Machine-Based, Self-guided Home Therapy for Individuals With Severe Arm Impairment After Stroke

Zondervan, Daniel K.; Augsburger, Renee; Bodenhoefer, Barbara; Friedman, Nizan; Reinkensmeyer, David J.; Cramer, Steven C.

doi:10.1177/1545968314550368

Cited by 37 publications

(45 citation statements)

References 72 publications

(128 reference statements)

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“…This implies that the development of poststroke spasticity is related to neuronal plastic changes within the central nervous system after the initial injury [see reviews (4–7, 45–47)]. Intensive therapy improves motor function, but has no effect on spasticity (48). A single dose of selective serotonin reuptake inhibitors (10 mg escitalopram) significantly increased spasticity (measured by reflex torque) without affecting muscle strength of spastic leg muscles after stroke (49).…”

Section: Poststroke Spasticity and Motor Recovery Are Mediated By Difmentioning

confidence: 99%

Spasticity, Motor Recovery, and Neural Plasticity after Stroke

2017

Front. Neurol.

203

161

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Spasticity and weakness (spastic paresis) are the primary motor impairments after stroke and impose significant challenges for treatment and patient care. Spasticity emerges and disappears in the course of complete motor recovery. Spasticity and motor recovery are both related to neural plasticity after stroke. However, the relation between the two remains poorly understood among clinicians and researchers. Recovery of strength and motor function is mainly attributed to cortical plastic reorganization in the early recovery phase, while reticulospinal (RS) hyperexcitability as a result of maladaptive plasticity, is the most plausible mechanism for poststroke spasticity. It is important to differentiate and understand that motor recovery and spasticity have different underlying mechanisms. Facilitation and modulation of neural plasticity through rehabilitative strategies, such as early interventions with repetitive goal-oriented intensive therapy, appropriate non-invasive brain stimulation, and pharmacological agents, are the keys to promote motor recovery. Individualized rehabilitation protocols could be developed to utilize or avoid the maladaptive plasticity, such as RS hyperexcitability, in the course of motor recovery. Aggressive and appropriate spasticity management with botulinum toxin therapy is an example of how to create a transient plastic state of the neuromotor system that allows motor re-learning and recovery in chronic stages.

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Section: Poststroke Spasticity and Motor Recovery Are Mediated By Difmentioning

confidence: 99%

Spasticity, Motor Recovery, and Neural Plasticity after Stroke

2017

Front. Neurol.

203

161

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“…Indeed, a study that used principal component decomposition to analyze the movement patterns associated with functional use of the hand found that >90 percent of the variance in hand kinematics could be explained by nine finger-thumb movement patterns similar to ones trained by the MusicGlove [50]. In this framework, practicing a key movement component that is used in a range of daily tasks may be more efficient at inducing functional recovery than practicing the individual tasks themselves [51][52][53], a hypothesis one could call "componentspecific training" in order to contrast it with the widely advocated approach of "task-specific training." A third possibility is that practice with the MusicGlove simply made the participants pay more attention to their hand, and thus they were more inclined to report an increased use of it in daily tasks.…”

Section: Increased Functional Use Of Hand After Musicglove Therapymentioning

confidence: 99%

Home-based hand rehabilitation after chronic stroke: Randomized, controlled single-blind trial comparing the MusicGlove with a conventional exercise program

Zondervan¹,

Friedman²,

Chang³

et al. 2016

J Rehabil Res Dev

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138

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Abstract-Individuals with chronic stroke have limited options for hand rehabilitation at home. Here, we sought to determine the feasibility and efficacy of home-based MusicGlove therapy. Seventeen participants with moderate hand impairment in the chronic phase of stroke were randomized to 3 wk of home-based exercise with either the MusicGlove or conventional tabletop exercises. The primary outcome measure was the change in the Box and Blocks test score from baseline to 1 mo posttreatment. Both groups significantly improved their Box and Blocks test score, but no significant difference was found between groups. The MusicGlove group did exhibit significantly greater improvements than the conventional exercise group in Motor Activity Log Quality of Movement and Amount of Use scores 1 mo posttherapy (p = 0.007 and p = 0.04, respectively). Participants significantly increased their use of MusicGlove over time, completing 466 gripping movements per day on average at study end. MusicGlove therapy was not superior to conventional tabletop exercises for the primary end point but was nevertheless feasible and led to a significantly greater increase in self-reported functional use and quality of movement of the impaired hand than conventional home exercises.Clinical Trial Registration: ClinicalTrials.gov; "Influence of Timing on Motor Learning"; NCT01769326;  https://clinicaltrials.gov/ct2/show/NCT01769326

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“…In a previous pilot study with a stationary version of LARA, a device called RAE, we found that users with severe arm impairment (FM score = 21.4 points ± 8.8 SD out of 66) could move the levers and synchronize to the resonance of the device, created by springs attached to the levers, and that repeatedly moving the levers had a therapeutic benefit [6], [7]. We then made RAE into LARA by incorporating one-way bearings into the levers and found that people with severe arm impairment could also drive LARA overground [8], [9].…”

Section: Introductionmentioning

confidence: 99%

There is plenty of room for motor learning at the bottom of the Fugl-Meyer: Acquisition of a novel bimanual wheelchair skill after chronic stroke using an unmasking technology

Sarigul-Klijn

Lobo-Prat

Smith

et al. 2017

2017 International Conference on Rehabilitation Robotics (ICORR)

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Many people with a stroke have a severely paretic arm, and it is often assumed that they are unable to learn novel, skilled behaviors that incorporate use of that arm. Here, we show that a group of people with chronic stroke (n = 5, upper extremity Fugl-Meyer scores: 31, 30, 26, 22, 8) learned to use their impaired arm to propel a novel, yoked-clutch lever drive wheelchair. Over six daily training sessions, each involving about 134 training movements with their “useless” arm, the users gradually achieved a 3-fold increase in wheelchair speed on average, with a 4–6 fold increase for three of the participants. They did this by learning a bimanual skill: pushing the levers with both arms while activating the yoked-clutches at the right time with their ipsilesional (i.e. “good”) hand to propel the wheelchair forward. They perceived the task as highly motivating and useful. The speed improvements exceeded a 1.5-factor improvement observed when young, unimpaired users learned to propel the chair. The learning rate also exceeded a sample of learning rates from a variety of classic learning studies. These results suggest that appropriately-designed assistive technologies (or “unmasking technologies - UTs”) can unleash a powerful, latent ability for motor learning even for severely paretic arms. While UTs may not reduce clinical impairment, they may facilitate large improvements in a specific functional ability.

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Machine-Based, Self-guided Home Therapy for Individuals With Severe Arm Impairment After Stroke

Cited by 37 publications

References 72 publications

Spasticity, Motor Recovery, and Neural Plasticity after Stroke

Spasticity, Motor Recovery, and Neural Plasticity after Stroke

Home-based hand rehabilitation after chronic stroke: Randomized, controlled single-blind trial comparing the MusicGlove with a conventional exercise program

There is plenty of room for motor learning at the bottom of the Fugl-Meyer: Acquisition of a novel bimanual wheelchair skill after chronic stroke using an unmasking technology

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