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[Abstract] Self-efficacy and Reach Performance in Individuals With Mild Motor Impairment Due to Stroke

Background: Persistent deficits in arm function are common after stroke. An improved understanding of the factors that contribute to the performance of skilled arm movements is needed. One such factor may be self-efficacy (SE).

Objective: To determine the level of SE for skilled, goal-directed reach actions in individuals with mild motor impairment after stroke and whether SE for reach performance correlated with actual reach performance.

Methods: A total of 20 individuals with chronic stroke (months poststroke: mean 58.1 ± 38.8) and mild motor impairment (upper-extremity Fugl-Meyer [FM] motor score: mean 53.2, range 39 to 66) and 6 age-matched controls reached to targets presented in 2 directions (ipsilateral, contralateral). Prior to each block (24 reach trials), individuals rated their confidence on reaching to targets accurately and quickly on a scale that ranged from 0 (not very confident) to 10 (very confident).

Results: Overall reach performance was slower and less accurate in the more-affected arm compared with both the less-affected arm and controls. SE for both reach speed and reach accuracy was lower for the more-affected arm compared with the less-affected arm. For reaches with the more-affected arm, SE for reach speed and age significantly predicted movement time to ipsilateral targets (R2 = 0.352), whereas SE for reach accuracy and FM motor score significantly predicted end point error to contralateral targets (R2 = 0.291).

Conclusions: SE relates to measures of reach control and may serve as a target for interventions to improve proximal arm control after stroke.

via Self-efficacy and Reach Performance in Individuals With Mild Motor Impairment Due to Stroke – Jill Campbell Stewart, Rebecca Lewthwaite, Janelle Rocktashel, Carolee J. Winstein, 2019

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[Abstract] Effectiveness of electrical stimulation therapy in improving arm function after stroke: a systematic review and a meta-analysis of randomised controlled trials

The aim of this study is to investigate the effectiveness of electrical stimulation in arm function recovery after stroke.

Data were obtained from the PubMed, Cochrane Library, Embase, and Scopus databases from their inception until 12 January 2019. Only randomized controlled trials (RCTs) reporting the effects of electrical stimulation on the recovery of arm function after stroke were selected.

Forty-eight RCTs with a total of 1712 patients were included in the analysis. The body function assessment, Upper-Extremity Fugl-Meyer Assessment, indicated more favorable outcomes in the electrical stimulation group than in the placebo group immediately after treatment (23 RCTs (n = 794): standard mean difference (SMD) = 0.67, 95% confidence interval (CI) = 0.51–0.84) and at follow-up (12 RCTs (n = 391): SMD = 0.66, 95% CI = 0.35–0.97). The activity assessment, Action Research Arm Test, revealed superior outcomes in the electrical stimulation group than those in the placebo group immediately after treatment (10 RCTs (n = 411): SMD = 0.70, 95% CI = 0.39–1.02) and at follow-up (8 RCTs (n = 289): SMD = 0.93, 95% CI = 0.34–1.52). Other activity assessments, including Wolf Motor Function Test, Box and Block Test, and Motor Activity Log, also revealed superior outcomes in the electrical stimulation group than those in the placebo group. Comparisons between three types of electrical stimulation (sensory, cyclic, and electromyography-triggered electrical stimulation) groups revealed no significant differences in the body function and activity.

Electrical stimulation therapy can effectively improve the arm function in stroke patients.

via Effectiveness of electrical stimulation therapy in improving arm function after stroke: a systematic review and a meta-analysis of randomised controlled trials – Jheng-Dao Yang, Chun-De Liao, Shih-Wei Huang, Ka-Wai Tam, Tsan-Hon Liou, Yu-Hao Lee, Chia-Yun Lin, Hung-Chou Chen, 2019

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[ARTICLE] Hand Rehabilitation Robotics on Poststroke Motor Recovery – Full Text


The recovery of hand function is one of the most challenging topics in stroke rehabilitation. Although the robot-assisted therapy has got some good results in the latest decades, the development of hand rehabilitation robotics is left behind. Existing reviews of hand rehabilitation robotics focus either on the mechanical design on designers’ view or on the training paradigms on the clinicians’ view, while these two parts are interconnected and both important for designers and clinicians. In this review, we explore the current literature surrounding hand rehabilitation robots, to help designers make better choices among varied components and thus promoting the application of hand rehabilitation robots. An overview of hand rehabilitation robotics is provided in this paper firstly, to give a general view of the relationship between subjects, rehabilitation theories, hand rehabilitation robots, and its evaluation. Secondly, the state of the art hand rehabilitation robotics is introduced in detail according to the classification of the hardware system and the training paradigm. As a result, the discussion gives available arguments behind the classification and comprehensive overview of hand rehabilitation robotics.

1. Background

Stroke, caused by death of brain cells as a result of blockage of a blood vessel supplying the brain (ischemic stroke) or bleeding into or around the brain (hemorrhagic stroke), is a serious medical emergency []. Stroke can result in death or substantial neural damage and is a principal contributor to long-term disabilities []. According to the World Health Organization estimates, 15 million people suffer stroke worldwide each year []. Although technology advances in health care, the incidence of stroke is expected to rise over the next decades []. The expense on both caring and rehabilitation is enormous which reaches $34 billion per year in the US []. More than half of stroke survivors experience some level of lasting hemiparesis or hemiplegia resulting from the damage to neural tissues. These patients are not able to perform daily activities independently and thus have to rely on human assistance for basic activities of daily living (ADL) like feeding, self-care, and mobility [].

The human hands are very complex and versatile. Researches show that the relationship between the distal upper limb (i.e., hand) function and the ability to perform ADL is stronger than the other limbs []. The deficit in hand function would seriously impact the quality of patients’ life, which means more demand is needed on the hand motor recovery. However, although most patients get reasonable motor recovery of proximal upper extremity according to relevant research findings, recovery at distal upper extremity has been limited due to low effectivity []. There are two main reasons for challenges facing the recovery of the hand. First, in movement, the hand has more than 20 degree of freedom (DOF) which makes it flexible, thus being difficult for therapist or training devices to meet the needs of satiety and varied movements []. Second, in function, the area of cortex in correspondence with the hand is much larger than the other motor cortex, which means a considerable amount of flexibility in generating a variety of hand postures and in the control of the individual joints of the hand. However, to date, most researches have focused on the contrary, lacking of individuation in finger movements []. Better rehabilitation therapies are desperately needed.

Robot-assisted therapy for poststroke rehabilitation is a new kind of physical therapy, through which patients practice their paretic limb by resorting to or resisting the force offered by the robots []. For example, the MIT-Manus robot uses the massed training approach by practicing reaching movements to train the upper limbs []; the Mirror Image Movement Enabler (MIME) uses the bilateral training approach to train the paretic limb while reducing abnormal synergies []. Robot-assisted therapy has been greatly developed over the past three decades with the advances in robotic technology such as the exoskeleton and bioengineering, which has become a significant supplement to traditional physical therapy []. For example, compared with the therapist exhausted in training patients with manual labor, the hand exoskeleton designed by Wege et al. can move the fingers of patients dexterously and repeatedly []. Besides, some robots can also be controlled by a patient’s own intention extracted from biosignals such as electromyography (EMG) and electroencephalograph (EEG) signals []. These make it possible to form a closed-loop rehabilitation system with the robotic technology, which cannot be achieved by any conventional rehabilitation therapy [].

Existing reviews of hand rehabilitation robotics on poststroke motor recovery are insufficient, for most studies research on the application of robot-assisted therapy on other limbs instead of the hand []. Furthermore, current reviews focus on either the hardware design of the robots or the application of specific training paradigms [], while both of them are indispensable to an efficient hand rehabilitation robot. The hardware system makes the foundation of the robots’ function, while the training paradigm serves as the real functional parts in the motor recovery that decides the effect of rehabilitation training. These two parts are closely related to each other.

This paper focuses on the application of robot-assisted therapy on hand rehabilitation, giving an overview of hand rehabilitation robotics from the hardware systems to the training paradigms in current designs, for a comprehensive understanding is pretty meaningful to the development of an effective rehabilitation robotic system. The second section provides a general view of the robots in the entire rehabilitation robotic system. Then, the third section sums up and classifies hardware systems and the training paradigms in several crucial aspects on the author’s view. Last, the state of the art hand rehabilitation robotics is discussed and possible direction of future robotics in hand rehabilitation is predicted.[…]

Continue —-> Hand Rehabilitation Robotics on Poststroke Motor Recovery


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Figure 3
Examples of different kinds of robots [].

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[Abstract] Efficacy of Virtual Reality Combined with Real Instrument Training for Patients with Stroke: A Randomized Controlled Trial



To investigate the efficacy of real instrument training in VR environment for improving upper-extremity and cognitive function after stroke.


Single-blind, randomized trial.


Medical center.


Enrolled subjects (N=31) were first-episode stroke, assessed for a period of 6 months after stroke onset; age between 20 and 85 years; patients with unilateral paralysis and a Fugl-Meyer assessment upper-extremity scale score >18.


Both groups were trained 30 min per day, 3 days a week, for 6 weeks, with the experimental group performing the VR combined real instrument training and the control group performing conventional occupational therapy.

Main Outcome Measures

Manual muscle test, Modified Ashworth scale, Fugl-Meyer upper motor scale, Hand grip, Box and Block, 9-hole pegboard, Korean mini-mental status examination, and Korean-Montreal cognitive assessment.


The experimental group showed greater therapeutic effects in a time-dependent manner than the control group, especially on the motor power of wrist extension, spasticity of elbow flexion and wrist extension, and box and block tests. Patients in the experimental group, but not the control, also showed significant improvements on the lateral, palmar, and tip pinch power; box and block, and 9-hole pegboard tests from before to immediately after training. Significantly greater improvements in the tip pinch power immediately after training and spasticity of elbow flexion 4 weeks after training completion were noted in the experimental group.


VR combined real instrument training was effective at promoting recovery of patients’ upper-extremity and cognitive function, and thus may be an innovative translational neurorehabilitation strategy after stroke.

via Efficacy of Virtual Reality Combined with Real Instrument Training for Patients with Stroke: A Randomized Controlled Trial – Archives of Physical Medicine and Rehabilitation

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[Abstract] Immersive virtual reality mirror therapy for upper limb recovery following stroke – A pilot study


Objective This study was designed to examine the feasibility of immersive virtual reality(VR) mirror therapy for upper limb paresis after stroke using a head-mounted display, and provide preliminary evidence of efficacy.

Design Ten outpatients with chronic stroke, upper limb hemiparesis, and a low predisposition for motion sickness completed a 12-session program of 30 minutes each of immersive VR mirror therapy. The VR system provided the illusion of movement in the hemiparetic upper limb while suppressing the visual representation of the non-paretic side. Feasibility was assessed via patient compliance, adverse event tracking, the System Usability Scale, and the Simulator Sickness Questionnaire. Preliminary efficacy was evaluated using the Fugl-Meyer Upper Extremity (FM-UE) and Action Research Arm Test.

Results Immersive VR mirror therapy for patients with chronic stroke was safe, well-tolerated, and without adverse events, such as simulator sickness. Motor outcomes revealed a small improvement for the FM-UE from 21.7 (SD= 8.68) to 22.8 (SD= 9.19) that did not achieve statistical significance (p=0.084).

Conclusion Four weeks of immersive virtual reality mirror therapy was well-tolerated by chronic stroke patients. Our findings support further clinical trials of immersive VR technologies and visually-enhanced mirror therapies for stroke survivors.

via Immersive virtual reality mirror therapy for upper limb reco… : American Journal of Physical Medicine & Rehabilitation

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[ARTICLE] Feasibility and clinical experience of implementing a myoelectric upper limb orthosis in the rehabilitation of chronic stroke patients: A clinical case series report – Full Text


Individuals with stroke are often left with persistent upper limb dysfunction, even after treatment with traditional rehabilitation methods. The purpose of this retrospective study is to demonstrate feasibility of the implementation of an upper limb myoelectric orthosis for the treatment of persistent moderate upper limb impairment following stroke (>6 months). Methods: Nine patients (>6 months post stroke) participated in treatment at an outpatient Occupational Therapy department utilizing the MyoPro myoelectric orthotic device. Group therapy was provided at a frequency of 1–2 sessions per week (60–90 minutes per session). Patients were instructed to perform training with the device at home on non-therapy days and to continue with use of the device after completion of the group training period. Outcome measures included Fugl-Meyer Upper Limb Assessment (FM) and modified Ashworth Scale (MAS). Results: Patients demonstrated clinically important and statistically significant improvement of 9.0±4.8 points (p = 0.0005) on a measure of motor control impairment (FM) during participation in group training. It was feasible to administer the training in a group setting with the MyoPro, using a 1:4 ratio (therapist to patients). Muscle tone improved for muscles with MAS >1.5 at baseline. Discussion: Myoelectric orthosis use is feasible in a group clinic setting and in home-use structure for chronic stroke survivors. Clinically important motor control gains were observed on FM in 7 of 9 patients who participated in training.

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Stroke is a leading cause of long term disability in the United States[1]. Traditional rehabilitation does not restore normal motor control for all stroke survivors, and upwards of 50% live with persistent upper limb dysfunction[2]. This leads to diminished functional independence and quality of life[3]. Motor learning-based interventions have shown promise[4]. However in today’s health care milieu, for those with chronic motor deficits, provision of the intensive rehabilitation necessary to provide motor learning-based interventions is challenging. Therefore, new treatment methods are needed under these constraints.

An emerging technology that warrants further investigation is myoelectric control which harnesses the user’s EMG signal to power a custom fabricated orthotic device. When the user activates a target muscle, the EMG signal from that muscle signals a motor to produce a desired movement. Myoelectric control has been studied in different populations[5], but its study in stroke has been limited. One commercially available upper limb myoelectric device is the MyoPro motion-G (Cambridge, MA). The MyoPro motion-G provides assistance to the weak upper limb and allows the patient to perform movement they otherwise are unable to complete. Preliminary evidence suggests it may be effective in improving motor control[69] and one study showed improvement in self-reported function and perception of recovery[10]. This device has been utilized in the occupational therapy (OT) clinic at our medical center for 5 years. The purpose of this study is to demonstrate feasibility of administering treatment with the MyoPro using a group therapy design in a cohort of patients with chronic stroke whose progress with standard OT had plateaued.[…]

Continue —> Feasibility and clinical experience of implementing a myoelectric upper limb orthosis in the rehabilitation of chronic stroke patients: A clinical case series report

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[ARTICLE] Effects of Hand Configuration on the Grasping, Holding, and Placement of an Instrumented Object in Patients With Hemiparesis – Full Text


Objective: Limitations with manual dexterity are an important problem for patients suffering from hemiparesis post stroke. Sensorimotor deficits, compensatory strategies and the use of alternative grasping configurations may influence the efficiency of prehensile motor behavior. The aim of the present study is to examine how different grasp configurations affect patient ability to regulate both grip forces and object orientation when lifting, holding and placing an object.

Methods: Twelve stroke patients with mild to moderate hemiparesis were recruited. Each was required to lift, hold and replace an instrumented object. Four different grasp configurations were tested on both the hemiparetic and less affected arms. Load cells from each of the 6 faces of the instrumented object and an integrated inertial measurement unit were used to extract data regarding the timing of unloading/loading phases, regulation of grip forces, and object orientation throughout the task.

Results: Grip forces were greatest when using a palmar-digital grasp and lowest when using a top grasp. The time delay between peak acceleration and maximum grip force was also greatest for palmar-digital grasp and lowest for the top grasp. Use of the hemiparetic arm was associated with increased duration of the unloading phase and greater difficulty with maintaining the vertical orientation of the object at the transitions to object lifting and object placement. The occurrence of touch and push errors at the onset of grasp varied according to both grasp configuration and use of the hemiparetic arm.

Conclusion: Stroke patients exhibit impairments in the scale and temporal precision of grip force adjustments and reduced ability to maintain object orientation with various grasp configurations using the hemiparetic arm. Nonetheless, the timing and magnitude of grip force adjustments may be facilitated using a top grasp configuration. Conversely, whole hand prehension strategies compound difficulties with grip force scaling and inhibit the synchrony of grasp onset and object release.



Cerebrovascular accidents (stroke) are a frequent cause of disability (1) and the recovery of upper-limb function in particular, is a key determinant of independence in activities of daily living (2). Broadly speaking, the physical impairment experienced by patients is characterized by loss of strength, abnormal movement patterns (pathological synergies), and changes in muscle tone to the side of the body contralateral to the stroke (34). This presentation is commonly referred to as hemiparesis and its severity tends to reflect the extent of the lesion to the corticospinal tract (5). Subtle changes in movement kinematics and hand function on the ipsilesional upper-limb have also been documented and may be the consequence of direct impairment of ipsilateral motor pathways (67), as well as reorganization of the non-lesioned hemisphere to support recovery of motor-function in the hemiparetic limb (810). Above all though, patients living with stroke find that limitations with manual dexterity of the hemiparetic arm have the most significant effect upon their ability to carry out activities involving hand use in daily life (11).

These impairments in patient hand function manifest in multiple different aspects of motor performance. This may include reduced strength (3), loss of individuated finger control (12), and abnormal force control at the level of the fingers (13). Increased muscle tone and spasticity though the flexors of the wrist and hand may further compound these difficulties and inhibit the ability to open the hand in preparation for grasping (14). Atypical reaching and grasping patterns are often seen to emerge both as a consequence of and as a response to the motor dysfunction (1516).

Unfortunately, rehabilitation of upper limb impairments proves to be challenging. Whilst numerous therapeutic modalities (e.g., bilateral training, constraint-induced therapy, electrical stimulation, task-oriented, high intensity programs) have been evaluated in clinical trials, none have demonstrated consistent effects upon hand function (1719). Indeed, previous research papers have described therapy outcomes in upper limb rehabilitation post stroke as “unacceptably poor” (20). Ideally, the design of neurorehabilitation programs should be grounded upon an understanding of basic mechanisms involved in neural plasticity and motor learning (2122). Part of this process implies coming to terms with the factors which characterize the disorganization in voluntary motor output (21). However, the majority of clinical tools currently used for evaluating hand function distinguish motor performance according to ordinal rating scales or task completion time (e.g., Frenchay Arm Test, Jebson-Taylor Hand Function Test) (2324). These kinds of assessments lack sensitivity and may prove insufficient for detecting the presence of mild motor deficits or subtle, yet clinically important changes in hand coordination (2526). Evidence based frameworks for hand rehabilitation have specifically called for the integration of new technology to support patient assessment and treatment planning (27). Despite this, the transposition of technology for upper limb rehabilitation from the research domain into clinical practice has been limited (2829). In the assessment of manual dexterity, the underlying challenge involves analyzing sensorimotor function of the hand with respect to its interaction with objects in the environment (30).

Successfully managing grasping and object handling tasks requires skilled control of prehensile finger forces. In healthy adults, grip forces are regulated to be marginally greater than the minimum required to prevent the object from slipping (31). This safety margin is calibrated according to the shape, surface friction and weight distribution of the object (3233). As the hand moves through space (lifting, transporting, object placement), grip force is continually modulated, proportional to the load forces associated with the mass and acceleration of that object (34). This temporal coupling between grip and load forces is considered a hallmark of anticipatory sensorimotor control (35). Disruption to motor planning, volitional motor control or somatosensory feedback may lead to a breakdown in the timing and magnitude of grip force adjustments.

Numerous studies have examined grip force regulation in neurological pathologies including cerebellar dysfunction (36), peripheral sensory neuropathy (3738), Parkinson’s disease (36373940) as well as congenital and acquired brain lesions (13364145). For patients suffering from hemiparesis post stroke, difficulty with coordinating the grasping and lifting action are frequently associated with temporal discrepancies between grip forces and load forces (46). The cerebral hemisphere implicated in the CVA (1347) and the extent of the resulting sensory deficits (4849) have also been observed to influence anticipatory grip force scaling. This body of work highlights the potential interest of using instrumented objects for the diagnosis and evaluation of the impairments associated with hemiparesis (4546485053).

As it stands, these objective studies of hand function post stroke have focused primarily upon either the lifting or the vertical movement components in object handling. To a certain extent, this limitation has been related to technical restrictions. Other than a handful of studies by Hermsdorfer et al. (849), research in this field has predominantly used manipulanda designed for the study of precision grip, where strain gauge force transducers are attached to a separate base unit [e.g., (232529333537)]. These devices cannot be freely handled by subjects, much less a person with an upper-limb movement disorder. Indeed, patients with hemiparesis often experience specific impairments with precision grip (53) and regularly use alternative grasping strategies such as whole hand grasping (151654). Previous researchers have hypothesized that these alternative grasp strategies may impact grip force scaling (55) and compromise patient ability to manage hand-object-environment relationships during object manipulation (56).

In a recent study with healthy adult subjects, (57) we demonstrated how an instrumented object with multiple load cells and an integrated inertial measurement unit (58) may be used to examine relationships between different grasp configurations, grip force regulation and object orientation. The purpose of the present investigation was to extend this work to the study of patients with hemiparesis post stroke. The first objective was to compare how four alternative grasp configurations commonly used in daily tasks affect grip force regulation in this population. The second objective was to explore the timing and coordination of the whole task sequence (grasping, lifting, holding, placement and object release). The third and final objective was to evaluate the stability of the hand-held object’s orientation across the different phases of the task.[…]


Continue —> Frontiers | Effects of Hand Configuration on the Grasping, Holding, and Placement of an Instrumented Object in Patients With Hemiparesis | Neurology

Figure 1. Illustration of the iBox device and the experimental setup. (A) The iBox instrumented object. (B)Setup for the experimental procedure. Initial positions of the iBox and hand start area are indicated by the dotted lines. The gray shaded rectangle indicates the deposit area for the top grasp task.


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[ARTICLE] Comparison Between Movement-Based and Task-Based Mirror Therapies on Improving Upper Limb Functions in Patients With Stroke: A Pilot Randomized Controlled Trial – Full Text


Objective: The aim of this trial was to compare the effect of movement-based mirror therapy (MMT) and task-based mirror therapy (TMT) on improving upper limb functions in patients with stroke.

Methods: A total of 34 patients with sub-acute stroke with mildly to moderately impaired upper limb motor functions. The participants were randomly allocated to one of three groups: MMT, TMT, and conventional treatment (CT). The MMT group underwent movement-based mirror therapy for around 30 min/day, 5 days/week, for 4 weeks, whereas the TMT group underwent dose-matched TMT. The CT group underwent only conventional rehabilitation. The MMT and TMT groups underwent CT in addition to their mirror therapy. Blinded assessments were administered at baseline and immediately after the intervention. Upper limb motor functions, measured using Fugl-Meyer Assessment-upper extremity (FMA-UE), Wolf Motor Function Test (WMFT), and hand grip strength; upper limb spasticity, measured using the modified Ashworth scale (MAS); and activities of daily living, measured using the modified Barthel index (MBI).

Results: A significant time-by-group interaction effect was noted in FMA-UE. Post-hoc analysis of change scores showed that MMT yielded a better effect on improving FMA-UE than the other two therapies, at a marginally significant level (P = 0.050 and 0.022, respectively). No significant interaction effect was noted in WMFT, hand grip strength, MAS, and MBI.

Conclusion: Both MMT and TMT are effective in improving the upper limb function of patients with mild to moderate hemiplegia due to stroke. Nevertheless, MMT seems to be superior to TMT in improving hemiplegic upper extremity impairment. Further studies with larger stroke cohorts are expected to be inspired by this pilot trial.


Mirror therapy (MT) has been shown to be a useful intervention for rehabilitation of upper limb functions following stroke, since the first attempt by Altschuler et al. (1). The neural correlate of MT remains under investigation. Three main theories explaining the neural mechanism underlying the clinical efficacy of MT have been proposed (2).

The first theory hypothesizes that the neural correlate of MT is the mirror neuron system (MNS), which is defined as a class of neurons that fire during action observation and action execution (3). It is assumed that the MNS can be triggered when people are observing mirror visual feedback (MVF) generated in MT (45). The affected cortical motor system can be accessed via the MNS owing to their functional connections (6). The second theory, supported by several studies with transcranial magnetic stimulation (TMS), suggests that a potential neural mechanism underlying the effect of MT can be the recruitment of the ipsilesional corticospinal pathway. Indeed, many TMS studies have demonstrated the increment of motor-evoked potentials of the ipsilesional primary motor cortex in participants with stroke when viewing MVF (7), which indicates a facilitatory effect of MVF on the ipsilesional corticospinal pathway. The last theory attributes the effect of MT to the compensation of restricted proprioception input from the affected limb and the enhancement of attention toward the paretic upper limb (8), which may contribute to the reduction of the learned non-use in patients with stroke (1).

A substantial number of randomized controlled trials (RCTs) have demonstrated that MT is useful in improving upper limb functions after stroke (912). A recently published meta-analytic review identified a moderate level of evidence supporting the effects of MT on improving upper limb motor functions (Hedges’ g = 0.47) and activities of daily living (ADLs) (Hedges’ g = 0.48) in patients with stroke (13). In the meta-analysis (13), the heterogeneity of conducting MT was obvious across studies. One major category of MT is movement-based MT (MMT), in which participants practice simple movements such as wrist flexion and extension, or finger flexion and extension, with their unaffected hands when viewing the MVF generated by a physical mirror placed at their mid-sagittal plane (1416). Another category of MT is task-based MT (TMT), in which participants perform specific motor tasks with their unaffected hands, such as squeezing sponges, placing pegs in holes, and flipping a card, while they are viewing the MVF (1217). In some studies, researchers applied MMT in the first few sessions and subsequently applied TMT in the following sessions, constituting a hybrid MT protocol (91018). MMT and TMT were also described as intransitive and transitive movements in some studies (910). However, a sub-group meta-analysis comparing MMT and TMT was not carried out in the meta-analysis study (13).

Initially, MMT was used for alleviating phantom pain after amputation and for treating upper limb hemiplegia after stroke (119). Subsequently, the effect of MMT in stroke upper limb rehabilitation has been systematically investigated by many clinical trials (141620). Arya et al. were the first to compare the effects of TMT with those of conventional rehabilitation on upper limb motor recovery after stroke, and they found a superior effect of TMT (12). The main rationale that Arya et al. mentioned was that the response of the MNS was better for object-directed actions than for non-object actions (1221). In a recent study comparing the effects of action observation training and MT on gait and balance in patients with stroke, the results showed that action observation training had significantly better effects on the improvement of balance functions than MT (22), indicating that action observation may be different from MT in terms of their neural mechanisms. In other studies in which TMT was introduced or combined with MMT, the authors did not explain why they employed TMT (911).

Thus far, no RCT has systematically investigated the difference between the effects of MMT and TMT. Therefore, we aimed to conduct an RCT to directly compare the effect of MMT and TMT, on improving hemiplegic upper limb motor functions, spasticity, and ADLs, in a group of patients with stroke.[…]


Continue —> Frontiers | Comparison Between Movement-Based and Task-Based Mirror Therapies on Improving Upper Limb Functions in Patients With Stroke: A Pilot Randomized Controlled Trial | Neurology

Figure 3. An example of the process of “fault and correction.” The given task is that participants are required to transfer an object placed in the No. 3 hole (in orange color) to the No. 2 hole (Step 1). However, participants usually move the object to the No. 4 hole when they are viewing the mirror reflection (Step 2). Then, participants realize the fault and transfer the object it to the No. 2 hole (Steps 3, 4).

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[Abstract + References] Dual dynamic and static progressive full composite flexion orthosis


Joint stiffness, especially in the hand, can greatly limit function and the ability to complete activities of daily living. As hand therapists, it is our role to reduce passive stiffness in joints and ultimately to improve function.1 Previous research has focused on a variety of avenues to attenuate joint stiffness, two of which are static progressive orthoses and dynamic orthoses.2 It has been stated that static progressive orthoses are more effective at treating chronic stiffness in the hand via stress relaxation which allows the tissue to reach a plastic deformation state.


  1. Fess, E.E. A history of splinting: to understand the present, view the past. J Hand Ther2002;15:97–132
  2. Glasgow, C., Tooth, L., Fleming, J. Which splint? Dynamic versus static progressive splinting to mobilise stiff joints in the hand. Br J Hand Ther2008;13:2104–2110
  3. Schwartz, D.A. Static progressive orthoses for the upper extremity: a comprehensive literature review. Hand2012;7:10–17
  4. Flowers, K., LaStayo, P. Effect of total end range time on improving passive range of motion. J Hand Ther1994;7:150–157
  5. Glasgow, C., Wilton, J., Tooth, L. Optimal daily total end range time for contracture: resolution in hand splinting. J Hand Ther2003;16:207–218
  6. Schwartz, D.A. Fabrication of a dynamic or static progressive composite finger flexion orthosis.J Hand Ther2018;31:157–158
  7. Wang, J., Erlandsson, G., Rui, Y.J., Xu, X.H. Composite flexion splint for the stiff hand. J Hand Ther2011;24:66–68
  8. Schwartz, D.A., Janssen, R.G. Static progressive splint for composite flexion. J Hand Ther2005;18:447–449

via Dual dynamic and static progressive full composite flexion orthosis – Journal of Hand Therapy

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[Thesis] Post-stroke rehabilitation of hand function based on Electromyography biofeedback – Full Text PDF


The aim of my thesis work is the application and validation of an electromyographic biofeedback (EMG-BF) system in post-stroke rehabilitation setting. The absolute number of strokes is expected to dramatically increase in coming years, thus suggesting a need for strategies to improve post-stroke assistance and rehabilitation. The electromyogram (EMG) signal has shown good perspectives in the analysis of movements and motor impairment and the introduction of closed loop rehabilitation strategies revealed an increase of patient self-consciousness and motivation. Results are promising but a lack in the optimization of the devices for the application in the clinical context has been revealed. The device and the related software employed in the present research have been specifically conceived with this purpose. The device has been optimized during a clinical pilot study and then, a complete clinical trial has been started to investigate the characteristics of post stroke patients eligible for a rehabilitation therapy with the device, and the short-term clinical effect of the therapy on the recovery of the hand functionality. A statistical analysis has been performed on the dataset collected for 3 months. The data analysis included both clinical data and data collected from patients with the device during the execution of the experimental protocol. The preliminary results of the data analysis have confirmed the suitability of the system for its intended use and highlighted that the patient ability of controlling the EMG-BF based device is related to the degree of impairment with minimum p-value<0.001, depending on the patient clinical picture and on the exercise performed.
Moreover, according preliminary results observed on four patients that received a 15 hours therapy for 3 weeks, the improvement of the parameters related to the hand and fingers motor function, suggests the efficacy of the therapy. Finally, aspects related to the analysis of continuous motions of the wrist performed during the therapy have been investigated and the relevance of the temporal information in the interpretation of this type of movements has been revealed (p<<0.01).

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