Robotic Table and Serious Games for Integrative Rehabilitation Early Post-Stroke: Two Case Reports (Preprint)

2021 ◽  
Author(s):  
Grigore Burdea ◽  
Nam H. Kim ◽  
Kevin Polistico ◽  
Ashwin Kadaru ◽  
Namrata Grampurohit ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Serious Games ◽  
Case Reports ◽  
Upper Extremities ◽  
Pinch Strength ◽  
Robotic Rehabilitation ◽  
Standardized Measures ◽  
Post Stroke ◽  
Active Flexion ◽  
Rehabilitation System

BACKGROUND BrightArm Compact is a new rehabilitation system for upper extremities. It provides bimanual training with gradated gravity loading and mediates interactions with serious games. OBJECTIVE To design and test a robotic rehabilitation table-based virtual rehabilitation system for training upper extremities early post-stroke. METHODS A new robotic rehabilitation table, controllers and adaptive games were developed. Participants underwent 12 experimental sessions in addition to the standard of care. Standardized measures of upper extremity motor impairment and function, depression severity, and cognitive function were administered pre- and post-intervention. Non-standardized measures included game variables and subjective evaluations. RESULTS Two case study participants attained high total arm repetitions per session (504 and 957, respectively), and achieved high grasp and finger extension counts. Training intensity contributed to marked improvements in affected arm shoulder strength (225% and 100%, respectively), grasp strength (27% and 16% increase), 3-finger pinch strength (31% and 15% increase). Shoulder active flexion range increased 17% and 18%, respectively, and elbow active supination was larger by 75% and 58%, respectively. Improvements in motor function were at/above Minimal Clinically Important Difference for Fugl-Meyer Assessment (11 and 10 points), Chedoke Inventory (11 and 14 points) and Upper Extremity Functional Index (19 and 23 points). Cognitive/emotive outcomes were mixed. CONCLUSIONS The design of the robotic rehabilitation table was successfully tested on two participants early post-stroke. Results are encouraging. CLINICALTRIAL ClinicalTrials.gov NCT04252170

scholarly journals Gambaran Peningkatan Kemampuan Motorik Ekstremitas Atas Setelah Pemberian Mirror Therapy Pada Pasien Pasca Stroke : Literature Review

2021 ◽  
Vol 1 ◽  
pp. 1536-1541
Author(s):  
Infa Dirah Pangestika Oktafiani ◽  
Wahyu Ersila
Keyword(s):  
Literature Review ◽  
Upper Extremity ◽  
Motor Skills ◽  
Functional Limitations ◽  
Upper Extremities ◽  
Google Scholar ◽  
Mirror Therapy ◽  
Stroke Patients ◽  
Post Stroke ◽  
Incidence And Mortality

AbstractStroke is a serious health problem with high incidence and mortality, and causes disability in patients. It causes complex problems, one of which is motor disorders, especially the upper extremities. Impaired motor function causes functional limitations and disabilities in stroke patients. Mirror Therapy is a new technique that is simple and able to improve upper extremity function with the concept of visual illusion. This study aimed to describe of the motoric improvement of the upper extremities after the implementation of Mirror Therapy in post-stroke patients. This study was a literature review by searching for articles from databases such as PubMed, Science Direct, and Google Scholar. The articles were chosen based on several inclusion and exclusion criteria as well as a feasibility test. The number of articles that was appropriate and reviewed was five. The results of review of the five articles showed that Mirror Therapy was proven to be able to improve the motoric skills of post-stroke patients with an average difference of 13.68 using the Fugl Meyer Assessment of Upper Extremity (FMA-UE) measuring instrument. The most common type of stroke was ischemic stroke (64.6%), and it was more common in males (72.3%) with an average age of 52.84 years. Mirror Therapy could improve the upper extremity motor skills in post-stroke patients. This study is expected to be the basis of action in performing physiotherapy management, especially in improving upper extremity motor skills in post-stroke patients with Mirror Therapy interventions.Keywords : Mirror skills; Motor Therapy; Post stroke AbstrakStroke merupakan masalah kesehatan yang penting dengan kejadian dan kematian tinggi dan menyebabkan kecacatan pada penderita. Permasalahan yang ditimbulkan kompleks, salah satunya gangguan motorik khususnya ekstremitas atas. Fungsi motorik yang terganggu menyebabkan keterbatasan fungsional dan disabilitas pada pasien stroke sehari-hari. Mirror therapy merupakan teknik baru yang sederhana dan mampu memperbaiki fungsi ekstremitas atas dengan konsep ilusi visual. Penelitian ini bertujuan untuk mengetahui gambaran peningkatan motorik ekstremitas atas setelah pemberian mirror therapy pada pasien pasca stroke. Penelitian menggunakan literature review dengan pencarian artikel melalui database seperti PubMed, Science Direct, dan Google Scholar. Artikel diambil berdasarkan kriteria inklusi dan eksklusi, serta dilakukan uji kelayakan. Jumlah artikel yang sesuai dan dilakukan review (n=5). Hasil literature review lima artikel menunjukkan bahwa pemberian mirror therapy terbukti dapat meningkatkan kemampuan motorik ekstremitas atas pasien pasca stroke dengan rata-rata selisih peningkatan sebesar 13,68 menggunakan alat ukur Fugl Meyer Assessment of Upper Extremity (FMA-UE). Jenis stroke terbanyak yaitu stroke iskemik 64,6% dan jenis kelamin laki-laki lebih banyak 72,3% dengan karakteristik rata-rata usia 52,84 tahun. Mirror Therapy dapat meningkatkan kemampuan motorik ekstremitas atas pasien pasca stroke. Diharapkan menjadi dasar tindakan dalam melakukan manajemen fisioterapi, mengenai masalah peningkatan kemampuan motorik ekstremitas atas pada pasien pasca stroke dengan intervensi mirror therapy.Kata kunci: Kemampuan motorik; Mirror therapy; Pasca stroke

scholarly journals EEG-modulated robotic rehabilitation system for upper extremity

2018 ◽  
Vol 32 (3) ◽  
pp. 795-803 ◽  
Author(s):  
Baoguo Xu ◽  
Aiguo Song ◽  
Guopu Zhao ◽  
Jia Liu ◽  
Guozheng Xu ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Robotic Rehabilitation ◽  
Rehabilitation System

scholarly journals Novel integrative rehabilitation system for the upper extremity: Design and usability evaluation

2021 ◽  
Vol 8 ◽  
pp. 205566832110128
Author(s):  
Grigore Burdea ◽  
Nam Kim ◽  
Kevin Polistico ◽  
Ashwin Kadaru ◽  
Doru Roll ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Usability Evaluation ◽  
Ease Of Use ◽  
The Novel ◽  
Robotic Rehabilitation ◽  
Virtual Rehabilitation ◽  
Therapeutic Game ◽  
Rehabilitation System ◽  
Bilateral Training ◽  
Bimanual Training

Purpose Design and test the usability of a novel virtual rehabilitation system for bimanual training of gravity supported arms, pronation/supination, grasp strengthening, and finger extension. Methods A robotic rehabilitation table, therapeutic game controllers, and adaptive rehabilitation games were developed. The rehabilitation table lifted/lowered and tilted up/down to modulate gravity loading. Arms movement was measured simultaneously, allowing bilateral training. Therapeutic games adapted through a baseline process. Four healthy adults performed four usability evaluation sessions each, and provided feedback using the USE questionnaire and custom questions. Participant’s game play performance was sampled and analyzed, and system modifications made between sessions. Results Participants played four sessions of about 50 minutes each, with training difficulty gradually increasing. Participants averaged a total of 6,300 arm repetitions, 2,200 grasp counts, and 2,100 finger extensions when adding counts for each upper extremity. USE questionnaire data averaged 5.1/7 rating, indicative of usefulness, ease of use, ease of learning, and satisfaction with the system. Subjective feedback on the custom evaluation form was 84% favorable. Conclusions The novel system was well-accepted, induced high repetition counts, and the usability study helped optimize it and achieve satisfaction. Future studies include examining effectiveness of the novel system when training patients acute post-stroke.

A Retrospective Study to Evaluate the Efficacy of a Plasma Energy System (Renuvion) in the Management of Skin Laxity to Improve Tightening at the Time of Standard Liposuction of the Arms

2021 ◽  
pp. 074880682110310
Author(s):  
Angelo Cuzalina ◽  
Pasquale G. Tolomeo
Keyword(s):  
Upper Extremity ◽  
Control Site ◽  
Clinical Staff ◽  
Upper Extremities ◽  
Final Visit ◽  
Recipient Site ◽  
Skin Laxity ◽  
Plasma Energy ◽  
Treatment Site ◽  
And Control

The aim of this study was to determine the efficacy of cool atmospheric plasma (Renuvion/J-plasma) in promoting skin tightening and soft tissue contouring following liposuction of the upper extremities. The study was a retrospective review of upper extremity liposuction with associated Renuvion therapy performed by the same surgeon. Patients were made aware of Renuvion therapy to assist with skin laxity and offered adjunctive treatment following liposuction. While a majority of patients elected to have Renuvion therapy performed bilaterally, a small subset of patients elected for unilateral treatment. This subset of patients pursued delayed treatment on the control side. The inclusion criteria for the study included patients with moderate fat excess of the upper extremity with associated mild to moderate cutaneous laxity. Exclusion criteria for the study included severe medical comorbidities, body mass index greater than 35 kg/m2 and those below the age of 30. The study included 5 female patients between the ages of 46 to 52. The method of treatment was liposuction of the bilateral upper extremities with removal of equal proportions of fat. The recipient site for Renuvion treatment was randomly selected by the study coordinator; the surgeon and clinical staff remained blinded to the selection. Following treatment, the patients were evaluated at 1 week, 6 weeks, and 6 months postoperatively to assess surgical outcomes subjectively. The surgeon and clinical staff were unblinded at the final visit. Patients were evaluated based on subjective criteria and photographic evaluation at each postoperative visit. At the 1-week visit, no significant differences were noted in all subjects. At the 6-week visit, two patients demonstrated improved results to the treatment site when compared with the control site. At the 6-month visit, four out of the five patients demonstrated a significant improvement in contour and laxity at the treatment site when compared with the control site. One patient demonstrated equal results on both treatment and control sites with no major abnormalities. Following the final evaluation, the patients underwent a secondary procedure to the control site with Renuvion to obtain similar results as the recipient site. One patient demonstrated equal results on both test and control sites with no major abnormalities. The use of plasma energy via Renuvion in conjunction with liposuction has demonstrated esthetic results with proposed long-term benefits. The plasma energy device, as an adjuvant therapy, may be beneficial in cases where liposuction alone may not address tissue laxity concerns. Additional studies with a larger sample size, objective criteria, and extended follow-ups are necessary to statistically analyze the results and determine its significance.

Posteroventral pallidotomy for midbrain tremor after a pontine hemorrhage

1999 ◽  
Vol 91 (5) ◽  
pp. 885-888 ◽  
Author(s):  
Yasushi Miyagi ◽  
Fumio Shima ◽  
Katsuya Ishido ◽  
Masashi Moriguchi ◽  
Kazufumi Kamikaseda
Keyword(s):  
Upper Extremity ◽  
High Frequency ◽  
Upper Extremities ◽  
Proximal Segment ◽  
Action Tremor ◽  
Content Type ◽  
Pontine Hemorrhage ◽  
Posteroventral Pallidotomy ◽  
Left Thalamus ◽  
Midbrain Tremor

✓ This 49-year-old man gradually developed a disabling action tremor in the proximal right upper extremity 8 months after suffering a pontine tegmental hemorrhage. The intraoperative microrecording in the nucleus ventralis intermedius (VIM) of the left thalamus revealed tremor-synchronous grouped discharges with a vigorous (2.7 Hz) action tremor predominantly in the shoulder and upper arm. High frequency electrical stimulation in the VIM did not affect the tremor. A posteroventral pallidotomy (PVP) was performed and resulted in the successful alleviation of all tremor activity. Posteroventral pallidotomy is known to alleviate parkinsonian tremors, especially those occurring in the contralateral lower extremity, trunk, and proximal segment of the contralateral upper extremity. The authors consider the pallidoreticular pathway to be an important tremor-mediating pathway for the proximal segment of the upper extremities and believe it can be controlled more effectively by PVP than by VIM thalamotomy, as demonstrated by the PVP-induced resolution of the midbrain tremor observed in this case.

Cognitive Demands Influence Upper Extremity Motor Performance During Recovery From Acute Stroke

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000011992
Author(s):  
David J Lin ◽  
Kimberly S Erler ◽  
Samuel B Snider ◽  
Anna K Bonkhoff ◽  
Julie A DiCarlo ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Grip Strength ◽  
Upper Extremity ◽  
Cognitive Dysfunction ◽  
Motor Performance ◽  
Motor Task ◽  
Upper Extremities ◽  
Cognitive Demands ◽  
Strength Performance ◽  
Lesion Symptom Mapping

Objective:To test the hypothesis that cognitive demands influence motor performance during recovery from acute stroke, we tested acute stroke patients on two motor tasks with different cognitive demands and related task performance to cognitive impairment and neuroanatomic injury.Methods:We assessed the contralesional and ipsilesional upper extremities of a cohort of 50 patients with weakness after unilateral acute ischemic stroke at three timepoints with two tasks: the Box & Blocks Test, a task with greater cognitive demand, and Grip Strength, a simple and ballistic motor task. We compared performance on the two tasks, related motor performance to cognitive dysfunction, and used voxel-based lesion symptom mapping to determine neuroanatomical sites associated with motor performance.Results:Consistent across contralesional and ipsilesional upper extremities and most pronounced immediately post-stroke, Box & Blocks scores were significantly more impaired than Grip Strength scores. The presence of cognitive dysfunction significantly explained up to 33% of variance in Box & Blocks performance but was not associated with Grip Strength performance. While Grip Strength performance was associated with injury largely restricted to sensorimotor regions, Box & Blocks performance was associated with broad injury outside sensorimotor structures, particularly the dorsal anterior insula, a region known to be important for complex cognitive function.Conclusions:Altogether, these results suggest that cognitive demands influence upper extremity motor performance during recovery from acute stroke. Our findings emphasize the integrated nature of motor and cognitive systems and suggest that it is critical to consider cognitive demands during motor testing and neurorehabilitation after stroke.

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