Upper-limb Activity Research Articles

Activity Monitors for Increasing Physical Activity in Adult Stroke Survivors.

Background Stroke is the third leading cause of disability worldwide. Physical activity is important for secondary stroke prevention and for promoting functional recovery. However, people with stroke are more inactive than healthy age‐matched controls. Therefore, interventions to increase activity after stroke are vital to reduce stroke‐related disability. Objectives To summarise the available evidence regarding the effectiveness of commercially available, wearable activity monitors and smartphone applications for increasing physical activity levels in people with stroke. Search methods We searched the Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, SPORTDiscus, and the following clinical trial registers: WHO International Clinical Trials Registry Platform, Clinical Trials, EU Clinical Trial Register, ISRCTN Registry, Australian and New Zealand Clinical Trial Registry, and Stroke Trials Registry to 3 March 2018. We also searched reference lists, Web of Science forward tracking, and Google Scholar, and contacted trial authors to obtain further data if required. We did not restrict the search on language or publication status. Selection criteria We included all randomised controlled trials (RCTs) and randomised cross‐over trials that included use of activity monitors versus no intervention, another type of intervention, or other activity monitor. Participants were aged 18 years or older with a diagnosis of stroke, in hospital or living in the community. Primary outcome measures were steps per day and time in moderate‐to‐vigorous intensity activity. Secondary outcomes were sedentary time, time spent in light intensity physical activity, walking duration, fatigue, mood, quality of life, community participation and adverse events. We excluded upper limb monitors that only measured upper limb activity. Data collection and analysis We followed standard Cochrane methodology to analyse and interpret the data. At least two authors independently screened titles and abstracts for inclusion. We resolved disagreements by consulting a third review author. We extracted the following data from included studies into a standardised template: type of study, participant population, study setting, intervention and co‐interventions, time‐frame, and outcomes. We graded levels of bias as high, low, or unclear, and assessed the quality of evidence for each outcome using the GRADE approach. Main results We retrieved 28,098 references, from which we identified 29 potential articles. Four RCTs (in 11 reports) met the inclusion criteria.The sample sizes ranged from 27 to 135 (total 245 participants). Time poststroke varied from less than one week (n = 1), to one to three months (n = 2), or a median of 51 months (n = 1). Stroke severity ranged from a median of one to six on the National Institutes of Health Stroke Scale (NIHSS). Three studies were conducted in inpatient rehabilitation, and one was in a university laboratory. All studies compared use of activity monitor plus another intervention (e.g. a walking retraining programme or an inpatient rehabilitation programme) versus the other intervention alone. Three studies reported on the primary outcome of daily step counts. There was no clear effect for the use of activity monitors in conjunction with other interventions on step count in a community setting (mean difference (MD) ‐1930 steps, 95% confidence interval (CI) ‐4410 to 550; 1 RCT, 27 participants; very low‐quality evidence), or in an inpatient rehabilitation setting (MD 1400 steps, 95% CI ‐40 to 2840; 2 RCTs, 83 participants; very low‐quality evidence). No studies reported the primary outcome moderate‐to‐vigorous physical activity, but one did report time spent in moderate and vigorous intensity activity separately: this study reported that an activity monitor in addition to usual inpatient rehabilitation increased the time spent on moderate intensity physical activity by 4.4 minutes per day (95% CI 0.28 to 8.52; 1 RCT, 48 participants; low‐quality evidence) compared with usual rehabilitation alone, but there was no clear effect for the use of an activity monitor plus usual rehabilitation for increasing time spent in vigorous intensity physical activity compared to usual rehabilitation (MD 2.6 minutes per day, 95% CI ‐0.8 to 6; 1 RCT, 48 participants; low‐quality evidence). The overall risk of bias was low, apart from high‐risk for blinding of participants and study personnel. None of the included studies reported any information relating to adverse effects. Authors' conclusions Only four small RCTs with 274 participants (three in inpatient rehabilitation and one in the community) have examined the efficacy of activity monitors for increasing physical activity after stroke. Although these studies showed activity monitors could be incorporated into practice, there is currently not enough evidence to support the use of activity monitors to increase physical activity after stroke.

"Remind-to-Move" for Promoting Upper Extremity Recovery Using Wearable Devices in Subacute Stroke: A Multi-Center Randomized Controlled Study.

This paper examined the effects of "Remind-to-Move" (RTM) via vibration cueing using wearable devices to increase the use of the affected upper limb and integrate upper limb activities undertaken at home in patients with subacute stroke after inpatient discharge. In a multi-centered randomized controlled trial, 84 eligible patients from four general hospitals, who had a first stroke in the last six months, were randomly allocated to either an experimental, sham, or control group, stratified by arm function levels. Patients in the experimental group were treated by RTM, using wearable devices for three consecutive hours daily, over four weeks. The sham group used sham devices, and the control group received usual care alone. A masked assessor evaluated the patients at 0th, 4th, 8th, and 12th weeks using outcome measures included arm function tests, motor activity log, and movement recorded by the devices. Results showed that there was a significant group by time interaction, and the average movement amount and Action Research Arm Test score in the experimental group were significantly higher than in the sham group. This paper demonstrates that RTM via wearable devices used for the hemiplegic upper extremities could promote more arm recovery than the sham or control and, hence, produce an optimal functional improvement for subacute stroke patients.

Factors affecting rehabilitation and use of upper limb after stroke: views from healthcare professionals and stroke survivors

ABSTRACTBackground: Training of the upper limb (UL) is limited in stroke rehabilitation, and about 50% of stroke survivors do not regain useful function in their upper limb.Objectives: This study explored what factors affect rehabilitation and use of upper limb after stroke from a stroke survivor and healthcare professional perspective to better understand low engagement in UL rehabilitation in the chronic stages of stroke.Method: Eight chronic stroke survivors and 21 healthcare professionals took part in semi-structured interviews or in one of three focus groups, respectively.Results: Thematic analysis revealed three main themes: Availability of resources, Healthcare professional–patient relationship, and Psychosocial factors. Availability of resources and Healthcare professional–patient relationship indicated that due to resource pressures and a lack of communication and education, positive upper limb rehabilitation behaviors (e.g. engaging and integrating the upper limb in daily activity) were not always established in the early stages post-stroke. Psychosocial factors illustrated the cognitive and psychological barriers to sustained engagement with upper limb rehabilitation.Conclusion: The findings indicate that stroke survivors and healthcare professionals have very similar understandings of barriers to UL activity, and positive upper limb rehabilitation behaviors are not always established early in recovery post-stroke. Increased resources and healthcare professional–patient relationships seem key factors to establishing positive perceptions of UL rehabilitation. Addressing psychosocial issues and resource limitations may help sustain engagement with UL rehabilitation.

Effects of High-intensity Robot-assisted Hand Training on Upper Limb Recovery and Muscle Activity in Individuals With Multiple Sclerosis: A Randomized, Controlled, Single-Blinded Trial.

Background : Integration of robotics and upper limb rehabilitation in people with multiple sclerosis (PwMS) has rarely been investigated.Objective: To compare the effects of robot-assisted hand training against non-robotic hand training on upper limb activity in PwMS. To compare the training effects on hand dexterity, muscle activity, and upper limb dysfunction as measured with the International Classification of Functioning.Methods: This single-blind, randomized, controlled trial involved 44 PwMS (Expanded Disability Status Scale:1.5–8) and hand dexterity deficits. The experimental group (n = 23) received robot-assisted hand training; the control group (n = 21) received non-robotic hand training. Training protocols lasted for 5 weeks (50 min/session, 2 sessions/week). Before (T0), after (T1), and at 1 month follow-up (T2), a blinded rater evaluated patients using a comprehensive test battery. Primary outcome: Action Research Arm Test. Secondary outcomes: Nine Holes Peg Test; Fugl-Meyer Assessment Scale–upper extremity section; Motricity Index; Motor Activity Log; Multiple Sclerosis (MS) Quality of Life−54; Life Habits assessment—general short form and surface electromyography.Results: There were no significant between-group differences in primary and secondary outcomes. Electromyography showed relevant changes providing evidence increased activity in the extensor carpi at T1 and T2.Conclusion: The training effects on upper limb activity and function were comparable between the two groups. However, robot-assisted training demonstrated remarkable effects on upper limb use and muscle activity. https://clinicaltrials.gov NCT03561155.

Can Whole-Body Vibration Exercises in Different Positions Change Muscular Activity of Upper Limbs? A Randomized Trial.

The aim of this study was to investigate the acute effects of whole-body vibration exercises (WBVE) in different positions on muscular activity of flexor digitorum superficialis (FD), wrist extensor (ED), and handgrip strength (HG) of healthy men. Fifteen participants have performed 5 test sets each one consisting of HG strength measurement and 1-minute WBVE intervention (frequency: 50 Hz, amplitude: 1.53 mm, synchronous tri-planar oscillating/vibratory platform), that could be control (no exposition to vibration), squat (30 seconds of rest and 30 seconds of WBVE in squat position), or push-up (30 seconds of rest, and 30 seconds of WBVE in push-up position). After testing, participants had 2 minutes of rest and then were encouraged to keep themselves on a pull-up bar for 30 seconds. During all procedures, muscular activity of FD and ED was measured by surface electromyography (EMG). Statistical analysis has revealed that the EMG measured in the FD during the static pull-up bar exercise after SQUAT condition was significantly higher (P = .004) than the CONTROL and PUSH-UP conditions. Whole-body vibration exercises in squat position increase acutely muscle activation of the FD during isometric exercises of longer duration, while muscle activation of ED and HG strength are not affected by WBVE.

A systematic review of the psychometric properties of the Action Research Arm Test in neurorehabilitation.

The Action Research Arm Test (ARAT) measures upper limb activity limitations in people with acquired brain injuries. Evidence relating to the use of this test in neurorehabilitation is scattered. This review identifies, rates and synthesises evidence on the original 1981 ARAT use within neurorehabilitation. Psychometric properties are reviewed, including specific examination of participants with upper limb spasticity. Systematic review of published articles describing psychometric properties and/or use of the original version of the ARAT in neurorehabilitation. COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) search strategy, reporting and methodological checklist with criterion-based appraisal of quality criteria for good measurement properties were applied. A best evidence synthesis for each psychometric property was completed. In 28 included studies, participants had suffered a stroke or traumatic brain injury, with 46% >6months post-injury. Six studies identified participants with upper limb spasticity. Methodological quality of psychometric properties ranged from poor to excellent. Best evidence synthesis determined moderate positive evidence for using the ARAT with people without limb spasticity: intra-rater reliability (ICC 0.71 (95% CI 0.53-0.89) to 0.99 (95% CI 0.98, 0.99)); responsiveness (ROC curve 0.72-0.88, SRM 0.89); and regarding construct validity, it is a valid measure of activity limitation. Limited evidence for psychometric properties of the ARAT were found when used with people with upper limb spasticity for construct validity and responsiveness (ES 0.55-0.78). Gaps in evidence were found for inter and test-retest reliability, measurement error, content validity, structural validity, floor and ceiling effects. The ARAT is an appropriate measure of activity limitation post-stroke and should be considered for use with people with TBI; evidence for people with upper limb spasticity is limited. Gaps and mixed limited to moderate evidence for psychometric properties in neurorehabilitation mean further research is required.

Wavlet phase-locking based binary classification of hand movement directions from EEG

Objective. Brain signals can be used to extract relevant features to decode various limb movement parameters such as the direction of upper limb movements. Amplitude based feature extraction techniques have been used to study such motor activity of upper limbs whereas phase synchrony, used to estimate functional relationship between signals, has rarely been used to study single hand movements in different directions. Approach. In this paper, a novel phase-locking-based feature extraction method, called wavelet phase-locking value (W-PLV) is proposed to analyse synchronous EEG channel-pairs and classify hand movement directions. EEG data collected from seven subjects performing right hand movements in four orthogonal directions in the horizontal plane is used for this analysis. Main results. Our proposed W-PLV based method achieves a mean binary classification accuracy of 76.85% over seven subjects using wavelet levels corresponding to ⩽12 Hz EEG. The results also show direction-dependent information in various wavelet levels and indicate the presence of relevant information in slow cortical potentials (<1 Hz) as well as higher wavelet levels (⩽12 Hz). Significance. This study presents a thorough analysis of the phase-locking patterns extracted from EEG corresponding to hand movements in different directions using W-PLV across various wavelet levels and verifies their discriminative ability in the single trial binary classification of hand movement directions.

Interventions involving repetitive practice improve strength after stroke: a systematic review.

Do interventions involving repetitive practice improve strength after stroke? Are any improvements in strength accompanied by improvements in activity? Systematic review of randomised trials with meta-analysis. Adults who have had a stroke. Any intervention involving repetitive practice compared with no intervention or a sham intervention. The primary outcome was voluntary strength in muscles trained as part of the intervention. The secondary outcomes were measures of lower limb and upper limb activity. Fifty-two studies were included. The overall SMD of repetitive practice on strength was examined by pooling post-intervention scores from 46 studies involving 1928 participants. The SMD of repetitive practice on strength when the upper and lower limb studies were combined was 0.25 (95% CI 0.16 to 0.34, I2=44%) in favour of repetitive practice. Twenty-four studies with a total of 912 participants investigated the effects of repetitive practice on upper limb activity after stroke. The SMD was 0.15 (95% CI 0.02 to 0.29, I2=50%) in favour of repetitive practice on upper limb activity. Twenty studies with a total of 952 participants investigated the effects of repetitive practice on lower limb activity after stroke. The SMD was 0.25 (95% CI 0.12 to 0.38, I2=36%) in favour of repetitive practice on lower limb activity. Interventions involving repetitive practice improve strength after stroke, and these improvements are accompanied by improvements in activity. PROSPERO CRD42017068658. [de Sousa DG, Harvey LA, Dorsch S, Glinsky JV (2018) Interventions involving repetitive practice improve strength after stroke: a systematic review. Journal of Physiotherapy 64: 210-221].

Construct validity and responsiveness of the functional Tactile Object Recognition Test for children with cerebral palsy.

The functional Tactile Object Recognition Test (fTORT) is a measure of haptic object recognition capacity recently adapted for use with children with neurological impairment. The current study aimed to investigate preliminary evidence of construct validity and responsiveness of the fTORT and its association with a measure of upper limb activity. A cross-sectional study of 28 children with spastic hemiplegic cerebral palsy (CP) (mean age 10years 8months; SD two years four months; 16 male) and 39 typically developing (TD) children (mean age 11years; SD two years nine months; 19 male) was utilised to investigate construct validity and association between measures. Sixteen children with CP (mean age 10years 10months; SD two years 8months; 9 male) who were randomly allocated to either a treatment (n=6) or control group (n=10) were assessed at four time points to assess test responsiveness. There was a very significant difference (P value <0.0001) indicating greater haptic object recognition ability for the TD group (n=39; median: 40; range: 33-42) than the group with CP (n=28; median: 32.5; range: 3-41). fTORT scores demonstrated a significant association with scores on the activity measure (Pearson's r: 0.68; P=0.0001). There were no significant changes over time in fTORT scores (P=0.22) and no significant difference between the treatment and control groups (P=0.47). The fTORT demonstrated preliminary construct validity, and was positively associated with an upper limb activity measure but scores did not change significantly following somatosensory training. This preliminary paper supports further research and future psychometric knowledge about the tool.

Impact of posture and upper-limb muscle activity on grip strength

Purpose. The current research was carried out to determine grip strength (GS) with change in posture and upper-limb muscle activity of manual workers and investigate the impacts of these changes. Methods. For the current research, 120 male and 80 female participants were selected and GS was assessed using a digital hand grip dynamometer in various conditions. Results. The outcomes showed that male participants had higher GS as compared to female participants. Maximum GS was found in a standing posture with the fixed forward shoulder at 45°, elbow at 90° and a neutral position of the wrist and forearm for all participants. Conclusions. Higher values of GS were attained in standing postures which may result in attainment of higher performance levels by the workers. The outcomes justify the importance of correct postures during manual work in industries employing traditional methods.

Evaluation of manual ability in stroke patients in Benin: cultural adaptation and Rasch validation of the ABILHAND-Stroke questionnaire.

ABILHAND is a self-reported questionnaire assessing manual ability. It was validated and calibrated using the Rasch analysis for European stroke patients. After a stroke, performing upper limb activities of daily living is influenced by personal and environmental contextual factors. It is thus important to conduct a contextual validation to use this questionnaire outside of Europe. The aim of this study was to perform a cross cultural validation of the ABILHAND-Stroke questionnaire for post-stroke patients living in Benin, a West-African country. Observational cross-sectional study. Outpatient rehabilitation centres. 223 Beninese chronic stroke patients. The experimental questionnaire was made of 59 items evaluating manual activities. Patients had to estimate their difficulty of performing each activity according to four response categories: impossible, very difficult, difficult and easy. For construct validity analysis, patients were also evaluated with other assessment tools: Box and Block Test, the motor subscale of the Functional Independence Measure, the Stroke Impairment Assessment Set, and ACTIVLIM-Stroke. Data were analysed with the Rasch partial credit model. The response categories very difficult and difficult were merged and the number of response categories was reduced from 4 to 3 (impossible, difficult and easy). The Rasch analyses selected 16 bimanual activities that fit the Rasch model (chi square=42.35; P=0.10). The item location ranged from -1.10 to 2.24 logits. The standard error ranged from 0.15 to 0.22 logits. There is no differential item functioning between subgroups (age, sex, dexterity, affected side, time since stroke). The person separation index is 0.82. The questionnaire can measure 3 levels of manual ability, similarly to the occidental version. The ABILHAND-stroke is a Rasch validated, unidimensional and invariant questionnaire to assess manual ability among Beninese patients. The ordinal score can be transformed into linear score using a conversion table. This assessment tool is clinically relevant in Benin, a developing country, since it requires no specific equipment or training. It should promote and standardize assessments for stroke patients in clinical practice and research in this African country.

Upper limb activity in myoelectric prosthesis users is biased towards the intact limb and appears unrelated to goal-directed task performance

Studies of the effectiveness of prosthetic hands involve assessing user performance on functional tasks, typically collected in the lab, sometimes combined with self-report of real-world use. In this paper we compare real-world upper limb activity between a group of 20 myoelectric prosthesis users and 20 anatomically intact adults. Activity was measured from wrist-worn accelerometers over a 7-day period. The temporal patterns in upper limb activity are presented and the balance of activity between the two limbs quantified. We also evaluated the prosthesis users’ performance on a goal-directed task, characterised using measures including task success rate, completion time, gaze behaviour patterns, and kinematics (e.g. variability and patterns in hand aperture). Prosthesis users were heavily reliant on their intact limb during everyday life, in contrast to anatomically intact adults who demonstrated similar reliance on both upper limbs. There was no significant correlation between the amount of time a prosthesis was worn and reliance on the intact limb, and there was no significant correlation between either of these measures and any of the assessed kinematic and gaze-related measures of performance. We found participants who had been prescribed a prosthesis for longer to demonstrate more symmetry in their overall upper limb activity, although this was not reflected in the symmetry of unilateral limb use. With the exception of previously published case studies, this is the first report of real world upper limb activity in myoelectric prosthesis users and confirms the widely held belief that users are heavily reliant on their intact limb.

Botulinum Neurotoxin Type A Combined with Functional Electrical Stimulation for Upper-Limb Poststroke Spasticity with Pain

Stroke is a complicated condition that leaves stroke survivors with prolonged disability. Common poststroke conditions are spasticity and pain, which directly affect daily activities and quality of life in these patients. Botulinum neurotoxin type A is an effective and well-tolerated treatment option for upper-limb spasticity. It reduces muscle tone and improves basic upper-limb activities. Functional electrical stimulation is also used widely as a therapeutic modality in the upper-limb muscle rehabilitation. Here, we present a case in which Botulinum neurotoxin type A injections combined with functional electrical stimulation were applied for upper-limb spasticity accompanied with pain in a poststroke patient.

Patient-Reported and Objectively Measured Function Before and After Reverse Shoulder Arthroplasty.

Documenting functional outcomes after reverse shoulder arthroplasty (RSA) is critical to advancing patient care. The interplay been self-reported and objectively measured outcome measures has not been widely described. The utilization of wearable devices to document upper extremity limb activity is a new approach for objectively measuring outcomes. Therefore, the purpose of this study was to evaluate changes in pain, and self-reported function and objectively measured limb activity after RSA. We also assessed the influence of pain on self-reported function and objectively measured limb activity to determine the impact of pain on outcomes after RSA. This study implemented a prospective, repeated-measures design. Fourteen patients undergoing RSA underwent testing before surgery, and 2 and 12 months after surgery. Patient-reported instruments included pain, Disabilities of Arm, Shoulder and hands (DASH), and physical component summary (PCS) of the 36-Item Short Form Health Survey. Objective limb activity (mean activity value, m/s/min epoch; inactive time, %; low activity, %; and high activity, %) was captured with triaxial accelerometers worn on the upper and lower arm. A repeated-measures ANOVA tested for differences across time. The Spearman rank-order correlation was calculated to evaluate the influence of pain on DASH, PCS scores, and mean limb activity. Patient-reported measures improved after surgery (pain, P < .01; DASH, P < .01; PCS, P = .01). No change in limb activity was found at 1 year compared with preoperative values for mean (forearm, P = 1.00; arm, P = .36), inactivity (forearm, P = .33; arm, P = .22), low (forearm, P = .77; arm, P = .11) or high (forearm, P = 1.00; arm, P = .20) activity. There was a relationship between pain and DASH scores 1 year after surgery (P = .04) but not before surgery (P = .16), or 2 months after surgery (P = .30). There was no relationship between pain and PCS scores at any time point (preoperative, P = .97; 2 months, P = .21; 1 year, P = .08) nor pain and limb activity (forearm: preoperative, P = .36; 2 months, P = .67; 1 year, P = .16; arm: preoperative, P = .97; 2 months, P = .59; 1 year, P = .51). RSA reduced pain and enhanced patient-perceived function. Objectively measured upper extremity limb activity is not different 1 year after surgery compared with preoperative levels. III.

Upper limb activity in chronic post-stroke survivors: A comparison of accelerometry data with the Action Research Arm Test (ARAT)

Only 5–20% of stroke survivors will regain full function of the upper limb (UL) with up to 60% still being impaired in the chronic phase. A plethora of outcome measures are used to assess UL function. However, they are often only a snap shot in time of the stroke survivor's capability and do not always reflect the stroke survivor's UL use in everyday real-world settings and contexts. The use of technologies has become a viable option for quantifying movements and activities during post-stroke rehabilitation in real-world contexts. This research compares the use of accelerometry with the ARAT over 96 hours with chronic stroke survivors and age-matched controls. Thirty chronic stroke survivors and 30 age-matched controls wore an accelerometer on each wrist for 96 hours. Stroke survivors were also assessed using the ARAT and reported their functional ability. Data were analysed to compare affected UL v non-affected UL, stroke survivor movement v control, and hand dominance v non-dominance. Accelerometry data were compared with the stroke survivors’ functional capability. Findings suggest there is an association between the ARAT and accelerometry; the greater the capability score the higher the usage of the affected UL. Controls carryout more bi-lateral activities compared to the stroke survivors who tend to use each arm independently. However, despite full functional capability scores, stroke survivors still do not use their impaired UL compared to their non-affected UL. This is due to sensory loss or mistrust of their affected UL. Compared to controls, chronic stroke survivors do not use their affected UL, nor do they carry out as much bi-lateral activity despite full capability. Accelerometry has the potential to measure UL movement and movement characteristics over long periods, which can provide essential feedback for both clinicians and stroke survivors.

Effect of Physical Therapy on Muscle Synergy Structure During Standing-Up Motion of Hemiplegic Patients

Stroke patients suffer from declined physical ability, and it is important to analyze rehabilitation intervention and clarify its effect on the motion of patients. In this study, the effect of intervention on the standing-up motion of stroke patients is investigated. First, the intervention timing of a physical therapist (PT) is analyzed quantitatively from the muscle activity of upper limbs during therapy. Next, the intervention effect is evaluated based on body kinematics and muscle synergy. In this study, twenty trials are conducted, in which the standing-up motion of hemiplegic patients (n=12) is measured with and without the intervention by a PT. The results show that PTs teach hemiplegic patients the timing of lifting their buttocks during standing-up motion. Furthermore, it has been found that this intervention could improve the standing-up motion, although stroke patients had inadequate muscle synergy structure. In particular, some patients had delayed activation of the synergy and they could only stood up after they moved their center of mass toward their feet. However, the intervention by PTs could induce earlier activation of the synergy. Moreover, the intervention could properly shorten the activation duration of muscle synergy for those who had unusually inappropriate longer activation of synergy. These results imply that disordered and inadequate muscle synergy structure can be improved by proper intervention, and this study contributes to the further development of new rehabilitation methodologies.

Using an interactive virtual environment to integrate a digital Action Research Arm Test, motor imagery and action observation to assess and improve upper limb motor function in patients with neuromuscular impairments: a usability and feasibility study protocol

IntroductionIn the recent past, training systems using an interactive virtual environment have been introduced to neurorehabilitation. Such systems can be applied to encourage purposeful limb movements and will increasingly be...

The effect of core stabilization training combined with virtual reality for treatment of the upper limb function in stroke

To study the therapeutic effect of core stabilization training combined with virtual reality for treatment of the upper limb function in stroke. Forty-six patients for hospitalization and outpatient treatment after stroke were randomly divided into a control and an experimental group. The two groups are all treated with physical therapy, occupational therapy, physical agents therapy and virtual reality, and core stabilization training are adopted in the experimental group. After four weeks of treatment, range of motion (ROM), Fugl–Meyer Assessment Upper Extremity (FMA-UE), Fugl–Meyer Assessment balance subscale (FMA-B) and Modified Barthel Index (MBI) used for evaluation and comparison before and after treatment. Before treatment, the ROM, FMA-UE, FMA-B and MBI scores in the two groups had no statistical significance ( P > 0.05). But after four weeks of treatment, the two groups had a significant improvement in the four scores ( P < 0.05). What is more, patients in the experimental group improved significantly more than those in the control group. The difference between the two groups is statistically significant ( P < 0.05). The core stabilization training combined with virtual reality can improve the upper limb activity range and balance function after stroke. At the same time it can obviously improve patients’ upper extremity motor function and quality of life.

Adaptation of upper limb movement using exoskeleton-based training and transfer of cinematic patterns to unconstrained movement: A preliminary study

Robotic technologies offer the possibility for highly specific training of upper limb movements. How exactly the motor coordination imposed during an intervention carries over into unconstrained upper limb activity, however, remains poorly understood. This preliminary study sought to examine the after effects of robotic training on upper limb joint kinematics during reaching. Using a four-degree of freedom upper limb exoskeleton, healthy adult subjects trained on a series of reaching tasks. Shoulder and elbow joint coordination was modified using a viscous corrective force field. Kinematic variables during the different reaching tasks without the robotic device were evaluated using a motion capture system prior to and following the intervention. Movement adaptation was evaluated with respect to subject performance on reaching toward experimental targets as well as untrained targets. Shoulder abduction profiles and terminal elbow position appeared modified two hours following the training. These changes reflected the joint kinematics forced during the robotic intervention. Furthermore, distance metrics based upon principal components analysis indicated that exposure to the corrective force field had durable effects upon shared coordination between the shoulder and elbow. This shift in movement patterns was observed for both the experimental and untrained targets. These preliminary results suggest that certain features of upper limb movement, trained using corrective force fields in an exoskeleton, may be retained following the intervention and potentially generalised to prehensile movements in the peripersonal workspace.

Does botulinum toxin treatment improve upper limb active function?

Spasticity following lesions of the central nervous system such as stroke is a major cause of impairment and disability, especially when it affects the upper limb, and can be focally relieved by intramuscular injections of botulinum toxin (BT). Functional improvements of the affected upper limb after a BT focal treatment remain controversial. We aimed to assess the functional effects of BT treatment on upper-limb spasticity in the literature, identify flaws and deficiencies in proving these effects and propose leads for future trials. We searched the MEDLINE and Cochrane databases for trials, reviews and meta-analyses assessing the effect of BT injection in upper-limb spasticity. This was a non-systematic narrative review, and the selection of articles was based on the authors' expertise. The review focused on stroke-related spasticity and disability. Patients' therapeutic targets involved use of the disability assessment scale (DAS) or goal attainment scale (GAS). Impairments and passive function goals prevailed for active function and participation and were more frequently achieved for the former than the latter. Meta-analyses showed no to mild effect sizes for improvement in upper-limb function but failed to show higher and/or better use of the paretic upper limb in activities of daily living after BT injection. BT injections for impairment and passive function are related to improved kinematic parameters; however, the relation between relief of spasticity and improved upper-limb activity has not been established. Possible explanations for the lack of functional effect in studies are first, disability is mainly due to muscle weakness rather than spasticity, so patients with the best underlying motricity may benefit the most from BT injections; second, assessment methods may not be adapted to screen eligible patients; third, most studies' endpoints were at 4 to 12 weeks after a single injection, but repeated treatment sessions might be needed to observe functional outcome on the upper limbs; and finally, the association of rehabilitation programs or non-pharmacological treatments may enhance the functional effects of BT injections.