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[WEB SITE] SMARTmove – FES

Summary

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.

     

The Need

Stroke is one of the largest causes of disability: 17 million strokes occur every year worldwide, meaning one stroke every two seconds. Half of stroke survivors lose the ability to perform everyday tasks with their upper limb, which affects their independence. The cost to society in the UK is nine billion pounds per year due to health and social care, informal care, productivity loss and benefit payments. As stroke is an age-related disease, these numbers are set to increase as the population ages.

Novelty

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.

Impact

This project will deliver a fabric-based wearable FES for home based stroke rehabilitation. The beneficiaries include:

  1. 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.
  2. 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.
  3. 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.
  4. 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.

What is FES?

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.

More…..

Source: SMARTmove

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[ARTICLE] The Relationship between Poststroke Depression and Upper Limb Recovery in Patients Admitted to a Rehabilitation Unit – Full Text PDF

Abstract

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.

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[ARTICLE] Adapting Tai Chi for Upper Limb Rehabilitation Post Stroke: A Feasibility Study

Abstract: 

Background: Tai chi (TC) has been reported as being beneficial for improving balance post stroke, yet its utility in upper limb rehabilitation remains unknown. Methods: Twelve chronic stroke survivors with persistent paresis of an upper limb underwent 60 minutes of adapted TC twice a week for eight weeks, with a 4-week follow up. A 10-min TC home program was recommended for the days without sessions. TC level of performance, attendance to the sessions, duration of self-practice at home, and adapted TC movements used were recorded. Results: Eleven participants completed the study. A clinical reasoning algorithm underlying the adaptation of TC was elaborated throughout the trial. Participants with varying profiles including a severely impaired upper limb, poor balance, shoulder pain, and severe spasticity were not only capable of practicing the adapted TC, but attended all 16 sessions and practiced TC at home for a total of 16.51 ± 9.21 h. The degree of self-practice for subgroups with low upper limb function, shoulder pain, or moderate-to-severe spasticity was similar to that of subgroups with greater upper limb function, no shoulder pain, and minimal-to-no spasticity. Conclusion: Adapted TC seems feasible for upper limb rehabilitation post stroke. Although the study was based on a small sample size and requires confirmation, low upper limb function, insufficient balance, spasticity, and shoulder pain do not appear to hinder the practice of TC.

1. Introduction

Stroke is a leading cause of serious, long-term disability among middle-aged and older adults worldwide [1]. Functional impairment of an upper limb is reported in approximately 85% of stroke survivors [2]. The effects of current treatments for arm weakness are shown to be suboptimal [3]. Though upper limb recovery has been found to continue even in the chronic stage [4], long-term rehabilitation services are limited for a large proportion of chronic stroke patients after returning home [5,6]. Therefore, novel and effective approaches are needed to provide timely and ongoing upper limb rehabilitation.
Tai chi is an ancient martial art originating from Chinese healing traditions. Typified by slow and gentle movements, tai chi is an “internal” martial art that cultivates the flow and balance of qi, which is translated as vital energy [7]. The relaxation of body and mind is a main feature which is said to facilitate the flow of qi [8]. Also, tai chi requires well-coordinated sequencing of segments to make the body move as a whole unit to help the flow of qi [9]. Thus, tai chi is a moving form of qigong, which is a practice focusing on cultivation, circulation, and harmonization of qi. To date, tai chi is accepted as a suitable, low impact, home-based exercise option for aged and patients with chronic diseases [10,11,12]. Since tai chi emphasizes slow and continuous weight transfer between the two feet, it has been widely shown as beneficial for improving balance and for fall prevention in the aged [13,14,15].
In recent years, some studies have also reported the benefits of tai chi in improving balance in chronic stroke patients [16,17,18]. However, the use of tai chi in upper limb rehabilitation post stroke remains unknown. Tai chi is not only an exercise of lower limb, but a whole-body exercise. Upper limb muscle strength and flexibility have been shown to improve in the aged following the practice of tai chi [19,20,21]. Tai chi practitioners have also demonstrated better arm movement control and eye–hand coordination in older adults [21,22,23,24]. Furthermore, the relaxation component of tai chi may have the potential to improve the motor function of the paretic upper limb. Therefore, tai chi may be a promising upper limb rehabilitation method.
However, the presence of hemiplegia may be an important barrier to using tai chi for upper limb rehabilitation post stroke, potentially limiting the ability to actually perform upper limb tai chi movements. Similarly, shoulder pain and severe spasticity of the affected arm may impact on the ability to perform tai chi movements. Furthermore, the standing position used in traditional tai chi styles poses difficulties for persons with poor balance. Adapting tai chi to take into account these limitations may need to be included in post-stroke rehabilitation. Although sitting tai chi has been reported to be used in persons with spinal cord injuries to improve muscle strength of the upper limbs [25], little is known about how to adapt tai chi with respect to paretic upper limbs. Moreover, the feasibility of using adapted tai chi movements for upper limb rehabilitation remains unknown.
Therefore, this study aimed to explore the use of adapted tai chi movements for upper limb rehabilitation. More specifically, the objective was to evaluate the feasibility of using adapted tai chi for upper limb rehabilitation post stroke, including: (1) whether the adapted tai chi was performable and acceptable by participants; and (2) whether the potential influencing factors such as impairment level of an upper limb, insufficient balance, shoulder pain, and spasticity constrained the practice of the adapted tai chi. A second objective was to document the clinical reasoning underlying the adaptations made to tai chi based on the participants’ characteristics when used for upper limb rehabilitation post stroke. The efficacy of adapted tai chi has been reported elsewhere [26]. […]

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Figure 1. Individual self-practice hours per month of participants.

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[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.

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[Abstract] The effect of kinesiotaping on hand function in stroke patients: A pilot study

Abstract

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.

Source: The effect of kinesiotaping on hand function in stroke patients: A pilot study – Journal of Bodywork and Movement Therapies

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[Abstract] Soft Tissue Surgery for Adults With Nonfunctional, Spastic Hands Following Central Nervous System Lesions: A Retrospective Study

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Source: Soft Tissue Surgery for Adults With Nonfunctional, Spastic Hands Following Central Nervous System Lesions: A Retrospective Study – Journal of Hand Surgery

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[ARTICLE] Effect of Robot-Assisted Game Training on Upper Extremity Function in Stroke Patients – Full Text

ObjectiveTo determine the effects of combining robot-assisted game training with conventional upper extremity rehabilitation training (RCT) on motor and daily functions in comparison with conventional upper extremity rehabilitation training (OCT) in stroke patients.

MethodsSubjects were eligible if they were able to perform the robot-assisted game training and were divided randomly into a RCT and an OCT group. The RCT group performed one daily session of 30 minutes of robot-assisted game training with a rehabilitation robot, plus one daily session of 30 minutes of conventional rehabilitation training, 5 days a week for 2 weeks. The OCT group performed two daily sessions of 30 minutes of conventional rehabilitation training. The effects of training were measured by a Manual Function Test (MFT), Manual Muscle Test (MMT), Korean version of the Modified Barthel Index (K-MBI) and a questionnaire about satisfaction with training. These measurements were taken before and after the 2-week training.

ResultsBoth groups contained 25 subjects. After training, both groups showed significant improvements in motor and daily functions measured by MFT, MMT, and K-MBI compared to the baseline. Both groups demonstrated similar training effects, except motor power of wrist flexion. Patients in the RCT group were more satisfied than those in the OCT group.

ConclusionThere were no significant differences in changes in most of the motor and daily functions between the two types of training. However, patients in the RCT group were more satisfied than those in the OCT group. Therefore, RCT could be a useful upper extremity rehabilitation training method.

INTRODUCTION

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 [1]. 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 [23]. 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 [2].

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 [4]. 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 [56]. The most important advantage of using robot-assisted rehabilitation treatment is the ability to deliver high-dosage and high-intensity training [7].

In rehabilitation patients may find such exercises monotonous and boring, and may lose motivation over time [8]. 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 [910111213].

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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Fig. 1. (A) Neuro-X, an upper extremity rehabilitation robot, consisting of a video monitor, a robot arm and a computer. (B) The patient performing robot-assisted game training with the upper extremity rehabilitation robot.

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[ARTICLE] The Efficacy of a Haptic-enhanced Virtual Reality System for Precision Grasp Acquisition in Stroke Rehabilitation – Full Text PDF

ABSTRACT
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.

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[Abstract] Quantification method of motor function recovery of fingers by using the device for home rehabilitation – IEEE Conference Publication

Abstract:

After leaving hospital, patients can carry out rehabilitation by using rehabilitation devices. However, they cannot evaluate the recovery by themselves. For this problem, a device which can both carry out the rehabilitation and evaluation of the degree of recovery is required. This paper proposes the method that quantifies the recovery of the paralysis of fingers to evaluate a patient automatically. A finger movement is measured by a pressure sensor on the rehabilitation device we have developed. A measured data is used as a time-series signal, and the recovery of the paralysis is quantified by calculating the dissimilarity between a healthy subject’s signal and the patient’s signal. The results of those dissimilarities are integrated over all finger to be used as a quantitative scale of recovery. From the experiment conducted with hemiplegia patients and healthy subjects, we could trace the process of the recovery by the proposed method.

Source: Quantification method of motor function recovery of fingers by using the device for home rehabilitation – IEEE Conference Publication

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[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.

Source: The Combined Effects of Adaptive Control and Virtual Reality on Robot-Assisted Fine Hand Motion Rehabilitation in Chronic Stroke Patients: A Case Study

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