ThedaCare(Neenah,WI) receives Stroke Quality Achievement award

 

Big fucking whoopee.

 

 But you tell us NOTHING ABOUT RESULTS. They remind us they 'care' about us  but never tell us how many 100% recovered.

Three measurements will tell me if the stroke hospital is possibly not completely incompetent; DO YOU MEASURE ANYTHING?

1. tPA full recovery? Better than 12%?
2. 30 day deaths? Better than competitors?

3. rehab full recovery? Better than 10%?

 

You'll want to know results so call that hospital president(Whoever that is) and demand to know what the RESULTS are for; tPA efficacy, 30 day deaths, 100% recovery. Because there is no point in going to that hospital if they are not willing to publish results.

The invalid chest thumping here:

ThedaCare(Neenah,WI) receives Stroke Quality Achievement award

ThedaCare Regional Medical Center-Neenah has achieved the American Heart Association/American Stroke Association’s Get With The Guidelines® Target: Stroke Honor Roll Gold Plus Quality Achievement Award. The award recognizes the hospital’s commitment to ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence.

“We are dedicated to improving the quality of care for our stroke patients by implementing the American Heart Association’s Get With The Guidelines-Stroke initiative,” said Mark Cockley, MD, ThedaCare’s Chief Clinical Officer and President of the Clinically Integrated Network. “The tools and resources help our teams understand each person’s unique medical background and current presentation for treatment. This allows the ThedaCare team to quickly provide the most appropriate research proven treatment. Our goal is to ensure people are able to get back to living their best life, sooner.”

ThedaCare is certified as a Comprehensive Stroke Center, reflecting the highest level of competence for treatment of serious stroke events. The certification affirms that ThedaCare addresses the full spectrum of stroke care – diagnosis, treatment, rehabilitation and education – and establishes clear metrics to evaluate outcomes. Comprehensive stroke centers are typically the best-equipped hospitals in a given geographical area that can treat any kind of stroke or stroke complication. In a growing number of states, stroke center certification determines to which facility a patient should be taken for the most appropriate, reimbursable care.

“By enhancing that coordinated care, we can live our mission of improving the health of the communities, creating peace of mind for all we serve,” said Dr. Cockley. “With stroke care, it is important to have the best teams and resources, and the ability to act organizationally with extreme efficiency because of the time-critical nature of these events. This certification underscores our commitment to providing all patients the level of expertise they deserve.”

ThedaCare earned the award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients at a set level for a designated period. These measures include evaluation of the proper use of medications and other stroke treatments aligned with the most up-to-date, evidence-based guidelines with the goal of speeding recovery, reducing death and disability, and establishing a treatment plan to help stroke patients maximize their recovery and prevent future chances for similar events. Before discharge, patients also receive education on managing their health and schedule a follow up visit, as well as other care transition interventions.

“We are pleased to recognize ThedaCare for their commitment to stroke care,” said Lee H. Schwamm, M.D., national chairperson of the Quality Oversight Committee and Executive Vice Chair of Neurology, Director of Acute Stroke Services, Massachusetts General Hospital, Boston, Massachusetts. “Research has shown that hospitals adhering to clinical measures through the Get With The Guidelines quality improvement initiative can often see fewer readmissions and lower mortality rates.”

The Centers for Disease Control and Prevention (CDC) estimates nearly 800,000 Americans suffer a stroke each year, with 140,000 deaths resulting. Strokes – especially ischemic strokes, which block blood flow to the brain – are the fifth leading cause of death in the U.S., per the CDC.

Hospitals and emergency medical facilities nationally are reporting a significant decrease in the number of patients presenting with stroke symptoms during the current coronavirus pandemic.

“We work hard to keep our patients safe every day, and we want those who think they are having a stroke to feel safe at our hospitals, especially during this time,” said Dr. Cockley. “Again, time is of the essence in treating a stroke. The longer someone waits to receive medical attention, treatment options decrease and disability conditions increase. Delaying emergency care is not an option, and all members of the community should know they can turn to our team for safe emergency stroke care.”

The American Heart Association and ThedaCare are community partners in the first Life is Why sponsorship in Wisconsin. Life is Why is a national brand element which emphasizes an emotional connection to the work of the AHA. The campaign encourages people of all ages, ethnicities and backgrounds to consider what or who they are living for and turn that into their personal motivation for making lifestyle changes that add up to healthier, happier and longer lives with the ones they love.

 

Seated Bilateral Leg Exercise Effects on Hemiparetic Lower Extremity Function in Chronic Stroke

 11 years. WHAT EXACTLY DID YOUR HOSPITAL DO WITH THIS?

Do you prefer your hospital incompetence NOT KNOWING? OR NOT DOING?

You will have to take charge, your hospital is a complete failure.

Seated Bilateral Leg Exercise Effects on Hemiparetic Lower Extremity Function in Chronic Stroke

Show all authors

Leif Johannsen, PhD, Alan Miles Wing, PhD, Trudy Pelton, MRes, ...

First Published October 12, 2009 Other Find in PubMed

https://doi.org/10.1177/1545968309347679

Article information

   

Abstract

Background. 

Bilateral arm training with rhythmic auditory cueing (BATRAC) improves hemiparetic upper extremity (UE) function in stroke. It is unknown whether a similar exercise for the hemiparetic lower extremity (LE) is effective.  

Objective. 

The authors sought to test whether the BATRAC strategy would transfer to the legs by improving LE motor function following ten 30-minute sessions of bilateral leg training with rhythmic auditory cueing (BLETRAC).  

Methods. 

Twenty-four chronic stroke participants, recruited from the community, were randomized to either the BLETRAC or the BATRAC intervention. Assessments were performed before (week 0) and after (week 6) training as well as 3 months later (week 18). Change in the Fugl-Meyer LE and UE subscales served as primary outcomes. Timed 10-m walk, movement parameters during treadmill walking, and a repetitive aiming task for both feet and hands were the secondary outcomes.  

Results. 

Following an intention-to-treat approach, data from 21 subjects were analyzed. After training, improvements in the Fugl-Meyer LE and UE subscales tended to be better for the corresponding intervention group. The BLETRAC group also showed increases in step length during treadmill walking and performance in the repetitive foot and hand aiming tasks. No differences between the intervention groups were found at follow-up.  

Conclusions. 

This exploratory trial demonstrates that transfer of the BATRAC approach to the legs is feasible. Transient improvements of limb motor function in chronic stroke participants were induced by targeted exercise (BATRAC for the UE and BLETRAC for the LE). It may be that further periods of training would increase and maintain effects.

 

Cooperative Hand Movements and their Potential for Stroke Rehabilitation

 You can read the 134 page thesis on your own.

Cooperative Hand Movements and their Potential for Stroke Rehabilitation

Trends in prevalence of acute stroke impairments: A population-based cohort study using the South London Stroke Register

Oh well, useless. ABSOLUTELY NOTHING ON HOW TO FIX THESE PROBLEMS.

Here is my list of stroke problems needing fixes. Which ones is your stroke hospital solving?

The current state of stroke is a complete failure. None of the following have cures. 

1. 30% get spasticity NOTHING THAT WILL CURE IT.

2. At least half of all stroke survivors experience fatigue Or is it 70%?

Or is it 40%?

NOTHING THAT WILL CURE IT.

3. Over half of stroke patients have attention problems.

NOTHING THAT WILL CURE IT.

NO PROTOCOLS THAT WILL CURE IT.

4.  The incidence of constipation was 48%.

NO PROTOCOLS THAT WILL CURE IT.

5. No EXACT stroke protocols that address any of your muscle limitations.

6. Poststroke depression(33% chance)

NO PROTOCOLS THAT WILL ADDRESS IT. 

7.  Poststroke anxiety(20% chance) NO PROTOCOLS THAT WILL ADDRESS IT. 

8. Posttraumatic stress disorder(23% chance)  NO PROTOCOLS THAT WILL ADDRESS IT.

  9.  12% tPA efficacy for full recovery NO ONE IS WORKING ON SOMETHING BETTER.

10.  10% seizures post stroke NO PROTOCOLS THAT WILL ADDRESS IT. 

11. 21% of patients had developed cachexia NO PROTOCOLS THAT WILL ADDRESS IT. 

 

12. You lost 5 cognitive years from your stroke  NO PROTOCOLS THAT WILL ADDRESS IT.

13.  33% dementia chance post-stroke from an Australian study?

       Or is it 17-66%?

       Or is it 20% chance in this research?

NO PROTOCOLS THAT WILL ADDRESS THIS

But the latest here:

Trends in prevalence of acute stroke impairments: A population-based cohort study using the South London Stroke Register

• Amanda Clery ,
• Ajay Bhalla,
• Anthony G. Rudd,
• Charles D. A. Wolfe,
• Yanzhong Wang

• Amanda Clery, 
• Ajay Bhalla, 
• Anthony G. Rudd, 
• Charles D. A. Wolfe, 
• Yanzhong Wang

x

• Published: October 9, 2020
• https://doi.org/10.1371/journal.pmed.1003366

• Article
• Authors
• Metrics
• Comments
• Media Coverage
• Peer Review

•  

Methods and findings

Acute stroke impairments often result in poor long-term outcome for stroke
survivors. The aim of this study was to estimate the trends over time in
 the prevalence of these acute stroke impairments.

All first-ever stroke patients recorded in the South London Stroke Register (SLSR) between 2001 and 2018 were included in this cohort study. Multivariable Poisson regression models with robust error variance were used to estimate the adjusted prevalence of 8 acute impairments, across six 3-year time cohorts. Prevalence ratios comparing impairments over time were also calculated, stratified by age, sex, ethnicity, and aetiological classification (Trial of Org 10172 in Acute Stroke Treatment [TOAST]). A total of 4,683 patients had a stroke between 2001 and 2018. Mean age was 68.9 years, 48% were female, and 64% were White. After adjustment for demographic factors, pre-stroke risk factors, and stroke subtype, the prevalence of 3 out of the 8 acute impairments declined during the 18-year period, including limb motor deficit (from 77% [95% CI 74%–81%] to 62% [56%–68%], p < 0.001), dysphagia (37% [33%–41%] to 15% [12%–20%], p < 0.001), and urinary incontinence (43% [39%–47%) to 29% [24%–35%], p < 0.001). Declines in limb impairment over time were 2 times greater in men than women (prevalence ratio 0.73 [95% CI 0.64–0.84] and 0.87 [95% CI 0.77–0.98], respectively). Declines also tended to be greater in younger patients. Stratified by TOAST classification, the prevalence of all impairments was high for large artery atherosclerosis (LAA), cardioembolism (CE), and stroke of undetermined aetiology. Conversely, small vessel occlusions (SVOs) had low levels of all impairments except for limb motor impairment and dysarthria. While we have assessed 8 key acute stroke impairments, this study is limited by a focus on physical impairments, although cognitive impairments are equally important to understand. In addition, this is an inner-city cohort, which has unique characteristics compared to other populations.

Conclusions

In this study, we found that stroke patients in the SLSR had a complexity of acute impairments, of which limb motor deficit, dysphagia, and incontinence have declined between 2001 and 2018. These reductions have not been uniform across all patient groups, with women and the older population, in particular, seeing fewer reductions.

Author summary

Why was this study done?

• Stroke is one of the top 5 causes of disability globally.
• We do not know how the different types of disability caused by stroke have improved or changed over time.

What did the researchers do and find?

• We analysed the changes in the prevalence of 8 different stroke impairments between 2001 and 2018 in a total of 4,683 stroke patients.
• Over time, fewer people experienced limb impairment, dysphagia (swallowing difficulties), and incontinence, but the other 5 impairments did not decline over time. These were visual field defect, neglect, sensory loss, dysphasia, and dysarthria.
• The people who tended to continue experiencing these impairments over time were older and female patients.

What do these findings mean?

• The type and number of disabilities that stroke patients in our study population face has changed over time.
• This has implications for how patients are cared for by clinicians in the short term and how the needs of stroke survivors are addressed by public health policy in the long term.

Figures

   

Citation: Clery A, Bhalla A, Rudd AG, Wolfe CDA, Wang Y (2020) Trends in prevalence of acute stroke impairments: A population-based cohort study using the South London Stroke Register. PLoS Med 17(10): e1003366. https://doi.org/10.1371/journal.pmed.1003366

Academic Editor: Joshua Z. Willey, Columbia University, UNITED STATES

Received: May 14, 2020; Accepted: August 31, 2020; Published: October 9, 2020

Copyright: © 2020 Clery et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The raw data for this study contain both personally identifiable and confidential clinical data. The participants of the study did not consent to sharing the information publicly, and our ethical approvals require strict information governance procedures. Requests for data access for academic use should be made to the South London Stroke Register, where data will be made available subject to academic review and acceptance of a data-sharing agreement. Information can be found/requested through the following link: https://www.kcl.ac.uk/lsm/research/divisions/hscr/research/groups/stroke.

 

Capital Health(TRENTON, NJ) Earns National Recognition for Excellence in Stroke Care

Big fucking whoopee.

 

 But you tell us NOTHING ABOUT RESULTS. They remind us they 'care' about us  but never tell us how many 100% recovered.

Three measurements will tell me if the stroke hospital is possibly not completely incompetent; DO YOU MEASURE ANYTHING?

1. tPA full recovery? Better than 12%?
2. 30 day deaths? Better than competitors?

3. rehab full recovery? Better than 10%?

 

You'll want to know results so call that hospital president(Whoever that is) and demand to know what the RESULTS are for; tPA efficacy, 30 day deaths, 100% recovery. Because there is no point in going to that hospital if they are not willing to publish results.

The invalid chest thumping here:

 

Capital Health(TRENTON, NJ) Earns National Recognition for Excellence in Stroke Care

TRENTON, N.J., Oct. 9, 2020 /PRNewswire/ -- Capital Health Regional Medical Center (RMC) has received the American Heart Association/American Stroke Association's Get With The Guidelines®-Stroke Gold Plus Award. This award recognizes the hospital's commitment and success in ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence.

"When the residents of our community need the most advanced stroke care in the region, they look to Capital Health," said Al Maghazehe, president and CEO of Capital Health. "Over the last decade, we have made an unparalleled commitment to providing high level stroke care. Our recognition through the American Heart Association's Get with the Guidelines-Stroke initiative at RMC demonstrates that we never stop working to improve the high quality of care we offer our stroke patients."

According to the American Heart Association/American Stroke Association, stroke is the fifth leading cause of death in the United States and a leading cause of adult disability. According to the Centers for Disease Control and Prevention, someone suffers a stroke every 40 seconds and more than 795,000 people suffer a new or recurrent stroke each year.

Capital Health Regional Medical Center earned the Get With The Guidelines® Stroke Gold Plus Award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients at a set level for a designated period. These measures include evaluation of the proper use of medications and other stroke treatments aligned with the most up-to-date, evidence-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients. Before discharge, patients should also receive education on managing their health, get a follow-up visit scheduled, as well as other care transition interventions

Additionally, RMC received the American Heart Association/American Stroke Association's Target: Stroke^SM Honor Roll Elite award. To qualify for this recognition, hospitals must meet quality measures developed to reduce the time between the patient's arrival at the hospital and treatment with the clot-buster tissue plasminogen activator, or tPA, the only drug approved by the U.S. Food and Drug Administration to treat ischemic stroke.

Capital Health Regional Medical Center, located in Trenton, New Jersey, is the only Comprehensive Stroke Center in the region certified by The Joint Commission, and one of only nine such hospitals in New Jersey. As part of Capital Health's Capital Institute for Neurosciences, it is available for patients who require the most advanced treatments for neurovascular and stroke care including neuroendovascular, neurosurgical and stroke services. In addition, Capital Health launched its innovative Mobile Stroke Unit in early 2017, designed to bring time-critical stroke care to patients at their home, or wherever it is dispatched to assess them. When it first went into service, Capital Health's Mobile Stroke Unit was the first unit of its kind in New Jersey, Pennsylvania or the Delaware Valley and just the seventh in the United States.

If you or a loved one is experiencing signs and symptoms of a stroke, call 911 immediately. To learn more about Capital Health's commitment to providing advanced care for stroke patients and those with other complex disorders of the brain and spine, visit capitalneuro.org.

SOURCE Capital Health

 

Development of a whole arm wearable robotic exoskeleton for rehabilitation and to assist upper limb movements Development of a whole arm wearable robotic exoskeleton for rehabilitation and to assist upper limb movements

6 years, what happened with this? And doing this with healthy subjects is useless.

Do you prefer your hospital incompetence NOT KNOWING? OR NOT DOING?

 

Development of a whole arm wearable robotic exoskeleton for rehabilitation and to assist upper limb movements Development of a whole arm wearable robotic exoskeleton for rehabilitation and to assist upper limb movements

 
http://journals.cambridge.org
Downloaded: 30 Jan 2014IP address: 70.24.216.160
Robotica: page 1 of 21. © Cambridge University Press 2014doi:10.1017/S0263574714000034
 M. H. Rahman
†
,
‡
∗
, M. J. Rahman
†
, O. L. Cristobal
†
,M. Saad
†
, J. P. Kenn´e
†
 and P. S. Archambault
‡
,
§
†
 Department of Electrical Engineering, ´  Ecole de Technologie Sup´ erieure (ETS), Montr ´ eal, Canada
‡
School of Physical & Occupational Therapy, McGill University, Montr ´ eal, Canada
§
 Interdisciplinary Research Center in Rehabilitation (CRIR), Montr ´ eal, Canada
(Accepted December 22, 2013)
SUMMARY
To assist physically disabled people with impaired upper limb function, we have developed a new7-DOF exoskeleton-type robot named
 Motion Assistive Robotic-Exoskeleton for Superior Extremity
(ETS-MARSE) to ease daily upper limb movements and to provide effective rehabilitation therapy to the superior extremity. The ETS-MARSE comprises a shoulder motion support part, an elbow and forearm motion support part, and a wrist motion support part. It is designed to be worn on the lateral side of the upper limb in order to provide naturalistic movements of the shoulder (vertical and horizontal flexion/extension and internal/external rotation), elbow (flexion/extension), forearm(pronation/supination), and wrist joint (radial/ulnar deviation and flexion/extension). This paper focuses on the modeling, design, development, and control of the ETS-MARSE. Experiments were carried out with healthy male human subjects in whom trajectory tracking in the form of passive rehabilitation exercises (i.e., pre-programmed trajectories recommended by a therapist/clinician)were carried out. Experimental results show that the ETS-MARSE can efficiently perform passiverehabilitation therapy.KEYWORDS: Robotic exoskeleton; Nonlinear control; Physical disability; Passive rehabilitation;Upper limb impairment.
1. Introduction
Upper limb impairment(such as full or partial loss of function in shoulder joint, elbow joint, and wrist joint movements) is very common in the elderly, but can also be a secondary effect due to strokes,cardiovascular diseases, trauma, sports injuries, occupational injuries, and spinal cord injuries. A proper functioning of the upper limb is very important for the performance of essential daily activities. According to the World Health Organization, each year strokes and cardiovascular diseases affect more than 15 million people worldwide.⁵Of these, 85% of stroke survivors incur acute arm impairment,and 40% are chronically impaired or permanently disabled, thereby placing burden on the family and community.⁸Rehabilitation programs are the main method to promote functional recovery in these subjects.¹¹Since the number of such cases is constantly growing, and the treatment duration is long,requiring skilled therapists or clinicians, introducing robots could therefore significantly contribute to the success of these programs in providing very efficient passive and tireless rehabilitation for long a period of time as the proposed Motion Assistive Robotic-Exoskeleton for Superior Extremity
( ETS-MARSE ) demonstrates.It has been shown in several studies that intensive and repetitive therapies significantly improve motor skills.¹³Further studies have revealed that enhanced motor learning occurs when patients
* Corresponding author. E-mail: mhrahman@ieee.org
 

Pushing the limits of recovery in chronic stroke survivors: a descriptive qualitative study of users perceptions of the Queen Square Upper Limb Neurorehabilitation Programme

Oh my God, measuring perceptions NOT RESULTS!

Pushing the limits of recovery in chronic stroke survivors: a descriptive qualitative study of users perceptions of the Queen Square Upper Limb Neurorehabilitation ProgrammePushing the limits of recovery in chronic stroke survivors: a descriptive qualitative study of users perceptions of the Queen Square Upper Limb Neurorehabilitation Programme

1. Kate Kelly1,
2. Fran Brander1,
3. Amanda Strawson1,
4. Nick Ward1,2,
5. http://orcid.org/0000-0001-5240-3264Kathryn Hayward3

Author affiliations

Abstract

Introduction The Queen Square Upper Limb (QSUL) Neurorehabilitation Programme is a clinical service within the National Health Service in the UK that provides 90-hours of therapy over 3-weeks to stroke survivors with persistent upper limb impairment. This study aimed to explore the perceptions of participants of this programme, including clinicians, stroke survivors and caregivers.

Design Descriptive qualitative. Data analysis was performed using a conventional thematic content approach to identify main themes by four researchers to avoid any potential bias or personal motivations, promoting confirmability.

Setting Clinical outpatient neurorehabilitation service.

Participants Clinicians (physiotherapists, occupational therapists, rehabilitation assistants) involved in the delivery of the QSUL Programme, as well as stroke survivors and caregivers who had participated in the programme were purposively sampled. Each focus group followed a series of semi-structured, open questions that were tailored to the clinical or stroke group. One independent researcher facilitated all focus groups, which were audio-recorded and transcribed verbatim by a professional transcription agency.

Results Four focus groups were completed: three including stroke survivors (n=16) and caregivers (n=2), and one including clinicians (n=11). The main stroke survivor themes related to psychosocial aspects of the programme (‘you feel valued as an individual’), as well as the behavioural training provided (‘gruelling, yet rewarding’). The main clinician themes also included psychosocial aspects of the programme (‘patient driven ethos—no barriers, no rules’) and knowledge, skills and resources of clinicians (‘it is more than intensity, it is complex’).

Conclusions As an intervention, stroke survivors and clinicians consider the QSUL Programme to be both comprehensive and complex. The nature of the interventions in the programme spans psychosocial and behavioural domains. We suggest the future clinical trials of upper limb rehabilitation consider testing the efficacy of these multiple interacting components.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

View Full Text

http://dx.doi.org/10.1136/bmjopen-2019-036481

 

 

Characterization and wearability evaluation of a fully portable wrist exoskeleton for unsupervised training after stroke

 'Wearability'? WHAT FUCKING CRAPOLA RESEARCH IS THAT? Do you not understand that survivors want recovery results? Testing using only two survivors is another failure point.

Characterization and wearability evaluation of a fully portable wrist exoskeleton for unsupervised training after stroke

• Charles Lambelet,
• Damir Temiraliuly,
• Marc Siegenthaler,
• Marc Wirth,
• Daniel G. Woolley,
• Olivier Lambercy,
• Roger Gassert &
• Nicole Wenderoth 

Journal of NeuroEngineering and Rehabilitation volume 17, Article number: 132 (2020) Cite this article

• 99 Accesses

• 1 Altmetric

• Metrics details

Abstract

Background

Chronic hand and wrist impairment are frequently present following stroke and severely limit independence in everyday life. The wrist orientates and stabilizes the hand before and during grasping, and is therefore of critical importance in activities of daily living (ADL). To improve rehabilitation outcomes, classical therapy could be supplemented by novel therapies that can be applied in unsupervised settings. This would enable more distributed practice and could potentially increase overall training dose. Robotic technology offers new possibilities to address this challenge, but it is critical that devices for independent training are easy and appealing to use. Here, we present the development, characterization and wearability evaluation of a fully portable exoskeleton for active wrist extension/flexion support in stroke rehabilitation.

Methods

First we defined the requirements, and based on these, constructed the exoskeleton. We then characterized the device with standardized haptic and human-robot interaction metrics. The exoskeleton is composed of two modules placed on the forearm/hand and the upper arm. These modules weigh 238 g and 224 g, respectively. The forearm module actively supports wrist extension and flexion with a torque up to 3.7 Nm and an angular velocity up to 530 deg/s over a range of 154^∘. The upper arm module includes the control electronics and battery, which can power the device for about 125 min in normal use. Special emphasis was put on independent donning and doffing of the device, which was tested via a wearability evaluation in 15 healthy participants and 2 stroke survivors using both qualitative and quantitative methods.

Results

All participants were able to independently don and doff the device after only 4 practice trials. For healthy participants the donning and doffing process took 61 ±15 s and 24 ±6 s, respectively. The two stroke survivors donned and doffed the exoskeleton in 54 s/22 s and 113 s/32 s, respectively. Usability questionnaires revealed that despite minor difficulties, all participants were positive regarding the device.

Conclusions

This study describes an actuated wrist exoskeleton which weighs less than 500 g, and which is easy and fast to don and doff with one hand. Our design has put special emphasis on the donning aspect of robotic devices which constitutes the first barrier a user will face in unsupervised settings. The proposed device is a first and intermediate step towards wearable rehabilitation technologies that can be used independently by the patient and in unsupervised settings.

Background

Stroke affects approximately 795’000 people each year in the US alone and is one of the leading causes of long-term adult disability and dependency [1]. Traditional stroke rehabilitation options for outpatients include therapist-based treatments with hands-on physical and occupational therapy in rehabilitation centres. The treatment lasts several weeks and is composed of periodic blocked practice, but overall training time remains low compared to the time the patient is inactive at home [2, 3]. Moreover, stroke patients are discharged at an increasingly early stage [4, 5] requiring new approaches for rehabilitation training in unsupervised settings. These novel approaches must be effective [6, 7], and empower patients to self-initiate rehabilitation training that will enable more distributed sessions. This is particularly important since, in the future, more rehabilitation resources will be moved to community settings and patient homes to complement conventional therapy [8–11].

Upper extremity hemiparesis is a common weakness following stroke and heavily impairs ADL [12]. Adequate wrist function is critical for orientating and stabilising the hand [13], but the recovery process of this specific joint is still not well understood in stroke survivors [14]. It has been shown that the probability of recovering distal functions (e.g. the wrist) are closely linked with the acute state of proximal functions (shoulder or elbow) [15]. In the same vein, distal training can lead to positive effects at the shoulder and elbow [16–18]. While the hand has received a lot of attention from the research community, there remains a need to provide wrist function training.

Robot-assisted therapy for stroke patients is a promising approach [19, 20] and proven advantages include: 1) increasing dose and intensity of training [21–23], 2) allowing quantitative measurements to assess performance and recovery of the patient more precisely than conventional rehabilitation training [24], and 3) engaging the patient in a motivating and stimulating environment [25, 26]. However, a robot-mediated therapy administered in unsupervised settings implies several technical, clinical and social challenges: first of all, the technology must be safe to be deployed in such a context, its footprint acceptable to the patient, relatives and caregivers, and it should adhere to conventional therapy principles to administer appropriate treatment to the user. Moreover, the device must be adaptable to the individual and designed such that patients can use it independently and in various environmental settings [27–29].

A myriad of devices have targeted training of the whole arm, and also more specifically the hand and fingers [19, 20, 30], while relatively few wearable exoskeletons have focused on the wrist [31–35]. Unlike stationary rehabilitation devices [36–38], a fully wearable exoskeleton offers the possibility to use (i.e. to train) the paretic limb during functional everyday tasks [7, 39, 40] where higher training dose could more conveniently be achieved. Exoskeletons interact at the level of individual joints and enable joint specific kinematic assessments [41, 42]. Moreover, it has been shown that training isolated individual joint movements facilitates learning complex multi-joint movements [43, 44]. Practically, this means that through the “part-whole transfer paradigm” simple low degree of freedom (DoF) robotic devices could facilitate the training of more complex movements. In an unsupervised training context, simplicity is paramount [45], therefore, simple wearable technologies might provide an interesting add-on to a conventional therapy where complex movements are trained.

We have previously presented a first prototype version of the eWrist [46]. Here we present further developments which focussed on improving portability, independence of use and adaptability in view of unsupervised use of the system. The eWrist is a fully wearable single DoF sEMG-based force controlled wrist exoskeleton that actively supports extension and flexion. We put special emphasis on the attachment mechanisms that facilitate the donning and doffing of the device so that a hemiparetic patient could mount the device independently with a single hand. Among the vast amount of published work on rehabilitation devices for in-home therapy, few have addressed the fixation issue, which constitutes the first barrier a user would have to overcome in order to use the device independently [47, 48]. Currently the eWrist is intended to be used as a training device rather than as an assistive exoskeleton during ADL. However, our long term design goal is to fuse training and assistance with the aim of increasing movement of the affected arm in daily life via technology that modulates assistance in order to improve upper arm function. This requires an exoskeleton that is fully wearable, easy to use, and especially simple to don and doff. The eWrist is our first wearable prototype that is capable of assisting wrist flexion and extension, the latter being particularly relevant for post stroke recovery [49].

Here we briefly describe the previous eWrist version, we then outline requirements for a fully wearable wrist exoskeleton and present an advanced eWrist device where we focussed on wearability improvements. We first characterize the current implementation based on standardized haptic and human-robot interaction metrics for rehabilitation devices. Secondly, we present the results of a wearability study which evaluates the donning/doffing procedure in healthy and stroke participants. Finally, limitations of the current work and potential future use of the eWrist are discussed.

 

Welcoming back my arm: affective touch increases body ownership following right-hemisphere stroke

Well shit this is no different than what Margaret Yekutiel wrote a whole book about this in 2001, 'Sensory Re-Education of the Hand After Stroke'. And I bet your stroke hospital has DONE NOTHING with this in the ensuing 19 years. THAT IS INCOMPETENCE BY ANY DEFINITION!

Welcoming back my arm: affective touch increases body ownership following right-hemisphere stroke

Paul M Jenkinson  ¹ , Cristina Papadaki  ² , Sahba Besharati  ^{3   4} , Valentina Moro  ⁵ , Valeria Gobbetto  ⁵ , Laura Crucianelli  ^{2   6} , Louise P Kirsch  ^{2   7} , Renato Avesani  ⁸ , Nick S Ward  ⁹ , Aikaterini Fotopoulou  ²

Affiliations

• PMID: 32954292
• PMCID: PMC7425337
• DOI: 10.1093/braincomms/fcaa034

Free PMC article

Abstract

Right-hemisphere stroke can impair the ability to recognize one's contralesional body parts as belonging to one's self. The study of this so-called 'disturbed sense of limb ownership' can provide unique insights into the neurocognitive mechanisms of body ownership. In this study, we address a hypothesis built upon experimental studies on body ownership in healthy volunteers. These studies have shown that affective (pleasant) touch, an interoceptive modality associated with unmyelinated, slow-conducting C-tactile afferents, has a unique role in the sense of body ownership. In this study, we systematically investigated whether affective touch stimulation could increase body ownership in patients with a disturbed sense of limb ownership following right-hemisphere stroke. An initial feasibility study in 16 adult patients with acute stroke enabled us to optimize and calibrate an affective touch protocol to be administered by the bedside. The main experiment, conducted with a different sample of 26 right hemisphere patients, assessed changes in limb ownership elicited following self- (patient) versus other- (experimenter) generated tactile stimulation, using a velocity known to optimally activate C-tactile fibres (i.e. 3 cm/s), and a second velocity that is suboptimal for C-tactile activation (i.e. 18 cm/s). We further examined the specificity and mechanism of observed changes in limb ownership in secondary analyses looking at (i) the influence of perceived intensity and pleasantness of touch, (ii) touch laterality and (iii) level of disturbed sense of limb ownership on ownership change and (iv) changes in unilateral neglect arising from touch. Findings indicated a significant increase in limb ownership following experimenter-administered, C-tactile-optimal touch. Voxel-based lesion-symptom mapping identified damage to the right insula and, more substantially, the right corpus callosum, associated with a failure to increase body ownership following experimenter-administered, affective touch. Our findings suggest that affective touch can increase the sense of body-part ownership following right-hemisphere stroke, potentially due to its unique role in the multisensory integration processes that underlie the sense of body ownership.

Keywords: DSO; affective touch; body ownership; interoception; multisensory integration.

© The Author(s) (2020). Published by Oxford University Press on behalf of the Guarantors of Brain.

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Graphical Abstract

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Schematic representation of the study…

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Raincloud plot illustrating change in…

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Lesion analysis. ( A )…