Posts Tagged Upper Extremity

[Abstract] Functional Brain Stimulation in a Chronic Stroke Survivor With Moderate Impairment  

Abstract

OBJECTIVE. To determine the impact of transcranial direct current stimulation (tDCS) combined with repetitive, task-specific training (RTP) on upper-extremity (UE) impairment in a chronic stroke survivor with moderate impairment.

METHOD. The participant was a 54-yr-old woman with chronic, moderate UE hemiparesis after a single stroke that had occurred 10 yr before study enrollment. She participated in 45-min RTP sessions 3 days/wk for 8 wk. tDCS was administered concurrent to the first 20 min of each RTP session.

RESULTS. Immediately after intervention, the participant demonstrated marked score increases on the UE section of the Fugl–Meyer Scale and the Motor Activity Log (on both the Amount of Use and the Quality of Movement subscales).

CONCLUSION. These data support the use of tDCS combined with RTP to decrease impairment and increase UE use in chronic stroke patients with moderate impairment. This finding is crucial, given the paucity of efficacious treatment approaches in this impairment level.

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Source: Functional Brain Stimulation in a Chronic Stroke Survivor With Moderate Impairment | American Journal of Occupational Therapy

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[Abstract] Supporting Stroke Motor Recovery Through a Mobile Application: A Pilot Study

Abstract

Neuroplasticity and motor learning are promoted with repetitive movement, appropriate challenge, and performance feedback. ARMStrokes, a smartphone application, incorporates these qualities to support motor recovery. Engaging exercises are easily accessible for improved compliance. In a multiple-case, mixed-methods pilot study, the potential of this technology for stroke motor recovery was examined. Exercises calibrated to the participant’s skill level targeted forearm, elbow, and shoulder motions for a 6-wk protocol. Visual, auditory, and vibration feedback promoted self-assessment. Pre- and posttest data from 6 chronic stroke survivors who used the app in different ways (i.e., to measure active or passive motion, to track endurance) demonstrated improvements in accuracy of movements, fatigue, range of motion, and performance of daily activities. Statistically significant changes were not obtained with this pilot study. Further study on the efficacy of this technology is supported.

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Source: Supporting Stroke Motor Recovery Through a Mobile Application: A Pilot Study | American Journal of Occupational Therapy

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[BLOG POST] Study Compares Intento Device and Traditional Occupational Therapy  

The Intento device is designed to enable patients to control the functional electronic stimulation that they receive, to help patients regain mobility in arms weakened by a stroke.

The Intento device is designed to enable patients to control the functional electronic stimulation that they receive, to help them regain mobility in arms weakened by a stroke.

A device from Ecole Polytechnique Fédérale de Lausanne startup company Intento is designed to enable stroke patients to self-administer functional electrical stimulation to help regain mobility in their arms weakened by the stroke.

The system consists of electrode patches, a device the patients control using their working hand, and tablet software. The therapist selects one of several programmed movements on the tablet and loads it, with a single click, onto the device. The program shows where the electrodes need to be placed and automatically configures the electrical pulse settings to generate the desired movement. Patients then move their functioning hand to control the electrical stimulation needed.

The ultimate aim is for patients to eventually perform the movements without using the device, explains a media release from Ecole Polytechnique Fédérale.

Results from a study investigating Intento’s device were published recently in Archives of Physical Medicine and Rehabilitation.

In the study, researchers from Lausanne University Hospital (CHUV) compared the device to conventional occupational therapy among 11 patients who were severely paralyzed as the result of a stroke. These patients experienced the stroke more than 6 months prior to the study, and other therapies did not work for them.

Over a period of 10 days, the 11 patients underwent 1.5-hour sessions using the Intento device.

Their mobility results from using the device were then compared to the results following conventional occupational therapy conducted over the same amount of time. The patients’ mobility was measured before and after each type of treatment, according to the release.

The results suggest that 70% of the patients experienced significant improvement in their motor functions, versus only 30% of the patients with the conventional occupational therapy.

“Above and beyond the study’s findings, several of the patients told us a few weeks later that they were already using their arms more than before,” says Andrea Maesani, Intento’s CEO and other cofounder, in the release.

Patients were still making steady progress 6 months after the study was conducted, suggesting that the treatment produces long-term effects, according to the release.

The next step will be a clinical study on a larger group before marketing the device, the founders state in the release.

[Source(s): Ecole Polytechnique Fédérale, EurekAlert]

Source: Study Compares Intento Device and Traditional Occupational Therapy – Rehab Managment

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[Abstract] Upper limb motor training using a Saebo™ orthosis is feasible for increasing task-specific practice in hospital after stroke

Abstract

Background/aim

Assistive technologies have the potential to increase the amount of movement practice provided during inpatient stroke rehabilitation. The primary aim of this study was to investigate the feasibility of using the Saebo-Flex device in a subacute stroke setting to increase task-specific practice for people with little or no active hand movement. The secondary aim was to collect preliminary data comparing hand/upper limb function between a control group that received usual rehabilitation and an intervention group that used, in addition, the Saebo-Flex device.

Methods

Nine inpatients (mean three months (median six weeks) post-stroke) participated in this feasibility study conducted in an Australian rehabilitation setting, using a randomised pre-test and post-test design with concealed allocation and blinded outcome assessment. In addition to usual rehabilitation, the intervention group received eight weeks of daily motor training using the Saebo-Flex device. The control group received usual rehabilitation (task-specific motor training) only. Participants were assessed at baseline (pre-randomisation) and at the end of the eight-week study period. Feasibility was assessed with respect to ease of recruitment, application of the device, compliance with the treatment programme and safety. Secondary outcome measures included the Motor Assessment Scale (upper limb items), Box and Block Test, grip strength and the Stroke Impact Scale.

Results

Recruitment to the study was very slow because of the low number of patients with little or no active hand movement. Otherwise, the study was feasible in terms of being able to apply the Saebo-Flex device and compliance with the treatment programme. There were no adverse events, and a greater amount of upper limb rehabilitation was provided to the intervention group. While there were trends in favour of the intervention group, particularly for dexterity, no between-group differences were seen for any of the secondary outcomes.

Conclusions

This pilot feasibility study showed that the use of assistive technology, specifically the Saebo-Flex device, could be successfully used in a sample of stroke patients with little or no active hand movement. However, recruitment to the trial was very slow. The use of the Saebo-FlexTM device had variable results on outcomes, with some positive trends seen in hand function, particularly dexterity.

Source: Upper limb motor training using a Saebo™ orthosis is feasible for increasing task-specific practice in hospital after stroke – Lannin – 2016 – Australian Occupational Therapy Journal – Wiley Online Library

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[Abstract+References] A therapy-driven gamification framework for hand rehabilitation

Abstract

Rehabilitative therapy is usually very expensive and confined to specialized rehabilitation centers or hospitals, leading to slower recovery times for corresponding patients. Therefore, there is a high demand for the development of technology-based personalized solutions to guide and encourage patients towards performing online rehabilitation program that can help them live independently at home. This paper introduces an innovative e-health framework that develops adaptive serious games for people with hand disabilities. The aim of this work is to provide a patient-adaptive environment for the gamification of hand therapies in order to facilitate and encourage rehabilitation issues. Theoretical foundations (i.e., therapy and patient models) and algorithms to match therapy-based hand gestures to navigational movements in 3D space within the serious game environment have been developed. A novel game generation module is introduced, which translates those movements into a 3D therapy-driven route on a real-world map and with different levels of difficulty based on the patient profile and capabilities. In order to enrich the user navigation experience, a 3D spatio-temporal validation region is also generated, which tracks and adjusts the patient movements throughout the session. The gaming environment also creates and adds semantics to different types of attractive and repellent objects in space depending on the difficulty level of the game. Relevant benchmarks to assess the patient interaction with the environment along with a usability and performance testing of our framework are introduced to ensure quantitative as well as qualitative improvements. Trial tests in one disability center were conducted with a total number of five subjects, having hand motor controls problems, who used our gamified physiotherapy solution to help us in measuring the usability and users’ satisfaction levels. The obtained results and feedback from therapists and patients are very encouraging.

Source: A therapy-driven gamification framework for hand rehabilitation | SpringerLink

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[ARTICLE] The Use of Functional Electrical Stimulation on the Upper Limb and Interscapular Muscles of Patients with Stroke for the Improvement of Reaching Movements: A Feasibility Study

Introduction: Reaching movements in stroke patients are characterized by decreased amplitudes at the shoulder and elbow joints and greater displacements of the trunk, compared to healthy subjects. The importance of an appropriate and specific contraction of the interscapular and upper limb (UL) muscles is crucial to achieving proper reaching movements. Functional electrical stimulation (FES) is used to activate the paretic muscles using short-duration electrical pulses.

Objective: To evaluate whether the application of FES in the UL and interscapular muscles of stroke patients with motor impairments of the UL modifies patients’ reaching patterns, measured using instrumental movement analysis systems.

Design: A cross-sectional study was carried out.

Setting: The VICON Motion System® was used to conduct motion analysis.

Participants: Twenty-one patients with chronic stroke.

Intervention: The Compex® electric stimulator was used to provide muscle stimulation during two conditions: a placebo condition and a FES condition.

Main outcome measures: We analyzed the joint kinematics (trunk, shoulder, and elbow) from the starting position until the affected hand reached the glass.

Results: Participants receiving FES carried out the movement with less trunk flexion, while shoulder flexion elbow extension was increased, compared to placebo conditions.

Conclusion: The application of FES to the UL and interscapular muscles of stroke patients with motor impairment of the UL has improved reaching movements.

Introduction

Reaching movements in stroke patients are characterized by decreased amplitudes at the shoulder and elbow joints compared to healthy subjects (16). The movement pattern of patients with stroke is highly related to their level of motor function impairment, which becomes modified due to the lack of inter-articular coordination (1). There is a decrease in the range of motion at the elbow joint with a tendency toward flexion, which avoids correct extension of the upper limb (UL), hampering the ability to perform appropriate reaching movements. Excessive shoulder abduction is also observed as a compensatory movement when there is a lack of appropriate shoulder flexion (7).

In the case of the trunk, greater trunk displacements have been observed in patients with stroke, forward displacements, and torsion movements, which are related to deficits in elbow extension, and shoulder flexion and adduction, as compensatory mechanisms that occur during reaching movements or other activity. Patients are able to develop new motor strategies to achieve their goal despite UL deficits (17). There is a greater involvement of the trunk and scapula during the execution of reaching movements due to the creation of new movement strategies to compensate for the deficiencies (8).

The scientific literature has shown that stroke patients need to create new movement strategies. This involves the development of pathological synergies to carry out the desired movements. An example of this is the excessive movements of the trunk and scapula to compensate the deficiencies resulting from the pathology (7). Proper activation of the interscapular muscles depends on the position of the trunk. Stroke patients, due to the deficits affecting their trunk and scapular movement patterns, are under unfavorable conditions for being able to perform appropriate and selective activation of these muscles, which has a negative impact on the movement of the UL (911).

Regarding the UL muscles involved in reaching movements, a deficit in muscle control and activation has been observed (51213). The synergistic contraction of the shoulder flexor and extensor muscles during reach becomes deteriorated due to muscle weakness and; therefore, the resulting movement is deficient (14). Furthermore, spastic muscle patterns may also prevent the correct performance of UL movements (1518).

Functional electrical stimulation (FES) is a form of treatment that seeks to activate the paretic muscles using short-duration electrical pulses applied via surface electrodes through the skin (19). The use of FES and neuroprostheses has spanned almost four decades (2021). The use of FES as a neuroprosthesis consists of self-treatment at home by means of a neuroprosthetic neuromuscular stimulation system. The objective of this modality is to assist the performance of an activity of daily living (ADL) (22). Recently, functional and clinical improvements have been reported with the therapeutic application of FES, in which stimulation was used to increase voluntary movement after stroke (2223). Therapeutic FES modalities have been used to recruit UL muscles, improving weakness, the dyscoordination of single and multiple joints movements, and spasticity (24).

Most studies employing therapeutic FES for paretic UL rehabilitation are based on stimulation of the shoulder, elbow, and wrist muscles without recruitment of the interscapular muscles (2528). The importance of an appropriate and specific contraction of the interscapular musculature during UL movement is necessary to adapt the position of the scapulothoracic joint to the degree of movement of the glenohumeral joint. This musculature has a stabilizing function upon the entire glenohumeral complex, which is necessary for a correct reaching movement (2931). In healthy subjects, the posture of the trunk has been shown to influence changes in scapular movement and interscapular muscle activity during UL elevation (2932). The motor control of shoulder movement influences the correct and proper activation and synchronization of these muscles (33).

In this study, we tested the ability of a FES system to assist the UL movement of stroke patients based on the stimulation of interscapular, shoulder, elbow, wrist, and finger muscles. To our knowledge, no empirical study to date directly addresses this question. The authors hypothesized that participants receiving FES to the UL and interscapular muscles would be able to perform the movement with less trunk anteroposterior tilt and major shoulder flexion and elbow extension. The aim of this feasibility study was to evaluate whether the application of FES to the UL and interscapular muscles of stroke patients with UL motor impairment would be able to modify their reaching patterns, measured using instrumental movement analysis systems.[…]

Continue —> Frontiers | The Use of Functional Electrical Stimulation on the Upper Limb and Interscapular Muscles of Patients with Stroke for the Improvement of Reaching Movements: A Feasibility Study | Neurology

Figure 1. Patient with the functional electrical stimulation device.

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[Abstract] Hand strengthening exercises in chronic stroke patients: Dose-response evaluation using electromyography

Abstract

Study Design

Cross-sectional.

Purpose of the Study

This study evaluates finger flexion and extension strengthening exercises using elastic resistance in chronic stroke patients.

Methods

Eighteen stroke patients (mean age: 56.8 ± 7.6 years) with hemiparesis performed 3 consecutive repetitions of finger flexion and extension, using 3 different elastic resistance levels (easy, moderate, and hard). Surface electromyography was recorded from the flexor digitorum superficialis (FDS) and extensor digitorum (ED) muscles and normalized to the maximal electromyography of the non-paretic arm.

Results

Maximal grip strength was 39.2 (standard deviation: 12.5) and 7.8 kg (standard deviation: 9.4) in the nonparetic and paretic hand, respectively. For the paretic hand, muscle activity was higher during finger flexion exercise than during finger extension exercise for both ED (30% [95% confidence interval {CI}: 19-40] vs 15% [95% CI: 5-25] and FDS (37% [95% CI: 27-48] vs 24% [95% CI: 13-35]). For the musculature of both the FDS and ED, no dose-response association was observed for resistance and muscle activity during the flexion exercise (P > .05).

Conclusion

The finger flexion exercise showed higher muscle activity in both the flexor and extensor musculature of the forearm than the finger extension exercise. Furthermore, greater resistance did not result in higher muscle activity during the finger flexion exercise. The present results suggest that the finger flexion exercise should be the preferred strengthening exercise to achieve high levels of muscle activity in both flexor and extensor forearm muscles in chronic stroke patients. The finger extension exercise may be performed with emphasis on improving neuromuscular control.

Level of Evidence

4b.

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[Abstract] Hand strengthening exercises in chronic stroke patients: Dose-response evaluation using electromyography

Abstract

Study Design

Cross-sectional.

Purpose of the Study

This study evaluates finger flexion and extension strengthening exercises using elastic resistance in chronic stroke patients.

Methods

Eighteen stroke patients (mean age: 56.8 ± 7.6 years) with hemiparesis performed 3 consecutive repetitions of finger flexion and extension, using 3 different elastic resistance levels (easy, moderate, and hard). Surface electromyography was recorded from the flexor digitorum superficialis (FDS) and extensor digitorum (ED) muscles and normalized to the maximal electromyography of the non-paretic arm.

Results

Maximal grip strength was 39.2 (standard deviation: 12.5) and 7.8 kg (standard deviation: 9.4) in the nonparetic and paretic hand, respectively. For the paretic hand, muscle activity was higher during finger flexion exercise than during finger extension exercise for both ED (30% [95% confidence interval {CI}: 19-40] vs 15% [95% CI: 5-25] and FDS (37% [95% CI: 27-48] vs 24% [95% CI: 13-35]). For the musculature of both the FDS and ED, no dose-response association was observed for resistance and muscle activity during the flexion exercise (P > .05).

Conclusion

The finger flexion exercise showed higher muscle activity in both the flexor and extensor musculature of the forearm than the finger extension exercise. Furthermore, greater resistance did not result in higher muscle activity during the finger flexion exercise. The present results suggest that the finger flexion exercise should be the preferred strengthening exercise to achieve high levels of muscle activity in both flexor and extensor forearm muscles in chronic stroke patients. The finger extension exercise may be performed with emphasis on improving neuromuscular control.

Level of Evidence

4b.

Source: Hand strengthening exercises in chronic stroke patients: Dose-response evaluation using electromyography – Journal of Hand Therapy

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[WEB SITE] Stroke rehabilitation device lets the patient do the shocking

 

When a person’s arm has become paralyzed due to a stroke, therapists often try to get it moving again using what’s known as functional electrical stimulation – this involves delivering electric shocks to the arm, causing its muscles to move. Studies have shown, however, that it works better when the patient is in charge of delivering those shocks themselves. A new device lets them do so, and it has met with promising results.

The system was developed by Intento, a company affiliated with Switzerland’s EPFL research institute. It consists of three parts: electrodes that the patient places on their arm, a controller that is operated by their “good” hand, and a tablet running custom software.

The therapist starts by selecting a desired arm movement on the tablet, and then loading it into the controller. A display on the tablet’s screen then shows the patient where the electrodes should be placed. Once those are attached, the patient sets about using the controller to deliver shocks to their arm muscles, resulting in the targeted movement – this could be something like pressing a button or picking up an object.

Ideally, once the action has been repeated enough times, the muscles will be “trained” and it will be possible for the patient to perform the movement without any external stimulation.

In a clinical trial performed at Lausanne University Hospital, 11 severely stroke-paralyzed patients – for whom other therapies hadn’t worked – used for the device for 1.5-hour daily sessions, over a course of 10 days. A claimed 70 percent of them subsequently “showed a significant improvement in their motor functions,” as opposed to just 30 percent who were undergoing conventional occupational therapy.

A larger clinical study is now being planned, after which the device will hopefully be commercialized. The research is described in a paper that was recently published in the journal Archives of Physical Medicine and Rehabilitation.

Source: EPFL

Source: Stroke rehabilitation device lets the patient do the shocking

 

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[ARTICLE] Influence of physician empathy on the outcome of botulinum toxin treatment for upper limb spasticity in patients with chronic stroke: A cohort study – Full Text

Abstract

Objective: To examine the relationship between patient-rated physician empathy and outcome of botulinum toxin treatment for post-stroke upper limb spasticity.

Design: Cohort study.

Subjects: Twenty chronic stroke patients with upper limb spasticity.

Methods: All patients received incobotulinumtoxinA injection in at least one muscle for each of the following patterns: flexed elbow, flexed wrist and clenched fist. Each treatment was performed by 1 of 5 physiatrists with equivalent clinical experience. Patient-rated physician empathy was quantified with the Consultation and Relational Empathy Measure immediately after botulinum toxin treatment. Patients were evaluated before and at 4 weeks after botulinum toxin treatment by means of the following outcome measures: Modified Ashworth Scale; Wolf Motor Function Test; Disability Assessment Scale; Goal Attainment Scaling.

Results: Ordinal regression analysis showed a significant influence of patient-rated physician empathy (independent variable) on the outcome (dependent variables) of botulinum toxin treatment at 4 weeks after injection, as measured by Goal Attainment Scaling (p < 0.001).

Conclusion: These findings support the hypothesis that patient-rated physician empathy may influence the outcome of botulinum toxin treatment in chronic stroke patients with upper limb spasticity as measured by Goal Attainment Scaling.

Introduction

Stroke is a leading cause of adult disability (1, 2). Damage to the descending tracts and sensory-motor networks results in the positive and negative signs of the upper motor neurone syndrome (UMNS) (1–3). The upper limb is commonly involved after stroke, with up to 69% of patients having arm weakness on admission to hospital (4). Recovery of upper limb function has been found to correlate with the degree of initial paresis and its topical distribution according to the cortico-motoneuronal representation of arm movements (5–9).

Spasticity is a main feature of UMNS. It is defined as a state of increased muscle tone with exaggerated reflexes characterized by a velocity-dependent increase in resistance to passive movement (10). Upper limb spasticity has been found to be associated with reduced arm function, low levels of independence and high burden of direct care costs during the first year post-stroke (11). It affects nearly half of patients with initial impaired arm function, with a prevalence varying from 17% to 38% of all patients at one year post-stroke (11). Up to 13% of patients with stroke need some form of spasticity treatment (drug therapy, physical therapy or other rehabilitation approaches) within 6–12 months post-onset (11, 12). Botulinum toxin type A (BoNT-A) has been proven safe and effective for reducing upper limb spasticity and improving arm passive function in adult patients (13, 14). While current literature reports highly patient-specific potential gains in function after BoNT-A treatment, there is inadequate evidence to determine the efficacy of BoNT-A in improving active function associated with adult upper limb spasticity (13).

Empathy refers to the ability to understand and share the feelings, thoughts or attitudes of another person (15). It is an essential component of the physician-patient relationship and a key dimension of patient-centred care (15, 16). This is even more important in rehabilitation medicine, where persons with disabilities often report encountering attitudinal and environmental barriers when trying to obtain rehabilitative care and express the need for better communication with their healthcare providers (17).

To the best of our knowledge, no previous research has investigated the influence of physician empathy on patient outcome after spasticity treatment. The aim of this study was to examine the relationship between patient-rated physician empathy and clinical outcome of BoNT-A treatment for upper limb spasticity due to chronic stroke. […]

Continue —> Journal of Rehabilitation Medicine – Influence of physician empathy on the outcome of botulinum toxin treatment for upper limb spasticity in patients with chronic stroke: A cohort study – HTML

 

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