Differences in Dual Task Performance After Robotic Upper Extremity Rehabilitation in Hemiplegic Stroke Patients

Background: Cognitive–motor interference is a phenomenon in which the concomitant performance of cognitive and motor tasks results in poorer performance than the isolated performance of these tasks. We aimed to evaluate changes in dual-task performance after robotic upper extremity rehabilitation in patients with stroke-induced hemiplegia.Methods: This prospective study included patients with left upper limb weakness secondary to middle cerebral artery stroke who visited a rehabilitation hospital. Participants performed a total of 640 robot-assisted planar reaching movements during a therapist-supervised robotic intervention that was conducted five times a week for 4 weeks. Cognitive and motor performance was separately evaluated in single- and dual-task conditions. The digit span test and Controlled Oral Word Association Test (COWAT) were used to assess cognitive performance, whereas motor performance was evaluated through kinematic assessment of the motor task.Results: In single-task conditions, motor performance showed significant improvement after robotic rehabilitation, as did the scores of the COWAT subdomains of animal naming (p < 0.001), supermarket item naming (p < 0.06), and phonemes (p < 0.05). In dual-task conditions, all motor task performance variables except mean velocity showed improvement after robotic rehabilitation. The type of cognitive task did not affect the dual-task effect, and there were no significant differences in the dual-task effects of motor, cognitive, or the sum of motor and cognitive performance after robotic rehabilitation.Conclusion: Post-stroke robotic rehabilitation has different effects on motor and cognitive function, with more consistent effects on motor function than on cognitive function. Although motor and cognitive performance improved after robotic rehabilitation, there were no changes in the corresponding dual-task effects.

Development of a Compensation-aware Virtual Rehabilitation System for Upper Extremity Rehabilitation in Community-Dwelling Older Adults with Stroke

Background: Compensatory movements are commonly observed in older adults with stroke when they take motor practice for rehabilitation, which could limit their motor recovery.Aim: This study aims to develop one virtual rehabilitation system (VRS) that can detect and reduce compensatory movements to improve the quality of upper extremity (UE) movements and hence the outcome of rehabilitation in community-dwelling older adults with stroke. Method: To design and validate the algorithm of compensation detection equipped in VRS, a study was first conducted to recruit 17 healthy and 6 stroke participants to identify and quantify compensatory movements when they played rehabilitation games provided by the VRS. Then a pilot study was conducted to test the feasibility and efficacy of the VRS deployed in community, where 18 stroke participants were assigned to either virtual reality (VR) group or conventional treatment (CT) group, and each participant underwent 10 sessions of an additional 6 minutes of VR games or CT respectively, on top of their usual rehabilitation programme. Participants were assessed before and after interventions using Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Wolf Motor Function Test(WMFT), Stroke Rehabilitation Motivation Scale (SRMS), Range of Motion (ROM) measurements and the number of compensatory movements.Results: VR group demonstrated a trend in reduction of trunk and upper-extremity compensations, increased intrinsic motivation scores, and statistically significant improvements in FMA-UE (p=0.045) and WMFT (p=0.009, p=0.0355) scores. There was, however, no significant difference in all outcome measures between two groups. Conclusion: The compensation-aware VRS demonstrates a trend towards reduced compensation and higher motivation level, which could be an effective adjunct to the conventional therapy with less supervision from a therapist as well as be potentially deployed in a community center or at an elder adult’s home.

Feasibility and preliminary efficacy of a combined virtual reality, robotics and electrical stimulation intervention in upper extremity stroke rehabilitation

Background Approximately 80% of individuals with chronic stroke present with long lasting upper extremity (UE) impairments. We designed the perSonalized UPper Extremity Rehabilitation (SUPER) intervention, which combines robotics, virtual reality activities, and neuromuscular electrical stimulation (NMES). The objectives of our study were to determine the feasibility and the preliminary efficacy of the SUPER intervention in individuals with moderate/severe stroke. Methods Stroke participants (n = 28) received a 4-week intervention (3 × per week), tailored to their functional level. The functional integrity of the corticospinal tract was assessed using the Predict Recovery Potential algorithm, involving measurements of motor evoked potentials and manual muscle testing. Those with low potential for hand recovery (shoulder group; n = 18) received a robotic-rehabilitation intervention focusing on elbow and shoulder movements only. Those with a good potential for hand recovery (hand group; n = 10) received EMG-triggered NMES, in addition to robot therapy. The primary outcomes were the Fugl-Meyer UE assessment and the ABILHAND assessment. Secondary outcomes included the Motor Activity Log and the Stroke Impact Scale. Results Eighteen participants (64%), in either the hand or the shoulder group, showed changes in the Fugl-Meyer UE or in the ABILHAND assessment superior to the minimal clinically important difference. Conclusions This indicates that our personalized approach is feasible and may be beneficial in improving UE function in individuals with moderate to severe impairments due to stroke. Trial registration ClinicalTrials.gov NCT03903770. Registered 4 April 2019. Registered retrospectively.

A Simulator for Testing Planar Upper Extremity Rehabilitation Robot Control Algorithms

In this study, we took advantage of the emergence of accurate biomechanical human hand models to develop a system in which the interaction between a human arm and a rehabilitation robot while performing a planar trajectory tracking task can be simulated. Seven biomechanical arm models were based on the 11-degree-of-freedom Dynamic Arm Simulation model and implemented in OpenSim. The model of the robot was developed in MatlabSimulink and interaction between the arm and robot models was achieved using the OpenSim API. The models were tested by simulating the performance of each model while moving the end effector of a simulated planar robot model through an elliptical trajectory with an eccentricity of 0.94. Without assistance from the robot, the average root-mean-square error (RMSE) for all subjects was 3.98 mm. With the simulated robot providing assistive torque, the average RMSE error reduced to 2.88 mm. The test was repeated after modifying the length of the robot links, and an average RMSE of 2.91 mm recorded. A single-factor ANOVA test revealed that there was no significant difference in the RMSE for the two different robot geometries (p-value = 0.479), revealing that the simulator was not sensitive to robot geometry.

Factors related to daily use of the paretic upper limb in patients with chronic hemiparetic stroke–A retrospective cross-sectional study

Aims The present study aimed to determine factors associated with the frequency of paralyzed upper extremity (UE) use in chronic stroke patients with severe UE functional deficiency. Methods We retrospectively reviewed the medical records of 138 consecutive patients, and 117 was analyzed (median age, 55 [range, 18–85] years; median stroke duration, 24.5 [range, 7–302] months) with chronic hemiparetic stroke who were admitted to our hospital for intensive upper extremity rehabilitation. The mean Fugl-Meyer Assessment (FMA) UE score was 28.6. All of them are independent in their activity of daily living (ADL) and without remarkable cognitive deficits. Amount-of-use score of Motor Activity Log-14 (MAL-AOU) was applied as the index of daily use of affected UE. The following parameters were examined as the explanatory variables: demographics, proximal and distal sub-scores of FMA UE, Modified Ashworth Scale (MAS), and sensory function scores in the Stroke Impairment Assessment Set (SIAS). Results The median MAL-AOU score was 0.57 [range, 0.28–0.80]. Ordinal regression analysis revealed that FMA proximal, FMA distal, and SIAS sensory function (touch) were associated with AOU score of MAL-14 (Pseudo R-square = 0.460). Conclusion Not only motor but also sensory function, especially tactile sensation, play a crucial role in the daily use of affected UE in chronic stroke patients with severe UE hemiparesis.