Adaptive hybrid robotic system for rehabilitation of reaching movement after a brain injury: a usability study.

BACKGROUND: Brain injury survivors often present upper-limb motor impairment affecting the execution of functional activities such as reaching. A currently active research line seeking to maximize upper-limb motor recovery after a brain injury, deals with the combined use of functional electrical stimulation (FES) and mechanical supporting devices, in what has been previously termed hybrid robotic systems. This study evaluates from the technical and clinical perspectives the usability of an integrated hybrid robotic system for the rehabilitation of upper-limb reaching movements after a brain lesion affecting the motor function. METHODS: The presented system is comprised of four main components. The hybrid assistance is given by a passive exoskeleton to support the arm weight against gravity and a functional electrical stimulation device to assist the execution of the reaching task. The feedback error learning (FEL) controller was implemented to adjust the intensity of the electrical stimuli delivered on target muscles according to the performance of the users. This control strategy is based on a proportional-integral-derivative feedback controller and an artificial neural network as the feedforward controller. Two experiments were carried out in this evaluation. First, the technical viability and the performance of the implemented FEL controller was evaluated in healthy subjects (N = 12). Second, a small cohort of patients with a brain injury (N = 4) participated in two experimental session to evaluate the system performance. Also, the overall satisfaction and emotional response of the users after they used the system was assessed. RESULTS: In the experiment with healthy subjects, a significant reduction of the tracking error was found during the execution of reaching movements. In the experiment with patients, a decreasing trend of the error trajectory was found together with an increasing trend in the task performance as the movement was repeated. Brain injury patients expressed a great acceptance in using the system as a rehabilitation tool. CONCLUSIONS: The study demonstrates the technical feasibility of using the hybrid robotic system for reaching rehabilitation. Patients' reports on the received intervention reveal a great satisfaction and acceptance of the hybrid robotic system. TRIAL REGISTRATION: Retrospective trial registration in ISRCTN Register with study ID ISRCTN12843006 .

Predictores de funcionalidad en el daño cerebral adquirido / Functionality predictors in acquired brain damage

Introducción: La mayoría de las personas que han sobrevivido a un daño cerebral presentan secuelas que afectan a componentes sensoriomotores, cognitivos, emocionales o conductuales. Estos déficits repercuten en la correcta ejecución de actividades de la vida diaria. El objetivo de este estudio es identificar diferencias funcionales entre personas con daño cerebral adquirido (DCA) unilateral, mediante la independencia funcional, la capacidad y la realización de las actividades cotidianas. Método: Diseño transversal descriptivo con una muestra de 58 personas con lesiones derechas (n = 14 TCE, n = 15 ECV) e izquierdas (n = 14 TCE, n = 15 ECV), diestros, con una media de edad de 47 años y una media de 4 ± 3,65 años de evolución. Las medidas utilizadas fueron la FIM FAM y la CIF. Resultados: Los datos apuntan hacia la existencia de diferencias significativas (p < 0,000) y un elevado tamaño del efecto (dr = 0,78) en las estimaciones transversales, otorgando una menor restricción en la participación en las personas con lesión derecha. Las diferencias más destacadas se encuentran en las variables «recepción de mensajes hablados», «escritura» y «habla inteligible». Al hacer una regresión lineal, los resultados muestran que solo 4 variables de la FIM FAM predicen, en su conjunto, un 44% la variancia de la CIF que mide la capacidad del individuo y hasta un 52% de la CIF que mide la realización del sujeto. Tan solo la marcha predeciría un 28% de la variancia. Conclusiones: Se sugiere que las personas con DCA en el hemisferio izquierdo presentan importantes diferencias en variables funcionales y de la comunicación. Los aspectos motores representan un gran factor pronóstico para la rehabilitación funcional

Introduction: Most individuals who have survived an acquired brain injury present consequences affecting the sensorimotor, cognitive, affective or behavioural components. These deficits affect the proper performance of daily living activities. The aim of this study is to identify functional differences between individuals with unilateral acquired brain injury using functional independence, capacity, and performance of daily activities. Method: Descriptive cross-sectional design with a sample of 58 people, with right-sided injury (n = 14 TBI; n = 15 stroke) or left-sided injury (n = 14 TBI, n = 15 stroke), right handed, and with a mean age of 47 years and time since onset of 4 ± 3.65 years. The functional assessment/functional independence measure (FIM/FAM) and the International Classification of Functioning (ICF) were used for the study. Results: The data showed significant differences (P<.000), and a large size effect (dr=0.78) in the cross-sectional estimates, and point to fewer restrictions for patients with a lesion on their right side. The major differences were in the variables ‘speaking’ and ‘receiving spoken messages’ (ICF variables), and ‘Expression’, ‘Writing’ and ‘intelligible speech’ (FIM/FAM variables). In the linear regression analysis, the results showed that only 4 FIM/FAM variables, taken together, predict 44% of the ICF variance, which measures the ability of the individual, and up to 52% of the ICF, which measures the individual's performance. Gait alone predicts a 28% of the variance. Conclusions: It seems that individuals with acquired brain injury in the left hemisphere display important differences regarding functional and communication variables. The motor aspects are an important prognostic factor in functional rehabilitation

Functionality predictors in acquired brain damage.

INTRODUCTION: Most individuals who have survived an acquired brain injury present consequences affecting the sensorimotor, cognitive, affective or behavioural components. These deficits affect the proper performance of daily living activities. The aim of this study is to identify functional differences between individuals with unilateral acquired brain injury using functional independence, capacity, and performance of daily activities. METHOD: Descriptive cross-sectional design with a sample of 58 people, with right-sided injury (n=14 TBI; n=15 stroke) or left-sided injury (n = 14 TBI, n = 15 stroke), right handed, and with a mean age of 47 years and time since onset of 4 ± 3.65 years. The functional assessment/functional independence measure (FIM/FAM) and the International Classification of Functioning (ICF) were used for the study. RESULTS: The data showed significant differences (P<.000), and a large size effect (dr=0.78) in the cross-sectional estimates, and point to fewer restrictions for patients with a lesion on their right side. The major differences were in the variables 'speaking' and 'receiving spoken messages' (ICF variables), and 'Expression', 'Writing' and 'intelligible speech' (FIM/FAM variables). In the linear regression analysis, the results showed that only 4 FIM/FAM variables, taken together, predict 44% of the ICF variance, which measures the ability of the individual, and up to 52% of the ICF, which measures the individual's performance. Gait alone predicts a 28% of the variance. CONCLUSIONS: It seems that individuals with acquired brain injury in the left hemisphere display important differences regarding functional and communication variables. The motor aspects are an important prognostic factor in functional rehabilitation.

Valoración de la integración en la comunidad de las personas con daño cerebral adquirido postagudo lateralizado / Evaluation of the community integration of persons with lateralised post-acute acquired brain injury

Introducción. La especialización hemisférica es un tema de interés que ha motivado un gran volumen de investigación en las últimas décadas. Tras una lesión cerebral lateralizada, las secuelas pueden afectar a diversas áreas de especialización, provocando, en función de la localización de la lesión, una afectación en la calidad de vida y en la integración comunitaria. Pacientes y métodos. Estudio transversal con una muestra de 58 pacientes, 28 con traumatismos craneoencefálicos (TCE) y 30 con accidentes cerebrovasculares (ACV), ambos lateralizados. El nivel de integración en la comunidad se midió con el cuestionario de integración comunitaria (CIQ). Resultados. De los grupos analizados teniendo en cuenta la lesión lateralizada (muestra completa, muestra de ACV y muestra de TCE), los resultados mostraron una significativamente mayor integración comunitaria de las personas con lesión en el hemisferio derecho. Sin embargo, al medir el nivel de integración comunitaria entre TCE y ACV, los resultados no mostraron diferencias significativas. Conclusión. Según los resultados del estudio, las personas con lesión cerebral en el hemisferio derecho presentan una mejor integración comunitaria que las personas con lesión en el hemisferio izquierdo, con independencia del origen de las lesiones (vascular o traumática). Se discuten las razones que pueden motivar las diferencias y las implicaciones clínicas (AU)

Introduction. Hemispheric specialization is a topic of interest that has motivated an enormous amount of research in recent decades. After a unilateral brain injury, the consequences can affect various areas of specialization, leading, depending on the location of the injury, impairment in quality of life and community integration. Patients and methods. Cross-sectional study with a sample of 58 patients, 28 traumatic brain injury (TBI) and 30 cerebrovascular accidents, both lateralized. The level of integration in the community is measured by the Community Integration Questionnaire. Results. There were three groups analyzed by considering unilateral injury (full sample, stroke sample, and TBI sample). Results showed a significantly high community integration of people with right hemisphere injury. However, to measure the level of community integration between TBI and stroke, the results showed no significant differences. Conclusion. According to the results of the study people with brain injury in the right hemisphere have a better community integration than people with lesions in the left hemisphere regardless of the origin of the lesions (vascular or traumatic). We discussed the reasons that may motivate the differences and clinical implications (AU)

[Evaluation of the community integration of persons with lateralised post-acute acquired brain injury]. / Valoracion de la integracion en la comunidad de las personas con daño cerebral adquirido postagudo lateralizado.

INTRODUCTION. Hemispheric specialization is a topic of interest that has motivated an enormous amount of research in recent decades. After a unilateral brain injury, the consequences can affect various areas of specialization, leading, depending on the location of the injury, impairment in quality of life and community integration. PATIENTS AND METHODS. Cross-sectional study with a sample of 58 patients, 28 traumatic brain injury (TBI) and 30 cerebrovascular accidents, both lateralized. The level of integration in the community is measured by the Community Integration Questionnaire. RESULTS. There were three groups analyzed by considering unilateral injury (full sample, stroke sample, and TBI sample). Results showed a significantly high community integration of people with right hemisphere injury. However, to measure the level of community integration between TBI and stroke, the results showed no significant differences. CONCLUSION. According to the results of the study people with brain injury in the right hemisphere have a better community integration than people with lesions in the left hemisphere regardless of the origin of the lesions (vascular or traumatic). We discussed the reasons that may motivate the differences and clinical implications.

TITLE: Valoracion de la integracion en la comunidad de las personas con daño cerebral adquirido postagudo lateralizado.Introduccion. La especializacion hemisferica es un tema de interes que ha motivado un gran volumen de investigacion en las ultimas decadas. Tras una lesion cerebral lateralizada, las secuelas pueden afectar a diversas areas de especializacion, provocando, en funcion de la localizacion de la lesion, una afectacion en la calidad de vida y en la integracion comunitaria. Pacientes y metodos. Estudio transversal con una muestra de 58 pacientes, 28 con traumatismos craneoencefalicos (TCE) y 30 con accidentes cerebrovasculares (ACV), ambos lateralizados. El nivel de integracion en la comunidad se midio con el cuestionario de integracion comunitaria (CIQ). Resultados. De los grupos analizados teniendo en cuenta la lesion lateralizada (muestra completa, muestra de ACV y muestra de TCE), los resultados mostraron una significativamente mayor integracion comunitaria de las personas con lesion en el hemisferio derecho. Sin embargo, al medir el nivel de integracion comunitaria entre TCE y ACV, los resultados no mostraron diferencias significativas. Conclusion. Segun los resultados del estudio, las personas con lesion cerebral en el hemisferio derecho presentan una mejor integracion comunitaria que las personas con lesion en el hemisferio izquierdo, con independencia del origen de las lesiones (vascular o traumatica). Se discuten las razones que pueden motivar las diferencias y las implicaciones clinicas.