Upper extremity motor impairment is one of the most prevalent problems following stroke. Considering the functional importance of the upper extremity in the daily life, the purpose of this study was to investigate the effect of kinesiotaping (KT) on hand function and spasticity in individuals following a stroke. Eight individuals who had experienced a stroke, with their age ranging from 47 to 66, participated in this pretest-posttest clinical study. An I- strip of tape was placed on the extensor muscles of the forearm. Primary outcome measures were the Modified Modified Ashwoth Scale, Box and Block test, and Nine Hole Peg test. At the immediate assessment, there were significant differences between two hand function tests scores. Secondary assessment was done after one week and the results showed significant differences between two hand function test scores. There was no significant change in flexor muscles spasticity after the intervention. This pilot study indicated that KT in the direction of the extensor muscles could result in better hand function in stroke patients.
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SMARTmove is a £1.1 million Medical Research Council research project running for 30 months from September 2016 to February 2019, funded under the Development Pathway Funding Scheme (DPFS). The project brings together a multidisciplinary team with expertise in functional materials, direct printing fabrication, control algorithms, wireless electronics, sensors, and end user engagement to address stroke rehabilitation. Working together with the advisory board members from six institutions, we will deliver a personalised wearable device for home-based stroke upper limb rehabilitation.
Current commercial devices using functional electrical stimulation (FES) have large electrodes that only stimulate a limited number of muscles, resulting in simple, imprecise movements and the rapid onset of fatigue. In addition, current commercial devices do not employ feedback control to account for the movement of patients, only reducing the level of precision in the resulting movements. In addition, devices are either bulky and expensive, or difficult to set-up due to trailing wires.
Our project uses bespoke screen printable pastes to print electrode arrays directly onto everyday fabrics, such as those used in clothing. The resulting garments will have cutting-edge sensor technologies integrated into them. Advanced control algorithms will then adjust the stimulation based on the patients’ limb motion to enable precise functional movements, such as eating, washing or dressing.
This project will deliver a fabric-based wearable FES for home based stroke rehabilitation. The beneficiaries include:
- Persons with stroke (PwS) and other neurological conditions. Stroke survivors are the direct beneficiaries of our research. The FES clothing can be adapted to also treat hand/arm disabilities resulting from other neurological conditions such as cerebral palsy, head injury, spinal cord injury, and multiple sclerosis. The use of the wearable training system increases the intensity of rehabilitation without an increase in clinical contact time. This leads to better outcomes such as reduced impairment, greater restoration of function, improved quality of life and increased social activity.
- The NHS. FES-integrated clothing is comfortable to wear and convenient to use for rehabilitation, enabling impaired people to benefit from FES at home. It will transfer hospital based professional care to home based self-care, and therefore will reduce NHS costs by saving healthcare professionals’ time and other hospital resources.
- Industry. Benefits include: bringing business to the whole supply chain; increasing the FES market demand by improving performance; benefiting other industry sectors such as rehabilitation for other neurological conditions.
- Research communities in related fields. Specifically, the fields of novel fabrication, control systems, design of medical devices, rehabilitation, smart fabrics, and remote healthcare will benefit from the highly transformative platform technology (e.g. direct write printing, fabric electrodes, iterative learning control systems) developed in this work.
Functional electrical stimulation (FES) is a technique used to facilitate the practice of therapeutic exercises and tasks. Intensive movement practice can restore the upper limb function lost following stroke. However, stroke patients often have little or no movement, so are unable to practice. FES activates muscles artificially to facilitate task practise and improve patients’ movement.
[ARTICLE] The Relationship between Poststroke Depression and Upper Limb Recovery in Patients Admitted to a Rehabilitation Unit – Full Text PDF
Objective: We sought to determine the relationship between poststroke depression and upper limb recovery in a cohort of patients admitted to a rehabilitation center in Singapore.
Method: We conducted a secondary analysis of an interventional study of 105 patients with a stroke. Depression was diagnosed using the Centre for Epidemiological Studies Depression Scale (CES-D) and this was correlated with the following measures: Fugl-Meyer Assessment of Upper Limb (FMA), Action Research Am Test (ARAT), Stroke Impact Scale – Upper Limb Items (SIS) and Functional Independence Measure-Selfcare (FIM-Selfcare) at 3, 7 and 15 weeks after admission to rehabilitation.
Results: Poststroke depression was present in 20% of patients on admission to rehabilitation. It was negatively correlated to SIS and FIM-Selfcare at 7 weeks and to FMA, ARAT, SIS and FIM-Selfcare at 15 weeks after rehabilitation admission. Depression on rehabilitation admission did not influence upper limb recovery at 3 weeks, 7 weeks, and 15 weeks after admission to rehabilitation.
Conclusion: Given the negative impact of depression on upper limb impairment, function and performance of selfcare, routine screening of depression should be considered in subacute stroke patients, especially in those with poorer upper limb function.
[ARTICLE] Effect of repetitive wrist extension with electromyography-triggered stimulation after stroke: a preliminary randomized controlled study – Full Text PDF
Objective: The purpose of this study was to explore the effect of repetitive wrist extension task training with electromyography (EMG)-triggered neuromuscular electrical stimulation (NMES) for wrist extensor muscle recovery in patients with stroke.
Design: Randomized controlled trial.
Methods: Fifteen subjects who had suffered a stroke were randomly assigned to an EMG-triggered NMES group (n=8) or control group (n=7); subjects in both groups received conventional therapy as usual. Subjects in the experimental group received application of EMG-triggered NMES to the wrist extensor muscles for 20 minutes, twice per day, five days per week, for a period of four weeks, and were given a task to make a touch alarm go off by activity involving extension of their wrist. In the control group, subjects
performed wrist self-exercises for the same duration and frequency as those in the experimental group. Outcome measures included muscle reaction time and spectrum analysis. Assessments were performed during the pre- and post-treatment periods.
Results: In the EMG-triggered NMES group, faster muscle reaction time was observed, and median frequency also showed improvement, from 68.2 to 75.3 Hz, after training (p<0.05). Muscle reaction time was significantly faster, and median frequency was significantly higher in the experimental group than in the experimental group after training.
Conclusions: EMG-triggered NMES is beneficial for patients with hemiparetic stroke in recovery of upper extremity function.
[Abstract] Soft Tissue Surgery for Adults With Nonfunctional, Spastic Hands Following Central Nervous System Lesions: A Retrospective Study
Soft tissue surgery for upper extremity contractures can improve hygiene, pain, and appearance in adults with central nervous system lesions. The goal of such interventions is highly individual; thus, goal attainment scaling (GAS; a method of scoring the extent to which patient’s individual goals are achieved [5 levels] in the course of intervention and using T score values) is pertinent to evaluate outcome. The objective of this study was to assess the effect of soft tissue surgery for upper extremity muscle contractures in patients with central nervous system lesions using GAS.
Retrospective data from 70 interventions were included (63 patients; 23 women). The mean age was 51.3 ± 16.2 years (range, 24.2–87.0 years). The primary goal was to improve hygiene (n = 58), pain (n = 10), or appearance (n = 2). The etiologies were stroke (n = 35), traumatic brain injury (n = 16), cerebral anoxia (n = 4), neurodegenerative disease (n = 6), and cerebral palsy (n = 2). The GAS score was calculated before surgery and 3 months after surgery.
The T score (which took into account the weight of each goal) was 52.3 at 3 months (38.5 before surgery), corresponding to a “better than expected” outcome. The mean of the differences of the GAS score for each goal before and after surgery increased by 1.27 for hygiene, 1.06 for pain, and 1.00 for appearance.
Soft tissue surgery can safely and effectively improve hygiene, pain, and appearance in adults with cerebral damage. The preoperative evaluation should be multidisciplinary. The GAS is a useful tool to assess the effectiveness of orthopedic surgery for these patients.
[ARTICLE] Effect of Robot-Assisted Game Training on Upper Extremity Function in Stroke Patients – Full Text
stroke is a central nervous system disease caused by cerebrovascular problems such as infarction or hemorrhage. Stroke may lead to impairment of various physical functions, including hemiplegia, language disorder, swallowing disorder or cognitive disorder, according to the location and degree of morbidity . Among these, hemiplegia is a common symptom occurring in 85% of stroke patients. In particular, upper extremity paralysis is more frequent and requires longer recovery time than lower extremity paralysis [2, 3]. To maintain the basic functions of ordinary life, the use of the upper extremities is essential; therefore, upper extremity paralysis commonly causes problems in performing the activities of daily living .
Robot-assisted rehabilitation treatment has recently been widely investigated as an effective neurorehabilitation approach that may augment the effects of physical therapy and facilitate motor recovery . Robot-assisted rehabilitation treatments have been developed in recent decades to reduce the expenditure of therapists’ effort and time, to reproduce accurate repetitive motions and to interact with force feedback [5, 6]. The most important advantage of using robot-assisted rehabilitation treatment is the ability to deliver high-dosage and high-intensity training .
In rehabilitation patients may find such exercises monotonous and boring, and may lose motivation over time . Upper extremity rehabilitation training using video games, such as Nintendo Wii games and the PlayStation EyeToy games, enhanced upper extremity functions and resulted in greater patient satisfaction than conventional rehabilitation treatment [9, 10, 11, 12, 13].
The objective of this study was to determine the effects of combining robot-assisted game training with conventional upper extremity rehabilitation training (RCT) on motor and daily functions in comparison to conventional upper extremity rehabilitation training (OCT) in stroke patients. This study was a randomized controlled trial and we evaluated motor power, upper extremity motor function, daily function and satisfaction. […]
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[ARTICLE] The Efficacy of a Haptic-enhanced Virtual Reality System for Precision Grasp Acquisition in Stroke Rehabilitation – Full Text PDF
Stroke is a leading cause of long-term disability, and virtual reality (VR)-based stroke rehabilitation is effective in increasing motivation and the functional performance in people with stroke. Although much of the functional reach and grasp capabilities of the upper extremities is regained, the pinch
movement remains impaired following stroke. In this study, we developed a haptic-enhanced VR system to simulate haptic pinch tasks to assist in long-term post-stroke recovery of upper-extremity fine motor function. We recruited 16 adults with stroke to verify the efficacy of this new VR system.
Each patient received 30-min VR training sessions 3 times per week for 8 weeks; all participants attended all 24 training sessions. Outcome measures, Fugl Meyer Assessment (FMA), Test Evaluant les Membres superieurs des Personnes Agees (TEMPA), Wolf Motor Function Test (WMFT), Box and
Block Test (BBT), and Jamar Grip Dynamometer, showed statistically significant progress from pretest to posttest and follow-up, indicating that the proposed system effectively promoted fine motor recovery of function. Additionally, our evidence suggests that this system was also effective under certain challenging conditions such as being in the chronic stroke phase or a co-side of lesion and dominant hand (non- dominant hand impaired). System usability assessment indicated the participants strongly intended to continue using this VR-based system in rehabilitation.
[Abstract] Quantification method of motor function recovery of fingers by using the device for home rehabilitation – IEEE Conference Publication
[Abstract] The Combined Effects of Adaptive Control and Virtual Reality on Robot-Assisted Fine Hand Motion Rehabilitation in Chronic Stroke Patients: A Case Study
Robot-assisted therapy is regarded as an effective and reliable method for the delivery of highly repetitive training that is needed to trigger neuroplasticity following a stroke. However, the lack of fully adaptive assist-as-needed control of the robotic devices and an inadequate immersive virtual environment that can promote active participation during training are obstacles hindering the achievement of better training results with fewer training sessions required. This study thus focuses on these research gaps by combining these 2 key components into a rehabilitation system, with special attention on the rehabilitation of fine hand motion skills. The effectiveness of the proposed system is tested by conducting clinical trials on a chronic stroke patient and verified through clinical evaluation methods by measuring the key kinematic features such as active range of motion (ROM), finger strength, and velocity. By comparing the pretraining and post-training results, the study demonstrates that the proposed method can further enhance the effectiveness of fine hand motion rehabilitation training by improving finger ROM, strength, and coordination.