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Shenbagam M, Kamatham AT, Vijay P, Salimath S, Patwardhan S, Sikdar S, Kataria C, Mukherjee B. A Sonomyography-Based Muscle Computer Interface for Individuals With Spinal Cord Injury. IEEE J Biomed Health Inform 2024; 28:2713-2722. [PMID: 38285571 DOI: 10.1109/jbhi.2024.3359483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Impairment of hand functions in individuals with spinal cord injury (SCI) severely disrupts activities of daily living. Recent advances have enabled rehabilitation assisted by robotic devices to augment the residual function of the muscles. Traditionally, electromyography-based muscle activity sensing interfaces have been utilized to sense volitional motor intent to drive robotic assistive devices. However, the dexterity and fidelity of control that can be achieved with electromyography-based control have been limited due to inherent limitations in signal quality. We have developed and tested a muscle-computer interface (MCI) utilizing sonomyography to provide control of a virtual cursor for individuals with motor-incomplete spinal cord injury. We demonstrate that individuals with SCI successfully gained control of a virtual cursor by utilizing contractions of muscles of the wrist joint. The sonomyography-based interface enabled control of the cursor at multiple graded levels demonstrating the ability to achieve accurate and stable endpoint control. Our sonomyography-based muscle-computer interface can enable dexterous control of upper-extremity assistive devices for individuals with motor-incomplete SCI.
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Kilgore KL, Anderson KD, Peckham PH. Neuroprosthesis for individuals with spinal cord injury. Neurol Res 2023; 45:893-905. [PMID: 32727296 PMCID: PMC9415059 DOI: 10.1080/01616412.2020.1798106] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 07/14/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Individuals who sustain a traumatic spinal cord injury (SCI) often have a loss of multiple body systems. Significant functional improvement can be gained by individual SCI through the use of neuroprostheses based on electrical stimulation. The most common actions produced are grasp, overhead reach, trunk posture, standing, stepping, bladder/bowel/sexual function, and respiratory functions. METHODS We review the fundamental principles of electrical stimulation, which are established, allowing stimulation to be safely delivered through implanted devices for many decades. We review four common clinical applications for SCI, including grasp/reach, standing/stepping, bladder/bowel function, and respiratory functions. Systems used to implement these functions have many common features, but are also customized based on the functional goals of each approach. Further, neuroprosthetic systems are customized based on the needs of each user. RESULTS & CONCLUSION The results to date show that implanted neuroprostheses can have a significant impact on the health, function, and quality of life for individuals with SCI. A key focus for the future is to make implanted neuroprostheses broadly available to the SCI population.
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Affiliation(s)
- Kevin L. Kilgore
- – MetroHealth System, Cleveland, Ohio
- – Case Western Reserve University, Cleveland, Ohio
- – VA Northeast Ohio Healthcare System, Cleveland, Ohio
| | - Kimberly D. Anderson
- – MetroHealth System, Cleveland, Ohio
- – Case Western Reserve University, Cleveland, Ohio
| | - P. Hunter Peckham
- – MetroHealth System, Cleveland, Ohio
- – Case Western Reserve University, Cleveland, Ohio
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Zhang F, Carnahan J, Ravi M, Bheemreddy A, Kirshblum S, Forrest GF. Combining Spinal Cord Transcutaneous Stimulation with Activity-based Training to Improve Upper Extremity Function Following Cervical Spinal Cord Injury . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082735 DOI: 10.1109/embc40787.2023.10340976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Recovery of upper extremity (UE) function is the top priority following cervical spinal cord injury (SCI); even partial function restoration would greatly improve the quality of their life and thus remains an important goal in SCI rehabilitation. Current clinical therapies focus on promoting neuroplasticity by performing task-specific activities with high intensity and high repetition. Repetitive training, paired with functional electrical, somatosensory, or transcranial magnetic stimulation, has been evaluated to augment functional recovery in chronic SCI, but improvements were modest. Evidence has demonstrated that the non-invasive spinal cord transcutaneous stimulation (scTS) can increase the excitability of spinal circuits and facilitate the weak or silent descending drive for restoration of sensorimotor function. Currently, we are conducting a multicenter randomized clinical trial to investigate the efficacy and potential mechanisms of scTS combined with activity-based training (ABT) to facilitate UE function recovery in individuals with tetraplegia. The preliminary outcomes from our four individuals with complete and incomplete injury demonstrated that the combination of scTS and ABT led to immediate and sustained (for up to 1-month follow-up) UE function recovery. Notably, one individual with motor complete injury showed a 5-fold improvement in UE function quantified by the Graded Redefined Assessment of Strength, Sensibility, and Prehension following scTS+ABT, as compared to receiving ABT alone. These functional gains were also reflected in the increased spinal excitability by measuring the scTS-evoked muscle response of UE motor pools, suggesting physiological evidence of reorganization of the non-functional, but surviving spinal networks after spinal transcutaneous stimulation.Clinical Relevance-This study offered the preliminary efficacy of combining scTS and ABT to facilitate UE function recovery following cervical SCI.
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Balbinot G, Li G, Gauthier C, Musselman KE, Kalsi-Ryan S, Zariffa J. Functional electrical stimulation therapy for upper extremity rehabilitation following spinal cord injury: a pilot study. Spinal Cord Ser Cases 2023; 9:11. [PMID: 37005407 PMCID: PMC10067812 DOI: 10.1038/s41394-023-00568-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 04/04/2023] Open
Abstract
STUDY DESIGN Pilot study. OBJECTIVES To examine if functional electrical stimulation therapy (FEST) improves neuromuscular factors underlying upper limb function in individuals with SCI. SETTING A tertiary spinal cord rehabilitation center specialized in spinal cord injury care in Canada. METHODS We examined 29 muscles from 4 individuals living with chronic, cervical, and incomplete SCI. The analysis was focused on the changes in muscle activation, as well as on how the treatment could change the ability to control a given muscle or on how multiple muscles would be coordinated during volitional efforts. RESULTS There was evidence of gains in muscle strength, activation, and median frequency after the FEST. Gains in muscle activation indicated the activation of a greater number of motor units and gains in muscle median frequency the involvement of higher threshold, faster motor units. In some individuals, these changes were smaller but accompanied by increased control over muscle contraction, evident in a greater ability to sustain a volitional contraction, reduce the co-contraction of antagonist muscles, and provide cortical drive. CONCLUSIONS FEST increases muscle strength and activation. Enhanced control of muscle contraction, reduced co-contraction of antagonist muscles, and a greater presence of cortical drive were some of the findings supporting the effects of FEST at the sensory-motor integration level.
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Affiliation(s)
- Gustavo Balbinot
- KITE Research Institute, University Health Network, Toronto, ON, M5G 2A2, Canada.
| | - Guijin Li
- KITE Research Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Cindy Gauthier
- KITE Research Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Kristin E Musselman
- KITE Research Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Sukhvinder Kalsi-Ryan
- KITE Research Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - José Zariffa
- KITE Research Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada
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Readioff R, Siddiqui ZK, Stewart C, Fulbrook L, O’Connor RJ, Chadwick EK. Use and evaluation of assistive technologies for upper limb function in tetraplegia. J Spinal Cord Med 2022; 45:809-820. [PMID: 33606599 PMCID: PMC9662059 DOI: 10.1080/10790268.2021.1878342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
CONTEXT More than half of all spinal cord injuries (SCI) occur at the cervical level leading to loss of upper limb function, restricted activity and reduced independence. Several technologies have been developed to assist with upper limb functions in the SCI population. OBJECTIVE There is no clear clinical consensus on the effectiveness of the current assistive technologies for the cervical SCI population, hence this study reviews the literature in the years between 1999 and 2019. METHODS A systematic review was performed on the state-of-the-art assistive technology that supports and improves the function of impaired upper limbs in cervical SCI populations. Combinations of terms, covering assistive technology, SCI, and upper limb, were used in the search, which resulted in a total of 1770 articles. Data extractions were performed on the selected studies which involved summarizing details on the assistive technologies, characteristics of study participants, outcome measures, and improved upper limb functions when using the device. RESULTS A total of 24 articles were found and grouped into five categories, including neuroprostheses (invasive and non-invasive), orthotic devices, hybrid systems, robots, and arm supports. Only a few selected studies comprehensively reported characteristics of the participants. There was a wide range of outcome measures and all studies reported improvements in upper limb function with the devices. CONCLUSIONS This study highlighted that assistive technologies can improve functions of the upper limbs in SCI patients. It was challenging to draw generalizable conclusions because of factors, such as heterogeneity of recruited participants, a wide range of outcome measures, and the different technologies employed.
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Affiliation(s)
- Rosti Readioff
- School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, UK,Correspondence to: Rosti Readioff, Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, LeedsLS2 9JT, UK. ; @Dr_Rosti
| | - Zaha Kamran Siddiqui
- Academic Department of Rehabilitation Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Caroline Stewart
- School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, UK,The Orthotic Research and Locomotor Assessment Unit (ORLAU), the Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Foundation Trust, Oswestry, UK
| | - Louisa Fulbrook
- The Orthotic Research and Locomotor Assessment Unit (ORLAU), the Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Foundation Trust, Oswestry, UK
| | - Rory J. O’Connor
- Academic Department of Rehabilitation Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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Anderson KD, Korupolu R, Musselman KE, Pierce J, Wilson JR, Yozbatiran N, Desai N, Popovic MR, Thabane L. Multi-center, single-blind randomized controlled trial comparing functional electrical stimulation therapy to conventional therapy in incomplete tetraplegia. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:995244. [PMID: 36188946 PMCID: PMC9500231 DOI: 10.3389/fresc.2022.995244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022]
Abstract
Background Loss of upper extremity function after tetraplegia results in significant disability. Emerging evidence from pilot studies suggests that functional electrical stimulation (FES) therapy may enhance recovery of upper extremity function after tetraplegia. The aim of this trial was to determine the effectiveness of FES therapy delivered by the Myndmove stimulator in people with tetraplegia. Methods A multi-center, single-blind, parallel-group, two-arm, randomized controlled trial was conducted comparing FES to conventional therapy in adults (≥18 years) with C4–C7 traumatic incomplete tetraplegia between 4 and 96 months post-injury, and with a baseline spinal cord injury independence measure III -self-care (SCIM III-SC) score of ≤10. Participants were enrolled at four SCI-specialized neurorehabilitation centers in the U.S. and Canada. Participants were stratified by center and randomized in a 1:1 ratio to receive either 40 sessions of FES or conventional therapy targeting upper extremities over a 14-week period. Blinded assessors measured SCIM III, Toronto Rehabilitation Institute Hand Function Test, and Graded Redefined Assessment of Strength, Sensibility, and Prehension at baseline, after 20th session, after 40th session or 14 weeks after 1st session, and at 24 weeks after 1st session. The primary outcome measure was change in SCIM III-SC from baseline to end of the treatment. Based on the primary outcome measure, a sample size of 60 was calculated. Seventeen participants' progress in the study was interrupted due to the COVID-19 lockdown. The protocol was modified for these participants to allow them to complete the study. Results Between June 2019 to August 2021, 51 participants were randomized to FES (n = 27) and conventional therapy (n = 24). Both groups gained a mean of 2 points in SCIM-SC scores at the end of treatment, which was a clinically meaningful change. However, there was no statistically significant difference between the groups on any outcomes. Conclusion Forty sessions of FES therapy delivered by the MyndMove stimulator are as effective as conventional therapy in producing meaningful functional improvements that persist after therapy is completed. Limitations of this study include the impact of COVID-19 limiting the ability to recruit the target sample size and per-protocol execution of the study in one-third of the participants. Registration This trial is registered at www.ClinicalTrials.gov, NCT03439319.
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Affiliation(s)
- Kim D. Anderson
- MetroHealth Rehabilitation Institute, MetroHealth System, Cleveland, OH, United States
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University School of Medicine, Cleveland, OH, United States
- Correspondence: Kim D. Anderson
| | - Radha Korupolu
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
- The Institute of Rehabilitation / Research (TIRR) Memorial Hermann, Houston, TX, United States
| | - Kristin E. Musselman
- The KITE Research Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Jacqueline Pierce
- HealthTech Connex Centre for Neurology Studies/Neuromotion Physiotherapy, Vancouver, BC, Canada
| | - James R. Wilson
- MetroHealth Rehabilitation Institute, MetroHealth System, Cleveland, OH, United States
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Nuray Yozbatiran
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
- The Institute of Rehabilitation / Research (TIRR) Memorial Hermann, Houston, TX, United States
| | - Naaz Desai
- Krembil Research Institute-University Health Network, Toronto, ON, Canada
| | - Milos R. Popovic
- The KITE Research Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- CRANIA, University Health Network, Toronto, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton ON, Canada
- Biostatistics Unit, St. Joseph’s Healthcare, Hamilton, ON, Canada
- Faculty of Health Sciences, University of Johannesburg, Johannesburg, Gauteng, South Africa
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Design and fast-fabrication of a system for functional electrical stimulation in upper limb of people with tetraplegia. Spinal Cord Ser Cases 2022; 8:54. [PMID: 35568701 PMCID: PMC9107485 DOI: 10.1038/s41394-022-00519-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Proof of concept. OBJECTIVES Standard Functional Electrical Stimulation (FES) systems can enhance motor learning in people with tetraplegia and are widely delivered by self-adhesive electrodes. Their limitations are dexterity, specific knowledge to place the electrodes on muscles, need to fix electrodes when they lose the gel layer, and time. We designed a new FES system, using an existing protocol of drinking-like movements, to the upper limb of a person with tetraplegia C5 that fits in any anthropometry and can be easily produced. Furthermore, we tested the system to assess its effectiveness and users' perception during FES rehabilitation. SETTING São Carlos, SP, Brazil. METHODS A shell was designed with parametric design and fast-fabrication methods, and a stimulation unit and a smartphone application were developed. Questionnaires assessed the perceptions of a patient and a physiotherapist, about the usability of the new system in relation to standard FES. Kinematic data of drinking-like movements were collected from the patient wearing both systems and compared with data from an aged-matched control subject. RESULTS The results are a personalized shell and an intuitive FES system, overcoming the limitations of standard FES. The new system suggested better wrist-flexion control shown by the mean angles (-18.93°), then the other system (-59.35°), and compared with the control (-10.97°). CONCLUSIONS Fast-fabrication with parametric design offers a promising alternative for personalizing FES systems, with potential for home use. Further studies are required including randomized clinical trials.
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Reduced Muscle Activity of the Upper Extremity in Individuals with Spinal Cord Injuries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084708. [PMID: 35457574 PMCID: PMC9027229 DOI: 10.3390/ijerph19084708] [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: 02/23/2022] [Revised: 04/04/2022] [Accepted: 04/12/2022] [Indexed: 11/17/2022]
Abstract
Compromised physical ability due to musculoskeletal impairment among spinal cord injury (SCI) patients is known to negatively affect their quality of life. It is essential to comprehensively understand the muscle strength of the upper extremity among patients with SCI to enhance muscle function and capacity to engage in an active lifestyle. The objective of this study was to evaluate the muscle strength of 15 upper extremity muscles among patients with SCI and compare the relative weakness of individual muscles to the control group. Seven male patients with SCI with ASIA impairment scale D and E and 33 males in the control group participated in this study. Each participant performed maximal voluntary contraction of individual muscles, and the electromyography data were recorded. The results showed that the majority of the upper extremity muscles (12 out of 15) showed considerable weakness (24 to 53%) relative to the control group. Furthermore, the relative strength (ranking) of individual muscles among 15 upper extremity muscles was different between patients with SCI and the control group. This information would be useful to the selective strengthening of specific muscles as an intensive rehabilitation effort and prevent overuse and adverse injuries due to excessive muscle training.
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Niu CM, Chou CH, Bao Y, Wang T, Gu L, Zhang X, Cui L, Xuan Z, Zhuang C, Li S, Chen Z, Lan N, Xie Q. A Pilot Study of Synergy-Based FES for Upper-Extremity Poststroke Rehabilitation. Neurosci Lett 2022; 780:136621. [PMID: 35395324 DOI: 10.1016/j.neulet.2022.136621] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/21/2022] [Accepted: 04/04/2022] [Indexed: 11/25/2022]
Abstract
A previous study indicated that synergy-based functional electrical stimulation (FES) may improve instantaneous upper-limb motor performance for stroke survivors. However, it remains unclear whether the improvements will sustain over time to achieve functional gains associated with a task-oriented training (TOT). This pilot study was designed to investigate whether there is any promising sign of functional benefits. A TOT protocol with repeated forward and lateral reaching movements assisted by synergy-based FES was conducted in 16 patients (9 FES, 7 Sham) with post-stroke hemiparesis. FES stimuli were applied to 7 upper-extremity muscles of elbow and shoulder during patient movements. Envelopes of stimuli were individualized by re-composing the muscle synergies extracted from a healthy subject. After a five-day training for one hour each day, synergy-based FES induced higher increases in Fugl-Meyer scores (6.67±5.20) than did the Sham (2.00±2.38, p<0.05). Peak velocity of forward reaching movements increased with a slope 73% steeper in FES group than Sham. In lateral reaching movements, the change in synergy similarity correlated with the change in elbow flexion for the FES group, but not the Sham group. Our results indicate that synergy-based FES therapy induced clinically traceable signs of improvements in poststroke motor performance. The muscle activation in patients also showed promising sign of alteration by FES. Results suggest that a larger scale clinical trial of synergy-based FES may be feasible towards an individualized therapeutic regimen.
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Affiliation(s)
- Chuanxin M Niu
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Laboratory of Neurorehabilitation Engineering, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chih-Hong Chou
- Laboratory of Neurorehabilitation Engineering, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yong Bao
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tong Wang
- Laboratory of Neurorehabilitation Engineering, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Lin Gu
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao Zhang
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lijun Cui
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhi Xuan
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Cheng Zhuang
- Laboratory of Neurorehabilitation Engineering, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Si Li
- Laboratory of Neurorehabilitation Engineering, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Zhi Chen
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ning Lan
- Laboratory of Neurorehabilitation Engineering, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Qing Xie
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Ohtsuka H, Nakajima T, Komiyama T, Suzuki S, Irie S, Ariyasu R. Execution of natural manipulation in the air enhances the beta-rhythm intermuscular coherences of the human arm depending on muscle pairs. J Neurophysiol 2022; 127:946-957. [PMID: 35294314 DOI: 10.1152/jn.00421.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Natural manipulation tasks in air consist of two kinematic components: a grasping component, with activation of the hand muscles, and a lifting component, with activation of the proximal muscles. However, it remains unclear whether the synchronized motor commands to the hand/proximal arm muscles are divergently controlled during the task. Therefore, we examined how intermuscular coherence was modulated depending on the muscle combinations during grip and lift (G&L) tasks. Electromyograms (EMGs) were recorded from the biceps brachii (BB), triceps brachii (TB), flexor digitorum superficialis (FDS), and extensor digitorum communis (EDC) muscles. The participants were required to maintain G&L tasks involving a small cubical box with the thumb and index and middle fingers. Consequently, we found that the beta-rhythm coherence (15-35 Hz) in BB-TB, BB-FDS, and TB-EDC pairs during G&L was significantly larger than that during the isolated task with cocontraction of the two target muscles but not BB-EDC, TB-FDS, and FDS-EDC (task and muscle pair specificities). These increases in beta-rhythm coherence were also observed in intramuscular EMG recordings. Furthermore, the results from the execution of several mimic G&L tasks revealed that the separated task-related motor signals and combinations between the motor signals/sensations of the fingertips or object load had minor contributions to the increase in the coherence. These results suggest that during G&L the central nervous system regulates synchronous drive onto motoneurons depending on the muscle pairs and that the multiple combination effect of the sensations of touch/object load and motor signals in the task promotes the synchrony of these pairs.NEW & NOTEWORTHY Natural manipulation in air consists of two kinematic components: grasping, with activation of hand muscles, and lifting, with activation of proximal muscles. We show that during the maintenance of object manipulation in air the central nervous system regulates the synchronous drive onto human motoneuron pools depending on the hand/proximal muscle pairs and that the multiple combination effect of the sensations of touch/object load and motor signals in the task promotes the synchrony of these pairs.
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Affiliation(s)
- Hiroyuki Ohtsuka
- Department of Integrative Physiology, Kyorin University School of Medicine, Mitaka City, Tokyo, Japan.,Department of Physical Therapy, Showa University School of Nursing and Rehabilitation Sciences, Yokohama City, Kanagawa, Japan
| | - Tsuyoshi Nakajima
- Department of Integrative Physiology, Kyorin University School of Medicine, Mitaka City, Tokyo, Japan
| | - Tomoyoshi Komiyama
- Division of Health and Sports Sciences, Faculty of Education, Chiba University, Chiba City, Chiba, Japan.,Division of Health and Sports Education, The United Graduate School of Education, Tokyo Gakugei University, Koganei City, Tokyo, Japan
| | - Shinya Suzuki
- Department of Integrative Physiology, Kyorin University School of Medicine, Mitaka City, Tokyo, Japan
| | - Shun Irie
- Department of Integrative Physiology, Kyorin University School of Medicine, Mitaka City, Tokyo, Japan
| | - Ryohei Ariyasu
- Department of Integrative Physiology, Kyorin University School of Medicine, Mitaka City, Tokyo, Japan
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Klein CS, Liu H, Zhao CN, Yang X. Quantitative ultrasound imaging of intrinsic hand muscles after traumatic cervical spinal cord injury. Spinal Cord 2022; 60:199-209. [PMID: 34172926 DOI: 10.1038/s41393-021-00653-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 06/04/2021] [Accepted: 06/08/2021] [Indexed: 02/06/2023]
Abstract
STUDY DESIGN This is a cross-sectional descriptive study. OBJECTIVES To quantify differences in hand muscle morphology between persons with cervical spinal cord injury (SCI) and uninjured adults. SETTING The study was performed at the Guangdong Work Injury Rehabilitation Hospital. METHODS We quantified hand muscle cross-sectional area (CSA), thickness, and echo intensity (EI) in 18 persons with subacute to chronic SCI and 23 controls using ultrasound imaging. RESULTS Mean SCI abductor pollicis brevis (APB), abductor digiti minimi (ADM), and first dorsal interosseous (FDI) CSA were ~26%, 43%, and 37% smaller than the control means, the deficit in the APB being less than the ADM (P < 0.05). Muscle thickness was also smaller after SCI, but deficits in ADM (31%) and FDI (20%) thickness were less than the CSA deficits (P < 0.05). In five SCI persons, APB CSA and/or opponens pollicis (OP) thickness were normal despite complete motor paralysis. Mean longitudinal image EI was 40% higher in the OP and 15% higher in the flexor pollicis brevis (FPB) after SCI (P < 0.05), suggesting denervation-induced infiltration of fat and fibrous tissues. OP EI was related to OP thickness (r = -0.6, P = 0.007, n = 18). Mean axial image EI was 10% higher in the APB and ADM after SCI (P < 0.05). There were no significant correlations between muscle morphological properties and clinical features in the SCI participants. CONCLUSION Our results indicate significant SCI atrophy and elevated EI that are muscle dependent.
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Affiliation(s)
- Cliff S Klein
- Guangdong Work Injury Rehabilitation Center, Guangzhou, China.
| | - Hui Liu
- Guangdong Work Injury Rehabilitation Center, Guangzhou, China
| | - Chen Ning Zhao
- Guangdong Work Injury Rehabilitation Center, Guangzhou, China
| | - Xinghua Yang
- Guangdong Work Injury Rehabilitation Center, Guangzhou, China
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Scano A, Mira RM, Gabbrielli G, Molteni F, Terekhov V. Whole-Body Adaptive Functional Electrical Stimulation Kinesitherapy Can Promote the Restoring of Physiological Muscle Synergies for Neurological Patients. SENSORS 2022; 22:s22041443. [PMID: 35214345 PMCID: PMC8877830 DOI: 10.3390/s22041443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/28/2022] [Accepted: 02/11/2022] [Indexed: 12/03/2022]
Abstract
Background: Neurological diseases and traumas are major factors that may reduce motor functionality. Functional electrical stimulation is a technique that helps regain motor function, assisting patients in daily life activities and in rehabilitation practices. In this study, we evaluated the efficacy of a treatment based on whole-body Adaptive Functional Electrical Stimulation Kinesitherapy (AFESK™) with the use of muscle synergies, a well-established method for evaluation of motor coordination. The evaluation is performed on retrospectively gathered data of neurological patients executing whole-body movements before and after AFESK-based treatments. Methods: Twenty-four chronic neurologic patients and 9 healthy subjects were recruited in this study. The patient group was further subdivided in 3 subgroups: hemiplegic, tetraplegic and paraplegic. All patients underwent two acquisition sessions: before treatment and after a FES based rehabilitation treatment at the VIKTOR Physio Lab. Patients followed whole-body exercise protocols tailored to their needs. The control group of healthy subjects performed all movements in a single session and provided reference data for evaluating patients’ performance. sEMG was recorded on relevant muscles and muscle synergies were extracted for each patient’s EMG data and then compared to the ones extracted from the healthy volunteers. To evaluate the effect of the treatment, the motricity index was measured and patients’ extracted synergies were compared to the control group before and after treatment. Results: After the treatment, patients’ motricity index increased for many of the screened body segments. Muscle synergies were more similar to those of healthy people. Globally, the normalized synergy similarity in respect to the control group was 0.50 before the treatment and 0.60 after (p < 0.001), with improvements for each subgroup of patients. Conclusions: AFESK treatment induced favorable changes in muscle activation patterns in chronic neurologic patients, partially restoring muscular patterns similar to healthy people. The evaluation of the synergic relationships of muscle activity when performing test exercises allows to assess the results of rehabilitation measures in patients with impaired locomotor functions.
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Affiliation(s)
- Alessandro Scano
- UOS STIIMA Lecco—Human-Centered, Smart & Safe, Living Environment, Italian National Research Council (CNR), Via Previati 1/E, 23900 Lecco, Italy;
- Correspondence: (A.S.); (V.T.)
| | - Robert Mihai Mira
- UOS STIIMA Lecco—Human-Centered, Smart & Safe, Living Environment, Italian National Research Council (CNR), Via Previati 1/E, 23900 Lecco, Italy;
| | | | - Franco Molteni
- Villa Beretta Rehabilitation Center, Ospedale Valduce, Via N. Sauro 17, 23845 Costa Masnaga, Italy;
| | - Viktor Terekhov
- VIKTOR S.r.l.—Via Pasubio, 5, 24044 Dalmine (BG), Italy;
- Correspondence: (A.S.); (V.T.)
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Tefertiller C, Bartelt P, Stobelaar M, Charlifue S, Sevigny M, Vande Griend E, Rozwod M. Improving Upper Extremity Strength, Function, and Trunk Stability Using Wide-Pulse Functional Electrical Stimulation in Combination With Functional Task-Specific Practice. Top Spinal Cord Inj Rehabil 2022; 28:139-152. [PMID: 35521056 PMCID: PMC9009203 DOI: 10.46292/sci21-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objectives To evaluate upper extremity (UE) function, strength, and dynamic sitting balance in individuals with spinal cord injury (SCI) who received an intensive outpatient therapy program focused on UE training augmented with wide pulse/high frequency functional electrical stimulation (WPHF-FES). Methods This prospective case series was conducted in an outpatient (OP) clinic in an SCI-specific rehabilitation hospital. Participants were a convenience sample (N = 50) of individuals with tetraplegia receiving OP therapy focused on UE recovery. Individuals participated in 60 minutes of UE functional task-specific practice (FTP) in combination with WPHF-FES 5 times/week for an average of 72 sessions. The primary outcome for this analysis was the Capabilities of Upper Extremity Test (CUE-T). Secondary outcomes include UE motor score (UEMS) and the modified functional reach (MFR). Results Fifty individuals (13 motor complete; 37 motor incomplete SCI) completed an OP UE training program incorporating WPHF-FES and were included in this analysis. On average, participants demonstrated significant improvements in the total CUE-T score of 14.1 (SD = 10.0, p < .0001) points; significant changes were also noted in UEMS and MFR, improving an average of 4.6 (SD = 5.2, p < .0001) points and 13.6 (SD = 15.8, p < .0001) cm, respectively. Conclusion Individuals with tetraplegia demonstrated significant improvements in UE strength, function, and dynamic sitting trunk balance after receiving UE training augmented with WPHF-FES. Future comparative effectiveness studies need to be completed to guide efficacious treatment interventions in OP therapy.
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Affiliation(s)
| | - Patricia Bartelt
- Department of Physical Therapy, Craig Hospital, Englewood, Colorado
| | - Maureen Stobelaar
- Department of Occupational Therapy, Craig Hospital, Englewood, Colorado
| | | | - Mitch Sevigny
- Research Department, Craig Hospital, Englewood, Colorado
| | | | - Meghan Rozwod
- Department of Physical Therapy, Craig Hospital, Englewood, Colorado
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14
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Khan MA, Saibene M, Das R, Brunner IC, Puthusserypady S. Emergence of flexible technology in developing advanced systems for post-stroke rehabilitation: a comprehensive review. J Neural Eng 2021; 18. [PMID: 34736239 DOI: 10.1088/1741-2552/ac36aa] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 11/04/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Stroke is one of the most common neural disorders, which causes physical disabilities and motor impairments among its survivors. Several technologies have been developed for providing stroke rehabilitation and to assist the survivors in performing their daily life activities. Currently, the use of flexible technology (FT) for stroke rehabilitation systems is on a rise that allows the development of more compact and lightweight wearable systems, which stroke survivors can easily use for long-term activities. APPROACH For stroke applications, FT mainly includes the "flexible/stretchable electronics", "e-textile (electronic textile)" and "soft robotics". Thus, a thorough literature review has been performed to report the practical implementation of FT for post-stroke application. MAIN RESULTS In this review, the highlights of the advancement of FT in stroke rehabilitation systems are dealt with. Such systems mainly involve the "biosignal acquisition unit", "rehabilitation devices" and "assistive systems". In terms of biosignals acquisition, electroencephalography (EEG) and electromyography (EMG) are comprehensively described. For rehabilitation/assistive systems, the application of functional electrical stimulation (FES) and robotics units (exoskeleton, orthosis, etc.) have been explained. SIGNIFICANCE This is the first review article that compiles the different studies regarding flexible technology based post-stroke systems. Furthermore, the technological advantages, limitations, and possible future implications are also discussed to help improve and advance the flexible systems for the betterment of the stroke community.
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Affiliation(s)
- Muhammad Ahmed Khan
- Technical University of Denmark, Ørsteds Plads Building 345C, Room 215, Lyngby, 2800, DENMARK
| | - Matteo Saibene
- Technical University of Denmark, Ørsteds Plads, Building 345C, Lyngby, 2800, DENMARK
| | - Rig Das
- Technical University of Denmark, Ørsteds Plads Building 345C, Room 214, Lyngby, 2800, DENMARK
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15
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Badi M, Wurth S, Scarpato I, Roussinova E, Losanno E, Bogaard A, Delacombaz M, Borgognon S, C Vanc Ara P, Fallegger F, Su DK, Schmidlin E, Courtine G, Bloch J, Lacour SP, Stieglitz T, Rouiller EM, Capogrosso M, Micera S. Intrafascicular peripheral nerve stimulation produces fine functional hand movements in primates. Sci Transl Med 2021; 13:eabg6463. [PMID: 34705521 DOI: 10.1126/scitranslmed.abg6463] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Marion Badi
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics, and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
| | - Sophie Wurth
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics, and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
| | - Ilaria Scarpato
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics, and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
| | - Evgenia Roussinova
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics, and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
| | - Elena Losanno
- Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56025 Pisa, Italy
| | - Andrew Bogaard
- Department of Neuroscience and Movement Sciences, Platform of Translational Neurosciences, Section of Medicine, Faculty of Sciences and Medicine, University of Fribourg, 1700 Fribourg, Switzerland
| | - Maude Delacombaz
- Department of Neuroscience and Movement Sciences, Platform of Translational Neurosciences, Section of Medicine, Faculty of Sciences and Medicine, University of Fribourg, 1700 Fribourg, Switzerland
| | - Simon Borgognon
- Department of Neuroscience and Movement Sciences, Platform of Translational Neurosciences, Section of Medicine, Faculty of Sciences and Medicine, University of Fribourg, 1700 Fribourg, Switzerland.,Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, EPFL, 1015 Lausanne, Switzerland
| | - Paul C Vanc Ara
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK, Bernstein Center Freiburg, and BrainLinks-BrainTools Center, University of Freiburg, 79110 Freiburg, Germany
| | - Florian Fallegger
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronics Interface, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, 1202 Geneva, Switzerland
| | - David K Su
- Neurological Surgery, Harborview Medical Center, Seattle, WA 98104, USA
| | - Eric Schmidlin
- Department of Neuroscience and Movement Sciences, Platform of Translational Neurosciences, Section of Medicine, Faculty of Sciences and Medicine, University of Fribourg, 1700 Fribourg, Switzerland
| | - Grégoire Courtine
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, EPFL, 1015 Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), EPFL, University Hospital of Lausanne (CHUV), and University of Lausanne (UNIL), 1015 Lausanne, Switzerland
| | - Jocelyne Bloch
- Defitech Center for Interventional Neurotherapies (NeuroRestore), EPFL, University Hospital of Lausanne (CHUV), and University of Lausanne (UNIL), 1015 Lausanne, Switzerland
| | - Stéphanie P Lacour
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronics Interface, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, 1202 Geneva, Switzerland
| | - Thomas Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK, Bernstein Center Freiburg, and BrainLinks-BrainTools Center, University of Freiburg, 79110 Freiburg, Germany
| | - Eric M Rouiller
- Department of Neuroscience and Movement Sciences, Platform of Translational Neurosciences, Section of Medicine, Faculty of Sciences and Medicine, University of Fribourg, 1700 Fribourg, Switzerland
| | - Marco Capogrosso
- Department of Neuroscience and Movement Sciences, Platform of Translational Neurosciences, Section of Medicine, Faculty of Sciences and Medicine, University of Fribourg, 1700 Fribourg, Switzerland.,Department of Neurological Surgery, Rehabilitation and Neural Engineering Laboratories, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Silvestro Micera
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics, and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland.,Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56025 Pisa, Italy
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16
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Do any physiotherapy interventions increase spinal cord independence measure or functional independence measure scores in people with spinal cord injuries? A systematic review. Spinal Cord 2021; 59:705-715. [PMID: 34099880 DOI: 10.1038/s41393-021-00638-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/14/2021] [Accepted: 04/14/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To determine whether any physiotherapy interventions increase Spinal Cord Independence Measure or Functional Independence Measure scores (SCIM/FIM) in people with spinal cord injury (SCI), with the overall aim of determining whether any physiotherapy interventions need to be controlled for in studies examining the effects of novel experimental interventions on SCIM/FIM. METHODS A systematic review was conducted to identify all randomised controlled trials examining the effect of any physiotherapy intervention on SCIM/FIM in people with SCI. PEDro scores were used to rate risk of bias. The results of similar trials and comparisons were pooled using meta-analyses. RESULTS Thirty-three trials met the inclusion criteria but only 27 provided useable data. The median (IQR) PEDro score was 6.0 (4.0-7.0). A meta-analysis of four trials comparing robotic gait training with overground gait training that used a combination of FIM/SCIM indicated a pooled mean (95% CI) between-group difference of 0.38 standardised mean difference (SMD; 95% CI, 0.08-0.67). A second meta-analysis of two trials comparing upper limb training with and without functional electrical stimulation using FIM indicated a pooled (95% CI) between-group difference of 1.31 SMD (0.62-1.99). Another six trials examining a range of different physiotherapy interventions reported a statistically significant mean between-group difference on SCIM/FIM. CONCLUSION There is low-quality evidence to indicate that a small number of physiotherapy interventions increase SCIM/FIM. The importance of controlling for all physiotherapy interventions in studies examining the effects of novel experimental interventions on SCIM/FIM is as yet unclear.
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Jovanovic LI, Kapadia N, Zivanovic V, Rademeyer HJ, Alavinia M, McGillivray C, Kalsi-Ryan S, Popovic MR, Marquez-Chin C. Brain-computer interface-triggered functional electrical stimulation therapy for rehabilitation of reaching and grasping after spinal cord injury: a feasibility study. Spinal Cord Ser Cases 2021; 7:24. [PMID: 33741900 PMCID: PMC7979732 DOI: 10.1038/s41394-020-00380-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/21/2020] [Accepted: 12/25/2020] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN Feasibility and preliminary clinical efficacy analysis in a single-arm interventional study. OBJECTIVES We developed a brain-computer interface-triggered functional electrical stimulation therapy (BCI-FEST) system for clinical application and conducted an interventional study to (1) assess its feasibility and (2) understand its potential clinical efficacy for the rehabilitation of reaching and grasping in individuals with sub-acute spinal cord injury (SCI). SETTING Spinal cord injury rehabilitation hospital-Toronto Rehabilitation Institute-Lyndhurst Centre. METHODS Five participants with sub-acute SCI completed between 12 and 40 1-hour sessions using BCI-FEST, with up to 5 sessions a week. We assessed feasibility by measuring participants' compliance with treatment, the occurrence of adverse events, BCI sensitivity, and BCI setup duration. Clinical efficacy was assessed using Functional Independence Measure (FIM) and Spinal Cord Independence Measure (SCIM), as primary outcomes. In addition, we used two upper-limb function tests as secondary outcomes. RESULTS On average, participants completed 29.8 sessions with no adverse events. Only one of the 149 sessions was affected by technical challenges. The BCI sensitivity ranged between 69.5 and 80.2%, and the mean BCI setup duration was ~11 min. In the primary outcomes, three out of five participants showed changes greater than the minimal clinically important differences (MCIDs). Additionally, the mean change in secondary outcome measures met the threshold for detecting MCID as well; four out of five participants achieved MCID. CONCLUSIONS The new BCI-FEST intervention is safe, feasible, and promising for the rehabilitation of reaching and grasping after SCI.
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Affiliation(s)
- Lazar I Jovanovic
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
- CRANIA, University Health Network, Toronto, ON, Canada.
| | - Naaz Kapadia
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- CRANIA, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Vera Zivanovic
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Hope Jervis Rademeyer
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Mohammad Alavinia
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Colleen McGillivray
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
| | - Sukhvinder Kalsi-Ryan
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Milos R Popovic
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- CRANIA, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Cesar Marquez-Chin
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- CRANIA, University Health Network, Toronto, ON, Canada
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18
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Clinical Benefit of Rehabilitation Training in Spinal Cord Injury: A Systematic Review and Meta-Analysis. Spine (Phila Pa 1976) 2021; 46:E398-E410. [PMID: 33620185 DOI: 10.1097/brs.0000000000003789] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A systematic review and meta-analysis. OBJECTIVE This study was performed to evaluate the effects of different rehabilitation interventions in spinal cord injury. SUMMARY OF BACKGROUND DATA Several activity-based interventions have been widely applied in spinal cord injury in the past, but the effects of these rehabilitation exercises are controversial. METHODS Publications were searched from databases (PubMed, Embase, Cochrane, the database of the U.S. National Institutes of Health and World Health Organization International Clinical Trials Registry Platform) using the searching terms like spinal cord injury, transcranial magnetic stimulation, functional electrical stimulation, activity-based therapy, and robotic-assisted locomotor training. Randomized controlled trials and controlled trials were included. The primary outcomes included functional upper/lower extremity independence, walking capacity, spasticity, and life quality of individuals with spinal cord injury. Meta-analysis was performed using Revman 5.0 software. RESULTS Thirty-one articles were included. Meta-analysis showed that transcranial magnetic stimulation improved walking speed (95% confidence interval [CI] 0.01, 0.16) and lower extremity function (95% CI 1.55, 7.27); functional electrical stimulation significantly increased upper extremity independence (95% CI 0.37, 5.48). Robotic-assisted treadmill training improved lower extremity function (95% CI 3.44, 6.56) compared with related controls. CONCLUSION Activity-based intervention like transcranial magnetic stimulation, functional electrical stimulation, and robotic-assisted treadmill training are effective in improving function in individuals with spinal cord injury.Level of Evidence: 1.
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19
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Inanici F, Brighton LN, Samejima S, Hofstetter CP, Moritz CT. Transcutaneous Spinal Cord Stimulation Restores Hand and Arm Function After Spinal Cord Injury. IEEE Trans Neural Syst Rehabil Eng 2021; 29:310-319. [DOI: 10.1109/tnsre.2021.3049133] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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20
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Simpson B, Villeneuve M, Clifton S. The experience and perspective of people with spinal cord injury about well-being interventions: a systematic review of qualitative studies. Disabil Rehabil 2020; 44:3349-3363. [PMID: 33377801 DOI: 10.1080/09638288.2020.1864668] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Promoting well-being is a key aim of rehabilitation. The intentional design of interventions to address well-being requires an understanding of the factors that affect this complex phenomenon. A growing body of qualitative literature has identified determinants that people with SCI report affect their well-being. It is unclear whether or how rehabilitation interventions can influence these well-being determinants. This study sought to explore the experience and perspective of people with SCI about interventions that target their well-being. METHOD Systematic search of seven databases. Deductive analysis to categorize findings related to well-being determinants, and further inductive coding to identify sub-themes, relationships and additional findings. RESULTS Twenty studies were selected, involving a wide range of interventions. Each intervention influenced a number of well-being determinants, which were inter-related. People with SCI reported improvements in both subjective and psychological well-being. However, well-being was not always well defined in the studies and people with SCI reported lack of priority for, and opportunity to engage in, well-being interventions in the current rehabilitation system. CONCLUSIONS Rehabilitation interventions can influence well-being determinants. These determinants form a useful framework for the intentional design of well-being interventions, which should be informed by a broad understanding of well-being.IMPLICATIONS FOR REHABILITATIONWell-being can be influenced by rehabilitation interventions, and a more explicit focus on well-being in intervention design and evaluation is recommended.Conceptual frameworks used to define and measure well-being should adopt a broad understanding of well-being.Well-being interventions should address the determinants identified by people with SCI (engaging in occupation, responsibility, values and perspectives, self-worth, self-continuity, relationships and the environment).People with SCI want a greater priority placed on well-being interventions, and more opportunities to engage in these interventions, especially in the community.
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Affiliation(s)
- Bronwyn Simpson
- Occupational Therapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Shane Clifton
- Centre for Disability Research, The University of Sydney, Sydney, Australia.,Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability, Sydney, Australia
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21
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Momeni K, Ramanujam A, Ravi M, Garbarini E, Forrest GF. Effects of Multi-Muscle Electrical Stimulation and Stand Training on Stepping for an Individual With SCI. Front Hum Neurosci 2020; 14:549965. [PMID: 33100994 PMCID: PMC7546792 DOI: 10.3389/fnhum.2020.549965] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/28/2020] [Indexed: 11/13/2022] Open
Abstract
The objective of this study was to evaluate the biomechanical, neural, and functional outcomes during a 10-min treadmill stepping trial before and after two independent interventions with neuromuscular electrical stimulation (ES) in an individual with spinal cord injury (SCI). In this longitudinal study, a 34-year-old male with sensory- and motor-complete SCI (C5/C6) underwent two consecutive interventions: 61 h of supine lower limb ES (ES-alone) followed by 51 h of ES combined with stand training (ST) using an overhead body-weight support (BWS) system (ST + ES). In post ES-alone (unloaded), compared to baseline, the majority (∼60%) of lower extremity muscles decreased their peak surface electromyography (sEMG) amplitude, while in post ST + ES (loaded), compared to post ES-alone, there was a restoration in muscle activation that endured the continuous 10-min stepping. Temporal α-motor neuron activity patterns were observed for the SCI participant. In post ST + ES, there were increases in spinal activity patterns during mid-stance at spinal levels L5–S2 for the right and left limbs. Moreover, in post ES-alone, trunk stability increased with excursions from the midline of the base-of-support (50%) to the left (44.2%; Baseline: 54.2%) and right (66.4%; baseline: 77.5%). The least amount of trunk excursion observed post ST + ES, from midline to left (43%; AB: 22%) and right (64%; AB: 64%). Overall, in post ES-alone, there were gains in trunk independence with a decrease in lower limb muscle activation, whereas in post ST + ES, there were gains in trunk independence and increased muscle activation in both bilateral trunk muscles as well as lower limb muscles during the treadmill stepping paradigm. The results of the study illustrate the importance of loading during the stimulation for neural and mechanical gains.
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Affiliation(s)
- Kamyar Momeni
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ, United States.,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Arvind Ramanujam
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ, United States
| | - Manikandan Ravi
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ, United States
| | - Erica Garbarini
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ, United States
| | - Gail F Forrest
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ, United States.,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States
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A Review of Different Stimulation Methods for Functional Reconstruction and Comparison of Respiratory Function after Cervical Spinal Cord Injury. Appl Bionics Biomech 2020; 2020:8882430. [PMID: 33014127 PMCID: PMC7519444 DOI: 10.1155/2020/8882430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/30/2020] [Accepted: 09/07/2020] [Indexed: 11/27/2022] Open
Abstract
Background Spinal cord injury (SCI) is a common severe trauma in clinic, hundreds of thousands of people suffer from which every year in the world. In terms of injury location, cervical spinal cord injury (CSCI) has the greatest impact. After cervical spinal cord injury, the lack of innervated muscles is not enough to provide ventilation and other activities to complete the respiratory function. In addition to the decline of respiratory capacity, respiratory complications also have a serious impact on the life of patients. The most commonly used assisted breathing and cough equipment is the ventilator, but in recent years, the functional electrical stimulation method is being used gradually and widely. Methods About hundred related academic papers are cited for data analysis. They all have the following characteristics: (1) basic conditions of patients were reported, (2) patients had received nerve or muscle stimulation and the basic parameters, and (3) the results were evaluated based on some indicators. Results The papers mentioned above are classified as four kinds of stimulation methods: muscle electric/magnetic stimulation, spinal dural electric stimulation, intraspinal microstimulation, and infrared light stimulation. This paper describes the stimulation principle and application experiment. Finally, this paper will compare the indexes and effects of typical stimulation methods, as well as the two auxiliary methods: training and operation. Conclusions Although there is limited evidence for the treatment of respiratory failure by nerve or muscle stimulation after cervical spinal cord injury, the two techniques seem to be safe and effective. At the same time, light stimulation is gradually applied to clinical medicine with its strong advantages and becomes the development trend of nerve stimulation in the future.
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Anderson KD, Wilson JR, Korupolu R, Pierce J, Bowen JM, O'Reilly D, Kapadia N, Popovic MR, Thabane L, Musselman KE. Multicentre, single-blind randomised controlled trial comparing MyndMove neuromodulation therapy with conventional therapy in traumatic spinal cord injury: a protocol study. BMJ Open 2020; 10:e039650. [PMID: 32988951 PMCID: PMC7523215 DOI: 10.1136/bmjopen-2020-039650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION This protocol is describing a multicentre, single-blind randomised controlled trial. The objective is to compare the efficacy of MyndMove therapy versus conventional therapy (CT) in improving upper extremity function in individuals with C4-C7 traumatic, incomplete spinal cord injury (SCI). It is being conducted in two US and two Canadian SCI rehabilitation centres. METHODS AND ANALYSIS Sixty people aged 18 years or older with a C4-C7 incomplete (AIS B-D) SCI between 4 months and 8 years postinjury are randomised to receive 40 sessions of MyndMove neuromodulation therapy or CT within a 14-week period of time. Therapy sessions are 1 hour in duration with a dose of 3-5 sessions per week. Assessments occur prior to randomisation, after 20 sessions, after 40 sessions and 10 weeks after the last session. The primary outcome measure is the efficacy of MyndMove therapy versus CT in improving upper extremity function as measured by Spinal Cord Independence Measure III: Self-Care subscore after 40 sessions. Secondary outcomes include: (1) improvements in the SCIM mobility subscore; (2) upper limb functions measured by Graded Redefined Assessment of Strength, Sensibility and Prehension and (3) Toronto Rehab Institute Hand Function Test; (4) To assess safety as measured by serious and non-serious adverse events recorded for participants in both groups of the study population over the duration of the study; (5) to compare the change in quality of life as measured by the Spinal Cord Injury-Quality of Life; and (6) to evaluate the impact on healthcare resource utilisation. ETHICS AND DISSEMINATION All ethical approvals were obtained prior to enrolling any participants. Dissemination of the results of the study will be made at peer-reviewed academic meetings and through peer-reviewed medical journals TRIAL REGISTRATION NUMBER: NCT03439319.
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Affiliation(s)
- Kim D Anderson
- Department of Physical Medicine and Rehabilitation, MetroHealth System, Cleveland, Ohio, USA
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, Ohio, USA
| | - James R Wilson
- Department of Physical Medicine and Rehabilitation, MetroHealth System, Cleveland, Ohio, USA
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, Ohio, USA
| | - Radha Korupolu
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, Texas, USA
- The Institute for Rehabilitation and Research (TIRR), Houston, Texas, USA
| | - Jacqueline Pierce
- Centre for Neurology Studies, Health Tech Connex, Surrey, British Columbia, Canada
| | - James M Bowen
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, Ontario, Canada
| | - Daria O'Reilly
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
- TELUS Health, Toronto, Ontario, Canada
| | - Naaz Kapadia
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Milos R Popovic
- The KITE Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
- Biostatistics Unit, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Kristin E Musselman
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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Kapadia N, Moineau B, Popovic MR. Functional Electrical Stimulation Therapy for Retraining Reaching and Grasping After Spinal Cord Injury and Stroke. Front Neurosci 2020; 14:718. [PMID: 32742254 PMCID: PMC7364342 DOI: 10.3389/fnins.2020.00718] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/16/2020] [Indexed: 12/31/2022] Open
Abstract
Neurological conditions like hemiplegia following stroke or tetraplegia following spinal cord injury, result in a massive compromise in motor function. Each of the two conditions can leave individuals dependent on caregivers for the rest of their lives. Once medically stable, rehabilitation is the main stay of treatment. This article will address rehabilitation of upper extremity function. It is long known that moving the affected limb is crucial to recovery following any kind of injury. Overtime, it has also been established that just moving the affected extremities does not suffice, and that the movements have to involve patient’s participation, be as close to physiologic movements as possible, and should ideally stimulate the entire neuromuscular circuitry involved in producing the desired movement. For over four decades now, functional electrical stimulation (FES) is being used to either replace or retrain function. The FES therapy discussed in this article has been used to retrain upper extremity function for over 15 years. Published data of pilot studies and randomized control trials show that FES therapy produces significant changes in arm and hand function. There are specific principles of the FES therapy as applied in our studies: (i) stimulation is applied using surface stimulation electrodes, (ii) there is minimum to virtually no pain during application, (iii) each session lasts no more than 45–60 min, (iv) the technology is quite robust and can make up for specificity to a certain extent, and (v) fine motor function like two finger precision grip can be trained (i.e., thumb and index finger tip to tip pinch). The FES therapy protocols can be successfully applied to individuals with paralysis resulting from stroke or spinal cord injury.
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Affiliation(s)
- Naaz Kapadia
- Rehabilitation Engineering Laboratory, The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,CRANIA, University Health Network and University of Toronto, Toronto, ON, Canada.,The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Bastien Moineau
- Rehabilitation Engineering Laboratory, The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada.,Myant Inc., Toronto, ON, Canada
| | - Milos R Popovic
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,CRANIA, University Health Network and University of Toronto, Toronto, ON, Canada.,The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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Khan MA, Das R, Iversen HK, Puthusserypady S. Review on motor imagery based BCI systems for upper limb post-stroke neurorehabilitation: From designing to application. Comput Biol Med 2020; 123:103843. [PMID: 32768038 DOI: 10.1016/j.compbiomed.2020.103843] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/18/2020] [Accepted: 06/02/2020] [Indexed: 12/21/2022]
Abstract
Strokes are a growing cause of mortality and many stroke survivors suffer from motor impairment as well as other types of disabilities in their daily life activities. To treat these sequelae, motor imagery (MI) based brain-computer interface (BCI) systems have shown potential to serve as an effective neurorehabilitation tool for post-stroke rehabilitation therapy. In this review, different MI-BCI based strategies, including "Functional Electric Stimulation, Robotics Assistance and Hybrid Virtual Reality based Models," have been comprehensively reported for upper-limb neurorehabilitation. Each of these approaches have been presented to illustrate the in-depth advantages and challenges of the respective BCI systems. Additionally, the current state-of-the-art and main concerns regarding BCI based post-stroke neurorehabilitation devices have also been discussed. Finally, recommendations for future developments have been proposed while discussing the BCI neurorehabilitation systems.
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Affiliation(s)
- Muhammad Ahmed Khan
- Department of Health Technology, Technical University of Denmark, 2800, Kgs. Lyngby, Denmark.
| | - Rig Das
- Department of Health Technology, Technical University of Denmark, 2800, Kgs. Lyngby, Denmark
| | - Helle K Iversen
- Department of Neurology, University of Copenhagen, Rigshospitalet, 2600, Glostrup, Denmark
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Dionne TP, Lenker JA, Hennessy P, Sullivan JE. Use of Electrical Stimulation for People With Spinal Cord Injury: A Survey of Occupational Therapy Practitioners. Am J Occup Ther 2020; 74:7403205110p1-7403205110p7. [PMID: 32365317 DOI: 10.5014/ajot.2020.035584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE When working with clients who have experienced spinal cord injury (SCI), occupational therapy practitioners can face challenges in achieving desired results during functional activity when using electrical stimulation (ES) interventions. In an effort to understand current practice, a survey study was conducted. OBJECTIVE For people with SCI, ES elicits positive physiological effects; however, no implementation guidelines exist for upper extremity application of ES for this population. Therefore, we surveyed occupational therapy practitioners about their use of ES with clients who have cervical-level SCI. DESIGN A 33-item, 20-min online survey was used. PARTICIPANTS AND SETTING We queried 57 occupational therapy practitioners with active caseloads in regional rehabilitation centers specializing in SCI, both outpatient and inpatient. RESULTS For clients with SCI, occupational therapy practitioners used ES most often for grasp-and-release, reaching, and grip or pinch activities using a broad range of parameter settings. Among respondents, 43% did not use a specific treatment protocol; 27% used research evidence to guide selection of parameters. CONCLUSIONS AND RELEVANCE Findings suggest that ES treatment parameters are not uniformly applied, introducing potential unknown effects on client outcomes and undermining treatment fidelity. WHAT THIS ARTICLE ADDS Our survey of occupational therapy practitioners regarding their practice and use of ES interventions with this population revealed variation in application of ES treatment parameters. Understanding different treatment approaches and justification used when applying ES to clients with SCI is an important first step in unifying and promoting best practice and maximizing patient outcomes.
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Affiliation(s)
- Timothy P Dionne
- Timothy P. Dionne, PhD, OTR/L, is Assistant Professor, Occupational Therapy Graduate Program, School of Medicine, The University of New Mexico, Albuquerque;
| | - James A Lenker
- James A. Lenker, PhD, OTR/L, FAOTA, is Associate Professor, Department of Rehabilitation Science, University at Buffalo, Buffalo, NY
| | - Patrick Hennessy
- Patrick Hennessy, PT, MPT, NCS, is Clinical Knowledge Broker, Infinity Rehab, Wilsonville, OR
| | - Jane E Sullivan
- Jane E. Sullivan, PT, DHS, MS, is Professor, Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago
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Restoration of Upper Limb Function After Chronic Severe Hemiplegia: A Case Report on the Feasibility of a Brain-Computer Interface-Triggered Functional Electrical Stimulation Therapy. Am J Phys Med Rehabil 2020; 99:e35-e40. [PMID: 30768447 DOI: 10.1097/phm.0000000000001163] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Functional electrical stimulation therapy (FEST) is a state-of-the-art treatment for retraining motor function after neurological injuries. Recent literature suggests that FEST can be further improved with brain-computer interface (BCI) technology. In this case study, we assessed the feasibility of using BCI-triggered FEST (BCI-FEST) to restore upper limb function in a 57-yr-old man with severe left hemiplegia resulting from a stroke 6 yrs before enrollment in the study. The intervention consisted of two blocks of forty 1-hr BCI-FEST sessions, with three sessions delivered weekly. During therapy, a single-channel BCI was used to trigger the stimulation programmed to facilitate functional movements. The measure of the feasibility of the BCI-FEST included assessing the implementation and safety of the intervention. Clinical improvements were assessed using (a) Functional Independence Measure, (b) Action Research Arm Test, (c) Toronto Rehabilitation Institute - Hand Function Test, and (d) Fugl-Meyer Assessment Upper Extremity test. Upon completion of 80 therapy sessions, 14-, 17-, and 18-point changes were recorded on Action Research Arm Test, Fugl-Meyer Assessment Upper Extremity test, and Toronto Rehabilitation Institute - Hand Function Test, respectively. The participant also indicated improvement as demonstrated by his ability to perform various day-to-day tasks. The results suggest that BCI-FEST is safe and viable.
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Mateo S, Di Marco J, Cucherat M, Gueyffier F, Rode G. Inconclusive efficacy of intervention on upper-limb function after tetraplegia: A systematic review and meta-analysis. Ann Phys Rehabil Med 2020; 63:230-240. [DOI: 10.1016/j.rehab.2019.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/21/2019] [Accepted: 05/06/2019] [Indexed: 01/01/2023]
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Venugopalan L, Taylor PN, Cobb JE, Swain ID. TetraGrip - a four channel upper limb FES device for people with C5/C6 tetraplegia: device design and clinical outcome. J Med Eng Technol 2020; 44:38-44. [PMID: 31997672 DOI: 10.1080/03091902.2020.1713239] [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] [Indexed: 01/11/2023]
Abstract
The TetraGrip is an inertial measurement unit-controlled surface upper limb FES device developed for improving hand functions of people with tetraplegia. The reliability of the control system and the repeatability and reproducibility of the device were assessed by analysing the results obtained when 14 able-bodied volunteers used the device. These volunteers were able to generate the control signals effectively once they had sufficient training. The two tetraplegic volunteers participated in a 12-week long clinical study (exercise, 4 weeks; functional tasks, 8 weeks), where they used the device to perform functional tasks. Outcome measures used were the grasp release test, the grip strength test, and the box and block test. Both tetraplegic volunteers showed improvement in performing the tasks specified in all outcome measures. The TetraGrip performed as intended when the able-bodied volunteers used it, and it improved the hand functions of both volunteers with tetraplegia. However, a larger clinical study is necessary to assess the performance of the device with a wider range of people with tetraplegia such as those with C5 complete/incomplete.
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Affiliation(s)
- L Venugopalan
- Department of Biomedical Engineering, Vel Tech Multi Tech Dr. Rangarajan and Dr. Sakunthala Engineering College, Chennai, India
| | - P N Taylor
- The National Clinical FES Centre, Salisbury District Hospital, Salisbury, UK
| | - J E Cobb
- The Faculty of Science and Technology, Bournemouth University, Poole, UK
| | - I D Swain
- The Faculty of Science and Technology, Bournemouth University, Poole, UK
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Moineau B, Marquez-Chin C, Alizadeh-Meghrazi M, Popovic MR. Garments for functional electrical stimulation: Design and proofs of concept. J Rehabil Assist Technol Eng 2019; 6:2055668319854340. [PMID: 35186317 PMCID: PMC8855467 DOI: 10.1177/2055668319854340] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 05/10/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction Repeated use of functional electrical stimulation can promote functional recovery in individuals with neurological paralysis. We designed garments able to deliver functional electrical stimulation. Methods Shirts and pants containing electrodes knitted with a conductive yarn were produced. Electrodes were moistened with water before use. Stimulation intensity at four thresholds levels (sensory, movement, full range of motion, and maximal), stimulation comfort, and electrical properties of the interface were tested in one able-bodied subject with garment electrodes and size-matched conventional gel electrodes. The pants and shirt were then used to explore usability and design limitations. Results Compared to gel electrodes, fabric electrodes had a lower sensory threshold (on forearm muscles) but they had a higher maximal stimulation threshold (for all tested muscles). The stimulation delivery was comfortable when the garment electrodes were recently moistened; however, as the electrodes dried (within 9 to 18 min) stimulation became unpleasant. Inconsistent water content in the fabric electrodes caused inconsistent intensity thresholds and inconsistent voltage necessary to apply a desired stimulation current. Garments’ tightness and impracticality of electrode lead necessitate further design improvement. Conclusions Fabric electrodes offer a promising alternative to gel electrodes. Further work involving people with paralysis is required to overcome the identified challenges.
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Affiliation(s)
- Bastien Moineau
- Rehabilitation Engineering Laboratory, Lyndhurst Centre, KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada
- Myant Inc., Toronto, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Cesar Marquez-Chin
- Rehabilitation Engineering Laboratory, Lyndhurst Centre, KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada
- Department of Occupational Sciences and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Milad Alizadeh-Meghrazi
- Rehabilitation Engineering Laboratory, Lyndhurst Centre, KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada
- Myant Inc., Toronto, ON, Canada
| | - Milos R Popovic
- Rehabilitation Engineering Laboratory, Lyndhurst Centre, KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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Aravind N, Harvey LA, Glinsky JV. Physiotherapy interventions for increasing muscle strength in people with spinal cord injuries: a systematic review. Spinal Cord 2019; 57:449-460. [PMID: 30723256 DOI: 10.1038/s41393-019-0242-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 12/20/2018] [Accepted: 12/24/2018] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A systematic review. OBJECTIVE The aim of this review was to determine the effectiveness of physiotherapy (PT) interventions for increasing voluntary muscle strength in people with spinal cord injuries (SCI). METHODS We included randomised controlled trials of PT interventions for people with SCI. We were interested in two comparisons: PT interventions compared with sham or no intervention, and PT interventions compared to each other. The outcome of interest was voluntary strength of muscles directly affected by SCI. All included studies were rated according to the Cochrane Risk of Bias Tool and results of similar trials were pooled using meta-analyses where possible. RESULTS Twenty-six trials met the inclusion criteria and provided useable data. A statistically significant between-group difference was found in four comparisons, namely, resistance training versus no intervention (standardised mean difference (SMD) = 0.64; 95% CI, 0.22-1.07; p = 0.003); resistance training combined with electrical stimulation versus no intervention (mean difference (MD) = 14 Nm; 95% CI, 1-27; p = 0.03); a package of PT interventions versus no intervention (MD = 4.8/50 points on the Lower Extremity Motor Score (LEMS); 95% CI 1.9-7.7; p = 0.01); and robotic gait training versus overground gait training (MD = 3.1/50 points on the LEMS; 95% CI, 1.3-5.0; p = 0.0008). CONCLUSION There is evidence that a small number of PT interventions increase voluntary strength in muscles directly affected by SCI.
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Affiliation(s)
- Nisha Aravind
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, University of Sydney, Sydney, Australia.
| | - Joanne V Glinsky
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, University of Sydney, Sydney, Australia
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Momeni K, Ramanujam A, Garbarini EL, Forrest GF. Multi-muscle electrical stimulation and stand training: Effects on standing. J Spinal Cord Med 2019; 42:378-386. [PMID: 29447105 PMCID: PMC6522918 DOI: 10.1080/10790268.2018.1432311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To examine the biomechanical and neuromuscular effects of a longitudinal multi-muscle electrical stimulation (submaximal intensities) training of the lower limbs combined with/without activity-based stand training, on the recovery of stability and function for one individual with spinal cord injury (SCI). DESIGN Single-subject, longitudinal study. SETTING Neuroplasticity laboratory. PARTICIPANT A 34-year-old male, with sensory- and motor-complete SCI (C5/C6). INTERVENTIONS Two consecutive interventions: 61 hours of supine, lower-limb ES (ES-alone) and 51 hours of ES combined with stand training using an overhead body-weight support system (ST + ES). OUTCOME MEASURES Clinical measures, trunk stability, and muscle activity were assessed and compared across time points. Trunk Stability Limit (TSL) determined improvements in trunk independence. RESULTS Functional clinical values increased after both interventions, with further increases post ST + ES. Post ES-alone, trunk stability was maintained at 81% body-weight (BW) loading before failure; post ST + ES, BW loading increased to 95%. TSL values decreased post ST + ES (TSLA/P=54.0 kg.cm, TSLM/L=14.5 kg.cm), compared to ES-alone (TSLA/P=8.5 kg.cm, TSLM/L=3.9 kg.cm). Trunk muscle activity decreased post ST + ES training, compared to ES-alone. CONCLUSION Neuromuscular and postural trunk control dramatically improved following the multi-muscle ES of the lower limbs with stand training. Multi-muscle ES training paradigm of the lower limb, using traditional parameters, may contribute to the functional recovery of the trunk.
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Affiliation(s)
- Kamyar Momeni
- Human Performance and Engineering Research, Kessler Foundation, New Jersey, USA,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, New Jersey, USA
| | - Arvind Ramanujam
- Human Performance and Engineering Research, Kessler Foundation, New Jersey, USA
| | - Erica L. Garbarini
- Human Performance and Engineering Research, Kessler Foundation, New Jersey, USA
| | - Gail F. Forrest
- Human Performance and Engineering Research, Kessler Foundation, New Jersey, USA,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, New Jersey, USA,Correspondence to: Gail F. Forrest, Ph.D., Human Performance and Engineering Research, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ07052, USA.
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de Oliveira CQ, Middleton JW, Refshauge K, Davis GM. Activity-Based Therapy in a Community Setting for Independence, Mobility, and Sitting Balance for People With Spinal Cord Injuries. J Cent Nerv Syst Dis 2019; 11:1179573519841623. [PMID: 31019375 PMCID: PMC6463227 DOI: 10.1177/1179573519841623] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 03/06/2019] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Activity-based therapy (ABT) aims to activate the neuromuscular system below the level of the spinal cord lesion and promote recovery of motor tasks through spinal reorganisation, motor learning and changes to muscles and sensory system. We investigated the effects of a multimodal ABT program on mobility, independence and sitting balance in individuals with spinal cord injury (SCI). METHODS Retrospective clinical data from 91 adults who independently enrolled in four community-based ABT centres in Australia were analysed. The multimodal ABT program was delivered for 3 to 12 months, one to four times per week. Assessments were undertaken every 3 months and included the Modified Rivermead Mobility Index (MRMI), Spinal Cord Independence Measure (SCIM) and seated reach distance (SRD). A linear mixed model analysis was used to determine time-based and other predictors of change. RESULTS There was a significant improvement after 12 months for all outcome measures, with a mean change score of 4 points in the SCIM (95% confidence interval [CI]: 2.7-5.3, d = 0.19), 2 points in the MRMI (95% CI: 1-2.3, d = 0.19) and 0.2 in the SRD (95% CI: 0.1-2.2, d = 0.52). Greater improvements occurred in the first 3 months of intervention. There were no interaction effects between time and the neurological level of injury, American Spinal Injury Association Impairment Scale classification, or duration post-injury for most outcomes. CONCLUSIONS A community-based ABT exercise program for people with SCI can lead to small improvements in mobility, independence and balance in sitting, with greater improvements occurring early during intervention.
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Affiliation(s)
- Camila Quel de Oliveira
- Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
- Discipline of Physiotherapy, Graduate School of Health
| | - James W Middleton
- John Walsh Center for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Sydney Medical School Northern, The University of Sydney, St Leonards, NSW, Australia
| | - Kathryn Refshauge
- Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
| | - Glen M Davis
- Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
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Barroso FO, Yoder B, Tentler D, Wallner JJ, Kinkhabwala AA, Jantz MK, Flint RD, Tostado PM, Pei E, Satish ADR, Brodnick SK, Suminski AJ, Williams JC, Miller LE, Tresch MC. Decoding neural activity to predict rat locomotion using intracortical and epidural arrays. J Neural Eng 2019; 16:036005. [DOI: 10.1088/1741-2552/ab0698] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Niu CM, Bao Y, Zhuang C, Li S, Wang T, Cui L, Xie Q, Lan N. Synergy-Based FES for Post-Stroke Rehabilitation of Upper-Limb Motor Functions. IEEE Trans Neural Syst Rehabil Eng 2019; 27:256-264. [DOI: 10.1109/tnsre.2019.2891004] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Effect of electrical stimulation on muscle atrophy and spasticity in patients with spinal cord injury – a systematic review with meta-analysis. Spinal Cord 2019; 57:258-266. [DOI: 10.1038/s41393-019-0250-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 12/29/2018] [Accepted: 01/03/2019] [Indexed: 11/09/2022]
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Cheung VCK, Niu CM, Li S, Xie Q, Lan N. A Novel FES Strategy for Poststroke Rehabilitation Based on the Natural Organization of Neuromuscular Control. IEEE Rev Biomed Eng 2019; 12:154-167. [DOI: 10.1109/rbme.2018.2874132] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Fawaz S, Kamel F, El Yasaky A, El Shishtawy H, Genedy A, Awad RM, El Nabil L. The therapeutic application of functional electrical stimulation and transcranial magnetic stimulation in rehabilitation of the hand function in incomplete cervical spinal cord injury. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2018. [DOI: 10.4103/err.err_48_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Cacho EWA, Cacho RDO, Ortolan RL, Lima NMFV, Silva Filho EMD, Cliquet Jr A. REACH AND PALMAR GRASP IN TETRAPLEGICS WITH NEUROMUSCULAR ELECTRICAL STIMULATION. REV BRAS MED ESPORTE 2018. [DOI: 10.1590/1517-869220182406180392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To evaluate the movement strategies of quadriplegics, assisted by neuromuscular electrical stimulation, on reach and palmar grasp using objects of different weights. Methods: It was a prospective clinical trial. Four chronic quadriplegics (C5-C6), with injuries of traumatic origin, were recruited and all of them had their reach and palmar grasp movement captured by four infrared cameras and six retro-reflective markers attached to the trunk and right arm, assisted or not by neuromuscular electrical stimulation to the triceps, extensor carpi radialis longus, extensor digitorum communis, flexor digitorum superficialis, opponens pollicis and lumbricals. It was measured by a Neurological and Functional Classification of Spinal Cord Injuries of the American Spinal Injury Association, Functional Independence Measure and kinematic variables. Results: The patients were able to reach and execute palmar grasp in all cylinders using the stimulation sequences assisted by neuromuscular electrical stimulation. The quadriplegics produced lower peak velocity, a shorter time of movement and reduction in movement segmentation, when assisted by neuromuscular electrical stimulation. Conclusion: This study showed that reach and palmar grasp movement assisted by neuromuscular electrical stimulation was able to produce motor patterns more similar to healthy subjects. Level of evidence IV; Case series.
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Affiliation(s)
| | | | | | | | | | - Alberto Cliquet Jr
- Universidade Estadual de Campinas, Brazil; Universidade de São Paulo, Brazil
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41
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Likitlersuang J, Koh R, Gong X, Jovanovic L, Bolivar-Tellería I, Myers M, Zariffa J, Márquez-Chin C. EEG-Controlled Functional Electrical Stimulation Therapy With Automated Grasp Selection: A Proof-of-Concept Study. Top Spinal Cord Inj Rehabil 2018; 24:265-274. [PMID: 29997429 DOI: 10.1310/sci2403-265] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Functional electrical stimulation therapy (FEST) is a promising intervention for the restoration of upper extremity function after cervical spinal cord injury (SCI). Objectives: This study describes and evaluates a novel FEST system designed to incorporate voluntary movement attempts and massed practice of functional grasp through the use of brain-computer interface (BCI) and computer vision (CV) modules. Methods: An EEG-based BCI relying on a single electrode was used to detect movement initiation attempts. A CV system identified the target object and selected the appropriate grasp type. The required grasp type and trigger command were sent to an FES stimulator, which produced one of four multichannel muscle stimulation patterns (precision, lateral, palmar, or lumbrical grasp). The system was evaluated with five neurologically intact participants and one participant with complete cervical SCI. Results: An integrated BCI-CV-FES system was demonstrated. The overall classification accuracy of the CV module was 90.8%, when selecting out of a set of eight objects. The average latency for the BCI module to trigger the movement across all participants was 5.9 ± 1.5 seconds. For the participant with SCI alone, the CV accuracy was 87.5% and the BCI latency was 5.3 ± 9.4 seconds. Conclusion: BCI and CV methods can be integrated into an FEST system without the need for costly resources or lengthy setup times. The result is a clinically relevant system designed to promote voluntary movement attempts and more repetitions of varied functional grasps during FEST.
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Affiliation(s)
- Jirapat Likitlersuang
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Ryan Koh
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Xinyi Gong
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.,Division of Engineering Science, University of Toronto, Toronto, Canada
| | - Lazar Jovanovic
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Isabel Bolivar-Tellería
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Matthew Myers
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - José Zariffa
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - César Márquez-Chin
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
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42
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A Wearable Body Controlling Device for Application of Functional Electrical Stimulation. SENSORS 2018; 18:s18041251. [PMID: 29670039 PMCID: PMC5948602 DOI: 10.3390/s18041251] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/14/2018] [Accepted: 04/17/2018] [Indexed: 11/28/2022]
Abstract
In this research, we describe a new balancing device used to stabilize the rear quarters of a patient dog with spinal cord injuries. Our approach uses inertial measurement sensing and direct leg actuation to lay a foundation for eventual muscle control by means of direct functional electrical stimulation (FES). During this phase of development, we designed and built a mechanical test-bed to develop the control and stimulation algorithms before we use the device on our animal subjects. We designed the bionic test-bed to mimic the typical walking gait of a dog and use it to develop and test the functionality of the balancing device for stabilization of patient dogs with hindquarter paralysis. We present analysis for various muscle stimulation and balancing strategies, and our device can be used by veterinarians to tailor the stimulation strength and temporal distribution for any individual patient dog. We develop stabilizing muscle stimulation strategies using the robotic test-bed to enhance walking stability. We present experimental results using the bionic test-bed to demonstrate that the balancing device can provide an effective sensing strategy and deliver the required motion control commands for stabilizing an actual dog with a spinal cord injury.
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de Freitas GR, Santo CCDE, de Machado-Pereira NAMM, Bobinski F, Dos Santos ARS, Ilha J. Early Cyclical Neuromuscular Electrical Stimulation Improves Strength and Trophism by Akt Pathway Signaling in Partially Paralyzed Biceps Muscle After Spinal Cord Injury in Rats. Phys Ther 2018; 98:172-181. [PMID: 29240948 DOI: 10.1093/ptj/pzx116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 11/30/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Electrical stimulation is often used to treat weakness in people with spinal cord injury (SCI); however its efficacy for increasing strength and trophism is weak, and the mechanisms underlying the therapeutic benefits are unknown. OBJECTIVE The purpose of this study was to analyze the effects of neuromuscular electrical stimulation (NMES) on muscle function, trophism, and the Akt pathway signaling involved in muscular plasticity after incomplete SCI in rats. DESIGN This was an experimental study. METHODS Twenty-one adult female Wistar rats were divided into sham, SCI, and SCI plus NMES groups. In injured animals, SCI hemisection was induced by a surgical procedure at the C5-C7 level. The 5-week NMES protocol consisted of biceps brachii muscle stimulation 5 times per week, initiated 48 h after injury. Forepaw function and strength, biceps muscle trophism, and the expression of phosphorylated Akt, p70S6K, and GSK-3ß cellular anabolic pathway markers in stimulated muscle tissue were assessed. RESULTS There was an increase in bicep muscle strength in the NMES group compared with the untreated SCI group, from postoperative day 21 until the end of the evaluation period. Also, there was an increase in muscle trophism in the NMES group compared with the SCI group. Forelimb function gradually recovered in both the SCI group and the NMES group, with no differences between them. Regarding muscle protein expression, the NMES group had higher values for phospho-Akt, phospho-p70S6K, and phospho-GSK-3ß than did the SCI group. LIMITATIONS The experimental findings were limited to an animal model of incomplete SCI and may not be fully generalizable to humans. CONCLUSIONS Early cyclical NMES therapy was shown to increase muscle strength and induce hypertrophy after incomplete SCI in a rat model, probably by increasing phospho-Akt, phospho-p70S6K, and phospho-GSK-3ß signaling protein synthesis.
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Affiliation(s)
- Gabriel R de Freitas
- Núcleo de Pesquisa em Lesão Medular (Core of Spinal Cord Injury Research) (NULEME), Programa de Pós-Graduação em Fisioterapia (PPGFt), Departamento de Fisioterapia, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil
| | - Caroline C do Espírito Santo
- Núcleo de Pesquisa em Lesão Medular (NULEME), Laboratório Neurobiologia da Dor e Inflamação (Neurobiology Laboratory of Pain and Inflammation) (LANDI), Departamento de Ciências Fisiológicas, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Nicolas A M M de Machado-Pereira
- Núcleo de Pesquisa em Lesão Medular (NULEME), Departamento de Fisioterapia, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC)
| | - Franciane Bobinski
- Núcleo de Pesquisa em Lesão Medular (NULEME), Programa de Pós-Graduação em Fisioterapia (PPGFt), Departamento de Fisioterapia, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), and Programa de Pós-Graduação em Ciências da Saúde, Universidade do Sul de Santa Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
| | - Adair R S Dos Santos
- Laboratório Neurobiologia da Dor e Inflamação (LANDI), Departamento de Ciências Fisiológicas, Universidade Federal de Santa Catarina (UFSC)
| | - Jocemar Ilha
- Núcleo de Pesquisa em Lesão Medular (NULEME), Programa de Pós-Graduação em Fisioterapia (PPGFt), Departamento de Fisioterapia, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Rua Pascoal Simone, 358-Coqueiros, Florianópolis, Santa Catarina, CEP 88080-350, Brazil
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Patel K, Milosevic M, Nakazawa K, Popovic MR, Masani K. Wheelchair Neuroprosthesis for Improving Dynamic Trunk Stability. IEEE Trans Neural Syst Rehabil Eng 2017; 25:2472-2479. [DOI: 10.1109/tnsre.2017.2727072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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45
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Harvey LA, Dunlop SA, Churilov L, Galea MP. Early intensive hand rehabilitation is not more effective than usual care plus one-to-one hand therapy in people with sub-acute spinal cord injury ('Hands On'): a randomised trial. J Physiother 2017; 63:197-204. [PMID: 28970100 DOI: 10.1016/j.jphys.2017.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
QUESTION What is the effect of adding an intensive task-specific hand-training program involving functional electrical stimulation to a combination of usual care plus three 15-minute sessions per week of one-to-one hand therapy in people with sub-acute tetraplegia? DESIGN A parallel group, randomised, controlled trial. Participants were randomly assigned (1:1) via a computer-generated concealed block randomisation procedure to either a control or experimental intervention. PARTICIPANTS Seventy people with C2 to T1 motor complete or incomplete tetraplegia within 6 months of injury. Participants were recruited from seven spinal units in Australia and New Zealand. INTERVENTION Experimental participants received intensive training for one hand. Intensive training consisted of training with an instrumented exercise workstation in conjunction with functional electrical stimulation for 1hour per day, 5 days per week for 8 weeks. Both groups received usual care and 15minutes of one-to-one hand therapy three times per week without functional electrical stimulation. OUTCOME MEASURES The primary outcome was the modified Action Research Arm Test reflecting arm and hand function, which was assessed at the end of the intervention, that is, 11 weeks after randomisation. Secondary outcomes were measured at 11 and 26 weeks. RESULTS Sixty-six (94%) participants completed the post-intervention assessment and were included in the primary intention-to-treat analysis. The mean (SD) modified Action Research Arm Test score for experimental and control participants at the post-intervention assessment was 36.5 points (SD 16.0) and 33.2 points (SD 17.5), respectively, with an adjusted mean between-group difference of 0.9 points (95% CI -4.1 to 5.9). CONCLUSION Adding an intensive task-specific hand-training program involving functional electrical stimulation to a combination of usual care plus three 15-minute sessions per week of one-to-one hand therapy does not improve hand function in people with sub-acute tetraplegia. REGISTRATION Australian and New Zealand Trial Registry ACTRN12609000695202 and ClinicalTrials.gov NCT01086930. [Harvey LA, Dunlop SA, Churilov L, Galea MP, Spinal Cord Injury Physical Activity (SCIPA) Hands On Trial Collaborators (2017) Early intensive hand rehabilitation is not more effective than usual care plus one-to-one hand therapy in people with sub-acute spinal cord injury ('Hands On'): a randomised trial. Journal of Physiotherapy 63: 197-204].
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Affiliation(s)
- Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, Sydney School of Medicine, University of Sydney; Kolling Institute, Royal North Shore Hospital, Sydney
| | - Sarah A Dunlop
- School of Biological Sciences, The University of Western Australia, Perth
| | - Leonid Churilov
- Florey Neuroscience Institutes (National Stroke Research Institute) and Department of Mathematics and Statistics, The University of Melbourne
| | - Mary P Galea
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne, Australia
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Hebert DA, Bowen JM, Ho C, Antunes I, O’Reilly DJ, Bayley M. Examining a new functional electrical stimulation therapy with people with severe upper extremity hemiparesis and chronic stroke: A feasibility study. Br J Occup Ther 2017. [DOI: 10.1177/0308022617719807] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Deborah A Hebert
- Practice Lead, Occupational Therapy, Toronto Rehabilitation Inst., University Health Network, Toronto, Canada
- Rocket Family Upper Extremity Clinic Lead, Toronto Rehabilitation Inst., University Health Network, Toronto, Canada
- Associate Professor, Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - James M Bowen
- Assistant Professor (Part-time), Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University Programs for Assessment of Technology in Health (PATH), St. Joseph’s Healthcare Hamilton, Canada
- Research Associate, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University Programs for Assessment of Technology in Health (PATH), St. Joseph’s Healthcare Hamilton, Canada
| | - Cindy Ho
- Occupational Therapist, Brain and Spinal Cord Rehabilitation Program, Toronto Rehab, University Health Network, Toronto, Canada
| | - Irene Antunes
- Physiotherapist, Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Daria J O’Reilly
- Associate Professor, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University Programs for Assessment of Technology in Health (PATH), St. Joseph’s Healthcare Hamilton, Canada
| | - Mark Bayley
- Medical Director, Brain and Spinal Cord Rehabilitation Program, UHN Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Professor, Division of Physiatry, University of Toronto, Toronto, Canada
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Prochazka A. Neurophysiology and neural engineering: a review. J Neurophysiol 2017; 118:1292-1309. [PMID: 28566462 PMCID: PMC5558026 DOI: 10.1152/jn.00149.2017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/30/2017] [Accepted: 05/30/2017] [Indexed: 12/19/2022] Open
Abstract
Neurophysiology is the branch of physiology concerned with understanding the function of neural systems. Neural engineering (also known as neuroengineering) is a discipline within biomedical engineering that uses engineering techniques to understand, repair, replace, enhance, or otherwise exploit the properties and functions of neural systems. In most cases neural engineering involves the development of an interface between electronic devices and living neural tissue. This review describes the origins of neural engineering, the explosive development of methods and devices commencing in the late 1950s, and the present-day devices that have resulted. The barriers to interfacing electronic devices with living neural tissues are many and varied, and consequently there have been numerous stops and starts along the way. Representative examples are discussed. None of this could have happened without a basic understanding of the relevant neurophysiology. I also consider examples of how neural engineering is repaying the debt to basic neurophysiology with new knowledge and insight.
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Affiliation(s)
- Arthur Prochazka
- Department of Physiology, University of Alberta, Edmonton, Alberta, Canada
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48
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Effects of orthotic therapeutic electrical stimulation in the treatment of patients with paresis associated with acute cervical spinal cord injury: a randomized control trial. Spinal Cord 2017; 55:1066-1070. [DOI: 10.1038/sc.2017.74] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 04/22/2017] [Accepted: 05/22/2017] [Indexed: 11/08/2022]
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Yozbatiran N, Keser Z, Hasan K, Stampas A, Korupolu R, Kim S, O'Malley MK, Fregni F, Francisco GE. White matter changes in corticospinal tract associated with improvement in arm and hand functions in incomplete cervical spinal cord injury: pilot case series. Spinal Cord Ser Cases 2017; 3:17028. [PMID: 28944083 DOI: 10.1038/scsandc.2017.28] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 04/20/2017] [Accepted: 04/25/2017] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION This is a prospective clinical pilot case series. Improvement of arm and hand functions after spinal cord injury (SCI) is one of the major rehabilitation goals. Electrical stimulation of the primary motor cortex via transcranial direct current stimulation (tDCS) coupled with high-intensity repetitive motor training may have potential to facilitate improvement in motor function in chronic, incomplete cervical SCI. We investigated the relationship between motor recovery and changes in white matter integrity in response to treatment intervention. This study was conducted in The Institute for Rehabilitation and Research Memorial Hermann, Houston, USA. CASE PRESENTATION Four right-handed adults with chronic, incomplete cervical SCI (age, 36-63 years, American Spinal Injury Association Impairment Scale grade C-D) were enrolled in 10 sessions of anodal tDCS at 2 mA versus sham tDCS followed by 1 h of robotic-assisted arm training. Changes in arm and hand function were measured with Jebsen-Taylor Hand Function Test and Motor Activity Log-Amount of Use. Diffusion tension imaging was used to measure changes in fractional anisotropy (FA) of corticospinal tracts (CSTs). DISCUSSION After 10 sessions of treatment, we found greater improvement in hand function and hand usage in patients who received active tDCS treatment versus sham treatment. There was an overall positive change in FA values across all patients. We show changes in arm and hand function associated with changes in CST tractographic mapping to quantify the motor system components in chronic incomplete cervical SCI.
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Affiliation(s)
- Nuray Yozbatiran
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, UTHealth NeuroRecovery Research Center at TIRR Memorial Hermann, Houston, TX, USA
| | - Zafer Keser
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, UTHealth NeuroRecovery Research Center at TIRR Memorial Hermann, Houston, TX, USA
| | - Khader Hasan
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center, Houston, TX, USA
| | - Argyrios Stampas
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, UTHealth NeuroRecovery Research Center at TIRR Memorial Hermann, Houston, TX, USA
| | - Radha Korupolu
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, UTHealth NeuroRecovery Research Center at TIRR Memorial Hermann, Houston, TX, USA
| | - Sam Kim
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, UTHealth NeuroRecovery Research Center at TIRR Memorial Hermann, Houston, TX, USA
| | - Marcia K O'Malley
- Department of Mechanical Engineering, Rice University, Houston, TX, USA
| | - Felipe Fregni
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gerard E Francisco
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, UTHealth NeuroRecovery Research Center at TIRR Memorial Hermann, Houston, TX, USA
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Quel de Oliveira C, Refshauge K, Middleton J, de Jong L, Davis GM. Effects of Activity-Based Therapy Interventions on Mobility, Independence, and Quality of Life for People with Spinal Cord Injuries: A Systematic Review and Meta-Analysis. J Neurotrauma 2017; 34:1726-1743. [PMID: 27809702 DOI: 10.1089/neu.2016.4558] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The aim of this study was to review the literature about the effects of activity-based therapy (ABT) interventions on mobility, functional independence, and quality of life for people with a spinal cord injury (SCI). A systematic review with meta-analysis of randomized and non-randomized trials was performed, including adults with a non-progressive SCI at any level. The intervention of interest was ABT, defined as any intervention that sought to improve muscle activation or sensory function below the level of injury in the spinal cord and does not rely on compensatory mechanisms for improving function. The comparison was either no intervention or conventional physical interventions targeted to regions above the level of injury. The outcome measures were quality-of-life questionnaires, mobility assessments, and functional independence scales. Nineteen trials were included in this systematic review. Three compared ABT to no intervention and 16 to conventional physical rehabilitation. The methodological quality of the trials was assessed using the PEDro scale as moderate. Six studies investigated the effects of ABT interventions for the upper limbs, 11 investigated gait-related interventions, and two applied multi-modal interventions. Compared with no intervention, the meta-analysis found that ABT was not more effective for improving independence or lower limb mobility, but conferred a large positive effect on upper limb function. Compared with conventional physical interventions, there was no significant effect of ABT on lower limb mobility, independence, or quality of life; however, it had positive effects on upper limbs. In conclusion, there is evidence that ABT can improve independence and functional ability when applied to the upper limbs in people with SCI. However, it is not superior to conventional physical interventions when applied to the lower limbs.
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Affiliation(s)
| | - Kathryn Refshauge
- 1 Faculty of Health Sciences, The University of Sydney , Sydney, Australia
| | - James Middleton
- 2 John Walsh Center for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Sydney Medical School Northern, The University of Sydney , Sydney, Australia
| | - Lysanne de Jong
- 1 Faculty of Health Sciences, The University of Sydney , Sydney, Australia
- 3 Radboud University Nijmegen , Nijmegen, the Netherlands
| | - Glen M Davis
- 1 Faculty of Health Sciences, The University of Sydney , Sydney, Australia
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