Tesi: "Stroke upper limb rehabilitation"

1

Burke, James. "Games for upper limb stroke rehabilitation". Thesis, University of Ulster, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.554247.

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Abstract (sommario):

Stroke is a major cause of disability worldwide. For rehabilitation to be effective, it must be early, intensive and repetitive. Stroke rehabilitation starts in hospital, where a structured plan of exercise for the stroke survivor is designed and facilitated by a physiotherapist. Once the patient is discharged, however, supervised therapy sessions can be very infrequent and often people with stroke find it difficult to remain motivated and engaged in rehabilitation programmes when in the home environment. New technology, exploiting natural user interfaces, may offer opportunities for people with stroke to engage in home-based, unsupervised rehabilitation. The problems of poor motivation and low levels of engagement may be addressed by embedding design principles of video games, which are often associated with high levels of user engagement, into the solution. The hypothesis of this thesis is through the incorporation of novel input technology and game design theory, game- based rehabilitation solutions can be designed that are usable, playable and engaging for people with stroke. Reviews of the key areas of conventional stroke therapy, natural user interface technology and game design theory have been conducted and, following analysis, consolidated into a novel 'Games for Rehabilitation' (GAMER) framework. The framework is intended to inform the design of usable, playable and engaging games for stroke rehabilitation and has been evaluated through the development of two implementations which support user interaction through two different interface technologies: video capture (2D) and augmented reality (3D). Evaluation of these implementations with able-bodied and stroke participants using a novel user-centred protocol suggest that the GAMER framework can inform the design of usable, playable, engaging games for upper limb stroke rehabilitation in the home.

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2

Crosbie, Jacqueline H. "Virtual reality in the rehabilitation of the upper limb following stroke". Thesis, University of Ulster, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.445058.

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3

Lindberg, Påvel. "Brain plasticity and upper limb function after stroke: some implications for rehabilitation /". Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7816.

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4

Ang, Wei Sin. "A Biomechanical Model of Human Upper Limb for Objective Stroke Rehabilitation Assessment". Research Showcase @ CMU, 2017. http://repository.cmu.edu/dissertations/1052.

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In stroke rehabilitation, the assessments of the severity of stroke that are based on objective and robust measurements are the key to improve the efficacy of the rehabilitation efforts. It is essential, therefore, to complement the existing tools, where the assessments are partly relied on therapists’ subjective judgements, with a tool that can quantify important indicators of stroke recovery. One such indicator is the level of spasticity. The reliability of the current methods of measuring the severity of spasticity can be significantly improved by incorporating a feasible way to measure muscle forces and activations during stroke assessment. However, most of the present methods of estimating muscle forces require input parameters that are difficult to obtain in a clinical setting. A musculoskeletal arm model has been developed to bridge the gap between the domains of muscle forces estimation and stroke rehabilitation assessment. The project is divided into three stages. In the first stage, a biomechanical arm model that computes the joint torques with kinematic data from sensors is developed. The model has three features that eliminate the need for parameters that are difficult to obtain thus making it a feasible tool in clinical settings. The first is the use of a hybrid method that combines the data from sensors and a shoulder rhythm model to compute the orientation of the shoulder complex. The second is a method to compute the elbow joint angles without the need to compute the ambiguous carrying angle. The third is a method of estimating the inertial properties using published data, scaled by parameters that can be easily measured. The musculoskeletal properties of the human arm are added to the model in the second stage. The muscle model consists of 22 muscles that span from the thorax via the shoulder and the upper arm to the forearm. The muscle path is defined using Obstacle Set method where the anatomical structures are modelled using regular-shaped rigid bodies. Dynamics of the muscle is computed based on the Hill’s type muscle model that consists of an active contractile element, a passive parallel element and a series element. Due the difficulties in defining the moment arms, an optimization routine is designed to compute the optimal moment arms for each muscle for a subject. The muscle-sharing problem is solved using optimization which minimises the square of sum of muscle stresses. The muscle activation predicted by the model is compared to EMG signal for validation. In the final stage of this project, the model is used in the application of spasticity assessment. The tonic stretch reflex threshold (TSRT) which is an indicator for the severity of spasticity is computed using the model. Fifteen patient subjects participated in the experiments where they were assessed by two qualified therapists using Modified Ashworth Scale (MAS), and their motions and EMG signals were captured at the same time. Using the arm model, the TSRT of each patient was measured and ranked. The estimated muscle activation profiles have a high correlation (0.707) to the EMG signal profiles. The null hypothesis that the rankings of the severity using the model and the MAS assessment have no correlation has been tested, and was rejected convincingly (p ≈ 0.0003). These findings suggest that the model has the potential to complement the existing practices by providing an alternative evaluation method.

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5

Lindberg, Påvel. "Brain Plasticity and Upper Limb Function After Stroke: Some Implications for Rehabilitation". Doctoral thesis, Uppsala University, Rehabilitation Medicine, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7816.

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Neuroimaging and neurophysiology techniques were used to study some aspects of cortical sensory and motor system reorganisation in patients in the chronic phase after stroke. Using Diffusion Tensor Imaging, we found that the degree of white matter integrity of the corticofugal tracts (CFT) was positively related to grip strength. Structural changes of the CFT were also associated with functional changes in the corticospinal pathways, measured using Transcranial Magnetic Stimulation. This suggests that structural and functional integrity of the CFT is essential for upper limb function after stroke.

Using functional magnetic resonance imaging (fMRI), to measure brain activity during slow and fast passive hand movements, we found that velocity-dependent brain activity correlated positively with neural contribution to passive movement resistance in the hand in ipsilateral primary sensory (S1) and motor (M1) cortex in both patients and controls. This suggests a cortical involvement in the hyperactive reflex response of flexor muscles upon fast passive stretch.

Effects of a four week passive-active movement training programme were evaluated in chronic stroke patients. The group improved in range of motion and upper limb function after the training. The patients also reported improvements in a variety of daily tasks requiring the use of the affected upper limb.

Finally, we used fMRI to explore if brain activity during passive hand movement is related to time after stroke, and if such activity can be affected with intense training. In patients, reduced activity over time was found in supplementary motor area (SMA), contralateral M1 and prefrontal and parietal association areas along with ipsilateral cerebellum. After training, brain activity increased in SMA, ipsilateral S1 and intraparietal sulcus, and contralateral cerebellum in parallel with functional improvements of the upper limb. The findings suggest a use-dependent modification of cortical activation patterns in the affected hand after stroke.

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6

Kutlu, Mustafa C. "A home-based functional electrical stimulation system for upper-limb stroke rehabilitation". Thesis, University of Southampton, 2017. https://eprints.soton.ac.uk/417274/.

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Due to an increased population of stroke patients and subsequent demand on health providers, there is an urgent need for effective stroke rehabilitation technology that can be used in patients' own homes. Over recent years, systems employing functional electrical stimulation (FES) have shown the ability to provide effective therapy. However, there is currently no low-cost therapeutic system available which simultaneously supplies FES to muscles in the patient's shoulder, arm and wrist to provide co-ordinated functional movement. This restricts the effectiveness of treatment, and hence the ability to support activities of daily living. In this thesis a home-based low cost rehabilitation system is developed which substantially extends the current state of art in terms of sensing and control methodologies. In particular, it embeds novel non-contact sensing approaches; the first use of an electrode array within a closed-loop model based control scheme; an interactive task display system; and an integrated learning-based controller for multiple muscles within the upper-limb (UL), which supports co-ordinated tasks. The thesis then focuses on compacting the prototype by upgrading the depth sensor and using embedded systems to transfer it to the home environment. Currently available home-based systems employing FES for UL rehabilitation are first reviewed in terms of their underlying technology, operation, scope and clinical evidence. Motivated by this, a detailed examination of a prototype system is carried out that combines low cost non-contact sensors with closed-loop FES controllers. Then potential avenues to extend the technology are highlighted, with specific focus given to low-cost non-contact based sensors for the hand and wrist. Sensing approaches are then reviewed and evaluated in terms of their scope to support the intended system requirements. Electrode array hardware is developed in order to provide accurate movement capability. Biomechanical models of the combined stimulated arm and mechanical support are then formulated. Using these, model-based iterative learning control methodologies are then designed and implemented. The system is evaluated with both unimpaired participants and stroke patients undergoing a course of treatment. Finally, a home-based prototype is developed which integrates and extends the aforementioned components. Results conrm the system's scope to provide more effective stroke rehabilitation. Based on the achieved results, courses of future work necessary to continue this development are outlined.

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Van, Vliet Paulette. "An investigation of reaching movements following stroke". Thesis, University of Nottingham, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.262879.

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8

Shublaq, Nour. "Use of inertial sensors to measure upper limb motion : application in stroke rehabilitation". Thesis, University of Oxford, 2010. http://ora.ox.ac.uk/objects/uuid:3b1709fb-8be6-4402-b846-096693fc75bc.

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Abstract (sommario):

Stroke is the largest cause of severe adult complex disability, caused when the blood supply to the brain is interrupted, either by a clot or a burst blood vessel. It is characterised by deficiencies in movement and balance, changes in sensation, impaired motor control and muscle tone, and bone deformity. Clinically applied stroke management relies heavily on the observational opinion of healthcare workers. Despite the proven validity of a few clinical outcome measures, they remain subjective and inconsistent, and suffer from a lack of standardisation. Motion capture of the upper limb has also been used in specialised laboratories to obtain accurate and objective information, and monitor progress in rehabilitation. However, it is unsuitable in environments that are accessible to stroke patients (for example at patients’ homes or stroke clubs), due to the high cost, special set-up and calibration requirements. The aim of this research project was to validate and assess the sensitivity of a relatively low cost, wearable, compact and easy-to-use monitoring system, which uses inertial sensors in order to obtain detailed analysis of the forearm during simple functional exercises, typically used in rehabilitation. Forearm linear and rotational motion were characterised for certain movements on four healthy subjects and a stroke patient using a motion capture system. This provided accuracy and sensitivity specifications for the wearable monitoring system. With basic signal pre-processing, the wearable system was found to report reliably on acceleration, angular velocity and orientation, with varying degrees of confidence. Integration drift errors in the estimation of linear velocity were unresolved. These errors were not straightforward to eliminate due to the varying position of the sensor accelerometer relative to gravity over time. The cyclic nature of rehabilitation exercises was exploited to improve the reliability of velocity estimation with model-based Kalman filtering, and least squares optimisation techniques. Both signal processing methods resulted in an encouraging reduction of the integration drift in velocity. Improved sensor information could provide a visual display of the movement, or determine kinematic quantities relevant to the exercise performance. Hence, the system could potentially be used to objectively inform patients and physiotherapists about progress, increasing patient motivation and improving consistency in assessment and reporting of outcomes.

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9

Gudipati, Radhika. "GENTLE/A : adaptive robotic assistance for upper-limb rehabilitation". Thesis, University of Hertfordshire, 2014. http://hdl.handle.net/2299/13895.

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Abstract (sommario):

Advanced devices that can assist the therapists to offer rehabilitation are in high demand with the growing rehabilitation needs. The primary requirement from such rehabilitative devices is to reduce the therapist monitoring time. If the training device can autonomously adapt to the performance of the user, it can make the rehabilitation partly self-manageable. Therefore the main goal of our research is to investigate how to make a rehabilitation system more adaptable. The strategy we followed to augment the adaptability of the GENTLE/A robotic system was to (i) identify the parameters that inform about the contribution of the user/robot during a human-robot interaction session and (ii) use these parameters as performance indicators to adapt the system. Three main studies were conducted with healthy participants during the course of this PhD. The first study identified that the difference between the position coordinates recorded by the robot and the reference trajectory position coordinates indicated the leading/lagging status of the user with respect to the robot. Using the leadlag model we proposed two strategies to enhance the adaptability of the system. The first adaptability strategy tuned the performance time to suit the user’s requirements (second study). The second adaptability strategy tuned the task difficulty level based on the user’s leading or lagging status (third study). In summary the research undertaken during this PhD successfully enhanced the adaptability of the GENTLE/A system. The adaptability strategies evaluated were designed to suit various stages of recovery. Apart from potential use for remote assessment of patients, the work presented in this thesis is applicable in many areas of human-robot interaction research where a robot and human are involved in physical interaction.

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10

Ramsay, Jill Rosamond Edith. "Proprioception in normal and brain damaged populations : assessment and rehabilitation of the upper limb". Thesis, University of Birmingham, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.368801.

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Proprioception, the often forgotten sixth sense, is frequently impaired following stroke, with rehabilitationists addressing this loss within the therapeutic techniques presented to resolve motor problems. The aims of the current studies were to (i) establish the current clinical reality of somatosensory assessment undertaken by physiotherapists nationwide, (ii) how proprioceptive loss in particular was addressed, (iii) explore upper limb weightbearing within everyday activity, (iv) evaluate the proprioceptive response in normal subjects having differences in age and activity. Proprioceptive loss following brain insult has been shown to have an adverse effect on outcome (iv) undertake a series of single case-studies to explore the effect of therapeutic intervention of weightbearing. The findings showed that (i) there was a high degree of agreement in the clinical practice of somatosensory assessment undertaken, (ii) therapeutic intervention of weightbearing was found to be recommended for both motor and proprioceptive loss (iii) upper limb weightbearing was found to be a non-trivial component of everyday life, (iv) positive effects of upper limb weightbearing were found on the proprioceptive responses of stroke victims. The implications of this research are that upper limb weightbearing activities should be incorporated in therapeutic activities to re-establish and maintain proprioceptive control of both upper and lower limbs.

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11

Thomson, Katie. "The use of commercial gaming devices as a intervention for stroke upper limb rehabilitation". Thesis, Glasgow Caledonian University, 2016. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.700998.

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12

Weiß, Patrick [Verfasser]. "Robotic rehabilitation after stroke. A modular system for training distal upper limb functions / Patrick Weiß". Lübeck : Zentrale Hochschulbibliothek Lübeck, 2015. http://d-nb.info/107901117X/34.

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13

Sarasola, Sanz Andrea [Verfasser], e Niels [Akademischer Betreuer] Birbaumer. "Novel Neural Interfaces For Upper-Limb Motor Rehabilitation After Stroke / Andrea Sarasola Sanz ; Betreuer: Niels Birbaumer". Tübingen : Universitätsbibliothek Tübingen, 2019. http://d-nb.info/1189653710/34.

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14

Al-Whaibi, Reem Mohammed. "Effect of environmental cues on upper limb movement of healthy neonates : implication for rehabilitation following perinatal stroke". Thesis, University of Newcastle Upon Tyne, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.514460.

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15

Donaldson, Catherine. "An investigation of conventional physiotherapy and functional strength training for rehabilitation of the upper limb after stroke". Thesis, St George's, University of London, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.497902.

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16

Flynn, Nicholas Mark. "An investigation into the implementation of robot-assisted upper limb therapy within an Australian rehabilitative setting". Phd thesis, Australian Catholic University, 2022. https://acuresearchbank.acu.edu.au/download/c14b409848e3d37c49785178b9b2bf9a516c0a36d1268177d5225556171adaa2/7333916/Flynn_2022_An_investigation_into_the_implementation_of.pdf.

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Abstract (sommario):

Background: Robot-assisted upper limb therapy (RT-UL) is an emerging intervention for stroke survivors with upper limb (UL) impairments. Research into RT-UL has concentrated on investigating the clinical efficacy but implementation and use of RT-UL in routine practice has not yet been adequately explored. This is a notable gap in the field when considering that non-adoption and abandonment is common for health technologies in the clinical setting. The aim of this doctoral research program was to investigate the implementation and use of the InMotion, RT-UL device, for the first time in an Australian clinical setting. Methods: A multiple methods approach was used in this program of research involving four studies, two qualitative and two quantitative. Study 1 explored therapists’ perceptions of RT-UL prior to the implementation through discipline specific focus groups. Study 2 was an observational study that investigated the amount of UL practice performed by subacute stroke survivors pre and post RT-UL implementation. Study 3 involved audits of RT-UL computer data to investigate the sustainability of RT-UL as part of routine practice over a two-year period. Study 4 explored therapist perceptions of the RT-UL post implementation through discipline specific focus groups. Results: Study 1 identified therapists were positive towards the implementation of RT-UL perceiving the device would provide opportunity for increased UL practice for strokes survivors in their clinical setting. The availability of a single RT-UL device may however create unique logistical challenges. Study 2 observed a significant increase in UL practice for stroke survivors including those with severe UL impairment following the implementation of RT-UL as part of routine practice. Study 3 discovered that RT-UL was in continued and regular use with stroke survivors two years after implementation. Study 4 found both disciplines continued to be accepting of RT-UL post implementation but it was physiotherapists who predominantly prescribed RT-UL. Implementation of RT-UL had been largely successful due to an increased level of UL practice for patients, the ease of using the device as part of routine practice and positive reception from patients. The implementation process was also clinician initiated and led. Conclusion: This research program was the first to evaluate the implementation of RT-UL into the routine practices of an Australian rehabilitation setting. New knowledge was acquired about RT-UL use with stroke survivors including occupational therapists and physiotherapists perceptions, impact on the amount of UL practice able to be delivered, sustainability of RT-UL within the inpatient rehabilitation setting and barriers and facilitator to RT-UL implementation.

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Sivan, Manoj. "Development of a home-based Computer Assisted Arm Rehabilitation (hCAAR) device for upper limb exercises in stroke patients". Thesis, University of Leeds, 2014. http://etheses.whiterose.ac.uk/8405/.

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Home-based robotic technologies may offer the possibility of self-directed upper limb exercise after stroke as a means of increasing the intensity of rehabilitation treatment. The aim of this research project was to develop and evaluate a robotic device hCAAR that can be used independently at home by stroke survivors with upper limb weakness. The project had two stages: Stage 1, hCAAR development using a user-centred design process; Stage 2, A feasibility clinical study in the home setting. Stage 1: Nine stroke survivors with upper limb weakness and six healthcare professionals were involved in the concept and design stages of device development. hCAAR consists of a powered joystick with a computer interface, which is used to direct the movement of the upper limb to perform therapeutic movements as directed by tasks on the screen. hCAAR also provides controlled assistance when the user’s voluntary upper limb movement is insufficient to complete the prescribed task. Stage 2: In the feasibility study, 19 participants (stroke survivors with upper limb weakness) were recruited and 17 participants used hCAAR in their homes for eight weeks. No serious adverse events were reported. All 17 participants were able to use the device independently. A statistically significant improvement was observed in the kinematic and clinical outcomes. Three participants showed clinically significant improvement in all clinical outcomes. Five participants reported improvement in functional ability in daily activities. Participants, family members and therapists were satisfied with the usability of hCAAR in the home setting. This research project also demonstrated that the International Classification of Functioning, Disability and Health (ICF) Comprehensive Core Set for stroke provides a useful basis to structure interviews to gather feedback from end-users and healthcare professionals in different stages of the rehabilitation device development. In summary, hCAAR is a home-based rehabilitation robotic device that can be independently used by stroke survivors with upper limb weakness and has the potential to improve upper limb movement and function.

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Griffin, Christine Elisabeth. "The feasibility of action observation combined with repetitive task practice on upper limb outcomes in moderately impaired chronic stroke survivors". The Ohio State University, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=osu1595342020635852.

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19

Filippini, Ilaria. "Robot-assisted Therapy e Therapist-mediated Training, due trattamenti a confronto nel recupero dell'arto superiore del paziente con stroke: Scoping Review". Bachelor's thesis, Alma Mater Studiorum - Università di Bologna, 2021. http://amslaurea.unibo.it/24555/.

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Background L’ictus rappresenta una delle principali cause di disabilità e la seconda causa di morte in tutto il mondo. Dopo uno stroke, più di 2/3 dei pazienti presentano menomazioni motorie e deficit funzionali all’arto superiore. Esiste un’ampia gamma di opzioni terapeutiche per la riabilitazione post-ictus che vanno dalla grande eterogeneità di trattamenti mediati dal terapista fino all’innovativo approccio robotico. Obiettivo L’obiettivo di questa Scoping Review è ricercare, esaminare e sintetizzare ciò che ad oggi è disponibile nelle principali banche dati di letteratura scientifica, in merito alla differenza tra riabilitazione convenzionale e robotica, nel trattamento dell’arto superiore del paziente con stroke. Metodi Nel periodo luglio-settembre 2021 sono state indagate le seguenti banche dati: Pubmed, Cochrane Library e Pedro. La ricerca ha permesso di ottenere 113 articoli dei quali, dopo un’attenta lettura di titolo ed abstract, sono stati selezionati solo quelli che rispettavano i criteri di inclusione ed eleggibilità di questa Review: letteratura con alto grado di evidenza, solo in inglese, comprendente pazienti maggiorenni con diagnosi di stroke (ischemico o emorragico) e compromissione motoria unilaterale. Risultati La revisione d’ambito ha incluso 7 fonti di evidenza che si prefiggono come obiettivo l’indagine delle differenze tra riabilitazione convenzionale e robotica per l’arto superiore del paziente emiplegico, senza considerare l’efficacia singola di uno solo dei due trattamenti. Conclusioni La Robot-assisted Therapy è assolutamente paragonabile in termini di significatività statistica al Therapist-mediated Training nell’incrementare la funzionalità e il controllo motorio dell’arto superiore. La robotica non è in grado di sostituire il trattamento mediato dal terapista ma può essere un valido strumento di supporto. La ricerca futura risulta fondamentale al fine di chiarire alcuni aspetti di questa innovativa metodica.

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Salgado, Amanda Pereira. "Eficácia da terapia do espelho na reabilitação do membro superior hemiparético após AVE em fase aguda/subaguda: revisão bibliográfica". Bachelor's thesis, [s.n.], 2019. http://hdl.handle.net/10284/7677.

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Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em Fisioterapia
Introdução: O AVE é uma doença que atinge uma parte importante da população mundial causando principalmente défices sensoriomotores no membro superior (MS) e inferior. No entanto, após reabilitação permanece frequentemente maiores défices no MS. Hoje em dia existe várias terapias complementares para melhorar a função motora e as atividades de vida diárias como por exemplo a terapia do espelho (TE). A TE é uma das técnicas que pode ser aplicada numa fase precoce após AVE. Objetivo: Verificar através de RCT quais são os efeitos da terapia do espelho no membro superior hemiparético após acidente vascular encefálico na fase aguda/subaguda. Metodologia: A pesquisa foi realizada nas bases de dados Pubmed e PEDro. Após a seleção dos estudos segundo os critérios de inclusão e exclusão, foi avaliada a qualidade metodológica através da PEDro (Physiotherapy Evidence Database Scoring Scale). Resultados: analisamos de 9 RCT, apesar de ligeiras variações nos protocolos, todos demostraram melhorias significativas na reabilitação do membro superior hemiparético em pelo menos um destes défices seja na função sensoriomotora, heminegligência, espasticidade, hemiparésia ou total hemiplegia do MS e nas AVD’s. Conclusão: A TE é eficaz no tratamento do MS hemiparetico na fase aguda e subaguda do AVE, tendo maior resultados na função distal do MS hemiparético. É uma técnica barata, simples e complementar à terapia convencional. Para alem disso o paciente pode usar em casa.
Background: Stroke is a disease that affects an important part of the world's population, mainly causing sensorimotor deficits in the lower and upper limbs (UL). However, after rehabilitation often remains greater deficits in UL. Today there are several complementary therapies to improve motor function and daily life activities (DLA’s) such as mirror therapy (MT). MT is one of the techniques that can be applied at an early stage after a stroke. Objective: To verify through RCT what effects has mirror therapy on the hemiparetic upper limb after an acute/subacute stroke. Methodology: The research was conducted in the Pubmed and PEDro databases. After selecting the studies according to the inclusion and exclusion criteria, the methodological quality was assessed through PEDro (Physiotherapy Evidence Database Scoring Scale). Results: we analyzed 9 RCT, despite slight variations in protocols, all showed significant improvements in the rehabilitation of the hemiparetic upper limb in at least one of these deficits: sensorimotor function, neglect, spasticity, hemiparesis or total hemiplegia of the MS and in the DLAs. Conclusion: The MT is an efficient treatment in upper limb rehabilitation after acute and subacute stroke. It has better results in distal function. It’s cheap, simple to apply and an additional therapy to the conventional therapy. It can also be self-use by the patients at home.
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21

Hammer, Ann M. "Forced use on arm function after stroke : clinically rated and self-reported outcome and measurement during the sub-acute phase". Doctoral thesis, Örebro universitet, Hälsoakademin, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-9601.

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The overall aim was to evaluate the effectiveness of forced use on arm and hand recovery after stroke by applying a restraining sling on the non-affected arm and to investigate psychometric properties of selected upper limb measures. Papers I and II reported a randomised trial with 1- and 3-month follow-ups. Thirty patients 1 to 6 months after stroke were included and received regular training for 2 weeks of intervention. The forced-use group had in addition a restraining sling on the non-paretic arm. Outcome measures were the Fugl-Meyer Assessment, the Modified Ashworth scale, the 16-hole peg test, grip force, the Action Research Arm test, and the Motor Assessment Scale (Paper I), and the Motor Activity Log (MAL) (Paper II). Results in Papers I and II showed no statistical difference in change between groups. Both groups improved over time. Paper III assessed the responsiveness of the MAL and its cross-sectional and longitudinal validity. The MAL was responsive to change, with Standardised Response Means and Responsiveness Ratios larger than 1.0. Correlations between the MAL and the other measures were mostly close to 0.50. Paper IV investigated test–retest intra-rater reliability of measuring grip force with Grippit, and assessed relationships between grip forces of both hands, and between sustained and peak grip force. The paretic hand needs to score a change of 10% or 50 N to exceed the measurement error. The mean ratio between sides was 0.66, and between sustained and peak grip force, 0.80–0.84. In conclusion, this thesis provides preliminary evidence that forced use does not generate greater improvement on upper limb motor impairment, capacity, and performance of activity than regular rehabilitation. The findings indicate that the MAL is a responsive measure of daily hand use in patients with stroke. Correlations of construct validity indicated that daily hand use might need to be measured separately from body function and activity capacity. The coefficients calculated for repeatability and reproducibility were acceptable, and the Grippit instrument can be recommended.

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Coupar, Fiona Mary. "Exploring upper limb interventions after stroke". Thesis, University of Glasgow, 2012. http://theses.gla.ac.uk/3739/.

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Abstract (sommario):

Stroke is a global health concern, with a significant impact on mortality and disability. Motor impairment, including upper limb impairment is particularly common following stroke. Upper limb impairment impacts on an individual’s ability to complete activities of daily living and quality of life. Effective interventions targeted at upper limb recovery are therefore important and further research, within this area, has been identified as necessary. However, challenges researching such complex interventions have been recognised. To attempt to overcome such difficulties the Medical Research Council (MRC) proposed a framework for the development and evaluation of RCTs for complex interventions. In this thesis the MRC framework has been used, focusing on the processes of developing and feasibility/piloting, to provide information for a phase III randomised controlled trial (RCT) of a novel intervention targeted at upper limb recovery following stroke. A systematic review and meta-analysis was undertaken to investigate and clarify any possible association between predictive variables and upper limb recovery. Observational studies of stroke patients investigating at least one predictive variable and its relationship with a defined measure of upper limb recovery at a future time point were included. For this review data analysis combined several approaches. Fifty eight studies were included and 41 predictor variables identified. Initial measures of upper limb function and impairment were found to be the most significant predictors of upper limb recovery; odds ratio (OR) 38.62 (95% confidence interval (CI) 8.40-177.55) and OR 14.84 (95% CI 9.08-24.25) respectively. Neurophysiological factors (motor evoked potentials and somatosensory evoked potentials) were also consistently identified as strongly associated with upper limb recovery; OR 11.76 (95% CI 2.73-69.05) and OR 13.73 (95% CI 2.73-69.05) respectively. Moderate evidence of association was found for global disability and lower limb impairment. Interpretation of results is complicated by methodological factors, particularly relating to the heterogeneous nature of the included studies. In order to identify interventions which show potential for reducing impairment and/or improving upper limb function after stroke, an overview of the available evidence was completed. This systematic review and meta-analysis included Cochrane systematic reviews, other reviews and, where necessary, additional RCTs of interventions to promote upper limb recovery. Thirteen relevant interventions were found, covered by nine Cochrane systematic reviews (bilateral training, constraint-induced movement therapy (CIMT), electromyograhphic (EMG) biofeedback, electrostimulation, hands-on therapy interventions, mental practice, repetitive task training (RTT), electromechanical/robotic devices and virtual reality) and four other reviews (neurophysiological approaches, high-intensity therapy, mirror therapy and splinting). A statistically significant result, in terms of arm recovery, was found in favour of eight of the interventions: CIMT (standardised mean difference (SMD) 0.74 95% CI 0.44-1.03), EMG biofeedback (SMD 0.41 95% CI 0.05-0.77), electrostimulation (SMD 0.40 95% CI 0.02-0.77), mental practice (SMD 1.37 95% CI 0.60-2.15), mirror therapy (SMD 0.41 95%CI 0.05-0.77), RTT (SMD 0.23 95% CI 0.06-0.41), electromechanical/robotic devices (SMD 0.30 95% CI 0.02-0.58) and virtual reality (SMD 0.52 95% CI 0.25-0.78). Two out of the eleven interventions, which investigated hand function outcomes found a positive result (CIMT SMD 0.39 95% CI 0.11-0.68 and repetitive task training SMD 0.27 95% CI 0.06-0.47). Analyses were limited by a relatively small number of RCTs, which were also generally small in size. Heterogeneity of the available data and methodological limitations further impacts on the conclusions. Despite these limitations this overview provided a concise and informative summary of the available evidence. The interventions found to be beneficial, or showing promise tend to include elements of intensive, repetitive, task-specific practice. To build the evidence base for upper limb interventions, two Cochrane systematic reviews were undertaken. These reviews investigated the effects of bilateral training and home therapy programmes on upper limb recovery. Both included RCTs of stroke patients. Eighteen trials were included in the bilateral review, of which 14 were included in the analyses. Most of the included trials were considered to be at high risk of bias and the evidence was further limited by heterogeneity. No statistically significant results were found for any of the primary outcomes. One study found a statistically significant result in favour of another upper limb intervention for performance in extended ADL. No statistically significant differences were found for any of the other secondary outcomes. Four RCTs were included in the home-based therapy programmes review. No statistically significant result was found for any of the outcomes. There is currently insufficient good quality evidence to determine the effects of both the interventions studied. Following the evidence gained from the overview of interventions elements of intensive, repetitive and task-specific practice were to be included in a novel upper limb intervention. Robotic interventions, which incorporate these principles, were also found to have a positive effect on upper limb outcomes. Therefore a pilot, feasibility and acceptability study of a novel device (Armeo®Spring) that included these elements was completed. Medically stable adults with a clinical diagnosis of stroke and arm deficits admitted to an acute stroke unit were recruited. Participants were randomly allocated to experimental intervention (high or low intensity training with the Armeo®Spring arm orthosis) or usual stroke unit care. Primary outcomes were feasibility and acceptability of the experimental device recorded at postintervention. Secondary outcomes were; safety and three efficacy outcomes recorded at post-intervention, and 3 month follow-up. Patient recruitment was challenging; over eight months 393 consecutive stroke admissions were screened and 12 participants recruited. This study demonstrated that per-protocol levels of intensity were not feasible to provide in an acute stroke unit. However, higher levels of intensity could be achieved and this novel intervention was found to be acceptable to patients. This pilot trial also found higher change scores on the three efficacy outcomes within both intervention groups, compared to the control group. Due to small sample size and other possible confounding factors, these findings must be interpreted with caution. Using the MRC complex intervention framework as a guide I completed development and feasibility/piloting work surrounding an upper limb intervention, following stroke. Following the results of this research further development, feasibility/piloting work is suggested for the ArmeoSpring device prior to the undertaking of a phase III RCT. The information gained from this research could be used to inform phase III RCTs of other upper limb interventions.

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23

Bouatrous, Amal. "Conception et développement d’un environnement de rééducation fonctionnelle personnalisée basé sur la réalité virtuelle". Electronic Thesis or Diss., Ecole nationale supérieure Mines-Télécom Atlantique Bretagne Pays de la Loire, 2024. http://www.theses.fr/2024IMTA0409.

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L'accident vasculaire cérébral (AVC) est une cause majeure de décès et d'invalidité, souvent suivie de séquelles telles que l'hémiparésie des membres supérieurs, qui a un impact négatif sur l'indépendance des personnes dans leurs activités quotidiennes. La rééducation classique est nécessaire pour retrouver la fonctionnalité perdue, mais elle peut être monotone. La réalité virtuelle (RV) offre une solution attrayante, motivante et efficace, répondant aux exigences nécessaires à une rééducation réussie. L'objectif de cette thèse est de concevoir et de développer un environnement virtuel pour la rééducation fonctionnelle personnalisée des membres supérieurs après un AVC. Plus précisément, nous nous sommes intéressés à la rééducation fonctionnelle de la main par le biais de jeux sérieux basés sur la RV. Ainsi, deux jeux sérieux visant à améliorer les mouvements grossiers et fins de la main ont été mis en place en simulant deux exercices cliniques, et en utilisant le capteur de mouvement Leap Motion. Nous avons incorporé des éléments de jeux vidéo pour motiver les patients et personnaliser la difficulté en fonction de leurs capacités motrices. Enfin, nous avons mis en œuvre une approche permettant d'adapter dynamiquement la difficulté des jeux. Une collaboration étroite avec les thérapeutes et les patients a été maintenue durant le processus de conception, afin de répondre aux spécifications cliniques. Le système a été évalué en termes de précision de mesure sur des individus sains, ce qui s'est avéré satisfaisant. En outre, une évaluation clinique subjective avec des patients réels a montré que le système était accepté et motivant, renforçant l'engagement des patients dans leur rééducation
Stroke is a major cause of death and disability, often followed by sequelae such as upper limb hemiparesis, which has a negative impact on people's independence in their daily activities. Conventional rehabilitation is necessary to regain lost functionality, but can be monotonous. Virtual reality (VR) offers an attractive, motivating and effective solution, meeting the necessary requirements for successful rehabilitation. The aim of this thesis is to design and develop a virtual environment for personalized functional rehabilitation of the upper limbs after stroke. More specifically, we have focused on the functional rehabilitation of the hand using VR-based serious games. Thus, two serious games aimed at improving coarse and fine hand movements were set up by simulating two clinical exercises, and using the Leap Motion motion sensor. Incorporating video game elements to motivate patients and personalize difficulty according to their motor skills. Finally, we implemented an approach to dynamically adapt the difficulty of the games. Close collaboration with therapists and patients was maintained during the design process, in order to meet clinical specifications. The system was evaluated in terms of measurement accuracy on healthy individuals, which proved satisfactory. In addition, a subjective clinical evaluation with real patients showed that the system was accepted and motivating, reinforcing patients' commitment to their rehabilitation

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24

Sacchi, Virginia. "L’efficacia della riabilitazione robotica sul recupero della funzionalità dell’arto superiore in soggetti con ictus: revisione sistematica della letteratura". Bachelor's thesis, Alma Mater Studiorum - Università di Bologna, 2021. http://amslaurea.unibo.it/24570/.

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Background: L’80% delle persone colpite da ictus cerebrale riporta una compromissione dell’arto superiore che persiste nel 60% dei casi a sei mesi dall’evento acuto. Negli ultimi anni stanno aumentando le evidenze sull'applicazione della terapia robotica. Questa rispetta infatti i principi neurofisiologici dell’apprendimento motorio, sebbene non sia ancora chiara la corretta modalità di associazione con la terapia tradizionale. Obiettivo: Indagare la letteratura riguardo l’efficacia della riabilitazione robotica associata alla fisioterapia tradizionale sul recupero della funzionalità dell’arto superiore in soggetti con ictus. Metodi: Sono state consultate le banche dati Pubmed, PEDro e CENTRAL. È stato definito il PICOS: P: Soggetti adulti con primo episodio di ictus, esiti di emiplegia unilaterale e compromissione della funzionalità dell’arto superiore; I: Riabilitazione robotica associata a fisioterapia tradizionale; C: Fisioterapia tradizionale isolata; O: Funzionalità dell’arto superiore; S: RCT. La ricerca è stata limitata alle pubblicazioni tra il 2011 e il 2021, con full-text in italiano o inglese, reperibili tramite il servizio proxy o contattando direttamente l’autore. Risultati: Sono stati inclusi cinque RCT. Sebbene gli outcome fossero conformi all’obiettivo, la tipologia dello strumento robotico e le modalità di intervento non erano omogenei. Tuttavia, quattro studi hanno dimostrato la superiorità dell'intervento sperimentale e uno studio ha riportato un’uguaglianza tra i due interventi. Conclusione: Nonostante l’eterogeneità dell’intervento applicato e delle fasi riabilitative non renda generalizzabili i risultati, la terapia robotica si è rivelata efficace nell’incremento della funzionalità dell’arto superiore in soggetti con ictus. Sono necessari approfondimenti per individuare la fase e la dose adeguate a poter delineare un protocollo specifico di integrazione tra terapia robotica e tradizionale e verificare gli effetti sul lungo termine.

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Manning, Victoria. "Exercise-based upper limb rehabilitation in rheumatoid arthritis". Thesis, King's College London (University of London), 2013. https://kclpure.kcl.ac.uk/portal/en/theses/exercisebased-upper-limb-rehabilitation-in-rheumatoid-arthritis(6f54df20-20dc-4ce6-b82f-2d19b08de5bf).html.

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Background: Rheumatoid arthritis (RA) is a chronic, systemic, disabling disease which reduces independence, quality of life, and longevity. Upper limb impairment causes considerable disability, contributes to work incapacity, and has substantial monetary and non-monetary, personal and societal consequences. Objectives: The studies in this thesis focus on the development and evaluation of a novel exercise programme for the rehabilitation of global upper limb disability in people with RA. It explores participants’ experiences and the factors influencing their uptake and maintenance of the programme. It evaluates the physical activity (PA) levels of adults with rheumatic diseases against PA guidelines, and assesses the proportion of respondents who report ever receiving PA advice from a healthcare professional (HCP). Methods: Following development of a global upper limb home exercise programme, supplemented by four supervised group education, self-management, and exercise sessions (the EXTRA programme), 108 people with RA of less than 5 years duration were randomly allocated to receive either the EXTRA programme or usual care. Self-reported disability, upper limb functional performance, strength, self-efficacy, quality of life (QOL), and disease activity were assessed at baseline, 12, and 36 weeks. Participants were interviewed to evaluate their experiences of the EXTRA programme. Physical activity participation, recommendation, and preferences were surveyed among 508 adults with a range of rheumatic diseases. Results: Following the EXTRA programme, there were significant improvements to upper limb disability, function, strength, and self-efficacy, but not QOL, and no adverse effects on disease activity or pain. Participants perceived the EXTRA programme to be effective and acceptable. Sixty-one percent of respondents met PA guidelines, although 27% were inactive. Forty-three percent of respondents reported receiving PA advice from a HCP. Walking was the most preferred PA (65%). Conclusions: The EXTRA programme improves upper limb disability, function, strength, and self-efficacy, with no adverse effects on disease activity or pain, in people with RA. Many people with rheumatic diseases are inactive and more than half have never discussed PA with a HCP. Recommending exercise and regular PA should be integral to rheumatic disease management.

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Plant, R. D. "Central nervous control of the upper limb after stroke". Thesis, University of Newcastle Upon Tyne, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.315634.

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Conceição, Cláudia Santos da. "Redesign of the user interface of Us'Em mobile aplication". Master's thesis, Universidade de Aveiro, 2014. http://hdl.handle.net/10773/13643.

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Mestrado em Comunicação Multimédia
The research presented here aims to design a feasible and adequate mobile application (app) user interface. This mobile app is part of Us'em system, designed to promote self-rehabilitation after stroke. The system is based on wearable, mobile and tracking sensors-based technology. The app works as a feedback tool, communicating Us’em system users about the frequency of their upper limb moves and about their recovery process. The mobile app aims increasing patient’s motivation in using their arm-hand through the day and improving their rehabilitation through self-training at home with continuous feedback. The design of its user interface is of great relevance, because it determines if post stoke patients can use Us’em system. The empirical part begins with interviews, questionnaires and observation of post stroke patients and physical therapists from Portugal and the Netherlands. It provides a better understanding of post stroke rehabilitation process and stroke victims’ characteristics and requirements regarding rehabilitation and mobile devices interaction. The gathered information contributed to the development of a prototype that materializes the defined Us’em app. The prototyping process ran through iterative cycles of design, implementation and evaluation to ascertain the adequacy of Us’em app user interface. The final prototype is the final product of this research project and it was evaluated through usability tests with post stroke patients from both countries aforementioned. Tests to the final prototype show it may be difficult to design a unique solution for all the users due to the wide range of their requirements. However, the core requirements of Us'em mobile app is simplicity: the number of user interface elements, the amount of information and the complexity of iteractions and functionalities of this app should be the lowest as possible. The research also allows to conclude that the user interface designed meets most of user’s requirements and it has a significant impact on the motivation of post stroke patients in moving their impaired arm-hand autonomously.
O trabalho de investigação aqui apresentado objetiva o desenvolvimento de uma viável e adequada interface de utilizador de uma aplicação móvel (app). Esta app é um dos componentes do sistema Us’em, desenvolvido para promover a auto reabilitação após acidentes vasculares cerebrais (AVC). O sistema é baseado em tecnologia vestível, móvel e de monitorização através de sensores. A app funciona como uma ferramenta de feedback, informando os utilizadores do sistema Us’em sobre a frequência dos movimentos dos seus membros superiores e sobre o seu processo de recuperação. A app objetiva aumentar a motivação dos pacientes em usar o seu braço ou mão debilitado ao longo do dia e, assim, promover a sua reabilitação através do treino autónomo em casa com feedback contínuo. O desenvolvimento da interface de utilizador é de grande relevância, pois determina se pacientes vítimas de AVC conseguem utilizar o sistema Us’em. O estudo empírico parte da realização de entrevistas, questionários e observação de pacientes vítimas de AVC e fisioterapeutas Portugueses e Holandeses. Este estudo permite uma melhor compreensão do processo de reabilitação e das características e requisitos de vítimas de AVC no que respeita à reabilitação e à interação com dispositivos móveis. A informação recolhida contribuiu para o desenvolvimento de um protótipo que concretizasse a app Us’em definida. O processo de prototipagem ocorreu ao longo de ciclos iterativos de desenvolvimento, implementação e teste de forma a verificar a adequação da interface de utilizador da app Us’em. O protótipo final é o produto final deste projeto de investigação e foi testado através de testes de usabilidade com pacientes vítimas de AVC de ambos os países referidos anteriormente. Os testes ao protótipo final revelam que poderá ser difícil desenvolver uma solução única para todos os utilizadores devido ao conjunto vasto dos seus requisitos. No entanto, o requisito chave da app Us’em é simplicidade: o número de elementos da interface de utilizador, a quantidade de informação e a complexidade das interações e funcionalidades da app deve ser o mais reduzido possível. Esta investigação também permite concluir que a interface de utilizador desenvolvida satisfaz a maior parte dos requisitos dos utilizadores e tem um impacto significativo na motivação de pacientes vítimas de AVC em movimentar o seu braço ou mão desabilitada de forma autónoma.

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Ball, Stephen Joseph. "Novel robotic mechanisms for upper-limb rehabilitation and assessment". Thesis, Kingston, Ont. : [s.n.], 2008. http://hdl.handle.net/1974/1344.

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Rahman, Mohammad Habibur. "Development of an exoskeleton robot for upper-limb rehabilitation". Mémoire, École de technologie supérieure, 2012. http://espace.etsmtl.ca/1048/1/RAHMAN_Mohammad_Habibur.pdf.

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Pour assister ou réadapter les personnes présentant une altération du fonctionnement d’un membre supérieur, nous avons développé un exosquelette robotique représentant un membre supérieur nommé, ETS-MARSE (motion assistive robotic-exoskeleton for superior extremity). MARSE est composé d’un support déplaçable pour l’épaule, d’un support déplaçable pour le coude et l’avant-bras et d’un support déplaçable pour le poignet. Il est conçu pour être porté sur le côté latéral du membre supérieur afin de fournir des mouvements naturels de l'épaule (flexion/extension verticale et horizontale et rotation interne/externe), du coude (flexion/extension), de l’avant-bras (pronation/supination) et de l’articulation du poignet (déviation radiale/ulnaire et flexion/extension). Cette thèse se concentre sur la modélisation, la conception (composants mécaniques et électriques), le développement et le contrôle de MARSE. Le robot MARSE proposée a été modélisé à partir de la biomécanique d’un membre supérieur, il a un poids relativement faible, un excellent rapport puissance/poids, facilement mis ou enlevé, et il est capable de compenser efficacement la gravité. De plus, afin d'éviter l'acheminement complexe des câbles qui pourraient se trouver dans plusieurs types d’exosquelettes, un nouveau mécanisme de transmission de puissance a été introduit pour aider la rotation interne/externe de l'articulation de l'épaule ainsi que la pronation/supination de l'avant-bras. L'exosquelette est conçu pour être utilisé par des adultes typiques. Cependant, des dispositions pour ajuster la longueur des membres ont été effectuées afin d’accommoder un grand éventail d’utilisateurs. La totalité du bras robotique est fabriquée principalement en aluminium, excepté pour les sections sous forte pression qui ont été fabriquées en acier pour donner à l’exosquelette une structure relativement légère. Des moteurs synchrones (incorporés avec des systèmes d’entraînement harmonique direct) ont été utilisés pour actionner MARSE. La cinématique de MARSE a été développée en se basant sur les notations de Denavit- Hartenberg modifiées. Dans le modèle dynamique et le contrôle, les paramètres du robot tels que les longueurs, la masse de ses membres et l’inertie sont estimés en fonction des propriétés d’un bras d'un adulte typique. Bien que l'exosquelette ait été développé avec l'objectif d'offrir différentes formes de thérapie de réadaptation (nommé mouvements passifs du bras, thérapie active-assistée, et thérapie résistive), cette recherche s'est concentrée uniquement sur la forme passive de la réadaptation. Les mouvements et les exercices passifs d’un bras sont généralement effectués à une vitesse plus lente que la vitesse naturelle du bras. Par conséquent, un PID simple et un PID avec souplesse ‘compliance’ ont été initialement utilisés pour contrôler le robot MARSE. Par la suite, la réalisation de la modélisation de la dynamique du mouvement du bras humain, qui est non linéaire par sa nature, ainsi qu’une méthode de commande par couple précalculé (CTC) et une méthode de commande par mode de glissement avec une loi de convergence exponentielle (mSMERL) ont été employées pour contrôler MARSE. Notez que pour améliorer les performances transitoires de poursuite et pour réduire les vibrations, cette thèse a proposé le mSMERL, une nouvelle approche de contrôle non linéaire qui combine le concept de la technique de mode glissant avec une loi de convergence exponentielle. L'architecture de contrôle a été mise en oeuvre sur un FPGA (field-programmable gate array) conjointement avec un ordinateur incluant un système d’exploitation en temps réel. Pour les expériences, des exercices typiques de réadaptation pour le déplacement d’une ou plusieurs articulations ont été exécutés. Ces expériences ont été réalisées avec des sujets humains sains où les poursuites (trajectoires préprogrammées recommandées par un thérapeute ou un clinicien) de trajectoires sous la forme d'exercices de réadaptation passive ont été effectuées. Cette thèse se concentre aussi sur le développement d’un prototype (modèle réduit) d’un membre supérieur à 7 DDL nommé « aster exoskeleton arm » (mExoArm). De plus, des expériences ont été réalisées avec le mExoArm où les sujets (utilisateurs de robots) ont opéré mExoArm pour manoeuvrer MARSE dans le but de fournir une réadaptation passive. Les résultats expérimentaux montrent que MARSE peut accomplir efficacement des exercices de réadaptation passive pour des mouvements de l'épaule, coude et poignet. Utiliser mExoArm offre aux utilisateurs une certaine souplesse sur les trajectoires préprogrammées sélectionnées, en particulier dans le choix de l'amplitude des mouvements et la vitesse du mouvement. Par ailleurs, le mExoArm pourrait potentiellement être utilisé pour la réadaptation à distance.

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Balkhoyor, Loaie B. "Smart dampers applied to upper-limb rehabilitation training systems". Thesis, University of Dundee, 2017. https://discovery.dundee.ac.uk/en/studentTheses/e4a06626-4517-40a3-8537-938a937d925b.

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There are several ways in which a disability can occur. Strokes are a leading cause, affecting older people in particular, with an estimated annual incidence rate of 180, 125, 200, and 280 per 100,000 citizens in the USA, Europe, England, and Scotland, respectively. Muscle strengthening through resistance training has been reported to have a positive effect on the recovery of normal physiological functions after the occurrence of a neurological or traumatic injury. A number of studies have shown that resistance training results in improved mobility, a reduction in pain, and improved stability. Several rehabilitation devices have been developed and introduced for use in the healthcare sector, but a new generation of intelligent therapy-assisted machines is needed if there is to be a significant impact on the numbers of patients that can be treated under current staffing level. In this project, the design and performance of multi-degree-of-freedom smart balland-socket dampers and their application to fully-controllable rehabilitation training systems were investigated. A key feature of these dampers is the use of magnetorheological (MR) fluids which can exhibit dramatic changes in their rheological properties, such as yield stress, when subjected to external magnetic fields. These fast and reversible fluid rheological changes would permit the smart damper to provide the required impedance at orthotic arm joints, which are aimed for upper-limb rehabilitations and in accord with the exercise specifications prescribed by the physiotherapist. An exemplar upper-limb orthotic arm incorporating smart ball-and-socket dampers at its joints was assessed using SolidWorks software and the results confirmed the response of the dampers to variable excitation inputs under an input simulating a wheelchair driving motion. This study also enabled the estimation of the orthotic arm reach envelope, task performance and limitations in which important device design factors such as the angle of rotation of the smart dampers were taken into account. Although, three smart dampers with variable torque resistance capability are required at the shoulder, elbow and wrist joints of upper-limb rehabilitation orthoses, this project was focused on the development of a smart ball-and-socket damper aimed for the shoulder joint only. The target was to produce a compact smart electromagnetic damper that is capable to deliver the required torque resistance with the least power consumption. The efficient excitation of MR fluids requires a magnetic circuit, which consists of a source of magnetic flux and a path to deliver it to the fluid. Electromagnetic finite element analysis using Ansys software were carried out to achieve the optimum design of the damper’s electromagnetic circuit. The effects of the relative permeability of the damper’s materials on the generation of the magnetic field and its delivery to the MR fluid were examined. Other factors such as the coil shape, size, orientation and location in addition to the utilisation of non-magnetic materials in the electromagnetic circuit design were also investigated with the aim to optimise the performance of the smart damper. Furthermore, 3-D electromagnetic analyses were conducted, which confirmed the validity of the 2-D magnetic trials. Accordingly, the size of the MR fluid ball-and-socket damper was estimated with a ball diameter of 100 mm, which was found to produce a braking torque of about 50 N.m when the MR fluid is energised by about 1 Tesla. The performance of the ball-and-socket damper was estimated using theoretical, and numerical approaches. The theoretical model combines the viscous-friction and the controllable field-dependent characteristics of the MR fluid in which a Bingham plastic model was used to simulate the shear stress of the fluid under various input conditions. The numerical approach involved a special procedure to simulate the device performance using computational fluid dynamics techniques, which were performed using Ansys CFX code. Three commercial MR fluids were assessed and it was found that the simulated device torque compared well with the theoretical values. The mechanical design of the optimised ball-and-socket damper was accomplished using SolidWorks software when several important design and manufacturing factors were taken into account. These factors included the assembly of the ball and socket parts, the sealing of the MR fluid inside its designated gap, winding of the coil inside the socket part, maintaining a uniform MR fluid gap, and insertion of the nonmagnetic rings at their predesigned locations. Finally, a dedicated experimental rig was constructed which facilitated the assessment of the smart damper under both static and dynamic testing conditions. It was found that agreement between model predictions and experimental observations was excellent. Furthermore, this device performance was found to meet torque requirements expected in most upper-limb rehabilitation regimes.

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Prashun, Prashant. "Virtual reality based upper extremity stroke rehabilitation system". Thesis, Bournemouth University, 2015. http://eprints.bournemouth.ac.uk/31295/.

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Some studies suggest that the use of Virtual Reality technologies as an assistive technology in combination with conventional therapies can achieve improved results in post stroke rehabilitation. Despite the wealth of ongoing research applied to trying to build a virtual reality based system for upper extremity rehabilitation, there still exists a strong need for a training platform that would provide whole arm rehabilitation. In order to be practical such a system should ideally be low cost (affordable or inexpensive for a common individual or household) and involve minimal therapist involvement. This research outlines some of the applications of virtual reality that have undergone clinical trials with patients suffering from upper extremity functional motor deficits. Furthermore, this thesis presents the design, development, implementation and feasibility testing of a Virtual Reality-based Upper Extremity Stroke Rehabilitation System. Motion sensing technology has been used to capture the real time movement data of the upper extremity and a virtual reality glove has been used to track the flexion/extension of the fingers. A virtual room has been designed with an avatar of the human arm to allow a variety of training tasks to be accomplished. An interface has been established to incorporate the real time data from the hardware to a virtual scene running on a PC. Three different training scenes depicting a real world scenario have been designed. These have been used to analyze the motion patterns of the users while executing the tasks in the virtual environment simulation. A usability study with the healthy volunteers performing the training tasks have been undertaken to study the ease of use, ease of learning and improved motivation in the virtual environment. Moreover this system costing approximately 2725 pounds would provide home based rehabilitation of the whole arm augmenting conventional therapy on a positive level. Statistical analysis of the data and the evaluation studies with the self report methodologies suggests the feasibility of the system for post stroke rehabilitation in home environment.

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Ackerley, Suzanne Jennifer. "Promoting use-dependent plasticity to improve upper limb recovery after stroke". Thesis, University of Auckland, 2011. http://hdl.handle.net/2292/9899.

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Motor recovery is a major factor influencing independence in everyday living after stroke. The objective of this dissertation was to explore two ways to promote use-dependent plasticity (UDP) to improve upper limb recovery after stroke. One approach was to adapt the delivery of training by incorporating auditory pacing. The specific aim was to augment UDP within the primary motor cortex (M1) by increasing synaptic efficacy through the synchronous arrival of auditory and sensorimotor input. Two cross-over, repeated-measures, studies were conducted in healthy adults. Training protocols consisted of simple, repetitive, upper limb movements that were either metronome-paced in synchrony or syncopation, selfpaced, or paced at a fast rate. Neurophysiological measures obtained with transcranial magnetic stimulation (TMS), and behavioural measures, were collected before and after training to evaluate UDP. The second approach was to prime M1 with theta burst stimulation (TBS) prior to training. The aim was to facilitate ipsilesional M1 excitability, and lower the threshold for UDP during subsequent training. TBS primed training was evaluated in two blinded, sham-controlled, repeated-measures studies in chronic subcortical stroke patients with upper limb impairment. In separate sessions, neurophysiological, behavioural, and clinical assessments were performed before and after precision grip training primed by one of three different TBS protocols (intermittent TBS, continuous TBS and sham TBS). A preliminary technical study was conducted to ensure the validity of the measure of sensorimotor integration used for the final study. Metronome-paced training at a comfortable speed improved synaptic efficacy within M1, as shown by selective facilitation of corticomotor excitability and altered kinematics of TMS-evoked movement that reflected the trained movement. Priming with intermittent TBS increased the receptiveness of ipsilesional M1 to afferent input and enabled stroke patients to engage in better quality motor training. Overall, this dissertation presents two clinically feasible approaches, “auditory-paced training” and “TBS primed training” to enhance UDP within a given therapy dose. Further clinical research is warranted to translate these promising novel approaches into rehabilitation practice.

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Price, Chrostopher Ian Morgan. "Clinical and biomechanical predictors of proximal upper limb recovery after stroke". Thesis, University of Newcastle upon Tyne, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.271123.

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34

Srisoparb, Waroonnapa. "Prediction of upper limb recovery post-stroke using wrist motor impairments". Thesis, University of Southampton, 2016. https://eprints.soton.ac.uk/414006/.

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Abstract (sommario):

More than 70% of people with stroke exhibit upper limb disability at one year. An understanding of upper limb motor recovery, and prediction of upper limb functional activity (ULFA) based on motor impairment, are important to inform rehabilitation. Recovery of upper limb motor impairment (measured by short form of the Fugl-Meyermotor scale), wrist motor impairments (measured by the redesigned wrist rig), and ULFA (measured by the Streamlined Wolf Motor Function Test for use with sub-acute patients) at 2, 4, 8, 12 and 26 weeks were investigated. Relationships between ULFA at 26 weeks and wrist motor impairments at each assessment point are reported, as well as prediction values for ULFA at 26 weeks, based on wrist motor impairments at 2, 4, 8 and 12 weeks. Three motor impairment phenomena, sub-divided into eight categories, were measured from 11 impairment indices. These were: 1) negative (a reduction of motor activity): range of active movement; muscle weakness; motor control accuracy; delayed muscle onset timing; 2) positive (excessive motor activity): spasticity and coactivation; and 3) secondary (later changes associated with negative and positive impairments): contracture and non-neural stiffness. Test-retest reliability of each impairment index was tested with 14 stroke participants at 8 weeks. Construct validity was tested in 25 stroke participants at two and 26 weeks post-stroke and with 25 matched pair healthy controls. All impairment indices demonstrated good to excellent test-retest reliability (intra-class correlation coefficient 0.78-0.99). The minimal detectable change of each index was established as a benchmark value. Wrist active range of motion (AROM), flexor and extensor isometric force (IF), sine and step tracking index (TI), path length, muscle onset timing and stretch index were statistically significantly different (p<0.05) between stroke and healthy participants, representing good construct validity. Fifty-two stroke participants were recruited into a longitudinal study. Upper limb motor impairment, ULFA, range of active movement and muscle weakness improved rapidly between weeks two and four with considerably slower improvement between weeks 4 and 26. Recovery profiles could be divided into three categories: 1) high scores at 2 weeks with continuous improvement over 26 weeks; 2) low to moderate scores at 2 weeks with continuous improvement over 26 weeks; and 3) zero scores at 2 weeks with little or no improvement at 26 weeks. Generally, ULFA at 26 weeks was more related to the negative (r 0.39 to 0.78; p<0.05) than to the positive (r-0.40 to -0.54; p<0.05) or the secondary (r,0.37 to 0.66; p<0.05) motor impairments. Range of active movement, muscle weakness spasticity and contracture are good predictors of ULFA at 26 weeks (OR between 1.02, 95%CI 1.01-1.04 to OR 7.00, 95%CI 2.19-22.48). This is the first exploratory study to demonstrate a prediction of ULFA based on a variety of wrist motor impairments. The findings may assist therapists to customise rehabilitation programmes during the 26 weeks of stroke recovery.

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Purton, Judith. "Stroke survivors' experiences of upper limb dysfunction : a longitudinal exploratory study". Thesis, Keele University, 2017. http://eprints.keele.ac.uk/2721/.

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Abstract (sommario):

The experiences of stroke survivors have been researched quite extensively, in particular the effect that stroke can have on a person’s life and sense of self, but how much upper limb dysfunction contributes to these experiences is not fully known. This study explores the impact that upper limb dysfunction, specifically, could have on people’s lives after stroke, and their hopes and expectations for recovery of the upper limb. Method: a longitudinal phenomenological study with a series of four semi-structured interviews at two-, six-, twelve-, and eighteen months post stroke with 13 participants recruited from a stroke rehabilitation unit. Data were analysed using thematic analysis and a modified form of framework analysis. Results: Three main themes were identified in the data: The Altered Life; The Disrupted Self; The Experience of Recovery. Findings indicated that upper limb dysfunction after stroke, and the loss of two-handedness, can adversely affect the lives of stroke survivors, and this, in turn, can affect a person’s self-esteem, self-image and identity. Stroke survivors initially viewed recovery of the lower limb as more important than the upper limb, but on returning home they recognised that the upper limb recovery was crucial in managing self-care and returning to meaningful activities and life roles. Therapy services, after hospital discharge, were short term and focused on mobility, not the upper limb, and stroke survivors were frustrated with the lack of information and advice. Participants wanted to be active partners with therapists, to self-manage recovery in their upper limb. Conclusion: Therapists should be more aware of the impact that upper limb dysfunction can have on stroke survivors’ lives and sense of self. Therapy, information and advice for the upper limb should be considered vital in rehabilitation, and models of services that capitalise on stroke survivors’ desire to self-manage their recovery should be explored.

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Van, Wijck Frederike Marlijn Jeanneke. "Skill acquisition in people with chronic upper limb spasticity after stroke". Thesis, Queen Margaret University, 2006. https://eresearch.qmu.ac.uk/handle/20.500.12289/7410.

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Abstract (sommario):

Background: After a stroke, a considerable proportion of people experience upper limb (UL) impairments, which may affect their activities of daily living. Focal spasticity is common, for which botulinum toxin-type A (BTX-A) is used increasingly. However, published randomised controlled trials have not used valid outcome measures to assess the effects of BTX-A on spasticity and have hardly explored its impact on UL function. The primary aim of this thesis was to investigate whether task-specific UL practice in the form of an evidence-based, functional skill acquisition programme, administered after BTX-A, would have any differential effects on upper limb spasticity or functional UL activity in people more than six months after stroke. The prerequisites were to: 1) clarify the definition of "spasticity", 2) pilot a novel biomechanical spasticity measurement device, 3) standardise the assessment of arm function, 4) systematically review the literature on the effects of BTX-A and 5) compile an evidence- and theory-based skill acquisition programme. Methods: Design: randomised controlled feasibility study with four repeated measures and a blinded assessor. Fourteen participants (time after stroke: range 1.4 -11.0 years) gave informed consent and were randomised into either the experimental group (EG: BTX-A plus skill acquisition) or the placebo control group (CG: BTX-A plus inflatable arm splint). Outcome measures were: Action Research Arm Test, Canadian Occupational Performance Measure, grip force of the affected hand, Stroke Impact Scale, EMG of the elbow flexors, biomechanically measured resistance to passive movement and Ashworth scale. Outcomes were assessed at baseline and weeks 4, 7 and 13 following BTX-A injection. Differences in change between the two groups were analysed using the Mann-Whitney U-test. Applying the Bonferroni correction for three repeated measures yielded a critical p-value of 0.017. Results: At baseline, there were no significant differences between the two groups in any of the dependent variables. Compared to the CG, the EG improved in self-reported hand function between baseline and week 4 (median change 25%, range 0 to 30% vs. CG: median change 0%, range -10 to 0%; p=0.04). The EG also improved in arm function between baseline and week 7 (median ARA T change 4 points, range 1 to 8 points vs. CG: median change -1 point, range -3 to 0 points; p=0.003) as well as in self-reported ADL between baseline and week 13 (median change 11.3%, range 5 to 20% vs. CG: median change 0%, range -2.5 to 5%; p=0.02). Only the differential improvement in ARAT by the EG reached statistical significance. There were no significant differences between the two groups in any of the other outcome measures. Although the programme was perceived as intensive, most participants in the experimental group had found the intervention to be enjoyable. Conclusion: The main finding of this study was that people with severe and chronic upper limb spasticity may still improve in functional activity involving their affected arm, using a combination of BTX-A and a functional skill acquisition programme - without exacerbating spasticity. BTX-A alone did not improve upper limb activity in this study. Implications for clinical practice and research were discussed.

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Sun, M. "A functional electrical stimulation (FES) control system for upper limb rehabilitation". Thesis, University of Salford, 2014. http://usir.salford.ac.uk/32854/.

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Abstract (sommario):

Functional electrical stimulation (FES) is the controlled use of electrical pulses to produce contraction of muscles in such a way as to support functional movement. FES is now widely used to aid walking in stroke patients and research into using FES to support other tasks is growing. However, in the more complex applications, it is very challenging to achieve satisfactory levels of FES control. The overall aim of the author’s PhD thesis is to develop improved techniques for real-time Finite State Machine (FSM) control of upper limb FES, using multiple accelerometers for tracking upper limb movement and triggering state transitions. Specific achievements include: 1) Development of new methods for using accelerometers to capture body segment angle during performance of an upper limb task and use of that data to trigger state transitions (angle triggering); 2) Development of new methods to improve the robustness of angle triggering; 3) Development of a flexible finite state-machine controller for control of upper limb FES in real time; 4) In collaboration with a clinical PhD student, implementation of a graphical user interface (GUI) that allows clinical users (e.g. physiotherapists) to set up FSM controllers for FES-assisted upper limb functional tasks. Three alternative methods that use 3-axis accelerometer data to track body segment angle with respect to gravity have been reported. The first uncalibrated method calculates the change in angle during a rotation using the gravity vectors before and after the rotation. The second uncalibrated method calculates the angle between the accelerometer x-axis and the gravity vector. The third calibrated method uses a calibration rotation to define the measurement plane and the positive rotation direction. This method then calculates the component of rotation that is in the same plane as the calibration rotation. All three methods use an algorithm that switches between using sine and cosine, depending on the measured angle, which overcomes the poor sensitivity problem seen in previous methods. xviii A number of methods can be included in the transition triggering algorithm to improve robustness and hence the usability of the system. The aim of such methods is to reduce the number of incorrect transition timings caused by signal noise, jerky arm movements and other negative effects, which lead to poor control of FES during reaching tasks. Those methods are: 1) Using the change in angle since entering a state rather than absolute angle; 2) Ignoring readings where the acceleration vector is significant in comparison to the gravity vector (i.e. the magnitude of the measured vector is significantly different from 9.81); and 3) Requiring a given number of consecutive or non-consecutive valid readings before triggering a transition. These have been implemented with the second uncalibrated angle tracking method and incorporated into a flexible FSM controller. The flexible FSM controller and the associated setup software are also presented in this thesis, for control of electrical stimulation to support upper limb functional task practice. In order to achieve varied functional task practice across a range of patients, the user should be able to set up a variety of different state machines, corresponding to different functional tasks, tailored to the individual patient. The goal of the work is to design a FSM controller and produce an interface that clinicians (even potentially patients) can use to design and set up their own task and patient-specific FSMs. The software has been implemented in the Matlab-Simulink environment, using the Hasomed RehaStim stimulator and Xsens MTx inertial sensors. The full system has been tested with stroke patients practicing a range of tasks in the laboratory environment, demonstrating the potential for further exploitation of the work.

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38

Bradnam, Lynley Valmai. "Neural control of the proximal upper limb: implications for recovery after stroke". Thesis, University of Auckland, 2011. http://hdl.handle.net/2292/7212.

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Abstract (sommario):

Reaching to pick up an object is a seemingly simple everyday task, yet one that requires the central nervous system to precisely coordinate activity of multiple muscles across the upper limb. A series of experiments were conducted to investigate the role of the contralateral and ipsilateral primary motor cortex (M1) in proximal upper limb control for healthy adults and stroke patients. A literature review was conducted to inform the experimental hypotheses. Transcranial magnetic stimulation was used in each experiment to assess the excitability of contralateral and ipsilateral descending projections from M1 during upper limb motor tasks. The first experiment investigated the role of the presumed cervical propriospinal system in coordinating reaching and gripping in healthy adults. Propriospinal neurons (PNs) were disinhibited during a grip-lift task, facilitating the functional cocontraction of proximal and distal muscles. In the next three experiments, non-invasive brain stimulation (NIBS) was used to suppress M1 excitability. There was a reduction in excitability of ipsilateral projections to PNs innervating a proximal upper limb muscle, and a degradation of selective proximal muscle activation in the ipsilateral arm following suppressive NIBS of M1. Together, these experiments provide evidence that ipsilateral M1 has an important contribution to proximal upper limb motor control in healthy adults, possibly via descending projections to ipsilateral PNs in the spinal cord. The final study investigated the effect of suppressive NIBS of contralesional M1 on proximal paretic upper limb control in stroke patients. There was evidence that paretic proximal upper limb motor control was improved in patients who have little compensatory up-regulation of contralesional M1, but may be contraindicated for patients in whom contralesional M1 is playing a compensatory role. A hypothetical model to explain ipsilateral neural control of the proximal upper limb and the effects of suppressive NIBS on proximal paretic upper limb control in patients with different levels of motor impairment is presented.

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Collins, Kathryn. "Investigation of upper limb kinematics and corticospinal pathway activity early after stroke". Thesis, University of East Anglia, 2016. https://ueaeprints.uea.ac.uk/59448/.

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Abstract (sommario):

Reach-to-grasp is an essential part of activities of daily living (ADL’s); despite rehabilitation reach-to-grasp often impaired after a stroke contributing to disability. Upper limb rehabilitation interventions need improvement. A deeper understanding of underlying kinematic characteristics and the neural correlates of movement can be achieved through neuro-biomechanical assessment. This would provide knowledge of the interaction of the nervous and musculoskeletal system, which may contribute to development of improved targeted upper limb interventions. A systematic review and meta-analysis was conducted investigating the kinematic differences in reach-to-grasp between stroke survivors and neurologically intact adults. The results indicate stroke survivors consistently demonstrate different kinematics to neurologically intact adults during reach-to-grasp in the central and ipsilateral workspace. There was heterogeneity of the reach-to-grasp task, and included studies demonstrated unclear or high potential risk of bias. A test-retest reliability study investigated transcranial magnetic stimulation (TMS) measures of corticospinal pathway excitability in the bilateral biceps, extensor carpi radialis (ECR), and abductor pollicis brevis (APB) in neurologically intact adults. The results demonstrate variable reliability; the lower end of the confidence interval was below acceptable reliability (ICC < 0.70) for many measures. The 95% confidence intervals (CI) and 95% limits of agreement (LOA) were wide, further indicating imprecision in measurement. A test-retest reliability study investigated TMS measures of corticospinal pathway excitability in the bilateral biceps, ECR and APB in stroke survivors within three months after stroke. The results demonstrate variable reliability; and the lower end of the confidence interval was below the range of acceptable reliability (ICC < 0.70) for many measures. The 95% CI and 95% LOA were wide, further indicating imprecision in measurement. Investigations into the variability of TMS measures in sub-acute stroke survivors and neurologically intact adults; as well as specificity of TMS measurement warrant future investigations to determine the use of TMS within these populations.

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Van, Dokkum Elisabeth Henriëtte. "Unfolding movement in time and space : defining upper-limb recovery post-stroke". Thesis, Montpellier 1, 2013. http://www.theses.fr/2013MON14004/document.

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Abstract (sommario):

Plusieurs champs de recherche ont été combinés - mettant en évidence l'utilité de l'analyse cinématique, non seulement afin d'évaluer le comportement moteur, mais aussi afin de contribuer à la compréhension de la récupération motrice post-AVC. Au travers d'analyses cinématiques, les mouvements du membre supérieur hémiplégique ont été décomposés dans le temps et l'espace, afin d'en extraire l'échelle et les composantes structurelles. Cette décomposition systématique, d'abord connue pour son bien-fondé clinique, nous a permis d'identifier les marqueurs les plus pertinents du contrôle du membre supérieur parétique : i.e., la fluidité, la rectitude et la vitesse. Subséquemment, il a été démontré que i) les changements cinématiques se stabilisent au cours de la phase de rééducation, indiquant potentiellement la nécessité de modifier la stratégie thérapeutique; ii) les patient post-AVC sont capables de percevoir la fluidité du mouvement en réalité virtuelle, cette perception étant meilleure lorsque le feedback visuel ne concerne que le point du travail du membre; iii) l'espace de travail post-AVC n'est pas isotrope pour un patient hémiplégique; iv) chez les patients post-AVC, le niveau de ‘bruit neuromoteur' est augmenté; et v) la cinématique reflète la conséquence des stratégies d'adaptation à l'augmentation du bruit, ces stratégies étant basées sur un compromis entre des modes de contrôle d'erreur en feedforward et en feedback des actions motrices. Ainsi, il peut être conclut que la décomposition du mouvement dans le temps et l'espace est un moyen simple et efficace d'appréhender contrôle moteur chez l'Homme en situation normale et âpres AVC. L'enjeu est maintenant d'implémenter ces méthodes d'analyse cinématique dans les protocoles de rééducation post-AVC quotidienne afin de développer de larges bases de données permettant, à l'aide de méthodes de modélisation, de définir des profils de récupération et ainsi personnaliser de façon optimale la rééducation à chaque patient particulier
Multiple research fields were combined – highlighting the value of kinematic analysis, not only to evaluate motor behaviour, but also to contribute to the understanding of motor recovery post-stroke. By means of kinematics, hemiplegic upper-limb movements were unfolded in time and space, to extract the scaling and structural components of the movement. This systematic decomposition, first proven to have clinical relevance, allowed us to identify the most pertinent markers of paretic upper-limb control: i.e. smoothness, directness and velocity. Subsequently it was shown that i) change in kinematics levels off over rehabilitation, possibly indicating that treatment may profit from change; ii) people post-stroke are able to perceive movement fluency in virtual realities, whereby simple end-point displays facilitate perception; iii) the workspace post-stroke is heterogeneous; iv) stroke patients have increased levels of neuromotor noise; and v) kinematics reflect the outcome of adaptation strategies to the increased noise in relation to the automaticity of error-corrections on the trade-off between feedforward and feedback based motor control. It may thus be concluded that unfolding the movement in space and time, is a simple and powerful way to define human motor control. The challenge is to implement kinematic analysis in daily post-stroke practice to develop a large database enabling the definition of recovery profiles contributing to provide each individual patient with the right therapy at the right time

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Barden, Hannah Louise Holman. "Spasticity in the Upper Motor Neuron Syndrome: Measuring Upper Limb Performance following Acquired Brain Injury". Thesis, The University of Sydney, 2015. http://hdl.handle.net/2123/13841.

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Abstract (sommario):

Difficulties exist with measuring functional upper limb (UL) change following Botulinum Toxin-A (BTX-A) injections for muscle spasticity in adults with acquired brain injury (ABI). These may result from limitations of clinical measures including psychometric properties and clinical relevance. Further, the complex nature of the upper motor neuron syndrome with the interplay of positive and negative features requires improved measures which evaluate both features simultaneously, such as emerging UL measures: Dynamic Computerised hand Dynamometry (DCD) and the Upper Limb Performance Analysis (ULPA). This research focused on the investigation of the psychometric properties and the capacity to quantify change in UL performance following BTX-A injection of DCD and the ULPA. A multicentre study design with longitudinal data collection over three time points was used to measure UL performance of 40 community dwelling adults with UL spasticity resulting from ABI and 27 healthy controls. Participants with ABI were consecutively recruited from three metropolitan spasticity management clinics. The research protocol consisted of a selection of UL performance measures spanning the ICF domains of Body Function and Structure and Activity. Results from this research demonstrate fair to excellent test-retest reliability and fair to good construct, concurrent and predictive validity of DCD. DCD was able to identify clear differences in hand performance between participants with and without ABI, and the affected and non-affected hands of ABI participants. Good construct and concurrent validity was demonstrated for the ULPA. Finally, significant change in UL performance was demonstrated using both DCD and the ULPA. This research has demonstrated the psychometric properties and clinical relevance of DCD and the ULPA. These measures may be used to measure treatment efficacy and assist clinical decision making for other UL interventions for adults with UMN syndrome resulting from ABI.

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Kousidou, Sophia. "Task-orientated multimodal feedback system for the rehabilitation of the upper limb". Thesis, University of Salford, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.490209.

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Abstract (sommario):

This thesis reports on the design and development of a software environment which allows the implementation of task-based physiotherapy for the upper limb providing at the same time effective multimodal feedback to the user. The software environment, Rehab Lab, uses the University of Salford Soft Exoskeleton as a ledium for delivering therapy.

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Dávila, Vilchis Juana Mariel. "MOSAR: A Soft-Assistive Mobilizer for Upper Limb Active Use and Rehabilitation". Tesis de doctorado, Universidad Autónoma del Estado de México, 2020. http://hdl.handle.net/20.500.11799/110472.

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Abstract (sommario):

In this study, a soft assisted mobilizer called MOSAR from (Mobilizador Suave de Asistencia y Rehabilitación) for upper limb rehabilitation was developed for a 11 years old child with right paretic side. The mobilizer provides a new therapeutic approach to augment his upper limb active use and rehabilitation, by means of exerting elbow (flexion-extension), forearm (pronation-supination) and (flexion-extension along with ulnar-radial deviations) at the wrist. Preliminarily, the design concept of the soft mobilizer was developed through Reverse Engineering of his upper limb: first casting model, silicone model, and later computational model were obtained by 3D scan, which was the parameterized reference for MOSAR development. Then, the manufacture of fabric inflatable soft actuators for driving the MOSAR system were carried out. Lastly, a law close loop control for the inflation-deflation process was implemented to validate FISAs performance. The results demonstrated the feasibility and effectiveness of the FISAs for being a functional tool for upper limb rehabilitation protocols by achieving those previous target motions similar to the range of motion (ROM) of a healthy person or being used in other applications.

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Evans, Iain Eric James. "A novel parametric scale for determining rehabilitation progress in the upper limb". Thesis, University of Newcastle upon Tyne, 2015. http://hdl.handle.net/10443/2967.

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Abstract (sommario):

The process of sensorimotor rehabilitation depends upon the clinical condition, age and circumstances of the patient and is unlikely to be continuous or predictable in nature. Mapping progress in conditions such as stroke, cerebral palsy and traumatic brain injury relies upon a variety of qualitative assessments, each resulting in different scales of measurement. Most current assessments are elaborate, specific to certain participants and/or stages of a condition, and subject to inter-rater and intra-rater variability. A simple and reliable measuring system is required that can capture rehabilitation progress from an initial state through to complete rehabilitation. It must be believable, flexible, understandable and accessible if the patient is to benefit from its use. Two-dimensional reaching tasks reflect movements made in typical therapies and activities of daily living. This thesis hypothesises that valuable parameters exist within positional and temporal data gathered from simple reaching tasks. Such parameters should be able to identify movement quality and hence measure state and progress during rehabilitation. They should correlate well with a variety of clinical scales to be meaningful and, as quantifiable measurands, they should be extendable beyond the range of established clinical scales. This thesis proposes a novel solution for the assessment of upper limb rehabilitation. An affordable desktop computer assessment system was developed and used with juvenile patient participants (N=11) to compare simple desktop reaching parameters with a clinical scale. A control group of normal juvenile participants (N=10) provided baseline data. The results indicated good correlation with the clinical scale based upon a weighted combination of pre-selected movement parameters. The methodology developed permits assessment against further clinical scales and additional participant groups allowing rapid, accurate, reliable and extendable assessments. The potential for mass data acquisition from clinical and domestic settings is identified to support the development of further assessments and, potentially, new therapies to address limited therapist availability and innovative treatments.

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Baker, K. "The use of a robotic device for upper limb retraining in subacute stroke". Thesis, University College London (University of London), 2014. http://discovery.ucl.ac.uk/1437284/.

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Abstract (sommario):

Stroke is a significant cause of disability in the population. When the arm is affected by stroke, functional recovery may be poor. The use of robotic aids to enhance arm recovery is a novel treatment adjunct. There is a growing support for using robots as an adjunct to therapy but there has been little translation from research into clinical use. The investigations reported in this thesis aimed to bridge the gap between research and clinical use of these devices. To achieve this,five stages were carried out: Firstly a systematic literature review of outcomes measure used for the upper limb was conducted.to establish the most reliable, valid and responsive scales. This review found a battery of measures (ABILHAND, CHAI, STREAM, FMA, ARAT, EQ5D, DASH, NIHSS). An evaluation of 125 consecutive acute stroke patients established the proportion of patients that potentially benefited from rehabilitation using a robotic device. This found that around 50% of subjects could use a robotic aid and that it was practically feasible to carry out the intervention. A pilot RCT performed on 37 participants using the battery of measures found a significant difference with use of the robotic device on the ABILHAND, This was not seen with the other measures, however there was a trend towards improvement in motor performance and function in the robotic group. In depth interviews with participants found subjects perceived gains with using the robot but fatigue stopped them using it for longer periods. Psychometric analysis of the outcome measures used found difficulties with the instruments in reflecting clinically change. The studies showed that a robotic device could be used practically; however stratifying subjects into arm severity would help provide further information over who could benefit from the intervention. Identifying appropriate ways of measuring changes that are clinically meaningful would also be beneficial.

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Golby, Christopher. "User-centred design of a task-oriented upper-limb assessment system for stroke". Thesis, University of Warwick, 2015. http://wrap.warwick.ac.uk/72926/.

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Abstract (sommario):

During rehabilitation from Stroke, patients require assessment of their upper-limb motor control. Outcome measures can often be subjective and objective data is required to supplement therapist/patient opinion on progress. This can be performed through goniometry; however, goniometry can be time-consuming, have inaccuracies of ±23º, and is therefore, often not used. Motion tracking technology is a possible answer to this problem, but can also be costly, time-consuming and not suitable for the clinical environment. This thesis aims to provide an objective, digital intervention method for assessing range of motion to supplement current outcome measures which is suitable for the clinical environment. This was performed by creating a low-cost technology through a user-centred design approach. Requirements elicitation demonstrated that a motivational, portable, cost-effective, non-invasive, time saving system for assessing functional activities was needed. Therefore, a system which utilised a Microsoft Kinect and EZ430 chronos wrist watch to track patient’s movements during and/or outside of therapy sessions was created. Measurements can be taken in a matter of minutes and provide a high quantity of objective data regarding patient movement. The system was verified, using healthy volunteers, by showing similar error rates in the system across 3 weeks in 10 able-bodied individuals, with error rates produced by a physiotherapist using goniometry. The system was also validated in the clinical setting with 6 stroke patients, over 15 weeks, as selected by 6 occupational therapists and 3 physiotherapists in 2 NHS stroke wards. The approach which has been created in this thesis is objective, repeatable, low-cost, portable, and non-invasive; allowing it to be the first tool for the objective assessment of upper-limb ROM which is efficiently designed and suitable for everyday use in stroke rehabilitation.

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Schneiberg, Dias Sheila. "Rehabilitation strategies to improve upper limb movement quality in children with cerebral palsy". Thesis, McGill University, 2009. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=66702.

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Abstract (sommario):

Children with CP are extremely heterogeneous in terms of etiology and clinical features. The diversity of symptoms among CP syndromes is a challenge for different branches of health research. Despite the efforts of many studies in examining rehabilitation strategies to improve upper limb (UL) function in children with CP, the confidence in the validity of these studies' evidence is still moderate to low. One limitation suggested is related to the type of outcomes used to measure improvement. Many are not sensitive enough to detect change (lack of responsiveness), are not age-related, and do not describe the movement quality. Movement quality concerns about movement performance or how well an activity is performed taking into reference normative data from typical populations. The assessment of movement quality in UL activities refers to the measurement of range of motion, hand trajectories, interjoint and intersegment coordination, muscle contraction patterns, and postural adjustments. The objective assessment of movement quality can be made by kinematic and kinetic analyses. The description of movement quality is important, because early brain injuries are more susceptible to 'maladaptative' plasticity, which might result in abnormal movement behaviors. The primary objective of this prospective single subject research design study was to determine the effect of two rehabilitation strategies in UL movement quality: arm constraint and trunk restraint, in the context of a modified constraint induced therapy (mCIT) and a task-oriented intervention, respectively. The UL movement quality was measured by kinematic analysis of a functional reaching task: a self-feeding simulation. Overall, the kinematic variables investigated are related to hand trajectories, arm angles and trunk forward displacement. Two clinical outcomes measuring UL movement quality were also used, the QUEST for the mCIT study, and the Melbou
Les enfants avec paralysie cérébrale (PC) constituent un groupe clinique fortement hétérogène, tant au point de vue de l'étiologie que des caractéristiques cliniques. Malgré les efforts de recherche qui ont été déployés dans plusieurs études pour examiner les stratégies de réadaptation visant l'amélioration de la fonction du membre supérieur chez les enfants avec PC, il demeure que la confiance démontrée envers la validité de ces résultats est encore de modérée à faible. Une des limites notées dans la littérature est reliée au type de variables qui sont mesurées : ces variables ne seraient pas assez sensibles pour détecter des changements ou ces études ne décriraient pas la qualité du mouvement. Cette évaluation objective de la qualité de mouvement peut être réalisée par l'intermédiaire d'analyses cinématiques ou cinétiques. La description de la qualité du mouvement est considérée primordiale, puisque des lésions cérébrales en bas âge sont plus susceptibles d'amener une plasticité « maladaptative » et donc d'engendrer des mouvements anormaux.Le premier objectif de cette recherche prospective à protocoles individuels est de déterminer les effets de 2 stratégies de réadaptation visant la qualité du mouvement du membre supérieur: la contrainte du bras et la restriction du tronc, réalisées respectivement dans le contexte d'une intervention par contrainte modifiée (mCIT) et d'une intervention orientée vers la tâche. Globalement, les variables cinématiques mesurées dans ces protocoles comprennent les trajectoires de la main, les angles articulaires du bras et le déplacement du tronc vers l'avant. Deux échelles de mesure cliniques reliées à la qualité du mouvement du bras ont aussi été utilisées : le QUEST (étude mCIT) et le Melboune assessment (intervention orientée vers la tâche). Étant donné l'observation d'une grande variabilité au

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48

Kan, Patricia Wai Ling. "Design of an Adaptive System for Upper-limb Stroke Rehabilitation". Thesis, 2008. http://hdl.handle.net/1807/17182.

Testo completo

Abstract (sommario):

Stroke is the primary cause of adult disability. To support this large population in recovery, robotic technologies are being developed to assist in the delivery of rehabilitation. A partially observable Markov decision process (POMDP) system was designed for a rehabilitation robotic device that guides stroke patients through an upper-limb reaching task. The performance of the POMDP system was evaluated by comparing the decisions made by the POMDP system with those of a human therapist. Overall, the therapist agreed with the POMDP decisions approximately 65% of the time. The therapist thought the POMDP decisions were believable and could envision this system being used in both the clinic and home. The patient would use this system as the primary method of rehabilitation. Limitations of the current system have been identified which require improvement in future research stages. This research has shown that POMDPs have promising potential to facilitate upper extremity rehabilitation.

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49

Lu, Elaine Chen. "Development of an Upper Limb Robotic Device for Stroke Rehabilitation". Thesis, 2011. http://hdl.handle.net/1807/31323.

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Abstract (sommario):

Stroke is the major cause of permanent adult disability worldwide. Often stroke affects the motor control of the upper limb, leading to difficulties in performing activities of daily living. Many hours are spent in resource-intensive therapy to regain functionality of the upper limb. In order to decrease the burden to therapists and increase access to rehabilitation, an upper limb rehabilitation robotic device was developed. Observations from therapists and an international survey of stroke therapists were conducted to understand general requirements of an upper limb rehabilitation device. These requirements were the basis of the mechanical design portion of the prototype. The prototype was evaluated with stroke therapists in a focus group. Although more iterations of design, testing and evaluation are needed, this project is a step in developing a lower cost, portable device to increase access to upper limb stroke rehabilitation.

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50

Tran, Johnathan. "Exploring the Use of Consumer Grade Technology for Kinematic Assessment of the Upper Limb Following a Stroke". Thesis, 2014. http://hdl.handle.net/10012/8548.

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Abstract (sommario):

Upper limb deficits post stroke affect up to 60% of stroke survivors. The assessment of motor deficits post stroke is important for identifying rehabilitation goals and assessing treatment efficacy. Current clinical tools used to assess motor impairment utilize clinical observation to describe the performance of diagnostic motor tasks. However there are some concerns regarding the ability of these scales to fully describe the quality of performance, and detect small but important changes which reflect motor recovery. Kinematic analysis has been increasingly suggested to augment clinical assessment; however, current kinematic tools are not well suited to the time and financial constraints of a clinical environment. The objective of this thesis was to investigate the feasibility of utilizing low-cost, depth sensing technology (Kinect sensor) to augment the current upper limb stroke assessment. Study one characterizes the accuracy of the Kinect sensor, and defines optimal markers and conditions for data collection. Results revealed sufficient ability to quantify metrics for the hand, and the trunk. Study two explored the feasibility of clinical use for the Kinect sensor, specifically its ability to distinguish kinematic performance between the affected and less-affected limbs within an individual, and differences in the affected limb between individuals. Results from study 2 indicated that the Kinect is able to identify interlimb differences and correlations with upper limb impairment scores for some kinematic metrics. Findings from this thesis suggest a potential use for the Kinect in a clinical environment for the purposes of upper limb stroke assessment; however, there are many factors and limitations which need to be considered prior to its use.

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Tesi sul tema "Stroke upper limb rehabilitation"

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