Journal of NeuroEngineering and Rehabilitation最新文献

Background: Technology is gaining momentum in rehabilitation. While evidence is emerging, a growing number of rehabilitation facilities are implementing devices, though with variable success. A public-private rehabilitation provider in Australia recently opened a technology therapy centre with robotic and virtual reality devices. This study was embedded in the setting, which saw substantial clinician uptake of devices and presented a unique opportunity to explore clinician experiences, perceptions and factors influencing uptake, implementation and sustainment of advanced technology in practice.

Methods: A longitudinal qualitative study was conducted, involving interviews with clinicians at three timepoints across the first 16 months of the centre opening. Allied health clinicians in the organisation (n = 119) were invited to participate in interviews, which were audio-recorded, transcribed, coded and analysed using an inductive thematic approach.

Results: In total, 63 interviews were conducted with 25 allied health clinicians across inpatient, outpatient and community rehabilitation services. An overarching finding that human interactions remain at the heart of rehabilitation with advanced technology, comprised three major themes with 12 subthemes. (1) Technology integration involves cognitive and emotional labour for clinicians, stemming from determining the value-add of advanced technology, juggling learning demands and negotiating patients' high expectations of technology. (2) Contextual factors shape clinician uptake and ongoing use of technology, including organisational culture, professional discipline, rehabilitation setting, patient characteristics and device features. (3) Shared understanding and priorities promote technology implementation and sustainment, including understanding advanced technology in relation to conventional therapy, creating a well-designed training model, equipping clinicians to manage patient expectations and maintaining a commitment to evidence-based practice.

Conclusions: While further high-quality evidence regarding the effectiveness of technology in rehabilitation is required, clinicians in this study perceived advanced technology as an adjunct to conventional therapy, with benefits for enhancing therapy dosage, patient engagement, manual handling and providing objective feedback. Important practice-derived considerations for integrating advanced technologies in rehabilitation include: developing clinician technical, clinical reasoning and interpersonal skills, reducing contextual barriers and fostering a positive organisational culture with strong leadership and targeted initiatives to support clinicians. Successful implementation of advanced rehabilitation technologies relies on clinician buy-in to champion change within an enabling person-centered context.

Background: Spinal cord injury (SCI) leads to gait impairment and loss of motor function and can be traumatic or non-traumatic in nature. Recently there has been important progress in the field of non-invasive central nervous stimulation, which can target the brain or spinal cord. In this review we aim to compare the effect of non-invasive cerebral and spinal cord stimulation on gait recovery and motor strength of lower limbs in subjects with SCI.

Methods: We conducted a search (from September 2022 until March 2024) using the PubMed, Cochrane, and PEDro databases, including all studies published since the year 2000. The protocol of the review followed PRISMA guidelines and only RCTs scoring above 5 on the PEDro scale were selected.

Results: A total of 12 RCTs with 341 participants were included. When all studies were pooled together, non-invasive central nervous system stimulation had significant effects on Lower Extremity Motor Scale (LEMS) score and gait speed. However, data was less apparent when subgrouped by type and level of stimulation. Repetitive transcranial magnetic stimulation (rTMS) showed large effect on LEMS, however transcranial direct current stimulation (tDCS) displayed a small effect on motor strength and gait speed. No meta-analysis could be performed for non-invasive spinal cord stimulation due to a lack of studies.

Conclusions: When all non-invasive stimulation techniques were pooled together, significant effects on motor strength and gait function were observed. However, subgroup analyses based on stimulation types and levels revealed a significant reduction in these effects, particularly when categorized by stimulation type (rTMS and tDCS). Furthermore, a meta-analysis could not be conducted for non-invasive spinal cord stimulation due to a lack of studies (only one study each on tsDCS and tSCS). Therefore, more randomized controlled trials are needed to evaluate neuromodulation interventions in spinal cord injury, particularly at the spinal cord level. Registration This systematic review with meta-analysis was registered in PROSPERO under the ID 512864.

Background: This prospective cohort study was designed to investigate and compare the effectiveness of rehabilitation training robots versus conventional rehabilitation training on stroke survivors by monitoring alterations in brain network of stroke patients before and after robot intervention.

Methods: Between September 2020 and November 2021, stroke patients at four grade-A tertiary hospitals underwent limb rehabilitation training. Of the total of participants, 117 patients received conventional limb rehabilitation, 93 patients participated in upper-limb robot training, and 103 patients underwent lower-limb robot training. The measured outcomes included modified Barthel Index (MBI), Fugl-Meyer assessment subscale (FMA), and manual muscle testing (MMT). Functional magnetic resonance imaging (fMRI) was conducted on 30 patients to assess changes in the brain network. Data were mainly analyzed based on the Intention-to-Treat (ITT) principle.

Results: Post-interventional analysis utilizing linear mixed models in ITT analysis revealed that the robot training group had greater enhancements compared to the conventional limb rehabilitation training group. Notably, the shoulder flexor strength (P = 0.043) was significantly higher in the upper-limb group. On the other hand, hip flexor strength (P < 0.001), hip extensor strength (P < 0.001), knee extensor strength (P = 0.013), ankle dorsiflexion strength (P < 0.001) and ankle plantarflexor strength (P < 0.001) were significantly higher in the lower-limb group. In the upper-limb group, region-of-interest (ROI) -to-ROI analysis revealed enhanced functional connectivity between the left hemisphere's motor control region and the auditory network. ROI-to-ROI analysis primarily showed enhanced interhemispheric functional connectivity in the lower-limb group, specifically between right the hemisphere's motor control region (central opercular cortex) and left hemisphere's primary motor area in the precentral gyrus.

Conclusions: According to our research findings, upper- and lower-limb rehabilitation robots demonstrated great potential in promoting motor function recovery in stroke patients. Robot-assisted training offers an alternative treatment method with comparable efficacy to traditional rehabilitation. Large-scale randomized controlled trials are needed to confirm these results.

Trial registration: The study was registered on the Chinese Clinical Trial Registry (ChiCTR1800019783).

Background: In general, people are unable to produce slow, smooth movements - as movements become slower (i.e., with longer durations), they become jerkier. A hallmark feature of Parkinson's disease is bradykinesia - slowness of movement. In this study, we investigate the intersection of these two observations - how do people with Parkinson's disease (PwP) perform in a slow tracking task, and how does it vary as a function of movement frequency? On the one hand, as PwP move more slowly in day-to-day life, they may be better in a slow tracking task. On the other hand, their general impairment in movement production may lead to worse tracking outcomes.

Methods: We used a well-tested tracking task known as the one-person mirror game, where participants control the left-right movement of an ellipse on a graphics tablet. They did so using a stylus and were instructed to match the horizontal location of a stimulus, an ellipse moving in a sinusoidal fashion at different movement frequencies and peak velocities. We calculated the submovement rate, identifying both type 2 (acceleration zero crossings) and type 3 (jerk zero crossings) from the trajectories, as well as relative position error (dX) and mean timing error (dT). To account for age-related performance decline, we tested three groups: PwP (N = 31), age-matched controls (OC; N = 29), and younger controls (YC; N = 30) in a cross-sectional study, and used mixed-design ANOVAs to compare across groups and movement frequencies.

Results: We reproduced earlier results showing that slow movements (i.e., with lower frequencies) require more submovements to track. PwP also generally performed more submovements than the other two groups, but only for type 3 submovements, whereas OC and YC performed submovements at a similar rate. Younger controls (YC) performed fewer tracking errors than older participants (both PwP and OC), and OC performed better than PwP.

Conclusions: The ability to smoothly track showed an age-related decline, with PwP producing more errors and using more submovements. This may be due to reduced automaticity in movement production. The findings of the study can be used to guide optimal movement frequencies for motor training for older adults and PwP.

Background: This study aimed to evaluate the combined effects of robotic training (RT) and botulinum toxin (BTX) injections on motor function and spasticity in individuals with post-stroke upper limb spasticity (ULS). We also sought to investigate the optimal timing of RT and BTX administration.

Methods: Forty-two participants with chronic stroke-induced ULS were initially enrolled and randomized into four groups: Group B4R4 (RT + BTX at 4 weeks [W4]), Group B0R0 (RT + BTX at baseline [W0]), Group B0R4 (BTX at W0, RT at W4), and Group B4R0 (RT at W0, BTX at W4). Clinical assessments and robotic kinematic evaluations were performed at W0, W4, and 8 weeks (W8). The primary outcome was the Fugl-Meyer assessment (FMA) score, and secondary outcomes included the modified Ashworth scale (MAS) of the elbow and kinematic parameters, such as spectral arc length, mean speed, hand path ratio, and movement deviation in various tasks. Changes in outcome measures over time were analyzed using a linear mixed-effects regression model or ordinal logistic regression.

Results: Of the 42 participants, 40 completed the study. From W0 to W4, Group B0R0 exhibited the most favorable outcomes in terms of spasticity (MAS-elbow flexor and extensor) and kinematic variables, suggesting that the combined application of BTX and RT is superior to sole interventions in improving motor function and spasticity. From W0 to W8, Group B0R4 demonstrated the most substantial improvements in FMA scores and kinematic parameters, indicating that the combined use of BTX and RT, particularly when RT is initiated 1 month after BTX injection, results in superior functional outcomes compared to other intervention timings.

Conclusions: The combination of RT and BTX is more effective in enhancing motor function and reducing spasticity in individuals with ULS than either intervention alone or no intervention. Furthermore, the timing of RT relative to BTX injection plays a critical role in maximizing therapeutic benefits in individuals with stroke and ULS, given the distinct modes of action of each intervention.

Trial registration: clinicaltrials.gov NCT02228863. The study was retrospectively registered on August 23, 2014.

Background: Assessing residual motor function in motor complete spinal cord injury (SCI) patients using surface electromyography (sEMG) is clinically important. Due to the prolonged loss of motor control and peripheral sensory input, patients may struggle to effectively activate residual motor function during sEMG assessments. The study proposes using virtual reality (VR) technology to enhance embodiment, motor imagery (MI), and memory, aiming to improve the activation of residual motor function and increase the sensitivity of sEMG assessments.

Methods: By Recruiting a sample of 12 patients with AIS A/B and capturing surface electromyographic signals before, druing and after VR training, RESULTS: Most patients showed significant electromyographic improvements in activation frequency and or 5-rank frequency during or after VR training. However, one patient with severe lower limb neuropathic pain did not exhibit volitional electromyographic activation, though their pain diminished during the VR training.

Conclusions: VR can enhance the activation of patients' residual motor function by improving body awareness and MI, thereby increasing the sensitivity of sEMG assessments.

Background: Quantifying and monitoring the sensorimotor state of persons with neurological disease by means of wearables in everyday life has been shown to be a promising approach. To date, the impact of physical activity volumes in fixed epoch approaches has been limiting the feasibility of kinematic analyses of everyday life upper limb use.

Methods: Using acceleration and angular velocity signals from wrist-worn sensors, we collected data of healthy controls (n = 12) as well as persons with multiple sclerosis (n = 17) or stroke (n = 14) during everyday life during inpatient neurorehabilitation. An activity recognition algorithm was used to avoid physical activity volume dependencies that come with epoch-based approaches. Behavioral kinematics were compared between samples and associated with clinical test performance. Further, changes of sensorimotor capacity and behavioral kinematics during neurorehabilitation (n = 15) were analyzed.

Results: Physical activity volume independence was achieved. Persons with neurological disease showed less activities and longer activity durations. Further, a PCA suggested three underlying components, namely: behavior, neurological state, and physical state. Components scores were lower (worse) for persons with neurological disease, except for behavior. However, component scores of persons with neurological disease showed great variability in all dimensions. Changes in sensorimotor capacity were partially associated with changes in behavioral kinematics, but effects of neurorehabilitation were mostly seen in outcomes associated with the physical state component.

Conclusions: Persons with neurological disease showed neurological impairments as well as declines in the physical condition, which can to some extent be seen in behavioral kinematics. Neurorehabilitation appeared to rather affect the physical than the neurological state. By the novel approach using an activity recognizer instead of fixed epochs, it was possible show traces of sensorimotor capacity, as assessed by clinical tests, in kinematics of everyday life behavior.

Background: Reduced arm swing movements during gait are an early motor manifestation of Parkinson's disease (PD). The clinical evolution, response to L-Dopa and pathophysiological underpinning of abnormal arm swing movements in PD remain largely unclear. By using a network of wearable sensors, this study objectively assesses arm swing movements during gait in PD patients across different disease stages and therapeutic conditions.

Methods: Twenty healthy subjects (HS) and 40 PD patients, including 20 early-stage and 20 mid-advanced subjects, underwent a 6-m Timed Up and Go test while monitored through a network of wearable inertial sensors. Arm swing movements were objectively evaluated in both hemibodies and different upper limb joints (shoulder and elbow), using specific time-domain (range of motion and velocity) and frequency-domain measures (harmonics and total harmonic distortion). To assess the effects of L-Dopa, patients under chronic dopaminergic therapy were randomly examined when OFF and ON therapy. Finally, clinical-behavioral correlations were investigated, primarily focusing on the relationship between arm swing movements and cardinal L-Dopa-responsive motor signs, including bradykinesia and rigidity.

Results: Compared to HS, the whole group of PD patients showed reduced range of motion and velocity, alongside increased asymmetry of arm swing movements during gait. Additionally, a distinct increase in total harmonic distortion was found in patients. The kinematic changes were prominent in the early stage of the disease and progressively worsened owing to the involvement of the less affected hemibody. The time- and frequency-domain abnormalities were comparable in the two joints (i.e., shoulder and elbow). In the subgroup of patients under chronic dopaminergic treatment, L-Dopa restored patterns of arm swing movements. Finally, the kinematic alterations in arm swing movements during gait correlated with the clinical severity of bradykinesia and rigidity.

Conclusions: Arm swing movements during gait in PD are characterized by narrow, slow, and irregular patterns. As the disease progresses, arm swing movements deteriorate also in the less affected hemibody, without any joint specificity. The positive response to L-Dopa along with the significant correlation between kinematics and bradykinesia/rigidity scores points to the involvement of dopaminergic pathways in the pathophysiology of abnormal arm swing movements in PD.

Background: Previous research has used the brain-computer interface (BCI) to promote upper-limb motor rehabilitation. However, the results of these studies were variable, leaving efficacy unclear.

Objectives: This review aims to evaluate the effects of BCI-based training on post-stroke upper-limb rehabilitation and identify potential factors that may affect the outcome.

Design: A meta-analysis including all available randomized-controlled clinical trials (RCTs) that reported the efficacy of BCI-based training on upper-limb motor rehabilitation after stroke.

Data sources and methods: We searched PubMed, Cochrane Library, and Web of Science before September 15, 2024, for relevant studies. The primary efficacy outcome was the Fugl-Meyer Assessment-Upper extremity (FMA-UE). RevMan 5.4.1 with a random effect model was used for data synthesis and analysis. Mean difference (MD) and 95% confidence interval (95%CI) were calculated.

Results: Twenty-one RCTs (n = 886 patients) were reviewed in the meta-analysis. Compared with control, BCI-based training exerted significant effects on FMA-UE (MD = 3.69, 95%CI 2.41-4.96, P < 0.00001, moderate-quality evidence), Wolf Motor Function Test (WMFT) (MD = 5.00, 95%CI 2.14-7.86, P = 0.0006, low-quality evidence), and Action Research Arm Test (ARAT) (MD = 2.04, 95%CI 0.25-3.82, P = 0.03, high-quality evidence). Additionally, BCI-based training was effective on FMA-UE for both subacute (MD = 4.24, 95%CI 1.81-6.67, P = 0.0006) and chronic patients (MD = 2.63, 95%CI 1.50-3.76, P < 0.00001). BCI combined with functional electrical stimulation (FES) (MD = 4.37, 95%CI 3.09-5.65, P < 0.00001), robots (MD = 2.87, 95%CI 0.69-5.04, P = 0.010), and visual feedback (MD = 4.46, 95%CI 0.24-8.68, P = 0.04) exhibited significant effects on FMA-UE. BCI combined with FES significantly improved FMA-UE for both subacute (MD = 5.31, 95%CI 2.58-8.03, P = 0.0001) and chronic patients (MD = 3.71, 95%CI 2.44-4.98, P < 0.00001), and BCI combined with robots was effective for chronic patients (MD = 1.60, 95%CI 0.15-3.05, P = 0.03). Better results may be achieved with daily training sessions ranging from 20 to 90 min, conducted 2-5 sessions per week for 3-4 weeks.

Conclusions: BCI-based training may be a reliable rehabilitation program to improve upper-limb motor impairment and function.

Trial registration: PROSPERO registration ID: CRD42022383390.