Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 53
Filtrar
Más filtros










Base de datos
Intervalo de año de publicación
1.
J Am Heart Assoc ; 11(10): e025109, 2022 May 17.
Artículo en Inglés | MEDLINE | ID: mdl-35574963

RESUMEN

Background Persistent sensorimotor impairments after stroke can negatively impact quality of life. The hippocampus is vulnerable to poststroke secondary degeneration and is involved in sensorimotor behavior but has not been widely studied within the context of poststroke upper-limb sensorimotor impairment. We investigated associations between non-lesioned hippocampal volume and upper limb sensorimotor impairment in people with chronic stroke, hypothesizing that smaller ipsilesional hippocampal volumes would be associated with greater sensorimotor impairment. Methods and Results Cross-sectional T1-weighted magnetic resonance images of the brain were pooled from 357 participants with chronic stroke from 18 research cohorts of the ENIGMA (Enhancing NeuoImaging Genetics through Meta-Analysis) Stroke Recovery Working Group. Sensorimotor impairment was estimated from the FMA-UE (Fugl-Meyer Assessment of Upper Extremity). Robust mixed-effects linear models were used to test associations between poststroke sensorimotor impairment and hippocampal volumes (ipsilesional and contralesional separately; Bonferroni-corrected, P<0.025), controlling for age, sex, lesion volume, and lesioned hemisphere. In exploratory analyses, we tested for a sensorimotor impairment and sex interaction and relationships between lesion volume, sensorimotor damage, and hippocampal volume. Greater sensorimotor impairment was significantly associated with ipsilesional (P=0.005; ß=0.16) but not contralesional (P=0.96; ß=0.003) hippocampal volume, independent of lesion volume and other covariates (P=0.001; ß=0.26). Women showed progressively worsening sensorimotor impairment with smaller ipsilesional (P=0.008; ß=-0.26) and contralesional (P=0.006; ß=-0.27) hippocampal volumes compared with men. Hippocampal volume was associated with lesion size (P<0.001; ß=-0.21) and extent of sensorimotor damage (P=0.003; ß=-0.15). Conclusions The present study identifies novel associations between chronic poststroke sensorimotor impairment and ipsilesional hippocampal volume that are not caused by lesion size and may be stronger in women.


Asunto(s)
Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Estudios Transversales , Femenino , Hipocampo/diagnóstico por imagen , Humanos , Masculino , Calidad de Vida , Recuperación de la Función , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico por imagen , Rehabilitación de Accidente Cerebrovascular/métodos , Extremidad Superior
2.
Trials ; 23(1): 262, 2022 Apr 05.
Artículo en Inglés | MEDLINE | ID: mdl-35382902

RESUMEN

BACKGROUND: Post-stroke hand impairment is prevalent and persistent even after a full course of rehabilitation. Hand diminishes stroke survivors' abilities for activities of daily living and independence. One way to improve treatment efficacy is to augment therapy with peripheral sensory stimulation. Recently, a novel sensory stimulation, TheraBracelet, has been developed in which imperceptible vibration is applied during task practice through a wrist-worn device. The objective of this trial is to determine if combining TheraBracelet with hand task practice is superior to hand task practice alone. METHODS: A double-blind randomized controlled trial will be used. Chronic stroke survivors will undergo a standardized hand task practice therapy program (3 days/week for 6 weeks) while wearing a device on the paretic wrist. The device will deliver TheraBracelet vibration for the treatment group and no vibration for the control group. The primary outcome is hand function measured by the Wolf Motor Function Test. Other outcomes include the Box and Block Test, Action Research Arm Test, upper extremity use in daily living, biomechanical measure of the sensorimotor grip control, and EEG-based neural communication. DISCUSSION: This research will determine clinical utility of TheraBracelet to guide future translation. The TheraBracelet stimulation is delivered via a wrist-worn device, does not interfere with hand motion, and can be easily integrated into clinical practice. Enhancing hand function should substantially increase stroke survivors' independence and quality of life and reduce caregiver burden. TRIAL REGISTRATION: NCT04569123 . Registered on September 29, 2020.


Asunto(s)
Actividades Cotidianas , Rehabilitación de Accidente Cerebrovascular , Mano , Humanos , Calidad de Vida , Recuperación de la Función , Resultado del Tratamiento , Extremidad Superior
3.
Trials ; 23(1): 301, 2022 Apr 12.
Artículo en Inglés | MEDLINE | ID: mdl-35413931

RESUMEN

BACKGROUND: Functional task performance requires proper control of both movement and force generation in three-dimensional space, especially for the hand. Control of force in three dimensions, however, is not explicitly treated in current physical rehabilitation. To address this gap in treatment, we have developed a tool to provide visual feedback on three-dimensional finger force. Our objective is to examine the effectiveness of training with this tool to restore hand function in stroke survivors. METHODS: Double-blind randomized controlled trial. All participants undergo 18 1-h training sessions to practice generating volitional finger force of various target directions and magnitudes. The experimental group receives feedback on both force direction and magnitude, while the control group receives feedback on force magnitude only. The primary outcome is hand function as measured by the Action Research Arm Test. Other outcomes include the Box and Block Test, Stroke Impact Scale, ability to direct finger force, muscle activation pattern, and qualitative interviews. DISCUSSION: The protocol for this clinical trial is described in detail. The results of this study will reveal whether explicit training of finger force direction in stroke survivors leads to improved motor control of the hand. This study will also improve the understanding of neuromuscular mechanisms underlying the recovery of hand function. TRIAL REGISTRATION: ClinicalTrials.gov NCT03995069 . Registered on June 21, 2019.


Asunto(s)
Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Mano , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Recuperación de la Función , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/terapia , Rehabilitación de Accidente Cerebrovascular/métodos , Resultado del Tratamiento , Extremidad Superior
4.
Neurorehabil Neural Repair ; 36(4-5): 255-268, 2022 04.
Artículo en Inglés | MEDLINE | ID: mdl-35311412

RESUMEN

BACKGROUND: Improved ability to predict patient recovery would guide post-stroke care by helping clinicians personalize treatment and maximize outcomes. Electroencephalography (EEG) provides a direct measure of the functional neuroelectric activity in the brain that forms the basis for neuroplasticity and recovery, and thus may increase prognostic ability. OBJECTIVE: To examine evidence for the prognostic utility of EEG in stroke recovery via systematic review/meta-analysis. METHODS: Peer-reviewed journal articles that examined the relationship between EEG and subsequent clinical outcome(s) in stroke were searched using electronic databases. Two independent researchers extracted data for synthesis. Linear meta-regressions were performed across subsets of papers with common outcome measures to quantify the association between EEG and outcome. RESULTS: 75 papers were included. Association between EEG and clinical outcomes was seen not only early post-stroke, but more than 6 months post-stroke. The most studied prognostic potential of EEG was in predicting independence and stroke severity in the standard acute stroke care setting. The meta-analysis showed that EEG was associated with subsequent clinical outcomes measured by the Modified Rankin Scale, National Institutes of Health Stroke Scale, and Fugl-Meyer Upper Extremity Assessment (r = .72, .70, and .53 from 8, 13, and 12 papers, respectively). EEG improved prognostic abilities beyond prediction afforded by standard clinical assessments. However, the EEG variables examined were highly variable across studies and did not converge. CONCLUSIONS: EEG shows potential to predict post-stroke recovery outcomes. However, evidence is largely explorative, primarily due to the lack of a definitive set of EEG measures to be used for prognosis.


Asunto(s)
Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Electroencefalografía , Humanos , Pronóstico , Recuperación de la Función , Accidente Cerebrovascular/diagnóstico , Extremidad Superior
5.
J Neurol Phys Ther ; 46(3): 198-205, 2022 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-35320135

RESUMEN

BACKGROUND/PURPOSE: To determine the feasibility of training with electromyographically (EMG) controlled games to improve control of muscle activation patterns in stroke survivors. METHODS: Twenty chronic stroke survivors (>6 months) with moderate hand impairment were randomized to train either unilaterally (paretic only) or bilaterally over 9 one-hour training sessions. EMG signals from the unilateral or bilateral limbs controlled a cursor location on a computer screen for gameplay. The EMG muscle activation vector was projected onto the plane defined by the first 2 principal components of the activation workspace for the nonparetic hand. These principal components formed the x- and y-axes of the computer screen. RESULTS: The recruitment goal (n = 20) was met over 9 months, with no screen failure, no attrition, and 97.8% adherence rate. After training, both groups significantly decreased the time to move the cursor to a novel sequence of targets (P = 0.006) by reducing normalized path length of the cursor movement (P = 0.005), and improved the Wolf Motor Function Test (WMFT) quality score (P = 0.01). No significant group difference was observed. No significant change was seen in the WMFT time or Box and Block Test. DISCUSSION/CONCLUSIONS: Stroke survivors could successfully use the EMG-controlled games to train control of muscle activation patterns. While the nonparetic limb EMG was used in this study to create target EMG patterns, the system supports various means for creating target patterns per user desires. Future studies will employ training with the EMG-controlled games in conjunction with functional task practice for a longer intervention duration to improve overall hand function.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A379).


Asunto(s)
Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Mano , Humanos , Músculo Esquelético , Proyectos Piloto , Accidente Cerebrovascular/terapia
6.
Hum Brain Mapp ; 43(1): 129-148, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-32310331

RESUMEN

The goal of the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) Stroke Recovery working group is to understand brain and behavior relationships using well-powered meta- and mega-analytic approaches. ENIGMA Stroke Recovery has data from over 2,100 stroke patients collected across 39 research studies and 10 countries around the world, comprising the largest multisite retrospective stroke data collaboration to date. This article outlines the efforts taken by the ENIGMA Stroke Recovery working group to develop neuroinformatics protocols and methods to manage multisite stroke brain magnetic resonance imaging, behavioral and demographics data. Specifically, the processes for scalable data intake and preprocessing, multisite data harmonization, and large-scale stroke lesion analysis are described, and challenges unique to this type of big data collaboration in stroke research are discussed. Finally, future directions and limitations, as well as recommendations for improved data harmonization through prospective data collection and data management, are provided.


Asunto(s)
Imagen por Resonancia Magnética , Neuroimagen , Accidente Cerebrovascular , Humanos , Estudios Multicéntricos como Asunto , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/patología , Accidente Cerebrovascular/fisiopatología , Rehabilitación de Accidente Cerebrovascular
7.
OTJR (Thorofare N J) ; 42(1): 30-39, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-34496711

RESUMEN

Subthreshold vibratory stimulation to the paretic wrist has been shown to prime the sensorimotor cortex and improve 2-week upper extremity (UE) therapy outcomes. The objective of this work was to determine feasibility, safety, and preliminary efficacy of the stimulation over a typical 6-week therapy duration. Four chronic stroke survivors received stimulation during 6-week therapy. Feasibility/safety/efficacy were assessed at baseline, posttherapy, and 1-month follow-up. For feasibility, all participants wore the device throughout therapy and perceived the stimulation comfortable/safe. Regarding safety, no serious/moderate intervention-related adverse events occurred. For efficacy, all participants improved in Wolf Motor Function Test and UE use in daily living based on accelerometry and stroke impact scale. Mean improvements at posttherapy/follow-up were greater than the minimal detectable change/clinically important difference and other trials with similar therapy without stimulation. In conclusion, the stimulation was feasible/safe for 6-week use. Preliminary efficacy encourages a larger trial to further evaluate the stimulation as a therapy adjunct.


Asunto(s)
Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Acelerometría , Humanos , Recuperación de la Función , Resultado del Tratamiento , Extremidad Superior
8.
Artículo en Inglés | MEDLINE | ID: mdl-34143736

RESUMEN

Rehabilitation device efficacy alone does not lead to clinical practice adoption. Previous literature identifies drivers for device adoption by therapists but does not identify the best settings to introduce devices, the roles of different stakeholders including rehabilitation directors, or specific criteria to be met during device development. The objective of this work was to provide insights into these areas to increase clinical adoption of post-stroke restorative rehabilitation devices. We interviewed 107 persons including physical/occupational therapists, rehabilitation directors, and stroke survivors and performed content analysis. Unique to this work, care settings in which therapy goals are best aligned for restorative devices were found to be outpatient rehabilitation, followed by inpatient rehabilitation. Therapists are the major influencers for adoption because they typically introduce new rehabilitation devices to patients for both clinic and home use. We also learned therapists' utilization rate of a rehabilitation device influences a rehabilitation director's decision to acquire the device for facility use. Main drivers for each stakeholder are identified, along with specific criteria to add details to findings from previous literature. In addition, drivers for home adoption of rehabilitation devices by patients are identified. Rehabilitation device development should consider the best settings to first introduce the device, roles of each stakeholder, and drivers that influence each stakeholder, to accelerate successful adoption of the developed device.


Asunto(s)
Fisioterapeutas , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Humanos , Sobrevivientes , Estados Unidos
9.
Transl Stroke Res ; 11(2): 204-213, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31444692

RESUMEN

Peripheral sensory stimulation augments post-stroke upper extremity rehabilitation outcomes. Most sensory stimulations interfere with natural hand tasks and the stimulation duration is limited. We developed TheraBracelet, low-level random-frequency vibration applied via a wristwatch, to enable stimulation during hand tasks and potentially extend stimulation durations. To determine safety of prolonged exposure to TheraBracelet. Single-site double-blind crossover randomized controlled trial. Chronic stroke survivors were instructed to wear a device on the affected wrist for > 8 h/day everyday for 2 months while coming to the laboratory weekly for evaluations, with a 2-week break between each month. The device applied vibration at 60% and 1% of the sensory threshold for the real and sham month, respectively. The order of the real and sham months was randomized/balanced. Adverse events (AEs) were assessed weekly, including worsening of hand sensation, dexterity, grip strength, pain, or spasticity and occurrence of skin irritation or swelling. Device-related AE rates were compared between the real and sham month. Twenty-five participants completed the study. Six participants (24%) experienced mild AEs involving worsened sensory scores that may be related to the intervention with reasonable possibility. Two experienced them in the real stimulation month only, 3 in the sham month only, and 1 in both months. Therefore, less participants experienced device-related AEs in the real than sham month. Daily stimulation using the device for a month is safe for chronic stroke survivors. Future studies examining the efficacy of pairing TheraBracelet with therapy for increasing neurorehabilitation outcomes are a logical next step. Trial registration: NCT03318341.


Asunto(s)
Rehabilitación de Accidente Cerebrovascular/métodos , Dispositivos Electrónicos Vestibles , Anciano , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estimulación Física/instrumentación , Estimulación Física/métodos , Seguridad , Rehabilitación de Accidente Cerebrovascular/efectos adversos , Resultado del Tratamiento , Vibración , Dispositivos Electrónicos Vestibles/efectos adversos , Muñeca
10.
Am J Occup Ther ; 73(4): 7304205090p1-7304205090p10, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31318673

RESUMEN

IMPORTANCE: Along with growth in telerehabilitation, a concurrent need has arisen for standardized methods of tele-evaluation. OBJECTIVE: To examine the feasibility of using the Kinect sensor in an objective, computerized clinical assessment of upper limb motor categories. DESIGN: We developed a computerized Mallet classification using the Kinect sensor. Accuracy of computer scoring was assessed on the basis of reference scores determined collaboratively by multiple evaluators from reviewing video recording of movements. In addition, using the reference score, we assessed the accuracy of the typical clinical procedure in which scores were determined immediately on the basis of visual observation. The accuracy of the computer scores was compared with that of the typical clinical procedure. SETTING: Research laboratory. PARTICIPANTS: Seven patients with stroke and 10 healthy adult participants. Healthy participants intentionally achieved predetermined scores. OUTCOMES AND MEASURES: Accuracy of the computer scores in comparison with accuracy of the typical clinical procedure (immediate visual assessment). RESULTS: The computerized assessment placed participants' upper limb movements in motor categories as accurately as did typical clinical procedures. CONCLUSIONS AND RELEVANCE: Computerized clinical assessment using the Kinect sensor promises to facilitate tele-evaluation and complement telehealth applications. WHAT THIS ARTICLE ADDS: Computerized clinical assessment can enable patients to conduct evaluations remotely in their homes without therapists present.


Asunto(s)
Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Telerrehabilitación , Extremidad Superior/fisiopatología , Adulto , Humanos , Movimiento
11.
Exp Brain Res ; 237(3): 805-816, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30607471

RESUMEN

Peripheral sensory stimulation has been used as a method to stimulate the sensorimotor cortex, with applications in neurorehabilitation. To improve delivery modality and usability, a new stimulation method has been developed in which imperceptible random-frequency vibration is applied to the wrist concurrently during hand activity. The objective of this study was to investigate effects of this new sensory stimulation on the sensorimotor cortex. Healthy adults were studied. In a transcranial magnetic stimulation (TMS) study, resting motor threshold, short-interval intracortical inhibition, and intracortical facilitation for the abductor pollicis brevis muscle were compared between vibration on vs. off, while subjects were at rest. In an electroencephalogram (EEG) study, alpha and beta power during rest and event-related desynchronization (ERD) for hand grip were compared between vibration on vs. off. Results showed that vibration decreased EEG power and decreased TMS short-interval intracortical inhibition (i.e., disinhibition) compared with no vibration at rest. Grip-related ERD was also greater during vibration, compared to no vibration. In conclusion, subthreshold random-frequency wrist vibration affected the release of intracortical inhibition and both resting and grip-related sensorimotor cortical activity. Such effects may have implications in rehabilitation.


Asunto(s)
Ondas Encefálicas/fisiología , Sincronización Cortical/fisiología , Electroencefalografía/métodos , Músculo Esquelético/fisiología , Corteza Sensoriomotora/fisiología , Percepción del Tacto/fisiología , Estimulación Magnética Transcraneal/métodos , Adulto , Electromiografía , Femenino , Humanos , Masculino , Estimulación Física , Vibración , Muñeca/fisiología , Adulto Joven
12.
Hum Factors ; 60(2): 191-200, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-29161154

RESUMEN

Objective We examined the impacts of pulling task (breakaway and pull-down tasks at different postures), glove use, and their interaction on achievable downward pull forces from a ladder rung. Background Posture, glove use, and the type of pulling task are known to affect the achievable forces. However, a gap in the literature exists regarding how these factors affect achievable downward pulling forces, which are relevant to recovery from a perturbation during ladder climbing. Methods Forty subjects completed four downward pulling tasks (breakaway force; pull force at maximum height, shoulder height, and a middle height), using three glove conditions with varying coefficient of friction (COF) levels (cotton glove, low COF; bare hand, moderate COF; and latex-coated glove, high COF) with their dominant and nondominant hand. The outcome variable was the maximum force normalized to body weight. Results The highest forces were observed for the highest hand postures (breakaway and maximum height). Increased COF led to higher forces and had a larger effect on breakaway force than the other tasks. The dominant hand was associated with higher forces than the nondominant hand. Male subjects generated greater forces than female subjects, particularly for higher hand positions. Conclusion This study suggests that a higher hand position on the ladder, while avoiding low-friction gloves, may be effective for improving recovery from ladder perturbations. Application This study may guide preferred climbing strategies (particularly those that lead to a higher hand position) for improving recovery from a perturbation during ladder climbing.


Asunto(s)
Fenómenos Biomecánicos/fisiología , Guantes Protectores , Mano/fisiología , Actividad Motora/fisiología , Postura/fisiología , Adulto , Femenino , Fricción , Humanos , Masculino
13.
J Pediatr Rehabil Med ; 10(1): 27-36, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28339408

RESUMEN

PURPOSE: The aim of this pilot study was to determine the feasibility and use accelerometers before, during, and after a camp-based constraint-induced movement therapy (CIMT) program for children with hemiplegic cerebral palsy. METHODS: A pre-test post-test design was used for 12 children with CP (mean = 4.9 yrs) who completed a 30-hour camp-based CIMT program. The accelerometer data were collected using ActiGraph GT9X Link. Children wore accelerometers on both wrists one day before and after the camp and on the affected limb during each camp day. Three developmental assessments were administered pre-post CIMT program. RESULTS: Accelerometers were successfully worn before, during, and directly after the CIMT program to collect upper limb data. Affected upper limb accelerometer activity significantly increased during the CIMT camp compared to baseline (p< 0.05). Significant improvements were seen in all twelve children on all assessments of affected upper limb function (p< 0.05) measuring capacity and quality of affected upper limb functioning. CONCLUSION: Accelerometers can be worn during high intensity pediatric CIMT programs to collect data about affected upper limb function. Further study is required to determine the relationship between accelerometer data, measure of motor capacity, and real-world performance post-CIMT.


Asunto(s)
Acelerometría/instrumentación , Parálisis Cerebral/rehabilitación , Movimiento , Modalidades de Fisioterapia , Restricción Física , Extremidad Superior/fisiopatología , Parálisis Cerebral/complicaciones , Parálisis Cerebral/fisiopatología , Niño , Preescolar , Estudios de Factibilidad , Femenino , Hemiplejía/etiología , Hemiplejía/fisiopatología , Hemiplejía/rehabilitación , Humanos , Masculino , Cooperación del Paciente , Proyectos Piloto , Estudios Prospectivos , Resultado del Tratamiento
14.
Appl Ergon ; 60: 163-170, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28166875

RESUMEN

Ladder falls cause many fatal injuries. The factors that affect whether a ladder perturbation leads to a fall are not well understood. This study quantified the effects of several factors on a person's ability to recover from a ladder perturbation. Thirty-five participants each experienced six unexpected ladder missteps, for three glove conditions (bare hands, high friction, low friction) and two climbing directions (ascent, descent). Fall severity was increased during ladder descent (p < 0.001). Gloves did not affect fall severity. Females compared to males had greater fall severity during ascent (p < 0.001) and descent (p = 0.018). During ascent, females had greater fall severity during the second perturbation but similar fall severity to males during the other perturbations. Additional protection may be needed when descending a ladder. Also, females may benefit from targeted interventions like training. This study does not suggest that gloves are effective for preventing ladder falls.


Asunto(s)
Accidentes por Caídas , Guantes Protectores , Accidentes por Caídas/prevención & control , Adaptación Fisiológica , Adolescente , Adulto , Fenómenos Biomecánicos , Femenino , Fricción , Articulación de la Cadera/fisiología , Humanos , Masculino , Movimiento , Factores de Riesgo , Factores Sexuales , Adulto Joven
15.
J Mot Behav ; 49(1): 55-66, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-27592686

RESUMEN

The effect of sensory deficits on power grip force from individual phalanges was examined. The authors found that stroke survivors with sensory deficits (determined by the Semmes-Weinstein monofilament test) gripped with phalanx force directed more tangential to the object surface, than those without, although both groups had similar motor deficits (Chedoke-McMaster and Fugl-Meyer), grip strength, and skin friction. Altered grip force direction elevates risk of finger slippage against the object thus grip loss/object dropping, hindering activities of daily living. Altered grip force direction was associated with altered muscle activation patterns. In summary, the motor impairment level alone may not describe hand motor control in detail. Information about sensory deficits helps elucidate patients' hand motor control with functional relevance.


Asunto(s)
Dedos/fisiología , Fuerza de la Mano/fisiología , Trastornos de la Sensación/fisiopatología , Accidente Cerebrovascular/fisiopatología , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos de la Sensación/complicaciones , Accidente Cerebrovascular/complicaciones
16.
Disabil Rehabil Assist Technol ; 12(2): 175-183, 2017 02.
Artículo en Inglés | MEDLINE | ID: mdl-26735630

RESUMEN

PURPOSE: The concept of a vibrating wristband, to improve dextrous hand function of stroke survivors, was recently proposed with clinical results and is referred to as 'TheraBracelet' in this paper. The purpose of this study was to demonstrate feasibility of a portable, wearable TheraBracelet, and to apply usability evaluation techniques to assess potential demands of TheraBracelet and to identify critical improvement needs of the prototype. METHOD: A prototype was developed with a vibrating element housed in an elastic wristband and connected to a wearable electronics box via a cable. Expectation for TheraBracelet and evaluation of the prototype were obtained from 10 chronic stroke survivors using surveys before and after using the prototype and House of Quality analysis. RESULTS: The survey for expectation showed stroke survivors' willingness to try out TheraBracelet at a low cost. The survey evaluating the prototype showed that the current prototype was overall satisfactory with a mean rating of 3.7 out of 5. The House of Quality analysis revealed that the priority improvement needs for the prototype are to improve clinical knowledge on long-term effectiveness, reduce cost, ease donning/doffing and waterproof. CONCLUSIONS: This study presents a potential for a low-cost wearable hand orthotic likable by stroke survivors. Implications for Rehabilitation Feasibility for a portable wearable wristband-type hand orthotic was demonstrated. The survey showed stroke survivors are willing to try such an orthotic at low cost. The current prototype was rated overall satisfactory by stroke survivors. This study provides a potential for a low-cost wearable hand orthotic likable by stroke survivors.


Asunto(s)
Mano , Modalidades de Fisioterapia , Rehabilitación de Accidente Cerebrovascular/instrumentación , Vibración/uso terapéutico , Dispositivos Electrónicos Vestibles , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Rehabilitación de Accidente Cerebrovascular/economía
17.
J Hand Ther ; 29(4): 465-473, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27769844

RESUMEN

STUDY DESIGN: Repeated measures. INTRODUCTION: The Kinect (Microsoft, Redmond, WA) is widely used for telerehabilitation applications including rehabilitation games and assessment. PURPOSE OF THE STUDY: To determine effects of the Kinect location relative to a person on measurement accuracy of upper limb joint angles. METHODS: Kinect error was computed as difference in the upper limb joint range of motion (ROM) during target reaching motion, from the Kinect vs 3D Investigator Motion Capture System (NDI, Waterloo, Ontario, Canada), and compared across 9 Kinect locations. RESULTS: The ROM error was the least when the Kinect was elevated 45° in front of the subject, tilted toward the subject. This error was 54% less than the conventional location in front of a person without elevation and tilting. The ROM error was the largest when the Kinect was located 60° contralateral to the moving arm, at the shoulder height, facing the subject. The ROM error was the least for the shoulder elevation and largest for the wrist angle. DISCUSSION: Accuracy of the Kinect sensor for detecting upper limb joint ROM depends on its location relative to a person. CONCLUSION: This information facilitates implementation of Kinect-based upper limb rehabilitation applications with adequate accuracy. LEVEL OF EVIDENCE: 3b.


Asunto(s)
Artrometría Articular/instrumentación , Rango del Movimiento Articular/fisiología , Articulación del Hombro/fisiología , Programas Informáticos , Adulto , Fenómenos Biomecánicos , Estudios de Cohortes , Femenino , Humanos , Masculino , Ontario , Mejoramiento de la Calidad , Extremidad Superior/fisiopatología , Adulto Joven
18.
J Rehabil Res Dev ; 53(3): 321-34, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27271199

RESUMEN

The emergence of lower-cost motion tracking devices enables home-based virtual reality rehabilitation activities and increased accessibility to patients. Currently, little documentation on patients' expectations for virtual reality rehabilitation is available. This study surveyed 10 people with stroke for their expectations of virtual reality rehabilitation games. This study also evaluated the usability of three lower-cost virtual reality rehabilitation games using a survey and House of Quality analysis. The games (kitchen, archery, and puzzle) were developed in the laboratory to encourage coordinated finger and arm movements. Lower-cost motion tracking devices, the P5 Glove and Microsoft Kinect, were used to record the movements. People with stroke were found to desire motivating and easy-to-use games with clinical insights and encouragement from therapists. The House of Quality analysis revealed that the games should be improved by obtaining evidence for clinical effectiveness, including clinical feedback regarding improving functional abilities, adapting the games to the user's changing functional ability, and improving usability of the motion-tracking devices. This study reports the expectations of people with stroke for rehabilitation games and usability analysis that can help guide development of future games.


Asunto(s)
Rehabilitación de Accidente Cerebrovascular/métodos , Juegos de Video , Realidad Virtual , Adulto , Anciano , Brazo , Femenino , Mano , Humanos , Masculino , Persona de Mediana Edad , Actividad Motora , Interfaz Usuario-Computador
19.
Exp Brain Res ; 234(4): 985-95, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26686531

RESUMEN

Grip relaxation is a voluntary action that requires an increase in short-interval intracortical inhibition (SICI) in healthy young adults, rather than a simple termination of excitatory drive. The way aging affects this voluntary inhibitory action and timing of grip relaxation is currently unknown. The objective of this study was to examine aging-related delays in grip relaxation and SICI modulation for the flexor digitorum superficialis muscle during grip relaxation. The main finding was that young adults increased SICI to relax their grips, whereas older adults did not increase SICI with a prolonged grip relaxation time (p < 0.05 for both SICI modulation and grip relaxation time). A secondary experiment showed that both young and older adults did not change H reflex excitability during grip relaxation. Our data suggest that grip relaxation is mediated by increased cortical inhibitory output in young adults, and aging-related impairment in increasing cortical inhibitory output may hamper timely cessation of muscle activity. Our data also suggest a lesser role of the spinal circuits in grip muscle relaxation. This knowledge may contribute to understanding of aging-related movement deterioration and development of interventions for improving modulation of SICI to improve muscle relaxation and movement coordination.


Asunto(s)
Envejecimiento/fisiología , Potenciales Evocados Motores/fisiología , Fuerza de la Mano/fisiología , Relajación Muscular/fisiología , Adolescente , Adulto , Anciano , Electromiografía/métodos , Femenino , Reflejo H/fisiología , Humanos , Masculino , Corteza Motora/fisiología , Factores de Tiempo , Adulto Joven
20.
Physiol Rep ; 3(11)2015 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-26603457

RESUMEN

Random vibration applied to skin can change the sense of touch. Specifically, low amplitude white-noise vibration can improve fingertip touch perception. In fact, fingertip touch sensation can improve even when imperceptible random vibration is applied to other remote upper extremity areas such as wrist, dorsum of the hand, or forearm. As such, vibration can be used to manipulate sensory feedback and improve dexterity, particularly during neurological rehabilitation. Nonetheless, the neurological bases for remote vibration enhanced sensory feedback are yet poorly understood. This study examined how imperceptible random vibration applied to the wrist changes cortical activity for fingertip sensation. We measured somatosensory evoked potentials to assess peak-to-peak response to light touch of the index fingertip with applied wrist vibration versus without. We observed increased peak-to-peak somatosensory evoked potentials with wrist vibration, especially with increased amplitude of the later component for the somatosensory, motor, and premotor cortex with wrist vibration. These findings corroborate an enhanced cortical-level sensory response motivated by vibration. It is possible that the cortical modulation observed here is the result of the establishment of transient networks for improved perception.

SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...