scholarly journals Changes in arm kinematics of chronic stroke individuals following “Assist-As-Asked” robot-assisted training in virtual and physical environments: A proof-of-concept study

2020 ◽  
Vol 7 ◽  
pp. 205566832092605
Author(s):  
Nahid Norouzi-Gheidari ◽  
Philippe S Archambault ◽  
Joyce Fung
Keyword(s):  
Virtual Environments ◽  
Motor Impairment ◽  
Chronic Stroke ◽  
Proof Of Concept ◽  
Robot Assisted ◽  
Concept Study ◽  
Physical Environments ◽  
Kinematic Measures ◽  
Upper Extremity Motor Impairment ◽  
Training Protocol

Introduction In this proof-of-concept study, we introduce a custom-developed robot-assisted training protocol, named “Assist-As-Asked”, aiming at improving arm function of chronic stroke subjects with moderate-to-severe upper extremity motor impairment. The study goals were to investigate the feasibility and potential adverse effects of this training protocol in both physical and virtual environments. Methods A sample of convenience of four chronic stroke subjects participated in 10 half-hour sessions. The task was to practice reaching six targets in both virtual and physical environments. The robotic arm used the Assist-As-Asked paradigm in which it helped subjects to complete movements when asked by them. Changes in the kinematics of the reaching movements and the participants’ perception of the reaching practice in both environments were the outcome measures of interest. Results Subjects improved their reaching performance and none of them reported any adverse events. There were no differences between the two environments in terms of kinematic measures even though subjects had different opinions about the environment preference. Conclusions Using the Assist-As-Asked protocol in moderate-to-severe chronic stroke survivors is feasible and it can be used with both physical and virtual environments with no evidence of one of them to be superior to the other based on users’ perspectives and movement kinematics.

scholarly journals Development of the Home based Virtual Rehabilitation System (HoVRS) to remotely deliver an intense and customized upper extremity training

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Qinyin Qiu ◽  
Amanda Cronce ◽  
Jigna Patel ◽  
Gerard G. Fluet ◽  
Ashley J. Mont ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Chronic Stroke ◽  
Hand Rehabilitation ◽  
Kinematic Data ◽  
Virtual Rehabilitation ◽  
Home Based ◽  
Rehabilitation System ◽  
Kinematic Measures ◽  
And Training ◽  
Training Protocol

Abstract Background After stroke, sustained hand rehabilitation training is required for continuous improvement and maintenance of distal function. Methods In this paper, we present a system designed and implemented in our lab: the Home based Virtual Rehabilitation System (HoVRS). Fifteen subjects with chronic stroke were recruited to test the feasibility of the system as well as to refine the design and training protocol to prepare for a future efficacy study. HoVRS was placed in subjects’ homes, and subjects were asked to use the system at least 15 min every weekday for 3 months (12 weeks) with limited technical support and remote clinical monitoring. Results All subjects completed the study without any adverse events. Subjects on average spent 13.5 h using the system. Clinical and kinematic data were collected pre and post study in the subject’s home. Subjects demonstrated a mean increase of 5.2 (SEM = 0.69) on the Upper Extremity Fugl-Meyer Assessment (UEFMA). They also demonstrated improvements in six measurements of hand kinematics. In addition, a combination of these kinematic measures was able to predict a substantial portion of the variability in the subjects’ UEFMA score. Conclusion Persons with chronic stroke were able to use the system safely and productively with minimal supervision resulting in measurable improvements in upper extremity function.

Robot-assisted therapy for upper extremity motor impairment after stroke: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Jingyi Wu ◽  
Hao Cheng ◽  
Jiaqi Zhang ◽  
Shanli Yang ◽  
Sufang Cai
Keyword(s):  
Randomized Controlled Trials ◽  
Upper Extremity ◽  
Meta Analysis ◽  
Motor Impairment ◽  
Controlled Trials ◽  
Robot Assisted ◽  
Randomized Controlled ◽  
Small Effect Size ◽  
Evidence Database ◽  
Upper Extremity Motor Impairment

Abstract Objective The purpose of this study was to review the effects of robot-assisted therapy (RT) for improving poststroke upper extremity motor impairment. Methods The PubMed, EMBASE, Medline, and Web of Science databases were searched from inception to April 8, 2020. Randomized controlled trials that were conducted to evaluate the effects of RT on upper extremity motor impairment poststroke and that used Fugl-Meyer Assessment Upper Extremity (FMA-UE) scores as an outcome were included. Two authors independently screened articles, extracted data, and assessed the methodological quality of the included studies using the Physiotherapy Evidence Database (PEDro) scale. A random-effects meta-analysis was performed to pool the effect sizes across the studies. Results Forty-one randomized controlled trials with 1916 stroke patients were included. Compared with dose-matched conventional rehabilitation, RT significantly improved the FMA-UE scores of the patients with stroke, with a small effect size (Hedges g = 0.25; 95% CI = 0.11 to 0.38; I2 = 45.9%). The subgroup analysis revealed that the effects of unilateral RT, but not that of bilateral RT, was superior to conventional rehabilitation (Hedges g = 0.32; 95% CI = 0.15 to 0.50; I2 = 55.9%). Regarding the type of robot devices, the effects of the end effector device (Hedges g = 0.22; 95% CI = 0.09 to −0.36; I2 = 35.4%), but not the exoskeleton device, were superior to conventional rehabilitation. Regarding the stroke stage, the between-group difference (ie, RT vs convention rehabilitation) was significant only for people with late subacute or chronic stroke (Hedges g = 0.33; 95% CI = 0.16 to 0.50; I2 = 34.2%). Conclusion RT might be superior to conventional rehabilitation in improving upper extremity motor impairment in people after stroke with notable upper extremity hemiplegia and limited potential for spontaneous recovery.

scholarly journals Development of the Home based Virtual Rehabilitation System (HoVRS) to Remotely Deliver an Intense and Customized Upper Extremity Training

2020 ◽  
Author(s):  
Qinyin Qiu ◽  
Amanda Cronce ◽  
Jigna Patel ◽  
Gerard G Fluet ◽  
Ashley Mont ◽  
...  
Keyword(s):  
Hand Function ◽  
Chronic Stroke ◽  
Hand Rehabilitation ◽  
Kinematic Data ◽  
Virtual Rehabilitation ◽  
Home Based ◽  
Rehabilitation System ◽  
Kinematic Measures ◽  
And Training ◽  
Training Protocol

Abstract Background: After stroke, sustained hand rehabilitation training is required for continuous improvement and maintenance of distal function. Methods: In this paper, we present a system designed and implemented in our lab: the Home based Virtual Rehabilitation System (HoVRS). Fifteen subjects with chronic stroke were recruited to test the feasibility of the system as well as to refine the design and training protocol to prepare for a future efficacy study. HoVRS was placed in subjects’ homes, and subjects were asked to use the system at least 15 minutes every weekday for 3 months (12 weeks) with limited technical support and remote clinical monitoring. Results: All patients completed the study without any adverse events. Subjects on average spent 13.5 hours using the system. Clinical and kinematic data were collected pre and post study. The whole group improved on the Fugl-Meyer (FM) assessment and on six kinematic measurements. In addition, a combination of these kinematic measures was able to predict a substantial portion of subjects’ FM scores. Conclusion: The outcomes of this pilot study warrant further investigation of the system’s ability to promote recovery of hand function in subacute and chronic stroke.

scholarly journals Development of the Home based Virtual Rehabilitation System (HoVRS) to remotely deliver an intense and customized upper extremity training

2020 ◽  
Author(s):  
Qinyin Qiu ◽  
Amanda Cronce ◽  
Jigna Patel ◽  
Gerard G Fluet ◽  
Ashley Mont ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Chronic Stroke ◽  
Hand Rehabilitation ◽  
Kinematic Data ◽  
Virtual Rehabilitation ◽  
Home Based ◽  
Rehabilitation System ◽  
Kinematic Measures ◽  
And Training ◽  
Training Protocol

Abstract Background: After stroke, sustained hand rehabilitation training is required for continuous improvement and maintenance of distal function. Methods: In this paper, we present a system designed and implemented in our lab: the Home based Virtual Rehabilitation System (HoVRS). Fifteen subjects with chronic stroke were recruited to test the feasibility of the system as well as to refine the design and training protocol to prepare for a future efficacy study. HoVRS was placed in subjects’ homes, and subjects were asked to use the system at least 15 minutes every weekday for 3 months (12 weeks) with limited technical support and remote clinical monitoring. Results: All subjects completed the study without any adverse events. Subjects on average spent 13.5 hours using the system. Clinical and kinematic data were collected pre and post study in the subject’s home. Subjects demonstrated a mean increase of 5.2 (SEM=0.69) on the Upper Extremity Fugl-Meyer Assessment (UEFMA). They also demonstrated improvements in six measurements of hand kinematics. In addition, a combination of these kinematic measures was able to predict a substantial portion of the variability in the subjects’ UEFMA score. Conclusion: Persons with chronic stroke were able to use the system safely and productively with minimal supervision resulting in measurable improvements in upper extremity function.

scholarly journals Task-specific training for improving propulsion symmetry and gait speed in people in the chronic phase after stroke: a proof-of-concept study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
J. F. Alingh ◽  
B. E. Groen ◽  
J. F. Kamphuis ◽  
A. C. H. Geurts ◽  
V. Weerdesteyn
Keyword(s):  
Gait Speed ◽  
Daily Life ◽  
Gait Training ◽  
Chronic Stroke ◽  
Stroke Survivors ◽  
Proof Of Concept ◽  
Concept Study ◽  
Walking Activity ◽  
Robotic Gait ◽  
Functional Gait

Abstract Background After stroke, some individuals have latent, propulsive capacity of the paretic leg, that can be elicited during task-specific gait training. The aim of this proof-of-concept study was to investigate the effect of five-week robotic gait training for improving propulsion symmetry by increasing paretic propulsion in chronic stroke survivors. Methods Twenty-nine individuals with chronic stroke and impaired paretic propulsion (≥ 8% difference in paretic vs. non-paretic propulsive impulse) were enrolled. Participants received ten 60-min sessions of individual robotic gait training targeting paretic propulsion (five weeks, twice a week), complemented with home exercises (15 min/day) focusing on increasing strength and practicing learned strategies in daily life. Propulsion measures, gait kinematics and kinetics, self-selected gait speed, performance of functional gait tasks, and daily-life mobility and physical activity were assessed five weeks (T0) and one week (T1) before the start of intervention, and one week (T2) and five weeks (T3) after the intervention period. Results Between T0 and T1, no significant differences in outcomes were observed, except for a marginal increase in gait speed (+ 2.9%). Following the intervention, propulsion symmetry (+ 7.9%) and paretic propulsive impulse had significantly improved (+ 8.1%), whereas non-paretic propulsive impulse remained unchanged. Larger gains in propulsion symmetry were associated with more asymmetrical propulsion at T0. In addition, following the intervention significantly greater paretic trailing limb angles (+ 6.6%) and ankle plantarflexion moments (+ 7.1%) were observed. Furthermore, gait speed (+ 7.2%), 6-Minute Walk Test (+ 6.4%), Functional Gait Assessment (+ 6.5%), and daily-life walking intensity (+ 6.9%) had increased following the intervention. At five-week follow-up (T3), gains in all outcomes were retained, and gait speed had further increased (+ 3.6%). Conclusions The post-intervention gain in paretic propulsion did not only translate into improved propulsion symmetry and gait speed, but also pertained to performance of functional gait tasks and daily-life walking activity levels. These findings suggest that well-selected chronic stroke survivors may benefit from task-specific targeted training to utilize the residual propulsive capacity of the paretic leg. Future research is recommended to establish simple baseline measures for identification of individuals who may benefit from such training and confirm benefits of the used training concepts in a randomized controlled trial. Trial registration: Registry number ClinicalTrials.gov (www.clinicaltrials.gov): NCT04650802, retrospectively registered 3 December 2020.

scholarly journals Using ambulatory virtual environments for the assessment of functional gait impairment: A proof-of-concept study

2010 ◽  
Vol 31 (4) ◽  
pp. 533-536 ◽  
Author(s):  
Martin Gérin-Lajoie ◽  
Deborah McK. Ciombor ◽  
William H. Warren ◽  
Roy K. Aaron
Keyword(s):  
Virtual Environments ◽  
Proof Of Concept ◽  
Gait Impairment ◽  
Concept Study ◽  
Functional Gait
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