The Influence of EMG-Triggered Robotic Movement on Walking, Muscle Force and Spasticity after an Ischemic Stroke

Background and Objectives: Application of the EMG-driven robotic training in everyday therapeutic processes is a modern and innovative form of neurorehabilitation among patients after stroke. Active participation of the patient contributes to significantly higher activation of the sensorimotor network during active motor control rather than during passive movement. The study objective was to determine the effect of electromyographic triggering (EMG-triggered) robotic rehabilitation device treatment on walking, muscle force, and spasticity after an ischemic stroke. Materials and Methods: A total of 60 participants with impaired motor function and gait after subacute stroke were included in the study. Each patient was randomly assigned to an intervention or control group (IG or CG). All patients, except standard therapy, underwent 1 additional session of therapy per day, 5 days a week for 6 weeks. IG had 30 min of training on the robot, while CG received exercises on the lower limb rotor. The subjects were assessed with Timed Up and Go Test (TUG), Ashworth scale, knee range of motion (ROM), Lovett Scale, and tight circumference at baseline and at weeks 2, 4, and 6. Results: For seven parameters, the values credibly increased between consecutive measurements, and for the Ashworth scale, they credibly decreased. The biggest changes were observed for the measurements made with Lovett scale. The average thigh circumference as measured 5 and 15 cm above the knee increased credibly more in the robot condition, as compared to control condition. Additionally, the decrease in Ashworth values over time, although statistically credible in both groups, was credibly higher in the robot condition. Conclusion: The inclusion of the EMG-triggered neurorehabilitation robot in the patient’s daily rehabilitation plan has a positive effect on outcomes of the treatment. Both proposed rehabilitation protocols significantly improved patients’ condition regarding all measured outcomes, but the spasticity and thigh circumference improved significantly better in the robotic group in comparison to controls.

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Concurrent Validity of Physiological Cost Index in Walking over Ground and during Robotic Training in Subacute Stroke Patients

BioMed Research International ◽

10.1155/2014/384896 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 9

Author(s):

Anna Sofia Delussu ◽

Giovanni Morone ◽

Marco Iosa ◽

Maura Bragoni ◽

Stefano Paolucci ◽

...

Keyword(s):

Random Sequence ◽

Pearson Correlation ◽

Control Group ◽

Stroke Patients ◽

Robotic Training ◽

Cost Index ◽

Physiological Cost ◽

Subacute Stroke ◽

Weight Support ◽

Walking Tests

Physiological Cost Index (PCI) has been proposed to assess gait demand. The purpose of the study was to establish whether PCI is a valid indicator in subacute stroke patients of energy cost of walking in different walking conditions, that is, over ground and on the Gait Trainer (GT) with body weight support (BWS). The study tested if correlations exist between PCI and ECW, indicating validity of the measure and, by implication, validity of PCI. Six patients (patient group (PG)) with subacute stroke and 6 healthy age- and size-matched subjects as control group (CG) performed, in a random sequence in different days, walking tests overground and on the GT with 0, 30, and 50% BWS. There was a good to excellent correlation between PCI and ECW in the observed walking conditions: in PG Pearson correlation was 0.919 (p<0.001); in CG Pearson correlation was 0.852 (p<0.001). In conclusion, the high significant correlations between PCI and ECW, in all the observed walking conditions, suggest that PCI is a valid outcome measure in subacute stroke patients.

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Motor Training of Upper Extremity With Functional Electrical Stimulation in Early Stroke Rehabilitation

Neurorehabilitation and Neural Repair ◽

10.1177/1545968308324548 ◽

2008 ◽

Vol 23 (2) ◽

pp. 184-190 ◽

Cited By ~ 47

Author(s):

Sabine Mangold ◽

Corina Schuster ◽

Thierry Keller ◽

Andrea Zimmermann-Schlatter ◽

Thierry Ettlin

Keyword(s):

Electrical Stimulation ◽

Upper Extremity ◽

Shoulder Pain ◽

Functional Electrical Stimulation ◽

Intervention Group ◽

Passive Movement ◽

Control Group ◽

Motor Training ◽

Stroke Patients ◽

Subacute Stroke

Background. Functional electrical stimulation (FES) allows active exercises in stroke patients with upper extremity paralysis. Objective. To investigate the effect of motor training with FES on motor recovery in acute and subacute stroke patients with severe to complete arm and/or hand paralysis. Methods. For this pilot study, 23 acute and subacute stroke patients were randomly assigned to the intervention (n = 12) and control group (n = 11). Distributed over 4 weeks, FES training replaced 12 conventional training sessions in the intervention group. An Extended Barthel Index (EBI) subscore assessed the performance of activities of daily living (ADL). The Chedoke McMaster Stroke Assessment (CMSA) measured hand and arm function and shoulder pain. The Modified Ashworth Scale (MAS) assessed resistance to passive movement. Unblinded assessments were performed prior to and following the end of the training period. Results. The EBI subscore and CMSA arm score improved significantly in both groups. The CMSA hand function improved significantly in the FES group. Resistance to passive movement of finger and wrist flexors increased significantly in the FES group. Shoulder pain did not change significantly. None of the outcome measures, however, demonstrated significant gain differences between the groups. Conclusions. We did not find clear evidence for superiority or inferiority of FES. Our findings, and those of similar trials, suggest that the number of sessions should be at least doubled to test for superiority of FES in these highly impaired patients and approximately 50 participants would have to be assigned to each therapeutic intervention to find significant differences.

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Acupuncture with Rehabilitation in the Treatment of Ischemic Stroke Recovery: A Randomized Controlled Trial

10.21203/rs.2.177/v2 ◽

2019 ◽

Author(s):

Lixia Li ◽

Weifeng Zhu ◽

Guohua Lin ◽

Chuyun Chen ◽

Donghui Tang ◽

...

Keyword(s):

Ischemic Stroke ◽

Controlled Trial ◽

Stroke Recovery ◽

Control Group ◽

Acupuncture Points ◽

Modified Ashworth Scale ◽

Significant Difference ◽

Scale Scores ◽

Before And After ◽

Ashworth Scale

Abstract Background: Acupuncture is a well known treatment for ischemic stroke recovery, but evidence of its effectiveness remains limited. Methods: Rehabilitation training was provided to a control group. In Arm 1 and Arm 2, acupoint schemes were determined by a 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 from modern RCT literature. Acupuncture was given on the acupoint. 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 was the National Institute of Health stroke scale (NIHSS), and the secondary outcomes were the Barthel index (BI) and the modified Ashworth scale (MAS). Outcomes were observed in patients both before and after treatment. Results: A total of 497 patients with ischemic stroke were randomized into either Arm 1 (159 cases), Arm 2 (173 cases) or a control group (165 cases). After 2 weeks of treatment, the NIHSS scores for 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). Additionally, 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). Conclusion: The clinical efficacy of Arm 1 and Arm 2 (acupuncture groups) was superior to that of the control group.

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Safety of Low Dose Intravenous Cangrelor in Acute Ischemic Stroke: A Case Series

Frontiers in Neurology ◽

10.3389/fneur.2021.636682 ◽

2021 ◽

Vol 12 ◽

Author(s):

Hisham Salahuddin ◽

Giana Dawod ◽

Syed F. Zaidi ◽

Julie Shawver ◽

Richard Burgess ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Intracranial Hemorrhage ◽

Low Dose ◽

Case Series ◽

Control Group ◽

Anterior Circulation ◽

Study Objective ◽

Safety And Efficacy ◽

Stroke Treatment

Background: Neurointerventional procedures in acute ischemic stroke often require immediate antiplatelet therapy in the cases of acute stenting and occasionally re-occluding vessels. Intravenous cangrelor is a P2Y12 receptor antagonist with short onset and quick offset. The study objective was to evaluate the safety and efficacy of intravenous cangrelor in patients with acute ischemic stroke requiring urgent antiplatelet effect.Methods: Patients who received intravenous cangrelor intra-procedurally during acute ischemic stroke treatment were identified from a prospectively collected database. Cangrelor was administered as a bolus of 15 mcg/kg, followed by an infusion rate of 2 mcg/kg/min. A historical control group consisting of anterior circulation tandem occlusions was used to compare to patients with similar lesions who received intravenous cangrelor. Outcomes of interest included in-stent thrombosis, thromboembolic complications, intracranial hemorrhage, and functional outcomes at 90 days.Results: Twelve patients received intravenous cangrelor for acute ischemic stroke between October 2018 and April 2020 at a comprehensive stroke center. Eleven patients had intra or extracranial stenting performed, which included two posterior circulation lesions. No cases of symptomatic intracranial hemorrhage were reported. At 90 day follow-up, two patients had died and 10 had a good functional outcome. Patients with anterior circulation tandem occlusions who received cangrelor and those who received dual antiplatelets orally had similar radiographic and clinical outcomes.Conclusion: Low dose intravenous cangrelor is similar in safety and efficacy to oral antiplatelets in acute ischemic stroke in a small case series. Larger prospective studies on the efficacy, safety, and effect on procedure times of intravenous cangrelor in neurointervention are warranted.

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

10.21203/rs.2.177/v1 ◽

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)

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Effectiveness of dry needling in equinovarus foot deformity in patients with cerebrovascular accident

Revista Fisioterapia Invasiva ◽

10.1055/s-0039-3401877 ◽

2019 ◽

Vol 02 (02) ◽

pp. 102-102

Author(s):

Sánchez Milá Z. ◽

López Pascua C. ◽

Ranz Ramírez E. ◽

Castrillo Calvillo A.

Keyword(s):

Motor Function ◽

Cerebrovascular Accident ◽

Tibialis Anterior ◽

Descriptive Analysis ◽

Tibialis Posterior ◽

Control Group ◽

Dry Needling ◽

Timed Up And Go ◽

Receive Treatment ◽

Ashworth Scale

Abstract Introduction Spasticity secondary to cerebrovascular accident is one of the main causes of disability in adults. Equinovarus foot is a common condition in patients with cerebrovascular accident, with an estimated prevalence of 18% (Verdié C. 2004). This deformity is mainly caused by spasticity of the tibialis posterior muscle, together with weakness of the tibialis anterior. Aims To determine the effects of deep dry needling together with neurorehabilitation treatment (based on the Bobath concept) on spasticity and motor function after a cerebrovascular accident. Material and Methods A single-blinded randomized experimental study, which comprised ten (n = 10) patients who had suffered a cerebrovascular accident, who were randomly assigned to a control group (CG) who received neurorehabilitation treatment (n = 5) and another experimental group (EG) who received ultrasound-guided dry needling in the tibialis posterior and tibialis anterior muscles plus neurorehabilitation treatment (n = 5). Measurements were made at baseline and ten minutes after treatment by a blinded evaluator who measured spasticity (Ashworth scale) and motor function (timed up and go test). Results The subjects who received dry needling showed a decrease in spasticity after treatment of the tibialis posterior (P < 0.001) and the tibialis anterior muscles (P < 0.003) compared to those who did not receive treatment. The descriptive analysis of the timed up and go test, (CG pre:22.7720/post:21.8060 and EG pre:23.8960/post:17.9780*) revealed a decrease in times for both groups, which was more significant in the group of neurorehabilitation treatment plus dry needling. Conclusion The inclusion of deep dry needling in a session of neurorehabilitation treatment (following the Bobath concept) appears to be effective for the normalization of tone and for the improvement of balance during the gait cycle in patients who have suffered a cerebrovascular accident.

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ArmAssist Robotic System versus Matched Conventional Therapy for Poststroke Upper Limb Rehabilitation: A Randomized Clinical Trial

BioMed Research International ◽

10.1155/2017/7659893 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 12

Author(s):

Tijana J. Dimkić Tomić ◽

Andrej M. Savić ◽

Aleksandra S. Vidaković ◽

Sindi Z. Rodić ◽

Milica S. Isaković ◽

...

Keyword(s):

Upper Limb ◽

Low Cost ◽

Primary Outcome Measure ◽

Robotic System ◽

Motor Deficits ◽

Control Group ◽

Robotic Training ◽

Upper Limb Rehabilitation ◽

Subacute Stroke ◽

Wolf Motor Function Test

The ArmAssist is a simple low-cost robotic system for upper limb motor training that combines known benefits of repetitive task-oriented training, greater intensity of practice, and less dependence on therapist assistance. The aim of this preliminary study was to compare the efficacy of ArmAssist (AA) robotic training against matched conventional arm training in subacute stroke subjects with moderate-to-severe upper limb impairment. Twenty-six subjects were enrolled within 3 months of stroke and randomly assigned to the AA group or Control group (n=13each). Both groups were trained 5 days per week for 3 weeks. The primary outcome measure was Fugl-Meyer Assessment-Upper Extremity (FMA-UE) motor score, and the secondary outcomes were Wolf Motor Function Test-Functional Ability Scale (WMFT-FAS) and Barthel index (BI). The AA group, in comparison to the Control group, showed significantly greater increases in FMA-UE score (18.0 ± 9.4 versus 7.5 ± 5.5,p=0.002) and WMFT-FAS score (14.1 ± 7.9 versus 6.7 ± 7.8,p=0.025) after 3 weeks of treatment, whereas the increase in BI was not significant (21.2 ± 24.8 versus 13.1 ± 10.7,p=0.292). There were no adverse events. We conclude that arm training using the AA robotic device is safe and able to reduce motor deficits more effectively than matched conventional arm training in subacute phase of stroke. The study has been registered at the ClinicalTrials.gov, ID:NCT02729649.

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Risk Factors of Recurrent Ischemic Events after Acute Noncardiogenic Ischemic Stroke

Current Pharmaceutical Design ◽

10.2174/1381612825666191029103756 ◽

2020 ◽

Vol 25 (45) ◽

pp. 4827-4834 ◽

Cited By ~ 1

Author(s):

Limin Zhang ◽

Xingang Li ◽

Dongzhi Wang ◽

Hong Lv ◽

Xuezhong Si ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Ischemic Stroke ◽

Operating Characteristic ◽

Control Group ◽

Case Group ◽

Stroke Patients ◽

Clopidogrel Therapy ◽

Ischemic Events

Background: A considerable proportion of acute noncardiogenic ischemic stroke patients continue to experience recurrent ischemic events after standard therapy. Aim: We aimed to identify risk factors for recurrent ischemic event prediction at an early stage. Methods : 286 non-cardioembolic ischemic stroke patients with the onset of symptoms within 24 hours were enrolled. Vascular risk factors, routine laboratory data on admission, thromboelastography test seven days after clopidogrel therapy and any recurrent events within one year were assessed. Patients were divided into case group (patients with clinical adverse events, including ischemic stokes, transient ischemic attack, myocardial infarction and vascular related mortality) and control group (events-free patients). The risk of the recurrent ischemic events was determined by the receiver operating characteristic curve and multivariable logistic regression analysis. Results: Clinical adverse events were observed in 43 patients (case group). The mean levels of Mean Platelet Volume (MPV), Platelet/Lymphocyte Ratio (PLR), Lymphocyte Count (LY) and Fibrinogen (Fib) on admission were significantly higher in the case group as compared to the control group (P<0.001). Seven days after clopidogrel therapy, the ADP-induced platelet inhibition rate (ADP%) level was lower in the case group, while the Maximum Amplitude (MA) level was higher in the case group as compared to the control group (P<0.01). The Area Under the Curve (AUC) of receiver operating characteristic(ROC) curve of LY, PLR, , Fib, MA, ADP% and MPV were 0.602, 0.614, 0.629, 0.770, 0.800 and 0.808, respectively. The logistic regression analysis showed that MPV, ADP% and MA were indeed predictive factors. Conclusion: MPV, ADP% and MA were risk factors of recurrent ischemic events after acute noncardiogenic ischemic stroke. Urgent assessment and individual drug therapy should be offered to these patients as soon as possible.

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Selective intra-carotid blood cooling in acute ischemic stroke: A safety and feasibility study in an ovine stroke model

Journal of Cerebral Blood Flow & Metabolism ◽

10.1177/0271678x211024952 ◽

2021 ◽

pp. 0271678X2110249

Author(s):

Giorgio FM Cattaneo ◽

Andrea M Herrmann ◽

Sebastian A Eiden ◽

Manuela Wieser ◽

Elias Kellner ◽

...

Keyword(s):

Ischemic Stroke ◽

Carotid Artery ◽

Acute Ischemic Stroke ◽

Neurological Outcome ◽

Artery Occlusion ◽

Control Group ◽

Stroke Model ◽

Primary Endpoints ◽

Neuroprotective Strategy ◽

Vessel Patency

Selective therapeutic hypothermia (TH) showed promising preclinical results as a neuroprotective strategy in acute ischemic stroke. We aimed to assess safety and feasibility of an intracarotid cooling catheter conceived for fast and selective brain cooling during endovascular thrombectomy in an ovine stroke model. Transient middle cerebral artery occlusion (MCAO, 3 h) was performed in 20 sheep. In the hypothermia group (n = 10), selective TH was initiated 20 minutes before recanalization, and was maintained for another 3 h. In the normothermia control group (n = 10), a standard 8 French catheter was used instead. Primary endpoints were intranasal cooling performance (feasibility) plus vessel patency assessed by digital subtraction angiography and carotid artery wall integrity (histopathology, both safety). Secondary endpoints were neurological outcome and infarct volumes. Computed tomography perfusion demonstrated MCA territory hypoperfusion during MCAO in both groups. Intranasal temperature decreased by 1.1 °C/3.1 °C after 10/60 minutes in the TH group and 0.3 °C/0.4 °C in the normothermia group (p < 0.001). Carotid artery and branching vessel patency as well as carotid wall integrity was indifferent between groups. Infarct volumes (p = 0.74) and neurological outcome (p = 0.82) were similar in both groups. Selective TH was feasible and safe. However, a larger number of subjects might be required to demonstrate efficacy.

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Multidirectional Overground Robotic Training Leads to Improvements in Balance in Older Adults

Robotics ◽

10.3390/robotics10030101 ◽

2021 ◽

Vol 10 (3) ◽

pp. 101

Author(s):

Lara A. Thompson ◽

Mehdi Badache ◽

Joao Augusto Renno Brusamolin ◽

Marzieh Savadkoohi ◽

Jelani Guise ◽

...

Keyword(s):

Older Adults ◽

Healthy Aging ◽

Robotic System ◽

Control Group ◽

Support Surface ◽

Training Methods ◽

Robotic Training ◽

Balance Confidence ◽

Balance Ability ◽

Abc Scale

For the rapidly growing aging demographic worldwide, robotic training methods could be impactful towards improving balance critical for everyday life. Here, we investigated the hypothesis that non-bodyweight supportive (nBWS) overground robotic balance training would lead to improvements in balance performance and balance confidence in older adults. Sixteen healthy older participants (69.7 ± 6.7 years old) were trained while donning a harness from a distinctive NaviGAITor robotic system. A control group of 11 healthy participants (68.7 ± 5.0 years old) underwent the same training but without the robotic system. Training included 6 weeks of standing and walking tasks while modifying: (1) sensory information (i.e., with and without vision (eyes-open/closed), with more and fewer support surface cues (hard or foam surfaces)) and (2) base-of-support (wide, tandem and single-leg standing exercises). Prior to and post-training, balance ability and balance confidence were assessed via the balance error scoring system (BESS) and the Activities specific Balance Confidence (ABC) scale, respectively. Encouragingly, results showed that balance ability improved (i.e., BESS errors significantly decreased), particularly in the nBWS group, across nearly all test conditions. This result serves as an indication that robotic training has an impact on improving balance for healthy aging individuals.

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