Rehabilitation Of Post-stroke Patients Research Articles

Brain-to-brain interface technology: A brief history, current state, and future goals.

A brain-to-brain interface (BBI), defined as a combination of neuroimaging and neurostimulation methods to extract and deliver information between brains directly without the need for the peripheral nervous system, is a budding communication technique. A BBI system is made up of two parts known as the brain-computer interface part, which reads a sender's brain activity and digitalizes it, and the computer-brain interface part, which writes the delivered brain activity to a receiving brain. As with other technologies, BBI systems have gone through an evolutionary process since they first appeared. The BBI systems have been employed for numerous purposes, including rehabilitation for post-stroke patients, communicating with patients suffering from amyotrophic lateral sclerosis, locked-in syndrome and speech problems following stroke. Also, it has been proposed that a BBI system could play an important role on future battlefields. This technology was not only employed for communicating between two human brains but also for making a direct communication path among different species through which motor or sensory commands could be sent and received. However, the application of BBI systems has provoked significant challenges to human rights principles due to their ability to access and manipulate human brain information. In this study, we aimed to review the brain-computer interface and computer-brain interface technologies as components of BBI systems, the development of BBI systems, applications of this technology, arising ethical issues and expectations for future use.

Network Reorganization for Neurophysiological and Behavioral Recovery Following Stroke.

<p>Stroke continues to be the main cause of motor disability worldwide. While it has been promised to improve recovery after stroke, efficacy in clinical trials has been mixed. We need to understand the cortical recombination framework to understand how biomarkers for neurophysiological reorganized neurotechnologies alter network activity. Here, we summarize the principles of the movement network, including the current evidence of changes in the connections and function of encephalic regions, recovery from stroke and the therapeutic effects of rehabilitation. Overall, improvements or therapeutic effects in limb motor control following stroke are correlated with the effects of interhemispheric competition or compensatory models of the motor supplementary cortex. This review suggests that future research should focus on cross-regional communication and provide fundamental insights into further treatment and rehabilitation for post-stroke patients.<p>.

Assessment of functional fitness impacted by hospital rehabilitation in post-stroke patients who additionally contracted COVID-19.

The aim of the study was to assess the effects of rehabilitation in post-stroke patients, or post-stroke patients with simultaneous COVID-19 infection, in relation to: improved locomotion efficiency, improved balance, reduced risk of falling as well as the patients' more effective performance in everyday activities. The study involved 60 patients in the early period (2-3 months) after a stroke. Group I consisted of 18 patients (30.0%) who, in addition to a stroke, also contracted COVID-19. Group II consisted of 42 patients (70%) post-stroke, with no SARS-CoV2 infection. The effects were assessed on the basis of: Tinetti test, Timed Up & Go test and Barthel scale. Both groups achieved a statistically significant improvement in their Barthel score after therapy (p < 0.001). The Tinetti test, assessing gait and balance, showed that participants in Group I improved their score by an average of 4.22 points. ±4.35, and in Group II, on average, by 3.48 points ± 3.45 points. In the Timed Up & Go test over a distance of 3 m, significant improvement was achieved in both groups, as well but the effect was higher in Group I (p < 0.001). Hospital rehabilitation in the early period after stroke improved locomotion efficiency and balance, and reduced the risk of falls in post-stroke patients, both with and without COVID-19 infection.

Youtube-based stroke care education development and its effectiveness on the levels of compliance with physical rehabilitation in post-stroke patients

Stroke is damage to brain tissue due to disruption of blood flow to the brain. One impact in stroke patients is weakness on one side of the body or hemiparesis. The management of stroke includes physical rehabilitation. However, many post-stroke patients still do not comply with physical rehabilitation, so education is needed about the importance of complying with physical rehabilitation to accelerate recovery and restore movement function in post-stroke patients. The purpose of this study is to develop Stroke Care Education and analyze its effectiveness on adherence to physical rehabilitation in post-stroke patients. The design of this study used Research and Development (R&amp;D) and a quasy experiment with a pretest-posttest control group design which was carried out for 21 days. The sampling technique used purposive sampling which consisted of 60 respondents who were divided into the intervention and control groups. The intervention group was given YouTube-based Stroke Care Education twice a day (20 minutes), while the control group was given a leaflet. The measurement method used a level of adherence questionnaire, namely the Morinsky Medication Adherence Scale (MMAS) with low, medium, and high measurement values. The data were analyzed using the Wilcoxon test and the Mann-Whitney test. The results of this study YouTube-based Stroke Care Education is suitable for use for post-stroke patients with a validity test result value of 87.5%. The statistical test results showed an increase in adherence to physical rehabilitation in the intervention group compared to the control group, from an average score of 4.40 to 7.57. Meanwhile, in the control group, it increased from 3.77 to 4.23 with a value of p = 0.000. In conclusion, YouTube-based Stroke Care Education is effective in increasing adherence to physical rehabilitation in post-stroke patients.

The Impact Of Family Support On Increasing Muscle Strength Rehabilitation Post-Stroke Adults In Bukittinggi City 2023

Stroke is still the main cause of disability in the world. The impact of a stroke relies heavily on the location and extent of damage, and age. Post-stroke is the most difficult period for patients in they personal care. Family support is essential to increase confidence for rehabilitation in post-stroke patients. Rehabilitation  in post-stroke patients is done so that post-stroke patients are able to perform daily activities independently. The aims of this study to determine the relationship family support with increasing muscle strength rehabilitation in  post-stroke adult. The Method : This research was an analytical observational and was conducted in Bukittinggi City on July, 2023. The variables studied family support with muscle strength. This research is a quantitative research with Cross-sectional design. The population in this study were post-stroke patients 50 people and the sample amounted to 42 respondent. Results : The result of this research shows that there is a strong relationship between family support and increasing muscle strength in rehabilitation p-value 0.006&lt;0.05. The conclusion is family support has impact to inceasing muscle strength rehabilitation of post-stroke adult patients. It is recommended for health workers to provide counseling to improve family support in curing stroke patients. The study confirms the importance of family support in terms of information support and awards support to the quality of life of patients with post-stroke.

Objectivizing Measures of Post-Stroke Hand Rehabilitation through Multi-Disciplinary Scales

There is a wide variety of tools and measures for rehabilitation outcomes in post-stroke patients with impairments in the upper limb and hand, such as paralysis, paresis, flaccidity, and spasticity. However, there is a lack of general recommendations for selecting the most appropriate scales, tests, and instruments to objectively evaluate therapy outcomes. Reviews on upper limb and hand measurements reveal that clinicians’ choices of tools and methods are highly varied. Some clinicians and medical teams continue to employ non-standard and unverified metrics in their research and measurements. This review article aims to identify the key parameters, assessed by outcome measures and instruments, that play a crucial role in upper limb and hand rehabilitation for post-stroke patients, specifically focusing on the recovery of hand function. The review seeks to assist researchers and medical teams in selecting appropriate outcome measures when evaluating post-stroke patients. We analyze the measured factors and skills found in these outcome measures and highlight useful tools that diversify assessments and enhance result objectivity through graphical representation. The paper also describes trends and new possibilities in hand outcome measures. Clinicians frequently use proven devices, such as EMG, goniometers, and hand dynamometers. Still, there is a growing trend towards incorporating technologies, such as pose and position estimation, using artificial intelligence, or custom hand grip measurement devices. Researchers are increasingly adopting scales previously successful in orthopedic and surgical patients, recognizing their potential for objectivizing outcomes in neurological patients with post-stroke hand complications. The review included only adults over the age of 18. Outcome measures were tested for usefulness in the rehabilitation of stroke patients.

Social Participation and Physical Activity Incentive at Home in Stroke Survivor: Contribution of Technologies.

Increased physical activity has been demonstrated as a relevant treatment after a stroke, with positive effects on impairment recovery, activity limitation, social participation and quality of life. Furthermore, PA is now recommended as part of the stroke recovery pathway, starting during inpatient care and extending through rehabilitation and community integration. The purpose of this presentation is to describe how current technologies may facilitate a continuity of care for stroke survivors. We present a synthesis of 8 studies that we have conducted to date to assess and monitor the activity level of post-stroke patients at home. The results of these studies show that home rehabilitation of post-stroke patients requires the use of individualized monitoring criteria to optimize patient care. To encourage the patient to increase his level of moderate physical activity and reduce his sedentary time, it would be recommended to propose a regularly monitored and structured program.

Enriched environment-induced neuroplasticity in ischemic stroke and its underlying mechanisms.

Stroke is a common cerebrovascular disease that can interrupt local blood flow in the brain, causing neuronal damage or even death, resulting in varying degrees of neurological dysfunction. Neuroplasticity is an important neurological function that helps neurons reorganize and regain function after injury. After cerebral ischemia, neuroplasticity changes are critical factors for restoring brain function. An enriched environment promotes increased neuroplasticity, thereby aiding stroke recovery. In this review, we discuss the positive effects of the enriched environment on neuroplasticity after cerebral ischemia, including synaptic plasticity, neurogenesis, and angiogenesis. In addition, we also introduce some studies on the clinical application of enriched environments in the rehabilitation of post-stroke patients, hoping that they can provide some inspiration for doctors and therapists looking for new approaches to stroke rehabilitation.

Body ownership illusion through virtual reality as modulator variable for limbs rehabilitation after stroke: a systematic review

Stroke is the leading cause of motor impairments and generates distortion of body representation. Hence, stroke can modulate the sense of embodiment, namely the feeling of being inside the body (ownership), in the place where the body is located (location), and moving the body according to its own intentions (agency). A growing number of studies have adopted virtual reality (VR) to train motor abilities. However, the impact of the body illusion on the rehabilitation outcome is not fully understood. The present systematic review investigates the modulating role of the body illusion elicited by VR on motor rehabilitation in post-stroke patients after embodying a virtual avatar. The research was led in the main databases—PubMed, Scopus, PsychINFO, and Web of Science—and four studies matched the inclusion criteria (e.g., to have a sample of adult post-stroke patients, to use VR as an instrument for motor rehabilitation, to adopt the paradigm of the body illusion as a modulator for motor rehabilitation, to test the sense of body illusion outcome). Research outcomes demonstrated that two studies adopted the immersive and two the non-immersive embodied VR; three studies focused on the upper limb, and one on lower limb rehabilitation. Two studies compare VR training with traditional therapy, and two are pilot studies with only one experimental group. The studies demonstrated the feasibility of the body illusion as an accelerator for motor rehabilitation compared to the non-embodied condition, and as a positive correlator of the rehabilitation outcome. The finding should be taken with caution due to the limited studies included; however, they are encouraging to justify further research efforts in this area.

Correlation of the Fugl Meyer assessment, Motricity Index and Barthel Index scales in the assessment of rehabilitation in post-stroke patients

Measuring scales are an indispensable tool in rehabilitation interventions, especially when you want to intervene with Traditional medicine methods on post-stroke patients. Appropriate scales are a prerequisite to assessing treatment response, the degree of recovery, and the value of the intervention method. The Barthel Index (BI) is a common scale used to measure activity function (activities of daily living - ADL), while the Fugl Meyer Assessment (FMA) and Motricity Index (MI) are commonly used scales to measure motor function. A descriptive cross-sectional study was conducted on 128 post-stroke patients with hemiplegia from March 2021 to November 2022. Spearman’s test assessed the correlation of 3 scales: BI, FMA, and MI. FMA and MI significantly correlate with BI, with correlation coefficients of r = 0.659 and r = 0.748, respectively. The subdomains of FMA, including FMA-UE (upper extremity), FMA-LE (lower extremity), and MI, including MI-UE (upper extremity), MI-LE (lower extremity), TCT (Trunk Control Test), are also highly correlated with BI. Research results show that scales such as FMA and MI strongly correlate with BI and can be a valuable tool to support the comprehensive assessment of motor and activity function in post-stroke patients.

Association Between Self And Caregiver Reported Sleep Problems And Polysomnographic Findings In Post-stroke Patients: A Cross Sectional Study. (S20.007)

<h3>Objective:</h3> To determine post-stroke sleep disturbances (PSSD) by polysomnography (PSG) and compare them with patient and caregiver reported symptoms and sleep questionnaires <h3>Background:</h3> Post stroke sleep disturbances (PSSD) are common with prevalence of 70–80%. The awareness of patients and caregivers about the various sleep problems and its implications on quality of life &amp; outcome has not studied extensively. Identification can aid in optimum management and rehabilitation of post-stroke patients. <h3>Design/Methods:</h3> In a cross-sectional study, we screened post-stroke patients (between one month to one year after stroke onset) &amp; their caregivers about various sleep problems. This was done by a screening questionnaire, followed by specific sleep questionnaires (Pittsburgh sleep quality index (PSQI) and STOP BANG questionnaire). A subset of consenting patients underwent overnight PSG. The association of sleep questionnaires with PSG findings were done. <h3>Results:</h3> In the study period (January 2021 and June 2022), 103 post-stroke patients were enrolled, of which 41(39.8%) underwent PSG. While only 15.5% (16/103) patients and/or caregivers reported any sleep disorders themselves, when specifically asked about insomnia, snoring, excessive daytime sleepiness &amp; abnormal leg movements in sleep, this number increased to 60.2% (60/103). Further, a PSQI&gt;5, signifying poor sleep quality was present in 71.8% (74/103), and high risk of obstructive sleep apnea (OSA) by STOP BANG questionnaire was present in 33% (34/103). PSG showed Apnea Hypopnea Index (AHI)&gt;5 in 65.9% (27/41) patients, 39% (16/41) had periodic leg movements (PLMS) and 34.2% (14/41) had disrupted sleep. Even when patients &amp; caregivers had denied any sleep disturbances, the PSG in 29 such patients showed OSA in 62 % (18/29) and PLMS in 34.5% (10/29). <h3>Conclusions:</h3> The study provided insight into the knowledge gap between patient &amp; caregiver perceived sleep disturbances &amp; sleep questionnaires and polysomnography. Longitudinal studies are warranted in this population to assess the effect of treatment of sleep disturbances on outcomes like quality of life and stroke recurrence. <b>Disclosure:</b> Dr. Tayade has nothing to disclose. Dr. Vibha has nothing to disclose. Dr. Tripathi has nothing to disclose. Rajesh Kumar Singh has nothing to disclose. Dr. Elavarasi has stock in Pfizer. Dr. Elavarasi has stock in PGHL. The institution of Dr. Elavarasi has received research support from All India Institute of Medical Sciences, New Delhi. The institution of Dr. Elavarasi has received research support from Indian Council for Medical Research.

Efficiency of High-Intensity Gait Training in the Rehabilitation of Post-Stroke Patients

Aim: Research of the effectiveness of high-intensity gait training in the rehabilitation of middle-aged patients in different periods after a stroke. Materials and Methods: Middle-aged post-stroke patients took part in the research. They performed either a comprehensive rehabilitation program with the addition of high-intensity gait training or only high-intensity gait training. All patients underwent an assessment of their functioning before and after rehabilitation programs. The following tests were used for assessment: the Berg Balance Scale, the Modified Rivermead Mobility Index, the Functional Ambulation Classification, the 10-meter walk test, and “Get Up and Go” test. The results were processed using statistical methods. Results: The application of high-intensity gait training has demonstrated high efficiency in middle-aged post-stroke patients. Adding the method of high-intensity gait training to comprehensive rehabilitation programs demonstrated significantly higher efficiency than the use of only high-intensity gait training. At the same time, in post-stroke patients, in the early recovery period, the improvement in functioning was better than in the late recovery period. Conclusions: Adding the method HIGT to the comprehensive rehabilitation of middle-age post-stroke patients leads to a significant improvement in their functioning, especially in the early recovery period.

Exoskeleton Design Using Kinematics Analysis for Upper Limb Rehabilitation in Post-Stroke Patients

Robotic technology in the last decade has developed to support the rehabilitation of post-stroke patients. The exoskeleton design model approach is carried out to simulate kinematics according to the needs of upper limb rehabilitation. The simulated design is identical to the structure of the human arm, so it requires planning and method according to the needs of human arm anatomy movements. The exoskeleton model must meet comfort and adjustment for medical rehabilitation, so it is essential to consider the kinematic analysis in its design. In this paper, we will analyze the kinematics of the exoskeleton and simulate flexion/extension and supination/pronation movements, with the targeted area being the forearm with the 3 Degrees of Freedom (DoF) mechanism consisting of two DoF. Kinematic simulations are carried out with the RoboAnalyzer software using predefined Denavit-Hartenberg parameters. The simulation results show that the end effector's initial position on the X axis is to coordinate 0 on the base 45o joint shoulder, then the rotational movement on the elbow is 1150 . In the wrist position, the action is supination and pronation because the joint is parallel to the elbow. Hence, the coordinates of the x and y-axis rotation changes follow elbow coordinates.

Machine Learning Techniques for the Prediction of Functional Outcomes in the Rehabilitation of Post-Stroke Patients: A Scoping Review

Stroke is one of the main causes of long-term disabilities, increasing the cost of national healthcare systems due to the elevated costs of rigorous treatment that is required, as well as personal cost because of the decreased ability of the patient to work. Traditional rehabilitation strategies rely heavily on individual clinical data and the caregiver’s experience to evaluate the patient and not in data extracted from population data. The use of machine learning (ML) algorithms can offer evaluation tools that will lead to new personalized interventions. The aim of this scoping review is to introduce the reader to key directions of ML techniques for the prediction of functional outcomes in stroke rehabilitation and identify future scientific research directions. The search of the relevant literature was performed using PubMed and Semantic Scholar online databases. Full-text articles were included if they focused on ML in predicting the functional outcome of stroke rehabilitation. A total of 26 out of the 265 articles met our inclusion criteria. The selected studies included ML approaches and were directly related to the inclusion criteria. ML can play a key role in supporting decision making during pre- and post-treatment interventions for post-stroke survivors, by utilizing multidisciplinary data sources.

Occurrence of Urinary Tract Infections and Physical Functioning in Patients After Stroke

Introduction: The majority of brain strokes result in a reduction of physical functioning and remain a major cause of disability. Post-stroke rehabilitation aims to improve physical functioning of patients who have suffered from stroke. Infections, including those of the urinary tract (UTI), are complications of stroke that occur in patients who undergo physical therapy at stationary departments of neurological rehabilitation and may significantly influence its effectiveness. Study aim: The main objective of the study is to assess the relationship between the UTI and physical functioning in patients after stroke, and the relationship between prevalence of UTIs and the results of rehabilitation in post-stroke patients. Material and methods: An observational case-control study was conducted, with a natural selection into the study groups according to the prevalence of UTI. Data was collected from the medical records of all stroke patients rehabilitated at the inpatient Neurological Rehabilitation Department of ORNR “Krzeszowice” in Krzeszowice during the period from 01 Jan. 2012 to 31 Dec. 2014. The study included 400 patients. Physical functioning was assessed using the Barthel and Rankin scales. Results. UTI occurred in 37.5% of patients. In the univariate analysis, the occurrence of UTIs was associated with worse physical functioning at admission and discharge. After adjustment to the influence of gender, age, side and type of stroke, the time since discharge from the stroke unit, the presence of diabetes and use urinary catheter, better physical functioning at admission to the neurological rehabilitation unit was inversely related to the occurrence of UTI (according to the Barthel scale: OR = 0.89, 95% CI: 0.85-0.94); according to the Rankin scale: OR = 1.75; 95% CI: 1.33-2.32). At discharge, after adjustment for: influence of physical functioning at admission to the ward and other confounding factors, the occurrence of UTI was not significantly correlated with the physical functioning of patients. During hospitalisation, physical functioning improved in both groups, but among the group of patients with UTI, the dynamics of the change was significantly greater than in patients without UTI. Conclusions. In stroke patients referred to inpatient neurological rehabilitation, UTIs are a common complication. The occurrence of UTI was associated with decreased physical functioning at admission to the department, but in patients with UTI, more dynamic improvement in physical functioning was found during rehabilitation. The incidence of UTI was not related to physical functioning at discharge from the ward.

Prognosis prediction of the effect of botulinum toxin therapy and intensive rehabilitation on the upper arm function in post-stroke patients using hierarchical cluster analysis

Purpose We analysed the effect of botulinum neurotoxin A therapy (BoNT-A) with intensive rehabilitation on the upper limb (UL) spasticity in post-stroke patients by classifying function by UL movement and examining differences in functional improvement. Materials and methods In this non-randomized, controlled study. The patient function was classified into groups from the score of the sub-categories of the Fugl–Meyer Assessment (FMA-UE) before treatment in the Intervention group by hierarchical cluster analysis. Results A total of 139 patients in the Intervention group were classified into six groups. All groups showed a significant improvement in FMA-UE after the intervention. In the group scoring 19–31 points on the FMA-UE and with the voluntary movement of shoulder, elbow, forearm, and finger, a significant improvement was observed compared to the Control group. Further, in the group scoring 26–47 points on the FMA-UE and with the voluntary movement of shoulder, elbow, forearm, wrist, and finger, a significant improvement was observed compared to the Control group. Conclusions In this study, BoNT-A and intensive rehabilitation showed improvement in spasticity and UL function. A high therapeutic effect is expected in patients with moderate impairment levels who have voluntary movement in whole UL or in UL except for the wrist. IMPLICATIONS FOR REHABILITATION Hierarchical cluster analysis focusing on the Fugl–Meyer Assessment of the Upper Extremity sub-categories may be useful for studies aimed to improve the upper arm function. Botulinum Neurotoxin A therapy (BoNT-A) and intensive rehabilitation in post-stroke patients showed improvement in spasticity and upper arm function. The degree of the upper arm function before the intervention may affect the improvement effect of BoNT-A and intensive rehabilitation. In the motor function, the post-stroke patients with a moderate impairment level who have voluntary movement of the whole upper limb or upper limb except for the wrist are most likely to receive these therapeutic effects.

Cross-validation of predictive models for functional recovery after post-stroke rehabilitation

BackgroundRehabilitation treatments and services are essential for the recovery of post-stroke patients’ functions; however, the increasing number of available therapies and the lack of consensus among outcome measures compromises the possibility to determine an appropriate level of evidence. Machine learning techniques for prognostic applications offer accurate and interpretable predictions, supporting the clinical decision for personalised treatment. The aim of this study is to develop and cross-validate predictive models for the functional prognosis of patients, highlighting the contributions of each predictor.MethodsA dataset of 278 post-stroke patients was used for the prediction of the class transition, obtained from the modified Barthel Index. Four classification algorithms were cross-validated and compared. On the best performing model on the validation set, an analysis of predictors contribution was conducted.ResultsThe Random Forest obtained the best overall results on the accuracy (76.2%), balanced accuracy (74.3%), sensitivity (0.80), and specificity (0.68). The combination of all the classification results on the test set, by weighted voting, reached 80.2% accuracy. The predictors analysis applied on the Support Vector Machine, showed that a good trunk control and communication level, and the absence of bedsores retain the major contribution in the prediction of a good functional outcome.ConclusionsDespite a more comprehensive assessment of the patients is needed, this work paves the way for the implementation of solutions for clinical decision support in the rehabilitation of post-stroke patients. Indeed, offering good prognostic accuracies for class transition and patient-wise view of the predictors contributions, it might help in a personalised optimisation of the patients’ rehabilitation path.

The Emergence of Dry Needling in Stroke Rehabilitation

The management of stroke, acute revascularization and rehabilitation techniques have taken a giant leap in the current decade. The presence of neurological deficits, spasticity and pain are the common limiting factors in post-stroke patients. The various rehabilitation measures in stroke are focused on improving the trio. Spasticity, in a post-stroke patient, is disabling and can be managed using oral pharmacological agents, botulinum toxin, intrathecal baclofen. The use of needle therapy, dry needling, which was commonly used in the management of myofascial pain syndromes has emerged useful in the management of spasticity. Further recent evidence has shown it to be useful in the other dimensions of stroke rehabilitation. Dry Needling is a skilled intervention, that is performed by trained personnel using a filiform needle. It can be performed superficially or deep. The speculative mechanisms by which dry needling reduces spasticity include inducing stretch in the muscle and afferent modulation of the sensory information from the muscle. It improves blood flow and oxygenation, reduces pain through central and peripheral mechanisms. (1)&#x0D; The use of dry needling in neurology has evolved from its use in the management of myofascial pain to spasticity in spastic tetra paresis and stroke rehabilitation. In post-stroke patients, dry needling has been used in the management of post-stroke spasticity, balance, post-stroke pain. In the management of spasticity, dry needling using ‘pistoning technique’ in the lower limbs (gastrocnemius, tibialis posterior) and upper limbs (shoulder, elbow and wrist) revealed improved scores in modified modified Ashworth scale (MMAS) that translated to improved gait and range of upper limb motion respectively. The dry needling was performed for 1 minute in each muscle studied. However, the number of sessions varied from a single session to 8-week therapy between studies. In the management of balance, the dry needling of the involved tibialis posterior muscle improved the balance as measured by single-leg stance, balance component of Fugl-Meyer scale and dynamic posturography. The improvement in the above measures is also shown to improve the functional outcome of post-stroke patients in Barthel index, 10-metre walk test, timed up and go test. The dry needling is shown to reduce pain including post-stroke shoulder pain by reducing the pain threshold. The above effects of dry needling were also evident in ultrasound assessment of the intervened gastrocnemius muscle that showed improved muscle length, reduced mean muscle thickness and angle of pennation. (1-3)&#x0D; The dry needling has also been studied in post-stroke rehabilitation as a component of the multimodal approach. The use of dry needling in conjunction with electrical stimulation of the muscle is shown to produce persistent improvement in the tone of the muscle. The adverse events noted following the use of dry needling include post interventional muscle soreness, bleeding, bruise and pain during the intervention. Major side effects such as loss of consciousness are rare and hence dry needling serves as a safe therapeutic option in the rehabilitation of post-stroke patients. (1-3)&#x0D; Hence dry needling is a safe, cost-effective technique that can be used in the management of post-stroke spasticity, balance, pain that translates to improved functional outcomes. However, further evidence is required to establish the efficacy of this promising technique in the management of post-stroke rehabilitation.

Walking skills recovery for patients suffered a stroke

Recovering the walking ability is one of the major goals in rehabilitation of poststroke patients. Locomotor training should be preceded by identifying pathological gait characteristics and functional gait assessment. The spectrum of rehabilitation methods for restoration of walking skills is quite wide and includes conventional training, training on a treadmill without body weight support and with body weight support, using of electromechanical and robotic devices, additional use of biofeedback, virtual reality, orthoses, electrical muscle stimulation, strength training and balance training. The review provides a brief description of these rehabilitation methods in view of evidence-based medicine. The individual choice of procedures depends on the severity, duration and characteristics of walking defiits, the patient’s preferences and limitations associated with his concomitant diseases.

Upper-Limb Rehabilitation Robot: A Measure of Intent Detection for Robot Aided Active Therapy Exercise

<h3>Research Objectives</h3> In robot-aided rehabilitation of post-stroke patients with upper limb impairment, robotic device must allow patient's effort in performing exercises. To estimate such effort, user's force exerted on robotic device can be used during active exercises. To validate use of force exerted by user/wearer by comparing with EMG signals as a measure of intent detection in robot-aided active therapy on rehabilitation robot, in this research, user's interactive force with robot was measured and compared with user's muscle activity (EMG) during elbow flexion-extension performed by an upper-limb rehabilitation robot (u-Rob). This physiological measure will help design rehab robot centering patient's need and level of impairment. Furthermore, it can give an indication of spastic behavior during rehab exercises. <h3>Design</h3> Experimental study of robot-aided therapy to observe force values with EMG values, leading to use force as a measure of intent detection. <h3>Setting</h3> Protocol: Elbow flexion/extension (0-120 deg) motion. Experiments (passive and active therapy exercise, five trials/exercise) were conducted with healthy subject in seated position wearing the robot. <h3>Participants</h3> 2 healthy males and 1 healthy female. <h3>Interventions</h3> Elbow flexion/extension (0-120 deg) motion. Experiments (passive and active therapy exercise, five trials) were conducted subject in seated position wearing the robot. <h3>Main Outcome Measures</h3> Force exerted by the participant and participant's EMG <h3>Results</h3> Significant amount of force is exerted during active exercise and significant amount of EMG activity is observed during active exercise. Besides, looking at the torque, it is seen that during active rehab exercise, robot has to contribute lesser torque than in passive exercise. <h3>Conclusions</h3> User-robot interactive forcesdetected by sensor can be used as a measure of intent detection during robot-aided active exercise. Moreover, measured forces can also be observed from muscle activity. It may give an idea of subject's spastic behavior. <h3>Author(s) Disclosures</h3> N/A.