Assessment of upper extremity impairment, function, and activity after stroke: foundations for clinical decision making

The effects of tactile stimulation and transcutaneous electrical nerve stimulation on upper limb function and daily activities in patients with stroke: a randomized controlled trial

The purpose of this study was to evaluate the separate effects of tactile stimulation (TS) and transcutaneous electrical nerve stimulation (TENS), combined with occupational therapy (OT) and physiotherapy (PT), on sensory-motor recovery in the upper limb of patients with stroke. Thirty-six patients were randomly assigned to three groups (mean age: TS group = 60.7, TENS group = 54.1, control group = 52.2 years). The average onset time was 9.7 months for the TS group, 11.1 months for the TENS group, and 10.2 months for the control group. Participants underwent a 2-week intervention provided in addition to standard OT and PT. The TS group received coarse sand stimulation (rubbing) over the affected hand and forearm for 15 min per session. The TENS group underwent electrical stimulation applied to the affected forearm for 30 min per session (10 Hz), while the control group received sham stimulation with 1 min of active current. Hand function was assessed with the Semmes-Weinstein monofilaments and grip strength, dexterity with the box and block test and Southampton hand assessment procedure, and performance in daily activities with the assessment of motor and process skills. In the TS group, patients significantly improved hand sensory perception, grip strength, and dexterity while the TENS group showed improvement in grip strength and dexterity. The control group exhibited no significant changes. Between-group comparisons revealed significant differences favoring TS for hand sensory perception and TENS for dexterity. These findings suggest that adding TS or TENS to OT and PT may enhance sensory-motor recovery after a stroke.

Upper extremity function assessment test using virtual environment technique in stroke survivors

PURPOSE

The objective assessment of the upper limbs of stroke survivors is challenging. Serious game-based assessments may allow for an objective assessment of this population. The present work aims to investigate the validity of the metrics provided by the Upper Extremity Smart Exercises-Innovative Treatment (USE-IT) assessment method for upper limb rehabilitation.

MATERIALS AND METHODS

Thirty-three stroke survivors were included in this study. We assessed the stroke survivors using The Fugl-Meyer Upper Extremity Scale (FM-UE), The Wolf Motor Function Test (WMFT), The Action Research Arm Test (ARAT), ABILHAND, ACTIVLIM, and the USE-IT. Validity was assessed by examining the correlation of the USE-IT metrics with the clinical scales.

RESULTS

All clinical scales and the Global Reaching Map total score, one of the two outputs of the USE-IT assessment method, were found to be moderately correlated (|r| = 0.52-0.69) (p < .05). The other outputs of the USE-IT assessment method, the Local Reaching Map total score, showed a correlation with the Fugl-Meyer Assessment Upper Arm (FM-UA), The Action Research Arm Test (ARAT) Grip, and the Wolf Motor Function Test (WMFT) parameters (|r| = 0.34-0.38) (p < .05).

CONCLUSIONS

This study showed that the USE-IT assessment is well correlated with commonly used clinical scales for the upper limb motor function in stroke survivors. Therefore, the USE-IT is a valid game-based system for assessing upper limb impairment in stroke survivors.

Estimation of Stroke's Motor Function Ability Using Multimodal Biomarkers and the Role of Contralesional Motor Area

PURPOSE

In the chronic phase, many stroke survivors did not regain their pre-stroke upper limb movement capabilities. This emphasizes the crucial role of assessing motor function in patients with stroke, as it provides valuable insights into setting effective rehabilitation goals. Accordingly, this study aimed to investigate the electroencephalography (EEG)-based functional brain network properties in stroke patients during motor tasks and assess their utility in predicting the upper limb Fugl-Meyer Assessment (UL-FMA) scores.

METHODS

We performed a comparative analysis of brain properties, including EEG power and network characteristics, in stroke patients and a healthy control (HC) group. Also, we selected prognostic factors of brain properties during voluntary movement for patients' motor function ability using stepwise regression analysis.

FINDINGS

Stroke patients manifested reduced global efficiency relative to the HC group, signifying impaired information processing attributed to brain injury. Local analyses highlighted pronounced disparities in the contralesional motor area (MA) between stroke patients and the HC group, revealing patterns indicative of compensatory mechanisms. Leveraging a multimodal approach incorporating EEG power and network features within the contralesional MA yielded a robust model for motor function estimation, outperforming unimodal models (adjusted R2 0.99, RMSE 0.13). The findings of this study outperformed other models for estimating the motor abilities of chronic stroke patients. Another chronic stroke dataset was used to externally validate this study, and it had an adjusted R2 of 0.95. This suggests that the results of this study can be generalized.

CONCLUSION

Our findings provide insight into the brain properties of stroke-related motor impairment. These results underscore the pivotal role of the contralesional MA in assessing UL-FMA scores and represent how a multimodal approach to this area can suggest the possibility of using it as a meaningful biomarker for motor function. They also have potential implications for the development of individualized rehabilitation strategies, particularly during the chronic phase of recovery.

Beyond unilateral motor impairments: Role of bilateral force control and strength asymmetry in gait coordination and falls post-stroke

Coordination between lower extremities is a fundamental aspect of walking, yet it has received limited attention in locomotor recovery post-stroke. We aimed to compare the impact of unilateral versus bilateral force impairments on gait coordination and examine the relationship between gait coordination and incidence of falls post-stroke. In adults with stroke (N = 22) and age-similar healthy controls (N = 22), we measured gait coordination with phase coordination index (PCI) during overground walking. We measured force control for ankle dorsiflexors in unilateral and bilateral conditions. Unilateral force impairments were quantified with force error during visuomotor tracking and maximum voluntary contraction force for each leg. Bilateral force impairments were measured with cross-correlation coefficient, time lag, and strength symmetry. We recorded the history of falls in the previous year for adults with stroke. Compared with controls, adults with stroke showed significantly increased PCI, decreased cross-correlation coefficient and increased time lag between bilateral forces. Force error of both paretic and non-paretic legs was increased in the stroke group. Strength symmetry and cross-correlation coefficient explained 59.5 % of the variance in PCI (p < 0.001). However, unilateral force impairments were not associated with PCI. Adults with stroke reported a previous fall incidence rate of 59.09 %. Stroke survivors with a history of fall showed significantly higher PCI relative to stroke survivors without a history of fall (p < 0.01). We found a significant relationship between falls and PCI (p < 0.05) such that poor gait coordination was related to past incidence of falls in stroke survivors. The current study provides novel insights that impairments in bilateral, but not unilateral force control influences coordination during overground walking post-stroke. Specifically, impaired timing between bilateral ankle forces and strength asymmetry negatively impacts gait coordination post-stroke. Impaired gait coordination elevates the risk for falling post-stroke, thereby compromising safe mobility in individuals with stroke.

Salivary chemokines and growth factors in patients with ischemic stroke

Stroke is a serious health problem that affects an increasing number of people. As a result of the blockage of blood flow, tissue necrosis occurs in areas of the brain supplied by the damaged vessel, and leads to the development of inflammation. Changes that occur in the brain allow molecules to enter the blood, and it has been suggested that some can also penetrate the saliva. This study is the first to assess the profile of 25 chemokines and growth factors in the saliva of stroke survivors compared to a control group. 22 stroke survivors and 22 individuals matched by age and gender were enrolled in the study. Salivary chemokines and growth factors were assessed using the multiplex ELISA method. In the unstimulated saliva of stroke patients, we demonstrated significantly higher levels of chemotactic factors (CTACK/CCL27, IL-8/CXCL8, MIG/CXCL9, MIF) and growth factors (basic FGF, G-CSF, HGF, LIF, VEGF) compared to controls. The levels of MCP-3/CCL7, eotaxin/CCL11, IP-10/CXCL10, IL-3/MCGF, and PDGF-BB were lower in the saliva of the study group. The concentration of basic FGF negatively correlated with cognitive function as measured by the Addenbrooke's Cognitive Examination (ACE) scale (p = 0.007 r = - 0.56), while salivary IL-3 and LIF levels positively correlated with scores on the Functional Independence Measure (FIM) scale (p = 0.019 r = 0.53; p  = 0.033 r = 0.47, respectively). Receiver Operating Characteristic (ROC) analysis showed that salivary basic FGF, HGF, IL-3 and LIF can distinguish ischemic stroke patients from the control group with high sensitivity and specificity. In conclusion, disruptions in chemokine and growth factor levels in saliva may suggest an inflammatory etiology of ischemic stroke. Salivary basic FGF, HGF, IL-3 and LIF could serve as potential biomarkers for stroke. Further research is needed to illuminate the differences in salivary inflammatory mediator profiles in stroke and to evaluate the diagnostic utility of chemokines and growth factors in clinical practice.

Exploring factors influencing the consistent adoption of a post-stroke upper extremity outcome measure using Normalisation Process Theory

BACKGROUND

Stroke rehabilitation guidelines recommend using outcome measures like the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) to assess post-stroke upper extremity function. However, integrating such outcome measures into routine clinical practice remains challenging, highlighting the need to understand factors affecting their implementation in evolving healthcare models.

OBJECTIVE

Our study aimed to identify the barriers and facilitators to sustain the routine use of the FMA-UE among hospital-based occupational therapists (OTs) using a theory-driven approach.

METHODS

Employing a mixed-method sequential exploratory study design rooted in Normalisation Process Theory (NPT), we gathered quantitative data through a validated survey followed by qualitative insights analysed with directed content analysis from focus group discussions involving occupational therapists from four hospitals.

RESULTS

Survey findings (n = 34) revealed barriers primarily associated with NPT constructs of collective action and coherence. Facilitators were linked to the cognitive participation construct. Key barriers identified in focus groups included insufficient coaching, competing priorities, and perceived limited value of the FMA-UE. Facilitators included legitimation of therapists' role in outcome measurements and an open learning culture.

CONCLUSIONS

Through a theory-based approach, we identified barriers and facilitators to sustain the routine of the FMA-UE. Our findings offer insights for designing implementation strategies to embed the FMA-UE into routine practice, supporting its sustained use in stroke rehabilitation.

Bottom-up versus Top-down designed rehabilitation sessions in chronic stroke survivors: a pilot randomized controlled trial

PURPOSE

The present study aimed to compare the effectiveness of Top-down and Bottom-up approaches on levels of the International Classification of Functioning, Disability and Health Framework (ICF), including impairments, activities, and participation.

MATERIALS AND METHODS

Thirty-nine chronic stroke survivors were recruited for this single-blinded randomized clinical trial. Participants were assigned to Top-down, Bottom-up interventions, or control group, and received a 6-week intervention. They were assessed before/after treatments and at follow-up (6 weeks later). Impairments were measured through kinematic analysis, Trail Making Tests (TMT), and Fugl-Meyer Assessment (FMA). Activity and participation were evaluated via Box and Block Test, Motor Activity Log (MAL), and Canadian Occupational Performance Measure (COPM), respectively.

RESULTS

We found significant improvements in impairment (FMA) and participation (COPM) in all groups, however, COPM scores improved beyond the MCID only in the Top-down, and FMA scores exceeded the MCID in Top-down and Bottom-up groups. Use of the upper limb in daily activities (MAL) enhanced in the Top-down group, although was not clinically significant.

CONCLUSION

In most of the outcome measures, no significant difference was observed between groups. It seems that Top-down, Bottom-up, and traditional interventions have relatively comparable effectiveness in chronic stroke survivors.

TRIAL REGISTRATION

IRCT20150721023277N2.

Mitigate the Effect of Arm Posture on Electromyography Pattern Recognition

The real-time use of electromyography (EMG)-based mechatronic rehabilitation devices aiming to detect stroke patients' hand grasping intention is hindered by a significant concern: the lack of robustness against variations in EMG signal patterns due to arm posture changes. This problem results in degraded EMG signal measurements and inaccurate recognition of muscle patterns. Several studies have aimed at tracking changes in EMG patterns by placing multiple EMG sensors around the forearm and developing a classifier using data collected from various arm postures recorded by all sensors. Although these methods show promise, the significant computational resources required for real-time data processing become notable concerns when using multiple EMG sensors. To address these challenges, this study introduces a novel approach that aims to reduce the number of EMG channels that need to be processed. The study proposes a new optimal-channel-selection technique, coupled with a convolutional neural network (CNN), which selects two out of eight EMG channels within an armband based on the arm posture and individual demographics. As a result of using only two channels rather than the entire array (eight channels), the user's grasping intention prediction time took only 2.3 seconds with a classification accuracy of around 81%. In comparison, the commonly used eight-channel method took 8.6 seconds for grasping intention detection with an accuracy level of 79%. These findings show potential in tackling the challenge of EMG measurement degradation caused by arm motion, offering a path towards enhanced accuracy and quicker responsiveness in EMG-based mechatronic rehabilitation devices.

Impact of Unilateral Breast Cancer Surgery on Upper Limb Functionality: Strength, Manual Dexterity, and Disability Prediction

Objectives: The aim of this study was to analyze differences in affected upper limb functionality (grip strength, digital pinch, sensitivity, and manual dexterity) in women with breast cancer and to determine whether these factors can predict perceived disability. This study highlights the motor and sensory deficits resulting from breast cancer treatments and underscores the need for a comprehensive approach to addressing them. Methods: A descriptive cross-sectional study was conducted with 42 women diagnosed with breast cancer who underwent surgery and received chemotherapy, radiotherapy, or hormonal therapy. Strength, sensitivity, and manual dexterity were assessed, along with pain and disability questionnaires. Results: Significant differences were found in affected upper limb functionality according to age, employment status, and time since surgery. Grip strength, pinch strength, manual dexterity, and sensitivity were identified as predictors of perceived disability, explaining 92.15% of the variance in SPADI scores. Conclusions: Women with breast cancer experience functional deficits in the upper limb, particularly in strength, sensitivity, and manual dexterity. Age, employment status, and time since surgery influence the perceived disability. These findings emphasize the need for comprehensive upper limb evaluations to identify functional deficits and guide personalized rehabilitation strategies.

Touchscreen-based assessment of upper limb kinematics after stroke: Reliability, validity and sensitivity to motor impairment

BACKGROUND

Conventional clinical tools for assessing upper limb motor function often lack the sensitivity and specificity needed to detect subtle changes in motor performance and may be subject to bias. Kinematic assessment offers a potential solution by providing objective, precise, and detailed data on movement quality. However, it is typically associated with high costs, complex equipment, time-consuming procedures, and the need for controlled environments, all of which limit its accessibility and practicality in clinical settings. This study aimed to evaluate the reliability, validity, and sensitivity of a low-cost, touchscreen-based kinematic assessment tool for measuring upper limb function in individuals post-stroke.

METHODS

Sixty-four individuals with stroke participated in this study. Participants performed a visually guided reaching task on a large touch screen that consisted in reaching from a central target to five outer targets arranged in a circular pattern, each at a time, and then returning to the central target. Their motor function was assessed using the Fugl-Meyer Assessment for Upper Extremity, the Box and Block Test, and the Nine Hole Peg Test. Kinematic measures of the trajectories performed during the reaching task were extracted and analyzed for reliability, convergent validity with clinical assessments, and sensitivity to impairment severity.

RESULTS

The kinematic measures demonstrated good to excellent test-retest reliability, with intraclass correlation coefficients ranging from moderate to excellent. The convergent validity analysis revealed multiple significant correlations between the kinematic parameters and clinical assessments, particularly in tests requiring higher skill and precision, such as the Coordination and Speed subscale of the Fugl-Meyer Assessment for Upper Extremity and the Nine Hole Peg Test. Additionally, the touchscreen-based assessment was sensitive to the severity of motor impairment, as reflected by notable differences in the kinematic measures among participants with varying levels of upper limb function.

CONCLUSIONS

The touchscreen-based kinematic assessment offered an affordable yet reliable, valid, and sensitive alternative for evaluating upper limb kinematics in individuals with stroke, which could complement clinical assessments by offering additional insights into motor performance. Furthermore, its low cost, high speed, and ease of use make it a practical option for widespread clinical adoption.

Downward adjustment of rehabilitation goals may facilitate post-stroke arm motor recovery

Objective: Patients starting with physical rehabilitation often hold unrealistically high expectations for their recovery. Because of a lower-than-expected rate of recovery, such unrealistic goals have been linked to adverse effects on mental health. Additionally, overtraining due to overly ambitious goals can lead to suboptimal recovery. We investigated the effectiveness of adjusting rehabilitation goals to a more realistic level as a strategy to select appropriate exercise intensity and achieve better recovery outcomes. Design: Patients with arm paralysis from recent stroke were recruited and went through 6-8 weeks of telerehabilitation and in-clinic rehabilitation programme conducted at 11 US sites (N = 124). Main Outcome Measures: Adjustment of recovery goal was assessed in two timepoints during the rehabilitation programme and arm motor function was assessed before and after the clinical trial. Results: Greater use of goal adjustment strategies predicted better recovery of arm motor function, independent from therapy compliance. This pattern was observed only when the choice of exercises is patient-regulated rather than directed by a physical therapist. Conclusion: Benefits from goal adjustment were more pronounced among patients who entered the programme with poorer motor functions, suggesting that goal adjustment is the most beneficial when goals of complete recovery are most unrealistic.

The complementary dominance hypothesis: a model for remediating the 'good' hand in stroke survivors

The complementary dominance hypothesis is a novel model of motor lateralization substantiated by decades of research examining interlimb differences in the control of upper extremity movements in neurotypical adults and hemisphere-specific motor deficits in stroke survivors. In contrast to earlier ideas that attribute handedness to the specialization of one hemisphere, our model proposes complementary motor control specializations in each hemisphere. The dominant hemisphere mediates optimal control of limb dynamics as required for smooth and efficient movements, whereas the non-dominant hemisphere mediates impedance control, important for countering unexpected mechanical conditions and achieving steady-state limb positions. Importantly, this model proposes that each hemisphere contributes its specialization to both arms (though with greater influence from either arm's contralateral hemisphere) and thus predicts that lesions to one hemisphere should produce hemisphere-specific motor deficits in not only the contralesional arm, but also the ipsilesional arm of stroke survivors - a powerful prediction now supported by a growing body of evidence. Such ipsilesional arm motor deficits vary with contralesional arm impairment, and thus individuals with little to no functional use of the contralesional arm experience both the greatest impairments in the ipsilesional arm, as well as the greatest reliance on it to serve as the main or sole manipulator for activities of daily living. Accordingly, we have proposed and tested a novel intervention that reduces hemisphere-specific ipsilesional arm deficits and thereby improves functional independence in stroke survivors with severe contralesional impairment.

Construct validity and responsiveness of clinical upper limb measures and sensor-based arm use within the first year after stroke: a longitudinal cohort study

BACKGROUND

Construct validity and responsiveness of upper limb outcome measures are essential to interpret motor recovery poststroke. Evaluating the associations between clinical upper limb measures and sensor-based arm use (AU) fosters a coherent understanding of motor recovery. Defining sensor-based AU metrics for intentional upper limb movements could be crucial in mitigating bias from walking-related activities. Here, we investigate the measurement properties of a comprehensive set of clinical measures and sensor-based AU metrics when gait and non-functional upper limb movements are excluded.

METHODS

In this prospective, longitudinal cohort study, individuals with motor impairment were measured at days 3 ± 2 (D3), 10 ± 2 (D10), 28 ± 4 (D28), 90 ± 7 (D90), and 365 ± 14 (D365) after their first stroke. Using clinical measures, upper limb motor function (Fugl-Meyer Assessment), capacity (Action Research Arm Test, Box & Block Test), and perceived performance (14-item Motor Activity Log) were assessed. Additionally, individuals wore five movement sensors (trunk, wrists, and ankles) for three days. Thirteen AU metrics were computed based on functional movements during non-walking periods. Construct validity across clinical measures and AU metrics was determined by Spearman's rank correlations for each time point. Criterion responsiveness was examined by correlating patient-reported Global Rating of Perceived Change (GRPC) scores and observed change in upper limb measures and AU metrics. Optimal cut-off values for minimal important change (MIC) were estimated by ROC curve analysis.

RESULTS

Ninety-three individuals participated. At D3 and D10, correlations between clinical measures and AU metrics showed variability (range rs: 0.44-0.90). All following time points showed moderate-to-high positive correlations between clinical measures and affected AU metrics (range rs: 0.57-0.88). Unilateral nonaffected AU duration was negatively correlated with clinical measures (range rs: -0.48 to -0.77). Responsiveness across outcomes was highest between D10-D28 within moderate to strong relations between GRPC and clinical measures (rs: range 0.60-0.73), whereas relations were weaker for AU metrics (range rs: 0.28-0.43) Eight MIC values were estimated for clinical measures and nine for AU metrics, showing moderate to good accuracy (66-87%).

CONCLUSIONS

We present reference data on the construct validity and responsiveness of clinical upper limb measures and specified sensor-based AU metrics within the first year after stroke. The MIC values can be used as a benchmark for clinical stroke rehabilitation.

TRIAL REGISTRATION

This trial was registered on clinicaltrials.gov; registration number NCT03522519.

Cross-cultural adaptation and validation of the Persian version of the Preparedness Assessment for the Transition Home After Stroke instrument: a methodological study

BACKGROUND

The successful transition of stroke patients from hospital to home relies on the preparedness of caregivers. Assessing this preparedness is crucial, but existing tools need adaptation and validation for Iranian caregivers.

OBJECTIVES

This study aimed to translate, culturally adapt, and validate the Persian version of the "Preparedness Assessment for the Transition Home After Stroke" (PATH-s) for use among Iranian caregivers of stroke survivors. It also assessed the association of patient and caregivers' characteristic association with the final PATH score.

METHODS

The PATH-s was translated and culturally adapted using the Backward-Forward translation method and expert consultations. Face and content validity were ensured through input from both caregivers and experts. Participants were recruited from two referral hospitals in Tehran, Iran. The sample consisted of 386 caregivers, 74.4% female with a mean age of 47.18 years (SD = 12.2). Construct validity was assessed using Exploratory and Confirmatory Factor Analyses (EFA and CFA). Convergent validity was evaluated through the correlation with Zarit Burden Interview scores. Reliability was tested through internal consistency (Cronbach's alpha) and test-retest reliability (Intraclass Correlation Coefficient, ICC).

RESULTS

The factor analysis revealed a seven-factor structure with robust fit indices (CFI = 0.92, TLI = 0.90, RMSEA = 0.068, SRMR = 0.074). Convergent validity was supported by a significant negative correlation with the Zarit Burden Interview (r = -0.27, p < 0.001). Reliability analysis showed good internal consistency (Cronbach's alpha = 0.84) and excellent test-retest reliability (ICC = 0.96).

CONCLUSIONS

The Persian version of PATH-s is a valid and reliable tool for assessing caregiver preparedness in Iran. Its use can improve patient outcomes and caregiver support during hospital-to-home transitions.

The Role of Mirror Therapy in the Rehabilitation of the Upper Limb's Motor Deficits After Stroke: Narrative Review

Stroke is one of the leading causes of death and disability worldwide and poses a tremendous socioeconomic burden upon individuals, countries and healthcare systems. It causes debilitating symptoms and thus interferes with many aspects of the patient's life, including physical functioning, cognition, emotional status, activities of daily living, social reintegration and quality of life. Post-stroke patients frequently experience functional motor disabilities of the upper limb, which restrict autonomy and self-efficacy and cause limitations in engagement with activities and social participation, as well as difficulties in performing important occupations. It is therefore not surprising that motor impairment or loss of motor function of the upper limb is one of the most devastating sequelae of stroke. On these grounds, achieving optimal functioning of the upper limb after stroke remains a fundamental goal of stroke rehabilitation. Mirror therapy (MT) represents one of the several rehabilitation techniques used for restoring the upper limb's motor function after a stroke. However, conflicting results about the role of MT in the rehabilitation of the upper limb's motor deficits have been reported in the literature. Accordingly, the aim of this narrative review is to summarize existing evidence regarding the effects of MT on the upper limb's motor function in post-stroke patients and to further explore its role when applied in different phases of stroke.

The effect of trunk control on sitting balance and upper extremity functions in patients with subacute stroke

BACKGROUND

Impairment of trunk control is a common problem after stroke, and trunk impairment may affect many functions such as breathing, speech, limb movements and transfers.

OBJECTIVE

The present study was aimed to investigate the effect of trunk control on sitting balance and upper extremity functions in individuals with subacute stroke.

METHODS

A total of 30 patients with subacute stroke (14 female, 16 male) were included in this study. The mean age of the included patients was 59.80 ± 13.22 years, and the mean disease duration was 2.90 ± 1.38 months. Trunk Impairment Scale (TIS), Trunk Control Test (TCT), Function in Sitting Test (FIST), Fugl-Meyer Assessment Upper Extremity (FMA-UE), Brunnstrom Recovery Stages of Arm (BRS-A) and Brunnstrom Recovery Stages of Hand (BRS-H) were performed to the patients.

RESULTS

The results of our study showed that there was a strong positive correlation was found between TIS and FIST (r = 0.765, p < 0.001). There was also a positive moderate correlation between TCT and FIST, FMA-UE, BRS-A and BRS-H (r = 0.67, r = 0.49, r = 0.49, r = 0.44; p < 0.05; respectively). There was a positive moderate correlation between TIS and FMA-UE, BRS-A and BRS-H (r = 0.67, r = 0.65 and r = 0.58; p < 0.005; respectively).

CONCLUSION

In conclusion, trunk control has been shown to be a factor associated with sitting balance and upper extremity function in patients with subacute stroke.

Role of joint interactions in upper limb joint movements: a disability simulation study using wearable inertial sensors for 3D motion capture

BACKGROUND

Restriction of movement at a joint due to disease or dysfunction can alter the range of motion (ROM) at other joints due to joint interactions. In this paper, we quantify the extent to which joint restrictions impact upper limb joint movements by conducting a disability simulation study that used wearable inertial sensors for three-dimensional (3D) motion capture.

METHODS

We employed the Wearable Inertial Sensors for Exergames (WISE) system for assessing the ROM at the shoulder (flexion-extension, abduction-adduction, and internal-external rotation), elbow (flexion-extension), and forearm (pronation-supination). We recruited 20 healthy individuals to first perform instructed shoulder, elbow, and forearm movements without any external restrictions, and then perform the same movements with restriction braces placed to limit movement at the shoulder, elbow, and forearm, separately, to simulate disability. To quantify the extent to which a restriction at a non-instructed joint affected movement at an instructed joint, we computed average percentage reduction in ROM in the restricted versus unrestricted conditions. Moreover, we performed analysis of variance and post hoc Tukey tests (q statistic) to determine the statistical significance (p < 0.05 denoted using *) of the differences in ROM of an instructed joint in the unrestricted versus restricted conditions.

RESULTS

Restricting movement at the shoulder led to a large reduction in the average ROM for elbow flexion-extension (21.93%, q = 9.34*) and restricting elbow movement significantly reduced the average ROM for shoulder flexion-extension (17.77%, q = 8.05*), shoulder abduction-adduction (19.80%, q = 7.60*), and forearm pronation-supination (14.04%, q = 4.96*). Finally, restricting the forearm significantly reduced the average ROM for shoulder internal-external rotation (16.71%, q = 3.81*) and elbow flexion-extension (10.01%, q = 4.27*).

CONCLUSIONS

Joint interactions across non-instructed joints can reduce the ROM of instructed movements. Assessment of ROM in the real-world using 3D motion capture, for example using the WISE system, can aid in understanding movement limitations, informing interventions, and monitoring progress with rehabilitation.

Quantifying Muscle Co-Activation for Impaired Finger Independence in Stroke Survivors

OBJECTIVE

Hand impairment frequently occurs in individuals following a stroke. There is evidence of abnormal muscle co-activation that contributes to impaired control of finger independence. This study quantitatively analyzed hand muscle co-activation patterns of chronic stroke survivors. Systematically quantifying the degree of muscle co-activation patterns in stroke survivors can help us to better understand the mechanisms behind compromised finger independence and enables a more accurate assessment of hand impairment.

METHODS

We analyzed muscle co-activation patterns both macroscopically and microscopically using high-density surface electromyographic (HD-sEMG) signals and decomposed motor unit signals from extrinsic and intrinsic flexor/extensor muscles. The muscle co-activation patterns between both sides of stroke survivors and neurologically intact controls were compared.

RESULTS

We observed increased levels of co-activation in the affected sides of stroke survivors compared with their contralateral sides and the control groups, with a higher degree in the extrinsic muscles than the intrinsic muscles. The asymmetry in muscle co-activation between hands correlated with impaired finger force independence and clinical assessment scales. In the micro-level analysis of motor unit action potentials (MUAPs) distributions, we observed a notable increase in action potential spread of MUAPs in the individual affected extrinsic muscles, but the altered MUAP distribution did not correlate with clinical assessment scales.

CONCLUSION

We systematically quantified abnormal muscle co-activation patterns in impaired finger independence after stroke.

SIGNIFICANCE

With further development, the outcomes provide a comprehensive understanding of hand dexterity deficits in stroke survivors, which may provide guidance for targeted rehabilitation strategies and offer a potential for automated impairment evaluations.

Effect of intermittent theta burst stimulation on upper limb function in stroke patients: a systematic review and meta-analysis

Background

Stroke is a serious health issue that affects individuals, families, and society. Particularly, the upper limb dysfunction caused by stroke significantly reduces the quality of life for patients and may lead to psychological issues. Current treatment modalities are not fully effective in helping patients regain upper limb motor function to optimal levels. Therefore, there is an urgent need to explore new rehabilitation methods to address this issue.

Objective

The purpose of this meta-analysis and systematic review is to explore the effects of intermittent theta burst stimulation (iTBS) on upper limb function in stroke patients.

Methods

We searched PubMed, Cochrane Library, Embase, Web of Science, PEDro and China National Knowledge Internet as of April 8, 2024. Retrieved a total of 100 articles. Standardized mean differences (SMDs) and 95% confidence intervals (CI) were calculated.

Results

The study included a total of 9 trials and involved 224 patients. The results demonstrate that compared to the control group, iTBS therapy significantly improved Fugl-Meyer assessment-upper extremity (FMA-UE) scores (SMD = 0.88; 95% CI = 0.11-1.66; P = 0.03, I 2 = 84%), Action Research Arm Test (ARAT) scores (SMD = 0.83; 95% CI = 0.16-1.50; P = 0.02, I 2 = 57%), and Barthel Index (BI) scores (SMD = 0.93; 95% CI = 0.53-1.32; P < 0.0001, I 2 = 0%) in stroke patients.

Conclusions

The comprehensive evidence suggests that iTBS has superior effects in improving upper limb function and activities of daily living in stroke patients.

ICF classification of therapeutic goals for outpatient episodes of neurorehabilitation in post-stroke and Parkinson disease

PURPOSE

To understand therapeutic priorities, a secondary data analysis on a retrospective cohort was conducted to classify rehabilitation goals according to the International Classification of Functioning, Disability, and Health (ICF).

MATERIALS AND METHODS

Therapeutic goals from an initial outpatient physical or occupational therapy evaluation for patients post-stroke or with Parkinson disease, were classified into Level 1 of the ICF. Goals in the Activity and Participation component were further sub-classified as activity capacity or activity performance (self-report or direct) in daily life.

RESULTS

776 goals across 104 participants were classified into Level 1 of the ICF. The majority, 73% (563/776) were classified as Activity and Participation, 20% (155/776) as Body Function and 2% (17/776) as Environmental Factors. Fifty-two percent (400/776) of all goals were classified as activity capacity and 21% (163/776) as activity performance in daily life, with 21% (160/776) of goals measuring self-report activity performance in daily life and less than 1% (3/776) of goals measuring direct activity performance in daily life.

CONCLUSIONS

While the majority of therapeutic goals were classified into the Activity and Participation component, less than 1% of goals measured direct activity performance in daily life. If people seek outpatient rehabilitation to improve functioning in their real-world environment, therapeutic goal setting should reflect this.

A novel biomechanical index for quality assessment of the upper-extremity movements in post-stroke patients

BACKGROUND

While motor recovery is preferred to compensatory movements for stroke patients with mild to moderate motion impairment, current movement quality assessments rarely reflect the differences between a patient's pre- and post-stroke movement patterns. Such comparison can help therapists to identify the rate of the restoration of premorbid motion patterns and prescribe the most effective treatment.

METHODS

This paper attempted to present a new biomechanical metric for the quality of upper-limb movements which uses the subject's optimal movements as a reference to evaluate his/her UL movement quality. To this end, an inverse optimal control algorithm was applied to find an estimation of the patient's premorbid motion patterns. The new biomechanical index was then calculated as a measure of similarity between the optimal and actual movement trajectories. In the next part, various simulation and clinimetric investigations were performed to evaluate the responses of the new index to variations of the movement quality as well as its test-retest reliability and concurrent validity.

RESULTS

Simulation-based analyses demonstrated that the proposed index, in contrast to the previous popular biomechanical indices, can successfully detect a wide range of abnormalities in motion signals. In addition, it showed good test-retest reliability (ICC = 0.89) and moderate correlation with clinical indices, Fugl-Meyer Assessment (r = 0.66), Action Research Arm Test (r = 0.47), and ABILHAND (r = 0.27).

CONCLUSIONS

Although the proposed index has the same degree of clinimetric properties as the previous metrics, the ability to identify the level of movement restoration and also various types and severities of motor disabilities may lead to better design and management of motor rehabilitation.

Effects of scapulo-humeral training on ultrasonographic and clinical evaluations in stroke: a randomized controlled trial

BACKGROUND

After stroke, the effects of focused scapulo-humeral training with simultaneous assessment of the changes in shoulder subluxation, related muscle thicknesses and upper limb performance have not been studied in the literature.

OBJECTIVES

This study aimed to investigate the effects of an 8-week scapulo-humeral training program in addition to conventional rehabilitation on upper extremity/trunk functions, shoulder pain, and sonographic measurements of the shoulder joint and periscapular muscles.

METHODS

Thirty stroke individuals were randomly separated into two groups as Group I-scapulo-humeral training (5F/10 M) and Group II - control (5F/10 M). Conventional rehabilitation program was applied to both groups, and a scapulo-humeral training exercise protocol was added for the scapulo-humeral group. All the treatments were applied for 1 hour/day, 3 days/week, 8 weeks. Clinical evaluations were made using the Fugl Meyer Assessment-Upper Extremity(FMA-UE), Action Research Arm Test(ARAT), ABILHAND, Visual Analog Scale, and Trunk Impairment Scale(TIS). Ultrasound was used to measure serratus anterior/lower trapezius muscle thicknesses, and acromion-greater tubercule/acromio-humeral distances.

RESULTS

FMA-UE, ARAT, ABILHAND and TIS scores increased in both groups, with greater increases in most parameters in the scapulo-humeral training group. Shoulder pain decreased only in the scapulo-humeral training group. Subacromial distances were decreased on the paretic side, and muscle thicknesses increased on both sides in the scapulo-humeral training group, and in the control group, only serratus anterior muscle thickness increased on the paretic side (p < 0.05 for all).

CONCLUSIONS

Additional scapulo-humeral exercises to conventional rehabilitation was seen to improve upper extremity/trunk performance and shoulder pain, and to increase scapula stabilizer muscle thicknesses in stroke individuals with mild-moderate upper extremity disability.

Stroke Survivors' Interaction With Hand Rehabilitation Devices: Observational Study

BACKGROUND

The hand is crucial for carrying out activities of daily living as well as social interaction. Functional use of the upper limb is affected in up to 55% to 75% of stroke survivors 3 to 6 months after stroke. Rehabilitation can help restore function, and several rehabilitation devices have been designed to improve hand function. However, access to these devices is compromised in people with more severe loss of function.

OBJECTIVE

In this study, we aimed to observe stroke survivors with poor hand function interacting with a range of commonly used hand rehabilitation devices.

METHODS

Participants were engaged in an 8-week rehabilitation intervention at a technology-enriched rehabilitation gym. The participants spent 50-60 minutes of the 2-hour session in the upper limb section at least twice a week. Each participant communicated their rehabilitation goals, and an Action Research Arm Test (ARAT) was used to measure and categorize hand function as poor (scores of 0-9), moderate (scores of 10-56), or good (score of 57). Participants were observed during their interactions with 3 hand-based rehabilitation devices that focused on hand rehabilitation: the GripAble, NeuroBall, and Semi-Circular Peg Board. Observations of device interactions were recorded for each session.

RESULTS

A total of 29 participants were included in this study, of whom 10 (34%) had poor hand function, 17 (59%) had moderate hand function, and 2 (7%) had good hand function. There were no differences in the age and years after stroke among participants with poor hand function and those with moderate (P=.06 and P=.09, respectively) and good (P=.37 and P=.99, respectively) hand function. Regarding the ability of the 10 participants with poor hand function to interact with the 3 hand-based rehabilitation devices, 2 (20%) participants with an ARAT score greater than 0 were able to interact with the devices, whereas the other 8 (80%) who had an ARAT score of 0 could not. Their inability to interact with these devices was clinically examined, and the reason was determined to be a result of either the presence of (1) muscle tone or stiffness or (2) muscle weakness.

CONCLUSIONS

Not all stroke survivors with impairments in their hands can make use of currently available rehabilitation technologies. Those with an ARAT score of 0 cannot actively interact with hand rehabilitation devices, as they cannot carry out the hand movement necessary for such interaction. The design of devices for hand rehabilitation should consider the accessibility needs of those with poor hand function.

Development and Validation of a Bedside Scale for Assessing Upper Limb Function Following Stroke: A Methodological Study

Background

Numerous tools are available for evaluation of upper limb (UL) functions among stroke survivors. Despite the excellent psychometric properties, many require considerable amount of time, are resource-intensive, and often impractical for bedside evaluation.

Objectives

To develop and concurrently validate a simple, resource-efficient, and time-efficient bedside tool for evaluating UL function in stroke survivors.

Methods

Relevant literature review was carried out to conceptualize and define the theoretical framework of day-to-day UL movement tasks. Subsequently, an item pool of 18 UL movements was developed. A mini-Delphi method was employed to verify content validity. During the iterative rounds, 18-items were revised and refined to a 12-items scale. The final bedside upper limb evaluation tool (BUFET) scale underwent concurrent validation by correlating the scores with Wolf Motor Function Test (WMFT) scores using Spearman's correlation coefficient. Internal consistency was evaluated through Cronbach's alpha.

Results

Concurrent validity and internal consistency of the scale were supported by a high correlation coefficient (r = 0.937; p<0.001) with WMFT and high Cronbach's alpha (0.948).

Conclusions

Newly developed BUFET was found to be a valid and reliable bedside tool in the evaluation of upper limb functions and can be administered in a resource and time-efficient manner.

U-Rate-UE; Measuring Perceived Recovery of the Affected Upper Extremity in Adults Post-stroke

OBJECTIVE

To establish initial validity of "U-Rate-UE", a single-question scale regarding perceived recovery of the stroke affected upper extremity (UE).

DESIGN

A retrospective longitudinal study of data collected at rehabilitation admission, 6 weeks, and 6 months since stroke.

SETTING

Stroke rehabilitation and community-based.

PARTICIPANTS

A convenience sample of 87 individuals, median (interquartile range) age 71.5 (65-80) years, 15.0 (12-20) days post-stroke.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The affected UE was assessed using the Fugl-Meyer Motor Assessment, grip strength, Action Research Arm Test, the Box and Block Test (BBT), and The Rating of Everyday Arm-Use in the Community and Home. Participants also rated how much they perceive that their affected UE recovered from the stroke using U-Rate-UE; 0-100 (no to full recovery). Longitudinal changes in U-Rate-UE ratings were assessed. In addition, at 6 weeks and 6 months post-stroke, the change in BBT was calculated and participants were grouped into achieved/did not achieve the minimal detectable change (MDC). Correlations between U-Rate-UE to the other UE assessments were assessed at all 3 timepoints.

RESULTS

Significant changes in U-Rate-UE were seen over time (P<.05). At 6 weeks and 6 months, participants who achieved BBT-MDC rated their recovery significantly higher than participants who did not. U-Rate-UE was moderately-strongly significantly correlated to UE assessments (rho=.61-.85, P<.001).

CONCLUSIONS

The U-Rate-UE is supported for use with UE assessments contributing to comprehensive clinical understanding of the recovery of the affected UE in adults post-stroke.

Occupational Therapy Practice: Time From Stroke Onset to Outpatient Upper Limb Rehabilitation

Upper limb stroke rehabilitation has been understudied in usual occupational therapy. The study's purpose was to describe the timing and amount of usual occupational therapy in the stroke population for hospital-based outpatient upper limb rehabilitation. A multi-site study of timing and amount of occupational therapy was calculated for mild and moderate upper limb stroke impairments using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE). Mild stroke participants (n = 58) had a mean of 164.25 days, and the moderate stroke participants (n = 64) had a mean of 106.75 days from the date of stroke onset to first treatment which was significantly different (p = .047). There were no significant differences in the amount of therapy between mild or moderate stroke patients. Mild stroke patients experience a longer delay in receiving outpatient occupational therapy compared with moderate impairments which may be attributed to the subtlety of the impairments that impact participation in daily activities.

Factors Influencing Real-World Use of the More-Affected Upper Limb After Stroke: A Scoping Review

IMPORTANCE

Current interventions are limited in improving use of the more-affected upper limb in real-world daily occupations and functional independence poststroke. A comprehensive understanding of the factors influencing real-world upper limb use is required to develop interventions to improve functional independence poststroke.

OBJECTIVE

To systematically review the factors that influence real-world use of the more-affected upper limb poststroke.

DATA SOURCES

We searched MEDLINE, Embase, PsycINFO, and the Physiotherapy Evidence Database for English-language articles from 2012 to 2023.

STUDY SELECTION AND DATA COLLECTION

Of 774 studies, we included 33 studies that had participants at least age 18 yr who exhibited upper limb impairments poststroke, objectively measured real-world upper limb use using a movement sensor, and measured factors affecting upper limb use. Two reviewers independently screened the abstracts.

FINDINGS

The results were categorized by International Classification of Functioning, Disability and Health domains. Prominent factors were upper limb impairment; motor ability; functional independence; task type; hand dominance; stroke-related factors, including time since stroke; and perception of use of the more-affected upper limb.

CONCLUSIONS AND RELEVANCE

Existing interventions primarily focus on upper limb impairments and motor ability. Our findings suggest that interventions should also incorporate other factors: task type (unilateral vs. bilateral), hand dominance, self-efficacy, and perception of more-affected limb use as active ingredients in improving real-world use of the more-affected upper limb poststroke. We also provide recommendations to use behavioral activation theory in designing an occupation-focused intervention to augment self-efficacy and confidence in use of the more-affected upper limb in daily occupations. Plain-Language Summary: In order to develop interventions to improve functional independence poststroke, occupational therapy practitioners must have a comprehensive understanding of the factors that influence real-world more-affected upper limb use. The study findings provide a set of distinct factors that practitioners can target separately or in combination to improve real-world use of the more-affected upper limb poststroke.

Associations Between Coordination and Wearable Sensor Variables Vary by Recording Context but Not Assessment Type

Motor coordination is an important driver of development and improved coordination assessments could facilitate better screening, diagnosis, and intervention for children at risk of developmental disorders. Wearable sensors could provide data that enhance the characterization of coordination and the clinical utility of that data may vary depending on how sensor variables from different recording contexts relate to coordination. We used wearable sensors at the wrists to capture upper-limb movement in 85 children aged 6-12. Sensor variables were extracted from two recording contexts. Structured recordings occurred in the lab during a unilateral throwing task. Unstructured recordings occurred during free-living activity. The objective was to determine the influence of recording context (unstructured versus structured) and assessment type (direct vs. indirect) on the association between sensor variables and coordination. The greatest associations were between six sensor variables from the structured context and the direct measure of coordination. Worse coordination scores were associated with upper-limb movements that had higher peak magnitudes, greater variance, and less smoothness. The associations were consistent across both arms, even though the structured task was unilateral. This finding suggests that wearable sensors could be paired with a simple, structured task to yield clinically informative variables that relate to motor coordination.

Upper limb assessment with inertial measurement units according to the international classification of functioning in stroke: a systematic review and correlation meta-analysis

OBJECTIVE

To investigate the usefulness of inertial measurement units (IMUs) in the assessment of motor function of the upper limb (UL) in accordance with the international classification of functioning (ICF).

DATA SOURCES

PubMed; Scopus; Embase; WoS and PEDro databases were searched from inception to 1 February 2022.

METHODS

The current systematic review follows PRISMA recommendations. Articles including IMU assessment of UL in stroke individuals have been included and divided into four ICF categories (b710, b735, b760, d445). We used correlation meta-analysis to pool the Fisher Z-score of each correlation between kinematics and clinical assessment.

RESULTS

A total of 35 articles, involving 475 patients, met the inclusion criteria. In the included studies, IMUs have been employed to assess the mobility of joint functions (n = 6), muscle tone functions (n = 4), control of voluntary movement functions (n = 15), and hand and arm use (n = 15). A significant correlation was found in overall meta-analysis based on 10 studies, involving 213 subjects: (r = 0.69) (95% CI: 0.69/0.98; p < 0.001) as in the d445 (r = 0.71) and b760 (r = 0.64) ICF domains, with no heterogeneity across the studies.

CONCLUSION

The literature supports the integration of IMUs and conventional clinical assessment in functional evaluation of the UL after a stroke. The use of a limited number of wearable sensors can provide additional kinematic features of UL in all investigated ICF domains, especially in the ADL tasks when a strong correlation with clinical evaluation was found.

Handgrip strength and upper limb functional performance measures in people over 18 years old: Analysis of relationships and influencing factors

BACKGROUND

Handgrip strength is a common, simple, and inexpensive method to measure muscle strength. On the other hand, the functional performance measurement involves a usual task which implies repeating elements between the individuals' interaction and the environment. This is fundamental for projecting their results to daily life situation.

PURPOSE

To explore the relationship between grip strength and measures of functional performance of the upper limbs (ULs) in people over 18 years of age, and to determine the influence of sociodemographic and anthropometric variables on the relationship.

STUDY DESIGN

A cross-sectional study was conducted under the analytical empirical approach, using linear associations between handgrip strength and functional performance measurement tests (correspondence analysis).

METHODS

Three hundred sixty-two male and female individuals between 18 and 91 years of age from 4 Colombian cities participated. The grip strength of both ULs measured with a digital dynamometry was associated with the Box and Block Test (BBT, manual dexterity), Nine-Hole Peg Test (NHPT, daily living tasks), and Jebsen-Taylor Hand Function Test (JJT, ability to grasp, pick up, and place). Multiple linear regression analyzes were performed to assess possible explanatory factors of a sociodemographic and anthropometric order.

RESULTS

A significant association was found between the grip strength of dominant and non-dominant ULs with all functional performance tests (ρ > 0.27 and p < .001), except for the writing and simulated feeding subtests of the JJT (ρ ≤ 0.16). An interactive effect of age was found in the relationship between grip strength and the 3 functional performance tests.

CONCLUSIONS

These results support the association between grip strength with the NHPT, JJT, and BBT measures and the interactive effect of age on the performance of all tests.

Research on multi-dimensional intelligent quantitative assessment of upper limb function based on kinematic parameters

BACKGROUND

Rehabilitation assessment is a critical component of rehabilitation treatment.

OBJECTIVE

This study focuses on a comprehensive analysis of patients' movement performance using the upper limb rehabilitation robot. It quantitatively assessed patients' motor control ability and constructed an intelligent grading model of functional impairments. These findings contribute to a deeper understanding of patients' motor ability and provide valuable insights for personalized rehabilitation interventions.

METHODS

Patients at different Brunnstrom stages underwent rehabilitation training using the upper limb rehabilitation robot, and data on the distal movement positions of the patients' upper limbs were collected. A total of 22 assessment metrics related to movement efficiency, smoothness, and accuracy were extracted. The performance of these assessment metrics was measured using the Mann-Whitney U test and Pearson correlation analysis. Due to the issue of imbalanced sample categories, data augmentation was performed using the Synthetic Minority Over-sampling Technique (SMOTE) algorithm based on weighted sampling, and an intelligent grading model of functional impairment based on the Extreme Gradient Boosting Tree (XGBoost) algorithm was constructed.

RESULTS

Sixteen assessment metrics were screened. These metrics were effectively normalized to their maximum values, enabling the derivation of quantitative assessment scores for motor control ability across the three dimensions through a weighted fusion approach. Notably, when applied to the data-enhanced dataset, the intelligent grading model exhibited remarkable improvement, achieving an accuracy rate exceeding 0.98. Moreover, significant enhancements were observed in terms of precision, recall, and f1-score.

CONCLUSION

The research findings demonstrate that this study enables the quantitative assessment of patients' motor control ability and intelligent grading of functional impairments, thereby contributing to the efficiency enhancement of clinical rehabilitation assessment. Moreover, this method resolves the issues associated with the subjectivity and prolonged periods of traditional rehabilitation assessment methods.

Effects of repetitive transcranial magnetic stimulation over the contralesional dorsal premotor cortex on upper limb function in severe ischaemic stroke: study protocol for a randomised controlled trial

INTRODUCTION

Repetitive transcranial magnetic stimulation (rTMS) is an evidence-based treatment widely recommended to promote hand motor recovery after ischaemic stroke. However, the therapeutic efficacy of rTMS over the motor cortex in stroke patients is currently restricted and heterogeneous. This study aimed to determine whether excitatory rTMS over the contralesional dorsal premotor cortex (cPMd) facilitates the functional recovery of the upper limbs during the postacute stage of severe ischaemic stroke.

METHODS AND ANALYSIS

This study will be conducted as a single-blind, controlled, randomised study, in which 44 patients with poststroke hemiplegia with a course of disease ranging from 1 week to 3 months and Fugl-Meyer upper limb score ≤22 will be enrolled. The study participants will be randomly assigned to groups A (n=22) and B (n=22). The two groups are based on routine rehabilitation training and drug treatment; group A will be treated with low-frequency (1 Hz) rTMS over the contralesional primary motor cortex (cM1), and group B will be treated with high-frequency (10 Hz) rTMS over cPMd. For 2 weeks, rTMS will be administered once a day, 5 days a week. The primary outcome is the Fugl-Meyer assessment of the upper limb. The secondary outcomes include the Arm Subscore of the Motricity Index, Hong Kong edition of Functional Test for the Hemiplegic Upper Extremity, Modified Barthel Index and Modified Ashworth Scale score of the paralysed pectoralis major and biceps brachii. Furthermore, data of diffusion tensor imaging and functional MRI will be collected. These outcomes will be assessed before and after the completion of the intervention.

ETHICS AND DISSEMINATION

This study has been approved by the Ethics Committee of the First Affiliated Hospital of Nanjing Medical University (2020 SR-266). The findings of this study will be spread through networks of scientists, professionals and the general public as well as peer-reviewed scientific papers and presentations at pertinent conferences.

TRIAL REGISTRATION NUMBER

ChiCTR2000038049.

Correlation between kinetic and kinematic measures, clinical tests and subjective self-evaluation questionnaires of the affected upper limb in people after stroke

Introduction

Assessment of stroke recovery should include multiple sources of information in order to obtain a complete understanding of the individual's rehabilitation progress. Self-evaluation questionnaires' scores do not always correspond to the scores of commonly used clinical evaluation tools. The purpose of this study was to assess the relationship between self-evaluation questionnaires, clinical tests, and kinematic and kinetic analyses of the affected upper limb after stroke, and to determine the correlation between these measures and self-reported general function 2-4 years after the stroke.

Methods

Twenty-six subjects recovering from stroke were included in the study. Spearman's correlation coefficient was used to measure the correlation between Stroke Impact Scale (SIS), Motor activity Log (MAL), Fugl-Meyer Assessment (FMA) and Action Reach Arm Test (ARAT) scores, and kinematic and kinetic analyses. A logistic regression was used to assess the extent to which these measures may predict the participants' functional self-reported status 2-4 years post stroke.

Results

Sections regarding hand function, hand force and general ADL of the self-evaluation questionnaires correlated with kinematic variables. However, only questionnaires that focus on hand function correlated with clinical tests. Mean and maximal hand velocity had the strongest correlations with self-evaluation questionnaires and with the clinical tests, more than other kinematic variables. Self-evaluation questionnaires and clinical tests were found to be correlated with hand kinetic metrics force-to-time ratio and number of force peaks. SIS hand force domain, mean velocity and maximal velocity predicted self-reported general function 2-4 years after the stroke.

Conclusion

Self-evaluation questionnaires should be considered for wider use in the clinical evaluation of a patient's stroke recovery, since they add important information on the individual's functional status, which is not reflected in the clinical tests.

Virtual Reality Intervention and Its Impact on Upper Extremity Function in the Stroke Population: A Scoping Review

The aim of this scoping review was to examine virtual reality (VR) interventions used within rehabilitation and their effect on the functional outcomes of individuals with stroke. Specifically, this study sought to determine the impact of VR on the upper extremity (UE) use of participants as it relates to body function, occupational participation, and overall UE function (UEfxn). Twenty-six articles were selected for inclusion and results were extracted to determine common themes of outcomes among the effects of VR intervention (VRI). Thematic analysis included details about the VRIs used, as well as the change in UE outcomes post-VRI. Overall, positive change in UEfxn was found across many of the studies, indicating that VR technologies may be an effective intervention technique for individuals, poststroke. Findings of this review encourage clinicians to conduct further research regarding VR technology for UE rehabilitation poststroke.

Recombinant Human Perlecan DV and Its LG3 Subdomain Are Neuroprotective and Acutely Functionally Restorative in Severe Experimental Ischemic Stroke

Despite recent therapeutic advancements, ischemic stroke remains a major cause of death and disability. It has been previously demonstrated that  ~ 85-kDa recombinant human perlecan domain V (rhPDV) binds to upregulated integrin receptors (α2β1 and α5β1) associated with neuroprotective and functional improvements in various animal models of acute ischemic stroke. Recombinant human perlecan laminin-like globular domain 3 (rhPDVLG3), a 21-kDa C-terminal subdomain of rhPDV, has been demonstrated to more avidly bind to the α2β1 integrin receptor than its parent molecule and consequently was postulated to evoke significant neuroprotective and functional effects. To test this hypothesis, fifty male C57Bl/6 J mice studied in a t-MCAO model were randomly allocated to either rhPDV treatment, rhPDVLG3, or equivalent volume of PBS at the time of reperfusion in a study where all procedures and analyses were conducted blind to treatment. On post-MCAO day 7, 2,3,5-triphenyltetrazolium chloride staining of brain slices was used to quantify infarct volume. We observed that treatment with rhPDVLG3 reduced infarct volume by 65.6% (p = 0.0001), improved weight loss (p < 0.05), and improved functional outcome measures (p < 0.05) when compared to PBS controls, improvements which were generally greater in magnitude than those observed for 2 mg/kg of rhPDV. In addition, treatment with 6 mg/kg of rhPDVLG3 was observed to significantly reduce mortality due to stroke in one model, an outcome not previously observed for rhPDV. Our initial findings suggest that treatment with rhPDVLG3 provides significant improvement in neuroprotective and functional outcomes in experimental stroke models and that further investigation of rhPDVLG3 as a novel neuroprotective therapy for patients with stroke is warranted.

The Promotoer, a brain-computer interface-assisted intervention to promote upper limb functional motor recovery after stroke: a statistical analysis plan for a randomized controlled trial

BACKGROUND

Electroencephalography (EEG)-based brain-computer interfaces (BCIs) allow to modulate the sensorimotor rhythms and are emerging technologies for promoting post-stroke motor function recovery. The Promotoer study aims to assess the short and long-term efficacy of the Promotoer system, an EEG-based BCI assisting motor imagery (MI) practice, in enhancing post-stroke functional hand motor recovery. This paper details the statistical analysis plan of the Promotoer study.

METHODS

The Promotoer study is a randomized, controlled, assessor-blinded, single-centre, superiority trial, with two parallel groups and a 1:1 allocation ratio. Subacute stroke patients are randomized to EEG-based BCI-assisted MI training or to MI training alone (i.e. no BCI). An internal pilot study for sample size re-assessment is planned. The primary outcome is the effectiveness of the Upper Extremity Fugl-Meyer Assessment (UE-FMA) score. Secondary outcomes include clinical, functional, and user experience scores assessed at the end of intervention and at follow-up. Neurophysiological assessments are also planned. Effectiveness formulas have been specified, and intention-to-treat and per-protocol populations have been defined. Statistical methods for comparisons of groups and for development of a predictive score of significant improvement are described. Explorative subgroup analyses and methodology to handle missing data are considered.

DISCUSSION

The Promotoer study will provide robust evidence for the short/long-term efficacy of the Promotoer system in subacute stroke patients undergoing a rehabilitation program. Moreover, the development of a predictive score of response will allow transferring of the Promotoer system to optimal clinical practice. By carefully describing the statistical principles and procedures, the statistical analysis plan provides transparency in the analysis of data.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04353297 . Registered on April 15, 2020.

Direction-dependent differences in the quality and quantity of horizontal reaching in people after stroke

Arm reaching is often impaired in individuals with stroke. Nonetheless, how aiming directions influence reaching performance and how such differences change with motor recovery over time remain unclear. Here, we elucidated kinematic parameters of reaching toward various directions in people with poststroke hemiparesis in the subacute phase. A total of 13 and 15 participants with mild and moderate-to-severe hemiparesis, respectively, performed horizontal reaching in eight directions with their more-affected and less-affected sides using an exoskeleton robotic device at the time of admission to and discharge from the rehabilitation ward of the hospital. The movement time, path length, and number of velocity peaks were computed for the mild group (participants able to reach toward all eight directions). In addition, the total amount of displacement (i.e., movement quantity) toward two simplified directions (mediolateral or anteroposterior) was evaluated for the moderate-to-severe group (participants who showed difficulty in completing the reaching task). Motor recovery was evaluated using the Fugl-Meyer assessment. The mild group showed worse values of movement parameters during reaching in the anteroposterior direction, irrespective of the side of the arm or motor recovery achieved. The moderate-to-severe group exhibited less movement toward the anteroposterior direction than toward the mediolateral direction at admission; however, this direction-dependent bias in movement quantity decreased, with the movement expanding toward the anteroposterior direction with motor recovery at discharge. These results suggest that direction-dependent differences in the quality and quantity of reaching performance exist in people after stroke, regardless of the presence or severity of hemiparesis. This highlights the need to consider the task work area when designing rehabilitative training.NEW & NOTEWORTHY Arm reaching, a fundamental function required for the upper extremities, is often impaired after stroke due to muscle weakness and abnormal synergies. Nonetheless, how aiming directions influence performance remains unclear. Here, we report that direction-dependent differences in the quality and quantity of reaching performance exist, surprisingly regardless of the presence or severity of hemiparesis. This result highlights the need to consider the task work area when designing rehabilitative training.

Development and Preliminary Validity Study of a Modified Version of the Upper Extremity Fugl-Meyer Assessment for Use in Telerehabilitation

BACKGROUND/PURPOSE

The Upper Extremity Fugl-Meyer Assessment (UEFMA, maximum 66) is widely used in clinics and research studies to examine poststroke upper extremity (UE) impairment. This study aimed to develop and provide pilot data to support the validity of a remote version of the UEFMA to examine UE impairment after stroke through telerehabilitation.

METHODS

Team members developed a remote version of the UEFMA for telerehabilitation (tUEFMA, maximum 44) using subscales II to IV and VII of the UEFMA. Twenty-two participants with moderate to severe arm impairment (UEFMA, median = 19) and chronic stroke (>1 year post) were evaluated using the UEFMA (face-to-face) and the tUEFMA (remotely). A prediction equation was used to identify the function to predict the UEFMA based on the tUEFMA. Intraclass correlation (ICC) was used to test the absolute agreement between the subscales included in the UEFMA and the tUEFMA, and between their 2 normalized total scores.

RESULTS

A strong and significant agreement was found between the total scores of the UEFMA and the projected value based on the tUEFMA (ICC = 0.79, P < 0.05). The ICC test also reported a good agreement in subscales II to IV and a poor agreement in subscale VII between the UEFMA and the tUEFMA using a real-time video link.

DISCUSSION AND CONCLUSIONS

The study findings suggest that the tUEFMA is a promising tool to remotely examine UE impairment in individuals with chronic stroke and moderate to severe arm impairment. Future research should evaluate additional psychometric properties and clinical utility of the tUEFMA across stroke participants with a broad range of arm impairments.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A441 ).

Psychometric properties of the Chinese version of the Arm Activity Measure in people with chronic stroke

Introduction

The Arm Activity Measure was developed to assess active and passive functions of the upper limb in people with unilateral paresis, but a Chinese version is not available and its psychometric properties have not been specifically tested in people with stroke. This study aimed to translate and culturally adapt the Chinese version of the Arm Activity Measure (ArmA-C) and establish its psychometric properties in people with chronic stroke.

Methods

The psychometric properties of ArmA-C were determined in 100 people with chronic stroke.

Results

The ArmA-C had good test-retest reliability (intraclass correlation coefficients [ICC] = 0.87-0.93; quadratic weighted Kappa coefficients = 0.53-1.00). A floor effect was identified in section A of the ArmA-C. The content validity and internal consistency (Cronbach's alpha coefficients = 0.75-0.95) were good. The construct validity of the ArmA-C was supported by acceptable fit to the two-factor structure model and significant correlations with the Fugl-Meyer Assessment for Upper Extremity score, grip strength, the Wolf Motor Function Test score, the Trail Walking Test completion time, and the Oxford Participation and Activities Questionnaire scores.

Conclusions

The ArmA-C is reliable and valid for assessing active and passive functions in people with chronic stroke.

The Use of Kinematic Features in Evaluating Upper Limb Motor Function Learning Progress Based on Machine Learning

Evaluating progress throughout a patient's rehabilitation process helps choose effective treatment and formulate personalised and evidence-based rehabilitation interventions. The evaluation process is difficult due to the limitations of current clinical assessments. They lack the ability to reflect sensitive changes continuously throughout the rehabilitation process. Kinematic features have been extracted from individual's movement to address this problem due to their sensitivity and continuity. However, choosing appropriate kinematic features for rehabilitation evaluation has always been challenging. This paper exploits the application of kinematic features to classify movement patterns and movement qualities. 12 kinematic features were firstly extracted from a 7-segment triangle pattern of motion to monitor the learning progress with more numbers of drawing attempts. A statistical analysis was then conducted to compare the selected kinematic features with the clinically validated normalised jerk. Two supervised machine learning models were finally developed to classify movement patterns and movement qualities based on the selected kinematic features. The study was based on data recorded from 14 participants using a single position sensor. 6 kinematic features were able to reflect sensitive changes during the experiment and all kinematic features contributed to the classification tasks. Consistent with the literature, the results indicated that features based on movement velocity were the most beneficial in the classification tasks.

Relative contributions of positive, negative, and adaptive features to limitations in upper-limb function three months after stroke

PURPOSE

To investigate the contributions of motor impairments to limitations in upper-limb function three months after stroke.

DESIGN

Cross-sectional, exploratory study.

METHODS

Dependent variable was upper-limb function, measured by the Motor Assessment Scale (MAS), which scores range from 0 to 18. Independent variables included measures of strength, dexterity, spasticity, and contracture of the paretic upper limb. Multiple linear regression analysis was employed to identify which of the independent variables could explain the MAS scores (p<0.05). Analysis was performed with the whole sample and with a sub-group of participants, who had high function (MAS≥12).

RESULTS

Sixty-nine individuals participated. Out of them, 63 had high upper-limb function. Regression analysis with the whole sample revealed that strength and dexterity were retained in the models. Together they explained 64% of the variance of the MAS scores (p<0.001), being strength the greater relative contributor. When the regression analysis included only participants with high upper-limb function, dexterity had a greater relative contribution, than strength. Together they explained 52 % of the variance (p< 0.001).

CONCLUSIONS

Strength was the main contributor to upper-limb function in individuals three months after stroke. However, in individuals, who already had higher upper-limb function, dexterity showed to be the major contributor.

Spanish consensus of occupational therapists on upper limb assessment tools in stroke

Introduction

There is a lack of explicit tool recommendations for upper limb (UL) assessment in stroke, occupational therapists are frequently underrepresented in consensus studies, and the frequency of use of tools is highly variable between countries. The objective was to generate national occupational therapy consensus recommendations on UL assessment tools in stroke, and to classify the tools that achieve consensus according to the International Classification of Functioning, Disability and Health (ICF) components.

Methods

Three-round e-Delphi study of national scope. Occupational therapists working in Spain with training and experience in neurorehabilitation were recruited. Rounds were based on the completion of questionnaires on UL stroke assessment tools. Consensus was reached when ⩾75% of experts gave a ⩾7 rating on a nine-point Likert scale.

Results

A total of 29 occupational therapists comprised the expert panel. Twenty-three (17.8%) assessment tools achieved consensus and were classified according to the ICF components of body functions and structures (7), activities (11), participation (3) and other (2).

Conclusion

The expert panel recommended 23 outcome measures for UL recovery in stroke, representing all ICF components. The consensus recommendations are intended to assist occupational therapists in their clinical decision-making process, and to reduce the heterogeneity of research tools.

Quantitative assessment of thenar to evaluate hand function after stroke by Bayes discriminant

BACKGROUND

The incidence rate of stroke or cerebrovascular accidents ranks first in China. More than 85% of stroke patients have residual upper limb motor dysfunction, especially hand dysfunction. Normalizing the rehabilitation evaluation process and standard quantitative evaluation method is a complex and key point in rehabilitation therapy. The study aimed to establish a function model based on the Bayes discriminant by measuring the thenar stiffness with shear wave elastography (SWE) to quantitatively evaluate the hand motor function of hemiplegic patients after stroke.

METHODS

This study collected 60 patients diagnosed with hemiplegia after stroke from October 2021 to October 2022. Therapists used the Brunnstrom assessment (BA)scale to divide the patients into the stage. All the patients underwent the measurement of SWE examination of abductor pollicis brevis (APB), opponens pollicis (OP), flexor pollicis long tendon (FPLT), and flexor pollicis brevis (FPB) by two sonographers. The SWE change rate of four parts of the thenar area was calculated prospectively with the non-hemiplegic side as the reference, the function equation was established by the Bayes discriminant method, and the evaluation model was fitted according to the acquired training set data. Lastly, the model was verified by self-validation, cross-validation, and external data validation methods. The classification performance was evaluated regarding the area under the ROC curve (AUC), sensitivity, and specificity.

RESULTS

The median SWE values of the hemiplegic side of patients were lower than those of the non-hemiplegic side. According to the BA stage and SWER of APB, OP, FPLT, and FPB, our study established the Bayes discriminative model and validated it via self-validation and cross-validation methods. Then, the discriminant equation was used to validate 18 patients prospectively, the diagnostic coincidence rate was about 78.8%, and the misjudgment rate was approximately 21.2%. The AUC of the discriminant model for diagnosing BA stage I-VI was 0.928(95% CI: 0.839-1.0),0.858(95% CI: 0.748-0.969),1.0(95% CI: 1.0-1.0), 0.777(95% CI: 0.599-0.954),0.785(95% CI: 0.593-0.977) and 0.985(95% CI: 0.959-1.0), respectively.

CONCLUSION

This Bayes discriminant model built by measuring thenar stiffness was of diagnostic value and can provide an objective basis for evaluating clinical rehabilitation.

A Narrative Review on Multi-Domain Instrumental Approaches to Evaluate Neuromotor Function in Rehabilitation

In clinical scenarios, the use of biomedical sensors, devices and multi-parameter assessments is fundamental to provide a comprehensive portrait of patients' state, in order to adapt and personalize rehabilitation interventions and support clinical decision-making. However, there is a huge gap between the potential of the multidomain techniques available and the limited practical use that is made in the clinical scenario. This paper reviews the current state-of-the-art and provides insights into future directions of multi-domain instrumental approaches in the clinical assessment of patients involved in neuromotor rehabilitation. We also summarize the main achievements and challenges of using multi-domain approaches in the assessment of rehabilitation for various neurological disorders affecting motor functions. Our results showed that multi-domain approaches combine information and measurements from different tools and biological signals, such as kinematics, electromyography (EMG), electroencephalography (EEG), near-infrared spectroscopy (NIRS), and clinical scales, to provide a comprehensive and objective evaluation of patients' state and recovery. This multi-domain approach permits the progress of research in clinical and rehabilitative practice and the understanding of the pathophysiological changes occurring during and after rehabilitation. We discuss the potential benefits and limitations of multi-domain approaches for clinical decision-making, personalized therapy, and prognosis. We conclude by highlighting the need for more standardized methods, validation studies, and the integration of multi-domain approaches in clinical practice and research.

The effectiveness of robotic-assisted upper limb rehabilitation to improve upper limb function in patients with cervical spinal cord injuries: a systematic literature review

Background

Spinal Cord Injury (SCI) damages corticospinal tracts and descending motor pathways responsible for transmitting signals from the brain to the spinal cord, leading to temporary or permanent changes in sensation, motor function, strength, and body function below the site of injury. Cervical SCI (cSCI), which leads to tetraplegia, causes severe functional upper limb (UL) impairments that increase falls risk, limits independence, and leads to difficulties with activities of daily living (ADLs). Robotic therapy (RT) has been developed in recent decades as a new treatment approach for people with cervical spinal cord injuries (cSCI). The present review aimed to explore current available evidence and studies regarding the effectiveness of RT for individuals with cSCI in improving UL function, identify current research gaps and future research directions.

Method

This review was conducted by searching PubMed, CINAHL, Medline, Embase, and APA PsycInfo for relevant studies published from January 2010 to January 2022. Selected studies were analyzed with a focus on the patients' self-perception of limited UL function and level of independence in activities of daily living. In addition, the JBI Critical Appraisal checklist was used to assess study quality.

Results

A total of 7 articles involving 87 patients (74 males and 13 females) were included in the analysis, with four studies utilizing exoskeleton and three studies utilizing end-effector robotic devices, respectively. The quality of these studies varied between JBI Critical Appraisal scores of 4 to 8. Several studies lacked blinding and a control group which affected internal validity. Nevertheless, four out of seven studies demonstrated statistically significant improvements in outcome measurements on UL function and strength after RT.

Conclusion

This review provided mixed evidence regarding the effectiveness of RT as a promising intervention approach to improve upper limb function in participants with cSCI. Although RT was shown to be safe, feasible, and reduces active therapist time, further research on the long-term effects of UL RT is still needed. Nevertheless, this review serves as a useful reference for researchers to further develop exoskeletons with practical and plausible applications toward geriatric orthopaedics.

The NuroSleeve, a user-centered 3D printed hybrid orthosis for individuals with upper extremity impairment

BACKGROUND

Active upper extremity (UE) assistive devices have the potential to restore independent functional movement in individuals with UE impairment due to neuromuscular diseases or injury-induced chronic weakness. Academically fabricated UE assistive devices are not usually optimized for activities of daily living (ADLs), whereas commercially available alternatives tend to lack flexibility in control and activation methods. Both options are typically difficult to don and doff and may be uncomfortable for extensive daily use due to their lack of personalization. To overcome these limitations, we have designed, developed, and clinically evaluated the NuroSleeve, an innovative user-centered UE hybrid orthosis.

METHODS

This study introduces the design, implementation, and clinical evaluation of the NuroSleeve, a user-centered hybrid device that incorporates a lightweight, easy to don and doff 3D-printed motorized UE orthosis and a functional electrical stimulation (FES) component. Our primary goals are to develop a customized hybrid device that individuals with UE neuromuscular impairment can use to perform ADLs and to evaluate the benefits of incorporating the device into occupational therapy sessions. The trial is designed as a prospective, open-label, single-cohort feasibility study of eight-week sessions combined with at-home use of the device and implements an iterative device design process where feedback from participants and therapists informs design improvement cycles.

RESULTS

All participants learned how to independently don, doff, and use the NuroSleeve in ADLs, both in clinical therapy and in their home environments. All participants showed improvements in their Canadian Occupational Performance Measure (COPM), which was the primary clinical trial outcome measure. Furthermore, participants and therapists provided valuable feedback to guide further development.

CONCLUSIONS

Our results from non-clinical testing and clinical evaluation demonstrate that the NuroSleeve has met feasibility and safety goals and effectively improved independent voluntary function during ADLs. The study's encouraging preliminary findings indicate that the NuroSleeve has met its technical and clinical objectives while improving upon the limitations of the existing UE orthoses owing to its personalized and flexible approach to hardware and firmware design.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT04798378, https://clinicaltrials.gov/ct2/show/NCT04798378 , date of registration: March 15, 2021.

Shared Decision-Making to Improve Health-Related Outcomes for Adults with Stroke Disease

Stroke is one of the leading causes of disability and death worldwide, a severe medical condition for which new solutions for prevention, monitoring, and adequate treatment are needed. This paper proposes a SDM framework for the development of innovative and effective solutions based on artificial intelligence in the rehabilitation of stroke patients by empowering patients to make decisions about the use of devices and applications developed in the European project ALAMEDA. To develop a predictive tool for improving disability in stroke patients, key aspects of stroke patient data collection journeys, monitored health parameters, and specific variables covering motor, physical, emotional, cognitive, and sleep status are presented. The proposed SDM model involved the training and consultation of patients, medical staff, carers, and representatives under the name of the Local Community Group. Consultation with LCG members, consists of 11 representative people, physicians, nurses, patients and caregivers, which led to the definition of a methodological framework to investigate the key aspects of monitoring the patient data collection journey for the stroke pilot, and a specific questionnaire to collect stroke patient requirements and preferences. A set of general and specific guidelines specifying the principles by which patients decide to use wearable sensing devices and specific applications resulted from the analysis of the data collected using the questionnaire. The preferences and recommendations collected from LCG members have already been implemented in this stage of ALAMEDA system design and development.

Development of a compensation-aware virtual rehabilitation system for upper extremity rehabilitation in community-dwelling older adults with stroke

BACKGROUND

Compensatory movements are commonly observed in older adults with stroke during upper extremity (UE) motor rehabilitation, which could limit their motor recovery.

AIM

This study aims to develop a compensation-aware virtual rehabilitation system (VRS) that can detect compensatory movements and improve the outcome of UE rehabilitation in community-dwelling older adults with stroke.

METHODS

The VRS development includes three main components: (1) the use of thresholds for determining compensatory movements, (2) the algorithm for processing the kinematic data stream from Kinect to detect compensation in real-time, and (3) the audio-visual feedback to assist older adults with stroke to be aware of the compensation. Two studies were conducted following the VRS development, where Study 1 identified the value of thresholds for determining compensatory movements in two planar motor exercises, and Study 2 provided preliminary validation for the developed VRS by comparing two groups undergoing VR training or conventional training (CT) in a community rehabilitation center.

RESULTS

The VRS could effectively detect all determined compensatory movements and timely trigger feedback in response to the detected compensatory movements. The VR participants showed significant improvements in Fugl-Meyer Assessment-Upper Extremity (FMA-UE, p = 0.045) and Wolf Motor Function Test (WMFT, p = 0.009). However, the VR and CT groups had no significant differences in outcome measures.

CONCLUSION

The VRS demonstrates the ability to detect compensation and the potential of assisting older adults with stroke to improve motor functions. Suggestions are given for further improvements of the VRS to support the older adult with stroke to reduce compensation.

Sensor-Based Rehabilitation in Neurological Diseases: A Bibliometric Analysis of Research Trends

BACKGROUND

As the field of sensor-based rehabilitation continues to expand, it is important to gain a comprehensive understanding of its current research landscape. This study aimed to conduct a bibliometric analysis to identify the most influential authors, institutions, journals, and research areas in this field.

METHODS

A search of the Web of Science Core Collection was performed using keywords related to sensor-based rehabilitation in neurological diseases. The search results were analyzed with CiteSpace software using bibliometric techniques, including co-authorship analysis, citation analysis, and keyword co-occurrence analysis.

RESULTS

Between 2002 and 2022, 1103 papers were published on the topic, with slow growth from 2002 to 2017, followed by a rapid increase from 2018 to 2022. The United States was the most active country, while the Swiss Federal Institute of Technology had the highest number of publications among institutions. Sensors published the most papers. The top keywords included rehabilitation, stroke, and recovery. The clusters of keywords comprised machine learning, specific neurological conditions, and sensor-based rehabilitation technologies.

CONCLUSIONS

This study provides a comprehensive overview of the current state of sensor-based rehabilitation research in neurological diseases, highlighting the most influential authors, journals, and research themes. The findings can help researchers and practitioners to identify emerging trends and opportunities for collaboration and can inform the development of future research directions in this field.