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Rikhof CJH, Feenstra Y, Fleuren JFM, Buurke JH, Prinsen EC, Rietman JS, Prange-Lasonder GB. Robot-assisted support combined with electrical stimulation for the lower extremity in stroke patients: a systematic review. J Neural Eng 2024; 21:021001. [PMID: 38527367 DOI: 10.1088/1741-2552/ad377c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 03/25/2024] [Indexed: 03/27/2024]
Abstract
Objective. The incidence of stroke rising, leading to an increased demand for rehabilitation services. Literature has consistently shown that early and intensive rehabilitation is beneficial for stroke patients. Robot-assisted devices have been extensively studied in this context, as they have the potential to increase the frequency of therapy sessions and thereby the intensity. Robot-assisted systems can be combined with electrical stimulation (ES) to further enhance muscle activation and patient compliance. The objective of this study was to review the effectiveness of ES combined with all types of robot-assisted technology for lower extremity rehabilitation in stroke patients.Approach. A thorough search of peer-reviewed articles was conducted. The quality of the included studies was assessed using a modified version of the Downs and Black checklist. Relevant information regarding the interventions, devices, study populations, and more was extracted from the selected articles.Main results. A total of 26 articles were included in the review, with 23 of them scoring at least fair on the methodological quality. The analyzed devices could be categorized into two main groups: cycling combined with ES and robots combined with ES. Overall, all the studies demonstrated improvements in body function and structure, as well as activity level, as per the International Classification of Functioning, Disability, and Health model. Half of the studies in this review showed superiority of training with the combination of robot and ES over robot training alone or over conventional treatment.Significance. The combination of robot-assisted technology with ES is gaining increasing interest in stroke rehabilitation. However, the studies identified in this review present challenges in terms of comparability due to variations in outcome measures and intervention protocols. Future research should focus on actively involving and engaging patients in executing movements and strive for standardization in outcome values and intervention protocols.
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Affiliation(s)
- C J H Rikhof
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Biomechanical Engineering, University of Twente, Drienerlolaan 5, Enschede 7522NB, The Netherlands
| | - Y Feenstra
- Roessingh Centre of Rehabilitation, Roessinghsbleekweg 33, Enschede 7522AH, The Netherlands
| | - J F M Fleuren
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Roessingh Centre of Rehabilitation, Roessinghsbleekweg 33, Enschede 7522AH, The Netherlands
| | - J H Buurke
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Biomedical Signals and systems, University of Twente, Drienerlolaan 5, Enschede 7522NB, The Netherlands
| | - E C Prinsen
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Biomechanical Engineering, University of Twente, Drienerlolaan 5, Enschede 7522NB, The Netherlands
| | - J S Rietman
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Biomechanical Engineering, University of Twente, Drienerlolaan 5, Enschede 7522NB, The Netherlands
- Roessingh Centre of Rehabilitation, Roessinghsbleekweg 33, Enschede 7522AH, The Netherlands
| | - G B Prange-Lasonder
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Biomechanical Engineering, University of Twente, Drienerlolaan 5, Enschede 7522NB, The Netherlands
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Repelaer van Driel-Delprat CC, van Dam EWCM, van de Ven PM, Aissa K, ter Haar MK, Feenstra Y, de Roos A, Beelen G, Schats R, Lambalk CB. Thyroid function and IVF outcome for different indications of subfertility. Reproduction and Fertility 2021; 2:280-291. [PMID: 35118405 PMCID: PMC8805483 DOI: 10.1530/raf-20-0065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 11/21/2022] Open
Abstract
Graphical Abstract
Abstract Studies evaluating pregnancy outcomes after assisted reproductive treatment (ART) in women with high-normal (2.5–4.5 mIU/L) thyroid-stimulating hormone (TSH) levels are conflicting, possibly due to different patient charactistics and subfertility indications. The aim of this study was to examine the hypothesis that high-normal compared to low-normal TSH levels are associated with adverse implications for pregnancy outcomes in conventional in vitro fertilization (IVF)-treated women. Therefore, we analyzed retrospectively the characteristics and pregnancy outcomes of 949 subfertile women with TSH 0.3–4.5 mIU/L, treated with conventional IVF between January 2008 and March 2012. Demographic and baseline characteristics were compared between groups of patients based on TSH quartiles, using one-way Anova, Kruskal–Wallis ANOVA and chi-square test. Women with high-normal quartile TSH were significantly more likely to be primary subfertile (P = 0.01), with a higher prevalence of unexplained subfertility and with 15% fewer live births after IVF compared to lower TSH quartiles (P = 0.02). In secondary subfertile women with high-normal TSH, male factor subfertility prevailed (P = 0.01), with more live births (P = 0.01). When analyzing primary and secondary subfertile women as one group, these differences failed to be observed, showing no differences in cumulative pregnancy outcomes of IVF between TSH quartiles (I: 0.3–1.21 mIU/L; II: 1.22–1.68 mIU/L; III: 1.69–2.31 mIU/L; IV: 2.32–4.5 mIU/L). In conclusion, primary subfertile women predominate in the high-normal TSH quartile, associated with significantly fewer live births in a subgroup of primary unexplained subfertile women (9%; n = 87/949), while in secondary subfertile women, dominated by male factor subfertility, high-normal TSH is associated with more live births. Lay summary Thyroid hormones are required for all cell processes in the body. An underactive thyroid gland, in which insufficient thyroid hormones are produced and thyroid-stimulating hormone (TSH) rises, is associated with a lower chance of pregnancy. It is not yet clear above which TSH level, 4.5 or also 2.5 mIU/L, this lower probability occurs. Therefore, in 949 couples treated with conventional IVF, we examined whether high-normal TSH levels (TSH: 2.5–4.5 mIU/L) compared to low normal TSH levels (0.3–2.5 mIU/L) affect the live birth rate. We found that women who were trying to become pregnant for the first time, especially without any other cause, that is unexplained subfertility, were more likely to have higher TSH levels. These women had a much lower chance of having a baby compared to women with low-normal TSH levels.
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Affiliation(s)
- C C Repelaer van Driel-Delprat
- 1Division of Reproductive Medicine, Department of Obstetrics, Gynaecology and Reproductive Medicine, Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - E W C M van Dam
- 2Division of Endocrinology, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - P M van de Ven
- 3Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - K Aissa
- 1Division of Reproductive Medicine, Department of Obstetrics, Gynaecology and Reproductive Medicine, Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - M K ter Haar
- 1Division of Reproductive Medicine, Department of Obstetrics, Gynaecology and Reproductive Medicine, Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Y Feenstra
- 1Division of Reproductive Medicine, Department of Obstetrics, Gynaecology and Reproductive Medicine, Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - A de Roos
- 1Division of Reproductive Medicine, Department of Obstetrics, Gynaecology and Reproductive Medicine, Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - G Beelen
- 1Division of Reproductive Medicine, Department of Obstetrics, Gynaecology and Reproductive Medicine, Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - R Schats
- 1Division of Reproductive Medicine, Department of Obstetrics, Gynaecology and Reproductive Medicine, Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - C B Lambalk
- 1Division of Reproductive Medicine, Department of Obstetrics, Gynaecology and Reproductive Medicine, Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Repelaer van Driel-Delprat C, van Dam E, van de Ven P, Aissa K, Ter Haar M, Feenstra Y, de Roos A, Beelen G, Schats R, Lambalk C. More Live Births in Primary Subfertile Intracytoplasmic Sperm Injection-Treated Women with High Normal TSH Levels. Gynecol Obstet Invest 2021; 86:398-407. [PMID: 34515132 DOI: 10.1159/000518083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 06/07/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to analyze the fertility outcome in intracytoplasmic sperm injection (ICSI)-treated women across normal range thyroid-stimulating hormone (TSH) levels. Published results are inconclusive about optimal TSH levels and fertility. DESIGN This is a retrospective cohort study in 752 ICSI-treated women with predominantly severe male factor subfertility, starting treatment between the first of January 2008 and the first of March 2012 with a follow-up until 2014. Participants/Materials, Setting, Methods: Women aged 22-45 years with TSH 0.3-4.5 mIU/L without thyroid hormone substitution were included in Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands, an iodine-sufficient area. Demographic and baseline characteristics were compared between groups of patients based on TSH, using one-way ANOVA, Kruskal-Wallis ANOVA, and χ2 test. The patient was the unit of analysis: all cumulative cycles per patient were analyzed up to and including the first ongoing pregnancy. The primary outcome was a cumulative live birth rate. Clinical pregnancy rate, pregnancy loss, and ongoing pregnancy rate were secondary outcomes. The χ2 test and logistic regression were used to compare interquartile groups while adjusting for confounders. Logistic regression was used with the natural logarithm of TSH as a continuous predictor. Primary and secondary subfertile women were analyzed separately. RESULTS Analysis of the total cohort (n = 752) showed no difference in fertility outcomes across the normal TSH range. The cumulative live birth rate for the 4 groups of primary subfertile women (n = 455) was 76% in the upper TSH quartile compared to 56%, 60%, and 59% in the lower TSH quartiles. LIMITATIONS Levels of thyroxine and presence of thyroid autoimmunity were not measured in this retrospective cohort study. CONCLUSIONS The observation that a higher live birth rate was found in primary subfertile ICSI-treated women with high but allegedly normal TSH levels contributes to the hypothesis that in certain subfertile women in addition to a male factor, female factors such as subtle hypothyroidism and/or thyroid autoimmunity may play a role in keeping them from conception, which can be overcome by the process of ICSI.
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Affiliation(s)
- Constance Repelaer van Driel-Delprat
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Division of Reproductive Medicine, Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eveline van Dam
- Department of Internal Medicine, Division of Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Peter van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Khadija Aissa
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Division of Reproductive Medicine, Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Melanie Ter Haar
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Division of Reproductive Medicine, Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Yikke Feenstra
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Division of Reproductive Medicine, Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Aletta de Roos
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Division of Reproductive Medicine, Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gaby Beelen
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Division of Reproductive Medicine, Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Roel Schats
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Division of Reproductive Medicine, Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cornelis Lambalk
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Division of Reproductive Medicine, Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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