Efficacy of robot-assisted fingers training in chronic stroke survivors: a pilot randomized-controlled trial.

BACKGROUND: While constraint-induced movement therapy (CIMT) is one of the most promising techniques for upper limb rehabilitation after stroke, it requires high residual function to start with. Robotic device, on the other hand, can provide intention-driven assistance and is proven capable to complement conventional therapy. However, with many robotic devices focus on more proximal joints like shoulder and elbow, recovery of hand and fingers functions have become a challenge. Here we propose the use of robotic device to assist hand and fingers functions training and we aim to evaluate the potential efficacy of intention-driven robot-assisted fingers training. METHODS: Participants (6 to 24 months post-stroke) were randomly assigned into two groups: robot-assisted (robot) and non-assisted (control) fingers training groups. Each participant underwent 20-session training. Action Research Arm Test (ARAT) was used as the primary outcome measure, while, Wolf Motor Function Test (WMFT) score, its functional tasks (WMFT-FT) sub-score, Fugl-Meyer Assessment (FMA), its shoulder and elbow (FMA-SE) sub-score, and finger individuation index (FII) served as secondary outcome measures. RESULTS: Nineteen patients completed the 20-session training ( TRIAL REGISTRATION: HKClinicalTrials.com HKCTR-1554); eighteen of them came back for a 6-month follow-up. Significant improvements (p < 0.05) were found in the clinical scores for both robot and control group after training. However, only robot group maintained the significant difference in the ARAT and FMA-SE six months after the training. The WMFT-FT score and time post-training improvements of robot group were significantly better than those of the control group. CONCLUSIONS: This study showed the potential efficacy of robot-assisted fingers training for hand and fingers rehabilitation and its feasibility to facilitate early rehabilitation for a wider population of stroke survivors; and hence, can be used to complement CIMT.

Effects of Electromyographically-driven Neuromuscular Stimulatio Cycling System on the Lower-Limb of Stroke Survivors.

This paper describes the design of an Electromyographically(EMG)-driven Neuromuscular Electrical Stimulation (NMES) cycling system. It utilises real-time EMG from actively participating stroke survivors as feedback control to drive the cycling system for rehabilitation. The user controls the speed of the cycling system using muscle activities of the side affected recorded by EMG electrodes. Additionally, adaptable NMES stimulations; also EMG based, were provided in cyclic pattern to the respective muscle groups in order to improve muscle coordination. The targeted muscle groups used to control the system were the Hamstring (HS), Tibialis Anterior (TA), Quadriceps (QC), Gastrocnemius Lateralis (GL) of the leg on the affected side. Using the system, 20 30-minutes sessions were conducted with chronic stroke survivors (n=10) at frequency of 2-4 sessions per week. Clinical assessment scores, namely FMA_LE, BBS and 6MWT were calculated before the first session and after the completion of 20 sessions. All the assessment scores showed significant improvement after using the system; FMA_LE(P=0.0244), BBS(P=0.0156), 6MWT(P=0.0112), and SI (P=0.0258), showing that the EMG-driven NMES cycling system provides effective rehabilitation for stroke survivors in terms of muscle strength and balance.

Design of Functional Electrical Stimulation Cycling System for Lower-Limb Rehabilitation of Stroke Patients.

The active participation of the stroke survivor during Functional Electrical Stimulation (FES) cycling system is an interesting question that we would like to investigate, since active rehabilitation can promote a better motor function recovery than passive training. In this pilot study, a smart FES cycling system which can assess the participants cycling effort was proposed to record real-time Electromyography (EMG) and torque during lower limb training for chronic stroke survivors. The rehabilitation goals were to increase the lower-limb muscle strength and enhance the muscle coordination. Chronic stroke patients (n=6) with gait impairment and moderate motor disability were recruited to evaluate the functionality of the system. The system was composed of a modified station bike with an adjustable chair, a programmable functional electrical stimulator, a step motor, a torque sensor, and a surface electromyography (EMG) amplifier. Four-channel FES and EMG electrodes were placed at quadriceps (QC), hamstrings (HS), tibialis anterior (TA) and gastrocnemius (GL) to exert stimulation. We adopted two measurements, clinical assessment scores and symmetric index (SI), to evaluate the training effects. The experimental results showed the proposed cycling system could improve the participants walking ability (p=.046) and enhance balance of the muscle coordination (p=.042) after training.

The Effectiveness of Functional Electrical Stimulation (FES) in On-Off Mode for Enhancing the Cycling Performance of Team Phoenix at 2016 Cybathlon.

In this study we designed a Functional Electrical Stimulation (FES) trike for a female subject with spinal cord injury to exercise her lower limbs and improve her lower limb muscle condition for attending the 2016 Cybathlon FES bike competition. Our FES pilot was the only female participant, in the FES cycling competition and she rode for Team Phoenix from the Chinese University of Hong Kong. Due to the weakness of muscles in the lower limb of the subject, and due to scoliosis over her thoracolumbar aéra, the mechanical structure of the trike had to be tailor-made to ensure she sat on the bike in a safe and secure position. A six-phase angle-driven stimulation pattern was developed to stimulate quadriceps and hamstrings without gluteus muscles for contraction through four surface electrodes, thereby creating a cycling movement. To improve the cycling endurance and reduce the muscle fatigue, an on-off mode was developed for controlling the stimulation time that allowed the subject to cycle for 20s, then pause while the trike advanced without stimulation for 5s, followed by a subsequent 20 sec stimulation, to continue cycling. The pilot participated in the training procedure including training exercise at home, trike fitting in the trike by modifying the mechanical structure, and conducting the cycling exercise for six months. We observed significant improvements in the pilot's lower limb condition. The on-off mode enabled our pilot to extend her cycling endurance effectively, from 1 min to 2.5 mins and the distance from 62m to 100m. Over the eight minutes time limit, our team successfully finished 100 m in the Cybathlon FES.

Does acupuncture therapy alter activation of neural pathway for pain perception in irritable bowel syndrome?: a comparative study of true and sham acupuncture using functional magnetic resonance imaging.

BACKGROUND/AIMS: Patients with irritable bowel syndrome (IBS) are characterized by abnormal central processing with altered brain activation in response to visceral nociceptive signals. The effect of electroacupuncture (EA) on IBS patients is unclear. The study is set to study the effect of EA on brain activation during noxious rectal distension in IBS patients using a randomized sham-controlled model. METHODS: Thirty IBS-diarrhea patients were randomized to true electroacupuncture or sham acupuncture. Functional MRI was performed to evaluate cerebral activation at the following time points: (1) baseline when there was rectal distension only, (2) rectal distension during application of EA, (3) rectal distension after cessation of EA and (4) EA alone with no rectal distension. Group comparison was made under each condition using SPM5 program. RESULTS: Rectal distension induced significant activation of the anterior cingulated cortex, prefrontal cortex, thalamus, temporal regions and cerebellum at baseline. During and immediately after EA, increased cerebral activation from baseline was observed in the anterior cingulated cortex, bilateral prefrontal cortex, thalamus, temporal regions and right insula in both groups. However, true electroacupuncture led to significantly higher activation at right insula, as well as pulvinar and medial nucleus of the thalamus when compared to sham acupuncture. CONCLUSIONS: We postulate that acupuncture might have the potential effect of pain modulation in IBS by 2 actions: (1) modulation of serotonin pathway at insula and (2) modulation of mood and affection in higher cortical center via ascending pathway at the pulvinar and medial nucleus of the thalamus.