Post-stroke Rehabilitation Therapy Research Articles

Using Subthreshold Vibratory Stimulation During Poststroke Rehabilitation Therapy: A Case Series.

Subthreshold vibratory stimulation to the paretic wrist has been shown to prime the sensorimotor cortex and improve 2-week upper extremity (UE) therapy outcomes. The objective of this work was to determine feasibility, safety, and preliminary efficacy of the stimulation over a typical 6-week therapy duration. Four chronic stroke survivors received stimulation during 6-week therapy. Feasibility/safety/efficacy were assessed at baseline, posttherapy, and 1-month follow-up. For feasibility, all participants wore the device throughout therapy and perceived the stimulation comfortable/safe. Regarding safety, no serious/moderate intervention-related adverse events occurred. For efficacy, all participants improved in Wolf Motor Function Test and UE use in daily living based on accelerometry and stroke impact scale. Mean improvements at posttherapy/follow-up were greater than the minimal detectable change/clinically important difference and other trials with similar therapy without stimulation. In conclusion, the stimulation was feasible/safe for 6-week use. Preliminary efficacy encourages a larger trial to further evaluate the stimulation as a therapy adjunct.

Irisin-Associated Neuroprotective and Rehabilitative Strategies for Stroke.

Irisin, a newly discovered protein hormone that is secreted in response to low frequency whole body vibration (LFV), could be a promising post-stroke rehabilitation therapy for patients who are frail and cannot comply with regular rehabilitation therapy. Irisin is generated from a membrane-bound precursor protein fibronectin type III domain-containing protein 5 (FNDC5). Aside from being highly expressed in muscle, FNDC5 is highly expressed in the brain. The cleaved form of FNDC5 was found in the cerebrospinal fluid as well as in various regions of the brain. Numerous studies suggest that irisin plays a key role in brain metabolism and inflammation regulation. Both the metabolism and inflammation govern stroke outcome, and in a published study, we demonstrated that LFV therapy following middle cerebral artery occlusion significantly reduced innate immune response, improved motor function and infarct volume in reproductively senescent female rats. The observed effect of LFV therapy could be working via irisin, therefore, the current review focuses to understand various aspects of irisin including its mechanism of action on the brain.

A Game-Based Rehabilitation Therapy for Post-Stroke Patients: An Approach for Improving Patient Motivation and Engagement

A brain stroke could result in the loss of neuromotor and cognitive functions. Poststroke rehabilitation therapy is used to enable patients to regain some of their lost functionalities. However, traditional rehabilitation faces problems related to the availability of physiotherapists and specific equipment. In home therapy is more convenient for poststroke patients, but their motivation and adherence to their medical regime must be addressed properly. This article presents a game-based in-home rehabilitation system based on two different design approaches. The first design approach (A1) consists of selecting games or ludic activities and adapting them to meet the treatment object ives, the second design approach (A2) consists of selecting and virtualizing the physiotherapy exercises being used at the hospital. The results of the usability study showed that the system is usable. The game difficulty levels were similar for both approaches. The perception of fun was greater for A1 than for A2. Additionally, both approaches were considered motivating for the subjects. The usability study showed that the rehabilitation games reported in this research are usable and motivating. In future research, these games will be integrated into a neuromotor rehabilitation program for poststroke patients.

Improving Healthcare Access: A Preliminary Design of a Low-Cost Arm Rehabilitation Device

AbstractA low-cost continuous passive motion (CPM) machine, the Gannon Exoskeleton for Arm Rehabilitation (GEAR), was designed. The focus of the machine is on the rehabilitation of primary functional movements of the arm. The device developed integrates two mechanisms consisting of a four-bar linkage and a sliding rod prismatic joint mechanism that can be mounted to a normal chair. When seated, the patient is connected to the device via a padded cuff strapped on the elbow. A set of springs have been used to maintain the system stability and help the lifting of the arm. A preliminary analysis via analytical methods is used to determine the initial value of the springs to be used in the mechanism given the desired gravity compensatory force. Subsequently, a multibody simulation was performed with the software simwise 4D by Design Simulation Technologies (DST). The simulation was used to optimize the stiffness of the springs in the mechanism to provide assistance to raising of the patient's arm. Furthermore, the software can provide a finite element analysis of the stress induced by the springs on the mechanism and the external load of the arm. Finally, a physical prototype of the mechanism was fabricated using polyvinyl chloride (PVC) pipes and commercial metal springs, and the reaching space was measured using motion capture. We believed that the GEAR has the potential to provide effective passive movement to individuals with no access to postoperative or poststroke rehabilitation therapy.

Robot-Aided Upper-Limb Rehabilitation Based on Motor Imagery EEG

Stroke is a leading cause of disability worldwide. In this paper, a novel robot-assisted rehabilitation system based on motor imagery electroencephalography (EEG) is developed for regular training of neurological rehabilitation for upper limb stroke patients. Firstly, three-dimensional animation was used to guide the patient image the upper limb movement and EEG signals were acquired by EEG amplifier. Secondly, eigenvectors were extracted by harmonic wavelet transform (HWT) and linear discriminant analysis (LDA) classifier was utilized to classify the pattern of the left and right upper limb motor imagery EEG signals. Finally, PC triggered the upper limb rehabilitation robot to perform motor therapy and gave the virtual feedback. Using this robot-assisted upper limb rehabilitation system, the patient's EEG of upper limb movement imagination is translated to control rehabilitation robot directly. Consequently, the proposed rehabilitation system can fully explore the patient's motivation and attention and directly facilitate upper limb post-stroke rehabilitation therapy. Experimental results on unimpaired participants were presented to demonstrate the feasibility of the rehabilitation system. Combining robot-assisted training with motor imagery-based BCI will make future rehabilitation therapy more effective. Clinical testing is still required for further proving this assumption.

The VECTORS study

Vector (v![Graphic][1]</img>k't![Graphic][2]</img>r), noun: a quantity that has magnitude and direction Stroke remains a leading cause of disability in humans. While most patients show some spontaneous return of behavior in the weeks to months following a stroke, most people are left with major new deficits. Billions of dollars are spent in the United States each year on poststroke rehabilitation. The motor system is among the neurologic domains most commonly affected by stroke.1 Many studies thus aim to improve motor function after stroke. Much of the work has focused on the content of motor therapy.2 Does adding motor imagery, robotics, brain stimulation, or concomitant pharmacologics help? Is one treatment strategy better than the next? Such investigations focus on qualitative aspects of rehabilitation therapy. However, the quantity of poststroke rehabilitation therapy might be just as important. A landmark article on this topic came from the laboratory of Tim Schallert, who in 1996 studied rats with unilateral forelimb weakness after focal stroke. In that report, Kozlowski et al.3 experimentally manipulated the … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif

Reflections of a Family Member

I wish to write about two subjects—rehabilitation facilities and poststroke rehabilitation therapy. My experience in these two areas comes from that fact that my wife, Pia, suffered a stroke in October of 2000, and she has been in rehabilitation ever since. I am a hotel architect, and I have never designed a hospital. Accordingly, any comments I advance regarding the design of rehabilitation facilities are personal and have been germinating in my mind during the hundreds of hours I have spent in these facilities. Also, I have had discussions with more learned colleagues from whom I gathered how complicated hospital design is and how costly it can be. Therefore, I shall be treading very lightly when proposing any modifications. It would be idle to relate the circumstances of Pia’s stroke, in October 2000, or the emotions one is subjected to when a dear one suffers adversity. There are excellent examples of literature on these matters, none better than a book written by a French author, Jean Dominique Bauby, who was editor-in-chief of Elle magazine. At the age of 43, he suffered a massive stroke that completely and permanently paralyzed him. A victim of locked-in syndrome, he was able to communicate only by blinking his left eyelid. And yet he managed to compose this stunning book by memorizing each sentence, which he was able to communicate to a young assistant holding a pointer and an alphabet chart hung on a wall opposite his hospital bed. Every time a pointer touched the desired letter, Mr. Bauby blinked. Letter by letter he formed the words and the sentences of this book, which one reviewer described as a celebration of the liberating power of consciousness. The book, entitled The Diving Bell and the Butterfly, was published 2 days before Mr. Bauby’s death and has become one of the most read books in Europe. This interjection allows me to skip the first 6 months following Pia’s stroke to a day when she was being discharged from a clinic in Switzerland in which she had been undergoing treatment. At 57, vivacious and witty and very athletic, she had been reduced to a stone-faced, aphasic, hemiplegic, invalid, confined to a wheelchair. The discharging doctor advised me, not unkindly, to consider adjusting our life in light of the prognosis of improbable improvement. Not to digress, the wheelchair was locked away and never used. By trial and mostly error and mule-headed stubbornness, she started taking one step at a time until one day, 12 months later, she completed her first mile. That was the time we requested to visit the Rehabilitation Institute of Chicago, which turned out to be one of our best decisions. We have been coming back every 6 months. This more or less tells our story. I would call ours a succeeding story while reserving the past tense, a success story, for a future date. Now I come to the essentials. Please allow me to start with the rehabilitation facilities and the impressions that one gets upon visiting them. Every rehabilitation facility we had visited consisted mainly of an open space, housing the material utilized during therapy, large storage spaces, and a few professional offices. Some facilities were bet-

User—robot personality matching and assistive robot behavior adaptation for post-stroke rehabilitation therapy

This paper describes a hands-off socially assistive therapist robot designed to monitor, assist, encourage, and socially interact with post-stroke users engaged in rehabilitation exercises. We investigate the role of the robot’s personality in the hands-off therapy process, focusing on the relationship between the level of extroversion–introversion of the robot and the user. We also demonstrate a behavior adaptation system capable of adjusting its social interaction parameters (e.g., interaction distances/proxemics, speed, and vocal content) toward customized post-stroke rehabilitation therapy based on the user’s personality traits and task performance. Three validation experiment sets are described. The first maps the user’s extroversion–introversion personality dimension to a spectrum of robot therapy styles that range from challenging to nurturing. The second and the third experiments adjust the personality matching dynamically to adapt the robot’s therapy styles based on user personality and performance. The reported results provide first evidence for user preference for personality matching in the assistive domain and demonstrate how the socially assistive robot’s autonomous behavior adaptation to the user’s personality can result in improved human task performance.