Feasibility and preliminary efficacy of a combined virtual reality, robotics and electrical stimulation intervention in upper extremity stroke rehabilitation

Abstract

Background Approximately 80% of individuals with chronic stroke present with long lasting upper extremity (UE) impairments. We designed the perSonalized UPper Extremity Rehabilitation (SUPER) intervention, which combines robotics, virtual reality activities, and neuromuscular electrical stimulation (NMES). The objectives of our study were to determine the feasibility and the preliminary efficacy of the SUPER intervention in individuals with moderate/severe stroke. Methods Stroke participants (n = 28) received a 4-week intervention (3 × per week), tailored to their functional level. The functional integrity of the corticospinal tract was assessed using the Predict Recovery Potential algorithm, involving measurements of motor evoked potentials and manual muscle testing. Those with low potential for hand recovery (shoulder group; n = 18) received a robotic-rehabilitation intervention focusing on elbow and shoulder movements only. Those with a good potential for hand recovery (hand group; n = 10) received EMG-triggered NMES, in addition to robot therapy. The primary outcomes were the Fugl-Meyer UE assessment and the ABILHAND assessment. Secondary outcomes included the Motor Activity Log and the Stroke Impact Scale. Results Eighteen participants (64%), in either the hand or the shoulder group, showed changes in the Fugl-Meyer UE or in the ABILHAND assessment superior to the minimal clinically important difference. Conclusions This indicates that our personalized approach is feasible and may be beneficial in improving UE function in individuals with moderate to severe impairments due to stroke. Trial registration ClinicalTrials.gov NCT03903770. Registered 4 April 2019. Registered retrospectively.

The roles of the LpSTS and DLPFC in self‐prioritization: A transcranial magnetic stimulation study

“…TMS was delivered by a figure-ofeight coil (Magstim coated Alpha Flat 50 mm diameter) attached to a Magstim Rapid 2 stimulator (Magstim, Carmarthenshire, UK). In line with prior studies (Camsari et al, 2019;Merchant et al, 2020;Norouzi-Gheidari et al, 2021), the coil was placed tangentially to the scalp in the present study to maximize the impact of TMS on the cortex. For the DLPFC group (Figure 2b), TMS stimulation was targeted to the left DLPFC at F3 using the 10-20 system (Curtin et al, 2019); for the LpSTS group, TMS stimulations were targeted to the left LpSTS at CP5 using the 10-20 system (Peretz & Lavidor, 2013); for the sham group, the Vertex (Cz of the 10-20 international system, e.g., Okabe, Ugawa, & Kanazawa, 2003) was chosen as the sham stimulation site based on previous studies (Pelisson, Habchi, Panouilleres, Hernoux, & Farne, 2018;Thakral, Madore, Kalinowski, & Schacter, 2020;Veniero et al, 2021), and the coil was tilted away from the scalp in a 90 angle, so there was no cortical stimulation but still touching the head (Jansen et al, 2019;Kaller et al, 2013).…”

Perceptions of stroke survivors regarding factors affecting adoption of technology and exergames for rehabilitation

“…To prepare for the future where individuals with stroke will expect the incorporation of technologies into clinical and home‐based rehabilitation, evaluating their perceptions regarding technologies is crucial in informing research and clinical practice. Exergames can supplement motor training with fun, engaging, supervised movement practice, as well as increase the intensity and quality of movement practice, thereby enhancing rehabilitation efficacy 23–25 and functional recovery 26–35 …”

“…Incorporating exergames such as Nintendo Wii Fit, Jintronix, Motion Rehab AVE 3D, Tetrax biofeedback, BIORescue, Kinect, and other noncommercial games have been shown to improve functional recovery 23–25,30,31,33,36–39 . However, the extent to which individuals with neurological disability such as stroke perceive technology and exergames favorably in the context of their rehabilitation experience remains unclear.…”

Research Status and Emerging Trends in Virtual Reality Rehabilitation: Bibliometric and Knowledge Graph Study

“…Another group investigated the elbow and shoulder movements of older patients with chronic stroke, using the Predict Recovery Potential algorithm. The training improved motivation, but the benefits of physical function in aging were unknown [ 2 , 37 ].…”