Coupled Bimanual Training Using a Non-Powered Device for Individuals with Severe Hemiparesis: A Pilot Study

Abstract

BackgroundFew options exist for training arm movements in participants with severe post-stroke hemiparesis who have little active range of motion. The purpose of this study was to test the safety and feasibility of training with a non-powered device, the Bimanual Arm Trainer (BAT), to facilitate motor recovery in individuals with severe hemiparesis. The BAT enabled coupled bimanual training of shoulder external rotation, which is reduced in individuals with severe post-stroke hemiplegia. The rationale for bimanual training was to harness contralesional cortical activity to drive voluntary movement in the affected arm in patients who could barely perform unimanual movements.MethodsNine participants with post-stroke hemiparesis, preserved passive range of motion and Modified Ashworth score of <3 in the shoulder and elbow joints, trained with the device for 45 minutes, twice a week for six weeks, and were assessed pre- and post-training.ResultsAll participants tolerated the training and no adverse events were reported. Participants showed significant improvement in the upper extremity Fugl-Meyer score post-training with an effect size of 0.89. Changes in the flexor synergy pattern accounted for 64.7% of the improvement. Improvement in active range of motion in the paretic limb occurred for both trained and untrained movements. Some participants showed improvement in the time taken to perform selected tasks on the Wolf Motor Function Test post-training.ConclusionThe results demonstrate the safety and feasibility of using the Bimanual Arm Trainer to facilitate motor recovery in individuals with severe hemiparesis.

Self-powered robots to reduce motor slacking during upper-extremity rehabilitation: a proof of concept study

“…By linking the impaired and unimpaired arms of a stroke survivor using a self-powered robot, we can potentially harness the body power generated by their unimpaired limb during compensation as a means to enlist effort from the impaired arm. Indeed, such coupling of motions has been shown to be an excellent brain priming tool to facilitate motor cortical excitability and accelerate motor recovery after stroke (Byblow et al, 2012; Raghavan et al, 2017; Stinear et al, 2014). Thus, prolonged use of a self-powered robotic device could prevent the formation of learned disuse in acute cases, or improve function for those that are already affected, albeit this hypothesis has to be verified in clinical trials.…”

The Role of Robotic Path Assistance and Weight Support in Facilitating 3D Movements in Individuals With Poststroke Hemiparesis

“…61 More important, the effects of weight support on arm movement control suggest that understanding the biomechanical principles underlying antigravity movements of the upper limb are important for overcoming poststroke synergy patterns and restoring movement poststroke. 62…”

Influence of bimanual exercise on muscle activation in post-stroke patients

“…Current bimanual therapy relies heavily on specific training devices [20,21]. These devices are based on passive mechanics, in which the system is driven by forces generated by the patient [22][23][24] or by active robotics [25,26] to provide symmetric repetitive motion patterns for arm movement. These devices are, however, unsuitable for investigating the biological mechanisms underlying bimanual motion training because they can only provide simple bimanual motions [27].…”

“…Furthermore, proprioceptive limitations associated with the stroke-affected arm suppress its motor function [35]. Mechanical coupling [23] may increase the sensory information required to control the paretic arm [14].…”