Robotics, Stem Cells, and Brain-Computer Interfaces in Rehabilitation and Recovery from Stroke

Boninger, Michael L.; Wechsler, Lawrence R.; Stein, Joel

doi:10.1097/phm.0000000000000128

Cited by 13 publications

(8 citation statements)

References 26 publications

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“…High-intensity and task-specific training are considered important for stroke rehabilitation [5,44,45]. Robot-assisted therapy contributes to high-intensity practice due either to an increase in number of repetitions [46] or to the robot being added to regular practice [9], or to both. The frequency of repetitions of reaching movements varied from patient to patient, ranging from 200 to 700 per 15-min session.…”

Section: Discussionmentioning

confidence: 99%

Reaching exercise for chronic paretic upper extremity after stroke using a novel rehabilitation robot with arm-weight support and concomitant electrical stimulation and vibration: before-and-after feasibility trial

et al. 2020

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Background Our group developed a rehabilitation robot to assist with repetitive, active reaching movement of a paretic upper extremity. The robot is equipped with a servo motor-controlled arm-weight support and works in conjunction with neuromuscular electrical stimulation and vibratory stimulation to facilitate agonist-muscle contraction. In this before-and-after pilot study, we assessed the feasibility of applying the robot to improve motor control and function of the hemiparetic upper extremity in patients who suffered chronic stroke. Methods We enrolled 6 patients with chronic stroke and hemiparesis who, while sitting and without assistance, could reach 10 cm both sagitally and vertically (from a starting position located 10 cm forward from the patient’s navel level) with the affected upper extremity. The patients were assigned to receive reaching exercise intervention with the robot (Yaskawa Electric Co., Ltd. Fukuoka, Japan) for 2 weeks at 15 min/day in addition to regular occupational therapy for 40 min/day. Outcomes assessed before and after 2 weeks of intervention included the upper extremity component of the Fugl-Meyer Assessment (UE-FMA), the Action Research Arm Test (ARAT), and, during reaching movement, kinematic analysis. Results None of the patients experienced adverse events. The mean score of UE-FMA increased from 44.8 [SD 14.4] to 48.0 [SD 14.4] (p = 0.026, r = 0.91), and both the shoulder–elbow and wrist–hand scores increased after 2-week intervention. An increase was also observed in ARAT score, from mean 29.8 [SD 16.3] to 36.2 [SD 18.1] (p = 0.042, r = 0.83). Kinematic analysis during the reaching movement revealed a significant increase in active range of motion (AROM) at the elbow, and movement time tended to decrease. Furthermore, trajectory length for the wrist (“hand path”) and the acromion (“trunk compensatory movement”) showed a decreasing trend. Conclusions This robot-assisted modality is feasible and our preliminary findings suggest it improved motor control and motor function of the hemiparetic upper extremity in patients with chronic stroke. Training with this robot might induce greater AROM for the elbow and decrease compensatory trunk movement, thus contributing to movement efficacy and efficiency. Trial registration UMIN Clinical Trial Registry, as UMIN000018132, on June 30, 2015. https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000020398

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Section: Discussionmentioning

confidence: 99%

Reaching exercise for chronic paretic upper extremity after stroke using a novel rehabilitation robot with arm-weight support and concomitant electrical stimulation and vibration: before-and-after feasibility trial

et al. 2020

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“…All of these techniques provide an approximate and indirect measure of the activated cerebral areas although the only real and direct measure of the activated cerebral areas (gamma activity) during movement would be electrocorticography (ECoG). The problem of ECoG is the high invasivity [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Induced gamma band activity from EEG as a possible index of training-related brain plasticity in motor tasks

Amo¹,

Santiago²,

Luciáñez³

et al. 2017

PLoS ONE

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The aim of this study was proposing gamma band activity (GBA) as an index of training-related brain plasticity in the motor cortex. Sixteen controls underwent an experimental session where electroencephalography (EEG) activity was recorded at baseline (resting) and during a motor task (hand movements). GBA was obtained from the EEG data at baseline and during the task. Index of plasticity (IP) was defined as the relationship between GBA at the end of the motor task (GBAM_FIN), divided by GBA at the beginning of the task (GBAM_INI) for movements of both hands. There was a significant increase in GBA at the end of the task, compared to the initial GBA for the motor task (GBAM_FIN > GBAM_INI). No differences were found at baseline (GBAB_FIN ≈ GBAB_INI). Individual IP values had a positive (r = 0.624) and significant correlation with subject’s handedness. Due to plastic changes, GBA could indirectly but objectively reveal changes in cerebral activity related to physical training. This method could be used as a future diagnostic test in the follow-up of patients undergoing rehabilitation. It could also have potential applications in the fields of sports medicine.

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“…Numerous rehabilitation clinics have investigated the effect of stem cell transplantation on the regeneration of the intervertebral disk [ 19 ] and on the restoration of cells of the nervous system [ 20 ]. Boninger, Wechsler, and Stein [ 21 ] proved that the use of bioengineering, robotics, and stem cells may provide synergy when coupled together with regenerative rehabilitation strategies.…”

Section: Introductionmentioning

confidence: 99%

Review of the Current Knowledge on the Role of Stem Cell Transplantation in Neurorehabilitation

Kamelska-Sadowska

Wojtkiewicz

Kowalski

2019

BioMed Research International

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The management involving stem cell (SC) therapy along with physiotherapy offers tremendous chance for patients after spinal cord injury (SCI), traumatic brain injury (TBI), stroke, etc. However, there are still only a limited number of reports assessing the impact of stem cells (SCs) on the rehabilitation process and/or the results of the simultaneous use of SC and rehabilitation. Additionally, since there is still not enough convincing evidence about the effect of SCT on humans, e.g., in stroke, there have been no studies conducted concerning rehabilitation program formation and expected outcomes. It has been shown that bone marrow-derived mesenchymal stem cell (BMSCs) transplantation in rats combined with hyperbaric oxygen therapy (HBO) can promote the functional recovery of hind limbs after SCI. An anti-inflammatory effect has been shown. One case study showed that, after the simultaneous use of SCT and rehabilitation, an SCI patient progressed from ASIA Grade A to ASIA Grade C. Such promising data in the case of complete tetraplegia could be a breakthrough in the treatment of neurologic disorders in humans. Although SCT appears as a promising method for the treatment of neurological conditions, e.g., complete tetraplegia, much work should be done towards the development of rehabilitation protocols.

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Robotics, Stem Cells, and Brain-Computer Interfaces in Rehabilitation and Recovery from Stroke

Cited by 13 publications

References 26 publications

Reaching exercise for chronic paretic upper extremity after stroke using a novel rehabilitation robot with arm-weight support and concomitant electrical stimulation and vibration: before-and-after feasibility trial

Reaching exercise for chronic paretic upper extremity after stroke using a novel rehabilitation robot with arm-weight support and concomitant electrical stimulation and vibration: before-and-after feasibility trial

Induced gamma band activity from EEG as a possible index of training-related brain plasticity in motor tasks

Review of the Current Knowledge on the Role of Stem Cell Transplantation in Neurorehabilitation

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