Robot-Aided Systems for Improving the Assessment of Upper Limb Spasticity: A Systematic Review

Spasticity is a motor disorder that causes stiffness or tightness of the muscles and can interfere with normal movement, speech, and gait. Traditionally, the spasticity assessment is carried out by clinicians using standardized procedures for objective evaluation. However, these procedures are manually performed and, thereby, they could be influenced by the clinician’s subjectivity or expertise. The automation of such traditional methods for spasticity evaluation is an interesting and emerging field in neurorehabilitation. One of the most promising approaches is the use of robot-aided systems. In this paper, a systematic review of systems focused on the assessment of upper limb (UL) spasticity using robotic technology is presented. A systematic search and review of related articles in the literature were conducted. The chosen works were analyzed according to the morphology of devices, the data acquisition systems, the outcome generation method, and the focus of intervention (assessment and/or training). Finally, a series of guidelines and challenges that must be considered when designing and implementing fully-automated robot-aided systems for the assessment of UL spasticity are summarized.

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Effectiveness of Botulinum Toxin Treatment for Upper Limb Spasticity Poststroke Over Different ICF Domains: A Systematic Review and Meta-Analysis

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2019.01.016 ◽

2019 ◽

Vol 100 (9) ◽

pp. 1703-1725 ◽

Cited By ~ 16

Author(s):

Aukje Andringa ◽

Ingrid van de Port ◽

Erwin van Wegen ◽

Johannes Ket ◽

Carel Meskers ◽

...

Keyword(s):

Systematic Review ◽

Botulinum Toxin ◽

Upper Limb ◽

Meta Analysis ◽

Limb Spasticity ◽

Botulinum Toxin Treatment

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Psychometric properties of measures of upper limb activity performance in adults with and without spasticity undergoing neurorehabilitation–A systematic review

PLoS ONE ◽

10.1371/journal.pone.0246288 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246288

Author(s):

Shannon Pike ◽

Anne Cusick ◽

Kylie Wales ◽

Lisa Cameron ◽

Lynne Turner-Stokes ◽

...

Keyword(s):

Systematic Review ◽

Psychometric Properties ◽

Upper Limb ◽

Methodological Quality ◽

Neurological Impairment ◽

Measurement Quality ◽

Measurement Tools ◽

Limb Spasticity ◽

Psychometric Studies

Introduction This systematic review appraises the measurement quality of tools which assess activity and/or participation in adults with upper limb spasticity arising from neurological impairment, including methodological quality of the psychometric studies. Differences in the measurement quality of the tools for adults with a neurological impairment, but without upper limb spasticity, is also presented. Methods 29 measurement tools identified in a published review were appraised in this systematic review. For each identified tool, we searched 3 databases (Medline, Embase, CINAHL) to identify psychometric studies completed with neurorehabilitation samples. Methodological quality of instrument evaluations was assessed with use of the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) checklist. Synthesis of ratings allowed an overall rating of the psychometric evidence for each measurement tool to be calculated. Results 149 articles describing the development or evaluation of psychometric properties of 22 activity and/or participation measurement tools were included. Evidence specific to tool use for adults with spasticity was identified within only 15 of the 149 articles and provided evidence for 9 measurement tools only. Overall, COSMIN appraisal highlighted a lack of evidence of measurement quality. Synthesis of ratings demonstrated all measures had psychometric weaknesses or gaps in evidence (particularly for use of tools with adults with spasticity). Conclusions The systematic search, appraisal and synthesis revealed that currently there is insufficient measurement quality evidence to recommend one tool over another. Notwithstanding this conclusion, newer tools specifically designed for use with people with neurological conditions who have upper limb spasticity, have emergent measurement properties that warrant further research. Systematic review registration PROSPERO CRD42014013190.

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The Effectiveness of Massage Therapy for Improving Sequelae in Post-Stroke Survivors. A Systematic Review and Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094424 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4424

Author(s):

Rosa Cabanas-Valdés ◽

Jordi Calvo-Sanz ◽

Pol Serra-Llobet ◽

Joana Alcoba-Kait ◽

Vanessa González-Rueda ◽

...

Keyword(s):

Systematic Review ◽

Motor Function ◽

Upper Limb ◽

Lower Limb ◽

Meta Analysis ◽

Stroke Survivors ◽

Randomized Controlled Clinical Trials ◽

Therapeutic Massage ◽

Limb Spasticity ◽

Conventional Physiotherapy

Objective: To assess the effect of therapeutic massage for improving sequelae in stroke survivors. Methods: A systematic review of the nine medical databases from January 1961 to December 2020 was carried out. The bibliography was screened to identify randomized controlled clinical trials (RCTs). Two reviewers independently screened references, selected relevant studies, extracted data and assessed the risk of bias using the PEDro scale. The primary outcome was upper and lower limb motor function and spasticity. Results: A total of 3196 studies were identified and 18 RCT were finally included (1989 individuals). A meta-analysis of RCTs in the comparison of Chinese massage (Tuina) plus conventional physiotherapy versus conventional physiotherapy was performed. The mean difference (MD) in the subacute stage on upper limb motor-function using the Fugl Meyer Assessment was 2.75; (95% confidence interval (CI) from 0.97 to 4.53, p = 0.002, I2 = 36%). The MD on upper limb spasticity using modified Ashworth scale was −0.15; (95% CI from −0.24 to −0.06, p < 0.02, I2 = 0%).The MD on lower limb spasticity was −0.59; (95% CI from −0.78 to −0.40, p < 0.001, I2 = 0%) in the endpoint. Conclusions: Therapeutic massage, especially Tuina, in addition to conventional therapy is effective for improving motor function and for reducing spasticity in stroke survivors.

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Tremor-Suppression Orthoses for the Upper Limb: Current Developments and Future Challenges

Frontiers in Human Neuroscience ◽

10.3389/fnhum.2021.622535 ◽

2021 ◽

Vol 15 ◽

Author(s):

Hoai Son Nguyen ◽

Trieu Phat Luu

Keyword(s):

Systematic Review ◽

Upper Limb ◽

Force Sensor ◽

Regulatory Compliance ◽

The Body ◽

Average Weight ◽

Motor Disorder ◽

Systematic Review Methodology ◽

Tremor Suppression ◽

Future Challenges

Introduction: Pathological tremor is the most common motor disorder in adults and characterized by involuntary, rhythmic muscular contraction leading to shaking movements in one or more parts of the body. Functional Electrical Stimulation (FES) and biomechanical loading using wearable orthoses have emerged as effective and non-invasive methods for tremor suppression. A variety of upper-limb orthoses for tremor suppression have been introduced; however, a systematic review of the mechanical design, algorithms for tremor extraction, and the experimental design is still missing.Methods: To address this gap, we applied a standard systematic review methodology to conduct a literature search in the PubMed and PMC databases. Inclusion criteria and full-text access eligibility were used to filter the studies from the search results. Subsequently, we extracted relevant information, such as suppression mechanism, system weights, degrees of freedom (DOF), algorithms for tremor estimation, experimental settings, and the efficacy.Results: The results show that the majority of tremor-suppression orthoses are active with 47% prevalence. Active orthoses are also the heaviest with an average weight of 561 ± 467 g, followed by semi-active 486 ± 395 g, and passive orthoses 191 ± 137 g. Most of the orthoses only support one DOF (54.5%). Two-DOF and three-DOF orthoses account for 33 and 18%, respectively. The average efficacy of tremor suppression using wearable orthoses is 83 ± 13%. Active orthoses are the most efficient with an average efficacy of 83 ± 8%, following by the semi-active 77 ± 19%, and passive orthoses 75 ± 12%. Among different experimental setups, bench testing shows the highest efficacy at 95 ± 5%, this value dropped to 86 ± 8% when evaluating with tremor-affected subjects. The majority of the orthoses (92%) measured voluntary and/or tremorous motions using biomechanical sensors (e.g., IMU, force sensor). Only one system was found to utilize EMG for tremor extraction.Conclusions: Our review showed an improvement in efficacy of using robotic orthoses in tremor suppression. However, significant challenges for the translations of these systems into clinical or home use remain unsolved. Future challenges include improving the wearability of the orthoses (e.g., lightweight, aesthetic, and soft structure), and user control interfaces (i.e., neural machine interface). We also suggest addressing non-technical challenges (e.g., regulatory compliance, insurance reimbursement) to make the technology more accessible.

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PND85 EFFICACY AND SAFETY OF ABOBOTULINUMTOXINA IN ADULTS WITH UPPER LIMB SPASTICITY AFTER STROKE: A SYSTEMATIC REVIEW

Value in Health ◽

10.1016/j.jval.2019.09.1855 ◽

2019 ◽

Vol 22 ◽

pp. S753

Author(s):

D. Klabukova ◽

V. Krysanova ◽

M. Davydovskaya ◽

T. Ermolaeva

Keyword(s):

Systematic Review ◽

Upper Limb ◽

Efficacy And Safety ◽

Limb Spasticity

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Protocol for systematic review and meta-analysis of efficacy and safety of acupuncture combined with rehabilitation therapy for upper limb spasticity after stroke

10.37766/inplasy2021.5.0076 ◽

2021 ◽

Author(s):

Huijuan Lou ◽

Xinxin Zhang ◽

Zhangxin Li ◽

Hongshi Zhang ◽

Yufeng Wang ◽

...

Keyword(s):

Systematic Review ◽

Upper Limb ◽

Meta Analysis ◽

Efficacy And Safety ◽

Rehabilitation Therapy ◽

Limb Spasticity

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The Role of Selective Peripheral Neurectomy in the Treatment of Upper Limb Spasticity

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835518500182 ◽

2018 ◽

Vol 23 (02) ◽

pp. 181-191 ◽

Cited By ~ 1

Author(s):

Li Yenn Yong ◽

Charis H.L. Wong ◽

Mark Gaston ◽

Wee Leon Lam

Keyword(s):

Systematic Review ◽

Surgical Technique ◽

Upper Limb ◽

Surgical Techniques ◽

Controlled Trials ◽

Neurosurgical Procedures ◽

Cochrane Central Register ◽

Inclusion Criteria ◽

Limb Spasticity ◽

Peripheral Neurectomy

Background: Management of upper limb spasticity remains challenging. Selective peripheral neurectomy (SPN) is a relatively recent intervention for cases refractory to medical therapy. The aim of this study was to conduct a systematic review looking at the efficacy and outcomes of SPN, in order to clarify the patient selection criteria and surgical technique. Methods: A search of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science Core Collection, Open Grey and CINAHL was conducted. Inclusion criteria included studies comparing pre- and post-operative outcomes for SPN, neurectomy, fasciculotomy and upper limb spasticity. Results: Only case series were reported with no randomised controlled trials found. 7 studies met the inclusion criteria with a total of 174 patients. A meta-analysis was not possible due to the degree of baseline heterogeneity. All studies had no control arm for comparison of outcomes, with a high risk of bias due to poor internal and external validity, as well as design and performance bias. Surgical techniques differ vastly between studies, with percentage of fascicles ablated between 30–80% and length of neurectomy between 5–10 mm. Some advocated removing end branches while others performed fascicular SPN proximally. 13 patients underwent orthopaedic or neurosurgical procedures, which are both confounding factors. All studies reported an improvement in spasticity although functional outcomes were reported with non-standardized measures. Recurrence rates were reported to be 0–16.1% (mean 3.72%). Conclusions: From this systematic review, SPN appeared to be a useful technique in selected cases, but overall no firm conclusions can be drawn regarding the best surgical technique, or the extent of functional improvement.

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