72 research outputs found

    Investigation of the feasibility of using focal vibratory stimulation with robotic aided therapy for spasticity rehabilitation in spinal cord injury

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    The occurrence of a traumatic spinal cord injury is in hundreds of thousands of people every year. Survivors are left with loss of many bodily functions, loss of sensation below the point of injury and many more painful and uncomfortable repercussions which interfere with activities of daily living. Over 70% of people with SCI develop spasticity: abnormally increased muscle tone and connected joint stiffness that interfere with residual volitional control of the limbs. Treatments for spasticity include many pharmacological and non-pharmacological techniques, however many of them have severe sideeffects. Evidence suggest the use of vibratory stimulation to relieve repercussions of spasticity, despite not agreeing on the most advantageous protocol. This thesis evaluated effects that focal vibratory stimulation have on the muscle performance. Within two studies, focal muscle vibration is compared against different application conditions such as timing and location. The results suggests that if focal vibrations are applied to the relaxed muscle, the increase in muscle's force is observed. Analysis of the cortical waves indicates minimal cortical involvement in vibratory stimulation modulation. On the other hand, FV applied of the connected tendon/bone imposed to a contraction seems to have a potential to increase muscle's activation. There is evidence that motor cortex is responding to this stimulation to stabilise the muscle in order to perform the contraction. Within clinical trial, focal muscle vibratory stimulation is employed in total of 6 interventional sessions while a joint's spastic exor and extensor muscles were relaxed. Spasticity appears to be reduced as a consequence of the stimulation. Moreover, engaging the joint into robotic-aided therapy increase volitional control of the wrist, according to the analysis of the active range of motion, joint stiffness and kinematic parameters associated to the movement. The measurement and movement facilitation device used in the clinical trial was designed and developed in accordance to the spasticity and spinal cord injury repercussions consideration. The studies conducted for this thesis demonstrated feasibility and potential for the use of focal muscle vibratory stimulation to enhance muscle power in healthy muscles but also relieve consequences of spasticity. Vibrations combined with movement robotic-aided therapy have a prospects to enhance motor control

    VIBROfocus: Design of a focal vibro-tactile robotic-assistive system for spasticity rehabilitation

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    The main focus of spasticity treatment is to alleviate pain, improve function and reduce risk of additional complications. In this paper the design of a robotic system with enhanced focal vibro-tactile stimulation for the treatment of spasticity in the upper limbs is presented. Building on emerging evidence on the use of vibrations in the treatment of spasticity, we propose a new integrated approach. Our design combines the use of vibro-tactile stimulation of the high tone muscle with robotic movement assistance to augment rehabilitation outcomes in patients with spasticity in the upper limbs

    Spinal Cord Injury and Transcutaneous Spinal Cord Stimulation

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    Recent research of epidural and transcutaneous electrical spinal cord stimulation has demonstrated unprecedented improvements in motor function thought to be irreversibly lost due to chronic, severe spinal cord injury. Studies in parallel assess these methods for spasticity management as an alternative to medications that are often accompanied by deleterious side effects. As a noninvasive intervention, transcutaneous spinal cord stimulation holds the great potential to find its way into wide clinical application. Its firm establishment and lasting acceptance as clinical practice in spinal cord injury will not only hinge on the demonstration of safety and efficacy, but also on the delineation of a conceptual framework of the underlying physiological mechanisms. This will also require advancing our understanding of immediate and temporary effects of transcutaneous spinal cord on neuronal circuits in the intact and injured spinal cord. The purpose of this collection of papers is to bring together peers in the field to share—and eventually fuse—their pertinent research into current neurorehabilitation practice by providing a clinical perspective and novel insights into the underlying mechanisms

    Effectiveness of intensive physiotherapy for gait improvement in stroke: systematic review

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    Introduction: Stroke is one of the leading causes of functional disability worldwide. Approximately 80% of post-stroke subjects have motor changes. Improvement of gait pattern is one of the main objectives of physiotherapists intervention in these cases. The real challenge in the recovery of gait after stroke is to understand how the remaining neural networks can be modified, to be able to provide response strategies that compensate for the function of the affected structures. There is evidence that intensive training, including physiotherapy, positively influences neuroplasticity, improving mobility, pattern and gait velocity in post-stroke recovery. Objectives: Review and analyze in a systematic way the experimental studies (RCT) that evaluate the effects of Intensive Physiotherapy on gait improvement in poststroke subjects. Methodology: Were only included all RCT performed in humans, without any specific age, that had a clinical diagnosis of stroke at any stage of evolution, with sensorimotor deficits and functional gait changes. The databases used were: Pubmed, PEDro (Physiotherapy Evidence Database) and CENTRAL (Cochrane Center Register of Controlled Trials). Results: After the application of the criteria, there were 4 final studies that were included in the systematic review. 3 of the studies obtained a score of 8 on the PEDro scale and 1 obtained a score of 4. The fact that there is clinical and methodological heterogeneity in the studies evaluated, supports the realization of the current systematic narrative review, without meta-analysis. Discussion: Although the results obtained in the 4 studies are promising, it is important to note that the significant improvements that have been found, should be carefully considered since pilot studies with small samples, such as these, are not designed to test differences between groups, in terms of the effectiveness of the intervention applied. Conclusion: Intensive Physiotherapy seems to be safe and applicable in post-stroke subjects and there are indications that it is effective in improving gait, namely speed, travelled distance and spatiotemporal parameters. However, there is a need to develop more RCTs with larger samples and that evaluate the longterm resultsN/

    Neuromodulation in the treatment of upper limb spasticity

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    In this thesis I investigated neurophysiological changes following transcutaneous electrical nerve stimulation (TENS) at 100 Hz, and TENS and transcutaneous spinal cord stimulation (tSCS) applied with high-frequency (10 kHz) trains (HF-TENS and HF-tSCS, respectively). I also assessed literature studying neuromodulation for spasticity in SCI and developed a mobile application (app) which aimed to improve spasticity self-management through education of triggers. Paired-pulses of cervical tSCS caused post-activation depression in posterior-root reflexes (PRRs) in wrist flexors and extensors at interstimulus intervals of < 2 s; showing a similar pattern of modulation observed in previous studies with H-reflex activity (8 healthy, able-bodied participants). Another study compared TENS, HF-TENS and HF-tSCS to sham stimulation. Changes in PRRs and motor-evoked potentials (MEPs) in the wrist flexor and extensor were assessed. HF-tSCS was most efficient at modulating corticospinal excitability immediately after intervention, causing a decrease in flexor MEPs lasting 30 minutes (p = 0.015), as well as a trend towards an increase in extensor MEPs. Late spinal inhibition of wrist flexors occurred following 60 minutes of HF-tSCS (p = 0.018). An app was designed to support users in identifying factors which trigger their spasticity by logging and rating events (Penn spasm frequency scale). The design of the app was assessed using questionnaires sent to clinicians and people with spasticity. Results showed that all responders felt that the design of the app could have potential in benefitting symptoms of spasticity. Bringing together neurophysiological and clinical measures of spasticity, a systematic review and meta-analysis of 27 studies assessed the effects of neuromodulation on spasticity in SCI. This revealed a lack of randomised control trials (RCTs). In 3 RCTs and 17 studies without a control group, there was a reduction in spasticity immediately following electrical stimulation according to clinical measures. Four studies included the H-reflex as an outcome measure, with 3/4 reporting no change, or varied results between participants

    Neurophysiological and clinical outcome measures of the impact of electrical stimulation on spasticity in spinal cord injury: Systematic review and meta-analysis

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    This systematic review and meta-analysis aims to determine whether non-invasive electrical stimulation (ES) is effective at reducing spasticity in people living with spinal cord injury (SCI). PubMed, Web of Science, Scopus and Cochrane Central Register of Controlled Trials databases were searched in April 2022. Primary outcome measures were the Ashworth scale (AS), Modified Ashworth scale (MAS), Pendulum test and the Penn spasm frequency scale (PSFS). Secondary outcomes were the Hoffman (H)- reflex, motor-evoked potentials (MEPs) and posterior-root reflexes (PRRs). A random-effects model, using two correlation coefficients, (Corr=0.1, Corr=0.2) determined the difference between baseline and post-intervention measures for RCTs. A quantitative synthesis amalgamated data from studies with no control group (non-RCTs). Twenty-nine studies were included: five in the meta-analysis and 17 in the amalgamation of non-RCT studies. Twenty studies measured MAS or AS scores, 14 used the Pendulum test and one used the PSFS. Four measured the H-reflex and no studies used MEPs or PRRs. Types of ES used were: transcutaneous electrical nerve stimulation (TENS), transcutaneous spinal cord stimulation (TSCS), functional electrical stimulation (FES) cycling and FES gait. Meta-analyses of 3 studies using the MAS and 2 using the Pendulum test were carried out. For MAS scores, non-invasive ES was effective at reducing spasticity compared to a control group (p = 0.01, Corr=0.1; p = 0.002, Corr=0.2). For Pendulum test outcomes, there was no statistically significant difference between intervention and control groups. Quantitative synthesis of non-RCT studies revealed that 22 of the 29 studies reported improvement in at least one measure of spasticity following non-invasive ES, 13 of which were statistically significant (p &lt; 0.05). Activation of the muscle was not necessary to reduce spasticity. Non-invasive ES can reduce spasticity in people with SCI, according to MAS scores, for both RCT and non-RCT studies, and Pendulum test values in non-RCT studies. This review could not correlate between clinical and neurophysiological outcomes; we recommend the additional use of neurophysiological outcomes for future studies. The use of TSCS and TENS, which did not induce a muscle contraction, indicate that activation of afferent fibres is at least required for non-invasive ES to reduce spasticity

    Design Principles for FES Concept Development

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    © Cranfield University 2013. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright owner.A variety of pathologies can cause injury to the spinal cord and hinder movement. A range of equipment is available to help spinal injury sufferers move their affected limbs. One method of rehabilitation is functional electrical stimulation (FES). FES is a technique where small electrical currents are applied to the surface of the user’s legs to stimulate the muscles. Studies have demonstrated the benefits of using this method and it has also been incorporated into a number of devices. The aim of the project was to produce a number of designs for a new device that uses FES technology. The project was completed in conjunction with an industrial partner. A review of the literature and consultation with industrial experts suggested a number of ways current devices could be improved. These included encouraging the user to lean forwards while walking and powering the device using a more ergonomic method. A group of designers were used to produce designs that allowed the user to walk with a more natural gait and avoided cumbersome power packs. The most effective of these designs were combined to form one design that solved both problems. A 3-dimensional model of this design was simulated using computer-aided design software. Groups of engineers, scientists and consumers were also invited to provide input on how a new device should function. Each of these groups provided a design that reflected their specific needs, depending on their experience with similar technology. Low level prototypes were produced of these designs. A group of designers were also used to design concepts for a functional electrical stimulation device based on an introduction given by industry experts. Each of the designs was presented to experienced professionals to obtain feedback. A set of guidelines were also produced during the project that instructed how to create the designs
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