Stroke Rehabilitation Training Research Articles

Facilitators and Barriers to Implementing High-Intensity Gait Training in Inpatient Stroke Rehabilitation: A Mixed-Methods Study.

(1) Background: High-intensity gait training (HIT) is a recommended intervention that improves walking function (e.g., speed and distance) in individuals who are undergoing stroke rehabilitation. This study explored clinicians' perceived barriers and facilitators to implementing HIT utilizing a mixed-methods approach comprising a survey and exploratory qualitative research. (2) Methods: Clinicians (n = 13) who were implementing HIT at three facilities participated. We collected and analyzed data using the consolidated framework for implementation research. Three focus groups were recorded and transcribed, and data were coded and thematically categorized. (3) Results: Survey results identified that the facilitators with a strong impact on implementation were access to knowledge/resources and intervention knowledge/beliefs. The only agreed-upon barrier with a strong impact was lack of tension for change. The focus groups resulted in 87 quotes that were coded into 27 constructs. Frequently cited outer setting facilitators were cosmopolitanism and peer pressure, and the only barrier was related to the patient needs. Innovation characteristics that were facilitators included relative advantage and design quality and packaging, and complexity was a barrier. Inner setting facilitators included networks and communication, learning climate, leadership engagement, and readiness for implementation. However, communication, leadership engagement, and available resources were also barriers. Regarding characteristics of individuals, knowledge and beliefs were both barriers and facilitators. In the implementation process domain, common facilitators were formally appointed implementation leaders and innovation participants. Barriers in this domain were related to the patients. (4) Conclusions: Clinicians identified many barriers and facilitators to implementing HIT that often varied between facilities. Further research is warranted to deepen our understanding of clinicians' experiences with HIT implementation.

Motor imagery decoding using source optimized transfer learning based on multi-loss fusion CNN.

Transfer learning is increasingly used to decode multi-class motor imagery tasks. Previous transfer learning ignored the optimizability of the source model, weakened the adaptability to the target domain and limited the performance. This paper first proposes the multi-loss fusion convolutional neural network (MF-CNN) to make an optimizable source model. Then we propose a novel source optimized transfer learning (SOTL), which optimizes the source model to make it more in line with the target domain's features to improve the target model's performance. We transfer the model trained from 16 healthy subjects to 16 stroke patients. The average classification accuracy achieves 51.2 ± 0.17% in the four types of unilateral upper limb motor imagery tasks, which is significantly higher than the classification accuracy of deep learning (p < 0.001) and transfer learning (p < 0.05). In this paper, an MI model from the data of healthy subjects can be used for the classification of stroke patients and can demonstrate good classification results, which provides experiential support for the study of transfer learning and the modeling of stroke rehabilitation training.

Analysis of Minimal Channel Electroencephalography for Wearable Brain–Computer Interface

Electroencephalography (EEG)-based brain—computer interface (BCI) is a non-invasive technology with potential in various healthcare applications, including stroke rehabilitation and neuro-feedback training. These applications typically require multi-channel EEG. However, setting up a multi-channel EEG headset is time-consuming, potentially resulting in patient reluctance to use the system despite its potential benefits. Therefore, we investigated the appropriate number of electrodes required for a successful BCI application in wearable devices using various numbers of EEG channels. EEG multi-frequency features were extracted using the “filter bank” feature extraction technique. A support vector machine (SVM) was used to classify a left/right-hand opening/closing motor imagery (MI) task. Nine electrodes around the center of the scalp (F3, Fz, F4, C3, Cz, C4, P3, Pz, and P4) provided high classification accuracy with a moderate setup time; hence, this system was selected as the minimal number of required channels. Spherical spline interpolation (SSI) was also applied to investigate the feasibility of generating EEG signals from limited channels on an EEG headset. We found classification accuracies of interpolated groups only, and combined interpolated and collected groups were significantly lower than the measured groups. The results indicate that SSI may not provide additional EEG data to improve classification accuracy of the collected minimal channels. The conclusion is that other techniques could be explored or a sufficient number of EEG channels must be collected without relying on generated data. Our proposed method, which uses a filter bank feature, session-dependent training, and the exploration of many groups of EEG channels, offers the possibility of developing a successful BCI application using minimal channels on an EEG device.

User Experience Evaluation of Upper Limb Rehabilitation Robots: Implications for Design Optimization: A Pilot Study.

With the development of science and technology, people are trying to use robots to assist in stroke rehabilitation training. This study aims to analyze the result of the formative test to provide the orientation of upper limb rehabilitation robot design optimization. We invited 21 physical therapists (PTs) and eight occupational therapists (OTs) who had no experience operating any upper limb rehabilitation robots before, and 4 PTs and 1 OT who had experience operating upper limb rehabilitation robots. Data statistics use the Likert scale. The general group scored 3.5 for safety-related topics, while the experience group scored 4.5. In applicability-related questions, the main function score was 2.3 in the general group and 2.4 in the experience group; and the training trajectory score was 3.5 in the general group and 5.0 in the experience group. The overall ease of use score was 3.1 in the general group and 3.6 in the experience group. There was no statistical difference between the two groups. The methods to retouch the trajectory can be designed through the feedback collected in the formative test and gathering further detail in the next test. Further details about the smooth trajectory must be confirmed in the next test. The optimization of the recording process is also important to prevent users from making additional effort to know it well.

Feasibility and outcomes of supplemental gait training by robotic and conventional means in acute stroke rehabilitation

IntroductionPracticality of implementation and dosing of supplemental gait training in an acute stroke inpatient rehabilitation setting are not well studied but can have positive impact on outcomes.ObjectivesTo determine the feasibility of early, intense supplemental gait training in inpatient stroke rehabilitation, compare functional outcomes and the specific mode of delivery.Design and settingAssessor blinded, randomized controlled trial in a tertiary Inpatient Rehabilitation Facility.ParticipantsThirty acute post-stroke patients with unilateral hemiparesis (≥ 18 years of age with a lower limb MAS ≤ 3).InterventionLokomat® or conventional gait training (CGT) in addition to standard mandated therapy time.Main outcome measuresNumber of therapy sessions; adverse events; functional independence measure (FIM motor); functional ambulation category (FAC); passive range of motion (PROM); modified Ashworth scale (MAS); 5 times sit-to-stand (5x-STS); 10-m walk test (10MWT); 2-min walk test (2MWT) were assessed before (pre) and after training (post).ResultsThe desired supplemental therapy was implemented during normal care delivery hours and the patients generally tolerated the sessions well. Both groups improved markedly on several measures; the CGT group obtained nearly 45% more supplemental sessions (12.8) than the Lokomat® group (8.9). Both groups showed greater FIM improvement scores (discharge – admission) than those from a reference group receiving no supplemental therapy. An overarching statistical comparison between methods was skewed towards a differential benefit (but not significant) in the Lokomat® group with medium effect sizes. By observation, the robotic group completed a greater number of steps, on average. These results provide some evidence for Lokomat® being a more efficient tool for gait retraining by providing a more optimal therapy “dose”.ConclusionsWith careful planning, supplemental therapy was possible with minimal intrusion to schedules and was well tolerated. Participants showed meaningful functional improvement with relatively little supplemental therapy over a relatively short time in study.

Evaluation of a stroke rehabilitation training programme for community-based primary healthcare.

Family caregiver training is an integral part of stroke rehabilitation programmes and is associated with improved caregiver and stroke survivor outcomes. In the Cape Winelands District, a low-resourced rural community-based setting in South Africa, stroke survivors and family caregivers mostly rely on assistance from community health workers (CHWs), despite their lack of stroke-specific rehabilitation training. To evaluate the implementation and immediate effects of a bespoke, 16 session, 21 h stroke rehabilitation training programme for CHWs to better support family caregivers. Two cooperative inquiry groups participated in participatory action research to design and develop the programme. This article reports on the implementation of this programme. Inquiry group members directly observed the training, obtained written and verbal feedback, interviewed CHWs and observed them in the community. Consensus on their learning was achieved after reflection on their experience and observations. Learning of the cooperative inquiry groups was categorised into the effect on community-based care, the training programme's design and development, how training was delivered and implications for service delivery. Community health workers empowered caregivers and stroke survivors and enabled access to care, continuity, coordination and person-centredness. The need for experiential learning and a spiral curriculum was confirmed. Therapists needed a different set of skills to deliver training. A systems approach and effective leadership were needed to enable community health workers to use their new skills. The stroke rehabilitation training programme demonstrated potential for integration into service delivery and equipping CHWs to support family caregivers and stroke survivors. Further evaluation of the programme's effectiveness and scale-up is needed. Evidence of an intervention to train CHWs to support stroke survivors and family caregivers.

EFFECTIVENESS OF SUPPLEMENTED BACKWARD WALKING TRAINING ALONG WITH CONVENTIONAL THERAPY ON BALANCE AND FUNCTIONAL OUTCOME IN PATIENTS WITH STROKE

Objective: A stroke is a significant cause of mortality and disability worldwide, including in India, where it ranks as the second leading cause of death and the third most common cause of disability. Impairments in motor functions, such as balance and walking, are common consequences of stroke and have a substantial impact on functional abilities. Various rehabilitation strategies have been employed, but the effectiveness of these approaches varies.&#x0D; Methods: The study included 40 individuals with a history of stroke who met specific inclusion and exclusion criteria. The subjects were randomly assigned to either the control group or the experimental group. The control group received conventional therapy, while the experimental group received supplemented backward walking training along with conventional therapy. Functional outcomes were assessed using the Barthel Index (BI), and balance was evaluated using the Berg Balance Scale (BBS). Pre-and post-test scores were collected for both groups.&#x0D; Results: The results showed that the experimental group demonstrated a significantly higher improvement in BI scores (9.94%) compared to the control group (4.95%), indicating that the supplemented backward walking training had a greater impact on enhancing activities of daily living. In terms of balance, both groups showed improvements in BBS scores, with the control group exhibiting a 3.49% change and the experimental group showing a larger improvement of 7.87%. These improvements were statistically highly significant.&#x0D; Conclusion: Supplemented backward walking training, when combined with conventional therapy, has a positive impact on balance and functional outcomes in stroke patients. The results emphasize the potential of incorporating backward walking training into stroke rehabilitation programs to enhance recovery and improve the quality of life for stroke survivors. However, the study has limitations, including a relatively small sample size and short intervention duration, necessitating further research with larger sample sizes and longer intervention periods to validate the effectiveness of supplemented backward walking training in stroke rehabilitation.

Video parameters for action observation training in stroke rehabilitation: a scoping review

Purpose Action observation training (AOT) is a therapeutic approach used in stroke rehabilitation. Videos form the core of AOT, and knowledge of constituent parameters is essential to make the intervention robust and generalizable. Currently, there is a dearth of available information on video parameters to be used for AOT. Our purpose was to identify and describe the parameters that constitute AOT videos for stroke rehabilitation. Method Electronic databases like PubMed, CINAHL, Scopus, Web of Science, ProQuest, and Ovid SP from inception to date according to PRISMA-ScR guidelines. Title, abstract, and full-text screening were done independently by two authors, with a third author for conflict resolution. Data on video parameters like length, quality, perspective, speed, screen size and distance, sound, and control videos were extracted. Results Seventy studies were included in this review. The most-reported parameters were video length (85.71%) and perspective of view (62.85%). Movement speed (7.14%) and sound (8.57%) were the least reported. Static landscapes or geometrical patterns were found suitable as control videos. Conclusion Most video parameters except for length and perspective of view remain underreported in AOT protocols. Future studies with better descriptions of video parameters are required for comprehensive AOT interventions and result generalisation.

A stroke rehabilitation training program for community-based primary health care, South Africa.

With an increasing burden of stroke and a lack of access to rehabilitation services in rural South African settings, stroke survivors rely on untrained family caregivers for support and care. Community health workers (CHWs) support these families but have no stroke-specific training. To describe the development of a contextually appropriate stroke training program for CHWs in the Cape Winelands District, South Africa. Twenty-six health professionals and CHWs from the local primary healthcare services participated in action research over a 15-month period from September 2014 to December 2015. The groups participated in two parallel cooperative inquiry (CI) groups. The inquiry followed the cyclical steps of planning, action, observation and reflection. In this article, the planning step and how the CI groups used the first three steps of the analyse, design, develop, implement, evaluate (ADDIE) instructional design model are described. The CHWs' scope of practice, learning needs, competencies and characteristics, as well as the needs of the caregivers and stroke survivors, were identified in the analysis step. The program design consisted of 16 sessions to be delivered over 20 h. Program resources were developed with appropriate technology, language and instructional methodology. The program aims to equip CHWs to support family caregivers and stroke survivors in their homes as part of their generalist scope of practice. The implementation and initial evaluation will be described in a future article. The study developed a unique training program for CHWs to support caregivers and stroke survivors in a resource-constrained, rural, middle-income country setting.

Robotic-Assisted Gait Training (RAGT) in Stroke Rehabilitation: A Pilot Study

ObjectiveTo compare the effects of 2 types of robotic-assisted gait training (RAGT) devices that have been used in stroke rehabilitation. DesignRetrospective cohort. SettingRehabilitation hospital. Participants24 community dwelling people with stroke (N=24). InterventionsRAGT with either an exoskeleton (Lokomat) (mean age=53.8 years; 30% men; mean duration of stroke =17.8 months) or an end-effector (G-EO) (mean age=50.5 years; 77.8% men; mean duration of stroke =13.11) delivered 3 times per week (36 sessions total). Main Outcome MeasuresThe following tests/scales were employed before and after RAGT: Functional Ambulation Categories (FACs), timed Up and Go (TUG), 10-Meter Walk Test (10MWT), 6-Minute Walk Test (6MWT), Trunk Impairment Scale, Dynamic Gait Index (DGI), Berg Balance Scale (BBS), and ability to climb stairs (time to climb 6 steps of 15 cm each; ability to climb stairs). ResultsThere were 5 dropouts, all from the G-EO group. At the end, 10 participants in the Lokomat and 9 in the G-EO group completed the intervention. From pre- to post-RAGT, G-EO patients improved on all functional tests/scales, whereas Lokomat patients improved only on the TUG, DGI, and BBS. Most patients showed improvements above the relative smallest real difference in the TUG, 10MWT, and 6MWT. ConclusionsBoth end-effectors and exoskeletons may improve clinically relevant aspects of walking function. However, this study had a small sample, was retrospective, non-randomized, and had a significant number of drop-outs, therefore its findings should be interpreted carefully. Future studies are needed for investigating potential differences in clinical results, side effects, contraindications, and cost effectiveness between these 2 different types of RAGT.

Factors Influencing the Sustainability of Stroke Rehabilitation Services in Community: An Analysis Based on Kano Model

A patient’s enthusiasm will affect their recovery during stroke rehabilitation training. Since rehabilitation training is a long process, patients are usually cared for at home, especially during the COVID-19 pandemic. However, professional supervision in the community is often lacking, resulting in low patient participation and initiative as well as the low sustainability of rehabilitation services. At present, many researchers are trying to optimize the process of community rehabilitation services to improve patient compliance. The majority of them, however, have failed to fully consider the psychological needs of the patients. Our aim was to find the key factors affecting patients’ enthusiasm to participate in rehabilitation training. We also wanted to provide an optimal scheme for enhancing the sustainability of community rehabilitation services. Based on patient-centered research, we applied the Kano model and the customer satisfaction coefficient to the study and established a framework for improving the community rehabilitation experience. We observed that patients must first understand basic rehabilitation information and effective rehabilitation methods. Additionally, we found that some factors related to incentive and pleasure could meet the psychological needs of patients. Furthermore, as a result of this research, we applied the framework in practice and refined the design of a rehabilitation-training service system. This work may have significance for the design of sustainable community rehabilitation services. The purpose of this paper is to indicate the direction of rehabilitation services so that patients can take the initiative in rehabilitation.

Pilot RCT examining feasibility and disability outcomes of a mobile health platform for strategy training in inpatient stroke rehabilitation (iADAPT)

ABSTRACT Background Strategy training is an intervention that may reduce disability when delivered in inpatient rehabilitation following stroke. However, shorter lengths of stay and challenges with continuity of care following discharge results in difficulties in achieving adequate intervention dosage and carryover of training. Objective We examined whether strategy training using a mobile health platform (iADAPT) is feasible during inpatient stroke rehabilitation and following discharge. Methods In this RCT, participants were randomized to receive strategy training using either the iADAPT application (n = 16) or a workbook (n = 15). Participants in both groups received 7 in-person sessions during inpatient rehabilitation and 3 remote sessions following discharge. We calculated descriptive statistics to examine acceptance, attendance, and adherence, and within-group effect sizes on satisfaction and disability. Results Participants in the iADAPT group attended fewer total intervention sessions (n = 5.5, workbook n = 9.0) but attempted a similar number of goals (n = 7.6, workbook n = 8.2). Both groups reported similar satisfaction with in-person intervention (Treatment Expectancy: iADAPT d = 0.60, workbook d = 0.47; Patient Provider Connection: iADAPT d = 0.18, workbook d = 0.31), but the mobile health group reported greater satisfaction with remote intervention (Treatment Expectancy: iADAPT d = −0.91, workbook d = −0.97; Patient Provider Connection: iADAPT d = 0.85, workbook d = −1.80). Conclusions Considering these promising feasibility metrics and the benefits of mobile health, it is worth continuing to explore the efficacy of strategy training using a mobile health platform.

The effect of motor relearning on balance, mobility and performance of activities of daily living among post-stroke patients: Study protocol for a randomised controlled trial.

Balance and gait impairments are the most common motor deficits due to stroke, limiting the patients' daily life activities and participation in society. Studies investigating effect of task-specific training using biomechanical balance and gait variables (i.e. kinetic and kinematic parameters) as well as posturography after stroke are scarce. The primary aim of this study is to assess the efficacy and long-term outcome of task-specific training based on motor relearning program (MRP) on balance, mobility and performance of activities of daily living among post-stroke patients. In this two-armed randomised controlled clinical trial, a total of 66 sub-acute stroke patients who meet the trial criteria will be recruited. The patients will randomly receive task-specific training based on MRP or a conventional physical therapy program (CPT). Twenty-four physiotherapy sessions will be conducted, divided into three training sessions per week, 1h per session, for 8weeks, followed by an analysis of changes in patient's balance, gait and performance of activates of daily living at three time periods; baseline, post-intervention and follow-up after 3-months, using clinical outcome measures and instrumental analysis of balance and gait. The results of this study can guide to better understanding and provide an objective clinical basis for the use of task-specific training in stroke rehabilitation. Also, it intends to help bridge the current knowledge gap in rehabilitation and training recommendations to provide a therapeutic plan in post-stroke rehabilitation. ClinicalTrials.gov (NCT05076383). Registered on 13 October 2021 (Protocol version: v2.0).

Effect of Interactive Dynamic Scalp Acupuncture on Post-Stroke Cognitive Function, Depression, and Anxiety: A Multicenter, Randomized, Controlled Trial.

To compare the clinical effects of interactive dynamic scalp acupuncture (IDSA), simple combination therapy (SCT), and traditional scalp acupuncture (TSA) on cognitive function, depression and anxiety in patients with post-stroke cognitive impairment. A total of 660 patients with post-stroke cognitive impairment who were admitted to 3 hospitals in Shenzhen City between May 2017 and May 2020 were recruited and randomly assigned to the IDSA (218 cases), SCT (222 cases) and TSA groups (220 cases) according to a random number table. All the patients received conventional drug therapy for cerebral stroke and exercise rehabilitation training. Scalp acupuncture and computer-based cognitive training (CBCT) were performed simultaneously in the IDSA group, but separately in the morning and in the afternoon in the SCT group. The patients in the TSA group underwent scalp acupuncture only. The course of treatment was 8 weeks. Before treatment (M0), 1 (M1) and 2 months (M2) after treatment, as well as follow-up at 1 (M3) and 2 months (M4), the cognitive function of patients was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment Scale (MoCA) Scales; depression, anxiety, sleep quality, and self-care ability of patients were assessed using Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Pittsburgh Sleep Quality Index (PSQI), and Modified Barthel Index (MBI), respectively. During this trial, all adverse events (AEs) were accurately recorded. There were no significant differences in the MMSE, MoCA, HAMD, HAMA, PSQI, and MBI scores among the 3 groups at M0 (all P>0.05). In the IDSA group, the MMSE, MoCA and MBI scores from M2 to M4 were significantly higher than those in the SCT and TSA groups, while the HAMD, HAMA and PSQI scores were significantly reduced (all P<0.01). The changes of all above scores (M2-M0, M4-M0) were significantly superior to those in the SCT and TSA groups (all P<0.01, except M4-M0 of HAMD). At M2, the severity of MMSE, HAMD, HAMA, PSQI and MBI in the IDSA group was significantly lower than that in the SCT and TSA groups (all P<0.01). There was no serious AE during this trial. IDSA can not only significantly improve cognitive function, but also reduce depression, anxiety, which finally improves the patient's self-care ability. The effect of IDSA was significantly better than SCT and TSA. (Trial registration No. ChiCTR1900027206).

A new 2-class unilateral upper limb motor imagery tasks for stroke rehabilitation training

The rehabilitation training based on motor imagery brain-computer interface (MI-BCI) is considered to be an effective method. We designed a new 2-class unilateral upper limb motor imagery tasks. Data from 15 healthy subjects and 10 stoke patients are collected in the study. The results of event-related desynchronization/synchronization (ERD/ERS) and power spectral density (PSD) analysis showed the significant different features on health subjects and stroke patients. The improved 2-Conv-FBCNET is used to classify Electroencephalogram (EEG) signals and the accuracy is (health: 61.0%, stroke: 59.4%). The new two types of tasks provide a new training method for MI-BCI rehabilitation training system.

Kinematic Accelerometry Assessment Of Music-Based Motor Training in Stroke Rehabilitation

<h3>Research Objectives</h3> To use a novel limb acceleration measure to reveal mechanisms of improved paretic limb control following music-based rehabilitation. <h3>Design</h3> A consecutive sample. <h3>Setting</h3> A music and health research facility in Toronto, CA. <h3>Participants</h3> 30 community dwellers aged 30-79 years in the chronic stroke phase with minimal volitional control of the affected limb. <h3>Interventions</h3> Nine training sessions thirty-minutes in length were administered three times per week by a Neurologic Music Therapist. The music-based training incorporated mapping rhythmically cued functional arm movements onto digital sonification touch tablets. The paretic limb's acceleration profile was recorded at 1000 Hz from a wrist-worn accelerometer. <h3>Main Outcome Measures</h3> Estimates of power-spectral-density were obtained with an approximately 1-s sliding window and a 50% window overlap across the entire training session. The power-spectral-density was computed as the median of all the windows within each trace. The dominant peak in the function was then identified and quantified as the height of the peak (i.e., peak-power). Peak-power was then used to quantify functional changes in limb control across sessions. <h3>Results</h3> Repeated-measures ANOVA for peak-power revealed a main effect of session (p < .001) and follow-up trend analyses revealed a significant linear trend, highlighting continuous motor improvement across all sessions. T-tests were then used to determine that movements of the paretic limb increased in peak power (p = .001; 95% CI = -.0002, - .0007) from session 1 (M = .00004) to session 9 (M = .0002) with peak-power being localized within the lower frequency spectrum (i.e., 4.4 Hz). <h3>Conclusions</h3> Peak-power increases within the lower frequency spectrum indicates improved volitional motor control and intentionality of paretic arm movements. Such functional changes in limb acceleration represent a mechanism underlying improved motor outcomes in music-based stroke interventions. <h3>Author(s) Disclosures</h3> The authors have nothing to disclose.

Classification of error-related potentials evoked during stroke rehabilitation training

Objective. Error-related potentials (ErrPs) are elicited in the human brain following an error’s perception. Recently, ErrPs have been observed in a novel task situation, i.e. when stroke patients perform upper-limb rehabilitation exercises. These ErrPs can be used to develop assist-as-needed (AAN) robotic stroke rehabilitation systems. However, to date, there is no reported research on assessing the feasibility of using the ErrPs to implement the AAN approach. Hence, in this study, we evaluated and compared the single-trial classification of novel ErrPs using various classical machine learning and deep learning approaches. Approach. Electroencephalogram data of 13 stroke patients recorded while performing an upper-limb physical rehabilitation exercise were used. Two classification approaches, one combining the xDAWN spatial filtering and support vector machines, and the other using a convolutional neural network-based double transfer learning, were utilized. Main results. Results showed that the ErrPs could be detected with a mean area under the receiver operating characteristics curve of 0.838, and a mean accuracy of 0.842, 0.257 above the chance level (p < 0.05), for a within-subject classification. The results indicated the feasibility of using ErrP signals in real-time AAN robot therapy with evidence from the conducted latency analysis, cross-subject classification, and three-class asynchronous classification. Significance. The findings presented support our proposed approach of using ErrPs as a measure to trigger and/or modulate as required the robotic assistance in a real-time human-in-the-loop robotic stroke rehabilitation system.

Enhancing Detection of SSMVEP Induced by Action Observation Stimuli Based on Task-Related Component Analysis

Action observation (AO)-based brain-computer interface (BCI) is an important technology in stroke rehabilitation training. It has the advantage of simultaneously inducing steady-state motion visual evoked potential (SSMVEP) and activating sensorimotor rhythm. Moreover, SSMVEP could be utilized to perform classification. However, SSMVEP is composed of complex modulation frequencies. Traditional canonical correlation analysis (CCA) suffers from poor recognition performance in identifying those modulation frequencies at short stimulus duration. To address this issue, task-related component analysis (TRCA) was utilized to deal with SSMVEP for the first time. An interesting phenomenon was found: different modulated frequencies in SSMVEP distributed in different task-related components. On this basis, a multi-component TRCA method was proposed. All the significant task-related components were utilized to construct multiple spatial filters to enhance the detection of SSMVEP. Further, a combination of TRCA and CCA was proposed to utilize both advantages. Results showed that the accuracies using the proposed methods were significant higher than that using CCA at all window lengths and significantly higher than that using ensemble-TRCA at short window lengths (≤2 s). Therefore, the proposed methods further validate the induced modulation frequencies and will speed up the application of the AO-based BCI in rehabilitation.

How does culture influence the implementation of strategy training in stroke rehabilitation? A rapid ethnographic study of therapist perspectives in Taiwan and the United States

Purpose Strategy training is a promising stroke rehabilitation intervention commonly delivered in Western countries. We examined the perspectives of rehabilitation therapists who have delivered strategy training in Taiwan and the United States to understand the influence of culture on strategy training implementation. Materials and methods In this rapid ethnographic study, the maximum variation sampling approach was used to recruit seven therapists in Taiwan and seven therapists in the United States with experience delivering strategy training. Data was collected from multiple sources, including interviews, study documents, therapist notes, and reflective memos. Interviews with the recruited therapists in Taiwan and the United States were conducted in Mandarin and English, respectively. Data were analyzed using a constant comparative approach. Results The following two themes were generated: (1) differences between conventional rehabilitation and strategy training, namely that conventional rehabilitation is therapist-directed and emphasizes impairment reduction, whereas strategy training empowers clients and focuses on real-life generalization, and (2) challenges in implementing strategy training in practice, including difficulty in achieving client buy-in and disengagement. Conclusions Therapists from both countries shared similar perspectives on the perceived advantages of strategy training, such as enhancing client empowerment and engagement, and the generalization of strategies. Family involvement was more prominently discussed by therapists in Taiwan than by those in the United States. IMPLICATIONS FOR REHABILITATION Strategy training differs from conventional rehabilitation in its emphasis on clients’ life participation and empowerment, generalization of strategies, and enhancement of their engagement, confidence, and problem-solving skills. Therapists may face challenges related to client buy-in and disengagement as well as difficulties in establishing a therapeutic rapport at the beginning of strategy training because clients have different expectations from those of conventional rehabilitation. Cultural differences in norms and expectations and the clinical experiences of therapists may influence the delivery of strategy training to clients. Family support may influence the success of strategy training. Thoughtful conversations to reach a mutual understanding regarding the expectations of strategy training among clients, family, and rehabilitation practitioners are necessary prior to implementing strategy training.

Effect of Body Weight Support Treadmill Training on Gait Speed in Acute Stroke Rehabilitation -A Quasi Experimental Study

Background: Stroke is a global health problem. The most common manifestation of stroke are gaitabnormalities along with other neuromusculor impairments. Around 60% of stroke survivors will be limitedin community ambulation, walking after stroke is characterized by altered gait parameters and reduction inthe gait speed, it changes the quality and adaptability of walking pattern, for the optimal ambulation needto restore the gait speed along with other gait parameter, Through the elimination of deterrents like bodyweight and other neuromusculor impairments will effectively helps to restore the gait parameters along withits speed. So, use of body weight support treadmill in gait training is effective in restoration of gait speedin acute stroke rehabilitation, in addition it is feasible and safe. Objective: To evaluate the effect of bodyweight supported treadmill training by using 10 meter walk test on gait speed in acute stroke subjects.Methodology: A Quasi experimental study, A total of 25 stroke patients were screened and only 20 wererecruited who are willing to be in the study and they were randomly allocated into two groups. In GroupA (n=10) subjects were received body weight supported treadmill training along with routine individualphysiotherapy , where in Group B (n=10) subjects were received routine individual physiotherapy only,10 meter walk test measured as outcome. Analysis: Statistical analysis was performed using the JASPversion 0.12.2, Paired t test for within group and Unpaired t test for between groups comparison. Results:Statistically significant difference was found between pre and post measures of gait speed in the controland study groups with greater improvement in the study group. Conclusion: adding body weight supporttreadmill training in acute stroke rehabilitation is effective in improvement of gait speed in acute strokerehabilitation, in addition it is feasible and safe.