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"Arm training"
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Myoelectric, Myo-Oxygenation, and Myotonometry Changes during Robot-Assisted Bilateral Arm Exercises with Varying Resistances
Robot-assisted bilateral arm training has demonstrated its effectiveness in improving motor function in individuals post-stroke, showing significant enhancements with increased repetitions. However, prolonged training sessions may lead to both mental and muscle fatigue. We conducted two types of robot-assisted bimanual wrist exercises on 16 healthy adults, separated by one week: long-duration, low-resistance workouts and short-duration, high-resistance exercises. Various measures, including surface electromyograms, near-infrared spectroscopy, heart rate, and the Borg Rating of Perceived Exertion scale, were employed to assess fatigue levels and the impacts of exercise intensity. High-resistance exercise resulted in a more pronounced decline in electromyogram median frequency and recruited a greater amount of hemoglobin, indicating increased muscle fatigue and a higher metabolic demand to cope with the intensified workload. Additionally, high-resistance exercise led to increased sympathetic activation and a greater sense of exertion. Conversely, engaging in low-resistance exercises proved beneficial for reducing post-exercise muscle stiffness and enhancing muscle elasticity. Choosing a low-resistance setting for robot-assisted wrist movements offers advantages by alleviating mental and physiological loads. The reduced training intensity can be further optimized by enabling extended exercise periods while maintaining an approximate dosage compared to high-resistance exercises.
Journal Article
Improving Upper-Limb Recovery in Patients with Chronic Stroke Using an 8-Week Bilateral Arm-Training Device
Upper-limb impairments after stroke significantly affect patients’ quality of life and require effective rehabilitation strategies. Rehabilitation devices play a vital role in enhancing motor recovery. This study evaluated the efficacy of the Arm Booster, a bilateral arm-training device, in improving upper-limb impairment in patients with chronic stroke. Eighteen participants were randomly assigned to two groups: a device group (n = 9), using the Arm Booster; and a conventional physiotherapy group (n = 9). Both groups performed six bilateral upper-limb exercises (32 repetitions each) three times per week for eight weeks. Participants were further classified into mild spasticity (n = 5) and moderate-to-severe spasticity (n = 4) subgroups. The primary outcome was motor impairment, assessed using the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE). Secondary outcomes included spasticity, measured by the Modified Ashworth Scale (MAS), and daily functional use of the arm, assessed with the Motor Activity Log (MAL). Both groups showed significant improvements in FMA-UE scores and overall arm movement. The conventional group demonstrated additional gains in hand and wrist function and coordination. Notably, in the moderate-to-severe spasticity subgroup, the device group exhibited improvements in upper-limb movement and a trend toward reduced spasticity. These findings suggest that the Arm Booster may support motor recovery, encourage the use of the affected arm, improve movement control, and provide an efficient means for patients to exercise more frequently on their own.
Journal Article
The modulatory effects of bilateral arm training (BAT) on the brain in stroke patients: a systematic review
ObjectiveTo systematically review the modulatory effects of bilateral arm training (BAT) on the brain of stroke patients in contrast to unilateral arm training (UAT) or regular motor training.MethodsWe conducted a literature search using PubMed, EMBASE, MEDLINE, and Science Citation Index Expanded databases from the inception to March 2019 for identifying any relevant studies. Two authors independently screened the literature, extracted data, and qualitatively described the included studies.ResultsEleven studies with a total of 225 stroke patients were included in this review. 156 out of those participants received neuroimaging or neurophysiological examinations. Six studies reported enhanced activation of the ipsilesional primary motor area (M1) induced by BAT, as measured by MEP and fMRI. Beyond the M1, three studies showed that supplementary motor area (SMA) was activated, and three studies found the primary sensory cortex area (S1) was activated by BAT in stroke patients, as measured by fMRI. One article showed that the inter-/intra-hemispheric functional connections of the sensorimotor network were more highly strengthened after BAT than regular motor training, in particular the functional connectivity between the SMA and the M1 in the bi-hemispheres. Three studies reported that BAT increased the inhibitory flow from the ipsilesional hemisphere to the contralesional hemisphere, as measured by interhemispheric transcallosal inhibition (IHI). However, the superiority of BAT in inducing a symmetric IHI than UAT was controversial.ConclusionBAT is potentially more effective than UAT in improving upper limb recovery after stroke by activating the ipsilesional primary motor area (M1), supplementary motor area (SMA), and primary sensory cortex (S1) and enhancing the intra-hemispheric and interhemispheric connectivity within the sensorimotor network and the cortical motor system.
Journal Article
Effects of robotic priming of bilateral arm training, mirror therapy, and impairment-oriented training on sensorimotor and daily functions in patients with chronic stroke: study protocol of a single-blind, randomized controlled trial
Background
Combining robotic therapy (RT) with task-oriented therapy is an emerging strategy to facilitate motor relearning in stroke rehabilitation. This study protocol will compare novel rehabilitation regimens that use bilateral RT as a priming technique to augment two task-oriented therapies: mirror therapy (MT) and bilateral arm training (BAT) with a control intervention: RT combined with impairment-oriented training (IOT).
Methods
This single-blind, randomized, comparative efficacy study will involve 96 participants with chronic stroke. Participants will be randomized into bilateral RT+MT, bilateral RT+BAT, and bilateral RT+IOT groups and receive 18 intervention sessions (90 min/day, 3 d/week for 6 weeks). The outcomes will include the Fugl-Meyer Assessment, Stroke Impact Scale version 3.0, Medical Research Council scale, Revised Nottingham Sensory Assessment, ABILHAND Questionnaire, and accelerometer and will be assessed at baseline, after treatment, and at the 3-month follow-up. Analysis of covariance and the chi-square automatic interaction detector method will be used to examine the comparative efficacy and predictors of outcome, respectively, after bilateral RT+MT, bilateral RT+BAT, and bilateral RT+IOT.
Discussion
The findings are expected to contribute to the research and development of robotic devices, to update the evidence-based protocols in postacute stroke care programs, and to investigate the use of accelerometers for monitoring activity level in real-life situations, which may in turn promote home-based practice by the patients and their caregivers. Directions for further studies and empirical implications for clinical practice will be further discussed in upper-extremity rehabilitation after stroke.
Trial registration
This trial was registered December 12, 2018, at www.clinicaltrials.gov (
NCT03773653
).
Journal Article
Ipsilesional arm training in severe stroke to improve functional independence (IPSI): phase II protocol
Background
We previously characterized hemisphere-specific motor control deficits in the ipsilesional, less-impaired arm of unilaterally lesioned stroke survivors. Our preliminary data indicate these deficits are substantial and functionally limiting in patients with severe paresis.
Methods
We have designed an intervention (“IPSI”) to remediate the hemisphere-specific deficits in the ipsilesional arm, using a virtual-reality platform, followed by manipulation training with a variety of real objects, designed to facilitate generalization and transfer to functional behaviors encountered in the natural environment. This is a 2-site (primary site – Penn State College of Medicine, secondary site – University of Southern California), two-group randomized intervention with an experimental group, which receives unilateral training of the ipsilesional arm throughout 3 one-hour sessions per week for 5 weeks, through our Virtual Reality and Manipulation Training (VRMT) protocol. Our control group receives a conventional intervention on the contralesional arm, 3 one-hour sessions per week for 5 weeks, guided by recently released practice guidelines for upper limb rehabilitation in adult stroke. The study aims to include a total of 120 stroke survivors (60 per group) whose stroke was in the territory of the middle cerebral artery (MCA) resulting in severe upper-extremity motor impairments. Outcome measures (Primary: Jebsen-Taylor Hand Function Test, Fugl-Meyer Assessment, Abilhand, Barthel Index) are assessed at five evaluation points: Baseline 1, Baseline 2, immediate post-intervention (primary endpoint), and 3-weeks (short-term retention) and 6-months post-intervention (long-term retention). We hypothesize that both groups will improve performance of the targeted arm, but that the ipsilesional arm remediation group will show greater improvements in functional independence.
Discussion
The results of this study are expected to inform upper limb evaluation and treatment to consider ipsilesional arm function, as part of a comprehensive physical rehabilitation strategy that includes evaluation and remediation of both arms.
Trial Registration
This study is registered with ClinicalTrials.gov (Registration ID:
NCT03634397
; date of registration: 08/16/2018).
Journal Article
Effect of Immersive Virtual Reality-Based Bilateral Arm Training in Patients with Chronic Stroke
Virtual reality (VR)-based therapies are widely used in stroke rehabilitation. Although various studies have used VR techniques for bilateral upper limb training, most have been only semi-immersive and have only been performed in an artificial environment. This study developed VR content and protocols based on activities of daily living to provide immersive VR-based bilateral arm training (VRBAT) for upper limb rehabilitation in stroke patients. Twelve patients with chronic stroke were randomized to a VRBAT group or a normal bilateral arm training (NBAT) group and attended 30-min training sessions five times a week for four weeks. At the end of the training, there was a significant difference in upper limb function in both groups (p < 0.05) and in the upper limb function sensory test for proprioception in the NBAT group (p < 0.05). There was no significant between-group difference in upper limb muscle activity after training. The relative alpha and beta power values for electroencephalographic measurements were significantly improved in both groups. These findings indicate that both VRBAT and NBAT are effective interventions for improving upper limb function and electroencephalographic activity in patients with chronic stroke.
Journal Article
Sequencing bilateral and unilateral task-oriented training versus task oriented training alone to improve arm function in individuals with chronic stroke
Background
Recovering useful hand function after stroke is a major scientific challenge for patients with limited motor recovery. We hypothesized that sequential training beginning with proximal bilateral followed by unilateral task oriented training is superior to time-matched unilateral training alone. Proximal bilateral training could optimally prepare the motor system to respond to the more challenging task-oriented training.
Methods
Participants: Twenty-six participants with moderate severity hemiparesis Intervention: Participants received either 6-weeks of bilateral proximal training followed sequentially by 6-weeks unilateral task-oriented training (COMBO) or 12-weeks of unilateral task-oriented training alone (SAEBO). A subset of 8 COMB0 and 9 SAEBO participants underwent three functional magnetic resonance imaging (fMRI) scans of hand and elbow movement every 6 weeks. Main Outcome Measures: Fugl-Meyer Upper extremity scale, Modified Wolf Motor Function Test, University of Maryland Arm Questionnaire for Stroke, Motor cortex activation (fMRI).
Results
The COMBO group demonstrated significantly greater gains between baseline and 12-weeks over all outcome measures (p = .018 based on a MANOVA test) and specifically in the Modified Wolf Motor Function test (time). Both groups demonstrated within-group gains on the Fugl-Meyer Upper Extremity test (impairment) and University of Maryland Arm Questionnaire for Stroke (functional use). fMRI subset analyses showed motor cortex (primary and premotor) activation during hand movement was significantly increased by sequential combination training but not by task-oriented training alone.
Conclusions
Sequentially combining a proximal bilateral before a unilateral task-oriented training may be an effective way to facilitate gains in arm and hand function in those with moderate to severe paresis post-stroke compared to unilateral task oriented training alone.
Journal Article
Protocol for a multisite randomised trial of Hand–Arm Bimanual Intensive Training Including Lower Extremity training for children with bilateral cerebral palsy: HABIT-ILE Australia
IntroductionChildren with bilateral cerebral palsy often experience difficulties with posture, gross motor function and manual ability, impacting independence in daily life activities, participation and quality of life (QOL). Hand–Arm Bimanual Intensive Training Including Lower Extremity (HABIT-ILE) is a novel intensive motor intervention integrating upper and lower extremity training. This study aimed to compare HABIT-ILE to usual care in a large randomised controlled trial (RCT) in terms of gross motor function, manual ability, goal attainment, walking endurance, mobility, self-care and QOL. A within-trial cost–utility analysis will be conducted to synthesise costs and benefits of HABIT-ILE compared with usual care.Methods and analysis126 children with bilateral cerebral palsy aged 6–16 years will be recruited across three sites in Australia. Children will be stratified by site and Gross Motor Function Classification System and randomised using concealed allocation to either receiving HABIT-ILE immediately or being waitlisted for 26 weeks. HABIT-ILE will be delivered in groups of 8–12 children, for 6.5 hours per day for 10 days (total 65 hours, 2 weeks). Outcomes will be assessed at baseline, immediately following intervention, and then retention of effects will be tested at 26 weeks. Primary outcomes will be the Gross Motor Function Measure and ABILHAND-Kids. Secondary outcomes will be brain structural integrity, walking endurance, bimanual hand performance, self-care, mobility, performance and satisfaction with individualised goals, and QOL. Analyses will follow standard principles for RCTs using two-group comparisons on all participants on an intention-to-treat basis. Comparisons between groups for primary and secondary outcomes will be conducted using regression models.Ethics and disseminationEthics approval has been granted by the Medical Research Ethics Committee of Children’s Health Queensland Hospital and the Health Service Human Research Ethics Committee (HREC/17/QRCH/282) of The University of Queensland (2018000017/HREC/17/QRCH/2820), and The Cerebral Palsy Alliance Ethics Committee (2018_04_01/HREC/17/QRCH/282).Trial registration numberACTRN12618000164291.
Journal Article
Feasibility of a Non-Anticipatory, Random-Action Target System to Improve Shooting Performance: A Brief Field Trial
Firearm shooting performance training rightfully focuses on shooting accuracy; however, additional foci should include decision processing speed and reaction time associated with decision making to avoid reaction-only based shooting responses. While advancements in realistic training environments attempt to mimic “real-world” situations, many remain largely anticipatory or subject to a speed–accuracy trade-off (SAT). The purpose of this brief field trial was to demonstrate the feasibility of a random-action target system (RATS) on participants’ shooting performance (i.e., accuracy, omission, and commission rates) among a convenience sample of six retired police officers and competitive shooters (age range: 45–58 years, mean age = 52.5 ± 5.89). Observational data were gathered from a single-day, three-round trial to test shooting accuracy and shooting errors when shooters were unable to anticipate target appearance location and target exposure speed. In Trial 1, the target exposure time was 0.5 s, which increased to 0.7 s in Trial 2, and decreased back to 0.5 s in Trial 3. Shooting accuracy generally increased, while omission and commission generally decreased, when shooters were presented with targets exposed for longer durations. From Trial 1 to Trial 3 (both trials with 0.5 s target exposures), shooters showed higher median accuracy rates, lower median omission rates, and lower median commission rates. Findings suggest that a non-anticipatory, RATS holds promise for improving shooting performance and offset SAT among shooters with firearm experience. However, additional trials are needed with the RATS to replicate these findings among a larger and more diverse set of participants, who train with the RATS consistently, over longer durations.
Journal Article