Increasing upper limb training intensity in chronic stroke using embodied virtual reality: a pilot study.

Technology-mediated neurorehabilitation is suggested to enhance training intensity and therefore functional gains. Here, we used a novel virtual reality (VR) system for task-specific upper extremity training after stroke. The system offers interactive exercises integrating motor priming techniques and embodied visuomotor feedback. In this pilot study, we examined (i) rehabilitation dose and training intensity, (ii) functional improvements, and (iii) safety and tolerance when exposed to intensive VR rehabilitation. Ten outpatient stroke survivors with chronic (>6 months) upper extremity paresis participated in a ten-session VR-based upper limb rehabilitation program (2 sessions/week). All participants completed all sessions of the treatment. In total, they received a median of 403 min of upper limb therapy, with 290 min of effective training. Within that time, participants performed a median of 4713 goal-directed movements. Importantly, training intensity increased progressively across sessions from 13.2 to 17.3 movements per minute. Clinical measures show that despite being in the chronic phase, where recovery potential is thought to be limited, participants showed a median improvement rate of 5.3% in motor function (Fugl-Meyer Assessment for Upper Extremity; FMA-UE) post intervention compared to baseline, and of 15.4% at one-month follow-up. For three of them, this improvement was clinically significant. A significant improvement in shoulder active range of motion (AROM) was also observed at follow-up. Participants reported very low levels of pain, stress and fatigue following each session of training, indicating that the intensive VR intervention was well tolerated. No severe adverse events were reported. All participants expressed their interest in continuing the intervention at the hospital or even at home, suggesting high levels of adherence and motivation for the provided intervention. This pilot study showed how a dedicated VR system could deliver high rehabilitation doses and, importantly, intensive training in chronic stroke survivors. FMA-UE and AROM results suggest that task-specific VR training may be beneficial for further functional recovery both in the chronic stage of stroke. Longitudinal studies with higher doses and sample sizes are required to confirm the therapy effectiveness. This trial was retrospectively registered at ClinicalTrials.gov database (registration number NCT03094650 ) on 14 March 2017

Feasibility study into self-administered training at home using an arm and hand device with motivational gaming environment in chronic stroke

© 2015 Nijenhuis et al. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.BACKGROUND: Assistive and robotic training devices are increasingly used for rehabilitation of the hemiparetic arm after stroke, although applications for the wrist and hand are trailing behind. Furthermore, applying a training device in domestic settings may enable an increased training dose of functional arm and hand training. The objective of this study was to assess the feasibility and potential clinical changes associated with a technology-supported arm and hand training system at home for patients with chronic stroke. METHODS: A dynamic wrist and hand orthosis was combined with a remotely monitored user interface with motivational gaming environment for self-administered training at home. Twenty-four chronic stroke patients with impaired arm/hand function were recruited to use the training system at home for six weeks. Evaluation of feasibility involved training duration, usability and motivation. Clinical outcomes on arm/hand function, activity and participation were assessed before and after six weeks of training and at two-month follow-up. RESULTS: Mean System Usability Scale score was 69 % (SD 17 %), mean Intrinsic Motivation Inventory score was 5.2 (SD 0.9) points, and mean training duration per week was 105 (SD 66) minutes. Median Fugl-Meyer score improved from 37 (IQR 30) pre-training to 41 (IQR 32) post-training and was sustained at two-month follow-up (40 (IQR 32)). The Stroke Impact Scale improved from 56.3 (SD 13.2) pre-training to 60.0 (SD 13.9) post-training, with a trend at follow-up (59.8 (SD 15.2)). No significant improvements were found on the Action Research Arm Test and Motor Activity Log. CONCLUSIONS: Remotely monitored post-stroke training at home applying gaming exercises while physically supporting the wrist and hand showed to be feasible: participants were able and motivated to use the training system independently at home. Usability shows potential, although several usability issues need further attention. Upper extremity function and quality of life improved after training, although dexterity did not. These findings indicate that home-based arm and hand training with physical support from a dynamic orthosis is a feasible tool to enable self-administered practice at home. Such an approach enables practice without dependence on therapist availability, allowing an increase in training dose with respect to treatment in supervised settings. TRIAL REGISTRATION: This study has been registered at the Netherlands Trial Registry (NTR): NTR3669 .Peer reviewe

IUCN UK Commission of Inquiry on Peatlands.

Peatlands are areas of land with a naturally accumulated layer of peat. These are formed under waterlogged conditions from carbon rich, dead and decaying plant material. In the UK mosses, mainly Sphagnum species, are the main formers of peat. Peatlands are found in at least 175 countries – from the tropics to the poles – and cover around 4 million km2 or 3% of the world’s land area. In Europe, peatlands extend to ca. 515,000 km2 . The UK is amongst the top ten nations of the world in terms of its total peatland area. The UK has between 9-15% of Europe’s peatland area (46,000-77,000 km2 ) and about 13% of the world’s blanket bog – one of the world’s rarest habitats. There are three main types of peatland in the UK: blanket bogs, raised bogs and fens. The international importance of the peatlands found in the UK give it an especial responsibility for their management and conservation. The IUCN UK Commission of Inquiry on Peatlands has gathered up-to-date knowledge from science, policy and practice. The assessment focuses on blanket bog and raised bog peatlands, because they represent over 95% of all UK peatland habitat and offer an opportunity to make early and substantial progress in delivering a combination of economic, social and biodiversity gains. However, we recognise that lowland, river and groundwater-fed fen peatlands are also vital carbon stores, as well as existing and potential areas of rich biodiversity, which have also been subject to intensive and damaging management. Fen peatlands share many of the issues affecting rain-fed peatlands but with distinct differences in terms of their functions, threats and pressures, which merit further investigation. A multidisciplinary team of experts produced this Report. It provides an authoritative assessment of the available evidence, based on peer-reviewed scientific consensus about the state of peatlands, the impacts of different activities on peatland ecosystems and the services they provide and the benefits of restoring and conserving them. The assessment explores mechanisms and processes for peatland conservation action, recognising the different social, economic and environmental drivers. The evidence-gathering approach was inclusive, engaging individual land managers as well as a wide range of organisations, which in itself has helped to foster joint action for peatland conservation and restoration. The Assessment Report sets out the main conclusions, highlighting gaps and opportunities for further action. It identifies ways to secure additional funding and develop expertise to help land managers restore the UK’s peatlands and to allow decision makers to take better account of their multiple benefits

IUCN UK Commission of Inquiry on Peatlands

Peatlands are areas of land with a naturally accumulated layer of peat. These are formed under waterlogged conditions from carbon rich, dead and decaying plant material. In the UK mosses, mainly Sphagnum species, are the main formers of peat. Peatlands are found in at least 175 countries – from the tropics to the poles – and cover around 4 million km 2 or 3% of the world’s land area. In Europe, peatlands extend to ca. 515,000 km 2 . The UK is amongst the top ten nations of the world in terms of its total peatland area. The UK has between 9-15% of Europe’s peatland area (46,000-77,000 km 2 ) and about 13% of the world’s blanket bog – one of the world’s rarest habitats. There are three main types of peatland in the UK: blanket bogs, raised bogs and fens. The international importance of the peatlands found in the UK give it an especial responsibility for their management and conservation. The IUCN UK Commission of Inquiry on Peatlands has gathered up-to-date knowledge from science, policy and practice. The assessment focuses on blanket bog and raised bog peatlands, because they represent over 95% of all UK peatland habitat and offer an opportunity to make early and substantial progress in delivering a combination of economic, social and biodiversity gains. However, we recognise that lowland, river and groundwater-fed fen peatlands are also vital carbon stores, as well as existing and potential areas of rich biodiversity, which have also been subject to intensive and damaging management. Fen peatlands share many of the issues affecting rain-fed peatlands but with distinct differences in terms of their functions, threats and pressures, which merit further investigation. A multidisciplinary team of experts produced this Report. It provides an authoritative assessment of the available evidence, based on peer-reviewed scientific consensus about the state of peatlands, the impacts of dif ferent activities on peatland ecosystems and the services they provide and the benefits of restoring and conserving them. The assessment explores mechanisms and processes for peatland conservation action, recognising the different social, economic and environmental drivers. The evidence-gathering approach was inclusive, engaging individual land managers as well as a wide range of organisations, which in itself has helped to foster joint action for peatland conservation and restoration. The Assessment Report sets out the main conclusions, highlighting gaps and opportunities for further action. It identifies ways to secure additional funding and develop expertise to help land managers restore the UK’s peatlands and to allow decision makers to take better account of their multiple benefits

Restoring brain function after stroke - bridging the gap between animals and humans

Stroke is the leading cause of complex adult disability in the world. Recovery from stroke is often incomplete, which leaves many people dependent on others for their care. The improvement of long-term outcomes should, therefore, be a clinical and research priority. As a result of advances in our understanding of the biological mechanisms involved in recovery and repair after stroke, therapeutic opportunities to promote recovery through manipulation of poststroke plasticity have never been greater. This work has almost exclusively been carried out in preclinical animal models of stroke with little translation into human studies. The challenge ahead is to develop a mechanistic understanding of recovery from stroke in humans. Advances in neuroimaging techniques now enable us to reconcile behavioural accounts of recovery with molecular and cellular changes. Consequently, clinical trials can be designed in a stratified manner that takes into account when an intervention should be delivered and who is most likely to benefit. This approach is expected to lead to a substantial change in how restorative therapeutic strategies are delivered in patients after stroke