Hemiparetic Stroke Patients Research Articles

Impact of Visual Feedback Configurations in a Task-oriented Immersive Virtual Reality Mirror Therapy.

Mirror Therapy is a form of upper limb therapy in stroke, which consists on showing the mirrored symmetric movement of the unimpaired side using a mirror placed in the medial sagittal plane. The illusion of movement corresponding to the impaired extremity could facilitate neuroplasticity, and assists patients in regaining certain lost motor functions. Recent studies have shown the potential and benefit of translating this effective therapy in an immersive virtual reality (VR) environment, using head mounted display and hand tracking systems. This work investigates the feasibility to use myoelectric control in an immersive VR environment for the mirror therapy to accomplish a funtional task. Surface electromyography sensors were used to measure muscle activation and detect user intention to perform grasping actions in two visual feedback configurations: unimanual and bimanual. Even though in both conditions the virtual mirrored hand is controlled by the healthy hand, the latter creates the illusion that two functional hands cooperate for grasping. A total of 18 healthy subjects participated in the evaluation of the environment, control method and a comparison between the two configurations. This includes self-rating surveys and performance metrics. Results from the Simulator Sickness Questionnaire showed negligible adverse symptoms related to the use of the VR-application proposed. Positive outcomes from the System Usability Scale and Presence Questionnaire affirmed its feasible as a form of therapy for the rehabilitation of hemiparetic stroke patients. Although the adapted Box and Blocks Test proved immediate training-induced learning, performance measures revealed no significant distinctions between visual feedback configurations.

Inertial measurement units to evaluate the efficacity of Equino Varus Foot surgery in post stroke hemiparetic patients: a feasibility study

IntroductionThis study evaluates the gait analysis obtained by Inetial Measurement Units (IMU) before and after surgical management of Spastic Equino Varus Foot (SEVF) in hemiplegic post-stroke patients and to compare it with the functional results obtained in a monocentric prospective cohort.MethodsPatients with post-stroke SEVF, who underwent surgery in a single hospital between November 2019 and December 2021 were included. The follow-up duration was 6 months and included a functional analysis using Goal Attainment Scaling (GAS) and a Gait analysis using an innovative Multidimensional Gait Evaluation using IMU: the semiogram.Results20 patients had a gait analysis preoperatively and at 6 months postoperatively. 90% (18/20) patients had a functional improvement (GAS T score ≥ 50) and 50% (10/20) had an improvement in walking technique as evidenced by the cessation of the use of a walking aid (WA). In patients with functional improvement and modification of WA the change in the semiogram area was + 9.5%, sd = 27.5%, and it was + 15.4%, sd = 28%. In the group with functional improvement without change of WA. For the 3 experiences (two patients) with unfavorable results, the area under the curve changed by + 2.3%, -10.2% and − 9.5%. The measurement of the semiogram area weighted by average speed demonstrated very good reproducibility (ICC(1, 3) = 0.80).DiscussionIMUs appear to be a promising solution for the assessment of post-stroke hemiplegic patients who have undergone SEVF surgery. They can provide a quantified, objective, reliable in individual longitudinal follow up automated gait analysis solution for routine clinical use. Combined with a functional scale such as the GAS, they can provide a global analysis of the effect of surgery.

IpsiHand Brain-Computer Interface Therapy Induces Broad Upper Extremity Motor Rehabilitation in Chronic Stroke.

Chronic hemiparetic stroke patients have very limited benefits from current therapies. Brain-computer interface (BCI) engaging the unaffected hemisphere has emerged as a promising novel therapeutic approach for chronic stroke rehabilitation. This study investigated the effectiveness of contralesionally-controlled BCI therapy in chronic stroke patients with impaired upper extremity motor function. We further explored neurophysiological features of motor recovery driven by BCI. We hypothesized that BCI therapy would induce a broad motor recovery in the upper extremity, and there would be corresponding changes in baseline theta and gamma oscillations, which have been shown to be associated with motor recovery. Twenty-six prospectively enrolled chronic hemiparetic stroke patients performed a therapeutic BCI task for 12 weeks. Motor function assessment data and resting state electroencephalogram signals were acquired before initiating BCI therapy and across BCI therapy sessions. The Upper Extremity Fugl-Meyer assessment served as a primary motor outcome assessment tool. Theta-gamma cross-frequency coupling (CFC) was computed and correlated with motor recovery. Chronic stroke patients achieved significant motor improvement in both proximal and distal upper extremity with BCI therapy. Motor function improvement was independent of Botox application. Theta-gamma CFC enhanced bilaterally over the C3/C4 motor electrodes and positively correlated with motor recovery across BCI therapy sessions. BCI therapy resulted in significant motor function improvement across the proximal and distal upper extremities of patients, which significantly correlated with theta-gamma CFC increases in the motor regions. This may represent rhythm-specific cortical oscillatory mechanism for BCI-driven rehabilitation in chronic stroke patients. Advarra Study: https://classic.clinicaltrials.gov/ct2/show/NCT04338971 and Washington University Study: https://classic.clinicaltrials.gov/ct2/show/NCT03611855.

Effectiveness and Usability of Hand–Wrist Stretching Device for Spasticity in Chronic Hemiparetic Stroke Patients

Effectiveness and Usability of Hand–Wrist Stretching Device for Spasticity in Chronic Hemiparetic Stroke Patients

Post-Stroke Impairments of Manual Dexterity and Finger Proprioception: Their Contribution to Upper Limb Activity Capacity

Background Knowing how impaired manual dexterity and finger proprioception affect upper limb activity capacity is important for delineating targeted post-stroke interventions for upper limb recovery. Objectives To investigate whether impaired manual dexterity and finger proprioception explain variance in post-stroke activity capacity, and whether they explain more variance than conventional clinical assessments of upper limb sensorimotor impairments. Methods Activity capacity and hand sensorimotor impairments were assessed using clinical measures in N = 42 late subacute/chronic hemiparetic stroke patients. Dexterity was evaluated using the Dextrain Manipulandum to quantify accuracy of visuomotor finger force-tracking (N = 36), timing of rhythmic tapping (N = 36), and finger individuation (N = 24), as well as proprioception (N = 27). Stepwise multivariate and hierarchical linear regression models were used to identify impairments best explaining activity capacity. Results Dexterity and proprioceptive components significantly increased the variance explained in activity capacity: (i) Box and Block Test was best explained by baseline tonic force during force-tracking and tapping frequency (adjusted R2 = .51); (ii) Motor Activity Log was best explained by success rate in finger individuation (adjusted R2 = .46); (iii) Action Research Arm Test was best explained by release of finger force and proprioceptive measures (improved reaction time related to use of proprioception; adjusted R2 = .52); and (iv) Moberg Pick-Up test was best explained by proprioceptive function (adjusted R2 = .18). Models excluding dexterity and proprioception variables explained up to 19% less variance. Conclusions Manual dexterity and finger proprioception explain unique variance in activity capacity not captured by conventional impairment measures and should be assessed when considering the underlying causes of post-stroke activity capacity limitations. URL: https://www.clinicaltrials.gov. Unique identifier: NCT03934073.

Improvements of mid-thigh circumferences following robotic rehabilitation in hemiparetic stroke patients.

Stroke has emerged as the leading cause of disability globally. The provision of long-term rehabilitation to stroke survivors poses a health care burden to many countries. Robotic devices have created a major turning point in stroke rehabilitation program. Currently, the anthropometric evidence to support the benefit of robotic rehabilitation (RR) among stroke patients is scarce. Therefore, the aim of this study was to evaluate the impact of RR on the mid-thigh circumferences of the paretic limbs in stroke patients. Twenty stroke patients from conventional rehabilitation (CR) (n=10) and RR (n=10) groups were recruited through a purposive sampling method. Patients in the CR group received a two-hour session of a five-day-a-week home-based CR program for 4weeks. Patients in the RR group received a five-day-a-week of an hour combined physiotherapy and occupational therapy session and a one-hour robotic therapy session using the HAL® Cyberdyne lower-limb, for 4weeks. The mid-thigh circumferences of both limbs were measured on day 1 (baseline), week 2 and week 4 of rehabilitation program. The results revealed no statistically significant difference in the mid-thigh circumferences between the paretic (F1.05,9.44=1.96, p=0.20), and the normal (F1.05,9.44=1.96, p=0.20) sides in the CR group (n=10). For the comparison between the paretic and normal sides in the RR group (n=10), the paretic mid-thigh circumferences revealed significant time effect results (F2,18=11.91, p=0.001), which were due to changes between baseline and week 2, and baseline and week 4 measurements. Interestingly, the normal mid-thigh circumferences also revealed a significant time effect (F2,18=6.56, p=0.007), which is due to changes between baseline and week 4. One-way analysis of variance was employed to compare the mean average between groups due to the difference in the baseline measurements of the mid-thigh circumferences between the paretic side of the CR and the RR groups. With this adjustment, the average means mid-thigh circumferences after 4weeks of therapy were shown to be significantly different between the CR and RR groups (F1,18=12.49, p=0.02). Significant increments in the mid-thigh circumferences following RR were seen in the paretic limbs of stroke patients. Hence, this study may provide some insights into further potential research related to the benefits of RR in stroke patients.

Effectiveness of Mirror Therapy through Telerehabilitation on Upper Extremity Performance in Hemiparetic Stroke Patients: An Experimental Study

Introduction: A major challenge in stroke rehabilitation is the paresis of the Upper Extremity (UE), resulting in limited functional performance. Recently, motor imagery and Mirror Therapy (MT) have been recommended as an additional rehabilitation strategies that could be beneficial for motor rehabilitation after a stroke. Aim: To determine the effectiveness of mirror visual feedback through Telerehabilitation (TR) on UE functional performance in hemiparetic stroke patients. Materials and Methods: An experimental pretest, post-test study design was conducted at SRM Medical College Hospital and Research Centre, SRMIST, Kattankulathur, Chengalpattu, Tamil Nadu, India from January 2021 to June 2021. Total of 60 patients diagnosed with hemiparetic stroke were included in the study through convenience sampling and divided into two groups. The experimental group (n=30) received TR, and the control group (n=30) received face-to-face MT for 12 weeks. A pretest and post-test evaluation were administered using the Wolf Motor Function Test (WMFT) and Fugl-Meyer Assessment for the Upper Extremity (FMA-UE). Within-group analysis was performed using the Wilcoxon Signed-Rank Test, while intergroup analysis was conducted using the Mann-Whitney U Test. Results: The study revealed statistical significance between the pretest and post-test scores of the WMFT-FAS (Functional Ability Score), WMFT-Time (Performance Time), and FMA-UE in the control and experimental groups. The results showed no statistically significant difference between the post-test scores of the control and experimental groups in the FMA and WMFTFAS. However, there was a statistically significant distinction in the post-test scores between the control and experimental groups in WMFT-Time. Conclusion: The study concluded that mirror visual feedback through TR was an effective treatment method to improve UE functional performance among hemiparetic stroke patients by offering an alternative service delivery model for occupational therapy

Investigating Activity Recognition for Hemiparetic Stroke Patients Using Wearable Sensors: A Deep Learning Approach with Data Augmentation.

Measuring the daily use of an affected limb after hospital discharge is crucial for hemiparetic stroke rehabilitation. Classifying movements using non-intrusive wearable sensors provides context for arm use and is essential for the development of a home rehabilitation system. However, the movement classification of stroke patients poses unique challenges, including variability and sparsity. To address these challenges, we collected movement data from 15 hemiparetic stroke patients (Stroke group) and 29 non-disabled individuals (ND group). The participants performed two different tasks, the range of motion (14 movements) task and the activities of daily living (56 movements) task, wearing five inertial measurement units in a home setting. We trained a 1D convolutional neural network and evaluated its performance for different training groups: ND-only, Stroke-only, and ND and Stroke jointly. We further compared the model performance with data augmentation from axis rotation and investigated how the performance varied based on the asymmetry of movements. The joint training of ND + Stroke yielded an increased F1-score by a margin of 31.6% and 10.6% compared to ND-only training and Stroke-only training, respectively. Data augmentation further enhanced F1-scores across all conditions by an average of 11.3%. Finally, asymmetric movements decreased the F1-score by 25.9% compared to symmetric movements in the Stroke group, indicating the importance of asymmetry in movement classification.

The impact of lesion side on bilateral upper limb coordination after stroke

BackgroundA stroke frequently results in impaired performance of activities of daily life. Many of these are highly dependent on effective coordination between the two arms. In the context of bimanual movements, cyclic rhythmical bilateral arm coordination patterns can be classified into two fundamental modes: in-phase (bilateral homologous muscles contract simultaneously) and anti-phase (bilateral muscles contract alternately) movements. We aimed to investigate how patients with left (LHS) and right (RHS) hemispheric stroke are differentially affected in both individual-limb control and inter-limb coordination during bilateral movements.MethodsWe used kinematic measurements to assess bilateral coordination abilities of 18 chronic hemiparetic stroke patients (9 LHS; 9 RHS) and 18 age- and sex-matched controls. Using KINARM upper-limb exoskeleton system, we examined individual-limb control by quantifying trajectory variability in each hand and inter-limb coordination by computing the phase synchronization between hands during anti- and in-phase movements.ResultsRHS patients exhibited greater impairment in individual- and inter-limb control during anti-phase movements, whilst LHS patients showed greater impairment in individual-limb control during in-phase movements alone. However, LHS patients further showed a swap in hand dominance during in-phase movements.ConclusionsThe current study used individual-limb and inter-limb kinematic profiles and showed that bilateral movements are differently impaired in patients with left vs. right hemispheric strokes. Our results demonstrate that both fundamental bilateral coordination modes are differently controlled in both hemispheres using a lesion model approach. From a clinical perspective, we suggest that lesion side should be taken into account for more individually targeted bilateral coordination training strategies.Trial registration: the current experiment is not a health care intervention study.

Muscle quality improvement in subacute post-stroke patients after rehabilitation: Usefulness of segmental phase angle from bioelectrical impedance analysis

During stroke rehabilitation, the whole-body Phase Angle (PhA) from Bioelectrical Impedance Analysis (BIA) is measured to assess whole-body muscle quality, which reflects cellular integrity and function. The segmental BIA is a valuable method for assessing the body composition of specific body segments, such as the arms, legs, and hemisoma. After a stroke insult, patients frequently experience hemiparesis, and segmental PhA from segmental BIA appears to be an appropriate parameter for examining the muscle quality of affected and unaffected limbs separately. This study aims to investigate whether segmental PhA is more informative than whole-body PhA in (a) assessing the deterioration of muscle quality in post-stroke patients and (b) monitoring its recovery following rehabilitative treatment. This longitudinal study recruited subacute post-stroke patients who were admitted to our rehabilitation center. At admission, demographic, anamnestic, and clinical information, such as the presence of comorbidities, were recorded. BIA was used to evaluate the whole-body PhA and segmental PhA of the affected and unaffected hemisoma, arms, and legs at admission (T0) and after a six-week rehabilitation program (T1). The modified Barthel Index (mBI), Fugl-Meyer Assessment for the Upper Extremity (FMA-UE), and Motricity Index of the Upper (MI-UE) and Lower (MI-LE) Extremities were evaluated at T0 and T1 to determine the patient's Activity of Daily Living (ADL) performance, upper limb motor performance, and upper and lower limb muscle strength, respectively. We evaluated segmental and whole-body BIA in 70 subacute post-stroke patients (women n=34, ischemic n=56, mean age 70±11) at T0 and T1. Whole-body PhA values of the patients were below the normal range. Considering segmental data, the affected hemisoma, arm, and leg had considerably lower PhA values as compared to the unaffected body segments. Furthermore, at T1, the PhA values of all affected body segments improved, while those of the unaffected ones and whole-body PhA did not. At both T0 and T1, the segmental PhA values of the affected body segments showed to be related with all clinical outcome measures, while whole-body PhA correlated only with mBI. This study emphasizes the significance of measuring segmental PhA in hemiparetic subacute stroke patients undergoing rehabilitation treatment. Segmental PhA is a more accurate parameter to evaluate rehabilitation treatment in patients with hemiparesis because it can distinguish affected from unaffected body segments, hence facilitating accurate monitoring of muscle quality improvements resulting from a rehabilitation program.

Efficacy of MCIMT with Auditory Cueing in order to Augment Functional Motor Recovery of Chronic Hemiparetic Arm

Background: Stroke is a leading cause of functional impairments globally, often resulting in long-term disability and a substantial impact on individuals, families, and caregivers. Learned nonuse, a phenomenon where motor deficits persist after a stroke due to central nervous system suppression, is a significant challenge in stroke rehabilitation. Constraint-Induced Movement Therapy (CIMT) is a well-established neurorehabilitation approach based on behavioural training, which includes repetitive task-specific training, behavioural techniques, and constraining the use of the more affected upper extremity. CIMT has been successful in improving functionality in chronic hemiparetic stroke patients, promoting cortical reorganization and neural plasticity.
 Method: This study involved 60 stroke survivors aged 20 or older, selected purposively and meeting specific criteria. Participants underwent an 8-week Modified CIMT (M-CIMT) program with auditory cueing for the hemiparetic upper limb. Data collection included pre-test and post-test assessments using the Wolf Motor Function Test (WMFT) and the Motor Activity Log (MAL) to evaluate functional activity. The M-CIMT program comprised warm-up sessions, M-CIMT protocols, and cool-down exercises, conducted five days a week.
 Results: Following participation in the M-CIMT program, significant improvements were observed in WMFT and MAL scores. The mean pre-test score of 46.60 seconds decreased to a mean post-test score of 16.85 seconds, with highly significant t-values of 14.292 and -51.356 and a p-value of 0.0, indicating a strong correlation between the two datasets. The analysis revealed that M-CIMT effectively enhanced upper extremity function in chronic stroke patients.
 Conclusion: This study highlights the effectiveness of the Modified CIMT protocol, emphasizing repeated use and a distributed practice schedule, in reducing upper-limb impairment and improving upper-limb use and function in chronic stroke patients. The significant improvement in post-test scores underscores the promise of M-CIMT as a valuable approach for upper extremity rehabilitation following chronic stroke, offering hope for enhanced recovery and improved quality of life for affected individuals.
 Keywords: Stroke; Rehabilitation; Upper Extremity; Constraint-Induced Movement Therapy; Motor Activity

Automated Quantifiable Assessments of Sensorimotor Function Using an Instrumented Fragile Object.

Accurate assessment of hand dexterity plays a critical role in informing rehabilitation and care of upper-limb hemiparetic stroke patients. Common upper-limb assessments, such as the Box and Blocks Test and Nine Hole Peg Test, primarily evaluate gross motor function in terms of speed. These assessments neglect an individual's ability to finely regulate grip force, which is critical in activities of daily living, such as manipulating fragile objects. Here we present the Electronic Grip Gauge (EGG), an instrumented fragile object that assesses both gross and fine motor function. Embedded with a load cell, accelerometer, and Hall-effect sensor, the EGG measures grip force, acceleration, and relative position (via magnetic fields) in real time. The EGG can emit an audible "break" sound when the applied grip force exceeds a threshold. The number of breaks, transfer duration, and applied forces are automatically logged in real-time. Using the EGG, we evaluated sensorimotor function in implicit grasping and gentle grasping for the non-paretic and paretic hands of 3 hemiparetic stroke patients. For all participants, the paretic hand took longer to transfer the EGG during implicit grasping. For 2 of 3 participants, grip forces were significantly greater for the paretic hand during gentle grasping. Differences in implicit grasping forces were unique to each participant. This work constitutes an important step towards more widespread and quantitative measures of sensorimotor function, which may ultimately lead to improved personalized rehabilitation and better patient outcomes.

Sliding Window Along With EEGNet-Based Prediction of EEG Motor Imagery

The need for repeated calibration and accounting for inter subject variability is a major challenge for the practical applications of a brain-computer interface. The problem becomes more severe when it is applied for the neurorehabilitation of stroke patients where the brain-activation pattern may differ quite a bit as compared to healthy individuals due to the altered neurodynamics because of a lesion. There were several approaches to handle this problem in the past that depend on creating customized features that can be generalized among the individual subjects. Recently, several deep learning architectures came into the picture although they often failed to produce superior accuracy as compared to the traditional approaches and mostly do not follow an end-to-end architecture as they depend on custom features. However, a few of them have the promising ability to create more generalizable features in an end-to-end fashion such as the popular EEGNet architecture. Although EEGNet was applied for decoding stroke patient’s motor imagery (MI) data with limited success it failed to achieve superior performance over the traditional methods. In this study, we have augmented the EEGNet based decoding by introducing a post-processing step called the longest consecutive repetition (LCR) in a sliding window-based approach and named it EEGNet+LCR. The proposed approach was tested on a dataset of 10 hemiparetic stroke patients’ MI data set yielding superior performance against the only EEGNet and a more traditional approach such as common spatial pattern (CSP)+support vector machine (SVM) for both within- and cross-subject decoding of MI signals. We also observed comparable and satisfactory performance of the EEGNet+LCR in both the within- and cross-subject categories which are rarely found in literature making it a promising candidate to realize practically feasible BCI for stroke rehabilitation.

Effects of Training with a Powered Exoskeleton on Cortical Activity Modulation in Hemiparetic Chronic Stroke Patients: A Randomized Controlled Pilot Trial

ObjectivesTo investigate the effects of exoskeleton-assisted gait training in stroke patients. DesignProspective randomized controlled trial. SettingRehabilitation department in a single tertiary hospital. ParticipantsThirty (N=30) chronic stroke patients with Functional Ambulatory Category scale (FAC) between 2 and 4. InterventionPatients were randomly assigned to 1 of 2 groups: training with Healbot G, a wearable powered exoskeleton (Healbot G group; n=15), or treadmill training (control group; n=15). All participants received 30 minutes of training, 10 times per week, for 4 weeks. Outcome MeasurementsThe primary outcome was oxyhemoglobin level changes, representing cortical activity in both motor cortices using functional near-infrared spectroscopy. The secondary outcomes included FAC, Berg Balance Scale, Motricity Index for the lower extremities (MI-Lower), 10-meter walk test, and gait symmetry ratio (spatial step and temporal symmetry ratio). ResultsCompared to the control group, during the entire training session, the pre-training and post-training mean cortical activity, and the amount of increment between pre- and post-training were significantly higher in the Healbot G group (∆mean ± SD; pre-training, 0.245±0.119, post-training, 0.697±0.429, between pre- and post-training, 0.471±0.401μmol, P<.001). There was no significant difference in cortical activity between affected- and unaffected hemispheres after Healbot G training. FAC (∆mean ± SD; 0.35 ± 0.50, P=.012), MI-Lower (∆mean ± SD; 7.01 ± 0.14, P=.001), and spatial step gait symmetry ratio (∆mean ± SD; -0.32 ± 0.25, P=.049) were improved significantly in the Healbot G group. ConclusionExoskeleton-assisted gait training induces cortical modulation effect in both motor cortices, a balanced cortical activation pattern with improvements in spatial step symmetry ratio, walking ability, and voluntary strength.

ID: 219084 The Effects of Transcranial Direct Current Stimulation and Rehab on CVA Patients: Preliminary Results

After strokes, many patients suffer from impaired upper extremity function which adversely affects the performance of activities of daily living [4,5]. Conventional rehabilitation such as task-oriented exercises may not always result in full recovery [2]. Applying Transcranial Direct Current Stimulation (tDCS) with motor training can improve motor recovery and neuroplasticity [1,3,4,6]. This study aims to explore the effects of combined occupational therapy on upper extremity and tDCS on hemiparetic stroke patients. The Cognitive and psychological outcomes will be measured along with physiological outcomes, consisting of motor evoked potential (MEP) amplitude by single-pulse transcranial magnetic stimulation(sTMS). Functional outcomes will be measured by the Fugl-Meyer Assessment.

Effect of Core Exercises on Motor Function Recovery in Stroke Survivors with Very Severe Motor Impairment

Paresis of the upper and lower limbs is a typical issue in stroke survivors. This study aims to determine whether core exercises help stroke survivors with very severe motor impairment recover their motor function. This study employed a within-subjects design. Eleven hemiparetic stroke patients with very severe motor impairment (FMA score < 35) and ages ranging from 24 to 52 years old were enrolled in this study. All participants engaged in supervised core exercise training twice a week for 12 weeks. The main outcome measures were Fugl-Meyer Assessment Lower Extremity (FMA-LE) and Fugl-Meyer Assessment Upper Extremity (FMA-UE), which were measured before training and at intervals of four weeks during training. Repeated measures ANOVA was used to analyze the effect of core exercises on motor function performance and lower extremity motor function and upper extremity motor function recovery. There were significant differences in the mean scores for motor function performance, lower extremity motor function, and upper extremity motor function throughout the four time points. A post-hoc pairwise comparison using the Bonferroni correction revealed that mean scores significantly increased and were statistically different between the initial assessment and follow-up assessments four, eight, and twelve weeks later. This study suggests that 12 weeks of core exercise training is effective for improving motor function recovery in patients with very severe motor impairment.

Efficacy of rhythmic auditory stimulation on gait parameters in hemiplegic stroke patients: a randomized controlled trial

BackgroundGait disorders which caused by stroke are one of the most common causes of functional disabilities in hemiparetic stroke patients that leads to significant impact on quality of life and financial cost. In this study, we focused on how certain gait metrics in stroke patients were affected by rhythmic auditory stimulation and treadmill training.ResultsIn this randomized controlled experiment, which involved 30 male stroke patients, there was a significant increase in post treatment walking speed, step cycle, step length, percent of time on each foot and ambulation index in both groups. The post treatment improvement in gait parameters was significantly higher in the study group compared to the controls.ConclusionsCombination of rhythmic auditory stimulation with treadmill training enhances the gait performance.

Ankle-Foot-Orthosis "Hermes" Compensates Pathological Ankle Stiffness of Chronic Stroke-A Proof of Concept.

Individuals with an upper motor neuron syndrome, e.g., stroke survivors, may have a pathological increase of passive ankle stiffness due to spasticity, that impairs ankle function and activities such as walking. To improve mobility, walking aids such as ankle-foot orthoses and orthopaedic shoes are prescribed. However, these walking aids generally limit the range of motion (ROM) of the foot and may therewith negatively influence activities that require a larger ROM. Here we present a new ankle-foot orthosis "Hermes", and its first experimental results from four hemiparetic chronic stroke patients. Hermes was designed to facilitate active ankle dorsiflexion by mechanically compensating the passive ankle stiffness using a negative-stiffness mechanism. Four levels of the Hermes' stiffness compensation (0%, 35%, 70% and 100%) were applied to evaluate active ROM in a robotic ankle manipulator and to test walking feasibility on an instrumented treadmill, in a single session. The robotic tests showed that Hermes successfully compensated the ankle joint stiffness in all four patients and improved the active dorsiflexion ROM in three patients. Three patients were able to walk with Hermes at one or more Hermes' stiffness compensation levels and without reducing their preferred walking speeds compared to those with their own walking aids. Despite a small sample size, the results show that Hermes holds great promise to support voluntary ankle function and to benefit walking and daily activities.

A Serious Game System for Upper Limb Motor Function Assessment of Hemiparetic Stroke Patients.

Stroke often results in hemiparesis, impairing the patient's motor abilities and leading to upper extremity motor deficits that require long-term training and assessment. However, existing methods for assessing patients' motor function rely on clinical scales that require experienced physicians to guide patients through target tasks during the assessment process. This process is not only time-consuming and labor-intensive, but the complex assessment process is also uncomfortable for patients and has significant limitations. For this reason, we propose a serious game that automatically assesses the degree of upper limb motor impairment in stroke patients. Specifically, we divide this serious game into a preparation stage and a competition stage. In each stage, we construct motor features based on clinical a priori knowledge to reflect the ability indicators of the patient's upper limbs. These features all correlated significantly with the Fugl-Meyer Assessment for Upper Extremity (FMA-UE), which assesses motor impairment in stroke patients. In addition, we design membership functions and fuzzy rules for motor features in combination with the opinions of rehabilitation therapists to construct a hierarchical fuzzy inference system to assess the motor function of upper limbs in stroke patients. In this study, we recruited a total of 24 patients with varying degrees of stroke and 8 healthy controls to participate in the Serious Game System test. The results show that our Serious Game System was able to effectively differentiate between controls, severe, moderate, and mild hemiparesis with an average accuracy of 93.5%.

Effect of Treadmill Training with Visual Biofeedback on Selected Gait Parameters in Subacute Hemiparetic Stroke Patients

Functional limitations after a stroke are unique to each person and often include impaired independent mobility. A reduction in existing gait deficits after a stroke is often one of the main goals of rehabilitation. Gait re-education after stroke is a complex process, which consists of the effects of many therapeutic interventions. The study aimed to analyze the effects of using a treadmill with visual feedback in gait re-education in the sub-acute stroke period and assess the impact of biofeedback treadmill training on selected gait parameters, improving static balance and reducing the need for orthopedic aids. The study included 92 patients (F: 45, M: 47) aged 63 ± 12 years, with post-ischemic sub-acute (within six months onset) stroke hemiparesis, treated at a neurological rehabilitation ward. All patients participated in a specific rehabilitation program, and in addition, patients in the study group (n = 62) have a further 10 min of treadmill training with visual feedback. Patients in the control group (n = 30) participated in additional conventional gait training under the direct supervision of a physiotherapist. The evaluation of static balance was assessed with the Romberg Test. A Biodex Gait Trainer 3 treadmill with biofeedback function was used to evaluate selected gait parameters (walking speed, step length, % limb loading, and traveled distance). The use of an orthopedic aid (walker or a crutch) was noted. After four weeks of rehabilitation, step length, walking speed, traveled distance, and static balance were significantly improved for the study and control group (p < 0.05). Treadmill gait training yielded significantly better results than a conventional rehabilitation program. Only the study group observed a corrected walking base (p < 0.001). All participants showed a reduction in the use of walking aids (p = 0.006). There was no asymmetry in the % of limb loading for either group prior to or following rehabilitation. The treadmill with visual biofeedback as conventional gait training has resulted in a significant improvement in parameters such as step length, walking speed, static balance, and a reduction in the use of locomotion aids. However, the achieved improvement in gait parameters is still not in line with the physiological norm.