Posts Tagged Upper Extremity
[Abstract+References] Robot assisted rehabilitation of the arm after stroke: prototype design and clinical evaluation
Robot assisted rehabilitation training is a promising tool for post-stroke patients’ recovery, and some new challenges are imposed on robot design, control, and clinical evaluation. This paper presents a novel upper limb rehabilitation robot that can provide safe and compliant force feedbacks to the patient for the benefits of its stiff and low-inertia parallel structure, highly backdrivable capstan-cable transmission, and impedance control method in the workspace. The “assist-as-needed” (AAN) clinical training principle is implemented through the “virtual tunnel” force field design, the “assistance threshold” strategy, as well as the virtual environment training games, and preliminary clinical results show its effectiveness for motor relearning for both acute and chronic stroke patients, especially for coordinated movements of shoulder and elbow.
[Abstract+References] A Low-Cost and Lightweight Alternative to Rehabilitation Robots: Omnidirectional Interactive Mobile Robot for Arm Rehabilitation
Robotic rehabilitation is a growing field. Robots facilitate repetitive therapies, which have positive effects on the rehabilitation of patients who lack arm control because of central nervous system lesions. However, the use of such rehabilitation robots is rare due to high costs and low acceptance among patients. Therefore, this study is focused on the development and control of a novel low-cost omnidirectional interactive mobile robotic platform with force feedback to assist and guide a patient’s hand during therapy. The primary goals for such a mobile robot are to minimize its weight and dimensions, which are significant factors in patient acceptance. Position-based stiffness control was employed with a proportional derivative controller to control the position of the robot and to assist the patient during motion. A user interface with given tasks was built to manage tasks, obtain test results and set control variables. Test results showed that the developed experimental mobile robot successfully assisted and guided the user during the test period.
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[Abstract] An attempt to explain the Vojta therapy mechanism of action using the surface polyelectromyography in healthy subjects: A pilot study
Rehabilitation according to Vojta is a neurophysiological method used to obtain reflex responses in muscles following stimulation of particular activation zones.
This study aims to objectively evaluate the muscular responses following stimulation according to Vojta’s method. The possible routes of spinal transmission responsible for the phenomenon of muscle activation in upper and lower extremities are considered.
Polyelectromyographic (pEMG) recordings in the upper and lower extremities in healthy volunteers (N = 25; aged 24 ± 1 year) were performed to find out the possible routes of spinal transmission, responsible for muscle activation. The left acromion and right femoral epicondyle were stimulated by a Vojta therapist; pEMG recordings were made including the bilateral deltoid and rectus femoris muscles.
Results and Discussion
Following acromion stimulation, muscle activation was mostly expressed in the contralateral rectus femoris, rather than the contralateral deltoid and the ipsilateral rectus femoris muscles. After stimulation of the lower femoral epicondyle, the following order was observed: contra lateral deltoid, ipsilateral deltoid and the contra lateral rectus femoris muscle.
One of the candidates responsible for the main crossed neural transmission involved in the Vojta therapy mechanism would be the long propriospinal tract neurons.
An estimated 80% of individuals with stroke experience upper limb dysfunction and 60% of stroke survivors will not regain full use of the affected arm. Improvement in motor function is possible even in the chronic phase of stroke through motor rehabilitation. Rehabilitation is a lengthy process and has little chance of success if a patient is not dedicated to his or her regime. Highly motivated patients are more likely to adhere to a rehabilitation program and motivation has been linked to better therapeutic outcomes in many studies.
This study evaluated how motivating participants of experimental stroke rehabilitation interventions found their upper extremity (UE) rehabilitation regime and compared those scores to the data gathered in the Human Performance Laboratory (HPL).
A literature review was conducted. Interventions were sorted into the categories gaming, gaming with assistance, robotic training, mixed reality, and conventional therapy. Six studies from the HPL were used. Mean interest/enjoyment (I/E) subscale scores of the Intrinsic Motivation Inventory (IMI) were gathered for each category and the level of intrinsic motivation was determined.
All categories produced a highly positive I/E scores. All of the categories except conventional therapy produced a higher mean score for reported I/E than the HPL.
Personality traits of the participants can likely account for these higher-than-average levels of intrinsic motivation. Though the HPL did not outperform the other categories, it is comparable to other gaming interventions and has the unique advantages of affordability and accessibility these lack. Future work in personalized virtual reality (PVR) therapy that seeks to make interventions more intrinsically motivating may consider the potential benefits that lie within these other approaches to UE rehabilitation including using specialized games for persons with stroke and providing external support to the players.
[Abstract] A Longitudinal EMG Study of Complex Upper-limb Movements in Post-stroke Therapy. 1: Heterogeneous EMG Changes despite Consistent Improvements in Clinical Assessments
Post-stroke weakness on the more-affected side may arise from reduced corticospinal drive, disuse muscle atrophy, spasticity, and abnormal co-ordination. This study investigated changes in muscle activation patterns to understand therapy-induced improvements in motor-function in chronic stroke compared to clinical assessments, and to identify the effect of motor-function level on muscle activation changes.
Electromyography (EMG) was recorded from 5 upper-limb muscles on the more-affected side of 24 patients during early- and late-therapy sessions of an intensive 14-day program of Wii-based Movement Therapy, and for a subset of 13 patients at 6-month follow-up. Patients were classified according to residual voluntary motor capacity with low, moderate or high motor-function. The area under the curve was calculated from EMG amplitude and movement duration. Clinical assessments of upper-limb motor-function pre- and post-therapy included the Wolf Motor Function Test, Fugl-Meyer Assessment and Motor Activity Log Quality of Movement scale.
Clinical assessments improved over time (p<0.01) with an effect of motor-function level (p<0.001). The pattern of EMG change by late-therapy was complex and variable, with differences between patients with low compared to moderate or high motor-function. The area under the curve (p=0.028) and peak amplitude (p=0.043) during Wii-tennis backhand increased for patients with low motor-function whereas EMG decreased for patients with moderate and high motor-function. The reductions included: movement duration during Wii-golf (p=0.048, moderate; p=0.026, high), and Wii-tennis backhand (p=0.046, moderate; p=0.023, high) and forehand (p=0.009, high); and the area under the curve during Wii-golf (p=0.018, moderate) and Wii-baseball (p=0.036, moderate). For the pooled data over time there was an effect of motor-function (p=0.016) and an interaction between time and motor-function (p=0.009) for Wii-golf movement duration. Wii-baseball movement duration decreased as a function of time (p=0.022). There was an effect on Wii-tennis forehand duration for time (p=0.002) and interaction of time and motor-function (p=0.005); and an effect of motor-function level on the area under the curve (p=0.034) for Wii-golf.
This study demonstrated different patterns of EMG changes according to residual voluntary motor-function levels despite heterogeneity within each level that was not evident following clinical assessments alone. Thus, rehabilitation efficacy might be underestimated by analyses of pooled data.
What is Gravity Compensation?
Weight supported systems assist patients with making more meaningful movements during the rehabilitation process. It counteracts the effects of gravity making it possible for clients to functionally integrate their affected arm during various tasks. Additionally, by “unweighting” the limb, compensation and fatigue are minimized thereby intensifying treatment and driving neural changes.
Why Mobile Arm Supports?
Mobile Arm Supports are gravity supported mechanical devices typically mounted on wheelchairs, tables or base frames. They are used to support the weak upper limb to improve function and movement. These devices allow patients with proximal weakness to perform self-care tasks such as feeding, hygiene, grooming, and writing.
Compensatory and Remedial.
In addition to using mobile arm supports to perform activities of daily living, recent scientific studies have shown that supporting the hemiparetic limb leads to improved motor recovery.
Relearn normal movement
Reduce abnormal synergy patterns
Ring Out the Old.
Traditionally, arm training has primarily been performed by the clinician, or caregiver, using manual techniques such as hand-over-hand assistance. More recently, arm training, using zero-gravity devices, have become increasingly popular as a new way to intensify rehabilitation. Regardless of the diagnosis, scientific evidence suggests that intensive therapy is required to make meaningful progress. With Saebo’s unweighting technology, clients can now maximize their recovery in the clinic and at home.
[Abstract] Gross Motor AbiLity predictS Response to upper extremity rehabilitation in chronic stroke
The majority of rehabilitation research focuses on the comparative effectiveness of different interventions in groups of patients, while much less is currently known regarding individual factors that predict response to rehabilitation. In a recent article, authors presented a prognostic model to identify the sensorimotor characteristics predictive of the extent of motor recovery after Constraint-Induced Movement (CI) therapy amongst individuals with chronic mild-to-moderate motor deficit using the enhanced probabilistic neural network (EPNN). This follow-up paper examines which participant characteristics are robust predictors of rehabilitation response irrespective of the training modality. To accomplish this, EPNN was first applied to predict treatment response amongst individuals who received a virtual-reality gaming intervention (utilizing the same enrollment criteria as the prior study). The combinations of predictors that yield high predictive validity for both therapies, using their respective datasets, were then identified. High predictive classification accuracy was achieved for both the gaming (94.7%) and combined datasets (94.5%). Though CI therapy employed primarily fine-motor training tasks and the gaming intervention emphasized gross-motor practice, larger improvements in gross motor function were observed within both datasets. Poorer gross motor ability at pre-treatment predicted better rehabilitation response in both the gaming and combined datasets. The conclusion of this research is that for individuals with chronic mild-to-moderate upper extremity hemiparesis, residual deficits in gross motor function are highly responsive to motor restorative interventions, irrespective of the modality of training.
The PABLO is the latest in a long row of clinically tried and tested robotic- and computer-assisted therapy devices for arms and hands. The new design and the specially developed tyroS software make the PABLO more flexible and offer an expanded spectrum of therapy options.
SaeboVR, a virtual ADL (activities of daily living) rehabilitation system designed to provide real-life challenges to help neurological patients rehabilitate their upper extremities, has recently received clearance from the US Food and Drug Administration.
Manufactured by medical device company Saebo Inc, SaeboVR features an ADL-focused virtual world that provides patients with real-life situations challenging patients to use their impaired upper limbs to perform, such as picking up, transferring, and manipulating virtual objects. Recreations include making breakfast, taking care of a pet, or planting a virtual garden.
Additional features include a virtual assistant to educate users and provide feedback, as well as the ability to be customized to challenge patients’ endurance, speed, range of motion, coordination, timing, and cognitive demand.
After each session, SaeboVR displays graphical reports, according to a media release from Saebo.
The system was borne from National Institutes of Health-sponsored research demonstrating the efficacy of using virtual ADL to help rehabilitate the upper extremities.
“The release of SaeboVR culminates 5 years of NIH-sponsored R&D and successful clinical trials that have provided a solid body of evidence for the efficacy of simulated ADLs in improving upper extremity motor function in individuals with acquired brain injury,” says Richard Adams, PhD, from Barron Associates Inc, which has partnered with Saebo Inc to create the system.
SaeboVR opens new possibilities for clinicians and patients,” notes Saebo Inc’s co-founder, Henry Hoffman, per the release. “Prior to this break-through technology, motion capture programs were primarily focused on games rather than real-life functional tasks. Although computer-based exercises can be beneficial, often times, therapists report that games are not always appropriate for a certain patient population or lack significance to maintain a client’s motivation and engagement.”
[Source(s): Saebo Inc, PR Newswire]
[Abstract] Efficacy and safety of botulinum toxin type A for upper limb spasticity after stroke or traumatic brain injury: a systematic review with meta-analysis.
Muscle spasticity is a positive symptom after stroke and traumatic brain injury. Botulinum toxin type A (BoNT-A) injection is widely used for treating post stroke and traumatic brain injury spasticity. This study aimed to evaluate efficacy and safety of BoNT-A for upper limb spasticity after stroke and traumatic brain injury and investigate reliability and conclusiveness of available evidence for BoNT-A intervention.
We searched electronic databases from inception to September 10 of 2016. Randomized controlled trials comparing the effectiveness between BoNT-A and placebo in stroke or traumatic brain injury adults with upper limb spasticity were included. Reliability and conclusiveness of the available evidence were examined with trial sequential analysis.
From 489 citations identified, 22 studies were included, reporting results for 1804 participants. A statistically significant decrease of muscle tone was observed at each time point after BoNT-A injection compared to placebo (SMD at week 4=-0.98, 95% CI: -1.28 to -0.68; I2=66%, P=0.004; SMD at week 6=-0.85, 95% CI: -1.11 to -0.59, I2=1.2%, P=0.409; SMD at week 8=-0.87, 95% CI: -1.15 to -0.6, I2=0%, P=0.713; SMD at week 12=-0.67, 95% CI: -0.88 to -0.46, I2=0%, P=0.896; and SMD over week 12=-0.73, 95% CI: -1.21 to -0.24, I2=63.5%, P=0.065).Trial sequential analysis showed that as of year 2004 sufficient evidence had been accrued to show significant benefit of BoNT-A four weeks after injection over placebo control. BoNT-A treatment also significantly reduced Disability Assessment Scale Score than placebo at 4, 6 and 12-week follow-up period (WMD=-0.33, 95% CI: -0.63 to -0.03, I2=60%, P=0.114; WMD=-0.54, 95% CI: -0.74 to -0.33, I2= 0%, P=0.596 and WMD=-0.3, 95% CI: -0.45 to -0.14, I2=0%, P=0.426 respectively), and significantly increased patients’ global assessment score at week 4 and 6 after injection (SMD=0.56, 95% CI: 0.28 to 0.83; I2=0%, P=0.681 and SMD=1.11, 95% CI: 0.4 to 1.77; I2=72.8%, P=0.025 respectively). No statistical difference was observed in the frequency of adverse events between BoNT-A and placebo group (RR=1.36, 95% CI [0.82, 2.27]; I2=0%, P=0.619).
As compared with placebo, BoNT-A injections have beneficial effects with improved muscle tone and well-tolerated treatment for patients with upper limb spasticity post stroke or traumatic brain injury.