Design of a VR-Based Upper Limb Gross Motor and Fine Motor Task Platform for Post-Stroke Survivors

Multidomain instrumental evaluation of post-stroke chronic patients, coupled with standard clinical assessments, has rarely been exploited in the literature. Such an approach may be valuable to provide comprehensive insight regarding patients’ status, as well as orienting the rehabilitation therapies. Therefore, we propose a multidomain analysis including clinically compliant methods as electroencephalography (EEG), electromyography (EMG), kinematics, and clinical scales. The framework of upper-limb robot-assisted rehabilitation is selected as a challenging and promising scenario to test the multi-parameter evaluation, with the aim to assess whether and in which domains modifications may take place. Instrumental recordings and clinical scales were administered before and after a month of intensive robotic therapy of the impaired upper limb, on five post-stroke chronic hemiparetic patients. After therapy, all patients showed clinical improvement and presented pre/post modifications in one or several of the other domains as well. All patients performed the motor task in a smoother way; two of them appeared to change their muscle synergies activation strategies, and most subjects showed variations in their brain activity, both in the ipsi- and contralateral hemispheres. Changes highlighted by the new multiparametric instrumental approach suggest a recovery trend in agreement with clinical scales. In addition, by jointly demonstrating lateralization of brain activations, changes in muscle recruitment and the execution of smoother trajectories, the new approach may help distinguish between true functional recovery and the adoption of suboptimal compensatory strategies. In the light of these premises, the multi-domain approach may allow a finer patient characterization, providing a deeper insight into the mechanisms underlying the relearning procedure and the level (neuro/muscular) at which it occurred, at a relatively low expenditure. The role of this quantitative description in defining a personalized treatment strategy is of great interest and should be addressed in future studies.

Download Full-text

β-Oscillations Reflect Recovery of the Paretic Upper Limb in Subacute Stroke

Neurorehabilitation and Neural Repair ◽

10.1177/1545968320913502 ◽

2020 ◽

Vol 34 (5) ◽

pp. 450-462 ◽

Cited By ~ 2

Author(s):

Chih-Wei Tang ◽

Fu-Jung Hsiao ◽

Po-Lei Lee ◽

Yun-An Tsai ◽

Ya-Fang Hsu ◽

...

Keyword(s):

Motor Function ◽

Upper Limb ◽

Primary Motor Cortex ◽

Hand Movement ◽

Stroke Recovery ◽

Stroke Survivors ◽

Healthy Controls ◽

Functional Changes ◽

Post Stroke ◽

Subacute Stroke

Background. Recovery of upper limb function post-stroke can be partly predicted by initial motor function, but the mechanisms underpinning these improvements have yet to be determined. Here, we sought to identify neural correlates of post-stroke recovery using longitudinal magnetoencephalography (MEG) assessments in subacute stroke survivors. Methods. First-ever, subcortical ischemic stroke survivors with unilateral mild to moderate hand paresis were evaluated at 3, 5, and 12 weeks after stroke using a finger-lifting task in the MEG. Cortical activity patterns in the β-band (16-30 Hz) were compared with matched healthy controls. Results. All stroke survivors (n=22; 17 males) had improvements in action research arm test (ARAT) and Fugl-Meyer upper extremity (FM-UE) scores between 3 and 12 weeks. At 3 weeks post-stroke the peak amplitudes of the movement-related ipsilesional β-band event-related desynchronization (β-ERD) and synchronization (β-ERS) in primary motor cortex (M1) were significantly lower than the healthy controls (p<0.001) and were correlated with both the FM-UE and ARAT scores (r=0.51-0.69, p<0.017). The decreased β-ERS peak amplitudes were observed both in paretic and non-paretic hand movement particularly at 3 weeks post-stroke, suggesting a generalized disinhibition status. The peak amplitudes of ipsilesional β-ERS at week 3 post-stroke correlated with the FM-UE score at 12 weeks (r=0.54, p=0.03) but no longer significant when controlling for the FM-UE score at 3 weeks post-stroke. Conclusions. Although early β-band activity does not independently predict outcome at 3 months after stroke, it mirrors functional changes, giving a potential insight into the mechanisms underpinning recovery of motor function in subacute stroke.

Download Full-text

Kinect-Assisted Performance-Sensitive Upper Limb Exercise Platform for Post-stroke Survivors

Frontiers in Neuroscience ◽

10.3389/fnins.2019.00228 ◽

2019 ◽

Vol 13 ◽

Cited By ~ 1

Author(s):

Adyasha Dash ◽

Anand Yadav ◽

Anand Chauhan ◽

Uttama Lahiri

Keyword(s):

Upper Limb ◽

Stroke Survivors ◽

Post Stroke ◽

Limb Exercise

Download Full-text

Upper limb activity in chronic post-stroke survivors: A comparison of accelerometry data with the Action Research Arm Test (ARAT)

Annals of Physical and Rehabilitation Medicine ◽

10.1016/j.rehab.2018.05.430 ◽

2018 ◽

Vol 61 ◽

pp. e187 ◽

Cited By ~ 1

Author(s):

J. Parker ◽

L. Powell ◽

B. Heller ◽

E. Schweiss ◽

S. Mawson

Keyword(s):

Action Research ◽

Upper Limb ◽

Stroke Survivors ◽

Post Stroke

Download Full-text

Racial Disparities in Stroke Recovery Persistence in the Post-Acute Stroke Recovery Phase: Evidence from the Health and Retirement Study

Ethnicity & Disease ◽

10.18865/ed.30.2.339 ◽

2020 ◽

Vol 30 (2) ◽

pp. 339-348

Author(s):

Joy N. J. Buie ◽

Yujing Zhao ◽

Suzanne Burns ◽

Gayenell Magwood ◽

Robert Adams ◽

...

Keyword(s):

Racial Differences ◽

Motor Skills ◽

Stroke Recovery ◽

Fine Motor ◽

Stroke Survivors ◽

Factors Associated ◽

Post Stroke ◽

Stroke Disability ◽

The Impact

Background and Purpose: Blacks have a higher burden of post-stroke disability. Factors associated with racial differences in long-term post-stroke disability are not well-understood. Our aim was to assess the long-term racial differences in risk factors associated with stroke recovery.Methods: We examined Health and Retirement Study (HRS) longitudinal interview data collected from adults living with stroke who were aged >50 years during 2000- 2014. Analysis of 1,002 first-time, non- Hispanic, Black (210) or White (792) stroke survivors with data on activities of daily living (ADL), fine motor skills (FMS) and gross motor skills (GMS) was conducted. Ordinal regression analysis was used to assess the impact of sex, race, household residents, household income, comorbidities, and the time since having a stroke on functional outcomes.Results: Black stroke survivors were younger compared with Whites (69 ± 10.4 vs 75 ± 11.9). The majority (~65%) of Black stroke survivors were female compared with about 54% White female stroke survivors (P=.007). Black stroke survivors had more household residents (P<.001) and comorbidities (P<.001). Aging, being female, being Black and a longer time since stroke were associated with a higher odds of having increased difficulty in ADL, FMS and/or GMS. Comorbidities were associated with increased difficulty with GMS. Black race increased the impact of comorbidities on ADL and FMS in comparison with Whites.Conclusion: Our data suggest that the effects of aging, sex and unique factors associated with race should be taken into consideration for future studies of post-stroke recovery and therapy.Ethn Dis. 2020;30(2):339-348; doi:10.18865/ ed.30.2.339

Download Full-text

Efficacy of motor therapy over sensorimotor therapy in upper limb functions of post stroke patients

Biomedicine ◽

10.51248/.v41i1.545 ◽

2021 ◽

Vol 41 (1) ◽

pp. 120-124

Author(s):

V. Rajalaxmi ◽

M. Tharunya ◽

S.S. Subramanian ◽

G. Vaishnavi ◽

Chandra Kumar K ◽

...

Keyword(s):

Upper Limb ◽

Fine Motor ◽

Stroke Patients ◽

Mean Values ◽

Post Stroke ◽

Medical College ◽

Significant Difference ◽

Group A ◽

Group B ◽

Nine Hole Peg Test

Introduction and Aim:Strokeis one of the leading causes of death and disability in India. The incidence of stroke rapidly increases with age, doubling for each decade after 55.In the majority of patients the upper limb is severely impaired than lower limb. The aim of this study was to analyze the efficacy of motor therapy over sensorimotor therapy in upper limb functions of post stroke patients. Materials and Methods: This was an experimental study, of pre-post type, that was conducted in the outpatient department of Physiotherapy at ACS Medical College and Hospital,chennai.30 samples were selected from 45 volunteers according to inclusion criteria and the study was conducted for Group A received sensorimotor therapy for one session/day for 6 days a week for 12 weeks. Group B received motor therapy for one session/day for 6 days a week for 12 weeks. Pre and post measurement were done using motor assessment scale, stroke upper limb capacity scale, action research arm test and nine-hole peg test. Results: There was a significant difference in mean values of group A and B on comparison. Group A seems to be more effective than group B. Conclusion: The study concludes that both motor therapy and sensorimotor therapy are beneficial in stroke rehabilitation, but sensorimotor therapy is more effective in improving the gross and fine motor skills of the upper limb of stroke patients.

Download Full-text

Serious Games Design Principles Using Virtual Reality to Gamify Upper Limb Stroke Rehabilitation

10.4018/978-1-7998-9223-6.ch011 ◽

2022 ◽

pp. 235-261

Author(s):

Robert Herne ◽

Mohd Fairuz Shiratuddin ◽

Shri Rai ◽

David Blacker

Keyword(s):

Virtual Reality ◽

Upper Limb ◽

Game Design ◽

Serious Games ◽

Stroke Rehabilitation ◽

Design Principles ◽

Stroke Survivors ◽

Upper Limb Rehabilitation ◽

Post Stroke ◽

Limb Rehabilitation

Stroke is a debilitating condition that impairs one's ability to live independently while also greatly decreasing one's quality of life. For these reasons, stroke rehabilitation is important. Engagement is a crucial part of rehabilitation, increasing a stroke survivor's recovery rate and the positive outcomes of their rehabilitation. For this reason, virtual reality (VR) has been widely used to gamify stroke rehabilitation to support engagement. Given that VR and the serious games that form its basis may not necessarily be engaging in themselves, ensuring that their design is engaging is important. This chapter discusses 39 principles that may be useful for engaging stroke survivors with VR-based rehabilitation post-stroke. This chapter then discusses a subset of the game design principles that are likely to engage stroke survivors with VR designed for upper limb rehabilitation post-stroke.

Download Full-text

Estimating Upper-Limb Impairment Level in Stroke Survivors Using Wearable Inertial Sensors and a Minimally-Burdensome Motor Task

IEEE Transactions on Neural Systems and Rehabilitation Engineering ◽

10.1109/tnsre.2020.2966950 ◽

2020 ◽

Vol 28 (3) ◽

pp. 601-611 ◽

Cited By ~ 1

Author(s):

Brandon Oubre ◽

Jean-Francois Daneault ◽

Hee-Tae Jung ◽

Kallie Whritenour ◽

Jose Garcia Vivas Miranda ◽

...

Keyword(s):

Upper Limb ◽

Inertial Sensors ◽

Motor Task ◽

Stroke Survivors ◽

Wearable Inertial Sensors

Download Full-text

EEG Spectral Feature Modulations Associated with Fatigue in Robot-Mediated Upper Limb Gross Motor and Fine Motor Interactions

10.1101/2021.04.22.440968 ◽

2021 ◽

Author(s):

Udeshika Chaturangee Dissanayake ◽

Volker Steuber ◽

Farshid Amirabdollahian

Keyword(s):

Upper Limb ◽

Activity Patterns ◽

Spectral Feature ◽

Mental Fatigue ◽

Fine Motor ◽

Alpha Band ◽

Gross Motor ◽

Band Power ◽

Delta Band ◽

Motor Interaction

AbstractThis paper investigates the EEG spectral feature modulations associated with fatigue induced by robot-mediated upper limb gross motor and fine motor interactions. Twenty healthy participants were randomly assigned to either perform a gross motor interaction with HapticMASTER or a fine motor interaction with SCRIPT passive orthosis for 20 minutes or until volitional fatigue. EEG relative and ratio band power measures were estimated from the data recorded before and after the interactions. Paired-samples t-tests found a significant increase in relative alpha band power on FC3, C3, P3 electrodes, and (θ + α)/β and α/β on C3 electrode following the gross motor interaction. Conversely, relative delta band power on C3 significantly decreased. A significant increase in relative alpha band power on FP1, C3 electrodes and relative theta band power on C4 electrode were found following the fine motor interaction whereas relative delta band power on FP1 electrode significantly decreased. Most participants reported an increase in their physical fatigue level following the gross movements and an increase in their mental fatigue level following the fine movements. Findings affirm that changes to localised brain activity patterns are an indication of fatigue developed from the robot-mediated interactions. It can be concluded that regional differences in the prominent EEG spectral features are most likely due to the differences in the nature of the task (fine/gross motor and distal/proximal upper limb) that may have differently altered an individual’s physical and mental fatigue level. The findings could potentially be utilised to monitor and moderate fatigue during robot-mediated post-stroke therapies.

Download Full-text