Poster 48 Enhancing Arm Recovery Post-Stroke: Use of Contralesional Inhibitory rTMS to Augment Functional Task Practice

AbstractDue to their quantitative nature, robotic systems are useful tools for systematically augmenting human behavior and performance in dynamic environments, such as therapeutic rehabilitation settings. The efficacy of human-robot interaction (HRI) in these settings will depend on the robot’s coaching style. Our goal was to investigate the influence of robot coaching styles designed to enhance motivation and encouragement on post-stroke individuals during motor task practice. We hypothesized that coaching styles incorporating user performance and preference would be preferred in a therapeutic HRI setting. We designed an evaluation study with seven individuals post stroke. A socially assistive robotics (SAR) system using three different coaching styles guided participants during performance of an upper extremity practice task. User preference was not significantly affected by the different robot coaching styles in our participant sample (H(2) = 2.638, p = 0.267). However, trends indicated differences in preference for the coaching styles. Our results provide insights into the design and use of SAR systems in therapeutic interactions aiming to influence user behavior.

Download Full-text

Cortical vs. afferent stimulation as an adjunct to functional task practice training: a randomized, comparative pilot study in people with cervical spinal cord injury

Clinical Rehabilitation ◽

10.1177/0269215514556087 ◽

2014 ◽

Vol 29 (8) ◽

pp. 771-782 ◽

Cited By ~ 18

Author(s):

Joyce Gomes-Osman ◽

Edelle C Field-Fote

Keyword(s):

Direct Current ◽

Nerve Stimulation ◽

Transcranial Direct Current Stimulation ◽

Transcutaneous Electrical Nerve Stimulation ◽

Short Term ◽

Electrical Nerve Stimulation ◽

Direct Current Stimulation ◽

Cohen’S D ◽

Task Practice ◽

Functional Task

Objective: To assess single-session effects of three different types of stimuli known to increase cortical excitability when combined with functional task practice. Design: Randomized cross-over trial. Participants: A total of 24 participants with chronic cervical spinal cord injury. Interventions: One 30-minute session of each, applied concurrently with functional task practice: transcranial direct current stimulation, vibration, and transcutaneous electrical nerve stimulation. Measurements: Nine-hole Peg Test, pinch force, visuomotor tracking, and cortical excitability were collected at pretest, posttest and late posttest (30 minutes after). Early effects (posttest minus pretest) and short-term persistence (late posttest minus pretest) were assessed using a general linear mixed model. Magnitude of effect size was assessed using the Cohen’s d. Results: Transcutaneous electrical nerve stimulation was associated with moderate, significant early effects and short-term persistence on Nine-hole Peg Test performance (1.8 ±1.8, p = 0.003, d = 0.59; 2.0 ±2.5, p < 0.001, Cohen’s d = 0.65, respectively). Transcranial direct current stimulation (1.8 ±2.5, p = 0.003, Cohen’s d = 0.52) was also associated with significant short-term persistence of moderate size on Nine-hole Peg Test performance (1.8 ±2.5, p = 0.003, Cohen’s d = 0.52) and visuomotor tracking performance ( p = 0.05, d = 0.51). Early effects on corticomotor excitability were significant for transcutaneous electrical nerve stimulation ( p = 0.003), approached significance for transcranial direct current stimulation ( p = 0.07), and only vibration was associated with significant short-term persistence ( p = 0.006). Conclusions: Meaningful improvements in aspects of hand-related function that persisted at least 30 minutes after intervention were observed with transcutaneous electrical nerve stimulation and transcranial direct current stimulation, when combined with functional task practice.

Download Full-text

Planar robotic rehabilitation of upper limb in post-stroke subjects: Transfer of training effects to a non-trained 3D functional task

Gait & Posture ◽

10.1016/j.gaitpost.2016.07.056 ◽

2016 ◽

Vol 49 ◽

pp. S23-S24 ◽

Cited By ~ 5

Author(s):

I. Carpinella ◽

J. Jonsdottir ◽

T. Lencioni ◽

T. Bowman ◽

M. Ferrarin

Keyword(s):

Upper Limb ◽

Transfer Of Training ◽

Robotic Rehabilitation ◽

Training Effects ◽

Post Stroke ◽

Functional Task

Download Full-text

Lost in Translation: Simple Steps in Experimental Design of Neurorehabilitation-Based Research Interventions to Promote Motor Recovery Post-Stroke

Frontiers in Human Neuroscience ◽

10.3389/fnhum.2021.644335 ◽

2021 ◽

Vol 15 ◽

Author(s):

Natalia Sánchez ◽

Carolee J. Winstein

Keyword(s):

Motor Control ◽

Experimental Design ◽

Motor Impairment ◽

Basic Research ◽

Future Research ◽

Targeted Interventions ◽

Post Stroke ◽

Task Practice ◽

Meaningful Context ◽

Research Based Interventions

Stroke continues to be a leading cause of disability. Basic neurorehabilitation research is necessary to inform the neuropathophysiology of impaired motor control, and to develop targeted interventions with potential to remediate disability post-stroke. Despite knowledge gained from basic research studies, the effectiveness of research-based interventions for reducing motor impairment has been no greater than standard of practice interventions. In this perspective, we offer suggestions for overcoming translational barriers integral to experimental design, to augment traditional protocols, and re-route the rehabilitation trajectory toward recovery and away from compensation. First, we suggest that researchers consider modifying task practice schedules to focus on key aspects of movement quality, while minimizing the appearance of compensatory behaviors. Second, we suggest that researchers supplement primary outcome measures with secondary measures that capture emerging maladaptive compensations at other segments or joints. Third, we offer suggestions about how to maximize participant engagement, self-direction, and motivation, by embedding the task into a meaningful context, a strategy more likely to enable goal-action coupling, associated with improved neuro-motor control and learning. Finally, we remind the reader that motor impairment post-stroke is a multidimensional problem that involves central and peripheral sensorimotor systems, likely influenced by chronicity of stroke. Thus, stroke chronicity should be given special consideration for both participant recruitment and subsequent data analyses. We hope that future research endeavors will consider these suggestions in the design of the next generation of intervention studies in neurorehabilitation, to improve translation of research advances to improved participation and quality of life for stroke survivors.

Download Full-text

A systematic review of repetitive functional task practice with modelling of resource use, costs and effectiveness

Health Technology Assessment ◽

10.3310/hta12300 ◽

2008 ◽

Vol 12 (30) ◽

Cited By ~ 35

Author(s):

B French ◽

M Leathley ◽

C Sutton ◽

J McAdam ◽

L Thomas ◽

...

Keyword(s):

Systematic Review ◽

Resource Use ◽

Task Practice ◽

Functional Task

Download Full-text

Does Inhibitory Repetitive Transcranial Magnetic Stimulation Augment Functional Task Practice to Improve Arm Recovery in Chronic Stroke?

Stroke Research and Treatment ◽

10.1155/2014/305236 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 18

Author(s):

Dorian K. Rose ◽

Carolynn Patten ◽

Theresa E. McGuirk ◽

Xiaomin Lu ◽

William J. Triggs

Keyword(s):

Transcranial Magnetic Stimulation ◽

Magnetic Stimulation ◽

Cortical Excitability ◽

Repetitive Transcranial Magnetic Stimulation ◽

Secondary Analysis ◽

Motor Impairment ◽

Analysis Data ◽

Chronic Stroke ◽

Task Practice ◽

Functional Task

Introduction. Restoration of upper extremity (UE) functional use remains a challenge for individuals following stroke. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive modality that modulates cortical excitability and is being explored as a means to potentially ameliorate these deficits. The purpose of this study was to evaluate, in the presence of chronic stroke, the effects of low-frequency rTMS to the contralesional hemisphere as an adjuvant to functional task practice (FTP), to improve UE functional ability.Methods. Twenty-two individuals with chronic stroke and subsequent moderate UE deficits were randomized to receive 16 sessions (4 times/week for 4 weeks) of either real-rTMS or sham-rTMS followed by 1-hour of paretic UE FTP.Results. No differences in UE outcomes were revealed between the real-rTMS and sham-rTMS intervention groups. After adjusting for baseline differences, no differences were revealed in contralesional cortical excitability postintervention. In a secondary analysis, data pooled across both groups revealed small, but statistically significant, improvements in UE behavioral measures.Conclusions. rTMS did not augment changes in UE motor ability in this population of individuals with chronic stroke. The chronicity of our participant cohort and their degree of UE motor impairment may have contributed to inability to produce marked effects using rTMS.

Download Full-text