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.

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 Structural and functional brain changes following four weeks of unimanual motor training: evidence from behaviour, neural stimulation, cortical thickness and functional MRI

2016 ◽  
Author(s):  
Martin V. Sale ◽  
Lee B. Reid ◽  
Luca Cocchi ◽  
Alex M. Pagnozzi ◽  
Stephen E. Rose ◽  
...  
Keyword(s):  
Functional Mri ◽  
Left Hemisphere ◽  
Cortical Thickness ◽  
Primary Motor Cortex ◽  
Right Hemisphere ◽  
Brain Plasticity ◽  
Motor Evoked Potential ◽  
Precentral Gyrus ◽  
Control Sequence ◽  
The Right

AbstractAlthough different aspects of neuroplasticity can be quantified with behavioural probes, brain stimulation, and brain imaging assessments, no study to date has combined all these approaches into one comprehensive assessment of brain plasticity. Here, 24 healthy right-handed participants practised a sequence of finger-thumb opposition movements for 10 minutes each day with their left hand. After four weeks, performance for the practised sequence improved significantly (p < 0.05 FWE) relative to a matched control sequence, with both the left (mean increase: 53.0% practised, 6.5% control) and right (21.0%; 15.8%) hands. Training also induced significant (cluster p-FWE < 0.001) reductions in functional MRI activation for execution of the learned sequence, relative to the control sequence. These changes were observed as clusters in the premotor and supplementary motor cortices (right hemisphere, 301 voxel cluster; left hemisphere 700 voxel cluster), as well as sensorimotor cortices and superior parietal lobules (right hemisphere 864 voxel cluster; left hemisphere, 1947 voxel cluster). Transcranial magnetic stimulation over the right (‘trained’) primary motor cortex yielded a 58.6% mean increase in a measure of motor evoked potential amplitude, as recorded at the left abductor pollicis brevis muscle. Cortical thickness analyses based on structural MRI suggested changes in the right precentral gyrus, right post central gyrus, right dorsolateral prefrontal cortex and potentially the right supplementary motor area. Such findings are consistent with LTP-like neuroplastic changes in areas that were already responsible for finger sequence execution, rather than improved recruitment of previously non-utilised tissue.

scholarly journals Is Lateropulsion Really Related with a Specific Lesion of the Brain?

2021 ◽  
Vol 11 (3) ◽  
pp. 354
Author(s):  
Kyoung Lee ◽  
Sang Yoo ◽  
Eun Ji ◽  
Woo Hwang ◽  
Yeun Yoo ◽  
...  
Keyword(s):  
Right Hemisphere ◽  
Parietal Lobe ◽  
Inferior Frontal Gyrus ◽  
Brain Lesions ◽  
Vertical Posture ◽  
Lesion Volume ◽  
Precentral Gyrus ◽  
Stroke Patients ◽  
The Right ◽  
Right Hemisphere Stroke

Lateropulsion (pusher syndrome) is an important barrier to standing and gait after stroke. Although several studies have attempted to elucidate the relationship between brain lesions and lateropulsion, the effects of specific brain lesions on the development of lateropulsion remain unclear. Thus, the present study investigated the effects of stroke lesion location and size on lateropulsion in right hemisphere stroke patients. The present retrospective cross-sectional observational study assessed 50 right hemisphere stroke patients. Lateropulsion was diagnosed and evaluated using the Scale for Contraversive Pushing (SCP). Voxel-based lesion symptom mapping (VLSM) analysis with 3T-MRI was used to identify the culprit lesion for SCP. We also performed VLSM controlling for lesion volume as a nuisance covariate, in a multivariate model that also controlled for other factors contributing to pusher behavior. VLSM, combined with statistical non-parametric mapping (SnPM), identified the specific region with SCP. Lesion size was associated with lateropulsion. The precentral gyrus, postcentral gyrus, inferior frontal gyrus, insula and subgyral parietal lobe of the right hemisphere seemed to be associated with the lateropulsion; however, after adjusting for lesion volume as a nuisance covariate, no lesion areas were associated with the SCP scores. The size of the right hemisphere lesion was the only factor most strongly associated with lateropulsion in patients with stroke. These results may be useful for planning rehabilitation strategies of restoring vertical posture and understanding the pathophysiology of lateropulsion in stroke patients.

scholarly journals Sensory deficits in ipsilesional upper-extremity in chronic stroke patients

2015 ◽  
Vol 73 (10) ◽  
pp. 834-839 ◽  
Author(s):  
Núbia Maria Freire Vieira Lima ◽  
Karina Cândido Menegatti ◽  
Érica Yu ◽  
Natália Yumi Sacomoto ◽  
Thais Botossi Scalha ◽  
...  
Keyword(s):  
Right Hemisphere ◽  
Thermal Sensation ◽  
Chronic Stroke ◽  
Sensory Loss ◽  
Stroke Patients ◽  
Sensory Assessment ◽  
Sensory Deficits ◽  
Left Handed ◽  
Right Hemisphere Damage ◽  
The Right

Objective To investigate somatosensory deficits in the ipsilesional wrist and hand in chronic stroke patients and correlate these deficits with contralesional sensorimotor dysfunctions, functional testing, laterality and handedness.Methods Fifty subjects (twenty-two healthy volunteers and twenty-eight stroke patients) underwent evaluation with Semmes-Weinstein monofilaments, the sensory and motor Fugl-Meyer Assessment, the Nottingham Sensory Assessment in both wrists and hands and functional tests.Results Twenty-five patients had sensory changes in the wrist and hand contralateral to the stroke, and eighteen patients (64%) had sensory deficits in the ipsilesional wrist and hand. The most significant ipsilesional sensory loss was observed in the left-handed patients. We found that the patients with brain damage in the right hemisphere had better scores for ipsilesional tactile sensation.Conclusions A reduction in ipsilesional conscious proprioception, tactile or thermal sensation was found in stroke subjects. Right hemisphere damage and right-handed subjects had better scores in ipsilesional tactile sensation.

scholarly journals Time Perception through the Processing of Verb Tenses: An ERP study regarding Mental Time Travel

2020 ◽  
Author(s):  
Charalabos Papageorgiou ◽  
Anastasios E. Giannopoulos ◽  
Athanasios S. Fokas ◽  
Paul M. Thompson ◽  
Nikolaos C. Kapsalis ◽  
...  
Keyword(s):  
Right Hemisphere ◽  
Brain Regions ◽  
Time Travel ◽  
Temporal Organization ◽  
Mental Time Travel ◽  
Precentral Gyrus ◽  
Alpha Oscillations ◽  
Biological Time ◽  
Underlying Mechanisms ◽  
The Right

ABSTRACTHumans are equipped with the so-called Mental Time Travel (MTT) ability, which allows them to consciously construct and elaborate past or future scenes. The mechanisms underlying MTT remain elusive. This study focused on the late positive potential (LPP) and alpha oscillations, considering that LPP covaries with the temporal continuity whereas the alpha oscillations index the temporal organization of perception. To that end, subjects were asked to focus on performing two mental functions engaging working memory, which involved mental self-projection into either the present-past (PP) border or the present-future (PF) border. To evaluate underlying mechanisms, the evoked frontal late positive potentials (LPP) as well as their cortical sources were analyzed via the standardized low-resolution brain electromagnetic tomography (sLORETA) technique. The LPP amplitudes - in the left lateral prefrontal areas that were elicited during PF tasks - were significantly higher than those associated with PP, whereas opposite patterns were observed in the central and right prefrontal areas. Crucially, the LPP activations of both the PP and PF self-projections overlapped with the brain’s default mode network and related interacting areas. Finally, we found enhanced alpha-related activation with respect to PP in comparison to PF, predominantly over the right hemisphere central brain regions (specifically, the precentral gyrus). These findings confirm that the two types of self-projection, as reflected by the frontally-distributed LPP, share common cortical resources that recruit different brain regions in a balanced way. This balanced distribution of brain activation might signify that biological time tends to behave in a homeostatic way.

scholarly journals Parietal Mechanisms for Transsaccadic Spatial Frequency Perception: An fMRI Study

2020 ◽  
Author(s):  
B. R. Baltaretu ◽  
B. T. Dunkley ◽  
W. Dale Stevens ◽  
J. D. Crawford
Keyword(s):  
Spatial Frequency ◽  
Posterior Parietal Cortex ◽  
Right Hemisphere ◽  
Interaction Analysis ◽  
Posterior Cingulate Cortex ◽  
Precentral Gyrus ◽  
General Role ◽  
Psychophysiological Interaction ◽  
The Right ◽  
Transsaccadic Memory

AbstractPosterior parietal cortex (PPC), specifically right supramarginal gyrus, is involved in transsaccadic memory of object orientation for both perception and action. Here, we investigated whether PPC is involved in transsaccadic memory of other features, namely spatial frequency. We employed a functional magnetic resonance imaging paradigm where participants briefly viewed a grating stimulus with a specific spatial frequency that later reappeared with the same or different frequency, after a saccade or continuous fixation. Post-saccadic frequency modulation activated a region in the right hemisphere spanning medial PPC (ventral precuneus) and posterior cingulate cortex. Importantly, the site of peak precuneus activation showed saccade-specific feature modulation (compared to fixation) and task-specific saccade modulation (compared to a saccade localizer task). Psychophysiological interaction analysis revealed functional connectivity between this precuneus site and the precentral gyrus (M1), lingual gyrus (V1/V2), and medial occipitotemporal sulcus. This differed from the transsaccadic orientation network, perhaps because spatial frequency signaled changes in object identity. Overall, this experiment supports a general role for PPC in transsaccadic vision, but suggests that different networks are employed for specific features.

Functional reorganization oF the primary motor cortex in a patient with a large arteriovenous malFormation involving the precentral gyrus

2013 ◽  
Vol 4 (2) ◽  
Author(s):  
Milan Radoš ◽  
Ines Nikić ◽  
Marko Radoš ◽  
Ivica Kostović ◽  
Patrick Hof ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Primary Motor Cortex ◽  
Right Hemisphere ◽  
Motor Area ◽  
Lower Limbs ◽  
Motor Deficits ◽  
Precentral Gyrus ◽  
Functional Reorganization ◽  
The Right ◽  
The Brain

AbstractIt is known that the brain can compensate for deficits induced by acquired and developmental lesions through functional reorganization of the remaining parenchyma. Arteriovenous malformations (AVM) usually appear prenatally before a functional regional organization of the brain is fully established and patients generally do not present with motor deficits even when the AVM is located in the primary motor area indicating the redistribution of functions in cortical areas that are not pathologically altered. Here we present reorganization of the motor cortex in a patient with a large AVM involving most of the left parietal lobe and the paramedian part of the left precentral gyrus that is responsible for controlling the muscles of the lower limbs. Functional MRI showed that movements of both the right and left feet activated only the primary motor cortex in the right hemisphere, while there was no activation in the left motor cortex. This suggests that complete ipsilateral control over the movements of the right foot had been established in this patient. A reconstruction of the corticospinal tract using diffusion tensor imaging showed a near-complete absence of corticospinal fibers from the part of the left precentral gyrus affected by the AVM. From this clinical presentation it can be concluded that full compensation of motor deficits had occurred by redistributing function to the corresponding motor area of the contralateral

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