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Amiri MS, Ramli R, Van M. Swarm-initialized adaptive controller with beetle antenna searching of wearable lower limb exoskeleton for sit-to-stand and walking motions. ISA TRANSACTIONS 2025; 158:640-653. [PMID: 39827031 DOI: 10.1016/j.isatra.2025.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 01/02/2025] [Accepted: 01/03/2025] [Indexed: 01/22/2025]
Abstract
In recent years, exoskeleton robots have attracted great interest from researchers in the area of robotics due to their ability to assist human functionality improvement. A wearable lower limb exoskeleton is aimed at supporting the limb functionality rehabilitation process and to assist physical therapists. Development of a stable and robust control system for multi-joint rehabilitation robots is a challenging task due to their non-linear dynamic systems. This paper presents the development of a Swarm-Initialized Adaptive (SIA) based controller, which is a combination of a swarm-based intelligence, named Swarm Beetle Antenna Searching (SBAS), and an adaptive Lyapunov-based controller. The SBAS initializes the parameters of SIA to efficiently improve the performance of the control system and then these controller parameters are updated by an adaptive controller. The control system is validated in a lower limb exoskeleton prototype with four degrees of freedom, using a healthy human subject for sit-to-stand and walking motions. The experimental results show the applicability of the proposed method and demonstrate that our approach obtained efficient control performance in terms of steady-state error and robustness and can be used for a lower limb exoskeleton to improve human mobility.
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Affiliation(s)
- Mohammad Soleimani Amiri
- Department of Manufacturing Engineering Technology, Faculty of Industrial and Manufacturing Technology and Engineering, Universiti Teknikal Malaysia Melaka, 76100 Durian Tunggal, Melaka, Malaysia.
| | - Rizauddin Ramli
- Department of Mechanical and Manufacturing Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, 43600 Bangi, Selangor, Malaysia.
| | - Mien Van
- School of Electronics, Electrical Engineering and Computer Science, Queen's University Belfast, BT9 5BN Belfast, United Kingdom.
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Tay SS, Zhang F, Visperas CA, Koh XH, Lau B, Neo JRE. Robot-mediated impairment-oriented and task-specific training on upper limb post stroke: feasibility and preliminary effects on physical function and quality of life. Front Neurol 2024; 15:1415773. [PMID: 39463787 PMCID: PMC11505121 DOI: 10.3389/fneur.2024.1415773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 09/18/2024] [Indexed: 10/29/2024] Open
Abstract
Objective To assess the feasibility and safety of conducting robot-mediated impairment training (RMIT) and robot-mediated task-specific training (RMTT). The device deployed is the Optimo Regen (OR®), capable of delivering both impairment-oriented training and task-specific training. Methods This was a single-centre, randomized, single-blinded, two-arm, parallel group, controlled trial. Patients fulfilling criteria were randomized into either the RMIT or RMIT + RMTT group and provided with 20 h of robotic therapy on top of standard care. Results A total of 4 patients were recruited, with 2 patients receiving treatment in each arm. The study was feasible, with a 66.7% enrolment rate, 75% completion rate, and 100% attendance for each intervention session. We achieved a 90% satisfaction rate with no serious adverse effects. All patients had improvement of motor power, Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Functional Independence Measure (FIM), Hospital Anxiety and Depression Scale (HADS), and quality of life scores at 1 month. FIM continued to improve at 3 months post-commencement of intervention. There was relative ease of use of the device. Conclusion This trial is feasible. A full-scale study is warranted, to compare RMIT against RMTT, which is a novel application.
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Affiliation(s)
- San San Tay
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore, Singapore
| | - Fuquan Zhang
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore, Singapore
| | | | - Xuan Han Koh
- Department of Health Services Research, Changi General Hospital, Singapore, Singapore
| | - Borisut Lau
- Department of Rehabilitative Services, Changi General Hospital, Singapore, Singapore
| | - Jin Rui Edmund Neo
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore, Singapore
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Tsai HT, Lau HY, Lin KC, Li YC, Lin CJ, Yao G, Lee YY, Chen WS, Chen CL, Chang YJ, Horng YS. Responsiveness and construct validity of two outcome measures of bilateral upper limb function in patients with chronic stroke. Front Neurol 2024; 15:1352365. [PMID: 38846043 PMCID: PMC11153685 DOI: 10.3389/fneur.2024.1352365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 05/07/2024] [Indexed: 06/09/2024] Open
Abstract
Background Stroke is a leading cause of long-term disability among stroke survivors. Despite the availability of numerous stroke rehabilitative therapies, such as mirror therapy, bilateral arm training, and robot-assisted therapy, the recovery of motor function after stroke remains incomplete. Bilateral arm function is a key component in stroke patients to perform activities of daily living and to reflect their functional autonomy. Objective This clinimetric study investigated and compared the construct validity and responsiveness of 2 bimanual activity outcome measures, the Chedoke Arm and Hand Activity Inventory (CAHAI) and the ABILHAND Questionnaire, in individuals receiving stroke rehabilitation. Methods The present study is a secondary analysis following the framework of the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). Individuals with chronic stroke (N = 113) were recruited from outpatient rehabilitation settings. Participants received 18 to 20 sessions of robot-assisted therapy, mirror therapy, combined therapy, or conventional rehabilitation for 4 to 6 weeks. The CAHAI, ABILHAND Questionnaire, and a comparison instrument, the Motor Activity Log (MAL), were administered twice at a 4- to 6-week interval to all participants. ABILHAND scores, in logits, were converted from raw ordinal scores into a linear measure. Results There was medium to large correlation of the CAHAI and the MAL (ρ = 0.60-0.62, p < 0.01) as well as the ABILHAND Questionnaire and the MAL (ρ = 0.44-0.51, p < 0.01). Change scores from the initial measurement to the post-intervention measurement demonstrated small to medium correlation of the CAHAI and the MAL (ρ = 0.27-0.31, p < 0.01) and medium to large correlation of the ABILHAND Questionnaire and the MAL (ρ = 0.37-0.41, p < 0.01). Overall, 7 of 8 hypotheses were supported. The hypothesis testing regarding the construct validity and responsiveness of the CAHAI and ABILHAND Questionnaire was confirmed. Conclusion The CAHAI and ABILHAND Questionnaire are both responsive and suitable to detect changes in bilateral arm functional daily activities in individuals with chronic stroke. Patient-reported outcome measures are recommended to use along with therapist-rated outcome measures for upper limb capacity evaluation in stroke rehabilitation. Further study with a prospective study design to capture specific clinical features of participants and the use of body-worn sensors, such as the arm accelerometer, is suggested.
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Affiliation(s)
- Han-ting Tsai
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hiu-ying Lau
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Keh-chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-chun Li
- Department of Occupational Therapy, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chia-jung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Grace Yao
- Department of Psychology, National Taiwan University, Taipei, Taiwan
| | - Ya-yun Lee
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-shiang Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chia-ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ya-ju Chang
- Neuroscience Research Center, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Yi-shiung Horng
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Tzuchi Hospital, Buddhist Tzuchi Medical Foundation, New Taipei City, Taiwan
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Ma HI, Liao WW, Lin CH, Chen IC, Wu CY. Indirect causal path from motor function to quality of life through daily use of the affected arm poststroke after task-specific training: a longitudinal mediation analysis. Disabil Rehabil 2024; 46:2089-2096. [PMID: 37243526 DOI: 10.1080/09638288.2023.2216948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE Task-specific training generally targets motor function, with the ultimate goal of improving quality of life (QoL). This study aimed to determine whether motor function indirectly affects QoL through daily use of the affected arm and activities of daily living (ADL) in patients with chronic stroke. METHODS This was a retrospective cohort study of 155 patients who received training for 90-120 min/session, 3-5 sessions/week, for 4-6 weeks. The training involved specific mirror or robot-assisted therapy, followed by functional task practice for 15-30 min in each session. Patients were assessed before and after the intervention. RESULTS At both pre-test and post-test, significant indirect effects of motor function on QoL through daily use of the affect arm and ADL were observed (β = 0.087-0.124). When the change scores of the measures between the pre-test and post-test were used, significant mediating effects of daily arm use on the relationship between motor function and QoL were identified (β = 0.094-0.103). CONCLUSIONS Enhanced motor function after intervention may lead to an increase in arm use for daily activities and subsequently result in an improvement in QoL. These results highlight the critical role of daily arm use in task-specific training aimed at improving QoL.
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Affiliation(s)
- Hui-Ing Ma
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wan-Wen Liao
- Department of Gerontological Health Care, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
| | - Chu-Hsu Lin
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - I-Chen Chen
- Department of Occupational Therapy, College of Nursing and Health Sciences, Da-Yeh University, Changhua, Taiwan
| | - Ching-Yi Wu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
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Hong R, Li B, Bao Y, Liu L, Jin L. Therapeutic robots for post-stroke rehabilitation. MEDICAL REVIEW (2021) 2024; 4:55-67. [PMID: 38515779 PMCID: PMC10954296 DOI: 10.1515/mr-2023-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/25/2024] [Indexed: 03/23/2024]
Abstract
Stroke is a prevalent, severe, and disabling health-care issue on a global scale, inevitably leading to motor and cognitive deficits. It has become one of the most significant challenges in China, resulting in substantial social and economic burdens. In addition to the medication and surgical interventions during the acute phase, rehabilitation treatment plays a crucial role in stroke care. Robotic technology takes distinct advantages over traditional physical therapy, occupational therapy, and speech therapy, and is increasingly gaining popularity in post-stroke rehabilitation. The use of rehabilitation robots not only alleviates the workload of healthcare professionals but also enhances the prognosis for specific stroke patients. This review presents a concise overview of the application of therapeutic robots in post-stroke rehabilitation, with particular emphasis on the recovery of motor and cognitive function.
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Affiliation(s)
- Ronghua Hong
- Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons’ Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
- Neurotoxin Research Center, Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Bingyu Li
- Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons’ Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Yunjun Bao
- Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons’ Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Lingyu Liu
- Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons’ Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Lingjing Jin
- Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons’ Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
- Neurotoxin Research Center, Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Collaborative Innovation Center for Brain Science, Tongji University, Shanghai, China
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Rozevink SG, Hijmans JM, Horstink KA, van der Sluis CK. Effectiveness of task-specific training using assistive devices and task-specific usual care on upper limb performance after stroke: a systematic review and meta-analysis. Disabil Rehabil Assist Technol 2023; 18:1245-1258. [PMID: 34788166 DOI: 10.1080/17483107.2021.2001061] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Task-specific rehabilitation is a key indicator for successful rehabilitation to improve the upper limb performance after stroke. Assistive robotic and non-robotic devices are emerging to provide rehabilitation therapy; however, the effectiveness of task-specific training programs using assistive training devices compared with task-specific usual care training has not been summarized yet. Therefore, the effectiveness of task-specific training using assistive arm devices (TST-AAD) compared with task-specific usual care (TSUC) on the upper limb performance of patients with a stroke was investigated. To assess task specificity, a set of criteria was proposed: participation, program, relevant, repeated, randomized, reconstruction and reinforced. MATERIALS AND METHODS Out of 855 articles, 17 fulfilled the selection criteria. A meta-analysis was performed on the Fugl-Meyer Assessment scores in the subacute and chronic stages after stroke and during follow-up. RESULTS AND CONCLUSION Both TST-AAD and TSUC improved the upper limb performance after stroke. In the sub-acute phase after stroke, TST-AAD was more effective than TSUC in reducing the upper limb impairment, although findings were based on only three studies. In the chronic phase, TST-AAD and TSUC showed similar effectiveness. No differences between the two types of training were found at the follow-up measurements. Future studies should describe training, device usage and criteria of task specificity in a standardized way to ease comparison.Implications for rehabilitationArm or hand function is often undertreated in stroke patients, assistive training devices may be able to improve the upper limb performance.Task-specific training using assistive devices is effective in improving the upper limb performance after stroke.Task-specific training using assistive devices seems to be more effective in reducing impairment compared with task specific usual care in the subacute phase after stroke, but they are equally effective in the chronic phase of stroke.
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Affiliation(s)
- Samantha G Rozevink
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - Juha M Hijmans
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - Koen A Horstink
- University of Groningen, University Medical Center Groningen, Department of Human Movement Sciences, Groningen, The Netherlands
| | - Corry K van der Sluis
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
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Chen ZJ, He C, Xu J, Zheng CJ, Wu J, Xia N, Hua Q, Xia WG, Xiong CH, Huang XL. Exoskeleton-Assisted Anthropomorphic Movement Training for the Upper Limb After Stroke: The EAMT Randomized Trial. Stroke 2023; 54:1464-1473. [PMID: 37154059 DOI: 10.1161/strokeaha.122.041480] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/07/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Robot-assisted arm training is generally delivered in the robot-like manner of planar or mechanical 3-dimensional movements. It remains unclear whether integrating upper extremity (UE) natural coordinated patterns into a robotic exoskeleton can improve outcomes. The study aimed to compare conventional therapist-mediated training to the practice of human-like gross movements derived from 5 typical UE functional activities managed with exoskeletal assistance as needed for patients after stroke. METHODS In this randomized, single-blind, noninferiority trial, patients with moderate-to-severe UE motor impairment due to subacute stroke were randomly assigned (1:1) to receive 20 sessions of 45-minute exoskeleton-assisted anthropomorphic movement training or conventional therapy. Treatment allocation was masked from independent assessors, but not from patients or investigators. The primary outcome was the change in the Fugl-Meyer Assessment for Upper Extremity from baseline to 4 weeks against a prespecified noninferiority margin of 4 points. Superiority would be tested if noninferiority was demonstrated. Post hoc subgroup analyses of baseline characteristics were performed for the primary outcome. RESULTS Between June 2020 and August 2021, totally 80 inpatients (67 [83.8%] males; age, 51.9±9.9 years; days since stroke onset, 54.6±38.0) were enrolled, randomly assigned to the intervention, and included in the intention-to-treat analysis. The mean Fugl-Meyer Assessment for Upper Extremity change in exoskeleton-assisted anthropomorphic movement training (14.73 points; [95% CI, 11.43-18.02]) was higher than that of conventional therapy (9.90 points; [95% CI, 8.15-11.65]) at 4 weeks (adjusted difference, 4.51 points [95% CI, 1.13-7.90]). Moreover, post hoc analysis favored the patient subgroup (Fugl-Meyer Assessment for Upper Extremity score, 23-38 points) with moderately severe motor impairment. CONCLUSIONS Exoskeleton-assisted anthropomorphic movement training appears to be effective for patients with subacute stroke through repetitive practice of human-like movements. Although the results indicate a positive sign for exoskeleton-assisted anthropomorphic movement training, further investigations into the long-term effects and paradigm optimization are warranted. REGISTRATION URL: https://www.chictr.org.cn; Unique identifier: ChiCTR2100044078.
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Affiliation(s)
- Ze-Jian Chen
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.-J.C., J.X., N.X., X.-L.H.)
- World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China (Z.-J.C., J.X., N.X., X.-L.H.)
| | - Chang He
- Institute of Medical Equipment Science and Engineering, Huazhong University of Science and Technology, Wuhan, China (C.H., C.-H.X.)
- State Key Laboratory of Digital Manufacturing Equipment and Technology, School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, China (C.H., C.-H.X.)
| | - Jiang Xu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.-J.C., J.X., N.X., X.-L.H.)
- World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China (Z.-J.C., J.X., N.X., X.-L.H.)
| | - Chan-Juan Zheng
- Department of Rehabilitation Medicine, Hubei Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Wuhan, China (C.-J.Z., J.W., Q.H.)
| | - Jing Wu
- Department of Rehabilitation Medicine, Hubei Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Wuhan, China (C.-J.Z., J.W., Q.H.)
| | - Nan Xia
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.-J.C., J.X., N.X., X.-L.H.)
- World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China (Z.-J.C., J.X., N.X., X.-L.H.)
| | - Qiang Hua
- Department of Rehabilitation Medicine, Hubei Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Wuhan, China (C.-J.Z., J.W., Q.H.)
| | - Wen-Guang Xia
- Hubei Rehabilitation Hospital, Wuhan, China (W.-G.X.)
| | - Cai-Hua Xiong
- Institute of Medical Equipment Science and Engineering, Huazhong University of Science and Technology, Wuhan, China (C.H., C.-H.X.)
- State Key Laboratory of Digital Manufacturing Equipment and Technology, School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, China (C.H., C.-H.X.)
| | - Xiao-Lin Huang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.-J.C., J.X., N.X., X.-L.H.)
- World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China (Z.-J.C., J.X., N.X., X.-L.H.)
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Purohit R, Wang S, Bhatt T. Effect of Aging and Cortical Stroke on Motor Adaptation to Overground Gait-Slips: Quantifying Differences in Adaptation Rate and Adaptation Plateau. BIOMECHANICS (BASEL, SWITZERLAND) 2023; 3:29-44. [PMID: 39802458 PMCID: PMC11722462 DOI: 10.3390/biomechanics3010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2025]
Abstract
We examined the effect of aging and cortical stroke on the rate of motor adaptation (adaptation rate) and amount of performance gains (adaptation plateau) in balance skills. Fourteen older (≥60 years) and fifteen younger (<60 years) adults with chronic stroke, and thirteen healthy older adults (≥60 years) participated. Participants experienced 8 consecutive gait-slips (≤45 cm) to their non-paretic/dominant limb. Slip outcome (backward/no balance loss) was compared using generalized estimating equations (GEE). Proactive (pre-slip stability) and reactive adjustments (post-slip stability, slip displacement and velocity, and compensatory step length) were compared using non-linear regression models. GEE showed the main effect of group, trial, and group × trial interaction for slip outcome (p < 0.05). There were no differences in the adaptation rate for proactive and reactive variables and plateau for proactive variables (p > 0.05). However, both stroke groups demonstrated a smaller adaptation plateau for the majority of reactive variables compared to healthy older adults (p < 0.05). The rate of adaptation to gait-slips does not slow with aging and cortical stroke; however, cortical stroke, age notwithstanding, may reduce performance gains in reactive balance skills, possibly hindering retention and transfer to real-life scenarios. People with stroke may need adjunctive therapies/supplemental agents to apply laboratory-acquired balance skills to daily life.
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Affiliation(s)
- Rudri Purohit
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL 60612, USA
- PhD program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois, Chicago, IL 60612, USA
| | - Shuaijie Wang
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL 60612, USA
| | - Tanvi Bhatt
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL 60612, USA
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Zanatta F, Farhane-Medina NZ, Adorni R, Steca P, Giardini A, D'Addario M, Pierobon A. Combining robot-assisted therapy with virtual reality or using it alone? A systematic review on health-related quality of life in neurological patients. Health Qual Life Outcomes 2023; 21:18. [PMID: 36810124 PMCID: PMC9942343 DOI: 10.1186/s12955-023-02097-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/07/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND In the field of neurorehabilitation, robot-assisted therapy (RAT) and virtual reality (VR) have so far shown promising evidence on multiple motor and functional outcomes. The related effectiveness on patients' health-related quality of life (HRQoL) has been investigated across neurological populations but still remains unclear. The present study aimed to systematically review the studies investigating the effects of RAT alone and with VR on HRQoL in patients with different neurological diseases. METHODS A systematic review of the studies evaluating the impact of RAT alone and combined with VR on HRQoL in patients affected by neurological diseases (i.e., stroke, multiple sclerosis, spinal cord injury, Parkinson's Disease) was conducted according to PRISMA guidelines. Electronic searches of PubMed, Web of Science, Cochrane Library, CINAHL, Embase, and PsychINFO (2000-2022) were performed. Risk of bias was evaluated through the National Institute of Health Quality Assessment Tool. Descriptive data regarding the study design, participants, intervention, rehabilitation outcomes, robotic device typology, HRQoL measures, non-motor factors concurrently investigated, and main results were extracted and meta-synthetized. RESULTS The searches identified 3025 studies, of which 70 met the inclusion criteria. An overall heterogeneous configuration was found regarding the study design adopted, intervention procedures and technological devices implemented, rehabilitation outcomes (i.e., related to both upper and lower limb impairment), HRQoL measures administered, and main evidence. Most of the studies reported significant effects of both RAT and RAT plus VR on patients HRQoL, whether they adopted generic or disease-specific HRQoL measures. Significant post-intervention within-group changes were mainly found across neurological populations, while fewer studies reported significant between-group comparisons, and then, mostly in patients with stroke. Longitudinal investigations were also observed (up to 36 months), but significant longitudinal effects were exclusively found in patients with stroke or multiple sclerosis. Finally, concurrent evaluations on non-motor outcomes beside HRQoL included cognitive (i.e., memory, attention, executive functions) and psychological (i.e., mood, satisfaction with the treatment, device usability, fear of falling, motivation, self-efficacy, coping, and well-being) variables. CONCLUSIONS Despite the heterogeneity observed among the studies included, promising evidence was found on the effectiveness of RAT and RAT plus VR on HRQoL. However, further targeted short- and long-term investigations, are strongly recommended for specific HRQoL subcomponents and neurological populations, through the adoption of defined intervention procedures and disease-specific assessment methodology.
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Affiliation(s)
- Francesco Zanatta
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Naima Z Farhane-Medina
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
- Department of Psychology, University of Córdoba, Córdoba, Spain
| | - Roberta Adorni
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.
| | - Patrizia Steca
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Anna Giardini
- Information Technology Department, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Marco D'Addario
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Antonia Pierobon
- Psychology Unit of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS, Montescano, Italy
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Johansen T, Sørensen L, Kolskår KK, Strøm V, Wouda MF. Effectiveness of robot-assisted arm exercise on arm and hand function in stroke survivors - A systematic review and meta-analysis. J Rehabil Assist Technol Eng 2023; 10:20556683231183639. [PMID: 37426037 PMCID: PMC10327418 DOI: 10.1177/20556683231183639] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Objective: To examine the treatment effect of commercially available robotic-assisted devices, compared to traditional occupational- and physiotherapy on arm and hand function in persons with stroke. Methods: A systematic literature search was conducted in Medline, EMBASE, CINAHL and Cochrane Central Register of Controlled Trials up to January 2022. Randomized controlled trials (RCT's) involving persons with stroke of all ages and robot-assisted exercise as method for arm and hand function, compared to traditional therapy methods were included. Three authors performed the selection independently. The quality of evidence across studies was assessed using GRADE. Results: Eighteen RCT's were included in the study. A random effects meta-analysis showed a statistically significantly higher treatment effect in the robotic-assisted exercise group (p=<0.0001) compared to the traditional treatment group, with a total effect size of 0.44 (CI = 0.22-0.65). Heterogeneity was high, measured with I2 of 65%). Subgroup analyses showed no significant effects of the type of robotic device, treatment frequency or duration of intervention. Discussion and conclusion: Even though the analysis showed significant improvement in arm and hand function in favor of the robotic-assisted exercise group, the results in this systematic review should be interpreted with caution. This is due to high heterogeneity among the studies included and the presence of possible publication bias. Results of this study highlight the need for larger and more methodological robust RCT's, with a focus on reporting training intensity during robotic exercise.
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Affiliation(s)
- Truls Johansen
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Linda Sørensen
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
- Department of Innovation, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Knut K Kolskår
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Vegard Strøm
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Matthijs F Wouda
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
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11
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Grosmaire AG, Pila O, Breuckmann P, Duret C. Robot-assisted therapy for upper limb paresis after stroke: Use of robotic algorithms in advanced practice. NeuroRehabilitation 2022; 51:577-593. [PMID: 36530096 DOI: 10.3233/nre-220025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Rehabilitation of stroke-related upper limb paresis is a major public health issue. OBJECTIVE Robotic systems have been developed to facilitate neurorehabilitation by providing key elements required to stimulate brain plasticity and motor recovery, namely repetitive, intensive, adaptative training with feedback. Although the positive effect of robot-assisted therapy on motor impairments has been well demonstrated, the effect on functional capacity is less certain. METHOD This narrative review outlines the principles of robot-assisted therapy for the rehabilitation of post-stroke upper limb paresis. RESULTS A paradigm is proposed to promote not only recovery of impairment but also function. CONCLUSION Further studies that would integrate some principles of the paradigm described in this paper are needed.
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Affiliation(s)
- Anne-Gaëlle Grosmaire
- Unité de Neurorééducation, Médecine Physique et de Réadaptation, Centre de Rééducation Fonctionnelle Les Trois Soleils, Boissise-Le-Roi, France
| | - Ophélie Pila
- Unité de Neurorééducation, Médecine Physique et de Réadaptation, Centre de Rééducation Fonctionnelle Les Trois Soleils, Boissise-Le-Roi, France
| | - Petra Breuckmann
- Unité de Neurorééducation, Médecine Physique et de Réadaptation, Centre de Rééducation Fonctionnelle Les Trois Soleils, Boissise-Le-Roi, France
| | - Christophe Duret
- Unité de Neurorééducation, Médecine Physique et de Réadaptation, Centre de Rééducation Fonctionnelle Les Trois Soleils, Boissise-Le-Roi, France
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12
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Lee YC, Li YC, Lin KC, Yao G, Chang YJ, Lee YY, Liu CT, Hsu WL, Wu YH, Chu HT, Liu TX, Yeh YP, Chang C. Effects of robotic priming of bilateral arm training, mirror therapy, and impairment-oriented training on sensorimotor and daily functions in patients with chronic stroke: study protocol of a single-blind, randomized controlled trial. Trials 2022; 23:566. [PMID: 35841056 PMCID: PMC9287972 DOI: 10.1186/s13063-022-06498-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 06/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Combining robotic therapy (RT) with task-oriented therapy is an emerging strategy to facilitate motor relearning in stroke rehabilitation. This study protocol will compare novel rehabilitation regimens that use bilateral RT as a priming technique to augment two task-oriented therapies: mirror therapy (MT) and bilateral arm training (BAT) with a control intervention: RT combined with impairment-oriented training (IOT). METHODS This single-blind, randomized, comparative efficacy study will involve 96 participants with chronic stroke. Participants will be randomized into bilateral RT+MT, bilateral RT+BAT, and bilateral RT+IOT groups and receive 18 intervention sessions (90 min/day, 3 d/week for 6 weeks). The outcomes will include the Fugl-Meyer Assessment, Stroke Impact Scale version 3.0, Medical Research Council scale, Revised Nottingham Sensory Assessment, ABILHAND Questionnaire, and accelerometer and will be assessed at baseline, after treatment, and at the 3-month follow-up. Analysis of covariance and the chi-square automatic interaction detector method will be used to examine the comparative efficacy and predictors of outcome, respectively, after bilateral RT+MT, bilateral RT+BAT, and bilateral RT+IOT. DISCUSSION The findings are expected to contribute to the research and development of robotic devices, to update the evidence-based protocols in postacute stroke care programs, and to investigate the use of accelerometers for monitoring activity level in real-life situations, which may in turn promote home-based practice by the patients and their caregivers. Directions for further studies and empirical implications for clinical practice will be further discussed in upper-extremity rehabilitation after stroke. TRIAL REGISTRATION This trial was registered December 12, 2018, at www. CLINICALTRIALS gov ( NCT03773653 ).
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Affiliation(s)
- Yi-Chen Lee
- School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xu Zhou Road, Taipei, Taiwan
| | - Yi-Chun Li
- School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xu Zhou Road, Taipei, Taiwan
| | - Keh-Chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xu Zhou Road, Taipei, Taiwan. .,Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
| | - Grace Yao
- Department of Psychology, National Taiwan University, Taipei, Taiwan
| | - Ya-Ju Chang
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Yun Lee
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Ting Liu
- Department of Rehabilitation, Taipei Tzu Chi Hospital, the Buddhist Tzu-Chi Medical Foundation, Taipei, Taiwan
| | - Wan-Ling Hsu
- Department of Rehabilitation, Taipei Tzu Chi Hospital, the Buddhist Tzu-Chi Medical Foundation, Taipei, Taiwan
| | - Yi-Hsuan Wu
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Ho-Ta Chu
- Rehabilitation Department, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Ting-Xuan Liu
- School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xu Zhou Road, Taipei, Taiwan
| | - Yi-Ping Yeh
- School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xu Zhou Road, Taipei, Taiwan
| | - Chieh Chang
- School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xu Zhou Road, Taipei, Taiwan
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13
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Zuccon G, Lenzo B, Bottin M, Rosati G. Rehabilitation robotics after stroke: a bibliometric literature review. Expert Rev Med Devices 2022; 19:405-421. [PMID: 35786139 DOI: 10.1080/17434440.2022.2096438] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Stroke is the leading cause of long-term disability in developed countries. Due to population aging, the number of people requiring rehabilitation after stroke is going to rise in the coming decades. Robot-mediated neurorehabilitation has the potential to improve clinical outcomes of rehabilitation treatments. A statistical analysis of the literature aims to focus on the main trend of this topic. AREAS COVERED A bibliometric survey on post-stroke robotic rehabilitation was performed through a database collection of scientific publications in the field of rehabilitation robotics. By covering the last 20 years, 17429 sources were collected. Relevant patterns and statistics concerning the main research areas were analyzed. Leading journals and conferences which publish and disseminate knowledge in the field were identified. A detailed nomenclature study was carried out. The time trends of the research field were captured. Opinions and predictions of future trends that are expected to shape the near future of the field were discussed. EXPERT OPINION Data analysis reveals the continuous expansion of the research field over the last two decades, which is expected to rise considerably in near future. More attention will be paid to the lower limbs rehabilitation and disease/design specific applications in early-stage patients.
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Affiliation(s)
- Giacomo Zuccon
- Department of Industrial Engineering, University of Padua, Padua, Italy
| | - Basilio Lenzo
- Department of Industrial Engineering, University of Padua, Padua, Italy
| | - Matteo Bottin
- Department of Industrial Engineering, University of Padua, Padua, Italy
| | - Giulio Rosati
- Department of Industrial Engineering, University of Padua, Padua, Italy
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14
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Nam C, Zhang B, Chow T, Ye F, Huang Y, Guo Z, Li W, Rong W, Hu X, Poon W. Home-based self-help telerehabilitation of the upper limb assisted by an electromyography-driven wrist/hand exoneuromusculoskeleton after stroke. J Neuroeng Rehabil 2021; 18:137. [PMID: 34526058 PMCID: PMC8442816 DOI: 10.1186/s12984-021-00930-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 08/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most stroke survivors have sustained upper limb impairment in their distal joints. An electromyography (EMG)-driven wrist/hand exoneuromusculoskeleton (WH-ENMS) was developed previously. The present study investigated the feasibility of a home-based self-help telerehabilitation program assisted by the aforementioned EMG-driven WH-ENMS and its rehabilitation effects after stroke. METHODS Persons with chronic stroke (n = 11) were recruited in a single-group trial. The training progress, including the training frequency and duration, was telemonitored. The clinical outcomes were evaluated using the Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), Motor Functional Independence Measure (FIM), and Modified Ashworth Scale (MAS). Improvement in muscle coordination was investigated in terms of the EMG activation level and the Co-contraction Index (CI) of the target muscles, including the abductor pollicis brevis (APB), flexor carpi radialis-flexor digitorum (FCR-FD), extensor carpi ulnaris-extensor digitorum (ECU-ED), biceps brachii (BIC), and triceps brachii (TRI). The movement smoothness and compensatory trunk movement were evaluated in terms of the following two kinematic parameters: number of movement units (NMUs) and maximal trunk displacement (MTD). The above evaluations were conducted before and after the training. RESULTS All of the participants completed the home-based program with an intensity of 63.0 ± 1.90 (mean ± SD) min/session and 3.73 ± 0.75 (mean ± SD) sessions/week. After the training, motor improvements in the entire upper limb were found, as indicated by the significant improvements (P < 0.05) in the FMA, ARAT, WMFT, and MAS; significant decreases (P < 0.05) in the EMG activation levels of the APB and FCR-FD; significant decreases (P < 0.05) in the CI of the ECU-ED/FCR-FD, ECU-ED/BIC, FCR-FD/APB, FCR-FD/BIC, FCR-FD/TRI, APB/BIC and BIC/TRI muscle pairs; and significant reductions (P < 0.05) in the NMUs and MTD. CONCLUSIONS The results suggested that the home-based self-help telerehabilitation program assisted by EMG-driven WH-ENMS is feasible and effective for improving the motor function of the paretic upper limb after stroke. Trial registration ClinicalTrials.gov. NCT03752775; Date of registration: November 20, 2018.
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Affiliation(s)
- Chingyi Nam
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Bingbing Zhang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Tszying Chow
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Fuqiang Ye
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yanhuan Huang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ziqi Guo
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Waiming Li
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Wei Rong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Xiaoling Hu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China. .,The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, 518034, China.
| | - Waisang Poon
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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15
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Lee YC, Li YC, Lin KC, Chen CL, Wu YH, Kuo C, Yeh YP, Liu TX. Effects of proximal priority and distal priority robotic priming techniques with impairment-oriented training of upper limb functions in patients with chronic stroke: study protocol for a single-blind, randomized controlled trial. Trials 2021; 22:604. [PMID: 34496938 PMCID: PMC8424932 DOI: 10.1186/s13063-021-05561-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 08/24/2021] [Indexed: 11/12/2022] Open
Abstract
Background The sequence of establishing a proximal stability or function before facilitation of the distal body part has long been recognized in stroke rehabilitation practice but lacks scientific evidence. This study plans to examine the effects of proximal priority robotic priming and impairment-oriented training (PRI) and distal priority robotic priming and impairment-oriented training (DRI). Methods This single-blind, randomized, comparative efficacy study will involve 40 participants with chronic stroke. Participants will be randomized into the PRI or DRI groups and receive 18 intervention sessions (90 min/day, 3 days/weeks for 6 weeks). The Fugl-Meyer Assessment Upper Extremity subscale, Medical Research Council Scale, Revised Nottingham Sensory Assessment, and Wolf Motor Function Test will be administered at baseline, after treatment, and at the 3-month follow-up. Two-way repeated-measures analysis of variance and the chi-square automatic interaction detector method will be used to examine the comparative efficacy and predictors of outcome, respectively, after PRI and DRI. Discussion Through manipulating the sequence of applying wrist and forearm robots in therapy, this study will attempt to examine empirically the priming effect of proximal or distal priority robotic therapy in upper extremity impairment-oriented training for people with stroke. The findings will provide directions for further studies and empirical implications for clinical practice in upper extremity rehabilitation after stroke. Trial Registration ClinicalTrials.gov NCT04446273. Registered on June 23, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05561-6.
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Affiliation(s)
- Yi-Chen Lee
- School of Occupational Therapy, College of Medicine, National Taiwan University, No.17, F4, Xu Zhou Road, Zhongzheng Dist, Taipei City, 100, Taiwan
| | - Yi-Chun Li
- School of Occupational Therapy, College of Medicine, National Taiwan University, No.17, F4, Xu Zhou Road, Zhongzheng Dist, Taipei City, 100, Taiwan
| | - Keh-Chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, No.17, F4, Xu Zhou Road, Zhongzheng Dist, Taipei City, 100, Taiwan. .,Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No.1, Changde St., Zhongzheng Dist, Taipei City, 100, Taiwan.
| | - Chia-Ling Chen
- Graduate Institute of Early Intervention, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan.,Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 33305, Taiwan
| | - Yi-Hsuan Wu
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No.1, Changde St., Zhongzheng Dist, Taipei City, 100, Taiwan
| | - Chihchieh Kuo
- Rehabilitation Department, Feng Yuan Hospital, Ministry of Health and Welfare, No.100, An-Kan Road, Fengyuan Dist, Taichung City, 420, Taiwan
| | - Yi-Ping Yeh
- School of Occupational Therapy, College of Medicine, National Taiwan University, No.17, F4, Xu Zhou Road, Zhongzheng Dist, Taipei City, 100, Taiwan
| | - Ting-Xuan Liu
- School of Occupational Therapy, College of Medicine, National Taiwan University, No.17, F4, Xu Zhou Road, Zhongzheng Dist, Taipei City, 100, Taiwan
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16
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Bohannon RW. Characterization of muscle strength using the strength domain of the stroke impact scale: An integrative review. ISOKINET EXERC SCI 2021. [DOI: 10.3233/ies-210101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE: Muscle weakness is among the most common and obvious impairments in older adults and individuals with neurologic disorders. Although impairments in muscle strength are typically characterized using performance measures, the impairments have also been described using patient or observer-report. The objective of this review was to summarize literature describing use of a patient-report instrument, the Strength Domain (SD) of the Stroke Impact Scale (SIS), to grade strength impairments. METHODS: Peer-reviewed literature reporting SD scores for the SIS was identified using computerized searches of the CINAHL, PubMed, and Scopus databases followed by hand searches. Potentially relevant articles were then mined for data on the participants tested, the SIS version used, scores documented, and clinimetric properties reported. RESULTS: Sixty-five articles were judged appropriate based on inclusion and exclusion criteria. The articles involved more than 7000 residents of 22 countries. All articles focused on individuals with stroke (usually chronic), although one also included community-dwelling adults without stroke. The SIS version used was frequently unreported, but 3.0 was version most often specified. For articles reporting SD scale scores the mean ranged from 19.7 to 85.5. Construct (known groups, convergent, and discriminant) validity of the SD was supported by the literature as was its internal consistency and test-retest reliability. Responsiveness of the SD was evinced by numerous studies showing increases in SD scores with time or accompanying effective interventions. However, only one study indicated responsiveness using an anchor-based statistic. CONCLUSIONS: The SD of the SIS is a well-established and mostly clinimetrically sound patient-report measure of paretic limb strength among individuals with stroke. Its use with individuals with weakness accompanying aging or diagnoses other than stroke remains to be substantiated.
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17
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Rong J, Ding L, Xiong L, Zhang W, Wang W, Deng M, Wang Y, Chen Z, Jia J. Mirror Visual Feedback Prior to Robot-Assisted Training Facilitates Rehabilitation After Stroke: A Randomized Controlled Study. Front Neurol 2021; 12:683703. [PMID: 34305792 PMCID: PMC8297738 DOI: 10.3389/fneur.2021.683703] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Robot-assisted training has been widely used in neurorehabilitation, but its effect on facilitating recovery after stroke remains controversial. One possible reason might be lacking consideration of the role of embodiment in robotic systems. Mirror visual feedback is an ideal method to approach embodiment. Thus, we hypothesized that mirror visual feedback priming with subsequent robot-assisted training might provide additional treatment benefits in rehabilitation. Method: This is a prospective, assessor-blinded, randomized, controlled study. Forty subacute stroke patients were randomly assigned into an experimental group (N = 20) or a control group (N = 20). They received either mirror visual feedback or sham-mirror visual feedback prior to robot-assisted training for 1.5 h/day, 5 days/week for 4 weeks. Before and after intervention, the Fugl-Meyer Assessment Upper Limb subscale, the Functional Independence Measure, the modified Barthel Index, and grip strength were measured. Scores of four specified games were recorded pre and post one-time mirror visual feedback priming before intervention in the experimental group. Results: All measurements improved significantly in both groups following interventions. Moreover, the Fugl-Meyer Assessment Upper Limb subscale, self-care subscale of the Functional Independence Measure, and the grip strength were improved significantly in the experimental group after a 4-week intervention, compared with the control group. Significantly higher scores of two games were revealed after one-time priming. Conclusions: Mirror visual feedback prior to robot-assisted training could prompt motor recovery, increase ability of self-care, and potentially enhance grip strength in stroke patients, compared to control treatment. Moreover, mirror visual feedback priming might have the capability to improve the patient's performance and engagement during robot-assisted training, which could prompt the design and development of robotic systems. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: ChiCTR1900023356.
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Affiliation(s)
- Jifeng Rong
- The Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Li Ding
- The Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Li Xiong
- The Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Wen Zhang
- The Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Weining Wang
- The Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Meikui Deng
- The Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Yana Wang
- The Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Zhen Chen
- The Neurorehabilitation Centre, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Jie Jia
- The Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China.,The National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
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18
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Exoskeleton-Assisted Anthropomorphic Movement Training (EAMT) for Poststroke Upper Limb Rehabilitation: A Pilot Randomized Controlled Trial. Arch Phys Med Rehabil 2021; 102:2074-2082. [PMID: 34174225 DOI: 10.1016/j.apmr.2021.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the feasibility of exoskeleton-assisted anthropomorphic movement training (EAMT) and its effects on upper extremity motor impairment, function, and kinematics after stroke. DESIGN A single-blind pilot randomized controlled trial. SETTING Stroke rehabilitation inpatient unit. PARTICIPANTS Participants with a hemiplegia (N=20) due to a first-ever, unilateral, subacute stroke who had a score of 8-47 on the Fugl-Meyer Assessment for Upper Extremity (FMA-UE). INTERVENTIONS The exoskeleton group received EAMT therapy that provided task-specific training under anthropomorphic trajectories and postures. The control group received conventional upper limb therapy. For both groups, therapy was delivered at the same intensity, frequency, and duration: 45 minutes daily, 5 days per week, for 4 weeks. MAIN OUTCOME MEASURES Primary outcome: feasibility analysis. SECONDARY OUTCOMES FMA-UE, Action Research Arm Test (ARAT), modified Barthel Index (MBI), and kinematic metrics during exoskeleton therapy. RESULTS Twenty participants with subacute stroke were recruited and completed all therapy sessions. EAMT therapy was feasible and acceptable for the participants. The recruitment rate, retention rate, and number of therapists required for EAMT therapy were acceptable compared with other robotic trials. EAMT was determined to be safe, as no adverse event occurred except tolerable muscle fatigue in 2 participants. There were significant between-group differences in the change scores of FMA-UE (difference, 4.30 points; P=.04) and MBI (difference, 8.70 points; P=.03) in favor of EAMT therapy. No significant between-group difference was demonstrated for the change scores of ARAT (P=.18). Participants receiving EAMT showed significant improvements in kinematic metrics after treatment (P<.01). CONCLUSIONS Our results indicate that EAMT is a feasible approach and may improve upper extremity motor impairment, activities of daily living, and kinematics after stroke. However, fully powered randomized controlled trials are warranted to confirm the results of this pilot study and explore the underlying mechanisms by which EAMT therapy might work.
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19
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Carswell C, Rea PM. What the Tech? The Management of Neurological Dysfunction Through the Use of Digital Technology. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1317:131-145. [PMID: 33945135 DOI: 10.1007/978-3-030-61125-5_7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Worldwide, it is estimated that millions of individuals suffer from a neurological disorder which can be the result of head injuries, ischaemic events such as a stroke, or neurodegenerative disorders such as Parkinson's disease (PD) and multiple sclerosis (MS). Problems with mobility and hemiparesis are common for these patients, making daily life, social factors and independence heavily affected. Current therapies aimed at improving such conditions are often tedious in nature, with patients often losing vital motivation and positive outlook towards their rehabilitation. The interest in the use of digital technology in neuro-rehabilitation has skyrocketed in the past decade. To gain insight, a systematic review of the literature in the field was conducting following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines for three categories: stroke, Parkinson's disease and multiple sclerosis. It was found that the majority of the literature (84%) was in favour of the use of digital technologies in the management of neurological dysfunction; with some papers taking a "neutral" or "against" standpoint. It was found that the use of technologies such as virtual reality (VR), robotics, wearable sensors and telehealth was highly accepted by patients, helped to improve function, reduced anxiety and make therapy more accessible to patients living in more remote areas. The most successful therapies were those that used a combination of conventional therapies and new digital technologies.
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Affiliation(s)
- Caitlin Carswell
- Anatomy Facility, School of Life Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Paul M Rea
- School of Life Sciences, University of Glasgow, Glasgow, UK.
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20
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Heng HM, Lu MK, Chou LW, Meng NH, Huang HC, Hamada M, Tsai CH, Chen JC. Changes in Balance, Gait and Electroencephalography Oscillations after Robot-Assisted Gait Training: An Exploratory Study in People with Chronic Stroke. Brain Sci 2020; 10:brainsci10110821. [PMID: 33171938 PMCID: PMC7694605 DOI: 10.3390/brainsci10110821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 11/24/2022] Open
Abstract
Robot-assisted gait training (RAGT) systems offer the advantages of standard rehabilitation and provide precise and quantifiable control of therapy. We examined the clinical outcome of RAGT and analyzed the correlations between gait analysis data and event-related desynchronization (ERD) and event-related synchronization (ERS) in patients with chronic stroke. We applied the Berg balance scale (BBS) and analyzed gait parameters and the ERD and ERS of self-paced voluntary leg movements performed by patients with chronic stroke before and after undergoing RAGT. A significant change was observed in BBS (p = 0.011). We also showed preliminary outcomes of changes in gait cycle duration (p = 0.015) and in ipsilesional ERS in the low-beta (p = 0.033) and high-beta (p = 0.034) frequency bands before and after RAGT. In addition, correlations were observed between BBS and ipsilesional ERS in the alpha and low-beta bands (r = −0.52, p = 0.039; r = −0.52, p = 0.040). The study demonstrated that RAGT can improve balance and provided an idea of the possible role of brain oscillation and clinical outcomes in affecting stroke rehabilitation.
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Affiliation(s)
- Hoon-Ming Heng
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung City 404, Taiwan; (H.-M.H.); (M.-K.L.); (H.-C.H.); (C.-H.T.)
| | - Ming-Kuei Lu
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung City 404, Taiwan; (H.-M.H.); (M.-K.L.); (H.-C.H.); (C.-H.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung City 404, Taiwan
| | - Li-Wei Chou
- Department of Rehabilitation, Asia University Hospital, Taichung City 404, Taiwan;
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung City 404, Taiwan;
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung City 404, Taiwan
| | - Nai-Hsin Meng
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung City 404, Taiwan;
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung City 404, Taiwan
| | - Hui-Chun Huang
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung City 404, Taiwan; (H.-M.H.); (M.-K.L.); (H.-C.H.); (C.-H.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung City 404, Taiwan
| | - Masashi Hamada
- Department of Neurology, The University of Tokyo, Graduate School of Medicine, Tokyo 100-0000, Japan;
| | - Chon-Haw Tsai
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung City 404, Taiwan; (H.-M.H.); (M.-K.L.); (H.-C.H.); (C.-H.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung City 404, Taiwan
| | - Jui-Cheng Chen
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung City 404, Taiwan; (H.-M.H.); (M.-K.L.); (H.-C.H.); (C.-H.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung City 404, Taiwan
- Department of Neurology, China Medical University Hsinchu Hospital, Hsinchu 300, Taiwan
- Correspondence:
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Rodgers H, Bosomworth H, Krebs HI, van Wijck F, Howel D, Wilson N, Finch T, Alvarado N, Ternent L, Fernandez-Garcia C, Aird L, Andole S, Cohen DL, Dawson J, Ford GA, Francis R, Hogg S, Hughes N, Price CI, Turner DL, Vale L, Wilkes S, Shaw L. Robot-assisted training compared with an enhanced upper limb therapy programme and with usual care for upper limb functional limitation after stroke: the RATULS three-group RCT. Health Technol Assess 2020; 24:1-232. [PMID: 33140719 PMCID: PMC7682262 DOI: 10.3310/hta24540] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Loss of arm function is common after stroke. Robot-assisted training may improve arm outcomes. OBJECTIVE The objectives were to determine the clinical effectiveness and cost-effectiveness of robot-assisted training, compared with an enhanced upper limb therapy programme and with usual care. DESIGN This was a pragmatic, observer-blind, multicentre randomised controlled trial with embedded health economic and process evaluations. SETTING The trial was set in four NHS trial centres. PARTICIPANTS Patients with moderate or severe upper limb functional limitation, between 1 week and 5 years following first stroke, were recruited. INTERVENTIONS Robot-assisted training using the Massachusetts Institute of Technology-Manus robotic gym system (InMotion commercial version, Interactive Motion Technologies, Inc., Watertown, MA, USA), an enhanced upper limb therapy programme comprising repetitive functional task practice, and usual care. MAIN OUTCOME MEASURES The primary outcome was upper limb functional recovery 'success' (assessed using the Action Research Arm Test) at 3 months. Secondary outcomes at 3 and 6 months were the Action Research Arm Test results, upper limb impairment (measured using the Fugl-Meyer Assessment), activities of daily living (measured using the Barthel Activities of Daily Living Index), quality of life (measured using the Stroke Impact Scale), resource use costs and quality-adjusted life-years. RESULTS A total of 770 participants were randomised (robot-assisted training, n = 257; enhanced upper limb therapy, n = 259; usual care, n = 254). Upper limb functional recovery 'success' was achieved in the robot-assisted training [103/232 (44%)], enhanced upper limb therapy [118/234 (50%)] and usual care groups [85/203 (42%)]. These differences were not statistically significant; the adjusted odds ratios were as follows: robot-assisted training versus usual care, 1.2 (98.33% confidence interval 0.7 to 2.0); enhanced upper limb therapy versus usual care, 1.5 (98.33% confidence interval 0.9 to 2.5); and robot-assisted training versus enhanced upper limb therapy, 0.8 (98.33% confidence interval 0.5 to 1.3). The robot-assisted training group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale) than the usual care group at 3 and 6 months. The enhanced upper limb therapy group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale), better mobility (as measured by the Stroke Impact Scale mobility domain) and better performance in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the usual care group, at 3 months. The robot-assisted training group performed less well in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the enhanced upper limb therapy group at 3 months. No other differences were clinically important and statistically significant. Participants found the robot-assisted training and the enhanced upper limb therapy group programmes acceptable. Neither intervention, as provided in this trial, was cost-effective at current National Institute for Health and Care Excellence willingness-to-pay thresholds for a quality-adjusted life-year. CONCLUSIONS Robot-assisted training did not improve upper limb function compared with usual care. Although robot-assisted training improved upper limb impairment, this did not translate into improvements in other outcomes. Enhanced upper limb therapy resulted in potentially important improvements on upper limb impairment, in performance of activities of daily living, and in mobility. Neither intervention was cost-effective. FUTURE WORK Further research is needed to find ways to translate the improvements in upper limb impairment seen with robot-assisted training into improvements in upper limb function and activities of daily living. Innovations to make rehabilitation programmes more cost-effective are required. LIMITATIONS Pragmatic inclusion criteria led to the recruitment of some participants with little prospect of recovery. The attrition rate was higher in the usual care group than in the robot-assisted training or enhanced upper limb therapy groups, and differential attrition is a potential source of bias. Obtaining accurate information about the usual care that participants were receiving was a challenge. TRIAL REGISTRATION Current Controlled Trials ISRCTN69371850. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 54. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Helen Rodgers
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Helen Bosomworth
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hermano I Krebs
- Mechanical Engineering Department, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Frederike van Wijck
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Denise Howel
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nina Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tracy Finch
- Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | | | - Laura Ternent
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Lydia Aird
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | - Sreeman Andole
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - David L Cohen
- London North West University Healthcare NHS Trust, London, UK
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Gary A Ford
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Medical Sciences Division, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard Francis
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Steven Hogg
- Lay investigator (contact Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK)
| | | | - Christopher I Price
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | - Duncan L Turner
- School of Health, Sport and Bioscience, University of East London, London, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Scott Wilkes
- School of Medicine, University of Sunderland, Sunderland, UK
| | - Lisa Shaw
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Comparisons between end-effector and exoskeleton rehabilitation robots regarding upper extremity function among chronic stroke patients with moderate-to-severe upper limb impairment. Sci Rep 2020; 10:1806. [PMID: 32019981 PMCID: PMC7000418 DOI: 10.1038/s41598-020-58630-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 01/19/2020] [Indexed: 11/08/2022] Open
Abstract
End-effector (EE) and exoskeleton (Exo) robots have not been directly compared previously. The present study aimed to directly compare EE and Exo robots in chronic stroke patients with moderate-to-severe upper limb impairment. This single-blinded, randomised controlled trial included 38 patients with stroke who were admitted to the rehabilitation hospital. The patients were equally divided into EE and Exo groups. Baseline characteristics, including sex, age, stroke type, brain lesion side (left/right), stroke duration, Fugl–Meyer Assessment (FMA)–Upper Extremity score, and Wolf Motor Function Test (WMFT) score, were assessed. Additionally, impairment level (FMA, motor status score), activity (WMFT), and participation (stroke impact scale [SIS]) were evaluated. There were no significant differences in baseline characteristics between the groups. After the intervention, improvements were significantly better in the EE group with regard to activity and participation (WMFT–Functional ability rating scale, WMFT–Time, and SIS–Participation). There was no intervention-related adverse event. The EE robot intervention is better than the Exo robot intervention with regard to activity and participation among chronic stroke patients with moderate-to-severe upper limb impairment. Further research is needed to confirm this novel finding.
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The Priming Effects of Mirror Visual Feedback on Bilateral Task Practice: A Randomized Controlled Study. Occup Ther Int 2019; 2019:3180306. [PMID: 31824233 PMCID: PMC6899317 DOI: 10.1155/2019/3180306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/23/2019] [Indexed: 11/18/2022] Open
Abstract
The priming effect of mirror visual feedback can be simply provided by inexpensive mirror therapy (MT), which exhibits beneficial effects on sensorimotor recovery in stroke. The present study was a single-blind pretest-posttest study that examined whether the priming effect of mirror visual feedback on bilateral task practice would render better outcomes. Twenty-three patients with chronic stroke were randomized to receive hospital-based task-oriented MT or bilateral arm training (BAT) for 4 weeks at 90 minutes/day, 3 days/week and a home practice for 30-40 minutes/day, 5 days/week. There was the potential trend for MT to improve temperature sense as measured by the revised Nottingham Sensory Assessment (Cohen's d = 1.00; 95% confidence interval, -0.09 to 2.09), and MT increased the Stroke Impact Scale 3.0 total score (d = 0.89; 0.003 to 1.71). MT also showed a trend for greater improvements in the Motor Activity Log (amount of use: d = 0.62; -0.24 to 1.44; quality of movement: d = 0.50; -0.35 to 1.31). MT involving bilateral movement practice with the priming effect of mirror visual feedback may render beneficial effects. The unilateral approach or MT augmented by extra feedback might be appropriate modifications.
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Wang H, Arceo R, Chen S, Ding L, Jia J, Yao J. Effectiveness of interventions to improve hand motor function in individuals with moderate to severe stroke: a systematic review protocol. BMJ Open 2019; 9:e032413. [PMID: 31562163 PMCID: PMC6773351 DOI: 10.1136/bmjopen-2019-032413] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The human hand is extremely involved in our daily lives. However, the rehabilitation of hand function after stroke can be rather difficult due to the complexity of hand structure and function, as well as neural basis that supports hand function. Specifically, in individuals with moderate to severe impairment following a stroke, previous evidence for effective treatments that recover hand function in this population is limited, and thus has never been reviewed. With the progress of rehabilitation science and tool development, results from more and more clinical trials are now available, thereby justifying conducting a systematic review. METHODS AND ANALYSIS This systematic review protocol is consistent with the methodology recommended by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols and the Cochrane handbook for systematic reviews of interventions. Electronic searches will be carried out in the PubMed, CINAHL, Physiotherapy Evidence Database and Cochrane Library databases, along with manual searches in the reference lists from included studies and published systematic reviews. The date range parameters used in searching all databases is between January 1999 and January 2019. Randomised controlled trials (RCTs) published in English, with the primary outcome focusing on hand motor function, will be included. Two reviewers will screen all retrieved titles, abstracts and full texts, perform the evaluation of the risk bias and extract all data independently. The risk of bias of the included RCTs will be evaluated by the Cochrane Collaboration's tool. A qualitative synthesis will be provided in text and table, to summarise the main results of the selected publications. A meta-analysis will be considered if there is sufficient homogeneity across outcomes. The quality of the included publications will be evaluated by the Grading of Recommendations Assessment, Development and Evaluation system from the Cochrane Handbook for Systematic Reviews of Interventions. ETHICS AND DISSEMINATION No ethical approval is needed, and the results of this review will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER CRD42019128285.
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Affiliation(s)
- Hewei Wang
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai, China
| | - Ray Arceo
- Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, USA
| | - Shugeng Chen
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai, China
| | - Li Ding
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Jia
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai, China
| | - Jun Yao
- Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, USA
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Hung CS, Lin KC, Chang WY, Huang WC, Chang YJ, Chen CL, Grace Yao K, Lee YY. Unilateral vs Bilateral Hybrid Approaches for Upper Limb Rehabilitation in Chronic Stroke: A Randomized Controlled Trial. Arch Phys Med Rehabil 2019; 100:2225-2232. [PMID: 31421096 DOI: 10.1016/j.apmr.2019.06.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 06/18/2019] [Accepted: 06/30/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the effects of unilateral hybrid therapy (UHT) and bilateral hybrid therapy (BHT) compared with robot-assisted therapy (RT) alone in patients with chronic stroke. DESIGN A single-blind, randomized controlled trial. SETTING Four hospitals. PARTICIPANTS Outpatients with chronic stroke and mild to moderate motor impairment (N=44). INTERVENTION UHT combined unilateral RT (URT) and modified constraint-induced therapy. BHT combined bilateral RT (BRT) and bilateral arm training. The RT group received URT and BRT. The intervention frequency for the 3 groups was 90 min/d 3 d/wk for 6 weeks. MAIN OUTCOME MEASURES Fugl-Meyer Assessment (FMA, divided into the proximal and distal subscale) and Stroke Impact Scale (SIS) version 3.0 scores before, immediately after, and 3 months after treatment and Wolf Motor Function Test (WMFT) and Nottingham Extended Activities of Daily Living (NEADL) scale scores before and immediately after treatment. RESULTS The results favored BHT over UHT on the FMA total score and distal score at the posttest (P=.03 and .04) and follow-up (P=.01 and .047) assessment and BHT over RT on the follow-up FMA distal scores (P=.03). At the posttest assessment, the WMFT and SIS scores of the 3 groups improved significantly without between-group differences, and the RT group showed significantly greater improvement in the mobility domain of NEADL compared with the BHT group (P<.01). CONCLUSIONS BHT was more effective for improving upper extremity motor function, particularly distal motor function at follow-up, and individuals in the RT group demonstrated improved functional ambulation post intervention.
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Affiliation(s)
- Chung-Shan Hung
- Department of Community and Aging, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Keh-Chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
| | - Wan-Ying Chang
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Wen-Chih Huang
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, Miaoli General Hospital, Ministry of Health and Welfare, Miaoli, Taiwan
| | - Ya-Ju Chang
- Physical Therapy Department and Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan; Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kaiping Grace Yao
- Department of Psychology, College of Science, National Taiwan University, Taipei, Taiwan
| | - Ya-Yun Lee
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
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Conroy SS, Wittenberg GF, Krebs HI, Zhan M, Bever CT, Whitall J. Robot-Assisted Arm Training in Chronic Stroke: Addition of Transition-to-Task Practice. Neurorehabil Neural Repair 2019; 33:751-761. [PMID: 31328671 DOI: 10.1177/1545968319862558] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Robot-assisted therapy provides high-intensity arm rehabilitation that can significantly reduce stroke-related upper extremity (UE) deficits. Motor improvement has been shown at the joints trained, but generalization to real-world function has not been profound. Objective. To investigate the efficacy of robot-assisted therapy combined with therapist-assisted task training versus robot-assisted therapy alone on motor outcomes and use in participants with moderate to severe chronic stroke-related arm disability. Methods. This was a single-blind randomized controlled trial of two 12-week robot-assisted interventions; 45 participants were stratified by Fugl-Meyer (FMA) impairment (mean 21 ± 1.36) to 60 minutes of robot therapy (RT; n = 22) or 45 minutes of RT combined with 15 minutes therapist-assisted transition-to-task training (TTT; n = 23). The primary outcome was the mean FMA change at week 12 using a linear mixed-model analysis. A subanalysis included the Wolf Motor Function Test (WMFT) and Stroke Impact Scale (SIS), with significance P <.05. Results. There was no significant 12-week difference in FMA change between groups, and mean FMA gains were 2.87 ± 0.70 and 4.81 ± 0.68 for RT and TTT, respectively. TTT had greater 12-week secondary outcome improvements in the log WMFT (-0.52 ± 0.06 vs -0.18 ± 0.06; P = .01) and SIS hand (20.52 ± 2.94 vs 8.27 ± 3.03; P = .03). Conclusion. Chronic UE motor deficits are responsive to intensive robot-assisted therapy of 45 or 60 minutes per session duration. The replacement of part of the robotic training with nonrobotic tasks did not reduce treatment effect and may benefit stroke-affected hand use and motor task performance.
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Affiliation(s)
| | - George F Wittenberg
- 2 University of Maryland School of Medicine, Baltimore, MD, USA.,3 VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,4 University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Min Zhan
- 2 University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christopher T Bever
- 1 Baltimore VA Medical Center, Baltimore, MD, USA.,2 University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jill Whitall
- 2 University of Maryland School of Medicine, Baltimore, MD, USA
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Hung CS, Hsieh YW, Wu CY, Lin KC, Lin JC, Yeh LM, Yin HP. Comparative Assessment of Two Robot-Assisted Therapies for the Upper Extremity in People With Chronic Stroke. Am J Occup Ther 2019; 73:7301205010p1-7301205010p9. [PMID: 30839256 DOI: 10.5014/ajot.2019.022368] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We investigated the effects on motor and daily function of robot-assisted therapies in people with chronic stroke using the Bi-Manu-Track (BMT) and InMotion 3.0 (IMT) compared with control treatment (CT). METHOD In this comparative efficacy trial, 30 participants were randomized to receive BMT, IMT, or CT. Outcome measures included the Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Motor Activity Log (MAL), and Medical Research Council (MRC) scale. RESULTS The IMT group improved more in FMA and proximal MAS scores than the BMT group (both ps < .01) and the CT group (p < .01 and p = .03, respectively). The IMT and BMT groups showed clinically relevant improvements after treatment on the MRC rather than the MAL. CONCLUSION The results indicate that the IMT might improve motor function. The IMT and BMT groups showed similar benefits for muscle power but limited improvements in self-perceived use of the affected arm.
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Affiliation(s)
- Chung-Shan Hung
- Chung-shan Hung, PhD, is Occupational Therapist, Community Health Center, Department of Community and Aging, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan. At the time of the study, she was Doctoral Candidate, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Wei Hsieh
- Yu-wei Hsieh, PhD, is Associate Professor, Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Yi Wu
- Ching-yi Wu, ScD, OTR, is Professor and Chair, Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Keh-Chung Lin
- Keh-chung Lin, ScD, OTR, is Professor, School of Occupational Therapy, College of Medicine, and Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan;
| | - Jui-Chi Lin
- Jui-chi Lin, MS, is Director, Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Li-Min Yeh
- Li-min Yeh, BS, is Director, Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsin-Pei Yin
- Hsin-pei Yin, MD, is Attending Physician and Chair, Department of Physical Medicine and Rehabilitation, Lo-Sheng Sanatorium and Hospital, Ministry of Health and Welfare, Taoyuan County, Taiwan
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Qian Q, Nam C, Guo Z, Huang Y, Hu X, Ng SC, Zheng Y, Poon W. Distal versus proximal - an investigation on different supportive strategies by robots for upper limb rehabilitation after stroke: a randomized controlled trial. J Neuroeng Rehabil 2019; 16:64. [PMID: 31159822 PMCID: PMC6545723 DOI: 10.1186/s12984-019-0537-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 05/16/2019] [Indexed: 11/21/2022] Open
Abstract
Background Different mechanical supporting strategies to the joints in the upper extremity (UE) may lead to varied rehabilitative effects after stroke. This study compared the rehabilitation effectiveness achieved by electromyography (EMG)-driven neuromuscular electrical stimulation (NMES)-robotic systems when supporting to the distal fingers and to the proximal (wrist-elbow) joints. Methods Thirty subjects with chronic stroke were randomly assigned to receive motor trainings with NMES-robotic support to the finger joints (hand group, n = 15) and with support to the wrist-elbow joints (sleeve group, n = 15). The training effects were evaluated by the clinical scores of Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Modified Ashworth Scale (MAS) before and after the trainings, as well as 3 months later. The cross-session EMG monitoring of EMG activation level and co-contraction index (CI) were also applied to investigate the recovery progress of muscle activations and muscle coordination patterns through the training sessions. Results Significant improvements (P < 0.05) in FMA full score, FMA shoulder/elbow (FMA-SE) and ARAT scores were found in both groups, whereas significant improvements (P < 0.05) in FMA wrist/hand (FMA-WH) and MAS scores were only observed in the hand group. Significant decrease of EMG activation levels (P < 0.05) of UE flexors was observed in both groups. Significant decrease in CI values (P < 0.05) was observed in both groups in the muscle pairs of biceps brachii and triceps brachii (BIC&TRI) and the wrist-finger flexors (flexor carpi radialis-flexor digitorum) and TRI (FCR-FD&TRI). The EMG activation levels and CIs of the hand group exhibited faster reductions across the training sessions than the sleeve group (P < 0.05). Conclusions Robotic supports to either the distal fingers or the proximal elbow-wrist could achieve motor improvements in UE. The robotic support directly to the distal fingers was more effective than to the proximal parts in improving finger motor functions and in releasing muscle spasticity in the whole UE. Clinical trial registration ClinicalTrials.gov, identifier NCT02117089; date of registration: April 10, 2014. https://clinicaltrials.gov/ct2/show/NCT02117089
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Affiliation(s)
- Qiuyang Qian
- Department of Biomedical Engineering, the Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Chingyi Nam
- Department of Biomedical Engineering, the Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Ziqi Guo
- Department of Biomedical Engineering, the Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Yanhuan Huang
- Department of Biomedical Engineering, the Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Xiaoling Hu
- Department of Biomedical Engineering, the Hong Kong Polytechnic University, Kowloon, Hong Kong.
| | - Stephanie C Ng
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yongping Zheng
- Department of Biomedical Engineering, the Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Waisang Poon
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Valkenborghs SR, Callister R, Visser MM, Nilsson M, van Vliet P. Interventions combined with task-specific training to improve upper limb motor recovery following stroke: a systematic review with meta-analyses. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1597439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Sarah R. Valkenborghs
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, NSW, Australia
- Centre for Research Excellence in Stroke Rehabilitation and Recovery, Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Biomedical Science and Pharmacy, Faculty of Health, University of Newcastle, Newcastle, NSW, Australia
| | - Robin Callister
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, NSW, Australia
- Centre for Research Excellence in Stroke Rehabilitation and Recovery, Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Biomedical Science and Pharmacy, Faculty of Health, University of Newcastle, Newcastle, NSW, Australia
| | - Milanka M. Visser
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Michael Nilsson
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, NSW, Australia
- Centre for Research Excellence in Stroke Rehabilitation and Recovery, Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Paulette van Vliet
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, NSW, Australia
- Centre for Research Excellence in Stroke Rehabilitation and Recovery, Hunter Medical Research Institute, Newcastle, NSW, Australia
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30
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Duret C, Grosmaire AG, Krebs HI. Robot-Assisted Therapy in Upper Extremity Hemiparesis: Overview of an Evidence-Based Approach. Front Neurol 2019; 10:412. [PMID: 31068898 PMCID: PMC6491567 DOI: 10.3389/fneur.2019.00412] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/04/2019] [Indexed: 01/15/2023] Open
Abstract
Robot-mediated therapy is an innovative form of rehabilitation that enables highly repetitive, intensive, adaptive, and quantifiable physical training. It has been increasingly used to restore loss of motor function, mainly in stroke survivors suffering from an upper limb paresis. Multiple studies collated in a growing number of review articles showed the positive effects on motor impairment, less clearly on functional limitations. After describing the current status of robotic therapy after upper limb paresis due to stroke, this overview addresses basic principles related to robotic therapy applied to upper limb paresis. We demonstrate how this innovation is an evidence-based approach in that it meets both the improved clinical and more fundamental knowledge-base about regaining effective motor function after stroke and the need of more objective, flexible and controlled therapeutic paradigms.
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Affiliation(s)
- Christophe Duret
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, Boissise-Le-Roi, France.,Centre Hospitalier Sud Francilien, Neurologie, Corbeil-Essonnes, France
| | - Anne-Gaëlle Grosmaire
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, Boissise-Le-Roi, France
| | - Hermano Igo Krebs
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Neurology, University of Maryland, Baltimore, MD, United States.,Department of Physical Medicine and Rehabilitation, Fujita Health University, Nagoya, Japan.,Institute of Neuroscience, University of Newcastle, Newcastle upon Tyne, United Kingdom.,Department of Mechanical Sciences and Bioengineering, Osaka University, Osaka, Japan.,Wolfson School of Mechanical, Electrical, and Manufacturing Engineering, Loughborough University, Loughborough, United Kingdom
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31
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Hung CS, Hsieh YW, Wu CY, Chen YJ, Lin KC, Chen CL, Yao KG, Liu CT, Horng YS. Hybrid Rehabilitation Therapies on Upper-Limb Function and Goal Attainment in Chronic Stroke. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2019; 39:116-123. [PMID: 30834812 DOI: 10.1177/1539449218825438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined the treatment effects between unilateral hybrid therapy (UHT; unilateral robot-assisted therapy [RT] + modified constraint-induced movement therapy) and bilateral hybrid therapy (BHT; bilateral RT + bilateral arm training) compared with RT. Thirty patients with chronic stroke were randomized to UHT, BHT, or RT groups. Preliminary efficacy was assessed using the Fugl-Meyer Assessment (FMA), the Chedoke Arm and Hand Activity Inventory (CAHAI), and the goal attainment scaling (GAS). Possible adverse effects of abnormal muscle tone, pain, and fatigue were recorded. All groups showed large improvements in motor recovery and individual goals. Significant between-group differences were found on GAS favoring the hybrid groups but not on FMA and CAHAI. No adverse effects were reported. Hybrid therapies are safe and applicable interventions for chronic stroke and favorable for improving individual functional goals. Treatment effects on motor recovery and functional activity might be similar among the three groups.
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Affiliation(s)
| | - Yu-Wei Hsieh
- 2 Chang Gung University, Taoyuan.,3 Chang Gung Memorial Hospital, Linkou
| | - Ching-Yi Wu
- 2 Chang Gung University, Taoyuan.,3 Chang Gung Memorial Hospital, Linkou
| | | | - Keh-Chung Lin
- 5 National Taiwan University, Taipei.,6 National Taiwan University Hospital, Taipei
| | - Chia-Ling Chen
- 2 Chang Gung University, Taoyuan.,3 Chang Gung Memorial Hospital, Linkou
| | | | - Chien-Ting Liu
- 7 Taipei Tzu Chi Hospital, Taipei.,8 Tzu Chi University, Hualien
| | - Yi-Shiung Horng
- 7 Taipei Tzu Chi Hospital, Taipei.,8 Tzu Chi University, Hualien
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32
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Nam C, Rong W, Li W, Xie Y, Hu X, Zheng Y. The Effects of Upper-Limb Training Assisted with an Electromyography-Driven Neuromuscular Electrical Stimulation Robotic Hand on Chronic Stroke. Front Neurol 2017; 8:679. [PMID: 29312116 PMCID: PMC5735084 DOI: 10.3389/fneur.2017.00679] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/29/2017] [Indexed: 01/03/2023] Open
Abstract
Background Impaired hand dexterity is a major disability of the upper limb after stroke. An electromyography (EMG)-driven neuromuscular electrical stimulation (NMES) robotic hand was designed previously, whereas its rehabilitation effects were not investigated. Objectives This study aims to investigate the rehabilitation effectiveness of the EMG-driven NMES-robotic hand-assisted upper-limb training on persons with chronic stroke. Method A clinical trial with single-group design was conducted on chronic stroke participants (n = 15) who received 20 sessions of EMG-driven NMES-robotic hand-assisted upper-limb training. The training effects were evaluated by pretraining, posttraining, and 3-month follow-up assessments with the clinical scores of the Fugl-Meyer Assessment (FMA), the Action Research Arm Test (ARAT), the Wolf Motor Function Test, the Motor Functional Independence Measure, and the Modified Ashworth Scale (MAS). Improvements in the muscle coordination across the sessions were investigated by EMG parameters, including EMG activation level and Co-contraction Indexes (CIs) of the target muscles in the upper limb. Results Significant improvements in the FMA shoulder/elbow and wrist/hand scores (P < 0.05), the ARAT (P < 0.05), and in the MAS (P < 0.05) were observed after the training and sustained 3 months later. The EMG parameters indicated a significant decrease of the muscle activation level in flexor digitorum (FD) and biceps brachii (P < 0.05), as well as a significant reduction of CIs in the muscle pairs of FD and triceps brachii and biceps brachii and triceps brachii (P < 0.05). Conclusion The upper-limb training integrated with the assistance from the EMG-driven NMES-robotic hand is effective for the improvements of the voluntary motor functions and the muscle coordination in the proximal and distal joints. Furthermore, the motor improvement after the training could be maintained till 3 months later. Trial registration ClinicalTrials.gov. NCT02117089; date of registration: April 10, 2014.
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Affiliation(s)
- Chingyi Nam
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Wei Rong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Waiming Li
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Yunong Xie
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Xiaoling Hu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Yongping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
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33
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Ienca M, Kressig RW, Jotterand F, Elger B. Proactive Ethical Design for Neuroengineering, Assistive and Rehabilitation Technologies: the Cybathlon Lesson. J Neuroeng Rehabil 2017; 14:115. [PMID: 29137639 PMCID: PMC5686808 DOI: 10.1186/s12984-017-0325-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 10/30/2017] [Indexed: 01/08/2023] Open
Abstract
Background Rapid advancements in rehabilitation science and the widespread application of engineering techniques are opening the prospect of a new phase of clinical and commercial maturity for Neuroengineering, Assistive and Rehabilitation Technologies (NARTs). As the field enters this new phase, there is an urgent need to address and anticipate the ethical implications associated with novel technological opportunities, clinical solutions, and social applications. Main idea In this paper we review possible approaches to the ethics of NART, and propose a framework for ethical design and development, which we call the Proactive Ethical Design (PED) framework. Conclusion A viable ethical framework for neuroengineering, assistive and rehabilitation technology should be characterized by the convergence of user-centered and value-sensitive approaches to product design through a proactive mode of ethical evaluation. We propose four basic normative requirements for the realization of this framework: minimization of power imbalances, compliance with biomedical ethics, translationality and social awareness. The aims and values of the CYBATHLON competition provide an operative model of this ethical framework and could drive an ethical shift in neuroengineering and rehabilitation.
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Affiliation(s)
- Marcello Ienca
- Institute for Biomedical Ethics, Faculty of Medicine, University of Basel, Bernoullistrasse 28, -4056, Basel, CH, Switzerland. .,Health Ethics & Policy Lab, Department of Health Sciences & Technology, ETH Zürich, Zürich, Switzerland.
| | - Reto W Kressig
- University Center for Medicine of Aging, Felix Platter Hospital, Basel, Switzerland.,Chair of Geriatrics, University of Basel, Basel, Switzerland
| | - Fabrice Jotterand
- Institute for Biomedical Ethics, Faculty of Medicine, University of Basel, Bernoullistrasse 28, -4056, Basel, CH, Switzerland.,Center for Bioethics and Medical Humanities, Institute for Health and Society, Medical College of Wisconsin, Madison, USA
| | - Bernice Elger
- Institute for Biomedical Ethics, Faculty of Medicine, University of Basel, Bernoullistrasse 28, -4056, Basel, CH, Switzerland.,University Center for Legal Medicine, University of Geneva, Geneva, Switzerland
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Rowe JB, Chan V, Ingemanson ML, Cramer SC, Wolbrecht ET, Reinkensmeyer DJ. Robotic Assistance for Training Finger Movement Using a Hebbian Model: A Randomized Controlled Trial. Neurorehabil Neural Repair 2017; 31:769-780. [PMID: 28803535 PMCID: PMC5894506 DOI: 10.1177/1545968317721975] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Robots that physically assist movement are increasingly used in rehabilitation therapy after stroke, yet some studies suggest robotic assistance discourages effort and reduces motor learning. OBJECTIVE To determine the therapeutic effects of high and low levels of robotic assistance during finger training. METHODS We designed a protocol that varied the amount of robotic assistance while controlling the number, amplitude, and exerted effort of training movements. Participants (n = 30) with a chronic stroke and moderate hemiparesis (average Box and Blocks Test 32 ± 18 and upper extremity Fugl-Meyer score 46 ± 12) actively moved their index and middle fingers to targets to play a musical game similar to GuitarHero 3 h/wk for 3 weeks. The participants were randomized to receive high assistance (causing 82% success at hitting targets) or low assistance (55% success). Participants performed ~8000 movements during 9 training sessions. RESULTS Both groups improved significantly at the 1-month follow-up on functional and impairment-based motor outcomes, on depression scores, and on self-efficacy of hand function, with no difference between groups in the primary endpoint (change in Box and Blocks). High assistance boosted motivation, as well as secondary motor outcomes (Fugl-Meyer and Lateral Pinch Strength)-particularly for individuals with more severe finger motor deficits. Individuals with impaired finger proprioception at baseline benefited less from the training. CONCLUSIONS Robot-assisted training can promote key psychological outcomes known to modulate motor learning and retention. Furthermore, the therapeutic effectiveness of robotic assistance appears to derive at least in part from proprioceptive stimulation, consistent with a Hebbian plasticity model.
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Affiliation(s)
- Justin B Rowe
- 1 University of California at Irvine, Irvine, CA, USA
| | - Vicky Chan
- 1 University of California at Irvine, Irvine, CA, USA
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