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Journal of NeuroEngineering and Rehabilitation
Published in: Journal of NeuroEngineering and Rehabilitation 1/2019

Open Access 01-12-2019 | Stroke | Research

Intensive virtual reality and robotic based upper limb training compared to usual care, and associated cortical reorganization, in the acute and early sub-acute periods post-stroke: a feasibility study

Authors: Jigna Patel, Gerard Fluet, Qinyin Qiu, Mathew Yarossi, Alma Merians, Eugene Tunik, Sergei Adamovich

Published in: Journal of NeuroEngineering and Rehabilitation | Issue 1/2019

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Abstract

Background

There is conflict regarding the benefits of greater amounts of intensive upper limb rehabilitation in the early period post-stroke. This study was conducted to test the feasibility of providing intensive therapy during the early period post-stroke and to develop a randomized control trial that is currently in process. Specifically, the study investigated whether an additional 8 h of specialized, intensive (200–300 separate hand or arm movements per hour) virtual reality (VR)/robotic based upper limb training introduced within 1-month post-stroke resulted in greater improvement in impairment and behavior, and distinct changes in cortical reorganization measured via Transcranial Magnetic Stimulation (TMS), compared to that of a control group.

Methods

Seven subjects received 8–1 h sessions of upper limb VR/robotic training in addition to their inpatient therapy (PT, OT, ST). Six subjects only received their inpatient therapy. All were tested on measures of impairment [Upper Extremity Fugl-Meyer Assessment (UEFMA), Wrist AROM, Maximum Pinch Force], behavior [Wolf Motor Function Test (WMFT)], and also received TMS mapping until 6 months post training. ANOVAs were conducted to measure differences between groups across time for all outcome measures. Associations between changes in ipsilesional cortical maps during the early period of enhanced neuroplasticity and long-term changes in upper limb impairment and behavior measures were evaluated.

Results

The VR/robotic group made significantly greater improvements on UEFMA and Wrist AROM scores compared to the usual care group. There was also less variability in the association between changes in the First Dorsal Interosseus (FDI) muscle map area and WMFT and Maximum Force change scores for the VR/robotic group.

Conclusions

An additional 8 h of intensive VR/robotic based upper limb training initiated within the first month post-stroke may promote greater gains in impairment compared to usual care alone. Importantly, the data presented demonstrated the feasibility of conducting this intervention and multiple outcome measures (impairment, behavioral, neurophysiological) in the early period post-stroke.
Literature
1.
2.
3.
Colomer C. E NO, Llorens R. Mirror therapy in chronic stroke survivors with severely impaired upper limb function: a randomized controlled trial. Eur J Phys Rehabil Med. 2016;52(3):271–8.PubMed
4.
Heller A, Wade DT, Wood VA, et al. Arm function after stroke: measurement and recovery over the first three months. J Neurol Neurosurg Psychiatry. 1987;50(6):714–9.CrossRef
5.
6.
7.
8.
9.
10.
Kwakkel G, Kollen BJ, Wagenaar RC. Long term effects of intensity of upper and lower limb training after stroke: a randomised trial. J Neurol Neurosurg Psychiatry. 2002;72(4):473–9.PubMedPubMedCentral
11.
Lincoln NB, Parry RH, Vass CD. Randomized, controlled trial to evaluate increased intensity of physiotherapy treatment of arm function after stroke. Stroke. 1999;30(3):573–9.CrossRef
12.
Winstein CJ, Wolf SL, Dromerick AW, Lane CJ, Nelsen MA, Lewthwaite R, Cen SY, Azen SP: Effect of a Task-Oriented Rehabilitation Program on Upper Extremity Recovery Following Motor Stroke: The ICARE Randomized Clinical Trial. Jama. 2016;315(6):571-81.CrossRef
13.
14.
15.
Nudo RJ. Adaptive plasticity in motor cortex: implications for rehabilitation after brain injury. J Rehabil Med. 2003;35(41 Suppl):7–10.CrossRef
16.
17.
Kleim J. Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. J Speech Lang Hear Res. 2008;51(1):S225–S39.CrossRef
18.
19.
Kimberley TJ, Samargia S, Moore LG, et al. Comparison of amounts and types of practice during rehabilitation for traumatic brain injury and stroke. J Rehabil Res Dev. 2010;47(9):851–62.CrossRef
20.
Fugl-Meyer AR, Jaasko L, Leyman I, et al. The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance. Scand J Rehabil Med. 1975;7(1):13–31.PubMed
21.
Wolf SL, Catlin PA, Ellis M, et al. Assessing Wolf motor function test as outcome measure for research in patients after stroke. Stroke. 2001;32(7):1635–9.CrossRef
22.
Traversa R, Cicinelli P, Bassi A, et al. Mapping of motor cortical reorganization after stroke. A brain stimulation study with focal magnetic pulses. Stroke. 1997;28(1):110–7.CrossRef
23.
24.
25.
26.
Delvaux V, Alagona G, Gerard P, et al. Post-stroke reorganization of hand motor area: a 1-year prospective follow-up with focal transcranial magnetic stimulation. Clin Neurophysiol. 2003;114(7):1217–25.CrossRef
27.
Cicinelli P, Traversa R, Rossini PM. Post-stroke reorganization of brain motor output to the hand: a 2-4 month follow-up with focal magnetic transcranial stimulation. Electroencephalogr Clin Neurophysiol. 1997;105(6):438–50.CrossRef
28.
29.
30.
Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67(2):206–7.CrossRef
31.
32.
Merians AS, Fluet GG. Rehabilitation applications using virtual reality for persons with residual impairments following stroke. New York: Springer; 2014.CrossRef
33.
34.
35.
36.
37.
38.
39.
Duncan PW, Propst M, Nelson SG. Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident. Phys Ther. 1983;63(10):1606–10.CrossRef
40.
Malouin F, Pichard L, Bonneau C, et al. Evaluating motor recovery early after stroke: comparison of the Fugl-Meyer assessment and the motor assessment scale. Arch Phys Med Rehabil. 1994;75(11):1206–12.CrossRef
41.
Deakin A, Hill H, Pomeroy VM. Rough guide to the Fugl-Meyer assessment, upper limb section. Physiotherapy. 2003;89:751–67.CrossRef
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
Liepert J, Bauder H, Wolfgang HR, et al. Treatment-induced cortical reorganization after stroke in humans. Stroke. 2000;31(6):1210–6.CrossRef
Metadata
Title
Intensive virtual reality and robotic based upper limb training compared to usual care, and associated cortical reorganization, in the acute and early sub-acute periods post-stroke: a feasibility study
Authors
Jigna Patel
Gerard Fluet
Qinyin Qiu
Mathew Yarossi
Alma Merians
Eugene Tunik
Sergei Adamovich
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Journal of NeuroEngineering and Rehabilitation / Issue 1/2019
Electronic ISSN: 1743-0003
DOI
https://doi.org/10.1186/s12984-019-0563-3

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