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Du J, Wang S, Cheng Y, Xu J, Li X, Gan Y, Zhang L, Zhang S, Cui X. Effects of Neuromuscular Electrical Stimulation Combined with Repetitive Transcranial Magnetic Stimulation on Upper Limb Motor Function Rehabilitation in Stroke Patients with Hemiplegia. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9455428. [PMID: 35027944 PMCID: PMC8752218 DOI: 10.1155/2022/9455428] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/04/2021] [Accepted: 12/09/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the effect of neuromuscular electrical stimulation (NMES) combined with repetitive transcranial magnetic stimulation (rTMS) on upper limb motor dysfunction in stroke patients with hemiplegia. METHODS A total of 240 stroke patients with hemiplegia who met the inclusion criteria were selected and randomly divided into 4 groups (60 cases in each group): control group, NMES group, rTMS group, and NMES + rTMS group. Before treatment and 4 weeks after treatment, we evaluated and compared the results including Fugl-Meyer assessment of upper extremity (FMA-UE) motor function, modified Barthel index (MBI), modified Ashworth scale (MAS), and motor nerve electrophysiological results among the 4 groups. RESULTS Before treatment, there was no significant difference in the scores of FMA-UE, MBI, MAS, and motor nerve electrophysiological indexes among the four groups, with comparability. Compared with those before treatment, the scores of the four groups were significantly increased and improved after treatment. And the score of the NMES + rTMS group was notably higher than those in the other three groups. CONCLUSION NMES combined with rTMS can conspicuously improve the upper extremity motor function and activities of daily life of stroke patients with hemiplegia, which is worthy of clinical application and promotion.
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Affiliation(s)
- Junqiu Du
- Department of Rehabilitation Medicine, Huai'an Second People's Hospital (The Affiliated Huai'an Hospital of Xuzhou Medical University), Huai'an, Jiangsu 223002, China
| | - Shouyong Wang
- Department of Neurology, Huai'an NO.3 People's Hospital, Huai'an, Jiangsu 223002, China
| | - Yun Cheng
- Department of Rehabilitation Medicine, Huai'an NO.3 People's Hospital, Huai'an, Jiangsu 223002, China
| | - Jiang Xu
- Department of Rehabilitation Medicine, Huai'an Second People's Hospital (The Affiliated Huai'an Hospital of Xuzhou Medical University), Huai'an, Jiangsu 223002, China
| | - Xuejing Li
- Department of Rehabilitation Medicine, Huai'an Second People's Hospital (The Affiliated Huai'an Hospital of Xuzhou Medical University), Huai'an, Jiangsu 223002, China
| | - Yimin Gan
- Department of Rehabilitation Medicine, Huai'an Second People's Hospital (The Affiliated Huai'an Hospital of Xuzhou Medical University), Huai'an, Jiangsu 223002, China
| | - Liying Zhang
- Department of Rehabilitation Medicine, Lianshui County People's Hospital (Affiliated Hospital of Kangda College, Nanjing Medical University), Huai'an, Jiangsu 223400, China
| | - Song Zhang
- Department of Rehabilitation Medicine, Lianshui County People's Hospital (Affiliated Hospital of Kangda College, Nanjing Medical University), Huai'an, Jiangsu 223400, China
| | - Xiaorui Cui
- Department of Rehabilitation Medicine, Lianshui County People's Hospital (Affiliated Hospital of Kangda College, Nanjing Medical University), Huai'an, Jiangsu 223400, China
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Upper Limb Rehabilitation Robot Powered by PAMs Cooperates with FES Arrays to Realize Reach-to-Grasp Trainings. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:1282934. [PMID: 29065566 PMCID: PMC5494786 DOI: 10.1155/2017/1282934] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 03/01/2017] [Indexed: 11/21/2022]
Abstract
The reach-to-grasp activities play an important role in our daily lives. The developed RUPERT for stroke patients with high stiffness in arm flexor muscles is a low-cost lightweight portable exoskeleton rehabilitation robot whose joints are unidirectionally actuated by pneumatic artificial muscles (PAMs). In order to expand the useful range of RUPERT especially for patients with flaccid paralysis, functional electrical stimulation (FES) is taken to activate paralyzed arm muscles. As both the exoskeleton robot driven by PAMs and the neuromuscular skeletal system under FES possess the highly nonlinear and time-varying characteristics, iterative learning control (ILC) is studied and is taken to control this newly designed hybrid rehabilitation system for reaching trainings. Hand function rehabilitation refers to grasping. Because of tiny finger muscles, grasping and releasing are realized by FES array electrodes and matrix scan method. By using the surface electromyography (EMG) technique, the subject's active intent is identified. The upper limb rehabilitation robot powered by PAMs cooperates with FES arrays to realize active reach-to-grasp trainings, which was verified through experiments.
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Ibáñez J, Monge-Pereira E, Molina-Rueda F, Serrano JI, Del Castillo MD, Cuesta-Gómez A, Carratalá-Tejada M, Cano-de-la-Cuerda R, Alguacil-Diego IM, Miangolarra-Page JC, Pons JL. Low Latency Estimation of Motor Intentions to Assist Reaching Movements along Multiple Sessions in Chronic Stroke Patients: A Feasibility Study. Front Neurosci 2017; 11:126. [PMID: 28367109 PMCID: PMC5355476 DOI: 10.3389/fnins.2017.00126] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/28/2017] [Indexed: 11/19/2022] Open
Abstract
Background: The association between motor-related cortical activity and peripheral stimulation with temporal precision has been proposed as a possible intervention to facilitate cortico-muscular pathways and thereby improve motor rehabilitation after stroke. Previous studies with patients have provided evidence of the possibility to implement brain-machine interface platforms able to decode motor intentions and use this information to trigger afferent stimulation and movement assistance. This study tests the use a low-latency movement intention detector to drive functional electrical stimulation assisting upper-limb reaching movements of patients with stroke. Methods: An eight-sessions intervention on the paretic arm was tested on four chronic stroke patients along 1 month. Patients' intentions to initiate reaching movements were decoded from electroencephalographic signals and used to trigger functional electrical stimulation that in turn assisted patients to do the task. The analysis of the patients' ability to interact with the intervention platform, the assessment of changes in patients' clinical scales and of the system usability and the kinematic analysis of the reaching movements before and after the intervention period were carried to study the potential impact of the intervention. Results: On average 66.3 ± 15.7% of trials (resting intervals followed by self-initiated movements) were correctly classified with the decoder of motor intentions. The average detection latency (with respect to the movement onsets estimated with gyroscopes) was 112 ± 278 ms. The Fügl-Meyer index upper extremity increased 11.5 ± 5.5 points with the intervention. The stroke impact scale also increased. In line with changes in clinical scales, kinematics of reaching movements showed a trend toward lower compensatory mechanisms. Patients' assessment of the therapy reflected their acceptance of the proposed intervention protocol. Conclusions: According to results obtained here with a small sample of patients, Brain-Machine Interfaces providing low-latency support to upper-limb reaching movements in patients with stroke are a reliable and usable solution for motor rehabilitation interventions with potential functional benefits.
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Affiliation(s)
- Jaime Ibáñez
- Neural Rehabilitation Group, Spanish National Research Council, Cajal InstituteMadrid, Spain; Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College LondonLondon, UK
| | - Esther Monge-Pereira
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University Madrid, Spain
| | - Francisco Molina-Rueda
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University Madrid, Spain
| | - J I Serrano
- Neural and Cognitive Engineering Group, Centro de Automática y Robótica, Universidad Politécnica de Madrid (UPM), Spanish National Research Council Madrid, Spain
| | - Maria D Del Castillo
- Neural and Cognitive Engineering Group, Centro de Automática y Robótica, Universidad Politécnica de Madrid (UPM), Spanish National Research Council Madrid, Spain
| | - Alicia Cuesta-Gómez
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University Madrid, Spain
| | - María Carratalá-Tejada
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University Madrid, Spain
| | - Roberto Cano-de-la-Cuerda
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University Madrid, Spain
| | - Isabel M Alguacil-Diego
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University Madrid, Spain
| | - Juan C Miangolarra-Page
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University Madrid, Spain
| | - Jose L Pons
- Neural Rehabilitation Group, Spanish National Research Council, Cajal Institute Madrid, Spain
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Young BM, Williams J, Prabhakaran V. BCI-FES: could a new rehabilitation device hold fresh promise for stroke patients? Expert Rev Med Devices 2014; 11:537-9. [PMID: 25060658 PMCID: PMC4194138 DOI: 10.1586/17434440.2014.941811] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
It has been known that stroke constitutes a major source of acquired disability, with nearly 800,000 new strokes each year in the USA alone. While advances in public and preventative health have helped reduce stroke incidence in high-income countries in recent decades, growth of the aging population, increasing stroke rates in low- to middle-income countries and medical advances that have reduced stroke mortality are all contributing to an increase in stroke survivors worldwide. Large numbers of stroke survivors have residual motor deficits. This editorial will provide an introduction to a class of new therapies being investigated with the aim of improving motor outcomes in stroke patients that uses what is known as brain-computer interface technology.
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Affiliation(s)
- Brittany M Young
- University of Wisconsin-Madison - Radiology, 600 Highland Avenue, Madison, Wisconsin 53792, USA
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