Search Results (191)

Early rehabilitation is essential for restoring functional recovery in patients with stroke, particularly during the early phase of post-acute care (PAC), or the subacute stage. We aimed to evaluate the effectiveness of a 7-week PAC rehabilitation program in improving muscle strength, physical performance, and functional recovery. A total of 219 inpatients with stroke in the subacute stage were initially recruited from the PAC ward of a regional teaching hospital in Northern Taiwan, with 79 eligible patients—within 1 month of an acute stroke—included in the analysis. The program was delivered 5 days per week, with 3–4 sessions daily (20–30 min each, up to 120 min daily), comprising physical, occupational, and speech–language therapies. Sociodemographic data, muscle strength, physical performance (Berg Balance Scale [BBS], gait speed, and 6-minute walk test [6MWT]), and functional recovery (modified Rankin Scale [mRS], Barthel Index [BI], Instrumental Activities of Daily Living [IADL], and Fugl–Meyer assessment: sensory and upper extremity) were collected at baseline, 3 weeks, and 7 weeks. Generalized estimating equations analyzed program effectiveness. Among the 56 patients (70.9%) who completed the program, significant improvements were observed in the muscle strength of both the affected upper (B = 0.93, p < 0.001) and lower limbs (B = 0.88, p < 0.001), as well as in their corresponding unaffected limbs; in physical performance, including balance (BBS score: B = 9.70, p = 0.003) and gait speed (B = 0.23, p = 0.024); and in functional recovery, including BI (B = 19.5, p < 0.001), IADL (B = 1.48, p < 0.001), and mRS (B = −0.13, p = 0.028). These findings highlight the 7-week PAC rehabilitation program as an effective strategy during the critical recovery phase for patients with stroke. Full article

Background: The present study aimed to determine whether the protocolized use of pneumatic splints within neurodevelopmental therapeutic approaches produces a positive effect on sensorimotor impairments of the hemiplegic upper extremity in patients. Methods: A randomized clinical single-blind trial was conducted. Stroke patients were recruited and randomized into an experimental group, which completed a treatment protocol of splinting plus physiotherapy for 45 min per session, two sessions per week for four weeks; or a control group, which received the same type of conventional physiotherapy treatment for the same period of time. The patients were evaluated by Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) and the Trunk Control Scale. Secondary variables were Mini-BEStest, the modified Ashworth scale for ankle flexors, and computerized measurements of upper limb functional parameters performed by Armeo Spring^® robotic systems and Amadeo^®. All variables were measured pre- and post-treatment. Results: Twenty stroke patients with subacute and chronic stroke completed the protocol. Mann–Whitney U tests showed statistically significant differences between groups for the FM sensation variable (Z = −2.19; p = 0.03). The rest of the variables studied in the comparison between the two study groups did not present statistically significant differences (p > 0.05). Conclusions: The use of air splints in combination with physiotherapy treatment produced improvements in exteroceptive and proprioceptive sensitivity in post-stroke adult patients in the subacute and chronic phases. Full article

Upper-limb impairments after stroke significantly affect patients’ quality of life and require effective rehabilitation strategies. Rehabilitation devices play a vital role in enhancing motor recovery. This study evaluated the efficacy of the Arm Booster, a bilateral arm-training device, in improving upper-limb impairment in patients with chronic stroke. Eighteen participants were randomly assigned to two groups: a device group (n = 9), using the Arm Booster; and a conventional physiotherapy group (n = 9). Both groups performed six bilateral upper-limb exercises (32 repetitions each) three times per week for eight weeks. Participants were further classified into mild spasticity (n = 5) and moderate-to-severe spasticity (n = 4) subgroups. The primary outcome was motor impairment, assessed using the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE). Secondary outcomes included spasticity, measured by the Modified Ashworth Scale (MAS), and daily functional use of the arm, assessed with the Motor Activity Log (MAL). Both groups showed significant improvements in FMA-UE scores and overall arm movement. The conventional group demonstrated additional gains in hand and wrist function and coordination. Notably, in the moderate-to-severe spasticity subgroup, the device group exhibited improvements in upper-limb movement and a trend toward reduced spasticity. These findings suggest that the Arm Booster may support motor recovery, encourage the use of the affected arm, improve movement control, and provide an efficient means for patients to exercise more frequently on their own. Full article

Background: Gait and balance alterations in post-stroke patients are one of the most disabling symptoms that can persist in chronic stages of the disease. In this context, rehabilitation has the fundamental role of promoting functional recovery, mitigating gait and balance deficits, and preventing falling risk. Robotic end-effector devices, like the G-EO system (e.g., G-EO system, Reha Technology, Olten, Switzerland), can be a useful device to promote gait recovery in patients with chronic stroke. Materials and Methods: Twelve chronic stroke patients were enrolled and evaluated at baseline (T0) and at post-treatment (T1). These patients received forty sessions of robotic gait training (RGT) with the G-EO system (experimental group, EG), for eight weeks consecutively, in addition to standard rehabilitation therapy. The data of these subjects were compared with those coming from a sample of twelve individuals (control group, CG) matched for clinical and demographic features who underwent the same amount of conventional gait training (CGT), in addition to standard rehabilitation therapy. Results: All patients completed the trial, and none reported any side effects either during or following the training. The EG showed significant improvements in balance (p = 0.012) and gait (p = 0.004) functions measured with the Tinetti Scale (TS) after RGT. Both groups (EG and CG) showed significant improvement in functional independence (FIM, p < 0.001). The Fugl-Meyer Assessment—Lower Extremity (FMA-LE) showed significant improvements in motor function (p = 0.001, p = 0.031) and passive range of motion (p = 0.031) in EG. In EG, gait and balance improvements were influenced by session, age, gender, time since injury (TSI), cadence, and velocity (p < 0.05), while CG showed fewer significant effects, mainly for age, TSI, and session. EG showed significantly greater improvements than CG in balance (p = 0.003) and gait (p = 0.05) based on the TS. Conclusions: RGT with end-effectors, like the G-EO system, can be a valuable complementary treatment in neurorehabilitation, even for chronic stroke patients. Our findings suggest that RGT may improve gait, balance, and lower limb motor functions, enhancing motor control and coordination. Full article

Introduction: Advanced magnetic resonance imaging (MRI) techniques in neuroplasticity evaluations provide important information on stroke disease and the underlying mechanisms of neuronal recovery. It has been observed that gray matter density or volume in brain regions closely related to motor function can be a valuable indicator of the response to treatment. Objective: To compare structural MRI-evaluated gray matter volume changes in patients with post-stroke upper limb spasticity for >1 year between those undergoing surgery and those treated with botulinum toxin A (BoNT-A) and to relate these findings to upper limb function and quality of life outcomes. Materials and Methods: Design. A two-arm controlled and randomized clinical trial in patients with post-stroke upper limb spasticity. Participants. Thirty post-stroke patients with spastic upper limbs. Intervention. Participants were randomly assigned (1:1 allocation ratio) for surgery (experimental group) or treatment with BoNT-A (control group). Main outcome measures. The functional parameters were analyzed with Fugl-Meyer, Zancolli, Keenan, House, Ashworth, pain visual analogue, and hospital anxiety and depression scales. Quality of life was evaluated using SF-36 and Newcastle stroke-specific quality of life scales. The carer burden questionnaire was also applied. Clinical examinations and MRI scans were performed at baseline and at six months post-intervention. Correlations between brain volume/thickness and predictors of interest were examined across evaluations and groups. Results: Five patients were excluded due to the presence of intracranial implants. Eleven patients were excluded from analyses since they were late dropouts. Changes were observed in the experimental group but not in the control group. Between baseline and six months, gray matter volume was augmented at the hippocampus and gyrus rectus and cortical thickness was increased at the frontal pole, occipital gyrus, and insular cortex, indicating anatomical changes in key areas related to motor and behavioral adaptation These changes were significantly related to subjective pain, Ashworth spasticity scale, and Newcastle quality of life scores, and marginally related to the carer burden score. Conclusions: The structural analysis of gray matter by MRI revealed differences in patients with post-stroke sequelae undergoing different therapies. Gray matter volume and cortical thickness measurements showed significant improvements in the surgery group but not in the BoNT-A group. Volume was increased in areas associated with motor and sensory functions, suggesting a neuroprotective or regenerative effect of upper limb surgery. Full article

Background/Objectives: Cerebellum might be one of the targets of repetitive transcranial magnetic stimulation (rTMS) for motor recovery in stroke patients. The aim of this study was to investigate the enhancing effects of rTMS over the cerebellum on inhibitory rTMS for motor recovery in patients with subacute ischemic stroke. Methods: Twenty-three patients with subacute ischemic stroke were recruited into this single-blind randomized, controlled study with a blinded observer. The Cr-Cbll group received Cr-Cbll rTMS consisting of continuous theta burst stimulation over the contralesional primary motor cortex (M1), a shoulder mobilization exercise, and high-frequency rTMS over the contralesional cerebellum. The Cr-sham group received sham rTMS over the cerebellum instead of high-frequency rTMS. All participants received ten daily sessions for 2 weeks. The Fugl-Meyer Assessment (FMA) was measured before, immediately after, and 2 months after the intervention. Results: A total of 20 participants (10 in the Cr-Cbll group and 10 in the Cr-sham group) who completed the two-week intervention were included in the intention-to-treat analysis. There was no significant difference in general and clinical characteristics between the two groups at baseline. Total and upper extremity scores of FMA showed a significant interaction between time and group (p < 0.05). Each improvement of upper extremity score of FMA immediately and 2 months after the intervention was significantly higher in the Cr-Cbll group than in the Cr-sham group (p < 0.05). Conclusions: These results demonstrated that rTMS over the cerebellum could have additional effects on inhibitory rTMS over contralesional M1 for improving upper extremity motor function in patients with subacute ischemic stroke. Full article

This study developed and evaluated a novel upper-limb rehabilitation device that integrates piano playing into task-oriented occupational therapy, addressing the limitations of traditional continuous passive motion (CPM) training in patient engagement and functional recovery. The system features a bi-axial sliding platform for precise 61-key positioning and a ten-link, four-loop robotic hand for key striking. A hierarchical control framework incorporates MIDI-based task mapping, finger optimization using an improved Hungarian algorithm, and impedance–admittance hybrid control for adaptive force–position modulation. An 8-week randomized controlled trial demonstrated that the experimental group significantly outperformed the control group, with a 74.7% increase in Fugl–Meyer scores (50.5 ± 2.5), a 14.6-point improvement in the box and block test (BBT), a 20.2-s reduction in nine-hole peg test (NHPT) time, and a 72.6% increase in rehabilitation motivation scale (RMS) scores (55.4 ± 3.8). The results indicate that combining piano playing with robotic rehabilitation enhances neuroplasticity and engagement, significantly improving motor function, daily activity performance, and rehabilitation adherence. This mechanical-control synergy introduces a new paradigm for music-interactive rehabilitation, with potential applications in home-based remote therapy and multimodal treatment integration. Full article

Background/Objectives: With the advancement of intelligent sensing technology, rehabilitation systems based on wearable devices have a positive impact on the functional recovery and quality of life of stroke patients. This study aims to evaluate the application value of a contextualized intelligent rehabilitation training system for stroke survivors, which is based on wearable devices, in the rehabilitation of motor function impairments following stroke. Methods: A randomized controlled trial design was employed, in which 100 stroke patients were randomly divided into a control group (n = 50, receiving standard physical therapy rehabilitation interventions) and an experimental group (n = 50). The experimental group additionally underwent motor function rehabilitation interventions and intelligent assessments through a wearable device-based contextual intelligent rehabilitation training system, with sessions conducted twice daily for 30 min each, five days a week, over a duration of eight weeks. Both groups of patients underwent clinical scale evaluations and data collection before and after the treatment, with primary outcome measures including motor ability (Fugl–Meyer Assessment, FMA), activities of daily living (Modified Barthel Index, MBI), and participation in rehabilitation therapy. The intervention effects of both groups were compared after eight weeks of rehabilitation. Results: Prior to the intervention, there were no significant differences in Fugl–Meyer Assessment (FMA) and Modified Barthel Index (MBI) scores between the experimental group and the control group (p > 0.05). After eight weeks of rehabilitation, the experimental group demonstrated significantly superior performance in motor function (FMA scores) and activities of daily living (MBI scores) compared to the control group (p < 0.01). Conclusions: The intelligent rehabilitation system significantly enhances motor function and activities of daily living in stroke survivors. Compared to traditional rehabilitation methods, it improves patient adherence to rehabilitation training and overall outcomes. Full article

Background: Although recent advancements in ischemic stroke management have reduced associated mortality rates, there remains a pressing need for more reliable, efficacious, and well-tolerated therapeutic approaches due to the narrow therapeutic window of current treatment approaches. The current meta-analysis sought to evaluate the safety and efficacy of stem cell-based therapeutic options for patients with ischemic stroke. Methods: PubMed, Web of Science, and Cochrane library databases were searched to retrieve randomized controlled trials (RCTs) evaluating the efficacy and safety of stem cell therapy (SCT) in ischemic stroke patients. Key outcomes included the National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), Barthel Index (BI), Fugl–Meyer Assessment (FMA), infarct size, and safety profile. The random effects model with the continuous method was used to calculate the pooled effect size in Review Manager 5.4.1, and subgroup analyses were performed based on demographics, stroke duration, and SCT delivery protocols. Results: A total of 18 RCTs involving 1026 patients were analyzed, with 538 in the treatment group and 488 in the control group. The mean change in NIHSS score was comparable between groups [MD = −0.80; 95% CI: −2.25, 0.65, p < 0.0001]. However, SCT showed better outcomes in mRS [MD = −0.56; 95% CI: −0.76, −0.35, p = 0.30] and BI scores [MD = 12.00; 95% CI: 4.00, 20.00, p = 0.007]. Additionally, the mean change in FMA score was significantly greater with SCT [MD = 18.16; 95% CI: 6.58, 29.75, p = 0.03]. The mean change in infarct volume also favored stem cell therapy [MD = 8.89; 95% CI: −5.34, 23.12, p = 0.08]. The safety profile was favorable, with adverse event rates comparable to or lower than controls. Conclusions: SCT offers a safe and effective approach to improving functional outcomes in stroke patients, particularly with early intervention. These findings highlight the potential of SCT in ischemic stroke rehabilitation while underscoring the need for standardized protocols and long-term safety evaluation. Full article

Background: Patients with stroke sequelae experience motor impairments that make it difficult to perform many activities of daily living, resulting in reduced social participation. Immersive virtual reality (VR) provides the necessary conditions for motor learning, such as repetitiveness, intensity, and task meaningfulness, and it could be a promising rehabilitation tool for upper limb recovery in individuals with stroke sequelae. Objective: The objectives of this study are to summarize the current scientific evidence on the use of immersive VR for upper limb rehabilitation in patients with subacute stroke and to identify clinical and instrumental criteria that may inform the development of a standardized VR treatment protocol. Materials and Methods: Bibliographic research on primary and secondary studies was conducted using the keywords “subacute stroke”, “immersive virtual reality/head-mounted display (HMD)”, and “upper extremity/arm/hand” in the following electronic databases: CINAHL, PubMed (MEDLINE), Embase, Web of Science, Cochrane Library, PEDro, and Google Scholar. Then, we performed the selection of studies and the assessment of the methodological quality of such studies using the PEDro scale. Finally, the qualitative synthesis of the data extracted from the selected studies was carried out. This systematic review was conducted according to the PRISMA 2020 guidelines. Results: After the selection process, five studies were included in this systematic review (two RCTs, two controlled clinical studies, one study protocol). Four studies reported significant improvements in some main outcomes after the VR intervention, including a significant increase in the Fugl-Meyer Upper Extremity total score, in favor of the virtual rehabilitation group. Conclusions: VR appears to be a promising rehabilitation tool for upper limb motor recovery. However, further research is needed to determine the intervention methods and long-term effects of VR on the stroke population. Full article

Background: Immersive virtual reality (imVR) has shown promise for upper limb stroke rehabilitation (ULSR). However, optimal implementation and treatment modalities remain unclear. This systematic review and meta-analysis aimed to evaluate imVR’s efficacy in ULSR and determine optimal treatment parameters. Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs), comparing imVR to conventional rehabilitation (CR) in adult stroke patients, was conducted. Databases including, the Web of Science, Scopus, and PubMed, were searched. Meta-regression further explored the relationship between intervention duration, frequency, and outcomes. Results: Twenty-three studies were included in the systematic review, representing 395 patients, with thirteen incorporated into the meta-analysis. imVR showed statistically significant improvements in the Fugl–Meyer Assessment Upper Extremity (FMA-UE) Scale (mean difference (MD) = 3.04, 95% CI [1.46; 4.62], p < 0.001) and the Box and Block Test (BBT) (MD = 2.85, 95% CI [0.70; 4.99], p = 0.009) compared to CR, but not in the Action Research Arm Test (ARAT) (MD = 3.47, 95% CI [−0.22; 7.15], p = 0.06). However, these improvements did not reach clinically significant thresholds (7 points for FMA-UE and 6 points for BBT). Clinical subgroup analysis showed significant improvements for both subacute (standardized mean difference (SMD) = 0.92, 95% CI [0.48; 1.36], p = 0.002) and chronic (SMD = 0.69, 95% CI [0.03; 1.35], p = 0.03) stroke stages. Meta-regression indicated that there was a significant positive relationship between the intervention duration and upper limb improvement. Conclusions: imVR demonstrates potential for improving upper limb motor function following stroke, particularly with longer intervention durations and individual session lengths for chronic stroke. However, the improvements observed were not clinically significant, highlighting the need for further research with larger sample sizes and standardized outcome measures to determine optimal treatment protocols. Full article

Upper limb training dose after stroke is usually quantified by time and repetitions. This study analyzed upper limb motor training dose in stroke participants (N = 36) using a more comprehensive approach. Participants, classified by initial motor severity (severe/moderate/mild) and recovery trajectory (good/poor), received daily robotic and occupational therapy. Treatment dose was reported using a multidimensional framework. Fugl-Meyer Assessment (FMA) score and robot-derived kinematic parameters (reach distance (cm), velocity (cm/s), accuracy (cm) and smoothness (number of velocity peaks)) were analyzed pre- and post-intervention. FMA scores (mean (SD)) improved significantly post-intervention in severe (+11 (12) pts; p < 0.001) and moderate (+13 (6) pts; p ≤ 0.01) impairment groups. In the severe group, good recoverers showed greater improvement (+18 (12) pts) than poor recoverers (+4 (4) pts). Despite similar robotic therapy duration (34 min/session) and number of movements (600–900/session) between good and poor recoverers, both groups experienced very different therapeutic plans in the use of physical modalities: good recoverers gradually moved from assisted to the unassisted then resisted modality. Kinematic analysis showed distinct patterns of motor improvement across severity levels, ranging from quantitative (reach distance/velocity) to qualitative (accuracy/smoothness) changes. This approach provides a more accurate description of the therapeutic dose by characterizing the movements actually performed and can help personalize rehabilitation strategies. Full article

Upper-limb paresis is one of the main complications after stroke. It is commonly associated with impaired wrist-extension function. Upper-limb paresis can place a tremendous burden on stroke survivors and their families. A novel soft-actuator device, the Balonikotron, was designed to assist in rehabilitation by utilizing a balloon mechanism to facilitate wrist-extension exercises. This pilot study aimed to observe the functional changes in the paralyzed upper limb and improvements in independent and cognitive functions following a 4-week regimen using the device, which incorporates a multimedia tablet application providing audiovisual feedback. The device features a cardboard construction with a hinge at wrist level and rails that guide hand movement as the balloon inflates, controlled by a microcontroller and a tablet-based application. It operates on the principle of moving the hand at the wrist by pushing the palm upwards through a surface actuated by a balloon. A model was developed to describe the relationship between the force exerted on the hand, the angle on hinge, the pressure within the balloon, and its volume. Experimental validation demonstrated a Pearson correlation of 0.936 between the model’s force predictions and measured forces, supporting its potential for real-time safety monitoring by automatically shutting down when force thresholds are exceeded. A pilot study was conducted with 12 post-stroke patients (six experimental, six control), who participated in a four-week wrist-extension training program. Clinical outcomes were assessed using the Fugl–Meyer Assessment for the Upper Extremity (FMA-UE), Modified Rankin Scale (mRS), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MOCA), wrist Range of Motion (ROM), and Barthel Index (BI). Statistically significant results were obtained for the Barthel index (p < 0.05) and FMA-UE, indicating that the experimental use of the device significantly improved functional independence and self-care abilities. The results of our pilot study suggest that the Balonikotron device, which uses the principles of mirror therapy, may serve as a valuable adjunct to conventional rehabilitation for post-stroke patients with hemiparetic hands (BI p = 0.009, MMSE p = 0.151, mRS p = 0.640, FMA-UE p = 0.045, MOCA p = 0.187, ROM p = 0.109). Full article

This case report explores the innovative integration of robotic and biomechatronic technologies, including the Motore and Ultra+ devices and neuro-suits, in a 10-session rehabilitation program for a young adult with dystonic spastic tetraparesis. Notable improvements were observed in upper limb motor function, coordination, and quality of life as measured by an increase of 18 pints on the Fugl-Meyer scale and a 25% improvement in the Bartle Index. Range of motion measurements showed consistent improvements, with task execution times improving by 10 s. These findings suggest the potential of combining wearable, robotic, and biomechatronic systems to enhance neurorehabilitation. Further refinement of these technologies might support clinicians in maximizing their integration in therapeutics, despite technical issues like synchronization issues that must be overcome. Full article

Multimodal brain–computer interfaces (BCIs) that combine electrical features from electroencephalography (EEG) and hemodynamic features from functional near-infrared spectroscopy (fNIRS) have the potential to improve performance. In this paper, we propose a multimodal EEG- and fNIRS-based BCI system with soft robotic (BCI-SR) components for personalized stroke rehabilitation. We propose a novel method of personalizing rehabilitation by aligning each patient’s specific abilities with the treatment options available. We collected 160 single trials of motor imagery using the multimodal BCI from 10 healthy participants. We identified a confounding effect of respiration in the fNIRS signal data collected. Hence, we propose to incorporate a breathing sensor to synchronize motor imagery (MI) cues with the participant’s respiratory cycle. We found that implementing this respiration synchronization (RS) resulted in less dispersed readings of oxyhemoglobin (HbO). We then conducted a clinical trial on the personalized multimodal BCI-SR for stroke rehabilitation. Four chronic stroke patients were recruited to undergo 6 weeks of rehabilitation, three times per week, whereby the primary outcome was measured using upper-extremity Fugl-Meyer Motor Assessment (FMA) and Action Research Arm Test (ARAT) scores on weeks 0, 6, and 12. The results showed a striking coherence in the activation patterns in EEG and fNIRS across all patients. In addition, FMA and ARAT scores were significantly improved on week 12 relative to the pre-trial baseline, with mean gains of 8.75 ± 1.84 and 5.25 ± 2.17, respectively (mean ± SEM). These improvements were all better than the Standard Arm Therapy and BCI-SR group when retrospectively compared to previous clinical trials. These results suggest that personalizing the rehabilitation treatment leads to improved BCI performance compared to standard BCI-SR, and synchronizing motor imagery cues to respiration increased the consistency of HbO levels, leading to better motor imagery performance. These results showed that the proposed multimodal BCI-SR holds promise to better engage stroke patients and promote neuroplasticity for better motor improvements. Full article