Case report: A period-based upper limb rehabilitation program using a degrees-of-freedom constraint strategy in severe post-stroke hemiparesis

 You can ask your competent? doctor to explain how this works in layperson terms and EXACTLY WHEN YOU GET TO USE IT!

Case report: A period-based upper limb rehabilitation program using a degrees-of-freedom constraint strategy in severe post-stroke hemiparesis

• 

  Norikazu Hishikawa 1

• K

  Koshiro Sawada 1

• Y

  Yuki Iwasaki 1

• S

  Satoru Kakoyama 2

• Y

  Yu Iitsuka 3

• Y

  Yoshiaki Komatsu 4

• H

  Hiroshi Maeda 2

• 

  Yasuo Mikami 1

• 1. Kyoto Furitsu Ika Daigaku Daigakuin Igaku Kenkyuka Rehabilitation Igaku Kyoshitsu, Kyoto, Japan

• 2. Gakusai Hospital, Kyoto, Japan

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Abstract

Background: Severe upper limb hemiparesis after stroke is often characterized by impaired motor function, increased flexor tone, and abnormal motor coordination, resulting in limited functional reaching. Because reaching requires coordinated control of joints, conventional task-oriented training may not sufficiently address motor control deficits arising from excessive or poorly regulated joint degrees of freedom (DoF). This case report describes a period-based upper limb rehabilitation program incorporating a constraint strategy targeting DoF to facilitate motor recovery in a patient with severe post-stroke hemiparesis. Case description: A 50-year-old man with left upper limb hemiparesis secondary to right putaminal hemorrhage (163 days post-onset) presented with severe impairment (Fugl–Meyer Assessment for Upper Extremity motor score, 12 points) and spasticity (Modified Ashworth Scale 2–3 in shoulder internal rotators, elbow flexors, and wrist flexors). Insufficient selective motor control and increased spasticity resulted in a dominant upper limb flexion synergy pattern, limiting his ability to perform forward reaching. Therapeutic intervention: A structured, period-based program was implemented over 21 consecutive days (60 minutes/day) with a proximal-to-distal progression and progressive release of movement constraints from the shoulder to the elbow and then to the wrist and fingers. Gravity-load management and DoF constraints were provided using an arm support device and a wrist–hand– finger orthosis in the early periods. As proximal voluntary control emerged, the wrist–hand–finger orthosis was replaced by a dynamic finger extension orthosis. In addition, neuromuscular electrical stimulation was applied to facilitate selective muscle activation across training periods. 

Follow-up and Outcomes: 

Spasticity of the paretic upper limb decreased progressively over the training period, with early reductions in proximal muscle tone followed by later reductions in distal spasticity.(Why are you treating spasticity at all? Don't you believe in the 'expert' opinion of Dr. William. F. Landau? 

 His statement from here:

Spasticity After Stroke: Why Bother? Aug. 2004 )

 Improvements in passive joint range of motion and consistent reductions in joint pain were observed throughout the intervention. Subsequently, motor function improved, as reflected by an increase in the Fugl–Meyer motor score to 16 points, with reduced synergistic movement patterns and more controlled reaching during tasks. Conclusion: An upper limb rehabilitation framework incorporating a DoF constraint strategy may support the recovery of coordinated motor control through a structured, period-based approach in individuals with severe post-stroke hemiparesis.

A Study on the Robot Structure of Hand for the Rehabilitation Training of Stroke Patients

Ask your doctor if this is far enough along for you to use in rehabilitating your hand.  You shouldn't even have to ask since your doctor should be up-to-date in all things stroke rehab. But you know that is not true.  Especially if your doctor has abandoned any pretense of knowledge of stroke rehab by writing prescriptions saying; E.T.(Evaluate and Treat).

A Study on the Robot Structure of Hand for the Rehabilitation Training of Stroke Patients 

Kim, Jong-Bok;Kim, Jong-Chul;Hwang, Dae-Joon

• Received : 2019.04.10
• Accepted : 2019.06.21
• Published : 2019.06.30

• 7 4

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Abstract

The rehabilitation training robots for treating the upper limbs of stroke patients were mainly focused on the upper proximal treatment of it, but recently studies of the distal parts of the upper limbs for rehabilitation of the hand is making some progress even though it is still a small number so far. In this paper, we present the hand robot for the rehabilitation training of stroke patients that is the fingertip contact-typed mechanism, and it has also equipped with the wrist rehabilitation unit to be worked like human hand that enables any movements through mutual cooperation by fingers while picking up or grasping objects. The robot that is presented for this purpose supports the movement of fingers with 5-DoF and the wrist with 3-DoF that moves independently, and operates with a structure that allows the joints of the wrist and fingers to be collaborated organically together to each other. Also, hereby the simulation and evaluation test on its robot mechanism are performed to ensure that fingers with 5-DoF and the wrist with 3-DoF of the serial kinematical mechanism are designed to comply with or exceed ROM for ADL.

Keywords

Stroke rehabilitation;Rehabilitation robot;Modified scott-russell mechanism;Degrees of freedom;Serial kinematic mechanism with 3-DoF

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Movement Training and Post-Stroke Rehabilitation Using a Six Degree of Freedom Upper-Extremity Robotic Orthosis and Virtual Environment

Not sure what degrees of freedom are but any research into this is good.
http://gradworks.umi.com/34/87/3487075.html
Abstract:
Prior research has shown that high-intensity repetitive movement training is an effective method for restoring some function to patients with chronic hemiparesis resulting from a stroke. The goal of this dissertation was to develop and evaluate a robotic system for assisting in post-stroke upper-extremity rehabilitative physical therapy. The primary contributions of this research are in: the development of control software for a rehabilitation robot; the development of a virtual environment for rehabilitation; the integration between a robot controller and a virtual environment; the design and analysis of an algorithm for maintaining a challenging level of therapy; and a clinical trial testing the efficacy of functional multi-joint movement therapy (FMJMT) versus isolated individual joint movement training (IIJMT).
The robotic mechanism created to provide therapy is a 6 degree-of-freedom (DOF) pneumatically actuated exoskeleton, which included a 3 DOF shoulder, a 1 DOF elbow, and a 2 DOF module for forearm supination/pronation and wrist flexion/extension. The shoulder is driven by redundant actuation of a novel spatial parallel mechanism. The elbow, forearm, and wrist are all actuated in serial with four-bar slider-crank mechanisms.
The virtual environment consisted of several games with point-to-point reaching or continuous tracking tasks. Some of the games required squeezing a pressure sensitive device for grasping items in the games. There was also another novel environment that allowed for a coordinated movement strength assessment. An algorithm that was developed to discretely alter the game difficulty was implemented in some games to maintain a challenging level of therapy for the patients. This algorithm is also shown to detect motor improvement.
The clinical trial involved a crossover design study with 20 patients who had chronic hemiparesis after stroke. Of these, 10 patients received FMJMT for 3 one hour sessions per week for 4 weeks followed by IIJMT for the same duration. The other 10 subjects received both interventions in the opposite order. The results from the study indicated both training techniques promoted motor recovery with slightly more benefit from IIJMT suggesting that the complexity of multi-DOF robots may not be necessary for promoting upper limb recovery in hemiplegic stroke survivors.