Integrated Gait Triggered Mixed Reality and Neurophysiological Monitoring as a Framework for Next-Generation Ambulatory Stroke Rehabilitation.

Brain stroke affects millions of people in the world every year, with 50 to 60 percent of stroke survivors suffering from functional disabilities, for which early and sustained post-stroke rehabilitation is highly recommended. However, approximately one third of stroke patients do not receive early in hospital rehabilitation programs due to insufficient medical facilities or lack of motivation. Gait triggered mixed reality (GTMR) is a cognitive-motor dual task with multisensory feedback tailored for lower-limb post-stroke rehabilitation, which we propose as a potential method for addressing these rehabilitation challenges. Simultaneous gait and EEG data from nine stroke patients was recorded and analyzed to assess the applicability of GTMR to different stroke patients, determine any impacts of GTMR on patients, and better understand brain dynamics as stroke patients perform different rehabilitation tasks. Walking cadence improved significantly for stroke patients and lower-limb movement induced alpha band power suppression during GTMR tasks. The brain dynamics and gait performance across different severities of stroke motor deficits was also assessed; the intensity of walking induced event related desynchronization (ERD) was found to be related to motor deficits, as classified by Brunnstrom stage. In particular, stronger lower-limb movement induced ERD during GTMR rehabilitation tasks was found for patients with moderate motor deficits (Brunnstrom stage IV). This investigation demonstrates the efficacy of the GTMR paradigm for enhancing lower-limb rehabilitation, explores the neural activities of cognitive-motor tasks in different stages of stroke, and highlights the potential for joining enhanced rehabilitation and real-time neural monitoring for superior stroke rehabilitation.

Immediate Effect of Whole Body Vibration on Knee Extensor Tendon Stiffness in Hemiparetic Stroke Patients.

Background and Objectives: Whole body vibration is widely used to enhance muscle performance, but evidence of its effects on the tendon stiffness of the knee extensor tendon in stroke remains inconclusive. Our study was aimed to determine the difference in patellar and quadriceps tendon stiffness between hemiparetic and unaffected limbs in stroke patients and to investigate the immediate effect of whole body vibration on tendon stiffness. Materials and Methods: The patellar and quadriceps tendon stiffness of first-ever hemiplegic stroke patients was evaluated with elastography to compare the differences between hemiparetic and unaffected limbs. After one 20 min session of whole body vibration exercise in the standing position, tendon stiffness was again measured to evaluate the immediate effects of whole body vibration on tendon stiffness. Results: The results showed no significant differences in the tendon stiffness of the patellar and quadriceps tendons between hemiparetic and unaffected limbs. However, significant associations were found between the tendon stiffness of the patellar and quadriceps tendons and knee extensor spasticity on the hemiparetic side (ρ = 0.62; p = 0.044). There were no significant changes in tendon stiffness after a single session of whole body vibration. Conclusions: In conclusion, knee extensor tendon stiffness in hemiparetic limbs is positively correlated to the degree of knee extensor spasticity in stroke patients. However, a single session of whole body vibration does not alter tendon stiffness.