Top PDF Automated Assessment of Upper Extremity Movement Impairment due to Stroke

Automated Assessment of Upper Extremity Movement Impairment due to Stroke

Automated Assessment of Upper Extremity Movement Impairment due to Stroke

The study results have shown that using low-cost motion capture with an automated scoring algorithm is a feasible method to assess objectively upper-arm impairment post stroke. Several recent studies have demonstrated the usefulness of whole-body kinematics in the assessment of improvements in post-stroke locomotion [41], arm-trunk coordination [42], and reaching movements [43]. Furthermore, motion capture was used to assess upper extremity motor function after constraint-induced move- ment therapy and was reported to have higher inter-rater reliability than possible with traditional clinical measures [44,45]. However, some major limitations of using motion capture for clinical needs is the cost, complexity, and lack of portability of traditional full body motion capture systems, which require several cameras and markers placed on subject’s body. With the development of low-cost markerless 3D motion capture systems, such as the Kinect Sensor used in this study, out-of-the-lab movement kinematics with sufficient accuracy is now available for general use. The potential cost savings for clinics using the new low-cost motion capture technology are substantial, e.g. Kinect Sensor costs about $ 200, while lab-based motion capture systems cost tens of thousands of dollars. However, the complexity of kinematic data is still a barrier to the widespread acceptance of it in clinical practice. Results of the current study aim to overcome this barrier by demonstrating the effectiveness of an automated algorithm to clinically assess arm impairment from kinematics. This allows for the automation of impairment assessment, which enables the inclusion of quantitative outcome measures in routine medical practice. Clinical automated assessments are already a reality for quantitative measures of gait and balance impairment using GAITRite (CIR Systems Inc) and SMART Balance Master (NeuroCom) respectively. The current study is the first to show that clinical assessment of arm motor impairment can be automated. The application of this technology may not only reduce the cost of assessment of post-stroke movement impair- ment, but also promote the acceptance of objective impairment measures into routine medical practice.
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A pilot study evaluating use of a computer-assisted neurorehabilitation platform for upper-extremity stroke assessment

A pilot study evaluating use of a computer-assisted neurorehabilitation platform for upper-extremity stroke assessment

Quantification of upper-extremity movement features in patients with stroke is a critical component for supporting the optimization of intervention plans [3], so as for understanding the underlying mechanism of the upper extremity impairments induced by stroke. In today's reha- bilitation practice, stroke assessment in clinical settings generally involves use of observer-based, ordinal scale instruments, such as the Functional Independence Meas- ure (FIM) [4], Fugl-Meyer Assessment [5], Wolf Motor Function Test [6], Chedoke-McMaster Stroke Assessment [7] and so on. Although these ordinal instruments are well established and have proven to be reliable and sensi- tive for measuring gross changes in functional perform- ance, they can be problematic because of poor consistency in the differences between scale increments [8]. They also lack sensitivity to characterize small yet potentially impor- tant changes during the intervention process [9,10]. The subjectivity of these tests is well recognized [11]. Further- more, due to the economic pressure on the healthcare sys- tem, patients with stroke, particularly the outpatient population, have a limited access to rehabilitation resources [12]. Due to these reasons, there is a need to develop cost-effective, semi-autonomous/autonomous, yet sensitive assessment instruments for patients with stroke at home, which is characterized by low cost and under-supervision from rehabilitation practitioners. Measures derived from kinematic trajectories associated with goal-directed tasks are continuous metrics which can potentially be sensitive to the subtle changes in the inter- vention process. They can also be more objective and repeatable across subjects than clinical ordinal scales [10]. The results from previous studies which examined the assessment capability of kinematic measures for stroke- induced impairments are summarized below.
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A cohort study investigating a simple, early assessment to predict upper extremity function after stroke - a part of the SALGOT study

A cohort study investigating a simple, early assessment to predict upper extremity function after stroke - a part of the SALGOT study

UE motor function at 3 days after stroke onset was assessed with the FMA-UE, [3, 15] consisting of 33 items, each scored 0-2 and summed to a total score of 0-66 points. The total score on the FMA-UE was strati- fied into two groups: severe UE impairment (≤31) and mild/moderate UE impairment (≥32). A score of FMA- UE ≥32 was used to identify patients from the SALGOT cohort who possessed the motor function required for a drinking task with the paretic arm and used as the cut- off between the two groups. This cut-off was based on a previous study [16], in which patients were included if they were able to perform a drinking task with their af- fected arm (lowest score for FMA-UE was 32 points). This drinking task requires the capacity to reach, grasp, lift, transport the glass as well as drink. Validation of the cut-off score of FMA-UE ≥32 to correctly classify pa- tients’ motor ability to drink from a glass (the drinking task) was based on the entire cohort. The results were: at 10 days sensitivity 98 % (CI 95 % 0.91-1.0) and specificity 89 % (0.77-0.96), at 1 month sensitivity 100 % (0.92-1.0) and specificity 93 % (0.84-0.98) and at 12 months sensitiv- ity 100 % (0.85-1.0) and specificity 96 % (0.87-1.0). These results confirmed the use of this cut-off in the subsequent analysis. The majority of classification errors occurred in data gathered at 10 days post stroke, on the group of patients with moderate/mild UE impairment but with a poor hand function and inability to grip and perform the drinking task (n = 6).
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Effectiveness of Modified Constraint Tnduced Movement Therapy (MCIMT) on upper extremity function among post stroke hemiparetic patients at selected Rehabilitation Centers, Coimbatore

Effectiveness of Modified Constraint Tnduced Movement Therapy (MCIMT) on upper extremity function among post stroke hemiparetic patients at selected Rehabilitation Centers, Coimbatore

(i) Literature related to stroke rehabilitation for post stroke patients. Luca Mirela Cristina, Daniela Matei et al (2015) conducted a study to evaluate the effects of Mirror therapy program in addition with physical therapy on upper limb recovery among 30 subacute ischemic stroke patients, 15 samples received a comprehensive rehabilitative treatment, 8 samples received only control therapy (CT) and 7 samples received mirror therapy (MT) for 30 min every day, 5 times a week, for 6 weeks with conventional therapy. Researchers used Brunnstrom stages, Fugl±Meyer Assessment scale (upper extremity), the Ashworth Scale, and Bhakta Test (finger flexion scale) to assess changes in upper limb motor recovery and motor function. After 6 weeks of treatment, post test result revealed that patients in both groups had significant improvements but mirror therapy (MT) showed greater improvements compared to the CT group. It concluded that mirror therapy (MT) was an easy and low-cost method which improves motor functions, manual skills and ADL for stroke patients.
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Exploring the Use of the Bimanual Arm Trainer for  Improving Upper Extremity Motor Function in Stroke Patients.

Exploring the Use of the Bimanual Arm Trainer for Improving Upper Extremity Motor Function in Stroke Patients.

A 2015 study conducted in Amsterdam compared three interventions including CIMT, modified bilateral arm training with rhythmic auditory cueing (mBATRAC), and Dose Matched Control Treatment (DMCT), and concluded that there was a large improvement in the control of the affected upper limb after mBATRAC treatment when compared to the other two, but the coupling between the hands remained the same (Delden, Beek, Roerdink, Kwakkel, & Peper, 2014). A 2010 randomized control trial comparing the efficacy of BATRAC versus dose- matched therapeutic exercises (DMTEs) on upper limb function after six weeks of training reported that both treatment modalities improved global upper limb impairment and function in chronic stroke patients. These improvements, seen in the upper extremities as a result of both treatment modalities, were sustained over four months. The study also hypothesized that BATRAC produced results through cortical remodeling in the ipsilesional precentral gyrus and the contralesional superior frontal gyrus (premotor cortex). The DMTE, on the other hand, produced similar treatment through other neuroplastic mechanisms (Whitall et al., 2010). It has been shown in patients with chronic stroke that coupled bimanual movement with neuromuscular stimulation improved bimanual force production, as evidenced by improved bimanual
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Effectiveness of Modified Constraint Induced Movement Therapy and Bilateral Arm Training on Upper Extremity Function after Chronic Stroke: A Comparative Study

Effectiveness of Modified Constraint Induced Movement Therapy and Bilateral Arm Training on Upper Extremity Function after Chronic Stroke: A Comparative Study

In this study we found, 8 weeks of BAT showed improvement in measures of motor impairment and func- tional use in patients with chronic upper extremity hemiparesis. This suggests that forced use in a repetitive manner, bilaterally can improve motor ability and functional use of upper extremity in chronic hemiparetic stroke patients. This result is consistent with the findings of Whittal et al., 2000 and Luft et al., 2004. In our study the BAT group showed better performance in the proximal part score of FMA than m-CIMT and Conven- tional Therapy group. The repetitive reaching type movements comprising shoulder flexion, protraction, elbow extension and shoulder extension/retraction; elbow flexion might have resulted in the improvement of proximal part motor ability, thereby improving the proximal part score of FMA in bilateral arm training group relative to m-CIMT and Conventional Therapy group. The effectiveness of the bilateral arm training can be found in the behavior and neurophysiology literature. Practicing bilateral simultaneous movements may result in a facilita- tion effect from non-paretic arm . For example, when the bimanual movements are initiated simultaneously, the arms act as a unit that supersedes individual arm action, indicating that both arms are strongly linked as a coor- dinated unit in the brain, (the entrainment effect). Studies by Kelso J.A., Putnam C.A., Goodman D., 1979 [15] on inter limb coordination during simultaneous performance of bimanual tasks suggest that when both limbs are performing identical actions, the same movement organization occurs in both hemispheres. In fact there may be a single command or central mechanisms applied to both limbs. When the two hands perform identical tasks, there is a tight phasic relationship observed in which one limb entrains the other, causing them to function to- gether as a unit. Another important aspect of bilateral arm training is repetition which is a well known motor learning principle and recent animal studies have demonstrated that forced use involving a motor task rather than forced use alone may best promote central nervous system plasticity [16].
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Human upper limb motion analysis for post-stroke impairment assessment using video analytics

Human upper limb motion analysis for post-stroke impairment assessment using video analytics

(b) elbow movement (degree). Fig. 7: Illustration of the tracking performance of the pro- posed DKF-SSIM and STR [22]. CC=column-coordinate. CCG=column-coordinate groundtruth. AG=angle groundtruth. The proposed DKF-SSIM tracking-by-detection scheme is best suited for bullseye marker tracking due to its ability to incorporate dynamic and measurement models during tracking and combining the luminance, contrast, and structure features of the marker for detection. Since the position of the centre co- ordinate of the detected marker block has significant influence on the accuracy of the joint angle calculation, none of the four benchmark tracking methods are suited for autonomous joint angle calculation due to their resulting low PMR. To further demonstrate this, we show the tracking performance of the proposed DKF-SSIM and STR [22], the best benchmarking scheme among JCTH [9], TLD [10] and STR [22] according to Tables I and II, on one trial of a healthy subject in Fig. 7, where Fig. 7(a) shows the column-coordinate of the wrist marker given the benchmarking hand-labelled column- coordinate groundtruth, and Fig. 7(b) shows the corresponding elbow movement angle (degree) given the benchmarking angle groundtruth calculated from the hand-labelled groundtruth shoulder, elbow, and wrist markers. The corresponding error is shown in Table III.
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Human upper limb motion analysis for post-stroke impairment assessment using video analytics

Human upper limb motion analysis for post-stroke impairment assessment using video analytics

PHILIP ROWE received the B.Sc. (Hons.) degree in mechanical engineering from the University of Birmingham, in 1982, and the Ph.D. degree in bioengineering from the University of Strath- clyde, in 1990. For his Ph.D. work, he received the European Society of Biomechanics, Clinical Biomechanics Award in 1987. After completing his Ph.D., he held various academic appointments with Queen Margaret University, Edinburgh, U.K., where he pursued his own research and was also responsible for research development within the School of Health Sciences. He re-joined the Biomedical Engineering Department, University of Strath- clyde, in 2005, as part of the HealthQWest research consortium, for which he was the Head of the Function for Living Research Program. His main research areas lie in clinical movement analysis, functional analysis, biome- chanics of the human body in motion, rehabilitation engineering, rehabil- itation technology, rehabilitation robotics, and robotic surgery especially applied to orthopaedics and stroke. His research has helped elucidate the clin- ical outcomes of various musculoskeletal and neurological disorders, such as knee replacement surgery, hip replacement surgery, hip fractures, back pain, hyper-mobility syndrome, patello-femoral pain syndrome, stroke, and aging. He is especially interested in the application of science and engineering methods to patient treatment and also their use to quantify and analyze the clinical effects of rehabilitation services. He considers that for service users to maximize their recovery from illness rehabilitation should encompass the physical, psychological, nutritional, and social factors effecting function simultaneously and should assist the patient travel from the acute setting through rehabilitation to self care or care in the community.
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Movement variability in stroke patients and controls performing two upper limb functional tasks: a new assessment methodology

Movement variability in stroke patients and controls performing two upper limb functional tasks: a new assessment methodology

Curve registration was first applied to gait data by Sadeghi and colleagues [20]. They recognised that characteristic features, such as peak values, vary between individuals in their precise location within the gait cycle. Averaging time-normalised curves across individuals therefore results in loss of information. Sadeghi and colleagues used the technique of curve registration to more appropri- ately align subjects' gait data prior to further analysis. Because upper limb motions during functional tasks are not cyclic yet have repetitive characteristics if constrained, we decided to apply such an approach to upper limb acceleration signals and report the warping cost as a valu- able outcome measure. Our results support this approach in that significant group differences with regard to time- warping were obtained. The next step is to apply this new methodology to a large number of stroke patients with various degrees of upper limb impairment and at different stages of rehabilitation to evaluate the merit of these met- rics in routine clinical evaluations.
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An overview of systematic reviews on upper extremity outcome measures after stroke

An overview of systematic reviews on upper extremity outcome measures after stroke

practice. However, there is a need to improve and evalu- ate further other commonly used measures of motor function along with measures that evaluate other aspects of impairment, such as strength and range of motion. On the activity level, five capacity measures could be recommended. Among those, the BBT can be classified as fast screening tool for gross manual dexterity, provid- ing information about the speed of performance, but offer no information on the reason of impaired perform- ance or the quality of movement. The other three rec- ommended capacity measures (ARAT, CAHAI, WMFT) are more time consuming and rely on the expertise of a therapist when the movement performance is scored. In general, these activity capacity measures assess the abil- ity to perform functional tasks including lifting and moving of objects of various shapes and sizes. There is however some differences between these scales, e.g. in the ARAT the affected arm is assessed unilaterally, in the WMFT two bimanual items are tested, while in the CAHAI only bimanual tasks are assessed; in the WMFT the tasks are both timed (WMFT-time) and scored (func- tional ability score), while in the ARAT the time compo- nent is integrated into the different scoring levels; both in ARAT and WMFT the maximum score cannot be reached when compensatory movements are used for task comple- tion in contrast to CAHAI where the independence and Table 4 Summary of psychometric properties and clinical utility of the outcome measures of activity limitation that met the standards or criteria set for the psychometric properties by the authors of the reviews
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A comparative study of conventional therapy Vs modified constraint induced movement therapy along with conventional therapy in improving upper extremity function of stroke patients

A comparative study of conventional therapy Vs modified constraint induced movement therapy along with conventional therapy in improving upper extremity function of stroke patients

This preliminary study aims “using Kinematic Analysis to evaluate Constraint Induced Movement Therapy in chronic stroke patients”. Concluded that the method of Kinematic Analysis was sensitive for as assessment of motor recovery induced by CIMT. The Kinematic results suggest that the increase in the use of the paretic limb in activities of daily living after the intervention is not only attributable to the patients increased attention to it and better hand dexterity, but it is also a consequence of the improved speed of movement and better co-ordination between shoulder and elbow joints.
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An overview of systematic reviews on upper extremity outcome measures after stroke

An overview of systematic reviews on upper extremity outcome measures after stroke

practice. However, there is a need to improve and evalu- ate further other commonly used measures of motor function along with measures that evaluate other aspects of impairment, such as strength and range of motion. On the activity level, five capacity measures could be recommended. Among those, the BBT can be classified as fast screening tool for gross manual dexterity, provid- ing information about the speed of performance, but offer no information on the reason of impaired perform- ance or the quality of movement. The other three rec- ommended capacity measures (ARAT, CAHAI, WMFT) are more time consuming and rely on the expertise of a therapist when the movement performance is scored. In general, these activity capacity measures assess the abil- ity to perform functional tasks including lifting and moving of objects of various shapes and sizes. There is however some differences between these scales, e.g. in the ARAT the affected arm is assessed unilaterally, in the WMFT two bimanual items are tested, while in the CAHAI only bimanual tasks are assessed; in the WMFT the tasks are both timed (WMFT-time) and scored (func- tional ability score), while in the ARAT the time compo- nent is integrated into the different scoring levels; both in ARAT and WMFT the maximum score cannot be reached when compensatory movements are used for task comple- tion in contrast to CAHAI where the independence and Table 4 Summary of psychometric properties and clinical utility of the outcome measures of activity limitation that met the standards or criteria set for the psychometric properties by the authors of the reviews
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Movement variability in stroke patients and controls performing two upper limb functional tasks: a new assessment methodology

Movement variability in stroke patients and controls performing two upper limb functional tasks: a new assessment methodology

Curve registration was first applied to gait data by Sadeghi and colleagues [20]. They recognised that characteristic features, such as peak values, vary between individuals in their precise location within the gait cycle. Averaging time-normalised curves across individuals therefore results in loss of information. Sadeghi and colleagues used the technique of curve registration to more appropri- ately align subjects' gait data prior to further analysis. Because upper limb motions during functional tasks are not cyclic yet have repetitive characteristics if constrained, we decided to apply such an approach to upper limb acceleration signals and report the warping cost as a valu- able outcome measure. Our results support this approach in that significant group differences with regard to time- warping were obtained. The next step is to apply this new methodology to a large number of stroke patients with various degrees of upper limb impairment and at different stages of rehabilitation to evaluate the merit of these met- rics in routine clinical evaluations.
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Model-based variables for the kinematic assessment of upper-extremity impairments in post-stroke patients

Model-based variables for the kinematic assessment of upper-extremity impairments in post-stroke patients

Investigation of underlying factors of motor recovery Finally we inspected the Model-based parameters both to evaluate redundancy among the parameters and to find whether longitudinal variations in these variables might have been explained by a restricted number of underlying (and unobserved) factors, putatively reflect- ing different aspects of motor recovery [11]. For this purpose, we performed a Factor Analysis (FA) with Maximum Likelihood extraction and promax rotation method on the Model-based parameters. These were pooled from all movement directions and repetitions for healthy subjects and patients at each day of rehabilita- tion. The number of retained factors was selected on the basis of “cleanliness of factor structure”, and both the in- dividual (>5 %) and the cumulative percentage (≥70 %) of total variance explained [30]. For each factor, the pa- rameters with loadings >0.6 were clustered together [30]. Variables with loadings not exceeding the threshold for none of the factors were named “shared”. To determine the time course of each factor along the rehabilitation process, for each patients group separately, we fitted the data to different functions: straight line, exponential decay, and double-exponential decay. The best fit was then selected among these three functions according to the Bayesian Information Criterion (BIC) [31].
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Comparison of Sensorimotor Retraining Methods by Movement Therapy Based on Limitations in Upper Extremity Function in Patients with Chronic Stroke

Comparison of Sensorimotor Retraining Methods by Movement Therapy Based on Limitations in Upper Extremity Function in Patients with Chronic Stroke

The review article showed the effectiveness of sensory therapy in upper extremity functionand improving the sense of hypesthesia, proprioception, two-pointdifferentiation, the perception of depth and distance, and Astereognosis. Chen et al. (2005) compared thestandard therapies using thermal methods.This study was conducted on 29 patients in the twotreatment and control groups. Thetreatment group received the intervention program of thermalmodalities to 5 days per week for 6 weeks.Each session was 30 minutes.Brunnstrom recovery stage test, grip strength, wrist bending, monofilament sensory evaluation, Ashworth Tone Assessment Scale were used. Results showed a significant improvement in the treatment group.Ben-Shabat et al. (2005) performed a research to evaluate sensory function after receiving brain's sensory interventions.The results of this study show an improvement in brain sensory function in the treatment group.Accera et al. (2007)applied mirror therapywithsensorimotorassignments on 40 patients in two 20-member control and treatment groups. The treatment group received 14 days therapy 20-30 minutes per session.There was a significant difference in the treatment group in the assessments of grip strength, pain reduction, and upper extremity motor function (12). Nasser Amini et al. (2012) conducted a study with the aim of assessing the impact of CIMT on the quality of life, function, and range of motion of upper extremity stroke patients. In this study, the healthy upper extremity of 15 patients was limited 3 days per week for 8 hours and 6 weeks with the orthopedic sling. The test results showed a significant improvement in SF-36,and Box and Block tests (19).Abdol Wahab et al. (2009) investigated the effects of CIMT on the activities of daily living.Barthel test and armfunctional test were used to evaluate the upper extremity function in activities of daily living. Results showed a significant difference after 8 weeks, 3 days per week for 8 hours limit in healthy upper extremity (20). Given the importance of a healthy senseforperforming daily livingactivities and the use of common methods by therapists, this study is conducted with the aim of comparing sensorimotor training and movement therapy based on limitingthe upper extremity function in patients with chronic stroke.
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Rasch analysis of the upper limb subscale of the stroke rehabilitation assessment of movement (STREAM) tool in an acute stroke cohort Rasch analysis of the upper limb subscale of the STREAM tool in an acute stroke population

Rasch analysis of the upper limb subscale of the stroke rehabilitation assessment of movement (STREAM) tool in an acute stroke cohort Rasch analysis of the upper limb subscale of the STREAM tool in an acute stroke population

Fig. 1 C and D correspond to item 4 before and after re-scoring, respectively. Before re- scoring, options 1a and 1c are the cause of the disordered threshold. Using the corresponding descriptions for these scores (see above), the optimal solution identified was to combine these 3 options resulting in the scoring pattern 01112. This suggests that for these questions, the distinction between only completing part of the movement, and the full movement (assuming impairment is noted), is not sufficiently different in terms of difficulty for the measure to discern, and thus re-scoring is necessary.
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Accelerometer measurement of upper extremity movement after stroke: a systematic review of clinical studies

Accelerometer measurement of upper extremity movement after stroke: a systematic review of clinical studies

Measurement of upper extremity movement by accelero- metry during day-to-day activities in hospital or at home has the potential to provide additional valuable informa- tion about recovery after stroke. The eight studies identi- fied for the present review, including a large multicentre clinical trial (n = 222) [14] and a prospective randomised controlled trial (n = 20) [17], have demonstrated that accelerometry can be systematically applied as a method for measuring overall upper extremity activity. However it is still uncommon that motion sensors are used to inform the development of new clinical rehabilitation approaches. Accelerometry data correlated well with the clinical tests of impairment and function, apart from measures which do not directly reflect upper limb motor function such as tone, sensation and mobility. Only the study by Rand et al. [16] reported that accelerometry failed to detect change in upper extremity usage after a rehabilitation programme whilst clinical tests showed a significant decrease in im- pairment and improved function. Interestingly, this was one of the two studies where the ratio of impaired to un- impaired arm usage was not calculated and reported the usage of impaired upper extremity only, but it should be also considered that rehabilitation approach, patient mo- tivation and learned non-use might be reasons why clin- ical recovery is not reflected in daily upper limb activity [16]. Improvements in stand-alone clinical assessments without matching accelerometer readings might indicate that participants have not translated motor recovery into daily life. Rand et al. [16] suggested that the gap between the recovery of capacity (i.e. clinical measurements) and the lack of improvement in performance (i.e. daily use of the upper extremities according to accelerometer data) provides a useful guide for clinicians. If this is demonstrated by appropriately designed studies then feedback of accelerometer data to patients and clinicians may have a therapeutic role. Improving the interpretation of accelerometry data with clinical questionnaires (e.g. the Motor Activity Log and ABILHAND) could allow re- searchers to capture a wider spectrum of change in daily function for stroke patients receiving rehabilitative
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Simple and Task-oriented Mirror Therapy for Upper Extremity Function in Stroke Patients: A Pilot Study

Simple and Task-oriented Mirror Therapy for Upper Extremity Function in Stroke Patients: A Pilot Study

Many recent studies have reported improved limb func- tional improvements after mirror therapy (Toh & Fong, 2013). Yavuzer et al. (2008) found that motor skills related to hand function were improved more by mirror therapy than by sham therapy in a random crossover study of 36 acute stroke patients. In another study, Stevens and Stoykov (2003), using the Fugl-Meyer Assessment (FMA), reported that the active range of motion, speed of move- ment, and hand dexterity increased for two stroke pa- tients, 3e4 weeks after the implementation of mirror therapy. Similarly, Altschuler et al. (1999) observed that upper extremity function (range of motion, speed of movement, and accuracy) was improved in chronic stroke patients who received mirror therapy. Sathian, Greenspan, and Wolf (2000) also concluded that mirror therapy effec- tively increased upper extremity movement and hand strength on the affected side of chronic stroke patients.
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Upper extremity rehabilitation of stroke: Facilitation of corticospinal excitability using virtual mirror paradigm

Upper extremity rehabilitation of stroke: Facilitation of corticospinal excitability using virtual mirror paradigm

According to recent transcranial magnetic stimulation (TMS) and functional magnetic resonance image (fMRI) research, the primary motor cortex can reorganize and modulate the interactions between the ipsilesional and contralesional motor cortex following a stroke [10,11]. Ab- normal strong interhemispheric inhibition from the con- tralesional to ipsilesional motor cortex was observed in stroke survivors, which was associated with a poor func- tional outcome and ipsilesional motor cortical activation, is important for good motor recovery [10-12]. This indi- cates that ipsilesional motor cortical priming in stroke considered an important part of the management of the balance between hemispheres and of the recovery of func- tions. The method of voluntary exercise evokes the stron- gest facilitation at the cortex and spine levels. However, an alternative facilitation method is necessary because volun- tary movements are difficult for stroke patients with severe paralysis of affected limbs. Therefore, the new treatment paradigm, which induced ipsilesional motor cortical prim- ing such as mirror therapy combined with VR, was mean- ingful in clinical setting.
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State of Evidence for Everyday Technology Use in Upper Extremity Motor Recovery Post-Stroke

State of Evidence for Everyday Technology Use in Upper Extremity Motor Recovery Post-Stroke

There is promising evidence from five outcome studies that mobile, app based ET was effective at improving UE motor control in individuals post-stroke. Outcome measures include Rosenbusch Test, BBT, SFQ, FMA, NHPT, grip strength, WMFT, Motricity Index, and MAS. The studies all showed improvements in UE motor performance for all specified outcomes used; however, the studies were small in size. Two studies did not contain statistical analyses around significance. There was limited evidence from outcome studies that therapy involving commercially available game systems is effective at improving UE function in individuals post-stroke. There were three studies with limited sample sizes, but that showed statistically significant improvements in measures of UE function.
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