Active prosthesis dependent functional cortical reorganization following stroke

Merkel, Christian; Hausmann, Janet; Hopf, Jens‐Max; Heinze, Hans‐Jochen; Buentjen, Lars; Schoenfeld, Mircea Ariel

doi:10.1038/s41598-017-09325-8

Cited by 6 publications

(5 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For these reasons, HAL (which provides lateral and cyclic forces based on conventional findings regarding physical therapy) generates somatosensory and motor cues and has the potential to enhance iBF because HAL amplifies the lateral sway of patients, allowing them to achieve near-normal voluntary movement. Previously developed devices that affect small muscle groups are capable of promoting plasticity and CNS map modification 24 ; however, proposed interventions related to gait and postural control during whole-body movement can be effectively promoted by recommended somatosensory and motor cues 14 , 25 – 27 . Although wearable cyborgs and robots have been applied in trials to improve the gait of patients with Parkinson’s disease 28 , 29 , it is challenging for these methods to directly assist postural control and rhythm generation in the frontal plane, as recommended by physical therapists.…”

Section: Introductionmentioning

confidence: 99%

Gait improvement with wearable cyborg HAL trunk unit for parkinsonian patients: five case reports

Uehara¹,

Kawamoto²,

Imai³

et al. 2023

Sci Rep

View full text Add to dashboard Cite

Cybernic treatment involves the generation of an interactive bio-feedback loop between an individual’s nervous system and the worn cyborg Hybrid Assistive Limb (HAL); this treatment has been applied for several intractable neuromuscular disorders. Thus, it is of interest to determine its potential for parkinsonian patients. This study confirmed the feasibility of using a HAL trunk unit to improve parkinsonian gait disturbance. HAL establishes functional and physical synchronization with the wearer by providing lateral cyclic forces to the chest in the form of somatosensory and motor cues. To confirm the feasibility of its use for improving parkinsonian gait disturbances, we conducted experiments with three Parkinson’s disease patients and two patients with progressive supranuclear palsy. During the experiments, the immediate effect of the intervention was assessed; all participants exhibited improvements in gait disturbance while wearing the HAL unit, and this improvement effect persisted without the HAL unit in two participants. Afterward, based on the assessment, we conducted a continuous intervention for one participant. In this intervention, the number of steps in the final experiment was significantly decreased compared with the initial state. These findings suggest that the proposed method is an option for treating parkinsonian patients to generate somatosensory and motor cues.

show abstract

Section: Introductionmentioning

confidence: 99%

Gait improvement with wearable cyborg HAL trunk unit for parkinsonian patients: five case reports

Uehara¹,

Kawamoto²,

Imai³

et al. 2023

Sci Rep

View full text Add to dashboard Cite

show abstract

“…It was argued that patients who maintain gait improvments for a longer time after the device is turned off may not need further therapy. In the current cohort, which was partially included in the series described by Merkel et al [18], there was no interaction between stimulation and time. In this larger cohort, even after long-term FES, cortical relearning and muscular training effects alone were not sufficient to increase gait velocity significantly in the absence of continued stimulation on a group level.…”

Section: Discussionmentioning

confidence: 97%

“…Recent evidence suggests that the prolonged use of implantable peroneal FES could enhance cortical plasticity in some patients, reflected by shifts of activated fields in the sensory cortex, as measured using MEG [18], and by normalisation of activity in the pre-motor area detected using FDG-PET [29]. Both phenomena could be interpreted as cortical relearning.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Long-term outcomes of semi-implantable functional electrical stimulation for central drop foot

Buentjen

Kupsch

Galazky

et al. 2019

J NeuroEngineering Rehabil

Self Cite

View full text Add to dashboard Cite

Background Central drop foot is a common problem in patients with stroke or multiple sclerosis (MS). For decades, it has been treated with orthotic devices, keeping the ankle in a fixed position. It has been shown recently that semi-implantable functional electrical stimulation (siFES) of the peroneal nerve can lead to a greater gait velocity increase than orthotic devices immediately after being switched on. Little is known, however, about long-term outcomes over 12 months, and the relationship between quality of life (QoL) and gait speed using siFES has never been reported applying a validated tool. We provide here a report of short (3 months) and long-term (12 months) outcomes for gait speed and QoL. Methods Forty-five consecutive patients (91% chronic stroke, 9% MS) with central drop foot received siFES (Actigait®). A 10 m walking test was carried out on day 1 of stimulation (T1), in stimulation ON and OFF conditions, and repeated after 3 (T2) and 12 (T3) months. A 36-item Short Form questionnaire was applied at all three time points. Results We found a main effect of stimulation on both maximum ( p < 0.001) and comfortable gait velocity (p < 0.001) and a main effect of time ( p = 0.015) only on maximum gait velocity. There were no significant interactions. Mean maximum gait velocity across the three assessment time points was 0.13 m/s greater with stimulation ON than OFF, and mean comfortable gait velocity was 0.083 m/s faster with stimulation ON than OFF. The increase in maximum gait velocity over time was 0.096 m/s, with post hoc testing revealing a significant increase from T1 to T2 ( p = 0.012 ) , which was maintained but not significantly further increased at T3. QoL scores showed a main effect of time ( p < 0.001), with post hoc testing revealing an increase from T1 to T2 (p < 0.001), which was maintained at T3 (p < 0.001). Finally, overall absolute QoL scores correlated with the absolute maximum and comfortable gait speeds at T2 and T3, and the increase in overall QoL scores correlated with the increase in comfortable gait velocity from T1 to T3. Pain was reduced at T2 (p < 0.001) and was independent of gait speed but correlated with overall QoL (p < 0.001). Conclusions Peroneal siFES increased maximal and comfortable gait velocity and QoL, with the greatest increase in both over the first three months, which was maintained at one year, suggesting that 3 months is an adequate follow-up time. Pain after 3 months correlated with QoL and was independent of gait velocity, suggesting pain as an independent outcome measure in siFES for drop foot.

show abstract

“…Approximately 20% of stroke survivors show foot drop. This affects walking and other daily activities [1].…”

Section: Introductionmentioning

confidence: 99%

Effect of an EMG–FES Interface on Ankle Joint Training Combined with Real-Time Feedback on Balance and Gait in Patients with Stroke Hemiparesis

2020

View full text Add to dashboard Cite

This study evaluated the effects of an electromyography–functional electrical stimulation interface (EMG–FES interface) combined with real-time balance and gait feedback on ankle joint training in patients with stroke hemiplegia. Twenty-six stroke patients participated in this study. All subjects were randomly assigned to either the EMG–FES interface combined with real-time feedback on ankle joint training (RFEF) group (n = 13) or the EMG–FES interface on ankle joint training (EF) group (n = 13). Subjects in both groups were trained for 20 min a day, 5 times a week, for 4 weeks. Similarly, all participants underwent a standard rehabilitation physical therapy for 60 min a day, 5 times a week, for 4 weeks. The RFEF group showed significant increases in weight-bearing lunge test (WBLT), Tardieu Scale (TS), Timed Up and Go Test (TUG), Berg Balance Scale (BBS), velocity, cadence, step length, stride length, stance per, and swing per (p < 0.05). Likewise, the EF group showed significant increases in WBLT, TUG, BBS, velocity, and cadence (p < 0.05). Moreover, the RFEF group showed significantly greater improvements than the EF group in terms of WBLT, Tardieu Scale, TUG, BBS, velocity, step length, stride length, stance per, and swing per (p < 0.05). Ankle joint training using an EMG–FES interface combined with real-time feedback improved ankle range of motion (ROM), muscle tone, balance, and gait in stroke patients. These results suggest that an EMG–FES interface combined with real-time feedback is feasible and suitable for ankle joint training in individuals with stroke.

show abstract

Active prosthesis dependent functional cortical reorganization following stroke

Cited by 6 publications

References 49 publications

Gait improvement with wearable cyborg HAL trunk unit for parkinsonian patients: five case reports

Gait improvement with wearable cyborg HAL trunk unit for parkinsonian patients: five case reports

Long-term outcomes of semi-implantable functional electrical stimulation for central drop foot

Effect of an EMG–FES Interface on Ankle Joint Training Combined with Real-Time Feedback on Balance and Gait in Patients with Stroke Hemiparesis

Contact Info

Product

Resources

About