scholarly journals Motor improvement estimation and task adaptation for personalized robot-aided therapy: a feasibility study

2019 ◽  
Author(s):  
Christian Giang ◽  
Elvira Pirondini ◽  
Nawal Kinany ◽  
Camilla Pierella ◽  
Alessandro Panarese ◽  
...  
Keyword(s):  
Motor Impairment ◽  
Motor Deficits ◽  
Pilot Test ◽  
Stroke Patients ◽  
Rehabilitation Therapy ◽  
Model Based ◽  
Link Type ◽  
Upper Limb Exoskeleton ◽  
Subacute Stroke ◽  
Motor Improvement

AbstractBackgroundIn the past years, robotic systems have become increasingly popular in both upper and lower limb rehabilitation. Nevertheless, clinical studies have so far not been able to confirm superior efficacy of robotic therapy over conventional methods. The personalization of robot-aided therapy according to the patients’ individual motor deficits has been suggested as a pivotal step to improve the clinical outcome of such approaches.MethodsHere, we present a model-based approach to personalize robot-aided rehabilitation therapy within training sessions. The proposed method combines the information from different motor performance measures recorded from the robot to continuously estimate patients’ motor improvement for a series of point-to-point reaching movements in different directions and comprises a personalization routine to automatically adapt the rehabilitation training. We engineered our approach using an upper limb exoskeleton and tested it with seventeen healthy subjects, who underwent a motor-adaptation paradigm, and two subacute stroke patients, exhibiting different degrees of motor impairment, who participated in a pilot test.ResultsThe experiments illustrated the model’s capability to differentiate distinct motor improvement progressions among subjects and subtasks. The model suggested personalized training schedules based on motor improvement estimations for each movement in different directions. Patients’ motor performances were retained when training movements were reintroduced at a later stage.ConclusionsOur results demonstrated the feasibility of the proposed model-based approach for the personalization of robot-aided rehabilitation therapy. The pilot test with two subacute stroke patients further supported our approach, while providing auspicious results for the applicability in clinical settings.Trial registrationThis study is registered in ClinicalTrials.gov (NCT02770300, registered 30 March 2016, https://clinicaltrials.gov/ct2/show/NCT02770300).

scholarly journals Eye Gaze Correlates of Motor Impairment in VR Observation of Motor Actions

2016 ◽  
Vol 55 (01) ◽  
pp. 79-83 ◽  
Author(s):  
A. Vourvopoulos ◽  
A. Bernardino ◽  
i Bermúdez Badia ◽  
J. Alves
Keyword(s):  
Virtual Reality ◽  
Smooth Pursuit ◽  
Healthy Subjects ◽  
Eye Gaze ◽  
Action Observation ◽  
Motor Impairment ◽  
Motor Deficits ◽  
Stroke Patients ◽  
Motor Actions ◽  
Healthy Participants

Summary Introduction: This article is part of the Focus Theme of Methods of Information in Medicine on “Methodologies, Models and Algorithms for Patients Rehabilitation”. Objective: Identify eye gaze correlates of motor impairment in a virtual reality motor observation task in a study with healthy participants and stroke patients. Methods: Participants consisted of a group of healthy subjects (N = 20) and a group of stroke survivors (N = 10). Both groups were required to observe a simple reach-and-grab and place-and-release task in a virtual environment. Additionally, healthy subjects were required to observe the task in a normal condition and a constrained movement condition. Eye movements were recorded during the observation task for later analysis. Results: For healthy participants, results showed differences in gaze metrics when comparing the normal and arm-constrained conditions. Differences in gaze metrics were also found when comparing dominant and non-dominant arm for saccades and smooth pursuit events. For stroke patients, results showed longer smooth pursuit segments in action observation when observing the paretic arm, thus providing evidence that the affected circuitry may be activated for eye gaze control during observation of the simulated motor action. Conclusions: This study suggests that neural motor circuits are involved, at multiple levels, in observation of motor actions displayed in a virtual reality environment. Thus, eye tracking combined with action observation tasks in a virtual reality display can be used to monitor motor deficits derived from stroke, and consequently can also be used for re -habilitation of stroke patients.

scholarly journals The Effect of Prolonged Inpatient Rehabilitation Therapy in Subacute Stroke Patients

2012 ◽  
Vol 36 (1) ◽  
pp. 16 ◽  
Author(s):  
Jong Hwa Lee ◽  
Sang Beom Kim ◽  
Kyeong Woo Lee ◽  
Ji Yeong Lee
Keyword(s):  
Inpatient Rehabilitation ◽  
Stroke Patients ◽  
Rehabilitation Therapy ◽  
Subacute Stroke

Does Proprioceptive Loss Influence Recovery of the Upper Extremity After Stroke?

1999 ◽  
Vol 13 (1) ◽  
pp. 15-21 ◽  
Author(s):  
Debbie Rand ◽  
Patrice L. (Tamar) Weiss ◽  
Daniel Gottlieb
Keyword(s):  
Upper Extremity ◽  
Detrimental Effect ◽  
Motor Impairment ◽  
Motor Deficits ◽  
Functional Abilities ◽  
Stroke Patients ◽  
Motor Paralysis ◽  
Significant Difference ◽  
Localization Test ◽  
Pure Motor

Stroke patients with motor paralysis and proprioceptive deficits are considered to have a worse functional outcome than those with pure motor paralysis, but the mechanism of this detrimental effect is not clear. In order to clarify it, we compared the motor and functional recovery of the affected upper extremity in stroke patients having pure motor paralysis with that of such patients with both motor and proprioceptive deficits. Forty patients undergoing stroke rehabilitation were studied: 20 with pure motor deficits and 20 also with proprioceptive deficits. They were assessed on four occasions during the first six weeks of rehabilitation. Motor impairment was assessed with the Fugl-Meyer subscale of the upper extremity, disability with the Frenchay Arm Test, and proprio ception by the Thumb Localization Test. Significant within-group improvement of the motor and functional abilities was demonstrated in both groups, between admission to six weeks later (p < 0.001, either group). However, no significant difference was found between the two groups, although pure motor patients had a slightly better outcome. It was concluded that the proprioception deficit did not influence limb recovery in the first six weeks of rehabilitation. Therefore, the upper extremity of all patients should be treated and given a similar chance because significant improvement can be expected in all cases. Key Words: Upper Extremity—Stroke—Proprioception—Rehabilitation.

scholarly journals Cerebrolysin Combined with Rehabilitation Enhances Motor Recovery and Prevents Neural Network Degeneration in Ischemic Stroke Patients with Severe Motor Deficits

2021 ◽  
Vol 11 (6) ◽  
pp. 545
Author(s):  
Won Hyuk Chang ◽  
Jungsoo Lee ◽  
Yong-Il Shin ◽  
Myoung-Hwan Ko ◽  
Deog Young Kim ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Diffusion Tensor ◽  
Motor Impairment ◽  
Motor Recovery ◽  
Stroke Onset ◽  
Stroke Patients ◽  
Rehabilitation Therapy ◽  
Severe Motor ◽  
Severe Motor Impairment ◽  
Over Time

The objective of this study was to evaluate whether Cerebrolysin combined with rehabilitation therapy supports additional motor recovery in stroke patients with severe motor impairment. This study analyzed the combined data from the two phase IV prospective, multicenter, randomized, double-blind, placebo-controlled trials. Stroke patients were included within seven days after stroke onset and were randomized to receive a 21-day treatment course of either Cerebrolysin or placebo with standardized rehabilitation therapy. Assessments were performed at baseline, immediately after the treatment course, and 90 days after stroke onset. The plasticity of the motor system was assessed by diffusion tensor imaging and resting state fMRI. In total, 110 stroke patients were included for the full analysis set (Cerebrolysin n = 59, placebo n = 51). Both groups showed significant motor recovery over time. Repeated-measures analysis of varianceshowed a significant interaction between time and type of intervention as measured by the Fugl–Meyer Assessment (p < 0.05). The Cerebrolysin group demonstrated less degenerative changes in the major motor-related white matter tracts over time than the placebo group. In conclusion, Cerebrolysin treatment as an add-on to a rehabilitation program is a promising pharmacologic approach that is worth considering in order to enhance motor recovery in ischemic stroke patients with severe motor impairment.

scholarly journals Translational effects of robot-mediated therapy in subacute stroke patients: an experimental evaluation of upper limb motor recovery

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e5544 ◽  
Author(s):  
Eduardo Palermo ◽  
Darren Richard Hayes ◽  
Emanuele Francesco Russo ◽  
Rocco Salvatore Calabrò ◽  
Alessandra Pacilli ◽  
...  
Keyword(s):  
Upper Limb ◽  
Effective Means ◽  
Post Treatment ◽  
Motor Deficits ◽  
Stroke Patients ◽  
Optoelectronic System ◽  
Clinical Scales ◽  
Post Stroke ◽  
Subacute Stroke ◽  
Kinematic Assessment

Robot-mediated therapies enhance the recovery of post-stroke patients with motor deficits. Repetitive and repeatable exercises are essential for rehabilitation following brain damage or other disorders that impact the central nervous system, as plasticity permits to reorganize its neural structure, fostering motor relearning. Despite the fact that so many studies claim the validity of robot-mediated therapy in post-stroke patient rehabilitation, it is still difficult to assess to what extent its adoption improves the efficacy of traditional therapy in daily life, and also because most of the studies involved planar robots. In this paper, we report the effects of a 20-session-rehabilitation project involving the Armeo Power robot, an assistive exoskeleton to perform 3D upper limb movements, in addition to conventional rehabilitation therapy, on 10 subacute stroke survivors. Patients were evaluated through clinical scales and a kinematic assessment of the upper limbs, both pre- and post-treatment. A set of indices based on the patients’ 3D kinematic data, gathered from an optoelectronic system, was calculated. Statistical analysis showed a remarkable difference in most parameters between pre- and post-treatment. Significant correlations between the kinematic parameters and clinical scales were found. Our findings suggest that 3D robot-mediated rehabilitation, in addition to conventional therapy, could represent an effective means for the recovery of upper limb disability. Kinematic assessment may represent a valid tool for objectively evaluating the efficacy of the rehabilitation treatment.

scholarly journals Time Course of Wrist Hyper-Resistance in Relation to Upper Limb Motor Recovery Early Post Stroke

2020 ◽  
Vol 34 (8) ◽  
pp. 690-701
Author(s):  
Aukje Andringa ◽  
Carel Meskers ◽  
Ingrid van de Port ◽  
Erwin van Wegen ◽  
Gert Kwakkel
Keyword(s):  
Upper Limb ◽  
Mixed Models ◽  
Time Course ◽  
Motor Impairment ◽  
Motor Recovery ◽  
Motor Deficits ◽  
Stroke Patients ◽  
Post Stroke ◽  
Resistance Components ◽  
Finger Extension

Background. Patients with an upper limb motor impairment are likely to develop wrist hyper-resistance during the first months post stroke. The time course of wrist hyper-resistance in terms of neural and biomechanical components, and their interaction with motor recovery, is poorly understood. Objective. To investigate the time course of neural and biomechanical components of wrist hyper-resistance in relation to upper limb motor recovery in the first 6 months post stroke. Methods. Neural (NC), biomechanical elastic (EC), and viscous (VC) components of wrist hyper-resistance (NeuroFlexor device), and upper limb motor recovery (Fugl-Meyer upper extremity scale [FM-UE]), were assessed in 17 patients within 3 weeks and at 5, 12, and 26 weeks post stroke. Patients were stratified according to the presence of voluntary finger extension (VFE) at baseline. Time course of wrist hyper-resistance components and assumed interaction effects were analyzed using linear mixed models. Results. On average, patients without VFE at baseline (n = 8) showed a significant increase in NC, EC, and VC, and an increase in FM-UE from 13 to 26 points within the first 6 months post stroke. A significant increase in NC within 5 weeks preceded a significant increase in EC between weeks 12 and 26. Patients with VFE at baseline (n = 9) showed, on average, no significant increase in components from baseline to 6 months whereas FM-UE scores improved from 38 to 60 points. Conclusion. Our findings suggest that the development of neural and biomechanical wrist hyper-resistance components in patients with severe baseline motor deficits is determined by lack of spontaneous neurobiological recovery early post stroke.

scholarly journals Language as a Predictor of Motor Recovery: The Case for a More Global Approach to Stroke Rehabilitation

2019 ◽  
Vol 33 (3) ◽  
pp. 167-178 ◽  
Author(s):  
Deanna Anderlini ◽  
Guy Wallis ◽  
Welber Marinovic
Keyword(s):  
Stroke Rehabilitation ◽  
Current Trend ◽  
Motor Impairment ◽  
Motor Recovery ◽  
Motor Deficits ◽  
Common Site ◽  
Stroke Patients ◽  
Patients Experience ◽  
Developed World ◽  
Choice Of Therapy

Stroke is the third leading cause of death in the developed world and the primary cause of adult disability. The most common site of stroke is the middle cerebral artery (MCA), an artery that supplies a range of areas involved in both language and motor function. As a consequence, many stroke patients experience a combination of language and motor deficits. Indeed, those suffering from Broca’s aphasia have an 80% chance of also suffering hemiplegia. Despite the prevalence of multifaceted disability in patients, the current trend in both clinical trials and clinical practice is toward compartmentalization of dysfunction. In this article, we review evidence that aphasia and hemiplegia do not just coexist, but that they interact. We review a number of clinical reports describing how therapies for one type of deficit can improve recovery in the other and vice versa. We go on to describe how language deficits should be seen as a warning to clinicians that the patient is likely to experience motor impairment and slower motor recovery, aiding clinicians to optimize their choice of therapy. We explore these findings and offer a tentative link between language and arm function through their shared need for sequential action, which we term fluency. We propose that area BA44 (part of Broca’s area) acts as a hub for fluency in both movement and language, both in terms of production and comprehension.

Abstract 72: A Novel VLSM-CST Lesion Load Model is a Superior Predictor of Motor Outcomes of Acute Stroke Patients

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Jasmine Wang ◽  
Wayne Feng ◽  
Pratik Y Chhatbar ◽  
Gottfried Schlaug
Keyword(s):  
Acute Stroke ◽  
Motor Impairment ◽  
Motor Deficits ◽  
Precentral Gyrus ◽  
Stroke Patients ◽  
Lesion Load ◽  
Days Of Therapy ◽  
Motor Outcome ◽  
Motor Tracts ◽  
Best Fit

Introduction: Lesion load of the Corticospinal Tract (CST-LL) can predict 64% of the variance in 3-months outcome of acute stroke patients. Voxel-based lesion symptom mapping (VLSM) studies have revealed brain voxels associated with motor impairment. A combined VLSM- CST-LL approach may give particular weight to voxels that are both part of an impairment map and the descending motor tracts. Hypothesis: A combined VLSM-wCST-LL model can predict acute motor outcome better than weighted CST-LL alone. Methods: We derived the VLSM map from a group of 50 chronic patients with variable motor deficits relating voxels of patients’ lesions to Upper Extremity Fugl-Meyer (UE-FM) scores. A correction for multiple comparisons was applied at FDR<0.05. Resulting VLSM T-maps were multiplied using our probabilistic CST maps, and then summed to form a canonical VLSM-weighted CST tract. Individual lesion maps from 76 acute stroke patients were overlaid onto the VLSM-weighted CST map to calculate lesion load. Patients were assessed for motor impairment (UE-FM) at baseline and at 3 months. Linear regressions were fit for baseline UE-FM, wCST-LL, and Days-of-Therapy (DoT) to determine predictions of 3-months outcome. A multivariate regression was run using VSLM-weighted CST-LL, controlling for baseline UE-FM and DoT. Age was not a significant regressor. Akaike Information Criterion was run to select the best fit model. Results: The VLSM analysis determined that voxels of lesions in the precentral gyrus, premotor regions, the corona radiata region, and within the descending motor tracts were significantly related to chronic motor impairment. VLSM-CST-LL applied to a group of acute stroke patients with motor impairment predicted 85% of the variance at 3 months motor outcome. AIC results confirmed with 99% certainty that VLSM is the best fit model. Conclusions: VLSM-weighted CST-LL is the superior fit model compared to the weighted CST-LL model for predicting 3 months outcome.

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