ABSTRACT
Stroke survivors usually exhibit concurrent motor and cognitive impairment. Historically, rehabilitation strategies post-stroke occur separately in terms of motor and cognitive functions. However, recent studies show that hand motor interventions can have a positive impact on cognitive recovery. In this work, we introduce AMBER (portAble and Modular device for comprehensive Brain Evaluation and Rehabilitation), a new device developed for the evaluation and rehabilitation of both hand motor function and cognition simultaneously. AMBER is a simple, portable, ergonomic and cheap device based on Force Sensitive Resistors, in which every finger interaction is recorded to provide information about finger strength, processing speed, and memory status. This paper presents the requirements of the device and the design of the system. In addition, a pilot study was conducted with 36 healthy individuals using the evaluation module of the device to assess its psychometric properties, as test-retest reliability and measurement error. Its validity was also evaluated comparing its measurements with three different gold standards for strength, processing speed and memory. The device showed good test-retest reliability for strength (ICC =0.741-0.852), reaction time (ICC =0.715 - 0.900) and memory (ICC =0.556-0.885). These measures were correlated with their corresponding gold standards (r =0.780-890). AMBER shows great potential to impact hand rehabilitation, offering therapists a valid, reliable and versatile tool to comprehensively assess patients. With ongoing advancements and refinements, it has the opportunity to significantly impact rehabilitation practices and improve patient outcomes.
ABSTRACT
OBJECTIVE: To synthetize the evidence on the effects of hand rehabilitation (RHB) interventions on cognition post-stroke and compare their efficacy. DATA SOURCES: PubMed, Embase, Cochrane, Scopus, Web of Science, and CINAHL were searched from inception to November 2022. DATA SELECTION: Randomized controlled trials conducted in adults with stroke where the effects of hand motor interventions on any cognitive domains were assessed. DATA EXTRACTION: Data were extracted by 2 independent reviewers. A Bayesian Network Meta-analysis (NMA) was applied for measures with enough studies and comparisons. Risk of bias was assessed with the Cochrane Risk of Bias tool. DATA SYNTHESIS: Fifteen studies were included in qualitative synthesis, and 11 in NMA. Virtual reality (VR) (n=7), robot-assisted (n=5), or handgrip strength (n=3) training were the experimental interventions and conventional RHB (n=14) control intervention. Two separate NMA were performed with MoCA (n=480 participants) and MMSE (n=350 participants) as outcome measures. Both coincided that the most probable best interventions were robot-assisted and strength training, according to SUCRA and rankogram, followed by conventional RHB and VR training. No significant differences between any of the treatments were found in the MoCA network, but in the MMSE, robot-assisted and strength training were significantly better than conventional RHB and VR. No significant differences between robot-assisted and strength training were found nor between conventional RHB and VR. CONCLUSIONS: Motor interventions can improve MoCA/MMSE scores post-stroke. Most probable best interventions were robot-assisted and strength training. Limited literature assessing domain-specific cognitive effects was found.
