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Langerak AJ, Regterschot GRH, Selles RW, Meskers CGM, Evers M, Ribbers GM, van Beijnum BJF, Bussmann JBJ. Requirements for home-based upper extremity rehabilitation using wearable motion sensors for stroke patients: a user-centred approach. Disabil Rehabil Assist Technol 2024; 19:1392-1404. [PMID: 36905631 PMCID: PMC11073044 DOI: 10.1080/17483107.2023.2183993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/17/2023] [Indexed: 03/12/2023]
Abstract
PURPOSE Telerehabilitation systems have the potential to enable therapists to monitor and assist stroke patients in achieving high-intensity upper extremity exercise in the home environment. We adopted an iterative user-centred approach, including multiple data sources and meetings with end-users and stakeholders to define the user requirements for home-based upper extremity rehabilitation using wearable motion sensors for subacute stroke patients. METHODS We performed a requirement analysis consisting of the following steps: 1) context & groundwork; 2) eliciting requirements; 3) modelling & analysis; 4) agreeing requirements. During these steps, a pragmatic literature search, interviews and focus groups with stroke patients, physiotherapists and occupational therapists were performed. The results were systematically analysed and prioritised into "must-haves", "should-haves", and "could-haves". RESULTS We formulated 33 functional requirements: eighteen must-have requirements related to blended care (2), exercise principles (7), exercise delivery (3), exercise evaluation (4), and usability (2); ten should-haves; and five could-haves. Six movement components, including twelve exercises and five combination exercises, are required. For each exercise, appropriate exercise measures were defined. CONCLUSION This study provides an overview of functional requirements, required exercises, and required exercise measures for home-based upper extremity rehabilitation using wearable motion sensors for stroke patients, which can be used to develop home-based upper extremity rehabilitation interventions. Moreover, the comprehensive and systematic requirement analysis used in this study can be applied by other researchers and developers when extracting requirements for designing a system or intervention in a medical context.
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Affiliation(s)
- A. J. Langerak
- Department of Rehabilitation Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - G. R. H. Regterschot
- Department of Rehabilitation Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands
| | - R. W. Selles
- Department of Rehabilitation Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Plastic and Reconstructive Surgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - C. G. M. Meskers
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - M. Evers
- Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - G. M. Ribbers
- Department of Rehabilitation Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - B. J. F. van Beijnum
- Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands
| | - J. B. J. Bussmann
- Department of Rehabilitation Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
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Devittori G, Dinacci D, Romiti D, Califfi A, Petrillo C, Rossi P, Ranzani R, Gassert R, Lambercy O. Unsupervised robot-assisted rehabilitation after stroke: feasibility, effect on therapy dose, and user experience. J Neuroeng Rehabil 2024; 21:52. [PMID: 38594727 PMCID: PMC11005116 DOI: 10.1186/s12984-024-01347-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/22/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Unsupervised robot-assisted rehabilitation is a promising approach to increase the dose of therapy after stroke, which may help promote sensorimotor recovery without requiring significant additional resources and manpower. However, the unsupervised use of robotic technologies is not yet a standard, as rehabilitation robots often show low usability or are considered unsafe to be used by patients independently. In this paper we explore the feasibility of unsupervised therapy with an upper limb rehabilitation robot in a clinical setting, evaluate the effect on the overall therapy dose, and assess user experience during unsupervised use of the robot and its usability. METHODS Subacute stroke patients underwent a four-week protocol composed of daily 45 min-sessions of robot-assisted therapy. The first week consisted of supervised therapy, where a therapist explained how to interact with the device. The second week was minimally supervised, i.e., the therapist was present but intervened only if needed. After this phase, if participants learnt how to use the device, they proceeded to two weeks of fully unsupervised training. Feasibility, dose of robot-assisted therapy achieved during unsupervised use, user experience, and usability of the device were evaluated. Questionnaires to evaluate usability and user experience were performed after the minimally supervised week and at the end of the study, to evaluate the impact of therapists' absence. RESULTS Unsupervised robot-assisted therapy was found to be feasible, as 12 out of the 13 recruited participants could progress to unsupervised training. During the two weeks of unsupervised therapy participants on average performed an additional 360 min of robot-assisted rehabilitation. Participants were satisfied with the device usability (mean System Usability Scale scores > 79), and no adverse events or device deficiencies occurred. CONCLUSIONS We demonstrated that unsupervised robot-assisted therapy in a clinical setting with an actuated device for the upper limb was feasible and can lead to a meaningful increase in therapy dose. These results support the application of unsupervised robot-assisted therapy as a complement to usual care in clinical settings and pave the way to its application in home settings. TRIAL REGISTRATION Registered on 13.05.2020 on clinicaltrials.gov (NCT04388891).
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Affiliation(s)
- Giada Devittori
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland.
| | - Daria Dinacci
- Clinica Hildebrand Centro di riabilitazione Brissago, Brissago, Switzerland
| | - Davide Romiti
- Clinica Hildebrand Centro di riabilitazione Brissago, Brissago, Switzerland
| | - Antonella Califfi
- Clinica Hildebrand Centro di riabilitazione Brissago, Brissago, Switzerland
| | - Claudio Petrillo
- Clinica Hildebrand Centro di riabilitazione Brissago, Brissago, Switzerland
| | - Paolo Rossi
- Clinica Hildebrand Centro di riabilitazione Brissago, Brissago, Switzerland
| | - Raffaele Ranzani
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland
- Future Health Technologies programme, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland
- Future Health Technologies programme, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
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Özlü A, Üstündağ S, Bulut Özkaya D, Menekşeoğlu AK. Effect of Exergame on Pain, Function, and Quality of Life in Shoulder Impingement Syndrome: A Prospective Randomized Controlled Study. Games Health J 2024; 13:109-119. [PMID: 38394299 DOI: 10.1089/g4h.2023.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
Objective: This study aimed to investigate the effect of a virtual reality (VR)-mediated gamified rehabilitation program added to a home exercise program on pain, functionality, and quality of life in shoulder impingement syndrome. Methods: Forty-eight participants with shoulder impingement syndrome were included in this prospective, randomized, single-blind study between January and July 2022. The participants were randomized into two groups: the VR group (n = 24) and the control group (n = 24). All participants were given a home exercise program for 3 weeks, with five sessions per week. The participants in the VR group received 15 sessions (45 minutes each session) of a gamified shoulder exercise program with an immersive VR headset, while those in the control group received 15 sessions (45 minutes each session) of supervised therapeutic exercises. The participants were evaluated and compared before and after treatment using the 36-item Short Form Survey (SF-36), range-of-motion (ROM) measurements, the Visual Analog Scale (VAS), and the Shoulder Pain and Disability Scale (SPADI). Results: At the baseline assessment, the two groups were homogenous regarding demographic and clinical parameters. The post-treatment shoulder extension and adduction ROM was significantly greater in the VR group and the post-treatment pain subscales for SPADI and SF-36 were significantly lower in the VR group. Conclusion: In individuals with shoulder impingement syndrome, a VR-mediated gamified exercise program added to a home exercise program increased shoulder ROM and reduced pain scores. Further clinical studies are needed to prove the long-term efficacy of the addition of VR-mediated gamified exercises to the treatment of this condition in clinical settings.
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Affiliation(s)
- Aysun Özlü
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - Sema Üstündağ
- Department of Internal Medicine, Faculty of Nursing, Kutahya Health Sciences University, Kutahya, Turkey
| | - Dilan Bulut Özkaya
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - Ahmet Kıvanç Menekşeoğlu
- Department of Physical Medicine and Rehabilitation, Istanbul Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
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Belschner J, Coley C, Kovelman S, Salvador T, Monfaredi R, Schladen M, Fooladi Talari H, Trujillo Rivera EA, Cleary K, Evans SH. PedBotLab: A Novel Video Game-Based Robotic Ankle Platform Created for Therapeutic Exercise for Children With Neurological Impairments. Phys Occup Ther Pediatr 2024:1-19. [PMID: 38419343 DOI: 10.1080/01942638.2024.2316163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 02/05/2024] [Indexed: 03/02/2024]
Abstract
AIMS Assess the potential benefits of using PedBotLab, a clinic based robotic ankle platform with integrated video game software, to improve ankle active and passive range of motion, strength, selective motor control, gait efficiency, and balance. METHODS Ten participants with static neurological injuries and independent ambulation participated in a 10-week pilot study (Pro00013680) to assess feasibility and efficacy of PedBotLab as a therapeutic device twice weekly. Isometric ankle strength, passive and active ankle range of motion, plantarflexor spasticity, selective motor control of the lower extremity, balance, and gait speed were measured pre- and post-trial. RESULTS Statistically significant improvements were seen in flexibility, active range of motion, and strength in multiple planes of ankle motion. Ankle dorsiflexion with knee flexion and knee extension demonstrated statistically significant results in all outcome measures. No significant changes were observed in gait speed outcomes. CONCLUSIONS The use of PedbotLab can lead to improvements in ankle strength, flexibility, and active range of motion for children with static neurological injuries. Future studies aim to evaluate the effect on gait quality and work toward developing a home-based device.
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Affiliation(s)
| | | | | | | | | | | | | | - Eduardo A Trujillo Rivera
- Children's National Hospital, Washington DC, USA
- Sheikh Zayed Research Institute, Washington DC, USA
- George Washington University, Washington DC, USA
| | - Kevin Cleary
- Sheikh Zayed Research Institute, Washington DC, USA
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5
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Sousa DL, Teixeira S, Fontenele JE, Santos RM, Pereira L, Baluz R, Bastos VH, Teles AS. Health Care Professional-Supported Co-Design of a Mime Therapy-Based Serious Game for Facial Rehabilitation. JMIR Serious Games 2024; 12:e52661. [PMID: 38265856 PMCID: PMC10851117 DOI: 10.2196/52661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/09/2023] [Accepted: 12/29/2023] [Indexed: 01/25/2024] Open
Abstract
This research letter presents the co-design process for RG4Face, a mime therapy-based serious game that uses computer vision for human facial movement recognition and estimation to help health care professionals and patients in the facial rehabilitation process.
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Affiliation(s)
| | | | | | | | | | - Rodrigo Baluz
- Parnaíba Delta Federal University, Parnaíba, Brazil
- State University of Piauí, Campus Parnaíba, Parnaíba, Brazil
| | | | - Ariel Soares Teles
- Parnaíba Delta Federal University, Parnaíba, Brazil
- Federal Institute of Maranhão, Campus Araioses, Araioses, Brazil
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6
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Kilbride C, Butcher T, Warland A, Ryan J, Scott DJM, Cassidy E, Athanasiou DA, Singla-Buxarrais G, Baker K, Norris M. Rehabilitation via HOMe-Based gaming exercise for the Upper limb post Stroke (RHOMBUS): a qualitative analysis of participants' experience. BMJ Open 2024; 14:e075821. [PMID: 38245009 PMCID: PMC10806457 DOI: 10.1136/bmjopen-2023-075821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/08/2023] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVE To report participants' experiences of trial processes and use of the Neurofenix platform for home-based rehabilitation following stroke. The platform, consisting of the NeuroBall device and Neurofenix app, is a non-immersive virtual reality tool to facilitate upper limb rehabilitation following stroke. The platform has recently been evaluated and demonstrated to be safe and effective through a non-randomised feasibility trial (RHOMBUS). DESIGN Qualitative approach using semistructured interviews. Interviews were audio recorded, transcribed verbatim and analysed using the framework method. SETTING Participants' homes, South-East England. PARTICIPANTS Purposeful sample of 18 adults (≥18 years), minimum 12 weeks following stroke, not receiving upper limb rehabilitation prior to the RHOMBUS trial, scoring 9-25 on the Motricity Index (elbow and shoulder), with sufficient cognitive and communicative abilities to participate. RESULTS Five themes were developed which explored both trial processes and experiences of using the platform. Factors that influenced participant's decision to take part in the trial, their perceptions of support provided during the trial and communication with the research team were found to be important contextual factors effecting participants' overall experience. Specific themes around usability and comfort of the NeuroBall device, factors motivating persistence and perceived effectiveness of the intervention were highlighted as being central to the usability and acceptability of the platform. CONCLUSION This study demonstrated the overall acceptability of the platform and identified areas for enhancement which have since been implemented by Neurofenix. The findings add to the developing literature on the interface between virtual reality systems and user experience. TRIAL REGISTRATION NUMBER ISRCTN60291412.
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Affiliation(s)
- Cherry Kilbride
- Department of Health Sciences, Brunel University London, Uxbridge, UK
| | - Tom Butcher
- Department of Health Sciences, Brunel University London, Uxbridge, UK
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Alyson Warland
- Department of Health Sciences, Brunel University London, Uxbridge, UK
| | - Jennifer Ryan
- Department of Health Sciences, Brunel University London, Uxbridge, UK
- Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Daniel J M Scott
- Department of Health Sciences, Brunel University London, Uxbridge, UK
- Neurofenix, London, UK
| | | | | | | | - Karen Baker
- Department of Health Sciences, Brunel University London, Uxbridge, UK
- Neurofenix, London, UK
| | - Meriel Norris
- Department of Health Sciences, Brunel University London, Uxbridge, UK
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7
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Tomlin KB, Johnson BP, Westlake KP. Age-Related Differences in Motor Skill Transfer with Brief Memory Reactivation. Brain Sci 2024; 14:65. [PMID: 38248280 PMCID: PMC10813682 DOI: 10.3390/brainsci14010065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Motor memories can be strengthened through online practice and offline consolidation. Offline consolidation involves the stabilization of memory traces in post-practice periods. Following initial consolidation of a motor memory, subsequent practice of the motor skill can lead to reactivation and reconsolidation of the memory trace. The length of motor memory reactivation may influence motor learning outcomes; for example, brief, as opposed to long, practice of a previously learned motor skill appears to optimize intermanual transfer in healthy young adults. However, the influence of aging on reactivation-based motor learning has been scarcely explored. Here, the effects of brief and long motor memory reactivation schedules on the retention and intermanual transfer of a visuomotor tracing task are explored in healthy older adults. Forty older adults practiced a virtual star-tracing task either three ("brief reactivation") or ten ("long reactivation") times per session over a two-week period. Comparison with a previously reported group of younger adults revealed significant age-related differences in the effect of the motor memory reactivation schedule on the intermanual transfer of the motor task. In older adults, unlike younger adults, no significant between-group differences were found by practice condition in the speed, accuracy, or skill of intermanual task transfer. That is, motor task transfer in healthy younger, but not older, adults appears to benefit from brief memory reactivation. These results support the use of age-specific motor training approaches and may inform motor practice scheduling, with possible implications for physical rehabilitation, sport, and music.
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Affiliation(s)
- Kylie B. Tomlin
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Brian P. Johnson
- Department of Occupational Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Kelly P. Westlake
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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8
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Gulde P, Vojta H, Schmidle S, Rieckmann P, Hermsdörfer J. Outside the Laboratory Assessment of Upper Limb Laterality in Patients With Stroke: A Cross-Sectional Study. Stroke 2024; 55:146-155. [PMID: 38037226 DOI: 10.1161/strokeaha.123.043657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/26/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND The rehabilitation of upper limb sensorimotor performance after stroke requires the assessment of daily use, the identification of key levels of impairment, and monitoring the course of recovery. It needs to be answered, how laboratory-based assessments and everyday behavior are connected, which dimension of metrics, that is, volume, intensity, or quality, is most sensitive to reduced function, and what sensor, that is, gyroscope or accelerometer, is best suited to gather such data. METHODS Performance in laboratory-based sensorimotor tests, as well as smartwatch-derived kinematic data of everyday life relative upper limb activity, during 1 day of inpatient neurorehabilitation (Germany, 2022) of 50 patients with stroke, was cross-sectionally assessed and resulting laterality indices (performance ratios) between the limbs were analyzed using ANCOVAs and principal component analysis. RESULTS Laboratory-based tests revealed the strongest laterality indices, followed by smartwatch-based (intensity>quality>volume) metrics. Angular velocity-based metrics revealed higher laterality indices than acceleration-based ones. Laterality indices were overall well associated; however, a principal component analysis suggested upper limb impairments to be unidimensional. CONCLUSIONS Our findings suggest that the use of sensors can deliver valid information of stroke-related laterality. It appeared that commonly used metrics that estimate the volume of use (ie, energy expenditure) are not the most sensitive. Especially reached intensities could be well used for monitoring, because they are more dependent on the performance of the sensorimotor system and less on confounders like age. The unidimensionality of the upper limb laterality suggests that an impaired limb with reduced movement quality and the inability to reach higher intensities will be used less in everyday life, especially when it is the nondominant side.
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Affiliation(s)
- Philipp Gulde
- School of Medicine and Health, Technical University of Munich, Germany (P.G., S.S., J.H.)
| | - Heike Vojta
- Center for Clinical Neuroplasticity, Medical Park Loipl, Bischofswiesen, Germany (H.V., P.R.)
| | - Stephanie Schmidle
- School of Medicine and Health, Technical University of Munich, Germany (P.G., S.S., J.H.)
| | - Peter Rieckmann
- Center for Clinical Neuroplasticity, Medical Park Loipl, Bischofswiesen, Germany (H.V., P.R.)
| | - Joachim Hermsdörfer
- School of Medicine and Health, Technical University of Munich, Germany (P.G., S.S., J.H.)
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Klaic M, Fong J, Crocher V, Davies K, Brock K, Sutton E, Oetomo D, Tan Y, Galea MP. Application of the extended technology acceptance model to explore clinician likelihood to use robotics in rehabilitation. Disabil Rehabil Assist Technol 2024; 19:52-59. [PMID: 35400278 DOI: 10.1080/17483107.2022.2060356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 03/26/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Evidence suggests that patients with upper limb impairment following a stroke do not receive recommended amounts of motor practice. Robotics provide a potential solution to address this gap, but clinical adoption is low. The aim of this study was to utilize the technology acceptance model as a framework to identify factors influencing clinician adoption of robotic devices into practice. MATERIALS AND METHOD Mixed methods including survey data and focus group discussions with allied health clinicians whose primary caseload was rehabilitation of the neurologically impaired upper limb. Surveys based on the technology acceptance measure were completed pre/post exposure to and use of a robotic device. Focus groups discussions based on the theory of planned behaviour were conducted at the conclusion of the study. RESULTS A total of 34 rehabilitation clinicians completed the surveys with pre-implementation data indicating that rehabilitation clinicians perceive robotic devices as complex to use, which influenced intention to use such devices in practice. The focus groups found that lack of experience and time to learn influenced confidence to implement robotic devices into practice. CONCLUSION This study found that perceived usefulness and perceived ease of use of a robotic device in clinical rehabilitation can be improved through experience, training and embedded technological support. However, training and embedded support are not routinely offered, suggesting there is a discordance between current implementation and the learning needs of rehabilitation clinicians.IMPLICATIONS FOR REHABILITATIONPatients do not receive adequate amounts of upper limb motor practice following a stroke, and although robotic devices have the potential to address this gap, clinical adoption is low.The technology acceptance model identified that clinicians perceive robotic devices to be complex to use with current implementation efforts failing to consider their training needs.Implementation adoption of robotic devices in rehabilitation should be supported with adequate training and technological support if sustainable practice change is to be achieved.
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Affiliation(s)
- Marlena Klaic
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
- Allied Health Department, The Royal Melbourne Hospital, Melbourne, Australia
| | - Justin Fong
- Department of Mechanical Engineering, University of Melbourne & Fourier Intelligence Joint Laboratory, The University of Melbourne, Melbourne, Australia
| | - Vincent Crocher
- Department of Mechanical Engineering, University of Melbourne & Fourier Intelligence Joint Laboratory, The University of Melbourne, Melbourne, Australia
| | - Katie Davies
- The Neurological Rehabilitation Group, Melbourne, Australia
| | - Kim Brock
- St Vincent's Hospital, Melbourne, Australia
| | | | - Denny Oetomo
- Department of Mechanical Engineering, University of Melbourne & Fourier Intelligence Joint Laboratory, The University of Melbourne, Melbourne, Australia
| | - Ying Tan
- Department of Mechanical Engineering, University of Melbourne & Fourier Intelligence Joint Laboratory, The University of Melbourne, Melbourne, Australia
| | - Mary P Galea
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne, Australia
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Hayes HA, McFadden M, Gerace L, Brusseau TA. Agreement of activity monitors for assessment of patients with sub-acute stroke in an inpatient rehabilitation facility. Disabil Rehabil Assist Technol 2023:1-7. [PMID: 38055316 DOI: 10.1080/17483107.2023.2290637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 11/28/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE Determine the level of agreement of three activity monitors compared with the gold standard (video review) on the activity level of patients with stroke. METHODS A prospective, observational, agreement study was performed on 47 individuals with sub-acute stroke in an inpatient rehabilitation facility. Data was collected during one physical therapy session. Individuals wore three device types; Actigraph (AG), Activpal (AP), and stepwatch activity monitor (SAM). Variables assessed were step counts for each limb (hemiparetic and non-hemiparetic) and percent time standing and other. ANALYSIS Results from the activity monitors were compared to the video review and assessed for agreement using the intraclass correlation coefficient (ICC) and accuracy of mean difference from video observation. RESULTS The step counts with the SAM on the non-hemiparetic limb had the highest ICC for step counts (ICC = 0.98, p < 0.001) and were overestimated with 21% accuracy. The SAM on the hemiparetic limb had 9.7% accuracy (ICC = 0.92, p < 0.001). For percent standing time all devices overestimated with poor reliability. For percent other activity time, the AP had the best accuracy and underestimated for both the hemiparetic limb (9.9% accuracy; ICC = 0.90, p < 0.001) and non-hemiparetic limb (8.3% accuracy; ICC = 0.84, p < 0.001). CONCLUSIONS The use of multiple devices may be warranted to capture an accurate understanding of activity levels in this population of individuals with sub-acute stroke. There are concerns with all monitors and clinicians and researchers should be aware of what measures they are wanting to understand about their population.
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Affiliation(s)
- H A Hayes
- Department of Physical Therapy and Athletic Training, University of UT, Salt Lake City, UT, USA
| | - M McFadden
- Study Design and Biostatistics Center, University of Utah, Salt Lake City, UT, USA
| | - L Gerace
- Department of Physical Therapy and Athletic Training, University of UT, Salt Lake City, UT, USA
| | - T A Brusseau
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
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Li S. Stroke Recovery Is a Journey: Prediction and Potentials of Motor Recovery after a Stroke from a Practical Perspective. Life (Basel) 2023; 13:2061. [PMID: 37895442 PMCID: PMC10608684 DOI: 10.3390/life13102061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/01/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
Stroke recovery is a journey. Stroke survivors can face many consequences that may last the rest of their lives. Assessment of initial impairments allows reasonable prediction of biological spontaneous recovery at 3 to 6 months for a majority of survivors. In real-world clinical practice, stroke survivors continue to improve their motor function beyond the spontaneous recovery period, but management plans for maximal recovery are not well understood. A model within the international classification of functioning (ICF) theoretical framework is proposed to systematically identify opportunities and potential barriers to maximize and realize the potentials of functional recovery from the acute to chronic stages and to maintain their function in the chronic stages. Health conditions of individuals, medical and neurological complications can be optimized under the care of specialized physicians. This permits stroke survivors to participate in various therapeutic interventions. Sufficient doses of appropriate interventions at the right time is critical for stroke motor rehabilitation. It is important to highlight that combining interventions is likely to yield better clinical outcomes. Caregivers, including family members, can assist and facilitate targeted therapeutic exercises for these individuals and can help stroke survivors comply with medical plans (medications, visits), and provide emotional support. With health optimization, comprehensive rehabilitation, support from family and caregivers and a commitment to a healthy lifestyle, many stroke survivors can overcome barriers and achieve potentials of maximum recovery and maintain their motor function in chronic stages. This ICF recovery model is likely to provide a guidance through the journey to best achieve stroke recovery potentials.
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Affiliation(s)
- Sheng Li
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center—Houston, Houston, TX 77025, USA;
- TIRR Memorial Hermann Hospital, Houston, TX 77030, USA
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Gardas SS, Lysaght C, McMillan AG, Kantak S, Willson JD, Patterson CG, Surkar SM. Bimanual Movement Characteristics and Real-World Performance Following Hand-Arm Bimanual Intensive Therapy in Children with Unilateral Cerebral Palsy. Behav Sci (Basel) 2023; 13:681. [PMID: 37622821 PMCID: PMC10451828 DOI: 10.3390/bs13080681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/26/2023] Open
Abstract
The purpose of this study was to quantify characteristics of bimanual movement intensity during 30 h of hand-arm bimanual intensive therapy (HABIT) and bimanual performance (activities and participation) in real-world settings using accelerometers in children with unilateral cerebral palsy (UCP). Twenty-five children with UCP participated in a 30 h HABIT program. Data were collected from bilateral wrist-worn accelerometers during 30 h of HABIT to quantify the movement intensity and three days pre- and post-HABIT to assess real-world performance gains. Movement intensity and performance gains were measured using six standard accelerometer-derived variables. Bimanual capacity (body function and activities) was assessed using standardized hand function tests. We found that accelerometer variables increased significantly during HABIT, indicating increased bimanual symmetry and intensity. Post-HABIT, children demonstrated significant improvements in all accelerometer metrics, reflecting real-world performance gains. Children also achieved significant and clinically relevant changes in hand capacity following HABIT. Therefore, our findings suggest that accelerometers can objectively quantify bimanual movement intensity during HABIT. Moreover, HABIT enhances hand function as well as activities and participation in real-world situations in children with UCP.
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Affiliation(s)
- Shailesh S. Gardas
- Department of Physical Therapy, East Carolina University, Greenville, NC 27834, USA; (S.S.G.); (C.L.); (A.G.M.); (J.D.W.)
| | - Christine Lysaght
- Department of Physical Therapy, East Carolina University, Greenville, NC 27834, USA; (S.S.G.); (C.L.); (A.G.M.); (J.D.W.)
| | - Amy Gross McMillan
- Department of Physical Therapy, East Carolina University, Greenville, NC 27834, USA; (S.S.G.); (C.L.); (A.G.M.); (J.D.W.)
| | - Shailesh Kantak
- Moss Rehabilitation Research Institute, Elkins Park, PA 19027, USA
- Department of Physical Therapy, Arcadia University, Glenside, PA 19038, USA
| | - John D. Willson
- Department of Physical Therapy, East Carolina University, Greenville, NC 27834, USA; (S.S.G.); (C.L.); (A.G.M.); (J.D.W.)
| | - Charity G. Patterson
- Department of Physical Therapy and School of Health and Rehabilitation Sciences Data Center, University of Pittsburgh, Pittsburgh, PA 15260, USA;
| | - Swati M. Surkar
- Department of Physical Therapy, East Carolina University, Greenville, NC 27834, USA; (S.S.G.); (C.L.); (A.G.M.); (J.D.W.)
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Forbrigger S, DePaul VG, Davies TC, Morin E, Hashtrudi-Zaad K. Home-based upper limb stroke rehabilitation mechatronics: challenges and opportunities. Biomed Eng Online 2023; 22:67. [PMID: 37424017 DOI: 10.1186/s12938-023-01133-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/01/2023] [Indexed: 07/11/2023] Open
Abstract
Interest in home-based stroke rehabilitation mechatronics, which includes both robots and sensor mechanisms, has increased over the past 12 years. The COVID-19 pandemic has exacerbated the existing lack of access to rehabilitation for stroke survivors post-discharge. Home-based stroke rehabilitation devices could improve access to rehabilitation for stroke survivors, but the home environment presents unique challenges compared to clinics. The present study undertakes a scoping review of designs for at-home upper limb stroke rehabilitation mechatronic devices to identify important design principles and areas for improvement. Online databases were used to identify papers published 2010-2021 describing novel rehabilitation device designs, from which 59 publications were selected describing 38 unique designs. The devices were categorized and listed according to their target anatomy, possible therapy tasks, structure, and features. Twenty-two devices targeted proximal (shoulder and elbow) anatomy, 13 targeted distal (wrist and hand) anatomy, and three targeted the whole arm and hand. Devices with a greater number of actuators in the design were more expensive, with a small number of devices using a mix of actuated and unactuated degrees of freedom to target more complex anatomy while reducing the cost. Twenty-six of the device designs did not specify their target users' function or impairment, nor did they specify a target therapy activity, task, or exercise. Twenty-three of the devices were capable of reaching tasks, 6 of which included grasping capabilities. Compliant structures were the most common approach of including safety features in the design. Only three devices were designed to detect compensation, or undesirable posture, during therapy activities. Six of the 38 device designs mention consulting stakeholders during the design process, only two of which consulted patients specifically. Without stakeholder involvement, these designs risk being disconnected from user needs and rehabilitation best practices. Devices that combine actuated and unactuated degrees of freedom allow a greater variety and complexity of tasks while not significantly increasing their cost. Future home-based upper limb stroke rehabilitation mechatronic designs should provide information on patient posture during task execution, design with specific patient capabilities and needs in mind, and clearly link the features of the design to users' needs.
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Affiliation(s)
- Shane Forbrigger
- Department of Electrical and Computer Engineering, Queen's University, Kingston, Canada
| | - Vincent G DePaul
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - T Claire Davies
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, Canada
| | - Evelyn Morin
- Department of Electrical and Computer Engineering, Queen's University, Kingston, Canada
| | - Keyvan Hashtrudi-Zaad
- Department of Electrical and Computer Engineering, Queen's University, Kingston, Canada.
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Morgado-Pérez A, Coll-Molinos M, Valero R, Llobet M, Rueda N, Martínez A, Nieto S, Ramírez-Fuentes C, Sánchez-Rodríguez D, Marco E, Puig J, Duarte E. Intensive Rehabilitation Program in Older Adults with Stroke: Therapy Content and Feasibility-Preliminary Results from the BRAIN-CONNECTS Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4696. [PMID: 36981605 PMCID: PMC10048316 DOI: 10.3390/ijerph20064696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
The main objective was to assess the feasibility of an intensive rehabilitation program (IRP) for stroke patients; and secondly, to detect eventual age-related differences in content, duration, tolerability, and safety in a prospective observational cohort of patients diagnosed with subacute stroke, admitted to inpatient rehabilitation (BRAIN-CONNECTS project). Activities during physical, occupational and speech therapy, and time dedicated to each one were recorded. Forty-five subjects (63.0 years, 77.8% men) were included. The mean time of therapy was 173.8 (SD 31.5) minutes per day. The only age-related differences when comparing patients ≥65 and <65 years were a shorter time allocated for occupational therapy (-7.5 min (95% CI -12.5 to -2.6), p = 0.004) and a greater need of speech therapy (90% vs. 44%) in the older adults. Gait training, movement patterns of upper limbs, and lingual praxis were the most commonly performed activities. Regarding tolerability and safety, there were no losses to follow-up, and the attendance ratio was above 95%. No adverse events occurred during any session in all patients. Conclusion: IRP is a feasible intervention in patients with subacute stroke, regardless of age, and there are no relevant differences on content or duration of therapy.
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Affiliation(s)
- Andrea Morgado-Pérez
- Rehabilitation Research Group, Hospital del Mar Research Institute, Dr. Aiguader, 88, 08003 Barcelona, Catalonia, Spain
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital de l’Esperança), Sant Josep de la Muntanya 12, 08024 Barcelona, Catalonia, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Passeig de la Vall d’Hebron, 119-129, 08035 Barcelona, Catalonia, Spain
| | - Maria Coll-Molinos
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital de l’Esperança), Sant Josep de la Muntanya 12, 08024 Barcelona, Catalonia, Spain
| | - Ruben Valero
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital de l’Esperança), Sant Josep de la Muntanya 12, 08024 Barcelona, Catalonia, Spain
| | - Miriam Llobet
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital de l’Esperança), Sant Josep de la Muntanya 12, 08024 Barcelona, Catalonia, Spain
| | - Nohora Rueda
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital de l’Esperança), Sant Josep de la Muntanya 12, 08024 Barcelona, Catalonia, Spain
| | - Andrea Martínez
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital de l’Esperança), Sant Josep de la Muntanya 12, 08024 Barcelona, Catalonia, Spain
| | - Sonia Nieto
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital de l’Esperança), Sant Josep de la Muntanya 12, 08024 Barcelona, Catalonia, Spain
| | - Cindry Ramírez-Fuentes
- Rehabilitation Research Group, Hospital del Mar Research Institute, Dr. Aiguader, 88, 08003 Barcelona, Catalonia, Spain
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital de l’Esperança), Sant Josep de la Muntanya 12, 08024 Barcelona, Catalonia, Spain
| | - Dolores Sánchez-Rodríguez
- Rehabilitation Research Group, Hospital del Mar Research Institute, Dr. Aiguader, 88, 08003 Barcelona, Catalonia, Spain
- Geriatrics Department, Brugmann University Hospital, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium
- WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, 4000 Liège, Belgium
| | - Ester Marco
- Rehabilitation Research Group, Hospital del Mar Research Institute, Dr. Aiguader, 88, 08003 Barcelona, Catalonia, Spain
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital de l’Esperança), Sant Josep de la Muntanya 12, 08024 Barcelona, Catalonia, Spain
- Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Aiguader 80, 08003 Barcelona, Catalonia, Spain
| | - Josep Puig
- Department of Radiology, Biomedical Research Institute Imaging Research Unit, Diagnostic Imaging Institute, Doctor Josep Trueta University Hospital of Girona, Avinguda de França, s/n, 17007 Girona, Catalonia, Spain
| | - Esther Duarte
- Rehabilitation Research Group, Hospital del Mar Research Institute, Dr. Aiguader, 88, 08003 Barcelona, Catalonia, Spain
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital de l’Esperança), Sant Josep de la Muntanya 12, 08024 Barcelona, Catalonia, Spain
- Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Aiguader 80, 08003 Barcelona, Catalonia, Spain
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15
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Ha Y, Park M. Effects of Stroke Rehabilitation Using Gait Robot-Assisted Training and Person-Centered Goal Setting: A Single Blinded Pilot Study. Healthcare (Basel) 2023; 11:healthcare11040588. [PMID: 36833122 PMCID: PMC9956145 DOI: 10.3390/healthcare11040588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/10/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023] Open
Abstract
Many stroke survivors have difficulties due to the mobility and activities required in daily living. A walking impairment negatively affects the independent lifestyle of stroke patients, requiring intensive post-stroke rehabilitation. Therefore, the purpose of this study was to examine the effects of stroke rehabilitation using gait robot-assisted training and person-centered goal setting on mobility, the activities of daily living, stroke self-efficacy, and health-related QoL in stroke patients with hemiplegia. An assessor-blinded quasi-experimental study with a pre-posttest nonequivalent control group was used. Participants who were admitted to the hospital with a gait robot-assisted training system were assigned to the experimental group, and those without gait robots were assigned to the control group. Sixty stroke patients with hemiplegia from two hospitals specialized in post-stroke rehabilitation participated. Stroke rehabilitation using gait robot-assisted training and person-centered goal setting for stroke patients with hemiplegia was conducted for a total of six weeks. There were significant differences between the experimental group and control group in the Functional Ambulation Category (t = 2.89, p = 0.005), balance (t = 3.73, p < 0.001), Timed Up and Go (t = -2.27, p = 0.027), Korean Modified Barthel Index (t = 2.58, p = 0.012), 10 m Walking test (t = -2.27, p = 0.040), stroke self-efficacy (t = 2.23, p = 0.030), and health-related quality of life (t = 4.90, p < 0.001). A gait robot-assisted rehabilitation using goal setting for stroke patients with hemiplegia improved gait ability, balance ability, stroke self-efficacy, and health-related quality of life in stroke patients.
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Affiliation(s)
- Yeongmi Ha
- College of Nursing, Institute of Health Sciences, Gyeongsang National University, Jinju 52727, Republic of Korea
| | - Mingyeong Park
- Yeson Rehabilitation Medicine Hospital, Jinju 52717, Republic of Korea
- Correspondence:
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16
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Forbrigger S, Liblong M, Davies TC, DePaul V, Morin E, Hashtrudi-Zaad K. Considerations for at-home upper-limb rehabilitation technology following stroke: Perspectives of stroke survivors and therapists. J Rehabil Assist Technol Eng 2023; 10:20556683231171840. [PMID: 37124709 PMCID: PMC10134106 DOI: 10.1177/20556683231171840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Introduction This study investigated the needs of stroke survivors and therapists, and how they may contrast, for the design of robots for at-home post stroke rehabilitation therapy, in the Ontario, Canada, context. Methods Individual interviews were conducted with stroke survivors (n = 10) and therapists (n = 6). The transcripts were coded using thematic analysis inspired by the WHO International Classification of Functioning, Disability, and Health. Results Design recommendations, potential features, and barriers were identified from the interviews. Stroke survivors and therapists agreed on many of the needs for at-home robotic rehabilitation; however, stroke survivors had more insights into their home environment, barriers, and needs relating to technology, while therapists had more insights into therapy methodology and patient safety and interaction. Both groups felt a one-size-fits-all approach to rehabilitation robot design is inappropriate. Designs could address a broader range of impairments by incorporating household items and breaking activities down into their component motions. Designs should incorporate hand and wrist supports and activities. Designs should monitor trunk and shoulder motion and consider incorporating group activities. Conclusion While therapists can provide insight in the early stages of design of rehabilitation technology, stroke survivors' perspectives are crucial to designing for the home environment.
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Affiliation(s)
- Shane Forbrigger
- Department of Electrical and Computer Engineering, Queen’s University, Kingston, ON, Canada
- Keyvan Hashtrudi-Zaad, Department of Electrical and Computer Engineering, Queen’s University, 19 Union St, Kingston, ON K7L 3N9, Canada. Email:
| | - Madeleine Liblong
- Department of Mechanical Engineering, Queen’s University, Kingston, ON, Canada
| | - TC Davies
- Department of Mechanical Engineering, Queen’s University, Kingston, ON, Canada
| | - Vincent DePaul
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
| | - Evelyn Morin
- Department of Electrical and Computer Engineering, Queen’s University, Kingston, ON, Canada
| | - Keyvan Hashtrudi-Zaad
- Department of Electrical and Computer Engineering, Queen’s University, Kingston, ON, Canada
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17
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Cha Y, Yoon H, Park C, You SJH. Untacted automated robotic upper-trunk- lower reciprocal locomotor training for knee osteoarthritis: A randomized controlled trial. J Back Musculoskelet Rehabil 2023; 36:1101-1110. [PMID: 37248877 DOI: 10.3233/bmr-220182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Although millions of people with osteoarthritis (OA) have altered biomechanical alignment, movement, and knee joint pain during gait, there are no effective and sustainable interventions. To mitigate such impairments, we developed an untacted self-automated robotic and electromyography (EMG)-augmented upper-trunk-lower reciprocal locomotor training (SRGT) intervention. OBJECTIVE To compare the effects of SRGT and conventional treadmill gait training (CTGT) on the medial knee joint space width (JSW), hip adduction moment (HAM), knee varus deformity, pain, and physical function in community-dwelling older adults with OA. METHODS Older adults diagnosed with medial compartment knee OA (5 men, 35 women; mean age = 78.50 ± 9.10 years) were recruited and underwent either SRGT or CTGT, 30 min a day, 3 times a week, over a 4-week period. Outcome measurements included the JSW, HAM, knee varus angle (VA), and Western Ontario McMaster Universities osteoarthritis index (WOMAC). RESULTS Analysis of covariance (ANCOVA) showed that SRGT ed to greater changes in medial knee JSW (p= 0.00001), HAM (p= 0.00001), VA (p= 0.00001), and WOMAC (p= 0.00001) scores. CONCLUSION This study provides the first evidence for the long-term clinical and biomechanical effects of SRGT on JSW, knee joint kinematics, kinetics, and WOMAC scores in older adults with OA. Most importantly, self-automatic robotic gait training may be an alternative, effective, and sustainable treatment for the upper-trunk-lower reciprocal locomotor training in older adults with OA.
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Affiliation(s)
- Youngjoo Cha
- Department of Physical Therapy, Cheju Halla University, Jeju, Korea
| | - Hyunsik Yoon
- Chungnam National University Hospital, Daejeon, Korea
| | - Chanhee Park
- Sports Movement Artificial-Intelligence Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju, Korea
- Department of Physical Therapy, Yonsei University, Wonju, Korea
| | - Sung Joshua H You
- Sports Movement Artificial-Intelligence Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju, Korea
- Department of Physical Therapy, Yonsei University, Wonju, Korea
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18
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Geller D, Nilsen DM, Quinn L, Van Lew S, Bayona C, Gillen G. Home mirror therapy: a randomized controlled pilot study comparing unimanual and bimanual mirror therapy for improved arm and hand function post-stroke. Disabil Rehabil 2022; 44:6766-6774. [PMID: 34538193 DOI: 10.1080/09638288.2021.1973121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To compare home-based unimanual mirror therapy (UMT) and bimanual mirror therapy (BMT) for upper limb recovery in subacute/chronic stroke individuals with moderate-to-severe arm impairment. METHOD Twenty-two participants were randomized into 1 of 3 groups: UMT, BMT or traditional occupational therapy (TOT) home-based programs. The intervention was 6-weeks and consisted of OT 2 days a week, weekly sessions with the research OT, and 30-minutes of the home-based program 5 days a week, according to group allocation. The Action Research Arm Test (ARAT), ABILHAND, Fugl-Meyer Assessment (FMA), grip strength, and Stroke Impact Scale (SIS) were used for outcome measures. RESULTS All groups significantly improved over time on all outcome measures and adhered to the prescribed dosage regardless of group (p<0.05). While there were no between-group differences, effect size and 95% confidence interval data suggest a clinical significance in favor of UMT as compared to the other groups. CONCLUSIONS All participants, regardless of home-based program, adhered to the prescribed dosage and significantly improved over time. Despite no between-group differences, effect size and 95% confidence interval data suggest that UMT may be more beneficial for individuals with moderate-to-severe arm impairment as compared to BMT or TOT. ClinicalTrials.gov: #NCT02780440Implications for RehabilitationHome-based unimanual mirror therapy (UMT), bimanual mirror therapy (BMT), and traditional occupational therapy (TOT), when administered in conjunction with outpatient OT, are helpful for improving upper limb recovery post-stroke.Home-based UMT may be more beneficial than BMT or TOT for improvement in upper limb motor function and activities of daily living of patients with moderate to severe arm impairment post-stroke.
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Affiliation(s)
- Daniel Geller
- Department of Occupational Therapy, New York University Langone Health, Rusk Rehabilitation, New York, NY, USA.,Department of Rehabilitation and Regenerative Medicine (Occupational Therapy), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Dawn M Nilsen
- Department of Rehabilitation and Regenerative Medicine (Occupational Therapy), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Lori Quinn
- Department of Behavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Stephen Van Lew
- Department of Occupational Therapy, New York University Langone Health, Rusk Rehabilitation, New York, NY, USA
| | - Claribell Bayona
- Department of Occupational Therapy, New York University Langone Health, Rusk Rehabilitation, New York, NY, USA
| | - Glen Gillen
- Department of Rehabilitation and Regenerative Medicine (Occupational Therapy), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Kim GJ, Parnandi A, Eva S, Schambra H. The use of wearable sensors to assess and treat the upper extremity after stroke: a scoping review. Disabil Rehabil 2022; 44:6119-6138. [PMID: 34328803 PMCID: PMC9912423 DOI: 10.1080/09638288.2021.1957027] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/25/2021] [Accepted: 07/13/2021] [Indexed: 01/27/2023]
Abstract
PURPOSE To address the gap in the literature and clarify the expanding role of wearable sensor data in stroke rehabilitation, we summarized the methods for upper extremity (UE) sensor-based assessment and sensor-based treatment. MATERIALS AND METHODS The guideline outlined by the preferred reporting items for systematic reviews and meta-analysis extension for scoping reviews was used to complete this scoping review. Information pertaining to participant demographics, sensory information, data collection, data processing, data analysis, and study results were extracted from the studies for analysis and synthesis. RESULTS We included 43 articles in the final review. We organized the results into assessment and treatment categories. The included articles used wearable sensors to identify UE functional motion, categorize motor impairment/activity limitation, and quantify real-world use. Wearable sensors were also used to augment UE training by triggering sensory cues or providing instructional feedback about the affected UE. CONCLUSIONS Sensors have the potential to greatly expand assessment and treatment beyond traditional clinic-based approaches. This capability could support the quantification of rehabilitation dose, the nuanced assessment of impairment and activity limitation, the characterization of daily UE use patterns in real-world settings, and augment UE training adherence for home-based rehabilitation.IMPLICATIONS FOR REHABILITATIONSensor data have been used to assess UE functional motion, motor impairment/activity limitation, and real-world use.Sensor-assisted treatment approaches are emerging, and may be a promising tool to augment UE adherence in home-based rehabilitation.Wearable sensors may extend our ability to objectively assess UE motion beyond supervised clinical settings, and into home and community settings.
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Affiliation(s)
- Grace J. Kim
- Department of Occupational Therapy, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY, USA
| | - Avinash Parnandi
- Department of Neurology, NYU Langone Grossman School of Medicine, New York, NY, USA
| | - Sharon Eva
- Department of Occupational Therapy, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Heidi Schambra
- Department of Neurology, NYU Langone Grossman School of Medicine, New York, NY, USA
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20
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Olivier GN, Dibble LE, Paul SS, Lohse KR, Walter CS, Marker RJ, Hayes HA, Foreman KB, Duff K, Schaefer SY. Personalized practice dosages may improve motor learning in older adults compared to "standard of care" practice dosages: A randomized controlled trial. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:897997. [PMID: 36189036 PMCID: PMC9397834 DOI: 10.3389/fresc.2022.897997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022]
Abstract
Standard dosages of motor practice in clinical physical rehabilitation are insufficient to optimize motor learning, particularly for older patients who often learn at a slower rate than younger patients. Personalized practice dosing (i.e., practicing a task to or beyond one's plateau in performance) may provide a clinically feasible method for determining a dose of practice that is both standardized and individualized, and may improve motor learning. The purpose of this study was to investigate whether personalized practice dosages [practice to plateau (PtP) and overpractice (OVP)] improve retention and transfer of a motor task, compared to low dose [LD] practice that mimics standard clinical dosages. In this pilot randomized controlled trial (NCT02898701, ClinicalTrials.gov), community-dwelling older adults (n = 41, 25 female, mean age 68.9 years) with a range of balance ability performed a standing serial reaction time task in which they stepped to specific targets. Presented stimuli included random sequences and a blinded repeating sequence. Participants were randomly assigned to one of three groups: LD (n = 15, 6 practice trials equaling 144 steps), PtP (n = 14, practice until reaching an estimated personal plateau in performance), or OVP (n = 12, practice 100% more trials after reaching an estimated plateau in performance). Measures of task-specific learning (i.e., faster speed on retention tests) and transfer of learning were performed after 2-4 days of no practice. Learning of the random sequence was greater for the OVP group compared to the LD group (p = 0.020). The OVP (p = 0.004) and PtP (p = 0.010) groups learned the repeated sequence more than the LD group, although the number of practice trials across groups more strongly predicted learning (p = 0.020) than did group assignment (OVP vs. PtP, p = 0.270). No group effect was observed for transfer, although significant transfer was observed in this study as a whole (p < 0.001). Overall, high and personalized dosages of postural training were well-tolerated by older adults, suggesting that this approach is clinically feasible. Practicing well-beyond standard dosages also improved motor learning. Further research should determine the clinical benefit of this personalized approach, and if one of the personalized approaches (PtP vs. OVP) is more beneficial than the other for older patients.
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Affiliation(s)
- Geneviève N. Olivier
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Leland E. Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
- Center on Aging, University of Utah, Salt Lake City, UT, United States
| | - Serene S. Paul
- Discipline of Physiotherapy, Faculty of Medicine and Health, Sydney School of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Keith R. Lohse
- Center on Aging, University of Utah, Salt Lake City, UT, United States
- Department of Health-Kinesiology-Recreation, University of Utah, Salt Lake City, UT, United States
- Program in Physical Therapy and Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Christopher S. Walter
- Department of Physical Therapy, University of Arkansas for Medical Sciences, Fayetteville, AR, United States
| | - Ryan J. Marker
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Heather A. Hayes
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
- Center on Aging, University of Utah, Salt Lake City, UT, United States
| | - K. Bo Foreman
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Kevin Duff
- Center on Aging, University of Utah, Salt Lake City, UT, United States
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Sydney Y. Schaefer
- Center on Aging, University of Utah, Salt Lake City, UT, United States
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
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21
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Surface Electromyography-Driven Therapeutic Gaming for Rehabilitation of Upper Extremity Weakness: A Pilot Study. Plast Reconstr Surg 2022; 150:125-131. [PMID: 35544314 DOI: 10.1097/prs.0000000000009208] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
SUMMARY In patients with severe upper extremity weakness that may result from peripheral nerve injuries, stroke, and spinal cord injuries, standard therapy in the earliest stages of recovery consists primarily of passive rather than active exercises. Adherence to prescribed therapy may be poor, which may contribute to suboptimal functional outcomes. The authors have developed and integrated a custom surface electromyography device with a video game to create an interactive, biofeedback-based therapeutic gaming platform. Sensitivity of the authors' custom surface electromyography device was evaluated with simultaneous needle electromyography recordings. Testing of this therapeutic gaming platform was conducted with a single 30-minute gameplay session in 19 patients with a history of peripheral nerve injury, stroke, spinal cord injury, and direct upper extremity trauma, including 11 patients who had undergone nerve and/or tendon transfers. The device was highly sensitive in detecting low levels of voluntary muscle activation and was used with 10 distinct muscles of the arm, forearm, and hand. Nerve and tendon transfer patients successfully activated the donor nerve/muscle and elicited the desired movement to engage in gameplay. On surveys of acceptability and usability, patients felt the system was enjoyable, motivating, fun, and easy to use, and their hand therapists expressed similar enthusiasm. Surface electromyography-based therapeutic gaming is a promising approach to rehabilitation that warrants further development and investigation to examine its potential efficacy, not only for building muscle strength and endurance but also for facilitating motor relearning after nerve and tendon transfer surgical procedures. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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22
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PrimSeq: A deep learning-based pipeline to quantitate rehabilitation training. PLOS DIGITAL HEALTH 2022; 1. [PMID: 36420347 PMCID: PMC9681023 DOI: 10.1371/journal.pdig.0000044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Stroke rehabilitation seeks to accelerate motor recovery by training functional activities, but may have minimal impact because of insufficient training doses. In animals, training hundreds of functional motions in the first weeks after stroke can substantially boost upper extremity recovery. The optimal quantity of functional motions to boost recovery in humans is currently unknown, however, because no practical tools exist to measure them during rehabilitation training. Here, we present PrimSeq, a pipeline to classify and count functional motions trained in stroke rehabilitation. Our approach integrates wearable sensors to capture upper-body motion, a deep learning model to predict motion sequences, and an algorithm to tally motions. The trained model accurately decomposes rehabilitation activities into elemental functional motions, outperforming competitive machine learning methods. PrimSeq furthermore quantifies these motions at a fraction of the time and labor costs of human experts. We demonstrate the capabilities of PrimSeq in previously unseen stroke patients with a range of upper extremity motor impairment. We expect that our methodological advances will support the rigorous measurement required for quantitative dosing trials in stroke rehabilitation. Stroke commonly damages motor function in the upper extremity (UE), leading to long-term disability and loss of independence in a majority of individuals. Rehabilitation seeks to restore function by training daily activities, which deliver repeated UE functional motions. The optimal number of functional motions necessary to boost recovery is unknown. This gap stems from the lack of measurement tools to feasibly count functional motions. We thus developed the PrimSeq pipeline to enable the accurate and rapid counting of building-block functional motions, called primitives. PrimSeq uses wearable sensors to capture rich motion information from the upper body, and custom-built algorithms to detect and count functional primitives in this motion data. We showed that our deep learning algorithm precisely counts functional primitives performed by stroke patients and outperformed other benchmark algorithms. We also showed patients tolerated the wearable sensors and that the approach is 366 times faster at counting primitives than humans. PrimSeq thus provides a precise and practical means of quantifying functional primitives, which promises to advance stroke research and clinical care and to improve the outcomes of individuals with stroke.
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Turk R, Whitall J, Meagher C, Stokes M, Roberts S, Woodham S, Clatworthy P, Burridge J. Task selection for a sensor-based, wearable, upper limb training device for stroke survivors: a multi-stage approach. Disabil Rehabil 2022; 45:1480-1487. [PMID: 35476616 DOI: 10.1080/09638288.2022.2065542] [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: 11/03/2022]
Abstract
PURPOSE Post-stroke survivors report that feedback helps to increase training motivation. A wearable system (M-MARK), comprising movement and muscle sensors and providing feedback when performing everyday tasks was developed. The objective reported here was to create an evidence-based set of upper-limb tasks for use with the system. MATERIALS AND METHODS Data from two focus groups with rehabilitation professionals, ten interviews with stroke survivors and a review of assessment tests were synthesized. In a two-stage process, suggested tasks were screened to exclude non-tasks and complex activities. Remaining tasks were screened for suitability and entered into a categorization matrix. RESULTS Of 83 suggestions, eight non-tasks, and 42 complex activities were rejected. Of the remaining 33 tasks, 15 were rejected: five required fine motor control; eight were too complex to standardize; one because the role of hemiplegic hand was not defined and one involved water. The review of clinical assessment tests found no additional tasks. Eleven were ultimately selected for testing with M-Mark. CONCLUSIONS Using a task categorization matrix, a set of training tasks was systematically identified. There was strong agreement between data from the professionals, survivors and literature. The matrix populated by tasks has potential for wider use in upper-limb stroke rehabilitation. IMPLICATIONS FOR REHABILITATIONRehabilitation technologies that provide feedback on quantity and quality of movements can support independent home-based upper limb rehabilitation.Rehabilitation technology systems require a library of upper limb tasks at different levels for people with stroke and therapists to choose from.A user-defined and evidence-based set of upper limb tasks for use within a wearable sensor device system have been developed.
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Affiliation(s)
- Ruth Turk
- School of Health Sciences, Faculty of Environmental Sciences, University of Southampton, Southampton, UK
| | - Jill Whitall
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Claire Meagher
- School of Health Sciences, Faculty of Environmental Sciences, University of Southampton, Southampton, UK
| | - Maria Stokes
- School of Health Sciences, Faculty of Environmental Sciences, University of Southampton, Southampton, UK.,Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nottingham, UK
| | - Sue Roberts
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | | | | | - Jane Burridge
- School of Health Sciences, Faculty of Environmental Sciences, University of Southampton, Southampton, UK
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24
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Savitz SI. Is There a Time-Sensitive Window in Patients With Stroke to Enhance Arm Recovery With Higher Intensity Motor Therapy? Stroke 2022; 53:1823-1825. [PMID: 35467996 DOI: 10.1161/strokeaha.121.037402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sean I Savitz
- Institute for Stroke and Cerebrovascular Disease, University of Texas Health Science Center, Houston
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25
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Simpson LA, Barclay R, Bayley MT, Dukelow SP, MacIntosh BJ, McKay-Lyons M, Menon C, Mortenson WB, Peng TH, Pollock CL, Pooyania S, Teasell R, Yang CL, Yao J, Eng JJ. Virtual Arm Boot Camp (V-ABC): study protocol for a mixed-methods study to increase upper limb recovery after stroke with an intensive program coupled with a grasp count device. Trials 2022; 23:129. [PMID: 35135585 PMCID: PMC8822776 DOI: 10.1186/s13063-022-06047-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/19/2022] [Indexed: 01/11/2023] Open
Abstract
Background Encouraging upper limb use and increasing intensity of practice in rehabilitation are two important goals for optimizing upper limb recovery post stroke. Feedback from novel wearable sensors may influence practice behaviour to promote achieving these goals. A wearable sensor can potentially be used in conjunction with a virtually monitored home program for greater patient convenience, or due to restrictions that preclude in-person visits, such as COVID-19. This trial aims to (1) determine the efficacy of a virtual behaviour change program that relies on feedback from a custom wearable sensor to increase use and function of the upper limb post stroke; and (2) explore the experiences and perceptions of using a program coupled with wearable sensors to increase arm use from the perspective of people with stroke. Methods This mixed-methods study will utilize a prospective controlled trial with random allocation to immediate or 3-week delayed entry to determine the efficacy of a 3-week behaviour change program with a nested qualitative description study. The intervention, the Virtual Arm Boot Camp (V-ABC) features feedback from a wearable device, which is intended to increase upper limb use post stroke, as well as 6 virtual sessions with a therapist. Sixty-four adults within 1-year post stroke onset will be recruited from seven rehabilitation centres. All outcomes will be collected virtually. The primary outcome measure is upper limb use measured by grasp counts over 3 days from the wearable sensor (TENZR) after the 3-week intervention. Secondary outcomes include upper limb function (Arm Capacity and Movement Test) and self-reported function (Hand Function and Strength subscale from the Stroke Impact Scale). Outcome data will be collected at baseline, post-intervention and at 2 months retention. The qualitative component will explore the experiences and acceptability of using a home program with a wearable sensor for increasing arm use from the point of view of individuals with stroke. Semi-structured interviews will be conducted with participants after they have experienced the intervention. Qualitative data will be analysed using content analysis. Discussion This study will provide novel information regarding the efficacy and acceptability of virtually delivered programs to improve upper extremity recovery, and the use of wearable sensors to assist with behaviour change. Trial registration ClinicalTrials.govNCT04232163. January 18, 2020.
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Affiliation(s)
- Lisa A Simpson
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada
| | - Ruth Barclay
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Mark T Bayley
- Division of Physical Medicine and Rehabilitation, University of Toronto and KITE Research Institute University Health Network, Toronto, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | | | | | - Carlo Menon
- Department of Health Sciences and Technology, ETH, Zurich, Switzerland
| | - W Ben Mortenson
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada.,International Collaboration on Repair Discoveries, Vancouver, Canada
| | - Tzu-Hsuan Peng
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada
| | - Courtney L Pollock
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Sepideh Pooyania
- Division of Physical Medicine and Rehabilitation, University of Manitoba, Winnipeg, Canada
| | - Robert Teasell
- Schulich School of Medicine & Dentistry, Western University and Parkwood Institute Research, Lawson Health Research Institute, London, Canada
| | - Chieh-Ling Yang
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada.,Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Jennifer Yao
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada.,Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada
| | - Janice J Eng
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada. .,International Collaboration on Repair Discoveries, Vancouver, Canada. .,Department of Physical Therapy, University of British Columbia, Vancouver, Canada. .,University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
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26
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Kooncumchoo P, Namdaeng P, Hanmanop S, Rungroungdouyboon B, Klarod K, Kiatkulanusorn S, Luangpon N. Gait Improvement in Chronic Stroke Survivors by Using an Innovative Gait Training Machine: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:224. [PMID: 35010482 PMCID: PMC8750435 DOI: 10.3390/ijerph19010224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
Chronic stroke leads to the impairment of lower limb function and gait performance. After in-hospital rehabilitation, most individuals lack continuous gait training because of the limited number of physical therapists. This study aimed to evaluate the effects of a newly invented gait training machine (I-Walk) on lower limb function and gait performance in chronic stroke individuals. Thirty community-dwelling chronic stroke individuals were allocated to the I-Walk machine group (n = 15) or the overground gait training (control) group (n = 15). Both groups received 30 min of upper limb and hand movement and sit-to-stand training. After that, the I-Walk group received 30 min of I-Walk training, while the control followed a 30-minute overground training program. All the individuals were trained 3 days/week for 8 weeks. The primary outcome of the motor recovery of lower limb impairment was measured using the Fugl-Meyer Assessment (FMA). The secondary outcomes for gait performance were the 6-minute walk test (6 MWT), the 10-meter walk test (10 MWT), and the Timed Up and Go (TUG). The two-way mixed-model ANOVA with the Bonferroni test was used to compare means within and between groups. The post-intervention motor and sensory subscales of the FMA significantly increased compared to the baseline in both groups. Moreover, the 6 MWT and 10 MWT values also improved in both groups. In addition, the mean difference of TUG in the I-Walk was higher than the control. The efficiency of I-Walk training was comparable to overground training and might be applied for chronic stroke gait training in the community.
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Affiliation(s)
- Patcharee Kooncumchoo
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathumthani 12120, Thailand; (P.K.); (P.N.); (S.H.)
- Center of Excellence in Creative Engineering Design and Development, Thammasat University, Pathumthani 12120, Thailand;
| | - Phuwarin Namdaeng
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathumthani 12120, Thailand; (P.K.); (P.N.); (S.H.)
| | - Somrudee Hanmanop
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathumthani 12120, Thailand; (P.K.); (P.N.); (S.H.)
| | - Bunyong Rungroungdouyboon
- Center of Excellence in Creative Engineering Design and Development, Thammasat University, Pathumthani 12120, Thailand;
- Department of Mechanical Engineering, Faculty of Engineering, Thammasat University, Pathumthani 12120, Thailand
| | - Kultida Klarod
- Department of Physical Therapy, Faculty of Allied Health Sciences, Burapha University, Chonburi 20131, Thailand; (K.K.); (S.K.)
| | - Sirirat Kiatkulanusorn
- Department of Physical Therapy, Faculty of Allied Health Sciences, Burapha University, Chonburi 20131, Thailand; (K.K.); (S.K.)
| | - Nongnuch Luangpon
- Department of Physical Therapy, Faculty of Allied Health Sciences, Burapha University, Chonburi 20131, Thailand; (K.K.); (S.K.)
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27
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Held JPO, Schwarz A, Pohl J, Thürlimann E, Porrtmann S, Branscheidt M, Fratian M, Van Duinen J, Veerbeek JM, Luft AR. Changes in stroke rehabilitation during the SARS-CoV-2 shutdown in Switzerland. J Rehabil Med 2021; 54:jrm00272. [PMID: 34927210 PMCID: PMC8902586 DOI: 10.2340/jrm.v53.1118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Many stroke survivors require continuous outpatient rehabilitation therapy to maintain or improve their neurological functioning, independence, and quality of life. In Switzerland and many other countries, the shutdown to contain SARS-CoV-2 infections led to mobility restrictions and a decrease in therapy delivery. This study investigated the impact of the COVID-19 shutdown on stroke survivors’ access to therapy, physical activity, functioning and mood. Methods A prospective observational cohort study in stroke subjects. At 4 time-points (before, during, after the shutdown, and at 3-month follow-up), the amount of therapy, physical activities, motor function, anxiety, and depression were assessed. Results Thirty-six community-dwelling stroke subjects (median 70 years of age, 10 months post-stroke) were enrolled. Therapy reductions related to the shutdown were reported in 72% of subjects. This decrease was associated with significantly extended sedentary time and minimal deterioration in physical activity during the shutdown. Both parameters improved between reopening and 3-month follow-up. Depressive symptoms increased slightly during the observation period. Patients more frequently reported on self-directed training during shutdown. Conclusion The COVID-19 shutdown had measurable immediate, but no persistent, effects on post-stroke outcomes, except for depression. Importantly, a 2-month reduction in therapy may trigger improvements when therapy is fully re-initiated thereafter.
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Affiliation(s)
- Jeremia P O Held
- University and University Hospital Zurich, Neurology, Frauenklinikstrasse 26, 8091 Zurich.
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28
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Handlery R, Shover E, Chhoun T, Durant L, Handlery K, Harrington SE, Stock MS, Fritz SL. We Don't Know Our Own Strength: A Survey of Strength Training Attitudes, Behaviors, and Knowledge in Physical Therapists and Physical Therapist Students. Phys Ther 2021; 101:6358618. [PMID: 34473297 DOI: 10.1093/ptj/pzab204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/18/2021] [Accepted: 07/27/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Strength training is frequently utilized by physical therapists; however, there has been discussion about whether physical therapists utilize strength training adequately. The purpose of this study was to describe and compare the strength training attitudes, behaviors, and knowledge of physical therapists and physical therapy students and to determine how participant characteristics influenced knowledge scores. METHODS An anonymous survey was created in 3 rounds. For round 1, researchers used textbooks to create items assessing demographics, attitudes, behaviors, and knowledge regarding strength training. Rounds 2 and 3 consisted of feedback from 7 content experts until 80% consensus was reached; items were added, removed, or edited based on feedback. The final survey was distributed through social media, list servs, and email targeting physical therapists and students based in the United States. Response frequencies for all items were reported. Overall knowledge scores were calculated by summing correct responses for each item, with a maximum score of 13; scores <70% were considered low. Binomial logistic regression determined which characteristics (demographics, attitudes, or behaviors) influenced whether participants adequately utilized strength training principles (scored ≥70% on knowledge items). RESULTS There were 777 physical therapist and 648 student participants. Nearly 90% of therapists and students reported frequently prescribing strength training. Over 48% of therapists felt their professional education did not prepare them to apply strength training (compared with 24% of students), and 68% believed that strength training is inadequately applied in physical therapy (compared with 40% of students). Sixty-two percent of therapists and 55% of students scored ≥70% for knowledge items. Additional strength training education and regular participation in strength training increased the odds of scoring ≥70% on knowledge items. CONCLUSION Physical therapists and physical therapy students frequently prescribe strength training despite similarly low knowledge scores. To increase knowledge, greater emphasis on strength training in professional education, continuing education, participation in strength training, or all 3 is warranted. IMPACT Strength training is an important intervention used in physical therapy and must be used appropriately to improve the health of patients. According to these findings, strength training education may not currently be optimal, as demonstrated by low knowledge scores by both therapists and students. Further work is needed to determine how knowledge of strength training relates to patient outcomes and also how best to implement strength training in physical therapy education and practice.
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Affiliation(s)
- Reed Handlery
- Arkansas Colleges of Health Education, School of Physical Therapy, Fort Smith, Arkansas, USA
| | - Emma Shover
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, Columbia, South Carolina, USA
| | - Thavi Chhoun
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, Columbia, South Carolina, USA
| | - Lauren Durant
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, Columbia, South Carolina, USA
| | - Kaci Handlery
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, Columbia, South Carolina, USA
| | - Shana E Harrington
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, Columbia, South Carolina, USA
| | - Matt S Stock
- School of Kinesiology and Physical Therapy, University of Central Florida, Orlando, Florida, USA
| | - Stacy L Fritz
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, Columbia, South Carolina, USA
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29
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Levin MF, Demers M. Motor learning in neurological rehabilitation. Disabil Rehabil 2021; 43:3445-3453. [PMID: 32320305 DOI: 10.1080/09638288.2020.1752317] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 03/14/2020] [Accepted: 04/02/2020] [Indexed: 12/27/2022]
Abstract
While most upper limb training interventions in neurological rehabilitation are based on established principles of motor learning and neural plasticity, recovery potential may be improved if the focus includes remediating an individual's specific motor impairment within the framework of a motor control theory. This paper reviews current theories of motor control and motor learning and describes how they can be incorporated into training programs to enhance sensorimotor recovery in patients with neurological lesions. An emphasis is placed on dynamical systems theory and the use of new technologies such as virtual, augmented and mixed reality applications for rehabilitation to facilitate learning.Implications for RehabilitationKinematic abundance allows the healthy nervous system to produce different combinations of joint rotations to perform a desired task.The structure of practice to improve the movement repertoire in rehabilitation should take into account the kinematic abundance of the system.Learning can be enhanced by varied practice with feedback about key movement elements.Virtual reality environments provide opportunities to manipulate the structure and schedule of practice and feedback.
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Affiliation(s)
- Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada
| | - Marika Demers
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada
- USA Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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30
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Sartor MM, Grau-Sánchez J, Guillén-Solà A, Boza R, Puig J, Stinear C, Morgado-Perez A, Duarte E. Intensive rehabilitation programme for patients with subacute stroke in an inpatient rehabilitation facility: describing a protocol of a prospective cohort study. BMJ Open 2021; 11:e046346. [PMID: 34663650 PMCID: PMC8524269 DOI: 10.1136/bmjopen-2020-046346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Rehabilitation is recognised as a cornerstone of multidisciplinary stroke care. Intensity of therapy is related to functional recovery although there is high variability on the amount of time and techniques applied in therapy sessions. There is a need to better describe stroke rehabilitation protocols to develop a better understanding of current practice increasing the internal validity and generalisation of clinical trial results. The aim of this study is to describe an intensive rehabilitation programme for patients with stroke in an inpatient rehabilitation facility, measuring the amount and type of therapies (physical, occupational and speech therapy) provided and reporting functional outcomes. METHODS AND ANALYSIS This will be a prospective observational cohort study of patients with subacute stroke admitted to our inpatient rehabilitation facility during 2 years. A therapy recording tool was developed in order to describe the rehabilitation interventions performed in our unit. This tool was designed using the Delphi method, literature search and collaboration with senior clinicians. Therapists will record the time spent on different activities available in our unit during specific therapy sessions. Afterwards, the total time spent in each activity, and the total rehabilitation time for all activities, will be averaged for all patients. Outcome variables were divided into three different domains: body structure and function outcomes, activity outcomes and participation outcomes and will be assessed at baseline (admission at the rehabilitation unit), at discharge from the rehabilitation unit and at 3 and 6 months after stroke. ETHICS AND DISSEMINATION This study was approved by the Medical Research Committee at Hospital del Mar Research Institute (Project ID: 34/C/2017). The results of this study will be presented at national and international congress and submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04191109.
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Affiliation(s)
- Monique Messaggi Sartor
- Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mediques, Barcelona, Spain
- Physiotherapy Degree, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Jennifer Grau-Sánchez
- Cognition and Brain Plasticity Unit, Department of Cognition, Development and Educational Psychology, University of Barcelona and Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Escola Universitària d'Infermeria i Teràpia Ocupacional de Terrassa (EUIT), Autonomous University of Barcelona, Terrassa, Spain
| | - Anna Guillén-Solà
- Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mediques, Barcelona, Spain
- Physiotherapy Degree, Universitat Autonoma de Barcelona, Barcelona, Spain
- Department of Physical Medicine and Rehabilitation, Hospitals del Mar i l'Esperança, Parc de Salut Mar, Barcelona, Spain
| | - Roser Boza
- Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mediques, Barcelona, Spain
| | - Josep Puig
- Department of Radiology, Biomedical Research Institute Imaging Research Unit, Diagnostic Imaging Institute, Doctor Josep Trueta University Hospital of Girona, Girona, Spain
| | - Cathy Stinear
- Centre for Brain Research, The University of Auckland, Auckland, New Zealand
| | - Andrea Morgado-Perez
- Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mediques, Barcelona, Spain
- Physiotherapy Degree, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Esther Duarte
- Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mediques, Barcelona, Spain
- Physiotherapy Degree, Universitat Autonoma de Barcelona, Barcelona, Spain
- Department of Physical Medicine and Rehabilitation, Hospitals del Mar i l'Esperança, Parc de Salut Mar, Barcelona, Spain
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31
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Moore JL, Bø E, Erichsen A, Rosseland I, Halvorsen J, Bratlie H, Hornby TG, Nordvik JE. Development and Results of an Implementation Plan for High-Intensity Gait Training. J Neurol Phys Ther 2021; 45:282-291. [PMID: 34369450 PMCID: PMC8423140 DOI: 10.1097/npt.0000000000000364] [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] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND AND PURPOSE High-intensity gait training is recommended in stroke rehabilitation to improve gait speed, walking distance, and balance. However, identifying effective and efficient implementation methods is a challenge for rehabilitation providers. This article describes the development of an implementation plan, presents findings of each implementation phase, and identifies the project's impact on clinicians and the health system. METHODS Two inpatient rehabilitation facilities, including 9 physical therapists, collaborated with a knowledge translation center to implement this program. We developed an implementation plan using the Knowledge-to-Action Framework and utilized the Consolidated Framework for Implementation Research to identify barriers and select implementation strategies. Using mix-methods research, including surveys and informal discussions, we evaluated current practice, barriers, outcomes, and the sustainability of high-intensity gait training in practice. RESULTS A multicomponent implementation plan that targeted barriers was developed. Before implementation, clinicians reported providing several balance, strength training, and gait interventions to improve walking. Barriers to using high-intensity gait training included knowledge, beliefs, adaptability of high-intensity gait training, resources, culture, and others. Twenty-six implementation strategies were selected to target the barriers. Surveys and informal discussions identified significant changes in perceived practice, adoption of high-intensity gait training, and positive impacts on the health system. The 2-year follow-up survey indicated that the new practice was sustained. DISCUSSION AND CONCLUSIONS Using a multicomponent implementation plan that targeted barriers, we successfully implemented high-intensity gait training in clinical practice. Contributors to successful implementation may include the implementation methods, usual care interventions, and clinicians' readiness for this change.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A352.).
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Affiliation(s)
- Jennifer L. Moore
- First Oslo team members are as follows: Tonje Barkenæs, Miriam Byhring, Magnus Hågå, Chris Henderson, Mari Klokkerud, Julia Mbalilaki, Stein-Arne Rimehaug, Thomas Tomren, and Karen Vergoossen
| | - Elisabeth Bø
- First Oslo team members are as follows: Tonje Barkenæs, Miriam Byhring, Magnus Hågå, Chris Henderson, Mari Klokkerud, Julia Mbalilaki, Stein-Arne Rimehaug, Thomas Tomren, and Karen Vergoossen
| | - Anne Erichsen
- First Oslo team members are as follows: Tonje Barkenæs, Miriam Byhring, Magnus Hågå, Chris Henderson, Mari Klokkerud, Julia Mbalilaki, Stein-Arne Rimehaug, Thomas Tomren, and Karen Vergoossen
| | - Ingvild Rosseland
- First Oslo team members are as follows: Tonje Barkenæs, Miriam Byhring, Magnus Hågå, Chris Henderson, Mari Klokkerud, Julia Mbalilaki, Stein-Arne Rimehaug, Thomas Tomren, and Karen Vergoossen
| | - Joakim Halvorsen
- First Oslo team members are as follows: Tonje Barkenæs, Miriam Byhring, Magnus Hågå, Chris Henderson, Mari Klokkerud, Julia Mbalilaki, Stein-Arne Rimehaug, Thomas Tomren, and Karen Vergoossen
| | - Hanne Bratlie
- First Oslo team members are as follows: Tonje Barkenæs, Miriam Byhring, Magnus Hågå, Chris Henderson, Mari Klokkerud, Julia Mbalilaki, Stein-Arne Rimehaug, Thomas Tomren, and Karen Vergoossen
| | - T. George Hornby
- First Oslo team members are as follows: Tonje Barkenæs, Miriam Byhring, Magnus Hågå, Chris Henderson, Mari Klokkerud, Julia Mbalilaki, Stein-Arne Rimehaug, Thomas Tomren, and Karen Vergoossen
| | - Jan Egil Nordvik
- First Oslo team members are as follows: Tonje Barkenæs, Miriam Byhring, Magnus Hågå, Chris Henderson, Mari Klokkerud, Julia Mbalilaki, Stein-Arne Rimehaug, Thomas Tomren, and Karen Vergoossen
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Critical Period After Stroke Study (CPASS): A phase II clinical trial testing an optimal time for motor recovery after stroke in humans. Proc Natl Acad Sci U S A 2021; 118:2026676118. [PMID: 34544853 PMCID: PMC8488696 DOI: 10.1073/pnas.2026676118] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 02/06/2023] Open
Abstract
Restoration of postinjury brain function is a signal neuroscience challenge. Animal models of stroke recovery demonstrate time-limited windows of heightened motor recovery, similar to developmental neuroplasticity. However, no equivalent windows have been demonstrated in humans. We report a randomized controlled trial applying essential elements of animal motor training paradigms to humans, to determine the existence of an analogous sensitive period in adults. We found a similar sensitive or optimal period 60 to 90 d after stroke, with lesser effects ≤30 d and no effect 6 mo or later after stroke. These findings prospectively demonstrated the existence of a sensitive period in adult humans. We urge the provision of more intensive motor rehabilitation within 60 to 90 d after stroke onset. Restoration of human brain function after injury is a signal challenge for translational neuroscience. Rodent stroke recovery studies identify an optimal or sensitive period for intensive motor training after stroke: near-full recovery is attained if task-specific motor training occurs during this sensitive window. We extended these findings to adult humans with stroke in a randomized controlled trial applying the essential elements of rodent motor training paradigms to humans. Stroke patients were adaptively randomized to begin 20 extra hours of self-selected, task-specific motor therapy at ≤30 d (acute), 2 to 3 mo (subacute), or ≥6 mo (chronic) after stroke, compared with controls receiving standard motor rehabilitation. Upper extremity (UE) impairment assessed by the Action Research Arm Test (ARAT) was measured at up to five time points. The primary outcome measure was ARAT recovery over 1 y after stroke. By 1 y we found significantly increased UE motor function in the subacute group compared with controls (ARAT difference = +6.87 ± 2.63, P = 0.009). The acute group compared with controls showed smaller but significant improvement (ARAT difference = +5.25 ± 2.59 points, P = 0.043). The chronic group showed no significant improvement compared with controls (ARAT = +2.41 ± 2.25, P = 0.29). Thus task-specific motor intervention was most effective within the first 2 to 3 mo after stroke. The similarity to rodent model treatment outcomes suggests that other rodent findings may be translatable to human brain recovery. These results provide empirical evidence of a sensitive period for motor recovery in humans.
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Forget NJ, Higgins J, Rivard M, Harris PG. Going beyond Activity and Participation: Development of the DIF-CHUM-A patient-reported outcome measure for individuals with Dupuytren's contracture. J Hand Ther 2021; 33:305-313. [PMID: 31492480 DOI: 10.1016/j.jht.2019.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 03/27/2019] [Accepted: 03/28/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN This is a cross-sectional clinical measurement. INTRODUCTION There are currently no Dupuytren's contracture (DC)-specific, patient-reported outcomes (PROs) that can provide a thorough clinical portrait of the patients' perceptions with regard to the execution of regular activities. PURPOSE OF THE STUDY The purpose of this study was to present the development of the Dupuytren's contracture Impact on Function-Centre Hospitalier de l'Université de Montréal (DIF-CHUM), a DC-specific PRO. METHODS The development process involved consultation of 45 individuals with DC and 7 health professionals, existing literature, and DC-specific PRO. RESULTS The DIF-CHUM is composed of 2 sections: section 1, Activity and Participation includes 8 items per hand, scored on Difficulty and Change scales; section 2, General Impact includes up to 18 items, scored on Difficulty, Importance, Change and Satisfaction scales. Preliminary evidence suggests that the DIF-CHUM demonstrates good content validity. DISCUSSION The DIF-CHUM is designed to be a patient-centered measure of Activity and Participation and Functional Competence for individuals with DC that will provide hand therapists with a unique perspective of the impact of DC on patients' lives. CONCLUSION Further validation of the DIF-CHUM, including its scoring, is under way.
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Affiliation(s)
- Nancy J Forget
- Public Health PhD Program, School of Public Health, University of Montreal, Montreal, Quebec, Canada.
| | - Johanne Higgins
- School of Rehabilitation, University of Montreal, Montreal, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
| | - Michèle Rivard
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada; Public Health Research Institute, University of Montreal, Montreal, Quebec, Canada
| | - Patrick G Harris
- Plastic Surgery Service, Department of Surgery, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
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Martins Â, Gouveia D, Cardoso A, Carvalho C, Silva C, Coelho T, Gamboa Ó, Ferreira A. Functional Neurorehabilitation in Dogs with an Incomplete Recovery 3 Months following Intervertebral Disc Surgery: A Case Series. Animals (Basel) 2021; 11:ani11082442. [PMID: 34438900 PMCID: PMC8388785 DOI: 10.3390/ani11082442] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/13/2021] [Accepted: 08/15/2021] [Indexed: 12/27/2022] Open
Abstract
Simple Summary A non-invasive neurorehabilitation multimodal protocol (NRMP) may be applicable to chronic T3-L3 dogs 3 months after undergoing surgery for acute Intervertebral Disc Disease (IVDD) Hansen type I; this protocol has been shown to be safe, feasible, and potentially effective at improving ambulation in both open field score (OFS) 0 and OFS 1 dogs. The specific sample population criteria limit the number of dogs included, mainly due to owners withdrawing over time. Thus, the present case series study aimed to demonstrate that an NRMP could contribute to a functional treatment possibly based on synaptic and anatomic reorganization of the spinal cord. Abstract This case series study aimed to evaluate the safety, feasibility, and positive outcome of the neurorehabilitation multimodal protocol (NRMP) in 16 chronic post-surgical IVDD Hansen type I dogs, with OFS 0/DPP− (n = 9) and OFS 1/DPP+ (n = 7). All were enrolled in the NRMP for a maximum of 90 days and were clinically discharged after achieving ambulation. The NRMP was based on locomotor training, functional electrical stimulation, transcutaneous electrical spinal cord stimulation, and 4-aminopyridine (4-AP) pharmacological management. In the Deep Pain Perception (DPP)+ dogs, 100% recovered ambulation within a mean period of 47 days, reaching OFS ≥11, which suggests that a longer period of time is needed for recovery. At follow-up, all dogs presented a positive evolution with voluntary micturition. Of the DPP− dogs admitted, all achieved a flexion/extension locomotor pattern within 30 days, and after starting the 4-AP, two dogs were discharged at outcome day 45, with 78% obtaining Spinal Reflex Locomotion (SRL) and automatic micturition within a mean period of 62 days. At follow-up, all dogs maintained their neurological status. After the NRMP, ambulatory status was achieved in 88% (14/16) of dogs, without concurrent events. Thus, an NRMP may be an important therapeutic option to reduce the need for euthanasia in the clinical setting.
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Affiliation(s)
- Ângela Martins
- Faculty of Veterinary Medicine, Lusófona University, Campo Grande, 1300-477 Lisboa, Portugal
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (C.S.); (T.C.)
- CIISA—Centro Interdisciplinar-Investigação em Saúde Animal, Faculdade de Medicina Veterinária, Av. Universidade Técnica de Lisboa, 1300-477 Lisboa, Portugal;
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1300-477 Lisboa, Portugal
- Correspondence:
| | - Débora Gouveia
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (C.S.); (T.C.)
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1300-477 Lisboa, Portugal
| | - Ana Cardoso
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (C.S.); (T.C.)
| | - Carla Carvalho
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (C.S.); (T.C.)
| | - Cátia Silva
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (C.S.); (T.C.)
| | - Tiago Coelho
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (C.S.); (T.C.)
| | - Óscar Gamboa
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal;
| | - António Ferreira
- CIISA—Centro Interdisciplinar-Investigação em Saúde Animal, Faculdade de Medicina Veterinária, Av. Universidade Técnica de Lisboa, 1300-477 Lisboa, Portugal;
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal;
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Hornby TG, Rafferty MR, Pinto D, French D, Jordan N. Cost-Effectiveness of High-intensity Training vs Conventional Therapy for Individuals With Subacute Stroke. Arch Phys Med Rehabil 2021; 103:S197-S204. [PMID: 34228956 DOI: 10.1016/j.apmr.2021.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/28/2021] [Accepted: 05/06/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This investigation estimated the incremental cost-effectiveness of high-intensity training (HIT) compared with conventional physical therapy in individuals with subacute stroke, based on the additional personnel required to deliver the therapy. DESIGN Secondary analysis from a pilot study and subsequent randomized controlled trial. SETTING Outpatient laboratory setting. PARTICIPANTS Data were collected from individuals with locomotor impairments 1-6 months poststroke (N=44) who participated in HIT (n=27) or conventional physical therapy (n=17). INTERVENTIONS Individuals performing HIT practiced walking tasks in variable contexts (stairs, overground, treadmill) while targeting up to 80% maximum heart rate reserve. Individuals performing conventional therapy practiced impairment-based and functional tasks at lower intensities (<40% heart rate reserve). MAIN OUTCOME MEASURES Costs were assessed based on personnel use with availability of similar equipment. Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves were calculated for quality-adjusted life years (QALYs) derived from the Medical Outcomes Short Form-36 questionnaire and gains in self-selected speeds (SSSs). RESULTS Personnel costs were higher after HIT (mean, $1420±234) vs conventional therapy (mean, $1111±219), although between-group differences in QALYs (0.05 QALYs; 95% confidence interval [CI], 0.0-0.10 QALYs) and SSS (0.20 m/s; 95% CI, 0.05-0.35 m/s) favored HIT. ICERs were $6180 (95% CI, -$96,364 to $123,211) per QALY and $155 (95% CI, 38-242) for a 0.1 m/s gain in SSS. CONCLUSIONS Additional personnel to support HIT are relatively inexpensive but can add substantial effectiveness to subacute rehabilitation. Future research should evaluate patient factors that increase the likelihood of improvement to maximize the cost-effectiveness of treatment post stroke.
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Affiliation(s)
- T George Hornby
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN; Rehabilitation Hospital of Indiana, Indianapolis, IN; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Miriam R Rafferty
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL; Shirley Ryan AbilityLab, Chicago, IL
| | - Daniel Pinto
- Department of Physical Therapy, Marquette University, Milwaukee, WI
| | - Dustin French
- Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Ophthalmology, Northwestern University Feinberg School of Medicine; Chicago, IL; Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, IL
| | - Neil Jordan
- Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, Chicago, IL; Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, IL
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Dalton EJ, Churilov L, Lannin NA, Corbett D, Campbell BCV, Hayward KS. Multidimensional Phase I Dose Ranging Trials for Stroke Recovery Interventions: Key Challenges and How to Address Them. Neurorehabil Neural Repair 2021; 35:663-679. [PMID: 34085851 DOI: 10.1177/15459683211019362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite an increase in the amount of published stroke recovery research, interventions have failed to markedly affect the trajectory of recovery poststroke. We argue that early-phase research to systematically investigate dose is an important contributor to advance the science underpinning stroke recovery. In this article, we aim to (a) define the problem of insufficient use of a systematic approach to early-phase, multidimensional dose articulation research and (b) propose a solution that applies this approach to design a multidimensional phase I trial to identify the maximum tolerated dose (MTD). We put forward a design template as a decision support tool to increase knowledge of how to develop a phase I dose-ranging trial for nonpharmaceutical stroke recovery interventions. This solution has the potential to advance the development of efficacious stroke recovery interventions, which include activity-based rehabilitation interventions.
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Affiliation(s)
| | | | - Natasha A Lannin
- Monash University, Melbourne, VIC, Australia.,Alfred Health, Melbourne, Australia
| | | | - Bruce C V Campbell
- University of Melbourne, Parkville, VIC, Australia.,Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Kathryn S Hayward
- University of Melbourne, Parkville, VIC, Australia.,Florey Institute of Neurosciences and Mental Health, Heidelberg, VIC, Australia
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Olivier GN, Paul SS, Walter CS, Hayes HA, Foreman KB, Duff K, Schaefer SY, Dibble LE. The feasibility and efficacy of a serial reaction time task that measures motor learning of anticipatory stepping. Gait Posture 2021; 86:346-353. [PMID: 33857800 PMCID: PMC8092847 DOI: 10.1016/j.gaitpost.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 03/03/2021] [Accepted: 04/02/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Motor learning has been investigated using various paradigms, including serial reaction time tasks (SRTT) that examine upper extremity reaching and pointing while seated. Few studies have used a stepping SRTT, which could offer additional insights into motor learning involving postural demands. For a task to measure motor learning, naïve participants must demonstrate a) improved performance with task practice, and b) a dose-response relationship to learning the task. RESEARCH QUESTION Is a stepping SRTT feasible and efficacious for measuring motor learning? METHODS In this prospective study, 20 participants stood on an instrumented mat and were presented with stimuli on a computer screen. They stepped to the corresponding positions on the mat as quickly as possible. Presented stimuli included random sequences and a blinded imbedded repeating sequence. Three days after completing the randomly assigned practice dose [high dose group (n = 10) performed 4320 steps; low dose group (n = 10) performed 144 steps], a retention test of 72 steps was performed. Feasibility was measured as the proportion of participants who completed the assigned practice dose without adverse events. Efficacy was measured as within-group performance improvement on the random sequences and on the repeating sequence (paired t-tests), as well as a dose-response relationship to learning both types of sequences (independent t-tests). RESULTS All participants (mean age 26.8 years) completed all practice sessions without adverse events, indicating feasibility. High dose practice resulted in performance improvement while low dose did not; a dose-response relationship was found, with high dose practice resulting in greater learning of the task than low dose practice, indicating efficacy. SIGNIFICANCE This stepping SRTT is a feasible and efficacious way to measure motor learning, which could provide critical insights into anticipatory stepping, postural control, and fall risk. Future research is needed to determine feasibility, efficacy, and optimal practice dosages for older and impaired populations.
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Affiliation(s)
- Geneviève N Olivier
- Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA.
| | - Serene S Paul
- Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Christopher S Walter
- Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Heather A Hayes
- Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - K Bo Foreman
- Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Kevin Duff
- Neurology, University of Utah, Salt Lake City, UT, USA
| | - Sydney Y Schaefer
- Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Leland E Dibble
- Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
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Lingo VanGilder J, Lohse KR, Duff K, Wang P, Schaefer SY. Evidence for associations between Rey-Osterrieth Complex Figure test and motor skill learning in older adults. Acta Psychol (Amst) 2021; 214:103261. [PMID: 33524606 DOI: 10.1016/j.actpsy.2021.103261] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 12/21/2020] [Accepted: 01/16/2021] [Indexed: 01/10/2023] Open
Abstract
Age-related declines in motor learning may be related to poor visuospatial function. Thus, visuospatial testing could evaluate older adults' potential for motor learning, which has implications for geriatric motor rehabilitation. To this end, the purpose of this study was to identify which visuospatial test is most predictive of motor learning within older adults. Forty-five nondemented older adults completed six standardized visuospatial tests, followed by three weekly practice sessions on a functional upper-extremity motor task. Participants were re-tested 1 month later on the trained task and another untrained upper-extremity motor task to evaluate the durability and generalizability of motor learning, respectively. Principal component analysis first reduced the dimensions of the visuospatial battery to two principal components for inclusion in a mixed-effects model that assessed one-month follow-up performance as a function of baseline performance and the principal components. Of the two components, only one was related to one-month follow-up. Factor loadings and post hoc analyses suggested that of the six visuospatial tests, the Rey-Osterrieth test (visual construction and memory) was related to one-month follow-up of the trained and untrained tasks. Thus, it may be plausible that older adults' long-term motor learning capacity could be evaluated using the Rey-Osterrieth test, which would be feasible to administer prior to motor rehabilitation to indicate risk of non-responsiveness to therapy.
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Additional Effects of Xbox Kinect Training on Upper Limb Function in Chronic Stroke Patients: A Randomized Control Trial. Healthcare (Basel) 2021; 9:healthcare9030242. [PMID: 33668355 PMCID: PMC7996301 DOI: 10.3390/healthcare9030242] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 01/01/2023] Open
Abstract
Background: Xbox Kinect-based virtual reality, being a novel approach, has therapeutic benefits in rehabilitation and its use is encouraged in stroke rehabilitation of upper extremities. Objective: Primary aim of the current study is to investigate the additional effects of Xbox Kinect training in combination with routine physiotherapy exercises based on each component of Fugl-Meyer Assessment Scale for Upper Extremity (FMA-UE). Moreover, effect of upper limb rehabilitation on cognitive functions was also assessed. Methods: This study was a parallel arm randomized control trial. Fifty-six participants were recruited and randomly allocated to either an Xbox Kinect training group (XKGT) or exercise training group (ETG). Measures of concern were recorded using FMA-UE, Box and Block Test (BBT), and Montreal Cognitive Assessment (MOCA). Evaluation was conducted at baseline and after completion of intervention at the sixth week. Results: There were significant differences from pre- to post-intervention scores of FMA-UE and BBT (p < 0.001) in both groups, whereas no difference was observed for MOCA (XKTG p value 0.417, ETG p value 0.113). At six-week follow-up there were significant differences between both groups in FMA-UE total score (p < 0.001), volitional movement within synergies (p < 0.001), wrist (p = 0.021), hand (p = 0.047), grasp (p = 0.006) and coordination/speed (p = 0.004), favoring the Xbox Kinect training group. Conclusion: To conclude, results indicate repetitive use of the hemiparetic upper extremity by Xbox Kinect-based upper limb rehabilitation training in addition to conventional therapy has a promising potential to enhance upper limb motor function for stroke patients.
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Clinical Practice Guideline to Improve Locomotor Function Following Chronic Stroke, Incomplete Spinal Cord Injury, and Brain Injury. J Neurol Phys Ther 2021; 44:49-100. [PMID: 31834165 DOI: 10.1097/npt.0000000000000303] [Citation(s) in RCA: 146] [Impact Index Per Article: 48.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Individuals with acute-onset central nervous system (CNS) injury, including stroke, motor incomplete spinal cord injury, or traumatic brain injury, often experience lasting locomotor deficits, as quantified by decreases in gait speed and distance walked over a specific duration (timed distance). The goal of the present clinical practice guideline was to delineate the relative efficacy of various interventions to improve walking speed and timed distance in ambulatory individuals greater than 6 months following these specific diagnoses. METHODS A systematic review of the literature published between 1995 and 2016 was performed in 4 databases for randomized controlled clinical trials focused on these specific patient populations, at least 6 months postinjury and with specific outcomes of walking speed and timed distance. For all studies, specific parameters of training interventions including frequency, intensity, time, and type were detailed as possible. Recommendations were determined on the basis of the strength of the evidence and the potential harm, risks, or costs of providing a specific training paradigm, particularly when another intervention may be available and can provide greater benefit. RESULTS Strong evidence indicates that clinicians should offer walking training at moderate to high intensities or virtual reality-based training to ambulatory individuals greater than 6 months following acute-onset CNS injury to improve walking speed or distance. In contrast, weak evidence suggests that strength training, circuit (ie, combined) training or cycling training at moderate to high intensities, and virtual reality-based balance training may improve walking speed and distance in these patient groups. Finally, strong evidence suggests that body weight-supported treadmill training, robotic-assisted training, or sitting/standing balance training without virtual reality should not be performed to improve walking speed or distance in ambulatory individuals greater than 6 months following acute-onset CNS injury to improve walking speed or distance. DISCUSSION The collective findings suggest that large amounts of task-specific (ie, locomotor) practice may be critical for improvements in walking function, although only at higher cardiovascular intensities or with augmented feedback to increase patient's engagement. Lower-intensity walking interventions or impairment-based training strategies demonstrated equivocal or limited efficacy. LIMITATIONS As walking speed and distance were primary outcomes, the research participants included in the studies walked without substantial physical assistance. This guideline may not apply to patients with limited ambulatory function, where provision of walking training may require substantial physical assistance. SUMMARY The guideline suggests that task-specific walking training should be performed to improve walking speed and distance in those with acute-onset CNS injury although only at higher intensities or with augmented feedback. Future studies should clarify the potential utility of specific training parameters that lead to improved walking speed and distance in these populations in both chronic and subacute stages following injury. DISCLAIMER These recommendations are intended as a guide for clinicians to optimize rehabilitation outcomes for persons with chronic stroke, incomplete spinal cord injury, and traumatic brain injury to improve walking speed and distance.
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Fahey M, Brazg G, Henderson CE, Plawecki A, Lucas E, Reisman DS, Schmit BD, Hornby TG. The Value of High Intensity Locomotor Training Applied to Patients With Acute-Onset Neurologic Injury. Arch Phys Med Rehabil 2020; 103:S178-S188. [PMID: 33383032 DOI: 10.1016/j.apmr.2020.09.399] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/31/2020] [Accepted: 09/17/2020] [Indexed: 11/02/2022]
Abstract
Long-standing research in animal models and humans with stroke or incomplete spinal cord injury (iSCI) indicate that specific physical training variables, such as the specificity and amount of practice, may influence neurologic recovery and locomotor function. More recent data highlight the contributions of exercise intensity, as estimated indirectly by cardiovascular exertion, as potentially more important than previously considered. The effects of exercise intensity are well described in neurologically intact individuals, although confusion regarding the definitions of intensity and safety concerns have limited its implementation during physical rehabilitation of patients with neurologic injury. The purpose of this review is to delineate some of the evidence regarding the effects of exercise intensity during locomotor training in patients with stroke and iSCI. We provide specific definitions of exercise intensity used within the literature, describe methods used to ensure appropriate levels of exertion, and discuss potential adverse events and safety concerns during its application. Further details on the effects of locomotor training intensity on clinical outcomes, and on neuromuscular and cardiovascular function will be addressed as available. Existing literature across multiple studies and meta-analyses reveals that exercise training intensity is likely a major factor that can influence locomotor function after neurologic injury. To extend these findings, we describe previous attempts to implement moderate to high intensity interventions during physical rehabilitation of patients with neurologic injury, including the utility of specific strategies to facilitate implementation, and to navigate potential barriers that may arise during implementation efforts.
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Affiliation(s)
- Meghan Fahey
- Rehabilitation Institute of Chicago, Chicago, IL
| | | | - Christopher E Henderson
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN; Rehabilitation Hospital of Indiana, Indianapolis, IN
| | | | - Emily Lucas
- Rehabilitation Hospital of Indiana, Indianapolis, IN
| | - Darcy S Reisman
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Brian D Schmit
- Department of Biomedical Engineering, Marquette University, Milwaukee, WI
| | - T George Hornby
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN; Rehabilitation Hospital of Indiana, Indianapolis, IN.
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Park S, Fraser M, Weber LM, Meeker C, Bishop L, Geller D, Stein J, Ciocarlie M. User-Driven Functional Movement Training With a Wearable Hand Robot After Stroke. IEEE Trans Neural Syst Rehabil Eng 2020; 28:2265-2275. [PMID: 32886611 DOI: 10.1109/tnsre.2020.3021691] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We studied the performance of a robotic orthosis designed to assist the paretic hand after stroke. It is wearable and fully user-controlled, serving two possible roles: as a therapeutic tool that facilitates device-mediated hand exercises to recover neuromuscular function or as an assistive device for use in everyday activities to aid functional use of the hand. We present the clinical outcomes of a pilot study designed as a feasibility test for these hypotheses. 11 chronic stroke (>2 years) patients with moderate muscle tone (Modified Ashworth Scale ≤ 2 in upper extremity) engaged in a month-long training protocol using the orthosis. Individuals were evaluated using standardized outcome measures, both with and without orthosis assistance. Fugl-Meyer post intervention scores without robotic assistance showed improvement focused specifically at the distal joints of the upper limb, suggesting the use of the orthosis as a rehabilitative device for the hand. Action Research Arm Test scores post intervention with robotic assistance showed that the device may serve an assistive role in grasping tasks. These results highlight the potential for wearable and user-driven robotic hand orthoses to extend the use and training of the affected upper limb after stroke.
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Flynn N, Froude E, Cooke D, Kuys S. Repetitions, duration and intensity of upper limb practice following the implementation of robot assisted therapy with sub-acute stroke survivors: an observational study. Disabil Rehabil Assist Technol 2020; 17:675-680. [PMID: 32809895 DOI: 10.1080/17483107.2020.1807621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Robot assisted upper limb (UL) therapy has been identified as an intervention with the potential to help improve the amount of practice performed by stroke survivors. OBJECTIVES This study aimed to measure the amount of UL practice (i.e., repetitions, duration, intensity) performed by subacute stroke survivors, in particular those with severe UL impairment, pre and post implementation of robot assisted upper limb therapy (RT-UL) into an inpatient rehabilitation setting. METHODS Two observational study phases (pre-RT-UL and post-RT-UL) were undertaken of occupational therapy and physiotherapy sessions performed by subacute stroke survivors. Upper limb tasks observed and recorded in therapy were classified as either impairment-related therapy or activity-related. RESULTS In the pre-RT-UL observational phase, 7 subacute stroke survivors were observed across 11 days involving 25 therapy sessions. Post-RT-UL, 12 subacute stroke survivors were observed across 12 days involving 29 therapy sessions. There were no significant differences in characteristics of patients observed in each phase (p > .05). The mean difference (95% CI) between pre and post RT-UL for repetitions (reps) (569 (1 to 1136) and intensity (7 (4-11)) reps/min of practice increased for all patients, including those with severe UL impairment (337 (37-638)) reps and 8 (2-14) reps/minute, with the duration of therapy unchanged. CONCLUSIONS This is the first study to have observed an increase in UL practice with the inclusion of RT-UL as part of routine clinical practice. This increase in practice is considered to be due to RT-UL providing highly supportive and expeditious semi-supervised practice. Notably, RT-UL was able to be implemented within the existing organisational structures with only basic training of therapy staff.IMPLICATIONS FOR REHABILITATIONRobotics presents as a viable intervention to increase the amount and intensity of upper limb practice performed by stroke survivors in routine clinical practiceRobotics were able to be implemented within the existing organisational structures with only basic training of therapy staff.
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Affiliation(s)
- Nicholas Flynn
- School of Allied Health, Australian Catholic University, Banyo, Australia
| | - Elspeth Froude
- School of Allied Health, Australian Catholic University, Banyo, Australia
| | - Deirdre Cooke
- School of Allied Health, Australian Catholic University, Banyo, Australia
| | - Suzanne Kuys
- School of Allied Health, Australian Catholic University, Banyo, Australia
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Kim H, Park G, Shin JH, You JH. Neuroplastic effects of end-effector robotic gait training for hemiparetic stroke: a randomised controlled trial. Sci Rep 2020; 10:12461. [PMID: 32719420 PMCID: PMC7385173 DOI: 10.1038/s41598-020-69367-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/10/2020] [Indexed: 11/09/2022] Open
Abstract
Detecting neuroplastic changes during locomotor neurorehabilitation is crucial for independent primal motor behaviours. However, long-term locomotor training-related neuroplasticity remains unexplored. We compared the effects of end-effector robot-assisted gait training (E-RAGT) and bodyweight-supported treadmill training (BWST) on cortical activation in individuals with hemiparetic stroke. Twenty-three men and five women aged 53.2 ± 11.2 years were recruited and randomly assigned to participate in E-RAGT (n = 14) or BWST (n = 14) for 30 min/day, 5 days/week, for 4 weeks. Cortical activity, lower limb motor function, and gait speed were evaluated before and after training. Activation of the primary sensorimotor cortex, supplementary motor area, and premotor cortex in the affected hemisphere significantly increased only in the E-RAGT group, although there were no significant between-group differences. Clinical outcomes, including the Fugl-Meyer assessment (FMA), timed up and go test, and 10-m walk test scores, improved after training in both groups, with significantly better FMA scores in the E-RAGT group than in the BWST group. These findings suggest that E-RAGT effectively improves neuroplastic outcomes in hemiparetic stroke, although its superiority over conventional training remains unclear. This may have clinical implications and provides insight for clinicians interested in locomotor neurorehabilitation after hemiparetic stroke.Trial Registration: ClinicalTrials.gov Identifier NCT04054739 (12/08/2019).
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Affiliation(s)
- Hayeon Kim
- Translational Research Center for Rehabilitation Robots, National Rehabilitation Center, Seoul, Republic of Korea
| | - Gyulee Park
- Translational Research Center for Rehabilitation Robots, National Rehabilitation Center, Seoul, Republic of Korea
| | - Joon-Ho Shin
- Translational Research Center for Rehabilitation Robots, National Rehabilitation Center, Seoul, Republic of Korea. .,Department of Rehabilitation Medicine, National Rehabilitation Center, 58, Samgaksan-ro, Gangbuk-gu, Seoul, 01022, Republic of Korea.
| | - Joshua H You
- Department of Physical Therapy, Dynamic Movement Institute and Technology, College of Health Science, Sports Movement Artificial-Intelligence Robotics Technology (SMART) Institute, "Yonsei GOODWELLNESS Center" for Sports, Wellness, and Fitness Across Life Span Disabilities, Yonsei University, 1 Yonseidae-gil, Wonju, Gangwon-do, 26493, Republic of Korea.
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Wuennemann MJ, Mackenzie SW, Lane HP, Peltz AR, Ma X, Gerber LM, Edwards DJ, Kitago T. Dose and staffing comparison study of upper limb device-assisted therapy. NeuroRehabilitation 2020; 46:287-297. [DOI: 10.3233/nre-192993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Marissa J. Wuennemann
- Human Motor Recovery Laboratory, Burke Neurological Institute, White Plains, NY, USA
| | - Stuart W. Mackenzie
- Human Motor Recovery Laboratory, Burke Neurological Institute, White Plains, NY, USA
| | - Heather Pepper Lane
- Human Motor Recovery Laboratory, Burke Neurological Institute, White Plains, NY, USA
| | - Avrielle R. Peltz
- Human Motor Recovery Laboratory, Burke Neurological Institute, White Plains, NY, USA
| | - Xiaoyue Ma
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, USA
| | - Linda M. Gerber
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, USA
| | - Dylan J. Edwards
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
- Edith Cown University, Joondalup, Australia
| | - Tomoko Kitago
- Human Motor Recovery Laboratory, Burke Neurological Institute, White Plains, NY, USA
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
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Baniña MC, Molad R, Solomon JM, Berman S, Soroker N, Frenkel-Toledo S, Liebermann DG, Levin MF. Exercise intensity of the upper limb can be enhanced using a virtual rehabilitation system. Disabil Rehabil Assist Technol 2020; 17:100-106. [DOI: 10.1080/17483107.2020.1765421] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Melanie C. Baniña
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Laval, Canada
| | - Roni Molad
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Laval, Canada
| | - John M. Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
- Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, India
| | - Sigal Berman
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Zlotowski Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Nachum Soroker
- Department of Neurological Rehabilitation, Loewenstein Hospital, Ra’anana, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Silvi Frenkel-Toledo
- Department of Physiotherapy, Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Dario G. Liebermann
- Department of Physical Therapy, The Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Mindy F. Levin
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Laval, Canada
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Proulx CE, Beaulac M, David M, Deguire C, Haché C, Klug F, Kupnik M, Higgins J, Gagnon DH. Review of the effects of soft robotic gloves for activity-based rehabilitation in individuals with reduced hand function and manual dexterity following a neurological event. J Rehabil Assist Technol Eng 2020; 7:2055668320918130. [PMID: 32435506 PMCID: PMC7223210 DOI: 10.1177/2055668320918130] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/17/2020] [Indexed: 12/20/2022] Open
Abstract
Despite limited scientific evidence, there is an increasing interest in soft robotic gloves to optimize hand- and finger-related functional abilities following a neurological event. This review maps evidence on the effects and effectiveness of soft robotic gloves for hand rehabilitation and, whenever possible, patients' satisfaction. A systematized search of the literature was conducted using keywords structured around three areas: technology attributes, anatomy, and rehabilitation. A total of 272 titles, abstracts, and keywords were initially retrieved, and data were extracted out of 13 articles. Six articles investigated the effects of wearing a soft robotic glove and eight studied the effect or effectiveness of an intervention with it. Some statistically significant and meaningful beneficial effects were confirmed with the 29 outcome measures used. Finally, 11 articles also confirmed users' satisfaction with regard to the soft robotic glove, while some articles also noticed an increased engagement in the rehabilitation program with this technology. Despite the heterogeneity across studies, soft robotic gloves stand out as a safe and promising technology to improve hand- and finger-related dexterity and functional performance. However, strengthened evidence of the effects or effectiveness of such devices is needed before their transition from laboratory to clinical practice.
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Affiliation(s)
- Camille E Proulx
- School of Rehabilitation, Université de Montréal, Montréal, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Myrka Beaulac
- School of Rehabilitation, Université de Montréal, Montréal, Canada
| | - Mélissa David
- School of Rehabilitation, Université de Montréal, Montréal, Canada
| | - Catryne Deguire
- School of Rehabilitation, Université de Montréal, Montréal, Canada
| | - Catherine Haché
- School of Rehabilitation, Université de Montréal, Montréal, Canada
| | - Florian Klug
- Technischen Universität Darmstadt, Darmstaadt, Germany
| | - Mario Kupnik
- Technischen Universität Darmstadt, Darmstaadt, Germany
| | - Johanne Higgins
- School of Rehabilitation, Université de Montréal, Montréal, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Dany H Gagnon
- School of Rehabilitation, Université de Montréal, Montréal, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
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48
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Levin MF. What is the potential of virtual reality for post-stroke sensorimotor rehabilitation? Expert Rev Neurother 2020; 20:195-197. [DOI: 10.1080/14737175.2020.1727741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Mindy F. Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, Quebec, Canada
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Lao B, Tamei T, Ikeda K. Data-Efficient Framework for Personalized Physiotherapy Feedback. FRONTIERS IN COMPUTER SCIENCE 2020. [DOI: 10.3389/fcomp.2020.00003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pundik S, McCabe J, Kesner S, Skelly M, Fatone S. Use of a myoelectric upper limb orthosis for rehabilitation of the upper limb in traumatic brain injury: A case report. J Rehabil Assist Technol Eng 2020; 7:2055668320921067. [PMID: 32612847 PMCID: PMC7307403 DOI: 10.1177/2055668320921067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 03/20/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Upper limb motor deficits following traumatic brain injury are prevalent and effective therapies are needed. The purpose of this case report was to illustrate response to a novel therapy using a myoelectric orthosis in a person with TBI.Case description: A 42-year-old female, 29.5 years post-traumatic brain injury with diminished motor control/coordination, and learned nonuse of the right arm. She also had cognitive deficits and did not spontaneously use her right arm functionally. INTERVENTION Study included three phases: baseline data collection/device fabrication (five weeks); in-clinic training (2×/week for nine weeks); and home-use phase (nine weeks). The orthosis was incorporated into motor learning-based therapy.Outcomes: During in-clinic training, active range of motion, tone, muscle power, Fugl-Meyer, box and blocks test, and Chedoke assessment score improved. During the home-use phase, decrease in tone was maintained and all other outcomes declined but were still better upon study completion than baseline. The participant trained with the orthosis 70.12 h, logging over 13,000 repetitions of elbow flexion/extension and hand open/close. DISCUSSION Despite long-standing traumatic brain injury, meaningful improvements in motor function were observed and were likely the results of high repetition practice of functional movement delivered over a long duration. Further assessment in a larger cohort is warranted.
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Affiliation(s)
- Svetlana Pundik
- Brain Plasticity and NeuroRecovery Laboratory, Louis Stokes
Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH,
USA
- Department of Neurology, Case Western Reserve University School
of Medicine, Cleveland, OH, USA
| | - Jessica McCabe
- Brain Plasticity and NeuroRecovery Laboratory, Louis Stokes
Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH,
USA
| | - Samuel Kesner
- Director of Research and Development, Myomo Inc., Cambridge, MA,
USA
| | - Margaret Skelly
- Brain Plasticity and NeuroRecovery Laboratory, Louis Stokes
Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH,
USA
| | - Stefania Fatone
- Department of Physical Medicine and Rehabilitation, Northwestern
University Feinberg School of Medicine, Chicago, IL, USA
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