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14 pages, 383 KiB

Open AccessReview

Focal Muscle Vibration (fMV) for Post-Stroke Motor Recovery: Multisite Neuroplasticity Induction, Timing of Intervention, Clinical Approaches, and Prospects from a Narrative Review

by Alessandro Viganò, Claudia Celletti, Giada Giuliani, Tommaso B. Jannini, Francesco Marenco, Ilaria Maestrini, Rosaceleste Zumpano, Edoardo Vicenzini, Marta Altieri, Filippo Camerota, Vittorio Di Piero and Massimiliano Toscano

Vibration 2023, 6(3), 645-658; https://doi.org/10.3390/vibration6030040 - 8 Aug 2023

Cited by 5 | Viewed by 3821

Abstract

Despite newly available therapies for acute stroke and innovative prevention strategies, stroke remains the third leading cause of disability-adjusted life-years (DALYs) lost worldwide, mostly because more than half of stroke survivors aged 65 and over exhibit an incomplete functional recovery of the paretic limb. Given that a repeated sensory input is one of the most effective modulators of cortical motor and somatosensory structures, focal muscle vibration (fMV) is gaining growing interest as a safe, well-tolerated, and non-invasive brain stimulation technique to promote motor recovery after stroke with a long-lasting and clinically relevant improvement in strength, step symmetry, gait, and kinematics parameters. In this narrative review, we first summarize the structural (neural plasticity) and functional changes (network relearning) triggered by the stroke lesion and carried out at a brain and spinal cord level in an attempt to recover from the loss of function. Then, we will focus on the fMV’s plasticity-based mechanisms reporting evidence of a possible concurrently acting multisite plasticity induced by fMV. Finally, to understand what the most effective fMV rehabilitation protocol could be, we will report the most recent evidence regarding the different clinical approaches and timing of the fMV treatment, the related open issues, and prospects. Full article

20 pages, 2500 KiB

Open AccessArticle

Time-Based and Path-Based Analysis of Upper-Limb Movements during Activities of Daily Living

by Sebastjan Šlajpah, Eva Čebašek, Marko Munih and Matjaž Mihelj

Sensors 2023, 23(3), 1289; https://doi.org/10.3390/s23031289 - 23 Jan 2023

Cited by 8 | Viewed by 3098

Abstract

Patients after stroke need to re-learn functional movements required for independent living throughout the rehabilitation process. In the study, we used a wearable sensory system for monitoring the movement of the upper limbs while performing activities of daily living. We implemented time-based and path-based segmentation of movement trajectories and muscle activity to quantify the activities of the unaffected and the affected upper limbs. While time-based segmentation splits the trajectory in quants of equal duration, path-based segmentation isolates completed movements. We analyzed the hand movement path and forearm muscle activity and introduced a bimanual movement parameter, which enables differentiation between unimanual and bimanual activities. The approach was validated in a study that included a healthy subject and seven patients after stroke with different levels of disabilities. Path-based segmentation provides a more detailed and comprehensive evaluation of upper limb activities, while time-based segmentation is more suitable for real-time assessment and providing feedback to patients. Bimanual movement parameter effectively differentiates between different levels of upper limb involvement and is a clear indicator of the activity of the affected limb relative to the unaffected limb. Full article

(This article belongs to the Special Issue Wearable Sensors for Human Activity Monitoring)

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11 pages, 649 KiB

Open AccessArticle

Experiences of SENSory Relearning of the UPPer Limb (SENSUPP) after Stroke and Perceived Effects: A Qualitative Study

by Håkan Carlsson, Ingrid Lindgren, Birgitta Rosén, Anders Björkman, Hélène Pessah-Rasmussen and Christina Brogårdh

Int. J. Environ. Res. Public Health 2022, 19(6), 3636; https://doi.org/10.3390/ijerph19063636 - 18 Mar 2022

Cited by 3 | Viewed by 3662

Abstract

Recently, it was shown that sensory relearning of the upper limb (SENSUPP) is a promising intervention to improve sensorimotor function after stroke. There is limited knowledge, however, of how participants perceive the training. Here, we explored how persons with sensory impairments in the upper limb experienced the SENSUPP protocol (combined sensory- and motor training and home exercises for 5 weeks) and its effect. Fifteen persons (mean age 59 years; 10 men; >6 months post-stroke) were individually interviewed, and data were analyzed with qualitative content analysis. An overall theme ‘Sensory relearning was meaningful and led to improved ability to perform daily hand activities’ and two categories with six subcategories emerged. The outpatient training was perceived as meaningful, although the exercises were demanding and required concentration. Support from the therapist was helpful and training in small groups appreciated. The home training was challenging due to lack of support, time, and motivation. Small improvements in sensory function were perceived, whereas increased movement control and ability in performing daily hand activities were reported. In conclusion, the SENSUPP protocol is meaningful and beneficial in improving the functioning of the UL in chronic stroke. Improving compliance to the home training, regular follow-ups, and an exercise diary are recommended. Full article

(This article belongs to the Section Disabilities)

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14 pages, 8020 KiB

Open AccessFeature PaperArticle

Cross-Modal Effect of Presenting Visual and Force Feedback That Create the Illusion of Stair-Climbing

by Takumi Okumura and Yuichi Kurita

Appl. Sci. 2021, 11(7), 2987; https://doi.org/10.3390/app11072987 - 26 Mar 2021

Cited by 9 | Viewed by 3504

Abstract

Image therapy, which creates illusions with a mirror and a head mount display, assists movement relearning in stroke patients. Mirror therapy presents the movement of the unaffected limb in a mirror, creating the illusion of movement of the affected limb. As the visual information of images cannot create a fully immersive experience, we propose a cross-modal strategy that supplements the image with sensual information. By interacting with the stimuli received from multiple sensory organs, the brain complements missing senses, and the patient experiences a different sense of motion. Our system generates the sense of stair-climbing in a subject walking on a level floor. The force sensation is presented by a pneumatic gel muscle (PGM). Based on motion analysis in a human lower-limb model and the characteristics of the force exerted by the PGM, we set the appropriate air pressure of the PGM. The effectiveness of the proposed system was evaluated by surface electromyography and a questionnaire. The experimental results showed that by synchronizing the force sensation with visual information, we could match the motor and perceived sensations at the muscle-activity level, enhancing the sense of stair-climbing. The experimental results showed that the visual condition significantly improved the illusion intensity during stair-climbing. Full article

(This article belongs to the Special Issue Haptics for Tele-Communication and Tele-Training)

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