Pilot Test of Dosage Effects in HEXORR II for Robotic Hand Movement Therapy in Individuals With Chronic Stroke

Abstract BackgroundImpaired use of the hand in functional tasks remains difficult to overcome in many individuals after a stroke. This often leads to compensation strategies using the less-affected limb, which allows for independence in some aspects of daily activities. However, recovery of hand function remains an important therapeutic goal of many individuals, and is often resistant to conventional therapies. In prior work, we developed HEXORR I, a robotic device that allows practice of finger and thumb movements with robotic assistance. In this study, we describe modifications to the device, now called HEXORR II, and a clinical trial in individuals with chronic stroke. MethodsFifteen individuals with a diagnosis of chronic stroke were randomized to 12 or 24 sessions of robotic therapy. The sessions involved playing several video games using thumb and finger movement. The robot applied assistance to extension movement that was adapted based on task performance. Clinical and motion capture evaluations were performed before and after training and again at a 6 month followup. ResultsFourteen individuals completed the protocol. Fugl-Meyer scores improved significantly over the 3 time points, indicating reductions in upper extremity impairment. Flexor hypertonia (Ashworth) also decreased significantly due to the intervention. Motion capture found increased finger range of motion and extension ability when the arm was supported by gravity. However, extension ability did not improve significantly during a reach and grasp task, and there was no change in a functional measure (Action Research Arm Test). At the followup, the high dose group had significant gains in hand displacement during a forward reach task. There were no other significant differences between groups. ConclusionsFuture work with HEXORR II should focus on integrating it with functional task practice and incorporating grip and squeezing tasks. Trial registration: CLINICALTRIALS.GOV, NCT04536987. Registered 3 September 2020 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT04536987

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Combined Use of Repetitive Task Practice and an Assistive Robotic Device in a Patient With Subacute Stroke

Physical Therapy ◽

10.2522/ptj.20050149 ◽

2006 ◽

Vol 86 (10) ◽

pp. 1378-1386 ◽

Cited By ~ 25

Author(s):

Ellen M Frick ◽

Jay L Alberts

Keyword(s):

Upper Extremity ◽

Hand Function ◽

Robotic Therapy ◽

Extremity Function ◽

Subacute Stroke ◽

Combined Use ◽

Before And After ◽

Task Practice ◽

Upper Extremity Function ◽

Combined Intervention

Abstract Background and Purpose. This case report describes a training program comprising repetitive task practice (RTP) and robotic therapy for a patient with subacute stroke and resultant impaired upper-extremity function. Case Description. A 63-year-old man with right-sided hemiplegia resulting from a hemorrhagic stroke received a combined intervention of RTP and robotic therapy for 4 hours per day for 3 weeks. Clinical and kinetic evaluations were performed before and after intervention. Outcomes. Following the combined intervention, clinical improvements in hand function were observed, maximum grip force decreased slightly, and interlimb coupling decreased. Discussion. An intervention of RTP with robotic therapy may be an effective method to improve upper-extremity function following stroke. Furthermore, the case suggests that improvements in strength are not necessary for improved dexterous function, provided that a minimal level of strength is present.

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Home-Based Therapy After Stroke Using the Hand Spring Operated Movement Enhancer (HandSOME II)

Frontiers in Neurorobotics ◽

10.3389/fnbot.2021.773477 ◽

2021 ◽

Vol 15 ◽

Author(s):

Rafael Casas ◽

Melissa Sandison ◽

Diane Nichols ◽

Kaelin Martin ◽

Khue Phan ◽

...

Keyword(s):

Functional Connectivity ◽

Real World ◽

Brain Plasticity ◽

Low Cost ◽

Biomechanical Testing ◽

Chronic Stroke ◽

Reaching Task ◽

Home Based ◽

Before And After ◽

Task Practice

We have developed a passive and lightweight wearable hand exoskeleton (HandSOME II) that improves range of motion and functional task practice in laboratory testing. For this longitudinal study, we recruited 15 individuals with chronic stroke and asked them to use the device at home for 1.5 h per weekday for 8 weeks. Subjects visited the clinic once per week to report progress and troubleshoot problems. Subjects were then given the HandSOME II for the next 3 months, and asked to continue to use it, but without any scheduled contact with the project team. Clinical evaluations and biomechanical testing was performed before and after the 8 week intervention and at the 3 month followup. EEG measures were taken before and after the 8 weeks of training to examine any recovery associated brain reorganization. Ten subjects completed the study. After 8 weeks of training, functional ability (Action Research Arm Test), flexor tone (Modified Ashworth Test), and real world use of the impaired limb (Motor Activity Log) improved significantly (p < 0.05). Gains in real world use were retained at the 3-month followup (p = 0.005). At both post-training and followup time points, biomechanical testing found significant gains in finger ROM and hand displacement in a reaching task (p < 0.05). Baseline functional connectivity correlated with gains in motor function, while changes in EEG functional connectivity paralleled changes in motor recovery. HandSOME II is a low-cost, home-based intervention that elicits brain plasticity and can improve functional motor outcomes in the chronic stroke population.

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Improvement of Hand Motor Function after Radial Shock Wave Therapy in Chronic Stroke Patients

Indonesian Journal of Physical Medicine & Rehabilitation ◽

10.36803/2019.ikfr.07(1).01 ◽

2019 ◽

pp. 2-12

Author(s):

M. Kamaluddin K ◽

Erna Setiawati ◽

Tanti Ajoe Kesoema

Keyword(s):

Shock Wave ◽

Motor Function ◽

Hand Function ◽

Chronic Stroke ◽

Control Group ◽

Shock Wave Therapy ◽

Stroke Patients ◽

Before And After ◽

And Control ◽

Experimental Group

IIntroduction: The Radial Shock Wave Therapy (RSWT) expected could improve spasticity and hand function in chronic stroke patients. This study aimed to find out the improvement of hand function after RSWT as an additional therapy in chronic stroke patients. Methods: Design study was a randomized controlled trial, in December 2018. The patients were assigned randomly to the experimental group (Infrared, Stretching, and RSWT) and control group (Infrared and Stretching) for six weeks. Hand motor function was measured using Fugl-Meyer Motor Assesment (FMA) before and after intervention. Results: The median values of wrist FMA scores in the experimental and control group before and after intervention were 2 vs 5 (p=0.001) and 3 vs 4 (p<0.001) respectively. The median values of hand FMA scores in the experimental and control group before and intervention were 4 vs 6 (p=0,.001) and 4 vs 5 (p<0.001). However, the delta between before and after intervention was higher in experimental group. Conclusion: The improvement of wrist and hand FMA scores after added treatment by RSWT was tend to higher.Keywords: Spasticity, Hand Function, Stroke, Radial Shock Therapy, Fugl-Meyer Motor Assesment

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Improvement of Hand Motor Function after Radial Shock Wave Therapy in Chronic Stroke Patients

Indonesian Journal of Physical Medicine & Rehabilitation ◽

10.36803/ijpmr.v7i01.115 ◽

2018 ◽

Vol 7 (01) ◽

pp. 2

Author(s):

M. Kamaluddin K ◽

Erna Setiawati ◽

Tanti Ajoe Kesoema

Keyword(s):

Shock Wave ◽

Motor Function ◽

Hand Function ◽

Chronic Stroke ◽

Control Group ◽

Shock Wave Therapy ◽

Stroke Patients ◽

Before And After ◽

And Control ◽

Experimental Group

IIntroduction: The Radial Shock Wave Therapy (RSWT) expected could improve spasticity and hand function in chronic stroke patients. This study aimed to find out the improvement of hand function after RSWT as an additional therapy in chronic stroke patients. Methods: Design study was a randomized controlled trial, in December 2018. The patients were assigned randomly to the experimental group (Infrared, Stretching, and RSWT) and control group (Infrared and Stretching) for six weeks. Hand motor function was measured using Fugl-Meyer Motor Assesment (FMA) before and after intervention. Results: The median values of wrist FMA scores in the experimental and control group before and after intervention were 2 vs 5 (p=0.001) and 3 vs 4 (p<0.001) respectively. The median values of hand FMA scores in the experimental and control group before and intervention were 4 vs 6 (p=0,.001) and 4 vs 5 (p<0.001). However, the delta between before and after intervention was higher in experimental group. Conclusion: The improvement of wrist and hand FMA scores after added treatment by RSWT was tend to higher.Keywords: Spasticity, Hand Function, Stroke, Radial Shock Therapy, Fugl-Meyer Motor Assesment

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Effects of Combined Robotic Therapy and Repetitive-Task Practice on Upper-Extremity Function in a Patient With Chronic Stroke

American Journal of Occupational Therapy ◽

10.5014/ajot.62.1.28 ◽

2008 ◽

Vol 62 (1) ◽

pp. 28-35 ◽

Cited By ~ 37

Author(s):

L. Rosenstein ◽

A. L. Ridgel ◽

A. Thota ◽

B. Samame ◽

J. L. Alberts

Keyword(s):

Upper Extremity ◽

Chronic Stroke ◽

Robotic Therapy ◽

Extremity Function ◽

Task Practice ◽

Upper Extremity Function

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Improvement of Hand Motor Function after Radial Shock Wave Therapy in Chronic Stroke Patients

Indonesian Journal of Physical Medicine & Rehabilitation ◽

10.36803/https://doi.org/10.36803/ijpmr.v7i01.115 ◽

2019 ◽

pp. 2-12

Author(s):

M. Kamaluddin K ◽

Erna Setiawati ◽

Tanti Ajoe Kesoema

Keyword(s):

Shock Wave ◽

Motor Function ◽

Hand Function ◽

Chronic Stroke ◽

Control Group ◽

Shock Wave Therapy ◽

Stroke Patients ◽

Before And After ◽

And Control ◽

Experimental Group

IIntroduction: The Radial Shock Wave Therapy (RSWT) expected could improve spasticity and hand function in chronic stroke patients. This study aimed to find out the improvement of hand function after RSWT as an additional therapy in chronic stroke patients. Methods: Design study was a randomized controlled trial, in December 2018. The patients were assigned randomly to the experimental group (Infrared, Stretching, and RSWT) and control group (Infrared and Stretching) for six weeks. Hand motor function was measured using Fugl-Meyer Motor Assesment (FMA) before and after intervention. Results: The median values of wrist FMA scores in the experimental and control group before and after intervention were 2 vs 5 (p=0.001) and 3 vs 4 (p<0.001) respectively. The median values of hand FMA scores in the experimental and control group before and intervention were 4 vs 6 (p=0,.001) and 4 vs 5 (p<0.001). However, the delta between before and after intervention was higher in experimental group. Conclusion: The improvement of wrist and hand FMA scores after added treatment by RSWT was tend to higher.

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Benefit/Risk Profile of Combined Antiplatelet Therapy with Ticlopidine and Aspirin

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648180 ◽

1991 ◽

Vol 65 (05) ◽

pp. 504-510 ◽

Cited By ~ 20

Author(s):

Raffaele De Caterina ◽

Rosa Sicari ◽

Walter Bernini ◽

Guido Lazzerini ◽

Giuliana Buti Strata ◽

...

Keyword(s):

Platelet Function ◽

Low Dose ◽

Bleeding Time ◽

Ex Vivo ◽

Stable Coronary Artery Disease ◽

High Dose ◽

Single Drug ◽

Before And After ◽

Serum Thromboxane ◽

Artery Disease

SummaryTiclopidine (T) and aspirin (ASA) are two antiplatelet drugs both capable of prolonging bleeding time (BT), with a different mechanism of action. A synergism in BT prolongation has been reported and is currently considered an argument for not recommending their combination. However, a profound suppression of platelet function might be a desirable counterpart of a marked prolongation of BT, with a possible use in selected clinical situations. We therefore studied ex vivo platelet function (aggregation by ADP 0.5-1-2.5 μM; adrenaline 0.75-2.5 μM; collagen 1.5-150 μg/ml; arachidonic acid 1 mM; PAF 1 μM; adrenaline 0.17 μM + ADP 0.62 μM; serum thromboxane ([TX]B2 generation) and BT (Mielke) in 6 patients with stable coronary artery disease receiving such combination. Patients underwent sequential laboratory evaluations at baseline, after 7 days of T 250 mg b.i.d., before and after the intravenous administration of ASA 500 mg, respectively, and, finally, after a minimum of 7 days of sole ASA oral administration (50 mg/day). The experimental design, therefore, allowed a comparison of T and ASA effects (2nd and 4th evaluation), and an assessment of the combination effect (3rd evaluation). Platelet aggregation in response to all doses of ADP was depressed more by T than by ASA. Conversely, responses to adrenaline, and arachidonate were affected more by ASA than by T. For all other agents, differences were not significant. T + ASA combination was more effective (p <0.05) than either treatment alone in depressing responses to high-dose collagen (% over control, mean ± SEM: T: 95 ± 3; ASA: 96 ± 5; T + ASA: 89 ± 4). Serum TXB2 (basal, ng/ml: 380 ± 54) did not change with T (372 ± 36), dropped to <1 ng/ml on ASA injection and slightly re-increased to 9.1 ± 3.1 ng/ml on oral low-dose ASA. BT (basal 7.4 ± 0.6 min) was affected similarly by T (9.2 ± 0.8) or ASA (9.7 ± 0.9) alone, but increased to 15.0 ± 0.7 min on combination treatment (106% increase over control). Thus, the strong synergism in BT prolongation by ASA-T combination has a counterpart in the inhibition of platelet function in response to strong stimuli such as high-dose collagen, not otherwise affected significantly by single-drug treatment. This effect is a possible rationale for the clinical evaluation of T + ASA combination.

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High-dose Cholecalciferol Supplementation Reducing Morning Blood Pressure in Normotensive DM1 Patients

Current Diabetes Reviews ◽

10.2174/1573399816999200729131508 ◽

2020 ◽

Vol 16 ◽

Cited By ~ 1

Author(s):

Natércia Neves Marques de Queiroz ◽

Franciane Trindade Cunha de Melo ◽

Fabrício de Souza Resende ◽

Luísa Corrêa Janaú ◽

Norberto Jorge Kzan de Souza Neto ◽

...

Keyword(s):

Blood Pressure ◽

Vitamin D ◽

Blood Pressure Monitoring ◽

Vitamin D Supplementation ◽

High Dose ◽

Before And After ◽

Patients With Diabetes ◽

Morning Blood Pressure ◽

Cholecalciferol Supplementation ◽

Lipids Profile

Background: Vitamin D (VD) deficiency has been related to several endocrine metabolic and cardiovascular diseases. Effect of VD supplementation on blood pressure (BP) in patients with diabetes is controversial. Objective: The aim of this study was to evaluate high-dose vitamin D supplementation effects on blood pressure of normotensive type 1 diabetes mellitus (T1DM) patients by 24-hour ambulatory blood pressure monitoring (ABPM). Methods: We performed a clinical trial including 35 T1DM normotensive patients, who received doses of 4,000 or 10,000 IU/day of cholecalciferol for 12 weeks according to previous VD levels. They underwent 24-hour ABPM, along with glycated hemoglobin, creatine, lipids profile and PCRus dosage before and after VD supplementation. Results and discussion: We found an expressive reduction of systolic and diastolic morning blood pressures (117±14 vs 112±14, p<0,05; 74±9 vs 70±10 mmHg, p<0,05, respectively) with no changes in other pressoric markers. Besides, we noticed a relation between levels of VD after supplementation and diastolic morning blood pressure (r= -0,4; p<0.05). Conclusion: Our study suggests an association between supplementation of high doses of vitamin D and the reduction of morning blood pressure in normotensive T1DM patients.

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