Effects of a Robot-aided Somatosensory Training on Proprioception and Motor Function in Stroke Survivors

Abstract Background- Proprioceptive deficits after stroke are associated with poor upper limb function, slower motor recovery, and decreased self-care ability. Improving proprioception should enhance motor control in stroke survivors, but current evidence is inconclusive. Thus, this study examined whether a robot-aided somatosensory-based training requiring increasingly accurate active wrist movements improves proprioceptive acuity and motor performance in chronic stroke. Methods - Twelve adults with chronic stroke completed a 2-day training (age range: 42 – 74 years; median time-after-stroke: 12 months; median Fugl-Meyer UE: 65). Retention was assessed at Day 5. Grasping the handle of a wrist-robotic exoskeleton, participants trained to roll a virtual ball to a target through continuous wrist adduction/abduction movements. During training vision was occluded, but participants received real-time, vibro-tactile feedback on their forearm about ball position and speed. Primary outcome was the just-noticeable-difference (JND) wrist position sense threshold as a measure of proprioceptive acuity. Secondary outcomes were spatial error in an untrained wrist tracing task and somatosensory-evoked potentials (SEP) as a neural correlate of proprioceptive function. Ten neurologically-intact adults were recruited to serve as non-stroke controls for age, gender and hand dominance (age range: 44 to 79 years; 6 women, 4 men).Results – Participants significantly reduced JND thresholds at posttest and retention (F(2, 38) = 4.54, p = 0.017, ηp2 = 0.20) in both groups. A higher pretest JND threshold was associated with a higher threshold reduction at posttest and retention (r = -0.86, -0.90, p ≤ 0.001) among the stroke participants. Error in the untrained tracing task was reduced by 22% at posttest, yielding an effect size of w = 0.13. Stroke participants exhibited significantly reduced P27-N30 peak-to-peak SEP amplitude at pretest (U = 11, p = 0.03) compared to the non-stroke group. SEP measures did not change systematically with training.Conclusion - This study provides proof-of-concept that non-visual, proprioceptive training can induce fast, measurable improvements in proprioceptive function in chronic stroke survivors. There is encouraging but inconclusive evidence that such somatosensory learning transfers to untrained motor tasks.Trial Registration Clinicaltrials.gov; Registration ID: NCT02565407; Date of registration: 01/10/2015; URL: https://clinicaltrials.gov/ct2/show/NCT02565407

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Effects of a robot‐aided somatosensory training on proprioception and motor function in stroke survivors

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-021-00871-x ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

I-Ling Yeh ◽

Jessica Holst-Wolf ◽

Naveen Elangovan ◽

Anna Vera Cuppone ◽

Kamakshi Lakshminarayan ◽

...

Keyword(s):

Chronic Stroke ◽

Tactile Feedback ◽

Just Noticeable Difference ◽

Current Evidence ◽

Control Group ◽

Stroke Survivors ◽

Spatial Error ◽

Stroke Group ◽

Age Range ◽

Proprioceptive Function

Abstract Background Proprioceptive deficits after stroke are associated with poor upper limb function, slower motor recovery, and decreased self-care ability. Improving proprioception should enhance motor control in stroke survivors, but current evidence is inconclusive. Thus, this study examined whether a robot-aided somatosensory-based training requiring increasingly accurate active wrist movements improves proprioceptive acuity as well as motor performance in chronic stroke. Methods Twelve adults with chronic stroke completed a 2-day training (age range: 42–74 years; median time-after-stroke: 12 months; median Fugl–Meyer UE: 65). Retention was assessed at Day 5. Grasping the handle of a wrist-robotic exoskeleton, participants trained to roll a virtual ball to a target through continuous wrist adduction/abduction movements. During training vision was occluded, but participants received real-time, vibro-tactile feedback on their forearm about ball position and speed. Primary outcome was the just-noticeable-difference (JND) wrist position sense threshold as a measure of proprioceptive acuity. Secondary outcomes were spatial error in an untrained wrist tracing task and somatosensory-evoked potentials (SEP) as a neural correlate of proprioceptive function. Ten neurologically-intact adults were recruited to serve as non-stroke controls for matched age, gender and hand dominance (age range: 44 to 79 years; 6 women, 4 men). Results Participants significantly reduced JND thresholds at posttest and retention (Stroke group: pretest: mean: 1.77° [SD: 0.54°] to posttest mean: 1.38° [0.34°]; Control group: 1.50° [0.46°] to posttest mean: 1.45° [SD: 0.54°]; F[2,37] = 4.54, p = 0.017, ηp2 = 0.20) in both groups. A higher pretest JND threshold was associated with a higher threshold reduction at posttest and retention (r = − 0.86, − 0.90, p ≤ 0.001) among the stroke participants. Error in the untrained tracing task was reduced by 22 % at posttest, yielding an effect size of w = 0.13. Stroke participants exhibited significantly reduced P27-N30 peak-to-peak SEP amplitude at pretest (U = 11, p = 0.03) compared to the non-stroke group. SEP measures did not change systematically with training. Conclusions This study provides proof-of-concept that non-visual, proprioceptive training can induce fast, measurable improvements in proprioceptive function in chronic stroke survivors. There is encouraging but inconclusive evidence that such somatosensory learning transfers to untrained motor tasks. Trial registration Clinicaltrials.gov; Registration ID: NCT02565407; Date of registration: 01/10/2015; URL: https://clinicaltrials.gov/ct2/show/NCT02565407.

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A Novel Wearable Device for Motor Recovery of Hand Function in Chronic Stroke Survivors

Neurorehabilitation and Neural Repair ◽

10.1177/1545968320926162 ◽

2020 ◽

Vol 34 (7) ◽

pp. 600-608

Author(s):

Supriyo Choudhury ◽

Ravi Singh ◽

A. Shobhana ◽

Dwaipayan Sen ◽

Sidharth Shankar Anand ◽

...

Keyword(s):

Upper Limb ◽

Hand Function ◽

Chronic Stroke ◽

Wearable Device ◽

Stroke Survivors ◽

Limb Function ◽

Median Baseline ◽

Healthy Humans ◽

Upper Limb Function ◽

Wearable Electronic Device

Background. In monkey, reticulospinal connections to hand and forearm muscles are spontaneously strengthened following corticospinal lesions, likely contributing to recovery of function. In healthy humans, pairing auditory clicks with electrical stimulation of a muscle induces plastic changes in motor pathways (probably including the reticulospinal tract), with features reminiscent of spike-timing dependent plasticity. In this study, we tested whether pairing clicks with muscle stimulation could improve hand function in chronic stroke survivors. Methods. Clicks were delivered via a miniature earpiece; transcutaneous electrical stimuli at motor threshold targeted forearm extensor muscles. A wearable electronic device (WD) allowed patients to receive stimulation at home while performing normal daily activities. A total of 95 patients >6 months poststroke were randomized to 3 groups: WD with shock paired 12 ms before click; WD with clicks and shocks delivered independently; standard care. Those allocated to the device used it for at least 4 h/d, every day for 4 weeks. Upper-limb function was assessed at baseline and weeks 2, 4, and 8 using the Action Research Arm Test (ARAT), which has 4 subdomains (Grasp, Grip, Pinch, and Gross). Results. Severity across the 3 groups was comparable at baseline. Only the paired stimulation group showed significant improvement in total ARAT (median baseline: 7.5; week 8: 11.5; P = .019) and the Grasp subscore (median baseline: 1; week 8: 4; P = .004). Conclusion. A wearable device delivering paired clicks and shocks over 4 weeks can produce a small but significant improvement in upper-limb function in stroke survivors.

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A combined transcranial direct current stimulation and virtual reality-based intervention on upper limb function in chronic stroke survivors with severe hemiparesis

2017 International Conference on Virtual Rehabilitation (ICVR) ◽

10.1109/icvr.2017.8007486 ◽

2017 ◽

Author(s):

Roberto Llorens ◽

Adrian Borrego ◽

Jorge Latorre ◽

Mariano Alcaniz ◽

Carolina Colomer ◽

...

Keyword(s):

Virtual Reality ◽

Upper Limb ◽

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Chronic Stroke ◽

Stroke Survivors ◽

Limb Function ◽

Direct Current Stimulation ◽

Upper Limb Function

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A robot-aided visuomotor wrist training induces gains in proprioceptive and movement accuracy in the contralateral wrist

Scientific Reports ◽

10.1038/s41598-021-84767-9 ◽

2021 ◽

Vol 11 (1) ◽

Cited By ~ 1

Author(s):

Yizhao Wang ◽

Huiying Zhu ◽

Naveen Elangovan ◽

Leonardo Cappello ◽

Giulio Sandini ◽

...

Keyword(s):

Position Sense ◽

Just Noticeable Difference ◽

Neurophysiological Mechanism ◽

Left Wrist ◽

Movement Accuracy ◽

Visuomotor Task ◽

Spatial Movement ◽

Proprioceptive Training ◽

Motor Error ◽

Proprioceptive Function

AbstractProprioceptive training is a neurorehabilitation approach known to improve proprioceptive acuity and motor performance of a joint/limb system. Here, we examined if such learning transfers to the contralateral joints. Using a robotic exoskeleton, 15 healthy, right-handed adults (18–35 years) trained a visuomotor task that required making increasingly small wrist movements challenging proprioceptive function. Wrist position sense just-noticeable-difference thresholds (JND) and spatial movement accuracy error (MAE) in a wrist-pointing task that was not trained were assessed before and immediately as well as 24 h after training. The main results are: first, training reduced JND thresholds (− 27%) and MAE (− 33%) in the trained right wrist. Sensory and motor gains were observable 24 h after training. Second, in the untrained left wrist, mean JND significantly decreased (− 32%) at posttest. However, at retention the effect was no longer significant. Third, motor error at the untrained wrist declined slowly. Gains were not significant at posttest, but MAE was significantly reduced (− 27%) at retention. This study provides first evidence that proprioceptive-focused visuomotor training can induce proprioceptive and motor gains not only in the trained joint but also in the contralateral, homologous joint. We discuss the possible neurophysiological mechanism behind such sensorimotor transfer and its implications for neurorehabilitation.

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