Journal of NeuroEngineering and Rehabilitation最新文献

Background: Disorders in the recovery of gait strategies in individuals with incomplete spinal cord injury (SCI) suggest difficulties in controlling lower limb intersegmental dynamics, which could relate to proprioceptive impairments. To probe discrete aspects of lower limb interjoint coordination, we present here a novel protocol to assess lower limb motor strategies and evaluate the influence of proprioceptive impairments following SCI.

Methods: Twelve able-bodied controls and 16 participants with SCI performed lower limb pointing to three targets that involved combined hip and knee flexion, or hip or knee flexion only while standing, with either full or obstructed visual feedback. We quantified lower limb proprioceptive sense in individuals with SCI using a robotic gait device. We used motion analysis to determine lower limb joint angles and foot trajectory, computed inverse dynamics to quantify joint and intersegmental dynamics, and derived muscle torque as an indicator of the motor strategies produced to control the motion to each target. We used linear mixed-effects models to assess differences between the control and SCI groups on end-point performance and muscle torque, and to assess the relationship of muscle torque with end-point performance and proprioceptive sense.

Results: Groups differed in motor strategies, but not end-point performance, when pointing to all three targets. Compared to controls, the SCI group had difficulty controlling knee muscle torque when performing the hip-flexion-only target (p = 0.008) or when flexing the hip and knee simultaneously (p = 0.0004). To complete the knee-flexion-only target, the SCI group had difficulties generating the required hip extensor muscle torque to maintain the thigh in neutral (p = 0.0001). These altered motor strategies in individuals with SCI were associated with proprioceptive impairments and end-point performance.

Conclusion: This novel lower limb pointing task can identify disordered motor strategies in individuals with SCI, especially at the knee, and are associated with proprioceptive impairment. Variations of this paradigm can be employed to further understand differences in motor strategies between controls and individuals with SCI, and the impact of proprioceptive deficits.

Background: Conventional clinical tools for assessing upper limb motor function often lack the sensitivity and specificity needed to detect subtle changes in motor performance and may be subject to bias. Kinematic assessment offers a potential solution by providing objective, precise, and detailed data on movement quality. However, it is typically associated with high costs, complex equipment, time-consuming procedures, and the need for controlled environments, all of which limit its accessibility and practicality in clinical settings. This study aimed to evaluate the reliability, validity, and sensitivity of a low-cost, touchscreen-based kinematic assessment tool for measuring upper limb function in individuals post-stroke.

Methods: Sixty-four individuals with stroke participated in this study. Participants performed a visually guided reaching task on a large touch screen that consisted in reaching from a central target to five outer targets arranged in a circular pattern, each at a time, and then returning to the central target. Their motor function was assessed using the Fugl-Meyer Assessment for Upper Extremity, the Box and Block Test, and the Nine Hole Peg Test. Kinematic measures of the trajectories performed during the reaching task were extracted and analyzed for reliability, convergent validity with clinical assessments, and sensitivity to impairment severity.

Results: The kinematic measures demonstrated good to excellent test-retest reliability, with intraclass correlation coefficients ranging from moderate to excellent. The convergent validity analysis revealed multiple significant correlations between the kinematic parameters and clinical assessments, particularly in tests requiring higher skill and precision, such as the Coordination and Speed subscale of the Fugl-Meyer Assessment for Upper Extremity and the Nine Hole Peg Test. Additionally, the touchscreen-based assessment was sensitive to the severity of motor impairment, as reflected by notable differences in the kinematic measures among participants with varying levels of upper limb function.

Conclusions: The touchscreen-based kinematic assessment offered an affordable yet reliable, valid, and sensitive alternative for evaluating upper limb kinematics in individuals with stroke, which could complement clinical assessments by offering additional insights into motor performance. Furthermore, its low cost, high speed, and ease of use make it a practical option for widespread clinical adoption.

Parkinson's disease (PD) can cause postural instability, which may result in falls. These issues have been associated with motor and non-motor symptoms (NMS), including cognitive dysfunction. Several techniques have been employed to investigate the underlying neural mechanisms involved in postural control in PD. These include behavioural studies assessing associations between cognition and postural control, functional neuroimaging studies, and resting-state neural correlates. This review provides an overview of these emerging bodies of research. Scopus, PubMed, and ProQuest were searched and detailed the brain-imaging technique, cohort, and postural control measures. A total of 79 studies were identified. Findings supported the notion of cortical involvement in postural control function to compensate for subcortical damage resulting from PD. Future studies should standardise their outcome measures and data analysis to allow comparisons of results across studies and ensure more comprehensive and robust data collection to enhance the reliability and validity of these findings.

Background: Children with cerebral palsy (CP) often experience gait impairments. Robot-assisted gait training (RGT) has been shown to have beneficial effects in this patient population. However, clinical outcomes of RGT vary substantially from patient to patient. This study explored the hypothesis that clinical outcomes are associated with changes in muscle synergies in response to RGT.

Methods: Thirteen children with CP and Gross Motor Function Classification Scale (GMFCS) levels I-IV were recruited in the study. Children participated in a 6 week-RGT intervention and underwent clinical evaluations and gait studies-with focus on the analysis of electromyographic (EMG) data-pre- and post-training. Lower-limb muscle synergies were derived from the EMG recordings. Pre- vs. post-RGT clinical outcomes and muscle synergies were compared to explore potential relationships.

Results: Three and, less often, two muscle synergies were detected in study participants pre-RGT. Linear mixed effect models showed that composition of the muscle synergies and their temporal activation coefficients present deviations from normative data proportional to the severity of functional limitations (i.e., GMFCS levels, p < 0.01). At a group level, changes in muscle synergies pre- vs. post-RGT did not significantly correlate with changes in clinical outcomes (p > 0.05). However, it was observed that participants who displayed prominent changes in muscle synergies also displayed large improvements in clinical scores.

Conclusions: Gait impairments in children with CP were associated with muscle synergies that deviated from normative. Participants who demonstrated the most substantial improvements in clinical scores following RGT exhibited multiple changes in the muscle synergies. However, no statistically significant correlations were identified at the group level. Future studies relying on larger datasets are needed to further investigate this observation and potential underlying mechanisms.

Background: The impact of noninvasive brain stimulation (NIBS) on cognitive and mental outcomes in Alzheimer's disease (AD) and mild cognitive impairment (MCI) remains under debate due to contradictory findings from systematic reviews and meta-analyses (SRMAs). To synthesize evidence from SRMAs assessing the effectiveness of NIBS techniques on cognitive and mental outcomes in AD and MCI populations. By comparing our findings to recent reviews and clinical guidelines, we highlight how this study addresses current limitations in the literature, provides a more holistic perspective on NIBS interventions, and guides future research and clinical practice.

Methods: We searched four databases from inception to May 15, 2024, reviewing SRMAs that analyzed the effects of NIBS. Effect sizes, 95% confidence intervals (CIs), and prediction intervals were computed for each meta-analysis. The methodological quality of the SRMAs was evaluated using the Measurement Tool to Assess Systematic Reviews 2, and the quality of evidence was assessed through the Grading of Recommendations, Assessment, Development, and Evaluation criteria.

Findings: Ten SRMAs detailing 22 associations were analyzed, focusing on two NIBS techniques across 12 unique outcomes. Significant improvements were observed in global cognition, language, executive function, and memory. Repetitive transcranial magnetic stimulation (rTMS) significantly enhanced short-term global cognition (standardized mean difference [SMD], 0.44; 95% CI 0.02-0.86), language (SMD, 1.64; 95% CI 1.22-2.06), executive function (SMD, 1.64; 95% CI 0.18-0.83), and long-term global cognition (SMD, 0.29; 95% CI 0.07-0.50). Transcranial direct current stimulation (tDCS) was effective in improving memory (SMD, 0.60; 95% CI 0.32-0.89) and executive function (SMD, 0.39; 95% CI 0.08-0.71). NIBS interventions showed no significant correlation with neuropsychiatric symptoms but demonstrated good tolerability in terms of safety and acceptability.

Interpretation: This umbrella review indicates that NIBS techniques, particularly rTMS and tDCS, can significantly improve cognitive functions such as global cognition, language, executive functions, and memory in patients with AD and MCI. Despite potential benefits, results should be interpreted cautiously due to study heterogeneity and methodological limitations. Future studies should investigate their long-term effects and applicability across dementia types.

Background: Phantom limb pain (PLP) is a restrictive condition in which patients perceive pain in a limb that is no longer present, greatly reducing their quality of life. Mirror Therapy, wherein patients observe a mirror reflection of their intact limb, has demonstrated efficacy in alleviating PLP. However, its unilateral and seated nature presents limitations. To address these constraints while still reducing PLP, and evaluating the impact of different virtual limb representations (anthropomorphic vs. non-anthropomorphic) on the user's sense of ownership, agency, and embodiment, PhantomAR was developed. Leveraging wearable first-person augmented reality (AR) technology, PhantomAR extends traditional Mirror Therapy by enabling users to move freely and engage in bimanual tasks.

Methods: The assistive mixed reality game application PhantomAR was deployed on the Microsoft HoloLens 2 and augmented the user's residual limb by superimposing a virtual arm or tentacle that was controlled via residual muscles on their stump using an EMG electrode array. This setup allowed patients to engage in a first-person perspective and manipulate virtual objects with both the healthy and augmented limbs, free from the confines of a seated position. The study enrolled 10 able-bodied individuals and 8 individuals with unilateral, transradial amputation. All amputees experienced PLP. The usability of the PhantomAR application was evaluated using the System Usability Scale (SUS) and a user-centric survey. Additionally, the Game Experience was assessed on a 5-point Likert questionnaire (GEQ). Participants rated their phantom sensations using the Numerical Rating Scale and McGill Pain Questionnaire before, during, and after interaction with PhantomAR. The embodiment and agency of the virtual superimposed arm were evaluated with an altered Prosthesis Embodiment Scale. The study protocol included two sessions of 30 min each, during which participants experienced PhantomAR.

Results: Participants (n = 18) rated PhantomAR highly usable (SUS m = 90.8%, SD = 6.88). Feedback on the Game Experience Questionnaire was overwhelmingly positive, showing high immersion (m = 4.46, SD = 0.08) and positive affect (m = 4.97, SD = 0.05). PLP (n = 8) significantly decreased post-intervention (NRS and McGill Pain Questionnaire, p < .001). Skin temperature in the residual limb increased significantly post-intervention (p < .01) but did not correlate with PLP (r = - 0.08, p = 0.83). Tentacle overlay yielded mixed ownership but high agency ratings.

Conclusion: PhantomAR leverages mixed reality to significantly reduce Phantom Limb Pain, enhance user engagement, and alter perceptions of ownership and agency of their augmented limb through bi-manual, dynamic, full-body interactions. Trial registration DRKS00033208 (Jan. 5th 2024).

Background: Upper extremity rehabilitation in persons with stroke should be dose-dependent and task-oriented. Virtual reality (VR) has the potential to be used safely and effectively in home-based rehabilitation. This study aimed to investigate the effects of home-based virtual reality upper extremity rehabilitation in persons with chronic stroke.

Methods: This was a single-blind, randomized, controlled trial conducted at two centers. The subjects were 14 outpatients with chronic stroke more than 6 months after the onset of the stroke. The participants were randomly divided into two groups. The intervention group (n = 7) performed a home rehabilitation program for the paretic hand (30 min/day, five days/week) using a VR device (RAPAEL Smart Glove™; NEOFECT Co., Yung-in, Korea) for four weeks. The control group (n = 7) participated in a conventional home rehabilitation program at the same frequency. All participants received outpatient occupational therapy once a week during the study period. The outcome measures included the Fugl-Meyer Assessment of upper extremity motor function (FMA-UE), Motor Activity Log-14 (MAL), Jebsen-Taylor Hand Function Test (JTT), and Box and Block Test (BBT) scores.

Results: All 14 participants completed the study. Compared to the control group, the intervention group showed more significant improvements in FMA-UE (p = 0.027), MAL (p = 0.014), JTT (p = 0.002), and BBT (p = 0.014). No adverse events were observed during or after the intervention.

Conclusion: Compared to a conventional home program, combining a task-oriented virtual reality home program and outpatient occupational therapy might lead to greater improvements in upper extremity function and the frequency of use of the paretic hand.

Trial registration: This study was registered in the University Hospital Medical Information Network (UMIN) Clinical Trial Registry in Japan (Unique Identifier: UMIN000038469) on November 1, 2019; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000043836 .

Objective: This study aimed to develop and validate a machine learning-based predictive model for gait recovery in patients with acute anterior circulation ischemic stroke.

Methods: Between May and November 2023, 237 patients with acute anterior circulation ischemic stroke were enrolled. Patients were randomly divided into training and validation sets at a 7:3 ratio. Thirty-one medical characteristics were collected, and the Least Absolute Shrinkage and Selection Operator (LASSO) regression was applied to screen predictor variables. Predictive models were developed using the Random Survival Forest (RSF) and COX regression methods. The optimal model was identified based on C-index values. The SHapley Additive exPlanations (SHAP) method was employed to interpret the RSF model globally and locally.

Results: Ten predictors were identified through LASSO regression, including age, gender, periventricular white matter hyperintensities (PVWMH), Montreal Cognitive Assessment (MoCA), National Institutes of Health Stroke Scale (NIHSS), enlarged perivascular spaces in basal ganglia (BG-EPVS), lacunes, parietal infarction, basal ganglia infarction, and Timed Up & Go (TUG) test score. The C-index values of the COX regression and RSF models were 0.741 and 0.761 in the training set and 0.705 and 0.725 in the validation set, respectively. SHAP analysis of the RSF model identified BG-EPVS, TUG, MoCA, age, and PVWMH as the top five most influential predictors of gait recovery.

Conclusion: The RSF model demonstrated superior performance to the COX regression model in predicting gait recovery, offering a reliable tool for clinical decision-making regarding stroke patients' prognoses.