Upper limbs cycle ergometer increases muscle strength, trunk control and independence of acute stroke subjects: A randomized clinical trial

Efficacy of kinesthetic motor imagery based brain computer interface combined with tDCS on upper limb function in subacute stroke

This study investigates whether the combined effect of kinesthetic motor imagery-based brain computer interface (KI-BCI) and transcranial direct current stimulation (tDCS) on upper limb function in subacute stroke patients is more effective than using KI-BCI or tDCS alone. Forty-eight subacute stroke survivors were randomized to the KI-BCI, tDCS, or BCI-tDCS group. The KI-BCI group performed 30 min of KI-BCI training. Patients in tDCS group received 30 min of tDCS. Patients in BCI-tDCS group received 15 min of tDCS and 15 min of KI-BCI. The treatment cycle was five times a week, for four weeks. After all intervention, the Fugl-Meyer Assessment-Upper Extremity, Motor Status Scale, and the Modified Barthel Index scores of the KI-BCI group were superior to those of the tDCS group. The BCI-tDCS group was superior to the tDCS group in terms of the Motor Status Scale. Although quantitative EEG showed no significant group differences, the quantitative EEG indices in the tDCS group were significantly lower than before treatment. In conclusion, after treatment, although all intervention strategies improved upper limb motor function and daily living abilities in subacute stroke patients, KI-BCI demonstrated significantly better efficacy than tDCS. Under the same total treatment duration, the combined use of tDCS and KI-BCI did not achieve the hypothesized optimal outcome. Notably, tDCS reduced QEEG indices, possibly indicating favorable future outcomes in future.Trial registry number: ChiCTR2000034730.

Feasibility and safety of upper limb extremity ergometer exercise in the cardiac intensive care unit in critically ill patients with cardiac disease: a prospective observational study

Background

There is no established method for early bed rehabilitation of patients after cardiogenic shock (CS) who require mechanical circulatory support (MCS). This study aimed to evaluate the safety of early upper limb extremity ergometer exercise in critically ill patients with CS or at risk for CS.

Methods

The study was conducted as a prospective, single-center feasibility and observational study. Patients with CS or at risk for CS in the cardiac intensive care unit were enrolled. Upper limb extremity ergometer exercise was performed with alternating intervals of exercise and rest, in parallel with the rehabilitation program focused on early mobilization. A multidisciplinary team was established to determine the criteria for exercise initiation and cessation. Endpoint measures included exercise-related adverse events (circulatory or respiratory failure requiring new medical intervention, inability to continue device support, bleeding requiring hemostatic treatment at the insertion site, and exercise-related skeletal pain), vital signs, and subjective symptoms.

Results

Forty-seven sessions in 28 patients (71 ± 15 years, 75% male) were included in the analysis. MCS was used in 86% of the patients, and rehabilitation was initiated within 3 ± 1 day. Two patients had temporary dyspnea, and none discontinued exercise. There was a significant increase in heart rate (p < 0.05) and respiratory rate (p < 0.001) during exercise compared with pre-excercise, but not in systolic or diastolic blood pressure and oxygen saturation.

Conclusion

Early upper limb extremity ergometer exercises for critically ill patients with CS or at risk for CS resulted in changes in heart rate and respiratory rate during exercise. However, no exercise-related adverse events occurred. Upper limb extremity ergometer exercise can be a new tool of physical therapy in the acute phase of patients after CS or at risk for CS.

An EMG-Modulated Asymmetric Arm Bike for Stroke Rehabilitation

Arm cycling has been proven to be an effective exercise for stroke rehabilitation. It strengthens the upper body, improves arm control, and can aid in restoring walking abilities. Promoting the engagement of the paretic arm is crucial, and tailoring the load to accommodate the limitations of the paretic side is a practical approach to encourage the safe use of this arm. We propose that the load modulation can be based on the EMG activity of the weaker side. This work assesses the feasibility of implementing arm cycling with asymmetric loading modulated by EMG activity and proposes a device design. We conducted two user experiments. The results of the first experiment show that asymmetric loading in arm cycling reduces peak activity in the targeted muscles. The second experiment underscores the potential to modulate the magnitude of the load using EMG activity.Clinical relevance- This work explores a novel approach to address motor impairments' unique and evolving challenges.

Effectiveness of Rehabilitation Exercise in Improving Physical Function of Stroke Patients: A Systematic Review

Rehabilitation is a crucial part of recovery for stroke survivors, and numerous studies have examined various exercises and treatments of stroke. In addition, it is very important for patients to choose the timing of rehabilitation and what kind of rehabilitation they will proceed with. The purpose of the current study is to examine research investigating the effects of rehabilitation exercise programs in recovery of physical function in patients with stroke, based on aspects of their physical function, physical strength, and daily activities, and systematically examine their effects. Therefore, through systematic review, we have investigated the effects of interventions in rehabilitation exercise programs for recovery of physical function in patients with stroke. We collected relevant publications through the databases MEDLINE/PubMed and Google scholar. Twenty-one articles were ultimately selected for the analysis. We classified the rehabilitation programs and identified the trends of treatment for stroke survivors. Our review indicated that task-oriented therapy is still dominant, but various types of combined rehabilitations have been attempted. In addition, it was identified that physical and active rehabilitation were required rather than unconditional rest, even at an early stage. Home-based treatment was used for rapid recovery and adaptation to daily life during the mid-term period.