Changes in circle area after gravity compensation training in chronic stroke patients

After a stroke, many people experience difficulties to selectively activate muscles. As a result many patients move the affected arm in stereotypical patterns. Shoulder abduction is often accompanied by elbow flexion, reducing the ability to extend the elbow. This involuntary coupling reduces the patient's active range of motion. Gravity compensation reduces the activation level of shoulder abductors which limits the amount of coupled elbow flexion. As a result, stroke patients can instantaneously increase their active range of motion [1]. The objective of the present study is to examine whether training in a gravity compensated environment can also lead to an increased range of motion in an unsupported environment. Parts of this work have been presented at EMBC2009, Minneapolis, USA

Influence of gravity compensation training on synergistic movement patterns of the upper extremity after stroke, a pilot study

Background\ud \ud The majority of stroke patients have to cope with impaired arm function. Gravity compensation of the arm instantaneously affects abnormal synergistic movement patterns. The goal of the present study is to examine whether gravity compensated training improves unsupported arm function. \ud \ud Methods\ud \ud Seven chronic stroke patients received 18 half-hour sessions of gravity compensated reach training, in a period of six weeks. During training a motivating computer game was played. Before and after training arm function was assessed with the Fugl-Meyer assessment and a standardized, unsupported circle drawing task. Synergistic movement patterns were identified based on concurrent changes in shoulder elevation and elbow flexion/extension angles. \ud \ud Results\ud \ud Median increase of Fugl-Meyer scores was 3 points after training. The training led to significantly increased work area of the hemiparetic arm, as indicated by the normalized circle area. Roundness of the drawn circles and the occurrence of synergistic movement patterns remained similar after the training. \ud \ud Conclusions\ud \ud A decreased strength of involuntary coupling might contribute to the increased arm function after training. More research is needed to study working mechanisms involved in post stroke rehabilitation training. The used training setup is simple and affordable and is therefore suitable to use in clinical setting

Application of arm support training in sub-acute stroke rehabilitation: First results on effectiveness and user experiences

A multi-center randomized clinical trial was performed in 7 Dutch rehabilitation centers, in the context of an implementation project (ROBAR), to compare the effect of an arm support (AS) training device to equally intensive conventional reach training (CON) on recovery of arm-hand function in sub-acute stroke. The Fugl-Meyer assessment (FM) and user experiences of therapists and patients were examined in both groups. An improvement of 10 and 8 points on the FM was found for respectively the CON and AS group. Both therapists and patients reported positive experiences on several aspects of user acceptance. These findings indicate that a low-tech system for arm support results in similar gains in arm function as conventional reach training in equal intensity, and is suitable for application in clinical practice

Direct effect of a dynamic wrist and hand orthosis on reach and grasp kinematics in chronic stroke

Many stroke patients have impaired arm and hand function. Distal arm and hand devices may support functional use of the upper extremity in activities in daily life. The present study assessed the direct effects of a passive dynamic wrist and hand orthosis on hand and arm movements during the performance of a reach and grasp task in ten mildly to moderately impaired chronic stroke patients. The use of the orthosis resulted in an increase in hand opening, increase in trunk displacement and decrease in elbow ROM during the performance of the reach and grasp task. Therefore, the use of an additional device supporting the arm against gravity should be considered when using such an orthosis in future research, to counteract potential compensatory trunk movements. The findings obtained in this study are being taken into consideration for a longitudinal feasibility study using this orthosis in combination with a computerized gaming environment in chronic stroke at home

Gaming and conventional exercises for improvement of arm function after stroke: a randomised controlled pilot study

Objective: The use of new technologies in rehabilitation, such as virtual reality and/or computerized gaming exercises, may be useful to enable patients to practice intensively in a motivating way. The objective of the present randomized controlled pilot study was to compare the effect of reach training using a target group specific-designed rehabilitation game to time-matched standardized conventional reach training on arm function after stroke. Materials and Methods: Twenty chronic stroke patients were randomized to either the rehabilitation game group or the conventional training group. Both groups received three arm training sessions of 30 minutes each week, during a period of 6 weeks. Arm (the upper extremity part of Fugl-Meyer [FM] assessment) and hand (the Action Research Arm [ARA] test) functions were tested 1 week before (T0) and 1 week after (T1) training. A follow-up measurement was performed at 1 month after T1 (T2). Results: ARA and FM scores improved significantly within both groups. Post hoc comparisons revealed significant increases in test scores between T0 and T1 and between T0 and T2 for both ARA and FM, but not for changes from T1 to T2. There were no significant differences between both groups for either clinical test. Conclusions: The present randomized controlled pilot study showed that both arm and hand function improved as much after training with a rehabilitation game as after time-matched conventional training

First results of a comparison between gaming and equal intensity conventional training to improve arm function after chronic stroke

The use of new technologies in rehabilitation, such as virtual reality (VR) and/or gaming, is promising to enable patients to practice intensively in a motivating way. In the present study changes in arm function after conventional reach training are compared to reach training within a gaming environment of equal intensity in 18 chronic stroke patients. Fugl-Meyer scores showed equal increases between both groups, suggesting that games are promising as a tool to enable more independent training without the need for continuous one-to-one therapist supervision in clinical practice