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We report a case of a patient with chronic stroke who improved his gait ability through weekly gait training using Gait Exercise Assist Robot (GEAR). A man in his 70s, who developed cerebral infarction 27 years ago, presented with right-sided hemiplegia. Before gait training, the patient's gait ability was assessed to be independent, but poor toe clearance was observed on the paralyzed side during the swing phase. Therefore, we started gait training using GEAR with the goal of improving his gait pattern. The patient underwent gait training using GEAR for 20 min/day, 1 day/week for 12 weeks, wherein the treadmill speed was increased as much as possible in order to improve the swing of the paralyzed lower limbs, and the visual and auditory feedback functions were also used to promote the load and swing of the paralyzed lower limbs. As a result, the overground gait velocity, Timed Up and Go Test, and 6-minute walking distance increased after 4 weeks. However, poor toe clearance was observed on the paralyzed side during the swing phase even after 12 weeks of the training. These results suggest that 4 weeks of gait training using GEAR (performed only 1 day/week) may effectively improve the gait ability of patients with chronic stroke. On the other hand, no improvement in gait pattern was observed, and further investigation is required in the future.
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Brain-computer interface (BCI) technology can activate the plasticity of the nervous system and induce the reconnection of nervous system information pathways. Techniques for recording brain activity include invasive methods and non-invasive methods. Non-invasive methods are safer, more portable and cheaper, but are prone to signal pollution. For upper limbs rehabilitation in patients with severe chronic stroke, BCI of electroencephalogram and robotic arm is usually used, almost combined with other rehabilitation approaches, and seems to improve the effectiveness. It is necessary to improve the accuracy of BCI motion intention decoding, carry out hierarchical and customized treatment for patients, develop hybrid and portable BCI system.
ABSTRACT
We report a case of a patient with chronic stroke who improved his gait ability through weekly gait training using Gait Exercise Assist Robot (GEAR). A man in his 70s, who developed cerebral infarction 27 years ago, presented with right-sided hemiplegia. Before gait training, the patient's gait ability was assessed to be independent, but poor toe clearance was observed on the paralyzed side during the swing phase. Therefore, we started gait training using GEAR with the goal of improving his gait pattern. The patient underwent gait training using GEAR for 20 min/day, 1 day/week for 12 weeks, wherein the treadmill speed was increased as much as possible in order to improve the swing of the paralyzed lower limbs, and the visual and auditory feedback functions were also used to promote the load and swing of the paralyzed lower limbs. As a result, the overground gait velocity, Timed Up and Go Test, and 6-minute walking distance increased after 4 weeks. However, poor toe clearance was observed on the paralyzed side during the swing phase even after 12 weeks of the training. These results suggest that 4 weeks of gait training using GEAR (performed only 1 day/week) may effectively improve the gait ability of patients with chronic stroke. On the other hand, no improvement in gait pattern was observed, and further investigation is required in the future.
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OBJECTIVE@#Circuit class therapy is a cost-efficient model of treatment that can be beneficial in a setting with limited resources. Current literature has conflicting results regarding which is a more effective approach to stroke rehabilitation: focusing on functional training or on improving impairments. This pilot study provides preliminary information comparing the effects of a task-oriented versus an impairment-focused circuit class therapy on walking ability among patients with chronic stroke.@*METHOD@#Eighteen participants with a single episode of chronic stroke and limited mobility were randomized into task-oriented circuit class (task group) (n=9) and impairment-focused circuit class (impairment group) (n=9). Both groups underwent intervention thrice a week for four weeks. Blind examination was done using the Ten Meter Walk Test for comfortable gait velocity (CGV) and fast gait velocit(FGV), Time Up and Down Stairs (TUDS), and Six Minute Walk Test (6MWT).@*RESULTS@#All participants completed the treatment sessions without adverse effects. After four weeks of treatment, the task group showed statistically significant within-group change in CGV (0.12±0.08, p=0.003) and FGV (0.25±0.22, p=0.007). The impairment group only showed statistically significant improvement in 6MWT (25.80±31.2, p=0.038). There were no statistically significant changes between the groups in all outcome measures.@*CONCLUSIONS@#The preliminary data from this pilot study suggest either program can improve walking-related outcomes and may not be different, although this needs to be confirmed using an appropriately-powered trial.
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Stroke is one of the most serious diseases that threaten human life and health. It is a major cause of death and disability in the clinic. New strategies for motor rehabilitation after stroke are undergoing exploration. We aimed to develop a novel artificial neural rehabilitation system, which integrates brain-computer interface (BCI) and functional electrical stimulation (FES) technologies, for limb motor function recovery after stroke. We conducted clinical trials (including controlled trials) in 32 patients with chronic stroke. Patients were randomly divided into the BCI-FES group and the neuromuscular electrical stimulation (NMES) group. The changes in outcome measures during intervention were compared between groups, and the trends of ERD values based on EEG were analyzed for BCI-FES group. Results showed that the increase in Fugl Meyer Assessment of the Upper Extremity (FMA-UE) and Kendall Manual Muscle Testing (Kendall MMT) scores of the BCI-FES group was significantly higher than that in the sham group, which indicated the practicality and superiority of the BCI-FES system in clinical practice. The change in the laterality coefficient (LC) values based on μ-ERD (ΔLC
Subject(s)
Humans , Electric Stimulation , Electric Stimulation Therapy , Electroencephalography , Recovery of Function , Stroke/therapy , Stroke RehabilitationABSTRACT
@#Objective: We evaluated the effects of a short ankle-foot orthosis (AFO) in patients with post-stroke hemiplegia by comparing its effectiveness to that of a conventional solid plastic AFO. The calf shells of the long and short AFOs were manufactured in lengths that extended proximally 2.5 cm distal to the fibular head and mid-calf level, respectively. Methods: Ten patients with chronic hemiparetic stroke were recruited for the study. Two types of AFOs, short and long, were used, both of which were individually molded and fitted. AFO preference was evaluated using a questionnaire regarding AFO weight, ease of donning and doffing, stability, and comfort. AFO effectiveness was evaluated using gait analysis. Results: The short AFO improved gait speed, stride length, and toe clearance as effectively as the long AFO. Additionally, we found that the short AFO had additional merits in terms of its lighter weight and ease of donning and doffing. Conclusion: The short AFO is a useful treatment option, especially in patients who dislike the heaviness of conventional AFOs or who have difficulty donning and doffing conventional AFOs.
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PURPOSE: This study aimed to determine the appropriate stimulus strength that could result in a positive effect on the ankle joint spasticity when patients with chronic stroke performed whole body vibration (WBV) exercise. METHODS: Among 72 patients who were diagnosed with stroke at least 6 months ago, those able to perform a half squat pose with ambulation issues due to ankle joint spasticity (modified Ashworth scale, MAS≥2) were included for analysis. Individuals participated in four different frequencies of vertical WBV exercise; 0 Hz, 10 Hz, 20 Hz, and 30 Hz. Vibration amplitude was 3-4 mm and 5 minutes WBV exercise was performed at each frequency, followed by a measurement after 2-minute rest. We assigned 18 individuals to each frequency and asked them to participate in the WBV exercise once every 3 weeks. The level of spasticity was evaluated by visual analogue scale (VAS) for self-assessment. The myoton PRO was utilized to objectively evaluate the level of spasticity and check the muscle tone and stiffness. RESULTS: Participants showed 0 Hz VAS was a significant difference between 20 Hz application conditions (p < 0.05). Muscle tone was significantly different at 0 Hz between 20 Hz, and 30 Hz (p < 0.05), significantly difference at 10 Hz between 30 Hz (p < 0.05). Muscle stiffness significantly difference at 0 Hz between 20 Hz, and 30 Hz (p < 0.05), significantly difference at 10 Hz between 20 Hz, and 30 Hz (p < 0.05). CONCLUSION: Findings of this study show that the frequency of more than 20 Hz was effective in improving the ambulatory ability in patients with chronic stroke. Currently, the effective WBV protocol is limited. Hence, this study was designed to suggest an effective WBV protocol to improve neuromodulation ability for chronic stroke patients.
Subject(s)
Humans , Ankle Joint , Ankle , Muscle Spasticity , Self-Assessment , Stroke , Vibration , WalkingABSTRACT
OBJECTIVE: To investigate the dose-related effect of trunk control training (TCT) using Trunk Stability Rehabilitation Robot Balance Trainer (TSRRBT) in chronic stroke patients with poor sitting balance. METHODS: This was a retrospective study of 38 chronic stroke patients with poor sitting balance that underwent TCT with TSRRBT. The participants were assigned either to the low-dose training (LDT) group (n=18) or to the highdose training (HDT) group (n=20). In addition to the conventional rehabilitation therapy, the LDT group received 5 sessions of TSRRBT intervention per week, whereas the HDT group received 10 sessions of TSRRBT intervention per week. The outcome measures were the scores on the Trunk Impairment Scale (TIS) and its subscales, Berg Balance Scale (BBS), Functional Ambulation Classification (FAC), and the Korean version of Modified Barthel Index (K-MBI). All outcome measures were assessed before the training and at the end of the 4-week training. RESULTS: After the 4-week intervention, TIS, BBS, FAC, and K-MBI scores showed improvement in both LDT and HDT groups. Furthermore, the improvements in TIS scores and its subscales were significantly greater in the HDT group than in the LDT group (p < 0.05). CONCLUSION: TCT using TSRRBT could be an additional treatment for the conventional rehabilitation therapy of chronic stroke patients with poor sitting balance. HDT may provide more beneficial effects on improving patients’ sitting balance than LDT.
Subject(s)
Humans , Biofeedback, Psychology , Classification , Outcome Assessment, Health Care , Rehabilitation , Retrospective Studies , Stroke , Video Games , WalkingABSTRACT
Ischemic stroke and cerebral infarction triggered by the blockage of blood supply can cause damage to the brain via a complex series of pathological changes. Recently, diverse therapies have emerged as promising candidates for the treatment of stroke. These treatments exert therapeutic effects by acting on diverse target molecules and cells in different time windows from the acute to chronic phases. Here, using immunohistochemistry, we show pathophysiological changes in the brain microenvironment at the hyperacute (within 6 h), acute (1~3 days), subacute (7 days), and chronic (1 month) phases following ischemic injury. Ischemic injury in rats was induced by occluding the middle cerebral artery and was validated by magnetic resonance imaging. The progression of damage to the brain was evaluated by immunohistochemistry for NeuN⁺ neurons, GFAP⁺ astrocytes, and Iba1⁺ microglia, and by the emergence of the cell death-related molecules such as AIF, FAF1, and activated caspase-3. Our data regarding the spatial and temporal information on pathophysiological changes may warrant the investigation of the timing of administration of therapeutic treatments in preclinical studies with an animal model of stroke.
Subject(s)
Animals , Rats , Astrocytes , Brain , Brain Ischemia , Caspase 3 , Cell Death , Cerebral Infarction , Immunohistochemistry , Magnetic Resonance Imaging , Microglia , Middle Cerebral Artery , Models, Animal , Neurons , Stroke , Therapeutic UsesABSTRACT
Objective:To observe the efficacy of combining transcranial direct current stimulation (tDCS) and functional electrical stimulation (FES) therapy on the upper limb function of chronic stroke patients.Method:Three subjects with chronic stroke patients received active tDCS + FES therapy for 4 weeks after 4 weeks of baseline observation.Surface electromyography (sEMG),transcranial magnetic stimulation (TMS) and upper limb part of the Fugl-Meyer assessment (U-FMA) were used to assess the performance of the subjects pre-and-post the intervention.Result:U-FMA scores improved after the intervention.There are five of the seven tested active muscles showed an increasing change in surface electromyography activation levels.Portion of the short latency cortical inhibition and facilitation data of the contralateral hemisphere tested with TMS paired pulse stimulation showed a change post the intervention.Conclusion:Subjects showed improvement with their upper limb motor function,thus the tDCS combine FES therapy may be a promising rehabilitation method for upper limb motor function of stroke in chronic stages.
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Objective:To observe the efficacy of combining transcranial direct current stimulation (tDCS) and functional electrical stimulation (FES) therapy on the upper limb function of chronic stroke patients.Method:Three subjects with chronic stroke patients received active tDCS + FES therapy for 4 weeks after 4 weeks of baseline observation.Surface electromyography (sEMG),transcranial magnetic stimulation (TMS) and upper limb part of the Fugl-Meyer assessment (U-FMA) were used to assess the performance of the subjects pre-and-post the intervention.Result:U-FMA scores improved after the intervention.There are five of the seven tested active muscles showed an increasing change in surface electromyography activation levels.Portion of the short latency cortical inhibition and facilitation data of the contralateral hemisphere tested with TMS paired pulse stimulation showed a change post the intervention.Conclusion:Subjects showed improvement with their upper limb motor function,thus the tDCS combine FES therapy may be a promising rehabilitation method for upper limb motor function of stroke in chronic stages.
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Botulinum toxin type A (BTXA) has been shown to be an effective treatment in reducing muscle tone and managing spasticity in poststroke patients. However, its effectiveness in improving function in lower limb spasticity has been more controversial. In this report, we present our findings in three cases of chronic stroke patients with lower limb spasticity wherein we examine the effectiveness of a 4-week intensive rehabilitation program following BTXA treatment. For each patient, BTXA was injected into spastic muscles of the affected lower limb and a rehabilitation program was provided for the patient in-hospital for 4 weeks. Before BTXA treatment (baseline) and at 2 and 4 week follow-ups after each treatment, the Stroke Impairment Assessment Set (SIAS), the Modified Ashworth Scale (MAS) and the Range of Motion (ROM) of the ankle, the 10 Meter Walking Test (10MWT), the 6 minutes walking distance (6MD), the Timed Up and Go Test (TUG), the Berg Balance Scale (BBS), and the Functional Independence Measure (FIM) were all assessed. In each patient, ankle MAS and ROM, 10MWT, 6MD, TUG, and BBS after 4 weeks improved from the baseline. Furthermore, the ankle MAS and ROM improved significantly within 2 weeks, as did the 10MWT and 6MD over the total 4 weeks. In conclusion, it is suggested that a better improvement of ambulation and balance, as well as spasticity, would be found with intensive rehabilitation following BTXA treatment for lower limb spasticity.
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Background: Upper limb hemiparesis is among the most common deficits after stroke that leads to disability. Learned nonuse develops due to over-reliance on the less affected limb for the functional activities. However for many stroke patients, participation in a traditional, more intense CIMT may be problematic, given the required practice intensity and the duration of the restraint schedule. So it is necessary to evaluate the effects of distributed form of Constraint Induced Movement Therapy (dCIMT) in improving functional outcome and quality of life in patients with chronic hemiparesis. Methods: 36 hemiplegic patients following stroke were included. The experimental group was given dCIMT for 5sessions/week for 4 consecutive weeks in addition to conventional therapy while the control group received only conventional therapy. The outcome measures were motor activity log, wolf motor functional test and nine hole peg test. Results: The results of within group analysis for both the experimental group (Group-A) and control group B showed highly significant improvement on all the 3 outcome measures with P <0.0001.But the difference in the improvement of group-A compared to group-B was highly significant on the MAL and NHPT (P <0.0001) whereas it was not significant for WMFT performance score but highly significant for WMFT duration (U=23). Conclusion: dCIMT is an effective measure in improving the upper extremity motor function in terms of the quality and amount of use & speed and co- ordination. Thus improves the functional level and the quality of life of the patients with chronic stroke.
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OBJECTIVE: Focal brain ischemia induced in rats by occlusion of middle cerebral artery (MCA) is a widely used paradigm of human brain infarct. The purpose of this study is to establish chronic stroke model by MCA occlusion using intraluminal filament in rats. METHOD: A total 44 rats were operated by modified Longa's method. The surgical procedure consisted of introducing an intraluminal filament into the internal carotid artery and advancing it intracranially to block blood flow for 60 minutes into MCA. After this procedure motor and postural change were assessed using a 0~5 point grading scale consisted of forelimb, hindlimb and circling test. Behavioral tests such as rotarod, stepping and cylinder tests were examined in the survived rats after MCA occlusion up to 14 weeks post-ischemia. Autopsy was done to evaluate the cerebral infarct volume. RESULTS: Thirteen rats were survived up to 14 weeks post-ischemia and for the severely paralyzed subjects by acute neurological severity scoring were examined with behavioral tests once a week for 14 weeks. Although rotarod test have not shown any specific changes during 14 weeks, stepping and cylinder tests have shown stabilizing pattern since 4 weeks after the procedure. CONCLUSION: MCA occlusion using intraluminal filament could be reliable method to make stroke model in rats. We concluded that 4 weeks post-ischemia by this method in rats might be regarded as chronic model.
Subject(s)
Animals , Humans , Rats , Autopsy , Brain , Brain Ischemia , Carotid Artery, Internal , Forelimb , Hindlimb , Middle Cerebral Artery , Rotarod Performance Test , StrokeABSTRACT
OBJECTIVE: To investigate whether transcranial direct current stimulation (tDCS) could improve the motor function of hemiparetic upper limb in chronic stroke patients through randomized double-blinded, sham-controlled study. METHOD: Twenty chronic post-stroke hemiparetic patients participated in this study. They were randomly assigned into either tDCS or sham group. Anodal tDCS was delivered on lesional primary motor cortex for 20 minutes in tDCS group and 30 seconds in sham group. Just after stimulation, both groups performed the shaping exercise for 30 minutes. Total 10 stimulation sessions (5 session/week for 2 weeks) were administered. Fugl-Meyer motor assessment, box and block test, grasp strength and FIM were assessed before stimulation, after 1 week of stimulation, after 2 weeks of stimulation, and 2 weeks after stimulation. RESULTS: The upper extremity score of Fugl-Meyer motor assessment and box and block test improved significantly in tDCS group compared to sham group (p<0.05). Their improvement lasted significantly for 2 week after stimulation. However, FIM, lower extremity score of Fugl-Meyer motor assessment and grasp power did not improved significantly in tDCS group compared to sham group. CONCLUSION: tDCS can improve the motor function of hemiparetic upper limb in chronic post-stroke patients, and the effects lasted after stimulation. tDCS may be used as an additional tool for stroke rehabilitation.