[ARTICLE] Effects of physical therapy-based rehabilitation on recovery of upper limb motor function after stroke in adults: a systematic review and meta-analysis of randomized controlled trials – Full Text

Background: Limb hemiplegia is one of the common sequelae of stroke. Physical therapy-based rehabilitation training can rapidly improve limb functioning and muscle strength. This study investigated the effect of physical therapy on the recovery of upper limb motor function by employing a literature search and meta-analysis.

Methods: We searched Embase, The Cochrane Central Register of Controlled Trials library, Wiley online library, PubMed, Ovid, and Clinicaltrials.org for randomized controlled trial (RCT) studies and performed an electronic search with the keyword combinations ‘physical therapy/rehabilitation’ & ‘stroke/post-stroke’ & ‘upper extremity/upper limb’. After screening the literature for inclusion criteria and assessing the risk of bias, Revman 5.4 software was used for the analysis and to obtain forest and funnel plots.

Results: A total of 15 RCTs with 1,081 patients were included in the quantitative analysis for this study. The meta-analysis results showed that compared with conventional therapy, physical therapy improved the upper limb Fugl-Meyer Assessment for Upper Extremity (FMA) scores in convalescent stroke patients (MD =7.27, 95% CI: 4.23–10.32, Z=4.68, P<0.00001), and increased the Functional Independence Measure (FIM) scores (MD =18.82, 95% CI: 6.34–31.30, Z=2.96, P=0.003), the Action Research Arm Test (ARAT) scores (MD =8.84, 95% CI: 6.53–11.15, Z=7.50, P<0.00001), and the Box and Block Test (BBT) scores (MD =6.11, 95% CI: 1.18–11.04, Z=2.43, P=0.02) of patients during the rehabilitation period.

Discussion: The use of physical therapy-based rehabilitation training in the recovery period for stroke patients with hemiplegia can improve upper limb movement ability, increase muscle strength, reduce limb pain, and improve the quality of life.

Introduction

Stroke is a common disease in neurology, with disability and mortality rates as high as 80% (1). The middle-aged and the elderly are the high incidence population of stroke. The function of tissues and organs of the elderly is declining, the autonomic nerve activity is disordered, the ability to regulate vasomotor and systolic is reduced, the degree of vascular wall sclerosis is aggravated, and the possibility of ischemic stroke is increased (2). After rescuing from death stroke patients nearly always have some kind of sequelae, such as coma, expression disorder, sensory disturbance, and limb hemiplegia, which create a self-care ability decline and affect their quality of life (3). Limb hemiplegia is a common sequela of stroke where patients present with loss of muscle strength and inability to perform free limb movements (4,5). Clinically, the primary treatments for hemiplegia after stroke include drugs and physical therapy. The drugs are mainly used to scavenge free radicals, improve brain function, and promote the recovery of limb function. Rehabilitation training can rapidly improve limb functioning and muscle strength, prevent muscle atrophy and joint stiffness, reduce the disability rate, and improve patients’ quality of life (6). Many different physical therapies are used clinically (7–9), and systematic analysis of these therapies is always focusing on just one kind of therapy. This study used a meta-analysis to quantitatively assess the effect of various physical therapy on limb hemiplegia during stroke rehabilitation. We present the following article in accordance with the PRISMA reporting checklist (available at https://apm.amegroups.com/article/view/10.21037/apm-21-3710/rc). […]

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[ARTICLE] Differential effects of anodal and dual tDCS on sensorimotor functions in chronic hemiparetic stroke patients – Full Text

Highlights

• Robot-based kinematics sensitively capture tDCS-induced performance changes
• tDCS induces profound, yet complex performance modulations
• Modulations include simultaneous performance increases and non-canonical decreases
• Overall, dual tDCS shows a more favorable response pattern compared to anodal tDCS

Abstract

Background and purpose

Previous tDCS studies in chronic stroke patients reported highly inconsistent effects on sensorimotor functions. Underlying reasons could be the selection of different kinematic parameters across studies and for different tDCS setups. We reasoned that tDCS may not simply induce global changes in a beneficial-adverse dichotomy, but rather that different sensorimotor kinematics are differentially affected. Furthermore, the often-postulated higher efficacy of bilateral-dual (bi-tDCS) over unilateral-anodal (ua-tDCS) could not yet be demonstrated consistently either. We investigated the effects of both setups on a wider range of kinematic parameters from standardized robotic tasks in patients with chronic stroke.

Methods

Twenty-four patients with arm hemiparesis received tDCS (20min, 1 mA) concurrent to kinematic assessments in a sham-controlled, cross-over and double-blind clinical trial. Performance was measured on four sensorimotor tasks (reaching, proprioception, cooperative and independent bimanual coordination) from which 30 parameters were extracted. On the group-level, the patterns of changes relative to sham were assessed using paired-samples t-tests and classified as (1) performance increases, (2) decreases and (3) non-significant differences. Correlations between parametric change scores were calculated for each task to assess effects on the individual-level.

Results

Both setups induced complex effect patterns with varying proportions of performance increases and decreases. On the group-level, more increases were induced in the reaching and coordination tasks while proprioception and bimanual cooperation were overall negatively affected. Bi-tDCS induced more performance increases and less decreases compared to ua-tDCS. Changes across parameters occurred more homogeneously under bi-tDCS than ua-tDCS, which induced a larger proportion of performance trade-offs.

Conclusions

Our data demonstrate profound tDCS effects on sensorimotor functions post-stroke, lending support for more pronounced and favorable effects of bi-tDCS compared to ua-tDCS. However, no uniformly beneficial pattern was identified. Instead, the modulations varied depending on the task and electrode setup, with increases in certain parameters occurring at the expense of decreases in others.

Abbreviations

bi-tDCS – bilateral-dual transcranial direct current stimulation

ua-tDCS – unilateral-anodal transcranial direct current stimulation

APM – Arm Position Matching task

CBC – cooperative bimanual coordination (Ball on Bar task)

IBC – independent bimanual coordination (Object Hitting task)

VGR – Visually Guided Reaching task

1. Introduction

Stroke constitutes a leading cause of acquired disability in higher age [1] as the recovery of cognitive and motor functions remains incomplete for most patients [2], impairing their life quality [3]. It is, therefore, imperative to explore new avenues to improve rehabilitation after stroke.

Transcranial direct current stimulation (tDCS) is a technique that is safe to administer in patients [4] and is increasingly applied as neuromodulatory adjuvant to neurorehabilitation. Unilateral-anodal tDCS (ua-tDCS), aiming at the facilitation of the ipsilesional sensorimotor cortices, is the most extensively studied setup and has been shown to improve a variety of motor outcomes measures in stroke patients [5]. Similarly, unilateral-cathodal tDCS has been reported to effectively modulate performance by inhibiting overactive contralesional cortices [6]. Dual or bilateral tDCS (bi-tDCS) combines the facilitation of the ipsilesional cortices (anodal component) with the inhibition of the contralesional cortex (cathodal component) and has thereby been shown to induce stronger effects than either unilateral setup [7]. Other studies, however, did not demonstrate these canonical [8] performance modulations for either setup [[9], [10], [11]] and recent meta-analyses and systematic reviews [[12], [13], [14], [15]] increasingly reveal heterogeneous and variable effects of tDCS on sensorimotor functions after stroke. One possible explanation could be that most previous studies only investigated effects on a limited set of movement parameters. Therefore, potential diverging effects on different aspects of (sensori)motor function may have been overlooked, particularly since most studies performed only between-group comparisons and thereby often fully neglected the individual-level at which large variability in responses occurs [8].

To overcome these issues, we here combine standardized robotic assessments of sensorimotor control with a double-blind, sham-controlled, cross-over experimental design to assess functional effects of tDCS in stroke patients with arm paresis. Focusing on the facilitation of the lesioned cortices, we use established protocols for ua-tDCS and bi-tDCS to assess setup-specific effects. Based on the evidence mentioned above [5,7], we hypothesized detectable performance changes in response to either tDCS setup with the aim to improve movement performance. Moreover, we expected overall behavioral improvements under both setups albeit with considerably larger proportions of functional improvements under bi-tDCS. By assessing multiple kinematic parameters simultaneously, we expected that not all parameters would be affected equally and hypothesized complex and interrelated patterns of either performance increases or decreases as well as unchanged parameters.

2. Methods

Data sets are available from the corresponding author upon reasonable request.

2.1. Patient sample

Patients were recruited from the Day Clinic for Cognitive Neurology at the University Hospital Leipzig. They were briefed about study procedures and intent and provided written informed consent in accordance with the Declaration of Helsinki. Twenty-four patients (16 males, mean age: 60.2 ± 12.4 years) with first stroke occurrence (13 right-affected) and mild to moderate upper extremity hemiparesis at least 6 months post-stroke were recruited. Fig. 3 provides a clinical characterization and lesion distributions; Fig. 4 displays individual sensorimotor deficits of the sample. Detailed information on patient recruitment and patient characteristics are provided in the Supplemental Material Section 1. The study was approved by the Ethics Committee of the University of Leipzig.

2.2. Experimental design and procedure

A double-blind, cross-over design was adopted. Overall experimental procedures are illustrated in Fig. 1.A. Patients underwent neurological examinations before enrolment where standardized clinical scales (Fig. 3.A, Supplemental Table I) were acquired by experienced staff. Enrolled patients were familiarized with the experimental setup, equipment and tested all kinematic tasks prior to data collection. The effects of stimulation were assessed in three test sessions, each separated by at least one week to avoid carry-over effects of tDCS [16]. The experimental procedures and kinematic assessments were identical in each session apart from the applied tDCS setup (Fig. 1.B). The order of sessions (tDCS setups) and kinematic tasks was pseudo-randomized across patients: respective randomization lists were generated a priori in MATLAB 9.3. (R2017b, MathWorks, Inc., Natick, MA, USA) and patient IDs were filled successively when a new patient was enrolled. Neuroimaging data were acquired for half of the sample before and the other half after the behavioral assessments. All data collection was conducted by the same blinded experimenter. A second experimenter allocated patients to the randomization lists, supervised the stimulator during testing and assisted with preparations but did otherwise not interact with patients.

Fig. 1. Experimental Design and Kinematic Assessments. A Testing occurred on three days separated by one week in a pseudo-randomized, cross-over design. B The same standardized procedures were used for all three sessions, only tDCS setups changed in pseudo-randomized order. Visual analogue scales and lifestyle-related information were acquired before and after testing (Supplemental Material Section 2). C tDCS was applied concurrent to task execution in the KINARM robotic environment. The semi-translucent mirror between hands and projector served as augmented-reality interface to simultaneously display stimulus material and visual feedback of hand positions. D Workspaces and virtual stimulus material are specific to each task and positionally adjusted for each patient. Exemplary workspaces provided for a right-affected patient. Workspaces were flipped for left-affected patients. Abbreviations: APM = Arm Position Matching (proprioception), CBC = Cooperative Bimanual Coordination, IBC = Independent Bimanual Coordination, VGR = Visually Guided Reaching (unimanual).

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[Abstract] Activities of Daily Living-based Rehabilitation System for Arm and Hand Motor Function Retraining after Stroke

Abstract

Most stroke survivors have difficulties completing activities of daily living (ADLs) independently. However, few rehabilitation systems have focused on ADLs-related training for gross and fine motor function together. We propose an ADLs-based serious game rehabilitation system for the training of motor function and coordination of both arm and hand movement where the user performs corresponding ADLs movements to interact with the target in the serious game. A multi-sensor fusion model based on electromyographic (EMG), force myographic (FMG), and inertial sensing was developed to estimate users’ natural upper limb movement. Eight healthy subjects and three stroke patients were recruited in an experiment to validate the system’s effectiveness. The performance of different sensor and classifier configurations on hand gesture classification against the arm position variations were analyzed, and qualitative patient questionnaires were conducted. Results showed that elbow extension/flexion has a more significant negative influence on EMG-based, FMG-based, and EMG+FMG-based hand gesture recognition than shoulder abduction/adduction does. In addition, there was no significant difference in the negative influence of shoulder abduction/adduction and shoulder flexion/extension on hand gesture recognition. However, there was a significant interaction between sensor configurations and algorithm configurations in both offline and real-time recognition accuracy. The EMG+FMG-combined multi-position classifier model had the best performance against arm position change. In addition, all the stroke patients reported their ADLs-related ability could be restored by using the system. These results demonstrate that the multi-sensor fusion model could estimate hand gestures and gross movement accurately, and the proposed training system has the potential to improve patients’ ability to perform ADLs.

Published in: IEEE Transactions on Neural Systems and Rehabilitation Engineering ( Early Access )

[Abstract] Ludic Table: a comparative study between playful rehabilitation and kinesiotherapy in restricting upper limb movements in individuals with stroke

Abstract

Stroke is a neurological syndrome resulting from the sudden interruption of blood flow. Among the symptoms/consequences of the stroke are muscle weakness in the lower and/or upper limbs, decreased sensitivity, altered fine motor skills, proprioception, and reflections. The treatment for the motor consequences is orthopedic management, in which the physiotherapist assists the individual in repetitive range of motion exercises, which can be demotivating during the treatment. The Ludic Table (LT), on the other hand, incorporates playfulness into therapy, making it a motivating tool. This research describes the comparative study between kinesiotherapy techniques and exercises using the LT, applied to the development of upper limb movements. For this, fourteen volunteers were divided into groups, submitted to interventions according to the techniques, and evaluated using systems such as goniometry, HAQ-DI, GMFM-88, and neurofunctional assessment. In general, it can be stated that regardless of the intervention, the individuals obtained gain in movements (minimum average of 7 degrees) and that the use of the LT allows the development of the angular amplitude and the reduction of the effects of spasticity. The individuals submitted to the intervention through the LT obtained the development of a greater number of articular movements of the shoulder and elbow.

Graphical abstract

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[Abstract] Decoding hand and Wrist Movement Intention From Chronic Stroke Survivors With Hemiparesis Using A Wearable, User-Centric Neural Interface – Research Poster

Research Objectives

To investigate the use of the NeuroLife® Sleeve to decode hand and wrist movements in chronic stroke survivors with hemiparesis for the eventual control of assistive devices. The NeuroLife Sleeve is a wearable garment worn on the forearm with 150 embedded electrodes spread across the forearm to record high-resolution surface electromyography (sEMG).

Design

Using the NeuroLife Sleeve, EMG activity was recorded while participants attempted 12 hand and wrist movements during three separate 2-hour sessions.

Setting

All studies were conducted at Battelle’s laboratories. Participants were referred from therapists in the Columbus area or recruited from local support groups.

Participants

Six chronic stroke survivors (>6 months after stroke) with upper extremity motor impairment (Upper Extremity Fugl-Meyer: 7-38).

Interventions

Participants followed a series of hand and wrist movements on a computer monitor and performed the shown movement to the best of their ability.

Main Outcome Measures

EMG decoding accuracy to correctly predict movement intention from EMG data recorded from the NeuroLife Sleeve.

Results

We demonstrate that the NeuroLife Sleeve can accurately decode 12 functional hand and wrist movements, including multiple types of grasps with 75% average accuracy across subjects in simulated real-time situations. These results highlight the utility of the NeuroLife Sleeve and decoding algorithms as potential control systems for assistive devices. Collected feedback from stroke survivors who tested the system demonstrate the user-centric design of the NeuroLife Sleeve, including being simple to don and doff, comfortable, portable, and lightweight.

Conclusions

The NeuroLife Sleeve represents a user-centric, platform technology to record and decode high-definition electromyography for the eventual real-time control of assistive devices.

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[WEB] Occupational Therapy Professor Pioneers Program for Stroke Survivors

Posted by Debbie Overman

Shannon L. Scott, assistant professor in the Department of Occupational Therapy, envisioned a program that would give her graduate students an opportunity for hands-on work and offer valuable therapy to community members. As a result, the “Upper Extremity Motor Recovery Boot Camp” pilot was born.

A full constraint-induced movement therapy (CIMT) program is an intensive two–week, six hours per day program; something that is difficult to implement in traditional rehabilitation settings due to its intensity. The bootcamp followed a modified version of the therapy that took place for four and five hours over the program’s two days.

Read the full article from Ithaca College in New York at theithacan.org/news/

[Abstract] Is mental practice effective for treating upper extremity deficits in individuals with hemiparesis after stroke? A Cochrane Review summary with commentary

Abstract

Background: Mental practice, which is proposed for the rehabilitation of people post-stroke, is a training method based on the repetition of the internal representation of a movement or a task with the aim of improving the performance.

Objective: The aim of this commentary is to discuss Cochrane evidence on the efficacy of mental practice in improving upper extremity functioning in people with hemiparesis after stroke.

Methods: To summarize and discuss from a rehabilitation perspective the published Cochrane Review “Mental practice for treating upper extremity deficits in individuals with hemiparesis after stroke” by Barclay et al.RESULTS:This Cochrane Review included 25 studies involving 676 people with hemiparesis after stroke. The authors analysed the following two comparisons: mental practice versus conventional therapy and mental practice in addition to other treatment versus other treatment (±placebo).

Conclusions: Mental practice in addition to other treatment, compared with other treatment, probably improves upper extremity activity and function in people with hemiparesis after stroke.

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• Combined functional task practice and dynamic high intensity resistance training promotes recovery of upper-extremity motor function in post-stroke hemiparesis: a case study.Patten C, Dozono J, Schmidt S, Jue M, Lum P.J Neurol Phys Ther. 2006 Sep;30(3):99-115. doi: 10.1097/01.npt.0000281945.55816.e1.PMID: 17029654
• Interventions for improving upper limb function after stroke.Pollock A, Farmer SE, Brady MC, Langhorne P, Mead GE, Mehrholz J, van Wijck F.Cochrane Database Syst Rev. 2014 Nov 12;2014(11):CD010820. doi: 10.1002/14651858.CD010820.pub2.PMID: 25387001 Free PMC article. Review.
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[Abstract] Treatment of upper limb spasticity with inhibitory repetitive transcranial magnetic stimulation: A randomized placebo-controlled trial

Abstract

BACKGROUND: Upper limb dysfunction is a frequent complication after stroke impairing outcome. Inhibitory repetitive transcranial magnetic stimulation (rTMS) applied over the contralesional hemisphere is supposed to enhance the positive effects of conventional rehabilitative treatment. OBJECTIVE:This double-blind randomized placebo-controlled trial investigated whether inhibitory rTMS as add-on to standard therapy improves upper limb spasticity.

METHODS: Twenty-eight patients (aged 44 to 80 years) with unilateral stroke in the middle cerebral artery territory were analyzed. Participants were randomly assigned to inhibitory, low-frequency (LF-) rTMS (n = 14) or sham-rTMS (n = 14). The primary outcome measure was the spasticity grade, which was assessed with the Modified Ashworth Scale (MAS). In addition, the Fugl-Meyer-Assessment (FMA) for the upper extremity (UE) and a resting-state fMRI were performed to measure motor functions and the sensorimotor network, respectively.

RESULTS: The MAS score was reduced in the LF-rTMS group only, whereas the FMA score improved in both groups over time. Regarding the fMRI data, both groups activated typical regions of the sensorimotor network. In the LF-rTMS group, however, connectivity to the left angular gyrus increased after treatment.

CONCLUSION: Changes in functional connectivity in patients receiving inhibitory rTMS over the contralesional motor cortex suggest that processes of neuronal plasticity are stimulated.

Source: NeuroRehabilitation, vol. 49, no. 3, pp. 425-434, 2021

[WEB] Occupational and Physical Therapists See Promise in New Paired VNS Therapy for Stroke Recovery

– Researchers and clinicians assert that the Vivistim® Paired VNS™ System is an adjunct intervention that improves outcomes of rehabilitation therapy for survivors of ischemic stroke

– FDA-approved Paired VNS Therapy generates 2-3 times more hand and arm function for stroke survivors than rehabilitation therapy alone

– The first commercial implantation of Vivistim is expected in the first half of 2022

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AUSTIN, Texas, March 1, 2022 /PRNewswire/ — Rehabilitation therapy researchers and clinicians embrace the FDA-approved, first-of-its-kind Vivistim® Paired VNS™ System with a positive outlook as an effective, outcomes-based adjunct intervention for survivors of ischemic stroke.
Manufactured by MicroTransponder^® Inc., a medical device company developing solutions to restore independence and dignity for people suffering from neurological conditions that impair sensory and motor function, the Vivistim System pairs vagus nerve stimulation with rehabilitation therapy to improve upper limb function for stroke survivors.

(PRNewsfoto/MicroTransponder)

Occupational and Physical Therapists See Promise in New Paired VNS Therapy for Stroke Recovery

Results of MicroTransponder’s 108-person, multicenter, triple-blinded, randomized controlled pivotal clinical trial, published in The Lancet, show that the Vivistim System generates two to three times more hand and arm function for stroke survivors than rehabilitation therapy alone.

These results, along with the assertion of a paradigm shift in stroke rehabilitation, were presented by Teresa Jacobson Kimberley, Ph.D., PT, FAPTA, a professor at MGH Institute of Health Professions, and Steven L. Wolf, Ph.D., PT, FAPTA, FAHA, FASNR, a professor in the Division of Physical Therapy at Emory University School of Medicine, during the American Physical Therapy Association’s 2022 Combined Sections Meeting. Kimberley and Wolf, who led the Vivistim clinical trial at their respective institutions, facilitated a symposium titled “Applying the Evidence: The Emerging Role of Vagus Nerve Stimulation Paired with Stroke Rehabilitation.”

“The standard of care in rehabilitation therapy for stroke survivors has limited effect on the restitution of arm and hand function. The Vivistim VNS System paired with intense rehabilitation empowers occupational and physical therapists to enhance the benefits of the treatment they provide,” said Kimberley. “The evidence suggests that vagus nerve stimulation with rehabilitation therapy harnesses neurophysiology to enhance restitution.”

As Paired VNS Therapy garners more recognition for being an innovative, results-oriented intervention in stroke recovery, Wolf advocates for buy-in from rehabilitation specialists by underscoring that this new intervention is a complement to therapy, not a replacement.

“The challenge we have as neurorehabilitation professionals working with stroke survivors is changing the rate of recovery to make gains last longer before a patient’s movement ability plateaus,” said Wolf. “The use of vagus nerve stimulation may offer an opportunity to create such changes.”

According to occupational and physical therapists who participated in the clinical trial, the Vivistim System enables therapists to guide stroke survivors to significant improvements in upper limb mobility because of the innovativeness of the technology, the therapy’s unique in-clinic protocol and the system’s capability to be activated at home by the patient.

During Vivistim Therapy, a therapist will use a wireless transmitter that communicates with proprietary software to signal the implanted Vivistim device to deliver a gentle pulse to the vagus nerve while the stroke survivor performs a specific task, such as putting on a hat, brushing hair or cutting food. Through Vivistim’s at-home feature, stroke survivors can continue practicing rehabilitation exercises or practice routine tasks on their own by swiping the Vivistim magnet over the implant area.

Researchers believe that the simultaneous pairing of the rehabilitation exercise with vagus nerve stimulation releases neuromodulators that create or strengthen neural connections to improve upper limb function and increase the benefit of physical therapy.

“Paired VNS therapy is targeted to enhance neuroplasticity in the central nervous system of stroke survivors, so the exercises we conduct are more movement- and patient-specific,” said Nuray Yozbatiran, a physical therapist and research faculty member at the NeuroRecovery Research Center at TIRR Memorial Hermann and Department of Physical Medicine and Rehabilitation at UT Health McGovern Medical School.

Therapists evaluate their patient’s upper limb function during each Vivistim Therapy session to tailor the exercises around hand and arm functions that need the most improvement. According to Yozbatiran, patients reported that they felt challenged during the sessions and appreciated the intensity.

“Most of the patients I worked with during the clinical trial felt empowered with another chance at an intervention to improve their use and movement of the hemiplegic upper extremity. It motivated them to incorporate their hand and arm into tasks they had not recently performed,” said Komal Sahu, MPH, OTR/L, an occupational therapist at Emory Healthcare. “The follow-up with patients after completing the clinic sessions proved beneficial. All of the patients confirmed that they were continuing their 30-minute daily Vivistim at-home therapy and even asked for new and challenging activities to practice. It’s driven me to think of additional activities and exercises that will help my patients accomplish specific movements and goals.”

Even though the Vivistim System protocols are extensive, most therapists in the clinical trial report that it’s easy to integrate into their practice. During the clinical trials, 71% of therapists said it was easy or very easy to trigger the vagus nerve stimulation during therapy.

“The Vivistim System has helped me maintain an effective balance, delivering the VNS, guiding the patient through tasks, and only intervening to prevent the patient from doing compensatory movements,” said Isha Vora, MS, OTR/L, an acute care occupational therapist and Ph.D. student in the Brain Recovery Lab at MGH Institute of Health Professions.

Vora adds that Paired VNS Therapy can be effective for many survivors of ischemic stroke. The ideal candidates are probably survivors who are consistent with their follow-up appointments and who are motivated to participate in rehabilitation therapy. She’s seen patients who have previously been stagnant in therapy achieve significant improvement in their hand and arm function with Vivistim Therapy.

Clinical teams are currently identifying potential candidates for the Vivistim System, with the first commercial implantation of Vivistim expected in the first half of 2022. Rehabilitation specialists, physiatrists, neurologists and neurosurgeons interested in learning more can click here and assess if their patients are ideal candidates for the Vivistim System.

About MicroTransponder^®, Inc.
MicroTransponder^®, Inc. is a privately held, global medical device company based in Austin, Texas, committed to developing research-based neuroscience solutions. The company focuses on restoring independence and dignity for people suffering from neurological conditions that impair sensory and motor function. MicroTransponder’s FDA-approved Vivistim^® Paired VNS™ System is a first-of-its-kind, clinically proven medical technology that generates two to three times more improvement in upper limb function than rehabilitation alone for stroke survivors after six weeks of in-clinic therapy. For more information, visit Vivistim.com. 

Media Contact:
Julie Lopez
julie@microtransponder.com

SOURCE MicroTransponder

[Abstract] Impact of the robotic-assistance level on upper extremity function in stroke patients receiving adjunct robotic rehabilitation: sub-analysis of a randomized clinical trial

Background

Robotic therapy has been demonstrated to be effective in treating upper extremity (UE) paresis in stroke survivors. However, it remains unclear whether the level of assistance provided by robotics in UE training could affect the improvement in UE function in stroke survivors. We aimed to exploratorily investigate the impact of robotic assistance level and modes of adjustment on functional improvement in a stroke-affected UE.

Methods

We analyzed the data of 30 subacute stroke survivors with mild-to-severe UE hemiplegia who were randomly assigned to the robotic therapy (using ReoGo System) group in our previous randomized clinical trial. A cluster analysis based on the training results (the percentage of each stroke patient’s five assistance modes of robotics used during the training) was performed. The patients were divided into two groups: high and low robotic assistance groups. Additionally, the two groups were sub-categorized into the following classes based on the severity of UE functional impairment: moderate-to-mild [Fugl-Meyer Assessment (FMA) score ≥ 30] and severe-to-moderate class (FMA < 30). The outcomes were assessed using FMA, FMA-proximal, performance-time in the Wolf motor function test (WMFT), and functional assessment scale (FAS) in WMFT. The outcomes of each class in the two groups were analyzed. A two-way analysis of variance (ANOVA) was conducted with robot assistance level and severity of UE function as explanatory factors and the change in each outcome pre- and post-intervention as the objective factor.

Results

Overall, significant differences of the group × severity interaction were found in most of the outcomes, including FMA-proximal (p = 0.038, η² = 0.13), WMFT-PT (p = 0.021, η² = 0.17), and WMFT-FAS (p = 0.045, η² = 0.14). However, only the FMA score appeared not to be significantly different in each group (p = 0.103, η² = 0.09).

Conclusion

An optimal amount of robotic assistance is a key to maximize improvement in post-stroke UE paralysis. Furthermore, severity of UE paralysis is an important consideration when deciding the amount of assistance in robotic therapy.

Publisher URL: https://link.springer.com/article/10.1186/s12984-022-00986-9

Open URL: https://jneuroengrehab.biomedcentral.com/track/pdf/10.1186/s12984-022-00986-9