Recovery Of Movement Research Articles

Artificial Neural Network (ANN) based Proportional Integral Derivative (PID) for Arm Rehabilitation Device

The current work was developed under the title of Artificial Neural Network (ANN) Proportional Integral Derivative (PID) for the arm rehabilitation device and included building and designing the simulation model and simulation results for the arm rehabilitation device. A set of tests were proposed to include firstly testing a system that represents the state of the open arm rehabilitation device and secondly It represents the closed arm rehabilitation device, third represents the closed-loop arm rehabilitation device with PID control device, fourth represents the arm rehabilitation device using ANN, and finally the closed-loop arm rehabilitation device can be used with a comparison between PIDC and ANN. To conduct all the proposed test cases, a program can be used MATLAB, which can help simulate a device that represents an attempt to regain movement in the arm, which is called rehabilitation. It can be noted that the target group is some people who suffer from stroke. By representing the system in the proposed simulation model, its effectiveness can be verified. It is possible to conduct tests aimed at improving performance by working on developing the model by adopting the appropriate design for the characteristics that match the required operational behavior of the system with all conditions that suit different situations. The test cases demonstrated through the simulation results the possibility of identifying the system behavior for the proposed cases. The difference between the system behavior for all these cases was also identified. In addition to the possibility of improving the performance of the movement recovery device to rehabilitate the injured arm through the system’s performance in the presence of an expert neural network controller, it is better than the traditional controller.

Movement Pattern Biofeedback Training After Total Knee Arthroplasty: A Randomized Controlled Trial.

Habitual movement compensations, such as decreased surgical peak knee extension moments (pKEM), persist years after total knee arthroplasty (TKA), are linked to poorer recovery, and may influence contralateral osteoarthritis progression. The purpose of this randomized clinical trial was to determine if a movement training program (MOVE) improves movement quality and recovery after TKA compared to a standardized rehabilitation program without movement training (CONTROL). One hundred thirty-eight individuals were randomized to either MOVE or CONTROL groups after TKA. Participants were assessed preoperatively, 10 weeks after (end of intervention), and six months after (primary endpoint) TKA. Outcomes assessed were pKEM during walking, six-minute walk test, stair climb test, 30-second sit to stand test (30STS), timed up and go test (TUG), physical activity level, strength, range of motion, and self-reported outcomes. At six months, there were no between-group differences in surgical pKEM during walking (primary outcome). The MOVE group exhibited less contralateral pKEM compared to CONTROL during self-selected gait speed (d = 0.44, P = 0.01). CONTROL performed better on TUG and 30STS at 10 weeks (P < 0.05), but differences attenuated at six months. The MOVE intervention did not lead to improved surgical pKEM during walking after TKA compared to CONTROL. However, the MOVE group did demonstrate less contralateral pKEM during walking. The CONTROL group demonstrated faster recovery on the TUG and 30STS, but it is unknown if this is due to improved recovery in the surgical knee or increased movement compensation relying on contralateral knee function.

The Effect of Chewing Gum on the Return of Bowel Activity after Colorectal Cancer Surgery.

Enhanced recovery after surgery (ERAS) protocols advocate for early enteral feeding to prevent postoperative ileus. Chewing gum acts as a type of sham feeding that triggers the cephalic phase of digestion by stimulating the cephalic vagus nerve. This can enhance gastrointestinal motility and may lead to quicker recovery of gas and bowel movements. To assess how chewing gum during the early postoperative phase affects the duration of postoperative ileus in terms of time to appreciation of first flatus, time to passage of first stools, and duration of hospital stay. The study was conducted in our division of colorectal surgery. This is a case-control study carried out over three years (2020-2023). A total of 100 patients were included, the first 50 were allocated to the control group, and another 50 were allocated to the chewing gum group. All patients above the age of 14 years who underwent resection for colorectal cancers were included. The average age in the control group was 51.44 years and that in the chewing gum group was 50.04 years. The average duration of surgery for the control group was 156.3 minutes (2.6 hours) and 163.8 minutes (2.7 hours) in the chewing gum group. The average time of passage of the first flatus in the chewing gum group was 51.28 hours compared to 66.26 hours in the control group (p = 0.0002). The average time to first bowel movement in the chewing gum group was 71.42 hours. In comparison, the time to first bowel movement in the control group was 85.78 hours (p = 0.000011). The average hospital stay in the chewing gum group was 6.3 days and that in the control group was 6.4 days (p = 0.274254). Chewing gum as a means of sham feeding is a cost-friendly method that significantly decreases the postoperative ileus but has no effect on postoperative hospital stay. Zargar T, Wagay BA, Banday I, et al. The Effect of Chewing Gum on the Return of Bowel Activity after Colorectal Cancer Surgery. Euroasian J Hepato-Gastroenterol 2024;14(2):210-213.

Study on the law of ore dilution and loss and control strategies under brow line failure in sublevel caving mining

To improve ore recovery ratio and the quality of medium-length hole blasting in non-pillar sublevel caving method, this study first investigated the effects of brow line failure on rock movement and ore recovery indexes based on rock blasting fragmentation mechanisms, the granular dynamics theory and ore drawing theory. Subsequently, control strategies to enhance blasting quality and reduce brow line failure were explored through energy impact crushing experiments, experiments on the radial rock-breaking effects of blast holes with different detonation velocities, and underground physical simulation experiments using full blast hole length detonating cord blasting. The experimental results indicate that as the degree of brow line failure increases, the ore recovery ratio gradually decreases, while the waste ratio gradually increases. Bottom initiation and the use of the full blast hole length detonating cord were identified as the optimal initiation method and charging structure for medium-length hole blasting in non-pillar sublevel caving method, effectively improving blasting quality and reducing damage to the brow line.

Long-term result of unicompartmental knee arthroplasty in knee osteoarthritis secondary to chondrodysplasia

Background. In determining the indications for unicondylar endoprosthesis of the knee joint the literature practically does not cover the results of such interventions in knee osteoarthritis in patients with chondrodysplasia. The purpose of our report was to publish our observation of the long-term results of unicondylar endoprosthesis of the knee joint in a patient with knee osteoarthritis due to chondrodysplasia. Material and methods. We operated on a patient with chondrodysplasia who came to the clinic at the age of 28 with complaints of pain in the right knee joint during walking, “clicking” and joint swelling. The radiological and magnetic resonance examination results of the right knee determined the presence of an area of aseptic necrosis of the medial femoral condyle. Considering the concordance of lower limb axis disorders, it was decided to perform unicondylar arthroplasty with preservation of the preoperative varus deformity to maintain the motor stereotype's compensation state. Results. In the postoperative period, there were no complications in wound healing, the rate of recovery of movements corresponded to similar indicators in patients with knee osteoarthritis of other etiologies after similar interventions, and the patient was discharged from the hospital on the sixth day after surgery with the preoperative range of motion in the operated joint. At the examination 10 years after the operation there were no complaints from the operated knee joint, the movements in the operated joint remained in the same range, and the patient moved without additional support with full load on the operated limb. Conclusions. Our results indicate the appropriateness of unicompartmental knee arthroplasty in patients with knee osteoarthritis secondary to.

Acceptability, validity and responsiveness of inertial measurement units for assessing motor recovery after gene therapy in infants with early onset spinal muscular atrophy: a prospective cohort study

BackgroundOnasemnogene abeparvovec gene replacement therapy (GT) has changed the prognosis of patients with spinal muscular atrophy (SMA) with variable outcome regarding motor development in symptomatic patients. This pilot study evaluates acceptability, validity and clinical relevance of Inertial Measurement Units (IMU) to monitor spontaneous movement recovery in early onset SMA patients after GT.MethodsClinical assessments including CHOPINTEND score (the gold standard motor score for infants with SMA) and IMU measurements were performed before (M0) and repeatedly after GT. Inertial data was recorded during a 25-min spontaneous movement task, the child lying on the back, without (10 min) and with a playset (15 min) wearing IMUs. Two commonly used parameters, norm acceleration 95th centile (||A||_95) and counts per minute (||A||_CPM) were computed for each wrist, elbow and foot sensors.Results23 SMA-patients were included (mean age at diagnosis 8 months [min 2, max 20], 19 SMA type 1, three type 2 and one presymptomatic) and 104 IMU-measurements were performed, all well accepted by families and 84/104 with a good child participation (evaluated with Brazelton scale). ||A||_95 and ||A||_CPM showed high internal consistency (without versus with a playset) with interclass correlation coefficient for the wrist sensors of 0.88 and 0.85 respectively and for the foot sensors of 0.93 and 0.91 respectively. ||A||_95 and ||A||_CPM were strongly correlated with CHOPINTEND (r for wrist sensors 0.74 and 0.67 respectively and for foot sensors 0.61 and 0.68 respectively, p-values < 0.001). ||A||_95 for the foot, the wrist, the elbow sensors and ||A||_CPM for the foot, the wrist, the elbow sensors increased significantly between baseline and the 12 months follow-up visit (respective p-values: 0.004, < 0.001, < 0.001, 0.006, < 0.001, < 0.001).ConclusionIMUs were well accepted, consistent, concurrently valid, responsive and associated with unaided sitting acquisition especially for the elbow sensors. This study is the first reporting a large set of inertial sensor derived data after GT in SMA patients and paves the way for IMU-based follow-up of SMA patients after treatment.

Heightened Reticulospinal Excitability after Severe Corticospinal Damage in Chronic Stroke.

After severe corticospinal tract damage poststroke in humans, some recovery of strength and movement proximally is evident. It is possible that alternate motor pathways, such as the reticulospinal tract, may be upregulated to compensate for the loss of corticospinal tract input. We investigated the extent of reticulospinal tract excitability modulation and its inter-dependence on the severity of corticospinal tract damage after stroke in humans. We used a novel startle conditioned transcranial magnetic stimulation paradigm to elicit ipsilateral motor evoked potentials, an index of reticulospinal tract excitability, in 22 chronic stroke participants with mild to severe corticospinal tract damage and 14 neurotypical age-matched controls. We found that ipsilateral motor evoked potential presence was higher in the paretic arm of people with severe corticospinal tract damage compared to their non-paretic arm, people with mild corticospinal tract damage, and age-matched controls. Interestingly, ipsilateral motor evoked potential presence was correlated with motor impairment across the entire stroke cohort, whereby individuals with worse impairment exhibited more frequent ipsilateral motor evoked potentials (ie, higher reticulospinal tract excitability). Following severe corticospinal tract damage, upregulated reticulospinal tract activity may compensate for a loss of corticospinal tract input, providing some proximal recovery of isolated and within-synergy movements, but deficits in performing out of synergy movements and finger fractionation remain. Interventions aimed at modulating the reticulospinal tract could be beneficial or detrimental to ameliorating motor impairment depending on the degree of reliance on this pathway for residual motor output. ANN NEUROL 2024.

Combining early lower eyelid surgery with neuromuscular retraining for synkinesis prevention after facial palsy: the role of the eye in aberrant facial nerve regeneration.

Facial synkinesis (FS) is a distressing sequela of facial palsy (FP) characterized by involuntary, simultaneous movements of facial muscles occurring during voluntary facial expressions. Treatment of synkinesis is challenging, and preventive methods are needed. This study evaluated the efficacy of physical facial nerve rehabilitation (PFNR) therapy alone vs. PNFR with eyelid surgery to correct lagophthalmos and prevent the onset of synkinesis. Twenty five outpatients were randomized to receive either PFNR alone (neuromuscular retraining and Kabat proprioceptive neuromuscular facilitation) or PNFR and early (90 days after FP onset) eyelid surgery (involving a conservative oculoplastic correction for lagophthalmos with epiphora or ectropion). Comprehensive otolaryngological assessments and Magnetic Resonance Imaging (MRI) were conducted. Synkinesis progression was measured using Another Disease Scale (ADS) at baseline, 3-, 6-, 12-, and 24-months post-treatment. The data were analyzed with ANOVA, τ-test, Chi-Square analyses. Patients undergoing eyelid surgery with PFNR showed faster (p < 0.001) and better recovery of facial movements (p < 0.05) than patients receiving PFNR alone comparing T0 and T12 (p < 0.0001). No synkinesis were observed in the PFNR plus surgery group while 37% of patients in PFNR alone had synkinesis (p = 0.03). At 24 months, none of the patients in the surgery group presented synkinesis. Combining early surgical treatment of paralytic lagophthalmos or epiphora with PFNR accelerated functional recovery and reduced synkinesis in patients with FP compared to facial rehabilitation alone. Further investigations in larger populations with long-term follow-up are needed. https://clinicaltrials.gov/study/NCT06538103, NCT06538103.

Превратить психологию «в науку о живом человеке...»: О психотехническом характере исследований школы А.Н. Леонтьева 1940-х гг.

&lt;p&gt;This paper analyzes select 1940s works of A.N. Leontiev&amp;rsquo;s school of psychological thought in light of the methodological principles of psychotechnical cognition which F.Ye. Vasilyuk formulated on the basis of L.S. Vygotsky&amp;rsquo;s ideas about practice as a constructive principle of psychological science. The paper refutes the assertion that Soviet-era cultural and activity psychology had no psychological practice in its own right, and demonstrates that such practice did really exist, had a distinctly activity-oriented nature, and contributed to the advancement of the activity theory. It was the practice of movement recovery which the team of psychologists, put together by A.N. Leontiev, practiced at the military hospital in Kourovka, fusing &amp;ldquo;psychotherapy&amp;rdquo;, research, and education into an inseparable whole. We observe that unity in Z.M. Istomina&amp;rsquo;s 1948 research, discussed in this paper in light of the eight general principles of psychotechnical cognition identified by F.Ye. Vasilyuk. Revisiting the Leontiev school&amp;rsquo;s heritage is relevant in the context of the ongoing conceptual revolution in psychology, for many methodological principles and provisions of activity psychology were ahead of their time.&lt;/p&gt;

Factors of postoperative recurrent laryngeal nerve paralysis and recovery of vocal cord movement in thyroid surgery

ObjectivePostoperative recurrent laryngeal nerve paralysis is one of the complications of thyroid surgery, and the prevention and management of paralysis is an important issue for surgeons. In this study, in order to gain further understanding of recurrent laryngeal nerve paralysis after thyroid surgery, we analyzed and examined the usefulness of nerve stimulators for recurrent laryngeal nerve paralysis and the factors that may cause recurrent laryngeal nerve paralysis. Furthermore, in cases where transient recurrent laryngeal nerve paralysis occurred, we analyzed and examined the timing of improvement in vocal cord movement for each intraoperative finding and intraoperative operation that caused the paralysis. MethodsAt the Department of Otorhinolaryngology Head and Neck Surgery, Sapporo Medical University Hospital, between January 2012 and December 2021, the subjects were 543 thyroid surgery cases (692 nerves) without preoperative paralysis or cancer nerve invasion performed. The relationship between postoperative transient and permanent paralysis of the recurrent laryngeal nerve was evaluated using univariate and multivariate analysis. The factors evaluated were gender, age, BMI, total thyroidectomy, benignity, malignancy, Graves’ disease, using IIONM (intermittent intraoperative nerve monitoring), using CIONM (continuous intraoperative nerve monitoring), malignant tumor T3b or higher, with lateral neck dissection, and years of experience of the surgeon. Furthermore, by targeting 87 nerves with transient paralysis, surgical operations were divided into three groups: minor injury, major injury, and adhesion, and their relationship with the timing of postoperative vocal fold movement improvement was evaluated. ResultsPermanent paralysis of the recurrent laryngeal nerve occurred in 12 nerves (1.7 %), and transient paralysis occurred in 100 nerves (14.5 %). Univariate analysis showed no association with each factor, but multivariate analysis showed that transient paralysis was significantly lower in men and in patients using IIONM. The improvement time for vocal cord paralysis was 2.8 months in the minor injury group, 4.5 months in the major injury group, and 3.2 months in the adhesion group, indicating a statistically significant difference between the minor injury group and the major injury group. ConclusionThis study suggests that the use of IIONM and gentle manipulation of women may prevent recurrent laryngeal nerve paralysis during thyroid surgery. In addition, understanding the period of nerve recovery for each operation for postoperative transient recurrent laryngeal nerve paralysis may contribute to patient explanations and determining the timing of therapeutic intervention for speech improvement surgery.

A genetic algorithm-based method to modulate the difficulty of serious games along consecutive robot-assisted therapy sessions

Background and Objective:One of the biggest challenges during neurorehabilitation therapies is finding an appropriate level of therapy intensity for each patient to ensure the recovery of movement of the affected limbs while maintaining motivation. Different studies have proposed adapting the difficulty of exercises based on psychophysiological state, based on success rate, or by modeling the user’s skills. However, all studies propose solutions for a single session, requiring a calibration process before using it in each session. We propose a dynamic adaptation method that can be used during different rehabilitation sessions, without the need for recalibration between sessions. Methods:The adaptation architecture is based on a genetic algorithm that aims to maintain a certain score level and to motivate the user to move. The method has been evaluated with two serious games for five sessions using a rehabilitation robot. A common initial evaluation was made for all the users involved in the study, and the game parameters that best suited each user from the previous session were introduced as the starting point of the next session. In addition, the desired score rate was lowered between sessions to increase the difficulty level. The psychophysiological state of the users was measured based on the Self-Assessment Manikin test, as well as different cardiorespiratory and galvanic skin response signals were analyzed. Results:The adaptation architecture proposed can find those game parameters that maximize the user movement for both games. In one of the games, the score rate set for each session is followed with high fidelity. The degree of personalization in the games increases between sessions as the dispersion of the game parameters grows. The Self-Assessment Manikin test and the physiological signals results would indicate that the psychophysiological state remains equal between sessions despite an increase in game difficulty. Conclusions:The genetic algorithm-based game adaptation has proven efficacy in maximizing the therapy performance through the sessions without needing recalibration. It also can be concluded that the design of the game influences the adaptation performance. Additionally, adaptive game design facilitated by our method does not significantly impact players’ emotional or physiological states.

Low ligation of the inferior mesenteric artery in robotic mid-low rectal cancer surgery: a comparative study from a single-center.

Laparoscopic total mesorectal excision is the main surgical approach for treating rectal cancer, but there is still no clear consensus on the issue of low ligation of the inferior mesenteric artery during the procedure. Robotic surgery has been shown to have certain advantages over laparoscopic surgery in multiple studies, but further research is needed to better understand the outcomes of robotic surgery in the context of low ligation procedures. In this study, we included 1590 patients with mid-low rectal cancer. Among them, 942 patients underwent low ligation surgery (LL), divided into 138 in the robotic group and 804 in the laparoscopic group. The high ligation surgery (HL) group consisted of 648 patients. The results of LL vs HL showed that the LL group had faster bowel movement recovery (P = 0.003), lower anastomotic leak rate (P = 0.032), and lower International Prostate Symptom Score (IPSS) at 6months postoperatively (P < 0.001). The results of Rob-LL vs Lap-LL showed that the Rob-LL group had longer operative time (P < 0.001), less blood loss (P = 0.001), more lymph nodes retrieved (P = 0.045), and lower Wexner score at 2weeks postoperatively (P = 0.029). The concept of low ligation of the inferior mesenteric artery is a promising surgical approach that can accelerate the patient's functional recovery. When combined with robotic technology, it may offer more benefits than laparoscopic techniques.

Incidence and risk factors for recurrent laryngeal nerve injury after thyroid surgery

ObjectivesInjury to the recurrent laryngeal nerve (RLNI) is a known possible morbidity after thyroid surgery. The clinical presentation varied in severity, from changes in voice quality and swallowing in unilateral cases to airway compromise in bilateral cases. In minor cases, vocal fold paralysis (VFP) may occur unnoticed. Although many intraoperative measures have been implemented to minimize nerve injury, the risk remains, either transient or permanent. This study evaluated the incidence and potential risk factors of recurrent laryngeal nerve injury after thyroidectomy.MethodsRetrospective data analysis was conducted on 1368 patients who underwent thyroidectomy at the National Guard Hospital, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia, between January 2008 and December 2021. Evaluations were conducted on the pathological features, surgical procedure type, and state of the recurrent laryngeal nerve during surgery as contributing to recurrent laryngeal nerve injury. All patients underwent preoperative and postoperative indirect laryngoscopy examinations with or without videostroboscopy. Physiological testing of the RLN using neurostimulation and laryngeal palpation (NSLP) or intraoperative neuromonitoring (IONM) was performed in all cases. VFP was considered present when vocal fold mobility was absent or significantly reduced.ResultsA total of 1368 patients (2177 nerves at risk) who underwent thyroidectomy and fulfilled the inclusive criteria (809 bilateral, 559 unilateral) were evaluated. A total of 62% of patients were more than 45 years old, and the mean age was 48.36 ± 13.03 with a male-to-female ratio of 1:3.6. Eight-hundred one (58.6%) patients underwent total or subtotal thyroidectomies (1602 nerves at risk). Two-hundred seventy-six patients underwent hemithyroidectomy (276 nerves at risk), and 291 patients underwent completion or redo surgeries (299 nerves at risk). Of these 1368 patients, post-surgery laryngoscopy showed reduced or absent vocal fold mobility in 47 (3.4%) patients. Forty-three out of 47 patients had unilateral vocal fold paralysis, and 4 had bilateral VFP. When we analyzed the three risk factors statistically significant for postoperative RLN palsy, age (OR, 1.01; 95% CI, 0.98–1.05; p = 0.365) became non-significant. The other risk factors (extent of surgery and histopathological diagnosis) remained statistically significant (p = 0.004 and 0.031). After adjustment, the extent of surgery, including total thyroidectomy and revision surgery, was strongly associated with a higher risk of odds of postoperative RLN palsy. Physiological RLN stimulation was performed in all cases with NSLP or INOM, and no significant association was observed in the incidence of VFP (p = 0.365). In most cases, symptoms were spontaneously resolved with recovery of vocal fold movement within a few months.ConclusionIn this study, 3.4% of the recurrent laryngeal nerve showed postoperative dysfunction either transient or permanent VFP. Intraoperative identification of the nerve remains the gold standard of care during thyroidectomy. Neuromonitoring aids in detecting the nerve, particularly in severe cases, but does not reduce the nerve injury compared to NSLP.

Selective injury of thalamocortical tract in neonatal rats impairs forelimb use: model validation and behavioral effects.

Unilateral brain injury in neonates results in largely contralateral hand function in children. Most research investigating neurorehabilitation targets for movement recovery has focused on the effects of brain injury on descending motor systems, especially the corticospinal tract. However, a recent human study demonstrated that sensory tract injury may have larger effects on dexterity than motor tract injury. To validate that the sensory tract injury impairs dexterity, we modeled the most common site of sensory tract injury in neonates by targeting the thalamocortical tract. In the postnatal day 7 rats, we used three types of lesions to the thalamocortical tract: periventricular blood injection, photothrombotic lesion, and electrolytic lesion. To test the sensitivity and specificity of these techniques, viral tracers were injected into the primary sensory or motor cortex immediately after injury. Electrolytic lesions were the most specific and reproducible for inducing a lesion compared to the other two methods. Electrolytic lesions disrupted 63% of the thalamocortical tract, while sparing the adjacent corticospinal tract in the internal capsule. To measure the impact on dexterity, the cylinder exploration and pasta handling tests were used to test the changes of forelimb use at 8 weeks after injury when the rats reached maturity. Lesions to the thalamocortical tract were associated with a significant decrease in the use of the contralateral forelimb in the cylinder task, and the degree of impairment positively correlated with the degree of injury. Overall, specific sensory system lesions of the thalamocortical tract impair forelimb use, suggesting a key role for skilled movement.

Ultrasound-guided vs. non-guided trigger finger release: a systematic review and meta-analysis.

Trigger finger (TF) is a common hand condition that can be treated with surgery. We conducted a systematic review and meta-analysis to assess whether ultrasound-guided (US-guided) percutaneous surgery is superior to other conventional surgical methods. We conducted a comprehensive search in Medline, Embase, and the Cochrane Library to identify relevant studies. We included randomized clinical trials (RCTs) and observational studies comparing US-guided TF release with blind percutaneous or open approaches. We combined Risk Ratios (RR) and Mean Differences (MD) with 95% Confidence Intervals (CI) across studies. Data processing and analysis were conducted using R software, version 4.3.1. Our analysis included eight RCTs and two observational studies with 555 patients. US-guided surgery significantly reduced postoperative DASH scores (MD -3.75 points; 95% CI = -7.48, -0.02; p < 0.01), shortened time to resume activities (MD -11.52 days; 95% CI = -16.13, -6.91; p < 0.01), hastened discontinuation of oral analgesics (MD -4.44 days; 95% CI = -8.01, -0.87; p < 0.01), and improved patient satisfaction scores (RR 1.13; 95% CI = 1.04, 1.23; p = 0.75). There were no significant differences in VAS scores, time to movement recovery, or surgical success rate. Ultrasound-guided percutaneous release is a safe, effective, and superior alternative for treating TF compared to other methods, leading to improved DASH scores, quicker recovery, faster cessation of oral analgesics, and enhanced patient satisfaction.

Noninvasive cerebellar stimulation and behavioral interventions: A crucial synergy for post-stroke motor rehabilitation

BACKGROUND: Improvement of functional movements after supratentorial stroke occurs through spontaneous biological recovery and training-induced reorganization of remnant neural networks. The cerebellum, through its connectivity with the cortex, brainstem and spinal cord, is actively engaged in both recovery and reorganization processes within the cognitive and sensorimotor systems. Noninvasive cerebellar stimulation (NiCBS) offers a safe, clinically feasible and potentially effective way to modulate the excitability of spared neural networks and promote movement recovery after supratentorial stroke. NiCBS modulates cerebellar connectivity to the cerebral cortex and brainstem, as well as influences the sensorimotor and frontoparietal networks. OBJECTIVE: Our objective was twofold: (a) to conduct a scoping review of studies that employed NiCBS to influence motor recovery and learning in individuals with stroke, and (b) to present a theory-driven framework to inform the use of NiCBS to target distinct stroke-related deficits. METHODS: A scoping review of current research up to August 2023 was conducted to determine the effect size of NiCBS effect on movement recovery of upper extremity function, balance, walking and motor learning in humans with stroke. RESULTS: Calculated effect sizes were moderate to high, offering promise for improving upper extremity, balance and walking outcomes after stroke. We present a conceptual framework that capitalizes on cognitive-motor specialization of the cerebellum to formulate a synergy between NiCBS and behavioral interventions to target specific movement deficits. CONCLUSION: NiCBS enhances recovery of upper extremity impairments, balance and walking after stroke. Physiologically-informed synergies between NiCBS and behavioral interventions have the potential to enhance recovery. Finally, we propose future directions in neurophysiological, behavioral, and clinical research to move NiCBS through the translational pipeline and augment motor recovery after stroke.

Using microdialysis to monitor dopaminergic support of limb-use control following mesencephalic neurosphere transplantation in a rodent model of Parkinson's Disease

Controlled nigrostriatal dopamine release supports effective limb use during locomotion coordination that becomes compromised after this pathway deteriorates in Parkinson’s Disease (PD). How dopamine release relates to active ongoing behavior control remains unknown. Restoring proper release strategy appears important to successful PD treatment with transplanted dopamine-producing stem cells. This is suggested by apparently distinct behavioral support from tonic or phasic release and corresponding requirements of requisite afferent control exhibited by intact nigrostriatal neurons. Our laboratory previously demonstrated that transplanted dopaminergic cells can elicit skilled movement recovery known to depend on phasic dopamine release. However, efforts to measure this movement-related dopamine release yielded seemingly paradoxical, incongruent results. In response, here we explored whether those previous observations derived from rapid reuptake transport into either transplanted cells or residual, lesion-surviving terminals. We confirmed this using minimal reuptake blockade during intrastriatal microdialysis. After unilateral dopamine depletion, rats received transplants and were subjected to our swimming protocol. Among dopamine-depleted and transplanted rats, treatment supported restoration of limb movement symmetry. Interestingly, subsequent reuptake-restricted microdialysis confirmed distinct swimming-induced dopamine increases clearly occurred among these lesioned/transplanted subjects. Thus, phasic firing control appears to contribute to transplant-derived recovery in Parkinsonian animals.

Enhancing poststroke hand movement recovery: Efficacy of RehabSwift, a personalized brain-computer interface system.

This study explores the efficacy of our novel and personalized brain-computer interface (BCI) therapy, in enhancing hand movement recovery among stroke survivors. Stroke often results in impaired motor function, posing significant challenges in daily activities and leading to considerable societal and economic burdens. Traditional physical and occupational therapies have shown limitations in facilitating satisfactory recovery for many patients. In response, our study investigates the potential of motor imagery-based BCIs (MI-BCIs) as an alternative intervention. In this study, MI-BCIs translate imagined hand movements into actions using a combination of scalp-recorded electrical brain activity and signal processing algorithms. Our prior research on MI-BCIs, which emphasizes the benefits of proprioceptive feedback over traditional visual feedback and the importance of customizing the delay between brain activation and passive hand movement, led to the development of RehabSwift therapy. In this study, we recruited 12 chronic-stage stroke survivors to assess the effectiveness of our solution. The primary outcome measure was the Fugl-Meyer upper extremity (FMA-UE) assessment, complemented by secondary measures including the action research arm test, reaction time, unilateral neglect, spasticity, grip and pinch strength, goal attainment scale, and FMA-UE sensation. Our findings indicate a remarkable improvement in hand movement and a clinically significant reduction in poststroke arm and hand impairment following 18 sessions of neurofeedback training. The effects persisted for at least 4 weeks posttreatment. These results underscore the potential of MI-BCIs, particularly our solution, as a prospective tool in stroke rehabilitation, offering a personalized and adaptable approach to neurofeedback training.

Measurement properties of movement smoothness metrics for upper limb reaching movements in people with moderate to severe subacute stroke

BackgroundMovement smoothness is a potential kinematic biomarker of upper extremity (UE) movement quality and recovery after stroke; however, the measurement properties of available smoothness metrics have been poorly assessed in this group. We aimed to measure the reliability, responsiveness and construct validity of several smoothness metrics.MethodsThis ancillary study of the REM-AVC trial included 31 participants with hemiparesis in the subacute phase of stroke (median time since stroke: 38 days). Assessments performed at inclusion (Day 0, D0) and at the end of a rehabilitation program (Day 30, D30) included the UE Fugl Meyer Assessment (UE-FMA), the Action Research Arm Test (ARAT), and 3D motion analysis of the UE during three reach-to-point movements at a self-selected speed to a target located in front at shoulder height and at 90% of arm length. Four smoothness metrics were computed: a frequency domain smoothness metric, spectral arc length metric (SPARC); and three temporal domain smoothness metrics (TDSM): log dimensionless jerk (LDLJ); number of submovements (nSUB); and normalized average rectified jerk (NARJ).ResultsAt D30, large clinical and kinematic improvements were observed. Only SPARC and LDLJ had an excellent reliability (intra-class correlation > 0.9) and a low measurement error (coefficient of variation < 10%). SPARC was responsive to changes in movement straightness (rSpearman=0.64) and to a lesser extent to changes in movement duration (rSpearman=0.51) while TDSM were very responsive to changes in movement duration (rSpearman>0.8) and not to changes in movement straightness (non-significant correlations). Most construct validity hypotheses tested were verified except for TDSM with low correlations with clinical metrics at D0 (rSpearman<0.5), ensuing low predictive validity with clinical metrics at D30 (non-significant correlations).ConclusionsResponsiveness and construct validity of TDSM were hindered by movement duration and/or noise-sensitivity. Based on the present results and concordant literature, we recommend using SPARC rather than TDSM in reaching movements of uncontrolled duration in individuals with spastic paresis after stroke.Trial RegistrationNCT01383512, https://clinicaltrials.gov/, June 27, 2011.

Development of a Novel Robotic Rehabilitation System Using Electrical Stimulation for Upper Limb Motor Recovery

To improve the quality of life for people with neurological disorders or accidents, it is important to create therapy tools for upper limb movement recovery that work and are easy for everyone to use. This study suggests a new artificial therapy device that uses electrical stimulation to help people recover their upper limb movement skills. The technology uses both artificial help and electrical treatment at the same time to help the brain change and learn new skills. The robotic therapy system is made up of a suit that moves with the upper limbs and supports them mechanically. It has sensors that can figure out what the user wants and change the amount of help based on that. In addition, the system has electrical activation probes that are put to target specific muscles or groups of muscles that help move the upper limbs. A closed-loop control system makes the system work. The user's moves are constantly tracked, and the robotic help and electrical stimulation are changed in real time. This flexible method lets recovery plans be made just for each person, based on their wants and results. A pilot study with people who have trouble moving their upper limbs was used to test how well the planned method would work. When the method was used for six weeks, the data showed big gains in motor function, muscle strength, and range of motion. Participants were also very happy with how easy the method was to use and how well it helped them improve their movement skills.