Application of a Robotic Rehabilitation Training System for Recovery of Severe Plegie Hand Motor Function after a Stroke

We have developed a rehabilitation training system (UR-System-PARKO: Useful and Ultimate Rehabilitation System-PARKO) for patients after a stroke to promote recovery of motor function of the severe plegic hand with hemiplegia. A clinical test with six patients for the therapeutic effect of the UR-System-PARKO for severe plegic hand was performed. For all patients, the active ranges of motion (total active motion) of finger extension improved after training with the UR-System-PARKO. Moreover, the modified Ashworth scale (MAS) scores of finger extension increased. Thus, the training reduced the spastic paralysis. These results suggest the effectiveness of training with the UR-System-PARKO for recovery of motor function as defined by finger extension in the severe plegic hand

Artificial Motor Control For Electrically Stimulated Upper Limbs Of Plegic Or Paretic People

Functional Electrical Stimulation (FES) is a technique used in the restoration and generation of movements performed by subjects with neuromuscular disorders such as spinal cord injury (SCI). The purpose of this article is to outline the state of the art and perspectives of the use of FES in artificial motor control of the upper limbs in paretic or plegic people. Methods: The databases used in papers selection were Google Scholar and Capes’ Portals as well as proceedings of the Annual Conference of the International Functional Electrical Stimulation Society (IFESS). Results: Approximately 85% of the reviewed studies showed FES profile with pulse duration ranging from 1 to 300 μs and modulating (burst) frequency between 10 and 40 Hz. Regarding the type of electrodes, 88% of the studies employed transcutaneous electrodes. Conclusion: We concluded that FES with closed-loop feedback and feedforward are the most used and most viable systems for upper limbs motor control, because they perform self-corrections slowing neuromuscular adaptation, allowing different planes and more range of movement and sensory-motor integration. One of the difficulties found in neuroprosthesis systems are electrical wires attached to the user, becoming uninteresting in relation to aesthetics and break. The future perspectives lead to a trend to miniaturization of the stimulation equipment and the availability of wireless networks, which allow the attachment of modules to other components without physical contact, and will become more attractive for daily use. © 2016, Sociedade Brasileira de Engenharia Biomedica. All rights reserved.32219921

Acupuncture for Spasticity after Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

The aim of this systematic review was to determine how effective acupuncture or electroacupuncture (acupuncture with electrical stimulation) is in treating poststroke patients with spasticity. We searched publications in Medline, EMBASE, and the Cochrane Library in English, 19 accredited journals in Korean, and the China Integrated Knowledge Resources Database in Chinese through to July 30, 2013. We included randomized controlled trials (RCTs) with no language restrictions that compared the effects of acupuncture or electroacupuncture with usual care or placebo acupuncture. The two investigators assessed the risk of bias and statistical analyses were performed. Three RCTs in English, 1 in Korean, and 1 in Chinese were included. Assessments were performed primarily with the Modified Ashworth Scale (MAS). Meta-analysis showed that acupuncture or electroacupuncture significantly decreased spasticity after stroke. A subgroup analysis showed that acupuncture significantly decreased wrist, knee, and elbow spasticity in poststroke patients. Heterogeneity could be explained by the differences in control, acupoints, and the duration after stroke occurrence. In conclusion, acupuncture could be effective in decreasing spasticity after stroke, but long-term studies are needed to determine the longevity of treatment effects

Neurotechnology for Brain Repair:Imaging, Enhancing and Restoring Human Motor Function

Neurotechnology is the application of scientific knowledge to the practical purpose of understanding, interacting and/or repairing the brain or, in a broader sense, the nervous system. The development of novel approaches to decode functional information from the brain, to enhance specific properties of neural tissue and to restore motor output in real end-users is a fundamental challenge to translate these novel solutions into clinical practice. In this Thesis, I introduce i) a novel imaging method to characterize movement-related electroencephalographic (EEG) potentials; ii) a brain stimulation strategy to improve brain-computer interface (BCI) control; iii) and a therapy for motor recovery involving a neuroprosthesis. Overall, results show i) that stable EEG topographies present a subject-independent organization that can be used to robustly decode actual or attempted movements in sub-acute stroke patients and healthy controls, with minimal a-priori information; ii) that transcranial direct-current stimulation (tDCS) enhances the modulability of sensorimotor rhythms used for brain-computer interaction in chronic Spinal Cord Injured (SCI) individuals and healthy controls; iii) that neuromuscular electrical stimulation (NMES) controlled via closed-loop neural activity induces significantly stronger upper limb functional recovery in chronic stroke patients than sham NMES therapy, and that these changes are clinically relevant. These results have or might have important implications in i) disease diagnostics and monitoring through EEG; ii) assistive technology and reduction of permanent disability following SCI; iii) rehabilitation and recovery of upper limb function following a stroke, also after several years of complete paralysis. Briefly, this Thesis provides the conceptual framework, scientific rationale, technical details and clinical evidence supporting translational Neurotechnology that improves, optimizes and disrupts current medical practice in monitoring, substituting and recovering lost upper limb function

Assess The Effectiveness of Mirror Therapy on Upper Limb Motor Functions Among Patients With Stroke Admitted In Rajiv Gandhi Government General Hospital

The present study was conducted with the objectives to explore the effect of mirror therapy for hand function among Cerebrovascular accident patient. Mirror therapy implementation promotes hand function. Initially, assessment was done and the clients were identified through movement of hand. Mirror therapy was implemented to the experimental group patient, where as no intervention given to the control group patient. Modified Ashworth Scale, Brunnstrom's Stage Recovery, scale was used to assess the hand function in both experimental and control group. There was a significant difference in hand function of the patient between experimental and control group after the implementation of mirror therapy. Donabedian System theory was adopted to identify the need of patient. Review of literature reveals many facts about various alternative and complementary therapies for hand function and highlighted the effect of mirror therapy to improve the hand function of patient among Cerebrovascular accident patient. The study was conducted in selected wards of Rajiv Gandhi Government General Hospital, Chennai. Quasi experimental pretest-post test with control design was adopted for the study. Simple random Sampling Technique was used to select the respondents. Total number of respondents selected was 60. Samples were assigned to experimental (30) and control group (30)

The Neural Correlates of Long-Term Carryover following Functional Electrical Stimulation for Stroke

Neurorehabilitation effective delivery for stroke is likely to be improved by establishing a mechanistic understanding of how to enhance adaptive plasticity. Functional electrical stimulation is effective at reducing poststroke foot drop; in some patients, the effect persists after therapy has finished with an unknown mechanism. We used fMRI to examine neural correlates of functional electrical stimulation key elements, volitional intent to move and concurrent stimulation, in a group of chronic stroke patients receiving functional electrical stimulation for foot-drop correction. Patients exhibited task-related activation in a complex network, sharing bilateral sensorimotor and supplementary motor activation with age-matched controls. We observed consistent separation of patients with and without carryover effect on the basis of brain responses. Patients who experienced the carryover effect had responses in supplementary motor area that correspond to healthy controls; the interaction between experimental factors in contralateral angular gyrus was seen only in those without carryover. We suggest that the functional electrical stimulation carryover mechanism of action is based on movement prediction and sense of agency/body ownership-the ability of a patient to plan the movement and to perceive the stimulation as a part of his/her own control loop is important for carryover effect to take place

Enhancing brain/neural-machine interfaces for upper limb motor restoration in chronic stroke and cervical spinal cord injury

Operation of assistive exoskeletons based on voluntary control of sensorimotor rhythms (SMR, 8-12 Hz) enables intuitive control of finger or arm movements in severe paralysis after chronic stroke or cervical spinal cord injury (SCI). To improve reliability of such systems outside the laboratory, in particular when brain activity is recorded non-invasively with scalp electroencephalography (EEG), a hybrid EEG/electrooculography (EOG) brain/neural-machine interface (B/NMI) was recently introduced. Besides providing assistance, recent studies indicate that repeated use of such systems can trigger neural recovery. However, important prerequisites have to achieved before broader use in clinical settings or everyday life environments is feasible. Current B/NMI systems predominantly restore hand function, but do not allow simultaneous control of more proximal joints for whole-arm motor coordination as required for most stroke survivors suffering from paralysis in the entire upper limb. Besides paralysis, cognitive impairments including post-stroke fatigue due to the brain lesion reduce the capacity to maintain effortful B/NMI control over a longer period of time. This impedes the applicability in daily life assistance and might even limits the efficacy of neurorehabilitation training. In contrast to stroke survivors, tetraplegics due to cervical SCI lack motor function in both hands. Given that most activities of daily living (ADL) involve bimanual manipulation, e.g., to open the lid of a bottle, bilateral exoskeleton control is required but was not shown yet in tetraplegics. To further enhance B/NMI systems, we first investigated whether B/NMI whole-arm exoskeleton control in hemiplegia after chronic stroke is feasible and safe. In contrast to simple grasping, control of more complex tasks involving the entire upper limb was not feasible with established B/NMIs because high- dimensionality of such multiple joint systems exceeds the bandwidth of these interfaces. Thus, we blended B/NMI control with vision-guidance to receive a semiautonomous whole-arm exoskeleton control. Such setup allowed to divide ADL tasks into a sequence of EEG/EOG-triggered sub-tasks reducing complexity for the user. While, for instance, a drinking task was resolved into EOG-induced reaching, lifting and placing back the cup, grasping and releasing movements were based on intuitive SMR control. Feasibility of such shared vision-guided B/NMI control was assumed when executions were initialized within 3 s (fluent control) and a minimum of 75 % of subtasks were executed within that time (reliable control). We showed feasibility in healthy subjects as well as stroke survivors without report of any side effects documenting safe use. Similarly, feasibility and safety of bilateral B/NMI control after cervical SCI was evaluated. To enable bilateral B/NMI control, established EEG-based grasping and EOG-based releasing or stop commands were complemented with a novel EOG command allowing to switch laterality by performing prolonged horizontal eye movements (>1 s) to the left or to the right. Study results with healthy subjects and tetraplegics document fluent initialization of grasping motions below 3 s as well as safe use as unintended grasping could be stopped before a full motion was conducted. Superiority of novel bilateral control was documented by a higher accuracy of up to 22 % in tetraplegics compared to a bilateral control without prolonged EOG command. Lastly, as reliable B/NMI control is cognitively demanding, e.g., by imagining or attempting the desired movements, we investigated whether heart rate variability (HRV) can be used as biomarker to predict declining control performance, which is often reported in stroke survivors due to their cognitive impairments. Referring to the close brain-heart connection, we showed in healthy subjects that a decline in HRV is specific as well as predictive to a decline in B/NMI control performance within a single training session. The predictive link was revealed by a Granger-causality analysis. In conclusion, we could demonstrate important enhancements in B/NMI control paradigms including complex whole-arm exoskeleton control as well as individual performance monitoring within a training session based on HRV. Both achievements contribute to broaden the use as a standard therapy in stroke neurorehabilitation. Especially the predictive characteristic of HRV paves the way for adaptive B/NMI control paradigms to account for individual differences among impaired stroke survivors. Moreover, we also showed feasibility and safety of a novel implementation for bilateral B/NMI control, which is necessary for reliable operation of two hand-exoskeletons for bimanual ADLs after SCI