scholarly journals A Multiparameter Approach to Evaluate Post-Stroke Patients: An Application on Robotic Rehabilitation

2018 ◽  
Vol 8 (11) ◽  
pp. 2248 ◽  
Author(s):  
Antonella Belfatto ◽  
Alessandro Scano ◽  
Andrea Chiavenna ◽  
Alfonso Mastropietro ◽  
Simona Mrakic-Sposta ◽  
...  
Keyword(s):  
Upper Limb ◽  
Brain Activity ◽  
Quantitative Description ◽  
Motor Task ◽  
Chronic Patients ◽  
Clinical Scales ◽  
Post Stroke ◽  
Robotic Therapy ◽  
Parameter Evaluation ◽  
Before And After

Multidomain instrumental evaluation of post-stroke chronic patients, coupled with standard clinical assessments, has rarely been exploited in the literature. Such an approach may be valuable to provide comprehensive insight regarding patients’ status, as well as orienting the rehabilitation therapies. Therefore, we propose a multidomain analysis including clinically compliant methods as electroencephalography (EEG), electromyography (EMG), kinematics, and clinical scales. The framework of upper-limb robot-assisted rehabilitation is selected as a challenging and promising scenario to test the multi-parameter evaluation, with the aim to assess whether and in which domains modifications may take place. Instrumental recordings and clinical scales were administered before and after a month of intensive robotic therapy of the impaired upper limb, on five post-stroke chronic hemiparetic patients. After therapy, all patients showed clinical improvement and presented pre/post modifications in one or several of the other domains as well. All patients performed the motor task in a smoother way; two of them appeared to change their muscle synergies activation strategies, and most subjects showed variations in their brain activity, both in the ipsi- and contralateral hemispheres. Changes highlighted by the new multiparametric instrumental approach suggest a recovery trend in agreement with clinical scales. In addition, by jointly demonstrating lateralization of brain activations, changes in muscle recruitment and the execution of smoother trajectories, the new approach may help distinguish between true functional recovery and the adoption of suboptimal compensatory strategies. In the light of these premises, the multi-domain approach may allow a finer patient characterization, providing a deeper insight into the mechanisms underlying the relearning procedure and the level (neuro/muscular) at which it occurred, at a relatively low expenditure. The role of this quantitative description in defining a personalized treatment strategy is of great interest and should be addressed in future studies.

Planar Robotic Systems for Upper-Limb Post-Stroke Rehabilitation

2008 ◽  
Author(s):  
Giulio Rosati ◽  
Riccardo Secoli ◽  
Damiano Zanotto ◽  
Aldo Rossi ◽  
Giovanni Boschetti
Keyword(s):  
Upper Limb ◽  
Leading Edge ◽  
Robotic Systems ◽  
Robot Arm ◽  
Chronic Patients ◽  
Upper Limb Rehabilitation ◽  
Post Stroke ◽  
Robotic Therapy ◽  
Robotic Devices ◽  
Limb Rehabilitation

Rehabilitation is the only way to promote recovery of lost function in post-stroke hemiplegic subjects, leading to independence and early reintegration into social and domestic life. In particular, upper limb rehabilitation is fundamental to regain ability in Activities of Daily Living (ADLs). Robot-aided rehabilitation is an emerging field seeking to employ leading-edge robotic systems to increase patient recovery in the rehabilitation treatment. Even though the effectiveness of robotic therapy is still being discussed, the use of robotic devices can increase therapists’ efficiency by alleviating the labor-intensive aspects of physical rehabilitation, and can produce a reduction in treatment costs. This paper presents a comparison between different planar robotic devices designed for upper-limb rehabilitation in chronic patients. A planar configuration of the workspace leads to straightforward mechanical and control system design, and allows to define very simple and understandable treatment exercises. Also, the graphical user interface becomes very intuitive for the patient, and a set of Cartesian-based measures of the patient’s performance can be defined easily. In the paper, SCARA (Selective Compliance Assembly Robot Arm) robots such as the MIT-Manus, Cartesian robots and cable-driven robots are considered and compared in terms of inertial properties and force exertion capabilities. Two cable-driven devices, designed at the Robotics Lab of the Department if Innovation In Mechanics and Management, University of Padua, Italy, are presented for the first time. The first robot employs four driven cables to produce a planar force on the end-effector, whereas the second one is based on a three-cable configuration plus a linear actuator to obtain better overall robot performance.

Sequentially applied myoelectrically controlled FES in a task-oriented approach and robotic therapy for the recovery of upper limb in post-stroke patients: A randomized controlled pilot study

2020 ◽  
pp. 1-11
Author(s):  
Gloria Perini ◽  
Rita Bertoni ◽  
Rune Thorsen ◽  
Ilaria Carpinella ◽  
Tiziana Lencioni ◽  
...  
Keyword(s):  
Upper Limb ◽  
Standard Care ◽  
Experimental Treatment ◽  
Stroke Patients ◽  
Rehabilitation Care ◽  
Post Stroke ◽  
Robotic Therapy ◽  
Arm Rehabilitation ◽  
Point Increase ◽  
Task Oriented

BACKGROUND: Functional recovery of the plegic upper limb in post-stroke patients may be enhanced by sequentially applying a myoelectrically controlled FES (MeCFES), which allows the patient to voluntarily control the muscle contraction during a functional movement and robotic therapy which allows many repetitions of movements. OBJECTIVE: Evaluate the efficacy of MeCFES followed by robotic therapy compared to standard care arm rehabilitation for post-stroke patients. METHODS: Eighteen stroke subjects (onset ⩾ 3 months, age 60.1 ± 15.5) were recruited and randomized to receive an experimental combination of MeCFES during task-oriented reaching followed by robot therapy (MRG) or same intensity conventional rehabilitation care (CG) aimed at the recovery of the upper limb (20 sessions/45 minutes). Change was evaluated through Fugl-Meyer upperextremity (FMA-UE), Reaching Performance Scale and Box and Block Test. RESULTS: The experimental treatment resulted in higher improvement on the FMA-UE compared with CG (P= 0.04), with a 10 point increase following intervention. Effect sizes were moderate in favor of the MRG group on FMA-UE, FMA-UE proximal and RPS (0.37–0.56). CONCLUSIONS: Preliminary findings indicate that a combination of MeCFES and robotic treatment may be more effective than standard care for recovery of the plegic arm in persons > 3 months after stroke. The mix of motor learning techniques may be important for successful rehabilitation of arm function.

scholarly journals Mirror therapy for upper limb rehabilitation in chronic patients after stroke

2016 ◽  
Vol 29 (2) ◽  
pp. 287-293 ◽  
Author(s):  
Dreyzialle Vila Nova Mota ◽  
André Luís Ferreira de Meireles ◽  
Marcelo Tavares Viana ◽  
Rita de Cássia de Albuquerque Almeida
Keyword(s):  
Upper Limb ◽  
Mirror Therapy ◽  
Chronic Patients ◽  
Upper Limb Rehabilitation ◽  
Postural Alignment ◽  
Paretic Limb ◽  
Before And After ◽  
Quasi Experimental ◽  
Conventional Physiotherapy ◽  
Limb Rehabilitation

Abstract Introduction: Individuals with stroke sequelae present changes in the postural alignment and muscle strength associated with hemiplegia or hemiparesis. Mirror therapy is a technique that aims to improve the motor function of the paretic limb. Objective: The aim of this study was to evaluate the effect of mirror therapy, associated with conventional physiotherapy, for range of motion (ROM), degree of spasticity of the affected upper limb, and the level of independence in the activities of daily living (ADL) of chronic patients after stroke. Methods: This was a quasi-experimental (before and after) study. The study included ten stroke survivors undertaking physiotherapy and presenting with upper limb paresis. The following gauges were used for the present study: goniometry, the Modified Ashworth Scale, Fugl-Meyer and Barthel Index. Fifteen sessions were performed, each lasting 30 minutes, consisting of stretching of the flexor and extensor muscles of the wrist and elbow, pronators and supinators, followed by mirror therapy with gradual functional exercises. Results: Improvement was observed in all aspects studied, however with significant differences for ROM wrist extension (p = 0.04) and forearm supination (p = 0.03) Conclusion: It can be concluded that mirror therapy contributed to the participants' good performance in the aspects studied, mainly in relation to ROM of the affected upper limb.

scholarly journals U-Limb: A multi-modal, multi-center database on arm motion control in healthy and post-stroke conditions

GigaScience ◽  
2021 ◽  
Vol 10 (6) ◽  
Author(s):  
Giuseppe Averta ◽  
Federica Barontini ◽  
Vincenzo Catrambone ◽  
Sami Haddadin ◽  
Giacomo Handjaras ◽  
...  
Keyword(s):  
Data Collection ◽  
Upper Limb ◽  
Brain Activity ◽  
Rehabilitation Robotics ◽  
Human Machine Interaction ◽  
Post Stroke ◽  
Upper Limb Movements ◽  
Arm Motion ◽  
And Control ◽  
Human Upper Limb

Abstract Background Shedding light on the neuroscientific mechanisms of human upper limb motor control, in both healthy and disease conditions (e.g., after a stroke), can help to devise effective tools for a quantitative evaluation of the impaired conditions, and to properly inform the rehabilitative process. Furthermore, the design and control of mechatronic devices can also benefit from such neuroscientific outcomes, with important implications for assistive and rehabilitation robotics and advanced human-machine interaction. To reach these goals, we believe that an exhaustive data collection on human behavior is a mandatory step. For this reason, we release U-Limb, a large, multi-modal, multi-center data collection on human upper limb movements, with the aim of fostering trans-disciplinary cross-fertilization. Contribution This collection of signals consists of data from 91 able-bodied and 65 post-stroke participants and is organized at 3 levels: (i) upper limb daily living activities, during which kinematic and physiological signals (electromyography, electro-encephalography, and electrocardiography) were recorded; (ii) force-kinematic behavior during precise manipulation tasks with a haptic device; and (iii) brain activity during hand control using functional magnetic resonance imaging.

scholarly journals A Data-Driven Investigation on Surface Electromyography Based Clinical Assessment in Chronic Stroke

2021 ◽  
Vol 15 ◽  
Author(s):  
Fuqiang Ye ◽  
Bibo Yang ◽  
Chingyi Nam ◽  
Yunong Xie ◽  
Fei Chen ◽  
...  
Keyword(s):  
Upper Limb ◽  
Surface Electromyography ◽  
Pearson Correlation ◽  
Chronic Stroke ◽  
Data Driven ◽  
Robot Assisted ◽  
Automated Assessment ◽  
Zero Crossing ◽  
Clinical Scales ◽  
Before And After

Background: Surface electromyography (sEMG) based robot-assisted rehabilitation systems have been adopted for chronic stroke survivors to regain upper limb motor function. However, the evaluation of rehabilitation effects during robot-assisted intervention relies on traditional manual assessments. This study aimed to develop a novel sEMG data-driven model for automated assessment.Method: A data-driven model based on a three-layer backpropagation neural network (BPNN) was constructed to map sEMG data to two widely used clinical scales, i.e., the Fugl–Meyer Assessment (FMA) and the Modified Ashworth Scale (MAS). Twenty-nine stroke participants were recruited in a 20-session sEMG-driven robot-assisted upper limb rehabilitation, which consisted of hand reaching and withdrawing tasks. The sEMG signals from four muscles in the paretic upper limbs, i.e., biceps brachii (BIC), triceps brachii (TRI), flexor digitorum (FD), and extensor digitorum (ED), were recorded before and after the intervention. Meanwhile, the corresponding clinical scales of FMA and MAS were measured manually by a blinded assessor. The sEMG features including Mean Absolute Value (MAV), Zero Crossing (ZC), Slope Sign Change (SSC), Root Mean Square (RMS), and Wavelength (WL) were adopted as the inputs to the data-driven model. The mapped clinical scores from the data-driven model were compared with the manual scores by Pearson correlation.Results: The BPNN, with 15 nodes in the hidden layer and sEMG features, i.e., MAV, ZC, SSC, and RMS, as the inputs to the model, was established to achieve the best mapping performance with significant correlations (r > 0.9, P < 0.001), according to the FMA. Significant correlations were also obtained between the mapped and manual FMA subscores, i.e., FMA-wrist/hand and FMA-shoulder/elbow, before and after the intervention (r > 0.9, P < 0.001). Significant correlations (P < 0.001) between the mapped and manual scores of MASs were achieved, with the correlation coefficients r = 0.91 at the fingers, 0.88 at the wrist, and 0.91 at the elbow after the intervention.Conclusion: An sEMG data-driven BPNN model was successfully developed. It could evaluate upper limb motor functions in chronic stroke and have potential application in automated assessment in post-stroke rehabilitation, once validated with large sample sizes.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02117089.

scholarly journals Robotic Assisted Upper Limb Training Post Stroke: A Randomized Control Trial Using Combinatory Approach Toward Reducing Workforce Demands

2021 ◽  
Vol 12 ◽  
Author(s):  
Aamani Budhota ◽  
Karen S. G. Chua ◽  
Asif Hussain ◽  
Simone Kager ◽  
Adèle Cherpin ◽  
...  
Keyword(s):  
Motor Function ◽  
Upper Limb ◽  
Conventional Therapy ◽  
Randomized Control Trial ◽  
Potential Method ◽  
Clinical Trial Registration ◽  
Upper Limb Rehabilitation ◽  
Post Stroke ◽  
Robotic Therapy ◽  
Randomized Control

Post stroke upper limb rehabilitation is a challenging problem with poor outcomes as 40% of survivors have functionally useless upper limbs. Robot-aided therapy (RAT) is a potential method to alleviate the effort of intensive, task-specific, repetitive upper limb exercises for both patients and therapists. The present study aims to investigate how a time matched combinatory training scheme that incorporates conventional and RAT, using H-Man, compares with conventional training toward reducing workforce demands. In a randomized control trial (NCT02188628, www.clinicaltrials.gov), 44 subacute to chronic stroke survivors with first-ever clinical stroke and predominant arm motor function deficits were recruited and randomized into two groups of 22 subjects: Robotic Therapy (RT) and Conventional Therapy (CT). Both groups received 18 sessions of 90 min; three sessions per week over 6 weeks. In each session, participants of the CT group received 90 min of 1:1 therapist-supervised conventional therapy while participants of the RT group underwent combinatory training which consisted of 60 min of minimally-supervised H-Man therapy followed by 30 min of conventional therapy. The clinical outcomes [Fugl-Meyer (FMA), Action Research Arm Test and, Grip Strength] and the quantitative measures (smoothness, time efficiency, and task error, derived from two robotic assessment tasks) were independently evaluated prior to therapy intervention (week 0), at mid-training (week 3), at the end of training (week 6), and post therapy (week 12 and 24). Significant differences within group were observed at the end of training for all clinical scales compared with baseline [mean and standard deviation of FMA score changes between baseline and week 6; RT: Δ4.41 (3.46) and CT: Δ3.0 (4.0); p < 0.01]. FMA gains were retained 18 weeks post-training [week 24; RT: Δ5.38 (4.67) and week 24 CT: Δ4.50 (5.35); p < 0.01]. The RT group clinical scores improved similarly when compared to CT group with no significant inter-group at all time points although the conventional therapy time was reduced to one third in RT group. There were no training-related adverse side effects. In conclusion, time matched combinatory training incorporating H-Man RAT produced similar outcomes compared to conventional therapy alone. Hence, this study supports a combinatory approach to improve motor function in post-stroke arm paresis.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02188628.

scholarly journals A modular telerehabilitation architecture for upper limb robotic therapy

2017 ◽  
Vol 9 (2) ◽  
pp. 168781401668725 ◽  
Author(s):  
Davide Simonetti ◽  
Loredana Zollo ◽  
Luca Vollero ◽  
Giulio Iannello ◽  
Eugenio Guglielmelli
Keyword(s):  
Upper Limb ◽  
New Technologies ◽  
Geographical Location ◽  
Modular Architecture ◽  
Stroke Treatment ◽  
Post Stroke ◽  
Robotic Therapy ◽  
Treatment Information ◽  
Early Supported Discharge ◽  
Rehabilitation Tasks

Several factors may prevent post-stroke subjects from participating in rehabilitation protocols, for example, geographical location of rehabilitation centres, socioeconomic status, economic burden and lack of logistics surrounding transportation. Early supported discharge from hospitals with continued rehabilitation at home represents a well-defined regimen of post-stroke treatment. Information-based technologies coupled with robotics have promoted the development of new technologies for telerehabilitation. In this article, the design and development of a modular architecture for delivering upper limb robotic telerehabilitation with the CBM-Motus, a planar unilateral robotic machine that allows performing state-of-the-art rehabilitation tasks, have been presented. The proposed architecture allows a therapist to set a therapy session on his or her side and send it to the patient’s side with a standardized communication protocol; the user interacts with the robot that provides an adaptive assistance during the rehabilitation tasks. Patient’s performance is evaluated by means of performance indicators, which are also used to update robot behaviour during assistance. The implementation of the architecture is described and a set of validation tests on seven healthy subjects are presented. Results show the reliability of the novel architecture and the capability to be easily tailored to the user’s needs with the chosen robotic device.

Effects of dry needling on post-stroke brain activity and muscle spasticity of the upper limb: a case report

2020 ◽  
pp. 096452842092029 ◽  
Author(s):  
Fatemeh Mohammadpour ◽  
Mohammad Ali Oghabian ◽  
Noureddin Nakhostin Ansari ◽  
Soofia Naghdi ◽  
Jan Dommerholt
Keyword(s):  
Case Report ◽  
Upper Limb ◽  
Brain Activity ◽  
Dry Needling ◽  
Muscle Spasticity ◽  
Post Stroke

Review: Functional Neuroimaging Studies of Early Upper Limb Recovery After Stroke: A Systematic Review of the Literature

2010 ◽  
Vol 24 (7) ◽  
pp. 589-608 ◽  
Author(s):  
Floor E. Buma ◽  
Eline Lindeman ◽  
Nick F. Ramsey ◽  
Gert Kwakkel
Keyword(s):  
Task Performance ◽  
Upper Limb ◽  
Primary Motor Cortex ◽  
Functional Neuroimaging ◽  
Imaging Techniques ◽  
Brain Activity ◽  
Treatment Strategies ◽  
Motor Task ◽  
Stroke Recovery ◽  
Future Research

Background. Understanding mechanisms of recovery may result in new treatment strategies to improve motor outcome after stroke. Imaging techniques such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) allow changes in brain activity after stroke recovery to be identified. Objective. To systematically review serial imaging studies on recovery within 6 months poststroke, assess their methodological quality, and identify trends in the association between task-related brain activation patterns and functional upper limb recovery. Methods. A literature search was performed using Medline, PICARTA, and EMBASE databases. Studies were appraised using binary weighted methodological criteria for internal, statistical, and external validity. Results. Twenty-two of the 869 identified studies met the inclusion criteria. Studies showed methodological weaknesses with respect to controlling for task performance, selecting appropriate outcome measures, and adequate presentation and execution of statistical analysis. After stroke, motor task performance shows unilateral overactivation of motor and nonmotor areas, a posterior shift in activity in the primary motor cortex, and bilateral recruitment of associated motor and nonmotor areas. Concomitant with neurological recovery, overactivation appears to diminish longitudinally, but not in all patients. Conclusion . Despite methodological shortcomings and heterogeneity, trends can be discerned. However, statistically sound associations with recovery are not consistent. The challenges in future research will be, controlling for confounding factors, finding outcomes that specifically measure dexterity of the paretic limb, to control for the extent of white matter damage and changes in perfusion in order to establish the longitudinal construct validity of fMRI and PET with regard to upper limb recovery after stroke.

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