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Chronic stroke survivors underestimate their upper limb motor ability in a simple 2D motor task. 慢性中风幸存者在简单的二维运动任务中低估了自己的上肢运动能力。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-10-01 DOI: 10.1186/s12984-024-01471-1
Sebastian Sporn, M Coll, S Bestmann, N S Ward

Background: Stroke survivors can exhibit a mismatch between the actual motor ability of their affected upper limb and how much they use it in daily life. The resulting non-use of the affected upper limb has a negative impact on participation in neurorehabilitation and functional independence. The factors leading to non-use of the affected upper limb are poorly understood. One possibility is that non-use comes about through inappropriately low confidence in their own upper limb motor abilities.

Objective: We asked whether chronic stroke survivors underestimate the motor ability of their affected upper limb.

Methods: 20 chronic stroke survivors (Mean FM: 28.2 ± 10.5) completed a 2D reaching task using an exoskeleton robot. Target sizes were individually altered to ensure success rates were similar for both upper limbs. Prior to each reaching movement, participants rated their confidence about successfully hitting the target (estimated upper limb motor ability).

Results: Confidence ratings were significantly lower for the affected upper limb (estimated ability), even though it was equally successful in the reaching task in comparison to the less affected upper limb (actual ability). Furthermore, confidence ratings did not correlate with level of impairment.

Conclusions: Our results demonstrate that chronic stroke survivors can underestimate the actual motor abilities of their affected upper limb, independent of impairment level. Low confidence in affected upper limb motor abilities should be considered as a therapeutic target to increase the incorporation of the affected upper limb into activities of daily living.

背景:脑卒中幸存者受影响上肢的实际运动能力与他们在日常生活中使用受影响上肢的程度不匹配。因此,不使用患侧上肢会对参与神经康复和功能独立性产生负面影响。人们对导致不使用受影响上肢的因素知之甚少。其中一种可能是,不使用患侧上肢是因为对自己的上肢运动能力信心不足:方法:20 名慢性中风幸存者(平均 FM:28.2 ± 10.5)使用外骨骼机器人完成一项 2D 伸手任务。目标大小被单独改变,以确保两个上肢的成功率相似。在每次伸手动作之前,参与者都要对自己成功击中目标的信心进行评分(估计上肢运动能力):结果:与受影响较小的上肢(实际能力)相比,尽管受影响的上肢在伸手任务中同样成功,但受影响的上肢(估计能力)的信心评级却明显较低。此外,信心评级与受损程度没有关联:我们的研究结果表明,慢性中风幸存者会低估其受累上肢的实际运动能力,这与受损程度无关。我们的研究结果表明,慢性中风幸存者会低估其患侧上肢的实际运动能力,这与受损程度无关。对患侧上肢运动能力的信心不足应被视为一个治疗目标,以提高患侧上肢在日常生活中的活动能力。
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引用次数: 0
The dose effectiveness of extracorporeal shockwave on plantar flexor spasticity of ankle in stroke patients: a randomized controlled trial. 体外冲击波对中风患者踝关节跖屈痉挛的剂量效应:随机对照试验。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-10-01 DOI: 10.1186/s12984-024-01473-z
Shu-Mei Yang, Yen-Hua Chen, You-Lin Lu, Chueh-Hung Wu, Wen-Shiang Chen, Meng-Ting Lin

Background: Extracorporeal shockwave therapy (ESWT) has been proven beneficial for post-stroke spasticity (PSS) of ankle plantar flexor muscles. This study aims to investigate the dose-response effectiveness of focused-ESWT and the duration of its effect on the treatment of ankle PSS in stroke patients.

Methods: In this double-blinded randomized controlled trial, stroke patients diagnosed with PSS in the ankle plantar flexor muscles were randomly assigned to two groups. The experimental group received double-dose ESWT (4000 pulses per session) targeting spastic calf muscles, while the control group received half the dose (2000 pulses per session). Both groups underwent four sessions over two weeks. The outcomes, including modified Ashworth Scale (MAS), modified Tardieu Scale (MTS), passive range of motion (PROM) of the ankle, Timed Up and Go (TUG) Test, Barthel index and strain elastography were evaluated at baseline, 1st, 4th, 12th, and 24th week after ESWT.

Results: Within-group analysis revealed significant improvements in MAS, PROM, TUG Test, and Barthel index for the double-dose ESWT group and improvements in Barthel index for the control group. Between-group analysis revealed greater improvements in TUG Test, Barthel Index and strain elastography for the double-dose ESWT group. Generalized estimating equations analysis indicated that the double-dose ESWT group achieved superior outcomes in the TUG Test, Barthel Index, and strain elastography across various time points and groups.

Conclusions: Double-dose ESWT showed better functional improvement and elastography compared to the control group. ESWT demonstrated dose-response effectiveness for PSS of ankle-equinus.

Trial registration: NCT05878223.

背景:体外冲击波疗法(ESWT体外冲击波疗法(ESWT)已被证实对中风后踝关节跖屈肌痉挛(PSS)有益。本研究旨在探讨聚焦体外冲击波疗法治疗中风患者踝关节 PSS 的剂量反应效果及其持续时间:在这项双盲随机对照试验中,被诊断为踝关节跖屈肌 PSS 的中风患者被随机分配到两组。实验组接受针对痉挛性小腿肌肉的双剂量 ESWT(每次 4000 脉冲),而对照组接受一半剂量(每次 2000 脉冲)。两组均在两周内接受了四次治疗。在 ESWT 治疗后的基线、第 1 周、第 4 周、第 12 周和第 24 周,对包括改良阿什沃斯量表 (MAS)、改良塔迪厄量表 (MTS)、踝关节被动活动范围 (PROM)、定时上下楼 (TUG) 测试、巴特尔指数和应变弹性成像在内的结果进行了评估:组内分析显示,双剂量 ESWT 组的 MAS、PROM、TUG 测试和 Barthel 指数均有明显改善,而对照组的 Barthel 指数则有所改善。组间分析显示,双剂量 ESWT 组在 TUG 测试、巴特尔指数和应变弹性成像方面有更大改善。广义估计方程分析表明,双剂量 ESWT 组在 TUG 测试、巴特尔指数和应变弹性成像方面取得了不同时间点和组间的更好结果:结论:与对照组相比,双剂量 ESWT 组的功能改善和弹性成像效果更好。ESWT对踝关节-奎努斯的PSS显示出剂量反应的有效性:试验注册:NCT05878223。
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引用次数: 0
Cerebellar tDCS combined with augmented reality treadmill for freezing of gait in Parkinson's disease: a randomized controlled trial. 小脑电刺激与增强现实跑步机相结合治疗帕金森病步态冻结:随机对照试验。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-09-28 DOI: 10.1186/s12984-024-01457-z
Fabrizio Pisano, Denise Mellace, Ambra Fugatti, Edoardo Nicolò Aiello, Silvia Diotti, Beatrice Curti, Alessandra Giust, Angelica Marfoli, Cecilia Perin, Angelica De Sandi, Dario Alimonti, Alberto Priori, Roberta Ferrucci

Background: Parkinson's disease (PD) is often accompanied by gait disorders and freezing of gait (FoG), disabling symptoms that are resistant to conventional dopamine treatments. Given the cerebellum's connectivity with the motor cortex and basal ganglia, and its implication in PD, combining transcranial direct current stimulation targeting the cerebellum (ctDCS) with physical exercise might improve gait and balance.

Objective: This study aimed to evaluate the effectiveness of a novel rehabilitation approach that combines noninvasive cerebellar stimulation with motor-cognitive training via an augmented reality treadmill (C-Mill VR+) in individuals with PD and FoG.

Methods: Seventeen individuals with PD exhibiting FoG were enrolled in a randomized controlled trial. The participants were randomly assigned to a group receiving motor-cognitive training on the C-Mill VR+ with either ctDCS or sham ctDCS. Assessments were conducted pre-intervention (T0), post-intervention (T1) after 10 sessions, and at 4-week follow-up (T2), using various clinical scales. Additionally, C-Mill assessments of postural stability and gait were conducted at T0 and T1.

Results: Although no significant time*group interactions were observed for any of the clinical variables measured, some were found in the C-Mill measures. Specifically, right lower limb sway in static conditions, both with eyes open (OAD) and eyes closed (OCD), significantly improved at T1 in the ctDCS group compared with the sham group.

Conclusions: C-Mill outcomes indicate that the combined treatment may enhance motor control. Participants who received ctDCS along with augmented reality motor-cognitive training showed better postural stability.

背景:帕金森病(PD)通常伴有步态障碍和步态冻结(FoG),这些致残症状对传统的多巴胺治疗具有抗药性。鉴于小脑与运动皮层和基底神经节的连接及其在帕金森病中的作用,将针对小脑的经颅直流电刺激(ctDCS)与体育锻炼相结合可能会改善步态和平衡:本研究旨在评估通过增强现实跑步机(C-Mill VR+)将无创小脑刺激与运动认知训练相结合的新型康复方法对帕金森病和 FoG 患者的效果:17名表现出FoG的帕金森病患者参加了随机对照试验。参与者被随机分配到一组,在 C-Mill VR+ 上接受带有 ctDCS 或假 ctDCS 的运动认知训练。在干预前(T0)、10 次训练后(T1)和 4 周随访时(T2),使用各种临床量表进行评估。此外,还在 T0 和 T1 阶段对姿势稳定性和步态进行了 C-Mill 评估:结果:虽然没有观察到任何临床变量在时间和组别之间有明显的交互作用,但在 C-Mill 测量中发现了一些交互作用。具体而言,在静态条件下,无论是睁眼(OAD)还是闭眼(OCD),ctDCS 组与假组相比,在 T1 阶段右下肢摇摆均有明显改善:结论:C-Mill 的结果表明,联合治疗可增强运动控制能力。接受ctDCS和增强现实运动认知训练的参与者显示出更好的姿势稳定性。
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引用次数: 0
Enhancing stroke rehabilitation with whole-hand haptic rendering: development and clinical usability evaluation of a novel upper-limb rehabilitation device. 利用全手触觉渲染增强中风康复:新型上肢康复设备的开发和临床可用性评估。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-09-27 DOI: 10.1186/s12984-024-01439-1
Raphael Rätz, François Conti, Irène Thaler, René M Müri, Laura Marchal-Crespo

Introduction: There is currently a lack of easy-to-use and effective robotic devices for upper-limb rehabilitation after stroke. Importantly, most current systems lack the provision of somatosensory information that is congruent with the virtual training task. This paper introduces a novel haptic robotic system designed for upper-limb rehabilitation, focusing on enhancing sensorimotor rehabilitation through comprehensive haptic rendering.

Methods: We developed a novel haptic rehabilitation device with a unique combination of degrees of freedom that allows the virtual training of functional reach and grasp tasks, where we use a physics engine-based haptic rendering method to render whole-hand interactions between the patients' hands and virtual tangible objects. To evaluate the feasibility of our system, we performed a clinical mixed-method usability study with seven patients and seven therapists working in neurorehabilitation. We employed standardized questionnaires to gather quantitative data and performed semi-structured interviews with all participants to gain qualitative insights into the perceived usability and usefulness of our technological solution.

Results: The device demonstrated ease of use and adaptability to various hand sizes without extensive setup. Therapists and patients reported high satisfaction levels, with the system facilitating engaging and meaningful rehabilitation exercises. Participants provided notably positive feedback, particularly emphasizing the system's available degrees of freedom and its haptic rendering capabilities. Therapists expressed confidence in the transferability of sensorimotor skills learned with our system to activities of daily living, although further investigation is needed to confirm this.

Conclusion: The novel haptic robotic system effectively supports upper-limb rehabilitation post-stroke, offering high-fidelity haptic feedback and engaging training tasks. Its clinical usability, combined with positive feedback from both therapists and patients, underscores its potential to enhance robotic neurorehabilitation.

导言:目前,用于中风后上肢康复的机器人设备缺乏易用性和有效性。重要的是,目前大多数系统都无法提供与虚拟训练任务一致的体感信息。本文介绍了一种专为上肢康复设计的新型触觉机器人系统,重点是通过全面的触觉渲染来增强传感运动康复:我们开发了一种新型触觉康复设备,该设备具有独特的自由度组合,可以进行功能性伸手和抓握任务的虚拟训练,我们使用基于物理引擎的触觉渲染方法来渲染患者双手与虚拟有形物体之间的全手互动。为了评估系统的可行性,我们对七名患者和七名神经康复治疗师进行了临床混合方法可用性研究。我们采用标准化问卷收集定量数据,并对所有参与者进行了半结构化访谈,以深入了解他们对我们技术解决方案的可用性和实用性的看法:结果:该设备使用方便,可适应各种手型,无需大量设置。治疗师和患者对该系统的满意度很高,认为该系统有助于进行有意义的康复训练。参与者提供了非常积极的反馈,尤其强调了系统的自由度和触觉渲染能力。治疗师对使用我们的系统学习到的感知运动技能在日常生活活动中的迁移能力表示有信心,但还需要进一步的调查来证实这一点:结论:新型触觉机器人系统能有效支持中风后上肢康复,提供高保真触觉反馈和引人入胜的训练任务。该系统的临床可用性,以及治疗师和患者的积极反馈,都凸显了它在加强机器人神经康复方面的潜力。
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引用次数: 0
How does fatigue affect handstand balance? a non-linear approach to study fatigue influence in handstand performance. 疲劳如何影响倒立平衡?
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-09-27 DOI: 10.1186/s12984-024-01442-6
Rafael Sabido, Fernando García-Aguilar, Carla Caballero, Francisco J Moreno

Background: The handstand is an essential skill in acrobatic sports. This skill requires the athlete to maintain an inverted upright stance with only the hands supported, which requires a great effort of muscular coordination and motor control. Several factors influence the ability to control the posture, including fatigue, which is a bit studied constraint of handstand performance.

Research question: With the aim to find out whether variability in movement control can be an indicator of fatigue, the present study was carried out.

Method: Fourteen male acrobatic gymnasts were required to perform handstands. The time series for analyzing variability were capturing using Force Platforms, which is a traditional laboratory instrument, and Inertial Measurement Units (IMU), which is a more recent and less widely used, but more accessible tool. For this purpose, an analysis of the amount of variability was carried out, using the standard deviation. And analysis of the structure of variability (or complexity), using Detrended Fluctuation Analysis (DFA) and Fuzzy Entropy (FuEn).

Results: Our results reveal that fatigue causes significant increases in the amount of variability in the medio-lateral axis on the force platform, and in the IMU located in the area of the L5 vertebra. These changes are accompanied by increased auto-correlation in the medio-lateral axis of the force platform, and more unpredictable behavior in the L5 IMU.

背景介绍倒立是杂技运动中的一项基本技能。这项技能要求运动员在仅有双手支撑的情况下保持一个倒立的直立姿势,这需要极大的肌肉协调和运动控制能力。有几个因素会影响控制姿势的能力,其中包括疲劳,而疲劳是制约倒立成绩的一个重要因素:本研究旨在了解动作控制的可变性是否可以作为疲劳的指标:方法:要求 14 名男子杂技体操运动员进行倒立。分析变异性的时间序列是使用力平台(一种传统的实验室仪器)和惯性测量单元(IMU)采集的。为此,使用标准偏差对变异量进行了分析。此外,还利用去趋势波动分析(DFA)和模糊熵(FuEn)分析了变异性的结构(或复杂性):结果:我们的研究结果表明,疲劳会导致力平台内侧轴和位于 L5 椎体区域的 IMU 的变异量显著增加。伴随这些变化的是,力平台内外侧轴的自相关性增加,L5 IMU 的行为更加难以预测。
{"title":"How does fatigue affect handstand balance? a non-linear approach to study fatigue influence in handstand performance.","authors":"Rafael Sabido, Fernando García-Aguilar, Carla Caballero, Francisco J Moreno","doi":"10.1186/s12984-024-01442-6","DOIUrl":"https://doi.org/10.1186/s12984-024-01442-6","url":null,"abstract":"<p><strong>Background: </strong>The handstand is an essential skill in acrobatic sports. This skill requires the athlete to maintain an inverted upright stance with only the hands supported, which requires a great effort of muscular coordination and motor control. Several factors influence the ability to control the posture, including fatigue, which is a bit studied constraint of handstand performance.</p><p><strong>Research question: </strong>With the aim to find out whether variability in movement control can be an indicator of fatigue, the present study was carried out.</p><p><strong>Method: </strong>Fourteen male acrobatic gymnasts were required to perform handstands. The time series for analyzing variability were capturing using Force Platforms, which is a traditional laboratory instrument, and Inertial Measurement Units (IMU), which is a more recent and less widely used, but more accessible tool. For this purpose, an analysis of the amount of variability was carried out, using the standard deviation. And analysis of the structure of variability (or complexity), using Detrended Fluctuation Analysis (DFA) and Fuzzy Entropy (FuEn).</p><p><strong>Results: </strong>Our results reveal that fatigue causes significant increases in the amount of variability in the medio-lateral axis on the force platform, and in the IMU located in the area of the L5 vertebra. These changes are accompanied by increased auto-correlation in the medio-lateral axis of the force platform, and more unpredictable behavior in the L5 IMU.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":"21 1","pages":"171"},"PeriodicalIF":5.2,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11430115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reliability and usability of a novel inertial sensor-based system to test craniocervical flexion movement control. 基于惯性传感器的新型系统的可靠性和可用性,用于测试颅颈屈曲运动控制。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-09-23 DOI: 10.1186/s12984-024-01438-2
Elena Bocos-Corredor, Filippo Moggioli, Tomás Pérez-Fernández, Susan Armijo-Olivo, Sonia Liébana, Aitor Martín-Pintado-Zugasti

Background: Neck pain has a significant global impact, ranking as the fourth leading cause of disability. Recurrent neck pain often leads to impaired sensorimotor control, particularly in craniocervical flexion (CFF). The Craniocervical Flexion Test (CCFT) has been widely investigated to assess the performance of deep cervical flexor muscles. However, its use requires skilled assessors who need to subjectively detect compensations, progressive increases in range of motion (ROM) or excessive superficial flexor activation during the test. The aim of this study was to design and develop a novel Craniocervical Flexion Movement Control Test (CFMCT) based on inertial sensor technology and real-time computer feedback and to evaluate its safety and usability, as well as inter and intra-rater reliability in both healthy individuals and patients with neck pain.

Methods: We used inertial sensor technology associated with new software that provides real-time computer feedback to assess CCF movement control through two independent test protocols, the progressive consecutive stages protocol (including progressive incremental stages of ROM) and the random stages protocol (providing dynamic and less predictable movement patterns). We determined intra and inter-rater reliability and standard error of the measurement for both protocols. The participants rated their usability was analysed through the System Usability Scale (SUS) and possible secondary effects associated with the tests were registered.

Results: The progressive consecutive stages protocol and the random stages protocol were safe and easy to use (SUS scores of 82.00 ± 11.55 in the pain group and 79.56 ± 13.36 in the asymptomatic group). The progressive consecutive stages protocol demonstrated good inter-rater reliability (intraclass correlation coefficient [ICC] ≥ 0.75) and moderate to good intra-rater reliability (ICC 0.62-0.80). However, the random stages protocol exhibited lower intra-rater reliability, especially in the neck pain group, where the reliability values were poor in some cases (ICC 0.48-0.72).

Conclusion: The CFMCT (progressive consecutive stages protocol) is a promising instrument to evaluate CCF motor control in patients with chronic neck pain. It has potential for telehealth assessment and easy adherence for exercise prescription and seems to be a safe and usable tool for patients with pain and asymptomatic individuals. Its use as a test or for exercise needs to be further investigated to facilitate its transfer to clinical practice.

背景:颈痛对全球影响重大,是导致残疾的第四大原因。反复发作的颈部疼痛往往会导致感觉运动控制能力受损,尤其是在颅颈屈(CFF)方面。颅颈屈曲测试(CCFT)已被广泛用于评估颈深屈肌的表现。然而,使用该方法需要熟练的评估人员,他们需要在测试过程中主观地检测代偿、运动范围(ROM)的逐渐增加或浅屈肌的过度激活。本研究旨在设计和开发一种基于惯性传感器技术和实时计算机反馈的新型颅颈屈曲运动控制测试(CFMCT),并评估其安全性和可用性,以及在健康人和颈痛患者中评分者之间和评分者内部的可靠性:我们使用惯性传感器技术和提供实时计算机反馈的新软件,通过两个独立的测试方案,即渐进连续阶段方案(包括ROM的渐进递增阶段)和随机阶段方案(提供动态和较难预测的运动模式)来评估CCF运动控制。我们确定了两个测试方案的评分者内部和评分者之间的可靠性以及测量的标准误差。通过系统可用性量表(SUS)分析了参与者对其可用性的评价,并记录了与测试相关的可能的次生效应:结果:渐进连续阶段方案和随机阶段方案均安全易用(疼痛组的 SUS 得分为 82.00 ± 11.55,无症状组的 SUS 得分为 79.56 ± 13.36)。渐进连续分期方案的评分者间可靠性良好(类内相关系数 [ICC] ≥ 0.75),评分者内部可靠性中上(ICC 0.62-0.80)。然而,随机分期方案的评分者内部可靠性较低,尤其是在颈部疼痛组,某些情况下可靠性值较差(ICC 0.48-0.72):CFMCT(渐进连续阶段方案)是评估慢性颈痛患者CCF运动控制能力的一种很有前途的工具。对于疼痛患者和无症状者来说,它似乎是一种安全可用的工具。为了将其应用于临床实践,还需要对其作为测试或运动的用途进行进一步研究。
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引用次数: 0
Effects of high-definition tDCS targeting individual motor hotspot with EMG-driven robotic hand training on upper extremity motor function: a pilot randomized controlled trial. 针对单个运动热点的高清 tDCS 与 EMG 驱动的机器人手部训练对上肢运动功能的影响:随机对照试验。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-09-20 DOI: 10.1186/s12984-024-01468-w
Chengpeng Hu, Chun Hang Eden Ti, Kai Yuan, Cheng Chen, Ahsan Khan, Xiangqian Shi, Winnie Chiu-Wing Chu, Raymond Kai-Yu Tong

Background: Delivering HD-tDCS on individual motor hotspot with optimal electric fields could overcome challenges of stroke heterogeneity, potentially facilitating neural activation and improving motor function for stroke survivors. However, the intervention effect of this personalized HD-tDCS has not been explored on post-stroke motor recovery. In this study, we aim to evaluate whether targeting individual motor hotspot with HD-tDCS followed by EMG-driven robotic hand training could further facilitate the upper extremity motor function for chronic stroke survivors.

Methods: In this pilot randomized controlled trial, eighteen chronic stroke survivors were randomly allocated into two groups. The HDtDCS-group (n = 8) received personalized HD-tDCS using task-based fMRI to guide the stimulation on individual motor hotspot. The Sham-group (n = 10) received only sham stimulation. Both groups underwent 20 sessions of training, each session began with 20 min of HD-tDCS and was then followed by 60 min of robotic hand training. Clinical scales (Fugl-meyer Upper Extremity scale, FMAUE; Modified Ashworth Scale, MAS), and neuroimaging modalities (fMRI and EEG-EMG) were conducted before, after intervention, and at 6-month follow-up. Two-way repeated measures analysis of variance was used to compare the training effect between HDtDCS- and Sham-group.

Results: HDtDCS-group demonstrated significantly better motor improvement than the Sham-group in terms of greater changes of FMAUE scores (F = 6.5, P = 0.004) and MASf (F = 3.6, P = 0.038) immediately and 6 months after the 20-session intervention. The task-based fMRI activation significantly shifted to the ipsilesional motor area in the HDtDCS-group, and this activation pattern increasingly concentrated on the motor hotspot being stimulated 6 months after training within the HDtDCS-group, whereas the increased activation is not sustainable in the Sham-group. The neuroimaging results indicate that neural plastic changes of the HDtDCS-group were guided specifically and sustained as an add-on effect of the stimulation.

Conclusions: Stimulating the individual motor hotspot before robotic hand training could further enhance brain activation in motor-related regions that promote better motor recovery for chronic stroke.

Trial registration: This study was retrospectively registered in ClinicalTrials.gov (ID NCT05638464).

背景:用最佳电场对单个运动热点进行 HD-tDCS 可克服中风异质性带来的挑战,有可能促进神经激活并改善中风幸存者的运动功能。然而,这种个性化的 HD-tDCS 对卒中后运动恢复的干预效果尚未得到探讨。在本研究中,我们旨在评估针对个体运动热点使用 HD-tDCS 后再进行 EMG 驱动的机器人手部训练是否能进一步促进慢性中风幸存者的上肢运动功能:在这项随机对照试验中,18名慢性中风幸存者被随机分配到两组。HDtDCS 组(n = 8)接受个性化的 HD-tDCS 治疗,利用基于任务的 fMRI 来引导对个人运动热点的刺激。假刺激组(n = 10)只接受假刺激。两组患者都接受了 20 次训练,每次训练都先进行 20 分钟的 HD-tDCS,然后再进行 60 分钟的机械手训练。在干预前、干预后和随访 6 个月时,分别进行了临床量表(Fugl-meyer 上肢量表,FMAUE;改良阿什沃斯量表,MAS)和神经影像学检查(fMRI 和 EEG-EMG)。采用双向重复测量方差分析比较 HDtDCS 组和 Sham 组的训练效果:结果:HDtDCS 组的运动改善效果明显优于 Sham 组,在 20 次干预后的即时和 6 个月后,HDtDCS 组的 FMAUE 分数(F = 6.5,P = 0.004)和 MASf(F = 3.6,P = 0.038)变化更大。在 HDtDCS 组中,基于任务的 fMRI 激活明显转向同侧运动区,并且这种激活模式在 HDtDCS 组训练 6 个月后越来越集中在受刺激的运动热点上,而在 Sham 组中,激活的增加并不持续。神经影像学结果表明,HDtDCS组的神经可塑性变化是在刺激的附加效应引导下发生的:结论:在机械手训练前刺激个体运动热点可进一步增强运动相关区域的大脑激活,从而促进慢性中风患者更好地恢复运动能力:本研究在ClinicalTrials.gov(ID NCT05638464)上进行了回顾性注册。
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引用次数: 0
Exploring stroke survivors' and physiotherapists' perspectives of the potential for markerless motion capture technology in community rehabilitation. 探讨中风幸存者和理疗师对无标记动作捕捉技术在社区康复中的潜力的看法。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-09-20 DOI: 10.1186/s12984-024-01467-x
Alice Faux-Nightingale, Fraser Philp, Enza Leone, Brinton Boreman Helliwell, Anand Pandyan

Introduction: Many stroke survivors do not receive optimal levels of personalised therapy to support their recovery. Use of technology for stroke rehabilitation has increased in recent years to help minimise gaps in service provision. Markerless motion capture technology is currently being used for musculoskeletal and occupational health screening and could offer a means to provide personalised guidance to stroke survivors struggling to access rehabilitation.

Aims: This study considered context, stakeholders, and key uncertainties surrounding the use of markerless motion capture technology in community stroke rehabilitation from the perspectives of stroke survivors and physiotherapists with a view to adapting an existing intervention in a new context.

Methods: Three focus groups were conducted with eight stroke survivors and five therapists. Data were analysed using reflexive thematic analysis.

Results: Five themes were identified: limited access to community care; personal motivation; pandemic changed rehabilitation practice; perceptions of technology; and role of markerless technology for providing feedback.

Conclusions: Participants identified problems associated with the access of community stroke rehabilitation, exacerbated by Covid-19 restrictions. Participants were positive about the potential for the use of markerless motion capture technology to support personalised, effective stroke rehabilitation in the future, providing it is developed to meet stroke survivor specific needs.

引言许多中风幸存者没有得到最佳水平的个性化治疗来支持他们的康复。近年来,中风康复技术的使用有所增加,以帮助最大限度地减少服务提供方面的差距。目的:本研究从中风幸存者和物理治疗师的角度出发,考虑了在社区中风康复中使用无标记动作捕捉技术的背景、利益相关者和主要不确定因素,以期在新的背景下调整现有的干预措施:方法: 与八名中风幸存者和五名治疗师进行了三次焦点小组讨论。采用反思性主题分析法对数据进行分析:结果:确定了五个主题:获得社区护理的机会有限;个人动机;大流行病改变了康复实践;对技术的看法;无标记技术在提供反馈方面的作用:参与者发现了与社区中风康复相关的问题,Covid-19 的限制加剧了这些问题。与会者对使用无标记动作捕捉技术在未来支持个性化、有效的中风康复方面的潜力持积极态度,前提是该技术的开发能满足中风幸存者的特定需求。
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引用次数: 0
Perturbational complexity index in assessing responsiveness to rTMS treatment in patients with disorders of consciousness: a cross-over randomized controlled trial study 评估意识障碍患者对经颅磁刺激治疗反应的扰动复杂性指数:一项交叉随机对照试验研究
IF 5.1 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-09-19 DOI: 10.1186/s12984-024-01455-1
Chengwei Xu, Zhanxing Yuan, Zerong Chen, Ziqin Liao, Shuiyan Li, Yanqi Feng, Ziqiang Tang, Jichan Nian, Xiyan Huang, Haili Zhong, Qiuyou Xie
Disorders of Consciousness (DoC) caused by severe brain injuries represent a challenging clinical entity, which is easy to misdiagnosis and lacks effective treatment options. Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive neuroelectric stimulation method that shows promise in improving consciousness for DoC, especially in minimally conscious state (MCS). However, there is little evidence of its effectiveness, especially in RCT studies. Twenty MCS patients participated in a double-blind, randomized, crossover, sham-controlled clinical study to evaluate the safety and efficacy of rTMS for MCS. Subjects were randomized into two groups: one group received rTMS-active for 10 consecutive days (n = 10), and the other group received rTMS-sham for 10 consecutive days (n = 10). After a 10-day washout period, the two groups were crossed over and received the opposite treatment. the rTMS protocol consisted of 2,000 pulses per day in the left dorsolateral prefrontal cortex (L-DLPFC), sent at 10 Hz. The stimulation intensity was 90% of the resting motor threshold. Coma Recovery Scale Revised (CRS-R), the main evaluation index, was evaluated before and after each phase in a double-blind manner. Meanwhile RS-EEG and TMS-EEG data were acquired and relative alpha power (RAP), and perturbational complexity index based on state transitions (PCIst) were caculated. One-way ANOVA revealed significantly higher scores in rTMS-active treatment compared to rTMS-sham across various measures, including CRS-R total score, RAP, PCIst (all P < 0.05). Among the 20 MCS patients, 7 (35%) were identified as responders following rTMS treatment. Compared to rTMS-sham, responder scores for CRS-R, RAP, and PCIst (all P < 0.05) were significantly elevated after rTMS-active treatment. Conversely, there was no significant difference observed in non-responders. Furthermore, post-hoc analysis revealed that baseline PCIst was significantly higher in responders than non-responders. Upon a 6-month follow-up, CRS-R scores significantly increased in all 20 patients (P = 0.026). However, the responder group exhibited a more favorable prognosis compared to the non-responder group (P = 0.031). Applying 10 Hz rTMS to L-DLPFC significantly increased consciousness level in MCS patients. PCIst is a neurophysiological index that has the potential to evaluate and predict therapeutic efficacy. www.ClinicalTrials.gov , identifier: NCT05187000.
严重脑损伤导致的意识障碍(DoC)是一种极具挑战性的临床症状,容易误诊且缺乏有效的治疗方案。重复经颅磁刺激(rTMS)是一种非侵入性神经电刺激方法,有望改善意识障碍患者的意识,尤其是在微意识状态(MCS)下。然而,有关其有效性的证据很少,尤其是在 RCT 研究中。20 名 MCS 患者参加了一项双盲、随机、交叉、假对照临床研究,以评估经颅磁刺激治疗 MCS 的安全性和有效性。受试者被随机分为两组:一组连续 10 天接受经颅磁刺激激活治疗(n = 10),另一组连续 10 天接受经颅磁刺激假对照治疗(n = 10)。经颅磁刺激方案包括每天对左侧背外侧前额叶皮层(L-DLPFC)进行 2000 次脉冲刺激,频率为 10 Hz。刺激强度为静息运动阈值的 90%。昏迷恢复量表修订版(CRS-R)是主要的评估指标,以双盲方式在每个阶段前后进行评估。同时采集 RS-EEG 和 TMS-EEG 数据,并计算相对α功率(RAP)和基于状态转换的扰动复杂性指数(PCIst)。单因素方差分析显示,在 CRS-R 总分、RAP、PCIst 等各项指标上,经颅磁刺激主动治疗的得分明显高于经颅磁刺激被动治疗的得分(P 均小于 0.05)。在 20 名多发性硬化症患者中,有 7 人(35%)被确定为经颅磁刺激治疗后的应答者。与经颅磁刺激-sham相比,经颅磁刺激-active治疗后,CRS-R、RAP和PCIst的应答者得分(均为P < 0.05)显著升高。相反,在无反应者中没有观察到明显差异。此外,事后分析显示,有反应者的基线 PCIst 明显高于无反应者。在 6 个月的随访中,所有 20 名患者的 CRS-R 评分都有明显提高(P = 0.026)。不过,与无反应组相比,有反应组的预后更佳(P = 0.031)。对 L-DLPFC 进行 10 Hz 经颅磁刺激可显著提高多发性硬化症患者的意识水平。PCIst是一种神经生理指标,具有评估和预测疗效的潜力。www.ClinicalTrials.gov ,标识符:NCT05187000.
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引用次数: 0
The inertial-based gait normalcy index of dual task cost during turning quantifies gait automaticity improvement in early-stage Parkinson’s rehabilitation 基于惯性的步态正常指数(转弯时的双重任务成本)可量化帕金森病早期康复中步态自动性的改善情况
IF 5.1 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-09-19 DOI: 10.1186/s12984-024-01456-0
Lin Meng, Yu Shi, Hongbo Zhao, Deyu Wang, Xiaodong Zhu, Dong Ming
The loss of gait automaticity is a key cause of motor deficits in Parkinson’s disease (PD) patients, even at the early stage of the disease. Action observation training (AOT) shows promise in enhancing gait automaticity. However, effective assessment methods are lacking. We aimed to propose a novel gait normalcy index based on dual task cost (NIDTC) and evaluate its validity and responsiveness for early-stage PD rehabilitation. Thirty early-stage PD patients were recruited and randomly assigned to the AOT or active control (CON) group. The proposed NIDTC during straight walking and turning tasks and clinical scale scores were measured before and after 12 weeks of rehabilitation. The correlations between the NIDTCs and clinical scores were analyzed with Pearson correlation coefficient analysis to evaluate the construct validity. The rehabilitative changes were assessed using repeated-measures ANOVA, while the responsiveness of NIDTC was further compared by t tests. The turning-based NIDTC was significantly correlated with multiple clinical scales. Significant group-time interactions were observed for the turning-based NIDTC (F = 4.669, p = 0.042), BBS (F = 6.050, p = 0.022) and PDQ-39 (F = 7.772, p = 0.011) tests. The turning-based NIDTC reflected different rehabilitation effects between the AOT and CON groups, with the largest effect size (p = 0.020, Cohen’s d = 0.933). The turning-based NIDTC exhibited the highest responsiveness for identifying gait automaticity improvement by providing a comprehensive representation of motor ability during dual tasks. It has great potential as a valid measure for early-stage PD diagnosis and rehabilitation assessment. Trial registration Chinese Clinical Trial Registry: ChiCTR2300067657
步态自动性的丧失是帕金森病(PD)患者运动障碍的主要原因,即使在疾病的早期阶段也是如此。动作观察训练(AOT)有望增强步态的自动性。然而,目前还缺乏有效的评估方法。我们旨在提出一种基于双重任务成本的新型步态正常指数(NIDTC),并评估其在早期帕金森病康复中的有效性和响应性。我们招募了 30 名早期帕金森病患者,并将他们随机分配到 AOT 组或主动对照组(CON)。在康复训练 12 周前和 12 周后,测量了直行和转身任务中的 NIDTC 和临床量表评分。采用皮尔逊相关系数分析法对 NIDTC 和临床评分之间的相关性进行分析,以评估构建有效性。采用重复测量方差分析评估康复变化,并通过 t 检验进一步比较 NIDTC 的反应性。以翻身为基础的 NIDTC 与多个临床量表有明显的相关性。在以翻身为基础的 NIDTC(F = 4.669,p = 0.042)、BBS(F = 6.050,p = 0.022)和 PDQ-39 (F = 7.772,p = 0.011)测试中,观察到了明显的组间交互作用。以翻身为基础的 NIDTC 反映了 AOT 组和 CON 组之间不同的康复效果,其效应大小最大(p = 0.020,Cohen's d = 0.933)。通过全面反映双重任务中的运动能力,基于转弯的 NIDTC 在识别步态自动性改善方面表现出最高的响应性。它作为早期帕金森病诊断和康复评估的有效测量指标具有很大的潜力。试验注册:中国临床试验注册中心:ChiCTR2300067657
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引用次数: 0
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Journal of NeuroEngineering and Rehabilitation
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