Good, then write up a protocol and distribute this to every stroke hospital in the world. OR, figure out a way to get this to everyone of the 10 million yearly stroke survivors. Your choice, DOING NOTHING IS NOT AN OPTION.
Do nothing, get fired.
Boosting robot-assisted rehabilitation of stroke hemiparesis by individualized selection of upper limb movements – a pilot study
- Orna RosenthalEmail authorView ORCID ID profile,
- Alan M. Wing,
- Jeremy L. Wyatt,
- David Punt,
- Briony Brownless,
- Chit Ko-Ko and
- R. Christopher Miall
Journal of NeuroEngineering and Rehabilitation201916:42
© The Author(s). 2019
- Received: 27 June 2018
- Accepted: 8 March 2019
- Published: 20 March 2019
Abstract
Background
Intensive robot-assisted
training of the upper limb after stroke can reduce motor impairment,
even at the chronic stage. However, the effectiveness of practice for
recovery depends on the selection of the practised movements. We
hypothesized that rehabilitation can be optimized by selecting the
movements to be practiced based on the trainee’s performance profile.
Methods
We present a novel principle
(‘steepest gradients’) for performance-based selection of movements. The
principle is based on mapping motor performance across a workspace and
then selecting movements located at regions of the steepest transition
between better and worse performance.
To assess the benefit of this
principle we compared the effect of 15 sessions of robot-assisted
reaching training on upper-limb motor impairment, between two groups of
people who have moderate-to-severe chronic upper-limb hemiparesis due to
stroke. The test group (N = 7)
received steepest gradients-based training, iteratively selected
according to the steepest gradients principle with weekly remapping,
whereas the control group (N = 9) received a standard “centre-out” reaching training. Training intensity was identical.
Results
Both groups showed improvement
in Fugl-Meyer upper-extremity scores (the primary outcome measure).
Moreover, the test group showed significantly greater improvement
(twofold) compared to control. The score remained elevated, on average,
for at least 4 weeks although the additional benefit of the
steepest-gradients -based training diminished relative to control.
Conclusions
This study provides a proof of
concept for the superior benefit of performance-based selection of
practiced movements in reducing upper-limb motor impairment due to
stroke. This added benefit was most evident in the short term,
suggesting that performance-based steepest-gradients training may be
effective in increasing the rate of initial phase of practice-based
recovery; we discuss how long-term retention may also be improved.
Trial registration
ISRCTN, ISRCTN65226825, registered 12 June 2018 - Retrospectively registered,
Once again researchers have gone for the low hanging fruit. Improvement in reaching while your hand is strapped to a handle with a glove does not make stroke survivors independent.
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