Restorative Neurology and Neuroscience - Volume 36, issue 2

Authors: Kashi, Shir | Levy-Tzedek, Shelly

Article Type: Research Article

Abstract: Background: The increasing number of opportunities for human-robot interactions in various settings, from industry through home use to rehabilitation, creates a need to understand how to best personalize human-robot interactions to fit both the user and the task at hand. In the current experiment, we explored a human-robot collaborative task of joint movement, in the context of an interactive game. Objective: We set out to test people’s preferences when interacting with a robotic arm, playing a leader-follower imitation game (the mirror game). Methods: Twenty two young participants played the mirror game with the robotic arm, where …one player (person or robot) followed the movements of the other. Each partner (person and robot) was leading part of the time, and following part of the time. When the robotic arm was leading the joint movement, it performed movements that were either sharp or smooth, which participants were later asked to rate. Results: The greatest preference was given to smooth movements. Half of the participants preferred to lead, and half preferred to follow. Importantly, we found that the movements of the robotic arm primed the subsequent movements performed by the participants. Conclusion: The priming effect by the robot on the movements of the human should be considered when designing interactions with robots. Our results demonstrate individual differences in preferences regarding the role of the human and the joint motion path of the robot and the human when performing the mirror game collaborative task, and highlight the importance of personalized human-robot interactions. Show more

Keywords: Human-robot interaction, human-robot collaboration, user preferences, socially assistive robotics, movement priming

DOI: 10.3233/RNN-170756

Citation: Restorative Neurology and Neuroscience, vol. 36, no. 2, pp. 147-159, 2018

Authors: Picelli, Alessandro | Chemello, Elena | Castellazzi, Paola | Filippetti, Mirko | Brugnera, Annalisa | Gandolfi, Marialuisa | Waldner, Andreas | Saltuari, Leopold | Smania, Nicola

Article Type: Research Article

Abstract: Background: Preliminary evidence showed additional effects of anodal transcranial direct current stimulation over the damaged cerebral hemisphere combined with cathodal transcutaneous spinal direct current stimulation during robot-assisted gait training in chronic stroke patients. This is consistent with the neural organization of locomotion involving cortical and spinal control. The cerebellum is crucial for locomotor control, in particular for avoidance of obstacles, and adaptation to novel conditions during walking. Despite its key role in gait control, to date the effects of transcranial direct current stimulation of the cerebellum have not been investigated on brain stroke patients treated with robot-assisted gait training. …Objective: To evaluate the effects of cerebellar transcranial direct current stimulation combined with transcutaneous spinal direct current stimulation on robot-assisted gait training in patients with chronic brain stroke. Methods: After balanced randomization, 20 chronic stroke patients received ten, 20-minute robot-assisted gait training sessions (five days a week, for two consecutive weeks) combined with central nervous system stimulation. Group 1 underwent on-line cathodal transcranial direct current stimulation over the contralesional cerebellar hemisphere + cathodal transcutaneous spinal direct current stimulation. Group 2 received on-line anodal transcranial direct current stimulation over the damaged cerebral hemisphere + cathodal transcutaneous spinal direct current stimulation. The primary outcome was the 6-minute walk test performed before, after, and at follow-up at 2 and 4 weeks post-treatment. Results: The significant differences in the 6-minute walk test noted between groups at the first post-treatment evaluation (p  = 0.041) were not maintained at either the 2-week (P  = 0.650) or the 4-week (P  = 0.545) follow-up evaluations. Conclusion: Our preliminary findings support the hypothesis that cathodal transcranial direct current stimulation over the contralesional cerebellar hemisphere in combination with cathodal transcutaneous spinal direct current stimulation might be useful to boost the effects of robot-assisted gait training in chronic brain stroke patients with walking impairment. Show more

Keywords: Central nervous system, cerebellum, spinal cord, rehabilitation

DOI: 10.3233/RNN-170784

Citation: Restorative Neurology and Neuroscience, vol. 36, no. 2, pp. 161-171, 2018

Authors: Liu, Gang | Peng, Kangqiang | Dang, Chao | Tan, Shuangquan | Chen, Hongbing | Xie, Chuanmiao | Xing, Shihui | Zeng, Jinsheng

Article Type: Research Article

Abstract: Background: Secondary degeneration of the fiber tract of the motor pathway below infarct foci and functional recovery after stroke have been well demonstrated, but the role of the fiber tract above stroke foci remains unclear. Objective: This study aimed to investigate diffusion changes in motor fibers above the lesion and identify predictors of motor improvement within 12 weeks after subcortical infarction. Methods: Diffusion tensor imaging and the Fugl-Meyer (FM) scale were conducted 1, 4, and 12 weeks (W) after a subcortical infarct. Proportional recovery model residuals were used to assign patients to proportional recovery and poor …recovery groups. Region of interest analysis was used to assess diffusion changes in the motor pathway above and below a stroke lesion. Multivariable linear regression was employed to identify predictors of motor improvement within 12 weeks after stroke. Results: Axial diffusivity (AD) in the underlying white matter of the ipsilesional primary motor area (PMA) and cerebral peduncle (CP) in both proportional and poor recovery groups was lower at W1 compared to the controls and values in the contralesional PMA and CP (all P  < 0.05). Subsequently, AD in the ipsilesional CP became relatively stable, while AD in the ipsilesional PMA significantly increased from W4 to W12 after stroke (P  < 0.05). In all of the patients, changes in the FM scores were greater in those with higher changes in AD of the ipsilesional PMA. Only initial impairment or lesion volume was predictive of motor improvement within 12 weeks after stroke in patients with proportional or poor recovery. Conclusion: Increases of AD in the motor pathway above stroke foci may be associated with motor recovery after subcortical infarction. Early measurement of diffusion metrics in the ipsilesional non-ischemic motor pathway has limited value in predicting future motor improvement patterns (proportional or poor recovery). Show more

Keywords: Axial diffusivity, diffusion tensor imaging, fugl-meyer scale, motor recovery, subcortical infarction

DOI: 10.3233/RNN-170747

Citation: Restorative Neurology and Neuroscience, vol. 36, no. 2, pp. 173-182, 2018

Authors: Palmer, Jacqueline A. | Wolf, Steven L. | Borich, Michael R.

Article Type: Research Article

Abstract: Background: Paired associative stimulation (PAS) combining repeated pairing of electrical stimulation of a peripheral nerve with transcranial magnetic stimulation (TMS) over the primary motor cortex (M1) can induce neuroplastic adaptations in the human brain and enhance motor learning in neurologically-intact individuals. However, the extent to which PAS is an effective technique for inducing associative plasticity and improving motor function in individuals post-stroke is unclear. Objective: The objective of this pilot study was to investigate the effects of a single session of PAS to modulate corticomotor excitability and motor skill performance in individuals post-stroke. Methods: Seven individuals …with chronic stroke completed two separate visits separated by at least one week. We assessed general corticomotor excitability, intracortical network activity and behavioral outcomes prior to and at three time points following PAS and compared these outcomes to those following a sham PAS condition (PASSHAM ). Results: Following PAS, we found increased general corticomotor excitability but no significant difference in behavioral measures between PAS conditions. There was a relationship between PAS-induced corticomotor excitability increase and enhanced motor skill performance across post-PAS testing time points. Conclusion: These results provide preliminary evidence for the potential of PAS to increase corticomotor excitability that could favorably impact motor skill performance in chronic individuals post-stroke and are an important first step for future studies investigating the clinical application and behavioral relevance of PAS interventions in post stroke patient populations. Show more

Keywords: Transcranial magnetic stimulation, paired associative stimulation, motor learning

DOI: 10.3233/RNN-170785

Citation: Restorative Neurology and Neuroscience, vol. 36, no. 2, pp. 183-194, 2018

Authors: Pagnussat, Aline Souza | Kleiner, Ana F.R. | Rieder, Carlos R.M. | Frantz, Anapaula | Ehlers, Jaira | Pinto, Camila | Dorneles, Gilson | Netto, Carlos Alexandre | Peres, Alessandra | Galli, Manuela

Article Type: Research Article

Abstract: Background: The decrease of Brain-Derived Neurotrophic Factor (BDNF) serum levels has been related to the pathophysiology of several neurodegenerative diseases as well as to neural plasticity and rehabilitation. Automated Mechanical Peripheral Stimulation (AMPS) has been investigated as a complementary therapy for Parkinson Disease (PD). Objectives: (1) to investigate the effects of AMPS on BDNF and Cortisol serum levels of subjects with PD; (2) to evidence the interplay between BDNF and Cortisol serum levels and the functional mobility improvement after AMPS treatment. Methods: Thirty-three subjects with PD were randomized into two groups: effective stimulation (AMPS, n  = 16) …or placebo stimulation (AMPS SHAM, n  = 17). Fourteen healthy aged-matched subjects were included as a reference group. Each AMPS group received eight sessions of treatment using a commercial medical device (Gondola™). BDNF and Cortisol serum levels, spatiotemporal gait parameters and TUG test were assessed at baseline and after eight sessions of treatment. Results: After the treatment, AMPS group showed significantly higher levels of BDNF and lower levels of Cortisol compared to AMPS SHAM. AMPS group also showed a positive effect on gait pattern as a higher improvement on gait velocity, stride length, and TUG performance was shown. Conclusion: Effective AMPS treatment increased BDNF and decreased Cortisol serum levels and produced improvements in functional mobility. Show more

Keywords: Parkinson Disease, brain-derived neurotrophic factor, glucocorticoids, rehabilitation, automated mechanical peripheral stimulation, Gondola™

DOI: 10.3233/RNN-170744

Citation: Restorative Neurology and Neuroscience, vol. 36, no. 2, pp. 195-205, 2018

Authors: Mendoza Laiz, Nuria | Del Valle Díaz, Sagrario | Rioja Collado, Natalia | Gomez-Pilar, Javier | Hornero, Roberto

Article Type: Research Article

Abstract: Background: Dementia is a disease that is constantly evolving in older people. Its diverse symptoms appear with varying degrees of severity affecting the daily life of those who suffer from it. The rate in which dementia progresses depends on different aspects of the treatment, chosen to try to control and slow down the development of the illness. Objective: The aim of this study is to assess the effectiveness of cognitive training through a Brain Computer Interface (BCI) and the NeuronUp platform in two age groups whose MMSE is between 18–23 MCI (mild dementia). Method: 32 subjects …took part in the study. There were 22 subjects in Group 1 (61–69 years of age) and 10 subjects in Group 2 (70–81 years of age). The criterium for the selection of the groups was to identify the age range with greater improvements due to the training. In order to estimate neuropsychological performance, the subjects were evaluated with the Luria-DNA neuropsychological battery before and after training. This design enables us to evaluate five cognitive areas: visuospatial, spoken language, memory, intellectual processes and attention. Results: After training, Group 1 showed significant improvements in almost all the variables measured when compared with Group 2. This reveals a significant increase in cognitive ability, the degree of which depends on the age. Conclusion: People with mild dementia may delay cognitive impairment with a suitable cognitive training program. Show more

Keywords: MCI, BCI, Neuro-feedback, Luria-DNA, independence ageing, autonomy ageing

DOI: 10.3233/RNN-170754

Citation: Restorative Neurology and Neuroscience, vol. 36, no. 2, pp. 207-213, 2018

Authors: Washabaugh, Edward P. | Krishnan, Chandramouli

Article Type: Research Article

Abstract: Background: Robotic-resisted treadmill walking is a form of task-specific training that has been used to improve gait function in individuals with neurological injury, such as stroke, spinal cord injury, or cerebral palsy. Traditionally, these devices use active elements (e.g., motors or actuators) to provide resistance during walking, making them bulky, expensive, and less suitable for overground or in-home rehabilitation. We recently developed a low-cost, wearable robotic brace that generates resistive torques across the knee joint using a simple magnetic brake. However, the possible effects of training with this device on gait function in a clinical population are currently unknown. …Objective: The purpose of this study was to test the acute effects of resisted walking with this device on kinematics, muscle activation patterns, and gait velocity in chronic stroke survivors. Methods: Six stroke survivors wore the resistive brace and walked on a treadmill for 20 minutes (4×5 minutes) at their self-selected walking speed while simultaneously performing a foot trajectory-tracking task to minimize stiff-knee gait. Electromyography, sagittal plane gait kinematics, and overground gait velocity were collected to evaluate the acute effects of the device on gait function. Results: Robotic-resisted treadmill training resulted in a significant increase in quadriceps and hamstring EMG activity during walking. Significant aftereffects (i.e., improved joint excursions) were also observed on the hip and knee kinematics, which persisted for several steps after training. More importantly, training resulted in significant improvements in overground gait velocity. These results were consistent in all the subjects tested. Conclusion: This study provides preliminary evidence indicating that robotic-resisted treadmill walking using our knee brace can result in meaningful biomechanical aftereffects that translate to overground walking. Show more

Keywords: Rehab robotics, EMG, task-specific, active engagement, functional resistance training, rehabilitation

DOI: 10.3233/RNN-170782

Citation: Restorative Neurology and Neuroscience, vol. 36, no. 2, pp. 215-223, 2018

Authors: Uswatte, Gitendra | Taub, Edward | Bowman, Mary H. | Delgado, Adriana | Bryson, Camille | Morris, David M. | Mckay, Staci | Barman, Joydip | Mark, Victor W.

Article Type: Research Article

Abstract: Purpose: To evaluate the efficacy of an expanded form of Constraint-Induced Movement Therapy (eCIMT) that renders CIMT, originally designed for treating mild-to-moderate upper-extremity hemiparesis, suitable for treating severe hemiparesis. Methods: Twenty-one adults ≥1 year after stroke with severe upper-extremity hemiparesis (with little or no capacity to make movements with the more-affected hand) were randomly assigned to eCIMT (n  = 10), a placebo-control procedure (n  = 4), or usual care (n  = 7). The participants who received usual care were crossed over to eCIMT four months after enrollment. The CIMT protocol was altered to include fitting of orthotics and adaptive equipment, selected …neurodevelopmental techniques, and electromyography-triggered functional electrical stimulation. Treatment was given for 15 consecutive weekdays with 6 hours of therapy scheduled daily for the immediate eCIMT group and 3.5 hours daily for the cross-over eCIMT group. Results: At post-treatment, the immediate eCIMT group showed significant gains relative to the combination of the control groups on the Grade-4/5 Motor Activity Log (MAL; mean = 1.5 points, P  < 0.001, f  = 4.2) and a convergent measure, the Canadian Occupational Performance Measure (COPM; mean = 2.3, P  = 0.014, f  = 1.1; f values ≥0.4 are considered large, on the COPM changes ≥2 are considered clinically meaningful). At 1-year follow-up, the MAL gains in the immediate eCIMT group were only 13% less than at post-treatment. The short and long-term outcomes of the crossover eCIMT group were similar to those of the immediate eCIMT group. Conclusions: This small, randomized controlled trial (RCT) suggests that eCIMT produces a large, meaningful, and persistent improvement in everyday use of the more-affected arm in adults with severe upper-extremity hemiparesis long after stroke. These promising findings warrant confirmation by a large RCT. Show more

Keywords: Stroke, upper extremity, plegia, rehabilitation, randomized controlled trial

DOI: 10.3233/RNN-170792

Citation: Restorative Neurology and Neuroscience, vol. 36, no. 2, pp. 225-244, 2018

Authors: Brown, Katlyn E. | Neva, Jason L. | Feldman, Samantha J. | Staines, W. Richard | Boyd, Lara A.

Article Type: Research Article

Abstract: Background: The integration of somatosensory information from the environment into the motor cortex to inform movement is essential for motor function. As motor deficits commonly persist into the chronic phase of stroke recovery, it is important to understand potential contributing factors to these deficits, as well as their relationship with motor function. To date the impact of chronic stroke on sensorimotor integration has not been thoroughly investigated. Objectives: The current study aimed to comprehensively examine the influence of chronic stroke on sensorimotor integration, and determine whether sensorimotor integration can be modified with an intervention. Further, it determined the …relationship between neurophysiological measures of sensorimotor integration and motor deficits post-stroke. Methods: Fourteen individuals with chronic stroke and twelve older healthy controls participated. Motor impairment and function were quantified in individuals with chronic stroke. Baseline neurophysiology was assessed using nerve-based measures (short- and long-latency afferent inhibition, afferent facilitation) and vibration-based measures of sensorimotor integration, which paired vibration with single and paired-pulse TMS techniques. Neurophysiological assessment was performed before and after a vibration-based sensory training paradigm to assess changes within these circuits. Results: Vibration-based, but not nerve-based measures of sensorimotor integration were different in individuals with chronic stroke, as compared to older healthy controls, suggesting that stroke differentially impacts integration of specific types of somatosensory information. Sensorimotor integration was behaviourally relevant in that it related to both motor function and impairment post-stroke. Finally, sensory training modulated sensorimotor integration in individuals with chronic stroke and controls. Conclusion: Sensorimotor integration is differentially impacted by chronic stroke based on the type of afferent feedback. However, both nerve-based and vibration-based measures relate to motor impairment and function in individuals with chronic stroke. Show more

Keywords: Sensorimotor integration, transcranial magnetic stimulation, aging, stroke

DOI: 10.3233/RNN-170790

Citation: Restorative Neurology and Neuroscience, vol. 36, no. 2, pp. 245-259, 2018

Authors: Eizicovits, Danny | Edan, Yael | Tabak, Iris | Levy-Tzedek, Shelly

Article Type: Research Article

Abstract: Background: Effective human-robot interactions in rehabilitation necessitates an understanding of how these should be tailored to the needs of the human. We report on a robotic system developed as a partner on a 3-D everyday task, using a gamified approach. Objectives: To: (1) design and test a prototype system, to be ultimately used for upper-limb rehabilitation; (2) evaluate how age affects the response to such a robotic system; and (3) identify whether the robot’s physical embodiment is an important aspect in motivating users to complete a set of repetitive tasks. Methods: 62 healthy participants, young (<30 …yo) and old (>60 yo), played a 3D tic-tac-toe game against an embodied (a robotic arm) and a non-embodied (a computer-controlled lighting system) partner. To win, participants had to place three cups in sequence on a physical 3D grid. Cup picking-and-placing was chosen as a functional task that is often practiced in post-stroke rehabilitation. Movement of the participants was recorded using a Kinect camera. Results: The timing of the participants’ movement was primed by the response time of the system: participants moved slower when playing with the slower embodied system (p  = 0.006). The majority of participants preferred the robot over the computer-controlled system. Slower response time of the robot compared to the computer-controlled one only affected the young group’s motivation to continue playing. Conclusion: We demonstrated the feasibility of the system to encourage the performance of repetitive 3D functional movements, and track these movements. Young and old participants preferred to interact with the robot, compared with the non-embodied system. We contribute to the growing knowledge concerning personalized human-robot interactions by (1) demonstrating the priming of the human movement by the robotic movement – an important design feature, and (2) identifying response-speed as a design variable, the importance of which depends on the age of the user. Show more

Keywords: Aging, human-robot interaction, personalized robotics, socially assistive robotics, movement priming, upper limb exercise, upper limb rehabilitation

DOI: 10.3233/RNN-170802

Citation: Restorative Neurology and Neuroscience, vol. 36, no. 2, pp. 261-274, 2018

Authors: Casco, Clara | Barollo, Michele | Contemori, Giulio | Battaglini, Luca

Article Type: Research Article

Abstract: Background: In recent years, the introduction of visual rehabilitation for patients with homonymous visual field defects has been met with both enthusiasm and caution. Despite the evidence that restitutive training results in expansion of the visual field, several concerns have been raised. Objective: We tested the effectiveness of a new rehabilitative protocol called “Neuro Restoration Training” (NRT) in reducing visual field defects and in restituting visual functions in the restored hemianopic area. Methods: Ten patients with homonymous visual field defects (lesion age >6 months) where trained in detecting low contrast Gabor patches randomly presented in the …blind field, which refers to regions of 0 dB sensitivity, and along the hemianopic boundary between absolute (0 dB) and partial blindness (>0 dB). Training included static, drifting, and flickering Gabors in different blocks. Positions along the hemianopic boundary were systematically shifted toward the blind field according to the threshold reduction during the training. Before and after the training, we assessed visual field expansion and improvement in different high-level transfer tasks (i.e., letter identification and shape recognition) performed in the hemianopic boundary and in the blind field. Results: NRT led to significant visual field enlargement (≈5 deg), as indicated by the conventional Humphrey perimetry, and two custom made evaluations of visual field expansion with eye movement control (one static and one dynamic). The restored area acquired new visual functions such as small letter recognition and perception of moving shapes. Finally, for some patients, NRT also improved detection, either aware or not, of high contrast flickering grating and recognition of geometrical shapes entirely presented within the blind field. Conclusion: These results suggest that NRT may lead to visual field enlargement and translate into untrained visual functions. Show more

Keywords: Hemianopia, Neuro Restoration Training, visual field, training, contrast sensitivity

DOI: 10.3233/RNN-170752

Citation: Restorative Neurology and Neuroscience, vol. 36, no. 2, pp. 275-291, 2018

Authors: Morone, Giovanni | Masiero, Stefano | Coiro, Paola | De Angelis, Domenico | Venturiero, Vincenzo | Paolucci, Stefano | Iosa, Marco

Article Type: Research Article

Abstract: Background: Robotic walking training improves probability to reach an autonomous walking in non-ambulant patients affected by subacute stroke. However, little information is available regarding the prognostic factors for identifying best responder patients. The purpose of the present study is therefore to investigate the clinical features of patients with subacute stroke that might benefit more from robotic walking therapy. Methods: One hundred subacute inpatients randomized in robotic or conventional gait training were assessed at baseline and after 4 weeks of training performed 5 times per week. Forward Binary Logistic Regression was performed using functional ambulation category (FAC) as dependent …variable and as independent variables: trunk function (trunk control test), global ability (Barthel Index), age, sex, time from stroke and beginning of rehabilitation, side and type of stroke, and in the first analysis also type of treatment. Results: The parameters that have a significant effect on the FAC-score at discharge were a higher BI-score at admission, a higher TCT-score at admission, a short time from the ictus and a robotic therapy. The variance explained by these four factors was 78%. When the two groups were separately analysed for type of treatment, a higher BI-score and a short time from stroke resulted in good prognosis for conventional therapy, whereas only a high TCT-score improved efficacy of robotic training. Conclusion: Efficacy of robotic walking training was not associated with global ability at admission. Hence, more severely disabled patients may obtain greater benefit from robotic training, independently by other factors, except the need of a residual trunk control that was identified as a good prognostic factor for robotic walking training. Show more

Keywords: Hemiparesis, walking, subacute stroke, robot-assisted training

DOI: 10.3233/RNN-170799

Citation: Restorative Neurology and Neuroscience, vol. 36, no. 2, pp. 293-299, 2018