Evaluation of upper extremity neurorehabilitation using technology: A European Delphi consensus study within the EU COST Action Network on Robotics for Neurorehabilitation

Background: The need for cost-effective neurorehabilitation is driving investment into technologies for patient assessment and treatment. Translation of these technologies into clinical practice is limited by a paucity of evidence for cost-effectiveness. Methodological issues, including lack of agreement on assessment methods, limit the value of meta-analyses of trials. In this paper we report the consensus reached on assessment protocols and outcome measures for evaluation of the upper extremity in neurorehabilitation using technology. The outcomes of this research will be part of the development of European guidelines. Methods: A rigorous, systematic and comprehensive modified Delphi study incorporated questions and statements generation, design and piloting of consensus questionnaire and five consensus experts groups consisting of clinicians, clinical researchers, non-clinical researchers, and engineers, all with working experience of neurological assessments or technologies. For data analysis, two major groups were created: i) clinicians (e.g., practicing therapists and medical doctors) and ii) researchers (clinical and non-clinical researchers (e.g. movement scientists, technology developers and engineers). Results: Fifteen questions or statements were identified during an initial ideas generation round, following which the questionnaire was designed and piloted. Subsequently, questions and statements went through five consensus rounds over 20 months in four European countries. Two hundred eight participants: 60 clinicians (29 %), 35 clinical researchers (17 %), 77 non-clinical researchers (37 %) and 35 engineers (17 %) contributed. At each round questions and statements were added and others removed. Consensus (≥69 %) was obtained for 22 statements on i) the perceived importance of recommendations; ii) the purpose of measurement; iii) use of a minimum set of measures; iv) minimum number, timing and duration of assessments; v) use of technology-generated assessments and the restriction of clinical assessments to validated outcome measures except in certain circumstances for research. Conclusions: Consensus was reached by a large international multidisciplinary expert panel on measures and protocols for assessment of the upper limb in research and clinical practice. Our results will inform the development of best practice for upper extremity assessment using technologies, and the formulation of evidence-based guidelines for the evaluation of upper extremity neurorehabilitation

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

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

Upper limb rehabilitation using robotic exoskeleton systems: a systematic review

Exoskeleton assisted therapy has been reported as a significant reduction in impairment and gain in functional abilities of stroke patients. In this paper, we conduct a systematic review on the upper limb rehabilitation using robotic exoskeleton systems. This review is based on typical mechanical structures and control strategies for exoskeletons in clinical rehabilitation conditions. A variety of upper limb exoskeletons are classified and reviewed according to their rehabilitation joints. Special attentions are paid to the performance control strategies and mechanism designs in clinical trials and to promote the adaptability to different patients and conditions. Finally, we analyze and highlight the current research gaps and the future directions in this field. We intend to offer informative resources and reliable guidance for relevant researcher’s further studies, and exert a far-reaching influence on the development of advanced upper limb exoskeleton robotic systems

Roboterunterstützte Rehabilitation der oberen Extremität nach Schlaganfall

Die Erkenntnisse neurowissenschaftlicher Grundlagenforschung zur Neuroplastizität verändern die herkömmliche neurologische Rehabilitationsbehandlung und werden in die Entwicklung neuer Therapieformen integriert. Wichtige Faktoren zur Steigerung trainingsinduzierter Plastizität können mit den Begriffen aufgabenorientiertes Training mit möglichst physiologischen Bewegungen, hochgradige Intensität und Repetition, aktive Beteiligung und Motivation umrissen werden. Roboter scheinen in besonderer Weise geeignet, diese Faktoren erfolgreichen motorischen Lernens umzusetzen. Dieser Beitrag gibt einen Einblick in die Technik und Anwendung der roboterunterstützten Bewegungstherapie am Beispiel des ARMin-Roboters. Neben den technischen Herausforderungen und Lösungsmöglichkeiten wird auch auf die klinische Anwendung zur neurologischen Rehabilitation nach Schlaganfall eingegangen

Roboterunterstützte RehaGames: Erfahrungen und Perspektiven

Der vorliegende Artikel bietet eine allgemeine Übersicht zur Kombination Robotik und Reha-Games in der Neurorehabilitation im Hinblick auf Vorteile und Herausforderungen, gepaart mit detaillierteren Ausführungen zu entsprechenden bisherigen und zukünftigen Entwicklungen in unserem Labor für Sensomotorische Systeme der ETH Zürich und Universität Zürich. Es wird aufgezeigt, dass die Kombination Robotik und RehaGames noch in ihren Anfängen steckt, jedoch im Hinblick auf die gleichzeitige Steigerung von Motivation und Trainingseffekten gerade mittels Mehrspieler-RehaGames großes Potential bietet. Wesentlich für diese Annahme sind die jüngsten Entwicklungen im Bereich der Regelung von Rehabilitationsrobotern und in der Gestaltung von RehaGames, welche ausführlich im vorliegenden Artikel dargelegt werden

Towards more effective robotic gait training for stroke rehabilitation: a review.

Stroke is the most common cause of disability in the developed world and can severely degrade walking function. Robot-driven gait therapy can provide assistance to patients during training and offers a number of advantages over other forms of therapy. These potential benefits do not, however, seem to have been fully realised as of yet in clinical practice

A robotic system to train activities of daily living in a virtual environment

In the past decade, several arm rehabilitation robots have been developed to assist neurological patients during therapy. Early devices were limited in their number of degrees of freedom and range of motion, whereas newer robots such as the ARMin robot can support the entire arm. Often, these devices are combined with virtual environments to integrate motivating game-like scenarios. Several studies have shown a positive effect of game-playing on therapy outcome by increasing motivation. In addition, we assume that practicing highly functional movements can further enhance therapy outcome by facilitating the transfer of motor abilities acquired in therapy to daily life. Therefore, we present a rehabilitation system that enables the training of activities of daily living (ADL) with the support of an assistive robot. Important ADL tasks have been identified and implemented in a virtual environment. A patient-cooperative control strategy with adaptable freedom in timing and space was developed to assist the patient during the task. The technical feasibility and usability of the system was evaluated with seven healthy subjects and three chronic stroke patients