Deans' stroke musings: A Case Report: Effect of Robotic Exoskeleton Based Therapy on Neurological and Functional Recovery of a Patient With Chronic Stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, July 15, 2021

A Case Report: Effect of Robotic Exoskeleton Based Therapy on Neurological and Functional Recovery of a Patient With Chronic Stroke

Good luck getting your insurance to pay for chronic therapy.

A Case Report: Effect of Robotic Exoskeleton Based Therapy on Neurological and Functional Recovery of a Patient With Chronic Stroke

Neha Singh¹,

Megha Saini¹,

Nand Kumar²,

M. V. Padma Srivastava³,

S. Senthil Kumaran⁴ and

Amit Mehndiratta^1,5^*

¹Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi, India
²Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
³Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
⁴Department of Nuclear Medicine and Resonance, All India Institute of Medical Sciences (AIIMS), New Delhi, India
⁵Department of Biomedical Engineering, All India Institute of Medical Sciences (AIIMS), New Delhi, India

Background: In this study, a novel electromechanical robotic exoskeleton was developed for the rehabilitation of distal joints. The objective was to explore the functional MRI and the neurophysiological changes in cortical-excitability in response to exoskeleton training for a 9-year chronic stroke patient.

Case-Report: The study involved a 52-year old female patient with a 9-year chronic stroke of the right hemisphere, who underwent 20 therapy sessions of 45 min each. Cortical-excitability and clinical-scales: Fugl-Mayer (FM), Modified Ashworth Scale (MAS), Brunnstrom-Stage (BS), Barthel-Index (BI), Range of Motion (ROM), were assessed pre-and post-therapy to quantitatively assess the motor recovery.

Clinical Rehabilitation Impact: Increase in FM wrist/hand by 6, BI by 10, and decrease in MAS by 1 were reported. Ipsilesional Motor Evoked Potential (MEP) (obtained using Transcranial Magnetic Stimulation) was increased by 98 μV with a decrease in RMT by 6% and contralesional MEP was increased by 43 μV with a decrease in RMT by 4%. Laterality Index of Sensorimotor Cortex (SMC) reduced in precentral- gyrus (from 0.152 to −0.707) and in postcentral-gyrus (from 0.203 to −0.632).

Conclusion: The novel exoskeleton-based training showed improved motor outcomes, cortical excitability, and neuronal activation. The research encourages the further investigation of the potential of exoskeleton training.

Introduction

Post-stroke motor recovery follows a non-linear trajectory (1). Although, there is a period of enhanced plasticity or spontaneous recovery of motor function following a stroke, it is insufficient and often negligible in patients with chronic-stroke. Intensive therapeutic and rehabilitative interventions primarily lead to functional restoration in chronic-stroke survivors (2). While research studies have explored neuronal and motor recovery, patients with chronic-stroke often manifest long-term disability and limitations in the activities of daily living (3). The exact behavior of neurophysiological aspects at a neuronal level showing enhanced responsiveness to treatment in chronic-stroke is not clear yet (1).

Robotic-training for physical therapy is now becoming a new normal for the rehabilitation community (4). It might share a good amount of the clinical load of the therapist and can substantially facilitate the phenomenon of functional neuro-rehabilitation and recovery. An electro-mechanical robotic-exoskeleton was developed for distal joints that synchronize wrist-extension with Metacarpophalangeal (MCP) flexion and wrist-flexion with MCP-extension (4). The exoskeleton targets spasticity through a synergy-based rehabilitation approach while also maintaining patient-initiated therapy through residual muscle activity using Electromyogram (EMG) for maximizing voluntary effort. Here, we present the case of a 52-year old female with late chronic-stroke of 9 years, who had a partial recovery, and its convergent association of potential brain reorganization in response to the novel exoskeleton. The objective of this case study was to explore the neurophysiological repertoire of behavior behind motor recovery in response to the goal-directed treatment using exoskeleton for a patient with chronic-stroke.