Hand Measurement System Based on Haptic and Vision Devices towards Post-Stroke Patients.

Diagnostics of a hand requires measurements of kinematics and joint limits. The standard tools for this purpose are manual devices such as goniometers which allow measuring only one joint simultaneously, making the diagnostics time-consuming. The paper presents a system for automatic measurement and computer presentation of essential parameters of a hand. Constructed software uses an integrated vision system, a haptic device for measurement, and has a web-based user interface. The system provides a simplified way to obtain hand parameters, such as hand size, wrist, and finger range of motions, using the homogeneous-matrix-based notation. The haptic device allows for active measurement of the wrist's range of motion and additional force measurement. A study was conducted to determine the accuracy and repeatability of measurements compared to the gold standard. The system functionality was confirmed on five healthy participants, with results showing comparable results to manual measurements regarding fingers' lengths. The study showed that the finger's basic kinematic structure could be measured by a vision system with a mean difference to caliper measurement of 4.5 mm and repeatability with the Standard Deviations up to 0.7 mm. Joint angle limits measurement achieved poorer results with a mean difference to goniometer of 23.6º. Force measurements taken by the haptic device showed the repeatability with a Standard Deviation of 0.7 N. The presented system allows for a unified measurement and a collection of important parameters of a human hand with therapist interface visualization and control with potential use for post-stroke patients' precise rehabilitation.

The Role of Supplementation with Natural Compounds in Post-Stroke Patients.

Malnutrition is a serious problem in post-stroke patients. Importantly, it intensifies with hospitalization, and is related to both somatic and psychological reasons, as well as is associated with the insufficient knowledge of people who accompany the patient. Malnutrition is a negative prognostic factor, leading to a reduction in the quality of life. Moreover, this condition significantly extends hospitalization time, increases the frequency of treatment in intensive care units, and negatively affects the effectiveness of rehabilitation. Obtaining growing data on the therapeutic effectiveness of new compounds of natural origin is possible through the use of pharmacodynamic and analytical methods to assess their therapeutic properties. The proper supply of nutrients, as well as compounds of natural origin, is an important element of post-stroke therapy, due to their strong antioxidant, anti-inflammatory, neuroprotective and neuroplasticity enhancing properties. Taking the above into account, in this review we present the current state of knowledge on the benefits of using selected substances of natural origin in patients after cerebral stroke.

Th17-Related Cytokines as Potential Discriminatory Markers between Neuromyelitis Optica (Devic's Disease) and Multiple Sclerosis-A Review.

Multiple sclerosis (MS) and Devic's disease (NMO; neuromyelitis optica) are autoimmune, inflammatory diseases of the central nervous system (CNS), the etiology of which remains unclear. It is a serious limitation in the treatment of these diseases. The resemblance of the clinical pictures of these two conditions generates a partial possibility of introducing similar treatment, but on the other hand, a high risk of misdiagnosis. Therefore, a better understanding and comparative characterization of the immunopathogenic mechanisms of each of these diseases are essential to improve their discriminatory diagnosis and more effective treatment. In this review, special attention is given to Th17 cells and Th17-related cytokines in the context of their potential usefulness as discriminatory markers for MS and NMO. The discussed results emphasize the role of Th17 immune response in both MS and NMO pathogenesis, which, however, cannot be considered without taking into account the broader perspective of immune response mechanisms.

The Relationship between Cognitive Dysfunction and Postural Stability in Multiple Sclerosis.

Background and Objectives: Multiple Sclerosis (MS) is a demyelinating disease of the central nervous system (CNS), most commonly characterized by balance dysfunction, fatigue syndrome and cognitive impairment. The goal of our study was to determine the association between cognitive functions and static posture control. Materials and Methods: The research group consisted of 76 randomized MS patients (ICDG 35.0) hospitalized at the Neurological Rehabilitation Clinic of the Medical University of Lodz. This group was divided into three subgroups according to the cognitive assessment based on the Mini Mental State Examination (MMSE) for patients over 65 years of age and the Montreal Cognitive Assessment (MoCA) under the age of 65. Fatigue syndrome was assessed using the Fatigue Severity Scale (FSS), and postural stability using a stabilometric platform. Results: The men demonstrated poorer stabilometric platform measurements than the women. Statistically significant differences were observed between patients without dysfunction and severe cognitive impairment. The results of the stabilometric platform were found to correlate with body mass index in all three groups of patients (Spearman's test). Conclusions: Body mass index and cognition have impact on postural stability in MS patients with moderate disability and fatigue syndrome.

[Brain stroke - risk of disability and possibilities of improvment in motor and cognitive functioning]. / Udar mózgu ­ ryzyko niepelnosprawnosci oraz mozliwosci poprawy funkcji motorycznych i poznawczych.

Diseases of the central nervous system are the most common cause of mobility and cognitive impairment. Stroke is the leading cause of hospitalization in the Neurological Rehabilitation Departments. Age increases the risk of stroke, therefore monitoring basic medical parameters, including blood pressure especially under age of 65, is a very important part of preventive healthcare. According to data from the National Association of Stroke, in 10% of patients after brain stroke, recovery of motor functions and mental state is almost complete, in 25% impairment is minimal, in 40% the functional and cognitive disability is moderated or significant therefore requires rehabilitation, in 10% in view of impossibility of active rehabilitation patients requires comprehensive nursing care service at home or in special long term care centers. Early mortality after stroke is about 15% of patients. Neurological rehabilitation after the incident of stroke is based on a multidisciplinary, individual approach to the problems arising directly from the consequences of stroke as well as comorbidities and social conditions and welfare in order to enable the best level of functioning at home and in society. The article discusses motor and cognitive impairment, which is important from neurological rehabilitation point of view as well as opportunities for their improvement. In addition, the work includes a description of the major risk factors for stroke, together with chosen predisposing genes statement.

Extracorporeal Shockwave Treatment as Additional Therapy in Patients with Post-Stroke Spasticity of Upper Limb-A Narrative Review.

Stroke is a severe injury of the central nervous system (CNS) and one of the leading causes of long-term disability and mortality. One of the main symptoms of neurological diseases is spasticity. This is defined as a motor condition characterized by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks and resulting in the hyperexcitability of the stretch reflex. Rehabilitation after a stroke is focused on relearning lost skills and regaining independence. Many new methods in neurorehabilitation have been introduced. This review concentrates on the current evidence for extracorporeal shockwave therapy (ESWT) as a noninvasive alternative to treat spasticity. We present the effect of EWST and radial EWST interventions to post-stroke patients with spasticity in the upper limb. Our collected data suggest that different parameters of shockwaves can be used to achieve functional improvementsin the upper limb after a stroke. Our accumulated data imply that ESWT is safe and can be used for pain relief, reduced muscle tension, and an increased range of motion. According to many studies, complications after shockwave treatment are infrequent. Transient complications after shockwave therapy (ESWT) include redness, tingling, pain, and bruising. We reviewed clinical trials that present the possible benefits in upper-limb function after shockwave therapy for post-stroke patients. In this article, we used many database search engines, including PEDro. In the stroke rehabilitation literature, a key methodological problem is the design of double-blind studies, which very often are not feasible.

Intracranial Hemorrhage-Is Very Early Rehabilitation Safe? A Narrative Review.

Intracerebral hemorrhage (ICH) is a serious neurological disease with a 30-day mortality rate of 34-50%. Rehabilitation can reduce disability and improve recovery from a stroke; however, it is uncertain whether early rehabilitation is safe. There are many studies and reviews on rehabilitation for chronic conditions, but there is not enough information on the details of rehabilitation in the acute and subacute phases of ICH. We analyzed clinical trials from the electronic databases PubMed, PubMedCentral, Medline, Cochrane Library, Embase, Scopus and PEDro. Based on the data, we determined that early rehabilitation of patients with ICH has beneficial effects on improving ADL scores, motor function, functional independence, quality of life, improved gait, improved trunk control and reduced mortality. Varying the duration and intensity of rehabilitation in patients with ICH may improve health status, functional outcomes and reduce the length of stay in the hospital. The earliest protocol for initiating rehabilitation after ICH included up to 24 h after stroke onset. The medical literature indicates the need for more randomized controlled group trials of early rehabilitation in patients with acute and subacute ICH with a precise timing of rehabilitation initiation. This narrative review aims to summarize the existing evidence and provide insights into the current state of knowledge regarding the safety of early rehabilitation. There is a need for a clear definition of "early rehabilitation" when determining the most appropriate time to begin rehabilitation therapy.

Objectivizing Measures of Post-Stroke Hand Rehabilitation through Multi-Disciplinary Scales.

There is a wide variety of tools and measures for rehabilitation outcomes in post-stroke patients with impairments in the upper limb and hand, such as paralysis, paresis, flaccidity, and spasticity. However, there is a lack of general recommendations for selecting the most appropriate scales, tests, and instruments to objectively evaluate therapy outcomes. Reviews on upper limb and hand measurements reveal that clinicians' choices of tools and methods are highly varied. Some clinicians and medical teams continue to employ non-standard and unverified metrics in their research and measurements. This review article aims to identify the key parameters, assessed by outcome measures and instruments, that play a crucial role in upper limb and hand rehabilitation for post-stroke patients, specifically focusing on the recovery of hand function. The review seeks to assist researchers and medical teams in selecting appropriate outcome measures when evaluating post-stroke patients. We analyze the measured factors and skills found in these outcome measures and highlight useful tools that diversify assessments and enhance result objectivity through graphical representation. The paper also describes trends and new possibilities in hand outcome measures. Clinicians frequently use proven devices, such as EMG, goniometers, and hand dynamometers. Still, there is a growing trend towards incorporating technologies, such as pose and position estimation, using artificial intelligence, or custom hand grip measurement devices. Researchers are increasingly adopting scales previously successful in orthopedic and surgical patients, recognizing their potential for objectivizing outcomes in neurological patients with post-stroke hand complications. The review included only adults over the age of 18. Outcome measures were tested for usefulness in the rehabilitation of stroke patients.

Impact of Moderate Individually Tailored Physical Activity in Multiple Sclerosis Patients with Fatigue on Functional, Cognitive, Emotional State, and Postural Stability.

Multiple sclerosis (MS) is a chronic disease, with fatigue syndrome as one of the main symptoms. The aim of this study was to demonstrate that moderate physical activity (MPA) may have a beneficial effect on postural stability, balance, and clinical parameters. The research group consisted of 137 randomized patients hospitalized at the Department of Neurological Rehabilitation, Medical University of Lodz. Finally, 76 patients were qualified who were divided into two groups-high fatigue (HF) and low fatigue (LF). Participants were assessed twice: before and after a 4-week MPA program using: the Expanded Disability Status Scale (EDSS), the Fatigue Severity Scale (FSS), the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the Beck Depression Inventory (BDI), and the Geriatric Depression Scale (GDS), and stabilometric platform tests were performed. Results obtained after the 4-week MPA program showed a positive effect of the MPA with differences between LF and HF groups. The MPA was more effective in MS patients with LF in cognitive functions, functional status, and postural stability but among HF patients in an emotional state, especially in MS patients below 65 years, although in total, both groups benefited from the MPA.

Novel Advances to Post-Stroke Aphasia Pharmacology and Rehabilitation.

Aphasia is one of the most common clinical features of functional impairment after a stroke. Approximately 21-40% of stroke patients sustain permanent aphasia, which progressively worsens one's quality of life and rehabilitation outcomes. Post-stroke aphasia treatment strategies include speech language therapies, cognitive neurorehabilitation, telerehabilitation, computer-based management, experimental pharmacotherapy, and physical medicine. This review focuses on current evidence of the effectiveness of impairment-based aphasia therapies and communication-based therapies (as well as the timing and optimal treatment intensities for these interventions). Moreover, we present specific interventions, such as constraint-induced aphasia therapy (CIAT) and melodic intonation therapy (MIT). Accumulated data suggest that using transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) is safe and can be used to modulate cortical excitability. Therefore, we review clinical studies that present TMS and tDCS as (possible) promising therapies in speech and language recovery, stimulating neuroplasticity. Several drugs have been used in aphasia pharmacotherapy, but evidence from clinical studies suggest that only nootropic agents, donepezil and memantine, may improve the prognosis of aphasia. This article is an overview on the current state of knowledge related to post-stroke aphasia pharmacology, rehabilitation, and future trends.

Pharmacological and Non-pharmacological Therapies of Cognitive Impairment in Multiple Sclerosis.

BACKGROUND: Cognitive impairment is one of the most important clinical features of neurodegenerative disorders including multiple sclerosis (MS). Conducted research shows that up to 65 percent of MS patients have cognitive deficits such as episodic memory, sustained attention, reduced verbal fluency; however, the cognitive MS domain is information processing speed. It is the first syndrome of cognitive dysfunction and the most widely affected in MS. Occasionally these impairments occur even before the appearance of physical symptoms. METHODS: Therefore, this review focused on the current status of our knowledge about possible methods of treatment cognitive impairment in MS patients including novel strategies. Research and online content was performed using Medline and EMBASE databases. RESULTS: The most recent research suggests that cognitive impairment is correlated with brain lesion volume and brain atrophy. The examination of the cognitive impairment is usually based on particular neuropsychological batteries. However, it can be not enough to make a precise diagnosis. This creates a demand to find markers that might be useful for identifying patients with risk of cognitive impairment at an early stage of the disease. Currently the most promising methods consist of neuroimaging indicators, such as diffusion tensor imaging, the magnetization transfer ratio, and N-acetyl aspartate levels. Diagnosis problems are strictly connected with treatment procedures. There are two main cognitive therapies: pharmacological (disease modifying drugs (DMD), symptomatic treatments) and non-pharmacological interventions that are focused on psychological and physical rehabilitation. Some trials have shown a positive association between physical activity and the cognitive function. CONCLUSION: This article is an overview of the current state of knowledge related to cognition impairment treatment in MS. Additionally, novel strategies for cognitive impairments such as cryostimulation and other complementary methods are presented.

Analysis of upper limb muscle strength in the early phase of brain stroke.

PURPOSE: The aim of this study was to determine the muscles with the lowest strength in non-affected (non-A) and affected upper limb (A), to assess differences between men and women and to correlate these values with age in patients after stroke. METHODS: Sixty patients (40 male, 20 female), hospitalized in Neurorehabilitation Ward, 1-2 weeks after stroke, were included in the study. Their age ranged from 50 to 80 years with a mean (sd) of 65.5 (18.7) years. Muscle force values from upper limb muscles were measured using the MicroFet 2 hand-held dynamometer. The results are given in Newtons [N], mean values of muscular force, effect sizes and confidence intervals are displayed as Cohen's d and 95% CI were determined. Moreover, we made the coefficients correlation for differences in muscular force versus the Rivermead Motor Assessment (RMA) arm section. RESULTS: Strength of (A) upper limb in comparison to (non-A) was 39% weaker. The severely affected muscle groups were the shoulder flexion 41% (women) versus 46% (men); elbow flexion 39% (women) versus 31% (men); wrist extension 36% (women) versus 42% (men). No significant correlations were found between muscle strength results and RMA or age. CONCLUSIONS: Muscle force of (A) upper limb after stroke demonstrates a 39% decrease. Men show more significant decrease than women (40% vs. 35%). Functional assessment in RMA values shows the better results in women (4.9 ± 4.1) than men (3.4 ± 3.2).