trend in clinical and neurophysiological assessments compared with the CS group.
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