Effectiveness Of Upper Limb Rehabilitation Research Articles

Bayesian optimization for assist-as-needed controller in robot-assisted upper limb training based on energy information

AbstractThe assist-as-needed (AAN) controller is effective in robot-assisted rehabilitation. However, variations of the engagement of subjects with fixed controller often lead to unsatisfying results. Therefore, adaptive AAN that adjusts control parameters based on individualized engagement is essential to enhance the training effect further. Nevertheless, current approaches mainly focus on the within-trial real-time engagement estimation, and the presence of measurement noise may cause improper evaluation of engagement. In addition, most studies on human-in-loop optimization strategies modulate the controller by greedy strategies, which are prone to fall into local optima. These shortcomings in previous studies could significantly limit the efficacy of AAN. This paper proposes an adaptive AAN to promote engagement by providing subjects with a subject-adaptive assistance level based on trial-wise engagement estimation and performance. Firstly, the engagement is estimated from energy information, which assesses the work done by the subject during a full trial to reduce the influence of measurement outliers. Secondly, the AAN controller is adapted by Bayesian optimization (BO) to maximize the subject’s performance according to historical trial-wise performance. The BO algorithm is good at dealing with noisy signals within limited steps. Experiments with ten healthy subjects resulted in a decrease of 34.59 $\%$ in their average trajectory error, accompanied by a reduction of 9.71 $\%$ in their energy consumption, thus verifying the superiority of the proposed method to prior work. These results suggest that the proposed method could potentially improve the effect of upper limb rehabilitation.

A novel upper-limb tracking system in a virtual environment for stroke rehabilitation

BackgroundThe transfer of the behaviors of a human’s upper limbs to an avatar is widely used in the field of virtual reality rehabilitation. To perform the transfer, movement tracking technology is required. Traditionally, wearable tracking devices are used for tracking; however, these devices are expensive and cumbersome. Recently, non-wearable upper-limb tracking solutions have been proposed, which are less expensive and more comfortable. However, most products cannot track the upper limbs, including the arms and all the fingers at the same time, which limits the limb parts for tracking in a virtual environment and may lead to a limited rehabilitation effect.MethodsIn this paper, a novel virtual reality rehabilitation system (VRRS) was developed for upper-limb rehabilitation. The VRRS could track the motion of both upper limbs, integrate fine finger motion and the range of motion of the entire arm and map the motion to an avatar. To test the performance of VRRS, two experiments were designed. In the first experiment, we investigated the effect of VRRS on virtual body ownership, agency and location of the body and usability in 8 healthy participants by comparing it with a partial upper-limb tracking method based on a Leap Motion controller (LP) in the same virtual environments. In the second experiment, we examined the feasibility of VRRS in upper-limb rehabilitation with 27 stroke patients.ResultsVRRS improved the users’ senses of body ownership, agency, and location of the body. The users preferred using the VRRS to using the LP. In addition, we found that although the upper limb motor function of patients from all groups was improved, the difference between the FM scores tested on the first day and the last day of the experimental group was more significant than that of the control groups.ConclusionsA VRRS with motion tracking of the upper limbs and avatar control including the arms and all the fingers was developed. It resulted in an improved user experience of embodiment and effectively improved the effects of upper limb rehabilitation in stroke patients.Trial registrationThe study was registered at the First Affiliated Hospital of Jinan University Identifier: KY-2020–036; Date of registration: June 01, 2020.

Additional Effects of Xbox Kinect Training on Upper Limb Function in Chronic Stroke Patients: A Randomized Control Trial.

Background: Xbox Kinect-based virtual reality, being a novel approach, has therapeutic benefits in rehabilitation and its use is encouraged in stroke rehabilitation of upper extremities. Objective: Primary aim of the current study is to investigate the additional effects of Xbox Kinect training in combination with routine physiotherapy exercises based on each component of Fugl-Meyer Assessment Scale for Upper Extremity (FMA-UE). Moreover, effect of upper limb rehabilitation on cognitive functions was also assessed. Methods: This study was a parallel arm randomized control trial. Fifty-six participants were recruited and randomly allocated to either an Xbox Kinect training group (XKGT) or exercise training group (ETG). Measures of concern were recorded using FMA-UE, Box and Block Test (BBT), and Montreal Cognitive Assessment (MOCA). Evaluation was conducted at baseline and after completion of intervention at the sixth week. Results: There were significant differences from pre- to post-intervention scores of FMA-UE and BBT (p < 0.001) in both groups, whereas no difference was observed for MOCA (XKTG p value 0.417, ETG p value 0.113). At six-week follow-up there were significant differences between both groups in FMA-UE total score (p < 0.001), volitional movement within synergies (p < 0.001), wrist (p = 0.021), hand (p = 0.047), grasp (p = 0.006) and coordination/speed (p = 0.004), favoring the Xbox Kinect training group. Conclusion: To conclude, results indicate repetitive use of the hemiparetic upper extremity by Xbox Kinect-based upper limb rehabilitation training in addition to conventional therapy has a promising potential to enhance upper limb motor function for stroke patients.

Effect of Combined Therapy of Robot and Low-Frequency Repetitive Transcranial Magnetic Stimulation on Hemispatial Neglect in Stroke Patients.

ObjectiveTo investigate the effect of upper limb rehabilitation combining robot with low-frequency repetitive transcranial magnetic stimulation (rTMS) on unilateral spatial neglect in stroke patients.MethodsPatients who had hemispatial neglect after right hemisphere stroke were randomly divided into rTMS only group, robot only group, and combined group. All groups received conventional neglect therapy and additional treatment for each group. rTMS group received rTMS therapy. Robot group received robot therapy, while combined group received both therapies. The effect of therapy was assessed with Motor-Free Visual Perception Test-3 (MVPT-3), line bisection test, star cancellation test, Catherine Bergego Scale (CBS), Mini-Mental State Examination (MMSE), and the Korean version of Modified Barthel Index (K-MBI). These measurements were evaluated before and after treatment.ResultsFor each group, 10 patients were recruited. There were no significant differences in baseline characteristics or initial values among the three groups. Two weeks after the therapy, all groups showed significant improvement in MVPT-3, line bisection test, star cancellation test, CBS, MMSE, and K-MBI. However, changes in measurements showed no significant differences among groups.ConclusionTreatment effect of the combined therapy of robotic therapy and low-frequency rTMS therapy for hemispatial neglect was not statistically different from that of each single treatment. Resultsof this study did not prove the superiority of any of the three treatments. Further study with large number of patients is needed to evaluate the superiority of these treatments.

What is the effectiveness of upper limb rehabilitation after tetraplegia: A systematic review and meta-analysis

Individuals with cervical spinal cord injury experience tetraplegia with dramatic impairment of upper limb (UL) including hand function and decreased autonomy. In absence of very recent evidence and meta-analysis, we addressed UL rehabilitation effectiveness after tetraplegia. Two independent reviewers performed the systematic review and meta-analysis addressing Pubmed, Pedro, Central and Scopus ® . We considered studies with a randomized controlled trial design, published in English language, which included individuals with tetraplegia and measured UL rehabilitation effect on strength, somesthesia, hand function and autonomy. From 573 records identified, 24 studies were included totaling 517 participants with C2 to C7 tetraplegia (ASIA A to D). Interventions lasted from 66 to 3780 minutes. Three different strategies were used i) bottom-up (namely massed practice, Functional Electrical Stimulation – FES, resistance or robotic training), ii) neuromodulation (i.e. electrical nerve, trans-cranial or magnetic stimulations), or iii) top-down (brain computer interfaces with FES or virtual reality). The 17 studies analyzed displayed heterogeneity for all outcomes except for strength. Overall, strength significantly increased with positive but non-significant effect on hand function and autonomy. Sub-analysis revealed a significant effect on strength only for bottom-up strategy. All other sub-analyzes albeit non-significant revealed at least a medium effect size for all outcomes with exception to the very small effect size displayed for somesthesia. These results support the effectiveness of UL rehabilitation on strength using. There is a potential interest of using bottom-up and neuromodulation strategies to improve hand function and autonomy but with heterogeneity between interventions and participants. Conversely, there is no evidence for top-down strategy and interventions targeting somesthesia appear ineffective. Further effort on funding may promote high-quality multi-centric studies with increased standardization in intervention and participants to completely address UL rehabilitation effectiveness after tetraplegia while separating recovery and compensation effects.

Effect of Upper Limb Rehabilitation Compared to No Upper Limb Rehabilitation in Lung Transplant Recipients: A Randomized Controlled Trial

ObjectiveTo investigate the effect of a supervised upper limb (UL) program (SULP) compared to no supervised UL program (NULP) after lung transplantation (LTx). DesignRandomized controlled trial. SettingPhysiotherapy gym. ParticipantsParticipants (N=80; mean age, 56±11y; 37 [46%] men) were recruited after LTx. InterventionsAll participants underwent lower limb strength thrice weekly and endurance training. Participants randomized to SULP completed progressive UL strength training program using handheld weights and adjustable pulley equipment. Main Outcome MeasuresOverall bodily pain was rated on the visual analog scale. Shoulder flexion and abduction muscle strength were measured on a hand held dynamometer. Health related quality of life was measured with Medical Outcomes Study 36-item Short Form health Survey and the Quick Dash. Measurements were made at baseline, 6 weeks, 12 weeks, and 6 months by blinded assessors. ResultsAfter 6 weeks of training, participants in the SULP (n=41) had less overall bodily pain on the visual analog scale than did participants in the NULP (n=36) (mean VAS bodily pain score, 2.1±1.3cm vs 3.8±1.7cm; P<.001) as well as greater UL strength than did participants in the NULP (mean peak force, 8.4±4.0Nm vs 6.7±2.8Nm; P=.037). At 12 weeks, participants in the SULP better quality of life related to bodily pain (76±17 vs 66±26; P=.05), but at 6 months there were no differences between the groups in any outcome measures. No serious adverse events were reported. ConclusionsUL rehabilitation results in short-term improvements in pain and muscle strength after LTx, but no longer-term effects were evident.

Early upper limb physiotherapy in stroke patients. Questions without answers

Abstract Stroke is still the most common cause of disability in Poland and in western countries. As many as 80% of patients report reduced upper limb function in the acute phase after stroke. It is estimated that only 5% to 20% of patients experience full functional recovery of an upper limb. In clinical practice, paretic upper limb stimulation after stroke is usually treated as of secondary importance. However, it constantly poses a challenge to physical therapists. The existing procedures do not provide detailed guidelines regarding upper limb rehabilitation model particularly in the first four weeks after stroke. It is hard to predict biological limitations and the effectiveness of upper limb rehabilitation. The aim of this work is to make an attempt at reviewing the knowledge of the current state of early upper limb physiotherapy, its intensity and strategy type as well as neurobiological foundations of the improvement process. Ample scientific evidence confirms that early post-stroke rehabilitation is crucial. There are relatively few foreign (and virtually no Polish) reports related to early upper limb rehabilitation that would take into account the type of exercises and their therapeutic dose. There are still no solid foundations for determining optimal intensity and type of upper limb rehabilitation (including physical and occupational therapy). There is a scarcity of extensive and uniform (in terms of research groups and tools) multicentre investigations aimed at defining an optimal model of upper limb rehabilitation at an early stage after stroke. Thus, a number of questions still remain unanswered.

How Therapists Use Visualizations of Upper Limb Movement Information From Stroke Patients: A Qualitative Study With Simulated Information.

BackgroundStroke is a leading cause of disability worldwide, with upper limb deficits affecting an estimated 30% to 60% of survivors. The effectiveness of upper limb rehabilitation relies on numerous factors, particularly patient compliance to home programs and exercises set by therapists. However, therapists lack objective information about their patients’ adherence to rehabilitation exercises as well as other uses of the affected arm and hand in everyday life outside the clinic. We developed a system that consists of wearable sensor technology to monitor a patient’s arm movement and a Web-based dashboard to visualize this information for therapists.ObjectiveThe aim of our study was to evaluate how therapists use upper limb movement information visualized on a dashboard to support the rehabilitation process.MethodsAn interactive dashboard prototype with simulated movement information was created and evaluated through a user-centered design process with therapists (N=8) at a rehabilitation clinic. Data were collected through observations of therapists interacting with an interactive dashboard prototype, think-aloud data, and interviews. Data were analyzed qualitatively through thematic analysis.ResultsTherapists use visualizations of upper limb information in the following ways: (1) to obtain objective data of patients’ activity levels, exercise, and neglect outside the clinic, (2) to engage patients in the rehabilitation process through education, motivation, and discussion of experiences with activities of daily living, and (3) to engage with other clinicians and researchers based on objective data. A major limitation is the lack of contextual data, which is needed by therapists to discern how movement data visualized on the dashboard relate to activities of daily living.ConclusionsUpper limb information captured through wearable devices provides novel insights for therapists and helps to engage patients and other clinicians in therapy. Consideration needs to be given to the collection and visualization of contextual information to provide meaningful insights into patient engagement in activities of daily living. These findings open the door for further work to develop a fully functioning system and to trial it with patients and clinicians during therapy.

A bilateral rehabilitation system for the lower limbs

Purpose: Bilateral and unilateral training equipment for the upper limbs facilitates rehabilitation after stroke. In this work, we tested the first device designed for bilateral training of the lower limbs. Method: Characteristics and usage of the novel MedExercise® ST device were evaluated by four healthy volunteers. A pedometer and temperature sensor were attached to the device and used to measure cadence and intensity of training, respectively. The heart rates of participants were recorded with a fingertip pulse oximeter. Thirty elderly patients assessed usability of the device and completed the survey. Results: It was shown that the device could be operated in sitting and recumbent positions. The resistance levels and range of joint motion were individually adjustable for each leg, allowing both bilateral and unilateral training. When pedals were linked together, one leg could help moving the other leg. Recording of training intensities allowed leg fitness testing, personalized exercise prescription and analysis of self-controlled training. A usability survey demonstrated positive perception of elderly patients towards the device. Conclusions: This training system has a range of useful features, which can facilitate rehabilitation of the lower limbs via early leg mobilization and self-controlled training.Implications for RehabilitationBilateral and unilateral training devices are widely used to improve the effectiveness of upper limb rehabilitation, but there is no analogous equipment available for the lower limbs.Here, we show that the MedExercise® ST training system allows independent exercise of each leg in bilateral and unilateral modes, and objective recording of training activities.Elderly patients attending the exercise rehabilitation clinic demonstrated a positive perception towards usability of this equipment.The results of this study suggest suitability of the system for optimization of lower limb rehabilitation, including early leg mobilisation and self-controlled training.