Repetitive Facilitation Exercise Research Articles

Evaluation of Short-Term Clinical Effects of a Novel Repetitive Facilitation Exercise Training Program Using a Hemiplegic Elbow Extension Rehabilitation System

Repetitive Facilitation Exercise (RFE) is known as an effective rehabilitation method that can elicit brain plasticity. In our previous study, we developed a hemiplegic upper limb rehabilitation system that can train the elbow and shoulder based on RFE theory. The system consists of a selective Arm-DoF constrainable mechanism and a multiple facilitative stimulus timing and duration control system. The selective Arm-DoF constrainable mechanism has three DoF, making it possible to selectively restrict a DoF of the shoulder or elbow. The multiple facilitative stimulation timing and duration control system only has an electrical stimulation source and a vibrator and no large actuators to perform the training exercise. In this study, we undertook an evaluation of the short-term clinical effects of a proposed elbow training program using the hemiplegic upper limb rehabilitation system. The training method consists of two sets, each involving 50 repetitions of the elbow extension exercise programmed in our system. We evaluated the short-term training effects through clinical trials for five stroke patients using the above method. In the evaluation, 10 repetitions of pre/post-tests without any facilitative stimulus were performed before and after the two sets of training. As a result, the maximum angular velocities or the average angular velocities of the elbow extensions improved significantly in most subjects. These results indicate that the quickness or the smoothness of elbow extension movements in the hemiplegic limb improved. Therefore, our clinical experiments support the short-term clinical benefits of the proposed method as well as the practicality of quantitative evaluation using our system.

Effects of Cognitive Sensory Motor Training Versus Repetitive Facilitation Exercises of Upper Limb in Hemiparetic Patients

Stroke [CVA] is the sudden loss of neurological function caused by an interruption of blood flow to the brain. Large numbers of people who survive a stroke are left with permanent impairment of arm and hand function, even after completion of conventional rehabilitation programs. The standard neuro physiological facilitation technique use for hemiplegic upper limb have not been confirmed to promote functional recovery of hemiplegic limb. This promote that more research needs to be conducted for same. Cognitive Sensory Motor Training Therapy & The repetitive facilitation exercises (RFEs) Both techniques will promote functional recovery of hemiparetic upper limb and hand by improving joint perception and realization of movement. Hence, this study aims to compare the effectiveness of cognitive sensory motor training versus repetitive facilitation exercises on quality of movement of upper limb, functional activity and Range of motion of upper limb in hemiparetic patients. A blinded randomized clinical trial was conducted 30 patients were divided into 2 groups (GROUP A and GROUP B)- those who performed cognitive Sensory Motor exercises(GROUP A- experimental group) and those who performed repetitive facilitation exercises (GROUP B-control group) Data for measures quality of movement performance of the hemiparetic arm and hand on MESUPES scale, Barthel Index (BI) measures the extent to which somebody can function independently and has mobility in their &, goniometer measuring the joint ranges in each plane of the joint was collected on day 1 (pretreatment session), and on 190 day after the experiment. This study produced a stastically significant increase in overall on quality of movement, functional activity and range of motion in both the group of upper limb in hemiplegic patients. This research also provides evidence that training exercise may be a valuable and important tool in clinical practice and is consistent with the current use by clinical physiotherapist in the treatment of upper limb in hemiplegic patients.

EFFECT OF MIRROR THERAPY VERSUS REPETITIVE FACILITATION EXERCISE ON UPPER LIMB FUNCTION IN POST STROKE PATIENT

Objective: To compare the effects of task-based mirror therapy and Repetitive Facilitation Exercise on upper limb function in post stroke patient. Methodology: A randomized controlled trial was conducted in Pakistan Railway general hospital, Rawalpindi. The duration of this study was from 10th July to 31st December 2019. Non-probability purposive sampling technique was used with n=50 male and female subacute and chronic post-stroke patients between 40-50 years. The patients with Modified Ashworth Scale <3 and the first-ever stroke was included. The participants were randomly divided by the sealed envelope method into mirror therapy group (n=25) and Repetitive Facilitation Exercise group (n=25). The Upper extremity functional index (UEFI) was used to assess the functional impairment in individuals with upper limb dysfunction, Fugl Meyer (FMA-UE) for assessment of activity in post stroke patients, “Wolf Motor Function Test (WMFT) for upper extremity performance and functional capability” and Brunnstrom recovery scale (BRS) for motor function of the upper limb was used in a post stroke patient. All the patients were assessed at baseline than after 3 weeks and again after 6week for interventional session of 30 min,3 days of the week. Data were analyzed through SPSS version 23. Results: The mean age of Group A (MT) was 50.97±6.741 and 49.76±12.66 of Group B (RFE). After 6 weeks of intervention between groups analysis of Task-based mirror therapy showed significant improvement in mirror therapy group as compare to Repetitive Facilitation Exercise group ,for upper extremity functional index scores(p<0.001) but for motor assessment(FMA-UE), Wolf Motor Function Test (WMFT) and for stroke recovery (Brunnstrom) no statistically significant difference (p≥0.05) was found. Within-group analysis of both groups showed statistically significant results in all variables (p<0.001). Conclusion: Mirror therapy and Repetitive facilitation Exercise both were found to be effective in improving upper limb motor functions of acute stroke patients. However, Mirror therapy has shown significant effects in upper extremity functional index. Keywords: Mirror therapy, Physical therapy, Repetitive Facilitation Exercise, Stroke, Upper extremity.

慢性期脳卒中患者の麻痺手使用の実現に向けてADOCによる目標設定と上肢への複合療法（電気刺激療法，装具療法，促通反復療法，CI療法）を実施した一例

慢性期脳卒中患者の麻痺手使用の実現に向けてADOCによる目標設定と上肢への複合療法（電気刺激療法，装具療法，促通反復療法，CI療法）を実施した一例

Brain–Machine Interface Using Functional Electrical Stimulation and Motion-Related Cortical Potentials Identified by a Support Vector Machine

This article presents a novel brain-machine interface system that uses electroencephalogram (EEG) and functional electric stimulation (FES) to support neurorehabilitation. Although repetitive facilitation exercise is a remarkable neurorehabilitation method, improving its success rate has proven difficult. This is because therapists are unable to detect patient motor commands and are thus, unable to stimulate the affected part of the body at the same time the motor commands are traveling along neuronal pathways. Here, we investigated the feasibility of both detecting the motor signal and, within milliseconds, stimulating the affected limb via a brain-machine interface system that combines the EEG and FES. The system extracts the timing of the motor commands from the EEG data using a support vector machine algorithm. Three healthy individuals participated in three experiments to: 1) decide the appropriate electric current value for stimulation; 2) determine the appropriate discrimination timing for the motor command detection algorithm; and 3) validate the effect using the system. The validation experiments were carried out under three experimental conditions-no system, fixed FES, and EEG-based FES. The results showed that for all three participants, wrist accelerations were significantly higher for EEG-based FES than for no system or fixed FES. We conclude that the EEG-based FES system detects the timing of motor commands and simultaneously stimulates a patient's affected limb in response.

Effects of concomitant neuromuscular electrical stimulation during repetitive transcranial magnetic stimulation before repetitive facilitation exercise on the hemiparetic hand.

Repetitive transcranial magnetic stimulation (rTMS) and Repetitive facilitative exercise (RFE) improves motor impairment after stroke. To investigate whether neuromuscular electrical stimulation (NMES) can facilitate the effects of rTMS and RFE on the function of the hemiparetic hand in stroke patients. This randomized double-blinded crossover study divided 20 patients with hemiparesis into two groups and provided treatment for 4 weeks at 5 days/week. NMES-before-sham group and NMES-following-sham group performed NMES sessions and sham NMES sessions for each 2 weeks. Patients received NMES or sham NMES for the affected extensor muscle concurrently with 1 Hz rTMS for the unaffected motor cortex for 10 min and performed RFE for 60 min. The Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), Box and Block Test (BBT) and Modified Ashworth Scale (MAS) were used for evaluation. FMA and ARAT improved significantly during both sessions. The gains in the BBT during an NMES session were significantly greater than those during a sham NMES session. MAS for the wrist and finger significantly decreased only during an NMES session. NMES combined with rTMS might facilitate, at least in part, the beneficial effects of RFE on motor function and spasticity of the affected upper limb.

The effects of neuromuscular electrical stimulation during repetitive transcranial magnetic stimulation before repetitive facilitation exercise on the hemiparetic hand in chronic stroke patients

The effects of neuromuscular electrical stimulation during repetitive transcranial magnetic stimulation before repetitive facilitation exercise on the hemiparetic hand in chronic stroke patients

Accuracy to detection timing for assisting repetitive facilitation exercise system using MRCP and SVM

This paper presents a feasibility study of a brain–machine interface system to assist repetitive facilitation exercise. Repetitive facilitation exercise is an effective rehabilitation method for patients with hemiplegia. In repetitive facilitation exercise, a therapist stimulates the paralyzed part of the patient while motor commands run along the nerve pathway. However, successful repetitive facilitation exercise is difficult to achieve and even a skilled practitioner cannot detect when a motor command occurs in patient’s brain. We proposed a brain–machine interface system for automatically detecting motor commands and stimulating the paralyzed part of a patient. To determine motor commands from patient electroencephalogram (EEG) data, we measured the movement-related cortical potential (MRCP) and constructed a support vector machine system. In this paper, we validated the prediction timing of the system at the highest accuracy by the system using EEG and MRCP. In the experiments, we measured the EEG when the participant bent their elbow when prompted to do so. We analyzed the EEG data using a cross-validation method. We found that the average accuracy was 72.9% and the highest at the prediction timing 280 ms. We conclude that 280 ms is the most suitable to predict the judgment that a patient intends to exercise or not.

Comparison between Effectiveness of Hand Arm Bimanual Intensive Training and Repetitive Facilitation Exercises on Upper Limb Functions In Post Stroke Hemiparetic Patients

Comparison between Effectiveness of Hand Arm Bimanual Intensive Training and Repetitive Facilitation Exercises on Upper Limb Functions In Post Stroke Hemiparetic Patients

Short-term effects of physiotherapy combining repetitive facilitation exercises and orthotic treatment in chronic post-stroke patients.

[Purpose] This study investigated the short-term effects of a combination therapy consisting of repetitive facilitative exercises and orthotic treatment. [Subjects and Methods] The subjects were chronic post-stroke patients (n=27; 24 males and 3 females; 59.3 ± 12.4 years old; duration after onset: 35.7 ± 28.9 months) with limited mobility and motor function. Each subject received combination therapy consisting of repetitive facilitative exercises for the hemiplegic lower limb and gait training with an ankle-foot orthosis for 4 weeks. The Fugl-Meyer assessment of the lower extremity, the Stroke Impairment Assessment Set as a measure of motor performance, the Timed Up & Go test, and the 10-m walk test as a measure of functional ambulation were evaluated before and after the combination therapy intervention. [Results] The findings of the Fugl-Meyer assessment, Stroke Impairment Assessment Set, Timed Up & Go test, and 10-m walk test significantly improved after the intervention. Moreover, the results of the 10-m walk test at a fast speed reached the minimal detectible change threshold (0.13 m/s). [Conclusion] Short-term physiotherapy combining repetitive facilitative exercises and orthotic treatment may be more effective than the conventional neurofacilitation therapy, to improve the lower-limb motor performance and functional ambulation of chronic post-stroke patients.

促通反復療法に基づく片麻痺膝関節屈曲機能回復訓練装置の開発

This paper proposes a functional recovery training device for hemiplegic knee flexion based on the Repetitive Facilitation Exercises, which can realize plasticity of the brain by a special procedure. Based on the Repetitive Facilitation Exercises, a muscle-rapidly-extended facilitating stimulus is proposed to induce knee flexion stretch reflex and cause voluntary knee flexion. Then a power assist control is given to help the voluntary movement and a mechanism is devised to realize the knee rehabilitation. Furthermore, facilitation assistant stimuli such as vibration stimulation, electrical stimulation, visual and hearing stimulation are proposed to improve the training effect. The performance and effectiveness of the device are shown by some results from able-bodied and hemiplegic subjects.

通所リハビリテーションにおける慢性期脳卒中片麻痺上肢への促通反復療法と治療的電気刺激・振動刺激との併用による麻痺改善効果

通所リハビリテーションにおける慢性期脳卒中片麻痺上肢への促通反復療法と治療的電気刺激・振動刺激との併用による麻痺改善効果

Outcomes of repetitive facilitation exercises in convalescent patients after stroke with impaired health status

Objective: To investigate the impact of stroke on health status and the effects of repetitive facilitation exercises (RFEs) for convalescent patients after stroke.Methods: The study was a prospective observational study of patients enrolled in an RFE programme. Between April 2008 and March 2012, 468 patients with stroke were enrolled in an intensive, comprehensive RFE programme. Patients participated in this interdisciplinary programme for 12 weeks, for an average of 5 hours per week. Before and immediately after the programme, several measures of rehabilitation outcomes and health-related quality-of-life were evaluated.Results: At baseline, most patients (95.4%) had modified Rankin scale scores of 3–5. Their health-related quality-of-life was significantly impaired, with physical and mental component summary scores on the Short Form 36-item questionnaire (SF-36) of 30.7 and 35.8, respectively. After the RFE programme, all outcome measures improved significantly.Conclusions: The results demonstrate that convalescent patients after stroke may benefit substantially from RFE programmes in stroke rehabilitation centres, even when patients have impaired health status or high levels of healthcare utilization. Thus, an RFE programme is a simple yet highly effective means to improve rehabilitation outcomes and health-related quality-of-life, with a relatively low dropout rate.

Timing Analysis of Robotic Neuromodulatory Rehabilitation System for Paired Associative Stimulation

In this paper, the timing accuracy of a tapping motion is analyzed for a robotic neuromodulatory rehabilitation system (RNRS). Paired associative stimulation (PAS) refers to repetitive application of conditioned transcranial magnetic stimulation (TMS) with peripheral stimulation at appropriate interstimulus intervals. When overlapped properly, this pairing can be used for rehabilitation through the rebuilding of neural pathways. Therefore in PAS, providing peripheral stimulation at the right time is crucial. The common procedure of PAS in the literature is to use electrical stimulation as peripheral stimulation. However, inspired by the repetitive facilitation exercise (RFE), mechanical stimulation is adopted in this RNRS experiment. Experiments show that RNRS can give mechanical stimulation accurately within a standard deviation of 5 ms. This stimulation is accurate enough when considering a 50 ms overlapping time window, the effective time range over which the overlap happens. The overlapping time window of mechanical stimulation is longer than that of electrical stimulation and it is expected to relax timing requirements in PAS by using RNRS. In addition, fMRI-compatible RNRS will allow further research on how mechanical stimulation itself affects on brain by observing brain activity through fMRI, where a general electrical stimulation device and TMS are not allowed. These results will help to get a consistent neural plasticity effect with RNRS for individuals with stroke and allow performing further research on brain plasticity in fMRI, contributing to the neuromodulation research.

脳梗塞急性期における片麻痺上肢への促通反復療法と持続的低周波電気刺激法の同時併用療法による運動機能と浮腫の改善

目的：脳梗塞急性期の片麻痺上肢への促通反復療法を持続的低周波電気刺激下で行う同時併用療法が麻痺と浮腫，関節可動域に及ぼす影響について検討した．対象：対象は2011 年4 月から2 年間に当院に入院した急性期脳梗塞片麻痺患者で，片麻痺と麻痺側手に浮腫があった患者30 名である．方法：単盲検無作為化比較試験を用い，促通反復療法と持続的低周波電気刺激との同時併用療法群（介入群）と関節可動域訓練群（対照群）に割付け，それぞれの治療を30 分，2 週間実施した．効果の評価はUpper Limb Fugl-Meyer Assessment（FMA），浮腫の測定，関節可動域テストを治療の前後に行った．結果：治療によって，介入群は全ての評価が有意に改善した．対照群はFMAに有意な改善を認めたが浮腫と関節可動域は改善がなく，改善度も介入群がFMAと浮腫，関節可動域で対照群より有意に大きかった．結語：促通反復療法と持続的低周波電気刺激の同時併用療法は，急性期片麻痺上肢の運動麻痺回復と麻痺側手の浮腫軽減を促進する．

S5-5. Effects of repetitive transcranial magnetic stimulation with repetitive facilitation exercise in post-stroke patients

Repetitive magnetic stimulation (rTMS) induces functional and structural plasticity, while repetitive facilitation exercises (RFEs) promote the functional recovery of the hemiplegic upper limb and hand to a greater extent than the conventional therapy. The aim of this study was to investigate whether multiple sessions of 1-Hz rTMS facilitated the effect of RFEs on hemiplegic upper-limb function in chronic post-stroke patients. The study design was a randomized double-blinded crossover study. Eighteen patients with hemiplegia of the upper limb, were assigned to two groups: the motor-before-sham rTMS group, which performed motor rTMS sessions for two weeks followed by sham rTMS sessions for two weeks; or the motor-following-sham rTMS group, which performed sham rTMS sessions for two weeks followed by motor rTMS sessions for two weeks. Patients received 1-Hz rTMS to the unaffected motor cortex for four minutes and performed RFEs for 40 min during motor rTMS sessions. The Fugl-Meyer assessment, Action Research Arm test and simple test for evaluating hand function were used to evaluate upper-limb function. Motor function improved significantly during the motor, but not sham, rTMS sessions. We concluded that multiple sessions of 1-Hz rTMS facilitated the effect of RFEs in improving the motor function of the affected upper limb.

Effects of repetitive trascranial magnetic stimulation on repetitive facilitation exercises of the hemiplegic hand in chronic stroke patients

To investigate whether multiple sessions of 1-Hz repetitive transcranial magnetic stimulation (rTMS) facilitates the effect of repetitive facilitation exercises on hemiplegic upper-limb function in chronic stroke patients. Randomized double-blinded crossover study. Eighteen patients with hemiplegia of the upper limb. Patients were assigned to 2 groups: a motor-before-sham rTMS group, which performed motor rTMS sessions for 2 weeks followed by sham rTMS sessions for 2 weeks; or a motor-following-sham rTMS group, which performed sham rTMS sessions for 2 weeks followed by motor rTMS sessions for 2 weeks. Patients received 1-Hz rTMS to the unaffected motor cortex for 4 min and performed repetitive facilitation exercises for 40 min during motor rTMS sessions. The Fugl-Meyer Assessment, Action Research Arm Test (ARAT) and Simple Test for Evaluating Hand Function were used to evaluate upper-limb function. The Modified Ashworth Scale and F-wave were measured to evaluate spasticity. Motor function improved significantly during the motor, but not sham, rTMS sessions. ARAT score gains were 1.5 (0-4.0) (median, interquartile range) during the motor rTMS session, and 0 (-0.8-1.8) during the sham rTMS session (p = 0.04). Spasticity did not significantly change during either session. Multiple sessions of 1-Hz rTMS facilitated the effects of repetitive facilitation exercises in improving motor function of the affected upper limb, but did not change spasticity.

脳卒中リハビリテーションの革新を目指す促通反復療法(川平法)

脳卒中リハビリテーションの革新を目指す促通反復療法(川平法)

1A1-C08 伸張反射が与える随意運動強度への影響評価(リハビリテーションロボティクス・メカトロニクス(1))

This paper reports strength change of a voluntary contraction when the voluntary motion is synchronized with a stretch reflex induced by involuntary stretch of a muscle. A device developed in this study introduces the stretch reflex on flexor muscles of MP joints by instantaneous extension of the MP joints of four fingers. The device also measure flexion torque of the MP joints and a bioelectric potential (BEP) signal around a forearm. First, it is confirmed by experiments that the reflective force of the stretch reflex becomes bigger when an angular velocity for the instantaneous extension of the MP joints increases. Second, it is found that the contraction force of voluntary flexion is intensified by the stretch reflex synchronization. These results will back up a mechanism of the repetitive facilitation exercise (RFE) that is patient's repetitive exercises of an intended movement accompanied with a facilitation given by a therapist.

Effect of Additive Application of Repetitive Facilitation Exercise to Conventional Rehabilitation in Hemiplegic Stroke Patients in the Recovery Stage: A Controlled Clinical Trial on Motor Functional Recovery in Hemiplegia and Activities of Daily Living

【目的】脳卒中回復期において，包括的リハビリテーション (包括的リハ) に促通反復療法を含む場合と含まない場合の治療成績を比較する．【対象・方法】対象は脳卒中回復期52 症例で，介入内容を通常の包括的リハ (通常治療群) と包括的リハに促通反復療法を取り入れた (促通反復群) とに無作為に割付け，約17 週の治療効果を前方視的に比較した．評価は運動麻痺を上田のグレードで，日常生活活動をFunctional Independence Measure (FIM)で行った．【結果】両群の年齢や罹病期間，加療期間などに有意の差はなかった．下肢や上肢，手指の麻痺改善度は統計学的有意にはいたらないが促通反復群で大きく，分離運動発現・分離例の割合は促通反復群が有意 (p<0.05) に大きかった．FIMの改善度も通常治療群に比べて下肢の促通反復群が総合項目および運動項目で有意 (p<0.05) に大きかった．手指の促通反復群ではFIMセルフケア項目でp値が0.080であった．【結論】促通反復療法を含む包括的リハは通常の治療より片麻痺とADLの改善を促進する可能性がある．