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The Effect of Task-Oriented Training on Upper-Limb Function, Visual Perception, and Activities of Daily Living in Acute Stroke Patients: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063186. [PMID: 35328874 PMCID: PMC8954660 DOI: 10.3390/ijerph19063186] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/06/2022] [Accepted: 03/06/2022] [Indexed: 11/17/2022]
Abstract
This pilot study aimed to investigate the effects of task-oriented training on upper-limb functioning, visual perception, and activities of daily living (ADL) in acute stroke patients. Of 20 participants, 10 were randomly assigned in a 1:1 ratio to experimental and control groups. Task-oriented training and table-top activity training were implemented for 6 weeks. Change in upper-limb functioning was assessed with the Manual Function Test (MFT); visual perceptual skill and ADL performance were evaluated using the Motor-Free Visual Perception Test—Vertical (MVPT-V) and Korean Modified Barthel Index (K-MBI), respectively. There was a significant interaction in the MFT and MBI score between the group and time (p < 0.05), but the group effect was not significant (p > 0.05). The MFT and MBI score significantly increased in both groups after the intervention (p < 0.001), but the effect size was greater in the task-oriented training group than the table-top activity training group. No significant interaction with MVPT-V score was found between the group and time (p > 0.05), and no statistical group difference was found either (p > 0.05). Both groups showed significant improvement in their MVPT-V score after the intervention (p < 0.001). The pilot study findings demonstrate that both task-oriented training and table-top activity training are effective in recovering upper-limb function, visual perception, and ADL in acute stroke patients.
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Saes M, Mohamed Refai MI, van Beijnum BJF, Bussmann JBJ, Jansma EP, Veltink PH, Buurke JH, van Wegen EEH, Meskers CGM, Krakauer JW, Kwakkel G. Quantifying Quality of Reaching Movements Longitudinally Post-Stroke: A Systematic Review. Neurorehabil Neural Repair 2022; 36:183-207. [PMID: 35100897 PMCID: PMC8902693 DOI: 10.1177/15459683211062890] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Disambiguation of behavioral restitution from compensation is important to better understand recovery of upper limb motor control post-stroke and subsequently design better interventions. Measuring quality of movement (QoM) during standardized performance assays and functional tasks using kinematic and kinetic metrics potentially allows for this disambiguation. Objectives To identify longitudinal studies that used kinematic and/or kinetic metrics to investigate post-stroke recovery of reaching and assess whether these studies distinguish behavioral restitution from compensation. Methods A systematic literature search was conducted using the databases PubMed, Embase, Scopus, and Wiley/Cochrane Library up to July 1st, 2020. Studies were identified if they performed longitudinal kinematic and/or kinetic measurements during reaching, starting within the first 6 months post-stroke. Results Thirty-two longitudinal studies were identified, which reported a total of forty-six different kinematic metrics. Although the majority investigated improvements in kinetics or kinematics to quantify recovery of QoM, none of these studies explicitly addressed the distinction between behavioral restitution and compensation. One study obtained kinematic metrics for both performance assays and a functional task. Conclusions Despite the growing number of kinematic and kinetic studies on post-stroke recovery, longitudinal studies that explicitly seek to delineate between behavioral restitution and compensation are still lacking in the literature. To rectify this situation, future studies should measure kinematics and/or kinetics during performance assays to isolate restitution and during a standardized functional task to determine the contributions of restitution and compensation.
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Affiliation(s)
- M Saes
- Department of Rehabilitation Medicine, 1209Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - M I Mohamed Refai
- Department of Biomedical Signals & Systems, Technical Medical Centre, 214825University of Twente, Enschede, Netherlands
| | - B J F van Beijnum
- Department of Biomedical Signals & Systems, Technical Medical Centre, 214825University of Twente, Enschede, Netherlands
| | - J B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - E P Jansma
- Medical Library, 1190Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUmcAmsterdam, The Netherlands
| | - P H Veltink
- Department of Biomedical Signals & Systems, Technical Medical Centre, 214825University of Twente, Enschede, Netherlands
| | - J H Buurke
- Department of Biomedical Signals & Systems, Technical Medical Centre, 214825University of Twente, Enschede, Netherlands.,Rehabilitation Technology, Roessingh Research and Development, Enschede, Netherlands.,Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, 12244Northwestern University, Chicago, Il, USA
| | - E E H van Wegen
- Department of Rehabilitation Medicine, 1209Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - C G M Meskers
- Department of Rehabilitation Medicine, 1209Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, Netherlands.,Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, 12244Northwestern University, Chicago, Il, USA
| | - J W Krakauer
- Departments of Neurology, Neuroscience and Physical Medicine and Rehabilitation, 1500Johns Hopkins University, Baltimore, MD, United States
| | - G Kwakkel
- Department of Rehabilitation Medicine, 1209Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, Netherlands.,Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, 12244Northwestern University, Chicago, Il, USA.,Department of Neurorehabilitation, 522567Amsterdam Rehabilitation Research Centre, Amsterdam, Netherlands
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Flexohand: A Hybrid Exoskeleton-Based Novel Hand Rehabilitation Device. MICROMACHINES 2021; 12:mi12111274. [PMID: 34832686 PMCID: PMC8621726 DOI: 10.3390/mi12111274] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/17/2021] [Accepted: 10/17/2021] [Indexed: 12/28/2022]
Abstract
Home-based hand rehabilitation has excellent potential as it may reduce patient dropouts due to travel, transportation, and insurance constraints. Being able to perform exercises precisely, accurately, and in a repetitive manner, robot-aided portable devices have gained much traction these days in hand rehabilitation. However, existing devices fall short in allowing some key natural movements, which are crucial to achieving full potential motion in performing activities of daily living. Firstly, existing exoskeleton type devices often restrict or suffer from uncontrolled wrist and forearm movement during finger exercises due to their setup of actuation and transmission mechanism. Secondly, they restrict passive metacarpophalangeal (MCP) abduction-adduction during MCP flexion-extension motion. Lastly, though a few of them can provide isolated finger ROM, none of them can offer isolated joint motion as per therapeutic need. All these natural movements are crucial for effective robot-aided finger rehabilitation. To bridge these gaps, in this research, a novel lightweight robotic device, namely "Flexohand", has been developed for hand rehabilitation. A novel compliant mechanism has been developed and included in Flexohand to compensate for the passive movement of MCP abduction-adduction. The isolated and composite digit joint flexion-extension has been achieved by integrating a combination of sliding locks for IP joints and a wire locking system for finger MCP joints. Besides, the intuitive design of Flexohand inherently allows wrist joint movement during hand digit exercises. Experiments of passive exercises involving isolated joint motion, composite joint motions of individual fingers, and isolated joint motion of multiple fingers have been conducted to validate the functionality of the developed device. The experimental results show that Flexohand addresses the limitations of existing robot-aided hand rehabilitation devices.
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Effect of Robot-Assisted Therapy on Participation of People with Limited Upper Limb Functioning: A Systematic Review with GRADE Recommendations. Occup Ther Int 2021; 2021:6649549. [PMID: 34393681 PMCID: PMC8349462 DOI: 10.1155/2021/6649549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 07/18/2021] [Indexed: 12/29/2022] Open
Abstract
Background Previous studies have suggested that robot-assisted therapy (RT) is effective in treating impairment and that it may also improve individuals' participation. Objective To investigate the effect of RT on the participation of individuals with limited upper limb functioning (PROSPERO: CRD42019133880). Data Sources: PEDro, Embase, MEDLINE, CINAHL, Cochrane, AMED, and Compendex. Inclusion Criteria. We selected randomized or quasirandomized controlled studies comparing the effects of RT with minimal or other interventions on participation of individuals with limited upper limb functioning. Data Extraction and Synthesis. Methodological quality of the included studies was assessed using the 0-10 PEDro scale, and effect estimates were reported using standardized mean differences (SMDs) with 95% confidence intervals (CIs), and the certainty of the current evidence was assessed using the GRADE. Results Twelve randomized controlled studies involving 845 participants were included. The estimates of medium effects between RT and minimal intervention (MI) at a short-term follow-up were pooled, but there are no short-term effects between RT and OI. Standardized differences in means were as follows: 0.6 (95% CI 0.1 to 1.2) and 0.2 (95% CI -0.0 to 0.4). There were also no effects of additional RT in the short- or medium-term follow-up periods. Standardized differences in means were as follows: -0.6 (95% CI -1.1 to -0.1) and 0.2 (95% CI -0.3 to 0.8). The methodological quality of the included studies potentially compromised the effect estimates of RT. The existing evidence was very low-quality with many confounding variables between studies. Conclusions For patients with upper limb neurological dysfunction, low-quality evidence supports RT over MI in terms of improving individual participation in the short term. The existing low- to very low-quality evidence does not support RT over OI in either the short- or medium-term follow-up periods with respect to community participation.
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Kuczynski AM, Kirton A, Semrau JA, Dukelow SP. Relative independence of upper limb position sense and reaching in children with hemiparetic perinatal stroke. J Neuroeng Rehabil 2021; 18:80. [PMID: 33980254 PMCID: PMC8117512 DOI: 10.1186/s12984-021-00869-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 04/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies using clinical measures have suggested that proprioceptive dysfunction is related to motor impairment of the upper extremity following adult stroke. We used robotic technology and clinical measures to assess the relationship between position sense and reaching with the hemiparetic upper limb in children with perinatal stroke. METHODS Prospective term-born children with magnetic resonance imaging-confirmed perinatal ischemic stroke and upper extremity deficits were recruited from a population-based cohort. Neurotypical controls were recruited from the community. Participants completed two tasks in the Kinarm robot: arm position-matching (three parameters: variability [Varxy], contraction/expansion [Areaxy], systematic spatial shift [Shiftxy]) and visually guided reaching (five parameters: posture speed [PS], reaction time [RT], initial direction error [IDE], speed maxima count [SMC], movement time [MT]). Additional clinical assessments of sensory (thumb localization test) and motor impairment (Assisting Hand Assessment, Chedoke-McMaster Stroke Assessment) were completed and compared to robotic measures. RESULTS Forty-eight children with stroke (26 arterial, 22 venous, mean age: 12.0 ± 4.0 years) and 145 controls (mean age: 12.8 ± 3.9 years) completed both tasks. Position-matching performance in children with stroke did not correlate with performance on the visually guided reaching task. Robotic sensory and motor measures correlated with only some clinical tests. For example, AHA scores correlated with reaction time (R = - 0.61, p < 0.001), initial direction error (R = - 0.64, p < 0.001), and movement time (R = - 0.62, p < 0.001). CONCLUSIONS Robotic technology can quantify complex, discrete aspects of upper limb sensory and motor function in hemiparetic children. Robot-measured deficits in position sense and reaching with the contralesional limb appear to be relatively independent of each other and correlations for both with clinical measures are modest. Knowledge of the relationship between sensory and motor impairment may inform future rehabilitation strategies and improve outcomes for children with hemiparetic cerebral palsy.
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Affiliation(s)
- Andrea M Kuczynski
- University of Calgary, 1403 29th St. NW, Foothills Medical Centre, Calgary, AB, T2N 0P8, Canada. .,Section of Neurology, Department of Pediatrics, Alberta Children's Hospital Research Institute, Calgary, AB, Canada.
| | - Adam Kirton
- University of Calgary, 1403 29th St. NW, Foothills Medical Centre, Calgary, AB, T2N 0P8, Canada.,Section of Neurology, Department of Pediatrics, Alberta Children's Hospital Research Institute, Calgary, AB, Canada.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Jennifer A Semrau
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Calgary, AB, Canada.,Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Sean P Dukelow
- University of Calgary, 1403 29th St. NW, Foothills Medical Centre, Calgary, AB, T2N 0P8, Canada.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, Calgary, AB, Canada
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Khalid S, Alnajjar F, Gochoo M, Renawi A, Shimoda S. Robotic assistive and rehabilitation devices leading to motor recovery in upper limb: a systematic review. Disabil Rehabil Assist Technol 2021:1-15. [PMID: 33861684 DOI: 10.1080/17483107.2021.1906960] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Stroke, spinal cord injury and other neuromuscular disorders lead to impairments in the human body. Upper limb impairments, especially hand impairments affect activities of daily living (ADL) and reduce the quality of life. The purpose of this review is to compare and evaluate the available robotic rehabilitation and assistive devices that can lead to motor recovery or maintain the current motor functional level. METHODS A systematic review was conducted of the literature published in the years from 2016-2021, to focus on the most recent rehabilitation and assistive devices available in the market or research environments. RESULTS A total of 230 studies published between 2016 and 2021 were identified from various databases. 107 were excluded with various reasons. Twenty-eight studies were taken into detailed review, to determine the efficacy of robotic devices in improving upper limb impairments or maintaining the current level from getting worse. CONCLUSION It was concluded that with a good strategy and treatment plan; appropriate and regular use of these robotic rehabilitation and assistive devices do lead to improvements in current conditions of most of the subjects and prolonged use may lead to motor recovery.Implications for RehabilitationStroke, accidents, spinal cord injuries and other neuromuscular disorders lead to impairments. Upper limb impairments have a tremendous adverse affect on ADL and reduces quality of life drastically.Advancement in technology has led to the designing of many robotic assistive and rehabilitation devices to assist in motor recovery or aid in ADL.This review analyses different available devices for rehabilitation and assistance and points out that use of these devices in time does help in motor recovery. Most of the studies reviewed showed improvements for the user.Future devices should be more portable and easier to use from home.
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Affiliation(s)
- Sumayya Khalid
- College of Information Technology, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Fady Alnajjar
- College of Information Technology, United Arab Emirates University, Al Ain, United Arab Emirates.,Intelligent Behavior Control Unit, CBS-TOYOTA Collaboration Center, RIKEN, Nagoya, Japan
| | - Munkhjargal Gochoo
- College of Information Technology, United Arab Emirates University, Al Ain, United Arab Emirates.,School of Information and Communication Technology, Ulaanbaatar, Mongolia
| | | | - Shingo Shimoda
- Intelligent Behavior Control Unit, CBS-TOYOTA Collaboration Center, RIKEN, Nagoya, Japan
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Jiang S, You H, Zhao W, Zhang M. Effects of short-term upper limb robot-assisted therapy on the rehabilitation of sub-acute stroke patients. Technol Health Care 2020; 29:295-303. [PMID: 33285652 DOI: 10.3233/thc-202127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Robot-assisted therapy (RT) has become a promising stroke rehabilitation intervention. OBJECTIVE To examine the effects of short-term upper limb RT on the rehabilitation of sub-acute stroke patients. METHODS Subjects were randomly assigned to the RT group (n= 23) or conventional rehabilitation (CR) group (n= 22). All subjects received conventional rehabilitation therapy for 30 minutes twice a day, for 2 weeks. In addition, the RT group received RT for 30 minutes twice a day, for 2 weeks. The outcomes before treatment (T0) and at 2 weeks (T1) and 1 month follow-up (T2) were evaluated in the patients using the upper limb motor function test of the Fugl-Meyer assessment (FMA) the Motricity Index (MI), the Modified Ashworth Scale (MAS), the Functional Independence Measure (FIM), and the Barthel Index (BI). RESULTS There were significant improvements in motor function scales (P< 0.001 for FMA and MI) and activities of daily living (P< 0.001 for FIM and BI) but without muscle tone (MAS, P> 0.05) in the RT and CR groups. Compared to the CR group, the RT group showed improvements in motor function and activities of daily living (P< 0.05 for FMA, MI, FIM, BI) at T1 and T2. There was no significant difference between the two groups in muscle tone (MAS, P> 0.05). CONCLUSIONS RT may be a useful tool for sub-acute stroke patients' rehabilitation.
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Yang J, Zhao Z, Du C, Wang W, Peng Q, Qiu J, Wang G. The realization of robotic neurorehabilitation in clinical: use of computational intelligence and future prospects analysis. Expert Rev Med Devices 2020; 17:1311-1322. [PMID: 33252284 DOI: 10.1080/17434440.2020.1852930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Although there is a need for rehabilitation treatment with the increase in the aging population, the shortage of skilled physicians frustrates this necessity. Robotic technology has been advocated as one of the most viable methods with the potential to replace humans in providing physical rehabilitation of patients with neurological impairment. However, because the pioneering robot devices suffer several reservations such as safety and comfort concerns in clinical practice, there is an urgent need to provide upgraded replacements. The rapid development of intelligent computing has attracted the attention of researchers concerning the utilization of computational intelligence algorithms for robots in rehabilitation. Areas covered: This article reviews the state of the art and advances of robotic neurorehabilitation with computational intelligence. We classified advances into two categories: mechanical structures and control methods. Prospective outlooks of rehabilitation robots also have been discussed. Expert opinion: The aggravation of global aging has promoted the application of robotic technology in neurorehabilitation. However, this approach is not mature enough to guarantee the safety of patients. Our critical review summarizes multiple computation algorithms which have been proved to be valuable for better robotic use in clinical settings and guide the possible future advances in this industry.
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Affiliation(s)
- Jiali Yang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State Key Laboratory of Mechanical Transmission, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University , Chongqing, China
| | - Zhiqi Zhao
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State Key Laboratory of Mechanical Transmission, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University , Chongqing, China
| | - Chenzhen Du
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State Key Laboratory of Mechanical Transmission, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University , Chongqing, China
| | - Wei Wang
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital , Chongqing, China
| | - Qin Peng
- Institute of Systems and Physical Biology, Shenzhen Bay Laboratory , Shenzhen, China
| | - Juhui Qiu
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State Key Laboratory of Mechanical Transmission, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University , Chongqing, China
| | - Guixue Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State Key Laboratory of Mechanical Transmission, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University , Chongqing, China
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A 4-DOF Workspace Lower Limb Rehabilitation Robot: Mechanism Design, Human Joint Analysis and Trajectory Planning. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10134542] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Most of currently rehabilitation robots cannot achieve the adduction/abduction (A/A) training of the hip joint and lack the consideration of the patient handling. This paper presents a four degrees of freedom (DOF) spatial workspace lower limb rehabilitation robot, and it could provide flexion/extension (F/E) training to three lower limb joints and A/A training to the hip joint. The training method is conducting the patient’s foot to complete the rehabilitation movement, and the patient could directly take training on the wheelchair and avoid frequent patient handling between the wheelchair and the rehabilitation device. Because patients own different joint range of motions (ROM), an analysis method for obtaining human joint motions is proposed to guarantee the patient’s joint safety in this training method. The analysis method is based on a five-bar linkage kinematic model, which includes the human lower limb. The human-robot hybrid kinematic model is analyzed according to the Denavit-Hartenberg (D-H) method, and a variable human-robot workspace based on the user is proposed. Two kinds of trajectory planning methods are introduced. The trajectory planning method and the human joint analysis method are validated through the trajectory tracking experiment of the prototype.
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Cai S, Chen Y, Huang S, Wu Y, Zheng H, Li X, Xie L. SVM-Based Classification of sEMG Signals for Upper-Limb Self-Rehabilitation Training. Front Neurorobot 2019; 13:31. [PMID: 31214010 PMCID: PMC6558101 DOI: 10.3389/fnbot.2019.00031] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/09/2019] [Indexed: 11/28/2022] Open
Abstract
Robot-assisted rehabilitation is a growing field that can provide an intensity, quality, and quantity of treatment that exceed therapist-mediated rehabilitation. Several control algorithms have been implemented in rehabilitation robots to develop a patient-cooperative strategy with the capacity to understand the intention of the user and provide suitable rehabilitation training. In this paper, we present an upper-limb motion pattern recognition method using surface electromyography (sEMG) signals with a support vector machine (SVM) to control a rehabilitation robot, ReRobot, which was built to conduct upper-limb rehabilitation training for post-stroke patients. For poststroke rehabilitation training using the ReRobot, the upper-limb motion of the patient's healthy side is first recognized by detecting and processing the sEMG signals; then, the ReRobot assists the impaired arm in conducting mirror rehabilitation therapy. To train and test the SVM model, five healthy subjects participated in the experiments and performed five standard upper-limb motions, including shoulder flexion, abduction, internal rotation, external rotation, and elbow joint flexion. Good accuracy was demonstrated in experimental results from the five healthy subjects. By recognizing the model motion of the healthy side, the rehabilitation robot can provide mirror therapy to the affected side. This method can be used as a control strategy of upper-limb rehabilitation robots for self-rehabilitation training with stroke patients.
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Affiliation(s)
- Siqi Cai
- Shien-Ming Wu School of Intelligent Engineering, South China University of Technology, Guangzhou, China
| | - Yan Chen
- Shien-Ming Wu School of Intelligent Engineering, South China University of Technology, Guangzhou, China
| | - Shuangyuan Huang
- Shien-Ming Wu School of Intelligent Engineering, South China University of Technology, Guangzhou, China
| | - Yan Wu
- ASTAR Institute for Infocomm Research, Singapore, Singapore
| | - Haiqing Zheng
- The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xin Li
- The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Longhan Xie
- Shien-Ming Wu School of Intelligent Engineering, South China University of Technology, Guangzhou, China
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Franceschini M, Mazzoleni S, Goffredo M, Pournajaf S, Galafate D, Criscuolo S, Agosti M, Posteraro F. Upper limb robot-assisted rehabilitation versus physical therapy on subacute stroke patients: A follow-up study. J Bodyw Mov Ther 2019; 24:194-198. [PMID: 31987544 DOI: 10.1016/j.jbmt.2019.03.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 03/29/2019] [Indexed: 01/01/2023]
Abstract
This study aims to analyse the long-term effects (6 months follow-up) of upper limb Robot-assisted Therapy (RT) compared to Traditional physical Therapy (TT), in subacute stroke patients. Although the literature on upper-limb rehabilitation with robots shows increasing evidence of its effectiveness in stroke survivors, the length of time for which the re-learned motor abilities could be maintained is still understudied. A randomized controlled follow-up study was conducted on 48 subacute stroke patients who performed the upper-limb therapy using a planar end-effector robotic system (Experimental Group-EG) or TT (Control Group-CG). The clinical assessments were collected at T0 (baseline), T1 (end of treatment) and T2 (6 months follow-up): Upper Limb part of Fugl-Meyer assessment (FM-UL), total passive Range Of Motion (pROM), Modified Ashworth Scale Shoulder (MAS-S) and Elbow (MAS-E). At T1, the intra-group analysis showed significant gain of FM-UL in both EG and CG, while significant improvement in MAS-S, MAS-E, and pROM were found in the EG only. At T2, significant increase in MAS-S were revealed only in the CG. In FM-UL, pROM and MAS-E the improvements obtained at the end of treatment seem to be maintained at 6 months follow-up in both groups. The inter-groups analysis of FM-UL values at T1 and T2 demonstrated significant differences in favour of EG. In conclusion, upper limb Robot-assisted Therapy may lead a greater reduction of motor impairment in subacute stroke patients compared to Traditional Therapy. The gains observed at the end of treatment persisted over time. No serious adverse events related to the study occurred.
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Affiliation(s)
- Marco Franceschini
- Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Via della Pisana, 235, 00163, Rome, Italy; San Raffaele University, Rome, Italy.
| | - Stefano Mazzoleni
- The BioRobotics Institute, Scuola Superiore Sant'Anna, V.le R. Piaggio 34, 56025, Pisa, Italy; Rehabilitation Bioengineering Laboratory, Volterra, Italy.
| | - Michela Goffredo
- Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Via della Pisana, 235, 00163, Rome, Italy.
| | - Sanaz Pournajaf
- Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Via della Pisana, 235, 00163, Rome, Italy.
| | - Daniele Galafate
- Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Via della Pisana, 235, 00163, Rome, Italy.
| | - Simone Criscuolo
- Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Via della Pisana, 235, 00163, Rome, Italy.
| | - Maurizio Agosti
- Department of Geriatrics and Rehabilitation, University Hospital Parma, Via Gramsci 14, 43126, Parma, Italy.
| | - Federico Posteraro
- Rehabilitation Bioengineering Laboratory, Volterra, Italy; Rehabilitation Department - Versilia Hospital - AUSL Tuscany North West, Via Aurelia 335, Camaiore - Lucca, Italy.
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Mehrholz J, Pohl M, Platz T, Kugler J, Elsner B. Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke. Cochrane Database Syst Rev 2018; 9:CD006876. [PMID: 30175845 PMCID: PMC6513114 DOI: 10.1002/14651858.cd006876.pub5] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Electromechanical and robot-assisted arm training devices are used in rehabilitation, and may help to improve arm function after stroke. OBJECTIVES To assess the effectiveness of electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength in people after stroke. We also assessed the acceptability and safety of the therapy. SEARCH METHODS We searched the Cochrane Stroke Group's Trials Register (last searched January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2018, Issue 1), MEDLINE (1950 to January 2018), Embase (1980 to January 2018), CINAHL (1982 to January 2018), AMED (1985 to January 2018), SPORTDiscus (1949 to January 2018), PEDro (searched February 2018), Compendex (1972 to January 2018), and Inspec (1969 to January 2018). We also handsearched relevant conference proceedings, searched trials and research registers, checked reference lists, and contacted trialists, experts, and researchers in our field, as well as manufacturers of commercial devices. SELECTION CRITERIA Randomised controlled trials comparing electromechanical and robot-assisted arm training for recovery of arm function with other rehabilitation or placebo interventions, or no treatment, for people after stroke. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, assessed trial quality and risk of bias, used the GRADE approach to assess the quality of the body of evidence, and extracted data. We contacted trialists for additional information. We analysed the results as standardised mean differences (SMDs) for continuous variables and risk differences (RDs) for dichotomous variables. MAIN RESULTS We included 45 trials (involving 1619 participants) in this update of our review. Electromechanical and robot-assisted arm training improved activities of daily living scores (SMD 0.31, 95% confidence interval (CI) 0.09 to 0.52, P = 0.0005; I² = 59%; 24 studies, 957 participants, high-quality evidence), arm function (SMD 0.32, 95% CI 0.18 to 0.46, P < 0.0001, I² = 36%, 41 studies, 1452 participants, high-quality evidence), and arm muscle strength (SMD 0.46, 95% CI 0.16 to 0.77, P = 0.003, I² = 76%, 23 studies, 826 participants, high-quality evidence). Electromechanical and robot-assisted arm training did not increase the risk of participant dropout (RD 0.00, 95% CI -0.02 to 0.02, P = 0.93, I² = 0%, 45 studies, 1619 participants, high-quality evidence), and adverse events were rare. AUTHORS' CONCLUSIONS People who receive electromechanical and robot-assisted arm training after stroke might improve their activities of daily living, arm function, and arm muscle strength. However, the results must be interpreted with caution although the quality of the evidence was high, because there were variations between the trials in: the intensity, duration, and amount of training; type of treatment; participant characteristics; and measurements used.
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Affiliation(s)
- Jan Mehrholz
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolFetscherstr. 74DresdenGermany01307
| | - Marcus Pohl
- Helios Klinik Schloss PulsnitzNeurological RehabilitationWittgensteiner Str. 1PulsnitzSaxonyGermany01896
| | - Thomas Platz
- Ernst‐Moritz‐Arndt‐Universität GreifswaldNeurorehabilitation Centre and Spinal Cord Injury Unit, BDH‐Klinik GreifswaldKarl‐Liebknecht‐Ring 26aGreifswaldGermany17491
- Ernst‐Moritz‐Arndt‐UniversitätNeurowissenschaftenGreifswaldGermany
| | - Joachim Kugler
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolFetscherstr. 74DresdenGermany01307
| | - Bernhard Elsner
- Dresden Medical School, Technical University DresdenDepartment of Public HealthFetscherstr. 74DresdenSachsenGermany01307
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Tran VD, Dario P, Mazzoleni S. Kinematic measures for upper limb robot-assisted therapy following stroke and correlations with clinical outcome measures: A review. Med Eng Phys 2018; 53:13-31. [PMID: 29361407 DOI: 10.1016/j.medengphy.2017.12.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 11/10/2017] [Accepted: 12/24/2017] [Indexed: 10/18/2022]
Abstract
AIM OF THE STUDY This review classifies the kinematic measures used to evaluate post-stroke motor impairment following upper limb robot-assisted rehabilitation and investigates their correlations with clinical outcome measures. METHODS An online literature search was carried out in PubMed, MEDLINE, Scopus and IEEE-Xplore databases. Kinematic parameters mentioned in the studies included were categorized into the International Classification of Functioning, Disability and Health (ICF) domains. The correlations between these parameters and the clinical scales were summarized. RESULTS Forty-nine kinematic parameters were identified from 67 articles involving 1750 patients. The most frequently used parameters were: movement speed, movement accuracy, peak speed, number of speed peaks, and movement distance and duration. According to the ICF domains, 44 kinematic parameters were categorized into Body Functions and Structure, 5 into Activities and no parameters were categorized into Participation and Personal and Environmental Factors. Thirteen articles investigated the correlations between kinematic parameters and clinical outcome measures. Some kinematic measures showed a significant correlation coefficient with clinical scores, but most were weak or moderate. CONCLUSIONS The proposed classification of kinematic measures into ICF domains and their correlations with clinical scales could contribute to identifying the most relevant ones for an integrated assessment of upper limb robot-assisted rehabilitation treatments following stroke. Increasing the assessment frequency by means of kinematic parameters could optimize clinical assessment procedures and enhance the effectiveness of rehabilitation treatments.
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Affiliation(s)
- Vi Do Tran
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Polo Sant'Anna Valdera, V.le R. Piaggio 34-56025 Pontedera, Italy; Rehabilitation Bioengineering Laboratory, Volterra, Italy
| | - Paolo Dario
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Polo Sant'Anna Valdera, V.le R. Piaggio 34-56025 Pontedera, Italy
| | - Stefano Mazzoleni
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Polo Sant'Anna Valdera, V.le R. Piaggio 34-56025 Pontedera, Italy; Rehabilitation Bioengineering Laboratory, Volterra, Italy.
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Hand Passive Mobilization Performed with Robotic Assistance: Acute Effects on Upper Limb Perfusion and Spasticity in Stroke Survivors. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2796815. [PMID: 29094043 PMCID: PMC5637828 DOI: 10.1155/2017/2796815] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 07/17/2017] [Indexed: 11/17/2022]
Abstract
This single arm pre-post study aimed at evaluating the acute effects induced by a single session of robot-assisted passive hand mobilization on local perfusion and upper limb (UL) function in poststroke hemiparetic participants. Twenty-three patients with subacute or chronic stroke received 20 min passive mobilization of the paretic hand with robotic assistance. Near-infrared spectroscopy (NIRS) was used to detect changes in forearm tissue perfusion. Muscle tone of the paretic UL was assessed by the Modified Ashworth Scale (MAS). Symptoms concerning UL heaviness, joint stiffness, and pain were evaluated as secondary outcomes by self-reporting. Significant (p = 0.014) improvements were found in forearm perfusion when all fingers were mobilized simultaneously. After the intervention, MAS scores decreased globally, being the changes statistically significant for the wrist (from 1.6 ± 1.0 to 1.1 ± 1.0; p = 0.001) and fingers (from 1.2 ± 1.1 to 0.7 ± 0.9; p = 0.004). Subjects reported decreased UL heaviness and stiffness after treatment, especially for the hand, as well as diminished pain when present. This study supports novel evidence that hand robotic assistance promotes local UL circulation changes, may help in the management of spasticity, and acutely alleviates reported symptoms of heaviness, stiffness, and pain in subjects with poststroke hemiparesis. This opens new scenarios for the implications in everyday clinical practice. Clinical Trial Registration Number is NCT03243123.
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Santos GL, Russo TL, Nieuwenhuys A, Monari D, Desloovere K. Kinematic Analysis of a Drinking Task in Chronic Hemiparetic Patients Using Features Analysis and Statistical Parametric Mapping. Arch Phys Med Rehabil 2017; 99:501-511.e4. [PMID: 28939425 DOI: 10.1016/j.apmr.2017.08.479] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/06/2017] [Accepted: 08/16/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare sitting posture and movement strategies between chronic hemiparetic and healthy subjects while performing a drinking task, using statistical parametric mapping (SPM) and feature analysis. DESIGN Cross-sectional study. SETTING A university physical therapy department. PARTICIPANTS Participants (N=26) consisted of chronic hemiparetic (n=13) and healthy individuals (n=13) matched for sex and age. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The drinking task was divided into phases: reaching, transporting the glass to mouth, transporting the glass to table, and returning to initial position. An SPM 2-sample t test was used to compare the entire kinematic waveforms of different joint angles (trunk, scapulothoracic, humerothoracic, elbow). Joint angles at the beginning and end of the motion, movement time, peak velocity timing, trajectory deviation, normalized integrated jerk, and range of motion were extracted from the motion data. Group differences for these parameters were analyzed using independent t tests. RESULTS At the static posture and beginning of the reaching phase, patients showed a shoulder position more deviated from the midline and externally rotated with increased scapula protraction, medial rotation, anterior tilting, trunk anterior flexion and inclination to the paretic side. Altered spatiotemporal variables throughout the task were found in all phases, except for the returning phase. Patients returned to a similar posture as the task onset, except for the scapula, which was normalized after the reaching phase. CONCLUSIONS Chronic hemiparetic subjects showed more deviations in the proximal joints during seated posture and reaching. However, the scapular movement drew nearer to the healthy individuals' patterns after the first phase, showing an interesting point to consider in rehabilitation programs.
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Affiliation(s)
- Gabriela Lopes Santos
- Laboratory of Neurological Physiotherapy Research, Department of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.
| | - Thiago Luiz Russo
- Laboratory of Neurological Physiotherapy Research, Department of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Angela Nieuwenhuys
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, CERM, University Hospital Pellenberg, Pellenberg, Belgium
| | - Davide Monari
- Clinical Motion Analysis Laboratory, CERM, University Hospital Pellenberg, Pellenberg, Belgium; Department of Mechanical Engineering, Faculty of Engineering, KU Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, CERM, University Hospital Pellenberg, Pellenberg, Belgium
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Lee WH, Jeong JR, Hahn J. Evaluation of research trends in physical therapy through analysis of articles published at the world confederation for physical therapy congress. J Phys Ther Sci 2017; 28:3473-3479. [PMID: 28174476 PMCID: PMC5276785 DOI: 10.1589/jpts.28.3473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 08/11/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to examine research trends in physical therapy
through analysis of articles published at the 2015 World Confederation for Physical
Therapy Congress. [Subjects and Methods] A total of 1,339 were analyzed (presentations:
346, posters: 993). The number of papers per subject area, number of oral presentations
and posters, and the number of moderator nations and regional publications were analyzed
by subject area. The mean and standard deviation was used for statistical analysis.
[Results] Of 1,339 items published, the musculoskeletal spine was the most common theme,
with 89. Among oral presentations, 24 had cardiorespiratory themes; among poster
presentations, themes related to the elderly were the most common, at 76. Eleven
moderators were from Australia, and the most frequent regional source of papers was Japan,
with 238. [Conclusion] The 2015 WCPT Congress published papers in a variety of subject
areas; Australia and the UK presented many papers, but Japan had the most of any region,
at 238.
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Affiliation(s)
- Wan-Hee Lee
- Graduate School of Physical Therapy, Sahmyook University, Republic of Korea
| | - Ju-Ri Jeong
- Musculoskeletal Center, Samsung Seoul R&D Medical Clinic, Republic Korea
| | - Joohee Hahn
- Graduate School of Physical Therapy, Sahmyook University, Republic of Korea
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Cho KH, Song WK. Feedback training using a non-motorized device for long-term upper extremity impairment after stroke: a single group study. J Phys Ther Sci 2016; 28:495-9. [PMID: 27064768 PMCID: PMC4792998 DOI: 10.1589/jpts.28.495] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 10/31/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To investigate the effect of feedback training using a non-motorized device on
the upper extremity kinematic performance of chronic stroke survivors. [Subjects] This
study had a single group design. Thirteen chronic stroke survivors (onset duration:
11.5 years, 62.6 years, mini-mental state examination score: 26.0) were enrolled.
[Methods] The feedback training system consisted of a non-motorized device that offered
weight support, and a projective display device and loud speakers that provided suitable
visual and auditory feedback to the user. Subjects participated in the feedback training
for 40 min per day, two times a week for 4 weeks. Upper extremity kinematic performance
(i.e., movement time) in three directions was confirmed twice (at baseline and
post-intervention). [Results] After 4 weeks of the intervention, a significant improvement
in upper extremity kinematic performance was observed in the three directions.
[Conclusion] The present study demonstrated the positive effects of feedback training
using a non-motorized device on the upper extremity kinematic performance of chronic
stroke survivors. Therefore, the findings of this study may provide beneficial information
for future studies on feedback training using a non-motorized device for chronic stroke
survivors.
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Affiliation(s)
- Ki Hun Cho
- Department of Rehabilitative and Assistive Technology, Korea National Rehabilitation Research Institute, Korea National Rehabilitation Center, Republic of Korea
| | - Won-Kyung Song
- Department of Rehabilitative and Assistive Technology, Korea National Rehabilitation Research Institute, Korea National Rehabilitation Center, Republic of Korea
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Bissolotti L, Villafañe JH, Gaffurini P, Orizio C, Valdes K, Negrini S. Changes in skeletal muscle perfusion and spasticity in patients with poststroke hemiparesis treated by robotic assistance (Gloreha) of the hand. J Phys Ther Sci 2016; 28:769-73. [PMID: 27134356 PMCID: PMC4842437 DOI: 10.1589/jpts.28.769] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 11/25/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this case series was to determine the effects of robot-assisted
hand rehabilitation with a Gloreha device on skeletal muscle perfusion, spasticity, and
motor function in subjects with poststroke hemiparesis. [Subjects and Methods] Seven
patients, 2 women and 5 men (mean ± SD age: 60.5 ±6.3 years), with hemiparesis (>6
months poststroke), received passive mobilization of the hand with a Gloreha (Idrogenet,
Italy), device (30 min per day; 3 sessions a week for 3 weeks). The outcome measures were
the total hemoglobin profiles and tissue oxygenation index (TOI) in the muscle tissue
evaluated through near-infrared spectroscopy. The Motricity Index and modified Ashworth
Scale for upper limb muscles were used to assess mobility of the upper extremity.
[Results] Robotic assistance reduced spasticity after the intervention by 68.6% in the
upper limb. The Motricity Index was unchanged in these patients after treatment. Regarding
changes in muscle perfusion, significant improvements were found in total hemoglobin.
There were significant differences between the pre- and posttreatment modified Ashworth
scale. [Conclusion] The present work provides novel evidence that robotic assistance of
the hand induced changes in local muscle blood flow and oxygen supply, diminished
spasticity, and decreased subject-reported symptoms of heaviness and stiffness in subjects
with post-stroke hemiparesis.
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Affiliation(s)
- Luciano Bissolotti
- Laboratory of Neuromuscular Rehabilitation and Adapted Physical Activity, Italy
| | | | - Paolo Gaffurini
- Laboratory of Neuromuscular Rehabilitation and Adapted Physical Activity, Italy
| | - Claudio Orizio
- Laboratory of Neuromuscular Rehabilitation and Adapted Physical Activity, Italy
| | | | - Stefano Negrini
- IRCCS Don Gnocchi Foundation, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Italy
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Civelek GM, Atalay A, Turhan N. Medical complications experienced by first-time ischemic stroke patients during inpatient, tertiary level stroke rehabilitation. J Phys Ther Sci 2016; 28:382-91. [PMID: 27065523 PMCID: PMC4792978 DOI: 10.1589/jpts.28.382] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 10/30/2015] [Indexed: 12/21/2022] Open
Abstract
[Purpose] The aim of this study was to assess the medical complications in first-time
ischemic stroke patients, to identify the factors related to occurrence of complications.
[Subjects and Methods] First-time ischemic stroke patients (n=81) admitted to a tertiary
level inpatient rehabilitation center during a 5 year period were included in the study.
The attending physiatrist noted the presence of specific medical complications and
complications that required transfer to the acute care facility from patient records. The
Oxfordshire Community Stroke Project classification was used to define the clinical
subtypes of the ischemic stroke patients. The Charlson comorbidity index was used to
evaluate co-morbid conditions. Functional disability was assessed using the Functional
Independence Measure at admission and discharge. [Results] We found that 88.9% of the
patients had at least one complication. The five most common complications were urinary
tract infection (48.1%), shoulder pain (37.0%), insomnia (37.0%), depression (32.1%), and
musculoskeletal pain other than shoulder pain (32.1%) and 11.1% of patients were
transferred to acute care facility during rehabilitation period. Functional Independence
Measure scores both at admission and discharge were significantly lower in patients with
at least one complication than in patients with no complications. [Conclusion] Medical
complications are common among patients undergoing stroke rehabilitation. Close
interdisciplinary collaboration between physiatrists and other medical specialities is
necessary for optimal management.
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Affiliation(s)
- Gul Mete Civelek
- Physical Medicine and Rehabilitation Clinic, Ankara Children's Hematology Oncology Training and Research Hospital, Turkey
| | - Ayce Atalay
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Acibadem University, Faculty of Medicine, Turkey
| | - Nur Turhan
- Physical Medicine and Rehabilitation Clinic, Bayındır Hospital, Turkey
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