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.

Showing posts with label robotic training. Show all posts
Showing posts with label robotic training. Show all posts

Friday, January 16, 2026

Effectiveness of mirror and robot-assisted therapy for upper extremity rehabilitation in post-stroke patients: a meta-analysis

 I guess your absolutely incompetent? doctor and hospital didn't create protocols on this for well over a decade! So, you DON'T have a functioning stroke doctor or hospital!

Do you prefer your doctor, hospital and board of director's incompetence NOT KNOWING? OR NOT DOING? Your choice; let them be incompetent or demand action!

  • mirror training (2 posts to September 2021)
  • robotic assisted therapy (19 posts to January 2017)
  • robotic exoskeletal hand (1 post to December 2024)
  • robotic exoskeleton (3 posts to October 2022)
  • robotic exosuit (1 post to November 2023)
  • robotic gait training (4 posts to December 2021)
  • robotic glove (2 posts to April 2023)
  • robotic harness (1 post to August 2017)
  • Robotic hip exoskeleton (3 posts to March 2024)
  • Robotic Knee Orthosis (1 post to August 2017)
  • Robotic mirror therapy (1 post to December 2022)
  • robotic rehabilitation (3 posts to May 2023)
  • robotic training (16 posts to January 2016)
  • robotic-assisted gait training (8 posts to November 2016)
  • robotics (349 posts to August 2011)
  • Once again pointing out the complete failure of having NO diagnosis stroke protocols that point to rehabilitation intervention stroke protocols.  You are fucking screwed since your doctor and therapists are 'winging it' for everything related to stroke and your recovery. 

    The latest here:

    Effectiveness of mirror and robot-assisted therapy for upper extremity rehabilitation in post-stroke patients: a meta-analysis

    You have full access to this open access article

    Journal of NeuroEngineering and Rehabilitation Aims and scope Submit manuscript
    Effectiveness of mirror and robot-assisted therapy for upper extremity rehabilitation in post-stroke patients: a meta-analysis

      We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

      Abstract

      Introduction

      Stroke is a leading cause of death and disability, with survivors often facing upper extremity (UE) impairments. Mirror therapy (MT) can enhance motor function but is influenced by cognitive and emotional factors. Robot-assisted therapy (RT) has shown efficacy in restoring UE function. Robot-mirror therapy (RMT), which combines MT and RT, has been investigated in several trials, with some showing benefits while others reported limited effects. This meta-analysis aimed to evaluate RMT’s effectiveness in improving UE function in stroke patients.

      Methods

      We included RCTs involving RMT in adult stroke patients. Searches covered ten databases (Cochrane Library, Scopus, PubMed, Web of Science, Embase, CNKI, CINAHL, PEDro, ClinicalTrials.gov, WHO ICTRP) through October 2025, with a grey literature search. Two independent reviewers conducted study selection, data extraction, and quality assessment. The risk of bias and the certainty of the evidence were assessed using the Cochrane collaboration’s tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guideline, respectively.

      Results

      Sixteen RCTs (n=736) were analyzed. RMT significantly improved UE motor function (Fugl-Meyer Assessment-Upper Extremity (FMA-UE); MD 7.52, 95% CI 4.16-10.87; P<.0001 and Wolf Motor Function Test; MD 5.13, 95% CI 2.33-7.92; P=.0003), distal UE motor function (FMA-UE (distal); MD 2.92, 95% CI 1.43-4.42; P=.0001), hand motor function (SMD 1.06, 95% CI 0.15-1.97; P=.02), hand muscle strength (grip strength; SMD 1.34, 95% CI 0.17-2.51; P=.02), activities of daily living (Modified Barthel Index; MD 7.80, 95% CI 4.15-11.45; P<.0001 and Functional Independence Measure; MD 4.73, 95% CI 0.30-9.15; P=.04), and quality of life (SMD 1.00, 95% CI 0.00-1.99; P=.05). Subgroup analysis showed better outcomes in older patients (≥55), shorter interventions (<18 hours), and trial length of 3–6 weeks.

      Conclusion

      Moderate-quality evidence supports the effectiveness of RMT-based interventions for improving UE motor function and activities of daily living in stroke patients.

      Trial Registration PROSPERO CRD420251077740.

      Monday, December 9, 2024

      Effects of robot therapy on upper body kinematics and arm function in persons post stroke: a pilot randomized controlled trial

      Where is the protocol located so survivors can bring it to their stroke medical 'professionals' attention? Top down dissemination of research is a complete fucking failure; bottom up is the way to go!

      Effects of robot therapy on upper body kinematics and arm function in persons post stroke: a pilot randomized controlled trial

      Ilaria Carpinella 1
      Tiziana Lencioni 1*
      Thomas Bowman 1
      Rita Bertoni 1
      Andrea Turolla 2
      Maurizio Ferrarin 1 and 
      Johanna Jonsdottir

      Abstract 


      Background: 

      Robot-based rehabilitation for persons post-stroke may improve arm function and daily-life activities as measured by clinical scales, but its effects on motor strategies during functional tasks are still poorly investigated. This study aimed at assessing the effects of robot-therapy versus arm-specific physiotherapy in persons post-stroke on motor strategies derived from upper body instrumented kinematic analysis, and on arm function measured by clinical scales. 

      Methods: 

      Forty persons in the sub-acute and chronic stage post-stroke were recruited. This sample included all those subjects, enrolled in a larger bi-center study, who underwent instrumented kinematic analysis and who were randomized in Center 2 into Robot (R_Group) and Control Group (C_Group). R_Group received robot-assisted training. C_ Group received arm-specific treatment delivered by a physiotherapist. Pre- and post-training assessment included clinical scales and instrumented kinematic analysis of arm and trunk during a virtual untrained task simulating the transport of an object onto a shelf. Instrumented outcomes included shoulder/elbow coordination, elbow extension and trunk sagittal compensation. Clinical outcomes included Fugl-Meyer Motor Assessment of Upper Extremity (FM-UE), modified Ashworth Scale (MAS) and Functional Independence Measure (FIM). 

      Results: 

      R_Group showed larger post-training improvements of shoulder/elbow coordination (Cohensd= - 0.81, p = 0.019), elbow extension (Cohensd= - 0.71, p = 0.038), and trunk movement (Cohensd= - 1.12, p = 0.002). Both groups showed comparable improvements in clinical scales, except proximal muscles MAS that decreased more in R_Group (Cohensd= - 0.83, p = 0.018). Ancillary analyses on chronic subjects confirmed these results and revealed larger improvements after robot-therapy in the proximal portion of FM-UE (Cohens d = 1.16, p = 0.019). 

      Conclusions: 

      Robot-assisted rehabilitation was as effective as arm-specific physiotherapy in reducing(NOT RECOVERY!) arm impairment (FM-UE) in persons post-stroke, but it was more effective(If not 100% recovery, IT IS NOT EFFECTIVE!) in improving motor control strategies adopted during an untrained task involving vertical movements not practiced during training. Specifically, robot therapy induced larger improvements of shoulder/elbow coordination and greater reduction of abnormal trunk sagittal movements. The beneficial effects of robot therapy seemed more pronounced in chronic subjects. Future studies on a larger sample should be performed to corroborate present findings. Trial registration: www.ClinicalTrials.gov NCT03530358. Registered 21 May 2018. Retrospectively registered. Keywords: Stroke, Robot therapy, Upper limb, Trunk, Kinematic analysis, Motor strategies 

      Monday, July 1, 2024

      Effects of training with a rehabilitation device (Rebless®) on upper limb function in patients with chronic stroke: A randomized controlled trial

       Check it out here: 3.12 minute video. I like the idea. Out for 2.5 years, does your doctor have any clue about this? If not, you don't have a functioning stroke doctor!

      Effects of training with a rehabilitation device (Rebless®) on upper limb function in patients with chronic stroke: A randomized controlled trial

      Chang, Jong Yoon MDa; Chun, Min Ho MD, PhDa,*; Lee, Anna BSb; Lee, Ahro BSb; Lee, Chang Min PhDc,d

      Author Information
      Medicine 103(26):p e38753, June 28, 2024. | DOI: 10.1097/MD.0000000000038753
      • Open

      Abstract

      Background: 

      Upper limb dysfunction is one of the most common sequelae of stroke and robotic therapy is considered one of the promising methods for upper limb rehabilitation.

      Objective: 

      This study aimed to explore the clinical effectiveness of upper limb training using a rehabilitation robotic device (Rebless®) for patients with stroke.

      Methods: 

      In this prospective, unblinded, randomized controlled trial, patients were randomly assigned to receive robotic training (experimental group, n = 15) or conventional therapy (control group, n = 15). Both groups received upper limb training lasting for 30 minutes per session with a total of 10 training sessions within 4 weeks. Motor function, functional evaluation, and spasticity were clinically assessed before and after the training. Cortical activation was measured using functional near-infrared spectroscopy at the 1st and 10th training sessions.

      Results: 

      The experimental group demonstrated a significant improvement in the Fugl–Meyer assessment-upper extremity score and the modified Ashworth scale grade in elbow flexors. The cortical activity of the unaffected hemisphere significantly decreased after 10 training sessions in the experimental group compared with the control group.

      Conclusions: 

      The experimental group showed significant improvement in the Fugl–Meyer assessment-upper extremity score and spasticity of elbow flexors and had significantly decreased cortical activity of the unaffected hemisphere. Training with Rebless® may help patients with chronic stroke in restoring upper limb function and recovering the contralateral predominance of activation in motor function.


      Friday, January 13, 2023

      Robot-based hand motor therapy after stroke

       With this showing improvements in chronic stroke your doctors and hospital should have realized that it would probably work even better when done much earlier. And in the 15 years since, I BET YOUR INCOMPETENT HOSPITAL HAS DONE NOTHING!

      Robot-based hand motor therapy after stroke

      2008, Brain


       
      Robot-based hand motor therapy after stroke
      Craig D.Takahashi,

      Lucy Der-Yeghiaian,Vu Le, Rehan R. Motiwala and Steven C.Cramer
      Department of Neurology and Department of Anatomy & Neurobiology,University of California, Irvine,USA*Present Address: Department of Engineering, Santa Ana College, Santa Ana,CA,USA Correspondence to: Steven C.Cramer, MD,University of California, Irvine Medical Center,101The City Drive South,Building 53 Room 203,Orange,CA 92868-4280,USAE-mail: scramer@uci.edu
      Robots can improve motor status after stroke with certain advantages, but there has been less emphasis to date on robotic developments for the hand. The goal of this study was to determine whether a hand-wrist robot would improve motor function, and to evaluate the specificity of therapy effects on brain reorganization.Subjects with chronic stroke producing moderate right arm/hand weakness received 3 weeks therapy that emphasized intense active movement repetition as well as attention, speed, force, precision and timing, and included virtual reality games. Subjects initiated hand movements. If necessary, the robot completed movements, a feature available at all visits for seven of the subjects and at the latter half of visits for six of the subjects. Significant behavioural gains were found at end of treatment, for example, in Action Research Arm Test (34±20 to 38±19, P< 0.0005) and arm motor Fugl-Meyer score (45±10 to 52±10, P< 0.0001). Results suggest greater gains for subjects receiving robotic assistance in all sessions as compared to those receiving robotic assistance in half of sessions.The grasp task practiced during robotic therapy, when performed during functional MRI, showed increased sensorimotor cortex activation across the period of therapy, while a non-practiced task, supination/pronation, did not. A robot-based therapy showed improvements in hand motor function after chronic stroke. Reorganization of motor maps during the current therapy was task-specific, a finding useful when considering generalization of rehabilitation therapy.Keywords:
       stroke; motor therapy; functional MRI; generalization
      Abbreviations:
       IP=interphalangeal; MCP=metacarpophalangeal
      Received July13, 2007. Revised November 27, 2007. Accepted November 28, 2007. Advance Access publication December 21, 2007

      Thursday, July 2, 2020

      Greater Transfer to Walking of Lower Extremity Training with Robotics and Virtual Reality than Robotics Training Alone: Preliminary Findings

      Where the fuck is the publicly available protocol for this? No protocol or not publicly available then totally useless.  As you can see 14.5 years of incompetency already.

      Greater Transfer to Walking of Lower Extremity Training with Robotics and Virtual Reality than Robotics Training Alone: Preliminary Findings

        Conference Paper
       · January 2006
      DOI: 10.1109/IWVR.2006.1707545 · Source: IEEE Xplore
       Anat Mirelman, Judith E. Deutsch and Paolo Bonato

      Abstract

       — Virtual reality systems have been used to deliver goal directed repetitive training to promote rehabilitation of individuals post-stroke. Lower extremity training of individuals post-stroke who used a robot coupled with virtual environment has been shown to transfer to improved overground locomotion. To isolate the active components of training in this study we compared the outcomes of training with the robot-virtual reality (VR) system to the robot alone. Four individuals post-stroke participated in a four-week training protocol. One group trained with the robot-VR system and the other group with the robot alone. The improvement in walking speed and endurance for the robot- VR group was greater than the robot group alone. Adherence as well as the number of exercises performed in each session was comparable for the two groups. The duration of training sessions was comparable at the beginning of the study. However, subjects in the robot group reported higher fatigue and produced 16% fewer minutes of training towards the end of the study. These findings support the use of virtual environments coupled with a robot for transfer of training from the virtual to the real world environment.

      Saturday, December 21, 2019

      An observational report of intensive robotic and manual gait training in sub-acute stroke

       With no protocol written up and distributed worldwide, this will be lost in the plethora of stroke research since our fucking failures of stroke associations

      don't even have enough sense to create a database of research and protocols.  Then you wouldn't need these systematic reviews wasting time better done doing real research. 

      An observational report of intensive robotic and manual gait training in sub-acute stroke

       Lucas Conesa
      1*

      , Úrsula Costa
      1

      , Eva Morales
      1
      , Dylan J Edwards
      3,4
      , Mar Cortes
      3
      , Daniel León
      2
      ,Montserrat Bernabeu
      2
      and Josep Medina
      1

      Abstract


      Background:
       The use of automated electromechanical devices for gait training in neurological patients is increasing, yet the functional outcomes of well-defined training programs using these devices and the characteristics of patients that would most benefit are seldom reported in the literature. In an observational study of functional outcomes, we aimed to provide a benchmark for expected change in gait function in early stroke patients, from an intensive inpatient rehabilitation program including both robotic and manual gait training.
      Methods:
       We followed 103 sub-acute stroke patients who met the clinical inclusion criteria for Body Weight Supported Robotic Gait Training (BWSRGT).(cherry picking patients again.) Patients completed an intensive 8-week gait-training program comprising robotic gait training (weeks 0-4) followed by manual gait training (weeks 4-8). A change in clinical function was determined by the following assessments taken at 0, 4 and 8 weeks (baseline, mid-point and end-point respectively): Functional Ambulatory Categories (FAC), 10 m Walking Test (10 MWT), and Tinetti Gait and Balance Scales.
      Results:
       Over half of the patients made a clinically meaningful improvement on the Tinetti Gait Scale (> 3 points)and Tinetti Balance Scale (> 5 points), while over 80% of the patients increased at least 1 point on the FAC scale(0-5) and improved walking speed by more than 0.2 m/s. Patients responded positively in gait function regardless of variables gender, age, aetiology (hemorrhagic/ischemic), and affected hemisphere. The most robust and significant change was observed for patients in the FAC categories two and three. The therapy was well tolerated and no patients withdrew for factors related to the type or intensity of training.
      Conclusions:
       Eight-weeks of intensive rehabilitation including robotic and manual gait training was well tolerated by early stroke patients, and was associated with significant gains in function. Patients with mid-level gait dysfunction showed the most robust improvement following robotic training.
      Keywords:
       Gait training, stroke, body weight support, rehabilitation

      Thursday, July 18, 2019

      Intensive virtual reality and robotic based upper limb training compared to usual care, and associated cortical reorganization, in the acute and early sub-acute periods post-stroke: a feasibility study

      How long before your doctors and therapists create a protocol for you based on this? Anything longer than one week is dire incompetence and should result in firing. My opinion, but unless we start holding our stroke professionals to some semblance of competency they will never improve.  Your stroke hospital should have analysts checking all stroke research and create protocols based on such research. They should be better at that than me, they are being paid to know such stuff.

      Intensive virtual reality and robotic based upper limb training compared to usual care, and associated cortical reorganization, in the acute and early sub-acute periods post-stroke: a feasibility study

      Journal of NeuroEngineering and Rehabilitation201916:92
      • Received: 18 January 2019
      • Accepted: 3 July 2019
      • Published:

      Abstract

      Background

      There is conflict regarding the benefits of greater amounts of intensive upper limb rehabilitation in the early period post-stroke. This study was conducted to test the feasibility of providing intensive therapy during the early period post-stroke and to develop a randomized control trial that is currently in process. Specifically, the study investigated whether an additional 8 h of specialized, intensive (200–300 separate hand or arm movements per hour) virtual reality (VR)/robotic based upper limb training introduced within 1-month post-stroke resulted in greater improvement in impairment and behavior, and distinct changes in cortical reorganization measured via Transcranial Magnetic Stimulation (TMS), compared to that of a control group.

      Methods

      Seven subjects received 8–1 h sessions of upper limb VR/robotic training in addition to their inpatient therapy (PT, OT, ST). Six subjects only received their inpatient therapy. All were tested on measures of impairment [Upper Extremity Fugl-Meyer Assessment (UEFMA), Wrist AROM, Maximum Pinch Force], behavior [Wolf Motor Function Test (WMFT)], and also received TMS mapping until 6 months post training. ANOVAs were conducted to measure differences between groups across time for all outcome measures. Associations between changes in ipsilesional cortical maps during the early period of enhanced neuroplasticity and long-term changes in upper limb impairment and behavior measures were evaluated.

      Results

      The VR/robotic group made significantly greater improvements on UEFMA and Wrist AROM scores compared to the usual care group. There was also less variability in the association between changes in the First Dorsal Interosseus (FDI) muscle map area and WMFT and Maximum Force change scores for the VR/robotic group.

      Conclusions

      An additional 8 h of intensive VR/robotic based upper limb training initiated within the first month post-stroke may promote greater gains in impairment compared to usual care alone. Importantly, the data presented demonstrated the feasibility of conducting this intervention and multiple outcome measures (impairment, behavioral, neurophysiological) in the early period post-stroke.

      Tuesday, October 2, 2018

      Robotic arm rehabilitation in chronic stroke patients with aphasia may promote speech and language recovery

      Novel idea, will your hospital implement this without your prodding? 

      Robotic arm rehabilitation in chronic stroke patients with aphasia may promote speech and language recovery

      • 1New York University, United States
      • 2Weill Cornell Medicine, Cornell University, United States
      • 3Harvard Medical School, United States
      • 4Department of Mechanical Engineering,Massachusetts Institute of Technology, United States
      • 5Feinstein Institute for Medical Research, United States
      Objective: This study aimed to determine the extent to which robotic arm rehabilitation for chronic stroke may promote recovery of speech and language function in individuals with aphasia.
      Methods: We prospectively enrolled 17 individuals in a robotic arm rehabilitation study and evaluated their speech and language performance before and after a 12-week (36 session) arm treatment regimen. Performance changes were evaluated with paired t-tests comparing pre- and post-test measures. There was no speech therapy included in the treatment protocol.
      Results: Overall, the individuals significantly improved on measures of motor speech production as well as overall aphasia severity from pre-test baseline to post-test.
      Conclusions: This work indicates the importance of considering approaches to stroke rehabilitation across different domains of impairment, and warrants additional exploration of the possibility that robotic arm motor treatment may enhance rehabilitation for speech and language outcomes.
      Keywords: Aphasia, stroke rehabilitation, apraxia of speech, motor control, Neurorehabilitation
      Received: 29 Jan 2018; Accepted: 21 Sep 2018.
      Edited by:
      Nicola Smania, Università degli Studi di Verona, Italy
      Reviewed by:
      Kyrana Tsapkini, Johns Hopkins University, United States
      Andrea Turolla, IRCCS Fondazione Ospedale San Camillo, Italy  
      Copyright: © 2018 Buchwald, Falconer, Rykman, Cortes, Pascual-Leone, Thickbroom, Krebs, Gerber, Oromendia, Chang, Volpe and Edwards. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
      * Correspondence: Prof. Adam Buchwald, New York University, New York City, United States, buchwald@nyu.edu

      Wednesday, January 3, 2018

      Robotic gait trainer in water: Development of an underwater gait-training orthosis

      I bet you never saw or heard of this from your doctor. Only 8 years old so you can tell how badly out of date your doctor is. I would call it incompetence.
      http://www.tandfonline.com/doi/abs/10.1080/09638280701191826
      Purpose. To develop a robotic gait trainer that can be used in water (RGTW) and achieve repetitive physiological gait patterns to improve the movement dysfunctions.
      Method. The RGTW is a hip-knee-ankle-foot orthosis with pneumatic actuators; the control software was developed on the basis of the angular motions of the hip and knee joint of a healthy subject as he walked in water. Three-dimensional motions and electromyographic (EMG) activities were recorded in nine healthy subjects to evaluate the efficacy of using the RGTW while walking on a treadmill in water.
      Results. The device could preserve the angular displacement patterns of the hip and knee and foot trajectories under all experimental conditions. The tibialis anterior EMG activities in the late swing phase and the biceps femoris throughout the stance phase were reduced whose joint torques were assisted by the RGTW while walking on a treadmill in water.
      Conclusion. Using the RGTW could expect not only the effect of the hydrotherapy but also the standard treadmill gait training, in particular, and may be particularly effective for treating individuals with hip joint movement dysfunction.

      Thursday, August 24, 2017

      Hand Robotic Therapy in Children with Hemiparesis

      Demand your doctor followup and get this technology to help your hand recovery.  Reporting medical malpractice might get your stroke hospitals attention.
      http://dl.umsu.ac.ir/handle/Hannan/155840#sthash.mogLN85N.dpbs
      Please use this identifier to cite or link to this item: http://dl.umsu.ac.ir/handle/Hannan/155840
      Title: Hand Robotic Therapy in Children with Hemiparesis
      Authors: Bishop, Lauri Gordon, Andrew M. Kim, Heakyung
      subject: soluble urokinase plasminogen activator
      Year: 2017
      Publisher: 
      Abstract: Objective: The aim of this study was to understand the impact of training with a hand robotic device on hand paresis and function in a population of children with hemiparesis.; Methods: Twelve children with hemiparesis (mean age, 9 [SD, 3.64] years) completed participation in this prospective, experimental, pilot study. Participants underwent clinical assessments at baseline and again 6 weeks later with instructions to not initiate new therapies. After these assessments, participants received 6 weeks of training with a hand robotic device, consisting of 1-hour sessions, 3 times weekly. Assessments were repeated on completion of training.; Results: Results showed significant improvements after training on the Assisting Hand Assessment (mean difference, 2.0 Assisting Hand Assessment units; P = 0.011) and on the upper-extremity component of the Fugl-Meyer scale (raw score mean difference, 4.334; P = 0.001). No significant improvements between pretest and posttest were noted on the Jebsen-Taylor Test of Hand Function, the Quality of Upper Extremity Skills Test, or the Pediatric Evaluation of Disability Inventory after intervention. Total active mobility of digits and grip strength also failed to demonstrate significant changes after training.; Interpretation: Participants tolerated training with the hand robotic device, and significant improvements in bimanual hand use, as well as impairment-based scales, were noted. Improvements were carried over into bimanual skills during play.; To Claim Cme Credits: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES:: Upon completion of this article, the reader should be able to: (1) Understand key components of neuroplasticity; (2) Discuss the benefits of robotic therapy in the recovery of hand function in pediatric patients with hemiplegia; and (3) Appropriately incorporate robotic therapy into the treatment plan of pediatric patients with hemiplegia.; Level: Advanced ACCREDITATION:: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.;
      URI: 
      http://dl.umsu.ac.ir/handle/Hannan/155840

      Tuesday, August 15, 2017

      Robotic Assistance for Training Finger Movement Using a Hebbian Model: A Randomized Controlled Trial

       I could use finger training but since this will never be written up in a stroke protocol I can't take these results to any therapist in the world and get the same results. I'm screwed like all stroke survivors with finger deficits.  Hope you know what Hebbian means.
      http://journals.sagepub.com/doi/abs/10.1177/1545968317721975
      First Published August 14, 2017 Research Article


      Background. Robots that physically assist movement are increasingly used in rehabilitation therapy after stroke, yet some studies suggest robotic assistance discourages effort and reduces motor learning.  
      Objective. To determine the therapeutic effects of high and low levels of robotic assistance during finger training.  
      Methods. We designed a protocol that varied the amount of robotic assistance while controlling the number, amplitude, and exerted effort of training movements. Participants (n = 30) with a chronic stroke and moderate hemiparesis (average Box and Blocks Test 32 ± 18 and upper extremity Fugl-Meyer score 46 ± 12) actively moved their index and middle fingers to targets to play a musical game similar to GuitarHero 3 h/wk for 3 weeks. The participants were randomized to receive high assistance (causing 82% success at hitting targets) or low assistance (55% success). Participants performed ~8000 movements during 9 training sessions.  
      Results. Both groups improved significantly at the 1-month follow-up on functional and impairment-based motor outcomes, on depression scores, and on self-efficacy of hand function, with no difference between groups in the primary endpoint (change in Box and Blocks). High assistance boosted motivation, as well as secondary motor outcomes (Fugl-Meyer and Lateral Pinch Strength)—particularly for individuals with more severe finger motor deficits. Individuals with impaired finger proprioception at baseline benefited less from the training.  
      Conclusions. Robot-assisted training can promote key psychological outcomes known to modulate motor learning and retention. Furthermore, the therapeutic effectiveness of robotic assistance appears to derive at least in part from proprioceptive stimulation, consistent with a Hebbian plasticity model.

      Monday, July 31, 2017

      Mobile robot companion for walking training of stroke patients in clinical post-stroke rehabilitation

      You'll have to ask your doctor what this looks like and how to purchase one. 
      http://ieeexplore.ieee.org/abstract/document/7989124/?reload=true

      Cognitive Robotics Lab, TU Ilmenau, 98684, Ilmenau (Germany)
      Cognitive Robotics Lab, TU Ilmenau, 98684, Ilmenau (Germany)
      Abstract:
      This paper introduces a novel robot-based approach to the stroke rehabilitation scenario, in which a mobile robot companion accompanies stroke patients during their walking self-training. This assistance enables them to move freely in the clinic practicing both their mobility and spatial orientation skills. Based on a set of questions for systematic evaluating the autonomy and practicability of assistive robots and a three-stage approach in conducting function and user tests in the clinical setting, we present the results of user trials performed with N=30 stroke patients in a stroke rehabilitation center between 4/2015 and 3/2016. This allowed us to make an honest inventory of the strengths and weaknesses of the developed robot companion and its already achieved practicability for clinical use. The results of the user studies show that patients and fellow patients were very open-minded and accepted the robotic coach. The robot motivated them for independent training and leaving their room, despite severe consequences of stroke (lower limbs paralysis, speech/language problems, loss of orientation, depression), provided a very self-determined training regime, and encouraged them to expand the radius of their training in the clinic.
      Date of Conference: 29 May-3 June 2017
      Date Added to IEEE Xplore: 24 July 2017
      ISBN Information:
       

      Tuesday, January 31, 2017

      Robotic wrist training after stroke: Adaptive modulation of assistance in pediatric rehabilitation

      So send your doctor after the protocol and equipment used. Each individual doctor wouldn't have to do this if we had a great stroke association keeping track of all research and protocols in a publicly available database.
      http://www.sciencedirect.com/science/article/pii/S0921889016303268
      Choose an option to locate/access this article:
      Check if you have access through your login credentials or your institution
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      Highlights

      Pediatric stroke leads to limb hemiparesis, sensory impairments, and spasticity.
      A 14-year old stroke patient completed in a 3-month wrist robotic training program.
      The robot provided online adaptive modulation of assistance instantaneously during each trial.
      Robot therapy led to positive changes in upper limb motor coordination and function.
      In addition, the patient needed less robot assistance to complete each trial.

      Abstract

      In this paper we present a case study in which a 14-year-old, right-handed stroke patient with severe weakness, spasticity, and motor dysfunction of the left upper extremity participated in a three-month distal robotic training program. The robotic device was compliant to the patients’ movements and was able to modulate the level of assistance continuously throughout the trial (i.e., online adaptive modulation). Standard clinical and robotic evaluations of upper extremity motor performance were conducted before and after robotic training. There were improvements in upper extremity spasticity and motor functions. In addition, robotic training lead to positive changes in wrist active range of motion and kinematics: movements were smoother and there was a noticeable decrease in the level of robotic intervention required to complete each trial. In sum, results of the present case study demonstrate that distal upper extremity robotic rehabilitation that features the proposed adaptive control algorithm promoted positive changes in upper limb motor coordination and function after pediatric stroke.

      Friday, October 21, 2016

      NSF grant supports new approach to gait training for stroke survivors

      There are lots of walking assist devices out there, I have described dozens. Your doctor should know of them and be testing them for the best ones to be implemented in their hospital. But I can guarantee that is not occurring. Your stroke  hospital is a fucking failure, they aren't doing one damn thing about new research and applying it to help survivors.
      http://www.udel.edu/udaily/2016/october/gait-training-stroke-survivors/
      Thirty percent of stroke survivors, including some 300,000 Americans every year, are left with compromised walking ability. As our population ages, these numbers will undoubtedly grow, increasing the already high demand for technology to support gait training.
      “For most stroke survivors who are left with mobility impairments, recovering the ability to walk is at or near the top of their wish list for rehabilitation,” says Darcy Reisman, associate professor of physical therapy at the University of Delaware. “It’s also critical to their being able to live at home again after a stroke.”
      Wearable robots, which use electrically actuated motors to control joint motion, are ideal candidates to automate gait training. However, while great advances have been made in sensing, actuation, and computation, the potential of wearable robots in gait neuro-rehabilitation has not yet been fully realized.
      Fabrizio Sergi, assistant professor of biomedical engineering at UD, says there are challenges in designing assistive forces for wearable robots that are capable of teaching stable and energetically efficient walking patterns while also accommodating variability from one individual to another.
      To address these challenges, Sergi is partnering with Reisman and Jill Higginson, associate professor of mechanical and biomedical engineering at UD. The team was recently awarded a three-year grant from the National Science Foundation’s National Robotics Initiative to develop an approach called GOALL (Goal-Oriented, subject Adaptive, robot-assisted Locomotor Learning).
      GOALL combines biomechanical modeling with experiments using a lower-extremity exoskeleton to determine the robotic assistance forces needed to induce changes in gait parameters like step length and walking speed.
      “We are currently pursuing a new approach to robotic gait training based on pulses of assistive forces,” says Sergi. “In this project, we will determine when to apply pulses, how large those pulses should be, and to which joints they should be applied.”
      Higginson adds, “The robot will have the unique ability to adapt to a patient’s needs as his or her walking improves, just as a therapist would do.”
      The interdisciplinary project combines Sergi’s expertise in robotic systems design and control with Higginson’s knowledge on the use of computational models to relate muscle impairments to gait deviations, as well as Reisman’s clinical perspective on post-stroke rehabilitation. The research methods used and the results obtained from the project will benefit both the robotics and biomechanics communities.

      Friday, June 10, 2016

      Combining Robotic Training and Non-Invasive Brain Stimulation in Severe Upper Limb-Impaired Chronic Stroke Patients

      Damn it all, write up a fucking protocol so it can be critiqued and refined or improved upon.  Because we have no one writing protocols no one knows what else is going on in other areas of the world. As a result stroke survivors are badly served. A great stroke association president would be knocking heads over this lack of professionalism.  And yet our fucking failures of stroke associations  do nothing to solve this problem. DAMN YOU ALL TO HELL!

      Combining Robotic Training and Non-Invasive Brain Stimulation in Severe Upper Limb-Impaired Chronic Stroke Patients

      Vincenzo Di Lazzaro1,2*, Fioravante Capone1,2, Giovanni Di Pino1,2, Giovanni Pellegrino1, Lucia Florio1, Loredana Zollo3, Davide Simonetti3, Federico Ranieri1,2, Nicoletta Brunelli1,2, Marzia Corbetto1,2, Sandra Miccinilli4, Marco Bravi4, Stefano Milighetti4, Eugenio Guglielmelli3 and Silvia Sterzi4
      • 1Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
      • 2Fondazione Alberto Sordi - Research Institute for Ageing, Rome, Italy
      • 3Unit of Biomedical Robotics and Biomicrosystems, Department of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy
      • 4Unit of Physical and Rehabilitation Medicine, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
      Previous studies suggested that both robot-assisted rehabilitation and non-invasive brain stimulation can produce a slight improvement in severe chronic stroke patients. It is still unknown whether their combination can produce synergistic and more consistent improvements. Safety and efficacy of this combination has been assessed within a proof-of-principle, double-blinded, semi-randomized, sham-controlled trial. Inhibitory continuous Theta Burst Stimulation (cTBS) was delivered on the affected hemisphere, in order to improve the response to the following robot-assisted therapy via a homeostatic increase of learning capacity. Twenty severe upper limb-impaired chronic stroke patients were randomized to robot-assisted therapy associated with real or sham cTBS, delivered for 10 working days. Eight real and nine sham patients completed the study. Change in Fugl-Meyer was chosen as primary outcome, while changes in several quantitative indicators of motor performance extracted by the robot as secondary outcomes. The treatment was well-tolerated by the patients and there were no adverse events. All patients achieved a small, but significant, Fugl-Meyer improvement (about 5%). The difference between the real and the sham cTBS groups was not significant. Among several secondary end points, only the Success Rate (percentage of targets reached by the patient) improved more in the real than in the sham cTBS group. This study shows that a short intensive robot-assisted rehabilitation produces a slight improvement in severe upper-limb impaired, even years after the stroke. The association with homeostatic metaplasticity-promoting non-invasive brain stimulation does not augment the clinical gain in patients with severe stroke.

      Introduction

      Severe upper limb impairment in chronic stroke patients does not respond to standard rehabilitation strategies; for this reason there is the need of new treatments that might be effective in patients with drastically limited residual movement capacity. In patients with moderate to severe upper-limb impairment, a slight improvement have been reported using robot-assisted rehabilitative treatment, even years after a stroke (Lo et al., 2010). Another innovative approach for the enhancement of motor recovery is represented by non-invasive human brain stimulation techniques, such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). These techniques can induce long-lasting changes in the excitability of central motor circuits via long-term potentiation/depression (LTP/LTD)-like phenomena (Di Pino et al., 2014b). A recent study reported a mild motor improvement after 10 sessions of rTMS in a group of severe chronic stroke patients (Demirtas-Tatlidedea et al., 2015).
      Aim of present study was to explore whether the combination of these two approaches might enhance their positive effects on motor recovery. To the end of assessing safety and potential efficacy of the combination of robot-assisted rehabilitation and non-invasive brain stimulation in a group of chronic stroke patients with severe upper limb impairment, we designed a proof-of-principle double blinded semi-randomized sham-controlled trial. We used continuous theta burst stimulation (cTBS), a robust form of inhibitory rTMS inducing LTD-like changes lasting for about 1 h [8]. The choice of employing cTBS on the affected hemisphere was based on the findings of our recent study, which suggested that this inhibitory protocol can improve the response to physical therapy (Di Lazzaro et al., 2013). Moreover, rTMS protocols suppressing cortical excitability have been shown to strongly facilitate motor learning in normal subjects (Jung and Ziemann, 2009). Jung and Ziemann suggested that such enhancement might involve the phenomenon of “homeostatic” plasticity, which can be induced in the human brain using a variety of brain stimulation protocols (Karabanov et al., 2015). Considering the close link between LTP and mammalian learning and memory (Malenka and Bear, 2004), an enhancement of learning after LTD induction might appear a paradox. However, the experimental studies by Rioult-Pedotti et al. demonstrated the existence of a homeostatic balance between learning and the induction of LTP/LTD (Rioult-Pedotti et al., 2000), thus showing that the ease of producing synaptic LTP/LTD depends on the prior history of neural activity. In the context of stroke, this predicts that by delivering a rTMS protocol that induces LTD-like effects on the stroke-affected hemisphere before performing rehabilitation, would luckily result in better relearning (Di Pino et al., 2014a).

      Sunday, May 22, 2016

      Accumulated Evidence of Robotic Gait Trainings now included in the AHA Stroke Rehabilitation Guidelines

      You can see how long before your stroke department starts following these.  My doctor at the time thought the Lokomat wasn't any good. I however loved it because it felt like normal walking and the therapists used it constantly.
      https://www.linkedin.com/groups/1774685/1774685-6138302618323136513
      The newest Guidelines for Adult Stroke Rehabilitation and Recovery by the American Heart Association (AHA)/American Stroke Association (ASA) have just been published (Winstein et al. 2016). Whereas in earlier Guidelines, evidence on electromechanically assisted gait training was often considered to be insufficient to draw conclusions, these new Guidelines now cite level A evidence that the benefits of using electromechanical gait trainers for stroke rehabilitation outweigh the harms. Specifically, the following recommendations were made:

      ► Robot-assisted movement training to improve motor function and mobility after stroke in combination with conventional therapy may be considered.
      » Evidence Class IIb (Benefit outweighs risks) level A (Data derived from multiple RCTs or Meta Analyses)
      ► Mechanically assisted walking (treadmill, electromechanical gait trainer, robotic device, servo-motor) with body weight support may be considered for patients who are nonambulatory or have low ambulatory ability early after stroke.
      » Evidence Class IIb (Benefit outweighs risks) level A (Data derived from multiple RCTs or Meta Analyses)
      ► Virtual reality may be beneficial for the improvement of gait.
      » Evidence Class IIb (Benefit outweighs risks) level B (Data derived from a single RCT or nonrandomized studies)

      This is a big step and shows that the research efforts in this field over the past years are starting to affect every-day clinical practice. Congratulations to all those who dedicated their time and efforts to this research for the benefit of our patients. May this success provide motivation to further push the field forward.

      Winstein, C. J. et al. (2016). "Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association." Stroke. Epub ahead of print. May 4th 2016.

      http://stroke.ahajournals.org/content/early/2016/05/04/STR.0000000000000098.abstrac
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