Upper-limb Training Research Articles

Wearable EMG Shirt for Upper Limb Training.

This work presents a wearable shirt fitted with dry electrodes to measure EMG in upper limbs during physical exercise. The hardware acquires signals from 6 channels and transmits wirelessly to a PC via Bluetooth. In the PC, EMG signals are analyzed to give feedback to the user regarding the exercise being performed. To alert for muscle fatigue, the Dimitrov index is used, with much better results that classic mean or median EMG frequency tracking. The system is able to monitor EMG activity and provide valuable information in real-time for professional and amateur athletes and their sports coach, improving their training protocols.

Effects of non-invasive brain stimulation for upper limb rehabilitation in acute stroke patients - A controlled clinical trial

This study was conducted in Tuen Mun Hospital (TMH) to evaluate the effects of rTMS and tDCS on upper limb functional recovery in acute stroke patients. Patients with acute stroke were randomly assigned to rTMS, tDCS or control group. For rTMS group, patient received 1 Hz rTMS at 90% of resting motor threshold to M1 of the unaffected hemisphere for 1200 pulses. For tDCS group, patient received 1 mA anodal stimulation to hand area of the affected hemisphere for 20 minutes. Five consecutive sessions of rTMS or tDCS together with intensive physiotherapy upper limb training were given. For control group, only intensive physiotherapy upper limb training were given. The upper extremity section of Fugl–Meyer Scale (UE-FM) was used as outcome measure. Twenty-nine patients (17 female and 12 male) were assigned to the rTMS ( n = 9), tDCS ( n = 11) and control ( n = 9) group. The mean age was 62.7 ± 12.0 years old and the mean time between stroke onset and the first UE-FM assessment was 9.14 ± 3.30 days. There was no statistically significant difference in mean age, baseline UE-FM mean score, mean time between stroke onset and the first UE-FM assessment among three groups [X 2 (2) = 4.81, P = 0.09] [X 2 (2) = 1.56, P = 0.457] [X 2 (2) = 0.04, P = 0.98]. No adverse effects of rTMS or tDCS were reported. For between-group comparison, the changes in mean score of UE-FM in rTMS (20.8 ± 6.59) and tDCS group (16.1 ± 4.97) were statistically significantly larger than that in control group (10.6 ± 4.13) (U = −2.97, P = 0.002) (U = −2.29, P = 0.02). However, there was no significant difference between rTMS and tDCS group (U = −1.49, P = 0.152). Findings of the present study showed that both rTMS and tDCS could augment physiotherapy treatment in enhancing upper limb motor functional recovery in acute stroke patients. These positive findings warrant further investigation of the application of non-invasive brain stimulation techniques to neurorehabilitation.

Translation of robot-assisted rehabilitation to clinical service: a comparison of the rehabilitation effectiveness of EMG-driven robot hand assisted upper limb training in practical clinical service and in clinical trial with laboratory configuration for chronic stroke

BackgroundRehabilitation robots can provide intensive physical training after stroke. However, variations of the rehabilitation effects in translation from well-controlled research studies to clinical services have not been well evaluated yet. This study aims to compare the rehabilitation effects of the upper limb training by an electromyography (EMG)-driven robotic hand achieved in a well-controlled research environment and in a practical clinical service.MethodsIt was a non-randomized controlled trial, and thirty-two participants with chronic stroke were recruited either in the clinical service (n = 16, clinic group), or in the research setting (n = 16, lab group). Each participant received 20-session EMG-driven robotic hand assisted upper limb training. The training frequency (4 sessions/week) and the pace in a session were fixed for the lab group, while they were flexible (1–3 sessions/week) and adaptive for the clinic group. The training effects were evaluated before and after the treatment with clinical scores of the Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), Functional Independence Measure (FIM), and Modified Ashworth Scale (MAS).ResultsSignificant improvements in the FMA full score, shoulder/elbow and wrist/hand (P < 0.001), ARAT (P < 0.001), and MAS elbow (P < 0.05) were observed after the training for both groups. Significant improvements in the FIM (P < 0.05), MAS wrist (P < 0.001) and MAS hand (P < 0.05) were only obtained after the training in the clinic group. Compared with the lab group, higher FIM improvement in the clinic group was observed (P < 0.05).ConclusionsThe functional improvements after the robotic hand training in the clinical service were comparable to the effectiveness achieved in the research setting, through flexible training schedules even with a lower training frequency every week. Higher independence in the daily living and a more effective release in muscle tones were achieved in the clinic group than the lab group.

Assessing User Transparency with Muscle Synergies during Exoskeleton-Assisted Movements: A Pilot Study on the LIGHTarm Device for Neurorehabilitation.

Exoskeleton devices for upper limb neurorehabilitation are one of the most exploited solutions for the recovery of lost motor functions. By providing weight support, passively compensated exoskeletons allow patients to experience upper limb training. Transparency is a desirable feature of exoskeletons that describes how the device alters free movements or interferes with spontaneous muscle patterns. A pilot study on healthy subjects was conducted to evaluate the feasibility of assessing transparency in the framework of muscle synergies. For such purpose, the LIGHTarm exoskeleton prototype was used. LIGHTarm provides gravity support to the upper limb during the execution of movements in the tridimensional workspace. Surface electromyography was acquired during the execution of three daily life movements (reaching, hand-to-mouth, and hand-to-nape) in three different conditions: free movement, exoskeleton-assisted (without gravity compensation), and exoskeleton-assisted (with gravity compensation) on healthy people. Preliminary results suggest that the muscle synergy framework may provide valuable assessment of user transparency and weight support features of devices aimed at rehabilitation.

Tele-UPCAT: study protocol of a randomised controlled trial of a home-based Tele-monitored UPper limb Children Action observation Training for participants with unilateral cerebral palsy

IntroductionA new rehabilitative approach, called UPper Limb Children Action Observation Training (UPCAT), based on the principles of action observation training (AOT), has provided promising results for upper limb rehabilitation in...

Evolution of upper limb kinematics four years after subacute robot-assisted rehabilitation in stroke patients

ABSTRACTPurpose: To assess functional status and robot-based kinematic measures four years after subacute robot-assisted rehabilitation in hemiparesis.Materials and methods: Twenty-two patients with stroke-induced hemiparesis underwent a ≥3-month upper limb combined program of robot-assisted and occupational therapy from two months post-stroke, and received community-based therapy after discharge. Four years later, 19 (86%) participated in this follow-up study. Assessments 2, 5 and 54 months post-stroke included Fugl-Meyer (FM), Modified Frenchay Scale (MFS, at Month 54) and robot-based kinematic measures of targeting tasks in three directions, north, paretic and non-paretic: distance covered, velocity, accuracy (root mean square (RMS) error from straight line) and smoothness (number of velocity peaks; upward changes in accuracy and smoothness represent worsening). Analysis was stratified by FM score at two months: ≥17 (Group 1) or <17 (Group 2). Correlation between impairment (FM) and function (MFS) was explored at 54 months.Results: FM scores were stable from 5 to 54 months (+1[−2;4], median [1st; 3rd quartiles], ns). Kinematic changes (three directions pooled) were: distance −1[−17;2]% (ns); velocity, −8[−32;28]% (ns); accuracy, +6[−13;98]% (ns); smoothness, +44[−6;126]% (p < 0.05). Group 2 showed decline vs. Group 1 (p < 0.001) in FM (Group 1, +3[1;5], p < 0.01; Group 2, −7[−11;−1], ns) and accuracy (Group 1, −3[−27;38]%, ns; Group 2, +29[17;140]%, p < 0.001). At 54 months, FM and MFS were highly correlated (Pearson's rho = 0.89; p < 0.001).Conclusions: While impairment appeared stable four years after robot-assisted upper limb training during subacute post-stroke phase, movement kinematics deteriorated despite community-based therapy, especially in more severely impaired patients.Trial registration: EudraCT 2016-005121-36. Registration: 2016-12-20. Date of enrolment of the first participant to the trial: 2009-11-24.

Home-based bimanual training based on motor learning principles in children with unilateral cerebral palsy and their parents (the COAD-study): rationale and protocols

BackgroundHome-based training is considered an important intervention in rehabilitation of children with unilateral cerebral palsy. Despite consensus on the value of home-based upper limb training, no evidence-based best practice exists. Promoting compliance of children to adhere to an intensive program while keeping parental stress levels low is an important challenge when designing home-based training programs. Incorporating implicit motor learning principles emerges to be a promising method to resolve this challenge.MethodsHere we describe two protocols for home-based bimanual training programs, one based on implicit motor learning principles and one based on explicit motor learning principles, for children with unilateral spastic cerebral palsy aged 2 through 7 years. Children receive goal-oriented, task-specific bimanual training in their home environment from their parents for 3.5 h/week for 12 weeks according to an individualized program. Parents will be intensively coached by a multidisciplinary team, consisting of a pediatric therapist and remedial educationalist. Both programs consist of a preparation phase (goal setting, introductory meetings with coaching professionals, design of individualized program, instruction of parents, home visit) and home-based training phase (training, video-recordings, registrations, and telecoaching and home visits by the coaching team). The programs contrast with respect to the teaching strategy, i.e. how the parents support their child during training. In both programs parents provide their child with instructions and feedback that focus on the activity (i.e. task-oriented) or the result of the activity (i.e. result-oriented). However, in the explicit program parents are in addition instructed to give exact instructions and feedback on the motor performance of the bimanual activities, whereas in the implicit program the use of both hands and the appropriate motor performance of the activity are elicited via manipulation of the organization of the activities.DiscussionWith the protocols described here, we aim to take a next step in the development of much needed evidence-based home-based training programs for children with unilateral cerebral palsy.

A three-stage trajectory generation method for robot-assisted bilateral upper limb training with subject-specific adaptation

Robot-assisted bilateral upper limb training typically requires two robotic devices that work cooperatively with a human user. The determination of appropriate movement trajectories is essential to avoid interference of the robotic systems and ensure an appropriate intersecting workspace with user limbs. This paper proposes a new three-stage trajectory generation method for bilateral upper limb training using interference analysis. These three stages include workspace analysis of robots and human hands, trajectory generation within the intersecting workspace, and interference analysis for training safety verification. This trajectory generation method is also implemented with subject-specific adaptation based on anthropometry of an individual. Experiments were conducted on seven healthy subjects with a variety of body sizes. All participants gave positive feedback on the suitability of the predefined training trajectories, and no robot interference was detected. This three-stage method provides guidelines for the standardization of robot-assisted bilateral upper limb training protocols. Future work will focus on proposing an adaptive trajectory generation algorithm with efficacy evaluation on a larger sample of subjects.

Effects of modified constraint-induced movement therapy with trunk restraint in early stroke patients: A single-blinded, randomized, controlled, pilot trial.

Reducing compensatory strategies during repetitive upper-limb training may be helpful in relearning motor skills. To explore the effects of modified constraint-induced movement therapy (mCIMT), additionally modified by adding trunk restraint (TR), on upper-limb function and activities of daily living (ADLs) in early post-stroke patients. Twenty-four participants with early stroke were randomly assigned to mCIMT combined with TR (mCIMT + TR) or mCIMT alone. Each group underwent twenty sessions (1 h/d, 5 d/wk for 4 weeks). Patients were assessed with the action research arm test (ARAT), the Fugl-Meyer Assessment-Upper extremity (FMA-UE), the Modified Barthel index (MBI), the Maximal elbow extension angle during reaching (MEEAR), and Motor Activity Logs (MAL-AOU and MAL-QOM). The mCIMT + TR group exhibited greater improvement in the ARAT, FMA-UE, MBI, MEEAR, and MAL-AOU, and MAL-QOM than the mCIMT group. Statistical analyses showed significant differences in ARAT (P = 0.003), FMA-UE (P = 0.042), MBI (P = 0.001), MEEAR (P = 0.002), and MAL-AOU (P = 0.005) between the groups. Modified CIMT combined with TR may be more effective than mCIMT alone in improving upper-limb function and ADLs in patients with early stroke.

Personalized upper limb training combined with anodal-tDCS for sensorimotor recovery in spastic hemiparesis: study protocol for a randomized controlled trial

BackgroundRecovery of voluntary movement is a main rehabilitation goal. Efforts to identify effective upper limb (UL) interventions after stroke have been unsatisfactory. This study includes personalized impairment-based UL reaching training in virtual reality (VR) combined with non-invasive brain stimulation to enhance motor learning. The approach is guided by limiting reaching training to the angular zone in which active control is preserved (“active control zone”) after identification of a “spasticity zone”. Anodal transcranial direct current stimulation (a-tDCS) is used to facilitate activation of the affected hemisphere and enhance inter-hemispheric balance. The purpose of the study is to investigate the effectiveness of personalized reaching training, with and without a-tDCS, to increase the range of active elbow control and improve UL function.MethodsThis single-blind randomized controlled trial will take place at four academic rehabilitation centers in Canada, India and Israel. The intervention involves 10 days of personalized VR reaching training with both groups receiving the same intensity of treatment. Participants with sub-acute stroke aged 25 to 80 years with elbow spasticity will be randomized to one of three groups: personalized training (reaching within individually determined active control zones) with a-tDCS (group 1) or sham-tDCS (group 2), or non-personalized training (reaching regardless of active control zones) with a-tDCS (group 3). A baseline assessment will be performed at randomization and two follow-up assessments will occur at the end of the intervention and at 1 month post intervention. Main outcomes are elbow-flexor spatial threshold and ratio of spasticity zone to full elbow-extension range. Secondary outcomes include the Modified Ashworth Scale, Fugl-Meyer Assessment, Streamlined Wolf Motor Function Test and UL kinematics during a standardized reach-to-grasp task.DiscussionThis study will provide evidence on the effectiveness of personalized treatment on spasticity and UL motor ability and feasibility of using low-cost interventions in low-to-middle-income countries.Trial registrationClinicalTrials.gov, ID: NCT02725853. Initially registered on 12 January 2016.

Patients' and Health Professionals' Experiences of Using Virtual Reality Technology for Upper Limb Training after Stroke: A Qualitative Substudy.

Background In recent years, virtual reality (VR) therapy systems for upper limb training after stroke have been increasingly used in clinical practice. Therapy systems employing VR technology can enhance the intensity of training and can also boost patients' motivation by adding a playful element to therapy. However, reports on user experiences are still scarce. Methods A qualitative investigation of patients' and therapists' perspectives on VR upper limb training. Semistructured face-to-face interviews were conducted with six patients in the final week of the VR intervention. Therapists participated in two focus group interviews after the completion of the intervention. The interviews were analyzed from a phenomenological perspective emphasizing the participants' perceptions and interpretations. Results Five key themes were identified from the patients' perspectives: (i) motivational factors, (ii) engagement, (iii) perceived improvements, (iv) individualization, and (v) device malfunction. The health professionals described the same themes as the patients but less positively, emphasizing negative technical challenges. Conclusion Patients and therapists mainly valued the intensive and motivational character of VR training. The playful nature of the training appeared to have a significant influence on the patients' moods and engagement and seemed to promote a “gung-ho” spirit, so they felt that they could perform more repetitions.

Development of a System Architecture for Evaluation and Training of Proprioceptive Deficits of the Upper Limb.

Proprioception plays a fundamental role in maintaining posture and executing movement, and the quantitative evaluation of proprioceptive deficits in poststroke patients is important. But currently it is not widely performed due to the complexity of the evaluation tools required for a reliable assessment. The aims of this pilot study were to (a) develop a system architecture for upper limb evaluation and training of proximal and distal sense of position in the horizontal plane and (b) test the system in healthy and pathological subjects. Two robotic devices for evaluation and training of, respectively, wrist flexion/extension and shoulder-elbow manipulation were employed. The system we developed was applied in a group of 12 healthy subjects and 10 patients after stroke. It was able to quantitatively evaluate upper limb sense of position in the horizontal plane thanks to a set of quantitative parameters assessing position estimation errors, variability, and gain. In addition, it was able to distinguish healthy from pathological conditions. The system could thus be a reliable method to detect changes in the sense of position of patients with sensory deficits after stroke and could enable the implementation of novel training approaches for the recovery of normal proprioception.

Effect of crossed-education using a tilt table task-oriented approach in subjects with post-stroke hemiplegia: A randomized controlled trial.

To determine the effect of crossed-education, using task-related training on a tilt table, on upper extremity function and grip strength in subjects with post-stroke hemiplegia. Double-blind, randomized controlled, pilot study. A total of 45 patients between 6 and 12 months post-stroke. Subjects were randomly allocated to the control group, or experimental group I or II. All subjects received conventional upper limb training for 30 min, 3 times a week for 6 weeks, and training on 3 different tilt table applications for 20 min a day. The outcome was evaluated using the Fugl-Meyer scale, Wolf Motor Function Test, and measurements of grip strength using a hydraulic hand dynamometer, prior to and 6 weeks post-intervention. There was a significantly greater increase, post-test, in the Fugl-Meyer scale (p = 0.003), maximal grip strength of the affected hand (p = 0.04), and grip strength, compared with the less-affected hand (p = 0.03), in subjects who underwent supplementary task-oriented training on a tilt table compared with those in the control group. There was also a significantly greater increase in Wolf Motor Function score (p = 0.001), post-test, in subjects who underwent task-oriented training on a tilt table compared with those in the 2 experimental groups. Compared with tilt table or conventional training alone, crossed-education using task-oriented training on a tilt table may result in improvements in arm function and maximal grip strength in persons with chronic hemiplegia post-stroke.

The Effects of Upper-Limb Training Assisted with an Electromyography-Driven Neuromuscular Electrical Stimulation Robotic Hand on Chronic Stroke.

Impaired hand dexterity is a major disability of the upper limb after stroke. An electromyography (EMG)-driven neuromuscular electrical stimulation (NMES) robotic hand was designed previously, whereas its rehabilitation effects were not investigated. This study aims to investigate the rehabilitation effectiveness of the EMG-driven NMES-robotic hand-assisted upper-limb training on persons with chronic stroke. A clinical trial with single-group design was conducted on chronic stroke participants (n = 15) who received 20 sessions of EMG-driven NMES-robotic hand-assisted upper-limb training. The training effects were evaluated by pretraining, posttraining, and 3-month follow-up assessments with the clinical scores of the Fugl-Meyer Assessment (FMA), the Action Research Arm Test (ARAT), the Wolf Motor Function Test, the Motor Functional Independence Measure, and the Modified Ashworth Scale (MAS). Improvements in the muscle coordination across the sessions were investigated by EMG parameters, including EMG activation level and Co-contraction Indexes (CIs) of the target muscles in the upper limb. Significant improvements in the FMA shoulder/elbow and wrist/hand scores (P < 0.05), the ARAT (P < 0.05), and in the MAS (P < 0.05) were observed after the training and sustained 3 months later. The EMG parameters indicated a significant decrease of the muscle activation level in flexor digitorum (FD) and biceps brachii (P < 0.05), as well as a significant reduction of CIs in the muscle pairs of FD and triceps brachii and biceps brachii and triceps brachii (P < 0.05). The upper-limb training integrated with the assistance from the EMG-driven NMES-robotic hand is effective for the improvements of the voluntary motor functions and the muscle coordination in the proximal and distal joints. Furthermore, the motor improvement after the training could be maintained till 3 months later. ClinicalTrials.gov. NCT02117089; date of registration: April 10, 2014.

Increasing upper limb training intensity in chronic stroke using embodied virtual reality: a pilot study

BackgroundTechnology-mediated neurorehabilitation is suggested to enhance training intensity and therefore functional gains. Here, we used a novel virtual reality (VR) system for task-specific upper extremity training after stroke. The system offers interactive exercises integrating motor priming techniques and embodied visuomotor feedback. In this pilot study, we examined (i) rehabilitation dose and training intensity, (ii) functional improvements, and (iii) safety and tolerance when exposed to intensive VR rehabilitation.MethodsTen outpatient stroke survivors with chronic (>6 months) upper extremity paresis participated in a ten-session VR-based upper limb rehabilitation program (2 sessions/week).ResultsAll participants completed all sessions of the treatment. In total, they received a median of 403 min of upper limb therapy, with 290 min of effective training. Within that time, participants performed a median of 4713 goal-directed movements. Importantly, training intensity increased progressively across sessions from 13.2 to 17.3 movements per minute. Clinical measures show that despite being in the chronic phase, where recovery potential is thought to be limited, participants showed a median improvement rate of 5.3% in motor function (Fugl-Meyer Assessment for Upper Extremity; FMA-UE) post intervention compared to baseline, and of 15.4% at one-month follow-up. For three of them, this improvement was clinically significant. A significant improvement in shoulder active range of motion (AROM) was also observed at follow-up. Participants reported very low levels of pain, stress and fatigue following each session of training, indicating that the intensive VR intervention was well tolerated. No severe adverse events were reported. All participants expressed their interest in continuing the intervention at the hospital or even at home, suggesting high levels of adherence and motivation for the provided intervention.ConclusionsThis pilot study showed how a dedicated VR system could deliver high rehabilitation doses and, importantly, intensive training in chronic stroke survivors. FMA-UE and AROM results suggest that task-specific VR training may be beneficial for further functional recovery both in the chronic stage of stroke. Longitudinal studies with higher doses and sample sizes are required to confirm the therapy effectiveness.Trial registrationThis trial was retrospectively registered at ClinicalTrials.gov database (registration number NCT03094650) on 14 March 2017.

Effects of non-invasive brain stimulation for upper limb rehabilitation in acute stroke patients – A controlled clinical trial

Introduction/Background This study was conducted in Tuen Mun Hospital (TMH) to evaluate the effects of rTMS and tDCS on upper limb functional recovery in acute stroke patients. Material and method Patients with acute stroke were randomly assigned to rTMS, tDCS or control group. For rTMS group, patient received 1 Hz rTMS at 90% of resting motor threshold to M1 of the unaffected hemisphere for 1200 pulses. For tDCS group, patient received 1 mA anodal stimulation to hand area of the affected hemisphere for 20 minutes. Five consecutive sessions of rTMS or tDCS together with intensive physiotherapy upper limb training were given. For control group, only intensive physiotherapy upper limb training were given. The upper extremity section of Fugl–Meyer Scale (UE-FM) was used as outcome measure. Results Twenty-nine patients (17 female and 12 male) were assigned to the rTMS ( n = 9), tDCS ( n = 11) and control ( n = 9) group. The mean age was 62.7 ± 12.0 years old and the mean time between stroke onset and the first UE-FM assessment was 9.14 ± 3.30 days. There was no statistically significant difference in mean age, baseline UE-FM mean score, mean time between stroke onset and the first UE-FM assessment among three groups [X 2 (2) = 4.81, P = 0.09] [X 2 (2) = 1.56, P = 0.457] [X 2 (2) = 0.04, P = 0.98]. No adverse effects of rTMS or tDCS were reported. For between-group comparison, the changes in mean score of UE-FM in rTMS (20.8 ± 6.59) and tDCS group (16.1 ± 4.97) were statistically significantly larger than that in control group (10.6 ± 4.13) (U = −2.97, P = 0.002) (U = −2.29, P = 0.02). However, there was no significant difference between rTMS and tDCS group (U = −1.49, P = 0.152). Conclusion Findings of the present study showed that both rTMS and tDCS could augment physiotherapy treatment in enhancing upper limb motor functional recovery in acute stroke patients. These positive findings warrant further investigation of the application of non-invasive brain stimulation techniques to neurorehabilitation.

Early Stroke Rehabilitation of the Upper Limb Assisted with an Electromyography-Driven Neuromuscular Electrical Stimulation-Robotic Arm

Effective poststroke motor rehabilitation depends on repeated limb practice with voluntary efforts. An electromyography (EMG)-driven neuromuscular electrical stimulation (NMES)-robot arm was designed for the multi-joint physical training on the elbow, the wrist, and the fingers. To investigate the training effects of the device-assisted approach on subacute stroke patients and to compare the effects with those achieved by the traditional physical treatments. This study was a pilot randomized controlled trial with a 3-month follow-up. Subacute stroke participants were randomly assigned into two groups, and then received 20-session upper limb training with the EMG-driven NMES-robotic arm (NMES-robot group, n = 14) or the time-matched traditional therapy (the control, n = 10). For the evaluation of the training effects, clinical assessments including Fugl-Meyer Assessment (FMA), Modified Ashworth Score (MAS), Action Research Arm Test (ARAT), and Function Independence Measurement (FIM) were conducted before, after the rehabilitation training, and 3 months later. Session-by-session EMG parameters in the NMES-robot group, including normalized co-contraction Indexes (CI) and EMG activation level of target muscles, were used to monitor the progress in muscular coordination patterns. Significant improvements were obtained in FMA (full score and shoulder/elbow), ARAT, and FIM [P < 0.001, effect sizes (EFs) > 0.279] for both groups. Significant improvement in FMA wrist/hand was only observed in the NMES-robot group (P < 0.001, EFs = 0.435) after the treatments. Significant reduction in MAS wrist was observed in the NMES-robot group after the training (P < 0.05, EFs = 0.145) and the effects were maintained for 3 months. MAS scores in the control group were elevated following training (P < 0.05, EFs > 0.24), and remained at an elevated level when assessed 3 months later. The EMG parameters indicated a release of muscle co-contraction in the muscle pairs of biceps brachii and flexor carpi radialis and biceps brachii and triceps brachii, as well as a reduction of muscle activation level in the wrist flexor in the NMES-robot group. The NMES-robot-assisted training was effective for early stroke upper limb rehabilitation and promoted independence in the daily living comparable to the traditional physical therapy. It could achieve higher motor outcomes at the distal joints and more effective release in muscle tones than the traditional therapy. ClinicalTrials.gov, identifier NCT02117089; date of registration: April 10, 2014.

Brain stimulation for arm recovery after stroke (B-STARS): protocol for a randomised controlled trial in subacute stroke patients

IntroductionMany patients with stroke have moderate to severe long-term sensorimotor impairments, often including inability to execute movements of the affected arm or hand. Limited recovery from stroke may be partly...

Task-Specific and Functional Effects of Speed-Focused Elliptical or Motor-Assisted Cycle Training in Children With Bilateral Cerebral Palsy: Randomized Clinical Trial

Background. Locomotor training using treadmills or robotic devices is commonly utilized to improve gait in cerebral palsy (CP); however, effects are inconsistent and fail to exceed those of equally intense alternatives. Possible limitations of existing devices include fixed nonvariable rhythm and too much limb or body weight assistance. Objective: To quantify and compare effectiveness of a motor-assisted cycle and a novel alternative, an elliptical, in CP to improve interlimb reciprocal coordination through intensive speed-focused leg training. Methods: A total of 27 children with bilateral CP, 5 to 17 years old, were randomized to 12 weeks of 20 minutes, 5 days per week home-based training (elliptical = 14; cycle = 13) at a minimum of 40 revolutions per minute, with resistance added when speed target was achieved. Primary outcomes were self-selected and fastest voluntary cadence on the devices and gait speed. Secondary outcomes included knee muscle strength, and selective control and functional mobility measures. Results: Cadence on trained but not nontrained devices increased, demonstrating task specificity of training and increased exercise capability. Mean gait speed did not increase in either group, nor did parent-reported functional mobility. Knee extensor strength increased in both. An interaction between group and time was seen in selective control with scores slightly increasing for the elliptical and decreasing for the cycle, possibly related to tighter limb coupling with cycling. Conclusions: Task-specific effects were similarly positive across groups, but no transfer was seen to gait or function. Training dose was low (≤20 hours) compared with intensive upper-limb training recommendations and may be insufficient to produce appreciable clinical change.

Rehabilitation for hemiplegia using an upper limb training system based on a force direction.

Hemiplegia patients have complete paralysis of half their body, and encounter many challenges in living an independent life. Rehabilitation of the lower body is more important than that of the upper body for independent living; thus, recovering upper body functions of their paralyzed side is not enough. Rehabilitation robots may be used to assist training without therapists. In this study, a small portable rehabilitation robot was developed for use at home, and a new training method was proposed. This robot consists on an omni wheel mechanism and a force sensor, and is capable of deciding the motion based on the force value. Voluntary movement of a hemiplegia patient is recovered by the rehabilitation robot and proposed training method. Thus, verification experiments were performed using participants with hemiplegia. The CCI (Co-Contraction Index) from after training were smaller than ones of before training, thus the movement skills of the participants improved with respect to controlling force direction and magnitude. Moreover, manual function test (MFT) scores increased as reflected by improvements in the motor function of the upper limb using the proposed training method.