Effects of Robot-Assisted Rehabilitation on Hand Function of People With Stroke: A Randomized, Crossover-Controlled, Assessor-Blinded Study.

IMPORTANCE: The effects of robot-assisted task-oriented training with tangible objects among patients with stroke remain unknown. OBJECTIVE: To investigate the effects of robot-assisted therapy (RT) with a Gloreha device on sensorimotor and hand function and ability to perform activities of daily living (ADLs) among patients with stroke. DESIGN: Randomized, crossover-controlled, assessor-blinded study. SETTING: Rehabilitation clinic. PARTICIPANTS: Patients (N = 24) with moderate motor and sensory deficits. INTERVENTION: Patients participated in 12 RT sessions and 12 conventional therapy (CT) sessions, with order counterbalanced, for 6 wk, with a 1-mo washout period. OUTCOMES AND MEASURES: Performance was assessed four times: before and after RT and before and after CT. Outcomes were measured using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Box and Block Test, electromyography of the extensor digitorum communis (EDC) and brachioradialis, and a grip dynamometer for motor function; Semmes-Weinstein hand monofilament and the Revised Nottingham Sensory Assessment for sensory function; and the Modified Barthel Index (MBI) for ADL ability. RESULTS: RT resulted in significantly improved FMA-UE proximal (p = .038) and total (p = .046) and MBI (p = .030) scores. Participants' EDC muscles exhibited higher efficacy during the small-block grasping task of the Box and Block Test after RT than after CT (p = .050). CONCLUSIONS AND RELEVANCE: RT with the Gloreha device can facilitate whole-limb function, leading to beneficial effects on arm motor function, EDC muscle recruitment efficacy, and ADL ability for people with subacute and chronic stroke. WHAT THIS ARTICLE ADDS: The evidence suggests that a task-oriented approach combined with the Gloreha device can facilitate engagement in whole-limb active movement and efficiently promote functional recovery.

Multifactorial and Species-Specific Feedback Regulation of the RNA Surveillance Pathway Nonsense-Mediated Decay in Plants.

Nonsense-mediated decay (NMD) is an RNA surveillance mechanism that detects aberrant transcript features and triggers degradation of erroneous as well as physiological RNAs. Originally considered to be constitutive, NMD is now recognized to be tightly controlled in response to inherent signals and diverse stresses. To gain a better understanding of NMD regulation and its functional implications, we systematically examined feedback control of the central NMD components in two dicot and one monocot species. On the basis of the analysis of transcript features, turnover rates and steady-state levels, up-frameshift (UPF) 1, UPF3 and suppressor of morphological defects on genitalia (SMG) 7, but not UPF2, are under feedback control in both dicots. In the monocot investigated in this study, only SMG7 was slightly induced upon NMD inhibition. The detection of the endogenous NMD factor proteins in Arabidopsis thaliana substantiated a negative correlation between NMD activity and SMG7 amounts. Furthermore, evidence was provided that SMG7 is required for the dephosphorylation of UPF1. Our comprehensive and comparative study of NMD feedback control in plants reveals complex and species-specific attenuation of this RNA surveillance pathway, with critical implications for the numerous functions of NMD in physiology and stress responses.

Alternative Splicing Substantially Diversifies the Transcriptome during Early Photomorphogenesis and Correlates with the Energy Availability in Arabidopsis.

Plants use light as source of energy and information to detect diurnal rhythms and seasonal changes. Sensing changing light conditions is critical to adjust plant metabolism and to initiate developmental transitions. Here, we analyzed transcriptome-wide alterations in gene expression and alternative splicing (AS) of etiolated seedlings undergoing photomorphogenesis upon exposure to blue, red, or white light. Our analysis revealed massive transcriptome reprogramming as reflected by differential expression of ∼20% of all genes and changes in several hundred AS events. For more than 60% of all regulated AS events, light promoted the production of a presumably protein-coding variant at the expense of an mRNA with nonsense-mediated decay-triggering features. Accordingly, AS of the putative splicing factor REDUCED RED-LIGHT RESPONSES IN CRY1CRY2 BACKGROUND1, previously identified as a red light signaling component, was shifted to the functional variant under light. Downstream analyses of candidate AS events pointed at a role of photoreceptor signaling only in monochromatic but not in white light. Furthermore, we demonstrated similar AS changes upon light exposure and exogenous sugar supply, with a critical involvement of kinase signaling. We propose that AS is an integration point of signaling pathways that sense and transmit information regarding the energy availability in plants.

A pneumatically-driven microfluidic system for size-tunable generation of uniform cell-encapsulating collagen microbeads with the ultrastructure similar to native collagen.

This study reports a microfluidic system for high throughput, uniform, and size-tunable generation of cell-containing collagen microbeads. The principle is based on two pneumatically-driven mechanisms to achieve multi-channel mixture suspension transportation, and to actuate the spotting actions of micro-vibrators that continuously generate tiny collagen micro-droplets into a thin oil layer and then a sterile Pluronic® F127 surfactant solution located below. The temporarily formed collagen microdroplets are then thermally gelatinized. By regulating the feeding rate of cells/collagen suspension, and the spotting frequency of micro-vibrator, the size of the collagen microbeads can be manipulated. One of the key technical features is its capability to generate uniform collagen microbeads (coefficient of variation: 5.4-8.6 %) with sizes ranging from 73.9 to 349.3 µm in diameter. This is currently difficult to achieve using the existing methods particularly the generation of cell-encapsulating collagen microbeads with diameter less than 100 µm. Another advantageous trait is that the ultrastructure of the generated collagen microbeads is similar to that found in native collagen. In this study, moreover, the use of the proposed device for the microencapsulation of 3T3 cells in collagen microbeads has been successfully demonstrated showing that the encapsulated cells maintained high cell viability (96 ± 2 %). Furthermore, a reasonable proliferative capability of the encapsulated cells was observed during 7 days culture. As a whole, the proposed device has opened up a new route to generate cell-containing collagen microbeads, which is found particularly meaningful for biomedical applications.

Effects of 3D-printed assistive device on daily life function in patients with neurological impairment: a pilot study.

PURPOSE: To explore the effects of customized 3D-printed assistive technology (AT) on functional performance and feasibility in patients with neurological impairment. METHODS: Patients with neurological impairment were recruited and randomized into customized 3D-printed assistive device group (group 1; n = 17) or standard device group (group 2; n = 14). The device was designed to assist their writing, spoon using, and typing. Each patient underwent 4-week intervention with the device (30 min per session, twice a week). RESULTS: We observed significant differences in shoulder abduction (p = .00), external rotation (p = .01), and internal rotation (p = .02) in group 1. And significant differences in abduction (p = .05) and external rotation (p = .05) between the 2 groups. Group 1 achieved significant improvements in writing without AT (p = .04) and with AT (p = .02), spoon use without AT (p = .02) and with AT (p = .03), and hemiplegia-side typing with AT (p = .00). Group 2 achieved significant improvements in writing without AT (p = .01), hemiplegia-side typing without AT (p = .01), and bil-side typing with AT (P = .05). Moreover, no significant differences were noted in other outcome measures. CONCLUSIONS: This study demonstrated that customized 3D-printed AT can improve shoulder active motion for patients with neurological impairment. A positive effect in functional hand tasks after AT intervention. Offering customized AT with specific training could enhance the efficacy of interventions. The feasibility of using 3D printing technology to produce customized AT, which has the potential to be cost-effective and efficient.

3D-printed assistive device incorporating a splint can improve shoulder active motion compared to conventional assistive device for patients with neurological impairment.A positive effect in functional hand tasks after assistive device intervention.

Effects of a wearable sensor-based virtual reality game on upper-extremity function in patients with stroke.

BACKGROUND: PABLO is a virtual reality game where a motion sensor system is used. Few studies have investigated the effects of the PABLO system in stroke rehabilitation. We investigated the effects of upper-extremity virtual reality training with the PABLO system in patients with stroke. METHODS: Stroke patients were randomly assigned to the virtual reality (n = 19) or standard rehabilitation groups (n = 18). Total of 18 sessions were conducted twice per week. The primary outcome measure was the Fugl-Meyer Assessment-Upper Extremity subscale. Secondary outcome measures included the active ranges of motion of the shoulder and elbow, the box and block test, hand grip strength, and the Stroke Impact Scale. Enjoyment of activities and side effects were also recorded. FINDINGS: No difference was observed between two groups in primary outcome. Virtual reality group exhibited greater improvements in the hand dexterity between groups (p = .05). In active motion, virtual reality group showed greater improvement in shoulder flexion between groups (p = .03). Virtual reality group also showed greater improvements in elbow pronation between groups (p = .03). The groups differed in their assessments of how enjoyment the rehabilitation activities were found (p = .01). No significant differences between groups were observed in any other tests. INTERPRETATION: Interventions based on the PABLO virtual reality system improved upper extremity hand function, shoulder and elbow movements, and elicited a higher degree of enjoyment from study participants, than did traditional treatment. TRIALS REGISTRATION: The study protocol was registered at ClinicalTrials.gov PRS (No.NCT04296032).

Robotic-assisted hand therapy for improvement of hand function in children with cerebral palsy: a case series study.

BACKGROUND: Most types of robot-assisted training (RT) have been used in Cerebral Palsy (CP) patients only focus on proximal upper extremity. Few of study investigated the effect of distal upper extremity training. CASE REPORT: Pediatric CP patients (N.=7) participated the RT sessions for 6 weeks (12 60-min sessions 2 times a week). Performance was assessed at 3 time points (pretest, posttest, and 1-month follow-up). RT significantly improved in body structure and function domains: FMA-UE scores (P=0.002). On electromyography, significant improvements in the mean brachioradialis muscle amplitude (P=0.015) and electrical agonist-antagonist muscle ratio (P=0.041) in the 1-inch cube-grasping task. The effects were maintained after 1 month. CLINICAL REHABILITATION IMPACT: RT using a Gloreha device which focuses on the distal part of the upper limb benefit on body structure and function, including upper-extremity motor function, brachioradialis muscle recruitment, and coordination in children with cerebral palsy.

Arabidopsis thaliana WRKY25 Transcription Factor Mediates Oxidative Stress Tolerance and Regulates Senescence in a Redox-Dependent Manner.

Senescence is the last developmental step in plant life and is accompanied by a massive change in gene expression implying a strong participation of transcriptional regulators. In the past decade, the WRKY53 transcription factor was disclosed to be a central node of a complex regulatory network of leaf senescence and to underlie a tight multi-layer control of expression, activity and protein stability. Here, we identify WRKY25 as a redox-sensitive up-stream regulatory factor of WRKY53 expression. Under non-oxidizing conditions, WRKY25 binds to a specific W-box in the WRKY53 promoter and acts as a positive regulator of WRKY53 expression in a transient expression system using Arabidopsis protoplasts, whereas oxidizing conditions dampened the action of WRKY25. However, overexpression of WRKY25 did not accelerate senescence but increased lifespan of Arabidopsis plants, whereas the knock-out of the gene resulted in the opposite phenotype, indicating a more complex regulatory function of WRKY25 within the WRKY subnetwork of senescence regulation. In addition, overexpression of WRKY25 mediated higher tolerance to oxidative stress and the intracellular H2O2 level is lower in WRKY25 overexpressing plants and higher in wrky25 mutants compared to wildtype plants suggesting that WRKY25 is also involved in controlling intracellular redox conditions. Consistently, WRKY25 overexpressers had higher and wrky mutants lower H2O2 scavenging capacity. Like already shown for WRKY53, MEKK1 positively influenced the activation potential of WRKY25 on the WRKY53 promoter. Taken together, WRKY53, WRKY25, MEKK1 and H2O2 interplay with each other in a complex network. As H2O2 signaling molecule participates in many stress responses, WRKK25 acts most likely as integrators of environmental signals into senescence regulation.

The Effect of a Virtual Reality Game Intervention on Balance for Patients with Stroke: A Randomized Controlled Trial.

OBJECTIVE: The aim of this study was to investigate the effects of virtual reality (VR) balance training conducted using Kinect for Xbox® games on patients with chronic stroke. MATERIALS AND METHODS: Fifty patients with mild to moderate motor deficits were recruited and randomly assigned to two groups: VR plus standard treatment group and standard treatment (ST) group. In total, 12 training sessions (90 minutes a session, twice a week) were conducted in both groups, and performance was assessed at three time points (pretest, post-test, and follow-up) by a blinded assessor. The outcome measures were the Berg Balance Scale (BBS), Functional Reach Test, and Timed Up and Go Test (cognitive; TUG-cog) for balance evaluations; Modified Barthel Index for activities of daily living ability; Activities-specific Balance Confidence Scale for balance confidence; and Stroke Impact Scale for quality of life. The pleasure scale and adverse events were also recorded after each training session. RESULTS: Both groups exhibited significant improvement over time in the BBS (P = 0.000) and TUG-cog test (P = 0.005). The VR group rated the experience as more pleasurable than the ST group during the intervention (P = 0.027). However, no significant difference was observed in other outcome measures within or between the groups. No serious adverse events were observed during the treatment in either group. CONCLUSIONS: VR balance training by using Kinect for Xbox games plus the traditional method had positive effects on the balance ability of patients with chronic stroke. The VR group experienced higher pleasure than the ST group during the intervention.

Sec14-nodulin proteins and the patterning of phosphoinositide landmarks for developmental control of membrane morphogenesis.

Polarized membrane morphogenesis is a fundamental activity of eukaryotic cells. This process is essential for the biology of cells and tissues, and its execution demands exquisite temporal coordination of functionally diverse membrane signaling reactions with high spatial resolution. Moreover, mechanisms must exist to establish and preserve such organization in the face of randomizing forces that would diffuse it. Here we identify the conserved AtSfh1 Sec14-nodulin protein as a novel effector of phosphoinositide signaling in the extreme polarized membrane growth program exhibited by growing Arabidopsis root hairs. The data are consistent with Sec14-nodulin proteins controlling the lateral organization of phosphatidylinositol 4,5-bisphosphate (PtdIns(4,5)P2) landmarks for polarized membrane morphogenesis in plants. This patterning activity requires both the PtdIns(4,5)P2 binding and homo-oligomerization activities of the AtSfh1 nodulin domain and is an essential aspect of the polarity signaling program in root hairs. Finally, the data suggest a general principle for how the phosphoinositide signaling landscape is physically bit mapped so that eukaryotic cells are able to convert a membrane surface into a high-definition lipid-signaling screen.