scholarly journals Evidence of Neuroplasticity With Robotic Hand Exoskeleton Study for Post-Stroke Rehabilitation: A Randomized Controlled Trial

2020 ◽  
Author(s):  
Neha Singh ◽  
Megha Saini ◽  
Nand Kumar ◽  
M.V. Padma Srivast ◽  
Amit Mehndiratta
Keyword(s):  
Cortical Excitability ◽  
Motor Evoked Potential ◽  
Clinical Scales ◽  
Robotic Therapy ◽  
Randomized Controlled ◽  
Active Range Of Motion ◽  
Modified Ashworth Scale ◽  
Resting Motor Threshold ◽  
Motor Outcomes ◽  
Ashworth Scale

Abstract Background: A novel electromechanical robotic-exoskeleton was designed in-house for rehabilitation of wrist joint and Metacarpophalangeal (MCP) joint. Objective: The objective was to compare the rehabilitation effectiveness (clinical-scales and neurophysiological-measures) of robotic-therapy training-sessions with dose-matched control in patients with stroke. Methods: A pilot prospective parallel single-blinded randomized controlled study at clinical-settings was designed with patients with stroke within 2 years of chronicity. Patients were randomly assigned to receive an intervention of 20 sessions of 45-minutes each, five days a week for four-weeks, in Robotic-therapy Group (RG) (n=12) and conventional upper-limb rehabilitation in Control-Group (CG) (n=11). We hypothesized to evaluate the exoskeleton based therapy for the effects on functionality of upper-limb and cortical-excitability in patients with stroke as compared to conventional-rehabilitation. Clinical-scales– Modified Ashworth Scale, Active Range of Motion, Barthel-Index, Brunstrom-stage and Fugl-Meyer scale (Shoulder/Elbow and Wrist/Hand component), and neurophysiological-measures of cortical-excitability (using Transcranial Magnetic Stimulation) –Motor Evoked Potential and Resting Motor-threshold, were acquired pre and post-therapy. No side effects were noticed in any of the patients. Results: RG and CG showed significant (p<0.05) improvement in all clinical motor-outcomes except Modified Ashworth Scale in CG. RG showed significantly (p<0.05) higher improvement over CG in Modified Ashworth Scale, Active Range of Motion and Fugl-Meyer (FM) scale and FM Wrist-/Hand component). Increase in cortical-excitability in ipsilesional-hemisphere was found to be statistically significant (p<0.05) in RG over CG, as indexed by decrease in Resting Motor-Threshold and increase in amplitude of Motor Evoked Potential. No significant changes were shown by the contralesional-hemisphere. Interhemispheric RMT-asymmetry evidenced significant (p<0.05) changes in RG over CG indicating increased cortical-excitability in ipsilesional-hemisphere along with interhemispheric changes. Conclusion: Neurophysiological-changes in RG could most likely be a consequence of plastic-reorganization and use-dependent plasticity. Robotic-exoskeleton training could significantly improve motor-outcomes and cortical-excitability in patients with stroke.

scholarly journals Evidence of neuroplasticity with robotic hand exoskeleton study for post-stroke rehabilitation: a randomized controlled trial

2021 ◽  
Author(s):  
Neha Singh ◽  
Megha Saini ◽  
Nand Kumar ◽  
M.V. Padma Srivast ◽  
Amit Mehndiratta
Keyword(s):  
Cortical Excitability ◽  
Motor Evoked Potential ◽  
Clinical Scales ◽  
Robotic Therapy ◽  
Randomized Controlled ◽  
Active Range Of Motion ◽  
Modified Ashworth Scale ◽  
Resting Motor Threshold ◽  
Motor Outcomes ◽  
Ashworth Scale

Abstract Background: A novel electromechanical robotic-exoskeleton was designed in-house for the rehabilitation of wrist joint and Metacarpophalangeal (MCP) joint. Objective: The objective was to compare the rehabilitation effectiveness (clinical-scales and neurophysiological measures) of robotic-therapy training sessions with dose-matched \conventional therapy in patients with stroke.Methods: A pilot prospective parallel randomized controlled study at clinical-settings was designed with patients with stroke within 2 years of chronicity. Patients were randomly assigned to receive an intervention of 20 sessions of 45 minutes each, five days a week for four weeks, in Robotic-therapy Group (RG) (n=12) and conventional upper-limb rehabilitation in Control-Group (CG) (n=11). We hypothesized to evaluate the exoskeleton based therapy for the effects on the functionality of upper-limb and cortical-excitability in patients with stroke as compared to conventional rehabilitation. Clinical-scales– Modified Ashworth Scale, Active Range of Motion, Barthel Index, Brunnstrom Stage and Fugl-Meyer scale, and neurophysiological measures of cortical-excitability (using Transcranial Magnetic Stimulation) –Motor Evoked Potential and Resting Motor threshold, were acquired pre and post-therapy. No side effects were noticed in any of the patients. Results: Both RG and CG showed significant (p<0.05) improvement in all clinical motor-outcomes except Modified Ashworth Scale in CG. RG showed significantly (p<0.05) higher improvement over CG in Modified Ashworth Scale, Active Range of Motion, and Fugl-Meyer (FM) scale and FM Wrist-/Hand component. An increase in cortical-excitability in ipsilesional-hemisphere was found to be statistically significant (p<0.05) in RG over CG, as indexed by a decrease in Resting Motor Threshold and increase in the amplitude of Motor Evoked Potential. No significant changes were shown by the contralesional-hemisphere. Interhemispheric RMT-asymmetry evidenced significant (p<0.05) changes in RG over CG indicating increased cortical-excitability in ipsilesional-hemisphere along with interhemispheric changes. Conclusion: Robotic-exoskeleton training appears to be benificial for improving motor-outcomes and cortical-excitability in patients with stroke. Neurophysiological changes in RG could most likely be a consequence of plastic reorganization and use-dependent plasticity. Trial Registry Number: ISRCTN95291802

scholarly journals Evidence of Neuroplasticity: A Robotic Hand Exoskeleton Study for Post-Stroke Rehabilitation

2020 ◽  
Author(s):  
Neha Singh ◽  
Megha Saini ◽  
Nand Kumar ◽  
M.V. Padma Srivast ◽  
Amit Mehndiratta
Keyword(s):  
Evoked Potential ◽  
Cortical Excitability ◽  
Motor Evoked Potential ◽  
Clinical Scales ◽  
Robotic Therapy ◽  
Active Range Of Motion ◽  
Modified Ashworth Scale ◽  
Resting Motor Threshold ◽  
Motor Outcomes ◽  
Ashworth Scale

Abstract Background: A novel electromechanical robotic-exoskeleton was designed in-house for rehabilitation of wrist joint and Metacarpophalangeal (MCP) joint. Objective: The objective was to compare the rehabilitation effectiveness (clinical-scales and neurophysiological-measures) of robotic-therapy training-sessions with dose-matched control in patients with stroke. Methods: An observational pilot study was designed with patients within 2 years of chronicity. Patients received an intervention of 20 sessions of 45-minutes each, five days a week for four-weeks) in Robotic-therapy Group (RG) (n=12) and conventional upper-limb rehabilitation in Control-Group (CG) (n=11). Clinical-scales– Modified Ashworth Scale, Active Range of Motion, Barthel-Index, Brunstrom-stage and Fugl-Meyer scale (Shoulder/Elbow and Wrist/Hand component), and neurophysiological-measures of cortical-excitability (using Transcranial Magnetic Stimulation) –Motor Evoked Potential and Resting Motor-threshold, were acquired pre and post-therapy. Results: RG and CG showed significant improvement in all clinical motor-outcomes (p<0.05) except Modified Ashworth Scale in CG. RG showed significantly higher improvement over CG in Modified Ashworth Scale, Active Range of Motion and Fugl-Meyer (FM) scale and FM Wrist-/Hand component) (p<0.05). Increase in cortical-excitability in ipsilesional-hemisphere was found to be statistically significant in RG over CG, as indexed by decrease in Resting Motor-Threshold and increase in amplitude of Motor Evoked Potential (p<0.05). No significant changes were shown by the contralesional-hemisphere. Interhemispheric RMT-asymmetry evidenced significant changes in RG over CG (p<0.05) indicating increased cortical-excitability in ipsilesional-hemisphere along with interhemispheric changes.Conclusion: Neurophysiological-changes in RG could be most likely a consequence of plastic-reorganization and use-dependent plasticity. Robotic-exoskeleton training could significantly improve motor-outcomes and cortical-excitability in patients with stroke.Registry number: IEC/NP-99/13.03.2015

scholarly journals A Case Report: Effect of Robotic Exoskeleton Based Therapy on Neurological and Functional Recovery of a Patient With Chronic Stroke

2021 ◽  
Vol 12 ◽  
Author(s):  
Neha Singh ◽  
Megha Saini ◽  
Nand Kumar ◽  
M. V. Padma Srivastava ◽  
S. Senthil Kumaran ◽  
...  
Keyword(s):  
Case Report ◽  
Right Hemisphere ◽  
Cortical Excitability ◽  
Motor Evoked Potential ◽  
Chronic Stroke ◽  
Precentral Gyrus ◽  
Clinical Scales ◽  
Robotic Exoskeleton ◽  
The Right ◽  
Motor Outcomes

Background: In this study, a novel electromechanical robotic exoskeleton was developed for the rehabilitation of distal joints. The objective was to explore the functional MRI and the neurophysiological changes in cortical-excitability in response to exoskeleton training for a 9-year chronic stroke patient.Case-Report: The study involved a 52-year old female patient with a 9-year chronic stroke of the right hemisphere, who underwent 20 therapy sessions of 45 min each. Cortical-excitability and clinical-scales: Fugl-Mayer (FM), Modified Ashworth Scale (MAS), Brunnstrom-Stage (BS), Barthel-Index (BI), Range of Motion (ROM), were assessed pre-and post-therapy to quantitatively assess the motor recovery.Clinical Rehabilitation Impact: Increase in FM wrist/hand by 6, BI by 10, and decrease in MAS by 1 were reported. Ipsilesional Motor Evoked Potential (MEP) (obtained using Transcranial Magnetic Stimulation) was increased by 98 μV with a decrease in RMT by 6% and contralesional MEP was increased by 43 μV with a decrease in RMT by 4%. Laterality Index of Sensorimotor Cortex (SMC) reduced in precentral- gyrus (from 0.152 to −0.707) and in postcentral-gyrus (from 0.203 to −0.632).Conclusion: The novel exoskeleton-based training showed improved motor outcomes, cortical excitability, and neuronal activation. The research encourages the further investigation of the potential of exoskeleton training.

Assessing Motor Deficits in Neurological Rehabilitation: Patterns of Instrument Usage

2001 ◽  
Vol 15 (1) ◽  
pp. 23-30 ◽  
Author(s):  
Frederike M.J. van Wijck ◽  
Anand D. Pandyan ◽  
Garth R Johnson ◽  
Michael P. Barnes
Keyword(s):  
Assessment Tools ◽  
Motor Deficits ◽  
Measurement Technology ◽  
Neurological Rehabilitation ◽  
Clinical Scales ◽  
Frequent Use ◽  
Modified Ashworth Scale ◽  
Use Of Assessment ◽  
Assessment Scales ◽  
Ashworth Scale

To describe current patterns in the use of clinical scales and measurement tech nology for the assessment of motor deficits in neurological rehabilitation. Question naire, sent to the 2,556 members of the World Forum for Neurological Rehabilita tion, distributed over 75 countries. Sixty-eight questionnaires were returned. Generally, participants indicated that the centres where they were based used a num ber of different clinical assessment scales (median, three), most frequently with a small proportion of patients. The (Modified) Ashworth Scale, the FIM, and the Fugl-Meyer were used most frequently. Only 35 respondents stated that their centre used one or more scales in >75% of their patients, but the choice of such routinely applied in struments varied between centres. The application of measurement technology was re stricted, with video and goniometry being used most frequently. The main barriers to more frequent use of assessment tools were perceived to be a lack of resources, infor mation, and training. The (albeit limited) results from this survey suggest that the assessment of motor deficits in neurological rehabilitation is currently mostly qualita tive and lacks standardisation. More resources and education are required to support a more routine application of assessment tools and to integrate measurement tech nology further in neurological rehabilitation to assist in the process of quantification of outcomes. Key Words: Motor deficits—Neurological rehabilitation—Outcome as sessment—Standardisation—Measurement technology.

Cortical dysfunction underlies disability in multiple sclerosis

2011 ◽  
Vol 18 (4) ◽  
pp. 425-432 ◽  
Author(s):  
Steve Vucic ◽  
Therese Burke ◽  
Kerry Lenton ◽  
Sudarshini Ramanathan ◽  
Lavier Gomes ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cortical Excitability ◽  
Short Interval ◽  
Motor Evoked Potential ◽  
Intracortical Inhibition ◽  
Progressive Multiple Sclerosis ◽  
Conduction Time ◽  
Cortical Function ◽  
Resting Motor Threshold ◽  
Cortical Dysfunction

Background: Gray matter atrophy has been implicated in the development of secondary progressive multiple sclerosis (SPMS). Cortical function may be assessed by transcranial magnetic stimulation (TMS). Determining whether cortical dysfunction was a feature of SPMS could be of pathophysiological significance. Objectives: Consequently, novel paired-pulse threshold tracking TMS techniques were used to assess whether cortical dysfunction was a feature of SPMS. Methods: Cortical excitability studies were undertaken in 15 SPMS, 25 relapsing–remitting MS patients (RRMS) and 66 controls. Results: Short interval intracortical inhibition (SPMS 3.0 ± 2.1%; RRMS 12.8 ± 1.7%, p < 0.01; controls 10.5 ± 0.7%, p < 0.01) and motor evoked potential (MEP) amplitude (SPMS 11.5 ± 2.2%; RRMS 26.3 ± 3.6%, p <0.05; controls 24.7 ± 1.8%, p < 0.01) were reduced in SPMS, while intracortical facilitation (SPMS -5.2 ± 1.9%; RRMS -2.0 ± 1.4, p < 0.05; controls -0.9 ± 0.7, p < 0.01) and resting motor threshold were increased (SPMS 67.5 ± 4.5%; RRMS 56.0 ± 1.5%, p < 0.01; controls 59.0 ± 1.1%, p < 0.001). Further, central motor conduction time was prolonged in SPMS (9.1 ± 1.2 ms, p < 0.001) and RRMS (7.0 ± 0.9 ms, p < 0.05) patients compared with controls (5.5 ± 0.2 ms). The observed changes in cortical function correlated with the Expanded Disability Status Scale. Conclusion: Together, these findings suggest that cortical dysfunction is associated with disability in MS, and documentation of such cortical dysfunction may serve to quantify disease severity in MS.

scholarly journals Low-Frequency Repetitive Transcranial Magnetic Stimulation for Stroke-Induced Upper Limb Motor Deficit: A Meta-Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-12 ◽  
Author(s):  
Lan Zhang ◽  
Guoqiang Xing ◽  
Shiquan Shuai ◽  
Zhiwei Guo ◽  
Huaping Chen ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Upper Limb ◽  
Magnetic Stimulation ◽  
Cortical Excitability ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Meta Analysis ◽  
Low Frequency ◽  
Motor Evoked Potential ◽  
Motor Deficit ◽  
Resting Motor Threshold

Background and Purpose. This meta-analysis aimed to evaluate the therapeutic potential of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) over the contralesional hemisphere on upper limb motor recovery and cortex plasticity after stroke.Methods. Databases of PubMed, Medline, ScienceDirect, Cochrane, and Embase were searched for randomized controlled trials published before Jun 31, 2017. The effect size was evaluated by using the standardized mean difference (SMD) and a 95% confidence interval (CI). Resting motor threshold (rMT) and motor-evoked potential (MEP) were also examined.Results. Twenty-two studies of 1 Hz LF-rTMS over the contralesional hemisphere were included. Significant efficacy was found on finger flexibility (SMD = 0.75), hand strength (SMD = 0.49), and activity dexterity (SMD = 0.32), but not on body function (SMD = 0.29). The positive changes of rMT (SMD = 0.38 for the affected hemisphere and SMD = −0.83 for the unaffected hemisphere) and MEP (SMD = −1.00 for the affected hemisphere and SMD = 0.57 for the unaffected hemisphere) were also significant.Conclusions. LF-rTMS as an add-on therapy significantly improved upper limb functional recovery especially the hand after stroke, probably through rebalanced cortical excitability of both hemispheres. Future studies should determine if LF-rTMS alone or in conjunction with practice/training would be more effective.Clinical Trial Registration Information. This trial is registered with unique identifierCRD42016042181.

scholarly journals Acupuncture versus Rehabilitation in the Treatment of Ischemic Stroke Recovery: A Randomized Controlled Trial

2019 ◽  
Author(s):  
Lixia Li ◽  
Weifeng Zhu ◽  
Guohua Lin ◽  
Chuyun Chen ◽  
Donghui Tang ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Ischemic Stroke ◽  
Controlled Trial ◽  
Stroke Recovery ◽  
Control Group ◽  
Acupuncture Points ◽  
Randomized Controlled ◽  
Modified Ashworth Scale ◽  
Significant Difference ◽  
Ashworth Scale

Abstract Background: Acupuncture is a treatment for ischemic stroke recovery, but evidence of its effectiveness remains limited. Methods: A total of 497 patients with ischemic stroke were randomized into Arm 1 (159 cases), Arm 2 (173 cases) and a control group (165 cases). In the control group, rehabilitation training was provided. In Arm 1 and Arm 2, acupoint schemes were determined by the consensus of acupuncture experts and previous clinical research. Arm 1 was based on an acupoint summary of ancient literature, and Arm 2 was based on the summary of effective acupuncture points in modern RCT literature. The treatment was given with conventional acupuncture at the appropriate position. After acupuncture, the needles were left in for 30 minutes, and checked every 10 minutes. The three groups received treatment once a day, 5 times a week, for 2 weeks. The primary outcome were the National Institute of Health stroke scale (NIHSS), and the secondary outcomes were the Barthel index (BI) and modified Ashworth scale (MAS). Outcomes were observed in patients both before and after treatment. Results: After 2 weeks of treatment, there was no significant difference between Arm 1 and the control group for either the BI scores or the modified Ashworth scale scores (P>0.05). However, the NIHSS scores of Arm 1 were lower than those of the control group (P=0.017); the BI scores were higher in Arm 2 than they were in the control group (P=0.020). Conclusion: The clinical efficacy of Arm 1 and Arm 2 (acupuncture groups) was superior to that of the control group. Trial Registration: Chinese Clinical Trial Registry: ChiCTR-IOR-16008627, Registered 11 June 2016, http://www.chictr.org.cn/index.aspx. Keywords: Acupuncture; ischemic stroke; randomized controlled trial (RCT)

scholarly journals Advanced quantitative estimation methods for spasticity: a literature review

2019 ◽  
Vol 48 (3) ◽  
pp. 030006051988842
Author(s):  
Zichong Luo ◽  
Wai Leung Ambrose Lo ◽  
Ruihao Bian ◽  
Sengfat Wong ◽  
Le Li
Keyword(s):  
Surface Electromyography ◽  
Quantitative Estimation ◽  
Estimation Methods ◽  
Clinical Scales ◽  
Post Stroke ◽  
Modified Ashworth Scale ◽  
Neural Information ◽  
Neural Factors ◽  
Ashworth Scale

Post-stroke spasticity seriously affects patients’ quality of life. Spasticity is considered to involve both neural and non-neural factors. Current clinical scales, such as the Modified Ashworth Scale and the Modified Tardieu Scale, lack reliability and reproducibility. These scales are also unable to identify the neural and non-neural contributions to spasticity. Surface electromyography and biomechanical and myotonometry measurement methods for post-stroke spasticity are discussed in this report. Surface electromyography can provide neural information, while myotonometry can estimate muscular properties. Both the neural and non-neural contributions can be estimated by biomechanical measurement. These laboratory methods can quantitatively assess spasticity. They can provide more valuable information for further study on treatment and rehabilitation than clinical scales.

Effects of pressure garment on spasticity and function of the arm in the early stages after stroke: a randomized controlled trial

2020 ◽  
Vol 34 (4) ◽  
pp. 515-523
Author(s):  
Hwa Kee Ooi ◽  
Siaw Chui Chai ◽  
Masne Kadar
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Randomized Controlled ◽  
Early Stages ◽  
Modified Ashworth Scale ◽  
The Mean ◽  
And Function ◽  
Ashworth Scale

Objective: To investigate the effects of pressure (Lycra) garment on the spasticity and function of the arm in the early stages after stroke. Design: A randomized controlled trial. Setting: Occupational therapy unit of a public hospital. Subjects: A total of 46 adults with stroke. Intervention: After random assignment, for six weeks, both intervention group and control group received a 2 hour/week conventional occupational therapy program, with the intervention group receiving an extra 6 hour/day pressure garment application (long glove). Main Measures: Modified Modified Ashworth Scale, Disabilities of Arm, Shoulder and Hand Outcome Measure, and Jebsen–Taylor Hand Function Test. Eligibility measures: Mini Mental State Examination and Modified Modified Ashworth Scale. Assessments were performed at baseline and six weeks postintervention. Results: There were 21 participants with the mean age of 51.19 (8.28) years in the intervention group and 22 participants with the mean (SD) age of 52.82 (8.71) years in the control group. The intervention group had median (interquartile range (IQR)) post-stroke duration of 1 (1) month, while for the control group, they were 2 (2) months. There was no difference in spasticity, and both perceived and actual arm functions between the groups at six weeks after baseline. Conclusion: Wearing a pressure garment on the arm for 6 hours daily had no effect in controlling spasticity or on improving arm function in the early stages after stroke.

scholarly journals Evaluation of Changes in Preoperative Cortical Excitability by Navigated Transcranial Magnetic Stimulation in Patients With Brain Tumor

2021 ◽  
Vol 11 ◽  
Author(s):  
Iuri Santana Neville ◽  
Alexandra Gomes dos Santos ◽  
Cesar Cimonari Almeida ◽  
Cintya Yukie Hayashi ◽  
Davi Jorge Fontoura Solla ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Cortical Excitability ◽  
Short Interval ◽  
Motor Evoked Potential ◽  
Biological Behavior ◽  
Navigated Transcranial Magnetic Stimulation ◽  
Resting Motor Threshold

Background: This prospective study aimed to evaluate the cortical excitability (CE) of patients with brain tumors surrounding or directly involving the corticospinal tract (CST) using navigated transcranial magnetic stimulation (nTMS).Methods: We recruited 40 patients with a single brain tumor surrounding or directly involving the CST as well as 82 age- and sex-matched healthy controls. The patients underwent standard nTMS and CE evaluations. Single and paired pulses were applied to the primary motor area (M1) of both affected and unaffected cerebral hemispheres 1 week before surgery. The CE parameters included resting motor threshold (RMT), motor evoked potential (MEP) ratio for 140 and 120% stimulus (MEP 140/120 ratio), short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF). Motor outcome was evaluated on hospital discharge and on 30-day and 90-day postoperative follow-up.Results: In the affected hemispheres of patients, SICI and ICF were significantly higher than in the unaffected hemispheres (p=0.002 and p=0.009, respectively). The 140/120 MEP ratio of patients' unaffected hemispheres was lower than that in controls (p=0.001). Patients with glioblastomas (GBM) had a higher interhemispheric RMT ratio than patients with grade II and III gliomas (p = 0.018). A weak correlation was observed among the RMT ratio and the preoperative motor score (R2 = 0.118, p = 0.017) and the 90-day follow-up (R2 = 0.227, p = 0.016).Conclusion: Using preoperative nTMS, we found that brain hemispheres affected by tumors had abnormal CE and that patients with GBM had a distinct pattern of CE. These findings suggest that tumor biological behavior might play a role in CE changes.

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