Video augmented mirror therapy for upper extremity rehabilitation after stroke: a randomized controlled trial

Closed-loop rehabilitation of upper-limb dyskinesia after stroke: from natural motion to neuronal microfluidics

This review proposes an innovative closed-loop rehabilitation strategy that integrates multiple subdomains of stroke science to address the global challenge of upper-limb dyskinesia post-stroke. Despite advancements in neural remodeling and rehabilitation research, the compartmentalization of subdomains has limited the effectiveness of current rehabilitation strategies. Our approach unites key areas-including the post-stroke brain, upper-limb rehabilitation robotics, motion sensing, metrics, neural microfluidics, and neuroelectronics-into a cohesive framework designed to enhance upper-limb motion rehabilitation outcomes. By leveraging cutting-edge technologies such as lightweight rehabilitation robotics, advanced motion sensing, and neural microfluidic models, this strategy enables real-time monitoring, adaptive interventions, and personalized rehabilitation plans. Furthermore, we explore the potential of closed-loop systems to drive neural plasticity and functional recovery, offering a transformative perspective on stroke rehabilitation. Finally, we discuss future directions, emphasizing the integration of emerging technologies and interdisciplinary collaboration to advance the field. This review highlights the promise of closed-loop strategies in achieving unprecedented integration of subdomains and improving post-stroke upper-limb rehabilitation outcomes.

Emerging Applications of Augmented and Mixed Reality Technologies in Motor Rehabilitation: A Scoping Review

BACKGROUND

Augmented Reality (AR) and Mixed Reality (MR) are emerging technologies with notable potential for motor rehabilitation. Given the novelty and breadth of this field, this scoping review aims to identify how and to what extent AR and MR technologies are used in motor rehabilitation.

METHODS

We conducted a search in Scopus and PubMed (2010-2024), following PRISMA-ScR guidelines. In the analysis, we focused on four key aspects: (I) the AR/MR display technologies, (II) the sensors used to collect data to generate the augmented information, (III) the pathologies addressed, and (IV) the assessment of usability and acceptability.

RESULTS

Among 105 selected studies, 58% developed new prototypes, while 42% tested existing systems. Head-mounted displays were the most common device (56.2%), followed by monitors (34.3%) and video projectors (14.3%). The most commonly used sensors were RGB-D cameras (31.4%), sensors for localization and mapping (33.3%), normal cameras (17.1%), and electromyography sensors (14.3%). Regarding the target pathology, 34.2% of studies did not focus on a specific pathology, 26.7% were on stroke, 10.5% on limb loss, and 9.5% on Parkinson's disease. Over half (51.4%) of the studies investigated usability and acceptance.

CONCLUSIONS

AR/MR technologies hold promise for motor rehabilitation, but limited comparative studies and long-term investigations currently hinder a clear understanding of their benefits.

Effects of mirror therapy on upper limb motor function of patients with stroke: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVES

This study aimed to investigate and review the effects of mirror therapy on upper limb function, including improvements in shoulder, elbow, forearm, wrist, and hand function, as well as coordination between the upper extremities, in patients with stroke.

DATA SOURCES

Six databases, CINAHL Plus with Full Text, Cochrane Central Register of Controlled Trials, Embase, Medline Complete, PubMed, and Web of Science, were searched from database inception to 15 October 2024, as well as manual searching of Google Scholar, for relevant trials.

REVIEW METHODS

The methodological quality of the trials was assessed using version 2 of the Cochrane risk-of-bias tool with five domains. A random-effects model was applied to calculate the pooled mean difference of dichotomous variables using the 95% confidence interval. The variance in effect estimation in a forest plot for each trial was then quantified using I2.

RESULTS

Eighteen studies, representing 633 patients with stroke, were included in this study. Mirror therapy significantly improved upper limb motor function (mean difference [MD] = 1.79; 95% CI = 0.04-3.54; p = 0.04) and hand function (MD = 1.48; 95% CI = 0.17-2.78; p = 0.03) in patients with stroke. Subgroup analyses of overall upper limb function showed that mirror therapy was effective in improving function when delivered more than 5 times a week (MD = 2.75; 95% CI = 1.02-4.48) over a period of ≤ 4 weeks (MD = 3.26; 95% CI = 1.19-5.33). The results of the methodology assessment using RoB-2 on all the trials included in the analysis showed that 16 trials were considered to have some concerns.

CONCLUSION

Mirror therapy appears to be beneficial for improving upper limb motor function after stroke. More trials are needed to determine the effects of mirror therapy on shoulder/elbow/forearm, wrist, and hand function and coordination between upper extremities after stroke.

Trends and Innovations in Wearable Technology for Motor Rehabilitation, Prediction, and Monitoring: A Comprehensive Review

(1) Background: Continuous health promotion systems are increasingly important, enabling decentralized patient care, providing comfort, and reducing congestion in healthcare facilities. These systems allow for treatment beyond clinical settings and support preventive monitoring. Wearable systems have become essential tools for health monitoring, but they focus mainly on physiological data, overlooking motor data evaluation. The World Health Organization reports that 1.71 billion people globally suffer from musculoskeletal conditions, marked by pain and limited mobility. (2) Methods: To gain a deeper understanding of wearables for the motor rehabilitation, monitoring, and prediction of the progression and/or degradation of symptoms directly associated with upper-limb pathologies, this study was conducted. Thus, all articles indexed in the Web of Science database containing the terms "wearable", "upper limb", and ("rehabilitation" or "monitor" or "predict") between 2019 and 2023 were flagged for analysis. (3) Results: Out of 391 papers identified, 148 were included and analyzed, exploring pathologies, technologies, and their interrelationships. Technologies were categorized by typology and primary purpose. (4) Conclusions: The study identified essential sensory units and actuators in wearable systems for upper-limb physiotherapy and analyzed them based on treatment methods and targeted pathologies.

Effects of wearable device training on upper limb motor function in patients with stroke: a systematic review and meta-analysis

OBJECTIVE

To evaluate the effect of wearable device training on improving upper limb motor function in patients who experienced strokes.

METHODS

The PubMed, Embase, Cochrane Library, Web of Science, MEDLINE, SCOPUS, China National Knowledge Infrastructure, WanFang, and VIP databases were searched for randomized controlled trials (RCTs) that assessed the effectiveness of wearable device training in improving upper limb motor function in patients with stroke. Two investigators independently screened studies by their titles and abstracts and cross-checked, downloaded, and evaluated the results. Disagreements were resolved by a third highly experienced researcher. Risk of bias was evaluated using the Cochrane risk-of-bias tool. This meta-analysis was registered in PROSPERO (registration No. CRD42023421633).

RESULTS

This study comprised 508 patients from 14 RCTs. The experimental group assessed various wearable devices, including 3D-printed dynamic orthoses, inertial measurement unit (IMU) sensors, electrical stimulation devices, and virtual reality (VR) devices for virtual interactive training. The control group received traditional rehabilitation therapies, including physical and conventional rehabilitation. The experimental group scored better on the Fugl-Meyer Assessment (FMA-UE) scale (standardized mean difference [SMD] 0.26, 95% confidence interval [CI] 0.07, 0.45) and Box and Block Test (BBT) (SMD 0.43, 95% CI 0.17, 0.69) versus controls. No significant intergroup differences were observed in the Action Research Arm Test (SMD 0.20, 95% CI -0.15, 0.55), motor activity log (mean difference [MD] 0.32, 95% CI -0.54, 0.33), and modified Ashworth scale (MD -0.08, 95% CI -0.81, 0.64). The probability rankings of wearable devices that improved FMA-UE scores in patients with stroke were: orthotic devices, with the highest probability ranking of 0.45, followed by sensor devices at 0.23, electrical stimulation devices at 0.21, and VR devices at 0.11.

CONCLUSIONS

Wearable device training was found to significantly improve upper limb motor function in patients with stroke, particularly for large-range movements. Improvements in FMA-UE and BBT scores reflected reduced impairment and enhanced manual dexterity, respectively. However, the training had no significant effect on hand movement frequency, fine motor skills, or spasticity. Among the different wearable devices tested, orthoses produced the most effective results.

Efficacy of a new video observational training method (intensive visual simulation) for motor recovery in the upper limb in subacute stroke: a feasibility and proof-of-concept study

OBJECTIVE

To demonstrate the feasibility and efficacy  of a new video-observation training method (intensive visual simulation) to improve upper limb function.

DESIGN

Small sample, randomized, evaluator-blind, monocentric study.

PATIENTS

Seventeen early subacute ischaemic stroke patients with complete hemiplegia were  randomly assigned to the therapeutic group (n = 8) or control group (CG, n = 9).

METHODS

Thirty sessions of intensive visual simulation combined with corrected visual feedback (therapeutic group) or uncorrected visual feedback (control group) were performed over 6 weeks on top of a standard rehabilitation programme.

MAIN OUTCOME MEASURE

400-point hand assessment test (400p-HA).

SECONDARY OUTCOME MEASURES

Box and Blocks (B&B), Purdue Pegboard test, Minnesota.

RESULTS

The 400p-HA test improved significantly from T0 to 6 months for both groups, with a significant difference between groups at 3 months (MW-UT p = 0.046) and 4 months (MW-UT p = 0.046) in favour of the therapeutic group. One-phase exponential modelling of 400p-HA showed a greater plateau for the therapeutic group (F test p = 0.0021). There was also faster recovery of the ability to perform the B&B tests for the therapeutic group (log-rank test p = 0.03).

CONCLUSION

This study demonstrated the feasibility and potential efficacy of an intensive visual simulation training programme to improve upper limb  function in subacute stroke patients. A larger study is needed to confirm these results.

360° immersive virtual reality-based mirror therapy for upper extremity function and satisfaction among stroke patients: a randomized controlled trial

BACKGROUND

Stroke is a leading cause of long-term disability worldwide; therefore, an effective rehabilitation strategy is fundamental. Mirror therapy (MT) has been a popular approach for upper extremity rehabilitation, but it presents some limitations. Recent advancements in virtual reality (VR) technology have introduced immersive VR-based MT, potentially overcoming these limitations and enhancing rehabilitation outcomes.

AIM

This study aimed to evaluate the effectiveness of a novel 360° immersive virtual reality-based MT (360MT) in upper extremity rehabilitation for stroke patients, comparing it to traditional MT (TMT) and conventional physical therapy control group (CG).

DESIGN

A prospective, active control, assessor blinded, parallel groups, randomized controlled trial.

POPULATION

Forty-five participants with chronic stroke within six months of onset.

METHODS

The participants were randomly allocated to 360MT, TMT, or CG groups. Outcome measures included Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Box and Block Test (BBT), and Manual Function Test (MFT). Additionally, patient experience and satisfaction in the groups of 360MT and TMT were assessed through questionnaires and interviews.

RESULTS

Results revealed that the 360MT group showed significantly greater improvements in FMA-UE, MFT and BBT compared to TMT (P<0.05) and CG (P<0.001) groups. Patient experience and satisfaction were more favorable in the 360MT group, with participants reporting higher engagement and motivation.

CONCLUSIONS

360MT appears to be a promising approach for upper extremity rehabilitation in stroke patients, providing better outcomes and higher patient satisfaction. However, further research is needed to confirm these findings and strengthen the evidence base for 360MT in stroke rehabilitation.

CLINICAL REHABILITATION IMPACT

360MT demonstrated notably enhanced upper extremity rehabilitation outcomes as well as better patient satisfaction among chronic stroke patients within six months of onset compared to traditional MT and conventional physical therapy. This novel approach not only fostered functional improvements but also elevated levels of engagement and motivation among participants, suggesting a promising future application in stroke rehabilitation framework.

Feasibility, safety, and efficacy of task-oriented mirrored robotic training on upper-limb functions and activities of daily living in subacute poststroke patients: a pilot study

BACKGROUND

Robotic training with high repetitions facilitates upper-limb movements but provides fewer benefits for activities of daily living. Integrating activities of daily living training tasks and mirror therapy into a robot may enhance the functional gains of robotic training.

AIM

The aim of this study was to investigate the feasibility, safety, and efficacy of the task-oriented mirrored upper-limb robotic training on the upper-limb functions and activities of daily living of subacute poststroke patients.

DESIGN

This study is a single-blinded, active-controlled pilot study.

SETTING

The study was carried out at rehabilitation outpatient clinic and ward.

POPULATION

A total of 32 subacute poststroke patients were enrolled in the study.

METHODS

The enrolled patients were allocated into two groups in a ratio of 1:1. The experimental group received 4 weeks of task-oriented mirrored upper-limb robotic training, consisting of five sessions of 30-minute duration, along with 30 minutes of conventional training. The control group only received 60 minutes of conventional training. The outcome measures were the Fugl-Meyer Assessment Scale for Upper Extremity, Modified Barthel Index, Stroke Self-Efficacy Scale, System Usability Scale, and Quebec User Evaluation with Assistive Technology.

RESULTS

All patients completed the full training sessions without significant adverse events related to robotic training. The task-oriented mirrored upper-limb robotic training led to increased Fugl-Meyer Assessment Scale for Upper Extremity (difference: 10.38 points, P<0.001) and Modified Barthel Index (difference: 18.38 points, P<0.001) scores, both of which exceeded the minimal clinically important difference. Intergroup analysis showed significantly higher improvements in the Fugl-Meyer Assessment Scale for Upper Extremity total scores, shoulder, wrist, and hand scores; and Modified Barthel Index scores in the experimental group than in conventional training (all P<0.05). Both groups showed significant improvements in Stroke Self-Efficacy Scale scores after the intervention (both P<0.001), but without a statistically significant intergroup difference (P>0.05). Participants in the experimental group scored an average usability perception score of 74.74 (good) and an average satisfaction score of four or more out of five.

CONCLUSIONS

In general, task-oriented mirrored upper-limb robotic training appears feasible and safe for subacute poststroke rehabilitation, facilitating the recovery of upper-limb functions and activities of daily living.

CLINICAL REHABILITATION IMPACT

Task-oriented mirrored upper-limb robotic training shows promise for future clinical rehabilitation and clinical trials involving subacute poststroke patients.

Agreement between Azure Kinect and Marker-Based Motion Analysis during Functional Movements: A Feasibility Study

(1) Background: The present study investigated the agreement between the Azure Kinect and marker-based motion analysis during functional movements. (2) Methods: Twelve healthy adults participated in this study and performed a total of six different tasks including front view squat, side view squat, forward reach, lateral reach, front view lunge, and side view lunge. Movement data were collected using an Azure Kinect and 12 infrared cameras while the participants performed the movements. The comparability between marker-based motion analysis and Azure Kinect was visualized using Bland-Altman plots and scatter plots. (3) Results: During the front view of squat motions, hip and knee joint angles showed moderate and high level of concurrent validity, respectively. The side view of squat motions showed moderate to good in the visible hip joint angles, whereas hidden hip joint angle showed poor concurrent validity. The knee joint angles showed variation between excellent and moderate concurrent validity depending on the visibility. The forward reach motions showed moderate concurrent validity for both shoulder angles, whereas the lateral reach motions showed excellent concurrent validity. During the front view of lunge motions, both the hip and knee joint angles showed moderate concurrent validity. The side view of lunge motions showed variations in concurrent validity, while the right hip joint angle showed good concurrent validity; the left hip joint showed poor concurrent validity. (4) Conclusions: The overall agreement between the Azure Kinect and marker-based motion analysis system was moderate to good when the body segments were visible to the Azure Kinect, yet the accuracy of tracking hidden body parts is still a concern.