Robot-Assisted Gait Training (RAGT) is a novel technology widely employed in the field of neurological rehabilitation for patients with subacute stroke. However, the effectiveness of RAGT compared to conventional gait training (CGT) in improving lower extremity function remains a topic of debate. This study aimed to investigate and compare the effects of RAGT and CGT on lower extremity movement in patients with subacute stroke. Comprehensive search was conducted across multiple databases, including PubMed, Web of Science, Cochrane Library, EBSCO, Embase, Scopus, China National Knowledge Infrastructure, Wan Fang, SinoMed and Vip Journal Integration Platform. The database retrieval was performed up until July 9, 2024. Meta-analysis was conducted using RevMan 5.4 software. A total of 24 RCTs were included in the analysis. The results indicate that, compared with CGT, RAGT led to significant improvements in the Fugl-Meyer Assessment for Lower Extremity [MD = 2.10, 95%CI (0.62, 3.59), P = 0.005], Functional Ambulation Category[MD = 0.44, 95%CI (0.23, 0.65), P < 0.001], Berg Balance Scale [MD = 4.55, 95%CI (3.00, 6.11), P < 0.001], Timed Up and Go test [MD = −4.05, 95%CI (−5.12, −2.98), P < 0.001], and 6-Minute Walk Test [MD = 30.66, 95%CI (22.36, 38.97), P < 0.001] for patients with subacute stroke. However, it did not show a significant effect on the 10-Meter Walk Test [MD = 0.06, 95%CI (−0.01, 0.14), P = 0.08]. This study provides evidence that RAGT can enhance lower extremity function, balance function, walking ability, and endurance levels compared to CGT. However, the quality of evidence for improvements in gait speed remains low.
{"title":"Efficacy of robot-assisted gait training on lower extremity function in subacute stroke patients: a systematic review and meta-analysis","authors":"Miao-miao Hu, Shan Wang, Cai-qin Wu, Kun-peng Li, Zhao-hui Geng, Guo-hui Xu, Lu Dong","doi":"10.1186/s12984-024-01463-1","DOIUrl":"https://doi.org/10.1186/s12984-024-01463-1","url":null,"abstract":"Robot-Assisted Gait Training (RAGT) is a novel technology widely employed in the field of neurological rehabilitation for patients with subacute stroke. However, the effectiveness of RAGT compared to conventional gait training (CGT) in improving lower extremity function remains a topic of debate. This study aimed to investigate and compare the effects of RAGT and CGT on lower extremity movement in patients with subacute stroke. Comprehensive search was conducted across multiple databases, including PubMed, Web of Science, Cochrane Library, EBSCO, Embase, Scopus, China National Knowledge Infrastructure, Wan Fang, SinoMed and Vip Journal Integration Platform. The database retrieval was performed up until July 9, 2024. Meta-analysis was conducted using RevMan 5.4 software. A total of 24 RCTs were included in the analysis. The results indicate that, compared with CGT, RAGT led to significant improvements in the Fugl-Meyer Assessment for Lower Extremity [MD = 2.10, 95%CI (0.62, 3.59), P = 0.005], Functional Ambulation Category[MD = 0.44, 95%CI (0.23, 0.65), P < 0.001], Berg Balance Scale [MD = 4.55, 95%CI (3.00, 6.11), P < 0.001], Timed Up and Go test [MD = −4.05, 95%CI (−5.12, −2.98), P < 0.001], and 6-Minute Walk Test [MD = 30.66, 95%CI (22.36, 38.97), P < 0.001] for patients with subacute stroke. However, it did not show a significant effect on the 10-Meter Walk Test [MD = 0.06, 95%CI (−0.01, 0.14), P = 0.08]. This study provides evidence that RAGT can enhance lower extremity function, balance function, walking ability, and endurance levels compared to CGT. However, the quality of evidence for improvements in gait speed remains low.","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-18DOI: 10.1186/s12984-024-01452-4
Jing He, Lingyu Wu, Wei Du, Fei Zhang, Shinuan Lin, Yun Ling, Kang Ren, Zhonglue Chen, Haibo Chen, Wen Su
The acute levodopa challenge test (ALCT) is a universal method for evaluating levodopa response (LR). Assessment of Movement Disorder Society’s Unified Parkinson’s Disease Rating Scale part III (MDS-UPDRS III) is a key step in ALCT, which is some extent subjective and inconvenience. This study developed a machine learning method based on instrumented Timed Up and Go (iTUG) test to evaluate the patients’ response to levodopa and compared it with classic ALCT. Forty-two patients with parkinsonism were recruited and administered with levodopa. MDS-UPDRS III and the iTUG were conducted in both OFF-and ON-medication state. Kinematic parameters, signal time and frequency domain features were extracted from sensor data. Two XGBoost models, levodopa response regression (LRR) model and motor symptom evaluation (MSE) model, were trained to predict the levodopa response (LR) of the patients using leave-one-subject-out cross-validation. The LR predicted by the LRR model agreed with that calculated by the classic ALCT (ICC = 0.95). When the LRR model was used to detect patients with a positive LR, the positive predictive value was 0.94. Machine learning based on wearable sensor data and the iTUG test may be effective and comprehensive for evaluating LR and predicting the benefit of dopaminergic therapy.
{"title":"Instrumented timed up and go test and machine learning-based levodopa response evaluation: a pilot study","authors":"Jing He, Lingyu Wu, Wei Du, Fei Zhang, Shinuan Lin, Yun Ling, Kang Ren, Zhonglue Chen, Haibo Chen, Wen Su","doi":"10.1186/s12984-024-01452-4","DOIUrl":"https://doi.org/10.1186/s12984-024-01452-4","url":null,"abstract":"The acute levodopa challenge test (ALCT) is a universal method for evaluating levodopa response (LR). Assessment of Movement Disorder Society’s Unified Parkinson’s Disease Rating Scale part III (MDS-UPDRS III) is a key step in ALCT, which is some extent subjective and inconvenience. This study developed a machine learning method based on instrumented Timed Up and Go (iTUG) test to evaluate the patients’ response to levodopa and compared it with classic ALCT. Forty-two patients with parkinsonism were recruited and administered with levodopa. MDS-UPDRS III and the iTUG were conducted in both OFF-and ON-medication state. Kinematic parameters, signal time and frequency domain features were extracted from sensor data. Two XGBoost models, levodopa response regression (LRR) model and motor symptom evaluation (MSE) model, were trained to predict the levodopa response (LR) of the patients using leave-one-subject-out cross-validation. The LR predicted by the LRR model agreed with that calculated by the classic ALCT (ICC = 0.95). When the LRR model was used to detect patients with a positive LR, the positive predictive value was 0.94. Machine learning based on wearable sensor data and the iTUG test may be effective and comprehensive for evaluating LR and predicting the benefit of dopaminergic therapy.","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142249021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-18DOI: 10.1186/s12984-024-01459-x
Stefan Vestring, Elias Wolf, Johanna Dinkelacker, Sibylle Frase, Carolin Hessling-Zeinen, Shrabon Insan, Maral M. Kumlehn, Bernd Feige, Katharina Domschke, Claus Normann, Lukas Frase
Transcranial direct current stimulation (tDCS) is capable of eliciting changes in cortical neuroplasticity. Increasing duration or repetition of tDCS during the after-effects of a first stimulation has been hypothesized to enhance efficacy. Computational models suggest sequential stimulation patterns with changing polarities to further enhance effects. Lasting tDCS effects on neural plasticity are of great importance for clinical applications. The study systematically examined the influence of different tDCS paradigms on long term potentiation (LTP)-like plasticity in humans, focusing on stimulation duration, repetition frequency and sequential combinations of changing polarities as the underlying characteristics. Amplitude changes of motor evoked potentials (MEP) were measured in response to paired associative stimulation (PAS) 6 h after application of different tDCS protocols. In total, 36 healthy participants completed the study, randomised into three groups with different stimulation protocols (N = 12 each). tDCS was able to display lasting modulatory effects on the inducibility of LTP-like plasticity in the human motor cortex 6 h after stimulation. TDCS with the anode on primary motor cortex significantly increased MEP amplitudes following PAS induction. Further analyses highlighted single stimulation block duration to be of higher importance than repetitive protocols for efficacy of effects. tDCS is capable of inducing lasting changes in the brain’s capability to interact with future stimuli. Especially, effects on the inducibility of LTP-like plasticity might only be detectable with specific tests such as PAS and might otherwise be overlooked. Refined tDCS protocols should focus on higher current and duration of single stimulations instead of implementing complex repetitive schedules.
{"title":"Lasting effects of transcranial direct current stimulation on the inducibility of synaptic plasticity by paired-associative stimulation in humans","authors":"Stefan Vestring, Elias Wolf, Johanna Dinkelacker, Sibylle Frase, Carolin Hessling-Zeinen, Shrabon Insan, Maral M. Kumlehn, Bernd Feige, Katharina Domschke, Claus Normann, Lukas Frase","doi":"10.1186/s12984-024-01459-x","DOIUrl":"https://doi.org/10.1186/s12984-024-01459-x","url":null,"abstract":"Transcranial direct current stimulation (tDCS) is capable of eliciting changes in cortical neuroplasticity. Increasing duration or repetition of tDCS during the after-effects of a first stimulation has been hypothesized to enhance efficacy. Computational models suggest sequential stimulation patterns with changing polarities to further enhance effects. Lasting tDCS effects on neural plasticity are of great importance for clinical applications. The study systematically examined the influence of different tDCS paradigms on long term potentiation (LTP)-like plasticity in humans, focusing on stimulation duration, repetition frequency and sequential combinations of changing polarities as the underlying characteristics. Amplitude changes of motor evoked potentials (MEP) were measured in response to paired associative stimulation (PAS) 6 h after application of different tDCS protocols. In total, 36 healthy participants completed the study, randomised into three groups with different stimulation protocols (N = 12 each). tDCS was able to display lasting modulatory effects on the inducibility of LTP-like plasticity in the human motor cortex 6 h after stimulation. TDCS with the anode on primary motor cortex significantly increased MEP amplitudes following PAS induction. Further analyses highlighted single stimulation block duration to be of higher importance than repetitive protocols for efficacy of effects. tDCS is capable of inducing lasting changes in the brain’s capability to interact with future stimuli. Especially, effects on the inducibility of LTP-like plasticity might only be detectable with specific tests such as PAS and might otherwise be overlooked. Refined tDCS protocols should focus on higher current and duration of single stimulations instead of implementing complex repetitive schedules.","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-18DOI: 10.1186/s12984-024-01462-2
Shishi Chen, Jingjing Gao, Ye Zhou, Beisi Zheng, Yuxiang Liu, Manting Cao, Haiping Huang, Xinyi Su, Jianer Chen
Improper gait patterns, impaired balance and foot drop consistently plague stroke survivors, preventing them from walking independently and safely. Neuromuscular electrical stimulation (NMES) technology can help patients reactivate their muscles and regain motor coordination. This study aims to systematically review and summarize the evidence for the potential benefits of NMES on the improvement of gait patterns after stroke. PubMed, Cochrane Library, Embase, Science Direct and Web of Science were systematically searched until April 2024, to identify randomized controlled trials with the following criteria: stroke survivors as participants; NMES as intervention; conventional rehabilitation as a comparator; and gait assessment, through scales or quantitative parameters, as outcome measures. 29 publications involving 1711 patients met the inclusion criteria. Meta-analysis showed no significant differences in Ten-meter walk test, Fugl-Meyer assessment lower extremity, Modified Ashworth Assessment and asymmetry between the NMES group and the control group. Besides, NMES was associated with changes in outcome indicators such as quantitative gait analysis speed [SMD = 0.53, 95% CI (0.20, 0.85), P = 0.001], cadence [SMD = 0.76, 95% CI (0.32, 1.20), P = 0.0008], affected side step length [SMD = 0.73, 95% CI (0.16, 1.31), P = 0.01], angle of ankle dorsiflexion [WMD = 1.57, 95% CI (0.80, 2.33), P < 0.0001], Six-Minute Walk Test [WMD = 14.83, 95% CI (13.55, 16.11), P<0.00001]. According to the PEDro scale, 21 (72.4%) studies were of high quality and 8 were of moderate quality (27.6%). Taken together, the review synthesis indicated that NMES might play a potential role in stroke-induced walking dysfunction. And NMES may be superior for survivors in the chronic phase than the acute and subacute phases, and the efficacy of short sessions received by patients was greater than that of those who participated in a longer session. Additionally, further comparisons of the effects of NMES with different types or stimulation frequencies may provide unexpected benefits.
步态不正确、平衡能力受损和足下垂一直困扰着中风患者，使他们无法独立、安全地行走。神经肌肉电刺激（NMES）技术可以帮助患者重新激活肌肉，恢复运动协调能力。本研究旨在系统回顾和总结 NMES 对改善中风后步态的潜在益处的证据。在 2024 年 4 月之前，对 PubMed、Cochrane Library、Embase、Science Direct 和 Web of Science 进行了系统检索，以确定符合以下标准的随机对照试验：以中风幸存者为参与者；以 NMES 为干预措施；以常规康复为比较对象；以通过量表或定量参数进行的步态评估为结果测量指标。符合纳入标准的出版物有 29 篇，涉及 1711 名患者。Meta 分析表明，NMES 组与对照组在十米步行测试、下肢 Fugl-Meyer 评估、改良 Ashworth 评估和不对称方面无明显差异。此外，NMES 与定量步态分析速度[SMD = 0.53，95% CI (0.20，0.85)，P = 0.001]、步幅[SMD = 0.76，95% CI (0.32，1.20)，P = 0.001]、受影响侧步长[SMD = 0.001，95% CI (0.32，1.20)，P = 0.001]等结果指标的变化相关。0008]、患侧步长[SMD=0.73，95% CI（0.16，1.31），P=0.01]、踝关节背屈角度[WMD=1.57，95% CI（0.80，2.33），P<0.0001]、六分钟步行测试[WMD=14.83，95% CI（13.55，16.11），P<0.00001]。根据 PEDro 量表，21 项研究（72.4%）为高质量，8 项为中等质量（27.6%）。综上所述，综述表明，NMES 可能在中风引起的行走功能障碍中发挥潜在作用。而且，NMES 对慢性期幸存者的疗效可能优于急性期和亚急性期，患者接受短期疗程的疗效优于参加长期疗程的疗效。此外，进一步比较不同类型或刺激频率的 NMES 效果可能会带来意想不到的益处。
{"title":"Implications of neuromuscular electrical stimulation on gait ability, balance and kinematic parameters after stroke: a systematic review and meta-analysis","authors":"Shishi Chen, Jingjing Gao, Ye Zhou, Beisi Zheng, Yuxiang Liu, Manting Cao, Haiping Huang, Xinyi Su, Jianer Chen","doi":"10.1186/s12984-024-01462-2","DOIUrl":"https://doi.org/10.1186/s12984-024-01462-2","url":null,"abstract":"Improper gait patterns, impaired balance and foot drop consistently plague stroke survivors, preventing them from walking independently and safely. Neuromuscular electrical stimulation (NMES) technology can help patients reactivate their muscles and regain motor coordination. This study aims to systematically review and summarize the evidence for the potential benefits of NMES on the improvement of gait patterns after stroke. PubMed, Cochrane Library, Embase, Science Direct and Web of Science were systematically searched until April 2024, to identify randomized controlled trials with the following criteria: stroke survivors as participants; NMES as intervention; conventional rehabilitation as a comparator; and gait assessment, through scales or quantitative parameters, as outcome measures. 29 publications involving 1711 patients met the inclusion criteria. Meta-analysis showed no significant differences in Ten-meter walk test, Fugl-Meyer assessment lower extremity, Modified Ashworth Assessment and asymmetry between the NMES group and the control group. Besides, NMES was associated with changes in outcome indicators such as quantitative gait analysis speed [SMD = 0.53, 95% CI (0.20, 0.85), P = 0.001], cadence [SMD = 0.76, 95% CI (0.32, 1.20), P = 0.0008], affected side step length [SMD = 0.73, 95% CI (0.16, 1.31), P = 0.01], angle of ankle dorsiflexion [WMD = 1.57, 95% CI (0.80, 2.33), P < 0.0001], Six-Minute Walk Test [WMD = 14.83, 95% CI (13.55, 16.11), P<0.00001]. According to the PEDro scale, 21 (72.4%) studies were of high quality and 8 were of moderate quality (27.6%). Taken together, the review synthesis indicated that NMES might play a potential role in stroke-induced walking dysfunction. And NMES may be superior for survivors in the chronic phase than the acute and subacute phases, and the efficacy of short sessions received by patients was greater than that of those who participated in a longer session. Additionally, further comparisons of the effects of NMES with different types or stimulation frequencies may provide unexpected benefits.","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-16DOI: 10.1186/s12984-024-01460-4
Matjaž Zadravec, Zlatko Matjačić
Gait event detection is crucial for assessment, evaluation and provision of biofeedback during rehabilitation of walking. Existing online gait event detection algorithms mostly rely on add-on sensors, limiting their practicality. Instrumented treadmills offer a promising alternative by utilizing the Center of Pressure (CoP) signal for real-time gait event detection. However, current methods have limitations, particularly in detecting cross-step events during perturbed walking conditions. We present and validate a CoP-based algorithm to detect gait events and cross-steps in real-time, which combines thresholding and logic techniques. The algorithm was evaluated on CoP datasets from healthy participants (age range 21–61 years), stroke survivors (age range 20–67 years), and people with unilateral transtibial amputation (age range 28–63 years) that underwent perturbation-based balance assessments, encompassing different walking speeds. Detected gait events from a simulated real-time processing operation were compared to offline identified counterparts in order to present related temporal absolute mean errors (AME) and success rate. The proposed algorithm demonstrated high accuracy in detecting gait events during native gait, as well as cross-step events during perturbed walking conditions. It successfully recognized the majority of cross-steps, with a detection success rate of 94%. However, some misclassifications or missed events occurred, mainly due to the complexity of cross-step events. AME for heel strikes (HS) during native gait and cross-step events averaged at 78 ms and 64 ms respectively, while toe off (TO) AME were 126 ms and 111 ms respectively. A statistically significant difference in the algorithm's success rate score in detecting gait events during cross-step intervals was observed across various walking speeds in a sample of 12 healthy participants, while there was no significant difference among groups. The proposed algorithm represents an advancement in gait event detection on instrumented treadmills. By leveraging the CoP signal, it successfully identifies gait events and cross-steps in the simulated real-time processing operation, providing valuable insights into human locomotion. The algorithm's ability to accommodate diverse CoP patterns enhance its applicability to a wide range of individuals and gait characteristics. The algorithm's performance was consistent across different populations, suggesting its potential for diverse clinical and research settings, particularly in the domains of gait analysis and rehabilitation practices.
{"title":"Cross-step detection using center-of-pressure based algorithm for real-time applications","authors":"Matjaž Zadravec, Zlatko Matjačić","doi":"10.1186/s12984-024-01460-4","DOIUrl":"https://doi.org/10.1186/s12984-024-01460-4","url":null,"abstract":"Gait event detection is crucial for assessment, evaluation and provision of biofeedback during rehabilitation of walking. Existing online gait event detection algorithms mostly rely on add-on sensors, limiting their practicality. Instrumented treadmills offer a promising alternative by utilizing the Center of Pressure (CoP) signal for real-time gait event detection. However, current methods have limitations, particularly in detecting cross-step events during perturbed walking conditions. We present and validate a CoP-based algorithm to detect gait events and cross-steps in real-time, which combines thresholding and logic techniques. The algorithm was evaluated on CoP datasets from healthy participants (age range 21–61 years), stroke survivors (age range 20–67 years), and people with unilateral transtibial amputation (age range 28–63 years) that underwent perturbation-based balance assessments, encompassing different walking speeds. Detected gait events from a simulated real-time processing operation were compared to offline identified counterparts in order to present related temporal absolute mean errors (AME) and success rate. The proposed algorithm demonstrated high accuracy in detecting gait events during native gait, as well as cross-step events during perturbed walking conditions. It successfully recognized the majority of cross-steps, with a detection success rate of 94%. However, some misclassifications or missed events occurred, mainly due to the complexity of cross-step events. AME for heel strikes (HS) during native gait and cross-step events averaged at 78 ms and 64 ms respectively, while toe off (TO) AME were 126 ms and 111 ms respectively. A statistically significant difference in the algorithm's success rate score in detecting gait events during cross-step intervals was observed across various walking speeds in a sample of 12 healthy participants, while there was no significant difference among groups. The proposed algorithm represents an advancement in gait event detection on instrumented treadmills. By leveraging the CoP signal, it successfully identifies gait events and cross-steps in the simulated real-time processing operation, providing valuable insights into human locomotion. The algorithm's ability to accommodate diverse CoP patterns enhance its applicability to a wide range of individuals and gait characteristics. The algorithm's performance was consistent across different populations, suggesting its potential for diverse clinical and research settings, particularly in the domains of gait analysis and rehabilitation practices.","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-14DOI: 10.1186/s12984-024-01465-z
Quting Huang, Michael K. Yeung, Kenneth N. K. Fong, Chi-Wen Chien
Children with developmental coordination disorder (DCD) have impaired online motor control. Researchers posit that this impairment could be due to a deficit in utilizing the internal model control process. However, there is little neurological evidence to support this view because few neuroimaging studies have focused specifically on tasks involving online motor control. Therefore, the aim of this study was to investigate the differences in cortical hemodynamic activity during an online movement adjustment task between children with and without DCD. Twenty children with DCD (mean age: 9.88 ± 1.67 years; gender: 14M/6F) and twenty age-and-gender matched children with typical development (TD) (mean age: 9.87 ± 1.59 years; gender: 14M/6F) were recruited via convenience sampling. Participants performed a double-step reaching task under two conditions (with and without online adjustment of reaching). Cortical hemodynamic activity during task in ten regions of interest, including bilateral primary somatosensory cortex, primary motor cortex, premotor cortex, superior parietal cortex, and inferior parietal cortex was recorded using functional near-infrared spectroscopy. In the analyses, change in oxyhemoglobin (ΔHbO) concentration was used to characterize hemodynamic response. Two-way analyses of variance were conducted for each region of interest to compare hemodynamic responses between groups and conditions. Additionally, Pearson’s r correlations between hemodynamic response and task performance were performed. Outcome showed that children with DCD required significantly more time to correct their reaching movements compared to the control group (t = 3.948, P < 0.001). Furthermore, children with DCD have a significantly lower ΔHbO change in the left superior parietal cortex during movement correction, compared to children with TD (F = 4.482, P = 0.041). Additionally, a significant negative correlation (r = − 0.598, P < 0.001) was observed between the difference in movement time of reaching and the difference in ΔHbO between conditions in the left superior parietal cortex. The findings of this study suggest that deficiencies in processing real-time sensory feedback, considering the function of the superior parietal cortex, might be related to the impaired online motor control observed in children with DCD. Interventions could target this issue to enhance their performance in online motor control.
{"title":"Cortical activity during online motor control in children with and without developmental coordination disorder: a cross-sectional functional near-infrared spectroscopy study","authors":"Quting Huang, Michael K. Yeung, Kenneth N. K. Fong, Chi-Wen Chien","doi":"10.1186/s12984-024-01465-z","DOIUrl":"https://doi.org/10.1186/s12984-024-01465-z","url":null,"abstract":"Children with developmental coordination disorder (DCD) have impaired online motor control. Researchers posit that this impairment could be due to a deficit in utilizing the internal model control process. However, there is little neurological evidence to support this view because few neuroimaging studies have focused specifically on tasks involving online motor control. Therefore, the aim of this study was to investigate the differences in cortical hemodynamic activity during an online movement adjustment task between children with and without DCD. Twenty children with DCD (mean age: 9.88 ± 1.67 years; gender: 14M/6F) and twenty age-and-gender matched children with typical development (TD) (mean age: 9.87 ± 1.59 years; gender: 14M/6F) were recruited via convenience sampling. Participants performed a double-step reaching task under two conditions (with and without online adjustment of reaching). Cortical hemodynamic activity during task in ten regions of interest, including bilateral primary somatosensory cortex, primary motor cortex, premotor cortex, superior parietal cortex, and inferior parietal cortex was recorded using functional near-infrared spectroscopy. In the analyses, change in oxyhemoglobin (ΔHbO) concentration was used to characterize hemodynamic response. Two-way analyses of variance were conducted for each region of interest to compare hemodynamic responses between groups and conditions. Additionally, Pearson’s r correlations between hemodynamic response and task performance were performed. Outcome showed that children with DCD required significantly more time to correct their reaching movements compared to the control group (t = 3.948, P < 0.001). Furthermore, children with DCD have a significantly lower ΔHbO change in the left superior parietal cortex during movement correction, compared to children with TD (F = 4.482, P = 0.041). Additionally, a significant negative correlation (r = − 0.598, P < 0.001) was observed between the difference in movement time of reaching and the difference in ΔHbO between conditions in the left superior parietal cortex. The findings of this study suggest that deficiencies in processing real-time sensory feedback, considering the function of the superior parietal cortex, might be related to the impaired online motor control observed in children with DCD. Interventions could target this issue to enhance their performance in online motor control.","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-13DOI: 10.1186/s12984-024-01449-z
Bonanno M, Maggio MG, Quartarone A, De Nunzio AM, Calabrò RS
Neurological disorders, such as Parkinson’s disease (PD), multiple sclerosis (MS), cerebral palsy (CP) and stroke are well-known causes of gait and balance alterations. Innovative devices (i.e., robotics) are often used to promote motor recovery. As an alternative, anti-gravity treadmills, which were developed by NASA, allow early mobilization, walking with less effort to reduce gait energy costs and fatigue. A systematic search, according to PRISMA guidelines, was conducted for all peer-reviewed articles published from January 2010 through September 2023, using the following databases: PubMed, Scopus, PEDro and IEEE Xplore. After an accurate screening, we selected only 16 articles (e.g., 5 RCTs, 2 clinical trials, 7 pilot studies, 1 prospective study and 1 exploratory study). The evidence collected in this systematic review reported promising results in the field of anti-gravity technology for neurological patients, in terms of improvement in gait and balance outcomes. However, we are not able to provide any clinical recommendation about the dose and parameters of anti-gravity treadmill training, because of the lack of robust high-quality RCT studies and large samples. Registration number CRD42023459665.
{"title":"Simulating space walking: a systematic review on anti-gravity technology in neurorehabilitation","authors":"Bonanno M, Maggio MG, Quartarone A, De Nunzio AM, Calabrò RS","doi":"10.1186/s12984-024-01449-z","DOIUrl":"https://doi.org/10.1186/s12984-024-01449-z","url":null,"abstract":"Neurological disorders, such as Parkinson’s disease (PD), multiple sclerosis (MS), cerebral palsy (CP) and stroke are well-known causes of gait and balance alterations. Innovative devices (i.e., robotics) are often used to promote motor recovery. As an alternative, anti-gravity treadmills, which were developed by NASA, allow early mobilization, walking with less effort to reduce gait energy costs and fatigue. A systematic search, according to PRISMA guidelines, was conducted for all peer-reviewed articles published from January 2010 through September 2023, using the following databases: PubMed, Scopus, PEDro and IEEE Xplore. After an accurate screening, we selected only 16 articles (e.g., 5 RCTs, 2 clinical trials, 7 pilot studies, 1 prospective study and 1 exploratory study). The evidence collected in this systematic review reported promising results in the field of anti-gravity technology for neurological patients, in terms of improvement in gait and balance outcomes. However, we are not able to provide any clinical recommendation about the dose and parameters of anti-gravity treadmill training, because of the lack of robust high-quality RCT studies and large samples. Registration number CRD42023459665.","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12DOI: 10.1186/s12984-024-01464-0
Michelle McNally, Gabriel Byczynski, Sven Vanneste
Many studies over the recent decades have attempted the modulation of motor learning using brain stimulation. Alternating currents allow for researchers not only to electrically stimulate the brain, but to further investigate the effects of specific frequencies, in and beyond the context of their endogenous associations. Transcranial alternating current stimulation (tACS) has therefore been used during motor learning to modulate aspects of acquisition, consolidation and performance of a learned motor skill. Despite numerous reviews on the effects of tACS, and its role in motor learning, there are few studies which synthesize the numerous frequencies and their respective theoretical mechanisms as they relate to motor and perceptual processes. Here we provide a short overview of the main stimulation frequencies used in motor learning modulation (e.g., alpha, beta, and gamma), and discuss the effect and proposed mechanisms of these studies. We summarize with the current state of the field, the effectiveness and variability in motor learning modulation, and novel mechanistic proposals from other fields.
{"title":"An overview of the effects and mechanisms of transcranial stimulation frequency on motor learning","authors":"Michelle McNally, Gabriel Byczynski, Sven Vanneste","doi":"10.1186/s12984-024-01464-0","DOIUrl":"https://doi.org/10.1186/s12984-024-01464-0","url":null,"abstract":"Many studies over the recent decades have attempted the modulation of motor learning using brain stimulation. Alternating currents allow for researchers not only to electrically stimulate the brain, but to further investigate the effects of specific frequencies, in and beyond the context of their endogenous associations. Transcranial alternating current stimulation (tACS) has therefore been used during motor learning to modulate aspects of acquisition, consolidation and performance of a learned motor skill. Despite numerous reviews on the effects of tACS, and its role in motor learning, there are few studies which synthesize the numerous frequencies and their respective theoretical mechanisms as they relate to motor and perceptual processes. Here we provide a short overview of the main stimulation frequencies used in motor learning modulation (e.g., alpha, beta, and gamma), and discuss the effect and proposed mechanisms of these studies. We summarize with the current state of the field, the effectiveness and variability in motor learning modulation, and novel mechanistic proposals from other fields.","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The use of visual and proprioceptive feedback is a key property of motor rehabilitation techniques. This feedback can be used alone, for example, for vision in mirror or video therapy, for proprioception in focal tendon vibration therapy, or in combination, for example, in robot-assisted training. This Electroencephalographic (EEG) study in healthy subjects explored the distinct neurophysiological impact of adding visual (video therapy), proprioceptive (focal tendinous vibration), or combined feedback (video therapy and focal tendinous vibration) to a motor imagery task. Sixteen healthy volunteers performed 20 mental imagery (MI) tasks involving right wrist extension and flexion under four conditions: MI alone (IA), MI + video feedback observation (IO), MI + vibratory feedback (IV), and MI + observation + vibratory feedback (IOV). Brain activity was monitored with EEG, and time-frequency neurophysiological markers of movement were computed. The emotions of the patients were also measured during the task. In the alpha band, we observed bilateral ERD in the visual feedback conditions (IO, IOV). In the beta band, the ERD was bilateral in the IA, IV and IOV but more lateralized in the IV and IOV. After movement, we observed strong ERS in the IO and IOV but not in the IA or IV. Embodiment was stronger in conditions with vibratory feedback (IOV > IV > IA and IO) Conditions with visual feedback (IO, IOV) recruit the mirror neurons system (alpha ERD) and provide more accurate feedback of the task than IA and IV, which triggers motor validation pathways (beta rebound analysis). Vibratory feedback enhances the recruitment of the left sensorimotor areas, with a synergistic effect in the IOV (beta ERD analysis), thus maximizing embodiment. Visual and vibratory feedback recruits the sensorimotor cortex during motor imagery in different ways and can be combined to maximize the benefits of both techniques https://clinicaltrials.gov/study/NCT04449328 .
使用视觉和本体感觉反馈是运动康复技术的一个关键特性。这种反馈可以单独使用，例如在镜子或视频疗法中用于视觉，在焦点肌腱振动疗法中用于本体感觉，也可以结合使用，例如在机器人辅助训练中。这项针对健康受试者的脑电图（EEG）研究探讨了在运动想象任务中添加视觉（视频疗法）、本体感觉（焦点肌腱振动）或组合反馈（视频疗法和焦点肌腱振动）对神经生理的不同影响。16 名健康志愿者在四种条件下完成了 20 项涉及右腕伸屈的心理意象（MI）任务：在四种条件下分别进行了 20 次涉及右腕伸屈的心理想象（MI）任务：单独（IA）、MI + 视频反馈观察（IO）、MI + 振动反馈（IV）和 MI + 观察 + 振动反馈（IOV）。通过脑电图监测大脑活动，并计算运动的时频神经生理学标记。在完成任务期间，我们还测量了患者的情绪。在α波段，我们观察到在视觉反馈条件（IO、IOV）下的双侧ERD。在β波段，ERD在IA、IV和IOV中为双侧，但在IV和IOV中更偏向一侧。运动后，我们在 IO 和 IOV 观察到强烈的 ERS，但在 IA 或 IV 没有观察到。在有振动反馈的条件下（IOV > IV > IA 和 IO），体现性更强。有视觉反馈的条件（IO、IOV）会招募镜像神经元系统（α ERD），并提供比 IA 和 IV 更准确的任务反馈，从而触发运动验证通路（β 反弹分析）。振动反馈增强了左侧感觉运动区的招募，并在 IOV 中产生了协同效应（β ERD 分析），从而最大限度地体现了这一点。在运动想象过程中，视觉和振动反馈会以不同的方式招募感觉运动皮层，可以结合使用，以最大限度地发挥两种技术的优势 https://clinicaltrials.gov/study/NCT04449328 。
{"title":"Distinct and additive effects of visual and vibratory feedback for motor rehabilitation: an EEG study in healthy subjects","authors":"Adham Ahmed, Bessaguet Hugo, Struber Lucas, Rimaud Diana, Ojardias Etienne, Giraux Pascal","doi":"10.1186/s12984-024-01453-3","DOIUrl":"https://doi.org/10.1186/s12984-024-01453-3","url":null,"abstract":"The use of visual and proprioceptive feedback is a key property of motor rehabilitation techniques. This feedback can be used alone, for example, for vision in mirror or video therapy, for proprioception in focal tendon vibration therapy, or in combination, for example, in robot-assisted training. This Electroencephalographic (EEG) study in healthy subjects explored the distinct neurophysiological impact of adding visual (video therapy), proprioceptive (focal tendinous vibration), or combined feedback (video therapy and focal tendinous vibration) to a motor imagery task. Sixteen healthy volunteers performed 20 mental imagery (MI) tasks involving right wrist extension and flexion under four conditions: MI alone (IA), MI + video feedback observation (IO), MI + vibratory feedback (IV), and MI + observation + vibratory feedback (IOV). Brain activity was monitored with EEG, and time-frequency neurophysiological markers of movement were computed. The emotions of the patients were also measured during the task. In the alpha band, we observed bilateral ERD in the visual feedback conditions (IO, IOV). In the beta band, the ERD was bilateral in the IA, IV and IOV but more lateralized in the IV and IOV. After movement, we observed strong ERS in the IO and IOV but not in the IA or IV. Embodiment was stronger in conditions with vibratory feedback (IOV > IV > IA and IO) Conditions with visual feedback (IO, IOV) recruit the mirror neurons system (alpha ERD) and provide more accurate feedback of the task than IA and IV, which triggers motor validation pathways (beta rebound analysis). Vibratory feedback enhances the recruitment of the left sensorimotor areas, with a synergistic effect in the IOV (beta ERD analysis), thus maximizing embodiment. Visual and vibratory feedback recruits the sensorimotor cortex during motor imagery in different ways and can be combined to maximize the benefits of both techniques https://clinicaltrials.gov/study/NCT04449328 .","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12DOI: 10.1186/s12984-024-01431-9
Isabelle Roy, Julia Salles, Erika Neveu, Danaë Lariviére-Bastien, Aurélie Blondin, Danielle Levac, Miriam H. Beauchamp
Digital health technologies are increasingly used by healthcare professionals working in pediatric hospital and rehabilitation settings. Multiple factors may affect the implementation and use of digital health technologies in these settings. However, such factors have not been identified in a multidisciplinary, pediatric context. The objective of this study was to describe actual use and to identify the factors that promote or hinder the intention to use digital health technologies (mobile learning applications, virtual/augmented reality, serious games, robotic devices, telehealth applications, computerized assessment tools, and wearables) among pediatric healthcare professionals. An online survey evaluating opinions, current use, and future intentions to use digital health technologies was completed by 108 professionals at one of Canada’s largest pediatric institutes. Mann-Whitney U tests were used to compare the attitudes of healthcare professionals who intend to increase their use of digital health technologies and those who do not. Linear regression analyses were used to determine predictors of usage success. Healthcare professionals reported mostly using mobile and tablet learning applications (n = 43, 38.1%), telehealth applications (n = 49, 43.4%), and computerized assessment tools (n = 33, 29.2%). Attitudes promoting the intention to increase the use of digital health technologies varied according to technology type. Healthcare professionals who wished to increase their use of digital health technologies reported a more positive attitude regarding benefits in clinical practice and patient care, but were also more critical of potential negative impacts on patient-professional relationships. Ease of use (β = 0.374; p = 0.020) was a significant predictor of more favorable usage success. The range of obstacles encountered was also a significant predictor (β = 0.342; p = 0.032) of less favorable evaluation of usage success. Specific factors that hinder successful usage are lack of training (β = 0.303; p = 0.033) and inadequate infrastructure (β = 0.342; p = 0.032). When working with children, incorporating digital health technologies can be effective for motivation and adherence. However, it is crucial to ensure these tools are implemented properly. The findings of this study underscore the importance of addressing training and infrastructure needs when elaborating technology-specific strategies for multidisciplinary adoption of digital health technologies in pediatric settings.
在儿科医院和康复机构工作的医护人员越来越多地使用数字医疗技术。多种因素可能会影响数字医疗技术在这些环境中的实施和使用。然而，这些因素尚未在多学科的儿科环境中得到确认。本研究旨在描述儿科医疗保健专业人员使用数字医疗技术（移动学习应用、虚拟/增强现实、严肃游戏、机器人设备、远程医疗应用、计算机化评估工具和可穿戴设备）的实际情况，并确定促进或阻碍其使用意愿的因素。加拿大最大的儿科机构之一的 108 名专业人员完成了一项在线调查，对数字医疗技术的意见、当前使用情况和未来使用意向进行了评估。曼-惠特尼 U 检验用于比较打算增加使用数字医疗技术的医疗保健专业人员与不打算增加使用数字医疗技术的医疗保健专业人员的态度。线性回归分析用于确定成功使用的预测因素。医护人员报告称，他们大多使用手机和平板电脑学习应用程序（43 人，占 38.1%）、远程医疗应用程序（49 人，占 43.4%）和计算机化评估工具（33 人，占 29.2%）。不同技术类型的医护人员对增加使用数字医疗技术的意愿态度各不相同。希望更多地使用数字医疗技术的医护人员对其在临床实践和患者护理方面的益处持更积极的态度，但同时也对患者与专业人员之间的关系可能产生的负面影响持更严厉的批评态度。易用性（β = 0.374; p = 0.020）是成功使用数字医疗技术的重要预测因素。遇到的障碍范围也是对使用成功率评价较低的一个重要预测因素（β = 0.342; p = 0.032）。阻碍成功使用的具体因素包括缺乏培训（β = 0.303; p = 0.033）和基础设施不足（β = 0.342; p = 0.032）。在为儿童提供服务时，采用数字医疗技术可以有效激发儿童的积极性和坚持性。然而，确保这些工具的正确实施至关重要。本研究的结果强调了在儿科环境中制定多学科采用数字医疗技术的特定技术策略时，满足培训和基础设施需求的重要性。
{"title":"Exploring the perspectives of health care professionals on digital health technologies in pediatric care and rehabilitation","authors":"Isabelle Roy, Julia Salles, Erika Neveu, Danaë Lariviére-Bastien, Aurélie Blondin, Danielle Levac, Miriam H. Beauchamp","doi":"10.1186/s12984-024-01431-9","DOIUrl":"https://doi.org/10.1186/s12984-024-01431-9","url":null,"abstract":"Digital health technologies are increasingly used by healthcare professionals working in pediatric hospital and rehabilitation settings. Multiple factors may affect the implementation and use of digital health technologies in these settings. However, such factors have not been identified in a multidisciplinary, pediatric context. The objective of this study was to describe actual use and to identify the factors that promote or hinder the intention to use digital health technologies (mobile learning applications, virtual/augmented reality, serious games, robotic devices, telehealth applications, computerized assessment tools, and wearables) among pediatric healthcare professionals. An online survey evaluating opinions, current use, and future intentions to use digital health technologies was completed by 108 professionals at one of Canada’s largest pediatric institutes. Mann-Whitney U tests were used to compare the attitudes of healthcare professionals who intend to increase their use of digital health technologies and those who do not. Linear regression analyses were used to determine predictors of usage success. Healthcare professionals reported mostly using mobile and tablet learning applications (n = 43, 38.1%), telehealth applications (n = 49, 43.4%), and computerized assessment tools (n = 33, 29.2%). Attitudes promoting the intention to increase the use of digital health technologies varied according to technology type. Healthcare professionals who wished to increase their use of digital health technologies reported a more positive attitude regarding benefits in clinical practice and patient care, but were also more critical of potential negative impacts on patient-professional relationships. Ease of use (β = 0.374; p = 0.020) was a significant predictor of more favorable usage success. The range of obstacles encountered was also a significant predictor (β = 0.342; p = 0.032) of less favorable evaluation of usage success. Specific factors that hinder successful usage are lack of training (β = 0.303; p = 0.033) and inadequate infrastructure (β = 0.342; p = 0.032). When working with children, incorporating digital health technologies can be effective for motivation and adherence. However, it is crucial to ensure these tools are implemented properly. The findings of this study underscore the importance of addressing training and infrastructure needs when elaborating technology-specific strategies for multidisciplinary adoption of digital health technologies in pediatric settings.","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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