中风后手功能近三年英文文献-2011.doc

1.Journal of Neuroengineering and Rehabilitation.J Neuroeng Rehabil. 2011 Aug 26;8(1):50. Epub ahead of printResults of Clinicians Using a Therapeutic Robotic System in an Inpatient Stroke Rehabilitation Unit.Abdullah HA, Tarry C, Lambert C, Barreca S, Allen OB.BACKGROUND: Physical rehabilitation is an area where robotics could contribute significantly to improved motor return for individuals following a stroke. This paper presents the results of a preliminary randomized controlled trial (RCT) of a robot system used in the rehabilitation of the paretic arm following a stroke.METHODS: The studys objectives were to explore the efficacy of this new type of robotic therapy as compared to standard physiotherapy treatment in treating the post-stroke arm; to evaluate client satisfaction with the proposed robotic system; and to provide data for sample size calculations for a proposed larger multicenter RCT. Twenty clients admitted to an inpatient stroke rehabilitation unit were randomly allocated to one of two groups, an experimental (robotic arm therapy) group or a control group (conventional therapy). An occupational therapist blinded to patient allocation administered two reliable measures, the Chedoke Arm and Hand Activity Inventory (CAHAI-7) and the Chedoke McMaster Stroke Assessment of the Arm and Hand (CMSA) at admission and discharge. For both groups, at admission, the CMSA motor impairment stage of the affected arm was between 1 and 3.RESULTS: Data were compared to determine the effectiveness of robot-assisted versus conventional therapy treatments. At the functional level, both groups performed well, with improvement in scores on the CAHAI-7 showing clinical and statistical significance. The CAHAI-7 (range7-49) is a measure of motor performance using functional items. Individuals in the robotic therapy group, on average, improved by 62% (95% CI: 26% to 107%) while those in the conventional therapy group changed by 30% (95% CI: 4% to 61%). Although performance on this measure is influenced by hand recovery, our results showed that both groups had similar stages of motor impairment in the hand. Furthermore, the degree of shoulder pain, as measured by the CMSA pain inventory scale, did not worsen for either group over the course of treatment.CONCLUSION: Our findings indicated that robotic arm therapy alone, without additional physical therapy interventions tailored to the paretic arm, was as effective as standard physiotherapy treatment for all responses and more effective than conventional treatment for the CMSA Arm (p=0.04) and Hand (p=0.04). At the functional level, both groups performed equally well.PMID:21871095PubMed - as supplied by publisher 2.J Neuroeng Rehabil. 2011 Aug 3;8:42.Feasibility of the adaptive and automatic presentation of tasks (ADAPT) system for rehabilitation of upper extremity function post-stroke.Choi Y, Gordon J, Park H, Schweighofer N.SourceDivision of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA. .AbstractBACKGROUND: Current guidelines for rehabilitation of arm and hand function after stroke recommend that motor training focus on realistic tasks that require reaching and manipulation and engage the patient intensively, actively, and adaptively. Here, we investigated the feasibility of a novel robotic task-practice system, ADAPT, designed in accordance with such guidelines. At each trial, ADAPT selects a functional task according to a training schedule and with difficulty based on previous performance. Once the task is selected, the robot picks up and presents the corresponding tool, simulates the dynamics of the tasks, and the patient interacts with the tool to perform the task.METHODS: Five participants with chronic stroke with mild to moderate impairments ( 9 months post-stroke; Fugl-Meyer arm score 49.2 5.6) practiced four functional tasks (selected out of six in a pre-test) with ADAPT for about one and half hour and 144 trials in a pseudo-random schedule of 3-trial blocks per task.RESULTS: No adverse events occurred and ADAPT successfully presented the six functional tasks without human intervention for a total of 900 trials. Qualitative analysis of trajectories showed that ADAPT simulated the desired task dynamics adequately, and participants reported good, although not excellent, task fidelity. During training, the adaptive difficulty algorithm progressively increased task difficulty leading towards an optimal challenge point based on performance; difficulty was then continuously adjusted to keep performance around the challenge point. Furthermore, the time to complete all trained tasks decreased significantly from pretest to one-hour post-test. Finally, post-training questionnaires demonstrated positive patient acceptance of ADAPT.CONCLUSIONS: ADAPT successfully provided adaptive progressive training for multiple functional tasks based on participants performance. Our encouraging results establish the feasibility of ADAPT; its efficacy will next be tested in a clinical trial.PMID:21813010 PubMed - in process PMCID: PMC31694563.J Neuroeng Rehabil. 2011 May 16;8:27.Robotically facilitated virtual rehabilitation of arm transport integrated with finger movement in persons with hemiparesis.Merians AS, Fluet GG, Qiu Q, Saleh S, Lafond I, Davidow A, Adamovich SV.SourceDepartment of Rehabilitation and Movement Sciences, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA. AbstractBACKGROUND: Recovery of upper extremity function is particularly recalcitrant to successful rehabilitation. Robotic-assisted arm training devices integrated with virtual targets or complex virtual reality gaming simulations are being developed to deal with this problem. Neural control mechanisms indicate that reaching and hand-object manipulation are interdependent, suggesting that training on tasks requiring coordinated effort of both the upper arm and hand may be a more effective method for improving recovery of real world function. However, most robotic therapies have focused on training the proximal, rather than distal effectors of the upper extremity. This paper describes the effects of robotically-assisted, integrated upper extremity training.METHODS: Twelve subjects post-stroke were trained for eight days on four upper extremity gaming simulations using adaptive robots during 2-3 hour sessions.RESULTS: The subjects demonstrated improved proximal stability, smoothness and efficiency of the movement path. This was in concert with improvement in the distal kinematic measures of finger individuation and improved speed. Importantly, these changes were accompanied by a robust 16-second decrease in overall time in the Wolf Motor Function Test and a 24-second decrease in the Jebsen Test of Hand Function.CONCLUSIONS: Complex gaming simulations interfaced with adaptive robots requiring integrated control of shoulder, elbow, forearm, wrist and finger movements appear to have a substantial effect on improving hemiparetic hand function. We believe that the magnitude of the changes and the stability of the patients function prior to training, along with maintenance of several aspects of the gains demonstrated at retention make a compelling argument for this approach to training.PMID:21575185 PubMed - indexed for MEDLINE PMCID: PMC31133214.PLoS Biol. 2011 Apr;9(4):e1001031. Epub 2011 Apr 12.Direct observation of the myosin Va recovery stroke that contributes to unidirectional stepping along actin.Shiroguchi K, Chin HF, Hannemann DE, Muneyuki E, De La Cruz EM, Kinosita K Jr.SourceDepartment of Physics, Faculty of Science and Engineering, Waseda University, Tokyo, Japan. AbstractMyosins are ATP-driven linear molecular motors that work as cellular force generators, transporters, and force sensors. These functions are driven by large-scale nucleotide-dependent conformational changes, termed strokes; the power stroke is the force-generating swinging of the myosin light chain-binding neck domain relative to the motor domain head while bound to actin; the recovery stroke is the necessary initial motion that primes, or cocks, myosin while detached from actin. Myosin Va is a processive dimer that steps unidirectionally along actin following a hand over hand mechanism in which the trailing head detaches and steps forward 72 nm. Despite large rotational Brownian motion of the detached head about a free joint adjoining the two necks, unidirectional stepping is achieved, in part by the power stroke of the attached head that moves the joint forward. However, the power stroke alone cannot fully account for preferential forward site binding since the orientation and angle stability of the detached head, which is determined by the properties of the recovery stroke, dictate actin binding site accessibility. Here, we directly observe the recovery stroke dynamics and fluctuations of myosin Va using a novel, transient caged ATP-controlling system that maintains constant ATP levels through stepwise UV-pulse sequences of varying intensity. We immobilized the neck of monomeric myosin Va on a surface and observed real time motions of bead(s) attached site-specifically to the head. ATP induces a transient swing of the neck to the post-recovery stroke conformation, where it remains for 40 s, until ATP hydrolysis products are released. Angle distributions indicate that the post-recovery stroke conformation is stabilized by 5 k(B)T of energy. The high kinetic and energetic stability of the post-recovery stroke conformation favors preferential binding of the detached head to a forward site 72 nm away. Thus, the recovery stroke contributes to unidirectional stepping of myosin Va.Comment in PLoS Biol. 2011 Apr;9(4):e1001043. PMID:21532738 PubMed - indexed for MEDLINE PMCID: PMC3075224Publication Types, MeSH Terms, Substances, Grant SupportPublication Types Research Support, N.I.H., Extramural Research Support, Non-U.S. Govt Research Support, U.S. Govt, Non-P.H.S.MeSH Terms5.J Diabetes Sci Technol. 2011 Mar 1;5(2):301-8.Learning in a virtual environment using haptic systems for movement re-education: can this medium be used for remodeling other behaviors and actions?Merians AS, Fluet GG, Qiu Q, Lafond I, Adamovich SV.SourceDepartment of Rehabilitation and Movement Sciences, University of Medicine and Dentistry of New Jersey, Newark, New Jersey 07107, USA. AbstractRobotic systems that are interfaced with virtual reality gaming and task simulations are increasingly being developed to provide repetitive intensive practice to promote increased compliance and facilitate better outcomes in rehabilitation post-stroke. A major development in the use of virtual environments (VEs) has been to incorporate tactile information and interaction forces into what was previously an essentially visual experience. Robots of varying complexity are being interfaced with more traditional virtual presentations to provide haptic feedback that enriches the sensory experience and adds physical task parameters. This provides forces that produce biomechanical and neuromuscular interactions with the VE that approximate real-world movement more accurately than visual-only VEs, simulating the weight and force found in upper extremity tasks. The purpose of this article is to present an overview of several systems that are commercially available for ambulation training and for training movement of the upper extremity. We will also report on the system that we have developed (NJIT-RAVR system) that incorporates motivating and challenging haptic feedback effects into VE simulations to facilitate motor recovery of the upper extremity post-stroke. The NJIT-RAVR system trains both the upper arm and the hand. The robotic arm acts as an interface between the participants and the VEs, enabling multiplanar movements against gravity in a three-dimensional workspace. The ultimate question is whether this medium can provide a motivating, challenging, gaming experience with dramatically decreased physical difficulty levels, which would allow for participation by an obese person and facilitate greater adherence to exercise regimes. 2011 Diabetes Technology Society.PMID:21527097 PubMed - in process PMCID: PMC31259206.Brain. 2011 May;134(Pt 5):1373-86. Epub 2011 Apr 22.Mental practice with motor imagery in stroke recovery: randomized controlled trial of efficacy.Ietswaart M, Johnston M, Dijkerman HC, Joice S, Scott CL, MacWalter RS, Hamilton SJ.SourceDepartment of Psychology, School of Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK. magdalena.ietswaartunn.ac.ukAbstractThis randomized controlled trial evaluated the therapeutic benefit of mental practice with motor imagery in stroke patients with persistent upper limb motor weakness. There is evidence to suggest that mental rehearsal of movement can produce effects normally attributed to practising the actual movements. Imagining hand movements could stimulate restitution and redistribution of brain activity, which accompanies recovery of hand function, thus resulting in a reduced motor deficit. Current efficacy evidence for mental practice with motor imagery in stroke is insufficient due to methodological limitations. This randomized controlled sequential cohort study included 121 stroke patients with a residual upper limb weakness within 6 months following stroke (on average 3 months post-stroke). Randomization was performed using an automated statistical minimizing procedure. The primary outcome measure was a blinded rating on the Action Research Arm test. The study analysed the outcome of 39 patients involved in 4 weeks of mental rehearsal of upper limb movements during 45-min supervised sessions three times a week and structured independent sessions twice a week, compared to 31 patients who performed equally intensive non-motor mental rehearsal, and 32 patients receiving normal care without additional training. No differences between the treatment groups were found at baseline or outcome on the Action Research Arm Test (ANCOVA statistical P=0.77, and effect size partial 2=0.005) or any of the secondary outcome measures. Results suggest that mental practice with motor imagery does not enhance motor recovery in patients early post-stroke. In light of the evidence, it remains to be seen whether mental practice with motor imagery is a valid rehabilitation technique in its own right.PMID:21515905 PubMed - indexed for MEDLINE PMCID: PMC30978927.Exp Transl Stroke Med. 2011 Apr 17;3(1):4.Effect of a tDCS electrode montage on implicit motor sequence learning in healthy subjects.Kang EK, Paik NJ.SourceDepartment of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea. njpaiksnu.ac.kr.AbstractBACKGROUND: This study was undertaken to test the hypothesis that a combination of excitatory anodal transcranial direct current stimulation (tDCS) to the contralateral motor cortex and inhibitory cathodal tDCS to the ipsilateral motor cortex of the motor performing hand (Bi-tDCS) would elicit more implicit motor sequence learning than anodal tDCS applied to the contralateral motor cortex alone (Uni-tDCS).METHODS: Eleven healthy right-handed adults underwent a randomized crossover experiment of Uni-tDCS, Bi-tDCS, or sham stimulation. Subjects performed a 12-digit finger sequence serial reaction time task with the right hand at baseline (Pre), at immediately (Post 1), and 24 hours after stimulation (Post 2). The ratios of reaction times of predetermined repeating sequence versus random sequence were subjected to statistical analysis.RESULTS: The paired t test showed that reaction time ratios were significant decreased by all stimulation types at Post 1 versus Pre (P 0.01). However, mean reaction time ratios showed a significant decrease after Uni-tDCS (P 0.01) and Bi-tDCS (P 0.01), but only a marginal decreased after Sham (P = 0.05) at Post 2, which suggests that motor sequence learning is consolidated by Uni-tDCS and Bi-tDCS, but only partially consolidated by sham stimulation. No significant differences were observed between Uni-tDCS and Bi-tDCS in terms of in reaction time ratios at Post 1 or 2.CONCLUSIONS: No significant difference was found between Uni-tDCS and Bi-tDCS in terms of induced implicit motor sequence learning, but tDCS led to greater consolidation of the learned motor sequence than sham stimulation. These findings need to be tested in the context of stroke hand motor rehabilitation.PMID:21496317 PubMed PMCID: PMC31011278.Eur J Phys Rehabil Med. 2011 Apr 14. Epub ahead of printThe Cochrane review of occupational therapy for cognitive impairment in stroke patients.Hoffmann T, Bennett S, Koh CL, McKenna KT.SourceDivision of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia - .au.AbstractCognitive impairment frequently follows stroke and impairs everyday activities. This review aimed to determine whether occupational therapy improves functional performance of basic activities of daily living (ADL) and specific cognitive abilities in people who have cognitive impairment after stroke. In this review, randomised and quasi-randomised controlled trials that evaluated an occupational therapy intervention focused on providing cognitive retraining to adults with clinically defined stroke and confirmed cognitive impairment were included. Searches up to April 2009 were conducted in: the Cochrane Stroke Group Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO, Psyc