Figure 1 - uploaded by Jill Whitall
Content may be subject to copyright.
Source publication
Chronic motor deficits in the upper limb (UL) are a major contributor to disability following stroke. This study investigated the effect of short-duration robot-assisted therapy on motor impairment, as measured by clinical scales and robot-derived performance measures in patients with chronic, severe UL impairments after stroke. As part of a larger...
Similar publications
Contemporary motor control theories propose competition between multiple motor plans before the winning command is executed. While most competitions are completed prior to movement onset, movements are often initiated before the competition has been resolved. An example of this is saccadic averaging, wherein the eyes land at an intermediate locatio...
This review discusses whether deficient inhibitory motor control is the core deficit of attention-deficit/hyperactivity disorder (ADHD). Inhibitory motor control is commonly assessed using the stop-signal paradigm. Since the last meta-analysis that was performed, 33 new studies have appeared. The current meta-analysis revealed a significant differe...
Low back pain (LBP) is often accompanied by changes in gait, such as a decreased (preferred) walking velocity. Previous studies have shown that LBP diminishes the normal velocity-induced transverse counter-rotation between thorax and pelvis, and that it globally affects mean erector spinae (ES) activity. The exact nature and causation of these effe...
Animals with rigid skeletons can rely on several mechanisms to simplify motor control--for example, they have skeletal joints that reduce the number of variables and degrees of freedom that need to be controlled. Here we show that when the octopus uses one of its long and highly flexible arms to transfer an object from one place to another, it empl...
Participants practiced short sequences of key presses; sequence length and response-effect mapping were the independent variables. Contingent, distinct key-effect relations were contrasted with either contingent but uniform or no response effects. In Experiment 1, tone effects were relevant as response-specific stimuli and also as effects. The sequ...
Citations
... However, it seems that it may be particularly effective in patients with more severe impairment. This was suggested in earlier studies (Conroy et al., 2011;Finley et al., 2005;MacClellan et al., 2005) and more recently in a retrospective study by our team . A recent meta-analysis also showed that the functional benefits of the therapy were more significant in patients with moderate to severe motor deficits (Wu et al., 2021). ...
Background:
Rehabilitation of stroke-related upper limb paresis is a major public health issue.
Objective:
Robotic systems have been developed to facilitate neurorehabilitation by providing key elements required to stimulate brain plasticity and motor recovery, namely repetitive, intensive, adaptative training with feedback. Although the positive effect of robot-assisted therapy on motor impairments has been well demonstrated, the effect on functional capacity is less certain.
Method:
This narrative review outlines the principles of robot-assisted therapy for the rehabilitation of post-stroke upper limb paresisRESULTS:A paradigm is proposed to promote not only recovery of impairment but also function.
Conclusion:
Further studies that would integrate some principles of the paradigm described in this paper are needed.
... In these cases, the training was regarded to be non-task specific. Examples of the latter were the training programs using the MIT-MANUS and its commercialized version, the InMotion, a robotic arm to train the shoulder and elbow, where participants had to reach for eight bulls-eye typed targets in a circular pattern [17][18][19][20][21]. This training program was not individualized, not randomized (the same movement was applied at all occasions: clockwise direction), not relevant in daily life and was not working towards a complete task since the task components remained the same. ...
Purpose
Task-specific rehabilitation is a key indicator for successful rehabilitation to improve the upper limb performance after stroke. Assistive robotic and non-robotic devices are emerging to provide rehabilitation therapy; however, the effectiveness of task-specific training programs using assistive training devices compared with task-specific usual care training has not been summarized yet. Therefore, the effectiveness of task-specific training using assistive arm devices (TST-AAD) compared with task-specific usual care (TSUC) on the upper limb performance of patients with a stroke was investigated. To assess task specificity, a set of criteria was proposed: participation, program, relevant, repeated, randomized, reconstruction and reinforced.
Materials and methods
Out of 855 articles, 17 fulfilled the selection criteria. A meta-analysis was performed on the Fugl-Meyer Assessment scores in the subacute and chronic stages after stroke and during follow-up.
Results and conclusion
Both TST-AAD and TSUC improved the upper limb performance after stroke. In the sub-acute phase after stroke, TST-AAD was more effective than TSUC in reducing the upper limb impairment, although findings were based on only three studies. In the chronic phase, TST-AAD and TSUC showed similar effectiveness. No differences between the two types of training were found at the follow-up measurements. Future studies should describe training, device usage and criteria of task specificity in a standardized way to ease comparison.
•
Implications for rehabilitation
• Arm or hand function is often undertreated in stroke patients, assistive training devices may be able to improve the upper limb performance.
• Task-specific training using assistive devices is effective in improving the upper limb performance after stroke.
• Task-specific training using assistive devices seems to be more effective in reducing impairment compared with task specific usual care in the subacute phase after stroke, but they are equally effective in the chronic phase of stroke.
... ballistic) phase of a movement, its strategy and ease [17]. Contrary to movement duration, PeakVel showed weak correlation with clinical scales [21,42] and less sensitivity to changes [37,43]. These arguments may explain their different sensitivities to the learning effect. ...
Background:
After stroke, kinematic measures obtained with non-robotic and robotic devices are highly recommended to precisely quantify the sensorimotor impairments of the upper-extremity and select the most relevant therapeutic strategies. Although the ArmeoSpring exoskeleton has demonstrated its effectiveness in stroke motor rehabilitation, its interest as an assessment tool has not been sufficiently documented. The aim of this study was to investigate the psychometric properties of selected kinematic parameters obtained with the ArmeoSpring in post-stroke patients.
Methods:
This study involved 30 post-stroke patients (mean age = 54.5 ± 16.4 years; time post-stroke = 14.7 ± 26.7 weeks; Upper-Extremity Fugl-Meyer Score (UE-FMS) = 40.7 ± 14.5/66) who participated in 3 assessment sessions, each consisting of 10 repetitions of the 'horizontal catch' exercise. Five kinematic parameters (task and movement time, hand path ratio, peak velocity, number of peak velocity) and a global Score were computed from raw ArmeoSpring' data. Learning effect and retention were analyzed using a 2-way repeated-measures ANOVA, and reliability was investigated using the intra-class correlation coefficient (ICC) and minimal detectable change (MDC).
Results:
We observed significant inter- and intra-session learning effects for most parameters except peak velocity. The measures performed in sessions 2 and 3 were significantly different from those of session 1. No additional significant difference was observed after the first 6 trials of each session and successful retention was also highlighted for all the parameters. Relative reliability was moderate to excellent for all the parameters, and MDC values expressed in percentage ranged from 42.6 to 102.8%.
Conclusions:
After a familiarization session, the ArmeoSpring can be used to reliably and sensitively assess motor impairment and intervention effects on motor learning processes after a stroke. Trial registration The study was approved by the local hospital ethics committee in September 2016 and was registered under number 05-0916.
... Staubli et al. (2009) examined the effectiveness of robot training in four chronic stroke patients and reported that, in one case of a patient with sensory disorder, the improvement in motor paralysis improvement was small [16]. Research on InMotion2 has been in upper limb paralysis motor patients [17,18], but few studies have focused on the improvement of paralysis in stroke patients with sensory disorder. ...
Sensory disorder is a factor preventing recovery from motor paralysis after stroke. Although several robot-assisted exercises for the hemiplegic upper limb of stroke patients have been proposed, few studies have examined improvement in function in stroke patients with sensory disorder using robot-assisted training. In this study, the efficacies of robot training for the hemiplegic upper limb of three stroke patients with complete sensory loss were compared with those of 19 patients without complete sensory loss. Robot training to assist reach motion was performed in 10 sessions over a 2-week period for 5 days per week at 1 h per day. Before and after the training, the total Fugl–Meyer Assessment score excluding coordination and tendon reflex (FMA-total) and the FMA shoulder and elbow score excluding tendon reflex (FMA-S/E) were evaluated. Reach and path errors (RE and PE) during the reach motion were also evaluated by the arm-training robot. In most cases, both the FMA-total and the FMA-S/E scores improved. Cases with complete sensory loss showed worse RE and PE scores. Our results suggest that motor paralysis is improved by robot training. However, improvement may be varied according to the presence or absence of somatic sensory feedback.
... Kinematic assessments are completed using the lnMotion2 robot evaluation, described in the literature, 43 and involve unassisted reaching for a series of point-to-point targets, reaching against resistance, response to perturbation, and circle drawing. Variables assessed include initiation time, distance from target, movement time, peak velocity, mean velocity, number of targets hit, and path ratio. ...
Objective
To demonstrate the feasibility of algorithmic prediction using a model of baseline arm movement, genetic factors, demographic characteristics, and multimodal assessment of the structure and function of motor pathways. To identify prognostic factors and the biological substrate for reductions in arm impairment in response to repetitive task practice.
Design
This prospective single-group interventional study seeks to predict response to a repetitive task practice program using an intent-to-treat paradigm. Response is measured as a change of ≥5 points on the Upper Extremity Fugl-Meyer from baseline to final evaluation (at the end of training).
Setting
General community.
Participants
Anticipated enrollment of community-dwelling adults with chronic stroke (N=96; onset≥6mo) and moderate to severe residual hemiparesis of the upper limb as defined by a score of 10-45 points on the Upper Extremity Fugl-Meyer.
Intervention
The intervention is a form of repetitive task practice using a combination of robot-assisted therapy coupled with functional arm use in real-world tasks administered over 12 weeks.
Main Outcome Measures
Upper Extremity Fugl-Meyer Assessment (primary outcome), Wolf Motor Function Test, Action Research Arm Test, Stroke Impact Scale, questionnaires on pain and expectancy, magnetic resonance imaging, transcranial magnetic stimulation, arm kinematics, accelerometry, and a saliva sample for genetic testing.
Results
Methods for this trial are outlined, and an illustration of interindividual variability is provided by example of 2 participants who present similarly at baseline but achieve markedly different outcomes.
Conclusion
This article presents the design, methodology, and rationale of an ongoing study to develop a predictive model of response to a standardized therapy for stroke survivors with chronic hemiparesis. Applying concepts from precision medicine to neurorehabilitation is practicable and needed to establish realistic rehabilitation goals and to effectively allocate resources.
... 28,29 For this more severe level of impairment, our results in response to treatment are almost double that reported by others who studied similar impairment level (4.7-5.5 FM point gains, respectively). 17,61 For studies of those with greater impairment level than ours, gains ranged from 1.2 to 4.01 FM points, 15,22,24,67 and for studies of more mildly impaired subjects than ours, FM gains ranged from 2 to 14 points. 3,4,6,11,21,27,63,66,68,69 Function. ...
Background:
Effective treatment methods are needed for moderate/severely impairment chronic stroke.
Objective:
The questions were the following: (1) Is there need for long-dose therapy or is there a mid-treatment plateau? (2) Are the observed gains from the prior-studied protocol retained after treatment?
Methods:
Single-blind, stratified/randomized design, with 3 applied technology treatment groups, combined with motor learning, for long-duration treatment (300 hours of treatment). Measures were Arm Motor Ability Test time and coordination-function (AMAT-T, AMAT-F, respectively), acquired pre-/posttreatment and 3-month follow-up (3moF/U); Fugl-Meyer (FM), acquired similarly with addition of mid-treatment.
Findings:
There was no group difference in treatment response ( P ≥ .16), therefore data were combined for remaining analyses (n = 31; except for FM pre/mid/post, n = 36). Pre-to-Mid-treatment and Mid-to-Posttreatment gains of FM were statistically and clinically significant ( P < .0001; 4.7 points and P < .001; 5.1 points, respectively), indicating no plateau at 150 hours and benefit of second half of treatment. From baseline to 3moF/U: (1) FM gains were twice the clinically significant benchmark, (2) AMAT-F gains were greater than clinically significant benchmark, and (3) there was statistically significant improvement in FM ( P < .0001); AMAT-F ( P < .0001); AMAT-T ( P < .0001). These gains indicate retained clinically and statistically significant gains at 3moFU. From posttreatment to 3moF/U, gains on FM were maintained. There were statistically significant gains in AMAT-F ( P = .0379) and AMAT-T P = .003.
... 20,21,24,116,186,187 Only a few studies have reported on the robot-derived outcomes inherent to machines such as the MIT-MANUS. 17,30,188,189 The robot-generated measures inherent to the MIT-MANUS in particular have demonstrated the ability to detect significant improvements in motor performance, even when the associated clinical measures in the study revealed only small changes. 188,189 The sensitivity of these measures allows researchers to look beyond clinical measures, and to quantitatively explore aspects of recovery that have traditionally relied on qualitative observation, such as smoothness of movement, 189 muscle tone, 190 and synergies. ...
... 17,30,188,189 The robot-generated measures inherent to the MIT-MANUS in particular have demonstrated the ability to detect significant improvements in motor performance, even when the associated clinical measures in the study revealed only small changes. 188,189 The sensitivity of these measures allows researchers to look beyond clinical measures, and to quantitatively explore aspects of recovery that have traditionally relied on qualitative observation, such as smoothness of movement, 189 muscle tone, 190 and synergies. 17 A 2015 study by Massie and colleagues 30 All participants had a Fugl-Meyer intake score of 7 to 38 and possessed adequate arm mobility to move the robotic manipulandum to target locations. ...
Background: Rehabilitation Robotics (RR) has become a more widely used and better understood treatment intervention and research tool in the last 15 years. Traditional research involves pre and post-test outcomes, making it difficult to analyze changes in behavior during the treatment process. Harnessing kinematics captured throughout each treatment allows motor learning to be quantified and questions of application and dosing to be answered.
Objective: The aims of this secondary analysis were: (i) to investigate the impact of treatment presentation during RR on upper extremity movement time (mt) in children with hemiplegic cerebral palsy (CP) and (ii) to investigate the impact of training structure (dose and intensity) on mt in children with CP participating in RR.
Methods: Subjects completed 16 intervention sessions of RR (2 x week; 8 weeks) with a total of 1,024 repetitions of movement per session and three assessments: pre, post and 6 month f/u. During each assessment and intervention, subjects completed “one-way record” assessments tracking performance on a planar task without robotic assistance. Kinematics from these records were extracted to assess subject performance over the course of and within sessions.
Results: For all participants, a significant decrease in mt was found at post-test and follow-up. No significant differences were found in mt for age, severity or group placement. A significant interaction was found between treatment day, block and group (p = .033). Significant mt differences were found between the three blocks of intervention within individual days (p = .001). Specifically, significant differences were found over the last block of treatment (p = .032) and between successive treatment days (p = .001).
Conclusion: The results indicate that for children with CP participating in RR, the number of repetitions per session is important. We hypothesized that children’s performance would plateau during a treatment day as attention waned, the opposite proved to be true. Despite the high-number of repetitions and associated cognitive demand, subjects’ performance actually trended upwards throughout the 1,024 repetitions suggesting that children were able to tolerate and learn from a high volume of repetitions.
... Given the thoroughness with which the neuromotor system has been shown to be directionally sensitive, established through studies of both cellular physiology as well as motor behavior, there is great need to develop robust strategies for adjusting for movement direction in analysis of kinematic data. The preponderance of studies make no mention of inclusion of any factor for direction whatsoever (Shadmehr et al., 1998;Rohrer et al., 2002;Daly et al., 2005;Finley et al., 2005;Hogan et al., 2006;Scheidt and Stoeckmann, 2007;Bosecker et al., 2010;Ganesh et al., 2014;Muceli et al., 2014;Sakamoto and Kondo, 2015); thus, we regard this approach as the "directionally insensitive" (DI) approach, where data from all movement directions are included in a single dataset with no directional co-variate term. Following the presumptive kinematic heterogeneity across multiple movement directions, we speculate that analytic approaches using the DI are more prone to error because of their substantial unexplained variance. ...
The kinematic character of hand trajectory in reaching tasks varies by movement direction. Often, direction is not included as a factor in the analysis of data collected during multi-directional reach tasks; consequently, this directionally insensitive model (DI) may be prone to type-II error due to unexplained variance. On the other hand, directionally specific models (DS) that account separately for each movement direction, may reduce statistical power by increasing the amount of data groupings. We propose a clustered-by-similarity (CS) in which movement directions with similar kinematic features are grouped together, maximizing model fit by decreasing unexplained variance while also decreasing uninformative sub-groupings. We tested model quality in measuring change over time in 10 kinematic features extracted from 72 chronic stroke patients participating in the VA-ROBOTICS trial, performing a targeted reaching task over 16 movement directions (8 targets, back- and forth from center) in the horizontal plane. Across 49 participants surviving a quality control sieve, 4.3 ± 1.1 (min: 3; max: 7) clusters were found among the 16 movement directions; clusters varied between participants. Among 49 participants, and averaged across 10 features, the better-fitting model for predicting change in features was found to be CS assessed by the Akaike Information criterion (61.6 ± 7.3%), versus DS (31.0 ± 7.8%) and DI (7.1 ± 7.1%). Confirmatory analysis via Extra Sum of Squares F-test showed the DS and CS models out-performed the DI model in head-to-head (pairwise) comparison in >85% of all specimens. Thus, we find overwhelming evidence that it is necessary to adjust for direction in the models of multi-directional movements, and that clustering kinematic data by feature similarly may yield the optimal configuration for this co-variate.
... Los activos, por su parte, contribuyen a la ejecución del movimiento del paciente si este no es capaz de realizarlo a partir de patrones de intencionalidad estimados con sensores de electromiografía, electroencefalografía y propioceptivos. El desarrollo de estos tipos de dispositivos ha permitido asistir el movimiento y las funciones motoras de las manos, los brazos y articulaciones del miembro inferior [49][50][51][52][53]. ...
The present PhD thesis applies an integrating procedure with biomechanical and clinical design criteria in the development of an exoskeleton for the rehabilitation of the upper limb in patients afflicted with painful hemiplegic shoulder.
The research work presents the process of selection of force actuators, mechanisms of arm rotation and forearm pronosupination, as well as the mechanical structure. The design is complemented by simple control and safety systems and an interface for exoskeleton control by the physiotherapist. It is proposed, as part of the procedure, a clinical protocol that incorporates instruments for evaluating the patient's evolution.
Finally, the results of a pilot study applied to 16 hemiplegic patients with painful shoulder after three months of therapy (eight patients with robotic therapy and eight with conventional treatment) are included.
As indicators of the effectiveness of rehabilitation with the exoskeleton compared to the conventional technique, a reduction and elimination in a few sessions of pain, a greater control of spasticity, a higher increase in the range of active joint mobility and muscle tone are reported. As a result, the patients showed a high level of satisfaction with the received therapy.
... The lack of significance was not just due to a small statistical power, because also the effect sizes were only small. In contrast, other studies detected changes in kinematic parameters for adult stroke patients [31][32][33] as well as children affected by CP [9,13] when training with assistive robots. Besides the differences in dosage (total number of movements, as discussed in the previous paragraph) between these studies and the current one, the kinematic assessment might also play a role. ...
Background
Novel neurorehabilitation technologies build upon treatment principles derived from motor learning studies. However, few studies have investigated motor learning with assistive devices in children and adolescents with Cerebral Palsy (CP). The aim of this study was to investigate whether children with CP who trained with weight support in a playful, virtual environment would improve upper extremity task performance (i.e. skill acquisition), transfer, and retention, three aspects that indicate whether motor learning might have occurred or not. Methods
Eleven children with CP (mean age 13.3 years, standard deviation 3.4 years), who were mildly to moderately impaired, participated. They played in the Armeo® Spring the exergame Moorhuhn with their more affected arm during 3 days (70 min pure play time). For this within-subject design, kinematic assessments, the Box and Block Test, and five items of the Melbourne Assessment were administered twice during a baseline week (one week before the intervention), directly before and after the intervention, and one day after the training phase (retention). ResultsThe average exergame score improved from 209.55 to 339.73 (p < 0.001, Cohen’s d = 1.80), indicating skill acquisition. The change in the Box and Block test improved from 0.45 (baseline week) to 3.95 (intervention week; p = 0.008, d = 1.59) indicating skill transfer. The kinematic assessments and the Melbourne items did not change. Improvement in game score and Box and Bock Test persisted one day later (retention). Conclusions
We found evidence indicating the successful acquisition, transfer, and retention of upper extremity skills in children with CP. We therefore infer that motor learning occurred when children with CP trained their more affected arm with weight-support in a playful, virtual environment.
