Field Of Neurorehabilitation Research Articles

Improving manual dexterity using ergonomic wearable glove in patients with multiple sclerosis: A quasi-randomized clinical trial

One main problem faced by people with multiple sclerosis (PwMS) is upper limb dysfunction, which can occur in the first decade of the disease and with the highest prevalence of disability in the progressive type of the disease. Then, PwMS may benefit from personalised and intensive treatment as provided by robotic devices. These innovative devices have increasingly been brought into the neurorehabilitation field, due to their ability to provide repetitive and task-oriented training. In this quasi-randomized study, we aim to evaluate the effects of robotic-assisted hand training, using the Hand TutorTM device, on hand functionality, active RoM, and manual dexterity, compared to conventional rehabilitation in PwMS. We enrolled 30 MS patients, who received 20 training sessions, each lasting 45 min with robotic-assisted hand training with Hand Tutor (n 15, experimental group) or conventional rehabilitation therapy (n 15, control group). All patients were evaluated at pre- and post-intervention with clinical scales for upper limb functionality (DASH, BBT, NHPT, and MI). In addition, only patients in the experimental group received an objective kinematic analysis of the hand and wrist movements, delivered by the Hand Tutor glove, both pre- and post-intervention. We found that PwMS in both groups statistically improved their upper limb functions, however the experimental group achieved better results in terms of manual dexterity. This promising rehabilitation training with Hand Tutor glove led to positive effects on upper limbs motor outcomes and kinematic parameters in patients with MS.

Gait Reconstruction Strategy Using Botulinum Toxin Therapy Combined with Rehabilitation.

Numerous studies have established a robust body of evidence for botulinum toxin A (BoNT-A) therapy as a treatment for upper motor neuron syndrome. These studies demonstrated improvements in spasticity, range of joint motion, and pain reduction. However, there are few studies that have focused on improvement of paralysis or functional enhancement as the primary outcome. This paper discusses the multifaceted aspects of spasticity assessment, administration, and rehabilitation with the goal of optimising the effects of BoNT-A on lower-limb spasticity and achieving functional improvement and gait reconstruction. This paper extracts studies on BoNT-A and rehabilitation for the lower limbs and provides new knowledge obtained from them. From these discussion,, key points in a walking reconstruction strategy through the combined use of BoNT-A and rehabilitation include: (1) injection techniques based on the identification of appropriate muscles through proper evaluation; (2) combined with rehabilitation; (3) effective spasticity control; (4) improvement in ankle joint range of motion; (5) promotion of a forward gait pattern; (6) adjustment of orthotics; and (7) maintenance of the effects through frequent BoNT-A administration. Based on these key points, the degree of muscle fibrosis and preintervention walking speed may serve as indicators for treatment strategies. With the accumulation of recent studies, a study focusing on walking functions is needed. As a result, it is suggested that BoNT-A treatment for lower limb spasticity should be established not just as a treatment for spasticity but also as a therapeutic strategy in the field of neurorehabilitation aimed at improving walking function.

The Use of Head-Mounted Display Systems for Upper Limb Kinematic Analysis in Post-Stroke Patients: A Perspective Review on Benefits, Challenges and Other Solutions.

In recent years, there has been a notable increase in the clinical adoption of instrumental upper limb kinematic assessment. This trend aligns with the rising prevalence of cerebrovascular impairments, one of the most prevalent neurological disorders. Indeed, there is a growing need for more objective outcomes to facilitate tailored rehabilitation interventions following stroke. Emerging technologies, like head-mounted virtual reality (HMD-VR) platforms, have responded to this demand by integrating diverse tracking methodologies. Specifically, HMD-VR technology enables the comprehensive tracking of body posture, encompassing hand position and gesture, facilitated either through specific tracker placements or via integrated cameras coupled with sophisticated computer graphics algorithms embedded within the helmet. This review aims to present the state-of-the-art applications of HMD-VR platforms for kinematic analysis of the upper limb in post-stroke patients, comparing them with conventional tracking systems. Additionally, we address the potential benefits and challenges associated with these platforms. These systems might represent a promising avenue for safe, cost-effective, and portable objective motor assessment within the field of neurorehabilitation, although other systems, including robots, should be taken into consideration.

Robotic Rehabilitation in India: A Survey of Attitudes and Perceptions

Abstract Introduction: Robotic rehabilitation is a recent advancement in the field of neurorehabilitation that can benefit patients suffering from traumatic brain injuries, strokes and spinal cord injuries. Despite its availability in India since more than a decade, the number of people who are availing such benefits are a minority of the patient population. Materials and Methods: The aim of the study was to understand the trends and perceptions of people from medical and non-medical professions. The objective of the study was to evaluate the awareness levels and general perceptions about robotics in rehabilitation, across people from healthcare and other fields including rehabilitation physicians from various parts of the country, through an open survey and using an 11-point scoring system for objective evaluation. The research work was conducted as an observational survey-based study. Questions related to awareness levels, self-perceived levels of affordability and effectiveness of robotics in the field of rehabilitation were covered through a questionnaire made by the author, completely masking the personal information of the respondents to ensure anonymity. Results: A total of 145 people from different parts of the country belonging to both healthcare and other fields responded. Scores were assessed out of 10, in all domains. The results show a significant number of people being completely unaware of robotics in the field of rehabilitation, with a low average awareness score of 3.4 out of 10. This trend was also seen amongst medical professionals. Although the reported levels of affordability were low at 3.6, the average scores of perceived effectiveness were high at 5.9. Most people believed financial limitations and lack of awareness and availability as common barriers of implementation of robotic rehabilitation in a country like India. Conclusion: This study shows that despite the availability of advanced resources in major cities in the country, there is a lack of awareness amongst doctors and members from other fields, which may result in potential benefiters not being able to make informed decisions about rehabilitative options. Although doctors of the field of rehabilitation generally had a more positive response, the rest of the members are largely unaware. Improving the availability and accessibility to such advances will help provide equal opportunity of access to clients who could benefit from the same. Upscaling the manufacturing and development of indigenous robots for rehabilitation, amongst other methods may help reduce the expenses on users, thereby improving logistic and financial accessibility and availability.

Current Status of Neurorehabilitation Services in the OIC Countries: Results of an International Online Survey

Objectives: Neurorehabilitation services are not widely available to most persons with disability (PWD) in the Organization of Islamic Cooperation countries. This study aimed to document status of neurorehabilitation services in OIC countries. Study Design and Setting: Cross-sectional online survey. Methods: Self-administered online survey conducted using Google Forms. Key resource persons for each OIC country working in field of neurorehabilitation were identified from various databases. The questionnaire was emailed to 20 identified resource persons. The response rate was 60% (12/20). Results: Neurorehabilitation services were available in 9 out of 12 surveyed countries. Only 2 countries reported providing access to neurorehabilitation services to 76-100% of their population. Five countries reported less than 25% of population had access to these services. Most commonly available neurorehabilitation services included services for stroke, spinal cord injury, pediatric neurorehabilitation, brain injury, and neuromuscular rehabilitation. Three countries had none of these specialized services. Five countries had neurorehabilitation training programs for physicians and other rehabilitation professionals. Patients had to pay out of pocket for these services in most of surveyed countries, followed by public funding and private insurance. Tele-neurorehabilitation and local disease-specific neurorehabilitation guidelines were not available in most of surveyed countries. Conclusion: Neurorehabilitation services in OIC region are not widely available, with significant variability in availability and quality. There is a need to develop and improve these services. Sharing knowledge and expertise through various forms, such as exchange visits and online sessions, can help improve neurorehabilitation services in these countries

Progress in neurorehabilitation research and the support by the National Natural Science Foundation of China from 2010 to 2022.

The National Natural Science Foundation of China is one of the major funding agencies for neurorehabilitation research in China. This study reviews the frontier directions and achievements in the field of neurorehabilitation in China and worldwide. We used data from the Web of Science Core Collection (WoSCC) database to analyze the publications and data provided by the National Natural Science Foundation of China to analyze funding information. In addition, the prospects for neurorehabilitation research in China are discussed. From 2010 to 2022, a total of 74,220 publications in neurorehabilitation were identified, with there being an overall upward tendency. During this period, the National Natural Science Foundation of China has funded 476 research projects with a total funding of 192.38 million RMB to support neurorehabilitation research in China. With the support of the National Natural Science Foundation of China, China has made some achievements in neurorehabilitation research. Research related to neurorehabilitation is believed to be making steady and significant progress in China.

ICF in Bachelor degree programs-the implementation of the ICF in the clinical reasoning process of physical therapists for neurological patients-optimizing the health curriculum for comprehensive patient care.

The International Classification of Function, Disability, and Health (ICF) is known to be a valuable classification model in interprofessional neurorehabilitation, as it can lead to more patient-centered and self-determined treatment. To acquire the competencies implementing the ICF in the field of neurorehabilitation, it is important to anchor essential skills in the basic training of healthcare professionals. The Institute of Physiotherapy at FH JOANNEUM in Graz/Austria developed a concept to help students learn the necessary skills for implementing the ICF in a structured way. In the area of neurorehabilitation, we linked the ICF model with the Clinical Reasoning Model (CR). Competences are acquired over six semesters. Besides the general topics relating to the ICF (such as history, intention, and language) and CR that are taught in the first year, we focus in the later semesters explicitly on transferring these skills to neurorehabilitation. Therefore, we use interprofessional group work and problem-based courses as essential didactic elements for this transfer of skills. This article aims to show how the ICF could be implemented in Bachelor's degree programs for physiotherapy as well as in other healthcare programs. The authors' experiences are described and some best practice examples when working with the ICF in this field are given.

Robot-Aided Motion Analysis in Neurorehabilitation: Benefits and Challenges

In the neurorehabilitation field, robot-aided motion analysis (R-AMA) could be helpful for two main reasons: (1) it allows the registration and monitoring of patients’ motion parameters in a more accurate way than clinical scales (clinical purpose), and (2) the multitude of data produced using R-AMA can be used to build machine learning algorithms, detecting prognostic and predictive factors for better motor outcomes (research purpose). Despite their potential in clinical settings, robotic assessment tools have not gained widespread clinical acceptance. Some barriers remain to their clinical adoption, such as their reliability and validity compared to the existing standardized scales. In this narrative review, we sought to investigate the usefulness of R-AMA systems in patients affected by neurological disorders. We found that the most used R-AMA tools are the Lokomat (an exoskeleton device used for gait and balance rehabilitation) and the Armeo (both Power and Spring, used for the rehabilitation of upper limb impairment). The motion analysis provided by these robotic devices was used to tailor rehabilitation sessions based on the objective quantification of patients’ functional abilities. Spinal cord injury and stroke patients were the most investigated individuals with these common exoskeletons. Research on the use of robotics as an assessment tool should be fostered, taking into account the biomechanical parameters able to predict the accuracy of movements.

Natural Semantic Networks of the Neurorehabilitation Concept by Spanish Physiotherapists-A Qualitative Phenomenological Representational Study.

The Natural Semantic Networks (NSN) model is highly useful in analyzing the words that define a concept in terms of the value, strength, weight, or density that a specific population assigns to the construction of a learned concept. The main objective of this study was to describe the conceptualization of the concept of neurorehabilitation by Spanish physiotherapists specializing in this field using NSN. A phenomenological study is presented. The participants were physiotherapy professionals who graduated from three Spanish universities and were working in the field of neurorehabilitation. A questionnaire was administered via Google Forms, which was constructed using the NSN technique. A total of 191 physiotherapists participated in this study. The Spanish physiotherapists interviewed used a total of 1247 defining words for the concept of neurorehabilitation. The semantic core of the concept was mainly formed by the words 'treatment', 'recovery', 'functionality', 'neuroplasticity', and 'learning', which carried significant weight. Results were also presented taking into account the academic level and years of professional experience of the sample. The semantic network observed in this study allows us to elucidate the polysemy of the concept of neurorehabilitation, which is composed not only of certain associated words but also the meanings they imply.

Classifying dynamic motor imagery with the locals-balanced extreme learning machine

The dynamic motor imagery (dMI) provides additional benefits as compared to the traditional motor imagery (MI) in training and neurorehabilitation field. The objective of this work is to develop a brain-computer interface (BCI) for dMI electroencephalograph (EEG). We propose a novel method by combining synchronization likelihood (SL) based functional brain network (FBN) and modified extreme learning machine (ELM) to interpret EEG. The proposed method 1) uses L1-norm and adaptive threshold instead of L2-norm and empirical threshold in SL method; 2) improves the procedure of FBN calculations (namely, SL matrix binarization) by combining threshold and MST methods; 3) detects two defects in standard ELM in fusion, and proposes the locals-balanced ELM (LBELM); 4) employs the special version of leave-one-out cross validation (LOO) approach improved the computational complexity of optimal threshold for binarization, the most effective fusion of two complementary features, and the optimal regularization parameters for regularized LBELM. As compared with the empirical threshold, the recognition rate of the optimal threshold increases by 1.39–11.11 %. Similarly, as compared with the regularized ELM, the recognition rate of LBELM increases by 2.78–9.73 %.

Interrelationship of Psychotherapy, Psychocorrection and Psychoconsultation

Modern neurorehabilitation is focused primarily on the restoration of speech and cognitive mental processes, considering the rehabilitation of the individual as a task of psychotherapy. The article shows that a gentle attitude, a change in "body image" and neurotic experiences, characteristic of most patients with organic brain lesions, significantly affect the effectiveness of neuropsychological rehabilitation. Neurorehabilitation focuses on the restoration of speech and cognitive processes, considering the rehabilitation of the individual as an object of psychotherapy. On the basis of clinical cases, it has been shown that the weakened attitude, body image changes, and neurotic experiences characteristic of most patients with idiophrenic disease affect the effectiveness of neuropsychological rehabilitation. The article examines the theoretical and methodological principles and defines the main concepts of the topic. The relevance of the article is determined by the new innovative social needs in solving problems of a psychological nature, taking into account the neurological features of human thinking. Scientific intelligence in the field of neurorehabilitation provides grounds for determining the most effective methods of psychocorrection. The purpose of the study is to determine the relationship between psychotherapy, psychocorrection and psycho-counseling based on neurorehabilitation. After studying the data, it was determined that the ischemic attack of the brain was unspecified, it was suggested that the observed neurological symptoms (disorders of speech, movements, emotional sphere) are related to residual (residual) symptoms after a transient ischemic attack, which requires a detailed study.

Self-attention-based convolutional neural network and time-frequency common spatial pattern for enhanced motor imagery classification

BackgroundMotor imagery (MI) based brain-computer interfaces (BCIs) have promising potentials in the field of neuro-rehabilitation. However, due to individual variations in active brain regions during MI tasks, the challenge of decoding MI EEG signals necessitates improved classification performance for practical application. New methodThis study proposes a self-attention-based Convolutional Neural Network (CNN) in conjunction with a time-frequency common spatial pattern (TFCSP) for enhanced MI classification. Due to the limited availability of training data, a data augmentation strategy is employed to expand the scale of MI EEG datasets. The self-attention-based CNN is trained to automatically extract the temporal and spatial information from EEG signals, allowing the self-attention module to select active channels by calculating EEG channel weights. TFCSP is further implemented to extract multiscale time-frequency-space features from EEG data. Finally, the EEG features derived from TFCSP are concatenated with those from the self-attention-based CNN for MI classification. ResultsThe proposed method is evaluated on two publicly accessible datasets, BCI Competition IV IIa and BCI Competition III IIIa, yielding mean accuracies of 79.28 % and 86.39 %, respectively. ConclusionsCompared with state-of-the-art methods, our approach achieves superior classification results in accuracy. Self-attention-based CNN combining with TFCSP can make full use of the time-frequency-space information of EEG, and enhance the classification performance.

Bridging the Gap between Basic Research and Clinical Practice: The Growing Role of Translational Neurorehabilitation.

Translational neuroscience is intended as a holistic approach in the field of brain disorders, starting from the basic research of cerebral morphology and with the function of implementing it into clinical practice. This concept can be applied to the rehabilitation field to promote promising results that positively influence the patient's quality of life. The last decades have seen great scientific and technological improvements in the field of neurorehabilitation. In this paper, we discuss the main issues related to translational neurorehabilitation, from basic research to current clinical practice, and we also suggest possible future scenarios.

COHERENCE NETWORKS OF BILATERAL UPPER LIMB MOTIONS IN CHRONIC STROKE PATIENTS

Understanding the mechanisms of how the skeletal system reduces multiple degrees of freedom in motor control is very important in the field of neurorehabilitation. We therefore need to understand the functional connectivity of these synergistic patterns in bilateral upper limb of stroke patients from different Brunnstrom Stages. The intermuscular coherence at different frequency bands is decomposed to obtain muscle synchronization. Muscle networks were then applied to describe the functional connectivity between muscle pairs. We recruited 35 stroke patients with Brunnstrom Stages III-VI. Muscle activity was acquired from seven muscles around forearm while participants performed voluntary upward reaching with both affected and unaffected sides. We decomposed IMC spectra by negative matrix factorization to identify shared frequencies and co-modulated muscles. Two muscle networks were found and functional muscle networks are evaluated by strength, transitivity and global efficiency. Results showed that the network topology was different significantly between the two sides and between Brunnstrom stages of stroke patients. These findings can throw light on the understanding of motor control and rehabilitation of motor impairment for stroke survivors, which may promote the post-stroke rehabilitation process by detecting impaired neuromuscular coordination in frequency domain.

Motivation as a Measurable Outcome in Stroke Rehabilitation: A Systematic Review of the Literature

Motivated behaviours are thought to lead to enhanced performances. In the neurorehabilitation field, motivation has been demonstrated to be a link between cognition and motor performance, therefore playing an important role upon rehabilitation outcome determining factors. While motivation-enhancing interventions have been frequently investigated, a common and reliable motivation assessment strategy has not been established yet. This review aims to systematically explore and provide a comparison among the existing motivation assessment tools concerning stroke rehabilitation. For this purpose, a literature search (PubMed and Google Scholar) was performed, using the following Medical Subject Headings terms: "assessment" OR "scale" AND "motivation" AND "stroke" AND "rehabilitation". In all, 31 randomized clinical trials and 15 clinical trials were examined. The existing assessment tools can be grouped into two categories: the first mirroring the trade-off between patients and rehabilitation, the latter reflecting the link between patients and interventions. Furthermore, we presented assessment tools which reflect participation level or apathy, as an indirect index of motivation. In conclusion, we are left to put forth a possible common motivation assessment strategy, which might provide valuable incentive to investigate in future research.

Recognition of single upper limb motor imagery tasks from EEG using multi-branch fusion convolutional neural network.

Motor imagery-based brain-computer interfaces (MI-BCI) have important application values in the field of neurorehabilitation and robot control. At present, MI-BCI mostly use bilateral upper limb motor tasks, but there are relatively few studies on single upper limb MI tasks. In this work, we conducted studies on the recognition of motor imagery EEG signals of the right upper limb and proposed a multi-branch fusion convolutional neural network (MF-CNN) for learning the features of the raw EEG signals as well as the two-dimensional time-frequency maps at the same time. The dataset used in this study contained three types of motor imagery tasks: extending the arm, rotating the wrist, and grasping the object, 25 subjects were included. In the binary classification experiment between the grasping object and the arm-extending tasks, MF-CNN achieved an average classification accuracy of 78.52% and kappa value of 0.57. When all three tasks were used for classification, the accuracy and kappa value were 57.06% and 0.36, respectively. The comparison results showed that the classification performance of MF-CNN is higher than that of single CNN branch algorithms in both binary-class and three-class classification. In conclusion, MF-CNN makes full use of the time-domain and frequency-domain features of EEG, can improve the decoding accuracy of single limb motor imagery tasks, and it contributes to the application of MI-BCI in motor function rehabilitation training after stroke.

How do we ensure safety and effectiveness of bioelectronic devices and judge when they are truly necessary for the rehabilitation of neurological conditions?

Bioelectronics have been gaining popularity in recent years due to their potential use in the field of neurorehabilitation. The aim is to use these technologies to help individuals recover from various neurological conditions such as stroke, spinal cord injury, and traumatic brain injury. The basic principle behind bioelectronics is to use electrical/optical stimulation to activate neurons in the brain and promote functional recovery. One example of bioelectronics use in neurorehabilitation is through the development of brain-computer interfaces (BCIs). BCIs are computer systems that use electrodes to detect and interpret electrical signals generated by the brain. These signals can then be used to control external devices such as robotic limbs, exoskeletons, and computer interfaces. The hope is that BCIs will help individuals with paralysis or other conditions regain movement and control over their limbs.

Dr Joseph Melzak (1903-1972). A pupil of two Jewish-Polish giants: Prof. Edward Flatau (1868- 1932), and Sir Ludwig Guttmann (1899-1980)

Dr Joseph Melzak, was born in Poland , September 1903 and died in September 1972 in Haifa, Israel. He joined the Polish army in the First World War. He studied medicine after the world war and became a neurologist. He was trained by the father of Polish neurology, Prof Edward Flatau (1868- 1932). During the second world war Joseph escaped from Poland . joined the Polish free army which became part of the British 8th army. He worked as a physician and surgeon in the British army in Italy and in Palestine. After the war he came to the UK and worked in the field of neuro-rehabilitation and eventually settled at Stoke Mandeville Hospital , and worked under the father of the comprehensive rehabilitation of the spinally injured: Sir Ludwig Guttmann (1899-1980). He retired from the National Health Service in the UK and immigrated to Israel, and worked for Community Health Organization, in Haifa. His academic publications are well known to those who work with spinal cord injuries.

Enhancing motor imagery practice using synchronous action observation

In this paper, we discuss a variety of ways in which practising motor actions by means of motor imagery (MI) can be enhanced via synchronous action observation (AO), that is, by AO + MI. We review the available research on the (mostly facilitatory) behavioural effects of AO + MI practice in the early stages of skill acquisition, discuss possible theoretical explanations, and consider several issues related to the choice and presentation schedules of suitable models. We then discuss considerations related to AO + MI practice at advanced skill levels, including expertise effects, practical recommendations such as focussing attention on specific aspects of the observed action, using just-ahead models, and possible effects of the perspective in which the observed action is presented. In section “Coordinative AO + MI”, we consider scenarios where the observer imagines performing an action that complements or responds to the observed action, as a promising and yet under-researched application of AO + MI training. In section “The dual action simulation hypothesis of AO + MI”, we review the neurocognitive hypothesis that AO + MI practice involves two parallel action simulations, and we consider opportunities for future research based on recent neuroimaging work on parallel motor representations. In section “AO + MI training in motor rehabilitation”, we review applications of AO, MI, and AO + MI training in the field of neurorehabilitation. Taken together, this evidence-based, exploratory review opens a variety of avenues for future research and applications of AO + MI practice, highlighting several clear advantages over the approaches of purely AO- or MI-based practice.

Cold for gravity, heat for microgravity: A critical analysis of the “Baby Astronaut” concept

The existing literature suggests that temperature and gravity may have much in common as regulators of physiological functions. Cold, according to the existing literature, shares with gravity common effects on the neuromuscular system, while heat produces effects similar to those of microgravity. In addition, there are studies evidencing unidirectional modification of the motor system to heat and hypoxia. Such agonistic relationship in a triad of “microgravity, heat, and hypoxia” and in a pair of “cold and gravity” in their effect on the neuromuscular system may have evolutionary origins. To address this problem, ten years ago, we came up with a concept with the working name Baby Astronaut hypothesis, which posed that “Synergetic adaptation of the motor system to different environments comes from their ontogenetic synchronicity.” More specifically, the synchronicity of microgravity (actually, the “wet immersion” model of microgravity), higher temperature, and hypoxia are the characteristics of the intrauterine environment of the fetus. After childbirth, this group of factors is rapidly replaced by the “extrauterine,” routine environment characterized by Earth gravity (1 G), normoxia, and lower ambient temperature. The physiological effect of cold and gravity on the motor system may well be additive (synergistic). We earlier estimated a “gravity-substitution” potential of cold-induced activity and adaptation to cold as 15–20% of G, which needs further validation and correction. In this study, we sought to critically analyze the interaction of temperature and gravity, based on the concept of Baby Astronaut, using data from the new academic literature. We have come to the conclusion that the concept of Baby Astronaut can be regarded as valid only for species such as a rat (immature, altricial species), but not for a human fetus. Several confirmatory experiments were suggested to verify (or falsify) the concept, which would allow us to consider it as empirical. In addition, the interaction of temperature and gravity may be of practical interest in the fields of neurorehabilitation and habilitation in childhood for constructing a physical environment, which would help strengthen or weaken muscle tone in specific muscles.