Hemiplegic Stroke Research Articles

Prototype of an Ankle Neurorehabilitation System with Heuristic BCI Using Simplified Fuzzy Reasoning

Neurorehabilitation using a brain–computer interface (BCI) requires machine learning, for which calculations take a long time, even days. However, the demands of actual rehabilitation are becoming increasingly rigorous, requiring that processes be completed within tens of minutes. Therefore, we developed a new effective rehabilitation system for treating patients such as those with stroke hemiplegia. The system can smoothly perform rehabilitation training on the day of admission to the hospital. We designed a heuristic BCI with simplified fuzzy reasoning, which can detect motor intention signals from an electroencephalogram (EEG) within several tens of minutes. The detected signal is sent to the newly developed ankle rehabilitation device (ARD), and the patient repeats the dorsiflexion motion by the ARD.

The Assessment Of Muscular Characteristics Using Tensiomyography In Hemiplegic Stroke Patients

The Assessment Of Muscular Characteristics Using Tensiomyography In Hemiplegic Stroke Patients

O-08 Brain connectivity modulation after exoskeleton gait in chronic stroke survivors: a pilot study

Background Restoration of independent gait after stroke is a principal goal of survivors. Exoskeleton overground gait training provides trunk support and inter-limb coordination based on fine-tuning of the robot control parameters. The aim of our study was to identify short-term plasticity based on electroencephalography (EEG) data induced by a single trial of exoskeleton gait training in unilateral hemiplegic stroke survivors. Material and methods 64-channel EEG was recorded before gait (T0), after overground walking (T1) and after overground exoskeleton (EksoGT) gait training (T2) in 9 stroke survivors. Relative power and coherence were estimated for alpha1 (8–10 Hz), alpha2 (10.5–12.5 Hz) and beta (13–30 Hz) frequency ranges. Graph analysis assessed network model properties: node strength (S) and betweenness centrality (BC). Results Left-hemisphere stroke subjects showed S decrease over anterior and posterior cortex in alpha1, alpha2 and beta at T1 and T2. BC decreased at vertex at T1 and T2 in alpha2 and beta. Right-hemisphere stroke subjects displayed power decrease after exoskeleton walking in alpha2 over CPZ and CP2, and in beta over left contralateral sensorimotor cortex (cSM) and right ipsilateral prefrontal cortex (iPFC). S increased in alpha1 and alpha2 over cSM and iPFC at T2; BC decreased in alpha2 over iPFC at T2 compared to T1. Conclusions A single session of tailored exoskeleton training provides short-term neuroplastic modulation in chronic stroke. Right-hemisphere stroke subjects re-establish a more physiological activation network; a similar reorganization does not take place in left-hemisphere stroke subjects, supporting the role of lateralization in limb control and stroke recovery.

Painful Shoulder at the Hemiplegic

Post stroke hemiplegia (CVA) is a common pathology occurring in France with an incidence of 140000 new cases / year, half of which has a motor disability. It is responsible for numerous complications contributing to the increase of the initial handicap

Posture analysis and intervention can improve the lower limb motor function of hemiplegic stroke survivors

Objective To investigate the effect of the posture analysis and intervention on the lower limb motor function of hemiplegic stroke survivors. Methods Forty hospitalized stroke survivors with hemiplegia were divided at random into a control group and an experimental group. The control group (n=20) received conventional rehabilitation training. The experimental group (n=20) additionally received therapy based on posture analysis. Before the treatment and after 2 and 4 weeks of treatment, Holden walking function grading was applied, along with Fugl-Meyer motor function rating, and the timed up and go test (TUGT) was administered. Results After 2 weeks of treatment there were no statistically significant differences between the groups in terms of any of the measures. After 4 weeks of treatment the average Holden and Fugl-Meyer scores of the experimental group were significantly better than those of the control group, though there was still no significant difference in the two groups′ average TUGT times. Conclusion Posture analysis-based intervention can improve the lower limb motor function of stroke patients with hemiplegia. Key words: Posture analysis and intervention; Stroke; Lower limb motor function

Stroke survivors exhibit stronger lower extremity synergies in more challenging walking conditions

The aim of this study was to examine how kinematic synergies are utilised as compensatory movements to stabilise foot positions under different walking task constraints in people with stroke. Ten (Males = 6, Females = 4) hemiplegic chronic stroke survivors volunteered to participate in this study, recruited from a rehabilitation centre. They completed a consent form and participated in treadmill walking tasks; flat, uphill, and crossing over a moving obstacle. The uncontrolled manifold method was used to quantify kinematic synergies in the paretic and non-paretic legs during their swing phase. The results of this study showed the strength of synergies was significantly greater in the obstacle task than in the uphill walking tasks at mid and terminal swing phases. In conclusion, the results suggest that walking in the challenging situations caused people with stroke to control step stability with greater compensation between lower extremity joints. Participants adapted to the increased challenge by increasing the amount of 'good variability', which could be a strategy to reduce the risks of falling.

Correlation of Swallowing Function With Bilateral Diaphragmatic Movement in Hemiplegic Stroke Patients.

ObjectiveTo investigate difference in bilateral diaphragm movement of patients with tracheal aspiration according to post stroke residue severity and determine correlations of Penetration-Aspiration Scale (PAS), residue scale, and bilateral diaphragm movement.MethodsA total of 47 patients diagnosed with hemiplegic stroke were enrolled in this study. PAS, severity of valleculae, and pyriform sinus retention during videofluoroscopic swallowing study (VFSS) were assessed. Bilateral fluoroscopic diaphragm movements during spontaneous breathing and forced breathing were measured.ResultsPatients with tracheal aspiration (PAS≥6) had significantly (p=0.035) lower ipsilateral diaphragm movement during spontaneous breathing. Post-swallow residue severity showed statistically significant (p=0.028) difference in patients with ipsilateral diaphragm movement during forced breathing. In linear regression analysis, PAS showed weak correlations with ipsilateral spontaneous diaphragm movement (r=0.397, p=0.006), ipsilateral forced diaphragm movement (r=0.384, p=0.008), and contralateral forced diaphragm movement (r=0.323, p=0.027). Weak correlation was also observed between post swallow residue severity and ipsilateral diaphragm movement during spontaneous breathing (r=0.331, p=0.023) and forced breathing (r=0.343, p=0.018).ConclusionWe confirmed the relationship between swallowing function and bilateral diaphragm movement in this study. The severity of dysphagia after hemiplegic stroke was correlated with bilateral diaphragm movement. Further longitudinal studies are needed to assess the effect of breathing exercise on post-stroke dysphagia.

Robot-assisted gait training improves the pelvis control and walking function of hemiplegic stroke survivors

Objective To explore the effect of robot-assisted gait training on pelvis kinematics and the walking function of hemiplegic stroke survivors. Methods Thirty stroke survivors with hemiplegia were randomly divided into a treatment group and a control group, each of 15. Both groups were given routine clinical medication and rehabilitation training, while the treatment group was additionally provided with 20 minutes of robot-assisted gait training a day, 6 d/wk for 8 weeks. Before and after the treatment, all of the patients′ pelvis kinematics were assessed using 10 m walking speed (MWS), the timed up and go test (TUGT) and functional ambulation categorization (FAC). Results Before the treatment there were no significant differences between the two group in any of the measurements. After the treatment, significant improvement was observed in both groups in the vertical displacement and rotation and tilt angles of the pelvis while walking, with significantly more improvement in the treatment group than in the control group. There was also significant improvement in the average walking speed, TUGT time and FAC score of both groups, with significantly more improvement in the treatment group. Conclusion Robot-assisted gait training can significantly improve the pelvis control and walking ability of hemiplegic stroke survivors. Key words: Robotics; Stroke; Pelvis kinematics; Walking

Effect of afferent electrical stimulation with mirror therapy on motor function, balance, and gait in chronic stroke survivors: a randomized controlled trial.

When solely mirror therapy is applied for a long period of time, spatial perception and attention to the damaged side may decrease, and the effect of mirror therapy may be limited. To overcome this limitation, it has recently been suggested that the combination of mirror therapy with mirror treatment is effective. The aim of this study was to investigate the effects of afferent electrical stimulation with mirror therapy on motor function, balance, and gait in chronic stroke survivors. A randomized controlled trial. Rehabilitation center. Thirty stroke survivors were randomly assigned to two groups: the experimental group (N.=15) and the control group (N.=15). Participants of the experimental group received afferent electrical stimulation with mirror therapy, and participants of the control group received sham afferent electrical stimulation with sham mirror therapy for 60 minutes per day, 5 days per week, for 4 weeks. Motor function was measured using a handheld dynamometer and the Modified Ashworth Scale, balance was measured using the Berg Balance Scale, and gait was assessed using the GAITRite® (GAITRite, CIR System Inc., Franklin, NJ, USA) pressure-sensitive walkway at baseline and after 4 weeks. The experimental group showed significant differences in muscle strength, Modified Ashworth Scale, and Berg Balance Scale results, and velocity, cadence, step length, stride length, and double support time of their gait (P<0.05) in the pre-post intervention comparison. Significant differences between the two groups in muscle strength, Berg Balance Scale, gait velocity, step length, and stride length (P<0.05) were found. Mirror therapy with afferent electrical stimulation may effectively improve muscle strength and gait and balance abilities in hemiplegic stroke survivors. Afferent electrical stimulation combined with mirror therapy can be used as an effective intervention to improve lower limb motor function, balance, and gait in chronic stroke survivors in clinical settings.

Efficacy evaluation of acupuncture combined with Lokohelp robot rehabilitation for hemiplegia following acute ischemic stroke

Objective To observe the clinical advantages of acupuncture combined with Lokohelp robot rehabilitation in the treatment of lower limb hemiplegia following acute ischemic stroke. Methods From June 2017 to May 2018, 117 patients with acute ischemic stroke hemiplegia were selected in the Traditional Chinese Medicine Hospital of Taihe County.The patients were divided into control group and observation group by random digital table method.There were 58 cases in the control group and 59 cases in the observation group.The patients of the two groups were all treated with rehabilitation and essential drugs.The control group received routine rehabilitation training, and the observation group received acupuncture combined with Lokohelp robot gait rehabilitation on the basis of routine rehabilitation training.Thirty days was set as the end time of the test. Results After treatment, the FMA-B score of the control group was (9.15±2.58)points, which of the observation group was (12.85±2.69)points.The FMA-L score of the control group was (23.78±5.33)points, which of the observation group was (29.79±6.45)points.The levels of FMA-B and FMA-L in the two groups were higher than those before treatment, and the levels in the observation group were higher than those in the control group, the differences were statistically significant(t=3.731, 11.441, 7.213, 11.318, 7.591, 5.489, all P<0.01). After treatment, the BaRthel index score of the control group was (56.11±17.12), which of the observation group was (79.59±21.31). The BaRthel index score of the two groups was higher than those before treatment, and the score in the observation group was higher than that in the control group, the difference was statistically significant(t=12.355, 18.279, 6.563, all P<0.01). Conclusion Acupuncture combined with Lokohelp robot rehabilitation for hemiplegic patients with acute ischemic stroke can significantly improve the degree of neurological impairment, reduce the score of neurological impairment, and synergetically improve the patients' walking ability, balance function, motor function and daily life activity ability. Key words: Stroke; Brain ischemia; Hemiplegia; Acupuncture therapy; Acupuncture points; Lokohelp robot; Moxibustion; Rehabilitation; Walking; Postural balance; Activities of daily living

Effects of Treadmill Gait Training with Obstacle-Crossing on Static and Dynamic Balance Ability in Patients with Post Stroke Hemiplegia

Effects of Treadmill Gait Training with Obstacle-Crossing on Static and Dynamic Balance Ability in Patients with Post Stroke Hemiplegia

Slower Reorientation of Trunk for Reactive Turning while Walking in Hemiparesis Stroke Patients

We examined the behavioral characteristics of reactive turning in hemiplegic stroke patients when they were informed of the turning direction just before turning was required at an unpredictable time. Eleven stroke patients and 20 healthy elderly control people were asked to initiate a turn as soon as a visual cue to inform them of the turning direction was activated unpredictably using a foot switch. Both the segmental reorientation and stepping type when turning 90° while walking were measured. The results indicated preserved segmental reorientation of the head and pelvis in stroke patients. Stroke patients showed delays in pelvic turning but not in head turning. Their delayed pelvic movement might be due to motor dysfunction and the time taken to ensure stability when deciding when to turn.

Predicting the Period Until Attaining Gait Independence in Patients with Stroke Hemiplegia in a Recovery Rehabilitation Unit

Predicting the Period Until Attaining Gait Independence in Patients with Stroke Hemiplegia in a Recovery Rehabilitation Unit

Effects of whole body Vibration exercise combined with Forced weight bearing on balance and gait in patients with Stroke Hemiplegia

Background/Objectives: Forced weight support and whole-body vibration exercise are being widely used in patients with stroke to improve balance and gait. Thirty patients with stroke participated in the experiment. Methods/Statistical analysis: A 10-mm insole underneath the non-affected lower foot and Galileo equipment were used in the experimental group. Only a 10-mm insole was provided underneath the shoe in the control group, and all activities of daily living were performed without the whole-body vibration exercise. The Berg balance scale (BBS), Timed up & go (TUG), and bio rescue balance tests before and after intervention were conducted in all subjects. Statistical analysis was performed using the SPSS version 22.0. Findings: There were statistically significant differences in the BBS test result, limit of stability (LOS), and 10 compared to comparator controls. However, there was no statistically significant difference in the TUG test result and foot print (FP). The experimental group displayed statistically significant differences between the BBS, TUG, FP, LOS, and 10mWT items in the before- and after-intervention comparisons. On the contrary, the control group displayed statistically significant differences in the BBS, TUG, FP, and 10mWT items; however, there was no statistically significant difference in the LOS. Improvements/Applications: In balance and gait, the forced weight support and whole-body vibration exercise yielded symmetrical body weight support and improved the walking speed of the patients with stroke.

3D Lower Limb Orthotic Therapy for Hemiplegic Stroke Patients Using an Adjustable Plastic Knee Ankle Foot Orthotic Device

3D Lower Limb Orthotic Therapy for Hemiplegic Stroke Patients Using an Adjustable Plastic Knee Ankle Foot Orthotic Device

Comparison of dual task specific training and conventional physical therapy in ambulation of hemiplegic stroke patients : A Randomized Controlled Trial

To compare the effectiveness of dual task specific training and conventional physical therapy in ambulation of patients with chronic stroke. The randomised controlled trial was conducted at the Habib Physiotherapy Complex, Peshawar, Pakistan, from January to August 2017, and comprised patients with chronic stroke. The patients were randomly assigned to two treatment groups. Group A received dual task training, while Group B received conventional physiotherapy. Dual task training included activities such as slowlywalking backward, sideways, and forward on a smooth surface while holding a 100gm sandbag. The conventional physiotherapy included mat activities, stretching and strengthening exercises and gait training. Pre-test and post-test data was taken for both spatial and temporal variables for both groups using Time Up and Go Test and 10-meter walk test. Step length, stride length, cycle time and cadence were also calculated before and after treatment. SPSS 23 was used to analyse the data. Of the 64 patients, there were 32(50%) in each of the two groups that both had 17(53%) males and 15(47%) females. Mean age in Group A was 58.28 ± 7.13 years, while in Group B it was 58.87 ± 6.13 years. Baseline parameters had no significant differences between the groups (p>0.05). Post-treatments scores revealed significant improvement of spatial and temporal variable of gait, 10-meter walk, cadence, step length, stride and cycle time in Group A compared to Group B (p<0.05 each). Conventional physical therapy and dual task training effectively improved gait ability of chronic stroke patients, and the latter showed significant improvement in all spatial and temporal gait variables compared to former.

Clinical assessment of motor imagery and physical function in mild stroke patients.

[Purpose] The aim of this study was to clarify whether the motor imagery of walking and physical function are related in mild hemiplegic stroke patients. [Participants and Methods] Sixteen mild hemiplegic stroke patients were included in this study. We evaluated motor imagery with a 10-m walking, the estimation error and the kinesthetic and visual imagery questionnaire. Physical function was evaluated with the actual 10-m walk test time, Brunnstrom recovery stage, stroke impairment assessment set, and functional independent measure. The correlation coefficient was calculated using Spearman’s correlation coefficient for all evaluation methods. [Results] The 10-m walking motor imagery took an average of 23.36 ± 22.14 s. The actual 10-m walk test averaged 24.87 ± 21.41 s. The 10-m walking motor imagery and the 10-m walking speed were significantly correlated. There was a significant correlation between the 10-m walking motor imagery and the Brunnstrom recovery stage, stroke impairment assessment set, and functional independent measure. There were no significant correlations between the estimation error and all the assessments. [Conclusion] These results show that the motor imagery of walking is related to physical function in mild hemiplegic stroke patients.

Effect of Inpatient Physiotherapy Intervention Versus Delayed Outpatient Physiotherapy Intervention in Post Stroke Hemiplegic Individuals

Effect of Inpatient Physiotherapy Intervention Versus Delayed Outpatient Physiotherapy Intervention in Post Stroke Hemiplegic Individuals

Mirror therapy can promote the activation and synchronization of lower-limb muscles after stroke

Objective To explore the effects of mirror therapy on the lower-limb muscles of hemiplegic stroke survivors. Methods Sixty-two hemiplegic stroke survivors were divided by stratified random grouping into a mirror group and a control group, each of 31. Both groups accepted routine rehabilitation training, while the mirror group was additionally provided with mirror therapy to train the non-paretic limb for 30 min per day, 5 days a week, lasting 4 weeks. Before and after the 4 weeks of training, integrated electromyography was performed and the maximum voluntary contraction force (MVC) of the tibialis anterior, rectus femoris and biceps femoris of the paretic limb were recorded and compared. Results Compared with before the training, the average root mean square values of the electromyographs and the average MVCs of all three muscles had improved significantly in both groups after training. Compared with the control group, the improvements were significantly greater in the mirror group. Conclusion Mirror therapy can promote the activation and synchronization of motor units, as well as increase the number discharging and the total discharge, promoting the recovery of muscle strength. Key words: Surface electromyography; Mirror therapy; Stroke; Hemiplegia; Lower limbs

Modified Biceps Suspension Procedure for Painful Glenohumeral Inferior Subluxation in Hemiplegic Stroke Patients: A Preliminary Study

Shoulder pain is a common cause of pain in hemiplegic stroke patients. Inferior glenohumeral subluxation has been associated with shoulder pain in stroke patients. Various nonsurgical modalities have been tried to alleviate shoulder pain in this patient population but have not been able to provide a long-term symptom relief. In this study, we sought to report the early outcomes of a biceps tendon suspension-rotator interval imbrication procedure performed in 5 hemiplegic stroke patients with intractable shoulder pain. This procedure was a modification of a previously reported technique and involved looping the distal end of the proximal biceps long head tendon through transosseous tunnels in the bicipital groove and imbrication of the rotator interval. The mean pain VAS score was significantly improved from 8 preoperatively to 2 postoperatively. The mean American Shoulder and Elbow Surgeons score was also improved from 12 to 45. Four patients were “very satisfied” and 1 patient was “somewhat satisfied” with the surgical outcome. Our study demonstrates that biceps suspension-rotator interval imbrication procedure can be an effective treatment for hemiplegic patients with painful glenohumeral joint inferior subluxation.