Quantification of Upper Limb Motor Recovery and EEG Power Changes after Robot-Assisted Bilateral Arm Training in Chronic Stroke Patients: A Prospective Pilot Study

Gandolfi, Marialuisa; Formaggio, Emanuela; Geroin, Christian; Storti, Silvia Francesca; Galazzo, Ilaria Boscolo; Bortolami, M.; Saltuari, Leopold; Picelli, Alessandro; Waldner, Andreas; Manganotti, Paolo; Smania, Nicola

doi:10.1155/2018/8105480

Cited by 42 publications

(33 citation statements)

References 76 publications

(115 reference statements)

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“…This finding is coherent with previous literature that used f-MRI to highlight that additional recruitment of sensorimotor areas after stroke may not correspond to restitution of motor function, but more likely to adaptive motor learning strategies to compensate for motor impairments [42]. In this study, some of the EEG findings agree as well, suggesting that neuroplastic processes are taking place at the cortical level, as observed in similar studies [50]. In particular, the enhancement of the ERD in the contralateral side, in the alpha band, and the increase of the LC, in the beta band, suggest the possible partial reorganization of the cortical lesioned areas [45], that are reflected, at a lower hierarchical level, by a modified proximal kinematics and, consequently, by slightly altered motor module recruitment patterns.…”

Section: Integrationsupporting

confidence: 93%

A Multiparameter Approach to Evaluate Post-Stroke Patients: An Application on Robotic Rehabilitation

et al. 2018

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Multidomain instrumental evaluation of post-stroke chronic patients, coupled with standard clinical assessments, has rarely been exploited in the literature. Such an approach may be valuable to provide comprehensive insight regarding patients’ status, as well as orienting the rehabilitation therapies. Therefore, we propose a multidomain analysis including clinically compliant methods as electroencephalography (EEG), electromyography (EMG), kinematics, and clinical scales. The framework of upper-limb robot-assisted rehabilitation is selected as a challenging and promising scenario to test the multi-parameter evaluation, with the aim to assess whether and in which domains modifications may take place. Instrumental recordings and clinical scales were administered before and after a month of intensive robotic therapy of the impaired upper limb, on five post-stroke chronic hemiparetic patients. After therapy, all patients showed clinical improvement and presented pre/post modifications in one or several of the other domains as well. All patients performed the motor task in a smoother way; two of them appeared to change their muscle synergies activation strategies, and most subjects showed variations in their brain activity, both in the ipsi- and contralateral hemispheres. Changes highlighted by the new multiparametric instrumental approach suggest a recovery trend in agreement with clinical scales. In addition, by jointly demonstrating lateralization of brain activations, changes in muscle recruitment and the execution of smoother trajectories, the new approach may help distinguish between true functional recovery and the adoption of suboptimal compensatory strategies. In the light of these premises, the multi-domain approach may allow a finer patient characterization, providing a deeper insight into the mechanisms underlying the relearning procedure and the level (neuro/muscular) at which it occurred, at a relatively low expenditure. The role of this quantitative description in defining a personalized treatment strategy is of great interest and should be addressed in future studies.

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Section: Integrationsupporting

confidence: 93%

A Multiparameter Approach to Evaluate Post-Stroke Patients: An Application on Robotic Rehabilitation

et al. 2018

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“…In addition, it is possible to use EEG during task performance in an ecological environment. This framework allows exploration of the brain's functional changes and monitoring of brain activity in response to rehabilitation tasks [201][202][203], potentially shedding light on specific brain-behavior relationships.…”

Section: Neural and Muscular Correlates Of The Sensorimotor Performancementioning

confidence: 99%

Perspectives and Challenges in Robotic Neurorehabilitation

et al. 2019

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The development of robotic devices for rehabilitation is a fast-growing field. Nowadays, thanks to novel technologies that have improved robots' capabilities and offered more cost-effective solutions, robotic devices are increasingly being employed during clinical practice, with the goal of boosting patients' recovery. Robotic rehabilitation is also widely used in the context of neurological disorders, where it is often provided in a variety of different fashions, depending on the specific function to be restored. Indeed, the effect of robot-aided neurorehabilitation can be maximized when used in combination with a proper training regimen (based on motor control paradigms) or with non-invasive brain machine interfaces. Therapy-induced changes in neural activity and behavioral performance, which may suggest underlying changes in neural plasticity, can be quantified by multimodal assessments of both sensorimotor performance and brain/muscular activity pre/post or during intervention. Here, we provide an overview of the most common robotic devices for upper and lower limb rehabilitation and we describe the aforementioned neurorehabilitation scenarios. We also review assessment techniques for the evaluation of robotic therapy. Additional exploitation of these research areas will highlight the crucial contribution of rehabilitation robotics for promoting recovery and answering questions about reorganization of brain functions in response to disease.In the last decades, innovative robotic technologies have been developed in order to effectively help clinicians during the neurorehabilitation process. The term "robotic technology" in this application domain refers to any mechatronic device with a certain degree of intelligence that can physically intervene on the behavior of the patient, optimizing and speeding up his/her sensorimotor recovery. The two key capabilities of these robots are: (1) Assessing the human sensorimotor function; and (2) re-training the human brain in order to improve the patient's quality of life. However, most of the studies in this field have been focused more on the development of the devices, whereas less effort was made on maximizing their efficacy for promoting recovery. The main challenge consists of designing effective training modalities, supported by appropriate control strategies. Thus, each robotic device supports a pre-defined training modality depending on the low-level control strategy implemented and also on the residual abilities of each patient. Usually, most of the rehabilitation devices implement a passive training modality (robot-driven, position control strategy), where the robot imposes the trajectories, and an active training modality (patient-driven), where the robot modulates its trajectory in response to the subject's intention to move [7,8]. However, among all the different training modalities, the most relevant is the assistive one. Assistive controllers help participants to move their impaired limbs according to the desired postures during grasping, reaching, or walki...

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“…MT is a treatment based on neuroplasticity for recovering the lesioned brain. Therefore, we used EEG to verify the effect of MT in terms of brain activation [37].…”

Section: Brain Activation Analysis: Eegmentioning

confidence: 99%

Quantitative Analysis of EEG Power Spectrum and EMG Median Power Frequency Changes after Continuous Passive Motion Mirror Therapy System

Park

Lee

Jeong

et al. 2020

Sensors

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Robotic mirror therapy (MT), which allows movement of the affected limb, is proposed as a more effective method than conventional MT (CMT). To improve the rehabilitation effectiveness of post-stroke patients, we developed a sensory stimulation-based continuous passive motion (CPM)-MT system with two different operating protocols, that is, asynchronous and synchronous modes. To evaluate their effectiveness, we measured brain activation through relative and absolute power spectral density (PSD) changes of electroencephalogram (EEG) mu rhythm in three cases with CMT and CPM-MT with asynchronous and synchronous modes. We also monitored changes in muscle fatigue, which is one of the negative effects of the CPM device, based on median power frequency (MPF) and root mean square (RMS). Relative PSD was most suppressed when subjects used the CPM-MT system under synchronous control: 22.11%, 15.31%, and 16.48% on Cz, C3, and C4, respectively. The absolute average changes in MPF and RMS were 1.59% and 9.78%, respectively, with CPM-MT. Synchronous mode CPM-MT is the most effective method for brain activation, and muscle fatigue caused by the CPM-MT system was negligible. This study suggests the more effective combination rehabilitation system for MT by utilizing CPM and magnetic-based MT task to add action execution and sensory stimulation compared with CMT. method uses voluntary exercise to improve a patient's motivation to rehabilitate [4] and prevents the deterioration of the motor ability of the lesioned brain hemisphere using a visual illusion that bilateral movement has been accomplished [5,6]. However, a major drawback of conventional MT (CMT) is that the paralyzed arm does not move at all during the treatment. Thus, muscle atrophy can be aggravated and the elbow can become stiff. Spasticity and hypertonus are likely to limit the functional use of the paralyzed limb. Additionally, muscle hyperexcitability may lead to secondary complications including contracture, pain, and reduced range of motion. In the long term, these complications may also result in structural changes in connective tissues and muscle fibers [7,8]. In such situations, patients lose their motivation to rehabilitate. In addition, the prevalence of strokes increases in an aging society, and the public healthcare burden of patients who have suffered a stroke increases. The current emphasis on cost reduction in medical services has resulted in reducing the duration of in-patient rehabilitation of post-stroke patients. This results in patients terminating treatment with incomplete recovery. These situations have triggered research on better and cost-efficient methods of treatment for post-stroke patients.To overcome the current limitations of CMT methods, a robotic system that actually moves the affected limb has recently been proposed as an emerging rehabilitative method [9,10]. However, building a new system for only one rehabilitation method, like MT, is difficult to introduce in many hospitals owing to budget and utilization issues. In addition, intro...

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Quantification of Upper Limb Motor Recovery and EEG Power Changes after Robot-Assisted Bilateral Arm Training in Chronic Stroke Patients: A Prospective Pilot Study

Cited by 42 publications

References 76 publications

A Multiparameter Approach to Evaluate Post-Stroke Patients: An Application on Robotic Rehabilitation

A Multiparameter Approach to Evaluate Post-Stroke Patients: An Application on Robotic Rehabilitation

Perspectives and Challenges in Robotic Neurorehabilitation

Quantitative Analysis of EEG Power Spectrum and EMG Median Power Frequency Changes after Continuous Passive Motion Mirror Therapy System

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