Acute Effect of Robotic Therapy (G-EO System™) on the Lower Limb Temperature Distribution of a Patient with Stroke Sequelae

Robotic therapy has been gaining prominence in poststroke rehabilitation programs. An example of these devices is the G-EO System™, which simulates gait as well as other more complexes standards of gait such as the steps on stairs. However, to the best of our knowledge, there are no studies that apply thermography as a tool to evaluate stroke patients who undertook rehabilitation programs with the aid of robotic devices. The patient IWPS undergoes sequelae of hemorrhagic stroke for 19 months and consequently hemiplegia, had scores of 93 points in the Fugl-Meyer scale, is undertaking a physical rehabilitation program for six months, has no complaints of discomfort due to thermic sensitivity imbalances between the plegic and the contralateral sides, and voluntarily reports that he realizes functionality improvements especially, according to his perception, due to the aid of the robotic therapy in his gait training with the G-EO System™. The thermographic images were captured by an infrared sensor FLIR T650SC. By analyzing the temperature differences between both hemispheres of the body, before, immediately after, and 30 minutes after a robotic therapy for gait training, we observed that the values firstly increased immediately after the training, but after the 30-minute rest an important thermoregulation was achieved.

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THE DEVELOPMENT OF AN EMG CONTROLLER-BASED ROBOTIC GAIT TRAINING SYSTEM AND ITS CLINICAL FEASIBILITY FOR SUBACUTE STROKE PATIENTS IN IMPROVING LOCOMOTIVE FUNCTION

Journal of Mechanics in Medicine and Biology ◽

10.1142/s0219519419400189 ◽

2019 ◽

Vol 19 (02) ◽

pp. 1940018

Author(s):

ANDY CHIEN ◽

FU-HAN HSIEH ◽

CHING HUANG ◽

FEI-CHUN CHANG ◽

NAI-HSIN MENG ◽

...

Keyword(s):

Muscle Activation ◽

Gait Cycle ◽

Gait Training ◽

Gait Pattern ◽

Rehabilitation Program ◽

Training System ◽

Stroke Patients ◽

Robotic Training ◽

Subacute Stroke ◽

Robotic Gait

One-third of stroke survivors fail to regain independent ambulation and strokes have been identified as a significant source of long-term disability and a tremendous health burden. Robot-assisted gait rehabilitation is gaining traction and advocators for its inclusion as part of the routine post-stroke rehabilitation program are on the increase. However, despite the recent technological advances in the development and design of better robotics, the research evidence on the best model of robotic training remains sparse and unclear. It is therefore the aim of the current study to comparatively investigate the clinical feasibility and efficacy of a recently developed HIWIN Robotic Gait Training System (MRG-P100) combined with the use of a lab-developed MBS-E100 EMG system as a controller on facilitating the development of an appropriate gait pattern for motor impaired subacute stroke patients. The results indicated that due to the heterogeneity of stroke-induced changes in muscle characteristics, an “auto-fit” algorithm was required to allow constant monitoring and updating of the appropriate threshold based on EMG signals captured during previous gait cycle in order to determine the desired muscle activation threshold for the current gait cycle. Eighteen participants were tested using the new auto-fit algorithm and results demonstrated a significantly more fluent and physiologically appropriate gait pattern.

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Abstract TP148: Characteristics and Estimated Rehabilitation Costs for Stroke Survivors Treated in a Community-Based Interdisciplinary Outpatient Rehabilitation Program Who Return to Work

Stroke ◽

10.1161/str.48.suppl_1.tp148 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Joan Breen ◽

Jeanne Andrusin ◽

Tom Ferlito ◽

Samantha Hobbs

Keyword(s):

Return To Work ◽

Treatment Cost ◽

Rehabilitation Program ◽

Outpatient Rehabilitation ◽

Stroke Survivors ◽

Stroke Patients ◽

Patient Centered ◽

Rehabilitation Programs ◽

Length Of Treatment ◽

Returning To Work

Background: Return to work is a motivating goal for many stroke survivors. Little is known about the cost, length of treatment, and characteristics of patients returning to work. Methods: Prospective observational study of stroke patients treated between 12/2014-6/2016 in an interdisciplinary outpatient rehabilitation program addressing physical, psychosocial, cognitive, communicative, driving, and vocational issues. The estimated average cost of treatment was calculated from reimbursement amounts received for skilled PT, OT, ST, and Nurse Practitioner services, including services received after patients returned to work. Results: Of 96 consecutive patients, 48% were working prior to their stroke. Of these, 9% of patients were work capable and 44% returned to work (n=20) by rehabilitation discharge (mean program length was 8 months, maximum of 34 months). Returning workers were 70% men, mean age of 56 years, 75% ischemic strokes (4 Left, 4 Right, 3 Bi-lateral hemisphere, 4 posterior circulation), and on program admit had an average NIHSS score of 3.4 (range 0-9), 40% were aphasic, 65% needed ADL assistance (55% mRS=3, 10% mRS=4). All patients working prior to their stroke were also driving and 90% of those who returned to work also returned to driving. All patients demonstrated improvements in multiple standardized rehab outcome measures. Mean treatment cost for patients who returned to work was $17,730 (60% had costs less than $7,500; 25% had costs from $7,501-$21,000; 15% had costs from $50,000-$92,000). Services continued for 75% of patients after returning to work for an average of 3.7 months(included in mean program length of 8 months). Almost half of these patients (47%) were aphasic. Mean treatment cost for patients not returning to work was $22,561, with mean program length of 6.5 months. Conclusions: These findings demonstrate that interdisciplinary, outpatient rehabilitation programs can promote successful return to work at a reasonable cost, with 60% of patients who returned to work costing less than $7500. Aphasic patients needed longer treatment, but were able to successfully return to work. Additional outcomes research is needed to understand mechanisms supporting stroke patients’ return to work and other patient-centered goals.

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A New Software for Quantifying Motor Deficit After Stroke: A Case–Control Feasibility Pilot Study

Frontiers in Neurology ◽

10.3389/fneur.2021.603619 ◽

2021 ◽

Vol 12 ◽

Author(s):

Raquel Gutiérrez Zúñiga ◽

María Alonso de Leciñana ◽

Alejandro Díez ◽

Gabriel Torres Iglesias ◽

Alejandro Pascual ◽

...

Keyword(s):

Pilot Study ◽

Motor Impairment ◽

Case Control ◽

The Body ◽

Motor Deficit ◽

Body Sway ◽

Shoulder Abduction ◽

Stroke Patients ◽

Rehabilitation Programs ◽

Degree Of Disability

Introduction: The degree of disability after stroke needs to be objectively measured to implement adequate rehabilitation programs. Here, we evaluate the feasibility of a custom-built software to assess motor status after stroke.Methods: This is a prospective, case–control pilot study comparing stroke patients with healthy volunteers. A workout evaluation that included trunk and upper limb movement was captured with Kinect® and kinematic metrics were extracted with Akira®. Trunk and joint angles were analyzed and compared between cases and controls. Patients were evaluated within the first week from stroke onset using the National Institutes of Health Stroke Scale (NIHSS), Fulg-Meyer Assessment (FMA), and modified Rankin Scale (mRS) scales; the relationship with kinematic measurements was explored.Results: Thirty-seven patients and 33 controls were evaluated. Median (IQR) NIHSS of cases was 2 (0–4). The kinematic metrics that showed better discriminatory capacity were body sway during walking (less in cases than in controls, p = 0.01) and the drift in the forearm–trunk angle during shoulder abduction in supination (greater in cases than in controls, p = 0.01). The body sway during walking was moderately correlated with NIHSS score (Rho = −0.39; p = 0.01) but better correlated with mRS score (Rho = −0.52; p < 0.001) and was associated with the absence of disability (mRS 0–1) (OR = 0.64; p = 0.02). The drift in the forearm–trunk angle in supination was associated with the presence of disability (mRS >1) (OR = 1.27; p = 0.04).Conclusion: We present a new software that detects even mild motor impairment in stroke patients underestimated by clinical scales but with an impact on patient functionality.

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Abstract WP195: Patients Beginning Community Based Outpatient Stroke Rehabilitation Program More Than 6 Months Post Stroke Achieve Equally Excellent Outcomes as Sub-Acute Patients

Stroke ◽

10.1161/str.47.suppl_1.wp195 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Joan Breen ◽

Jeanne Andrusin ◽

Tom Ferlito

Keyword(s):

Activities Of Daily Living ◽

Daily Living ◽

Rehabilitation Program ◽

Chronic Stroke ◽

Outpatient Rehabilitation ◽

Stroke Severity ◽

Stroke Patients ◽

Community Based ◽

Post Stroke ◽

Rehabilitation Programs

Background: Despite the availability of community based outpatient rehabilitation programs in the U.S., few use standardized measure sets and assessments, and outcomes studies are sparse. There is especially a knowledge gap regarding outcomes of participating chronic stroke patients (rehabilitation begins more than 6 months post stroke). Methods: Prospective observational study of stroke patients treated between 12/2011-1/2015 in an interdisciplinary outpatient rehabilitation program that addresses health literacy, risk factors, physical, psychosocial, cognitive, communicative and vocational issues. Patients were classified as chronic if admitted to the program >6 months and sub-acute if admitted <6 months post stroke. Results: Among 96 consecutive patients, 71 were sub-acute (72% ischemic, 28% hemorrhages) and 25 chronic (68% ischemic, 32% hemorrhages) who were admitted to the program an average 18.5 months post stroke (range 6-121 months). Chronic vs subacute stroke patients were 64% vs 59% male, with no difference in age (mean 66, range 27-90 years vs 65, range 18-90 years), but with greater stroke severity (chronic mean NIHSS score 8.32, range 2-15 vs subacute NIHSS of 5.2, range 0-16). On admission, chronic vs subacute patients were 44% vs 34% aphasic and 96% vs 86% needed assistance with activities of daily living (chronic with modified Rankin Scale [mRS] of 3=28% and 4=68% vs subacute mRS of 3=65% and 4=21%). The percent change in outcomes from baseline to program discharge for subacute and chronic stroke patients is presented in the Table. Conclusions: Although age, sex and stroke types were similar in both groups, chronic patients were more severely impaired than subacute patients but achieved greater improvement in activities of daily living, recovery, walking speed, balance, and risk factor knowledge. These findings demonstrate that outpatient rehabilitation programs can aid in stroke recovery independent of time since stroke onset.

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Pengaruh Akupresur Stroke 14 Titik Terhadap Rentang Gerak Ekstermitas Atas dan Bawah pada Pasien Stroke Non Hemoragik

PROFESSIONAL HEALTH JOURNAL ◽

10.54832/phj.v2i1.139 ◽

2020 ◽

Vol 2 (1) ◽

pp. 51-63

Author(s):

Reza Indra Wiguna Reza ◽

Lalu Hersika Asmawariza

Keyword(s):

Range Of Motion ◽

Hemorrhagic Stroke ◽

Intervention Group ◽

Lower Extremities ◽

The Body ◽

Control Group ◽

Stroke Patients ◽

Post Test ◽

Upper And Lower Extremities ◽

Stroke Center

Decreased limb function is one of the complications that often occurs in non-hemorrhagic stroke patients who experience hemiparesis as a result of limited joint motion in the upper and lower extremities. Acupressure is useful in improving extremity function by increasing the movement of qi (vital energy) flow in the body, but acupressure has never been done by nurses in hospital care rooms as a therapy to prevent and overcome motor function complications in non-hemorrhagic stroke patients. This study aims to identify the effect of acupressure at 14 points on the range of motion of the upper and lower extremities in non-hemorrhagic stroke patients. This study used an experimental design with a pre-post test approach design with a control group of 38 respondents (n control and n intervention = 19). The intervention group was given 14-point stroke acupressure for 15 minutes once a day for 7 days. The results showed that there were differences between the control and control ranges between the intervention group and the control group (p = 0.000). Acupressure at 14 points is an effective intervention to increase the range of motion of the upper and lower extremities in non-hemorrhagic stroke patients who have hemiparesis. The recommendation in this study is that nurses in the stroke center can apply 14-point acupressure as one of the SOPs in the treatment of non-hemorrhagic stroke patients to improve the range of motion in the extremities.

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Kinematic variables for upper limb rehabilitation robot and correlations with clinical scales: A review

Bulletin of Electrical Engineering and Informatics ◽

10.11591/eei.v9i1.1856 ◽

2020 ◽

Vol 9 (1) ◽

pp. 75-82

Author(s):

Sulaiman Mazlan ◽

Hisyam Abdul Rahman ◽

Yeong Che Fai ◽

Babul Salam Ksm Kader Ibrahim ◽

Muhamad Saif Huq

Keyword(s):

Motor Impairment ◽

Clinical Score ◽

Rehabilitation Program ◽

Upper Body ◽

Speed Ratio ◽

Stroke Patients ◽

Upper Limb Rehabilitation ◽

Clinical Scales ◽

Robotic Devices ◽

Peak Speed

The paper presents a comprehensive review carried out to identify the kinematic variables used in upper body rehabilitation assisted by robotic devices to assess the motor impairment of stroke patients and investigates the correlation between the kinematic variables and the clinical scales. Twenty-nine kinematic variables have been studied from twenty-eight articles involving 738 subacute or chronic stroke patients. The movement of speed, distance, accuracy, peak speed, peak speed ratio and number of peak speed were found to be the most frequently used kinematic variables in the aforementioned studies. Seven out of twenty-eight included articles examined the correlations between the kinematic variables used with the clinical scales. Some kinematic variables seem to have a strong correlation with the clinical scales but most of the kinematic variables have a moderate or weak correlation value. The important kinematic variables for evaluating the motor performance during rehabilitation assisted by robotic devices have been discussed. A suitable selected set of kinematic variables and clinical scale can potentially enhance the correlation value, at the same time can predict the clinical score evaluated by physiotherapist during the rehabilitation program with a high degree of accuracy.

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Velocity Determinants in Spastic Patients after Stroke—A Gait Analysis Study

Neurology International ◽

10.3390/neurolint12030011 ◽

2020 ◽

Vol 12 (3) ◽

pp. 48-54

Author(s):

Miguel Reis e Silva ◽

Jorge Jacinto

Keyword(s):

Gait Analysis ◽

Knee Flexion ◽

Stride Length ◽

Stance Phase ◽

Gait Training ◽

Swing Phase ◽

The Body ◽

Gait Velocity ◽

Stroke Patients ◽

Exclusion Criteria

Introduction: Gait velocity in spastic patients after stroke is both a life quality and mortality predictor. However, the precise biomechanical events that impair a faster velocity in this population are not defined. This study goal is to find out which are the gait parameters associated with a higher velocity in stroke patients with spastic paresis. Methods: The registries of a Gait analysis laboratory were retrospectively analyzed. The inclusion criteria were: trials of adult stroke patients with unilateral deficits. The exclusion criteria were: trials when patients used an external walking device, an orthosis, or support by a third person. Of the 116 initial patients, after the application of the exclusion criteria, 34 patients were included in the cohort, all with spatiotemporal, static and dynamic kinematic and dynamometric studies. Results: There was a correlation of velocity with cadence, stride length of the paretic (P) limb, stride length, and time of the P and non-paretic (NP) limb, double support time, all the parameters related to hip extension during stance phase, knee flexion during swing phase, and parameters related to ankle plantarflexion during stance phase. Conclusions: The main gait analysis outcomes that have a correlation with speed are related to the formula velocity = step length × cadence or are related to stance phase events that allow the anterior projection of the body. The only swing phase outcome that has a correlation with speed is knee flexion. More studies are needed from gait analysis laboratories in order to point out the most relevant goals to achieve with gait training in spastic stroke patients.

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Beneficial Effects of Robot-Assisted Gait Training on Functional Recovery in Women after Stroke: A Cohort Study

Medicina ◽

10.3390/medicina57111200 ◽

2021 ◽

Vol 57 (11) ◽

pp. 1200

Author(s):

Nicola Lamberti ◽

Fabio Manfredini ◽

Luc Oscar Lissom ◽

Susanna Lavezzi ◽

Nino Basaglia ◽

...

Keyword(s):

Functional Recovery ◽

Statistical Significance ◽

Gait Training ◽

Functional Independence ◽

Rehabilitation Program ◽

Stroke Patients ◽

Robot Assisted ◽

Multidisciplinary Rehabilitation ◽

Subacute Stroke ◽

Significant Difference

Background and Objectives: Robot-assisted gait training (RAGT) could be a rehabilitation option for patients after experiencing a stroke. This study aims to determine the sex-related response to robot-assisted gait training in a cohort of subacute stroke patients considering mixed results previously reported. Materials and Methods: In this study, 236 participants (145 males, 91 females) were admitted to a rehabilitation facility after experiencing a stroke and performed RAGT within a multidisciplinary rehabilitation program. Functional Independence Measure (FIM) and Functional Ambulatory Category (FAC) were assessed at admission and discharge to determine sex-related outcomes. Results: At the baseline, no significant difference among sexes was observed. At the end of rehabilitation, both males and females exhibited significant improvements in FIM (71% of males and 80% of females reaching the MCID cut-off value) and FAC (∆score: men 1.9 ± 1.0; women 2.1 ± 1.1). A more remarkable improvement was observed in women of the whole population during the study, but statistical significance was not reached. When analysing the FAC variations with respect to the total number of RAGT sessions, a more significant improvement was observed in women than men (p = 0.025). Conclusion: In conclusion, among subacute stroke patients, benefits were observed following RAGT during a multidisciplinary rehabilitation program in both sexes. A greater significant recovery for women with an ischemic stroke or concerning the number of sessions attended was also highlighted. The use of gait robotics for female patients may favour a selective functional recovery after stroke.

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Use of Vestibular Rehabilitation in the Pediatric Population

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_pers-sig7-2019-0002 ◽

2019 ◽

Vol 4 (6) ◽

pp. 1399-1405 ◽

Cited By ~ 1

Author(s):

Jennifer Christy

Keyword(s):

Pediatric Population ◽

Dynamic Balance ◽

Vestibular Rehabilitation ◽

Rehabilitation Program ◽

Gross Motor ◽

Gaze Stabilization ◽

Motor Delay ◽

Rehabilitation Programs ◽

Motor Practice ◽

Balance Exercises

Purpose The purpose of this article was to provide a perspective on vestibular rehabilitation for children. Conclusion The developing child with vestibular dysfunction may present with a progressive gross motor delay, sensory disorganization for postural control, gaze instability, and poor perception of motion and verticality. It is important that vestibular-related impairments be identified early in infancy or childhood so that evidence-based interventions can be initiated. A focused and custom vestibular rehabilitation program can improve vestibular-related impairments, enabling participation. Depending on the child's age, diagnosis, severity, and quality of impairments, vestibular rehabilitation programs may consist of gaze stabilization exercises, static and dynamic balance exercises, gross motor practice, and/or habituation exercises. Exercises must be modified for children, done daily at home, and incorporated into the daily life situation.

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Diagnosis of cerebral hemorrhage before the era of computed tomography

Orvosi Hetilap ◽

10.1556/oh.2013.29739 ◽

2013 ◽

Vol 154 (44) ◽

pp. 1743-1746

Author(s):

Gergely Hofgárt ◽

Rita Szepesi ◽

Bertalan Vámosi ◽

László Csiba

Keyword(s):

Computed Tomography ◽

Cerebrospinal Fluid ◽

Positive Predictive Value ◽

Predictive Value ◽

Hemorrhagic Stroke ◽

Cranial Computed Tomography ◽

Cerebral Stroke ◽

Daily Routine ◽

Stroke Patients ◽

The Difference

Introduction: During the past decades there has been a great progress in neuroimaging methods. Cranial computed tomography is part of the daily routine now and its use allows a fast diagnosis of parenchymal hemorrhage. However, before the availability of computed tomography the differentiation between ischemic and hemorrhagic stroke was based on patient history, physical examination, percutan angiography and cerebrospinal fluid sampling, and the clinical utility could be evaluated by autopsy of deceased patients. Aim: The authors explored the diagnostic performance of cerebrospinal fluid examination for the diagnosis of ischemic and hemorrhagic stroke. Method: Data of 200 deceased stroke patients were retrospectively evaluated. All patients had liquor sampling at admission and all of them had brain autopsy. Results: Bloody or yellowish cerebrospinal fluid at admission had a positive predictive value of 87.5% for hemorrhagic stroke confirmed by autopsy, while clear cerebrospinal fluid had positive predictive value of 90.7% for ischemic stroke. Patients who had clear liquor, but autopsy revealed hemorrhagic stroke had higher protein level in the cerebrospinal fluid, but the difference was not statistically significant (p = 0.09). Conclusions: The results confirm the importance of pathological evaluation of the brain in cases deceased from cerebral stroke. With this article the authors wanted to salute for those who contributed to the development of the Hungarian neuropathology. In this year we remember the 110th anniversary of the birth, and the 60th anniversary of the death of professor Kálmán Sántha. Professor László Molnár would be 90 years old in 2013. Orv. Hetil., 154 (44), 1743–1746.

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