The effect of robot therapy assisted by surface EMG on hand recovery in post-stroke patients. A pilot study

Background: Hemiparesis caused by a stroke negatively limits a patient's motor function. Nowadays, innovative technologies such as robots are commonly used in upper limb rehabilitation. The main goal of robot-aided therapy is to provide a maximum number of stimuli in order to stimulate brain neuroplasticity. Treatment applied in this study via the AMADEO robot aimed to improve finger flexion and extension. Aim: To assess the effect of rehabilitation assisted by a robot and enhanced by surface EMG. Research project: Before-after study design. Materials and methods: The study group consisted of 10 post-stroke patients enrolled for therapy with the AMADEO robot for at least 15 sessions. At the beginning and at the end of treatment, the following tests were used for clinical assessment: Fugl-Meyer scale, Box and Block test and Nine Hole Peg test. In the present study, we used surface electromyography (sEMG) to maintain optimal kinematics of hand motion. Whereas sensorial feedback, provided by the robot, was vital in obtaining closed-loop control. Thus, muscle contraction was transmitted to the amplifier through sEMG, activating the mechanism of the robot. Consequentially, sensorial feedback was provided to the patient. Results: Statistically significant improvement of upper limb function was observed in: Fugl-Meyer (p = 0.38) and Box and Block (p = 0.27). The Nine Hole Peg Test did not show statistically significant changes in motor skills of the hand. However, the functional improvement was observed at the level of 6% in the Fugl-Meyer, 15% in the Box and Block, and 2% in the Nine Hole Peg test. Conclusions: Results showed improvement in hand grasp and overall function of the upper limb. Due to sEMG, it was possible to implement robot therapy in the treatment of patients with severe hand impairment

Effect of Intensive Rehabilitation Program in Thermal Water on a Group of People with Parkinson’s Disease: A Retrospective Longitudinal Study

: The main objective of this study is to test the effect of thermal aquatic exercise on motor symptoms and quality of life in people with Parkinson's Disease (PD). Fourteen participants with diagnosis of idiopathic PD completed the whole rehabilitation session and evaluation protocol (Hoehn and Yahr in OFF state: 2-3; Mini Mental State Examination >24; stable pharmacological treatment in the 3 months prior participating in the study). Cognitive and motor status, functional abilities and quality of life were assessed at baseline and after an intensive rehabilitation program in thermal water (12 sessions of 45 min in a 1.4 m depth pool at 32-36 ∘C). The Mini Balance Evaluation System Test (Mini-BESTest) and the PD Quality of Life Questionnaire (PDQ-39) were considered as main outcomes. Secondary assessment measures evaluated motor symptoms and quality of life and psychological well-being. Participants kept good cognitive and functional status after treatment. Balance of all the participants significantly improved (Mini-BESTest: p<0.01). The PDQ-39 significantly improved after rehabilitation (p=0.038), with significance being driven by dimensions strongly related to motor status. Thermal aquatic exercise may represent a promising rehabilitation tool to prevent the impact of motor symptoms on daily-life activities of people with PD. PDQ-39 improvement foreshows good effects of the intervention on quality of life and psychological well-being

Computational models and motor learning paradigms: Could they provide insights for neuroplasticity after stroke? An overview

Computational approaches for modelling the central nervous system (CNS) aim to develop theories on processes occurring in the brain that allow the transformation of all information needed for the execution of motor acts. Computational models have been proposed in several fields, to interpret not only the CNS functioning, but also its efferent behaviour. Computational model theories can provide insights into neuromuscular and brain function allowing us to reach a deeper understanding of neuroplasticity. Neuroplasticity is the process occurring in the CNS that is able to permanently change both structure and function due to interaction with the external environment. To understand such a complex process several paradigms related to motor learning and computational modeling have been put forward. These paradigms have been explained through several internal model concepts, and supported by neurophysiological and neuroimaging studies. Therefore, it has been possible to make theories about the basis of different learning paradigms according to known computational models. Here we review the computational models and motor learning paradigms used to describe the CNS and neuromuscular functions, as well as their role in the recovery process. These theories have the potential to provide a way to rigorously explain all the potential of CNS learning, providing a basis for future clinical studies

Elektrostymulacja funkcjonalna dla objawu opadającej stopy – wpływ na szybkość i wytrzymałość chodu – dane wstępne

Introduction: Foot-drop is a frequent symptom of the Central Nervous System diseases (CNS) that may cause walking disorder. The primary therapeutic choice for foot-drop disease are the various classical Ankle-Foot Orthoses (AFO). The Functional Electrical Stimulation (FES) of the ankle dorsiflexors muscles was described as quite effective at enhancing balance control and ankle dynamic stability during gait.Aim: The purpose of the study was to assess and consider the effects of FES-application regarding either the gait velocity or the resistance, in patients with foot-drop due to a chronic upper motor neuron lesion. Research project: Before-after study.Material and methods: There were enrolled 20 subjects, with an upper motor neuron lesion which presented foot-drop. Patients were divided randomly into 2 training groups (the FES group, N=10 or the Control Group, N=10). The treatment in the FES group consisted of neuroprosthesis application, for 2h/day, 5 days/weekly, for 3 weeks whereas, in the Control Group patients executed the gait treatment with the help of AFO. In both groups the FES or AFO application was considered as an additional gait training to the individual rehabilitation programme. The participants were assessed by using the 5 – 10 – 20 meters (m) Walking Test and 2 – 6 – 12 minutes (min) Timed Walking Test. Results: A higher degree of gait improvement was noted in subjects from the group which underwent FES treatment, than in those treated with AFO. Regarding the FES group, a statistically significant improvement was demonstrated by patients in tests as follows: 20m p&lt;0.024 and 2min p&lt;0.028; 6min p&lt;0.008; 12min p&lt;0.005, but not in the 5m p&lt;0.079 and 10mt p&lt;0.084 Walking Test. While, in the control group we did not note a statistically significant difference (5m p&lt;0.228; 10m p&lt;0.260; 20m p&lt;0.107 and 2min p&lt;0.474; 6min p&lt;0.575; 12min p&lt;0.477). Conclusions: Despite the limited sample of the patients enrolled, the results are encouraging because the tests demonstrate that FES-treatment could increase walking resistance and distance.Wstęp: Syndrom opadającej stopy jest częstym objawem chorób ośrodkowego układu nerwowego (OUN), które mogą powodować zaburzenia chodzenia. Powszechnie, w przypadku opadającej stopy, jako pierwszy wybór stosuje się różnego rodzaju klasyczne ortezy stawu skokowego. Elektrostymulacja funkcjonalna (FES – functional electrical stimulation) mięśni zginaczy grzbietowych stopy została opisana jako skuteczna terapia w leczeniu zaburzeń równowagi i kontroli stabilności dynamicznej stawu skokowego podczas chodu. Cel: Celem badania była ocena wpływu zastosowania elektrostymulacji funkcjonalnej (FES) na poprawę szybkości chodu i zwiększenie wytrzymałości u pacjentów z syndromem opadającej stopy powstałej w wyniku uszkodzenia górnego neuronu ruchowego. Projekt badawczy: Badanie „przed i po” Materiał i metody: Do badania włączono 20 osób z uszkodzeniem górnego neuronu ruchowego i objawami opadającej stopy. Pacjentów podzielono losowo na 2 grupy ćwiczeniowe (grupę FES, n=10 i grupę kontrolną, n=10). Postępowanie rehabilitacyjne w grupie FES polegało na aplikacji neuroprotezy przez 2 godz. dziennie, 5 dni w tygodniu, przez 3 tygodnie. Natomiast w grupie kontrolnej przez ten sam okres czasu, postępowanie rehabilitacyjne polegało na zastosowaniu klasycznej ortezy stawu skokowego. W obydwu grupach zarówno elektrostymulacja funkcjonalna jak i noszenie klasycznej ortezy w czasie chodu stanowiły element dodatkowego treningu chodu uzupełniającego indywidualny programu rehabilitacji. Pacjenci oceniani byli za pomocą testów marszowych: 5 – 10 – 20 metrów (mt) Walking Test i 2 – 6 – 12 minut (min) Timed Walking Test. Wyniki: Odnotowano znaczącą poprawę chodu w grupie FES, czego nie zaobserwowano w grupie kontrolnej. W grupie FES następujące testy wykazały istotną statystycznie poprawę: 20mt p<0.024; 2min p<0.028; 6min p<0.008; 12min p<0.005, oprócz 5mt p<0.079 i 10mt p<0.084 Walking test. Natomiast w grupie kontrolnej nie znaleźliśmy statystycznie istotnych różnic (5mt p<0.228; 10mt p<0.260; 20mt p<0.107 and 2min p<0.474; 6min p<0.575; 12min p<0.477). Wnioski: Pomimo ograniczonej liczby pacjentów włączonych do badania, wyniki są zachęcające i wskazują na zwiększenie wytrzymałości i szybkości chodu u osób poddanych treningowi za pomocą FES

Aktualny stan wiedzy o wybranych metodach rehabilitacji chorych po udarach mózgu

Understanding brain plasticity after stroke is important in developing rehabilitation strategies. Active movement therapies show considerable promise but their individual application is still not fully implemented. Among the analysed, available therapeutic modalities, some became widely used in therapeutic practice. Thus, we selected three relatively new methods, i.e. mirror therapy, motor imagery and constraint-induced movement therapy (CIMT). Mirror therapy was initially used in the treatment of phantom pain in patients with amputated limbs and later, in stroke patients. Motor imagery is widely used in sport to improve performance, which raises the possibility of applying it both as a rehabilitative method and in accessing the motor network independently of recovery. Whereas CIMT is based on the paradigm that impairment of arm function is exacerbated by learned non-use and that this, in turn, leads to loss of cortical representation in the upper limb.Zrozumienie zmian określanych mianem plastyczności mózgu jest ważne w celu opracowania odpowiednich strategii rehabilitacji. Terapie oparte na ruchach czynnych wykazały obiecujące znaczenie lecz indywidualne ich zastosowanie nie zostało w pełni wdrożone. Pośród dostępnych metod terapeutycznych, które zostały poddane analizie, niektóre stały się powszechnie stosowane w praktyce klinicznej. W celu realizacji tego artykułu wybrano zatem trzy metody, które są stosunkowo nowe, tj. terapię lustrzaną, wyobrażeniowy trening planowania ruchu i terapię ograniczania i wymuszania ruchu. Terapia lustrzana była początkowo wykorzystywana do leczenia bólów fantomowych u osób po amputacjach kończyn, dopiero później wypróbowano jej działanie u chorych po udarach mózgu. Wyobrażeniowy trening planowania ruchu jest często stosowany w sporcie w celu poprawy osiągnięć co pozwala również na jego zastosowanie jako metody rehabilitacyjnej. Terapia ograniczania i wymuszania ruchu opiera się natomiast na teorii, która mówi, że zaburzenia funkcji kończyny górnej u osób po udarze mózgu są spotęgowane przez wyuczone nieużywanie kończyny górnej, prowadzące do fizycznych zmian w korowej reprezentacji kończyny w pierwotnej korze czuciowej

Does the score on the MRC strength scale reflect instrumented measures of maximal torque and muscle activity in post-stroke survivors?

It remains unknown whether variation of scores on the Medical Research Council (MRC) scale for muscle strength is associated with operator-independent techniques: dynamometry and surface electromyography (sEMG). This study aimed to evaluate whether the scores of the MRC strength scale are associated with instrumented measures of torque and muscle activity in post-stroke survivors with severe hemiparesis both before and after an intervention. Patients affected by a first ischemic or hemorrhagic stroke within 6 months before enrollment and with complete paresis were included in the study. The pre- and post-treatment assessments included the MRC strength scale, sEMG, and dynamometry assessment of the triceps brachii (TB) and biceps brachii (BB) as measures of maximal elbow extension and flexion torque, respectively. Proprioceptive-based training was used as a treatment model, which consisted of multidirectional exercises with verbal feedback. Each treatment session lasted 1 h/day, 5 days a week for a total 15 sessions. Nineteen individuals with stroke participated in the study. A significant correlation between outcome measures for the BB (MRC and sEMG p = 0.0177, ρ = 0.601; MRC and torque p = 0.0001, ρ = 0.867) and TB (MRC and sEMG p = 0.0026, ρ = 0.717; MRC and torque p = 0.0001, ρ = 0.873) were observed post intervention. Regression models revealed a relationship between the MRC score and sEMG and torque measures for both the TB and BB. The results confirmed that variation on the MRC strength scale is associated with variation in sEMG and torque measures, especially post intervention. The regression model showed a causal relationship between MRC scale scores, sEMG, and torque assessments

Rzeczywistość wirtualna w rehabilitacji poudarowej – badania, trening i efekty terapii wirtualnej

The motor function impairment deriving from stroke injury has a negative impact on autonomy and on the activities of daily living. Several studies have demonstrated that learning new motor skills is important to induce neuroplasticity and functional recovery. To facilitate the activation of brain areas and consequently neuroplasticity, it may be advantageous to combine traditional motor rehabilitation with innovative technology, in order to promote motor re-learning and skill re-acquisition by means of an enhanced training. Following these principles, exercises should involve multiple sensory modalities exploiting the adaptive nature of the nervous system, in order to promote active patient participation. Movement re-learning could be improved by means of training in an enriched environment focused on optimizing the affordances between the motor system and the physical environment: virtual reality technologies allow for the possibility to create specific settings where the affordances are optimized. Several autors report that patients treated in virtual representation could, in both acute and chronic stroke, improve their arm motor function. Reinforced Feedback in a Virtual Environment (RFVE), can incorporate the elements necessary to maximize motor learning, such as repetitive and differentiated task practice, feedback of performance and results, and reinforcement of the motivation. The RFVE approach may lead to better rehabilitation outcomes in the treatment of the upper limb in stroke patients.Upośledzenie funkcji ruchowych związanych z udarem mózgu ma w przypadku wielu chorych negatywny wpływ na samodzielność i na czynności Ŝycia codziennego i osoby te muszą być poddawane długotrwałej rehabilitacji. Liczne badania wykazały, że uczenie się nowych umiejętności motorycznych pobudza neuroplastyczność mózgu i w efekcie umożliwia poprawę funkcjonalną. W celu ułatwienia aktywacji obszarów mózgu, a w konsekwencji neuroplastyczności, korzystne może być łączenie tradycyjnej rehabilitacji ruchowej z innowacyjną technologią tak, aby poprzez wzmocniony trening promować ponowne uczenie się ruchu i ponowne nabywania umiejętności funkcjonalnych. W myśl tej zasady, wykorzystując adaptacyjne zdolności układu nerwowego, ćwiczenia powinny angażować wiele zmysłów i wymuszać aktywny udziału pacjenta. Trening ponownego uczenia się ruchu może być skuteczniejszy we wzbogaconym przez sprzężenie zwrotne środowisku koncentrując się na optymalizacji intrakcji osoby z komputerem między układem ruchu a fizycznym środowiskiem: technologia rzeczywistości wirtualnej dopuszcza możliwość utworzenia specjalnych ustawień, gdzie interakcja człowieka z komputerem jest zoptymalizowana. Wzmocnione sprzężenie zwrotne w środowisku wirtualnym (RFVE) może zawierać elementy potrzebne do maksymalizacji efektu uczenia się ruchu, np. praktyka powtarzających się i zróżnicowanych zadań, zastosowanie sprzężenia zwrotnego w odniesieniu do działania i efektu działania, oraz zwiększona motywacja. Zastosowanie RFVE może prowadzić do lepszych wyników w usprawnianiu niedowładnej kończyny górnej u pacjentów z udarem mózg

Wpływ rehabilitacji z zastosowaniem robota wspomaganej przez powierzchowne EMG na poprawę sprawności ręki u chorych po udarze mózgu − badanie pilotażowe

Background: Hemiparesis caused by a stroke negatively limits a patient’s motor function. Nowadays, innovative technologies such as robots are commonly used in upper limb rehabilitation. The main goal of robot-aided therapy is to provide a maximum number of stimuli in order to stimulate brain neuroplasticity. Treatment applied in this study via the AMADEO robot aimed to improve finger flexion and extension. Aim: To assess the effect of rehabilitation assisted by a robot and enhanced by surface EMG. Research project: Before-after study design. Materials and methods: The study group consisted of 10 post-stroke patients enrolled for therapy with the AMADEO robot for at least 15 sessions. At the beginning and at the end of treatment, the following tests were used for clinical assessment: Fugl-Meyer scale, Box and Block test and Nine Hole Peg test. In the present study, we used surface electromyography (sEMG) to maintain optimal kinematics of hand motion. Whereas sensorial feedback, provided by the robot, was vital in obtaining closed-loop control. Thus, muscle contraction was transmitted to the amplifier through sEMG, activating the mechanism of the robot. Consequentially, sensorial feedback was provided to the patient. Results: Statistically significant improvement of upper limb function was observed in: Fugl-Meyer (p = 0.38) and Box and Block (p = 0.27). The Nine Hole Peg Test did not show statistically significant changes in motor skills of the hand. However, the functional improvement was observed at the level of 6% in the Fugl-Meyer, 15% in the Box and Block, and 2% in the Nine Hole Peg test. Conclusions: Results showed improvement in hand grasp and overall function of the upper limb. Due to sEMG, it was possible to implement robot therapy in the treatment of patients with severe hand impairment.Background: Hemiparesis caused by a stroke negatively limits a patient’s motor function. Nowadays, innovative technologies such as robots are commonly used in upper limb rehabilitation. The main goal of robot-aided therapy is to provide a maximum number of stimuli in order to stimulate brain neuroplasticity. Treatment applied in this study via the AMADEO robot aimed to improve finger flexion and extension. Aim: To assess the effect of rehabilitation assisted by a robot and enhanced by surface EMG. Research project: Before-after study design. Materials and methods: The study group consisted of 10 post-stroke patients enrolled for therapy with the AMADEO robot for at least 15 sessions. At the beginning and at the end of treatment, the following tests were used for clinical assessment: Fugl-Meyer scale, Box and Block test and Nine Hole Peg test. In the present study, we used surface electromyography (sEMG) to maintain optimal kinematics of hand motion. Whereas sensorial feedback, provided by the robot, was vital in obtaining closed-loop control. Thus, muscle contraction was transmitted to the amplifier through sEMG, activating the mechanism of the robot. Consequentially, sensorial feedback was provided to the patient. Results: Statistically significant improvement of upper limb function was observed in: Fugl-Meyer (p = 0.38) and Box and Block (p = 0.27). The Nine Hole Peg Test did not show statistically significant changes in motor skills of the hand. However, the functional improvement was observed at the level of 6% in the Fugl-Meyer, 15% in the Box and Block, and 2% in the Nine Hole Peg test. Conclusions: Results showed improvement in hand grasp and overall function of the upper limb. Due to sEMG, it was possible to implement robot therapy in the treatment of patients with severe hand impairment

Neurophysiological Evidence of Motor Network Reorganization in Myotonic Dystrophy Type 1: A Pilot Magnetoencephalographic Study

PURPOSE: Myotonic dystrophy type 1 is the most common muscular dystrophy in adults. Although brain involvement is well recognized, the relationship between cortical motor control and voluntary movement has not been sufficiently explored. This study aims at assessing magnetoencephalographic (MEG) rhythms at oscillatory and connectivity levels to map central motor control. METHODS: Magnetoencephalographic data were acquired from healthy subjects and five myotonic dystrophy type 1 subjects during resting state and foot movement. Resting state EEG band power, event-related desynchronization/synchronization, functional connectivity, and network features (node strength and betweenness centrality) were estimated. A statistical comparison of these indexes between the two groups was run; a linear correlation between event-related desynchronization and motor performance was obtained. RESULTS: Myotonic dystrophy type 1 subjects showed higher theta power over central motor regions and lower beta power over frontal areas, with a decrease of beta node strength over the dominant hemisphere and an increase of betweenness centrality over the vertex. Foot movement in the most impaired myotonic dystrophy type 1 subjects was inefficient in evoking event-related desynchronization. In less severely impaired participants, dominant foot movement was related to a bilateral sensorimotor event-related desynchronization. CONCLUSIONS: Results provide proof of a central dysfunction of movement. Identification of neurophysiological motor patterns in myotonic dystrophy type 1 could provide a guide for tailored therapy