Alterations in Muscle Networks in the Upper Extremity of Chronic Stroke Survivors

Introduction Homework-based rehabilitation programs can help stroke survivors restore upper extremity function. However, compensatory motions can develop without therapist supervision, leading to sub-optimal recovery. We developed a visual feedback system using a live video feed or an avatar reflecting users' movements so users are aware of compensations. This pilot study aimed to evaluate validity (how well the avatar characterizes different types of compensations) and acceptability of the system. Methods Ten participants with chronic stroke performed upper-extremity exercises under three feedback conditions: none, video, and avatar. Validity was evaluated by comparing agreement on compensations annotated using video and avatar images. A usability survey was administered to participants after the experiment to obtain information on acceptability. Results There was substantial agreement between video and avatar images for shoulder elevation and hip extension (Cohen's κ: 0.6–0.8) and almost perfect agreement for trunk rotation and flexion (κ: 0.80–1). Acceptability was low due to lack of corrective prompts and occasional noise with the avatar display. Most participants suggested that an automatic compensation detection feature with visual and auditory cuing would improve the system. Conclusion The avatar characterized four types of compensations well. Future work will involve increasing sensitivity for shoulder elevation and implementing a method to detect compensations.

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Influence of Chronic Stroke on Functional Arm Reaching: Quantifying Deficits in the Ipsilesional Upper Extremity

Rehabilitation Research and Practice ◽

10.1155/2019/5182310 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10

Author(s):

Savitha Subramaniam ◽

Rini Varghese ◽

Tanvi Bhatt

Keyword(s):

Reaction Time ◽

Upper Extremity ◽

Movement Time ◽

Chronic Stroke ◽

Community Dwelling ◽

Stroke Survivors ◽

Initiation Time ◽

Peak Acceleration ◽

Movement Initiation ◽

And Performance

Purpose. The purpose of this study was to quantify ipsilesional upper extremity (UE) stand-reaching performance (kinematics and kinetics) among chronic stroke survivors.Method. Community-dwelling chronic stroke survivors (n=13) and age-similar healthy adults (n=13) performed flexion- and abduction-reaching tasks. Surface EMG and acceleration were sampled using wireless sensors from the prime movers (anterior and middle deltoid) and provided performance-outcome (reaction time, burst duration, movement time, and movement initiation time) and performance-production (peak acceleration) measures and were then evaluated.Results. Individuals with chronic stroke demonstrated significantly reduced performance outcomes (i.e., longer reaction time, burst duration, movement time, and movement initiation time) and performance production ability (i.e., smaller peak acceleration) compared to their healthy counterparts (p< 0.05) for both flexion- and abduction-reaching movements.Conclusion. Our results are suggestive of post-stroke deficits in ipsilesional motor execution during a stand-reaching task. Based on these findings, it is essential to integrate ipsilesional UE training into rehabilitation interventions as this might aid functional reaching activities of daily living and could ultimately help community-dwelling chronic stroke survivors maintain their independent living.

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Exercise-Induced Changes of the Upper Extremity in Chronic Stroke Survivors

Topics in Stroke Rehabilitation ◽

10.1310/let5-xnby-98q6-q8tg ◽

2005 ◽

Vol 12 (1) ◽

pp. 58-68 ◽

Cited By ~ 2

Author(s):

Patricia Kluding ◽

Sandra A. Billinger

Keyword(s):

Upper Extremity ◽

Chronic Stroke ◽

Stroke Survivors ◽

Exercise Induced ◽

Induced Changes

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Abstract WP205: Home-Based Virtual Reality Therapy for Hand Recovery After Stroke

Stroke ◽

10.1161/str.51.suppl_1.wp205 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Adam MacLellan ◽

Catherine Legault ◽

Alay Parikh ◽

Leonel Lugo ◽

Stephanie Kemp ◽

...

Keyword(s):

Virtual Reality ◽

Upper Extremity ◽

Large Scale ◽

Controlled Trial ◽

Hand Function ◽

Chronic Stroke ◽

Stroke Survivors ◽

Hand Rehabilitation ◽

Stroke Patients ◽

Home Based

Background: Stroke is the leading cause of disability worldwide, with many stroke survivors having persistent upper limb functional impairment. Aside from therapist-directed rehabilitation, few efficacious recovery tools are available for use by stroke survivors in their own home. Game-based virtual reality systems have already shown promising results in therapist-supervised settings and may be suitable for home-based use. Objective: We aimed to assess the feasibility of unsupervised home-based use of a virtual reality device for hand rehabilitation in stroke survivors. Methodology: Twenty subacute/chronic stroke patients with upper extremity impairment were enrolled in this prospective single-arm study. Participants were instructed to use the Neofect Smart Glove 5 days per week for 8 weeks, in single sessions of 50 minutes or two 25-minute sessions daily. We measured (1) compliance to prescribed rehabilitation dose, (2) patient impression of the intervention, and (3) efficacy measures including the upper extremity Fugl-Meyer (UE-FM), the Jebsen-Taylor hand function test (JTHFT) and the Stroke Impact Scale (SIS). Results: Seven subjects (35%) met target compliance of 40 days use, and 6 subjects (30%) used the device for 20-39 days; there were no age or gender differences in use. Subjective patient experience was favorable, with ninety percent of subjects reporting satisfaction with their overall experience, and 80% reporting perceived improvement in hand function (figure 1). There was a mean improvement of 26.6±48.8 seconds in the JTHFT ( p =0.03) and 16.1±15.3 points in the domain of the SIS that assesses hand function ( p <0.01). There was a trend towards improvement in the UE-FM (2.2±5.5 points, p =0.10). Conclusions: A novel virtual reality gaming device is suitable for unsupervised use in stroke patients and may improve hand/arm function in subacute/chronic stroke patients. A large-scale randomized controlled trial is needed to confirm these results.

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