Emerging Technologies for Neuro-Rehabilitation after Stroke

2015 ◽  
pp. 1-21 ◽  
Author(s):  
Andrés F. Ruiz Olaya ◽  
Alberto López Delis
Keyword(s):  
Motor Learning ◽  
Motor Function ◽  
Upper Limb ◽  
Neural Plasticity ◽  
Lower Limb ◽  
Emerging Technologies ◽  
Research Field ◽  
Motor Deficits ◽  
Intensive Training ◽  
Learning Principles

Rehabilitation of motor function has been linked to motor learning that occurs during repetitive, frequent, and intensive training. Neuro-rehabilitation is based on the assumption that motor learning principles can be applied to motor recovery after injury, and that training can lead to permanent improvements in motor function in patients with motor deficits. The emergent research field of Rehabilitation Engineering may provide promised technologies for neuro-rehabilitation therapies, exploiting the motor learning and neural plasticity concepts. Among those promising technologies are robotic exoskeletons and active FES-assisted systems, which could provide repetitive training-based therapies and have been developed to aid or control the upper and lower limb movements in response to user's intentionality. This chapter describes those emerging technologies to enhance the neuro-rehabilitation processes of motor-disabled people at upper limb level and presents how a natural control to command above external devices from Electromyography could be implemented.

scholarly journals Motor learning-based activities may improve functional ability in adults with severe cerebral palsy: A controlled pilot study

2021 ◽  
pp. 1-11
Author(s):  
Helle Hüche Larsen ◽  
Rasmus Feld Frisk ◽  
Maria Willerslev-Olsen ◽  
Jens Bo Nielsen
Keyword(s):  
Cerebral Palsy ◽  
Motor Learning ◽  
Motor Function ◽  
Functional Ability ◽  
Active Group ◽  
Control Group ◽  
Gross Motor ◽  
Gross Motor Function ◽  
Learning Principles

BACKGROUND: Cerebral palsy (CP) is a neurodevelopmental disturbance characterized by impaired control of movement. Function often decreases and 15% of adults are classified as severely affected (Gross Motor Function Classification Scale III-V). Little is known about interventions that aim to improve functional abilities in this population. OBJECTIVE: To evaluate a 12-week intervention based on motor learning principles on functional ability in adults with severe CP. METHODS: 16 adults (36±10 years, GMFCS III-V) were enrolled and divided into an intervention group (Active group) and a standard care group (Control group). Primary outcome measure was Gross Motor Function Measure (GMFM-88). Secondary measures were neurological status. The Active group were measured at baseline, after the intervention and at one-month follow-up. The Control group were measured at baseline and after one month. RESULTS: Analysis showed statistically significant improvement in GMFM-88 for the Active group from baseline to post assessment compared with the Control group (group difference: 5 points, SE 14.5, p = 0.008, CI: 1.2 to 8.7). Improvements were maintained at follow-up. Results from the neurological screening showed no clear tendencies. CONCLUSIONS: The study provides support that activities based on motor learning principles may improve gross motor function in adults with severe CP.

scholarly journals Relationship between upper limb motor function and activities of daily living after removing the influence of lower limb motor function in subacute patients with stroke: A cross-sectional study

2020 ◽  
pp. 156918612092660
Author(s):  
Haruka Yamamoto ◽  
Kazuya Takeda ◽  
Soichiro Koyama ◽  
Keisuke Morishima ◽  
Yuichi Hirakawa ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Motor Function ◽  
Upper Limb ◽  
Lower Limb ◽  
Daily Living ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Motor Score ◽  
Cross Sectional ◽  
The Relationship

Background Previous studies have reported a relationship between upper limb motor function and activities of daily living. However, their relationship after removing the influence of lower limb motor function has not been clarified. Objective This study aimed to investigate the relationship between Fugl-Meyer assessment upper limb and total Functional Independence Measure motor score and between Fugl-Meyer assessment upper limb and each item contained in Functional Independence Measure motor score after eliminating the influence of the motor function of the affected lower limb. Methods This retrospective cross-sectional study included 58 subacute stroke patients. To investigate the relationship between the Fugl-Meyer assessment upper limb and total Functional Independence Measure motor score before and after removing the influence of Fugl-Meyer assessment lower limb, Spearman’s rank correlation coefficient and partial correlation analysis were used. Additionally, the relationship between Fugl-Meyer assessment upper limb and each item of Functional Independence Measure motor score after removing the influence was assessed. Results Before removing the influence of Fugl-Meyer assessment lower limb, Fugl-Meyer assessment upper limb was strongly correlated with total Functional Independence Measure motor score (r = 0.74, p < 0.001). However, it became weak after removing the influence (r = 0.27, p = 0.04). Regarding each item of Functional Independence Measure motor score, Fugl-Meyer assessment upper limb was correlated with grooming (r = 0.27, p = 0.04), bathing (r = 0.28, p = 0.03), dressing upper body (r = 0.33, p = 0.01), dressing lower body (r = 0.31, p = 0.02), and stair-climbing (r = 0.31, p = 0.02) after removing the influence. Conclusion These findings suggest that the relationship between the upper limb motor function and activities of daily living is strongly influenced by lower limb motor function.

scholarly journals Effects of Excitatory Transcranial Magnetic Stimulation of the Anterior Intraparietal Area in Chronic Stroke Patients

2018 ◽  
Author(s):  
Ronaldo Luis da Silva ◽  
Angela Maria Costa de Souza ◽  
Francielly Ferreira Santos ◽  
Sueli Toshie Inoue ◽  
Johanne Higgins ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Motor Function ◽  
Upper Limb ◽  
Lower Limb ◽  
Magnetic Stimulation ◽  
Sensory Function ◽  
Stroke Patients ◽  
Chronic Patients ◽  
Upper Limb Function ◽  
Stimulation Of

1) Objective: to evaluate the effects of excitatory transcranial magnetic stimulation of the anterior intraparietal area in chronic patients with a frontal lesion and parietal sparing due to stroke on the impaired upper (UL) and lower limb (LL) as measured by Fugl-Meyer Assessment (FMA). 2) Methods: three patients (P1: 49.83/2.75, P2: 53.17/3.83, P3:63.33/3.08 years-old at stroke/years post-stroke, respectively) received two weeks (five days/ week) of rTMS at 10 Hz of the left anterior intraparietal area (AIP). A patient was treated in similar conditions with a sham coil (56.58/4.33) No complimentary therapy was delivered during the study. Patients were evaluated before, after- and two-months post-treatment (A1, A2 and A3, respectively). 3) Results: We found increased scores for lower limb in motor function subsection for P1 and P3 and in sensory function for P2 by A2 that remained at A3. We also found an increased score for upper limb motor function for P2 and P3, but the score decreased by A3 for P2. P3 score for upper limb ROM increased by A3 compared to A1 and A2. 4) Conclusion: AIP excitatory rTMS increased the FMA scores for lower and upper limb function, showing a broader effect when compared to M1 stimulation.

scholarly journals Emergence of Virtual Reality as a Tool for Upper Limb Rehabilitation: Incorporation of Motor Control and Motor Learning Principles

2015 ◽  
Vol 95 (3) ◽  
pp. 415-425 ◽  
Author(s):  
Mindy F. Levin ◽  
Patrice L. Weiss ◽  
Emily A. Keshner
Keyword(s):  
Virtual Reality ◽  
Motor Control ◽  
Motor Learning ◽  
Upper Limb ◽  
Limb Movement ◽  
Motor Recovery ◽  
Upper Limb Rehabilitation ◽  
Wide Range ◽  
Learning Principles ◽  
Limb Rehabilitation

The primary focus of rehabilitation for individuals with loss of upper limb movement as a result of acquired brain injury is the relearning of specific motor skills and daily tasks. This relearning is essential because the loss of upper limb movement often results in a reduced quality of life. Although rehabilitation strives to take advantage of neuroplastic processes during recovery, results of traditional approaches to upper limb rehabilitation have not entirely met this goal. In contrast, enriched training tasks, simulated with a wide range of low- to high-end virtual reality–based simulations, can be used to provide meaningful, repetitive practice together with salient feedback, thereby maximizing neuroplastic processes via motor learning and motor recovery. Such enriched virtual environments have the potential to optimize motor learning by manipulating practice conditions that explicitly engage motivational, cognitive, motor control, and sensory feedback–based learning mechanisms. The objectives of this article are to review motor control and motor learning principles, to discuss how they can be exploited by virtual reality training environments, and to provide evidence concerning current applications for upper limb motor recovery. The limitations of the current technologies with respect to their effectiveness and transfer of learning to daily life tasks also are discussed.

scholarly journals Upper Limb Immobilisation: A Neural Plasticity Model with Relevance to Poststroke Motor Rehabilitation

2016 ◽  
Vol 2016 ◽  
pp. 1-17 ◽  
Author(s):  
Leonardo Furlan ◽  
Adriana Bastos Conforto ◽  
Leonardo G. Cohen ◽  
Annette Sterr
Keyword(s):  
Upper Limb ◽  
Neural Plasticity ◽  
Future Research ◽  
Motor Deficits ◽  
Plasticity Model ◽  
Motor Rehabilitation ◽  
Adult Humans ◽  
Upper Limb Hemiparesis ◽  
Hemiparetic Stroke ◽  
Rehabilitation Strategies

Advances in our understanding of the neural plasticity that occurs after hemiparetic stroke have contributed to the formulation of theories of poststroke motor recovery. These theories, in turn, have underpinned contemporary motor rehabilitation strategies for treating motor deficits after stroke, such as upper limb hemiparesis. However, a relative drawback has been that, in general, these strategies are most compatible with the recovery profiles of relatively high-functioning stroke survivors and therefore do not easily translate into benefit to those individuals sustaining low-functioning upper limb hemiparesis, who otherwise have poorer residual function. For these individuals, alternative motor rehabilitation strategies are currently needed. In this paper, we will review upper limb immobilisation studies that have been conducted with healthy adult humans and animals. Then, we will discuss how the findings from these studies could inspire the creation of a neural plasticity model that is likely to be of particular relevance to the context of motor rehabilitation after stroke. For instance, as will be elaborated, such model could contribute to the development of alternative motor rehabilitation strategies for treating poststroke upper limb hemiparesis. The implications of the findings from those immobilisation studies for contemporary motor rehabilitation strategies will also be discussed and perspectives for future research in this arena will be provided as well.

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

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.

scholarly journals Effectiveness of combined modified constraint-induced movement therapy for upper and lower limb in stroke rehabilitation: a study protocol for randomized controlled trial (Preprint)

2018 ◽  
Author(s):  
Lawan Umar
Keyword(s):  
Motor Function ◽  
Upper Limb ◽  
Lower Limb ◽  
Gait Speed ◽  
Stride Length ◽  
Controlled Trial ◽  
Stroke Survivors ◽  
Hrqol Score ◽  
Randomized Controlled ◽  
Post Hoc

BACKGROUND Background: The translation of neuroscientific research into care has led to new approaches and renewed promise. Stroke survivors with hemiparesis often exhibit impaired balance, ambulation dysfunction and asymmetrical weight distribution leading to physical dysfunction and decreased Health-Related Quality of Life (HRQoL).Constraint-induced movement therapy (CIMT) approach could be translated into a clinical protocol for gait rehabilitation. Modified CIMT for upper limb and lower limb when applied singly improve lower limb motor function, balance, gait and HRQoL of stroke survivors OBJECTIVE However, effects of combined modified CIMT for upper and lower limbs (CoMCIMTULL) have not been investigated. Therefore, the effects of four-week CoMCIMTULL was compared with Modified CIMT Lower Limb (MCIMTLL) and Modified CIMT Upper Limb (MCIMTUL) among hemiparetic stroke survivors in this study. METHODS This single-blind randomized controlled trial involved random assignment of 56 consecutive stroke survivors to three groups: CoMCIMTULL (n=19), MCIMTLL (n=20), and MCIMTUL (n=17). The CoMCIMTULL group received both upper and lower limb CIMT for the reduced use of the upper limb and maladaptive use of the lower limb. The MCIMTLL group used the affected lower limb to lead weight bearing activities and exercises while the MCIMTUL group used the affected upper limbs for motor task practice following the unaffected hand’s restraining in a special splint. These treatments were administared in the clinic for two hours daily, five times per week for four consecutive weeks. Lower Limb Motor Function (LLMF) and balance were assessed using Fugyl Meyer Motor Assessement Scale, Lower Limb Use (LLU) with Lower Extremity Motor Activity Log, balance confidence using Activities-specific Balance Confidence Scale, Weight Asymmetry Ratio (WAR) using two weighing scales, spatiotemporal gait parameters [gait speed (m/s) and stride length (m)] using foot print method and HRQoL using the Stroke Impact Scale. These assessments were done at baseline, ends of weeks two and four. Data were analysed using descriptive statistics, ANOVA with post-hoc, Kruskal-Wallis with post-hoc and Wilcoxon Signed Rank at ᾳ0.05. RESULTS MBetween-group comparisons showed that the differences were significant in CoMCIMTULL (HRQoL score=70.00(10.00) ; LLMF = 29.00(5.00); gait speed=0.650(0.70)m/s ; Stride length=0.60(0.30)m ; and WAR=0.90(0.80) ) compared to MCIMTLL (HRQoL score=80.00(17.50); LLMF =29.50(2.50) ; gait speed=0.80(0.28)m/s; Stride length=0.65(0.40)m; and WAR=0.85(0.40) and MCIMTUL (HRQoL score= 60.00(10.00; LLMF =26.00(4.00) ; gait speed= 0.60(0.20)m/s;Stride length= 0.40(0.40)m; and WAR= 0.80(0.40) CONCLUSIONS It is expected, the outcome of this study will clarify whether the effect of combined modified CIMT upper and lower limb (CoMCIMTULL), Modified CIMT Lower Limb (MCIMTLL) and Modified CIMT Upper Limb (MCIMTUL) will leads to better recovery of motor function in stroke survivors. CLINICALTRIAL This study has been approved by both Health Research Ethics Committee of Universty of Ibadan/University College Hospital (UI/EC/14/0101) and the Murtala Muhammad Specialist Hospital, Kano (HMB/GEN/488/VOL.I)(Nigeria). Additionaly, the study employed a randomized controlled clinical trial design, registered with Pan Africa Clinical Trial Registry PACTR 201611001646207, available on www.pactr.org.

Effect of residual lower-extremity function on strategies and execution time for raising and lowering trousers in patients with hemiparetic stroke: a cross-sectional study

2021 ◽  
pp. 1-7
Author(s):  
Kenji Iwata ◽  
Soichiro Koyama ◽  
Toshihiro Yamazaki ◽  
Keisuke Kimura ◽  
Hiroaki Sakurai ◽  
...  
Keyword(s):  
Motor Function ◽  
Upper Limb ◽  
Lower Limb ◽  
Execution Time ◽  
Standing Position ◽  
Cross Sectional Study ◽  
Lower Extremity Function ◽  
Cross Sectional ◽  
Paretic Side ◽  
Hemiparetic Stroke

Background/aims There are no established methods for patients with hemiparetic stroke to practice the raising and lowering of trousers. The aim of this study was to investigate the use of different strategies by patients with hemiparetic stroke for lowering and raising trousers by using the non-paretic upper limb in the standing position, based on residual motor function in the paretic lower limb. Methods A total of 28 patients with hemiparetic stroke were included in the study (n=10, 12, and 6 with lower-limb Brunnstrom stages III, IV and V respectively). Endpoints were execution time and frequency of changing the manipulation region. Results Lower-limb Brunnstrom stages III, IV and V were associated with execution times of 24.1 ± 11.1, 18.1 ± 6.5 and 16.9 ± 9.6 seconds respectively, and the mean frequency of manipulation of trousers on the posterior paretic side was significantly lower than those of the anterior paretic, anterior non-paretic, and posterior non-paretic sides in all patients (P<0.05). Conclusions Motor function of the paretic lower limb did not affect the strategies used for lowering and raising trousers with the non-paretic upper limb. Manipulation of trousers on the posterior paretic side was especially difficult.

The relationship between upper limb function and activities of daily living without the effects of lower limb function: A cross-sectional study

2021 ◽  
pp. 030802262110300
Author(s):  
Haruka Yamamoto ◽  
Kazuya Takeda ◽  
Soichiro Koyama ◽  
Keisuke Morishima ◽  
Yuichi Hirakawa ◽  
...  
Keyword(s):  
Motor Function ◽  
Upper Limb ◽  
Lower Limb ◽  
Daily Living ◽  
Partial Correlation ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Partial Correlation Analysis ◽  
Cross Sectional ◽  
The Relationship

Introduction Upper limb motor function and activities of daily living (ADL) are related in chronic stroke patients. This study investigated this relationship after removal of the influence of motor function of the affected lower limb, which until now has remained unclear. Methods This retrospective cross-sectional study included 53 patients with chronic stroke. Upper and lower limb motor function and ADL were assessed using the Fugl-Meyer assessment of the upper (FMA-UL) and lower limbs (FMA-LL) and functional independence measure motor score (FIM-M). To clarify the relationship between FMA-UL and total FIM-M before and after removal of the influence of FMA-LL, Spearman’s rank correlation coefficient and partial correlation analysis were used. The relationship between FMA-UL and each item of FIM-M after removal of the influence of FMA-LL was assessed using partial correlation analysis. Results Before the influence of FMA-LL was removed, FMA-UL was moderately to well correlated with total FIM-M. This became weak after the influence was removed. Regarding each item of FIM-M, FMA-UL was correlated with dressing (upper body), toileting, and walking or wheelchair after removal of the influence. Conclusion The relationship between upper limb motor function and ADL is strongly influenced by lower limb motor function.

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