Smart Protocols for Physical Therapy of Foot Drop Based on Functional Electrical Stimulation: A Case Study

Functional electrical stimulation (FES) is used for treating foot drop by delivering electrical pulses to the anterior tibialis muscle during the swing phase of gait. This treatment requires that a patient can walk, which is mostly possible in the later phases of rehabilitation. In the early phase of recovery, the therapy conventionally consists of stretching exercises, and less commonly of FES delivered cyclically. Nevertheless, both approaches minimize patient engagement, which is inconsistent with recent findings that the full rehabilitation potential could be achieved by an active psycho-physical engagement of the patient during physical therapy. Following this notion, we proposed smart protocols whereby the patient sits and ankle movements are FES-induced by self-control. In six smart protocols, movements of the paretic ankle were governed by the non-paretic ankle with different control strategies, while in the seventh voluntary movements of the paretic ankle were used for stimulation triggering. One stroke survivor in the acute phase of recovery participated in the study. During the therapy, the patient’s voluntary ankle range of motion increased and reached the value of normal gait after 15 sessions. Statistical analysis did not reveal the differences between the protocols in FES-induced movements.The APC was funded by Lund University Librar

Povezanost demografskih odlika, kognitivnog funkcionisanja i funkcionalne nezavisnosti kod bolesnika posle moždanog udara

Introduction It has been assumed that there is causality of the achieved level of functional independence with the degree of preservation of cognitive function in stroke patients. Demographic characteristics may be important for monitoring the achieved level of functional independence. Objective The aim of this study was to examine the relationship of demographic characteristics and functional independence in regard to the level of cognitive impairment in stroke patients. Methods The study included 50 stroke patients after rehabilitation, as well as age- and gender-matched 50 subjects selected randomly, according to the demographic characteristics of the studied sample, who in their medical history had no neurological disorders. For the assessment of functional independence, the Functional Independence Measure (FIM) test was used. The general cognition was estimated by the Mini-Mental State Examination (MMSE) test. The statistical analyses included the Mann-Whitney test, for two independent samples, measures of canonical correlation, and χ2 test. Results There was a statistically significant difference between the groups in relation to risk factors, hypertension and diabetes mellitus type II (p lt 0.001); There was a statistically significant difference within the groups in relation to the cognitive impairment in all the examined demographic characteristics (p lt 0.001); the differences within the groups in relation to the cognitive impairment are present on all subscales of the FIM test (p lt 0.05); the differences within the groups in relation to handedness, hemiparesis, show that mild cognitive impairment is more common among left hemiparesis, while a more severe one is more common among right-sided hemiparesis (p lt 0.05); More severe cognitive impairment is common among women, the elderly and in persons with lower education (p lt 0.05). Conclusion By prevention of risk factors, and prevention of possible cognitive impairment, consequences of stroke can be reduced, the recovery can be made more successful, and quality of life can be improved.Uvod Pretpostavlja se da postoji uslovljenost postignutog nivoa funkcionalne nezavisnosti sa stepenom očuvanosti kognitivnih funkcija kod bolesnika posle moždanog udara. Demografske odlike mogu biti značajne u praćenju postignutog nivoa funkcionalne nezavisnosti. Cilj rada Cilj istraživanja je bio da se ispita odnos demografskih odlika i funkcionalne nezavisnosti u odnosu na nivo kognitivnog oštećenja kod bolesnika posle moždanog udara. Metode rada Istraživanjem je obuhvaćeno 50 bolesnika posle moždanog udara u procesu rehabilitacije i 50 ispitanika odabranih metodom slučajnog uzorka, usklađenih prema demografskim odlikama, koji u svojoj anamnezi nisu imali neurološka oboljenja. Za procenu funkcionalne nezavisnosti korišćen je FIM test (engl. Functional Independence Measure), za procenu kognitivnog stanja korišćena je MMSE skala (engl. Mini Mental State Examination), dok su za statističku obradu podataka korišćeni Man-Vitnijev (Mann-Whitney) test, neparametrijski test za dva nezavisna uzorka, mere kanoničke korelacije i χ2-test. Rezultati Postoji statistički značajna razlika između grupa u pogledu faktora rizika, hipertenzije i dijabetes melitusa tip II (p lt 0,001). Statistički značajna unutargrupna razlika zabeležena je i u odnosu na kognitivno oštećenje kod svih ispitanih demografskih odlika (p lt 0,001). Unutar- grupna razlika u odnosu na kognitivno oštećenje postojala je na svim supskalama FIM testa (p lt 0,05). Unutargrupna razlika u odnosu na lateralizovanost hemipareza pokazala je da je blago kognitivno oštećenje češće kod levostranih, dok je teže oštećenje češće kod desnostranih hemipare- za (p lt 0,05). Teže kognitivno oštećenje je bilo češće kod žena, kod osoba starije životne dobi i ispitanika nižeg obrazovanja (p lt 0,05). Zaključak Prevencijom faktora rizika i mogućih kognitivnih oštećenja posledice moždanog udara mogu se umanjiti; oporavak će biti uspešniji, a kvalitet života bolesnika bolji

Correlation between Functional Independence and Quality of Executive Functions in Stroke Patients

Objective: The rehabilitation of stroke patients is complex. It is believed that there is a correlation between the quality of functional independence and degree of preserved executive and cognitive functions. The aim of this work was to investigate potential correlations between the quality of executive and cognitive functions and the achieved level of functional independence during the rehabilitation of stroke patients. Material and Methods: The study included 50 stroke patients evaluated during rehabilitation and 50 beneficiaries of the Gerontology Center as control subjects randomly chosen, with no diagnosed neurological damage. The following tests were used: Wisconsin Card Sorting Test (WCST) for executive function assessment, Mini-Mental State Examination (MMSE) for cognitive screening, and Functional Independence Measure (FIM) test for functional independence assessment. The statistical analyses included the Mann-Whitney U test for comparisons between two independent samples, canonical correlation analysis, and.2-test. Results: Our results show a statistically significant difference in all assessed functions between the two groups (p lt .001). Furthermore, we show a positive correlation between executive functions and achieved functional independence in stroke patients (p lt .001). Moreover, a positive correlation exists between cognitive functions and level of functional independence in stroke patients. Conclusion: Our results show that stroke patients with lower executive function scores achieve less functional independence. Stroke patients with existing cognitive impairment achieve less functional independence in all domains compared with stroke patients without cognitive impairment

Correlation between the Quality of Attention and Cognitive Competence with Motor Action in Stroke Patients

It is considered that cognitive function and attention could affect walking, motion control, and proper conduct during the walk. To determine whether there is a difference in the quality of attention and cognitive ability in stroke patients and patients without neurological damage of similar age and education and to determine whether the connection of attention and cognition affects motor skills, the sample consisted of 50 stroke patients tested with hemiparesis, involved in the process of rehabilitation, and 50 persons, randomly chosen, without neurological damage. The survey used the following tests: Trail Making (TMT A B) test for assessing the flexibility of attention; Mini-Mental State Examination (MMSE) for cognitive status; Functional Ambulation Category (FAC) test to assess the functional status and parameters of walk: speed, frequency, and length of stride; STEP test for assessing the precision of movement and balance. With stroke patients, relationship between age and performance on the MMSE test was marginally significant. The ratio of performance to TMT A B test and years does not indicate statistical significance, while statistical significance between the MMSE test performance and education exists. In stroke patients, performance on MMSE test is correlated with the frequency and length of stride walk. The quality of cognitive function and attention is associated with motor skills but differs in stroke patients and people without neurological damage of similar age. The significance of this correlation can supplement research in neurorehabilitation, improve the quality of medical rehabilitation, and contribute to efficient recovery of these patients

Effects of a short-term differently dosed aerobic exercise on maximum aerobic capacity in breast cancer survivors: A pilot study

Background/Aim. Regular physical activity and exercise improves quality of life and possibly reduces risk of disease relapse and prolongs survival in breast cancer survivors. The aim of this study was to evaluate the impact of a 3-week moderate intensity aerobic training, on aerobic capacity (VO2max) in breast cancer survivors. Methods. A prospective, randomized clinical study included 18 female breast cancer survivors in stage I-IIIA, in which the primary treatment was accomplished at least 3 months before the study inclusion. In all the patients VO2max was estimated using the Astrand’s protocol on a bicycle-ergometer (before and after 3 weeks of training), while subjective assessment of exertion during training were estimated by the Category-Ratio RPE Scale. Each workout lasted 21 minutes: 3 minutes for warmup and cool-down each and 15 min of full training, 2 times a week. The workload in the group E1 was predefined at the level of 45% to 65% of individual VO2max, and in the group E2 it was based on subjective evaluation of exertion, at the level marked 4-6. Data on the subjective feeling of exertion were collected after each training course in both groups. Results. We recorded a statistically significant improvement in VO2max in both groups (E1 - 11.86%; E2 - 17.72%), with no significant differences between the groups. The workload level, determined by the percent of VO2max, was different between the groups E1 and E2 (50.47 ± 7.02% vs 55.58 ± 9.58%), as well as subjective perception of exertion (in the groups E1 and E2, 11.6% and 41.6% of training, respectively, was graded in the mark 6). Conclusion. In our group of breast cancer survivors, a 3-week moderate intensity aerobic training significantly improved the level of VO2max

A decision support system for electrode shaping in multi-pad FES foot drop correction

Background: Functional electrical stimulation (FES) can be applied as an assistive and therapeutic aid in the rehabilitation of foot drop. Transcutaneous multi-pad electrodes can increase the selectivity of stimulation; however, shaping the stimulation electrode becomes increasingly complex with an increasing number of possible stimulation sites. We described and tested a novel decision support system (DSS) to facilitate the process of multi-pad stimulation electrode shaping. The DSS is part of a system for drop foot treatment that comprises a customdesigned multi-pad electrode, an electrical stimulator, and an inertial measurement unit. Methods: The system was tested in ten stroke survivors (3-96 months post stroke) with foot drop over 20 daily sessions. The DSS output suggested stimulation pads and parameters based on muscle twitch responses to short stimulus trains. The DSS ranked combinations of pads and current amplitudes based on a novel measurement of the quality of the induced movement and classified them based on the movement direction (dorsiflexion, plantar flexion, eversion and inversion) of the paretic foot. The efficacy of the DSS in providing satisfactory pad-current amplitude choices for shaping the stimulation electrode was evaluated by trained clinicians. The range of paretic foot motion was used as a quality indicator for the chosen patterns. Results: The results suggest that the DSS output was highly effective in creating optimized FES patterns. The position and number of pads included showed pronounced inter-patient and inter-session variability; however, zones for inducing dorsiflexion and plantar flexion within the multi-pad electrode were clearly separated. The range of motion achieved with FES was significantly greater than the corresponding active range of motion (p < 0.05) during the first three weeks of therapy. Conclusions: The proposed DSS in combination with a custom multi-pad electrode design covering the branches of peroneal and tibial nerves proved to be an effective tool for producing both the dorsiflexion and plantar flexion of a paretic foot. The results support the use of multi-pad electrode technology in combination with automatic electrode shaping algorithms for the rehabilitation of foot drop.The research has been supported in part by grants of the Basque Government (PI2013-10), the ERA-NET EU/MINECO project (INDIGO-DBT2-051) and by the Ministry of Education, Science and Technological Development of Serbia (Project no. 175016)

Feedback-Mediated Upper Extremities Exercise: Increasing Patient Motivation in Poststroke Rehabilitation

Purpose. This proof-of-concept study investigated whether feedback-mediated exercise (FME) of the affected arm of hemiplegic patients increases patient motivation and promotes greater improvement of motor function, compared to no-feedback exercise (NFE). Method. We developed a feedback-mediated treatment that uses gaming scenarios and allows online and offline monitoring of both temporal and spatial characteristics of planar movements. Twenty poststroke hemiplegic inpatients, randomly assigned to the FME and NFE group, received therapy five days a week for three weeks. The outcome measures were evaluated from the following: (1) the modified drawing test (mDT), (2) received therapy time—RTT, and (3) intrinsic motivation inventory—IMI. Results. The FME group patients showed significantly higher improvement in the speed metric (P<0.01), and smoothness metric (P<0.01), as well as higher RTT (P<0.01). Significantly higher patient motivation is observed in the FME group (interest/enjoyment subscale (P<0.01) and perceived competence subscale (P<0.01)). Conclusion. Prolonged endurance in training and greater improvement in certain areas of motor function, as well as very high patient motivation and strong positive impressions about the treatment, suggest the positive effects of feedback-mediated treatment and its high level of acceptance by patients

Učestalost dizartrije kod pacijenata sa moždanim udarom

Stroke can cause various forms of dysarthria in patients. Studies of dysarthria in this population are relatively rare, and empirical data on its frequency are quite variable. The aim of this study was to determine the incidence of dysarthria in stroke patients referred for speech therapy. The sample consisted of 152 subjects with stroke who were referred for a speech therapy examination. The age of the respondents was 55 years (SD = 10.04), the average age of education was 13 years (SD = 10.04), the male person was 98 (64.4%), while the female person was 54 (35.5%). The average time from stroke was 8 months (SD = 18.92). The examinedes were in inpatient rehabilitation treatment at the Clinic for Rehabilitation “Dr. Miroslav Zotović” in Belgrade, in the period from September 1, 2020 to September 1, 2021. years. A screening test for dysarthria was used to determine the presence of dysarthria. From the statistical tests, descriptive statistics, Chi square test, and T test were used. The results showed the presence of dysarthria in 44 (29%) subjects included in the study. Given the high incidence of dysarthria in persons after stroke, the data indicate the importance of timely assessment and treatment to enable the best possible functioning of the person in everyday life and communicationMoždani udar (MU) može da uzrokuje različite forme dizartrije kod obolelih. Studije dizartrije u ovoj populaciji su relativno retke, a empirijski podaci o njenoj učestalosti prilično varijabilni. Cilj ovog rada je utvrđivanje učestalosti dizartrije kod pacijenata sa moždanim udarom koji su upućeni na logopedski tretman. Uzorak se sastojao od 152 ispitanika sa MU koji su upućeni na logopedski pregled. Starosna dob ispitanika bila je 55 godina (SD = 10.04), prosečne godine obrazovanja bile su 13 godina (SD = 10.04), osoba muškog pola bilo je 98 (64,4%), dok je osoba ženskog pola bilo 54 (35,5%). Prosečno vreme od povrede iznosilo je 8 meseci (SD = 18.92). Ispitanici su se nalazili na stacionarnom rehabilitacionom tretmanu na Klinici za rehabilitaciju ’’dr Miroslav Zotović’’ u Beogradu, u periodu od 01.09.2020 do 01.09.2021. godine. U određivanju prisutva dizartrije korišćen je Skrining test za dizartriju. Od statističkih testova korišćena je deskriptivna statistika, Hi kvadrat test, i T test. Rezultati su pokazali prisustvo dizartrije kod 44 (29%) ispitanika uključenih u studiju. S obzirom na visoku učestalost dizartrije kod osoba nakon MU, podaci ukazuju na značaj pravovremene procene i tretmana kako bi se omogućilo što bolje funkcionisanje osobe u svakodnevnom živototu i komunikaciji

ArmAssist Robotic System versus Matched Conventional Therapy for Poststroke Upper Limb Rehabilitation: A Randomized Clinical Trial

The ArmAssist is a simple low-cost robotic system for upper limb motor training that combines known benefits of repetitive task-oriented training, greater intensity of practice, and less dependence on therapist assistance. The aim of this preliminary study was to compare the efficacy of ArmAssist (AA) robotic training against matched conventional arm training in subacute stroke subjects with moderate-to-severe upper limb impairment. Twenty-six subjects were enrolled within 3 months of stroke and randomly assigned to the AA group or Control group (n = 13 each). Both groups were trained 5 days per week for 3 weeks. The primary outcome measure was Fugl-Meyer Assessment-Upper Extremity (FMA-UE) motor score, and the secondary outcomes were Wolf Motor Function Test-Functional Ability Scale (WMFT-FAS) and Barthel index (BI). The AA group, in comparison to the Control group, showed significantly greater increases in FMA-UE score (18.0 +/- 9.4 versus 7.5 +/- 5.5, p = 0.002) and WMFT-FAS score (14.1 +/- 7.9 versus 6.7 +/- 7.8, p = 0.025) after 3 weeks of treatment, whereas the increase in BI was not significant (21.2 +/- 24.8 versus 13.1 +/- 10.7, p = 0.292). There were no adverse events. We conclude that arm training using the AA robotic device is safe and able to reduce motor deficits more effectively than matched conventional arm training in subacute phase of stroke.Andrej M. Savic and Milica S. Isakovic are employed at Tecnalia Serbia Ltd., Belgrade, Serbia, and Cristina Rodriguez-de-Pablo and Thierry Keller are employed at TECNALIA, San Sebastian, Spain, from which they receive financial compensation. No external support was received for conducting this study