Bilateral assessment of functional tasks for robot-assisted therapy applications.

This article presents a novel evaluation system along with methods to evaluate bilateral coordination of arm function on activities of daily living tasks before and after robot-assisted therapy. An affordable bilateral assessment system (BiAS) consisting of two mini-passive measuring units modeled as three degree of freedom robots is described. The process for evaluating functional tasks using the BiAS is presented and we demonstrate its ability to measure wrist kinematic trajectories. Three metrics, phase difference, movement overlap, and task completion time, are used to evaluate the BiAS system on a bilateral symmetric (bi-drink) and a bilateral asymmetric (bi-pour) functional task. Wrist position and velocity trajectories are evaluated using these metrics to provide insight into temporal and spatial bilateral deficits after stroke. The BiAS system quantified movements of the wrists during functional tasks and detected differences in impaired and unimpaired arm movements. Case studies showed that stroke patients compared to healthy subjects move slower and are less likely to use their arm simultaneously even when the functional task requires simultaneous movement. After robot-assisted therapy, interlimb coordination spatial deficits moved toward normal coordination on functional tasks.

Quantifying learned non-use after stroke using unilateral and bilateral steering tasks.

Learned non-use (LNU) is common after stroke and manifests when persons with stroke spontaneously use their stronger less-impaired arm despite residual functional abilities in the impaired arm. This tendency of under utilizing the impaired arm slows down the re-acquisition of bilateral coordination on activities of daily living. We wanted to examine whether this behavior could be studied and quantified using the TheraDrive system, a low-cost, mechatronic/robotic stroke rehabilitation system which uses a commercial force-feedback steering wheel along with custom games and unilateral and bilateral steering tasks for therapy and assessment. We attempt to quantify the role of the impaired arm in bilateral tracking with one and two-wheeled modes of the TheraDrive. Our results indicate that impaired arm use, arm bias and learned non-use behaviors may best be detected in decoupled bilateral tracking tasks.

Evaluation of the TheraDrive system for robot/computer assisted motivating rehabilitation after stroke.

This paper presents experimental data evaluating the merits of using a fun and engaging therapy protocol over a less engaging one in the context of a low-cost robot/computer motivating rehabilitation system for stroke rehabilitation called TheraDrive. The preliminary results suggest that there is a small advantage of the engaging therapy over the rote therapy in reducing motor impairment, improving ADL function, and improving stability. The more engaging protocol has an advantage in maintaining engagement and interest in therapy.

Effect of electrical stimulation on arteriogenesis and angiogenesis after bilateral femoral artery excision in the rabbit hind-limb ischemia model.

The effects of electrical stimulation (ES) on arteriogenesis (the opening of preexisting collaterals) and angiogenesis (formation of new capillaries) were studied after acute bilateral hind limb ischemia was induced via bilateral femoral artery excision in a rabbit model. The study evaluated the rabbit hind limbs' normal response to acute ischemia and to application of ES by calculating changes in arterial and capillary densities. Comparisons were made with our prior study, in which the femoral artery was unilaterally excised, as we attempted to expand on the topics of arteriogenesis and angiogenesis. Twelve adult New Zealand white rabbits were randomly assigned to 1 of 2 series. In Series 1, the control group, both femoral arteries were excised and no ES was applied. In Series 2, both femoral arteries were excised and ES was applied to the left limb. One lead was implanted into the left adductor muscle near the site of the excised left femoral artery (Series 2), and a stimulator (Thera, Medtronic, Inc, Minneapolis, MN) was implanted in a separate pocket. ES was applied at a rate of 3 V, 30 contractions per minute, beginning immediately after surgery and continuously for 1 month. Angiography was performed in all 12 rabbits 1 month after surgery to establish the anatomy of the collateral vessels and to demonstrate that the femoral artery stump continued to be an end artery. Contrast-opacified arteries (COAs) that crossed the grid's midline, and the total number of grid lines intersected by COAs, were tallied according to an established method. Capillary density was calculated as the number of capillaries per square millimeter of muscle. In Series 1, after 1 month, the number of COAs crossing the grid's midline was 4.5 +/-1.5 on the left and 4.8 +/-1.2 on the right side. In Series 2, the number of COAs crossing the grid's midline was 7.9 +/-1.8 on the left side (p<0.05 vs Series 1) and 5.9 +/-1.6 on the right side of the same rabbit (p=NS vs Series 1). In Series 1, 36.7 +/-5.4 and 30.5 +/-7.7 total intersections were crossed by COAs on the left and right sides, respectively. In Series 2, total grid intersections crossed by COAs were 48.4 +/-8.5 and 47.5 +/-9.1 in the left and right sides, respectively (p<0.001 vs series 1). Baseline capillary density before femoral artery excision was 180.2 +/-21.3/mm(2). The capillary densities on the left sides were 94.2 +/-19.1 and 264.5 +/-7.6 in Series 1 and 2, respectively (p<0.001). The right sides showed a similar pattern with capillary densities of 88.5 +/-37.2 and 135.8 +/-6.8 (p<0.05) in Series 1 and 2, respectively. When capillary density was compared on the left and right sides of the same rabbit in Series 2, a statistically significant increase was also found; 264.5 +/-7.6 vs 135.8 +/-6.8 (p<0.001) in the left and right sides, respectively. Comparisons of the effect of electrical stimulation and the body's normal physiologic response to acute ischemia revealed a significant increase in the opening of preexisting collaterals (arteriogenesis) and the promotion of capillary density (angiogenesis) with the use of electrical stimulation.

Transplantation of autologous endothelial cells induces angiogenesis.

This study examined the feasibility and efficacy of autologous endothelial cell (EC) transplantation using a fibrin matrix in the ischemic myocardium of sheep. Four weeks after placing an ameroid constrictor in the circumflex artery of 12 adult sheep, four animals (EC group) were subjected to EC transplantation. In four others (saline [SAL] group) saline with added inactivated cells was injected and four animals served as controls. Eight weeks after treatment the animals were sacrificed to assess histology and ultrastructure. Eight weeks after injection, ventricular function was markedly improved in the EC transplant group, but had deteriorated in the SAL and control groups. Myocardial blood flow was also increased in the EC group. Histology and electron microscopy revealed extensive neovascularization after EC transplantation and improved myocardial appearance. Heterotopic transplantation of EC within a fibrin matrix enhances neovascularization, increases myocardial blood flow, and improves left ventricular function.

Slowed progression or elimination of atherosclerosis by low-frequency electrical impulses.

BACKGROUND: In our previous investigations we showed that electrical impulses (EI) can prevent the development of atherosclerosis if they began simultaneously with high cholesterol diet (HCD) or in the early stages of atherosclerosis (after three weeks of HCD only). In this investigation we demonstrated the slow progression or elimination of atherosclerosis by low-frequency EI in case of moderate atherosclerosis (after eight weeks of HCD). METHODS: Series I rabbits (control group) were fed HCD for eight weeks. Series II rabbits were fed HCD for eight weeks and were then switched to normal diet for eight weeks (no EI). Series III rabbits were fed HCD for eight weeks and then switched to a normal diet with simultaneous EI (applied near the abdominal aorta) for eight weeks (3 V, 30 single impulses per minute, 24 hours/day). After euthanization, the level of atherosclerosis, percentage of surface area involved in the atherosclerosis process, and an atherosclerosis score were calculated in the aortic arch, thoracic and abdominal aorta. RESULTS: Statistically significant differences were seen in the level of atherosclerosis in the abdominal aorta between series III animals (0.4 +/- 0.2) and the other two groups: 1.5 +/- 0.4 in series I (HCD only), 1.2 +/- 0.3 in series II (HCD then normal diet). Gross examination of the surface also revealed statistically significant differences (p < 0.05) in the percentage of atherosclerosis between the control series I (30.1 +/- 4.1%) and series II (21.3 +/- 3.6%), compared with series III (5.5 +/- 5.4%). In addition, the atherosclerosis score was also significantly different: 45.8 +/- 3.9 in series I, 25.2 +/- 6.9 in series II, and 2.2 +/- 2.0 in series III (p < 0.05). CONCLUSION: Our study showed that, when applied near the abdominal aorta, low-frequency electrical impulses decrease atherosclerotic deposition in the abdominal aorta.

Deferoxamine-fibrin accelerates angiogenesis in a rabbit model of peripheral ischemia.

The intramuscular (i.m.) injection of a modified fibrin meshwork plus deferoxamine was tested in a rabbit model of acute hind-limb ischemia. After excision of the left external iliac and femoral arteries, 12 rabbits at the Milwaukee Heart Institute were divided into two groups: control and fibrin meshwork plus deferoxamine (FDEF) i.m. The rabbits underwent angiography before surgery, immediately after, and 1 month postoperatively. These data were compiled through counting by means of a grid overlay. Another 12 rabbits at the Vakhidov Center of Surgery, which did not undergo angiography, underwent lower limb-calf blood pressure (L-CBP) measurements made immediately after surgery and at postoperative days 10, 20 and 30. Biopsies from thigh skeletal muscles of rabbits that had L-CBP measurements underwent alkaline phosphatase staining on day 30 to determine the percentage of biopsied area that was occupied by capillaries. The number of arteries and arterioles crossing 71 grid intersections immediately post-surgery decreased from 30.2 +/- 2.3 to 18.0 +/- 2.0 (p < 0.05). One month postsurgery this number increased to 29.2 +/- 2.4 in controls (p < 0.05 vs immediately post-surgery) and to 59.6 +/- 3.2 in the FDEF group (p < 0.001 vs immediately post-surgery). By day 30 the L-CBP ratio improved in the FDEF group (0.8 +/- 0.02) vs controls (0.3 +/- 0.04). By day 30 the capillary density increased from that of normal muscle tissue (198.6 +/- 12.9/mm2) to 292 +/- 12.4/mm2 in the FDEF group (p < 0.05), but decreased in the control group to 98.7 +/- 7.7/mm2. I.m. injection of FDEF considerably accelerated angiogenesis in severely ischemic hind-limb tissue in this model, making it a viable treatment method for clinical use in patients who have critical limb ischemia.

Pathologic and histologic results of electrical impulses in a rabbit model of atherosclerosis: 24-hour versus 8-hour regimen.

OBJECTIVE: Low frequency electrical impulses (EIs) reduce new atherosclerotic plaque formation in previously diseased arteries and may reverse the extent of previous pathologic damage in these structures. METHODS: A pacemaker was implanted on the left side of rabbit abdominal aortas, and an electrode was placed close to the other side of the aorta in the psoas major muscle. For the induction of atherosclerosis, the rabbits were placed on a high cholesterol diet (HCD) for 11 weeks. No EIs were applied to the control series I. In the experimental series, the rabbits were fed an HCD for 3 weeks, after which EIs were applied simultaneously with an HCD for 8 additional weeks (3V, 30 contractions per minute). Experimental series II had 24-hour/day EIs, and series III had 8-hour/day EIs. RESULTS: The closer to the area where the EIs were applied, the more local severity increased (atherosclerosis level and surface area). In the control series, the severity of atherosclerosis in the lower aorta assessed with an arbitrary grading system was 1.75 +/- 0.5 (versus 1.5 +/- 0.57 with 8-hour/day EIs and 0.5 +/- 0.3 with 24-hour/day EIs). The involved surface area was 32.5% +/- 9.5% (versus 1.0% +/- 0.8% with 8-hour/day EIs and 0.75% +/- 0.95% with 24-hour/day EIs). CONCLUSION: Both 24-hour/day and 8-hour/day EIs applied close to the abdominal aorta decreased the severity of atherosclerosis in rabbits placed on a HCD, but 24-hour/day EIs decreased the severity more extensively.