Upper-extremity Rehabilitation Research Articles

Development of a sliding mode controller with chattering suppressor for human lower extremity exoskeleton robot

Exoskeleton robot-based human upper and lower extremity rehabilitation is an appealing solution for many disabled individuals. To deliver the desired form of physical therapy efficiently, robots with streamlined maneuverability are needed. Sliding mode control is a robust control scheme that works efficiently for a nonlinear system such as a serial link manipulator. The main limitation of the sliding mode control system is the chattering phenomenon. Chattering leads to rough movements and often causes actuator saturation leading to reduced actuator life and an energy-inefficient system. A sliding mode control system without a chattering suppressor needs more powerful actuators that make the manipulator heavy. In this paper, a seven degrees of freedom human lower extremity dynamic model for an exoskeleton robot is presented first. To control the robot dynamics, a sliding mode controller (SMC) is employed. To study the effects of chattering phenomenon, dynamic simulations are done with and without continuous mode chattering suppressor. A continuous mode chattering suppressor is introduced. A realistic friction model is included in the human lower extremity dynamic model to simulate joint friction effects. Simulation results show the effectiveness of the developed Sliding mode controller with continuous mode chattering suppressor while tracking trajectories involving sequential as well as simultaneous joint movements. A performance comparison of the developed Sliding mode controller with linear (PID) and nonlinear control techniques (Computed torque controller) is presented.

A trade-off between kinematic and dynamic control of bimanual reaching in virtual reality.

Bimanual coordination is an essential component of human movement. Cooperative bimanual reaching tasks are widely used to assess the optimal control of goal-directed reaching. However, little is known about the neuromuscular mechanisms governing these tasks. Twelve healthy, right-handed participants performed a bimanual reaching task in a three-dimensional virtual reality environment. They controlled a shared cursor, located at the midpoint between the hands, and reached targets located at 80% of full arm extension. Following a baseline of normal reaches, we placed a wrist weight on one arm and measured the change in coordination. Relative contribution (RC) was computed as the displacement of the right hand divided by the sum of displacements of both hands. We used surface electromyography placed over the anterior deltoid and biceps brachii to compute muscle contribution (MC) from root mean squared muscle activity data. We found RC was no different than 50% during baseline, indicating participants reached equal displacements when no weights were applied. Participants systematically altered limb coordination in response to altered limb dynamics. RC increased by 0.91% and MC decreased by 5.3% relative to baseline when the weight was applied to the left arm; RC decreased by 0.94% and MC increased by 6.3% when the weight was applied to the right arm. Participants adopted an optimal control strategy that attempted to minimize both kinematic and muscular asymmetries between limbs. What emerged was a trade-off between these two parameters, and we propose this trade-off as a potential neuromuscular mechanism of cooperative bimanual reaching.NEW & NOTEWORTHY This study is the first to propose a trade-off between kinematic and dynamic control parameters governing goal-directed reaching. We propose a straightforward tool to assess this trade-off without the need for computational modeling. The technologies and techniques developed in this study are discussed in the context of upper extremity rehabilitation.

Role of Telerehabilitation in Upper Extremity Rehabilitation of Parkinson's Patients: Review of the Literature

Parkinson's Disease (PD) is one of the most common neurodegenerative diseases that mostly affect motor function. Upper extremity dysfunction occurs in these patients from the early stage and negatively affects the activities of the individual such as reaching, grasping, and writing, which are frequently used in daily life. The fact that PD is a chronic neurodegenerative disease increases the need for long-term rehabilitation of individuals. On the other hand, long-term rehabilitation service leads to high costs for both health institutions and patients. Telerehabilitation applications enable physiotherapy and rehabilitation services to be applied more practically, at lower costs, and by saving more time. Considering that Parkinson's patients mostly consist of the geriatric population, the increase in diseases such as the emerging Covid-19 epidemic has made it more difficult for patients with PD to reach rehabilitation. This situation has accelerated the emergence of rehabilitation services that can be an alternative to the rehabilitation services used in the clinic. Due to the limited physiotherapy and rehabilitation services provided in hospitals or clinics for patients with Parkinson's, therapists focus more on developing transfer-oriented skills such as balance and walking, and they often cannot find enough time for upper extremity training. Therefore, telerehabilitation applications appear as an advantageous option for upper extremity training. Telerehabilitation is defined as the transmission of rehabilitation services to long distances by using various communication technologies. Recently, telerehabilitation approaches have been frequently preferred in many neurological disease groups such as stroke, Multiple Sclerosis, and PD. In this review, it is aimed to discuss the telerehabilitation approaches used in the upper extremity rehabilitation of patients with PD.

Kinect-Based Rehabilitation Systems for Stroke Patients: A Scoping Review.

Method This study was conducted according to Arksey and O'Malley's framework. To investigate the evidence on the effects of Kinect-based rehabilitation, a search was executed in five databases (Web of Science, PubMed, Cochrane Library, Scopus, and IEEE) from 2010 to 2020. Results Thirty-three articles were finally selected by the inclusion criteria. Most of the studies had been conducted in the US (22%). In terms of the application of Kinect-based rehabilitation for stroke patients, most studies had focused on the rehabilitation of upper extremities (55%), followed by balance (27%). The majority of the studies had developed customized rehabilitation programs (36%) for the rehabilitation of stroke patients. Most of these studies had noted that the simultaneous use of Kinect-based rehabilitation and other physiotherapy methods has a more noticeable effect on performance improvement in patients. Conclusion The simultaneous application of Kinect-based rehabilitation and other physiotherapy methods has a stronger effect on the performance improvement of stroke patients. Better effects can be achieved by designing Kinect-based rehabilitation programs tailored to the characteristics and abilities of stroke patients.

Capturing Upper Body Kinematics and Localization with Low-Cost Sensors for Rehabilitation Applications.

For upper extremity rehabilitation, quantitative measurements of a person’s capabilities during activities of daily living could provide useful information for therapists, including in telemedicine scenarios. Specifically, measurements of a person’s upper body kinematics could give information about which arm motions or movement features are in need of additional therapy, and their location within the home could give context to these motions. To that end, we present a new algorithm for identifying a person’s location in a region of interest based on a Bluetooth received signal strength (RSS) and present an experimental evaluation of this and a different Bluetooth RSS-based localization algorithm via fingerprinting. We further present algorithms for and experimental results of inferring the complete upper body kinematics based on three standalone inertial measurement unit (IMU) sensors mounted on the wrists and pelvis. Our experimental results for localization find the target location with a mean square error of 1.78 m. Our kinematics reconstruction algorithms gave lower errors with the pelvis sensor mounted on the person’s back and with individual calibrations for each test. With three standalone IMUs, the mean angular error for all of the upper body segment orientations was close to 21 degrees, and the estimated elbow and shoulder angles had mean errors of less than 4 degrees.

Biomechanical design and control of an eight DOF human lower extremity rehabilitation exoskeleton robot

Exoskeleton robot-assisted physical therapy has received a lot of research attention due to its positive impact on human upper and lower extremity rehabilitation. The exoskeleton robot attaches closely to the human limbs and facilitates natural movements at the joints. The effectiveness of the exoskeleton robot-assisted physical therapy is influenced by the mechanical design of the manipulator. An ergonomic design helps the user exercise for an extended period. In this paper, the mechanical design of an 8 degrees of freedom human lower extremity exoskeleton robot for rehabilitation is presented. Among the 8 degrees of freedom, 7 are actively actuated and 1 is passively actuated. A cam follower mechanism is developed to replicate the complex motion at the knee joint. To make the exoskeleton comfortable and easy to use for the users, ergonomic design rules are followed. A dynamic model of the human lower extremity exoskeleton robot is also developed for controlling the robot. A Sliding mode controller with super twisting algorithm is employed to simulate the dynamic model. Results for stability analysis of the developed controller are also presented.

Hand Detection and Segmentation in First Person Image Using Mask R-CNN

In this work, we propose a technique to automatically detect and segment hands on first-person images of patientsin upper limb rehabilitation exercises. The aim is to automate the assessment of the patient's recovery processthrough rehabilitation exercises. The proposed technique includes the following steps: 1) setting up a wearablecamera system and collecting upper extremity rehabilitation exercise data. The data is filtered, selected andannotated with the left and right hand as well as segmented the image area of the patient's hand. The datasetconsists of 3700 images with the name RehabHand. This dataset is used to train hand detection and segmentationmodels on first-person images. 2) conducted a survey of automatic hand detection and segmentation models usingMask-RCNN network architecture with different backbones. From the experimental architectures, the Mask -RCNN architecture with the Res2Net backbone was selected for all three tasks: hand detection; left - right handidentification; and hand segmentation. The proposed model has achieved the highest performance in the tests. Toovercome the limitation on the amount of training data, we propose to use the transfer learning method alongwith data enhancement techniques to improve the accuracy of the model. The results of the detection of objects onthe test dataset for the left hand is AP = 92.3%, the right hand AP = 91.1%. The segmentation result on the test dataset forleft hand is AP = 88.8%, right hand being AP = 87%. These results suggest that it is possible to automatically quantifythe patient's ability to use their hands during upper extremity rehabilitation.

Robotic Rehabilitation and Transcranial Direct Current Stimulation in Children With Bilateral Cerebral Palsy.

AimTo identify challenges of combining robotic upper extremity rehabilitation with tDCS in children with upper extremity bilateral cerebral palsy (CP) by assessing feasibility, tolerability and safety.MethodsThis was an unblinded, open-label, pilot clinical trial. Participants completed 10 × 1 h sessions of robotic rehabilitation combined with motor cortex anodal tDCS. Feasibility, acceptability and practicality, were assessed including the number of participants completing the protocol, factors limiting participation, time required for sessions, and completion of functional assessments and tolerability scales. To assess safety, standardized clinical and robotic measures of sensorimotor function were performed. The trial was registered at clinicaltrials.gov (NCT04233710).ResultsEight children were recruited (mean age 8y ± 1.8y, range 6–11 years) and 5 completed the intervention. There were no serious adverse events. One child developed focal seizures 6 weeks after the trial that were deemed to be unrelated. Barriers to completion included time and scheduling demands and patient factors, specifically cognitive/behavioral impairments and dyskinesia. No decline in clinical function was appreciated.ConclusionsRobotic upper extremity rehabilitation combined with tDCS may be feasible in children with bilateral CP. Careful participant selection, family engagement, and protocol adaptations are recommended to better understand the feasibility and tolerability of future trials.

A Robust Controller for Upper Limb Rehabilitation Exoskeleton

In this paper, a portable exoskeleton for the rehabilitation of upper extremities of three degrees of freedom (DOF) is proposed. With these degrees of freedom, the exoskeleton provides the movements of flexion–extension and abduction–adduction of the arm and flexion–extension of the forearm. A robust generalized proportional integral (GPI) controller for trajectory tracking to provide smooth movements for rehabilitation with the exoskeleton is proposed. This controller only requires output measurements and is robust against different types of disturbances. Simulation results are presented in the MSC Adams® software environment in co-simulation with Matlab-Simulink® to show the controller’s performance against different types of disturbances. The results of a PID type controller are also contrasted with the results of the GPI controller.

Performance Validation of An Upper Limb Exoskeleton Using Joint ROM Signal

Exoskeleton systems are emerging for robotic assistive surgery and rehabilitation of neurologically impaired patients. A novel upper extremity (UE) exoskeleton has been developed in our lab, potentially to be used for robotic assistive surgery and stroke rehabilitation in our laboratory. The purpose of this study was to introduce the methodology of voluntary control of the UE exoskeleton by processing the range of motion (ROM) of UE joints. Ipsilateral-to-ipsilateral synchronous (IIS) control and ipsilateral-to-contralateral mirror (ICM) control mechanism were designed for UE exoskeleton movement control. A 3D simulation was performed to validate mechanical designs for kinesiologic motion. The performance of the ROM-controlled UE exoskeleton was then validated among six healthy subjects. The UE exoskeleton performed drawing movements in a 2D panel. The drawings created by the UE exoskeleton were compared to the drawings created by a healthy subject to determine the accuracy of the drawing performance. Reliability statistical analysis (Cronbach test) was performed to determine the inter-rater agreement between subject performance and UE exoskeleton performance. Results showed an excellent agreement between the human drawings and exoskeleton drawings (Cronbach Alpha value = 0.904, p<0.01). This study demonstrated that ROM of UE joints can be processed for voluntary control of a UE exoskeleton. Potentially, UE exoskeletons can be used for robotic assistive orthopaedic surgery and UE rehabilitation trainings.

Differences in Dual Task Performance After Robotic Upper Extremity Rehabilitation in Hemiplegic Stroke Patients

Background: Cognitive–motor interference is a phenomenon in which the concomitant performance of cognitive and motor tasks results in poorer performance than the isolated performance of these tasks. We aimed to evaluate changes in dual-task performance after robotic upper extremity rehabilitation in patients with stroke-induced hemiplegia.Methods: This prospective study included patients with left upper limb weakness secondary to middle cerebral artery stroke who visited a rehabilitation hospital. Participants performed a total of 640 robot-assisted planar reaching movements during a therapist-supervised robotic intervention that was conducted five times a week for 4 weeks. Cognitive and motor performance was separately evaluated in single- and dual-task conditions. The digit span test and Controlled Oral Word Association Test (COWAT) were used to assess cognitive performance, whereas motor performance was evaluated through kinematic assessment of the motor task.Results: In single-task conditions, motor performance showed significant improvement after robotic rehabilitation, as did the scores of the COWAT subdomains of animal naming (p < 0.001), supermarket item naming (p < 0.06), and phonemes (p < 0.05). In dual-task conditions, all motor task performance variables except mean velocity showed improvement after robotic rehabilitation. The type of cognitive task did not affect the dual-task effect, and there were no significant differences in the dual-task effects of motor, cognitive, or the sum of motor and cognitive performance after robotic rehabilitation.Conclusion: Post-stroke robotic rehabilitation has different effects on motor and cognitive function, with more consistent effects on motor function than on cognitive function. Although motor and cognitive performance improved after robotic rehabilitation, there were no changes in the corresponding dual-task effects.

Feasibility of High Repetition Upper Extremity Rehabilitation for Children with Unilateral Cerebral Palsy

Aims In pediatric upper extremity rehabilitation, feasible repetition rates are unknown. Our objectives were to examine repetition rates during rehabilitation and their impact on outcomes. Methods Children with unilateral cerebral palsy due to perinatal stroke (n = 55, median 10 y 7 mo, 30 males) received Constraint-Induced Movement Therapy (CIMT) followed by Bimanual Therapy, each for 5 days. Repetitions were documented during one-on-one therapy (1.5 h/day). Outcomes included the Assisting Hand Assessment (AHA), Jebsen Taylor Test of Hand Function (JTTHF), and Box and Block Test (BBT). Means and standard deviations for motor outcomes and frequencies for repetition rates were calculated. Factors associated with repetition rates and outcome change were explored using standard linear regression. Results Repetitions/hour averaged 365 ± 165 during CIMT and 285 ± 103 during Bimanual Therapy. Higher repetition rates were associated with higher baseline function by older age, a main effect of younger age, and improving motor skill (p < .05). Higher repetition rates corresponded with improvement of the AHA and BBT (p < .05, standardized ß = 0.392, 0.358). Conclusions Results suggest high repetition therapy is feasible in school-aged children with perinatal stroke, albeit with high individual variability. Multiple associations between repetition rates and baseline function and change point to the clinical importance of this measurable and potentially modifiable factor.

Feasibility of inducing new intermuscular coordination patterns through an electromyographic signal-guided training in the upper extremity: a pilot study.

Abnormal intermuscular coordination has been highlighted in the field of post-stroke upper extremity (UE) rehabilitation. Relatively recent studies have quantified the altered "muscle synergies", distinctive co-activation patterns of a group of muscles, which characterize the stroke-induced abnormal intermuscular coordination. Nonetheless, whether targeting the altered muscle synergy(ies) would ameliorate the stroke-induced motor impairment and improve motor function remains unknown. Our ultimate aim is to design an exercise protocol that modifies abnormal muscle synergies and improves motor function in UE after stroke. In this study, the feasibility of an electromyographic (EMG) signal-guided exercise protocol, which targeted the alteration of an elbow flexor synergy, was tested in healthy subjects. Four neurologically intact adults participated in a six-week isometric exercise to activate two major elbow flexor muscles, biceps and brachioradialis, in isolation. Participants performed an isometric reaching in a virtual three-dimensional (3D) force space to assess any potential changes in muscle synergies during the assessment at week zero, two, four, and six of the training. EMGs of 12 UE muscles and 3D forces were collected simultaneously. A non-negative matrix factorization (NMF) was applied to the EMGs to identify synergies. From the third-to-fourth week of the training, when the participants intended to use the newly learned motor skill, they were able to activate the targeted muscle pair in isolation and induce the formation of newly emerging synergistic muscle groups. As the participants practiced to expand their repertoire of intermuscular coordination patterns, their motor control of the trained UE was improved. These findings suggest that our isometric exercise protocol can potentially modulate impaired muscle coordination in a way that benefits stroke survivor's performance in activities of daily living (ADLs) and, eventually, their quality of life.

Therapeutic Instrumental Music Training and Motor Imagery in Post-Stroke Upper-Extremity Rehabilitation: A Randomized-Controlled Pilot Study

ObjectiveTo investigate the potential benefits of 3 therapeutic instrumental music performance (TIMP)-based interventions in rehabilitation of the affected upper-extremity (UE) for adults with chronic poststroke hemiparesis. DesignRandomized-controlled pilot study. SettingUniversity research facility. ParticipantsCommunity-dwelling volunteers (N=30; 16 men, 14 women; age range, 33-76 years; mean age, 55.9 years) began and completed the protocol. All participants had sustained a unilateral stroke more than 6 months before enrollment (mean time poststroke, 66.9 months). InterventionTwo baseline assessments, a minimum of 1 week apart; 9 intervention sessions (3 times/week for 3 weeks), in which rhythmically cued, functional arm movements were mapped onto musical instruments; and 1 post-test following the final intervention. Participants were block-randomized to 1 of 3 conditions: group 1 (45 minutes TIMP), group 2 (30 minutes TIMP, 15 minutes metronome-cued motor imagery [TIMP+cMI]), and group 3 (30 minutes TIMP, 15 minutes motor imagery without cues [TIMP+MI]). Assessors and investigators were blinded to group assignment. Main Outcome MeasuresFugl-Meyer Upper-Extremity (FM-UE) and Wolf Motor Function Test- Functional Ability Scale (WMFT-FAS). Secondary measures were motor activity log (MAL)–amount of use scale and trunk impairment scale. ResultsAll groups made statistically significant gains on the FM-UE (TIMP, P=.005, r=.63; TIMP+cMI, P=.007, r=.63; TIMP+MI, P=.007, r=.61) and the WMFT-FAS (TIMP, P=.024, r=.53; TIMP+cMI, P=.008, r=.60; TIMP+MI, P=.008, r=.63). Comparing between-group percent change differences, on the FM-UE, TIMP scored significantly higher than TIMP+cMI (P=.032, r=.57), but not TIMP+MI. There were no differences in improvement on WMFT-FAS across conditions. On the MAL, gains were significant for TIMP (P=.030, r=.54) and TIMP+MI (P=.007, r=.63). ConclusionTIMP-based techniques, with and without MI, led to significant improvements in paretic arm control on primary outcomes. Replacing a physical training segment with imagery-based training resulted in similar improvements; however, synchronizing internal and external cues during auditory-cMI may pose additional sensorimotor integration challenges.

Development of Reaching, Grasping & Manipulation indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project

Objective To describe the development of structure, process, and outcome indicators aimed to advance the quality of Reaching, Grasping & Manipulation (RG&M) rehabilitation for Canadians living with spinal cord injury or disease (SCI/D). Method Upper extremity rehabilitation experts developed a framework of indicators for evaluation of RG&M rehabilitation quality. A systematic search of the literature identified potential upper extremity indicators that influence RG&M outcomes. A Driver diagram summarized factors influencing upper extremity outcomes to inform the selection of structure and process indicators. Psychometric properties, clinical utility, and feasibility of potential upper extremity measures were considered when selecting outcome indicators. Results The selected structure indicator is the number of occupational and physical therapists with specialized certification, education, training and/or work experience in upper extremity therapy related to RG&M at a given SCI/D rehabilitation center. The process indicator is the total hours of upper extremity therapies related to RG&M and the proportion of this time allocated to neurorestorative therapy for each individual with tetraplegia receiving therapy. The outcome indicators are the Graded Redefined Assessment of Strength, Sensation and Prehension (GRASSP) strength and Spinal Cord Independence Measure III (SCIM III) Self-Care subscores implemented at rehabilitation admission and discharge, and SCIM III Self-Care subscore only at 18 months post-admission. Conclusion The selected indicators align with current practice, will direct the timing of routine assessments, and enhance the volume and quality of RG&M therapy delivered, with the aim to ultimately increase the proportion of individuals with tetraplegia achieving improved upper extremity function by 18 months post-rehabilitation.

Upper Extremity Activity-based Interventions for Functional Recovery in Spinal Cord Injury

<h3>Objective(s)</h3> To summarize the characteristics of reported high-intensity activity-based interventions for upper extremity rehabilitation in spinal cord injury (SCI). <h3>Data Sources</h3> The scoping review included articles from MEDLINE, CINAHL, Cochrane CENTRAL, and OTseeker. <h3>Study Selection</h3> Inclusion criteria were non-invasive upper extremity activity-based interventions duration at least 2 weeks, functional outcome measures, participants 13 years or older, English language, and SCI at least three months post onset/injury. <h3>Data Extraction</h3> The following data was extracted, tabulated, and summarized by the research team: population, study design, setting, technology, and intervention. <h3>Data Synthesis</h3> The search yielded 21 studies, all in adults. There were seven studies prior to 2017 and 14 studies from 2017-2021. Prior to 2017, studies consisted of task-specific training (TST) and gaming, with and without electrical stimulation, and one study utilized a robotic exoskeleton. The 14 studies done since 2017 also consisted of TST and gaming but also included several studies examining robotic exoskeletons and virtual reality, as well as one study utilizing brain stimulation. Study designs included nine RCT's, eight non-randomized clinical trials and four case reports. Over the past four years there has been an increase in non-randomized clinical trials, likely a reflection of studies piloting new technologies. Although the volume of studies being performed has increased since 2017, there remains limited variety in study environment with the overwhelming majority of studies being performed in the outpatient setting. Only two of the 21 studies utilized in-home interventions, and none examined telerehab interventions. <h3>Conclusions</h3> Over the past four years scholarly work investigating activity-based interventions for SCI rehabilitation has increased significantly in quantity and breadth. However, this area of research is still significantly lacking in rigorous study designs and home-based or telehealth studies. <h3>Author(s) Disclosures</h3> None.

Upper Extremity Activity-based Interventions for Functional Recovery in Spinal Cord Injury

<h3>Research Objectives</h3> To summarize the characteristics of reported high-intensity activity-based interventions for upper extremity rehabilitation in spinal cord injury (SCI). <h3>Design</h3> The scoping review included articles from MEDLINE, CINAHL, Cochrane CENTRAL, and OTseeker. The following data was extracted, tabulated, and summarized by the research team: population, study design, setting, technology, and intervention. <h3>Setting</h3> N/A - Scoping Review. <h3>Participants</h3> Inclusion criteria were non-invasive upper extremity activity-based interventions duration at least 2 weeks, functional outcome measures, participants 13 years or older, English language, and SCI at least three months post onset/injury. <h3>Interventions</h3> N/A - Scoping Review. <h3>Main Outcome Measures</h3> N/A - Scoping Review. <h3>Results</h3> The search yielded 21 studies, all in adults. There were seven studies prior to 2017 and 14 studies from 2017-2020. Prior to 2017, studies consisted of task-specific training (TST) and gaming, with and without electrical stimulation, and one study utilized a robotic exoskeleton. The 14 studies done since 2017 also consisted of TST and gaming but also included several studies examining robotic exoskeletons and virtual reality, as well as one study utilizing brain stimulation. Study designs included nine RCT's, eight non-randomized clinical trials and four case reports. Over the past four years there has been an increase in non-randomized clinical trials, likely a reflection of studies piloting new technologies. Although the volume of studies being performed has increased since 2017 has increased, there remains limited variety in study environment with the overwhelming majority of studies being performed in the outpatient setting. Only two of the 21 studies utilized in-home interventions, and none examined telerehab interventions. <h3>Conclusions</h3> Over the past four years scholarly work investigating activity-based interventions for SCI rehabilitation has increased significantly in quantity and breadth. However, this area of research is still significantly lacking in rigorous study designs and home-based or telehealth studies. <h3>Author(s) Disclosures</h3> None.

Development of a Short Form Assessment of Upper Extremity Motor Ability for Individuals Post Stroke

Research Objectives To develop a short form assessment that combines items from the Fugl Meyer Assessment-Upper Extremity (FMA) and the Wolf Motor Function Test (WMFT) to provide a more comprehensive and precise measure of UE motor ability post stroke. Design We used a convenience sample of pre-intervention data from two upper extremity rehabilitation trials conducted with stroke survivors. Factor analysis and the Rasch rating scale model were applied to examine the properties of the full item bank prior to the development of the short form. Setting Outpatient, academic research center. Participants Data were pooled since the parent studies had similar eligibility criteria. Participants were included in the studies if they experienced a stroke ≥ 3 months prior and had UE hemiparesis. Participants were excluded if they had severe hemiparesis, severe spasticity (Modified Ashworth Scale >3 in elbow, wrist, or fingers), or reported UE pain. 167 individuals with stroke who completed both the WMFT and FMA were included. Interventions N/A. Main Outcome Measures Data from the 30-item FMA and the 15-item WMFT (rating scale score) were analyzed using factor analysis to ensure unidimensionality. Item response theory methodologies were used to develop the short form. The Rasch rating scale model was applied to examine the measurement properties. Results A 15-item short form was developed. Item infit statistics (Mnsq) ranged from 0.63-1.35 and point measure correlations ranged from 0.39-0.90. Person reliability was 0.93 and the person separation index was 3.7 indicating the measure can separate between 5 statistically different strata. Conclusions Items from the FMA and WMFT can be combined to provide a precise measure of UE motor ability. The short form demonstrated acceptable psychometric properties. Author(s) Disclosures The authors have no conflicts of interest to disclose. To develop a short form assessment that combines items from the Fugl Meyer Assessment-Upper Extremity (FMA) and the Wolf Motor Function Test (WMFT) to provide a more comprehensive and precise measure of UE motor ability post stroke. We used a convenience sample of pre-intervention data from two upper extremity rehabilitation trials conducted with stroke survivors. Factor analysis and the Rasch rating scale model were applied to examine the properties of the full item bank prior to the development of the short form. Outpatient, academic research center. Data were pooled since the parent studies had similar eligibility criteria. Participants were included in the studies if they experienced a stroke ≥ 3 months prior and had UE hemiparesis. Participants were excluded if they had severe hemiparesis, severe spasticity (Modified Ashworth Scale >3 in elbow, wrist, or fingers), or reported UE pain. 167 individuals with stroke who completed both the WMFT and FMA were included. N/A. Data from the 30-item FMA and the 15-item WMFT (rating scale score) were analyzed using factor analysis to ensure unidimensionality. Item response theory methodologies were used to develop the short form. The Rasch rating scale model was applied to examine the measurement properties. A 15-item short form was developed. Item infit statistics (Mnsq) ranged from 0.63-1.35 and point measure correlations ranged from 0.39-0.90. Person reliability was 0.93 and the person separation index was 3.7 indicating the measure can separate between 5 statistically different strata. Items from the FMA and WMFT can be combined to provide a precise measure of UE motor ability. The short form demonstrated acceptable psychometric properties.

Designing and pilot testing a novel high-definition transcranial burst electrostimulation device for neurorehabilitation

Objective. Non-invasive brain stimulation has been promoted to facilitate neuromodulation in treating neurological diseases. Recently, high-definition (HD) transcranial electrical stimulation and a novel electrical waveform combining a direct current (DC) and theta burst stimulation (TBS)-like protocol were proposed and demonstrated high potential to enhance neuroplastic effects in a more-efficient manner. In this study, we designed a novel HD transcranial burst electrostimulation device and to preliminarily examined its therapeutic potential in neurorehabilitation. Approach. A prototype of the transcranial burst electrostimulation device was developed, which can flexibly output a waveform that combined a DC and TBS-like protocol and can equally distribute the current into 4 × 1 HD electrical stimulation by automatic impedance adjustments. The safety and accuracy of the device were then validated in a series of in vitro experiments. Finally, a pilot clinical trial was conducted to assess its clinical safety and therapeutic potential on upper-extremity rehabilitation in six patients with chronic stroke, where patients received either active or sham HD transcranial burst electrostimulation combined with occupational therapy three times per week for four weeks. Main results. The prototype was tested, and it was found to comply with all safety requirements. The output parameters were accurate and met the clinical study needs. The pilot clinical study demonstrated that the active HD transcranial burst electrostimulation group had greater improvement in voluntary motor function and coordination of the upper extremity than the sham control group. Additionally, no severe adverse events were noted, but slight skin redness under the stimulus electrode immediately after stimulation was seen. Conclusions. The results demonstrated the feasibility of incorporating the HD electrical DC and TBS-like protocol in our device; and the novel neuromodulatory device produced positive neurorehabilitation outcomes in a safe fashion, which could be the basis for the future clinical implementation for treating neurological diseases. Trial registration: ClinicalTrials.gov Identifier: NCT04278105. Registered on 20 February 2020.

Effects of proximal priority and distal priority robotic priming techniques with impairment-oriented training of upper limb functions in patients with chronic stroke: study protocol for a single-blind, randomized controlled trial

BackgroundThe sequence of establishing a proximal stability or function before facilitation of the distal body part has long been recognized in stroke rehabilitation practice but lacks scientific evidence. This study plans to examine the effects of proximal priority robotic priming and impairment-oriented training (PRI) and distal priority robotic priming and impairment-oriented training (DRI).MethodsThis single-blind, randomized, comparative efficacy study will involve 40 participants with chronic stroke. Participants will be randomized into the PRI or DRI groups and receive 18 intervention sessions (90 min/day, 3 days/weeks for 6 weeks). The Fugl-Meyer Assessment Upper Extremity subscale, Medical Research Council Scale, Revised Nottingham Sensory Assessment, and Wolf Motor Function Test will be administered at baseline, after treatment, and at the 3-month follow-up. Two-way repeated-measures analysis of variance and the chi-square automatic interaction detector method will be used to examine the comparative efficacy and predictors of outcome, respectively, after PRI and DRI.DiscussionThrough manipulating the sequence of applying wrist and forearm robots in therapy, this study will attempt to examine empirically the priming effect of proximal or distal priority robotic therapy in upper extremity impairment-oriented training for people with stroke. The findings will provide directions for further studies and empirical implications for clinical practice in upper extremity rehabilitation after stroke.Trial RegistrationClinicalTrials.gov NCT04446273. Registered on June 23, 2020.