POST STROKE REHABILITATION: CLINICAL EFFICACY OF BCI-DRIVEN HAND EXOSKELETON IN COMPARISON WITH "AMADEO" ROBOTIC MECHANOTHERAPY

Motor function deficit due to stroke is one of the leading causes for disability among working-age population. The most effective evidence-based treatment strategies are task oriented exercise approaches including constrained-induced movement therapy. Robot-assisted training provides high amount of repetitions and feedback to patient. Adjuvant therapies such as mirror therapy and motor imagery show their effectiveness if used in combination with basic neurorehabilitation methods and are treatment of choice for patients with severe motor impairment. Brain-computer interfaces allow to control motor imagery as a process by giving different type of feedback (e.g. kinesthetic via exoskeleton) during training sessions. It is poorly known if kinesthetic motor imagery is more effective comparing to robot-assisted training as a part of post-stroke rehabilitation. Materials and methods: 55 patients with arm paresis >1 month after stroke were enrolled in the current study. Screening and randomization were performed. Participants underwent rehabilitation treatment where BCI controlled motor imagery training in main group and robot-assisted training in control group were included. Motor function of the paretic arm was assessed using Action Research Arm Test (ARAT) and Fugl-Meyer Assessment (FMA) before and after intervention. Results: Recovery of upper extremity motor function did not correlate with time since stroke and age of participants neither in main group, nor in control group. Correlations between change in motor scales scores and initial severity of motor deficit was shown in both groups (p

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Effectiveness of mirror therapy on upper limb function, activities of daily living, and depression in post-stroke depression patients

Turkish Journal of Physical Medicine and Rehabilitation ◽

10.5606/tftrd.2021.6635 ◽

2021 ◽

Vol 67 (3) ◽

pp. 365-369

Author(s):

Xiang Zhang ◽

Yi Zhang ◽

Yu Liu ◽

Qiujin Yao

Keyword(s):

Occupational Therapy ◽

Motor Function ◽

Daily Living ◽

Control Group ◽

Mirror Therapy ◽

Post Stroke ◽

Upper Limb Function ◽

Mirror Group ◽

Post Stroke Depression ◽

The Mean

Objectives: This study aims to investigate the effects of mirror therapy (MT) on upper limb function, activities of daily living (ADLs), and depression in post-stroke depression patients. Patients and methods: Between November 2018 and December 2019, a total of 60 post-stroke patients (33 males, 27 females; mean age: 58.45±11.13 years; range, 35 to 88 years) were included. The patients were randomly divided into either the cosntrol group (n=30) or the MT group (n=30). Regular occupational therapy was provided for the control group (two times per day for 30 min per session, five times per week over four weeks). Occupational therapy and MT were used to treat patients in the mirror group (one 30 min session once per day, five times per week over four weeks). Motor function (Fugl-Meyer Assessment of the Upper Extremity, FMA-UE), ADL (Modified Barthel Index, MBI) and depression (17-item Hamilton Depression Scale, HAMD-17) were used to evaluate the treatment outcomes. Results: Before treatment, the mean HAMD-17, FMA-UE, and MBI scores showed no significant difference between the two groups (p>0.05). After treatment, the mirror group exhibited more significant improvements than the control group in terms of the mean HAMD-17, FM-UE, and MBI (p<0.05). After four weeks, the mean FMA-UE and MBI scores revealed more significant improvements than the baseline scores in the control group (p<0.01). The mean HAMD-17, FMA-UE, and MBI scores showed more significant improvements than the baseline scores in the MT group (p<0.001). Conclusion: Based on these results, MT can effectively improve motor function, ADLs, and depression in post-stroke depression patients. The curative effectiveness of MT seems to be more prominent than the regular occupational therapy.

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Direct Drive Hand Exoskeleton for Robot-assisted Post Stroke Rehabilitation

Acta Polytechnica Hungarica ◽

10.12700/aph.18.5.2021.5.4 ◽

2021 ◽

Vol 18 (5) ◽

pp. 37-54

Author(s):

Márk Ottó Bauer ◽

Máté Benjámin Vizi ◽

Péter Galambos ◽

Tibor Szalay

Keyword(s):

Stroke Rehabilitation ◽

Direct Drive ◽

Robot Assisted ◽

Post Stroke ◽

Hand Exoskeleton

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Early post-stroke rehabilitation for upper limb motor function using virtual reality and exoskeleton: equally efficient in older patients

Neurologia i Neurochirurgia Polska ◽

10.5603/pjnns.a2020.0096 ◽

2020 ◽

Author(s):

Tereza Gueye ◽

Miriama Dedkova ◽

Vladimir Rogalewicz ◽

Marcela Grunerova-Lippertova ◽

Yvona Angerova

Keyword(s):

Virtual Reality ◽

Motor Function ◽

Upper Limb ◽

Older Patients ◽

Stroke Rehabilitation ◽

Post Stroke

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Cross-education plus mirror therapy as a post-stroke rehabilitation intervention: A case study

Physiotherapy Practice and Research ◽

10.3233/ppr-180125 ◽

2019 ◽

Vol 40 (1) ◽

pp. 51-57

Author(s):

D. Simpson ◽

M. Ehrensberger ◽

P. Broderick ◽

F. Horgan ◽

C. Blake ◽

...

Keyword(s):

Stroke Rehabilitation ◽

Mirror Therapy ◽

Post Stroke ◽

Rehabilitation Intervention ◽

Cross Education

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Efficacy of motor imagery additional to motor-based therapy in the recovery of motor function of the upper limb in post-stroke individuals: a systematic review

Topics in Stroke Rehabilitation ◽

10.1080/10749357.2019.1627716 ◽

2019 ◽

Vol 26 (7) ◽

pp. 548-553 ◽

Cited By ~ 6

Author(s):

Tácia Cotinguiba Machado ◽

Adriani Andrade Carregosa ◽

Matheus S. Santos ◽

Nildo Manoel da Silva Ribeiro ◽

Ailton Melo

Keyword(s):

Systematic Review ◽

Motor Function ◽

Motor Imagery ◽

Upper Limb ◽

Post Stroke ◽

Recovery Of Motor Function

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The effect of mirror therapy on lower extremity motor function and ambulation in post-stroke patients: A prospective, randomized-controlled study

Turkish Journal of Physical Medicine and Rehabilitation ◽

10.5606/tftrd.2020.2719 ◽

2020 ◽

Vol 66 (2) ◽

pp. 154-160

Author(s):

Hatice İkizler May

Keyword(s):

Lower Extremity ◽

Motor Function ◽

Randomized Controlled Study ◽

Controlled Study ◽

Mirror Therapy ◽

Stroke Patients ◽

Post Stroke ◽

Randomized Controlled

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Brain Functional Changes in Stroke Following Rehabilitation Using Brain-Computer Interface-Assisted Motor Imagery With and Without tDCS: A Pilot Study

Frontiers in Human Neuroscience ◽

10.3389/fnhum.2021.692304 ◽

2021 ◽

Vol 15 ◽

Author(s):

Mengjiao Hu ◽

Hsiao-Ju Cheng ◽

Fang Ji ◽

Joanna Su Xian Chong ◽

Zhongkang Lu ◽

...

Keyword(s):

Motor Function ◽

Motor Imagery ◽

Brain Computer Interface ◽

Low Frequency ◽

Computer Interface ◽

Stroke Patients ◽

Post Intervention ◽

Functional Changes ◽

Post Stroke ◽

Assessment Scores

Brain-computer interface-assisted motor imagery (MI-BCI) or transcranial direct current stimulation (tDCS) has been proven effective in post-stroke motor function enhancement, yet whether the combination of MI-BCI and tDCS may further benefit the rehabilitation of motor functions remains unknown. This study investigated brain functional activity and connectivity changes after a 2 week MI-BCI and tDCS combined intervention in 19 chronic subcortical stroke patients. Patients were randomized into MI-BCI with tDCS group and MI-BCI only group who underwent 10 sessions of 20 min real or sham tDCS followed by 1 h MI-BCI training with robotic feedback. We derived amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), and functional connectivity (FC) from resting-state functional magnetic resonance imaging (fMRI) data pre- and post-intervention. At baseline, stroke patients had lower ALFF in the ipsilesional somatomotor network (SMN), lower ReHo in the contralesional insula, and higher ALFF/Reho in the bilateral posterior default mode network (DMN) compared to age-matched healthy controls. After the intervention, the MI-BCI only group showed increased ALFF in contralesional SMN and decreased ALFF/Reho in the posterior DMN. In contrast, no post-intervention changes were detected in the MI-BCI + tDCS group. Furthermore, higher increases in ALFF/ReHo/FC measures were related to better motor function recovery (measured by the Fugl-Meyer Assessment scores) in the MI-BCI group while the opposite association was detected in the MI-BCI + tDCS group. Taken together, our findings suggest that brain functional re-normalization and network-specific compensation were found in the MI-BCI only group but not in the MI-BCI + tDCS group although both groups gained significant motor function improvement post-intervention with no group difference. MI-BCI and tDCS may exert differential or even opposing impact on brain functional reorganization during post-stroke motor rehabilitation; therefore, the integration of the two strategies requires further refinement to improve efficacy and effectiveness.

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Abstract TMP31: Peripheral Nerve Stimulation Paired with Constraint-Induced Therapy to Enhance Post-Stroke Upper Extremity Motor Performance

Stroke ◽

10.1161/str.44.suppl_1.atmp31 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Cheryl Carrico ◽

KC Chelette ◽

Laurie Nichols ◽

Lumy Sawaki

Keyword(s):

Peripheral Nerve ◽

Upper Extremity ◽

Motor Function ◽

Nerve Stimulation ◽

Motor Performance ◽

Motor Recovery ◽

Peripheral Nerve Stimulation ◽

Motor Deficit ◽

Motor Training ◽

Post Stroke

Research has shown that peripheral nerve stimulation (PNS) can enhance motor learning following cortical lesions. Studies have also shown that intensive upper extremity motor training can significantly enhance post-stroke motor performance. Constraint-induced therapy (CIT) is a form of intensive training that restricts use of the non-paretic upper extremity during repetitive, task-oriented motor training of the paretic extremity. Extensive evidence has validated the effectiveness of CIT for enhancing post-stroke upper extremity motor recovery. No studies have evaluated how PNS may modulate the effects of CIT. Therefore, we conducted a pilot study of PNS paired with CIT and hypothesized that in subjects with stroke, pairing CIT with active PNS would lead to significantly more improved motor function in the paretic upper extremity than CIT paired with sham PNS. Outcome measures included the Fugl-Meyer Assessment Scale (FMA; primary outcome measure), the Wolf Motor Function Test (WMFT), and the Action Research Arm Test (ARAT). Nineteen chronic stroke subjects with mild to moderate upper extremity motor deficit received 2 hours of either active (n=10) or sham (n=9) PNS preceding 4 hours of CIT for 10 consecutive weekdays. Changes in FMA, WMFT, and ARAT were analyzed using factorial ANOVA. Results showed significant (p<0.05) change in all measures at completion evaluation compared with baseline (FMA (p=0.005); WMFT (p=0.030); ARAT (p=0.020)) as well as 1-month follow-up compared with baseline (FMA (p=0.048); WMFT (p=0.045); ARAT (p=0.047)). These results highlight the enormous potential for PNS paired with CIT to enhance post-stroke upper extremity motor recovery more effectively than CIT alone.

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