Action Research Arm Test Research Articles

Abstract TP109: Safety and Feasibility of Paired Upper Extremity Gamified Rehabilitation and Vagus Nerve Stimulation in Patients with Chronic Stroke

Introduction: Upper extremity motor impairment and hemiparesis are prevalent following stroke, and can impact independence, ability to perform activities of daily living and overall quality of life.1 While the majority of motor recovery post stroke occurs within the initial 3 months, gains can continue through chronic stages.2 Evidence has identified vagus nerve stimulation (VNS) paired with intensive rehabilitation as an effective intervention for improving upper extremity (UE) function in persons with chronic stroke.3 Utilization of gaming-based stroke rehabilitation has been shown to increase engagement and improve UE motor function.4–6 This work reports on a cohort of patients with chronic stroke who participated in gamified UE rehabilitation paired with VNS. Methods: Data from 6 patients with UE motor impairment due to chronic stroke (> 1 year) were included. Following surgical vagus nerve stimulator implantation, patients participated in UE therapy sessions 3 times a week for 6 weeks. Intervention included gamified rehabilitation with VNS triggered upon each movement attempt. Between sessions, patients were provided with a magnet to activate VNS while performing an UE home activity program up to 8 times per day. Each self-initiated stimulator activation delivered 30 minutes of VNS. At the conclusion of 6 weeks, patients were encouraged to continue their VNS home program. Safety was assessed using adverse event reporting. Feasibility was assessed using time on task reported by the gamified rehabilitation software. Exploratory clinical outcomes included the Action Research Arm Test (ARAT) and Fugl Meyer Assessment (FMA) at baseline following implantation, upon completion of 6 weeks of therapy, and at 4 months post intervention. Results: Patients participated in 64.1 ± 14.9 mins of gamified rehabilitation per session with 29.9 ±8.6 of those minutes being active time on task. No adverse events were reported. FMA-UE motor subscale and ARAT scores increased from baseline to the end of 6 weeks by an average of 9.3±3.6 and 7±7.4 respectively. Average increases from baseline to 4 month follow up for FMA-UE motor subscale and ARAT score were 14±6.3 and 10±8.2 respectively. Conclusion: These findings suggest that VNS paired with gamified rehabilitation is a safe and feasible intervention for UE motor impairment post stroke. Future work will investigate short- and long-term feasibility and efficacy of the intervention in patients with chronic stroke.

Construct validity and responsiveness of clinical upper limb measures and sensor-based arm use within the first year after stroke: a longitudinal cohort study

BackgroundConstruct validity and responsiveness of upper limb outcome measures are essential to interpret motor recovery poststroke. Evaluating the associations between clinical upper limb measures and sensor-based arm use (AU) fosters a coherent understanding of motor recovery. Defining sensor-based AU metrics for intentional upper limb movements could be crucial in mitigating bias from walking-related activities. Here, we investigate the measurement properties of a comprehensive set of clinical measures and sensor-based AU metrics when gait and non-functional upper limb movements are excluded.MethodsIn this prospective, longitudinal cohort study, individuals with motor impairment were measured at days 3 ± 2 (D3), 10 ± 2 (D10), 28 ± 4 (D28), 90 ± 7 (D90), and 365 ± 14 (D365) after their first stroke. Using clinical measures, upper limb motor function (Fugl-Meyer Assessment), capacity (Action Research Arm Test, Box & Block Test), and perceived performance (14-item Motor Activity Log) were assessed. Additionally, individuals wore five movement sensors (trunk, wrists, and ankles) for three days. Thirteen AU metrics were computed based on functional movements during non-walking periods. Construct validity across clinical measures and AU metrics was determined by Spearman’s rank correlations for each time point. Criterion responsiveness was examined by correlating patient-reported Global Rating of Perceived Change (GRPC) scores and observed change in upper limb measures and AU metrics. Optimal cut-off values for minimal important change (MIC) were estimated by ROC curve analysis.ResultsNinety-three individuals participated. At D3 and D10, correlations between clinical measures and AU metrics showed variability (range rs: 0.44–0.90). All following time points showed moderate-to-high positive correlations between clinical measures and affected AU metrics (range rs: 0.57–0.88). Unilateral nonaffected AU duration was negatively correlated with clinical measures (range rs: -0.48 to -0.77). Responsiveness across outcomes was highest between D10-D28 within moderate to strong relations between GRPC and clinical measures (rs: range 0.60–0.73), whereas relations were weaker for AU metrics (range rs: 0.28–0.43) Eight MIC values were estimated for clinical measures and nine for AU metrics, showing moderate to good accuracy (66–87%).ConclusionsWe present reference data on the construct validity and responsiveness of clinical upper limb measures and specified sensor-based AU metrics within the first year after stroke. The MIC values can be used as a benchmark for clinical stroke rehabilitation.Trial registrationThis trial was registered on clinicaltrials.gov; registration number NCT03522519.

Myoelectric pattern recognition with virtual reality and serious gaming improves upper limb function in chronic stroke: a single case experimental design study

BackgroundMyoelectric pattern recognition (MPR) combines multiple surface electromyography channels with a machine learning algorithm to decode motor intention with an aim to enhance upper limb function after stroke. This study aims to determine the feasibility and preliminary effectiveness of a novel intervention combining MPR, virtual reality (VR), and serious gaming to improve upper limb function in people with chronic stroke.MethodsIn this single case experimental A-B-A design study, six individuals with chronic stroke and moderate to severe upper limb impairment completed 18, 2 h sessions, 3 times a week. Repeated assessments were performed using the Fugl-Meyer Assessment of Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), grip strength, and kinematics of the drinking task at baseline, during, and post intervention. The results were analyzed by using visual analysis and Tau-U statistics.ResultsAll participants improved upper limb function assessed by FMA-UE (Tau-U 0.72–1.0), and five out of six improved beyond the minimal clinical important difference (MCID). Four participants improved ARAT and grip strength scores (Tau-U 0.84–1.0), with one reaching the MCID for ARAT. Three out of four participants in the kinematic analysis achieved improvements beyond the MCID in movement time and smoothness, two with a Tau-U > 0.90, and two participants improved trunk displacement beyond the MCID (Tau-U 0.68). Most participants showed some deterioration in the follow-up phase.ConclusionsMPR combined with VR and serious gaming is a feasible and promising intervention for improving upper limb function in people with chronic stroke.Trial Registration: ClinicalTrials.gov, reference number NCT04154371.

Effects of a Wearable-Based Intervention on the Hemiparetic Upper Limb in Persons With Stroke: A Randomized Controlled Trial

Introduction Wearables have emerged as a transformative rehabilitation tool to provide self-directed training in the home. Objective. In this study, we examined the efficacy of a novel wearable device, “Smart Reminder” (SR), to provide home-based telerehabilitation for hemiparetic upper limb (UL) training in persons with stroke. Methods Forty stroke survivors from community support groups were randomized (stratified by the period after stroke onset and impairment severity) to either the SR group or the sham device group. Participants received either 20 hours of telerehabilitation using the SR device or training with pictorial handouts and a sham device over 4 weeks. In addition, all participants wore a standard accelerometer for 3 hours each day, 5 times a week, outside the prescribed training. Participants were assessed by a masked assessor at baseline, post-intervention (week 4), and follow-up (week 8). The outcome measures included Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Action Research Arm Test, Motor Activity Log, muscle strength, active range of motion and amount of movement of the UL, and compliance rate of training. Results The SR group improved substantially in their FMA-UE scores after treatment (mean difference = 2.05, P = .036) compared to the sham group. Also, adherence to the training using the SR device was significantly higher, 97%, than the sham group, 82.3% (P = .038). Conclusion The 4-week telerehabilitation program using a “SR” device demonstrated potential efficacy in improving FMA-UE scores of the hemiparetic upper limb. However, it did not significantly enhance the performance of the affected limb in daily activities. The trial was registered on ClinicalTrial.gov (URL: http://www.clinicaltrials.gov) with the identifier NCT05877183.

Upper-extremity motor recovery after stroke: A systematic review and meta-analysis of usual care in trials and observational studies.

A better knowledge of upper-extremity (UE) recovery in patients with stroke receiving usual care (UC) is crucial for informing clinicians on expected recovery and serves as reference for future studies. This systematic review and meta-analysis aimed to assess rate and amount of recovery of UE with UC in the subacute phase of stroke and identify covariates of UE recovery. PRISMA-guidelines were used for search in PubMed, Cinahl and PEDro. Observational studies (OS) and UC groups of randomized control trials (RCT) of adults with subacute stroke and UE paresis were included, each reporting UE function at least at two time points. Placebo-, sham-controlled, dose-matched trials and trials with <10 participants were excluded. From 1220 records, 54 papers (19 OS and 35 RCTs) involving 2774 subacute stroke patients were included. Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT) were most frequently reported UE outcomes. Across RCTs, FMA-UE and ARAT improved 10 and 8 points, respectively, on average at 4-weeks from baseline. In OS, FMA-UE, improved 12 points at 12weeks and 16 points at 24weeks from baseline. Stroke severity, UE function, and lesion load of the cortico-spinal tract at baseline were associated with UE recovery. UE function in subacute stroke showed improvements that exceeded the threshold for clinically important change across RCTs and OS. This review provides estimates of expected change in UC groups for sample size calculations and planning of future trials, thereby enhancing statistical power and comparability of findings.

Clinical Study on the Treatment of Upper Limb Dysfunction in Stroke Patients Using Ultrasound-Guided Electroacupuncture.

This study aimed to compare the effects of electroacupuncture on traditional acupoints and muscle belly of different target muscles against upper limb dysfunction in stroke patients with hemiplegia. A total of thirty-nine stroke patients with subacute hemiplegia were randomly divided into the control group (n = 19) and observation group (n = 20). The control group was treated with physical therapy and normal electroacupuncture, while the observation group was treated with physical therapy and ultrasound-guided electroacupuncture on the muscle belly. After three weeks' intervention, the scores of Barthel Index, Fugl-Meyer assessment and Action Research Arm Test were compared between the two groups. Before the intervention, there were no significant differences in the scores of Barthel Index, Fugl-Meyer assessment and Action Research Arm Test between these two groups. After three weeks' intervention, there was significant increase in the scores of Barthel Index, Fugl-Meyer assessment, and Action Research Arm Test between the observation and control groups. Electroacupuncture on muscle belly under ultrasound guidance could significantly improve the performance of activities of daily living, motor function and the upper limb function in patients with subacute hemiplegia after stroke, and its effect was superior to electroacupuncture on the acupoints.

Italian translation, cultural adaptation, and validation of the Action Research Arm Test (ARAT) and the Stroke Upper Limb Capacity Scale (SULCS) for individuals post-stroke.

This study aims to culturally adapt and validate the Stroke Upper Limb Capacity Scale (SULCS) and Action Research Arm Test (ARAT) for use with post-stroke patients in Italy. The original scales were translated and culturally adapted following the "Translation and Cultural Adaptation of Patient Reported Outcomes Measures - Principles of Good Practice" guidelines. We assessed internal consistency and test-retest reliability, while concurrent validity was evaluated using Pearson correlation coefficients with the Italian version of the Disability Arm Shoulder and Hand (DASH). A total of 56 participants were recruited for the study. The Italian versions of the scales demonstrated excellent stability and reliability both within and between raters. The Cronbach's alpha coefficients were 0.904 for SULCS and 0.998 for ARAT, indicating strong internal consistency among items. The interclass correlation coefficients were 0.998 (95% C.I.: 0.993-0.990) for inter-rater reliability and 0.987 (95% C.I.: 0.984-0.995) for intra-rater reliability for SULCS, and 0.998 (95% C.I.: 0.999-0.996) for inter-rater reliability and 0.992 (95% C.I.: 0.998-0.987) for intra-rater reliability for ARAT. Both scales exhibit robust validity and reliability, making them valuable tools for clinical assessment and functional evaluation of upper limb capacity in post-stroke patients. We recommend the integration of the ARAT and SULCS into initial patient assessments and ongoing monitoring to enhance rehabilitation outcomes.

The translation into Polish, cultural adaptation, and initial validation of the Action Research Arm Test in subacute stroke patients.

In Poland, there are limited validated outcome measures to evaluate upper extremity function in stroke patients for clinical and research use. The Action Research Arm Test (ARAT) aims to assess functional performance of the upper extremities. To translate and culturally adapt the original version of ARAT into Polish, and to determine its reliability and validity. A Polish version of ARAT (ARAT-PL) was developed using a forward-backward translation. The study then examined 60 patients with subacute stroke. Internal consistency (α), test-retest and inter-rater reliability (intra-class correlation (ICC), κ), standard error of measurement (SEM), minimal detectable change (MDC), and floor and ceiling effects were determined. The construct validity was evaluated using the method of hypothesis testing based on the results of correlations (rho) between subscale and total scores of the ARAT-PL and the upper and lower extremity section of the Fugl-Meyer Assessment (FMA-UE and FMA-LE). The internal consistency of the total scores and subscale was excellent (α = 0.97-0.99). Test-retest and inter-rater reliability scores were almost perfect (κ = 0.85-1.0) and excellent for the total and subscale scores (ICC = 0.99-1). The SEM and MDC for the test-retest and inter-rater reliability were 0.479, 1.327 points and 0.335, 0.930 points, respectively. The ceiling effect amounted to 48%. The validity levels with respect to FMA-UE and FMA-LE were found to be high (rho ranging from 0.70 to 0.83) and moderate (rho ranging from 0.53 to 0.68), respectively. A Polish version of ARAT is a reliable and valid tool for assessing upper extremity function in subacute stroke patients in Poland. However, it appears to have a ceiling effect that limits differentiation of patients with mild upper limb impairment.

Motivation in veterans with an acute/subacute ischemic stroke did not improve cognition and functional motor recovery but reduced deaths.

The role of motivation per se in the presence or absence of depression in stroke-related cognitive and functional motor recovery has not been studied. This study aimed to determine the role of motivation on cognition and functional motor recovery in patients after an acute and subacute ischemic stroke. Prospective, observational, single-center study. Enrollment was undertaken in an inpatient neurorehabilitation facility. A total of 125 veterans with stroke were admitted to an inpatient neurorehabilitation facility. Recovery locus of control (RLOC) measured the degree of motivation. The primary outcome measures were changes from baseline in the Action Research Arm Test (ARAT), total and sub-scores of Functional Independence Measures (TFIM), and the 2-minute walk test (2-MWT) on discharge from the IRF. The mean age of the study sample was 65±9.3 years, they were mainly non-Hispanic white (N.=92, 74%) men (N.=119, 95%) admitted 9±11 days after acute stroke. When the sample was divided into less motivated (score 0-25, N.=32) and motivated (score ≥ 26, N.=93) as measured by the total RLOC for a statistical median of 26, the two groups had similar baseline characteristics including admission depression, TFIM, ARAT, and 2-MWT scores. The change in the primary outcome measure scores from baseline was similar between the two groups. Motivated group veterans had a lower all-cause mortality rate at 12 months than less motivated veterans (P=0.001). A higher level of motivation irrespective of the degree of depression did not improve cognitive or functional motor recovery scores. However, motivated veterans had a lower all-cause mortality at 12 months. The result of this study has important implications in clinical practice highlighting that motivated patients are more likely to be discharged home and have a lower all-cause mortality.

Sheffield Adaptive Patterned Electrical Stimulation (SHAPES) Therapy for Post Stroke Arm spasticity: study protocol for a 3-arm, a partially blinded, randomised controlled trial

IntroductionPost stroke elbow spasticity (PSES) affects over a third of individuals following stroke and negatively impacts on functional recovery, comfort and quality of life. Drug therapies have limited efficacy and unwanted side effects, botulinum toxin, although effective, is costly, and conventional electrical stimulation therapies are limited long term by habituation. We aim to investigate the efficacy of Sheffield Adaptive Patterned Electrical Stimulation (SHAPES), that delivers temporally and spatially varying pattern of electrical stimulation, against transcutaneous electrical stimulation (TENS) and standard care at reducing PSES.Methods and designOverall, 297 people with PSES will be randomised (1:1:1) to one of 3 arms: Standard care (no electrical stimulation), TENS (conventional patterned electrical stimulation) or SHAPES (adaptive patterned electrical stimulation). Both SHAPES and TENS are delivered using a specially designed electrical stimulation sleeve used for 60 min each day for 6-weeks. Outcome measures are completed at baseline, end of treatment (EOT 6 weeks) and then 6-weeks, 12-weeks and 24-weeks after the end of treatment. Efficacy will be determined based on the proportion of participants experiencing meaningful improvement (18%) in the 7-day Numerical Rating Scale (NRS-S) for PSES, compared between both intervention arms and standard care, and between the two intervention groups. Measures of arm motor function (Action Research Arm Test, MRC scale), and quality of life (SQoL-6D, EQ-5D) will also be measured along with a parallel health economic evaluation.DiscussionThe results of the SHAPES trial will inform management of elbow spasticity after stroke. The SHAPES intervention is a low cost, self-administered intervention for the management of spasticity that can be used repeatedly, and if found to be more effective than TENS or control has the potential to be widely implemented in the UK NHS healthcare setting. Furthermore, despite the wide use of TENS in the management of spasticity, this study will provide critically required evidence regarding its efficacy. The trial has been registered with the ISRCTN registry (ISRCTN26060261).

Effect of Upper Robot-Assisted Training on Upper Limb Motor, Daily Life Activities, and Muscular Tone in Patients With Stroke: A Systematic Review and Meta-Analysis.

Upper limb rehabilitation robot is a relatively new technology, but its effectiveness remains debatable due to the inconsistent results of clinical trials. This article intends to assess how upper limb rehabilitation robots help the functional recovery of stroke patients. PubMed, Embase, Cochrane Library, and Web of Science databases were searched for eligible studies to explore the effect of upper limb rehabilitation robots on upper limb motor function, muscle tone, and daily living activities. Eighteen trials with 573 stroke patients met the inclusion criteria. The results showed that compared to conventional rehabilitation training, patients who received upper limb robotic therapy (RT) had significantly improved Fugl-Meyer Upper Extremity Motor Assessment (FMA-UE) scores (weighted mean differences [WMD]: 5.27, 95% confidence intervals [CI]: 3.36, 7.17), Action Research Arm Test (ARAT) scores (WMD: 4.07, 95% CI: -4.14, 12.28), Modified Barthel Index (MBI) scores (WMD: 9.55, 95% CI: 6.37, 12.73), and modified Ashworth Scale (MAS) scores (WMD: -0.28, 95% CI: -0.50, 0.06), with no significant heterogeneity. Upper limb robot-assisted training is superior to conventional training in terms of improving upper limb motor impairment, ability to perform daily living activities, and muscle tone recovery, which supports the application of robots in clinical practice.

Improvements in upper extremity isometric muscle strength, dexterity, and self-care independence during the sub-acute phase of stroke recovery: an observational study on the effects of intensive comprehensive rehabilitation.

Stroke often impairs upper extremity motor function, with recovery in the sub-acute phase being crucial for regaining independence. This study examines changes in isometric muscle strength, dexterity, and self-care independence during this period, and evaluates the effects of a comprehensive intensive rehabilitation (COMIRESTROKE). Individuals in sub-acute stroke recovery and age- and sex-matched controls were assessed for pre- and post-rehabilitation differences in primary outcomes (grip/pinch strength, Nine Hole Peg Test [NHPT], Action Research Arm Test [ARAT]). COMIRESTROKE's effects on primary and secondary outcomes (National Institute of Health Stroke Scale [NIHSS], Modified Rankin Scale [MRS], Functional Independence Measure [FIM]) were evaluated. Outcomes were analyzed for dominant and non-dominant limbs, both regardless of impairment and with a focus on impaired limbs. Fifty-two individuals with stroke (NIHSS 7.51 ± 5.71, age 70.25 ± 12.66 years, 21.36 ± 12.06 days post-stroke) and forty-six controls participated. At baseline, individuals with stroke showed significantly lower strength (dominant grip, key pinch, tip-tip pinch, p adj < 0.05), higher NHPT scores (p adj < 0.05), and lower ARAT scores (p adj < 0.001). COMIRESTROKE led to improvements in dominant key pinch, non-dominant tip-tip pinch, NHPT, and both dominant and non-dominant ARAT (p adj < 0.05). Notably, non-dominant key pinch improved significantly when considering only impaired hands. Pre- and post-test differences between groups were significant only for ARAT (both limbs), even after adjustment (p adj < 0.05). All secondary outcomes (NIHSS, MRS, FIM) showed significant improvement post-COMIRESTROKE (p adj < 0.001). Individuals with stroke exhibit reduced muscle strength and dexterity, impairing independence. However, comprehensive intensive rehabilitation significantly improves these functions. Data are available from the corresponding author upon request and are part of a sub-study of NCT05323916.

Brain-computer interfaces based on near-infrared spectroscopy and electroencephalography registration in post-stroke rehabilitation: a comparative study

Motor imagery training under the control of a brain-computer interface (BCI) facilitates motor recovery after stroke. The efficacy of BCI based on electroencephalography (EEG-BCI) has been confirmed by several meta-analyses, but a more convenient and noise-resistant method of near-infrared spectroscopy in the BCI circuit (NIRS-BCI) has been practically unexamined; comparisons of the two types of BCI have not been performed.Objective: to compare the control accuracy and clinical efficacy of NIRS-BCI and EEG-IMC in post-stroke rehabilitation.Material and methods. The NIRS-BCI group consisted of patients from an uncontrolled study (n=15; 9 men and 6 women; age – 59.0 [49.0; 70.0] years; stroke duration – 7.0 [2.0; 10.0] months; upper limb paresis – 47.0 [35.0; 54.0] points on the Fugl-Meyer Assessment for motor function evaluation of the upper limb – FM-UL). The EEG-IMC group was formed from the main group of the randomized controlled trial “iMove” (n=17; 13 men and 4 women; age – 53.0 [49.0; 70.0] years; stroke duration – 10.0 [6.0; 13.0] months; upper limb paresis – 33.0 [12.0; 53.0] points on the FM-UL). Patients participated in a comprehensive rehabilitation program supplemented by BCI-guided movement imagery training (average of 9 training sessions).Results. Median of average BCI control rates achieved by the patients was 46.4 [44.2; 60.4]% in the NIRS group and 40.0 [35.7; 45.1]% in the EEG group (p=0.004). For the NIRS-BCI group, the median of the maximum BCI control accuracy achieved was 66.2 [56.4; 73.7]%, for EEGBCI – 50.6 [43.0; 62.3]% (p=0.006). The proportion of patients who achieved a clinically significant improvement according ARAT and the proportion of patients who achieved a clinically significant improvement according FM-UL were comparable in both groups. The NIRS-BCI group showed greater improvement in motor function compared to the EEG-BCI group according to Action Research Arm Test (ARAT; an increase of 5.0 [4.0; 8.0] points compared to an increase of 1.0 [0.0; 3.0] points; p=0.008), but not according to FM-UL scale (an increase of 5.0 [1.0; 10.0] and 4.0 [2.0; 5.0] points, respectively; p=0.455).Conclusion. NIRS-BCI has an advantage in control accuracy and ease of use in clinical practice. Achieving higher control accuracy of BCI provides additional opportunities for the use of game feedback scenarios to increase patient motivation.

Effect of intermittent theta burst stimulation on upper limb function in stroke patients: a systematic review and meta-analysis.

Stroke is a serious health issue that affects individuals, families, and society. Particularly, the upper limb dysfunction caused by stroke significantly reduces the quality of life for patients and may lead to psychological issues. Current treatment modalities are not fully effective in helping patients regain upper limb motor function to optimal levels. Therefore, there is an urgent need to explore new rehabilitation methods to address this issue. The purpose of this meta-analysis and systematic review is to explore the effects of intermittent theta burst stimulation (iTBS) on upper limb function in stroke patients. We searched PubMed, Cochrane Library, Embase, Web of Science, PEDro and China National Knowledge Internet as of April 8, 2024. Retrieved a total of 100 articles. Standardized mean differences (SMDs) and 95% confidence intervals (CI) were calculated. The study included a total of 9 trials and involved 224 patients. The results demonstrate that compared to the control group, iTBS therapy significantly improved Fugl-Meyer assessment-upper extremity (FMA-UE) scores (SMD = 0.88; 95% CI = 0.11-1.66; P = 0.03, I 2 = 84%), Action Research Arm Test (ARAT) scores (SMD = 0.83; 95% CI = 0.16-1.50; P = 0.02, I 2 = 57%), and Barthel Index (BI) scores (SMD = 0.93; 95% CI = 0.53-1.32; P < 0.0001, I 2 = 0%) in stroke patients. The comprehensive evidence suggests that iTBS has superior effects in improving upper limb function and activities of daily living in stroke patients.

A reliable and valid assessment of upper limb movement quality after stroke: the observational Drinking Task Assessment.

To develop and evaluate the reliability and validity of a new observational Drinking Task Assessment (DTA) designed to assess quality of movement in task performance after stroke. Reliability and validity. The DTA measures movement time and movement quality (smoothness, trunk, shoulder, elbow, and grasp movements) on a 4-level ordinal scale. Thirty participants with chronic stroke were assessed independently by 2 therapists. Intra-class correlation (ICC), standard error of measurement (SEM) and minimal real difference (MRD), weighted kappa, percentage of agreement, and Svensson method were used for reliability assessment. Motion capture-based kinematics and established clinical scales were used to evaluate validity. The absolute SEM and MRD for movement time were 0.4 and 1 s (11%), respectively. The ICC (≥ 0.93) and weighted kappa (0.71-1.0) showed good to excellent agreement for intra- and inter-rater reliability. DTA showed strong correlations with Fugl-Meyer Assessment (0.74), Action Research Arm Test (0.93), and kinematic measures of smoothness (0.93), trunk displacement (0.91), elbow extension (0.73), and shoulder movements (0.56), indicating good construct validity. The new DTA proved to be a reliable and valid tool for assessment of movement quality during task performance after stroke.

Bimanual Arm Trainer Versus Traditional Occupational Therapy Services in Upper Extremity Function.

Upper extremity (UE) dysfunction resulting from stroke significantly affects a person's ability to complete self-care activities, consequently diminishing functional independence. Effective interventions that improve UE function in persons with stroke are needed. To explore the effectiveness of the Bimanual Arm Trainer (BAT) compared with traditional occupational therapy treatment sessions (i.e., a control group) on improving UE function after acute ischemic stroke. Clinical trial, two-group, nonrandomized repeated-measures design. Inpatient rehabilitation facility. Twenty-seven persons with ischemic stroke and an Action Research Arm Test (ARAT) score ≤17. Minimum of three 10-min sessions on the BAT. ARAT, Upper Extremity Fugl-Meyer Assessment of Motor Recovery after Stroke (FMA-UE). Both the intervention and control groups showed significant improvement on the ARAT from evaluation to discharge (main effect of time: p = .02). There was no statistically significant main effect of group and no significant Time × Group interaction (p = .63). FMA-UE scores also improved significantly in the intervention group from evaluation to discharge (p < .001). FMA-UE scores were not available for the control group. Both the intervention and control groups demonstrated significant improvements in UE function from evaluation to discharge. There were no statistically significant differences between groups, indicating that the BAT results in similar improvements in UE function, as would be expected in traditional occupational therapy. Further research is warranted to examine additional BAT programs, use different outcome measures, and assess participants over a longer time span. Plain-Language Summary: The Bimanual Arm Trainer (BAT) is a novel device that can be used in occupational therapy to improve arm function among stroke patients. There is limited research on BAT's effectiveness in improving arm function among stroke patients. In an acute inpatient rehabilitation setting, we compared outcome scores of patients who received traditional occupational therapy services with those who also used the BAT. Both groups achieved significant improvements in arm function from evaluation to discharge. We found that the addition of the BAT interventions did not significantly affect the outcome measure scores for either group. We conclude that more research is needed to examine additional BAT programs, use different outcome measures, and assess participants over a longer period of time.

Effects of wearable device training on upper limb motor function in patients with stroke: a systematic review and meta-analysis.

To evaluate the effect of wearable device training on improving upper limb motor function in patients who experienced strokes. The PubMed, Embase, Cochrane Library, Web of Science, MEDLINE, SCOPUS, China National Knowledge Infrastructure, WanFang, and VIP databases were searched for randomized controlled trials (RCTs) that assessed the effectiveness of wearable device training in improving upper limb motor function in patients with stroke. Two investigators independently screened studies by their titles and abstracts and cross-checked, downloaded, and evaluated the results. Disagreements were resolved by a third highly experienced researcher. Risk of bias was evaluated using the Cochrane risk-of-bias tool. This meta-analysis was registered in PROSPERO (registration No. CRD42023421633). This study comprised 508 patients from 14 RCTs. The experimental group assessed various wearable devices, including 3D-printed dynamic orthoses, inertial measurement unit (IMU) sensors, electrical stimulation devices, and virtual reality (VR) devices for virtual interactive training. The control group received traditional rehabilitation therapies, including physical and conventional rehabilitation. The experimental group scored better on the Fugl-Meyer Assessment (FMA-UE) scale (standardized mean difference [SMD] 0.26, 95% confidence interval [CI] 0.07, 0.45) and Box and Block Test (BBT) (SMD 0.43, 95% CI 0.17, 0.69) versus controls. No significant intergroup differences were observed in the Action Research Arm Test (SMD 0.20, 95% CI -0.15, 0.55), motor activity log (mean difference [MD] 0.32, 95% CI -0.54, 0.33), and modified Ashworth scale (MD -0.08, 95% CI -0.81, 0.64). The probability rankings of wearable devices that improved FMA-UE scores in patients with stroke were: orthotic devices, with the highest probability ranking of 0.45, followed by sensor devices at 0.23, electrical stimulation devices at 0.21, and VR devices at 0.11. Wearable device training was found to significantly improve upper limb motor function in patients with stroke, particularly for large-range movements. Improvements in FMA-UE and BBT scores reflected reduced impairment and enhanced manual dexterity, respectively. However, the training had no significant effect on hand movement frequency, fine motor skills, or spasticity. Among the different wearable devices tested, orthoses produced the most effective results.

Altered Resting-State Electroencephalogram Microstate Characteristics in Stroke Patients.

Stroke remains a leading cause of disability globally and movement impairment is the most common complication in stroke patients. Resting-state electroencephalography (EEG) microstate analysis is a non-invasive approach of whole-brain imaging based on the spatiotemporal pattern of the entire cerebral cortex. The present study aims to investigate microstate alterations in stroke patients. Resting-state EEG data collected from 24 stroke patients and 19 healthy controls matched by age and gender were subjected to microstate analysis. For four classic microstates labeled as class A, B, C and D, their temporal characteristics (duration, occurrence and coverage) and transition probabilities (TP) were extracted and compared between the two groups. Furthermore, we explored their correlations with clinical outcomes including the Fugl-Meyer assessment (FMA) and the action research arm test (ARAT) scores in stroke patients. Finally, we analyzed the relationship between the temporal characteristics and spectral power in frequency bands. False discovery rate (FDR) method was applied for correction of multiple comparisons. Microstate analysis revealed that the stroke group had lower occurrence of microstate A which was regarded as the sensorimotor network (SMN) compared with the control group (p = 0.003, adjusted p = 0.036, t = -2.959). The TP from microstate A to microstate D had a significant positive correlation with the Fugl-Meyer assessment of lower extremity (FMA-LE) scores (p = 0.049, r = 0.406), but this finding did not survive FDR adjustment (adjusted p = 0.432). Additionally, the occurrence and the coverage of microstate B were negatively correlated with the power of delta band in the stroke group, which did not pass adjustment (p = 0.033, adjusted p = 0.790, r = -0.436; p = 0.026, adjusted p = 0.790, r = -0.454, respectively). Our results confirm the abnormal temporal dynamics of brain activity in stroke patients. The study provides further electrophysiological evidence for understanding the mechanism of brain motor functional reorganization after stroke.

High-frequency magnetic paired associated stimulation promotes motor function recovery in ischemic stroke patients: a study protocol for single-center, sham stimulation randomized controlled trials (H2MPAS)

BackgroundNumerous studies have validated the clinical effectiveness of electromagnetic pairing-associated stimulation. Building upon this foundation, we have developed a novel approach involving high-frequency magnetic paired-associated stimulation, aiming to enhance clinical applicability and potentially improve efficacy. However, the clinical effectiveness of this approach remains unclear. Our objective is to demonstrate the therapeutic efficacy of this novel approach by employing high-frequency pairing to intervene in patients experiencing motor dysfunction following a stroke.MethodsThis is a single-center, single-blind, sham stimulation controlled clinical trial involving patients with upper limb motor dysfunction post-stroke. The intervention utilizes paired magnetic stimulation, combining peripheral and central magnetic stimulation, in patients with Brunnstrom stage III–V stroke lasting from 3 months to 1 year. Evaluation of patients’ upper limb motor function occurred before the intervention and after 3 weeks of intervention. Follow-up visits will be conducted after 5 weeks and 3 months of intervention. The primary outcome measure is the Action Research Arm Test, with secondary measures including the Fugl-Meyer Assessment-upper, Modified Barthel Index, modified Tardieu scale, functional near-infrared spectroscopy, and neuroelectrophysiology.DiscussionThe high-frequency magnetic paired associative stimulation used in this study combined high-frequency magnetic stimulation with paired stimulation, potentially facilitating both cortical excitation through high-frequency stimulation and specific circuit enhancement through paired stimulation. As dual-coil magnetic stimulation equipment becomes increasingly popular, magnetic-magnetic paired associated stimulation may offer patients improved clinical outcomes at reduced costs.Trial registrationChinese Clinical Trial Registry,ChiCTR2400083363. Registered on 23 April 2024.

Efficacy of Virtual Reality-Based Sword Fighting Exercises to Improve Upper Body Movements in Hemiplegic Patients

Background: Stroke is a leading cause of disability, with hemiplegia affecting the motor function of stroke survivors. Traditional rehabilitation methods often yield limited improvements. Virtual reality (VR) technology offers a novel approach to enhancing upper body movements through immersive, task-oriented exercises.Objective: To evaluate the efficacy of VR-based sword fighting exercises in improving upper body movements in hemiplegic patients.Methods: A randomized, controlled, single-blind trial was conducted with 62 hemiplegic patients at Hussain Memorial Hospital, Lahore. Participants were randomly assigned to either the VR-based sword fighting group or the conventional physical therapy (CT) group. Both groups received 12 sessions over three weeks. Outcomes were measured using the Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Functional Independence Measure (FIM). Data were analyzed using SPSS version 25, with a p-value of &lt;0.05 considered significant.Results: The VR group showed significantly greater improvements compared to the CT group in post-treatment scores for FIM (115.32 ± 6.665 vs. 79.71 ± 10.681, p = 0.000), FMA, and ARAT (z = -6.778, p = 0.000).Conclusion: VR-based sword fighting exercises significantly improved upper body movements in hemiplegic patients compared to conventional therapy, suggesting a promising role for VR in stroke rehabilitation.