Robotic Arm Rehabilitation in Chronic Stroke Patients With Aphasia May Promote Speech and Language Recovery (but Effect Is Not Enhanced by Supplementary tDCS)

Buchwald, Adam; Falconer, Carolyn; Rykman-Peltz, Avrielle; Cortes, Mar; Pascual‐Leone, Álvaro; Thickbroom, Gary; Krebs, Hermano Igo; Fregni, Felipe; Gerber, Linda M.; Oromendia, Clara; Chang, Johanna L.; Volpe, Bruce T.; Edwards, Dylan

doi:10.3389/fneur.2018.00853

“…To explore its clinical effect, some researchers used M1-tDCS to intervene in patients with PSA. The results show that M1-tDCS can improve aphasia patients' motor and communication function in conjunction with enhancing the retrieval ability of action-related words in the long term [ 16 ]. Interestingly, studies demonstrated that language function could be improved by asking patients to watch videos of task-oriented movements of the UE with voice guidance [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, current studies rarely focus on simultaneous UE motor dysfunction with language deficits and even less on both functions' concurrent recovery during stroke recovery. Most studies only unexpectedly found this phenomenon or were mostly exploratory paradigm intervention studies [1,[14][15][16]. Few studies have focused on the difference in UE motor function status between patients with PSA and nonphasic poststroke patients.…”

Section: Introductionmentioning

confidence: 99%

Associations between Upper Extremity Motor Function and Aphasia after Stroke: A Multicenter Cross-Sectional Study

Yan

¹

,

Pan

²

,

Yang

³

et al. 2021

Behavioural Neurology

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Background and Purpose. Poststroke aphasia (PSA) often coexists with upper extremity (UE) motor dysfunction. However, whether the presence of PSA affects UE motor performance, and if language function associates with UE motor performance, are unclear. This study is aimed at (1) comparing the motor status of UE between patients with PSA and without PSA and (2) investigating the association between language function and UE motor status in patients with PSA. Methods. Patients with stroke were compared and correlated from overall and three periods (1-3 months, 4-6 months, and >6 months). Fugl-Meyer assessment for the upper extremity (FMA-UE) and action research and arm test (ARAT) were used to compare the UE motor status between patients with PSA and without PSA through a cross-sectional study among 435 patients. Then, the correlations between the evaluation scale scores of UE motor status and language function of patients with PSA were analyzed in various dimensions, and the language subfunction most closely related to UE motor function was analyzed by multiple linear regression analysis. Results. We found that the scores of FMA-UE and ARAT in patients with PSA were 14 points ((CI) 10 to 18, p < 0.001 ) and 11 points lower ((CI) 8 to 13, p < 0.001 ), respectively, than those without PSA. Their FMA-UE ( r = 0.70 , p < 0.001 ) and ARAT ( r = 0.62 , p < 0.001 ) scores were positively correlated with language function. Regression analysis demonstrated that spontaneous speech ability may account for UE motor function ( R 2 = 0.51 , p < 0.001 ; R 2 = 0.42 , p < 0.001 ). Consistent results were also obtained from the analyses within the three time subgroups. Conclusion. Stroke patients with PSA have worse UE motor performance. UE motor status and language function showed positive correlations, in which spontaneous speech ability significantly accounts for the associations.

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“…In the study by Harnish et al, 58 following 6 weeks each of 2 exercise regimens, one using aerobic exercise and one involving stretching, both followed by speech therapy, those patients with aphasia receiving aerobic exercise demonstrated greater language gains. Even more recently, in a preliminary study of 17 patients with aphasia and rightsided hemiparesis, Buchwald et al 6 cautiously reported language gains following 36 sessions of robot-assisted arm treatment without the benefit of speech therapy, echoing the earlier study by Hesse et al 55 , while noting the need for further controlled experiments.…”

Section: Aphasia Research and Treatmentmentioning

confidence: 92%

“…One exciting perspective that is emerging from these multidisciplinary studies is the potential interaction between motor and aphasia recovery. 5,6 Increasingly, collateral effects on language production and comprehension have been reported as a result of the observation of movement. 7 Not coincidentally, given the close proximity of hand-arm and speech-language neural structures, in many patients with poststroke aphasia, the contralesional hand and arm are often simultaneously impaired.…”

Section: The Problemmentioning

confidence: 99%

Poststroke Aphasia Rehabilitation: Why All Talk and No Action?

Wortman-Jutt

¹

,

Edwards

²

2019

Neurorehabil Neural Repair

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Aphasia is a debilitating language disorder that often follows stroke. It can affect any or all aspects of linguistic expression and comprehension, whether verbal, written, or gestural. Despite a growing understanding of the phenomenology of aphasia, new treatment paradigms are needed that directly target the underlying impairment. There are varying aphasia types and levels of severity, determined largely by the site and extent of stroke lesion as well as the degree of white matter integrity. 1 Herein, we will focus largely on the nonfluent or expressive poststroke aphasias, emphasizing how the affected anterior brain regions of the dominant hemisphere are interwoven with proximate cortical areas supporting upper limb and hand movement. Speech therapy is beneficial for patients with aphasia; however, no single treatment has proven most advantageous. 2 Many patients with aphasia experience chronic language deficits. Promising strategies to reduce permanent language deficits, such as pharmacological agents 3 and noninvasive brain stimulation 4 alone or in combination with speech therapy, have yet to be tested in appropriately powered clinical trials. One exciting perspective that is emerging from these multidisciplinary studies is the potential interaction between motor and aphasia recovery. 5,6 Increasingly, collateral effects on language production and comprehension have been reported as a result of the observation of movement. 7 Not coincidentally, given the close proximity of handarm and speech-language neural structures, in many patients with poststroke aphasia, the contralesional hand and arm are often simultaneously impaired. While the extent and limitations of hand-arm and speech-language cortical reciprocity remain under debate, it is likely that hand-arm movement and spoken language have at least a parallel, if not primary, relationship. 8 Nonetheless, stroke patients receiving speech-language therapy for aphasia are frequently seated during treatment, with hands and arms impassive. The use of hand-arm movement and exercise (eg, reaching, grasping, lifting) has not been sufficiently explored for direct use in aphasia rehabilitation. Objects that may be named in aphasia treatment, however, may also be simultaneously grasped. Manual tasks may be accompanied by verbal language, as they often are during activities of daily living. In this "Point-of-View" article, we provide an overview of data supporting hand-arm and language cortical reciprocity garnered from literature across multiple disciplines. Toward this aim, a PubMed search was conducted using multiple combinations of the terms "Limb," "Arm," "Gesture," "Speech," "Language" "Motor," "Action Verbs" and "Aphasia," yielding 652 articles. We excluded 384 articles due to their lack of relevance to our topic. For example, if the terms were combined incongruously or as part of a larger unrelated topic, these articles were excluded.

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“…The recovery process results can be improved by varying the force applied by the mechanical devices, increasing the movement amplitude, decreasing assistance, and increasing resistance, even with less supervision from therapists [ 2 ]. Aphasia, language rehabilitation, and shoulder-hand neuropathic pain may also benefit from robotic-assisted therapy [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

The Efficacity of the NeuroAssist Robotic System for Motor Rehabilitation of the Upper Limb—Promising Results from a Pilot Study

Tohănean

¹

,

Tucan

²

,

Vanta

³

et al. 2023

JCM

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The research aimed to evaluate the efficacy of the NeuroAssist, a parallel robotic system comprised of three robotic modules equipped with human–robot interaction capabilities, an internal sensor system for torque monitoring, and an external sensor system for real-time patient monitoring for the motor rehabilitation of the shoulder, elbow, and wrist. The study enrolled 10 consecutive patients with right upper limb paresis caused by stroke, traumatic spinal cord disease, or multiple sclerosis admitted to the Neurology I Department of Cluj-Napoca Emergency County Hospital. The patients were evaluated clinically and electrophysiologically before (T1) and after the intervention (T2). The intervention consisted of five consecutive daily sessions of 30–45 minutes each of 30 passive repetitive movements performed with the robot. There were significant differences (Wilcoxon signed-rank test) between baseline and end-point clinical parameters, specifically for the Barthel Index (53.00 ± 37.72 vs. 60.50 ± 36.39, p = 0.016) and Activities of Daily Living Index (4.70 ± 3.43 vs. 5.50 ± 3.80, p = 0.038). The goniometric parameters improved: shoulder flexion (70.00 ± 56.61 vs. 80.00 ± 63.59, p = 0.026); wrist flexion/extension (34.00 ± 28.75 vs. 42.50 ± 33.7, p = 0.042)/(30.00 ± 22.97 vs. 41.00 ± 30.62, p = 0.042); ulnar deviation (23.50 ± 19.44 vs. 33.50 ± 24.15, p = 0.027); and radial deviation (17.50 ± 18.14 vs. 27.00 ± 24.85, p = 0.027). There was a difference in muscle activation of the extensor digitorum communis muscle (1.00 ± 0.94 vs. 1.40 ± 1.17, p = 0.046). The optimized and dependable NeuroAssist Robotic System improved shoulder and wrist range of motion and functional scores, regardless of the cause of the motor deficit. However, further investigations are necessary to establish its definite role in motor recovery.

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Robotic Arm Rehabilitation in Chronic Stroke Patients With Aphasia May Promote Speech and Language Recovery (but Effect Is Not Enhanced by Supplementary tDCS)

Cited by 10 publications

References 11 publications

Associations between Upper Extremity Motor Function and Aphasia after Stroke: A Multicenter Cross-Sectional Study

Associations between Upper Extremity Motor Function and Aphasia after Stroke: A Multicenter Cross-Sectional Study

Poststroke Aphasia Rehabilitation: Why All Talk and No Action?

The Efficacity of the NeuroAssist Robotic System for Motor Rehabilitation of the Upper Limb—Promising Results from a Pilot Study

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