Advances in motion and electromyography based wearable technology for upper extremity function rehabilitation: A review

Study DesignScoping review.IntroductionWith the recent advances in technologies, interactive wearable technologies including inertial motion sensors and e-textiles are emerging in the field of rehabilitation to monitor and provide feedback and therapy remotely.Purpose of the StudyThis review article focuses on inertial measurement unit motion sensor and e-textiles–based technologies and proposes approaches to augment these interactive wearable technologies.MethodsWe conducted a comprehensive search of relevant electronic databases (eg, PubMed, the Cumulative Index to Nursing and Allied Health Literature, Embase, PsycINFO, The Cochrane Central Register of Controlled Trial, and the Physiotherapy Evidence Database). The scoping review included all study designs.ResultsCurrently, there are a numerous research groups and companies investigating inertial motion sensors and e-textiles–based interactive wearable technologies. However, translation of these technologies to the clinic would need further research to increase ease of use and improve clinical validity of the outcomes of these technologies.DiscussionThe current review discusses the limitations of the interactive wearable technologies such as, limited clinical utility, bulky equipment, difficulty in setting up equipment inertial motion sensors and e-textiles.ConclusionThere is tremendous potential for interactive wearable technologies in rehabilitation. With the evolution of cloud computing, interactive wearable systems can remotely provide intervention and monitor patient progress using models of telerehabilitation. This will revolutionize the delivery of rehabilitation and make rehabilitation more accessible and affordable to millions of individuals.     

Chronic stroke survivors achieve comparable outcomes following virtual task specific repetitive training guided by a wearable robotic orthosis (UL-EXO7) and actual task specific repetitive training guided by a physical therapist

Survivors post stroke commonly have upper limb impairments. Patients can drive neural reorganization, brain recovery and return of function with task specific repetitive training (TSRT). Fifteen community independent stroke survivors (25–75 years, >6 months post stroke, Upper Limb Fugl Meyer [ULFM] scores 16–39) participated in this randomized feasibility study to compare outcomes of upper limb TSRT guided by a robotic orthosis (bilateral or unilateral) or a physical therapist. After 6 weeks of training (18 h), across all subjects, there were significant improvements in depression, flexibility, strength, tone, pain and voluntary movement (ULFM) (p < 0.05; effect sizes 0.49–3.53). Each training group significantly improved ULFM scores and range of motion without significant group differences. Virtual or actual TSRT performed with a robotic orthosis or a physical therapist significantly reduced arm impairments around the shoulder and elbow without significant gains in fine motor hand control, activities of daily living or independence.     

任务导向性训练对上肢周围神经损伤患者肌电图及手功能的影响

目的本文拟观察任务导向性训练对上肢周围神经损伤患者手功能障碍的影响,为其提供一种新的康复治疗手段。 方法采用随机数字表法将60例上肢周围神经损伤导致手功能障碍患者随机分为治疗组（30例）和对照组（30例）,两组患者均给予药物治疗及常规康复治疗,治疗组辅以任务导向性训练。于干预前及干预3个月时,通过手功能评定量表评估手功能,通过肌电图（EMG）检测周围神经的恢复情况。 结果治疗3个月时,治疗组手功能实用率高于对照组,差异有统计学意义（P<0.05）。治疗3个月时,治疗组正中神经、尺神经、桡神经运动神经传导速度（MCV）均高于治疗前,且桡神经MCV高于对照组,差异均有统计学意义（均P<0.05）,对照组正中神经、尺神经、桡神经MCV均高于治疗前,差异均有统计学意义（均P<0.05）;治疗组正中神经、尺神经、桡神经EMG潜伏期（LAT）较治疗前均明显缩短,差异均有统计学意义（均P<0.05）,对照组正中神经、桡神经LAT均较治疗前明显缩短,差异均有统计学意义（均P<0.05）;治疗组正中神经、尺神经、桡神经EMG波幅（AMP）均高于治疗前,且正中神经、尺神经AMP均高于对照组,差异均有统计学意义（均P<0.05）,对照组正中神经、桡神经AMP均高于治疗前,差异均有统计学意义（均P<0.05）。 结论任务导向性训练能明显提高上肢周围神经损伤后手功能障碍患者的神经肌肉兴奋度,改善手功能,为一种安全、实用、有效的训练方案。     

Effects of proprioceptive exercises and strengthening on pain and functionality for patellofemoral pain syndrome in women: A randomized controlled trial

ObjectiveThe objective of this study was to verify the effects of resisted and proprioceptive exercises program for the treatment of patients diagnosed with patellofemoral pain syndrome (PFPS).Design methodRandomized Controlled Trial – level of evidence, II.MethodsSixty female patients, clinically diagnosed with PFPS, were allocated into two experimental groups. The exercise group (ExG) underwent 6 weeks of a resisted and proprioceptive exercises for the trunk muscles, abductors and lateral hip rotators and knee extensors. The Guidance Group (GG) received educational, cognitive and behavioral guidance on healthcare. Before and after the program implementation period, all participants were evaluated in relation to the injured limb for pain assessment, subjective functionality, maximum isometric strength and 2D biomechanical analysis.ResultsAfter a six-week follow-up, ExG showed significant improvement in the Numerical Pain Rating Scale, Anterior Knee Pain Scale and Knee Outcome Survey- Activities of Daily Living Scale when compared to the control group (p ≤ 0,05). The ExG also proved superior for increased muscle strength of knee extensors, hip abductors, decreased dynamic knee valgus and pelvic drop in relation to GG (p ≤ 0.05). However, when we consider the strength of the hip lateral rotator muscles there was no difference between the two interventions (p > 0.05).ConclusionResisted and proprioceptive exercises yielded superior results to those of a treatment focused on educational, cognitive and behavioral guidance in improving pain and lower limb function for women with PFPS.     

Development and validation of the Burnt Hand Outcome Tool (BHOT): A patient-led questionnaire for adults with hand burns

Hand burns are unique in their functional, aesthetic and emotional impact on patients. Measuring the progress of a patient’s ability to carry out essential and desired tasks, their emotional state, interaction with society as well as scar, pain and itch as their burn heals, has until now relied on the use of a combination of several different tools. We have developed a questionnaire specifically to address the multiple different aspects of the impact of a hand burn on a patient. This has been validated in a study of adult patients with hand burns in a UK unit, by a variety of psychometric tests. Ninety-four patients entered the study and questionnaires were completed over the course of a year at five time points. The total BHOT and DASH questionnaires completed at each time point was as follows: 86 before; 52 healed; 29 at 3 months; 31 at 6 months; 28 at 1 year, i.e. 226 DASH and 226 BHOT questionnaires in total.The questionnaire has been shown to have excellent reliability, criterion validity, construct validity, and responsiveness. The result is the Burnt Hand Outcome Tool (BHOT), a patient reported, quick and easy to use yet comprehensive questionnaire specifically for adult patients with burns to the hand.     

康复疗法联合强肌增活训练在手部烧伤整形术患者中的应用效果

分析在手部烧伤患者整形术后给予康复疗法联合强肌增活训练的效果。方法 选取2022年1月-2023年1月于我院接受整形术治疗的130例手部烧伤患者为研究对象,随机分为对照组和观察组,每组65例。对照组接受常规干预,观察组接受康复疗法联合强肌增活训练,比较两组手功能恢复情况、关节活动度及日常生活能力。结果 观察组手功能总恢复率为98.46%,高于对照组的76.92%（P ＜0.05）;观察组干预后T AM及C a r r o l l手功能测试评分均高于对照组（P ＜0 . 0 5）;观察组A D L评分高于对照组（P ＜0.05）。结论 针对手部烧伤整形术患者给予康复疗法联合强肌增活训练的效果良好,可有效促进手功能恢复,有利于改善患者的关节活动度,提高其日常生活能力。     

Hand function in female patients with hand osteoarthritis: relation with radiological progression

Objective

We aimed to investigate the effect of hand osteoarthritis (HOA) on hand strength, dexterity, and upper extremity functional scores, as well as to determine the relation of radiological severity of HOA with these parameters.

Methods

Sixty patients and 40 controls were enrolled in the study. The presence of hand pain, nodes, and tenderness in hand joints was determined. Grip and pinch strengths were measured by Jamar dynamometer and pinch meter, dexterity was assessed by Purdue pegboard test, and upper extremity function was determined by disabilities of arm, shoulder and hand (DASH) test. Hand radiographs were evaluated according to the Kallman grading scale.

Results

The mean age of the patients and control subjects were 58.9 ± 4.8 and 56.6 ± 5.8 years, respectively. The level of hand pain and tenderness, and the number of nodes were significantly higher in the patient group than in control subjects. The mean grip and pinch strengths were lower in the patient group,: however, the difference was significant only in left lateral and left three chuck pinch. In hand dexterity, all scores except Purdue 1 were significantly lower in the patient group. In the functional evaluation DASH outcome, questionnaire scores of the patient and control groups were 48.3 ± 26.3 and 39.5 ± 23.5, respectively (p > 0.05). In the patient group, Kallman scores indicating radiological severity were found to be correlated with age, DASH scores, grip and pinch strengths, and Purdue scores (except Purdue assembly). Pain by visual analog scale was significantly higher in the patient group and correlated significantly with DASH scores.

Conclusion

In patients with HOA, using standardized tests for evaluations may not be adequate. The determination of grip–pinch strength, dexterity and functional disability will lead to a clearer definition of the needs of the patients and will likely increase the gains from the rehabilitation programs.     

Voluntary ambulation using voluntary upper limb muscle activity and Hybrid Assistive Limb® (HAL®) in a patient with complete paraplegia due to chronic spinal cord injury: A case report

Context: We sought to describe our experience with the Hybrid Assistive Limb® (HAL®) for active knee extension and voluntary ambulation with remaining muscle activity in a patient with complete paraplegia after spinal cord injury.

Findings: A 30-year-old man with complete paraplegia used the HAL® for 1 month (10 sessions) using his remaining muscle activity, including hip flexor and upper limb activity. Electromyography was used to evaluate muscle activity of the gluteus maximus, tensor fascia lata, quadriceps femoris, and hamstring muscles in synchronization with the Vicon motion capture system. A HAL® session included a knee extension session with the hip flexor and voluntary gait with upper limb activity. After using the HAL® for one month, the patient’s manual muscle hip flexor scores improved from 1/5 to 2/5 for the right and from 2/5 to 3/5 for the left knee, and from 0/5 to 1/5 for the extension of both knees.

Conclusion/clinical relevance: Knee extension sessions with HAL®, and hip flexor and upper-limb-triggered HAL® ambulation seem a safe and feasible option in a patient with complete paraplegia due to spinal cord injury.     

超早期康复护理改善脑卒中患者偏瘫肢体功能的效果分析

目的分析超早期康复护理改善脑卒中患者偏瘫肢体功能的效果。方法随机将105例脑卒中患者进行分组,对照组给予常规护理干预,实验组在对照组基础上配合超早期康复护理干预,分析两组干预效果。结果实验组提高ADL评分、提高FMA评分和降低临床神经功能缺损评分幅度明显高于对照组（P〈0.01）;实验组干预后总有效率92.45%明显高于对照组75.00%（P〈0.05）;实验组肩手综合征和足外翻发生率低于对照组（P〈0.05）。结论超早期康复护理能够改善脑卒中患者偏瘫肢体功能,促进中枢神经功能重建,在提高日常生活活动能力和生活质量方面具有积极的作用。     

镜像神经元理论在脑梗死患者上肢关节运动康复治疗中的应用

目的探讨镜像神经元理论在脑梗死患者上肢关节运动康复治疗中的应用及对患肢功能的影响。方法选取2017年11月-2018年11月收治的脑梗死患者92例,按随机数字表法为对照组与观察组。在脑梗死上肢关节运动康复治疗中,对照组进行常规康复治疗,观察组在对照组上肢关节康复治疗的基础上加用镜像神经元理论。对比两组肢体功能评分、生活质量量表得分以及两组患肢关节活动度。结果治疗前两组肢体功能评分差异均不具可比性(P>0.05),经治疗,两组肢体功能评分均比治疗前提高,且观察组评分显著高于对照组(P<0.05);治疗前两组生活质量得分差异无可比性(P>0.05),治疗后2、3、4周观察组生活质量量表得分均高于对照组(P<0.05);治疗前两组上肢各关节活动度无明显差异(P>0.05),治疗后观察组肩关节前驱、肘关节伸展、腕关节背伸的关节活动度均优于对照组(P<0.05)。结论在脑梗死患者上肢关节运动康复治疗中应用镜像神经元理论,可以改善患者上肢运动功能,提高患者生活质量,应用效果良好,值得推广。     

An assessment of the osteogenic index of therapeutic exercises for stroke patients: relationship to severity of leg motor impairment

Summary  Exercise may be a viable way to promote bone health in stroke survivors. This study used the osteogenic index to evaluate the osteogenic potential of selected exercises for stroke survivors. The results show that brisk walking and stepping may be good skeletal loading exercises for this population. Introduction  Exercise may induce positive effects on bone health in stroke patients. The purpose of this study was to evaluate the osteogenic potential of selected exercises for stroke survivors. Methods  Sixty stroke patients were categorized into group 1 (moderate to severe leg motor impairment) and group 2 (mild to moderate impairment). Each subject performed five exercises in random order: walking at self-selected speed, walking at maximal speed, stepping onto a 6-in. riser, sit-to-stand, and jumping. The peak ground reaction force (GRF) on the hemiparetic side and the number of loading cycles achieved in 1 min were determined. The osteogenic index (OI) was computed for each exercise, based on the formula: OI = Peak GRF (in body weight) × In (number of loading cycles + 1). Two-way analysis of variance was used to compare the OI among the five exercises between the two groups. Results  For group 1, stepping had significantly higher OI than other exercises (p < 0.001). For group 2, both walking at maximal speed and stepping had significantly higher OI than other exercises (p < 0.001). Conclusions  Stepping had the highest OI for those with more severe leg motor impairment. Both stepping and brisk walking had superior OI for those with mild leg motor impairment.     

Combined effects of botulinum toxin type A and repetitive transcranial magnetic stimulation with intensive motor training immediately after injection in a patient with chronic stroke: A case report

Study DesignSingle case report.IntroductionA previous study clarified that spasticity and motor function were improved by combined treatment with botulinum toxin type A (BTX) injection and 1-Hz repetitive transcranial magnetic stimulation (rTMS) with intensive motor training at 4 weeks after injection. However, it is not clear whether 1-Hz rTMS with intensive motor training immediately after BTX injection also improves spasticity and motor function in stroke patients.Purpose of the Case ReportThe purpose of this case report is to test the short- and long-term effects of BTX injection and rTMS with intensive motor training on the spasticity, motor function, and usefulness of the paretic hand in a stroke patient.MethodsA 64-year-old male, who suffered from a right cerebral hemorrhage 53 months previously, participated in the present study. BTX was injected into the spastic muscles of the affected upper limb. He then received the new protocol for a total of 24 sessions. The Modified Ashworth Scale (MAS), Fugl-Meyer Assessment (FMA), and Motor Activity Log, consisting of the amount of use and quality of movement scales, were assessed before and immediately after BTX injection, at discharge, and monthly for up to 5 months after discharge.ResultsFor the short-term effects of the therapy, the MAS scores of the elbow and wrist, FMA score, and quality of movement score improved. For the long-term effects of the therapy, the MAS score of the fingers, FMA score, and amount of use score improved for up to 5 months after discharge.ConclusionsThe present case report showed the improvement of all assessments performed in the short and/or long term and suggest the possibility of shortening the intervention period of combined therapy of BTX and rTMS with intensive motor training.     

Functional outcome using early controlled active motion in rehabilitation of a replanted hand: A case report

Study DesignCase report.IntroductionThis case report details the postsurgical rehabilitation and outcome of a young maintenance man who sustained a complete amputation of his dominant upper limb at the level of the distal forearm. The patient underwent replantation surgery with 2-centimeter bone shortening, followed by early controlled active motion commencing on day 6.Purpose of the StudyTo illustrate the use of early motion after replantation.ResultsThe patient achieved almost full active range of motion of the digits, intrinsic function, 30 seconds on Nine-Hole Peg Test and early return to work without any additional reconstructive procedures.DiscussionSeveral fairly recently published protocols advocate initiating active range of motion at only 3 or 4 weeks after upper limb replantation. The following therapeutic interventions were considered important contributors to our favorable functional outcome; early controlled active motion, occupation-based therapy in combination with therapeutic exercises and many custom molded orthoses.ConclusionFuture research is required to determine if bone shortening, which is an integral part of replantation surgery, reduces tendon repair tension, allowing for early active motion and thereby contributing to a favorable outcome.     

Long-term survival of chronic dialysis patients in comparison to that of stroke and acute myocardial infarction patients

Background. There are no data comparing the long-term survival of chronic dialysis patients with that of acute myocardial infarction (AMI) or stroke patients. We obtained outcome data from two community-based registries, one for dialysis patients and one for patients who suffered an AMI or stroke. Methods. Patients were entered into the registries between April 1, 1988, and March 31, 1991, in Okinawa, Japan. Only patients who survived for 28 days after starting dialysis or after the onset of AMI and stroke were studied. A total of 646 chronic dialysis patients, 747 AMI patients, and 3809 stroke patients were followed up until March 1, 1999. Survival rates were compared between the dialysis patients and those suffering AMI or stroke, based on Cox proportional hazard analysis, and relative risk (95% confidence interval [CI]) of death was estimated after adjusting for sex and age at onset. Results. The relative risk (95% CI) of death for AMI and stroke patients was 0.39 (0.33–0.46) and 0.40 (0.36–0.46), respectively, when the death risk of dialysis patients was taken as reference (1.00). The relative risk for patients with cerebral hemorrhage was 0.44 (0.38–0.50), with the value being 0.40 (0.35–0.46) for patients with cerebral infarction, and 0.37 (0.28–0.49) for those with subarachnoid hemorrhage. Conclusions. Survival in dialysis patients is clearly worse than that in AMI and stroke patients. Specific factors leading to the higher mortality rate in dialysis patients remain to be determined. Received: December 6, 2000 / Accepted: February 15, 2001     

脑卒中患者尿路感染病原菌分布及耐药性分析

目的调查本院脑卒中患者合并尿路感染的病原菌分布及耐药状况,以指导临床合理应用抗菌药物。方法选择本院2009年1月至2012年6月共145例脑卒中合并尿路感染住院患者,按照《全国临床检验操作规程》进行尿细菌培养,药敏试验采用K-B方法。结果脑卒中患者尿路感染分离病原菌均有不同程度的耐药,主要病原菌为大肠埃希菌、粪肠球菌、肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌和真菌等,分别占48.97%（71/145）、13.10%（19/145）、6.89%（10/145）、6.21%（9/145）、4.83%（7/145）和8.97%（13/145）,其中部分大肠埃希菌呈多药耐药。结论脑卒中患者多为老年人,该类患者基础疾病多,自理能力差,多合并神经源性膀胱,尿路感染发病率高,病原菌耐药性不断增加,须采取有效的干预措施预防和控制感染的发生。