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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
Efficacy of robot-assisted gait training on lower extremity function in subacute stroke patients: a systematic review and meta-analysis 机器人辅助步态训练对亚急性中风患者下肢功能的疗效:系统综述与荟萃分析
IF 5.1 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-09-19 DOI: 10.1186/s12984-024-01463-1
Miao-miao Hu, Shan Wang, Cai-qin Wu, Kun-peng Li, Zhao-hui Geng, Guo-hui Xu, Lu Dong
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.
机器人辅助步态训练(RAGT)是一种新型技术,被广泛应用于亚急性中风患者的神经康复领域。然而,与传统步态训练(CGT)相比,RAGT 在改善下肢功能方面的有效性仍是一个争论不休的话题。本研究旨在调查和比较 RAGT 和 CGT 对亚急性脑卒中患者下肢运动的影响。本研究对多个数据库进行了全面检索,包括PubMed、Web of Science、Cochrane Library、EBSCO、Embase、Scopus、中国国家知识基础设施、万方数据库、SinoMed和Vip期刊集成平台。数据库检索截止到 2024 年 7 月 9 日。使用 RevMan 5.4 软件进行元分析。共有 24 项研究纳入分析。结果表明,与 CGT 相比,RAGT 显著改善了 Fugl-Meyer 下肢评估[MD = 2.10, 95%CI (0.62, 3.59),P = 0.005]、功能性行走类别[MD = 0.44, 95%CI (0.23, 0.65),P < 0.001]、Berg 平衡量表[MD = 4.55,95%CI (3.00,6.11),P < 0.001]、定时上下楼测试[MD = -4.05,95%CI (-5.12,-2.98),P < 0.001]和 6 分钟步行测试[MD = 30.66,95%CI (22.36,38.97),P < 0.001]对亚急性脑卒中患者的影响。然而,它对 10 米步行测试的影响并不明显[MD = 0.06,95%CI (-0.01, 0.14),P = 0.08]。本研究提供的证据表明,与 CGT 相比,RAGT 可以增强下肢功能、平衡功能、行走能力和耐力水平。然而,有关步态速度改善的证据质量仍然较低。
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引用次数: 0
Instrumented timed up and go test and machine learning-based levodopa response evaluation: a pilot study 仪器计时起立行走测试和基于机器学习的左旋多巴反应评估:一项试点研究
IF 5.1 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-09-18 DOI: 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.
急性左旋多巴挑战试验(ALCT)是评估左旋多巴反应(LR)的通用方法。运动障碍协会帕金森病统一评定量表第三部分(MDS-UPDRS III)的评估是 ALCT 的关键步骤,但这在一定程度上存在主观性和不便性。本研究开发了一种基于仪器计时起立行走(iTUG)测试的机器学习方法来评估患者对左旋多巴的反应,并将其与经典的ALCT进行了比较。研究人员招募了42名帕金森病患者,并为其服用左旋多巴。MDS-UPDRS III 和 iTUG 分别在停药和用药状态下进行。从传感器数据中提取了运动参数、信号时域和频域特征。采用 "留一弃一 "交叉验证方法训练了两个 XGBoost 模型,即左旋多巴反应回归(LRR)模型和运动症状评估(MSE)模型,以预测患者的左旋多巴反应(LR)。LRR 模型预测的左旋多巴反应与经典 ALCT 计算的左旋多巴反应一致(ICC = 0.95)。当 LRR 模型用于检测 LR 为阳性的患者时,其阳性预测值为 0.94。基于可穿戴传感器数据和 iTUG 测试的机器学习可有效、全面地评估 LRR 并预测多巴胺能治疗的益处。
{"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":"194 1","pages":""},"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}
引用次数: 0
Lasting effects of transcranial direct current stimulation on the inducibility of synaptic plasticity by paired-associative stimulation in humans 经颅直流电刺激对配对联想刺激诱导人体突触可塑性的持久影响
IF 5.1 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-09-18 DOI: 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.
经颅直流电刺激(tDCS)能够引起大脑皮层神经可塑性的变化。据推测,在首次刺激的后效应期间,增加经颅直流电刺激的持续时间或重复次数可提高疗效。计算模型表明,改变极性的连续刺激模式可进一步增强效果。tDCS 对神经可塑性的持久影响对临床应用非常重要。本研究以刺激持续时间、重复频率和极性变化的顺序组合为基本特征,系统地研究了不同的 tDCS 范式对人类长期电位(LTP)样可塑性的影响。在使用不同的 tDCS 方案 6 小时后,测量了运动诱发电位(MEP)对配对联想刺激(PAS)的振幅变化。共有 36 名健康参与者完成了这项研究,他们被随机分为三组,每组有不同的刺激方案(每组 12 人)。阳极位于初级运动皮层的 TDCS 能显著增加 PAS 诱导后的 MEP 振幅。进一步的分析显示,就疗效而言,单次刺激阻滞持续时间比重复刺激方案更为重要。特别是对 LTP 类可塑性诱导的影响可能只能通过 PAS 等特定测试才能检测到,否则可能会被忽视。经过改进的 tDCS 方案应侧重于更高的电流和更长的单次刺激时间,而不是实施复杂的重复时间表。
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引用次数: 0
Implications of neuromuscular electrical stimulation on gait ability, balance and kinematic parameters after stroke: a systematic review and meta-analysis 神经肌肉电刺激对中风后步态能力、平衡和运动参数的影响:系统回顾和荟萃分析
IF 5.1 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-09-18 DOI: 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。
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引用次数: 0
Cross-step detection using center-of-pressure based algorithm for real-time applications 利用基于压力中心的算法进行跨步检测,以实现实时应用
IF 5.1 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-09-16 DOI: 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.
步态事件检测对于步行康复过程中的评估、评价和提供生物反馈至关重要。现有的在线步态事件检测算法大多依赖于附加传感器,限制了其实用性。带仪器的跑步机利用压力中心(CoP)信号进行实时步态事件检测,提供了一种有前途的替代方法。然而,目前的方法存在局限性,尤其是在检测扰动行走条件下的交叉步事件时。我们介绍并验证了一种基于 CoP 的算法,该算法结合了阈值和逻辑技术,可实时检测步态事件和交叉步。该算法在健康参与者(年龄在 21-61 岁之间)、中风幸存者(年龄在 20-67 岁之间)和单侧经胫截肢者(年龄在 28-63 岁之间)的 CoP 数据集上进行了评估,这些数据集接受了基于扰动的平衡评估,包括不同的行走速度。将模拟实时处理操作中检测到的步态事件与离线识别的步态事件进行比较,以显示相关的时间绝对平均误差(AME)和成功率。所提出的算法在检测原生步态中的步态事件以及扰动行走条件下的交叉步态事件方面表现出了很高的准确性。它成功识别了大多数交叉步,检测成功率高达 94%。不过,也出现了一些错误分类或遗漏事件,这主要是由于交叉步事件的复杂性。在原生步态和交叉步事件中,脚跟击球(HS)的AME平均值分别为78毫秒和64毫秒,而脚趾离开(TO)的AME分别为126毫秒和111毫秒。在 12 名健康参与者的样本中,在不同步行速度下,该算法检测跨步间隔步态事件的成功率得分在统计学上存在显著差异,而不同组间则无显著差异。所提出的算法代表了仪器跑步机步态事件检测的进步。通过利用 CoP 信号,该算法在模拟实时处理操作中成功识别了步态事件和交叉步,为人类运动提供了宝贵的见解。该算法能够适应不同的CoP模式,从而提高了其对各种个体和步态特征的适用性。该算法在不同人群中的表现是一致的,这表明它在不同的临床和研究环境中,特别是在步态分析和康复实践领域具有潜力。
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引用次数: 0
Cortical activity during online motor control in children with and without developmental coordination disorder: a cross-sectional functional near-infrared spectroscopy study 发育协调障碍儿童和非发育协调障碍儿童在线运动控制过程中的皮层活动:横断面功能性近红外光谱研究
IF 5.1 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-09-14 DOI: 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.
患有发育协调障碍(DCD)的儿童在线运动控制能力受损。研究人员认为,这种障碍可能是由于在利用内部模型控制过程中出现了缺陷。然而,支持这一观点的神经学证据很少,因为很少有神经影像学研究专门关注涉及在线运动控制的任务。因此,本研究旨在调查患有和未患有 DCD 的儿童在完成在线运动调整任务时大脑皮层血流动力学活动的差异。本研究通过便利取样法招募了 20 名患有 DCD 的儿童(平均年龄:9.88 ± 1.67 岁;性别:14M/6F)和 20 名年龄与性别匹配的典型发育(TD)儿童(平均年龄:9.87 ± 1.59 岁;性别:14M/6F)。参加者在两种条件下(有和没有在线伸手调整)完成了双步伸手任务。使用功能性近红外光谱仪记录了任务过程中十个相关区域的皮层血液动力学活动,包括双侧初级躯体感觉皮层、初级运动皮层、前运动皮层、上顶叶皮层和下顶叶皮层。在分析中,氧合血红蛋白(ΔHbO)浓度的变化被用来描述血液动力学反应。对每个相关区域进行了双向方差分析,以比较不同组别和条件下的血液动力学反应。此外,还进行了血液动力学反应与任务表现之间的皮尔逊 r 相关性分析。结果显示,与对照组相比,患有 DCD 的儿童需要更多的时间来纠正他们的伸手动作(t = 3.948,P < 0.001)。此外,与 TD 儿童相比,DCD 儿童在动作纠正过程中左上顶叶皮层的 ΔHbO 变化明显较低(F = 4.482,P = 0.041)。此外,在左上顶叶皮层中,伸手运动时间的差异与不同条件下的ΔHbO差异之间存在明显的负相关(r = - 0.598,P < 0.001)。本研究的结果表明,考虑到顶叶上皮层的功能,处理实时感觉反馈的缺陷可能与在 DCD 儿童中观察到的在线运动控制受损有关。可以针对这一问题进行干预,以提高他们的在线运动控制能力。
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引用次数: 0
Simulating space walking: a systematic review on anti-gravity technology in neurorehabilitation 模拟太空行走:反重力技术在神经康复中的应用系统综述
IF 5.1 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-09-13 DOI: 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.
众所周知,帕金森病(PD)、多发性硬化症(MS)、脑瘫(CP)和中风等神经系统疾病是导致步态和平衡改变的原因。创新设备(即机器人)通常用于促进运动恢复。美国国家航空航天局(NASA)开发的反重力跑步机是一种替代方案,它可以让患者尽早活动起来,以较小的力气行走,从而减少步态能量消耗和疲劳。根据PRISMA指南,我们使用以下数据库对2010年1月至2023年9月期间发表的所有同行评审文章进行了系统检索:PubMed、Scopus、PEDro 和 IEEE Xplore。经过精确筛选,我们只选出了 16 篇文章(如 5 项研究性临床试验、2 项临床试验、7 项试点研究、1 项前瞻性研究和 1 项探索性研究)。本系统综述收集的证据显示,反重力技术在改善神经系统患者的步态和平衡能力方面取得了可喜的成果。然而,由于缺乏可靠的高质量 RCT 研究和大样本,我们无法就反重力跑步机训练的剂量和参数提供任何临床建议。注册编号:CRD42023459665。
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引用次数: 0
An overview of the effects and mechanisms of transcranial stimulation frequency on motor learning 经颅刺激频率对运动学习的影响和机制综述
IF 5.1 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-09-12 DOI: 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.
近几十年来,许多研究都尝试利用脑刺激来调节运动学习。交变电流使研究人员不仅能对大脑进行电刺激,还能进一步研究特定频率在其内在关联范围内外的影响。因此,经颅交变电流刺激(tACS)已被用于运动学习,以调节所学运动技能的习得、巩固和表现。尽管有关经颅交流电刺激的效果及其在运动学习中的作用的综述很多,但很少有研究能将众多频率及其各自与运动和知觉过程相关的理论机制综合起来。在此,我们简要概述了用于运动学习调节的主要刺激频率(如α、β和γ),并讨论了这些研究的效果和拟议机制。我们总结了该领域的现状、运动学习调控的有效性和可变性,以及来自其他领域的新机制建议。
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引用次数: 0
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Journal of NeuroEngineering and Rehabilitation
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