New Technologies and Concepts for Rehabilitation in the Acute Phase of Stroke: A Collaborative Matrix

The process of developing a successful stroke rehabilitation methodology requires four key components: a good understanding of the pathophysiological mechanisms underlying this brain disease, clear neuroscientific hypotheses to guide therapy, adequate clinical assessments of its efficacy on multiple timescales, and a systematic approach to the application of modern technologies to assist in the everyday work of therapists. Achieving this goal requires collaboration between neuroscientists, technologists and clinicians to develop well-founded systems and clinical protocols that are able to provide quantitatively validated improvements in patient rehabilitation outcomes. In this article we present three new applications of complementary technologies developed in an interdisciplinary matrix for acute-phase upper limb stroke rehabilitation – functional electrical stimulation, arm robot-assisted therapy and virtual reality-based cognitive therapy. We also outline the neuroscientific basis of our approach, present our detailed clinical assessment protocol and provide preliminary results from patient testing of each of the three systems showing their viability for patient use.

[1]  D. Corbett,et al.  Efficacy of Rehabilitative Experience Declines with Time after Focal Ischemic Brain Injury , 2004, The Journal of Neuroscience.

[2]  R. Teasell,et al.  The Role of Task-Specific Training in Rehabilitation Therapies , 2005, Topics in stroke rehabilitation.

[3]  Thierry Keller,et al.  Modular transcutaneous functional electrical stimulation system. , 2005, Medical engineering & physics.

[4]  H. Vet,et al.  Clinimetric Properties of the Motor Activity Log for the Assessment of Arm Use in Hemiparetic Patients , 2004, Stroke.

[5]  Leslie G. Ungerleider,et al.  Formation of a Motor Memory by Action Observation , 2005, The Journal of Neuroscience.

[6]  Schönle Pw [The Early Rehabilitation Barthel Index--an early rehabilitation-oriented extension of the Barthel Index]. , 1995 .

[7]  K. Mauritz,et al.  Repetitive training of isolated movements improves the outcome of motor rehabilitation of the centrally paretic hand , 1995, Journal of the Neurological Sciences.

[8]  C. Calautti,et al.  Dynamics of Motor Network Overactivation After Striatocapsular Stroke: A Longitudinal PET Study Using a Fixed-Performance Paradigm , 2001, Stroke.

[9]  H. Feys,et al.  Effect of a therapeutic intervention for the hemiplegic upper limb in the acute phase after stroke: a single-blind, randomized, controlled multicenter trial. , 1998, Stroke.

[10]  G. Verbeke,et al.  Early and Repetitive Stimulation of the Arm Can Substantially Improve the Long-Term Outcome After Stroke: A 5-Year Follow-up Study of a Randomized Trial , 2004, Stroke.

[11]  J. Rankin Cerebral Vascular Accidents in Patients over the Age of 60: III. Diagnosis and Treatment , 1957, Scottish medical journal.

[12]  Douglas C Noll,et al.  Cortical Plasticity During Three-Week Motor Skill Learning , 2004, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[13]  N. A. Bernshteĭn The co-ordination and regulation of movements , 1967 .

[14]  F. Mahoney,et al.  FUNCTIONAL EVALUATION: THE BARTHEL INDEX. , 2018, Maryland state medical journal.

[15]  N. Miller,et al.  Technique to improve chronic motor deficit after stroke. , 1993, Archives of physical medicine and rehabilitation.

[16]  Thierry Keller,et al.  Overcoming abnormal joint torque patterns in paretic upper extremities using triceps stimulation. , 2005, Artificial organs.

[17]  R. Bloch,et al.  Interobserver agreement for the assessment of handicap in stroke patients. , 1988, Stroke.

[18]  Malcolm MacLachlan,et al.  Enabling technologies : body image and body function , 2004 .

[19]  Thierry Keller,et al.  Compex Motion: neuroprosthesis for grasping applications , 2004 .

[20]  G. Nelles,et al.  Cortical reorganization--effects of intensive therapy. , 2004, Restorative neurology and neuroscience.

[21]  E. Taub,et al.  Constraint-Induced Movement Therapy: a new family of techniques with broad application to physical rehabilitation--a clinical review. , 1999, Journal of rehabilitation research and development.

[22]  H. Freund,et al.  Quantitative Assessment of Recovery from Motor Hemineglect in Acute Stroke Patients , 2006, Cerebrovascular Diseases.

[23]  R J Seitz,et al.  Diffusion- and perfusion-weighted MRI. The DWI/PWI mismatch region in acute stroke. , 1999, Stroke.

[24]  F. Binkofski,et al.  The mirror neuron system and action recognition , 2004, Brain and Language.

[25]  Gereon R Fink,et al.  MR imaging in acute stroke: diffusion-weighted and perfusion imaging parameters for predicting infarct size. , 2002, Radiology.

[26]  B. Dobkin Strategies for stroke rehabilitation , 2004, The Lancet Neurology.

[27]  P. Schönle [The Early Rehabilitation Barthel Index--an early rehabilitation-oriented extension of the Barthel Index]. , 1995, Die Rehabilitation.

[28]  Peter Langhorne,et al.  Effects of Augmented Exercise Therapy Time After Stroke: A Meta-Analysis , 2004, Stroke.

[29]  Dejan B Popović,et al.  The drawing test: assessment of coordination abilities and correlation with clinical measurement of spasticity. , 2005, Archives of physical medicine and rehabilitation.

[30]  Christian Weimar,et al.  Assessment of Functioning and Disability After Ischemic Stroke , 2002, Stroke.

[31]  C. Calautti,et al.  Sequential activation brain mapping after subcortical stroke: changes in hemispheric balance and recovery , 2001, Neuroreport.

[32]  R. Nudo,et al.  Effects of Repetitive Motor Training on Movement Representations in Adult Squirrel Monkeys: Role of Use versus Learning , 2000, Neurobiology of Learning and Memory.

[33]  B. Bussel,et al.  Longitudinal Study of Motor Recovery After Stroke: Recruitment and Focusing of Brain Activation , 2002, Stroke.

[34]  J. Marler,et al.  Measurements of acute cerebral infarction: a clinical examination scale. , 1989, Stroke.

[35]  R. Beaglehole,et al.  Recovery of motor function after stroke. , 1988, Stroke.

[36]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[37]  H Steinmetz,et al.  The pattern of motor deficits in relation to the site of stroke lesions. , 1995, European neurology.

[38]  C. Anderson,et al.  Validation of the Short Form 36 (SF-36) health survey questionnaire among stroke patients. , 1996, Stroke.

[39]  David L Streiner,et al.  Test-retest reliability, validity, and sensitivity of the Chedoke arm and hand activity inventory: a new measure of upper-limb function for survivors of stroke. , 2005, Archives of physical medicine and rehabilitation.

[40]  E. Troisi,et al.  Early versus delayed inpatient stroke rehabilitation: a matched comparison conducted in Italy. , 2000, Archives of physical medicine and rehabilitation.

[41]  B. Rosen,et al.  A functional MRI study of subjects recovered from hemiparetic stroke. , 1997, Stroke.

[42]  S. Black,et al.  Bilateral movement enhances ipsilesional cortical activity in acute stroke: A pilot functional MRI study , 2001, Neurology.